- High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners.
- The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis.
- Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method.
- High ongoing pregnancy rates after deferred transfer through bipronuclear oocyte cryopreservation and post-thaw extended culture.
- Similar ongoing pregnancy rates after blastocyst transfer in fresh donor cycles and autologous cycles using cryopreserved bipronuclear oocytes suggest similar viability of transferred blastocysts.
1. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners.
OBJECTIVE: To determine the prevalence of histologically proven endometriosis in a subset of infertile women. DESIGN: Retrospective case series with electronic file search and multivariable logistic regression analysis. SETTING: Tertiary academic fertility center. PATIENT(S): Two hundred twenty-one infertile women without previous surgical diagnosis for infertility with regular cycles (variation, 21-35 days) whose partners have a normal semen analysis. INTERVENTION(S): Diagnostic laparoscopy and, if necessary, operative laparoscopy with CO(2) laser excision. MAIN OUTCOME MEASUREMENT(S): The prevalence of endometriosis and of fertility-reducing nonendometriotic tubal and/or uterine pathology. RESULT(S): The prevalence of endometriosis was 47% (104/221), including stage I (39%, 41/104), stage II (24%, 25/104), stage III (14%, 15/104), and stage IV (23%, 23/104) endometriosis, and was comparable in patients with (54%, 61/113) and without (40%, 43/108) pelvic pain. The prevalence of fertility-reducing nonendometriotic tubal and/or uterine pathology was 29% in all patients (15% in women with and 40% in women without endometriosis). A multivariate logistic regression model including pain, ultrasound data, age, duration of infertility, and type of fertility was not or not sufficiently reliable for the prediction of endometriosis according to the revised American Fertility Society (rAFS) classifications I-II and rAFS III-IV, respectively. CONCLUSION(S): Reproductive surgery is indicated in infertile women belonging to the study population, regardless of pain symptoms or transvaginal ultrasound results, since half of them have endometriosis and 40% of those without endometriosis have fertility-reducing pelvic pathology.
Reference
Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D’Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2009 Jul;92(1):68-74. Epub 2008 Aug 5.
2. The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis.
OBJECTIVE: To investigate the effect of surgical treatment of endometrioma on pregnancy rate and ovarian response to gonadotrophin stimulation in women undergoing IVF. DESIGN: A systematic review and meta-analysis. SETTING: Tertiary referral center for reproductive medicine. PATIENT(S): Subfertile women with endometrioma undergoing IVF. INTERVENTION(S): Surgical removal of endometrioma or expectant management. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate and ovarian response to gonadotrophins (number of gonadotrophin ampoules, peak E(2) levels, number of oocytes retrieved, and number of embryos available for transfer). RESULT(S): A search of three electronic databases for articles published between January 1985 and November 2007 yielded 20 eligible studies. Meta-analysis was conducted for five studies that compared surgery vs. no treatment of endometrioma. There was no significant difference in clinical pregnancy rate between the treated and the untreated groups. Similarly, no significant difference was found between the two groups with regard to the outcome measures used to assess the response to controlled ovarian hyperstimulation with gonadotrophins. CONCLUSION(S): Collectively the available data in the literature show that surgical management of endometriomas has no significant effect on IVF pregnancy rates and ovarian response to stimulation compared with no treatment. Randomized controlled trials are needed before producing best-practice recommendations on this topic.
Reference
Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG. The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis.
Fertil Steril. 2009 Jul;92(1):75-87. Epub 2008 Aug 9. Review.
3. Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method.
OBJECTIVE: To evaluate the outcome of oocyte vitrification using the Cryotop method, observed in an egg donation program by simultaneously evaluating embryos derived from vitrified and fresh oocytes coming from the same stimulated cycle. DESIGN: Cohort prospective randomized study. SETTING: Instituto Valenciano de Infertilidad (IVI) Valencia, Spain. PATIENT(S): Thirty oocyte donors and 30 recipients with informed consents. INTERVENTION(S): Vitrification by the Cryotop method. Warming 1 hour after vitrification. Microinjection of surviving MII and fresh oocytes, evaluation of fertilization, embryo development, and clinical results. MAIN OUTCOME MEASURE(S): Survival, fertilization, and cleavage rate. Embryo quality, pregnancy rate (PR), and implantation rate. RESULT(S): Survival rate observed was 96.7%. There was no difference in fertilization rates (76.3% and 82.2%), day 2 cleavage (94.2% and 97.8%), day 3 cleavage (80.8% and 80.5%), and blastocyst formation (48.7% and 47.5%) for vitrified and fresh oocytes, respectively. Embryo quality on day 3 and on day 5-6 were similar for vitrification and fresh oocyte group (80.8% vs. 80.5% and 81.1% vs. 70%, respectively). A total of 23 embryo transfers were carried out in the vitrification group. Pregnancy rates, implantation rates, miscarriage rates, and ongoing PR were 65.2%, 40.8%, 20%, and 47.8%, respectively. CONCLUSION(S): The Cryotop method preserves the potential of vitrified oocytes to fertilize and further develop, which is similar, when evaluated simultaneously, to fresh counterparts. Excellent clinical outcome indicates the possible use of this technology for egg donation programs, as well as a high potential for establishing oocyte banking.
Reference
Cobo A, Kuwayama M, Pérez S, Ruiz A, Pellicer A, Remohà J. Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method. Fertil Steril. 2008 Jun;89(6):1657-64. Epub 2007 Sep 24.
4. High ongoing pregnancy rates after deferred transfer through bipronuclear oocyte cryopreservation and post-thaw extended culture.
OBJECTIVE: To describe success rates with bipronuclear (2PN) oocyte cryopreservation, followed by thaw, extended culture, and blastocyst transfer. DESIGN: Retrospective study. SETTING: Private fertility center. PATIENT(S): There were 48 blastocyst transfers after post-thaw extended culture in patients less than 35 years old and 43 transfers in patients 35-40 years old. INTERVENTION(S): Patients opted for cryopreservation of their entire cohorts at the 2PN stage. Thawed 2PN oocytes were cultured to the blastocyst stage before transfer. MAIN OUTCOME MEASURE(S): Implantation, ongoing pregnancy. RESULT(S): Among patients less than 35 years old at oocyte retrieval, there were 59 thaws of 2PN oocytes, 48 blastocyst transfers, and 40 ongoing pregnancies (79.2% per transfer), the implantation rate was 64.2%, and the ongoing pregnancy rate (PR) per thaw was 64.4%. Among patients 35-40 years of age at retrieval, there were 58 thaws, 43 blastocyst transfers, and 22 ongoing pregnancies (51.2% per transfer), the implantation rate was 44.0%, and the ongoing PR per thaw was 39.3%. Patients less than 35 years old had significantly greater rates of implantation and ongoing pregnancy than did patients 35-40 years of age. Patients with 12 or more 2PN oocytes had significantly greater rate of ongoing pregnancy than those with fewer than 12 2PN oocytes. CONCLUSION(S): Post-thaw extended culture and blastocyst transfer yield high rates of implantation and ongoing pregnancy. Ongoing PRs decline with increasing age.
Reference
Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S.
High ongoing pregnancy rates after deferred transfer through bipronuclear oocyte cryopreservation and post-thaw extended culture. Fertil Steril. 2009 Nov;92(5):1594-9. Epub 2008 Nov 11.
5. Similar ongoing pregnancy rates after blastocyst transfer in fresh donor cycles and autologous cycles using cryopreserved bipronuclear oocytes suggest similar viability of transferred blastocysts.
This retrospective cohort study compared blastocyst transfers in 136 fresh oocyte donor cycles and 69 autologous cycles using blastocysts derived from culture of thawed bipronuclear oocytes, all with oocytes derived from patients or donors less than 35 years old. The autologous cycles and oocyte donor cycles had similar rates of implantation (65.9% vs. 62.1%, respectively) and ongoing pregnancy (79.7% vs. 75.0%, respectively), suggesting that autologous blastocysts transferred after post-thaw extended culture have viability and implantation potential that are comparable with those of blastocysts transferred in fresh oocyte donor cycles.
Reference
Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S.
Similar ongoing pregnancy rates after blastocyst transfer in fresh donor cycles and autologous cycles using cryopreserved bipronuclear oocytes suggest similar viability of transferred blastocysts. Fertil Steril. 2009 Aug 13. [Epub ahead of print]
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