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15.11.2001
 
Newsletter Nr.12
 
  1. Low-dose dexamethasone augments the ovarian response to exogenous gonadotrophins in IVF treatment.
  2. Pronuclear morphology and pregnancy rates in IVF/ICSI treatment
  3. Hydrosalpinx and IVF outcome.
  4. The effect of intramural uterine fibroids on the outcome of assisted conception .

1. Low-dose dexamethasone augments the ovarian response to exogenous gonadotrophins in IVF treatment.

Cancellation of assisted conception cycles because of poor ovarian response to gonadotrophins is a significant problem in assisted reproduction. That is why various additional treatments have been suggested to improve responsiveness. The authors report on the potential benefits of low dose dexamethasone administration during ovarian stimulation with gonadotrophins. In this study patients <40 years of age were invited to participate in a twin centre prospective double blind randomized placebo controlled study. A total of 290 patients were recruited and computer randomized using sealed envelopes to receive either 1 mg dexamethasone (n = 145) or placebo tablets (n = 145) in addition to a standard long protocol gonadotrophin-releasing hormone analogue with gonadotrophin stimulation regime. A significantly lower cancellation rate for poor ovarian response was observed in the dexamethasone group compared with controls (2.8 versus 12.4% respectively, P < 0.002). The authors conclude that a low dose dexamethasone co-treatment reduces the incidence of poor ovarian response. It may also increase clinical pregnancy rates and should be considered for inclusion in stimulation regimes to optimize ovarian response.

Reference

Keay, S.D., Lenton, EA, Cooke ID, Hull MGR, Jenkins, JM (2001) Low-dose dexamethason augments the ovarian response to exogenous gonadotrophins leading to a reduction in cycle cancellation rate in a standard IVF programme. Hum. Reprod. 16: 1861-2001

2. Pronuclear morphology and pregnancy rates in IVF/ICSI treatment.

The authors studied zygote evaluation based on pronuclear morphology under the German embryo protection law, according to which only a maximum of three zygotes are allowed to be cultured for embryo transfer. In this prospective multicentre study, a total of 512 treatment cycles was performed at 10 centres, between November 1999 and October 2000. Zygotes were classified into seven patterns (0A, 0B and 1-5). Pattern 0A and 0B zygotes were preferentially used for further culture and transfer. Cycles with transfer of at least one embryo derived from pattern 0B, but not pattern 0A, resulted in significantly higher pregnancy (37.9%) and implantation rates (20.5%) compared with non-pattern 0B cycles (26.4 and 15.7%; P < 0.05 and P < 0.01 respectively). In younger patients (aged <=35 years), significantly more 0B zygotes were available for transfer than in older patients (34.2 versus 25.8%; P < 0.005). From these data, it is concluded that evaluation of pronuclear morphology is beneficial, especially for countries with legal restrictions regarding embryo selection. The authors state that additional selection of embryos in the cleavage stages would further improve the results, which is, however, not possible in the present legal situation.

Reference

Montag M, Van der Ven H (2001) Evaluation of pronuclear morphology as the only selection criterion for further embryo culture and transfer: results of a prospective multicenter study. Hum. Reprod. 16: 2384-2389

3. Hydrosalpinx and IVF outcome.

In a previous study it was shown that salpingectomy does not adversely affect ovarian function with respect to controlled ovarian hyperstimulation by exogenous gonadotrophins. The subsequent article is aimed at analysing the effect of salpingectomy on cumulative birth rate, including all individual transfer cycles. A total of 186 women underwent 452 cycles. Among the 77 women randomized to no surgical intervention, 24 underwent salpingectomy after one or two failed cycles. Implantation rate was significantly higher in patients who had undergone salpingectomy (27.2% versus 20.2, P = 0.03) and, in the subgroup of patients with ultrasound-visible hydrosalpinges, the difference was even larger (30.3% versus 17.1%, P = 0.003). The results of the cumulative cycles strengthen the recommendation for a laparoscopic salpingectomy prior to IVF in patients with ultrasound-visible hydrosalpinges.

References

Strandell A, Lindhard A, Waldenström U, Thorburn J (2001) Prophylactic salpingectomy does not impair the ovarian response in IVF treatment. Hum Reprod. 2001 Jun;16(6):1135-9.

Strandell A, Lindhard A, Waldenström U, Thorburn J (2001) Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomised controlled trial. Hum. Reprod. 16: 2403-2410

4. The effect of intramural uterine fibroids on the outcome of assisted conception.

Uterine fibroids occur in 30% of women and are associated with a degree of subfertility. Their effect on the outcome of IVF or ICSI treatment, however, has not been prospectively studied. Data were prospectively collected on 434 women undergoing IVF/ICSI. Patients were assessed for the presence of fibroids by transvaginal ultrasound and hysterosonography or hysteroscopy where appropriate. During the study period, 112 women with (study), and 322 women without (controls), intramural fibroids were treated. Patients were similar regarding the cause and duration of their infertility, number of previous treatments, and basal serum FSH concentration. Women in the study group were on average 2 years older (36.4 versus 34.6 years; P < 0.01). There was no significant difference in the duration of ovarian stimulation or gonadotrophin requirement, number of follicles developed, oocytes collected, embryos available for transfer or replaced. When analysing only women with intramural fibroids of <=5 cm in size (n = 106) pregnancy, implantation and ongoing pregnancy rates were significantly reduced. The mean size of the largest fibroids was 2.3 cm (90% range 2.1-2.5 cm). Logistic regression analysis demonstrated that the presence of intramural fibroids was one of the significant variables affecting the chance of an ongoing pregnancy, even after controlling for the number of embryos available for replacement and increasing age. The results of the study demonstrate that an intramural fibroid halves the chances of an ongoing pregnancy following assisted conception.

Reference

Hart R, Khalaf Y, Yeong C-T, Seed P, Taylor A, Braude P (2001) A prospective controlled study of the effet of intramuralo uterine fibroids on the outcome of assisted conception. Hum. Reprod. 2411-2417

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Gerhard Leyendecker