Are factors that influence oocyte fertilization also predictive? an assessment of 148 cycles of in vitro fertilization without gonadotropin stimulation

Fertilization characteristics of 152 consecutively obtained oocytes in an in vitro fertilization (IVF) program employing only natural and clomiphene citrate-induced cycles were retrospectively analyzed. Fertilization occured significantly more often (1) in women with tubal infertility, (2) in spontaneous cycles, and (3) in cases on secondary infertility. Grade 1 sperm motility from the original semen sample and the duration of infertility were also significant influencing factors. A similar sperm correlate was not identified on samples after sperm migration. Preovulatory follicular fluid steroids, progeterone (P), estradiol (E2), E2:P ratio, and luteinizing hormone (LH), as well as baleline plasma LH and the magnitude of the LH surge did not correlate with fertilization (descriminant analysis), only 58.3 percent of oocytes were correctly classified. This data supports the concept of performing IVF as a test in its own right

In vitro Fertilization: the Jamacian experience

In June 2000, twenty-eight infertile couples were treated by vitro fertilization and embryo transfer at our initial assisted reproduction programme carried out in conjunction with Midland Fertility Services, Aldridge, Birmingham, England. A pre-requisite for treatment was that on day 3 of the menstrual cycle the levels of follicle stimulating hormone (FSH) and oestradiol (E2) should be <10iu/l and <100pg/ml respectively in the female partner. The ages of the women ranged from 26 to 42 years with a mean age of 35.5 years. Down regulation was carried out by using buserelin acetate 0.5 ug subcutaneously from day 21 of the cycle for 21 days. This process was completed when the ovaries and pituitary gland were quiescent and the endometrial thickness <4 mm in diameter. On completion of down regulation the gonadotrophin hormone, pergonal (dosage of 150-450 units) was used for ovarian hyperstimulation. A total of 294 oocytes (mean of 10.5, range 2-45) were retrieved of which 138 were fertilized (mean of 4.9, range of 0-28). Twenty-four patients each received a mean of two embryos. Five patients (20.8 percent) had positive pregnancy tests. Three patients (0.1 percent) developed ovarian hyperstimulation syndrome (OHSS), one had the severe, and two, the mild form of the syndrome. All three cases were treated successfully. The success at the initial IFV controlled ovarian hyperstimulation augers well for the future of infertile couples seeking treatment at the Fertility Management Unit, The University of the West Indies, Jamaica (AU)