The potential effect of controlled ovarian hyperstimulation on follicular vascular perfusion: a study applying power Doppler ultrasonography within a treatment programme using donor sperm.

This was a prospective observational study to evaluate the effect of controlled ovarian hyperstimulation on follicular vascularity. A subjective grading system was applied to assess vascularity using transvaginal power Doppler ultrasonography on the day of insemination (32-36 hours post-HCG administration) in donor treatment cycles undergoing either controlled ovarian hyperstimulation (COH group) with gonadotrophin and intrauterine insemination or intracervical insemination with/without clomiphene stimulation (non-COH group). The incidence of follicles (81% vs. 53%; P < 0.05) as well as cycles (63% vs. 49%; P < 0.05) with uniformly high grade vascularity was significantly higher in treatments that had controlled ovarian hyperstimulation compared with unstimulated or clomiphene induced donor cycles. Pregnancy rates were higher and early pregnancy loss rates lower, in cycles with uniformly high grade follicular vascularity in both treatment groups compared with other vascularity grades. Using multiple logistic regression analysis, the only independent variable that was significantly related to pregnancy rates in this treatment programme was follicular vascularity. Controlled ovarian hyperstimulation appears to have an effect on follicular vascularity and this may contribute to improved outcome in donor insemination treatment programmes.

In vitro fertilisation: a study of clients waiting for pregnancy test results.

The aim of this study was to obtain a descriptive account of clients' perceptions of the delay between embryo transfer and pregnancy test. The clients' responses were collected using a structured interview. The study sample comprised 15 couples, and the interviews took place on day 28 (or 13 days after embryo transfer) of the in vitro fertilisation (IVF) cycle, before the outcome of treatment was known. The study identified the 'wait at home' interlude between embryo transfer and pregnancy test as the most stressful aspect of treatment. Clients' responses indicated that adequate provision of information, contact with the IVF team and a specified nurse responsible for their care, may have benefited some couples during this time. The conclusion was that although the sample size was small, it comprised a pilot study which could be replicated in several centres. The recommendations made on the basis of the results include an advice sheet pertinent to this waiting time, the adoption of primary nursing and the development of nursing intervention to provide emotional support. This may help to ameliorate the isolation felt by couples during this delay.