In Vitro Fertilization Versus Mild Stimulation Intrauterine Insemination in Women Aged 40 and Older.

INTRODUCTION: The objective of this study was to compare clinical pregnancy rates (PRs) and pregnancy outcomes (POs) in patients undergoing in vitro fertilization (IVF) and a specific controlled ovarian hyperstimulation (mild-stimulation or mini-stim) and intrauterine insemination (IUI) protocol in women older than 40. METHODS: It is a retrospective chart review of 770 cycles of all women aged 40 and older who underwent a first cycle of either IVF or mini-stim IUI between the years 2007 and 2012 at a single infertility center. RESULTS: The PR in all women aged 40 and above was 12% (65/531) for IVF and 5% (13/239) for mini-stim IUI ( P = .004). When divided into age-groups, the PR of IVF at age 40 was superior to that at age 41 and above (15% vs 7%, P = .002), while the PR of mini-stim IUI remains similar (3% vs 7%, P = .307). When comparing the outcomes of the 2 treatments in the different age-groups, it showed that in women aged 40, IVF PR was superior to that of mini-stim IUI (15% vs 3%, P = .032); while in women aged 41 and above, IVF and mini-stim IUI have similar PR (7% vs 7%, P = .866). When POs were compared, the rate of live birth per cycle initiated was 9.2% for IVF versus 1.28% for mini-stim IUI ( P < .001). CONCLUSIONS: While IVF and mini-stim IUI were found to have similar PRs in women aged 41 and above, POs are significantly better in IVF. A larger study is required to clarify the above results.

Cryopreserved embryos in the United States and their availability for research.

OBJECTIVE: To determine the number of embryos stored at assisted reproductive technology (ART) clinics in the United States and their current disposition. DESIGN: A targeted survey instrument sent by the SART-RAND team to all medical practices providing in vitro fertilization services in the United States. RESULTS: The SART-RAND team surveyed all 430 ART practices in the United States. Of these practices, 340 returned surveys for analysis. The data from these surveys were merged with data taken from the 1999 SART dataset, which contains information about practice size and success rates. Responding clinics reported a total of 396,526 embryos in storage as of April 11, 2002. The vast majority of the embryos (88.2%) were targeted for patient use. Small numbers of embryos were available for research, donation, destruction, quality assurance, or other uses. CONCLUSIONS: Nearly 400,000 embryos are stored in the United States, the majority of which (88.2%) are targeted for patient use. Few are available for research (2.8%), limiting possible conversion into embryonic stem cell lines.

Comparison of in vitro fertilization/intracytoplasmic sperm injection outcomes in male factor infertility patients with and without spinal cord injuries.

OBJECTIVE: To determine if outcomes after in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI) using sperm from men with spinal cord injury (SCI group) differ from those of other etiologies of male factor infertility (non-SCI group). In men with SCI, to determine if IVF/ICSI outcomes differ with sperm obtained by penile vibratory stimulation (PVS group) versus electroejaculation (EEJ group). DESIGN: Retrospective analysis. SETTING: University medical center and major infertility center. PATIENT(S): Couples with male factor infertility due to SCI versus other etiologies. INTERVENTION(S): PVS, EEJ, surgical sperm retrieval, and IVF/ICSI. MAIN OUTCOME MEASURE(S): Rates of fertilization, pregnancy, and live birth. RESULT(S): A total of 31 couples in the SCI group underwent 48 cycles of IVF/ICSI, and a total of 297 couples in the non-SCI group underwent 443 cycles of IVF/ICSI. The SCI group had lower fertilization rates but similar pregnancy and live birth rates compared with the non-SCI group. These rates, however, did not differ significantly when the PVS group was compared with the EEJ group. CONCLUSION(S): IVF/ICSI of sperm from men with SCI yield lower fertilization rates but similar pregnancy and live birth outcomes as IVF/ICSI of sperm from men with other etiologies of male factor infertility. Sperm collected by PVS versus EEJ in men with SCI appear to result in similar IVF/ICSI success rates.

Prognostic value of beta-human chorionic gonadotropin is dependent on day of embryo transfer during in vitro fertilization.

OBJECTIVE: To determine threshold ß-hCG levels predictive of an ongoing pregnancy (OP), live birth (LB), and multiple gestation (MG) in IVF cycles resulting from day-3 (D3) vs. day-5 (D5) embryo transfers (ET), to compare IVF cycle characteristics and pregnancy outcomes in D3 vs. D5 ET groups, and to assess the degree to which maternal characteristics and cycle parameters were predictive of higher ß-hCG levels. DESIGN: Retrospective analysis. SETTING: Infertility center. PATIENT(S): Women who had ET performed for IVF cycles between July 2004 and January 2010. INTERVENTION(S): Embryo transfer performed on either D3 or D5 after oocyte fertilization. MAIN OUTCOME MEASURE(S): Beta-hCG on day 15 after oocyte fertilization. RESULT(S): Beta-hCG levels were significantly higher with D5 ET compared with D3 ETs (D3: 103.6 ± 4.4 IU/L vs. D5: 198.0 ± 10.6 IU/L), and a multivariate analysis demonstrated that D5 ET was a significant predictor of higher ß-hCG levels. The ß-hCG thresholds predictive of OP were 78 IU/L and 160 IU/L for D3 and D5 ET, which predicted OP in 96% and 91% of cases, respectively. Similarly, for LB, the ß-hCG thresholds were 94 IU/L (79% positive predictive value [PPV]) and 160 IU/L (88% PPV), and for MG were 250 IU/L (18% PPV) and 316 IU/L (34% PPV), respectively. CONCLUSION(S): Initial ß-hCG levels are dependent on the day of ET and are a reliable and highly predictive tool for OP outcomes.