Successful pregnancy outcome after in vitro fertilization in a pancreas-kidney recipient.

OBJECTIVE: To describe the first case of IVF pregnancy in a pancreas-kidney recipient. DESIGN: Case report. SETTING: Reproductive Medicine Department, Hôpital Edouard Herriot, Lyon, France. INTERVENTION(S): In vitro fertilization in a pancreas-kidney recipient. PATIENT(S): A 39 year-old nulliparous woman, with primary infertility and a history of pancreas-kidney transplant at 29 years of age. MAIN OUTCOME MEASURE(S): Multidisciplinary agreement for the couple to be managed by IVF. Follow-up of pregnancy and delivery. RESULT(S): Singleton IVF pregnancy in a pancreas-kidney recipient, maintained up to 34 weeks. Cesarian delivery ahead of labor. No severe maternal or fetal complications. Live birth. Normal postpartum renal function and glycemia. CONCLUSION(S): An IVF pregnancy is feasible in a pancreas-kidney recipient. Such treatment should follow agreement by all the medical teams following the patient. Pregnancy in a pancreas-kidney recipient is at-risk, requiring close monitoring.

Case of progressive intrauterine twin pregnancy after surgical treatment of cornual pregnancy.

OBJECTIVE: To report on a case of heterotopic triplet pregnancy after in utero transfer of three embryos obtained by in vitro fertilization (IVF), with progression of the intrauterine twin pregnancy after resection of the cornual pregnancy. DESIGN: Technique and instrumentation. SETTING: Département de Médecine de la Reproduction, Hôpital Edouard Herriot, Lyon, France. PATIENTS: A 32-year-old woman, nulliparous with primary infertility for the previous 12 years due to mixed causes (tubal and male infertility). INTERVENTIONS: Diagnosis by ultrasound scan and per-laparoscopic confirmation, followed by resection of the cornual pregnancy by laparotomy. MAIN OUTCOME MEASURES: Ultrasound diagnosis and follow-up of the pregnancy. Delivery. RESULTS: Complete ablation of the cornual pregnancy. Progression of the intrauterine twin pregnancy without difficulties until 31 weeks of gestation. Cesarean upon onset of labor. Birth of two living infants. The scar of the uterine horn, examined during the caesarean, was thick and solid. CONCLUSIONS: The early diagnosis and surgical treatment of an ectopic pregnancy permitted the development of the intrauterine pregnancy. The risk of heterotopic pregnancy is increased by medical techniques that facilitate procreation. This risk is directly related to the number of embryos transferred. In the case of heterotopic pregnancy, the rate of progressive intrauterine pregnancy after treatment of the ectopic pregnancy is encouraging.

Sperm DNA fragmentation decreases the pregnancy rate in an assisted reproductive technique.

BACKGROUND: Standard sperm characteristics are poor predictors of the outcome of IVF treatments. On the contrary, sperm genome quality has been emphasized for several years as playing a major role in early embryogenesis, thus in the success of IVF attempt. METHODS: Sperm DNA fragmentation from a selected group of 104 couples undergoing assisted reproductive techniques (ART) (IVF: n = 50; and ICSI: n = 54) was measured by TUNEL assay and correlated with semen and ART outcomes. RESULTS: A negative correlation was found between sperm characteristics and the proportion of sperm showing DNA fragmentation. For fragmentation >10%, a significant decrease of the fertilization rate was observed. No correlation was found between sperm DNA fragmentation and embryo quality. A high proportion of sperm with fragmented DNA was a pejorative factor to obtain pregnancies when ICSI was performed, but there was no relationship when conventional IVF was performed. CONCLUSIONS: The proportion of sperm with DNA fragmentation appears to be potentially useful as a predictor of ICSI outcome, whereas embryo quality based on morphological criteria, appeared unaffected by DNA fragmentation.