Natural oocyte retrieval with intravaginal fertilization: a simplified approach to in vitro fertilization.

To simplify in vitro fertilization (IVF), we have combined natural-cycle oocyte retrieval with intravaginal fertilization. Our subjects ranged in age from 28-40 years and were monitored by ultrasound and steroid hormone levels. Oocyte retrieval was carried out under vaginal ultrasound-guided aspiration 32-36 hours after the onset of the LH surge. The oocyte was identified and placed in a sealed capsule containing culture media and sperm. The capsule, in a sealed cryoflex envelope, was placed in the woman's vagina and removed 42-48 hours later. The embryo was then isolated and transferred to the woman's uterus. Fifty-one retrieval cycles were attempted in 45 patients. At least one oocyte was retrieved in 88% of cycles, and fertilization was achieved in 84% of oocytes. Of the five clinical pregnancies (10%), four have delivered and one is ongoing. The cost of this procedure is approximately one-third that of standard IVF. The advantages of our method are the elimination of the use of gonadotropins, the simplicity of monitoring and oocyte retrieval, and the lack of need for expensive laboratory equipment. Natural oocyte retrieval with intravaginal fertilization may prove appropriate for those women requiring IVF who fear multiple pregnancies, have side effects from controlled ovarian hyperstimulation, or cannot afford standard IVF.

In vitro fertilization without ovarian stimulation: a simplified protocol applied in 80 cycles.

Ovulation induction with various hormonal agents has become a standard component of in vitro fertilization (IVF) cycles to obtain multiple oocytes. Failure to anticipate the retrieval of more than two oocytes often results in cancellation of the cycle. In this study, we report our results in 80 unstimulated IVF cycles. Serum estradiol (E2) and pelvic ultra-sound monitoring were begun on day 9 of the cycle. Human chorionic gonadotropin (hCG) was administered when the E2 level exceeded 180 pg/mL and the dominant follicle was greater than 18 mm. Eighteen pregnancies were obtained (22.5%/cycle), and 14 (17.5%/cycle) are ongoing. We conclude that favorable results can be obtained from unstimulated IVF cycles, despite replacement of a single embryo.

A new in vitro fertilization technique: intravaginal culture.

Intravaginal culture (IVC) is a new technique elaborated by the authors for the fertilization and culture of human oocytes. Its principle consists of fertilization and early development of the eggs in a closed, air-free milieu without the addition of CO2. One to five ovocytes are deposited in a tube completely filled with 3 ml of culture medium less than 1 hour after their recovery, with 10,000 to 20,000 spermatozoa per ml previously prepared. The tube is then hermetically closed and it is placed in the maternal vagina and held by a diaphragm for incubation for 44 to 50 hours. After this time, the content of the tube is examined and embryos are transferred to the uterus. In the first 100 consecutive punctures, 22 clinical pregnancies were obtained: 17 deliveries, 3 spontaneous abortions, and 2 tubal pregnancies. Also, a randomized study comparing IVC to in vitro fertilization (IVF) was done (160 cycles) and no statistically different cleavage, transfer, or pregnancy rate was seen between IVC and IVF. By simplifying the laboratory manipulations, this technique decreases the cost of IVF and permits its standardization and diffusion. It creates a psychologic comfort permitting active participation of the mother in this stage of embryo development. Also, the use of this technique may give greater knowledge of human gamete metabolism and of the physiology of reproduction.

[The posterior arch of the Paget's ivory vertebra. Biopsy of six cases (author's transl)]. / L'arc postérieur de la vertèbre d'ivoire pagétique. A propos de six cas biopsiés.

The authors report 6 cases of isolated "ivory" vertebra which were confirmed as being due to Paget's disease after trocar biopsy. They analyse the radiological characteristics and find evidence of constant involvement of the posterior arch which shows the classical signs of Paget's disease: bone condensation, increase in size and cortico-medullary de-differentiation.

Unexpected low oxygen tension of intravaginal culture.

The goal of this study was to assess whether the metabolic activity of gametes or the local environment had a greater influence on the pH, pO2 and pCO2 of the culture medium in the intravaginal culture (IVC) technique. The pH, pO2 and pCO2 of the culture medium in four groups of intravaginal cryotubes with or without spermatozoa and oocytes, together with the pO2 and pCO2 of vaginal epithelium, were measured before and 48 h after IVC. Hermetically closed cryotubes sealed in a cryoflex envelope were used throughout. Similar results were obtained from all four groups. The pH and pCO2 were unchanged but pO2 significantly decreased during IVC, presumably because of equilibration with the low pO2 (5 mmHg) and pCO2 (49 mmHg) present in the vaginal epithelium. A second series of experiments was then performed with standard culture conditions using culture medium with or without motile spermatozoa in cryotubes covered with cryoflex maintained in air supplemented with 5% CO2. The pH, pO2 and pCO2 were all unchanged in all samples. When the samples were maintained in air only, the pH increased, pO2 remained unchanged and pCO2 decreased, presumably because of equilibration with the low pCO2 (0. 3 mmHg) present in the air. However, when the samples were cultured under venous blood, the pH and pO2 decreased and pCO2 increased, presumably because of the high pCO2 and low pH of venous blood. Thus the pO2 and pCO2 of the culture medium were able to equilibrate with the local environmental gas milieu owing to the permeability of O2 and CO2 through the plastic material. IVC results in a constant pH due to an identical pCO2 in the vaginal epithelium but in a reduced pO2 concentration due to the lower pO2 in the vaginal epithelium.

[The current role of microsurgery and in vitro fertilization in the treatment of tubal infertility]. / Places actuelles de la microchirurgie et de la fécondation in vitro dans le traitement des stérilités tubaires.

Tubal sterility is an important cause of sterility in the couple. Its treatment has been revolutionised, firstly by the progress in microsurgery and, more recently, by the current progress in in vitro fertilisation. Consequently, the gynecologist must have a very good knowledge of sterility in the couple and of tubal pathology. The authors report the results of 400 microsurgical operations performed in the Maternity department of the Port-Royal hospital and compare these results with those of in vitro fertilisation. In the light of these results, they then attempt to define the therapeutic indications which depend on a very precise investigation of the condition of the tubes. Microsurgery and in vitro fertilisation constitute complementary approaches in cases which are difficult to evaluate.

[Intravaginal culture and embryo transfer]. / Culture intravaginale et transfert d'embryons (CIVETE).

The intra-vaginal culture and embryo transfer is based on the principle of fertilization of hyman ovocytes in the absence of CO2-enriched air. Ovocytes and spermatozoa are placed in a water-tight tube filled with B2 medium and placed in the vagina during the culture. Once the culture is done, the embryos are replaced in the uterus. The various studies done with intra-vaginal culture and embryo transfer, their results as well as future prospects are reviewed in detail.

[Intravaginal culture and embryo transfer. A new method for the fertilization of human oocytes]. / La CIVETE. Une nouvelle technique de fécondation des ovocytes humains.

This technique was developed at the University Clinic of Port-Royal. It corresponds to the intravaginal culture of embryos and their transfer into the uterus. After ovocyte stimulation, most often by Clomid HMG, the follicles are aspirated under laparoscopic or sonographic control 34 to 36 hours after HCG. After being collected, the ovocytes are placed, whatever their stage of maturity, in one or several 3 ml tubes completely filled with culture medium (B2 of pure Menezo). Up to 4 ovocytes per tube are thus fertilized with 10 to 20,000 mobile spermatozoids/ml, prepared in the usual dilution, centrifugation and migration. Then the tube(s) are placed in the posterior vaginal cul-de-sac, kept in place with a diaphragm where they will remain during the 44 to 48 hours of culture time. Following that time, the contents of the tube are examined in order to evaluate the occurrence and the stage of embryonic division. A first series of 100 aspirations has enabled to obtain 15 pregnancies, still evolving, including two births of healthy children. A randomized series is currently in progress to determine a possible difference in the rates of pregnancy between CIVETE and the classic technique. Beside its new psychological contribution, this technique has demonstrated that it was possible to culture human embryos in the absence of CO2; its extreme simplicity should lead to a broader expansion of this technique.