Pituitary down-regulation in IVF cycles: is it necessary to use strict criteria?

PURPOSE: In a retrospective study we have reviewed the data of 570 consecutive IVF cycles in which a GnRH agonist (GnRHa) was started in the early follicular phase (long protocol). Cycles were divided in groups according to estradiol levels before HMG administration: A, < 20 pg/ml; B, 20 to 50 pg/ml; C, 51 to 100 pg/ml. Our objective was to determine if the degree of pituitary suppression had any effect on the ovarian response to stimulation by exogenous gonadotropins, and/or on the IVF outcome. RESULTS: There were no significant differences in cycle cancellation rates, no. of days of stimulation and ampoules of HMG, serum estradiol after HMG, no. of oocytes retrieved and fertilization rates between groups. Pregnancy rates (19.4%, 21% and 31.8%/cycle, and 24.1%, 27.5% and 37.8% / embryo transfer, respectively) and live-birth rates (16.2%, 16.1% and 25.0%/cycle, 20.1%, 21.2% and 29.7%/embryo transfer, respectively) were also not significantly different. CONCLUSIONS: The degree of pituitary suppression had no effects on either the ovarian response to gonadotropins (including HMG requirements) or the overall IVF results.

[Echographic studies of the thickness of the endometrium during spontaneous and induced cycles: its application to in-vitro fertilization]. / Etude échographique de l'épaisseur de l'endomètre au cours des cycles spontanés et stimulés: Applications à la fécondation in vitro.

The authors have estimated the thickness of the endometrium by measuring it ultrasonically between the 5th preovulatory and the 6th post-ovulatory day. This study, which was carried out as part of an in vitro fertilisation programme (IVF) was performed during 162 cycles of which 22 were spontaneous and 140 were stimulated by Clomiphene and HMG. The endometrium is significantly thicker and grows more rapidly when the cycles are stimulated. There is a correlation between the levels of progesterone in the blood and the thickness of the endometrium on the 2nd post-laparoscopy day. On the other hand there was no relationship between the thickness of the endometrium and with the development or otherwise of a pregnancy after replacing embryos.

[Characteristics of pregnancies obtained by in vitro fertilization]. / Caractéristiques des grossesses obtenues par fécondation in vitro.

193 patients had 212 cycles induced for in vitro fertilisation between May 1983 and May 1984. 20 pregnancies of which 10 are still in progress were obtained with 6 spontaneous abortions. There were 2 so-called biochemical pregnancies and 3 extra-uterine pregnancies. The figure of 17% pregnancies where embryos were replaced totals less than 10% if one considers those pregnancies that really carry on. The number of extra-uterine pregnancies is disturbing. Finally, 2 multiple pregnancies continued, one of them being a quadruple pregnancy. The authors have made a special study to see the parameters of the conditions under which the pregnancies were obtained and the prognosis for such pregnancies.