ABSTRACT
OBJECTIVE: The goal of this work is to expand the usefulness of antimüllerian hormone (AMH) in predicting in vitro fertilization cycle outcome by demonstrating that AMH concentration obtained in an ongoing treatment cycle predicts both oocyte number and pregnancy. STUDY DESIGN: Serum samples were obtained from 190 in vitro fertilization patients at onset of follicle-stimulating hormone stimulation. These were analyzed retrospectively during a single cycle in which clinicians were blinded to the results. Our major outcome measures were the number of oocytes obtained and ongoing pregnancy. RESULTS: Patients with an initial AMH concentration of >3 ng/mL were found to produce a mean of 19.8 oocytes and had an ongoing pregnancy rate of 60.3%. In contrast, those with AMH values of ≤1 ng/mL yielded a mean of 6.2 oocytes and had an ongoing pregnancy rate of 23.4% (P < .0001 for both). CONCLUSION: Greater AMH serum concentration strongly predicts an increased number of oocytes and ongoing pregnancy (P ≤ .0001).
Subject(s)
Anti-Mullerian Hormone/blood , Fertilization in Vitro/methods , Infertility, Female/therapy , Adult , Female , Humans , Oocytes/physiology , Pregnancy , Pregnancy Rate , Retrospective Studies , Treatment OutcomeABSTRACT
This is a prospective cohort study of CA-125 levels drawn on the day of hCG administration in 386 women undergoing IVF treatment. The CA-125 levels were not helpful in determining pregnancy outcome, as indicated by poor sensitivity (40.8%) and specificity (52.7%), as well as an area under the receiver operator characteristic curve close to 0.50.
Subject(s)
CA-125 Antigen/blood , Fertilization in Vitro , Infertility, Female/therapy , Pregnancy Outcome , Pregnancy/blood , Chorionic Gonadotropin/therapeutic use , Cohort Studies , Female , Humans , Prospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
In patients undergoing in vitro fertilization, the presence of higher E(2) levels at the time of hCG administration predict a greater likelihood of ongoing pregnancy.
Subject(s)
Estradiol/blood , Fertilization in Vitro , Pregnancy Rate , Female , Humans , Predictive Value of Tests , PregnancyABSTRACT
OBJECTIVE: To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility. DESIGN: Adaptive decision model. SETTING: Academic infertility clinic. PATIENT(S): A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women <35 years old with unexplained infertility undergoing IVF. INTERVENTION(S): Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes. MAIN OUTCOME MEASURE(S): Live birth rate, incremental cost-effectiveness ratio (ICER). RESULT(S): In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666. CONCLUSION(S): In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI.
Subject(s)
Fertility , Fertilization in Vitro/economics , Health Care Costs , Infertility/economics , Infertility/therapy , Sperm Injections, Intracytoplasmic/economics , Adult , Cost-Benefit Analysis , Decision Support Techniques , Decision Trees , Female , Humans , Infertility/etiology , Infertility/physiopathology , Live Birth/economics , Male , Models, Economic , Patient Selection , Pregnancy , Pregnancy Rate , Treatment OutcomeABSTRACT
OBJECTIVE: To describe an unusual case of heterotopic pregnancy. DESIGN: Case report. SETTING: Division of Reproductive Medicine and Infertility, Women & Infants' Hospital of Rhode Island, Brown Medical School. Providence, Rhode Island. PATIENT(S): A woman with an unusual heterotopic pregnancy who had had prior bilateral salpingectomies, but delivered a healthy female infant near term after requiring laparotomy for a ruptured left cornual pregnancy 28 days after embryo transfer. INTERVENTION(S): IVF, laparotomy with wedge resection of the left tubal cornu, and near-term cesarean section. MAIN OUTCOME MEASURE(S): Excision of ectopic pregnancy with preservation of intrauterine pregnancy. RESULT(S): Delivery of a 2920 gram (6 lb, 7 oz) female infant. CONCLUSION(S): Heterotopic pregnancy may occur after bilateral salpingectomy, but a satisfactory outcome can be obtained in such circumstances after surgical excision of the ectopic gestation and preservation of the intrauterine pregnancy.
Subject(s)
Fallopian Tubes/surgery , Pregnancy, Ectopic , Adult , Cesarean Section , Female , Hemorrhage/complications , Humans , Infant, Newborn , Pregnancy , Term BirthABSTRACT
Clinical pregnancy rate (CPR) and implantation rate (IR) in 1,177 patients who had 1,788 fresh, nondonor, nonPGD IVF cycles were highest in cycle 1, significantly declined in cycle 2, and reached a plateau for cycles 3-5 at a rate lower than in cycle 2. In patients >38 years of age CPR and IR in cycles 1 and 2 were significantly lower than in younger patients, but there was no decline in CPR or IR with advancing IVF attempts.