Gonadotropin Therapy versus Laparoscopic Ovarian Drilling in Clomiphene Citrate-Resistant Polycystic Ovary Syndrome Patients: A Retrospective Cost-Effectiveness Analysis.

BACKGROUND: Gonadotropin therapy and laparoscopic ovarian drilling (LOD) are treatment options for ovulation induction (OI) in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients. The current evidence of the cost-effectiveness of both treatments is scarce, conflicting and performed from different health-economic perspectives. METHODS: A retrospective health-economic evaluation was performed from a societal perspective in which human menopausal gonadotropin (hMG) therapy (n = 43) was compared with LOD (n = 35), followed by OI with CC and/or hMG if spontaneous ovulation did not occur within 2 months. Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment. Outcomes were expressed as ongoing pregnancy rate and number of live-born children. RESULTS: The ongoing pregnancy rate was 21/35 (60%) after LOD and 30/43 (69.8%) after hMG treatment (relative risk 0.85, 95% CI 0.61-1.19). The societal cost per patient, up to an ongoing pregnancy, was significantly higher after LOD versus hMG treatment (adjusted mean difference EUR 1,073, 95% CI 180-1,967). CONCLUSION: This economic evaluation based on real-life data shows that the societal cost up to an ongoing pregnancy is less after hMG treatment when compared with LOD surgery in CC-resistant PCOS patients.

History of oral contraception.

On the 50th birthday of the pill, it is appropriate to recall the milestones which have led to its development and evolution during the last five decades. The main contraceptive effect of the pill being inhibition of ovulation, it may be called a small miracle that this drug was developed long before the complex regulation of ovulation and the menstrual cycle was elucidated. Another stumbling block on its way was the hostile climate with regard to contraception that prevailed at the time. Animal experiments on the effect of sex steroids on ovulation, and the synthesis of sex steroids and orally active analogues were the necessary preliminaries. We owe the development of oral contraceptives to a handful of persons: two determined feminists, Margaret Sanger and Katherine McCormick; a biologist, Gregory Pincus; and a gynaecologist, John Rock. Soon after the introduction of the first pills, some nasty and life-threatening side effects emerged, which were due to the high doses of sex steroids. This led to the development of new preparations with reduced oestrogen content, progestins with more specific action, and alternative administration routes. Almost every decade we have witnessed a breakthrough in oral contraception. Social and moral objections to birth control have gradually disappeared and, notwithstanding some pill scares, oral contraceptives are now one of the most used methods of contraception. Finally, all's well that ends well: recent reports have substantiated the multiple noncontraceptive health benefits paving the way for a bright future for this 50-year-old product.

The efficacy of the embryo transfer catheter in IVF and ICSI is operator-dependent: a randomized clinical trial.

BACKGROUND: Embryo transfer is a crucial step in the IVF process. Most randomized prospective studies comparing transfer catheters have demonstrated significantly higher pregnancy rates with soft versus firm catheters, but none have taken the operator effect into account. Our aim was to perform a prospective randomized clinical trial comparing two catheters and to study interactions between catheters and operators. METHODS: A prospective randomized trial comparing the Cook K-SOFT-5100 and Frydman classical catheters 4.5 was performed. Three experienced operators participated in the trial, using a fixed distance transfer protocol. Primary end-point was clinical pregnancy rate, secondary end-points were rates of difficult transfer and of catheter failure. Patients were randomized by a computer program prior to embryo transfer. RESULTS: A total of 1446 embryo transfers were performed in 1155 women undergoing IVF or ICSI treatment. A total of 723 cycles were randomized to the Cook catheter and 723 cycles to the Frydman catheter. Following intention-to-treat analysis, the adjusted odds ratio of clinical pregnancy between for the Cook versus the Frydman catheter was 1.11 [95% confidence interval (95% CI) 0.89-1.38]. Odds ratios of clinical pregnancy between the Cook and Frydman catheters for the three operators were respectively 1.19 (95% CI 0.84-1.69), 2.35 (95% CI 1.40-3.95) and 0.69 (95% CI 0.48-0.99). CONCLUSIONS: Variation in pregnancy rates between embryo transfer catheters depends on variation between operators. Results from randomized clinical trials comparing embryo transfer catheters should not be generalized, because inconsistent conclusions may be unavoidable on the account of different proportions of cycles with transfers by each type of operator. The study was registered at clinicaltrials.gov. NCT00766714.

Effect of temporary nuclear arrest by phosphodiesterase 3-inhibitor on morphological and functional aspects of in vitro matured mouse oocytes.

The present study aimed to analyze detailed morphological and functional characteristics of mouse in vitro matured oocytes after a pre-maturation culture (PMC) by temporary nuclear arrest with the specific phosphodiesterase 3-inhibitor (PDE3-I) Cilostamide. In a first experiment the lowest effective dose of Cilostamide was determined. Cumulus-oocyte complexes (COCs), isolated from small antral follicles, were exposed to different concentrations of Cilostamide (ranging from 0 (control) to 10 microM) for 24 hr. Afterwards, oocytes were removed from PDE3-I-containing medium and underwent in vitro maturation (IVM) for 16-18 hr. A concentration of 1 microM Cilostamide was the lowest effective dose for maximum level of inhibition and reversibility of meiosis inhibition. This concentration was used in further experiments to evaluate oocyte quality following IVM in relation to different parameters: kinetics of meiotic progression, metaphase II (MII) spindle morphology, aneuploidy rate, fertilization, and embryonic developmental rates. The results were compared to nonarrested (in vitro control) and in vivo matured oocytes (in vivo control). Following withdrawal of the inhibitor, the progression of meiosis was more synchronous and accelerated in arrested when compared to nonarrested oocytes. A PMC resulted in a significant increase in the number of oocytes constituting a MII spindle of normal morphology. None of the oocytes exposed to PDE3-I showed numerical chromosome alterations. In addition, fertilization and embryonic developmental rates were higher in the PMC group compared to in vitro controls, but lower than in vivo controls. These results provide evidence that induced nuclear arrest by PDE3-I is a safe and reliable method to improve oocyte quality after IVM.

Efficiency of assisted oocyte activation as a solution for failed intracytoplasmic sperm injection.

Failed fertilization after intracytoplasmic sperm injection (ICSI) can occur due to an oocyte activation defect. In these cases assisted oocyte activation (AOA) may help but efficiency is still unknown. Prior to AOA, the mouse oocyte activation test (MOAT) can be carried out by injecting human spermatozoa into mouse oocytes to evaluate their activating capacity. According to the MOAT activation percentage achieved, patients were classified into three groups: 0-20% (16 patients); 20-85% (seven patients); 85-100% (seven patients). For AOA, CaCl(2) was injected together with spermatozoa followed by a double Ca(2+) ionophore treatment. The fertilization rates before application of AOA in 50 cycles were 6%, 22% and 14% in, respectively, groups 1, 2 and 3 without any pregnancy. Fertilization and pregnancy rates after AOA in 61 cycles were significantly increased to 75% and 34% for group 1, 73% and 43% for group 2, and 75% and 17% for group 3 (P < 0.0001 and P < 0.004, respectively). Application of AOA results in normal fertilization and pregnancy rates in patients whose spermatozoa show deficient activation. When MOAT reveals no activation deficiency in spermatozoa, AOA still allows for high fertilization and acceptable pregnancy rates. The obstetric and neonatal outcomes after AOA were normal as no malformations were observed.

Effect of ionomycin on oocyte activation and embryo development in mouse.

Artificial oocyte activation using the calcium ionophore ionomycin is applied successfully in assisted reproduction but some concern exists on the clinical use. The aims of the present study were to optimize the oocyte activation scheme and to address embryo toxicity in a mouse model. Efficiency of oocyte activation and subsequent development was evaluated and ionomycin was found to be an efficient activator at 10 micromol/l. An improved effect of a second exposure to 5 micromol/l ionomycin on blastocyst development was observed. Toxicity of ionomycin on embryos was then investigated by evaluating pre- and post-implantation development of in-vivo fertilized oocytes following exposure to ionomycin. Blastocyst development, blastocyst cell numbers in trophectoderm and inner cell mass were not different between treated and non-treated zygotes. Also implantation rates and fetal parameters such as length, weight and morphological parameters were similar between the fetuses originating from zygotes treated with ionomycin and non-treated zygotes. Furthermore, healthy offspring originating from ionomycin-treated zygotes was born. In conclusion, no adverse effects of ionomycin on in-vitro or in-vivo mouse embryo development were noticed, giving arguments in favour of the use of ionomycin, although negative long-term effects of this compound cannot be excluded at present.

Shorter CAG repeats in the androgen receptor gene may enhance hyperandrogenicity in polycystic ovary syndrome.

BACKGROUND: The main goal of the present study was to assess the influence of the androgen receptor gene CAG repeat polymorphism on hyperandrogenism and its phenotypical features in patients with polycystic ovary syndrome (PCOS). METHODS: CAG repeat lengths were analyzed in 97 oligo-anovulatory women with ultrasound features of PCOS. All individuals were assessed for endocrine parameters and their phenotypical features were recorded. These parameters were correlated with the CAG repeat lengths. RESULTS: PCOS patients with a bi-allelic mean lower than 21 repeats had lower dihydrotestosterone levels (p = 0.007), lower androstenedione levels (p = 0.023), lower luteinizing hormone levels (p = 0.023), a lower luteinizing hormone/follicle-stimulating hormone ratio (p = 0.021) and the highest percentage of patients with acne and/or hirsutism (p = 0.021). CONCLUSIONS: Our findings support the hypothesis that the PCOS phenotype may result from either elevated androgen levels or an enhanced sensitivity to androgens caused by a more active androgen receptor.

A multi-center prospective, randomized, double-blind trial studying the effect of misoprostol on the outcome of intrauterine insemination.

BACKGROUND: Because seminal prostaglandins play a role at natural fertilization, it was hypothesized that vaginal supplementation of prostaglandins at the time of intrauterine insemination (IUI) might enhance chances of conception. We investigated the effect of misoprostol, a prostaglandin analogue, on the success rate of IUI. METHODS: A multi-center double-blind randomized controlled trial, using a cross-over design with alternating sequence, was designed. Vaginal tablets of misoprostol or placebo were used in conjunction to intrauterine insemination. In total, 199 women, comprising 466 cycles, were analyzed. Main outcome measures were pregnancy rate and prevalence of vaginal bleeding and uterine cramps. RESULTS: The misoprostol group accounted for 146 cycles with 19 pregnancies, whereas the placebo group cycles totaled 164 cycles with 21 pregnancies (13.0 vs. 12.8%, not significant). There was a statistically significant increase in vaginal bleeding (12.3 vs. 1.8%; OR 7.55; 95% CI 2.31-24.48) and abdominal cramping rates (15.1 vs. 4.3%; OR 3.98; 95% CI 1.68-9.39) after application of misoprostol. Due to these severe adverse events the study was prematurely terminated. CONCLUSION: Although prostaglandins surely play a role in natural human reproduction, vaginal administration of misoprostol at the time of IUI is associated with a high rate of side effects and does not seem to enhance the outcome.

Culture medium preferences of pre-implantation cloned mouse embryos.

Somatic cloning technology involves the transfer of a somatic cell nucleus into an enucleated oocyte, followed by activation and in vitro culture. Efficiency in terms of live offspring generally remains very low. Little attention has been devoted so far to the impact of culture environment on cloned embryo development. Failure of genomic reprogramming of the donor nucleus in nuclear transfer (NT) experiments could lead to an altered phenotype in these cloned embryos that could be manifested by different medium preferences of the NT embryos. We describe here the application of sequential culture media to support preimplantation development of mouse embryos reconstructed using conventional NT techniques. Embryo-quality analysis was performed on NT blastocysts obtained. Additionally, NT embryos that arrested during development also were analyzed.

Long term effects of micro-surgical testicular sperm extraction on androgen status in patients with non obstructive azoospermia.

BACKGROUND: The aim of our study was to review the results of microsurgically performed testicular sperm extraction (TESE) and to evaluate its possible long term effects on serum testosterone (T). METHODS: We operated on 48 men (35 +/- 8 years) with non-obstructive azoospermia (NOA). If no spermatozoa were found following a micro epididymal sperm extraction (Silber et al., 1994) and testicular biopsy, testicular microdissection was performed or multiple microsurgical testicular biopsies were taken. The mean follow-up of the serum T was 2.4 +/- 1.1 years. RESULTS: Sperm was retrieved in 17/48 (35%) of the men. The per couple take home baby rate if sperm was retrieved was 4/17 (24%). Serum T decreased significantly at follow-up (p < 0.05) and 5/31 (16%) de novo androgen deficiencies developed CONCLUSION: In patients with non-obstructive azoospermia in whom no spermatozoa were found following a micro epididymal sperm aspiration and a simple testicular biopsy, we were able to retrieve spermatozoa in 35% of the men. The take home baby rate was 24% among couples with spermatozoa present upon TESE. De novo androgen deficiency occurred in 16% of the male patients following TESE indicating that, in men with NOA, long term hormonal follow up is recommended after TESE.

Clinical benefit of metaphase I oocytes.

BACKGROUND: We studied the benefit of using in vitro matured metaphase I (MI) oocytes for ICSI in patients with a maximum of 6 mature metaphase II (MII) oocytes at retrieval. METHODS: In 2004, 187 ICSI cycles were selected in which maximum 6 MII oocytes and at least one MI oocyte were retrieved. MI oocytes were put in culture to mature until the moment of ICSI, which was performed between 2 to 11 hours after oocyte retrieval (day 0). In exceptional cases, when the patient did not have any mature oocyte at the scheduled time of ICSI, MI oocytes were left to mature overnight and were injected between 19 to 26 hours after retrieval (day 1). Embryos from MI oocytes were chosen for transfer only when no other good quality embryos from MII oocytes were available. Outcome parameters were time period of in vitro maturation (IVM), IVM and fertilization rates, embryo development, clinical pregnancy rates, implantation rates and total MI oocyte utilization rate. RESULTS: The overall IVM rate was 43%. IVM oocytes had lower fertilization rates compared to in vivo matured sibling oocytes (52% versus 68%, P < 0.05). The proportion of poor quality embryos was significantly higher in IVM derived oocytes. One pregnancy and live birth was obtained out of 13 transfers of embryos exclusively derived from IVM oocytes. This baby originated from an oocyte that was injected after 22 hrs of IVM. CONCLUSION: Fertilization of in vitro matured MI oocytes can result in normal embryos and pregnancy, making IVM worthwhile, particularly when few MII oocytes are obtained at retrieval.

Ovarian tissue cryopreservation: therapeutic prospects and ethical reflections.

Along with improved survival, methods to preserve or restore the fertility potential of young women and children treated with cytotoxic chemotherapy or pelvic radiotherapy have been developed or are in the offing. Surgery, radiotherapy and chemotherapy can all impact on the future ovarian function, but patient and disease tailored application and use of preventive measures can limit ovarian damage. When the loss of reproductive ovarian function is unavoidable, different alternatives to preserve fertility or at least to restore the procreative potential are available. Creation of embryos by IVF, oocyte donation and cryopreservation of mature or immature oocytes are potential issues, the advantages and limitations of which are discussed. Recently, ovarian tissue cryopreservation has spurred interest in the medical literature as well as in the lay press as a method for preservation and restoring fertility. Considering the available data and current state of knowledge, we want to stress that this methodology is still in an experimental phase and we would like to caution against unwarranted enthusiasm of physicians and patients. The medical information preceding the informed consent should mention the actual uncertainties of this method. Moreover, the imperative character of the offer and in particular for paediatric oncological patients, the force of the moral rules that define parental obligations towards children should not be ignored.

Poor response after hormonal stimulation for in vitro fertilization is not related to ovarian aging.

OBJECTIVE: To investigate whether the diminished efficacy of ART in young poor responders compared to young normal responders is due to a quantitative or a qualitative oocyte factor. DESIGN: Retrospective comparative analysis. SETTING: University-based infertility center. PATIENT(S): Nine thousand six hundred forty-four patients who underwent ART procedures at our hospital from 1993 until 2001. INTERVENTION(S): Controlled ovarian hyperstimulation, ultrasonographic monitoring of the ovarian response, oocyte retrieval, ART procedure, embryo transfer, and follow-up of pregnant patients until 12 weeks of amenorrhea. MAIN OUTCOME MEASURES: Clinical rates of pregnancy and miscarriage. RESULT(S): Nine thousand six hundred forty-four ART cycles were analyzed. The pregnancy rate for poor responders was significantly lower than for normal responders (17% vs. 35%). In cycles in which two good-quality embryos were transferred, the pregnancy rate was similar in poor responders and normal responders (33% vs. 42%). The rate of miscarriage was no higher in poor responders than normal responders. CONCLUSION(S): Young poor responders have a lower pregnancy rate than young normal responders because they have fewer oocytes, which leads to fewer good-quality embryos to choose from for transfer. The quality of their oocytes and embryos is not inferior to that of normal responders.

Dynamic changes in microtubular cytoskeleton of human postmature oocytes revert after ooplasm transfer.

OBJECTIVE: Study of the influence of ooplasm transfer on the microtubule dynamics in human postmature oocytes. DESIGN: Prospective experimental study. SETTING: Academic hospital-based fertility center. MATERIALS(S): Human in vitro matured (IVM) oocytes (n = 65). Experimental groups: In set 1, sibling oocytes were processed either within 2-3 hours ("young"; n = 16) or at 12-14 hours after maturation ("presumably postmature," or PPM; n = 14). In set 2, young and PPM oocytes (n = 6 and 10, respectively) were assigned to be ooplasm donors and recipients, respectively. In set 3, PPM oocytes were used as ooplasm donors (n = 2) and recipients (n = 4). Control groups: Metaphase II oocytes from superovulated golden hamsters in set 1; sibling oocytes of ooplasm donor young (n = 4) and PPM oocytes (n = 7) in set 2; and sibling PPM oocytes in set 3 (n = 2). INTERVENTION(S): Immunocytochemistry for alphatubulin with or without treatment with taxol (Paclitaxel, a microtubule-enhancing agent) in set 1; aspiration and microinjection of approximately 20 picolitres ooplasm from donor young and PPM oocytes into recipient PPM oocytes in sets 2 and 3, respectively. Taxol treatment and tubulin immunocytochemistry on ooplasm recipients and control young and PPM sibling oocytes. MAIN OUTCOME MEASURE(S): Morphology and pattern of the microtubules in the spindle and ooplasm as evaluated by confocal microscopy and three-dimensional image reconstructions. RESULT(S): In set 1, taxol-untreated young oocytes had normal spindle morphology and orientation to the oolemma with no microtubules in the ooplasm. Taxol-treated young oocytes revealed markedly broadened spindle poles and minimal or absent ooplasmic microtubules. Taxol-untreated PPM oocytes had variable spindle morphology and a notable increase in cortical ooplasmic microtubules. Taxol treatment of PPM oocytes resulted in a marked increase in ooplasmic microtubules in addition to a broadening of spindle poles and formation of polar asters. In set 2, control young and PPM oocytes had the same findings as the corresponding oocytes in set 1. However, all ooplasm recipient PPM oocytes showed a striking diminution in ooplasmic microtubules, despite the taxol treatment, compared with their sibling PPM control oocytes in set 2 and PPM ooplasm-injected PPM oocytes in set 3. CONCLUSION(S): Postmature oocytes exhibit a dynamic increase in ooplasmic microtubules. However, these changes revert after transfer of ooplasm from young oocytes.

Creation of a neovagina with use of a pudendal thigh fasciocutaneous flap and restoration of uterovaginal continuity.

OBJECTIVE: To create a neovagina and an endocervival canal in two patients with vaginal aplasia and a functioning uterus. DESIGN: Technique and instrumentations. SETTING: University hospital. PATIENT(S): A 31-year-old woman with vaginal aplasia and a double noncommunicating uterus (classified as Mayer-Rokitansky-Kuster-Hauser syndrome) and a 19-year-old woman with partial vaginal aplasia and a functional uterus. INTERVENTION(S): Creation of a neovagina by using the bilateral pudendal thigh fasciocutaneous flap procedure and laparotomy to establish uterovaginal continuity. MAIN OUTCOME MEASURE(S): Clinical follow-up evaluation of restoration of outflow of menstrual blood and coital satisfaction. RESULT(S): Uterovaginal continuity was established in both patients, resulting in normal menstruation. Granulomatous polyps occurred in one patient, and stenosis at the site of anastomosis occurred in the other patient; these conditions were successfully managed. Unimpeded menstrual flow continued after 1 year of follow-up in one patient and 3 years of follow-up in the other patient. CONCLUSION(S): Bilateral fasciocutaneous pudendal thigh flaps permit vaginal reconstruction and a uterovaginal connection in patients with vaginal agenesis and a functional uterus. The main advantages of this technique are that postoperative dilatation is not necessary, sensation is maintained, and the resulting scar is inconspicuous. The main disadvantage is the presence of some sebaceous vaginal secretion and hair in the vaginal lining; the latter can be managed by preoperative and postoperative laser depilation.

Enzymatic differentiation of Candida parapsilosis from other Candida spp. in a membrane filtration test.

A previously reported enzyme assay on a membrane filter using 4-methylumbelliferyl (4-MU)-N-acetyl-beta-D-galactosaminide, -phosphate and -pyrophosphate as substrates for the differentiation of four Candida spp. has been extended to Candida parapsilosis. The substrate 4-MU-beta-D-glucoside was hydrolyzed by 28 test strains of this species but to a variable extent by seven other yeasts also. For a full enzymatic differentiation of C. parapsilosis from other medical yeasts, a battery of six reactions was required. Of 71 C. parapsilosis positive clinical samples, 4.2% gave a false negative result due to overgrowth by Candida albicans. The present assay is more rapid than a described spectrofluorometric determination of beta-D-glucosidase in a broth, i.e., 9-11 h versus up to >48 h.

A private matter: how patients decide what to do with cryopreserved embryos after infertility treatment.

This study describes patients' satisfaction with the information they received regarding the disposition of supernumerary embryos in the context of their decision making, as well as partners' roles and the involvement of others. An anonymous mail questionnaire was sent to 412 female patients from the Department of Reproductive Medicine (Ghent University Hospital, Ghent, Belgium). The questionnaire had a response rate of 79%. The majority of patients who did not want to continue the storage of their embryos (87.9%) thought the information provided was sufficient to make a decision. Patients who were not satisfied more often failed to reach a decision compared to other patients (4/25 vs. 6/173, p = 0.0248). The majority of couples (81.7%) reached a decision jointly between partners. Nonetheless, in 15.6% of couples, one of the partners had made the decision alone, mostly after consulting their partners. Only a minority of the couples (13.2%) consulted others (mostly family members or close friends), suggesting that patients view these decisions as a private matter. Only 1.1% of all patients had talked to someone at the centre about their decision. To conclude, for most patients, the information provided was adequate in light of their disposition decision making. Overall, patients' decision making appears to be a private matter which happens out of sight from medical staff, making it hard to assist patients who face difficulties.

"Something of the two of us". The emotionally loaded embryo disposition decision making of patients who view their embryo as a symbol of their relationship.

OBJECTIVES: This paper describes a recently identified conception of the cryopreserved embryo as a symbol of one's relationship (SOR). METHODS: A questionnaire was sent together with the embryo disposition decision (EDD) form to patients for whom embryos were cryopreserved at the department in Ghent, Belgium. We collected data on patient characteristics, their EDD attitudes and the reasons for their willingness or unwillingness to consider each of the disposition options (donation to others for reproduction, donation for science and discarding). RESULTS: The SOR view was found more often in patients who were less educated and whose last treatment was less than 3 years ago. Viewing the embryo as a SOR was not linked to more difficult decision making, but to more emotionally loaded decision making. In particular, patients with this view more often reported feelings of grief. This view was also linked to the outcome of the decision making process. CONCLUSION: The conception of the embryo as a SOR is part of an affective attitude towards embryos that has an impact on patients' disposition decisions. Alongside patients' values and principles, it is important that counselors acknowledge and clarify patients' affective conceptualizations.

The frozen embryo and its nonresponding parents.

OBJECTIVE: To describe patients who at least once did not reply to correspondence of the center about embryo disposition. DESIGN: Anonymous questionnaire. SETTING: Department of Reproductive Medicine, Ghent University Hospital (Belgium). PATIENT(S): Patients whose embryos were stored for at least 2 years. INTERVENTION(S): Mail survey. MAIN OUTCOME MEASURE(S): Patients' reply behavior, their characteristics, their embryo disposition decision, and their attitudes toward this decision. RESULT(S): The response rate was 79%. Twelve percent of the patients were nonrepliers, mostly because they were not able to reach a (joint) decision. Nonrepliers were somewhat older, their last treatment cycle was longer ago, and it more often had a negative outcome. Nonrepliers were childless twice as often as other patients. They also more often experienced anticipated regret about the decision, and they valued their embryos more often in relation to the use for their own treatment. The proportion of patients who seldom thought about their embryos was the same in both groups. CONCLUSION(S): Treatment failure, anticipated regret, and valuing the embryo on the basis of probability of use influence patients' reply behavior and may be key elements for prevention measures.