Previous mode of delivery and pregnancy outcomes after single euploid embryo transfer: A retrospective study.

RESEARCH QUESTION: Are the pregnancy outcomes (clinical, biochemical and ectopic pregnancies) of women with a history of vaginal birth and women with a history of caesarean section who underwent single euploid embryo transfer at Fakih IVF Fertility Centre comparable? DESIGN: This retrospective cross-sectional chart review with multi-variate analysis, including 1157 women, compared pregnancy outcomes between women with a history of caesarean section and women with a history of vaginal birth who underwent in-vitro fertilization (IVF) at Fakih IVF Fertility Centre. All women who underwent single euploid frozen embryo transfer were included. Fresh and multiple embryo transfers were excluded. The primary outcome was clinical pregnancy, and the secondary outcomes were biochemical and ectopic pregnancies. RESULTS: Regarding pregnancy outcomes, the caesarean section group had fewer clinical pregnancies than the vaginal birth group [299 (61.1 %) vs 417 (67.3 %); p = 0.0346]. The rate of ectopic pregnancy did not differ significantly between the two groups (p = 0.4320). Similarly, there was no significant difference between the two groups regarding biochemical pregnancy [caesarean section group 22 (4.3 %) vs vaginal birth group 26 (4.0 %); p = 0.8122]. CONCLUSION: This study showed a decreased likelihood of clinical pregnancy in women with a history of caesarean section. No significant differences in biochemical or ectopic pregnancies were observed between the groups. These findings have practical clinical implications for counselling patients on the impact of prior caesarean sections in assisted reproduction.

Morphokinetic analysis of cleavage stage embryos and its relationship to aneuploidy in a retrospective time-lapse imaging study.

PURPOSE: To analyze differences in morphokinetic parameters of chromosomally normal and aneuploid embryos utilizing time-lapse imaging and CGH microarray analysis. METHODS: This retrospective cohort study included patients undergoing IVF treatment and preimplantation genetic diagnosis for sex selection. A total of 460 embryos cultured in incubators with time-lapse imaging system (EmbryoScope) were selected for biopsy on day 3 of development. Subsequently, CGH microarray analysis was performed for aneuploidy screening of 24 chromosomes. Kinetic parameters including time for appearance of second polar body (tPB2), time of pronuclei appearance (tPNa), time of pronuclei fading (tPBf), time to division to 2(t2), 3(t3), 4(t4), 5(t5) cells, length of second and third cell cycle (CC2= t3 t2, CC3=t5-t3), synchrony of cell division from 2 to 4 cells (S2=t4-t3) and interval t5-t2 were analyzed to compare chromosomally normal and abnormal embryos. RESULTS: The mean time durations for tPNf, t2, t5, CC2, CC3, t5-t2 differed significantly between normal and abnormal embryos. CONCLUSIONS: Time-lapse imaging morphokinetics may play a role in early prediction of aneuploid embryos due to differences in kinetic behavior that may aid in improving clinical outcome.

Consanguinity and family clustering of male factor infertility in Lebanon.

OBJECTIVE: To investigate the influence of consanguineous marriage on male factor infertility in Lebanon, where rates of consanguineous marriage remain high (29.6% among Muslims, 16.5% among Christians). DESIGN: Clinic-based, case-control study, using reproductive history, risk factor interview, and laboratory-based semen analysis. SETTING: Two IVF clinics in Beirut, Lebanon, during an 8-month period (January-August 2003). PATIENT(S): One hundred twenty infertile male patients and 100 fertile male controls, distinguished by semen analysis and reproductive history. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Standard clinical semen analysis. RESULT(S): The rates of consanguineous marriage were relatively high among the study sample. Patients (46%) were more likely than controls (37%) to report first-degree (parental) and second-degree (grandparental) consanguinity. The study demonstrated a clear pattern of family clustering of male factor infertility, with patients significantly more likely than controls to report infertility among close male relatives (odds ratio = 2.58). Men with azoospermia and severe oligospermia showed high rates of both consanguinity (50%) and family clustering (41%). CONCLUSION(S): Consanguineous marriage is a socially supported institution throughout the Muslim world, yet its relationship to infertility is poorly understood. This study demonstrated a significant association between consanguinity and family clustering of male factor infertility cases, suggesting a strong genetic component.

Comparison of urinary and recombinant human chorionic gonadotropin during ovulation induction in intrauterine insemination cycles: a prospective randomized clinical trial.

OBJECTIVES: To compare the in vivo effectiveness of recombinant (r) hCG with urinary (u) hCG during controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) cycles. DESIGN: Prospective controlled clinical study. SETTING: Private IVF center. PATIENT(S): Two hundred eighty-four subjects undergoing COH-IUI cycles. INTERVENTIONS(S): Women were randomized into receiving r-hCG or u-hCG for final maturation and induction of ovulation. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate and outcome of pregnancy. RESULT(S): Background characteristics were similar in the two groups studied except for a slight difference in the mean duration of infertility (3.0 vs. 2.3). There was no significant difference in the number of follicles > or =16 mm, mean peak E(2), or mean 1-week P levels between the two groups. The clinical pregnancy rate was 27.1% in the recombinant group compared with 28.5% in the urinary group. The outcome of pregnancy was similar in both groups. CONCLUSION(S): Recombinant hCG was found to be as effective as u-hCG in achieving pregnancy during COH-IUI cycles. This is in agreement with earlier studies on the effectiveness of r-hCG in IVF cycles.

Gestational sac aspiration: a novel alternative to dilation and evacuation for management of early pregnancy failure.

STUDY OBJECTIVE: To explore the effectiveness (success, safety, and complications) of a novel technique of gestational sac aspiration in the management of early pregnancy failure as an alternative to dilation and evacuation (D&E) and conservative management. DESIGN: Prospective historical cohort study comparing effectiveness of gestational sac aspiration (study group) to conservative management (control group) with follow-up until negative quantitative beta human chorionic gonadotropin testing is achieved (Canadian Task Force classification II-1). SETTING: An infertility treatment center. PATIENTS: Among 60 women with failed early pregnancies that were achieved by in vitro fertilization or intrauterine insemination, 20 underwent gestational sac aspiration, whereas 40 chose conservative management. INTERVENTIONS: Gestational sac aspiration was done by transvaginal ultrasound-guided needle aspiration under conscious sedation. Aspirated tissue was sent for karyotyping. Both study and control (conservative management) groups received close follow-up with ultrasound and serial beta human chorionic gonadotropin measurements. MEASUREMENTS AND MAIN RESULTS: There was no significant difference in age, infertility factor, or treatment between study and control groups. Mean gestational age was 8 versus 6 weeks in study and control groups, respectively (p < .05). One and 11 patients required D&E in the study and control groups, respectively (p < .05). Karyotyping was successful in all except one patient in the study group. Chromosomal abnormalities were found in 36% of products of conception. No significant complications occurred CONCLUSION: Gestational sac aspiration is a simple and safe outpatient technique that is more effective than conservative management of early pregnancy failure and less invasive than D&E. Moreover, the technique provides a high probability of obtaining a noncontaminated adequate gestation tissue sample for chromosomal study.

Arab Americans, African Americans, and infertility: barriers to reproduction and medical care.

OBJECTIVE: To compare barriers to infertility care among African Americans and Arab Americans. DESIGN: Qualitative study using semi-structured reproductive histories and open-ended ethnographic interviews. SETTING: Infertile volunteers in a private IVF clinic in Dearborn, Michigan, an Arab American ethnic enclave community in metropolitan Detroit. PATIENT(S): Arab American men presenting for infertility diagnosis and treatment, including assisted reproductive technologies. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Perceived barriers to effective infertility care. RESULT(S): Arab Americans and African Americans living in metropolitan Detroit are at increased risk of infertility and share similar histories of poverty, racism, and cultural barriers to medical treatment. This study, which focused on infertile Arab American men living in or near Dearborn (an ethnic enclave community composed mainly of recent immigrants and war refugees), revealed significant barriers to effective infertility care, including economic constraints, linguistic and cultural barriers, and social marginalization in mainstream U.S. society, particularly after September 11, 2001. CONCLUSION(S): Arab Americans experience disparities in access to infertility care, largely because of poverty and social marginalization in post-September 11th America.