Random antral follicle count performed on any day of the menstrual cycle has the same predictive value as AMH for good ovarian response in IVF cycles.

OBJECTIVE: To determine whether the predictive value of AFC for ovarian response to stimulation for IVF depends on the day of the menstrual cycle when ultrasound is performed. METHODS: 410 women undergoing their first IVF cycle were included. All the women had AFC performed twice. The first measurement, random AFC (r-AFC), was performed during the fertility workup whatever the day of their menstrual cycle. Three groups were constituted according to the period of ultrasound performance: at early follicular phase i.e., day 1 to day 6 (eFP-AFC); at mid follicular phase i.e., day 7 to 12 (mFP-AFC) and at luteal phase i.e., day 13 or after (LP-AFC). A second AFC measurement was performed before the start of the ovarian stimulation (SD1-AFC). AMH dosing was done in the early follicular phase. RESULTS: Random AFC (r-AFC) was correlated to AMH (r = 0.69; p<0.001), SD1-AFC (r = 0.75; p<0.001) and number of oocytes retrieved (r = 0.49; p<0.001). When regarding AFC depending on the cycle day group, the correlation with AMH was 0.65, 0.66 and 0.85 for the eFP-AFC, the mFP-AFC and the LP-AFC respectively (all p were <0.001). The ROC analysis showed the same predictive value for good ovarian response (more than 6 oocytes retrieved) for the eFP-AFC, mFP-AFC and LP-AFC (AUC 0.73, 0.75 and 0.84 respectively; p = 0.28). The AUC of r-AFC (0.76) were similar to those of AMH (0.74) and SD1-AFC (0.74) (p = 0.21 and 0.92 respectively). CONCLUSION: AFC is strongly correlated with AMH and highly predictive of good ovarian response during the whole menstrual cycle.

A meta-analysis of the efficacy of progestin-primed ovarian stimulation with medroxyprogesterone acetate in ovulation induction in poor ovarian responders.

PURPOSE: To systematically evaluate the effect of progestin-primed ovarian stimulation (PPOS) in in vitro fertilization (IVF)/oocyte intracytoplasmic sperm injection-embryo transfer (ICSI-ET) in patients with poor ovarian response and to find an optimal ovulation induction protocol for such patients. METHOD: A literature search of PubMed, Medline, EBSCO, Cochrane Library, Vip.com, CNKI, and the Wanfang database was conducted to find case-control studies of PPOS with medroxyprogesterone acetate and other traditional stimulation regimens for ovulation induction in patients with poor ovarian response. The period of time searched was from the database establishment to August 2020. Patients in the experimental group underwent PPOS and those in the control group underwent another program (e.g., the gonadotropin-releasing hormone antagonist protocol). RevMan 5.3 software was used for meta-analysis. RESULTS: A total of sixteen case-control studies (one of them is randomized controlled trial), with 4422 induction cycles, were included. All the included patients met the 2011 Bologna diagnostic criteria for poor ovarian response. The numbers of mature eggs, available embryos, optimal embryos, and the rate of cumulative pregnancies in the PPOS group were all better than those in the control group (P<0.05). There was a lower Serum luteinizing hormone on the day of human chorionic gonadotropin (HCG) injection and a lower rate of cycle cancellation in the PPOS group (P<0.05). No other differences between PPOS and other treatments were statistically significant. CONCLUSION: PPOS can reduce the need for cycle cancellation, improve the follicles and embryos, and improve the pregnancy rate and thus, can present an effective choice for IVF/ICSI-ET in patients with poor ovarian response.

Ultrasound-guided follicle aspiration at time of laparotomy in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To demonstrate a unique case of direct ultrasound-guided follicle aspiration at time of a laparotomy in a patient with Mayer-Rokitansky-Küster-Hauser Syndrome. DESIGN: Video presentation. SETTING: Academic fertility center PATIENT(S): A 32-year-old gravida 0 with Mayer-Rokitansky-Küster-Hauser Syndrome and bilateral ovarian masses presented as a fertility preservation consult from gynecologic oncology due to the possibility of bilateral oophorectomy. Due to the appearance and size of the left ovary oncology planned to perform an exploratory laparotomy and left oophorectomy, with possible right oophorectomy. The patient and her partner desired embryo cryopreservation with plans for future use in a gestational carrier. She had previously undergone vaginal dilator therapy, however her ovaries were inaccessible transvaginally due to their cephalad location and small caliber of the vaginal pouch. The plan was made to proceed with controlled ovarian stimulation and concurrent ultrasound-guided follicle aspiration of the right ovary at the time of laparotomy following left oophorectomy. INTERVENTION(S): Ultrasound-guided follicle aspiration in vivo at time of laparotomy. MAIN OUTCOME MEASURE(S): Successful controlled ovarian stimulation, oocyte retrieval and embryo cryopreservation. RESULT(S): The patient underwent a long agonist protocol and received a total of 2,525 units of gonadotropin with a peak estradiol of 3,264 pg/ml. She required a total of 9 days of stimulation. The normal right ovary responded as expected, and the left ovary remained unchanged. Following laparotomy and left oophorectomy, direct application of the transvaginal ultrasound probe was used to aspirate all visible follicles on the right side in vivo. Twenty-four oocytes were retrieved, 15 were mature and 5 blastocysts were cryopreserved. Final pathology of left ovary returned as serous cystadenoma. The right ovary was examined by gynecologic oncology prior to and following retrieval and was thought to be normal and remained in situ. CONCLUSION(S): Although the approach described here is not feasible in most cases, this video demonstrates a unique and successful fertility preservation technique by direct ultrasound-guided follicle aspiration in vivo at the time of laparotomy in a Mayer-Rokitansky-Küster-Hauser Syndrome patient and to our knowledge, is the first description of its kind. This retrieval would have otherwise been limited by lack of access transvaginally and limited visualization transabdominally. This combined approach should be considered in future patients with müllerian anomalies and similar complicating factors necessitating laparotomy.

Gestación heterotópica tras estimulación ovárica con clomifeno / Heterotopic pregnancy following induction of ovulation with clomiphene citrate

Introducción: la gestación heterotópica consiste en la coexistencia de una gestación intraútero y otra ectópica. La incidencia se ha multiplicado, debido especialmente a las técnicas de reproducción asistida. Es un cuadro infradiagnosticado. El diagnóstico será ecográfico o laparoscópico. Caso clínico: mujer de 27 años gestante en la semana 5 tras tratamiento con clomifeno que acude a urgencias por abdominalgia. En ecografía, saco gestacional intraútero y en anejo izquierdo saco de 5,73 mm con vesícula vitelina y líquido libre en Douglas. Ante la sospecha de gestación heterotópica se indica laparoscopia diagnóstico- terapéutica: trompa izquierda dilatada con embarazo tubárico. Se realiza salpinguectomía (AU)

Blackground: A heterotopic pregnancy is defined by the coexistence of an intrauterine pregnancy and ectopic pregnancy. The incidence of heterotopic pregnancy has increased due to Assisted Reproduction Therapy and it tends to be underdiagnosed. The diagnosis is made by Ultrasound and Laparoscopy. Case report: A 27-year-old woman in her fifth week of pregnancy, after treatment with Clomiphene comes to the emergency room for abdominal pain. A routine ultrasound finds an intrauterine gestational sac, along with a left adnexal mass resembling a gestational sac with vitelline vesicle and a collection in Douglas. A diagnostictherapeutic laparoscopy was performed, finding a left tubaric pregnancy which was removed by salpinguectomy (AU)

Efectos de las técnicas de capacitación sobre la morfología espermática y los resultados de la inseminación intrauterina / Effects of techniques for sperm capacitation of sperm morphology and results of Intrauterine Insemination

ANTECEDENTES: La inseminación intrauterina (IIU) combinada con la hiperestimulación ovárica controlada es un tratamiento económico, sencillo, menos estresante e invasivo que otras técnicas de Reproducción Asistida. Su tasa de éxito tras varios ciclos, resulta similar a la obtenida con las técnicas más complejas y depende de varios factores, entre los que destacan la edad, el índice de masa corporal, el grosor endometrial, el número de folículos superiores a 16 mm, la calidad del semen utilizado, la morfología espermática y el tipo de esterilidad de causa femenina. Sin embargo, no existe un consenso sobre la medida en la que estos factores influyen en la probabilidad de conseguir embarazo en IIU. OBJETIVOS: Analizar la influencia de la morfología espermática sobre la tasa de gestación en IIU con el fin de recomendar la técnica de selección espermática más adecuada para la realización de la inseminación. Además, se pretende identificar los factores que predicen la obtención de gestación en IIU, con el fin de desarrollar un modelo de predicción de gestación basado tanto en las variables femeninas, como en las de la muestra de semen. Ámbito: Estudio retrospectivo de cohortes de muestras de semen en el laboratorio de Andrología de la Unidad de Reproducción Humana Asistida del Hospital Universitari I Politécnic La Fe de Valencia desde Enero de 2013 hasta Abril de 2014. DISEÑO: Se analizaron 100 muestras de sémenes diagnósticos para ver la técnica de capacitación más adecuada y 120 muestras de IIU para identificar los factores predictores de gestación. MATERIAL Y MÉTODO: El estudio de los sémenes diagnósticos, incluyó la evaluación de variables macroscópicas, microscópicas y de la morfología mediante la tinción de Diff-quick y el sistema CASA. La preparación de las muestras de semen se realizó utilizando las técnicas de swim-up y gradientes de densidad. Tras finalizar el proceso de capacitación, se evaluó el recuento, motilidad, número total de espermatozoides móviles capacitados y morfología para ambas técnicas de selección espermática. El estudio de las muestras de semen destinadas a IIU, incluyó la evaluación de recuento, motilidad y morfología en fresco y tras el capacitado de la muestras mediante swim-up. Se evaluó la relación de variables asociadas a la mujer (edad, IMC, número de folículos mayores de 16 mm, causa de esterilidad, grosor endometrial) y al varón (causa de esterilidad, concentración, motilidad, morfología, número de espermatozoides móviles totales utilizados para inseminación, origen de la muestra) con la tasa de gestación en IIU RESULTADOS: Se analizaron un total de 100 muestras de sémenes diagnósticos, de los cuales el 52 % se correspondieron con varones normozoospérmicos y el 48 % con varones oligozoospérmicos. Además, se estudiaron un total de 120 ciclos de IIU con un total de 12 embarazos y 2 abortos, lo que supone una TG global por ciclo del 10% y una tasa de aborto del 1,7 %. Los resultados obtenidos demuestran que la morfología espermática se asocia a la esterilidad de causa masculina y que los gradientes de densidad permiten recuperar un porcentaje significativamente mayor de espermatozoides normales (p-valor=0,0000), aunque la morfología de la muestra capacitada no influye en la TG en IIU. Los criterios estrictos de Kruger y el sistema CASA no permiten predecir el éxito de la IIU y en el análisis de regresión logística realizado se ha podido observar que las variables femeninas grosor endometrial, número de folículos >16 mm y la variable seminal motilidad en capacitado aumentan la probabilidad de conseguir gestación en IIU. CONCLUSIONES: La técnica de selección espermática que permite recuperar un porcentaje significativamente mayor de espermatozoides morfológicamente normales son los gradientes de densidad. Sin embargo, se ha demostrado que la morfología espermática de la muestra de semen capacitada no influye en la TG en IIU. Además, los criterios estrictos de Kruger y el sistema CASA no permiten predecir el éxito de la IIU. Por último, se obtiene un modelo de predicción de gestación en IIU que dependería de las variables femeninas grosor endometrial y número de folículos mayores de 16 mm el día de la hCG, y de la variable motilidad de la muestra capacitada para la realización de la IIU

BACKGROUND: The combined intrauterine insemination (IUI) with controlled ovarian hyperstimulation is an inexpensive, simple, less stressful and less invasive treatment compared with other Assisted Reproduction Techniques (ART). Its success rate after several cycles, is similar to that obtained with the most sophisticated techniques and depends on several factors, among which are age, body mass index, endometrial thickness, the number of follicles over 16 mm, semen quality used, sperm morphology and type of female infertility cause. However, there is no consensus on the extent to which these factors influence the likelihood of achieving pregnancy in IUI. OBJECTIVES: The aim of this study is to analyze the influence of sperm morphology on IUI pregnancy rate (PR) to recommend the most appropriate sperm selection technique for performing insemination. Another objective is to relate the morphology parameters with concentration and motility fresh and capacitation semen samples, and identify factors that predict the positive or negative result of pregnancy through a gestation model based on female variables and semen sample characteristics. SETTING: Retrospective cohort study of semen samples in the laboratory of Andrology in the Assisted Human Reproduction Unit of the Hospital La Fe in Valencia, from January 2013 to April 2014. DESIGN: 100 semen diagnoses samples were studied to identify the most appropriate sperm selection technique and 120 samples of IUI to identify predictors of pregnancy MATERIAL AND METHOD: The study of semen diagnosis included evaluation of macroscopic and microscopic variables, and of morphology by Diff-quick and CASA system. The preparation of semen samples was performed using the swim-up techniques and density gradients. Count, motility, total number of motile sperm and morphology for both sperm selection techniques was evaluated after completing the capacitation. The study of semen samples intended for IUI, included evaluation of count, motility and morphology in fresh samples and after the samples capacitated by swim-up. The relationship of variables associated with women (age, BMI, number of follicles over 16 mm, cause of infertility, endometrial thickness) and with men (cause of infertility, concentration, motility, morphology, number of total motile sperm used, origin of the sample) was correlated with pregnancy rate after IUI. RESULTS: A total of 100 semen diagnosis samples were studied: 52% corresponded to normozoospermic men and 48% corresponded to oligozoospermic men. In addition, a total of 120 cycles of IUI were studied; the outcome was 12 pregnancies and 2 miscarriages, which meant a pregnancy rate (PR) of 10% and a miscarriage rate of 1,7%. No multiple pregnancies were obtained and there was one ectopic pregnancy. The results show that sperm morphology is associated with male infertility causes and density gradients can retrieve a significantly higher percentage of normal spermatozoa (p-value=0,0000), although sperm morphology does not affect the IUI pregnancy rate. Kruger ́s strict criteria and the CASA system cannot predict IUI success and the logistic regression analysis performed showed that the endometrial thickness, number of follicles > 16 mm and sperm motility increase the likelihood of getting pregnant in IUI. CONCLUSIONS: The sperm selection technique that makes it possible to recover a significantly greater percentage of normal spermatozoa are density gradients. However, it has been demonstrated that sperm morphology of the capacitation semen samples does not affect IUI pregnancy rate. In addition, Kruger ́s strict criteria and the CASA system cannot predict IUI success. Lastly, a gestation prediction model for IUI is obtained that depends on the female variables: endometrial thickness, number of follicles over 16 mm on the day of hCG and of the sperm motility to perform IUI

Preovulatory follicle diameter, growth rate and time of ovulation during induced oestrus using a CIDR® in trypanotolerant female Bos taurus N'Dama cattle.

The aim of this study was to assess the dose (300 to 600 IU) effects of equine chorionic gonadotropin (eCG) on the preovulatory follicle diameter, growth rate and time of ovulation characterized by echography. The eCG was injected at the end (D0) of the 7-day treatment with a controlled internal device release (CIDR®) and a PGF2α being injected 2 days before the removal of the CIDR® (d-2). The 120 N'Dama female were distributed into five experimental groups. The control group (n = 26) was treated with physiological saline at the removal of the CIDR®, while the animals in the four treated groups received, respectively, 300 IU (n = 25), 400 IU (n = 24), 500 IU (n = 22) and 600 IU (n = 23) of eCG. The diameter of the preovulatory follicle was significantly higher (P < 0.05) in the animals treated with 300 IU (10.1 ± 1.4 mm) than in untreated animals (9.3 ± 1.2 mm). Follicle growth rate was significantly (P < 0.05) higher in treated animals (1.0 ± 0.4 mm/day) than in the control group (0.9 ± 0.4 mm/day). The average interval between the time of eCG injection and ovulation was similar in the non-treated (83.7 ± 14.4 h) and treated animals (79.7 ± 11.9). Treated animals showed a significant increase in the percentage of ovulation (94.7 % compared to 73.1 %) (P < 0.01). Use of eCG contributed towards synchronising the time of ovulation between 72 to 96 h, which would facilitate the use of systematic insemination.

Protocolo weekend-free con cetrorelix y lutropina alfa en inseminaciones intrauterinas / A weekend-free protocol with cetrorelix and recombinant luteinizing hormone in intrauterine inseminations

Objetivo. Evaluar la eficacia de un nuevo protocolo de supresión hipofisaria con cetrorelix y lutropina alfa (LH recombinante) en la estimulación ovárica con FSH recombinante para evitar las inseminaciones intrauterinas en fin de semana por razones logísticas. Sujetos y métodos. Estudio prospectivo, abierto y comparativo que incluye 182 parejas que realizaron su primer ciclo de estimulación ovárica para inseminación intrauterina de febrero de 2006 a diciembre de 2009. Se establecieron 2 grupos de estudio en función de la respuesta ovárica y el desarrollo folicular que conducía a una inseminación en fin de semana (grupo A: 91 pacientes) y las primeras 91 parejas cuyo ciclo se completó con la inseminación en días laborables. Los criterios de inclusión fueron: edad de la mujer < 39 años, FSH basal < 10 UI/l, estradiol basal < 80 pg/ml o PRL< 40 ng/ml, índice de masa corporal < 32 kg/m2, permeabilidad tubárica bilateral y parámetros seminales con morfología espermática normal > 4% y recuento total de espermatozoides móviles (REM) igual o superior a 10 millones/ml. Resultados. El total de gestaciones conseguidas en el grupo A fue de 30 (32,9%), mientras que en el grupo B fue de 19 (20,9%), diferencias que no alcanzaron la significación estadística (Chi cuadrado; p = 0,066). Conclusión. La supresión hipofisaria con cetrorelix y LH recombinante, administrados en forma de dosis múltiple en un protocolo de estimulación ovárica controlada con FSH recombinante para inseminación intrauterina, es seguro para evitar las inseminaciones en fin de semana por razones logísticas (AU)

Objective. To evaluate the efficacy of a new protocol for pituitary suppression with cetrorelix and recombinant luteinizing hormone (LH) for ovarian stimulation with recombinant follicle-stimulating hormone (FSH) to avoid weekend intrauterine inseminations for logistical reasons. Subjects and methods. This prospective, open, comparative study included 182 couples who underwent their first cycle of ovarian stimulation for intrauterine insemination between February 2006 and December 2009. Two study groups were established based on ovarian response and follicular development: one group that required weekend insemination (Group A: 91 patients) and another consisting of the first 91 couples whose cycles were completed with insemination on weekdays (Group B: 91 patients). The following inclusion criteria were applied: women aged < 39 years, baseline FSH < 10 IU/L, baseline estradiol < 80 pg/ml or prolactin (PRL) < 40 ng/ml, body mass index < 32 kg/m2, bilateral tubal permeability and seminal parameters with normal sperm morphology > 4%, and total motile sperm count (MSC) equal to or greater than 10 million/ml. Results. The total number of pregnancies achieved in group A was 30 (32.9%), while 19 (20.9%) were achieved in group B. This difference was not significant (X2 P = .066). Conclusion. Pituitary suppression with cetrorelix, administered in multiple doses with recombinant LH and recombinant FSH during a protocol of controlled ovarian stimulation for intrauterine insemination, allows weekend inseminations to be safely avoided for logistical reasons (AU)

Obesidad como factor pronóstico reproductivo en ciclos de fecundación in vitro-inyección espermática intracitoplasmática / Obesity as a reproductive prognostic factor in in vitro fertilization-intracytoplasmic sperm injection cycles

Objetivo. Comparar los resultados reproductivos en función del índice de masa corporal (IMC) en las pacientes sometidas a ciclos de FIV-ICSI. Sujeto y métodos. Ochocientos sesenta y tres ciclos de FIV-ICSI sometidos a estimulación ovárica controlada con protocolo de antagonistas de la GnRH. Resultados. Se encontraron diferencias en la edad media de las pacientes de los diferentes grupos, no clínicamente relevantes (± 1 año). No se encontraron diferencias significativas en la duración de la estimulación, ni en la dosis total de gonadotropinas utilizadas entre los diferentes grupos. Sin embargo, hubo menor número de folículos seleccionados, ovocitos recuperados, ovocitos maduros y de embriones disponibles para transferir al incrementarse el IMC, siendo las diferencias estadísticamente significativas. En cuanto a los resultados reproductivos; la tasa de embarazo clínico y nacido vivo se reduce progresivamente a medida que aumenta el IMC, siendo las diferencias estadísticamente significativas (grupo I: 41,4%, grupo II: 32,5%, grupo III: 29,6%; p < 0,05). Conclusiones. El sobrepeso y la obesidad empeoran los resultados reproductivos en ciclos de FIV-ICSI, reduciéndose de forma significativa la tasa de embarazo clínico y nacido vivo a medida que aumenta el IMC (AU)

Objective. To compare reproductive outcomes in our in vitro fertilization (IVF) program according to women's body mass index (BMI). Subjects and methods. We included a total of 863 IVF-intracytoplasmic sperm injection (ICSI) cycles with controlled ovarian stimulation with GnRH antagonists. Results. Patient age differed among the BMI groups but this difference was not clinically relevant (± 1 year). No significant differences were found among BMI groups in the duration of ovarian stimulation or in the total follicle-stimulating hormone dose used. However, there were significantly fewer selected follicles, retrieved oocytes, mature oocytes and transferred embryos at higher BMIs. Rates of pregnancy and live births were progressively and significantly reduced as BMI increased (group i: 41.4%, group i: 32.5%, group iii: 29.6%; P<.05). Conclusions. Female overweight and obesity impair IVF outcomes. Pregnancy and live birth rates were progressively reduced as BMI increased (AU)

Vitrificación de espermatozoides: una alternativa a la inyección intracitoplasmática de espermatozoides en paciente con oligoastenozoospermia severa / Vitrification sperm: An alternative to intracytoplasmic sperm injection in oligoasthenozoospermic patient

El tratamiento de elección para pacientes con oligozoospermia severa es la inyección intracitoplasmática de espermatozoides (ICSI), pero su alto coste limita su aplicación en países cuyos sistemas de salud no cubren este procedimiento médico. La nueva técnica de vitrificación permite almacenar espermatozoides post selección espermática hasta obtener la concentración mínima para realizar ciclos de inseminación intrauterina (IIU). Se presenta este caso clínico de un recién nacido sano, tras dicha técnica, de una pareja (varón 32 años, mujer 31 años) con antecedente de 2ciclos ICSI, uno de los cuales fue exitoso, con un hijo vivo sano. Espermatozoides mótiles fueron obtenidos por swim-up, resuspendidos en medio Vitrisperm®, almacenados en pajuelas a una concentración de 0,5-1,5×106células/ml y vitrificados en contacto directo con nitrógeno líquido. Se realizó estimulación ovárica y la IIU se realizó 36h después de la administración de hCG. La muestra post desvitrificación presentó una concentración de 3,0×106espermatozoides motiles. La evolución de un desarrollo fetal normal fue controlada por ecografía 3D, con el posterior nacimiento por parto cesárea de un recién vivo sano de sexo masculino. Aunque son resultados preliminares, la congelación ultrarrápida, al preservar un alto número de espermatozoides con función conservada, genera una alternativa de tratamiento de bajo coste en pacientes con oligozoospermia severa (AU)

Therapy for patients with severe oligozoospermia is the intracytoplasmic sperm injection (ICSI). However, its high cost limits its application in countries whose health systems do not cover this medical technique. The new vitrification technique makes it possible to store sperm after sperm selection until reaching the minimum concentration for cycles of intrauterine insemination (IUI). A clinical case is reported of a couple (male age 32, female age 31) who underwent 2 ICSI procedures, one of which was successful, resulting in the birth of a healthy, live born son. Motile sperm were obtained by swim-up, resuspended in Vitrisperm® medium, stored in straws at a concentration of 0.5 to 1.5×106cells/mL, and vitrified in direct contact by liquid nitrogen. Ovarian stimulation was induced and IUI was performed 36hours after hCG administration. The post-devitrification sample presented a concentration of 3.0×106 motile sperm. The evolution of normal fetal development was controlled by 3D ultrasound and subsequent birth by cesarean delivery of a healthy male newborn. Although these are preliminary results, ultrarapid freezing preserves the physiological function in a high number of spermatozoa. This generates a low-cost alternative treatment for patients with severe oligozoospermia (AU)

Autoclaved, previously used intravaginal progesterone devices induces estrus and ovulation in anestrous Toggenburg goats.

Intravaginal progesterone devices are used worldwide for estrus induction in goats. Reused devices are able to induce estrus; however, this can be a health risk within a flock. The objective was to compare new and previously used (and autoclaved) progesterone-releasing intravaginal devices for induction of estrus and ovulation in seasonally anestrous Toggenburg goats. Anestrous goats (n=42) received new intravaginal devices containing 0.3g progesterone (CONTROL), or similar devices previously used for either 6 (USED6) or 12d (USED12) and subsequently autoclaved. All goats received 5mg dinoprost at device insertion and 200 IU eCG 5d later, and all devices were removed after 6d. After device removal, estrus was monitored and females displaying signs of estrus were mated by fertile bucks. Transrectal ovarian ultrasonography was performed after device removal until detection of ovulation. Blood samples were collected for determination of plasma progesterone concentration at different times. There was no difference (P>0.05) among groups CONTROL, USED6 or USED12 for: estrus response (87, 100 or 100%, respectively); duration of estrus (32.3±2.3, 25.2±3.4 or 27.3±4.1h); ovulation rate (100, 88 or 100%); number of ovulations (1.5±0.2, 1.9±0.3 or 1.7±0.3); and pregnancy rate (60, 58 or 67%). Plasma progesterone (P4) concentrations were greater (P<0.05) in CONTROL than in USED6-treated and USED12-treated goats (7.2±1.2, 4.7±0.7 and 4.3±0.6 ng/mL, respectively) at 6h after device insertion; these differences were maintained until 4d after device insertion (3.4±0.4, 2.3±0.2, and 2.5±0.2 ng/mL). Overall, plasma progesterone concentrations were greater (P<0.05) in nulliparous than in lactating goats (3.1±0.8 compared to 2.4±0.6 ng/mL, respectively). In conclusion, autoclaved, previously used intravaginal progesterone-releasing devices resulted in significant lesser plasma progesterone concentrations than new devices, but were similarly effective in inducing estrus and ovulation in anestrous goats.

The redesigned follitropin α pen injector for infertility treatment.

INTRODUCTION: Treatment for infertility may require multiple drugs and complex dosing schedules. Available injection devices for patients who require regular injections during treatment are reviewed in this article, focusing on pen injectors used to self-administer recombinant human follicle-stimulating hormone (follitropin α). Following the introduction of the first and second follitropin α pen injectors in the last decade, a third pen injector with improved design for the administration of follitropin α has been developed for use in fertility treatment cycles. AREAS COVERED: This paper presents the results of the dose accuracy testing with this pen injector that was performed in accordance with international standards (EN ISO 11608-1:2000). This overview also provides an understanding of the key features of the redesigned pen injector that are of interest to healthcare professionals. EXPERT OPINION: The availability of an improved injection device for the delivery of follitropin α used during infertility treatment cycles of ovulation induction and assisted reproductive technology offers patients and healthcare professionals new treatment administration options. As fertility treatment cycles involve the use of several injectable gonadotropins, a standard device that could be used for all such treatments would simplify both the administration and the teaching of administration considerably.

In vitro fertilization-intracytoplasmic sperm injection outcomes in single- versus double-lumen oocyte retrieval needles in normally responding patients: a randomized trial.

We compared the retrieval efficiency of single- (direct follicular aspiration) and double-lumen-needle (attained with follicular flushing) procedures in normal-responder IVF-intracytoplasmic sperm injection cycles. This prospective randomized study did not demonstrate a beneficial effect of double-lumen needle retrieval compared with single-needle retrieval in normal-responder IVF-intracytoplasmic sperm injection cycles in terms of retrieved oocytes, clinical pregnancy rates, and live birth rates.

[Clinical application of prefilled pen and conventional syringe during controlled ovarian stimulation for in vitro fertilization].

OBJECTIVE: To investigate the efficacy, convenience and costs of recombinant follitropin alpha administered by a prefilled pen device and conventional syringe in Chinese women undergoing controlled ovarian stimulation for in vitro fertilization (IVF). METHODS: A total of 184 patients undergoing IVF treatment were enrolled in this study. According to a long-term recombinant follicle-stimulating hormone (rFSH) protocol, ovarian stimulation was performed with the prefilled pen and conventional syringe at random in these subjects, and the dose of follitropin, number of oocytes and embryo parameters and IVF-ET outcome were compared between the two groups. RESULTS: The total rFSH dose, cost, and frequency of hospital visits were significantly lower in the pen protocol group, but the residual rFSH amount was higher. Compared with conventional injections, the prefilled pen was associated with significantly lowered rate of local redness, high rate of local bruise, more frequent follitropin dose modulation and lower serum oestradiol levels on HCG day. No significant difference was found in the endometrial thickness, numbers of oocytes retrieved, MII oocytes, transferred embryo, or the clinical pregnancy rates between the two groups. The ratio of MII oocytes, good quality embryo rates and implantation rates was significantly higher in the pen group with lower incidences of moderate and severe ovarian hyperstimulation syndrome. CONCLUSION: The prefilled pen provides an easy, safe, effective and more patient-friendly means for controlled ovarian stimulation procedure in Chinese women, but more attention should be given to protocol optimization and patient education.

A administração de hCG incrementa a incidência de ovulações duplas e múltiplas em éguas da raça Campolina apresentando folículos codominantes? / Does hCG administration increase the incidence of double and multiple ovulations in Campolina mares with co-dominant follicles?

A gonadotrofina coriônica humana (hCG) é rotineiramente empregada na indução de ovulação em éguas. A incidência de duplas ovulações é variável, sendo comum em determinadas raças brasileiras, como Brasileiro de Hipismo e Campolina. O objetivo deste trabalho foi avaliar se a administração de hCG em éguas da raça Campolina incrementa a incidência de ovulações duplas e múltiplas. Através de palpação retal e ultrassonografia, foram avaliados dois ciclos estrais de 104 éguas, divididas em dois grupos. À detecção de um ou mais folículos ³35 mm e edema endometrial grau 2, 2.500 IU de hCG (IV) eram administrados às éguas do grupo I. O grupo II serviu como controle. Os resultados obtidos foram analisados pelo Qui-quadrado. A incidência de ovulações duplas nos grupos I e II foi de, respectivamente, 32,7% (34/104) versus 30,8% (32/ 104). Ambos os grupos obtiveram incidência semelhante de ovulações triplas (1,9% - 2/104). Apenas uma ovulação quádrupla (1,0% - 1/104) foi detectada, no grupo controle. A incidência de duplas e múltiplas ovulações foi similar entre os grupos (p > 0,05). Pelo fato das éguas da raça Campolina apresentarem, fisiologicamente, considerável incidência de ovulações duplas e múltiplas, é possível que a administração de hCG não tenha influenciado estes padrões ovulatórios.

The human chorionic gonadotrophin (hCG) has been routinely used in the equine species to induce ovulations for more than four decades. The incidence of multiple ovulations in horses is variable, being double ovulations a common occurrence in some Brazilian breeds, such as Brasileiro de Hipismo and Campolina. The aim of this work was to evaluate the role of hCG administration to increase, in Campolina mares, the incidence of double and multiple ovulations, which are desirable in embryo transfer programs. One hundred and four (104) mares had their estrous cycles recorded through rectal palpation and ultrasonographic evaluation during the breeding season of 2003 - 2004, in a total of two hundred and eight (208) cycles (two cycles per mare). Animals were allocated in two groups, with fifty two (52) horses each. In Group I mares, once one or more = 35 mm follicles and grade 2 uterine edema were present, 2.500 IU of hCG were intravenously administered. The untreated mares in Group II served as control. The Chi-Square test was used to analyze obtained results. The incidence of double ovulations in groups I and II was, respectively, of 32.7% (34/104) versus 30.8% (32/104). The incidence of triple ovulations was low in both groups, of 1.9% (2/104). Only once in the control group (1.0% - 1/104) was a quadruple ovulation detected. There was no difference in the incidence of double and multiple ovulations between both groups (p > 0.05). Possibly, hCG administration did not influence ovulation patterns in this work due to the fact that Campolina breed mares physiologically show a considerable incidence of double and multiple ovulations.

Donación de ovocitos / Oocyte donation

Objetivo: Conocer el marco legal y científico, indicaciones, resultados, aspectos emocionales y controversias existentes relacionadas con la técnica de donación de ovocitos en reproducción asistida. Material y métodos: Revisión de las principales guías de práctica clínica publicadas en la bibliografía internacional (ESHRE, American Society for Reproductive Medicine, Royal College of Obstetricians and Gyneacologist [RCOG]). Resultados: La tasa de embarazo obtenida mediante esta técnica varía entre el 30 y 50% en función de las fuentes consultadas. La prestación asumida por el Servicio Andaluz de Salud sólo cubre el 17% de las indicaciones que se hacen en sanidad privada. Conclusiones: La donación de ovocitos es una técnica que obtiene buenos resultados en el segmento poblacional con peor pronóstico reproductivo. Su extensión difiere sustancialmente entre el sector privado y el público. Con la generalización de la técnica han aparecido nuevas controversias no del todo resueltas. El escaso número de donantes y los aspectos morales son los dos principales factores que limitan la extensión de la técnica (AU)

Objective: To determine the legal and scientific framework, indications, results, emotional issues, and current debates related to oocyte donation in assisted reproduction. Material and methods: We reviewed the main clinical practice guidelines published in the international literature (ESHRE, American Society for Reproductive Medicine, Royal College of Obstetricians and Gynecologists). Results: The pregnancy rate obtained by this technique varied between 30% and 50%, depending on the sources consulted. The services provided by the Andalusian Health Service covered only 17% of the indications covered by private health providers. Conclusions: Oocyte donation provides good results in the segment of the population with the worst reproductive prognosis. The use of this technique differs substantially between the private and public sectors. With the widespread use of this technique, new controversies have appeared that have not been entirely resolved. The two main factors limiting wider use of oocyte donation are the low number of donors and moral issues (AU)

The J-Tip Needle-Free Injection System in controlled ovarian hyperstimulation in in vitro fertilization: a pilot study.

OBJECTIVE: To evaluate the use of a novel needle-free system (J-Tip) in the administration of gonadotropins for controlled ovarian hyperstimulation (COH) in IVF. DESIGN: An open-label, single-center, pilot study. SETTING: Assisted conception unit of a university hospital. PATIENT(S): Twenty patients undergoing COH over a 3-month period. INTERVENTION(S): COH was carried out using a fixed dose of rFSH administered via the J-Tip System in a GnRH antagonist cycle. MAIN OUTCOME MEASURE(S): The primary endpoint was the mean number of oocytes collected per patient, and secondary endpoints were incidence of technically correct injections, clinical pregnancy, and cancellation rates. Patient diaries were kept throughout the study. RESULT(S): Sixteen patients completed the trial, four of whom became pregnant, with a high overall satisfaction rate. CONCLUSION(S): This is the first report of the use of the novel J-Tip Needle-Free Injection System for administration of gonadotropins in IVF with successful ovarian stimulation and achievement of pregnancies. This report indicates that this technique is associated with minimal pain and high patient acceptability. Large-scale multicenter studies are required to examine the reproducibility of these results and the J-Tip's cost-effectiveness as well as to compare the J-tip System with conventional needle-wise administration for COH before its introduction into routine IVF practice.

New advances in ovulation induction.

PURPOSE OF REVIEW: To review recent advances in ovulation induction. RECENT FINDINGS: Aromatase inhibitors can replace clomiphene citrate as ovulation-inducing substances. The most widely used aromatase inhibitor for this purpose is letrozole and the optimal dose is 5 mg daily for 5 days. Compared to clomiphene citrate, it is associated with a thicker endometrium and a better pregnancy rate. It is as effective as gonadotropin but yet less expensive. The overall rates of congenital malformation among newborns conceived after infertility treatment with letrozole or clomiphene citrate are similar. When letrozole is combined with gonadotropin, it leads to lower gonadotropin requirements with pregnancy rates comparable to gonadotropin treatment alone. Another promising aromatase inhibitor is anastrazole. Recent evidence suggests that luteinizing hormone activity in human menopausal gonadotropin modifies follicular development so that fewer intermediate-sized follicles develop. Compared to the use of follicular stimulating hormone only, human menopausal gonadotropin is associated with less ovarian hyperstimulation. SUMMARY: Aromatase inhibitors are alternative drugs to clomiphene or gonadotropin for ovulation induction or superovulation.

A retrospective comparison of clinical outcomes and satisfaction using reconstituted recombinant gonadotropins (rFSH) or cartridge rFSH with a pen device in donor oocyte cycles.

BACKGROUND: Use of recombinant follicle stimulating hormone (rFSH) in a cartridge pen device offers obvious benefits for donor oocyte cycles including the administration of fewer and more patient-friendly injectable medications. METHODS: In a University-based IVF program, a total of 98 oocyte donor cycles using rFSH either reconstituted or as a pen device given to 118 recipients (eight split cycles) were retrospectively reviewed. Following discontinuation of oral contraceptive, controlled ovarian hyperstimulation was begun using either reconstituted rFSH (n = 19) or rFSH with a cartridge pen device (n = 79) (150-300 IU qd). GnRH-antagonists (Ganirelix, Organon) and an additional 75 IU of rFSH/day were begun when lead follicles were 13-14 mm in greatest diameter. The primary endpoints analyzed included cycle stimulation characteristics for each donor group and donor medication tolerance assessment with respect to each rFSH formulation, while secondary outcome measures included clinical pregnancy and implantation rates. RESULTS: Oocyte donors using the pen required significantly less rFSH (2734 IU vs. 3276 IU, p < 0.05) and scored significantly higher medication tolerance scores (3.9 +/- 0.4 vs. 3.1 +/- 0.6, p < 0.05). No other differences in cycle stimulation for oocyte donors and clinical outcomes for recipients were seen including pregnancy rates (pen, 77% vs. reconstituted, 55%, p - NS) and clinical pregnancy rates (61% vs. 45%, p - NS). However, significantly greater implantation rates (57% vs. 31%, p < 0.01) occurred in the pen group. CONCLUSION: Compared to reconstituted formulations, the pen device results in lower gonadotropin requirements and provides a simplified dosing method with better tolerance.

Applicability of a progesterone-based timed artificilal insemination protocol after follicular fluid aspiration using the ovum pick-up technique in suckled beef cows.

We conducted a progesterone-based timed AI protocol after follicular fluid aspiration using the ovum pick-up (OPU) technique to examine its applicability to the suckled beef cow. A total of 19 beef cows were randomly allocated to one of the following three groups based on the number of days postpartum: 13 to 60 days (Group A: suckled; early postpartum period, n=9), 61 to 150 days (Group B: suckled; mid postpartum period, n=6), or 151 to 281 days (Group C: non-suckled; prolonged open period, n=4) postpartum. These cows were treated with follicular fluid aspiration and insertion of a progesterone-releasing intravaginal device (PRID) on day 0. The PRID was removed and 500 microg of cloprostenol was intramuscularly administered on day 7. A dose (100 microg) of fertirelin acetate was injected intramuscularly 48 hours later, and this was followed by a timed AI (TAI) after another 18 hours (day 10). Serum samples were taken on days 0, 7, 9, 10, 12, 17, 24 and 31 for determination of the estradiol-17beta (E(2)) and progesterone concentrations. Pregnancy diagnosis was made by rectal palpation approximately 60 days after TAI. There was no significant difference in the peripheral E(2) concentrations among the three groups during the period of the hormonal treatment. The average progesterone concentrations in Group A on day 17 were significantly higher than those in Group B and exceeded 1.0 ng/ml on day 17 and thereafter. There was no significant difference in the numbers of collected immature oocytes among the three groups. The pregnancy rates in Groups A, B, and C were 77.8% (7/9), 83.3% (5/6) and 50.0% (2/4), respectively. In conclusion, this timed AI protocol is applicable to suckled beef cows within the period of 60 days postpartum.