Treatment period and medical care costs to achieve the first live birth by assisted reproductive technology are lower in the single embryo transfer period than in the double embryo transfer period: a retrospective analysis of women younger than 40 years of age.

Aim: It was examined whether the single embryo transfer policy makes the treatment period longer for couples to achieve their first live birth by assisted reproductive technology. Methods: This study retrospectively analyzed women who started assisted reproductive technology at younger than 40 years of age in the authors' organization. The treatment periods for couples to achieve the first live birth by assisted reproductive technology, between the women who started assisted reproductive technology from 2004 to 2009 (the double embryo transfer period group, n=250), in which the double embryo transfer was predominant, and the women who started assisted reproductive technology from 2010 to 2015 (the single embryo transfer period group, n=298), in which the single embryo transfer was predominant, were compared. Results: The age at the start of assisted reproductive technology, pregnancy rate per embryo transfer, and rate of women who achieved a live birth by assisted reproductive technology per number of women who tried assisted reproductive technology were all significantly higher in the single embryo transfer period group. Among the women who achieved a live birth by assisted reproductive technology, the incidence of multiple births and severe ovarian hyperstimulation syndrome, the treatment period, and medical care costs needed to achieve the first live birth were all significantly lower in the single embryo transfer period group. Conclusion: In the single embryo transfer period group, those women who were younger than 40 years of age achieved their first live birth by assisted reproductive technology more safely, quickly, and reasonably.

Reactivity of CA19-9 and CA125 in histological subtypes of epithelial ovarian tumors and ovarian endometriosis.

Previous reports have shown that some ovarian endometrioid adenocarcinomas and ovarian clear cell adenocarcinomas derive from ovarian endometriosis (OE), and that endocervical-like mucinous borderline ovarian tumors are associated with OE. We examined the relationship between the staging and histological subtypes of OE or epithelial ovarian tumors (EOT) and the serum levels of carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125) to evaluate the potential of these markers for preoperative diagnosis. First, we analyzed the preoperative serum levels of CA19-9 and CA125 in 195 patients who were histopathologically diagnosed with OE or EOT. We then performed a case-control study in which 308 women were enrolled, the 195 women described above and 113 healthy women as control subjects. Serum CA19-9 and CA125 levels were found to be useful in differentiating between OE and serous adenocarcinoma, but not between OE and other EOT. Moreover, serum CA19-9 levels were useful for preoperative assessment between OE and stage I mucinous borderline ovarian tumors, with or without the interstitial infiltration. In addition, considering that the serum CA19-9 levels in stage I mucinous borderline ovarian tumors were elevated via the interstitial infiltration of leukocytes and that precancerous lesions are associated with a cancerous glycosylation disorder in the process of inflammatory carcinogenesis, the CA19-9 level may be considered a suitable biomarker for estimating drug susceptibility.

[Comparison of intracytoplastic sperm injection outcomes with fresh and frozen-thawed testicular sperm].

Testicular sperm can be obtained from patients with non-obstructive azoospermia. However, there is not enough evidence concerning whether fresh or frozen-thawed sperm is better for successful pregnancy. We retrospectively compared initial treatment results of intracytoplasmic sperm injection using fresh and frozen-thawed testicular sperm in our institution. From August 1997 to May 2006, a total of 27 cases including 18 cases using fresh sperm (269 oocytes) and 9 cases using frozen sperm (97 oocytes) were evaluated. In the fresh and frozen sperm groups 33.4 and 32.9%, respectively, developed good quality embryo. There was no significant difference between the two groups in successful pregnancy and birth rates.

Perinatal management of cervicoisthmic pregnancy.

Cervicoisthmic pregnancy has a high risk of abortion or preterm delivery, and only 11 cases of live birth have been reported since 1980. In addition, almost all cases require blood transfusion and hysterectomy because of profuse bleeding after delivery of the placenta. A 39-year-old nulliparous woman who became pregnant after a fourth intracytoplasmic sperm injection was diagnosed with cervicoisthmic pregnancy on ultrasonography at 6 weeks' gestation. A healthy neonate was delivered by cesarean section at 32 weeks, but hysterectomy and blood transfusion were required. Perinatal management is discussed.

Costs of maternal and neonatal medical care for triplet and quadruplet pregnancies in Japan.

Aims: It is well documented that maternal morbidity and neonatal morbidity and mortality increase alike in high-order multiple (HOM) births. There have, however, been few reports concerning the costs of maternal and neonatal medical care associated with HOM births. This is the first such report on the situation in Japan. Materials and methods: All triplet and quadruplet pregnancies managed at this institution from before 16 weeks' gestation, and delivered at no earlier than 22 weeks' gestation, between 1997 and 2002 were included. Prophylactic cervical ligature, hospitalization to prevent premature labor from 23 weeks' gestation until delivery, and delivery by cesarean section, were all routine for HOM pregnancies. All women with singleton and twin pregnancies, who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and also delivered their babies at no earlier than 22 weeks' gestation at this institution, between 1997 and 2002, were also examined as controls. Prophylactic cervical ligature, preventive hospitalization, and cesarean section were not routine in the control group. Results: The average gestational ages at delivery in singleton (n = 58), twin (n = 21), triplet (n = 14) and quadruplet (n = 1) pregnancies, were 39.4, 35.6, 31.9 and 25.1 weeks, respectively (P < 0.001 by anova). Birthweights were 2886 ± 425 g, 2117 ± 623 g, 1430 ± 373 g, and 633 ± 77 g (mean ± SD), respectively (P < 0.001). The average inpatient medical care cost for mother and child(ren), from maternal admissions after 12 weeks' gestation to the discharge of all family members from hospital, was ¥703 279 yen (∼US$5861), ¥4 903 270 (∼US$40 861), ¥11 810 327 (∼US$98 419), and ¥44 961 000 (∼US$374 675), respectively (P < 0.001). Conclusion: The present study outlined the high costs of medical care for HOM pregnancies. Not only from a medical viewpoint, but also from the viewpoint of medical costs, it is important to avoid HOM pregnancies as a result of infertility treatment. (Reprod Med Biol 2004; 3: 159-164).

[Testicular sperm extraction for non-obstructive azoospermia: results with conventional and microsurgical techniques].

Testicular sperm extraction (TESE) was performed on patients with non-obstructive azoospermia using the conventional or microdissection technique. First, conventional TESE was attempted on all patients. If the sperm was retrieved successfully, the TESE procedure was terminated. Microdissection TESE was indicated only for patients for whom the conventional sperm retrieval was unsuccessful. Sperm was successfully retrieved with conventional TESE from four (24%) of 17 patients with non-obstructive azoospermia. The remaining 13 patients underwent microdissection TESE and sperm was successfully retrieved from four of them. Application of the microdissection technique resulted in an improvement in sperm retrieval rates from 24% with conventional TESE to 48% when combined with the microdissection technique. None of the patients showed any acute or chronic complications after TESE. Intracytoplasmic sperm injection (ICSI) was performed on five of the eight patients with successful sperm retrieval and the partner of four of these patients became pregnant and progressed to delivery. These results indicate the usefulness of microdissection for improving the sperm retrieval rate in men with non-obstructive azoospermia.