A more realistic approach to the cumulative pregnancy rate after in-vitro fertilization.

As most studies overestimate the cumulative pregnancy rate, a method is proposed to estimate a more realistic cumulative pregnancy rate by taking into account the reasons for an early cessation of treatment with in-vitro fertilization (IVF). Three methods for calculating cumulative pregnancy rates were compared. The first method assumed that those who stopped treatment had no chance at all of pregnancy. The second method, the one used most often, assumed the same probability of pregnancy for those who stopped as for those who continued. The third method assumed that only those who stopped treatment, because of a medical indication, had no chance at all of pregnancy and that the others who stopped had the same probability of pregnancy as those who continued treatment. Data were used from 616 women treated at the University Hospital Nijmegen, Nijmegen, The Netherlands. The cumulative pregnancy rates after five initiated IVF cycles for the three calculation methods were in the ranges 37-51% for the positive pregnancy test result, 33-55% for a clinical pregnancy and 30-56% for an ongoing pregnancy. As expected, the first method underestimated the cumulative pregnancy rate and the second overestimated it. The third method produced the most realistic cumulative pregnancy rates.

Different follicle stimulating hormone/luteinizing hormone ratios for ovarian stimulation.

The aim of the present study was to investigate whether reducing the amount of luteinizing hormone (LH) in gonadotrophic preparations impairs follicular growth in in-vitro fertilization (IVF) cycles during suppression of endogenous LH levels. A selected group of 20 IVF patients was randomly divided into two groups. One group was treated with Org 31338 [follicle stimulating hormone (FSH)/LH 3:1], the other group with Metrodin (purified FSH), both during pituitary down-regulation with buserelin. A fixed daily dose of 150 IU FSH i.m. was given. Serum concentrations of FSH, LH, oestradiol and progesterone were determined frequently and serial ultrasound examinations were performed. Multiple follicular growth with concomitant rise of oestradiol levels was observed in all cycles. The duration of the stimulation phase was shorter in the group treated with Org 31338 than in the group treated with Metrodin. The number of follicles and oocytes and the fertilization rate was larger and the mean embryo quality was higher in the Org 31338 group, but the differences did not reach statistical significance. No significant differences were found in hormonal values. In women with normal endocrine profiles, lowering of the LH activity in gonadotrophic preparations during gonadotrophin-releasing hormone agonist treatment results in adequate ovarian stimulation. However, a preparation with some LH needed a shorter stimulation than a purified FSH preparation. Whether the other beneficial effects of Org 31338 also occur in a larger population needs further investigation.

Human follicular fluid adverses hamster spermatozoa motility.

To determine the optimal conditions for in vitro spermatozoa vitality, human and hamster spermatozoa were incubated at 37 degrees C in T6 medium supplemented with different biologic fluids (10% v/v). The fluids tested were human serum (HUS), hamster serum (HAS), and human follicular fluid (HUF). After incubation the spermatozoa were investigated for their qualitative and quantitative motility. Human spermatozoa maintained a good vitality in all fluids tested (approximately 25% motility after 18-h incubation). The hamster spermatozoa had after an incubation of 4 h a motility of 28.4% in HUS, 14.2% in HAS, and 2.2% in HUF. The quality of the motility was also extremely low in HUF, whereas it was adequate in HUS and in HAS. The presence of species-specific substances in mammalian follicular fluid is discussed.

Inverse relationships between steroid concentration and volume in preovulatory follicles of the golden hamster.

In order to investigate variations in the microenvironment of oocytes within a cohort of maturing follicles the follicular volumes as well as the intrafollicular concentrations of oestradiol (E2) and progesterone (P) were measured in the golden hamster. At 10 h before ovulation the follicular volumes varied from 0.009 to 0.037 mm3 (mean +/- SD: 0.0187 +/- 0.0071 mm3; n = 36). Large follicles (greater than 0.025 mm3; n = 8) contained statistically significantly lower E2 and P levels (30.1 +/- 10.4 and 517 +/- 113 mumol/l, respectively) than the medium sized group (less than 0.025 and greater than 0.015 mm3; n =20): 46.9 +/- 16.0 (P less than 0.02) and 919 +/- 264 (P less than 0.0001) mumol/l, respectively. Small follicles (less than 0.015 mm3) showed the highest steroid levels: 97.0 +/- 33.3 and 1590 +/- 517 mumol/l for E2 and P (P less than 0.001 versus the medium sized group values). Correlation coefficients for the steroid concentrations and the follicular volumes appeared to be -0.674 for E2 and -0.612 for P (P less than 0.001). At the time studied a positive correlation between E2 and P concentrations in the follicles was found: r = 0.655 (P less than 0.001). The mean ratios of intrafollicular over serum steroid concentrations appeared to be approx 36 x 10(3) in the case of E2 and about 17 x 10(3) in the case of P. These results clearly show that there is an inverse relationship between follicular volume and intrafollicular steroid concentrations. The presence of a fine regulatory mechanism for a collective maturation of follicles is hypothesized.

Ovulation, ovum transport and implantation in the adult golden hamster.

The time of ovulation in various hamster colonies and its relationship with the period of light as reported in the literature was compared with the observations made in this study. Ovulation and transport of ova to the oviduct was studied during days 4 and 1 of the estrous cycle. Microscopical examination of the various oviducal segments for the presence of ova resulted in a detailed description of physiological ovum transport for the adult golden hamster. Simultaneously the developmental stages of ova were checked together with the occurrence of unfertilized ova and the percentage of ova implanted in the uterus. Finally, the contractility of the oviduct in vitro was observed for groups of animals at different times in the pre- and postovulatory period. The presented data indicate that the golden hamster is useful for the study of ovum transport processes. This is due to the regularity of its estrous cycle including multiple ovulations, and because ovum transport can easily be monitored microscopically with a high degree of reliability.