A randomised controlled trial of intra-uterine insemination versus in vitro fertilisation in patients with idiopathic or mild male infertility.

BACKGROUND: The cause of infertility is unexplained or poorly explained in 30-40% of couples undergoing standard investigations, and treatment ranges from expectant management to IUI and IVF. AIMS: The aim of this study was to compare the clinical pregnancy rates and costs of intra-uterine insemination (IUI) and in vitro fertilisation (IVF) in women where the same ovarian stimulation led to the development of two or three mature follicles. METHODS: A randomised controlled clinical trial compared the efficacy of IUI and IVF in a tertiary fertility centre (ISRCTN28780587). Primary outcome measures were fetal heart positive pregnancy rate and cost per live birth. The selection criteria were age: females 18-42 years and males 18-60 years, infertility for one year or more, no IVF or IUI for 12 months prior to the trial, and no coital, tubal or ovulatory disorders, oligospermia, untreated endometriosis or contraindication for multiple pregnancy. All women (n = 102) had the same dose FSH stimulation protocol. Those who developed two or three preovulatory follicles were randomised 3:1 to IUI (n = 33) or IVF (n = 10). IUI or IVF was performed 36 h after hCG administration with single or double embryo transfer on day two. RESULTS: Clinical pregnancy rates (40% vs 12%, P = 0.04) and live birth rate (40% vs 6%, P = 0.01) were higher for IVF than IUI. The cost per live birth was AU$8735 for IVF compared with $42,487 for IUI. CONCLUSIONS: This study provides evidence that IVF is more successful and cost-effective than IUI using the same doses of FSH. Further confirmatory studies are required.

A pilot study to assess the use of the gonadotrophin antagonist cetrorelix in preserving ovarian function during chemotherapy.

Cyclophosphamide treatment can cause premature ovarian failure. This pilot study evaluates the protective effect of the gonadotrophin releasing hormone (GnRH) antagonist, cetrorelix, on ovarian function, when used during cyclophosphamide chemotherapy in women aged 18-35. Primary outcomes measured were serum follicle stimulating hormone (FSH) and inhibin prior to and at 6 and 12 months after chemotherapy. Secondary outcomes were hormonal evidence of a suppressive effect and the side effect profile.

The first Australian experience of heterotopic grafting of cryopreserved ovarian tissue: evidence of establishment of normal ovarian function.

Cryostorage of reproductive potential, in the form of ovarian cortex, for young women about to undergo cytotoxic therapies has been offered clinically for some time. However, the prospects of re-establishing reproductive function using this tissue remain unclear. We now report reproducible follicular development, oocyte retrieval and embryo development following heterotopic grafting of cryopreserved ovarian cortex which had been stored for over 10 years.

Fertility preservation in female oncology patients.

Survival rates for patients treated for the majority of childhood and young adult cancers have improved dramatically in recent years. Despite the high probability of survival, and often good quality of life in female survivors, until recently the concept of fertility preservation has not been seen to be an important component of the overall management of these patients. Over the last few years, various protection and preservation strategies have been developed, which may address potential reproductive concerns. Gametes or embryos may be frozen prior to potentially gonadotoxic cancer therapy, and ovarian tissue may be frozen and stored, with several pregnancies described after subsequent grafting. There is also increasing interest in the possibility of ovarian protection using gonadotrophin-releasing hormone analogues during chemotherapy, despite the lack of randomised controlled trials. Additionally, there are reports of novel protective strategies, including therapeutic alteration or manipulation of the sphingomyelin pathways. This review summarises methods of fertility protection and preservation currently available, as well as the emergence of promising new strategies.

Is there increased monozygotic twinning after assisted reproductive technology?

Over the past two decades there has been an association between assisted reproductive technologies and increased monozygotic twinning. The association is not clear nor are the causes of assisted reproductive technology-related monozygotic twinning understood, although there are several theories as to the possible mechanisms involved. This review looks at some of the assisted reproductive technologies which may be associated with an increased risk of monozygotic twinning such as intracytoplasmic sperm injection, assisted hatching and blastocyst transfers. Determining the true incidence of monozygotic twinning after assisted reproductive technologies is important as there is a well-documented increase in perinatal morbidity and mortality of monozygotic twins compared to singleton and dizygotic pregnancies.