Timing human chorionic gonadotropin administration by days of estradiol rise.

A critical aspect of human in vitro fertilization (IVF) treatment programs is the timing of human chorionic gonadotropin (hCG) administration to induce final oocyte maturation. Patients were treated with clomiphene citrate (Serophene, Serono Laboratories, Inc., Randolph, MA), 100 mg, and human menopausal gonadotropin (Pergonal, Serono Laboratories, Inc.) 1 ampule daily from cycle days 4 through 8. The baseline estradiol (E2) level was determined by averaging the E2 values from cycle days 3 and 4. The first day of E2 rise was defined as the day that the E2 level exceeded 150% of the baseline. In general, 5000 IU of hCG (Profasi-HP, Serono Laboratories, Inc.) was administered on the evening of the sixth day of E2 rise. Significantly fewer oocytes were recovered per patient when the hCG was administered on the seventh day of E2 rise, compared with the fifth or sixth day. The recovered oocytes in the seventh-day E2 group had a significantly lower fertilization rate, compared with the other groups. The use of E2-rise days proved to be a simple, successful technique for the timing of hCG administration in an IVF treatment program.

Simultaneous in vitro fertilization and gamete intrafallopian transfer (GIFT).

During a 6-month period, a combination of gamete intrafallopian transfer (GIFT) and in vitro fertilization (IVF) was offered to all couples beginning an IVF treatment cycle in whom the wife had anatomically normal fallopian tubes. It was recommended to these couples that sufficient oocytes be reserved for insemination in vitro to determine whether the husband's spermatozoa could fertilize the wife's oocytes. During this interval, 16 couples underwent the combined IVF-GIFT procedure. All of the IVF-GIFT couples had at least two oocytes inseminated in vitro and at least two oocytes for GIFT. Of the 16 IVF-GIFT couples, only 1 (6.25%) achieved a clinical pregnancy. More important, 50% (8/16) of the IVF-GIFT couples had no oocytes fertilized in vitro. With the information concerning lack of fertilization in vitro, appropriate recommendations concerning future fertility management can be made. If the same couples had undergone the GIFT procedure alone, without additional oocytes fertilized in vitro, this information would not have been obtained.

Psychological screening and the success of donor insemination.

In a previous case series, a psychologist's rating of couples' emotional adjustment and readiness for donor insemination was predictive of pregnancy rates. We attempted to replicate this finding with an extended series of 120 consecutive couples in which each spouse filled out questionnaires when evaluated for donor insemination. The Stress and Infertility Questionnaire measured specific attitudes and anxieties about donor insemination. The Brief Symptom Inventory assessed psychological distress. The Dyadic Adjustment Scale measured marital happiness. A psychologist used these questionnaires to rate the couple's overall adjustment in regard to donor insemination. Those couples rated as distressed had a session of psychological counselling. Outcome was reviewed at a mean of 20 months after evaluation, with categories of pregnancy, continuing donor insemination, failure to begin the programme, or dropped out. For the 120 couples overall, psychological factors did not predict pregnancy outcome. Younger age of the wife did predict higher pregnancy rates.