Female poor responders.

Female poor responders are represented by normovulatory women showing a 'gonadal failure' in term of inadequate number of recruited follicles under conventional controlled ovarian hyperstimulation (COH) for assisted reproductive technologies (ART). ARTs offers today a high chance of pregnancy to infertile couples when a normal ovarian response provides a large choice of embryos for transfer. On the contrary, failure of the ovary to produce enough oocyte for treatment, reduces significantly the likelihood of conceiving in ART, not only in the treatment cycle, but also predicting a poor prognosis in subsequent cycles. Up to date, poor response remains one of the most frequent problems in the field of assisted reproduction. First described in 1981, poor response has been investigated by several authors, but many aspects are still controversial. In this paper definition, pathophysiology and management of poor response are revised and discussed.

Pregnancies in postmenopausal women over 50 years old in an oocyte donation program.

OBJECTIVE: To determine the potential of the aging uterus in terms of pregnancy, implantation, and abortion rates, and obstetric complications in postmenopausal women age 50 and over, receiving oocyte donation. DESIGN: Retrospective data analysis. SETTING: A tertiary infertility center. PATIENTS: Thirty-four postmenopausal women (50 to 62 years of age) undergoing a total of 61 cycles of oocyte donation. INTERVENTIONS: Hormone replacement therapy (HRT) was given using increasing doses of 17 beta-E2 (2, 4, and 6 mg) and 100 mg of P in oil. MAIN OUTCOME MEASURES: Pregnancy, abortion, and implantation rates, and pregnancy outcome. RESULTS: There were 34 patients treated through 61 cycles. Fifty-five transfer cycles were performed. A total of 18 clinical pregnancies were achieved with a pregnancy rate per transfer of 32.7% and per patient of 52.9%. There was one abortion, resulting in an abortion rate of 5.5%. Twenty-one of the 116 transferred embryos implanted, resulting in an implantation rate of 18%. No statistically different rates were found in oocytes donors. CONCLUSION: Women over the age of 50 and up to 62 can become pregnant using donated oocytes. The aging uterus after HRT allows implantation as well as in young women, and it is able to carry pregnancy to term apparently without any problems.

Human amniotic fluid for fertilization and culture of human embryos: results of clinical trials in human in vitro fertilization (IVF) programs.

We report the outcome of clinical trials carried out in two IVF programs, comparing the use of human amniotic fluid (HAF) as a complete medium to Whittingham's T6 medium containing human serum (T6 + 10% HS) for egg incubation, insemination, embryo culture, and embryo transfer. There were no significant differences in the clinical trials between HAF used alone as a complete medium and T6 + 10% HS in fertilization rates of eggs, cleavage rates of embryos up to 48 hours in culture, pregnancy success rates after embryo replacement or the outcome of pregnancies. There was no advantage in using T6 + 10% HS for fertilization of eggs and HAF as a complete medium for embryo culture and transfer in any of the parameters examined. We conclude that HAF does not meet the complete requirements of human eggs and embryos in vitro and further developments of culture media are required to obtain embryo development equivalent to that in vivo.

Influence of spermatozoa characteristics on gamete intra-fallopian transfer procedures: analysis of results obtained utilizing normozoospermic, oligoasthenozoospermic and donor spermatozoa.

The objective of this study was to analyze the efficacy of the gamete intra-Fallopian transfer (GIFT) procedure in relation to spermatozoa characteristics. A total of 268 infertile couples enlisted for GIFT were categorized into three groups on the basis of semen characteristics in the husband. These included oligoasthenozoospermic men in 88 retrieval cycles (group 1), normozoospermic men in 116 cycles (group 2) and azoospermic partners who needed donor semen in 86 cycles (group 3). All female patients had ovarian stimulation and laparoscopic GIFT. Pregnancy rates were significantly higher with donor spermatozoa than with oligoasthenozoospermic or normozoospermic spermatozoa, i.e. 51.1% versus 15.9% (P < 0.001), and 32.7% (P < 0.005). Implantation rates were significantly higher with donor spermatozoa than with normo- or oligoasthenozoospermic spermatozoa (P < 0.01). These data suggest that GIFT does not give good results with male factor infertility. Donor cryopreserved semen gives higher pregnancy and implantation rates than normozoospermic semen, and GIFT with donor spermatozoa gives a good chance of pregnancy to couples previously treated with artificial insemination using donor semen.

Hysteroscopic gamete intra-fallopian transfer: a good alternative, in selected cases, to laparoscopic intra-fallopian transfer.

Results obtained in two groups of patients treated with gamete intra-Fallopian transfer (GIFT) are reported. Hysteroscopic GIFT was carried out in some cases where general anaesthesia was not advisable or possible, i.e. difficulties in tubal catheterization due to pelvic adhesions, extended distal tubal damage, patients' intolerance, lack of available operating theatre. Ovarian stimulation was started on 131 patients for a total of 147 cycles. Twenty-five cycles were cancelled because of failure of the ovarian response. Either laparoscopic (group 1; 73 patients) or hysteroscopic GIFT (group 2; 50 patients) was performed. In group 1 a mean of 6.8 +/- 3.4 oocytes per cycle were retrieved and a mean of 4.7 +/- 1.3 mature oocytes were transferred. The pregnancy rate was 30.1% per retrieval (22 clinical pregnancies). In group 2, a mean of 5.0 +/- 3.1 oocytes was harvested and 3.9 +/- 2.0 mature oocytes per cycle were transferred. Thirteen clinical pregnancies were achieved (26.5% per cycle) in group 2. Comparing the two groups, the number of recovered and transferred oocytes was significantly lower in hysteroscopic GIFT (P less than 0.05 and P less than 0.001 respectively).