This fortnightly news service brings you the latest news on Assisted Reproduction Techniques as they have been reported in the media. Sources include on-line media, medical data bases, original press releases, trade journals, national daily newspapers and broadcasts reports, as well as peer-reviewed publications. It also keeps you up-to-date with the latest issue of the Ferti.Net Magazine.

New publication on male reproductive health

The second edition of the book entitled Adrology: Male Reproductive Health and Dysfunction, E. Nieschlag, H.M. Behre (eds), will appear in September 2000. This comprehensive book covers an extensive range of topics, including andrological disorders, environmental influences on male reproductive health, male infertility and assisted reproduction. This expanded and up-to-date edition is published by Springer, Heidelberg, Germany. Orders can be placed by contacting the publisher at orders@springer.de

ICSI outcome in patients of 40 years age and over: a retrospective analysis.

Nikolettos N, Kupker W, Al-Hasani S, Demirel LC, Schopper B, Sturm R, Diedrich K Democritus University of Thrace, Faculty of Medicine, Alexandroupolis, Greece
Objective: To report and analyse our experience with ICSI treatment in infertile women >/=40 years of age, with the intention of contributing to current debates on the effect of aging on the reproductive potential. Study design: 107 infertile couples in which the female partner was aged >/=40 years and who received ICSI treatment between January 1996 and December 1998. Results: A total of 107 women underwent 171 treatment cycles during this period. Of 171 cycles initiated 33 were cancelled (cancellation rate=19.3%). In this way, 17 women did not have embryo transfer at all, while 90 patients had 138 cycles with oocyte retrieval and successful embryo transfer, with a mean number of embryos per transfer 2.36. Sixteen pregnancies occurred and eight of them ended in spontaneous abortion. The implantation rate was 4.9%, the pregnancy rate per initiated cycle was 9.35% and per transfer cycle 11.59%. The miscarriage rate was 50%. Moreover, 12 patients had supernumerary embryos, that were cryopreserved and transferred in 17 thawing cycles and resulted in two pregnancies ending in abortion. All pregnancies occurred when three embryos were available, except in two cases with two available embryos. The great majority of the total pregnancies (16 of 18) resulting in women aged between 40 and 42 years. Conclusion: Our data show that women 40 and older with existing ovarian function may benefit from ICSI treatment, even when the indication for treatment is male factor infertility. Supernumerary embryos, that are cryopreserved and transferred in subsequent cycles can improve the overall pregnancy rates per oocyte retrieval, although these women should be aware of the very high risk of miscarriage.
Eur J Obstet Gynecol Reprod Biol 2000 Aug 1;91(2):177-182

Source: http://www.ncbi.nlm.nih.gov/

Zygote intrafallopian transfer in patients with tubal factor infertility after repeated failure of implantation with in vitro fertilization-embryo transfer.

Farhi J, Weissman A, Nahum H, Levran D IVF Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Objective: To evaluate the efficacy of zygote intrafallopian transfer (ZIFT) in terms of implantation and pregnancy rates in patients with tubal factor infertility and repeated implantation failure in IVF-ET cycles.Design: Retrospective analysis of ZIFT cycles.Setting: An IVF unit in a university hospital.Patient(s): Criteria for patient selection for ZIFT included at least four failures of implantation in IVF-ET cycles in which at least 3 embryos were replaced per transfer and a cause of infertility diagnosed as male, unexplained, or tubal factor with proof of one patient tube.Intervention(s): Four to six zygotes were transferred by laparoscopy into the fallopian tube 24-26 hours after oocyte retrieval.Main Outcome Measure(s): Implantation and pregnancy rates were determined in 112 ZIFT cycles performed in 81 patients with repeated failure of implantation. Results were further stratified for patients with tubal factor (n = 15) and patients without tubal factor (n = 66).Result(s): The pregnancy and implantation rates for all ZIFT cycles were 35.1% and 11.1%, respectively. Pregnancy and implantation rates per cycle in patients with tubal factor versus patients without tubal factor were 26.6% versus 37.1% and 9.4% versus 11.4%, respectively.Conclusion(s): ZIFT can be considered as a mode of treatment for patients with repeated failure of implantation in IVF-ET and with tubal factor with proved patency of one tube.
Fertil Steril 2000 Aug 1;74(2):390-393

Source: http://www.ncbi.nlm.nih.gov/

Blastocyst quality affects the success of blastocyst-stage embryo transfer.

Balaban B, Urman B, Sertac A, Alatas C, Aksoy S, Mercan R Assisted Reproduction Unit, American Hospital of Istanbul, Istanbul, Turkey
Objective:To determine the relationship between blastocyst quality and the results of embryo transfer at the blastocyst stage.Design:Retrospective case analysis.Setting:Tertiary care private hospital IVF center.Patient(s):A total of 350 blastocyst-stage embryo transfer cycles.Intervention(s):In vitro culture to the blastocyst stage was undertaken in 350 ICSI cycles where four or more cleavage-stage embryos were available on day 3.Main Outcome Measure(s):Relationship between blastocyst quality and implantation and clinical and multiple pregnancy rates.Result(s):Transfer of at least one grade 1 or grade 2 blastocyst or one hatching blastocyst was associated with very high implantation and pregnancy rates. However, transfer of grade 3 blastocysts yielded very low implantation and pregnancy rates.Conclusion(s):There appears to be a strong correlation between blastocyst quality and success of blastocyst transfer.
Fertil Steril 2000 Aug 1;74(2):282-287

Source: http://www.ncbi.nlm.nih.gov/

Obstetric outcome of singleton pregnancies after IVF: a matched control study in four Dutch university hospitals.

Koudstaal J, Braat DD, Bruinse HW, Naaktgeboren N, Vermeiden JP, Visser GH Department of Obstetrics and Gynaecology, University Medical Centre, Utrecht, Department of Obstetrics and Gynaecology, University Hospital Nijmegen, Nijmegen, Department of Gynaecology and Reproductive Medicine, Leiden University Medical Centre, Leiden and IVF Centre, Division of Endocrinology and Fertility, Institute of Endocrinology, Reproduction and Metabolism, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands.
In singleton pregnancies after IVF a high rate of preterm deliveries and an increased rate of small-for-gestational age (SGA) children in comparison to the general parturient population have been reported. However, due to differences between IVF mothers and their peers who conceived naturally, careful selection of the control group is necessary to assess whether IVF pregnancies really carry increased risks of adverse outcome. In our study 307 IVF pregnancies were compared with 307 control pregnancies after elaborate matching for an extensive number of maternal characteristics, as well as for the hospital that provided the obstetric care. Four Dutch university hospitals contributed to the study. In cases with spontaneous onset of labour, gestational age at delivery was 3 days shorter in the IVF group (275 versus 278 days, P = 0.05). The proportion of SGA was higher in the IVF group (16.2 versus 7.9%, P < 0.001). The combination of these two results denotes a distinct difference between IVF and control pregnancies. Placental weight was comparable in both groups.
Hum Reprod 2000 Aug;15(8):1819-1825

Source: http://humrep.oupjournals.org/

Comparison between day-2 embryos obtained either from ICSI or resulting from short insemination IVF: influence of maternal age.

Menezo Y, Barak Y Laboratoire Marcel Merieux, 1 Rue Laborde, BRON, France and In Vitro Fertilization Unit, Herzliya Medical Center, 7 Ramot-Yam Street, Herzliya-on-Sea, Israel.
Short incubation time prevents deleterious effects of cumulus cell degeneration and excess spermatozoa in IVF embryos. We performed a short incubation (3 h) protocol in 328 IVF cycles, in order to compare the developmental potential of regular IVF embryos with those originating from 316 cycles entered our intracytoplasmic sperm injection (ICSI) programme over the same period. Embryo transfers were performed in all patients on day 2. The mean number of embryos transferred was 1.92 for the ICSI group and 1.73 for the IVF group (P < 0.007). This was related only to the wishes of patients. However, the policy of the centre is to transfer a low number of embryos in young patients in order to avoid multiple pregnancies. All spare embryos were permitted to grow to the blastocyst stage for freezing. Shortening incubation time did not decrease fertilization rates. In our overall population, no difference was observed in the implantation rates per embryo for IVF (19%) or for ICSI (20%). An age-related decrease in embryo production was observed for both groups of patients (P < 0.01 for ICSI and P < 0.001 for IVF). The age-related decrease in embryo implantation was only significant for the IVF group (P < 0.03 for patients <30 and >35 years of age). A significant overall decrease in blastocyst formation was observed for spare embryos after ICSI versus IVF (34.2 versus 43.8%; P < 0.05). The significance of this observation is discussed.
Hum Reprod 2000 Aug;15(8):1776-1780

Source: http://humrep.oupjournals.org/

The alternating-sequence design (or multiple-period crossover) trial for evaluating treatment efficacy in infertility.

Norman GR, Daya S McMaster University, Hamilton, Ontario, Canada
Objective: To determine whether a constant-sequence or an alternating-sequence design is better for the evaluation of infertility treatment efficacy when multiple cycles of treatment are undertaken. Design: A simulation exercise using analytical methods. Setting: University medical center. Patient(s): A hypothetical, heterogeneous population of infertile patients participating in a randomized trial comparing an experimental treatment, with effectiveness of 2.0, to no treatment. Intervention(s): Comparison of a constant-sequence design in which the subject receives the same intervention or the alternating-sequence design in which experimental and control treatments are crossed over after each successive cycle. Main Outcome Measure(s): Relative risks of pregnancy per cycle and overall after a maximum of five cycles of treatment. Result(s): With both designs, the pregnancy rates in experimental and control groups showed a consistent decrease with each successive cycle. The overall effectiveness in the constant-sequence design was underestimated at 1.83, whereas in the alternating-sequence design it was overestimated at 2.06. However, by restricting the analysis in the latter design only to the odd-numbered cycles, the relative risk was precisely correct at 2.00.Conclusion(s): When multiple cycles of treatment are undertaken to evaluate the efficacy of infertility therapy, the alternating-sequence design with restriction of the analysis to only the odd-numbered treatment cycles provides an unbiased estimation of the treatment effect.
Fertil Steril 2000 Aug 1;74(2):319-324

Source: http://www.ncbi.nlm.nih.gov

NO is necessary and sufficient for egg activation at fertilization.

Kuo RC, Baxter GT, Thompson SH, Stricker SA, Patton C, Bonaventura J, Epel D Neurosciences Program, Stanford University School of Medicine, Stanford University, California, USA.
The early steps that lead to the rise in calcium and egg activation at fertilization are unknown but of great interest--particularly with the advent of in vitro fertilization techniques for treating male infertility and whole-animal cloning by nuclear transfer. This calcium rise is required for egg activation and the subsequent events of development in eggs of all species. Injection of intact sperm or sperm extracts can activate eggs, suggesting that sperm-derived factors may be involved. Here we show that nitric oxide synthase is present at high concentration and active in sperm after activation by the acrosome reaction. An increase in nitrosation within eggs is evident seconds after insemination and precedes the calcium pulse of fertilization. Microinjection of nitric oxide donors or recombinant nitric oxide synthase recapitulates events of egg activation, whereas prior injection of oxyhaemoglobin, a physiological nitric oxide scavenger, prevents egg activation after fertilization. We conclude that nitric oxide synthase and nitric-oxide-related bioactivity satisfy the primary criteria of an egg activator: they are present in an appropriate place, active at an appropriate time, and are necessary and sufficient for successful fertilization.
Nature 2000 Aug 10;406(6796):633-6

Source: http://www.ncbi.nlm.nih.gov

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