Background. The best way to avoid undesirable multiple pregnancies following in vitro fertilization procedure (IVF) is to perform elective single embryo transfer, but the procedure might result in a ...reduction of the pregnancy rates. Aim of our study was to establish whether a single blastocyst transfer using a hyaluronan rich transfer medium results in higher pregnancy rates in comparison to the transfer using a conventional transfer medium. Material and methods. Our prospective randomized study included 107 patients enrolled in the 1st, 2nd and 3rd classical IVF or intracytoplasmic sperm injection (ICSI) treatment attempt. Patients included were under 37 years of age with at least one blastocyst developed in the procedure. In the study group (47 patients) blastocyst transfers using the hyaluronan rich transfer medium were performed and in the control group (60 patients) the conventional medium was used. The pregnancy rates in the study and in the control group were compared. Results. The average pregnancy rate per single blastocyst transfer was 30 %; there were no twin pregnancies. The single blastocyst transfer using hyaluronan resulted in a non-significantly higher pregnancy rate (11 %). A significantly higher pregnancy rate with the use of hyaluronan was found in the subgroup of patients with two or more blastocysts developed in their 2nd and 3rd IVF attempt (p = 0.045). Conslusions. The single blastocyst transfer results in high implantation rates. Hyaluronan significantly contributes to higher implantation rates in a selected subgroup of patients following previous implantation failure and with multiple blastocysts developed.
Background. To determine the relationship between sperm morphological abnormalities, DNA fragmentation and fertilization rate in IVF and ICSI. Methods. Sperm samples from 10 IVF and 20 ICSI cycles ...were analyzed. Morphology was assessed according to strict criteria, and DNA fragmentation was measured by terminal deoxynucleotidyl transferase (TdT)-mediated fluorescein-dUTP nick end labelling (TUNEL) using a flow cytometry. Results. There was a significant difference in the amount of morphological abnormalities between sperm samples with low (< 20 %) and high (≥ 20 %) degree of DNA fragmentation. The percentages of amorphous heads (10 vs. 4 %) and overall head abnormalities (42 vs. 30 %) were significantly higher in sperm samples with elevated degree of DNA fragmentation. No correlation was found between sperm DNA fragmentation and fertilization rate after IVF and ICSI. When the predominant morphological abnormality in sperm samples was determined, a negative correlation was found between the percentage of spermatozoa with elongated heads and fertilization rate in ICSI (r = –0.45, P < 0.05). The fertilization rate after IVF was lower in the case of acrosomal abnormalities (35.3 %), compared to the cases of other predominant morphological abnormalities. Conclusions. Head abnormalities, especially amorphous heads, are related to elevated degree of DNA fragmentation. Predominant abnormal form in sperm samples, such as elongated heads and acrosomal abnormalities, may affect fertilization in ART.
Background: In-vitro fertilization (IVF) is performed with oocytes collected in natural and stimulated cycles. Different approaches to ovarian stimulation have been employed worldwide. Fol- lowing ...the introduction of gonadotrophin realising hormone (GnRH) antagonists and strategies to reduce multiple birth such as single embryo transfer, there is an interest in the revival of natural and mild approaches to ovarian stimulation in IVF. Particulary mild ovarian stimulation aims to achieve cost-effective, patient-friendly regimens which optimize the balance between outcomes and risks of treatment. Methods: Pubmed was searched up to 2009 for papers on natural, modified natural, mild and con- ventional IVF cycles. Results: Data discussed in this review do not allow any conclusions to be drawn regarding the most optimal mild ovarian stimulation protocol. However, it is absolutelly clear that introduction of GnRH antagonists into clinical practice has allowed for the introduction of milder stimulation approaches for IVF treatment because of preventing premature luteinising hor- mone (LH) rise by competitive blockade of the GnRH receptors. Studies also show that mild exogenous gonadotrophins interference with the decrease in follicle-stimulating hormone ((FSH) levels in the mid-folicular phase was sufficient to override the selection of a single dominant follicle and enhance the most mature follicles to growth due to their increased sensitivity for FSH and acquired responsiveness to LH. Conclusions: The implementation of mild stimulation and modified natural cycle into standard clinical practise appears to be justified, although more prospective studies are needed to find the most appropriate mild stimulation approaches.
Background. Selection of mature sperm for intracytoplasmic sperm injection (ICSI) has recently been made possible by hyaluronan, a naturally occurring substance found in the cumulus cells. Only fully ...mature sperm have the receptors on the head that effectively bind to the oocyte cumulus, or, to be more precise, to hyaluronan. The aim of this study was to evaluate the differences in fertilization rates and in embryo development to the blastocyst stage after ICSI performed either with sperm selected by hyaluronan or by standard morphological sperm appearance. Methods. This retrospective study involved 17 couples undergoing ICSI. One half of sibling oocytes were fertilized with sperm selected by hyaluronan (84 oocytes), and the other half with sperm selected on the basis of morphological appearance (89 oocytes). The comparison between the two groups involved fertilization rates and the percentages of arrested embryos, and delayed (morulae) and advanced blastocysts. Blastocysts were classified as early, developed and expanded. Results. In the group with hyaluronan-selected sperm 65 % of oocytes fertilized, and in the group with sperm selected by morphological appearance 70 % of oocytes. The fertilization rates did not statistically differ between the two groups, and neither did the percentages of arrested embryos (47 % vs. 62 %), morulae (11 % vs. 11 %), and blastocysts (42 % vs. 26 %). In the group with hyaluronan-selected sperm the shares of expanded and early blastocysts were significantly greater (P ≤ 0.04 and P ≤ 0.002, respectively) than in the group with sperm selected according to morphological appearance. Conclusions. The use of hyaluronan for sperm selection in ICSI does not affect fertilization rates. Hyaluronan-selected sperm improves subsequent development of embryos. A larger study sample is required for the assessment of hyaluronan-selected sperm on the achievement of pregnancies.
Background: Multiple pregnancies are undesired consequence of infertility treatment by in vitro fertilization (IVF). In 2008 the Health Insurance Institute of Slovenia strove for lowering the number ...of multiple pregnancies. It widened the rights of patients by reimbursement of two additional IVF cycles, having totally six cycles reimbursed. But in women younger than 36, only one top-quality embryo in the first two IVF cycles has to be transferred. The aim of the study was to assess, how the new approach, including also the transfers of frozen-thawed embryos, influenced the IVF outcomes. Methods: In year 2008, the transfer of one optimal embryo had to be done in 47.4 % (287/650) of IVF cycles. The criteria for optimality of early cleavage stage embryos were: at least 6 blastomeres and less than 20 % of fragmentation; and for blastocysts: expanded blastocoel and oval inner-cell-mass. Embryos were cultured to blastocysts in 79.4 % (228/287) of cycles. The surplus blastocysts were vitrified in 172 cycles. The transfer of devitrified blastocysts was performed in 82 patients, which did not conceive in fresh cycle. The pregnancy rate and twins rate after fresh transfers and after transfers of devitrified embryos were analyzed. Results: Single embryo or blastocyst transfer was done in 58.9 % of women. In the remaining 41.1 % of cycles the embryos were morphologically not optimal and we decided for double embryo or blastocyst transfer. In the group in which a single and mostly the only embryo was trans- ferred, only 17.2 % of women became pregnant. After the transfer of elective single blastocyst, 51.4 % of women conceived. After double blastocyst transfer, 40.9 % of patients conceived and 50 % of them had twins. The replacement of devitrified blastocysts was successful in 23.2 %. The cumulative pregnancy rate in group of cycles with single fresh blastocyst transfer, followed by transfers of devitrified blastocysts, was 62.9 %. The cumulative pregnancy and multiple pregnancy rate in the whole group was 50.9 % and 14.4 %, respectively. Conclusions: By the policy of reduction the number of transferred embryos into the uterus in IVF pro- gramme, the multiple pregnancy rate decreased from previously 40 % down to 14.4 %.
Background: Slovenian perinatal results are compared with European results: sometimes they are in the higher, sometimes in the lower range. Analysing trends and comparisons with other countries helps ...in planning changes in organisation and function so we are prepared for future challenges. Introduction of new technologies demands appropriate answers to challenges, including ethical ones. Methods: We compared perinatal results in Slovenia from 1987 to 1996, the PERISTAT project results from the year 2000 and the EURO-PERISTAT project with 2004 perinatal results including the Slovenian. Results: Some of the more prominent Slovenian perinatal results are shown. Cesarean section rate is the lowest among 26 countries in Europe. Deliveries after artificial reproductive techniques are second most frequent. Teenage pregnancies are very rare. Seemingly high maternal mortality mirrors also strict recording and cross checking with other data bases. Relatively high stillbirth rate may reflect the fact that all induced labours for fetal malformations are recorded. Conclusions: In Slovenia we do have tools for quality collection of perinatal results which should be used and audited. To have comparable results inside Slovenia, definitions should be written at http://www.obgyn-si.org/. When changing delivery record markers of prenatal care should be added – they could be easily obtained from maternity booklets (electronic or paper). In maternity booklet there is a place to write about grand dad prostate cancer; let us replace it with risk factors for preterm delivery (medical history and cervical length), 12 weeks screening for preeclampsia and intrauterine growth restriction (ultrasonic and biochemi- cal markers), gestational diabetes and obesity (body mass index, waist – hips ratio) and hypothyroidism; let us leave some free space for the future screening tests. Known and proven efficient management (e.g. progesterone for recurrent preterm delivery prevention) should be used.
Background. Spontaneous miscarriage isn’t an unexpected complication either in early spontaneous or in ART pregnancy. Previous studies showed that incidence of SM was slightly increased in ART ...pregnancies in comparison with spontaneous ones after adjusting for maternal age and previous SM. Our objective was to examine the relationship between SM and embryo quality after transfer of one or two blastocysts. Materials and methods. The total of 1433 stimulated IVF and ICSI cycles achieved in our center in the period from 2001 to 2002 after SBT or DBT were retrospectively analyzed. Of these, in the final analysis we included only cases with positive βhCG for which complete data on pregnancy outcome were available – 418 cycles in total. Results. The mean age of patients was 32.2 ± 4.5 years. IVF was performed in 133 cases and ICSI was performed in 285 cases, SBT in 69 and DBT in 349. After SBT, SM rate was 11.6 % and after DBT it was 12.0 %. In SBT group we didn’t find significant relationship between embryo quality and SM (logistic regression: c2 = 0.88; p > 0.05). In this groups, using standard statistical tests, we also couldn’t find significant difference in SM rate between subgroups where optimal or suboptimal quality blastocyst was transferred (Yates corrected c2 test: p > 0.05, Student’s t-test: p > 0.05). In DBT group, we found a strong relationship between embryo quality and SM (logistic regression: c2 = 10.12; p < 0.01). After standard analysis, we confirmed significant difference between subgroups with different combinations of blastocyst quality: after transfer of both optimal blastocysts SM rate was 8.5 %, after transfer of optimal and suboptimal blastocyst SM rate was 10.1 % and after transfer of both suboptimal blastocyst SM rate was 25.4 % (Kruskal-Wallis test: p < 0.001; one-way ANOVA: p < 0.001). We confirmed strong relationship between age of the patients and SM (logistic regression: c2 = 14.57; p < 0.0001). Conclusions. In our study SM rate was 11.9 % which was lower than in previous reports; it was even at the lower limit of expected SM rate in general population. This discrepancy was probably the consequence of longer selection period of blastocysts in in vitro conditions. We didn’t find a significant relationship between SM and blastocyst quality after SBT, which was probably due to the small sample size. A strong relationship between SM and blastocyst quality after DBT was proved. We also confirmed a strong relationship between age of the patients and SM.
The aim was to determine whether pregnant women conceiving through in vitro fertilization (IVF) differ from those conceiving spontaneously in terms of psychological well-being and the quality of ...life.
In a prospective study we included 75 women conceived after IVF and 78 who conceived spontaneously in the same time period (control group). All the women were sent a self-report questionnaire about demographic and reproductive history, health, pregnancy concerns, containing Subjective Quality of Life Scale (QLS), Positive and Negative Affect Schedule (PANAS), the Psychological Well-Being Scale (PWB), Beck Depression Inventory (BDI), and Zung Self-Assessment Anxiety Scale (SAS); obstetric and newborn's data were obtained from medical records. Response rate was 66.6% in the IVF and 83.3% in control group.
The mean women's age was 33.8 years in the IVF, and 32.5 years in the control group (NS). There were no significant differences between groups on the most of the outcome measures assessing psychological status. IVF mothers were just less satisfied in "friend/acquaintances" (P=0.03), a higher percentage had sexual problems prior to conception (P=0.03); the length of hospitalization during pregnancy was longer (P=0.02), and the preterm delivery rate was higher (P=0.01). Withingroup changes over gestation time indicated that IVF women, not controls, showed an increase in positive affect (P=0.04) and purpose in life (P=0.05).
IVF women are inclined to social isolation. Despite more medical problems during pregnancy, they reported improved positive emotions and purpose in life as the pregnancy progressed.
The aim of our study was to establish the prevalence of high-risk human papillomavirus (hr-HPV) infection in a population of women included in an in vitro fertilisation (IVF) program and to correlate ...the outcome of IVF cycles with HPV status.
A total of 195 women undergoing the IVF program were included in the study. A cervical smear for cytological analysis and hr-HPV determination was collected from every woman. RealTime High Risk HPV test (Abbott Molecular Inc., Des Plaines, IL) has been used for the detection of hr-HPV infection. All participants were invited to complete an anonymous questionnaire that included questions regarding medical and sexual history as well as risk factors for HPV infection. HPV 16 and HPV 18 positive women were invited for follow-up gynaecological examinations, including colposcopy 4 to 6 months after the inclusion.
Mean age of included infertile women was 33.7 ± 4.36 years. A total of 16/195 women (8.2%) were hr-HPV positive. Hr-HPV infection was not associated with the percentage of mature oocytes, the percentage of fertilised oocytes, with embryo quality or with pregnancy rate in our study.
The prevalence of hr-HPV genotypes in Slovenian infertile women undergoing IVF is lower than the hr-HPV prevalence in the general population. We were unable to find an association between hr-HPV cervical infection and the outcome of IVF cycles.
Namen naše raziskave je bil ugotoviti zastopanost okužbe z visokorizičnimi genotipi humanih papilomskih virusov (vr-HPV) v populaciji žensk, vključenih v postopke zunajtelesne oploditve (ZTO). Nadalje smo želeli ugotoviti, ali ima okužba s HPV vpliv na izid postopkov ZTO.
Vključili smo 195 žensk, ki so se zdravile s postopki ZTO. Vsaki ženski smo odvzeli bris materničnega vratu za citološko preiskavo in bris za določanje okužbe z vr-HPV. Za dokazovanje okužbe z vr-HPV smo uporabili test RealTime High Risk HPV (Abbott Molecular Inc., Des Plaines, IL). Vsako žensko smo prosili, da izpolni anonimni vprašalnik, ki je vključeval ginekološko anamnezo in dejavnike tveganja za okužbo s HPV. Ženske, ki so bile HPV 16 ali HPV 18 pozitivne, smo povabili na kontrolni pregled in kolposkopijo po štirih do šestih mesecih.
Povprečna starost vključenih neplodnih žensk je bila 33,7 ± 4,36 leta. V naši raziskavi je bilo 16/195 žensk (8,2 %) vr-HPV pozitivnih. Okužba z vr-HPV ni imela vpliva na število ali odstotek zrelih jajčnih celic, odstotek oplojenih jajčnih celic, kakovost zarodka ali na stopnjo zanositve.
V populaciji žensk, vključenih v postopke ZTO, je prevalenca okužbe z vr-HPV nižja kot v splošni populaciji slovenskih žensk. Okužba z vr-HPV ni bila povezana z uspehom postopkov ZTO.
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