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ABSTRACT: The objective of this study was to evaluate the prognosis of patients with a first treatment cycle that was defined as a poor ovarian response cycle according to the new ESHRE consensus criteria. The first documented cycle of poor response for a patient and all the cycles that followed were retrospectively analysed. Factors that were associated with ongoing pregnancy rates were assessed using multivariate analysis. In total, this study evaluated 1014 patients that underwent 2819 consecutive IVF cycles. As expected, patients with poor response cycles were older and had less oocytes retrieved and less embryos transferred. Multivariate analysis for ongoing pregnancy rates adjusted for patient and the cycle characteristics revealed that the intracytoplasmic sperm injection (ICSI) procedure was associated with a significant increase of 40% in ongoing pregnancy rate (adjusted success ratio 1.40, 95% CI 1.00-1.96). Age over 41years and additional cycles with poor response, were associated with significantly less ongoing pregnancy rate. However, the cumulative pregnancy rates were 29.5% and 36.4% following five and seven cycles, respectively. In conclusion, performing ICSI may improve the ongoing pregnancy rates in poor responders. Further studies are needed to establish the number of cycles recommended in these patients. Patients with poor ovarian response cycles are currently the most challenging group of fertility patients. We are yet far from understanding the factors which cause reduced ovarian response and further away from finding a solution to this painful problem. In this work, we present that with current available treatment modalities, the results can be improved. We show that performing intracytoplasmic sperm injection and implementation of additional number of treatment cycles may improve the ongoing pregnancy rates of patients with a first treatment cycle that is defined as a poor ovarian response cycle. In addition, we investigated the cumulative pregnancy rates in this group and the effect of performing a number of treatment cycles.
Reproductive biomedicine online 09/2012; · 2.04 Impact Factor
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ABSTRACT: Aim: To evaluate the effect of local injury to the endometrium during spontaneous menstrual cycles before in vitro fertilization (IVF) treatment on implantation and pregnancy rates in women with recurrent implantation failure (RIF). Methods: In a prospective randomized controlled trial (RCT), a total of 36 patients, with RIF undergoing IVF, were randomized to two groups. In 18 patients, endometrial biopsies were performed using a pipelle curette on days 9-12 and 21-24 of the menstrual cycle preceding IVF treatment. In 18 control patients, a cervical pipelle was performed. Results: The implantation rate (2.08% versus 11.11%; p = 0.1), clinical (0% versus 31.25%; p < 0.05) and live births rates (0% versus 25%; p = 0.1) were lower in the experimental group compared with controls. Conclusion: Our RCT did not find any benefit from local injury to the endometrium in women with a high number of RIFs. Further studies are warranted to better define the target population of patients who may benefit from this procedure.
Gynecological Endocrinology 09/2012; · 1.58 Impact Factor
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ABSTRACT: Early pregnancy loss is common among women treated with assisted reproduction treatment, but whether it is a prognostic factor for success in subsequent IVF cycles is not well established. The aim of this study was to determine whether a biochemical pregnancy (BP) or spontaneous abortion (SA) affects the pregnancy rates in the following cycle. A retrospective study of 2687 women undergoing 6678 cycles between January 1998 and March 2010 was performed. Ongoing pregnancy rate (PR) per cycle was compared between patients with a pregnancy loss versus a negative β-HCG in their previous cycles. Multivariate analysis of factors affecting ongoing pregnancy rate was performed. BP and/or SA in the first three cycles did not significantly alter the chances to conceive (16.9% patients with BP and/or SA in the previous cycle versus 16.5% patients with no previous pregnancy). From cycle 4 onwards, the presence of a previous abortion (either BP or SA) was associated with better ongoing PR (23.0% versus 11.2%, P<0.001). In conclusion, BP and/or SA in a previous cycle appears to be a positive marker for success in subsequent cycles in patients with repeated IVF failures. These results should be further investigated in this challenging group of patients. Pregnancy loss in the first trimester is common among women treated with assisted reproduction treatment, but its significance regarding chances of future ongoing pregnancies is not well established. The aim of this study was to determine whether an early pregnancy loss during an IVF cycle, affects the ongoing pregnancy rates in following IVF cycles. A retrospective study of 2687 women undergoing 6678 IVF cycles between January 1998 and March 2010 was performed. Ongoing pregnancy rate was compared between patients with a pregnancy loss in their previous IVF cycle versus patients who failed to conceive (negative-human chorionic gonadotrophin blood test) in their previous IVF cycle. A multivariate analysis of factors affecting ongoing pregnancy rate including age, number of embryos transferred and aetiology of infertility was performed. We found that early pregnancy loss during the first three IVF cycles did not significantly alter the chances to conceive (pregnancy rates: 16.9% for patients with early pregnancy loss in the previous cycle compared to 16.5% in patients who didn't conceive in the previous cycle). From cycle 4 onwards, the presence of a previous early pregnancy loss was associated with better ongoing pregnancy rate (23.0% compared to 11.2%, P<0.001). In conclusion, early pregnancy loss in the previous cycle appears to be a positive marker for success in subsequent cycles in patients with repeated IVF failures.
Reproductive biomedicine online 07/2012; 25(4):339-44. · 2.04 Impact Factor
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ABSTRACT: STUDY QUESTION: What is the rate of spontaneous live births after successful IVF treatment in a cost-free environment, and were couples who achieved a spontaneous live birth referred prematurely? SUMMARY ANSWER: Despite unlimited IVF treatments offered free of charge, the spontaneous live birth rate following successful IVF remained unchanged compared with that cited in previous literature. Couples were not referred prematurely to IVF before fully utilizing other less invasive treatments. WHAT IS KNOWN ALREADY: A significant number of infertile couples, who achieve their first live birth through assisted reproductive technology (ART), subsequently achieve a second live birth spontaneously. As IVF has become more widely available, it is used in less severe cases of infertility, perhaps explaining a rise in the subsequent spontaneous live birth rate after successful treatments. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study was performed at a university-based tertiary medical center. The study population included women aged <35 years, with primary infertility, referred for their first IVF treatment to the Sheba Medical Center IVF unit between 2001 and 2002 and followed up for 7 years. The primary outcome was spontaneous live birth rate following successful ART. Relevant data were obtained from the patient files and supplemented by a standardized telephone questionnaire. PARTICIPANTS/MATERIALS, SETTING, METHODS: Of the 171 couples who met the study inclusion criteria, 6 refused to participate in the questionnaire and 31 couples were lost to follow-up. Of the 134 couples who participated, 109 achieved a first live birth with ART. After achieving their first live birth with ART, seven couples who began using contraception or separated or divorced were excluded. MAIN RESULTS AND THE ROLE OF CHANCE: Of 102 couples who continued unprotected intercourse after successful ART, 22 subsequently achieved their second live birth spontaneously (21.6%). The women who achieved a second birth spontaneously were not referred earlier to IVF, and actually performed a higher number of ovulation induction cycles before initiating IVF, compared with women who did not conceive spontaneously. LIMITATIONS, REASONS FOR CAUTION: This is a retrospective cohort study, and findings should be reaffirmed with a larger prospective randomized study comparing retreatment to achieve a second pregnancy with attempting to conceive spontaneously. WIDER IMPLICATIONS OF THE FINDINGS: Our data suggests that young patients (<35 years), who previously conceived with IVF, without utilizing ICSI and with no known tubal pathology, should consider attempting to conceive spontaneously. STUDY FUNDING AND COMPETING INTEREST(S): No funding was obtained for this study and the authors have no competing interests.
Human Reproduction 06/2012; 27(8):2380-3. · 4.47 Impact Factor
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ABSTRACT: To evaluate sperm quality and fertility potential of men with psychogenic anejaculation treated by electroejaculation (EEJ) and intracytoplasmic sperm injection (ICSI). Treatment results were compared to spinal cord injured (SCI) patients treated similarly.
Retrospective clinical study.
Academic tertiary referral fertility center.
Couples with isolated psychogenic anejaculation or SCI.
Electroejaculation and ICSI.
Semen analysis, fertilization rate, implantation rate, pregnancy rate, delivery rate and safety of the procedure.
Fifteen patients diagnosed with psychogenic anejaculation underwent 40 EEJ/ICSI cycles. The semen retrieved was characterized by low motility (mean 10.7% ± 12.3%), normal volume (2.2 ± 1.9 mL) and normal count (25.1 ± 29.9 × 10(6)/mL), according to World Health Organization criteria. Results of EEJ/ICSI were compared with 22 SCI patients treated by 66 EEJ/ICSI cycles during the same period. Mean female age and the number of oocytes retrieved per cycle were similar between the groups. Similar semen parameters after EEJ were found between psychogenic and SCI patients. Fertilization rate was significantly lower in the psychogenic patients compared to SCI (47.0% and 57.0%, respectively). No significant differences were found regarding pregnancy rates (20% and 22.7%, respectively), implantation rate (10.2% and 11.6%, respectively) or delivery rates (15% and 18.2%, respectively).
Sperm retrieved by EEJ is characterized by asthenospermia and normal count. In spite of the lower fertilization rate in psychogenic patients, combination of EEJ and ICSI gives adequate results to couples with psychogenic anejaculation similar to the results obtained for SCI patients. Current results give these couples a reasonable chance of pregnancy achievement.
Fertility and sterility 02/2012; 97(5):1056-60. · 3.97 Impact Factor
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ABSTRACT: To assess the long-term success rate among couples with primary infertility offered unrestricted, free in vitro fertilization (IVF) treatments.
Historical prospective cohort study.
University-based tertiary medical center with unlimited coverage of IVF for couples' first two children.
Women aged <35 years, with primary infertility, referred for their first IVF treatment to the Sheba Medical Center IVF unit between 2001 and 2002.
Relevant data were obtained from patient files and supplemented by a standardized telephone questionnaire.
Pregnancies, live births, adoptions, divorces, and discontinuations of further treatment.
During the 5- to 7-year follow-up period, 95.5% of couples conceived, and 89.6% of couples gave birth to a live infant. Of these couples, 81.3% achieved a live birth within the first 4 years of the follow-up period, and 85.1% within eight treatment cycles. Of the 14 couples (10.4%) who did not give birth to a live infant, five adopted, two divorced, four are still undergoing IVF treatments, and three (1.8%) decided not to become parents.
Young couples beginning IVF treatment in an environment free of economic hurdles can be reassured that they have an excellent chance (∼ 90%) of achieving a live birth within 4 years. When IVF is provided free of cost, very few couples discontinue treatment before a live birth is achieved.
Fertility and sterility 02/2011; 95(2):568-72. · 3.97 Impact Factor
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ABSTRACT: This study determined the influence of inter-cycle variation of basal FSH concentrations on IVF treatment results, in patients with a history of high basal FSH. Patients underwent at least two IVF cycles, one with basal serum FSH ⩾10IU/l and the other at least 3IU/l lower (interval between cycles being <1year when the second cycle had the elevated FSH). A subanalysis was performed in patients with exceptionally large differences in values (⩾16IU/l and ⩽12IU/l). IVF outcomes were compared according to basal FSH concentrations in two consecutive cycles. Seventy-six patients met the inclusion criteria. Mean basal serum FSH were 15.0±3.6IU/l in the 'high FSH' group (range 12-24IU/l) and 9.0±3.0IU/l in the 'low FSH' group (range 5-14IU/l). Patient age, oestradiol at HCG administration, number of collected oocytes, fertilization and clinical pregnancy rates were similar for all cycles compared. Analysis of the subgroup with exceptionally large differences of basal FSH concentration yielded similar results. Neither high nor low basal serum FSH values were associated with IVF outcome in patients with reduced ovarian reserve and previously determined high basal FSH concentrations. Ovarian stimulation need not be delayed until FSH declines.
Reproductive biomedicine online 11/2010; 21(5):631-5. · 2.04 Impact Factor
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ABSTRACT: Women's fertility progressively declines with advanced age due to depletion of the ovarian follicular reserve and poorer oocyte quality. However, many women of advanced age are eager to conceive from their own ova. The aim of the present study was to evaluate the outcome of IVF cycles among older patients. All IVF retrievals performed in the unit in patients >or=42 years old between 1998 and 2006 were retrospectively analysed. Data were compared with patients <35 years old treated in the unit during the same time period. A total of 843 IVF retrievals in 459 patients >or=42 years old were assessed. Clinical pregnancy rates per cycle were 7.7%, 5.4% and 1.9% for 42, 43 and 44 years old, respectively. Only one IVF cycle in patients aged 44 years resulted in delivery. None of the 54 cycles performed in women of 45 years or older resulted in a pregnancy. A marked decline in clinical pregnancy and delivery rates, accompanied by an increase in spontaneous abortion rates, was found in patients >or=42 years old. In view of these results and as the option of egg donation is a promising alternative with delivery rates close to 50%, it appears that IVF treatment should be limited to patients not older than 43 years old with adequate ovarian response.
Reproductive biomedicine online 10/2009; 19(4):599-603. · 2.04 Impact Factor
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ABSTRACT: The success rates of medical termination of pregnancy in two time periods (2000-2001 and 2002-2003) were compared to assess the effectiveness of medical abortion introduction to a large academic tertiary medical center. The success rates were markedly reduced over time (87.0% vs. 79.3%) probably owing to the difficulty in defining clear sonographic criteria for treatment failure and the complexity of a follow-up program implemented at a large teaching hospital by a broad staff with widely varying experience and knowledge of the new procedure.
Fertility and sterility 09/2008; 91(4 Suppl):1374-7. · 3.97 Impact Factor
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Dror Meirow, Micha Baum,
Rabinovici Yaron,
Jacob Levron,
Izhar Hardan,
Eyal Schiff,
Arnon Nagler,
Dina Ben Yehuda,
Hila Raanani,
Ariel Hourvitz,
Jehoshua Dor
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ABSTRACT: Cryopreservation of ovarian tissue is currently practiced in an attempt to preserve fertility before commencing potentially sterilizing chemotherapy. Clinical and laboratory guidelines are needed to standardize the procedure. Over the last 10 years ovarian tissue was stored in female patients with hematologic malignancies. Patients' records and consultation charts were evaluated, surgical and laboratory reports were revised and ovarian histology was investigated. Fifty-six patients with hematologic malignancies (age 24 +/- 5.5) had cryopreserved ovarian tissue. Thirty-three patients had Hodgkin's disease, 14 non-Hodgkin's lymphoma, 6 acute leukemia, and 3 chronic myelocytic leukemia. Harvesting of ovarian tissue was also performed following previous exposure to chemotherapy (33 patients), 13 of them shortly after the chemotherapy. Partial oophorectomy was the preferred surgical procedure. Fertility was restored with ovarian tissue transplantation in a sterilized patient and following fertility treatment in a patient with very low ovarian reserve. We recommend that indications and timing of ovarian tissue banking should be individualized. Patients previously exposed to chemotherapy can consider ovarian tissue freezing. The extent of tissue removed should take into account the large number of follicles lost and the risk of future sterilization. Tissue handling should enable further investigation of primordial follicles and identification of cancer cells.
Leukemia and Lymphoma 09/2007; 48(8):1569-76. · 2.58 Impact Factor
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ABSTRACT: Early pregnancy loss (EPL) significantly reduces the initial success rate of assisted reproduction treatments and increases the psychological burden on the patient. The aim of the current study was to investigate the association between embryo quality and EPL in IVF. A retrospective study of 1471 women undergoing IVF between July 2000 and October 2004 was performed. Multivariate logistic regression models evaluated the effect on EPL of the woman's age, type and cause of infertility, endometrial thickness on the day of oocyte retrieval, performance of intracytoplasmic sperm injection, number of transferred embryos, embryo quality as assessed by the number of blastomeres in the leading transferred embryo at day 3, and the percentage of fragmentation. The 2902 oocyte retrieval-embryo transfer cycles resulted in 816 pregnancies (28.1%; 705 women) constituting the study cohort. Of these, 259 pregnancies (31.7%) ended in EPL and 557 (68.3%) in ongoing pregnancies. EPL risk was significantly associated with advanced (>35 years) maternal age (OR=1.53; 95% CI 1.12-2.09) and five or fewer blastomeres in the leading embryo transferred at day 3 (OR=1.82; 95% CI 1.16-2.85). In conclusion, the quality of transferred embryos, as assessed by the total number of blastomeres in the leading transferred embryo, and maternal age are predictors of EPL.
Reproductive biomedicine online 10/2006; 13(4):504-9. · 2.04 Impact Factor
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ABSTRACT: The purpose of this study was to compare IVF outcome following sequential embryo transfer (ET) with that following the transfer of early cleavage embryos among patients with previous multiple IVF failures but adequate ovarian response. A retrospective matched case-control analysis was made of the medical files of 66 women who underwent sequential transfer of day 3 embryos and blastocysts in the Chaim Sheba Medical Centre between January 1999 and May 2004. The control group included 117 matched women who underwent embryo transfer on day 3 only. Sequential transfer of embryos in women resulted in a pregnancy rate of 30.3% (20/66) compared with 17.1% (20/117) following day 3 ET (P < 0.05). Multiple pregnancies (most of them twins) were significantly more common in women undergoing sequential transfer (10/20 versus 2/20; P < 0.02). Sequential transfer of embryos may be indicated for women with repeated IVF cycles, but the number of embryos transferred must be limited in order to prevent multifetal gestations. More data are needed to support this approach.
Reproductive biomedicine online 10/2006; 13(3):376-9. · 2.04 Impact Factor
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ABSTRACT: To compare the levels of end-tidal carbon monoxide (ETCOc) among women with and without uterine contractions in term and preterm pregnancies.
In all, 55 nonsmoking healthy pregnant women were enrolled. ETCOc levels were compared among women with contractions (10 preterm and 13 term) and 32 women without contractions (34-41 weeks gestation).
Maternal age, gravidity and parity were similar among study and control groups. ETCOc levels were significantly lower among women that had uterine contractions (0.99+/-0.38 parts per million (ppm) and 1.15+/-0.34 p.p.m. respectively), compared to women with no contractions (1.70+/-0.52 p.p.m., P<0.002). However, there was no significant difference in the ETCOc levels between women with preterm or term contractions (P=0.48).
Low levels of ETCOc are associated with preterm and term uterine contractions.
Journal of Perinatology 06/2004; 24(5):275-8. · 1.80 Impact Factor
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ABSTRACT: The possible role of heme oxygenase and its byproduct carbon monoxide (CO) in the regulation of blood pressure is under investigation. The aim of this study was to compare end tidal breath CO (ETCO) levels in women with gestational hypertension (GH) or pre-eclampsia to the levels in healthy pregnant and nonpregnant women.
We prospectively performed ETCO measurements corrected for ambient CO (ETCOc) in two medical centers (Stanford, CA and Cleveland, OH). A Natus CO-Stat End Tidal Breath Analyzer (Natus Medical Inc., San Carlos, CA) was used. The study group included a convenience sample of 31 women with GH/pre-eclampsia (PE). Control groups included 46 nonpregnant healthy women, 44 first-trimester and 48 third-trimester pregnant healthy women.
Mean+/-SD ETCOc measurements were significantly lower in the GH/PE group compared to first-trimester (p=0.004) and third-trimester (p=0.001) normotensive pregnant and nonpregnant women (p=0.002) (1.36+/-0.30 vs 1.76+/-0.47, 1.72+/-0.42 and 1.78+/-0.54 ppm, respectively). The ETCOc values were < or =1.6 ppm in 89% of GH/PE women compared with, respectively, only 45, 54, and 46% of nonpregnant, first- and third-trimester normotensive pregnant women (p<0.05). ETCO measurements were not influenced by maternal age, parity, ethnicity, body mass index, gestational age or presence of household smokers. In the two centers, the controls had a similar mean ETCOc and the differences found remained significant when results for each center were analyzed separately.
ETCOc levels were found to be significantly lower in women with GH/PE. Further investigation is required to determine if the lower CO levels reflect a deficient compensatory response to the increase in blood pressure or whether these are primary changes of significance to our understanding of the pathogenesis of GH/PE.
Journal of Perinatology 04/2004; 24(4):213-7. · 1.80 Impact Factor
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ABSTRACT: Fetal growth is influenced by many intrinsic and extrinsic factors. Our objective was to determine the pattern of heme oxygenase (HO) expression in the pregnant rat and to study its association with fetal growth and growth factors. Uterine tissues were obtained from nonpregnant and from time-mated rats at 7, 13, 16, 19, and 21 d of pregnancy. Placental tissue was obtained on d 13, 16, 19 and 21 of pregnancy. Tissues were evaluated for HO activity, HO-1, HO-2, leptin and vascular endothelial growth factor protein, and HO-1 and HO-2 mRNA. HO activity in both the uterus and placenta peaked on d 21 of pregnancy. In the uterus, HO-1 and HO-2 protein and total mRNA levels peaked on d 16 of pregnancy, whereas, in the placenta, HO-1 and HO-2 protein levels peaked on d 19. Additionally, placental HO-1 mRNA peaked on d 16, but placental HO-2 mRNA declined toward the end of pregnancy. Placental leptin and vascular endothelial growth factor protein levels followed a similar pattern to placental HO-1 and peaked on d 16. We conclude that there is a clear uterine and placental gestational pattern of HO expression in the rat. This pattern is comparable to that of vascular endothelial growth factor and leptin.
Pediatric Research 09/2003; 54(2):172-8. · 2.70 Impact Factor
