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Objective: To determine the effect of increased follicle size at the time of hCG administration on the outcome of in vitro fertilization (IVF)., Methods: Fifty women immediately before 50 immediately after a protocol change were reviewed retrospectively. The criterion for hCG administration was changed from a leading follicle size of at least 17 mm to one of at least 20 mm (average of two dimensions). Changes in follicle size and number, oocytes recovered, fertilization rate, embryo development, implantation rate, and pregnancy rate were examined. Women over 40 years of age, those undergoing intracytoplasmic sperm injection, and those whose stimulation did not include GnRH agonists were excluded., Results: The number of large follicles increased, but peak estradiol concentrations and number of oocytes recovered did not differ when hCG was administered at a follicular size of at least 20 mm. The numbers of oocytes fertilized, embryos replaced, and embryos cryopreserved were not statistically different. The percentage of cleaved fertilized oocytes was greater and the degree of embryo fragmentation smaller when hCG was administered at an increased follicular size. The implantation rate was higher and clinical and ongoing pregnancy rates tended to be higher when hCG was administered at a larger follicle size., Conclusion: The administration of hCG at a larger follicle size appears to have a beneficial effect on the outcome of IVF. Embryo quality-as reflected by decreased fragmentation, increased cleavage, and increased implantation rate-appears to be improved when hCG is delayed until two or more follicles reach at least 20 mm in diameter.

Pregnancy rates with endometriosis-associated infertility may be improved by laparoscopic surgery or laparotomy for moderate to severe disease. Surgery for minimal to mild disease does not increase pregnancy rates. Medical treatment has not been shown to increase fecundity for any stage of the disease. Pregnancy rates with assisted reproductive technology for endometriosis appear to be comparable with those for tubal disease that are also treated with assisted reproductive technology. Medical and surgical treatments for pelvic pain with endometriosis are both effective, but surgery avoids the side-effects associated with drugs and may result in a lower recurrence rate.

Objective: To compare the developmental potential of cryopreserved human zygotes after thawing to sibling zygotes that were transferred without cryopreservation., Methods: Retrospective analysis of embryo data and pregnancy outcome for all in vitro fertilization (IVF) patients who had sufficient zygotes to allow fresh embryo transfer and cryopreservation of additional sibling zygotes for later use., Results: Zygotes survived cryopreservation at a high rate (87%). After thawing, cryopreserved zygotes developed at rates similar to those of fresh zygotes. Pregnancy occurred at similar rates after replacement of fresh embryos (27.9%) or replacement of cryopreserved-thawed zygote-derived embryos (24.3%)., Conclusions: Human embryos can be cryopreserved at the pronuclear zygote stage with little loss of developmental potential. Cryopreservation allowed a reduction in the number of embryos transferred during an IVF retrieval cycle, thereby reducing the occurrence of multiple pregnancy. The total cumulative pregnancy rate per retrieval cycle doubled when pregnancies from cryopreserved-thawed zygotes were added to those originating from fresh zygotes.

Objective: To investigate the correlation between presenting symptoms and cystometric data in patients with urodynamically proven detrusor instability., Methods: A retrospective review was conducted of standardized urodynamic data bases and cystometrograms from the gynecologic urodynamics laboratories at Duke University Medical Center, Durham, North Carolina, and Grady Memorial Hospital, Atlanta, Georgia., Results: Of the 100 patients reviewed, 86% complained of urge incontinence and 78% complained of urinary urgency; however, 76% also complained of stress incontinence. Statistical evaluation of symptoms by analysis of variance showed no significant correlations between the symptoms of urinary frequency and urgency and any of the cystometric indices. Patients with motor urge incontinence had significantly smaller mean cystometric bladder capacities than patients without this complaint (299.9 +/- 132.5 versus 553.6 +/- 173.6 mL; P < .01). One-third (34) of the patients had mixed incontinence due to genuine stress incontinence as well as detrusor instability. Compared with patients suffering from detrusor instability alone, patients with mixed incontinence had significantly larger cystometric bladder capacities (396.0 +/- 172.9 versus 308.1 +/- 154.8 mL; P < .02) and a lower amplitude of the maximum detrusor contraction (38.8 +/- 21.7 versus 49.9 +/- 25.1 cm H2O; P < .04)., Conclusions: Women with detrusor instability represent a diverse population with a wide variety of symptoms and urodynamic findings. Patients with mixed incontinence may represent a subpopulation distinct from those with pure detrusor instability. Further research that attempts to describe other discrete subpopulations of patients with detrusor instability may improve our understanding of this troublesome clinical problem.