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Background: To elucidate possible differences between unexplained and minimal peritoneal endometriosis-associated infertility, we studied their outcome in natural cycle IVF (NIVF).Methods: A prospective cohort study was carried out on unexplained (33 couples), minimal peritoneal endometriosis-associated (30 couples) and tubal factor (24 couples) infertility in 223 NIVF cycles, using human chorionic gonadotrophin (HCG) for ovulation induction.Results: During the first NIVF attempt, follicular and luteal phase oestradiol, FSH, LH and progesterone concentrations, as well as endometrial thickness and follicular diameter were similar among the three groups. Periovulatory follicular growth monitored from day of HCG administration to oocyte aspiration was significantly lowered in unexplained infertility compared with minimal endometriosis-associated and tubal factor infertility. The fertilization rate, clinical pregnancy rate per initiated cycle, per successful oocyte retrieval and per embryo transfer, in minimal endometriosis (80.0, 10.4, 16.0 and 23.5% respectively) were similar to that in tubal factor infertility patients (68.6, 5.8, 11.4 and 16.0%) but significantly higher (P < 0.05) than that of the unexplained infertility group (62.2, 2.6, 5.4 and 8.7%).Conclusions: The significant reduction in follicular periovulatory growth, fertilization and pregnancy rates in unexplained infertility compared with minimal peritoneal endometriosis patients may be explained by sub-optimal follicular development with possibly reduced oocyte quality, intrinsic embryo quality factors or by impaired implantation. From a clinical point of view, NIVF is less suited to unexplained infertility treatment, but might represent an interesting treatment option for minimal peritoneal endometriosis-associated infertility. [ABSTRACT FROM AUTHOR]

The impact of insulin resistance on the outcome of IVF or intracytoplasmic sperm injection (ICSI) in women with polycystic ovarian syndrome (PCOS) was examined. Insulin sensitivity was measured by the continuous infusion of glucose with model assessment (CIGMA) test. Insulin-resistant (n = 26) and non-insulin-resistant women (n = 30) with PCOS underwent a total of 100 cycles of long-term down-regulation with buserelin acetate, stimulation with human recombinant FSH, and IVF or ICSI. Blood samples were taken throughout ovarian stimulation for hormone assays. Insulin-resistant and non-insulin-resistant women had similar concentrations of FSH, LH, testosterone and androstenedione throughout stimulation, but insulin-resistant women had hyperinsulinaemia and lower sex hormone binding globulin concentrations. Insulin-resistant women also had lower oestradiol concentrations during stimulation and required higher FSH doses, but these differences disappeared after controlling for the higher body weight in the group of insulin-resistant women. Groups had similar number of oocytes collected, similar implantation and pregnancy rates, and the incidence of ovarian hyperstimulation syndrome was also similar. Obesity, independent of hyperinsulinaemia, was related to a lower oocyte count and increased FSH requirement. It is concluded that in PCOS women receiving long-term down-regulation and stimulation with recombinant FSH, insulin resistance is neither related to hormone levels nor to IVF outcome. Obesity, independent of insulin resistance, is associated with relative gonadotrophin resistance. [ABSTRACT FROM AUTHOR]

To investigate the clinical importance of leptin's intraovarian effects, we studied the concentration of leptin and leptin binding activity in the plasma and in the follicular fluid of PCOS patients (n=20; median BMI: 27.1 kg/m2, range 19.7-36.3) undergoing controlled ovarian stimulation with long-term GnRH agonist, recombinant FSH, and in vitro fertilization. Follicular fluid and blood samples were collected during follicle aspiration for IVF. Total leptin concentration was measured by radioimmunoassay, and specific leptin binding activity was accessed by a gel filtration column assay. Follicular fluid and plasma leptin levels were similar (median 1135 pmol/l vs. 1409 pmol/l; p=0.81). Follicular fluid to plasma leptin ratio was independently associated with cumulative FSH dose (r=0.63; p=0.006) and insulin resistance index (r=-0.45; p=0.04). Specific leptin binding activity was higher in the plasma than in the follicular fluid [median 7.94% vs. 3.49%; p<0.001]. When multivariate analysis was used to predict FSH consumption, only follicular fluid leptin levels were significantly associated with cumulative FSH dose (r=0.46; p=0.04). We infer that at least in part by increased intrafollicular leptin levels, obesity directly affects ovarian function in PCOS, and may induce a relative resistance to gonadotropin stimulation. This intraovarian effect of leptin can be even more profound because of low leptin binding activity in the preovulatory follicle of obese patients. [ABSTRACT FROM AUTHOR]

To study the effect of somatostatin on ovarian function, we investigated the action of physiological concentrations of somatostatin (5.0 x 10(-12)-1.0 x 10(-10) M) on the basal and luteinizing hormone (LH)-stimulated progesterone release from cultured human granulosa-luteal cells obtained from in-vitro fertilization patients. Somatostatin exerted a significant and inhibitory effect on basal progesterone release from the granulosa-luteal cells, whereas it was unable to inhibit LH-stimulated progesterone release. Instead, a significant increase in progesterone release was observed after concomitant incubation with LH and somatostatin compared with the untreated controls. We suggest that somatostatin may serve as a regulator of ovarian functions under physiological conditions. [ABSTRACT FROM AUTHOR]

To demonstrate the presence of somatostatin in human pre-ovulatory follicular fluid, and to assess the role of this peptide in follicular maturation, a total of 66 follicular fluid samples were obtained from 26 patients at the time of oocyte recovery for in-vitro fertilization. Follicular fluid concentrations of somatostatin, oestradiol, progesterone and androstenedione were measured by immunoassays. Somatostatin concentrations in concomitantly obtained plasma samples were also analysed. Follicular fluid somatostatin concentrations ranged from undetectable (<1.5 pmol/1) to 109.4 pmol/1. The mean ±SE somatostatin concentrations in follicular fluid (12.8± 1.8 pmol/1) were significantly (P< 0.0001) increased compared to corresponding plasma concentrations of somatostatin (6.5 ± 0.2 pmol/1). A significant and positive correlation existed between follicular fluid and plasma somatostatin concentrations ( = 0.27; < 0.03). No differences in either follicular fluid or plasma somatostatin concentrations were found between different stimulation protocols or diagnostic groups. Neither did follicular fluid somatostatin concentration vary with follicular size. Similarly, no differences in somatostatin concentrations were found between follicular fluids associated with fertilized (13.2 ± 2.1 pmol/1) or non-fertilized oocytes (10.5± 1.6 pmol/1). Follicular fluid concentrations of somatostatin correlated positively with those of progesterone ( % 0.30; = < 0.04), but not with those of oestradiol or androstenedione or with the androstenedione/oestradiol ratio. The relationship between follicular fluid somatostatin and progesterone concentrations suggests that follicular fluid somatostatin may have a physiological role in follicular maturation and the luteinization process. [ABSTRACT FROM PUBLISHER]

Forty-four infertile patients with the polycystic ovarian syndrome (PCOS) resistant to other treatment modalities were treated in 58 cycles of IVF after accomplishment of pituitary gonadotroph suppression with a GnRH-agonist. Four cycles were cancelled before oocyte retrieval while embryo transfer was deferred for 10 cycles due to imminent ovarian hyperstimulation syndrome (OHSS). Follicle aspiration yielded 18.8±9 oocytes per cycle. The cleavage rate was 68%. There was no cleavage in five cycles. The pregnancy rate was 33.3% per embryo transfer. In 32 cycles 9.0±5 suitable supernumerary embryos were cryopreserved. Transfer of cryopreserved embryos gave three additional pregnancies. The accumulated pregnancy rate per patient was 36%. In clomiphene citrate resistant patients, transfer of cryopreserved embryos was accomplished after secretory transformation of the endometrium by oestradiollprogester one substitution. Although seven pregnancies ended in a miscarriage, the ‘take-home’ baby rate was 20%. OHSS ensued in 28(46.7%) cycles. In PCOS, in-vitro fertilization following pituitary gonadotroph suppression seems a treatment alternative with pregnancy rates comparable to normo-ovulatory women with tubal factor infertility. However, the incidence of OHSS is high and constitutes the major problem of cycle control. [ABSTRACT FROM PUBLISHER]

Forty-three patients who responded poorly to previous stimulation with clomiphene citrate (CC)/human menopausal gonadotrophin (HMG) for IVF were followed during 70 further cycles. Eighteen patients had a normal FSH response to CC in the previous cycle, while 25 had an abnormal FSH response. Three stimulation protocols were used: buserelin/HMG, CC/HMG and HMG only. No difference between the two groups was observed in the dose of HMG used for any stimulation protocol. More cycles were cancelled due to a poor response in the abnormal response group compared to the normal response group. In the completed cycles, the maximum oestradiol level and number of oocytes retrieved were lower in the abnormal response group compared to the normal response group. The total pregnancy rate per patient, including spontaneous conceptions during the study period, was lower in the abnormal response group compared to the normal response group, 4 versus 33%. We conclude that poor responders with an abnormal FSH response to CC have a latent ovarian failure with a low chance of success in further IVF attempts. [ABSTRACT FROM AUTHOR]

A comparison of the relative efficacy of in-vitro fertilization with uterine embryo transfer (IVF), tubal embryo stage transfer (TEST) and gamete intra-Fallopian transfer (GIFT) was performed in infertile patients with patent Fallopian tubes. A total of 150 couples with unexplained infertility, peritoneal endometriosis or reduced semen quality were included in the study. The three groups were comparable with regard to age distribution, indications, semen parameters, stimulation regimens, response to stimulation and numbers of oocytes retrieved. In the IVF and TEST groups there was no cleavage in 24% and a cleavage rate of only 47.6%. The highest cleavage rate was obtained in the endometriosis patients. The pregnancy rate was highest in the two groups in which in-vitro fertilization was performed, IVF = 45.7%, TEST = 37.9%, GIFT = 26.2%. To obtain one live intrauterine fetus, more oocytes had to be transferred in the GIFT group compared to the number of embryos in the IVF group, 14.4 versus 6.2, P less than 0.05. Due to a high success rate of IVF but at the same time a high frequency of no cleavage in cases of unexplained infertility or male subfertility, we recommend IVF as the primary procedure in infertile couples with patent Fallopian tubes. [ABSTRACT FROM AUTHOR]

The levels of ionized calcium in seminal plasma were approximately 20% of the serum levels. In contrast, cervical mucus contained a level of ionized calcium similar to both serum and follicular fluid. Titration of seminal plasma and serum with increasing concentrations of calcium chloride indicated a 10-fold higher calcium-binding capacity for seminal plasma. In a random group of men under semen investigation, concentrations of ionized calcium and citrate in semen were inversely correlated (r = 0.732; P less than 0.001), an observation which was confirmed by studies of split ejaculates. These findings supported the contention that citrate is the major regulator of the levels of ionized calcium in seminal plasma and primarily responsible for maintaining the calcium gradient between the seminal plasma and cervical mucus. No significant relationship could be demonstrated between the levels of ionized calcium in the ejaculates and any of the motility characteristics of the spermatozoa in the same sample. Furthermore, the addition of increasing quantities of calcium chloride (0.16-20.00 mM) to washed spermatozoa had no major effects on their progressive motility. These data suggest that human spermatozoa are effective in maintaining an appropriate level of internal ionized calcium, necessary for normal motility, despite fluctuations in external calcium. [ABSTRACT FROM AUTHOR]

The epithelial cells lining the inner surface of the Fallopian tube influence the reproductive process by both their ciliary and secretory activities. The aim of the present work was to establish a method to culture these cells as a model for more specific studies of their properties. Minor slices of the mucosal ridges were cut and minced extensively using a fine scissor. The resulting pieces were washed once, resuspended in RPMI 1640 with 20% fetal calf serum and seeded in plastic dishes. After 2 days, the medium was replaced with RPMI 1640 containing human albumin, insulin and transferrin. Seven to 10 days later, the cell number had increased 5−8 times in 70% of the cultures. The identity of the cells was assessed after 1−3 weeks in culture. Of the cells, 98% stained positive for the antibody to epithelial cell-specific protein cytokeratin. Electron microscopic studies of the cultures showed epithelial characteristics including cilia, microvUli and intercellular junctions in the form of desmosomes. The cells could be kept in culture for 6−8 weeks. In conclusion, a method to culture epithelial cells from the human Fallopian tube is described. The cells have been identified and they can be kept in culture for 6−8 weeks in quantities sufficient for experimental use. [ABSTRACT FROM PUBLISHER]

Follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestradiol and prolactin levels were studied in a sequential clomiphene citrate/human menopausal gonadotrophin (CC/HMG) regimen for in-vitro fertilization. At completion of CC administration, the median FSH level in 44 cancelled cycles was elevated compared to a control group of 65 completed cycles, 29 IU/l versus 15 IU/l, P less than 0.01. Also the median FSH/LH ratio was higher in the cancelled cycles than in the control group, 1.08 versus 0.71, P less than 0.05. Conversely, the median oestradiol level was lower in the cancelled cycles than in the completed cycles, 0.27 nmol/l versus 0.59 nmol/l, P less than 0.01. No difference was seen in the median LH and prolactin levels. An FSH value above the 95% confidence limit was found in 24 of the cancelled cycles, but in only two of the completed cycles. Based on this study, an elevated FSH value following CC administration predicts a poor response to further stimulation with an accuracy of 92.3% and should result in cancellation of the cycle. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of pregestational maternal, obstetric and perinatal factors on neonatal outcome in extreme preterm deliveries., Methods: Retrospective study of deliveries in a Norwegian tertiary teaching hospital. All women with live births at 24(+0)- 27(+6) weeks of gestation between 2004 and 2007 were included. Major morbidity is defined as intraventricular haemorrhage grade 3-4, periventricular leukomalacia, bronchopulmonary dysplasia or necrotizing enterocolitis. Pregestational maternal, obstetric and perinatal variables were initially compared for mortality and survival with major morbidity at 24-h, 7- or 28-day postpartum/discharge in univariate analysis. Then, a multivariate analysis was conducted in order to determine independent factors associated with mortality and survival with major morbidity., Results: A total of 109 babies were delivered alive in 92 women, representing 1.6% of total births. The survival rates were 93.6, 84.4 and 80.7%, with a prevalence of major morbidity among survivors of 40.4, 32.1 and 39.4% at 24-h, 7- and 30-day postpartum/discharge, respectively. After adjustment using multiple logistic regression, only a 5-min Apgar score ≤ 3 and babies with at least one major morbidity had significantly independent effects on neonatal survival. Multiple pregnancy and gestational age <26 weeks were the only two independent risk factors for survival with major morbidity., Conclusions: Neonatal survival was significantly predicted by a 5-min Apgar score and neonatal morbidity, independent of pregestational maternal disease, obstetric complications, method of delivery, gestational age and birth weight in extreme preterm deliveries. The excess morbidity rate was confined among multiples and babies who were delivered before 26 weeks of gestation.

Objective: To investigate the effect of advanced maternal age (AMA) separately in nulliparous and multiparous women on obstetric and perinatal outcomes in singleton gestations., Study Design: A historical cohort study on data from 6,619 singleton pregnancies between 2004 and May 2007 was performed. AMA was defined as 35 years and older. Obstetric and perinatal outcomes in AMA versus women younger than 35 years (non-AMA) were compared for both nulli- and multiparae with Student's t-test and Chi-square test in univariate analysis. Multiple logistic regression analysis was performed to examine the independent effect of AMA., Results: Out of 6,619 singleton pregnancies, the frequency of nulliparity was 42.7 and 33.4% of the parturients were of AMA. Among nulliparous women, AMA was significantly associated with a higher frequency of caesarean section both before labour (OR 2.26 with 95% CI 1.74-2.94), in labour (OR 1.44 with 95% CI 1.07-1.93), and more instrumental vaginal deliveries (ORs 1.49 with 95% CI 1.13-1.96). Among multiparous women, AMA was only significantly associated with a higher caesarean section rate before labour (ORs 1.42, 95% CI 1.19-1.69). There were no significant differences between the two age groups in the prevalence of other adverse obstetric outcomes and adverse perinatal outcomes., Conclusions: Operative delivery is increased in AMA, including caesarean sections, as well as instrumental vaginal deliveries in nulliparous women. In multiparous women, however, only the rate of caesarean section before labour was increased. AMA had no significant effect on other adverse obstetric and perinatal outcomes irrespective of parity.

Objective: To test whether the clinical efficiency of recombinant FSH (rFSH) and highly purified human menotrophin (hMG) differs in terms of pregnancy and live birth rates during the first treatment cycle of IVF or ICSI., Design: Prospective cohort study., Setting: Department of Gynecology and Obstetrics, Rikshospitalet, Oslo University Hospital., Study Population: Records of 1,136 infertile couples undergoing their first IVF (n = 682) or ICSI (n = 454) treatments were reviewed. The effect of hMG and rFSH was analyzed for the IVF and ICSI groups separately., Methods: Patients received long term down-regulation with GnRH agonist and controlled ovarian hyperstimulation with hMG or rFSH. Oocytes were fertilized by IVF or ICSI. Embryos were transferred on Day 2., Main Outcome Measures: Primary outcome measures were pregnancy and live birth rates, secondary outcome measures were duration of treatment, doses of hMG or rFSH applied, number of oocytes retrieved and the number and quality of embryos obtained., Results: Similar pregnancy and live birth rates were observed with hMG and rFSH. Compared to hMG, treatment cycles with rFSH were characterized by significantly shorter stimulation, lower gonadotrophin consumption, and increased number of oocytes and embryos., Conclusion: We conclude that rFSH and hMG are equivalent in terms of clinical efficacy.

Tissue reorganization during ovulation and corpus luteum formation involves a coordinated action of matrix metalloproteinases (MMPs) and tissue MMP inhibitors (TIMPs). In this study we investigated the cellular source of ovarian MMPs and TIMPs. Cells isolated from the preovulatory human follicle were cultured after immunobead depletion of CD45-expressing cells, which allowed differential assessment of leukocyte and granulosa-lutein cell fractions. Secretion of MMP-9 by follicular fluid-derived cells was associated with the presence of leukocytes. Granulosa-lutein cells synthesized low levels of MMP-9 but failed to secrete this enzyme that presumably accumulated in the cytoplasm, indicated by an increased MMP-9 expression of luteinized cells in sectioned midluteal phase corpora lutea. Synthesis and secretion of TIMP by follicular fluid-derived cells was associated with granulosa-lutein cells. TIMPs derived by granulosa-lutein cells failed to inhibit MMP-related pericellular proteolysis. The findings support a two-cell model of periovulatory MMP/TIMP release, in which leukocytes secrete MMPs and granulosa-lutein cells release TIMP, suggesting that there exists an intriguing interaction among cells that intertwingle during ovulation and corpus luteum formation.

Objective: The objective of this retrospective study of male patients with hypogonadotrophic hypogonadism (HH) was to assess the outcome of fertility after induction of spermatogenesis by gonadotrophin injections., Methods: During 1995-2005 17 men with HH were referred to our department for gonadotrophin treatment to stimulate spermatogenesis., Results: Genetic/idiopathic hypogonadotrophic hypogonadism (IHH) was the most common cause (n = 10) followed by post-operative pituitary failure in three cases. In genetic/IHH, 5 out of 10 cases were born in the Middle East. Gonadotrophin injections induced spermatogenesis in 12 out of 13 HH men indicated by presence of ejaculated motile spermatozoa. All men with proved spermatogenesis and a paternity desire became fathers, five through assisted reproduction with intracytoplasmic sperm injection. A total of 16 children were born as a result of gonadotrophin therapy. Three spontaneously conceived singletons and two twin couples after assisted reproduction were born preterm. Two children from two separate dichorionic twin couples were diagnosed with congenital malformations., Conclusions: Gonadotrophin therapy is successful for men with HH aiming to initiate or re-establish spermatogenesis. Despite low sperm output in some of these men, the rate of pregnancies both spontaneous and after assisted reproduction, was high. More children than expected were born preterm.

Background: Unfertilized oocytes, embryos and ovarian issue can be cryopreserved before cancer treatment of post-pubertal women. Fertility may be restored by retransplantation in women who are pronounced healthy., Material and Methods: The article is based on relevant literature and our own clinical experience since 2004, when the procedure was first allowed in Norway., Results and Interpretation: Cryopreservation of ovarian tissue is an established procedure in Norway. As of January 2007, ovarian tissue from 22 women, aged 14-35 years, has been cryopreserved at Rikshospitalet. There is an upper age limit of 35 years because of age-related follicular loss. The treating oncologist and a gynaecologist should be responsible for informing patients about the possibility of preserving fertility by ovarian cryopreservation before chemo- and/or radiation therapy. The patient should, at the same time, be told about the limited world-wide experience with this procedure.

Background: In Norway, assisted reproduction has been regulated by law since 1987, but the in vitro fertilization (IVF)-clinics are free to decide the number of embryos transferred. During the 1990ies, the number of embryos replaced was reduced from three to two. Triplets almost disappeared, but the twinning rate remained unchanged. According to the latest national data, 27.5 % of the deliveries following IVF and intracytoplasmic sperm injection (ICSI) in 2002 were multiple births. In our hospital, 23.9 % of the deliveries following IVF/ICSI in 2003 were multiple births. To reduce the multiple pregnancy rate, eSET was introduced as a routine in patients with a high probability to become pregnant in November 2004., Material and Methods: The results of eSET from the beginning of November 2004 until July 2005 are presented. All three inclusion criteria for eSET had to be fulfilled: 1) age

Purpose: To investigate possible differences between unexplained and stage I endometriosis-associated infertility in ICSI cycles conducted after low fertilization (<20%) in preceding IVF cycles with normal semen parameters., Methods: Retrospective cohort study consisting of patients with unexplained (n=48) and stage I endometriosis-associated infertility (n=43) with a minimum of one IVF cycle with <20% fertilized oocytes and normal semen quality, treated with ICSI from January 1997 to January 2006. Age matched male factor infertility patients (n=91) were used as controls., Results: Diploid fertilization rate was significantly lower in the stage I endometriosis-associated infertility group compared to the unexplained infertility group. Score of the transferred embryos, implantation rate, pregnancy rate and outcome were similar in the two groups., Conclusions: ICSI appears to be an efficient treatment option after fertilization failure with IVF in unexplained and stage I endometriosis-associated infertility.

Background: Down-regulation with GnRH agonist has been suggested to result in a profound suppression of LH bioactivity, reduced estradiol synthesis, and thus impaired IVF and pregnancy outcome. The aims of this study were: (i) to assess the usefulness of serum LH measurement on stimulation day 1 as a predictor of ovarian response, conception and pregnancy outcome in patients treated with long-term down-regulation with GnRH agonist and recombinant FSH, and (ii) to define the best threshold LH value, if any, to discriminate between women with different outcomes of IVF., Methods: Records of 2625 cycles in 1652 infertile women undergoing IVF (n = 1856) and/or ICSI (n = 769) treatment were reviewed., Results: The range of LH concentrations on stimulation day 1 overlapped among non-conception cycles, conception cycles, ongoing pregnancies and early pregnancy losses. Receiver operating characteristic (ROC) analysis showed that serum LH concentrations on stimulation day 1 were unable to discriminate between conception and non-conception cycles (AUC(ROC) = 0.51; 95% CI: 0.49-0.54) or ongoing pregnancies versus early pregnancy loss groups (AUC(ROC) = 0.52; 95% CI: 0.47-0.57). Stratification for various low serum levels of LH did not reveal significant differences with respect to conception or pregnancy outcome among different LH levels on stimulation day 1., Conclusions: Serum LH concentration on stimulation day 1 cannot predict ovarian response, conception and pregnancy outcome in women receiving long-term down-regulation during assisted reproduction treatment.

Background: This study was undertaken in order to compare pregnancy outcome after IVF and ICSI in unexplained and endometriosis-associated infertility using tubal factor infertility as controls., Methods: This was a retrospective cohort study of early IVF/ICSI pregnancies verified by serum hCG measurement, comparing the subsequent outcome in unexplained (n = 274) and minimal endometriosis-associated (n = 212) with tubal factor (n = 540) infertility as controls. From January 1990 to December 2002, 1026 conception cycles after treatment with IVF or ICSI complied with the inclusion criteria., Results: Live birth rate, twin birth rate after transfer of two embryos and abortion rate prior to 6 weeks of gestation were superior for the unexplained (78.8, 23.5 and 11.7%) compared to endometriosis-associated (66.0, 15.0 and 19.3%) and tubal factor (66.7, 18.1 and 18.0%) infertility groups (P < 0.05). Compared to the endometriosis-associated, the unexplained infertility group attained a higher pregnancy rate after the first treatment cycle (P < 0.05)., Conclusions: The overall better outcome for the unexplained infertility group with respect to live birth rate, twin birth rate and early abortion rate compared to the minimal peritoneal endometriosis-associated and tubal factor infertility groups might be a guide to select diagnostic groups for single embryo transfer and be useful in patient counselling.

Background: Underweight and overweight may affect reproduction and interfere with treatment of infertility. The purpose of this report is to describe the independent effect of body weight on treatment with IVF and ICSI., Methods: Records of 5019 IVF or ICSI treatments in 2660 couples were reviewed. The influence of body mass index (BMI) on treatment outcome was examined, after accounting for differences in age and infertility diagnosis., Results: The cumulative live birth rate within three treatment cycles was 41.4% [95% confidence interval (CI) 32.1-50.7] in obese women with BMI > or =30 kg/m2 and 50.3 (95% CI 47.0-53.7) in normal weight women with BMI 18.5-24.9 kg/m2. Obesity was associated with an increased risk of early pregnancy loss occurring before 6 weeks gestation. Positive correlation between BMI and gonadotrophin requirement during stimulation and negative correlation between BMI and number of collected oocytes were observed. Underweight (BMI <18.5 kg/m2) was not related to an impaired outcome of IVF or ICSI., Conclusions: Obesity is associated with lower chances for live birth after IVF and ICSI and with an impaired response to ovarian stimulation.

In this study we assessed how insulin resistance affects pregnancy rates in infertile women with the polycystic ovary syndrome (PCOS) treated with laparoscopic ovarian electrocautery. Sixty-four PCOS women were included in the study in a consecutive fashion. Following the CIGMA (continuous infusion of glucose with model assessment) test, 28 women were classified as insulin resistant and 36 women as non-insulin resistant. After the ovarian electrocautery patients were observed for 12-18 months. If pregnancy did not ensue, they were referred for one or more cycles of in vitro fertilization (IVF). Following ovarian electrocautery the non-insulin-resistant women more frequently achieved a regular menstrual cycle and ovulation than the insulin-resistant PCOS women. Consequently 18 (50%) of the non-insulin-resistant PCOS women achieved a pregnancy versus only five (18%) of women in the insulin-resistant PCOS group. Following treatment with both ovarian electrocautery and IVF, 27 (75%) of the non-insulin resistant PCOS women achieved a successful pregnancy, while 13 (46%) of the insulin-resistant PCOS group achieved this. In conclusion, insulin resistance may be an important marker of a poor outcome of treatment in PCOS infertility. Further studies are needed to evaluate the possible effect of treatment alternatives to alleviate the unfavorable influences of insulin resistance and hyperinsulinemia on ovulation induction in PCOS women.

The aim of this study was to compare the prevalence at birth of birth defects in children born after intracytoplasmatic sperm injection (ICSI) and children born after traditional in vitro fertilisation (IVF). Altogether 553 children were born after ICSI treatment in Norway during the period 1996-1998 (351 singletons, 95 twins-pairs and 4 triplets) while 1731 were born after IVF treatment (1004 singletons, 344 sets of twins and 13 triplets). Birth defects were registered in 5.42% of children born after ICSI and in 5.14% of children born after IVF; 3,07% and 3.00% respectively were major birth defects. We conclude that intracytoplasmic sperm injection does not imply a significant increase in the prevalence at birth of birth defects compared to children conceived by traditional IVF.