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Objective: To report the case of a woman who presented for fertility preservation before breast cancer treatment who was found to be pregnant with an undesired pregnancy. Design: Case report. Setting: Single infertility practice. Patient: A 28-year-old woman with a new diagnosis of grade 3 invasive ductal carcinoma of the breast was planning to undergo oocyte cryopreservation and was found to be pregnant with an undesired pregnancy. She underwent a medical termination at a gestational age of 5 weeks 4 days. Neither the patient nor her oncology team wished to delay treatment more than was necessary. The physician and patient decided to initiate controlled ovarian hyperstimulation (COH) before her human chorionic gonadotropin (hCG) returned to normal. Intervention(s): COH in the setting of a positive quantitative hCG. Main Outcome Measure(s): Number of metaphase II (MII) oocytes cryopreserved; doses of Gonal-F and Menopur; serum E2, follicle-stimulating hormone, luteinizing hormone, hCG levels. Result(s): COH began 7 days after passing the products of conception. Baseline labs demonstrated hCG at 222 mIU/mL, follicle-stimulating hormone at

Objective To evaluate whether assisted hatching improves clinical outcomes of embryo transfers to good prognosis patients, defined as patients ≤39 years with normal follicle-stimulating hormone (FSH) and E 2 levels, no more than one previous unsuccessful cycle of in vitro fertilization (IVF)–embryo transfer, and good embryo quality. Design Prospective randomized controlled trial. Setting Private assisted reproductive technology (ART) center. Patient(s) One hundred ninety-nine good prognosis patients undergoing IVF–embryo transfer. Intervention(s) In vitro fertilization followed by embryo transfer on day 3 after oocyte retrieval with or without assisted hatching using a 1,480-nm wavelength infrared laser. Main Outcome Measure(s) Clinical intrauterine pregnancy, spontaneous pregnancy loss, and live birth. Result(s) Rates of clinical intrauterine pregnancy with fetal cardiac activity (53% vs. 54% per cycle), spontaneous pregnancy loss (13% vs. 16% per pregnancy), and live birth (47% vs. 46% per cycle) were very similar between treatment cycles with laser-assisted hatching and control cycles in which embryos were transferred without assisted hatching. There were no significant differences between treatment and control groups in any measured clinical outcome parameters. Conclusion(s) Assisted hatching does not improve clinical outcomes among good prognosis patients.

Objective: To test the hypothesis that IVF-ET pregnancy rates (PRs) for patients with tubal factor infertility are decreased in patients with hydrosalpinges and that surgical correction reverses this effect. Design: Retrospective chart review. Setting: Private practice IVF-ET program. Patient(s): Patients ( n = 160) undergoing 238 cycles of IVF-ET were stratified into groups based on the presence of hydrosalpinges and whether surgical correction had been performed. Patients > 39 years old and patients with male factor infertility were excluded from the study. Intervention(s): Patients with hydrosalpinges were offered surgical correction. Main Outcome Measure(s): Clinical pregnancy defined by an intrauterine gestational sac. Result(s): Patients with hydrosalpinges had significantly decreased implantation rates and PRs per transfer (2.8% and 8.5%, respectively) than patients with tubal factor infertility but without hydrosalpinges (15.7% and 38.6%). Surgical correction improved implantation rates and PRs in patients with prior failed cycles (16.1% and 37.5%) and in patients undergoing surgery before IVF-ET (21.8% and 51.7%). The type of surgery performed did not affect success rates in the small number of patients evaluated. Conclusion(s): The presence of a hydrosalpinx during an IVF-ET cycle results in significant decreases in implantation rates and PRs. Surgical treatment of hydrosalpinges before IVF-ET cycles improves implantation rates and PRs.

Objective: To report a normal twin delivery after transfer of two fresh day 7 blastocysts. Design: Case report. Setting: Private infertility clinic. Patient(s): A 35-year-old woman with a 6-year history of primary infertility with significant pelvic adhesions. Intervention(s): Review of individual IVF-ET therapy cycle. Main Outcome Measure(s): Full-term delivery after day 7 blastocyst transfer. Result(s): During the patient's first IVF-ET cycle, the decision was made to undertake blastocyst transfer after extended culture. No blastocysts had formed until late on day 6, by which time the patient had been hospitalized with a renal stone. Subsequently, on day 7, the patient was asymptomatic and presented for embryo transfer, and after assisted hatching, two expanded blastocysts were transferred to her uterus under ultrasound guidance. After confirmation of implantation of a viable twin, pregnancy was uneventful with no obstetrical complications, and a dizygotic twin was delivered vaginally at 38 weeks of gestation. Conclusion(s): Few reports have been made regarding viability of more slowly developing blastocysts; however, this case indicates that blastocysts that did not fully expand until day 7 of extended in vitro culture are still able to implant after superovulation and IVF-ET therapy. Assisted hatching of these embryos may have been beneficial in achieving this successful outcome by hastening the blastocyst hatching, allowing more rapid contact with the endometrium.

Objective To perform preimplantation genetic diagnosis (PGD) with 1.48-μm infrared diode laser assistance during embryo biopsy for two patients undergoing IVF. Design Case reports. Setting Private ART laboratory. Patient(s) Two couples undergoing IVF for infertility therapy, both of whom had previously delivered offspring afflicted with spinal muscular atrophy (type 1) after IVF therapy, and who underwent subsequent cycles of IVF coupled with PGD to screen for this disorder. Intervention(s) Two individual IVF cases involving intracytoplasmic sperm injection (ICSI), embryo biopsy with laser assistance, and PGD. Main outcome measure(s) The ease and apparent safety of human embryo biopsy using a 1.48-μm infrared laser for partial zona pellucida (ZP) dissection to assist with embryo blastomere biopsy was evaluated. Result(s) Both couples were deemed to have some unafflicted embryos for transfer on the fifth day of development after blastomere biopsy in conjunction with PGD. Patient A had a singleton pregnancy and delivered a healthy normal singleton male. Patient B had a twin pregnancy; however, one twin was spontaneously lost at 10 weeks but she ultimately delivered a healthy normal singleton male. Conclusion(s) These successful outcomes help to demonstrate the efficacy and safety of laser-assisted embryo biopsy to facilitate PGD screening.

In order to identify parameters which predict prognosis for success with in vitro fertilization, 17-hydroxyprogesterone and progesterone levels were evaluated in 254 patients undergoing 296 in vitro fertilization cycles. Selected response and outcome data were recorded.Patients with intermediate values of serum progesterone (0.7-0.8 ng/ml) at the time of human chorionic gonadotropin administration achieved significantly higher pregnancy rates than patients with lower (0.7 ng/ml) or higher (0.8 ng/ml) levels. The clinical pregnancy rates were 46%, 31%, and 27% respectively (P = 0.02). There was no change in 17-hydroxyprogesterone concentration which predicted a higher pregnancy rate.Excellent clinical pregnancy rates were noted in cycles with a progesterone level of 0.7-0.8 ng/ml, as well as good results in cycles above 0.8 ng/ml. There is therefore no reason to administer human chorionic gonadotropin at a smaller follicle size to prevent a rise in serum progesterone.