Search

Infertility can be overcome by using a variety of techniques, including oocyte donation in which eggs from one woman's ovary are removed, fertilized and transplanted to an infertile woman's uterus in order to produce a successful pregnancy. Women having no ovaries, dysfunctioning ovaries, egg retrieval failure, or potential genetic disease transmission can benefit from egg donation. Prior to egg donation procedures, women having no menstrual cycles require artificial hormonal stimulation to create a receptive uterine environment. Due to the difficulties in coordinating donor and recipient cycles, frozen eggs can be used or hormonal medications may be manipulated to lengthen a portion of the recipient's cycle. The rate of pregnancy per fertilized egg transfer is 20 to 30 percent using this method. In the Monash-Epworth study the oocyte donation method used resulted in 22 pregnancies, and, to date, 13 healthy infants have been born. From this research the hormonal requirements of the uterus can be studied to further evaluate the requirements for successful oocyte implantation.

Frozen-thawed donor semen was compared with freshly ejaculated donor semen for in vitro fertilization of human oocytes in patients with infertile husbands. There was no significant difference in the fertilization rates between frozen-thawed (85%) and fresh spermatozoa (78%). Fertilization occurred with semen stored for as long as 27months and with numbers of spermatozoa as low as 20,000/ml culture medium for insemination of oocytes. Pregnancy rates of embryos, fertilized with frozen-thawed and freshly ejaculated spermatozoa, were similar following embryo transfer.

In vitro fertilization (NF) and embryo transfer (ET) have resulted in the birth of nine babies, including twins. One of the twins had a congenital cardiac malformation and seven of the nine babies were girls. Labor occurred preterm in two pregnancies; and in six delivery was by cesarean section. Plasma human chorionic gonadotropin (hCG), progesterone (P), and estriol (E3) measurements and ultrasonic scans showed no obvious differences from pregnancies resulting from natural conception.

An instrument has been devised specifically for the collection of mature oocytes at laparoscopy for the purpose of in vitro fertilization. The instrument was evaluated and the oocyte recovery rate was compared with that obtained with two other instruments, which had been in use previously, in a controlled trial over the same period of time. It was found that the newly devised instrument resulted in the recovery of all of the oocytes from 17 follicles in which aspiration was attempted. The oocyte recovery rate was significantly better with this instrument than with either of the two instruments previously used. It was also apparent that the finer-bore needle of the two instruments previously used was more effective for oocyte recovery. The new instrument is now in routine use for oocyte collection.

The results of in vitro fertilization of mature oocytes obtained at diagnostic laparoscopy from patients with both known and unknown clinical causes of infertility are presented. A simple regimen involving the use of clomiphene and human chorionic gonadotropin which enabled laparoscopy to coincide with available surgical lists resulted in the recovery of mature oocytes from 15 of the 18 patients treated. Apparently normal embryos developed from five of six oocytes recovered from patients who had blocked fallopian tubes or who were being investigated after 8 to 12 months of artificial insemination by donor. No normal embryos developed from oocytes from nine patients who had sustained infertility of unknown cause for 2 years or more. When this latter group was compared with other groups a high rate of fertilization failure was noted, and severe polyspermy developed in two cases. The results are discussed in relation to the diagnosis of infertility and the management of infertile patients.

In a program of human in vitro fertilization (IVF), the results of 204 attempted intracervical embryo transfers (ETs), using a variety of catheters in three trials over 18months, have been analyzed for the ease of transfer and pregnancy rate. In nulliparous patients, transfers were more difficult than in multiparous patients; and a closed-end Teflon catheter was found to be more easily passed through the smaller cervical canal than an open-end catheter. The overall pregnancy rate was 17% (March 1980 to August 1981) and was not related to catheter type, although when chemical pregnancies were excluded, it was found that transfers using open-end catheters were more successful. The transfer procedure developed finally for routine use incorporates a consideration of these results.

In vitro fertilization (IVF) and embryo transfer (ET) have resulted in the birth of nine babies, including twins. One of the twins had a congenital cardiac malformation and seven of the nine babies were girls. Labor occurred preterm in two pregnancies; and in six delivery was by cesarean section. Plasma human chorionic gonadotropin (hCG), progesterone (P), and estriol (E3) measurements and ultrasonic scans showed no obvious differences from pregnancies resulting from natural conception. Cytogenetic studies from cord blood and histologic examination of the placentas were unremarkable. The theoretic risks of pregnancy following IVF and ET are discussed. Definite conclusions cannot be drawn until a larger number of babies are delivered and a long-term follow-up is completed. Initial results from the current small sample are encouraging.

An analysis of nine pregnancies resulting from in vitro fertilization and embryo transfer was made in order to identify factors common to all of the pregnancies. These factors included clomiphene stimulation; general anesthesia for laparoscopy; identification of large follicles (>8 ml) and a mature oocyte; preincubation of the oocyte for 4.7 to 6.5 hours in vitro before insemination; insemination with 0.8 to 1.3 × 106fresh spermatozoa from fertile samples; transfer to the uterus of two-, four-, and eight-cell embryos, 38 to 50 hours after insemination; and uncomplicated uterine transfers of embryos. It was difficult to determine whether these factors are causal or coincidental in the attainment of successful pregnancies.

In 831 patients having 1533 in vitro fertilization treatments, pregnancy rates were examined in relation to clinical and laboratory factors. Pregnancy rates were significantly affected by the month and year of treatment, the age of the patient, the type of ovarian stimulation, the use of human chorionic gonadotropin, the number of eggs collected, the number of eggs fertilized, the number of embryos developed, and the number of embryos transferred. The most important factors determining pregnancy rates were the number of oocytes collected and the number of embryos transferred. The low pregnancy rate when only one egg was collected raises the problem of how to predict and manage such a patient in a current or future treatment cycle.

The success of in vitro fertilization (IVF) and embryo transfer has been examined with regard to five categories of infertility over a 2-year period. Fertilization rates in vitro were highest in women with bilateral tubal blockage and women treated for endometriosis. There was a significant reduction of~13% in the fertilization rate of couples with idiopathic infertility and women who had failed to conceive after 12cycles of artificial insemination by donor. A further substantial reduction in the fertilization rate occurred when the husband had low quality semen, particularly when no abnormality was detected in the wife. Repeated IVF in couples with idiopathic infertility eventually resulted in fertilization. It is recommended that donor spermatozoa not be used for cases of idiopathic infertility, but it may be needed in cases of poor semen quality. There were no differences in the pregnancy rates following embryo replacement in any of the groups studied, nor was there any detectable effect of age on fertilization or pregnancy rates up to the age of 44years.

The initial stage of an ongoing program for in vitro fertilization of human eggs and the transfer of cultured embryos into the uteri of women with occluded fallopian tubes is described. All women included in the program had ovulatory menstrual cycles and were given a 5-day course of clomiphene citrate to induce stimulated ovarian follicular development. A marked increase in urinary estrogen excretion was used for timing the administration of human chorionic gonadotropin (hCG), which was injected 19 to 36 hours before follicles were aspirated during laparoscopy or laparotomy. In the 27 patients treated, an average of 5.7 follicles was aspirated per patient and yielded an average of one preovulatory egg per patient. The mean duration of the luteal phase was 13.4 days and increased significantly to a mean of 16.4 days (P<0.01) when 1000IU of hCG were injected on the 2nd and 4th days after follicular aspiration. Of 33 eggs inseminated in vitro, 16 contained morphologic criteria of fertilization. Of these, five cleaved in culture and three were transferred into the uterine cavities of the egg donors at the eight-cell stage of development. In two patients a transient increase in hCG excretion was detected after an embryo was transferred into the uterus.