Adjusting to life when assisted conception fails.

According to our basic (psychosomatic) tenet, every somatic problem has its emotional side; therefore, medical treatment and counselling are not separate but are interlinked and equally important. First interviews and interviews after failed assisted reproductive technology (ART) are held together in four person settings; the couple with two counsellors. The sessions last for approximately 1 h.

Prognostic appraisal of success and failure in an in vitro fertilization program by transvaginal Doppler ultrasound at the time of ovulation induction.

In 323 stimulated cycles of women participating in in vitro fertilization treatment, a transvaginal Doppler examination was performed on the day of ovulation induction to investigate the value of blood flow velocimetry of the uterine artery. The results showed a significantly lower pulsatility index in patients who conceived (n = 42) compared with those who did not become pregnant (n = 272). The differences were especially marked during the first cycles.

[Ultrasound monitoring of follicle growth in IVF].

Vaginal sonography is a well-established method to monitor follicular growth and to detect the optimum time for induction of ovulation with hCG. In this study we found significantly less and smaller follicles in the left ovary compared to the right. However, during the procedure of oocyte retrieval we found an equal number of follicles and oocytes in both ovaries.

[Vaginal ultrasonographic observation of uterine contractions in embryo transfer and its relevance to treatment success].

441 patients were treated by in-vitro fertilisation and embryo transfer (ET) from January 1989 to May 1990. Transvaginal ultrasound allowed pre-transfer assessment of the uterine architecture and confirmation of successful transfer after the procedure. The length and direction of the cervical and uterine cavity were noted.

[Comparison of various methods of cryopreservation of human pre-embryos].

A human egg and embryo freezing program for non-fertilized eggs and spare embryos has been established in our in vitro fertilization clinic. In the following we report on our first experience with different methods of human pre-embryo cryopreservation. In a simple evaluation we have compared different conventional freezing techniques using cryoprotectant substances such as glycerol, DMSO and 1.

Experience with a new fixed-stimulation protocol without hormone determinations for programmed oocyte retrieval for in-vitro fertilization.

A new fixed schedule of ovarian stimulation for in-vitro fertilization (IVF) was developed that is not only simpler and easier to handle for the patients but also gives a better fertilization and pregnancy rate. The period and the start of stimulation is shifted by means of a contraceptive pill in such a way that stimulation is generally started on a Sunday. The patient takes clomiphene, (100 mg) for 5 days and prednisolone (7.

A fixed stimulation protocol for in vitro fertilization (IVF) without determinations of hormones in blood.

A new fixed schedule of ovarian stimulation for IVF was developed, which is not only simpler and easier to handle for the patients but also yields better fertilization and pregnancy rates. The period and beginning of stimulation are shifted by means of a contraceptive pill, so that stimulation can generally be started on a Sunday. The patient takes 100 mg clomiphene for 5 days and 7.

Treatment of unruptured ectopic pregnancy by needling of sac and injection of methotrexate or PG E2 under transvaginal sonography control. Report of 10 cases.

We report transvaginal puncture of ectopic pregnancy and instillation therapy under sonographic control in 10 cases. Only patients with rising beta-hCG levels were selected for treatment. In 9 cases we instilled methotrexate and in 1 case prostaglandin E2.

Studies on psychosomatic implications of infertility--effects of emotional stress on fertilization and implantation in in-vitro fertilization.

A case report shows the long and stony path of a couple who had to go through eight attempts at IVF in 4 years until the desired child was achieved. The psychosomatic implications of the various 'failures' of treatment become clearer when compared with the results of a psycho-endocrinological questionnaire completed by 551 patients and 115 controls since 1982. This questionnaire contains among others the Giessen personality test for the image of self, mother and father, a somatic complaints score to evaluate the severity of autonomic disorders, items for the presence and severity of possible gynaeco-endocrinological symptoms and items to evaluate the reference persons and their changes during childhood.

[Transvaginal Doppler sonography for measuring blood flow in the pelvis].

This is a report on our first experience with transvaginal Doppler sonography. In this way we can measure the different blood flow parameters in the internal iliac, ovarian and uterine arteries during the menstrual cycle. The detection of the particular vessels and their typical waves of flow are described in detail.

Prednisolone supplementation to Clomid and/or gonadotrophin stimulation for in-vitro fertilization--a prospective randomized trial.

In a prospective randomized trial, 73 patients received prednisolone, 7.5 mg daily, for one cycle in addition to Clomid and/or gonadotrophins, while another 73 patients were not given the corticosteroid. In-vitro fertilization (IVF) resulted in 16 versus six clinical pregnancies in the prednisolone and the non-prednisolone group, respectively (P less than 0.

Smoking and in-vitro fertilization.

One-hundred and fourteen patients who underwent IVF treatment were asked about their smoking habits. Their rhodanide (SCN) concentrations were then estimated in serum and follicular fluid. SCN has been identified as an indicator for the amount of cigarettes smoked.

Transvaginal sector scan sonography for needle guided transvaginal follicle aspiration and other applications in gynecologic routine and research.

A transvaginal sector scanner probe has been developed for precise needle-guided transvaginal follicle aspiration under sonographic control. The first results of transvaginal needle-guided follicle aspiration are presented. A high recovery rate was obtained (86% /follicle).

The use of synthetic culture medium and patient serum for human in vitro fertilization and embryo replacement.

The use of heat-inactivated patient serum as both fertilization and embryo replacement medium was compared in a prospective randomized study with a fully synthetic culture medium containing human serum albumin without serum addition (B3 INRA Menezo). Another series of the author's IVF program was analyzed retrospectively when a commercially available synthetic medium with bovine serum albumin (B2 INRA Menezo) or B3, as mentioned above, was used without serum addition for fertilization but with 50-100% patient serum as embryo replacement medium. Fertilization rates were significantly higher in the synthetic culture media (70%) than in serum (57%).

[Initial results of a cryopreservation program for human ova and embryos].

A human egg and embryo freezing program for non fertilized eggs and spare embryos was established recently in our ib vitro fertilization clinic. The first results are reported. Two cryoprotectants, glycerol and dimethylsulfoxid (DMSO) were used in an automatic computerized freezing program.

Trans-vaginal oocyte retrieval using a trans-vaginal sector scan probe combined with an automated puncture device.

A new trans-vaginal sector scanning ultrasound probe has been developed providing a forward viewing sector of 240 degrees. Due to its rotating one-beam scanner, the images of the uterus and the ovaries with their follicles are of high resolution and are clearly outlined on the screen. An automated puncturing device has been adjusted to this probe which gives the surgeon more precision in placing the tip of an aspiration needle into the middle of the follicle.