Outcome of IVF pregnancies following severe OHSS.

Because severe ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening iatrogenic complication, much effort is made to prevent it and the anticipated pregnancy naturally becomes of secondary importance. There are many publications on OHSS, but very few on pregnancy outcomes. This work is to review the effect of OHSS on pregnancy outcome along the pregnancy course.

Can pregnancy rate be improved in gonadotropin-releasing hormone (GnRH) antagonist cycles by administering GnRH agonist before oocyte retrieval? A prospective, randomized study.

Objective: To examine whether the addition of one dose of preovulatory GnRH agonist could improve implantation and pregnancy rates in GnRH antagonist IVF cycles.

Design: Prospective, randomized clinical trial.

Setting: University-affiliated IVF and infertility unit.

A randomized clinical trial comparing recombinant hyaluronan/recombinant albumin versus human tubal fluid for cleavage stage embryo transfer in patients with multiple IVF-embryo transfer failure.

Background: We aimed to examine the efficacy of using an embryo transfer medium enriched with hyaluronan (HA) to improve implantation in a selected group of patients aged <43 years with repeated (>4) implantation failures after IVF-embryo transfer.

Methods: About 101 patients, meeting our selection criteria, were randomly allocated to undergo embryo transfer either using our routine embryo transfer medium without HA (control group) or a HA enriched commercial embryo transfer medium (study group). The primary outcome was clinical pregnancy rate.

Prospective, randomized trial of metformin and vitamins for the reduction of plasma homocysteine in insulin-resistant polycystic ovary syndrome.

One hundred and two women with insulin-resistant polycystic ovary syndrome were randomized to treatment with a vitamin B preparation, metformin, or both, in conjunction with standard infertility treatment. Plasma homocysteine levels were significantly reduced by both B vitamins and metformin, but to a greater degree by B vitamins, and higher pregnancy rates were associated with vitamin B treatment.

Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure.

Local injury to the endometrium prior to controlled ovarian stimulation may considerably improve implantation rates and pregnancy outcomes in intracytoplasmic sperm injection patients with high-order implantation failure (> or =4 IVF trials and > or =12 transferred embryos).

Ultrasonographic-guided percutaneous transabdominal puncture for oocyte retrieval in a rare patient with Rokitansky syndrome in an in vitro fertilization surrogacy program.

Objective: To describe the option of ultrasonographic-guided percutaneous transabdominal puncture for ovum pickup in a rare case of Rokitansky syndrome with subcostal located ovaries and a right single kidney.

Design: Technique and instrumentation.

Setting: A university-based hospital IVF and Reproductive Medicine Unit.

In vivo maturation of oocytes by extending the interval between human chorionic gonadotropin administration and oocyte retrieval.

Objective: To find whether the percentage of mature oocytes can be increased in the following ICSI cycle, in a selected group of patients with >or=47% immature oocytes, with the prolongation of hCG-to-oocyte retrieval interval.

Design: Randomized study.

Setting: In vitro fertilization unit in a medical center in Israel.

Oocyte maturity and preimplantation development in relation to follicle diameter in gonadotropin-releasing hormone agonist or antagonist treatments.

Objective: To analyze the distribution of oocytes nuclear maturational stages and intracytoplasmic sperm injection (ICSI) outcome in relation to follicular size, after controlled ovarian hyperstimulation (COH), using gonadotropin-releasing hormone (GnRH) antagonist or agonist protocols.

Design: Prospective comparative study.

Setting: Fertility unit in an academic hospital.

Luteal phase characteristics following GnRH antagonist or agonist treatment - a comparative study.

Due to inherent differences between gonadotrophin-releasing hormone (GnRH) antagonists and agonists, their late effect on ovarian steroidal production during the luteal phase of IVF cycles may differ. The aim of this study was to characterize and compare the luteal phase hormonal profile after the use of GnRH antagonists or agonists in ovarian stimulation protocols for IVF, in non-conception cycles, to avoid the effect of human chorionic gonadotrophin (HCG) during the luteal phase in conception cycles. Seventy-eight normo-ovulatory patients <35 years old, undergoing IVF due to male or tubal infertility were randomly allocated either to a GnRH antagonist (study group) or GnRH agonist treatment (control group).

Diagnosis of conjoined twins before 16 weeks' gestation: the 4-year experience of one medical center.

Background: Descriptions of the rarely occurring condition of conjoined twins are sparse.

Methods: We report a case series of four conjoined twin pregnancies diagnosed up to 16 weeks of gestation. One was in a quadruplet in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) pregnancy of cryopreserved embryos and the others were spontaneous conceptions.

Eight years' experience with an IVF surrogate gestational pregnancy programme.

The aim of this study was to retrospectively audit eight years' experience of an IVF surrogate gestational programme and to compare the outcome of surrogacy due to absence of the uterus with surrogacy indicated for repeated IVF failure and recurrent abortions. A total of 60 cycles of IVF surrogate pregnancy were initiated in 19 treated couples. Absence of the uterus was the indication for surrogacy in 10 cases: Rokitansky syndrome (eight cases) and post-hysterectomy (two cases) designated as group A.

A comparison of the incidence, presentation, and management of ovarian pregnancies between two periods of time.

Study Objective: To compare the prevalence, presentation diagnostic modalities, and management of 37 ovarian pregnancies in one institution during two time periods.

Design: A retrospective study (Canadian Task Force classification II-2).

Setting: Department of Gynecology in a university-affiliated hospital.

Vasa previa: the impact of prenatal diagnosis on outcomes.

Objective: To evaluate outcomes and predictors of neonatal survival in pregnancies complicated by vasa previa and to compare outcomes in prenatally diagnosed cases of vasa previa with those not diagnosed prenatally.

Methods: We performed a multicenter study of 155 pregnancies complicated by vasa previa. Cases were obtained from the Vasa Previa Foundation and 6 large hospitals.

Ovarian pregnancy-a 12-year experience of 19 cases in one institution.

Objectives: To report the prevalence, presentation, diagnostic modalities, and treatment of ovarian pregnancy in one institution.

Study Design: Retrospective case control study of 19 cases of ovarian pregnancy treated between 1990 and 2001 at Assaf Harofeh Medical Center, Zerifin, Israel.

Main Outcome Measures: Prevalence, presentation, diagnostic modalities, surgical treatment, and relation to intrauterine device (IUD) use.

Birth of healthy twins resulting from donated oocytes and posthumous use of frozen-thawed spermatozoa obtained prior to chemotherapy.

The improvement in life expectancy, following better cancer therapy combined with new options in treating male infertility have increased the use of sperm freezing. We describe a rare case of twin pregnancy of a childless widow, using donated oocytes after ICSI with her deceased husband's banked frozen spermatozoa. Sperm was frozen before chemotherapy treatment and a written consent for future thawing and injection to donor oocytes was given.

Insulin resistance in patients with polycystic ovary syndrome is associated with elevated plasma homocysteine.

Background: Elevated levels of plasma homocysteine have recently been implicated as a significant risk factor for cardiovascular disease, pre-eclampsia, and recurrent pregnancy loss, and have been found to be associated with insulin resistance in a number of clinical situations. We examined the relationship between plasma homocysteine and insulin resistance in patients with polycystic ovary syndrome (PCOS).

Methods: A total of 155 infertile patients with PCOS as defined by clinical, biochemical and ultrasound criteria were screened for insulin resistance utilizing single-sample fasting insulin and glucose measurement, calculated by glucose:insulin ratio or homeostasis model assessment (HOMA) index.

Increased frequency of female partner chromosomal abnormalities in patients with high-order implantation failure after in vitro fertilization.

Objective: To find the type and frequency of chromosomal abnormalities in a selected group of high-order implantation failure (> or =6 IVF trials and > or =15 transferred embryos) and to evaluate its impact on pregnancy outcome.

Design: A retrospective study.

Setting: In vitro fertilization (IVF) unit in a university affiliated hospital.

Increased early pregnancy loss in IVF patients with severe ovarian hyperstimulation syndrome.

Background: Since severe ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproduction, the focus of attention in such cases is placed firmly upon the health of the patient, with the endeavour to achieve a pregnancy being considered of secondary importance. The aim of this study was to focus on the pregnancy rate and pregnancy outcome in IVF patients hospitalized for severe or critical OHSS, in one centre, during a period of 6 years.

Methods: We compared the characteristics of patients with severe OHSS: those who conceived with the ones who did not conceive, and among pregnant IVF patients, those with ongoing pregnancies with those that miscarried.