Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection.

Background: Embryo transfer (ET) was traditionally performed two days after oocyte retrieval; however, developments in culture media have allowed embryos to be maintained in culture for longer periods. Delaying transfer from Day two to Day three would allow for further development of the embryo and might have a positive effect on pregnancy outcomes.

Objectives: To determine if there are any differences in live birth and pregnancy rates when embryo transfer is performed on day three after oocyte retrieval, compared with day two, in infertile couples undergoing treatment with in vitro fertilisation (IVF), including intracytoplasmic sperm injection (ICSI).

Flexibility in starting ovarian stimulation at different phases of the menstrual cycle for treatment of infertile women with the use of in vitro fertilization or intracytoplasmic sperm injection.

Objective: To investigate flexibility in starting controlled ovarian stimulation at any phase of the menstrual cycle in infertile women undergoing treatment with assisted reproduction.

Design: Retrospective cohort study.

Setting: Academic tertiary-care medical center.

Luteal support: progestogens for pregnancy protection.

Following ovulation, the granulosa cells undergo luteinization and form part of the corpus luteum; this then secretes progesterone that causes secretory transformation of the endometrium so that implantation can occur. The ideal time for implantation is 6-10 days after the luteinizing hormone (LH) surge; implantation occurring outside this optimal window is associated with a higher likelihood of miscarriage. Before the placenta takes over progesterone production, the progesterone produced by the corpus luteum also provides the necessary support to early pregnancy.

WITHDRAWN: Luteal phase support in assisted reproduction cycles.

Background: The aspiration of the granulosa cells that surround the oocyte and the use of gonadotropin releasing hormone agonists (GnRHa) during assisted reproduction technology (ART) treatment can interfere with the production, during the luteal phase, of progesterone, which is necessary for successful implantation of the embryo. Providing hormonal supplementation during the luteal phase with either progesterone itself, or human chorionic gonadotropin (hCG), which stimulates progesterone production, may improve implantation and, thus, pregnancy rates.

Objectives: To determine (1) if luteal phase support after assisted reproduction increases the pregnancy rate, (2) the optimal hormone for luteal phase support, i.

Assisted reproductive technologies (ART) in Canada: 2003 results from the Canadian ART Register.

Objective: To present the success rates of assisted reproductive technologies (ART) cycles performed in 2003 in Canada. This is the third annual report of outcomes compiled in the Canadian Assisted Reproductive Technologies Register.

Design: Prospective cohort study.

Methodological issues in infertility research.

It is now well established that clinical decision-making can be enhanced by incorporating evidence from valid studies. This evidence-based approach to health-care management requires a critical appraisal of the available evidence, most of which is of relatively poor quality. If the best evidence is to be put forward to support clinical decisions then it must be derived from studies of high methodological rigour.

Assisted reproductive technologies (ART) in Canada: 2002 results from the Canadian ART Register.

Objective: To present the success rates of assisted reproductive technology (ART) cycles performed in 2002 in Canada. This is the second annual report of Canadian ART outcomes.

Design: Prospective cohort study.

Is there a benefit of low-dose aspirin in assisted reproduction?

Purpose Of Review: Assisted reproduction is an effective treatment for infertile women but, despite advances in ovarian stimulation and laboratory techniques, overall pregnancy rates are still relatively low suggesting that methods to improve implantation are required. One strategy is to increase the blood flow to the uterus with low-dose aspirin. The objective of this review is to determine if low-dose aspirin improves clinical pregnancy rates when administered to infertile women undergoing treatment with assisted reproduction.

Assisted reproductive technologies (ART) in Canada: 2001 results from the Canadian ART Register.

Objective: To present the success rates of assisted reproductive technologies (ART) cycles performed in 2001 in Canada.

Design: Retrospective cohort study.

Setting: Nineteen of 22 ART centers in Canada.

Follicle-stimulating hormone in clinical practice: an update.

Follicle-stimulating hormone (FSH), a glycoprotein produced by the anterior pituitary gland, plays an important role in the regulation of fertility in both men and women. FSH is used clinically to treat women with anovulatory infertility, for controlled ovarian stimulation in women being treated with assisted reproductive technologies (ART), and in the treatment of male hypogonadotrophic hypogonadism. Urine-derived gonadotropin preparations containing variable amounts of FSH together with urinary proteins have been available for many years.

Evidence-based investigations and treatments of recurrent pregnancy loss.

Objective: To give an overview of currently used investigations and treatments offered to women with recurrent pregnancy loss (RPL) and, from an evidence-based point of view, to evaluate the usefulness of these interventions.

Design: Ten experts on epidemiologic, genetic, anatomic, endocrinologic, thrombophilic, immunologic, and immunogenetic aspects of RPL discussed methodologic problems threatening the validity of research in RPL during and after an international workshop on the evidence-based management of RPL.

Conclusion(s): Most RPL patients have several risk factors for miscarriage, and an extensive investigation for all major factors should always be undertaken.

Life table (survival) analysis to generate cumulative pregnancy rates in assisted reproduction: are we overestimating our success rates?

The variability in the numbers of treatment cycles couples may undertake with assisted reproductive technology (ART) and the length of time they may have to wait between successive cycles of treatment make the evaluation of treatment efficacy and prognosis complicated. The cumulative pregnancy rate using the life table method of analysis is being used more frequently to estimate the effectiveness of treatment. Although this approach is valid in some areas of infertility research, its use in ART is not appropriate, because the factors necessary for the analysis (particularly the scale for measuring the passage of time and lack of informative censoring) are not satisfied.

Ovulation induction in women with polycystic ovary syndrome: randomized trial of clomiphene citrate versus low-dose recombinant FSH as first line therapy.

This single centre randomized controlled trial was undertaken to compare the efficacy and safety of clomiphene citrate and low-dose recombinant FSH as first line pharmacological therapy for anovulatory infertility associated with polycystic ovary syndrome (PCOS). Seventy-six infertile patients with PCOS were randomized to receive clomiphene citrate (50-150 mg/day for 5 days) (clomiphene citrate group, n = 38) or recombinant human FSH (FSH group, n = 38) in a chronic, low-dose, step-up protocol (daily starting dose 75 IU) for up to three consecutive cycles. Ovarian response was monitored by transvaginal ultrasonography and human chorionic gonadotrophin (HCG) was given to trigger ovulation in all cycles with appropriate follicular development.

European Classification of Infertility Taskforce (ECIT) response to Habbema et al., 'Towards less confusing terminology in reproductive medicine: a proposal'.

The European Classification of Infertility Taskforce (ECIT) has been formed by ESHRE to develop a set of infertility-related codes (descriptions, interventions and outcomes) appropriate for computerization (http://www.ecit.info).

Cost-effectiveness of recombinant versus urinary follicle-stimulating hormone in assisted reproduction techniques in the Spanish public health care system.

Purpose: To evaluate the relative cost-effectiveness of recombinant and urinary follicle-stimulating hormone (FSH) in assisted reproduction techniques in the Spanish National Health Service.

Methods: Markov modelling was used to compare costs and outcomes of three complete treatment cycles using recombinant or urinary FSH for controlled ovarian stimulation. Cost and effectiveness estimates were obtained from the literature and from Spanish clinicians.

Characteristics of good causation studies.

The study of causal relationships is important when addressing questions of efficacy of treatment interventions and etiology of disease. The evaluation of a cause-and-effect relationship between exposure to a putative causal factor and outcome can be undertaken using a variety of study designs including randomized controlled trial and cohort and case control studies. Study participants should be selected in a manner that minimizes bias and confounding and is representative of the target population.

Updated meta-analysis of recombinant follicle-stimulating hormone (FSH) versus urinary FSH for ovarian stimulation in assisted reproduction.

Objective: To determine the relative efficacy of recombinant FSH (rFSH) and urinary FSH (uFSH) for ovarian stimulation in assisted reproductive techniques (ART).

Design: Systematic review and meta-analysis of randomized, controlled trials comparing rFSH and uFSH.

Setting: Infertility centers providing treatment with ART.

Analysis of the cost effectiveness of recombinant versus urinary follicle-stimulating hormone in in vitro fertilization/intracytoplasmic sperm injection programs in the United States.

Objective: To compare the cost effectiveness of recombinant human FSH (Gonal-F; Serono, Inc., Randolph, MA) and urinary FSH (Fertinex; Serono, Inc.) for ovarian stimulation during IVF with or without intracytoplasmic sperm injection for the treatment of infertility.