Indications for and results of intracytoplasmic sperm injection (ICSI).

In this report the indications for, and the results of, 1275 consecutive ICSI cycles carried out between October 1991 and December 1993 are described. Failure of fertilization in at least one previous IVF cycle, semen parameters below the threshold for standard IVF treatment and successful MESA or TESE procedure performed in patients with obstructive or non-obstructive azoospermia, respectively, were the indications in these ICSI cycles. In 1194 cycles, ejaculated spermatozoa were used, whereas 59 and 17 cycles were performed with epididymal and testicular spermatozoa, respectively.

Fertility after hysteroscopic myomectomy.

The available data concerning hysteroscopic myomectomy for submucous myomas has been reviewed with the aim of evaluating the safety and efficacy of this technique in infertile women who wish to preserve or to enhance their fertility potential. A total of 134 infertile patients undergoing hysteroscopic myomectomy by resectoscope or by Nd: YAG laser or by scissors have been collectively recorded. Of these, 79 (58.

A survey of four years of experience with intracytoplasmic sperm injection.

The present report covers the results of a 38-month period in which 2853 consecutive intracytoplasmic sperm injection (ICSI) cycles were performed in 1953 couples. These couples were afflicted with male factor infertility and had at least one previous failed conventional in vitro fertilization (IVF) treatment cycle. In other couples, the husband had semen parameters incompatible with conventional IVF or suffered from excretory or secretory azoospermia where it was possible to recover spermatozoa by microsurgical epididymal sperm aspiration (mesa) or by testicular sperm extraction (tese) procedure.

Pregnancy and birth after high serum progesterone concentrations during the follicular phase in an in-vitro fertilization cycle with gonadotrophin-releasing hormone agonist suppression.

This case illustrates the possibility of achieving a pregnancy and birth when elevated progesterone concentrations (> 4 ng/ml) are present during the follicular phase (from 6 days before human chorionic gonadotrophin injection) of a gonadotrophin-releasing hormone agonist/menotrophin cycle for in-vitro fertilization (IVF). The present patient underwent three IVF/embryo transfer cycles in which progesterone concentrations were repeatedly increased from the midfollicular phase onwards. A pregnancy was achieved after the first IVF attempt but ended in a miscarriage in the 19th week of gestation.

Operative laparoscopy for pelvic and extrapelvic pathology.

The treatment of pelvic adhesions has been the first and more successful indication for operative laparoscopy. Frequently this intervention is the first step of others laparoscopic procedures. The different modalities of these interventions, i.

Operative laparoscopy for uterine pathology.

In the first years of its use, operative laparoscopy for uterine pathology was employed in the surgical treatment of myomas and in the correction of uterine retroversion (hysteropexy). More recently the technique has been employed for the laparoscopically assisted hysterectomy or for subtotal laparoscopical hysterectomy using the Semm Kit. Also radical hysterectomy has been performed in advanced centers by laparoscopy.

Operative laparoscopy for tubal pathology.

Tubal pathology has represented in the last years, the main indication to operative laparoscopy, mainly as a consequence of the widespread use of this technique in the treatment of the ectopic pregnancy. Furthermore, operative laparoscopy has been widely applied to the treatment of the distal tubal pathology for infertility, when IVF/ET failed or was not accepted. The Authors discuss the rationale for these applications of operative laparoscopy and also the possibility of performing by laparoscopy demolitive interventions on the tubes.

Operative laparoscopy in assisted reproduction.

After the introduction of transvaginal ultrasound guided recovery of oocyte, the use of laparoscopy in Assisted Reproductive Technology is limited to GIFT and ZIFT or TET method and to the selection of patients. In this paper the Authors discuss about these methods, the advantages of tubal gametes or embryos transfer versus uterine transfer.

Operative laparoscopy for ovarian pathology.

In the last few years, the improvements of the operative laparoscopy have led to the use of these techniques as an alternative to traditional surgical approaches. Ovarian pathology has been more and more treated by a laparoscopic approach. In this paper, the risks and complications of the operative laparoscopy in the different forms of ovarian pathology.

Luteal phase defects in assisted reproduction: the role of luteal phase supplementation.

Data from literature show that whereas in non-GnRH-a controlled ovarian hyperstimulation cycles luteal phase supplementation is not crucial, its use in GnRH-a/gonadotropins protocols seems to lead to a definite reduction of the negative effects of such drugs. The most important side effect of the hCG use as luteal support is the increased rate of the ovarian hyperstimulation syndrome (OHSS). Therefore its use should be reserved for very selected patients, for those subjects with preovulatory levels of E2 < 2500 pg/ml.