We report five cases of early rupture of cornual pregnancy with history of previous salpingectomy and cornual resection following in-vitro fertilization (IVF) and embryo transfer. We discuss the predisposing factors, diagnostic and therapeutic modalities in these patients. A high index of suspicion is required for an early diagnosis. It is imperative that the physicians who care for the patients be fully aware of the possibility of such a complication in a high risk population; therefore, appropriate counselling and close follow-up might help to avoid such obstetrical catastrophes, by termination of pregnancy, either surgically or medically.

In 1987, we became aware of the importance of remaining in contact with couples whose embryos had been cryopreserved for > 1 year. As a result, a questionnaire was designed to follow the fate of these embryos. Of 407 couples with cryopreserved embryos, 262 couples opted to use them within 1 year with the intention of fulfilling a parental plan. The remaining 145 couples were questioned by six successive questionnaires sent out between 1987 and 1992. By the end of the study, 336 of the 407 couples (82.5%) had chosen to utilize their embryos in a parental plan. In most cases, the maximum delay of response (5 years according to the Council of State) was respected. The remaining 71 couples (17.5%) either abandoned the parental plan or had not given any information by the end of the study. Initially, anonymous donation to another couple was chosen in preference to destroying the surplus embryos (32 versus 18 couples, P < 0.05). Latterly, however, these differences have balanced out (24 versus 28, not significant). Only those couples who initially opted to donate embryos to another couple changed their attitude in later years. In the long run, 62 couples decided not to pursue their parental plan; of these, 24 couples chose to make a gift to another couple, 28 couples opted for destruction, and 10 chose to make a gift to research. Nine couples (out of 71) declined to make a decision, but they had all achieved a pregnancy during an in-vitro fertilization (IVF) attempt. Three of these were lost to follow-up, i.e. 0.7% of all couples benefiting from the freezing technique.

Two techniques for the separation of spermatozoa were compared: swim-up migration (SUM) and centrifugation on a discontinuous Percoll gradient (CPG). Their respective effects on sperm motility were analysed by computer-assisted videomicrography in either normal or asthenozoospermic groups. In both groups, there was no difference in any of the motion parameters between the two treatments after 1-h incubation. However, a clear difference was observed after 24 h when excellent motility was retained only in the CPG-treated group. A total of 350 ejaculates were produced by the husbands of women undergoing oocyte retrieval in an IVF programme. Spermatozoa were treated by CPG when the infertility was due to poor quality spermatozoa (n = 91), when there was a known previous history of semen infection (n = 73) or when frozen semen, originating from a donor, was used (n = 36). In all other cases (n = 150), spermatozoa were treated by SUM. The cleavage rates obtained were 32.2, 70.1, 60.9 and 68.6% respectively in the four categories. The clinical pregnancy rates per oocyte retrieval were 19.8, 31.5, 22.2 and 18.0% respectively. Forty-eight births occurred in the CPG group: 28 boys and 20 girls, all normal. We conclude that CPG is useful, both in cases of poor semen quality and in tubal infertility, in which the clinical pregnancy rate increased significantly from 18.0 to 31.5%.

Unfertilized oocytes from an in-vitro fertilization programme were stored in different saline solutions and then utilized in a zona binding assay (ZBA). The four saline solutions tested were identical with regard to the capacity of the zona to bind spermatozoa provided by healthy donors. Spermatozoa from 150 infertile patients were tested in the ZBA. The number of spermatozoa bound to the zona correlated positively with sperm concentration, the percentage sperm motility and the percentage of morphologically normal spermatozoa. The population was then divided into two groups according to the level of alpha-glucosidase activity, an epididymal marker. The average number of spermatozoa bound to the zona was diminished in the group with low alpha-glucosidase activity, even when considering strictly equivalent classes of sperm concentration, motility and morphology, respectively.

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A total of 130 transfers of frozen-thawed (F-T) human embryos was carried out after moderate ovarian stimulation with human menopausal gonadotrophin (HMG). Embryos were replaced 3 days after the spontaneous luteinizing hormone (LH) surge or 4 days if ovulation was induced by human chorionic gonadotrophin (HCG). Embryos were thawed a few hours prior to transfer. One-hundred-and-twenty-three transfers were effective and 23 pregnancies were achieved. The rate of ongoing pregnancies per transfer was 17.9% (22/123). The survival rate of embryos originating from cycles stimulated by a combination of an LHRH analogue and HMG in a long protocol (LA-HMG protocol) was significantly lower when compared with the rate of embryos retrieved from clomiphene citrate-HMG (CC-HMG protocol) stimulated cycles (52 versus 67%, P less than 0.05). When fresh embryos originated from cycles stimulated with an LHRH analogue and HMG in a short protocol (SA-HMG protocol), the survival rate was not affected (59 versus 67%, NS). Although the difference was not significant, the ongoing pregnancy rate per transfer according to the three protocols from which the embryos originated seemed to be better with the SA-HMG protocol: 16% with the CC-HMG protocol, 14.5% with the LA-HMG protocol versus 27.6% with the SA-HMG protocol. The success rate was independent of the number of F-T transferred embryos if at least one embryo with 100% intact blastomeres was replaced.

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