This study explores the relevance of mid-luteal serum hormonal concentrations in cryopreserved embryo transfer cycles conducted under hormone replacement therapy (HRT) control and which involved single-embryo transfer (SET) of 529 vitrified blastocysts. Widely ranging mid-luteal oestradiol and progesterone concentrations ensued from the unique HRT regimen. Oestradiol had no influence on clinical pregnancy or live birth rates, but an optimal progesterone range between 70 and 99 nmol/l (P < 0.005) was identified in this study. Concentrations of progesterone below 50 nmol/l and above 99 nmol/l were associated with decreased implantation rates. There was no clear interaction between oestradiol and progesterone concentrations but embryo quality grading did show a significant influence on outcomes (P < 0.001 and P = 0.002 for clinical pregnancy and live birth rates, respectively). Multiple comparison analysis showed that the progesterone effect was influential regardless of embryo grading, body mass index or the woman's age, either at vitrification or at cryopreserved embryo transfer. The results support the argument that careful monitoring of serum progesterone concentrations in HRT-cryopreserved embryo transfer is warranted and that further studies should explore pessary adjustments to optimize concentrations for individual women to enhance implantation rates.

Reduced in-vitro fertilization of human oocytes from patients with raised basal luteinizing hormone levels during the follicular phase 58, 203-212. Vandenberg, J . L. & Y e n , S. S. (1973) Effect of antioestrogenic action of clomiphene during the menstrual cycle: evidence for a change in the feedback sensitivity. J Clipl Endocrind Mercrh 37, 356-365. Whittingham, D . (1971) Culture of mouse ova. J Reprod Fertil 14, [Suppl.] 7-21,

In a sequential crossover study of IVF conducted from 2002 to 2006, growth hormone (GH) supplementation was assessed in poor-prognosis patients, categorized on the basis of past failure to conceive (mean 3.05 cycles) due to low response to high-dose stimulation (<3 metaphase II oocytes) or poor-quality embryos. Pregnancy rates in both fresh and frozen transfer cycles and the total productivity rates (fresh and frozen pregnancies per egg collection) were compared. In all, 159 patients had 488 treatment cycles: 221 with GH and 241 without GH. These cycles were also compared with 1572 uncategorized cycles from the same period. GH co-treatment significantly improved the clinical pregnancy rate per fresh transfer (P<0.001) as well as per frozen-thawed embryo derived from GH cycles (P<0.05) creating a highly significant productivity rate (P<0.001). The effect was significant across all age groups, especially in younger patients, and was independent of stimulation modality or number of transfers. GH cycles resulted in significantly more babies delivered per transfer than non-GH cycles (20% versus 7%; P<0.001) although less than the uncategorized cycles (53%). The data uniquely show that the effect of GH is directed at oocyte and subsequent embryo quality.

PIVET Medical Centre has developed an empirical algorithm for the dose of FSH administration based upon day-2 FSH, antral follicle count, anti-Müllerian hormone, body mass index, age and smoking parameters in an attempt to reduce the incidence of ovarian hyperstimulation syndrome particularly in at-risk women with elevated antral follicle count and anti-Müllerian hormone. The algorithm utilized the incremental dosage capabilities of the recombinant FSH pens to fine-tune the daily concentration of FSH. Application of the algorithm aimed to minimize any form of excessive follicle recruitment that necessitated increased clinical awareness. The measure used to assess the impact of the algorithm was the number of women who, after oocyte retrieval, were considered to be potentially at risk of any degree of OHSS and were allocated to increased monitoring. Compared with the previous 20-month period, introduction of the algorithm significantly reduced both the incidence of referral for increased monitoring, treatment for OHSS and the incidence of freeze-all cycles (all P < 0.05). This was particularly focused on those considered to be at risk without reducing the fresh cycle pregnancy rate.

Transvaginal ultrasound-guided embryo transfer was performed on 121 consecutive patients. Observation was made of guiding cannula and transfer catheter placement in relation to the endometrial surface and uterine fundus during embryo transfer. The position and movement of a transfer-associated air bubble and the impact of subendometrial myometrial contraction leading to endometrial movement was observed. Results indicate that tactile assessment of embryo transfer catheter placement is unreliable: in 17.4% of transfers the outer guiding catheter inadvertently abutted the fundal endometrium. The outer guiding cannula indented the endometrium in 24.8% and the transfer catheter embedded in the endometrium in 33.1%. Unavoidable sub-endometrial transfers occurred in 22.3% of transfers. Ultrasound-guided transfer avoided accidental tubal transfer in 7.4% of transfers. Transfer catheter withdrawal did not significantly affect embryo transfer-associated air bubble position. Endometrial movement due to sub-endometrial myometrial contraction was obvious in 36.4% of cases, with active motion of the transfer-associated air bubble occurring in 28.1%. Pregnancies occurred in 45.5% of transfers with endometrial movement compared to 15.6% (P < 0.001) without.