Instituut for Endocrinology, Reproduction and Metabolism, IVF Center, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
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Abstract |
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Key words: IVF/natural cycle/tubal
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Introduction |
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Case report |
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In the meantime, a study protocol had been started in our centre for IVF in natural cycles. Women aged 38 years and with a history of secondary tubal infertility and regular menstrual cycles could participate. This patient was eligible and willing to participate. A baseline ultrasound scan on day 2 of menses was performed to exclude ovarian cysts, and a blood sample was drawn to determine a baseline follicle stimulating hormone (FSH) value. Serial transvaginal ultrasound and serum oestradiol plus luteinizing hormone (LH) concentration determinations were started on day 10. Follicular diameter was established by calculating the mean value of the two largest measurements perpendicular to each other. Subsequently, the patient was seen every other day until the leading follicle reached a diameter
13 mm. From then on the patient was monitored every day. When the follicular diameter reached >18 mm and the morning serum LH was <15 IU/l, the ovulation was triggered with 10 000 IU HCG between 23.30 and 24.00 h on that day (De Lauretis et al., 1994
). Vaginal oocyte retrieval was scheduled 35 h later. Only the dominant follicle was aspirated. We failed to obtain an oocyte during the first three cycles. As the patient was very eager to continue, a new attempt was started. At the fourth cycle we succeeded in obtaining an oocyte, which was fertilized. Two days later we transferred a 4-cell embryo with score 1. Early testing for serum HCG, 15 days after oocyte retrieval, confirmed pregnancy. An ultrasound performed 33 days after ovum retrieval revealed an intrauterine pregnancy with a crownrump length (CRL) of 4.3 mm and fetal heart beat of 108/min. This pregnancy ended in a miscarriage at a gestational duration of 8 weeks and 5 days. The patient started a new attempt a few months later. The protocol was not changed. Again we obtained one oocyte and transferred a 4-cell embryo score 2. The patient became pregnant again, but unfortunately this pregnancy ended also in a miscarriage at a gestational age of 8 weeks. Nevertheless, the patient was very eager to continue IVF treatment in a natural cycle and started again. This sixth attempt proceeded smoothly. During the whole period the patient was treated, no changes were made in laboratory methods, oocyte retrieval or embryo transfer techniques. The patient became pregnant once more. The first ultrasound performed at a gestational term of 6 weeks and 2 days showed an intrauterine pregnancy with a CRL of 3.2 mm and positive heart beat. Ultrasound examination at 8 and 10 weeks revealed normal progress. Amniocentesis was performed between 14 and 15 weeks gestation. The fetal karyotype was reported to be normal 46,XX, and the
-fetoprotein value was within normal limits. The patient delivered a healthy daughter after an uncomplicated pregnancy at a gestational term of 42 weeks.
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Discussion |
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The patient conceived each time after the embryo transfer in natural cycle IVF but, despite the transfer of comparable quality embryos, she never conceived in stimulated IVF. The first explanation might be that of a coincidence. However, the endometrium in natural cycle IVF is spared from the adverse effects associated with ovarian stimulation (Fossum et al., 1989; Paulson et al., 1990
) and as such might be the explanation for the success.
Natural cycle IVF is a low-cost and low-risk treatment, easy to perform, comfortable for the patient and it can be repeated on a monthly basis, therefore increasing the overall chance of success. Other authors have used natural cycle IVF as a good model for assessing fertilization and embryo development under spontaneous conditions (Zayed et al., 1997), or as a good alternative for stimulated cycles in poor responders (Bassil et al., 1999
). Encouraging results have been obtained. To establish whether it makes sense to offer natural cycle IVF to infertile patients with tubal pathology as a regular treatment, a prospective, randomized study comparing natural cycle IVF and stimulated IVF is required.
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Notes |
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References |
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De Lauretis, L., Scarduelli, C., Bailo, U. et al. (1994) IVF in natural cycles: our experience. Hum. Reprod., 9 (suppl. 4), 131.[ISI][Medline]
Fossum, G.T., Davidson, A. and Paulson, R. J. (1989) Ovarian hyperstimulation inhibits embryo implantation in the mouse. J. In vitro Fertil. Embryo Transf., 6, 710.[ISI][Medline]
Garcia, J.E., Seegar Jones, G. and Wright, G.L. (1981) Prediction of the time of ovulation. Fertil. Steril., 36, 308315.[ISI][Medline]
Johnston, I., Lopata, A., Speirs, A. et al. (1981) In vitro fertilization: the challenge of the eighties. Fertil. Steril., 36, 699706.[ISI][Medline]
Jones, H.W., Seegar Jones, G., Andrews, M.C. et al. (1982) The program for in vitro fertilization at Norfolk. Fertil. Steril., 38, 1421.[ISI][Medline]
Paulson, R.J., Sauer, M.V. and Lobo, R.A. (1990) Embryo implantation after human in vitro fertilization: importance of endometrial receptivity. Fertil. Steril., 53, 870874.[ISI][Medline]
Rongières-Bertrand, C., Olivennes, F., Righini, C. et al. (1999) Revival of the natural cycles in in-vitro fertilization with the use of a new gonadotrophin-releasing hormone antagonist (Cetrorelix): a pilot study with minimal stimulation. Hum. Reprod., 14, 683688.
Steptoe, P.C. and Edwards, R.G. (1978) Birth after the reimplantation of a human embryo. Lancet, ii, 336.
Zayed, F., Lenton, E.A. and Cooke, I.D. (1997) Natural cycle in-vitro fertilization in couples with unexplained infertility: impact of various factors on outcome. Hum. Reprod., 12, 24022407.[Abstract]
Submitted on April 20, 1999; accepted on July 15, 1999.