A randomized trial of in vitro fertilization versus conventional treatment for infertility (original) (raw)

Intracytoplasmic sperm injection versus in vitro fertilization for patients with a tubal factor as their sole cause of infertility: a prospective, randomized trial

Fertility and Sterility, 2000

To compare the efficacy of intracytoplasmic sperm injection and IVF in women with a tuboperitoneal factor as their sole cause of infertility. Prospective, randomized study. Hacettepe University Assisted Reproduction Unit, Ankara, Turkey. Seventy-six consecutively seen patients with tuboperitoneal factor infertility were randomized on an alternate basis to undergo either intracytoplasmic sperm injection (38 patients and cycles) or IVF (38 patients and cycles). Intracytoplasmic sperm injection and IVF. Fertilization, implantation, and clinical pregnancy rates. A comparable number of oocytes and embryos were obtained with intracytoplasmic sperm injection and IVF. The two-pronuclei fertilization rates per metaphase II oocyte or mature cumulus-oocyte complex were similar in the two groups. The numbers of total and grade I embryos transferred also were similar. Comparisons of intracytoplasmic sperm injection and IVF did not reveal any statistically significant differences in individual implantation rates (38.75% +/- 24.46% and 34.58% +/- 16.97%, respectively) clinical pregnancy rates per cycle (21.05% and 21.05%, respectively), or take-home infant rates (18.42% and 15.79%, respectively). The type of procedure performed was not a significant predictor of clinical pregnancy. When a decision is made to proceed with an assisted reproductive technique in patients with a tubal factor as their sole cause of infertility, IVF should be the initial treatment of choice.

A Comparison of Fertility Rates in Women Undergoing IVF with a Tubal Factor with Surgery, Tubal Factor Infertility Without Surgery, and Unexplained Infertility

Journal of Obstetrics, Gynecology and Cancer Research, 2020

Background & Objective: Many factors are essential for a pregnancy to be successful. Recognizing the factors caused by surgical trauma may be effective in guiding pregnancies toward success using the assisted reproductive treatment methods. Surgery changes the natural anatomical relation between the ovaries and fallopian tubes. Tubal surgery is hypothesized to reduce ovarian reserve due to the anatomical relationship between the ovarian arteries and nerves and fallopian tubes. There is no consensus on whether or not salpingectomy affects ovarian reserve. Some authors believe that salpingectomy has no effects, while others suggest that it diminishes ovarian reserve. Therefore, comparing fertility rates between women undergoing in vitro fertilization with tubal factor infertility with surgery, tubal factor infertility without surgery, and unexplained infertility can provide valuable data. Materials & Methods: Eighty patients who met the inclusion criteria were studied. Study groups included people with a history of tubal surgery, individuals who had tubal problems without a history of surgery, and cases with unexplained infertility. Anti-Mullerian hormone (AMH) was measured every day of the cycle and other hormones, including follicle-stimulating hormone (FSH), luteinizing hormone, prolactin, and thyroid-stimulating hormone (TSH) were assessed on days 2-5 of the cycle. On the third day of the menstrual cycle, the uterus, endometrial thickness, ovaries, the size of the ovaries, and antral follicle count were evaluated using transvaginal sonography. Following ovulation induction, treatment-related factors, namely endometrial thickness, gonadotropin (Gn) time and count, E2, viable embryos, and good quality embryos, were examined. Results: Our findings showed no difference between the study groups in terms of treatment-related factors. No significant correlation was observed between the studied groups and chemical pregnancy (P=0.9514). moreover, the studied groups were not significantly correlated with clinical pregnancy (P=0.5052). Conclusion: The AMH was correlated with FSH, AFC, E2, and gonadotropin time and count. According to the results of the present study, tubal surgery does not affect the outcome of assisted reproductive cycles.

Evidence-based reproductive surgery: tubal infertility

International Congress Series, 2004

The goal for any infertile couple is to explore all reasonable attempts to achieve pregnancy. The couple with infertility resulting from tubal disease has two therapeutic options to achieve this goal: reconstructive tubal surgery and in vitro fertilization. However, the increasing demand for new techniques of assisted reproduction has called into question the value of the more established methods of treatment for tubal infertility. There are some causes of tubal infertility for which surgery has virtually no chance of success. For these situations, in vitro fertilization is clearly the only therapeutic option. For other situations, the decision-making process requires detailed discussion on the effectiveness, adverse effects and cost of the procedures. Endoscopic evaluation of the tubal mucosa is essential for the selective application of tubal surgery. The available evidence shows that tubal surgery can be as, or more, effective as in vitro fertilization for cases of filmy adhesions, mild distal tubal occlusion and proximal obstruction. It may, however, be reasonable to discuss in vitro fertilization with any couple without pregnancy 12 months after tubal surgery. In women with moderate to severe distal tubal disease, the diminishing success rates from surgery suggest that in vitro fertilization should be considered as the first line of treatment. In the case of unsuccessful reconstructive surgery, or if a hydrosalpinx is irreparably damaged, a salpingectomy prior to in vitro fertilization has to be considered. Tubal surgery has indisputable benefits for the patient if infertility is cured by the intervention. A successful tubal repair gives the patient the possibility of conceiving more than once without further treatment. It also gives the couple the psychological advantage of being able to conceive spontaneously. Probably the most pragmatic viewpoint is to consider reproductive surgery and in vitro fertilization as complementary options that are directed towards increasing the overall probability of achieving a pregnancy in the most efficient manner. D 2004 Published by Elsevier B.V.

Tubal disease and assisted reproduction

The Obstetrician & Gynaecologist, 2008

• Surgery can be useful in selected cases of tubal infertility and may have a complementary role for some women undergoing in vitro fertilisation (IVF). • Salpingectomy for women with large hydrosalpinges can improve the success rate of IVF. • There is little evidence that laparoscopy offers any advantage over laparotomy for tubal surgery. • Structured training in reproductive surgical techniques is of critical importance. Learning objectives: • To understand the selection criteria for tubal surgery and evaluate the supporting evidence. • To understand the limitations of the existing evidence. • To be able to counsel infertile couples appropriately. Ethical issues: • Couples seeking fertility treatment may receive unreliable or biased information when considering tubal surgery. • Is it ethical to perform tubal surgery on women with a low chance of success simply because they are unable to have IVF? Keywords in vitro fertilisation / hydrosalpinges / salpingectomy / tubal surgery Please cite this article as: Siassakos D, Syed A, Wardle P. Tubal disease and assisted reproduction.

Pregnancy Success Rates by Different Assisted Reproductive Techniques in Tubal, Ovarian, and Sperm Disorders

Journal of Client-Centered Nursing Care, 2020

Background: Assisted Reproductive Techniques (ART) have been used for addressing numerous causes of infertility. However, it remains unclear which kind of these methods are best for various infertility types. Accordingly, this study aimed at determining pregnancy success rates by different ART in tubal, ovarian, and sperm disorders. Methods: The present descriptive retrospective study used the records of individuals who had referred to the Infertility Center of Kerman University of Medical Sciences from March 2016 to December 2017. All subjects underwent Intracytoplasmic Sperm Injection (ICSI) and In Vitro Fertilization (IVF). The sperm parameters were assessed based on the criteria of the World Health Organization (WHO) for determining the causes of male infertility. The data were documented and compared with the criteria of the WHO. Then, they were analyzed by analysis of variance, Paired Samples t-test, Chi-squared, or Fisher’s Exact tests using SPSS. Results: The overall Mean±SD fertility rate in IVF and ICSI was 4.28±2.87 and 3.62±2.54, respectively and the difference was not significant (t=1.02, P=0.319). There was a significant difference in the fertility rate due to tubal infertility (P=0.018) between ICSI and IVF; the fertility rate in the IVF method was significantly higher than that of the ICSI. The pregnancy rate in the freeze method was higher than those of the other methods (P<0.001). This discrepancy was also found in all causes of infertility. There was no significant difference in the disorders of sperm and the result of two methods (IVF/ICSI). Conclusion: The obtained results suggested that in the freeze method, the pregnancy rate was higher than other approaches; this discrepancy was found in all the causes of infertility. It is suggested that frozen-thawed embryo transfer be used in infertile individuals. This is because it increases the success rate of pregnancy and prevents complications due to the repeated use of infertility treatments and exorbitant treatment costs.

Female infertility

BMJ clinical evidence, 2010

About 17% of couples in industrialised countries seek help for infertility, which may be caused by ovulatory failure, tubal damage or endometriosis, or a low sperm count. In developed countries, 80% to 90% of couples attempting to conceive are successful after 1 year and 95% after 2 years. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for infertility caused by ovulation disorders? What are the effects of treatments for tubal infertility? What are the effects of treatments for infertility associated with endometriosis? What are the effects of treatments for unexplained infertility? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) an...

Maternal characteristics and pregnancy outcomes after assisted reproductive technology by infertility diagnosis: ovulatory dysfunction versus tubal obstruction

Fertility and Sterility, 2014

Objective: To examine differences in maternal characteristics and pregnancy outcomes between women with ovulatory dysfunction (OD) and women with tubal obstruction (TO) who underwent assisted reproductive technology (ART). Design: Retrospective cohort study. Setting: Centers for Disease Control and Prevention. Patient(s): Exposed and nonexposed groups were selected from the 2000-2006 National ART Surveillance System linked with livebirth certificates from three states: Florida, Massachusetts, and Michigan. Intervention(s): None. Main Outcome Measure(s): Maternal characteristics and pregnancy outcomes, including newborn's health status right after delivery (Apgar score, <7 vs. R7) as the study outcome of interest, were assessed among women with OD/polycystic ovary syndrome (PCOS) and TO who used ART. Result(s): A significantly higher prevalence of women with OD/PCOS were younger (<35 years of age; 65.7% vs. 48.9%), were white (85.4% vs. 74.4%), had higher education (29.4% vs. 15.6%), and experienced diabetes (8.8% vs. 5.3%) compared with those having TO. The odds of having a lower (<7) Apgar score at 5 minutes were almost twice as high among newborns of women with OD/PCOS compared with those with TO (crude odds ratio, 1.86; 95% confidence interval [CI], 1.31, 2.64; adjusted odds ratio, 1.90; 95% CI, 1.30, 2.77). Conclusion(s): Women with OD/PCOS who underwent ART have different characteristics and health issues (higher prevalence of diabetes) and infant outcomes (lower Apgar score) compared with women with TO. (Fertil Steril Ò Discuss: You can discuss this article with its authors and with other ASRM members at http:// fertstertforum.com/grigorescuv-infertility-ovulatory-dysfunction-tubal-obstructionpcos-art/

Treatment-independent pregnancy rate in patients with severe reproductive disorders

Human Reproduction, 1998

A long waiting list for in-vitro fertilization (IVF) offers the possibility to study treatment-independent pregnancy rates in patients with severe reproductive disorders. We performed a retrospective cohort study with a nested casecontrol design in which the cases achieved a spontaneous pregnancy while on the waiting list for IVF, or for IVF with intracytoplasmic sperm injection (ICSI), and the controls did not become pregnant while on the waiting list. Spontaneous pregnancies occurred in 76 of 1391 patients on the waiting list. Significant differences between pregnant and non-pregnant patients were found for duration of subfertility (couples on the IVF waiting list), and for progressive sperm motility and basal 17β-oestradiol (couples on the ICSI waiting list). The 12 months cumulative pregnancy rate for patients on the waiting list was 2.4% (95% CI 1.2-3.9%) for tubal subfertility patients, 5.9% (3.7-8.7%) for longstanding unexplained subfertility patients, and 6.6% (4.5-9.3%) for male subfertility patients. Of the 76 control patients, 21% of tubal subfertility patients, 18% of unexplained subfertility patients, and 17% of male subfertility patients achieved a pregnancy in their first IVF or ICSI treatment cycle. We confirm that the treatment-independent pregnancy rate in patients with severe reproductive disorders is low. More than 75% of the spontaneous pregnancies in the tubal subfertility and unexplained subfertility couples occurred during their first three months on the waiting list, whereas spontaneous pregnancy rate in male subfertility couples showed a more gradual but persisting increase. We conclude that one cycle of IVF or ICSI is superior to 12 months of expectant management in patients with severely impaired fertility due to tubal, unexplained or male factors.

Surgical management of tubal infertility

Acta Obstetricia et Gynecologica Scandinavica, 1996

Objective. To investigate an unselected group of patients in a regional area undergoing tubal surgery for infertility and to identify those women who would benefit from surgery and those who should be referred directly to in vitro fertilization (IVF). Design. A retrospective study based on medical records and questionnaires. Setting. The Departments of Obstetrics and Gynecology, Gentofte, Glostrup and Herlev Hospitals, University of Copenhagen, Denmark. Subjects. Two hundred and thirty-six women with primary or secondary infertility undergoing tubal surgery or adhesiolysis during a five year period from 1985 to 1989 with a follow-up period of minimum of 24 months. Results. Ninety-four women (40%) became pregnant at least once and accounted for the total number of 144 pregnancies. One hundred and forty-two patients (60%) did not become pregnant. The delivery rate was 25%, and 37 women (16%) had at least one ectopic pregnancy. There were no significant differences in the delivery rates of the operations in between, but the risk of ectopic pregnancy was significantly lower after adhesiolysis only than after tubal surgery (~~0 . 0 5 ) .