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PURPOSE: To evaluate the effect of the individual physician performing embryo transfer, on clinical pregnancy rates. METHOD: Data from a total of 485 consecutive embryo transfers performed on 485 women aged 23-37 years were prospectively collected for this study. All patients underwent a standard downregulation long protocol for ovarian stimulation. Oocyte recovery was performed at 36 h after hCG administration. Embryo transfer took place at 48 h after insemination. The patients were matched in two groups that have been linked to two different ET providers (A and B). The same method of loading embryos into the embryo transfer catheter was used. RESULTS: Clinical pregnancy rates varied significantly (p< or =0.01) between the two providers: 36.1% in group A and 20.6% in group B. The number and quality of embryos transferred did not differ between the groups. CONCLUSION: The results suggest that the physician factor may be an important variable in embryo transfer technique.

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OBJECTIVE: To report on the treatment with recombinant FSH of an azoospermic normogonadotropic patient with a Y-chromosome microdeletion. DESIGN: Case report. SETTING: An assisted reproduction center. PATIENT(S): A 32-year-old patient with azoospermia. INTERVENTION(S): Histological testicular biopsy, Y-chromosome screening, FSH treatment, and intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S): Fertilization, embryo development, pregnancy, and delivery. RESULT(S): After 6 months of treatment with gonadotropins, a small number of spermatozoa were found in the patient's ejaculate and used for IVF, resulting in a successful twin pregnancy and the delivery of two healthy girls. CONCLUSION(S): In this study, treatment with gonadotropins promoted the spermatogenesis process and led to the production of spermatozoa in a normogonadotropic azoospermic patient.

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OBJECTIVE: To determine the effects of ovarian stimulation with highly purified urofollitropin on oocyte and embryo quality. DESIGN: Parallel randomized open-label clinical study. SETTING: Assisted reproduction centers. PATIENT(S): Two hundred sixty-seven infertile couples undergoing IVF/ICSI. INTERVENTION(S): All participants underwent standard down-regulation with GnRH analogue. One hundred thirty-three participants received highly purified urinary FSH and 134 controls received recombinant FSH. MAIN OUTCOME MEASURE(S): Primary end points were number of morphologically mature oocytes retrieved, embryo quality, and pregnancy and implantation rates. Secondary end points were: total number of days of FSH stimulation, total dose of gonadotropin administered, fertilization rate per number of retrieved oocytes, embryo cleavage rate, live birth and miscarriage rates, endometrial thickness and estradiol level on the day of hCG administration, cancellation rate, and incidence of moderate or severe ovarian hyperstimulation syndrome. RESULT(S): Pregnancy and implantation rates were nonsignificantly higher in the urinary FSH group than the recombinant FSH group (46.5% vs. 36.8% and 22.1% vs. 15.8%, respectively). The grade 1 embryo score was significantly higher in the urinary FSH group than the recombinant FSH (42.1% vs. 33.5%), and the live birth rate was nonsignificantly higher in the former group. CONCLUSION(S): Highly purified urinary FSH is as effective, efficient, and safe for clinical use as recombinant FSH.

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OBJECTIVE: To report an ongoing twin pregnancy after transfer of embryos that were vitrified at the 2-pronuclei stage in a new vitrification solution. DESIGN: Case report. SETTING: A tertiary-care infertility clinic. PATIENT(S): A 26-year-old infertile woman in whom two previous IVF implantations failed. INTERVENTION(S): Vitrification of 2-pronuclei embryos, in vitro culture for 48 hours, and transfer into the uterus. MAIN OUTCOME MEASURE(S): Survival and cleavage after vitrification and achievement of clinical pregnancy. RESULT(S): Six zygotes were vitrified by using a three-step protocol (4% ethylene glycol for 3 minutes, 20% ethylene glycol for 1 minute, and 38% ethylene glycol and 1.2 M trehalose for 0.5 minute). After 2 months of storage in a double-straw system in liquid nitrogen, two zygotes were warmed and cryoprotectants were removed by using a four-step protocol (1 M, 0.5 M, 0.25 M, and 0.125 M of trehalose). Two embryos were transferred after 48 hours of in vitro culture, cleaving to 5 and 6 cells. The resulting twin pregnancy was confirmed by ultrasonography at the sixth week. CONCLUSION(S): Vitrification by using ethylene glycol and trehalose appears to be a safe, promising method for cryopreservation of human zygotes. Storage of vitrified zygotes in a double-straw system does not compromise their subsequent potential for survival and development.

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