Does prolonged pituitary down regulation with gonadotrophin releasing hormone agonist increase live birth rate in in vitro fertilization treatment?

Capsule:
In a comparison of the regular long protocol with a prolonged protocol with 28-days’ down-regulation, a significantly higher live-birth rate (55.56% vs. 45.73%) was observed with the prolonged protocol.

Authors:
Jianzhi Ren, M.D., Aiguo Sha, M.D., Dongmei Han, M.D., Ping Li, M.D., Jie Geng, M.D., Chaihui Ma, M.D.

Volume 102, Issue 1, Pages 75–81

Abstract:

Objective:
To evaluate the effects of a prolonged duration of gonadotropin-releasing hormone agonist (GnRH-a) in pituitary down-regulation for controlled ovarian hyperstimulation (COH) on the live-birth rate in nonendometriotic women undergoing in vitro fertilization and embryo transfer (IVF-ET).

Design:
Retrospective cohort study.

Setting:
University-affiliated hospital.

Patient(s):
Normogonadotropic women undergoing IVF.

Intervention(s):
Three hundred seventy-eight patients receiving a prolonged pituitary down-regulation with GnRH-a before ovarian stimulation and 422 patients receiving a GnRH-a long protocol.

Main Outcome Measure(s):
Live-birth rate per fresh ET.

Result(s):
In comparison with the long protocol, the prolonged down-regulation protocol required a higher total dose of gonadotropins. A lower serum luteinizing hormone (LH) level on the starting day of gonadotropin and the day of human chorionic gonadotropin (hCG) and a fewer number of oocytes and embryos were observed in the prolonged down-regulation protocol. However, the duration of stimulation and number of high-quality embryos were comparable between the two groups. A statistically significantly higher implantation rate (50.27% vs. 39.69%), clinical pregnancy rate (64.02% vs. 56.87%) and live-birth rate per fresh transfer cycle (55.56% vs. 45.73%) were observed in the prolonged protocol.

Conclusion(s):
Prolonged down-regulation in a GnRH-a protocol might increase the live-birth rates in normogonadotropic women.

Peri implantation intercourse lowers fecundability

Capsule:
Two or more acts of intercourse during the peri-implantation window is associated with a lower probability of pregnancy given prior intercourse during the fertile window.

Authors:
Anne Zweifel Steiner, M.D., M.P.H., David Pritchard, M.S., Steven L. Young, M.D., Ph.D., Amy H. Herring, Sc.D.

Volume 102, Issue 1, Pages 178–182

Abstract:

Objective:
To determine the impact of sexual intercourse around the time of implantation on the probability of achieving a pregnancy.

Design:
Time-to-pregnancy cohort using day-specific probability of pregnancy modeling to account for intercourse during the fertile window.

Setting:
Community cohort.

Patient(s):
Women trying to conceive naturally, ages 30–44, without known infertility.

Intervention(s):
None.

Main Outcome Measure(s):
Positive pregnancy test.

Result(s):
A total of 564 women provided 1,332 complete cycles for analysis. Intercourse frequency during the fertile window and during the peri-implantation window were significantly correlated. Cycles in which couples had 2 or more days with intercourse during the implantation window were significantly less likely to result in a positive pregnancy test compared with cycles in which couples did not have intercourse in this window, after adjusting for age, race, history of regular menstrual cycles, previous pregnancy, and body mass index (fecundability ratio, 0.62; 95% confidence interval, 0.42–0.91).

Conclusion(s):
Intercourse during the peri-implantation window may be detrimental to natural fertility. Methods that allow couples to time intercourse to the fertile window may decrease time to pregnancy by not only increasing the probability of fertilization but also decreasing the probability of failed implantation.

Ethics of uterus transplantation with live donors

Capsule:
Before launching live donor liver transplantation in Chicago, the preparations included thorough ethical discussion, which was subsequently published in The New England Journal of Medicine.

Authors:
Michael Olausson, M.D., Ph.D., Liza Johannesson, M.D., Ph.D., Daniel Brattgård, V.D.M.,; Cesar Diaz Garcia, M.D., Cecilia Lundmark, R.N., B.Sc., Klaus Groth, M.D., Ph.D., Janusz Marcickiewizc, M.D., Ph.D., Anders Enskog, M.D., Ph.D., Randa Akouri, M.D., Ph.D., Andreas Tzakis, M.D., Ph.D., Xavier Rogiers, M.D., Ph.D., Per Olof Janson, M.D., Ph.D., Mats Brännström, M.D., Ph.D.

Volume 102, Issue 1, Pages 40–43

Abstract:
Before launching live donor liver transplantation in Chicago, the preparations included thorough ethical discussion, which was subsequently published in The New England Journal of Medicine. Despite not being the first team with a successful case, the Chicago group earned credit for introducing the procedure in a careful and sensitive manner. Many transplant centers around the world built on this experience and ethical analysis to initiate live donor liver transplantation at regional programs.

Articles of Special Interest

Does prolonged pituitary down regulation with gonadotrophin releasing hormone agonist increase live birth rate in in vitro fertilization treatment?

Wednesday, June 25, 2014
In a comparison of the regular long protocol with a prolonged protocol with 28-days’ down-regulation, a significantly higher live-birth rate (55.56%vs. 45.73%) was observed with the prolonged protocol.

Peri implantation intercourse lowers fecundability

Wednesday, June 25, 2014
Two or more acts of intercourse during the peri-implantation window is associated with a lower probability of pregnancy given prior intercourse during the fertile window.

Ethics of uterus transplantation with live donors

Wednesday, June 25, 2014
Before launching live donor liver transplantation in Chicago, the preparations included thorough ethical discussion, which was subsequently published in The New England Journal of Medicine.

Identifying risk factors for recurrent cesarean scar pregnancy A case control study

Wednesday, June 25, 2014
This is a case-control study of risk factors for recurrent cesarean scar pregnancy. Findings on risk factors might be helpful for the prevention and early diagnosis of the disease.