By Bin Wu, embriolog
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Additional info for Advances in embryo transfer
Pgs. 279-283, 1995.  Check JH, Davies E, Adelson H: A randomized prospective study comparing pregnancy rates following clomiphene citrate and human menopausal gonadotropins therapy. Hum Reprod 1992;7:801-805.  Trounson AO, Leeton JF, Wood C, Webb J, Wood J: Pregnancies in human by fertilization in vitro and embryo transfer in controlled ovulatory cycle. Science 1981;212:681-682.  Garcia-Velasco JA, Moreno L, Pacheco A, Guillen A, Duque L, Requena A, Pellicer A: The aromatase inhibitor letrozole increases the concentration of intraovarian androges and improves in vitro fertilization outcome in low responder patients: a pilot study.
Thus, we may face the risk that the oocyte could release before oocyte retrieval. Even though a bolus injection of human chorionic gonadotropin (hCG) is used before the spontaneous LH rise, it must be done without compromising the maturity of the follicle and the oocyte within. In order to overcome this problem, some IVF centers trying to attain the one best dominant follicle will wait until the dominant follicle approaches a 14mm size and boost with 75 IU FSH with or without a GnRH antagonist.
Less than adequate mitochondria lead to a greater risk of meiosis errors which cause poor pregnancy rates and higher miscarriage rates. Another alternate hypothesis is that the selection of follicles is simply positional but age itself leads to aging of the mitochondria in the follicles and further leads to meiosis errors. Several 1980s studies found very poor pregnancy rates even in younger women with diminished oocyte reserve as manifested by elevated day 3 serum FSH levels (40-43). Even in the modern IVF era some of the top IVF centers still claim extremely poor (or even zero) live delivery rate in younger women despite the transfer of several normal morphologic embryos especially if day 3 FSH exceeded 15 mIU/mL (44,45).