OBJECTIVE: Anti-Mullerian Hormone (AMH) is a glycoprotein dimer composed of two 72kDa monomers linked by disulfide bridges and is a member of the transforming growth factor-β super family. AMH is produced in small amounts by ovarian granulosa cells after birth until menopause, and then becomes undetectable. AMH performs various physiological functions, e.g. controlling antral follicle development. AMH is routinely used clinically to help determine ovarian reserve status and subsequently, gonadotropin stimulation protocols. Whereas, AMH values can help predict the quantity of oocytes obtained during retrieval, little to no information is available regarding AMH levels on embryo formation rates. To determine if circulating anti-mullerian hormone (AMH) levels relate to blastocyst formation rates following ovarian stimulation in donor IVF.DESIGN: Retrospective analysis of donor cycles. AMH levels were measured and correlated with blastocyst (Grade A or B) formation rates during the IVF cycle.MATERIALS AND METHODS: Circulating AMH levels were measured in donors by a commercially available assay. ART cycles were normalized to control for ovarian stimulation protocol (antagonist) and gonadotropin dose, no male factor, number of stimulation days (10-12 days) and day 5 transfers. Data were analyzed by regression analysis.RESULTS: A total of 18 donor ART cycles were included in this study. The overall blastocyst formation rate was 28.93% (80/342). The mean (+s.e.) AMH level in the donors was 3.941 (+0.459) ng/mL. AMH levels ranged from a low of 1.27 ng/mL to a high of 8.25 ng/mL. Regression analysis revealed a statistically significant binomial correlation between circulating AMH levels in oocyte donors and blastocyst formation rates (P<0.05).CONCLUSION: The data demonstrates a significant and positive correlation between circulating AMH levels in oocyte donors and blastocyst formation rates. This is the first report demonstrating a significant relationship between AMH and blastocyst formation rates. OBJECTIVE: Anti-Mullerian Hormone (AMH) is a glycoprotein dimer composed of two 72kDa monomers linked by disulfide bridges and is a member of the transforming growth factor-β super family. AMH is produced in small amounts by ovarian granulosa cells after birth until menopause, and then becomes undetectable. AMH performs various physiological functions, e.g. controlling antral follicle development. AMH is routinely used clinically to help determine ovarian reserve status and subsequently, gonadotropin stimulation protocols. Whereas, AMH values can help predict the quantity of oocytes obtained during retrieval, little to no information is available regarding AMH levels on embryo formation rates. To determine if circulating anti-mullerian hormone (AMH) levels relate to blastocyst formation rates following ovarian stimulation in donor IVF. DESIGN: Retrospective analysis of donor cycles. AMH levels were measured and correlated with blastocyst (Grade A or B) formation rates during the IVF cycle. MATERIALS AND METHODS: Circulating AMH levels were measured in donors by a commercially available assay. ART cycles were normalized to control for ovarian stimulation protocol (antagonist) and gonadotropin dose, no male factor, number of stimulation days (10-12 days) and day 5 transfers. Data were analyzed by regression analysis. RESULTS: A total of 18 donor ART cycles were included in this study. The overall blastocyst formation rate was 28.93% (80/342). The mean (+s.e.) AMH level in the donors was 3.941 (+0.459) ng/mL. AMH levels ranged from a low of 1.27 ng/mL to a high of 8.25 ng/mL. Regression analysis revealed a statistically significant binomial correlation between circulating AMH levels in oocyte donors and blastocyst formation rates (P<0.05). CONCLUSION: The data demonstrates a significant and positive correlation between circulating AMH levels in oocyte donors and blastocyst formation rates. This is the first report demonstrating a significant relationship between AMH and blastocyst formation rates.

OBJECTIVE: To investigate pregnancy outcomes in women with hydrosalpinges treated with Essure micro-inserts prior to IVF and FET. DESIGN: Prospective, single arm, clinical study. MATERIALS AND METHODS: Six women ages 34-41 with unilateral (N=1; prior Left Salpingoophorectomy) or bilateral hydrosalpinges (N=5) diagnosed by Hysterosalpingogram (HSG) scheduled to undergo IVF or FET following tubal occlusion by the Essure micro-inserts. RESULTS: Essure placements were performed by one physician in office setting using local anesthetic (N=4) or in out-patient surgery center with sedation (N=2). Five patients had bilateral successful placement on first attempt. One patient had unilateral placement on first attempt and one month later underwent a successful second placement procedure. Tubal occlusion was confirmed by HSG in all patients. Three patients became pregnant on their first IVF treatment cycle; two delivered full-term without complications and one had a fetal demise at 8 weeks due to trisomy 13. Subsequently she conceived on a FET with twins and then had an uneventful fetal demise of one twin; the other was delivered at term without complications. Fourth patient (age 40), underwent four IVF cycles; the first two cycles were unsuccessful, the third cycle resulted in a twin pregnancy that miscarried at 6 weeks and her last cycle resulted in a chemical pregnancy, she is now pursuing adoption. Fifth patient (age 37 with prior LSO), discontinued treatment after an unsuccessful IVF cycle due to poor ovarian stimulation response. The sixth patient (age 34 with prior myomectomy, pelvic adhesions and recurrent fibroids) had a single unsuccessful IVF cycle and has four frozen embryos available and is pursuing a gestational carrier. CONCLUSION: Placement of the Essure micro-inserts in patients with hydrosalpinges provides a minimally invasive option for proximal tubal occlusion prior to IVF and FET and appears to result in excellent pregnancy rates and outcomes.

Objective: The association between reproductive dysfunction and extremes of BMI has been well studied and established in the past by many investigators. In contrast, the effect of body weight and outcome of IVF is less clear. Several studies have revealed no effect between extremes of body weight and IVF success while others have seen an adverse effect only in patients with a high BMI (25 and >30). In an effort to resolve these issues, we looked at the effect of BMI on IVF pregnancy rates in our practice. Design: Retrospective cohort study. Materials/Methods: A total of 465 patients undergoing IVF with fresh embryo transfer (non-donor oocytes) from 11/96–12/00 were included. BMI was calculated using the formula of weight (in kgs) divided by height (in meters) squared (kg/m2). Data were analyzed using Fisher's exact test and logistic regression. Results: Median age, peak estradiol levels and number of embryos transferred were similar across BMI groups. Pregnancy rates were greater in the 350 patients with BMI <28 (51.4%) than in the 105 patients with BMI ≥28 (35.2%). This difference remained after adjusting for age, peak estradiol levels and number of embryos transferred (odds ratio = 1.69, p < 0.03). The 46 women with BMI ≤19.9 also had reduced pregnancy rates relative to the 314 women with BMI 20-27.9 (34.8% vs. 52.3%, p < 0.039). Conclusions: As with advancing age and elevated basal FSH levels, extremes of BMI (both low and high) can also be used to predict the outcome of IVF success. Since these patients can comprise as much as a third of IVF patients and given that BMI is one factor that is potentially modifiable with lifestyle and diet changes, further studies on the mechanisms, treatments and effects of extremes of body mass on assisted reproductive technologies are needed.

Objective: To compare TVF outcomes between infertile African American and white women.Design: Retrospective cohort study.Setting: Hospital-based IVF practice.Patient(s): Women undergoing IVF procedures between November 1996 and June 2000.Intervention(s): None.Main Outcomes Measure(s): Implantation and pregnancy rates.Result(s): There were 24 African American and 273 white women less than or equal to 40 years of age who underwent 25 and 333 IVF cycles, respectively. African American women were more likely to have had tubal factor as a primary diagnosis, to have had a child, and to have undergone fewer previous assisted reproductive technology (ART) cycles as compared to white women. No differences between the two groups for clinical variables were noted with the exception of body mass index (BMI [kg/m(2)], 27.1 in African Americans vs. 24.8 in whites). implantation rates were higher in African American than in white women (35% vs. 23%, respectively). Pregnancy rates were 71% in African Americans and 48% in whites. After adjustment for tubal factor, BMT, and parity, the odds ratio for pregnancy in African American women versus white women increased from 2.6 to 3.3.Conclusion(s): This is the first study to demonstrate a significantly higher clinical pregnancy rate in African American women as compared to white women undergoing ART. These data strongly contradict a recent study comparing the same two groups of women undergoing ART. We urge other ART centers to report their data pertaining to race. (C) 2001 by American Society for Reproductive Medicine.

Objectives: In couples undergoing conventional IVF procedures who have had a successful oocyte retrieval, complete fertilization failure can occur in up to 10–27% of cycles with poor fertilization rates (<35%) occurring even more frequently. Conventional reinsemination of 1 day-old unfertilized oocytes can be attempted but generally results in variable and limited fertilization and success rates. "Rescue" or 2nd-day ICSI has also been used to salvage failed or poor fertilization IVF cycles with greater than 50% fertilization rates being reported. Cleavage rates and embryo quality have been acceptable with clinical pregnancy rates of up to 7–15% and no detectable abnormalities noted in the resultant offspring. The objective of this study was to evaluate the use of rescue ICSI at our institution for salvage of complete fertilization failures after conventional IVF.Design: Retrospective chart analysis of patients who underwent IVF in our institution from 1/97 to 10/99. Data reviewed of all rescue ICSI cycles in IVF patients (non-male factor) with complete fertilization failure (n=11).Materials and Methods: Non-fertilized mature oocytes from IVF cycles were micro-injected by ICSI technique 24 to 28 hours after oocyte pick-up. All embryos underwent assisted hatching prior to embryo transfer which was performed 3 or 4 days after oocyte retrieval. Fertilization and cleavage rates, polyploidy, number of embryos transferred, embryo quality, clinical pregnancy and embryo implantation rates were assessed.Results: A total of 107 metaphase II (MII) oocytes were subjected to ICSI giving rise to fertilization of 59 oocytes (55%) with a cleavage rate of 91% and polyploid (>2PN) rate of only 7%. All patients (11) went to embryo transfer with the average number of embryos replaced being 3.1 (range 1–5). Average embryo stage: 5.9 cells (range 2 cell-early morula) and grade: 2.4 (range 1–4). Day 3 transfers were performed on 4 patients (1/4 pregnant) and Day 4 transfers in 7 (2/7 pregnant). Clinical pregnancy rate was 27% (3/11) with an implantation rate of 12%. One set of twins and two singletons, all healthy, have been delivered to date.Conclusions: Rescue ICSI can result in very acceptable pregnancy rates, comparable to the recent SART data for IVF success rates in 1996, in what would otherwise have been a failed IVF cycle without embryo transfer. Certainly, concern about the possibility of chromosomal abnormalities of 1-day old oocytes that have been reinseminated exists, however, it appears to be unfounded to date. Further studies are needed to examine other factors such as time of reinsemination, assisted hatching or day of embryo transfer that might influence the success rate of performing a rescue ICSI procedure. Objectives: In couples undergoing conventional IVF procedures who have had a successful oocyte retrieval, complete fertilization failure can occur in up to 10–27% of cycles with poor fertilization rates (<35%) occurring even more frequently. Conventional reinsemination of 1 day-old unfertilized oocytes can be attempted but generally results in variable and limited fertilization and success rates. "Rescue" or 2nd-day ICSI has also been used to salvage failed or poor fertilization IVF cycles with greater than 50% fertilization rates being reported. Cleavage rates and embryo quality have been acceptable with clinical pregnancy rates of up to 7–15% and no detectable abnormalities noted in the resultant offspring. The objective of this study was to evaluate the use of rescue ICSI at our institution for salvage of complete fertilization failures after conventional IVF. Design: Retrospective chart analysis of patients who underwent IVF in our institution from 1/97 to 10/99. Data reviewed of all rescue ICSI cycles in IVF patients (non-male factor) with complete fertilization failure (n=11). Materials and Methods: Non-fertilized mature oocytes from IVF cycles were micro-injected by ICSI technique 24 to 28 hours after oocyte pick-up. All embryos underwent assisted hatching prior to embryo transfer which was performed 3 or 4 days after oocyte retrieval. Fertilization and cleavage rates, polyploidy, number of embryos transferred, embryo quality, clinical pregnancy and embryo implantation rates were assessed. Results: A total of 107 metaphase II (MII) oocytes were subjected to ICSI giving rise to fertilization of 59 oocytes (55%) with a cleavage rate of 91% and polyploid (>2PN) rate of only 7%. All patients (11) went to embryo transfer with the average number of embryos replaced being 3.1 (range 1–5). Average embryo stage: 5.9 cells (range 2 cell-early morula) and grade: 2.4 (range 1–4). Day 3 transfers were performed on 4 patients (1/4 pregnant) and Day 4 transfers in 7 (2/7 pregnant). Clinical pregnancy rate was 27% (3/11) with an implantation rate of 12%. One set of twins and two singletons, all healthy, have been delivered to date. Conclusions: Rescue ICSI can result in very acceptable pregnancy rates, comparable to the recent SART data for IVF success rates in 1996, in what would otherwise have been a failed IVF cycle without embryo transfer. Certainly, concern about the possibility of chromosomal abnormalities of 1-day old oocytes that have been reinseminated exists, however, it appears to be unfounded to date. Further studies are needed to examine other factors such as time of reinsemination, assisted hatching or day of embryo transfer that might influence the success rate of performing a rescue ICSI procedure.