Objective: Since little is known about the actual incidence and fate of vacuoles at different stages of development this preliminary study was set up to accurately measure vacuoles and track them to day 5.Design: Prospective study.Setting: Women's General Hospital in Austria.Patient(s): A total of 223 consecutive IVF and intracytoplasmic sperm injection (ICSI) cycles (206 patients).Intervention(s): Accurate measurement of vacuoles. Affected gametes and embryos were cultured individually and tracked until day 5.Main Outcome Measure(s): Size and number of vacuoles, fertilization rate, blastocyst formation rate, blastocyst quality.Result(S): There was a significant relationship between size of the vacuole (cut-off value 14 Am) and fertilization (P <.05). At zygote stage the incidence of vacuoles was higher (P <.01) in ICSI (11.6%) than in IVF (5.3%). Only 32.2% of affected ICSI-embryos reached blastocyst stage on day 5 compared with 53.0% of the normal ones (P <.001). In terms of blastocyst formation vacuolization on day 4 (P <.001) turned out to be the most severe one. At blastocyst stage inner cell mass was affected less frequently than the trophectoderm (P <.05).Conclusion(s): Three types of vacuoles could be identified: (1) those already present at oocyte collection, which develop during maturation (day 0); (2) those artificially created by ICSI (day 1); and (3) those accompanied with developmental arrest (day 4). The later that vacuoles arose, the more detrimental their effect on blastocyst formation. (c) 2005 by American Society for Reproductive Medicine.

BACKGROUND:In MII oocytes showing difficult oolemma breakage, ICSI can cause an increase in the degeneration rate. This may be overcome by laser-assisted ICSI using a 5-10 micro m opening in the zona pellucida for injection. However, such a small opening might impair the hatching process, especially if assisted hatching is applied in addition. In order to prevent this, the present study used routine injection through an area of zona pellucida in which laser zona thinning had been applied, providing for both a reduced mechanical stress to the oocyte and assisted hatching.METHODS:This prospective study involved 100 cycles with 1016 MII oocytes. Conventional ICSI (control group) was compared with a modified laser-assisted ICSI (study group) in sibling oocytes. In the latter group oocytes were injected through an extended area of zona thinning.RESULTS:Degeneration rate was significantly lower in the study group (P < 0.004). There were no differences in fertilization, or formation and quality of blastocysts. In the study group embryo quality on day 2 was significantly better (P = 0.004) and herniation of day 5 blastocysts was increased (P = 0.005). Rates of implantation and pregnancy were not affected. However, on day 3 laser-assisted ICSI proved beneficial (P = 0.038) in terms of clinical pregnancy rate.CONCLUSIONS:The new method combines a less invasive ICSI technique with assisted hatching. Our preliminary data indicate that in addition to an improved oocyte survival, this new approach increases the hatching rate in vitro, which may explain the increase in pregnancy rate, at least in day 3 transfers.

BACKGROUND: Complete fertilization failure after ICSI is a rare event, and it may happen repeatedly even in cases of normal sperm parameters and good ovarian response. In these cycles, alternative ICSI techniques may prove useful. METHODS: Our modified ICSI (mICSI) is characterized by aspiration close to the opposite membrane (the region of the mitochondria with a high inner mitochondrial membrane potential) which is followed by central deposition of the sperm. The method was applied prospectively to ICSI cycles of patients with a history of complete fertilization failure in previous ICSI cycles. In parallel, mICSI was compared with conventional ICSI in terms of further preimplantation development and treatment outcome. RESULTS: In patients with previous ICSI failures using conventional ICSI (no 2Pn zygotes out of 70 oocytes that had been injected) application of mICSI led to adequate fertilization (53.6%) and pregnancy rates (33.3%) ( P <0.001; P <0.01). In patients without previous failed fertilization, no improvement in the rates of fertilization, blastocyst formation, implantation or clinical pregnancy could be seen. CONCLUSIONS: Our data indicate that the present version of ICSI is a reliable alternative to conventional ICSI. However, although it overcomes oocyte-dependent activation failure, routine application does not improve the overall results.

Rupture of the membranes before the fetus has achieved viability within the womb is an event of enormous importance for both mother and physician. The potential outcome ranges from fetal death, a frequent occurrence, to a severely disabled life or a happy (but rare) birth without any mental or physical retardation for the child. The aim of the present investigation was to provide the consulting physician with valid data, enabling him/her to make a realistic assessment of the risks and to inform the patient accordingly. METHOD: In a retrospective analysis, we followed 36 cases with spontaneous rupture of the maternal membranes and development of oligoanhydramnios and anhydramnios before 24 weeks of gestation. The patients had been treated between January 1994 and 2004. In a more detailed assessment, the patient cohort was divided into one group of women with rupture between 10 and 20 weeks of gestation and another group with a gestational age between start of week 21 and end of week 23. RESULTS: Of the 36 children, seven (19.4%) survived initially, with two of the seven survivors dying subsequently. Among women with amniorrhexis before week 21 of gestation, only three of the 26 children survived, while four of 10 children survived among women with premature rupture of membranes between 21 and 23 weeks of gestation (p = 0.053) No case of mental retardation could be observed in the surviving children. Perinatal outcome was found to be significantly different in the presence of amnionitis (3 of 27) compared to the group without this event (4 of 9) (p = 0.028). CONCLUSIONS: Because of the poor fetal outcome, termination of an ongoing pregnancy must also be considered in counseling the mother. If the mother decides to continue her pregnancy, amnionitis will be the most critical factor for ultimate termination of pregnancy.

The purpose of this study was to document the accuracy of 3-D uterus volume and to compare it with 2-D measurements. Transvaginal ultrasound (US) examinations were performed in 48 consecutive patients before hysterectomy. The examinations were stored digitally on an internal disk drive for subsequent measurements in virtual organ computer-aided analysis (VOCAL) program. Immediately after the hysterectomy, the true volume was measured in a water bath. A total of 5 patients were excluded due to difficulty of identifying the borders of their uterus; 8 patients were excluded because of too large fibroids or diffuse hypertrophic enlargement of uterus (volume > 220 mL). Although the volumes estimated by the 3-D method were not significantly different (p = 0.126 first measurement, p = 0.561 second measurement), the volumes estimated by the 2-D method were significantly different (p = 0.005 first measurement, p = 0.012 second measurement). The mean error rates of the two 3-D volume measurements by the same observer were 7.4% and 7.9%, and they were 22.2% and 21.0% for the 2-D volume measurements. It may be concluded that the volume of the uterus can be measured more accurately by 3-D US than by 2-D US.

Objective To evaluate the reproducibility of transvaginal three-dimensional (3D) endometrial volume measurement in patients with postmenopausal bleeding and to compare the reproducibility of this technique to that of two-dimensional (2D) endometrial thickness measurement.Methods In a prospective, blinded study, transvaginal ultrasound examinations were performed in 51 consecutive patients with postmenopausal bleeding. Three-dimensional volume and 2D thickness measurements were made and intraobserver and interobserver reproducibility of each technique were assessed.Results The intraobserver correlation of 3D endometrial volume measurement of the first observer was 0.97 and that of the second observer was 0.99. Thus, mean intraobserver correlation was 0.98. The mean interobserver correlation was 0.95 (0.95 vs. 0.96). There was no significant difference in reproducibility at different volume cut-offs. The mean intra- and interobserver correlation of endometrium volume measurements for five patients with endometrial carcinoma did not differ significantly front that for Patients without carcinoma (0.98, 0.98 vs. 0.98, 0.95). The intraobserver correlation of 2D endometrial thickness measurements front the first observer was 0.71 and that front second observer 0.87. Thus, mean intraobserver correlation of the endometrial thickness measurements was 0.79. The mean interobserver correlation was 0.76 (0.84 vs. 0.70).Conclusions Endometrial volume and thickness measurements by 3D and 2D ultrasound, respectively, show good reproducibility but the reproducibility of 3D ultrasound is better.

Recent advances in ultrasound technology have enabled the diagnosis of overall tissue vascularization by three-dimensional (3D) power Doppler. This case report describes 3D power Doppler characteristics of unilateral ovarian torsion 2 weeks after embryo transfer in a pregnant patient with bilateral hyperstimulated ovaries. Before laparoscopic treatment the twisted right ovary showed the following 3D power Doppler indices: mean grayness index, 15.66; vacularization index, 0.24; flow index, 21.99; vascularization flow index, 0.05. One hour after laparoscopic treatment 3D power Doppler indices of the untwisted ovary were as follows: mean grayness index, 25.61; vacularization index, 3.81; flow index, 42.800; vascularization flow index, 1.63. The resistance index of the ovarian vessels before and after laparoscopy showed no significant difference (5.1 vs. 5.2). The diagnosis of ovarian torsion can be better made with 3D power Doppler sonography than with two-dimensional Doppler sonography.

BACKGROUND The hormonal milieu during ovarian stimulation is known to affect oolemma behaviour as well as zona pellucida thickness and structure. This led us to investigate whether a special subgroup of patients with oocytes where penetration of the oolemma is difficult during ICSI may benefit from assisted hatching. METHODS A total of 77 couples (mean age: 32.9 +/- 4.6 years; range: 22-38) had oocytes that could hardly be penetrated by the ICSI pipette. Nineteen patients underwent two ICSI cycles, giving a total number of 96 cycles, which were randomly split into either the study group (n = 52) or the non-hatching group (n = 44). Hatching was done using a non-contact 1.48 mm wavelength diode laser. Implantation and pregnancy rates were recorded. RESULTS The pregnancy rate was 36.6% (19/52) in the study group and 13.6% (6/44) in the non-hatching group (P < 0.05). In addition, a higher number (P < 0.05) of embryos implanted in the study group (23/106; 21.7%) than in the non-hatching group (9/92; 9.8%). CONCLUSIONS Once oolema penetration during ICSI has proven difficult, prospective hatching of embryos considered for transfer may increase their implantation behaviour.

Aim: This prospective study was performed to evaluate the predictive value of endometrium thickness in patients undergoing IVF-ET. Method: Measurements of endometrium thickness as well as pattern assessments were performed in 936 cycles (722 patients) on the day of administering human chronic gonadotropin (HCG). Results: The overall pregnancy rate was 31.1% (2911936 The age of non pregnant patient was significantly higher (p < 0.029). There was a significant influence of oestradiol (p < 0.029), number of transferred embryos (p < 0.004), and embryo quality (p<0.002) on the pregnancy rate. Overall, the mean (+/-SD) endometrium thickness was 11.16 mm (+/- 2.13). The mean (+/-SD) endometrium thickness of pregnant patients was 11.25 mm (+/-2.19). The mean (+/-SD) endometrium thickness of non-pregnant patients was 11.12 mm (+/-2.10). A stepwise logistic regression analysis showed no statistically significant correlation between endometrium thickness and pregnancy rate (p < 0.23). Conclusion: Sonographic measurement of endometrium thickness on the day of human chorionic treatment with gonadotropin is not useful in predicting IVF outcome.

PURPOSE:To determine the influence of technical pitfalls and oocyte morphology on survival rate and cleavage behavior after ICSI.METHODS:A total of 2210 injection procedures was examined for morphological and technical deviations. Survival rate and cleavage behavior were evaluated.RESULTS:In 77.8% of all cases ICSI was unsuspicous. Out of 491 deviations from optimal injection deep penetration of the oocyte and abundant presence of cumulus cells showed significant correlation with degeneration rate (p < 0.001). Morphological anomalies associated with the periphery of the oocyte were rather related to degeneration than cytoplasmic anomalies (p < 0.001). Early embryonic development was not impaired by technical or morphological parameters.CONCLUSIONS:To conclude, these prospective data may be of prognostic value in regard of the number of embryos available for transfer and may help to improve treatment outcome.