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621. Unusual patient

29 March 2004 by goolam hussim mohamed
I recently had a very unusual patient and would appreciate some help/ comments.
I had a 24year old female , who I diagnosed as having PCOS and I had started her on the long protocol with a view to ICSI for severe male factor infertility. Downregulation was commenced on leuprolide acetate 200 micrograms daily sc.
When she did not have a withdrawal bleed after 14 days i decided to do a ULTASOUND and was shocked to find about 20 follicles on each side ranging between 15 and 25 mm. I then did a ESTRDIOL etc and the E@ was 44000 pmol/l
the fsh was 0.3miu LH was 5 the bhcg was neg.
I cancelled the cycle and did some ovarian tumor markers .
My question are 1) Should i have emptied those follicles??2) would i have found anything
3) what possibly could be driving those follicles??
4) would a antagonist protocol be better next time?
5) should i use a step instead of a step down protocol???
Your help will be greatly appreciated
Dr GH Mohamed
        Replies (2)

622. Globozoospermia, ICSI, and Egg Activation

29 March 2004 by Michael L. Reed
What are the current thoughts, experiences, and so forth, on perfoming ICSI with round-head sperm (globozoospermia), with or without ionophore-induced egg activation? I have a fairly extensive literature review, and I understand that there can be zero or reduced fertilization rate due to egg activation, centrosome dysfunction, and premature chromatin condensation - but what is known about the effects of calcium ionophore on further development - even though there have been births after expsoing oocytes to the ionopore? In addition, there are references to a pattern of heritability associated with this diagnosis, which brings up consents and genetic counseling - any suggestions beyond the obvious?

        Replies (0)

623. Oocyte maturity

28 March 2004 by Joe Conaghan
I'm seeing quite a dramatic drop in the percentage of oocytes that are mature at retrieval when comparing the first 2 months of 2004 with 2003. I've talked to one other person, several thousand miles away, who is seeing the same thing. If anyone else is experiencing this problem or is interested in talking about it, please contact me.
        Replies (0)

624. Post biopsy embryo development

28 March 2004 by Joe Conaghan
This question is for anyone out there that does a lot of embryo biopsies on day 3 with embryo transfer the next day. I'm trying to establish if our rates of embryo development in the 24h post biopsy are normal or abnormal, but I don't know what the expectation is. I've asked a couple of people that I consider should know the answer to this question and I'm told that if an embryo shows any development (even increasing blastomere number by just one), then the embryo is ok. This is a little vague for me however and I'd like to know if anyone has established criteria for what to expect when looking at embryos on day 4.
        Replies (1)

625. Acrosomal integrity and also Chromation condensation

22 March 2004 by S.Selvaraju
How to grade acrosomal integrity and also Chromation condensation by different staining (Light/phase contrast microscopy) procedures.
        Replies (0)

626. Oocyte Quality

22 March 2004 by DR.ASHRAF
Sometimes we find almost all the oocytes in certain women to have granular cytoplasm, central pitting, large & small vacoules or having ser.
Could it be related to any particular disease entity or to the hormonal therapy.
We could observe granularity in the perivittaline space to have some correlation to increased use of hmg, also the central vacoules relating to endometriosis.

Your comments please
        Replies (0)

627. New IVF clinic in Tanzania and Kenya

21 March 2004 by Paul Kihaile
I need to start a new IVF clinic in Tanzania and Kenya. Please advise me about the most important instruments and media I must buy and the cost/price of EACH.
        Replies (5)

628. Moving to animal IVF

07 March 2004 by Charlotte Knight
I am interested in moving from human IVF to animal IVF - specifically wildlife. I would be very grateful if anybody could give me contacts or details about getting into this field of work.
        Replies (0)

629. Seeding during embryo cryopreservation

07 March 2004 by MAYS ALADHAM
What is the most appropriate postion for doing seeding during embryo freezing ,is it preferble near the embryos or away?

i would be pleased to receive a reply on this and the reason for it.
        Replies (1)

630. Oocyte fragility

07 March 2004 by mariana hernandez
I have a sudden breakage rate of about 15-20% during icsi of MII oocytes. Of these, 12 to 20% degenerate after icsi.
Recently, 17 oocytes out of 21 of the same patient had sudden breakage and 16 of them degenerate.
I changed 3 times the icsi pipetes but that didn?t help.
Is there any culture factor that can cause changes in the oocytes membranes with posterior sudden breakage ?
        Replies (3)

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