#1 Cost efficient IVF service and eduion in U.S. Outpatient based IVF. Complete facilities include ultrasound suite,endocrine and andrology labs, and all IVF facilities. Located at new outpatient therapy center offering the latest in laparoscopy and hysteroscopy. Accomodations for visitors are nearby, safe, and inexpen

PCOS: More Keys to the Puzzle
Title: Heterogeneity in beta activity, hepatic insulin clearance and peripheral insulin sensitivity in women with polycystic ovary syndrome
Author: M. Ciampelli.
Address: Rome, Italy
Source: Human Reproduction 12, 1897-1901 (September) 1997
Summary: This study evaluated the impact of reduced peripheral insulin sensitivity, beta cell hypersecretion and reduced hepatic insulin clearance in (PCOS) patients. Study population was comprised of 35 women, aged 17-31 with PCOS. PCOS was diagnosed by the following criteria: presence of amenorrhea or oligomenorrhea; hirsuitism; elevated plasma androstenedione or testosterone; and bilaterally normal or enlarged ovaries with the 7 or more microcysts less than 5mm diameter. LH/FSH ration was not considered as part of the exclusion criteria. PCOS patients were divided into 4 groups based on their body mass index (BMI) and insulin secretion. Ten lean ovulatory women were used as controls. The groups were classified as: normoinsulinemic-lean; normoinsulinemic-obese; hyperinsulinemic lean; hyperinsulinemic-obese. Obesity was defined as a (BMI) over 25 (normal range 19-25). All PCOS groups showed significantly higher insulin secretion. Glucose load elicited no differences in insulin response in any of the groups. Secretion of c-peptide was greater in PCOS groups and all hyper-insulinemic PCOS patients had lower values of hepatic insulin clearance independent of BMI when compared with the controls P less than 0.0001 or with the PCOS normo-insulinemic patients Pless than 0.01. Lean PCOS subjects and controls had higher body glucose utilization rates than the normo and hyperinsulinemic obese subjects. The authors suggest that insulin resistance and hyper-insulinemia may represent 2 distinct features of the insulin disorder in PCOS: the former appears to reflect the presence of obesity, while the latter may be a primary feature of PCOS.
Comment:Possibly another piece of the PCOS puzzle. It is still hard to know whether to be a lumper of splitter when considering the manifestation of the the PCO spectrum.

Successful Pregnancy Reported with Immature Oocytes
Title:Unstimulated immature oocyte retrieval: early vs midfollicular endometrial priming
Author: J. Russell et al
Address:Newark, Deleware
Source: Fertility and Sterility 67:4;616-620 (April)
Synopsis: This study assessed the ability to retrieve transvaginally understimulated immature oocytes from 14 patients who had failed at least one IVF cycle. It was hypothesized that change in preparation of the endometrium may improve pregnancy rates. Group A contributed 83 oocytes and early follicular priming was initiated on cycle day 3 with 2 mg oral estradiol twice a day. Group B contributed 78 oocytes and midfollicular endometrial priming was initiated with 1-2 mg/day of oral estradiol between cycle days 5 and 7 and increased by 1-2 mg/d until the oocyte retrieval. An average of 11-12 oocytes were obtained from each group. Media was supplemented with FSH and LH. Fertilization rate was indentical at 75%; cleavage arrest 36%(group A) vs 8.3 (groupB), embryos transferred 1.8 (group A) vs 4.0 (group)B. One pregnancy was achieved in group B.
Comment: Treatment of patients with previously failed IVF cycles is extremely challenging. Many patients will be successful in subsequent cycles, while others fail despite all attempts. Everyone is looking for new technologies for these patients; especially, if the cost of ovarian stimulation, in terms of monetary inconvenience, risks of hyperstimulation and multiple gestations, can be lessened. This technique of immature oocyte aspiration has been very much in the news and virtually all IVF centers are discussing its implications. The overall success rate with technique at all centers is low, as attested by a single pregnancy in 14 patients in the present study. As proposed by the above authors, proper endometrial priming possibly could improve success rates. No doubt immature occyte utilization is in the future of IVF technology. Patients should be very cautious about premature conclusions of its usefulness of this technique until it has been confirmed in other studies.