A clinical assessment of nine pregnancies obtained by in vitro fertilization and embryo transfer.

An analysis of nine pregnancies resulting from in vitro fertilization and embryo transfer was made in order to identify factors common to all of the pregnancies. These factors included clomiphene stimulation; general anesthesia for laparoscopy; identification of large follicles (greater than 8 ml) and a mature oocyte; preincubation of the oocyte for 4.7 to 6.5 hours in vitro before insemination; insemination with 0.8 to 1.3 x 10(6) fresh spermatozoa from fertile samples; transfer to the uterus of two-, four-, and eight-cell embryos, 38 to 50 hours after insemination; and uncomplicated uterine transfers of embryos. It was difficult to determine whether these factors are causal or coincidental in the attainment of successful pregnancies. The detailed analysis was useful in demonstrating factors which did not prevent the establishment of pregnancy by in vitro fertilization and embryo transfer. These factors included a variety of causes of infertility, including idiopathic and male infertility; age of the infertile woman over 35 years; the presence of T-mycoplasma in the genital tract; the use of human chorionic gonadotropin; a variety of agents used for general anesthesia; the use of carbon dioxide to induce pneumoperitoneum; a delay of up to 50 minutes in the interval between the induction of general anesthesia and oocyte recovery; the use of antiprostaglandins at the time of embryo transfer; and a brown discharge from the vagina following embryo transfer.