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PubMed1995

Mock embryo transfer with a full bladder immediately before the real transfer for in-vitro fertilization treatment: the Birmingham experience of 113 cases.

The technique of embryo transfer can have a great impact on the outcome of in-vitro fertilization (IVF) treatment. Transcervical embryo transfer is a blind procedure and difficulty can unexpectedly arise. Many IVF programmes therefore perform a 'mock' embryo transfer prior to the treatment cycle to determine the most suitable catheter and technique for transfer. This, however, adds an extra separate procedure with time and cost implications. Moreover, as the uterus is mobile, its direction may vary on the day of the embryo transfer from what it was during the mock embryo transfer. Performing mock embryo transfer immediately before the real transfer would circumvent these problems. We report here on 113 embryo transfer procedures where a 'step-wise' mock embryo transfer protocol was performed with a full bladder immediately before the embryo transfer. The number of embryos transferred (mean +/- SD) was 2.6 +/- 0.67, the pregnancy rate per embryo transfer was 45.1%, and the intrauterine implantation rate per embryo transferred was 20.6%.

Embryo Implantation↗

PubMed1989

Establishment of pregnancy after embryo transfer in mares with gonadal dysgenesis.

Embryo transfer was performed in three mares with gonadal dysgenesis. Karyotypes of the mares were as follows: Mare 1, 63,XX, 64,XX, 65,XX; Mare 2, 63,X; and Mare 3, 65,XXX. The mares were administered progesterone in oil, 300 mg intramuscularly daily, starting 1 or 2 days after donor mare ovulation. Embryos were transferred on day 7 after donor ovulation. Mare 1 became pregnant after the first embryo transfer and had a normally developing fetus on necropsy on day 45 of gestation. Mare 3 became pregnant after the third embryo transfer, but the embryo was lost between day 14 and day 18 of gestation. Mare 2 received embryos on six occasions without maintaining pregnancy after transfer. Mares with gonadal dysgenesis treated with progesterone can establish and maintain pregnancy after embryo transfer, but there may be differences in this capability among mares, possibly related to the cause of the gonadal dysgenesis.

Animals↗

PubMed2006

Cryopreserved-thawed embryo transfer in natural or down-regulated hormonally controlled cycles: a retrospective study.

OBJECTIVE: To assess the implantation, pregnancy, and live birth rates after the transfer of frozen-thawed embryos (FET) in a natural or hormonal control cycle. DESIGN: Retrospective study. SETTING: National Health Service tertiary referral center for reproductive medicine in Manchester, United Kingdom. PATIENT(S): Two comparable groups of women with regular menstrual cycles: Group A (n = 212) had FET in a natural cycle after spontaneous ovulation; group B (n = 205) had FET in a pituitary-desensitized hormonally controlled cycle. INTERVENTION(S): In group B, GnRH agonist was commenced in the midluteal phase of the previous cycle and discontinued 3 days before embryo transfer. Oral estradiol valerate and vaginal progesterone pessary were used to prepare the endometrium. Embryo transfer was carried out 3 days after detection of the endogenous LH surge in group A and on day 3 of progesterone administration in group B. MAIN OUTCOME MEASURE(S): Implantation, pregnancy, and live birth rates per cycle and per embryo transfer (ET). RESULT(S): In the 212 women who had natural-cycle FET, 172 ETs were performed and 247 embryos replaced. The implantation rate was 14.1% (35/247). Twenty clinical pregnancies (20/172, 11.6%) were achieved. In the 205 women who had down-regulated hormone replacement-cycle FET, 173 embryo transfers were performed and 243 embryos replaced. The implantation rate was 13.5% (33/243). Eighteen clinical pregnancies (18/173, 10.2%) were achieved. There were no significant differences between the two groups with regard to the implantation, clinical pregnancy, or live birth rates per cycle or per ET. CONCLUSION(S): These findings suggest that both FET protocols are equally effective in terms of implantation rate and pregnancy outcome in women with regular menstrual cycles.

Administration, Intravaginal↗

PubMed1998

Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfers.

OBJECTIVE: To determine whether the transfer of blastocysts on day 5, developed in sequential culture media, resulted in an increase in implantation rate compared with embryos transferred on day 3. DESIGN: Comparative study of embryo culture regimes. SETTING: Private practice assisted reproductive technology center. PATIENT(S): Twenty-three patients undergoing routine IVF cycles. INTERVENTION(S): Culture of embryos to day 3 in either standard culture conditions or a serum-free chemically defined medium. One hundred one embryos were subsequently cultured from day 3 to day 5 in a second serum-free medium specifically designed to support development of the blastocyst. MAIN OUTCOME MEASURE(S): Embryo cell number and quality on day 3. Blastocyst development on day 5. Implantation rate (determined by fetal heart) and ongoing pregnancy rate (PR). RESULT(S): Implantation rates for embryos transferred at the blastocyst stage of development were twice that observed for embryos transferred on day 3, around the eight-cell stage. Significantly more embryos were required for transfer on day 3, compared with day 5, to establish similar PRs. CONCLUSION(S): Viable human blastocysts can be obtained in sequential culture media in the absence of coculture and serum. Transfer of blastocysts in IVF will facilitate high PRs while limiting the number of embryos transferred and therefore minimizes the risk of multiple gestation.

Adult↗

PubMed1996

Increasing the efficiency of suckled calf production using embryo transfer technology.

The data reviewed in this paper illustrate the benefits of increased output that can be obtained from suckler herds using embryo transfer technology. The technology can be used within breeding schemes to increase the rate of genetic progress for selected traits or to transfer embryos of superior genetic merit and, in the future, embryos of predetermined sex to beef cows. The success of the technology is dependent on the achievement of good pregnancy rates. Experience gained on commercial farms suggests that the main reason for poor success rates in some herds lies with the general level of management of such herds rather than with the reproductive technology itself. Much experience has been gained on the management of embryo transfer recipients and twin-bearing cows. In particular, the nutritional requirements of such animals during the early post partum period and during mid and late pregnancy, and the management of twin-bearing cows during the perinatal period, are discussed.

Animals↗

PubMedDate not supplied

The echoguide embryo transfer maximizes the IVF results.

The performance of two different methods of embryo transfer for IVF has been evaluated in 132 consecutive embryo transfers. Thirty Eight pregnancies were achieved, corresponding to a pregnancy rate of 28.7% of all embryos transfers. The embryo transfer under ultrasound control was used in 61 cases of our study whereas 71 cases were performed with the "clinical feel" method without ultrasound control. The echoguide embryo transfer procedure yielded a significantly higher pregnancy rate than the blind method (36.06% versus 22.6%). The mean number of embryos transferred per attempt was similar in the two groups (3.1 +/- 0.1 and 3.0 +/- 0.1) as was the quality. The randomized comparative study will continue in order to get more data.

Adult↗

PubMed2002

The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy.

BACKGROUND: The role of embryo transfer as regards the success of IVF/ICSI treatments is recognized but has not been comprehensively evaluated. In order to determine its importance, the degree of difficulty of 4807 embryo transfers after IVF/ICSI was analysed retrospectively. METHODS: Logistic regression analysis identified the age of the subject, type of treatment (IVF versus ICSI), number of embryos transferred and degree of difficulty of embryo transfer as independent factors predicting pregnancy. The main focus of the study was to evaluate the importance of the difficulty of embryo transfer after taking into account the other confounding variables. RESULTS: Embryo transfer was classified as easy (2821), intermediate (1644) or difficult (342). The transfer was considered difficult if it was time consuming, the catheter met great resistance, there was a need to change the catheter, if sounding or cervical dilatation was needed or if blood was found in any part of the catheter. Easy or intermediate transfers resulted in a 1.7-fold higher pregnancy rate than difficult transfers (P < 0.0001; 95% confidence interval: 1.3-2.2). CONCLUSIONS: This study demonstrates that the degree of difficulty of embryo transfer is an independent factor as regards achieving pregnancy after IVF/ICSI. All efforts should be made to avoid difficult embryo transfers. Physicians should be alert to the factors associated with embryo transfer and should be instructed to use a stepwise approach in difficult transfers.

Catheterization↗

PubMed1985

Aspects of multiple embryo transfer.

Three hundred seventy-two patients underwent laparoscopy for in vitro fertilization and embryo transfer. Of these, 156 were treated with clomiphene citrate alone, 203 with clomiphene citrate and hMG, and 13 with hMG alone. Two-hundred seventy-two of these patients underwent embryo transfer, and 55 pregnancies resulted. Of these, 30 were ongoing, 14 biochemical, 6 ectopic, and 5 aborted. Where four embryos were transferred, the pregnancy rate was found to be significantly higher than when a lesser number were transferred. When the embryos transferred were analyzed, however, it was found that fewer than 10% of all transferred embryos implanted and it was largely a function of multiple embryo transfer per patient that led to success. When the type of hyperstimulation was compared, clomiphene citrate cycles were found to be less successful in that they produced fewer oocytes and embryos than did cycles in which hyperstimulation was achieved by supplementary hMG. It is conceded that this is an overall analysis and that individuals, especially those producing twins, had more than one good embryo transferred into a receptive uterus. The data suggest that unsuccessful cycles had somewhat poorer quality embryos, nonreceptive endometria, or a combination of these factors when compared with those of the successful embryo transfer cycles. The only predictive factor as to outcome relates to the multiplicity of embryos transferred. The fact that some IVF cycles produce multiple pregnancies indicates that a predictor of embryo health is urgently required. However, until such a reliable predictor is obtained, multiple embryo transfer remains a major advance in the success of IVF and ET.

Abortion, Spontaneous↗

PubMed2005

Ultrasound-guided miduterine cavity embryo transfer is associated with a decreased incidence of retained embryos in the transfer catheter.

After initiating a policy of ultrasound-guided miduterine cavity embryo transfer (ET) on August 1, 2001, the incidence of retained embryos in the transfer catheter declined significantly from 4.2% (46 of 1,101 ETs) during the time interval January 1, 2000 to July 31, 2001, to 0.7% (6 of 908 ETs) during the time interval August 1, 2001 to December 31, 2002. Blood on the transfer catheter (38% vs. 19%) occurred with significantly greater frequency at ET in which embryos were retained; ETs of > or =4 embryos were more likely to be associated with retained embryos than ETs of <4 embryos (3.7% vs. 2.2%), and both the clinical pregnancy rate (PR) and implantation rate (IR) were lower when embryo retention occurred at ET than they were when embryos were not retained (25% vs. 34% clinical PR; 12% vs. 19% IR).

Catheterization↗

PubMed1989

Use of embryo transfer to induce twinning in beef cattle: embryo survival rate, gestation length, birth weight and weaning weight of calves.

Experiments were conducted in 1985 and 1986 at the Eastern Ohio Resource Development Center, Belle Valley, to examine the feasibility of using embryo transfer to induce twinning and to examine the influence of twinning on traits of the cow and calf. Embryos were collected from a total of 14 superovulated Angus donors on two dates each in 1985 and 1986 and were transferred to Angus recipients. A total of 124 embryos were transferred to 79 recipients, with 43 (34.7%) calves born alive. Seven of 45 (15.6%) recipients implanted with two embryos produced twins. In no case did both halves of the 15 embryos that were split to produce identical twins and implanted in the same recipient survive to birth. Proportion of calves born alive did not differ among transfer codes 3 (nonsplit embryos from two different donors implanted in separate uterine horns of the same recipient), 6 (nonsplit embryos from one embryo flush implanted in separate uterine horns of the same recipient) and 7 (nonsplit embryos from two different donors implanted in the same uterine horn of one recipient). Surgical transfers tended to result in a higher proportion of embryos surviving to birth (.43 vs .21; P = .16) and a higher twinning rate (.29 vs .04; P = .36) than did nonsurgical transfers. Age of recipient did not influence embryo survival (P = .98) or twinning rate (P = .99). Gestation length was 5 d shorter (P less than .01) for twin calves than for singles. Singles were 9 kg heavier (P less than .01) at birth and 32 kg heavier (P less than .01) at weaning than twins. However, cows raising twins produced 108 kg (51%) more total weaning weight than did cows raising singles.

Animals↗

PubMed1986

Synchronization of estrus in embryo transfer recipients receiving demi-embryos with Syncro-Mate B or estrumate.

One hundred thirty-five crossbred heifers were used to compare the effectiveness of Estrumate and Syncro-Mate B in synchronizing estrus in recipient heifers for transfer of demi-embryos. A higher percentage (P<0.01) of Syncro-Mate B heifers showed estrus within 5 d following treatment than did Estrumate heifers (100.0 vs 85.1%). Demi-embryos were transferred to 41 and 26 heifers treated with Syncro-Mate B and Estrumate, respectively. The pregnancy rate of heifers synchronized with Estrumate was higher (P<0.01) than that of heifers synchronized with Syncro-Mate B (64.3 vs 27.8%). A single blood sample was collected on the day of embryo transfer from all heifers receiving demi-embryos, and progesterone concentration was determined. There were no significant differences in mean serum progesterone concentrations either between heifers synchronized with Syncro-Mate B and Estrumate or between pregnant and open heifers within synchronization treatment. There was no relationship between serum progesterone concentration and pregnancy rate in the Estrumate recipients (P>0.10). However, 25.0% of the Syncro-Mate B recipients had serum progesterone levels <1.00 ng/ml, and these heifers had a lower pregnancy rate (P<0.05) than Syncro-Mate B heifers with serum progesterone levels between 1.00 to 3.00 ng/ml. It appears that the Syncro-Mate B heifers with <1.00 ng/ml progesterone had either a delay in corpora lutea function or a continuously reduced concentration of serum progesterone which altered the uterine environment of these heifers and caused the lower pregnancy rate in the Syncro-Mate B group. Based on the large difference in pregnancy rates, Estrumate appears to be a more effective method to synchronize estrus in recipient heifers receiving demi-embryos.

Journal Article↗

PubMed2004

Air in the transfer catheter does not affect the success of embryo transfer.

OBJECTIVE: To investigate the effect on embryo transfer (ET) success of air loaded into the transfer catheter to bracket the embryo-containing medium. DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PATIENT(S): One hundred two consecutive patients undergoing ET after IVF. INTERVENTION(S): In group 1 (n = 52), embryos were loaded as follows: 200 microL of air in the syringe, 100-125 microL of air in the proximal part of the catheter, 20-25 microL of medium containing the embryos to be transferred, and 10 microL of air at the tip of the catheter. In group 2 (n = 50), the syringe and the entire catheter were filled with medium and the embryo-containing medium (20-25 microL) was aspirated without being bracketed by air spaces. MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates. RESULT(S): No differences were found between groups 1 and 2 with respect to implantation and pregnancy rates. CONCLUSION(S): The air loaded into the transfer catheter to bracket the embryo-containing medium has no negative effect on ET success.

Air↗

PubMed2005

Soft versus firm embryo transfer catheters for assisted reproduction: a systematic review and meta-analysis.

BACKGROUND: The true impact of the embryo transfer catheter choice on an IVF programme has not been fully examined. We therefore decided to systematically review the evidence provided in the literature so that we may evaluate a single variable in relation to a successful transfer, the firmness of the embryo transfer catheter. METHODS: An extensive computerized search was conducted for all relevant articles published as full text, or abstracts, and critically appraised. In addition, a hand search was undertaken to locate any further trials. RESULTS: A total of 23 randomized controlled trials (RCT) evaluating the types of embryo transfer catheters were identified. Only ten of these trials, including 4141 embryo transfers, compared soft versus firm embryo catheters. Pooling of the results demonstrated a statistically significantly increased chance of clinical pregnancy following embryo transfer using the soft (643/2109) versus firm (488/2032) catheters [P = 0.01; odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.08-1.79]. When only the truly RCT were analysed, the results were again still in favour of using the soft embryo transfer catheters [soft (432/1403) versus firm (330/1402)], but with a greater significance (P < 0.00001; OR = 1.49, 95% CI = 1.26-1.77). CONCLUSION: Using soft embryo transfer catheters for embryo transfer results in a significantly higher pregnancy rate as compared to firm catheters.

Catheterization↗

PubMed2004

Pregnancy outcome after blastocyst transfer as compared to early cleavage stage embryo transfer.

BACKGROUND: Retrospective cohort study to evaluate differences in outcome when embryo transfer was performed either on day 2-3 (cleavage stage, CS-group) or on day 4-5 (blastocyst stage, BS-group). METHODS: A total of 1259 consecutive cycles yielding 500 live born babies performed at a single centre in Bregenz, Austria, were included. Main outcome measures were implantation and (multiple) pregnancy rates and neonatal outcome including birth defects. RESULTS: Total Pregnancy rate was 44% vs 28% (P < 0.001) and the total 'take home baby rate' was 37% vs 22% in the BS-group and the CS-group, respectively. Rate of multiple gestations (34% vs 17%, P = 0.001) was significantly higher among the BS-group, resulting in a higher rate of preterm deliveries < 36 weeks (26% vs 17%, P = 0.045). Female factor causing infertility (40% vs 21%, P < 0.001) was significantly higher among the BS-group. For the CS-group, rate of singleton pregnancies (83% vs 66%, P = 0.001) and idiopathic cause of infertility (34% vs 22%, P = 0.012) were significantly higher. No statistically significant differences were found in sex, Caesarean section rate, Apgar score and umbilical artery pH-values, total mean birth weight, admission rate to intensive care unit, days of hospitalization and number of minor and major birth defects. CONCLUSIONS: Our data suggest that blastocyst transfer may lead to a higher pregnancy rate with an overall better take-home baby rate (THBR) at the cost of higher rates of multiples and preterm deliveries.

Adult↗

PubMed2006

A prospective randomized study to assess the benefit of partial zona pellucida digestion before frozen-thawed embryo transfers.

BACKGROUND: Assisted hatching (AH) in fresh embryo transfer (ET) could be associated with increased implantation rates. However, very few prospective randomized studies have specifically addressed the issue of AH during frozen-thawed embryo transfers (FET) cycles, those that have reported controversial results. The aim of this study was to evaluate the benefit of an enzymatic zona pellucida treatment of frozen-thawed embryos before transfer. METHODS: This was a prospective study including 125 non-donor FET cycles from 125 infertile couples. FETs were randomly allocated into AH group (n = 61, embryos pretreated with pronase 5 IU/ml for 1 min at 37 degrees C) or control group (n = 64, untreated embryos). Zona pellucida thickness was measured for each transferred embryo. The main outcome parameters were clinical pregnancy and implantation rates. RESULTS: The two groups were comparable regarding mean women's age, duration and indications of infertility, IVF outcome after fresh ETs, numbers and quality of fresh and frozen embryos, frozen-thawed embryo survival rates and blastomeres survival indexes. Despite a statistically significant decrease of zona pellucida thickness after pronase treatment [(mean +/- SD) 18.5 +/- 2.25 versus 14.5 +/- 2.75 microm; P < 0.0001], implantation (9.6 versus 9.2%) and clinical pregnancy rates (18.0 versus 17.2%) were not statistically different after FETs, with a similar mean number of embryos transferred between AH and control groups, respectively. CONCLUSION: Within the constraints of our protocol, partial enzymatic digestion of zona pellucida by pronase was not related with any benefit of the FET outcome especially concerning the implantation ability of frozen-thawed embryos.

Adult↗

PubMed1987

Commercial feasibility of embryo transfer technology: a case study.

The owner of a 500-cow Holstein herd requested economic assessment of his embryo transfer program. Actual net economic benefit was determined from marginal cost and present value of lifetime milk predicted from first lactations of 24 cows produced by embryo transfer compared with those of their 51 contemporaries sired by artificial insemination. Actual average pregnancy rate was 60% by embryo transfer or AI. An average of 5.5 transferable embryos was obtained per collection, which produced 1.37 cows in first lactation. Additional milk from embryo transfer cows was from more intensive selection of sires. Additional milk from the donor cows did not differ from zero. Actual marginal cost of a replacement by embryo transfer was +215, but it would have been +200 with same +25/unit semen price as contemporaries. If donors had been from the elite 5% for transmitting ability in milk, present value of gain in milk (5% real interest rate) ignoring additional feed costs would have been less than the cost of embryo transfer. For management and costs similar to this case, embryo transfer is not economically justified for producers earning income primarily from the sale of milk.

Animal Husbandry↗

PubMed1985

Ectopic pregnancy and spontaneous abortions following in-vitro fertilization and embryo transfer.

In-vitro fertilization and embryo transfer was performed in 25 patients with diseased oviducts. Three pregnancies were achieved, but all ended in early abortion. One patient had ectopic pregnancy, one spontaneous abortion having a severe autosomal chromosome abnormality, and one had a rise in serum hCG but vaginal bleeding started 18 days after embryo transfer. We conclude that repeated ultrasonic examinations of all pregnancies following in-vitro fertilization and embryo transfer is recommendable until intra-uterine implantation has been confirmed and that amniocentesis should be offered to all these patients.

Abortion, Spontaneous↗

PubMed1987

A controlled study between the use of gamete intrafallopian transfer (GIFT) and in vitro fertilization and embryo transfer in the management of idiopathic and male infertility.

A randomized controlled trial comparing the use-effectiveness between gamete intrafallopian transfer (GIFT) and in vitro fertilization (IVF) and embryo transfer (ET) procedures showed no significant difference in pregnancy rates in the management of patients presenting with idiopathic or male infertility. The cost-effectiveness of GIFT appears superior to IVF and ET with laparoscopic oocyte collection, but comparable to IVF-ET with ultrasonic oocyte collection. The lack of data on the fertilizing capacity of sperm in GIFT procedures in cases of male infertility is a real disadvantage and currently precludes the management of severe male infertility with this method.

Adult↗