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Meiotic spindle presence and oocyte morphology do not predict clinical ICSI outcomes: a study of 967 transferred embryos.

With a view to correlating oocyte morphology and meiotic spindle presence to clinical intracytoplasmic sperm injection (ICSI) outcomes, 967 oocytes that led to 967 transferred embryos in 404 embryo transfers were studied. No relationship was found between oocyte morphology (ooplasm texture, perivitelline space largeness, perivitelline space granulation absence/presence and the first polar body shape) or meiotic spindle presence or absence and clinical pregnancy per transfer and implantation rates after ICSI. It was concluded that oocyte morphology and meiotic spindle presence or absence can only predict fertilization, cleavage rates and embryo quality, as previously described in the literature, but do not help in daily ICSI practice in the choice of the metaphase II oocyte that will lead to the embryo that starts clinical pregnancy.

Adult↗

Abdominal pregnancy on the bladder wall following embryo transfer with cryopreserved-thawed embryos: a case report.

OBJECTIVE: To describe the occurrence and management of an abdominal pregnancy of the bladder after ET with cryopreserved-thawed embryos. DESIGN: Case report. SETTING: Infertility program in a tertiary care hospital. PATIENT(S): A woman with secondary infertility and a history of breast cancer. INTERVENTION(S): Transfer of cryopreserved-thawed embryos was performed, serial serum hormonal measurements were obtained, methotrexate was given IM, operative laparoscopy was performed. MAIN OUTCOME MEASURE(S): Documentation of abdominal pregnancy after transfer of cryopreserved-thawed embryos and its successful laparoscopic management. RESULT(S): Abdominal pregnancy occurred after ET of cryopreserved embryos in a patient with mild tubal disease. Diagnosis and management using laparoscopy were achieved. CONCLUSION(S): Abdominal pregnancy can occur using ET of cryopreserved-thawed embryos in a patient with mild tubal disease. If anatomically accessible, such a pregnancy can be managed successfully laparoscopically.

Adult↗

Effect of developmental stage of embryo at freezing on pregnancy outcome of frozen-thawed embryo transfer.

BACKGROUND: The study aim was to investigate the impact of the developmental stage of embryos on pregnancy outcome of frozen embryo transfer (FET). METHODS: The survival rates of embryos after thawing and pregnancy outcome following FET were compared retrospectively between three cryopreservation strategies utilizing either zygote, day 2 or day 3 embryo freezing. RESULTS: A total of 4006 embryos was analysed in 1657 thaw cycles. The highest (P < 0.0001) survival rate (all cells survived) was observed for zygotes (86.5%), followed by day 2 (61.7%) and day 3 (43.1%) embryos. FET was performed in 1586 (95.7%) of all thaw cycles, resulting in overall clinical pregnancy and implantation rates of 20.7 and 14.2% respectively. The delivery rate per transfer was 16.5%, and live birth rate per transferred embryo 11%. There were no significant differences in clinical pregnancy, implantation, delivery and birth rates between frozen zygote, day 2 and 3 embryo transfers. However, an elevated miscarriage rate was observed in the day 3 group (45%) compared with zygotes (21.3%; P = 0.049) and day 2 embryos (18.3%; P = 0.004). The overall efficacy of FET (birth rate per thawed embryo) was 7.3%. The efficacy was lower in day 3 group (4.2%) than in the zygote (7.1%; P = 0.082) and day 2 (7.6%; P = 0.027) groups. CONCLUSIONS: The developmental stage of embryos at freezing has a profound effect on their post-thaw survival, but seems to have little effect on rates of clinical pregnancy, implantation, delivery and birth after FET. The elevated miscarriage rate for day 3 frozen embryo transfers may be caused by damage during freeze-thaw procedures. The low survival rate and elevated miscarriage rate were both responsible for a reduced overall efficacy for day 3 FET when compared with zygotes and day 2 embryos.

Abortion, Spontaneous↗

Conception rates after artificial insemination or embryo transfer in lactating dairy cows during summer in Florida.

The objective was to compare conception rates to embryo transfer relative to AI, during summer heat stress, in lactating dairy cows. Holstein cows (n = 180; 50 to 120 d postpartum) were allocated randomly to 1 of 3 groups: artificial insemination (AI, n = 84), embryo transfer using either embryos collected from superovulated donors (ET-DON, n = 48), or embryos produced in vitro (ET-IVF, n = 48). Embryos from superovulated donors were frozen in 10% glycerol and were rehydrated in a 3-step procedure, in decreasing concentrations of glycerol in a sucrose medium before transfer. Embryos produced in vitro were frozen in 1.5 M ethylene glycol, thawed and transferred without rehydration. Blood samples were collected from AI and ET recipients on Days 0, 7 and 22 for measurement of progesterone in plasma. Conception rate was estimated for the three groups at Day 22 (progesterone > 1 ng/mL) and confirmed at Day 42 by palpation per rectum. Conception rate estimates at Day 22 did not differ among groups (AI, 60.7%; ET-DON, 60.4%; ET-IVF, 54.2%), but conception rates at Day 42 differed (AI, 21.4%; ET-DON, 35.4%; ET-IVF, 18.8%; AI versus ET: P > 0.10 and ET-DON versus ET-IVF: P < 0.05). In cows considered pregnant at 22 d but diagnosed open at 42 d, the interestrous intervals were 28.8 +/- 2.2, 35.2 +/- 3.5 and 31.6 +/- 2.9 d, respectively, for AI, ET-DON and ET-IVF groups. Transfer of embryos collected from nonheat-stressed superovulated donors significantly increased conception rates in heat stressed dairy cattle. However, transfer of IVF-derived embryos had no advantage over AI. Where appropriate mechanisms are in place to attenuate the effects of heat stress, embryo transfer using frozen-thawed donor embryos increases conception rates.

Animals↗

Factors affecting pregnancy rates and early embryonic death after equine embryo transfer.

In the present study, 638 embryo transfers conducted over 3 yr were retrospectively examined to determine which factors (recipient, embryo and transfer) significantly influenced pregnancy and embryo loss rates and to determine how rates could be improved. On Day 7 or 8 after ovulation, embryos (fresh or cooled/transported) were transferred by surgical or nonsurgical techniques into recipients ovulating from 5 to 9 d before transfer. At 12 and 50 d of gestation (Day 0 = day of ovulation), pregnancy rates were 65.7% (419 of 638) and 55.5% (354 of 638). Pregnancy rates on Day 50 were significantly higher for recipients that had excellent to good uterine tone or were graded as "acceptable" during a pretransfer examination, usually performed 5 d after ovulation, versus recipients that had fair to poor uterine tone or were graded "marginally acceptable." Embryonic factors that significantly affected pregnancy rates were morphology grade, diameter and stage of development. The incidence of early embryonic death was 15.5% (65 of 419) from Days 12 to 50. Embryo loss rates were significantly higher in recipients used 7 or 9 d vs 5 or 6 d after ovulation. Embryos with minor morphological changes (Grade 2) resulted in more (P<0.05) embryo death than embryos with no morphological abnormalities (Grade 1). Between Days 12 and 50, the highest incidence of embryo death occurred during the interval from Days 17 to 25 of gestation. Embryonic vesicles that were imaged with ultrasound during the first pregnancy exam (5 d after transfer) resulted in significantly fewer embryonic deaths than vesicles not imaged until subsequent exams. In the present study, embryo morphology was predictive of the potential for an embryo to result in a viable pregnancy. Delayed development of the embryo upon collection from the donor or delayed development of the embryonic vesicle within the recipient's uterus was associated with a higher incidence of pregnancy failure. Recipient selection (age, day after ovulation, quality on Day 5) significantly affected pregnancy and embryo loss rates.

Acepromazine↗

Embryo transfer: ultrasound-guided versus clinical touch.

In this prospective control study, the pregnancy and implantation rates were compared between ultrasound-guided and clinical touch uterine embryo transfers. In addition, a subset of patients was sought that would particularly benefit from embryo transfer under ultrasound guidance. A total of 187 patients (93 ultrasound and 94 clinical touch) was enrolled. Allocation was random and depended on whether their embryo transfers were done during the 1 h each day in which the ultrasound was available. Pregnancy and implantation rates of 37.8 and 20.4% respectively were achieved when ultrasound was used, compared with 28.9 and 16.2% respectively with clinical touch. This difference was not statistically significant. There was no significant difference in the pregnancy rate when the number of embryos transferred was controlled. Older women (>/=37 years old) had an apparently higher pregnancy rate (38.1 versus 20.4%; not significant) with ultrasound guidance during embryo transfer. In the subgroup where the clinician rated the transfer procedure as difficult, there appeared to be a substantial improvement in the pregnancy rate in the group that used ultrasound (54.5 versus 10.0%; not significant). Although our results were not statistically significant, we believe that ultrasound-guided embryo transfers should be used in clinically difficult embryo transfers and in older women, as it appears to improve the pregnancy rate over clinical touch transfers.

Adult↗

The window for embryo transfer in oocyte donation cycles depends on the duration of progesterone therapy.

In 192 oocyte donation cycles performed between January 1993 and July 1996, we examined the width of 'the window for embryo transfer' using standard hormonal replacement methods. All transfers were performed within 48 h of insemination. We varied the day of embryo transfer with regard to the initiation of progesterone therapy and, thus, the duration of endometrial exposure to progesterone and analysed the resulting pregnancy rates. Patients were divided into five groups (I-V) and embryo transfers were performed 2, 3, 4, 5 or 6 days following initiation of progesterone therapy. The number of pregnancies per transfer cycle achieved in groups I-V were 0 (0%), 3 (12%), 16 (40%), 29 (48.3%), and 10 (20.4%) respectively. The increased pregnancy rate in group III in comparison to group II is statistically significant (P < 0.03). Furthermore, the pregnancy rate in group IV (5 days of progesterone administration before embryo transfer) was significantly higher than in group V (6 days of progesterone administration before embryo transfer; P < 0.005). We also noted that, when embryos were transferred 4 or 5 days after initiation of progesterone therapy, the pregnancy rates were not significantly different between menopausal and cycling recipients (50% vs 43.7%). Our results indicate that the window for embryo transfer is dependent on duration of treatment with progesterone; it begins approximately 48 h after starting progesterone administration and lasts for approximately 4 days. The optimum period for transferring embryos at the 4- to 8-cell stage corresponds to cycle days 18 and 19. Transfers performed on the 17th and 20th days of the cycle can result in successful implantation, although the rates of implantation are highest when transfers are done on days 18 and 19.

Abortion, Spontaneous↗

Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure.

BACKGROUND: The objective of this study was to determine the incidence of undiagnosed thrombophilic factors and its relation to IVF and embryo transfer failure in women who have had three or more previous IVF-embryo transfer cycles. METHODS: The study group comprised of 90 consecutive women with three or more previously failed IVF-embryo transfer cycles (group A). Two control groups were enrolled: group B (n=90) included women who have had successful pregnancy after their first IVF-embryo transfer cycle, and group C (n=100) included women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of inherited [factor V Leiden (FVL) mutation, prothrombin mutation, methylenetetrahydrofolate reductase (MTHFR) mutation and deficiencies in proteins S and C and antithrombin III] or acquired (lupus anticoagulant and anticardiolipin) thrombophilic factors. RESULTS: An increase in the incidences of FVL, MTHFR and antiphospholipid antibodies was found in the study group compared with the two control groups. At least one inherited or acquired thrombophilic factor was detected in 68.9% of women with repeated IVF failure compared with 25.6 and 25% in the groups B and C, respectively (P<0.01). Combined thrombophilia (two or more thrombophilic factors) was significantly higher in women who have had repeated IVF failure as compared with the two control groups (35.6 versus 4.4 and 3%) (P<0.0001). CONCLUSION: Thrombophilia has a significant role in IVF-embryo transfer implantation failure. Women with repeated IVF-embryo transfer failure should be screened for thrombophilia.

Embryo Implantation↗

An android body fat distribution in females impairs the pregnancy rate of in-vitro fertilization-embryo transfer.

To assess if the waist:hip ratio (WHR) is associated with the pregnancy rate (PR) in in-vitro fertilization (IVF) and embryo transfer, waist and hip girths, in addition to height, weight, body mass index (BMI), indications for IVF, PR and other related variables, were measured in 220 women undergoing IVF-embryo transfer. Three variables were significantly negatively associated with PR; high age, smoking and WHR >0.80. Women with WHR between 0.70-0.79 had a PR of 29.9% as compared to 15.9% in women with WHR >0.80 [odds ratio 0.42, 95% confidence interval (CI) 0.2-0.9, P = 0.03]. There were no correlations between BMI and PR, nor were there any significant differences for the indications for IVF-embryo transfer, number of oocytes or oocyte fertilization rate, cleavage rate and number of embryos transferred. The association between a low PR and WHR >0.80 remained unchanged after adjustment for age, BMI, smoking, indication for IVF, parity and number of embryos transferred. In IVF-embryo transfer, fertilization is a laboratory and clinically controlled process, until the embryo is transferred to the uterus. Possible reasons for our finding of a decreased PR in women with an android body fat distribution include a different endocrinological and biochemical milieu for the oocyte in the growing follicle, oocytes of poor quality, or endometrial changes due to hormonal dysfunction.

Adipose Tissue↗

Modelling of the probability of success of the stages of in-vitro fertilization and embryo transfer: stimulation, fertilization and implantation.

The aim of this study was to find the factors explaining the probability of success of in-vitro fertilization (IVF)-embryo transfer and its different stages: stimulation, fertilization and implantation. The sample came from a retrospective cohort followed in the IVF-embryo transfer centre of the Centre Hospitalier Universitaire of Pellegrin, Bordeaux, France; the data from 471 couples giving rise to 923 IVF-embryo transfer cycles were recorded. Four logistic regression models were specified for global process, stimulation, fertilization and implantation stages. Random effect models were used for taking into account the correlations of the different cycles for the same woman. The main outcome measures were: ongoing pregnancy, number of oocytes, number of embryos. A total of 135 ongoing pregnancies was observed. The significant explanatory variables were for global process: age [> or = 38 years: odds ratio (OR) = 0.28], donor sperm IVF-embryo transfer (OR = 2.1), number of ampoules (OR = 0.98), previous IVF-embryo transfer livebirth (OR = 2.36); for stimulation: age (> or = 35 years: OR = 0.38) and number of days of treatment > 13 days (OR = 0.20); for fertilization: accident during previous IVF-embryo transfer gestation (OR = 0.39), absolute tubal infertility (OR = 1.38) and the number of ampoules of human menopausal gonadotrophin (HMG) per day (OR = 0.85); for implantation: age (age > or = 38 years: OR = 0.34), donor sperm IVF-embryo transfer (OR = 4.58), number of ampoules (OR = 0.98), number and quality of the embryos. Estimates of the probabilities of success are also given for the global process.

Adult↗

Bluetongue virus and embryo transfer in cattle.

Embryos recovered nonsurgically from donor cattle infected with bluetongue virus (BTV) were transferred to seronegative, uninfected recipients. High titers of BTV were found in donor blood at the time of embryo recovery and BTV could be isolated from the recovery medium obtained from many of the donors. Bluetongue virus was not isolated from the blood of any of the 39 recipients that received embryos from infected donors, and none of these recipients seroconverted within 60 days of transfer. There was no evidence that BTV was transmitted to the early embryo in viremic donors. These results indicate that, under standard conditions of embryo transfer, transmission of BTV from infected donors to recipients is unlikely to occur.

Animals↗

Tubal embryo transfer for the treatment of infertility.

The outcome of treatment for male factor infertility with either gamete intrafallopian transfer (GIFT) or in vitro fertilization and embryo transfer (IVF/ET) has been unsatisfactory. A better approach may be tubal embryo transfer (TET). In our medical center, from November 1989 to December 1990, 80 couples (male factor, n = 35, non-male factor, n = 45) entered our program for TET. Superovulation was conducted with either human menopausal gonadotropins (hMG) or gonadotropin-releasing hormone agonist (GnRH-a, buserelin)/hMG. Ovum retrieval (OR) was possible in 73 patients and successful fertilization after insemination occurred in 64 of them. TET was performed only when there was at least one grade III-V embryo. The mean number of embryos transferred was 3.92 +/- 0.13 (range 1-5). There were 35 pregnancies out of 55 TET (64% per TET, 48% per OR). In the group with male factor infertility, OR occurred in 32, and 24 achieved fertilization. Ten pregnancies were achieved after 19 TET (53% per TET, 31% per OR). In comparison, the group with non-male factor infertility had a higher pregnancy rate (69% per TET and 61% per OR). There have been 15 live births, 14 ongoing pregnancies (eight sets of twins and 21 singletons), five abortions and one ectopic pregnancy. Our results indicate that: 1) TET is a valuable treatment for non-tubal factor infertility; and 2) in the group with male factor infertility, it has the advantages of demonstrating fertilization in vitro and preventing unrewarding laparoscopies.

Embryo Transfer↗

Clinical efficacy of body mass index as predictor of in vitro fertilization and embryo transfer outcomes.

The aim of this study was to evaluate the clinical efficacy of body mass index (BMI) as a predictor of in vitro fertilization and embryo transfer (IVF-ET) outcomes. Two hundred twenty-three IVF-ET cycles in 164 patients under 37 yr using GnRH agonist long protocols were included in this retrospective study. All of the selected cases were divided into two groups by a cutoff of 24 kg/m2 and these two groups were compared in regard to the outcomes of IVF-ET. There were no significant differences between group 1 (BMI <24 kg/m2) and group 2 (BMI > or = 24 kg/m2) in age, basal serum FSH level, estradiol (E2) level and endometrial thickness on hCG day, number of retrieved oocytes and transferred embryos. However, higher doses of gonadotropins were used in group 2 (30.8+/-12.7 ampoules vs. 35.4+/-15.3 ampoules, p=0.051). The clinical pregnancy rate was significantly lower in group 2 (25.9% vs. 10.5%, p=0.041) and implantation rate tended to be lower in group 2 (12.7% vs. 6.8%, p=0.085). BMI > or = 24 kg/m2 can be a candidate prognosticator of IVF-ET outcomes.

Adult↗

Single embryo transfer in IVF to prevent multiple pregnancies.

As the success rates of IVF clinics improve, one of the adverse consequences is the increased incidence of twins, due largely to the number of embryos transferred. Even if the number of embryos transferred is restricted to two, the twinning rate can exceed 40% of the pregnancies. An obvious way to reduce this high twin rate would be to transfer only one embryo. This would require that cryopreservation of the supernumerary embryos be efficacious enough so that the chance of achieving an ongoing pregnancy is not diminished by transferring a single embryo in the stimulated cycle. Previous studies utilising embryos on day 2 and 3 of development have shown that the pregnancy rates can be acceptable (about 40%) and that the cumulative rate can be up to 60%. Most of these studies, however, do not include a comparison with the cumulative pregnancy rate with two embryos transferred in the stimulated cycle. Therefore, the efficacy has not been proven. We present clinical data from the past few years to illustrate the increase in success rates and the concomitant increase in twinning rates. The increased success in the cryopreservation program has enabled us to trial a single embryo transfer program and compare the results to the transfer of two embryos. The results strongly suggest that the transfer of a single embryo is the better clinical option.

Embryo Transfer↗

Non-homogeneous hyperechogenic pattern 3 days after embryo transfer is associated with lower pregnancy rates.

The purpose of this study was to investigate the relationship between mid-luteal phase echo patterns and IVF-embryo transfer outcome in women who have demonstrated adequate endometrial development by the late proliferative phase. A prospective study was carried out of 86 patients undergoing IVF-embryo transfer and 86 patients undergoing frozen embryo transfer who all underwent sonographic monitoring of the endometrium 3 days after embryo transfer. The cycles were classified into two groups: those with the homogeneous hyperechogenic (HH) pattern and those without it. The women who had an HH pattern had higher clinical pregnancy (32.8 versus 10.7%, P < 0.05) and implantation rates in stimulated cycles (14.3 versus 4.1%, P < 0.05 respectively) than those that did not. There was no significant difference in the clinical pregnancy or implantation rates by echo pattern (18.2 and 8.1% for non-HH and 18. 7 and 8.0% for HH respectively) in frozen embryo transfer cycles. These data demonstrate that in embryo transfer cycles where ovarian stimulation was used, there were decreased pregnancy and implantation rates in cycles where the HH pattern was not observed 3 days after transfer. The failure of the endometrium to display this pattern may indicate some endometrial abnormality resulting in implantation defects.

Adult↗

[Embryo transfer in a Senegal village environment].

This study aims to identify the embryo transfer constraints and production costs at a village level in the district of Kolda (Senegal). Fifteen (15) donors cows were superovulated using 2500 UI PMSG (group A n = 8), 32 mg of FSH (group B n = 3) and 36 mg of FSH (group C n = 4). The average number of yellow bodies that were palpated was 5.06 and the mean rates of collected embryos were 5.66 for group A, 2.5 for group B and 3.3 for group C. The average transferable embryos were 2.33 for group A, 0 for group B and 1.4 for group C. The identified constraints are nutritional, healthy, social and logistic nature. The average cost of a produced and transferred embryo amount respectively to 75.940 F CFA and 99310 F CFA. Embryo transfer can fit in with a dairy production development plan in Senegal.

Animals↗

Cumulative number and morphological score of embryos resulting in success: realistic expectations from in vitro fertilization-embryo transfer.

OBJECTIVE: To define statistical thresholds for the number and morphological score of embryos transferred that would be predictive of reproductive success in an IVF program. DESIGN: A retrospective review of patient records. SETTING: The Mount Sinai Medical Center Assisted Reproductive Technologies Program. PARTICIPANTS: One hundred women who underwent IVF-ET for a diagnosis of tubal occlusion and later delivered viable infants. RESULTS: The mean number of embryos transferred before achieving live birth was 10.7 +/- 7.9 (mean +/- SD), with one half of patients achieving success within the first seven embryos transferred, and 95% achieving success within 25 embryos. For high quality embryos, the numbers were 7.5 +/- 6.3, 5, and 17, respectively, and, for the cumulative embryo score, a measure of both embryo morphology and metabolic activity, were 114.2 +/- 86.0, 83, and 280, respectively. Greater than 50% of live births occurred within the first two ET attempts. CONCLUSIONS: Although more than half of patients achieved reproductive success within the first two ETs and the first five high quality embryos transferred, after this threshold, fecundity declined rapidly. The calculation of cumulative embryo scores offered additional prognostic information. While all prior attempts to define IVF-ET failure have done so by including patients who did not become pregnant, we have found an analysis of our successes to be a useful adjunct in counseling patients.

Adult↗

Ultrasound detection of pyometra at the time of embryo transfer after ovum retrieval for in vitro fertilization.

OBJECTIVE: To report the detection of pyometra after ovum retrieval for IVF with the routine use of ultrasound-guided embryo transfer. DESIGN: Case report. SETTING: Tertiary fertility center. PATIENTS: A 29-year-old woman who developed pyometra after ovum retrieval for IVF detected at the time of ultrasound-guided embryo transfer. INTERVENTION(S): Cancellation of the embryo transfer, cryopreservation of the embryos, treatment of the pyometra, and a successful frozen-embryo transfer. MAIN OUTCOME MEASURE(S): Normal uterine cavity after treatment and a delivered twin pregnancy. RESULT(S): A successful delivered twin pregnancy. CONCLUSION(S): Routine use of ultrasound-guided embryo transfer resulted in the rescue of the patient's embryos for cryopreservation, with a resulting ongoing pregnancy.

Adult↗