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PubMed2000

Impact of reducing the number of embryos transferred from three to two in women under the age of 35 who produced three or more high-quality embryos.

OBJECTIVE: To investigate the effect of a reduction in the number of good-quality embryos transferred in patients <35 years of age on pregnancy and multiple pregnancy rate. DESIGN: Prospective observational study with historical controls. SETTING: Academic tertiary referral unit. PATIENT(S): Three hundred eight patients <35 years of age undergoing IVF-ET. INTERVENTION(S): For patients who had three or more good quality embryos available for transfer, those in group 1 were given the option to have either two or three embryos replaced, whereas those in group 2 were allowed a maximum of two embryos transferred. In both groups, patients who had less than three good-quality embryos had the option to have three embryos transferred. MAIN OUTCOME MEASURE(S): Pregnancy and multiple pregnancy rates. RESULT(S): Patients in group 1, compared with those in group 2, had significantly more embryos (3 vs. 2) of significantly higher cumulative embryo score (31 vs. 24) transferred. This resulted in significantly higher multiple (57.8% vs. 30.8%) and triplet (15.6% vs. 1.4%) pregnancy rates in group 1. However, no difference in overall clinical pregnancy rate (37.2% vs. 41.2%) or live birth rate (28.1% vs. 29.4%) was observed between group 1 and 2. CONCLUSION(S): In women <35 years of age, who have three or more good-quality embryos available for transfer, a maximum of two embryos should generally be transferred.

Adult↗
PubMed2003

Day 2 vs. day 3 embryo transfer after intracytoplasmic sperm injection. A prospective, randomized study.

OBJECTIVE: To compare, in a prospective, randomized study, implantation and pregnancy rates between day 2 and day 3 embryo transfer intracytoplasmic sperm injection (ICSI). STUDY DESIGN: A total of 106 patients undergoing ICSI cycles who had at least 1 embryo suitable for cryopreservation were prospectively randomized into 2 groups: group I, embryo transfer performed on day 2; group II, embryo transfer performed on day 3. RESULTS: Patient ages did not differ (P = .58) between groups I (33.1 +/- 4.5) and II (32.7 +/- 4.4). The number of oocytes retrieved from group I (13.7 +/- 5.2) was similar (P = .82) to that retrieved from group II (13.7 +/- 5.4). In addition, there was no difference (P = .30) in the number of oocytes retrieved at metaphase II between groups I (10.6 +/- 4.4) and II (9.7 +/- 4.2). Fertilization and cleavage rates were also similar (P = .58 and P = .50, respectively) between groups I (78.2 +/- 14.0% and 98.7 +/- 4.3%) and II (76.2 +/- 14.8% and 99.8 +/- 1.24%, respectively). The total number of embryos and of embryos transferred were similar (P = .22 and P = .36; respectively) for groups I (8.0 +/- 3.0, 2.8 +/- 0.7) and II (7.16 +/- 3.2, 2.6 +/- 0.8). Pregnancy rates per transfer, implantation rates and abortion rates were also similar for groups I (43.4%, 20.8% and 8.7%, respectively) and II (41.5%, 24.1% and 23%, respectively) (P = 1.0, P = .57 and P = .24, respectively). CONCLUSION: The results suggest that extending the embryo culture period from 2 to 3 days for patients who had at least 1 embryo left for cryopreservation had no effect on implantation, pregnancy or abortion rates in an ICSI program.

Adult↗
PubMed1998

[Factors affecting the clinical pregnancy rate in an in vitro fertilization and embryo transfer program].

OBJECTIVE: To analyze the various factors in an in vitro fertilization and embryo transfer (IVF-ET) program which may affect the clinical pregnacy rate. METHODS: A retrospective study was done on 559 IVF-ET cycles from 1992-Nov. 1995. The indication for treatment was bilateral tubal blockage. The chi 2 analysis of single factor variants with SPSS-PC + V3.0 was used for statistics. RESULTS: The overall clinical pregnancy rate in 559 cycles was 21.6%. The cause of tubal blockage due to tuberculoses consisted of 28.4%, and 34.9% of secondary sterility had the history of artificial abortion. The changes of environment, the different causes of tubal blockage, the history of previous intrauterine pregnancy did not affect the clinical pregnancy rate. When the number of embryos transferred increased to 5, the clinical pregnancy rate was highest 32.5%. The cumulative embryo score or embryo quality was related significantly with clinical pregnancy rate. CONCLUSIONS: The number and quality of embryos transferred are important factors affecting the clinical pregnancy rate. However, measures to prevent high-order multiple pregnancy and studies on the survival potential of embryos besides their morphology should be emphasized.

Chorionic Gonadotropin↗
PubMed1989

[Triple extra-uterine pregnancy following in vitro fertilization and embryo transfer].

The article reports on an ectopic pregnancy after IVF/ET that was characterized by the simultaneous nidation of three of the four transferred pre-implantation embryos in both (heavily damaged) Fallopian tubes. The ectopic nidation not only in one of the Fallopian tubes must be seen as a pointer to the importance of active mechanisms of transport from the cavum into the Fallopian tubes. Therefore it is unlikely that ectopic pregnancies after IVF/ET--even if the technique is satisfactory--can be avoided completely. In view of the fact that several IVF treatments were performed in vain, the nidation of three of the four transferred embryos must be interpreted as supporting the theory that the conditions in the Fallopian tubes are more favourable for the development of the human pre-implantation embryos.

Adult↗
PubMed2004

Zygote transfer on day 1 versus cleavage stage embryo transfer on day 3: a prospective randomized trial.

BACKGROUND: It has been reported that pronuclear morphology is related to embryo quality and viability, and that zygote stage embryos might establish pregnancies after being transferred to the uterus. The objective of this study was to investigate whether transferring zygotes on day 1 would result in similar pregnancy rates compared to transferring cleavage stage embryos on day 3 in a prospective randomized trial. METHODS: Patients undergoing IVF/ICSI treatments were randomized to either day 1 or day 3 transfers by envelope withdrawal technique. Zygotes were classified as 'pattern 0' and 'non-pattern 0' according to the size and alignment of pronuclei, the number and distribution of nucleoli. The two best zygotes or embryos were transferred on day 1 or day 3 respectively. The primary outcome measure was pregnancy rate. RESULTS: Pregnancy rates were higher in day 3 group (55/131, 42%) when compared to day 1 (34/123, 28%, P = 0.024). Similarly, implantation rates were higher in day 3 group (P = 0.03). There were more cycles with cryopreservation in the day 1 group (P < 0.001). Embryo quality on day 3 was similar between pattern 0 and non-pattern 0 zygotes. CONCLUSIONS: Day 3 embryo transfers result in better pregnancy and implantation rates compared to day 1 zygote transfers. The present pronuclei scoring cannot reliably select zygotes for transfer on day 1.

Adult↗
PubMed1995

Prospective evaluation of simple morphological criteria for embryo selection in double embryo transfer cycles.

Preventing the occurrence of high-rank multiple pregnancies without reducing the pregnancy rate remains a high priority of in-vitro fertilization and embryo transfer programmes. Our previous study demonstrated that, if there is at least one embryo with a good morphological grade, then the transfer of two (a double embryo transfer) instead of three embryos does not result in a lower pregnancy rate, and that the influence of the number of embryos transferred becomes significant only when poor-quality embryos are transferred. This result allowed us to employ the simple policy of systematically selecting double embryo transfer cycles without affecting the pregnancy rate. Since January 1994, when patients < 37 years of age had more than two embryos available for transfer, only two instead of three embryos were transferred if at least one of the embryos demonstrated a good morphological grade. After a 1 year application of this policy, of the 147 cycles (group A) that fulfilled the above criteria, two embryos were transferred in 92 cycles, while three embryos were transferred in the other 55 cycles. The results of these cycles were compared to those of the control 144 cycles (group B) in which three embryos were transferred, prior to the application of this policy. The on-going pregnancy rates and the incidence of multiple and triplet pregnancies were 24% and 28%, 22% and 23%, and 2% and 9% in groups A and B respectively. The rates were not significantly different. In conclusion, although our prospective trial demonstrated a tendency of decreasing pregnancy rate and an invariable incidence of multiple pregnancies, the very low occurrence of triplets during this period indicated that this policy provided a practical compromise between achieving a high pregnancy rate and an acceptable incidence of triplet pregnancies.

Adult↗
PubMed2004

[Estrogen role in the luteal phase support in in vitro fertilization with embryo transfer cycles].

OBJECTIVE: To evaluate the effectiveness of estradiol administration for luteal phase support and to describe the progesterone and estradiol behavior in vitro fertilization-embryo transfer luteal phase. MATERIAL AND METHODS: Patients undergoing in vitro fertilization-embryo transfer with controlled ovarian hyperstimulation and using gonadotropin releasing hormone agonist. They were divided at random into two groups: group 1 would receive progesterone alone, and group 2 would take estrogen and progesterone. Serum concentrations of estradiol and progesterone were measured on days 7 and 14 post-embryo transfer. RESULTS: We examined 52 patients; 24 received progesterone alone and 28 took estrogen and progesterone. Significantly higher estradiol and progesterone concentrations on day 14 were found in pregnant women. It was not on day 7. A significant increment of estrogen was found in the estrogen and progesterone group. Progesterone did not increase significantly. Pregnancy rate was the same in both groups. CONCLUSIONS: For patients undergoing in vitro fertilization-embryo transfer, the addition of estradiol to the progesterone support regimen does not have beneficial effects in terms of pregnancy rate. On day 7 neither progesterone nor estradiol are good predictors of pregnancy.

Adult↗
PubMed1985

Experiences with the first 100 consecutive pregnancies achieved after in vitro fertilization and embryo transfer at the University Women's Hospital in Erlangen.

As of March 31, 1985, 100 clinical pregnancies have been achieved since the program for extracorporeal fertilization was started in Erlangen. 531 (71%) of 768 follicular punctures resulted in an embryo transfer. The overall pregnancy rate is 13% with regard to the total number of laparoscopies and 19% with regard to the number of embryo transfer. The most effective stimulation proved to be the pure hMG regimen. Employing this protocol, we have achieved a clinical pregnancy rate after IVF and ET of 32% during the last 6 months. Oocyte recovery related to the number of patients is 97%, with laparoscopy being superior to ultrasonically guided puncture. The success rate is appreciably affected by both the number of transferred embryos and the atraumatic transfer technique. We question the rationale of supporting the luteal phase.

Abortion, Spontaneous↗
PubMed2003

Rapid reaccumulation of hydrometra after drainage at embryo transfer in patients with hydrosalpinx.

OBJECTIVE: To report the occurrence and management of hydrometra at the time of scheduled embryo transfer in two patients who underwent drainage of hydrosalpinges at oocyte retrieval. DESIGN: Case report. University IVF clinic. PATIENT(S): Two patients with hydrosalpinges visible on ultrasonography who deferred tubal surgery. Although no fluid was seen at the time of oocyte retrieval, hydrometra was noticed and drained before planned embryo transfer (ET). MAIN OUTCOME MEASURE(S): Reoccurrence of hydrometra after drainage. RESULT(S): Rapid reaccumulation of hydrometra despite drainage was seen in both patients, one of whom had reoccurrence in 1 hour. Embryo transfer was deferred until after tubal surgery, and all embryos were cryopreserved. CONCLUSION(S): In patients with hydrosalpinges, ultrasonography before ET is useful to detect newly developed hydrometra. Aspiration of the uterine fluid is unlikely to help because of rapid reaccumulation of hydrometra. Cryopreservation of the embryos for future transfer after the hydrosalpinx is removed or ligated is recommended.

Body Fluids↗
PubMed2001

ICSI and day 5 embryo transfers: higher implantation rates and lower rate of multiple pregnancy with prolonged culture.

This retrospective review study, carried out in a private IVF clinic, compared pregnancy and implantation rates with day 3 versus day 5 embryo transfers in a selected group of patients. Participants were patients who failed to achieve pregnancy in at least one previous attempt with embryo transfer on days 2 or 3, and had more than five oocytes fertilized. A total of 296 patients who had undergone day 3 (group A) transfers were compared with 154 who had undergone day 5 transfers (group B). Interventions were intracytoplasmic sperm injection (ICSI), day 3 and day 5 embryo transfer. Outcome measures were pregnancy, implantation, multiple gestation and blastocyst formation rates. Overall, 86.4% of embryos were at the six- to eight-cell stage at 72 h and 30% developed to blastocyst by day 5. The mean number of embryos transferred was 4.0 on day 3 and 3.0 on day 5. Pregnancy and implantation rates were 34.8 and 11.5% in group A, versus 45.3 and 18.5% in group B. Multiple gestation rate was 47.1% in group A and 28.5% in group B. Prolonging embryo culture in vitro to day 5 improved embryo selection and implantation rates. A significant decrease in high order gestations was achieved by reducing the number of embryos transferred, without compromising the pregnancy rates.

Journal Article↗
PubMed2005

A randomized double-blind controlled study of the efficacy of laser-assisted hatching on implantation and pregnancy rates of frozen-thawed embryo transfer at the cleavage stage.

BACKGROUND: Assisted hatching (AH) in fresh embryo transfer (ET) cycles increases the implantation and pregnancy rates, especially in women with a poor prognosis, repeated implantation failures and in older women. Little information exists in the literature regarding the role of AH in frozen-thawed embryo transfer (FET) cycles. METHODS: Embryos were cryopreserved at the cleavage stage. On the day of FET, 160 patients were randomized according to a computer-generated randomization list in sealed envelopes into the AH group and the control group. The patients and the clinicians were blinded to the group assigned. In the AH group, the outer half of the zona pellucida over a quarter of the diameter of zona was removed using a 1480 nm non-contact laser. RESULTS: The two groups were comparable in terms of demographic characteristics, ovarian response of the stimulated cycle and quality of fresh and frozen-thawed embryos. No differences in implantation, pregnancy and multiple pregnancy rates were found between the two groups. There was a non-significant trend of a higher implantation rate in the AH group when the zona thickness was > or = 16 mm. CONCLUSION: Laser AH did not improve the implantation rate of FET cycles and should not be performed routinely in all frozen-thawed embryos at the cleavage stage.

Adult↗
PubMed1999

Serum oxytocin concentration during embryo transfer procedure.

OBJECTIVE: To determine the effect of the embryo transfer (ET) procedure on serum concentration of oxytocin. STUDY DESIGN: Prospective clinical study of 10 women undergoing in vitro fertilization (IVF) treatment with ET in the Section of Reproductive Medicine and Endocrinology at the Department of Obstetrics and Gynecology, University of Bonn, Germany. Serial blood samples were collected in time intervals of 20 s during embryo transfer procedure and serum oxytocin concentration was measured. RESULTS: In the absence of tenaculum placement, none of the procedures associated with ET led to an increase in serum oxytocin concentration. When tenaculum placement was used, it was temporally (four out of five patients) associated with an elevation in oxytocin level, which remained elevated until of the end of ET procedure. CONCLUSION: Application of a cervical tenaculum during ET or possibly also during intra uterine insemination (IUI) procedure can stimulate the release of oxytocin in some patients.

Adult↗
PubMedDate not supplied

[The role of ultrasound scanning of endometrium in the superovulation stimulation program during in vitro fertilization and embryo transfer].

The intensive introduction of in vitro fertilization and embryo transfer into the clinical practice of sterility treatment has conditioned the necessity of developing reliable methods of control of the response of ovaries to the application of gonadotropic hormones for stimulating superovulation. There is not sufficient data about prognostic value of ultrasound scanning of structure of endometrium before or after the day of HCG administration in IVF cycles. Several authors have revealed differences in endometrial structure between the women with or without pregnancy. According to the results of our studies, the endometrium thickness has a rather positive prognostic index for evaluating the possibility of the occurrence of pregnancy. Therefore, it is a highly informative ultrasound criterion for making a decision of the completion of superovulation induction and introduction of the embryo transfer and, consequently, makes an important contribution to the in vitro fertilization procedure optimization.

Embryo Transfer↗
PubMed1997

Micromolar concentration of pentoxifylline improves development in vitro of hamster 8-cell embryos: confirmation of biological viability by embryo transfer.

The influence of the sperm motility stimulant pentoxifylline (PF) on preimplantation embryo development in hamsters was evaluated. Eight-cell embryos were cultured in hamster embryo culture medium (HECM)-2, with or without PF (0.023-3.6 mM). There was 90%, 37% and 29% inhibition of blastocyst development by 3.6 (used for human sperm), 0.9 and 0.45 mM PF, respectively. However, 23 microM PF (exposed to hamster oocytes during IVF) significantly (P < 0.05) improved blastocyst development (63.6% v. 51.8%); morulae development was, however, not curtailed by 0.45 mM or 0.9 mM PF (51.8%+/-6.0 or 50.5%+/-11.3, respectively). Post-implantation viability of PF-treated embryos was assessed by embryo transfer; 43% of 80 PF-treated embryos implanted compared with 40% of 79 control embryos. Of the 9 recipients, 6 females delivered pups (19, i.e. 16% of transferred embryos or 53% of implanted embryos). These data show that in hamsters, continuous presence of PF at 0.45-3.6 mM is detrimental to 8-cell embryo development whereas 23 microM PF improves the development of embryos to viable blastocysts which produce live offspring.

Animals↗
PubMed1985

[Clomiphene-HMG ovarian stimulation in human in vitro fertilization and embryo transfer].

In a program for in vitro fertilization and embryo transfer, laparoscopies for oocyte aspiration were performed in 40 cycles in 36 normally menstruating women with irreparable tubal diseases (IVF patients) who received clomiphene citrate (CC) and human menopausal gonadotropin (hMG). An intramuscular injection of human chorionic gonadotropin (hCG) was given to all patients after completion of follicular maturation. Fourteen cycles in 13 spontaneously ovulating women (control patients), also stimulated with CC and hMG, were adequately monitored to identify the appearance of the spontaneous luteinizing hormone (LH) surge. The follicular maturation was followed by daily ovarian ultrasonographic examination and serum estradiol estimations. Just before the LH surge the diameter of the leading follicle was 20.2 +/- 0.7 (mean +/- S.E.) mm and the serum estradiol concentration per follicle was 384.1 +/- 16.3pg/ml in the control patients. In the IVF patients the former was 20.6 +/- 0.3mm and the latter was 305.8 +/- 13.3pg/ml prior to hCG administration. When the relationship of follicular size to the rates of oocytes recovery, maturation, fertilization and cleavage was examined, larger follicles (3ml less than or equal to follicular fluid volume) showed good results. Of the 152 oocytes that were recovered from these IVF patients, 96 (63.2%) were fertilized and 79 (52.0%) cleaved. Three pregnancies resulted from 35 embryo transfers.

Adult↗
PubMed1993

Excess concepti compared with number of embryos transferred in in vitro fertilization.

To reduce the risk of multiple pregnancy, most in vitro fertilization programs limit the number of embryos transferred; because monozygotic twinning may occur, it is possible that more concepti are produced than the number of embryos transferred. To quantify the prevalence of this phenomenon, 1820 clinical pregnancies generated from 11,601 in vitro fertilization treatment cycles were reviewed. Two patients conceived four fetuses each after having had three embryos transferred, while one conceived three fetuses after having had two embryos transferred. The overall prevalence rate was, therefore, one in 607 cases. The obstetric details of these three pregnancies are reported.

Journal Article↗
PubMed1998

Optimization of culture conditions for human in vitro fertilization and embryo transfer.

Approximately 20 years ago the first child conceived with in vitro fertilization (IVF) and embryo transfer was born in England. Although overall pregnancy rates and delivery rates after IVF have improved over the years, success between IVF clinics can vary as much as tenfold. The factors that influence the success rate include type of patient, ovarian stimulation protocol, quality of oocytes, culture conditions, handling of gametes and embryos, quality of embryos, embryo transfer technique, and endometrial receptivity. Culture conditions and handling of gametes and embryos will be reviewed with the hope of improving success of human IVF. The ongoing clinical pregnancy rates in our program increased from about 30% in 1995 and 1996 to about 50% in 1997. Improved embryo culture conditions and embryo cryopreservation technology should not only increase fresh but also frozen-thawed embryo transfer pregnancy. This will make IVF efficient and cost-effective while achieving high overall pregnancy rates with lower multiple pregnancy rates.

Cell Culture Techniques↗