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PubMed1998

A woman with three ectopic pregnancies after in-vitro fertilization and embryo transfer.

Although a higher incidence of ectopic pregnancy has been reported after in-vitro fertilization (IVF) and embryo transfer, three ectopic pregnancies in the same woman is very rare. A patient of 32 years underwent IVF-embryo transfer six times within 3 years. Three of four conceptions resulted in ectopic pregnancies. The first involved simultaneous intrauterine and left tubal pregnancy, the second was a right tubal pregnancy, and the third was a right interstitial pregnancy. In IVF-embryo transfer, bilateral salpingectomy does not remove the risk of interstitial or cornual pregnancy.

Adult↗

PubMed2003

Improving successful pregnancies after embryo transfer.

Over the past 20 years the rate of blastocyst development in vitro has improved through the development of sequential defined media, refining the oxygen concentrations during culture and providing substrates to ameliorate free radical accumulation. Despite these advances there has been little progress in improving calving rates after the transfer of in vitro produced embryos. This suggests that the culture conditions have been very effective in enabling those fertilised oocytes to reach the blastocyst stage that otherwise would not occur in vivo. We suggest that the next advance by which the embryo transfer technology gains more acceptance in cattle production will be identifying those cows which are intrinsically superior recipients. This must be coupled to the development of non-invasive assessments of the developmental competence of both the oocyte and the blastocyst. Until these two goals are achieved the ET industry will remain static and unable to overcome the economic loss caused by embryo mortality occurring 7-10 days after transfer.

Abortion, Veterinary↗

PubMed1996

Serum relaxin and the major endometrial secretory proteins in in-vitro fertilization and down-regulated hormone-supported and natural cycle frozen embryo transfer.

Relaxin has been postulated to be a modulator of the expression of the endometrial secretory proteins, insulin-like growth factor binding protein (IGFBP-1) and placental protein 14 (PP14). This study evaluated the expression of relaxin in relation to concentrations of these secretory proteins along with oestradiol, progesterone and human chorionic gonadotrophin in groups of pregnant and non-pregnant patients who underwent differing assisted conception treatments. Serum samples were taken from 88 patients at 8 and 12 days after embryo transfer. At 12 days after embryo transfer, relaxin concentrations in the pregnant patients who had undergone in-vitro fertilization (IVF) or natural cycle frozen embryo transfer were significantly higher than those who did not conceive in these groups (mean concentrations 8334 versus 28 and 2608 versus 62 pg/ml respectively, P<0.001). However concentrations in the pregnant patients who had hormone support and transfer of frozen embryos were not significantly different from the patients who did not conceive after the same treatment. Although relaxin expression was associated with corpus luteum activity, it was not related to the number of corpora lutea in IVF patients. A wide range of relaxin concentrations was seen to be compatible with a healthy pregnancy. These serum relaxin concentrations were not found to be directly related to the serum concentrations of IGFBP-1, PP14 or the other factors assessed in this study.

Chorionic Gonadotropin↗

PubMed2004

Ultrasound guidance is not necessary during easy embryo transfers.

PURPOSE: To determine whether the use of ultrasound (US) to guide embryo transfer (ET) in a population previously defined as likely to have easy transfer would change the implantation and pregnancy rates in an ICSI program. METHODS: A total of 100 patients identified as likely to have easy transfer after mock transfer were divided into two groups: Group I, US-guided ET (N = 50) and Group II, ET without the aid of US (N = 50). RESULTS: Implantation and pregnancy rates were similar (p = 0.51, p = 0.29) for Group I (19.6%, 42%) and Group II (16.3%, 30%), as also was the abortion rate (p = 0.55) (Group I: 1/21; Group II: 2/15). CONCLUSION: As long as previous mock transfers are routinely performed during a cycle preceding assisted reproduction and the clinician considers transfer to be easy, ultrasound does not benefit the process of embryo transfer.

Abortion, Spontaneous↗

PubMed1995

Screening of some variables influencing the results of embryo transfer in the ewe. I. Five-day-old embryos.

Rasa Aragonesa ewes (n = 89) received 2 embryos on Day 6 of the estrous cycle (Day 0 = estrus) from 46 donors of the same breed that had been superovulated with FSH-p. The influence of several variables on fertility and prolificacy after transfer was studied by discriminant analysis. Our results showed that the main variables that contributed to a high fertility rate were the degree of synchrony (better outcome if donors come into estrus later than the recipients); Fluorogestone acetate (FGA) to estrus interval and interval from previous lambing in the recipients, ovulation rate of the donors and recipients (better if superior to the mean); prolificacy of recipients in the previous lambing; and difference in developmental stage of the pair of transferred embryos (better if inferior to the mean). The main variables affecting prolificacy were the ovulation rate and weight of the donors and progesterone concentrations of the recipients (better if lower than the mean); age of the donors and difference in progesterone concentrations between donors minus those of the recipients (better if higher than the mean). The percentage of ewes correctly classified into lambing or not lambing status was 73% (P < 0.001) and that of the ewes correctly classified as lambing 1 or 2 lambs was 81.8% (P < 0.001). Whether or not the criteria we have established for optimum transfer results are applicable to conditions other than our own still needs to be confirmed.

Journal Article↗

PubMed1999

Ultrasound evaluation of the uterine zonal anatomy during in-vitro fertilization and embryo transfer.

This study was designed to establish if ultrasound could detect differences in uterine zonal anatomy between conception and non-conception in-vitro fertilization (IVF)/embryo transfer cycles. A transvaginal ultrasound scan was performed on the day of down regulation (D0), on day 8 of ovulation induction (D8), on the day of human chorionic gonadotrophin (HCG) injection, at the time of oocyte retrieval, and at embryo transfer. Thicknesses of endometrium, junctional zone, myometrium and full thickness of the uterus were recorded for every patient and comparisons made at all the assessment points. Differences between measurements on D0 and all other measurements (temporal changes) and between every subsequent measurement (dynamic changes) were also compared. There were no statistically significant differences in endometrial thickness between pregnant and non-pregnant groups at any time. The diameter of the uterus increased during therapy and was significantly greater in the pregnant subset at the time of HCG injection, oocyte retrieval and embryo transfer (P < 0.02, 0.03 and 0.02 respectively). The myometrium was significantly thicker in the pregnant group on D0, on D8 and at HCG administration (P < 0.03, 0.004 and 0.02). There was a decrease in junctional zone thickness in both groups during the first week of ovulation induction, and on D8 the junctional zone in pregnant patients was significantly thinner (P < 0.04). The junctional zone became significantly thicker at embryo transfer in the pregnant group (P < 0.01). This was confirmed by significant temporal and dynamic changes at the time of oocyte retrieval and embryo transfer (P < 0.01, 0.0001 and P < 0.05, 0.01 respectively). In the patients who did not conceive, changes in the junctional zone were less pronounced. In conclusion, it was not possible to predict the likelihood of pregnancy from endometrial thickness at any time during the IVF cycle, but changes occurred in other uterine layers that were more pronounced in conception cycles. The responsiveness of the junctional zone seems to be associated with implantation, and its measurements at the time of downregulation and embryo transfer can be used to predict treatment outcome.

Adult↗

PubMed2004

17 alpha-hydroxyprogesterone caproate versus intravaginal progesterone in IVF-embryo transfer cycles: a prospective randomized study.

One of the main issues in the management of IVF and embryo transfer techniques is to ensure adequate concentrations of progesterone. The aim of this prospective, randomized study was to compare the effectiveness of 17 alpha -hydroxyprogesterone caproate (17-HPC) administered intramuscularly and intra-vaginal progesterone in gel in luteal phase support in patients undergoing IVF-embryo transfer cycles. A total of 320 patients were randomly treated with either 17-HPC (341 mg i. m. every 3 days) or progesterone vaginal gel (90 mg daily). The inclusion criteria were the use of gonadotrophin-releasing hormone down-regulation and age <40 years. The outcome of IVF in both study groups was evaluated for implantation rate, biochemical pregnancy, clinical pregnancy, miscarriage, and ongoing pregnancy rate. The results of this study showed that 17-HPC conferred more benefit to IVF-embryo transfer cycles compared with intra-vaginal progesterone, as demonstrated by the results of most of the main outcome parameters considered. The data showed that 17-HPC administered every 3 days appears to be more effective in providing luteal support in comparison to intra-vaginal progesterone.

17 alpha-Hydroxyprogesterone Caproate↗

PubMed2006

Interspecific embryo transfer from mouflon (Ovis gmelini musimon) to domestic Corriedale sheep in Argentina.

An interspecific embryo transfer program was conducted for genetic improvement and increasing the number of offspring from a flock of mouflon sheep in Argentina. The female donor mouflons were divided into three groups, G1 (n=5), G2 (n=4) and G3 (n=5). The total NIH-FSH-P1 dose given to each donor on the superovulatory treatment was 260, 200 and 160 mg for G1, G2 and G3, respectively. The mouflons in G3 were maidens, while the others were multiparous. Domestic Corriedale ewes (n=60) were synchronized and used as recipients. The embryo recovery and transfer was performed by a surgical method. Mouflons (n=13) responded to the superovulatory treatment with an average of 9.1+/-2.8 ovulations. A low incidence of early luteal regression was found (1 out of 14 donors). Embryo recovery rates were 60, 31 and 76% in groups G1, G2 and G3, respectively. The percentage of transferable embryos obtained in G1 and in G2 exceeded 80%. None of the embryos obtained from G3 were of transferable quality. In G1, 25 transferable embryos were recovered and transferred to 13 recipients, resulting in a pregnancy rate of 76.9% (10/13). In G2, 10 embryos were transferred to 5 recipients, resulting in a 60% pregnancy rate (3/5). Lambing rate was 60% (15/25) and 30% (3/10) for G1 and G2, respectively. Thirteen lambs were born to the 14 donors following natural service after the embryo recoveries. This study demonstrates that the application of IET technology would have great reproductive impact, especially when the donor mouflon hinds are selected according to age and reproductive history.

Animals↗

PubMed2006

Does gravidity influence the success of in vitro fertilization-embryo transfer cycles?

OBJECTIVE: To evaluate the influence of gravidity on the results of in vitro fertilization (IVF)-embryo transfer (ET) cycles. PATIENTS AND METHODS: All consecutive women aged <35 years admitted to our IVF unit from January 2002 to December 2004 were enrolled in the study. Only patients undergoing one of their first three IVF cycle attempts were included. Gravidity, ovarian stimulation characteristics, number of oocytes retrieved, number of embryo transferred and clinical pregnancy rate were assessed. RESULTS: Three hundred and forty-two consecutive IVF cycles were evaluated. One hundred and sixty-one cycles were from nulligravidas and 181 from women with a history of at least one previous clinical pregnancy. Forty-eight (29.8%) clinical pregnancies were observed in the nulligravida group and 56 (30.9%) in the gravida group. There were no differences between nulligravidas and gravidas in causes of infertility, length of ovarian stimulation, peak estradiol and progesterone levels, number of oocytes retrieved, fertilization rate and number of embryos transferred. Gravidas were significantly older (30.4 vs. 27.6 years, p < 0.001) and used more gonadotropin ampoules (36.1 vs. 31.8, p < 0.004) compared with the nulligravidas. CONCLUSIONS: Patient gravidity has no influence on the likelihood of achieving pregnancy in IVF-ET cycles.

Adult↗

PubMed2006

[Elective single embryo transfer: a justified policy for selected patients].

OBJECTIVE: Prevention of twin pregnancies using elective Single Embryo Transfer (e-SET) is now considered by many Assisted Reproductive Techniques teams as a necessity. The aim of this study was to assess the efficacy of e-SET in a prospective manner in a selective population of patients using Take Home Baby Rate per couple as principal parameter. PATIENTS AND METHODS: This prospective study was conducted from January 2003 to December 2004. Elective Single Embryo was proposed to women above 37 years in their first IVF or ICSI attempt. It was then performed only in cases when at least one embryo with high implantation potential (score-4 embryo in our embryo scoring) was obtained for transfer and one more (score-3 or score-4 embryo) was available for freezing. RESULTS: e-SET was proposed and accepted in 225 couples (25% of eligible couples and 7.8% of total population) and was possible in 96 of these). Two embryos were transferred in all other eligible patients (Double Embryo Transfer group=DET). Cumulative delivery rate after fresh embryo transfers and, if necessary, after frozen-thawed embryo transfers were 39.5% per couple e-SET group and 41.7% in DET group (NS). On the other hand, the percentage of twin pregnancies was significantly different between the two groups (2.6% vs 26.6% respectively; P<0.01). DISCUSSION AND CONCLUSION: In women younger than 37 years in their first IVF/ICSI attempt, the elective transfer of only one embryo with high implantation potential strongly allowed to avoid twin pregnancies without any significant delivery rate decrease. This transfer policy is particularly efficient in laboratories displaying good results in their embryo freezing program.

Cryopreservation↗

PubMed2006

No transuterine migration of fertilised ova after unilateral embryo transfer in mice.

Transuterine migration is the passage of fertilised ova from one uterine horn into the other. The phenomenon has been described for animals of different species with a bicornuate type of uterus. Whether or not it occurs in rodents is questionable, but could have an impact on the way embryo transfers are carried out, i.e. unilaterally or bilaterally. The aim of this study was to examine the occurrence of transuterine migrations in nulliparous and multiparous mice after unilateral embryo transfer. Sixteen two-cell embryos were transferred into either the left or the right oviduct of mice with different genetic origin. With the exception of one reabsorption site in the opposite uterine horn, we never found evidence for the occurrence of transuterine migration. This is also true for embryo transfers carried out after parturition of the surrogate mother. Even the successful development of up to 13 embryos in one uterine horn did not result in transmigration but may be the reason for the widespread assumption that transuterine migration occurs after unilateral embryo transfers. The separation of the uterine body and the prevaginal portion of the uterine cervix into two canals by a septum seems to be the main reason for the absence of successful transuterine migration in mice.

Animals↗

PubMed1987

Seasonal effects on embryo transfer results in Brahman cows.

To determine factors affecting embryo donor reproductive performance in Bos indicus cows, 1,841 embryo collection records of 813 Brahman donor cows were analyzed using least-squares methods for unequal subclass numbers. The basic model included the main effects of either season or month, technician, and year of collection. Season and year did not affect (P>.10) the variance of number of ova collected. The most skillful technician collected 2.8 more ova per flush compared with the least skillful. Number of transferable embryos recovered per donor cow was affected by season (P<.06). Maximal recovery of transferable embryos occurred during the fall season (4.2) with a lower number (2.9) recovered during the winter season. Pregnancy rate in the recipients followed a seasonal pattern with lower (31.8%) pregnancy rates during the winter and higher (41.0%) ones in the fall. There was a trend toward higher pregnancy rates during February through October and lower rates December and January. Number of blastocysts recovered per donor was affected by season (P<.08), and year (P<.01). Number of blastocysts recovered per donor was lower (2.0) during the winter season than during the fall season (3.1). These data establish the concept of seasonal effects on embryo donor reproductive performance in Brahman cows.

Journal Article↗

PubMed1995

Polycystic ovarian syndrome: pregnancy outcome following in vitro fertilization-embryo transfer.

A retrospective study of a series of pregnant patients with polycystic ovarian syndrome following in vitro fertilization-embryo transfer was conducted to assess the outcome after ovarian stimulation by different protocols. Forty-one pregnancies were evaluated in patients with polycystic ovarian syndrome who conceived during in vitro fertilization-embryo transfer using human menopausal gonadotropin alone (17 pregnancies), or combined with gonadotropin releasing hormone analog (24 pregnancies). The demographic data of in vitro fertilization-embryo transfer cycles and pregnancy outcome were compared with the use of Student's t-test, the Mann-Whitney U test and Fisher's exact test, where appropriate. Among the pregnancies that were initiated following treatment, the protocol of the combination of the two was not associated with a higher rate of deliveries. The rate of first-trimester abortions was not statistically different between the two groups. These results suggest that the combined use of gonadotropin releasing hormone agonist and human menopausal gonadotropin in an in vitro fertilization program may not have beneficial effects on pregnancy outcome in patients with polycystic ovarian syndrome.

Adult↗

PubMed1995

The creation of mouse models for human diseases associated with reproductive disturbances by in vitro fertilization and embryo transfer.

The induction of ovulation by hormone treatment, preparation of fertilized eggs by in vitro fertilization and recovery of offspring by embryo transfer were studied in five strains of mutant mice: C57BL/6-dy/dy progressive muscular dystrophy model, C57BL/6-ob/ob obesity model, and BALB/c-rl/rl, BALB/c- shi/shi and C57BL/6-mld/mld motor ataxia models. The homozygotes of these mutant mice are all affected with the disease about 2 weeks after birth, followed by reproductive disturbances. Ovulation could be induced by injection with PMSG-hCG in the females. Sperm was obtained from the cauda epididymis of males and used for in vitro fertilization. The success rate of the in vitro fertilization was as low as 71.6% in C57BL/6-dy/dy mice, but was over 85% in the other strains. When 2-cell embryos obtained by in vitro fertilization were transferred to the oviducts of pseudopregnant recipients, offspring were obtained from 39.2-57.7% of the transferred embryos. These offspring developed the expected diseases about 2 weeks after birth, and it was confirmed that the disease characters were reliably reproduced. These results demonstrate that the experimental system of in vitro fertilization and embryo transfer enables production of the offspring homozygous for a mutant gene and use of them for experiments before the onset of the disease which has been impossible.

Animals↗

PubMed1998

Embryo transfer--can we learn anything new from the observation of junctional zone contractions?

To assess whether embryo transfer can alter junctional zone contractility, we studied the effect of easy and difficult mock transfers in 14 oocyte donors during in-vitro fertilization (IVF) cycles. An Echovist bolus (30 microl) was used to represent embryos and transfer medium. An 'easy' transfer was judged to be an atraumatic insertion of the catheter without touching the uterine fundus. A 'difficult' embryo transfer was mimicked by deliberately touching the uterine fundus twice with the soft end of the cannula. Transvaginal scan images were recorded, digitized and converted into five times normal speed to allow us to evaluate junctional zone contractility. Easy mock embryo transfers did not change endometrial mechanical activity. Echovist remained in the upper part of the uterine cavity and was not dispersed after 45 min. A difficult procedure generated strong random waves in the fundal area and waves from fundus to cervix which relocated the Echovist in six out of seven cases. We observed movements of the transfer bolus from the upper part of the uterus towards the cervix (four cases) and into Fallopian tubes (two patients). Our study confirms that the mechanical activity of the uterus is capable of relocating intrauterine embryos and that this activity depends on physical stimulation. Junctional zone contractions can be implicated in cases of IVF/embryo transfer failure or ectopic gestation.

Adult↗

PubMed1987

Transferable embryo recovery rates following different insemination schedules in superovulated beef cattle.

The objective of this study was to evaluate the transferable embryo recovery rates from superovulated donor cattle after different artificial insemination (AI) schedules. Sixty mixed-breed crossbred females were administered follicle stimulating hormone (FSH) and prostaglandin F(2)alpha (PGF(2)alpha) to induce a superovulatory response. At standing estrus, donor females were randomly allotted to one of five treatment groups for AI. Donors were inseminated with two units of high-quality or low-quality frozen semen at 12, 24, 36, or 48 h after the onset of estrus in treatment Groups I, II, III, and IV, respectively, or inseminated with two units at 12, 24, 36, and 48 h (eight units/donor) in control Group V. Donor females inseminated once at either 12 or 24 h after the onset of estrus did not differ from donors inseminated in Group V in overall fertilization and transferable embryo recovery rates. The highest fertilization rate (89.5%) and transferable embryo recovery rate (74.9%) per donor resulted when AI was performed with high-quality semen at 24 h after the onset of estrus. These findings indicate that repeated insemination of superovulated beef cattle is not necessary to attain optimal fertilization rates and production of transferable quality embryos in beef cattle.

Journal Article↗

PubMed2003

Embryo transfer: hysteroscopic assessment of transfer catheter effects on the endometrium.

So far as is known, this is the first series to report the effects of embryo transfers on endometrial integrity as assessed by direct hysteroscopic visualization. Subjects (n = 30) were patients of reproductive age undergoing diagnostic hysteroscopy. A mock embryo transfer was performed by a single clinician, immediately followed by saline hysteroscopy using a 2.7 mm hysteroscope. Hegar dilators or uterine sounds were not used. Representative video clips were recorded for independent assessment of endometrial integrity. (The movie sequence may be purchased for viewing on the internet at www.rbmonline.com/Article/1040; it is free to web subscribers.) Outcomes measured were ease of transfer (easy, moderate, difficult, very difficult) and details of the transfer technique. Endometrial damage was independently assessed and graded as follows: none, minor, moderate or severe. Of the easy transfers, 54% showed no endometrial damage. However, there 37% showed moderate to severe damage in the easy transfer group. Of the moderately difficult transfers, there was no clear association between perceived difficulty of transfer and amount of endometrial damage. Clinical perception of ease of transfer does not correlate well with the degree of endometrial disruption (P = 0.41). Use of hysteroscopy offers a unique insight into the effects of embryo transfer on endometrial integrity.

Adult↗

PubMed2004

Pregnancy rates and metabolic profiles in cattle treated with propylene glycol prior to embryo transfer.

The objective of this study was to determine the effect of a sustained propylene glycol administration to recipients of frozen/thawed in vivo derived bovine embryos. Heifers were treated with oral propylene glycol for the last 20 days before embryo transfer (n = 142), and untreated as controls (n = 133). Progesterone, insulin, insulin-like growth factor-I, glucose, urea and triglyceride were analysed in blood on Day 0 and Day 7 of the estrous cycle corresponding to embryo transfer. The heifers were selected as recipients when showing progesterone levels <2.0 ng/ml (Day 0) and >2.5 ng/ml (Day 7), according to corpus luteum quality on Day 7 by technicians unaware of animals treated. Within treated animals, significantly more recipients were selected, and increased progesterone, corpus luteum quality, pregnancy and calving rates were recorded. Day 7 progesterone concentrations were higher in heifers treated and transferred. Propylene glycol increased insulin and insulin-like-growth factor-I, but glucose, urea and triglyceride did not vary. Furthermore, insulin-like-growth factor-I, glucose and triglyceride increased at estrous time, but urea decreased and insulin remained unaltered. Together with the sustained gain in pregnancy rates throughout the experiment (2 years), other evidences suggested that the observed effects did not rely on nutritional deficiency. Thus, propylene glycol improved pregnancy rates after embryo-transfer, and progesterone, insulin and insulin-like-growth factor-I are probably involved in this effect.

Animals↗