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PubMed1994

The fluid dynamics of injection: variables as they relate to transvaginal gamete intra-fallopian transfer and tubal embryo transfer.

Transvaginal gamete intra-Fallopian transfer (GIFT) and tubal embryo transfer have not, in most cases, produced pregnancy rates as high as the equivalent transabdominal methods. We postulated that two parameters, i.e. wide dispersion of the gametes and peritoneal spill of gametes or embryos, are of prime importance in explaining this difference. We designed this study to analyse the effect of varying the rate of injection (microliter/min) of radio-opaque contrast media and the distance the transfer catheter is placed into the tubal isthmus upon these two parameters. Selective salpingography was performed on 30 patients who were allocated to one of two experiments. In the first experiment (flow rate), 20 patients were divided into four groups so that we could analyse four sets of 10 Fallopian tubes. Each group was subjected to injection of contrast at different flow rates: 100, 50, 25 or 12.5 microliters/min. Peritoneal spill occurred from 4, 2, 0 and 0 tubes and wide dispersion (> 4 cm) of contrast occurred in 6, 5, 1 and 0 tubes at the respective injection rates of 100, 50, 25 and 12.5 microliters/min. At 12.5 microliters/min contrast was localized to < 2 cm of tubal ampulla in all cases. In the second experiment (catheter placement), the remaining 10 patients were divided to allow analysis of two groups of 10 Fallopian tubes. The transfer catheter was placed either 1.5 cm or 5 cm into the tube and the radio-opaque contrast was injected at 12.5 microliters/min. No difference in the degree of dispersion of contrast along the Fallopian tube was observed. No backflow of contrast into the uterine cavity was observed in any patient following removal of the catheter.(ABSTRACT TRUNCATED AT 250 WORDS)

Biophysical Phenomena↗

PubMed1996

[Quality of the conceptus: embryo transfer strategy].

Embryo transfer is one of the key points of human IVF. Success or failure, as well as further incidence of multiple pregnancies are the immediate consequence of this technical point. The IVF transferus has also to manage with the patient anxiety. The technical points of embryo transfer are reviewed. Results of the national french registry concerning transfers of 2 or 3 embryons are also analysed. Then, an experience concerning delayed embryo transfer at the blastocyst stage is reported, taking in to account the high PR obtained after transfer of frozen thawed blastocysts.

Adult↗

PubMed2004

Middle to lower uterine segment embryo transfer improves implantation and pregnancy rates compared with fundal embryo transfer.

OBJECTIVE: To assess differences in pregnancy and implantation rates as a function of the embryo placement. DESIGN: Prospective cohort study. SETTING: A tertiary care center. SUBJECT(S): All fresh, nondonor IVF cycles performed in 2001. INTERVENTION(S): Alteration in embryo transfer (ET) target location from the fundal region to the middle to lower uterine segment. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (sonographic sac evidence/number of transfer cycles), implantation rate (number of sacs/number of embryos transferred), patient age, peak E(2), and fertilization rate. RESULT(S): A total of 393 fundal and 273 lower to middle uterine segment ETs were performed. The pregnancy (PR), implantation, and birth rates were significantly higher after a middle to lower uterine segment ET compared with fundal ET (39.6% vs. 31.2%; 21% vs. 14%; and 34.1% vs. 26.2%, respectively). Groups did not differ regarding patient age, basal FSH, peak E(2), number of intracytoplasmic sperm injection (ICSI) cycles, fertilization rate, embryo quality, or number of embryos transferred. CONCLUSION(S): Both PR and implantation rates are favorably affected by directing embryo placement to the lower to middle uterine segment. By some unknown mechanism, it appears that this endometrial location provides a more favorable region for embryo deposition.

Cohort Studies↗

PubMed1996

The influence of number of embryos transferred on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer (IVF-ET).

The purpose of this study was to retrospectively examine the influence of number of embryos transferred on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer (IVF-ET) between July 1990-December 1991 at the Royal Free Hospital, London, United Kingdom. This study included three groups of patients: group 1-the number of embryo used for transferring was one embryo, group 2-the number of embryos used for transferring was two embryos and group 3-the number of embryos used for transferring was three embryos. This study demonstrated that the clinical pregnancy rate increased significantly when transferring two or three embryos compared to one. But this rate did not differ significantly when two embryos were compared with three embryos. The multiple pregnancy rate, miscarriage rate, and ectopic pregnancy rate did not differ significantly among the three groups studied but there was a risk of higher order multiple pregnancy if more embryos were transferred. In this study we found 3 triplets out of 35 pregnancies when 3 embryos were transferred (Group 3). In conclusion, this study demonstrates that when two or three embryos were transferred the clinical pregnancy rate increased significantly. Transferring two embryos instead of three did not alter the pregnancy rate. Moreover, triplets pregnancies were eliminated. Therefore, we suggest limiting the number of embryos to be transferred at two and the supernumerary embryos should be cryopreserved for future transfer.

Adult↗

PubMed1990

Dummy embryo transfer: a technique that minimizes the problems of embryo transfer and improves the pregnancy rate in human in vitro fertilization.

Three hundred thirty-five patients selected for in vitro fertilization (IVF) were randomly divided into two groups. Group A (n = 167) was subjected to dummy embryo transfer (ET) before the start of IVF treatment to choose the most suitable catheter for each patient. Group B (n = 168) started their IVF treatment without dummy ET. Embryo transfer technique was difficult in 50 cases (29.8%) in group B, whereas no difficulty was met in group A. Pregnancy rate and implantation rate (22.8%, 7.2%) in group A were significantly higher than in group B (13.1%, 4.3%). The lower pregnancy rate in group B is due to the very low pregnancy rate (4%) in difficult ET cases. Dummy ET is a simple procedure that determines the most suitable ET catheter for each patient and avoids unexpected difficult and failed ET.

Adult↗

PubMed1985

Embryo transfers in Angora and Saanen goats.

Sixteen mixed age Angora does were synchronised by progesterone injections and superovulated with either PMSG or FSH in 1982 and six synchronised Angora and seven Saanens were superovulated with FSH in 1983. All donors entire mated and were subjected to egg recovery by a uterine flush conducted during surgery about five days after oestrus. The mean ovulation rate and number of transferable embryos recovered from Angoras treated with PMSG in 1982 was 9.1 and 5.1, respectively, and for FSH treated donors was 15.1 and 11.0. Results for Angoras treated in 1983 were 5.3 and 5.0 and for Saanens were 29.3 and 25.3. Each year recipient feral and Angora does were synchronised, and 329 embryos were transferred surgically to 151 recipients. One hundred and sixteen (77%) of the recipients kidded producing 191 kids (58% embryo survival). Well fed Angora and Saanen donors superovulated with FSH produced 8 and 17 offspring, respectively, in the year of surgery. This rate of reproduction is about 8 times faster than normal and about double that achieved when donors are superovulateb with PMSG.

Journal Article↗

PubMed1994

Relationship between the day of embryo transfer and the outcome in human in vitro fertilization and embryo transfer.

PURPOSE: To clarify the optimal date of embryo transfer (ET), we retrospectively analyzed the relationship between the day of ET and the outcome in human in vitro fertilization and embryo transfer (IVF-ET). METHOD: Of a total of 307 human IVF-ET cycles performed at Kyoto University Hospital between January 1990 and March 1994, we focused on 207 cases of IVF-ET cycles in which two or three good-quality embryos were transferred. These 207 IVF-ET cycles consisted of 54 Day 2 ET cycles, 79 Day 3 ET cycles, 46 Day 4 ET cycles, and 28 Day 5 ET cycles. We compared the pregnancy and live-birth (plus ongoing pregnancy) rates among these four ET groups. RESULTS: The pregnancy rates of ET on Days 2 to 4 were not significantly different, whereas Day 5 ET produced a significantly lower pregnancy rate (Day 2, 29.6%; Day 3, 32.9%; Day 4, 30.4%; Day 5, 10.7%). Similar results were obtained for the live-birth (plus ongoing pregnancy) rates (Day 2, 20.3%; Day 3, 18.9%; Day 4, 17.9%; Day 5, 7.1%). CONCLUSIONS: These results suggest that the day of ET does not fundamentally affect the pregnancy rate in human IVF-ET provided that transfer is made before Day 5.

Embryo Transfer↗

PubMed2001

One versus two embryo transfer after IVF and ICSI: a randomized study.

BACKGROUND: The main reason for adverse treatment outcome in assisted reproduction is the high rate of multiple pregnancies. The only strategy to avoid dizygotic twins is to transfer one embryo at a time. METHODS: A total of 144 women, who had had at least four good quality embryos available after IVF/intracytoplasmic sperm injection (ICSI) and who had no more than one previous failed treatment cycle, were randomized to have either one or two embryos transferred. The treatment outcomes including those after frozen embryo transfer were compared between these groups. RESULTS: The clinical pregnancy rate per transfer was 32.4% in the one embryo transfer group and 47.1% in the two embryo transfer group, the difference being not significant. Eleven twin deliveries (n = 39) occurred in the two embryo transfer group and there was one pair of monozygotic twins in the one embryo transfer group. The cumulative pregnancy rate per patient after transfer of fresh and frozen embryos was 47.3% in the one embryo transfer group and 58.6% in the two embryo transfer group. CONCLUSIONS: Our results indicate that among women who have good quality embryos in their first IVF/ICSI, good treatment results can be achieved. They support the idea of changing embryo transfer policy towards one embryo transfer without any remarkable decrease in the success rate, while dizygotic twins can be avoided.

Adult↗

PubMed1995

The probability of pregnancy after embryo transfer is affected by the age of the patient, cause of infertility, number of embryos transferred and the average morphology score, as revealed by multiple logistic regression analysis.

Because the process of conception is affected by many variables, a multiple logistic regression analysis was performed to assess (i) the impact and relative weight of both patient and embryo variables and (ii) their possible effects on the probability of a vital pregnancy after embryo transfer. A statistical model was constructed predicting the probability of pregnancy after embryo transfer. The variables that contributed significantly to the predictive value of the model were the age of the patient, the cause of infertility, the number of embryos transferred and the average morphology score of the transferred embryos. Embryo variables appeared to have a significant but modest value in predicting the probability of pregnancy after embryo transfer. Other variables, such as the thickness of the endometrium, were found to have no prognostic value. Moreover, we found that their effect could be explained by the variables already included in the model.

Adult↗

PubMed1991

Fluid accumulation of the uterine cavity before embryo transfer: a possible hindrance for implantation.

Accumulation of fluid in the uterine cavity was recorded in three cases during vaginal ultrasound (US) monitoring for in vitro fertilization (IVF) cycles. The three patients had hydrosalpinges and tuboovarian cystic masses. They all had a common complaint of intermittent vaginal discharge. Attempts at aspirating the fluid to empty the cavity was done in two cases but the fluid recollected. This condition possibly renders the uterine cavity hostile to the transferred embryos and careful consideration should be taken to diagnose it.

Adult↗

PubMed1997

An increased vulnerability to stress is associated with a poor outcome of in vitro fertilization-embryo transfer treatment.

OBJECTIVE: To evaluate the association between the vulnerability to stress and the treatment outcome of couples undergoing IVF-ET. DESIGN: Controlled, prospective clinical study. SETTING: The Assisted Reproduction Unit of the Department of Obstetrics and Gynecology, University of Modena. PATIENT(S): Forty-nine infertile women consecutively admitted to standard superovulation treatment. Mean age was 33.9 years, duration of infertility was 6.3 years. Reasons for assisted reproduction were mechanical factor in 22 cases, sperm problem in 9 cases, and endocrine disorder in 6 cases. In 12 cases, infertility was unexplained. More than 55% already had an IVF-ET attempt. INTERVENTION(S): The day of oocyte pick-up, subjects were submitted to Stroop Color and Word test, a task measuring the ability to cope with a cognitive stressor, involving attentional and sympathoadrenal systems. Systolic (SBP) and diastolic blood pressure, as well as heart rate (HR) were measured at baseline, during the test, and 10 minutes after the end of testing. MAIN OUTCOME MEASURE(S): The evidence of a biochemical pregnancy (beta-hCG value 12 days after ET) define the success and failure groups. RESULT(S): Sixteen women (33%) had a biochemical pregnancy, 12 also had ultrasound evidence. Eight gave birth to healthy infants. Age, education, causes, and duration of infertility were similar in the success and failure groups. The latter were more involved in a job outside home than the former. Moreover, they had a lower number of both fertilized oocytes and transferred embryos. In response to the Stroop test, every subject reported an increase of cardiovascular parameters. However, women becoming pregnant showed a lower response of both SBP and HR than women who failed. CONCLUSION(S): Both a major cardiovascular vulnerability to stress and working outside home are associated to a poor outcome of IVF-ET treatment.

Adult↗

PubMed1996

Organ-specific autoantibodies are possible markers for reproductive failure: a prospective study in an in-vitro fertilization-embryo transfer programme.

This study was conducted to investigate the usefulness of organ-specific autoantibodies as possible markers for reproductive failure. Antithyroid and antiovarian autoantibody concentrations were measured in 78 patients with mechanical or unexplained infertility that were enrolled in an in-vitro fertilization (IVF)/embryo transfer programme with follow-up of the outcome. In all, 16 patients (20.5%) were positive for antithyroid antibodies, nine (11.5%) were positive for antiovarian autoantibodies and two (2.6%) were positive for both autoantibodies. All 23 patients who were positive for either antithyroid or antiovarian autoantibodies, or both, were defined as the study group, and 55 who were negative for autoantibodies were considered as the control group. No statistical difference in the incidence of autoantibodies was found between the patients with mechanical infertility and those with unexplained infertility. No differences were found in the mean number of oocytes retrieved, fertilization rates or mean numbers of transferred embryos between the study and the control groups. The pregnancy rate per cycle was 10.8% (7/65) in the study group, compared with 25.0% (24/96) in the control group (P < 0.05). We conclude that organ-specific autoantibodies such as antithyroid and antiovarian antibodies may serve as possible markers for reproductive failure. Further investigation is required to understand the possible immunopathological mechanism for reproduction failure in patients with organ-specific autoantibodies.

Adult↗

PubMed1999

Nucleolar ultrastructure in bovine nuclear transfer embryos.

Nuclear transfer experiments in mammals have attempted to reprogram a donor nucleus to a state equivalent to the zygotic one. Reprogramming of the donor nucleus is, among other features, indicated by a synthesis of ribosomal RNA (rRNA). The initiation of rRNA synthesis is simultaneously reflected in nuclear morphology as a transformation of the nucleolus precursor body into a functional rRNA synthesising nucleolus with a characteristic ultrastructure. We examined nucleolar ultrastructure in bovine in vitro produced (control) embryos and in nuclear transfer embryos reconstructed from a MII phase (nonactivated) or S phase (activated) cytoplasts. Control embryos were fixed at the two-, four-, early eight- and late eight-cell stages; nuclear transfer embryos were fixed at 1 and 3 hr post fusion and at the two-, four-, and eight-cell stages. Control embryos possessed a nucleolar precursor body throughout all three cell cycles. In the eight-cell stage embryo, a primary vacuole appeared as an electron lucid area originating in the centre of the nucleolar precursor body. In nuclear transfer embryos reconstructed from nonactivated cytoplasts, the nuclear envelope was fragmented or completely broken down at 1 hr after fusion and, by 3 hr after fusion, it was restored again. At this time, the reticulated fibrillo-granular nucleolus had an almost round shape. The nucleolar precursor body seen in the two-cell stage nuclear transfer embryos consisted of intermingled filamentous components and secondary vacuoles. A nucleolar precursor body typical for the two-cell stage control embryos was never observed. None of the reconstructed embryos of this group reached the eight-cell stage. Nuclear transfer embryos reconstructed from activated cytoplasts, in contrast, exhibited a complete nuclear envelope at all time intervals after fusion. In the two-cell stage nuclear transfer embryo, the originally reticulated nucleolus of the donor blastomere had changed into a typical nucleolar precursor body consisting of a homogeneous fibrillar structure. A primary vacuole appeared in the four-cell stage nuclear transfer embryos, which was one cell cycle earlier than in control embryos. Only nuclear transfer embryos reconstructed from activated cytoplasts underwent complete remodelling of the nucleolus. The reorganisation of the donor nucleolar architecture into a functionally active nucleolus was observed as early as in the four-cell stage nuclear transfer embryo. These ultrastructural observations were correlated with our autoradiographic data on the initiation of RNA synthesis in nuclear transfer embryos.

Animals↗

PubMed2006

[How to improve ART results? Is France behind other countries? Strategy for single embryo transfer: The value of embryo selection and embryo freezing].

Multiple embryo transfer is associated with a high frequency of twin pregnancies with costly complications involving both mother and child. As a result high priority is currently being given to the development of single embryo transfer (SET) programs. France seems to be lagging behind Northern European countries in the development of SET and widespread use of SET will depend on convincing physicians that this policy will not have a negative impact on success rate, as has been the case for many protocols described in the literature as well as in our own experience. Our SET program includes patients less than 36 years of age undergoing their first FIV-ICSI. If two embryos showing satisfactory morphology are obtained, one is selected transferred and the other is systematically frozen. Selection for transfer is based on two criteria, i.e. observation of even early cleavage 26 hours after FIV-ICSI and evaluation of embryo morphology score on day 2. Embryo morphology score is based on the presence of four blastomeres and absence of blastomere irregularities and anucleated fragmentation. Last, a prerequisite for SET is an effective freezing program. A pregnancy rate of 13% per thawing was sufficient enough to obtain a cumulative pregnancy rate after SET (N = 205) and subsequent frozen embryo transfer (FET) similar to the cumulative pregnancy rate obtained after double embryo transfer (N = 394) and subsequent FET (46.3 vs 46.7%, NS). Twin delivery rate were respectively 2,6% after SET and 26,6% after double embryo transfer (P < 0.01).

Adult↗

PubMed1993

Multiple attempts at embryo transfer: effect on pregnancy outcome in an in vitro fertilization and embryo transfer program.

PURPOSE: This study derives from the observation that a correlation exists between failed first attempts (FFA) at embryo transfer caused by one or more embryos remaining in the catheter and reduced pregnancy rates (20.3 vs 3.0%). The aim of this study was to examine the relationship between failed first attempts at transfer and contamination of the transfer set; the related aspects of cervix dilatation and late embryo transfer were also investigated. RESULTS: The following observations were made. Retention of embryos in the transfer sets significantly reduced the pregnancy rate (P = 0.015); catheters contaminated with blood and cervical mucus indirectly contributed to this effect by increasing the incidence of failed first transfer attempts. Even though cervical dilatations, if indicated by uterus sounding, were done 2 days before embryo transfer, no pregnancies were effected in these 18 cases (P = 0.0001). Late transfers of embryos, due to delayed fertilization or slow cleavage rates, yielded a pregnancy rate of 10.5%. CONCLUSION: The approach of immediately retransferring retained embryos does not solve the problem of reduced pregnancy rates in FFA cases. It is suggested that ET should be repeated 1 day later in FFA cases in an attempt to improve pregnancy rates.

Blood↗

PubMed1995

Do patients need to remain in bed following embryo transfer? The Birmingham experience of 103 in-vitro fertilization cycles with no bed rest following embryo transfer.

Since the early days of human in-vitro fertilization and embryo transfer, rest in bed for hours immediately following the transfer has been advocated and widely practised. However, there is no scientific validation for this practice which is both time-consuming for the patient and increases space occupancy in the hospital or clinic. We report here on a study of 103 in-vitro fertilization cycles with no bed rest in hospital following the embryo transfer. The mean number of embryos transferred was 2.7 (range 1-3) and the clinical pregnancy rate per embryo transfer procedure was 40%. These results suggest that bed rest is not necessary following embryo transfer.

Adult↗

PubMed2005

In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial.

BACKGROUND: Elective single embryo transfer (eSET) in a selected group of patients (i.e. young patients with at least one good quality embryo) reduces the number of multiple pregnancies in an IVF programme. However, the reduced overall multiple pregnancy rate (PR) is still unacceptably high. Therefore, a randomized controlled trial (RCT) was conducted comparing eSET and double embryo transfer (DET) in an unselected group of patients (i.e. irrespective of the woman's age or embryo quality). METHODS: Consenting unselected patients were randomized between eSET (RCT-eSET) (n = 154) or DET (RCT-DET) (n = 154). Randomization was performed just prior to the first embryo transfer, provided that at least two 2PN zygotes were available. Non-participants received our standard transfer policy [SP-eSET in a selected group of patients (n = 100), otherwise SP-DET (n = 122)]. RESULTS: The ongoing PR after RCT-eSET was significantly lower as compared with RCT-DET (21.4 versus 40.3%) and the twin PR was reduced from 21.0% after RCT-DET to 0% after RCT-eSET. The ongoing PRs after SP-eSET and SP-DET did not differ significantly (33.0 versus 30.3%), with an overall twin PR of 12.9%. CONCLUSION: To avoid twin pregnancies resulting from an IVF treatment, eSET should be applied in all patients. The consequence would be a halving of the ongoing PR as compared with applying a DET policy in all patients. The transfer of one embryo in a selected group of good prognosis patients leads to a less drastic reduction in PR but maintains a twin PR of 12.9%.

Adult↗

PubMed2005

Comparison of zygote intrafallopian tube transfer and transcervical uterine embryo transfer in patients with repeated implantation failure.

OBJECTIVE: This study was designed to evaluate the role of zygote intrafallopian transfer (ZIFT) procedure in patients with repeated failure of implantation. STUDY DESIGN: A total of 141 ZIFT cycles of 132 women and 145 embryo transfer (ET) cycles of 97 women in whom five or more embryos were transferred were included in this study. Transcervical uterine embryo transfer and ZIFT cycle outcome in patients with five or more previous implantation failure were compared. Embryos were transferred by laparoscopy into the fallopian tube 24-27 h following oocytes retrieval in the ZIFT group. In the ET group, embryos were transferred transcervically on the third day following oocytes retrieval. RESULTS: The mean age was 34+/-4.9 and 34.9+/-5.0 years in ZIFT and ET group, respectively. No difference was determined between the two groups regarding the basal FSH, E2 value on the day of HCG injection and the number of oocytes retrieved or fertilized. The implantation rate was 6.5% versus 7.2%, clinical pregnancy rate was 22.7% versus 24.8% and live birth rate was 21.2% versus 16.5% in ZIFT and ET groups, respectively. CONCLUSIONS: Implementation of ZIFT procedure in patients with repeated implantation failure is not superior to transcervical uterine embryo transfer.

Adult↗