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Influence of summer heat stress on pregnancy rates of lactating dairy cattle following embryo transfer or artificial insemination.

Lactating Holstein cows were used to determine if pregnancy rate from embryo transfer (n = 113) differed from contemporary control cows (n = 524) that were artificially inseminated (AI). Holstein heifers (n = 55) were superovulated with FSH-P (32 mg total) and inseminated artificially during estrus and subsequently managed under shade structures. On Day 7 post estrus, embryos were recovered, and primarily excellent to good quality embryos (90.3%) were transferred to estrus-synchronized lactating cows. Cows were managed under conditions of exposure to summer heat stress. Pregnancy status was determined by milk progesterone concentrations at Day 21 and palpation per rectum at 45 to 60 d post estrus. Pregnancy rates of cows presented for AI (Day 21, 18.0%; Days 45 to 60, 13.5%) were typical for lactating cows inseminated during periods of summer heat stress in Florida. Pregnancy rates of embryo recipient cows were higher (P<0.001) than those of control cows (Day 21, 47.6%; Days 45 to 60, 29.2%). Summer heat stress had no adverse effect on heifer superovulatory response, but it increased (P<0.05) the incidence of retarded embryos (</= 16 cells) and embryos graded as fair to poor quality. Increased pregnancy rate of recipient lactating cows indicates that the bovine embryo is sensitive to maternal heat stress during the first 7 d after estrus. Embryo transfer may bypass this period of embryonic sensitivity and provide an alternative to AI to partially circumvent heat stress-induced infertility in cattle.

Journal Article↗

Replacement of one selected embryo is just as successful as two embryo transfer, without the risk of twin pregnancy.

The transition of in vitro fertilization from research to standard clinical practice has, to a great extent, been as a result of the use of controlled ovarian hyper stimulation. A disadvantage of the availability of multiple embryos has been the replacement of several embryos leading to an epidemic of multiple pregnancies. This retrospective review of 2606 fresh embryo transfers between 2001 and 2003, where either one or two selected embryos were replaced from an available cohort of at least four, shows that single embryo transfers have a similar pregnancy rate without the risk of multiple pregnancy.

Adult↗

Day 3 compared with day 2 cryopreservation does not affect embryo survival but improves the outcome of frozen-thawed embryo transfers.

A retrospective study was performed to determine the differences in embryo survival and frozen-thawed embryo transfers outcome between cryopreservation performed on day 3 versus day 2. We conclude that freezing supernumerary embryos on day 3 provides similar thawing survival parameters, better implantation, pregnancy, and live-birth rates compared with day 2 cryopreservation.

Adult↗

Avoiding multiple pregnancies in ART: a plea for single embryo transfer.

It has been generally accepted that triplets after IVF/intracytoplasmic sperm injection (ICSI) can and should be avoided by adopting a standard strategy of replacing no more than two embryos. However, there is an increasing awareness of the risks and costs and of the epidemic size of twin pregnancies after IVF/ICSI. This has resulted in efforts to replace no more than one embryo. However, this approach has been hampered by our relative inability to identify embryos with a very high implantation potential. To identify such embryos, a number of strategies are being considered, both at the two pronuclear (2PN), early cleavage and the blastocyst stages. At the 2PN stage, the polarity characteristics of the nucleoli have been shown to be correlated with a high implantation rate. Similarly, the morphological characteristics at day 2 and 3 have been used to describe top quality embryos in approximately 75% of all IVF/ICSI cycles. Blastocyst culture has resulted in very high implantation rates in the hands of some authors. No approach has shown its superiority at present, but initial experience with single embryo transfer (SET) at the early cleavage stage by Scandinavian and Belgian groups shows that an ongoing pregnancy rate of 35% and more can be achieved. Proper identification of patients at risk of a twin pregnancy after double embryo transfer is equally important. It is clear that mainly young patients (aged <34 years) during their first, perhaps first two, IVF/ICSI cycles constitute the main population at risk (responsible for >80% of all twins) and are the main target group for twin prevention by SET of a top quality embryo at whatever stage. Therefore, in our opinion, although a further fine-tuning of both embryo and patient characteristics relating to a high risk for (twin) pregnancy is desirable, SET should be introduced carefully and progressively in each IVF/ICSI programme from now on. Correct counselling is very important and both public and private insurers will have to join in the discussion.

Blastocyst↗

Morphology of seminal and swim-up spermatozoa and the outcome of in vitro fertilization and embryo transfer.

Tubal infertility was treated by in vitro fertilization-embryo transfer (IVF-ET) in 112 couples. Twenty-eight pregnancies were obtained in 140 treatment cycles. Couples are accepted for treatment in our IVF-ET programme if previous semen samples fulfil the inclusion criteria: ejaculate volume greater than 1.5 ml, concentration of spermatozoa greater than 15 x 10(6) ml-1, greater than 40% motile spermatozoa, and greater than 25% spermatozoa with normal morphology. In order to determine to which extent IVF-ET treatment results are influenced by sperm morphology, within this selected group of patients, we have retrospectively analysed the data from both original semen samples and swim-up preparations. The sperm morphology was not related to the outcome of treatment in terms of fertilization (ovum cleavage rate), early embryo development, or pregnancy. Nor was any relationship detected between early embryo development or pregnancy and the degree of improvement in morphology resulting from the swim-up procedure. However, if improvement in morphology by swim-up was high, ovum cleavage rate was low. Sperm morphology within the limits set by our inclusion criteria could not predict the outcome of IVF-ET treatment. It is further concluded that the presence of abnormal spermatozoa at the site of fertilization may be without harm if only the number of normal sperms is high enough.

Embryo Transfer↗

Towards a single embryo transfer.

The delivery of a single, healthy child is the desired outcome of human assisted reproduction techniques. To attain this goal, there is an increasing movement toward single embryo transfer. The question is, therefore, at what stage to transfer the human embryo back to the uterus? Maximal implantation rates reported to date have come from the transfer of blastocysts (70% fetal heart rate). In any given cycle of treatment the probability of conceiving a child will be further increased by the ability to cryopreserve those embryos not transferred. It is therefore proposed that the transfer of a single blastocyst is the best treatment for most patients, given the high implantation rates of fresh transfers, and that it is now possible to cryopreserve supernumerary blastocysts effectively. The next decision is how to culture the human embryo to the blastocyst stage. The use of sequential culture media, designed not only to allow for changes in nutrient requirements and metabolism as development proceeds, but also to minimize intracellular trauma, can facilitate the development of highly viable blastocysts. Sequential culture media have been evaluated against a single-step culture system. It has been shown that sequential media (G1/G2) produce more viable blastocysts than those embryos cultured in a single medium formulation (simplex optimized medium with elevated potassium and with amino acids, KSOM(AA)) throughout the preimplantation period. Furthermore, even if KSOM(AA) is used for embryo culture, it is essential that the medium be renewed after 48 h to alleviate the toxicity associated with ammonium build-up. Of great significance, embryos cultured in sequential media G1 and G2 have the same rate of development as embryos developed in vivo.

Animals↗

Embryo transfer by midwife or gynecologist: a prospective randomized study.

BACKGROUND: Embryo transfer (ET) in assisted reproduction treatments has traditionally been performed by gynecologists in the Nordic countries. As gynecologists often have a busy schedule, midwives and nurses have become increasingly important in performing the treatment, providing subject information, ultrasound monitoring and assistance at ET. As part of the continuous development of our IVF treatment we have carried out a prospective randomized pilot study where either a midwife or a gynecologist has performed ET. The aim of this study was to see if a skilled IVF midwife could perform ET with similar results to a gynecologist. METHODS: On the day of oocyte aspiration the subjects were randomized, by means of closed envelopes, for ET to be performed either by a midwife or a gynecologist. A total of 102 subjects were included in the study, 51 for ET by a skilled midwife and 51 by a gynecologist. There were no differences in the groups in respect to ET routine and catheters used. RESULTS: No significant differences were observed in subject characteristics as regards age, method of pituitary down-regulation or proportion of IVF/ICSI cycles. Similar clinical pregnancy rates between ETs performed by midwives vs. gynecologists, 31% vs. 29%, respectively, were seen. Subject experience as judged by a questionnaire also showed high acceptance of ET by a midwife. CONCLUSION: The results show that it is a feasible option to allow midwives to carry out ETs.

Adult↗

New Belgian embryo transfer policy leads to sharp decrease in multiple pregnancy rate.

Since 1 July 2003, a new transfer policy aiming to reduce multiple pregnancies was brought into law in Belgium. The policy restricts the number of embryos transferred, depending on the patient's age and treatment cycle. This study aimed to evaluate the effect of this policy. Two 15-month periods before and after the start of the new law were compared for the following parameters: positive human chorionic gonadotrophin (HCG), clinical pregnancy rate and multiple pregnancy rate according to the age categories defined by the policy: <36, 36-39 and 40-42 years. HCG rates (34.2 and 32.8%) and clinical pregnancy rates (26.2 and 24.0%) per cycle were similar for the two periods. Overall, the multiple pregnancy rate was reduced from 29.1 to 9.5% (all patients) and from 28.9 to 6.2% in women <36 years. Most twins were observed in the third cycle of patients <36 years and in the first three cycles in women of 36-39 years. It can be concluded that a significant decline (P < 0.001) in multiple pregnancies was mainly observed in patients <36 years of age. Clinical pregnancy rates were not compromised by the new law. Elective single embryo transfer should be considered more seriously for women 36-39 years of age.

Adult↗

Flushing the endometrium prior to the embryo transfer does not affect the pregnancy rate.

This study aimed to determine whether direct flushing of endometrial cavity with culture media just after cervical irrigation at the time of embryo transfer has any effect on pregnancy rates. A total of 240 women were prospectively randomised; one group of patients (group 1) underwent intrauterine direct flushing of endometrial cavity with culture media just after cervical irrigation at the time of embryo transfer as detected by transabdominal ultrasound and the other group of patients (group 2) had cervical flushing but did not undergo intrauterine flushing. Pregnancy (positive human chorionic gonadotrophin) rates were 57.5% and 62.9% for group 1 and group 2, respectively. Clinical pregnancy (positive fetal heart rate) rates were 45.2% and 51.4% for group 1 and group 2, respectively. Implantation rates were 20.0% and 21.2% for group 1 and group 2, respectively. Ongoing pregnancy (>12 weeks of pregnancy) rates were 47.9% and 47.2% for group 1 and group 2, respectively. There were no significant differences in pregnancy rates, clinical pregnancy rates, implantation rates and ongoing pregnancy rates between the two groups. In conclusion, even direct flushing of media into the uterine cavity neither improves nor adversely affects the pregnancy rate.

Adult↗

A successful pregnancy after intracytoplasmic sperm injection and embryo transfer in a patient with endometrial cancer who was treated conservatively.

OBJECTIVE: To describe a patient with polycystic ovary syndrome (PCOS) conceiving with intracytoplasmic sperm injection (ICSI) and embryo transfer after conservative treatment of early stage endometrial cancer. DESIGN: Case report. SETTING: Tertiary center for assisted reproductive technologies.A 32-year-old woman with PCOS, primary infertility of 4 years duration, and grade 1 endometrioid endometrial cancer. INTERVENTION(S): Assessment of myometrial invasion and extrauterine spread with magnetic resonance imaging (MRI) and explorative laparotomy. High-dose progestin treatment and ICSI and embryo transfer. MAIN OUTCOME MEASURE(S): Successful take-home baby and no residual endometrial cancer. RESULT(S): A healthy normal female infant with a birth weight of 1740 g was born by cesarean section at 30 weeks' gestation. No residual cancer was detected at the follow-up curettage performed 2 months after the delivery. CONCLUSION(S): Conservative uterus-preserving treatment may be considered in patients with early stage endometrial cancer. Assisted reproductive technologies may be used in such patients for immediate achievement of pregnancy.

Adenocarcinoma↗

Early cleavage: an additional predictor of high implantation rate following elective single embryo transfer.

The value of early cleavage (EC) assessment is still being debated. The aim of this prospective study was to examine the predictive value of EC assessment performed exactly 26 h after insemination by IVF or intracytoplasmic sperm injection (ICSI) in a programme of elective single embryo transfer (SET) performed at day 2. If day 2 scoring demonstrated several embryos with high implantation potential, an EC embryo was transferred preferentially. EC was assessed only during normal laboratory hours so that there were two groups: EC assessed, and EC not assessed, the latter being the control. A total of 277 elective SET were performed in women under 37 years undergoing their first IVF or ICSI cycle (mean age 30.5 years, range 21-37). The overall clinical and ongoing pregnancy rates were 40.1% (111/277) and 32.9% (91/277) respectively. Significantly higher overall clinical and ongoing pregnancy rates were obtained after transfer of an EC embryo than a non-EC embryo: 49.4 versus 33.3% (P < 0.05) and 42.4 versus 25.9% (P < 0.02) respectively. However there was no significant difference between the EC assessed and control groups: 40.4 versus 39.3% and 33.2 versus 32.1 respectively. These findings confirm the value of EC assessment for selection of embryos with high implantation potential.

Adult↗

Embryo transfer is equally effective at cleavage stage and blastocyst stage: a randomized prospective study.

OBJECTIVE: To compare the implantation and pregnancy rates after cleavage stage embryo transfer (ET) with transfer of blastocyst-stage (days 5-6) embryos. STUDY DESIGN: Prospective randomized trial at an assisted reproduction unit in a university hospital. Women with six or more follicles at the last ultrasound scan before oocyte aspiration were randomized for transfer of a maximum of two embryos after 2-3 days (n = 80) or after 5-6 days (n = 64) of culture. Embryo quality, implantation and pregnancy rates were evaluated. Statistical significance was tested with the Chi-square test and Fisher's exact test. RESULT(S): No significant difference was observed in implantation rates (21.1% versus 20.9%, respectively) and clinical pregnancy rates (36.7% versus 32.5% respectively) after blastocyst and cleavage stage transfers for the two groups. The pregnancy rate among subjects who had at least one good quality embryo transferred was 37.5% per day 2-3 ET and 60% per day 5-6 ET. CONCLUSION(S): The overall implantation and pregnancy rates after embryo transfer at cleavage stage and at blastocyst stage transfer were not statistically different. Women who had at least one good quality blastocyst (n = 25) had a high pregnancy rate (60% per ET). Blastocyst transfer is a good alternative for couples with many good quality embryos on day 2 after insemination.

Adult↗

Colour Doppler assessment of ascendent uterine artery perfusion in an in-vitro fertilization-embryo transfer programme after pituitary desensitization and ovarian stimulation with human recombinant follicle stimulating hormone.

The purpose of the present study was to evaluate the use of colour Doppler sonography of ascendent uterine artery perfusion in 91 patients undergoing in-vitro fertilization (IVF)-embryo transfer treatment after ovarian stimulation with a depot formulation of goserelin and recombinant human follicle stimulating hormone according to the long protocol. Resistance index (RI), pulsatility index (PI), maximum peak velocity (Vmax) and minimum diastolic velocity (Vmin) were assessed for the left and right ascending uterine artery on day 1 of ovarian stimulation, on day -2 [the day of human chorionic gonadotrophin (HCG) application] and on day +14 (12 days after embryo transfer). The data of 75 patients who had at least two cleaved preimplantation embryos available for transfer were analysed: 21 patients became pregnant resulting in a pregnancy rate of 28% (21/75). After exclusion of biochemical, ectopic and abortive pregnancies (n = 5), the data from 54 non-pregnant patients and 16 pregnant patients were analysed. No differences with respect to patient age, current cycle number, indication for IVF treatment, endometrial thickness at day -2 and serum oestradiol and serum progesterone concentrations at day -2 were found between the pregnant and non-pregnant groups. Compared to the non-pregnant patients the ascendent uterine artery flow of the pregnant patients showed significantly lower RI (P < 0.009) and PI (P < 0.03) values at the beginning of ovarian stimulation. Vmax and Vmin did not differ between the two groups. On day -2 no differences in RI, PI, Vmax and Vmin were found between pregnant and non-pregnant patients. On day +14 the flow in the ascendent uterine arteries of the pregnant patients showed significantly lower RI (P < 0.008) and PI (P < 0.03) values and significantly higher Vmax (P < 0.003) and Vmin (P < 0.0001) values. RI (P < 0.009) and PI (P < 0.003) values had decreased significantly and Vmax (P < 0.0002) and Vmin (P < 0.0001) had increased significantly on day +14 compared to the previous observation times in both the pregnant and non-pregnant groups. A significant correlation between the increase of serum progesterone concentrations and the decrease of RI (r = 0.68, P < 0.009), and the increase of Vmin (r = 0.67, P < 0.01) was only detected in the pregnant group. In conclusion, the differences found in RI and PI values at the beginning of ovarian stimulation were not clinically helpful as there was a wide overlap between non-pregnant and pregnant patients. The parameters currently used in colour Doppler assessment of uterine artery perfusion are not clinically helpful in discriminating prospectively which patients will and will not become pregnant in an IVF programme. In pregnant patients, increasing progesterone concentration is correlated with a significant decrease in impedance to uterine perfusion in the late luteal phase.

Adult↗

[Laparoscopic salpingectomy in heterotopic pregnancy after fertilization in vitro and embryo transfer].

A case report of a patient with tubal infertility treated by in vitro fertilisation and embryo transfer (IVF + ET) of 4 embryos is described. The patient presented with vaginal bleeding and lower abdominal pain and during emergency laparoscopy tubal heterotopic pregnancy was eliminated. The patient did well till term and delivered a 3450 g and 50 cm newborn with congenital valvular pulmonal artery stenosis. The incidence and treatment options of heterotopic pregnancies and influences of foetal outcome concerning congenital anomalies are discussed.

Adult↗

Establishment and maintenance of pregnancy after embryo transfer in ovariectomized mares treated with progesterone.

Pregnancy was established and maintained after embryo transfer in 3 ovariectomized mares treated with progesterone only. Four ovariectomized mares were used as recipients, and 7 transfers were performed. Progesterone in oil, 300 mg i.m. daily, was given starting 5 days before transfer of a 7-day embryo. If the mare was pregnant at 20 days, progesterone treatment was continued to 100 days of gestation. The 3 pregnant mares carried to term and delivered live foals with normal parturition, lactation and maternal behaviour. No differences were seen between pregnant and non-pregnant ovariectomized mares in jugular plasma concentrations of oestrogen, LH or FSH from day of transfer (Day 7) to Day 20. Pregnant ovariectomized mares showed a rise in LH, reflecting production of horse CG, starting at Day 36. Oestrogen values remained low until Day 50.

Animals↗

[A preliminary study on in vitro fertilization and embryo transfer].

Forty-two women with infertility were enrolled in an in vitro fertilization and embryo transfer (IVF/ET) program, from July, 1986 to February, 1988, at the First Affiliated Hospital, Human Medical University. CC/hMG/hCG and hMG/hCG regimens for ovulation induction were used for 35 and 7 patients. Monitoring methods consisted of daily follicular ultrasonography and serum estradiol measurements. Human chorionic gonadotropin 10,000IU was administered when the leading follicle reached 18mm in diameter and serum E2 level was equal to or more than 1,480 pmol/L (400 pg/ml). Twenty-one laparoscopies and nineteen laparotomies for oocyte retrieval were performed. The IVF/ET results using CC/hMG/hCG for ovarian stimulation were as follows: an average of 6.1 follicles were aspirated and 3.5 oocytes recovered for one case. The recovery rate and fertilization rate was 57.0% and 60.1% respectively. In twenty-five women one to five embryos were transferred and a clinical pregnancy occurred in one who received three embryos. Laparotomy for oocyte retrieval showed that more oocytes could be obtained than laparoscopy. The purity of CO2 used for laparoscopy was considered to affect the IVF results.

Adult↗

Clinical significance of transvaginal color Doppler ultrasonography of the ovarian artery as a predictor of ovarian response in controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer.

PURPOSE: Our purpose was to verify whether the blood flow impedance of the ovarian stromal artery in transvaginal color Doppler ultrasonography can predict the in vitro fertilization and embryo transfer (IVF-ET) outcomes. METHODS: Transvaginal color Doppler ultrasonographic examinations were performed in 99 patients undergoing controlled ovarian hyperstimulation (COH) for IVF-ET. The pulsatility index (PI) was evaluated in the bilateral ovarian stromal arteries on the starting day of COH (PI1) and the day of hCG administration (PI2). The patients were classified into three groups by the mean PI1, PI2, and API (PI1 - PI2), respectively, and the IVF-ET outcomes were analyzed and compared. RESULTS: There were no significant differences in the duration of COH, the total dosage of gonadotropins used for COH, the serum E2 concentration on day of hCG administration, the number of follicles on the day of hCG administration, the number of oocytes retrieved or fertilized in vitro, and the number of embryos transferred between their respective PI1, PI2, and API values. However, the pregnancy rate was significantly lower in the higher PI1 and PI2 groups than in the lower groups (p < 0.05, p < 0.05). Significant positive correlations were also found between PI1 and PI2 and the total dosage of gonadotropins for COH (Y= 0.483X + 27.1, r = 0.052, p < 0.05; Y = 0.877X + 26.6, r = 0.075, p < 0.05). CONCLUSIONS: Our results showed that the lower PI in the ovarian stromal artery during COH is associated with the higher the pregnancy rate and the smaller amount of gonadotropins used for effective COH. This study suggests that the color Doppler ultrasonographic index (PI) of the ovarian stromal artery during COH may be useful for predicting the success of IVF-ET in infertile patients.

Adult↗