Assisted Reproductive Technology Unit Research Articles

Insights into Early Pregnancy Demise following Intracytoplasmic Sperm Injection in Women with Unexplained Infertility.

To investigate the effects of some potential risk factors on early pregnancy loss -EPL - in a cohort of pregnant women treated by assisted reproductive technology - ART. This is a retrospective cohort of 195 pregnancies, defined as serum human chorionic gonadotrophins ≥ 10 IU/l on day 14 - 17 after embryo transfer, recruited from an assisted reproductive technology unit, Ain Shams & Al-Azhar Maternity hospital, Cairo, Egypt, during the period from January 1st, 2016 to December 31, 2020. Risk factors investigated were maternal age, body mass index, status, baseline hormonal profiles, treatment protocol, quality and number of embryos. Overall early pregnancy loss among the studied 195 pregnant women was 29 cases (15%). The risk of early pregnancy loss was associated with older age and fewer number of embryos transferred. Women > 35 years were found to have two and half times of early pregnancy loss compared with younger age group < 25 years, this was not significant after adjusting for other factors. The risk in both lean (BMI < 25 kg/m2) and very obese (BMI > 35 kg/m2) women was also not significantly higher in unadjusted analysis. Transfer of two or more embryos was associated with a non-significant reduced risk of early pregnancy loss, and after adjusting for other factors, the reduction was about 70%. Early pregnancy loss represents a considerable drawback of intracytoplasmic sperm injection treated women with old age to increase the risk of early pregnancy loss and transferring more than one embryo to reduce the risk by about 70%. Obesity and other factors appeared to play a minor role.

SUBTLE ENDOMETRIAL ABNORMALITIES DO NOT AFFECT THE PREGNANCY RATE IN FRESH ICSI CYCLES

The study aimed to determine whether the presence of subtle endometrial abnormalities discovered by office hysteroscopy (OH) affects the pregnancy rate in fresh intracytoplasmic sperm injection (ICSI) cycles. A prospective cohort study included women undergoing their first ICSI cycles was performed in assisted reproductive technology unit. Patients were divided into two groups: patients with subtle endometrial abnormalities diagnosed by OH (group 1, n=78), and patients with normal uterine cavity (group 2, n=122). OH was conducted post-menstrual and subtle abnormalities detected included hypervascularization, petechiae, mucosal elevation, micropolyps, pale endometrium and single adhesion band. The main outcome measures were clinical pregnancy and implantation rates The most common subtle abnormality observed was pale endometrium in 35.9% of cases. Both groups were comparable regarding the baseline clinical data and endometrial thickness. Additionally, total amount of gonadotrophins used, duration of stimulation, peak estradiol concentrations, peak endometrial thickness, number of mature follicles and number of embryos transferred were not significantly different between both groups. The implantation rate was similar in both groups (2.35 ± 0.83 vs. 2.22 ± 0.84, p=0.465). Also, the pregnancy rate was similar in both groups (38.5% vs. 33.6%, p=0.067) Subtle endometrial abnormalities diagnosed by OH do not negatively affect pregnancy and implantation outcomes in fresh ICSI cycles.

Correlation between Serum Anti-Müllerian Hormone Levels and Antral follicle count in prediction of clinical pregnancy in women with unexplained infertility undergoing ICSI cycles

Background: It is obvious that after years of publications worldwide. The question of whether the serum level of AMH predicts pregnancy after ICSI still unresolved. In the present study the correlation between serum AMH levels and pregnancy rate in a population of women undergoing their first ICSI cycle is investigated.Objective: We assess accuracy of serum anti-mullerian hormone levels and anti follicle count in prediction of clinical pregnancy in women with unexplained infertility and undergoing ICSI cycles. Patients and Methods: This is a retrospectively study in assisted reproductive technology unit at Maternity Hospital – Ain Shams University from August 2018 to June 2019. This study included 71 women with unexplained primary infertility in ART unit undergoing ICSI cycles. Simple random sampling. Results: we included (patients with unexplained primary infertility who underwent their first ICSI cycle aged 20-35 years with BMI ≤ 30 without associated medical problems as diabetes mellitus, hypertension and polycystic ovary. Serum AMH was measured within 3 months before the beginning of the ICSI cycle, ovarian stimulation was carried out, and all embryos transfer were carried out on a fresh cycle. Conclusion: In this study it was found that as the AMH level increases, the number of oocytes increases as well, but it is not a predictor of oocyte quality or pregnancy rate.

Ovarian and Uterine Blood Flow Indices in Patients with Unexplained Infertility Undergoing ICSI and their Relation to Clinical Pregnancy Rate

Background: Infertility is defined by the World Health Organisation (WHO) as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse and is estimated to affect as many as 48.5 million couples worldwide. Unexplained infertility (UI) constitutes an important portion of the infertility reasons (up to 30%) and is diagnosed when the causes of male or female infertility remains unknown.Aim: The aim of the study was to compare ovarian, uterine artery and subendometrial vessels resistance by measuring PI and RI of patients diagnosed as UI undergoing ICSI in the day of embryo transfer and control group diagnosed as fertile by having at least one livebirth in peri-implantation period from day 19 to day 21.Materials and Methods:The current study is a prospective case control study, which was conducted at the Assisted Reproduction Technology unit of Ain Shams University Maternity Hospital during the period from September 2017 to July 2019. The current study included two groups of patients one group is unexplained infertility attending the Assisted Reproduction Unit and the other is control fertile group each group consists of 51 women.Results: There was statistically significant difference between the unexplained infertility group and control fertile group as regard Uterine and subendometrial artery PI, RI and ovarian artery RI in which resistance indexes was significantly higher in the UI group than control group. The cut off values of PI, RI between unexplained infertility and fertile group are ≥1.88, ≥0.8 for Uterine artery, and ≥ 0.87, ≥0.53 for subendometrial arteries, and ≥ 0.59 for ovarian artery RI. Among the unexplained infertility undergoing ICSI patients the pregnancy rate is 23.5%. There was no statistically significant difference between the two groups (pregnant group and non-pregnant group) as regard the age, BMI, duration of infertility or the basal hormonal profile.Conclusion: Doppler parameters are useful tools to assess endometrial receptivity in unexplained infertility patients undergoing ICSI. This study found that Uterine, Ovarian, subendometrial arteries plasticity index (PI) and resistance index RI measured on the day of embryo transfer higher than fertile women and have value in judging endometrial receptivity and predict the final outcome of IVF/ ICSI- ET. Uterine, ovarian and subendometrial blood flow assessed by measuring PI, RI of these arteries was impaired in unexplained infertility patients compared to fertile women. Also, uterine arteries PI, ovarian and subendometrial arteries PI, RI differ in pregnancy outcome in unexplained infertility patients undergoing ICSI.

Effect of Nursing Guidelines on Coping of Infertile Couples Undergoing In Vitro Fertilization

Context: Infertility is defined as not being able to conceive after one year of unprotected sex. In vitro fertilization (IVF) is a process of fertilization where an ovum is combined with sperm outside the body, in vitro. In vitro fertilization (IVF) is psychologically and emotionally stressful. Coping strategies are needed to master, tolerate, reduce, or minimize stressful events.&#x0D; Aim: This study aimed to evaluate the effect of nursing guidelines on coping of infertile couples' undergoing In Vitro Fertilization.&#x0D; Methods: A quasi-experimental research design was utilized to achieve the aim of this study. This study conducted at the assisted reproductive technology unit of Ain shams Maternity University Hospital on a convenient sample of 98 couples undergoing fertility treatments. Two tools were used for data collection; the first tool was a structured interviewing questionnaire to assess the couple's socio-demographic data, obstetric history, the couple's knowledge regarding in vitro fertilization. The second tool was ways of coping scale (WQS) to assess coping strategies among the infertile couple.&#x0D; Results: There is no statistically significant difference between couples in both groups according to their knowledge and their coping strategies to IVF before the implementation of nursing guidelines (p&gt; 0.05). In contrast, there is a highly statistically significant improvement in knowledge and coping strategies of couples on the study group compared to control group couples after implementation of nursing guidelines(p&lt;0.001).&#x0D; Conclusion: The finding of the current study supported the hypothesis, which stated that the infertile couples who will expose to the nursing guidelines, will exhibit improved coping strategies to IVF compared to the controls. The study recommended the application of nursing guidelines at the IVF unit of Ain Shams Maternity University Hospital and other settings for IVF treatment as routine care to improve infertile couples' coping strategies.

Intracytoplasmic Sperm Injection Outcome in Patient at Risk of Poor Responder Using Mild Ovarian Stimulation Protocol versus Short Gonadotropin Releasing Hormone Agonist Protocol

Background: Poor ovarian response to stimulation in IVF cycles is a challenging and frustrating condition for both clinician and patient, due to its poor prognosis in terms of pregnancies and live births. Although in the literature a large number of papers have been published in which many stimulation protocols suggested should be considered as the best for these women, however, no conclusive results have been reached. Aim of the Work: To evaluate ICSI outcome in patient at risk of poor responder using mild ovarian stimulation protocol versus short gonadotropins releasing hormone agonist protocol. Patients and Methods: This randomized controlled study was conducted on one hundred patients, complaining of infertility at risk of poor responders, patients with at least two of the criteria specific for poor responders at assisted reproductive technology unit, international Islamic center for population studies and research, Alazhar University, Cairo, Egypt, between august 2016 and august 2017. Results: Statistically significant differences were found in the Endometrial thickness, E2 at day of HCG, No. of dominant follicles at day of HCG, Number of retrieved oocyte, fertilization rate, Embryo number, Number of transferred embryos, Pregnancy rate and cost p-value 0.029, 0.036, 0.007, 0.027, 0.048, 0.019, 0.046, 0.044 ,0.001 respectively. Conclusion: ICSI outcome was evaluated in patients at risk of poor responders using short Gonadotropin releasing hormone agonist versus mild ovarian stimulation protocol (clomiphene citrate); showing that short Gonadotropin releasing hormone agonist should be preferred in these patients.

A review of pregnancy outcomes following laparoscopic ovarian drilling for infertile women with clomiphene resistant polycystic ovarian syndrome (PCOS) at a public health facility in Ilorin, Nigeria.

Background : Polycystic ovarian syndrome (PCOS) is the common endocrine disorder in women and its prevalence is on the increase due to availability of diagnostic tools. It is usually managed medically but for some resistant cases may require surgical intervention in the form of laparoscopic ovarian drilling (LOD). LOD is a one-off therapy avoids the need of medical therapy and its attendant complications. Aim and Objectives: The objective of this study was to determine the impact of LOD on reproductive outcomes of infertile women with clomiphene resistance PCOS among clients attending the Assisted Reproduction Technology unit of University of Ilorin Teaching Hospital. Materials and Method s: This is a prospective / longitudinal study of twenty three (23) patients of clomiphene resistant PCOS who underwent LOD between January and December 2012. Results : The patients were aged 24-45years with a mean age of 31.7 ± 5.2 years. Twenty (87%) out of twenty three were nulliparous and majority (87%) belong to middle social class. Eleven (47.8%) had primary infertility while 12 (52.2%) had secondary infertility. The mean duration of infertility is 4.5 ± 2.9 years and the number of drills per ovary ranged from 4 to 15 (mean, right ovary=8.6±3.24; left ovary=9.3±3.4). Majority (95.7%) had at least one patent tube. The mean age of patients' husbands is 38.8 ± 5.7 years with majority (82.6%) having normozoospermia. In the follow-up period, all 23 patients (100%) resumed menstruation and achieved ovulation (ovulation rate= 100%). The mean time of menstruation and ovulation were 4.1± 1.9 days and 5.3 ± 3.2 weeks respectively. Seven pregnancies were recorded from 23 patients giving a cumulative pregnancy rate of 30.4%. Of the remaining four pregnancies, one of the patients had successfully delivered, giving a live birth rate of 14.3%, while others are on-going. The mean time interval from LOD to pregnancy was 4.7 ± 1.6 months. The pregnancy outcomes had no significant association with age of the women, parity, duration of infertility and types of infertility with p > 0.05. Conclusion : LOD is a safe and effective one-off treatment for PCOS related infertility in patients who failed to respond to CC with efficacy equal to gonadotrophins and metformin. We recommend the need for its domestication in our locality. Keywords : Anovulatory infertility, Laparoscopic ovarian drilling, Polycystic ovarian syndrome, Live birth

Transforming growth factor-β1 and its receptor soluble endoglin are altered in polycystic ovary syndrome during controlled ovarian stimulation

To evaluate the relationship between transforming growth factor (TGF)-β1 and its receptor, soluble endoglin (sENG), in the serum and follicular fluid of women with polycystic ovarian syndrome (PCOS) compared with that of non-PCOS normal ovulating women during controlled ovarian stimulation (COS). Prospective case-control study. Academic-affiliated assisted reproductive technology unit. Fourteen PCOS and 14 matched non-PCOS control women undergoing COS. Serum was collected on day 3 (baseline), day of hCG, and day of retrieval. Follicular fluid (FF) was collected on day of oocyte retrieval. ELISA was performed to determine TGF-β1 and sENG protein levels. Serum and FF levels of TGF-β1 and sENG. Serum TGF-β1 did not change significantly during COS but was increased in PCOS compared with non-PCOS women on day 3 and days of hCG administration and oocyte retrieval. Serum sENG increased after hCG administration only in the non-PCOS control group. In addition, serum sENG was decreased in PCOS compared with non-PCOS control women on the days of hCG and retrieval. Accordingly, the bioavailability of TGF-β1 (TGF-β1/sENG ratio) was increased in women with PCOS compared with non-PCOS controls at all three time points. No differences in either factor were noted in FF between groups. The increased TGF-β1 bioavailability in PCOS is not only due to increased TGF-β1 levels but also to decreased levels of its receptor, sENG. These data suggest that increased TGF-β1 bioavailability may contribute to the pathogenesis of PCOS and its increased risk for ovarian hyperstimulation.

Early and short follicular gonadotropin-releasing hormone antagonist supplementation improves the meiotic status and competence of retrieved oocytes in in vitro fertilization–embryo transfer cycles

To investigate whether early and short follicular administration of GnRH antagonist using the flexible protocol has the potential to improve IVF-ET clinical results. Prospective, controlled, randomized study. University-affiliated assisted reproductive technology unit. Fifty-three consecutive infertile women were enrolled to the study and control groups. Both groups were treated with recombinant FSH and the flexible GnRH antagonist protocol. Women in the study group were additionally supplemented with three injections of GnRH antagonist (0.25 mg/d on days 1, 2, and 3 of the menstrual cycle). Hormonal milieu, oocyte meiotic status, competence for normal fertilization, cleavage, and clinical pregnancy rate. Both groups had comparable baseline characteristics. The duration of recombinant FSH treatment was significantly longer in the study group as compared with the control group (10.9+/-3.1 and 9.7+/-1.3 days, respectively). The number of follicles>or=14 mm and E2 level on the day of hCG administration, number of retrieved oocytes, and endometrial thickness were similar between the two groups. However, the fertilization rate was significantly higher in the study as compared with the control group (85%+/-16% and 69%+/-24%, respectively). Moreover, the cumulative rate of mature first polar body oocytes was significantly higher in the study group as compared with the control group (93% and 85%, respectively). Concomitantly, day-3 FSH and LH levels after initiation of treatment were significantly lower in the study as compared with the control group (6.1+/-2.4 mIU/mL vs. 7.2+/-1.9 mIU/mL and 2.4+/-1.6 mIU/mL vs. 5.6+/-2.7 mIU/mL, respectively). Early and short follicular GnRH antagonist supplementation using flexible GnRH antagonist treatment improves the meiotic status and competence of retrieved oocytes. It seems that early and short pituitary shutdown has the potential to improve clinical results in IVF-ET GnRH antagonist cycles.

Effects of delta-9-tetrahydrocannabinol, the primary psychoactive cannabinoid in marijuana, on human sperm function in vitro

To investigate effects of delta-9-tetrahydrocannabinol (THC) on human sperm function in vitro. Laboratory analysis of sperm motility after exposure to THC using computer-assisted semen analysis and acrosome reaction by fluoroscein isothiocyanate-labeled peanut agglutinin staining. An assisted reproductive technology unit. Seventy-eight male patients. Sperm were divided into 90% (the best fertilizing potential used in assisted conception) and 45% (the poorer subpopulation) fractions by density centrifugation and incubated with THC at concentrations equivalent to therapeutic (0.032 microM) and recreational (0.32 and 4.8 microM) plasma levels at 37 degrees C for 3 h. Sperm motility and spontaneous and induced acrosome reactions. Percentage progressive motility was decreased dose dependently in the 90% fraction (by 2%-21%; P<.05; P<.001). The 45% fraction showed a greater decrease in percentage progressive motility (by 28% at 0.032 microM; 56% at 4.8 microM; P=.004 and P=.01 res). Straight line velocity and the average path velocity also were reduced (by 10%, in the 90% LAYER) in both fractions. Spontaneous acrosome reactions were reduced in the 90% (17% at 0.032 microM, 35% at 4.8 microM P=.004 and P<.001 resp) and more markedly in the 45% fractions (17%-35%; P<.001). When the acrosome reaction was artificially induced (90% fraction) by A23187, THC (4.8 microM) resulted in a 57% inhibition (P<.001). The use of THC as a recreational drug may adversely affect male fertility.

Proximal occlusion of hydrosalpinx by hysteroscopic placement of microinsert before in vitro fertilization–embryo transfer

To describe proximal occlusion of a hydrosalpinx by hysteroscopic placement of a microinsert before IVF-ET. Case report. Health maintenance organization and tertiary-care assisted reproductive technology unit. Obese, infertile woman with pelvic adhesive disease and unilateral hydrosalpinx. Hysteroscopic placement of a microinsert into the proximal segment of a fallopian tube that was distally obstructed by hydrosalpinx. No intraoperative or postoperative complications occurred with hysteroscopic placement of microinsert. Nonincisional proximal tubal occlusion under local anesthesia and intravenous sedation. Pregnancy by IVF-ET. No intraoperative or postoperative complications with hysteroscopic placement of microinsert were seen. After uterine transfer of three embryos, dichorionic-diamniotic twins were delivered by cesarean section at 34 weeks of gestation. Hysteroscopic placement of a microinsert to proximally occlude a hydrosalpinx might be an alternative to laparoscopic proximal tubal occlusion or salpingectomy in patients with tubal disease planning IVF-ET.

Single blastocyst transfer: a prospective randomized trial

Objective To determine the efficacy of single blastocyst transfer. Design Prospective randomized trial. Setting Private assisted reproductive technology unit. Patient(s) Forty-eight women undergoing IVF-embryo transfer with day 3 FSH ≤10 mIU/mL and at least 10 follicles >12 mm in diameter on day of hCG administration. Intervention(s) Embryo culture to the blastocyst stage in sequential media G1/G2 followed by transfer of either one or two blastocysts. Main outcome measure(s) Implantation rate, ongoing pregnancy rate, and twinning. Result(s) The transfer of a single blastocyst resulted in an implantation and ongoing pregnancy rate of 60.9% with no twins. The transfer of two blastocysts resulted in an implantation rate of 56%, an ongoing pregnancy rate of 76% with a 47.4% incidence of twins. Conclusion(s) Single blastocyst transfer is an effective method of eliminating multiple births while maintaining high pregnancy rates in this selected group of patients.

Pregnancy rate fluctuations during routine work in an assisted reproduction technology unit.

Fluctuations in spontaneous pregnancy rates have been observed in the general population. The purpose of this study was to evaluate whether pregnancy rates fluctuate over time in a homogeneous assisted reproduction treatment unit. The study sample consisted of 3522 consecutive assisted reproduction cycles conducted from January 1996 to December 1999. Only fresh cycles in women <41 years old were included. All pertinent clinical data were prospectively collected on a computerized database and analysed at the end of the study. Throughout the 4 years of the study, monthly pregnancy rates fluctuated between 10.5 and 34.1% (mean 21.4%) per cycle, and between 13.6 and 41% (mean 27.26%) per transfer. These fluctuations did not follow any specific seasonal pattern. During routine work in an assisted reproduction treatment unit, there are random fluctuations in the pregnancy rate. This factor should be considered in studies performed in a specific time-period.

Noninvasive assessment of human embryo nutrient consumption as a measure of developmental potential

Objective: To determine the relationship between blastocyst development and morphology and embryo metabolism. Design: Noninvasive assessment of carbohydrate uptake and ammonium production by individual embryos. Setting: Private assisted reproductive technology unit. Patient(s): Patients donated, with consent, cryopreserved pronucleate embryos and noncryopreserved blastocysts. Intervention(s): Culture of 60 thawed pronucleate embryos in sequential media to the blastocyst stage with concomitant noninvasive analysis of embryo metabolism and analysis of 13 blastocysts from noncryopreserved embryos. Main Outcome Measure(s): Pyruvate and glucose consumption as well as blastocyst formation and quality. Result(s): Pyruvate and glucose uptakes on day 4 were significantly higher by embryos that went on to form blastocysts than by embryos that failed to develop to the blastocyst stage. Glucose uptakes were greatest in those blastocysts of highest grade, whereas pyruvate uptakes were similar irrespective of blastocyst grade, indicating that glucose is the more important nutrient for the human blastocyst. Among blastocysts of the same grade from the same patient, there was considerable spread of glucose consumption, indicating that glucose consumption may be of use in identifying blastocysts for transfer. Ammonium production by individual embryos was also measured, reflecting amino acid transamination and use by the human embryo. Conclusion(s): The ability to identify in culture the embryo with the highest developmental potential will facilitate the move to single-embryo transfers.

Double (consecutive) transfer of early embryos and blastocysts: aims and results

Objective: The aim of this study was to evaluate the consecutive transfer approach of early embryos and blastocyst(s). Design: Case-control study. Setting: Public assisted reproduction technology unit. Patient(s): The study population consisted of three groups. In Group 1, a double transfer was performed on 136 consecutive women, that is, a standard transfer of embryos on day 2 or 3, and a second transfer of a blastocyst(s). In Group 2, an early transfer of only two embryos and a second transfer of one blastocyst were performed on 29 women from group 1 who had more than three high-quality embryos available for early transfer. In Group 3, a single early transfer was performed on 139 consecutive women who received three high-quality embryos (controls). Intervention(s): Early embryo transfer, extended culture of the spare embryos, and a second transfer of a blastocyst(s). Main Outcome Measure(s): Implantation and pregnancy rates. Result(s): No differences were detected among the three groups in either pregnancy or implantation rates (pregnancy: 36.8%, 41.4%, and 37.4%, respectively; implantation: 14.6%, 19.9%, and 19.8%, respectively). Conclusion(s): The double (consecutive) transfer of early embryos and blastocyst(s) does not offer any advantage over the traditional early transfer. This may be from the adverse effect of the second transfer on the implantation process.

Blastocyst culture and transfer increases the efficiency of oocyte donation

Objective: To determine the impact of blastocyst transfer on an oocyte donation program. Design: Retrospective review of embryo transfer in an IVF clinic. Setting: Private assisted reproductive technology unit. Patient(s): Two hundred and twenty nine patients undergoing oocyte donation. Intervention(s): Culture of pronucleate embryos to either day 3 or day 5 followed by embryo transfer. Main Outcome Measure(s): Implantation rates, pregnancy rates, and multiple gestations were analyzed. Result(s): Implantation rates and pregnancy rates were significantly increased by moving to extended embryo culture and transfer on day 5. After day 3 transfers, implantation and pregnancy rates were 47.1% and 75%, respectively. In contrast, on day 5 these rates were increased to 65.8% and 87.6%. Concomitantly, there were significantly fewer embryos transferred on day 5 (2.1) compared to day 3 (3.2). Conclusion(s): Blastocyst transfer is a highly effective treatment for patients who receive donor oocytes, allowing excellent pregnancy rates while significantly reducing the incidence of high-order multiple gestations.

Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer

Objective: To determine the relationship between blastocyst score and pregnancy outcome. Design: Retrospective review of blastocyst transfer in an IVF clinic. Setting: Private assisted reproductive technology unit. Patient(s): 107 patients undergoing blastocyst culture and transfer of two embryos. Intervention(s): Culture of all pronucleate embryos in sequential media to the blastocyst stage (day 5), followed by transfer of two blastocysts. Main Outcome Measure(s): Implantation rates, pregnancy rates, and twinning were analyzed. Result(s): When a patient received two top-scoring blastocysts (64% of patients), implantation and pregnancy rates were 70% and 87%, respectively. The twinning rate in this group was 61%. When only one top-quality blastocyst was available for transfer (21% of patients), the implantation and pregnancy rates were 50% and 70%. The twinning rate for this group was 50%. In contrast, when only low-scoring blastocysts were available for transfer (15% of patients), implantation and pregnancy rates were 28% and 44%, and the twinning rate was 29%. No monozygotic twins were observed in this group of patients. Conclusion(s): The ability to transfer one high-scoring blastocyst should lead to pregnancy rates greater than 60%, without the complication of twins.

Blastocyst culture and transfer: analysis of results and parameters affecting outcome in two in vitro fertilization programs

Objective: To determine whether previously described advanced blastocyst development and high implantation rates are confirmed in an expanded multicenter trial. Design: Retrospective review. Setting: Two private assisted reproductive technology units. Patient(s): One hundred seventy-four patients who underwent blastocyst culture and transfer. Intervention(s): Culture of all pronucleate embryos in sequential media to the blastocyst stage (day 5) followed by ET. Main Outcome Measure(s): The number and percentage of blastocysts developed, implantation rates, pregnancy rates, and parameters that affected outcome were analyzed. Result(s): Only 3 of 174 patients failed to achieve blastocyst-stage ET. The mean blastocyst development rate was 48%. The ongoing pregnancy rate was 66.3% per oocyte retrieval, with a mean (±SE) of 2.2 ± 0.05 blastocysts transferred and an implantation rate of 48% per blastocyst transferred. Conclusion(s): Blastocyst culture and transfer is an effective means of treating patients who respond well to gonadotropins. High pregnancy rates can be accomplished with low numbers of embryos transferred. Patients who failed to achieve ET were rare.

Fibrin glue improves pregnancy rates in women of advanced reproductive age and in patients in whom in vitro fertilization attempts repeatedly fail

Objective: To evaluate the possible contribution of fibrin sealant to the ET stage of IVF. Design: Case-control study. Setting: An assisted reproductive technology unit that performed 2,535 treatment cycles from 1996–1997. Patient(s): All consecutively seen patients who underwent ET from January 1996 to September 1997. Intervention(s): All women who underwent ET with the aid of fibrin sealant during the study period were compared with those who underwent standard ET (controls). Thereafter, a case-control study was conducted on the first consecutively seen 174 women who underwent ET with fibrin sealant and a control group that was matched for age and number of previous unsuccessful cycles. Main Outcome Measure(s): Patient age, number of previous unsuccessful IVF attempts, number of embryos transferred, and pregnancy rates. Result(s): During the study period, ET was performed with fibrin sealant in 265 women and by the standard procedure in 1,402 women. Women in the fibrin sealant group were significantly older. The pregnancy rate was not significantly different between the groups in the whole-cohort study (20.4% versus 23.1%), but it was significantly higher in the fibrin sealant group in the case-control study (25.3% versus 14.9%). This also was true when the older women (>35 years) and the women with ≥4 previous failed IVF attempts were analyzed separately (23.2% versus 9.8% and 26.1% versus 13.4%, respectively). Conclusion(s): The use of fibrin sealant in ET appears to be beneficial in women of advanced reproductive age and in patients in whom IVF attempts repeatedly fail.

Variation in the determination of follicular diameter: an inter-unit pilot study using an ultrasonic phantom.

Ultrasound operators in assisted reproductive technology units in New South Wales, Australia cooperated in a study that was conducted to assess their ability to measure fixed objects embedded in an ultrasound phantom. The results have demonstrated a large variation ranging between 10 and 25% coefficient of variation on distances between 10 and 32 mm. As ultrasonic imaging is the only component of assisted reproductive technology not currently controlled by an external quality assurance scheme, the authors suggest there may be a need to establish a programme.