Outcome Of Blastocyst Transfer Research Articles

P-132 Outcomes of blastocyst transfer derived from oocytes with smooth endoplasmic reticulum clusters (sERC)

Abstract Study question Are blastocysts derived from oocytes with smooth endoplasmic reticulum clusters (sERC+) as suitable for transfer as those from oocytes without such clusters (sERC-)? Summary answer Blastocysts from sERC+ oocytes are considered for embryo transfer; however, it is recommended to prioritize them lower than those from sERC- oocytes. What is known already One of the cytoplasmic abnormalities in human oocytes, sERC, typically manifests during the MII stage oocytes and disappears after fertilization when the female and male pronuclei emerge. Despite this, the mechanism behind sERC development remains unclear. While it is suggested that sERC in oocytes may adversely impact embryo development and implantation, a definitive conclusion on its safety or use has not been reached. Although the 2011 Istanbul consensus discouraged injecting or inseminating sERC+ oocytes, a 2017 expert panel reconsidered this recommendation, advocating for a case-by-case approach. Therefore, there are widespread variations in responses to sERC in clinical practices. Study design, size, duration A retrospective review of intracytoplasmic sperm injection (ICSI) cycles between April 2014 and April 2023 was conducted, exclusively on single frozen blastocyst transfers of two pronuclei (2PN)-derived embryos performed before June 2023. A dataset comprising 95 blastocysts from sERC+ oocytes and 8,698 blastocysts from sERC- oocytes was assembled. To reduce bias between groups, maternal age at retrieval and transfer counts were matched in a 1:1 ratio using propensity score matching, yielding 95 comparable cycle pairs. Participants/materials, setting, methods Among all ICSI cycles, 78 exclusively involved embryos from sERC+ oocytes, 847 included embryos from both sERC+ and sERC- oocytes, and 6,599 had no embryos derived from sERC+ oocytes. Among the 8,698 sERC- blastocysts transferred, 1,083 and 7,615 originated from cycles with and without sERC+ oocytes, respectively. Implantation, miscarriage, and live birth rates were then compared in 95 matched pairs of blastocysts derived from sERC+ and sERC- oocytes. Main results and the role of chance Following propensity score matching adjustments, the mean patient age at retrieval (mean ± SD) for blastocyst transfers derived from sERC+ and sERC- oocytes were 38.6 ± 4.7 years and 38.7 ± 4.8 years, respectively (p = 0.927). The transfer counts were 4.2 ± 3.4 times for sERC+ and 4.1 ± 3.1 times for sERC- blastocyst transfers (p = 0.840). The proportion of high-quality blastocysts was 48.4% for sERC+ transfers and 54.7% in sERC- transfers (p = 0.384). The implantation rates were 24.2% for sERC+ and 32.6% for sERC- transfers (p = 0.198), miscarriage rates were 43.5% vs. 35.5% (p = 0.552), and live birth rates were 13.7% vs. 21.1% (p = 0.172), respectively, with no statistically significant differences. Thirteen live births from sERC+ blastocyst transfers were recorded, and no congenital abnormalities were observed. Limitations, reasons for caution This study exclusively centered on oocytes subjected to ICSI, and the inclusion criteria were restricted to embryos derived from sERC+ oocytes in accordance with clinic policy limitations. Preimplantation genetic testing was not performed on the majority of the transferred embryos. Wider implications of the findings No congenital abnormalities were observed in live births resulting from sERC+ derived blastocyst transfers. However, the limited number of embryo transfers involving sERC+ oocytes poses a constraint in drawing a definitive conclusion regarding the safety of embryos from sERC+ oocytes, and further data is required. Trial registration number non-clinical trials

P-144 Utilizing artificial intelligence to uncover Day 5 morphokinetic features associated with single blastocyst transfer implantation outcome

Abstract Study question Can AI aid in studing embryos’ continuous development in Day5 and identifying morphokinetic features (blastocyst growth and spontaneous collapse etc.), to improve implantation potential prediction? Summary answer The AI system utilized time-lapse images to measure newly identified morphokinetic features, establishing a significant correlation with clinical pregnancy outcomes. What is known already In Single Blastocyst Transfer (SBT), the conventional Gardner evaluation system may inadequately differentiate between embryos of comparable morphology scores in specific cases. To address this, integrating new morphokinetic features is essential for enhanced blastocyst evaluation. Spontaneous collapse (SC) during blastocyst expansion is a phenomenon that was revealed relatively recently following the clinical application of time-lapse monitoring in IVF laboratories. Previous studies link embryo size and SC to quality, yet these correlations require further validation. In the critical selection process utilizing time-lapse imaging (TLI) systems, AI technology is indispensable for developing automated and interpretable tools to ensure precise quantitative measurements. Study design, size, duration 255 patients underwent IVF with Day5 single blastocyst transfer in fresh cycles at the Center for Reproductive Medicine, Nanjing Drum Tower Hospital, from April 2021 to August 2022, and were analyzed in this retrospective study. Embryos were cultured in time-lapse incubators (CCM-iBIS, ASTEC). On Day 3 embryos were transferred to sequential media (G2, Vitrolife, Sweden) and cultured in the same incubator until Day5. In this cohort, there were 167 clinical pregnancies and 88 non-pregnant cases. Participants/materials, setting, methods An AI system was developed to calculate the development curves of areas in each part of the embryo (ZP,blastocel, ICM and TE) based on TLI images from 92 to 116 phi(±2). T-test and correlation analysis were used to select effective features. The dataset was divided into training and testing subset in an 80:20 ratio. The performance of different prediction models were compared by Delong test. Main results and the role of chance In this study, an AI system automatically generated blastocyst development curves, from which 35 morphokinetic features were extracted. These features were carefully defined to comprehensively capture the dynamics of embryo size development and spontaneous collapse (SC). Six parameters, including maximum size, max/min ratio of blastocyst area (with and without ZP region), speed of expansion after tSB, and number of minor SC, exhibited statistical correlation with clinical pregnancy outcomes. Using these parameters, an XGBoost model achieved an AUC of 0.71 for pregnancy prediction, surpassing (p = 0.0307, p < 0.05) the AUC of 0.48 from the model trained with manual Gardner evaluation. These findings underscore the potential of AI-generated morphokinetic features of D5 in enhancing blastocyst evaluation systems. Limitations, reasons for caution The limited sample size used in this retrospective experiment may lead to an underrepresentation of certain significant features. Wider implications of the findings In contrast to prior findings, most SC-based features in our study did not significantly correlate with clinical pregnancy outcome. Further research is needed to understand their causes and implications. Integrating AI with TLI offers promise for improving single blastocyst transfer outcomes, emphasizing quantifiability and interpretability in approach. Trial registration number NA

Does cleavage stage morphology increase the discriminatory power of prediction in blastocyst transfer outcome?

To evaluate the contribution of the cleavage stage morphological parameters to the prediction of blastocyst transfer outcomes. A retrospective study was conducted on 8383 single-blastocyst transfer cycles including 2246 fresh and 6137 vitrified-warmed cycles. XGboost, LASSO, and GLM algorithms were employed to establish models for assessing the predictive value of the cleavage stage morphological parameters in transfer outcomes. Four models were developed using each algorithm: all-in model with or without day 3 morphology and embryo quality-only model with or without day 3 morphology. The live birth rate was 48.04% in the overall cohort. The AUCs of the models with the algorithm of XGboost were 0.83, 0.82, 0.63, and 0.60; with LASSO were 0.66, 0.66, 0.61, and 0.60; and with GLM were 0.66, 0.66, 0.61, and 0.60 respectively. In models 1 and 2, female age, basal FSH, peak E2, endometrial thickness, and female BMI were the top five critical features for predicting live birth; In models 3 and 4, the most crucial factor was blastocyst formation on D5 rather than D6. In model 3, incorporating cleavage stage morphology, including early cleavage, D3 cell number, and fragmentation, was significantly associated with successful live birth. Additionally, the live birth rates for blastocysts derived from on-time, slow, and fast D3 embryos were 49.7%, 39.5%, and 52%, respectively. The value of cleavage stage morphological parameters in predicting the live birth outcome of single blastocyst transfer is limited.

Methods to improve frozen-thawed blastocyst transfer outcomes- the IVF laboratory perspective

During the last few years, the number of frozen-thawed embryo transfer cycles (FET) significantly increased due to the universal application of more efficient cryopreservation techniques in the IVF laboratory and the improved survival rates of blastocyst stage embryos and the wide implementation of “freeze all” IVF cycles to prevent OHSS, or for preimplantation genetic testing for aneuploidy (PGT-A). Blastocyst cryopreservation allows single embryo transfers to reduce the rate of multiple pregnancies and improve perinatal outcomes. There is no consensus regarding the optimal laboratory protocol for blastocyst cryopreservation, and research is ongoing for its amelioration. This review summarizes different laboratory methods that may improve frozen-thawed blastocyst embryo transfer outcomes, alone or in combination. Some of the techniques relate to embryo survival; some of them work on endometrial receptivity.

P-232 Beyond 12 months, blastocyst cryostorage duration in close system affects live birth rate: a monocentric retrospective study

Abstract Study question In order to evaluate the effect of blastocyst cryopreservation duration on live birth rate (LBR). Summary answer Blastocyst cryopreservation duration negatively affects live birth rate when blastocysts are vitrified in complete close system for more than 12 months. What is known already With the development of embryo vitrification, frozen-thawed program embryo transfer has been widely used in the past decade. However, the association between cryopreservation duration and frozen blastocyst transfer outcomes are limited. So far, very few studies have provided evidence on the relationship between blastocyst storage duration and LBR. Study design, size, duration This monocentric retrospective study included 1267 women (n = 1462 cycles) who underwent single frozen blastocyst transfer. Duration of vitrification in close system was categorized into five groups included 2144 frozen blastocysts (Day 5/6) : <3 months (n = 417; mean female age = 32.6 ± 4.74y), 3-6 months (n = 596; mean female age = 33.2 ± 4.96y), 6-12 months (n = 440; mean female age = 33.4 ± 4.83y), 12-36 months (n = 512; mean female age = 32.6 ± 4.75y), and >36 months (n = 179; mean female age = 31.1 ± 3.90y). Participants/materials, setting, methods Clinical pregnancy and live birth outcomes were compared between the cohorts stratified according to blastocyst cryostorage duration. A binary multivariate logistic regression was performed, adjusting for confounders: female age at vitrification, male age, ART technique (IVF or ICSI) and endometrial preparation protocol (spontaneous, substituted and stimulated FET cycle). Multivariable analysis was used to assess the association between crystorage duration of vitrified blastocyst and LBR. All frozen blastocyst transfers were realized in spontaneous, substituted or stimulated cycles. Main results and the role of chance After multivariable analysis, live birth rate was significantly different depending on blastocyst cryostorage duration (all groups combined) (p = 0.033): live birth rate was significantly lower when blastocyst cryostorage duration was between 12-36 months (OR 0.740 IC95%[0.558; 0.981] p = 0.036) and beyond 36 months (OR 0.674 IC95%[0.456; 0.986] p = 0.044) compared to less than 3 months of blastocyst cryostorage duration. However, no significant impact of blastocyst cryostorage duration was observed on clinical pregnancy rate (p = 0.52). Limitations, reasons for caution Our study was limited by its retrospective design with restricted samples. Wider implications of the findings This study provides new findings on the effect of blastocyst cryostorage duration with a significant impact on LBR beyond 12 months of vitrification in close system. However, it’s crucial to confirm that cryostorage duration doesn’t lead to adverse obstetric and perinatal outcomes after vitrified blastocyst transfer. Trial registration number not applicable

Adverse impact of elevated progesterone levels on human chorionic gonadotropin trigger day on blastocyst transfer outcomes in gonadotropin-releasing hormone agonist cycles

ObjectiveDose an elevated serum progesterone (P) level on the human chorionic gonadotropin (hCG) trigger day have a negative effect on clinical pregnancy outcomes for embryos transferred at different stages of development in long-acting gonadotropin-releasing hormone agonist (GnRHa) in vitro fertilization-embryo transfer (IVF-ET) cycles? Study designThis was a noninterventional, retrospective, observational, single-centre cohort study. A total of 1951 patients received long-acting GnRHa for pituitary downregulation in IVF-ET cycles at Nanjing Drum Tower Hospital from January 2018 to December 2020. The serum P levels on the day of hCG administration were measured, together with other cycle parameters, to explore the relationship between P levels and the clinical pregnancy rate (CPR) of different embryos transferred. ResultsWhen the serum P level on the hCG day was higher than 1.5 ng/mL, the CPR did not decrease significantly. There was no correlation between the CPR of cleavage-stage embryo transfer and the serum P level on the hCG day. In addition, the interaction analysis suggested that the CPR of patients undergoing blastocyst transfer decreased as serum P levels on the hCG day increased. Progesterone levels on the day of hCG administration were closely related to the CPR of blastocyst transfer rather than cleavage-stage embryo transfer. ConclusionAn increased serum P level on the day of hCG administration did not affect the CPR of cleavage-stage embryo transfer, but it reduced the CPR of blastocyst transfer cycles.

P-395 Use of a granulocyte-macrophage colony-stimulating factor (GM-CSF)-containing medium for poor-grade blastocyst transfer increases the clinical pregnancy and live birth rates

Abstract Study question Does the post-thaw use of a GM-CSF-containing medium improve blastocyst transfer outcomes in all blastocysts in a frozen-thawed embryo transfer cycle? Summary answer The use of a GM-CSF-containing medium at post-thawing especially improves the live birth (LB) rate of morphologically poor blastocysts in a frozen-thawed embryo transfer cycle. What is known already GM-CSF, a cytokine secreted by the epithelial cells of the female reproductive tract, plays an important role in embryonic development, implantation, and subsequent development in humans and animals. In humans, GM-CSF increases the blastocyst developmental rate and decreases the chances of miscarriage. Previously, we reported that the use of a GM-CSF-containing medium for blastocyst recovery culture after thawing improves the clinical pregnancy (CP) rate in a frozen-thawed blastocyst transfer cycle (ESHRE, 2019). However, it is unclear whether GM-CSF improves embryo transfer outcomes in all blastocysts. In addition, it is necessary to accumulate information regarding its effects on neonatal outcomes. Study design, size, duration We performed a retrospective observational study to compare two groups: a GM-CSF group (GM-CSF-containing medium; SAGE-1step GM-CSF, Cooper Surgical) and a control group (GM-CSF-free medium; ONE STEP Medium, NAKA Medical). We analyzed 566 blastocyst transfer cycles in patients aged 30–39 years who underwent frozen-thawed single embryo transfer at Takahashi Women’s Clinic (Japan) from February 2018 to February 2019. Chromosomal analysis was not performed. Participants/materials, setting, methods We used a control medium for blastocyst culture and a Cryotop safety kit for blastocyst vitrification. After thawing, we cultured blastocysts in a GM-CSF-containing medium or control medium for 3–5 h until transfer. Embryo transfer outcomes were compared. We performed the multivariate logistic regression analysis(MVRA) to adjust confounding bias. A subgroup analysis was also performed of morphological grade according to Gardner’s criteria (excellent: ≥AA, good: blastocysts containing B, poor: blastocysts containing C). Main results and the role of chance There were no difference in patient background between the two groups. The CP and LB rates in the GM-CSF group and control group were 54.3% vs. 42.6% and 42.9% vs. 31.1%. The MVRA adjusted by confounding factors(patient age, BMI, basal AMH, blastocyst grade, day of vitrification, number of previous failed ETs, and assisted hatching) demonstrated that CP (p = 0.0193; adjusted odds ratio [aOR], 1.55) and LB rate (p = 0.0080; aOR, 1.67) were significantly higher in GM-CSF group than that of control group. Moreover, the CP and LB rates of the GM-CSF group and control group were: excellent-blastocysts at 62.0% vs. 58.8% (p = 0.5955; OR, 1.14), 52.7% vs. 45.6% (p = 0.2466, aOR:1.33), good-blastocysts 52.1% vs. 37.6% (p = 0.0561; OR, 1.80), 38.0% vs. 26.6% (p = 0.1072; OR, 1.69), and poor-blastocysts 38.9% vs. 17.9% (p = 0.0115; OR, 2.92), 25.9% vs. 9.0% (p = 0.0164; OR, 3.56). A GM-CSF-containing medium significantly improved the CP and LB rates of poor-grade blastocysts. There were no significant differences between the GM-CSF group and control group in the male ratio (52.7％ vs. 51.0%, p = 0.8057), pregnancy duration (38.8±1.4 weeks vs. 38.5±1.8 weeks, p = 0.2558), cesarean section rate (38.2% vs. 40.8%, p = 0.6979), birth weight (3133±466g vs. 3037±437g, p = 0.1281), and congenital anomaly rate (0.91% vs. 2.04％, p = 0.6026). Limitations, reasons for caution This was a single-center, retrospective study. Chromosomal abnormalities in embryos were not considered; however, the LB rate among babies was analyzed. The basic chemical composition of the culture medium (salt concentration, glucose concentration, etc.) used in the control group was different from that of the GM-CSF-containing medium. Wider implications of the findings We found that the use of a GM-CSF-containing medium improved the clinical pregnancy and live birth rates of poor-grade blastocysts without affecting the babies. This may be an effective therapeutic strategy for some patients as it may allow for the effective use of poor-grade euploid blastocysts. Trial registration number not applicable

Trophectoderm Mitochondrial DNA Content Associated with Embryo Quality and Day-5 Euploid Blastocyst Transfer Outcomes.

Mitochondria play a critical role in cell function and embryo development. Recently, increasing studies have investigated whether mitochondrial DNA (mtDNA) can be used as a predictive biomarker of embryo implantation. However, the results of its effect on implantation are still controversial. To further understand the clinical application value of mtDNA content for reproductive potential, we analyzed the influence of relative mtDNA quantity on embryo quality and transfer outcomes based on the results of second-generation sequencing of preimplantation genetic testing patients in our center. Biopsied trophectoderm (TE) from aneuploid blastocysts contained much larger amounts of mtDNA than those from euploid blastocysts (p < 0.000). In an analysis of only euploid blastocysts (n = 769), female age had no effect on mtDNA content (p = 0.216). TE cells biopsied on day 5 (n = 355) contained significantly higher amounts of mtDNA compared to those biopsied on day 6 (n = 388) or day 7 (n = 26) (p < 0.000). Higher quality trophoblast was associated with lower mtDNA content (p = 0.026), but quality of inner cell mass was not correlated with quantity of mtDNA (p = 0.112). For transferred embryos, the biopsied date and mtDNA content were significantly associated with embryo implantation and live birth outcomes. Day-5 euploid blastocysts with lower quantities of mtDNA exhibited higher implantation rate and live birth rate. However, our data indicated that mtDNA content may not be considered an independent predictive marker, it may be a useful reference for the selection of day-5 transferred euploid blastocysts.

Fresh versus frozen blastocyst transfer outcomes deriven from the same ICSI cycle in male factor infertility

Fresh versus frozen blastocyst transfer outcomes deriven from the same ICSI cycle in male factor infertility

Do day-3 embryo grade predict day-5 blastocyst transfer outcomes in patients with good prognosis?

The main aim was to investigate whether or not day-3 embryo grade could predict day-5 blastocyst transfer outcomes in patients with good prognosis. This study included 233 elective single blastocyst transfers (eSBT) by D5 selection with conventional morphology (CM) and 121 elective single blastocyst transfers (eSBT) by D5 selection with time-lapse monitoring system (TL) from October 2016 to October 2017. All the patients were submitted to controlled ovarian stimulation (COS) with long-term protocol and transferred for the first time. The main outcome measures were clinical pregnancy rates (CPR) and ongoing pregnancy (OPR). Our results suggested that CPR (58.04 versus 57.89 versus 55.56%; p = .957) and OPR (66.07 versus 65.79 versus 64.44%; p = .981) were comparable among day 3 grades I, grades II, and grades III groups. We also observed that the TL group showed a slightly better CPR and OPR than CM group (p > .05). Our findings suggested that good or poor embryos at day-3 were not predictive of the outcomes of good-quality blastocysts in a good-prognosis population. It needed to be emphasized that time-lapse monitoring might be useful for elective single blastocyst transfer.

Assisted reproduction technology: Comparison of clinical outcomes between day 3 and day 5 embryo transfers

BACKGROUND: Embryo transfer (ET) is a critical step in in vitro fertilization (IVF). Selecting the day of transfer for achieving the desired outcomes has been a great challenge. AIMS AND OBJECTIVES: The aim of this study was to compare the pregnancy rates of day 3 and day 5 ET in assisted conception. MATERIALS AND METHODS: This is a longitudinal prospective study of 122 eligible patients that underwent assisted reproduction program in our facility. All patients had controlled ovarian hyperstimulation using antagonist protocol. Patients with four or more zygotes were randomly allocated on day 1 to either day 3 or 5 transfers (58 vs. 64 patients). Fertilization was achieved through conventional IVF. Zygotes were kept in a single-step medium (Global total ®) for day 3 and 5 transfers, respectively. The morphologically best two or three embryos or blastocysts were chosen for transfer in both groups. RESULTS: The overall clinical pregnancy and live birth rates for both groups were 40.2% and 33.6%. There was no statistically significant difference between day 3 and day 5 transfer regarding clinical pregnancy rates (36.2% vs. 43.8% [P = 0.51]), live birth rates (27.6% vs. 9.1% [P = 1.0]), twinning rates (18.8% vs. 20% [P = 1.0]), and rates of early pregnancy loss (8.6% versus 4.7% P = [0.2]). CONCLUSION: In this study, the clinical outcomes of blastocyst transfer are similar to day 3 ET. This underscores the need for patient selection for the choice of days of ET. Further controlled randomized prospective studies with larger sample sizes are recommended.

Intervention improves assisted conception intracytoplasmic sperm injection outcomes for patients with high levels of sperm DNA fragmentation: a retrospective analysis.

Sperm DNA fragmentation (SDF) is used in assisted reproductive technology (ART) programs as an indicator for sperm quality, although there is still a lack of consensus as to its clinical utility. In this retrospective study, we examined intracytoplasmic sperm injection (ICSI) outcomes of 1924 infertile patients who underwent SDF analysis using the sperm chromatin integrity test. ART patients were classified as having low [DNA fragmentation index (DFI) <29%] or high SDF (DFI ≥29%) and by whether or not an intervention [physiological intracytoplasmic sperm injection (PICSI), intracytoplasmic morphologically selected sperm injection (IMSI), testicular sperm extraction (TESE)/testicular sperm aspiration (TESA), frequent ejaculation] was performed. High SDF patients who did not have an intervention had a lower fertilization rate and poorer clinical outcomes from blastocyst transfers as compared with low SDF patients; the fertilization rate was 66.0% vs. 70.2% (p=0.042), single embryo transfer (SET) fetal heart pregnancy rate was 28.5% vs. 45.2% (p=0.042), and SET live birth rate was 24.9% vs. 40.6% (p=0.060), respectively. Furthermore, high SDF patients who had an intervention had significantly improved blastocyst transfer outcomes, similar to those of low SDF patients; the SET live birth rate for high SDF intervention patients was 43.8% as compared with 24.9% for high SDF no intervention patients (p=0.037) and 40.6% for low SDF patients (p=0.446). Analysis of the three main intervention subgroups for high SDF patients revealed that TESE/TESA patients had the highest SET live birth rate; in comparison with 24.2% for high SDF patients who did not have an intervention, PICSI patients had 38.3% (p=0.151), IMSI patients had 28.7% (p=0.680), and TESE/TESA patients had 49.8% (p=0.020). Our data suggest that SDF results indicate ICSI outcomes and that patients who have high SDF benefit from an intervention.

Coasting, embryo development and outcomes of blastocyst transfer: a case–control study

This study compared the effect on blastocyst development and clinical outcome of coasting in women at increased risk of moderate–severe ovarian hyperstimulation syndrome (OHSS; n = 389) with a control group matched for age and basal FSH that did not undergo coasting (n = 386) in IVF/intracytoplasmic sperm injection (ICSI) cycles. The main outcome measures were rate of blastocyst development and live birth. More cycles progressed to the blastocyst stage in the coasted group (n = 169) compared with the control group (n = 83; 43.4% versus 21.5%; P < 0.001). The biochemical pregnancy, clinical pregnancy and live birth rates were similar (46.5% versus 42.0%; 40.6% versus 37.8%; 31.6% versus 30.1%). The duration of coasting up to 4 days did not affect progression to blastocyst stage. The multivariate model showed that coasting (OR 1.73, P = 0.004) and the number of oocytes retrieved (OR 1.17, P = 0.001) were positively correlated with blastocyst formation. Coasting, a measure to reduce the risk of OHSS, does not impair blastocyst development or clinical outcome. Coasting should remain an effective measure to prevent OHSS.

Significance of endometrial stripe thickness (EST) in programmed frozen thawed blastocyst transfer outcomes

While previous studies linking EST and transfer outcomes have focused on the transfer of cleavage stage embryos, we wished to examine the relationship between EST and the outcomes of medicated frozen-thawed blastocyst (BL) transfer cycles.

Clinical outcomes of blastocyst transfer using a single culture medium

Blastocyst stage transfer requires that the in vitro environment of the embryo is optimized to support growth. Cultivation of human blastocysts in simple medium from Day 1-3, followed by culture in more complex media has been advocated for optimal blastocyst culture and successful day 5 transers. This study presents our experience with the use of a single culture medium from Day 1-6 for the generation of high quality blastocysts.

P-925: The effect of pre-implantation genetic diagnosis on day 5 vs. day 6 embryo transfer outcomes

To determine the effect of Pre-implantaion Genetic Diagnosis (PGD) on pregnancy rate as it relates to day 5 and day 6 blastocyst transfer outcomes. A retrospective clinical analysis of patients undergoing PGD with subsequent blastocyst transfer on day 5 or day 6 after oocyte retrieval. 199 completed cycles of patients undergoing in vitro fertilization - embryo transfer (IVF-ET) with controlled ovarian hyperstimulation (COH) were reviewed. 78 cycles of women undergoing in-vitro fertilization-embryo transfer with preimplantation genetic diagnosis from January 1, 2005 to January 1, 2006 were analyzed for pregnancy rates. An additional 121 cycles of IVF-ET without PGD and subsequent day 5 or day 6 blastocyst transfers were used as controls. Pregnancy was defined as the presence of positive serum beta hCG two weeks after embryo transfer. The difference in mean age between the two groups was analyzed using the unpaired student t test. Patients were further stratified according to day of blastocyst transfer. Fisher’s exact test was used to analyze data and determine if a significant difference exists. Mean age of patients with PGD and without PGD : 37.53 vs 36.62 respectively; p = 0.2649 PGD embyos: PR 62% vs 64% for D5 and D6 respectively; p = 1.00 Non-PGD embryos: PR 73% vs 62% for D5 and D6 respectively; p = .2420 Day 5 embryos: PR 62% vs 73% for PGD vs non-PGD respectively; p = .2813 Day 6 embryos: PR 64% vs 62% for PGD vs non-PGD respectively; p = 1.00. Whereas the advantages of preimplantation genetic diagnosis are sometimes clear, the effects on pregnancy rate based on day of transfer are not so obvious. Although not statistically significant, there is a trend towards a poorer pregnancy rate with embryos undergoing PGD transferred on day 5 compared to day 5 embryos that had not undergone PGD. Furthermore, there does not appear to be an additional benefit by transferring PGD-embryos on day 6 rather than day 5. Therefore, his study has illuminated one of the drawbacks of patients undergoing PGD without a true clinical indication.

P-253: Analysis of pregnancy outcome following blastocyst transfer

With the advent of more physiological culture conditions, blastocyst transfer has become a routine procedure in human IVF. Here we analyze the outcome of blastocyst transfer using one sequential media system, G III Series media, over a four year period, 2001 to 2005.

P-929: Comparison of two different treatment options for implantation failure patients: Preimplantation genetic diagnosis versus blastocyst transfer

Implantation failure is a complex condition which might involve different aetiologies. At the IVF setting, different treatment options such as blastocyst transfer, preimplantation genetic diagnosis (PGD), and fragment removal in embryos have been proposed for the treatment of this complex condition. We have compared the clinical outcome of blastocyst transfer with and without PGD in an embryo co-culture system.

Reducing the Risk of Multi-Fetal Gestation by Implementation of a Single Blastocyst Transfer Policy

Retrospective analysis of blastocyst transfer outcomes at our program revealed that patients transferring two good or excellent quality blastocysts had a high incidence of multi-fetal gestation (65% of all clinical pregnancies). To reduce the risk of multi-fetal gestation after blastocyst transfer, we implemented a single blastocyst transfer policy (SBT-P) on June 1, 2004. This study evaluates the effect of our SBT-P on blastocyst transfer outcomes.

Expectations for Blastocyst Cryopreservation and Frozen-Thawed Blastocyst Transfer Outcomes

Patients increasingly inquire about their prospects of cryopreservation and expected outcomes with their frozen embryos when embarking on an IVF cycle. Many patients contemplate their cumulative clinical outcome for an IVF cycle and demand a realistic answer regarding their potential to have cryopreserved embryos and expected outcomes if the current fresh IVF cycle does not result in a viable pregnancy. Two major factors that may affect these outcomes are patient age and ovarian response (Rodriguez et al., 2000).