IVF Treatment Cycles Research Articles

Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval

To evaluate a single treatment center's experience with autologous IVF using vitrified and warmed oocytes, including fertilization, embryonic development, pregnancy, and birth outcomes, and to estimate the likelihood of live birth of at least one, two, or three children according to the number of mature oocytes cryopreserved by elective fertility preservation patients. Retrospective cohort study. Private practice clinic. Women undergoing autologous IVF treatment using vitrified and warmed oocytes. Indications for oocyte vitrification included elective fertility preservation, desire to limit the number of oocytes inseminated and embryos created, and lack of available sperm on the day of oocyte retrieval. Oocyte vitrification, warming, and subsequent IVF treatment. Post-warming survival, fertilization, implantation, clinical pregnancy, and live birth rates. A total of 1,283 vitrified oocytes were warmed for 128 autologous IVF treatment cycles. Postthaw survival, fertilization, implantation, and birth rates were all comparable for the different oocyte cryopreservation indications; fertilization rates were also comparable to fresh autologous intracytoplasmic sperm injection cycles (70% vs. 72%). Implantation rates per embryo transferred (43% vs. 35%) and clinical pregnancy rates per transfer (57% vs. 44%) were significantly higher with vitrified-warmed compared with fresh oocytes. However, there was no statistically significant difference in live birth/ongoing pregnancy (39% vs. 35%). The overall vitrified-warmed oocyte to live born child efficiency was 6.4%. Treatment outcomes using autologous oocyte vitrification and warming are as good as cycles using fresh oocytes. These results are especially reassuring for infertile patients who must cryopreserve oocytes owing to unavailability of sperm or who wish to limit the number of oocytes inseminated. Age-associated estimates of oocyte to live-born child efficiencies are particularly useful in providing more explicit expectations regarding potential births for elective oocyte cryopreservation.

How do patient perceived determinants influence the decision-making process to accept or decline preimplantation genetic screening?

Identify the determinants that influence the patient's decision-making process when deciding to accept or decline preimplantation genetic screening (PGS) in a given IVF cycle. Pilot, retrospective, cross-sectional study that used a questionnaire containing a combination of quantitative and qualitative items. Private practice IVF clinic. Patients and partners initiating an IVF treatment cycle, both autologous and donor, between October 2012 and January 2015. None. Identification of patient perceived determinants and the importance of each on the decision to accept or decline PGS. Responses from the questionnaire (N = 117) were returned, and of these, 60% accepted PGS. The female response rate was 75% (N = 88) and the male response rate was 25% (N = 29). Ninety-eight percent were Christian (N = 112) and 88% college educated (N = 102) with 39% (N = 40) having some postgraduate education. Sixty-eight percent (N = 79) had no knowledge of PGS before the IVF cycle; however, after provider education, 92% (N = 108) correctly identified that PGS was elective and 93% (N = 109) reported sufficient knowledge to make an informed decision to accept or decline PGS. The additional cost of screening, the provider information and influence, and social support or acceptance from partner, family, and/or friends, were the three statistically significant variables affecting the decision. This is the first study, to the authors' knowledge, to identify and assess the determinants of the patient decision-making process when presented with the choice of PGS. Several factors contribute to the patient-perceived determinants when choosing to accept or decline PGS, including cost, religious and ethical beliefs and values, social and family support, provider influences, and the past reproductive experience of the patient.

Comparison of clinical pregnancy rates after single embryo transfer of day 5 versus day 6 euploid embryo

Comparison of clinical pregnancy rates after single embryo transfer of day 5 versus day 6 euploid embryo

Lessening the burden of care: stepped vs. fixed estradiol protocol for frozen embryo transfer

identify significance of multi-variables. RESULTS: Responses (N1⁄4117) were returned. The female rate was 66% (N1⁄488). The majority,98%, were Christian (N1⁄4112). The majority, 88%, were college educated (N1⁄4102) with 39% (N1⁄440) with some post-graduate education. Sixty-eight percent (N1⁄479) had no knowledge of PGS prior to their IVF cycle; however, after provider education, ninety-two percent (N1⁄4108) correctly identified that PGS was elective and 93% (N1⁄4109) reported their knowledgewas sufficient to make an informed decision to accept or decline PGS. The additional cost of screening (P1⁄40.004), the provider information and influence (P1⁄40.0001), and social support or acceptance from partner, family, friends (P1⁄40.03), were the three variables affecting the decision. In a logistical regression model, additional cost (P1⁄40.003) and explanation from the provider (P1⁄40.0003) were the only significant determinants influencing the decision. Religious and ethical beliefs were important (P1⁄40.20), but not statistically significant nor was information regarding the disposition of abnormal embryos (P1⁄40.18) or the concerns regarding cryopreservation and transfer at a later date (P1⁄40.79). CONCLUSIONS: PGS use as an adjuvant therapy to aid in selection of the embryo with the greatest potential for success, has become readily available inmany IVF clinics. Researchers have spent time, resources, and effort on the clinical benefits and limitations of PGS, yet little research on the patient perspective, knowledge, education, and awareness regarding the options and ultimate decision making capabilities of the patient. This is the first study to the authors knowledge to identify and assess the determinants of the patient decision making process when presented with the choice of PGS in a given IVF treatment cycle. Several factors contribute to the patient perceived determinants when choosing to accept or decline PGS, including cost, religious/ethical values, social influence, and the past experience of the patient.

Beliefs, values, knowledge, and perspectives: which determinants influence the patient to utilize preimplantation genetic screening (PGS)?

Clinics and patients are making decisions to utilize PGS. No studies have been published assessing the patient determinants considered to make the decision to use PGS. The purpose of this project is to identify the factors that influence the patient. Pilot, retrospective, cross-sectional study. An invitation, with a unique link, was emailed to patients and partners (N=266) who participated in autologous or donor IVF between October 2012-January 2015 at the study site. Content validity was Supported from four experts including an academic statistician, the medical director of the study site, an embryologist, and an academic nursing advisor.Univariate and chi-squared analysis was completed though the use of SPSS software program. A value of P=0.05 was the identifier for statistical significance. A logistical regression model was also utilized to identify significance of multi-variables. Responses (N=117) were returned. The female rate was 66% (N=88). The majority,98%, were Christian (N=112). The majority, 88%, were college educated (N=102) with 39% (N=40) with some post-graduate education. Sixty-eight percent (N=79) had no knowledge of PGS prior to their IVF cycle; however, after provider education, ninety-two percent (N=108) correctly identified that PGS was elective and 93% (N=109) reported their knowledge was sufficient to make an informed decision to accept or decline PGS. The additional cost of screening (P=0.004), the provider information and influence (P=0.0001), and social support or acceptance from partner, family, friends (P=0.03), were the three variables affecting the decision. In a logistical regression model, additional cost (P=0.003) and explanation from the provider (P=0.0003) were the only significant determinants influencing the decision. Religious and ethical beliefs were important (P=0.20), but not statistically significant nor was information regarding the disposition of abnormal embryos (P=0.18) or the concerns regarding cryopreservation and transfer at a later date (P=0.79). PGS use as an adjuvant therapy to aid in selection of the embryo with the greatest potential for success, has become readily available in many IVF clinics. Researchers have spent time, resources, and effort on the clinical benefits and limitations of PGS, yet little research on the patient perspective, knowledge, education, and awareness regarding the options and ultimate decision making capabilities of the patient. This is the first study to the authors knowledge to identify and assess the determinants of the patient decision making process when presented with the choice of PGS in a given IVF treatment cycle. Several factors contribute to the patient perceived determinants when choosing to accept or decline PGS, including cost, religious/ethical values, social influence, and the past experience of the patient.

Clinical outcome is not impaired by vitrification of all embryos in IVF treatment cycles

Clinical outcome is not impaired by vitrification of all embryos in IVF treatment cycles

Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study.

to compare the baseline characteristics and chance of live birth in the different categories of poor responders identified by the combinations of the Bologna criteria and establish whether these groups comprise a homogenous population. database containing clinical and laboratory information on IVF treatment cycles carried out at the Mother-Infant Department of the University Hospital of Modena between year 2007 and 2011 was analysed. This data was collected prospectively and recorded in the registered database of the fertility centre. Eight hundred and thirty women fulfilled the inclusion/ exclusion criteria of the study and 210 women fulfilled the Bologna criteria definition for poor ovarian response (POR). Five categories of poor responders were identified by different combinations of the Bologna criteria. There were no significant differences in female age, AFC, AMH, cycle cancellation rate and number of retrieved oocytes between the five groups. The live birth rate ranged between 5.5 and 7.4% and was not statistically different in the five different categories of women defined as poor responders according to the Bologna criteria. The study demonstrates that the different groups of poor responders based on the Bologna criteria have similar IVF outcomes. This information validates the Bologna criteria definition as women having a uniform poor prognosis and also demonstrates that the Bologna criteria poor responders in the various subgroups represent a homogenous population with similar pre-clinical and clinical outcomes.

Clinical significance of intercellular contact at the four-cell stage of human embryos, and the use of abnormal cleavage patterns to identify embryos with low implantation potential: a time-lapse study

To investigate the clinical significance of intercellular contact point (ICCP) in four-cell stage human embryos and the effectiveness of morphology and abnormal cleavage patterns in identifying embryos with low implantation potential. Retrospective cohort study. Private IVF center. A total of 223 consecutive IVF and intracytoplasmic sperm injection treatment cycles, with all resulting embryos cultured in the Embryoscope, and a subset of 207 cycles analyzed for ICCP number where good-quality four-cell embryos were available on day 2 (n = 373 IVF and n = 392 intracytoplasmic sperm injection embryos). None. Morphologic score on day 3, embryo morphokinetic parameters, incidence of abnormal biological events, and known implantation results. Of 765 good-quality four-cell embryos, 89 (11.6%) failed to achieve six ICCPs; 166 of 765 (21.7%) initially had fewer than six ICCPs but were able to establish six ICCPs before subsequent division. Embryos with fewer than six ICCPs at the end of four-cell stage had a lower implantation rate (5.0% vs. 38.5%), with lower embryology performance in both conventional and morphokinetic assessments, compared with embryos achieving six ICCPs by the end of four-cell stage. Deselecting embryos with poor morphology, direct cleavage, reverse cleavage, and fewer than six ICCPs at the four-cell stage led to a significantly improved implantation rate (33.6% vs. 22.4%). Embryos with fewer than six ICCPs at the end of the four-cell stage show compromised subsequent development and reduced implantation potential. Deselection of embryos with poor morphology and abnormal cleavage revealed via time-lapse imaging could provide the basis of a qualitative algorithm for embryo selection.

The updated Cochrane review 2014 on GnRH agonist trigger: repeating the same errors

Cochrane reviews are powerful tools, internationally recognized as the highest standard in evidence-based health care. A Cochrane analysis makes use of precise, reproducible criteria in the selection of studies for review. In the context of a previous Cochrane review (2010) on the subject of gonadotrophin-releasing hormone agonist (GnRHa) trigger, we questioned whether a review should be conducted during the research phase when new concepts are being developed. Recently, an updated Cochrane review was published, reaching the same general conclusion as the first one, i.e., GnRHa triggers lower the chance of pregnancy in fresh autologous IVF and intracytoplasmic injection treatment cycles. We argue that the new review repeats previous errors by compiling data from studies that were not comparable as different luteal phase protocols were used. From the clinical point of view, the luteal support used is the variable which affects the pregnancy rate and not the use of the GnRHa trigger for final oocyte maturation. Therefore, a meaningful comparison between GnRHa and HCG trigger must be confined to outcome measures that are not affected by the luteal support used. We conclude that the updated review falls short of addressing meaningful clinical and fundamental questions in the context of GnRHa trigger.

Clinical Pregnancy Rate after Single Euploid Embryo Transfer is Age Independent

BackgroundSingle embryo transfer (SET) is a proven option to achieve high pregnancy rates in young patients [1]. Introduction of PCR-based preimplantation genetic testing (PGT) can become a basis to expand SET to the older patient population. Precise evaluation of the genetic status of embryos should facilitate accurate embryo selection for the transfer [2].ObjectiveThe purpose of this study was to compare pregnancy rates after SET for patients under 38 y.o. and over 38 y.o. in PGT cycles.DesignA retrospective study of SNP PGT pregnancy outcome data from single embryo transfers was conducted to identify differences in clinical pregnancy for patients <38 y.o. and ≥38 y.o.Materials and Methods140 cycles of IVF treatment with PGT between January 2013 and June 2014 were included in the study. In all cases only one euploid embryo was selected for transfer. 63 IVF cycles (53 patients) were included in the young (<38 y.o.) patient group (average age - 33.45±3.31) and 77 IVF cycles (72 patients) in the older (≥38 y.o.) patient age group (average age - 40.22±1.85). The average number of embryos available for biopsy per case in the group of patient <38 y.o. was significantly higher than in the group of for patients ≥38 y.o.: 6.63±2.39 and 3.96±1.91 respectively, p<0.05.ResultsThe clinical pregnancy rate for patients <38 y.o. was 52.4% (33/63). The clinical pregnancy rate for patients ≥38 y.o. was 54.6%, (42/77). The difference in pregnancy rate between two groups was not statistically significant: p=0.968, χ2=0.065. 60 out of 63 SETs in the young patient group were elective SETs (two or more euploid embryos were available for transfer), while in the older patient group only 47 out of 77 SETs were elective SETs. Euploidy rate was statistically higher in young patient group than in older patient group: 55.14% and 38.35% respectively (p<0.05, χ2= 28.284).ConclusionsAnalysis of the data proved effectiveness of preimplantation genetic testing for infertile patients of advanced maternal age. Single embryo transfer in PGT cases can significantly decrease multiple gestation rate without compromising clinical pregnancy rate regardless of patient age.SupportNone.

Diagnostic Ambiguity and Psychosocial Distress among Chinese Women with Idiopathic and Non-Idiopathic Infertility

The aim of this study is to investigate how women with different diagnoses on their cause of infertility—non-idiopathic (female, male, mixed), or idiopathic (unknown causes)—display different levels of psychosocial well-being prior to their IVF treatment. Women who attended an assisted reproduction clinic were recruited to fill out a set of questionnaire about 3 months before the start of their first IVF treatment cycle (valid N = 330). Measures included anxiety, somatic, emotional, and spiritual distress, as well as marital satisfaction. Somatic distress was found to be highest among women without a known cause of infertility. Women with mixed-factor diagnosis reported significantly lower emotional distress. Spiritual distress was found to be the highest in female-factor infertility group. Results remained significant after controlling for marital satisfaction. The current findings suggest that facing infertility whose cause is unexplained, women may express their distress through somatic complaints. Whe...

Does bariatric surgery improve ovarian stimulation characteristics, oocyte yield, or embryo quality?

BackgroundObesity is a major global health concern associated with multiple co-morbidities. Bariatric surgery has been considered a good treatment option in cases of morbid obesity. This preliminary study aims to investigate the effect of bariatric surgery on ovarian stimulation characteristics and IVF treatment cycle outcome.MethodsA retrospective study that was performed in a tertiary, university-affiliated medical center and included all patients who underwent IVF treatment both before and after bariatric surgery. Data on ovarian stimulation variables of IVF treatment cycle prior and following the bariatric surgery were reviewed and compared.ResultsFrom January 2005 to June 2014, seven women fulfilled the inclusion criteria. After the operation, BMI was significantly reduced (mean ± SD) (43.1 ± 3.3 vs. 29.6 ± 7.33, p = 0.018), as was the number of gonadotropin ampoules required during stimulation (69.3 ± 10.5 vs. 44.5 ± 17, p = 0.043). No between-cycle differences were observed in peak estradiol level, the number of oocytes retrieved, and percentage of mature oocytes.ConclusionsTo the best of our knowledge, this preliminary case series is the first comparison of IVF cycle characteristics prior to and following bariatric surgery. The operation seems to reduce treatment costs without affecting oocyte or embryo quality. Further large studies are required to establish the surgery’s effect on IVF outcome among infertile women.

Age-specific drop-out rates following minimal ovarian stimulation and natural cycle IVF: analysis of a 3-year cohort involving 2876 treatment cycles from a single, Japanese center

Currently there is a lack of published studies (Verberg et al, 2008) evaluating treatment discontinuation following the use of mild IVF approaches. We aimed to calculate overall and age-specific drop-out rates in a large cohort of mild IVF treatment cycles from our center.

The effect of progesterone level prior to oocyte retrieval on the numbers of oocytes retrieved and embryo quality in IVF treatment cycles: an analysis of 2,978 cycles.

The study was designed to evaluate the relationship between serum progesterone (P4) response after hCG administration and the number of oocytes retrieved and the embryo quality in fresh IVF cycles. We conducted a retrospective cohort study of women aged 24-43 years who underwent first fresh IVF cycle from 2011 to 2013 at a single practice. We compared the post-hCG serum P4 level with values on the day of hCG trigger. Patients were analyzed in long and short protocols independently. In addition, patients were stratified by post-hCG P4 response. Number of oocytes retrieved and embryo quality were the primary outcomes of interest. Ordinary least square regression models and logistic regression analysis models were created to identify predictive factors associated with embryological outcomes while adjusting for potential confounders. Among the 2,978 IVF cycles, 2,484 patients were in long protocols, and 494 patients were in short protocols. After adjusting for patient age, rFSH duration, and basal FSH levels, the associations between P4 response after hCG administration and number of oocytes retrieved (P < 0.001) remained statistically significant in both long and short protocols. Additionally, mature oocyte rate, fertilization rate, good quality embryo rate, pregnancy rate and implantation rate were not significantly associated with the P4 increase when adjusting for the same factors. However, pregnancy rate and implantation rate from frozen-thawed cycles increased gradually across the seven groups. Post-hCG P4 levels were positively associated with the number of oocytes retrieved, but did not affect oocyte or embryo quality. Our study suggests that the change in the post-hCG P4 level is another parameter that can be used by clinicians to assess the number of oocytes retrieved, and may further to estimate the pregnancy rate and live birth rate indirectly.

Do Multiple Attempts at Embryo Transfer Affect Clinical Pregnancy Rates?

ObjectiveDuring an in vitro fertilization treatment cycle, having embryos retained in the catheter after embryo transfer is a relatively uncommon and frustrating event. The reported incidence of retained embryos varies between 1% and 8%. It can be difficult to explain this unwanted event to patients. We wished to determine the incidence and the effect on pregnancy rates of having embryos retained in the transfer catheter, followed by immediate completion of transfer. MethodsWe performed a retrospective chart review of all IVF cycles with embryos retained in the transfer catheter, followed by repeat transfer, between October 2009 and March 2012. We reviewed IVF cycles with or without ICSI, and included fresh and frozen embryo transfer cycles. All embryos were transferred on the third day after oocyte retrieval. Transabdominal ultrasound was used for guidance during the embryo transfer. ResultsA total of 49 IVF treatment cycles with retained embryos that required re-transfer were identified. This represented 7.5% (49/652) of all IVF cycles with embryo transfer during that period. The clinical pregnancy rate in the repeat transfer group was 30.6% (15/49). The clinical pregnancy rate in all cycles in the same time period was 34.8% (227/652). These rates were not significantly different (P = 0.521). ConclusionHaving to re-transfer embryos retained in the transfer catheter does not have any significant effect on clinical pregnancy rates during IVF treatment cycles.

What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization

To identify the incidence, risk factors, and obstetric/perinatal outcomes associated with monozygotic twins (MZTs) after IVF. Nested case-control. University-based center. The IVF cycles eventuating in pregnancy from 2000-2009. None. The MZT incidence, chorionicity/zygosity, pregnancy/neonatal outcome. Of 6,223 gestations, 131 MZTs were diagnosed (2.1% incidence; 2.0% in autologous and 2.7% in donor IVF cycles), 10 were dichorionic, and 121 were monochorionic. Controlling for all risk factors, young oocyte age, extended culture (noncleavage embryos transferred on/after day 4), and year of IVF treatment cycle were significantly associated with MZT. When assessing factors associated with specific MZT placentation, day 3 assisted hatching correlated more with dichorionic MZT, whereas extended culture and advanced day 5 embryonic stage correlated with monochorionic MZT. Comparing monozygotic to dizygotic multigestation outcomes, MZT fared worse; however, once controlling for triplet gestation, only gestational age at delivery remained significantly compromised in the monozygotic group. After IVF the incidence of MZT is high, with young oocyte age, year of treatment, and extended culture (or embryo stage at transfer) conferring greatest risk. Regarding MZT type, assisted reproductive technology (ART) procedures may influence the timing of embryonic splitting (i.e., division in early embryonic development may be influenced by zona pellucida [ZP] manipulation whereas later splitting may occur during delayed implantation). Poor obstetric/perinatal outcome is significantly impacted by the presence of an "extra" fetus, as high-order multiple gestation concurrent with an MZT conveyed the worst prognosis.

Universal coverage of IVF pays off

What was the clinical and economic impact of universal coverage of IVF in Quebec, Canada, during the first calendar year of implementation of the public IVF programme? Universal coverage of IVF increased access to IVF treatment, decreased the multiple pregnancy rate and decreased the cost per live birth, despite increased costs per cycle. Public funding of IVF assures equality of access to IVF and decreases multiple pregnancies resulting from this treatment. Public IVF programmes usually mandate a predominant SET policy, the most effective approach for reducing the incidence of multiple pregnancies. This prospective comparative cohort study involved 7364 IVF cycles performed in Quebec during 2009 and 2011 and included an economic analysis. IVF cycles performed in the five centres offering IVF treatment in Quebec during 2009, before implementation of the public IVF programme, were compared with cycles performed at the same centres during 2011, the first full calendar year following implementation of the programme. Data were obtained from the Canadian Assisted Reproductive Technologies Register (CARTR). Comparisons were made between the two periods in terms of utilization, pregnancy rates, multiple pregnancy rates and costs. The number of IVF cycles performed in Quebec increased by 192% after the new policy was implemented. Elective single-embryo transfer was performed in 1.6% of the cycles during Period I (2009), and increased to 31.6% during Period II (2011) (P < 0.001). Although the clinical pregnancy rate per embryo transfer was lower in 2011 than in 2009 (24.9 versus 39.9%, P < 0.001), the multiple pregnancy rate was greatly reduced (6.4 versus 29.4%, P < 0.001). The public IVF programme increased government costs per IVF treatment cycle from CAD$3730 to CAD$4759. Despite increased costs per cycle, the efficiency defined by the cost per live birth, which factored in downstream health costs up to 1 year post delivery, decreased from CAD$49 517 to CAD$43 362 per baby conceived by either fresh and frozen cycles. The costs described in the economic model are likely an underestimate as they do not factor in many of the long-term costs that can occur after 1 year of age. The information collected in the Canadian ART register precludes the calculation of cumulative pregnancy rates. Our study confirms that the implementation of a public IVF programme favouring eSET not only sharply decreases the incidence of multiple pregnancy, but also reduces the cost per live birth. M.P.V. holds a fellowship award from the Canadian Institutes of Health Research (CIHR). The economic analysis performed by M.P.C. was supported by an unrestricted grant from Ferring Pharmaceutical.

Association between response to ovarian stimulation and miscarriage following IVF: an analysis of 124 351 IVF pregnancies

Is there a relationship between ovarian reserve, quantified as ovarian response to stimulation, and miscarriage rate following IVF treatment? There is a strong association between the number of oocytes retrieved and miscarriage rate following IVF treatment, with the miscarriage rate decreasing with an increasing number of oocytes and then levelling off: poor responders have a higher miscarriage rate across all age groups. Poor ovarian response is a manifestation of a decline in the quantity of the primordial follicle pool. Whether poor ovarian response is associated with a decline in oocyte quality contributing to miscarriage is however debated. Anonymous data were obtained from the Human Fertilization and Embryology Authority (HFEA), the statutory regulator of assisted reproduction treatment (ART) in the UK. The HFEA has collected data on all ART performed in the UK since 1991. Data from 1991 to June 2008 involving 402 185 stimulated fresh IVF cycles and 124 351 pregnancy outcomes were analysed. Data on all women undergoing a stimulated fresh IVF treatment cycle with at least one oocyte retrieved during the period from 1991 to June 2008 were analysed for their early pregnancy outcomes. There was a strong association between the number of oocytes retrieved and the clinical miscarriage rate. The miscarriage rate fell from 20 to 13% with an increasing number of oocytes before levelling off. Stepwise logistic regression identified three cut-off points (4, 10 and 15 oocytes) at or beyond which the probability of clinical miscarriage fell. There was no increase in miscarriage rate with very high oocyte numbers (>20 oocytes). The lowest risk of miscarriage (9.9%) was for women under 38 years of age, with primary infertility without a female cause and producing more than three oocytes. Although the analysis was performed only on stimulated IVF cycles (excluding unstimulated cycles), the data had the limitation that there was no information on the total gonadotrophin consumption. The model was adjusted for age and type of infertility, but the dataset contained no information on other confounders such as body mass index (BMI) of the women to allow adjustment. Analysis of this extensive dataset suggests that poor responders have a higher risk of clinical miscarriage, indicating that poor ovarian response is associated with a parallel decline in both oocyte quantity and quality. The miscarriage rate is also higher with advanced age, secondary infertility and a female cause of infertility compared with a younger age, male factor infertility and unexplained cause.

Role of baseline antral follicle count and anti-Mullerian hormone in the index stimulation cycle of IVF treatment in predicting outcome of subsequent frozen-thawed embryo transfers

This retrospective cohort study aims at determining whether baseline antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) level in the index stimulation cycle predict live-birth outcome in subsequent frozen-thawed embryo transfer (FET) cycles. We studied 500 women undergoing the first IVF cycle who had embryo(s) cryopreserved. The main outcome measures were live-birth in the first FET cycle and cumulative live-birth in all the FETs combined after the same stimulation cycle. Our results showed that baseline AFC and AMH level on the day before ovarian stimulation showed significant correlation. In the first FET cycle, AFC and AMH level were significantly higher in subjects attaining live-birth in the first FET cycle or cumulative live-birth from all FETs than those who did not. Both AMH and AFC were insignificant predictors of live-birth in the first FET cycle or cumulative live-birth after adjusting for age. The areas under the ROC curves for AMH, AFC and age were 0.654, 0.625 and 0.628, respectively, for predicting cumulative live-birth. In conclusion, we reported for the first time that baseline AFC and AMH in the index stimulation cycle have only modest predictive performance on cumulative live-birth in subsequent FET cycles.

Culture of Individually Required Number of 2-Pronuclei-Stage Oocytes - Patient Participation in Decision-Making is in Accordance with the Aim of Avoiding Surplus Embryo Freezing.

Background: The aim of this study was to evaluate how many embryos will develop if more than 3 2-pronuclei-stage oocytes (2-PNOs) are cultured at the patient's request and in accordance with the Germany Embryo Protection Law. Methods: A total of 106 cycles of patients undergoing their 1st, 2nd or 3rd cycle of IVF or ICSI treatment in 2010 were prospectively included in the study. In each individual case, a decision was taken prior to treatment about the number of 2-PNOs to be cultured after each cycle. Results: Ninety female patients were treated for a total of 106 cycles. A mean of two to six 2-PNOs were cultivated for a period of between 3 and 6 days for each patient. After culture, no viable embryo was identified for 5 patients (4.7 %), a single viable embryo was identified for 37 cycles (34.7 %), and 2 viable embryos were identified for 52 cycles (48.8 %). Eleven patients (10.3 %) had 3 viable embryos after a further 11 cycles and 1 patient had 4 viable embryos in a single cycle. Ten of the patients with 3 embryos each opted to have all 3 embryos transferred in the same cycle. This meant that a single embryo from one patient with 3 viable embryos and a single embryo of the patient with 4 viable embryos were cryopreserved after culture. The pregnancy rate was 19 % per embryo transfer and 25 % per blastocyst transfer (20 pregnancies in total). All cryopreserved embryos were transferred in a subsequent cycle. Discussion: Based on this study it is possible to make a statement about the number of viable embryos which should be cultivated to obtain, at best, two embryos for transfer without running an unacceptably high risk of producing too many embryos which would then need to be cryopreserved. Only 12 patients (13.3 %) had more than 2 viable embryos. The number of supernumerary pre-implantation-stage embryos was acceptably low (only 2 patients had additional viable embryos, 2.2 %). This means that it is possible to fulfil the wishes of individual patients while complying with the German Embryo Protection Law.