Time Of Embryo Transfer Research Articles

Comparison of early development in utero of cloned fetuses derived from bovine fetal fibroblasts at the G1 and G0/G1 phases

In bovine somatic cell nuclear transfer (NT), embryos are more likely to develop to full term when they are derived from fibroblasts at the G1 phase instead of cells at the G0/G1 phase. To better understand the reason for this difference, we examined morphological development in the early pregnancy of NT embryos using G1 phase cells (G1-NT embryos) and G0/G1 phase cells (G0/G1-NT embryos). Blastocysts derived from G1 and G0/G1-NT embryos were transferred to recipient heifers, and the conceptuses at day 50 of gestation were retrieved non-surgically using prostaglandin F 2α and oxytocin. In vitro-fertilized (IVF), parthenogenetic and artificially inseminated (AI) embryos were used as controls. The percentages of embryos that developed to the blastocyst stage did not differ between G1 and G0/G1-NT embryos. Pregnancy rates at day 30 of recipient heifers carrying G1-NT, G0/G1-NT, IVF, parthenogenetic and AI embryos were similar (57–100%). Two recipient heifers carrying parthenogenetic embryos returned to estrus between days 30 and 50 of gestation, whereas all other pregnancies remained viable. Most fetuses at day 50 of gestation of all experimental groups (83%) were recovered non-surgically by several PGF 2α and oxytocin treatments. Recovery rates of normal fetuses derived from G1-NT embryos (83%), IVF embryos (80%) and AI embryos (88%) were greater than those of G0/G1-NT embryos (33%) and parthenogenetic embryos (0%). Our results suggest that NT embryos reconstructed with cells at the G1 phase have a high developmental competence from the time of embryo transfer to day 50 of gestation.

Intrauterine inoculation of seronegative heifers with bovine viral diarrhea virus concurrent with transfer of in vivo–derived bovine embryos

Bovine viral diarrhea virus (BVDV) has been shown to be associated with single transferable in vivo–derived bovine embryos despite washing and trypsin treatment. Hence, the primary objective was to evaluate the potential of BVDV to be transmitted via the intrauterine route at the time of embryo transfer. In vivo–derived bovine embryos (n = 10) were nonsurgically collected from a single Bos tarus donor cow negative for BVDV. After collection and washing, embryos were placed into transfer media containing BVDV (SD-1; Type 1a). Each of the 10 embryos was individually loaded into an 0.25-mL straw, which was then nonsurgically transferred into the uterus of 1 of the 10 seronegative recipients on Day 0. The total quantity of virus transferred into the uterus of each of the 10 Bos tarus recipients was 878 cell culture infective doses to the 50% end point (CCID 50)/mL. Additionally, control heifers received 1.5 × 10 6 CCID 50 BVDV/.5 mL without an embryo (positive) or heat-inactivated BVDV (negative). The positive control heifer and all 10 recipients of virus-exposed embryos exhibited viremia by Day 6 and seroconverted by Day 15 after transfer. The negative control heifer did not exhibit a viremia or seroconvert. At 30 d after embryo transfer, 6 of 10 heifers in the treatment group were pregnant; however, 30 d later, only one was still pregnant. This fetus was nonviable and was positive for BVDV. In conclusion, the quantity of BVDV associated with bovine embryos after in vitro exposure can result in viremia and seroconversion of seronegative recipients after transfer into the uterus during diestrus.

Efficacy of luteal supplementation of vaginal sildenafil and oral estrogen on pregnancy rate following IVF-ET in women with a history of thin endometria: A pilot study

Objective: The several strategies for unexplained thin endometrium are under debate. We evaluated the effect of concomitant administration of vaginal sildenafil and oral estrogen in women with a thin endometrium undergoing in vitro fertilization (IVF). Methods: Forty-eight women showing thin endometrium less than 8 mm at the time of embryo transfer were randomly assigned to the study (n=21) and control group (n=27) in their subsequent IVF cycles. Routine luteal support was made by vaginal micronized progesterone 600 mg/day. In the study group, oral estradiol valerate 4 mg/day + vaginal sildenafil 25 mg/day was administered from the day of embryo transfer. Results: The clinical pregnancy rate was two-fold higher in the study group, although it was not statistically significant (47.6% vs. 25.9%, P=0.209). Conclusion: Our study supports that luteal administration of vaginal sildenafil and oral estrogen has modest beneficial impact on the uterine receptivity.

The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: A pilot study

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center. 57 infertile patients undergoing IVF or IVF/ICSI. Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care. Perceive Stress Scale scores, pregnancy rates. women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased their perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status. The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

97 BOER GOAT OFFSPRING BORN FOLLOWING TRANSFER OF CRYOPRESERVED EMBRYOS

Cryopreservation of embryos is an important technique in the whole MOET program, which could help improve the transportation of genetic material across South Africa and globally. This trial evaluated the survival rate of goat embryos following transfer with cryopreserved Boer goat embryos. Twenty-seven multiparous Boer goat recipients were synchronized with CIDR for 16 days and injected with 300 IU of eCG at CIDR withdrawal. The recipients were allocated into 3 groups (n = 9). Group 1 received fresh embryos; Group 2 received slow frozen embryos; and Group 3 received vitrified embryos. Expanded blastocysts used were surgically collected from donors superovulated with pFSH on 7 following AI. Two blastocysts were transferred laparoscopically to the uterine horn ipsilateral to functional CL. A pregnancy rate of 85.7% (6) was obtained following the transfer of fresh embryos and tended to be better than in the does receiving slow frozen and vitrified embryos, (n = 4; 50.0% and n = 3; 37.5% does pregnant, respectively) with no significant differences. The kidding rate of the recipient does declined to 57.0% (4) and 25.0% (2) for fresh and slow frozen groups, respectively. The embryo survival rate of 35.7% (n = 5) for fresh, 25.0% (n = 4) for conventional slow freezing and 31.3% (n = 5) for vitrification was obtained and was not affected by the number of CL present on the respective ovaries at the time of embryo transfer. Although the pregnancy rate following the transfer of fresh embryos was satisfactory, the embryo survival rate following the transfer of fresh or cryopreserved embryos tended to be lower. The authors acknowledge the University of the Free State for financial and facility support and National Research Foundation (Thuthuka) for financial support for conducting this trial.

First Irish delivery following sequential, two-stage embryo and blastocyst transfer

BackgroundThe timing of embryo transfer (ET) after in vitro fertilisation (IVF) remains controversial, and there are no reliable guidelines available to prospectively identify which patients would benefit from either day-3 or blastocyst transfer. While blastocyst transfer is generally favoured over day-3 transfers, very few IVF patients get both in the same treatment cycle.Case descriptionWe report on a 35.5-year-old female with tubal factor infertility who underwent IVF, which included transfer of a fresh day-3 embryo and a thawed blastocyst frozen at day 6. Transfer occurred on two separate days (days 3 and 6) in a two-stage/dual catheter fashion and resulted in a healthy term singleton livebirth.ConclusionsWhile combined day-3 and day-5 ET has been available elsewhere for several years, this is the first description of its successful application in Ireland and confirms the effectiveness of coordinated two-stage transfer in a single IVF treatment cycle.

The impact of acupuncture on assisted reproductive technology outcome

To evaluate the impact of acupuncture on the outcome of in-vitro fertilization treatment using data from published randomized studies. The main outcome measure of interest is the clinical pregnancy rate. Fourteen relevant trials including 2870 women were examined. Significant clinical and statistical heterogeneity were encountered among the studies. Five trials (n = 877) evaluated in-vitro fertilization outcome when acupuncture was performed around the time of oocyte retrieval and found no difference in the clinical pregnancy rate between the two groups [relative risk (RR) = 1.06, 95% confidence interval (CI) 0.82-1.37, P = 0.65]. Likewise, nine trials (n = 1993) reported in-vitro fertilization outcome when acupuncture was performed around the time of embryo transfer and showed no significant difference in the clinical pregnancy rate (RR = 1.16, 95% CI 0.92-1.48, P = 0.22). Currently available literature does not provide sufficient evidence that adjuvant acupuncture, whether performed at the time of oocyte retrieval or embryo transfer, improves in-vitro fertilization outcome. On the basis of this evidence, acupuncture should not be recommended during in-vitro fertilization to increase its success rate.

Fluctuation in anandamide levels from ovulation to early pregnancy in in-vitro fertilization-embryo transfer women, and its hormonal regulation

Low levels of plasma arachidonoylethanolamide (anandamide) (AEA) (<2 nM) are associated with a successful early pregnancy in the mouse, and are thought to be regulated by sex steroid hormones. A similar association in the human may exist, although it has never been studied. The objective of this study was to investigate plasma AEA concentrations from the time of ovulation to implantation in pregnant and non-pregnant women, and whether AEA is hormonally regulated. Women who had undergone IVF/ICSI-embryo transfer were divided into pregnant (n = 12) and non-pregnant (n = 12) groups, based on serum beta-hCG >5 IU at 4 weeks and a viable intrauterine singleton pregnancy confirmed by ultrasound at 6 weeks gestation. Blood samples for plasma AEA and sex steroid hormonal measurements were taken at the time of oocyte collection, embryo transfer and pregnancy test, and an extra sample was also taken from the pregnant group at the viability ultrasound scan. In pregnant women, there was a significant initial decrease in plasma AEA levels from the day of oocyte retrieval to that of embryo transfer. In addition, in the viable pregnancy group, plasma AEA was high at 4 and 5 weeks gestation, and a decline was observed at 6 weeks gestation (P = 0.003). No correlations were seen between plasma AEA and serum estradiol (E2), progesterone (P4) or beta-hCG in pregnant women; however, there was a significant correlation between plasma AEA and E2 (P = 0.022), but not between plasma AEA and serum P4, in non-pregnant women. Our observations suggest that in successful pregnancy, a higher plasma AEA level at ovulation and a significantly lower level during implantation are required. The drop in AEA levels could be used as a biomarker for the appropriate timing of embryo transfer.

Semen analysis and seminal plasma

Semen analysis is routinely used to evaluate the male partner in infertile couples. Unfortunately, sperm measurements that discriminate between fertile and infertile men are not well defined. Treatment decisions should therefore not be based exclusively on semen analysis, except for those cases with very poor sperm parameters. Treatments such as intra-uterine insemination (IUI) or intracytoplasmic sperm injection (ICSI) can usually be performed with sufficient pregnancy rates. In couples in which even ICSI fails, intracytoplasmatic, morphogically selected sperm injection (IMSI) seems to be promising. Collecting a semen sample with high quality is always important for male patients in assisted reproduction technology (ART) programs. Sperm quality can be improved using simple methods, such as modifying sexual abstinence or collecting semen samples at home. There is new evidence that the use of seminal plasma in ART treatment may improve endometrial receptivity and consequently implantation. Sexual intercourse around the time of embryo transfer also seems to improve the clinical outcome of ART.

Comparison of survival rate of cleavage stage embryos produced from in vitro maturation cycles after slow freezing and after vitrification

Significantly more embryos survived the vitrification procedure compared to slow freezing (85.5% vs. 61.8%) in cleavage-stage human embryos produced from in vitro maturation cycles, suggesting that vitrification is more efficient than slow freezing for cryopreservation.

Reproductive efficiency of women over the age of 40 and the low risk of multiple pregnancies

Infertile patients over the age of 40 are generally considered to have a low chance of success with assisted cycles despite high numbers of embryos transferred. The risk of multiple pregnancy in this group of patients is not well established. The present study determined the rate of embryos that fail to produce a live birth and the rate of multiple pregnancies in a cohort of women over the age of 40 undergoing IVF/intracytoplasmic sperm injection cycles, utilizing Society for Assisted Reproductive Technology reported cycle outcomes from national summaries as well as from two university-based IVF centres. The rate of embryo wastage for women over the age of 40 is approximately 95% and these women have a correspondingly low rate of multiple pregnancy per cycle started (2.5% and 1.6% for women aged 41–42 years and 43–44 years, respectively). These data underscore the low reproductive efficiency of oocytes in women over the age of 40 and the very low probability of a multiple-gestation live birth despite the high number of embryos transferred. This information is an important additional counselling tool at the time of embryo transfer in this group of patients.

Low-dose aspirin and uterine haemodynamics on the day of embryo transfer in women undergoing IVF/ICSI: a randomized, placebo-controlled, double-blind study

Increased uterine artery (UtA) vascular impedance at the time of embryo transfer can decrease implantation and pregnancy rates in women undergoing IVF/ICSI. We hypothesized that low-dose aspirin decreases UtA vascular impedance on the day of embryo transfer in unselected IVF/ICSI patients when medication is started concomitantly with controlled ovarian stimulation. In addition, as secondary outcome measures, we investigated whether low-dose aspirin decreases the incidence of non-optimal (bilateral UtA PI > or = 3.0) uterine haemodynamics and whether it affects arcuate, radial and spiral artery vascular impedances and endometrial thickness. A total of 122 women who underwent IVF/ICSI were randomized to receive 100 mg aspirin (n = 61) or placebo (n = 61) daily, starting on the first day of gonadotrophin stimulation. Doppler ultrasonography was performed on the day of embryo transfer. Embryo transfer took place in 57 women in the aspirin group and in 56 women in the placebo group. UtA mean PI values did not differ significantly between the groups. The incidence of non-optimal uterine haemodynamics was lower in the aspirin group than in the placebo group (P = 0.03). Other secondary outcome measures did not differ between the groups. In unselected IVF/ICSI women, low-dose aspirin therapy, when started concomitantly with controlled ovarian stimulation, did not affect UtA vascular impedance on the day of embryo transfer. However, the incidence of non-optimal uterine haemodynamics was significantly lower in the aspirin group than in the placebo group. ClinicalTrials.gov: NCT00683202.

A randomized controlled study of human serum albumin and serum substitute supplement as protein supplements for IVF culture and the effect on live birth rates

It has been speculated that the addition of proteins more complex than human serum albumin (HSA) to culture media may improve IVF outcomes. Whether the expense, labor and risk of adding additional human-derived protein to IVF media are warranted is a question unanswered. In a randomized controlled trial with couples undergoing routine IVF or ICSI, 528 patients were assigned to one of two treatment groups. Embryos were cultured in either media supplemented with HSA as a solitary protein supplement or in media supplemented with HSA+serum substitute supplement (SSS) from the 2PN stage until the time of embryo transfer. Clinical end-points monitored included implantation (total 1151 embryos) and live birth rates (total 528 patients). The transfer of embryos cultured in HSA+SSS resulted in higher embryo implantation (289/571, 50.6% versus 254/580, 43.8%; difference 6.8% with 95% CI 1.0-12.7, P = 0.042) and live birth rates (167/266, 62.8% versus 142/262, 54.2%; difference 8.6% with 95% CI 0.1-17.3, P = 0.043) when compared with those of women whose embryos were cultured with HSA as the sole protein supplement. SSS added to commercial HSA-supplemented embryo culture media resulted in an overall increase in implantation and live birth rates. It remains uncertain whether the use of human-derived blood products in culture media and the requirement for ultra-rigorous quality control measures make these findings applicable to the average IVF laboratory. Protein enrichment of media may significantly improve the blastocyst implantation rate, creating opportunities to transfer single blastocysts without compromising the live birth rate. The study was registered at clinicaltrials.gov. NCT00708383.

Effect of powdered gloves, worn at the time of embryo transfer, on the pregnancy outcome of IVF cycles

To assess the effect of wearing powdered gloves during embryo transfer as compared to un-powdered gloves on the pregnancy outcome of IVF cycles. Patients, undergoing embryo transfer procedures, were prospectively randomized into two groups: In the first (group A, n=356) group embryo transfer was performed while wearing powdered gloves; in the second (group B, n=356) group embryo transfer was performed while wearing un-powdered gloves. The primary end point of the study was the clinical pregnancy rate. The two groups were comparable with respect to the mean age, mean number of grade one embryos obtained, and the mean number of embryos transferred. The clinical pregnancy rates of the two groups were not different. Powdered gloves, worn during embryo transfer, have no adverse effect on the pregnancy outcome of IVF cycles.

140 INTRAUTERINE INOCULATION OF CATTLE WITH BOVINE VIRAL DIARRHEA VIRUS SIMULTANEOUS TO TRANSFER OF IN VIVO-DERIVED BOVINE EMBRYOS

Bovine viral diarrhea virus (BVDV) has been shown to be associated with single transferable in vivo-derived and in vitro-produced bovine embryos despite washing. Hence, the primary objective of this study was to evaluate the potential of BVDV to be transmitted via the intrauterine route at the time of embryo transfer. A total of 10 in vivo-derived Day 7 bovine embryos were nonsurgically collected from a BVDV negative and seronegative donor cow. After collection, embryos were washed in accordance with the International Embryo Transfer Society (IETS) standards. Following washing, embryos were placed into transfer media containing BVDV (SD-1; type 1a). The embryos were immediately aspirated into 0.25-mL straws and transferred into seronegative recipients (Day 0). The total quantity of virus transferred into the uterus of each recipient was 900 to 1000 cell culture infective dose 50 (CCID50)/straw. This amount of virus was previously shown to be consistent with the average amount of BVDV associated with in vivo-derived and in vitro-produced embryos following standard IETS washing procedures after in vitro exposure to virus. The positive control heifer received 1.5 × 106 CCID50/straw of BVDV without an embryo. The negative control heifer received 1.5 × 106 CCID50/straw of heat-inactivated BVDV without an embryo. Serum and buffy coat samples were drawn from all heifers on Days 0, 3, 4, 6, 7, 8, 9, 10, 12, 15, and 30 after inoculation and analyzed for serum neutralizing antibodies and virus, respectively. The positive control heifer and all recipients of virus-exposed embryos exhibited viremia by Day 6 and seroconverted by Day 15. The negative control heifer did not exhibit viremia or seroconvert. All recipients receiving embryos were assessed for pregnancy using transrectal ultrasonography on Day 30 and 6 of 10 heifers were pregnant. On Day 60 the pregnant heifers were again assessed for pregnancy using transrectal ultrasonography. At this time only 1 of the 6 heifers was still pregnant. However, the fetus was determined to be nonviable and was removed via colpotomy. The fetus, fetal fluids and membranes were determined to be positive for BVDV via immunohistochemistry and PCR. Additionally, 213 base pairs of the 5′ nontranslated region of this PCR product were sequenced and found to be consistent with the inoculated strain. Results demonstrate that the average quantity of BVDV associated with bovine embryos after in vitro exposure and washing can result in viremia and seroconversion of seronegative recipients following transfer into the uterus during diestrus.

141 EFFECT OF ENVIRONMENTAL TEMPERATURE ON EMBRYO PRODUCTION AND CONCEPTION RATES IN BEEF AND DAIRY CATTLE

The aim of this study was to evaluate the effect of environmental temperature at the time of embryo collection and transfer on embryo quality and conception rates after transfer of fresh and frozen embryos. Purebred dairy (Holstein, Czech spotted cattle, n = 174) and beef (Charolais, Blonde d’Aquitaine, Piedmontese, Hereford, Limousin and Simmental; n = 72) donors were collected during 2005 to 2007. Donor cows received one application of PGF2α and superstimulation was initiated 9 to 11 days following estrus with pFSH (Folltropin-V; Bioniche Animal Health, Belleville, ON, Canada) given twice daily for 4 days. Prostaglandin2α was given on Day 3 of the superstimulation treatment. Donors were inseminated 3 times, with 1 unit of semen on Days 5 and 6 of treatment. Embryo recovery was carried out on Day 7 after insemination. The recipients were synchronized with PGF2α and embryos were transferred on Day 7 after estrus. The effect of temperature at the time of 246 embryo recoveries and 1338 transfers (fresh and frozen embryos) was analyzed using the GLM, assuming quasi-poisson and quasi-binomial error distribution by R software (www.r-project.org). We evaluated the total number of ova/embryos collected, embryo quality, and conception rates after transfer at the environmental temperatures shown below. Temperatures were divided into the following ranges: A) from –5 to 5°C; B) from 6 to 15°C; C) from 16 to 20°C; and D) over 20°C. The average temperature values were obtained from the Czech hydrometeorological institute and corresponded to the following seasons: winter (range A and B); spring (range B and C); summer (range C and D); fall (range C and B). Dairy cows were managed intensively in barns whereas beef cows were managed in barns during the winter and on pasture from April until October. In beef donors the mean number of total ova/embryos collected and transferable embryos were 9.1 ± 7.9 and 4.2 ± 4.5, respectively and no significant effect of temperature was detected (P &gt; 0.05). In dairy donors the mean number of total ova/embryos collected and transferable embryos were 7.9 ± 6.0 and 4.9 ± 4.5, respectively and no significant effect of temperature was detected (P = 0.27). Conception rate was greatest (P &lt; 0.001) in temperature range D (63.64%) compared with the other temperature ranges (A = 27.66%; B = 43.65%; C = 43.21%;) in beef cows and in the range C (65.31%) than in the other temperature ranges (A = 34.7%; B = 52.67%; D = 56.25%) in dairy cows. It was concluded that temperature at the time of embryo collection did not affect embryo production and quality. However, environmental temperature did have a significant effect on conception rates in both beef and dairy recipients. Nutritional status may also have contributed to the increased conception in beef cattle during warmer temperatures. However, the optimal period for conception in dairy cows was in temperature range from 16 to 20°C, because of the potential adverse effect of heat stress in high-yielding cows. Supported by MEYS CR MSM 2678846201, LA 330; NAZV 1B44034.

Successful vitrified oocyte donation program with blastocyst transfer. One year of follow up study in Mexico city

OBJECTIVE: Up to now few clinical data are available about large series of vitrified egg donation and there are a lot of doubts if the vitrification method affect spindle morphology, aberrant chromatin alignment or premature cortical granule releases that can be affect embryo development and pregnancy, implantation and/or miscarriage rates. Blastocyst development stage allow self selection from those embryos capable of blastulation and self exclusion from those which have a lack of embryonic development or arrestment. Our objective is to show that oocyte vitrification and the sequential culture is a good combination to have a success in a oocyte donation program with an oocyte bank. DESIGN: Retrospective and descriptive study. MATERIALS AND METHODS: We included sixteen patient's cycles receptors, done from May 2006 to December 2007. 30 oocytes donors were frozen by vitrificaction, and Sixten cycles were thawed. Donators were stimulated with conventional down regulation protocols. For this study a requirement was that all of the donors had a proven in vivo or in vitro fertility. Oocytes were retrieved by ultrasound-guided transvaginal aspiration and vitrified with the Cryotop method. 154 oocytes were thawed, and a mean of 7 oocytes MII were assigned for each recipient. The survived oocytes were inseminated by intracytoplasmic sperm injection. The zygotes were further cultured in vitro for up to 120 hours until time of embryo transfer, day 5 or 6 according to embryo development. RESULTS: The oocyte survival rate observed was 96.7%. Fertilization rate was 85,71%, day 2 cleavage (93,9%), day 3 cleavage (77,41%), and blastocyst development (41,6%). A total of 29 embryos were transferred on the 5th or 6th day. The media of embyos transferred were two. The refreezing rate by vitrification was (27,5 %) blastocyst, that are still frozen. Pregnancy, implantation and miscarriage rates, were 66,67%, 31,06%, and 22,22%, respectively. Our pregnancy, implantation and miscarriage rates in fresh egg donation are (70,55 %), (36,11 %) and (13,04 %) respectively. CONCLUSIONS: Excellent clinical outcome indicates the possibility to use of the egg donation program technology and establishes oocyte banking. The costs and time of this procedure are other benefits for patients waiting for oocytes. Sequential culture is a strategy to consider to selected embryos with a high potential implantation to transfer. More studies should be done to confirm these results.

A systematic review and meta‐analysis of acupuncture in in vitro fertilisation

Numerous randomised studies have reported pregnancy outcome in women who received acupuncture during their in vitro fertilisation (IVF) treatment cycle. The objective of this study was to conduct a systematic review with meta-analysis of the trials of acupuncture during IVF treatment on the outcomes of clinical pregnancy and live birth rates. Searches were conducted in MEDLINE, EMBASE, Cochrane Library, ISI Proceedings and SCISEARCH. All randomised controlled trials that evaluated the effects of acupuncture compared with no treatment or sham acupuncture in women undergoing IVF-intracytoplasmic sperm injection treatment were included. Study selection, quality appraisal and data extraction were performed independently and in duplicate. A sensitivity analysis was conducted where the meta-analysis was restricted to trials in which sham acupuncture was used in the control group. Meta-regression analysis was used to explore the association between study characteristics and pregnancy rates. Thirteen relevant trials, including a total of 2500 women randomised to either acupuncture or control group, were identified. No evidence of publication bias was found (Begg's test, P = 0.50). Five trials (n = 877) evaluated IVF outcome when acupuncture was performed around the time of transvaginal oocyte retrieval, while eight trials (n = 1623) reported IVF outcome when acupuncture was performed around the time of embryo transfer (ET). Meta-analysis of the five studies of acupuncture around the time of egg collection did not show a significant difference in clinical pregnancy (relative risks [RR] = 1.06, 95% CI 0.82-1.37, P = 0.65). Meta-analysis of the eight studies of acupuncture around the time of ET showed no difference in the clinical pregnancy rate (RR = 1.23, 95% CI 0.96-1.58, P = 0.1). Live birth data were available from five of the eight studies of acupuncture around the time of ET. Meta-analysis of these studies did not show a significant increase in live birth rate with acupuncture (RR = 1.34, 95% CI 0.85-2.11). Using meta-regression, no significant association between any of the studied covariates and clinical pregnancy rate was found (P > 0.05 for all covariates). Currently available literature does not provide sufficient evidence that adjuvant acupuncture improves IVF clinical pregnancy rate.

Elevated body mass index (BMI) does not adversely affect in vitro fertilization outcome in young women

To determine if elevated body mass index in young women with normal ovarian reserve was associated with poorer ovarian response, difficulty at embryo transfer, and lower clinical pregnancy rates. Retrospective study of 417 first, fresh in vitro fertilization cycles performed between October 2004 and December 2006. All women were under the age of 35 and had normal cycle day 3 follicle stimulating hormone and estradiol levels. Subjects were divided into groups by BMI: <18.5, 18.5-24.9, 25-29.9, > or = 30. Cancellation rates, peak estradiol levels, and mean number of oocytes retrieved were similar in all groups. There was a trend toward increasing difficulty in visualizing the air bubble at time of embryo transfer and lower implantation rates at higher body mass indices. Clinical and ongoing pregnancy rates were similar among groups. Obesity in young women does not adversely affect clinical pregnancy rates in patients treated with in vitro fertilization.

A randomized controlled clinical trial of 2295 ultrasound-guided embryo transfers

We wanted to test the hypothesis that using abdominal ultrasound at the time of embryo transfer to guide replacement, improved pregnancy rates by at least 5%. An RCT in a large assisted conception unit. A pilot study and power calculation suggested that at least 2000 embryo transfers were required to demonstrate a difference of 5%, for a test with 80% power and Type 1 error 0.05. Randomization, data entry and analysis were arranged independently. Randomization was stratified for age and fresh/frozen embryo transfer. Analysis was by intention to treat. There was no difference in clinical pregnancy or live birth rates between the two groups. The clinical pregnancy rate for ultrasound-guided embryo transfer was 22% and for non-ultrasound-guided embryo transfer was 23% (odds ratio: 0.96; 95% confidence interval: 0.79-1.18). We set out to determine whether ultrasound-guided embryo transfer improved clinical pregnancy rates and live birth rates in assisted conception. We used an appropriately powered RCT design. We did not demonstrate a difference. This outcome is at odds with the UKs National Institute of Clinical Excellence recommendations for fertility treatment (Fertility Assessment and Treatment for People with Fertility Problems. London, UK: RCOG Press, 2004, 112.) which used a meta-analysis of four smaller trials (range 362-800 patients, totalling 2051 embryo transfers) to conclude that ultrasound should be offered. We suggest that the current Cochrane review should be updated with data from our trial and recommend that consideration is given to accounting for heterogeneity between the included trials.