Uterine Embryo Transfer Research Articles

O-017 Appeased embryo transfer with hypnosis

Abstract text Objective , We report in this presentation the use for couples undergoing infertility treatment of a new way of accompaniment. Hypnosis associated with learning of self-hypnosis is a solid support to valid an appeased uptake of an infertility program and lower the emotional charge associated with such treatments. Main enhance emotional comfort in couples undergoing infertility treatment. Secondary patients feelings after results of the attempt (whether failure or success), pregnancy rates. Contains During a first meeting family and historical back ground is analyzed as well as medical file and causes for infertility. Then a first specific session is proposed in relation with underlying problems using ericksonian hypnosis. For example sessions using amnesia can be used in patients having had traumatic experiences. Comfort and wellbeing suggestions are used after each hypnosis session. Two other sessions can be proposed at office, one called “the two chests” first one to pack all past failures and second to collect present or past successes regarding all fields. These successes will be resourceful to refer to. The second session will be to enhance self-confidence using contes. In order to enhance autonomy patients are given 4 audio sessions prerecorded to home practice. Three of them are specific to intra uterine insemination or embryo transfer. One is called FIVETE to listen the day before medical procedure, one is called SIMPLE INDUCTION to start just before and throughout the procedure. One to do after procedure at home called DO NOTHING. Patients are called few weeks after the attempt for debrief and results.

Porcine blastocyst viability and developmental potential is maintained for 48 h of liquid storage at 25 °C without CO2 gassing

Short- and medium-term storage of pig embryos has become relevant for commercial application of non-surgical deep uterine embryo transfer (NsDU-ET) in the light of the strict legal and administrative requirements posed by the International Association for Air Transport (IATA) to allow shipment of liquid nitrogen (LN2) containers and the technical drawbacks when using vitrified embryos. Therefore, this study developed an efficient method for the liquid storage of in vivo-derived porcine blastocysts for a moderate duration (48 h) without controlled CO2 gassing. We evaluated two storage temperatures (25 °C and 37 °C) and three HEPES-supplemented media: the chemically defined media TL-PVA and NCSU-PVA and the semi-defined medium NCSU-BSA. We observed no differences in survival, hatching rate or final developmental stage between the two temperatures, but storage at 25 °C was more efficient to preserve zona pellucida (ZP) integrity. Blastocysts were successfully stored for 24 h in a chemically defined medium. Yet, only 48 h storage in NCSU-BSA medium supported blastocyst development. Although all storage conditions resulted in an embryonic developmental delay, blastocysts stored in NCSU-BSA at either tested temperature could hatch and attain the same final developmental stage as control blastocysts when cultured under standard conditions after storage. Moreover, blastocysts stored at 25 °C for 48 h in NCSU-BSA medium could produce pregnancies after surgical transfer. In conclusion, porcine blastocysts maintain their viability and developmental potential after storage in the semi-defined medium NCSU-BSA for at least 48 h at 25 °C.

Simple storage (CO2-free) of porcine morulae for up to three days maintains the in vitro viability and developmental competence

The advancement of porcine embryo transfer (ET) technology is constrained by regulatory hurdles (liquid nitrogen transportation) or, more importantly, the technical obstacles of using vitrified embryos in combination with nonsurgical deep uterine ET technology. Maintaining embryos in culture during transport and prior ET collides with the need of CO2 gassing and the best choice of culture medium. In this work, we describe storage conditions for short-term embryo CO2-free storage that allowed for a majority of in vivo-derived porcine morulae to survive after 3 days of storage in a liquid state, and to develop to the blastocyst stage unhatched, a sanitary prerequisite for ET. The storage conditions included NCSU-23 medium supplemented with bovine serum albumin, where bicarbonate was partially replaced by HEPES to avoid the need for CO2 gassing, and a temperature of 37 °C. These conditions were able to maintain the functionality of the stored embryos (hatching capacity after exposure to conventional culture conditions) and their developmental competence after ET (normal fetuses by day 38 of pregnancy). Use of this strategy of CO2-free storage should allow the shipment of fresh embryos worldwide in the absence of liquid nitrogen.

Surgical embryo collection but not nonsurgical embryo transfer compromises postintervention prolificacy in sows

Recent advances in nonsurgical deep uterine (NsDU) embryo transfer (ET) technology allow the noninvasive transfer of porcine embryos into recipients, overcoming the most important impediment for commercial ET in this species. Although many factors in the porcine ET-field have been recently evaluated, many others remain to be explored. We investigated here the future reproductive performance of donors and recipients after artificial insemination subsequent to the default surgical embryo recovery approach and to the NsDU-ET procedure, respectively. Although surgical embryo collection did not influence subsequent farrowing rates (90.5%), litter size decreased severely (8.9 ± 0.8 piglets) compared to presurgery (10.8 ± 0.3 piglets) and control group (10.7 ± 0.3 piglets). In contrast, NsDU-ETs did neither affect fertility nor prolificacy of recipients in the cycle subsequent to ET, regardless of whether they were pregnant after NsDU-ET or not. These results indicate that while the surgical embryo collection procedure compromises the reproductive future of donor sows, the NsDU-ET approach does not affect the reproductive potential of the recipients after reintroduction to the breeding stock of the farm. Further research is thus needed to improve surgical embryo collection.

The Recipients' Parity Does Not Influence Their Reproductive Performance Following Non-Surgical Deep Uterine Porcine Embryo Transfer.

With the development of the non-surgical deep uterine (NsDU) embryo transfer (ET) technology, the commercial applicability of ET in pigs is now possible. There are, nevertheless, many factors that influence NsDU-ET effectiveness that need to be addressed. The aim of this study was to evaluate the effects of the weaned recipients' parity on fertility and prolificacy following NsDU-ET. The recipients (n = 120) were selected based on their reproductive history and body condition and grouped into three categories according to their parity: primiparous sows, sows of parity 2 and sows of parities from 3 to 5. Thirty fresh embryos (morulae and unhatched blastocysts) were non-surgically transferred into one uterine horn of each recipient. It was possible to insert the NsDU-ET catheter through the cervix along a uterine horn in 98.3% of the recipients. The parity had no influence on the difficulty grade of the insertions or on the percentage of correct insertions. The cervix and uterine wall were not perforated during the insertions, and vaginal discharge was not observed after transfer in any of the recipients. There were no differences in the pregnancy rates (74.8%), farrowing rates (71.2%) or litter sizes (9.6 ± 3.3) between groups. Also, there were no differences between groups regarding to the piglets' birthweights or piglet production efficiency. In conclusion, these results demonstrate that weaned sows from parity 1 to 5 are appropriate to be used as recipients in NsDU-ET programs, which increase the possibilities for the utilization of ET in the recipient farms.

156 LAPAROSCOPIC UTERINE EMBRYO TRANSFER IN THE CAT

In the first successful transfer of cat embryos (Theriogenology 11, 51–62), the uterus was accessed by midventral laparotomy. That surgical approach was the most widely used method for transferring cat embryos for more than two decades. Then, 10 to 15 years ago pregnancies were reported after early cleavage stage embryos were transferred to the oviduct of recipients using a laparoscopic technique. Even though laparoscopic oviducal embryo transfer has produced higher survival/pregnancy rates than were obtained previously there are valid reasons for establishing a minimally invasive, technically simple method for depositing morulae and blastocysts into the uterus of recipients. Thus, the purpose of the present project was to develop a technique for laparoscopic uterine embryo transfer in the cat. Recipients (n = 4) were gonadotropin-treated females (Theriogenology 81, 126–37) from which prevoulatory oocytes (n = 27–42/retrieval) had been recovered 7 or 8 days previously. The procedure for accessing the reproductive tract has been described (Theriogenology 71, 864–71). Briefly, after abdominal insufflation via a Veress needle, two 5-mm ports were inserted in the midline – one ~2.5 cm anterior to the umbilicus and the other between the two most posterior teats. An endoscope/camera and a Babcock forceps were placed in the anterior and posterior ports, respectively. After the left uterine horn was stabilised with the Veress needle, the Babcock forceps were gently applied at ~2–3 cm from the anterior tip. In the first two attempts, a 16 g × 5 cm thin-walled stainless steel (s.s.) trocar/cannula was inserted transabdominally such that it aligned with the anterior portion of the left uterine horn when elevated with the forceps. Then, either a 14-cm, 3.5 Fr tom cat catheter with a s.s. sharp-tipped stylette or a 20/22 g × 6 cm indwelling catheter was passed through the s.s. cannula and inserted into the uterine horn. In each case, the length of the s.s. cannula restricted depth of insertion of the catheter into the horn. Polyethylene tubing (PE10) containing the embryos was threaded through the catheter and embryos were expelled with a 1-mL threaded-plunger syringe. The failure to establish pregnancies after transfer of five or six Day 7 or Day 8 IVF-derived “fresh” embryos into the first two recipients was attributed to technical difficulties. So, for the third and fourth procedures, we shortened the s.s. trocar/cannula to 2.5 cm and, for insertion into the horn, a 20/22 g × 6 cm indwelling catheter was used. With the third procedure, in which cryopreserved d 8 IVF blastocysts were transferred into a Day 7 recipient, the failure was possibility due sub-optimal in vitro development of embryos after thawing on d 7. For the fourth transfer, 6 “fresh” Day 8 IVF blastocysts – 2 expanding and 4 in the early stages of emerging from the zona pellucida – were auto-transferred into a 3-year-old recipient. A singleton pregnancy was diagnosed by ultrasonography on Day 28 and a live, healthy male kitten (119 g) was born on Day 67. In summary, we demonstrated the feasibility of transferring in vitro-derived cat embryos into the uterus of recipients by the minimally invasive technique of laparoscopy.

Design, development, and application of a non-surgical deep uterine embryo transfer technique in pigs

There is enormous potential for the use of embryo transfer in pig production because it should make it possible to move genetic material (i.e., embryos) with minimal risk of disease transmission, reduced transportation costs, and no effect on animal welfare during transport. Unlike other livestock, the commercial use of embryo transfer in pigs has been very limited because embryo collection and transfer require surgical procedures. Recently, a new and unique procedure for the non-surgical transfer of porcine embryos deep into a uterine horn of non-sedated gilts and sows has been developed. The excellent reproductive performance of recipients following non-surgical transfer of fresh embryos and the promising results obtained with vitrified embryos represent a fundamental advance in the widespread commercial use of embryo transfer by the pig industry.

Comparison of pregnancy and implantation rates in zygote intrafallopian transfer and uterine embryo transfer for nontubal infertility

We carried out a prospective randomized trial on 220 couples with nontubal factor infertility to compare pregnancy rates and implantation rates after zygote intrafallopian transfer (ZIFT) and uterine embryo transfer (UET). The zygote was transferred by laparoscopy into the fallopian tube 24 hours after oocyst retrieval. UET was performed 72 hours after retrieval with abdominal sonography guide. Transfer was performed in 102 cycles in the ZIFT and 100 cycles in the U ET group. The pregnancy and implantation rates were significantly higher in the ZIFT group (42.1% and 11.7%) than in the UET group (21.0% and 7.8%) (P < 0.05). ZiFT could be considered for couples who have limited time and adequate financial support.

Outcomes Of Assisted Reproductive Technologies At The Nairobi In Vitro Fertilisation Centre

Infertility is a common problem affecting up to ten per cent of married couples. A systematic evaluation of aetiologic factors forms the basis for choice of treatment and future fertility. On the global perspective, Assisted Reproductive Technologies (ART) has become internationally recognised treatment option for some infertile couples. A report on the current outcomes of ART practice at The Nairobi IVF Centre is presented. To describe the practice of assisted reproduction and present a report on the current outcomes. A retrospective survey of data on assisted reproduction practice from August 2005 to July 2008. The Nairobi IVF Centre a private medical practice in Nairobi, Kenya. Treatment of infertile couples by various assisted reproductive technologies including in vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI), uterine fresh embryo transfer (ET), and frozen/thawed uterine ET (FTET). Fertilisation, embryo cleavage, ET, embryo freeze/thaw survival, preclinical pregnancy and clinical pregnancy rates, live births and other obstetric outcomes. A total of 362 IVF cycles were performed. Following controlled ovarian hyperstimulation, an average of 12 oocytes were retrieved per patient while the fertilisation and subsequent embryo cleavage rates were 67 and 91.2% respectively. An average of three embryos were transferred and the embryo transfer rate was 93.3% per cycle started and 96.6% per oocyte retrieval. Surplus embryos were available for cryopreservation in 106 (50.1%) cycles. On thawing frozen embryos, the survival rate was 65.5%. Following ET, the overall pre-clinical pregnancies were 124 (36.2%) of which 99 (28.9%) developed into clinical pregnancies per cycle. Of the clinical pregnancies, 72 (73%) were singletons, 23 (23%) twin gestations and four triplets (4%). A total of 52 mothers have been delivered either by Caesarian section 45 (86.5%) or spontaneous vertex delivery seven (13.5%) to 61 live babies of whom 36 were females and 25 males. A further 28 IVF clinical pregnancies are ongoing, 26 following fresh embryo transfer and two from frozen/thawed embryos. Our results on ART practice reflects a pregnancy outcome comparable to that reported by other fertility centres globally. Couples with infertility in East and Central Africa for whom ART treatment is indicated may now access the service locally.

39 FACTORS AFFECTING PREGNANCY RATE FOLLOWING TRANSFER OF SOMATIC CELL NUCLEAR TRANSFER EMBRYOS IN DOGS

There have been attempts to find out factors influencing pregnancy rate after transfer of somatic cell nuclear transferred (SCNT) couplets in several species. The purpose of this study was to investigate the effects of parity, surgical history, and synchronization state between oocytes donor and recipient on the pregnancy rate following transfer of SCNT embryos in dogs. A total of 25 mixed-breed female dogs, aged 1 to 5 years old, weighing 20 to 35 kg were used in this study. In vivo-matured oocytes, obtained by flushing uterine tubes of donor dogs approximately 72 h after ovulation, were used for SCNT. Ovulation was determined by daily serum progesterone concentration. Reconstructed embryos (range = 7–36, average = 18.0 embryos) with normal morphology were surgically transferred into the ampullary portion of the uterine tube of recipient dogs. Pregnancy was determined at least 26 days after transfer by untrasonography. In experiment 1, recipient females were divided into 2 groups: nulliparous (7 bitches) and multiparous (17 bitches) groups. In experiment 2, recipient females were divided into 2 groups by surgical history: operated (10 bitches) and non-operated (14 bitches) groups. Operated group included those with a history of 1 laparotomy, either flushing of uterine tubes or SCNT embryo transfer. Non-operated group included those without history of any surgery. In experiment 3, recipient females were divided into 2 groups: synchronous (13 bitches) and asynchronous (7 bitches) groups. Synchronous was defined that the oocyte donor dog and the recipient dog ovulate at the same day. Asynchronous was defined that the oocyte donor dog ovulates 1 day earlier than the recipient. Data were analyzed using the Statistical Analysis System program (SAS Institute, version 9.1, Cary, NC, USA). In experiment 1, pregnancy rate was significantly higher in the multiparous group than the nulliparous group (23.5 v. 14.2%, P &lt; 0.05). In experiment 2, surgical history did not influence the pregnancy rate between operated and non-operated groups (20.0 and 21.4%, respectively). In experiment 3, pregnancy rate was significantly higher in the asynchronous group than the synchronous group (42.9 v. 15.4%, P &lt; 0.05). In conclusion, multiparous bitches improved the efficiency of SCNT embryo transfer. A higher pregnancy rate resulted when the oocyte donor dog’s ovulation time was 1 day earlier than that of the recipient dog. Other factors should be investigated for further improvement of the SCNT embryo transfer efficiency. This study was financially supported by the Korean MEST, through KOSEF (grant # M10625030005-08N250300510) and the BK21 program for Veterinary Science, and SNU foundation (Benefactor; RNL BIO).

Tubal embryo transfer a therapeutic option for patients with IVF- uterine embryo transfer failure

OBJECTIVE: The application of Tubal Embryo Transfer (TET) in IVF population has gradually declined worldwide over the years. A meta-analysis of randomized, controlled trials found no difference in pregnancy and implantation rates between women undergoing TET and IVF-ET (Habana and Van Thillo; Fertil Steril 2001) though few studies have evaluated the worth of TET in recurrent IVF uterine transfer failure. Our study evaluated the outcome of TET in women undergoing IVF who have a history of 2 IVF failures with uterine embryo transfer (UET). DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We evaluated the whole IVF population in our center between 2003 and 2007. We selected 261 infertile patients with two failed IVF-ET which performed a third attempt. They were divided into two groups: Group A (43); performed TET (laparoscopically) on day 2 of in vitro culture and Group B (218); received atraumatic ultrasound guided UET on day 3. A pre-requisite for TET was the absence of significant tubal pathology. Main outcome measures were: Implantation, clinical pregnancy, live birth rates and twin pregnancy rate. RESULTS: Patient characteristics and response to stimulation were comparable for both groups. Pregnancy rate (51% vs. 33%), and live birth rates (48% vs. 27%) were significantly higher in the TET group as compared to the UET group, respectively. We also found a significant higher twin pregnancy rate in TET group.Table 1TET (n=43)UET (n=218)PAverage Embryos transferred2.9 ± 0.932.8 ± 1.03NSImplantation rate (%)27/125 (21%)77/613 (12%)NSClinical pregnancies (%)22 (51%)71 (33%)<0.05Twin pregnancies (%)5 (22%)6 (8%)<0.05Abortions (%)4 (18%)11 (15%)NSLive birth Rate21 (48%)59 (27%)<0.05 Open table in a new tab CONCLUSIONS: Tubal Embryo Transfer provides an effective choice associated with better outcome than UET for women with recurrent IVF-UET treatment failure.

The presence of uterine adenomyosis does not affect implantation in an oocyte donation program

OBJECTIVE: The presence of uterine adenomyosis does not affect implantation in an oocyte donation program.DESIGN: Retrospective case-control study.MATERIALS AND METHODS: A total of 49 patients undergoing oocyte donation between January 1st 2003, and June 30th 2007, with the diagnosis of adenomyosis by ultrasound were included. The presence of hypoecogenic and heterogeneous areas and elliptic intramyometrial cystic spaces > 4mm in diameter, asymmetric thickening of anterior and posterior myometrial walls, and hypoechogenic subendometrial halo were used to diagnose adenomyosis. Care was taken to exclude patient with the concomitant presence of uterine fibroids and/or endometriosis. Each case was matched by age with a control undergoing oocyte donation in the same period of time in which the presence of adenomyosis, endometriosis or fibroids was also ruled out. Main interventions were controlled ovarian stimulation and oocyte retrieval in donors and uterine embryo transfer on day 3 in recipients after appropriate exogenous replacement therapy. Implantation, pregnancy, and ongoing / term pregnancy rates were the main outcome measures.RESULTS: A total number of 83 cycles were recorded in the adenomyosis group and 103 in the controls throughout the study period. Women with adenomyosis had a significantly (p=0.001) longer story of infertility than controls [5.3 (SD=3.7) vs 3.6 (SD=2.5 yrs)]. With a similar number of oocytes received (12.4 (SD=3.9) vs 12.7 (SD=4.2), respectively), fertilization rates (67.0% vs 67.1%) and quality of the embryos replaced on day 3, a total of 1.9 (SD=0.5) embryos were transferred in adenomyosis patients and 1.7 (SD=0.6) in the controls. Implantation rates were respectively 25.0 and 27.3% (p>0.05), and clinical pregnancy rates were 38.6 and 44.0% (p>0.05), respectively. About 43.7 and 35.4% of the pregnancies were twins in each group.CONCLUSIONS: A careful analysis of women with adenomyosis as the sole entity present in the pelvis to explain infertility has shown that embryo implantation is not affected in oocyte donation. Thus, if adenomyosis is associated with infertility, its mechanism cannot be explained by impaired implantation. Similarly, in women with adenomyosis oocyte donation can be indicated with the same prognosis than other patients undergoing this method of assisted reproduction. OBJECTIVE: The presence of uterine adenomyosis does not affect implantation in an oocyte donation program. DESIGN: Retrospective case-control study. MATERIALS AND METHODS: A total of 49 patients undergoing oocyte donation between January 1st 2003, and June 30th 2007, with the diagnosis of adenomyosis by ultrasound were included. The presence of hypoecogenic and heterogeneous areas and elliptic intramyometrial cystic spaces > 4mm in diameter, asymmetric thickening of anterior and posterior myometrial walls, and hypoechogenic subendometrial halo were used to diagnose adenomyosis. Care was taken to exclude patient with the concomitant presence of uterine fibroids and/or endometriosis. Each case was matched by age with a control undergoing oocyte donation in the same period of time in which the presence of adenomyosis, endometriosis or fibroids was also ruled out. Main interventions were controlled ovarian stimulation and oocyte retrieval in donors and uterine embryo transfer on day 3 in recipients after appropriate exogenous replacement therapy. Implantation, pregnancy, and ongoing / term pregnancy rates were the main outcome measures. RESULTS: A total number of 83 cycles were recorded in the adenomyosis group and 103 in the controls throughout the study period. Women with adenomyosis had a significantly (p=0.001) longer story of infertility than controls [5.3 (SD=3.7) vs 3.6 (SD=2.5 yrs)]. With a similar number of oocytes received (12.4 (SD=3.9) vs 12.7 (SD=4.2), respectively), fertilization rates (67.0% vs 67.1%) and quality of the embryos replaced on day 3, a total of 1.9 (SD=0.5) embryos were transferred in adenomyosis patients and 1.7 (SD=0.6) in the controls. Implantation rates were respectively 25.0 and 27.3% (p>0.05), and clinical pregnancy rates were 38.6 and 44.0% (p>0.05), respectively. About 43.7 and 35.4% of the pregnancies were twins in each group. CONCLUSIONS: A careful analysis of women with adenomyosis as the sole entity present in the pelvis to explain infertility has shown that embryo implantation is not affected in oocyte donation. Thus, if adenomyosis is associated with infertility, its mechanism cannot be explained by impaired implantation. Similarly, in women with adenomyosis oocyte donation can be indicated with the same prognosis than other patients undergoing this method of assisted reproduction.

Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure

Local injury to the endometrium prior to controlled ovarian stimulation may considerably improve implantation rates and pregnancy outcomes in intracytoplasmic sperm injection patients with high-order implantation failure (> or =4 IVF trials and > or =12 transferred embryos).

P-157: Performance of tubal embryo transfer may be of value in women undergoing assisted reproduction with history of recurrent IVF-ET failure or low number of zygotes available for uterine transfer

To study the outcome of tubal embryo transfer (TET) in women undergoing IVF who have a history of recurrent failure of IVF with uterine embryo transfer (UET), or have three or fewer zygotes after in vitro fertilization

Comparison of Tubal Transfer and Transcervical Uterine Embryo Transfer of Immediate Injected Oocytes and 2 - 3 Days Old Cultured Embryos

Objective: The aim of this study was to assess the outcomes of laparoscopic intrafallopian transfer of injected oocytes rapidly (1 hour at most) after intracytoplasmic sperm injection (rapid ICSI-ZIFT). Materials and Methods: Data on 58 cycles in 58 couples, who underwent rapid ICSI-ZIFT treatment over a 12-month period were retrospectively investigated. The control group included 28 patients, who underwent intrauterine embryo transfer (ET) after ICSI. Following down-regulation with goserelin acetate, step-up ovulation induction with recombinant gonadotropins was carried out. After oocyte retrieval and ICSI, a maximum of 4 injected oocytes with intact cytoplasmic membrane and clear cytoplasm were replaced within 1 hour into a unilateral fallopian tube under laparoscopic guidance. Biochemical pregnancy, clinical pregnancy, implantation, miscarriage, and take-home baby rates were our outcome measures. Rapid ICSI-ZIFT and conventional ICSI-ET groups were compared using univariate and multivariate analyses. Results: After controlling for confounding factors by logistic regression, none of the outcome variables were found to be improved with rapid ICSI-ZIFT. Implantation rates were also comparable (17.2% for rapid ICSI-ZIFT and 17.1% for ICSI-ET) with no significant differences (p=0.9). The multiple pregnancy rate in the ICSI-ZIFT group was exceedingly high (34.8% versus 0%, p=0.07). Conclusions: Immediate tubal transfer of microinjected oocytes is associated with similar implantation and take-home baby rates compared to rates for intrauterine ET after ICSI. Given the risk of laparoscopy and the unavoidable higher risk of multiple pregnancy, intratubal transfer of injected oocytes seems unsuitable for clinical use.

Comparison of zygote intrafallopian tube transfer and transcervical uterine embryo transfer in patients with repeated implantation failure

Objective: This study was designed to evaluate the role of zygote intrafallopian transfer (ZIFT) procedure in patients with repeated failure of implantation. Study Design: A total of 141 ZIFT cycles of 132 women and 145 embryo transfer (ET) cycles of 97 women in whom five or more embryos were transferred were included in this study. Transcervical uterine embryo transfer and ZIFT cycle outcome in patients with five or more previous implantation failure were compared. Embryos were transferred by laparoscopy into the fallopian tube 24–27 h following oocytes retrieval in the ZIFT group. In the ET group, embryos were transferred transcervically on the third day following oocytes retrieval. Results: The mean age was 34 ± 4.9 and 34.9 ± 5.0 years in ZIFT and ET group, respectively. No difference was determined between the two groups regarding the basal FSH, E2 value on the day of HCG injection and the number of oocytes retrieved or fertilized. The implantation rate was 6.5% versus 7.2%, clinical pregnancy rate was 22.7% versus 24.8% and live birth rate was 21.2% versus 16.5% in ZIFT and ET groups, respectively. Conclusions: Implementation of ZIFT procedure in patients with repeated implantation failure is not superior to transcervical uterine embryo transfer.

Successful nonsurgical deep uterine embryo transfer in pigs

At present, it is possible to transfer pig embryos directly into the uterine body of sows by nonsurgical procedures. The aim of this study was to develop a procedure for nonsurgical embryo transfer (ET) into the upper part of one uterine horn in gilts and sows. In experiment 1, 29 gilts and 43 sows were used. Intrauterine insertions took place for each female at days 4–6 of the estrous cycle (D0=onset of estrus). An artificial insemination (AI) spirette was inserted into the cervix to assist with the guidance of a modified flexible catheter originally developed for deep intrauterine insemination in pigs. The flexible catheter length inserted anterior to the inserted AI spirette was 43.0±1.7 cm. The time required to complete the procedure was affected by the type of female ( P<0.001) and by the difficulties encountered for inserting the catheter ( P<0.001). However, when no or minor difficulties were encountered during the insertion of the catheter (in approximately 70 and 80% of gilts and sows, respectively), the time required to complete the procedure did not differ between gilts (2.5±0.1 min) and sows (2.3±0.1 min). In experiment 2, 24 to 31 fresh morulae and/or blastocysts were transferred to each of 24 recipients. Seventeen animals (70.8%) farrowed an average of 6.9±0.7 piglets, of which 0.6±0.3 piglets were born dead. In conclusion, the procedure described in this study offers new possibilities to transfer embryos nonsurgically to the uterine horn of pigs.

Impact of transabdominal ultrasound guidance on performance and outcome of transcervical uterine embryo transfer.

To determine the impact of transabdominal ultrasound guidance on embryo transfer during IVF therapy. Retrospective analysis of 823 consecutive embryo transfers. Three hundred and sixty-seven procedures performed with transabdominal ultrasound guidance were compared to 456 cases performed with the "clinical touch" method. Ultrasound-guided embryo transfer yielded higher, but not statistically significant, clinical pregnancy (48% vs. 44%) and implantation rates (22% vs. 20%). The incidence of multiple pregnancies, ectopic and multiple pregnancy rates were similar. The frequency of negative factors typically associated with difficult transfers, such as requirement of use of tenaculum, and presence of blood or mucus in the catheter tip, were significantly lower in the ultrasound-guided group in comparison with the clinical touch group. Ultrasound-guided embryo transfer was associated with a significantly increased easiness of transfer performance; 95% of the transfers were rated as very easy in the ultrasound-guidance group compared to 87% in the clinical touch group. The use of a soft pass catheter was the only variable independently and significantly associated with pregnancy success (odds ratio = 2.74). Ultrasound-guidance facilitates embryo transfer and in combination with the use of a soft catheter should be implemented to optimize embryo transfer results.

Lower implantation rate with downward displacement of ultrasonograpic based echogenic drop following uterine embryo transfer

Objective: to evaluate the impact of ultrasonographic based embryo shift following uterine embryo transfer on reproductive outcome. Design: Prospective study Materials/Methods: Between September 2001 and February 2002, a total of 83 patients undergoing IVF cycles whose age was less than 38 years were included. Patients with more than 2 IVF failures and poor responders were excluded. Uterine embryo transfer was done under transabdominal ultrasound guidance. The distance between the cephalic tip of the echogenic drop and the top of the endometrial cavity was measured immediately following embryo transfer(d1) and repeated 10–15 minutes later(d2). Embryo shift(d) represents the change in direction and distance between the 2 measurements. Based on embryo shift, patients were divided into 3 groups: Group 1 (n = 17)with d ≤0, group 2(n = 31) with d = 0. 1–3 mm and Group 3 (n = 31) with d >3mm. statistical analysis was done with student t-test or Fisher exact test as indicated. Results: There was no statistically significant difference in age, stimulation and downreguation protocol, number of eggs retrieved, number of embryos transferred, type of catheter used, ease of transfer and loading method between the 3 groups. Miscarriage, a clinical, ongoing and multiple pregnancy rates were not statistically different between the 3 groups. Implantation and multiple pregnancy rates were 11.3% and 22.2% in group 1. The difference was significant when compared to group 2(27.1%, 37.5%) and group 3(28% and 66.7%). Results are shown in table I. Table IIVF outcome following uterine embryo transfer in the 3 groups of patients based on embryo shiftGroup 1 (d ≤ 0): n = 21Group 2 (d = 0.1–3mm): n = 31Group 3 (d3): n = 31Mean age35.234.934.7mean number of embryos transferred3.43.13.2fertilization rate76.881.279.0implantation rate15.3∗The difference was statistically significant compared to the other 2 groups (p < 0.05)27.128ongoing pregnancy rate42.951.667.miscarriage rate9.59.73.2Multiple pregnancy rate22.2∗The difference was statistically significant compared to the other 2 groups (p < 0.05)37.566.7∗ The difference was statistically significant compared to the other 2 groups (p < 0.05) Open table in a new tab Conclusions: The direction of shift in the ultrasonographic echogenic drop following uterine transfer does seem to affect implantation rate. Careful and slow withdrawal of the transfer catheter might avoid downward shift of the transferred embyos and improve implantation rate. Supported by: IVF Michigan.

Does ultrasonographic measurement of uterine embryo transfer material predict clinical pregnancy?

Objective: The trans-cervical transfer of embryos, culture media, and air at the time of uterine transfer creates a point of increased reflection of ultrasound waves. This echogenic complex can be seen to shift within the endometrial cavity shortly after transfer. The purpose of this study is to determine if movement of the echogenic material seen on ultrasound following uterine embryo transfer is useful as a predictor of pregnancy rate.Design: Prospective analysis.Materials/Methods: Ninety-eight patients undergoing uterine transfer between November, 2001 and March, 2002 were evaluated. Transfers included day 3 embryos, day 5 blastocysts, fresh cycles, frozen cycles, donor eggs, and gestational surrogacy cycles. Transabdominal ultrasound was performed at the time of transfer, and repeated 10–20 minutes later. The bladders of patients remained full during transfer and until the second ultrasound. The echogenic point created at time of transfer was measured as a linear distance from the cephalad extent of the endometrial lining.Results: Eighty-four echocomplexes (85.7%) drifted cephalad. One each remained motionless and dispersed, and 12 (12.2%) moved caudad. The overall clinical pregnancy rate was 64/98 (65.3%). 56 of 84 (66.7%) of cephalad complexes implanted, whereas 6 of 12 (50%) of caudad complexes were able to implant. There was no statistically significant difference in pregnancy rate for echocomplexes moving cephalad (phi=0.488) or caudad (phi=0.234). There was no difference in pregnancy rate for magnitude of drift encountered. Echocomplexes were seen even in the four embryo transfers that were done without using the air-transfer method as described elsewhere. The patients that had dispersed or stationary echocomplexes both have ongoing pregnancies.Conclusions: Although the nature of the physical interactions between embryos, media, and air bubbles may not be well known, the presence, direction, and magnitude of drifting transfer material do not appear to correlate with pregnancy rate, even as indirect indicators. The echogenic focus is not entirely dependent on the presence of air in the transfer catheter, and its disappearance does not necessarily imply that the embryos have been expelled from the uterus. Since pregnancies were generated following uterine transfer, persistence of the echogenic transfer material appears consistent with short-term retention of the embryos within the uterus following transfer.Supported by: None. Objective: The trans-cervical transfer of embryos, culture media, and air at the time of uterine transfer creates a point of increased reflection of ultrasound waves. This echogenic complex can be seen to shift within the endometrial cavity shortly after transfer. The purpose of this study is to determine if movement of the echogenic material seen on ultrasound following uterine embryo transfer is useful as a predictor of pregnancy rate. Design: Prospective analysis. Materials/Methods: Ninety-eight patients undergoing uterine transfer between November, 2001 and March, 2002 were evaluated. Transfers included day 3 embryos, day 5 blastocysts, fresh cycles, frozen cycles, donor eggs, and gestational surrogacy cycles. Transabdominal ultrasound was performed at the time of transfer, and repeated 10–20 minutes later. The bladders of patients remained full during transfer and until the second ultrasound. The echogenic point created at time of transfer was measured as a linear distance from the cephalad extent of the endometrial lining. Results: Eighty-four echocomplexes (85.7%) drifted cephalad. One each remained motionless and dispersed, and 12 (12.2%) moved caudad. The overall clinical pregnancy rate was 64/98 (65.3%). 56 of 84 (66.7%) of cephalad complexes implanted, whereas 6 of 12 (50%) of caudad complexes were able to implant. There was no statistically significant difference in pregnancy rate for echocomplexes moving cephalad (phi=0.488) or caudad (phi=0.234). There was no difference in pregnancy rate for magnitude of drift encountered. Echocomplexes were seen even in the four embryo transfers that were done without using the air-transfer method as described elsewhere. The patients that had dispersed or stationary echocomplexes both have ongoing pregnancies. Conclusions: Although the nature of the physical interactions between embryos, media, and air bubbles may not be well known, the presence, direction, and magnitude of drifting transfer material do not appear to correlate with pregnancy rate, even as indirect indicators. The echogenic focus is not entirely dependent on the presence of air in the transfer catheter, and its disappearance does not necessarily imply that the embryos have been expelled from the uterus. Since pregnancies were generated following uterine transfer, persistence of the echogenic transfer material appears consistent with short-term retention of the embryos within the uterus following transfer. Supported by: None.