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PP-22 IMPLANTATION AND ONGOING PREGNANCY IS MOST AFFECTED BY PROGESTERONE REGIME AND NOT AH OR EMBRYO STAGE IN FROZEN THAWED EMBRYO TRANSFER (FET) CYCLES
S58
8th Biennial Conference of ALPHA Scientists in Reproductive Medicine
conducted a frozen/thawed embryo transfer in 13, with 7 pregnancies (53.85%). The overall pregnancy rate in our oocyte donation program was 74.26%, with 75 pregnancies out of 101 cycles. Conclusion: As a result, we conclude that embryo vitrification is a convenient technique to preserve spare embryos in an oocyte donation cycle. Furthermore it is very useful to increase the overall result of the program. PP-22 IMPLANTATION AND ONGOING PREGNANCY IS MOST AFFECTED BY PROGESTERONE REGIME AND NOT AH OR EMBRYO STAGE IN FROZEN THAWED EMBRYO TRANSFER (FET) CYCLES Alison Finn, Darlene Davies, Bryan Kloos, Olcay Ocali, Renee Perkins, Lynette Scott. Fertility Centers of New England, USA Aim: Day of cryopreservation, assisted hatching and endometrial receptivity are suggested to influence pregnancy outcome in FET cycles. Method: Ongoing pregnancy rates for all FET cycles, excluding donors regardless of age from 2007 through 2009 were compared. From Jan 2007 to August 2008 a replacement protocol of estrace and progesterone (P4) was followed with D3 embryos (8-cell) ET on the 5th day of P4; D5 embryos (blastocysts) on the 7th (Gr I). From September 2008 through 2009 this protocol was changed: D3 embryos ET on the 4th day of P4 and D5 embryos on the 6th day of P4 (Gr II). Day 3 embryos were hatched (75% of cases) but D5 blastocysts were not. A sequential embryo selection system (SES) was used for all fresh ET and selecting embryos for cryopreservation (Scott et al, 2007). The ongoing/delivered rates for both groups, and effect of AH were compared. Results: There were 131 Day 3 embryo FET’s in Gr I with 36 ongoing/ delivered pregnancies (27.5%; 15% IR). AH resulted in a 29.5% ongoing/delivered rate and no AH, 21.2% (p < 0.05; Chi square). In Gr II, 52 of 124 transfers resulted in ongoing or delivered pregnancies (42%, IR 33%; P < 0.01 cf. Gr I). AH in Gr II was not helpful: AH 41.3% vs. no AH 42.5%. The results of D5 blastocyst transfers (no AH) also increased with the change in protocol; Gr I: 14/77, 18% and Gr11: 22/53, 41.5% (p < 0.01), and was no different to rates with Gr II D3 embryos. Conclusion: Endometrial receptivity was related to days of P4 at the time of FET, but not embryo stage at freezing. Early transfer by day of P4 start resulted in increased pregnancy rates compared to late transfer. The stage of embryo development at the time of cryo, when high quality embryos selected for cryo by SES, was not a factor. AH only improved pregnancy rates when ET was performed late. PP-23 ARE THE NEGATIVE EFFECTS OF BEING OVERWEIGHT ON REPRODUCTIVE POTENTIAL EVIDENT IN FET CYCLES? Darlene Davies, Alison Finn, Joseph Hill, Lynette Scott. Fertility Centers of New England, USA Aim: Body Mass Index (BMI) has been shown to negatively affect clinical outcomes (Fedorcsak et al.), but the etiology behind this is still unclear. It is possible that hormonal disturbances caused by additional adipose tissue in overweight patients affect endometrial, oocyte and embryo quality. In the event that a frozen thawed embryo transfer (FET) is performed, the endometrium is not subjected to excess stimulating drugs,
eliminating this factor for patients with abnormal BMIs. A better endometrial environment in an FET cycle compared to a fresh embryo transfer (ET) may improve pregnancy outcomes in overweight patients. Method: The study analyzed data from patients having fresh ETs with cryopreservation and patients having FETs between August 2008 and October 2009. There were 232 fresh cycles and 171 FETs; excluding donor egg, gestational carrier and PGD cycles. Fetal heartbeat rates (FHB) were compared between fresh ET and FET in patients with normal BMI (<25.0) and high BMI (>25.0). Results: Patients with normal BMIs had a 57% (101/176) FHB rate after a fresh ET while patients with a high BMI having a fresh ET had a FHB rate of 38% (21/56), p < 0.05. Conversely, there was no difference in FET rates between BMI groups. Patients with normal BMIs had a 49% (53/108) FHB rate compared to patients with high BMIs who had a 52% (33/63) FHB rate with an FET. Conclusion: IVF patients with high BMIs have significantly lower FHB rates in fresh cycles yet not in FET cycles compared to patients with normal BMIs. The negative effects of excess stimulating drug during a fresh IVF cycle may be eliminated by considering an FET instead of a fresh transfer for some or all overweight patients. PP-24 DAILY EMBRYO REGROUPING IN MINIMAL MEDIUM VOLUME INCREASES THE EMBRYO VIABILITY ON UNSELECTED PATIENT POPULATION K´ alm´ an Sz˝ ucs, Gy¨ ongyi Bojtor, Istv´ an D´ evai. D´ evai Institute, Budapest, Hungary Aim: The human embryos expresses growth factors/citokins/metabolites to culture medium to create their own embryonic niche. These autocrine/paracrine factors regulates the embryonic development and the embryo viability but the expression depends on the embryo quality and the embryo surface/medium volume ratio. If we would like to use these promoting factors to help the embryo culture we must to use daily embryo regrouping basic on their quality (dynamic embryo culture DEC) in ultramicro drop culture (UMDC). Method: We compared the results of the 50 microliter single drop individual embryo culture (conventional method, from January 2006 to August 2006, 204 patients, 217 transfers) with the DECUMDC ones (from January 2008 to October 2008, 211 patients, 239 transfers) on the same type of media (Medi-Cult Universal, ISM1, ISM2, UTM). During the DEC-UMDC cycles we scored the 2PN-s based on their pronuclear morphology on the day after punction (D1) and then we cultured together the same quality preembryos in 7 microliter medium (max. three 2PN-s/drop) to the next day. On D2 we repeated the quality scoring according the D2 morphology and if needed we regrouping the embryos (max. three embryos/7 microliter drop). We repeated every day the scoring and regrouped the embryos to the planned transfer day (D3, D4, D5 or D6) and such a way the embryos with the same score were together during the culture period. Results: We transferred 536 fresh or frozen thawed embryos after the 239 DEC-UMDC cycles to 211 patients resulting 111 detected embryo sacs on cycle day 21 and 78 clinical pregnancies (32.6% clinical pregnancy rate/cycle, 37% clinical pregnancy rate/patient and 20.7% implantation rate). These rates are elevated but not significantly compared to conventional cycles (28.1%, 30%, 15.8%).
8th Biennial Conference of ALPHA Scientists in Reproductive Medicine
conducted a frozen/thawed embryo transfer in 13, with 7 pregnancies (53.85%). The overall pregnancy rate in our oocyte donation program was 74.26%, with 75 pregnancies out of 101 cycles. Conclusion: As a result, we conclude that embryo vitrification is a convenient technique to preserve spare embryos in an oocyte donation cycle. Furthermore it is very useful to increase the overall result of the program. PP-22 IMPLANTATION AND ONGOING PREGNANCY IS MOST AFFECTED BY PROGESTERONE REGIME AND NOT AH OR EMBRYO STAGE IN FROZEN THAWED EMBRYO TRANSFER (FET) CYCLES Alison Finn, Darlene Davies, Bryan Kloos, Olcay Ocali, Renee Perkins, Lynette Scott. Fertility Centers of New England, USA Aim: Day of cryopreservation, assisted hatching and endometrial receptivity are suggested to influence pregnancy outcome in FET cycles. Method: Ongoing pregnancy rates for all FET cycles, excluding donors regardless of age from 2007 through 2009 were compared. From Jan 2007 to August 2008 a replacement protocol of estrace and progesterone (P4) was followed with D3 embryos (8-cell) ET on the 5th day of P4; D5 embryos (blastocysts) on the 7th (Gr I). From September 2008 through 2009 this protocol was changed: D3 embryos ET on the 4th day of P4 and D5 embryos on the 6th day of P4 (Gr II). Day 3 embryos were hatched (75% of cases) but D5 blastocysts were not. A sequential embryo selection system (SES) was used for all fresh ET and selecting embryos for cryopreservation (Scott et al, 2007). The ongoing/delivered rates for both groups, and effect of AH were compared. Results: There were 131 Day 3 embryo FET’s in Gr I with 36 ongoing/ delivered pregnancies (27.5%; 15% IR). AH resulted in a 29.5% ongoing/delivered rate and no AH, 21.2% (p < 0.05; Chi square). In Gr II, 52 of 124 transfers resulted in ongoing or delivered pregnancies (42%, IR 33%; P < 0.01 cf. Gr I). AH in Gr II was not helpful: AH 41.3% vs. no AH 42.5%. The results of D5 blastocyst transfers (no AH) also increased with the change in protocol; Gr I: 14/77, 18% and Gr11: 22/53, 41.5% (p < 0.01), and was no different to rates with Gr II D3 embryos. Conclusion: Endometrial receptivity was related to days of P4 at the time of FET, but not embryo stage at freezing. Early transfer by day of P4 start resulted in increased pregnancy rates compared to late transfer. The stage of embryo development at the time of cryo, when high quality embryos selected for cryo by SES, was not a factor. AH only improved pregnancy rates when ET was performed late. PP-23 ARE THE NEGATIVE EFFECTS OF BEING OVERWEIGHT ON REPRODUCTIVE POTENTIAL EVIDENT IN FET CYCLES? Darlene Davies, Alison Finn, Joseph Hill, Lynette Scott. Fertility Centers of New England, USA Aim: Body Mass Index (BMI) has been shown to negatively affect clinical outcomes (Fedorcsak et al.), but the etiology behind this is still unclear. It is possible that hormonal disturbances caused by additional adipose tissue in overweight patients affect endometrial, oocyte and embryo quality. In the event that a frozen thawed embryo transfer (FET) is performed, the endometrium is not subjected to excess stimulating drugs,
eliminating this factor for patients with abnormal BMIs. A better endometrial environment in an FET cycle compared to a fresh embryo transfer (ET) may improve pregnancy outcomes in overweight patients. Method: The study analyzed data from patients having fresh ETs with cryopreservation and patients having FETs between August 2008 and October 2009. There were 232 fresh cycles and 171 FETs; excluding donor egg, gestational carrier and PGD cycles. Fetal heartbeat rates (FHB) were compared between fresh ET and FET in patients with normal BMI (<25.0) and high BMI (>25.0). Results: Patients with normal BMIs had a 57% (101/176) FHB rate after a fresh ET while patients with a high BMI having a fresh ET had a FHB rate of 38% (21/56), p < 0.05. Conversely, there was no difference in FET rates between BMI groups. Patients with normal BMIs had a 49% (53/108) FHB rate compared to patients with high BMIs who had a 52% (33/63) FHB rate with an FET. Conclusion: IVF patients with high BMIs have significantly lower FHB rates in fresh cycles yet not in FET cycles compared to patients with normal BMIs. The negative effects of excess stimulating drug during a fresh IVF cycle may be eliminated by considering an FET instead of a fresh transfer for some or all overweight patients. PP-24 DAILY EMBRYO REGROUPING IN MINIMAL MEDIUM VOLUME INCREASES THE EMBRYO VIABILITY ON UNSELECTED PATIENT POPULATION K´ alm´ an Sz˝ ucs, Gy¨ ongyi Bojtor, Istv´ an D´ evai. D´ evai Institute, Budapest, Hungary Aim: The human embryos expresses growth factors/citokins/metabolites to culture medium to create their own embryonic niche. These autocrine/paracrine factors regulates the embryonic development and the embryo viability but the expression depends on the embryo quality and the embryo surface/medium volume ratio. If we would like to use these promoting factors to help the embryo culture we must to use daily embryo regrouping basic on their quality (dynamic embryo culture DEC) in ultramicro drop culture (UMDC). Method: We compared the results of the 50 microliter single drop individual embryo culture (conventional method, from January 2006 to August 2006, 204 patients, 217 transfers) with the DECUMDC ones (from January 2008 to October 2008, 211 patients, 239 transfers) on the same type of media (Medi-Cult Universal, ISM1, ISM2, UTM). During the DEC-UMDC cycles we scored the 2PN-s based on their pronuclear morphology on the day after punction (D1) and then we cultured together the same quality preembryos in 7 microliter medium (max. three 2PN-s/drop) to the next day. On D2 we repeated the quality scoring according the D2 morphology and if needed we regrouping the embryos (max. three embryos/7 microliter drop). We repeated every day the scoring and regrouped the embryos to the planned transfer day (D3, D4, D5 or D6) and such a way the embryos with the same score were together during the culture period. Results: We transferred 536 fresh or frozen thawed embryos after the 239 DEC-UMDC cycles to 211 patients resulting 111 detected embryo sacs on cycle day 21 and 78 clinical pregnancies (32.6% clinical pregnancy rate/cycle, 37% clinical pregnancy rate/patient and 20.7% implantation rate). These rates are elevated but not significantly compared to conventional cycles (28.1%, 30%, 15.8%).