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The future of IVF: vitrified-warmed blastocyst transfer
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Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) 251–263
integrated family planning services has in relation to curbing excess maternal mortality from preventable causes. http://dx.doi.org/10.1016/j.ejogrb.2016.07.016 Efficacy of hysteroscopy with local endometrial injury in patients with recurrent implantation failure ´ T. Bizjak, M. J. Knez ∗ , V. Kovaˇc, J. Pukl Batistic, Reljiˇc Department of Reproductive Medicine and Gynaecologic Endocrinology, University Medical Centre Maribor, Maribor, Slovenia Introduction: Treatment of recurrent implantation failure represents one of the greatest challenges in reproductive medicine today. Low embryo quality and reduced endometrial receptivity are considered as the most important causes. Local endometrial injury is a promising procedure that could enhance endometrial receptivity, but the evidence of its effects is still controversial. The aim of the study was to evaluate the benefit of hysteroscopy with local endometrial injury (LEI) in patients with unexplained recurrent implantation failure (RIF). Methods: The retrospective, case-controlled study included 378 women (age < 40 years, at least three previous embryo transfers with failed implantation, available good quality embryos and without intrauterine pathology) in a period from May 2011 to December 2014. Women in the intervention group (n = 104) underwent hysteroscopy with LEI in the three-month period before embryo transfer. Women in the control group (n = 274) did not undergo hysteroscopy with LEI. Short antagonist or long agonist protocols with recombinant FSH were used for ovarian stimulation. All patients were treated with IVF/ICSI procedure. Results: There were no significant differences between the intervention and control group in the mean patients’ age (33.76 vs. 34.24 years), number of previous IVF/ICSI cycles (4.21 vs. 4.37), duration of stimulation (10.05 vs. 10.44 days), number of oocytes retrieved (12.31 vs. 11.31), ICSI rate (66.35% vs. 64.97%), fertilisation rate (56.21% vs. 55.34%), number of good quality embryos (4.53 vs. 4.09) and the number of transferred embryos (1.79 vs. 1.86). Higher clinical pregnancy and implantation rates were observed in the intervention group compared to the control group (42.30% and 30.87% vs. 32.23% and 22.44%), however these differences were not of statistical significance. Conclusion: Our results suggest that hysteroscopy with local injury to the endometrium prior to ovarian stimulation for IVF/ICSI can improve implantation and pregnancy rates in women experiencing RIF. However, large studies are needed to confirm these findings. http://dx.doi.org/10.1016/j.ejogrb.2016.07.019 The future of IVF: vitrified-warmed blastocyst transfer J. Knez ∗ , B. Kovaˇciˇc, M. Reljiˇc Department of Reproductive Medicine and Gynaecologic Endocrinology, University Medical Centre Maribor, Maribor, Slovenia Introduction: The development of blastocyst vitrification has significantly changed the approach to embryo transfer. In cases where there is a high risk for developing ovarian hyperstimulation syndrome, all embryos can be vitrified and transferred in
subsequent menstrual cycles. On the other hand, vitrification of surplus embryos at the time of transfer allows for higher cumulative pregnancy rates. The optimal method of endometrium preparation for frozen-thawed embryo transfer (FET) still remains uncertain. The aim of this study was to compare the outcomes of vitrifiedwarmed blastocyst transfers in natural and artificially prepared cycles. Methods: All vitrified-warmed blastocyst transfers performed in the last two years (2013 and 2014) at our IVF centre were included in this retrospective study. In women with predictable and regular ovulatory cycles, FETs were performed in natural cycles without hCG triggering. In patients with irregular and anovulatory cycles, FETs were performed in artificially prepared cycle using the combination of oestradiol and micronized progesterone without GnRH agonist suppression. Patients’ characteristics, treatment parameters and pregnancy outcomes were compared using Pearson’s Chi-squared test and Student’s t-test. Results: In the study period, 835 vitrified-warmed blastocyst transfers were performed in natural and 278 in artificially prepared cycles. There were no statistically significant differences in patients’ characteristics and treatment parameters between both groups, with the exception of the average number of transferred embryos (1.30 in natural cycles vs. 1.41 in artificial cycles, p < 0.05). The biochemical pregnancy rate observed was higher in artificial cycles (8.90% vs. 17.64%), but there were no statistically significant differences in clinical pregnancy rate (36.03% vs. 34.89%), implantation rate (31.26% vs. 28.94%), abortion rate (14.54% vs. 21.00%) and live birth/ongoing pregnancy rate (30.53% vs. 25.18%) in natural compared to artificial cycles. Conclusion: Vitrified-warmed blastocyst transfers in natural and artificially prepared cycles are equally successful in terms of implantation, ongoing pregnancy and live birth rate. The outcome of vitrified-warmed blastocyst transfer in natural as well as artificial cycles appears to be comparable to blastocyst transfer in fresh IVF cycles. http://dx.doi.org/10.1016/j.ejogrb.2016.07.020 The impact of staging laparoscopy on treatment strategy in advanced ovarian cancer Borut Kobal 1,∗ , Branko Cvjeticanin 2 , Matija 3 , Olga Cerar 3 ˇ Barbiˇc 1 , Leon Megliˇc 2 , Erik Skof 1
University Medical Centre Ljubljana, Division of Gynaecology and Obstetrics, Department of Gynaecology; Faculty of Medicine, University of Ljubljana, Slovenia 2 University Medical Centre Ljubljana, Division of Gynaecology and Obstetrics, Department of Gynaecology, Slovenia 3 Institute of oncology Ljubljana, Slovenia Introduction: Complete primary cytoreductive surgery (PCS) is the most important prognostic factor for progression free survival (PFS) and overall survival (OS) in patients with advanced (FIGO stage III) ovarian cancer (AOC). In patients with poor general conditions or with heavy disease burden, complete PCS is difficult to achieve. Various patterns of abdominal disease spread represent biological aggressiveness affect prognosis and demands visual evaluation before planning treatment strategy. Beside imaging methods, laparoscopic pretreatment evaluation of resectability was proposed to more accurately identify those patients that can not be completely resected. In such cases neoadjuvant chemotherapy (NACT), followed with interval debulking surgery (IDS) is proposed. We present the preliminary results of treatment with NACT and
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) 251–263
integrated family planning services has in relation to curbing excess maternal mortality from preventable causes. http://dx.doi.org/10.1016/j.ejogrb.2016.07.016 Efficacy of hysteroscopy with local endometrial injury in patients with recurrent implantation failure ´ T. Bizjak, M. J. Knez ∗ , V. Kovaˇc, J. Pukl Batistic, Reljiˇc Department of Reproductive Medicine and Gynaecologic Endocrinology, University Medical Centre Maribor, Maribor, Slovenia Introduction: Treatment of recurrent implantation failure represents one of the greatest challenges in reproductive medicine today. Low embryo quality and reduced endometrial receptivity are considered as the most important causes. Local endometrial injury is a promising procedure that could enhance endometrial receptivity, but the evidence of its effects is still controversial. The aim of the study was to evaluate the benefit of hysteroscopy with local endometrial injury (LEI) in patients with unexplained recurrent implantation failure (RIF). Methods: The retrospective, case-controlled study included 378 women (age < 40 years, at least three previous embryo transfers with failed implantation, available good quality embryos and without intrauterine pathology) in a period from May 2011 to December 2014. Women in the intervention group (n = 104) underwent hysteroscopy with LEI in the three-month period before embryo transfer. Women in the control group (n = 274) did not undergo hysteroscopy with LEI. Short antagonist or long agonist protocols with recombinant FSH were used for ovarian stimulation. All patients were treated with IVF/ICSI procedure. Results: There were no significant differences between the intervention and control group in the mean patients’ age (33.76 vs. 34.24 years), number of previous IVF/ICSI cycles (4.21 vs. 4.37), duration of stimulation (10.05 vs. 10.44 days), number of oocytes retrieved (12.31 vs. 11.31), ICSI rate (66.35% vs. 64.97%), fertilisation rate (56.21% vs. 55.34%), number of good quality embryos (4.53 vs. 4.09) and the number of transferred embryos (1.79 vs. 1.86). Higher clinical pregnancy and implantation rates were observed in the intervention group compared to the control group (42.30% and 30.87% vs. 32.23% and 22.44%), however these differences were not of statistical significance. Conclusion: Our results suggest that hysteroscopy with local injury to the endometrium prior to ovarian stimulation for IVF/ICSI can improve implantation and pregnancy rates in women experiencing RIF. However, large studies are needed to confirm these findings. http://dx.doi.org/10.1016/j.ejogrb.2016.07.019 The future of IVF: vitrified-warmed blastocyst transfer J. Knez ∗ , B. Kovaˇciˇc, M. Reljiˇc Department of Reproductive Medicine and Gynaecologic Endocrinology, University Medical Centre Maribor, Maribor, Slovenia Introduction: The development of blastocyst vitrification has significantly changed the approach to embryo transfer. In cases where there is a high risk for developing ovarian hyperstimulation syndrome, all embryos can be vitrified and transferred in
subsequent menstrual cycles. On the other hand, vitrification of surplus embryos at the time of transfer allows for higher cumulative pregnancy rates. The optimal method of endometrium preparation for frozen-thawed embryo transfer (FET) still remains uncertain. The aim of this study was to compare the outcomes of vitrifiedwarmed blastocyst transfers in natural and artificially prepared cycles. Methods: All vitrified-warmed blastocyst transfers performed in the last two years (2013 and 2014) at our IVF centre were included in this retrospective study. In women with predictable and regular ovulatory cycles, FETs were performed in natural cycles without hCG triggering. In patients with irregular and anovulatory cycles, FETs were performed in artificially prepared cycle using the combination of oestradiol and micronized progesterone without GnRH agonist suppression. Patients’ characteristics, treatment parameters and pregnancy outcomes were compared using Pearson’s Chi-squared test and Student’s t-test. Results: In the study period, 835 vitrified-warmed blastocyst transfers were performed in natural and 278 in artificially prepared cycles. There were no statistically significant differences in patients’ characteristics and treatment parameters between both groups, with the exception of the average number of transferred embryos (1.30 in natural cycles vs. 1.41 in artificial cycles, p < 0.05). The biochemical pregnancy rate observed was higher in artificial cycles (8.90% vs. 17.64%), but there were no statistically significant differences in clinical pregnancy rate (36.03% vs. 34.89%), implantation rate (31.26% vs. 28.94%), abortion rate (14.54% vs. 21.00%) and live birth/ongoing pregnancy rate (30.53% vs. 25.18%) in natural compared to artificial cycles. Conclusion: Vitrified-warmed blastocyst transfers in natural and artificially prepared cycles are equally successful in terms of implantation, ongoing pregnancy and live birth rate. The outcome of vitrified-warmed blastocyst transfer in natural as well as artificial cycles appears to be comparable to blastocyst transfer in fresh IVF cycles. http://dx.doi.org/10.1016/j.ejogrb.2016.07.020 The impact of staging laparoscopy on treatment strategy in advanced ovarian cancer Borut Kobal 1,∗ , Branko Cvjeticanin 2 , Matija 3 , Olga Cerar 3 ˇ Barbiˇc 1 , Leon Megliˇc 2 , Erik Skof 1
University Medical Centre Ljubljana, Division of Gynaecology and Obstetrics, Department of Gynaecology; Faculty of Medicine, University of Ljubljana, Slovenia 2 University Medical Centre Ljubljana, Division of Gynaecology and Obstetrics, Department of Gynaecology, Slovenia 3 Institute of oncology Ljubljana, Slovenia Introduction: Complete primary cytoreductive surgery (PCS) is the most important prognostic factor for progression free survival (PFS) and overall survival (OS) in patients with advanced (FIGO stage III) ovarian cancer (AOC). In patients with poor general conditions or with heavy disease burden, complete PCS is difficult to achieve. Various patterns of abdominal disease spread represent biological aggressiveness affect prognosis and demands visual evaluation before planning treatment strategy. Beside imaging methods, laparoscopic pretreatment evaluation of resectability was proposed to more accurately identify those patients that can not be completely resected. In such cases neoadjuvant chemotherapy (NACT), followed with interval debulking surgery (IDS) is proposed. We present the preliminary results of treatment with NACT and