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41 Oocyte donation program: how to improve the results
S110
9th Annual Meeting, Mediterranean Society for Reproductive Medicine
41 Oocyte donation program: how to improve the results A. Smirnova, M. Anshina, N. Shamugia, E. Ablyaeva, I. Kalinina, K. Iliyn, S. Sergeev IVF&Genetics Centre “FertiMed”, Moscow, Russia Oocyte donation is the only way to become mother for women with bilateral oophorectomy or premature ovarian failure but this method also may be successfully used in women with previous numerous IVF failures. In our centre the clinical pregnancy rate in oocyte donation program is 65% after fresh blastocyst transfer and 45% after frozen//thawed blastocyst transfer. But some women do not achieve pregnancy in spite of donor’s oocytes usage. For these women we proposed combined or dual embryo transfer. Methods: In patients with regular ovulation and psychological rejection of donor oocytes only we perform IVF in natural cycle with simultaneous transfer of cryopreserved embryo(s) from donor oocytes and fresh embryo gotten from patient’s oocyte. Eleven patients with the history of 5 8 unsuccessful IVF underwent follicle aspiration 28 32 hours after hCG injection in the natural cycle. All fresh and frozen/thawed embryos were transferred simultaneously on day 5 after puncture. In 6 women with history of hypergonadotropic amenorrhea and more than 3 failed fresh or frozen/thawed blastocyst transfer dual fresh embryo transfer was done: first one on day 3 and second one on day 5 after donor oocyte retrieval. Results: The pregnancy rate in group with combined embryo transfer was 55%. All women conceived after dual embryo transfer: five with singletons and one with twins. Conclusion: Combined and dual embryo transfer allows to improve the results of oocyte donation program. 42 In-vitro human follicle culture J. Smitz UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium Progress has been made in improving the methods for in vitro growth and maturation of ovarian follicles by making use of different animal models including rodents, ruminants, primates. Strategies used in follicle culture must be orientated around the activation and sustained in vitro growth of primordial, primary or secondary follicles, as these follicles are present in the cortex. Although longterm ruminant and primate follicle culture systems are a better model for human follicle culture than shorter term rodent follicle culture systems, ultimately the best model for the therapeutic derivation of fertile human oocytes is a human follicle culture system. As human follicle culture will make use of cryopreserved ovarian tissues the culture systems must be developed for frozen and thawed tissues. Progress is hampered by the limited availability of accurate biological information on the genes and growth factors that govern follicle growth and oocyte development to maturity in vivo in humans. It is
important to understand the consequences of extended follicle culture on key programming events during oogenesis and embryogenesis. 43 The timing of ART treatment in class I and II of endometriosis: Supporting the role of surgery E. Somigliana Dept Obstet-Gynecol, Fondazione C` a Granda, Ospedale Maggiore Policlinico, Milan, Italy There is a general lack of strong clinical evidence in the field of surgery for endometriosis-related infertility. Endometriosis stage I II represents an exception in this area. Noteworthy, even if generally accepted, the benefits of the intervention for endometriosis stage III IV have never been demonstrated. On these bases, it is somehow surprising that we have herein to justify the role of surgery for endometriosis stage I II. The most criticized point is the magnitude of the benefit of surgery that is generally considered limited. Focussing on the rate of deliveries of the two available RCTs, the experimental event rate is 26% versus a control event rate of 18%. The absolute benefit increase of 8% translates into a number needed to treat (NNT) of 12 (twelve laparoscopies should be performed to obtain one additional pregnancy compared with no treatment). This undoubtedly compares unfavourably with the rate of success of Assisted Reproductive Technologies (ART) and of IVF in particular. One may thus wonder about the necessity to expose the women to the surgical risks and costs given this relatively small benefit. As such, it is now mostly stated that ART should be offered as first-line treatment. On the other hand, surgery may offer additional benefits on pain symptoms and provide a definite diagnosis thus allowing for a complete information to the couple and for drawing an optimal management strategy. Moreover, and of utmost importance, it has to be pointed out that a consistent proportion of women do not refer for ART treatments or withdraw prematurely because of fears about the procedure. These women, unfortunately, are generally forgotten when reporting the rate of success of ART. To date, a comprehensive and personalized approach in the decision-making process to identify the best option for the couples should be adopted. It is advisable to clearly expose the pros and cons of diagnostic laparoscopy and to investigate the beliefs of the couples regarding ARTs. The ultimate aim is to assume a shared decision with the patients so that the overall chances of pregnancy can be maximised. 44 Safety in laparoscopy V. Tanos Department of Obstetrics and Gynaecology, Aretaeio Hospital, Nicosia, Cyprus Introduction: Patient’s safety in laparoscopy depends upon patient selection, surgeon’s training and skills, equipment fidelity, instruments reliability and hospital directives and policies.
9th Annual Meeting, Mediterranean Society for Reproductive Medicine
41 Oocyte donation program: how to improve the results A. Smirnova, M. Anshina, N. Shamugia, E. Ablyaeva, I. Kalinina, K. Iliyn, S. Sergeev IVF&Genetics Centre “FertiMed”, Moscow, Russia Oocyte donation is the only way to become mother for women with bilateral oophorectomy or premature ovarian failure but this method also may be successfully used in women with previous numerous IVF failures. In our centre the clinical pregnancy rate in oocyte donation program is 65% after fresh blastocyst transfer and 45% after frozen//thawed blastocyst transfer. But some women do not achieve pregnancy in spite of donor’s oocytes usage. For these women we proposed combined or dual embryo transfer. Methods: In patients with regular ovulation and psychological rejection of donor oocytes only we perform IVF in natural cycle with simultaneous transfer of cryopreserved embryo(s) from donor oocytes and fresh embryo gotten from patient’s oocyte. Eleven patients with the history of 5 8 unsuccessful IVF underwent follicle aspiration 28 32 hours after hCG injection in the natural cycle. All fresh and frozen/thawed embryos were transferred simultaneously on day 5 after puncture. In 6 women with history of hypergonadotropic amenorrhea and more than 3 failed fresh or frozen/thawed blastocyst transfer dual fresh embryo transfer was done: first one on day 3 and second one on day 5 after donor oocyte retrieval. Results: The pregnancy rate in group with combined embryo transfer was 55%. All women conceived after dual embryo transfer: five with singletons and one with twins. Conclusion: Combined and dual embryo transfer allows to improve the results of oocyte donation program. 42 In-vitro human follicle culture J. Smitz UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium Progress has been made in improving the methods for in vitro growth and maturation of ovarian follicles by making use of different animal models including rodents, ruminants, primates. Strategies used in follicle culture must be orientated around the activation and sustained in vitro growth of primordial, primary or secondary follicles, as these follicles are present in the cortex. Although longterm ruminant and primate follicle culture systems are a better model for human follicle culture than shorter term rodent follicle culture systems, ultimately the best model for the therapeutic derivation of fertile human oocytes is a human follicle culture system. As human follicle culture will make use of cryopreserved ovarian tissues the culture systems must be developed for frozen and thawed tissues. Progress is hampered by the limited availability of accurate biological information on the genes and growth factors that govern follicle growth and oocyte development to maturity in vivo in humans. It is
important to understand the consequences of extended follicle culture on key programming events during oogenesis and embryogenesis. 43 The timing of ART treatment in class I and II of endometriosis: Supporting the role of surgery E. Somigliana Dept Obstet-Gynecol, Fondazione C` a Granda, Ospedale Maggiore Policlinico, Milan, Italy There is a general lack of strong clinical evidence in the field of surgery for endometriosis-related infertility. Endometriosis stage I II represents an exception in this area. Noteworthy, even if generally accepted, the benefits of the intervention for endometriosis stage III IV have never been demonstrated. On these bases, it is somehow surprising that we have herein to justify the role of surgery for endometriosis stage I II. The most criticized point is the magnitude of the benefit of surgery that is generally considered limited. Focussing on the rate of deliveries of the two available RCTs, the experimental event rate is 26% versus a control event rate of 18%. The absolute benefit increase of 8% translates into a number needed to treat (NNT) of 12 (twelve laparoscopies should be performed to obtain one additional pregnancy compared with no treatment). This undoubtedly compares unfavourably with the rate of success of Assisted Reproductive Technologies (ART) and of IVF in particular. One may thus wonder about the necessity to expose the women to the surgical risks and costs given this relatively small benefit. As such, it is now mostly stated that ART should be offered as first-line treatment. On the other hand, surgery may offer additional benefits on pain symptoms and provide a definite diagnosis thus allowing for a complete information to the couple and for drawing an optimal management strategy. Moreover, and of utmost importance, it has to be pointed out that a consistent proportion of women do not refer for ART treatments or withdraw prematurely because of fears about the procedure. These women, unfortunately, are generally forgotten when reporting the rate of success of ART. To date, a comprehensive and personalized approach in the decision-making process to identify the best option for the couples should be adopted. It is advisable to clearly expose the pros and cons of diagnostic laparoscopy and to investigate the beliefs of the couples regarding ARTs. The ultimate aim is to assume a shared decision with the patients so that the overall chances of pregnancy can be maximised. 44 Safety in laparoscopy V. Tanos Department of Obstetrics and Gynaecology, Aretaeio Hospital, Nicosia, Cyprus Introduction: Patient’s safety in laparoscopy depends upon patient selection, surgeon’s training and skills, equipment fidelity, instruments reliability and hospital directives and policies.