- Email: [email protected]
ICSI treatment?
Abstracts - Aspire: Optimizing infertility management in Asia
embryo. LH/LHR presents with a dynamic pattern in human embryos and endometrium during the implantation window, strongly suggesting that LH has a directly effect (paracrine and autocrine action) on the implantation site. AC-001 A new method for improving pregnancy rates in frequent repeaters who exhibit the oestrogen rebound phenomenon Yoshimasa Y, Makita M, Yokota M, Yokota H, Sato S Yokota Ob/Gyn Clinic Correspondence: [email protected] Introduction: It is imperative to improve the ovarian response in women with persistent infertility. The aim of this study was to evaluate oestrogen rebound plus follicle-stimulating hormone (FSH) by gonadotrophin-releasing hormone agonist (GnRHa) flare-up for patients with frequent IVF failures. Materials/Methods: The study group consisted of 88 patients (88 cycles) who had been treated with a prior short protocol or long protocol. In this randomized prospective study, the women were divided into two groups. The first group was given a repeat treatment using the same protocol (short: 20 patients, 20 cycles; long: 24 patients, 24 cycles). The second group (44 patients, 44 cycles) was treated with oestrogen rebound plus flare-up. The second group had undergone frequent prior treatment cycles (average 3.8 ± 2.1). The efficacy of the treatment for the second group was compared with that of the first group. We evaluated the maximal serum oestradiol levels, follicular development, dose and duration of gonadotrophin treatment, implantation rate and pregnancy rate. Results: The patients in the oestrogen rebound plus flare-up group were given the same dose of gonadotrophin for the same duration as in their prior treatment cycle. The cancellation rate decreased from 21.2% to 13%, but was not significant. It was noted that the pregnancy rate per embryo transfer significantly improved from 19.4% (7/36) to 41.0% (16/39; P < 0.05). The miscarriage rate decreased from 42.9% (3/7) to 18.8% (3/16; P < 0.05). Conclusion: Exogenous oestrogen administration with Premarin plus flare-up appears to enhance fertility for the frequent repeater. AC-002 Analysis of 94 ectopic pregnancies after IVF Xiao HM1, Gong F, Mao ZH, Zhang H, Xiao XM, Li XH, Lu GX Institute of Human Reproduction and Stem Cell Engineering of Central South University; Reproductive and Genetic Hospital of CITICXiangya 1Correspondence: [email protected] Introduction: The first IVF pregnancy was an ectopic pregnancy, and the frequency of ectopic pregnancies has increased with the use of assisted reproductive technologies. There are many available reports documenting the different causes of ectopic pregnancy. The objective of this study was to assess retrospectively the evidence and affecting factors of ectopic pregnancy in 94 patients after assisted conception. Materials/Methods: The indications and methods of assisted conception of 94 ectopic pregnancies were analysed retrospectively. The ectopic pregnancies occurred after receiving IVF, intracytoplasmic sperm injection (ICSI) or freezing–thawing embryo transfer (FET) during March 1995 to September 2005. Results: A total of 6007 embryo transfers were performed and 2322 clinical pregnancies were obtained, among which 94 were ectopics, and the rate of ectopic pregnancy was 4.05% (94/2322). Ninetytwo were Fallopian pregnancies, with an incidence rate of 3.96%, constituting 97.87% (92/94) of all ectopic pregnancies. There were two ectopic pregnancies in other parts (2.32%, one in the abdominal cavity and one cornual pregnancy). Twenty ectopic pregnancies combined with normal pregnancy occurred in 0.86% (20/2322) and constituted 21.28% (20/94) of total ectopic pregnancies; two bilateral Fallopian pregnancies combined with intrauterine pregnancy occurred in 0.86% (2/2322). Among all ectopic pregnancies, 86 underwent assisted conception because of Fallopian factor and/or pelvic adherence (91.49%) and 24 had a history of ectopic pregnancy
18
(25.53%). The difference of pregnancy rates between IVF-ET, ICSI and FET was not significant (0.1 < P < 0.25). The ectopic pregnancy rate of the IVF-ET group was significantly higher than that of ICSI or FET (P < 0.025 and P < 0.05); the ectopic pregnancy rate of the FET group also was higher than that of the ICSI group (P < 0.025). Conclusion: The ectopic pregnancy rate after IVF was higher than that of the normal population, and the main cause of ectopic pregnancy was Fallopian tube abnormality and history of operation on Fallopian tubes. AC-003 Are Asian women different from non-Asian women in IVF/ICSI treatment? Andrew K1, Tan CY, Leung P IVF Australia 1Correspondence: [email protected] Introduction: We observed that Asian women behaved differently from non-Asian women both demographically and in response to our standard stimulation regime when they undertook IVF/ intracytoplasmic sperm injection (ICSI), and set out to prove whether this was so. Materials/Methods: One-hundred and eighty-five first-generation Asian patients from January 1, 2001 to December 31, 2004 were included in the study group and 540 non-Asian patients in the control for this retrospective cohort study. We included only each woman’s first fresh non-donor IVF or ICSI cycle. The comparison of pregnancy outcomes was performed using the univariate and logistic regression analysis. Results: Based on univariate analysis, we found that Asian women were much older (37.4 versus 34.6); the duration of infertility much longer (44.2 versus 33.4 months); and the dosages of gonadotrophin used much higher (3,455.7 versus 2,718.1 IU) than for non-Asian women. We also found that there were differences in clinical outcomes between these two groups: the number of oocytes obtained (8.5 versus 10.8); the number of embryos fertilized (4.6 versus 6.0); the number of embryos cryopreserved (0.9 versus 1.8); and the clinical pregnancy rate (15.7% versus 26.7%) in Asian women were much lower than in non-Asian women. After adjusting for confounders and clinical outcomes using the logistic regression model, we found that ‘Asianness’ in itself did not explain the apparent difference in pregnancy rate of the two groups. The difference could well be due to the number of embryos transferred (P = 0.000); the number of embryos fertilized (P = 0.014); and the duration of infertility (P = 0.028). Conclusion: We found that Asian women achieved a significantly lower clinical pregnancy rate than their non-Asian counterparts. Instead of racial difference, factors such as number of embryos transferred, number of embryos fertilized and duration of infertility could explain the difference in pregnancy rate. AC-004 Birth outcomes and infant development after blastocyst culture with or without trophectoderm biopsy Jansen R1, Gee A, McArthur S, De Boer KA Sydney IVF 1Correspondence: [email protected] Introduction: Blastocyst biopsy is highly effective for elective single embryo transfer, and is associated with low rates of subsequent miscarriage. This study aimed to determine through retrospective analysis if blastocyst culture or biopsy at the stage of blastocyst affects birth or infant outcomes compared with naturally conceived children. Materials/Methods: Between March 1999 and December 2001 at Sydney IVF, 450 pregnancies resulted from embryo transfer after 5–6 days of culture in Cook Sydney IVF Cleavage Medium and Blastocyst Medium (Cook Australia, Brisbane) in MINC incubators and low (5%) oxygen conditions, producing 568 live births (blastocyst cohort). Birth data and medical follow-up were obtained for 428 pregnancies (546 infants, or 96%) and compared
embryo. LH/LHR presents with a dynamic pattern in human embryos and endometrium during the implantation window, strongly suggesting that LH has a directly effect (paracrine and autocrine action) on the implantation site. AC-001 A new method for improving pregnancy rates in frequent repeaters who exhibit the oestrogen rebound phenomenon Yoshimasa Y, Makita M, Yokota M, Yokota H, Sato S Yokota Ob/Gyn Clinic Correspondence: [email protected] Introduction: It is imperative to improve the ovarian response in women with persistent infertility. The aim of this study was to evaluate oestrogen rebound plus follicle-stimulating hormone (FSH) by gonadotrophin-releasing hormone agonist (GnRHa) flare-up for patients with frequent IVF failures. Materials/Methods: The study group consisted of 88 patients (88 cycles) who had been treated with a prior short protocol or long protocol. In this randomized prospective study, the women were divided into two groups. The first group was given a repeat treatment using the same protocol (short: 20 patients, 20 cycles; long: 24 patients, 24 cycles). The second group (44 patients, 44 cycles) was treated with oestrogen rebound plus flare-up. The second group had undergone frequent prior treatment cycles (average 3.8 ± 2.1). The efficacy of the treatment for the second group was compared with that of the first group. We evaluated the maximal serum oestradiol levels, follicular development, dose and duration of gonadotrophin treatment, implantation rate and pregnancy rate. Results: The patients in the oestrogen rebound plus flare-up group were given the same dose of gonadotrophin for the same duration as in their prior treatment cycle. The cancellation rate decreased from 21.2% to 13%, but was not significant. It was noted that the pregnancy rate per embryo transfer significantly improved from 19.4% (7/36) to 41.0% (16/39; P < 0.05). The miscarriage rate decreased from 42.9% (3/7) to 18.8% (3/16; P < 0.05). Conclusion: Exogenous oestrogen administration with Premarin plus flare-up appears to enhance fertility for the frequent repeater. AC-002 Analysis of 94 ectopic pregnancies after IVF Xiao HM1, Gong F, Mao ZH, Zhang H, Xiao XM, Li XH, Lu GX Institute of Human Reproduction and Stem Cell Engineering of Central South University; Reproductive and Genetic Hospital of CITICXiangya 1Correspondence: [email protected] Introduction: The first IVF pregnancy was an ectopic pregnancy, and the frequency of ectopic pregnancies has increased with the use of assisted reproductive technologies. There are many available reports documenting the different causes of ectopic pregnancy. The objective of this study was to assess retrospectively the evidence and affecting factors of ectopic pregnancy in 94 patients after assisted conception. Materials/Methods: The indications and methods of assisted conception of 94 ectopic pregnancies were analysed retrospectively. The ectopic pregnancies occurred after receiving IVF, intracytoplasmic sperm injection (ICSI) or freezing–thawing embryo transfer (FET) during March 1995 to September 2005. Results: A total of 6007 embryo transfers were performed and 2322 clinical pregnancies were obtained, among which 94 were ectopics, and the rate of ectopic pregnancy was 4.05% (94/2322). Ninetytwo were Fallopian pregnancies, with an incidence rate of 3.96%, constituting 97.87% (92/94) of all ectopic pregnancies. There were two ectopic pregnancies in other parts (2.32%, one in the abdominal cavity and one cornual pregnancy). Twenty ectopic pregnancies combined with normal pregnancy occurred in 0.86% (20/2322) and constituted 21.28% (20/94) of total ectopic pregnancies; two bilateral Fallopian pregnancies combined with intrauterine pregnancy occurred in 0.86% (2/2322). Among all ectopic pregnancies, 86 underwent assisted conception because of Fallopian factor and/or pelvic adherence (91.49%) and 24 had a history of ectopic pregnancy
18
(25.53%). The difference of pregnancy rates between IVF-ET, ICSI and FET was not significant (0.1 < P < 0.25). The ectopic pregnancy rate of the IVF-ET group was significantly higher than that of ICSI or FET (P < 0.025 and P < 0.05); the ectopic pregnancy rate of the FET group also was higher than that of the ICSI group (P < 0.025). Conclusion: The ectopic pregnancy rate after IVF was higher than that of the normal population, and the main cause of ectopic pregnancy was Fallopian tube abnormality and history of operation on Fallopian tubes. AC-003 Are Asian women different from non-Asian women in IVF/ICSI treatment? Andrew K1, Tan CY, Leung P IVF Australia 1Correspondence: [email protected] Introduction: We observed that Asian women behaved differently from non-Asian women both demographically and in response to our standard stimulation regime when they undertook IVF/ intracytoplasmic sperm injection (ICSI), and set out to prove whether this was so. Materials/Methods: One-hundred and eighty-five first-generation Asian patients from January 1, 2001 to December 31, 2004 were included in the study group and 540 non-Asian patients in the control for this retrospective cohort study. We included only each woman’s first fresh non-donor IVF or ICSI cycle. The comparison of pregnancy outcomes was performed using the univariate and logistic regression analysis. Results: Based on univariate analysis, we found that Asian women were much older (37.4 versus 34.6); the duration of infertility much longer (44.2 versus 33.4 months); and the dosages of gonadotrophin used much higher (3,455.7 versus 2,718.1 IU) than for non-Asian women. We also found that there were differences in clinical outcomes between these two groups: the number of oocytes obtained (8.5 versus 10.8); the number of embryos fertilized (4.6 versus 6.0); the number of embryos cryopreserved (0.9 versus 1.8); and the clinical pregnancy rate (15.7% versus 26.7%) in Asian women were much lower than in non-Asian women. After adjusting for confounders and clinical outcomes using the logistic regression model, we found that ‘Asianness’ in itself did not explain the apparent difference in pregnancy rate of the two groups. The difference could well be due to the number of embryos transferred (P = 0.000); the number of embryos fertilized (P = 0.014); and the duration of infertility (P = 0.028). Conclusion: We found that Asian women achieved a significantly lower clinical pregnancy rate than their non-Asian counterparts. Instead of racial difference, factors such as number of embryos transferred, number of embryos fertilized and duration of infertility could explain the difference in pregnancy rate. AC-004 Birth outcomes and infant development after blastocyst culture with or without trophectoderm biopsy Jansen R1, Gee A, McArthur S, De Boer KA Sydney IVF 1Correspondence: [email protected] Introduction: Blastocyst biopsy is highly effective for elective single embryo transfer, and is associated with low rates of subsequent miscarriage. This study aimed to determine through retrospective analysis if blastocyst culture or biopsy at the stage of blastocyst affects birth or infant outcomes compared with naturally conceived children. Materials/Methods: Between March 1999 and December 2001 at Sydney IVF, 450 pregnancies resulted from embryo transfer after 5–6 days of culture in Cook Sydney IVF Cleavage Medium and Blastocyst Medium (Cook Australia, Brisbane) in MINC incubators and low (5%) oxygen conditions, producing 568 live births (blastocyst cohort). Birth data and medical follow-up were obtained for 428 pregnancies (546 infants, or 96%) and compared