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Cervical mucus score at the time of intrauterine insemination and its association with conception probability
2. Levy G, Hill MJ, Ramirez CI, Correa L, Ryan ME, DeCherney AH, Levens ED, Whitcomb BW.The use of follicle flushing during oocyte retrieval in assisted reproductive technologies: a systematic review and meta-analysis. Hum Reprod. 2012;27:2373-9.
P-231 Tuesday, October 20, 2015 CERVICAL MUCUS SCORE AT THE TIME OF INTRAUTERINE INSEMINATION AND ITS ASSOCIATION WITH CONCEPTION PROBABILITY. E. A. Evans-Hoeker,a,b A. Liberty,c A. Z. Steiner.b aReproductive Medicine and Fertility, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA; bObstetrics and Gynecology, University of North Carolina, Raleigh, NC; cUniversity of North Carolina School of Medicine, Chapel Hill, NC. OBJECTIVE: Studies demonstrate that cervical mucus scores at time of ovulation predict fecundability among couples attempting to conceive naturally. It is unknown if this is due to the cervical mucus (CM) itself or associated factors. The aims of this study were to determine 1) the prevalence of fertile type CM, 2) factors associated with fertile type CM, and 3) whether fertile type CM predicts pregnancy following intrauterine insemination (IUI). DESIGN: Clinical cohort study. MATERIALS AND METHODS: All clinical providers were trained on CM scoring. Providers recorded the CM score at time of insemination. CM was classified as absent, type 3 or type 4. Fertile type CM was defined as types 3 and 4. This analysis includes all cycles with CM type documented at the time of IUI performed at our academic center between 8/2012-7/ 2013. Data was collected regarding patient demographics, medical history, treatment types and outcome, and were analyzed using regression models with a cluster term. RESULTS: One hundred and seventy nine women contributed 321 IUI cycles during the study time period. One hundred eighty cycles (56%) had documented CM type and were included in our analysis. There were no differences between cycles with and those without documented CM. Women (n¼125) were typically Caucasian (76%), with an average age of 34.4 years, body mass index (BMI) of 25.4 kg/m2 and a diagnosis of unexplained (29%) or male factor (22%) infertility. A majority of cycles utilized oral ovulation induction agents (73%) and ovulation prediction kit monitoring for IUI timing (67%). Gonadotropins were used in 18% of cycles and 9% were un-medicated. Fertile type CM was present in 91% of cycles. There were no differences between fertile versus non-fertile type CM in regards to patient age, race, BMI, AMH, number of follicles on midcycle ultrasound, endometrial thickness, method used for IUI timing, fertility medications, or infertility diagnosis. Cycle pregnancy rate did not differ between fertile type CM (17%) and non-fertile type CM (19%), p¼0.75. CONCLUSIONS: Most patients undergoing IUI demonstrate fertile type cervical mucus on the day of IUI. Type of cervical mucus does not predict probability of conceiving following IUI. Therefore, it is likely the cervical mucus itself that facilitates fertilization during procreative intercourse. P-232 Tuesday, October 20, 2015 TO WHAT DEGREE SHOULD THE ZONA PELLUCIDA BE CUT OPEN IN ASSISTED HATCHING FOR BEST CLINICAL RESULTS? H. Watanabe, R. Suzuki, M. Kobayashi, H. Hasegawa, K. Tsukamoto, S. Saitou, J. Kobayashi. Kanagawa Ladies Clinic, Yokohama, Japan. OBJECTIVE: Assisted hatching is widely used to improve implantation by opening or thinning of Zona Pellucida artificially. However, there is no consensus to what degree the Zona Pellucida should be cut open for best clinical results. We compared the size of the opening of the Zona Pellucida with clinical results, using Saturn 5 ActiveTM (Research Instruments Ltd. UK) for lazar assisted hatching (LAH) and EmbryoScopeBR(Vitrolife AB. Sweden) for continuous observation. DESIGN: prospective randmaized study. MATERIALS AND METHODS: Cryopreserved blastocysts (SBB grade) which were donated by patients for research were used for this study. LAH was performed on warmed blastocysts after one hour of culturing. The blastocysts were divided into 5 groups by the size of the opening for assisted hatching: Group1 has been performed 50% opening (n¼9) and Group2 has been performed 30% opening (n¼12). Group3 has
FERTILITY & STERILITYÒ
been conducted 12 micrometers opening (n¼12) so as Group4 has been done the thinning (n¼12). For Group5 no LAH has been performed (n¼12).We observed the start timing of hatching, time of hatching, hatched rate and frequency of contraction until blastocysts finished hatching by Time Lapse after LAH. RESULTS: The time until the initiating of hatching was significantly longer for groups 4 and 5 when compared to other groups. In fact, blastocysts of groups 4 and 5 needed 1-3 times of contraction to start hatching as found by Time Lapse observation. Time of hatching for Group 3 was significantly slower than for other groups. In that group, embryos were stuck by the small hole of the Zona Pellucida and repeated contraction occurred during hatching. The hatched rates were significantly lower in groups 3, 4 and 5 when compared to groups 1 and 2. Frequency of contraction until the blastocysts finished hatching was higher for groups 3, 4 and 5. There was no significant difference between groups 1 and 2. CONCLUSIONS: From this study, we found that adequate LAH improve subsequent hatching rates. In fact, the Zona Pellucida should not merely be thinned by rather cut open, at least 30%.
ART - IN VITRO FERTILIZATION P-233 Tuesday, October 20, 2015 NOVEL APPROACH FOR MANAGING DECREASED FERTILIZATION WITH SEQUENTIAL ARTIFICIAL OOCYTE ACTIVATION: PROSPECTIVE RANDOMIZED CLINICAL TRIAL. M. Fawzy,a H. Abdelghaffar,b A. Alaboudy,a M. Sabry,b H. Kasem,a M. Y. Abdel-Rahman,b M. Gad,a A. Metwallley,c E. Othman,d A. Mahran,d S. M. Rasheed.b aIbnsina IVF Center, Sohag, Egypt; bSohag Faculty of Medicine, Sohag, Egypt; cAlBarka IVF Center, Manama, Bahrain; d Banon IVF Center, Assiut, Egypt. OBJECTIVE: To compare outcomes between two different strategies of artificial Oocyte activation: Calcium Ionophore activation protocol versus a novel sequential protocol using Ca Ionophore followed by Strontium Chloride, In cases of previously decreased fertilization ICSI cycles. DESIGN: Prospective Randomized Clinical Trial. MATERIALS AND METHODS: Patients with previous low fertilization who presented to Ibnsina IVF Center, Sohag, Egypt (private center), between January 2015 to March 2015 were recruited to undergo ICSI into this study. Mature Oocytes (840) collected from 69 patients injected and randomly assigned to two groups (420 each). Group I Oocytes activated artificially for 15 min in ready made Ca Ionophore (GM508 Cult-Active, GYNEMED, Germany) immediately after ICSI followed by culture in (GLOBAL TOTALÒ, LIFEGLOBALÒ, Canada). Group II Oocytes underwent sequential activation using Ca ionophore (GM508 Cult-Active, GYNEMED, Germany) same protocol followed by another activation step by washing and incubation for 60 min in Strontium Chloride (Sigma 69042). The Strontium Chloride Prepared in our laboratory at a concentration of 10 micromol/ml in culture media (GLOBAL TOTALÒ, LIFEGLOBALÒ, Canada). The activated oocytes cultured traditionally according to our protocol. All patients underwent Day 5 extended culture, and the embryos selected had been randomized either from group I or II to be transferred using closed envelope method.Outcome measures included: Fertilization rate, top quality embryos day at 3, blastocyst formation rate and finally pregnancy rate for each group. We compare the data of our two group with the Chi-square test. RESULTS: Study groups patients were similar regarding mean age, BMI, the dose of FSH/HMG used, number of oocytes collected and number of cycle days. There were a statistically significant increase in the rate of fertilization in group II versus group I (group II 69% versus group I 46% P value < 0.01). We documented higher blastocyst formation rate in group II versus group I (group II 59% compared to 38% group I P<0.0001). We documented a better pregnancy outcome in group II, but the difference is not statistically significant (P value equal 0.06). CONCLUSIONS: In our laboratory, We recorded a statistically significant improvement in multiple embryological parameters. The increased parameters with our novel approach of double artificial oocytes activation are fertilization rate and blastocyst formation rate. We reported a higher pregnancy rate with our novel oocytes activation method; however, the difference did not reach statistical significance. Moreover, we continue
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P-231 Tuesday, October 20, 2015 CERVICAL MUCUS SCORE AT THE TIME OF INTRAUTERINE INSEMINATION AND ITS ASSOCIATION WITH CONCEPTION PROBABILITY. E. A. Evans-Hoeker,a,b A. Liberty,c A. Z. Steiner.b aReproductive Medicine and Fertility, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA; bObstetrics and Gynecology, University of North Carolina, Raleigh, NC; cUniversity of North Carolina School of Medicine, Chapel Hill, NC. OBJECTIVE: Studies demonstrate that cervical mucus scores at time of ovulation predict fecundability among couples attempting to conceive naturally. It is unknown if this is due to the cervical mucus (CM) itself or associated factors. The aims of this study were to determine 1) the prevalence of fertile type CM, 2) factors associated with fertile type CM, and 3) whether fertile type CM predicts pregnancy following intrauterine insemination (IUI). DESIGN: Clinical cohort study. MATERIALS AND METHODS: All clinical providers were trained on CM scoring. Providers recorded the CM score at time of insemination. CM was classified as absent, type 3 or type 4. Fertile type CM was defined as types 3 and 4. This analysis includes all cycles with CM type documented at the time of IUI performed at our academic center between 8/2012-7/ 2013. Data was collected regarding patient demographics, medical history, treatment types and outcome, and were analyzed using regression models with a cluster term. RESULTS: One hundred and seventy nine women contributed 321 IUI cycles during the study time period. One hundred eighty cycles (56%) had documented CM type and were included in our analysis. There were no differences between cycles with and those without documented CM. Women (n¼125) were typically Caucasian (76%), with an average age of 34.4 years, body mass index (BMI) of 25.4 kg/m2 and a diagnosis of unexplained (29%) or male factor (22%) infertility. A majority of cycles utilized oral ovulation induction agents (73%) and ovulation prediction kit monitoring for IUI timing (67%). Gonadotropins were used in 18% of cycles and 9% were un-medicated. Fertile type CM was present in 91% of cycles. There were no differences between fertile versus non-fertile type CM in regards to patient age, race, BMI, AMH, number of follicles on midcycle ultrasound, endometrial thickness, method used for IUI timing, fertility medications, or infertility diagnosis. Cycle pregnancy rate did not differ between fertile type CM (17%) and non-fertile type CM (19%), p¼0.75. CONCLUSIONS: Most patients undergoing IUI demonstrate fertile type cervical mucus on the day of IUI. Type of cervical mucus does not predict probability of conceiving following IUI. Therefore, it is likely the cervical mucus itself that facilitates fertilization during procreative intercourse. P-232 Tuesday, October 20, 2015 TO WHAT DEGREE SHOULD THE ZONA PELLUCIDA BE CUT OPEN IN ASSISTED HATCHING FOR BEST CLINICAL RESULTS? H. Watanabe, R. Suzuki, M. Kobayashi, H. Hasegawa, K. Tsukamoto, S. Saitou, J. Kobayashi. Kanagawa Ladies Clinic, Yokohama, Japan. OBJECTIVE: Assisted hatching is widely used to improve implantation by opening or thinning of Zona Pellucida artificially. However, there is no consensus to what degree the Zona Pellucida should be cut open for best clinical results. We compared the size of the opening of the Zona Pellucida with clinical results, using Saturn 5 ActiveTM (Research Instruments Ltd. UK) for lazar assisted hatching (LAH) and EmbryoScopeBR(Vitrolife AB. Sweden) for continuous observation. DESIGN: prospective randmaized study. MATERIALS AND METHODS: Cryopreserved blastocysts (SBB grade) which were donated by patients for research were used for this study. LAH was performed on warmed blastocysts after one hour of culturing. The blastocysts were divided into 5 groups by the size of the opening for assisted hatching: Group1 has been performed 50% opening (n¼9) and Group2 has been performed 30% opening (n¼12). Group3 has
FERTILITY & STERILITYÒ
been conducted 12 micrometers opening (n¼12) so as Group4 has been done the thinning (n¼12). For Group5 no LAH has been performed (n¼12).We observed the start timing of hatching, time of hatching, hatched rate and frequency of contraction until blastocysts finished hatching by Time Lapse after LAH. RESULTS: The time until the initiating of hatching was significantly longer for groups 4 and 5 when compared to other groups. In fact, blastocysts of groups 4 and 5 needed 1-3 times of contraction to start hatching as found by Time Lapse observation. Time of hatching for Group 3 was significantly slower than for other groups. In that group, embryos were stuck by the small hole of the Zona Pellucida and repeated contraction occurred during hatching. The hatched rates were significantly lower in groups 3, 4 and 5 when compared to groups 1 and 2. Frequency of contraction until the blastocysts finished hatching was higher for groups 3, 4 and 5. There was no significant difference between groups 1 and 2. CONCLUSIONS: From this study, we found that adequate LAH improve subsequent hatching rates. In fact, the Zona Pellucida should not merely be thinned by rather cut open, at least 30%.
ART - IN VITRO FERTILIZATION P-233 Tuesday, October 20, 2015 NOVEL APPROACH FOR MANAGING DECREASED FERTILIZATION WITH SEQUENTIAL ARTIFICIAL OOCYTE ACTIVATION: PROSPECTIVE RANDOMIZED CLINICAL TRIAL. M. Fawzy,a H. Abdelghaffar,b A. Alaboudy,a M. Sabry,b H. Kasem,a M. Y. Abdel-Rahman,b M. Gad,a A. Metwallley,c E. Othman,d A. Mahran,d S. M. Rasheed.b aIbnsina IVF Center, Sohag, Egypt; bSohag Faculty of Medicine, Sohag, Egypt; cAlBarka IVF Center, Manama, Bahrain; d Banon IVF Center, Assiut, Egypt. OBJECTIVE: To compare outcomes between two different strategies of artificial Oocyte activation: Calcium Ionophore activation protocol versus a novel sequential protocol using Ca Ionophore followed by Strontium Chloride, In cases of previously decreased fertilization ICSI cycles. DESIGN: Prospective Randomized Clinical Trial. MATERIALS AND METHODS: Patients with previous low fertilization who presented to Ibnsina IVF Center, Sohag, Egypt (private center), between January 2015 to March 2015 were recruited to undergo ICSI into this study. Mature Oocytes (840) collected from 69 patients injected and randomly assigned to two groups (420 each). Group I Oocytes activated artificially for 15 min in ready made Ca Ionophore (GM508 Cult-Active, GYNEMED, Germany) immediately after ICSI followed by culture in (GLOBAL TOTALÒ, LIFEGLOBALÒ, Canada). Group II Oocytes underwent sequential activation using Ca ionophore (GM508 Cult-Active, GYNEMED, Germany) same protocol followed by another activation step by washing and incubation for 60 min in Strontium Chloride (Sigma 69042). The Strontium Chloride Prepared in our laboratory at a concentration of 10 micromol/ml in culture media (GLOBAL TOTALÒ, LIFEGLOBALÒ, Canada). The activated oocytes cultured traditionally according to our protocol. All patients underwent Day 5 extended culture, and the embryos selected had been randomized either from group I or II to be transferred using closed envelope method.Outcome measures included: Fertilization rate, top quality embryos day at 3, blastocyst formation rate and finally pregnancy rate for each group. We compare the data of our two group with the Chi-square test. RESULTS: Study groups patients were similar regarding mean age, BMI, the dose of FSH/HMG used, number of oocytes collected and number of cycle days. There were a statistically significant increase in the rate of fertilization in group II versus group I (group II 69% versus group I 46% P value < 0.01). We documented higher blastocyst formation rate in group II versus group I (group II 59% compared to 38% group I P<0.0001). We documented a better pregnancy outcome in group II, but the difference is not statistically significant (P value equal 0.06). CONCLUSIONS: In our laboratory, We recorded a statistically significant improvement in multiple embryological parameters. The increased parameters with our novel approach of double artificial oocytes activation are fertilization rate and blastocyst formation rate. We reported a higher pregnancy rate with our novel oocytes activation method; however, the difference did not reach statistical significance. Moreover, we continue
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