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Comparison of Clinical Pregnancy Rates and Incidence of High Order Multiple Gestations in Day 3 vs. Day 5 Embryo Transfers (ET)
Materials and Methods: Beginning in May of 1999, women undergoing ART procedures in which their day-of-hCG E2 levels were between 5,000 and 6,999 pg/ml were counseled on the risks of OHSS. They were given several options, including the transfer of just a single blastocyst. Results: There were four women who had E2 levels between 5,000 – 6,999 pg/ml, as measured by the Immulite chemiluminescent enzyme immunoassay (Los Angeles, CA). None of them chose to cancel the cycle. Three of the women underwent single blastocyst transfer, and one woman had 2 blastocysts transferred. Their data are summarized below:
Patient number 1 2 3 4
Age
Diagnosis
E2level on day of hCG (pg/ml)
30 32 36 34
Severe endometriosis Oligospermia Oligospermia Oligospermia
6,600 5,993 5,098 5,159
Number of oocytes retrieved
Number of blastocysts transferred
OHSS (Golan’s criteria)
Outcome
35 44 17 22
1 1 1 2
None Mild None Mod
Singleton pregnancy Singleton pregnancy Not pregnant Twin pregnancy
Of the three women undergoing single blastocyst transfers, only one woman developed mild OHSS (by Golan’s classification) that resolved rapidly with restricted activity. Two of the three women have ongoing pregnancies. The one woman who underwent a transfer of 2 blastocysts developed moderate OHSS that resolved by the seventh week of pregnancy. She had a resulting twin pregnancy. Conclusion: Single blastocyst transfer may represent a reasonable strategy for decreasing the incidence of OHSS in women at high risk by limiting the chance of multiple gestations.
P-004 Comparison of Clinical Pregnancy Rates and Incidence of High Order Multiple Gestations in Day 3 vs. Day 5 Embryo Transfers (ET). R. J. Kiltz, D. J. Woodhouse, V. Polanski, D. B. Miller. CNY Fertility Center, Syracuse, NY. Objective: Maintaining high clinical pregnancy rates while significantly reducing the risk of high order multiple gestations is a primary goal of advancing reproductive technologies. Can this goal be achieved with the advent of blastocyst culture and transfer utilizing the sequential G-media system? The purpose of this study was to evaluate G1 and G2 media by assessing clinical pregnancy rates and incidence of high order multiple gestations in patients for which day 3 multi-cell or day 5 blastocyst ET were performed. Design: A retrospective analysis of clinical outcomes in a private IVF center. Materials and Methods: All fresh, non-donor IVF cycles which resulted in ET (n5201) performed from March 1999 through December 1999 were included in this study. Following conventional insemination or ICSI, all embryos were cultured in G1.2 medium to day 3. The decision to perform ET on day 3 or day 5 was made based on day 3 embryo number and morphology, patient age, and prior failed cycles. Embryos selected for extended culture were placed to G2.2 medium on day 3, cultured to day 5 and subsequently transferred. The highest quality and most advanced embryos were chosen for ET (day 3 and day 5). Slow embryo development observed on day 5 (morulae) occurred in three cycles, and resulted in day 6 ET. These cycles are included in the day 5 ET group. ET did not occur in one case as embryos selected for extended culture did not develop to blastocyst. Clinical pregnancy rates and incidence of high order multiple gestations were determined for day 3 transfers (n5111) and day 5 transfers (n 590).
FERTILITY & STERILITYt
Results: Results are summarized in the table below:
Day 3 ET Day 5 ET
n
Age (6SD)
No. embryos/ ET (6SD)
Clinical preg (%)
111 90
34.3 (65.5) 33.1 (65.0)
3.8 (61.5) 3.0 (61.0)
37 (34.2) 28 (33.3)
Twins (%)
Triplets (%)
Quadruplets (%)
9 (24.3) 9 (32.1)
5 (13.5) 1 (3.6)
1 (2.7) 0 (0.0)
Conclusion: Comparable clinical pregnancy rates were achieved when using G1 media alone for day 3 ET, and using the G1 and G2 sequential system for day 5 ET. The advent of blastocyst culture and transfer has enabled our facility to decrease the risk of high order multiple gestations while maintaining the clinical pregnancy rate of the day 3 ET. Synchronization of the embryonic stage with the uterus is achieved through extended culture and a prospective, randomized study would be beneficial to determine if extended culture can exclusively be applied to all patients.
P-005 Does Blastocyst Transfer Attenuate the Expected Age-Related Decline in Pregnancy and Implantation Rates? J. A. Rodriguez, D. Bookout, C. Hardwick, D. Ward, J. Madden and M. Meintjes. Presbyterian Hospital ARTS Program, Dallas, TX. Objectives: The age related decline in in vitro fertilization (IVF) pregnancy- and implantation rates have been well documented. However, it is speculated that blastocyst transfer may improve the genetic composition of embryos and, therefore, may attenuate this expected decline. The objective of this study was to evaluate the effect of age on pregnancy- and implantation rates for day-5 blastocyst transfers. Design: Data from couples undergoing IVF and blastocyst transfer in 1999 were collected prospectively and then analyzed for pregnancy- and implantation rates with respect to age. Donor oocytes were not considered in this study. Materials and Methods: All patients undergoing blastocyst transfers in 1999 were divided into four treatment groups according to SART age categories. Patients in Treatments (Trt) A, B, C and D were #34, 35 to 37, 38 to 40 and $41 years old, respectively. Each age group was evaluated for number of blastocysts transferred, pregnancy- and implantation rate. Results: The results of this study are summarized in the table. Age treatment group (years)
#34
35 to 37
38 to 40
$41
Number of transfers 241 108 63 22 Number of blastocysts transferred (average) 538 (2.23) 255 (2.36) 153 (2.42) 54 (2.45) Clinical pregnancies (%) 143 (59.3)A 56 (51.8)AB 30 (47.6)BC 7 (31.8)C Implantations (%) 246 (45.7)a 84 (32.9)a 48 (31.4)b 9 (16.7)c
Numbers in rows with no common superscript are different. x2; P,0.07. Numbers in rows with different superscripts are different. x2; P,0.03.
A,B a,b
Conclusions: Results from this study confirm the expected age-dependant decline of IVF pregnancy- and implantation rates even when highly selected blastocysts are transferred. Despite this decline, it was possible to maintain competitive pregnancy- and implantation rates in this program without increasing the number of blastocysts transferred to older patients. Pregnancy rates only started to decline significantly in the 38- to 40-year-old age group. However, the implantation rate started to decline in the 35- to 37-year-old age group.
P-006 A Day 3 Embryo Index to Help Predict Blastocyst Formation for Day 5 Embryo Transfer. M. Abae´, W. K. Firisin, M. H. Majercik. Center for Advanced Reproductive Endocrinology, Plantation, FL. Objectives: In order to provide objective criteria to help with the clinical decision of the day on which embryo transfer (ET) should occur, a Day 3
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Patient number 1 2 3 4
Age
Diagnosis
E2level on day of hCG (pg/ml)
30 32 36 34
Severe endometriosis Oligospermia Oligospermia Oligospermia
6,600 5,993 5,098 5,159
Number of oocytes retrieved
Number of blastocysts transferred
OHSS (Golan’s criteria)
Outcome
35 44 17 22
1 1 1 2
None Mild None Mod
Singleton pregnancy Singleton pregnancy Not pregnant Twin pregnancy
Of the three women undergoing single blastocyst transfers, only one woman developed mild OHSS (by Golan’s classification) that resolved rapidly with restricted activity. Two of the three women have ongoing pregnancies. The one woman who underwent a transfer of 2 blastocysts developed moderate OHSS that resolved by the seventh week of pregnancy. She had a resulting twin pregnancy. Conclusion: Single blastocyst transfer may represent a reasonable strategy for decreasing the incidence of OHSS in women at high risk by limiting the chance of multiple gestations.
P-004 Comparison of Clinical Pregnancy Rates and Incidence of High Order Multiple Gestations in Day 3 vs. Day 5 Embryo Transfers (ET). R. J. Kiltz, D. J. Woodhouse, V. Polanski, D. B. Miller. CNY Fertility Center, Syracuse, NY. Objective: Maintaining high clinical pregnancy rates while significantly reducing the risk of high order multiple gestations is a primary goal of advancing reproductive technologies. Can this goal be achieved with the advent of blastocyst culture and transfer utilizing the sequential G-media system? The purpose of this study was to evaluate G1 and G2 media by assessing clinical pregnancy rates and incidence of high order multiple gestations in patients for which day 3 multi-cell or day 5 blastocyst ET were performed. Design: A retrospective analysis of clinical outcomes in a private IVF center. Materials and Methods: All fresh, non-donor IVF cycles which resulted in ET (n5201) performed from March 1999 through December 1999 were included in this study. Following conventional insemination or ICSI, all embryos were cultured in G1.2 medium to day 3. The decision to perform ET on day 3 or day 5 was made based on day 3 embryo number and morphology, patient age, and prior failed cycles. Embryos selected for extended culture were placed to G2.2 medium on day 3, cultured to day 5 and subsequently transferred. The highest quality and most advanced embryos were chosen for ET (day 3 and day 5). Slow embryo development observed on day 5 (morulae) occurred in three cycles, and resulted in day 6 ET. These cycles are included in the day 5 ET group. ET did not occur in one case as embryos selected for extended culture did not develop to blastocyst. Clinical pregnancy rates and incidence of high order multiple gestations were determined for day 3 transfers (n5111) and day 5 transfers (n 590).
FERTILITY & STERILITYt
Results: Results are summarized in the table below:
Day 3 ET Day 5 ET
n
Age (6SD)
No. embryos/ ET (6SD)
Clinical preg (%)
111 90
34.3 (65.5) 33.1 (65.0)
3.8 (61.5) 3.0 (61.0)
37 (34.2) 28 (33.3)
Twins (%)
Triplets (%)
Quadruplets (%)
9 (24.3) 9 (32.1)
5 (13.5) 1 (3.6)
1 (2.7) 0 (0.0)
Conclusion: Comparable clinical pregnancy rates were achieved when using G1 media alone for day 3 ET, and using the G1 and G2 sequential system for day 5 ET. The advent of blastocyst culture and transfer has enabled our facility to decrease the risk of high order multiple gestations while maintaining the clinical pregnancy rate of the day 3 ET. Synchronization of the embryonic stage with the uterus is achieved through extended culture and a prospective, randomized study would be beneficial to determine if extended culture can exclusively be applied to all patients.
P-005 Does Blastocyst Transfer Attenuate the Expected Age-Related Decline in Pregnancy and Implantation Rates? J. A. Rodriguez, D. Bookout, C. Hardwick, D. Ward, J. Madden and M. Meintjes. Presbyterian Hospital ARTS Program, Dallas, TX. Objectives: The age related decline in in vitro fertilization (IVF) pregnancy- and implantation rates have been well documented. However, it is speculated that blastocyst transfer may improve the genetic composition of embryos and, therefore, may attenuate this expected decline. The objective of this study was to evaluate the effect of age on pregnancy- and implantation rates for day-5 blastocyst transfers. Design: Data from couples undergoing IVF and blastocyst transfer in 1999 were collected prospectively and then analyzed for pregnancy- and implantation rates with respect to age. Donor oocytes were not considered in this study. Materials and Methods: All patients undergoing blastocyst transfers in 1999 were divided into four treatment groups according to SART age categories. Patients in Treatments (Trt) A, B, C and D were #34, 35 to 37, 38 to 40 and $41 years old, respectively. Each age group was evaluated for number of blastocysts transferred, pregnancy- and implantation rate. Results: The results of this study are summarized in the table. Age treatment group (years)
#34
35 to 37
38 to 40
$41
Number of transfers 241 108 63 22 Number of blastocysts transferred (average) 538 (2.23) 255 (2.36) 153 (2.42) 54 (2.45) Clinical pregnancies (%) 143 (59.3)A 56 (51.8)AB 30 (47.6)BC 7 (31.8)C Implantations (%) 246 (45.7)a 84 (32.9)a 48 (31.4)b 9 (16.7)c
Numbers in rows with no common superscript are different. x2; P,0.07. Numbers in rows with different superscripts are different. x2; P,0.03.
A,B a,b
Conclusions: Results from this study confirm the expected age-dependant decline of IVF pregnancy- and implantation rates even when highly selected blastocysts are transferred. Despite this decline, it was possible to maintain competitive pregnancy- and implantation rates in this program without increasing the number of blastocysts transferred to older patients. Pregnancy rates only started to decline significantly in the 38- to 40-year-old age group. However, the implantation rate started to decline in the 35- to 37-year-old age group.
P-006 A Day 3 Embryo Index to Help Predict Blastocyst Formation for Day 5 Embryo Transfer. M. Abae´, W. K. Firisin, M. H. Majercik. Center for Advanced Reproductive Endocrinology, Plantation, FL. Objectives: In order to provide objective criteria to help with the clinical decision of the day on which embryo transfer (ET) should occur, a Day 3
S97