Comparison of ectopic pregnancy rates between patients undergoing embryo transfer on day 3 vs. day 5

Objective: To determine if patients failing to conceive from their first IVF attempt with a blastocyst stage transfer have a diminished chance of conceiving in a subsequent cycle with blastocyst stage embryo transfer. Design: Retrospective review of cycles within an IVF program from November 1, 1998 to December 31, 2001. Materials/Methods: In a period of 3 years, 107 patients (Group 1) received a blastocyst stage embryo transfer after an assisted reproduction cycle (ICSI or IVF). Thirty-one patients returned for a second cycle after failing to conceive or maintain an ongoing pregnancy. In their second cycle 20 patients experienced a day 3 embryo transfer (Group 2) and 11 patients (Group 3) repeated with a day 5 blastocyst stage transfer. The female patients ranged in age from 21 to 41 at the time of their oocyte retrieval. Embryos were cultured in the sequential media P-1 and blastocyst for 5 days (Irvine Scientific). With a few exceptions, most patients had to meet specific criteria to qualify for extended culture to blastocyst stage transfer, relating to age of patient and quality of embryos on day 3. Results: There was no statistical difference between any of the groups for age of the female (31.8, 33.7, 33.4 yr), number of oocytes retrieved (14.1,13.1,13.4), and fertilization rate (78, 63, 77%). Clinical preganancy rate (56, 50, 73%) and implantation rate (35, 20, 44%) per transfer were not different between the first cycle group and the repeat cycle groups (Group 2 and 3). Statistically more embryos were transferred in Group 2 than in the original blastocyst transfer, Group 1 (p ⬍.05). Conclusions: This data evaluates a select group of patients within an IVF facility that proceed to blastocyst stage transfer. Our results suggest that failure to conceive in an IVF cycle that utilizes blastocyst stage transfer is not a negative predictor of success in a subsequent blastocyst stage transfer. Supported by: n/a. P-379 Comparison of ectopic pregnancy rates between patients undergoing embryo transfer on day 3 vs. day 5. Ali Nasseri, Alan Berkeley, Fred Licciardi, Lewis Krey, Edith Terzano, Jamie Grifo. New York Univ Program for IVF, New York, NY; The Valley Hosp Ctr for IVF, Paramus, NJ. Objective: To compare the incidence of ectopic pregnancy between patients receiving embryos at cleavage stage (day 3) or at morula/blastocyst stage (day 5) and to examine factors that may contribute to the ectopic pregnancy rate. Design: Retrospective analysis of data collected from all IVF/ET cycles at a large University-based IVF center of all IVF/ET cycles from 1996 to 2002. Materials/Methods: The protocol for extending embryo culture to day 5 (D5) for blastocyt transfer was initiated in September 1999. Only those patients with an appropriate number of good quality embryos were considered to be candidates for blastocyst transfer (Group A); otherwise embryos were transferred on day 3 (D3, Group B). Variables examined included patient age and diagnosis, baseline and peak serum estradiol (E2) levels, number of eggs retrieved, number of embryos transferred, the type of catheter used for embryo transfer, the degree of difficulty of the transfer, and the physician and embryologist handling the embryos. Pregnancy was defined by the presence of a fetal heartbeat. Chi-square and t-tests were used for statistical analysis; p ⬍0.05 was considered significant Results: The rate of clinical pregnancy rate per transfer and the ectopic pregnancy rate per clinical pregnancy remained unchanged for patients who had D3 embryo transfers prior to (44% and 1.2%) and following (41% and 1.4%) the adoption of blastocyst protocol. Although a significantly greater proportion of ectopic pregnancies occurred after D5 transfers (Group A: 11/ 719 transfers) compared to D3 transfers (Group B: 9/ 1570 transfers, p ⬍0.05), the incidence of ectopic pregnancy as a function of clinical pregnancies observed did not differ (Group A:11/ 426 or 2.6%; Group B: 9/ 659 or 1.4%). There was no difference between groups A and B with respect to patient age (35 ⫾ 3 vs. 37 ⫾ 4 yrs), baseline E2 (31 ⫾ 17 vs. 35 ⫾ 11 pg/ml), peak E2 (2052 ⫾ 878 vs. 1719 ⫾ 1136 pg/ml), number of eggs retrieved (19 ⫾ 9 vs. 12 ⫾ 10) and the number of embryos transferred (3 ⫾ 1 vs. 4 ⫾ 1). Furthermore, there was no difference between Groups A and B with respect to the physician and embryologist handling the transfer, the frequency of various diagnoses as indication for IVF including the diagnosis of pelvic factor (pelvic adhesions, endometriosis and tubal disease), the degree of difficulty of the transfer and the type of catheter used for embryo transfer. Conclusions: Although a higher rate of ectopic pregnancy per transfer was experienced with D5 compared to the conventional D3 embryo transfers, this higher ectopic rate is most likely related to the higher implantation and pregnancy rates that result from the transfer of morulae or blastocysts.

FERTILITY & STERILITY威

Previous studies by other investigators have linked ectopic pregnancy to an aberrant uterine contractility pattern; our data suggest that IVF patients are as likely to develop such anomalous patterns on D3 as on D5. Supported by: None. P-380 Transferring two embryos is the optimal approach in IVF—A multivariate analysis of 5310 cycles from one center. Shai Elizur, Liat GevaLerner, Jacob Levron, Jehoshua Dor. Chaim Sheba Medical Ctr, Tel Hashomer, Israel. Objective: One of the major concerns in IVF today is the increasing number of multiple pregnancies causing perinatal mortality and morbidity due to premature deliveries. Decreasing the number of embryos transferred may result in less multiple pregnancies but may also affect delivery rates. The objective of our study was to find out the optimal number of transferred embryos and to analyze other factors predicting success rate following IVF. Design: We analyzed our computerized database for IVF cycles performed between 01/01/1995 to 01/06/2001. Factors evaluated included women age, number oocytes retrieved, the performance of Intracytoplasmic sperm injection (ICSI), infertility factor and number embryos transferred. Materials/Methods: We estimated the influence of different covariates on the success rate until the first delivery using Cox proportional hazards model. The data was collected retrospectively from a single university IVF center. Results: A total of 5310 consecutive IVF cycles among 1980 patients were evaluated. These treatments resulted in 1120 pregnancies and 680 deliveries. Transferring two embryos doubled the chance of achieving delivery compared to one embryo (95% confidence interval 1.31–3.37) but transferring three embryos was not superior to two embryos. The multiple delivery rates after transferring 2 embryos (21.5% twins) were lower compared with transferring 3 embryos (27.1% twins, 6.1% triplets) and 4 embryos (31.5% twins, 7.8% triplets) (p ⬍0.06, p ⬍0.05 respectively). The optimal results were observed in the age group of 26 –30 with gradual decline in delivery rates with advanced women age. In addition application of ICSI in couples with male factor infertility resulted in higher delivery rates (15.4% per cycle) compared with conventional insemination in couples with female factors (10.3%) (p ⬍0.05). Conclusions: Using a multivariate analysis of large number IVF treatments we concluded that transferring two embryos achieves best results in IVF regarding delivery rates and multiple pregnancies. In addition the highest delivery rates are observed in women age group 26 –30 years and in couples with male factor infertility undergoing ICSI. Supported by: IVF Unit, Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. P-381 Natural cycles with GnRH antagonist application in poor responders. Shulman Adrian, Weiss Boaz, Feldman Baruch, Rabinovici Jaron, Dor Jehoshua. Chaim Sheba Medical Ctr, Tel Hashomer, Israel. Objective: Poor ovarian response is observed in 9–24% of patients undergoing ovarian stimulation. Many strategies of treatment were suggested to improve the historically poor outcome of this group. Previous study in our department has suggested that patients defined as poor responders achieve better results by spontaneous as compared to stimulated cycles. However, managing these patients by natural cycles results in high rate of cancellations due to premature LH surge. Objective: To compare the results of previous natural cycles to spontaneous cycles with GnRH antagonists in poor responders. Design: A retrospective study comparing two protocols of induction of ovulation for patients diagnosed as poor responders (low ovarian response in previous four IVF cycles despite high dose of hMG). Group I patients underwent IVF with natural cycles and group II, patients performed IVF in spontaneous cycles supported by GnRH antagonists (Cetrorelix). Materials/Methods: Both groups were monitored by daily ultrasound follicular measurements and whenever a follicle larger than 13 mm was scaned daily assessment of E2, progesterone and LH levels were started. When the follicular diameter ? 17mm., 5000 IU of hCG were administered and OPU was performed. In group II, Cetrorelix (0.25mg) and hMG (150 IU) were administered when the domonant follicle reached a diameter of at least 14-mm. Follicular aspiration was performed as described above.

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