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Does length of ovarian stimulation affect IVF pregnancy and implantation rates?
CONCLUSION: The overall lower pregnancy outcomes obtained with testicular sperm may have a genetic component. Attention to pronuclear morphology may be of especial importance in cases involving testicular sperm and could enhance embryo selection. Supported by: None
PR of 54.7%. Significant differences in pregnancy and implantation rates were observed between the Sat/Sun and Mon/Tues/Wed transfer groups. CONCLUSION: The observed differences between groups might suggest that optimally timed drug stimulation regimes could yield significant improvements in IVF pregnancy and implantation rates. Although endocrine and ultrasonographic information are useful in the determination of optimal HCG administration, they may not necessarily reflect appropriate nuclear and cytoplasmic maturational synchrony of the oocytes retrieved. In poor and hyper-responders, abnormally short and long treatment regimes may upset the delicate equilibrium of nuclear and cytoplasmic events within an oocyte, i.e. nuclear mature oocytes with post mature granularity and vacuolation that ultimately results in poor embryo development. An 11 or 12-day ovarian stimulation regime may optimally strike a balance between immature, mature, and post mature nuclear and cytoplasmic events leading to optimized results in the form of better quality embryos. However, inherent patient variables (less stress on weekends, better patient compliance), reduced stress levels amongst clinical and laboratory staff, and practice philosophy cannot be ruled out as important prognostic factors. Supported by: None
Wednesday, October 20, 2004 2:30 P.M.
Wednesday, October 20, 2004 2:45 P.M.
O-241 Does length of ovarian stimulation affect IVF pregnancy and implantation rates? M. P. Portmann, L. S. Morrison, D. R. Prinz, B. A. McGuirk, R. F. Feinberg, M. J. Tucker. Reproductive Associates of Delaware, Newark, DE; Georgia Reproductive Specialists, Atlanta, GA. OBJECTIVE: To determine if day of hCG administration following controlled gonadotropin stimulation affects pregnancy and implantation rates in patients undergoing fresh, non-donor IVF and day 3 embryo transfer. DESIGN: Retrospective analysis of 154 fresh non-donor IVF cycles during a 16 month period. All cycle starts that occurred on a Friday with subsequent day 3 transfer were included in the study. Three groups were compared; transfers occurring on a Thursday or Friday (9 or 10 day med protocol); transfers occurring on a Saturday or Sunday (11 or 12 day med protocol); and transfers occurring on a Monday, Tuesday or Wednesday (13, 14 or 15 day treatment). All retrievals initiated prior to day 9 and after 15 days of drug treatment were excluded from the study. Pregnancy and implantation rates were compared between the groups using Chi Square Analysis. MATERIALS AND METHODS: Oocytes were retrieved in HTF (InVitrocare), hyaluronidased after 2 to 3 hours incubation and ICSI’ed following COC removal. Oocytes were placed in IVC-1 (IVC) after ICSI and cultured individually until Day 3. Embryos were placed into CCM (Vitrolife) on the morning of Day 3 for extended culture. The best embryos were identified and laser hatched (Zilos-Hamilton Thorne) prior to transfer. Morphologic assessment occurred on Day 2, 3, 5 and 6. Blastocysts were cryopreserved on Day 5, 6 or 7. All transfers occurred on Day 3 using a Wallace 23cm stylet (Irvine Scientific) and Cook Echotip Catheter (Cook OB/GYN) under abdominal ultrasound guidance and performed by the same physician (RFF). RESULTS:
In the 148 cycles analyzed, 352 fresh embryos were AH and transferred (avg. 2.4 embryos/transfer), yielding a clinical implantation rate of 29% and
FERTILITY & STERILITY威
O-242 Delayed fertilization of oocytes following in vitro culture results in increased embryo aneuploidy. B. R. Emery, K. R. Chohan, A. L. Wilcox, V. W. Aoki, D. T. Carrell. University of Utah School of Medicine, Salt Lake City, UT. OBJECTIVE: Rescue ICSI (rICSI), the re-insemination of oocytes after failed fertilization or delayed ICSI (dICSI), the fertilization of oocytes following in vitro maturation from the GV or MI stage, are controversial assisted reproduction techniques. While some laboratories have reported pregnancies from rICSI and dICSI, it is generally accepted that the pregnancy rates are lower than traditional ART procedures and there may be an increased risk of chromosomal abnormalities. The intent of this study was to identify if dICSI results in an increased embryonic aneuploidy status. DESIGN: An institutional review board approved, controlled, prospective study, within a university setting. MATERIALS AND METHODS: Patients were randomly selected for participation in the study. Experimental oocytes were GV or MI stage oocytes retrieved from consenting patients undergoing ICSI. These oocytes were subjected to 18 –24 hrs of incubation in HTF medium supplemented with maternal serum to obtain maturity. Oocytes from the experimental group were fertilized with standard ICSI procedures within 24 hrs using the same ejaculate prepared for the initial fertilization. The control group consisted of normally-fertilized embryos not transferred on day three and donated for research by the patient. All embryos were cultured to the 8 –10 cell stage, graded for embryo quality, then biopsied and individual blastomeres were removed and fixed in Carnoy’s Solution. Aneuploidy was evaluated in all blastomeres containing a defined nucleus by fluorescent in situ hybridization for chromosomes 13, 18, 21, X & Y using the Vysis Multivysion Probe Cocktail and visualized on a Nikon E400 equipped with the Vysis Quips workstation. Embryos were considered aneuploid if greater than 50% of the blastomeres were abnormal. RESULTS: Embryos created from delayed fertilization following in vitro maturation resulted in 51 of 64 embryos as aneuploid (80%). Control embryos analyzed resulted in 26 of 43 embryos as aneuploid (60%). Chi square analysis of the two groups describes a significant difference, p ⬍ 0.05. Mosaicism was elevated in experimental and control embryos. The mean embryo score ⫾ standard error for the experimental and control groups were 2.46 ⫾ 0.080 and 2.59 ⫾ 0.081 respectively. A two-sample Student’s t test indicates that there is no variance in embryo quality between the two groups. CONCLUSION: Embryos created from oocytes following 16 –24 hours of in vitro maturation contain a higher level of aneuploidy than embryos created using standard IVF procedures. It is true that the control group contains some inherent bias in that, all embryos analyzed were not selected for transfer and therefore are biased to have a poorer morphology than transferred embryos. Despite that bias, no difference in embryo quality was observed between the two groups, indicating that the increased aneuploidy may not be associated with poor embryo morphology. The failure to
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PR of 54.7%. Significant differences in pregnancy and implantation rates were observed between the Sat/Sun and Mon/Tues/Wed transfer groups. CONCLUSION: The observed differences between groups might suggest that optimally timed drug stimulation regimes could yield significant improvements in IVF pregnancy and implantation rates. Although endocrine and ultrasonographic information are useful in the determination of optimal HCG administration, they may not necessarily reflect appropriate nuclear and cytoplasmic maturational synchrony of the oocytes retrieved. In poor and hyper-responders, abnormally short and long treatment regimes may upset the delicate equilibrium of nuclear and cytoplasmic events within an oocyte, i.e. nuclear mature oocytes with post mature granularity and vacuolation that ultimately results in poor embryo development. An 11 or 12-day ovarian stimulation regime may optimally strike a balance between immature, mature, and post mature nuclear and cytoplasmic events leading to optimized results in the form of better quality embryos. However, inherent patient variables (less stress on weekends, better patient compliance), reduced stress levels amongst clinical and laboratory staff, and practice philosophy cannot be ruled out as important prognostic factors. Supported by: None
Wednesday, October 20, 2004 2:30 P.M.
Wednesday, October 20, 2004 2:45 P.M.
O-241 Does length of ovarian stimulation affect IVF pregnancy and implantation rates? M. P. Portmann, L. S. Morrison, D. R. Prinz, B. A. McGuirk, R. F. Feinberg, M. J. Tucker. Reproductive Associates of Delaware, Newark, DE; Georgia Reproductive Specialists, Atlanta, GA. OBJECTIVE: To determine if day of hCG administration following controlled gonadotropin stimulation affects pregnancy and implantation rates in patients undergoing fresh, non-donor IVF and day 3 embryo transfer. DESIGN: Retrospective analysis of 154 fresh non-donor IVF cycles during a 16 month period. All cycle starts that occurred on a Friday with subsequent day 3 transfer were included in the study. Three groups were compared; transfers occurring on a Thursday or Friday (9 or 10 day med protocol); transfers occurring on a Saturday or Sunday (11 or 12 day med protocol); and transfers occurring on a Monday, Tuesday or Wednesday (13, 14 or 15 day treatment). All retrievals initiated prior to day 9 and after 15 days of drug treatment were excluded from the study. Pregnancy and implantation rates were compared between the groups using Chi Square Analysis. MATERIALS AND METHODS: Oocytes were retrieved in HTF (InVitrocare), hyaluronidased after 2 to 3 hours incubation and ICSI’ed following COC removal. Oocytes were placed in IVC-1 (IVC) after ICSI and cultured individually until Day 3. Embryos were placed into CCM (Vitrolife) on the morning of Day 3 for extended culture. The best embryos were identified and laser hatched (Zilos-Hamilton Thorne) prior to transfer. Morphologic assessment occurred on Day 2, 3, 5 and 6. Blastocysts were cryopreserved on Day 5, 6 or 7. All transfers occurred on Day 3 using a Wallace 23cm stylet (Irvine Scientific) and Cook Echotip Catheter (Cook OB/GYN) under abdominal ultrasound guidance and performed by the same physician (RFF). RESULTS:
In the 148 cycles analyzed, 352 fresh embryos were AH and transferred (avg. 2.4 embryos/transfer), yielding a clinical implantation rate of 29% and
FERTILITY & STERILITY威
O-242 Delayed fertilization of oocytes following in vitro culture results in increased embryo aneuploidy. B. R. Emery, K. R. Chohan, A. L. Wilcox, V. W. Aoki, D. T. Carrell. University of Utah School of Medicine, Salt Lake City, UT. OBJECTIVE: Rescue ICSI (rICSI), the re-insemination of oocytes after failed fertilization or delayed ICSI (dICSI), the fertilization of oocytes following in vitro maturation from the GV or MI stage, are controversial assisted reproduction techniques. While some laboratories have reported pregnancies from rICSI and dICSI, it is generally accepted that the pregnancy rates are lower than traditional ART procedures and there may be an increased risk of chromosomal abnormalities. The intent of this study was to identify if dICSI results in an increased embryonic aneuploidy status. DESIGN: An institutional review board approved, controlled, prospective study, within a university setting. MATERIALS AND METHODS: Patients were randomly selected for participation in the study. Experimental oocytes were GV or MI stage oocytes retrieved from consenting patients undergoing ICSI. These oocytes were subjected to 18 –24 hrs of incubation in HTF medium supplemented with maternal serum to obtain maturity. Oocytes from the experimental group were fertilized with standard ICSI procedures within 24 hrs using the same ejaculate prepared for the initial fertilization. The control group consisted of normally-fertilized embryos not transferred on day three and donated for research by the patient. All embryos were cultured to the 8 –10 cell stage, graded for embryo quality, then biopsied and individual blastomeres were removed and fixed in Carnoy’s Solution. Aneuploidy was evaluated in all blastomeres containing a defined nucleus by fluorescent in situ hybridization for chromosomes 13, 18, 21, X & Y using the Vysis Multivysion Probe Cocktail and visualized on a Nikon E400 equipped with the Vysis Quips workstation. Embryos were considered aneuploid if greater than 50% of the blastomeres were abnormal. RESULTS: Embryos created from delayed fertilization following in vitro maturation resulted in 51 of 64 embryos as aneuploid (80%). Control embryos analyzed resulted in 26 of 43 embryos as aneuploid (60%). Chi square analysis of the two groups describes a significant difference, p ⬍ 0.05. Mosaicism was elevated in experimental and control embryos. The mean embryo score ⫾ standard error for the experimental and control groups were 2.46 ⫾ 0.080 and 2.59 ⫾ 0.081 respectively. A two-sample Student’s t test indicates that there is no variance in embryo quality between the two groups. CONCLUSION: Embryos created from oocytes following 16 –24 hours of in vitro maturation contain a higher level of aneuploidy than embryos created using standard IVF procedures. It is true that the control group contains some inherent bias in that, all embryos analyzed were not selected for transfer and therefore are biased to have a poorer morphology than transferred embryos. Despite that bias, no difference in embryo quality was observed between the two groups, indicating that the increased aneuploidy may not be associated with poor embryo morphology. The failure to
S97