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Effects of extremes of body mass index (BMI) on in vitro fertilization (IVF) pregnancy rates.
treatment (egg-sharing) with the outcome of IVF using eggs donated by altruistic non-infertile women. Materials/Methods: In our egg-sharing programme, IVF patients ⬍36 years with normal basal follicle stimulating hormone (FSH) agreed to donate half of their eggs if they produced ⬎5, in return for reduced cost treatment. The outcome of 69 recipient IVF cycles (group A) using eggs donated by such egg-sharers were compared with the outcome of 60 IVF cycles (group B) using eggs donated by ‘altruistic’ donors with no history of infertility who also were ⬍36 years with normal basal FSH. Therefore, donors for group A were infertile, and donated half of the collected eggs, while donors for group B were not infertile and donated all of their eggs. A maximum of 3 embryos were transferred. In group A the indications for IVF treatment in the donors were tubal disease (47%); male factor (34%); endometriosis (9%) and unexplained (10%). The mean age was 30.6 years for the donors in group A and 30.9 for those in group B. The corresponding values for basal FSH were 6.0 and 6.1 IU/L, respectively. The mean age for recipients was 38.5 in group A and 37.2 in group B. The indications for egg donation in group A were genetic problem (3%), premature ovarian failure (39%) and previous poor response (58%). The corresponding values for group B were 2%, 35% and 63%, respectively. All were not significantly different (p0.05). Differences in proportions were analysed using Chisquare statistics and differences in means by the unpaired t-test. Results: As expected, group B had more eggs donated per patient compared with group A. However, there were no significant differences in the pregnancy and implantation rates between the two groups, as illustrated in the table below.
Results: Initial sperm concentrations ranged from 29.0 to 206.0 million per ml, and sperm motility ranged from 45 to 77%. There was no difference in the number of embryos resulting from the two methods, 84 embryos from the ”Combined“ protocol and 83 embryos from the Isolate protocol. There was also no difference in the number of 2-cell, 3-cell, 4-cell, 5-cell, or 6-cell embryos on Day 3 in culture between the two groups. There was, however, a significant difference in the number of 8-cell embryos on Day 3. Spermatozoa selected by the “Combined” Method resulted in a significantly greater number of 8-cell embryos (48.8%) as compared to sperm selected by the Isolate Method (34.9%), (p ⬍ 0.05). Embryo cell number on day 3 culture. Embryo 2 cell 3 cell 4 cell 5 cell 6 cell 8 cell # % % % % % %* Combined Method Isolate Method
Eggs donated per recipient Fertilization rate Embryos transferred per recipient Pregnancy rate Implantation rate
Group A (n ⫽ 69)
Group B (n ⫽ 60)
14.3 14.5
15.5 16.9
8.3 15.7
48.8 34.9
8.7 74% 2.2 49% 24%
12.7 63% 2.7 47% 25%
Wednesday, October 24, 2001 2:00 P.M. p ⬍ 0.05 NS p ⬍ 0.01 NS NS
Conclusions: Using IVF patients who are good responders (by virtue of their young age, normal basal FSH and number of eggs produced) as egg donors will lead to similar pregnancy and implantation rates for recipients compared to using altruistic non-infertile donors of similar age and FSH. These results support the use of egg-sharing to increase the availability of donated eggs, without putting a third party at risk or jeopardising the success rate for recipients.
Wednesday, October 24, 2001 4:45 P.M. O-196 Sperm selection method enhances embryo development. J. M. Nani, J. G. Brasch, R. Summers, R. Springer, R. Jeyendran. Advanced Reproductive Health Centers, Ltd, Orland Park, IL; Andrology Lab Service, Inc, Chicago, IL. Objective: To determine whether sperm selection method effects embryo development. Design: Sibling oocytes were exposed in-vitro to sperm acquired through two different selection methods. Materials/Methods: Consecutive ejaculates from fifteen (15) patients with sperm concentration ⬎ 20 million per ml and sperm motility ⬎ 40% were divided into two equal halves. One half of each ejaculate was processed by “The Combined Method,” a combination of TEST-Yolk buffer (Irvine Scientific, Santa Ana, CA) and glass wool column filtration (Cook Sperm Filter, Cook OB/GYN, Spenser, IN) methods (Fertil Steril 1996;66:459-62). The remaining ejaculate was processed solely by the Isolate Density Gradient Centrifugation (Irvine Scientific, Santa Ana, CA) method. Sibling oocytes were then exposed in-vitro to equal numbers of sperm samples selected via the ”Combined“ and Isolate Methods, respectively. All embryos were scored objectively by counting the number of cells on Day 3 in culture. Resulting data was statistically analyzed (Chi-square).
Abstracts
6.0 4.8
ART: CLINICAL ART II
NS: not significant (p ⬎ 0.05). Implantation rate: number of fetal hearts on scan at 6 weeks gestation/number of embryos transferred.
S74
7.1 13.3
Conclusions: The Combined Method resulted in nearly one-half of the embryos reaching the 8-cell stage by Day 3, whereas the Isolate Method resulted in only one-third of embryos reaching the 8-cell stage. Sperm selection methods therefore have a profound effect on embryo development.
Results (reported as ‘means’).
Outcome/group
84 83
O-197 Effects of extremes of body mass index (BMI) on in vitro fertilization (IVF) pregnancy rates. J. E. Nichols, P. B. Miller, W. R. Boone, M. M. Crane. Greenville Hosp System, Greenville, SC. Objective: The association between reproductive dysfunction and extremes of BMI has been well studied and established in the past by many investigators. In contrast, the effect of body weight and outcome of IVF is less clear. Several studies have revealed no effect between extremes of body weight and IVF success while others have seen an adverse effect only in patients with a high BMI (25 and ⬎30). In an effort to resolve these issues, we looked at the effect of BMI on IVF pregnancy rates in our practice. Design: Retrospective cohort study. Materials/Methods: A total of 465 patients undergoing IVF with fresh embryo transfer (non-donor oocytes) from 11/96-12/00 were included. BMI was calculated using the formula of weight (in kgs) divided by height (in meters) squared (kg/m2). Data were analyzed using Fisher’s exact test and logistic regression. Results: Median age, peak estradiol levels and number of embryos transferred were similar across BMI groups. Pregnancy rates were greater in the 350 patients with BMI ⬍28 (51.4%) than in the 105 patients with BMI ⱖ28 (35.2%). This difference remained after adjusting for age, peak estradiol levels and number of embryos transferred (odds ratio ⫽ 1.69, p ⬍ 0.03). The 46 women with BMI ⱕ19.9 also had reduced pregnancy rates relative to the 314 women with BMI 20-27.9 (34.8% vs. 52.3%, p ⬍ 0.039).
Conclusions: As with advancing age and elevated basal FSH levels, extremes of BMI (both low and high) can also be used to predict the outcome of IVF success. Since these patients can comprise as much as a third of IVF patients and given that BMI is one factor that is potentially modifiable with lifestyle and diet changes, further studies on the mechanisms, treatments and effects of extremes of body mass on assisted reproductive technologies are needed.
Vol. 76, No. 3, Suppl. 1, September 2001
Results: Initial sperm concentrations ranged from 29.0 to 206.0 million per ml, and sperm motility ranged from 45 to 77%. There was no difference in the number of embryos resulting from the two methods, 84 embryos from the ”Combined“ protocol and 83 embryos from the Isolate protocol. There was also no difference in the number of 2-cell, 3-cell, 4-cell, 5-cell, or 6-cell embryos on Day 3 in culture between the two groups. There was, however, a significant difference in the number of 8-cell embryos on Day 3. Spermatozoa selected by the “Combined” Method resulted in a significantly greater number of 8-cell embryos (48.8%) as compared to sperm selected by the Isolate Method (34.9%), (p ⬍ 0.05). Embryo cell number on day 3 culture. Embryo 2 cell 3 cell 4 cell 5 cell 6 cell 8 cell # % % % % % %* Combined Method Isolate Method
Eggs donated per recipient Fertilization rate Embryos transferred per recipient Pregnancy rate Implantation rate
Group A (n ⫽ 69)
Group B (n ⫽ 60)
14.3 14.5
15.5 16.9
8.3 15.7
48.8 34.9
8.7 74% 2.2 49% 24%
12.7 63% 2.7 47% 25%
Wednesday, October 24, 2001 2:00 P.M. p ⬍ 0.05 NS p ⬍ 0.01 NS NS
Conclusions: Using IVF patients who are good responders (by virtue of their young age, normal basal FSH and number of eggs produced) as egg donors will lead to similar pregnancy and implantation rates for recipients compared to using altruistic non-infertile donors of similar age and FSH. These results support the use of egg-sharing to increase the availability of donated eggs, without putting a third party at risk or jeopardising the success rate for recipients.
Wednesday, October 24, 2001 4:45 P.M. O-196 Sperm selection method enhances embryo development. J. M. Nani, J. G. Brasch, R. Summers, R. Springer, R. Jeyendran. Advanced Reproductive Health Centers, Ltd, Orland Park, IL; Andrology Lab Service, Inc, Chicago, IL. Objective: To determine whether sperm selection method effects embryo development. Design: Sibling oocytes were exposed in-vitro to sperm acquired through two different selection methods. Materials/Methods: Consecutive ejaculates from fifteen (15) patients with sperm concentration ⬎ 20 million per ml and sperm motility ⬎ 40% were divided into two equal halves. One half of each ejaculate was processed by “The Combined Method,” a combination of TEST-Yolk buffer (Irvine Scientific, Santa Ana, CA) and glass wool column filtration (Cook Sperm Filter, Cook OB/GYN, Spenser, IN) methods (Fertil Steril 1996;66:459-62). The remaining ejaculate was processed solely by the Isolate Density Gradient Centrifugation (Irvine Scientific, Santa Ana, CA) method. Sibling oocytes were then exposed in-vitro to equal numbers of sperm samples selected via the ”Combined“ and Isolate Methods, respectively. All embryos were scored objectively by counting the number of cells on Day 3 in culture. Resulting data was statistically analyzed (Chi-square).
Abstracts
6.0 4.8
ART: CLINICAL ART II
NS: not significant (p ⬎ 0.05). Implantation rate: number of fetal hearts on scan at 6 weeks gestation/number of embryos transferred.
S74
7.1 13.3
Conclusions: The Combined Method resulted in nearly one-half of the embryos reaching the 8-cell stage by Day 3, whereas the Isolate Method resulted in only one-third of embryos reaching the 8-cell stage. Sperm selection methods therefore have a profound effect on embryo development.
Results (reported as ‘means’).
Outcome/group
84 83
O-197 Effects of extremes of body mass index (BMI) on in vitro fertilization (IVF) pregnancy rates. J. E. Nichols, P. B. Miller, W. R. Boone, M. M. Crane. Greenville Hosp System, Greenville, SC. Objective: The association between reproductive dysfunction and extremes of BMI has been well studied and established in the past by many investigators. In contrast, the effect of body weight and outcome of IVF is less clear. Several studies have revealed no effect between extremes of body weight and IVF success while others have seen an adverse effect only in patients with a high BMI (25 and ⬎30). In an effort to resolve these issues, we looked at the effect of BMI on IVF pregnancy rates in our practice. Design: Retrospective cohort study. Materials/Methods: A total of 465 patients undergoing IVF with fresh embryo transfer (non-donor oocytes) from 11/96-12/00 were included. BMI was calculated using the formula of weight (in kgs) divided by height (in meters) squared (kg/m2). Data were analyzed using Fisher’s exact test and logistic regression. Results: Median age, peak estradiol levels and number of embryos transferred were similar across BMI groups. Pregnancy rates were greater in the 350 patients with BMI ⬍28 (51.4%) than in the 105 patients with BMI ⱖ28 (35.2%). This difference remained after adjusting for age, peak estradiol levels and number of embryos transferred (odds ratio ⫽ 1.69, p ⬍ 0.03). The 46 women with BMI ⱕ19.9 also had reduced pregnancy rates relative to the 314 women with BMI 20-27.9 (34.8% vs. 52.3%, p ⬍ 0.039).
Conclusions: As with advancing age and elevated basal FSH levels, extremes of BMI (both low and high) can also be used to predict the outcome of IVF success. Since these patients can comprise as much as a third of IVF patients and given that BMI is one factor that is potentially modifiable with lifestyle and diet changes, further studies on the mechanisms, treatments and effects of extremes of body mass on assisted reproductive technologies are needed.
Vol. 76, No. 3, Suppl. 1, September 2001