High-speed automated robotic microinjection

Cochrane guidelines were followed. An information specialist searched 5 databases. The search was limited to English language, publication year 1990 to present and to standardized IVFþ/- ICSI procedures. Included studies compared IVFþ/-ICSI to naturally conceived pregnancies (NC). Data had to be broken down by plurality. Two reviewers independently assessed eligibility and quality of studies and extracted relevant data. Statistical analyses were done using Review Manager 5. Random effects models for pooled relative risk (RR) with 95% confidence interval (CI) were used. RESULTS: Of the 3,464 studies initially revealed, 100 cohort and 10 case-control studies met the inclusion criteria. Six of eighteen outcomes were assessed and data shown. Based on the MA, the RR for various complications comparing IVFþ/-ICSI to NC were derived. Based on these RR’s and the expected complication rates in the national population, the rate for each complication in the IVFþ/-ICSI population were determined. Estimates for higher order MG are limited by available data. TABLE 1. Rate (%) of neonatal complications in the IVF þ/-ICSI group

PTD

LBW

<37 wks <32 wks <2500 g <1500 g CP

Neonatal Death

P-214 Tuesday, October 20, 2009 HIGH-SPEED AUTOMATED ROBOTIC MICROINJECTION. Y. Sun, Z. Lu, X. Liu, A. Jurisicova, N. Esfandiari, R. F. Casper. Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada; Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. OBJECTIVE: Current manual microinjection of mammalian oocytes/zygotes suffers from long training, low speed, human errors, and inter-operator variability. The lack of automated systems capable of high-throughput mouse oocyte/zygote injection hampers the investigation of wide ranges of potential molecular targets involved in mammalian embryo development. DESIGN: Leveraging robotic technologies, we have developed an automated microinjection system. The aim was to quantify the efficiency of the robotic microinjection system using one-cell mouse embryos. MATERIALS AND METHODS: All the mouse zygotes were injected with PBS at the 1-cell stage (20-25hr post-hCG) with the automated robotic microinjection system, and cultured using KSOM under 37 C and 5% CO2. RESULTS: The system demonstrated: (a) an injection speed of 12 mouse zygotes per minute; (b) a lysis rate of 1.1%; and (c) a high blastocyst formation rate of 89.8%, as shown in tabel 1. TABLE 1. Automated robotic mouse zygote injection statistics

Singletons (%) Twins (%) Tripletsþ (%)

21 69 81

3 20 13

13 64 54

2 14 7

0.4 2 *

1 3 2 injection

*no studies available ** wks ¼ weeks, g¼ grams, PTD ¼ pre-term delivery, BW ¼ birth weight, CP¼ cerebral palsy

groups

CONCLUSIONS: MGs significantly increase risks to mom and babies. These estimates may be used to counsel patients on ART specific pregnancy complications as a function of singleton, twin or tripletþ pregnancies. Supported by: PSI grant.

control groups

P-213 Tuesday, October 20, 2009 OPTIMAL IVF: TAILORED PROTOCOLS ACCORDING TO ANTRAL FOLLICLE COUNT AND MENSTRUAL CYCLICITY. J.-S. Yoon, S.-Y. Lee, M.-Y. Won, J.-H. Jung, J.-H. Lim. Maria Fertility Hospital, Songpa-Gu, Seoul, Korea. OBJECTIVE: The aim of this study is to verify the effectiveness of individualized IVF protocols for the purpose of both minimizing the use of gonadotropins and obtaining acceptable pregnancy outcome. DESIGN: Prospective descriptional study MATERIALS AND METHODS: A total of 168 patients underwent 191 cycles between August 2008 and February 2009. According to the baseline ultrasound scan on day 2-3 and menstrual cyclicity, patients were divided into four groups. Group 1 patients had irregular menstrual cycle and a total of > 10 antral follicles in both ovaries and were treated with IVF using in vitro maturation of immature oocytes (IVM). Group 2 patients had regular menstrual cycle and a total of > 10 antral follicles and were treated with natural cycle IVF combined with in vitro maturation of immature oocytes (IVF/ M). Group 3 patients had 6-10 antral follicles with either regular or irregular menstrual cycles and were treated with ovarian stimulation using clomiphene citrate and gonadotropin(every two days) (Mild IVF). Group 4 patients had 5 or less antral follicles with either regular or irregular menstrual cycles and were treated with controlled ovarian stimulation using gonadotropin and GnRH antagonist(COH). RESULTS: A total of 191 cycles were started, and 185 cycles(96.7%) were completed. Of 191 cycles, 37(19.4%) were treated by IVM, 33(17.3%) underwent IVF/M, 67(35.1%) underwent mild IVF, and 54(28.3%) underwent COH. Clinical pregnancy rate were 45.9% for IVM, 36.4% for IVF/M, 49.2% for mild IVF, and 32.0% for COH respectively. The overall pregnancy rate was 41.6%(77 out of 185). Moderate to severe ovarian hyperstimulation syndrome was not observed. CONCLUSIONS: Approximately 72% of the patients could avoid exposure to high dose gonadotropin(IVM, IVF/M and Mild IVF). Moreover, the result from this study demonstrates that acceptable pregnancy rate(41.4%) can be attained without any ovarian stimulation in 36.6% of patients(IVM and IVF/M), who are high risk group of developing ovarian hyperstimulation syndrome.

FERTILITY & STERILITYÒ

experimental days

#1

#2

#3

#4

#4

total

total # of injected mouse zygotes # of injected mouse zygotes developing into blastocyst total # in culture # of cultured mouse zygotes developing into blastocyst

45

45

43

25

24

182

30

34

37

34

11

135

15 12

15 14

50 42

16 15

13 7

109 90

Due to the advantages of high reproducibility and skill independence, the system has also been extended to automated robotic human ICSI. Preliminary human ICSI trials were performed, using human sperm and oocytes donated by patients for research use. The automated robotic microinjection system produced an ICSI success rate (non-lysis rate) of 100% on the 8 human oocytes injected tested. CONCLUSIONS: The system promises practical use in both biology laboratories/mouse facilities and fertility clinics. Supported by: The authors acknowledge financial support from Natural Sciences and Engineering Research Council of Canada, Ontario Centres of Excellence, Marksman Cellject Inc., and the Canada Research Chairs Program.

P-215 Tuesday, October 20, 2009 RANDOMIZED TRIAL OF HARP MUSIC THERAPY IN IVF-ET. V. A. Moragianni, J. Hopkins, S. G. Somkuti, A. Lee, J. S. Schinfeld, L. I. Barmat. Obstetrics & Gynecology, Abington Memorial Hospital, Abington, PA. OBJECTIVE: To evaluate the clinical and psychological outcomes of Harp Music Therapy (HMT) during IVF-ET. DESIGN: Prospective randomized trial. MATERIALS AND METHODS: After obtaining IRB approval 126 patients undergoing IVF were enrolled in this trial between 06/2007 and 03/ 2009. Patients were randomized to control (C;n¼59) or harp (H;n¼67) groups using a random numbers table. On the day of ET, both before and after the procedure, all patients had blood pressure (BP), respiratory rate (RR) and heart rate (HR) measured and completed a State Trait Anxiety Inventory (STAI). All patients underwent ET following standard protocol, while H patients were additionally exposed to 20 minutes of live HMT during ET. Main outcomes analyzed included vital signs, STAI scores, implantation (IR) and clinical pregnancy rates (CPR). Statistical analysis utilized the two-tailed Fisher’s exact test and statistical significance was defined as a p-value of <0.05. RESULTS: Patients had similar demographic characteristics and baseline FSH. Results are summarized in Table 1.

S147