Human Oocytes Cryopreservation by Slow-Freezing Technique—A Case Report

2. Less than half of the embryos analyzed by PGD were normal in all three groups (41  31%, 37  38%, and 48  31%, in MESA, TESA, and EJAC, respectively; Table 1) 3. There was no statistical difference in the rates of aneuploid, polyploid, haploid or euploid. 4. Complex Abnormalities were more common in the group of MESA than EJAC (48.3% versus 26.5%, p¼ .0005; Table 2). Conclusion: Despite the fact that MESA and TESE procedures are reserved for the most severe forms of male factor, rates of fertilization, embryo cleavage, pregnancy, and euploidy are similar to EJAC-derived embryos. The rate of aneuploidy in embryos derived from MESA and TESE is not higher than that found in EJAC-derived embryos. There is increased incidence of complex abnormal chromosomes in embryos derived from MESA. We therefore conclude that MESA and TESE followed by ICSI and PGD appears to be a plausible approach with results comparable to using ejaculated sperm. TABLE 1. Demographic data of 3 studied groups

Group

MESA

TESE

EJAC

P-value

Case number 11 11 101 Maternal age 33.8  4.4 36.5  4.0 38.5  4.3 n, Retrieved eggs 10.6  6.3 12.0  8.4 9.4  5.7 n, Mature eggs 8.6  5.3 8.5  5.6 7.4  4.2 %, Fertilization 75  20 71  27 73  26 n, Embryos for PGD 58 54 460 %, Embryo cleavage 87  30 83  24 87  20 %, None biopsy 13  30 23  31 9  15 %, normal chromosome 41  31 37  38 48  31 %, pregnancy 36 (4/11) 18 (2/11) 20 (20/101)

.004 .64 .68 .62 .77 .20 .37 .35

TABLE 2. Chromosome abnormalities in MESA, TESE, and EJAC embryos

Group

MESA (%)

TESE (%)

EJAC (%)

Normal Polyploid Haploid Aneuploid Complex abnormal Total embryos

21 (36.2) 1 (1.7) 1 (1.7) 7 (12.1) 28 (48.3)a 58

24 (44.4) 3 (5.6) 1 (1.9) 6 (11.1) 20 (37.0) 54

225 (48.9) 27 (5.9) 6 (1.3) 80 (17.4) 122 (26.5)a 460

a

p¼ .0005

P-23 To Transfer or Not to Transfer: An Important Question that PGD Answers. B. Trivax, A. Huang, S. Sarajari, N. Buehler, M. Surrey, H. Danzer, D. Hill. Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles; Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles; Southern California Reproductive Center, Beverly Hills, CA. Background: The ability to know when to perform a procedure is almost as important as knowing when not to perform it. As reproductive technology continues to advance, there is pressure to include more chromosomes in the FISH panel. The underlying thought is that more is equal to better. If we are able to look at more chromosomes, we will have more information which will translate to better outcomes for patients. Ultimately, it may be the information that helps decide not to perform an embryo transfer. This overlooked benefit of PGD plays an important role in counseling and caring for the infertile couple. Objective: The purpose of this study was to examine the impact of a 12 chromosome FISH panel on decision making for embryo transfer, and the effect of PGD 12 on pregnancy rates. Materials and Methods: This was a retrospective study investigating 36 patients over a 6-month period undergoing IVF with PGD12. A chart review was conducted looking at age, number of embryos biopsied, number of normal embryos per PGD, number of embryos transferred, pregnancy outcome, and cancelled embryo transfers. All stimulation protocols were similar and comparable. Student t-test and chi-squared test were used for statistical analyses. Results: The data for the two groups is displayed in the table. The mean age, number of embryos biopsied, the number of embryos transferred, and number of cancelled embryo transfers were similar between the PGD 9

S20

PCRS Abstracts

and PGD 12 groups. The numbers between the 9 chromosome panel and the 12 chromosome panel are very similar. Means Age # Embryos biopsied # Normal embryos %Normal embryos # Embryos transferred Pregnancy rate/ET NoCancelled ET

9 Chr PGD

12 Chr PGD

41.7 7.54 1.66 21.9 1.14 31.0% 15

40 7.45 1.3 15 1.23 32% 13

Conclusion: Whereas the possibility of having all abnormal embryos after PGD 9 and PGD 12 exists, this allows for embryo transfers to be cancelled. This is beneficial by avoiding an unnecessary procedure and decreasing the miscarriage rate by not transferring abnormal embryos. The 12-chromosome panel, while similar in results to the 9-chromosome panel, could eventually provide even more data to aid in clinical decision making.

P-24 Human Oocytes Cryopreservation by Slow-Freezing Technique—A Case Report. D. Elow, M.C. Rodriguez-Karl, D.G. Diaz, J.E. Moody, A. La. West Coast Fertility Centers, Fountain Valley, CA. Objective: To describe the successful use of oocyte cryopreservation in an IVF cycle. Design: Case report. Setting: Private ART Clinic. Patient: A 33-year-old patient with tubal and oligoasthenoteratospermia underwent controlled ovarian hyperstimulation and IVF-ET in February 2003. A total of 8 oocytes were collected. Three MII oocytes were ICSI and 5 (4 MII, 1 MI) were cryopreserved per couple requested. She became pregnant and delivered a baby girl in November 2003. The patient returned 3 years later for a frozen cycle. Cryopreserved oocytes were thawed, inseminated via ICSI, and culture. To synchronize the recipient’s endometrium, the patient was given estradiol replacement, and when the endometrium reached >8-mm thickness, progesterone in oil was started. Embryo transfer was performed on day 4 of progesterone. Intervention: An IVF cycle resulting in frozen oocytes per patient request using slow-freezing method with 3-steps dehydration protocol of 1,2-propanediol and sucrose. Result: The patient’s initial serum b-hCG level was 236 mIU/mL 14 days after ET. An initial ultrasound at the sixth week of gestation revealed one gestational sac with positive cardiac motion and appropriate-sized yolk sac. The pregnancy was uneventful and culminated in a cesarean delivery of a healthy baby girl. Conclusions: This case illustrates the feasibility of oocyte cryopreservation resulting in a normal pregnancy and healthy baby. Patients undergoing IVF have an option of freezing either embryos or oocytes and decreasing the stress of the ethical dilemma that many couples go through when they make decisions concerning the fate of their embryos and excess oocytes.

P-25 Oocyte Cryopreservation for Fertility Preservation: The Effect of Age on the Quantity and Maturity of Oocytes. J. Barritt, M. Luna, M. Duke, L. Valluzzo, M. Howard, J. Klein, A.B. Copperman Objective: Recent advances in human oocyte cryopreservation have enabled this therapeutic modality to enter the clinical arena for long-term female fertility preservation. After completing an IRB-approved clinical study of oocyte cryopreservation and thaw, with a 75% pregnancy rate, our center initiated another IRB-approved clinical trial for long-term female fertility preservation. We report the initial experience with this program at our large academic reproductive center. The relationship between cycle cancellation, patient age, and the oocytes available for cryopreservation were evaluated. Design: Retrospective data analysis. Materials and Methods: Data from women presenting for elective oocyte cryopreservation were reviewed between January 2005 and December 2006. Variables analyzed included cancellation rate, patient age, number of

Vol. 87, Suppl 2, April 2007