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Intra-Uterine Insemination (IUI) outcome is enhanced by shorter intervals from semen collection to sperm wash, from sperm wash to IUI time, and from semen collection to IUI time
P-94 Embryos frozen at the 2PN stage demonstrate a reduced number of cells at the third day compared with fresh embryos of the same cycles. Ishai Levin, Tamar Schwartz, Nava Mey-Raz, Mira Malcov, Dalit BenYosef, Ami Amit. Sara Racine IVF Unit, Lis Maternity Hosp, Tel-Aviv, Israel. Objective: To determine the cleavage potential of three-day embryos that were frozen at the 2PN stage, compared with embryos from the corresponding fresh cycles. Design: Retrospective computer generated data base study. Materials and Methods: Embryos from 248 fresh IVF cycles and their corresponding 344 freeze-thaw cycles were analyzed using our computerized data base. Eighteen hours after in-vitro fertilization, embryos were examined and determined to be at a 2PN stage. At that time embryos were either left to continue incubation (fresh cycle) of frozen (freeze-thaw cycle). Seventy-two hours after fertilization in the “fresh cycle” or 48 hours after the thaw in freeze cycles the degree of cleavage was determined according to the number of blastomers in each embryo. This information was recorded in our computer database. We retrospectively compared the cleavage degree of embryos from the “fresh cycle” with the “freeze-thaw cycle” embryos according to their blastomer number: from 2 cells to the morula stage. Results: The fraction of embryos with a lower degree of cleavage (2-3 blastomer embryos) was significantly higher in the “freeze-thaw” cycles being 10.06% of the embryos compared with 5.1% in the “fresh” cycle (p⬍0.001 by Fisher’s exact test). Additionally, the fraction of higher degree cleavage embryos (8 balstomers-morula) was significantly lower in the “freeze-thaw” cycles being 34.95% of the embryos compared with 45.41% in the “fresh” cycle (p⬍0.001) Conclusion: We demonstrated that following a “freeze-thaw” cycle the degree of embryo cleavage is reduced significantly compared with fresh cycles.
ART: OUTCOME PREDICTORS P-95 Abnormal sperm DNA condensation is associated with low fertilization rate in IVF. R. D. Powers, Michael M. Alper, Marie Hayes, Shafrira Shai, G. Fihman. Boston IVF, Waltham, MA; Bioshaf, Haifa, Israel. Objective: The objective of the present study was to evaluate the application of a flow cytometer-based kit for testing sperm DNA condensation as a predictor test for low fertilization rates in IVF treatments. Design: A prospective study of 113 patients who underwent IVF at Boston IVF from January to March, 2003. Materials and Methods: Flowcytometric analysis was performed using a flow cytometer supplied with argon laser, measuring emission of FL-1530nm, FL-2-582nm and FL-3-660nm, analyzing particle size and a newly developed Flowcytometric kit for sperm DNA condensation (BioShaf Ltd, Israel). Normal DNA condensation was defined by the staining pattern of sperm DNA with Acridine Orange (Sigma Inc) obtained from 87 fertile males with normal sperm morphology (based on the W.H.O 1999 manual). The accuracy of the staining pattern was demonstrated by the shift of the normal staining pattern as a result of pre treatment the sperm cells with DNAase (low concentration) or by high temperature that influence DNA condensation. DNA condensation was tested in 113 patients who underwent IVF at Boston IVF during Jan-March of 2003. DNA condensation and fertilization results were compared using Chi Square analysis. The association between abnormal DNA condensation and the fertilization rate among 113 couples that attended our IVF clinic was tested and the chi squared test was applied to check the association between abnormal DNA condensation and low fertilization rate in IVF treatment. Results: The level of decondensation in the normal population was established as greater than 65%. A strong association was shown to be present between samples with abnormal DNA condensation and suboptimal fertilization. A significantly higher proportion of patients showing ⬍40% fertilization exhibited abnormal percentages of decondensation compared to patients with ⬎ 40% fertilization (2 ⫽ 28 P⬍ 0.001). The table below shows the data:
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Abstracts
Conclusion: A high association between abnormal DNA condensation and low fertilization rate in conventional IVF was found. The Flowcytometric kit for DNA condensation can help to direct patients to ICSI treatment.
P-96 Outcome of recipients with and without ovarian function. Vincent Graziano, Jerome H. Check, Deborah Lurie, Carrie Wilson. UMDNJ, Robert Wood Johnson Med. Sch, Camden, NJ. Objectives: It was reported in Human Reproduction in 1995 that recipients with ovarian failure had a significantly higher pregnancy rate (PR) than those recipients with ovarian function. With all the improvements in in vitro fertilization (IVF) such as better growth medias, transfer techniques, salpingectomy for hydrosalpinges, and the use of lower doses of leuprolide acetate, the possibility exists these previous conclusions are no longer valid. This study re-evaluated if this difference in PR would still be found in the modern era of IVF. Design: Retrospective review. Materials and Methods: The first recipient cycle of all women who underwent embryo transfer (ET) in the donor oocyte program from 1/97 through 7/02 were retrospectively reviewed. Recipients were given graduated oral estradiol followed by progesterone (HRT) and those with ovarian function received HRT plus leuprolide acetate. Main outcome measures were implantation rate defined as number of gestational sacs divided by the number of embryos transferred, clinical PR defined by the presence of at least a single gestational sac after six weeks, and ongoing/delivered PR defined as a live pregnancy after the first trimester. Results: For the women with ovarian function (n⫽229) the average age, endometrial thickness, and average number of embryos transferred was 41.6 years, 10.0mm, 3.1 embryos/transfer. The recipients without ovarian function (n⫽112) had averages of 40.8 years, 10.1mm and 3.2 embryos/transfer. The ovarian function group had clinical, viable, and implantation rates of 57.6%, 50.2%, and 32.2%, respectively. Corresponding rates in the group without ovarian function were 52.7%, 47.3%, and 30.1%. Conclusions: These data suggest that recipients with ovarian function no longer suffer worse pregnancy outcomes than those without ovarian function. Given the similar profiles of the two groups, no confounding variables were identified. One possible explanation for this improvement could be attributed to the 50% reduction in the dosage of leuprolide acetate used today to suppress ovarian function than used previously.
P-97 Intra-Uterine Insemination (IUI) outcome is enhanced by shorter intervals from semen collection to sperm wash, from sperm wash to IUI time, and from semen collection to IUI time. Yalcin Yavas, Minna R. Selub, Holly Lefkow, Deborah Carmichael. Florida Institute for Reproductive Science and Technologies (FIRST), Cooper City, FL. Objective: To determine if IUI outcome was affected by: 1) place of semen collection (home vs. clinic); and 2) intervals from semen collection to sperm wash (C-SW), from sperm wash to IUI time (SW-IUI), and from semen collection to IUI time (C-IUI). Design: A retrospective analysis of IUI results from January 2000 to March 2003. Materials and Methods: In 132 IUI cycles, women with infertility of various causes received either clomiphene citrate (CC) or human menopausal gonadotropin (hMG). Women stimulated with CC received 50-250 mg/day for 5 days starting on cycle day 3; and women stimulated with hMG were started on cycle day 3, if a baseline ultrasound revealed no ovarian cyst. When the largest follicle(s) reached a mean diameter of 19 mm, ovulation was induced with 10,000 IU hCG, and a single IUI was performed 36-38 hours later. Women underwent IUI using their respective partners’
Vol. 80, Suppl. 3, September 2003
washed sperm obtained from ejaculates collected either at home (H), or at our clinic (FIRST, F). Ejaculates were allowed at least 15 minutes for liquefaction before sperm wash by a gradient density method. Pregnancy was defined as ultrasonographic detection of a fetal heart beat(s). Pregnancy data were analyzed by least squares analysis of covariance using the General Linear Models Procedure of Statistical Analysis System (SAS), with medication type (CC, hMG) and semen collection place (H, F) as treatments in a 2 x 2 factorial design, and age of women and the total number of progressively-motile spermatozoa as covariates. In a sub-group of 70 women, the intervals of C-SW, SW-IUI, and C-IUI were compared by Student’s t-test between: 1) collection places; and 2) pregnant and nonpregnant women within medication types. Results: Results are shown in the tables.
*a,b: Pⱕ0.05 within treatments; **a,b,c: Pⱕ0.05
When the ⬎35 and ⬍38 age group was examined, it was found that the ongoing pregnancy rate of those patients receiving 3 embryos meeting the same criteria (lead embryo at least 8 cells of the highest grade) (n⫽123) was 53%. Those receiving 3 embryos had singleton, twin and triplet rates of 55%, 34%, and 8%, respectively (P⬎.05 when compared to ⬍35 group). As there were no patients in this age group that electively chose only 2 embryos for transfer, these data cannot be directly compared to those of the ⬍35 group receiving 2 embryos. Conclusion: These data raise an interesting possibility for the age group between 35 and 38. It is clear that in the under 35 age group, 3 embryos offer no advantage over 2 embryos when high quality embryos are available for transfer. Moreover, the addition of a third embryo in this group does not increase the overall pregnancy rate-only the high order multiple pregnancy rate (triplets). The fact that the 35-38 age group receiving 3 embryos displayed almost identical pregnancy rates as the under 35 group receiving 3 embryos and that the singleton, twin and triplet rates were not different between the groups suggests that even the older group may benefit from having only 2 high quality embryos transferred. These data suggests doing so would not compromise overall pregnancy rates but would have the benefit of reducing the high order multiple rates. Furthermore, these data fully support the SART guideline of transferring only 2 embryos in younger patients that have a good prognosis. In addition, these data suggest that extending that guideline to include patients up to 38 with a good prognosis may be justified.
P-99
Mean ⫾ SEM; *Intervals in minutes Conclusion: CC and hMG result in similar pregnancy rates when semen is collected either at home or at clinic. Semen collection at clinic results in higher pregnancy rate than at home both in CC- and hMG-treated women. Pregnancy is not affected by intervals of C-SW, SW-IUI, and C-IUI in CC-treated women, but is associated with shorter intervals in hMG-treated women. The study is ongoing, and updated results will be presented at the meeting. P-98 Two versus three embryos for transfer on day 3: Influence of female age and embryo quality on outcome. Jacques P. Stassart, Ricardo Castillo, G. D. Ball. Reproductive Medicine & Infertility Assoc, Woodbury, MN. Objective: The objective of this study was to determine the optimal number of embryos to transfer on day 3 in females up to age 38. The dual goals are to maintain a high pregnancy rate and minimize the multiple pregnancy rate. Design: This is a retrospective study with data collected from January 1999 through March 2003. All embryo transfers were performed on day 3 after oocyte retrieval and excluded any oocyte donor cases. Patients were classified by age into one of two groups: females ⬍35, or females ⬎35 and ⬍38. Outcome comparisons (ongoing pregnancy rates defined as presence of a heart beat at 9 weeks gestation) were made by Chi-Square analysis. Only patients with at least 3 embryos at transfer were included in the data analysis. Materials and Methods: All patients underwent an ovarian stimulation protocol using either a GnRH agonist prior to stimulation with gonadotropins, or a GnRH antagonist following gonadotropin stimulation. Oocyte retrieval was performed 36 hrs post hCG administration and embryos were transferred approximately 72hrs post oocyte retrieval. Patients utilizing either standard IVF or ICSI were included in this study. Embryos were cultured in commercially prepared media and graded for quality (cell stage, degree of fragmentation, symmetry of blastomeres) immediately prior to transfer. The highest quality embryos available were chosen for transfer. Results: For the ⬍35 age group, it was found that patients receiving 2 high quality embryos (lead embryo at least 8 cells and of the highest grade) at transfer (n⫽141) had an ongoing pregnancy rate of 55% while those receiving 3 such embryos (n⫽196) had an ongoing rate of 56% (P⬎.05). The singleton, twin and triplet rate for pregnancies of patients receiving 2 embryos was 62%, 38%, and 0%, respectively. Patients receiving 3 embryos had a singleton, twin, and triplet rate of 55%, 34 % and 11%, respectively.
FERTILITY & STERILITY威
Determining factors of early embryo cleavage to 2-cell stage for predicting the pregnancy outcome of in vitro fertilization. Bo Sun Joo, Hwa Sook Moon, Sae Hee Park, Soo Kyung Lee, Myung Sun Lee, Kyung Seo Kim. Ctr for Reproductive Medicine, Busan, Republic of Korea. Objective: To determine critical factors that early embryo cleavage to 2-cell stage predicts the successful pregnancy in in vitro fertilization and embryo transfer. Design: Prospective study. Materials and Methods: This study was performed in 82 cycles who underwent in vitro fertilization at the infertility clinic of Moon Hwa hospital from January 2002 to March 2003. Cleavage (EC) to 2-cell stage was assessed at 25 and 27h postinsemination/ICSI. Embryos that had cleaved at each time point were designated as EC-1 and EC-2, respectively, while others were designated as ’non-early cleavage (NEC). Embryos were preferentially transferred for early cleavage embryos. Results: Early cleavage was observed in 31 (37.8%) for EC-1 and 60 (73.2%) for the EC-2 of the 82 cycles assessed. Clinical pregnancies were significantly higher in the EC-1 group (71.0%, 22/31) compared to the EC-2 group (53.3%, 10/29, P⬍ .05) or the NEC group (31.8%, 7/22). There were no differences for patient’s age, the number of oocytes retrieved, the number of embryos fertilized, and the number of embryos transferred. Significant improvement of the pregnancy rate was found when at least two or more embryos were early cleaved at 25 h postinsemination or when the proportion of early cleavage embryo at 25 h postinsemination is more than 20%. Conclusion: These results suggest that the time from postinsemination to early cleavage to 2-cell stage, the number and the proportion of early cleavage embryos are effective factor for predicting the pregnancy outcome of in-vitro fertilization.
P-100 Examination of pronuclear patterns in a cohort of embryos selected for transfer on the basis of day 3 embryo score. Nina Desai, Namita Kattal, James Goldfarb. Cleveland Clin Fertility Ctr, Beachwood, OH. Objective: Studies have suggested that scoring of zygote patterns may aid in selection of embryos most likely to implant. Our laboratory uses a unique scoring system specifically designed for Day 3-embryo selection (Desai et al, 2000 ) that incorporates features unique to Day 3 embryos. The goal of this study was to examine pronuclear (PN) grades in transferred embryos and to see how they relate to cycle outcomes, where embryo selection was based on Day 3 score. Design: Examination of pronuclear and Day 3 morphology scores in pregnant and non-pregnant patients.
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ART: OUTCOME PREDICTORS P-95 Abnormal sperm DNA condensation is associated with low fertilization rate in IVF. R. D. Powers, Michael M. Alper, Marie Hayes, Shafrira Shai, G. Fihman. Boston IVF, Waltham, MA; Bioshaf, Haifa, Israel. Objective: The objective of the present study was to evaluate the application of a flow cytometer-based kit for testing sperm DNA condensation as a predictor test for low fertilization rates in IVF treatments. Design: A prospective study of 113 patients who underwent IVF at Boston IVF from January to March, 2003. Materials and Methods: Flowcytometric analysis was performed using a flow cytometer supplied with argon laser, measuring emission of FL-1530nm, FL-2-582nm and FL-3-660nm, analyzing particle size and a newly developed Flowcytometric kit for sperm DNA condensation (BioShaf Ltd, Israel). Normal DNA condensation was defined by the staining pattern of sperm DNA with Acridine Orange (Sigma Inc) obtained from 87 fertile males with normal sperm morphology (based on the W.H.O 1999 manual). The accuracy of the staining pattern was demonstrated by the shift of the normal staining pattern as a result of pre treatment the sperm cells with DNAase (low concentration) or by high temperature that influence DNA condensation. DNA condensation was tested in 113 patients who underwent IVF at Boston IVF during Jan-March of 2003. DNA condensation and fertilization results were compared using Chi Square analysis. The association between abnormal DNA condensation and the fertilization rate among 113 couples that attended our IVF clinic was tested and the chi squared test was applied to check the association between abnormal DNA condensation and low fertilization rate in IVF treatment. Results: The level of decondensation in the normal population was established as greater than 65%. A strong association was shown to be present between samples with abnormal DNA condensation and suboptimal fertilization. A significantly higher proportion of patients showing ⬍40% fertilization exhibited abnormal percentages of decondensation compared to patients with ⬎ 40% fertilization (2 ⫽ 28 P⬍ 0.001). The table below shows the data:
S152
Abstracts
Conclusion: A high association between abnormal DNA condensation and low fertilization rate in conventional IVF was found. The Flowcytometric kit for DNA condensation can help to direct patients to ICSI treatment.
P-96 Outcome of recipients with and without ovarian function. Vincent Graziano, Jerome H. Check, Deborah Lurie, Carrie Wilson. UMDNJ, Robert Wood Johnson Med. Sch, Camden, NJ. Objectives: It was reported in Human Reproduction in 1995 that recipients with ovarian failure had a significantly higher pregnancy rate (PR) than those recipients with ovarian function. With all the improvements in in vitro fertilization (IVF) such as better growth medias, transfer techniques, salpingectomy for hydrosalpinges, and the use of lower doses of leuprolide acetate, the possibility exists these previous conclusions are no longer valid. This study re-evaluated if this difference in PR would still be found in the modern era of IVF. Design: Retrospective review. Materials and Methods: The first recipient cycle of all women who underwent embryo transfer (ET) in the donor oocyte program from 1/97 through 7/02 were retrospectively reviewed. Recipients were given graduated oral estradiol followed by progesterone (HRT) and those with ovarian function received HRT plus leuprolide acetate. Main outcome measures were implantation rate defined as number of gestational sacs divided by the number of embryos transferred, clinical PR defined by the presence of at least a single gestational sac after six weeks, and ongoing/delivered PR defined as a live pregnancy after the first trimester. Results: For the women with ovarian function (n⫽229) the average age, endometrial thickness, and average number of embryos transferred was 41.6 years, 10.0mm, 3.1 embryos/transfer. The recipients without ovarian function (n⫽112) had averages of 40.8 years, 10.1mm and 3.2 embryos/transfer. The ovarian function group had clinical, viable, and implantation rates of 57.6%, 50.2%, and 32.2%, respectively. Corresponding rates in the group without ovarian function were 52.7%, 47.3%, and 30.1%. Conclusions: These data suggest that recipients with ovarian function no longer suffer worse pregnancy outcomes than those without ovarian function. Given the similar profiles of the two groups, no confounding variables were identified. One possible explanation for this improvement could be attributed to the 50% reduction in the dosage of leuprolide acetate used today to suppress ovarian function than used previously.
P-97 Intra-Uterine Insemination (IUI) outcome is enhanced by shorter intervals from semen collection to sperm wash, from sperm wash to IUI time, and from semen collection to IUI time. Yalcin Yavas, Minna R. Selub, Holly Lefkow, Deborah Carmichael. Florida Institute for Reproductive Science and Technologies (FIRST), Cooper City, FL. Objective: To determine if IUI outcome was affected by: 1) place of semen collection (home vs. clinic); and 2) intervals from semen collection to sperm wash (C-SW), from sperm wash to IUI time (SW-IUI), and from semen collection to IUI time (C-IUI). Design: A retrospective analysis of IUI results from January 2000 to March 2003. Materials and Methods: In 132 IUI cycles, women with infertility of various causes received either clomiphene citrate (CC) or human menopausal gonadotropin (hMG). Women stimulated with CC received 50-250 mg/day for 5 days starting on cycle day 3; and women stimulated with hMG were started on cycle day 3, if a baseline ultrasound revealed no ovarian cyst. When the largest follicle(s) reached a mean diameter of 19 mm, ovulation was induced with 10,000 IU hCG, and a single IUI was performed 36-38 hours later. Women underwent IUI using their respective partners’
Vol. 80, Suppl. 3, September 2003
washed sperm obtained from ejaculates collected either at home (H), or at our clinic (FIRST, F). Ejaculates were allowed at least 15 minutes for liquefaction before sperm wash by a gradient density method. Pregnancy was defined as ultrasonographic detection of a fetal heart beat(s). Pregnancy data were analyzed by least squares analysis of covariance using the General Linear Models Procedure of Statistical Analysis System (SAS), with medication type (CC, hMG) and semen collection place (H, F) as treatments in a 2 x 2 factorial design, and age of women and the total number of progressively-motile spermatozoa as covariates. In a sub-group of 70 women, the intervals of C-SW, SW-IUI, and C-IUI were compared by Student’s t-test between: 1) collection places; and 2) pregnant and nonpregnant women within medication types. Results: Results are shown in the tables.
*a,b: Pⱕ0.05 within treatments; **a,b,c: Pⱕ0.05
When the ⬎35 and ⬍38 age group was examined, it was found that the ongoing pregnancy rate of those patients receiving 3 embryos meeting the same criteria (lead embryo at least 8 cells of the highest grade) (n⫽123) was 53%. Those receiving 3 embryos had singleton, twin and triplet rates of 55%, 34%, and 8%, respectively (P⬎.05 when compared to ⬍35 group). As there were no patients in this age group that electively chose only 2 embryos for transfer, these data cannot be directly compared to those of the ⬍35 group receiving 2 embryos. Conclusion: These data raise an interesting possibility for the age group between 35 and 38. It is clear that in the under 35 age group, 3 embryos offer no advantage over 2 embryos when high quality embryos are available for transfer. Moreover, the addition of a third embryo in this group does not increase the overall pregnancy rate-only the high order multiple pregnancy rate (triplets). The fact that the 35-38 age group receiving 3 embryos displayed almost identical pregnancy rates as the under 35 group receiving 3 embryos and that the singleton, twin and triplet rates were not different between the groups suggests that even the older group may benefit from having only 2 high quality embryos transferred. These data suggests doing so would not compromise overall pregnancy rates but would have the benefit of reducing the high order multiple rates. Furthermore, these data fully support the SART guideline of transferring only 2 embryos in younger patients that have a good prognosis. In addition, these data suggest that extending that guideline to include patients up to 38 with a good prognosis may be justified.
P-99
Mean ⫾ SEM; *Intervals in minutes Conclusion: CC and hMG result in similar pregnancy rates when semen is collected either at home or at clinic. Semen collection at clinic results in higher pregnancy rate than at home both in CC- and hMG-treated women. Pregnancy is not affected by intervals of C-SW, SW-IUI, and C-IUI in CC-treated women, but is associated with shorter intervals in hMG-treated women. The study is ongoing, and updated results will be presented at the meeting. P-98 Two versus three embryos for transfer on day 3: Influence of female age and embryo quality on outcome. Jacques P. Stassart, Ricardo Castillo, G. D. Ball. Reproductive Medicine & Infertility Assoc, Woodbury, MN. Objective: The objective of this study was to determine the optimal number of embryos to transfer on day 3 in females up to age 38. The dual goals are to maintain a high pregnancy rate and minimize the multiple pregnancy rate. Design: This is a retrospective study with data collected from January 1999 through March 2003. All embryo transfers were performed on day 3 after oocyte retrieval and excluded any oocyte donor cases. Patients were classified by age into one of two groups: females ⬍35, or females ⬎35 and ⬍38. Outcome comparisons (ongoing pregnancy rates defined as presence of a heart beat at 9 weeks gestation) were made by Chi-Square analysis. Only patients with at least 3 embryos at transfer were included in the data analysis. Materials and Methods: All patients underwent an ovarian stimulation protocol using either a GnRH agonist prior to stimulation with gonadotropins, or a GnRH antagonist following gonadotropin stimulation. Oocyte retrieval was performed 36 hrs post hCG administration and embryos were transferred approximately 72hrs post oocyte retrieval. Patients utilizing either standard IVF or ICSI were included in this study. Embryos were cultured in commercially prepared media and graded for quality (cell stage, degree of fragmentation, symmetry of blastomeres) immediately prior to transfer. The highest quality embryos available were chosen for transfer. Results: For the ⬍35 age group, it was found that patients receiving 2 high quality embryos (lead embryo at least 8 cells and of the highest grade) at transfer (n⫽141) had an ongoing pregnancy rate of 55% while those receiving 3 such embryos (n⫽196) had an ongoing rate of 56% (P⬎.05). The singleton, twin and triplet rate for pregnancies of patients receiving 2 embryos was 62%, 38%, and 0%, respectively. Patients receiving 3 embryos had a singleton, twin, and triplet rate of 55%, 34 % and 11%, respectively.
FERTILITY & STERILITY威
Determining factors of early embryo cleavage to 2-cell stage for predicting the pregnancy outcome of in vitro fertilization. Bo Sun Joo, Hwa Sook Moon, Sae Hee Park, Soo Kyung Lee, Myung Sun Lee, Kyung Seo Kim. Ctr for Reproductive Medicine, Busan, Republic of Korea. Objective: To determine critical factors that early embryo cleavage to 2-cell stage predicts the successful pregnancy in in vitro fertilization and embryo transfer. Design: Prospective study. Materials and Methods: This study was performed in 82 cycles who underwent in vitro fertilization at the infertility clinic of Moon Hwa hospital from January 2002 to March 2003. Cleavage (EC) to 2-cell stage was assessed at 25 and 27h postinsemination/ICSI. Embryos that had cleaved at each time point were designated as EC-1 and EC-2, respectively, while others were designated as ’non-early cleavage (NEC). Embryos were preferentially transferred for early cleavage embryos. Results: Early cleavage was observed in 31 (37.8%) for EC-1 and 60 (73.2%) for the EC-2 of the 82 cycles assessed. Clinical pregnancies were significantly higher in the EC-1 group (71.0%, 22/31) compared to the EC-2 group (53.3%, 10/29, P⬍ .05) or the NEC group (31.8%, 7/22). There were no differences for patient’s age, the number of oocytes retrieved, the number of embryos fertilized, and the number of embryos transferred. Significant improvement of the pregnancy rate was found when at least two or more embryos were early cleaved at 25 h postinsemination or when the proportion of early cleavage embryo at 25 h postinsemination is more than 20%. Conclusion: These results suggest that the time from postinsemination to early cleavage to 2-cell stage, the number and the proportion of early cleavage embryos are effective factor for predicting the pregnancy outcome of in-vitro fertilization.
P-100 Examination of pronuclear patterns in a cohort of embryos selected for transfer on the basis of day 3 embryo score. Nina Desai, Namita Kattal, James Goldfarb. Cleveland Clin Fertility Ctr, Beachwood, OH. Objective: Studies have suggested that scoring of zygote patterns may aid in selection of embryos most likely to implant. Our laboratory uses a unique scoring system specifically designed for Day 3-embryo selection (Desai et al, 2000 ) that incorporates features unique to Day 3 embryos. The goal of this study was to examine pronuclear (PN) grades in transferred embryos and to see how they relate to cycle outcomes, where embryo selection was based on Day 3 score. Design: Examination of pronuclear and Day 3 morphology scores in pregnant and non-pregnant patients.
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