- Email: [email protected]
ICSI-ET: A Randomized, Prospective Study
found no statistical differences in the parameters compared, we prefer ICSI/IVF procedures combined with Day 3-ET because it is possible to select embryos with higher potential (lower MR in both ICSI and IVF procedures) and maybe a better synchronization between embryo and endometrium.
P-046 Catheter Placement May Contribute to IVF-Conceived Ectopic Gestations. M. X. Ransom, E. E. Petrova, A. J. Garcia. Department of Obstetrics/ Gynecology, Saint Joseph’s Hospital & Medical Center, Paterson, NJ. Objectives: Approximately 2 to 5 percent of gestations conceived through in vitro fertilization are tubal pregnancies. While retrograde migration of embryos following transfer has been offered traditionally as an explanation for this occurrence, growing evidence supports that embryo implantation localizes to their site of deposition. To that end, we examined inadvertent catheter placement directly into the fallopian tube as a possible contributor to ectopic pregnancy. Design: An IRB-approved prospective study of consecutive patients undergoing hysterosalpingography (HSG) as part of a standard infertility investigation. Materials and Methods: Seventy consecutive patients undergoing HSG participated in this IRB-approved study. HSGs were obtained during the follicular phase of the cycle. After speculum placement, sounding of the uterus and measurement was performed and a scout film was taken. A Wallace catheter containing radio-opaque dye was then introduced transcervically to a mark previously ascertained by mock transfer and fluoroscopy performed. Three milliliters of dye was injected to document distal catheter position and contrast flow. Catheter placement was categorized as either intracavitary (group A), intratubal (group B), or coiled back upon itself (group C). Once the catheter position had been confirmed, the catheter was withdrawn and the HSG was completed by standard technique. Patient demographics, indications for HSG and uterine abnormalities discovered at the time of HSG were recorded. Results: During the ten month study period, 70 patients were enrolled and HSGs performed successfully in all. The mean age, weight, height, and parity for patients undergoing HSG were 33.4 6 4.8 years, 75.6 6 18.0 kg, 167.9 6 8.3 cm, and 0.4 6 0.7, respectively. Group A totaled 56 (80%) patients, group B equaled 6 (8.6%) patients and group C comprised 5 (7.1%) patients. The remaining 3 patients included 2 patients in whom the catheter was placed into the cornual region of the uterus and 1 into a cesarean scar defect. Four of the 56 group A patients (7.1%) had intracavitary abnormalities (2 fibroids, 1 septum, 1 synechiae), 3 of the 6 group B patients (50%) had discovered abnormalities (1 septate, 1 arcuate, 1 rudimentary horn) and 2 of 5 in group C (40%) had abnormal findings (1 sepatate and 1 fibroid). Improper catheter placement was significantly associated with uterine abnormality (p,0.005). Conclusions: Misdirected placement of soft-tipped catheters during embryo transfer procedures likely occurs with a frequency similar to the observed ectopic rate reported with in vitro fertilization. Intracavitary uterine abnormalities are strongly associated with improper catheter placement. The ectopic gestation rate associated with in vitro fertilization may be as much a function of catheter placement as it is of retrograde embryo migration. Normalization of the uterine cavity and ultrasonographic confirmation of intrauterine catheter placement may reduce this phenomenon.
P-047 Extended Embryo Culture in Poor Prognosis Patients. M. Langley, D. Marek, J. Patton, C. McKean, K.M. Doody, K.J. Doody. Center for Assisted Reproduction, Bedford, TX. Objective: Extended embryo culture has been demonstrated to result in high implantation and pregnancy rates in good prognosis (Fertil Steril, 1998;69:84 – 8) and non-selected patients (Fertil Steril, 1999;72:1035– 40). It has been suggested that application of extended embryo culture to poor prognosis patients with low zygote number or slow cleavage rate may result in poor outcome (Fertil Steril, 2000;73:558 – 64). The objective of this study was to evaluate the implantation and pregnancy rates when blastocyst culture is applied to patients with slow cleaving embryos and or low zygote number.
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Abstracts
Design: A retrospective analysis of embryo transfer results from January 1, 1998 through June 30, 1999. Materials and Methods: Patients undergoing IVF were selected for blastocyst culture regardless of the number rapidly cleaving embryos or number of normally fertilized oocytes. Only patients with slow cleaving embryos containing less than eight-cells on day 3 were included in this investigation. Pronuclear embryos were cultured in 100 ml micro-drops S-1/G1.2 media (IVF Science) in groups of two under oil for 48 hours followed by culture in 100 ml micro-drops S-2/G2.2 media for 48 to 72 hours to blastocyst stage. Results:
Mean patient age (6SEM): Number retrievals: Number embryo transfers: Pregnancies (1hCG)/ongoing: Biochemical/miscarriage/ectopic: Pregnancy/ongoing rate per transfer: Total embryos/mean transferred: Number 2PN/mean number 2PN: Number blastocyst/per 2PN: Number clinical sacs (1/2/3): Implantation rate:
$8 2PN
,8 2PN
33.1 6 0.97 30 29 15/11 3/1/0 51.7%/37.9% 73/2.52 286/9.53 111*/38.8% 8/3/1 23.3%
34.7 6 0.40 113 101 44/31 6/6/1 43.5%/30.7% 231/2.29 436/3.86 115/26.4% 27/8/2 21.2%
* P,.001 (vs. ,8 2PN category using Chi Square Test). Conclusion: Acceptable implantation and pregnancy rates can be obtained with extended culture from patients with slowly cleaving embryos even when less than eight two pronuclei embryos were present. Rates of blastocyst formation for patients with fewer than eight zygotes are significantly less than patients with eight or more zygotes and when compared to all IVF patients (52.0%) during the same time period (P,.001).
P-048 MIFT versus IVF/ICSI-ET: A Randomized, Prospective Study. T. Delahaye, M. Camus, P. Platteau, A. Devos, A. Van Steirteghem, P. Devroey. Center of Reproductive Medicine, Free University of Brussels, Belgium. Objective: Comparison of the implantation rate in patients with tubal replacement of intracytoplasmatic injected oocytes (MIFT) versus the replacement of four cell embryos after ICSI. Study design: This prospective randomized study was designed to analyze the implantation potential of an embryo obtained after ICSI versus a micro-injected oocyte transferred in the Fallopian tube. Materials and Methods: Infertile patients between 18 and 37 years of age with normal menstrual cycles and no more than 3 previous ICSI attempts were included in the study. All patients were stimulated with the association of a GnRH agonist and human menopausal gonadotrophins (long protocol). All patients previously underwent a hysterosalpingography or a laparoscopy indicating tubal patency. Results: 60 patients were included in the study, 30 in the IVF-ET group and 30 in the tubal replacement group. Results are available for 17 patients after IVF-ET and 19 patients after tubal replacement. All patients who started treatment had either an embryo- or an oocyte transfer. There was no significant difference in average age, duration of infertility, previous trials, number of ampoules used, number of stimulation days or number of oocyte-cumulus complexes retrieved.
Mean MII oocytes Mean MII oocytes replaced Mean no of embryos replaced Ongoing clinical pregnancy rate Ongoing implantation rate Mean no of frozen embryos
IVF-ET
MIFT
11.2 (4–21)
10.5 (2–23) 2.9 (2–4)
2.1 (1–3) 35% (6/17) 25% (9/36) 3.1 (0–11)
37% (7/19) 14.3% (8/56) 2.8 (0–11)
Conclusions: The clinical pregnancy rate was equal in both groups, probably due to the higher number of oocytes replaced in the MIFT group. The implantation rate on the contrary tends to be lower in the MIFT group
Vol. 74, No. 3, Suppl. 1, September 2000
(at the moment not significant) which is probably due to the better embryo selection on day 2 in the IVF-ET group. The physiological advantage of tubal replacement does not compensate for the better day 2 embryo selection. In this group of patients there is no advantage in tubal replacement of micro injected oocytes. A randomized prospective study is necessary in patients older than 37 years, where the physiological circumstances and minimal manipulation of the zygotes might be more beneficial. This is an ongoing study and more results will be presented during the ASRM meeting. P-049 A Mild to Moderate Decrease in Estradiol Level After Administration of Human Chorionic Gonadotropin (HCG) During an In Vitro Fertilization (IVF) Cycle Is Not Associated With a Poorer Prognosis. D. O. Kreger, M. Hayes, J. D. Brannian, P. Long, and K. A. Hansen. Department of Obstetrics/Gynecology, University of South Dakota School of Medicine, Sioux Falls, SD. Objective: It is widely accepted that a fall in estradiol level following HCG administration during an IVF cycle is associated with a poor prognosis. Textbooks routinely recommend canceling IVF cycles when a drop of 10 –20% occurs. However, there is surprisingly little data regarding the effect of such a drop during modern IVF cycles utilizing gonadotropin releasing hormone (GnRH) agonists. We wish to identify if a fall in estradiol level after HCG administration during an IVF cycle is associated with a poorer prognosis. Design: A retrospective cohort study of 132 consecutive IVF cycles at the University of South Dakota School of Medicine. Materials and Methods: Estradiol levels were compared on the day of HCG administration and the day after. Cycles were divided into three groups: Group 1 had a decrease in estradiol level of greater than 5%, Group 2 had no significant change in estradiol level with a 5% decrease to a 5% increase, and Group 3 had an increase in estradiol level of greater than 5%. After grouping the cycles, fertilization, cleavage, clinical pregnancy, and implantation rates were calculated and compared. Results: Rates in %
Change in Group estradiol 1 2 3
Mean change in estradiol (range)
N
Decrease 211% (26–225) 16 No change 1% (24.4–4.4) 14 Increase 32% (5–92) 102
Mean Fertili- Cleav- Preg- Implanage zation age nancy tation (years) rate rate rate rate 35.8 33.5 33.5
69 69 76
94 88 86
50 42 38
25 24 18
Conclusions: A decrease in estradiol level of 5%–25% is not associated with decreased levels of fertilization, cleavage, pregnancy or implantation in our IVF program. Although not statistically significant, there is a trend towards decreased implantation rates with increased estradiol levels after HCG administration during IVF cycles. Future studies will evaluate the relationship between changes in estradiol levels and success after frozen embryo transfer. P-050 The Effect of Propofol Anaesthesia on Oocytes, Fertilization and Early Embryo Quality. 1I. Ben-Shlomo, 2R. Moskovich, 1V. Eyali, 1J. Golan, 2 Y. Katz, 1E. Shalev. 1Department of Obstetrics & Gynecology, 2Department of Anaesthesiology, HaEmek Medical Centre, Afula, and the Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Objective: Propofol, which is frequently used for induction of anaesthesia in assisted reproduction procedures, has been suspected to damage oocytes. A recent study showed that concentrations of propofol increase in follicular fluid during oocyte retrieval. Our study was designed to assess whether exposure to these increasing concentrations of propofol has a measurable effect on in vitro fertilization, cleavage and embryo development. Design: A prospective cohort split study. Materials and Methods: A cohort of 130 women underwent intravenous
FERTILITY & STERILITYt
anesthesia using propofol and fentanyl. Time from injection of propofol was measured, and so were the doses of the two drugs. In women expected to have more than 15 oocytes, early, middle and last oocytes, respectively were cultured separately. Results: Mean time of anesthesia was 439 (6201) sec. Time from injection to first follicle aspiration was 200 sec. The mean time for the aspiration of each oocyte was 17.6 sec. Mean number of oocytes retrieved was 12.6 6 7.5. The mean total dose of propofol was 2.79 6 0.59 mg/kg and that of fentanyl 1.3 6 0.31 mg/kg. No differences were found in fertilization (75% 6 24% vs. 77% 6 32%), cleavage (89% 6 21% vs. 85% 6 25%) and embryo cell number (4.6 6 1.6 vs. 4.6 6 1.8), respectively. Conclusions: Within the time frame of our technique, the time which elapses from the retrieval of the first to the last oocyte does not affect oocyte quality, as reflected in subsequent in vitro development.
P-051 Prospective Controlled Study of the Effect of Uterine Fibroids on the Outcome of Assisted Conception Cycles. R. Hart, Y. Khalaf, C. T. Yeong, H. Bickerstaff, R. Lawson, A. Taylor, P. Braude. Assisted Conception Unit, Guy’s and St. Thomas’ Hospitals Trust, Lambeth Palace Road, London SE 1 7EH, UK. Introduction: The effect of fibroids on the outcome of assisted conception has been the subject of recent debate. We set out to prospectively evaluate the outcome assisted conception (IVF&ICSI) cycles in the presence of uterine fibroids. Materials and Methods: All patients from 1st August 1999 to date were included in the study. Prior to embarking on a cycle of assisted conception all patients underwent a pelvic ultrasound scan. If a submucosal fibroid was suspected hydrosonography was performed and the fibroid resected if appropriate. The outcome of the subsequent assisted conception cycle was then analyzed. Multifollicular stimulation was carried out using our standard protocol. All aspects of the stimulation and outcome of the treatment were studied. A difference was significant when p,0.05. Results: We have treated 71 patients to date, of whom 68 patients have completed treatment (2 patients had all embryos frozen). The control group were those patients without fibroids treated during the same time interval. Both study and control groups are matched in age, duration of infertility, and basal serum FSH levels. The overall pregnancy and implantation rates were 15.2% and 8.6% in the study patients compared to 28.0% and 13.0% in the control group respectively (p50.42 for pregnancy rate and p50.14 for implantation rate). Conclusion: Our study suggests that uterine fibroids are associated with a tendency towards lower implantation and pregnancy rates in assisted conception treatment.
P-052 Can We Predict Patient’s Chance to Conceive at the Time of Embryo Transfer? 1,2I. Tur-Kaspa, 1C. Chapman, 1V. Karande, 1D. Hazlett, 1W. Skoog, and 1N. Gleicher. 1ART Program, The Center for Human Reproduction (CHR), Chicago, IL, USA and 2IVF Unit, Department of Obstetrics/ Gynecology, Barzilai Medical Center, Ben-Gurion University, Ashklon, Israel. Objectives: To determine whether infertility specialists and embryologists can mutually predict a patient’s chance to conceive at time of embryo transfer. Design: Prospective blinded study of 100 consecutive Day 3 ETs done in January–February 2000. Materials and Methods: A simple form with two to three possible options was developed by the embryology/physician staff. The forms were filled out individually by two experienced embryologists and three experienced infertility specialists for each transfer. Parameters were: age, $40, 35–39, or ,35; gravida, 0 or $1; IVF cycle number, 1, 2–3, or $4; day of hCG, $12 days, #9 days, or 10 –11 days; E2 on day hCG ,750 pg/ml, .2501 pg/ml or 751–2500 pg/ml; total oocytes retrieved, #5, .21 or 6 –20; percent mature oocytes, ,30, 30 – 60, or .61; percent 2PN zygotes, ,30, 30 – 60, or .61; total number of cleaved embryos, #5, .21 or 6 –20; quality of embryos at transfer (assessed by embryologist), fair, good or excellent; number of embryos transferred, 1, $4 or 2–3; AZH, yes or no; difficulty of
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P-046 Catheter Placement May Contribute to IVF-Conceived Ectopic Gestations. M. X. Ransom, E. E. Petrova, A. J. Garcia. Department of Obstetrics/ Gynecology, Saint Joseph’s Hospital & Medical Center, Paterson, NJ. Objectives: Approximately 2 to 5 percent of gestations conceived through in vitro fertilization are tubal pregnancies. While retrograde migration of embryos following transfer has been offered traditionally as an explanation for this occurrence, growing evidence supports that embryo implantation localizes to their site of deposition. To that end, we examined inadvertent catheter placement directly into the fallopian tube as a possible contributor to ectopic pregnancy. Design: An IRB-approved prospective study of consecutive patients undergoing hysterosalpingography (HSG) as part of a standard infertility investigation. Materials and Methods: Seventy consecutive patients undergoing HSG participated in this IRB-approved study. HSGs were obtained during the follicular phase of the cycle. After speculum placement, sounding of the uterus and measurement was performed and a scout film was taken. A Wallace catheter containing radio-opaque dye was then introduced transcervically to a mark previously ascertained by mock transfer and fluoroscopy performed. Three milliliters of dye was injected to document distal catheter position and contrast flow. Catheter placement was categorized as either intracavitary (group A), intratubal (group B), or coiled back upon itself (group C). Once the catheter position had been confirmed, the catheter was withdrawn and the HSG was completed by standard technique. Patient demographics, indications for HSG and uterine abnormalities discovered at the time of HSG were recorded. Results: During the ten month study period, 70 patients were enrolled and HSGs performed successfully in all. The mean age, weight, height, and parity for patients undergoing HSG were 33.4 6 4.8 years, 75.6 6 18.0 kg, 167.9 6 8.3 cm, and 0.4 6 0.7, respectively. Group A totaled 56 (80%) patients, group B equaled 6 (8.6%) patients and group C comprised 5 (7.1%) patients. The remaining 3 patients included 2 patients in whom the catheter was placed into the cornual region of the uterus and 1 into a cesarean scar defect. Four of the 56 group A patients (7.1%) had intracavitary abnormalities (2 fibroids, 1 septum, 1 synechiae), 3 of the 6 group B patients (50%) had discovered abnormalities (1 septate, 1 arcuate, 1 rudimentary horn) and 2 of 5 in group C (40%) had abnormal findings (1 sepatate and 1 fibroid). Improper catheter placement was significantly associated with uterine abnormality (p,0.005). Conclusions: Misdirected placement of soft-tipped catheters during embryo transfer procedures likely occurs with a frequency similar to the observed ectopic rate reported with in vitro fertilization. Intracavitary uterine abnormalities are strongly associated with improper catheter placement. The ectopic gestation rate associated with in vitro fertilization may be as much a function of catheter placement as it is of retrograde embryo migration. Normalization of the uterine cavity and ultrasonographic confirmation of intrauterine catheter placement may reduce this phenomenon.
P-047 Extended Embryo Culture in Poor Prognosis Patients. M. Langley, D. Marek, J. Patton, C. McKean, K.M. Doody, K.J. Doody. Center for Assisted Reproduction, Bedford, TX. Objective: Extended embryo culture has been demonstrated to result in high implantation and pregnancy rates in good prognosis (Fertil Steril, 1998;69:84 – 8) and non-selected patients (Fertil Steril, 1999;72:1035– 40). It has been suggested that application of extended embryo culture to poor prognosis patients with low zygote number or slow cleavage rate may result in poor outcome (Fertil Steril, 2000;73:558 – 64). The objective of this study was to evaluate the implantation and pregnancy rates when blastocyst culture is applied to patients with slow cleaving embryos and or low zygote number.
S110
Abstracts
Design: A retrospective analysis of embryo transfer results from January 1, 1998 through June 30, 1999. Materials and Methods: Patients undergoing IVF were selected for blastocyst culture regardless of the number rapidly cleaving embryos or number of normally fertilized oocytes. Only patients with slow cleaving embryos containing less than eight-cells on day 3 were included in this investigation. Pronuclear embryos were cultured in 100 ml micro-drops S-1/G1.2 media (IVF Science) in groups of two under oil for 48 hours followed by culture in 100 ml micro-drops S-2/G2.2 media for 48 to 72 hours to blastocyst stage. Results:
Mean patient age (6SEM): Number retrievals: Number embryo transfers: Pregnancies (1hCG)/ongoing: Biochemical/miscarriage/ectopic: Pregnancy/ongoing rate per transfer: Total embryos/mean transferred: Number 2PN/mean number 2PN: Number blastocyst/per 2PN: Number clinical sacs (1/2/3): Implantation rate:
$8 2PN
,8 2PN
33.1 6 0.97 30 29 15/11 3/1/0 51.7%/37.9% 73/2.52 286/9.53 111*/38.8% 8/3/1 23.3%
34.7 6 0.40 113 101 44/31 6/6/1 43.5%/30.7% 231/2.29 436/3.86 115/26.4% 27/8/2 21.2%
* P,.001 (vs. ,8 2PN category using Chi Square Test). Conclusion: Acceptable implantation and pregnancy rates can be obtained with extended culture from patients with slowly cleaving embryos even when less than eight two pronuclei embryos were present. Rates of blastocyst formation for patients with fewer than eight zygotes are significantly less than patients with eight or more zygotes and when compared to all IVF patients (52.0%) during the same time period (P,.001).
P-048 MIFT versus IVF/ICSI-ET: A Randomized, Prospective Study. T. Delahaye, M. Camus, P. Platteau, A. Devos, A. Van Steirteghem, P. Devroey. Center of Reproductive Medicine, Free University of Brussels, Belgium. Objective: Comparison of the implantation rate in patients with tubal replacement of intracytoplasmatic injected oocytes (MIFT) versus the replacement of four cell embryos after ICSI. Study design: This prospective randomized study was designed to analyze the implantation potential of an embryo obtained after ICSI versus a micro-injected oocyte transferred in the Fallopian tube. Materials and Methods: Infertile patients between 18 and 37 years of age with normal menstrual cycles and no more than 3 previous ICSI attempts were included in the study. All patients were stimulated with the association of a GnRH agonist and human menopausal gonadotrophins (long protocol). All patients previously underwent a hysterosalpingography or a laparoscopy indicating tubal patency. Results: 60 patients were included in the study, 30 in the IVF-ET group and 30 in the tubal replacement group. Results are available for 17 patients after IVF-ET and 19 patients after tubal replacement. All patients who started treatment had either an embryo- or an oocyte transfer. There was no significant difference in average age, duration of infertility, previous trials, number of ampoules used, number of stimulation days or number of oocyte-cumulus complexes retrieved.
Mean MII oocytes Mean MII oocytes replaced Mean no of embryos replaced Ongoing clinical pregnancy rate Ongoing implantation rate Mean no of frozen embryos
IVF-ET
MIFT
11.2 (4–21)
10.5 (2–23) 2.9 (2–4)
2.1 (1–3) 35% (6/17) 25% (9/36) 3.1 (0–11)
37% (7/19) 14.3% (8/56) 2.8 (0–11)
Conclusions: The clinical pregnancy rate was equal in both groups, probably due to the higher number of oocytes replaced in the MIFT group. The implantation rate on the contrary tends to be lower in the MIFT group
Vol. 74, No. 3, Suppl. 1, September 2000
(at the moment not significant) which is probably due to the better embryo selection on day 2 in the IVF-ET group. The physiological advantage of tubal replacement does not compensate for the better day 2 embryo selection. In this group of patients there is no advantage in tubal replacement of micro injected oocytes. A randomized prospective study is necessary in patients older than 37 years, where the physiological circumstances and minimal manipulation of the zygotes might be more beneficial. This is an ongoing study and more results will be presented during the ASRM meeting. P-049 A Mild to Moderate Decrease in Estradiol Level After Administration of Human Chorionic Gonadotropin (HCG) During an In Vitro Fertilization (IVF) Cycle Is Not Associated With a Poorer Prognosis. D. O. Kreger, M. Hayes, J. D. Brannian, P. Long, and K. A. Hansen. Department of Obstetrics/Gynecology, University of South Dakota School of Medicine, Sioux Falls, SD. Objective: It is widely accepted that a fall in estradiol level following HCG administration during an IVF cycle is associated with a poor prognosis. Textbooks routinely recommend canceling IVF cycles when a drop of 10 –20% occurs. However, there is surprisingly little data regarding the effect of such a drop during modern IVF cycles utilizing gonadotropin releasing hormone (GnRH) agonists. We wish to identify if a fall in estradiol level after HCG administration during an IVF cycle is associated with a poorer prognosis. Design: A retrospective cohort study of 132 consecutive IVF cycles at the University of South Dakota School of Medicine. Materials and Methods: Estradiol levels were compared on the day of HCG administration and the day after. Cycles were divided into three groups: Group 1 had a decrease in estradiol level of greater than 5%, Group 2 had no significant change in estradiol level with a 5% decrease to a 5% increase, and Group 3 had an increase in estradiol level of greater than 5%. After grouping the cycles, fertilization, cleavage, clinical pregnancy, and implantation rates were calculated and compared. Results: Rates in %
Change in Group estradiol 1 2 3
Mean change in estradiol (range)
N
Decrease 211% (26–225) 16 No change 1% (24.4–4.4) 14 Increase 32% (5–92) 102
Mean Fertili- Cleav- Preg- Implanage zation age nancy tation (years) rate rate rate rate 35.8 33.5 33.5
69 69 76
94 88 86
50 42 38
25 24 18
Conclusions: A decrease in estradiol level of 5%–25% is not associated with decreased levels of fertilization, cleavage, pregnancy or implantation in our IVF program. Although not statistically significant, there is a trend towards decreased implantation rates with increased estradiol levels after HCG administration during IVF cycles. Future studies will evaluate the relationship between changes in estradiol levels and success after frozen embryo transfer. P-050 The Effect of Propofol Anaesthesia on Oocytes, Fertilization and Early Embryo Quality. 1I. Ben-Shlomo, 2R. Moskovich, 1V. Eyali, 1J. Golan, 2 Y. Katz, 1E. Shalev. 1Department of Obstetrics & Gynecology, 2Department of Anaesthesiology, HaEmek Medical Centre, Afula, and the Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Objective: Propofol, which is frequently used for induction of anaesthesia in assisted reproduction procedures, has been suspected to damage oocytes. A recent study showed that concentrations of propofol increase in follicular fluid during oocyte retrieval. Our study was designed to assess whether exposure to these increasing concentrations of propofol has a measurable effect on in vitro fertilization, cleavage and embryo development. Design: A prospective cohort split study. Materials and Methods: A cohort of 130 women underwent intravenous
FERTILITY & STERILITYt
anesthesia using propofol and fentanyl. Time from injection of propofol was measured, and so were the doses of the two drugs. In women expected to have more than 15 oocytes, early, middle and last oocytes, respectively were cultured separately. Results: Mean time of anesthesia was 439 (6201) sec. Time from injection to first follicle aspiration was 200 sec. The mean time for the aspiration of each oocyte was 17.6 sec. Mean number of oocytes retrieved was 12.6 6 7.5. The mean total dose of propofol was 2.79 6 0.59 mg/kg and that of fentanyl 1.3 6 0.31 mg/kg. No differences were found in fertilization (75% 6 24% vs. 77% 6 32%), cleavage (89% 6 21% vs. 85% 6 25%) and embryo cell number (4.6 6 1.6 vs. 4.6 6 1.8), respectively. Conclusions: Within the time frame of our technique, the time which elapses from the retrieval of the first to the last oocyte does not affect oocyte quality, as reflected in subsequent in vitro development.
P-051 Prospective Controlled Study of the Effect of Uterine Fibroids on the Outcome of Assisted Conception Cycles. R. Hart, Y. Khalaf, C. T. Yeong, H. Bickerstaff, R. Lawson, A. Taylor, P. Braude. Assisted Conception Unit, Guy’s and St. Thomas’ Hospitals Trust, Lambeth Palace Road, London SE 1 7EH, UK. Introduction: The effect of fibroids on the outcome of assisted conception has been the subject of recent debate. We set out to prospectively evaluate the outcome assisted conception (IVF&ICSI) cycles in the presence of uterine fibroids. Materials and Methods: All patients from 1st August 1999 to date were included in the study. Prior to embarking on a cycle of assisted conception all patients underwent a pelvic ultrasound scan. If a submucosal fibroid was suspected hydrosonography was performed and the fibroid resected if appropriate. The outcome of the subsequent assisted conception cycle was then analyzed. Multifollicular stimulation was carried out using our standard protocol. All aspects of the stimulation and outcome of the treatment were studied. A difference was significant when p,0.05. Results: We have treated 71 patients to date, of whom 68 patients have completed treatment (2 patients had all embryos frozen). The control group were those patients without fibroids treated during the same time interval. Both study and control groups are matched in age, duration of infertility, and basal serum FSH levels. The overall pregnancy and implantation rates were 15.2% and 8.6% in the study patients compared to 28.0% and 13.0% in the control group respectively (p50.42 for pregnancy rate and p50.14 for implantation rate). Conclusion: Our study suggests that uterine fibroids are associated with a tendency towards lower implantation and pregnancy rates in assisted conception treatment.
P-052 Can We Predict Patient’s Chance to Conceive at the Time of Embryo Transfer? 1,2I. Tur-Kaspa, 1C. Chapman, 1V. Karande, 1D. Hazlett, 1W. Skoog, and 1N. Gleicher. 1ART Program, The Center for Human Reproduction (CHR), Chicago, IL, USA and 2IVF Unit, Department of Obstetrics/ Gynecology, Barzilai Medical Center, Ben-Gurion University, Ashklon, Israel. Objectives: To determine whether infertility specialists and embryologists can mutually predict a patient’s chance to conceive at time of embryo transfer. Design: Prospective blinded study of 100 consecutive Day 3 ETs done in January–February 2000. Materials and Methods: A simple form with two to three possible options was developed by the embryology/physician staff. The forms were filled out individually by two experienced embryologists and three experienced infertility specialists for each transfer. Parameters were: age, $40, 35–39, or ,35; gravida, 0 or $1; IVF cycle number, 1, 2–3, or $4; day of hCG, $12 days, #9 days, or 10 –11 days; E2 on day hCG ,750 pg/ml, .2501 pg/ml or 751–2500 pg/ml; total oocytes retrieved, #5, .21 or 6 –20; percent mature oocytes, ,30, 30 – 60, or .61; percent 2PN zygotes, ,30, 30 – 60, or .61; total number of cleaved embryos, #5, .21 or 6 –20; quality of embryos at transfer (assessed by embryologist), fair, good or excellent; number of embryos transferred, 1, $4 or 2–3; AZH, yes or no; difficulty of
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