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New strategy for patients with repeated implantation failure
P-468 Wednesday, October 16, 2013 NEW STRATEGY FOR PATIENTS WITH REPEATED IMPLANTATION FAILURE. A. Yoshida, S. Koyama, H. Sasaki, M. Shimizu, Y. Yamada, M. Tanaka. Kiba Park Clinic, Koto, Tokyo, Japan. OBJECTIVE: To evaluate the effectiveness of two-step (day 4 and day 6) vitrified-thawed blastocyst transfer in patients with repeated implantation failure (RIF). DESIGN: Retrospective analysis. MATERIALS AND METHODS: Twenty-four patients who were failed in spite of several attempts of vitrified-thawed blastocyst transfers were included in this study. The average number of failed cycles among the 24 patients was 3.51.4 times. Two-step vitrified-thawed blastocyst transfers were performed for these patients. All women received estradiol for the preparation of the endometrium. The administration of progesterone (50 mg in oil, daily) was initiated when endometrium thickness exceeded 8 mm. In the previous cycles, on day 5 after the initiation of progesterone treatment, the blastocysts were transferred. In the two-step cycles, on day 4 and day 6 after the initiation of progesterone treatment, the blastocysts were transferred twice. The results between the previous cycles and the two-step cycles were compared. RESULTS: The average embryo transfer number of the two-step cycles and the previous cycles was 2.00.0 and 1.20.4, respectively. The goodquality blastocyst rate in the two-step cycles (51.9% 27/52) was comparable with that in the previous cycles (50.5% 50/99). The implantation rate by the two-step cycles (13.5% 7/52) was comparable with that by the previous cycles (5.1% 5/99). However, the pregnancy rate (positive fetal heart movement) by the two-step cycles (23.7% 6/26) was significantly higher than that by the previous cycles (3.8% 3/80). Moreover, the abortion rate in the two-step cycles (42.9% 3/7) was significantly lower than that in the previous cycles (100% 8/8). No dichorionic diamniotic twin pregnancy was occurred in the two-step cycles. CONCLUSION: Two-step vitrified-thawed blastocyst transfer is presumably one of the effective clinical approaches for patients with RIF in terms of defective endometrial receptivity such as premature or overmature endometrium. Further evaluation is recommended.
CONCLUSION: Recent studies have shown better pregnancy rates with frozen embryos transfers cycles. Our findings showed higher pregnancy and ongoing pregnancy rates using fresh embryos compared to the frozen ones, however when comparing by days, there was no statistical difference among pregnancy rates but there was among clinical pregnancy rates, which could be explained by a greater number of biochemical pregnancy for group 1 in comparison to group 2.
P-470 Wednesday, October 16, 2013 DOES KNOWING THE MORPHOLOGICAL STATUS OF VITRIFIED BLASTOCYSTS PRIOR TO WARMING IMPROVE IMPLANTATION OUTCOME? C. F. Boylan, L. S. Morrison, S. M. Carney, E. A. Jannaman, G. Kovalevsky, R. F. Feinberg. Reproductive Associates of Delaware, Newark, DE. OBJECTIVE: To compare the outcome of individually vitrified and warmed blasts of known pre-vitrified morphology to those individually vitrified with unknown morphology. DESIGN: A retrospective study of FETs from Feb 2012-Apr 2013. Blast morphology of one group was known at warming; the other group’s morphology was not known. No embryos were subjected to PGS. MATERIALS AND METHODS: Embryos were vitrified on day 5, 6 or 7 using 7.5% to 15% EG/DMSO 0.6M sucrose. Prior to Feb 2012, a patient’s blasts were run through the vit solutions as a group, then placed on individual carriers. Post Feb 2012, vitrified blasts were separated throughout, allowing individual morph ID. Warming occurred using 1.0M to 0.5M sucr/mHTF. Since individual morph was unknown for blasts vitrified prior to Feb 2012, a random embryo was chosen at warming; post Feb 2012, morphology was used to choose embryos. RESULTS: The known morph group showed 93.9% survival, 53.7% ongoing pregnancy and 66.1% implantation. The unknown group displayed 95.1% survival, 48.2% ongoing pregnancy and 49.7% implantation. Implantation was the only significant finding.
P-469 Wednesday, October 16, 2013 FRESH VERSUS CRYOPRESERVED EMBRYO TRANSFERS, A COMPARISON OF PREGNANCY AND CLINICAL PREGNANCY RATES. L. Gonzalez-Berchelmann, R. Santos-Haliscak, J. Rosales-De Leon, A. Aguilar-Melgar, P. Diaz-Spindola, A. Davila-Garza. Reproductive Medicine, IECH - Fertility Center, Monterrey, Nuevo Leon, Mexico. OBJECTIVE: To compare clinical pregnancy rates between fresh and frozen embryo transfer cycles. DESIGN: Retrospective study. MATERIALS AND METHODS: 657 consecutive fresh embryo transfers and 134 consecutive vitrified-thawed embryo transfers. Divided into 2 groups: fresh (group 1) vs. vitrified embryos (group 2). ANOVA test used to assess for differences between the two groups and their correlation to pregnancy rate. RESULTS: Table 1 shows demography and ovarian stimulation for group 1 and the main outcomes for group 2. The average day of transfer for group 1 was of 3.37, 92.2% embryos of high quality, a fertility rate of 49.13, a pregnancy rate of 54.5% and a clinical ongoing pregnancy rate of 37%, as for group 2, the average day of transfer was of 3.3, 83.5 % embryos of high quality, a fertility rate of 52.6, a pregnancy rate of 45.5 and a clinical ongoing pregnancy rate of 23%. Among groups on day 3, the pregnancy rate was of 53.9 (group 1) vs. 48.8% (group 2) (p¼NS) and a clinical pregnancy rate of 29.8 vs. 32.4% (p¼0.001), respectively. When comparing day 5 transfer pregnancy rate was 59.7 (group 1) vs. 41.2% (group 2) (p¼NS) and clinical pregnancy rate was 39.7 vs. 8.7% (p¼0.03), respectively.
N (trans) Mean age Mean trans Survival OGPR Implantation *
Known morphology pre-vit
Unknown morphology pre-vit
54 33.0 1.1 93.9% 53.7% 66.1%*
137 32.7 1.1 95.1% 48.2% 49.7%*
p¼0.03.
CONCLUSION: Blast vitrification provides significant enhancement to IVF cumulative pregnancy rates and options for achieving future pregnancies. Since blast morphology has been correlated with implantation success, we hypothesized that linking pre-vit morphology to embryo selection post-warming could enhance implantation and pregnancy rates. Although retrospective, this analysis showed statistically higher implantation rates in the ‘known morphology’ group when compared to an age-matched cohort with ‘unknown morphology’. Larger prospective trials are needed to determine if this approach will yield higher ongoing preg rates per warmed transfer and if a shorter time to normal pregnancy can be achieved, particularly with single embryo transfer.
TABLE 1.
Group
Age
Day 3 FSH
Day 3 E2
1 2
34.71 Age 34.36
10.16 13.57 Day 3 embryos 45.63%
59.36 95.4 Day 5 embryos 54.36%
S284
ASRM Abstracts
Average use of rFSH per cycle
Average day of transfer
2304.4 11.2 # of embryos thawed 257
3.37 0.77 % of embryo survival 96.49 % (N ¼ 248)
Vol. 100, No. 3, Supplement, September 2013
CONCLUSION: Recent studies have shown better pregnancy rates with frozen embryos transfers cycles. Our findings showed higher pregnancy and ongoing pregnancy rates using fresh embryos compared to the frozen ones, however when comparing by days, there was no statistical difference among pregnancy rates but there was among clinical pregnancy rates, which could be explained by a greater number of biochemical pregnancy for group 1 in comparison to group 2.
P-470 Wednesday, October 16, 2013 DOES KNOWING THE MORPHOLOGICAL STATUS OF VITRIFIED BLASTOCYSTS PRIOR TO WARMING IMPROVE IMPLANTATION OUTCOME? C. F. Boylan, L. S. Morrison, S. M. Carney, E. A. Jannaman, G. Kovalevsky, R. F. Feinberg. Reproductive Associates of Delaware, Newark, DE. OBJECTIVE: To compare the outcome of individually vitrified and warmed blasts of known pre-vitrified morphology to those individually vitrified with unknown morphology. DESIGN: A retrospective study of FETs from Feb 2012-Apr 2013. Blast morphology of one group was known at warming; the other group’s morphology was not known. No embryos were subjected to PGS. MATERIALS AND METHODS: Embryos were vitrified on day 5, 6 or 7 using 7.5% to 15% EG/DMSO 0.6M sucrose. Prior to Feb 2012, a patient’s blasts were run through the vit solutions as a group, then placed on individual carriers. Post Feb 2012, vitrified blasts were separated throughout, allowing individual morph ID. Warming occurred using 1.0M to 0.5M sucr/mHTF. Since individual morph was unknown for blasts vitrified prior to Feb 2012, a random embryo was chosen at warming; post Feb 2012, morphology was used to choose embryos. RESULTS: The known morph group showed 93.9% survival, 53.7% ongoing pregnancy and 66.1% implantation. The unknown group displayed 95.1% survival, 48.2% ongoing pregnancy and 49.7% implantation. Implantation was the only significant finding.
P-469 Wednesday, October 16, 2013 FRESH VERSUS CRYOPRESERVED EMBRYO TRANSFERS, A COMPARISON OF PREGNANCY AND CLINICAL PREGNANCY RATES. L. Gonzalez-Berchelmann, R. Santos-Haliscak, J. Rosales-De Leon, A. Aguilar-Melgar, P. Diaz-Spindola, A. Davila-Garza. Reproductive Medicine, IECH - Fertility Center, Monterrey, Nuevo Leon, Mexico. OBJECTIVE: To compare clinical pregnancy rates between fresh and frozen embryo transfer cycles. DESIGN: Retrospective study. MATERIALS AND METHODS: 657 consecutive fresh embryo transfers and 134 consecutive vitrified-thawed embryo transfers. Divided into 2 groups: fresh (group 1) vs. vitrified embryos (group 2). ANOVA test used to assess for differences between the two groups and their correlation to pregnancy rate. RESULTS: Table 1 shows demography and ovarian stimulation for group 1 and the main outcomes for group 2. The average day of transfer for group 1 was of 3.37, 92.2% embryos of high quality, a fertility rate of 49.13, a pregnancy rate of 54.5% and a clinical ongoing pregnancy rate of 37%, as for group 2, the average day of transfer was of 3.3, 83.5 % embryos of high quality, a fertility rate of 52.6, a pregnancy rate of 45.5 and a clinical ongoing pregnancy rate of 23%. Among groups on day 3, the pregnancy rate was of 53.9 (group 1) vs. 48.8% (group 2) (p¼NS) and a clinical pregnancy rate of 29.8 vs. 32.4% (p¼0.001), respectively. When comparing day 5 transfer pregnancy rate was 59.7 (group 1) vs. 41.2% (group 2) (p¼NS) and clinical pregnancy rate was 39.7 vs. 8.7% (p¼0.03), respectively.
N (trans) Mean age Mean trans Survival OGPR Implantation *
Known morphology pre-vit
Unknown morphology pre-vit
54 33.0 1.1 93.9% 53.7% 66.1%*
137 32.7 1.1 95.1% 48.2% 49.7%*
p¼0.03.
CONCLUSION: Blast vitrification provides significant enhancement to IVF cumulative pregnancy rates and options for achieving future pregnancies. Since blast morphology has been correlated with implantation success, we hypothesized that linking pre-vit morphology to embryo selection post-warming could enhance implantation and pregnancy rates. Although retrospective, this analysis showed statistically higher implantation rates in the ‘known morphology’ group when compared to an age-matched cohort with ‘unknown morphology’. Larger prospective trials are needed to determine if this approach will yield higher ongoing preg rates per warmed transfer and if a shorter time to normal pregnancy can be achieved, particularly with single embryo transfer.
TABLE 1.
Group
Age
Day 3 FSH
Day 3 E2
1 2
34.71 Age 34.36
10.16 13.57 Day 3 embryos 45.63%
59.36 95.4 Day 5 embryos 54.36%
S284
ASRM Abstracts
Average use of rFSH per cycle
Average day of transfer
2304.4 11.2 # of embryos thawed 257
3.37 0.77 % of embryo survival 96.49 % (N ¼ 248)
Vol. 100, No. 3, Supplement, September 2013