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Observed vs. expected embryo implantation distribution (EID) as an indicator of transfer efficiency.
P-91 Observed vs. expected embryo implantation distribution (EID) as an indicator of transfer efficiency. J. P. Stassart, R. H. Castillo, G. D. Ball. Reproductive Medicine & Infertility Assoc, P A, St. Paul, MN. Objective: When implantation rates (IR) are considered for a given population, some implicit assumptions are made: 1) All embryos involved in a transfer have the potential to implant; many studies have established a link between embryo morphology (embryo scoring) and IR. 2) The transfer technique should result in the delivery of all embryos to a site that is favorable for implantation; this should not be followed by embryo expulsion and. 3) The host’s uterus will not reject an otherwise normal embryo. If such assumptions are correct and if the embryo population is relatively homogeneous, one should expect to observe an Embryo Implantation Distribution (EID) that is binomial and reflects the IR. Design: This was a retrospective study of patients treated between April 1999 and December 2000. Donor oocyte cases were excluded from analysis. The selected 98 consecutive patients met the following criteria: ⬍37 years at the time of oocyte retrieval (based on published data showing limited detrimental impact of age on IR’s until and including age 36 [1]), 3 high quality embryos, optimal transfer (Wallace catheter under US guidance). Materials/Methods: All ovarian stimulation cycles included down regulation with a GnRH agonist followed by ovarian stimulation with injectable gonadotropins. Follicles were aspirated when at least 2 follicles reached a mean diameter of 18 mm. All embryos were transferred were on day 3 after oocyte retrieval. The presence of intrauterine sacs containing a fetus with cardiac activity was determined by sonographic evaluation at 8 to 9 weeks gestation and IR were calculated by dividing the sum of those by the sum of all embryos transferred. We compared observed distributions to theoretical distributions calculated on the basis of average IR. Results: The first two sets of bars within each grouping compare observed (OBS) and expected EID values (on the basis of a 34% average IR): excellent concordance is evident. As an example of discordant expected and observed values (possibly due to transfer technique or uterine receptivity deficiency), the third set of bars within in each grouping represents the expected distribution if an average IR of 43% was observed in 80% of the studied group, and a 0% IR was observed in the remaining 20% of the cases. In such a case, fewer ongoing pregnancies would be observed, whereas the proportion of multiple pregnancies would increase.
M. Orbea-Travez, A. Bermudez, E. Effio, A. J. Gutierrez-Najar. Grupo de Reproduccion y Genetica, Mexico City, Mexico. Objective: To compare the obstetric outcome in singleton pregnancies derived from Assisted Reproductive Techniques (ART): intracitoplasmatic sperm injection (ICSI) and in-vitro fertilization (IVF); controlled ovarian hyperstimulation with intrauterine insemination (COH-IUI) and timed intercourse (TI) compared with spontaneous pregnancies (SP). Design: Retrospective and comparative study of singleton 915 pregnancies attended in our clinic from January 1996 to December 2000. Materials/Methods: We analyze 915 pregnancies resulting from ICSIIVF, COH-IUI, TI and SP. In each group we studied maternal age, prevalence of disorders in first, second and third trimesters, gestational birth age, cesarean section rate, Apgar score, sex and birth weight. The statistical method used was t student with significant p value ⬍0.05. Results: Table 1 are shown statistical differences in maternal age, abortion rate, ectopic pregnancy rate, cesarean rate and vaginal bleeding during first trimester between ART group and SP (p ⫽ 0.001). And statistical differences in abortion rate and vaginal bleeding between COH-IUI group and SP groups (p ⫽ 0.0001). No differences were found in gestational age at delivery, Apgar score, premature labor, PROM, preeclampsia and diabetes (p 0.05). The percentage of the sex have no statistical differences between the groups (p 0.05). Table 1. ART (128)
COH-IUI (77)
TI (27)
SP (683)
Maternal age (STD) 33.8 (5.08) 31.7 (4.05) 29.1 (3.4) 30.8 (4.8) Abortion rate % 18.7 19.2 14.8 12.2 Ectopic pregnancy % 7.8 3.8 0 3.2 Birth weight gr 2965 (595) 2980 (840) 2902 (473) 3023 (518) (STD) Gestational age w 36.6 (2.3) 37.1 (3.3) 37.9 (2.1) 37.9 (1.6) (STD) Cesarean rate % 95.5 74 62.5 72.6 Vaginal bleeding % 36.4 9.6 3.6 2.9
Conclusions: Compared with spontaneous pregnancies there was an increased incidence among ART singletons of abortion, ectopic pregnancy, gestational age, cesarean rate and vaginal bleeding. No differences were found with other obstetric complications either in newborn sex between groups. The ART and COH-IUI are related with conditions that conduced to an elevated complications rate during pregnancy in our center. Supported by: Grupo de Reproduccion y Genetica.
P-93
Conclusions: This study does not suggest the presence of a sizable subgroup of patients that will “reject” otherwise capable embryos. The data also provides reassurance with regards to the predictive value of our day 3 embryo scoring system which becomes increasingly important at a time when we are moving towards reducing the number of embryos transferred. Finally, the data suggests that when combining ultrasound guidance and the use of an atraumatic soft catheter maximum transfer efficiency may have been reached with the given set of variables as observed and expected outcomes are in agreement. Supported by: 1. Spandorfer SD et al. J Assist Reprod Genet 2000;17: 303– 6. P-92 Comparison of the obstetric outcome in singleton pregnancies obtained with ART, COH-IUI, timed intercourse and spontaneous pregnancies.
FERTILITY & STERILITY威
The size and trophectoderm of blastocysts are sensitive indicators for pregnancy. W. A. Wun, G. M. Grunert, R. C. Dunn, C. T. Valdes, L. M. Schenk, R. K. Mangal. Ob & Gyn Assoc, Houston, TX. Objective: The quality of blastocyst has been examined by the size, inner cell mass (ICM), and trophectoderm (TRO) (D. Gardner’s criteria). It was not clear which attribute was more correlated or sensitive to pregnancy and implantation rate. This study reviewed these attributes and their correlation to ART success. Design: The data was analyzed retrospectively. Materials/Methods: All ART cases with blastocyst transfer during 3/1/ 2000 –12/31/2000 (156 cycles) were included. For Logistic Regression Analysis, 2 models were examined. One model assumed the quality was continuous. The other model assumed the quality was categorical. Pregnancy was defined by the presence of embryo sac (s). The implantation rate was defined by number sac/number transferred. Results: The significant probabilities are listed in the table.
S143
M. Orbea-Travez, A. Bermudez, E. Effio, A. J. Gutierrez-Najar. Grupo de Reproduccion y Genetica, Mexico City, Mexico. Objective: To compare the obstetric outcome in singleton pregnancies derived from Assisted Reproductive Techniques (ART): intracitoplasmatic sperm injection (ICSI) and in-vitro fertilization (IVF); controlled ovarian hyperstimulation with intrauterine insemination (COH-IUI) and timed intercourse (TI) compared with spontaneous pregnancies (SP). Design: Retrospective and comparative study of singleton 915 pregnancies attended in our clinic from January 1996 to December 2000. Materials/Methods: We analyze 915 pregnancies resulting from ICSIIVF, COH-IUI, TI and SP. In each group we studied maternal age, prevalence of disorders in first, second and third trimesters, gestational birth age, cesarean section rate, Apgar score, sex and birth weight. The statistical method used was t student with significant p value ⬍0.05. Results: Table 1 are shown statistical differences in maternal age, abortion rate, ectopic pregnancy rate, cesarean rate and vaginal bleeding during first trimester between ART group and SP (p ⫽ 0.001). And statistical differences in abortion rate and vaginal bleeding between COH-IUI group and SP groups (p ⫽ 0.0001). No differences were found in gestational age at delivery, Apgar score, premature labor, PROM, preeclampsia and diabetes (p 0.05). The percentage of the sex have no statistical differences between the groups (p 0.05). Table 1. ART (128)
COH-IUI (77)
TI (27)
SP (683)
Maternal age (STD) 33.8 (5.08) 31.7 (4.05) 29.1 (3.4) 30.8 (4.8) Abortion rate % 18.7 19.2 14.8 12.2 Ectopic pregnancy % 7.8 3.8 0 3.2 Birth weight gr 2965 (595) 2980 (840) 2902 (473) 3023 (518) (STD) Gestational age w 36.6 (2.3) 37.1 (3.3) 37.9 (2.1) 37.9 (1.6) (STD) Cesarean rate % 95.5 74 62.5 72.6 Vaginal bleeding % 36.4 9.6 3.6 2.9
Conclusions: Compared with spontaneous pregnancies there was an increased incidence among ART singletons of abortion, ectopic pregnancy, gestational age, cesarean rate and vaginal bleeding. No differences were found with other obstetric complications either in newborn sex between groups. The ART and COH-IUI are related with conditions that conduced to an elevated complications rate during pregnancy in our center. Supported by: Grupo de Reproduccion y Genetica.
P-93
Conclusions: This study does not suggest the presence of a sizable subgroup of patients that will “reject” otherwise capable embryos. The data also provides reassurance with regards to the predictive value of our day 3 embryo scoring system which becomes increasingly important at a time when we are moving towards reducing the number of embryos transferred. Finally, the data suggests that when combining ultrasound guidance and the use of an atraumatic soft catheter maximum transfer efficiency may have been reached with the given set of variables as observed and expected outcomes are in agreement. Supported by: 1. Spandorfer SD et al. J Assist Reprod Genet 2000;17: 303– 6. P-92 Comparison of the obstetric outcome in singleton pregnancies obtained with ART, COH-IUI, timed intercourse and spontaneous pregnancies.
FERTILITY & STERILITY威
The size and trophectoderm of blastocysts are sensitive indicators for pregnancy. W. A. Wun, G. M. Grunert, R. C. Dunn, C. T. Valdes, L. M. Schenk, R. K. Mangal. Ob & Gyn Assoc, Houston, TX. Objective: The quality of blastocyst has been examined by the size, inner cell mass (ICM), and trophectoderm (TRO) (D. Gardner’s criteria). It was not clear which attribute was more correlated or sensitive to pregnancy and implantation rate. This study reviewed these attributes and their correlation to ART success. Design: The data was analyzed retrospectively. Materials/Methods: All ART cases with blastocyst transfer during 3/1/ 2000 –12/31/2000 (156 cycles) were included. For Logistic Regression Analysis, 2 models were examined. One model assumed the quality was continuous. The other model assumed the quality was categorical. Pregnancy was defined by the presence of embryo sac (s). The implantation rate was defined by number sac/number transferred. Results: The significant probabilities are listed in the table.
S143