Obstetric and perinatal risks in IVF pregnancies conceived with own oocytes or donor oocytes

P-77

Table 1. The result of IVF-ET cycles in groups by freezing status

Cycle type No freezing D3 freezing only 2 PN freezing only 2 PN ⫹ D3 freezing

# Case

Age

Egg #

ET#

Clinical Cumulative Pregnancy Pregnancy

46 37.9 ⫾ 3.8 9.0 ⫾ 5.5 3.6 ⫾ 1.6 30 37.1 ⫾ 4.2 14.6 ⫾ 5.2 3.4 ⫾ 1.2

28% 40%

N/A 43%

14 33.8 ⫾ 4.4 23.3 ⫾ 9.6 3.6 ⫾ 1.0

57%

64%

23 36.0 ⫾ 5.5 24.7 ⫾ 8.4 2.7 ⫾ 0.8

70%

83%

Conclusions: These data provide evidence that, with freezing portion of embryos at 2-pronuclear stage, fresh embryo transfer pregnancy rates are not compromised. Furthermore, the cycles with 2 PN freezing have greater potential of increasing cumulative pregnancy rates from a single egg retrieval. Therefore, in our experience, IVF-ET outcome can be optimized in the most cost-effective manner allowing for a different strategy in IVF treatment. Supported by: N/A. P-76 Delivery rates in poor responders that decline cycle cancellation. Richard A. Cochran, Mark L. Jutras, Mary T. Jutras. Reproductive Medicine and Fertility Ctr, Orlando, FL. Objective: Currently, most programs use a cutoff value of ⱖ500 pg/ml peak serum concentration of estradiol, as well as a follicle count of at least 3 follicles ⱖ 15 mm before proceeding to hCG injection and retrieval. If patients fail to reach these criteria, the cycle is generally cancelled since it is believed that there is not a reasonable chance of success with that cycle. In this retrospective analysis, we present data collected over the last five years with patients whose peak serum estradiol concentrations were ⬍500 pg/ml having at least 1 follicle ⱖ15 mm in diameter. Design: Retrospective data analysis. Materials/Methods: Data were recorded for all IVF stimulation cycles in our facility from January, 1996 through December, 2001 from a total of 380 patients age 40 and under. Patients 40 years of age and under, whose peak serum estradiol concentrations were ⬍500 pg/ml and who had at least 1 follicle ⱖ 15 mm in diameter are included, regardless of stimulation protocol or primary infertility diagnosis. All assays for serum estradiol were performed on the DPC Immulite analyzer. hCG was generally given when the lead follicle was ⱖ 18 mm. All embryo transfers were carried out on Day 2 or 3. Results: The results from the data collected for patients age 40 and under with peak E2 concentrations ⬍500 pg/ml are presented in Table 1. The delivery rates were 25.9% per cycle start and 43.8% per retrieval. The lowest peak serum E2 concentration with a delivery was 150 pg/ml and the oldest patient to deliver was 39. Table 1 Age

⬍35

35–37

38–40

N 10 10 7 Mean Peak E2 (Range) 263 (75–477) 246 (93–473) 294 (104–496) Mean # Follicles/ 3.0 (1–5) 4.2 (3–8) 3.7 (3–4) Retrieval (Range) Mean # Embryos/ 1.9 (1–4) 2.7 (2–4) 2.7 (2–4) Transfer (Range) Delivered/Cycle Start 4/10 2/10 1/7 Delivered/Retrieval 4/8 2/5 1/3 Delivered/Transfer 4/6 2/3 1/3 Cancelled 2/10 5/10 4/7 Conclusions: The data presented here suggests that the delivery rates are good in patients 40 years of age and under with peak serum estradiol concentrations ⬍500 pg/ml and at least one follicle ⱖ 15 mm at the time of hCG injection. Since many of the cycle expenses have already been incurred by the patient, retrieval should be offered to these patients. These findings suggest a lack of importance of estradiol monitoring during the stimulation process. Supported by: n/a.

FERTILITY & STERILITY威

Is ultrasound guidance or length of time to accomplish embryo transfer more important in achieving pregnancy in first cycle in vitro fertilization (IVF) patients? Stephanie B. McCulloch, Kay Sullivan, Victoria M. Sopelak, Randall S. Hines. Univ of Mississippi Medical Ctr, Jackson, MS. Objective: Embryo transfer is the final critical step in the IVF process. Studies have looked at the impact that ease of transfer and the type of catheter have on pregnancy and implantation rates. In the present study, we specifically evaluated the impact of 2 factors on pregnancy outcome: the use of ultrasound guidance to visualize catheter placement (used by one physician) versus tactile only placement (used by another physician), in addition to the length of time needed to accomplish transfer in first cycle IVF patients of all ages. Design: Retrospective analysis of pregnancy outcome was done on first cycle IVF patients (N⫽82) of all ages, analyzed by use of ultrasound (US Yes) or lack of ultrasound guidance (US No) and length of time to accomplish transfer (ⱕ 2 minutes versus ⬎2 minutes). Greater than 90% of patients had a trial transfer during the pre-cycle period. Transfers were accomplished using the Sydney IVF transfer set (Cook IVF)(N⫽68), the Edwards-Wallace catheter (SIMS Portex, UK)(N ⫽ 12) or the JansenAnderson catheter (Cook IVF)(N ⫽ 2). Materials/Methods: All first cycle IVF patients having an embryo transfer were selected from our 2000 –2001 database irrespective of age (range ⫽ 23.8 to 45.6 years). At the time of embryo transfer, a stopwatch was used to time the interval from removal of the embryos from the incubator until expulsion from the transfer catheter into the uterine cavity. Data regarding length of time for transfer were grouped as those accomplished in ⱕ 2 minutes versus ⬎2 minutes and analyzed by Chi-square with a p ⬍0.05 considered significant. Similarly, data were regrouped and analyzed by use of ultrasound guidance and visualization of catheter placement (US Yes) or no ultrasound (US No). Lastly, patients were regrouped by age (⬍35 versus ⱖ35) and pregnancy outcome was analyzed. In instances where the oocytes were from a donor, the age of the oocyte donor was used. Values are expressed as Mean ⫾ SEM. Data were analyzed by Chi-square and ANOVA statistics where appropriate, with a p ⬍0.05 considered significant. Results: The length of time to accomplish transfer (range ⫽ 60 to 973 seconds) did not influence pregnancy outcome (see table). Similarly, there were no significant differences in the pregnancies/transfer (%) in the US Yes group which was 21/52 ⫽ 40.4% and in the US No group which was 10/30 ⫽ 33.3%. However, the age of the patient had a significant impact on pregnancy outcome (p ⬍0.05), with individuals ⬍35 having a pregnancy rate/transfer of 43.4% compared to 27.6% in those ⱖ 35 years of age. Demographics of patients with transfer time of ⱕ2 or 2 minutes

N ⫽ patients with transfer Age Oocytes inseminated Fertilization rate (%) Number of Pregnancies Pregnancy rate/transfer (%)

ⱕ2 minutes

2 minutes

*P

52 33.9 ⫾ 0.6 8.6 ⫾ 0.6 74.4% 20 38.5%

30 33.2 ⫾ 0.9 8.5 ⫾ 0.8 69.4% 11 36.6%

NS NS NS NS NS

* Significantly different Conclusions: In our retrospective study, neither the length of time to accomplish embryo transfer or the use of ultrasound guidance had a significant impact on pregnancy outcome. At our institution, patient age had the greatest impact upon pregnancy outcome. Supported by: Department of Obstetrics and Gynecology. P-78 Obstetric and perinatal risks in IVF pregnancies conceived with own oocytes or donor oocytes. Jose Gaytan, Carlos Troncoso, Luis Pedro Rossal, Ernesto Bosch, Antonio Pellicer, Jose Remohi. Inst Valenciano de Infertilidad, Valencia, Spain. Objective: Determine if the obstetric and perinatal outcome of IVF pregnancies using patients own oocytes in the late reproductive years (around 35 years of age) differs from those obtained in patients of the same

S141

age obtained with donated oocytes. Design: Retrospective comparative study. Materials/Methods: The obstetric and perinatal outcome from 889 IVF pregnancies obtained with patients own oocytes and the outcome of 450 IVF oocyte donation pregnancies was compared. Data was analyzed using a logistic regression to determine the odds ratio from different complications between this two groups. Results: The mean age was 35.4 ⫾ 4.6 and 35.1 ⫾ 1.9 years (p ⫽ NS) in de own oocyte and oocyte donation groups respectively. Comparing the oocyte dontation group (reference line) with the own oocyte group, the later group presents a higer incidence in preterm labour, pregnancy diabetes, preterm rupture of membranes, abruptio placentae and intrauterine growth restriction showed also a higher incidence (p ⬍0.05), the rest of the variables were N.S.

Results Table Group A (95% CI)

Group B (95% CI)

P value

Total Cycles 148 117 NS Total Transfers 112 83 NS Age 37 ⫾ 4.5 38 ⫾ 4.6 NS Average Total Oocytes 10.9 ⫾ 5.6 (4.0–20.0) 11.3 ⫾ 7.7 (2.0–26.0) NS Average Total mature 8.9 ⫾ 4.4 (3.0–17.0) 8.4 ⫾ 5.4 (2.0–19.0) NS Embryo Cellularity 7.2 ⫾ 1.3 (5.0–8.4) 7.0 ⫾ 1.4 (4.0–9.0) NS Embryo Grade 3.6 ⫾ 0.6 (3.0–4.5) 3.5 ⫾ 0.5 (3.0–4.0) NS Embryo Compaction 18.4% (47/256) 9.5% (20/211) 0.025* Clinical Implantation 18.5% (56/302) 15.9% (37/232) NS Rate Clinical Pregnancy 35.7% (40/112) 28.9% (24/83) NS Rate * Chi-squared analysis Conclusions: Embryo compaction, cellularity and EQS are reliable indicators of embryo development. Utilizing a recombinant FSH gonadotropin regimen with the microdose protocol appears to have a positive impact on compaction as compared to the FSH/LH combination protocol. It is possible that with more IVF cycles, a recombinant FSH microdose stimulation protocol would also result in significantly higher pregnancy rates. Supported by: Foundation of Reproductive Medicine, Chicago, Illinois. P-80

Conclusions: Oocyte quality in late reproductive age may be suboptimal, this may explain why pregnancies obtained in the own oocyte group are at a higher risk of presenting obstetric and perinatal complications than pregnancies in the oocyte donation group. Supported by: None provided.

P-79 Impact on embryo quality when adding LH (hMG) in microdose Lupron stimulation of low responders. Patricia Mangan, David Hazlett, Vishvanath Karande, Mary Vietzke, Tricia Nasta. The Ctr for Human Reproduction, Hoffman Estates, IL. Objective: Whether exogenous LH should be added to a microdose Lupron stimulation protocol remains an unresolved issue. In this study, we examined compaction, cellularity, and day 3 embryo quality scores as tests to evaluate the impact of exogenous LH. Design: Retrospective cohort study. Materials/Methods: During the year 2001, 265 low responders that underwent a cycle utilizing a microdose Lupron stimulation protocol were evaluated. Patients were categorized into two groups: group A (148 cycles) were stimulated with recombinant FSH and group B (117 cycles) were stimulated with a combination of recombinant FSH with additional LH (hMG). An embryo quality score (EQS) of 1–5 was assigned to the embryos which were transferred (1.0⫽poor quality with high fragmentation, 5.0⫽high quality without fragmentation). The number of blastomeres as well as the presence or absence of embryo compaction was also evaluated. The clinical implantation and clinical pregnancy rates of both groups were then calculated. All blastocyst transfers were excluded. An appropriate statistical analysis was completed. Results: No significant differences were found for the following parameters (refer to Table 1): mean age, etiology, day 3 FSH, prior in vitro fertilization (IVF) cycles, peak estradiol, number of embryo transfer cancellations, and total, as well as mature oocytes retrieved (p ⬎0.05). The EQS for each group were comparable in grade (mean, SD CIs). Differences in total cellularity was also not significant. The embryo compaction analysis by chi-squared analysis was also significant(mean SD, CI p ⫽ 0.025)in favor of the pure FSH cycles (mean SD CI Mann-Whitney Rank sum test ⫽ 0.61). The clinical implantation rates for the two groups were: group A ⫽ 18.5% (56/302) and group B ⫽ 15.9% (37/232). The clinical pregnancy rates for group A ⫽ 35.7% (40/112) and group B ⫽ 28.9% (24/83).

S142

Abstracts

A comparison of the effects of short-term oocyte culture in glucose/ phosphate-free medium or in glucose/phosphate-supplemented medium prior to intracytoplasmic sperm injection (ICSI) on clinical outcome. Neil R. Stoddart, Hwan C. Rho, Amjud Hussain, Steven D. Fleming, Marc A. Bernhisel. Univ Community Hosp, Tampa, FL; Westmead Hosp, Sydney, Australia. Objective: We compared, in a semi-randomised prospective trial, the performance of two different commercially-available culture media which were used for culture of Oocyte/Cumulus Complexes (OCCs) prior to insemination using ICSI. These were P1 medium supplemented 10% v/v with Synthetic Serum Substitute (‘P1 medium’, Irvine) or Universal IVF Medium (Medicult). ‘P1 medium’ lacks glucose and phosphate, whilst Universal IVF medium contains both glucose and phosphate. Design: Each week, all patients undergoing Oocyte Retrieval (O/R) that week who were to be treated exclusively using ICSI were allocated to one of the two culture medium systems (either ‘P1’ medium (48 cycles) or Universal IVF medium (65 cycles)), the culture medium system used being alternated on a weekly basis (a total of 113 ICSI treatment cycles). Materials/Methods: OCCs were collected and cultured in one or other culture system until insemination of oocytes using ICSI had been completed (using standard methods). Injected oocytes were then transferred to the same culture medium system (glucose/phosphate-fee) for further culture. Treatment continued using standard methods. Outcome parameters assessed included fertilization rate, zygote-cleavage rate, and clinical pregnancy and implantation rates. Female patients above the age of 40 years who were treated with their own oocytes were excluded from analysis. Statistical analysis was performed by Student’s t-test or by G-test, as appropriate. A clinical pregnancy was defined as the detection of one or more fetal hearts (FH) by ultrasonography. Results: There were no significant differences (p ⬍0.05) between the two groups in mean female patient age, number of previous ART cycles, number of oocytes retrieved, number of embryos transferred per Embryo Transfer (ET) procedure, proportion of patients having an ET on either Day 2/3 or Day 5/6 post-O/R, nor in the proportion of all oocytes collected that were inseminated, normal (2PN) or total (⬎/ ⫽ 2PN) fertilization rates, 2PN zygote-cleavage rate (Day 2 Post-O/R), mean number of embryos cryopreserved per ET, implantation rate per ET, clinical pregnancy rate per O/R, nor mean number of fetal hearts detected per patient presenting with a clinical pregnancy. Conclusions: We found no significant differences in the performance of the two culture medium systems examined when used to culture OCCs/oocytes up to the time of insemination by ICSI. Our study indicates that either culture system can be equally confidently used in current routine ART practice and suggests that the use of glucose/phosphate-free media following Oocyte Re-

Vol. 78, No. 3, Suppl. 1, September 2002