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P-272 Fibrin sealant (FS) improves pregnancy rates in the elderly in-vitro fertilization (IVF) population, and maintains them within the more youthful range
highly purified FSH results in reduced cytoplasmic maturation but improved egg quality and ART outcomes.
P-271 The Effect of Day-3 Versus Day-2 Embryo Cultures on P r e g n a n c y Rates Following Tubal Embryo Transfer (TET). J. R. Ramey, T. L. Sheeley, S. Gernhart, D. M. Baldwin, C. J. De Jonge, V. M. Maclin-Collins. Olson Center for Women's Health, Dept of OB/GYN, University of Nebraska Medical Center, Omaha, NE. Objectives: To determine if embryos cultured for 3 days verses 2 days would increase pregnancy rates after transfer to the fallopian tubes. The effects of embryo grade and patient age were also evaluated. Design: Retrospective case study utilizing patient records from a University based in vitro fertilization (IVF) program. Materials and Methods: Clinical pregnancy rates observed from 66 day-3 TETs were compared to 64 day-2 TETs. A clinical pregnancy was defined as a positive fetal heart rate by ultrasound at 6 - 8 weeks gestational age. Average embryo grades were calculated for both positive and negative pregnancy outcome groups. Embryos were classified into three grades: (1) equal size blastomeres with no fragmentation; (2) unequal size blastomeres; and (3) evidence of fragmentation. Clinical pregnancy rates and average embryo grade were further stratified by patient age. The data were analyzed by appropriate parametric or nonparametric analysis. Results: The overall pregnancy rates for day-3 versus day-2 TETs were not significantly different being 45.5% (n=66) and 42.2% (n=64), respectively. The average age of the patients between the two groups were similar. Since no differences in pregnancy rates were noted between the day-3 and day-2 transfers, these data were combined and stratified according to age. The combined pregnancy rate was 43.9% (n=130). Pregnancy rates for women 30 years of age or younger was 46.4% (n=28); 3 1 - 3 5 years of age was 46.7% (n=60); 36-39 years of age was 54.5% (n=22); with those 40 years or older being 20.0% (n--20). Pregnancy rates were significantly lower (P<0.05) in the 40 years old and above group compared to the younger aged groups. The average embryo grade was not significantly different among the various age groups or between pregnant and nonpregnant patients. The mean _+ SEM embryo grade was 1.86___0.05. Conclusions: These data would indicate that by increasing the time of embryo culture by 1 day does not alter pregnancy outcome in patients using TET procedures. Thus, using a 2 day embryo culture may be more cost effective. Our data further indicate that pregnancy rates employing TET methodology remain relatively constant in women less than 40 years of age after which there is a significant decline in fertility. The average embryo quality did not appear to influenced pregnancy outcome in this patient population.
P-272 Fibrin Sealant (FS) Improves P r e g n a n c y Rates in the Elderly In-Vitro Fertilization (IVF) Population,
and Maintains Them Within the More Youthful Range. I. Bar-Hava, J. Ashkenazi, D. Feldberg, M. Shelef, A. Schwartz, M. Brengauz, Z. Voliovich, R. Orvieto, Z. BenRafael. Dept. of OB/GYN, Rabin Medical Center (Golda Campus), Petah-Tikva, Israel, and Sackler School of Medicine, Tel Aviv University, Israel. Objectives: To evaluate the influence of embryo transfer (ET) with FS on pregnancy rates in an IVF-ET program. Design: Case control study. Materials and Methods: All women who reached the ET stage in our IVF Unit between J a n u a r y 1st and September 30th 1996 were included in the study. In 123 women, the embryos were transferred with FS, and the women were ambulated immediately. In 601, the embryos were transferred with no FS and the women remained recumbent for I hour before they were discharged. Each patient had undergone a counseling session where the theoretical advantage of FS was discussed. Based on our previous experience, we tended to recommend FS for the elderly, recurrent failure, IVF population. Thereafter, the decision to use FS was in accordance with the patient's wishes. Results:
Fibrin sealant (n = 123) Control (n = 601) Student's t-test
Age (+_SD)
No. of oocytes retrieved (_+SD)
No. of embryos transferred (_+SD)
Pregnancy rate (%)
37.4 -+ 4.8
8.8 -+ 3.8
3.4 _+ 1.7
20.3
34.2 -- 5.4
9.4 +_ 4.5
3.5 _+ 1.6
22.4
P < 0.0005
NS
NS
NS (X 2)
SD = S t a n d a r d Deviation; NS = Not significant.
Conclusion: Fibrin sealant assists in maintaining the pregnancy rate of elderly IVF patients in the range of that achieved for the younger population.
P-273 Results of R o u n d Spermatids Injection (ROSI) for Treatment of Defective Spermiogenesis. D. Levran, H. Nahum, O. Kotlirov, A. Benet, H. Zakut, A. Sidi, J. Farhi. IVF Unit, Department of Urology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon and Tel Aviv University, Israel. Objective: To present our initial experience with the use of ROSI into human oocytes for the treatment of azoospermic patients with severely defective spermiogenesis. Design: Prospective study. Material and Methods: Nine treatment cycles in 5 couples are presented. Spermatids were extracted from open testicular biopsies. Identification of spermatids was based on the typical characteristics of prominent nucleolus, clear cytoplasm and cell size. Spermatids were injected into the ooplasm using Humagen pipette. Results: 107 oocytes were retrieved of which 84 were found to be in M2 stage and injected with round spermatids. There was a high incidence (9.5%) of oocyte damage Abstracts
S223
P-271 The Effect of Day-3 Versus Day-2 Embryo Cultures on P r e g n a n c y Rates Following Tubal Embryo Transfer (TET). J. R. Ramey, T. L. Sheeley, S. Gernhart, D. M. Baldwin, C. J. De Jonge, V. M. Maclin-Collins. Olson Center for Women's Health, Dept of OB/GYN, University of Nebraska Medical Center, Omaha, NE. Objectives: To determine if embryos cultured for 3 days verses 2 days would increase pregnancy rates after transfer to the fallopian tubes. The effects of embryo grade and patient age were also evaluated. Design: Retrospective case study utilizing patient records from a University based in vitro fertilization (IVF) program. Materials and Methods: Clinical pregnancy rates observed from 66 day-3 TETs were compared to 64 day-2 TETs. A clinical pregnancy was defined as a positive fetal heart rate by ultrasound at 6 - 8 weeks gestational age. Average embryo grades were calculated for both positive and negative pregnancy outcome groups. Embryos were classified into three grades: (1) equal size blastomeres with no fragmentation; (2) unequal size blastomeres; and (3) evidence of fragmentation. Clinical pregnancy rates and average embryo grade were further stratified by patient age. The data were analyzed by appropriate parametric or nonparametric analysis. Results: The overall pregnancy rates for day-3 versus day-2 TETs were not significantly different being 45.5% (n=66) and 42.2% (n=64), respectively. The average age of the patients between the two groups were similar. Since no differences in pregnancy rates were noted between the day-3 and day-2 transfers, these data were combined and stratified according to age. The combined pregnancy rate was 43.9% (n=130). Pregnancy rates for women 30 years of age or younger was 46.4% (n=28); 3 1 - 3 5 years of age was 46.7% (n=60); 36-39 years of age was 54.5% (n=22); with those 40 years or older being 20.0% (n--20). Pregnancy rates were significantly lower (P<0.05) in the 40 years old and above group compared to the younger aged groups. The average embryo grade was not significantly different among the various age groups or between pregnant and nonpregnant patients. The mean _+ SEM embryo grade was 1.86___0.05. Conclusions: These data would indicate that by increasing the time of embryo culture by 1 day does not alter pregnancy outcome in patients using TET procedures. Thus, using a 2 day embryo culture may be more cost effective. Our data further indicate that pregnancy rates employing TET methodology remain relatively constant in women less than 40 years of age after which there is a significant decline in fertility. The average embryo quality did not appear to influenced pregnancy outcome in this patient population.
P-272 Fibrin Sealant (FS) Improves P r e g n a n c y Rates in the Elderly In-Vitro Fertilization (IVF) Population,
and Maintains Them Within the More Youthful Range. I. Bar-Hava, J. Ashkenazi, D. Feldberg, M. Shelef, A. Schwartz, M. Brengauz, Z. Voliovich, R. Orvieto, Z. BenRafael. Dept. of OB/GYN, Rabin Medical Center (Golda Campus), Petah-Tikva, Israel, and Sackler School of Medicine, Tel Aviv University, Israel. Objectives: To evaluate the influence of embryo transfer (ET) with FS on pregnancy rates in an IVF-ET program. Design: Case control study. Materials and Methods: All women who reached the ET stage in our IVF Unit between J a n u a r y 1st and September 30th 1996 were included in the study. In 123 women, the embryos were transferred with FS, and the women were ambulated immediately. In 601, the embryos were transferred with no FS and the women remained recumbent for I hour before they were discharged. Each patient had undergone a counseling session where the theoretical advantage of FS was discussed. Based on our previous experience, we tended to recommend FS for the elderly, recurrent failure, IVF population. Thereafter, the decision to use FS was in accordance with the patient's wishes. Results:
Fibrin sealant (n = 123) Control (n = 601) Student's t-test
Age (+_SD)
No. of oocytes retrieved (_+SD)
No. of embryos transferred (_+SD)
Pregnancy rate (%)
37.4 -+ 4.8
8.8 -+ 3.8
3.4 _+ 1.7
20.3
34.2 -- 5.4
9.4 +_ 4.5
3.5 _+ 1.6
22.4
P < 0.0005
NS
NS
NS (X 2)
SD = S t a n d a r d Deviation; NS = Not significant.
Conclusion: Fibrin sealant assists in maintaining the pregnancy rate of elderly IVF patients in the range of that achieved for the younger population.
P-273 Results of R o u n d Spermatids Injection (ROSI) for Treatment of Defective Spermiogenesis. D. Levran, H. Nahum, O. Kotlirov, A. Benet, H. Zakut, A. Sidi, J. Farhi. IVF Unit, Department of Urology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon and Tel Aviv University, Israel. Objective: To present our initial experience with the use of ROSI into human oocytes for the treatment of azoospermic patients with severely defective spermiogenesis. Design: Prospective study. Material and Methods: Nine treatment cycles in 5 couples are presented. Spermatids were extracted from open testicular biopsies. Identification of spermatids was based on the typical characteristics of prominent nucleolus, clear cytoplasm and cell size. Spermatids were injected into the ooplasm using Humagen pipette. Results: 107 oocytes were retrieved of which 84 were found to be in M2 stage and injected with round spermatids. There was a high incidence (9.5%) of oocyte damage Abstracts
S223