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children born from donor embryos and 23 children born from donor oocytes. CONCLUSION: Frozen donor embryo cycles during in vitro fertilization have a success rate of over forty percent and is a suitable option for couples seeking this method to achieve pregnancy. Donor embryo use during in vitro fertilization is equally effective to use of donor oocytes during frozen cycle in vitro fertilization. It may be more superior in achieving pregancies over 10 weeks gestation and achieiving sucessful deliveries. Supported by: None

P-295 MORPHOLOGY AND AXIS OF FIRST CLEAVAGE: IMPACT ON EMBRYO DEVELOPMENT AND IVF-ET OUTCOME. L. Hesters, N. Prisant, R. Fanchin, R. Frydman, G. Tachdjian, N. Frydman. Antoine Beclere Hospital, Clamart, France. OBJECTIVE: Recent published data indicate that examination of the zygote first mitotic division time frame could be a new criterion for embryo selection. The objective of this study was to evaluate the impact of the first division morphology on embryo developement and IVF-ET outcome. DESIGN: Prospective study, between February and December 2005, at the university hospital Antoine Beclere, Clamart, France. MATERIALS AND METHODS: We studied prospectively 201 day 2 (D2) double embryos transfers (DET). All zygotes were checked 25-26h post ICSI or 26-27h post conventional IVF for early cleavage. Three groups were characterized: persistence of 2PN, BD (2PN breakdown) and early cleaved zygotes (EC). For each EC, the morphology and axis of the first cleavage were recorded as follows: number of cells, respective size of each blastomeres and percentage of anucleated fragment. Consequently, EC with 2 cells of even size and less than 20% fragmentation rate were defined as “even”. EC with 2 cells of uneven size (⬎ 20% of difference) and less than 20% fragmentation rate were scored as “uneven”. EC with more than 20% of fragmentation rate whatever the size of cells were defined as “fragmented”. D2 embryo quality was assessed as “top” embryo (4 even sized mononucleated blastomeres with less than 20% fragmentation) or “non-top”. Chi-square and/or Fisher’s test were used when appropriate. Differences were considered to be statistically significant when p was less than 0.05. RESULTS: A total of 1307 zygotes were assessed: 516 (39.5%) were at the 2-cell stage (EC), 406 (31.1%) were BD and 385 (29.4%) at 2PN stage. EC yielded significantly more top quality embryo than BD (55.4% vs 46.3%, p⫽0.005) and 2PN (55.4% vs 28.6%, p⬍10-4). Among the 516 EC, 305 (59.1%) were even, 67 (13.0%) uneven and 144 (27.9%) fragmented. Even EC yielded significantly more “top” embryos than uneven (235/305: 77.0% vs 31/67 46.3%, p⫽10-4) and fragmented EC (77.0% vs 20/144: 13.9%, p⫽10-4). Among the 201 DET, 125 comprised at least one even EC and 76 only BD or 2PN embryos. A significantly higher pregnancy rate (80/125: 64.0% vs 33/76: 43.4%, p⫽0.01) and implantation rate (105/250: 42.0% vs 42/152: 27.6%, p⫽0.006) were obtained when at least one even EC embryo was transferred. There was no difference between the two groups in terms of female age, treatment regimen, or fertilization rate. CONCLUSION: Our results confirm that early cleavage has a positive impact on embryo quality and ART outcome. Furthermore, the morphology of this first cleavage appears to be involved in preimplantation embryo development. Indeed even EC yielded significantly more D2 “top” embryo than uneven and fragmented EC. On the basis of zygote polarity, it is possible that an asymmetrical axis of cleavage could lead to unequal distribution of animal and vegetal cytoplasm between the 2 daughter cells that could be detrimental for subsequent embryo divisions. Supported by: None

P-296 EMBRYO DEPOSITION IN LOWER UTERINE CAVITY DOES NOT AFFECT IMPLANTATION AND PREGNANCY RATES: A RANDOMIZED CONTROLLED TRIAL. I. P. Kosmas, R. Jensens, W. Verpoest, J. Van der Elst, H. Toyrnaye, P. Devroey. Dutch-Speaking Brussels Free Univ, Brussels, Belgium. OBJECTIVE: It is not defined yet the best embryo placement after an ET. Current dogma in IVF commands for a fundal ET but certain studies start

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Abstracts

rising the opposite fact. Especially three studies (Frankfurter et al, 2004, Pope et al, 2004, Franco et al, 2004) found that middle and lower uterine embryo deposition might offer better implantation and clinical pregnancy rates than higher one. DESIGN: To understand whether embryo release in upper or lower uterine compartment achieves better results, we designed a single performer, single sonographer, computer randomized trial .All embryo transfers undertaken with an empty bladder. MATERIALS AND METHODS: Thirty eight women aged less than 40 years that undergone fresh, no donor ET, from March 2006 till April 2006, were included once in the study. During this study we assess a new catheter (K-J-SPPE echo tip,Cook) with ultrasound guidance. All patients had infertility of greater than 3.48 year duration. Diagnostic categories included male infertility, endometriosis, unexplained infertility, ovulatory dysfunction and other no categorized indications. All fresh ET included in the study, even if embryos had undergone PGD. Frozen ET and women with no-good uterine visualization, were excluded. We performed downregulation with agonist and antagonist protocols. Ovarian stimulation was performed with various forms of urinary and recombinant FSH. OPU was performed 36 hours after the administration of hCG, 10000 units, given when at least 3 follicles had an average diameter ⱖ 17 mm. For luteal support we use progesterone vaginally. Study data was analyzed using independent t-test and Chi-square test. Patients did not asked for a full bladder. RESULTS: Patients analyzed in the arm where originally randomized. Both groups were well balanced on all baseline characteristics. Groups did not differ in number of ICSI cycles. 21 upper uterine and 17 lower uterine ET were performed .Seven out of seventeen embryos could not stop in lower uterine cavity, after embryologist flushing. Overall pregnancy rates were 42.9% and 58.8 % in the upper uterine and lower uterine ET group respectively. All values between the two groups did not presented statistically significant difference.

CONCLUSION: In patients undergoing ET by an experienced performer, upper uterine compartment ET does not offer any benefit for overall pregnancy rates. Although there is some difficulty to deposition embryo in lower uterine cavity, embryos mainly deposited exactly were intended to be. Embryo transfer in lower uterine compartment, with an empty bladder, can achieve significant results in overall pregnancy rates. Supported by: None.

P-297 FROZEN EMBRYO REPLACEMENT CYCLES: DUAL HORMONE URINE MONITORING IN THE SPONTANEOUS CYCLE IS AS EFFECTIVE AS BLOOD HORMONE MEASUREMENT. E. A. Lenton, P. Smith, A. Salih. CafeFertility, Sheffield, United Kingdom; CareFertility, Sheffield, United Kingdom. OBJECTIVE: Moving to single embryo transfer means increasing numbers of frozen-thawed cycles become necessary. Minimising the cost of these treatment cycles whilst retaining efficacy is an important goal. Frozen thawed embryos can be replaced in artificial (HRT) cycles but use of the spontaneous cycle generally gives better outcomes. Monitoring for the plasma luteinising hormone (LH) surge can be expensive and is time consuming for the patient. There is also some evidence that women can

Vol. 86, Suppl 2, September 2006