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Pre-embryo transfer sham at the time of embryo transfer improves clinical pregnancy rates
thawed using a rapid thawing method. After 30 min incubation, thawed ovarian cortical sections were divided into 2 groups (20 each) and threaded into 3-0 vicryl sutures. The first group was implanted into the space between breast tissue and pectoralis muscle. The second group was implanted into the space between rectus sheath and rectus muscle. Blood samples for sequential evaluation of serum concentrations of FSH, LH, estradiol (E2), progesterone (P4), and testosterone were collected monthly. Ultrasonographic examinations were performed monthly on the same days of blood sampling. When restoration of ovarian function was confirmed, blood was collected every 2 days for one month. Results: The hormonal profiles were consistent with a postmenopausal state until 10 weeks after transplantation (FSH 87-100 IU/L; E2 undetectable). By 14 weeks after transplantation, the reestablishment of ovarian function was evidenced by the serum estradiol (57.5 pg/ml) and FSH (39 IU/L) concentrations as well as detection of a dominant follicle (8.5⫻11 mm). Starting 24 weeks post-grafting, the hormonal profiles were obtained every 2 days for 5 weeks. During this period spontaneous ovulation was evidenced by the LH surge (69.8 IU/L) followed by the elevation of P4 concentration (9.6 ng/ml). The E2 level was 305 pg/ml before the LH surge. The ultrasound revealed a dominant follicle (10⫻10 mm) in the abdominal site, however, there was no sign of follicular development in the breast site. Ovarian function ceased around 31 weeks after transplantation (FSH 98.9 IU/L; E2 undetectable). Conclusions: Previously, there was a report of spontaneous ovulation after heterotopic autotransplantation with fresh human ovarian tissue, but not with frozen-thawed ovarian tissue. The present study demonstrated not only restoration of endocrine function but also spontaneous ovulation after heterotopic autotransplantation of frozen-thawed human ovarian tissue. It appeared that the pre-rectus space was an effective and practical site for heterotopic ovarian tissue transplantation, but breast tissue was not an effective site.
Wednesday, October 15, 2003 2:45 P.M. O-249 Pre-embryo transfer sham at the time of embryo transfer improves clinical pregnancy rates. Adrienne B. Neithardt, Cynthia M. Murdock, James H. Segars, Jeffrey L. McKeeby. National Inst of Health, Bethesda, MD; National Inst of Health, Bethesda, MD; Walter Reed Army Medical Ctr, Washington, DC. Objective: Over the past several years clinical pregnancy rates with ART have improved. While many variables have been analyzed to determine their effect on ART outcomes, the role of embryo transfer (ET) techniques is unquestionably important. Immediate pre-embryo transfer sham has been utilized in cases thought to be difficult transfers, however the effect of a routine pre-transfer sham is unproven. Design: Retrospective cohort analysis. Materials and Methods: IRB-approved review of 127 embryo transfers at a University-based ART program. Inclusion criteria consisted of all ETs performed by a single provider over a one year period. Patients having a fresh day 3 ET after undergoing gonadotropin stimulation on either luteal lupron or microdose flare stimulation were included for analysis. All transfers were performed in lithotomy position with ultrasound guidance as described (Hearns-Stokes, et al. 2000). For ’sham’ transfers, a WallaceEdwards catheter was inserted with the outer sheath at the internal os, the inner catheter was withdrawn but the outer catheter remained in the lower endometrial cavity, and the embryos were loaded using a second inner catheter. For direct transfers, embyros were deposited with a WallaceEdwards catheter directly into the endometrial cavity under ultrasound guidance 1.5 cm from the uterine fundus. Primary outcome variables were clinical pregnancy and implantation rates (IR). Differences between groups were tested with chi-square with p ⬍ 0.05. Results: Patients were divided into two groups: sham, or no sham. The two patient groups did not differ with respect to age, basal FSH, or number of embryos transferred (Table I). The IR in the sham group was 24.7% compared to 20.5% is the no sham group. The clinical pregnancy rate per transfer (CPR/T) in the sham group was 52.4% compared to 34.9%% in those not receiving a pre-embryo transfer sham (p ⫽ 0.06).
FERTILITY & STERILITY威
Table I
Conclusions: Although statistical significance was not achieved, there was a trend toward improved implantation rates in patients who received a mock embryo sham immediately before embryo transfer. Similarly, clinical pregnancy rates were substantially higher in patients who received a sham. A randomized trial of pre-transfer sham is needed.
Wednesday, October 15, 2003 3:00 P.M. O-250 Electro-acupuncture for ovum pick-up—a good alternative to conventional anesthetics. Peter S. Humaidan, Leif Bungum, Kirsten B. Andersen. Viborg Sygehus (Skive), Skive, Denmark. Objective: Electro-acupuncture (EA) has proved its anaesthetic effect in the ovum pick up (OPU) situation for in-vitro fertilisation (IVF). Until now, it has been more time consuming compared to conventional medical anaesthesia (CMA). In this prospective randomised study EA was applied a few minutes prior to OPU making it more attractive for clinical use. The purpose of this study was to compare time consumption and costs, patient compliance, and the anaesthetic/analgesic effect of EA and paracervical block (PCB) during OPU for IVF with CMA (premedication and i.v. alfentanil) and PCB. Design: Prospective randomised study. Materials and Methods: 200 Patients undergoing IVF and OPU were randomised to receive either EA and PCB or CMA and PCB during the OPU. Time consumption for preparation and procedure in the two groups was recorded. Doses of benzodiazepine and alfentanil were recorded. A visual analogue scale (VAS) was used by the patient to evaluate anxiety level before the procedure and pain level before, during and after the OPU with 30 min. intervals until leaving the clinic. VAS-rating of the patients’ pain was also performed by the nurse during the OPU procedure. After leaving the clinic, patients continued pain rating according to the VASscheme approximately every 6 hours for the following 24 hours. Results: Demographic data did not differ among groups. The VAS ratings regarding anxiety before the procedure did not differ among groups. There were no significant differences between the VAS-rating regarding expected pain and pain before the OPU. During the OPU the EA group had significantly higher VAS scores, consistent with the nurses’ VAS-rating compared with the CMA group. There were no significant differences between the groups regarding pain after the OPU at the clinic, and no significant differences in the patients’ home rating. The use of supplementary painkillers did not differ in the groups. Preparation and procedure time did not differ in the two groups. Patients in the EA group were discharged significantly quicker and “medication” costs were significantly lower in the EA group. 87% of the patients who had EA would prefer EA again as an anaesthetic method for OPU. The clinical outcome parameters did not differ among groups showing high pregnancy rates per embryo transfer in both groups. Conclusion: A significant difference was found between the EA and the CMA groups regarding VAS pain scoring during the OPU, but not before or after the procedure. Nevertheless 87% of patients would prefer EA again for OPU. Generally patients were very positive to EA feeling less confused and more present during the OPU, and without tiredness and drowsiness for the rest of the day. Costs and time to discharge were lower for the EA group. EA is a good alternative to conventional anaesthetics during OPU, with a high patient compliance.
ART: OUTCOME PREDICTORS II Wednesday, October 15, 2003 2:00 P.M. O-251 The role of patient age when deciding to transfer at the blastocyst stage. Should we be more aggressive with day 3 transfers in older patients?
S95
Wednesday, October 15, 2003 2:45 P.M. O-249 Pre-embryo transfer sham at the time of embryo transfer improves clinical pregnancy rates. Adrienne B. Neithardt, Cynthia M. Murdock, James H. Segars, Jeffrey L. McKeeby. National Inst of Health, Bethesda, MD; National Inst of Health, Bethesda, MD; Walter Reed Army Medical Ctr, Washington, DC. Objective: Over the past several years clinical pregnancy rates with ART have improved. While many variables have been analyzed to determine their effect on ART outcomes, the role of embryo transfer (ET) techniques is unquestionably important. Immediate pre-embryo transfer sham has been utilized in cases thought to be difficult transfers, however the effect of a routine pre-transfer sham is unproven. Design: Retrospective cohort analysis. Materials and Methods: IRB-approved review of 127 embryo transfers at a University-based ART program. Inclusion criteria consisted of all ETs performed by a single provider over a one year period. Patients having a fresh day 3 ET after undergoing gonadotropin stimulation on either luteal lupron or microdose flare stimulation were included for analysis. All transfers were performed in lithotomy position with ultrasound guidance as described (Hearns-Stokes, et al. 2000). For ’sham’ transfers, a WallaceEdwards catheter was inserted with the outer sheath at the internal os, the inner catheter was withdrawn but the outer catheter remained in the lower endometrial cavity, and the embryos were loaded using a second inner catheter. For direct transfers, embyros were deposited with a WallaceEdwards catheter directly into the endometrial cavity under ultrasound guidance 1.5 cm from the uterine fundus. Primary outcome variables were clinical pregnancy and implantation rates (IR). Differences between groups were tested with chi-square with p ⬍ 0.05. Results: Patients were divided into two groups: sham, or no sham. The two patient groups did not differ with respect to age, basal FSH, or number of embryos transferred (Table I). The IR in the sham group was 24.7% compared to 20.5% is the no sham group. The clinical pregnancy rate per transfer (CPR/T) in the sham group was 52.4% compared to 34.9%% in those not receiving a pre-embryo transfer sham (p ⫽ 0.06).
FERTILITY & STERILITY威
Table I
Conclusions: Although statistical significance was not achieved, there was a trend toward improved implantation rates in patients who received a mock embryo sham immediately before embryo transfer. Similarly, clinical pregnancy rates were substantially higher in patients who received a sham. A randomized trial of pre-transfer sham is needed.
Wednesday, October 15, 2003 3:00 P.M. O-250 Electro-acupuncture for ovum pick-up—a good alternative to conventional anesthetics. Peter S. Humaidan, Leif Bungum, Kirsten B. Andersen. Viborg Sygehus (Skive), Skive, Denmark. Objective: Electro-acupuncture (EA) has proved its anaesthetic effect in the ovum pick up (OPU) situation for in-vitro fertilisation (IVF). Until now, it has been more time consuming compared to conventional medical anaesthesia (CMA). In this prospective randomised study EA was applied a few minutes prior to OPU making it more attractive for clinical use. The purpose of this study was to compare time consumption and costs, patient compliance, and the anaesthetic/analgesic effect of EA and paracervical block (PCB) during OPU for IVF with CMA (premedication and i.v. alfentanil) and PCB. Design: Prospective randomised study. Materials and Methods: 200 Patients undergoing IVF and OPU were randomised to receive either EA and PCB or CMA and PCB during the OPU. Time consumption for preparation and procedure in the two groups was recorded. Doses of benzodiazepine and alfentanil were recorded. A visual analogue scale (VAS) was used by the patient to evaluate anxiety level before the procedure and pain level before, during and after the OPU with 30 min. intervals until leaving the clinic. VAS-rating of the patients’ pain was also performed by the nurse during the OPU procedure. After leaving the clinic, patients continued pain rating according to the VASscheme approximately every 6 hours for the following 24 hours. Results: Demographic data did not differ among groups. The VAS ratings regarding anxiety before the procedure did not differ among groups. There were no significant differences between the VAS-rating regarding expected pain and pain before the OPU. During the OPU the EA group had significantly higher VAS scores, consistent with the nurses’ VAS-rating compared with the CMA group. There were no significant differences between the groups regarding pain after the OPU at the clinic, and no significant differences in the patients’ home rating. The use of supplementary painkillers did not differ in the groups. Preparation and procedure time did not differ in the two groups. Patients in the EA group were discharged significantly quicker and “medication” costs were significantly lower in the EA group. 87% of the patients who had EA would prefer EA again as an anaesthetic method for OPU. The clinical outcome parameters did not differ among groups showing high pregnancy rates per embryo transfer in both groups. Conclusion: A significant difference was found between the EA and the CMA groups regarding VAS pain scoring during the OPU, but not before or after the procedure. Nevertheless 87% of patients would prefer EA again for OPU. Generally patients were very positive to EA feeling less confused and more present during the OPU, and without tiredness and drowsiness for the rest of the day. Costs and time to discharge were lower for the EA group. EA is a good alternative to conventional anaesthetics during OPU, with a high patient compliance.
ART: OUTCOME PREDICTORS II Wednesday, October 15, 2003 2:00 P.M. O-251 The role of patient age when deciding to transfer at the blastocyst stage. Should we be more aggressive with day 3 transfers in older patients?
S95