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Pregnancies and Live Births After Transfer of Cryopreserved Hatching or Hatched Blastocysts
development. Future studies are planned to assess the implantation potential of the embryos derived from oocyte cryopreservation and whether the differences in D3 embryo development translate into differences in pregnancy.
P-20 Efficacy of Frozen Embryo Transfer Using Natural Cycle Timing in Patients With Oligomenorrhea. R.B. Quintero, R.O. Burney, A.A. Milki. Background: Frozen embryo transfer (FET) is an important component of assisted reproductive technology (ART) treatment, accounting for approximately 15% of total ART cycles. Many centers elect to perform all FETs in a programmed cycle using GnRH-agonist down-regulation followed by estrogen and progesterone endometrial preparation. Others use the natural cycle in patients with regular menses to avoid the dependence on injectable steroid replacement, and reserve the programmed cycle for those with oligomenorrhea. It is possible that patients with oligomenorrhea will fare well if given the benefit of monitoring with a natural cycle FET, though data to this effect are lacking in the literature. Objective: To review our experience with natural cycle FET in patients with oligomenorrhea. Material and Methods: Retrospective review of FET cycles from 2001 to 2004. All FETs were performed using cryopreserved blastocysts with transfer timed five days after ovulation. Cycles in which the transfer occurred on or after day 26 were analyzed, as these were indicative of oligomenorrhea, defined as cycle length ⱖ35 days. Patients had an ultrasound performed between cycle days 11 and 15. Subsequent ultrasounds were timed based on projected follicular growth, and HCG was administered once the follicle reached 17 mm. Result(s): A total of 36 oligomenorrheic patients underwent natural cycle FET. The mean transfer day was cycle day 30, with a range of day 26 to 45 (equivalent to a cycle length 35 to 54 days). The mean patient age was 34.3, with a range of 30 to 44 years. There were thirteen ongoing or delivered pregnancies, for a rate of 36.1%. Conclusion(s): This study suggests that using the natural cycle to time FET in oligomenorrheic patients is a viable option. The success rate achieved compares very favorably with the national SART figure of 20.4% (F&S, May 2004) and with our own published result of 27% for blastocyst FET (F&S April 2002). We believe this data offers reassurance that there is no deleterious effect of a prolonged follicular phase on implantation with FET. In choosing a mechanism of timing FET, programs and patients should evaluate the expense of repeated ultrasound monitoring against the inconvenience associated with steroid injections.
P-21 The Prevalence of Erectile Dysfunction in an Infertile Population. R.B. Quintero, L.M. Westphal, R.B. Lathi, A.A. Milki, L.C. Giudice, S.W. McCallum. Stanford University Medical Center, Stanford, California. Introduction: Infertility can be a stressful experience that may impact the quality of one’s sex life. In infertile women, the prevalence of sexual dysfunction has been reported to be as high as 50%. Objective: to present the prevalence of male sexual dysfunction in a population of couples undergoing infertility treatments at an academic medical center. Material and Methods: Exempt IRB was obtained at Stanford University Medical Center to conduct these surveys from June 2004 to October 2004. Couples seeking infertility services at the reproductive endocrinology and infertility center were queried with a demographic questionnaire and the men completed the international index of erectile function (IIEF) survey. An IIEF score of less than 26 is associated with erectile dysfunction. The IIEF results were also evaluated and correlated with baseline demographic parameters and infertility treatments. Additionally, men were questioned about a change in sexual satisfaction pre-and-post infertility diagnosis. Multivariate analysis and Spearman’s Correlations were performed to determine associations in baseline population characteristics, duration of infertility, infertility treatments, and a variety of other basic demographic parameters. Result(s): A total of 88 men completed the basic demographic components, and 85 had evaluable IIEF questionnaire. The mean age of participants was 37.3 (range 23-56) with an average IIEF score of 27.7 (SD
S20
PCRS Abstracts
⫾4.13), with 17/85 (20%) having scores below 26. The same proportion of participants 17 (20%), also reported a decline in sexual satisfaction after the diagnosis of infertility, with only 2 (2.3%) of respondents reporting and improvement in sexual satisfaction. Significant correlations were found to exist between duration of infertility and the IIEF. Statistical significance was approached when analyzing the IIEF with highly educated male’s whose partners had undergone in vitro fertilization. No correlations were noted between the IIEF and body mass index, or sexual frequency. Conclusions: We have shown that 20% of our population would qualify as having erectile dysfunction that may also be associated with their duration of infertility. Further studies are necessary to look at longitudinal changes in male sexual function pre and post infertility diagnosis and during the course of the couple’s treatments.
P-22 Pregnancies and Live Births After Transfer of Cryopreserved Hatching or Hatched Blastocysts. Y. Shu, J. Gebhardt, J. Watt, J. Lyon, J. Jensen, B. Behr. IVF Program, Stanford University Medical Center, Palo Alto, California. Background and Significance: Blastocyst transfer has been demonstrated to reduce high-order multiple pregnancies while maintaining high implantation and pregnancy rate. Surplus blastocysts after day 3 or day 5 transfer are usually frozen for later use. Although blastocyst freezing has gained popularity in recent years, there is little few data available on cryopreservation of hatching and hatched human blastocysts. Objective: We aimed to evaluate the survival and implantation potential of frozen hatching or hatched blastocysts. Materials and Methods: Frozen-thaw blastocyst transfer cycles between July 1999 and September 2004 in our center were reviewed. All the blastocysts frozen and thawed that were hatching or hatched blastocysts were included in this retrospective study. Day 5 or day 6 blastocysts were frozen and thawed using Menezo 2-step slow freezing and 2-step rapid thawing protocols with glycerol and sucrose as cryoprotectants. Blastocyst survival post thaw was defined as more than 50% of inner cell mass and trophectoderm cells remaining intact and re-expansion after culture in vitro for 3-4 hours before transfer. The thawed blastocysts were replaced into luteal day 5 endometrium in natural or programmed cycles. Blastocyst survival, implantation, and pregnancy rates were recorded. Results: Out of the 36 frozen-thawed blastocysts from 22 patients, 8 were hatched blastocysts and the other 28 were hatching blastocysts at freezing. Seven blastocysts failed to survive the frozen-thaw process; the survival rate was 80.5%. Twenty-nine blastocysts were transferred in 18 cycles. Two live births and 4 ongoing pregnancies were obtained. The implantation and clinical pregnancy rate were 20.7% and 33.3% respectively. Conclusion: Our data suggest that hatching or hatched human blastocysts can be successfully cryopreserved using the 2-step slow freezing protocol. However, a larger study is warranted to determine whether hatching is a favorable quality prior to freezing.
P-23 Successful Pituitary Down-Regulation Using 1.8 mg Leuprolide with Subsequent Controlled Ovarian Hyperstimulation in Ovum Donation In Vitro Fertilitzation (IVF) Cycles. C.C. Slater, K. Hill, J. Roscoe, R. Foulk. Idaho Center for Reproductive Medicine, Boise, Idaho. Background and Significance: Pituitary down regulation prior to gonadotropin stimulation during an in vitro fertilization cycle is achieved with the use of GnRH agonists. Common GnRH agonist’s regimens include 0.5 mg of daily subcutaneous injection of leuprolide and a 3.75 mg single intramuscular injection of leuprolide. Objective: The objective of this study was to evaluate the characteristics of an ovum donor (OD) IVF stimulation cycle after achieving down regulation with a single intramuscular injection of leuprolide using the decreased dose 1.8 mg. Materials and Methods: In this retrospective study, data was extracted from medical records of sixty-two OD cycles completed between 8/02 and 11/04 at the infertility clinic. All ovum donors were between 20 and 34 years of age and had cycle day 3 follicle stimulating hormone values ⱕ9 mIU/mL. Ovum donors were placed on oral contraceptive pills (OCPs) in
Vol. 83, Suppl 2, May 2005
P-20 Efficacy of Frozen Embryo Transfer Using Natural Cycle Timing in Patients With Oligomenorrhea. R.B. Quintero, R.O. Burney, A.A. Milki. Background: Frozen embryo transfer (FET) is an important component of assisted reproductive technology (ART) treatment, accounting for approximately 15% of total ART cycles. Many centers elect to perform all FETs in a programmed cycle using GnRH-agonist down-regulation followed by estrogen and progesterone endometrial preparation. Others use the natural cycle in patients with regular menses to avoid the dependence on injectable steroid replacement, and reserve the programmed cycle for those with oligomenorrhea. It is possible that patients with oligomenorrhea will fare well if given the benefit of monitoring with a natural cycle FET, though data to this effect are lacking in the literature. Objective: To review our experience with natural cycle FET in patients with oligomenorrhea. Material and Methods: Retrospective review of FET cycles from 2001 to 2004. All FETs were performed using cryopreserved blastocysts with transfer timed five days after ovulation. Cycles in which the transfer occurred on or after day 26 were analyzed, as these were indicative of oligomenorrhea, defined as cycle length ⱖ35 days. Patients had an ultrasound performed between cycle days 11 and 15. Subsequent ultrasounds were timed based on projected follicular growth, and HCG was administered once the follicle reached 17 mm. Result(s): A total of 36 oligomenorrheic patients underwent natural cycle FET. The mean transfer day was cycle day 30, with a range of day 26 to 45 (equivalent to a cycle length 35 to 54 days). The mean patient age was 34.3, with a range of 30 to 44 years. There were thirteen ongoing or delivered pregnancies, for a rate of 36.1%. Conclusion(s): This study suggests that using the natural cycle to time FET in oligomenorrheic patients is a viable option. The success rate achieved compares very favorably with the national SART figure of 20.4% (F&S, May 2004) and with our own published result of 27% for blastocyst FET (F&S April 2002). We believe this data offers reassurance that there is no deleterious effect of a prolonged follicular phase on implantation with FET. In choosing a mechanism of timing FET, programs and patients should evaluate the expense of repeated ultrasound monitoring against the inconvenience associated with steroid injections.
P-21 The Prevalence of Erectile Dysfunction in an Infertile Population. R.B. Quintero, L.M. Westphal, R.B. Lathi, A.A. Milki, L.C. Giudice, S.W. McCallum. Stanford University Medical Center, Stanford, California. Introduction: Infertility can be a stressful experience that may impact the quality of one’s sex life. In infertile women, the prevalence of sexual dysfunction has been reported to be as high as 50%. Objective: to present the prevalence of male sexual dysfunction in a population of couples undergoing infertility treatments at an academic medical center. Material and Methods: Exempt IRB was obtained at Stanford University Medical Center to conduct these surveys from June 2004 to October 2004. Couples seeking infertility services at the reproductive endocrinology and infertility center were queried with a demographic questionnaire and the men completed the international index of erectile function (IIEF) survey. An IIEF score of less than 26 is associated with erectile dysfunction. The IIEF results were also evaluated and correlated with baseline demographic parameters and infertility treatments. Additionally, men were questioned about a change in sexual satisfaction pre-and-post infertility diagnosis. Multivariate analysis and Spearman’s Correlations were performed to determine associations in baseline population characteristics, duration of infertility, infertility treatments, and a variety of other basic demographic parameters. Result(s): A total of 88 men completed the basic demographic components, and 85 had evaluable IIEF questionnaire. The mean age of participants was 37.3 (range 23-56) with an average IIEF score of 27.7 (SD
S20
PCRS Abstracts
⫾4.13), with 17/85 (20%) having scores below 26. The same proportion of participants 17 (20%), also reported a decline in sexual satisfaction after the diagnosis of infertility, with only 2 (2.3%) of respondents reporting and improvement in sexual satisfaction. Significant correlations were found to exist between duration of infertility and the IIEF. Statistical significance was approached when analyzing the IIEF with highly educated male’s whose partners had undergone in vitro fertilization. No correlations were noted between the IIEF and body mass index, or sexual frequency. Conclusions: We have shown that 20% of our population would qualify as having erectile dysfunction that may also be associated with their duration of infertility. Further studies are necessary to look at longitudinal changes in male sexual function pre and post infertility diagnosis and during the course of the couple’s treatments.
P-22 Pregnancies and Live Births After Transfer of Cryopreserved Hatching or Hatched Blastocysts. Y. Shu, J. Gebhardt, J. Watt, J. Lyon, J. Jensen, B. Behr. IVF Program, Stanford University Medical Center, Palo Alto, California. Background and Significance: Blastocyst transfer has been demonstrated to reduce high-order multiple pregnancies while maintaining high implantation and pregnancy rate. Surplus blastocysts after day 3 or day 5 transfer are usually frozen for later use. Although blastocyst freezing has gained popularity in recent years, there is little few data available on cryopreservation of hatching and hatched human blastocysts. Objective: We aimed to evaluate the survival and implantation potential of frozen hatching or hatched blastocysts. Materials and Methods: Frozen-thaw blastocyst transfer cycles between July 1999 and September 2004 in our center were reviewed. All the blastocysts frozen and thawed that were hatching or hatched blastocysts were included in this retrospective study. Day 5 or day 6 blastocysts were frozen and thawed using Menezo 2-step slow freezing and 2-step rapid thawing protocols with glycerol and sucrose as cryoprotectants. Blastocyst survival post thaw was defined as more than 50% of inner cell mass and trophectoderm cells remaining intact and re-expansion after culture in vitro for 3-4 hours before transfer. The thawed blastocysts were replaced into luteal day 5 endometrium in natural or programmed cycles. Blastocyst survival, implantation, and pregnancy rates were recorded. Results: Out of the 36 frozen-thawed blastocysts from 22 patients, 8 were hatched blastocysts and the other 28 were hatching blastocysts at freezing. Seven blastocysts failed to survive the frozen-thaw process; the survival rate was 80.5%. Twenty-nine blastocysts were transferred in 18 cycles. Two live births and 4 ongoing pregnancies were obtained. The implantation and clinical pregnancy rate were 20.7% and 33.3% respectively. Conclusion: Our data suggest that hatching or hatched human blastocysts can be successfully cryopreserved using the 2-step slow freezing protocol. However, a larger study is warranted to determine whether hatching is a favorable quality prior to freezing.
P-23 Successful Pituitary Down-Regulation Using 1.8 mg Leuprolide with Subsequent Controlled Ovarian Hyperstimulation in Ovum Donation In Vitro Fertilitzation (IVF) Cycles. C.C. Slater, K. Hill, J. Roscoe, R. Foulk. Idaho Center for Reproductive Medicine, Boise, Idaho. Background and Significance: Pituitary down regulation prior to gonadotropin stimulation during an in vitro fertilization cycle is achieved with the use of GnRH agonists. Common GnRH agonist’s regimens include 0.5 mg of daily subcutaneous injection of leuprolide and a 3.75 mg single intramuscular injection of leuprolide. Objective: The objective of this study was to evaluate the characteristics of an ovum donor (OD) IVF stimulation cycle after achieving down regulation with a single intramuscular injection of leuprolide using the decreased dose 1.8 mg. Materials and Methods: In this retrospective study, data was extracted from medical records of sixty-two OD cycles completed between 8/02 and 11/04 at the infertility clinic. All ovum donors were between 20 and 34 years of age and had cycle day 3 follicle stimulating hormone values ⱕ9 mIU/mL. Ovum donors were placed on oral contraceptive pills (OCPs) in
Vol. 83, Suppl 2, May 2005