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Role of Zygote Intrafallopian Transfer as a Mode of Treatment for Repeated Implantation Failure in IVF in Patients with Tubal Infertility
patients with repeated implantation failure in IVF. 2. Postponing tubal transfer may allow selection of morphologically sound embryos, consequently reducing the number of transferred embryos in order to lower the risk of multiple pregnancies.
P-197 Role of Zygote Intrafallopian Transfer as a Mode of Treatment for Repeated Implantation Failure in IVF in Patients with Tubal Infertility. J. Farhi, A. Weissman, H. Nahum, Z. Shteinfeld, M. Friedman, D. Levran. IVF unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Israel. Objective: To evaluate the effect of zygote intrafallopian transfer (ZIFT) on implantation and pregnancy rates in patients with tubal factor infertility and repeated failure of implantation in IVF-ET cycles. Design: Retrospective study. Materials and Methods: Criteria for patient selection for ZIFT included at least 4 failures of implantation in IVF-ET cycles in which at least 3 embryos were replaced per transfer. Tubal factor patients were offered to undergo ZIFT if there was evidence of one patent tube. Four to six zygotes/embryos were transferred by laparoscopy into the fallopian tube 24 – 48 hours after oocyte retrieval. Implantation and pregnancy rates are reported of the entire group of patients and for tubal factor patients (n515) compared to non-tubal factor patients (n566). Results of ZIFT in tubal factor patients with repeated implantation failure were also compared to results of standard transcervical ET in similar patients with tubal factor infertility and repeated implantation failure treated at the same time in our IVF unit. Results: The pregnancy and implantation rates for all 112 ZIFT cycles in 81 patients were 35.1% and 11.1% respectively. Similar pregnancy and implantation rates were found in tubal factor and non-tubal factor patients, 26.6% and 9.4% vs 37.1% and 11.4% respectively. In the tubal patients all pregnancies resulted in delivery. In the non-tubal patients 90% of pregnancies resulted in delivery, 7.5% abortion and 2.5% EUP. The pregnancy and implantation rates in tubal factor patients with repeated failure of implantation treated with the routine IVF-trans cervical ET was 6.9% (10/145) and 2.5% (14/562) respectively. These results are significantly lower then the results achieved in tubal factor patients treated by ZIFT for repeated failure of implantation. Conclusion: This is the first report on results of ZIFT in patients with tubal factor infertility and repeated implantation failure in IVF. 1. Results of ZIFT were similar in tubal and non-tubal factor patients. 2. ZIFT should be considered as a preferred mode of treatment for tubal factor patients with repeated implantation failure in IVF if there is proof of patency of one tube.
P-198 Safety of Long Term Oral Estradiol Administration in an Oocyte Donation Program. 1A. Requena, 1J. A. Garcı´a-Velasco, 1C. Anarte, 2,3J. Remohi, 2,3A. Pellicer, 2,3C. Simo´n. IVI-Madrid, Madrid, Spain, 2Instituto Valenciano de Infertilidad, and 3Valencia University School of Medicine, Valencia, Spain. Objectives: To assess the hepatic, lipid, coagulation, and hormonal profile in patients undergoing long term oral estradiol administration as endometrial preparation before oocyte donation. Design: Observational study during the last semester of 1999 of the different analytical profiles on the day of embryo transfer in patients from our oocyte donation program. Materials and Methods: Fifty one patients included in an oocyte donation program received oral estradiol valerate (Progynova®, Schering, Spain) OF increasing doses of 2, 4 and 6 mg/day, starting the day 3 after the onset of menses, and maintained until embryo transfer was performed and onwards. Blood sample was taken at the day of embryo transfer and immediately analyzed. The hepatic profile included SGOT, SGPT, and SGGT. Lipid profile consisted in total cholesterol, triglycerides, HDL, and LDL. Antithrombin III was the only coagulation parameter checked. Hormonal studies covered estradiol, progesterone, FSH, LH, and prolactin. A previous basal analysis with all values within the normal ranges was obtained prior to commencement of estradiol administration. All serum determinations were
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analyzed using a commercially available microparticle enzyme immunoassay kit (Abbot Laboratories, Abbot Park, IL). Inter- and intraassay variability for E2 at a concentration of ,40 pg/mL was 2.8% and 4.3%, respectively, and 4.6% and 6.1% for FSH. Results: Patients received embryos from donated oocytes after 45.3 6 2.1 days. All hepatic enzymes were within the normal range (sASAT 13.2 6 0.6 IU/L; sALAT 6.6 6 0.5 IU/L; sGGT 10.5 6 3.5 IU/L). Total cholesterol was mildly increased in 14/51 patients (27.4%), although triglycerides were unaltered in most patients. LDL was altered in 9/51 patients (17.6%), and HDL serum levels were above the normal range in 4/51 patients (7.8%). Antithrombin III was reduced below the normal range in 16/51 patients (31– 4%). Mean serum estradiol level was 161.2 6 12.5 pg/mL. Progesterone levels were within the ovulatory range (14.2), as blood was taken after two days of transvaginal micronized progesterone administration. FSH, LH, prolactine remained unaltered. Conclusions: Long term oral estradiol administration does not alter the hepatic enzymes and hormonal profiles. However, severe variations have been observed in total serum cholesterol levels as well as in antithrombin III. An increase in LDL as well as a decrease in ATIII activity may increase the thrombotic risk in these patients. Careful surveillance of these variables is suggested. P-199 A Prospective Randomized Study to Ascertain If Gonadotropins with Differing FSH:LH Ratios Affect Oocyte Maturation, Fertilization and Outcome in Assisted Conception Cycles. R. E. Irvine, H. I. Abdalla, J. W. Studd. IVF Unit, The Lister Hospital, London, United Kingdom. Objectives: Purer forms of follicle stimulating hormone (FSH) are now being used in controlled ovarian hyperstimulation to improve oocyte maturation, fertilization, embryo quality and hence outcome. The aim of this study was to ascertain if gonadotropins containing more exogenous luteinising hormone (LH) affected outcome. Design: A prospective, randomized study involving 153 couples undertaking assisted conception treatment. All entered had to fulfill the criteria of; age ,37; ,5 attempts at assisted conception and normal semen parameters. Materials and Methods: All patients underwent pituitary down regulation in a long protocol followed by controlled superovulation with 150iu of each gonadotropin. 153 couples were randomly allocated to three groups to receive gonadotropins with ratio of FSH:LH; 1:0, 1:1 and 3:1. Prior to egg collection all patients received HCG. The outcome measures were total number of ampules used, number of oocytes collected, fertilization rate and pregnancy rate. Results: There was equal distribution between all 3 groups for age, duration and cause of infertility, the treatment type—In vitro fertilization (IVF) or gamete intra fallopian tube transfer (GIFT) and the number transferred. The clinical pregnancy rate were 40.0% (FSH:LH 1:0), 40.4% (FSH:LH 1:1) and 31.4% (FSH:LH 3:1). There was no significant difference in any of the other outcome measures. Conclusion: The study failed to show that increased exogenous luteinizing hormone adversely affects outcome. P-200 Does Blastocyst Transfer Affect Sex Ratio? A. A. Milki1, S. B. Mooney1, M. D. Hinckley1, E. S. Ginsburg2, C. Racowsky2, B. Behr1. 1Department of Gynecology and Obstetrics, Stanford University, Stanford, CA; 2Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. Objective: Advances in embryo culture have made blastocyst transfer (BT) a valuable technique in IVF. Embryos with the fastest cleavage rates and the best morphologic appearance are selected for transfer. Evidence exists that male embryos may grow more rapidly than female embryos. Recent published data (Menezo, et. al. Fertil Steril 1999; 72:221) have noted that there is a significant increase in the ratio of male offspring (58%) with fresh blastocysts grown in co-culture. Thus, concern exists regarding whether BT might result in an altered sex ratio favoring males. The objective of this study was to assess the sex ratio of pregnancies resulting from fresh BT in sequential media. Design: Retrospective chart review of pregnancies resulting from fresh BT at two academic institutions.
Vol. 74, No. 3, Suppl. 1, September 2000
P-197 Role of Zygote Intrafallopian Transfer as a Mode of Treatment for Repeated Implantation Failure in IVF in Patients with Tubal Infertility. J. Farhi, A. Weissman, H. Nahum, Z. Shteinfeld, M. Friedman, D. Levran. IVF unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Israel. Objective: To evaluate the effect of zygote intrafallopian transfer (ZIFT) on implantation and pregnancy rates in patients with tubal factor infertility and repeated failure of implantation in IVF-ET cycles. Design: Retrospective study. Materials and Methods: Criteria for patient selection for ZIFT included at least 4 failures of implantation in IVF-ET cycles in which at least 3 embryos were replaced per transfer. Tubal factor patients were offered to undergo ZIFT if there was evidence of one patent tube. Four to six zygotes/embryos were transferred by laparoscopy into the fallopian tube 24 – 48 hours after oocyte retrieval. Implantation and pregnancy rates are reported of the entire group of patients and for tubal factor patients (n515) compared to non-tubal factor patients (n566). Results of ZIFT in tubal factor patients with repeated implantation failure were also compared to results of standard transcervical ET in similar patients with tubal factor infertility and repeated implantation failure treated at the same time in our IVF unit. Results: The pregnancy and implantation rates for all 112 ZIFT cycles in 81 patients were 35.1% and 11.1% respectively. Similar pregnancy and implantation rates were found in tubal factor and non-tubal factor patients, 26.6% and 9.4% vs 37.1% and 11.4% respectively. In the tubal patients all pregnancies resulted in delivery. In the non-tubal patients 90% of pregnancies resulted in delivery, 7.5% abortion and 2.5% EUP. The pregnancy and implantation rates in tubal factor patients with repeated failure of implantation treated with the routine IVF-trans cervical ET was 6.9% (10/145) and 2.5% (14/562) respectively. These results are significantly lower then the results achieved in tubal factor patients treated by ZIFT for repeated failure of implantation. Conclusion: This is the first report on results of ZIFT in patients with tubal factor infertility and repeated implantation failure in IVF. 1. Results of ZIFT were similar in tubal and non-tubal factor patients. 2. ZIFT should be considered as a preferred mode of treatment for tubal factor patients with repeated implantation failure in IVF if there is proof of patency of one tube.
P-198 Safety of Long Term Oral Estradiol Administration in an Oocyte Donation Program. 1A. Requena, 1J. A. Garcı´a-Velasco, 1C. Anarte, 2,3J. Remohi, 2,3A. Pellicer, 2,3C. Simo´n. IVI-Madrid, Madrid, Spain, 2Instituto Valenciano de Infertilidad, and 3Valencia University School of Medicine, Valencia, Spain. Objectives: To assess the hepatic, lipid, coagulation, and hormonal profile in patients undergoing long term oral estradiol administration as endometrial preparation before oocyte donation. Design: Observational study during the last semester of 1999 of the different analytical profiles on the day of embryo transfer in patients from our oocyte donation program. Materials and Methods: Fifty one patients included in an oocyte donation program received oral estradiol valerate (Progynova®, Schering, Spain) OF increasing doses of 2, 4 and 6 mg/day, starting the day 3 after the onset of menses, and maintained until embryo transfer was performed and onwards. Blood sample was taken at the day of embryo transfer and immediately analyzed. The hepatic profile included SGOT, SGPT, and SGGT. Lipid profile consisted in total cholesterol, triglycerides, HDL, and LDL. Antithrombin III was the only coagulation parameter checked. Hormonal studies covered estradiol, progesterone, FSH, LH, and prolactin. A previous basal analysis with all values within the normal ranges was obtained prior to commencement of estradiol administration. All serum determinations were
S158
Abstracts
analyzed using a commercially available microparticle enzyme immunoassay kit (Abbot Laboratories, Abbot Park, IL). Inter- and intraassay variability for E2 at a concentration of ,40 pg/mL was 2.8% and 4.3%, respectively, and 4.6% and 6.1% for FSH. Results: Patients received embryos from donated oocytes after 45.3 6 2.1 days. All hepatic enzymes were within the normal range (sASAT 13.2 6 0.6 IU/L; sALAT 6.6 6 0.5 IU/L; sGGT 10.5 6 3.5 IU/L). Total cholesterol was mildly increased in 14/51 patients (27.4%), although triglycerides were unaltered in most patients. LDL was altered in 9/51 patients (17.6%), and HDL serum levels were above the normal range in 4/51 patients (7.8%). Antithrombin III was reduced below the normal range in 16/51 patients (31– 4%). Mean serum estradiol level was 161.2 6 12.5 pg/mL. Progesterone levels were within the ovulatory range (14.2), as blood was taken after two days of transvaginal micronized progesterone administration. FSH, LH, prolactine remained unaltered. Conclusions: Long term oral estradiol administration does not alter the hepatic enzymes and hormonal profiles. However, severe variations have been observed in total serum cholesterol levels as well as in antithrombin III. An increase in LDL as well as a decrease in ATIII activity may increase the thrombotic risk in these patients. Careful surveillance of these variables is suggested. P-199 A Prospective Randomized Study to Ascertain If Gonadotropins with Differing FSH:LH Ratios Affect Oocyte Maturation, Fertilization and Outcome in Assisted Conception Cycles. R. E. Irvine, H. I. Abdalla, J. W. Studd. IVF Unit, The Lister Hospital, London, United Kingdom. Objectives: Purer forms of follicle stimulating hormone (FSH) are now being used in controlled ovarian hyperstimulation to improve oocyte maturation, fertilization, embryo quality and hence outcome. The aim of this study was to ascertain if gonadotropins containing more exogenous luteinising hormone (LH) affected outcome. Design: A prospective, randomized study involving 153 couples undertaking assisted conception treatment. All entered had to fulfill the criteria of; age ,37; ,5 attempts at assisted conception and normal semen parameters. Materials and Methods: All patients underwent pituitary down regulation in a long protocol followed by controlled superovulation with 150iu of each gonadotropin. 153 couples were randomly allocated to three groups to receive gonadotropins with ratio of FSH:LH; 1:0, 1:1 and 3:1. Prior to egg collection all patients received HCG. The outcome measures were total number of ampules used, number of oocytes collected, fertilization rate and pregnancy rate. Results: There was equal distribution between all 3 groups for age, duration and cause of infertility, the treatment type—In vitro fertilization (IVF) or gamete intra fallopian tube transfer (GIFT) and the number transferred. The clinical pregnancy rate were 40.0% (FSH:LH 1:0), 40.4% (FSH:LH 1:1) and 31.4% (FSH:LH 3:1). There was no significant difference in any of the other outcome measures. Conclusion: The study failed to show that increased exogenous luteinizing hormone adversely affects outcome. P-200 Does Blastocyst Transfer Affect Sex Ratio? A. A. Milki1, S. B. Mooney1, M. D. Hinckley1, E. S. Ginsburg2, C. Racowsky2, B. Behr1. 1Department of Gynecology and Obstetrics, Stanford University, Stanford, CA; 2Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. Objective: Advances in embryo culture have made blastocyst transfer (BT) a valuable technique in IVF. Embryos with the fastest cleavage rates and the best morphologic appearance are selected for transfer. Evidence exists that male embryos may grow more rapidly than female embryos. Recent published data (Menezo, et. al. Fertil Steril 1999; 72:221) have noted that there is a significant increase in the ratio of male offspring (58%) with fresh blastocysts grown in co-culture. Thus, concern exists regarding whether BT might result in an altered sex ratio favoring males. The objective of this study was to assess the sex ratio of pregnancies resulting from fresh BT in sequential media. Design: Retrospective chart review of pregnancies resulting from fresh BT at two academic institutions.
Vol. 74, No. 3, Suppl. 1, September 2000