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Soft Embryo Transfer Catheters for Assisted Reproduction: A Systematic Review & Meta-Analysis
CONCLUSION: Although previous studies have suggested that cervical dilatation at the time of ET has a detrimental effect, our results do not support this. The observed difference from pervious studies may be a result of (1) Cervical dilatation being performed using ultrasound guidance to assure that the tip of the dilator does not extend beyond the internal cervical os; (2) Cervical dilatation using tappered graduated flexible teflon dilators of a smaller size are less traumatic than the traditional plastic or metal cervical dilators; (3) The performance of a trial or mock transfer just prior to the acutal transfer; (4) The largest teflon dilator used is marginally greater in diameter than the outside diameter of the Wallace catheter and this avoids overzealous dilatation. Our data suggests that a time period between cervical dilatation and ET is not necessary. Cervical dilatation to overcome cervical stenosis at the time of ET in an IVF does not alter the clinical pregnancy outcome of an IVF cycle. Supported by: None
P-559 Soft Embryo Transfer Catheters for Assisted Reproduction: A Systematic Review & Meta-Analysis. A. M. Abou-Setta, H. G. Al-Inany, R. T. Mansour, G. I. Serour, M. A. Aboulghar. The Egyptian IVF-ET Center, Cairo, Egypt. OBJECTIVE: Embryo transfer is considered as the most crucial step in IVF/ICSI cycles. The amount of high quality literature concerning embryo transfer technique is limited. Only a few small well-designed and conducted clinical studies are available. Even though a recent meta-analysis showed that soft catheters performed superiourly to firm catheters. Therefore we decided to determine Edwards-Wallace and Cook catheters have the same success rates. DESIGN: Systematic review and meta-analysis of randomized, controlled trials comparing Edwards-Wallace with Cook embryo transfer catheters during trans-cervical embryo transfer.. MATERIALS AND METHODS: A computerized search was conducted using MEDLINE (1978 - Present), EMBASE (1980 - Present), the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library Issue 2, 2005, and the National Research Register (NRR), and the Medical Research Council’s Clinical Trials Register. In addition, the reference lists of all known primary studies and review articles were also examined to identify additional relevant citations. Furthermore, a hand search of the citation lists of relevant publications, review articles; abstracts of scientific meetings and included studies were searched for trials. RESULTS: A total of 21 prospective randomized controlled trials evaluating the types of embryo transfer catheters were identified (10 full-text papers, 11 conference abstracts comparing different types of embryo transfer catheters). Of these studies, one was excluded because it compared a soft embryo transfer catheter to surgical placement of the embryos in the uterine cavity using a hysteroscope. In the remaining studies, only seven trials compared Wallace versus Cook embryo catheters including 1,468 embryo transfers. Using the fixed effect model, pooling of the results demonstrated a no statistically significant difference of clinical pregnancy following embryo transfer using the Wallace (315/ 742) vs Cook catheters (288/ 726) (P ⫽ 0.42; O.R ⫽ 1.09, 95% CI ⫽ 0.88 - 1.35). Moreover, when only the fresh cycles were analyzed, using the fixed effect model, there was also no significant statistical difference with regards the pregnancy rate following embryo transfer using the Wallace (293/ 706) vs Cook catheters (268/ 693) (P ⫽ 0.40; O.R ⫽ 1.10, 95% CI ⫽ 0.88 - 1.36). Furthermore, when only the truly randomized controlled trials were analyzed, using the fixed effect model, there was also no significant statistical difference with regards the pregnancy rate following embryo transfer using the Wallace (126/ 316) vs Cook catheters (125/ 315) (P ⫽ 0.94; O.R ⫽ 1.01, 95% CI ⫽ 0.73 - 1.40). In addition, there was no statistical difference with regards the implantation rate following embryo transfer using the Wallace (133/ 557) vs Cook catheters (107/ 432) (P ⫽ 0.38; O.R ⫽ 0.87, 95% CI ⫽ 0.65 - 1.18). CONCLUSION: Using the Edwards-Wallace or the Cook transfer catheters for ET results in a relatively similar clinical pregnancy rate and implanation rate. Other issues must be taken into consideration including price, ease of use and availability. More RCTs are needed to further confirm these results. Supported by: None
S354
Abstracts
P-560 Correlation Between Follicular Diameters and Flushing or not Flushing on Oocyte Maturity, Fertilization Rate and Embryo Quality in Patients Undergoing ICSI. S. Mehri, K. Greco, W. Anderson, G. Martinez, D. Sakkas, P. Patrizio. Yale University, New Haven, CT. OBJECTIVE: To determine the correlation between follicular sizes, oocyte maturity, normal fertilization rate, cleavage and embryo quality in intracytoplasmic sperm injection (ICSI) cycles. To establish whether oocytes recovered with or without follicular flushing have different developmental competence. DESIGN: Prospective observational study. MATERIALS AND METHODS: Ovarian stimulation was accomplished with r-FSH after luteal phase leuprolide acetate suppression. A total of 103 oocytes from 23 ICSI cycles were available for the analysis. Follicles were classified into three groups according to their diameter measured by ultrasound on the day of the egg retrieval: group A (mean diameter 12-14.5mm), group B (mean diameter15-18 mm) and group C (mean diameter 18.5-25 mm). The follicular aspiration was carried out by using a double lumen needle (Cook, IN). If an oocyte was not recovered, the follicle was flushed twice with 2 ml of buffer media. Oocytes were independently recorded according to the follicular size and whether obtained by flushing or not. In the embryology laboratory, the oocytes were kept separated and classified according to their nuclear maturation as germinal vesicle (GV), metaphase I (MI), or metaphase II (MII). Following standard ICSI procedure, oocytes were individually cultured in IVF media for 18 hrs and examined for normal fertilization (2 PN). The embryos were progressively evaluated by morphologic criteria (fragmentation, granularity, number and size of blastomers) until the time of transfer, freezing or discard if not cleaved. Fisher’s exact test was used for statistical analysis. RESULTS: Oocytes recovered from follicles of group C were all in metaphase II as opposed to group A and B (p⬍0.01). There was a progressive increase in fertilization rates from Group A follicles to group C (48% vs. 61% vs. 70%, respectively P ⫽0.06). The rate of oocytes abnormally fertilized (i.e. 1p and 3p) or not fertilized was higher in group A than B or C (52% vs.39% and 30%, respectively p⫽0.06). A total of 78 oocytes (only from group B and C) were evaluated according to whether obtained by
Vol. 84, Suppl 1, September 2005
P-559 Soft Embryo Transfer Catheters for Assisted Reproduction: A Systematic Review & Meta-Analysis. A. M. Abou-Setta, H. G. Al-Inany, R. T. Mansour, G. I. Serour, M. A. Aboulghar. The Egyptian IVF-ET Center, Cairo, Egypt. OBJECTIVE: Embryo transfer is considered as the most crucial step in IVF/ICSI cycles. The amount of high quality literature concerning embryo transfer technique is limited. Only a few small well-designed and conducted clinical studies are available. Even though a recent meta-analysis showed that soft catheters performed superiourly to firm catheters. Therefore we decided to determine Edwards-Wallace and Cook catheters have the same success rates. DESIGN: Systematic review and meta-analysis of randomized, controlled trials comparing Edwards-Wallace with Cook embryo transfer catheters during trans-cervical embryo transfer.. MATERIALS AND METHODS: A computerized search was conducted using MEDLINE (1978 - Present), EMBASE (1980 - Present), the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library Issue 2, 2005, and the National Research Register (NRR), and the Medical Research Council’s Clinical Trials Register. In addition, the reference lists of all known primary studies and review articles were also examined to identify additional relevant citations. Furthermore, a hand search of the citation lists of relevant publications, review articles; abstracts of scientific meetings and included studies were searched for trials. RESULTS: A total of 21 prospective randomized controlled trials evaluating the types of embryo transfer catheters were identified (10 full-text papers, 11 conference abstracts comparing different types of embryo transfer catheters). Of these studies, one was excluded because it compared a soft embryo transfer catheter to surgical placement of the embryos in the uterine cavity using a hysteroscope. In the remaining studies, only seven trials compared Wallace versus Cook embryo catheters including 1,468 embryo transfers. Using the fixed effect model, pooling of the results demonstrated a no statistically significant difference of clinical pregnancy following embryo transfer using the Wallace (315/ 742) vs Cook catheters (288/ 726) (P ⫽ 0.42; O.R ⫽ 1.09, 95% CI ⫽ 0.88 - 1.35). Moreover, when only the fresh cycles were analyzed, using the fixed effect model, there was also no significant statistical difference with regards the pregnancy rate following embryo transfer using the Wallace (293/ 706) vs Cook catheters (268/ 693) (P ⫽ 0.40; O.R ⫽ 1.10, 95% CI ⫽ 0.88 - 1.36). Furthermore, when only the truly randomized controlled trials were analyzed, using the fixed effect model, there was also no significant statistical difference with regards the pregnancy rate following embryo transfer using the Wallace (126/ 316) vs Cook catheters (125/ 315) (P ⫽ 0.94; O.R ⫽ 1.01, 95% CI ⫽ 0.73 - 1.40). In addition, there was no statistical difference with regards the implantation rate following embryo transfer using the Wallace (133/ 557) vs Cook catheters (107/ 432) (P ⫽ 0.38; O.R ⫽ 0.87, 95% CI ⫽ 0.65 - 1.18). CONCLUSION: Using the Edwards-Wallace or the Cook transfer catheters for ET results in a relatively similar clinical pregnancy rate and implanation rate. Other issues must be taken into consideration including price, ease of use and availability. More RCTs are needed to further confirm these results. Supported by: None
S354
Abstracts
P-560 Correlation Between Follicular Diameters and Flushing or not Flushing on Oocyte Maturity, Fertilization Rate and Embryo Quality in Patients Undergoing ICSI. S. Mehri, K. Greco, W. Anderson, G. Martinez, D. Sakkas, P. Patrizio. Yale University, New Haven, CT. OBJECTIVE: To determine the correlation between follicular sizes, oocyte maturity, normal fertilization rate, cleavage and embryo quality in intracytoplasmic sperm injection (ICSI) cycles. To establish whether oocytes recovered with or without follicular flushing have different developmental competence. DESIGN: Prospective observational study. MATERIALS AND METHODS: Ovarian stimulation was accomplished with r-FSH after luteal phase leuprolide acetate suppression. A total of 103 oocytes from 23 ICSI cycles were available for the analysis. Follicles were classified into three groups according to their diameter measured by ultrasound on the day of the egg retrieval: group A (mean diameter 12-14.5mm), group B (mean diameter15-18 mm) and group C (mean diameter 18.5-25 mm). The follicular aspiration was carried out by using a double lumen needle (Cook, IN). If an oocyte was not recovered, the follicle was flushed twice with 2 ml of buffer media. Oocytes were independently recorded according to the follicular size and whether obtained by flushing or not. In the embryology laboratory, the oocytes were kept separated and classified according to their nuclear maturation as germinal vesicle (GV), metaphase I (MI), or metaphase II (MII). Following standard ICSI procedure, oocytes were individually cultured in IVF media for 18 hrs and examined for normal fertilization (2 PN). The embryos were progressively evaluated by morphologic criteria (fragmentation, granularity, number and size of blastomers) until the time of transfer, freezing or discard if not cleaved. Fisher’s exact test was used for statistical analysis. RESULTS: Oocytes recovered from follicles of group C were all in metaphase II as opposed to group A and B (p⬍0.01). There was a progressive increase in fertilization rates from Group A follicles to group C (48% vs. 61% vs. 70%, respectively P ⫽0.06). The rate of oocytes abnormally fertilized (i.e. 1p and 3p) or not fertilized was higher in group A than B or C (52% vs.39% and 30%, respectively p⫽0.06). A total of 78 oocytes (only from group B and C) were evaluated according to whether obtained by
Vol. 84, Suppl 1, September 2005