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The endometrial function test (EFT) directs care and predicts ART outcome
Monday, October 14, 2002 3:00 P.M.
Monday, October 14, 2002 3:45 P.M. O-44
O-43 ICSI as a therapeutic measure for failed conventional in-vitro fertilization cycles: The Cornell experience. June Hariprashad, Deborah Liotta, Carol Cook, Nikica Zaninovic, Lucinda Veeck. Weill Medical Coll of Cornell Univ, New York, NY. Objective: To determine whether ICSI is an effective tool for improving pregnancy rates among patients with previously unsuccessful IVF cycles resulting from poor or total fertilization failure. Design: A retrospective analysis inclusive of cycles from April 1995 to December 2001 was carried out at our IVF center in a hospital university setting. The study encompassed a patient population where poor or failed IVF attempts were followed by ICSI cycles. Two groups, Insemination and ICSI, were compared using fertilization, clinical pregnancy, implantation, and ongoing pregnancy rates. Materials/Methods: All female patients were ⬍38 years old and possessed more than 3 mature oocytes. Only couples where the male partner presented with optimal semen parameters on the day of oocyte retrieval were included so as to preclude the possibility of a negative impact caused by poor sample quality. Semen characteristics were restricted according to WHO criteria for normality: concentration ⬎20 ⫻ 106/ml and motility ⬎40%. Patients with preimplantation genetic diagnosis were excluded from the study. A total of 68 patients underwent 75 insemination cycles and subsequently returned for 89 ICSI cycles. Within the insemination group, the average sperm concentration (⫾SD) and motility (⫾SD) was 122.8 ⫻ 106/ml ⫾ 80.7 and 60.8% ⫾ 10.3, respectively. The semen characteristics of the ICSI group were: average sperm concentration (⫾SD): 121.1 ⫻ 106/ml ⫾ 69.2 and motility (⫾SD): 60.4% ⫾ 11.1. Results: Of the attempted 75 insemination cycles, only 56 had preembryos of sufficient quality for transfer while 88 of the 89 ICSI cycles underwent preembryo replacement. In the Insemination group, 13 cycles failed to produce normal fertilization in any oocytes; there were no fertilization failures in the ICSI group. Fertilization, clinical pregnancy and implantation rates were all significantly higher once ICSI was performed. Furthermore,the ongoing pregnancy rate also increased dramatically within the ICSI group (34.1%; 30/88), significantly higher than the Insemination group (10.7%; 6/56) (p ⬍0.05). Results: Insemination Cycles
ICSI cycles
No. Matched Patients/ 75 89 Cycles Maternal Age 32.8 ⫾ 3.0 33.6 ⫾ 2.9 (Mean ⫾ SD) Fertlization 319/716 (44.6%) 604/784 (77.0%) (2PN/MII injected) Mean No. Transferred 2.7 ⫾ 1.0 3.4 ⫾ 1.0 (⫾ SD) Clinical Pregnancy/Transfer 11/56 (19.6%) 37/88 (42.1%) Implantation Rate 15/152 (9.9%) 64/296 (21.6%) (No. Sacs/Transferred)
NS p ⬍ 0.05
Objective: We have developed an endometrial function test (EFT) where an abnormal EFT is associated with pregnancy failure (lack of implantation or early loss) while a normal EFT is associated with pregnancy success. We examined the impact the EFT had on ART care in several infertility practices. Design: Immunohistochemical testing of endometrial biopsies was correlated with clinical outcomes. Materials/Methods: Endometrial biopsies were collected during the previous two years from 195 patients on cycle days 15 and 24 or only cycle day 24 from natural and mock cycles. Natural cycle biopsies were timed with the LH surge (set as cycle day 13) while mock cycles were timed by P start date (set as cycle day 14). The EFT consisted of immunohistochemistry utilizing antibodies against progesterone receptor, mouse ascites Golgi mucin (MAG), cyclin E, and p27. Each biopsy was graded as normal or abnormal compared to the results obtained from fertile controls. Followup data were collected every 6 months after the initial EFT. Results: EFTs were performed on 195 patients with one or more previous ART failures. 50 patients (26%) were normal while 145 (74%) were abnormal. Of the patients with normal EFTs, 15 of 29 with subsequent ART procedures became pregnant (52%), of which 10 (34%) carried to term. Of the 145 patients with initial abnormal EFTs, 37 had some form of intervention prior to their next embryo transfer. Of these, 12 subsequent EFTs were either normal or significantly improved (39%). Of the patients with an improved second EFT where a subsequent ART procedure was performed (n ⫽ 7), 5 became pregnant (71%). 6 patients with an intervention did not have a followup EFT. 5 (83%) of these patients had an ongoing pregnancy. Of the 17 patients with an initial abnormal EFT who did not have any form of intervention, 7 (41%) became pregnant, but only 2 (12%) carried past the 1st trimester. Patients with subsequent embryo transfers who were normal or had an intervention (n ⫽ 45) had 23 ongoing pregnancies (51%). Patients who were abnormal without intervention (n ⫽ 22) had 2 ongoing pregnancies (9%). 2-way contingency table analysis revealed that a patient with an abnormal EFT who had no form of intervention was 10.5 times less likely to have an ongoing pregnancy (OR ⫽ 10.5, 95% CI: 1.29 - 680; PPV ⫽ 91%, 95% CI: 72 - 100%; p ⬍0.001 (Fisher Exact Test)) than a patient who had a normal EFT or had an intervention following an abnormal EFT. Conclusions: When the EFT resulted in altered clinical practice by the physicians who participated in this study, pregnancy rates increased. Patients with normal EFTs immediately underwent an ART cycle while patients with abnormal EFTs either underwent medical or surgical intervention or had their stimulation protocols adjusted. These interventions yielded an overall 80% pregnancy rate in a group of patients with a previously high ART failure rate. Supported by: No external support.
p ⬍ 0.05
Monday, October 14, 2002 4:00 P.M.
p ⬍ 0.05 p ⬍ 0.05
Conclusions: Increased fertilization, clinical pregnancy, and implantation rates within the ICSI group demonstrate that ICSI can overcome certain factors which may cause abnormally low or absent fertilization. Even in these situations, when semen parameters are not compromised, ICSI can play a role in reversing a negative result. Therefore, ICSI should be considered as the first line of treatment once poor fertilization or complete fertilization failure has been documented, so as to optimize subsequent reproductive outcome. Supported by: The Center for Reproductive Medicine & Infertility of The Weill Medical College of Cornell University.
FERTILITY & STERILITY威
The endometrial function test (EFT) directs care and predicts ART outcome. Harvey J. Kliman, Juliette C. McSweet, George M. Grunert, Vito RS Cardone, Ken Cadesky, David L. Keefe. Yale Univ, New Haven, CT; Obstetrical Gynecological Assoc, Houston, TX; Fertility Ctr of New England, Reading, MA; START Clin of Toronto, Toronto, ON, Canada; Brown Univ, Providence, RI.
O-45 Effect of embryo transfer catheter on implantation rates. Sharon T. Mortimer, Margo Fluker, Albert Yuzpe. Genesis Fertility Ctr, Vancouver, BC, Canada. Objective: While changes in our IVF culture system had resulted in significant improvements in embryo quality, these improvements did not translate into improvements in pregnancy and implantation rates. The influence of the embryo transfer catheter upon pregnancy has been investigated in a number of previous studies, but with no consistent conclusions. The aim of the present investigation was to determine whether, in our system, the embryo transfer catheter affected pregnancy outcome.
S17
Monday, October 14, 2002 3:45 P.M. O-44
O-43 ICSI as a therapeutic measure for failed conventional in-vitro fertilization cycles: The Cornell experience. June Hariprashad, Deborah Liotta, Carol Cook, Nikica Zaninovic, Lucinda Veeck. Weill Medical Coll of Cornell Univ, New York, NY. Objective: To determine whether ICSI is an effective tool for improving pregnancy rates among patients with previously unsuccessful IVF cycles resulting from poor or total fertilization failure. Design: A retrospective analysis inclusive of cycles from April 1995 to December 2001 was carried out at our IVF center in a hospital university setting. The study encompassed a patient population where poor or failed IVF attempts were followed by ICSI cycles. Two groups, Insemination and ICSI, were compared using fertilization, clinical pregnancy, implantation, and ongoing pregnancy rates. Materials/Methods: All female patients were ⬍38 years old and possessed more than 3 mature oocytes. Only couples where the male partner presented with optimal semen parameters on the day of oocyte retrieval were included so as to preclude the possibility of a negative impact caused by poor sample quality. Semen characteristics were restricted according to WHO criteria for normality: concentration ⬎20 ⫻ 106/ml and motility ⬎40%. Patients with preimplantation genetic diagnosis were excluded from the study. A total of 68 patients underwent 75 insemination cycles and subsequently returned for 89 ICSI cycles. Within the insemination group, the average sperm concentration (⫾SD) and motility (⫾SD) was 122.8 ⫻ 106/ml ⫾ 80.7 and 60.8% ⫾ 10.3, respectively. The semen characteristics of the ICSI group were: average sperm concentration (⫾SD): 121.1 ⫻ 106/ml ⫾ 69.2 and motility (⫾SD): 60.4% ⫾ 11.1. Results: Of the attempted 75 insemination cycles, only 56 had preembryos of sufficient quality for transfer while 88 of the 89 ICSI cycles underwent preembryo replacement. In the Insemination group, 13 cycles failed to produce normal fertilization in any oocytes; there were no fertilization failures in the ICSI group. Fertilization, clinical pregnancy and implantation rates were all significantly higher once ICSI was performed. Furthermore,the ongoing pregnancy rate also increased dramatically within the ICSI group (34.1%; 30/88), significantly higher than the Insemination group (10.7%; 6/56) (p ⬍0.05). Results: Insemination Cycles
ICSI cycles
No. Matched Patients/ 75 89 Cycles Maternal Age 32.8 ⫾ 3.0 33.6 ⫾ 2.9 (Mean ⫾ SD) Fertlization 319/716 (44.6%) 604/784 (77.0%) (2PN/MII injected) Mean No. Transferred 2.7 ⫾ 1.0 3.4 ⫾ 1.0 (⫾ SD) Clinical Pregnancy/Transfer 11/56 (19.6%) 37/88 (42.1%) Implantation Rate 15/152 (9.9%) 64/296 (21.6%) (No. Sacs/Transferred)
NS p ⬍ 0.05
Objective: We have developed an endometrial function test (EFT) where an abnormal EFT is associated with pregnancy failure (lack of implantation or early loss) while a normal EFT is associated with pregnancy success. We examined the impact the EFT had on ART care in several infertility practices. Design: Immunohistochemical testing of endometrial biopsies was correlated with clinical outcomes. Materials/Methods: Endometrial biopsies were collected during the previous two years from 195 patients on cycle days 15 and 24 or only cycle day 24 from natural and mock cycles. Natural cycle biopsies were timed with the LH surge (set as cycle day 13) while mock cycles were timed by P start date (set as cycle day 14). The EFT consisted of immunohistochemistry utilizing antibodies against progesterone receptor, mouse ascites Golgi mucin (MAG), cyclin E, and p27. Each biopsy was graded as normal or abnormal compared to the results obtained from fertile controls. Followup data were collected every 6 months after the initial EFT. Results: EFTs were performed on 195 patients with one or more previous ART failures. 50 patients (26%) were normal while 145 (74%) were abnormal. Of the patients with normal EFTs, 15 of 29 with subsequent ART procedures became pregnant (52%), of which 10 (34%) carried to term. Of the 145 patients with initial abnormal EFTs, 37 had some form of intervention prior to their next embryo transfer. Of these, 12 subsequent EFTs were either normal or significantly improved (39%). Of the patients with an improved second EFT where a subsequent ART procedure was performed (n ⫽ 7), 5 became pregnant (71%). 6 patients with an intervention did not have a followup EFT. 5 (83%) of these patients had an ongoing pregnancy. Of the 17 patients with an initial abnormal EFT who did not have any form of intervention, 7 (41%) became pregnant, but only 2 (12%) carried past the 1st trimester. Patients with subsequent embryo transfers who were normal or had an intervention (n ⫽ 45) had 23 ongoing pregnancies (51%). Patients who were abnormal without intervention (n ⫽ 22) had 2 ongoing pregnancies (9%). 2-way contingency table analysis revealed that a patient with an abnormal EFT who had no form of intervention was 10.5 times less likely to have an ongoing pregnancy (OR ⫽ 10.5, 95% CI: 1.29 - 680; PPV ⫽ 91%, 95% CI: 72 - 100%; p ⬍0.001 (Fisher Exact Test)) than a patient who had a normal EFT or had an intervention following an abnormal EFT. Conclusions: When the EFT resulted in altered clinical practice by the physicians who participated in this study, pregnancy rates increased. Patients with normal EFTs immediately underwent an ART cycle while patients with abnormal EFTs either underwent medical or surgical intervention or had their stimulation protocols adjusted. These interventions yielded an overall 80% pregnancy rate in a group of patients with a previously high ART failure rate. Supported by: No external support.
p ⬍ 0.05
Monday, October 14, 2002 4:00 P.M.
p ⬍ 0.05 p ⬍ 0.05
Conclusions: Increased fertilization, clinical pregnancy, and implantation rates within the ICSI group demonstrate that ICSI can overcome certain factors which may cause abnormally low or absent fertilization. Even in these situations, when semen parameters are not compromised, ICSI can play a role in reversing a negative result. Therefore, ICSI should be considered as the first line of treatment once poor fertilization or complete fertilization failure has been documented, so as to optimize subsequent reproductive outcome. Supported by: The Center for Reproductive Medicine & Infertility of The Weill Medical College of Cornell University.
FERTILITY & STERILITY威
The endometrial function test (EFT) directs care and predicts ART outcome. Harvey J. Kliman, Juliette C. McSweet, George M. Grunert, Vito RS Cardone, Ken Cadesky, David L. Keefe. Yale Univ, New Haven, CT; Obstetrical Gynecological Assoc, Houston, TX; Fertility Ctr of New England, Reading, MA; START Clin of Toronto, Toronto, ON, Canada; Brown Univ, Providence, RI.
O-45 Effect of embryo transfer catheter on implantation rates. Sharon T. Mortimer, Margo Fluker, Albert Yuzpe. Genesis Fertility Ctr, Vancouver, BC, Canada. Objective: While changes in our IVF culture system had resulted in significant improvements in embryo quality, these improvements did not translate into improvements in pregnancy and implantation rates. The influence of the embryo transfer catheter upon pregnancy has been investigated in a number of previous studies, but with no consistent conclusions. The aim of the present investigation was to determine whether, in our system, the embryo transfer catheter affected pregnancy outcome.
S17