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The impact of ultrasound-guided embryo transfer on pregnancy rates following intracytoplasmic sperm injection.
Control
RPL
p value
366 42.1%
380 35.5%
0.07
41.1% 29.0% 30.0%
40.1% 26.7% 33.2%
0.83 0.60 0.47
58.4% 30.5% 11.0%
63.0% 25.2% 11.8%
0.43 0.31 0.60
Total # Embryos % ⱖ8 cells ⬍8-cell Frag ⬍10% 10–25% ⬎25% ⱖ8-cell Frag ⬍10% 10–25% ⬎25%
P-413
Conclusions: The application of IVF for women with infertility and RPL results in similar pregnancy rates to patients with tubal disease utilizing ART. Furthermore, embryos derived from patients with RPL do not exhibit decreased quality as compared with those from tubal factor patients. A history of RPL does not diminish the likelihood of a successful pregnancy following IVF. P-412 The impact of ultrasound-guided embryo transfer on pregnancy rates following intracytoplasmic sperm injection. M. Sasy, G. Abdo, T. Abozaid, H. Salem, M. Ashraf, M. Abuzeid. The Ctr for Reproductive Medicine, Hurley Medical Ctr, Flint, MI; IVF Michigan, Hurley Medical Ctr. Objective: To evaluate the effectiveness of transabdominal ultrasound scan guided embryo transfer after ICSI procedure compared to the alternative practice of traditional embryo transfer and tubal embryo transfer. Design: Retrospective study. Materials/Methods: In the period between 4/94 and 12/2000, 842 ICSI cycles were performed in couples with severe male factor infertility. The mean female age was 33.3 ⫾ 4.7 years and duration of infertility was 4.7 ⫾ 3.7 years. Patients were divided into four groups based on female age, ⬍35, 35–37, 38 – 40 and ⱖ41 years. Each group was subdivided into three subgroups according to the method of embryo transfer: ultrasound-guided embryo transfer (USET), traditional embryo transfer (ET) and tubal embryo transfer (TET). The clinical pregnancy (CP) rate, delivery rate/ongoing pregnancy rate and implantation rate were calculated. Analysis of variance and 2 analysis were used for statistical analysis where appropriate. Results: There was no significant difference in mean age, duration of infertility and mean number of embryos transferred among the three methods of embryo transfer in each age group. The results are summarized in the table below. The clinical pregnancy rate was significantly higher in USET compared to traditional ET in the age groups of ⬍35, 35–37 and ⱖ41. There was a significantly higher delivery/ongoing pregnancy rate in USET compared to traditional ET in women under 38 years of age. There was no significant difference in CP rate or delivery/ongoing pregnancy rate between USET and TET in all age groups. ⬍35 USET
ET
35–37 TET
USET
ET
TET
Cycle # 120 126 221 Pregnancy rate % 41.7** 25.4 44.8 Delivery rate/ 32.5** 19.0 35.3 ongoing rate % Implantation rate % 12.8 7.8 11.7
49 42.9* 38.8**
65 24.6 15.4
67 49.3 37.3
6.5
13.9
11.5 ⱖ41
38–40
Cycle # Pregnancy rate % Delivery rate/ ongoing rate % Implantation rate %
USET
ET
TET USET
ET
TET Total
29 31.0 17.2
37 18.9 16.2
56 15 23.2 26.7* 16.1 13.3
30 3.3 3.3
27 842 18.5 34.4 7.4 26.1
6.1
5.2
6.1
6.1
0.9
3.6
9.6
* P ⬍ 0.05, ** P ⬍ 0.001. Conclusions: This data suggest that in women less than 38 years old USET is associated with a significantly higher pregnancy and delivery rates
S250
Abstracts
compared to traditional ET. Such results are comparable to TET outcome, but obviously much simpler.
Contribution of the assisted hatching to ICSI outcome: clinical results according to the rank of the attempt. F. Entezami, F. Olivennes, M. Volante, R. Frydman, S. Hamamah. Antoine Be´cle`re Hosp, Clamart, France. Objective: Assisted hatching (AH) procedures have been developed in order to overcome the impaired embryonic hatching mechanism, which may be induced by in vitro culture conditions. Many indications and technical methods for the AH have already been suggested. The aim of this study was to analyse the beneficial contribution of the AH in ICSI cycles according to the rank of the attempt. Design: A prospective study in a university based IVF centre, on the efficiency of the AH performed by a non-contact laser system according to the rank of the attempt. Materials/Methods: 154 cycles of ICSI were included in this study. 1396 oocytes were retrieved and 1174 were injected by ICSI procedure. 702 embryos were obtained and 430 were transferred after hatching either on day 2 or day 3. The AH was performed by a non-contact 1.48 diode laser (Fertilase®, Switzerland). The indications for AH in our centre were: female age ⬎38, or elevated basal FSH, or increased zona pellucida thickness ⬎17m, or after repeated implantation failures ⬎3. This study was only focused on the rank of the attempt with no regard to the other indications of the AH. We compared the clinical outcome (fertilization rate FR, implantation rate IR, and pregnancy rates PR per cycle and per transfer) of the cycles where the rank of the attempt was ⱕ3, with the results of the cycles where the rank of the attempt was ⬎3. Results: Data are summarized in the table below. Results.
Rank ⱕ3 ⬎3
Cycles (n)
Female age (mean ⫾ SD)
IR (%)
PR/C PR/T (%) (%)
63 91
34.2 ⫾ 4.7 33.9 ⫾ 3.2
7.0 13.3
13.8 22.7
7.5 22.7
Ongoing Ongoing PR/C PR/T (%) (%) 9.1 20.6
9.1 20.6
Conclusions: The AH seems to be helpful in improving the clinical outcome of ICSI attempts with more than 3 previous implantation failures. A significant increased implantation and pregnancy rates are obtained when the rank of the attempt is ⬎3, in comparison with the ranks ⱕ3 (13.3% vs 7.0%, and 22.7% vs 13.8% respectively). Considering only the rank of ICSI attempt, the AH seems to improve the clinical and ongoing pregnancy rates (22.7% and 20.6%) and should be performed after 3 previous implantation failures. P-414 What does the SART success rate for a given IVF program mean? S. I. Lalwani, R. Friedman, L. J. Timmreck, D. Harris, A. S. Penzias, R. H. Reindollar. Beth Israel Deaconess Medical Ctr, Harvard Medical Sch, Boston, MA; Boston IVF, Boston, MA. Objective: The Society of Assisted Reproductive Technology (SART) database is used by many to assess the effectiveness of in-vitro fertilization (IVF) programs and the quality of the embryology laboratories. Factors other than just the embryology laboratory, influence IVF success. These include patient demographics, clinician management, and embryo transfer techniques. These factors are not reflected in the SART statistics, which only report overall center pregnancy rates for each age group. Our purpose is to determine if variations in individual physician success rates exist in a large IVF program, with a uniform laboratory and treatment protocols. Design: Retrospective analysis of the 1999 SART data for Boston IVF (BIVF) and its 13 physicians. The clinical pregnancy rate and live birth rate were analyzed for patients ⬍38 years of age and for patients 38 – 40 years of age who underwent non-donor, fresh embryo transfer. An ‘ideal’ patient group ⬍38 yrs of age, 3 or fewer IVF cycles, 8 or greater number of oocytes
Vol. 76, No. 3, Suppl. 1, September 2001
RPL
p value
366 42.1%
380 35.5%
0.07
41.1% 29.0% 30.0%
40.1% 26.7% 33.2%
0.83 0.60 0.47
58.4% 30.5% 11.0%
63.0% 25.2% 11.8%
0.43 0.31 0.60
Total # Embryos % ⱖ8 cells ⬍8-cell Frag ⬍10% 10–25% ⬎25% ⱖ8-cell Frag ⬍10% 10–25% ⬎25%
P-413
Conclusions: The application of IVF for women with infertility and RPL results in similar pregnancy rates to patients with tubal disease utilizing ART. Furthermore, embryos derived from patients with RPL do not exhibit decreased quality as compared with those from tubal factor patients. A history of RPL does not diminish the likelihood of a successful pregnancy following IVF. P-412 The impact of ultrasound-guided embryo transfer on pregnancy rates following intracytoplasmic sperm injection. M. Sasy, G. Abdo, T. Abozaid, H. Salem, M. Ashraf, M. Abuzeid. The Ctr for Reproductive Medicine, Hurley Medical Ctr, Flint, MI; IVF Michigan, Hurley Medical Ctr. Objective: To evaluate the effectiveness of transabdominal ultrasound scan guided embryo transfer after ICSI procedure compared to the alternative practice of traditional embryo transfer and tubal embryo transfer. Design: Retrospective study. Materials/Methods: In the period between 4/94 and 12/2000, 842 ICSI cycles were performed in couples with severe male factor infertility. The mean female age was 33.3 ⫾ 4.7 years and duration of infertility was 4.7 ⫾ 3.7 years. Patients were divided into four groups based on female age, ⬍35, 35–37, 38 – 40 and ⱖ41 years. Each group was subdivided into three subgroups according to the method of embryo transfer: ultrasound-guided embryo transfer (USET), traditional embryo transfer (ET) and tubal embryo transfer (TET). The clinical pregnancy (CP) rate, delivery rate/ongoing pregnancy rate and implantation rate were calculated. Analysis of variance and 2 analysis were used for statistical analysis where appropriate. Results: There was no significant difference in mean age, duration of infertility and mean number of embryos transferred among the three methods of embryo transfer in each age group. The results are summarized in the table below. The clinical pregnancy rate was significantly higher in USET compared to traditional ET in the age groups of ⬍35, 35–37 and ⱖ41. There was a significantly higher delivery/ongoing pregnancy rate in USET compared to traditional ET in women under 38 years of age. There was no significant difference in CP rate or delivery/ongoing pregnancy rate between USET and TET in all age groups. ⬍35 USET
ET
35–37 TET
USET
ET
TET
Cycle # 120 126 221 Pregnancy rate % 41.7** 25.4 44.8 Delivery rate/ 32.5** 19.0 35.3 ongoing rate % Implantation rate % 12.8 7.8 11.7
49 42.9* 38.8**
65 24.6 15.4
67 49.3 37.3
6.5
13.9
11.5 ⱖ41
38–40
Cycle # Pregnancy rate % Delivery rate/ ongoing rate % Implantation rate %
USET
ET
TET USET
ET
TET Total
29 31.0 17.2
37 18.9 16.2
56 15 23.2 26.7* 16.1 13.3
30 3.3 3.3
27 842 18.5 34.4 7.4 26.1
6.1
5.2
6.1
6.1
0.9
3.6
9.6
* P ⬍ 0.05, ** P ⬍ 0.001. Conclusions: This data suggest that in women less than 38 years old USET is associated with a significantly higher pregnancy and delivery rates
S250
Abstracts
compared to traditional ET. Such results are comparable to TET outcome, but obviously much simpler.
Contribution of the assisted hatching to ICSI outcome: clinical results according to the rank of the attempt. F. Entezami, F. Olivennes, M. Volante, R. Frydman, S. Hamamah. Antoine Be´cle`re Hosp, Clamart, France. Objective: Assisted hatching (AH) procedures have been developed in order to overcome the impaired embryonic hatching mechanism, which may be induced by in vitro culture conditions. Many indications and technical methods for the AH have already been suggested. The aim of this study was to analyse the beneficial contribution of the AH in ICSI cycles according to the rank of the attempt. Design: A prospective study in a university based IVF centre, on the efficiency of the AH performed by a non-contact laser system according to the rank of the attempt. Materials/Methods: 154 cycles of ICSI were included in this study. 1396 oocytes were retrieved and 1174 were injected by ICSI procedure. 702 embryos were obtained and 430 were transferred after hatching either on day 2 or day 3. The AH was performed by a non-contact 1.48 diode laser (Fertilase®, Switzerland). The indications for AH in our centre were: female age ⬎38, or elevated basal FSH, or increased zona pellucida thickness ⬎17m, or after repeated implantation failures ⬎3. This study was only focused on the rank of the attempt with no regard to the other indications of the AH. We compared the clinical outcome (fertilization rate FR, implantation rate IR, and pregnancy rates PR per cycle and per transfer) of the cycles where the rank of the attempt was ⱕ3, with the results of the cycles where the rank of the attempt was ⬎3. Results: Data are summarized in the table below. Results.
Rank ⱕ3 ⬎3
Cycles (n)
Female age (mean ⫾ SD)
IR (%)
PR/C PR/T (%) (%)
63 91
34.2 ⫾ 4.7 33.9 ⫾ 3.2
7.0 13.3
13.8 22.7
7.5 22.7
Ongoing Ongoing PR/C PR/T (%) (%) 9.1 20.6
9.1 20.6
Conclusions: The AH seems to be helpful in improving the clinical outcome of ICSI attempts with more than 3 previous implantation failures. A significant increased implantation and pregnancy rates are obtained when the rank of the attempt is ⬎3, in comparison with the ranks ⱕ3 (13.3% vs 7.0%, and 22.7% vs 13.8% respectively). Considering only the rank of ICSI attempt, the AH seems to improve the clinical and ongoing pregnancy rates (22.7% and 20.6%) and should be performed after 3 previous implantation failures. P-414 What does the SART success rate for a given IVF program mean? S. I. Lalwani, R. Friedman, L. J. Timmreck, D. Harris, A. S. Penzias, R. H. Reindollar. Beth Israel Deaconess Medical Ctr, Harvard Medical Sch, Boston, MA; Boston IVF, Boston, MA. Objective: The Society of Assisted Reproductive Technology (SART) database is used by many to assess the effectiveness of in-vitro fertilization (IVF) programs and the quality of the embryology laboratories. Factors other than just the embryology laboratory, influence IVF success. These include patient demographics, clinician management, and embryo transfer techniques. These factors are not reflected in the SART statistics, which only report overall center pregnancy rates for each age group. Our purpose is to determine if variations in individual physician success rates exist in a large IVF program, with a uniform laboratory and treatment protocols. Design: Retrospective analysis of the 1999 SART data for Boston IVF (BIVF) and its 13 physicians. The clinical pregnancy rate and live birth rate were analyzed for patients ⬍38 years of age and for patients 38 – 40 years of age who underwent non-donor, fresh embryo transfer. An ‘ideal’ patient group ⬍38 yrs of age, 3 or fewer IVF cycles, 8 or greater number of oocytes
Vol. 76, No. 3, Suppl. 1, September 2001