- Email: [email protected]
The order of priority for embryo transfer - study of assort by blastocyst expansion, inner cell mass and trophectoderm grade
OBJECTIVE: G-CSF is a lymphohemotopoetic cytokine. Non-lymphohemopoietic cells including endothelial cells, oligodendrocytes, certain tumor cells, and placental trophoblast cells can also express G-CSF receptors. In the female reproductive tract, G-CSF is synthesized under the regulatory influence of estrogen in uterus. Fertility declines in G-CSF deficient mice. Few data exists about G-CSF use for IVF patients with RIF or thin endometrium and recurrent aborters with promising results. However, exact way of administration, timing and dosing are still debatable. DESIGN: Preliminary case-series. MATERIALS AND METHODS: G-CSF was given to 32 patients with 3 and more unsuccessful ivf/icsi treatments in their next cycle. The intrauterine (IU) route of G-CSF was given on hCG day; G-CSF (Neupogen, Roche, Istanbul Turkey, 48 MIU/0.5 ml) was given via an IU insemination catheter after cleansing the cervix. Subcutaneous (SC) injection was started on day of oocyte retrieval and given for 15 days at 100000 IU/kg. Maximum 2 embryos were given according to Turkish legislations. Pregnancy was defined as the presence of fetal cardiac activity. Side effects were only minor uterine cramps in IU route and none in SC route. RESULTS: The mean age of the patients was 31,9 yrs (SD 4,1) and similar in each groups. Mean number of previous IVF/ICSI attempt was 3.2 (SD: 0.4, min:3-max:5). When patients were grouped to be normal, high or poor responder, the pregnancy rates (pr) were 58,8%,62,5%, and 57,2%, respectively. Nine patients were given only via IU before hCG. Fifteen were given SC starting day of oocyte retrieval. Eight patients were given dual route including both IU and SC. PRs were 44,0% with IU route, 60,0% with SC route, 75,0% with dual routes, despite there was no statistical significance mainly due to small sample size. CONCLUSION: Our preliminary results show that G-CSF is a promising and safe agent to increase the PRs in patients with RIF. Dual administration of G-CSF seems to be the best way. The study is still going on.
P-495 Wednesday, October 16, 2013 ADENOMYOSIS DOES NOT INFLUENCE PREGNANCY RATE IN WOMEN UNDERGOING IVF. L. Benaglia, L. Cardellicchio, A. Paffoni, M. Leonardi, S. Faulisi, E. Somigliana. Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy. OBJECTIVE: The relationship between adenomyosis and infertility is yet unclear. Available evidence is scanty and conflicting. To gain insights into this controversial issue, we set up a prospective study aimed at comparing IVF outcome in women with and without adenomyosis. DESIGN: Prospective cohort study of women undergoing IVF. MATERIALS AND METHODS: Women selected for IVF between January to December 2012 were considered for study entry. Exclusion criteria were age > 42 years, a history of surgery for adenomyosis and previous IVF cycles. Eligible women underwent a transvaginal ultrasound scan prior to initiate the cycle aimed at identify the presence of adenomyosis. Women with doubtful ultrasound findings and those with fibroids were excluded. Women who were diagnosed with adenomyosis were considered as cases whereas the rest of the cohort was used as the control group. Women who subsequently failed to transfer viable embryos were excluded from both study groups. RESULTS: Forty-nine women with adenomyosis and 300 controls were ultimately selected. Age, tests of ovarian reserve and obstetric history did not differ between the study groups. Conversely, indications to the procedure significantly differed (p<0.001). Endometriosis prevailed among cases (43%) whereas a male factor cause of infertility was the most common indication among controls (53%). Considering IVF outcomes, variables reflecting ovarian responsiveness to hyperstimulation were similar. The chances of success resulted also comparable. The clinical pregnancy rate and the ongoing/delivery rate in cases and controls were 37% and 27% (p¼0.17) and 29% and 21% (p¼0.27), respectively. The abortion rate was 22% and
21%, respectively (p¼1.00). Multivariate analyses confirmed the lack of any detrimental effect of adenomyosis on the clinical pregnancy rate and the ongoing/delivery rate. CONCLUSION: The chances of pregnancy are not influenced by the presence of adenomyosis in IVF cycles. Adenomyosis does not seem to affect embryo implantation. P-496 Wednesday, October 16, 2013 THE ORDER OF PRIORITY FOR EMBRYO TRANSFER - STUDY OF ASSORT BY BLASTOCYST EXPANSION, INNER CELL MASS AND TROPHECTODERM GRADE. N. Kawakami, Y. Aoi, C. Shindou, H. Saito, R. Hirata, N. Hayashi. Okayama Couple’s Clinic, Okayama, Japan. OBJECTIVE: Comparisons of ]the effect of the embryo expansion, trophectoderm (TE) morphology grade, and inner cell mass (ICM) morphology grade on pregnancy rate, miscarriage rate and live birth rate in single blastocyst transfers. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We studied women who underwent a total of 1860 frozen-thawed single-blastocyst transfer cycles, from January 2007 through to December 2011. All blastocysts were evaluated by use of the Gardner and Schoolcraft grading system. RESULTS: Pregnancy rates were 41.8%, 37.8%, and 27.0% for expansion 5, 4, and 3, respectively. Expansion 3 had a significantly lower pregnancy rate. Pregnancy rates were 47.6%, 45.2%, 40.0%, 33.8%, 32.4%, 18.6%, 15.4%, 4.5%, and 0% for ICM and TE grades BA, AA, CA, BB, AB, BC, AC, CB, and CC, respectively. ICM and TE grade AA and BA had significantly higher pregnancy rates, secondly AB and BB to the exclusion of CA and CC. There was no significant miscarriage rate associated with expansion. Miscarriage rates were 0%, 20.0%, 21.3%, 22.7%, 22.9%, 37.5%, 46.2%, and 100% for ICM and TE grades CB, AA, BB, AB, BA, AC, BC, and CA, respectively. ICM and TE grades BC and CA had significantly high miscarriage rates compared to ICM and TE grade not containing C. Live birth rate was not significantly associated with Expansion. Live birth rates were 100%, 79.0%, 77.2%, 76.7%, 75.7%, 62.5%, 53.8%, and 0% for ICM and TE grades CB, AA, BB, AB, BA, AC, BC, and CA, respectively. ICM and TE grades BC and CA had significantly high live birth rates compared to ICM and TE grade not containing C. CONCLUSION: When selecting blastocysts for frozen-thawed single blastocyst transfer, it will be beneficial consider to select primarily ICM and TE grade AA and BA, and secondly, AB and BB. P-497 Wednesday, October 16, 2013 DEGREE OF BLASTOCOEL EXPANSION VERSUS OUTCOME IN VITRIFIED/WARMED CYCLES VERSUS FRESH TRANSFER CYCLES. S. LaBrie, K. Lynch, P. St. Marie, K. Hemingway, M. Arny, L. Ashcraft. Baystate Reproductive Medicine, Baystate Health, Springfield, MA. OBJECTIVE: To determine what effect blastocoel expansion has on implantation and ongoing pregnancy rates in vitrified/warmed and fresh blastocyst transfer cycles. DESIGN: A retrospective study of 271 cycles; 193 patients. Fresh cycles performed 8/15/10-12/31/12. FET cycles of blastocysts vitrified/warmed/ transferred 8/15/10-12/31/12. Patients <38 years were included. Blastocysts with known fates were included. Development of sacs, heartbeats and ongoing heartbeats as they relate to expansion were determined. MATERIALS AND METHODS: Embryos were cultured in Sage media in 5% O2. Fresh blastocyst transfers were performed on Day 5. FET cycles
Implantation rates and development based on degree of blastocoel expansion
Fresh Blast Cycles Degree of Expansion Gestational Sacs (%) Heartbeats (%) Ongoing heartbeats (%) Vit Cycles: Survival (%)
FET Blast Cycles
3
4
5
3
4
5
61/105 (58) 59/105 (56) 57/108 (53) x
38/60 (63) 36/60 (60) 31/60 (52) x
1/1 (100) 1/1 (100) 1/1 (100) x
44/71 (62)# 43/73 (59)$ 41/73 (56)^ 78/85 (92)
37/79 (47)# 30/80 (30)$ 25/82 (30)^ 99/105 (94)
25/34 (74)# 22/33 (67)$ 21/33 (64)^ 36/40 (90)
# P¼ 0.02, $ P¼ 0.004, ^ P¼ 0.001.
S292
ASRM Abstracts
Vol. 100, No. 3, Supplement, September 2013
P-495 Wednesday, October 16, 2013 ADENOMYOSIS DOES NOT INFLUENCE PREGNANCY RATE IN WOMEN UNDERGOING IVF. L. Benaglia, L. Cardellicchio, A. Paffoni, M. Leonardi, S. Faulisi, E. Somigliana. Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy. OBJECTIVE: The relationship between adenomyosis and infertility is yet unclear. Available evidence is scanty and conflicting. To gain insights into this controversial issue, we set up a prospective study aimed at comparing IVF outcome in women with and without adenomyosis. DESIGN: Prospective cohort study of women undergoing IVF. MATERIALS AND METHODS: Women selected for IVF between January to December 2012 were considered for study entry. Exclusion criteria were age > 42 years, a history of surgery for adenomyosis and previous IVF cycles. Eligible women underwent a transvaginal ultrasound scan prior to initiate the cycle aimed at identify the presence of adenomyosis. Women with doubtful ultrasound findings and those with fibroids were excluded. Women who were diagnosed with adenomyosis were considered as cases whereas the rest of the cohort was used as the control group. Women who subsequently failed to transfer viable embryos were excluded from both study groups. RESULTS: Forty-nine women with adenomyosis and 300 controls were ultimately selected. Age, tests of ovarian reserve and obstetric history did not differ between the study groups. Conversely, indications to the procedure significantly differed (p<0.001). Endometriosis prevailed among cases (43%) whereas a male factor cause of infertility was the most common indication among controls (53%). Considering IVF outcomes, variables reflecting ovarian responsiveness to hyperstimulation were similar. The chances of success resulted also comparable. The clinical pregnancy rate and the ongoing/delivery rate in cases and controls were 37% and 27% (p¼0.17) and 29% and 21% (p¼0.27), respectively. The abortion rate was 22% and
21%, respectively (p¼1.00). Multivariate analyses confirmed the lack of any detrimental effect of adenomyosis on the clinical pregnancy rate and the ongoing/delivery rate. CONCLUSION: The chances of pregnancy are not influenced by the presence of adenomyosis in IVF cycles. Adenomyosis does not seem to affect embryo implantation. P-496 Wednesday, October 16, 2013 THE ORDER OF PRIORITY FOR EMBRYO TRANSFER - STUDY OF ASSORT BY BLASTOCYST EXPANSION, INNER CELL MASS AND TROPHECTODERM GRADE. N. Kawakami, Y. Aoi, C. Shindou, H. Saito, R. Hirata, N. Hayashi. Okayama Couple’s Clinic, Okayama, Japan. OBJECTIVE: Comparisons of ]the effect of the embryo expansion, trophectoderm (TE) morphology grade, and inner cell mass (ICM) morphology grade on pregnancy rate, miscarriage rate and live birth rate in single blastocyst transfers. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We studied women who underwent a total of 1860 frozen-thawed single-blastocyst transfer cycles, from January 2007 through to December 2011. All blastocysts were evaluated by use of the Gardner and Schoolcraft grading system. RESULTS: Pregnancy rates were 41.8%, 37.8%, and 27.0% for expansion 5, 4, and 3, respectively. Expansion 3 had a significantly lower pregnancy rate. Pregnancy rates were 47.6%, 45.2%, 40.0%, 33.8%, 32.4%, 18.6%, 15.4%, 4.5%, and 0% for ICM and TE grades BA, AA, CA, BB, AB, BC, AC, CB, and CC, respectively. ICM and TE grade AA and BA had significantly higher pregnancy rates, secondly AB and BB to the exclusion of CA and CC. There was no significant miscarriage rate associated with expansion. Miscarriage rates were 0%, 20.0%, 21.3%, 22.7%, 22.9%, 37.5%, 46.2%, and 100% for ICM and TE grades CB, AA, BB, AB, BA, AC, BC, and CA, respectively. ICM and TE grades BC and CA had significantly high miscarriage rates compared to ICM and TE grade not containing C. Live birth rate was not significantly associated with Expansion. Live birth rates were 100%, 79.0%, 77.2%, 76.7%, 75.7%, 62.5%, 53.8%, and 0% for ICM and TE grades CB, AA, BB, AB, BA, AC, BC, and CA, respectively. ICM and TE grades BC and CA had significantly high live birth rates compared to ICM and TE grade not containing C. CONCLUSION: When selecting blastocysts for frozen-thawed single blastocyst transfer, it will be beneficial consider to select primarily ICM and TE grade AA and BA, and secondly, AB and BB. P-497 Wednesday, October 16, 2013 DEGREE OF BLASTOCOEL EXPANSION VERSUS OUTCOME IN VITRIFIED/WARMED CYCLES VERSUS FRESH TRANSFER CYCLES. S. LaBrie, K. Lynch, P. St. Marie, K. Hemingway, M. Arny, L. Ashcraft. Baystate Reproductive Medicine, Baystate Health, Springfield, MA. OBJECTIVE: To determine what effect blastocoel expansion has on implantation and ongoing pregnancy rates in vitrified/warmed and fresh blastocyst transfer cycles. DESIGN: A retrospective study of 271 cycles; 193 patients. Fresh cycles performed 8/15/10-12/31/12. FET cycles of blastocysts vitrified/warmed/ transferred 8/15/10-12/31/12. Patients <38 years were included. Blastocysts with known fates were included. Development of sacs, heartbeats and ongoing heartbeats as they relate to expansion were determined. MATERIALS AND METHODS: Embryos were cultured in Sage media in 5% O2. Fresh blastocyst transfers were performed on Day 5. FET cycles
Implantation rates and development based on degree of blastocoel expansion
Fresh Blast Cycles Degree of Expansion Gestational Sacs (%) Heartbeats (%) Ongoing heartbeats (%) Vit Cycles: Survival (%)
FET Blast Cycles
3
4
5
3
4
5
61/105 (58) 59/105 (56) 57/108 (53) x
38/60 (63) 36/60 (60) 31/60 (52) x
1/1 (100) 1/1 (100) 1/1 (100) x
44/71 (62)# 43/73 (59)$ 41/73 (56)^ 78/85 (92)
37/79 (47)# 30/80 (30)$ 25/82 (30)^ 99/105 (94)
25/34 (74)# 22/33 (67)$ 21/33 (64)^ 36/40 (90)
# P¼ 0.02, $ P¼ 0.004, ^ P¼ 0.001.
S292
ASRM Abstracts
Vol. 100, No. 3, Supplement, September 2013