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Ultrasound-guided embryo transfer: Does it improve IVF success?
P-19 Egg collection with a double lumen needle in poor responder patients undergoing in vitro fertilization treatment. Adrian Ellenbogen, Medeia Michaeli, Shlomo Ballas. Dept. of Obstetrics and Gynecology, IVF Unit. Hillel Yaffe Medical Ctr, Hadera, Israel. Objective: To assess the advantage of double lumen needle aspiration in poor responder patients in regard to amount of oocytes retrieved. Design: Prospective study. Materials and Methods: Sixty-three poor responder patients with mean number of 3.7⫾1.5 follicles ⬎16 mm at hCG administration, underwent egg collection during 75 IVF cycles. Each follicle was aspirated separately with a double lumen needle, the needle being held in position while the follicular fluid was checked by the embryologist. If no oocyte was found, the follicle was flushed and re-aspirated, otherwise another follicle was punctured and aspirated, and the procedure repeated. Oocytes retrieved from first aspirate and flushed follicle were recorded separately. Results: The total mean number of oocytes retrieved was 4.5⫾1.7. Statistically significant more eggs were collected from flushing medium vs. first aspirate (2.82⫾1.92 vs.1.76⫾2.01, respectively, p⬍0.01). The fertilization rate was 54%. 2.04⫾1.29 embryos were found suitable and transferred. Conclusion: In selected cases, double lumen needle aspiration may help to recover additional oocytes, although ovum pick-up have been performed by an experience physician. The results may improve IVF outcome. P-20 Reduced incidence of embryo retention in the transfer catheter after universal adaptation of mid-cavity transfer by a large multiple clinician IVF center. Tali Silberstein, James R. Trimarchi, David Frankfurter, Kelly Pagidas, David Keefe, Shayne Plosker. Women and Infants Hospital/ Brown Univ Sch of Medicine, Chestnut Hill, MA. Objective: To evaluate factors contributing to embryos being retained in the transfer catheter and to determine the effect of retained embryos and retransfer on pregnancy rate. Design: Retrospective Analysis of a Computerized IVF Database. Materials and Methods: We analyzed 2,036 consecutive, non-donor, ultrasound-guided embryo transfers (ETs) performed between January 1, 2000 and December 31, 2002. After ET, the transfer catheter was withdrawn and evaluated by an embryologist for retained embryos. Retained embryos were reloaded into a new catheter and immediately re-transferred. We evaluated the relationship between retained embryos and the following independent variables: (1) year of ET, (2) type of catheter used (3) number of embryos transferred, (4) day of transfer, and (5) ET occurring prior to 08/01/01 versus ET occurring after this date, as on this date we universally began ET to the mid-uterine cavity. Dependant variables analyzed were implantation rate (IR), clinical pregnancy rate (CPR), and blood on the transfer catheter post ET. Statistical analysis was performed using Z-test, chi square, Fisher’s exact tests. Results: Fifty three out of 2,036 ET were retransferred (2.67%).
*p ⫽ 0.003 From 2000 to 2001 we observed a significant decline in the occurrence of embryos retained in the catheter, which was maintained through 2002. Between 01/01/01 to 07/31/01 embryo retention occurred in higher rate compared to the period from 08/01/01 to 12/31/01 (p ⫽ 0.04). There was no significant impact of the number of embryos transferred, the catheter used nor day of ET on the occurrence of retained embryos. Blood on the catheter was seen significantly more frequently in ETs with retained embryos (39.6%) compared to ETs with no retention (19.0%) (p⬍0.001). IR and CPR were 12%/25% for ETs with retained embryos, compared to 19%/34% for ETs with no retention. Due to the differences in group sizes, the differences in IR and CPR were not statistically significant. Conclusions: (1) A significant decline in the incidence of retained embryos occurred after adaptation of universal ultrasound guided mid-cavity ET. (2) Blood was more likely to be present on the transfer catheter when
FERTILITY & STERILITY威
retransfer was required due to embryo retention. (3) Although not statistically significant, the lower IR and CPR for ET in which embryos were retained and retransferred may be clinically significant. P-21 Does a difficult embryo transfer affect the results of IVF and ICSI? A meta-analysis of controlled studies. Hassan N. A. Sallam, Sameh S. Sadek, Abdel-Fattah A. Agameya. Alexandria Univ, Alexandria, Egypt. Objective: Difficult embryo transfers have been claimed by some clinicians to diminish the pregnancy and implantation rates in IVF and ICSI. However, some studies have found no relationship between the difficulty of embryo transfer and the pregnancy and implantation rate. The aim of this work was to conduct a meta-analysis of controlled trials in order to clarify the situation. We have calculated that in order to improve the clinical pregnancy rate from 25 to 30%, the least number needed to study was 636 patients in each arm of the study, accepting a probability of 80% of detecting a true difference and taking 5% as the level of significance. Design: A meta-analysis of controlled studies. Materials and Methods: A meticulous search of the literature was conducted searching the Medline database, the EMBase, the Cochrane library as well as hand searching relevant publications and proceedings of international congresses. A total of 114 studied were retrieved. The studies were evaluated independently by the first two reviewers and the differences were settled by consensus with the third reviewer. Of the 114 studies, 9 fulfilled our inclusion criteria (Leeton et al, 1982; Wood et al, 1985; Tur-Kaspa et al, 1998; Nabi et al, 1999; Noyes et al, 1999; Burke et al, 2000; Tomas et al, 2002, Sallam et al, 2003; Spandorfer et al, 2003). The primary outcome measures were the clinical pregnancy and implantation rates. The metaanalysis was conducted using the RevMan software with the Peto-modified Mantel-Haenszel method and the fixed effect model. Results: The clinical pregnancy rate for patients with difficult transfers was 22.3% compared to 31.6% for patients with easy transfers [OR⫽ 0.74 (95% CI 0.64-0.87)]. The implantation rate for patients with difficult transfers was 11.7% compared to 18.7% for easy transfers [OR⫽ 0.64 (95% CI 0.52-0.77)]. Conclusion: Difficult embryo transfers diminish the pregnancy and implantation rates significantly for patients undergoing IVF and ICSI. P-22 Fragment removal in day 3 human embryos in routine IVF. Beatriz Amorocho, Emilio Go´ mez, Inmaculada Pe´ rez-Cano, Jose Landeras, Marı´a Nicolas, Agustı´n Ballesteros. IVI-MURCIA, Murcia, Spain. Objective: The aims of this work was to evaluate the effects of fragment removal on day 3 human embryos on implantation and pregnancy rates. Design: We have retrospectively analyzed day 3 embryo transfer with or without fragmentation removal. Materials and Methods: The study population consisted of 124 IVF/ ICSI cycles with embryos with high degree of fragmentation (⬎20%). It was expressed as a percentage and defined as the volume of the perivitelline space. In 64 cycles fragments removal was performed (group A). The clinical pregnancy and implantation rates of this group of patients were compared with a group of 60 cycles performed in the same period of time and with similar age, infertility cause and embryo quality (number of cells and high fragmentation degree before the fragment removal) (group B). Results: Pregnancy and implantation rate in group A was 46.9 and 26.7%, respectively, and 36.2 and 20.9% in group B. No significant differences were observed. Conclusion: In this study the results show that implantation rate is increased from 20.9 to 26.70% even though no significant differences, but a clear tendency, were obtained, perhaps because of the low number of cycles in which we have practiced fragments removal. A proper prospective study would be necessary to support the clear tendency observed in this group of patients. P-23 Ultrasound-guided embryo transfer: Does it improve IVF success? Mousa I. Shamonki, Steven D. Spandorfer, Jeffrey E. Roberts, Zev Rosen-
S127
waks. Cornell Ctr for Reproductive Medicine, New York, NY. Objective: Recent studies have suggested that ultrasound-guided embryo transfer (U/S-guided ET) may improve the outcome in in-vitro fertilization (IVF). In our center, we perform trial ET without U/S guidance in preparation for actual ET. The goal of our study is to determine if U/S guidance may better our ability to perform ET. Design: Prospective observational study. Materials and Methods: Patients at a university-based IVF center undergoing traditional IVF transfer were offered embryo transfer under abdominal ultrasound (U/S) guidance. Sixty-seven consecutive patients underwent ultrasound-guided embryo transfer from January 2003 to March 2003. Patients in the study had full bladders at the time of ultrasound-guided embryo transfer and all transfers were performed with a Wallace catheter by the same physician. At time of transfer, the catheter tip was placed approximately 1.5 cm from the fundus as measured by abdominal ultrasound. The embryos were transferred subsequently under U/S visualization. Total cavity length by ultrasound (length of catheter within the uterus and cervix ⫹ length from tip of catheter to the fundus by ultrasound) was compared to the length of the cavity as noted by trial transfer. A difference of 1.5 cm or greater was considered as a significant difference. Patients were grouped as having a difference of 1.5 cm from the trial transfer (Group A) or having no difference (Group B), however, all embryos were placed within 1-2 cm of the fundus by U/S. IVF outcomes were evaluated. Results: Ten patients (15.9%) had a difference of ⬎ 1.5 cm from the trial transfer (group A). Between groups, there was no difference in age, number of eggs retrieved, number of mature eggs, or number of embryos transferred. Four patients were excluded from the study as their bladders were empty at the time of embryo transfer, thus making visualization of the cavity difficult. The overall pregnancy rate was 60.3% (38/63). The pregnancy rate for group A was 60% (6/10 patients) while the pregnancy rate for group B was 60.4% (32/53 patients), p ⫽ 0.98. When the patients were segregated by transfer ⬍ 1.5cm from the fundus by U/S (group C) vs ⬎ 1.5 cm by U/S (group D), the pregnancy rates were 51.7% (15/29 group C) and 67.6% (23/34 group D), p ⫽ 0.19. Conclusion: In our analysis, 15% of patients had a discrepancy of ⬎ 1.5 cm noted at the time of ultrasound-guided embryo transfer when compared to the cavity length at trial transfer. This suggests a benefit to U/S-guided ET. Furthermore, our study suggests a trend for better outcome with transfer between 1.5 to 2 cm from the fundus. A prospective randomized trial comparing ultrasound-guided transfer with the traditional blind transfer is required to further assess if ultrasound-guided transfer should be used in all cases of embryo transfer.
P-24 Comparison of recovery and viability of sperm in ICSI pipette after ultra rapid freezing or slow freezing. J. O. Sohn, S. H. Jun, L. S. Park, E. K. Kim, T. G. Chung, D. R. Lee. Infertility Medical Ctr, CHA Gen Hosp, Pochon CHA Univ Coll of Medicine, Seoul, Republic of Korea. Objective: Patients with severe oligozoospermia have been able to avoid from infertility by availability of intracytoplasmic sperm injection (ICSI). Conventional sperm/semen freezing methods, accompanied by thawing and washing procedures, usually lead to a disappointing sperm recovery from the severe oligozoospermia. Also, this procedure is labor intensive and costly. The objective of this study was to evaluate the feasibility on the direct freezing of small numbers of motile sperm using ICSI pipette. Design: Recovery and survival rates after freezing/thawing were analyzed in order to evaluate the suitability and efficiency of the methods (ultra rapid freezing vs. slow freezing method). Materials and Methods: Semen samples (N⫽10) with severe oligozoospermia were centrifuged and concentrated before freezing. Sperm pellet was divided into two samples for ultra rapid freezing and slow freezing. Each sperm pellet loaded into the freezing media drop. Motile spermatozoa were collected using micropipette for ICSI. ICSI pipette with sperm held in liquid nitrogen (LN2) vapour for 20 min prior to plunging into LN2 (slow freezing) or directly submerged into LN2 (ultra rapid freezing). Each pipette tip contained 20-22 sperm cells. After thawing, pipettes were mounted on micromanipulator and sperm cells were gently expelled into a small drop of sperm wash medium. We evaluated the recovery rates and viability on each sample. Results: The recovery rate of slow freezing was not different from those
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of ultra rapid freezing (90.1% vs. 79.6%). Motility of sperm recovered from two groups after freezing/thawing were very low and showed no difference. Viability of initial sperm before freezing was 57.4%, and it was decreased in both slow and ultra rapid freezing group after freezing and thawing. However, viability of sperm from slow freezing was higher than those of ultra rapid freezing (28.8% vs. 8.2%, p⬍ 0.01) Conclusion: Slow freezing method accompanied by collection of motile sperm using ICSI pipette can be used efficiently for management of severe oligozoospermia in human IVF program.
P-25 Trans-abdominal follicular aspiration for oocyte retrieval in patients with abnormal pelvic anatomy. Antonio R. Gargiulo, Elizabeth S. Ginsburg, Joseph A. Politch, Carol B. Benson. Brigham and Women’s Hosp, Harvard Medical Sch, Boston, MA. Objective: Transvaginal follicular aspiration for oocyte retrieval is not feasible if the ovaries are located outside of the pelvis. In these cases a classic laparoscopic technique can be considered, which entails endotracheal anesthesia and higher costs and risk of complications. Our study evaluated the efficacy and safety of transabdominal follicular aspiration in women whose ovaries could not be identified by transvaginal sonography during cycles of controlled ovarian hyperstimulation. Design: Retrospective case-controlled series. Material and Methods: 7362 consecutive IVF cycles from January 1, 1997 to December 31, 2002 were reviewed. We identified 15 patients who underwent a total of 27 transabdominal follicular aspiration because of inability to identify the ovaries by transvaginal sonography. The anatomic distorsion was associated with: neovagina following repair of congenital cloaca (n⫽1), mullerian anomalies (n⫽2), oophoropexy for pelvic radiation with or without radical hysterectomy (n⫽4), severe adhesive disease following abdominal surgery (n⫽5), and obese body habitus (n⫽3). The patients received either intravenous general (n⫽ 14) or spinal (n ⫽ 13) anesthesia. A standard 16-gauge needle was inserted with sterile technique through the skin in the infraumbilical region, and follicular aspiration was performed under transabdominal ultrasound guidance. Our control group consisted of cycles in which transvaginal follicular aspiration was performed, that were matched by patient age and by follicle number on day of hCG administration. Outcome variables compared in the two groups using the Mann-Whitney U test included the number of: total oocytes retrieved, mature oocytes, degenerated oocytes, oocytes with broken zona pellucida, and zygotes. P ⬍ 0.05 was considered statistically significant. Results: The study and control groups did not differ for patient age or number of measurable follicles on the day of hCG administration. Likewise, no significant differences were found in the two groups regarding any of the outcome parameters analyzed: all relevant results are summarized in the table below (data reported as median and range). No operative complications were observed in either the transabdominal or the transvaginal aspiration group. oocyte retrieval in patients whose ovaries are not identified transvaginally.
Conclusions: We report the first large series of transabdominal follicular aspirations for oocyte retrieval. Analysis of matched controls suggests that the procedure is safe and that it yields clinical results in women with ovarian displacement that compare well with those achieved by the transvaginal technique in women with normal pelvic anatomy.
P-26 Semen sample collection in medium has no beneficial effect on fertilization and pregnancy rates. Aycan Isiklar, Ramazan Mercan, Basak
Vol. 80, Suppl. 3, September 2003
*p ⫽ 0.003 From 2000 to 2001 we observed a significant decline in the occurrence of embryos retained in the catheter, which was maintained through 2002. Between 01/01/01 to 07/31/01 embryo retention occurred in higher rate compared to the period from 08/01/01 to 12/31/01 (p ⫽ 0.04). There was no significant impact of the number of embryos transferred, the catheter used nor day of ET on the occurrence of retained embryos. Blood on the catheter was seen significantly more frequently in ETs with retained embryos (39.6%) compared to ETs with no retention (19.0%) (p⬍0.001). IR and CPR were 12%/25% for ETs with retained embryos, compared to 19%/34% for ETs with no retention. Due to the differences in group sizes, the differences in IR and CPR were not statistically significant. Conclusions: (1) A significant decline in the incidence of retained embryos occurred after adaptation of universal ultrasound guided mid-cavity ET. (2) Blood was more likely to be present on the transfer catheter when
FERTILITY & STERILITY威
retransfer was required due to embryo retention. (3) Although not statistically significant, the lower IR and CPR for ET in which embryos were retained and retransferred may be clinically significant. P-21 Does a difficult embryo transfer affect the results of IVF and ICSI? A meta-analysis of controlled studies. Hassan N. A. Sallam, Sameh S. Sadek, Abdel-Fattah A. Agameya. Alexandria Univ, Alexandria, Egypt. Objective: Difficult embryo transfers have been claimed by some clinicians to diminish the pregnancy and implantation rates in IVF and ICSI. However, some studies have found no relationship between the difficulty of embryo transfer and the pregnancy and implantation rate. The aim of this work was to conduct a meta-analysis of controlled trials in order to clarify the situation. We have calculated that in order to improve the clinical pregnancy rate from 25 to 30%, the least number needed to study was 636 patients in each arm of the study, accepting a probability of 80% of detecting a true difference and taking 5% as the level of significance. Design: A meta-analysis of controlled studies. Materials and Methods: A meticulous search of the literature was conducted searching the Medline database, the EMBase, the Cochrane library as well as hand searching relevant publications and proceedings of international congresses. A total of 114 studied were retrieved. The studies were evaluated independently by the first two reviewers and the differences were settled by consensus with the third reviewer. Of the 114 studies, 9 fulfilled our inclusion criteria (Leeton et al, 1982; Wood et al, 1985; Tur-Kaspa et al, 1998; Nabi et al, 1999; Noyes et al, 1999; Burke et al, 2000; Tomas et al, 2002, Sallam et al, 2003; Spandorfer et al, 2003). The primary outcome measures were the clinical pregnancy and implantation rates. The metaanalysis was conducted using the RevMan software with the Peto-modified Mantel-Haenszel method and the fixed effect model. Results: The clinical pregnancy rate for patients with difficult transfers was 22.3% compared to 31.6% for patients with easy transfers [OR⫽ 0.74 (95% CI 0.64-0.87)]. The implantation rate for patients with difficult transfers was 11.7% compared to 18.7% for easy transfers [OR⫽ 0.64 (95% CI 0.52-0.77)]. Conclusion: Difficult embryo transfers diminish the pregnancy and implantation rates significantly for patients undergoing IVF and ICSI. P-22 Fragment removal in day 3 human embryos in routine IVF. Beatriz Amorocho, Emilio Go´ mez, Inmaculada Pe´ rez-Cano, Jose Landeras, Marı´a Nicolas, Agustı´n Ballesteros. IVI-MURCIA, Murcia, Spain. Objective: The aims of this work was to evaluate the effects of fragment removal on day 3 human embryos on implantation and pregnancy rates. Design: We have retrospectively analyzed day 3 embryo transfer with or without fragmentation removal. Materials and Methods: The study population consisted of 124 IVF/ ICSI cycles with embryos with high degree of fragmentation (⬎20%). It was expressed as a percentage and defined as the volume of the perivitelline space. In 64 cycles fragments removal was performed (group A). The clinical pregnancy and implantation rates of this group of patients were compared with a group of 60 cycles performed in the same period of time and with similar age, infertility cause and embryo quality (number of cells and high fragmentation degree before the fragment removal) (group B). Results: Pregnancy and implantation rate in group A was 46.9 and 26.7%, respectively, and 36.2 and 20.9% in group B. No significant differences were observed. Conclusion: In this study the results show that implantation rate is increased from 20.9 to 26.70% even though no significant differences, but a clear tendency, were obtained, perhaps because of the low number of cycles in which we have practiced fragments removal. A proper prospective study would be necessary to support the clear tendency observed in this group of patients. P-23 Ultrasound-guided embryo transfer: Does it improve IVF success? Mousa I. Shamonki, Steven D. Spandorfer, Jeffrey E. Roberts, Zev Rosen-
S127
waks. Cornell Ctr for Reproductive Medicine, New York, NY. Objective: Recent studies have suggested that ultrasound-guided embryo transfer (U/S-guided ET) may improve the outcome in in-vitro fertilization (IVF). In our center, we perform trial ET without U/S guidance in preparation for actual ET. The goal of our study is to determine if U/S guidance may better our ability to perform ET. Design: Prospective observational study. Materials and Methods: Patients at a university-based IVF center undergoing traditional IVF transfer were offered embryo transfer under abdominal ultrasound (U/S) guidance. Sixty-seven consecutive patients underwent ultrasound-guided embryo transfer from January 2003 to March 2003. Patients in the study had full bladders at the time of ultrasound-guided embryo transfer and all transfers were performed with a Wallace catheter by the same physician. At time of transfer, the catheter tip was placed approximately 1.5 cm from the fundus as measured by abdominal ultrasound. The embryos were transferred subsequently under U/S visualization. Total cavity length by ultrasound (length of catheter within the uterus and cervix ⫹ length from tip of catheter to the fundus by ultrasound) was compared to the length of the cavity as noted by trial transfer. A difference of 1.5 cm or greater was considered as a significant difference. Patients were grouped as having a difference of 1.5 cm from the trial transfer (Group A) or having no difference (Group B), however, all embryos were placed within 1-2 cm of the fundus by U/S. IVF outcomes were evaluated. Results: Ten patients (15.9%) had a difference of ⬎ 1.5 cm from the trial transfer (group A). Between groups, there was no difference in age, number of eggs retrieved, number of mature eggs, or number of embryos transferred. Four patients were excluded from the study as their bladders were empty at the time of embryo transfer, thus making visualization of the cavity difficult. The overall pregnancy rate was 60.3% (38/63). The pregnancy rate for group A was 60% (6/10 patients) while the pregnancy rate for group B was 60.4% (32/53 patients), p ⫽ 0.98. When the patients were segregated by transfer ⬍ 1.5cm from the fundus by U/S (group C) vs ⬎ 1.5 cm by U/S (group D), the pregnancy rates were 51.7% (15/29 group C) and 67.6% (23/34 group D), p ⫽ 0.19. Conclusion: In our analysis, 15% of patients had a discrepancy of ⬎ 1.5 cm noted at the time of ultrasound-guided embryo transfer when compared to the cavity length at trial transfer. This suggests a benefit to U/S-guided ET. Furthermore, our study suggests a trend for better outcome with transfer between 1.5 to 2 cm from the fundus. A prospective randomized trial comparing ultrasound-guided transfer with the traditional blind transfer is required to further assess if ultrasound-guided transfer should be used in all cases of embryo transfer.
P-24 Comparison of recovery and viability of sperm in ICSI pipette after ultra rapid freezing or slow freezing. J. O. Sohn, S. H. Jun, L. S. Park, E. K. Kim, T. G. Chung, D. R. Lee. Infertility Medical Ctr, CHA Gen Hosp, Pochon CHA Univ Coll of Medicine, Seoul, Republic of Korea. Objective: Patients with severe oligozoospermia have been able to avoid from infertility by availability of intracytoplasmic sperm injection (ICSI). Conventional sperm/semen freezing methods, accompanied by thawing and washing procedures, usually lead to a disappointing sperm recovery from the severe oligozoospermia. Also, this procedure is labor intensive and costly. The objective of this study was to evaluate the feasibility on the direct freezing of small numbers of motile sperm using ICSI pipette. Design: Recovery and survival rates after freezing/thawing were analyzed in order to evaluate the suitability and efficiency of the methods (ultra rapid freezing vs. slow freezing method). Materials and Methods: Semen samples (N⫽10) with severe oligozoospermia were centrifuged and concentrated before freezing. Sperm pellet was divided into two samples for ultra rapid freezing and slow freezing. Each sperm pellet loaded into the freezing media drop. Motile spermatozoa were collected using micropipette for ICSI. ICSI pipette with sperm held in liquid nitrogen (LN2) vapour for 20 min prior to plunging into LN2 (slow freezing) or directly submerged into LN2 (ultra rapid freezing). Each pipette tip contained 20-22 sperm cells. After thawing, pipettes were mounted on micromanipulator and sperm cells were gently expelled into a small drop of sperm wash medium. We evaluated the recovery rates and viability on each sample. Results: The recovery rate of slow freezing was not different from those
S128
Abstracts
of ultra rapid freezing (90.1% vs. 79.6%). Motility of sperm recovered from two groups after freezing/thawing were very low and showed no difference. Viability of initial sperm before freezing was 57.4%, and it was decreased in both slow and ultra rapid freezing group after freezing and thawing. However, viability of sperm from slow freezing was higher than those of ultra rapid freezing (28.8% vs. 8.2%, p⬍ 0.01) Conclusion: Slow freezing method accompanied by collection of motile sperm using ICSI pipette can be used efficiently for management of severe oligozoospermia in human IVF program.
P-25 Trans-abdominal follicular aspiration for oocyte retrieval in patients with abnormal pelvic anatomy. Antonio R. Gargiulo, Elizabeth S. Ginsburg, Joseph A. Politch, Carol B. Benson. Brigham and Women’s Hosp, Harvard Medical Sch, Boston, MA. Objective: Transvaginal follicular aspiration for oocyte retrieval is not feasible if the ovaries are located outside of the pelvis. In these cases a classic laparoscopic technique can be considered, which entails endotracheal anesthesia and higher costs and risk of complications. Our study evaluated the efficacy and safety of transabdominal follicular aspiration in women whose ovaries could not be identified by transvaginal sonography during cycles of controlled ovarian hyperstimulation. Design: Retrospective case-controlled series. Material and Methods: 7362 consecutive IVF cycles from January 1, 1997 to December 31, 2002 were reviewed. We identified 15 patients who underwent a total of 27 transabdominal follicular aspiration because of inability to identify the ovaries by transvaginal sonography. The anatomic distorsion was associated with: neovagina following repair of congenital cloaca (n⫽1), mullerian anomalies (n⫽2), oophoropexy for pelvic radiation with or without radical hysterectomy (n⫽4), severe adhesive disease following abdominal surgery (n⫽5), and obese body habitus (n⫽3). The patients received either intravenous general (n⫽ 14) or spinal (n ⫽ 13) anesthesia. A standard 16-gauge needle was inserted with sterile technique through the skin in the infraumbilical region, and follicular aspiration was performed under transabdominal ultrasound guidance. Our control group consisted of cycles in which transvaginal follicular aspiration was performed, that were matched by patient age and by follicle number on day of hCG administration. Outcome variables compared in the two groups using the Mann-Whitney U test included the number of: total oocytes retrieved, mature oocytes, degenerated oocytes, oocytes with broken zona pellucida, and zygotes. P ⬍ 0.05 was considered statistically significant. Results: The study and control groups did not differ for patient age or number of measurable follicles on the day of hCG administration. Likewise, no significant differences were found in the two groups regarding any of the outcome parameters analyzed: all relevant results are summarized in the table below (data reported as median and range). No operative complications were observed in either the transabdominal or the transvaginal aspiration group. oocyte retrieval in patients whose ovaries are not identified transvaginally.
Conclusions: We report the first large series of transabdominal follicular aspirations for oocyte retrieval. Analysis of matched controls suggests that the procedure is safe and that it yields clinical results in women with ovarian displacement that compare well with those achieved by the transvaginal technique in women with normal pelvic anatomy.
P-26 Semen sample collection in medium has no beneficial effect on fertilization and pregnancy rates. Aycan Isiklar, Ramazan Mercan, Basak
Vol. 80, Suppl. 3, September 2003