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Which is the best day for embryo transfer?
chosen on day 3 transfer but were not selected for transfer on day 5; pregnancy and implantation rates were 51% (20/39) and 44% (33/75), respectively. In addition there were 33 twin pregnancies in which at least one of the transferred embryos would not have been selected for day 3 transfer. CONCLUSIONS: Embryo quality on day 3, as determined by cell number and morphology, does not always predict the potential for progression to a good quality blastocyst. Our results provide further evidence that culture to day 5 allows for the selection of embryos with the best prognosis for initiating a viable pregnancy. Supported by: None.
were transferred. The overall positive hCG rate per ET was 13.2% (9/68). Implantation rate was 5.9% (6/102) and delivery rate was 8.8% (6/68). No multiple pregnancies occurred. A separate analysis of cases with only grade III and only grade IV or V embryos showed a positive hCG rate per ET of 20,7% (6/29) and 6,8%(2/29), respectively. Delivery rates were 13,8%(4/ 29) and 3,4% (1/29), respectively. Only one child showed a major malformation (Interventricular communication) born after the transfer of two grade IV embryos. CONCLUSIONS: The information provided by the present study helps in counseling couples that develop only poor quality embryos on their decision to undergo ET considering that the chance of a delivery is close to 10%. Supported by: None.
A-169 WHICH IS THE BEST DAY FOR EMBRYO TRANSFER? J. A. Agirregoikoa Iza, I. Ausin Hernandez, R. Jimenez Viruega, T. Ganzabal Areso, A. Lopez de Larruzea Orbe, G. Barrenetxea Ziarrusta. Quiron Bilbao, Bilbao, Spain. OBJECTIVE: To evaluate the efficacy of blastocyst transfer among egg recipients, and to compare pregnancy and implantation rates with classical 3rd day transfer. DESIGN: Retrospective clinical study. MATERIALS AND METHODS: 247 oocyte recipients cycles performed between January 2006 and December 2007, carried out in a private ART center were analyzed. Blastocyst stage transfer(5th-6th day) was compared to ‘‘classic’’ 3rd day embryo transfer, comparing pregnancy and multiple pregnancy rates. Selective embryo transfer (SET) was also evaluated. SPSS 16.0 for Mac was used for data analysis. RESULTS: Clinical pregnancy rate was 54,2%. The pregnancy rate was significantly higher in blastocyst transfer group (65,8%) compared to 3rd day transfer (43,1%) (c2¼1,247; p¼0,000). There was no significant difference in multiple pregnancy rates. There was no difference in pregnancy rate between a selective embryo transfer (neither 3rd day nor on blastocyst) and three embryos, but the multiple pregnancy rate was higher when three blastocyst were transferred (c2¼8,823; p¼0,003). CONCLUSIONS: Blastocyst stage embryo transfer appears to be a successful chance in egg donation program. A selective transfer can also reduce multiple pregnancy. Embryo vitrification should further reduce the multiple pregnancy rates. Supported by: None.
A-171 ONLY POOR QUALITY EMBRYOS: TRANSFER OR CANCEL? P. Gonzalez, C. Ortega, P. Donoso, V. Saez, R. Enriquez, I. Carrasco. Reproductive Medicine Unit., Clinica Alemana Stgo. Universidad del Desarrollo, Santiago, Chile. OBJECTIVE: Cleavage stage embryo morphology is currently the gold standard tool for embryo selection since good quality embryos have a higher implantation and delivery rate. In most fertility centers, only high quality embryos are selected for transfer or cryopreservation and poor quality embryos are discarded. Because of ethical committee regulations embryo cryopreservation is not allowed at our Center, thus all the obtained embryos after in vitro fertilization (IVF) are transferred. The aim of this study is to describe the results in cases when only poor quality embryos are available. DESIGN: Retrospective clinical analysis. MATERIALS AND METHODS: A retrospective analysis of IVF/ICSI cycles performed at our center between 1998-2007 was conducted. The inclusion criteria was patients whom only had poor quality embryos transferred, defined as grade III, IV or V according to the classification by Veeck et al1. All the patients underwent ovarian stimulation with GnRH analogues and gonadotropins. After IVF or ICSI, embryo transfer (ET) was performed on day two or three after oocyte retrieval. Embryo quality grading was done immediately before ET. RESULTS: Sixty-eight cycles in sixty-one patients fulfilled the inclusion criteria with a total of 102 embryos (mean female age 35.54.0). ICSI was performed on 57 cycles and IVF in eleven. In two cycles embryos were developed from frozen-thawed oocytes. In 29 cycles only grade III embryos were transferred and in 29 cycles only grade IV or V embryos were replaced. Ten cycles combined grade III, IVor Vembryos. A mean of 1.50.7 embryos
FERTILITY & STERILITYÒ
A-172 DAY 4 EMBRYO TRANSFER IMPROVES IVF OUTCOMES COMPARED WITH DAY 3 EMBRYO TRANSFER. M. K. Kim, S.-H. Lee, H. W. Choi, M. K. Koong, I. O. Song, C. K. Lim. Laboratory of Reproductive Biology and Infertility, Cheil General Hosp. & Women’s Healthcare Ctr., Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Cheil General Hosp. & Women’s Healthcare Ctr., Seoul, Republic of Korea. OBJECTIVE: Even though the majority of embryos are transferred on day 3 following in vitro fertilization (IVF), the morphological assessment of day 3 embryos may not accurately predict further developmental competency and pregnancy potential. We compared the clinical outcomes of day 4 ET cycles with day 3 ET cycles in both fresh IVF-ET and frozen-thawed ET cycles (FET) to assess whether day 4 ET improves clinical outcomes. DESIGN: Retrospective study. MATERIALS AND METHODS: Total 759 fresh IVF-ET (660 on day 3 and 99 on day 4) cycles and 261 frozen-thawed ET (231 on day 3 and 30 on day 4) cycles were analyzed retrospectively during the period from Jan. 2006 to Aug. 2007. In this study, to avoid unbiased comparison regard to embryo quality, we selected the ET cycles which have at least one good quality 8-cell stage embryo on day 3. Clinical outcomes were evaluated in day 3 and day 4 ET cycles. Chi-square test or t-test was used for statistical analysis, and P values of < 0.05 were considered significant. RESULTS: There were no differences in clinical parameters between two groups. The mean number of transferred embryos on day 4 ET cycles was significantly lower than that of day 3 ET cycles (3.1 0.7 vs. 3.3 0.7, p < 0.01). In fresh IVF-ET cycles, day 4 ET cycles showed significantly higher IR (26.2% vs. 19.8%, p < 0.01) and CPR (56.6% vs. 45.5%) compared with day 3 ET cycles. In frozen-thawed ET cycles, survival rates and mean number of transferred embryos were similar between two groups. CPR and IR of frozen-thawed day 4 ET cycles were significantly higher than those of frozenthawed day 3 ET cycles (70.0% vs. 45.5% and 31.3% vs. 19.6%, p < 0.05). CONCLUSIONS: Day 4 ET cycles showed higher pregnancy outcomes compared with day 3 ET cycles. These results suggest that day 4 ET more synchronized with in vivo reproductive processes than day 3 ET. Supported by: None.
A-174 IMPROVED IMPLANTATION RATES AND REDUCED MISCARRIAGE RATES DEMONSTRATES THE SUPERIORITY OF DAY 5 EMBRYO TRANSFER. A. Adler, T.-L. Lee, A. Reh, L. Krey, J. Grifo. Fertility Center-Dept. Ob/Gyn, New York University School of Medicine, New York, NY. OBJECTIVE: The availability of more complex media allows for extended embryo culture beyond the cleavage stage in order to learn more about the viability and improve selection of embryos with greater potential for embryo transfer (ET). In this study the rates of clinical pregnancy and implantation as well as those of first trimester miscarriage and associated aneuploidies after the implementation of a day 5 ET were examined. DESIGN: A retrospective chart review of IVF/ICSI cycles at a large university based program. MATERIALS AND METHODS: This study included patients <42 yrs old between 1996–1998 when only day 3 ETs were performed and 2003-2006 when a day 5 ET protocol was fully implemented. Pre-implantation genetic screening/diagnosis cycles were excluded. Clinical pregnancy rates (gestational sac/ET) and miscarriage rates (spontaneous abortion /clinical pregnancy) were also compared between day 3 and
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were transferred. The overall positive hCG rate per ET was 13.2% (9/68). Implantation rate was 5.9% (6/102) and delivery rate was 8.8% (6/68). No multiple pregnancies occurred. A separate analysis of cases with only grade III and only grade IV or V embryos showed a positive hCG rate per ET of 20,7% (6/29) and 6,8%(2/29), respectively. Delivery rates were 13,8%(4/ 29) and 3,4% (1/29), respectively. Only one child showed a major malformation (Interventricular communication) born after the transfer of two grade IV embryos. CONCLUSIONS: The information provided by the present study helps in counseling couples that develop only poor quality embryos on their decision to undergo ET considering that the chance of a delivery is close to 10%. Supported by: None.
A-169 WHICH IS THE BEST DAY FOR EMBRYO TRANSFER? J. A. Agirregoikoa Iza, I. Ausin Hernandez, R. Jimenez Viruega, T. Ganzabal Areso, A. Lopez de Larruzea Orbe, G. Barrenetxea Ziarrusta. Quiron Bilbao, Bilbao, Spain. OBJECTIVE: To evaluate the efficacy of blastocyst transfer among egg recipients, and to compare pregnancy and implantation rates with classical 3rd day transfer. DESIGN: Retrospective clinical study. MATERIALS AND METHODS: 247 oocyte recipients cycles performed between January 2006 and December 2007, carried out in a private ART center were analyzed. Blastocyst stage transfer(5th-6th day) was compared to ‘‘classic’’ 3rd day embryo transfer, comparing pregnancy and multiple pregnancy rates. Selective embryo transfer (SET) was also evaluated. SPSS 16.0 for Mac was used for data analysis. RESULTS: Clinical pregnancy rate was 54,2%. The pregnancy rate was significantly higher in blastocyst transfer group (65,8%) compared to 3rd day transfer (43,1%) (c2¼1,247; p¼0,000). There was no significant difference in multiple pregnancy rates. There was no difference in pregnancy rate between a selective embryo transfer (neither 3rd day nor on blastocyst) and three embryos, but the multiple pregnancy rate was higher when three blastocyst were transferred (c2¼8,823; p¼0,003). CONCLUSIONS: Blastocyst stage embryo transfer appears to be a successful chance in egg donation program. A selective transfer can also reduce multiple pregnancy. Embryo vitrification should further reduce the multiple pregnancy rates. Supported by: None.
A-171 ONLY POOR QUALITY EMBRYOS: TRANSFER OR CANCEL? P. Gonzalez, C. Ortega, P. Donoso, V. Saez, R. Enriquez, I. Carrasco. Reproductive Medicine Unit., Clinica Alemana Stgo. Universidad del Desarrollo, Santiago, Chile. OBJECTIVE: Cleavage stage embryo morphology is currently the gold standard tool for embryo selection since good quality embryos have a higher implantation and delivery rate. In most fertility centers, only high quality embryos are selected for transfer or cryopreservation and poor quality embryos are discarded. Because of ethical committee regulations embryo cryopreservation is not allowed at our Center, thus all the obtained embryos after in vitro fertilization (IVF) are transferred. The aim of this study is to describe the results in cases when only poor quality embryos are available. DESIGN: Retrospective clinical analysis. MATERIALS AND METHODS: A retrospective analysis of IVF/ICSI cycles performed at our center between 1998-2007 was conducted. The inclusion criteria was patients whom only had poor quality embryos transferred, defined as grade III, IV or V according to the classification by Veeck et al1. All the patients underwent ovarian stimulation with GnRH analogues and gonadotropins. After IVF or ICSI, embryo transfer (ET) was performed on day two or three after oocyte retrieval. Embryo quality grading was done immediately before ET. RESULTS: Sixty-eight cycles in sixty-one patients fulfilled the inclusion criteria with a total of 102 embryos (mean female age 35.54.0). ICSI was performed on 57 cycles and IVF in eleven. In two cycles embryos were developed from frozen-thawed oocytes. In 29 cycles only grade III embryos were transferred and in 29 cycles only grade IV or V embryos were replaced. Ten cycles combined grade III, IVor Vembryos. A mean of 1.50.7 embryos
FERTILITY & STERILITYÒ
A-172 DAY 4 EMBRYO TRANSFER IMPROVES IVF OUTCOMES COMPARED WITH DAY 3 EMBRYO TRANSFER. M. K. Kim, S.-H. Lee, H. W. Choi, M. K. Koong, I. O. Song, C. K. Lim. Laboratory of Reproductive Biology and Infertility, Cheil General Hosp. & Women’s Healthcare Ctr., Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Cheil General Hosp. & Women’s Healthcare Ctr., Seoul, Republic of Korea. OBJECTIVE: Even though the majority of embryos are transferred on day 3 following in vitro fertilization (IVF), the morphological assessment of day 3 embryos may not accurately predict further developmental competency and pregnancy potential. We compared the clinical outcomes of day 4 ET cycles with day 3 ET cycles in both fresh IVF-ET and frozen-thawed ET cycles (FET) to assess whether day 4 ET improves clinical outcomes. DESIGN: Retrospective study. MATERIALS AND METHODS: Total 759 fresh IVF-ET (660 on day 3 and 99 on day 4) cycles and 261 frozen-thawed ET (231 on day 3 and 30 on day 4) cycles were analyzed retrospectively during the period from Jan. 2006 to Aug. 2007. In this study, to avoid unbiased comparison regard to embryo quality, we selected the ET cycles which have at least one good quality 8-cell stage embryo on day 3. Clinical outcomes were evaluated in day 3 and day 4 ET cycles. Chi-square test or t-test was used for statistical analysis, and P values of < 0.05 were considered significant. RESULTS: There were no differences in clinical parameters between two groups. The mean number of transferred embryos on day 4 ET cycles was significantly lower than that of day 3 ET cycles (3.1 0.7 vs. 3.3 0.7, p < 0.01). In fresh IVF-ET cycles, day 4 ET cycles showed significantly higher IR (26.2% vs. 19.8%, p < 0.01) and CPR (56.6% vs. 45.5%) compared with day 3 ET cycles. In frozen-thawed ET cycles, survival rates and mean number of transferred embryos were similar between two groups. CPR and IR of frozen-thawed day 4 ET cycles were significantly higher than those of frozenthawed day 3 ET cycles (70.0% vs. 45.5% and 31.3% vs. 19.6%, p < 0.05). CONCLUSIONS: Day 4 ET cycles showed higher pregnancy outcomes compared with day 3 ET cycles. These results suggest that day 4 ET more synchronized with in vivo reproductive processes than day 3 ET. Supported by: None.
A-174 IMPROVED IMPLANTATION RATES AND REDUCED MISCARRIAGE RATES DEMONSTRATES THE SUPERIORITY OF DAY 5 EMBRYO TRANSFER. A. Adler, T.-L. Lee, A. Reh, L. Krey, J. Grifo. Fertility Center-Dept. Ob/Gyn, New York University School of Medicine, New York, NY. OBJECTIVE: The availability of more complex media allows for extended embryo culture beyond the cleavage stage in order to learn more about the viability and improve selection of embryos with greater potential for embryo transfer (ET). In this study the rates of clinical pregnancy and implantation as well as those of first trimester miscarriage and associated aneuploidies after the implementation of a day 5 ET were examined. DESIGN: A retrospective chart review of IVF/ICSI cycles at a large university based program. MATERIALS AND METHODS: This study included patients <42 yrs old between 1996–1998 when only day 3 ETs were performed and 2003-2006 when a day 5 ET protocol was fully implemented. Pre-implantation genetic screening/diagnosis cycles were excluded. Clinical pregnancy rates (gestational sac/ET) and miscarriage rates (spontaneous abortion /clinical pregnancy) were also compared between day 3 and
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