Morphological aspect of embryos obtained after fertilization in vitro for male factor or ICSI

OBJECTIVE: In order to study the eventual impact on fertilization and embryo characteristics of the microinjection procedure we compared the quality of the embryos obtained by ICSI with those of in vitro fertilization with male factors (MF IVF). MATERIAL AND METHODS: One hundred thirty-four cycles of IVF treatment (group 1) were selected with oligoasthenozoospermia according to WHO criteria with a total number of motile spermatozoa between 500,000 and 1 million. One thousand eighty-eight mature oocytes and 486 embryos were obtained. One hundred forty-three cycles of intracytoplasmic sperm injection (group 2) were performed in couples whose in vitro fertilization was imparticable because of extreme sperm impairment. One thousand one hundred forty-seven mature oocytes were injected and 626 embryos were obtained. RESULTS: In group 1, the pregnancy rate per embryo transfer and the implantation rate were respectively 22.7% and 12.3%. In group 2, the pregnancy rate per embryo transfer was 37.1% and the implantation rate was 17%. The statistical analysis of the embryos obtained in the two different groups did not demonstrate any difference in the distribution of the more regular and less fragmented embryos (group A) and those of the more irregular and fragmented embryos (group B). No statistical difference was demonstrated in the chronology of the division of these embryos (groups 1 and 2). CONCLUSION: The pregnancy rate by cycle and by transfer reported by ICSI (p < 0.003 and p < 0.015 respectively) could be related to a significantly higher mean number of transferred embryos (2.65 vs 2.02) in probable relation with a higher cleavage rate (p < 0.00001).     

Stress and marital satisfaction among women before and after their first cycle of in vitro fertilization and intracytoplasmic sperm injection

OBJECTIVE: To compare the value of 17 IVF variables, including a new mean score of transferred embryos (MSTE), in predicting pregnancy rate. DESIGN: Retrospective study. SETTING: Private IVF unit. PATIENT(S): Women who underwent 10,000 embryo transfers. MAIN OUTCOME MEASURE(S): Duration of infertility, type of infertility, female age, rank of IVF attempt, type of ovarian treatment, progesterone level, sperm count, sperm motility, sperm morphology, number of retrieved oocytes, number of mature oocytes, maturation rate, number of embryos obtained, fertilization rate, number of transferred embryos, cumulative embryo score (CES), mean score of transferred embryos (MSTE), and pregnancy rate. RESULT(S): Outcome of IVF-ET was significantly correlated with female age, type of infertility, number of retrieved oocytes, number of mature oocytes, maturation rate, embryos obtained, fertilization rate, transferred embryos, CES, and MSTE. Multivariate analysis demonstrated that MSTE was a better predictor of pregnancy than the number of transferred embryos and female age. CONCLUSION(S): Embryo quality is the best predictor of pregnancy. The embryo score described herein should be used in IVF-ET programs to choose the best embryos for transfer.     

Adverse effects of hepatitis B virus on sperm motility and fertilization ability during IVF

The consequences of hepatitis B virus (HBV) infection for fertility are still unclear. Spermatozoa with decreased motility have been reported in HBV-infected patients. It has been demonstrated in vitro that HBV S protein has adverse effects on human sperm function with consequences for fertilization. In a case-control study design, 32 IVF cycles in couples with male HBV infection were compared with 64 cycles in non-infected couples, matched for age, time period, cycle rank and sperm parameters on the day of oocyte retrieval. Sperm motility before selection was significantly reduced in the HBV group (36.3 ± 11.6% versus 45.3 ± 14.4%,P = 0.003). A low fertilization rate (LFR) was more frequently observed in the HBV group (34.4% versus 15.6%, P = 0.036) and was associated with a decreased number of embryos available for transfer, although embryo quality on day 2 or 3 was not different.Implantation and pregnancy rates were comparable between groups. This study shows that HBV has a deleterious effect on sperm motility in vivo and that couples whose male partner is infected have a higher risk of LFR after IVF, a risk which is independent from the initial sperm motility.     

低氧对体外受精-胚胎移植胚胎发育潜能的影响

目的:探讨低氧环境(体积分数5%O2)对体外受精-胚胎移植(in vitro fertilization-em-bryo transfer,IVF-ET)中胚胎发育潜能及临床结局的影响。方法:将接受IVF-ET长方案治疗的265名不孕症患者随机分为研究组(n=156):患者取卵后受精及整个胚胎培养过程全部在三气培养箱(体积分数5%O2)中进行,对照组(n=109):患者取卵后受精及整个胚胎培养过程全部在常规培养箱(体积分数20%O2)内进行,所有患者均移植授精第2日或第3日胚胎。比较组间受精率、正常受精率、卵裂率、正常卵裂率、优质胚胎率、可用胚胎率、生化妊娠率、临床妊娠率和异位妊娠率。结果:组间患者年龄、不孕年限、体质量指数、基础性激素、获卵数、成熟卵数、授精至移植时间和移植胚胎数均无统计学差异(P>0.05)。研究组受精率(84.4%)、正常受精率(72.0%)、卵裂率(97.6%)、优质胚胎率(43.3%)和可用胚胎率(72.5%)均显著高于对照组(分别为80.8%、68.7%、96.1%、35.1%、59.5%)(P<0.01或P<0.05),研究组与对照组正常卵裂率(97.7%vs 98.0%)、生化妊娠率(50.0%vs 39.4%)、临床妊娠率(44.9%vs 35.8%)、异位妊娠率(8.6%vs 12.8%)均无统计学差异(P>0.05)。结论:低氧环境(5%O2)似乎能够提高胚胎的发育潜能,获得更多优质胚胎和可用胚胎。     

薄型子宫内膜新鲜胚胎和冻融胚胎移植妊娠结局比较

目的探讨在薄型子宫内膜患者中新鲜胚胎移植与冻融胚胎移植(FET)妊娠结局的差异。方法回顾性分析接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗采用长方案胚胎移植h CG注射日与冻融周期胚胎移植内膜转化日的内膜厚度≤7 mm的患者共592个周期的临床资料。将移植周期按胚胎是否冻融分为新鲜胚胎移植组(n=173)和FET组(n=419)。比较组间的胚胎种植率、临床妊娠率、流产率、多胎率和异位妊娠率有无差异。结果新鲜胚胎移植组患者平均移植胚胎(2.1±0.4)枚,与FET组患者平均移植胚胎(2.1±0.5)枚比较,组间有统计学差异(P0.05);按照移植胚胎数分为3个亚组,新鲜胚胎移植组1枚胚胎者,妊娠率为7.7%,2枚者为30.2%,3枚者为23.8%;FET组1枚胚胎者15.6%,2枚者为34.9%,3枚者为41.6%,新鲜胚胎移植组与FET组间差异均无统计学意义(P0.05)。组间着床率、流产率、异位妊娠率等结果也均无统计学差异(P0.05)。移植3枚胚胎新鲜组多胎率(80.0%)高于FET组(29.7%)(P0.05)。新鲜胚胎移植组多胎率3个亚组间有统计学差异(P0.05),FET组妊娠率和流产率3个亚组间均有统计学差异(P0.05)。将移植胚胎数作为协变量,纳入Logistics回归模型对结果变量进行分析,说明周期类型与临床妊娠率间无显著相关性(OR=0.726,95%CI=0.504~1.104)。结论子宫内膜厚度≤7 mm的薄型内膜患者新鲜胚胎移植和FET妊娠结局相似,选择新鲜周期移植不影响妊娠结局并可缩短治疗周期,降低总费用。     

Evaluation of a synthetic serum substitute to replace fetal cord serum for human oocyte fertilization and embryo growth in vitro

A comparison was made between a serum substitute. UltroSer G (Gibco, Ghent, Belgium) (2%) (medium B) and 10% human fetal cord serum (medium A), as regards their ability to support 1-cell and 2-cell mice embryo development in vitro. Sixty percent and 56% of the 1-cell embryos reached the expanded blastocyst stage when cultured in media A and B, respectively. Eighty-four percent and 88% of 2-cell embryos reached the expanded blastocyst stage when cultured in media A and B, respectively. A prospective randomized study was then performed to evaluate this synthetic serum substitute in human in vitro fertilization. Among 141 ovum pick-up (OPU), oocytes retrieved in 74 cases were processed in medium A and oocytes retrieved in 67 others in medium B. In media A and B, the fertilization rate was 67% and 44.3% respectively, and the pregnancy rate/OPU 23% and 9%, respectively. The pregnancy rate/transfer was 28.8% and 12.2% respectively, and the implantation rate/transferred embryo 9.5% and 4.2%. In the human sperm survival assay, the vitality and residual motility after 24 hours of incubation were significantly lower in medium B. In conclusion, UltroSer G successfully sustained the development in vitro of mouse embyros. However in human, it reduced sperm survival, oocyte fertilization, and embryo viability.     

Statistical analysis of factors affecting fertilization rates and clinical outcome associated with intracytoplasmic sperm injection

OBJECTIVE: To identify and evaluate the statistically significant predictors of intracytoplasmic sperm injection (ICSI) fertilization rates and clinical pregnancy in a single population using appropriate statistical techniques. DESIGN: Retrospective study. SETTING: Fertility and Endocrinology Center, University of Washington Medical Center, Seattle, Washington. PATIENT(S): Four hundred forty-one patients undergoing their first attempt at IVF-ICSI from January 1, 1999, to May 21, 2001. INTERVENTION(S): Each ICSI procedure for an individual patient was performed by a single operator. Sperm parameters, oocyte age, culture condition, ICSI technique, and ICSI operator were assessed as variables influencing the fertilization rate. We also assessed the impact of patient age, serum E(2) concentration on the day of hCG administration, embryo quality, and number of embryos transferred on the probability of achieving a clinical pregnancy. MAIN OUTCOME MEASURE(S): Fertilization rate and clinical pregnancy. RESULT(S): The 2 pronuclei (2PN) rate was significantly correlated with sperm motility, and there were significant differences in the 2PN rates among the ICSI operators. There was no difference in the 2PN rate among different sperm types or among the eight laboratory incubators or whether the eggs were cultured individually or in groups. Patient age, serum E(2) concentration on the day of hCG administration, embryo quality, and number of embryos transferred were all statistically significant predictors of clinical pregnancy. CONCLUSION(S): In our program, sperm motility and ICSI operator are the two most important predictors for the ICSI fertilization rate in vitro. Patient age, serum E(2) concentration on the day of hCG administration, embryo quality, and number of embryos transferred were all statistically significant predictors of clinical pregnancy.     

Intracytoplasmic sperm injection is not associated with poor outcome in couples with normal semen parameters and previous idiopathic fertilization failure in conventional in vitro fertilization

In this study, we compared the results of intracytoplasmic sperm injection (ICSI) in patients with normal semen parameters and a history of failed fertilization with conventional IVF (study group) and in patients with male factor infertility (control group). Patient and cycle characteristics were similar in both groups. The mean number of retrieved and metaphase II oocytes, fertilized oocytes, embryos developed, embryos transferred and the number of cycles with fertilization failure also did not differ between groups. Although differences were not statistically significant, pregnancy rate (56.3% vs. 31.5%), implantation rate (14.2% vs. 12%) and ongoing pregnancy rate (37.5% vs. 17.7%) per embryo transfer were higher in the study group than the ones in the control group. We concluded that previous idiopathic fertilization failure with conventional IVF is not associated with poor outcome in subsequent ICSI treatment.     

常规IVF中受精失败相关因素及后续处理结果分析

目的:分析常规IVF受精失败原因,以进一步提高IVF受精率。方法:回顾性分析常规IVF中受精率低下或受精失败患者的各种因素及后续处理结果。结果:438个常规IVF取卵周期中,受精率≤25%的周期30个(A组)(6.85%)。其中12个周期第1日行补救性ICSI或重复IVF,最终共20个周期进行了胚胎移植,但均未获得临床妊娠。与受精率正常的周期(B组)相比,A组精子密度、活率、a级精子比例、前向运动精子比例(PMS)及分离后的精子活率、PMS比例、精子密度等均显著降低(P均<0.05)。组间的获卵数无明显差别,但A组MI期及GV期卵的数量明显高于B组(P<0.01)。其他受精失败因素包括对精子因素导致受精失败的7例在随后的周期进行ICSI,5例获得临床妊娠。结论:受精失败的原因是多方面的,但精液各参数下降及卵子发育不成熟是其主要原因;第1日行补救性ICSI或重复IVF的妊娠结局差;对于精子因素造成的受精失败,在以后的周期中行ICSI能获得理想的结果。     

Prediction of in vitro fertilization outcome by sperm penetration assay with TEST-yolk buffer preincubation.

OBJECTIVE: To evaluate sperm penetration assay (SPA) value as a screening tool before in vitro fertilization (IVF). DESIGN: Follow-up study comparing sperm variables and IVF outcome. SETTING: Infertile couples in an academic research environment. PATIENTS, PARTICIPANTS: Two hundred forty-one infertile couples scheduled for IVF. INTERVENTIONS: Sperm penetrating assay with cold Tes-TRIS (TEST) Yolk buffer semen preincubation and IVF. MAIN OUTCOME MEASURES: Percent of egg penetration recoded into poor and good category (0% to 20%, 21% to 100%) and compared with fertilization, embryo transfer, and pregnancy rate (PR) in IVF, as well as sperm count motility and morphology. RESULTS: Sperm penetrating assay predicted fertilization with a high negative (74%) and positive (82%) predictive rate and good specificity value (0.96). One of 31 patients in the poor SPA category (3%) fertilized less than 50% of eggs; no pregnancy occurred. In the good SPA category, 87 of 210 patients (41%) fertilized greater than or equal to 50% of eggs with 34.3% PR. Sperm penetrating assay correlated better with fertilization rate than did sperm count and motility but not morphology. CONCLUSIONS: Sperm penetrating assay is a useful screening assay before IVF together with sperm morphology.     

Levels of Tektin 2 and CatSper 2 in normozoospermic and oligoasthenozoospermic men and its association with motility, fertilization rate, embryo quality and pregnancy rate

Purpose

To compare the expression profiles of Tektin 2 and CatSper 2 motility proteins in the spermatozoa of normozoospermic and oligoasthenozoospermic men and determine its correlation with sperm motility, fertilization rate, embryo quality and pregnancy rate.

Methods

Tektin 2 and CatSper 2 protein expression was studied using Western Blotting and immunofluorescence. Tektin 2 and CatSper 2 protein levels were quantified by ELISA.

Results

Oligoasthenozoospermic men were found to have lower fertilization rates, poor embryo quality and lower pregnancy rates as compared to normozoospermic men. The levels of Tektin 2 and CatSper 2 are significantly lower in spermatozoa of oligoasthenozoospermic men as compared to normozoospermic controls; the levels were also lower in immotile fraction as compared to motile fraction of spermatozoa obtained from normozoospermic individuals. The levels of Tektin 2 and CatSper 2 were higher in individuals demonstrating sperm motility >60 % as compared to sperm motility <30 %. Tektin 2 but not CatSper 2 levels were positively associated with fertilization rate, embryo quality and pregnancy rate.

Conclusion

Levels of Tektin 2 and CatSper 2 proteins are positively associated with sperm motility parameters. Measurements of Tektin 2 levels can be correlated with the clinical outcome of ICSI.     

Die ersten Ergebnisse mit dem intratubaren Embryotransfer

Summary The intratubal transfer of pronucleus or early cleavage stage embryos (2–8-cell stage) is a new method in the treatment of human infertility. Following transvaginal sonographic oocyte retrieval in vitro fertilization is performed and the fertilized (pronucleus-stage) or embryos are transferred into the tube by laparoscopy. In comparison to GIFT (intratubal gamete transfer) fertilization under in vitro conditions offers the advantage that the success of the fertilization process can be examined. Therefore, this method can give important diagnostic information — especially in cases of poor sperm quality or unexplained infertility. After fertilization in vitro and transfer into the tube the embryone development occurs in the physiological milieu of the oviduct. Up to now the new procedure was performed in 40 patients with male factor or unexplained infertility. In 11 cases (28%) a pregnancy could be achieved. One abortion, but no ectopic pregnancy was observed. No difference in the pregnancy rates could be observed between the transfer of pronucleus stage and the early cleavage stage embryos. This methode combinds the advantage of IVF and GIFT and offers a successful procedure for the treatment of infertility.      

Higher pregnancy rates after in vitro fertilization and embryo transfer in cases with sperm defects

One hundred thirty-three couples were classified into four groups according to previous sperm analyses. These couples underwent 237 in vitro fertilization trials that led to 46 clinical pregnancies (19.4%/trial). Clinical pregnancy rate per laparoscopy of the group with male defects was significantly higher than that of the normospermic couples (25 versus 14%, P less than 0.05). The fertilization rate was significantly reduced only if two sperm anomalies were present (P less than 0.05). However, the mean number of embryos transferred did not differ significantly among the four groups, but the proportion of trials without transfer was increased with regard to the severity of sperm defect. Implantation rate per embryo in cases of triple transfer was significantly higher in the group with sperm anomalies as compared with the normospermic cases (18 versus 10%, P less than 0.02). Correction of the male problem through IVF treatment allows higher female fertility to be disclosed in these cases.     

Application of vitrification to human embryo freezing

To solve the problem of multiple pregnancies during the in vitro fertilization (IVF) and embryo transfer procedure, excess embryos must be cryopreserved for embryo transfer in future. We applied the vitrification method to cryopreservation of human embryos. A total of 31 frozen-thawed embryo transfer cycles were analyzed at the Yamagata University Hospital, Yamagata, Japan. The patients were introduced to IVF treatment and had an excess of valuable embryos to be frozen after the transfer of three fresh embryos that did not result in establishing a pregnancy. Excess human 8- to 16-cell stage embryos were exposed to vitrification solution and then frozen in liquid nitrogen. The cryoprotectant was removed by washing the embryos in media containing different concentrations of cryoprotectant. Three days after LH surge and/or 2 days after ultrasonographic ovulation the embryos were transferred. The rate of poor quality embryos significantly increased and the rate of good quality embryos decreased after thawing the embryos frozen by the vitrification method. In menstrual cycles with good quality embryo transfer, a higher rate of pregnancies was established than in the cycles in which fair or poor quality embryos were the highest grade of embryos transferred into the uterus. In total, 5 pregnancies were established from 31 embryo tansfers; 4 pregnancies were in cycles associated with the transfer of good quality embryos, and 1 pregnancy was in a cycle in which the highest grade of embryo was fair. When compared with slow embryo freezing methods, vitrification has marked advantages for clinical application in terms of cost and time. Vitrification will be an alternative method for embryo freezing.     

两种活动精子分离法的体外受精结局比较

目的:评价Percoll密度梯度法和上游法两种活动精子分离方法在体外受精-胚胎移植(IVF-ET)中的效果。对象和方法:以本中心1999年6月～2001年1月完成的362个IVF-ET治疗周期为研究对象,回顾性地比较了两种活动精子分离方法的受精率、卵裂率、胚胎发育状况和临床妊娠结局。结果:Percoll法和上游法两组比较,受精率分别为71.8％和71.2％,卵裂率88.4％和89.2％,差异均不显著(P>0.05)。取卵后d2,两组胚胎的细胞数分别为2.7±1.3个和3.0±1.0个,差异不显著(P>0.05);两组<20％碎片的优良胚胎率分别为77.6％和65.9％,差异具有统计学意义(P<0.01)。两组临床妊娠率分别为43.7％和36.6％,妊娠周期的活婴出生率分别为70.3％和60.7％,均具有显著性差异(P<0.01)。结论:在IVF-ET治疗不育与不孕中,Percoll法分离的活动精子临床妊娠结局优于上游法。     

脱氢表雄酮在卵巢储备功能低下高龄患者体外受精/卵胞质内单精子注射-胚胎移植中的应用研究

目的探讨口服脱氢表雄酮(DHEA)辅助治疗在卵巢储备功能低下(DOR)高龄患者体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)中的临床疗效。方法选取行IVF/ICSI助孕治疗的DOR患者152例,所有患者均行2次及以上助孕周期,前一周期为未加用药周期(治疗前组),本次为用药周期(治疗后组),进行自身用药前后对照分析。比较口服DHEA后卵巢储备功能的变化情况,同时比较是否加用DEHA患者IVF/ICSI-ET的临床治疗参数、实验室参数及临床结局。结果 (1)口服DHEA后患者血清抗苗勒管激素(AMH)、硫酸脱氢表雄酮(DHEA-s)、睾酮(T)及窦卵泡计数(AFC)较用药前升高,卵泡刺激素(FSH)较前下降,差异有统计学意义(P0.05);(2)治疗后组h CG注射日E2及孕酮(P)水平、获卵数、受精率、可移植胚胎数、胚胎种植率及临床妊娠率高于治疗前组,Gn总用量、Gn使用时间、周期取消率低于治疗前组,差异有统计学意义(P0.05)。结论 DOR的高龄患者在进入IVF/ICSI周期前口服DHEA可改善其卵巢储备功能及助孕结局。     

胚胎移植12 491个周期的临床效果及影响因素分析

目的 探讨体外受精-胚胎移植(IVF-ET)治疗不孕的临床效果及其影响因素.方法 回顾性分析北京大学第三医院2005至2007年间,12 491个胚胎移植周期(其中6832个周期为新鲜胚胎移植周期,5659个周期为冻融胚胎移植周期)的临床资料,对影响妊娠结局的因素进行单因素和多因素分析.结果 新鲜胚胎移植周期临床妊娠率为32.99%(2254/6832),活产率为25.75%(1394/5413),早期流产率为9.36%(211/2254),围产儿出生缺陷率为1.45%(25/1722).年轻(20～24岁)患者新鲜胚胎移植周期临床妊娠率高达42.25%(60/142).单纯男方因素不孕患者的临床妊娠率(40.10%,476/1187)明显高于单纯女性因素不孕患者(31.55%,1168/3702)和双方因素不孕患者(31.39%,610/1943);首次接受IVF-ET治疗者的临床妊娠率(34.63%,1831/5287)高于多次接受IVF-ET治疗者;常用的4种IVF-ET超促排卵(COH)治疗方案中,接受促性腺激素释放激素激动剂(GnRH-a)超长方案和长方案治疗者临床妊娠率分别为51.72%(30/58)和36.88%(489/1326),明显高于GnRH-a短方案(32.05%,1703/5313)和促性腺激素释放激素拮抗剂(GnRH-ant)方案(22.12%,23/104),差异有统计学意义(P<0.05).多因素logistic分析证实,年龄、获卵数和COH治疗周期数对IVF-ET治疗后妊娠结局的影响有统计学意义,而年龄是最主要的影响因素.治疗过程中,中重度卵巢过度刺激综合征(OHSS)的发生率为3.68%(321/8720),异位妊娠率为6.12%(138/2254),早期流产率为9.36%(211/2254).冻融胚胎移植周期临床妊娠率(38.08%,2155/5659),高于新鲜胚胎移植周期(32.99%,2254/6832),两者比较,差异有统计学意义(P<0.001);多胎妊娠率为27.70%(597/2155),早期流产率为8.96%(193/2155),异位妊娠率为2.23%(48/2155).结论 IVF-ET用于不孕症治疗,临床妊娠率和活产率高,是一种安全、有效的助孕治疗方法;年龄、卵巢反应性是影响治疗结局的主要因素;冻融胚胎移植周期临床妊娠率与新鲜胚胎移植周期比较,无明显差异,并可有效提高单次促排卵周期的累计妊娠率.     

Factors influencing the success rate of human embryo freezing in an in vitro fertilization and embryo transfer program

Certain factors influencing the success of embryo cryopreservation were analyzed from 124 cycles of in vitro fertilization and embryo transfer (IVF-ET) program in which 193 1- or 2-day embryos were frozen and had already been thawed. There were 100 transfers of one or two surviving embryos from which 26 pregnancies were initiated. Several factors significantly influenced embryo survival after thawing. They were: the developmental stage of frozen embryos; the appearance of the embryo at the time of freezing; and the mode of ovarian stimulation in the IVF cycle. The pregnancy rate after frozen-thawed embryo transfer was higher with 4-cell frozen embryos than with embryos at all other stages combined. There were also tendencies for the pregnancy rate to be higher if a spontaneous luteinizing hormone surge occurred in the transfer cycle or if the duration of embryo storage did not exceed 1 to 2 months. The results obtained support a new policy in IVF-ET programs: it should be advantageous for the sterile couple if the immediate fresh embryo transfer is only performed with the categories of embryos that demonstrate a poor aptitude for survival following cryopreservation procedures.     

Day 3 embryo transfer may have better pregnancy outcomes in younger than 35-year-old patients with poor ovarian response

Objective

To explore the pregnancy outcomes of embryo transfer with D2 or D3 embryos in patients with poor ovarian response.

Methods

The pregnancy outcomes of 620 patients who had poor ovarian response and underwent the first in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. Of the 620 cycles, all available fresh D2 embryos were used in 365 cycles (day 2 embryo transfer) and all available fresh D3 embryos were used in 255 cycles (day 3 embryo transfer) without superfluous embryos for freezing.

Results

There was a significant difference in clinical pregnancy rate between day 2 (32.73 %) and day 3 (50.83 %) embryo transfer in younger than 35-year-old patients, but no significant differences in implantation rate, live birth rate and spontaneous abortion rate (P > 0.05). There were similar pregnancy outcomes between day 2 and 3 embryo transfer in 35-year and older patients.

Conclusion

D3 embryo transfer may have better pregnancy outcomes in younger than 35-year-old patients with poor ovarian response.     

Improved human zygote development in a modified Ham's F10 medium in vitro

Purpose: Our purpose was to determine the effect of modified Ham's F10 media with and without glucose, hypoxanthine, phosphate, and transition metals (MM) on human embryo development. Methods: Patients with at least one zygote were randomized by alternate assignment to one of the treatment groups. The treatment groups were as follows: normal Hams F10, MM, and MM with 0.5 mM glucose (LGMM). Patients were undergoing in vitro fertilization and embryo transfer or frozen-thawed embryo transfer. Zygotes (fresh and frozen-thawed) were incubated in one of three media for 24 hr before transfer. The groups were compared with respect to embryo quality, number of embryos transferred, age of the patients, clinical pregnancy rate, and implantation rate. Results: The clinical pregnancy rate and the implantation rate were significantly higher in the group of patients whose zygotes were cultured in MM. LGMM did not appear to improve the pregnancy outcome compared to normal Ham's F10. However, the quality of the embryos cultured in MM or LGMM appears to be superior to the normal Ham's F10 with respect to the number of excellent and good-quality embryos and embryos without fragments. Conclusion: A modified Ham's F10 medium (MM) without added glucose appears to be superior to normal Ham's F10 for culture of human zygotes for embryo transfer.Presented at the Forty-Third Annual Meeting of the Society for Gynecological Investigation, March 20–23, 1996, Philadelphia, Pennsylvania.