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1.
Söderström-Anttila V Vilska S Mäkinen S Foudila T Suikkari AM 《Human reproduction (Oxford, England)》2003,18(9):1858-1863
BACKGROUND: High pregnancy rates have been noted after oocyte donation (OD). Multiple pregnancies should be avoided, because oocyte recipients have an increased risk of obstetric complications. METHODS: We analysed our OD results from 2000-2001 when elective single embryo transfer (eSET) was introduced as a recommended policy for all recipients if at least one good quality embryo was available. The results were compared with those achieved in 1998-1999, when usually two embryos were transferred (double embryo transfer, DET). Between 1998 and 2001, 100 healthy women donated oocytes and 135 fresh embryo transfers were carried out. The mean age of the donors was 31 years and that of the recipient women was 35 years. RESULTS: The proportion of eSET of all OD transfers was 17.1% in 1998-1999 and 61.0% in 2000-2001. There was no statistically significant difference in clinical pregnancy (36.8 versus 45.8%) and delivery rates (31.6 versus 33.9%) per embryo transfer between the two time periods. The proportion of twins declined from 29% (1998-1999) to 10% (2000-2001). The delivery rate was similar after eSET and DET (32.6 versus 32.1% respectively). CONCLUSIONS: By increasing the proportion of eSETs it is possible to reduce the number of twins without affecting delivery rates in oocyte recipients. 相似文献
2.
Tiitinen A Unkila-Kallio L Halttunen M Hyden-Granskog C 《Human reproduction (Oxford, England)》2003,18(7):1449-1453
BACKGROUND: It is unclear how the implementation of elective single embryo transfer in clinical practice would affect clinical pregnancy and delivery rates and multiple birth rates. METHODS: This retrospective study analysed 1871 IVF/ICSI cycles carried out from 1997 to 2001 in the IVF programme of a single university infertility clinic. RESULTS: The number of elective single embryo transfers increased from 11 to 56%. At the same time the clinical pregnancy rate was relatively stable; mean 34.0% (range 28-42). The number of embryos per embryo transfer decreased from 1.8 to 1.3. The multiple pregnancy and delivery rates dropped markedly from 25 to 7.5% and from 25 to 5% respectively. CONCLUSIONS: An elective single embryo transfer programme can be adopted in daily practice that decreases the twinning rate to <10% and does not affect the overall pregnancy rate. 相似文献
3.
Martikainen H Orava M Lakkakorpi J Tuomivaara L 《Human reproduction (Oxford, England)》2004,19(6):1364-1366
BACKGROUND: Single embryo transfer (SET) after IVF/ICSI has been shown to result in an acceptable pregnancy rate in selected subjects. In our unit, SET is routinely carried out among women under the age of 36 in the first or second treatment cycle when a top-quality embryo is available. In order to define further the selection criteria for SET, we have analysed the outcome of elective SET (eSET), including the cumulative pregnancy rate after frozen embryo transfers, performed in the years 2000-2002 in the Oulu Fertility Center. METHODS: During the study period, a total of 1271 transfers were performed, and in 468 cycles SET (39% of all transfers) was carried out. Of the SET cycles, in 308 cases a top-quality embryo was transferred on day 2 and extra embryos were frozen. Of these eSET cycles, ICSI was carried out in 87 cycles (28%). RESULTS: The overall clinical pregnancy rate per transfer was 34.7% in the eSET cycles. In the eSET ICSI cycles, the clinical pregnancy rate was significantly higher than in the corresponding IVF cycles (50.6 versus 28.5%, P < 0.001). The cumulative pregnancy rate per patient after fresh and frozen embryo transfers was also significantly higher after ICSI (71.2 versus 53.4%, P < 0.01). CONCLUSIONS: A high cumulative pregnancy rate per oocyte retrieval can be achieved after eSET in daily clinical practice. The implantation rate of fresh top-quality embryos in the ICSI cycles was significantly higher than in the IVF cycles, possibly due to more successful selection of the embryo for embryo transfer on day 2 after ICSI. In addition, our data suggest that embryo quality is a more important determinant of outcome than the age of the woman. 相似文献
4.
E Van Royen K Mangelschots D De Neubourg M Valkenburg M Van de Meerssche G Ryckaert W Eestermans J Gerris 《Human reproduction (Oxford, England)》1999,14(9):2345-2349
In most in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) programmes approximately one ongoing pregnancy in three is multiple. The need to characterize embryos with optimal implantation potential is obvious. We retrospectively examined all of 23 double transfers resulting in ongoing twins, occurring between January 1, 1996 and May 19, 1997. Characteristics of these top quality embryos were absence of multinucleated blastomeres, four or five blastomeres on day 2, seven or more cells on day 3, and =20% anucleated fragments. In a subsequent series of 400 IVF/ICSI cycles (out of which 372 were selected for embryo transfer) from May 20, 1997 to July 31, 1998, only women <38 years of age had multiple pregnancies: after 221 transfers of two embryos, 45/116 (39%) were multiple, and after 77 transfers of >2 embryos, 11/31 (35%) were multiple. We applied our top quality criteria to the 221 double transfers: 106 transfers with two top embryos resulted in 65 (63%) ongoing pregnancies with 37 (57%) twins, 65 transfers with one top embryo in 38 (58%) ongoing pregnancies with eight (21%) twins. In the group without top embryos, 12/52 (23%) ongoing singletons occurred, with no twins. The corresponding ongoing implantation rates were 49, 35 and 12%. This analysis suggests that single embryo transfer with an acceptable pregnancy rate might be considered if a top quality embryo is available. 相似文献
5.
J Gerris D De Neubourg K Mangelschots E Van Royen M Van de Meerssche M Valkenburg 《Human reproduction (Oxford, England)》1999,14(10):2581-2587
A prospective randomized study comparing single embryo transfer with double embryo transfer after in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) was carried out. First, top quality embryo characteristics were delineated by retrospectively analysing embryos resulting in ongoing twins after double embryo transfer. A top quality embryo was characterized by the presence of 4 or 5 blastomeres at day 2 and at least 7 blastomeres on day 3 after insemination, the absence of multinucleated blastomeres and <20% cellular fragments on day 2 and day 3 after fertilization. Using these criteria, a prospective study was conducted in women <34 years of age, who started their first IVF/ICSI cycle. Of 194 eligible patients, 110 agreed to participate of whom 53 produced at least two top quality embryos and were prospectively randomized. In all, 26 single embryo transfers resulted in 17 conceptions, 14 clinical and 10 ongoing pregnancies [implantation rate (IR) = 42.3%; ongoing pregnancy rate (OPR) = 38.5%] with one monozygotic twin; 27 double embryo transfers resulted in 20 ongoing conceptions with six (30%) twins (IR = 48.1%; OPR = 74%). We conclude that by using single embryo transfer and strict embryo criteria, an OPR similar to that in normal fertile couples can be achieved after IVF/ICSI, while limiting the dizygotic twin pregnancy rate to its natural incidence of <1% of all ongoing pregnancies. 相似文献
6.
Elective transfer of one embryo results in an acceptable pregnancy rate and eliminates the risk of multiple birth. 总被引:6,自引:0,他引:6
S Vilska A Tiitinen C Hydén-Granskog O Hovatta 《Human reproduction (Oxford, England)》1999,14(9):2392-2395
To avoid multiple pregnancies without compromising pregnancy rates (PR) is a challenge in assisted reproduction. We have compared pregnancy results among 74 elective one-embryo transfers (group 2) and 94 transfers where only one embryo was available (group 1). All the fresh embryo cycles during 1997 in two clinics in Helsinki were analysed, and cumulative PR among these couples after frozen-thawed embryo transfers up to June 1998 were counted. In group 2, where at least two embryos were available for transfer, and only one was transferred on day 2 or 3, the PR per embryo transfer was 29.7%. In group 1, the PR per embryo transfer was 20.2%. In group 2, the cumulative PR after frozen-thawed embryo transfers was 47.3% per oocyte retrieval. Over the same time, 742 two-embryo transfers were carried out. The PR per embryo transfer was 29.4% in these subjects, but 23.9% of these pregnancies were twins. The implantation rates, as well as the PR, were highest when the embryos were at the four- to five-cell stage on day 2 (35.8 versus 9.7% compared with the two- to three-cell stage, P < 0.001) or at the six- to eight-cell stage on day 3 (45.5%). The PR per embryo transfer was higher when a grade 1 or 2 embryo was transferred compared with a grade three embryo (34. 0 and 26.7% versus 8.8% respectively, P < 0.05). In women 35 years or younger, the PR per elective one-embryo transfer was 32.8%. The corresponding figure in women older than 35 years was 18.8%. On the basis of these results, elective one-embryo transfer can be highly recommended, at least in subjects who are younger than 35 years of age, and who have grade one or grade two embryos available for transfer. 相似文献
7.
van Montfoort AP Dumoulin JC Land JA Coonen E Derhaag JG Evers JL 《Human reproduction (Oxford, England)》2005,20(2):433-436
BACKGROUND: Elective single embryo transfer (eSET), applied in the first or second IVF cycle in young patients with good quality embryos, has been demonstrated to lower the twin pregnancy rate, while the overall pregnancy rate is not compromised. It is as yet unclear whether eSET could be the preferred transfer policy in all treatment cycles, or that it should be restricted to the first or first two cycles. METHODS: eSET policy (when two or more embryos were available, at least one of them being of good quality) was offered to patients younger than 38 years in the first three treatment cycles. Retrospectively, treatment cycle outcome was studied. RESULTS: In 326 patients, 586 treatment cycles were performed (326 first, 168 second and 92 third treatment cycles). In 65 cycles (11%), eSET could not be applied because there was either no fertilization, or only one embryo available. In the remaining 521 cycles, eSET was performed in 111 cycles (19%), while in 410 cycles, no good quality embryo was available resulting in the transfer of two embryos (double embryo transfer, DET). No significant differences in ongoing pregnancy rates after transfer of fresh embryos were observed between eSET and DET in the first (both 33%), second (36 and 23%, respectively) and third treatment cycles (20 and 24%, respectively). In significantly more eSET cycles compared to DET cycles, could embryos be frozen. This resulted in a significantly higher cumulative pregnancy rate after eSET compared to DET. CONCLUSIONS: In patients younger than 38 years with at least one top quality embryo, eSET can be the transfer policy of choice in at least the first three treatment cycles, since the pregnancy rates obtained in each treatment cycle are comparable to those after DET. 相似文献
8.
Early cleavage predicts the viability of human embryos in elective single embryo transfer procedures 总被引:13,自引:0,他引:13
Salumets A Hydén-Granskog C Mäkinen S Suikkari AM Tiitinen A Tuuri T 《Human reproduction (Oxford, England)》2003,18(4):821-825
BACKGROUND: The reduction of multiple pregnancies by using elective single embryo transfers (eSET) requires critical and careful selection of the embryo for transfer. The current study was undertaken to assess whether early cleavage could be used as a marker of embryo competence in eSET procedures. METHODS: The study included analysis of 178 eSET procedures. All embryos were checked for early cleavage at 25-27 h post insemination or ICSI. The embryos that possessed two cells at 25-27 h post insemination or ICSI were designated as 'early cleavage' (EC) embryos and those that had not yet cleaved were classified as 'no early cleavage' (NEC) embryos. Selection of the embryo for transfer was based on embryo morphology and growth rate on day 2 and not early cleavage. Clinical parameters were compared between 72 EC and 106 NEC single embryo transfers. RESULTS: A significantly higher clinical pregnancy rate was observed after transfer of EC (50%) than NEC (26.4%) embryos. CONCLUSIONS: The current study provides compelling evidence that EC embryos possess significantly higher developmental competence than NEC embryos. 相似文献
9.
Coskun S Hollanders J Al-Hassan S Al-Sufyan H Al-Mayman H Jaroudi K 《Human reproduction (Oxford, England)》2000,15(9):1947-1952
Blastocyst transfer has been suggested to improve implantation rate without affecting pregnancy rate. The aim of this study was to compare the pregnancy and implantation rates of day 3 and 5 transfers in a prospective randomized manner. Patients with four or more zygotes were randomly allocated on day 1 to either day 3 or 5 transfers. Fertilization was achieved through regular IVF or intracytoplasmic sperm injection. Zygotes were kept in Medicult IVF medium for day 3 transfers and transferred into G1.2 and G2.2 on day 1 and 3 respectively for day 5 transfers. The morphologically best two or three embryos or blastocysts were chosen for transfer in both groups. Overall pregnancy rates per embryo transfer were the same (39%) in day 3 and 5 transfers. Implantation rates were 21 and 24% for day 3 and 5 transfers respectively. The pregnancy and implantation rates for day 5 transfers were significantly affected by the availability of at least one blastocyst to transfer and the number of zygotes. The number of good quality embryos on day 3 also significantly affected pregnancy and implantation rates on day 5 transfers. Multiple gestation rate, number of abortions and ongoing pregnancies were similar in both groups. In conclusion, day 3 and 5 transfer had similar pregnancy, implantation and twinning rates. Currently, day 5 transfers have no advantages over day 3 transfers. 相似文献
10.
Does the choice of catheter for embryo transfer influence the success rate of in-vitro fertilization? 总被引:8,自引:7,他引:1
Y Gonen M Dirnfeld S Goldman M Koifman H Abramovici 《Human reproduction (Oxford, England)》1991,6(8):1092-1094
The performance of two different transfer catheters has been evaluated in 193 consecutive embryo transfers. Forty pregnancies were achieved, corresponding to a pregnancy rate of 21% of all embryo transfers. The Frydman catheter was used in 123 attempts whereas 70 embryo transfers were performed with the Tom Cat catheter. The Tom Cat catheter yielded a significantly higher pregnancy rate than the Frydman catheter (28% versus 16%; P = 0.03). The mean number of embryos transferred per attempt was similar in the two groups (2.9 +/- 0.1 and 3.0 +/- 0.1 in the Tom Cat and Frydman groups respectively) as was the quality. When more than three embryos were transferred, a pregnancy rate of 37% per embryo transfer was achieved using the Tom Cat versus 20% using the Frydman catheters (P = 0.03). A higher frequency of difficult transfer procedures was observed when the Frydman catheter was used while the Tom Cat performed much better in difficult cases. An alternate use of the two catheters suggests a significantly better performance of the Tom Cat catheter in relation to the efficiency of establishing pregnancy. 相似文献
11.
Tiitinen A Halttunen M Härkki P Vuoristo P Hyden-Granskog C 《Human reproduction (Oxford, England)》2001,16(6):1140-1144
In-vitro fertilization is associated with a high rate of multiple pregnancies, a consequence of the number of embryos transferred. There is a challenge in avoiding even twin pregnancies in assisted reproduction, and this can be accomplished with elective single embryo transfer and a good cryopreservation programme. In our follow-up study, we analysed all our elective single embryo transfers during 1998-1999. In all these cycles at least one embryo was frozen. A total of 127 elective single embryo transfers were performed with a clinical pregnancy rate of 38.6%. The highest implantation rate was obtained with four-cell embryos with <10% fragmentation (39.8%). Thirty-four patients have delivered (26.8%), one of these being a monozygotic pregnancy. In total 129 frozen-thawed cycles have been achieved in 83 patients. One frozen-thawed embryo has been transferred in 46 cycles with a clinical pregnancy rate of 17.4%, and two embryos have been transferred in 83 cycles, with a clinical pregnancy rate of 37.3%. Up until now, 66 of 125 patients in our single embryo transfer programme have delivered or have on-going pregnancies, and 77 still have embryos frozen. The cumulative delivery rate per oocyte retrieval is 52.8% and the twin rate 7.6%. We conclude that elective single embryo transfer with a good cryopreservation programme results in very acceptable pregnancy rates with a low risk of twins. This is a cost-effective practice that substantially reduces all risks associated with multiple pregnancies and lowers the cost per delivery. 相似文献
12.
Prevention of twin pregnancies after IVF/ICSI by single embryo transfer. ESHRE Campus Course Report 总被引:27,自引:20,他引:7
Twin pregnancies constitute the most serious complication for both mother and children after IVF/ICSI treatment, but transfer of at least two 'best looking' embryos remains the standard policy. This is due to our inability and reluctance to identify both the 'twin prone' patient and the top quality embryo. Some centres now electively transfer a single embryo (eSET) when particular embryo quality and patient criteria are met. Results from several centres were presented during an ESHRE Campus Course, held on May 6(th) 2000. Sound clinical trials are needed to clarify several points of discussion. What is the clinical profile of patients in whom eSET should be considered? Will the overall (ongoing) pregnancy rate of the IVF/ICSI programme decrease if eSET is performed in these patients? What is the twinning rate when eSET is a routine policy? Will the financial gain by avoiding perinatal hospitalization costs of prevented twins be balanced by the likely need to perform a number of extra IVF/ICSI cycles? What will be gained by freezing the extra number of high quality embryos? Should eSET be performed at the 2 pronuclear stage, the early cleaving embryo or the blastocyst stage? Common sense dictates that eSET as a concept should be applied from now onwards. 相似文献
13.
Comparison of two elective transfer policies of two embryos to reduce multiple pregnancies without impairing pregnancy rates. 总被引:2,自引:0,他引:2
F Devreker S Emiliani P Revelard M Van den Bergh I Govaerts Y Englert 《Human reproduction (Oxford, England)》1999,14(1):83-89
A first elective transfer policy of two embryos based solely on embryo morphology was compared to a more restrictive policy transferring two embryos to all patients aged < 35 years with less than three previous cycles to reduce the incidence of multiple pregnancies. With a significant reduction in the number of triple transfers from 72.4 to 44.3%, the delivery rates were similar for both policies, 31 and 32.1%. However, the multiple pregnancy rates per transfer significantly decreased from 12.5 to 7.8% (P < 0.05). Of 99 pregnancies, only 24.2% were multiple including 1% of triplets compared to 40.7% multiple pregnancies including 6.7% of triplets for the first policy. Forty-eight transfers of two average embryos with the new policy were compared to 264 transfers of three average embryos with the old policy. Multiple pregnancy rates per transfer were significantly reduced by a third from 23 to 8% (P < 0.05) without a reduction of the pregnancy rates (42 and 48%). This study demonstrated that elective transfer of two embryos reduced the number of multiple pregnancies without impairing the pregnancy rates even with the transfer of average embryos. 相似文献
14.
Pelinck MJ; De Vos M; Dekens M; Van der Elst J; De Sutter P; Dhont M 《Human reproduction (Oxford, England)》1998,13(4):960-963
The aim of the present study was to investigate pregnancy rates ensuing
from transfer of embryos with multinucleated blastomeres. In our in- vitro
fertilization (IVF)/intracytoplasmic sperm injection (ICSI) programme, 1735
embryo transfers were performed from January 1, 1995 to August 31, 1996. In
136 of these transfers at least one embryo with one or more multinucleated
blastomeres was present per transfer (study group). For each of these 136
transfers, two matched controls with transfer of exclusively mononucleated
embryos were selected (control group). Matching was carried out according
to age, method of fertilization (IVF or ICSI), number of transferred
embryos and quality score of transferred embryos. In the study group, there
were eight transfers of exclusively multinucleated embryos from which one
pregnancy ensued and 128 transfers in which multinucleated and
mononucleated embryos were transferred together leading to 23 pregnancies.
The overall clinical pregnancy rate per transfer was 16.9% in the study
group versus 28.7% in the control group (P = 0.01). The ongoing pregnancy
rate per transfer was 13.2% in the study group versus 23.2% in the control
group (P = 0.03). The implantation rate per transferred embryo was 6.0% in
the study group versus 11.3% in the control group (P = 0.003). This study
shows that embryos with one or more multinucleated blastomeres have a
poorer implantation potential than embryos with mononucleated blastomeres.
Transfer of embryos with multinucleated blastomeres should hence only be
considered when insufficient numbers of embryos with only mononucleated
blastomeres are present.
相似文献
15.
Prognostic factors for the success rate of embryo freezing 总被引:5,自引:6,他引:5
Karlstrom PO; Bergh T; Forsberg AS; Sandkvist U; Wikland M 《Human reproduction (Oxford, England)》1997,12(6):1263-1266
To find some prognostic factors for the outcome of frozen-thawed cycles, we
have retrospectively analysed all frozen pre-embryos that were thawed
during 1993 and 1994 at two in-vitro fertilization (IVF) units in Sweden.
Supernumerary pre-embryos were frozen from 551 oocyte retrievals and these
resulted in 660 frozen-thawed cycles which lead to 623 thawed embryo
transfers. The outcome of these transfers was 137 clinical pregnancies with
a pregnancy rate of 22% per frozen-thawed embryo transfers. Women <40
years of age had a higher birth rate than those > or =40 years, 19 and
5% respectively (P < 0.01). Transfers with two and three pre-embryos
resulted in pregnancy rates of 23 and 27%, respectively, compared with 14%
for transfer of one embryo. A pregnancy resulting from the initial embryo
transfers had a predictive value for results of the subsequent
frozen-thawed cycle. Embryo grade and cleavage stage at the time of
freezing was important for the survival of the frozen-thawed pre-embryos.
The pregnancy rate was not influenced by the cleavage stage, but a tendency
toward a lower pregnancy rate was seen for the embryos with lower grading.
To conclude, cryopreservation seems to be beneficial in women <40 years
of age, who have supernumerary pre-embryos of good quality for freezing and
of which at least two can be transferred.
相似文献
16.
Fiddelers AA van Montfoort AP Dirksen CD Dumoulin JC Land JA Dunselman GA Janssen JM Severens JL Evers JL 《Human reproduction (Oxford, England)》2006,21(8):2090-2097
BACKGROUND: Twin pregnancies after IVF are still frequent and are considered high-risk pregnancies leading to high costs. Transferring one embryo can reduce the twin pregnancy rate. We compared cost-effectiveness of one fresh cycle elective single embryo transfer (eSET) versus one fresh cycle double embryo transfer (DET) in an unselected patient population. METHODS: Patients starting their first IVF cycle were randomized between eSET and DET. Societal costs per couple were determined empirically, from hormonal stimulation up to 42 weeks after embryo transfer. An incremental cost-effectiveness ratio (ICER) was calculated, representing additional costs per successful pregnancy. RESULTS: Successful pregnancy rates were 20.8% for eSET and 39.6% for DET. Societal costs per couple were significantly lower after eSET (7334 euro) compared with DET (10,924 euro). The ICER of DET compared with eSET was 19,096 euro, meaning that each additional successful pregnancy in the DET group will cost 19,096 euro extra. CONCLUSIONS: One cycle eSET was less expensive, but also less effective compared to one cycle DET. It depends on the society's willingness to pay for one extra successful pregnancy, whether one cycle DET is preferred from a cost-effectiveness point of view. 相似文献
17.
Neubourg DD Mangelschots K Van Royen E Vercruyssen M Ryckaert G Valkenburg M Barudy-Vasquez J Gerris J 《Human reproduction (Oxford, England)》2002,17(10):2621-2625
BACKGROUND: The aim of this study was to evaluate the impact of transferring a single top quality embryo in the first IVF/ICSI cycle of patients <38 years old who chose to have one or two embryos transferred. METHODS: A total of 262 patients participated in the study, and 243 transfers were performed: 156 (64%) patients chose the transfer of a single top quality embryo, if available, and two non-top quality embryos if not available; 87 (36%) patients chose to have a double embryo transfer regardless of embryo quality. RESULTS: In the first group an ongoing pregnancy rate of 40% (63/156) with a twin pregnancy rate of 2% (1/63) was achieved. In the second group the ongoing pregnancy rate was 44% (38/87) with 26% (10/38) twin pregnancies. In the patient group with only one embryo transferred, irrespective of the patient's choice, the ongoing pregnancy rate was 43% (54/127) with no twin pregnancies. For the study population as a whole, the ongoing pregnancy rate was 42% (101/243) with 11% (11/101) twins. CONCLUSION: We conclude that the introduction of single embryo transfer in the first IVF/ICSI cycle is highly acceptable in women <38 years old. 相似文献
18.
van Montfoort AP Fiddelers AA Land JA Dirksen CD Severens JL Geraedts JP Evers JL Dumoulin JC 《Human reproduction (Oxford, England)》2007,22(6):1669-1674
INTRODUCTION: In several clinics, elective single-embryo transfer (eSET) is applied in a selected group of patients based on age and the availability of a good-quality embryo. Whether or not eSET can be applied irrespective of the presence of a good-quality embryo in the first cycle, to further reduce the twin pregnancy rate, remains to be elucidated. METHODS: In patients <38 years two transfer strategies were compared, which differed in the first cycle only: group A (n = 141) received eSET irrespective of the availability of a good-quality embryo, and group B (n = 174) received eSET when a good-quality embryo was available while otherwise they received double embryo transfer (DET; referred to as eSET/DET transfer policy). In any subsequent cycle, in both groups the eSET/DET transfer policy was applied. RESULTS: After completion of their IVF treatment (including a maximum of three fresh cycles and the transfer of frozen-thawed embryos), comparable cumulative live birth rates (62.4% in group A and 62.6% in group B) and twin pregnancy rates (10.1 versus 13.4%) were found. However, patients in group A required significantly more fresh (2.0 versus 1.8) and frozen (0.8 versus 0.5) cycles. CONCLUSIONS: The transfer of one embryo in the first cycle, irrespective of the availability of a good-quality embryo, in all patients <38 years, is not an effective transfer policy for reducing the overall twin pregnancy rate. 相似文献
19.
Pelinck MJ Vogel NE Hoek A Arts EG Simons AH Heineman MJ 《Human reproduction (Oxford, England)》2005,20(3):642-648
BACKGROUND: The use of the natural cycle for IVF offers the advantage of a patient-friendly and low-risk protocol. Its effectiveness is limited, but may be improved by using a GnRH antagonist to prevent untimely LH surges. METHODS: In this pilot study, minimal stimulation IVF with late follicular phase administration of the GnRH antagonist cetrorelix and simultaneous substitution with recombinant FSH was applied for a maximum of three cycles per patient. Main outcome measures were pregnancy rates per started cycle and cumulative pregnancy rates after three cycles. RESULTS: A total of 50 patients completed 119 cycles (2.4 per patient). Fifty-two embryo transfers resulted in 17 ongoing pregnancies [14.3% per started cycle; 32.7% per embryo transfer; 95% confidence interval (CI) 7.9-20.7% and 19.7-45.7%, respectively]. One dizygotic twin pregnancy occurred after transfer of two embryos, the other pregnancies were singletons. The cumulative ongoing pregnancy rate after three cycles was 34% (95% CI 20.6-47.4%). Live birth rate was 32% per patient (95% CI 18.8-45.2%). CONCLUSIONS: Pregnancy rates after IVF with minimal, late follicular phase stimulation are encouraging. Considering the low-risk and patient-friendly nature of this protocol, it may be a feasible alternative to IVF with ovarian hyperstimulation. 相似文献
20.
Resumption of mitosis during post-thaw culture: a key parameter in selecting the right embryos for transfer 总被引:1,自引:11,他引:1
Ziebe S; Bech B; Petersen K; Mikkelsen AL; Gabrielsen A; Andersen AN 《Human reproduction (Oxford, England)》1998,13(1):178-181
This retrospective study of 701 thaw cycles analysed the clinical
importance of whether or not embryos resumed mitosis during 24 h of
post-thaw culture. A total of 3360 frozen embryos were thawed; 1922 embryos
survived the freeze-thaw procedure with at least one intact blastomere and
were then cultured for 24 h before transfer. All transfers were registered
into either the 'cleaved embryo group' (n = 459), which was defined as
transfers where at least one of the transferred embryos cleaved during the
post-thaw culture period, or the 'non-cleaved embryo group' (n = 153),
where none of the transferred embryos cleaved during the post-thaw culture
period. A total of 1408 thawed embryos were transferred in 612 cycles; 459
embryo transfers were in the cleaved embryo group, resulting in an
implantation rate of 10%, significantly higher than the 4% in the
non-cleaved embryo group (P = 0.0003). A total of 130 pregnancies (28% per
transfer) were obtained in the cleaved embryo group which was significantly
higher than the 17 pregnancies (11% per transfer) obtained in the
non-cleaved embryo group (P = 0.0001). However, the average number of
transferred embryos was significantly higher in the cleaved embryo group
(2.46 +/- 0.03) compared to the non-cleaved embryo group (1.82 +/- 0.07).
No difference was found in the age of the women between the two groups.
When analysing transfers where all transferred embryos had cleaved during
the post-thaw culture period the clinical pregnancy rate increased
significantly from 13% transferring two embryos to 36% transferring three
embryos (P = 0.0136). In this latter subgroup an implantation rate as high
as 17% was obtained. The overall multiple pregnancy rate was 16%. The
multiple pregnancy rate was 19% in the cleaved embryo group. In conclusion,
24 h post-thaw culture may allow a better selection of the embryos and
thereby we may be able to increase the implantation and pregnancy rates.
This may enable us further to reduce the number of embryos transferred.
相似文献