胚胎移植技术对体外受精-胚胎移植结果的影响——653例临床分析

目的:分析胚胎移植技术与体外受精后临床妊娠、种植率和继续妊娠率之间的关系。方法:回顾性分析653例新鲜胚胎移植,比较移植情况和临床结果之间的关系。结果:腹部超声引导下胚胎移植后临床妊娠率为47.3%,种植率25.0%,继续妊娠39.7%。移植管顶端位于宫内不同位置以及血染情况不影响结果。8.8%困难移植明显降低种植率(20%比26%),临床妊娠率也降低(35.8%比48.3%),但无统计学差异。结论:腹部超声引导下胚胎移植可以达到较好的临床结果。胚胎放置在宫腔内不同位置以及移植管血染不影响临床结果,但要尽量避免困难移植.     

Effect of blood and mucus on the success rates of embryo transfers

Objectives

To provide information about the effects of blood and mucus on the embryo transfer (ET) catheters after transfer on embryo transfer outcomes.

Study design

Retrospective analysis of 8311 ultrasound-guided embryo transfers performed in a single center. In 6897 cases (82.9%), there were no blood on the catheter after ET, 1168 transfers were associated with mild blood (14.1%), 33 transfers with moderate blood (0.4%) and 213 transfers with severe blood (2.6%). A total of 6162 transfer catheters were free of mucus (74.8%), whereas mucus was detected on 2081 catheters (25.2%).

Results

The implantation rate (IR) was highest in the group with no blood on the transfer catheter, and lowest in the group with severe blood on the catheter. The clinical pregnancy rate (CPR) was lowest in the group with severe blood on the catheter. The presence of mucus on the catheter was found to have no effect on IR, CPR, biochemical pregnancy rates, miscarriage rates and live birth rates.

Conclusions

This study showed decreased IR, CPR and live birth rates in ETs associated with blood on the catheter. Mucus on the catheter appeared to be a simple contamination in this study and pregnancy rates remained unaffected.     

Comparison of Pregnancy, Implantation, and Multiple Gestation Rates for Day 3 Versus Day 5 Embryo Transfers

Purpose : To compare pregnancy, implantation, and multiple gestation rates resulting from day 3 and day 5 embryo transfers after in vitro fertilization emphasizing a subset of patients who met criteria for day 5 transfer but elected to undergo day 3 transfer. Method : A retrospective analysis of day 3 and day 5 embryo transfers from January 2001 to June 2002 were evaluated in a community teaching hospital setting. A total of 331 patients 40 years old were included. Using Student's t test, ²test, and Fisher's exact test, we compared the pregnancy, implantation, and multiple gestation rates. Results : Pregnancy, implantation, and multiple gestation rates were not significantly different between the subgroup who met criteria for day 5 embryo transfer but elected day 3 transfer. There was no significant difference between similar parameters in the overall comparison of day 3 versus day 5 embryo transfers. Conclusions : Blastocyst transfers have similar multiple gestation rates, pregnancy rates, and implantation rates when compared to day 3 embryo transfers.     

Clinical analysis of the patients with single fair cleavage-stage embryo on day 3

Objective: This study aimed to explore an appropriate selection for the patients with single fair cleavage-stage embryo on day 3.

Methods: This study included 469 fresh transfers and 220 frozen-thawed transfers from January 2014 to June 2016. Furthermore, in 72 patients who have only 4–6 fair embryos (4–5 blastomeres) on day 3, the blastocysts were cultured to day 5 for transfer.

Results: In the fresh transfers, the clinical pregnancy rate of 4–5 blastomeres group was significantly lower than 6–7 and 8–10 blastomeres group (5.88 vs. 30.13%, p<.001and 5.88 vs. 26.09%, p?p?=?.040 and 10.00 vs. 33.33%, p?=?.005). For the blastocyst transfers derived from fair embryos with 4–5 blastomeres, the clinical pregnancy rate was significantly higher than single and double fair embryo transfers of similar quality (44.44 vs. 7.04%, p?p?=?.013).

Conclusions: For the patients with single fair embryo (6–7 blastomeres or 8–10 blastomeres), transfer at the cleavage stage is feasible. For the patients with single fair embryo (4–5 blastomeres), transfer of single fair embryo at the blastocyst stage or accumulating two fair embryos might be worthy of consideration.     

Impact of Physician Performing Embryo Transfer on Pregnancy Rates in an Assisted Reproductive Program

Purpose : To evaluate the effect of the individual physician performing embryo transfer, on clinical pregnancy rates. Method : Data from a total of 485 consecutive embryo transfers performed on 485 women aged 23–37 years were prospectively collected for this study. All patients underwent a standard downregulation long protocol for ovarian stimulation. Oocyte recovery was performed at 36 h after hCG administration. Embryo transfer took place at 48 h after insemination. The patients were matched in two groups that have been linked to two different ET providers (A and B). The same method of loading embryos into the embryo transfer catheter was used. Results : Clinical pregnancy rates varied significantly (p≤0.01) between the two providers: 36.1% in group A and 20.6% in group B. The number and quality of embryos transferred did not differ between the groups. Conclusion : The results suggest that the physician factor may be an important variable in embryo transfer technique.     

Abdominal Ultrasound-Guided Embryo Transfer Improves Clinical Pregnancy Rates After In Vitro Fertilization: Experiences from 330 Clinical Investigations

Purpose: To investigate the effect of ultrasound-guided embryo transfer on the rate of implantation and clinical pregnancy.Methods: A prospective randomized trial was performed to compare ultrasound-guided embryo transfer with the traditional method. A total of 330 patients were randomly divided into two groups on the day of embryo transfer. For the cases (n = 178), ultrasound-guided was used; controls (n = 152) was performed using routine methods.Results: The rate of implantation and clinical pregnancy for the cases (19.6 and 37.1%, respectively) was significantly higher than for the controls (12.6 and 25%, respectively; p < 0.05).Conclusion: Ultrasound-guided embryo transfer can significantly increase the rate of implantation and clinical pregnancy, and should be recommended as a routine procedure in the process of in vitro fertilization and embryo transfer (IVF-ET).     

A Matched Study to Determine Whether Low-Dose Aspirin Without Heparin Improves Pregnancy Rates Following Frozen Embryo Transfer and/or Affects Endometrial Sonographic Parameters

Purpose: The objective of the matched, controlled study was to determine whether low-dose aspirin therapy without heparin improves pregnancy rates following frozen embryo transfer. Methods: Thirty-six women who did not achieve a pregnancy following fresh embryo transfer and who had frozen embryos available for another transfer were included. Eighteen women were treated with 81 mg aspirin from day 2 of the cycle through pregnancy testing. If the -human chorionic gonadotropin level was positive, aspirin was continued through the pregnancy. Eighteen women were not given aspirin. The mean outcome variables were pregnancy and implantation rates. Results: The clinical pregnancy rate in the aspirin group was 11.1%, compared with 33.3% for the controls, and implantation rates were 2.9 and 10.9%, respectively. Conclusions: No positive effects of low-dose aspirin therapy on pregnancy rates following frozen embryo transfer were observed.     

The impact of the depth of embryo replacement on IVF outcome

Purpose: To evaluate the effect of the depth of embryo transfer replacement on clinical pregnancy rate. Methods: Data from a total of 104 consecutive embryo transfers performed on 104 womenn aged 26–37 years were prospectively collected for this study. All patients underwent a standard down regulation protocol for ovarian stimulation. Oocytes retrieval were performed at 36 h after hCG administration. Embryo transfer took place at 48 h after insemination. The patients were matched in two groups according to the distance between the tip of the catheter and the uterine fundus at transfer (group A > 10 < 15 mm and group B ≤ 10 mm). The same method of loading embryos into the embryo transfer catheter was used. Results: Clinical pregnancy rates varied significantly (p ≤ 0.05) between the two groups: 27.7% in group A and 14% in group B. The number and quality of embryos transferred did not differ between the groups. Conclusions: The results suggest that the depth of embryo replacement may be an important variable in embryo transfer technique.     

Antibubble trajectory during embryo transfers in donor egg IVF does not predict success

Transient motion of embryo transfer-associated antibubbles was observed. This prospective study was performed to determine if this antibubble movement can predict a successful outcome. Transabdominal ultrasound-guided embryo transfers were performed in 187 recipients receiving identical hormone replacement therapy. All embryo transfers were performed by the first author, using the Sureview embryo transfer catheter, in 30 mul of culture media. Observation was made of the catheter placement in relation to the endometrial surface and uterine fundus during embryo transfer. Ultrasound-guided tracking of antibubble within the uterine cavity was done immediately after the piston was depressed at the time of embryo deposition. The antibubble movement was upwards (group A) in 104 embryo transfers and downwards (group B) in 83 transfers. No movement of embryo-associated air out of the uterine cavity, either into the cervix or the intramural portion of the Fallopian tube, was observed. The clinical pregnancy rate was similar in both groups: 47.12% in group A versus 45.78% in group B. The total implantation rate/embryo transferred was 19.34% in group A compared with 20.07% in group B. The movement of the embryo transfer-associated antibubble is unlikely to be a factor in predicting success in donor egg IVF cycles.     

A meta-analysis of ultrasound-guided versus clinical touch embryo transfer

OBJECTIVE: To determine the relative efficacy of ultrasound-guided embryo transfer and embryo transfer by clinical touch alone. DESIGN: Systematic review and meta-analysis of randomized, controlled trials comparing ultrasound-guided embryo transfer with embryo transfer by clinical touch alone. SETTING: Infertility centers providing treatment with in vitro fertilization/embryo transfer. PATIENT(S): Women undergoing embryo transfer. INTERVENTION(S): Embryo transfer with or without transabdominal ultrasound guidance. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate and embryo implantation rate. RESULT(S): A total of eight prospective controlled trials were identified. Of these studies, four were nonrandomized or quasi-randomized and four were genuinely randomized. Meta-analysis demonstrated a significantly increased chance of clinical pregnancy following ultrasound-guided embryo transfer in all studies and in the genuinely randomized subgroup. The embryo implantation rate was also significantly increased following ultrasound-guided embryo transfer. CONCLUSION(S): Ultrasound-guided embryo transfer significantly increases the chance of clinical pregnancy and significantly increases the embryo implantation rate.     

Effect of air bubble localization after transfer on embryo transfer outcomes

Objectives

Our study aimed to provide information about the effects of air bubble localization after transfer on embryo transfer outcomes.

Study design

Retrospective analysis of 7489 ultrasound-guided embryo transfers. Group 1 included 6631 embryo transfers in which no movement of the air bubbles was observed after transfer. Group 2 consisted of 407 embryo transfers in which the air bubbles moved towards the uterine fundus spontaneously, a little time after transfer. Group 3 included 370 embryo transfers in which the air bubbles moved towards the uterine fundus with ejection, immediately after transfer. Group 4 consisted of 81 embryo transfers in which the air bubbles moved towards the cervical canal.

Results

The four patient groups were different from one another with respect to positive pregnancy tests. Post hoc test revealed that this difference was between group 4 and other groups.

Conclusions

An initial finding of our study was significantly decreased positive pregnancy test rates and clinical pregnancy rates with air bubbles moving towards the cervical canal after transfer. Although air bubbles moving towards the uterine fundus with ejection were associated with higher pregnancy rates, higher miscarriage rates and similar live birth rates were observed compared to air bubbles remaining stable after transfer.     

Contamination of Embryo Transfer Catheter and Treatment Outcome in In Vitro Fertilization

Purpose: The effect of embryo transfer (ET) catheter contamination with mucus and/or blood on treatment outcome in an in vitro fertilization (IVF) program was evaluated. Methods: One thousand four ET procedures in 877 patients having conventional IVF in the long (1189 cycle) and short (15 cycles) protocol were analyzed to determine the impact of catheter contamination on the Incidence of retained embryos and the clinical pregnancy rate. Results: Catheter contamination with mucus and/or blood is a feature of difficult ET. Embryos were significantly more likely to be retained when the transfer catheter was contaminated with mucus (17.8 versus 3.3%) or blood (12 versus 3.3%). When the catheter was contaminated and an embryo(s) was retained and immediately retransferred, the pregnancy rate was not compromised. The pregnancy rate was significantly reduced when the ET catheter was contaminated with blood (15.5 versus 27.1%;P = 0.002), but no embryo was retained in the catheter set. Conclusions: Catheter contamination compromises the treatment outcome in IVF only when there is no associated retained embryo(s). As increased vigilance in searching for extruded embryos may not be practical, we suggest that cervical mucus should be routinely aspirated and ET performed as atraumatically as possible.     

Ultrasound Guidance Is Not Necessary During Easy Embryo Transfers

Purpose: To determine whether the use of ultrasound (US) to guide embryo transfer (ET) in a population previously defined as likely to have easy transfer would change the implantation and pregnancy rates in an ICSI program.Methods: A total of 100 patients identified as likely to have easy transfer after mock transfer were divided into two groups: Group I, US-guided ET (N=50) and Group II, ET without the aid of US (N=50).Results: Implantation and pregnancy rates were similar (p=0.51, p=0.29) for Group I (19.6%, 42%) and Group II (16.3%, 30%), as also was the abortion rate (p=0.55) (Group I: 1/21; Group II: 2/15).Conclusion: As long as previous mock transfers are routinely performed during a cycle preceding assisted reproduction and the clinician considers transfer to be easy, ultrasound does not benefit the process of embryo transfer.     

Impact of retained embryos on the outcome of assisted reproductive technologies

OBJECTIVE: To assess the impact of embryo retention in the embryo transfer catheter followed by "immediate" retransfer on pregnancy outcome in women undergoing assisted reproduction. DESIGN: Retrospective analysis of embryo transfer following in vitro fertilization. SETTING: Assisted reproductive technology practice in a university in vitro fertilization program. PATIENT(S): In vitro fertilization charts for 1,812 embryo transfer cycles representing 1,139 patients between January 1997 and March 2002 were reviewed. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy rate, implantation rate, delivery rate. RESULT(S): Three embryo transfer cycles were excluded from analysis because of missing data, leaving 1,364 embryo transfers during oocyte recovery cycles and 445 embryo transfer cycles using thawed embryos. Seventy-one embryo transfers (3.9% of all transfers) were complicated by finding retained embryos after the initial embryo transfer-all retained embryos were immediately retransferred. There was no difference in the frequency of retained embryos during oocyte retrieval versus thawed embryo cycles. The pregnancy, implantation, and delivery rates per embryo transfer were not negatively affected by embryo(s) retained in the transfer catheter. Age, fresh versus frozen embryo, use of ultrasound during the procedure, or transferring physician did not influence pregnancy outcome. CONCLUSION(S): Immediate retransfer of embryos retained in the catheter following the initial transfer attempt did not have an adverse effect on pregnancy outcome.     

Effect of a programmed short-term stimulation protocol on the replacement of cryopreserved embryos

Purpose: Through problems in the management of embryo thawings and transfers, we investigated in a comparative study the use of the natural cycle and of a programmed short-term stimulation protocol as preparation method for the replacement of cryopreserved embryos. To date, 117 embryos have been thawed, and 60 (51%) survived with 50% intact blastomeres. Methods: In 31 cases, replacement of the frozen-thawed embryos was planned in the natural cycle (group A), and in nine cases in the stimulated cycle (group B). In group A, 16 replacements could be performed (cancellation rate 48%). Six transfers took place on weekends (37%). Two clinical pregnancies could be established (13% per replacement). In group B, there were no canceled cycles (p<0.025). All thawings and transfers could be conducted between Monday and Friday. In one case, the single one frozen embryo was degenerated after thawing. Results: Thus, eight replacements could be performed which resulted in three clinical pregnancies (38% per replacement, n.s.) and one biochemical pregnancy. Conclusions: Based on our results, we conclude that a programmed short-term protocol not only provides viable embryos with a good cryopreservation potential, but it is also a reliable preparation method for the replacement of frozen-thawed embryos.     

The Effect of Endometrial Polyps on Outcomes of In Vitro Fertilization (IVF) Cycles

Purpose: Our purpose was to investigate the effect of endometrial polyps on pregnancy outcome in an in vitro fertilization (IVF) program. Methods: Endometrial polyps less than 2 cm in diameter were suspected by transvaginal ultrasound before oocyte recovery in 83 patients. Forty-nine women (Group I) had standard IVF–embryo transfer, while in 34 women (Group II) hysteroscopy and polypectomy were performed immediately following oocyte retrieval, the suitable embryos were all frozen, and the replacement cycle took place a few months later. Results: Of the 32 hysteroscopies, a polyp was diagnosed in 24 cases (75%) and polypoid endometrium in another 5 patients (15.6%). An endometrial polyp was confirmed by histopathological examination in 14 women (58.3%). The pregnancy rate in group I was similar to the general pregnancy rate of our unit over the same period (22.4 vs 23.4%) but the miscarriage rate was higher (27.3 vs 10.7%, P = 0.08). In Group II, the pregnancy and miscarriage rates were similar to those of the frozen embryo cycles at Bourn Hall (30.4 and 14.3 vs 22.3 and 12.1%, respectively). Conclusions: Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss. A policy of oocyte retrieval, polypectomy, freezing the embryos, and replacing them in the future might increase the take-home baby rate.     

A new safe embryo transfer technique and its impact on ICSI outcome

ObjectiveTo assess and modify the after load technique of embryo transfer developed by Adrienne et al. [Adrienne BN, James HS, Sasha H, Aidita NJ, Jeffrey LM. Embryo afterloading: a refinement in embryo transfer technique that may increase clinical pregnancy. Fertil Steril 2005;83:710–4] and to study its impact on ICSI outcome.DesignProspective comparative analysis.SettingA private referral IVF center.Patient'sOne hundred and forty-four ICSI–ETs were performed by a single provider and a single embryologist over a 1-year period of time in a private IVF center. Ninety-nine ICSI–ETs were performed as the classic ETs technique and forty-five ICSI–ETs were performed by the external sheath 1st technique.Main outcome measurePrimary outcome: – the degree of presence of mucous and blood in the embryo transfer catheter. Secondary outcome: – clinical pregnancy.ResultsThe average age of all the patients was 30.4±4.3years, with a range of 21–38years. The overall pregnancy rate was 32.6%. The external sheath 1st technique group showed highly significant easy technique and higher clinical pregnancy than the classic technique (P-value=0.0023, 0.0025, respectively), also the external sheath 1st technique showed a significantly lower mucous, blood in the inner sheath catheter and the outer sheath catheter over the classic embryo transfer group.ConclusionExternal sheath 1st-embryo transfer is a refinement of standard ET technique and may improve clinical pregnancy rates by facilitating the ease of embryo transfer.     

Donor oocyte cytoplasmic transfer did not enhance implantation of embryos of women with poor ovarian reserve

Purpose : To determine whether donor oocyte cytoplasm transferred into the oocytes of women 40 years or with diminished ovarian reserve would enhance embryo quality, implantation, or pregnancy rates. Methods : Study subjects included women 40 years (15) or with abnormal FSH levels (3). Healthy volunteers (18) produced oocytes for cryopreservation. Donor oocytes were thawed and cytoplasm from surviving oocytes was injected with a single sperm into the cytoplasm of recipient oocytes. Outcome measures included embryo quality scores, implantation, and pregnancy rates. Results : Eighteen donors produced 213 oocytes for cryopreservation and 39/171 (22.8%) survived thawing. Eighteen recipients initiated 25 IVF cycles with embryo transfer in 20 cycles after cytoplasmic transfer (CT). Four cycles resulted in three biochemical losses and one aneuploid clinical loss. Embryo quality did not improve with CT compared to pre-CT IVF cycles in six recipients. Conclusions : CT with cryopreserved donor oocyte cytoplasm did not enhance success in women with advanced reproductive age or low ovarian reserve.     

Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study

Purpose

To evaluate the role of co-transfer of embryos derived from vitrified oocytes accumulated during the previous modified natural cycles and an embryo developed from the last one as an alternative to repetitive single embryo transfer in a fresh modified natural cycle.

Methods

Thirty-six patients underwent ICSI procedure with three frozen natural oocytes supplemented by a fresh one obtained from the fourth modified natural cycle. Thirty-one controls received at least three consecutive single embryo transfer in a fresh modified natural cycle.

Results

In the study group the oocyte retrieval, survival and total fertilization rate were 73.0 %, 78.1 %, and 64.5 %, respectively. Fifty-two embryos were transferred in 29 transfers. In the control group the oocyte retrieval and fertilization rate was 77.4 % and 83.7 %, respectively. Fifty single embryo transfers were performed. Of a total 14 pregnancies obtained in the study group 10 were defined as clinical and 4 as abortions. In the control group a total of 8 single clinical pregnancies and 2 miscarriages were encountered. The overall (20.0 % vs 48.2 %) and the clinical (16.0 % vs 34.4 %) pregnancy rate were significantly higher in the study group having cumulative embryo transfer following the oocyte accumulation.

Conclusions

These data demonstrate that the co-transfer of embryos derived from vitrified oocytes accumulated during the previous modified natural cycles and an embryo developed from the last fresh modified natural cycle assure an excellent clinical outcome with the overall and clinical pregnancy rate significantly higher compared to the repetitive single embryo transfer in a fresh modified natural cycle.