Relationship between the day of embryo transfer and the outcome in human in vitro fertilization and embryo transfer

Purpose To clarify the optimal date of embryo transfer (ET), we retrospectively analyzed the relationship between the day of ET and the outcome in human in vitro fertilization and embryo transfer (IVF-ET).Method Of a total of 307 human IVF-ET cycles performed at Kyoto University Hospital between January 1990 and March 1994, we focused on 207 cases of IVF-ET cycles in which two or three good-quality embryos were transferred. These 207 IVF-ET cycles consisted of 54 Day 2 ET cycles, 79 Day 3 ET cycles, 46 Day 4 ET cycles, and 28 Day 5 ET cycles. We compared the pregnancy and live-birth (plus ongoing pregnancy) rates among these four ET groups.Results The pregnancy rates of ET on Days 2 to 4 were not significantly different, whereas Day 5 ET produced a significantly lower pregnancy rate (Day 2, 29.6%; Day 3, 32.9%; Day 4, 30.4%; Day 5, 10.7%). Similar results were obtained for the live-birth (plus ongoing pregnancy) rates (Day 2, 20.3%; Day 3, 18.9%; Day 4, 17.9%; Day 5, 7.1%).Conclusions These results suggest that the day of ET does not fundamentally affect the pregnancy rate in human IVF-ET provided that transfer is made before Day 5.     

体外受精-胚胎移植技术中74例异位妊娠的临床分析

目的:分析体外受精-胚胎移植(in vitro fertilization and embryo tranfer,IVF-ET)助孕技术中发生异位妊娠的影响因素、诊断、治疗方法及预防措施。方法:回顾性分析IVF-ET助孕技术中发生异位妊娠74例患者的临床资料。结果:所有接受IVF-ET的1 585患者中,共发生异位妊娠74例,异位妊娠发生率为4.67%;异位妊娠类型中输卵管妊娠71例,占总异位妊娠的95.95%。新鲜胚胎移植周期组异位妊娠发生率(5.41%)显著性高于冷冻胚胎复苏移植(frozing embryo transfer,FET)周期组(2.35%)(P<0.05)。移植深度距离宫底>1.2 cm时异位妊娠发生率显著性低于移植深度0.8~1.2 cm组。结论:IVF-ET助孕技术中异位妊娠发生率较自然妊娠过程中高;输卵管因素、促排卵药物的应用以及胚胎移植的深度是异位妊娠发生的主要影响因素。     

Ectopic pregnancies after in vitro fertilization and embryo transfer

Objective Our objective was to analyze the risk factors, stimulation characteristics, and future fecundity of patients with ectopic pregnancies after in vitro fertilization (IVF).Methods We retrospectively evaluated all cases of ectopic pregnancy occurring between January 1989 and March 1993 (Cornell series 1 to 17). A case-control group of intrauterine pregnancies was used for comparison of the stimulation and transfer characteristics.Results Twenty-seven of 1123 pregnancies (2.4%) were ectopic, following 2812 fresh IVF embryo transfers, while 8 of 105 pregnancies (7.6%) were ectopic, following 405 frozen-thawed embryo transfers. Tubal factor was the cause of infertility in the majority (85.7%) of ectopic pregnancies. No difference was found between the ectopics and the matched controls in stimulation and transfer characteristics. Thirty ectopic pregnancies were ampullary, two were interstitial, two were cervical, and one was heterotopic. Twenty of the patients subsequently underwent 29 IVF attempts, with a pregnancy rate of 41.4% per transfer.Conclusions Ectopic pregnancy after IVF appears to be related to preexisting tubal pathology; embryo transfer of cryopreserved thawed embryos in a natural cycle may result in a higher ectopic rate in these patients; in subsequent IVF cycles the intrauterine pregnancy rate of these patients is not decreased.     

两种不同胚胎装载技术对体外受精-胚胎移植及冻融胚胎移植临床结局的影响

目的探讨两种不同胚胎装载技术对体外受精-胚胎移植(IVF-ET)和冻融胚胎移植(FET)临床妊娠率及胚胎种植率的影响。方法回顾性分析了543个新鲜胚胎移植周期及658个FET周期。根据移植时胚胎装载方法分为A组(含胚培养液体积周围空气体积)和B组(含胚培养液体积周围空气体积)。比较两种胚胎装载方法对妊娠结局的影响。结果新鲜周期中,B组的临床妊娠率(64.52%)显著高于A组(54.62%)(P0.05),种植率组间虽无统计学差异(P0.05),但B组明显高于A组。FET周期中卵裂胚移植B组的临床妊娠率(49.43%)明显高于A组(38.24%),但没有统计学差异(P0.05),B组(34.62%)的种植率显著高于A组(23.61%)(P0.05)。囊胚移植两组的妊娠率和种植率均没有统计学差异(P0.05),但B组比A组有增高的趋势。结论胚胎移植时含胚培养液体积周围空气体积会显著提高IVF-ET和FET的临床妊娠率和种植率。     

Ultrasonic assessment of endometrial changes in stimulated cycles in an in vitro fertilization and embryo transfer program

Four distinct patterns in the ultrasonic appearance of preovulatory endometrium can be identified and described in patients undergoing stimulated cycles in an in vitro fertilization program. Ultrasonically, this endometrial response can be seen as a quantitative change in thickness and a qualitative change in gray-scale appearance or reflectivity. The application of this additional parameter of endometrial assessment together with the conventional measurement of follicular diameter as a means of optimally timing oocyte collection has been associated with a reduction in the preoperative ovulation rate from 10.9 to 3.2%, an increase in the fertilization rate from 59.2 to 82.5%, and in a pregnancy rate per embryo transfer of 20.5% in our program without the use of hormonal assays.     

An 18-month survey of infertility treatment by in vitro fertilization,gamete and zygote intrafallopian transfer,and replacement of frozen-thawed embryos

An 18-month survey of infertility treatment by in vitro fertilization (IVF) and related procedures at the Centre for Reproductive Medicine of the Vrije Universiteit Brussel is described. During this period, 1326 treatment cycles were started in patients with long-standing infertility and 1135 oocyte retrievals were performed in 771 different patients. IVF and embryo transfer (ET) after laparoscopic (N=793) or ultrasonically guided (N=342) ovum pickup, gamete intrafallopian transfer (GIFT;N=284), or zygote intrafallopian transfer (ZIFT;N=15) combined with IVF as well as the replacement of cryopreserved embryos yielded an overall pregnancy rate of 21.8% per started cycle. Echographic and laparoscopic oocyte retrieval gave similar results except for a higher fertilization rate after echographic-guided retrieval. For in vitro fertilization and embryo transfer an overall pregnancy rate of 26% per transfer was obtained. For GIFT and ZIFT the pregnancy rates were, respectively, 27.8 and 46.7% per replacement. For each procedure onethird of the pregnancies aborted. After the replacement of frozen and thawed embryos, during a natural cycle, a significantly lower fetal loss was observed.     

Multiple attempts at embryo transfer: Effect on pregnancy outcome in an in vitro fertilization and embryo transfer program

Purpose This study derives from the observation that a correlation exists between failed first attempts (FFA) at embryo transfer caused by one or more embryos remaining in the catheter and reduced pregnancy rates (20.3 vs 3.0%). The aim of this study was to examine the relationship between failed first attempts at transfer and contamination of the transfer set; the related aspects of cervix dilatation and late embryo transfer were also investigated.Results The following observations were made. Retention of embryos in the transfer sets significantly reduced the pregnancy rate (P =0.015); catheters contaminated with blood and cervical mucus indirectly contributed to this effect by increasing the incidence of failed first transfer attempts. Even though cervical dilatations, if indicated by uterus sounding, were done 2 days before embryo transfer, no pregnancies were effected in these 18 cases (P =0.0001). Late transfers of embryos, due to delayed fertilization or slow cleavage rates, yielded a pregnancy rate of 10.5%. Conclusion The approach of immediately retransferring retained embryos does not solve the problem of reduced pregnancy rates in FFA cases. It is suggested that ET should be repeated 1 day later in FFA cases in an attempt to improve pregnancy rates.     

子宫内膜异位症合并不孕患者经体外受精/卵胞质内单精子注射-胚胎移植治疗后妊娠结局及相关因素的分析

目的探讨子宫内膜异位症(EMS)对不孕患者经体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)治疗后妊娠结局的影响及其与妊娠结局相关的因素。方法选择行IVF/ICSI-ET治疗的46例EMS合并不孕患者的55个取卵周期作为EMS组;选择同期行IVF/ICSI-ET治疗的126例非EMS患者的156个周期作为对照组。回顾性分析患者的临床资料,并进一步分析与妊娠结局相关的因素。结果 EMS组CA-125水平、周期取消率显著高于对照组(P0.05);基础窦卵泡数(AFC)、hCG注射日成熟卵泡数、获卵数、MII卵数、双原核(2PN)数、卵裂数、优质胚胎数、优质胚胎率显著低于对照组(P0.05);hCG注射日成熟卵泡数与EMS患者未妊娠的相关回归系数0。结论 EMS合并不孕患者卵巢储备功能下降,卵子和胚胎质量下降,更易取消周期。但其卵子成熟率、正常受精率及临床结局与非EMS对照组不孕患者相比无统计学差异;hCG注射日成熟卵泡数是EMS患者妊娠的保护因素。     

Impact of a second insemination on the results of an in vitro fertilization-embryo transfer (IVF-ET) program

In an attempt to increase the fertilization and pregnancy rates in our program, a second insemination was carried out when the first insemination yielded fewer than two fertilized oocytes. One hundred eighty consecutive patients were studied retrospectively and thirty-four required second insemination, 35% of them by donor-semen. Fifty-five and nine-tenths percent of the patients had at least one fertilized oocyte for embryo transfer, but only 21.9% of the oocytes exposed to a second insemination were fertilized. No pregnancy resulted from the transfer of oocytes fertilized by the second insemination. There were no significant correlations between the success of fertilization after a second insemination and the number of oocytes retrieved, the protocol for the induction of superovulation, or the age of the female patient. Considering that the first insemination was done at a variable time after oocyte retrieval to allow oocyte maturation, we expected all oocytes to be mature at the time of first insemination and we considered the possibility of delayed fertilization as negligible since second insemination was done at least 24–30 hr after oocyte retrieval. Even though a second insemination provides further hope for the patient, by yielding additional fertilized oocytes for embryo transfer, its main value is that it may provide additional information about male fertility.     

体外受精-胚胎移植中注射人绒毛膜促性腺激素后不同时间受精对早期胚胎发育及临床结局的影响

目的探讨人绒毛膜促性腺激素(h CG)注射后不同时间受精对体外受精-胚胎移植(IVF-ET)治疗患者实验室指标及临床指标的影响。方法选取行IVF-ET治疗并符合纳入标准的患者200例,根据h CG注射后受精时间不同随机分为4组:h CG注射后38.0~39.0 h受精为A组;注射h CG后39.1~40.0 h受精为B组、h CG注射后40.1~41.0 h受精为C组、h CG注射后41.1~42.0 h受精为D组,每组50例,观察并比较四组间实验室指标及临床指标。结果可用胚胎率B组(65.7%)、C组(63.3%)、D组(66.8%)均高于A组(55.5%)(P0.05);优质胚胎率A组(50.6%)显著低于C组(60.2%)与D组(63.6%)(P0.05),B组(54.3%)明显低于D组(P0.05);C组获得了较好的临床结局,临床妊娠率(50.0%)和着床率(34.2%)较高,流产率(9.1%)较低。正常受精率、正常卵裂率、临床妊娠率、着床率以及流产率组间比较,差异均无统计学意义(P0.05)。结论在一定时间范围内(38.0~42.0 h),随着h CG注射后受精时间的延长,优质胚胎率呈增高趋势;本中心IVF-ET治疗患者的最佳受精时间为h CG注射后40.1~41.0 h,此时受精患者有较高的临床妊娠率,较低的早期流产率及较好的临床妊娠结局。     

体外受精-胚胎移植患者心理因素与妊娠结局的调查

目的:探讨体外受精-胚胎移植(IVF-ET)患者心理因素与妊娠结局的关系。方法:以康奈尔医学指数(CMI)为效标对180名IVF-ET患者进行心理评估。结果:CMI得分与妊娠结局分析具有统计学意义(P0.05),Logistic回归分析结果提示,IVF-ET患者经济收入及CMI测评得分是患者妊娠成功的主要影响因素。结论:通过对患者心理状态评估,给予适当的护理、医疗干预,可以提高患者身心治疗的积极性和依从性,最终提高妊娠成功率。     

体外受精-胚胎移植术后宫角妊娠合并宫腔粘连1例病例报告与文献回顾

目的介绍1例行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)、出现宫角妊娠合并宫腔粘连并成功活产的病例。方法对本院1例重度宫腔粘连分解术后行IVF-ET病例发生宫角妊娠合并宫腔粘连的临床资料进行分析,并对相关文献进行系统性回顾。结果该病例于孕36+3周行子宫下段剖宫产术,成功活产一男婴。结论宫角妊娠是可能危及生命的妇产科急症,但对于妊娠困难的患者,严密监测及期待治疗可获得良好的妊娠结局。     

剖宫产手术史对体外受精-胚胎移植患者临床结局的影响

目的探讨剖宫产手术史对体外受精-胚胎移植(IVF-ET)患者临床结局的影响。方法回顾性分析2013年1月—2015年12月行IVF-ET且有剖宫产手术史的144例患者的助孕情况、妊娠及分娩结局,对照组为同期行IVF-ET且既往仅有阴道分娩史的166例患者。结果与对照组比较,剖宫产史组基础卵泡刺激素水平(b FSH)、人绒毛膜促性腺激素(h CG)注射日雌二醇(E2)水平、子宫内膜厚度、促性腺激素(Gn)用量、G n刺激时间,获卵率、受精率、卵裂率、优质胚胎率、胚胎移植数、多胎妊娠率、流产率、异位妊娠率差异均无统计学意义(P0.05);但剖宫产手术史组胚胎移植困难比例(6.25%)高于阴道分娩史组(0.00%),胚胎种植率(24.01%)及临床妊娠率(40.28%)明显低于阴道分娩史组(分别为34.98%和54.82%),差异均有统计学意义(P0.05);剖宫产史组双胎妊娠者较对照组双胎妊娠发生前置胎盘、产后出血比例增加(P0.05);无论是剖宫产手术史组还是阴道分娩史组,双胎分娩较单胎分娩新生儿出生孕周、体质量明显降低(P0.01)。结论剖宫产手术史可能降低IVF-ET患者的胚胎种植率和临床妊娠率,增加胚胎移植难度。对疤痕子宫妇女应严格控制移植胚胎数目,妊娠后加强孕期监管。     

In vitro fertilization-embryo transfer in three women with ovarian failure

Attempts at in vitro fertilization-embryo transfer (IVF-ET) for women with hypergonadotropic hypogonadism and bilateral tubal disease demonstrated a very low fertilization rate and no clinical pregnancies.     

体外受精 - 胚胎移植后异位妊娠的危险因素、诊断及治疗

目的　探讨体外受精 -胚胎移植 (IVF-ET)后异位妊娠 (EP)的危险因素、诊断及治疗方法。方法　对我院 1992年 10月～ 2 0 0 2年 6月接受体外受精-胚胎移植治疗 (包括单精子胞浆内注射 ,ICSI)后 82 1例临床妊娠中 38例异位妊娠进行回顾性分析。结果　IVF -ET后异位妊娠的发生率 4 6 % ,多胚胎不同部位妊娠(HP)的发生率 0 6 %。异位妊娠组取卵数明显多于对照组。单因素分析发现异位妊娠史、盆腔炎性疾病 (PID)史是IVF-ET后异位妊娠的危险因素。结论　盆腔炎性疾病史、异位妊娠史是IVF -ET后异位妊娠的高危因素。胚胎移植后妇女激素水平可能与异位妊娠的发生相关 ,但需进一步的研究证实。早期诊断和微创性治疗 ,减少异位妊娠的并发症和死亡率     

IVF-ET后补充小剂量雌激素不改善妊娠率

目的:探讨体外受精-胚胎移植(IVF-ET)黄体支持中补充小剂量雌激素(E2)对妊娠率的影响。方法:①回顾性分析912个IVF-ET周期,根据黄体支持方案将其分为A组(511个周期),给予黄体酮80mg/d;B组(401个周期),给予黄体酮80mg/d+补佳乐2mg/d,比较组间妊娠率;②按照hCG日与ET日E2比值,分为<4.0组(291个周期)和≥4.0组(220个周期),比较二组妊娠率,了解E2下降程度与妊娠的关系;③另选择IVF超排卵妇女因某种因素未行移植(24个周期)和自然周期排卵妇女(32个周期)比较黄体中期E2水平,以了解超促排卵对黄体中期E2的影响。结果:黄体期补充与不补充E2组间种植率和妊娠率均无差异(P>0.05);E2下降程度不同的二组间种植率和妊娠率也无差异(P>0.05)。IVF超排妇女黄体中期E2水平明显高于自然周期妇女(P<0.01)。结论:取卵后E2水平下降不影响IVF结局,补充E2进行黄体支持不能改善IVF妊娠率。     

子宫内膜异位症对体外受精-胚胎移植的影响

目的　探讨子宫内膜异位症 (内异症 )对体外受精 -胚胎移植 (Invitrofertilization -embryotransfer,IVF -ET)的影响。方法　对 2 0 0 1年 1月～ 2 0 0 3年 1 0月 86例内异症合并不育患者超促排卵、体外受精和胚胎移植结局等进行回顾性分析 (共 94个周期 ) ;同期 2 0 0例输卵管因素不育患者作为对照组。结果　内异症组促性腺激素需要量显著高于对照组 (P <0 0 1 )。内异症组的获卵数、受精率、优质胚胎数显著低于对照组 (P<0 0 5 ) ;裂率比较 ,差异无显著性 ;内异症组的胚胎着床率 (1 4 2 1 % )、临床妊娠率 (2 9 5 5 % ) ,低于对照组(1 9 5 2 % ,38 2 6 % ) ,差异无统计学意义。结论　内异症影响卵巢对促超排卵的反应 ,影响卵母细胞的受精。内异症患者着床率和临床妊娠率显示降低的趋势     

A formula for scoring human embryo growth rates in in vitro fertilization: Its value in predicting pregnancy and in comparison with visual estimates of embryo quality

Two systems for measuring embryo development in vitro were evaluated. One was a 1–4 scale based on a subjective evaluation of embryo quality (EQ) from microscopic appearance. In addition, a formula for scoring embryo growth rate in vitro was developed. The embryo development rating (EDR) was based on the ratio between the time at which embryos were observed at a particular stage after insemination and the time at which they would be expected to reach that stage in a hypothetical ideal growth rate with a cell cycle length of 11.9 hr. Using this scoring system, normally growing embryos scored 100. This approach was aimed at partially normalizing the data and allowed all embryos to be analyzed similarly regardless of the time of observation. Analysis of 1539 embryo replacements resulting in 232 clinical pregnancies showed that both EDR and embryo-quality scores were of value in predicting success, with clinical pregnancy most likely to eventuate from a combination of moderate to good EQ scores (2–4) coupled with average or above-average growth rates (EDR scores from 90 to 129). Poor-quality and very slowly or very rapidly growing embryos were underrepresented in cycles that proceeded to pregnancy. These inferences were based on all embryos transferred (mean, 2.73 per transfer cycle), and they were substantiated by an analysis of 33 pregnancies resulting from replacement of a single embryo and from 18 pregnancies in which all embryos scored the same with both systems. EQ and EDR were significantly associated with each other and together provide a valuable guide in predicting pregnancy, in selecting embryos for freezing, and in monitoring day-to-day performance in the in vitro fertilization (IVF) program.     

体重对体外受精-胚胎移植妊娠结局的影响

目的探讨在体外受精-胚胎移植(IVF-ET)周期中,女方体重对妊娠结局的影响。方法对中山大学附属第一医院生殖医学中心2005年1月至2008年3月进行2973个IVF周期和1884个卵胞浆内单精子注射(ICSI)周期进行辅助生殖的患者,年龄小于40岁,排除常见的与自然流产有关的疾病,分别进行回顾性分析。按照WHO推荐的亚洲人体重指数(BMI)分级标准,将患者分为体重过低组(BMI<18.5)、体重正常组(BMI18.5~<23.0)、超重组(BMI23.0~<25.0)、肥胖组(BMI≥25.0),分别比较IVF及ICSI患者的基本临床资料、卵子和胚胎情况、妊娠结局。结果IVF及ICSI各组患者的年龄、不孕年限、周期第次、基础内分泌水平差异无统计学意义;卵子和胚胎资料差异无统计学意义;IVF及ICSI各组的周期取消率、种植率、妊娠率差异均无统计学意义;早期流产率在ICSI各组患者中差异无统计学意义,而在IVF患者中,肥胖组早期流产率显著高于体重正常组;无论IVF还是ICSI周期,肥胖组抱婴回家率均显著低于体重正常组。结论女性肥胖增加IVF周期的早期自然流产率;并对IVF及ICSI的妊娠结局均产生负面影响。