Predictors of success after embryo transfer: experience from a single provider

OBJECTIVE: Our goal was to examine the variables present at the time of embryo transfer and to determine their effects on the clinical pregnancy rate. STUDY DESIGN: All fresh and frozen embryo transfers during a 3-year period in a university-based in vitro fertilization program were examined. Female age, previous in vitro fertilization attempt, diagnosis, embryo number and quality, transfer technique, and presence of a clinical pregnancy were recorded for each couple. Logistic regression analyses were performed both univariately and multivariately to determine the association between a clinical pregnancy and the independent variables. RESULTS: All transfers during the study period were included in the analysis. The four primary diagnoses were pelvic or tubal disease, male factor infertility, unexplained infertility, and endometriosis. The 46 frozen embryo transfers had a clinical pregnancy rate similar to that among the 159 fresh embryo transfers and were therefore included in the analysis. One variable was found to significantly affect the outcome, the number of high-grade embryos placed. The presence of a previous failed embryo transfer tended to lower the success rate for future attempts; however, this result did not reach statistical significance. The catheter type and the transfer difficulty did not affect outcome. CONCLUSION: The two most important variables for predicting a clinical pregnancy are a first-time transfer and the number of high-grade embryos placed. Neither the type of embryo transfer catheter used nor the diagnosis affected outcome. In this small sample difficult embryo transfers did not diminish the chance for a successful outcome.     

Pregnancy after in vitro fertilization,cryopreservation, and embryo transfer

Summary We reported on the first pregnancy achieved in the Erlangen IVF program after cryopreservation and embryo transfer. After hMG stimulation in the first treatment cycle, nine oocytes were retrieved by laparoscopy from a 31-year-old woman and three embryos transferred. Fived other oocytes were fertilized and developed to four- to eight-cell embryos, which were subsequently cryopreserved. Transfer of these embryos two cycles later resulted in a singleton pregnancy and the birth of a healthy girl.     

冻融胚胎移植周期无创性内膜刺激胚胎移植策略的临床疗效探究

目的探讨无创性内膜刺激胚胎移植(stimulation of endometrium embryo transfer,SEET)技术在冻融胚胎移植(frozen-thawed embryo transfer,FET)周期中对妊娠结局的影响。方法回顾性分析2016年3月—2017年2月在本中心进行体外受精-胚胎移植(IVF-ET)并首次行单囊胚FET的不孕症患者的临床资料,按移植方式分组:A组(实验组)57个周期,FET时采用SEET技术;B组(对照组)56个周期,FET时采用传统囊胚移植技术。结果 A组采用SEET技术后的胚胎种植率(64.9%)和临床妊娠率(64.9%)显著高于B组(44.6%,44.6%)。结论 SEET技术可以显著提高临床妊娠率,为改善IVF结局提供了一种新的移植策略。     

Pregnancy rates after transfer of cryopreserved blastocysts cultured in a sequential media

OBJECTIVE: This study was undertaken to determine the pregnancy rate after transfer of cryopreserved blastocysts. STUDY DESIGN: Retrospective review of 61 patients from January 1, 2002, to December 31, 2003, who were transferred with blastocyst embryos cryopreserved on day 5 or 6 after culture in a sequential media. The cryopreserved blastocysts were thawed by using a 7-step dilution process after rapid thawing half hour to 2 hours before embryo transfer. RESULTS: The pregnancy rate after transfer of 61 patients with cryopreserved blastocysts was 66%, with 49% having cardiac activity. The pregnancy rate after transfer of 3 blastocysts was 71% and after transfer of 2 blastocysts was 66%. The pregnancy rate of blastocysts cryopreserved after intracytoplasmic sperm injection was 56%. CONCLUSION: Cryopreservation and transfer of blastocysts appears to be a reliable procedure, and that the human blastocyst can be cryopreserved and thawed without a significant loss of viability.     

Pregnancy rates after reconstructive surgery on the fallopian tubes

Current practices at Johns Hopkins Hospital with regard to surgery for tubal disease are presented. Statistical support for a particular point could not always be provided, but overall end results are given. Between 1965 and 1972, 66 patients at the Johns Hopkins Hospital had tuboplasties: 24 salpingolyses, 18 fimbrioplasties, 6 anastomoses, 8 cornual implantations, and 10 multiple procedures. The average patient age was 29.3. The duration of infertility was between 8 months and 10 years, with an average of 53.2 months. 41 of the patients had primary and 25 had secondary infertility. The operations of lysis of adhesions were done for patients whose hysterosalpingograms or dye studies at endoscopy showed patent tubes where peritubal adhesions were visualized. Fimbrioplasty has proved to be the most frustrating operation. Resection and anastomosis was almost exclusively done for repair of the tubes after surgical ligation. A high percent of good results are expected after cornual implantation. The pregnancy rates after correction of obstruction at various sites were 58% for salpingolysis, 22% for fimbrioplasty, 50% for midtubal obstructure, 38% for cornual implantation, and 20% for multiple procedures. The overall pregnancy rate was 39.4%. These rates depended on the length of the followup: the shorter the duration of followup, the lower the pregnancy rate. In order to circumvent this problem, expectancies of pregnancy, when followed up for an indefinite time, were calculated by computer. By this algorithm, it was found that 50% of patients could expect pregnancy following tuboplasties of all kinds: 66% after tubolysis, 40% after fimbrioplasty, 50% after anastomosis, 38% after cornual implantation, and 21% after multiple procedures.     

The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer

This experimental prospective quasi-randomized study examining the impact of a medical clowning encounter after embryo transfer (ET) after in vitro fertilization (IVF) found that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.67; 95% confidence interval, 1.36-5.24). Medical clowning as an adjunct to IVF-ET may have a beneficial effect on pregnancy rates and deserves further investigation.     

Implantation, clinical pregnancy and miscarriage rates after introduction of ultrasound-guided embryo transfer

The purpose of this study was to compare the reproductive outcome of ultrasound-guided (USG) embryo transfers versus clinical touch embryo transfers. A statistically powered retrospective analysis of women undergoing fresh and frozen embryo transfers in a National Health Service-based tertiary referral centre in the Department of Reproductive Medicine, St Mary's Hospital, Manchester was carried out. A total of 1723 embryo transfers were included in the analysis. The implantation rate was significantly higher in the USG embryo transfer group compared with the non-USG embryo transfer group (fresh: 19.9 versus 9.5%, P < 0.0001; frozen: 13.1 versus 7.3%, P < 0.0004). The clinical pregnancy rate was also significantly higher in the former group (fresh: 26.9 versus 12.5%, P < 0.0001; frozen: 15.6 versus 8.9%, P < 0.0015). For the frozen embryos, the miscarriage rate was significantly elevated among the USG embryo transfer group [unadjusted rate ratio (RR) = 1.65, 95% CI: 1.04, 2.62], but this was of borderline significance when the model was adjusted for the potential confounders (adjusted RR = 1.56, 95% CI: 0.997, 2.45). There was no difference in the ectopic pregnancy rates between the two groups. The findings of this study show that the practice of USG embryo transfer is associated with statistically higher implantation and clinical pregnancy rates in IVF.     

Treatment with oxytocin antagonists before embryo transfer may increase implantation rates after IVF

This report aimed to examine the effects of atosiban on pregnancy outcome after IVF–embryo transfer. A prospective, randomized, placebo-controlled clinical study was performed. A total of 180 women undergoing intracytoplasmic sperm injection who had top-quality embryos were randomly allocated into treatment and control groups. All the patients had infertility due to tubal factor, hormonal-anovulatory disorders, male factor or unexplained reasons. The treatment group received intravenous administration of atosiban before embryo transfer with a total administered dose of 37.5 mg. In the control group, the same number of cycles was performed with placebo medication. The clinical pregnancy rate (PR) per cycle and implantation rate (IR) per transfer were 46.7% and 20.4% in the atosiban-treated group, which were significantly higher than in the control group (28.9% and 12.6%, respectively, P = 0.01). The miscarriage rates of groups 1 and 2 were 16.7% and 24.4%, respectively (P = 0.01). These results have indicated that atosiban increases the IR and PR after IVF–embryo transfer. These results suggest that atosiban treatment before embryo transfer is effective in priming of the uterus for implantation. This is the first study to investigate the possible contributions of atosiban for improving the PR after IVF–embryo transfer.     

Pregnancy outcome following frozen embryo transfer after artificial cycle or treatment by clomiphene citrate

The optimal method to prepare endometrium before frozen embryo transfer (FET) is not yet established. We retrospectively studied 4496 FET and detailed pregnancy and miscarriage rates in three groups of patients according to the endometrium preparation they have followed before their successive FET: clomifene citrate (CC, group 1), artificial cycle (AC, group 2) or switch between CC and AC (group 3). The overall pregnancy rates per transfer were 24.3, 20.8 and 17.3% while the miscarriage rates reached 23.2, 29.8 and 42.5%, respectively. Group 1 experienced the highest ongoing pregnancy rate (18.6%), the lowest being observed in group 3 (10.0%, p?相似文献   

Pregnancy rates for single embryo transfer (SET) of day 5 and day 6 blastocysts after cryopreservation by vitrification and slow freeze

Purpose

The purpose of this study was to compare clinical and ongoing pregnancy rates in cycles with single embryo transfer (SET) of blastocysts cryopreserved on day 5 or day 6. Our aim was to determine whether day 6 blastocysts perform adequately to recommend SET.

Methods

Retrospective cohort study including 468 transfer cycles for 392 women younger than age 38 undergoing SET at a university-affiliated IVF clinic in the USA. A total of 261 day 5 blastocysts and 207 day 6 blastocysts for frozen-thawed SET between 2010 and 2016 were analyzed. Data included cryopreservation by both a slow freeze method and vitrification.

Results

In total, 59.0% of day 5 SET cycles resulted in a clinical pregnancy compared to 54.1% of day 6 blastocysts (p = 0.54). Ongoing pregnancy rates from day 5 frozen-thawed blastocysts (51.7%) were comparable to day 6 (44.9%, p = 0.14). When looking at vitrified blastocysts only, there were no significant differences between day 5 and day 6 blastocysts, with a clinical pregnancy rate of 69.2% for day 5 and 72.5% for day 6 (p = 0.68).

Conclusions

SETs of day 6 cryopreserved blastocysts resulted in similar clinical and ongoing pregnancy rates compared to day 5, particularly after vitrification.

     

Pregnancy after fimbriectomy reversal: results of microsurgery augmented by gamete intrafallopian tube transfer and embryo transfer.

In this study, fimbriectomy reversal resulted in a 43% intrauterine PR and a fecundability of 6.6%. The cumulative PR and the fecundability were 57% and 7.8%, respectively, when microsurgery was augmented by GIFT and embryo cryopreservation during the same treatment cycle and by subsequent embryo thaw and transfer.     

Pregnancy loss rates after midtrimester amniocentesis

OBJECTIVE: The purpose of this study was to quantify the contemporary procedure-related loss rate after midtrimester amniocentesis using a database generated from patients who were recruited to the First And Second Trimester Evaluation of Risk for Aneuploidy trial. METHODS: A total of 35,003 unselected patients from the general population with viable singleton pregnancies were enrolled in the First And Second Trimester Evaluation of Risk for Aneuploidy trial between 10 3/7 and 13 6/7 weeks gestation and followed up prospectively for complete pregnancy outcome information. Patients who either did (study group, n=3,096) or did not (control group, n=31,907) undergo midtrimester amniocentesis were identified from the database. The rate of fetal loss less than 24 weeks of gestation was compared between the two groups, and multiple logistic regression analysis was used to adjust for potential confounders. RESULTS: The spontaneous fetal loss rate less than 24 weeks of gestation in the study group was 1.0% and was not statistically different from the background 0.94% rate seen in the control group (P=.74, 95% confidence interval -0.26%, 0.49%). The procedure-related loss rate after amniocentesis was 0.06% (1.0% minus the background rate of 0.94%). Women undergoing amniocentesis were 1.1 times more likely to have a spontaneous loss (95% confidence interval 0.7-1.5). CONCLUSION: The procedure-related fetal loss rate after midtrimester amniocentesis performed on patients in a contemporary prospective clinical trial was 0.06%. There was no significant difference in loss rates between those undergoing amniocentesis and those not undergoing amniocentesis. LEVEL OF EVIDENCE: II-2.     

Pregnancy rates after laparoscopy for infertility

To obtain prognostic data on the likelihood of pregnancy in infertile women with no observable abnormalities at diagnostic laparoscopy, the occurrence of pregnancy was studied in a series of 229 patients. The cumulative conception rate during a follow-up period of at most 5 yr was 50%. The probability of pregnancy proved to decline with age and duration of infertility. The cumulative conception rate during the first year after laparoscopy was approx. 30%, and there was no significant difference between the patients that were treated with respect to other sub-optimal fertility factors (subfertile group) and the patients in whom no rational treatment could be instituted (unexplained infertility group). Implications of these findings with respect to the treatment of long-term infertility are discussed. Knowledge of pregnancy rates after infertility laparoscopy seems important for the evaluation of results of therapy in unexplained infertility.