Ultrasound guided embryo transfer significantly improves pregnancy rates in women undergoing oocyte donation.

OBJECTIVES: Recent reports suggest ultrasound (US) guided embryo transfer (ET) improves pregnancy rates. Using the ovum donation model to eliminate confounding variables, we assessed the impact of US guided ET on pregnancy rates, implantation rates, and multiple gestation rates. METHODS: All women who underwent IVF-ET cycles using donated oocytes from November 1997 to September 1998 (n = 137) were evaluated retrospectively. ET from November 1997 to April 1998 were performed without US, while all ET from May 1998 to September 1998 were performed using transvaginal or transabdominal US. ET was further categorized as easy or difficult. Difficult ET was defined as requiring at least two attempts and/or the presence of blood on the catheter and/or > 5 min. RESULTS: Pregnant patients (n = 73) were similar with respect to the number and morphology of the embryos transferred compared to non-pregnant patients (n = 65). US guidance significantly improved implantation and pregnancy rates in cycles with easy transfers [28.8 vs. 18.4% and 63.1 vs. 36.1%, respectively (P < 0.05)] without impacting multiple pregnancy rates. CONCLUSION: US guided ET is simple and reassuring and appears to significantly improve pregnancy outcomes in ovum donation cycles by optimizing the placement of embryos.     

Preliminary experience offering oocyte donation to human immunodeficiency virus-1 serodiscordant couples

CASE REPORT: Our preliminary experience on the use of donor oocytes in human immunodeficiency virus-1 (HIV-1) serodiscordant couples who have previously failed conventional in vitro fertilization (IVF) therapy is presented. Five HIV-1 serodiscordant couples in which the male is infected and the female is seronegative underwent IVF with intracytoplasmic sperm injection (ICSI) utilizing donor oocytes with day 3 embryo transfer and cryopreservation. Six oocyte donation cycles in the five couples yielded 16.8 +/- 9.5 (mean +/- SD) (range 11-34) oocytes; 3.8 +/- 0.4 (range 3-4) transferred embryos; and 1.8 +/- 2.2 (range 0-5) cryopreserved embryos per attempt. The fertilization rate from ICSI was 0.60 +/- 0.16 (range 0.40-0.88). Three of five couples conceived; two from one attempt (one singleton pregnancy and one twin pregnancy); and another after a failed fresh cycle using cryopreserved embryos. All female recipients tested remained seronegative 3 and 6 months post-embryo transfer. All babies (n=4) were seronegative at birth and 3 months postpartum. CONCLUSION: Oocyte donation may be considered as an alternative for childbearing in HIV serodiscordant couples in whom conventional IVF has failed due to factors inherent to the female partner.     

同期体外受精-胚胎移植(IVF-ET)赠卵的临床应用

目的:探讨当前形势下中国赠卵的可行性、赠卵数、影响因素及存在的问题。方法:行IVF-ET并自愿捐卵的21例患者及同期接受赠卵并完成IVF-ET周期的23例患者,分析供、受双方的受精率、妊娠率和种植率。结果:23例患者共接受赠卵135枚,平均每周期接受卵子5.6±1.5枚,29个移植周期,12例妊娠,周期妊娠率为41.4%。供卵的21例患者,9个新鲜胚胎移植周期,2例妊娠;32个解冻胚胎移植周期,12例妊娠,冷冻移植周期的妊娠率为37.5%。供、受双方受精率、冷冻胚胎移植周期的妊娠率、累积妊娠率均无统计学差异(P>0.05)。结论:供卵者提供6个左右的卵子既不影响供卵者的妊娠,也能为受卵者提供一个良好的妊娠机会。     

21-hydroxylase deficiency and Turner's syndrome: a reason for diminished endometrial receptivity

OBJECTIVE: To report a case of cryptic 21-hydroxylase deficiency identified at the time of ovum donation in a patient with Turner's syndrome. DESIGN: Case report. SETTING: University IVF practice. PATIENT(S): A 28-year-old woman with Turner's syndrome who presented for ovum donation. INTERVENTION(S): Four cycles of donor IVF. MAIN OUTCOME MEASURE(S): Pregnancy, endometrial appearance, progesterone, and 17-hydroxyprogesterone values. RESULT(S): The patient failed two fresh and two frozen ET cycles with donated oocytes. The appearance of the endometrium suggested elevated progesterone before progesterone supplementation. An elevated progesterone was detected but not suppressed by leuprolide acetate. Progesterone was suppressed by adding dexamethasone. The diagnosis of cryptic 21-hydroxylase deficiency was confirmed biochemically. CONCLUSION(S): Patients with Turner's syndrome reportedly have poorer outcomes with donor IVF than other women. They also have an increased incidence of carrying a defective 21-hydroxylase gene. We suggest that some of the poorer outcomes may be explained by the presence of elevated progesterone and recommend evaluation of possible congenital adrenal hyperplasia in patients with Turner's syndrome who want oocyte donation.     

Transfer of nonselected transferable day 3 embryos in low embryo producers

OBJECTIVE: To examine the implantation potential of embryos from assisted reproductive technology cycles with low embryo production and to assess the effects of clinical variables and embryo scores (ES) on pregnancy outcome. DESIGN: Prospective clinical study. SETTING: Assisted reproductive technology unit in a tertiary medical center. PATIENT(S): From July 1998 to December 2001, 280 cycles in 229 infertile couples produced a limited number of one, two, or three embryos 3 days after oocyte retrieval and underwent fresh embryo transfer (ET). INTERVENTION(S): Embryos with two or more blastomeres were scored and transferred. MAIN OUTCOME MEASURE(S): ES and implantation rate per ET. RESULT(S): Of 863 fresh ET cycles during the study period, 32.4% (280) were low embryo producers. Among them, there were no significant differences in average ES of individual embryos in single, dual, or triple ET or in embryos obtained from patients with low or high E2 responses, or young or old age. Embryos derived from conventional IVF had a better ES than those derived from intracytoplasmic sperm injection. The clinical pregnancy rate was strongly correlated with the cumulative ES. Implantation rates were similar among and between groups, with an average rate of 15.9%. CONCLUSION(S): Embryos of low embryo producers had an inherently low implantation potential that appeared to be unrelated to the number of embryos transferred, female age, ovarian E2 genesis, or fertilization method. The cumulative ES can serve as a predictor of pregnancy.     

Five years of single embryo transfer with anonymous and non-anonymous oocyte donation

Single embryo transfer (SET) has been the main embryo transfer strategy in the oocyte donation programme at the authors' clinic since 2000. The primary aim of this study was to evaluate the effect of SET on the clinical outcome in an unselected group of oocyte recipients. A retrospective analysis of the outcome in 142 recipient cycles (116 from anonymous donors; 26 from known donors) was performed. The oocytes from each anonymous donor were shared between two recipients if at least 10 oocytes were obtained. The proportion of SET of all fresh transfers was 77.3%. The clinical pregnancy rate (CPR) was 43.2% and the delivery rate 31.1% per embryo transfer. The outcome was similar in recipients undergoing anonymous and non-anonymous donation. The delivery rates were similar after SET (30.4%) or double embryo transfer (DET) (33.3%), whereas the twin rate was 0% after SET and 40% after DET. The implantation rate was significantly better (P < 0.01) with good-quality embryos (54.7%) compared with non-optimal embryos (27.1%). Of 152 frozen-thawed embryo transfer cycles, 78.9% were SET. The CPR was 28.3% and the twin rate was 7.1%. In fresh oocyte donation cycles, elective SET can be recommended if the embryo quality is considered good, and always if there is a contraindication for twin pregnancy.     

Shared oocyte donation: society's benefits

Objective: To assess the efficacy of oocyte donation when a cohort of oocytes is shared between two phenotypically matched recipients.

Design: A retrospective analysis of a program using shared anonymous oocyte donation.

Setting: Academic infertility center.

Patient(s): Recipient women with partial or complete ovarian failure; oocyte donors who have been properly screened.

Intervention(s): Each oocyte donor was phenotypically matched with two potential recipients. The cohort of donated oocytes were divided between these two recipients if eight or more mature oocytes were obtained at retrieval. Recipients underwent hormone replacement therapy consisting of down-regulation with a GnRH agonist, transdermal estradiol, and intramuscular progesterone in a dose determined by a previous preparatory cycle.

Main Outcome Measure(s): Pregnancy and delivery rates for all transfers originating from a cohort of oocytes obtained by retrieval of a single donor; pregnancy and delivery rates per recipient; rate of conversion of a shared donation cycle to a single recipient.

Result(s): A total of 249 donor cycles permitted 241 retrievals. Each recipient received 8.3 ± 3.5 oocytes per donation. There were 424 fresh ETs and 48 frozen ETs performed. For fresh ETs, clinical pregnancy and ongoing or delivery rates per recipient were 56.8% and 49.7%, respectively. For frozen ETs, these rates were 50% and 39.5%. Implantation rates were 31.8% and 26.1% for fresh and frozen ET, respectively. When analyzed per donor retrieval, clinical pregnancy and ongoing or delivery rates were 109.5% and 95.4%. These high pregnancy rates per donor reflect the numerous fresh and frozen ETs that can result from one donor’s retrieval. Conversion of a donation cycle from two recipients to one recipient occurred for 26 of 241 cycles (10.8%).

Conclusion(s): Shared anonymous oocyte donation provides a very high pregnancy rate per donor retrieval that is not achievable with unshared donation. In addition, there is a diminished risk exposure of donors per total completed recipient transfers. We support shared oocyte donation as the most efficient use of the precious resource of human oocytes.     

Do donor spermatozoa improve reproductive outcomes after oocyte donation failure? A retrospective analysis of cumulative live birth rates per donor oocyte consumed

Research questionDo donor spermatozoa improve IVF outcomes after first oocyte donation failure?DesignRetrospective, multicentre study including couples undergoing oocyte donation cycles using autologous or donor spermatozoa after a failed first attempt. Male partners were further characterized as normozoospermic or oligoasthenoteratospermic, i.e. fewer than 5 million motile progressive spermatozoa in the ejaculate. The main outcomes measured were live birth rate (LBR) per embryo transfer, LBR per number of embryos transferred, and cumulative LBR (CLBR) considering oocytes consumed in the previous donation cycles.ResultsAnalysis comprised 6065 cycles of oocyte donation failure; among these, subgroup analyses by sperm quality comprised 4113 cycles with severe male factor and 1150 cycles with suboptimal/normal spermatozoa. Sperm replacement in the first cycle after failure increased LBR per embryo transfer (OR 2.21, 95% CI 1.7–2.8, P < 0.001) and per number of embryos transferred (OR 2.46, 95% CI 1.9–3.1, P < 0.001) for normospermic and oligoasthenoteratospermic men. Replacement by the third cycle after failure was less beneficial (LBR per embryo transfer: OR 1.35, 95% CI 0.9–2.1, P = 0.16; LBR per embryos transferred: OR 1.33, 95% CI 0.9–2.0, P = 0.186). Kaplan–Meier curves of CLBR per oocyte fertilized with autologous or donor spermatozoa were statistically different (P < 0.001) and demonstrate how each additional oocyte may affect success based on sperm source (donor/autologous).ConclusionsDonor spermatozoa improved outcomes when used after an initial failed oocyte donation cycle. The CLBR curves can be used to determine the cumulative chances of live birth using either autologous or donor spermatozoa, providing guidance on when to replace spermatozoa.     

Anonymous oocyte donation performed exclusively with embryos cryopreserved at the pronuclear stage

OBJECTIVE: To evaluate the clinical outcomes of patients who participated in an anonymous oocyte donation program that used embryos cryopreserved at the pronuclear stage. DESIGN: Observational study. SETTING: A tertiary care reproductive medicine unit. PATIENT(S): Anonymous oocyte donors and their respective recipients. INTERVENTION(S): Oocyte donors underwent a standard controlled ovarian hyperstimulation protocol and transvaginal ultrasound-guided oocyte retrieval. Oocyte recipients underwent at least one programmed hormone replacement cycle with transcervical ET. MAIN OUTCOME MEASURE(S): Thaw survival, implantation, clinical and ongoing pregnancy rates. RESULT(S): Thirty-six oocyte retrievals resulted in one ET to date. The mean numbers of oocytes that were retrieved and normally fertilized were 18.2 and 11.6, respectively. Fifty-one embryo thaw-transfer cycles were performed, with an embryo thaw survival rate of 93.5%. The clinical and ongoing pregnancy rates per ET were 52.9% and 51%, respectively. The overall implantation rate was 28.7%. The percentage of oocyte retrievals that resulted in at least one ongoing pregnancy to date was 69.4%. CONCLUSION(S): Anonymous oocyte donation can be conducted efficiently with the exclusive use of embryos cryopreserved at the pronuclear stage. This approach facilitates synchronization of the donor-recipient pair, eliminates the risk that recipients will begin hormonal therapy without embryo availability, and produces an acceptable ongoing pregnancy rate per oocyte donation.     

Early pregnancy losses in in vitro fertilization and oocyte donation

Objective: To evaluate prospectively the incidence of early pregnancy losses (before menstruation occurs) in IVF and ovum donation cycles.

Design: Prospective case-control study.

Setting: Tertiary care, university-associated center.

Patient(s): One hundred forty-five patients undergoing IVF and 92 undergoing oocyte donation were recruited. The control group for IVF consisted of 15 ovum donors who had no ET and were instructed to avoid intercourse. The control group for oocyte donation included 10 women undergoing a mock cycle of steroid replacement.

Intervention(s): Starting on day 6 after ET, the women were instructed to collect the first urine sample of the day every 2 days. Each patient collected six different specimens of urine (days 6, 8, 10, 12, 14, and 16 after ET for cases or the same days without ET for controls.

Main Outcome Measure(s): β-HCG was measured with a standardized microparticle enzyme immunoassay, and IVF reproductive outcome was assessed.

Result(s): For IVF, positive implantation was registered in 88 of 145 cycles of embryo replacement (60.7%). Only 30 (20.7%) resulted in viable pregnancies, whereas the remaining 58 miscarried. Forty-two of these miscarriages (72.4%) were early pregnancy losses and 13 (22.4%) were classified as clinical abortions. In ovum donation, positive implantation was recorded in 64 of 92 cycles of ET (69.6%). A total of 30 (32.6%) ended in viable pregnancies, whereas the remaining 34 (37.0%) were miscarriages. Early pregnancy loss accounted for 70.6% of pregnancy losses, whereas biochemical pregnancies and clinical abortions accounted for 11.8% and 17.6%, respectively.

Conclusion(s): Our results demonstrate that patients undergoing assisted reproductive technology have an increased rate of early pregnancy loss compared with fertile patients. In addition, these data indicate that implantation is more frequently impaired in IVF than in oocyte donation cycles, resulting in a high incidence of early pregnancy loss. This suggests that implantation may be subjected to abnormal conditions in assisted reproduction.     

Factors useful in predicting the success of oocyte donation: a 3-year retrospective analysis.

OBJECTIVE: To establish prognostic relevance of parameters assessed in oocyte donation cycles. DESIGN: Retrospective analysis. SETTING: Large university-based donor oocyte program. PATIENT(S): All oocyte recipient cycles achieving embryo transfer from September 1995 to October 1998. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): Recipient age and reproductive status, day 9 and 12 serum estradiol (E(2)) levels and a progesterone (P) level obtained 2 days after initiation of hormonal therapy did not correlate with pregnancy. Endometrial thickness, but not endometrial pattern, was useful in predicting pregnancy outcome. The clinical pregnancy and live-birth rate in cycles where the endometrial thickness was less than 8 mm was significantly lower when compared to cycles with an endometrial thickness > or =9 mm. Cycles where optimal quality embryos were transferred had the highest implantation (36%), clinical pregnancy (63%) and live birth (54%) rates and these rates were significantly higher than those of cycles where only poor quality embryos were available for transfer (10% implantation, 17% clinical pregnancy, and 8% live birth rates, respectively; P<.05). CONCLUSION(S): The most reliable predictive factors for pregnancy in oocyte donation cycles are the quality of the embryos transferred and the recipient's mid-cycle endometrial thickness. Recipient monitoring should minimally include ultrasound assessment of endometrial thickness.     

Factors that determine discordant outcome from shared oocytes

OBJECTIVE: To investigate the factors that may be related to pregnancy in oocyte recipients who shared oocytes from the same donor and showed discordant pregnancy outcome. DESIGN: Matched pair analysis. SETTING: IVF academic center. PATIENT(S): Five hundred forty-two oocyte donation cycles that shared oocytes from 197 donors with discordant outcome. INTERVENTION(S): Egg donation and embryo transfer. MAIN OUTCOME MEASURE(S): Pregnancy rate and implantation rate. RESULT(S): Three hundred sixty-five matched-paired discordant outcome oocyte recipients were analyzed. Pregnant and nonpregnant recipients were similar in terms of age, serum E(2) levels, endometrial thickness, indications for oocyte donation, and abnormal sperm parameters. No differences were found in the number of oocytes received per patient, fertilization rate, IVF/intracytoplasmic sperm injection (ICSI) distribution, embryo quality, or on embryo transfer difficulty. CONCLUSION(S): Discordant pregnancy outcome could not be explained by the different egg recipients and cycle factors studied. In addition to chance, other factors must be investigated that could explain discordant outcome in egg recipients sharing oocytes from single donors.     

Transfer and uterine factors are the major recipient-related determinants of success with donor eggs

OBJECTIVE: To define the recipient-related determinants of outcome with donor eggs. DESIGN: Case-control study. SETTING: Community hospital-based assisted reproductive technology (ART) program. PATIENT(S): One hundred thirty-four embryo transfers (ETs) in which two recipients were matched to one donor. INTERVENTION(S): Controlled ovarian hyperstimulation (COH) and ovum retrieval in donors; IVF and ET to recipients. MAIN OUTCOME MEASURE(S): Recipients' age, body mass index (BMI), medical conditions, endometriosis, gravidity, uterine pathology, endometrial thickness, egg number, total motile sperm count, intracytoplasmic sperm injection (ICSI), zygote number, fertilization rate, embryos per ET, embryos frozen, embryo quality, difficulty with transfer, and ongoing pregnancies per ET. RESULT(S): Forty-one recipient pairs had discordant outcomes. Pregnant patients had a lower frequency (9.7% vs. 31.7%, P=.04) and lesser severity of uterine pathology. Endometrium <8 mm was found solely in failed cycles. Pregnant women had fewer moderate or difficult ETs (9.7% vs. 31.7%, P=.04) and more good embryos (1.8 vs. 1.3, P=.03) than the nonpregnant group. CONCLUSION(S): Analysis of recipient pairs with discordant outcomes identifies the recipient-related predictors of success by keeping oocyte quality and the laboratory component constant. Uterine pathology, thin endometrium, transfer difficulty, and number of high-grade embryos are the principal recipient-related determinants of outcome with donor eggs.     

An oocyte donation protocol using the GnRH antagonist ganirelix acetate,does not compromise embryo quality and is associated with high pregnancy rates

Purpose: To evaluate the effect of the GnRH antagonist, ganirelix acetate, on oocyte quality. Methods: Stimulation characteristics, implantation rates and clinical pregnancy rates were compared between 29 oocyte donors 21–31 years of age who underwent 31 cycles of ovarian stimulation with gonadotropins and ganirelix acetate, and 36 infertile couples of similar age range who underwent 51 cycles of ovarian stimulation using the same protocol. Results: A significantly lower number of embryos were transferred in the donor/recipient group as compared to the infertile group (2.32±0.54 vs. 2.82±0.71, P<0.05). In contrast, implantation and clinical pregnancy rates per transfer, were significantly higher in the donor/recipient group (38.1% vs. 10.4%, P<0.01) and (61.3% vs. 23.1%, P<0.05) respectively, as compared to the infertile group. Conclusions: Incorporation of ganirelix acetate for pituitary suppression in stimulation protocols for oocyte donation is associated with high pregnancy rates suggesting that ganirelix acetate does not exert an adverse effect on oocyte or embryo quality.Capsule: Incorporation of ganirelix acetate in stimulation protocols for oocyte donation is associated with high pregnancy rates suggesting that there is no adverse effect on oocyte quality     

Analysis of factors associated with multiple pregnancy in an oocyte donation programme

The aim of this study is to identify the factors associated with multiple pregnancy in an oocyte donation programme. A retrospective study (2000-2007) of 945 synchronous cycles was performed. Two embryos were transferred in all cycles on day 2 after oocyte retrieval. All variables (egg donor and recipient age, number of inseminated oocytes, fertilized oocytes, cleaved embryos, good-quality embryos available, good-quality embryos transferred and frozen embryos) were analysed in relation to the clinical pregnancy rate per transfer (PR) and the multiple pregnancy rate (MPR). The donor age was 26.8±4.5 years and recipient age was 41.0±5.4. The number of good-quality embryos per recipient was 3.1±2.5. The PR was 55.1% and the MPR 36.5%. The number of good-quality embryos transferred (2 versus 0) was significantly associated (P<0.05) with the PR (60.6% versus 43.5%). The relationship between the MPR and the number of good-quality embryos transferred was adjusted by donor and recipient's age. For those patients who received 2 versus 0 good-quality embryos, the odds ratio of a multiple pregnancy was 2.1 (95% CI 1.121-3.876). The only predictive factor for multiple pregnancies in an oocyte donation programme is the quality of the transferred embryos. Since the development of assisted reproduction techniques, most countries have witnessed increased rates of multiple pregnancy. In IVF/intracytoplasmic sperm injection, effective strategies must be established to prevent multiple pregnancy without reducing overall pregnancy rates. In oocyte donation programmes, there is less awareness about the related risks. Actually, a minimum of two embryos are still transferred in most centres. The patient's age is higher and this fact implies more obstetric and perinatal complications. The aim of this study is to identify the factors associated with multiple pregnancy to contribute to establish future guidelines to avoid those risks.     

Elective single embryo transfer: Comparison of blastocyst and cleavage-stage embryo transfer

Objective:   Blastocysts are reportedly suitable for preventing multiple pregnancies as a result of the high implantation rate per embryo. The present study compared clinical results for elective single embryo transfer (ET) between blastocysts and cleavage-stage embryos in order to ascertain the usefulness of blastocyst culturing in single ET.
Methods:   Between January 2002 and December 2004, conventional in vitro fertilization ET and/or intracytoplasmic sperm injection was carried out for single ET in 86 cycles, to prevent multiple pregnancies (for medical reasons or because of patient wishes).
Results:   Among the 80 cycles in which a fresh embryo was transferred, pregnancy/implantation rates per ET were 35.3% for day 2/3 ET and 50.0% for day 5 ET, and pregnancy/implantation rates per oocyte retrieval were 35.3% for day 2/3 ET and 44.2% for day 5 ET. Ongoing pregnancy/delivery rates per oocyte retrieval were 32.4% for day 2/3 ET and 38.5% for day 5 ET. Monozygotic twinning occurred in one case of day 5 ET.
Conclusions:   Pregnancy rates per single ET tended to be higher for day 5 ET than for day 2/3 ET. However, no marked differences were identified in ongoing pregnancy/delivery rates per oocyte retrieval between groups. (Reprod Med Biol 2005; 4 : 197–201)     

The Use of Donor Eggs and Embryos in the Management of Human Infertility

The use of donor eggs and embryos is indicated in those infertility cases where the recipient's eggs are either absent, unavailable or inappropriate for in vitro fertilization (IVF) and embryo transfer (ET) programmes. Donor eggs may be fertilized by either the sperm of the recipient's husband (donor egg programme) or by donor sperm (donor embryo programme), in vitro or in vivo and may be transferred as either fresh or frozen-thawed embryos. Human pregnancies and livebirths have recently been reported following the donation of embryos fertilized both in vitro and in vivo. The development of this new technique will allow the achievement of normal pregnancy in infertile women who hitherto had no possible chance of pregnancy.     

The impact of early testicular sperm extraction or cryopreservation on the outcome of intracytoplasmic sperm injection--a randomized controlled study

Purpose : To compare the outcome of sperm extraction 24 h before ovum pickup and on the day of oocyte retrieval. Methods : A controlled study was performed to compare the outcome of 90 sperm extractions and in vitro sperm injection cycles performed in 54 patients. Results : Available fresh sperm for the sperm injection procedure and cryopreservation obtained on the day of ovum pickup were similar to sperm collected 1 day before (33.3% vs. 39.4%, respectively). Fertilization rate obtained with fresh sperm was also similar (48.9% vs. 54%), respectively. Clinical pregnancy rate was 38% vs. 22% per embryo transfer, respectively (P = 0.235). When comparing an additional 24 cycles with cryopreservation of sperm retrieved on the day of ovum pickup, as well as a day previously, no significance was noted in the parameters. Conclusions : Sperm retrieved 24 h before oocyte retrieval and used as fresh or frozen–thawed for sperm injection are as effective as those used on the day of ovum pickup.     

Middle to lower uterine segment embryo transfer improves implantation and pregnancy rates compared with fundal embryo transfer

OBJECTIVE: To assess differences in pregnancy and implantation rates as a function of the embryo placement. DESIGN: Prospective cohort study. SETTING: A tertiary care center. SUBJECT(S): All fresh, nondonor IVF cycles performed in 2001. INTERVENTION(S): Alteration in embryo transfer (ET) target location from the fundal region to the middle to lower uterine segment. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (sonographic sac evidence/number of transfer cycles), implantation rate (number of sacs/number of embryos transferred), patient age, peak E(2), and fertilization rate. RESULT(S): A total of 393 fundal and 273 lower to middle uterine segment ETs were performed. The pregnancy (PR), implantation, and birth rates were significantly higher after a middle to lower uterine segment ET compared with fundal ET (39.6% vs. 31.2%; 21% vs. 14%; and 34.1% vs. 26.2%, respectively). Groups did not differ regarding patient age, basal FSH, peak E(2), number of intracytoplasmic sperm injection (ICSI) cycles, fertilization rate, embryo quality, or number of embryos transferred. CONCLUSION(S): Both PR and implantation rates are favorably affected by directing embryo placement to the lower to middle uterine segment. By some unknown mechanism, it appears that this endometrial location provides a more favorable region for embryo deposition.     

受卵体外受精-胚胎移植治疗结局分析

目的:探讨受卵体外受精-胚胎移植(IVF-ET)治疗结局和疗效。方法:回顾分析2004年9月至2005年11月在本中心接受卵子赠送IVF-ET的患者共21周期的临床资料。赠卵组(20例)均采用长方案控制性超排卵行IVF-ET。受卵组(21例)采用激素替代治疗准备子宫内膜。赠卵者所赠卵子与受卵者丈夫精液行IVF-ET。选择同期常规IVF-ET患者55例做对照。结果:赠卵组种植率和临床妊娠率(7.3%,15.79%)明显低于受卵组(34.9%,52.38%)和同期IVF-ET组(21.19%,34.55%),P<0.05。结论:受卵IVF-ET是治疗卵巢功能不良和遗传原因不能生育健康后代妇女的有效方法;激素替代周期的种植率和临床妊娠率高于控制性超排卵周期。