Pregnancies after intrafallopian transfer of embryos

Six patients with a history of infertility of more than 4 years were offered in vitro fertilization (IVF) followed by translaparoscopic embryo transfer to the fallopian tubes. Three of the patients became pregnant. In one patient the oocytes did not fertilize in vitro. Intrafallopian transfer of embryos may be an alternative to gamete intrafallopian transfer (GIFT) or IVF, especially in those cases where confirmation of fertilization is wanted.     

Birth of a triplet after transfer of four frozen-thawed embryos

This is apparently the first triplet pregnancy after four freeze-thawed embryos that terminated in a birth of three healthy infants, with relatively good birth weights and uneventful follow-up.     

Pregnancies after transfer of ultrarapidly frozen human embryos

Purpose: We report our experience of freezing human embryos using an ultrarapid freezing method. Methods: The patients were superovulated. Oocytes were inseminated and cultured in HTF + 10% serum. A maximum of three embryos was transferred and the rest of the embryos were frozen ultrarapidly after a 3-min equilibration period in PB1 + 3.5 MDMSO + 0.25 Msucrose. Embryos were thawed in a 37°C water bath for 6 sec, then cultured in PB1 + 20% serum for 10 min. The surviving embryos were transferred into patients on the same day of thawing. Results: Sixty-three embryos were thawed. of which 52 embryos (83%) survived with at least one intact blastomere. Nineteen frozen-thawed embryo transfers were made. The mean embryos per transfer was 2.7. Three pregnancies (16%/transfer) were established. One miscarriage occurred in the eighth week of pregnancy. Two pregnancies went to term and three healthy infants were born. Conclusions: The present data demonstrate that ultrarapid freezing is a method worth consideration in the area of human embryo freezing.     

Pregnancy after transfer of frozen-thawed human embryos.

Cryopreservation of human embryos has been successfully applied in in vitro fertilization (IVF) and embryo transfer (ET) programs at the National Taiwan University Hospital since 1988. Our preliminary results with 120 frozen-thawed embryos in 31 transfer cycles showed that the survival rate of frozen embryos was 66%. Following transfer, the implantation rate and clinical pregnancy rate were 6.5% and 13%, respectively. Four clinical pregnancies and one preclinical pregnancy following a frozen-thawed embryo transfer were achieved. Two normal male babies have been delivered and another pregnancy is progressing without any problem.* Unfortunately, one pregnancy was terminated due to intrauterine fetal death discovered at the 10th week of gestation; chromosome abnormality (47, XX, +5) of the fetus was found. The single preclinical pregnancy showed an elevation of serum beta-human chorionic gonadotropin levels for three consecutive weeks following ET, but no definite gestational sac was visualized by transvaginal ultrasound.     

Pregnancies achieved after transferring frozen morula/compact stage embryos

OBJECTIVE: To report two cases of frozen embryo transfers in which embryos were frozen at the morula/compact stage and pregnancies were achieved after transfer. DESIGN: Case report. SETTING: Private assisted reproductive program. PATIENT(S): Two women had transfer of embryos that were frozen at the morula/compact stage. INTERVENTION(S): Human morula/compact embryos were cryopreserved and transferred after subsequent thaw. MAIN OUTCOME MEASURE(S): Embryo survival after thawing and subsequent pregnancy outcome. RESULT(S): Three and five compact embryos were frozen on day 4 for two patients, respectively. In the first case, all three embryos survived after thawing, and all were transferred. In the second patient, three of five embryos survived after thawing, and those three surviving embryos were transferred. Pregnancies were achieved in both patients. The first woman became pregnant with twins and delivered two girls weighing 2,270 g and 2,071 g, respectively. The second patient became pregnant with a singleton and delivered a boy weighing 2,837 g. CONCLUSION(S): Human embryos can be frozen and thawed in the morula/compact stage and achieve normal pregnancy. Advantages of embryo freezing/thawing at the morula/compact stage include the following: [1] compared with earlier embryonic stage freezing, morula/compact-stage embryos provide better embryo selection and [2] it is easier and safer to perform assisted hatching on compact-stage embryos when compared with those from other preimplantation stages.     

The establishment of an ovum donation program using a simple fixed-dose estrogen-progesterone replacement regimen

Most ovum donation (OD) programs involve cycle synchronization between recipient and donor for normally cycling recipients and a complex estrogen-progesterone replacement regimen for recipients with ovarian failure. In 1987, Serhal and Craft (1) suggested the use of a fixeddose estrogen-progesterone regimen for recipients who were normally ovulatory and to those with ovarian failure. Following this protocol, and simplifying it still, the authors administered 6 mg estradiol valerate (E₂) daily orally starting on day 2–6 of induced withdrawal bleeding, augmented with 100 mg progesterone in ethyl oleate (P) intramuscularly daily, starting any time between 4 days prior to and the day of oocyte pickup. All recipients underwent embryo transfer at a 2-pronuclei (2PN)-10-cell stage. A group of 21 patients underwent 26 treatment cycles, resulting in 16 pregnancies. Twelve of the patients gave birth, one to triplets, two to twins, and nine to singletons. Four patients miscarried in the first trimester of pregnancy.     

Elevated incidence of chromosomally chaotic embryos among frozen-thawed preimplantation embryos

OBJECTIVE: The aim of the study was to evaluate the effect of cryopreservation on the formation of chromosomal abnormalities in human preimplantation embryos. STUDY DESIGN: The chromosomal constitutions of cleavage stage embryos (n = 61) were assessed using fluorescent in situ hybridisation (FISH) technique, applying probes for chromosomes 13, 16, 18, 21, X and Y. Study group embryos frozen at zygote or two-cell stage (n = 29) were cultured in vitro post-thawing until they reached four- to six-cell stage, after which their chromosomal constitutions were assessed. Control group embryos frozen at four- to six-cell stage (n = 32) were analysed immediately after thawing in order to exclude any post-thaw effect. The proportions of genetically normal and abnormal embryos were compared between study and control group. RESULTS: The proportions of normal, aneuploid and mosaic embryos were similar in both groups. However, significantly (P < 0.05) higher proportion of chaotic embryos in study (24.1%) compared to control group (6.3%) was observed. CONCLUSION: The elevated level of chromosomally chaotic embryos among embryos that had undergone cellular division after thawing as compared to embryos analysed immediately after thawing indicates a potential negative impact of cryopreservation on the formation of chromosomal abnormalities in preimplantation embryos.     

Twin pregnancy obtained with frozen-thawed embryos after in vitro maturation in a patient with polycystic ovarian syndrome

Purpose : A twin pregnancy was obtained in a patient with polycystic ovary syndrome after the transfer of three in vitro maturation-derived day 3 embryos that has been frozen and thawed. Methods : The patient had received mild hMG stimulation followed by hCG injection. After culture for 24–48 h, mature oocytes were fertilized by ICSI. Embryos were cultured until day 3; supernumerary embryos were cryopreserved using a slow protocol. Results : Among 15 nonatretic oocytes, 9 matured, 8 were fertilized. Four embryos were transferred but they did not implant. The subsequent transfer of three frozen–thawed embryos resulted in the delivery of two healthy girls. Conclusions : These results indicate that a pregnancy could be obtained with in vitro maturation-derived day-3 frozen–thawed embryos.     

Monozygotic pregnancy after the treatment for infertility by transfer of frozen-thawed embryos]

OBJECTIVES: It has been suggested that monozygotic pregnancies occur more frequently after in vitro fertilisation. This phenomenon is attributed to a number of factors including in vitro culture conditions, malformation of the zona pellucida due to manipulation on the oocytes and artificial opening of the zona pellucida. DESIGN: Retrospective analysis of monozygotic pregnancies in an IVF-ET procedures and obstetrical these pregnancies outcome. MATERIALS AND METHODS: A total of 2254 IVF-ET procedures were analysed. Three protocols were used for ovarian stimulation: short or long protocols with gonadotropins releasing hormone analogue or clomiphene citrate with hMG. In 811 cases male factor was diagnosed and intracitoplasmatic sperm injections were performed. RESULTS: 549 clinical pregnancies were achieved in analysed group. In six cases ultrasound examination 5 weeks after embryo transfer showed a greater number of foetus than the number of embryo transferred. In three of those cases the embryos were obtained after ICSI. Age and average thickness of zona pellucida were similar in group of patients with monozygotic pregnancies when compared with all pregnant patients after IVF treatment. CONCLUSIONS: The incidence of monozygotic pregnancy is increased in group pregnancies resulting from IVF ET. No single risk factor can explain this phenomena. This type of pregnancy needs special obstetrical attention.     

Increased incidence of post-term delivery and Cesarean section after frozen-thawed embryo transfer during a hormone replacement cycle

Purpose

This study aimed to clarify the risks of adverse pregnancy outcomes in patients who conceive singletons after frozen embryo transfer (FET) during a hormone replacement cycle and their offspring.

Methods

A retrospective cohort study was conducted in patients who conceived after FET, based on the Japanese-assisted reproductive technology registry for 2013. The perinatal outcomes in cases with live-born singletons achieved through natural ovulatory cycle FET (NC-FET) (n?=?6287) or hormone replacement cycle FET (HRC-FET) (n?=?10,235) were compared. Multiple logistic regression analyses were performed to determine the potential confounding factors.

Results

The frequencies of macrosomia (1.1% in NC-FET and 1.4% in HRC-FET; P?=?0.058) were comparable between patients after NC-FET and HRC-FET. The proportions of post-term delivery (0.2% in NC-FET and 1.3% in HRC-FET; P?<?0.001) and Cesarean section (33.6% in NC-FET and 43.0% in HRC-FET; P?<?0.001) were higher in patients after HRC-FET than in patients after NC-FET. The risks of post-term delivery (adjusted odds ratio (AOR) 5.68, 95% confidence interval (CI) 3.30–9.80) and Cesarean section (AOR 1.64, 95% CI 1.52–1.76) were also higher in patients after HRC-FET than in patients after NC-FET.

Conclusions

Patients who conceived singletons after HRC-FET were at increased risk of post-term delivery and Cesarean section compared with those who conceived after NC-FET.

     

The use of portable CO2 incubator for cross-border shipping of embryos in an international egg donation program

Two groups of egg recipients were treated, one in situ (165 patients; 195 cycles) and one after cross-border embryo transportation (340 cycles; 340 cycles) using mobile CO₂ incubator. The positive pregnancy rate per cycle was 199/340 (58.6%) and 99/195 (50.7%) in the transportation and the traveling group, respectively (NS). The clinical pregnancy rate (fetal heart beat) was 48.1 and 43.1% per embryo transfer cycle, respectively (NS) and the delivery rate was 44.1 and 35.9% per embryo transfer cycle, respectively (p?=?0.01). Long distance transportation of human pre-implantation embryos using portable CO₂ incubator is safe and do not jeopardize their developmental potential.     

Assessment of patients’ perceptions towards embryo disposition after donation of embryos to a research biobank

Purpose To explore perceptions towards embryo disposition among patients donating excess embryos to a research biobank.MethodsCross-sectional study of survey responses collected as part of enrollment in a research biobank. Patients are asked questions regarding the difficulty of their disposition decision, their alternative disposition choice if donation to research was not available, quality of the counseling they received, and if additional counseling throughout their treatment would have been beneficial. Survey responses use 5-point Likert scales, with “1” being lowest/least and “5” being highest/most.ResultsA total of 157 men and 163 women enrolled in the biobank. Median scores for difficulty of disposition decision were 3 for females and 2 for males, and for quality of counseling, the median scores were 4 for females and 3 for males. Seventy percent of patients would have chosen to discard their excess embryos had donation to research not been an option. Statistical analyses showed no significant difference in responses based on variations in race, religion, sexual orientation, and infertility diagnoses. Concordance of responses within heterosexual couples was tested and found to be poor to moderate.ConclusionsAssessing patients’ perceptions towards embryo disposition after donation of their excess embryos to a research biobank affords a unique perspective. The difficulty of the disposition decision, the tendency to discard embryos in the absence of a means for donation to research, and the poor agreement between heterosexual partners highlight the importance of donation to research as an accessible disposition option and the need for a personalized approach to counseling and consenting for embryo disposition.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-022-02659-x.Keyword: Embryo disposition     

Successful transfer of frozen-thawed embryos obtained after subtotal colectomy for colorectal cancer and before fluorouracil-based chemotherapy

Background. Fertility preservation is applied to patients with cancer who may be rendered sterile from chemotherapy or radiotherapy. Fluorouracil is considered as having almost no effect on human reproductive function, although clinical data defining infertility risk is negligible. Case. Controlled ovarian stimulation, in vitro fertilization (IVF), and embryo freezing were performed before fluorouracil-based chemotherapy in a 28-year-old woman who underwent subtotal colectomy for colorectal cancer (CRC). Three years later, when the clinical and hormonal analysis confirmed ovarian failure, two thawed embryos were transferred to the uterus. She gave birth at term to a 3200g infant. Discussion. Women with good prognosis who wish to bear children in the future should be offered fertility preservation options before chemotherapy, even if the likelihood of permanent ovarian failure appears to be negligible.     

Pregnancy rate in an oocyte donation program

Oocyte donation programs offer an alternative treatment for infertile women with ovarian failure or abnormal ovarian function. Seventeen cycles of in vitro fertilization and embryo transfer with donated oocytes were performed in 13 women, with a mean age of 34.8 years. The hormonal replacement therapy consisted of a fixed dose of oral estradiol valerate, 6 mg daily, and intramuscular progesterone in oil, 100 mg daily. Estrogen and progesterone were continued for 10 more weeks after embryo transfer if pregnancy was established. After 13 embryo transfers, 8 pregnancies were obtained, for a pregnancy rate per transfer of 61.5%. Today seven pregnancies are progressing normally, including one set of twins. This results suggest that an oocyte donation program using a fixed and simple hormonal replacement therapy is an adequate treatment for these infertile couples.     

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.