A prospective trial of blastocyst culture and transfer

Size: px
Start display at page:

Download "A prospective trial of blastocyst culture and transfer"

Transcription

1 Human Reproduction Vol.17, No.7 pp , 2002 A prospective trial of blastocyst culture and transfer Takafumi Utsunomiya 1, Tae Naitou and Miyuki Nagaki St Luke Clinic, 5, Tsumori-Tomioka, Oita City, , Japan 1 To whom correspondence should be addressed. St-luke@oct-net.ne.jp BACKGROUND: The aim of this study was to evaluate the effectiveness of the blastocyst culture method compared with the conventional day 3 transfer method using a prospective trial. METHODS: A total of 235 patients with 273 cycles were evaluated for a period of almost 1 year. Depending upon the sequence in which the ovum retrieval was performed, patients were prospectively assigned (alternate allocation) to a culture period of 3 or 5 days duration. Embryos were transferred either on day 3 (after culture in human tubal fluid) or on day 5 (after culture in sequential media). RESULTS: The pregnancy rates after embryo transfer on days 3 and 5 were similar at 26.5 and 25.9% respectively. Among the day 5 embryo transfer group, patients were divided into three groups corresponding to three sequential media. The pregnancy rates were 32.0% using Irvine blastocyst medium, 6.9% using G1.2/G2.2 and 32.4% using Cook blastocyst medium. CONCLUSIONS: The results of our study were not as successful as previous studies had been. Additionally, there may have been problems in day 5 embryo transfer, such as choosing the sequential media, quality control, contamination and so on. From the results of this study, it appears that day 5 embryo transfer has no advantages for ordinary patients of assisted reproductive technology. Key words: assisted reproduction/blastocyst/embryo transfer/pregnancy/sequential media Introduction Although the use of assisted reproductive techniques (ART) has rapidly expanded, the pregnancy rate has not been impressive at ~20% in non-selective cases. Some reports have stated that good results were obtained with blastocyst stage culture using special sequential media (Alves da Motta et al., 1998; Gardner et al., 1998, 2000; Cruz et al., 1999; Graham et al., 2000). A very high pregnancy rate of 87% was obtained using sequential media in patients who had a good response to gonadotrophin stimulation and two top scoring blastocysts (Gardner et al., 2000). The blastocyst-stage transfer was useful even for patients with multiple failures of IVF (Cruz et al., 1999). Very few reports on the use of these sequential media (Gardner et al., 1998; Coskun et al., 2000; Huismann et al., 2000) were designed to evaluate and compare results on a prospective basis. This study was designed to evaluate and compare the results of conventional day 3 embryo transfer using a conventional culture medium of human tubal fluid (HTF) and a new technique based on day 5 embryo transfer using sequential media with strictly prospective and alternative allocation schedules. Material and methods Patients This study was performed under a prospective schedule. The study was open to all patients who consented to enter the trial between September 1999 and September Depending on the sequence in which the ovum retrieval was performed, patients were prospectively assigned to a culture period of 3 or 5 days duration. Patients were prospectively assigned at the morning of ovum retrieval (day 3: 185 patients, day 5: 185 patients). In one cycle in the day 3 group and five cycles in the day 5 group no oocyte was retrieved. Among the three groups of day 5 embryo transfer, patients were also prospectively assigned depending on the sequence (Figure 1). The total number of eligible patients was 325 (day 3 embryo transfer group: 153, day 5 embryo transfer group: 172) and the number of eligible cycles was 364 (day 3: 184, day 5: 180). Among them, 58 cycles (day 3: 20, day 5: 38) were cancelled because all embryos were cryopreserved to prevent ovarian hyperstimulation syndrome (OHSS). Furthermore, 33 cycles (day 3: 12, day 5: 21) were cancelled because the fertilized oocyte could not be obtained. We recognize that the day 5 embryo transfer group had a higher level of excluded cycles. We believe this to be due to natural phenomena and not the result of human bias. Finally, 235 patients with 273 cycles were registered and divided into two groups (Figure 1, Table I). The number of randomized patients in the day 3 embryo transfer group was 121 and the number of cycles 152. In the day 5 embryo transfer group, the number of patients was 114 and the number of cycles 121.The first group (G-I) consisted of 121 patients with 152 cycles using day 3 embryo transfer, which was used as our control group utilizing HTF (Irvine Scientific, Santa Ana, USA). The second group (G-II) consisted of 49 patients with 53 cycles using the day 5 embryo transfer and Irvine blastocyst medium (Irvine Scientific). The third group (G-III) consisted of 29 patients with 30 cycles using day 5 embryo transfer and G1.2/G2.2 medium (IVF Science Scandinavia, Gothenburg, Sweden). Lastly, the fourth group (G-IV) consisted of 36 patients with 38 cycles using day 5 embryo transfer and Cook blastocyst medium (Cook IVF, 1846 European Society of Human Reproduction and Embryology

2 Controlled trial of blastocyst embryo transfer Table I. Clinical data and outcome of day 3 and day 5 embryo transfer groups G-I Day 3 embryo transfer G-II, -III, -IV Day 5 embryo transfer Eligible patients (n) Eligible cycles (n) Cancelled cycles 2PN cryopreservation cycles (n) a No. of non-fertilized cycles (n) b Registered patients (n) Cycles (n) Mean age (years; range) c (25 44) (25 45) Mean no. previous ART failure cycles (range) c (1 20) (1 25) Mean no. of oocytes (range) c (1 26) (2 25) Mean fertilization rate (range) c (8 100) (6 100) No. of cancellations (%) c 1 (0.7) 5 (4.1) Mean no. of embryo transfer embryos (range) c (0 5) (0 6) Mean endometrial thickness (mm; range) c (5.8 17) (6.1 22) No. of embryo transfer (%) c 151 (99.3) 116 (95.9) Mean blastulation rate (range) (0 100) No. of pregnancies (%) (per all cycle) c 40 (26.3) 30 (24.8) No. of pregnancies (%) (per embryo transfer) c 40 (26.5) 30 (25.9) No. of abortions (%) c 10 (25.0) 10 (33.3) No. of implantations (%) c 52 (11.7) 33 (9.2) a All 2PN stage embryos were cryopreserved to prevent ovarian hyperstimulation syndrome. b Cycles cancelled because the fertilized eggs could not be obtained. c There is no difference between the two groups statistically. Oocyte retrieval and insemination Oocyte retrieval was performed by transvaginal ultrasound-guided aspiration under i.v. anaesthesia with modified neuro-lepto-analgesia (NLA) 34 h after HCG administration. Oocytes were inseminated by conventional IVF or by ICSI 3 4 h after oocyte retrieval. ICSI was performed if the sperm concentration was /ml with a total progressive motility 50% and/or sperm morphology 10% normal forms according to strict criteria (Kruger et al., 1988; Menkveld et al., 1991). Sydney, Australia). There was no difference between the day 3 and day 5 embryo transfer groups in mean age, number of retrieved oocytes, number of embryos transferred or endometrial thickness. Controlled ovarian stimulation In all patients, nasal GnRH agonist (Suprecur; Hoechst, Frankfurt, Germany) was administered to achieve pituitary down-regulation from the preceding mid-luteal phase in a long stimulation protocol. Controlled ovarian stimulation was carried out with HMG (Pergogreen; Serono, Japan) or urinary FSH (Fertinorm; Serono). When the mean diameter of the follicles within the cohort reached 18 mm, IU of HCG (Profasi; Serono) was administered to induce the final stage of oocyte maturation. Embryo culture Embryos were cultured under mineral oil in each medium at 36.7 C in a 5% O 2,5%CO 2 and 90% N 2 environment. HTF with 10% patient s serum was used for the G-I group. In the G-II group, embryos were cultured in HTF with 10% patient s serum for 3 days, then transferred into Irvine blastocyst medium with 10% patient s serum and cultured for a further 2 days. In the G-III group, embryos were cultured in G1.2 medium for 3 days after insemination and then carefully transferred into G2.2 medium and cultured for an additional 2 days. In the G-IV group, embryos were cultured in HTF with 10% patient s serum for 3 days, then transferred into Cook blastocyst medium and cultured for an additional 2 days. Embryo transfer The embryos were evaluated using embryo scoring (Mills et al., 1992) and blastocysts were graded using a blastocyst scoring system (Gardner et al., 1999). Around three good quality embryos were selected for embryo transfer. If no blastulated embryo was obtained on day 5, embryo transfer was cancelled. Luteal support To support the luteal phase, the patients were injected with 1000 IU HCG on the day of embryo transfer, day 4 and day 7. Additionally, 30 mg of didrogesterone (Daiichi Seiyaku, Tokyo, Japan) was 1847

3 T.Utsunomiya, T.Naitou and M.Nagaki Table II. Patient profiles, results of conventional IVF and ICSI for each group Day 3 embryo transfer group Day 5 embryo transfer group IVF ICSI IVF ICSI Patients (n) Cycles (n) Mean age (years; range) (26 42) a (25 44) (25 44) c (27 45) Mean no. of oocytes (range) (1 26) a (3 22) (2 25) (2 22) Mean fertilization rate (range) (8 100) (10 100) (22 100) (6 100) No. of cancellations (%) 0 (0.0) 1 (1.3) 4 (5.9) 1 (1.9) Mean no. of embryo (1 5) (0 4) (0 6) (0 5) transfer embryos (range) No. of embryo transfers (%) 76 (100) 75 (98.7) 64 (94.1) 52 (98.1) Mean blastulation rate (range) (0 100) b (0 60) Mean endometrial thickness (mm; range) (6 17) (5.8 16) (6.3 17) (6.1 22) No. of pregnancies (%) 25 (32.9) 15 (19.7) 21 (30.9) 9 (17.0) (per all cycle) No. of pregnancies (%) 25 (32.9) 15 (20.0) 21 (32.8) 9 (17.3) (per embryo transfer) No. of abortions (%) 6 (24.0) 4 (26.7) 7 (33.3) 3 (33.3) No. of implantations (%) 34 (14.8) a 18 (8.3) 23 (11.4) 10 (6.3) a P 0.05: difference between conventional IVF and ICSI in day 3 embryo transfer group. b P 0.05: difference between conventional IVF and ICSI in day 5 embryo transfer group. c P 0.01: difference between conventional IVF and ICSI in day 5 embryo transfer group. administered daily for 16 days. Some of the patients were not administered HCG in order to avoid OHSS. Sixteen days after ovum retrieval, the urinary HCG level was checked. A transvaginal ultrasound visualization of the gestational sac was performed to confirm clinical pregnancy 23 days after ovum retrieval. Statistical analysis Data were compared with the use of the χ 2 - and Student s t-tests. Results Pregnancy rate In the day 3 embryo transfer group, 40 pregnancies were obtained in 152 cycles. The pregnancy rate was 26.5% and the implantation rate was 11.7% per embryo transferred. In the day 5 embryo transfer group, 30 pregnancies in 121 cycles were obtained, with a pregnancy rate of 25.9% and an implantation rate of 9.2%. The abortion rate was 25.0% in the day 3 group and 33.3% in the day 5 group. The cancellation rate was 0.7% in the day 3 group and 4.1% in the day 5 group. There was no difference in pregnancy, implantation, abortion or cancellation rates between the day 3 and day 5 embryo transfer groups (Table I). In the day 3 embryo transfer group, there was no difference in pregnancy, abortion or cancellation rates when using either conventional IVF or ICSI. The same held true for the day 5 embryo transfer group. However, in the day 3 group, the implantation rate of the conventional IVF group was higher than that of the ICSI group (Table II). The patients who participated in day 5 embryo transfer were divided into three groups (G-II, -III and -IV). Among them, the pregnancy rate in G-II was 32% using HTF and Irvine blastocyst medium; in G-III, it was 6.9% using G1.2/G2.2; and in G-IV it was 32.4% using HTF and Cook blastocyst 1848 medium. G-III showed statistically significant lower pregnancy and implantation rates than did the other groups (Table III). Discussion To obtain good results with ART, many techniques and theories have been reported; these include assisted hatching, co-culture, gamete intra-fallopian tube transfer and so on. Recently, the new technique of blastocyst stage embryo transfer using sequential media was reported. The basis for this new method is quite practical and persuasive. There has been no theoretical doubt that the transfer of well-developing embryos in advanced cellular stages should result in high implantation and subsequently high pregnancy rates. Human gene expression may first occur between the 4- and 8-cell stages of preimplantation development (Braude et al., 1988). So, within the hatching stage, the longer the embryos are cultured, the easier it is to select the best embryos. It has been suggested (Ménézo et al., 1998) that it is time to switch from co-culture to sequential media for transfer at the blastocyst stage. However, contrary to our expectations, the results of our prospective study were not as successful as previous studies. A high pregnancy rate of 87% has been reported (Gardner et al., 2000) using day 5 embryo transfer with sequential media. However, in that report the pregnancy rate of the control group using day 3 embryo transfer was also quite high at 66%. We believe this to be because the patients were selected using a criteria based on a number of favourable characteristics, and who therefore had a good chance of responding well. They had a healthy uterine endometrium, no physiological disorders and no sperm abnormalities. Their main aim was to avoid multiple gestations, as the patients had good odds of becoming pregnant. Also, a good result was reported (Milki et al., 2000) using P1 medium plus 10%

4 Controlled trial of blastocyst embryo transfer Table III. Comparison of clinical data and outcomes for each day 5 embryo transfer culture medium HTF/Irvine G1.2/G2.2 HTF/Cook blastocyst medium blastocyst medium Patients (n) Cycles (n) Mean age (years; range) (25 45) (26 44) (25 41) Mean no. of oocytes (range) (2 20) (3 25) (2 22) Mean fertilization rate (range) (26 100) (29 100) (6 100) No. of cancellations (%) 3 (5.7) 1 (3.3) 1 (2.6) Mean no. of embryo (0 6) (0 5) (0 4) transfer embryos (range) Mean blastulation rate (range) (0 100) (0 70) (0 62) No. of embryo transfer (%) 50 (94.3) 29 (96.7) 37 (97.4) Mean endometrial (6.2 17) (6.1 20) (6.1 22) thickness (mm; range) No. of pregnancies (%) 16 (30.2) a 2 (6.7) a 12 (31.6) (per all cycle) No. of pregnancies (%) 16 (32.0) a 2 (6.9) a 12 (32.4) (per embryo transfer) No. of abortions (%) 5 (31.3) 0 (0.0) 5 (41.7) No. of implantations (%) 17 (10.8) 3 (3.2) 13 (11.9) a P 0.05: difference between G 1.2 /G 2.2 and Irvine, Cook blastocyst media. HTF human tubal fluid. synthetic serum supplement and day 5 embryo transfer in patients 40 years old and with three or more 8-cell embryos on day 3. The result of the day 5 embryo transfer pregnancy rate was 68% compared with the day 3 embryo transfer rate of 46%. On the other hand, some reports showed no statistical differences between day 3 and day 5 embryo transfer results using prospective studies (Scholtes and Zeilmaker, 1996; Huisman et al., 2000; Coskun et al., 2000). We too had the same result in this study. In particular, the cancellation rate of the day 5 embryo transfer group was a little higher than that of the control day 3 embryo transfer. Furthermore, the implantation rate of the day 5 embryo transfer group was a little lower than that of the day 3 group, although this was not statistically significant. Our blastulation rate of 21.6% is similar to (Coskum et al., 2000; 28%) and lower than other prospective randomized reports (Huisman et al., 2000; 48%). In this study, the mean age of 34 years was higher (30 years in Coskum et al. and 33 years in Huisman et al.) and the average number of previous ART cycles were 4.7 in the day 3 group and 5.5 in the day 5 group (Table I). These facts showed that there were many difficult cases in this study and this is one of the reasons why the blastulation rate was lower than in other studies. Thus, the day 5 embryo transfer may not become an established clinical practice, due to factors (Tsirigotis, 1998) such as: (i) concerns over nutritional support for embryos cultured long term in vitro; (ii) the lack of specific knowledge with regard to the time needed for the intratubal descent towards the uterus of the naturally conceived embryos and the peri-implantation events (i.e. synchronization of the endometrium); (iii) the lack of established criteria for blastocyst morphology and growth velocity; and not least (iv) the professional worries that embryos will not be available for transfer in ~40% of patients after 5 days of laboratory culture (Scholtes and Zeilmaker, 1998; Shoukir et al., 1998). Currently there are many difficulties associated with day 5 embryo transfer. There is the very tough question as to which sequential media would be the best in which to culture the embryos for 5 days. Even though there are many types of sequential media, there is no paper or study to compare each of them except the report on the controlled comparison of commercial media for human IVF between Ménézo B2 medium, Medi-Cult universal and BM1 medium (Ellios Bio-Media, Igny, France) (Staessen et al., 1998). In this study, we have tried to compare the effectiveness of three media for blastocyst stage embryo transfer. Our study demonstrated that two of the media had better results than the other one. Because our sample was not large enough, we could not arrive at a clear conclusion, and more prospective randomized studies are therefore needed. It is uncertain why the pregnancy rate of G-III was lower than that of G-II and G-IV. One explanation is that it may be due to batch to batch variability. This may be another reason why our blastulation rate of 21.6% (Table II) is lower than that of other reports (Coskun et al., 2000; Huisman et al., 2000). The special medium might play an important role in culturing matured embryos, especially due to its concentration of minerals, electrolytes, vitamins, amino acids and so on. Unfortunately, we do not know the concentration of these materials in some culture media. However, we can guess the concentration of these materials from data obtained from experiments with animals (Gardner and Sakkas, 1993; Gardner et al., 1994; Lane and Gardner, 1998). That being said, the fact still remains that the condition of the culture and the materials for human embryos may differ from those required by animals. Concerning the 5 day culture, a lot of complexities may arise which could easily frustrate situations in the laboratory. We usually evaluate embryo quality every day until the day of embryo transfer. As a result, there are many more culture dishes in the incubators for the 5 day culture than in a conventional 3 day culture. Additionally, the performance of 1849

5 T.Utsunomiya, T.Naitou and M.Nagaki quality control on the culture media every day for 5 days may be quite difficult and complex. Furthermore, the environment in the dishes may be easily contaminated since it provides a nutritious fluid for bacteria and fungi such as Aspergillus. Even in the conventional day 3 embryo transfer procedure, microbial contamination was reported in IVF and embryo transfer (Cottell et al., 1996). To obtain a good pregnancy rate with ART, an accurate evaluation of embryos is useful. Many reports evaluate embryo quality using simpler methods than the day 5 culture of embryos, including the morphology of the first polar body (PB), pronuclear (PN) morphology, the duration of the 2-cell stage and 72 h blastomere cell number, and these studies have reported good pregnancy rates obtained using these parameters. The morphology of the first PB at the time of ICSI seems to be a suitable indicator for the development potential of zygotes (Ebner et al., 1999). Hence, the elective transfer of embryos selected on the basis of first PB morphology resulted in a higher pregnancy rate of 35.7% compared with that of the control group at 23.3%. PN morphology can be used as a selection criterion for embryo transfer with a high implantation rate occurring when two or more embryos are available with juxtaposed pronuclei with nucleoli aligned at the PN interface and with a halo effect to the cytoplasm (Scott and Smith, 1998). Additionally, they reported that if there were 50% of the pre-embryos with these characteristics, the pregnancy rate would be very low. The morphological parameters used to evaluate the number of nucleolar precursor bodies and their distribution in each pronucleus can be used to predict the developmental fate of embryos (Tesarik and Greco, 1999; Scott et al., 2000). The new evaluation criteria in these reports can be used as early as the PN stage, simply and without requiring repeated observation. In Germany, the German embryo protection law does not allow embryo selection, only the selection of PN stage oocytes. Therefore, the clinical usefulness of PN stage scoring was reported (Ludwig et al., 2000). This method might help to offer patients in Germany the transfer of two selected PN oocytes, which would reduce multiple gestation rates. At the early blastomere stage, the cleavage speed may have a predictive value as to the embryo s viability (Sakkas et al., 1998). The early cleavage of embryos up to the 2-cell stage after ICSI might be an indicator of embryo viability. Also, it has been demonstrated that the more developed 72 h embryos are more likely to become blastocysts and expand (Shapiro et al., 2000). Implantation rates are greater for the transfer of more developed embryos. Contrary to these reports on the blastomere stage, others (Rijnders and Jansen, 1998; Graham et al., 2000) demonstrated that the predictive value of embryo morphology on day 3 for subsequent blastocyst formation was limited. Originally, the idea of blastocyst stage embryo transfer was initiated to avoid multiple gestations in patients who usually obtained a number of embryos, due to the fact that they were good responders (Gardner et al., 1998, 2000). On the other hand, the most important and difficult issue in this field is the treatment of difficult cases who cannot conceive using any approach. The fundamental situation may be different between these difficult cases and blastocyst embryo transfer cases. So, the majority of difficult cases may not be rescued by blastocyst embryo transfer. Therefore, we should choose culture methods with the type of medium that is adequate for patients with high failure rates. We conclude that the pregnancy rates of day 5 and day 3 embryo transfer were equal, while the cancellation rate and the abortion rate of day 5 embryo transfer was a little higher than that of day 3 embryo transfer, and that blastocyst stage embryo transfer is not a viable technique to be used routinely in all patients undergoing ART. The indications for blastocyst stage embryo transfer should be studied further. References Alves da Motta, E.L., Alegretti, J.R., Baracat, E.C., Olive, D. and Serafini, P.C. (1998) High implantation and pregnancy rates with transfer of human blastocysts developed in preimplantation stage one and blastocyst media. Fertil. Steril., 70, Braude, P., Bolton, V. and Moor, S. (1988) Human gene expression first occurs between the four- and eight-cell stages of preimplantation development. Nature, 332, Coskun, S., Hollanders, J., Al-Hassan, S., Al-Sufyan, H., Al-Mayman, H. and Jaloudi, K. (2000) Day 5 versus day 3 embryo transfer: a controlled randomized trial. Hum. Reprod., 15, Cottell, E., Fawsy, M., McMorrow, J., Cafferkey, M., Lennon, B. and Harrison, R.F. (1996) Microbial contamination in an in vitro fertilization embryo transfer system. Fertil. Steril., 66, Cruz, J.R., Dubey, A.K., Patel, J., Peak, D., Hartog, B. and Gindoff, R. (1999) Is blastocyst transfer useful as an alternative treatment for patients with multiple in vitro fertilization failures? Fertil. Steril., 72, Ebner, T., Moser, M., Yaman, C., Feichtinger, O., Hartl, J. and Tews, G. (1999) Elective transfer of embryos selected on the bases of first polar body morphology is associated with increased rates of implantation and pregnancy. Fertil. Steril., 72, Gardner, D.K. and Sakkas, D. (1993) Mouse embryo cleavage, metabolism and viability: role of medium composition. Hum. Reprod., 8, Gardner, D.K. and Schoolcraft, W.B. (1999) In vitro culture of human blastocyst. In Jansen, R. and Mortimer, D. (eds) Towards Reproductive Certainty: Infertility and Genetics Beyond Parthenon Press, Carnforth, UK, pp Gardner, D.K., Lane, M., Spitzer, A. and Batt, P. (1994) Enhanced rates of cleavage and development for sheep zygotes cultured to the blastocyst stage in vitro in the absence of serum and somatic cells: amino acids, vitamins, and culturing embryos in groups stimulate development. Biol. Reprod., 50, Gardner, D.K., Schoolcraft, W.B., Wagley, L., Schlenker, T., Stevens, J. and Hesla, J. (1998) A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. Hum. Reprod., 13, Gardner, D.K., Lane, M., Stevens, J., Schlenker, T. and Schoolcraft, W.B. (2000) Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil. Steril., 73, Graham, J., Han, T., Porter, R., Levy, M., Stillman, R. and Tucker, M. (2000) Day 3 morphology is a poor predictor of blastocyst quality in extended culture. Fertil. Steril., 74, Huisman, G.J., Fauser, B.C.J.M., Eijikemans, M.J.C. and Pieters, M.H.E.C. (2000) Implantation rates after in vitro fertilization and transfer of a maximum of two embryos that have undergone three to five days of culture. Fertil. Steril., 73, Kruger, T.F., Swanson, R.J., Acosta, A.A. Matta, J.F., Simmons, K.F. and Oehninger, S. (1988) Predictive value of abnormal sperm morphology in in vitro fertilization. Fertil. Steril., 49, Lane, M. and Gardner, D.K. (1998) Amino acids and vitamins prevent cultureinduced metabolic perturbations and associated loss of viability of mouse blastocysts. Hum. Reprod., 13,

6 Controlled trial of blastocyst embryo transfer Ludwig, M., Schopper, B., Al-Hasani, S. and Diedrich, K. (2000) Clinical use of a pronuclear stage score following intracytoplasmic sperm injection: impact on pregnancy rates under the conditions of the German embryo protection law. Hum. Reprod., 15, Ménézo, Y.J., Hamamah, S., Hazout, A. and Dale, B. (1998) Time to switch from co-culture. Hum. Reprod., 13, Menkveld, R., Oettle, E.E., Kruger, T.F. Swanson, R.J., Acosta, A.A. and Oehninger, S. (1991) Atlas of Human Sperm Morphology. Williams and Wilkins, Maryland, USA, pp. 15. Milki, A.A., Hinkley, M.D., Fisch, J.D., Dasig, D. and Behr, B. (2000) Comparison of blastocyst transfer with day 3 embryo transfer in similar patient populations. Fertil. Steril., 73, Mills, C.L. (1992) Factors affecting embryological parameters and embryo selection for IVF ET. In Brinsden, P.R. and Rainsbury, P.A. (eds) A Textbook of In vitro Fertilization and Assisted Reproduction. Parthenon Press, Carnforth, UK, pp Rijnders, P.M. and Jansen, C.A.M. (1998) The predictive value of day 3 embryo morphology regarding blastocyst formation, pregnancy and implantation rate after day 35 transfer following in-vitro fertilization or intracytoplasmic sperm injection. Hum. Reprod., 13, Sakkas, D., Shoukir, Y., Chardonnens, D., Bianchi, P.G. and Campana, A. (1998) Early cleavage of human embryos to the two-cell stage after intracytoplasmic sperm injection as an indicator of embryo viability. Hum. Reprod., 13, Scholtes, M.C.W. and Zeilmaker, G.H. (1996) A prospective, randomized study of embryo transfer results after 3 or 5 days of embryo culture in in vitro fertilization. Fertil. Steril., 65, Scholtes, M.C.W. and Zeilmaker, G.H. (1998) Blastocyst transfer in day 5 embryo transfer depends primarily on the number of oocytes retrieved and not the age. Fertil. Steril., 69, Scott, L.A. and Smith, S. (1998) The successful use of pronuclear embryo transfers the day following oocyte retrieval. Hum. Reprod., 13, Scott, L.A., Alvero, R., Leondires, M. and Miller, B. (2000) The morphology of human pronuclear embryos is positively related to blastocyst development and implantation. Hum. Reprod., 15, Shapiro, B.S., Harris, D.C. and Richter, K.S. (2000) Predictive value of 72- hour blastomere cell number on blastocyst development and success of subsequent transfer based on the degree of blastocyst development. Fertil. Steril., 73, Shoukir, Y., Chardonnens, D., Campana, A., Bischof, P. and Sakkas, D. (1998) The rate of development and time of transfer play different roles in influencing the viability of human blastocysts. Hum. Reprod., 13, Staessen, C., Janssenswillen, C., Clerck, E.D. and Steirteghem, A.V. (1998) Controlled comparison of commercial media for human in-vitro fertilization: Ménézo B medium versus Medi-Cult universal and BMI medium. Hum. Reprod., 13, Tesarik, J. and Greco, E. (1999) The probability of abnormal preimplantation development can be predicted by a single static observation on pronuclear stage morphology. Hum. Reprod., 14, Tsirigotis, M. (1998) Too soon to abandon current practice? Hum. Reprod., 13, Submitted on January 16, 2001; resubmitted on September 17, 2001; accepted on March 20,

Comparison of embryo development in sibling oocytes cultured in two different sequential media

Comparison of embryo development in sibling oocytes cultured in two different sequential media Middle East Fertility Society Journal Vol. 9, No. 2, 2004 Copyright Middle East Fertility Society Comparison of embryo development in sibling oocytes cultured in two different sequential media Necati Findikli,

More information

Extended embryo culture in human assisted reproduction treatments

Extended embryo culture in human assisted reproduction treatments Human Reproduction Vol.16, No.5 pp. 902 908, 2001 Extended embryo culture in human assisted reproduction treatments M.T.Langley 1,3, D.M.Marek 1, D.K.Gardner 2, K.M.Doody 1 and K.J.Doody 1 1 Center for

More information

Blastocyst-stage embryo transfer in patients who failed to conceive in three or more day 2 3 embryo transfer cycles: a prospective, randomized study

Blastocyst-stage embryo transfer in patients who failed to conceive in three or more day 2 3 embryo transfer cycles: a prospective, randomized study FERTILITY AND STERILITY VOL. 81, NO. 3, MARCH 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Blastocyst-stage embryo transfer

More information

UvA-DARE (Digital Academic Repository) Optimizing the embryo transfer technique Abou-Setta, A.M. Link to publication

UvA-DARE (Digital Academic Repository) Optimizing the embryo transfer technique Abou-Setta, A.M. Link to publication UvA-DARE (Digital Academic Repository) Optimizing the embryo transfer technique Abou-Setta, A.M. Link to publication Citation for published version (APA): Abou-Setta, A. M. (2008). Optimizing the embryo

More information

Original Effect of A Time-lapse Incubator (EmbryoScope ) on in vitro Culture of Human Embryos

Original Effect of A Time-lapse Incubator (EmbryoScope ) on in vitro Culture of Human Embryos J. Mamm. Ova Res. Vol. 31 (1), 40 44, 2014 40 Original Effect of A Time-lapse Incubator (EmbryoScope ) on in vitro Culture of Human Embryos Yamato Mizobe*, Toshiaki Akiyoshi, Shiho Minami, Kan Matsuo,

More information

Day 4 embryo selection is equal to Day 5 using a new embryo scoring system validated in single embryo transfers

Day 4 embryo selection is equal to Day 5 using a new embryo scoring system validated in single embryo transfers Human Reproduction Vol.23, No.7 pp. 1505 1510, 2008 Advance Access publication on February 21, 2008 doi:10.1093/humrep/dem419 Day 4 embryo selection is equal to Day 5 using a new embryo scoring system

More information

Assisted Reproduction. Diane G. Hammitt, 2,4 Christopher A. Sattler, 3 Misty L. Manes, 2 and Anita P. Singh 2 INTRODUCTION

Assisted Reproduction. Diane G. Hammitt, 2,4 Christopher A. Sattler, 3 Misty L. Manes, 2 and Anita P. Singh 2 INTRODUCTION ( C 2004) Assisted Reproduction Selection of Embryos for Day-3 Transfer at the Pronuclear-Stage and Pronuclear-Stage Cryopreservation Results in High Delivery Rates in Fresh and Frozen Cycles 1 Diane G.

More information

Alternative Embryo Transfer on Day 3 or Day 5 for Reducing the Risk of Multiple Gestations

Alternative Embryo Transfer on Day 3 or Day 5 for Reducing the Risk of Multiple Gestations University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Roman L. Hruska U.S. Meat Animal Research Center U.S. Department of Agriculture: Agricultural Research Service, Lincoln,

More information

Should we advise patients undergoing IVF to start a cycle leading to a day 3 or a day 5 transfer?

Should we advise patients undergoing IVF to start a cycle leading to a day 3 or a day 5 transfer? Human Reproduction Vol.19, No.11 pp. 2550 2554, 2004 Advance Access publication August 6, 2004 doi:10.1093/humrep/deh447 Should we advise patients undergoing IVF to start a cycle leading to a day 3 or

More information

Role of embryo morphology in Intracytoplasmic Sperm Injection cycles for prediction of pregnancy

Role of embryo morphology in Intracytoplasmic Sperm Injection cycles for prediction of pregnancy Iranian Journal of Reproductive Medicine Vol.5. No.1. pp:23-27, Winter 2007 Role of embryo morphology in Intracytoplasmic Sperm Injection cycles for prediction of pregnancy Mir Mehrdad Farsi, Ph.D., Ali

More information

Blastocyst culture and transfer increases the efficiency of oocyte donation

Blastocyst culture and transfer increases the efficiency of oocyte donation FERTILITY AND STERILITY VOL. 74, NO. 3, SEPTEMBER 2000 Copyright 2000 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Blastocyst culture

More information

Infertility treatment

Infertility treatment In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation

More information

Article Blastocyst culture and transfer: lessons from an unselected, difficult IVF population

Article Blastocyst culture and transfer: lessons from an unselected, difficult IVF population RBMOnline - Vol 17. No 2. 2008 220-228 Reproductive BioMedicine Online; www.rbmonline.com/article/3381 on web 27 June 2008 Article Blastocyst culture and transfer: lessons from an unselected, difficult

More information

Articles Does pronuclear morphology and/or early cleavage rate predict embryo implantation potential?

Articles Does pronuclear morphology and/or early cleavage rate predict embryo implantation potential? RBMOnline - Vol 2. No 1. 12 16 Reproductive BioMedicine Online webpaper 2000/039 on web 7/2/01 Articles Does pronuclear morphology and/or early cleavage rate predict embryo implantation potential? Dr Monalill

More information

Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists

Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists Human Reproduction Vol.21, No.4 pp. 1012 1017, 2006 Advance Access publication December 8, 2005. doi:10.1093/humrep/dei415 Menstruation-free interval and ongoing pregnancy in IVF using GnRH antagonists

More information

Predictive value of embryo grading for embryos with known outcomes

Predictive value of embryo grading for embryos with known outcomes Predictive value of embryo grading for embryos with known outcomes Vanessa N. Weitzman, M.D., Jennifer Schnee-Riesz, M.D., Claudio Benadiva, M.D., John Nulsen, M.D., Linda Siano, M.S., and Donald Maier,

More information

Ensieh Shahrokh Tehraninejad 1,2, Elham Azimi Nekoo 2, Firouzeh Ghaffari 1, Maryam Hafezi 1, Leila Karimian 3 and Arezoo Arabipoor 1.

Ensieh Shahrokh Tehraninejad 1,2, Elham Azimi Nekoo 2, Firouzeh Ghaffari 1, Maryam Hafezi 1, Leila Karimian 3 and Arezoo Arabipoor 1. doi:10.1111/jog.12779 J. Obstet. Gynaecol. Res. Vol. 41, No. 11: 1779 1784, November 2015 Zygote intrafallopian tube transfer versus intrauterine cleavage or blastocyst stage transfer after intracytoplasmic

More information

Characterization of a top quality embryo, a step towards single-embryo transfer

Characterization of a top quality embryo, a step towards single-embryo transfer Human Reproduction vol.14 no.9 pp.2345 2349, 1999 Characterization of a top quality embryo, a step towards single-embryo transfer Eric Van Royen 1, Katelijne Mangelschots, Diane De Neubourg, Marion Valkenburg,

More information

A prospective randomized study: day 2 versus day 5 embryo transfer

A prospective randomized study: day 2 versus day 5 embryo transfer Human Reproduction Vol.17, No.6 pp. 1507 1512, 2002 A prospective randomized study: day 2 versus day 5 embryo transfer Ingrid Van der Auwera 1, Sophie Debrock, Carl Spiessens, Hilde Afschrift, Els Bakelants,

More information

Assisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi

Assisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi Assisted Reproduction By Dr. Afraa Mahjoob Al-Naddawi Learning Objectives: By the end of this lecture, you will be able to: 1) Define assisted reproductive techniques (ART). 2) List indications for various

More information

Article Outcome of blastocyst transfer according to availability of excess blastocysts suitable for cryopreservation

Article Outcome of blastocyst transfer according to availability of excess blastocysts suitable for cryopreservation RBMOnline - Vol 7. No 5. 587 592 Reproductive BioMedicine Online; www.rbmonline.com/article/1010 on web 10 October 2003 Article Outcome of blastocyst transfer according to availability of excess blastocysts

More information

Article Relationship between even early cleavage and day 2 embryo score and assessment of their predictive value for pregnancy

Article Relationship between even early cleavage and day 2 embryo score and assessment of their predictive value for pregnancy RBMOnline - Vol 14. No 3. 27 294-299 Reproductive BioMedicine Online; www.rbmonline.com/article/2585 on web 22 January 27 Article Relationship between even early cleavage and day 2 embryo score and assessment

More information

Influence ovarian stimulation on oocyte and embryo quality. Prof.Dr. Bart CJM Fauser

Influence ovarian stimulation on oocyte and embryo quality. Prof.Dr. Bart CJM Fauser Influence ovarian stimulation on oocyte and embryo quality Prof.Dr. Bart CJM Fauser How to balance too much vs too little? Lecture Outline Context ovarian stimulation Impact ovarian stimulation on oocyte

More information

Early compaction on day 3 may be associated with increased implantation potential

Early compaction on day 3 may be associated with increased implantation potential Early compaction on day 3 may be associated with increased implantation potential Christine C. Skiadas, M.D., Katharine V. Jackson, B.S., and Catherine Racowsky, Ph.D. Department of Obstetrics, Gynecology

More information

Study on Several Factors Involved in IVF-ET of Human Beings

Study on Several Factors Involved in IVF-ET of Human Beings Study on Several Factors Involved in IVF-ET of Human Beings Lei X 1, Zhuoran W 1, Bin L 1, Huiming L 1, Hongxiu Z 1, Yajuan Z 1, Yingbo Q 1, Guixue Z 2 1 The First Clinical College of Harbin Medical University,

More information

Patient selection criteria for blastocyst culture in IVF/ICSI treatment

Patient selection criteria for blastocyst culture in IVF/ICSI treatment J Assist Reprod Genet (2010) 27:555 560 DOI 10.1007/s10815-010-9457-9 ASSISTED REPRODUCTION Patient selection criteria for blastocyst culture in IVF/ICSI treatment M. Y. Thum & V. Wells & H. Abdalla Received:

More information

ASSISTED REPRODUCTION TECHNOLOGIES. S. Fernández-Shaw & R. Cercas & C. Braña & C. Villas & I. Pons

ASSISTED REPRODUCTION TECHNOLOGIES. S. Fernández-Shaw & R. Cercas & C. Braña & C. Villas & I. Pons J Assist Reprod Genet (2015) 32:177 184 DOI 10.1007/s10815-014-0387-9 ASSISTED REPRODUCTION TECHNOLOGIES Ongoing and cumulative pregnancy rate after cleavage-stage versus blastocyst-stage embryo transfer

More information

RBMOnline - Vol 14. No Reproductive BioMedicine Online; on web 23 November 2006

RBMOnline - Vol 14. No Reproductive BioMedicine Online;  on web 23 November 2006 RBMOnline - Vol 14. No 1. 2007 85-91 Reproductive BioMedicine Online; www.rbmonline.com/article/2583 on web 23 November 2006 The value of early cleavage (EC) assessment is still being debated. The aim

More information

Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles?

Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles? J Assist Reprod Genet (26) 23:427 431 DOI 1.17/s1815-6-965-x ASSISTED REPRODUCTION Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation

More information

Understanding eggs, sperm and embryos. Marta Jansa Perez Wolfson Fertility Centre

Understanding eggs, sperm and embryos. Marta Jansa Perez Wolfson Fertility Centre Understanding eggs, sperm and embryos Marta Jansa Perez Wolfson Fertility Centre What does embryology involve? Aims of the embryology laboratory Creation of a large number of embryos and supporting their

More information

Honorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive FIGO s Distinguished Merit Award for Services towards women s health.

Honorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive FIGO s Distinguished Merit Award for Services towards women s health. Prof.Duru Shah Founder President The PCOS Society (India) President Elect of the Indian Society for Assisted Reproduction (ISAR) Honorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive

More information

Incidence and development of zygotes exhibiting abnormal pronuclear disposition after identification of two pronuclei at the fertilization check

Incidence and development of zygotes exhibiting abnormal pronuclear disposition after identification of two pronuclei at the fertilization check Incidence and development of zygotes exhibiting abnormal pronuclear disposition after identification of two pronuclei at the fertilization check David E. Reichman, M.D., Katharine V. Jackson, B.A., and

More information

Evaluating the Quality of Human Embryos with a Measurement of Oxygen Consumption by Scanning Electrochemical Microscopy

Evaluating the Quality of Human Embryos with a Measurement of Oxygen Consumption by Scanning Electrochemical Microscopy J. Mamm. Ova Res. Vol. 25, 2 7, 2008 2 Mini Review Evaluating the Quality of Human Embryos with a Measurement of Oxygen Consumption by Scanning Electrochemical Microscopy Takafumi Utsunomiya 1 *, Kaori

More information

Embryo Selection after IVF

Embryo Selection after IVF Embryo Selection after IVF Embryo Selection after IVF Many of human embryos produced after in vitro fertilization carry abnormal chromosomes. Placing a chromosomally normal embryo (s) into a normal uterus

More information

Comparison between day-2 embryos obtained either from ICSI or resulting from short insemination IVF: influence of maternal age*

Comparison between day-2 embryos obtained either from ICSI or resulting from short insemination IVF: influence of maternal age* Human Reproduction vol.15 no.8 pp.1776 1780, 2000 Comparison between day-2 embryos obtained either from ICSI or resulting from short insemination IVF: influence of maternal age* Yves Ménézo 1,3 and Yona

More information

Paternal effects acting during the first cell cycle of human preimplantation development after ICSI

Paternal effects acting during the first cell cycle of human preimplantation development after ICSI Human Reproduction Vol.17, No.1 pp. 184 189, 2002 Paternal effects acting during the first cell cycle of human preimplantation development after ICSI Jan Tesarik 1,2,5, Carmen Mendoza 2,3 and Ermanno Greco

More information

Analyzing Factors Affecting the Success Rate of Frozen Thawed Embryos

Analyzing Factors Affecting the Success Rate of Frozen Thawed Embryos ( C 2003) Analyzing Factors Affecting the Success Rate of Frozen Thawed Embryos Assisted Reproductive Technologies S. Lahav-Baratz, 1,2 M. Koifman, 1 H. Shiloh, 1 D. Ishai, 1 Z. Wiener-Megnazi, 1 and M.

More information

Embryo transfer in days 2 to 4 following intracytoplasmic sperm injection: a prospective cohort study

Embryo transfer in days 2 to 4 following intracytoplasmic sperm injection: a prospective cohort study Original Article Medical Journal of the Islamic Republic of Iran (MJIRI) Iran University of Medical Sciences Embryo transfer in days to following intracytoplasmic sperm injection: a prospective cohort

More information

Possible factors affecting the development of oocytes in in-vitro maturation

Possible factors affecting the development of oocytes in in-vitro maturation Human Reproduction Vol. 15, (Suppl. 5) pp. 11-17, 2000 Possible factors affecting the development of oocytes in in-vitro maturation Anne Lis Mikkelsen 1 ' 2, Steven Smith 1 and Svend Lindenberg 1 ^he Fertility

More information

IVF AND PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A) WHAT THE COMMUNITY PHYSICIAN NEEDS TO KNOW

IVF AND PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A) WHAT THE COMMUNITY PHYSICIAN NEEDS TO KNOW IVF AND PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A) WHAT THE COMMUNITY PHYSICIAN NEEDS TO KNOW Jon Havelock, MD, FRCSC, FACOG Co-Director - PCRM Disclosure No conflict of interest in relation

More information

Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas

Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas Late stages of embryo progression are a much better predictor of clinical pregnancy than early cleavage in intracytoplasmic sperm injection and in vitro fertilization cycles with blastocyst-stage transfer

More information

Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M

Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis Badrawi A, Zaki S, Al-Inany H, Ramzy A M, Hussein M Record Status This is a critical abstract of an economic

More information

Oocyte maturation. A.Trounson 1 ' 3, C.Anderiesz 1, G.MJones 1, A.Kausche 1, N.Lolatgis 2 and C.Wood 2

Oocyte maturation. A.Trounson 1 ' 3, C.Anderiesz 1, G.MJones 1, A.Kausche 1, N.Lolatgis 2 and C.Wood 2 A.Trounson 1 ' 3, C.Anderiesz 1, G.MJones 1, A.Kausche 1, N.Lolatgis 2 and C.Wood 2 Centre for Early Human Development, Institute of Reproduction and Development, Monash University, Monash Medical Centre,

More information

Puerto Rico Fertility Center

Puerto Rico Fertility Center Puerto Rico Fertility Center General Information of the In-Vitro Fertilization Program Dr. Pedro J. Beauchamp First test-tube baby IN PUERTO RICO Dr. Pedro Beauchamp with Adlin Román in his arms. Paseo

More information

INDICATIONS OF IVF/ICSI

INDICATIONS OF IVF/ICSI PROCESS OF IVF/ICSI INDICATIONS OF IVF/ICSI IVF is most clearly indicated when infertility results from one or more causes having no other effective treatment; Tubal disease. In women with blocked fallopian

More information

Pronuclear scoring as a predictor of embryo quality in in vitro fertilization program

Pronuclear scoring as a predictor of embryo quality in in vitro fertilization program FOLIA HISTOCHEMICA ET CYTOBIOLOGICA Vol. 45, Supp. 1, 2007 pp. 87-91 Pronuclear scoring as a predictor of embryo quality in in vitro fertilization program Magdalena Depa-Martynow, Piotr Jedrzejczak, Leszek

More information

Comparison of human blastulation rates and total cell number in sequential culture media with and without co-culture

Comparison of human blastulation rates and total cell number in sequential culture media with and without co-culture Human Reproduction vol.14 no.3 pp.774 781, 1998 Comparison of human blastulation rates and total cell number in sequential culture media with and without co-culture Chui-Yee Fong and Ariff Bongso 1 Department

More information

Frozen-thawed embryo transfer is associated with a significantly reduced incidence of ectopic pregnancy

Frozen-thawed embryo transfer is associated with a significantly reduced incidence of ectopic pregnancy ORIGINAL ARTICLES: EARLY PREGNANCY Frozen-thawed embryo transfer is associated with a significantly reduced incidence of ectopic pregnancy Bruce S. Shapiro, M.D., Ph.D., a,b Said T. Daneshmand, M.D., a,b

More information

Fixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol

Fixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol Yamanashi Med. J. 14(3), 77 ~ 82, 1999 Original Article Fixed Schedule for in vitro Fertilization and Embryo Transfer: Comparison of Outcome between the Short and the Long Protocol Tsuyoshi KASAI and Kazuhiko

More information

LOW RESPONDERS. Poor Ovarian Response, Por

LOW RESPONDERS. Poor Ovarian Response, Por LOW RESPONDERS Poor Ovarian Response, Por Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment. Diagnosis Female About Low responders In patients

More information

Biology of fertility control. Higher Human Biology

Biology of fertility control. Higher Human Biology Biology of fertility control Higher Human Biology Learning Intention Compare fertile periods in females and males What is infertility? Infertility is the inability of a sexually active, non-contracepting

More information

Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection

Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection Acupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection Sandra L. Emmons, MD Phillip Patton, MD Source: Medical Acupuncture, A Journal For Physicians By Physicians Spring

More information

Comparison of Two Embryo Scoring Systems for Prediction of Outcome in Assisted Reproductive Techniques Cycles

Comparison of Two Embryo Scoring Systems for Prediction of Outcome in Assisted Reproductive Techniques Cycles ORIGINAL ARTICLE Comparison of Two Embryo Scoring Systems for Prediction of Outcome in Assisted Reproductive Techniques Cycles Farnaz Sohrabvand 1, Mamak Shariat 2, Navid Fotoohi Ghiam 3, and Mahdi Hashemi

More information

Fertility 101. About SCRC. A Primary Care Approach to Diagnosing and Treating Infertility. Definition of Infertility. Dr.

Fertility 101. About SCRC. A Primary Care Approach to Diagnosing and Treating Infertility. Definition of Infertility. Dr. Dr. Shahin Ghadir A Primary Care Approach to Diagnosing and Treating Infertility St. Charles Bend Grand Rounds November 30, 2018 I have no conflicts of interest to disclose. + About SCRC State-of-the-art

More information

MALE FACTOR. Fabienne Devreker, M.D.,* Kate Hardy, Ph.D., Marc Van den Bergh, M.T., Joel Winston, Jamila Biramane, M.T., and Yvon Englert, Ph.D.

MALE FACTOR. Fabienne Devreker, M.D.,* Kate Hardy, Ph.D., Marc Van den Bergh, M.T., Joel Winston, Jamila Biramane, M.T., and Yvon Englert, Ph.D. FERTILITY AND STERILITY VOL. 73, NO. 5, MAY 2000 Copyright 2000 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. MALE FACTOR Noninvasive

More information

In vitro development and pregnancy outcomes for human embryos cultured in either a single medium or in a sequential media system

In vitro development and pregnancy outcomes for human embryos cultured in either a single medium or in a sequential media system In vitro development and pregnancy outcomes for human embryos cultured in either a single medium or in a sequential media system Soledad Sepulveda, Ph.D., Javier Garcia, Ph.D., Elard Arriaga, Lic., Julio

More information

A prospective randomized comparison of sequential versus monoculture systems for in-vitro human blastocyst development

A prospective randomized comparison of sequential versus monoculture systems for in-vitro human blastocyst development Human Reproduction Vol.17, No.10 pp. 2700 2705, 2002 A prospective randomized comparison of sequential versus monoculture systems for in-vitro human blastocyst development N.S.Macklon 1,3, M.H.E.C. Pieters

More information

The number of eight-cell embryos is a key determinant for selecting day 3 or day 5 transfer

The number of eight-cell embryos is a key determinant for selecting day 3 or day 5 transfer FERTILITY AND STERILITY VOL. 73, NO. 3, MARCH 2000 Copyright 2000 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. The number of eight-cell

More information

I. ART PROCEDURES. A. In Vitro Fertilization (IVF)

I. ART PROCEDURES. A. In Vitro Fertilization (IVF) DFW Fertility Associates ASSISTED REPRODUCTIVE TECHNOLOGY (ART) Welcome to DFW Fertility Associates/ Presbyterian-Harris Methodist Hospital ARTS program. This document provides an overview of treatment

More information

A study of the effect of an extremely low oxygen concentration on the development of human embryos in assisted reproductive technology

A study of the effect of an extremely low oxygen concentration on the development of human embryos in assisted reproductive technology Reprod Med Biol (2010) 9:163 168 DOI 10.1007/s12522-010-0052-7 ORIGINAL ARTICLE A study of the effect of an extremely low oxygen concentration on the development of human embryos in assisted reproductive

More information

Effect of ovarian stimulation on oocyte quality and embryonic aneuploidy: a prospective, randomised controlled trial

Effect of ovarian stimulation on oocyte quality and embryonic aneuploidy: a prospective, randomised controlled trial FULL PROJECT TITLE: Effect of ovarian stimulation on oocyte quality and embryonic aneuploidy: a prospective, randomised controlled trial (STimulation Resulting in Embryonic Aneuploidy using Menopur (STREAM)

More information

IVF Protocols: Hyper & Hypo-Responders, Implantation

IVF Protocols: Hyper & Hypo-Responders, Implantation IVF Protocols: Hyper & Hypo-Responders, Implantation Midwest Reproductive Symposium June 4-5, 4 2010 Subset : Hyper-Responders Mark R. Bush, MD, FACOG, FACS OBJECTIVE: Important goals for the PCOS patient

More information

Article Kinetic markers of human embryo quality using time-lapse recordings of IVF/ICSI-fertilized oocytes

Article Kinetic markers of human embryo quality using time-lapse recordings of IVF/ICSI-fertilized oocytes RBMOnline - Vol 17 No 3. 2008 385-391 Reproductive BioMedicine Online; www.rbmonline.com/article/3327 on web 30 July 2008 Article Kinetic markers of human embryo quality using time-lapse recordings of

More information

ASSISTED REPRODUCTIVE TECHNOLOGIES (ART)

ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) Dr. Herve Lucas, MD, PhD, Biologist, Andrologist Dr. Taher Elbarbary, MD Gynecologist-Obstetrician Geneva Foundation for Medical Education and research Definitions

More information

Article Examination of frozen cycles with replacement of a single thawed blastocyst

Article Examination of frozen cycles with replacement of a single thawed blastocyst RBMOnline - Vol 11. No 3. 2005 349-354 Reproductive BioMedicine Online; www.rbmonline.com/article/1679 on web 5 July 2005 Article Examination of frozen cycles with replacement of a single thawed blastocyst

More information

The Jones Institute for Reproductive Medicine Founded on Science, Dedicated to Life

The Jones Institute for Reproductive Medicine Founded on Science, Dedicated to Life The Jones Institute for Reproductive Medicine Founded on Science, Dedicated to Life Assisted reproductive technologies: State-of-the-ART Sergio Oehninger, MD, PhD Professor and Vice-Chair, Dept. Ob/Gyn

More information

Improvement in early human embryo development using new formulation sequential stage-specific culture media

Improvement in early human embryo development using new formulation sequential stage-specific culture media FERTILITY AND STERILITY VOL. 78, NO. 6, DECEMBER 2002 Copyright 2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Improvement in early

More information

Synchronization between embryo development and endometrium is a contributing factor for rescue ICSI outcome

Synchronization between embryo development and endometrium is a contributing factor for rescue ICSI outcome Reproductive BioMedicine Online (2012) 24, 527 531 www.sciencedirect.com www.rbmonline.com ARTICLE Synchronization between embryo development and endometrium is a contributing factor for rescue ICSI outcome

More information

IVF: PAST, PRESENT AND FUTURE

IVF: PAST, PRESENT AND FUTURE IVF: PAST, PRESENT AND FUTURE Mark Larman Chief Scientific Officer 1 HISTORY OF IVF IVF first achieved with rabbits in 1959 IVF with human gametes - pioneered by Robert Edwards and Patrick Steptoe during

More information

Is it the seed or the soil? Arthur Leader, MD, FRCSC

Is it the seed or the soil? Arthur Leader, MD, FRCSC The Physiological Limits of Ovarian Stimulation Is it the seed or the soil? Arthur Leader, MD, FRCSC Objectives 1. To consider how ovarian stimulation protocols work in IVF 2. To review the key events

More information

Effect of transferring a morphologically impaired embryo with a good quality embryo on the pregnancy and implantation rates

Effect of transferring a morphologically impaired embryo with a good quality embryo on the pregnancy and implantation rates European Review for Medical and Pharmacological Sciences Effect of transferring a morphologically impaired embryo with a good quality embryo on the pregnancy and implantation rates I. EL-DANASOURI 1-4,

More information

Advanced Assisted Reproductive Technologies

Advanced Assisted Reproductive Technologies Advanced Assisted Reproductive Technologies 體外受孕中心 IVF Centre IVF CENTRE at Hong Kong Sanatorium & Hospital The IVF Centre at Hong Kong Sanatorium & Hospital has been offering excellent patient care and

More information

The effects of prior gravidity on the outcomes of ovum donor and own oocyte cycles

The effects of prior gravidity on the outcomes of ovum donor and own oocyte cycles FERTILITY AND STERILITY Vol. 65, No.3, March 1996 Copyright t';, 1996 American Society for Reproductive Medicine Printed on acid-free paper in U. s. A. The effects of prior gravidity on the outcomes of

More information

H.Van de Velde 1, Z.P.Nagy, H.Joris, A.De Vos and A.C.Van Steirteghem

H.Van de Velde 1, Z.P.Nagy, H.Joris, A.De Vos and A.C.Van Steirteghem Human Reproduction vol.12 no.10 pp.2246 2250, 1997 Effects of different hyaluronidase concentrations and mechanical procedures for cumulus cell removal on the outcome of intracytoplasmic sperm injection

More information

Luteal phase rescue after GnRHa triggering Progesterone and Estradiol

Luteal phase rescue after GnRHa triggering Progesterone and Estradiol Luteal phase rescue after GnRHa triggering Progesterone and Estradiol L. Engmann University of Connecticut Disclaimer Fertility Speaker Bureau Merck Pharmaceuticals Introduction GnRH agonist is effective

More information

Abstract. Introduction. RBMOnline - Vol 8. No Reproductive BioMedicine Online; on web 19 April 2004

Abstract. Introduction. RBMOnline - Vol 8. No Reproductive BioMedicine Online;  on web 19 April 2004 RBMOnline - Vol 8. No 6. 2004 695-700 Reproductive BioMedicine Online; www.rbmonline.com/article/1296 on web 19 April 2004 Article Pronuclear morphology predicts embryo development and chromosome constitution

More information

In Vitro Fertilization What to expect

In Vitro Fertilization What to expect Patient Education In Vitro Fertilization What to expect This handout describes how to prepare for and what to expect when you have in vitro fertilization. It provides written information about this process,

More information

WOMEN & INFANTS HOSPITAL Providence, RI CONSENT FOR IVF WITH EMBRYO TRANSFER

WOMEN & INFANTS HOSPITAL Providence, RI CONSENT FOR IVF WITH EMBRYO TRANSFER *40639* 40639 WOMEN & INFANTS HOSPITAL Providence, RI 02905 CONSENT FOR IVF WITH EMBRYO TRANSFER I have requested treatment by the physicians and (Print Patient s name) staff of the Women & Infants Fertility

More information

in vitro fertilization

in vitro fertilization FERTILITY AND STERILITY VOL 69, NO. 6, JUNE 1998 Copyright (#1998 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Elevated levels of basal

More information

A Tale of Three Hormones: hcg, Progesterone and AMH

A Tale of Three Hormones: hcg, Progesterone and AMH A Tale of Three Hormones: hcg, Progesterone and AMH Download the Ferring AR ipad/iphone app from the Apple Store: http://bit.ly/1okk74m Interpreting Follicular Phase Progesterone Ernesto Bosch IVI Valencia,

More information

Article Controlled natural cycle IVF with antagonist use and blastocyst transfer

Article Controlled natural cycle IVF with antagonist use and blastocyst transfer RBMOnline - Vol 11. No 6. 2005 685 689 Reproductive BioMedicine Online; www.rbmonline.com/article/1936 on web 10 October 2005 Article Controlled natural cycle IVF with antagonist use and blastocyst transfer

More information

Immature oocyte retrieval combined with in-vitro oocyte maturation

Immature oocyte retrieval combined with in-vitro oocyte maturation Immature oocyte retrieval combined with in-vitro oocyte maturation J.B.Russell The Center for Human Reproduction, 4745 Ogletown Stanton Road, Suite 111, Newark, DE 19713, USA Immature oocyte retrieval

More information

IVF Patient Information

IVF Patient Information What is IVF? IVF (In Vitro Fertilisation) is a treatment by which fertilisation of eggs by sperm takes place outside the body in a dish in an IVF laboratory. An ovary has a pool of immature eggs. In a

More information

Vanessa N. Weitzman, M.D., Lawrence Engmann, M.D., Andrea DiLuigi, M.D., Donald Maier, M.D., John Nulsen, M.D., and Claudio Benadiva, M.D.

Vanessa N. Weitzman, M.D., Lawrence Engmann, M.D., Andrea DiLuigi, M.D., Donald Maier, M.D., John Nulsen, M.D., and Claudio Benadiva, M.D. Comparison of luteal estradiol patch and gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation versus microdose gonadotropin-releasing hormone agonist protocol

More information

Timur Giirgan, M.D.* Bulent Urman, M.D. Hakan Yarali, M.D. Hakan E. Duran, M.D.

Timur Giirgan, M.D.* Bulent Urman, M.D. Hakan Yarali, M.D. Hakan E. Duran, M.D. FERTILITY AND STEFULI~ Vol. 68, No. 3, September 1997 Copyright 1997 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Published by Elsevier Science Inc. Follicle-stimulating

More information

CONSENT FOR ASSISTED REPRODUCTION In Vitro Fertilization, Intracytoplasmic Sperm Injection, Assisted Hatching, Embryo Freezing and Disposition

CONSENT FOR ASSISTED REPRODUCTION In Vitro Fertilization, Intracytoplasmic Sperm Injection, Assisted Hatching, Embryo Freezing and Disposition CONSENT F ASSISTED REPRODUCTION In Vitro Fertilization, Intracytoplasmic Sperm Injection, Assisted Hatching, Embryo Freezing and Disposition Please read the following consent carefully. If you do not understand

More information

Universal Embryo Cryopreservation: Frozen versus Fresh Transfer. Zaher Merhi, M.D.

Universal Embryo Cryopreservation: Frozen versus Fresh Transfer. Zaher Merhi, M.D. Universal Embryo Cryopreservation: Frozen versus Fresh Transfer Zaher Merhi, M.D. Disclosure: None Fewer complications with IVF 1.5% children in US are born through ART 1.1 million children since 2006

More information

Comparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization

Comparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization Comparison of serum and follicular fluid hormone levels with recombinant and urinary human chorionic gonadotropin during in vitro fertilization Peter Kovacs, M.D., a Timea Kovats, M.D., a Artur Bernard,

More information

For these reasons we hypothesized that, because the ICSI procedure can be performed in a few minutes by experienced

For these reasons we hypothesized that, because the ICSI procedure can be performed in a few minutes by experienced Use of a medium buffered with N-hydroxyethylpiperazine-N-ethanesulfonate (HEPES) in intracytoplasmic sperm injection procedures is detrimental to the outcome of in vitro fertlization Francesco Morgia,

More information

Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles

Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles Human Reproduction Vol.17, No.1 pp. 83 87, 2002 Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles Joseph E.Peña, Peter L.Chang 1, Lai-King Chan, Khaled

More information

Female Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF

Female Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF Female Reproductive Physiology Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF REFERENCE Lew, R, Natural History of ovarian function including assessment of ovarian reserve

More information

Infertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations

Infertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Infertility Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Beneficial effects of IUI not consistently documented in studies No deleterious effects on fertility 3-4 cycles of IUI should

More information

Intracytoplasmic Sperm Injection and Conventional In Vitro Fertilization Are Complementary Techniques in Management of Unexplained Infertility

Intracytoplasmic Sperm Injection and Conventional In Vitro Fertilization Are Complementary Techniques in Management of Unexplained Infertility ( C 2003) Assisted Reproduction Intracytoplasmic Sperm Injection and Conventional In Vitro Fertilization Are Complementary Techniques in Management of Unexplained Infertility Kamal Jaroudi, 1 Saad Al-Hassan,

More information

Abstract. Introduction. Materials and methods. Patients and methods

Abstract. Introduction. Materials and methods. Patients and methods RBMOnline - Vol 8. No 3. 344-348 Reproductive BioMedicine Online; www.rbmonline.com/article/1178 on web 20 January 2004 Article Cumulative live birth rates after transfer of cryopreserved ICSI embryos

More information

The Influence of Culture Medium on Embryonic Viability. Klaus E. Wiemer PhD Director of Embryology and Reproductive Sciences

The Influence of Culture Medium on Embryonic Viability. Klaus E. Wiemer PhD Director of Embryology and Reproductive Sciences The Influence of Culture Medium on Embryonic Viability Klaus E. Wiemer PhD Director of Embryology and Reproductive Sciences Developmental Difference In Vivo vs. In Vitro Developmental Environment Attempts

More information

Clinical consequences of ovarian stimulation in assisted conception and in PCOS Al-Inany, H.G.

Clinical consequences of ovarian stimulation in assisted conception and in PCOS Al-Inany, H.G. UvA-DARE (Digital Academic Repository) Clinical consequences of ovarian stimulation in assisted conception and in PCOS Al-Inany, H.G. Link to publication Citation for published version (APA): Al-Inany,

More information

Patrick Quinn IVF PROTOKOL FOR SINGLE EMBRYO CULTURE

Patrick Quinn IVF PROTOKOL FOR SINGLE EMBRYO CULTURE 1. With cumulus-free oocytes and embryos up to Day (D) 3, use 275-300 um diameter pipette tips to minimize medium transfer between drops; transfer volume should be < 1 ul. DAY -1 2. At ~ 4.00 pm on the

More information

The outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology

The outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology Human Reproduction vol.14 no.1 pp.167 171, 1999 The outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology Lawrence Engmann 1,2,5, Noreen Maconochie

More information

WOMEN & INFANTS HOSPITAL Providence, RI CONSENT FOR IN VITRO FERTILIZATION USING A GESTATIONAL CARRIER (PATIENT/INTENDED PARENTS) 1.

WOMEN & INFANTS HOSPITAL Providence, RI CONSENT FOR IN VITRO FERTILIZATION USING A GESTATIONAL CARRIER (PATIENT/INTENDED PARENTS) 1. *40675* 40675 MR-838 (9-2017) WOMEN & INFANTS HOSPITAL Providence, RI 02905 CONSENT FOR IN VITRO FERTILIZATION USING A GESTATIONAL CARRIER (PATIENT/INTENDED PARENTS) 1. I, and (Print Patient s name) (Print

More information