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ABSTRACT: To determine the pregnancy rate following frozen embryo transfer using embryos derived from low dosage follicle stimulating hormone (FSH) stimulation protocols in women aged < 42 who did not have diminished egg reserve as evidenced by a day 3 serum FSH < or =12 mIU/ml.
A retrospective review was performed evaluating pregnancy rates on frozen embryo transfers from women who usually had diminished egg reserve and thus used no more than 150 IU of FSH. The pregnancy rates were calculated on the first frozen embryo transfer of women failing to successfully conceive on the fresh embryo transfer.
The clinical and live delivered pregnancy rates per transfer were 33.3% (14/42) and 23.8%. The implantation rate was 20.0%. Thirty-one percent of the transfers were in women aged 40-42.
These data show that despite the fact that with minimal stimulation protocols, the remaining frozen embryos are of lesser quality because of de-selection, nevertheless, it is worth transferring these embryos.
Clinical and experimental obstetrics & gynecology 01/2012; 39(2):139-40. · 0.43 Impact Factor
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ABSTRACT: To determine if the presence of a lower percentage of metaphase II eggs during oocyte retrieval leads to a lower fertilization rate of these metaphase II eggs since they may be more likely to be not quite fully mature, and to determine if transfer of embryos made from these eggs leads to lower pregnancy and implantation rates.
Fertilization and pregnancy rates determined according to deciles of percent of metaphase II eggs beginning with <30%.
Though there was no difference in fertilization rates when comparing those with <60% metaphase II eggs vs a 60%, there were significantly higher clinical and live delivered pregnancy rates and implantation rates when there were a 60% of the eggs retrieved that were metaphase II.
An inferior pregnancy outcome with a lower percentage of metaphase II eggs despite similar fertilization rates is consistent with the hypothesis that subtle full maturation defects may result in pregnancy failure despite embryo transfer.
Clinical and experimental obstetrics & gynecology 01/2012; 39(2):147-8. · 0.43 Impact Factor
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ABSTRACT: To test the hypothesis that very advanced reproductive age leads to an increased risk of zona pellucida hardening by comparing fertilization rates and rates of failed fertilization with conventional oocyte insemination vs intracytoplasmic sperm injection (ICSI).
Women aged > or = 45 were given the option of ICSI vs conventional oocyte insemination in circumstances where there was no male factor present. They were advised of the theoretical benefit of ICSI overcoming zona hardening but also advised that ICSI might lower pregnancy rates and is more costly.
There were 364 cycles evaluated and 74% chose ICSI. The failed fertilization rates were similar--28.4% (66/232) for ICSI vs 26.5% (35/132) for conventional insemination. The fertilization rates were similar 56.0% with ICSI vs 50.9% with conventional oocyte insemination.
Based on similar fertilization and failed fertilization rates in women aged > or = 45 undergoing IVF-ET, zona hardening does not appear to be a consequence of reproductive aging.
Clinical and experimental obstetrics & gynecology 01/2012; 39(4):440-1. · 0.43 Impact Factor
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ABSTRACT: To determine the relative pregnancy rates following frozen embryo transfer according to the reason for deferring fresh embryo transfer and freezing all embryos.
A retrospective review over a 10-year time period of all in vitro fertilization (IVF) cycles that deferred fresh transfer and cryopreserved all embryos related to risk of ovarian hyperstimulation syndrome or if there was inadequate endometrial thickness. Pregnancy rates according to the reason for freezing were then compared.
The clinical and live delivered pregnancy rates following frozen embryo transfer in women < or = age 39 was 42.8% and 31.9%, respectively for women deferring for risk of ovarian hyperstimulation syndrome vs 28.7% and 21.8% for those freezing for inadequate endometrial thickness (p = 0.01 and p = 0.07, respectively).
Embryo cryopreservation may not be a complete panacea for problems of inadequate endometrial thickness.
Clinical and experimental obstetrics & gynecology 01/2012; 39(4):434-5. · 0.43 Impact Factor
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ABSTRACT: To corroborate or refute the claim that intracytoplasmic sperm injection (ICSI) can overcome the problem found after conventional insemination of oocytes with sperm with low hypoosmotic swelling (HOS) tests of forming embryos with low implantation potential.
Matched couple pairs sharing one pool of oocytes were identified where one of the male partners had a low HOS test score and the other one with a normal one. Intracytoplasmic sperm injection was always used in those with low HOS test scores (i.e., < 50%) vs ICSI only used for semen abnormalities in the normal HOS group.
There were no differences found in either fertilization rates or clinical or live delivered pregnancy rates or implantation rates between these groups.
Intracytoplasmic sperm injection can completely negate the adverse effect that fertilization with sperm with subnormal HOS scores has on embryo implantation potential.
Clinical and experimental obstetrics & gynecology 01/2012; 39(1):21-2. · 0.43 Impact Factor
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ABSTRACT: To determine if the use of Embryo glue improves implantation and pregnancy rates following embryo transfer (ET) in women who failed to conceive in three previous attempts.
A matched controlled study was performed in women undergoing IVF-ET, donor oocyte recipients and women using their own oocytes having fresh or frozen ETs. A woman having Embryo glue was matched with the very next woman not using glue within six months of age and having the same number of previous failed ETs.
Embryo glue did not seem to improve pregnancy or implantation rates. In fact, in evaluating fresh embryo transfers there was a significantly higher live delivered pregnancy rate in the women not using Embryo glue (39.3%) vs those using the glue (14.3%).
Embryo glue does not improve pregnancy outcome in women failing in previous IVF cycles.
Clinical and experimental obstetrics & gynecology 01/2012; 39(1):11-2. · 0.43 Impact Factor
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ABSTRACT: To describe a modification of a simplified freezing protocol for the cryopreservation of blastocysts.
1.5 M glycerol was substituted as a cryoprotectant instead of propanediol.
There was a survival rate of 59.1% (13/22) with three live deliveries in seven transfers (42.9% per transfer). The implantation rate was 28.6% (4/14).
This is the first description of a new technique for freezing blastocysts. A larger series is needed to determine if the good pregnancy rates will continue.
Clinical and experimental obstetrics & gynecology 01/2010; 37(2):99. · 0.43 Impact Factor
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ABSTRACT: To determine if longer storage of embryos in a cryopreserved state negatively affects the chance of successful implantation following thawing and transfer.
A retrospective cohort analysis of frozen-thawed embryos that had been donated to recipients. Four time periods were evaluated.
No significant decrease in pregnancy or implantation rates was found in the longest freezing group (> or =6 years). In fact, if there was a trend, it was for improved pregnancy rates with longer storage. One of the successes was from embryos stored about 12 years.
Hopefully these data and results from other IVF centers will influence those countries having a mandatory discarding policy to reconsider and lift these restrictions, especially to increase the pool of embryos available for donation.
Clinical and experimental obstetrics & gynecology 01/2010; 37(3):185-6. · 0.43 Impact Factor
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ABSTRACT: To determine if the blastomere number of embryos at the time of freezing is related to its quality post-thaw.
A retrospective cohort analysis of frozen/thawed embryos. Only multi-cell embryos were used for this study. If an embryo was of good quality it would either be transferred or re-frozen.
There did not appear to be any trend for a lower percentage of good quality embryos with fewer numbers of blastomeres.
Though 4-cell embryos have a markedly lower implantation potential upon fresh embryo transfer compared to 6-8-cell embryos, this is not reflected in their ability to survive freeze-thawing.
Clinical and experimental obstetrics & gynecology 01/2009; 36(4):209. · 0.43 Impact Factor
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ABSTRACT: To compare the efficacy of freezing embryos at the 2 pronuclear stage vs multi-cell stage using a simplified freezing protocol with a one-step removal of the cryoprotectant.
A retrospective analysis was performed. Survival, delivered pregnancy and implantation rates were compared in transfers of all embryos frozen at 2 pronuclear stage (2PN) or all embryos frozen at multi-cell stage. The results were further stratified and compared according to the number of high quality embryos transferred.
In all categories despite comparing similar numbers and quality of embryos transferred there was a significantly higher survival rate of 2PN embryos. Significantly higher delivered pregnancy and implantation rates were seen with 2PN vs multi-cell embryos when there was only one or two embryos with > or = 6 blastomeres and < 25% fragmentation, and a trend for higher delivered pregnancy rates when there were three top quality embryos transferred.
When given the option it is preferable when using this simplified freezing and thawing protocol to freeze at the 2PN stage.
Clinical and experimental obstetrics & gynecology 01/2009; 36(4):210-1. · 0.43 Impact Factor
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ABSTRACT: To determine if intracytoplasmic sperm injection (ICSI) for mild male factor may create embryos less likely to implant.
A retrospective analysis of pregnancy outcome following oocyte fertilization with ICSI vs conventional egg insemination was performed.
Though there were many less cases using conventional oocyte insemination compared to ICSI so that a meaningful comparison of outcome could not be made, the data could suggest the fertilization by ICSI might result in embryos less likely to implant.
This pilot study should encourage IVF centers to consider conventional oocyte insemination for mild male factor instead of ICSI. Only by evaluating a larger series can it be determined with certainty that fertilization by ICSI may lower the implantation potential of the embryo that is formed.
Clinical and experimental obstetrics & gynecology 01/2009; 36(4):212-3. · 0.43 Impact Factor
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ABSTRACT: To determine in cases of unexplained infertility whether conventional oocyte insemination vs. intracytoplasmic sperm injection results in differences in fertilization rates, frequency of failed fertilization, clinical and live delivered pregnancy rates, and implantation rates.
Retrospective evaluation of these parameters in couples undergoing in vitro fertilization embryo transfer (IVF-ET) (minimum 2 embryos) in women with unexplained infertility over a 7-year period.
There was a significantly higher fertilization rate (p < .001) with ICSI vs. conventional insemination (73.7% vs. 63.7%). However of greater clinical importance, the clinical and live delivered pregnancy rates were significantly higher with conventional insemination (52.7% and 46.2%) than with ICSI 33.6% and 29.0%. The implantation rates were also significantly higher with conventional oocyte insemination (24.9% vs. 17.8%). Failed fertilization was low in both groups.
The process of ICSI, whether it involves possible subtle oocyte damage by the procedure or the andrologist not choosing the ideal sperm, may lead to embryos that are less hearty despite their normal appearance.
Clinical and experimental obstetrics & gynecology 01/2009; 36(3):150-1. · 0.43 Impact Factor
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ABSTRACT: To determine the pregnancy rates according to age in women failing to conceive after three previous embryo transfers or having a husband whose sperm shows a DNA fragmentation index (DFI) > 30% when performing the sperm chromatin structure assay.
Women up to age 45 were included and there was no restriction for low egg reserve. Live delivered pregnancy rates were determined according to three age groups: < or =34, 35-38, 39-45. The data were also analyzed in a group comparable to previous publications using high magnification ICSI, i.e., younger women with normal egg reserve. Pregnancy rates following frozen embryo transfer were also evaluated.
Using all 86 in vitro fertilization-embryo transfer (IVF-ET) cycles the live delivered pregnancy rates were 40% (10/25) for women < or = age 34, 24% (6/25) in women age 35-38, and 13.8% in women aged 39-45. Evaluating the younger group with normal egg reserve with > or =3 previous failed IVF-ET cycles the live delivered pregnancy rate per transfer was 38% (16/42). If one adds the additional six live deliveries from subsequent frozen embryo transfer (6 of 17, 35.3%) this group of women had a 52.3% (22/42) live delivered pregnancy rate from one egg retrieval.
These data were uncontrolled and thus conclusions should be viewed with caution. The results are sufficiently encouraging to warrant a prospective controlled trial and possibly encourage a company to consider commercially manufacturing high magnification microscopes.
Clinical and experimental obstetrics & gynecology 01/2009; 36(3):152-3. · 0.43 Impact Factor
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ABSTRACT: Failed fertilization with ICSI in women having at least five mature oocytes retrieved is uncommon. The present study evaluated 19 such patients to determine--based on this outcome--what option they would choose next and what the outcome would be.
The study requirements included females age < or = 43 and use of ejaculated sperm.
Five of 19 women (26.3%) had severe oligoasthenozoospermia. Options chosen were 1) donor egg (n = 3), 2) donor embryo (n = 1), 3) donor sperm (n = 1), 4) treatment cessation (n = 3), 5) resuming IVF-ET and ICSI (n = 11). Live deliveries occurred in 1) (n = 2), 2) (n = 1), and 5) (n = 4).
When faced with failed fertilization with ICSI a small majority of women (11/19, 57.9%) chose to still try with their own gametes and some succeeded (36.3%). These data may be helpful in counseling couples who fail fertilization despite IVF with ICSI in making a decision as to their next therapeutic choice.
Clinical and experimental obstetrics & gynecology 01/2007; 34(2):109-10. · 0.43 Impact Factor
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ABSTRACT: To determine if cryopreservation influences pregnancy outcome following transfer.
Retrospective cohort analyses of frozen embryo transfer (ET) cycles divided into five different categories according to reason for freezing.
Frozen embryos remaining as a result of failing to conceive with the previous fresh transfer or those remaining because of cancellation of fresh ET related to inadequate endometrial thickness, result in lower pregnancy rates (PRs).
The fact that embryos never deselected in a group whose fresh ET was canceled because of risk of ovarian hyperstimulation did not have the best results suggests that these oocytes may not be of equal quality to those attained with a more modest response.
Clinical and experimental obstetrics & gynecology 02/2005; 32(1):19-20. · 0.43 Impact Factor
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ABSTRACT: To determine if top embryos require an unusual, and possibly fortuitous, combination of excellent oocyte quality and sperm, or whether some oocyte property alone leads to the formation of superior quality embryos on day 3.
The embryo quality of donor oocyte recipient cycles was evaluated to find a woman who made 100% top embryos. After finding such an individual, the quality of the recipient's embryos was also evaluated. The shared donor oocyte recipient cycles were also evaluated for pregnancy outcome.
All 15 embryos were graded top. The six embryos transferred to the donor and recipient resulted in two sets of triplets. One of the fetuses of the recipient aborted related to trisomy 21.
The data indicates that the formation of an extremely high percentage (100%) of top embryos can be related to an oocyte factor. It is extremely unlikely to find two male partners who produce sperm with a unique property that makes superior morphologic embryos implant.
Clinical and experimental obstetrics & gynecology 02/2004; 31(4):265-6. · 0.43 Impact Factor
