Using 100% embryo implantation IVF cycles to identify preferred embryo development...
1
Tuesday, October 14, 2003 2:30 P.M. O-186 Coasting compares favorably to cryopreservation of all embryos for management of high responders. Heather E. Gibson, Katharine V. Jack- son, Janis H. Fox, Catherine Racowsky, Elizabeth S. Ginsburg. Brigham and Women’s Hosp, Boston, MA. Objective: Two strategies are commonly utilized for managing cycles of high responders with elevated estradiol (E2) levels. Either the E2 level is forced to decline by complete withdrawal of gonadotropin stimulation for one or more days prior to administering hCG or, alternatively, hCG is ordered in the setting of a high E2 and all resulting embryos are cryopre- served. It is unknown which strategy results in improved clinical outcome. The present study was performed to assess the relative efficacy of these two strategies. Design: Retrospective analysis of patients undergoing IVF from January 2001–December 2002. Materials and Methods: Of 2954 IVF cycles reviewed, 577 cycles were identified in which an E2 3000 pg/ml was achieved on any day of stimu- lation. Of these, 57 cycles were identified in which complete withdrawal of gonadotropin stimulation for one or more days was employed (coast group). An additional 52 cycles were identified in which all embryos were cryo- preserved in order to reduce the likelihood of ovarian hyperstimulation syndrome (OHSS) (cryo group). In order to correct for IVF attempt number, patients who were on their third or more IVF cycle attempt were excluded. Patients who were coasted but then had cryo were also excluded. The final study dataset comprised 39 coast group cycles and 50 cryo group cycles. Age, day 3 FSH, E2 levels, follicle number, total number of oocytes and MII oocytes retrieved, cancellation rate and rate of severe OHSS were com- pared. Pregnancy rate for the coasted group was calculated as the pregnancy rate per embryo transfer (ET) from the coasted cycle. Pregnancy rate for the cryo group was calculated as the pregnancy rate/ET from the first subse- quent cryopreserved embryo transfer (CET) cycle. Mann-Whitney U and chi square tests were utilized where appropriate, with p 0.05 considered significant. Results: The patient groups did not differ for age, day three FSH levels, follicles at retrieval and peak E2 levels. Coasted patients had significantly lower E2:follicle ratios (144.7 vs. 207.7; p 0.0004) compared to cryo patients. Coasted patients also had statistically fewer oocytes (18.0 vs 29.0; p 0.0001) and fewer MII oocytes (14.8 vs 23.0; p 0.0001) retrieved. Cancellation rates, severe OHSS rates and rates of ongoing-delivered/ET were not different between the groups. See table below. Conclusion: Our results indicate that high responder patients who un- dergo coasting have lower E2:follicle ratios at retrieval and have fewer total eggs and MII oocytes retrieved compared to patients who undergo cryo- preservation of all embryos. Importantly, however, both groups have similar pregnancy rates following the first transfer attempt. It remains to be seen whether cumulative pregnancy rates are significantly higher in the cryo group. Both groups have similar rates of cycle cancellation and hospital- ization for severe OHSS. Collectively, this information is of use when counseling the high responder patient. Tuesday, October 14, 2003 2:45 P.M. O-187 Using 100% embryo implantation IVF cycles to identify preferred embryo development patterns—morphokinetics. David Frankfurter, Richard Hackett, David L. Keefe, James B. Trimarchi. The George Wash- ington Univ, Washington, DC; Women and Infants’ Hosp, Providence, RI. Objective: Eliminating multiple gestations from assisted reproduction requires performing single embryo transfers (ET). This rests on the pre- transfer selection of a single, developmentally competent embryo from the cohort of available embryos. Primary methods for assessing embryo com- petence have not clarified the dynamic relationship between patterns of embryo development (morphokinetics) and the odds of implantation. We used cycles resulting in 100% embryo implantation to identify preferred morphokinetic patterns that predict favorable IVF-ET outcomes. Design: University based retrospective cohort study conducted from 1/01/02-11/30/02. Materials and Methods: Individual embryo culture allowed daily evalu- ation of embryos. Morphokinetic patterns were assigned based upon blas- tomere number and cell symmetry observed at 48 and 72 hours post retrieval. 100% embryo implantation was defined by sonographic confir- mation that embryonic sac number equaled the number of embryos returned. The most common (Preferred) morphokinetic patterns resulting in 100% implantation were used to screen all fresh, non-donor ET cycles performed during the study period and analyzed for an association with cycle outcome. Statistical analysis was carried out using 2 with p 0.05 considered statistically significant. Results: Forty-five cycles (96 embryos) resulted in 100% implantation. These 96 embryos displayed 36 morphokinetic patterns. 5 Preferred mor- phokinetic patterns described 53.1% of the implanted embryos (Table 1). Considering the ET cycles that did not display 100% implantation, cohorts containing at least 1 embryo with 1 of the 5 Preferred morphokinetic patterns had significantly higher pregnancy and implantation rates regard- less of whether the embryo exhibiting this pattern was transferred (Table 2). Table 1. Description of Preferred morphokinetic patterns Table 2. IVF-ET outcome according to embryo disposition and embryo availability of Preferred morphokinetic pattern a p 0.002 when compared to all other groups. b p 0.04 when compared to all other groups. Conclusion: By analyzing embryo morphokinetic patterns in 100% im- plantation cycles, we identified 5 Preferred embryo development patterns. Screening all ET cycles for Preferred patterns suggests that they can aid in prognostication. Non-invasive morphokinetic assessment provides the op- portunity to identify developmentally competent embryos and thereby des- ignate cycles for single ET. This may aid in maintaining IVF-ET pregnancy rates and curtail multiple pregnancy outcomes. Tuesday, October 14, 2003 3:00 P.M. O-188 Cost analysis for ART using a model of the effect of age and FSH levels upon pregnancy rates: The concept of a minimally acceptable preg- nancy rate. Adrienne B. Neithardt, William H. Catherino, Cynthia M. Murdock, James H. Segars. National Inst of Health, Bethesda, MD. Objective: It is universally accepted that increasing age and diminished ovarian reserve reduce the likelihood of pregnancy with ART. However, FERTILITY & STERILITY S71
-
Upload
david-frankfurter -
Category
Documents
-
view
215 -
download
2
Transcript of Using 100% embryo implantation IVF cycles to identify preferred embryo development...
Tuesday, October 14, 20032:30 P.M.
O-186
Coasting compares favorably to cryopreservation of all embryos formanagement of high responders. Heather E. Gibson, Katharine V. Jack-son, Janis H. Fox, Catherine Racowsky, Elizabeth S. Ginsburg. Brighamand Women’s Hosp, Boston, MA.
Objective: Two strategies are commonly utilized for managing cycles ofhigh responders with elevated estradiol (E2) levels. Either the E2 level isforced to decline by complete withdrawal of gonadotropin stimulation forone or more days prior to administering hCG or, alternatively, hCG isordered in the setting of a high E2 and all resulting embryos are cryopre-served. It is unknown which strategy results in improved clinical outcome.The present study was performed to assess the relative efficacy of these twostrategies.
Design: Retrospective analysis of patients undergoing IVF from January2001–December 2002.
Materials and Methods: Of 2954 IVF cycles reviewed, 577 cycles wereidentified in which an E2 3000 pg/ml was achieved on any day of stimu-lation. Of these, 57 cycles were identified in which complete withdrawal ofgonadotropin stimulation for one or more days was employed (coast group).An additional 52 cycles were identified in which all embryos were cryo-preserved in order to reduce the likelihood of ovarian hyperstimulationsyndrome (OHSS) (cryo group). In order to correct for IVF attempt number,patients who were on their third or more IVF cycle attempt were excluded.Patients who were coasted but then had cryo were also excluded. The finalstudy dataset comprised 39 coast group cycles and 50 cryo group cycles.Age, day 3 FSH, E2 levels, follicle number, total number of oocytes and MIIoocytes retrieved, cancellation rate and rate of severe OHSS were com-pared. Pregnancy rate for the coasted group was calculated as the pregnancyrate per embryo transfer (ET) from the coasted cycle. Pregnancy rate for thecryo group was calculated as the pregnancy rate/ET from the first subse-quent cryopreserved embryo transfer (CET) cycle. Mann-Whitney U andchi square tests were utilized where appropriate, with p � 0.05 consideredsignificant.
Results: The patient groups did not differ for age, day three FSH levels,follicles at retrieval and peak E2 levels. Coasted patients had significantlylower E2:follicle ratios (144.7 vs. 207.7; p � 0.0004) compared to cryopatients. Coasted patients also had statistically fewer oocytes (18.0 vs 29.0;p � 0.0001) and fewer MII oocytes (14.8 vs 23.0; p � 0.0001) retrieved.Cancellation rates, severe OHSS rates and rates of ongoing-delivered/ETwere not different between the groups. See table below.
Conclusion: Our results indicate that high responder patients who un-dergo coasting have lower E2:follicle ratios at retrieval and have fewer totaleggs and MII oocytes retrieved compared to patients who undergo cryo-preservation of all embryos. Importantly, however, both groups have similarpregnancy rates following the first transfer attempt. It remains to be seenwhether cumulative pregnancy rates are significantly higher in the cryogroup. Both groups have similar rates of cycle cancellation and hospital-ization for severe OHSS. Collectively, this information is of use whencounseling the high responder patient.
Tuesday, October 14, 20032:45 P.M.
O-187
Using 100% embryo implantation IVF cycles to identify preferredembryo development patterns—morphokinetics. David Frankfurter,
Richard Hackett, David L. Keefe, James B. Trimarchi. The George Wash-ington Univ, Washington, DC; Women and Infants’ Hosp, Providence, RI.
Objective: Eliminating multiple gestations from assisted reproductionrequires performing single embryo transfers (ET). This rests on the pre-transfer selection of a single, developmentally competent embryo from thecohort of available embryos. Primary methods for assessing embryo com-petence have not clarified the dynamic relationship between patterns ofembryo development (morphokinetics) and the odds of implantation. Weused cycles resulting in 100% embryo implantation to identify preferredmorphokinetic patterns that predict favorable IVF-ET outcomes.
Design: University based retrospective cohort study conducted from1/01/02-11/30/02.
Materials and Methods: Individual embryo culture allowed daily evalu-ation of embryos. Morphokinetic patterns were assigned based upon blas-tomere number and cell symmetry observed at 48 and 72 hours postretrieval. 100% embryo implantation was defined by sonographic confir-mation that embryonic sac number equaled the number of embryos returned.The most common (Preferred) morphokinetic patterns resulting in 100%implantation were used to screen all fresh, non-donor ET cycles performedduring the study period and analyzed for an association with cycle outcome.Statistical analysis was carried out using 2 with p � 0.05 consideredstatistically significant.
Results: Forty-five cycles (96 embryos) resulted in 100% implantation.These 96 embryos displayed 36 morphokinetic patterns. 5 Preferred mor-phokinetic patterns described 53.1% of the implanted embryos (Table 1).Considering the ET cycles that did not display 100% implantation, cohortscontaining at least 1 embryo with 1 of the 5 Preferred morphokineticpatterns had significantly higher pregnancy and implantation rates regard-less of whether the embryo exhibiting this pattern was transferred (Table 2).
Table 1. Description of Preferred morphokinetic patterns
Table 2. IVF-ET outcome according to embryo disposition and embryoavailability of Preferred morphokinetic pattern
a p � 0.002 when compared to all other groups. b p � 0.04 when comparedto all other groups.
Conclusion: By analyzing embryo morphokinetic patterns in 100% im-plantation cycles, we identified 5 Preferred embryo development patterns.Screening all ET cycles for Preferred patterns suggests that they can aid inprognostication. Non-invasive morphokinetic assessment provides the op-portunity to identify developmentally competent embryos and thereby des-ignate cycles for single ET. This may aid in maintaining IVF-ET pregnancyrates and curtail multiple pregnancy outcomes.
Tuesday, October 14, 20033:00 P.M.
O-188
Cost analysis for ART using a model of the effect of age and FSH levelsupon pregnancy rates: The concept of a minimally acceptable preg-nancy rate. Adrienne B. Neithardt, William H. Catherino, Cynthia M.Murdock, James H. Segars. National Inst of Health, Bethesda, MD.
Objective: It is universally accepted that increasing age and diminishedovarian reserve reduce the likelihood of pregnancy with ART. However,
FERTILITY & STERILITY� S71
