ABSTRACT
Transfer of human embryos to the uterus at the blastocyst stage has several advantages. There may be an improvement in success rates of pregnancy due to better synchronization of the uterine and embryonic development, self-selection of embryos for transfer along with the possibility of reducing the number of embryos transferred and the risk of multiple pregnancies without altering the overall pregnancy rate would be decreased. However, embryos are transferred to the uterus on day 2 or 3 after insemination before the blastocyst stage is reached in many cases. This may be a reflection of sub-optimal culture conditions although inherent abnormalities like chromosomal anomalies will also contribute to the loss.1~8 Physiologically, the human endometrium prepares itself to its optimum approximately on days 5~7 after ovulation so as to receive a cavitated blastocyst from the fallopian tube for successful implantation.1,9,10 However, conventionally, in most programs offering in vitro fertilization (iVF), 4~8 cell stage embryos are replaced to the uterus.1,9,11 This asynchrony of embryonic stage and preparation of endometrium may be one major contributory cause of increased abortion and low take-home baby rates in infertility patients.1,10~12 Leaving all embryos in extended culture until they develop to the blastocyst stage might result in cancellation of the embryo transfer (ET) procedure if none of the embryos reach that stage. This could have a major adverse psychological impact on the patient, and also denies her the possibility of implantation of early embryos that did not develop to the blastocyst stage in vitro but might have done so in vivo.2 To avoid such events while explore the feasibility of blastocyst transfer, subsequent ET (SET) of early embryos and blastocysts was applied on day 2~3 and 5.2,6,7,13,14 The current study was conducted to investigate the effectiveness of attempted SET of blastocysts on day 5~7 following initial multi-cell embryos transfer on day 2, 3 or 4 in iVF cycles.
Subject(s)
Female , Humans , Pregnancy , Blastocyst , Embryo Transfer , Embryonic Development , Embryonic Structures , Endometrium , Fallopian Tubes , Fertilization in Vitro , Infertility , Insemination , Ovulation , Pregnancy Rate , Pregnancy, Multiple , UterusABSTRACT
OBJECTIVE: To evaluate the clinical efficacy of human blastocyst transfer following in vitro culture for five days in in vitro fertilization and embryo transfer (IVF-ET), and to compare the efficiency of P1-BL and G1-G2 media in the culture of human blastocyst. METHODS: Seventy-two infertile patients undergoing blastocyst transfer in IVF-ET were classified into the conventional IVF (n=52) and ICSI (n=20) groups, and P1-BL (n=37) and G1-G2 (n=35) groups. The outcomes of blastocyst transfer cycles were evaluated and compared, respectively. RESULTS: There were no significant differences in the outcomes of controlled ovarian hyperstimulation (COH) and IVF-ET, such as duration of COH, total dosage of gonadotropins used, serum estradiol (E2) level on hCG day, numbers of oocytes retrieved and fertilized, and number of blastocysts transferred between the conventional IVF and ICSI groups, and between P1-BL and G1-G2 groups, respectively. Total blastulation rate was significantly higher in IVF group than ICSI group (53.6% vs. 37.3%, p<0.05). Implantation, clinical pregnancy, and multiple pregnancy rates were significantly higher in IVF group than ICSI group (15.1% vs. 4.1%, p<0.05; 36.5% vs. 15.0%, p<0.05; 36.8% vs. 0%, p<0.01). There were no significant differences in total blastulation, implantation, and clinical pregnancy rates between P1-BL and G1-G2 groups. However, multiple pregnancy rate was significantly higher in G1-G2 group than P1-BL group (60.0% vs. 8.3%, p<0.05). CONCLUSIONS: In human blastocyst transfer following in vitro culture for five days in IVF-ET, conventional IVF showed better outcomes of embryo development and pregnancy than ICSI. The efficiency of P1-BL media in the culture of human blastocyst was comparable to that of G1-G2 media. Further investigation will be necessary to compare the efficiency of various media in the blastocyst culture and to confirm the risk of multiple pregnancy in cases using G1-G2 media.
Subject(s)
Female , Humans , Pregnancy , Blastocyst , Culture Media , Embryo Transfer , Embryonic Development , Embryonic Structures , Estradiol , Fertilization in Vitro , Gonadotropins , Oocytes , Pregnancy Rate , Pregnancy, Multiple , Sperm Injections, IntracytoplasmicABSTRACT
OBJECTIVE: To evaluate the clinical efficacy of human blastocyst transfer following in vitro culture for five days in in vitro fertilization and embryo transfer (IVF-ET), and to compare the efficiency of P1-BL and G1-G2 media in the culture of human blastocyst. METHODS: Seventy-two infertile patients undergoing blastocyst transfer in IVF-ET were classified into the conventional IVF (n=52) and ICSI (n=20) groups, and P1-BL (n=37) and G1-G2 (n=35) groups. The outcomes of blastocyst transfer cycles were evaluated and compared, respectively. RESULTS: There were no significant differences in the outcomes of controlled ovarian hyperstimulation (COH) and IVF-ET, such as duration of COH, total dosage of gonadotropins used, serum estradiol (E2) level on hCG day, numbers of oocytes retrieved and fertilized, and number of blastocysts transferred between the conventional IVF and ICSI groups, and between P1-BL and G1-G2 groups, respectively. Total blastulation rate was significantly higher in IVF group than ICSI group (53.6% vs. 37.3%, p<0.05). Implantation, clinical pregnancy, and multiple pregnancy rates were significantly higher in IVF group than ICSI group (15.1% vs. 4.1%, p<0.05; 36.5% vs. 15.0%, p<0.05; 36.8% vs. 0%, p<0.01). There were no significant differences in total blastulation, implantation, and clinical pregnancy rates between P1-BL and G1-G2 groups. However, multiple pregnancy rate was significantly higher in G1-G2 group than P1-BL group (60.0% vs. 8.3%, p<0.05). CONCLUSIONS: In human blastocyst transfer following in vitro culture for five days in IVF-ET, conventional IVF showed better outcomes of embryo development and pregnancy than ICSI. The efficiency of P1-BL media in the culture of human blastocyst was comparable to that of G1-G2 media. Further investigation will be necessary to compare the efficiency of various media in the blastocyst culture and to confirm the risk of multiple pregnancy in cases using G1-G2 media.