The Correlation of Ovarian Follicular Concentrations of IGF-II, IGFBP-1, and 3 between Cumulative Embryo Score in Patients Undergoing IVF-ET / 대한산부인과학회잡지

OBJECTIVE: To investigate the correlation between the concentrations of insulin-like growth factor-II (IGF-II), insulin-like growth factor binding protein-1, 3 (IGFBP-1, 3) in the follicular fluid and the cumulative embryo score (CES) in the patient who underwent in vitro fertilization and embryo transfer (IVF-ET). MATERIALS AND METHODS: A total of 21 cycles of 18 patients which underwent IVF-ET cycle after controlled ovarian hyperstimulation (COH) were included in this study. Using immunoradiometric assay (IRMA), we measured the concentrations of IGF-II, IGFBP-1, 3 in the follicular fluid. The patients were grouped into the pregnant and non-pregnant group. The concentrations of IGF-II, IGFBP-1, 3 in the follicular fluid were compared between the two groups and the correlations of the follicular concentrations of IGF-II, IGFBP-1, 3 and cumulative embryo score were evaluated. Results were analyzed with Mann-Whitney U test and Spearman's rank correlation coefficient and statistical significance was defined as p<0.05. RESULTS: There were no statistical significance in the follicular concentrations of IGF-II, IGFBP-1, 3 between the pregnant group and non-pregnant group. There were signifiant correlation between the follicular concentration of IGF-II and cumulative embryo score (p=0.001). There might be correlations between the follicular concentration of IGFBP-3, and free IGF-II and cumulative embryo score (p=0.053, p=0.056, respectively). CONCLUSION: The follicular IGF-II and free IGF-II might have an influence to development of good- quality embryos in patients undergoing IVF-ET.

Cumulative Pregnancy Rate of In Vitro Fertilization and Embryo Transfer With Intracytoplasmic Sperm Injection / 대한산부인과학회잡지

OBJECTIVE: To compare the clinical outcomes between Day 2 and Day 3 embryo transfer(ET) groups in in vitro fertilization and embryo transfer(IVF-ET) with intracytoplasmic sperm injection(ICSI). METHODS: From May, 1997 to December, 1998, 174 cycles of IVF-ET with ICSI were performed and classified into two groups: Day 2 ET group(n=134) and Day 3 ET group (n=40). In Day 3 ET group, embryos fertilized after ICSI were cultured in vitro for further 24 hours in M3 media. RESULTS: There were no significant differences in the age and BMI of patients, basal serum FSH level, protocol of controlled ovarian hyperstimulation(COH), indication of ICSI, and source of sperm for ICSI between two groups. Only the number of the previous failed IVF-ET cycles was significantly higher in Day 3 ET group(p<0.05). Serum E2 level on hCG day, the numbers of oocytes retrieved after COH, oocytes fertilized after ICSI, and embryos transferred, and the rates of fertilization, cleavage, and implantation showed no significant differences. However, cumulative embryo score(CES) was significantly higher in Day 3 ET group(p<0.05). Although there were no significant differences in the rates of pregnancy per ET, spontaneous abortion, and live birth, the rates of biochemical and multiple pregnancy were significantly higher in Day 3 ET group(p<0.05). CONCLUSIONS: In IVF-ET with ICSI, the relatively higher CES may contribute to the higher risk of multiple pregnancy in Day 3 ET group, compared with the conventional Day 2 ET group.

Intracyplasmic Sperm Injection in Patients with Past History of Failed or Poor Fertilization in Previous IVF - ET Cycles : Comparison with Patients with Severe Male Factor / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine whether intracytoplasmic sperm injection(ICSI) could overcome the defects of oocytes in IVF-ET patients with previous fertilization failure by conventional fertilization technique. Design: Retrospective study Materials and METHODS: A total of 119 ICSI cycles in 57 IVF-ET patients performed from May, 1995 to December, 1997 was enrolled. Subjects were divided into two groups: FR group included 66 ICSI cycles in 35 patients with normal sperm who underwent ICSI due to past history of failed or poor fertilization in the previous IVF-ET cycles, and OAT group included 53 ICSI cycles in 22 patients with severe oligoasthenoterato- zoospermia(OAT) which was defined as sperm concentration < 20 million/ml, mo#dlity < 30% and normal morphology < 4% by strict morphologic criteria. The outcomes of ICSI were analyzed and compared in both groups. RESULTS: The age of female patients, basal serum FSH level, and the numbers of oocytes retrieved and metaphase II oocytes were all comparable in both groups. The fertilization rate after ICSI was similar in both groups(68.7+/-25.3% vs. 67.7+/-24.5%), as were the cleavage rate of normally fertilized oocytes(93.1+/-21.4% vs. 89.3+/-21.6%), the number of embryos transferred(4,00+/-1.98 vs. 4.64+/-2.10), and cumulative embryo score(CES) indicating the quality of embryos(47.3+/-33.2 vs. 54.1+/-33.2). The implantation rate(4.3+/-10.5% vs. 3.8+/-11.0%) and the clinical pregnancy rate per cycle(15.2% vs. 13.2%) were also comparable in both groups. CONCLUSIONS: Although it has been shown that there is a higher risk of chromosomal abnormalities in oocytes from IVF-ET patients with pevious failed or poor fertilization, higher implantation and clinical pregnancy rates wer#e not observed in patients with OAT following ICSL Therefore, the functional defect of sperm such as loss of capacitation, defect of aaasome reaction, and abnormality of nucleus decondensation should be also considered in patients with previous failed or poor fertilization.

The Impact of Oocyte Maturity and Embryo Quality on Pregnancy Rate of In Vitro fertilization-EmbryoTransfer(IVF-ET) Program / 대한산부인과학회잡지

There are a number of factors affecting the pregnancy rate in in vitro fertilization(IVF): the etiology of infertility, ages of husband and wife, the type of ovarian stimulation,the number of aspirated oocytes, the maturity of oocyte, embryo quality, the number offertilized oocytes, the cumulative embryo score, and the number of embryos transferred. Amongthem the maturity of oocyte and the quality of embryo appear to be the most importantfactors influencing the pregnancy rate. The aim of this study designed to evaluate the effectof oocyte maturity, embryo quality, the number of embryos transferred, and the cumulativeembryo score to fertilization rate on whether the patient conceived or not. A total of146 consecutive cycles of in vitro fertilization-embryo transfer(IVF-ET) were studied usingtwo ovarian hyperstimulation protocols; follicular stimulating hormone(FSH)/ humanmenopausal gonadotropin(HMG)/human chorionic gonadotropin(hCG) and gonadotropin releasinghormone agonist(GnRH-a)/FSH/HMG/hCG.Following were the results.1. The quality and quantity of oocytes and embryos, fertilization rate, and cumulativeembryo score between two ovarian hyperstimulation protocols were not different.2. The more mature oocytes exhibited, the greater fertilization rates in both methods(p < 0.01).3. The average numbers of embryos transferred were 3.65 +/- 0.27 in conceived groupand 2.54 +/- 0.18 in nonconceived group, which was statistically higher in conceived group(p < 0.001).4. The pregnancy rate was higher if any matured embryo(Grade I) was present amongthe embryos transferred(p < 0.05).5. The average cumulative embryo score was 69.70 +/- 6.13 inconceived group and 43.51 +/- 3.41 in nonconceived group, which was statistically higher in conceived group(p < 0.001).These data suggest that the pregnancy rate is higher when the oocyte maturation isBetter, the number of embryos transferred is greater, there is at least one matured embryoamong the embryos transferred, and the cumulative embryo score is higher.