Live birth from a frozen-thawed pronuclear stage embryo almost 20 years after its cryopreservation.

OBJECTIVE: To report a live birth after transfer of cryopreserved pronuclear embryos in cryostorage for almost 20 years. DESIGN: Case report. SETTING: Academic IVF center. PATIENT(S): A 42-year-old female patient with low ovarian reserve receiving donated embryos. These embryos were the result of an anonymous donation from an infertile couple who had conceived during her IVF treatment. INTERVENTION(S): Cryopreservation (slow-freeze method) and thawing of pronuclear stage embryos, and ultrasound-guided uterine ET. MAIN OUTCOME MEASURE(S): Live birth. RESULT(S): Five pronuclear embryos were thawed; two embryos survived, cleaved, and were transferred on day 2. A singleton term pregnancy was achieved with the delivery of a healthy boy. CONCLUSION(S): A healthy live birth was documented after uterine transfer of pronuclear stage cryopreserved (slow freeze)-thawed embryos that were in storage for 19 years and 7 months. To our knowledge this case represents the "oldest" cryopreserved human embryos resulting in a live birth to date.

Two singleton live births after the transfer of cryopreserved-thawed day-3 embryos following an unstimulated in-vitro oocyte maturation cycle.

The objective was to report two singleton live births after transfer of cryopreserved-thawed day-3 embryos resulting from an unstimulated in-vitro oocyte maturation (IVM) cycle. A 29-year-old female patient with polycystic ovaries (PCO) underwent an unstimulated IVM cycle. A total of 43 prophase-I oocytes were retrieved; 21 oocytes achieved in-vitro maturation to the metaphase-II stage at 36 h post-retrieval and 18 oocytes were fertilized (two pronuclei) after intracytoplasmic sperm injection. Two embryos were transferred in the fresh cycle (no pregnancy) and 15 day-3 embryos (post-oocyte microinjection) were cryopreserved. Subsequently, the patient became pregnant after each of two embryo transfer cycles from cryopreserved-thawed embryos (three and two embryos transferred respectively), with delivery of a single, term, healthy baby after each transfer. It is concluded that healthy live births were documented in a PCO patient undergoing unstimulated IVM followed by transfer of day-3 cryopreserved (slow-freeze)-thawed embryos, adding these methodologies to the armamentarium of assisted reproductive technologies.

Does storage time influence postthaw survival and pregnancy outcome? An analysis of 11,768 cryopreserved human embryos.

OBJECTIVE: To evaluate the impact of cryopreservation storage duration on embryo survival, implantation competence, and pregnancy outcome. DESIGN: Retrospective study. SETTING: Academic tertiary-referral infertility center. PATIENT(S): In vitro fertilization patients and recipients of oocyte donation cycles who had cryopreserved embryos and underwent at least one thaw cycle from 1986 to 2007. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Postthaw survival proportion and implantation, clinical pregnancy, miscarriage, and live birth rates. RESULT(S): Length of storage time did not have a significant effect on postthaw survival for IVF or oocyte donation cycles, or for embryos frozen at the pronuclear or cleavage stages. There was no significant impact of the duration of storage on clinical pregnancy, miscarriage, implantation, or live birth rate, whether from IVF or oocyte donation cycles. Logistic regression analysis demonstrated that the length of storage time or developmental stage at freezing were not predictive of embryo survival or pregnancy outcome. Only oocyte age, survival proportion, and number of transferred embryos were positive predictors of pregnancy outcome. CONCLUSION(S): Cryostorage duration did not adversely affect postthaw survival or pregnancy outcome in IVF or oocyte donation patients.

Elective transfer of two embryos: reduction of multiple gestations while maintaining high pregnancy rates.

PURPOSE: To determine if the elective transfer of two embryos reduced the incidence of multiple gestations while maintaining high pregnancy rates. METHODS: IVF patients and recipients of oocyte donation with an elective day-3 transfer of 2 or 3 embryos were studied. RESULT(S): In IVF, the elective transfer of 2 embryos resulted in similar pregnancy rate but significantly reduced the overall incidence of multiple gestations (20% versus 39%) when compared to the elective transfer of 3 embryos. Twin gestations decreased from 28% to 19%, and triplets significantly decreased from 9% to 1%. In oocyte donation, the elective transfer of 2 embryos resulted in similar pregnancy rate but also significantly reduced the overall incidence of multiple gestations (26% versus 48%), with twins decreasing from 34% to 24%, and with a significant reduction of triplets (13% versus 2%). CONCLUSIONS: In IVF and oocyte donation, the elective transfer of 2 embryos resulted in similar pregnancy rates and significantly reduced multiple gestation rates when compared to the elective transfer of 3 embryos.

Total quality improvement in the IVF laboratory: choosing indicators of quality.

The purpose of this paper is to describe a programme of total quality improvement (TQI) within the IVF laboratory and to provide specific examples of indicators that could be used in such a TQI programme. Although TQI is sometimes confused with quality control (QC) and quality assurance (QA), there are major differences between the three quality plans: (i) QC is an activity designed to ensure that a specific element within the laboratory is functioning correctly; (ii) QA is a comprehensive programme designed to looks at a laboratory as a whole and to identify problems or errors that exist in an attempt to improve the entire process; (iii) TQI is also a comprehensive monitoring process designed not only to detect and eliminate problems, but also to enhance a laboratory's performance by exploring innovation and developing flexibility and effectiveness in all processes. Indicators used in a TQI plan should be objective, relevant to the laboratory, and measure a broad range of specific events or aspects of treatment that reflect the quality of care. Threshold values for each of the indicators should be based on how the specific protocols used in the laboratory impact the outcomes and the nature of the indicators on quality of care.