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.

Interobserver and intraobserver variation in day 3 embryo grading.

OBJECTIVE: Variations in pregnancy rates (PR) between IVF programs are due to multiple factors, including embryo quality. Standardized embryo grading systems have been developed to improve communication between embryologists and clinicians. However, these grading systems have not been validated. We sought to quantify both interobserver and intraobserver variability using a standardized day 3 embryo grading system (Veeck scale). DESIGN: Prospective, sample-randomized, controlled, blinded study. SETTING: University hospital. PATIENT(S): Twenty-six practicing embryologists. INTERVENTION(S): Observation and grading of 35 video clips of day 3 embryos. MAIN OUTCOME MEASURE(S): Interobserver and intraobserver variability. Embryologists were also assessed by education level, years of experience, size of IVF program, and type of grading system used. Kappa scores and intraclass correlation coefficients were calculated. RESULT(S): Practicing embryologists differed from control (Lucinda Veeck) by as much as two grades, despite using the same grading system (Kappa = 0.24, interclass correlation coefficient = 0.98). There was also variability in grading the same embryo (Kappa = 0.69, interclass correlation coefficient = 0.88). Programs with higher cycle numbers per year had lower variability. CONCLUSION(S): There is substantial interobserver variability and moderate intraobserver variability among embryologists. Such variability could alter both the expected quality of embryos transferred, as well as the number transferred, both of which directly impact IVF program success.

Follicular phase serum levels of luteinizing hormone do not influence delivery rates in in vitro fertilization cycles down-regulated with a gonadotropin-releasing hormone agonist and stimulated with recombinant follicle-stimulating hormone.

OBJECTIVE: To assess the value of serum LH measurements in early and late follicular phase as predictors of ovarian response and IVF outcome in patients treated with recombinant FSH with GnRH agonist (GnRH-a) pituitary down-regulation. DESIGN: Retrospective cohort analysis. SETTING: Institutional. PATIENT(S): Women undergoing 157 consecutive IVF cycles suppressed with leuprolide acetate (LA) started in the midluteal phase and stimulated with recombinant FSH. Only women <40 years of age and with a basal cycle day 3 serum FSH

Impact of transabdominal ultrasound guidance on performance and outcome of transcervical uterine embryo transfer.

PURPOSE: To determine the impact of transabdominal ultrasound guidance on embryo transfer during IVF therapy. METHODS: Retrospective analysis of 823 consecutive embryo transfers. Three hundred and sixty-seven procedures performed with transabdominal ultrasound guidance were compared to 456 cases performed with the "clinical touch" method. RESULTS: Ultrasound-guided embryo transfer yielded higher, but not statistically significant, clinical pregnancy (48% vs. 44%) and implantation rates (22% vs. 20%). The incidence of multiple pregnancies, ectopic and multiple pregnancy rates were similar. The frequency of negative factors typically associated with difficult transfers, such as requirement of use of tenaculum, and presence of blood or mucus in the catheter tip, were significantly lower in the ultrasound-guided group in comparison with the clinical touch group. Ultrasound-guided embryo transfer was associated with a significantly increased easiness of transfer performance; 95% of the transfers were rated as very easy in the ultrasound-guidance group compared to 87% in the clinical touch group. The use of a soft pass catheter was the only variable independently and significantly associated with pregnancy success (odds ratio = 2.74). CONCLUSION(S): Ultrasound-guidance facilitates embryo transfer and in combination with the use of a soft catheter should be implemented to optimize embryo transfer results.

Cryopreserved embryos in the United States and their availability for research.

OBJECTIVE: To determine the number of embryos stored at assisted reproductive technology (ART) clinics in the United States and their current disposition. DESIGN: A targeted survey instrument sent by the SART-RAND team to all medical practices providing in vitro fertilization services in the United States. RESULTS: The SART-RAND team surveyed all 430 ART practices in the United States. Of these practices, 340 returned surveys for analysis. The data from these surveys were merged with data taken from the 1999 SART dataset, which contains information about practice size and success rates. Responding clinics reported a total of 396,526 embryos in storage as of April 11, 2002. The vast majority of the embryos (88.2%) were targeted for patient use. Small numbers of embryos were available for research, donation, destruction, quality assurance, or other uses. CONCLUSIONS: Nearly 400,000 embryos are stored in the United States, the majority of which (88.2%) are targeted for patient use. Few are available for research (2.8%), limiting possible conversion into embryonic stem cell lines.

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.