Day 2 embryo transfer (ET) and day 3 ET afford similar reproductive outcomes in the poor responder.

A retrospective review of 237 initial, fresh nondonor IVF cycles in which all embryos generated during the cycle were transferred on either day 2 (n = 109) or day 3 (n = 128) were evaluated with regards to reproductive outcomes. Patients who underwent a day 2 ET had similar conception (18% vs. 16%; relative risk [RR], 1.1; 95% confidence interval [CI], 0.64-1.95), clinical pregnancy (13% vs. 16%; RR, 0.8; 95% CI, 0.44-1.55), implantation (6% vs. 7%; RR, 0.9; 95% CI, 0.50-1.68), and live-birth (10% vs. 16%; RR, 0.7; 95% CI, 0.32-1.29) rates as those who underwent a day 3 ET.

Profound teratospermia does not influence sex chromosomal aneuploidy rate in in vitro fertilization-preimplantation genetic diagnosis cycles.

Because spermatocyte meiotic error results in embryonic sex chromosomal aneuploidy, it is speculated that teratospermia correlates with increased embryonic sex chromosomal abnormalities. Our findings contradict this theory, suggesting that morphology does not correlate with sex chromosomal genotype.

The use of lead follicle diameter to initiate gonadotropin-releasing hormone antagonist does not affect in vitro fertilization clinical pregnancy, implantation, or live birth rates: a prospective, randomized study.

In this prospective, randomized study, waiting for the lead follicle to reach 14 mm before initiating GnRH antagonist administration effectively prevents an LH surge and ovulation during an IVF cycle. Furthermore, delaying GnRH start until the dominant follicle reaches 14 mm neither impacts the clinical pregnancy, implantation, or live birth rates nor increases the incidence of severe ovarian hyperstimulation syndrome.

Effects of triploidy after intracytoplasmic sperm injection on in vitro fertilization cycle outcome.

OBJECTIVE: To evaluate the impact on the rates of clinical pregnancy and live birth of polyploidy after intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective cohort study. SETTING: University-based IVF center. PATIENT(S): One hundred forty-three patients undergoing their first IVF-embryo transfer cycle requiring ICSI. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patients were divided into two groups on the basis of the proportion of post-ICSI triploid fertilization that was observed at the time of fertilization assessment: group 1 included patients with 20% 3PN zygotes. The primary outcomes compared between groups were pregnancy and implantation rates; secondary outcome measures included clinical-pregnancy rate and live-birth rate per embryo transfer. RESULT(S): Pregnancy, implantation, clinical-pregnancy, and live-birth rates were significantly higher in the cohort of patients who had 20% of zygotes appearing triploid (relative risk [RR] for pregnancy, 2.4 [95% confidence interval {CI}, 1.22-4.77]; RR for implantation, 2.6 [95% CI, 1.17-5.56]; RR for clinical pregnancy, 2.8 [95% CI, 1.16-6.85]; and RR for live birth, 2.6 [95% CI, 1.06-6.38]). The proportion of 3PN zygotes after ICSI had a statistically significant inverse relationship to clinical-pregnancy rate. CONCLUSION(S): The proportion of triploid zygotes after ICSI serves as a negative prognostic indicator for IVF cycle outcome. This finding suggests that triploidy proportion is a surrogate marker of oocyte competence that represents the integrity of the oocytes in the entire recruited cohort. Such findings therefore may influence recommendations for embryo transfer number and freezing of supernumerary embryos.

Does ethnicity influence in vitro fertilization (IVF) birth outcomes?

OBJECTIVE: To determine if ethnicity influences IVF birth outcome. DESIGN: Retrospective cohort study. SETTING: University-based IVF program. PATIENT(S): All African American women (n = 71) and Caucasian women (n = 180) who underwent initial fresh, nondonor IVF/embryo transfer (ET) cycles between January 1, 2004 and December 31, 2005. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Gonadotropin dose, duration of stimulation, peak estradiol levels, oocyte yield, implantation, clinical pregnancy, and live birth rates. RESULT(S): African American women generated significantly fewer embryos than Caucasian women (5.3 +/- 3.7 vs. 6.6 +/- 4.8) despite having similar ages, day 3 FSH, peak estradiol levels, length of stimulation, and number of oocytes retrieved. In addition, compared with Caucasian women, African American had significantly greater body mass indices (26.5 +/- 5.2 vs. 23.7 +/- 4.8) and required significantly more total gonadotropin (IU) (4,791 +/- 2,161 vs. 3,725 +/- 2,005) for ovarian stimulation. African American women were more likely to have uterine fibroids (21% vs. 3%) and tubal factor infertility (23% vs. 9%). Caucasian women were more likely to have unexplained infertility (53% vs. 32%). Differences in embryo yield between patient groups persisted after accounting for differences in infertility diagnosis and prevalence of fibroids. Biochemical, clinical pregnancy, and live birth rates as well as implantation rates (number of sacs visualized/number of embryos transferred) did not significantly differ between groups. CONCLUSION(S): Although African Americans yield fewer embryos than Caucasian women with IVF, these ethnic groups do not seem to differ with regard to IVF pregnancy outcomes.

The influence of sperm morphology on preimplantation genetic diagnosis cycles outcome.

OBJECTIVE: To evaluate the impact of abnormal sperm morphology on the rates of aneuploidy, implantation, and clinical pregnancy. DESIGN: Retrospective cohort study. SETTING: University-based IVF center. PATIENT(S): Fifty-two patients undergoing their first IVF-preimplantation genetic diagnosis (PGD) cycle. INTERVENTION(S): The PGD analysis of embryos. MAIN OUTCOME MEASURE(S): Patients were divided into two groups based on sperm morphology: teratospermic group (TSG) and normal sperm group (NSG). The primary outcome measures of rates of aneuploidy, implantation, clinical pregnancy rate (PR) per cycle, and clinical PR per embryo transfer were compared between TSG and NSG according to PGD analysis results. RESULTS: A higher percentage of normal embryos was seen in the NSG (32%) versus the TSG (20%). Overall, 30% of IVF-PGD cycles had no normal embryos for transfer. The clinical PR per cycle was 44% in the NSG compared to 14% in the TSG (relative risk [RR] = 3.19; 95% confidence interval [CI] 1.1-9.0). A similar trend was noted with the clinical PR per embryo transfer with 57% patients becoming pregnant in the NSG versus 20% patients in the TSG (RR = 2.76; 95% CI 1.2-7.2). Implantation was twice as likely to occur in the NSG as compared to TSG (RR = 2.5; 95% CI 1.1-7.2). CONCLUSION(S): Rates of euploidy, implantation, clinical PR per cycle, and clinical PR per embryo transfer were higher in the NSG compared to the TSG, suggesting that sperm morphology plays an important role in the outcome of IVF-PGD cycles.

Novel follicular-phase gonadotropin-releasing hormone antagonist stimulation protocol for in vitro fertilization in the poor responder.

Poor responders continue to be vexing in infertility therapy. By using GnRH antagonists before ovarian stimulation, we demonstrate an improvement in oocyte, embryo, and zygote yield in patients with a prior poor response.

Second cycle: to hatch or not to hatch?

The objective of this study was to assess the impact of assisted hatching (AH) on pregnancy rate (PR), clinical pregnancy rate (CPR), and implantation rate (IR) after a single failed, fresh, nondonor IVF cycle. Accordingly, we report that patients with one prior implantation failure benefit from AH with improved PR, CPR, and IR in a subsequent cycle.