Evaluation of embryo transfer through a scoring system: ETSS (Embryo transfer scoring system).

INTRODUCTION: To create a scoring system by including all of the factors that are recommended for an ideal ET and to investigate its correlation with the Β-HCG results. MATERIALS AND METHODS: This study was conducted as a retrospective trial between January 2009 and December 2018. Women who had a single ET between the specified dates were included in the study. The embryo grade, ET day, distance between the fundus to embryo transfer site measured via ultrasonography, endometrial thickness on ET day, and presence of mucus and blood in the catheter after transfer were the variables evaluated. Each one of the five variables that constituted the scoring system were rated separately. RESULTS: Overall, 1652 patients participated in this research. Antral follicle count (13,3 ± 8 vs. 14,6 ± 8,2, p: 0,001), endometrial thickness on the ET day (9.9 ± 2 vs.10.3 ± 2, p = 0.006) and number of mature oocytes (8.6 ± 6 vs. 9 ± 5.1, p: 0.003) were significantly higher in patients with positive Β-HCG values. The total score in the Β-HCG positive group was 9.8 ± 1.4 versus 8.9 ± 1.4 in the Β-HCG negative group (p < 0.001). The best ETSS cut-off value for predicting Β-HCG positivity was 9.5, with 82% sensitivity and 67% specificity (AUC:0.808). CONCLUSION: Our scoring system is an important step toward standardization, as it offers a new, practical, cost-free, and applicable scoring system based on pre- and post-ET measurements and laboratory data.

Association of raised serum progesterone level with ovulation trigger and histology of endometrium in stimulated cycles

Abstract This was a forthcoming study of those patients, who undergo in-vitro fertilization (IVF) and freeze-all embryo, who acquiesce for the study. The number of participated patients (n=350) in this study, underwent for IVF. The blood sample was collected from patients to evaluate the level of serum progesterone in vacuum vials on the day of ovulation trigger. After 36 hrs of ovulation trigger, ovum picked up was done. Quantitative methods were used to estimate the level of serum progesterone through the electrochemiluminescence immunoassay and correlation of serum progesterone with embryo transfer (ET) outcomes. Main outcome of this current study was to evaluate the value of mean serum progesterone level i.e.0.868± 0.712 ng/ml and 0.88±0.723 ng/ml was found in case of pregnancy positive and negative respectively, at p=0.216 value. In antagonist (n=40) and agonist (n=310) cases, it was 8(20%) and 37(11.94%) PL occurrence was noted at p=0.143 respectively. An overall value of the premature lutenization (PL) occurrences was 13.63% and 15.25% observed in both positive and negative cases of pregnancy at p=0.216 respectively. This study concluded that 12.66% of PL occurrences were recorded in the case of IVF. Study results proved, there were no significant effect of PL on pregnancy outcomes.

Medical Devices; Obstetrical and Gynecological Devices; Classification of the Intravaginal Culture System. Final order.

The Food and Drug Administration (FDA) is classifying the intravaginal culture system into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the intravaginal culture system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Criopreservación embrionaria: del protocolo lento a la vitrificación / Embryo criopreservation: from slow freezing to vitrification

Objetivo: Comparamos los resultados de criopreservación embrionaria en dos grupos de pacientes cuyos embriones habían sido criopreservados bien con protocolo lento (PL) o bien con vitrificación (V), valorando la tasa de supervivencia embrionaria, número de transferencias y número de embriones por transfer, así como la tasa de gestación y estadio de división, y la tasa de gestación acumulada, con el objetivo de determinar qué protocolo era el más eficaz. Posteriormente se analizaron los resultados dividiendo la población en tres grupos según la procedencia de los embriones para valorar la posibilidad de diferir la transferencia embrionaria en los casos de riesgo de Sdr. de Hiperestimulación ovárica, y su efecto en los resultados. Los grupos fueron: a) Sobrantes: Transferencias con embriones criopreservados, tras haber efectuado un primer transfer de embriones en fresco en un ciclo de FIV-ICSI. b) RSHO: Pacientes en las que se criopreservó toda la cohorte embrionaria por presentar RSHO, realizando la transferencia embrionaria en un segundo tiempo. En estas pacientes la inducción de la ovulación tuvo lugar con la administración de LHr. c) RSHO- GnRHag: En este grupo la estimulación de la ovulación se realizó en un ciclo con protocolo antagonista, presentando las pacientes RSHO, por lo que se inducía la ovulación con análogos agonistas de la GnRH (GnRHag), criopreservando todos los embriones y difiriendo la transferencia a un segundo tiempo. Material y métodos: Se ha realizado un estudio retrospectivo de criopreservación embrionaria, en un total de 1391 ciclos de 1193 pacientes estériles sometidas a FIV/ICSI, que acudieron a la Unidad de Reproducción Humana del Hospital Universitario de Canarias, desde el año 2001 al 2011 con un total de 4634 embriones. Se criopreservaron con PL: 2326 embriones en 614 ciclos de 590 pacientes y con V: 2308 embriones en 777 ciclos de 603 pacientes. Resultados: La supervivencia embrionaria en la V fue del 76,2% frente al 31,3% del PL, (p<0,001), con incremento de transferencias (94,9% vs 52,1%), embriones transferidos por paciente (2±0,5 vs 1±1), gestación por ciclo (20,6% vs 6,5%), y por transfer (21,7% vs 12,5%) con la vitrificación (p<0,001). Respecto al día en que se efectúo la vitrificación, no encontramos diferencias entre el día +2 o +3 post-punción en ninguno de los parámetros estudiados. La tasa de gestación en las transferencias de pacientes con RSHO (24,6% en el grupo de inducción con GnRH-ag y del 20,3% en el de inducción con LH), es superior a la obtenida en los transfer de embriones sobrantes del 12%. (p<0,001). Conclusiones: La vitrificación embrionaria presenta mejores resultados que el protocolo lento en cuanto a tasa de supervivencia embrionaria, número de transferencias por ciclo iniciado y número de embriones transferidos por paciente, con un incremento en la tasa de gestación. Los resultados de la vitrificación son independientes del día postpunción +2 ó +3, en que se realice. La vitrificación permite congelar embriones en casos de RSHO sin que ello conlleve una disminución en los resultados de FIV/ICSI (AU)

Objective: We compare results of embryo cryopreservation in two groups of patients, with slow cooling protocol (SP) or vitrification method (V), we evaluated embryo survival rate, number of embryos transferred and number of embryos per transfer, also pregnancy rate, division stage and cumulative pregnancy rate, with the purpose of establish the more efficient protocol. Secondly we analyzed results dividing our population in three groups in order to establish the option of differing embryo transfer in cases of hiperstimulation risk (HHS). Our groups were: a) exceeding embryos cryopreserved after fresh embryo transfer in cycle IVF-ICSI. b) HHS: patients with all cohort of embryos cryopreserved to prevent HHS, doing transfer in a second time. Those patients had ovulation induction with rLH administration. c) HHS-GnRHag: in this group ovulation stimulation was made with antagonists, and ovulation induction developed with agonist analogs of GnRH, cryopreserving all embryo cohort for being transferred in a second time. Methods:A retrospective study was made of embryo cryopreservation in a total of 1391 embryos from 1193 sterile patients submitted to IVF/ICSI treatment in our Human Reproduction Unit at the Canary University Hospital since 2001 to 2011 with a total of 4634 embryos. 2326 embryos were cryopreserved with the cooling protocol, in 614 cycles from 590 patients and 2308 embryos were vitrified in 777 cycles from 603 patients. Results: Survival rate of V was 76.2 % vs. 31.3 % in SP (p<0.001), with an increase of transfers (94.9 % vs. 52.1 %), more embryos transferred per patient (2+0,5 vs. 1+1), more pregnancy rate per cycle (20.6% vs. 6.5%), and per transfer (21.7% vs. 12.5%) with vitrification (p<0.001). Regarding the vitrification day we found no differences between day +2 and +3 post punction in none of the studied parameters. Pregnancy rate in patients with HHS risk is higher than the obtained in the group a): (24.6 % in the GnRH-ag group and 20.3% in the HHS LH inducted group, vs. 12% in the exceeding embryos group; p<0.001). Conclusions: Embryo vitrification presents better results than the slow cooling protocol in embryo survival rate, embryo transfers per cycle, number of embryos transferred per patient, with an increase in pregnancy rate. Those results are independent of day of cryopreservation +2 or +3. Vitrification allows cryopreserve embryos in cases of HHS with no reducing results in pregnancy after IVF/ICSI cycle (AU)

Medical devices; obstetrical and gynecological devices; classification of the assisted reproduction laser system. Final rule.

The Food and Drug Administration (FDA) is classifying the assisted reproduction laser system into class II (special controls). The special control that will apply to the device is the guidance document entitled "Class II Special Controls Guidance Document: Assisted Reproduction Laser Systems." The agency is classifying this device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. Elsewhere in this issue of the Federal Register, FDA is publishing a notice of availability of the guidance document that is the special control for this device.

Equity in the use of IVF in Finland in the late 1990s.

AIMS: The purpose of this study was to describe equity in the use of in vitro fertilization (IVF; including micro-injections and frozen-embryo transfers), and compare its use with that of other assisted reproduction technologies (other ARTs; including ovulation inductions with or without inseminations). METHODS: The women who received IVF (n=9, 175) and other ARTs (n=10,254) between 1996 and 1998 were identified from the reimbursement records of the Social Insurance Institution (SII) covering all Finns. Population controls, matched by age and municipality, were selected for IVF women (n=9,175). Information concerning background characteristics came from the Central Population Register and the SII's reimbursement files. The sector (public vs. private) was defined using prescribing physicians' codes. IVF use was studied by the proportions of women treated and the frequency of treatment. RESULTS: The age-standardized IVF incidence per thousand 20-to-49-year-old women was 8.8 in urban and 7.3 in rural areas, but the use of other ARTs did not vary correspondingly (9.2, 9.3). The regional incidence of IVF and other ARTs varied considerably. In the private sector, women in the highest socioeconomic position were over-represented (29% private, 18% public, 16% controls). During the mean 1.5 years of the study period, the IVF women had somewhat more treatment cycles in the private than in the public sector (mean 3.3, 2.7), and those in the highest socioeconomic position had more cycles than others (3.5, 3.2); the frequency was not age-dependent. In the public sector the number of cycles did not differ by socioeconomic group (mean 2.7-2.8 per woman), and women aged 25 to 39 had more cycles than others. CONCLUSION: There were socioeconomic differences in use of IVF services, but they were small because of the equitable use of public services.

Efecto del tabaco sobre los resultados de un programa de fecundación in vitro / Effect of tobacco on the results of an in vitro fertilization program

Objetivo: Comprobar si existen diferencias dependientes del hábito de fumar en los resultados de nuestro programa de fecundación in vitro. Pacientes y método: Realizamos un análisis retrospectivo de 1.041 pacientes incluidas en un programa de fecundación in vitro desde el año 1998 hasta el 2001, las cuales se dividieron en tres grupos de 614 mujeres no fumadoras, 308 fumadoras de menos de 15 cigarrillos por día y 119 fumadoras de más de esta cantidad. Resultados: La tasa de implantación y de embarazos fue similar en los tres grupos de pacientes. Las muy fumadoras necesitaron más dosis de hormona foliculoestimulante para llegar a un desarrollo folicular adecuado y alcanzaron niveles menores de estradiol al final del ciclo (p < 0,05). Las no fumadoras obtuvieron un mayor número de folículos maduros y de ovocitos que las fumadoras (p < 0,05). Conclusión: Aunque la consecución del embarazo no se afecta por el hecho de fumar, otros parámetros, como el desarrollo folicular, el nivel de estradiol o el número de ovocitos recuperados, disminuyen con el consumo de tabaco. (AU)