ObjectiveThe culture of embryos has been approached by two culture protocols. The two-step protocol is thought to mimic the physiological interaction between specific developmental stages of the embryo within the oviduct and uterus. The opposing system in based on the ‘let the embryo choose’ principal that is analogous to a single-step culture medium. By culturing sibling oocytes in both media under the same culture conditions, we compared both groups with respect to outcome and implantation.DesignRetrospective analysis.MATERIALS AND METHODSA single-step medium (GLOBAL, IVFonline, Guilford, CT) was compared to a two-step media from SAGE (Trumbull, CT). Embryo culture was performed as group culture in 4-well dishes under oil and 5% oxygen. On day-1, following 2pn-check, sibling zygote cohorts from 181 patients (average age of 33.5±4.5) were randomly allocated into the SAGE or GLOBAL culture media. 953 embryos were cultured in the SAGE, whereas 1049 embryos were cultured in GLOBAL. 58 transfers from the SAGE system were compared to 123 transfers from the GLOBAL system. Clinical pregnancies showing FCA activity as determined by ultrasound. Chi square test was used for statistical analysis.RESULTSFrom both culture systems an average of 1.6±0.5 embryos were transferred. Almost 70% of the transfers (123/181) had embryos selected from the GLOBAL culture system. Overall, the total number of embryos cryopreserved and transferred was significantly higher in the GLOBAL group (57.3%; 601/1049; P<.04) compared to the SAGE group (47.6%; 454/953). Clinical pregnancy was slightly, but not significantly higher in SAGE (58.6%; 34/58; P<.92) than in GLOBAL (56.1%; 69/123). Furthermore, implantation was marginal, but not significant higher in SAGE (46.1%; 42/91; P<.75) compared to GLOBAL (42%; 82/196).CONCLUSIONThis trial demonstrates that embryos selected from a single-step media provide the same potential in achieving good clinical pregnancy and implantation rates compared to their sibling embryos cultured in a two-step media. ObjectiveThe culture of embryos has been approached by two culture protocols. The two-step protocol is thought to mimic the physiological interaction between specific developmental stages of the embryo within the oviduct and uterus. The opposing system in based on the ‘let the embryo choose’ principal that is analogous to a single-step culture medium. By culturing sibling oocytes in both media under the same culture conditions, we compared both groups with respect to outcome and implantation. The culture of embryos has been approached by two culture protocols. The two-step protocol is thought to mimic the physiological interaction between specific developmental stages of the embryo within the oviduct and uterus. The opposing system in based on the ‘let the embryo choose’ principal that is analogous to a single-step culture medium. By culturing sibling oocytes in both media under the same culture conditions, we compared both groups with respect to outcome and implantation. DesignRetrospective analysis. Retrospective analysis. MATERIALS AND METHODSA single-step medium (GLOBAL, IVFonline, Guilford, CT) was compared to a two-step media from SAGE (Trumbull, CT). Embryo culture was performed as group culture in 4-well dishes under oil and 5% oxygen. On day-1, following 2pn-check, sibling zygote cohorts from 181 patients (average age of 33.5±4.5) were randomly allocated into the SAGE or GLOBAL culture media. 953 embryos were cultured in the SAGE, whereas 1049 embryos were cultured in GLOBAL. 58 transfers from the SAGE system were compared to 123 transfers from the GLOBAL system. Clinical pregnancies showing FCA activity as determined by ultrasound. Chi square test was used for statistical analysis. A single-step medium (GLOBAL, IVFonline, Guilford, CT) was compared to a two-step media from SAGE (Trumbull, CT). Embryo culture was performed as group culture in 4-well dishes under oil and 5% oxygen. On day-1, following 2pn-check, sibling zygote cohorts from 181 patients (average age of 33.5±4.5) were randomly allocated into the SAGE or GLOBAL culture media. 953 embryos were cultured in the SAGE, whereas 1049 embryos were cultured in GLOBAL. 58 transfers from the SAGE system were compared to 123 transfers from the GLOBAL system. Clinical pregnancies showing FCA activity as determined by ultrasound. Chi square test was used for statistical analysis. RESULTSFrom both culture systems an average of 1.6±0.5 embryos were transferred. Almost 70% of the transfers (123/181) had embryos selected from the GLOBAL culture system. Overall, the total number of embryos cryopreserved and transferred was significantly higher in the GLOBAL group (57.3%; 601/1049; P<.04) compared to the SAGE group (47.6%; 454/953). Clinical pregnancy was slightly, but not significantly higher in SAGE (58.6%; 34/58; P<.92) than in GLOBAL (56.1%; 69/123). Furthermore, implantation was marginal, but not significant higher in SAGE (46.1%; 42/91; P<.75) compared to GLOBAL (42%; 82/196). From both culture systems an average of 1.6±0.5 embryos were transferred. Almost 70% of the transfers (123/181) had embryos selected from the GLOBAL culture system. Overall, the total number of embryos cryopreserved and transferred was significantly higher in the GLOBAL group (57.3%; 601/1049; P<.04) compared to the SAGE group (47.6%; 454/953). Clinical pregnancy was slightly, but not significantly higher in SAGE (58.6%; 34/58; P<.92) than in GLOBAL (56.1%; 69/123). Furthermore, implantation was marginal, but not significant higher in SAGE (46.1%; 42/91; P<.75) compared to GLOBAL (42%; 82/196). CONCLUSIONThis trial demonstrates that embryos selected from a single-step media provide the same potential in achieving good clinical pregnancy and implantation rates compared to their sibling embryos cultured in a two-step media. This trial demonstrates that embryos selected from a single-step media provide the same potential in achieving good clinical pregnancy and implantation rates compared to their sibling embryos cultured in a two-step media.

Today, vitrification of human blastocysts provides an excellent outcome. However, often there is a difference in outcome between day 5 and day 6 vitrified blastocysts. Day 6 blastocysts might have less ability to get sufficiently dehydrated prior to the vitrification steps. By collapsing the blastocoele prior to the vitrification procedure, it would allow sufficient dehydration of these cells and improve their implantation potential. Therefore, we evaluated the effectiveness of artificially collapsing day 6 blastocysts vitrified without artificial collapse to those that were artificially collapsed. Retrospective analysis. A total of 627 frozen embryo transfers (FET; patient average age 35.4±4.9) using day 6 blastocysts without artificial collapse (group A) were analyzed. Group B contained a total of 65 FET (patient average age 35.4±5.2) with artificially collapsed day 6 blastocysts. Prior to vitrification, the junction between two trophectoderm cells in the blastocyst was located and one laser shot at 100% power with a 500ms pulse (Hamilton Thorne) was released. For vitrification, the High Security Vitrification Kit (CryoBioSystem, France) was used as a closed carrier, with a mixture of 15% Ethylene Glycol/Dimethyl Sulfoxide (v/v)+0.5M sucrose. Statistical significance was evaluated by Chi-Square. Group A and B didn't show any statistical significance for the average number of embryos transferred (1.8 vs. 1.7) and survival rate (98.1 vs. 98.7%). There was a significant increase in the clinical pregnancy and implantation rate in group B compared with group A (57.5% vs. 39.9%; P<.001; and 44.6% vs. 28.4%; P<.001). The overall ongoing pregnancy was significant higher in group B compared with group A (51.7% vs. 35.1%; P<.001). Our data clearly reveals the benefit of artificial collapse of day 6 blastocysts prior to the steps of vitrification by improving their probability of increased pregnancy rate and implantation potential.

OBJECTIVE: To compare pregnancy outcomes in donor oocyte cycles with vaginal progesterone (Endometrin) vs. intramuscular progesterone in oil for luteal phase support. DESIGN: Retrospective analysis of donor oocyte cycles at a large IVF program. MATERIALS AND METHODS: From June 2007 to December 2008, over 100 donor oocytes cycles were identified using Endometrin (Ferring) vaginal progesterone or intramuscular progesterone in oil (PIO). Donor oocyte stimulation cycles, controlled endometrial preparation for recipients, and standard laboratory protocols were followed. Clinical pregnancy was defined as a gestational sac on ultrasound. Kruskal-Wallis, Mann-Whitney and chi-square tests were used as appropriate. Logistic regression was performed on clinical pregnancy after controlling for age and number of embryos transferred. P values < 0.05 were considered significant. Means are presented as mean ± SD. RESULTS: A total of 106 cycles were included in the analysis. Although age and the number of embryos transferred were significantly higher in the Endometrin group compared to the PIO group, these differences are not clinically significant. There was no statistically significant difference between the groups with respect to clinical pregnancy rate. The final logistic regression model did not include any of the independent variables, indicating that no statistically significant differences were found between the groups even after controlling for age and the number of embryos transferred.Tabled 1Endometrin n=45PIO n=61P-valueAge (mean)42.7 ± 3.339.6 ± 4.60.001Number of embryos transferred (mean)2.3 ± 0.72.0 ± 0.40.011Clinical pregnancy rate24/45 (53.3%)38/61 (62.3%)0.36 Open table in a new tab CONCLUSIONS: In donor oocyte cycles, luteal phase support with Endometrin appears to have similar clinical pregnancy outcomes when compared to progesterone in oil. Endometrin provides a valuable alternate progesterone vaginal preparation thus avoiding intramuscular injections for the patient.

ObjectiveTo evaluate the effect of adding LH (as hMG) in younger versus older IVF patients using a GnRH agonist protocol.DesignRetrospective analysis comparing all patients undergoing assisted reproduction using GnRH agonist protocols treated in a group practice with a single IVF laboratory from 2001 to 2003.Materials and methodsA total of 2596 fresh, nondonor IVF cycles were available for analysis, which included a broad spectrum of patients presenting for advance reproductive technologies. Down-regulation with GnRH agonist protocols were employed with the administration of recombinant FSH (recFSH) (either Follitropin-alpha, Serono, Inc, Rockland, MA, or Follitropin-beta, Organon, West Orange, NJ) or recFSH supplemented with hMG in a large cohort of younger (<35 years old) versus older patients (>35 years old). Final follicular maturation was achieved with either urinary (10,000 IU im) or recombinant hCG (250 ug sc) when 2 or more lead follicles with a minimum mean diameter of 20 mm was attained. Oocyte retrieval was performed 35 hours after hCG injection. Standard laboratory protocols were followed, including intracytoplasmic sperm injection, assisted hatching for cleavage embryos, and extended culture for blastocyst transfer, as clinically appropriate. Ultrasound guided embryo transfer was performed and all patients received luteal progesterone support. Serum hCG levels were measured 15 days after retrieval, and a clinical pregnancy was defined as the presence of a gestational sac on ultrasound. The main outcome measures were oocytes retrieved and pregnancy rates for patients treated with recFSH alone versus recFSH with hMG. Data were analyzed by two-way ANOVA and Chi Square tests with significance at p<0.05. Data are expressed as mean ± SD or percentages (%).ResultsThe pure recFSH protocols resulted in a lesser number of ampules used, an increase of 1.6 additional oocytes retrieved, and a 7–9% higher clinical pregnancy rates as compared to the combination protocols. The number of embryos transferred was comparable. As expected the number of oocytes obtained and pregnancy rates declined with increasing age. However, the difference between recFSH alone and recFSH with hMG were consistent across age groups.Conclusion ObjectiveTo evaluate the effect of adding LH (as hMG) in younger versus older IVF patients using a GnRH agonist protocol. To evaluate the effect of adding LH (as hMG) in younger versus older IVF patients using a GnRH agonist protocol. DesignRetrospective analysis comparing all patients undergoing assisted reproduction using GnRH agonist protocols treated in a group practice with a single IVF laboratory from 2001 to 2003. Retrospective analysis comparing all patients undergoing assisted reproduction using GnRH agonist protocols treated in a group practice with a single IVF laboratory from 2001 to 2003. Materials and methodsA total of 2596 fresh, nondonor IVF cycles were available for analysis, which included a broad spectrum of patients presenting for advance reproductive technologies. Down-regulation with GnRH agonist protocols were employed with the administration of recombinant FSH (recFSH) (either Follitropin-alpha, Serono, Inc, Rockland, MA, or Follitropin-beta, Organon, West Orange, NJ) or recFSH supplemented with hMG in a large cohort of younger (<35 years old) versus older patients (>35 years old). Final follicular maturation was achieved with either urinary (10,000 IU im) or recombinant hCG (250 ug sc) when 2 or more lead follicles with a minimum mean diameter of 20 mm was attained. Oocyte retrieval was performed 35 hours after hCG injection. Standard laboratory protocols were followed, including intracytoplasmic sperm injection, assisted hatching for cleavage embryos, and extended culture for blastocyst transfer, as clinically appropriate. Ultrasound guided embryo transfer was performed and all patients received luteal progesterone support. Serum hCG levels were measured 15 days after retrieval, and a clinical pregnancy was defined as the presence of a gestational sac on ultrasound. The main outcome measures were oocytes retrieved and pregnancy rates for patients treated with recFSH alone versus recFSH with hMG. Data were analyzed by two-way ANOVA and Chi Square tests with significance at p<0.05. Data are expressed as mean ± SD or percentages (%). A total of 2596 fresh, nondonor IVF cycles were available for analysis, which included a broad spectrum of patients presenting for advance reproductive technologies. Down-regulation with GnRH agonist protocols were employed with the administration of recombinant FSH (recFSH) (either Follitropin-alpha, Serono, Inc, Rockland, MA, or Follitropin-beta, Organon, West Orange, NJ) or recFSH supplemented with hMG in a large cohort of younger (<35 years old) versus older patients (>35 years old). Final follicular maturation was achieved with either urinary (10,000 IU im) or recombinant hCG (250 ug sc) when 2 or more lead follicles with a minimum mean diameter of 20 mm was attained. Oocyte retrieval was performed 35 hours after hCG injection. Standard laboratory protocols were followed, including intracytoplasmic sperm injection, assisted hatching for cleavage embryos, and extended culture for blastocyst transfer, as clinically appropriate. Ultrasound guided embryo transfer was performed and all patients received luteal progesterone support. Serum hCG levels were measured 15 days after retrieval, and a clinical pregnancy was defined as the presence of a gestational sac on ultrasound. The main outcome measures were oocytes retrieved and pregnancy rates for patients treated with recFSH alone versus recFSH with hMG. Data were analyzed by two-way ANOVA and Chi Square tests with significance at p<0.05. Data are expressed as mean ± SD or percentages (%). ResultsThe pure recFSH protocols resulted in a lesser number of ampules used, an increase of 1.6 additional oocytes retrieved, and a 7–9% higher clinical pregnancy rates as compared to the combination protocols. The number of embryos transferred was comparable. As expected the number of oocytes obtained and pregnancy rates declined with increasing age. However, the difference between recFSH alone and recFSH with hMG were consistent across age groups. The pure recFSH protocols resulted in a lesser number of ampules used, an increase of 1.6 additional oocytes retrieved, and a 7–9% higher clinical pregnancy rates as compared to the combination protocols. The number of embryos transferred was comparable. As expected the number of oocytes obtained and pregnancy rates declined with increasing age. However, the difference between recFSH alone and recFSH with hMG were consistent across age groups. Conclusion

ObjectiveTo evaluate the clinical outcomes of recombinant hCG (rhCG) 250ug and urinary hCG (uhCG) 10,000 IU in assisted reproductive technology.DesignRetrospective analysis comparing all patients undergoing IVF from 2001 to 2003 using rhCG with patients using uhCG for final follicular maturation.Materials and methodsA total of 3649 fresh, nondonor IVF cycles were available for analysis. This database encompassed a broad spectrum of patients representing typical infertility patients presenting for assisted reproduction. The patients ranged in age from 21–44 and underwent controlled ovarian hyperstimulation by standard midluteal phase GnRH agonist down regulation or GnRH antagonist protocol using recombinant FSH or in combination with HMG. Adjustments were made based on individual responses, and when two or more follicles had attained a minimum mean diameter of 20 mm, follicular triggering was achieved with either Ovidrel (rhCG) 250 ug sc or urinary hCG (uhCG) 10,000 IU im. Oocyte retrieval was performed 35 hours after hCG injection. Standard laboratory protocols were followed, including intracytoplasmic sperm injection, assisted hatching for cleavage embryos and extended culture for blastocyst transfer, as clinically appropriate. Ultrasound guided embryo transfer was perfomed, and all patients received luteal progesterone support. Serum hCG levels were measured 15 days after retrieval, and a clinical pregnancy was defined as the presence of a gestational sac on ultrasound. Data were analyzed by chi square, Student’s group t test and ANOVA as appropriate. A value of P <0.05 was considered to be statistically significant. Results are expressed as mean ± SD.ResultsThe patient characteristics were similar in the two groups with respect to age and prior IVF cycles. All other parameters evaluated demonstrated no significant differences. The number of oocytes retrieved and clinical pregnancy rates were comparable with recombinant and urinary hCG.Conclusion ObjectiveTo evaluate the clinical outcomes of recombinant hCG (rhCG) 250ug and urinary hCG (uhCG) 10,000 IU in assisted reproductive technology. To evaluate the clinical outcomes of recombinant hCG (rhCG) 250ug and urinary hCG (uhCG) 10,000 IU in assisted reproductive technology. DesignRetrospective analysis comparing all patients undergoing IVF from 2001 to 2003 using rhCG with patients using uhCG for final follicular maturation. Retrospective analysis comparing all patients undergoing IVF from 2001 to 2003 using rhCG with patients using uhCG for final follicular maturation. Materials and methodsA total of 3649 fresh, nondonor IVF cycles were available for analysis. This database encompassed a broad spectrum of patients representing typical infertility patients presenting for assisted reproduction. The patients ranged in age from 21–44 and underwent controlled ovarian hyperstimulation by standard midluteal phase GnRH agonist down regulation or GnRH antagonist protocol using recombinant FSH or in combination with HMG. Adjustments were made based on individual responses, and when two or more follicles had attained a minimum mean diameter of 20 mm, follicular triggering was achieved with either Ovidrel (rhCG) 250 ug sc or urinary hCG (uhCG) 10,000 IU im. Oocyte retrieval was performed 35 hours after hCG injection. Standard laboratory protocols were followed, including intracytoplasmic sperm injection, assisted hatching for cleavage embryos and extended culture for blastocyst transfer, as clinically appropriate. Ultrasound guided embryo transfer was perfomed, and all patients received luteal progesterone support. Serum hCG levels were measured 15 days after retrieval, and a clinical pregnancy was defined as the presence of a gestational sac on ultrasound. Data were analyzed by chi square, Student’s group t test and ANOVA as appropriate. A value of P <0.05 was considered to be statistically significant. Results are expressed as mean ± SD. A total of 3649 fresh, nondonor IVF cycles were available for analysis. This database encompassed a broad spectrum of patients representing typical infertility patients presenting for assisted reproduction. The patients ranged in age from 21–44 and underwent controlled ovarian hyperstimulation by standard midluteal phase GnRH agonist down regulation or GnRH antagonist protocol using recombinant FSH or in combination with HMG. Adjustments were made based on individual responses, and when two or more follicles had attained a minimum mean diameter of 20 mm, follicular triggering was achieved with either Ovidrel (rhCG) 250 ug sc or urinary hCG (uhCG) 10,000 IU im. Oocyte retrieval was performed 35 hours after hCG injection. Standard laboratory protocols were followed, including intracytoplasmic sperm injection, assisted hatching for cleavage embryos and extended culture for blastocyst transfer, as clinically appropriate. Ultrasound guided embryo transfer was perfomed, and all patients received luteal progesterone support. Serum hCG levels were measured 15 days after retrieval, and a clinical pregnancy was defined as the presence of a gestational sac on ultrasound. Data were analyzed by chi square, Student’s group t test and ANOVA as appropriate. A value of P <0.05 was considered to be statistically significant. Results are expressed as mean ± SD. ResultsThe patient characteristics were similar in the two groups with respect to age and prior IVF cycles. All other parameters evaluated demonstrated no significant differences. The number of oocytes retrieved and clinical pregnancy rates were comparable with recombinant and urinary hCG. The patient characteristics were similar in the two groups with respect to age and prior IVF cycles. All other parameters evaluated demonstrated no significant differences. The number of oocytes retrieved and clinical pregnancy rates were comparable with recombinant and urinary hCG. Conclusion