To evaluate day 5, day 6 and total blastocyst formation rates in IVF and ICSI cycles occurring over a 16 year period. A retrospective analysis of blastocyst formation from 6115 cycles beginning January 1, 1998 through December 31, 2013. Embryos were cultured in Vitrolife (1998 to 2008), Sage (2008 to 2011) sequential media and Irvine continuous culture media (2012 to 2013). Extended culture was implemented in all patients undergoing IVF. Rates of Blastocyst Formation.Tabled 1YearCyclesDay 5 BlastDay 6 BlastTotal BlastTotal IVF1998-200039250.8%7.8%58.6%2001-200344850.0%14.6%64.6%2004-200640856.8%9.9%66.7%2007-200932255.1%12.8%67.9%2010-201328664.7%8.5%73.1%Total ICSI1998-200067742.9%7.1%50.1%2001-200363840.4%13.4%53.8%2004-200674454.3%9.4%63.8%2007-200968549.4%12.5%61.9%2010-201389252.4%6.9%62.0%IVF <351998-200021752.5%8.5%61.0%2001-200324954.0%14.8%68.7%2004-200622260.3%10.1%70.5%2007-200918860.8%13.0%73.8%2010-201313266.9%8.2%75.1%ICSI <351998-200040044.8%8.1%52.9%2001-200334743.6%15.0%58.6%2004-200638559.3%9.4%68.8%2007-200935752.9%13.2%66.1%2010-201340255.0%10.3%65.3%IVF 35-371998-20009551.0%6.3%57.3%2001-20039846.9%15.8%62.7%2004-20069958.8%10.8%69.5%2007-20097147.0%12.8%59.8%2010-20136972.4%8.6%81.0%IVF 35-371998-200014941.1%5.9%47.0%2001-200311139.8%15.3%55.1%2004-200617849.4%11.5%60.9%2007-200914648.7%12.3%60.9%2010-201318251.5%9.2%60.7%IVF 38-401998-20006447.3%8.5%55.8%2001-20037441.0%12.3%53.3%2004-20065248.5%10.6%59.0%2007-20093948.2%12.3%60.6%2010-20135351.5%9.0%60.5%ICSI 38-401998-20009238.7%5.3%44.0%2001-200311833.1%8.9%42.0%2004-200611150.0%6.2%56.2%2007-200910541.6%11.9%53.5%2010-201316747.7%7.9%55.6%IVF >401998-20001533.3%4.3%37.7%2001-20032739.6%12.2%51.8%2004-20063527.9%4.6%72.1%2007-20092434.9%11.9%46.8%2010-20132756.4%9.2%65.6%ICSI >401998-20003634.8%3.5%38.4%2001-20036230.0%5.2%35.3%2004-20067028.1%6.8%34.8%2007-20097732.4%7.4%39.8%2010-201314244.2%8.2%52.3%IVF Donor1998-20009760.1%7.3%67.4%2001-20037959.0%12.9%71.9%2004-20065455.6%13.1%68.7%2007-20093766.7%14.1%80.7%2010-20132279.4%6.9%86.3%ICSI Donor1998-20008056.3%8.7%64.9%2001-20037056.2%12.1%68.3%2004-20066351.1%13.0%64.1%2007-20095459.1%14.3%73.5%2010-20136771.8%7.8%79.6% Open table in a new tab This data suggest, although rates of blastocyst formation are reduced with advanced reproductive age, acceptable rates of blastocyst formation can be observed for all patients. A decrease in blastulation can be observed for all ICSI cycles versus traditional insemination. Rates of blastocyst formation were observed to increase over time.

An unplanned intensive care unit admission within 24 hours of a procedure with an anaesthetist in attendance (UIA) is a recommended clinical indicator. It is designed to identify preventable iatrogenic complications. Often understood as a specific anaesthetic outcome, its value has been repeatedly questioned. Iatrogenic complications however, often result from successive mishaps. In the specific context of an UIA these complications can be related both to anaesthesia and surgery. UIA is therefore probably more a global indicator of the safety of surgical care (anaesthetic and surgical) rather than a specific anaesthetic outcome. Its utility as such is however unknown. The purpose of this study was to assess the value of UIA as a global measure of avoidable iatrogenic complications in surgical patients. Using computerised patient records and medical charts, all patients with an UIA over a study period of five years were identified. The proportion, cause and preventability of iatrogenic complications amongst these patients were assessed. A total of 188 UIA patients were identified by peer reviewers. Of these, 87% to 92% had a complication caused by anaesthesia and/or surgery. Anaesthesia was found to be responsible for 24% to 31% of iatrogenic complications. All other cases related to the combination of anaesthesia and surgery or surgery alone. Of these, 74% to 92% of complications were found to be preventable. Despite intrinsic limitations of the retrospective chart review method, UIA can be considered as a valuable tool to detect avoidable iatrogenic complications related to both surgical and anaesthetic care.

assisted hatching.Clinical pregnancy was identified by the appearance of gestational sac.RESULTS: Totally 855 (group A: 286, group B: 408, and group C: 161) immature oocytes were retrieved and used for analysis.Number of retrieved immature oocytes per cycle in group A (10.2 Ϯ 7.2) was significantly lower (PϽ0.01)than either group B (15.7 Ϯ 8.1) or group C (13.4 Ϯ 10.0).However, there were no significant differences in either maturation rates (48.9%,47.3% and 41.0%) or fertilization rates (81.4%, 87.6% and 83.3%) among group A, B and C, respectively.The rates of embryo transfer per retrieval were similar in group A (64.3%), B (80.8%) and C (66.7%).The pregnancy rates were highest in group C (50%), second in group B (26.7%) and lowest in group A (22.2%).CONCLUSION: Either Metformin alone or low dose FSH combined with Metformin pretreatment increased the number of immature oocyte retrieved.Combination of Metformin pretreatment with low dose FSH achieved highest pregnancy rate per transfer (50%) and second highest was Metformin pretreatment alone (26.7%).The pregnancy rate of IVM-IVF without any pretreatment was the lowest (22.2%).The present study suggests that pretreatment of PCOS patients with not only Metformin but also low dose FSH combined with Metformin enhances the clinical outcomes of IVM-IVF treatment.

The objective of this study was to evaluate the rates of maturation of germinal vesicle and metaphase I oocytes in G1 version 2 and G1 version 3. A retrospective analysis of 1256 immature oocytes cultured for 56 to 58 hours post hCG administration in either G1 version 2 from January 1, 2001 to January 19, 2002 or in G1 version 3 from November 20, 2002 to March 31, 2004. Patients underwent Antagon® (Organon) or Cetrotide® (Serono) antagonist protocols, Lupron® (TAP) agonist protocols, or flare protocols prior to controlled ovarian hyper-stimulation with Follistim® (Organon) or Gonal-F® (Serono). Oocyte retrieval occurred 36-39 hours post Human Chorionic Gonadotropin (hCG) administration. Intracytoplasmic sperm injection (ICSI) was performed 38-42 hours post hCG. Oocytes were individually placed in 50-100μl micro-drops of sequential media (G1.2, G1.3, IVF Science, Vitrolife) under oil (Squibb, Sigma) and cultured overnight. Degree of maturation was evaluated 16-18 hours after ICSI was performed. If applicable, maturation ICSI was performed on metaphase II oocytes and evaluated for fertilization the following day. See tables. Tabled 1 Tabled 1 Tabled 1 These findings suggest the ability of maturing cumulus free oocytes in culture in both G1 version 2 and G1 version 3. Similar numbers have been reported by N. Cekleniak (Fertility and Sterility, Vol. 75, No. 6, June 2001) where 59.7% of GV and MI oocytes reached MII stage by 24 hours when cultured in P1-S (Irvine Scientific). Of those GV/MI oocytes that reach metaphase II and were injected, 29.1% fertilized. Although fertilization can be achieved from these immature oocytes, only 7.1% of maturation ICSI 2PN oocytes reached blastocyst and were either transferred or cryopreserved.

We aimed to compare the outcome of ovarian stimulation protocols using GnRH antagonist to those incorporating GnRH agonist in IVF or ICSI, non-donor fresh blastocyst transfer cycles. Retrospective comparison of GnRH antagonist IVF or ICSI cycles to GnRH agonist cycles from a university-affiliated private ART program. Cycles were included only if they resulted in blastocyst transfer. A total of 750 IVF and 1288 ICSI, fresh non-donor blastocyst transfer cycles were included. Patients on GnRH agonists received daily leuprolide acetate injections using either long luteal phase or flare protocols. Patients on GnRH antagonist received cetrorelix acetate 3 mg administered 4 days before the start of FSH stimulation for synchronization of the antral follicle cohort and a repeat dose was given when a lead follicular diameter of 13-14 mm was reached. Embryo Progression Index (EPI) was calculated from the area under the curve of numerical conversion of the available embryo progression data by trapezoidal integration. Gardner/Schoolcraft blastocyst grades were converted into numerical Blastocyst Quality Scores (BQS). Mean EPI for day 3 and day 5/6 for all blastocysts and mean BQS of developed and transferred embryos were used as separate variables to serve as measures of embryo progression and blastulation. IVF and ICSI cycles were analyzed separately. The comparisons were made by independent t- and chi-square tests where appropriate. The significant predictors of clinical pregnancy were analyzed by logistic regression. Cycle outcomes were summarized in the following table (Table 1.). Cycles with GnRH antagonists had reduced implantation and clinical pregnancy rates although the embryo progression and blastulation parameters were comparable in IVF cycles and were superior in ICSI cycles which employed GnRH antagonists. Evaluation of first treatment cycles did not change these findings. Logistic regression models further supported the negative impact of GnRH antagonist on clinical pregnancy in both IVF and ICSI cycles. Tabled 1 Non-donor IVF or ICSI cycles with fresh blastocyst transfer using GnRH antagonist result in lower implantation and clinical pregnancy rates as compared with GnRH agonist cycles, although the embryo progression and blastulation scores are comparable or superior in GnRH antagonist cycles. These findings suggest potential adverse effects of GnRH antagonist on endometrial receptivity which justifies further investigation.

ObjectiveInsulin is commonly employed in tissue culture techniques to enhance cell growth and development. It has been suggested that the addition of insulin to sequential media may improve blastocyst development. The purpose of the study was to evaluate the rate of production of excellent quality blastocyst resulting from two similar secondary sequential media types (CCM, G2.3, IVF Science, Vitrolife) one of which (CCM, IVF Science, Vitrolife) contains insulin.DesignA retrospective analysis of day 5 excellent quality blastocyst cultured in CCM or G2.3 in IVF cycles occurring between January 1st, 2001 and May 1st, 2003.Materials and methodsPatients underwent Antagon® (Organon) or Cetrotide® (Serono) antagonist protocols, Lupron® (TAP) agonist protocols, or flare protocols prior to controlled ovarian hyper-stimulation with Follistim® (Organon) or Gonal-F® (Serono). Oocyte retrieval occurred 36-39 hours post Human Chorionic Gonadotropin (hCG) administration. Insemination was performed 38-42 hours post hCG using a two hour co-incubation of sperm with oocytes or sperm injection. Oocytes were individually placed in 50-100μl micro-drops of sequential media (G1.2, G1.3, IVF Science, Vitrolife) under oil (Squibb, Sigma) and cultured overnight. Fertilization was evaluated 18-20 hours after insemination. Fertilized oocytes were placed into fresh 50-100μl micro-drops of sequential media (G1.2, G1.3) and cultured in groups of two under oil to Day 3. Multi-cell embryos were moved to new 50-100μl micro-drops of sequential media (CCM, G2.3, IVF Science, Vitrolife) under oil for culture to Day 5. Blastocysts were graded using the system of Gardner and Schoolcraft et al. (Fertility and Sterility, 1999). Excellent quality blastocyst were defined as embryos that had reached at least a full blastocyst stage (≥3) where the blastocoele completely fills the embryo cavity and zona thinning is observed. In addition, inner cell mass (ICM) and trophectoderm grades were considered. Only blastocyst with an ICM grade of "A" (tightly packed, many cells) and a trophectoderm grade of "A" or "B" (many to moderate cells forming a cohesive epithelium) were considered for this analysis.ResultsSee table.ConclusionTabled 1 ObjectiveInsulin is commonly employed in tissue culture techniques to enhance cell growth and development. It has been suggested that the addition of insulin to sequential media may improve blastocyst development. The purpose of the study was to evaluate the rate of production of excellent quality blastocyst resulting from two similar secondary sequential media types (CCM, G2.3, IVF Science, Vitrolife) one of which (CCM, IVF Science, Vitrolife) contains insulin. Insulin is commonly employed in tissue culture techniques to enhance cell growth and development. It has been suggested that the addition of insulin to sequential media may improve blastocyst development. The purpose of the study was to evaluate the rate of production of excellent quality blastocyst resulting from two similar secondary sequential media types (CCM, G2.3, IVF Science, Vitrolife) one of which (CCM, IVF Science, Vitrolife) contains insulin. DesignA retrospective analysis of day 5 excellent quality blastocyst cultured in CCM or G2.3 in IVF cycles occurring between January 1st, 2001 and May 1st, 2003. A retrospective analysis of day 5 excellent quality blastocyst cultured in CCM or G2.3 in IVF cycles occurring between January 1st, 2001 and May 1st, 2003. Materials and methodsPatients underwent Antagon® (Organon) or Cetrotide® (Serono) antagonist protocols, Lupron® (TAP) agonist protocols, or flare protocols prior to controlled ovarian hyper-stimulation with Follistim® (Organon) or Gonal-F® (Serono). Oocyte retrieval occurred 36-39 hours post Human Chorionic Gonadotropin (hCG) administration. Insemination was performed 38-42 hours post hCG using a two hour co-incubation of sperm with oocytes or sperm injection. Oocytes were individually placed in 50-100μl micro-drops of sequential media (G1.2, G1.3, IVF Science, Vitrolife) under oil (Squibb, Sigma) and cultured overnight. Fertilization was evaluated 18-20 hours after insemination. Fertilized oocytes were placed into fresh 50-100μl micro-drops of sequential media (G1.2, G1.3) and cultured in groups of two under oil to Day 3. Multi-cell embryos were moved to new 50-100μl micro-drops of sequential media (CCM, G2.3, IVF Science, Vitrolife) under oil for culture to Day 5. Blastocysts were graded using the system of Gardner and Schoolcraft et al. (Fertility and Sterility, 1999). Excellent quality blastocyst were defined as embryos that had reached at least a full blastocyst stage (≥3) where the blastocoele completely fills the embryo cavity and zona thinning is observed. In addition, inner cell mass (ICM) and trophectoderm grades were considered. Only blastocyst with an ICM grade of "A" (tightly packed, many cells) and a trophectoderm grade of "A" or "B" (many to moderate cells forming a cohesive epithelium) were considered for this analysis. Patients underwent Antagon® (Organon) or Cetrotide® (Serono) antagonist protocols, Lupron® (TAP) agonist protocols, or flare protocols prior to controlled ovarian hyper-stimulation with Follistim® (Organon) or Gonal-F® (Serono). Oocyte retrieval occurred 36-39 hours post Human Chorionic Gonadotropin (hCG) administration. Insemination was performed 38-42 hours post hCG using a two hour co-incubation of sperm with oocytes or sperm injection. Oocytes were individually placed in 50-100μl micro-drops of sequential media (G1.2, G1.3, IVF Science, Vitrolife) under oil (Squibb, Sigma) and cultured overnight. Fertilization was evaluated 18-20 hours after insemination. Fertilized oocytes were placed into fresh 50-100μl micro-drops of sequential media (G1.2, G1.3) and cultured in groups of two under oil to Day 3. Multi-cell embryos were moved to new 50-100μl micro-drops of sequential media (CCM, G2.3, IVF Science, Vitrolife) under oil for culture to Day 5. Blastocysts were graded using the system of Gardner and Schoolcraft et al. (Fertility and Sterility, 1999). Excellent quality blastocyst were defined as embryos that had reached at least a full blastocyst stage (≥3) where the blastocoele completely fills the embryo cavity and zona thinning is observed. In addition, inner cell mass (ICM) and trophectoderm grades were considered. Only blastocyst with an ICM grade of "A" (tightly packed, many cells) and a trophectoderm grade of "A" or "B" (many to moderate cells forming a cohesive epithelium) were considered for this analysis. ResultsSee table. See table. ConclusionTabled 1

The objective of this study was to review the advantage of pre-positioning a malleable stylet prior to the introduction of an embryo transfer catheter. A retrospective analysis of excellent quality fresh embryo transfer results from January 1, 2000 through March 31, 2004. A total of 701 patients underwent fresh embryo transfers performed on Day 5 or Day 6 with excellent quality embryos. No practice embryo transfers performed. From January 1, 2000 to December 31, 2001, an initial embryo transfer was attempted using either a Wallace or Cook catheter alone. If the initial transfer attempt failed, repeated attempts followed, utilizing a Wallace or Cook catheter with a Wallace malleable stylet. Beginning January 1, 2002, a malleable stylet was pre-positioned in the cervical os prior to introduction of the embryo transfer catheter. In all transfers, embryos were transferred with approximately 15-20 μl of media and expelled with either a full column of air or media. An abdominal ultrasound (5 MHz) was used to assist the intrauterine placement of the embryo transfer catheter. Patients were requested to present with a full bladder to help in placement of the catheter. See table. Tabled 1 From review of the data, no significant difference was noted for overall pregnancy (P=.6826), clinical pregnancy (P= 1.0) or implantation (P=.8293) rates between non pre-positioned and pre-positioned groups. There was a slight decrease in retained embryos and the average number of transfer attempts when an outer stylet was pre-positioned prior to transfer.

To define and validate novel metrics of embryo progression and morphology during extended embryo culture, and to analyze the predictive effects of early cleavage versus blastulation stages of development on ICSI and IVF cycle outcome in a universal blastocyst-stage transfer program. Retrospective analysis of serial daily embryo observations and pregnancy outcomes in a university-affiliated private ART program. Serial daily embryo observations in 1295 ICSI and 851 IVF cycles were analyzed separately. All were fresh, non-donor cycles proceeding to Day 5 or 6 embryo transfer. Cell numbers for cleavage-stage embryos were recorded, and Total Cell Numbers (TCN) for blastocysts were estimated according to serial observations of blastocyst morphology scoring using the method devised by Gardner and Schoolcraft. TCN represents the cell number in the inner cell mass and trophectoderm. Embryo Progression Index (EPI) was calculated from the area under the curve (AUC) of TCN data by trapezoidal integration. Early cleavage was analyzed using the AUC from Days 1-3, and blastulation was measured using the AUC throughout extended embryo culture to the blastocyst stage. EPI measures using base2 logarithm TCN were also calculated to give more equal weight to early and late progression data. Gardner/Schoolcraft blastocyst scoring was converted into numerical Blastocyst Quality Scores (BQS). Clinical pregnancy was defined by sonographic fetal heart activity. Receiver Operating Characteristic (ROC) analysis was used to evaluate the predictive value of the above measures for pregnancy outcome. Panel A shows the ROC curve for Clinical Pregnancy in ICSI cycles. Per-cycle mean EPI and mean BQS for all embryos developing into blastocysts, and mean BQS for the transferred embryos are all significantly predictive of clinical pregnancy. Panel B shows that maternal age was also predictive of cycle outcome but to a lesser extent than EPI or BQS. However mean EPI for Days 1-3, a measure of early cleavage, was not predictive of clinical pregnancy. Similar results were obtained for IVF cycles (Panels C and D), although maternal age was a better outcome predictor than for ICSI cycles, but was still less predictive than mean BQS for transferred blastocysts. EPI measures using base2-log transformed TCN data (not shown) were less predictive of outcome than EPI based on non-transformed linear TCN, providing further evidence that embryo progression on Days 4 and 5 was more important than that on Days 1-3. Early cleavage has been incorporated into selection of cleavage-stage embryos for transfer as a putative marker of embryo quality. We have shown that late-stage embryo development is a more sensitive and specific predictor of pregnancy outcome in blastocyst transfer cycles. Our data supports the use of extended embryo culture for embryo selection. Further, this study suggests that assessment of fertilization on Day 1, change to sequential medium on Day 3, and embryo observation and scoring starting on Day 5 may be equivalent in value to daily serial embryo observations.

To compare the efficacy of triggering ovulation by the GnRH agonist leuprolide acetate to recombinant hCG in oocyte donation cycles employing GnRH antagonist suppression. Retrospective analysis of oocyte donation cycles employing the same GnRH antagonist/recombinant FSH/microdose recombinant hCG protocol but receiving either leuprolide acetate or recombinant hCG for triggering ovulation. A total of 10 oocyte donors (8 IVF/2 ICSI) triggered by leuprolide acetate to prevent ovarian hyperstimulation syndrome (OHSS) was identified. These patients were compared with 13 matched patients (6 IVF/7 ICSI) who were triggered by recombinant hCG. The cycle parameters were compared with independent t-test when the test of homogeneity was not significant, otherwise Mann-Whitney test was utilized. Chi-square and Fischer exact tests were used where appropriate. The cycle parameters of patients triggered by GnRH agonist or recombinant hCG are detailed in the following table (Table 1.). There were 2 moderate OHSS cases noted in the group triggered by recombinant hCG, although the ovarian stimulation cycle parameters were comparable in both groups. Both groups demonstrated comparable number of mean total oocytes and mature oocytes retrieved. The embryos obtained as a result of IVF or ICSI procedures resulted in comparable pregnancy rates in the recipients. Tabled 1 Triggering ovulation by the GnRH agonist leuprolide acetate results in comparable cycle outcome as compared with recombinant hCG trigger while preventing OHSS in oocyte donation cycles. Ovulation induction with GnRH agonist may be utilized liberally in oocyte donation cycles employing GnRH antagonist suppression to decrease the risk of OHSS without negatively impacting the outcome.

This survey was conducted to obtain the egg donor's perspective of the egg donation experience. The questions address emotional and legal aspects of egg donation, in addition to personal experiences. The goals of this survey were: to gain a better understanding of the donor's experience, find out what long-term effects may be perceived by the donor to be associated with donation, and determine if there are similarities in the personalities of egg donors, which may aid in the recruitment process of new donors. A total of 117 surveys were sent out to egg donors who are not currently active in our program. The survey consisted of 25 questions, which covered emotional issues and physical aspects of the egg donation cycle as well as patient education for the donor. 23 of the 25 questions were assayed on a numerical scale as follows false = 1, slightly true = 2, mainly true = 3, very true = 4. Opportunity was also provided for the donors to provide free text comments as well. A compensation of $20 was offered for completion of the survey if the donor chose to sign the survey. Anonymous surveys were also accepted. None 41 surveys were returned as undeliverable by the post office. 32 surveys were completed and returned. All of the returned surveys were signed by the donors. In conclusion, the majority of the donors felt well prepared emotionally and physically and do not express regret following the egg donation process. The significant number of donors who did not respond (44) may indicate their level of detachment from the experience. Overall, most donors have a positive experience and do not show any long-term emotional or physical distress.

Objective: Culture micro-drop temperature measurements differ substantially from heated stage temperature set points. Extensive monitoring of micro-drop temperature showed while stage temperature set points were 37°C, a significantly lower culture drop temperature was observed. Reasons for this discrepancy may be due to the insulting properties of the culture dish or radiation of heat from the culture dish to the cooler ambient air of the IVF Laboratory and/or the objective lens opening of the microscope. Temperature adjustments were made on each stage by increasing the set points to approximately 41°C and 43°C degrees on each microscope respectively raising the micro-drop temperature to 37°C. This abstract evaluated blastulation rates, fertilization rates, and number of embryos remaining for cryopreservation for IVF and ICSI cases three months before and after temperature adjustment. Design: A retrospective analysis of IVF and ICSI cases performed between October 1, 2001 and April 12, 2002. Materials/Methods: Temperature monitoring and adjustments of all IVF equipment was performed with a GMH 3230 Thermometer (Greisinger) utilizing both micro-submergible and surface temperature probes before the start of all 2002 IVF cases. The heated stage (Research Instruments) temperature setting was adjusted for both IVF inverted microscopes (Nikon) while monitoring culture media micro-drop temperature. Oocytes underwent ICSI with maximum exposure time outside of incubator, on the heated stage being approximately five to seven minutes. Embryos were evaluated at 24 hour intervals from Day 2 to Day 5 or Day 6, with subsequent embryo transfer and freezing at the blastocyst stage. Results: Please refer to table. TableResults:IVF: Before Temperature AdjustmentIVF: After Temperature AdjustmentICSI: Before Temperature AdjustmentICSI: After Temperature Adjustmentn49536765Fertilization Rate:63.23%63.61%70.72%73.12%†P < 0.01 (Fisher's Exact)Blastulation Rate:62.22%69.68%46.88%58.86%Average Number of Embryos Frozen:3.53.31.72.9†P < 0.01 (Fisher's Exact)Percent of 2PN Frozen:38.46%38.06%22.85%35.62%†P < 0.01 (Fisher's Exact)† P < 0.01 (Fisher's Exact) Open table in a new tab Conclusions: It was determined that while each heated stage set point was 37°C, the micro-drop in a culture dish sitting on the heated stage over a period of five to seven minutes temperature was 4°C and 6°C cooler on each inverted microscope stage respectively. While no change in fertilization rate, blastulation rate, or number of embryos frozen was observed in the traditional insemination group, possibly due to the fact of limited exposure outside of the incubator, a significant improvement was observed in blastulation rate and number of embryos frozen in the ICSI group after temperature adjustment. It is hypothesized that increasing the stage temperature to maintain micro-drop temperature close to 37°C decreased incidence of spindle apparatus disruption due to temperature fluctuation, therefore decreasing embryonic aneuploidy and thus increasing blastocyst formation in the ICSI group. Supported by: N/A.

Objective: Frozen embryo transfer of one single embryo has been reported to result in a reduction of multiple gestations with consistent implantation and pregnancy rates. The purpose of this study is to evaluate pregnancy and implantation rates resulting from transfer of one blastocyst embryo derived from frozen cycles.Design: A retrospective analysis of frozen embryo transfer results from January 1, 1998 through March 31, 2002.Materials/Methods: Frozen embryos thawed for transfer were placed into 100l micro-drops of sequential media (S-2, G-2.2 or CCM; IVF Science) under oil and cultured in 5% CO2 and air at 37°C approximately four hours prior to transfer. Embryos were frozen on Day 5, 6 or 7. All embryos were frozen and thawed using modified glycerol protocols previously reported. In preparation for embryo transfer, estrogen and progesterone supplementation was administered to all patients. An abdominal ultrasound (5 MHz) was utilized to assist intrauterine placement of the embryo transfer catheter (Wallace; Cook). A sonogram to determine total gestational sacs and fetal hearts was performed at 4–6 weeks post positive hCG. If cardiac activity was not documented at the initial sonogram, a follow-up sonogram was performed 1 week later.Results: Please refer to the table. TableSingle Frozen Embryo Transfer ResultsElective Frozen Embryo TransferNon-Elective Frozen Embryo TransferTotal Cycles:1348Mean Patient Age:35.635.9Pregnancies (+hCG)/Ongoing:5/216/7Biochemical/Miscarriages:2/15/4Pregnancy Rate (+hCG):38.5% NS33.3%Clinical Pregnancy Rate:23.1% NS22.9%Ongoing Pregnancy Rate:15.4% NS14.6%Clinical Sacs (1/2/3):3/0/011/0/0Implantation Rate:23.1% NS22.9%Not Significant (NS) vs. non-elective frozen embryo transfers Open table in a new tab Conclusions: Of the 61 single frozen embryo transfers, 13 (21.3%) patients requested to transfer one embryo and have their additional embryos remain cryopreserved. The remaining patients utilizing frozen embryos were forced to transfer only one embryo due to the limited availability of supernumerary embryos for transfer. The selection of patients for single embryo transfer was generally based on the non-availability of additional embryos rather than patient choice. Similiar pregnancy and implantation rates are evident. No multiple gestations were noted.Supported by: Not Applicable. Objective: Frozen embryo transfer of one single embryo has been reported to result in a reduction of multiple gestations with consistent implantation and pregnancy rates. The purpose of this study is to evaluate pregnancy and implantation rates resulting from transfer of one blastocyst embryo derived from frozen cycles. Design: A retrospective analysis of frozen embryo transfer results from January 1, 1998 through March 31, 2002. Materials/Methods: Frozen embryos thawed for transfer were placed into 100l micro-drops of sequential media (S-2, G-2.2 or CCM; IVF Science) under oil and cultured in 5% CO2 and air at 37°C approximately four hours prior to transfer. Embryos were frozen on Day 5, 6 or 7. All embryos were frozen and thawed using modified glycerol protocols previously reported. In preparation for embryo transfer, estrogen and progesterone supplementation was administered to all patients. An abdominal ultrasound (5 MHz) was utilized to assist intrauterine placement of the embryo transfer catheter (Wallace; Cook). A sonogram to determine total gestational sacs and fetal hearts was performed at 4–6 weeks post positive hCG. If cardiac activity was not documented at the initial sonogram, a follow-up sonogram was performed 1 week later. Results: Please refer to the table. Not Significant (NS) vs. non-elective frozen embryo transfers Conclusions: Of the 61 single frozen embryo transfers, 13 (21.3%) patients requested to transfer one embryo and have their additional embryos remain cryopreserved. The remaining patients utilizing frozen embryos were forced to transfer only one embryo due to the limited availability of supernumerary embryos for transfer. The selection of patients for single embryo transfer was generally based on the non-availability of additional embryos rather than patient choice. Similiar pregnancy and implantation rates are evident. No multiple gestations were noted. Supported by: Not Applicable.

Objective: The objective of this study was to demonstrate the ability to successfully freeze and thaw embryos twice resulting in successful pregnancy.Design: A retrospective analysis of frozen embryo transfers following two freeze-thaw cycles.Materials/Methods: Frozen multi-cell Day 3 embryos selected for culture to Day 6 (D6) were thawed and placed into 50μl micro-drops of G2.2 or CCM media under oil and cultured three days prior to transfer. All embryos were cultured in 5% CO2 and air at 37°C. Blastocyst (BL) and multi-cell (MC) embryos were frozen and thawed using modified glycerol and propanediol protocols (Testart et al. 1986, Tucker et al. 1997, Menezo et al. 1992, Menezo et al 1996). Supernumerary frozen-thawed embryos were cryopreserved at the blastocyst stage for a second time and subsequently thawed following identical protocols as mentioned above. In preparation for embryo transfer, estrogen and progesterone supplementation was administered to all patients. Transfers were performed with an abdominal ultrasound (5 MHz) to aid intrauterine placement of the embryo transfer catheter (Wallace).Results: Please refer to table. TableResults:PatientNumber of MC Embryos1st Freeze/Thaw2nd Freeze/ThawOutcomeEmbryo Stage: Pre- FreezeEmbryo Stage: Post- ThawEmbryo Culture (hours)Embryo Stage: Re- FreezeEmbryo Stage: Post ThawEmbryo Trans- ferred: (Yes/ No)137C/6C/8C5C/4C/7C72 hrs (D6)3BB/3BB/4BBAtretic/3BB/4BBN/Y/YFull-term Delivery; Male216C6C72 hrs (D6)4BC4BCYBio- chemical Pregnancy336C/7C/8C5C/7C/8C72 hrs (D6)4BC/4BC/4BBAtretic/Atretic/4CCN/N/NN/A427C/8C7C/8C72 hrs (D6)4BB/3BBAtretic/AtreticN/NN/A538C/6C/6C7C/6C/6C72 hrs (D6)3AA/1BC/1CC3BB/Atretic/1CCY/N/YFull-term Delivery; Female Open table in a new tab Conclusions: This data set consisted of 5 patients where a total of 39 MC embryos were initially frozen. Following the first thaw, a total of 9 (23.1%) embryos were transferred, 12 (25.6%) supernumerary embryos were refrozen at the blastocyst stage (D6) and the remaining 18 (46.2%) showed no evident signs of survival and were discarded. Of the 12 embryos refrozen, 5 (41.7%) embryos survived the second thaw and were transferred. Overall blastulation rate from frozen MC embryos was 53.9%. These results demonstrate the ability to refreeze blastocyst stage embryos derived from extended embryo culture of previously frozen day 3 embryos for subsequent thaw and transfer. Refreezing blastocyst stage embryos is of great advantage to the patient and clinician where surplus or supernumerary embryos exist. The alternative to refreeze embryos is of greater potential benefit than transferring excessive number of embryos or discarding viable zygotes.Supported by: N/A. Objective: The objective of this study was to demonstrate the ability to successfully freeze and thaw embryos twice resulting in successful pregnancy. Design: A retrospective analysis of frozen embryo transfers following two freeze-thaw cycles. Materials/Methods: Frozen multi-cell Day 3 embryos selected for culture to Day 6 (D6) were thawed and placed into 50μl micro-drops of G2.2 or CCM media under oil and cultured three days prior to transfer. All embryos were cultured in 5% CO2 and air at 37°C. Blastocyst (BL) and multi-cell (MC) embryos were frozen and thawed using modified glycerol and propanediol protocols (Testart et al. 1986, Tucker et al. 1997, Menezo et al. 1992, Menezo et al 1996). Supernumerary frozen-thawed embryos were cryopreserved at the blastocyst stage for a second time and subsequently thawed following identical protocols as mentioned above. In preparation for embryo transfer, estrogen and progesterone supplementation was administered to all patients. Transfers were performed with an abdominal ultrasound (5 MHz) to aid intrauterine placement of the embryo transfer catheter (Wallace). Results: Please refer to table. Conclusions: This data set consisted of 5 patients where a total of 39 MC embryos were initially frozen. Following the first thaw, a total of 9 (23.1%) embryos were transferred, 12 (25.6%) supernumerary embryos were refrozen at the blastocyst stage (D6) and the remaining 18 (46.2%) showed no evident signs of survival and were discarded. Of the 12 embryos refrozen, 5 (41.7%) embryos survived the second thaw and were transferred. Overall blastulation rate from frozen MC embryos was 53.9%. These results demonstrate the ability to refreeze blastocyst stage embryos derived from extended embryo culture of previously frozen day 3 embryos for subsequent thaw and transfer. Refreezing blastocyst stage embryos is of great advantage to the patient and clinician where surplus or supernumerary embryos exist. The alternative to refreeze embryos is of greater potential benefit than transferring excessive number of embryos or discarding viable zygotes. Supported by: N/A.

Objective: Previous reports have suggested that extended embryo 2culture can be used to increase the implantation rate in unselected In-Vitro Fertilization (IVF) patients. This study was undertaken to see if application of extended embryo culture to all IVF patients combined with a policy of transfer of no more than two embryos in all but the worst prognosis patients could reduce the risk of high order multiple gestation. Design: Analysis of IVF outcome of all IVF cases from January 1, 2000 through December 31, 2000. Materials/Methods: Extended embryo culture in sequential media (G-1.2, G-2.2 or CCM, IVF Science) was applied to all patients undergoing IVF. A maximum of two embryos was transferred in all patients unless multiple poor prognosis factors (maternal age >38, elevated FSH, extremely poor embryo quality or multiple prior failed cycles) were present. In those cases with more than two or more poor prognosis factor, a maximum of three embryos were transferred. Results: Please refer to table. Blastocyst embryo transfer results. Tabled 11 Embryo transferred2 Embryos transferred3 Embryos transferredTotal transferredMean Patient Age:34.334.837.134.9Total Cycles/Embryos Transferred:40/40337/67429/87406/801Pregnancies (+hCG)/ Ongoing:15/6209/15915/10239/175Biochemical/Miscarriages:8/134/162/344/20Clinical/Ongoing Rate:17.5%/15.0%51.9%/46.9%44.8%/34.5%48.0%/42.9%Clinical Sacs (1/2/3):7/0/0104/69/16/6/1117/75/2Fetal Hearts (0/1/2/3/4):0/6/1/0/014/103/52/4/11/7/5/0/015/116/58/4/1Implantation Rate:17.5%25.8%14.9%24.2% Open table in a new tab Conclusions: Extended embryo culture combined with transfer of only two embryos (or three in patients with extreme poor prognosis) can reduce, but not eliminate high order multiple gestation pregnancies. Although no poor prognosis patients with three embryos transferred conceived with greater than a twin pregnancy, a small number of two embryos transfers resulted in high order multiple gestations secondary to monozygotic embryo splitting. Despite this phenomenon, this strategy resulted in a good pregnancy rate with a much lower high order multiple gestation rate than seen in programs using conventional culture techniques in conjunction with a strategy of transferring more embryos (SART data comparison).

Objective: Previous studies have reported that patients with elevated baseline levels of FSH on cycle day 2 or 3 or on day 10 following administration of 100 g clomiphene on day 5–9 have a poor prognosis for pregnancy with IVF. It has been suggested that an FSH level should be interpreted as elevated only when the level is above what is seen in successfully conceiving patients. This study was undertaken to see if a calculation of the sum of day 2 or day 3 and day 10 FSH value could identify poor prognosis patients in which neither day 2 or day 3 or day 10 value was considered significantly elevated. Design: A retrospective analysis of fresh embryo transfer results from January 1, 1999 through December 31, 2000. Materials/Methods: All patients were offered a clomid challenge test prior to undergoing stimulation. Patients day 2 or day 3 and day 10 FSH levels were determined prior to cycle start (Immulite, DPC). Patients felt to be candidates for IVF underwent down regulation with the gonadotropin releasing hormone analog, Lupron® (TAP) or flare protocols prior to controlled ovarian hyper-stimulation with Follistim® (Organon) or Gonal-F® (Serono). Oocyte retrieval occurred 36–39 hours post Human Chorionic Gonadotropin (hCG) administration. Embryos were cultured 5 to 6 days prior to embryo transfer. Results: Please refer to table. Results: ∗Day 2/3 + Day 10 FSH <15 mIU/mlDay 2/3 + Day 10 FSH ≥15 mIU/mlNumber Cycle Starts/Retrievals:388/372216/173Number Cancellations (%):16 (4.1%) ∗P < 0.01 (Fisher's Exact);43 (19.9%)Number Transfers (%):36 (9.7%)26 (15.0%)Average Day 2/3 + Day 10 Value:11.2 mIU/ml18.2 mIU/mlAverage Age:35.135.5Average Amps FSH:41.0 ∗P < 0.01 (Fisher's Exact);51.4Average Number Oocytes/2PN:13.5/7.7 †P < 0.05 (t-test).10.5/5.7Average Number Blastocysts:4.23.0Percent Positive hCG per Start:48.2% ∗P < 0.01 (Fisher's Exact);34.7%Percent Ongoing Pregnancy per Start:32.7%∗P < 0.01 (Fisher's Exact);22.2%∗ P < 0.01 (Fisher's Exact);† P < 0.05 (t-test). Open table in a new tab Conclusions: Based on this investigation, a significant increase in the number of cancelled cycles can be observed when patients day 2 or day 3 plus day 10 value exceeds 15 mIU/ml. In addition, a significant increase in gonadotropin consumption as well as a significant decrease in pregnancy rates both positive hCG and ongoing can be observed in the same group. Although day 2 or day 3 plus day 10 value ≥15 does not preclude successful outcomes this information may prove useful in counseling patients and/or determination of gonadotropin dosage.

Objective: Previous reports have suggested that extended embryo culture can be used to increase the implantation rate in unselected In-Vitro Fertilization (IVF) patients. This study was undertaken to see if application of extended embryo culture to all frozen embryo transfer (FET) cycles combined with a policy of transfer of no more than two embryos in all but the worst prognosis patients could reduce the risk of high order multiple gestation in cryopreservation/thaw cycles. Design: Analysis of outcome of all FET cases from January 1, 2000 through December 31, 2000. Materials/Methods: Extended embryo culture in sequential media (G-1.2, G-2.2 or CCM, IVF Science) has been applied to all patients undergoing IVF since January 1998. Supernumary embryos are cryopreserved at the blastocyst stage with a glycerol/sucrose protocol. In some cases, embryos frozen prior to 1998 at cleavage stages were thawed and cultured to blastocyst prior to transfer. A maximum of two embryos was transferred in all patients unless multiple poor prognosis factors (maternal age >38, elevated FSH, extremely poor embryo quality or multiple prior failed cycles) were present. In those cases with more than two or more poor prognosis factors, a maximum of three embryos were transferred. Results: Please refer to table. Frozen blastocyst transfer results. Tabled 11 Embryo transferred2 Embryos transferred3 Embryos transferredTotal transferredMean patient age:36.635.536.335.6Total cycles/embryos transferred22/22119/23812/36153/296Pregnancies (+hCG)/ongoing:7/560/386/373/46Biochemical/miscarriages:2/016/63/021/6Clinical/ongoing rate:22.7%/22.7%37.0%/31.9%25.0%/25.0%34.0%/30.1%Clinical sacs (1/2/3):5/0/036/8/02/1/043/9/0Fetal hearts (0/1/2/3/4):0/5/0/0/02/34/8/0/01/1/1/0/03/40/9/0/0Implantation rate:22.7%21.9%11.1%20.6% Open table in a new tab Conclusions: Extended embryo culture prior to cryopreservation combined with transfer of only two embryos (or three in patients with extreme poor prognosis) prevented high order multiple gestation pregnancies. This strategy resulted in a good pregnancy rate (49 ongoing pregnancies/153 thaw cycles) with a relatively low twin gestation rate (9/49 ongoing pregnancies). This approach may be preferable to the traditional strategy of cryopreservation at the cleavage stage and transfer of greater numbers of embryos.

Objective: Previous studies have reported lower blastulation and pregnancy rates when ICSI is performed compared with traditional IVF. If has been speculated that this may be an effect of either the ICSI procedure itself or may result from intrinsic sperm abnormalities. The objective of this study was to evaluate blastocyst development, pregnancy and implantation rates stratified by motility with specific comparison of IVF to ICSI. Design: A retrospective analysis of IVF and ICSI embryo transfer results from January 1, 1998 through December 31, 2000. Materials/Methods: Patients underwent controlled ovarian hyperstimulation using recombinant FSH only (Follistim®, Organon or Gonal-F®, Serono). Oocyte retrieval occurred 36–39 hours post Human Chorionic Gonadotropin administration. Insemination was performed 38-42 hours post hCG using a two hour co-incubation of sperm with oocytes or intracytoplasmic sperm injection (ICSI) of metaphase II oocytes following hyaluronidase treatment. All IVF semen specimens were analyzed before and after density-gradient-centrifugation to determine degree of sperm function including motility, progressive motility, and concentration using a CASA (computer assisted semen analysis) IVOS system (Hamilton-Thorne). Fertilization was evaluated 18–20 hours after insemination. Pronuclear embryos were cultured in 50 μl micro-drops S-1/G1.2 media (IVF Science) in groups of two under oil for 48 hours followed by culture in 50 μl micro-drops S-2/G2.2/CCM media for 48 hours to blastocyst stage. Embryo replacement occurred utilizing abdominal ultrasound (5 MHz) and transfer catheter (Wallace). Results: Please refer to table. Results: ∗Percent pre-wash motility (CASA-IVOS)0–10%11–20%21–30%31–40%41–50%>50%TotalsCases IVF/ICSI:0/1370/693/5510/8728/63341/176382/587Percent Fertilization IVF/ICSI:0/73.5%0/81.0%57.1%/ 76.4%60.2%/ 78.2%49.7%/ 76.9%57.8%/ 76.7%57.3%/ 76.8%∗P < 0.01 (IVF vs. ICSI; Fisher’s Exact).Percent Blastulation IVF/ICSI:0/47.7%0/55.4%39.3%/ 54.0%58.5% 55.3%60.1%/ 49.8%57.9%/ 44.6%57.8%/ 50.6%∗P < 0.01 (IVF vs. ICSI; Fisher’s Exact).Number Positive hCG IVF/ICSI:0/630/412/313/4017/28198/72220/275Percent Positive hCG IVF/ICSI:0/46.0%0/59.4%66.7%/ 56.4%30.0%/ 46.0%60.7%/ 44.4%58.1%/ 40.9%57.6%/ 46.9%∗P < 0.01 (IVF vs. ICSI; Fisher’s Exact).Number Ongoing Pregnancy IVF/ICSI:0/380/272/231/2811/20145/49159/185Percent Ongoing Pregnancy IVF/ICSI:0/27.7%0/39.1%66.7%/ 41.8%10.0%/ 32.2%39.3%/ 31.8%42.5%/ 27.8%41.6%/ 31.5%∗P < 0.01 (IVF vs. ICSI; Fisher’s Exact).Implantation Rate IVF/ICSI:0/27.5%0/33.8%60.0%/ 36.5%15.8%/ 26.7%29.8%/ 25.8%34.8%/ 22.1%34.1%/ 27.3%∗P < 0.01 (IVF vs. ICSI; Fisher’s Exact).∗ P < 0.01 (IVF vs. ICSI; Fisher’s Exact). Open table in a new tab Conclusions: Although fertilization rate was significantly higher in ICSI cycles compared to IVF, blastulation, pregnancy and implantation rates were all significantly lower. The impairment of blastulation and pregnancy rates with IVF was not related to pre-wash motility or other sperm parameters (data not shown). This suggests that the ICSI procedure itself (i.e. mechanical or other effects) is the likely cause of impaired embryo progression.

Objective: Recent reports from several In-Vitro Fertilization clinics have suggested that there is a significant increase in monozygotic twinning following blastocyst embryo culture and fresh embryo transfer. This study was undertaken to compare the incidence of monozygotic twinning resulting from embryo transfer following extended culture in sequential media. Design: A retrospective analysis of embryo transfer results from January 1, 1998 through December 31, 2000. Materials/Methods: Patients underwent down regulation with the gonadotropin releasing hormone analog, Lupron® (TAP) or flare protocols prior to controlled ovarian hyper-stimulation with Follistim® (Organon) or Gonal-F® (Serono). Oocyte retrieval occurred 36–39 hours post Human Chorionic Gonadotropin (hCG) administration. Insemination was performed 38–42 hours post hCG using a two hour co-incubation of sperm with oocytes or sperm injection. Oocytes were individually placed in 100μl micro-drops of sequential media (S1, G1.2, IVF Science) under oil (Squibb) and cultured overnight in 5% CO2 and air at 37°C. Fertilization was evaluated 18–20 hours after insemination. Fertilized oocytes were placed into fresh 100μl micro-drops of sequential media (S1, G1.2) and cultured in groups of two under oil to Day 3. Multi-cell embryos were moved to new 100 μl micro-drops of sequential media (S2, G2.2, CCM, IVF Science) under oil for culture to Day 5 or Day 6. Embryos were generally transferred on Day 5 if at least two embryos had reached the blastocyst stage. Culture to Day 6 was performed for the remaining group of patients. An abdominal ultrasound (5 MHz) was utilized to assist intrauterine placement of the embryo transfer catheter (Wallace). A sonogram to determine total gestational sacs and fetal heart beats (FHB) was performed at 4–6 weeks post positive hCG. If cardiac activity was not documented at the initial sonogram, a follow-up sonogram was performed 1 week later. Results: Please refer to table. Monozygotic twinning results from extended culture. Tabled 11 Embryo transferred2 Embryos transferred3 Embryos transferredTotal transferredMean Patient Age:34.834.835.434.9Total Cycles/Embryos Transferred:105/105761/1522237/7111103/2338Pregnancies (+hCG)/Ongoing:35/15468/354140/101643/470Biochemical/Miscarriages:12/879/3524/15115/58Clinical/Ongoing Rate:21.9%/14.3%51.1%/46.5%48.9%/42.6%47.9%/42.6%Clinical Sacs (1/2/3):23/0/0219/163/367/30/18309/193/21Fetal Hearts (0/1/2/3/4).8/15/0/0/035/214/124/10/215/61/30/8/158/290/154/18/3Monozygotic occurrences:017118Clinical Monozygotic Rate:0.0%4.4%0.9%3.4%Clinical Implantation Rate:21.9%36.4%25.5%32.4% Open table in a new tab Conclusions: These results indicate 17 incidents of monozygotic twinning within the larger (n = 761) group in which two embryos were transferred and one incident within the next largest (n = 237) group in which three embryos were transferred. Although the overall percentage of monozygotic twinning from 1103 fresh cycles was relatively low (3.4%), a significant impact on the incidence of high order multiple gestations was noted, accounting for 55.6% of triplets (10/18 with 3 FHB) and 100% of quadruplets (3/3 with 4 FHB).

Objective: Recent reports have demonstrated that GnRH antagonists can be successfully used in conjunction with rFSH for IVF. In these investigations, gonadotropin stimulation was initiated following the onset of a spontaneous menses. Many IVF centers may be reluctant to employ these protocols secondary to cycle scheduling concerns. Difficulties in predicting cycle start dates leads to difficulty predicting the range of dates on which the egg retrieval and embryo transfer may be performed. Previous studies have touted the use of oral contraceptives for pretreatment in GnRH agonist/gonadotropin protocols as a means to facilitate IVF cycle scheduling. The purpose of this study is to evaluate the effect of oral contraceptive pretreatment in IVF cycles using a recFSH and a GnRH antagonist. Design: Prospective trial of three oral contraceptive pretreatment protocols employed in consecutive egg donor patients undergoing stimulation with rFSH/GnRH antagonist. Oral contraceptives were discontinued with the last pill taken one, three or five days prior to start of gonadotropins. Materials/Methods: Twenty-five egg donor cycles were conducted in which pretreatment with Desogen was initiated at least three weeks prior to entering into an IVF cycle. Group A had last pill on Monday, group B had last pill on Wednesday, and group C had last pill on Friday. Follistim was begun in all patients on the Saturday following the last pill. Blood sampling was performed daily for hormonal analysis after discontinuation of Desogen. No change in stimulation dose was made based on any results of hormonal testing. Daily GnRH antagonist (Antagon) was initiated when lead follicles were 10–12 mm mean diameter. HCG was administered 36 hours prior to oocyte aspiration. Cycle parameters including outcome data were evaluated and compared to prior cycles of these same egg donors in which a GnRH agonist (Lupron) had been used. Results: Please refer to table. Results: †Group AGroup BGroup CAllAntagonLupronAntagonLupronAntagonLupronAntagonLupronNumber Cycles:11574792518Mean Number Days of Stimulation:11.410.412.410.513.310.212.310.4Mean Peak E2:1243.31886.01411.43436.0573.11925.01076.0 †P < 0.01 (t-test);2415.7Mean Number of Amps:30.232.029.123.933.627.130.927.7Mean Number Ova:13.118.413.622.811.616.812.719.3Percent Fertilization:74.3%59.8%76.8%78.0%64.2%56.3%72.2% ∗P < 0.01 (Fisher’s Exact). All Groups: Antagon vs. Lupron.65.9%Percent Blastulation:76.6%66.7%58.9%69.0%59.2%80.2%65.2%71.1%Mean Number of Frozen Embryos:4.95.804.09.81.74.33.5 ∗P < 0.01 (Fisher’s Exact). All Groups: Antagon vs. Lupron.6.6Positive hCG:54.6%50.0%75.0%75.0%57.1%80.0%61.5%70.0%Ongoing Pregnancy:54.6%50.0%62.5%25.0%57.1%80.0%57.7%60.0%† P < 0.01 (t-test);∗ P < 0.01 (Fisher’s Exact). All Groups: Antagon vs. Lupron. Open table in a new tab Conclusions: Oral contraceptive pre-treatment can be used successfully in IVF protocols employing rFSH and a GnRH antagonist. In some cases, oral contraception leads to profound suppression of endogenous gonadotropins. Initiation of gonadotropins prior to resolution of this suppression is associated with delayed follicular growth and increased consumption of gonadotropins.