Transfer of blastocysts and morulae on day 5.

OBJECTIVE: To limit the number of embryos transferred and reduce high-order multiple pregnancies without compromising a patient's opportunity to become pregnant. DESIGN: Retrospective, nonrandomized analysis of embryo development and patient outcome when embryos were transferred on day 5. SETTING: Private practice. PATIENT(S): Women undergoing in vitro fertilization (IVF) treatment. INTERVENTION(S): Extend embryo culture to day 5 before embryo transfer (ET) to reduce the number of embryos transferred and minimize high-order multiple pregnancies. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (CPR), implantation rate (IR), and live born rate (LBR) from expanding (expanded blastocysts and blastocysts) and nonexpanding (early blastocysts and morulae) embryos transferred on day 5. RESULT(S): Approximately 60% of patients had expanding embryos (EXE) on day 5. Forty percent of patients having an ET had transferable non-expanding embryos (NEE). Patients with EXE had higher CPR and LBR compared to patients with NEE. Implantation rate and multiple pregnancy rate (MPR) were also higher for patients with EXE. The miscarriage rate (MCR) for patients with EXE and NEE was not different. Approximately 5.5% of patients did not have an ET, with most (>98%) of the ET failures from patients with <==3 two pronuclei (2PN) embryos. The number of 2PN embryos had an effect on CPR, LBR, MPR, and the number of patients having cryopreservation. CONCLUSION(S): Day 5 ET allows for the selection of embryos with the highest implantation potential as evidenced by acceptable pregnancy rates for patients with either EXE or NEE, without the need to transfer more than two embryos.

Integration of blastocyst transfer for all patients.

OBJECTIVE: To evaluate the efficacy of using day-5 embryo transfer (ET) for all patients. DESIGN: Retrospective, non-randomized comparison of day-3 ET versus day-5 ET. SETTING: Private practice. PATIENT(S): Women having in vitro fertilization and receiving either day-3 ET or day-5 ET. INTERVENTION(S): Extended embryo culture through embryonic genome activation to select those embryos with higher implantation potential. MAIN OUTCOME MEASURE(S): The following parameters were compared for day-3 ET and day-5 ET: clinical and ongoing pregnancy rates, implantation rates, patients having cryopreservation, and liveborn rates. RESULT(S): Blastocyst embryo transfer (day-5 ET) increased the clinical and ongoing pregnancy rate for patients <35 years of age and for the total program. The risk of high order multiple pregnancy was reduced by a decrease in the number of embryos transferred (2.0 vs. 2.7; day-5 ET vs. day-3 ET, respectively). However, the multiple pregnancy rate was not different due to an increase in the implantation rate (day-5 ET 43% vs. day-3 ET 27%). There was no difference in the percent of patients not having an ET (day-5 ET 2.8%; day-3 ET 1.3%). CONCLUSION(S): Blastocyst ET increased the clinical and ongoing pregnancy rate for patients <35 years of age and for the total program, with a concomitant decrease in the number of embryos transferred. However, the decrease in the number of embryos transferred did not decrease the multiple rate, but did reduce the incidence of high order multiples. Most patients (97%) had an embryo transfer. Therefore, culturing embryos an additional 48 hours through embryonic genome activation allows for selection of the most viable embryos without compromising the patient's opportunity to become pregnant.

Successful in vitro fertilization with anonymous donor oocytes in a patient with recurrent massive hemoperitoneum following spontaneous and induced ovulation.

OBJECTIVE: To report a case of severe von Willebrand's disease treated with in vitro fertilization using donor oocytes. DESIGN: Case report and literature review. SETTING: Private practice infertility center. PATIENT(S): Infertility patient with recurrent massive hemoperitoneum following spontaneous and induced ovulation. INTERVENTION(S): In vitro fertilization using donor oocytes. MAIN OUTCOME MEASURE(S): Successful term delivery. RESULTS(S): Delivery of healthy term singleton infant without maternal complication. CONCLUSION(S): The indications for in vitro fertilization using donor oocytes, while primarily for patients with medical/surgical menopause or genetic disorders, can be expanded to patients with contraindications for spontaneous or induced ovulation.