Chorionic villous sampling through transvaginal ultrasound approach: A retrospective analysis of 1138 cases.

AIM: The aim of this study was to evaluate the effectiveness and safety of a transvaginal approach for chorionic villous sampling (CVS). METHODS: We carried out a retrospective data analysis of all the transvaginal CVS procedures performed for the purpose of prenatal diagnosis in a university-level referral center between January 2000 and December 2014. Women underwent the prenatal testing between 10 and 17 weeks of gestation mainly for hematological disorders involving single gene defects. The main outcomes were successful sampling rate, maternal contamination rate, post-procedure complications rates, and immediate fetal loss rate (<14 days post-procedure). RESULTS: A total of 1138 transvaginal CVS were performed during the study period and were available for analysis. The sampling success rate after the first attempt was 98.5% (1121/1138) and the overall success rate was 99.6% (1133/1138). The maternal contamination rate was 0.4% (5/1138). While two patients had vaginal bleeding (0.2%), fresh retroplacental collection was noted in four patients (0.4%) post-procedure. None of the patients developed ascending uterine infection following CVS. The immediate fetal loss rate was 0.2% (2/1138). CONCLUSION: Transvaginal approach is associated with high sampling success, along with low rates of maternal contamination and post-procedure complications; hence, it can be offered as an effective alternative method of CVS.

Uterine flushing with supernatant embryo culture medium in vitrified warmed blastocyst transfer cycles: a randomized controlled trial.

PURPOSE: Does transfer of supernatant embryo culture fluid (stimulation of endometrial embryo transfer - SEET) prior to vitrified warmed blastocyst transfer result in better clinical pregnancy and live birth rates than direct vitrified warmed blastocyst transfer? METHODS: This randomized controlled trial compared SEET group and direct transfer group (control) in 60 women undergoing vitrified warmed blastocyst transfers. The duration of the study was 3 years. The patients were undergoing vitrified warmed blastocyst transfer at university level infertility centre. Sixty women were randomized to SEET (n = 30) or control (n = 30). RESULTS: Data was available for analysis from all the 30 women in the SEET group and 30 women in the control group. There were no drop outs in the trial. The implantation rate was significantly lower in the SEET group compared to the control group (27 vs. 44 %, P = 0.018). The clinical pregnancy rates were similar in both the groups (47 vs. 53 %) but the live birth rate was also significantly lower in SEET group (23 vs. 50 %, P = 0.03). LIMITATIONS: The sample size based on clinical pregnancy rates was small and hence not adequately powered to detect differences in live birth rates. Lack of blinding leading to possible bias cannot be ruled out. CONCLUSION: There was no evidence of an improvement in clinical pregnancy rate following SEET in vitrified warmed blastocyst transfer compared to direct transfer.

Ovulation triggers in anovulatory women undergoing ovulation induction.

BACKGROUND: Anovulation is a common cause of infertility. Drugs used to treat anovulation include selective oestrogen receptor modulators, aromatase inhibitors and gonadotrophins. Ovulation triggers are used with these drugs, as a surrogate for the hormonal surge seen in spontaneous menstrual cycles, to control the timing of ovulation and the timing of sexual intercourse. Ovulation triggers given without reliable evidence of oocyte maturity could be inappropriately timed; they increase costs, and the need to time intercourse precisely after the ovulation trigger is given adds to psychological stress.This is an update of a Cochrane review first published in Issue 3, 2008, of the Cochrane Database of Systematic Reviews. OBJECTIVES: To determine the benefits and harms of administering an ovulation trigger to anovulatory women receiving treatment with ovulation-inducing agents in comparison with spontaneous ovulation following ovulation induction. SEARCH METHODS: We updated searches of the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to November 2013. We checked conference proceedings, trial registries and reference lists and contacted researchers. SELECTION CRITERIA: Parallel-group, randomised, controlled trials (RCTs) evaluating the administration of an ovulation trigger to anovulatory women receiving treatment with ovulation-inducing agents. DATA COLLECTION AND ANALYSIS: We independently assessed trial eligibility and trial quality and extracted data. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous data and used the random-effects model in meta-analyses when significant heterogeneity was present. We assessed overall quality of the evidence by using the GRADE approach. MAIN RESULTS: No new trials were identified. This review includes two RCTs with low risk of bias that compared urinary human chorionic gonadotrophin (hCG) versus no treatment in anovulatory women receiving clomiphene citrate. Urinary hCG did not result in an increase in live birth rate over no hCG (OR 0.97, 95% CI 0.52 to 1.83; two trials, 305 participants, I(2) = 16%; low-quality evidence), but very serious imprecision around the effect estimate reduces our confidence in the apparent lack of effect of hCG as an ovulation trigger in clomiphene-induced cycles in anovulatory women.Among this review's secondary outcomes, urinary hCG may not increase ovulation rate (OR 0.99, 95% CI 0.36 to 2.77; two trials, 305 participants, I(2) = 55%; low-quality evidence), clinical pregnancy rate (OR 1.02, 95% CI 0.56 to 1.89; two trials, 305 participants, I(2) = 35%; low-quality evidence) or miscarriage rate in pregnant women (OR 1.19, 95% CI 0.17 to 8.23; two trials, 54 participants, I(2) = 0%; low-quality evidence). Multiple pregnancies and preterm deliveries were uncommon, and ovarian hyperstimulation syndrome, adverse events and deaths were not reported as outcomes in either trial. We found no trials evaluating other ovulation triggers. AUTHORS' CONCLUSIONS: Evidence is inadequate to recommend or refute the use of urinary hCG as an ovulation trigger in anovulatory women treated with clomiphene citrate. We found no trials evaluating the use of ovulation triggers in anovulatory women treated with other ovulation-inducing agents.

Minimally invasive versus open surgery for reversal of tubal sterilization.

BACKGROUND: Although tubal sterilization procedures are considered to be permanent, requests for reversal of the procedure (re-canalisation) are not infrequent. The reversal procedure can be done either by an open laparotomy or by minimally invasive surgery (laparoscopic or robotic approach). OBJECTIVES: To compare the relative effectiveness and safety of reversal of tubal sterilization by open laparotomy, laparoscopy and robotically assisted endoscopy. SEARCH METHODS: On 23 October 2012 we searched the Cochrane Menstrual Disorders and Subfertility Review Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 10, 2012); MEDLINE; EMBASE; LILACS; clinical trials registries; regional databases; conference proceedings; and references for relevant published, unpublished and ongoing trials. SELECTION CRITERIA: Randomised trials comparing the different methods of surgical reversal of tubal sterilisation. DATA COLLECTION AND ANALYSIS: No trials that met the selection criteria were identified. MAIN RESULTS: No data for evaluation were obtained AUTHORS' CONCLUSIONS: Currently there is no evidence from randomised controlled trials to recommend or refute the use of a minimally invasive surgical approach (laparoscopic or robotic) or open surgery for reversal of tubal sterilization. There is a need for well conducted and reported randomised clinical trials to generate reliable evidence to inform clinical practice.

Affordable ART: a different perspective.

BACKGROUND: Although ≈ 10% of the population is affected by infertility, the treatment option of in-vitro fertilisation (IVF) remains unaffordable for the majority of infertile couples. We have initiated a lowcost programme incorporating an uncommonly used, but recognized, ovarian stimulation protocol, together with certain costlimiting initiatives in an established assisted reproductive technology (ART) set up. METHODS: The medical records of women who underwent the lowcost programme were analysed. Clomiphene citrate 50 mg daily was administered from Day 2 of the cycle and continued till the day of hCG trigger, thus preventing the LH surge. Intermittent doses of human menopausal gonadotrophin 150 IU were administered on alternate days from the 5th day onwards. Oocyte retrieval was carried out once at least two follicles of >18 mm were identified. The cycle was monitored by ultrasound only, with embryo transfer being carried out on Day 3. Clinical outcomes were recorded together with an estimation of the direct costs per cycle. Direct cost calculations did not include professional charges or facility costs. RESULTS: Of 143 women evaluated, 104 women underwent embryo transfer. The live birth rate and clinical pregnancy rate per embryo transfer were 19 and 22%. The live birth rate per initiated cycle was 14% (20/143). The multiple pregnancy rate was 26% with no case of ovarian hyperstimulation syndrome being recorded. The average direct cost per cycle was US$ 675 for IVF and US$ 725 for an ICSI treatment cycle. CONCLUSIONS: Using this protocol, together with several costcutting measures, we achieved an acceptable live birth rate per transfer of 19% at a reasonable cost. This approach could be used by established ART centres to provide treatment to couples who cannot afford conventional ART.

Letrozole or clomiphene citrate as first line for anovulatory infertility: a debate.

Clomiphene citrate has been traditionally used as the drug of choice in treating women with anovulatory infertility. In the last decade letrozole, an aromatase inhibitor has emerged as alternative ovulation induction agent. Literature confirms that letrozole has a definitive role in anovulatory women who have not responded to the clomiphene therapy. However its role as an alternative to clomiphene as first line therapy continues to be debated. Although it is probable that the overall benefits of letrozole surpass clomiphene citrate, currently available data does not confirm this view. There is need for large well-designed trials.

Ovulation triggers in anovulatory women undergoing ovulation induction.

BACKGROUND: Anovulation is a common cause for infertility. Drugs used to treat anovulation include selective estrogen receptor modulators, aromatase inhibitors and gonadotrophins. Ovulation triggers are used with these drugs, in order to time intercourse. Ovulation triggers without reliable evidence of oocyte maturity could be inappropriately timed, increase costs and psychological stress. This review evaluates different ovulation triggers used when treating anovulatory women with ovulation inducing agents compared to spontaneous ovulation. OBJECTIVES: To determine the efficacy of administering an ovulation trigger compared to spontaneous ovulation in anovulatory women being treated with ovulation inducing agents. SEARCH STRATEGY: We searched the Menstrual Disorders and Subfertility Group Trials Register (August week 1 2007), Cochrane Central Register of Controlled Trials (CENTRAL Cochrane library issue 3 2007) and the electronic databases MEDLINE (1950 July week 4 2007), EMBASE(1980 to week 31 2007) and CINAHL (1982 to August week 1 2007) for studies in all languages. SELECTION CRITERIA: Randomised controlled trials (RCT). DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, assessed quality and extracted data. Disagreement was resolved by discussion with the third author and by contacting trial authors. Categorical data were analysed using relative risks and their 95% confidence intervals. A random effects model was used in the presence of significant heterogeneity. MAIN RESULTS: Two RCTs comparing urinary hCG versus no treatment in anovulatory women receiving clomiphene citrate were identified. Urinary hCG did not result in increases in the primary outcome of live birth rate over no treatment { OR 0.98, 95% CI 0.52 to 1.83}.Among the secondary outcomes, urinary hCG did not increase ovulation rate ( OR 0.95, 95% CI 0.49 to 1.83), clinical pregnancy rate (OR 1.02, 95% CI 0.56 to 1.88), multiple pregnancy rate (OR 0.47, 95% CI 0.05 to 4.59), miscarriage rate( OR 1.18, 95% CI 0.18 to 7.66) and preterm delivery (OR 0.12,95% CI 0.00 to 6.29) compared to no treatment. Trials evaluating other ovulation triggers were not identified. AUTHORS' CONCLUSIONS: There is inadequate evidence to recommend or refute the use of urinary hCG, as an ovulation trigger, in anovulatory women being treated with clomiphene citrate. We did not find trials evaluating the use of ovulation triggers in anovulatory women, being treated with other ovulation inducing agents.

Local endometrial injury in women with failed IVF undergoing a repeat cycle: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of local endometrial injury in women undergoing in vitro fertilization (IVF) with at least one previous unsuccessful attempt. STUDY DESIGN: Randomized controlled trial. Recruited women were randomized into two groups. In group A (pipelle group), women underwent pipelle biopsy twice in the luteal phase in the cycle prior to IVF. In group B (control), women did not undergo any intervention prior to IVF. The primary outcome was clinical pregnancy rate. The secondary outcomes included live birth, miscarriage, multiple pregnancy and preterm delivery rates. RESULTS: One hundred and eleven women were included in the study with 55 in the pipelle group and 56 in the control arm. The baseline clinical characteristics were similar in both groups. The clinical pregnancy rates were not significantly different between pipelle and control group (34.09% vs. 27.65%; Odds ratio, OR 1.35, 95% confidence interval, CI 0.55-3.30). The live birth (31.81% vs. 25.53%; OR 1.36, 95% CI 0.55-3.39), multiple pregnancy (33.33% vs. 61.54%; OR 0.31, 95% CI 0.07-1.47), miscarriage (6.66% vs. 7.69%; OR 0.86, 95% CI 0.05-15.23) and preterm delivery rates (35.71% vs. 66.66%; OR 0.28, 95% CI 0.05-1.4) were also not significantly different between the two groups. CONCLUSION: Current study did not find any improvement in IVF success rates following endometrial injury in woman undergoing IVF after previous failed attempt.

Prevalence of chromosomal abnormalities and Y chromosome microdeletion among men with severe semen abnormalities and its correlation with successful sperm retrieval.

AIM: To estimate the prevalence of chromosomal abnormalities and Y chromosome microdeletion among men with azoospermia and severe oligozoospermia and its correlation with successful surgical sperm retrieval. SETTING AND DESIGN: A prospective study in a tertiary level infertility unit. MATERIALS AND METHODS: In a prospective observation study, men with azoospermia and severe oligozoospermia (concentration <5 million/ml) attending the infertility center underwent genetic screening. Peripheral blood karyotype was done by Giemsa banding. Y chromosome microdeletion study was performed by a multiplex polymerase chain reaction. RESULTS: The study group consisted of 220 men, 133 of whom had azoospermia and 87 had severe oligozoospermia. Overall, 21/220 (9.5%) men had chromosomal abnormalities and 13/220 (5.9%) men had Y chromosome microdeletions. Chromosomal abnormalities were seen in 14.3% (19/133) of azoospermic men and Y chromosome microdeletions in 8.3% (11/133). Of the 87 men with severe oligozoospermia, chromosomal abnormalities and Y chromosome microdeletions were each seen in 2.3% (2/87). Testicular sperm aspiration was done in 13 men and was successful in only one, who had a deletion of azoospermia factor c. CONCLUSIONS: Our study found a fairly high prevalence of genetic abnormality in men with severe semen abnormalities and a correlation of genetic abnormalities with surgical sperm retrieval outcomes. These findings support the need for genetic screening of these men prior to embarking on surgical sperm retrieval and assisted reproductive technology intracytoplasmic sperm injection.

Factors predicting the outcome of intracytoplasmic sperm injection for infertility.

BACKGROUND: Male factor abnormality is the cause of infertility in about 20%-40% of infertile couples. Assisted reproduction with intracytoplasmic sperm injection is the only treatment option for severe forms of andrological infertility. METHODS: We retrospectively analysed patients who had had intracytoplasmic sperm injection for male factor infertility. The clinical and laboratory factors that influenced the pregnancy rate were also analysed. RESULTS: One hundred and seventy-five cycles in 164 couples were analysed. The fertilization, cleavage and pregnancy rates were similar in the groups that had had intracytoplasmic sperm injection with epididymal, testicular or ejaculate sperm. Univariate analysis of the clinical variables showed progressive reduction in pregnancy rate with increase in the woman partner's age and body mass index, and presence of pelvic disease, but these were not statistically significant. The age of the woman was the most significant factor affecting the pregnancy rate after adjusting for body mass index and pelvic disease in the multivariate analysis (OR 0.26, 95% CI: 0.08-0.84, p=0.03). The oocyte number, embryo transfer number and transfer day had no significant influence on the outcome. CONCLUSION: The woman partner's age influences the success of assisted reproduction with intracytoplasmic sperm injection in male factor infertility. Thus, the chances of success are better if the couple seeks treatment at an early age.

Effectiveness of GnRH antagonist in intrauterine insemination cycles.

OBJECTIVE: To evaluate the effectiveness of GnRH antagonists in women undergoing controlled ovarian stimulation and intrauterine insemination cycles (COS/IUI). STUDY DESIGN: Randomized controlled trial. Recruited women were randomized into two groups: GnRH antagonist and control group. The primary outcomes were incidence of premature LH surge and clinical pregnancy rates. RESULTS: One hundred and forty-one consecutive women were included in the study, with 70 in the antagonist group and 71 in the control arm. The baseline clinical characteristics were similar in both groups. The incidence of premature LH surge and premature luteinization was lower in the antagonist group as compared to the control group (5% vs. 10.3%, P=0.45 and 5% vs. 13.8, P=0.31) but not statistically significant. The clinical pregnancy rates were lower in the antagonist group (2.8% vs. 10%, P=0.12), which was also not statistically significant. CONCLUSION: The addition of GnRH antagonist during controlled ovarian stimulation and intrauterine insemination cycles does not lead to improvement in clinical pregnancy rates.

Comparison of clinical outcomes following vitrified warmed day 5/6 blastocyst transfers using solid surface methodology with fresh blastocyst transfers.

OBJECTIVES: The literature regarding clinical outcomes following day 5/6 vitrified warmed blastocysts transfer has been conflicting. We decided to evaluate and compare the clinical outcomes following vitrified warmed day 5/6 blastocyst transfer using a solid surface vitrification protocol with fresh blastocyst transfers. SETTINGS: University teaching hospital. STUDY DESIGN: A total of 249 women were retrospectively analyzed: 146 fresh day 5 blastocyst (group 1), 57 day 5 vitrified warmed blastocyst (group 2), and 46 vitrified warmed day 6 blastocyst (group 3) transfer cycles. Vitrification was done using solid surface methodology (non immersion protocol). The main outcomes were implantation rates, clinical pregnancy, and live birth rate per embryo transfer. RESULTS: The baseline clinical characteristics were similar among all three groups. The implantation and clinical pregnancy rates following vitrified warmed day 6 blastocyst transfers (20.9% and 32.6%) were significantly lower as compared to day 5 fresh and vitrified warmed day 5 blastocyst transfers (40.3% and 56.1%, 36.3%, and 52.6%). However, there was no significant difference in the live birth rates across the three groups (group 1: 37.6%, group 2: 40.3%, and group 3: 28.2%). CONCLUSION: No statistically significant difference was observed in live birth rates between fresh day 5 blastocyst transfers and vitrified warmed day 5/6 blastocyst transfers. Vitrification of blastocysts using solid surface methodology is an efficient method of cryopreservation.

Prevalence of metabolic syndrome in women with polycystic ovary syndrome attending an infertility clinic in a tertiary care hospital in south India.

OBJECTIVE: The aim of the present study was to evaluate the prevalence of metabolic syndrome in women with polycystic ovary syndrome (PCOS). SETTING: Infertility clinic in a tertiary care hospital. STUDY DESIGN: A prospective cross-sectional study. MATERIALS AND METHODS: All the women attending the infertility clinic categorized as polycystic ovary syndrome according to Rotterdam criteria (2003) during the study period were included in the study. The women with PCOS underwent screening for metabolic syndrome as defined by the modified American Heart Association/National Heart Lung Blood Institute (AHA/NHLBI) modified ATP 111 (2005) definition. A multivariate logistic regression analysis was applied and significant predictors identified for the prediction of metabolic syndrome. RESULTS: The overall prevalence of metabolic syndrome according to the modified AHA/NHLBI ATP III (2005) criteria was 37.5%. A total of 5.8 % cases were detected to have diabetes mellitus, 8.3% had impaired fasting glucose, and 11.7 % had an impaired glucose test. Dyslipidemia was present in 93.3% cases of PCOS. Among all the risk factors, age and waist hip ratio ≥0.85 were strongly associated with the presence of metabolic syndrome. CONCLUSION: Infertile women with PCOS, particularly those with age ≥25 years or with central obesity (a waist hip ratio of ≥0.85), are at a higher risk of developing metabolic syndrome and should be offered screening tests.

Blastocyst cryopreservation using solid surface vitrification: A preliminary study.

OBJECTIVE: The objective was to evaluate the effectiveness of a blastocyst cryopreservation program using solid surface vitrification. SETTING: This study took place in a university teaching hospital. STUDY DESIGN: Retrospective observational study. MATERIALS AND METHODS: Women undergoing frozen embryo transfer cycles over a 4-year period between 2006 and 2010 were studied. The cryopreservation policy followed was a vitrification protocol performed at the blastocyst stage, using a solid surface (nonimmersion) method. The post-thaw survival rate, implantation rate, clinical pregnancy rate, live birth rate, and neonatal outcome were recorded. RESULTS: Eighty-one women underwent 86 frozen embryo transfer cycles. Of the 240 blastocysts warmed, 204 survived giving a cryosurvival rate of 85% (204/240). The clinical pregnancy, implantation, miscarriage, ongoing pregnancy, and live birth rates per transfer were 47%, 29%, 12%, 16%, and 23% respectively. Of the 20 live births, there were 16 singletons and 4 twins. Eleven boys and 13 girls were delivered with no major or minor abnormality detected. CONCLUSION(S): The blastocyst vitrification protocol using the solid surface method is effective with results comparable to fresh blastocyst transfers. While retaining the rapid cooling effect, the nonimmersion technique eliminates the risk of contamination and disease transmission. Larger studies with long-term follow-up data would further confirm the efficacy and safety of this method of vitrification.

Fertility and age.

The changing social scenario together with economic growth and an increase in job opportunities has to a great extent reduced gender inequality and has resulted in more and more older women seeking help from infertility clinics. Fertility and aging have always been closely linked and the age of the female partner remains the single most important factor in predicting success with treatment. Although tests for the ovarian reserve are an important informative tool and are helpful in selecting treatment options, they are poor predictors of the outcome.

Aromatase inhibitors in women with clomiphene citrate resistance: a randomized, double-blind, placebo-controlled trial.

In 36 women with polycystic ovary syndrome and clomiphene citrate resistance, letrozole, an aromatase inhibitor, statistically significantly increased the ovulation rate by 33.3% in the treatment group, indicating that letrozole can be used as an effective and simple alternate ovulation-inducing agent in these women.

Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome.

OBJECTIVE: To determine the predictive factors for pregnancy after controlled ovarian hyperstimulation (COH)/intrauterine insemination (IUI). DESIGN: Prospective observational study. SETTING: University-level tertiary care center. PATIENTS AND METHODS: 366 patients undergoing 480 stimulated IUI cycles between November 2007 and December 2008. INTERVENTIONS: Ovarian stimulation with gonadotrophins was initiated and a single IUI was performed 36 h after triggering ovulation. MAIN OUTCOME MEASURES: The primary outcome measures were clinical pregnancy and live birth rates. Predictive factors evaluated were female age, duration of infertility, indication for IUI, number of preovulatory follicles, luteinizing hormone level on day of trigger and postwash total motile fraction (TMF). RESULTS: The overall clinical pregnancy rate and live birth rate were 8.75% and 5.83%, respectively. Among the predictive factors evaluated, the duration of infertility (5.36 vs. 6.71 years, P = 0.032) and the TMF (between 10 and 20 million, P = 0.002) significantly influenced the clinical pregnancy rate. CONCLUSION: Our results indicate that COH/IUI is not an effective option in couples with infertility due to a male factor. Prolonged duration of infertility is also associated with decreased success, and should be considered when planning treatment.

A rare case report: ovarian heterotopic pregnancy after in vitro fertilization.

OBJECTIVE: To report a case of ovarian heterotopic pregnancy after an IVF cycle. DESIGN: Case report. SETTING: Reproductive medicine unit, Christian Medical College Hospital, Vellore, India. PATIENT(S): A woman with an ovarian heterotopic pregnancy. INTERVENTION(S): Laparoscopic removal of ovarian ectopic pregnancy. MAIN OUTCOME MEASURE(S): Early detection and successful treatment of heterotopic pregnancy. RESULT(S): Successful laparoscopic management of ovarian pregnancy resulting in a single viable ongoing intrauterine pregnancy. CONCLUSION(S): Clinicians need to be aware of such rare and potentially fatal presentations after IVF, because early diagnosis and management in these cases can yield a favorable outcome.

Symptomatic unilateral pleural effusion: A rare presentation of ovarian hyperstimulation syndrome.

Isolated pleural effusion is a rare presentation of ovarian hyperstimulation syndrome. The pathogenesis of this disorder has not been fully elucidated. It supports the role of systemic factors rather than transudation of fluid from the surface of enlarged ovaries. This article describes a rare case of isolated pleural effusion following controlled ovarian hyperstimulation during an in-vitro fertilization cycle.

Blastocyst stage transfer vs cleavage stage embryo transfer.

OBJECTIVE: To evaluate the efficacy of blastocyst transfer in comparison with cleavage stage embryo in a similar cohort of women. DESIGN: Retrospective analysis. SETTING: University teaching hospital. MATERIALS AND METHODS: Women aged 35 or less undergoing in vitro fertilization/intracytoplasmic sperm injection between January 2005 and December 2006 were included in the study. When four or more grade 1 embryos were observed on day 3, extended culture till day 5 was undertaken. This policy was compared with a cohort of women who had at least three grade 1 embryos on day 3 and who had undergone a cleavage stage embryo transfer during the time period of January 2002-December 2004. Primary outcome evaluated was implantation rate and clinical pregnancy rate. RESULTS: Group 1 consisted of 50 women who underwent extended culture and blastocyst transfer. Group 2 comprised of 85 women who had cleavage transfer. The implantation rate for embryos transferred in group 1 was significantly higher than that for embryos transferred on day 3 (40.16% vs 11.43%). The clinical pregnancy rate was also significantly better with blastocyst transfer as compared with cleavage stage transfer (62% vs 29.76%). Significantly fewer embryos were required for transfer at the blastocyst stage compared with day 3 transfer (2.54 vs 3.45). CONCLUSION: In selected cases, blastocyst transfer with fewer embryos can be performed with high implantation and clinical pregnancy rates. This policy could lead to a reduction in the incidence of higher-order pregnancies.