Edward F. Fugger

Clinical status of human embryo cryopreservation in the United States of America

This report describes the results with frozen human embryos from 25 member institutions of the Society of Assisted Reproductive Technology with cryopreservation experience before 1989. Two thousand eighty-five patients had a total of 7397 oocytes and pre-implantation embryos frozen. The number of oocytes, zygotes, cleaved embryos, and blastocysts frozen, thawed, transferred, and the resulting number of pregnancies were 463/127/8/0, 2,133/778/540/47, 4,460/1,567/1,089/68, and 341/186/138/3, respectively. The number of embryos transferred per pregnancy and pregnancy rate per transfer for zygotes, cleaved embryos, and blastocysts were 11.5/17.4%, 16.0/12.5%, and 46.0/4.3%, respectively. The average number of frozen-thawed embryos transferred per pregnancy was 15.0 and the average clinical pregnancy rate per transfer was 13.4%. Forty-eight births have resulted in 41 singletons and 7 sets of twins. Of centers reporting frozen-thawed transfers, 54.6% (12/22) have at least one clinical pregnancy and 75.0% (9/12) of centers reporting a pregnancy have at least one birth.

Comparisons of pregnancy loss patterns after intracytoplasmic sperm injection and other assisted reproductive technologies

OBJECTIVE To compare outcome of pregnancies after intracytoplasmic sperm injection (ICSI) with those of other assisted reproductive technologies. DESIGN Pregnancy outcomes after ICSI were followed prospectively and compared with pregnancy outcomes after IVF with fresh and frozen ETs and donor oocyte cycles. SETTING A private tertiary referral center for genetics and infertility in Fairfax, Virginia. PATIENTS One hundred thirty-six couples achieving pregnancy after undergoing ICSI, 71 after IVF, 35 donor oocyte recipients, and 19 after transfer of frozen-thawed embryos. INTERVENTIONS In vitro fertilization and/or ET for all couples. Dilatation and curettage to obtain products of conception for chromosome analysis in 28 women experiencing spontaneous abortion. MAIN OUTCOME MEASURES Pregnancy outcomes were classified as preclinical loss, clinical loss, and ongoing pregnancy. RESULTS The mean frequency of preclinical pregnancy loss was 26% after ICSI, 28% after IVF, 3% after ET using donor oocytes, and 11% after frozen ET. The rate of clinical loss after ICSI (21%) was compared with IVF (18%), donor oocyte cycles (11%), and frozen ETs (21%). CONCLUSIONS Intracytoplasmic sperm injection is not associated with an increase in pregnancy losses, clinical or preclinical, compared with conventional IVF.

Preimplantation Genetic Diagnosis in Marfan Syndrome

The in vitro fertilization technology coupled with the ability to amplify DNA from a single cell has been used for the preimplantation genetic diagnosis of Marfan syndrome. An intragenic FBN1 gene marker has been used to track the inheritance of this disorder in a family. Marker genotyping was established following two rounds of amplification. Whenever possible, two blastomeres were separately assayed per embryo. The transfer of five embryos resulted in a singleton pregnancy and the birth of a full-term male infant.