F.W. Larsen

Blastocyst development rate impacts outcome in cryopreserved blastocyst transfer cycles

OBJECTIVE To assess cycle outcome among day 5 and day 6 cryopreserved frozen-thawed blastocyst embryo transfers (FBET). DESIGN Retrospective cohort study. SETTING Military-based assisted reproduction technology (ART) center. PATIENT(S) One hundred seventy-two nondonor, programmed cryopreserved embryo cycles. INTERVENTION(S) Fully expanded blastocysts on day 5 were cryopreserved on day 5, and those achieving this state on day 6 were cryopreserved on day 6. Leuprolide acetate was given for ovulation inhibition, and endometrial supplementation was by oral and vaginal estradiol. Progesterone in oil was administered, and blastocyst transfer occurred in the morning of the sixth day of progesterone. MAIN OUTCOME MEASURE(S) Implantation, pregnancy, and live-birth rates. RESULT(S) Fresh and frozen cycle characteristics were similar between groups. Day-5 FBET had statistically significantly higher implantation rates (32.2% vs. 19.2%), which remained significant even when adjusting for covariates (odds ratio: 1.91; 95% confidence interval, 1.00, 3.67). Live-birth rates trended toward improvement after adjusting for covariates (odds ratio: 1.18; 95% confidence interval, 0.61, 2.30). CONCLUSION(S) Cryopreserved day-5 blastocysts have higher implantation rates and trend toward improved pregnancy outcomes compared with cryopreserved day-6 blastocysts. This suggests that embryo development rate may, in part, predict implantation and subsequent FBET outcomes, although embryos not achieving the blastocyst stage until day 6 still demonstrate acceptable outcomes.

Ovarian follicular flushing among low-responding patients undergoing assisted reproductive technology

A randomized comparison trial was performed to evaluate whether follicular reaspiration with use of a double-lumen retrieval needle improves oocyte recovery when compared with direct follicular aspiration among low-responding patients undergoing ART. There were no differences observed in the number of oocytes retrieved (single lumen: 6.5 +/- 2.2 oocytes, double lumen: 7.2 +/- 2.3 oocytes) whereas follicular reaspiration with the double-lumen retrieval needle resulted in a twofold increase in procedure time.

Microdose follicular flare: a viable alternative for normal-responding patients undergoing in vitro fertilization?

OBJECTIVE To compare cycle outcomes among normal-responding patients <or=30 years old receiving microdose follicular flare (MDF) and long-luteal agonist (LL). DESIGN Retrospective cohort study. SETTING Military-based assisted reproductive technology (ART) center. PATIENT(S) First autologous ART cycles among 499 women <or=30 years old from January 1999 to December 2005. INTERVENTION(S) After oral contraceptive pill (OCP) administration before cycle start, patients were nonrandomly assigned to either LL or MDF for LH surge suppression. Patients in the LL group received 1 mg/day leuprolide acetate (LA) on cycle day 21, which was reduced to 0.25 mg/day 10-14 days later. Patients in the MDF group received LA (40 microg twice a day) beginning 3 days after discontinuing OCPs. Both groups received a combination of hMG and recombinant FSH. MAIN OUTCOME MEASURE(S) Primary outcomes were implantation, clinical pregnancy, and live-birth rates; in-cycle variables included peak E(2), oocytes retrieved, oocyte maturity, and fertilization rate. RESULT(S) Multivariable models controlling for confounding by treatment indication found no significant differences between groups in implantation (MDF, 36%; LL, 38%), clinical pregnancy (MDF, 53%; LL, 56%), and live-birth rates (MDF, 47%; LL, 50%). No differences were observed in peak E(2), oocytes retrieved, oocyte maturity, fertilization rate, or embryos transferred. CONCLUSION(S) MDF use among normal-responding ART patients produced no differences in cycle outcome when compared with LL. Therefore, MDF may be a viable alternative for normal-responding patients.

Balloon fluoroscopy as treatment for intrauterine adhesions: a novel approach

OBJECTIVE To report a unique fluoroscopically guided approach to treat severe intrauterine adhesions and cervical stenosis using balloon hysteroplasty. DESIGN Case report. SETTING Military-based fertility center. PATIENT(S) A 33-year-old woman undergoing assisted reproductive technology whose uterus could not be cannulated because of the development of intrauterine synechiae and cervical stenosis after a post-IUI infection that was further complicated by a prominent lower uterine segment-filling defect in the location of a prior cesarean delivery scar. INTERVENTION(S) Fluoroscopic cannulation and balloon uterine dilation. MAIN OUTCOME MEASURE(S) Resolution of synechiae by hysterosalpingogram and successful uterine cannulation. RESULT(S) A postprocedure hysterosalpingogram demonstrated a normalized uterine cavity with the exception of a persistent prominent lower uterine segment-filling defect from a prior cesarean delivery. A frozen ET cycle was performed successfully. CONCLUSION(S) Hysteroplasty, using standard interventional radiographic techniques, may provide an alternative treatment modality for patients with intrauterine adhesions and lower uterine defects from prior cesarean deliveries in select cases. While treating intrauterine adhesions improves pregnancy outcome, the effect of lower uterine segment-filling defects from cesarean deliveries on pregnancy outcome in assisted reproductive technology cycles warrants further investigation.