J. Gebhardt

Accuracy of day 3 criteria for selecting the best embryos

OBJECTIVE To assess the accuracy of day 3 morphologic criteria in identifying the best embryos. DESIGN Prospective observational study. SETTING University IVF program. PATIENT(S) One hundred cycles in women desiring blastocyst transfer who had > or =3 eight-cell embryos on day 3. INTERVENTION(S) On day 3, the embryologist chose the two embryos that would have been transferred that day. On day 5, embryos were examined to determine the best and second-best blastocysts. MAIN OUTCOME MEASURE(S) Accuracy of day 3 picks as measured in culture on day 5, outcome of nontransferred picks, and cryopreservation rate. RESULT(S) All cycles reached the blastocyst stage and 73% had cryopreservation. The mean number of blastocysts was 4.8 (3.2 on day 5 and 1.6 on day 6). Neither pick was chosen in 39% of cycles; one pick was transferred in 38%; and both picks were transferred in 23%. Of 116 nontransferred picks, 51 were frozen and 65 arrested, with both picks arresting in 9 cycles. The single best blastocyst was chosen from the picks in 39% of cycles. CONCLUSION(S) Morphologic criteria for cleavage-stage embryo selection may fall short when the transfer is limited to two embryos. Culture to blastocyst is warranted in this population to avoid high-order multiples and still be able to choose the two embryos with the highest implantation potential.

The value of fast blastocoele re-expansion in the selection of a viable thawed blastocyst for transfer

OBJECTIVE To investigate the role of fast blastocoele re-expansion in the selection of viable thawed blastocysts for transfer. DESIGN Retrospective study. SETTING Academic assisted reproductive program. PATIENT(S) Transfer cycles were divided into two groups according to the presence or absence of fast re-expanded blastocysts. In group I (124 cycles), all transferred blastocysts had fast re-expanding blastocoele. In group II (113 cycles), no fast re-expanded blastocysts were included in the transfer. INTERVENTION(S) Blastocyst survival was defined as >50% of cells remaining intact after thaw and re-expansion after culture in vitro for 2-4 hours before transfer. Blastocysts with >or=50% re-expansion were designated as fast re-expanded blastocysts. MAIN OUTCOME MEASURE(S) Percentage of blastomere loss immediately after thaw, degree of blastocoele re-expansion, and clinical outcomes (pregnancy and implantation rates). RESULT(S) The rates of survival and fast blastocoele re-expansion of partially intact blastocysts were significantly reduced as compared with fully intact blastocysts. Significantly higher rates of clinical pregnancy (37.1% vs. 16.8%) and implantation (26.7% vs. 11.3%) were obtained when all transferred blastocysts had fast re-expanding blastocoele as compared with those transfers without fast re-expanded blastocysts included. CONCLUSION(S) Our results showed that blastomere loss of thawed blastocyst was associated with a reduced ability to re-expand. As a discriminative morphologic marker of superior embryo viability, a fast re-expanded blastocyst would be given priority for transfer to better utilize the cryopreserved blastocysts.

Testosterone concentrations in early pregnancy: relation to method of conception in an infertile population

This prospective cohort study of infertility patients compared testosterone concentrations in early pregnancy in infertility patients who conceived naturally or after treatment. Although all groups demonstrated some increase in pregnancy testosterone from baseline concentrations, subjects who conceived following ovulation induction showed a significantly increased rise in testosterone as compared with controls (P<0.01).

Fluorescence staining of nuclear deoxyribonucleic acid allows for accurate assessment of the hamster egg penetration assay**Presented in part at the 40th Annual Meeting of the Pacific Coast Fertility Society, Indian Wells, California, April 8 to 12, 1992.

To improve the assessment of sperm penetration during the hamster penetration assay, we compared the Hoechst 33342 and 33258 DNA-specific fluorescent stains with the standard acetolacmoid stain. The fluorescence stains produced distinct staining of the DNA within the egg cytoplasm and nucleus, and this allowed for accurate and fast assessment of sperm penetration.