Melanie R. Freeman

EMBRYO DISPOSITION: CHOICES MADE BY PATIENTS AND DONOR OOCYTE RECIPIENTS

OBJECTIVE To compare final embryo disposition between patients and donor oocyte recipients. DESIGN Retrospective study. SETTING Private infertility practice. PATIENT(S) Patients undergoing IVF with embryo cryopreservation. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Final cryopreserved embryo disposition. RESULT(S) A total of 1,262 patients using autologous oocytes had 5,417 embryos cryopreserved. A majority either used their embryos (39%) or continued storage (35%). Of 364 patients, who did not use their remaining 1,406 embryos, 77 (21%) donated 290 embryos to other infertile couples, 41 (11%) donated 160 embryos for research, and 246 (68%) discarded 956 embryos. Concurrently, 272 donor oocyte recipients had 1,233 embryos cryopreserved. A majority either used their embryos (40%) or continued storage (23%). Of 110 recipients that did not use their remaining 455 embryos, 62 (56%) donated 280 embryos to other infertile couples, 6 (6%) donated 31 embryos for research, and 42 (38%) discarded 144 embryos. CONCLUSION(S) In our patient population, a higher proportion of patients with infertility ultimately used or stored their cryopreserved embryos for future reproduction compared with donor oocyte recipients. However, recipients were much more likely to donate to other infertile couples and less likely to discard their remaining embryos compared with patients.

A cost-effectiveness comparison of embryo donation with oocyte donation.

OBJECTIVE To compare the cost-effectiveness of embryo donation (ED) to that of oocyte donation (OD). DESIGN Calculation of cost-effectiveness ratios (costs per outcome achieved) using data derived from clinical practices. SETTING In vitro fertilization centers and embryo donation programs. PATIENT(S) Infertile couples undergoing oocyte donation or embryo donation. INTERVENTION(S) Oocyte donation or embryo donation cycles. MAIN OUTCOME MEASURE(S) Cost-effectiveness ratios. RESULT(S) For a single cycle, ED is approximately twice as cost-effective as OD, with a cost-effectiveness ratio of

Autologous granulosa cell coculture demonstrates zygote suppression of granulosa cell steroidogenesis**Presented in part at the 51st Annual Meeting of the American Society for Reproductive Medicine. Seattle, Washington, October 7 to 12, 1995.††Supported in part by Physician Scientist Award (AG00566 [D.B.S.] and R01HD31894 [A.L.S.]) from the National Institutes of Health, National Institute on Aging, Bethesda, Maryland.

21,990 per live delivery compared to 40,600 dollars. When strategies of up to three cycles (to achieve one live delivery) are used, ED costs 13,505 dollars per live delivery compared to 31,349 dollars for OD. CONCLUSION(S) Cost-effectiveness is a compelling reason for infertile couples to consider embryo donation.

Coculture of mouse embryos with cells isolated from the human ovarian follicle, oviduct, and uterine endometrium**Supported by Biomedical Research Support, grant #RR 95424 from Vanderbilt University, Nashville, Tennessee, and grant #HD 28128 from The National Institutes of Health, Bethesda, Maryland.††Presented in part at the 47th Annual Meeting of The American Fertility Society, Orlando, Florida, October 19 to 24, 1991.

OBJECTIVE To determine if embryos can modulate steroid hormone production by luteinized granulosa cells. DESIGN Granulosa cells obtained from follicular aspirates were cultured alone or in the presence of a two-pronuclear zygote. The production of E2 and P by these cultures was evaluated by RIA. SETTING In Vitro Fertilization Unit in an academic research environment. PATIENTS Sixteen women undergoing IVF. INTERVENTIONS Standard IVF-ET treatment cycle using leuprolide acetate for pituitary desensitization before hMG or urofollitropin for ovarian stimulation. MAIN OUTCOME MEASURES Estradiol and P concentration in culture media of luteinized granulosa cells alone or granulosa cells cocultured with a two-pronuclear embryo. RESULTS Both E2 and P production by luteinized granulosa cells was reduced when cultured in the presence of an embryo. CONCLUSIONS Human embryos secrete a factor that regulates granulosa cell steroidogenesis.

The influence of oocyte maturity and embryo quality on pregnancy rate in a program for in vitro fertilization-embryo transfer

OBJECTIVE To examine the specificity of somatic cell support by comparing embryonic development during long-term in vitro coculture with feeder cells derived from the human ovarian follicle, oviduct, and endometrium. DESIGN Comparative study of murine embryo development and degeneration during 6 days of in vitro coculture. RESULTS All feeder-cell cultures were beneficial to embryonic development and viability. Few differences were observed between feeder cell types (epithelial or fibroblastic) or cell origin (ovarian follicle, oviductal, or endometrial). Embryos developed to the eight-cell stage in 24 hours whether in coculture (83.6% to 100%) or in media alone (85.2%); however, further development in media alone decreased compared with coculture (15.6% versus 63.4% to 87.7%, plating) and embryo degeneration increased (67.9% versus 5.5% to 19.4%) after 6 days. CONCLUSIONS [1] Coculture of embryos with human reproductive tract cells is beneficial to embryonic development and viability. [2] Human somatic cell support of murine embryos during long-term in vitro coculture is not tissue specific nor dependent on cell type.