Factors predicting outcome in 215 consecutive thawed embryo replacements**Presented at The Canadian Fertility and Andrology Society Annual Meeting, Kananaskis, Alberta, Canada, November 24 to 28, 1992

The effect of elevated serum estradiol levels on the day of human chorionic gonadotropin injection on pregnancy outcomes in an assisted reproduction program

BACKGROUND

Women who have a high estradiol level on the day of human chorionic gonadotropin injection are considered to have their in vitro fertilisation treatments compromised. How this really affects the pregnancy rates needs to be questioned.

AIM

To determine if elevated serum estradiol levels on the day of human chorionic gonadotropin injection have a deleterious effect on clinical and ongoing pregnancy rates in an assisted reproduction program.

METHODS

A retrospective analysis was done of women with estradiol levels higher than 10,000 pmol/L and women with estradiol levels between 8000-10,000 pmol/L on the day of ovulation trigger undergoing in vitro fertilisation treatment at the Fertility Unit of the Royal Prince Alfred Hospital, University of Sydney, Australia. Pregnancy rates were compared for those having fresh embryo transfers and those having frozen thawed embryo transfers in subsequent cycles.

RESULTS

There was no difference between the groups in terms of clinical and ongoing pregnancy rates.

CONCLUSION

Frozen thawed embryos obtained from controlled ovarian hyperstimulation cycles resulted in similar clinical and ongoing pregnancy rates as those obtained in previous fresh embryo transfer cycles.

Relationship between peak serum estradiol levels and treatment outcome in in vitro fertilization cycles after embryo transfer on day 3 or day 5

OBJECTIVE

To examine the relationships between peak serum estradiol (E(2)) levels and treatment outcome in in vitro fertilization (IVF) cycles after embryo transfer (ET) on day 3 or day 5.

DESIGN

Retrospective analysis of 697 IVF-ET cycles between January 1999 and December 2001.

SETTING

A university-affiliated assisted reproduction program.

PATIENT(S)

Infertile patients undergoing IVF-ET cycles.

INTERVENTION(S)

Peak E(2) concentration in serum was determined on the day of human chorionic gonadotropin (hCG) administration. The IVF-generated embryos were cultured for 2 days until transfer on day 3. If more than four 8-cell embryos were present on day 3, embryo culture was continued until day 5 for blastocyst transfer.

MAIN OUTCOME MEASURE(S)

Clinical pregnancy rates.

RESULT(S)

High peak E(2) levels did not adversely affect treatment outcome. After the cycles were divided according to the day of ET, high peak E(2) levels were associated with improved pregnancy rates after ET on day 5 but not on day 3.

CONCLUSION(S)

Increasing peak E(2) levels in IVF cycles are associated with improved pregnancy rates after ET on day 5.

Cumulative birth rates following cryopreservation of all embryos in stimulated in vitro fertilization (IVF) cycles

OBJECTIVE

To cryopreserve all good-quality embryos available after IVF is one way to avoid an impending hyperstimulation and a more attractive alternative to a couple than cancellation of the cycle. At Sahlgrenska University Hospital this method has been practiced since 1991. The aim of this study was to assess the success rate (defined as childbirth per couple) after IVF treatment including one stimulated cycle, resulting in cryopreservation of all good-quality embryos available, followed by replacement of frozen/thawed embryos in one or more natural cycles.

DESIGN

A cohort of 32 women undergoing one stimulation for IVF between January 1991 and December 1993 where all good-quality embryos were cryopreserved and transferred in a later spontaneous cycle were studied retrospectively. The cumulative childbirth rate per couple was calculated.

RESULTS

A total of 28 women underwent a total of 45 transfers with frozen-thawed embryos. In 4 women no transfer has taken place so far. The clinical pregnancy rate per embryo transfer was 33% (15/45) and per patient 54% (15/28). Three spontaneous abortions occurred giving a cumulative childbirth rate per patient of 39% (11/28). In addition, 6 out of the 28 women still have embryos left in the freezer.

CONCLUSION

Cryopreservation of all good-quality embryos available after IVF is a highly effective alternative to cancellation of a cycle when there is impending hyperstimulation. The use of this approach results in a cumulative childbirth rate per couple of at least 39%. Since only one stimulation was performed, it also seems to be cost effective.