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26.05.2008

Newsletter No. 3/2008

Urinary hMG on diploidy rates in preimplantation embryos Ultrasonographic characteristics of the endometrium among patients with fibroids undergoing ART. The relationship between endometrial thickness and outcome of medicated frozen embryo replacement cycles. The effect of legislation on outcomes of assisted reproduction technology: lessons from the 2004 Italian law. 1. Urinary hMG on diploidy rates in preimplantation embryos The aim of this study was to evaluate the effect of ovarian stimulation with LH-containing gonadotropins (human menopausal gonadotropin, hMG), on ploidy of human cleavage-stage-embryos. METHODS: A total of 104 women, at ages 27-43 years, undergoing one cycle of controlled ovarian hyperstimulation for IVF in combination with preimplantation genetic diagnosis, were eligible for enrollment in this retrospective, controlled cohort study. Ovarian stimulation included down-regulation with long agonist and stimulation with either recombinant FSH or hMG. Since the ploidy of embryos changes with female age, patients were matched for age and dosage of the respective gonadotropin. RESULTS: Despite similar numbers of chromosomally normal embryos in both groups, women undergoing hMG stimulation demonstrated significantly higher percentages of diploid embryos than did the FSH-stimulated patients (69.8 versus 45.3%; P < 0.01). CONCLUSIONS: Long protocol LH-containing ovarian stimulation improves embryonic ploidy in comparison to pure FSH stimulation. This observation may explain higher IVF pregnancy rates, reported for hMG stimulation in some studies. Reference Weghofer A, Munné S, Brannath W, Chen S, Tomkin G, Cekleniak N, Garrisi M, Barad D, Cohen J, Gleicher N The impact of LH-containing gonadotropins on diploidy rates in preimplantation embryos: long protocol stimulation. Hum Reprod. 2008 Mar;23(3):499-503. TOP 2. Ultrasonographic characteristics of the endometrium among patients with fibroids undergoing ART. A retrospective cohort study examining all completed nondonor first ART cycles was performed to evaluate the ultrasonographic appearance of the endometrial pattern and thickness at time of hCG administration among precycle screened patients with uterine fibroids compared with patients without fibroids. There was no difference in the endometrial thickness (10.3 +/- 2.0 mm vs. 10.0 +/- 2.6 mm) between those with fibroids and controls; however, the rate of nonproliferative endometrial pattern (3.1% vs. 1.0%) and live birth rates (34.4% vs. 43.0%) were significantly different, most notably among those patients with intramural fibroids. Reference Levens ED, Stegmann BJ, Feinberg EC, Larsen FW. Ultrasonographic characteristics of the endometrium among patients with fibroids undergoing ART. Fertil Steril. 2008 Apr;89(4):1005-7. TOP 3. The relationship between endometrial thickness and outcome of medicated frozen embryo replacement cycles. OBJECTIVE: To examine the relationship between endometrial thickness and outcome of medicated frozen-thawed embryo replacement (FER) cycles. DESIGN: A retrospective observational study. SETTING: Assisted conception unit at a university hospital. PATIENT(S): All patients who underwent an FER cycle between 1997 and April 2006 and met the inclusion criteria. INTERVENTION(S): For endometrial preparation, a daily dose of 6 mg of oral E(2) valerate was started on menstrual day 1, and P pessaries (800 mg daily) were administrated when the endometrial thickness had reached 7 mm or more, with ET taking place 2-3 days later. The FER cycles were categorized according to endometrial thickness measurement on the day of P supplementation. MAIN OUTCOME MEASURE(S): Implantation, clinical pregnancy, ongoing pregnancy, and live birth rates. RESULT(S): In all, 768 consecutive medicated FER cycles were analyzed. The lowest pregnancy rates were associated with endometrial thickness <7 mm (n = 13) and >14 mm (n = 12; 7% in both groups). Significantly higher implantation (19% vs. 12%), clinical pregnancy (30% vs. 18%), ongoing pregnancy (27% vs. 16%), and live birth (25% vs. 14%) rates were achieved in cycles where endometrial thickness was 9-14 mm (n = 386), compared with those in which endometrial thickness was 7-8 mm (n = 357). These differences remained significant after adjusting for confounding variables (adjusted odds ratio [OR] = 1.83 [confidence interval {CI} = 1.3-2.6] for clinical pregnancy, 1.8 [CI = 1.2-2.6] for ongoing pregnancy and 1.9 [CI = 1.3-2.8] for live birth). CONCLUSION(S): In medicated FER cycles, an endometrial thickness of 9-14 mm measured on the day of P supplementation is associated with higher implantation and pregnancy rates compared with an endometrial thickness of 7-8 mm. Reference El-Toukhy T, Coomarasamy A, Khairy M, Sunkara K, Seed P, Khalaf Y, Braude P. The relationship between endometrial thickness and outcome of medicated frozen embryo replacement cycles. Fertil Steril. 2008 Apr;89(4):832-9. TOP 4. The effect of legislation on outcomes of assisted reproduction technology: lessons from the 2004 Italian law. OBJECTIVE: To evaluate the effect of the 2004 Italian regulations (insemination of <or=3 oocytes/cycle, transfer of all embryos, prohibition of embryo cryopreservation) on outcomes of assisted reproduction treatment (ART). DESIGN: Case-control study. SETTING: The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. PATIENT(S): Women undergoing ART for the first time. INTERVENTION(S): Comparing outcomes of ART between 2 years before (n = 900) and after (n = 936) the laws implementation (March 10, 2004). MAIN OUTCOME MEASURE(S): Rates of fertilization, pregnancy, "take-home baby," and multiple pregnancies. RESULT(S): During the pre-law period, statistically significantly more patients reached embryo transfer (odds ratio 1.9; 95% CI, 1.5, 2.5), and embryo transfer rate per cycle was statistically significantly higher (3.1 +/- 1.7 vs. 2.2 +/- 0.7), but the overall transfer of good embryos was lower (OR 0.6; 95% CI, 0.5, 0.8). The pregnancy rates per aspiration cycle were similar between the periods, but the pregnancy rate per embryo transfer and birth rate with at least one liveborn baby per embryo transfer were statistically significantly lower in the pre-law period (OR 0.7; 95% CI, 0.5, 0.9). The multiple births rate was not different between the two periods. CONCLUSION(S): In contrast to prior pessimistic expectations, the obligation to transfer all available embryos produced from Reference La Sala GB, Villani MT, Nicoli A, Valli B, Iannotti F, Blickstein I. The effect of legislation on outcomes of assisted reproduction technology: lessons from the 2004 Italian law. Fertil Steril. 2008 Apr;89(4):854-9. TOP

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