Human Reproduction, Vol 12, 1513-1521, Copyright © 1997 by Oxford University Press
J Van der Elst, E Van den Abbeel, S Vitrier, M Camus, P Devroey and AC Van Steirteghem
We investigated whether further in-vitro culture of human multicellular
embryos that survive cryopreservation can select the viable embryos for
transfer. Embryos for cryopreservation were supernumerary multicellular
embryos obtained after in-vitro fertilization (IVF) and intracytoplasmic
sperm injection (ICSI) treatments, with <20% of their volume filled with
anucleate fragments. These had been cryopreserved using a slow-freezing and
slow-thawing protocol with 1.5 M dimethylsulphoxide as the cryoprotectant.
From the start of our cryopreservation programme until September 12, 1994,
the thawing strategy was to thaw frozen embryos up to the exact number
needed for transfer. Embryos for transfer were selected on the basis of
their morphological appearance and embryo transfer to the patient was done
on the day of thawing. From September 12, 1994 onwards we used a more
selective thawing strategy where a cohort of up to a maximum of 12 frozen
embryos per patient is thawed from which embryos of the best morphological
quality, and which are furthest advanced in terms of cleavage after a 24 h
in-vitro culture period in Menezo B2 medium, are selected. We took delivery
rates, embryo implantation rates and birth rates into account to see if
there is any difference between the following three types of transfers
used: 187 transfers exclusively of embryos having continued to cleave after
thawing, 107 mixed transfers of embryos with and without further cleavage
and 53 transfers exclusively of embryos with no further cleavage. The
overall outcome in terms of delivery rate and embryo implantation and birth
rates were not different between the new and the earlier thawing policies
(6.6, 5.2 and 3.6% versus 6.0, 4.1 and 2.7% respectively). Only when a
distinction was made between transfers on the basis of the presence of
embryos with further cleavage, did the advantage of selection on the basis
of cleavage capacity become evident. Significantly higher delivery and
embryo implantation and birth rates (11.2, 7.7 and 6.5% respectively) were
recorded with transfers exclusively of embryos with further cleavage versus
mixed transfers of embryos with and without further cleavage (1.9, 2.9 and
0.6% respectively). Fifty-three transfers exclusively of embryos with no
further cleavage did not lead to any delivery. Our results demonstrate that
selection of human multicellular embryos which survive cryopreservation and
continue to cleave in vitro can significantly improve the delivery rate per
transfer and the implantation rate per transferred embryo.
ARTICLES
Selective transfer of cryopreserved human embryos with further cleavage after thawing increases delivery and implantation rates
Centre for Reproductive Medicine, Dutch-speaking Brussels Free University Hospital, Belgium.
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