Human Reproduction, Vol 13, 3434-3440, Copyright © 1998 by Oxford University Press
DK Gardner, WB Schoolcraft, L Wagley, T Schlenker, J Stevens and J Hesla
The effectiveness of blastocyst culture and transfer in human in-vitro
fertilization (IVF) was evaluated in a prospective randomized trial in
patients having a moderate to good response to gonadotrophin stimulation.
Embryos were transferred either on day 3 after culture to around the 8-cell
stage in Ham's F-10 medium supplemented with fetal cord serum, or on day 5
after culture to the blastocyst stage in the sequential serum-free media G
1.2 and G 2.2. The pregnancy rates after transfer on day 3 or day 5 were
equivalent, 66 and 71% respectively; however, significantly more embryos
were transferred on day 3 (3.7) than on day 5 (2.2). The number of
blastocysts transferred did not affect the implantation rate, and pregnancy
rates when either two or three blastocysts were transferred were 68 and 87%
respectively. The implantation rate of the blastocysts (50.5% fetal heart
beat) was significantly higher compared to the cleavage stage embryos
transferred on day 3 (30.1%). The percentage of blastocyst development was
not affected by the number of 2-pronuclear embryos, or by maternal age.
Irrespective of the number of blastocysts formed, pregnancy rates were
similar. Furthermore, the pregnancy rate following blastocyst transfer in
patients with 10 or more follicles at the time of human chorionic
gonadotrophin administration was not affected by patient age. More than 60%
of patients having blastocyst culture and transfer had supernumerary
embryos for cryopreservation. The establishment of a pregnancy following
thaw and transfer confirmed the viability of cryopreserved blastocysts
cultured in the absence of serum or co- culture. The ability to transfer
just two blastocysts while maintaining high pregnancy rates will therefore
help to eliminate high order multiple gestations and improve the overall
efficiency of human IVF.
ARTICLES
A prospective randomized trial of blastocyst culture and transfer in in- vitro fertilization
Colorado Center for Reproductive Medicine, Englewood 80110, USA.
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