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Introduction of blastocyst culture and transfer for all patients in an in vitro fertilization program
D Marek1, M Langley, D K Gardner
1Center for Assisted Reproduction, Bedford, Texas 76022, USA. delm@embryo.net
Objective:
To evaluate the nonselective application of extended embryo culture on the outcome of IVF.
Design:
Retrospective analysis.
Setting:
Private practice assisted reproductive technology center.
Patient(S):
Seven hundred ninety nonselected patients undergoing IVF with controlled ovarian stimulation.
Intervention(S):
For day 3 ET, multicell embryos were cultured in human tubal fluid medium and 12% synthetic serum substitute. For day 5 ET, embryos were cultured for 48 hours in S1 medium and then for 48 hours in S2 medium.
Main Outcome Measure(S):
Implantation rate (determined by total no. of visualized gestational sacs), ongoing pregnancy rate, and number of embryos available for ET.
Result(S):
Respective day 3 and day 5 implantation rates for patients aged <35 years (29.5% and 38.9%), patients aged 35-39 years (20.7% and 28.2%), and all patients combined (23.3% and 32.4%) were statistically significantly different. Significantly more embryos were transferred on day 3 than on day 5 for patients aged <35 years (2.9 vs. 2.4), patients aged 35-39 years (3.1 vs. 2.6), and all patients combined (3.0 vs. 2.5). The difference in ongoing pregnancy rates per retrieval was statistically significant for day 3 compared with day 5 transfers for all patients combined (35.9% vs. 43.8%). Cancellation rates for transfer after retrieval increased significantly for day 3 compared with day 5 transfer (2.9% vs 6.7%).
Conclusion(S):
These results demonstrate the feasibility of using extended embryo culture in a nonselective manner for couples undergoing IVF. Overall, extended embryo culture was associated with a significant increase in pregnancy rates and implantation rates and a significant decrease in the number of embryos transferred. The rate of multiple implantation among patients aged <35 years warrants consideration of single blastocyst transfers for this group.