Document Detail


Patient selection criteria for blastocyst culture in IVF/ICSI treatment.
MedLine Citation:
PMID:  20676752     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The development and refinement of blastocyst media in recent years has allowed embryos to be cultured in-vitro for 5 or 6 days post oocyte retrieval and has been established as an effective selection tool to aid embryo selection for IVF treatment. It is generally accepted that blastocyst culture is not an appropriate option for all patients but the criteria for patient selection varies between clinics. Our blastocyst culture programme started in February 2005; the patient criteria was set at a minimum of 4 oocytes retrieved, a minimum of 4 2PN pronuclear embryos and at least 4 8-cell embryos of any quality on Day 3 where the female patient was 34 years and under. In the female age group of 35 years and over the criteria was at least 6 oocytes retrieved, a minimum of 6 2PN pronuclear embryos and at least 6 8-cell embryos of any quality on day 3. Improvements in pregnancy rates demonstrated the effectiveness of blastocyst transfer and clinical opinion was that the criteria should be adjusted to allow this option to be available to an increased patient population. From February 2007 the blastocyst patient selection criteria was changed to at least 4 oocytes retrieved, at least 4 2PN pronuclear embryos and at least 2 8-cell and 2 6-cell or 7-cell embryos of top quality on Day 3 in women 38 years and under. For women 39 years and over the criteria was lowered to at least 5 eggs retrieved, at least 5 2PN and at least 3 8-cell embryos and 2 6-cell embryos of top quality on Day 3.
METHODS: Retrospective statistical analysis was carried out to determine the pregnancy rates, live birth rates and twin rate for the period under the initial criteria and to examine the impact that lowering the criteria for patient selection for blastocyst culture had on these parameters.
RESULTS: There was an overall fall in the ongoing pregnancy/live birth rate from 50.9% under the old criteria to 45.0% under the new criteria. However, the patients who had blastocyst culture under the new criteria but would have had day-3 embryo transfer under the initial criteria had a significantly increased live birth/ongoing pregnancy rate from 22.7% to 40.7%. There is an increase in the number of blastocyst culture cycles from 26.4% under the old criteria to 39.1% with the refined criteria. The twin pregnancy rate was reduced from 25.2% to 17.5%.
CONCLUSION: The result of this cohort study revealed that lowering the blastocyst selection criteria may lead to a lower overall clinical live birth rate from blastocyst culture; however, it will benefit a specific group of patients to achieve a better pregnancy and live birth rate. Furthermore, it increases the number of patients who will benefit from the blastocyst culture programme and also reduces multiple pregnancy rate.
Authors:
M Y Thum; V Wells; H Abdalla
Publication Detail:
Type:  Journal Article     Date:  2010-07-31
Journal Detail:
Title:  Journal of assisted reproduction and genetics     Volume:  27     ISSN:  1573-7330     ISO Abbreviation:  J. Assist. Reprod. Genet.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-10-28     Completed Date:  2011-02-04     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  9206495     Medline TA:  J Assist Reprod Genet     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  555-60     Citation Subset:  IM    
Affiliation:
Lister Fertility Clinic, Lister Hospital, London, UK. mythum@doctors.net.uk
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Blastocyst
Chi-Square Distribution
Cleavage Stage, Ovum
Embryo Culture Techniques*
Female
Humans
Patient Selection*
Pregnancy
Pregnancy Outcome
Pregnancy Rate
Reproductive Techniques, Assisted*
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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