Search

Introduction: Female fecundity is known to decline with age. Declining oocyte quality and quantity is known to be a major contributor. Uterine factors are also thought to contribute to the causes of female infertility. The question arises as to whether the ageing uterus of older women contributes to declining fertility. The objective of the study is to compare the clinical pregnancy, delivery and implantation rate per embryo transfer in patients with young uterine age using their own oocytes and patients with advance uterine age using donor oocytes. Materials/Methods: A retrospective analysis was undertaken of 21 donor cycles (group A) and 42 own-oocyte cycles (group B) done at the TMC Fertility Centre (formerly the Damansara Fertility Centre) in the year 2006. The criteria for patient selection were normal uterus with regular trilaminar endometrium pattern and endometrium thickness of 7 mm or more. Patients with an abnormal uterus such as bicornuate, submucous fibroids and polyps were excluded from the data. These criteria were determined from ultrasound scanning. Results: The mean age of the oocytes in group A was 26.3 and in group B was 27.3. There was no significant difference between the mean age of the two groups (P > 0.05). The age range for donors in group A and patients in group B was 23 to 29 years old. The age range for recipients in group A was 37 to 49 years old, with a mean of 43.2. The clinical pregnancy rate (PR), delivery rate (DR) and implantation rate (IR) for group A and group B were 73.7%, 63.2% and 47.3% and 52.6%, 44.7% and 34.1%, respectively. The PR, DR and IR appear higher in the older patients but none of the comparisons was statistically significant (P = 0.106, P = 0.151 and P = 0.08 respectively). Conclusions: Based on the results obtained, despite a more advanced recipients' age, the clinical pregnancy, delivery and implantation rates were as good if not better compared with women using their own oocytes. This study shows that pregnancy outcome is not compromised by the age of the uterus, provided the uterus appears normal on ultrasound assessment. [ABSTRACT FROM AUTHOR]

Introduction: Blastocyst culture has been associated with higher implantation rates (IR) and pregnancy rates (PR). This could be explained by the synchrony between the endometrial and embryo development. However, prolonged culture to the blastocyst stage is associated with a high attrition rate of embryos. This could be because many of the embryos in the cleavage stage are actually abnormal embryos. Thus, these embryos could not survive sustained culture to blastocysts. This could also explain in part, the higher IR and PR associated with blastocyst culture. We wanted to evaluate the potential for blastocyst culture to reduce chromosomally abnormal embryos. Materials/Methods: This was a retrospective study performed in the TMC Fertility Centre (formerly known as Damansara Fertility Centre, Malaysia), involving 192 ART and PGD cases done between 1 January 2006 to 31 December 2007. All the embryos were biopsied and analysed using 5-probe fluorescence in-situ hybridization (FISH) for chromosomes 13, 18, 21, X and Y. All cleavage stage embryos with satisfactory quality (6 to 12 cells, less than 15% fragmentation) at 65 to 70 h post insemination were biopsied and a single cell was removed for chromosome analysis. Embryos that were not suitable for biopsy during the cleavage stage, either due to early compaction or suboptimal embryo quality, were cultured to the blastocyst stage. Biopsies of blastocysts were done at 132 to 137 h post insemination for blastocysts graded higher than BG3 BB. About three to eight trophectoderm cells were removed from each blastocyst. The aneuploidy rate for blastomeres derived from cleavage stage embryos was compared with the results obtained from trophectoderm cells collected from the blastocysts. Results: A total of 766 embryos were biopsied. Five hundred and ninety five embryos had a biopsy done at the cleavage stage. Of these, 294 (49.4%) were found to be normal while 301 embryos (50.5%) showed aneuploidy. In the blastocyst group, 171 blastocysts were biopsied. Of these, 106 blastocysts (62%) were normal and 65 (38%) showed aneuploidy. There was a significant reduction in aneuploidy rates in the blastocysts group (P < 0.005). The overall clinical pregnancy rate for all ART with PGD cases for 2006 was 51.0%, the delivery rate was 43.1% and the IR was 44.0% Conclusions: Prolonged culture of embryos to the blastocyst stage helps to improve the selection of chromosomally normal embryos for transfer. [ABSTRACT FROM AUTHOR]

Introduction: Preimplantation genetic diagnosis (PGD) by detecting aneuploidy, allows us to choose healthy embryos for transfer, thus reducing miscarriage rates. By the same token, PGD should also theoretically produce an increase in implantation rates (IR). There is also a possibility that the process of biopsy might in fact help in embryo hatching and thus increase the implantation rate of the embryos. On the other hand the possible benefit might be countered by the stress encountered by the embryos itself during biopsy and handling. The objective of this study was to evaluate the IR for embryos that had PGD compared with those without PGD. Materials/Methods: This was a retrospective review. The embryos from all patients undergoing ART in the TMC Fertility Centre, Malaysia (formerly Damansara Fertility Centre, Malaysia) from 1 January to 31 December 2006 were included in this study. Since aneuploidy rates increase with age, patients were divided into two age groups, patients aged <38 years compared with those ge;38 years. PGD was either performed on day 3, day 5 or day 6. In the cleavage stage embryos, only one blastomere was biopsied, whereas in the blastocysts, 3-5 trophectoderm cells were biopsied. All specimens were fixed and hybridized for aneuploidy screening for chromosomes 13, 16, 18, 21, 22, X and Y. Embryos with no abnormalities detected by PGD were selected for transfer. The authors defined IR as the number of gestational sacs seen on ultrasonography among all the embryos that were transferred into the uterus. Results: The mean age was comparable for patients aged <38, i.e. 32.3 (PGD) and 31.9 (non-PGD). Similarly the mean age was also comparable for patients aged ge;38, i.e. 40.1 versus 40.4 for the PGD and non-PGD groups, respectively. A total of 1224 embryos were analysed. Of these, 91 embryos had PGD while the remaining 1133 embryos did not undergo PGD. PGD was done for 71 embryos in the <38 age group and 20 embryos in the ge;38 age group. The IR in the PGD group was significantly higher than in the non-PGD group (44% versus 28.2%; P < 0.05). When stratified for age, in patients aged <38 the IR was significantly higher in the PGD group compared with the non- PGD group (49.3% versus 33.1%; P < 0.05). In the ge;38 age group, there was no significant difference in the IR between the two groups (25% versus 15.3%; P = 0.195), although there was a trend towards higher IR in the PGD group. It is possible that in the ge;38 age group, the failure to demonstrate statistical significance could be due to the small sample size. Conclusions: The IR for embryos with PGD were higher compared with those without PGD. [ABSTRACT FROM AUTHOR]