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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: 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]

Introduction: To review the outcome of oocyte donation cases at TMC Fertility Centre for the year 2007. Materials/Methods: This is a retrospective analysis of all oocyte donation treatment cycles in the TMC Fertility Centre for 2007. Oocyte donors were assessed according to ASRM guidelines. Oocyte donation was performed for sub-fertile women with low ovarian reserve. The oocyte donors were either known or anonymous (ratio 1:26). Oocyte recipients, except non-cycling women were down-regulated to synchronize with the donor and subsequently received both oestrogen and progesterone for endometrial development. The oocytes collected then underwent IVF or ICSI. Results: A total of 82 oocyte retrievals were done. Of these, 70 cases progressed to embryo transfer. The mean age of oocyte donors was 25.3 (ranging from 18-45 years old) and for the recipients was 41.1 (ranging from 23-53 years old). A total of 181 embryos were transferred, resulting in 69 pregnancy sacs. The mean number of embryos transferred was 2.6 and the implantation rate was 38.1%. There were 45 clinical pregnancies, giving a clinical pregnancy rate per embryo transfer of 64.3%. The ongoing/delivery rate per embryo transfer was 54.3%. Of the 38 ongoing or delivered pregnancies, 23 are singleton (60.5%), 13 sets are twins (34.2%) and two sets are triplets (5.3%). Conclusions: Oocyte donation offers an effective treatment option for sub-fertile women with low ovarian reserve. [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: TMC Fertility Centre, Johor Bahru, Malaysia (TMC) is a small reproductive medicine centre that has been operational since 2005. We wanted to review our annual pregnancy rates. Materials/Methods: This was a retrospective review of all assisted reproduction techniques cycles commenced at TMC from 1 January 2007 until 31 December 2007. Patients were commenced on a long down-regulation protocol starting in the mid-luteal phase. Recombinant FSH (Gonal-F® or Puregon®) was used for stimulation. The criteria for doing intracytoplasmic sperm injection (ICSI) were: poor sperm morphology (<5% Kruger's strict criteria 2004), low sperm count (<3 million/ml after swim-up), low sperm motility (<90% after swim-up), and patients who had less than five follicles retrieved during oocyte retrieval. The embryo transfer was done either on day 2 or day 3 after oocyte retrieval. All the embryo transfers were done according to protocols developed by TMC. Results: For the year 2007, the results for the IVF and ICSI cases, respectively, were as follows: mean patient ages were 31.3 and 32.8 years; the number of cases started were 22 and 101; the number of cases that reached embryo transfer were 21 and 91; the mean number of embryos transferred were 2.8 for both groups; clinical pregnancy rates (CPR) per case started were 59.1% and 38.6%; CPR per case that reached embryo transfer were 61.9% and 42.9%; CPR per embryo transfer for patients aged <37 years old were 63.2% and 49.3%; CPR per embryo transfer for patients aged 37 years old were 50.0% and 20.0%; implantation rates (IR) were 32.8% and 25.3%; IR for patients aged <37 years old were 34.0% and 29.6%; in patients aged 37 years, IR were 20.0% and 8.3% respectively. There were 30 (57.7%) singleton pregnancies, 17 twin (32.7%) pregnancies and five triplet (9.6%) pregnancies. No higher order pregnancies were reported. The incidence of ovarian hyperstimulation syndrome (OHSS) per case started was 8.1%. One patient had severe OHSS. All her embryos were frozen and transferred in a subsequent unstimulated cycle. There were no ectopic pregnancies reported. Conclusion: Satisfactory pregnancy rates were achieved with few complications reported. In view of the high rates of multiple pregnancies, we are moving towards transferring fewer embryos in the future. [ABSTRACT FROM AUTHOR]