Risk of monozygotic twinning with blastocyst transfer decreases over time: an 8-year experience

OBJECTIVE

The purpose of our study is to compare the occurrence of monozygotic twinning (MZT) from blastocyst transfer (BT) in our program between an earlier and more recent time period.

DESIGN

Retrospective.

SETTING

Academic IVF practice.

PATIENT(S)

All pregnancies conceived between March 2002 and December 2005 (N = 932) in our program were compared to pregnancies conceived before March 2002 (N = 554), which were the subject of a previous study.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The incidence of MZT with day 3 embryo transfer and BT were compared between the study and control groups.

RESULT(S)

During the study period, the rate of MZT was not significantly different for BT at 2.3% (9/385) compared to day 3 embryo transfer at 1.8% (10/547). This rate of 2.3% for BT was significantly lower than the rate of 5.6% (11/197) reported at our institution for BT before March 2002.

CONCLUSION(S)

Our study suggests that the risk of MZT with BT is significantly lower in the more recent time period and is in the range of what is seen with cleavage stage transfer. It is likely that improvements in culture systems as experience is gained with BT played a role.

Day-3 embryo morphology predicts euploidy among older subjects

OBJECTIVE

To evaluate whether day-3 embryo morphology predicts euploidy.

DESIGN

Retrospective.

SETTING

Private IVF center.

PATIENT(S)

Subjects (n = 144) undergoing in vitro fertilization and preimplantation genetic diagnosis (PGD).

INTERVENTION(S)

Translate day-3 embryo characteristics into a standardized score.

MAIN OUTCOME MEASURE(S)

Day-3 embryo morphology score and PGD fluorescence in situ hybridization results for chromosomes: 13, 15, 16, 17, 18, 21, 22, X, and Y.

RESULT(S)

Of 1,043 biopsied blastomeres, 67% (n = 696) were chromosomally abnormal. Women with advanced maternal age (AMA) were 1.3 times more likely to have chromosomal errors (95% CI 1.1-1.4) than younger subjects (<38 years old). Morphology predicted PGD results in the AMA group (n = 553), but not in younger women. Fragmentation predicted euploidy in both the younger and the AMA group, but cell number did not.

CONCLUSION(S)

Day-3 embryo morphology selects for euploidy among AMA subjects but not among younger women who may have other factors responsible for embryo dysmorphism. However, cellular fragmentation is a sensitive proxy for selecting chromosomally normal embryos in both age groups. It is unclear that PGD-aneuploidy screening is a better tool for selecting which embryos to transfer than the standard approach of using day-3 embryo features, particularly among older women, a group for whom this technology is targeted.

Von Willebrand disease presenting as recurrent hemorrhage after transvaginal oocyte retrieval

A 34-year-old nulligravid woman experienced hemorrhage after each of 2 oocyte retrievals. Initial coagulopathy screening was negative. Treatments used during in vitro fertilization likely interfered with assay performance. Reevaluation remote from medications confirmed the diagnosis of von Willebrand disease. Treatments used during in vitro fertilization may increase bleeding risk and confound coagulopathy evaluation.

Relative sparing of emotionally influenced memory in Alzheimer's disease

Studies suggest that emotionally influenced events enhance long-term memory. This study aimed to uncover whether this phenomenon exists in Alzheimer's Disease (AD) by comparing patients' performance with that of controls on a memory task. Overall, controls performed better than AD subjects on a delayed recognition task of a story containing emotional elements (95.8+/-2.4% vs 66.6+/-28.5%; mean +/- s.d.), respectively. Among AD subjects, there was relative sparing of emotionally influenced memory, which was not seen in controls because of a ceiling effect. Retention of the emotional phase of the story differed significantly from that of the neutral phases. These findings suggest that the influence of emotion on memory is spared, at least to some degree, in AD.