Blastocyst versus early cleavage embryo transfer: a retrospective analysis of 4,165 transfers

PURPOSE

To compare the clinical outcomes after the transfer of blastocysts versus early cleavage embryos in assisted reproduction technologies (ART).

METHODS

A retrospective analysis of all the ovarian stimulation-in vitro fertilization-embryo transfer cycles performed at the Centre for Human Reproduction, Athens, Greece, between June 1997 and December 2001.

RESULTS

The number of blastocysts transferred per ET was significantly lower compared to that of all early cleavage embryos. The implantation rate of blastocysts was significantly higher compared to that of all other modes of transfer. Clinical pregnancy rate after the transfer of blastocysts was significantly increased compared to that after transfer of any early cleavage embryo. The viable pregnancy rate after the transfer of blastocysts was significantly increased only compared to that after the transfer of day-2 embryos. There were no significant differences regarding the multiple gestation rates among the various modes of transfer.

CONCLUSION

The use of blastocysts in ART is beneficial when compared to that of day-2 embryos and at least comparable to that of day-3 embryos. Blastocyst culture and transfer remains a favourable and promising option in ART.

Triplet pregnancy after oocyte donation in women 46 years of age and older: three case reports

PURPOSE

Presentation of three triplet pregnancies achieved in women 46 years of age and older with the use of donated oocytes.

MATERIAL & METHODS

Two healthy perimenopausal women 46 and 48 years old and one healthy menopausal woman 48 years old, requesting fertility options. All of them followed oocyte donation programs resulting in triplet pregnancy. Maternal as well as perinatal complications, mode of delivery and birth weight are reported.

RESULTS

Three triplet pregnancies were achieved using donated oocytes. Prenatal diagnosis was reassuring. Preterm rupture of membranes, preterm labor and gestational diabetes complicated the pregnancies. Cesarean section was the mode of delivery for all the cases giving birth to nine healthy neonates weighing between 1,130 and 2,450 g. No postpartum complications were encountered.

CONCLUSIONS

Triplet pregnancies achieved with the use of donated oocytes at a very advanced maternal age represent high-risk obstetrical cases. Cautious prenatal evaluation of maternal health and intensive antenatal surveillance are imperative principles allowing the most favorable outcome of these pregnancies.

Clinical pregnancy in a woman of 45 years after gamete intrafallopian transfer (GIFT)

Clinical pregnancy in women over 44 years is rare in assisted reproductive technology (ART). A case of a 45-year-old woman with clinical pregnancy after GIFT is described.

A randomised, controlled study of uterine exteriorisation and repair at caesarean section

OBJECTIVE

To determine the surgical and anaesthetic benefits and problems associated with the practice of routine exteriorisation of the uterus to facilitate repair at caesarean section.

DESIGN

A randomised controlled study of women undergoing caesarean section. After establishment of anaesthesia, women were randomised to either exteriorisation and uterine repair or suture of the uterus in the abdomen.

SETTING

A maternity hospital in the United Kingdom.

MAIN OUTCOME MEASURES

Peri-operative haemoglobin change, duration of operation, maternal morbidity and length of hospital stay. Intra-operative pain, nausea, vomiting, pulling or tugging sensations were secondary outcome measures.

RESULTS

Three hundred and sixteen women were randomised, of whom 288 were subsequently analysed (139 women in whom the uterus was exteriorised and 149 where the uterus was not exteriorised). Exteriorisation of the uterus, an elective caesarean section and a spinal or general anaesthesia each had a statistically significant association with reduced blood loss (P < 0.05). There were no statistically significant differences between the two groups with regard to intra-operative complications or pain, nor were there any statistically significant difference in post-operative wound sepsis, pyrexia, deep vein thrombosis, blood transfusion or length of hospital stay.

CONCLUSION

With effective anaesthesia, exteriorisation of the uterus for repair following caesarean delivery is not associated with significant problems and is associated with less blood loss.