ICSI does not compromise blastocyst development

In conclusion we can say the following: 1) Patients with AMA have 70% of embryos showing aneuploidy. 2) Almost 30% of patients with AMA have no embryos to transfer. 3) PGD does not increase the pregnancy rate in this group. However, this finding may encourage couples to proceed to other options such as donor oocytes or adoption. P-8 ICSI does not compromise blastocyst development. L. M. Westphal, M.D. Hinckley, B. Behr, A. A. Milki. Stanford University School of Medicine, Stanford, CA. Objective: Recent studies have suggested that ICSI may contribute to a reduced capacity for blastocyst formation in vitro compared to conventional IVF. As many patients using ICSI to treat male factor infertility have an otherwise good prognosis for conception, blastocyst transfer (BT) in conjunction with ICSI has proven to be a valuable tool for helping control the risk of high-order multiple gestation. The present study investigates whether IVF/ICSI results in reduced capacity for blastocyst formation compared to IVF. Design: Retrospective analysis Materials/Methods: From January 1998 until January 2000, all patients under age 40 with more than three 8-cell embryos on day 3 were offered BT. The decision to use ICSI was based upon abnormal semen parameters and/or previous low fertilization rates with IVF. 145 patient cycles met criteria and underwent BT with IVF or IVF/ICSI. A regimen of sequential medium was utilized starting with P1  10% SSS until day 3, then moving to Blastocyst Medium with 10% SSS until day 5 or 6. A clinical pregnancy was defined as fetal cardiac activity seen on ultrasound by 7 weeks of gestation. Results: 87 patients underwent conventional IVF and 58 patient cycles used ICSI. The groups did not differ in age (34 vs. 35), average number of oocytes (16.1 vs. 17.6), average number of zygotes (10.2 vs. 11.8), average number of 8-cell embryos (6.4 vs. 5.9), or average number of blastocysts (4.0 vs. 3.3). Progression to blastocysts was 79% in the conventional IVF group and 76% in the ICSI group. Clinical pregnancy rates for the IVF group were 56% compared to 53% in the ICSI group. All p-values were greater than 0.05. Conclusions: Our findings show that the developmental competence of ICSI embryos does not appear to be compromised by sequential culture. Embryonic maturation in vitro after ICSI appears equal to IVF. Not only was the fertilization rate equal between the groups, but the progression to blastocyst and the likelihood of conceiving a viable pregnancy were also unaltered. Thus it seems appropriate to counsel patients with male factor infertility of the advantages of BT in selecting the most viable embryos while minimizing the risk of conceiving a high-order gestation. P-10 A model of parents’ experiences with surrogacy arrangements. C. B. Kleinpeter. California State University, Long Beach, CA. In the past 50 years, options for infertile couples have expanded. Two generations ago, couples with fertility problems could remain childless or they could adopt. Currently, infertile couples in addition to adoption can choose the use of assisted reproductive technology methods in planning a family. Recently, there has been a revival of interest in surrogacy. There are many reasons why couples choose surrogacy over adoption. In some cases, the wife may have eggs but cannot carry a child; the couple may feel that they are minimizing the possibility of substance abuse effects or HIV infection in the child; the couple may have been rejected by an adoption agency due to age or other factors; or they may reject adoption due to lack of availability of or lengthy waiting period for a healthy infant. This qualitative study explored the experiences of 26 parents who were involved in surrogate parenting arrangements in a California-based surrogacy program. Participants were mostly white (88%), married (96%), females (92%), with high levels of education and income. The mean age at the time of the first child’s birth was 39 years. All subjects reported infertility S14 PCRS Abstracts as their reason to explore surrogacy as a method of building a family. Subjects participated in telephone interviews regarding their decision-making, the method of fertilization, their relationship with their surrogate, and the support that they received during the surrogacy process. Content analysis was used to identify themes and sub-themes that emerged from the transcripts. Results indicate that parents overall were very pleased with their experiences. The majority of couples used IVF as the method of conception. Most were interested in having a close relationship with their surrogate, including going to doctor visits and participating in the labor and delivery process. Couples struggled with the loss of control they felt over the prenatal care of their child. Some couples indicated they could benefit from counseling, especially if complications arose during the pregnancy. Implications for those counseling infertile couples include: discussing various aspects of fertilization, and expectations regarding relationships between the couple, child, and surrogate during and after the pregnancy. P-11 A randomized, comparative, 3-arm, parallel group, open-label, multicenter study of the efficacy and safety of Bravelle™ (purified human FSH) and Repronex威 when mixed in the same syringe and administered subcutaneously in continuous or sequential dose ratios to patients (34 – 40 years) undergoing in-vitro fertilization: interim data. D. C. Marshall1, M. Surrey2, B. VanVoorhis3, D. Kenigsberg4, J. H. Check5, P. McShane6, J. Eisermann7, M. D. Scheiber8, L. M. Westphal9, W. R. Keye, Jr.10 for the Ferring Mixed Protocol Study Group. 1Ferring Pharmaceuticals Inc, Tarrytown, NY; 2Southern California Reproductive Center, Beverly Hills, CA; 3University of Iowa Hospital and Clinic, Iowa City, IA; 4Long Island IVF, Lake Success, NY; 5Cooper Institute, Marlton, NJ; 6Reproductive Science Center, Waltham, MA; 7South Florida Institute for Reproductive Medicine, Miami, FL; 8Institute for Reproductive Health, Cincinnati, OH; 9Stanford University School of Medicine, Stanford, CA; 10William Beaumont Hospital, Royal Oaks, MI. Introduction: There is widespread use of combined FSH and hMG (mixed protocols) in controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). However, there have been no systematic efficacy and safety studies examining various ratios of FSH and hMG mixed in a single daily dose. Objectives: To assess the therapeutic efficacy and safety of continuous and sequential dose ratios of FSH:LH (Bravelle, hFSH and Repronex, hMG) combined in the same syringe and administered subcutaneously, once daily, in COH-IVF patients (Pts) 34 – 40 years of age. Materials/Methods: Eligible Pts received leuprolide acetate (LA, 0.5 mg, OD, SC) starting seven days before anticipated onset of menses and continuing for ⱕ20 days until estradiol (E2) was ⱕ40 pg/ml with endometrial lining ⱕ6 mm. Thereafter, LA was reduced to 0.25 mg/d and continued until day before hCG. Pts were randomized to treatment (Tx) groups A, B or C, and gonadotropin stimulation (GS) began for ⱕ15 days. After 5 days of GS (225 IU FSH/d), doses were individualized every 2 days to ⱕ450 IU/d. When ultrasound showed ⱖ3 follicles with diameters of ⱖ16 mm, and E2 levels acceptable, GS was stopped and hCG (10,000 IU IM) given on the next day; oocytes were retrieved 34 –36 hrs later. The FSH:LH ratios were: TxA had a 2:1 ratio throughout; TxB had a 3:0 ratio that was changed to and maintained at 2:1 after GS day 5; TxC had a 3:1 ratio that, after GS day 5, was sequentially adjusted to 4:1, 5:1 or 6:1 as needed. Primary efficacy was the number of oocytes retrieved. Results: In this ongoing study, there are no significant differences among Tx groups in oocytes retrieved. However, some numerical differences in efficacy in Tx groups containing LH at start of GS must await more data to interpret the results. There were no differences in safety. Conclusion: These interim data suggest that in patients 34 – 40 years of age, FSH:LH starting ratios of 2:1 or 3:1 might produce numerically greater implantation and continuing pregnancy rates, although overall responses for these Pts are excellent in all three treatment groups. Vol. 77, No. 4, Suppl. 3, April 2002