Factors Influencing Pregnancy Outcome Following Slow Cooling Cryoembryo Transfer and Risk of Multiple Conception

Objective To investigate the factors that influence the potential for cryoembryo implantation and multiple pregnancy. Methods In this retrospective study, a total of 93 7 thawing cycles （859 couples） in which 3286 d 3-embryos were thawed. Rates of implantation, clinical pregnancy and multiple conception following FET were observed. Results There were significant differences in female age （P〈0.05） and number of good quality embryos （P〈0. 05） between cycles that resulted in pregnancy and those did not. There was a trend toward decreasing rates of implantation, clinical pregnancy and multiple pregnancy with increasing female age. Compared with transferring 1 good quality embryo, clinical pregnancy rate of transferring 2 and 3 good quality embryos was increased significantly （P〈0. 001）, there was no significant difference in clinical pregnancy rate between transferring 2 and 3 good quality embryos. Multiple pregnancy rate was increased significantly in the group of transferring 3 good quality embryos （P〈0.05）,but there was no significant differences in multiple pregnancy rate between transferring 1 and 2 good quality embryos. Younger women （≤ 30 years） also had a significantly higher multiple pregnancy rates （28.13%） than the older ones（〉35 years） （13.64%）. With an increase in age from ≤ 30 years to〉40 years, clinical pregnancy rate declined from 47 61% to 25.00%.Conclusion Female age and the number of gooa quality embryos transferred are important factors influencing the clinical and multiple pregnancy rate, reducing the number of good quality embryos transferred may decrease the rate of multiple pregnancy but do not affect the clinical pregnancy rate.

Sonography Cervical Assessment in Multiple Pregnancy in Correlation with Gestational Age

Objective: Observe and correlate the cervical length by ultrasound and likelihood of cervical incompetence and premature delivery in multiple gestations. Materials and Methods: Retrospective study in multiple pregnancy (twin, triplet, quadruplet) delivered between 2002-2003, in King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. A total of 68 multiple pregnancies underwent routine ultrasound for fetal assessment between 16 - 32 weeks when the cervix was observed. The sonographic measurements included cervix > 2.5 cm and <2.5 cm. The time of ultrasound was divided in five groups by gestational age from 18 - 20 weeks, 21 - 24 weeks, 25 - 26 weeks, 29 - 32 weeks and >32 weeks. The gestational age at delivery was our outcome parameter. The data was analyzed statistically using Fisher’s exact test and P-value below 0.05 was considered significant. Results: Endovaginal ultrasongoraphic cervical measurement in multiple pregnancies predicted increased preterm delivery risk regardless of maternal age, previous history of preterm deliveries or presence of vaginal infection. It was found that spontaneous preterm labor < 32 weeks is a relatively rate outcome with cervix > 25 mm;this majority reached > 32 weeks while the patient who had cervix < 25 mm, 1 in 25 of the women who underwent a cervical ultrasound assessment will have preterm labor. The finding in ultrasound justifies the results of higher aggressive management inpatient with cervix Conclusion: Cervical assessment during routine ultrasound in multiple gestations seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, we suggest further study with bigger sample and prospective trial for valued conclusions.

Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.

A Delayed-interval Delivery of An in vitro-fertilized Twin Pregnancy with Premature Rupture of Membranes

This article presents a case of conservative managements of an in vitro-fertilized twin pregnancy with early loss of the first fetus. A 37-year-old woman in the 21st week of a twin pregnancy delivered her one of the fetuses with unfortunate outcome after the premature rupture of membranes. The umbilical cord of the first fetus was ligated at the cervical level and the second surviving fetus was left in utero. In order to save the surviving fetus, conservative managements including combination of steroids, tocolytics, antibiotics and cervical cerclage were performed. The second fetus was delivered vaginally in the 27th week of pregnancy, 4 h after premature rupture of membranes of the remaining amniotic sac, 41 d after the first fetus was born. The child and the mother have been followed up for 4 years and they are healthy. Conservative managements including steroids, tocolytics, antibiotics and cervical cerclage in a closely monitored environment would be given following the delivery of the first fetus. Delayed-interval pregnancy appears to be safe for the mother and the remaining fetuses.

Effect of embryo quality on pregnancy outcomes for women completing biochemical pregnancy in in vitro fertilizationembryo transfer(IVF-ET)

Objective To analyze the effect of the numbers of transferred good-quality embryos on pregnancy outcomes in in vitro fertilization-embryo transfer （IVF-ET）, supplying a reference for selection of transferred embryos.Methods Five hundreds and one infertile patients who underwent IVF-ET were retrospectively analyzed. All cycles were divided into 3 groups by the number of transferred good-quality embryos （group A： two good-quality embryos, group B： one good-quality embryo, group C： no good-quality embryo）, with no significant difference in general condition such as age, infertility duration and infertility types. The pregnancy outcomes were compared and analyzed among the three groups.Results 1） Live-birth rate was improved with increasing good-quality transferred embryo numbers. Groups A （70.3%） and B （69.8%） had no significant difference （P=0. 409）, whereas it was significantly greater in groups A and B than in group C （57. 7%） （P=0.009, P=0.036）. 2） The loss of single gestational sacs rate, which have no significant difference among 3 groups （P=0.221, P=0.539, P=0.226）, reduced with increasing good-quality transferred embryos numbers. 3） Biochemical pregnancy abortion rate in groups A （10.9%） and B （10.1%） was significantly lower than that in group C （18.3%）（P=0.049, P=0.049）. 4） There was no significant difference among 3 groups in ectopic pregnancy rate （P=0.174, P=0.129, P=0.404）. 5）Multiple-birth rate was improved with increasing good-quality transferred embryos numbers, it was significantly greater in group A （31.6%） than in group C （15.0%）（P=0.020）, while groups B and A had no significant difference （P=0.489, P=0.126）.Conclusion Two good-quality transferred embryos have no significantly difference to 1 good-quality embryo in all pregnancy outcomes. In clinic treatment, we can select 1 good-quality embryo and 1 poor-quality embryo when patients only have few goodquality embryos. Meanwhile, a good-quality embryo can improve live-birth rate and multiple pregnancy rate simultaneously. In order to meet a better assisted reproductive technology （ART） outcome, we need to seek a balance between pregnancy rate and multiple pregnancy rate.

Effect of Patient Age and Embryo Parameters on Pregnancy Outcomein In Vitro Fertilization-Embryo Transfer(IVF-ET)

Objective To study the effect of patient age, the number and quality of embryos transferred on pregnancy outcome in in vitro fertilization-embryo transfer procedures （IVF-ETs）. Methods A retrospective study was conducted with infertile women who underwent a total of 1 800 cycles of lVF-ET and intracytoplasmic sperm injection （ICSI） at the Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical College from Jan. 2006 to Dec. 2007. The patients were divided into three groups based on age （year）. 〈30, 30-34 and 235. The rates of clinical pregnancy and multiple pregnancies were compared in each group when 1-3 embryos and 0-3 goodquality embryos were transferred respectively. Results 1） In the group of patients aged 〈30 years, there was no significant difference in pregnancy outcomes with 1-3 embryos transferred. However, pregnancy rates were similar when 2 3 good-quality embryos were transferred, which was significantly higher compared with 0-1 good-quality embryos transferred; the incidence of multiple pregnancies was not an issue when only 1 embryo was transferred. 2） The pregnancy rate of the patients aged 30 34 was not significant not only when only 2-3 embryos were transferred but also when 2-3 good-quality embryos were transferred, which was significant compared with when 1 embryo or 0 1 good-quality embryo was transferred. The subgroup of 3 good-quality embryos transferred, at the same time, was expected to significantly increase multiple pregnancy rate. 3） For the patients aged 235, there were similar pregnancy rates in the subgroup involving 1-3 embryos transferred. Compared with 0-2 good-quality embryos transferred, the pregnancy rate was significantly higher in the patients with 3 good-quality embryos transferred. An increased trend toward multiple pregnancies was observed among not only the subgroups with 1-3 embryos transferred, but also when 1-3 good-quality embryos were transferred, although it was significantly higher in patients with 3 good-quality embryo transferred. Conclusion In an effort to achieve the ideal pregnancy rate without the risk of multiple pregnancies, it is desirable to employ a single good-quality embryo transfer for patients aged 〈30 years and 2 good-quality embryos for patients aged 330. As older women （aged 335 years）, this is important, need to abstain from poor-quality embryo transferred by increasing the number of embryos transferred in an effort to improve the rate of clinical pregnancy, if the patients have had enough 2 high-quality embryos.