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University Medical Centre Department for Reproductive Medicine L j ublj anska 5 SI-2000 Maribor

University Medical Centre Department for Reproductive Medicine L j ublj anska 5 SI-2000 Maribor Slovenia Accredited by EBCOG/ESHRE i vf.mb@uk c-mb.si www.ivf-mb.net IVF Maribor , Lacerta D54 ° 18’59.66’’. 8.-11.September 2011, Brijuni.

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University Medical Centre Department for Reproductive Medicine L j ublj anska 5 SI-2000 Maribor

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  1. University Medical Centre Department for Reproductive Medicine Ljubljanska 5 SI-2000 Maribor Slovenia Accredited by EBCOG/ESHRE ivf.mb@ukc-mb.si www.ivf-mb.net IVF Maribor, Lacerta D54°18’59.66’’

  2. 8.-11.September 2011, Brijuni Influence of oocyte number on IVF/ICSI results Veljko Vlaisavljević Department of Reproductive Medicine and Gynecologic Endocrinology University Clinical Centre Maribor Maribor, Slovenia E: ivf-mb@ukc-mb.si

  3. Non stimulated cycle (“natural” cycle) • Minimal stimulation • Oocyte cryopreservation • Single embryo transfer • Blastocyst transfer

  4. Today our choice of ovarian stimulation regimen is often made using experience-based medicine • The choice of starting dose takes into account patient characteristics but is used empirically • Decision for cultivation for blastocyst stage takes into account patients age, number of oocytes, embryo quality and its number

  5. From cookery to science Cochrane data (2009) • Primary outcome ( live births per couple) • Secondary outcome ( clinical pregnancy rate, multiple pregnancy rate, high order MPR, cryopreservation, failure to have any ET per couple ) • Outcomes not appropriate for statistical analysis ( live births per OPU and ET, CPR/OPU&ET, implantation rate

  6. The Cochrane Metanalysis 2009 : Live birth rate The Cochrane Library 2009

  7. Aim: To evaluate the efficacy of using blastocyst stage embryo transfer in routine practice • Design: Retrospective analysis in 7059 IVF/ICSI cycles • SBT: Extended embryo culture through embrionic genome activation to select those embryos with higher implantation rate

  8. Strategy for patients selection for blastocyst culture: NUMBER OF FLLICLES OR OOCYTES • Good responders on COH during the stimulation • Patients with 5 oocytes and more after OPU

  9. Strategy for patients selection for blastocyst culture: FERTILIZATION • Patients with more than 4 fertilized oocytes • Patients with more than three embryos on day 3 .

  10. Duration of cultivation ( Day 3 or Day 5) and rate of cancelled embryo transfers on 4009 IVF/ICSI cycles (<10 oocytes) Number of aspirated oocytes

  11. Cancelled embryo transfers

  12. Nonstimulated cycles (#391) Day 3 ET Day 5 BT 187 204 Delivery rate per cycle 12.2 % 11.7 %

  13. Poor responders(one oocyte)N=252 No ET ET 160 36.1% Delivery rate /ET 6.9% Delivery rate/cycle = 4.3%

  14. Embryo transfer rate on D3 and D5 in patients younger than 40

  15. Delivery rate per embryo transfer on D2 and D5 in 2002 IVF/ICSI cycles) Delivery rate per cycle

  16. Embryo transfer rate per cycle was higher when day 2 embryos were transferred • Expected pregnancy rate in poor responders calculated per embryo(s) available on day 2 was not affected by oocyte culture to the blastocyst stage.

  17. Low responders(2-4 oocytes)Oocyte number afer OPU (#1276) # oocytes 2 2 3 3 4 4 ET (no ET 12.3%) 320 8 (D5) 367 14 (D5) 336 74 (D5) Delivery rate per ET 12.6 25.8 17.3 28.6 18.5 37.8 Delivery/ cycle 10.4% 15.7% 20.2%

  18. Normal responders(>4 oocytes/OPU)# 3131 No BC for transfer eSBT SBT eDBT DBT TBT 224 (6.7%) 659 355 1135 957 125 (3.8%) Delivery rate 48.0 19.4 55.0 35.5 26.4

  19. Delivery rate per cycle after blastocyst transfers

  20. Should the practice of double blastocyst transfer be abandoned? Vlaisavljevic et al., RBM Online, 2008;16:671. Double blastocyst transfer Delivery rate per transfer Twins rate Vlaisavljevic et al. RBM Online 2008

  21. Number of embryos transferred in reimbursed cycles (IVF, Raport to Ministy of Health for 2009 Centre Maribor) 48.5%

  22. Number of embryos transferred in cross border patients ( IVF Centre Maribor, Raport for 2009) 24.9%

  23. Number of embryos required for transfer per baby born Embryos 4934 443 2639

  24. Number of blastocysts required for transfer per baby born

  25. Conclusions • eSBT is standard procedure in our centre • same number of pregnancies with smaller number of fresh transferred embryos • actual reimbursement system • successfull vitrification programme • Major barriers for eSET seems to be: • patients’ lack of knowledge

  26. In 2009 4,2 % of all babies born in Slovenia were concieved with MAR

  27. SymposiumNaših prvih 5000 otrokOur first 5000 childrenHotel HabakukMaribor, Slovenija 9.-10. marec 2012

  28. Reproductive Medicine Maribor Hospital: Veljko Vlaisavljević Vida Gavrić Lovrec Milan Reljič Vilma Kovač Lea Mlakar Polona Kores Testen Ksenija Rakić Marko Došen Nurses: Božena Rodeš Daniela Hanžel Marija Kristovič Jasna Muršič Marija Piperski Lucija Nikolič ART Laboratory: Borut Kovačič Nina Hojnik Martin Ivec Barbara Breznik Petra Robič Marjan Taborin Naca Herceg Secretary: Suzana Knuplež Marina Kokol

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