Chanson, A.

De Grandi, P.

Germond, M.

Senn, A.

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an average of 5.1 times, underwent 35 cycles of eitherintracytoplasmic sperm injection (ICSI) or standard in-vitrofertilization (IVF). Embryo transfer on days 2-3 of develop-ment was performed in all cycles and supernumerary embryoswere further cultured in a cell-free culture system. Wheneverblastocysts were developed, they were transferred at a secondtransfer 2-3 days following the first transfer.Results: A total of 202 transferable embryos were obtained,of which 81 were transferred on days 2-3 of embryonicdevelopment in all treatment cycles (mean of 2.3 embryos pertransfer). A total of 121 embryos were further cultured ofwhich 36 embryos (27.9%) reached the stages of early,expanded or hatching blastocysts on days 5-7. In 19 cycles(group A), 24 blastocysts were transferred 2-3 days followingthe first transfer (mean of 1.3 blastocysts per transfer). In 16cycles (group B), no blastocysts were available for transferandthus a second transfer was not performed. Higher pregnancyand implantation rates were obtained in group A (42%and 20.3%) as compared to group B (25% and 11.1%)respectively.Conclusion: Our results demonstrate the beneficial effect ofa double embryo transfer in cases of repeated implantationfailure. The observation that a relatively high pregnancy ratewas obtained in cases of a failure to achieve blastocystdevelopment indicates that in-vitro selection for embryonicdevelopment may not always reflect in-vivo selection criteria.Performing a double embryo transfer of both cleavage stageas well as blastocysts provides the advantages of both environ-ments for the selection of embryos possessing the potentialfor a complete embryonic development.P-097. Luteinizing hormone urinary test is an efficientand cost-effective method to monitor ovulation for thetransfer of cryopreserved embryos in natural cyclesChanson A., Senn A., De Grandi P. and Germond M.Reproductive Medicine Unit, Dept. Obstet.-Gynaecol.,CHUV, CH-l0ll Lausanne, SwitzerlandIntroduction: There is a need for the clinician to provide hispatients with the most efficient treatment, in terms of takehome baby rate, cost per initiated cycle and respect for ethicaland legal issues. In Switzerland, the selection at the embryostage is no longer allowed, necessitating freezing at the zygotestage. The maximum number of embryos transferred is legallylimited to three. Moreover, to decrease the number of multiplepregnancies, only two embryos are generally transferred whenthe patients are <35 years old. Consequently, more zygotesarecryopreserved per oocyte retrieval, and more transfer cyclesare needed to replace these cryopreserved zygotes, with anincrease of the overall cost of the treatment. The aim of thisretrospective study was to compare luteinizing hormone (LH)urinary test, a low cost ovulation monitoring method, with thestandard approach measuring plasma LH, progesterone andoestradiol levels, for the transfer of cryopreserved zygotes innatural cycles.Materials and methods: Zygotes were frozen with the slowprotocol using 1.5 M propanediol and 0.1 M sucrose in humanAbstracts of the 15th Annual meeting of the ESHRE, Tours, France 1999tubal fluid medium containing SSR-2 (Medicult) and 0.5%human serum albumin. Zygotes were thawed 24-26 h beforetransfer. The embryo transfer was performed 3 days after theLH surge monitored using two different methods: a twice dailyurinary test performed in the morning (INTEX-Ovulationstest;INTEX Pharmazeutische Produkte AG, Muttenz, Switzerland),or a plasma determination of LH, progesterone and oestradiol.All the patients using the urinary test received a short oralinstruction and were asked to call the Unit on the day of theLH surge. In the event of a problem (difficulties in interpretingthe LH urinary tests, ovulation delay, etc.), they were invitedto come to the Unit for complementary blood testing. Aplasma pregnancy test (human chorionic gonadotrophin) wasperformed 14 days after embryo transfer and clinical pregnancywas diagnosed 28 or 35 days after embryo transfer using anultrasound examination (cardiac activity observation).Results: From January 1996 to December 1998, 314 spon-taneously ovulating patients (21-45 years old) underwent 544thawed embryo transfers using natural cycles. Blood testmonitoring was used for 390 cycles (group A, 220 patients),whereas urinary testing was used for 121 cycles (group B, 81patients). For 33 cycles, the urinary testing was problematicand blood testing was used to confirm or determine theovulation (group C, 31 patients). The mean number of bloodtests was 3 for group A and 1.5 for group C. The mean ageof the patients, the mean number of transferred embryos andthe mean embryo score were the same in the three groups.The percentage of eggs originating from intracytoplasmicsperm injection cycles (,...,50%) was similar for the three groups.The pregnancy rate per embryo transfer was 16% for groupA, 18% for group Band 27% for group C (not significant)with an implantation rate of 9.3%, 9.8% and 19.7% (P <0.03) respectively. The mean cost for a cycle in group B wasaround 40% lower than in group A (740 versus 1200 FRS),for a similar rate of success. The cost in group C wasintermediate.Conclusion: These data clearly show that most of the spon-taneously ovulating patients can monitor their LH surge at homeusing a low cost urinary test after adequate oral instruction. Inthe event of a problem, blood testing can still be performed,and, in almost every case, the ovulation can be confirmed ordetermined and the embryo transferred. The use of a urinarytest is efficient in terms of pregnancy and implantation ratesand cost-effective, as an important economy can be achievedfor each thawed transfer cycle. Following this retrospectiveanalysis, the actual policy of the Unit is to propose theurinary test to all the patients presenting suitable ovulationcharacterized during the pre-in-vitro fertilization control cycle.P-098. Change of embryo transfer strategy improves in-vitro fertilization-embryo transfer outcomeBarandi Z.S.I, Vargha P.2, Urbancsek J.1 and Papp Z.1'Lst Dept of Ob/Gyn, Semmelweis University Medical School,Budapest and 21st Dept of Internal Medicine, SemmelweisUniversity Medical School, Budapest, HungaryIntroduction: In-vitro fertilization (IVF) attempts are fre-quently unsuccessful because embryos placed into the uterus189

P-097. Luteinizing hormone urinary test is an efficient and cost-effective method to monitor ovulation for the transfer of cryopreserved embryos in natural cycles

P-097. Luteinizing hormone urinary test is an efficient and cost-effective method to monitor ovulation for the transfer of cryopreserved embryos in natural cycles

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