transferred. Blastocyst quality was categorized as excellent (AA), good (AB,
sperm injection (ICSI) cycles followed by embryo transfer were included;
BA or BB) or fair (BC, CB or CC) based on their trophectoderm and inner cell
cycles using donor eggs were excluded. Outcomes of the stimulation response,
mass (ICM) quality scores (Gardner & Schoolcraft). Before SBT-P (6/2003 -
egg and embryo number and quality, pregnancy and live birth rates were
5/2004) all patients could elect to transfer one or two day 5 embryos. As of June
assessed in patients reported as never smokers, past smokers and current
2004 patients were informed of our SBT-P before they started their treatment
smokers. The sample size was nearly twice that needed to have 80% power to
cycle. Under the SBT-P, only one blastocyst was transferred to all patients Ͻ38
detect a 5% effect of smoking on pregnancy outcome, based on preliminary
years old who had no previous failed fresh IVF-ET cycles at our program and
data indicating a 26% smoking incidence. Potential covariates were evaluated
had at least one good or excellent quality blastocyst. Those patients who did not
and data was stratified between two groups dependent upon patient age (Ͻ 35
meet the SBT-P criteria could elect to transfer one or two day 5 embryos.
and Ն 35 years old). Categorical variables were compared using a chi-square
Clinical pregnancies were confirmed by the observation of a fetal cardiac
tests and Fisher’s exact tests were used to compare small sample sizes. Con-
activity by ultrasound 6 weeks after transfer. Statistical analysis was performed
tinuous variables were compared using PROC ANOVA. Relative risks for
by the t-test and chi-square analysis.
association with positive pregnancy and live birth were estimated using a
RESULTS: Single blastocyst transfers were performed for 11% and 51% of
log-binomial regression model estimated using PROC GENMOD.
the day 5 transfers performed before and after SBT-P implementation (pϽ.05).
RESULTS: 9.3% of patients reported current smoking, and 12.1% re-
The pre- and post-SBT-P periods had similar embryo implantation rates (56%
ported a history of smoking. Two-thirds of currently smoking women
and 58%). The average number of embryos transferred was significantly lower
(21/30) smoked 10 cigarettes or fewer per day with a range of 1-30.
after SBT-P implementation (1.9 pre-SBT-P vs. 1.5 post-SBT-P; p Ͻ.05).
Smoking status did not significantly affect peak estradiol levels, number of
Enforcement of the SBT-P significantly reduced the incidence of multi-fetal
oocytes retrieved, egg maturity, log mean ovarian volume, fertilization rate,
gestations without reducing clinical and ongoing pregnancy rates for all patients
cleavage rate, embryo quality, percent of 6 cell embryos, pregnancy rate or
Ͻ38 undergoing a day 5 embryo transfer (Table 1).
live birth rate in women Ͻ 35 or Ն 35 years old. Outcomes were thenevaluated controlling for day 3 FSH alone, and for FSH, number of oocytesretrieved and embryo quality score together. The relative risk of smokingcontinued to have no significant impact on pregnancy rate or other fertilityoutcomes when controlling for these factors.
CONCLUSION: The question of whether smoking affects IVF outcome
is significant to patient care given that some insurance companies areconsidering denying coverage for IVF to women who smoke. 21.4% of IVFpatients in this study had past or present exposure to cigarette smoking withno measurable effect on IVF outcome. It is possible that the aggressivecontrolled ovarian hyperstimulation employed with ART overcomes thenegative effects of smoking on fertility, and that the relative paucity ofvascular supply to primordial follicles may protect them from the detrimen-tal effects of smoking. Smoking may have served as a surrogate marker forother, more significant lifestyle factors in previous retrospective studiesreporting adverse effects of smoking on IVF outcome.
a, b Percentages with the same letter within the same column are signifi-
CONCLUSION: Implementation of our SBT-P appears to optimize blas-
Elevated Blood Mercury Levels are Associated With Poor Outcome in
tocyst transfer outcomes by reducing the risk of multi-fetal gestation with-
IVF Cycles. M. Fateh, K. Sultan, M. Obasaju, S. Abeyawardene, M. Chan,
out compromising the pregnancy rate. The SBT-P was accepted by all
S. Khan. New York Fertility Institute, New York, NY.
patients after they were counseled about expected pregnancy rates and therisks of multi-fetal gestation. Given that a single, healthy baby should be the
OBJECTIVE: Elevated blood mercury levels are associated with in-
goal of IVF-ET procedures, programs with high blastocyst implantation
creased seafood intake with potential carcinogenic, reproductive and geno-
rates should implement a policy of single blastocyst transfer for selected
toxic effects (FDA/ EPA consumer advisory, 2004). We attempted to assess
patients to improve the safety of IVF.
the impact of elevated blood mercury levels on the outcome of IVF cycles
DESIGN: Prospective blinded studyMATERIALS AND METHODS: 106 patients age 30 -37 underwent 106
IVF cycles between November 2003 and December 2004. Blood mercury
levels were measured on day 3 of the IVF cycle. Patients underwent
gonadotropin stimulation, oocyte retrieval and embryo transfer. All retriev-als and transfers were performed by a single physician and embryologist
who were blinded to the blood mercury level results
In Vitro Fertilization may Overcome the Negative Effects of Smoking
RESULTS: There were 80 patients with normal blood mercury levels
on Fertility. K. L. Page, J. R. Trimarchi, J. Allsworth, D. Keefe. Women
(Ͻ5.0 g/L) and 26 patients with an elevated level. 4 cycles were cancelled
and Infants’ Hospital/Brown Medical School, Providence, RI; Women and
due to poor response 3 from the normal mercury level group 1 from the
Infants’ Hospital, Providence, RI; Brown University, Providence, RI.
elevated group. 102 cycles were assessed. The two groups had no significantdifference when examined for patients age, peak estradiol level, number of
OBJECTIVE: Cigarette smoking is widely believed to decrease fecundity
oocytes retrieved, fertilization rate or number of embryos transferred. There
in naturally conceiving populations. However, the effect of smoking by
were significantly less ongoing pregnancies in the elevated blood mercury
females undergoing in vitro fertilization (IVF) is less clear. We retrospec-
group 16.0 % (4/25), versus normal blood mercury level group 37.7%
tively evaluated the effect of smoking on pregnancy rate and other measures
(29/77) (pϽ0.05). Ongoing pregnancy was defined as a clinical pregnancy
of IVF outcome in a large, diverse socioeconomic population located in a
in the second trimester. There were no pregnancies in patients with blood
state where IVF coverage is mandated by law.
mercury levels greater than 30 g/L (nϭ5).
DESIGN: Retrospective cohort analysis of a database at an academic
CONCLUSION: It appears that elevated blood mercury levels are associated
with a poor outcome possibly due to poor implantation. We are continuing this
MATERIALS AND METHODS: We analyzed cycle data from 404 patients
study to further evaluate the significance of this finding. We are also assessing
who had undergone either their first attempt at IVF treatment or their first cycle
if decreasing mercury levels by dietary change has a reversal effect.
of IVF following a clinical pregnancy. Standard IVF and intracytoplasmic
FERTILITY & STERILITY
Who did he beat? Who had the mount? How fast did they go? What’s his breeding? For the answers look to the past performance pages of thetrack program. It all might look intimidating at first, but this page will show you how to use the wealth of data supplied for each horse. C 7 ALEXANDRIA (AL) Trainer: Howard E. Wolfendale ( 2-0-0-0
Some of the important complications include infections, blood clots, inadvertent injury to blood vessels or nerves, problems regaining flexion or extension of the knee and difficulties with wound healing. Deep infec-tion may require removal of the implant, prolonged antibiotics and later surgery to insert a new implant. Major clots are rare but can be fatal. All surgery and anaesthesia carries r
transferred. Blastocyst quality was categorized as excellent (AA), good (AB,
sperm injection (ICSI) cycles followed by embryo transfer were included;
BA or BB) or fair (BC, CB or CC) based on their trophectoderm and inner cell
cycles using donor eggs were excluded. Outcomes of the stimulation response,
mass (ICM) quality scores (Gardner & Schoolcraft). Before SBT-P (6/2003 -
egg and embryo number and quality, pregnancy and live birth rates were
5/2004) all patients could elect to transfer one or two day 5 embryos. As of June
assessed in patients reported as never smokers, past smokers and current
2004 patients were informed of our SBT-P before they started their treatment
smokers. The sample size was nearly twice that needed to have 80% power to
cycle. Under the SBT-P, only one blastocyst was transferred to all patients Ͻ38
detect a 5% effect of smoking on pregnancy outcome, based on preliminary
years old who had no previous failed fresh IVF-ET cycles at our program and
data indicating a 26% smoking incidence. Potential covariates were evaluated
had at least one good or excellent quality blastocyst. Those patients who did not
and data was stratified between two groups dependent upon patient age (Ͻ 35
meet the SBT-P criteria could elect to transfer one or two day 5 embryos.