Comparison of Tubal Transfer and Transcervical Uterine Embryo Transfer of Immediate Injected Oocytes and 2 - 3 Days Old Cultured Embryos

Zusammenfassung

Ziel: Zu untersuchen, ob der intratubare Transfer frisch injizierter Eizellen (ca. 1 Stunde nach der intrazytoplasmatischen Spermieninjektion [r-ICSI-ZIFT]) mit einem besseren Erfolg korreliert als der herkömmliche intrauterine Transfer 2 - 3 Tage nach ICSI. Methode: 58 Zyklen von 58 Paaren mit r-ICSI-ZIFT innerhalb eines Zeitraums von 12 Monaten wurden retrospektiv ausgewertet. Die Kontrollgruppe beinhaltete 28 Patientinnen, die einen herkömmlichen intrauterinen Embryotransfer nach ICSI erhielten. Die Ovulation wurde nach „Downregulation“ mit Goserelinacetat und aufsteigender Stimulation mit rekombinantem FSH induziert. Nach der Eizellgewinnung mit anschließendem ICSI wurden innerhalb einer Stunde maximal 4 injizierte Eizellen mit intakter Zytoplasmamembran und klarem Zytoplasma unter laparoskopischer Überwachung intratubar transferiert. Die biochemische und klinische Schwangerschaftsrate, die Implantationsrate, die Abortrate und die Geburtenrate wurden ermittelt. Die statistische Auswertung erfolgte mit univariater und multivariater Analyse. Ergebnisse: Die Regressionsanalyse ergab für keine der Variablen einen Vorteil für die r-ICSI-ZIFT. Die Implantationsrate betrug 17,2 % für die r-ICSI-ZIFT und 17,1 % für ICSI‐ET (nicht signifikanter Unterschied, p = 0,3). Die Mehrlingsschwangerschaftsrate war für r-ICSI-ZIFT signifikant erhöht (34,8 versus 0 %, p = 0,06). Schlussfolgerung: Sofortiger tubarer Transfer von mikroinjizierten Eizellen führt im Vergleich zu dem herkömmlichen intrauterinen Embryotransfer zu einer vergleichbaren Implantationsrate und Geburtenrate. Unter Berücksichtigung der Gefahren durch die Laparoskopie und die Mehrlingsschwangerschaften scheint der intratubare Transfer frisch injizierter Eizellen nach ICSI für die klinische Anwendung ungeeignet.

Abstract

Objective: The aim of this study was to assess the outcomes of laparoscopic intrafallopian transfer of injected oocytes rapidly (1 hour at most) after intracytoplasmic sperm injection (rapid ICSI-ZIFT). Materials and Methods: Data on 58 cycles in 58 couples, who underwent rapid ICSI-ZIFT treatment over a 12-month period were retrospectively investigated. The control group included 28 patients, who underwent intrauterine embryo transfer (ET) after ICSI. Following down-regulation with goserelin acetate, step-up ovulation induction with recombinant gonadotropins was carried out. After oocyte retrieval and ICSI, a maximum of 4 injected oocytes with intact cytoplasmic membrane and clear cytoplasm were replaced within 1 hour into a unilateral fallopian tube under laparoscopic guidance. Biochemical pregnancy, clinical pregnancy, implantation, miscarriage, and take-home baby rates were our outcome measures. Rapid ICSI-ZIFT and conventional ICSI‐ET groups were compared using univariate and multivariate analyses. Results: After controlling for confounding factors by logistic regression, none of the outcome variables were found to be improved with rapid ICSI-ZIFT. Implantation rates were also comparable (17.2 % for rapid ICSI-ZIFT and 17.1 % for ICSI‐ET) with no significant differences (p = 0.9). The multiple pregnancy rate in the ICSI-ZIFT group was exceedingly high (34.8 % versus 0 %, p = 0.07). Conclusions: Immediate tubal transfer of microinjected oocytes is associated with similar implantation and take-home baby rates compared to rates for intrauterine ET after ICSI. Given the risk of laparoscopy and the unavoidable higher risk of multiple pregnancy, intratubal transfer of injected oocytes seems unsuitable for clinical use.

Schlüsselwörter

Embryotransfer - injizierte Eizelle - intrazytoplasmatische Spermieninjektion - Schwangerschaftsrate - intratubarer Transfer

Key words

Embryo transfer - injected oocyte - intracytoplasmic sperm injection - outcome - intrafallopian transfer

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