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Objective: To identify common clinical and laboratory practices among consistently high-performing IVF programs., Design: Questionnaire study of selected IVF programs., Setting: Academic and private practice IVF programs., Patient(s): Ten of 12 programs identified as having consistently high singleton delivery rates per cycle., Intervention(s): None., Main Outcome Measure(s): Common clinical practices., Result(s): Common clinical practices identified among these programs included testing all patients for ovarian reserve, endometrial defects, and hydrosalpinges; use of a mixed LH and FSH stimulation protocol with step-down dosing; and use of ultrasound guidance for ET. Common laboratory practices included selective use of intracytoplasmic sperm injection, group culture of embryos in microdrops, and use of blastocyst ET in selected cases. Common laboratory features included good air quality using filtration and heated stages for oocyte and embryo work., Conclusion(s): Although a number of factors were identified in this best-practices questionnaire, programs often differed in many aspects of care. However, high-performing programs cited experience of physicians, embryologists, and staff members as well as consistency of approach, attention to detail, and good communication as being vital to excellent outcomes., (Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the clinical factors associated with blastocyst development and pregnancy., Design: Evaluation of a prospectively collected IVF database., Setting: An academic IVF practice., Patient(s): Couples (n = 529) undergoing their first IVF cycle who qualified for extended embryo culture (more than six zygotes) over the past 5 years., Intervention(s): Seven or eight zygotes were cultured for 5 days, assessed for quality, and then transferred with excess zygotes cryopreserved at the pronuclear stage., Main Outcome Measure(s): Clinical predictors of blastocyst development and pregnancy., Result(s): The mean blastocyst development rate was 49.8%, with a median number of total and good-quality blastocysts of 4 and 2, respectively. Clinical factors that were significantly associated with good-quality blastocyst formation were younger female age, increased parity, standard insemination, and lower doses of gonadotropins. Clinical factors that were significantly associated with successful pregnancy were younger female age, higher antral follicle counts, greater numbers of total and good-/excellent-quality blastocysts, and absence of male factor infertility., Conclusion(s): Several clinical factors are associated with the development of good-quality blastocysts after extended embryo culture and successful pregnancy outcome. These patient and cycle characteristics may be very useful in selecting the best candidates for extended embryo culture and single blastocyst transfers, thus optimizing outcomes while reducing the risks associated with multiple pregnancies., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)