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Resume Objectif Actuellement, il est primordial que les centres d'AMP disposent d'outils applicables en routine pour selectionner l'embryon avec le potentiel implantatoire le plus eleve afin de reduire le taux de grossesses multiples. Dans cette etude, une analyse prospective a ete menee pour determiner si des marqueurs de developpement non invasifs a j1, combines aux evaluations morphologiques conventionnelles de j2 permettent de predire le developpement in vitro de blastocystes. Patient(e)s et methodes Cette etude a ete fondee sur le suivi individuel de 4190 embryons issus de patients du programme de FIV/ICSI du CHU de Tours entre janvier 2002 et decembre 2004. De j1 a j5/j6, une culture en microgouttes sous huile a permis d'enregistrer la progression sequentielle in vitro de ces embryons et la cinetique des blastocystes obtenus. Resultats Les resultats mettent en evidence une relation positive significative entre un profil 0 des zygotes, un premier clivage precoce, un embryon avec quatre blastomeres et moins de 20 % de fragmentation a j2 et le taux de blastocystes a j5 (p Discussion et conclusion L'evaluation des zygotes et l'appreciation du premier clivage a j1, la morphologie embryonnaire a j2 sont predictives isolement du developpement jusqu'au stade blastocyste a j5 ou j6. Ces caracteristiques peuvent etre combinees pour etablir un modele sequentiel predictif d'evolution longitudinale in vitro applicable en routine.

Routine early developmental parameters are widely used in IVF centres to evaluate embryo development and fresh single-blastocyst transfer currently seems superior to single-embryo transfer. Would early morphological parameters help to choose the single blastocyst to be transferred, thereby improving the chances of implantation and live birth rate? This prospective observational study analysed the individual outcomes of 2617 embryos from 511 IVF couples scheduled for a single-blastocyst transfer. Embryo and blastocyst scores were constructed. There was a clear relationship between the kinetics and morphology of blastocysts and further implantation and live birth rate. There was a limited predictive value of embryo score with regard to blastocyst development and growth kinetics. Implanted and non-implanted blastocysts showed similar embryo scores. Thus usual morphological parameters on days 1 and 2 seem to have no additional value in indicating the right blastocyst to transfer. Non-invasive approaches might be helpful to increase the chances of implantation in the future. (C) 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

BACKGROUND: Whether extended culture allowing selection of embryos with high development potential has any advantage over cleavage-stage embryo transfer remains a matter of debate. Among the currently unsolved questions, the cumulative delivery rate resulting from fresh and frozen embryo transfers needs to be taken into account in both strategies. The aim of our study was, therefore, to compare the efficacy of single embryo transfer either on Day 2 or on Day 5/6 combining fresh and frozen embryo transfers. METHODS: A prospective study including 478 couples assigned on a voluntary basis to undergo elective single embryo transfer (eSET, n = 243) on Day 2 or single blastocyst transfer (SBT, n = 235) on Day 5/6 was performed. The primary outcome measurement was the cumulative delivery rate including fresh and frozen-thawed cycles in both groups. RESULTS: The delivery rate per cycle following fresh embryo transfer was significantly higher in the SBT group compared with the eSET group (P < 0.01). Conversely, frozen embryo and/or blastocyst transfers tended to result in a higher number of deliveries in the eSET compared with the SBT group. Altogether, the cumulative delivery rate per couple, including fresh and frozen embryo transfers, was similar between the two groups (37.9% versus 34.2% in the SBT and eSET groups, respectively). CONCLUSIONS: The observed cumulative delivery rates in this study do not allow us to take a position in favor of SBT or eSET. An improvement in blastocyst cryopreservation may change this attitude.

BACKGROUND: This study was designed to determine the efficacy of a programme using frozen donor semen in a cohort of patients returning for treatment after previously conceiving through donor insemination (DI). METHODS: The cohort included 222 couples with secondary infertility (previous live birth) in one University Hospital Centre. The treatment sequence involved DI cycles until completion. Live births, drop-out for personal or medical reasons and recourse to IVF with donor semen (IVF-D) were recorded for all patients. Live births were expressed as both rate per cycle and crude cumulative rate. RESULTS: At the end of the DI cycles, 65% of couples in the cohort achieved second parenthood. Most of them (77%) succeeded after only four DI cycles. The majority of couples who stopped treatment did so for personal reasons. CONCLUSIONS: Patients involved in a second parenthood project belong to a 'selected' population. Management and counselling of such patients need to reconcile the early efficacy of DI cycles, the invasiveness of the IVF-D procedure and the availability of donor semen.