Our results are in line with the best European centers. The data reported refers to the period between 2010-2015.
The success rates of the different assisted reproduction treatments (IVF and ICSI) depend upon the woman age, the cause of infertility and may vary considerably from couple to couple and from cycle to cycle. Our team of expert tailors a customized protocol for each couple to optimize the results in each single cycle. In our center, the most sophisticated assisted reproductive techniques are adopted and the clinical data carefully interpreted.
IVF/ICSI CYCLES FOLLOWING OVARIAN STIMULATION
In the period between 2010-2015, 6.474 cycles of oocyte pick-up (OPU) for assisted fertilization (IVF/ICSI) were carried out at the GENERA center, and 6.170 underwent the embryo transfer (ET) of fresh and/or frozen embryos.
The average number of mature oocytes obtained was 5.5 per ovarian stimulation. This number varies considerably according to woman age, ovarian reserve and the controlled ovarian stimulation protocol (COS) adopted. In women younger than 35, on average 8 mature oocytes are obtained.
There is no predetermined number of oocytes to be inseminated, instead it is determined by the gynecologist responsible for the treatment in order to optimize it for each specific case (Constitutional Court Ruling 151/2009).
The oocyte fertilization rate was around 70% with both fresh and frozen oocytes.
The blastocyst development rate was 56% after fertilization of fresh oocytes, 44% after fertilization of frozen oocytes and over 70% with donated oocytes.
The delivery rate is shown as percentage per oocyte pick-up (OPU) and per embryo transfer (ET). The success rates for the period under consideration are shown hereafter. These data refer to transfers of both fresh and frozen embryos.
When the results are displayed according to woman age, it becomes evident that this factor is the most important predictor of pregnancy. A pregnancy is defined as the presences of at least one gestational sac observed by ultrasound scan; delivery means a pregnancy, which resulted in a livebirth.
Not all cycles result in an ET that may be cancelled for the following reasons:
- No oocytes retrieved
- Absence of fertilization
- Failure of embryo development or absence of embryos that are compatible with implantation
The cancellation of a fresh ET can also be a medical decision taken to preserve woman’s health and/or to optimize the evaluation of the embryo and/or to better synchronize the endometrium with the embryo. In any case, mature oocytes and/or viable embryos are cryopreserved.
From 2013, in the light of our results also published on Human Reproduction (Ubaldi et al., 2015), of international scientific literature and in the absence of other specific indications, single embryo transfer is recommended in women aged under 35 years or a single euploid blastocyst in cases of Preimplantation genetic diagnosis in all age groups.
The multiple pregnancy rates obtained at our center are listed below and were found to be highly dependent on the policy of the center with a significant reduction in twin pregnancy rate and none triplet pregnancy from 2013. Importantly the efficacy of the treatment, namely the pregnancy rate per started cycles was kept unchanged.
The average number of embryos transferred was 2.2 in 2010, 1.9 in 2011, 1.8 in 2012, 1.4 in 2013 and finally 1.1 in 2014 and 2015. This policy has led to a significant improvement of the obstetrical outcomes, with a reduction of pre-term deliveries and low weight after birth.
CYCLES WITH WARMED EMBRYOS AND OOCYTES
During 2015, 764 warming cycles (after vitrification) were carried out and 742 reached the ET (97.1%). Overall, 308 clinical pregnancies (41.5% per embryo transfer) were obtained, of which 244 delivered (32.8%). The results are therefore similar to those obtained in fresh cycles.
PRE-IMPLANTATION GENETIC TESTING: our results
The global effectiveness of the pre-implant diagnosis depends: on one side, on the number of available embryos and from their degree of development, and on the other side from the output of the diagnostic molecular method used. The clinical examinations obtained in our centre (2763 oocyte retrievals from 2280 couples in our clinic until April 2017; average of age of the woman: 39,5 years) underline that:
– An average of 78% of the cycles, present at least one analysable blastocyst
– About 67% of the cases in which the biopsy is carried out, there can be identified evolutionary embryos with normal set of chromosomes (euploid; rate of ploidy: 47% of the 6600 analysed blastocysts)
– The delivery rate due to embryo transfer throughout these cycles is 43% on average.
Twin pregnancies are 0,5% as a result of an average number of transferred blastocysts equal to 1,01 for each embryo transfer.
Figure 2. Possibility to obtain at least one blastocyst in relation to maternal age
Figure 3. Possibility to identify one chromosomally normal blastocyst with increasing maternal age
Figure 4. Implant rate of euploid blastocysts depending on the women’s oocyte retrieval. 1630 transfers of 1654 euploid blastocysts.
Figure 5. Abortion rate for the women’s age at the oocyte retrieval
During 104 cycles performed by 85 patient carriers of structural rearrangement in the maternal or fatherly karyotype (average age of the woman: 35 years), 420 blastocysts have been analysed. 37% of these didn’t present chromosomal instabilities. 75% of the cycles were solved with at least one transferable blastocyst. Until today, 90 transfers of 92 euploid blastocysts result in only 1 abortion (3% for clinical pregnancy) with a delivery rate of 43%.
58 patients (average age of the woman: 36 years) have performed 71 cycles. 66% of the blastocysts revealed not to be affected for the specific monogenic pathology in examination. 50% of the unaffected blastocysts have also been diagnosed euploid. This resulted in 76% of the cycles with at least one unaffected blastocyst and chromosomally normal. The abortion rate was 12% while the delivery rate due to transfer was of 44%.