Minimal precycle testing and ongoing cycle monitoring for in vitro fertilization and fresh pre-embryo transfer do not compromise fertilization, implantation, or ongoing pregnancy rates

OBJECTIVE: We sought to assess the fertilization, implantation, and ongoing pregnancy rates with a minimal precycle and ongoing cycle monitoring proto col for in vitro fertilization and embryo transfer. STUDY DESIGN: Retrospective review was conducted of 103 consecutive cycles of fresh in vitro fertilization and embryo transfer from 1996 to 1998. Prec ycle screening included semen analysis without strict morphologic analysis, and hysterosalpingography-sonohysterography within the last year. Serum pr olactin, serum thyroid-stimulating hormone, reactive plasma reagin, human i mmunodeficiency virus, rubella titer, blood type, hepatitis B surface antig en, and hepatitis C antibody testing was performed on all patients within 3 months of cycle initiation. Women greater than or equal to 37 years old un derwent clomiphene challenge testing. The monitoring protocol included the following: baseline transvaginal ultrasonography after 12 to 14 days of mid luteal gonadotropin-releasing hormone agonist down-regulation to assess end ometrial thickness and adnexal appearance, transvaginal ultrasonography for follicle evaluation at 7 and 10 days, serum estradiol assay if greater tha n or equal to 20 follicles, quantitative beta-human chorionic gonadotropin 12 to 14 days after pre-embryo transfer, repeat quantitative beta-human cho rionic gonadotropin 3 to 5 days later, and transvaginal ultrasonography for intrauterine gestational sac confirmation 7 to 9 days after the initial po sitive pregnancy test result. The dose of gonadotropin used remained consta nt unless the sonogram obtained on day 7 indicated a suboptimal response (< 3 follicles each, with an average diameter of 10 to 12 mm) or hyperresponse (greater than or equal to 15 follicles with an average diameter of 10 to 1 2 mm). RESULTS: The per embryo implantation rate (fetal cardiac activity) was 13.1 %, and the live birth rate per 100 pre-embryo transfers was 31.5 for patien ts less than or equal to 40 years old. The average number of pre-embryos tr ansferred was 3.1. The singleton pregnancy rate was 71%, and there were no multiple gestations greater than twins. The mean number of oocytes fertiliz ed was 66%. There was 1 case of failed fertilization with intracytoplasmic sperm injection. There were two other cases of failed fertilization. One ca se of severe ovarian hyperstimulation occurred in spite of cryopreservation of all embryos. CONCLUSIONS: In vitro fertilization and embryo transfer can be accomplished with minimal precycle testing and ongoing cycle monitoring without comprom ising fertilization, implantation, and ongoing pregnancy rates. This result s in reduced overall costs for couples.