Autologous endometrial coculture in patients with IVF failure: outcome of the first 1,030 cases.
OBJECTIVE
To analyze the effectiveness of autologous endometrial coculture (AECC) in improving embryo quality and pregnancy rates in 1,030 consecutive cycles of in vitro fertilization-embryo transfer (IVF-ET) utilizing AECC from January 1996 to December 2001.


METHODS
Embryos from each of 1,030 patients allocated to growth on AECC were analyzed for outcome. All patients had previously undergone failed IVF cycles. During a luteal phase biopsy (5-12 days after the luteinizing hormone surge) performed prior to the treatment cycle, glandular (G) and stromal (S) endometrial cells were isolated by enzymatic digestion and separated based on differential sedimentation rates. These cells were cryopreserved, then plated as a 50%/50% combination of G and S cells prior to embryo exposure. The conditioned medium was changed every 2 days. Embryos were randomly grown on endometrial coculture (ECC) or conventional media if > 6 oocytes were normally fertilized. Otherwise, all embryos were grown on AECC.


RESULTS
The patients' mean age was 36.9 (+/-3.1) years. The patients had on average a history of 3.1 (+/- 1.7) failed prior attempts. When comparing a previous cycle (same institution only), the cleaved embryos on day 3 were of an improved quality (6.8+/-1.2 vs. 5.5+/-1.0 blastomeres and 14.6% +/- 9.3 vs. 27.2% +/- 9.8 fragmentation, P <.05). Twenty-two (2.13%) patients did not undergo ET secondary to poor embryonic development. Overall positive and clinical pregnancy rates of 49.8% and 41.5% were noted, respectively. Age remained the most important predictor of outcome.


CONCLUSIONS
We demonstrated a significant improvement in embryo quality with ECC. We also demonstrated that patients with a poor prognosis secondary to prior IVF failures can have a good outcome when utilizing AECC.
Spandorfer
Steven D
SD
Center for Reproductive Medicine and Infertility, Department of Obstetrics and Gynecology, Cornell University Medical Center, New York, New York, USA.
Pascal
Patricia
P
Parks
Jason
J
Clark
Robert
R
Veeck
Lucinda
L
Davis
Owen K
OK
Rosenwaks
Zev
Z
D000328:Adult; D018929:Cell Culture Techniques; D015925:Cryopreservation; D003470:Culture Media; D004624:Embryo Transfer; D004717:Endometrium / Q000166:cytology* / Q000502:physiology; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis
D003470:Culture Media