physical development is costly and time consuming, the use of parent-administered questionnaires has been proposed as way of monitoring thedevelopment of ICSI offspring.

Design: Prospective survey using a home-administered questionnaire tocompare the psychological and physical development of 3 year old childrenconceived by ICSI and standard IVF, respectively.

Materials/Methods: Consenting parents (IRB # 0399–613) of 3 year old(�6 months) children completed the Ages & Stages Questionnaires (ASQ),a series of developmental questionnaires. The ASQ is an illustrated 30-itemquestionnaire for assessing child development (from birth to 5 years of age)in their natural environment. Five key developmental areas—communica-tion, gross motor, fine motor, problem solving, and personal-social—wereevaluated in addition to a section addressing specific parental concerns.Questionnaires were ranked according to the child’s score, as ‘typical’development or ‘at risk’ therefore needing further evaluation.

Results: Of 450 ICSI families invited, only 20.0% (n � 89) respondedand only 11.9% (36/302) of the IVF families completed the questionnaires.Based on the ASQ screening cut-off points, 86.5% (77/89) of the ICSIchildren displayed normal development, comparable to the 88.9% (32/36) ofIVF children. A total of 12 (13.5%) ICSI children were considered ‘at risk’,five coming from multiple pregnancies, while in the IVF group four (11.1%)children were found to be ‘at risk’, with two being from a high ordergestation. There were no differences between boys and girls among the fivedevelopmental areas.

Conclusions: This study indicates that the ASQ provides a cost- andtime-effective method through which to monitor the development of chil-dren resulting from assisted reproductive technology, particularly for cen-ters where a pediatric and psychological follow-up would be inconvenient.The 3 year old children assessed in the ICSI and IVF groups, are developingwell without significant delays in the cognitive abilities, socio-emotionaldevelopment, and motor skills. The low response rate may be attributable tothe confidence that parents have in the normality of their ART children.Because of the relatively low response rate, definitive conclusions cannot bedrawn as yet.

Supported by: This study was partially supported by an unrestricted grantfrom Organon Inc., USA.

P-407

Comparison of outcomes from blastocyst transfer on day 5 and 6.James Graham, Michael Tucker, Taer Han, Alana Davis, Jennifer Carter,Michal Levy. Shady Grove Fertility Centers, Rockville, MD; Shady GroveFertility Centers, Georgia Reproductive Science Ctr, Rockville, MD.

Objective: To undertake a review of blastocyst transfer data to analyzeimpact of transfer delay (day 5 or 6) due to slower development, andconsequences of insemination type upon implantation and pregnancy rates.

Design: Retrospective analysis of 16 months clinical IVF data from aprivate infertility clinic.

Materials/Methods: 514 couples undergoing 542 cases of IVF with ET atthe blastocyst stage. Using extended in vitro culture of human embryos toenable enhanced discrimination of embryo quality, thereby allowing a morelimited number of embryos to be transferred at the last stage of preimplan-tation development.

Results: Pregnancy rate and embryonic implantation per embryo trans-ferred. The age of patient and mean number of embryos transferred were thesame for both groups (day 5 or 6). Pregnancy rates in the day 5 group (64%)were significantly higher than the day 6 (50%) p �0.0079*. Implantationrate per embryo transferred were significantly higher in the day 5 group(46%) versus the day 6 group (36%) p �0.0045* *Chi-square analysis

Day 5 Day 6 Combined

CONV ICSI CONV ICSI CONV ICSI

ET’s 245 173 64 60 309 233#Embryos 497 (2.03) 361 (2.09) 140 (2.19) 138 (2.30) 637 (2.06) 499 (2.14)FHB’s 250 (50%) 169 (47%) 48 (34%) 54 (39%) 298 (47%) 223 (45%)Viable

Pregnancies159 (65%) 108 (63%) 28 (44%) 34 (57%) 187 (61%) 142 (61%)

Implantation 238 (48%) 160 (44%) 47 (34%) 54 (39%) 285 (45%) 214 (43%)

Conclusions: There is a suggestion that slower blastocyst formation isrelated to increased maternal age, although with unbalanced numbers thistrend was not significant in the overall day 5/6 comparisons in Table 1.Initial heart beats, and viable pregnancy and embryonic implantation rateswere all significantly lower in the day 6 ET group compared to day 5 ETgroup. When these data are broken down into insemination types (Table 1),there were no significant differences between any outcomes either accordingto day of ET, or even when the overall data are combined from both day 5and 6 ETs. From this it is clear that delayed blastocyst formation isassociated with reduced implantation and pregnancy, although these ratesare clinically acceptable. All day 6 blastocysts underwent assisted hatchingif they had not already initiated natural hatching. Insemination type had noimpact on blastocyst formation or pregnancy outcome.

Supported by: na.

P-408

Increased embryo implantation with increased protein quantity andcomplexity in a sequential embryo culture system. Marius Meintjes,David Ward, Henry Wehrland, Alfred J. Rodriguez, David M. Bookout,James D. Madden. Presbyterian Hosp ARTS Program, Dallas, TX.

Objective: Since the abandonement of co-cultures, the presence of morecomplex rather than simple protein molecules in the embryo culture mediumis advocated and frequently implicated in improved in vitro embryo perfor-mance and subsequent in vivo viability. However, many commercial culturemedia are recommended for use with human serum albumin (HSA) only.The objective of this study was to evaluate the effect of an increase in thequantity and complexity of the embryo culture medium protein supplementon implantation and clinical pregnancy rates.

Design: Only first cycle-, previous live birth- or donor-recipient coupleswere eligible for this study. Patients were randomly assigned to the controlgroup (culture media with 0.3% HSA) or the treatment group (culture mediawith 0.3% HSA and 10% serum substitute supplement) after signing anIRB-approved consent. Further block randomization was performed withinphysician and age group. The age groups considered were �34 years(n�181), 35–37 years (n�59), 38 to 40 years (n�54) and donor oocyte-recipient couples (n�84).

Materials/Methods: All oocytes were inseminated in P-1 medium con-taining 0.3% HSA. Embryos were produced either by conventional in vitrofertilization or ICSI with ejaculated sperm. After fertilization evaluation, allfertilized embryos were cultured in G-1/G-2 sequential culture media in anatmosphere of 5% CO2, 5% O2 and 90% N2 at 37.1°C. Embryos weretransferred to patients on day 2, 3 or 5, depending on the number of qualityembryos available for culture.

Results: The results are summarized in the table. The higher implantationrates and trend towards higher clinical pregnancy rates per oocyte retrievalwere observed for all age groups.

Clinical outcomes for SSS/HSA culture medium supplementation.

Serum SubstituteSupplement

Human SerumAlbumin

Number Percent Number Percent

No. Patients 195 183Clin. Preg./Retrieval 120/195 61.5 102/183 55.7Implantations 214/378a 56.6 162/401b 40.4No. Embryos Frozen 154 120

a,b Numbers within rows with different superscripts are different; �2; P �0.0001

Conclusions: Serum Substitute Supplement contains a more complexglobulin fraction in addition to HSA. By adding 10% serum substitutesupplement to the HSA-containing G-1/G-2 culture media, implantationrates are significantly increased, regardless of the day of transfer. In addi-tion, clinical pregnancy rates and the number of embryos available forblastocyst crypreservation may also improve. The results from this studysupport the supplementation of commercial sequential embryo culture me-dia with additional, more complex protein for improved results.

Supported by: none.

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