Atlas of Vitrified Blastocysts in Human Assisted Reproduction

The method of vitrification of oocytes and embryos is fundamental for the outcome of IVF. This atlas presents data on
both closed system and open vitrification techniques, and the consequences of each method for survival rates, aiding
the comparison of vitrification methods. Structured on a patient-by-patient basis, the atlas describes 100 clinically
documented case studies that follow the evolution of cryopreserved blastocysts between warming and blastocyst transfer.
It relates fresh to post-warming blastocyst morphology and to response to controlled ovarian hyperstimulation. For each
case, pronuclear morphology and synchrony, as well as embryo morphology, are reported and described. Data on
indications for treatment, stimulation type and duration, are accompanied by over 400 high-quality images of vitrified
blastocysts. Covering the state-of-the-art techniques, this atlas is an essential aid in selecting the vitrification
method for clinical embryologists and physicians in reproductive medicine.


Highlights morphological changes during vitrification and provides before and after images to aid the comparison of
previtrification morphology
Contains serial images after warming to aid the scoring of viability of blastocysts
Includes neonatal data of newborn babies, enabling the reader to relate blastocyst morphology to the health of the
newborn child
Highlights special cases such as IMSI and ionophore, to aid blastocyst prediction in poor prognosis patients

CONTENTS
Preface ix
List of abbreviations x
Introduction 1
Part A Open Vitrification Method 13
Case 1 Hypogonadotropic hypogonadism: not pregnant 14
Case 2 Male factor infertility: missed abortion (no heart activity) 16
Case 3 Endometriosis, PCO: live birth, healthy boy 18
Case 4 Male factor infertility: live birth, healthy twins (monochorionic
diamniotic) 20
Case 5 Male factor infertility: live birth, healthy twins (dichorionic
diamniotic) 22
Case 6 PCO: live birth, boy with cerebral edema 24
Case 7 Male factor infertility (translocation carrier): live birth, healthy
girl 26
Case 8 Male factor infertility: live birth. Major malformation (cardiac
anomaly, child death at age 5 months) 28
Case 9 Male factor infertility: live birth, healthy dichorionic, diamniotic
twins (2 girls) 30
Case 10 PCO, male factor infertility: pregnant, intrauterine fetal death due
to trisomy 21 32
Case 11 Endometriosis: not pregnant 34
Case 12 Tubal infertility: ectopic pregnancy 36
Case 13 Tubal infertility: dichorionic-diamniotic twin pregnancy, live
birth, 1 healthy girl, 1 girl with atresia of duodenum 38
Case 14 Male factor infertility: live birth, healthy girl 40
Case 15 Male factor infertility: live birth, healthy boy 42
Case 16 PCO: live birth, healthy boy 44
Case 17 Male factor infertility: termination of pregnancy due to
Case 18 Male factor infertility: live birth, healthy girl 48
Case 19 Male factor infertility (HIV): not pregnant 50
Case 20 Endometriosis, tubal infertility: live birth, healthy boy 52
Case 21 Tubal infertility: live birth, healthy boy 54
Case 22 Male factor infertility: live birth, healthy boy 56
Case 23 Male factor infertility: not pregnant 58
Case 24 Male factor infertility, PCO: live birth, boy with Goldenhar
syndrome 60
Case 25 Male factor infertility: live birth, healthy boy 62
Case 26 Male factor infertility: biochemical pregnancy 64
Case 27 Endometriosis, tubal infertility: live birth, healthy boy 66
Case 28 Endometriosis: ectopic pregnancy 68
Case 29 Unexplained infertility: live birth, healthy boy 70
Case 30 Male factor infertility: live birth, healthy girl 72
Case 31 Male factor infertility: biochemical pregnancy 74
Case 32 Male factor infertility, pregnant, missed abortion (no heart
activity) 76
Case 33 Male factor infertility: missed abortion (no heart activity) 78
Case 34 Male factor infertility: live birth, healthy boy 80
Case 35 Male factor infertility: not pregnant 82
Case 36 PCO, male factor infertility: live birth, dichorionic diamniotic
twins, one girl with minor malformation (ventricular septum
defect) 84
Case 37 Male factor infertility: live birth, healthy dichorionic diamniotic
twins (boy and girl) 86
Case 38 HIV, male factor infertility: not pregnant 88
Case 39 PCO, male factor infertility: biochemical pregnancy 90
Case 40 Male factor infertility: live birth, healthy boy 92
Case 41 Endometriosis, male factor infertility: live birth, healthy boy 94
Case 42 Endometriosis: live birth, healthy boy 96
Case 43 Male factor infertility: missed abortion (no heart activity) 98
Case 44 Male factor infertility: missed abortion (positive heart
activity) 100
Case 45 Male factor infertility: missed abortion (positive heart
activity) 102
Case 46 Endometriosis, tubal infertility: live birth, healthy girl 104
Case 47 Male factor infertility: biochemical pregnancy 106
Case 48 Male factor infertility, PCO: live birth, healthy boy 108
Case 49 Tubal infertility, recurrent abortion: ectopic pregnancy 110
Case 50 PCO, male factor infertility: biochemical pregnancy 112
Case 51 PCO: live birth, healthy boy 114
Case 52 Male factor infertility: live birth, healthy boy 116
Case 53 Male factor infertility: not pregnant 118
Case 54 Unexplained infertility: biochemical pregnancy 120
Case 55 Male factor infertility: live birth, healthy boy 122
Case 56 Male factor infertility: live birth, healthy boy 124
Case 57 Male factor infertility: live birth, healthy girl 126
Case 58 Male factor infertility: live birth, healthy girl 128
Case 59 Male factor infertility: not pregnant 130
Case 60 Male factor infertility: live birth, healthy girl 132
Case 61 Tubal infertility: live birth, healthy girl 134
Case 62 Tubal infertility: pregnant, missed abortion
(no heart activity) 136
Case 63 Male factor infertility: live birth, healthy girl 138
Case 64 Male factor infertility: live birth, healthy boy 140
Case 65 Male factor infertility: missed abortions (2 positive heart
activities) 142
Case 66 Tubal infertility, male factor infertility: missed abortion
(positive heart activity) 144
Case 67 Male factor infertility: live birth, healthy girl 146
Case 68 Endometriosis: live birth, healthy boy 148
Case 69 Male factor infertility, hypothalamic pituitary failure: live birth,
healthy girl 150
Case 70 Endometriosis: live birth, healthy girl 152
Part B Closed Vitrification Method 155
Case 71 Male factor infertility: live birth, 2 healthy twin boys 156
Case 72 Male factor infertility: clinical pregnancy, abortion gestation
week 7 158
Case 73 PCOS: live birth, healthy boy 162
Case 74 Endometriosis, male factor infertility: not pregnant 164
Case 75 PCOS, male factor infertility: live birth twins (2 healthy boys) 166
Case 76 PCOS: stillbirth after premature labor and loss of amniotic fluid in
gestation week 24 168
Contents vii
Case 77 PCOS, male factor infertility: not pregnant/early pregnancy loss
gestation week 8 after one positive heart activity 170
Case 78 Male factor infertility: live birth, healthy boy 174
Case 79 Unexplained infertility: biochemical pregnancy 176
Case 80 Azoospermia after seminoma and chemotherapy: live birth,
healthy boy 178
Case 81 Tubal factor: not pregnant 180
Case 82 PCOS, male factor infertility: live birth, healthy boy 184
Case 83 Endometriosis: live birth, healthy girl 186
Case 84 Male factor infertility: not pregnant 188
Case 85 Endometriosis: live birth, healthy girl 190
Case 86 Tubal factor: after detection of 2 embryos with positive heart
activity live birth of one healthy girl 194
Case 87 Tubal factor: biochemical pregnancy 198
Case 88 PCOS, male factor infertility: live birth, healthy boy 200
Case 89 Tubal factor: live birth, healthy girl 202
Case 90 Amenorrhea, tubal factor: not pregnant 204
Case 91 Ovarectomy right, cervical anomaly: live birth, healthy boy 206
Case 92 Endometriosis, male factor infertility: live birth, healthy girl 208
Case 93 PCOS, male factor infertility: live birth, healthy girl 210
Case 94 PCOS, OAT: live birth, healthy boy after 2 positive heart
activities 212
Case 95 Tubal factor, endometriosis: live birth of a healthy twin pair
(one girl and one boy) 216
Case 96 PCOS: live birth, healthy girl 218
Case 97 Male factor, endometriosis: live birth, healthy girl 220
Case 98 Endometriosis, uterine polyps, male factor infertility: live birth,
healthy twin pair (one girl and one boy) 222
Case 99 Tubal factor, uterus anomaly, male factor infertility: triplet
pregnancy, loss of one embryo after positive heart activity, birth
of monozygotic twins gestation week 36 (healthy girls) 224
Case 100 Male factor infertility, recurrent pregnancy loss: live birth,
healthy girl 228
Index 231
viii Contents