1. Outcome Measurement for Assisted Reproductive Technology DAVID L. KEEFE, M.D. Tufts New England Medical Center, Boston, Massachusetts Laboratory for Reproductive Medicine, Marine Biological Laboratory, Woods Hole, MA Brown University, and Women & Infants Hospital, Providence, RI

5. IVF- Clinical Processes Assess sperm quality and count Wash sample Sperm collection Egg equilibration Assessment of fertilization Incubate Wash/remove excess sperm Assess & Transfer

6. IVF- Laboratory Processes Eggs retrieved Eggs stripped and cleaned Assess sperm quality and count Wash sample Sperm collection Egg equilibration Fertilization- IVF or ICSI Assess fertilization Incubate Wash/remove excess sperm Assess & Transfer Embryos

7. Controlled Ovarian Hyperstimulation Regimens for Assisted Reproductive Technology GnRH Antagonist Protocols GnRH Agonist Protocols 225 IU per day (150 IU Europe) Individualized Dosing of FSH/HMG 250  g per day antagonist Individualized Dosing of FSH/HMG GnRHa 1.0 mg per day up to 21 days 0.5 mg per day of GnRHa 225 IU per day (150 IU Europe) Day 6 of FSH/HMG Day of hCG Day 1 of FSH/HMG Day 6 of FSH/HMG Day of hCG 7 – 8 days after estimated ovulation Down regulation Day 2 or 3 of menses Day 1 FSH/HMG OCP

25. Aneuploid Embryos Can Develop Normally Until Day 5 of Life! Development of Embryo with Trisomy 21, determined by PGD on day 3, with develoment to normal-appearing blastocyst Day 1 Day 5 Day 4 Day 3 Day 2

29. Gt.s’ Play Key Role in Meiosis FSH then LH (Gonal F, Repronex, Follistim, Bravelle, then hCG) Immature Oocytes w/I Follicles Metaphase II (MII) Metaphase I (MI)

30. Eggs From Older Women Have Abnormal Spindles Age (years) % Abnormal Spindles 20-35 17 40-45 79 Battaglia et al, Hum Reprod. 1996;11:2217 .

31. Spindle Function Imaged by Polscope

32. Eggs With Normal Spindles Develop Better