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By Bin Wu, embriolog

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First, this chapter will describe certain historical developments in MAR. Next, current ovarian stimulation protocols and desired aims of modern era ovarian stimulation, embryo culture and embryo transfer outcome will be discussed. A single-centre MAR results analysis was performed in a ten year span in order to help resolve one of the ultimate questions: what is the optimal number of oocytes needed to achieve clinical pregnancy after embryo transfer? 2. Milestones in evolution of ovarian stimulation and embryo transfer Ever since the beginnings of MAR, increasing the chance of a live birth has been the most important aim of researchers’ efforts.

The oocytes with chromosome abnormalities are more likely to undergo atresia. If there is a good cryopreservation program, all embryos will eventually be transferred. However, those IVF centers that do not excel in embryo freezing programs may not transfer the “best ones” on fresh transfer but the odds of transferring the better embryos fresh may be greater with mild stimulation. 5. Controlled ovarian stimulation – Effects on the post-ovulatory endometrium By comparing pregnancy rates from infertile oocyte donors sharing half their oocytes with recipients, a very significant adverse effect of COH has been suggested based on a much higher pregnancy rate in recipients vs.

Theoretically this procedure will obtain more top quality embryos for transfer, especially considering a blastocyst transfer. With more embryos there will be a greater opportunity for subsequent frozen embryo transfer. A frozen embryo transfer does not create a risk of OHSS and is usually much less expensive than fresh IVF cycle. Furthermore there is no cost for expensive gonadotropins and GnRH agonists or antagonists and no charge for anesthesia. The most important aim of IVF program is to obtain a live delivered pregnancy from a given oocyte harvest whatever a fresh or frozen embryo transfer is performed (12).

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