AMH levels in a cohort of patients during initial work up: diminished ovarian reserve often misclassified as unexplained infertility

overall ED visits increased by only 14.8%. The percentage of patients admitted with a principal diagnosis of PCOS decreased over this time (11% to 4%, p< .01), suggesting the severity of problems assessed at the PCOS ED visits may have lessened over time. In 2014, the South had a higher number of visits for PCOS (1,134) than any other region (636 in the Midwest, 431 in the Northeast and 374 in the West, p< .01). A disproportionate number of the PCOS ED visits were in the South, with the South comprising 40% of all U.S. ED visits, but 44% of all PCOS ED visits (p< .01). On the contrary, the West comprised 18.7% of all ED visits nationally, but only 14.5% of patients with a principal diagnosis of PCOS (p< .01). CONCLUSIONS: The number of ED visits for PCOS more than doubled between 2006 and 2014. Patients with PCOS in the South represent a higher number of ED visits compared with patients in other regions, especially the West. Future analysis of patient-level data will help to identify the specific reasons for PCOS patients seeking medical care in the ED, leading to improved healthcare delivery and appropriate ED utilization. Reference: 1. HCUPnet (Healthcare Cost and Utilization Project (HCUP). 20062014. Agency for Healthcare Research and Quality, Rockville, MD. http://hcupnet.ahrq.gov/ Accessed April 20-21 and 25, 2014.) Supported by: University of Michigan Department of Obstetrics and Gynecology. P-12 Tuesday, October 31, 2017 AMH LEVELS IN A COHORT OF PATIENTS DURING INITIAL WORK UP: DIMINISHED OVARIAN RESERVE OFTEN MISCLASSIFIED AS UNEXA. Davila,a PLAINED INFERTILITY. A. Gil,a I. Obeso,a A. E. Aguilar,a P. Patrizio,b P. Galache.a aIECH Fertility Center, Monterrey, Mexico; bObstetrics, Gynecology & Reproductive Sciences, Yale Fertility Center & Fertility Preservation, New Haven, CT. OBJECTIVE: Antimullerian hormone (AMH) has changed the diagnostic and treatment approach of infertile couples. Unfortunately, primary evaluation by general OBGYN’s not always includes AMH levels for all infertile patients but mostly for older women and this can lead to a misdiagnosis. We sought to establish the prevalence of diminished ovarian reserve in patients initially classified as unexplained infertility. DESIGN: Prospective, analytical, observational study at a private fertility center. MATERIALS AND METHODS: First time consultations (January 2015 to April 2017) were included. As part of the evaluation, data from previous assessments done by OBGYN’s and the initial referral diagnosis was collected, which included hormonal test, semen analysis and tubal patency. Patients were classified as: tubal factor, uterine factor, male factor, endometriosis (confirmed by laparoscopy), ovarian factor (including aging, >37yo) and unexplained infertility. At the initial infertility consult, AMH levels were measured in all and patients with a diagnosis of unexplained infertility were reclassified as per recently published nomograms (Gleicher et al). RESULTS: A total of 337 new patients were part of the study. Overall, aging was involved in 51% of cases, 21% were male factor, 16% tubal factor, 10% endometriosis, 9% uterine factor, 12% anovulation/PCOS and 18% for unexplained infertility was the cause for referral. After consultation and measurements of AMH (cut point 1.5 ng/mL), 25/62 (40%) of the referrals for unexplained infertility were reclassified as diminished ovarian reserve. The mean age was 32.4 y 2.9 and AMH levels were 1.72 ng/mL 2.4 for these patients. CONCLUSIONS: Due to the high percentage of patients who were reclassified as diminished ovarian reserve, AMH levels should be part of the primary infertility evaluation by OBGYN’s. A more accurate diagnosis will allow prompt initiation of referrals to advanced fertility treatments, particularly for patients with diminished ovarian reserve. Reference: 1. Gleicher N, Kushner VA, Sen A, Darmon SK, Weghofer A, Wu YG, Wang Q, Zhang L, Albertini DF, Barad DH. Definition by FSH, AMH and embryo numbers of good-, intermediate and poor-prognosis patients suggests previously unknown IVF outcome-determining factor associated with AMH. J Transl Med 2016;14(1):172. P-13 Tuesday, October 31, 2017 LEVERAGING ONLINE PATIENT REVIEWS TO IMPROVE QUALITY OF CARE: ART-SPECIFIC INSIGHTS FOR PRACTICE ADMINISTRATORS AND PHYSICIANS. Y. Kizawa. Columbia University, New York, NY.

e112

ASRM Abstracts

OBJECTIVE: To identify factors that contribute to positive patient experience in clinical ART setting through patients’ ratings of physicians and IVF centers, and determine whether online patient reviews and ratings can be used as a reliable indicator of provider service quality. DESIGN: Cross-sectional study. MATERIALS AND METHODS: Online reviews and ratings by patients were collected from FertilityIQ, a patient review site of U.S. IVF centers and reproductive endocrinology physicians. Outcome data for the year 2012, the latest available during the time of data compilation in 2016, was gathered from publicly available data reported by the Society for Assisted Reproductive Technology (SART). RESULTS: 120 IVF centers with the largest number of total ART cycles reported to SART in 2012 were included. 5 centers that could not be confidently identified in FertiltiyIQ were then excluded, leaving 115 centers in the analyses. In 2012, a vast majority (87.1%) of the centers performed fewer than 2000 cycles, with just a handful of large centers performing up to 7000+ cycles.The number of patient ratings per IVF center varied greatly (9.35 +/1.97). However, most (85.3%) of the centers received fewer than 15 ratings. Consistent with a prior analysis in other medical specialties1, a vast majority of reviewers rated the centers positively, with a mean overall score of 8.30 (+/- 0.31) out of 10. Individual physician ratings were similarly high at 8.34 +/- 0.30. Contrary to common fear in the industry, ratings were not dominated by disgruntled patients, with only 7% of them giving ratings below 5.Among the factors analyzed, average physician ratings, smooth operations and nursing team excellence were the most highly correlated with overall positive ratings for IVF centers. Counter-intuitively, but consistent with a prior finding in cardiac surgery2, fresh total live birth rates (LBR) reported to SART were not predictive of positive overall ratings. Also consistent with a prior study of surgeon ratings3, the number of total fresh cycles performed was not significantly correlated with positive overall ratings. CONCLUSIONS: While the limited number of ratings make generalization difficult, this study found that management of operational and administrative factors are just as important as interactions with clinicians when it comes to ensuring positive patient experience. As more physician practices rely on online review sites to improve performance4, ART-specific online rating sites with nuanced and thorough prompts has a potential to provide insights to practice administrators working to improve patient experience.The results of this study confirm prior findings in other specialties that higher volume and better clinical outcomes do not necessarily result in better patient experience and higher online ratings. Patients are well advised to use the online ratings to complement the insights garnered from published ART outcome data when selecting a center, rather than relying one or the other in isolation. References: 1. Gao GG, McCullough JS, Agarwal R, et al. A changing landscape of physician quality reporting: analysis of patients’ online ratings of their physicians over a 5-year period. J Med Internet Res 2012;14:338. 2. Okike K, Peter-Bibb TK, Xie KC, et al. Association Between Physician Online Rating and Quality of Care. J Med Internet Res 2016;18:e324. 3. Segal J, Sacopulos M, Sheets V, et al. Online doctor reviews: do they track surgeon volume, a proxy for quality of care? J Med Internet Res 2012;14:e50. 4. Emmert M, Meszmer N, Sander U. Do Health Care Providers Use Online Patient Ratings to Improve the Quality of Care? Results From an Online-Based Cross-Sectional Study. J Med Internet Res 2016;18:e254.

P-14 Tuesday, October 31, 2017 OPPORTUNITIES FOR EXPANDING ACCESS TO CARE IN REPRODUCTIVE MEDICINE VIA SOCIAL MEDIA. N. M. Crawford,a F. Hasselhof,b E. A. Evans-Hoeker.c aAustin Fertility Institute, Austin, TX; bAultman Ob/Gyn, Austintown, OH; cObstetrics and Gynecology, Carilion Clinic, Virginia Tech Carilion SOM, Roanoke, VA. OBJECTIVE: To evaluate current use and perceptions of the role of social media in medicine. DESIGN: Survey study. MATERIALS AND METHODS: Social media users, recruited via multiple social media platforms (blogs, Facebook, Instagram, Twitter), were asked to complete an electronic survey evaluating the role of social media in reproductive medicine. RESULTS: A total of 3,080 people participated the survey. A majority of respondents were Caucasian (81%), highly educated (87.5% completion of 4

Vol. 108, No. 3, Supplement, September 2017