Does gender selection devalue women?

ART - OTHER P-462 RELATIONSHIP BETWEEN SPINDLE LOCATION AND EMBRYONIC DEVELOPMENTAL COMPETENCE IN INTRACYTOPLASMIC SPERM INJECTION AND ITS EFFECT ON CLINICAL OUTCOME. Y. Ishida. Cinema ART Clinic, Tokyo, Japan. OBJECTIVE: The spindle is generally considered to be located near the first polar body. Therefore, intracytoplasmic sperm injection (ICSI) is usually performed with the first polar body positioned at 12 o’clock or 6 o’clock to put the spindle away from the injection route and so avoid injury to the spindle. In recent years, however, cases have been reported in which the position of the spindle is not close to the first polar body. This prompted us to investigate the usefulness of ICSI where the spindle is visualized using OCTAX ICSI GuardÔ to avoid injury to the spindle. The relationship between the spindle position and treatment outcome was examined. MATERIALS AND METHODS: Informed consent for ICSI was obtained from 29 subjects aged 29 to 44 years (average age: 38.8  4.2). Four hours after egg collection, cumulus cells were removed and the spindle was examined immediately before the spindle aligned ICSI. RESULTS: When the first polar body was placed at the 12 o’clock position, the spindle had the following positions: 0 –5 , 40.8% (42/103); 6 –45 , 30.1% (31/103); 46 –90 , 2.9% (3/103); >90 , 2.9% (3/103). Fifty percent (37/74) of the spindles of subjects aged less than 40 years were located at 0 –5 , but only 17.2% (5/29) in subjects aged 40 years and older (P<0.05). Fertilisation percentages declined with increasing angle: 0 –5 , 83.3%; 6 – 45 , 83.9%; 46 –90 , 66.7%; >90 , 0%. Percentages of good quality embryos also declined with angle: 0 –5 , 54.8%; 6 –45 , 35.5%. The implantation rate of the 0 –5 eggs was 33.3% (14/42), significantly higher (P<0.05) than that of the other groups (12.9%). The pregnancy rate with the 0 –5 eggs was 75%. CONCLUSIONS: Eggs whose spindle is close to the first polar body have a higher fertilisation rate, better embryo quality, and higher implantation and pregnancy rates than eggs whose spindle is clearly dislocated from the polar body. Supported by: None.

P-463 OUTCOME OF 234 FIRST-TRIMESTER TRANSVAGINAL MULTIFETAL PREGNANCY REDUCTION BY ASPIRATION NON-KCL OR KCL INJECTION METHOD. X. Chen, J. Qiao, G. Chen, C. Ma. OB/GYN, Reproductive Medicine Center, Peking University Third Hospital, Beijing, China.

TABLE. Pregnancy outcome in relation to MFPR method

Outcome

Aspiration (n ¼ 73)

KCl (n ¼ 112)

P

Early abortion Late abortion Premature delivery <34 weeks delivery Neonatal death Take baby home

1 (1.4%) 5 (6.8%) 12 (16.4%) 3 (4.1%) 1 (1.4%) 66 (90.4%)

4 (3.6%) 7 (6.2) 22 (19.6%) 4 (3.6%) 4 (3.6%) 97 (86.6%)

0.65 1.00 0.70 1.00 0.65 0.24

CONCLUSIONS: MFPR seems to be the relatively safe and efficient method to improve the outcome of multiple pregnancies. Early transvaginal non-KCl method seems to be the better way to perform MFPR, but if it failed, rescued KCl injection method is also safe and efficient. MFPR to singleton fetus could be considered for the better outcome of IVF pregnancy. Supported by: None. P-464 DOES GENDER SELECTION DEVALUE WOMEN? N. Gleicher, D. Barad. The Center for Human Reproduction, New York, NY. OBJECTIVE: The American College of Obstetricians and Gynecologists (ACOG) recently issued an ethics opinion, condemning all methods and indications for elective gender selection as devaluatory and sexist to women. We decided to evaluate choice of gender at our center to see if one was, indeed, significantly preferred. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We investigated 101 consecutive elective gender selection cycles performed between 2004 and 2006. Embryology and medical records were reviewed to determine if gender selection was performed for female or male. Patients were classified for analysis as from Non-Minority (Caucasian and Hispanic) or Minority (Asian, African, Middle Eastern) populations. A logistic regression model, adjusted for age, was used to evaluate the possible association of female gender preference with the couples minority/non-minority status, utilizing SPSS for windows 15 with significance defined as P<0.05. RESULTS: Amongst 92 first cycles, 36 (39.1%) were selected for female and 56 (60.9%) for male (P< 0.04). Each decade increase in maternal age was associated with 2.5 times increase in the relative odds of preference for female gender selection (RR 2.5 (1.15 to 5.2), P<0.02). The Table summarizes choices by ethnicity. Gender preference was, significantly associated with the couple’s ethnic/cultural background (P<0.001). Among Caucasian/ Hispanics 31/52 (60%) preferred female gender (P¼ 0.16) while among non-Hispanic minority women the preference was 35/40 (88%) in favor of male gender (P<0.001. Thus ethnic/cultural status was strongly associated with gender preference (P<0.001). TABLE 1.

OBJECTIVE: Multifetal pregnancy reduction (MFPR) was introduced to avoid the increased incidence of abortion and premature labor associated with multiple pregnancies. The procedure has proved to be both safe and effective. Several methods of multifetal pregnancy reduction have been proposed. One option is the puncture and aspiration of embryonic parts early in the gestation (6–8 weeks) using the transvaginal ultrasound-guided technique. Intrathoracic injection of potassium chloride (KCl) was also used by the transvaginal route. This study was undertaken to evaluate 7 years of data on multifetal pregnancy reductions in one center with extensive experiences. DESIGN: Retrospective clinical study. MATERIALS AND METHODS: A total of 185 consecutive treatments of MFPR performed between 1999 through 2006 in our center were analyzed. MFPR was done by transvaginal ultrasound-guided aspiration in 6–8 weeks of gestation (73 cases, aspiration group) or KCl injection in 7–12 weeks of gestation (112 cases, KCl group) in multiple pregnancies. There were 21 cases (<8 weeks gestation) using KCl injection MFPR method because of the failure of aspiration at the first attempt. RESULTS: The total survival rate and total fetal loss rate after MFPR were 88.1% (163/185) and 11.9%, respectively. Total early abortion occurred within 12 weeks gestation was 2.7% (5/185). Total late abortion occurred between 12–28 weeks gestation were 6.5% (12/185). Eighty seven percent (161/185) of pregnancies delivered after 34 weeks of gestation. The pregnancy outcome comparison between the aspiration group and KCl group was shown in Table 1. The survival rate of pregnancies reduced to singleton was significantly higher than that in reduced to twins (100% (43/43) vs. 84.5% (120/142), P<0.0001).

S260

Abstracts

Ethnicity

N

Male Preference (%)

RR (95% C.I)*

Caucasian/Hispanic Chinese Asian-Indian African Arab Other Asian

52 22 5 5 6 2

21 (40%) 21 (95%) 5 (100%) 3 (60%) 5 (83%) 1 (50%)

1.00 47, (5 to 425) — 1.8, (0.27 to 11.7) 5.1, (0.5 to 52) 2.2, (0.08 to 62)

*Adjusted for age/Caucasian/Hispanic as reference group. CONCLUSIONS: This study confirms an overall larger demand for males. Closer examination reveals, however, that this demand is restricted to nonHispanic ethnic minorities. Amongst Caucasian/Hispanic patients the bias is actually towards the selection of females. Elective gender selection can, therefore, not be universally considered as devaluatory towards women. Ethics guidelines should consider ethnic diversity and should not be based on assumptions of universality. Supported by: Foundation for Human Reproduction. P-465 ASIAN ETHNICITY IS ASSOCIATED WITH LONGER DURATION OF INFERTILITY AND DECREASED PREGNANCY RATES FOLLOWING INTRAUTERINE INSEMINATION (IUI). J. D. Lamb, K. J. Purcell, A. E. Modan, E. Vittinghoff, H. G. Huddleston, V. Y. Fujimoto. Department

Vol. 88, Suppl 1, September 2007