Lessening the burden of care: stepped vs. fixed estradiol protocol for frozen embryo transfer

for statistical significance. A logistical regression model was also utilized to identify significance of multi-variables. RESULTS: Responses (N¼117) were returned. The female rate was 66% (N¼88). The majority,98%, were Christian (N¼112). The majority, 88%, were college educated (N¼102) with 39% (N¼40) with some post-graduate education. Sixty-eight percent (N¼79) had no knowledge of PGS prior to their IVF cycle; however, after provider education, ninety-two percent (N¼108) correctly identified that PGS was elective and 93% (N¼109) reported their knowledge was sufficient to make an informed decision to accept or decline PGS. The additional cost of screening (P¼0.004), the provider information and influence (P¼0.0001), and social support or acceptance from partner, family, friends (P¼0.03), were the three variables affecting the decision. In a logistical regression model, additional cost (P¼0.003) and explanation from the provider (P¼0.0003) were the only significant determinants influencing the decision. Religious and ethical beliefs were important (P¼0.20), but not statistically significant nor was information regarding the disposition of abnormal embryos (P¼0.18) or the concerns regarding cryopreservation and transfer at a later date (P¼0.79). CONCLUSIONS: PGS use as an adjuvant therapy to aid in selection of the embryo with the greatest potential for success, has become readily available in many IVF clinics. Researchers have spent time, resources, and effort on the clinical benefits and limitations of PGS, yet little research on the patient perspective, knowledge, education, and awareness regarding the options and ultimate decision making capabilities of the patient. This is the first study to the authors knowledge to identify and assess the determinants of the patient decision making process when presented with the choice of PGS in a given IVF treatment cycle. Several factors contribute to the patient perceived determinants when choosing to accept or decline PGS, including cost, religious/ethical values, social influence, and the past experience of the patient. O-83 Monday, October 19, 2015 12:15 PM LESSENING THE BURDEN OF CARE: STEPPED VS. FIXED ESTRADIOL PROTOCOL FOR FROZEN EMBRYO C. M. Bergh,a T. Molinaro,a,b TRANSFER. A. B. Tepper,a a,b a P. A. Bergh. Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ; bObstetrics, Gynecology & Reproductive Sciences, RutgersRobert Wood Johnson Medical School, New Brunswick, NJ. OBJECTIVE: Simplification of cycle medication protocols without a reduction in efficacy is a key priority in lessening the patient’s burden of care. This study sought to compare frozen embryo transfer (FET) cycle outcomes between estradiol therapies using a 1mg stepped protocol or 2mg fixed protocol at cycle start. DESIGN: Retrospective database study. MATERIALS AND METHODS: Analysis was performed on 3,984 patients’ electronic medical records at Reproductive Medicine Associates of New Jersey (RMANJ) from October 9, 1999 to April 30, 2015. FET cycles using autologous oocytes and blastocyst transfers with a starting dose of either 1 or 2mg were included in this study. Gestational Carrier cycles were excluded. Chi-square and t-test were performed for our normally distributed population. The study was powered to detect a 5% difference between groups. Logistic regression was performed to control for confounders. RESULTS: There were small statistical significant differences in endometrial thickness, length of cycle and use of CCS. Implantation rates were similar between both groups. When controlling for age, CCS use, number of embryos transferred, and method of cryopreservation, there were no significant differences in clinical pregnancy (OR 0.96; 95%CI 0.79 - 1.15) nor clinical loss rate (OR 0.98; 95%CI 0.79 - 1.22).

Cycle Characteristics Stratified By Starting Estradiol Dose.

1mg. estradiol 2mg. estradiol p value Sample Size (n) Oocyte Age (years) Endometrial Thickness (mm) Length of Cycle (days) Use of Comprehensive Chromosome Screening (CCS) (%) Clinical Pregnancy Rate (%) Implantation Rate (%)

FERTILITY & STERILITYÒ

3102 34.2 9.9 12.5 53.5

882 34.2 9.6 11.8 57.4

p ¼ 0.887 p ¼ 0.000 p ¼ 0.000 p ¼ 0.041

76.7 68.7

77.0 69.5

p ¼ 0.835 p ¼ 0.618

CONCLUSIONS: Clinical pregnancy and loss rates are not impacted by using a 2 mg fixed protocol for a FET cycle. Using a standardized fixed protocol may reduce provider ordering and patient administration errors, number of monitoring visits, and improve patient compliance. As described, a fixed FET protocol may reduce the patient’s burden of care without compromising outcomes.

O-84 Monday, October 19, 2015 12:30 PM GAY SURROGACY-THE QUANDRY OF ACCESSING VERIFIABLE FACTS. D. Smotrich,a A. Botes,a X. Wang,a M. Gaona,b D. Batzofin.a a IVF, LaJolla IVF, La Jolla, CA; bEmbryology/Andrology, LaJolla IVF, La Jolla, CA. OBJECTIVE: To bring attention to the lack of verifiable data pinpointing clinics that are accommodating to LGBT patients as well as being able to easily obtain LGBT friendly legitimate and objective statistical data regarding the use and success of gestational surrogate (GS) egg donor (ED) cycles to create their families. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Retrospective review of IVF laboratory database and patients’ charts was conducted on 529 consecutive fresh GS/ED cycles performed for gay couples from January 2004 - December 2013 (a ten year period) at a private clinic in California. After May 2005 all gamete providers were subject to FDA regulations. Standard stimulation protocols, monitoring, egg retrievals and embryo transfers were performed. Embryos were created with ICSI (100%), PGD/S (75%) and blastocyst transfers (80%). A review of a subset of 200 randomly selected gay intended parents’ charts from the 529 cycles was undertaken to analyze documented comments by patients regarding their country of origin, from where they learned about GS/ED as a treatment option and what additional information would have been useful in their decision making. RESULTS: From January 2004 - December 2013, 529 fresh GS/ED cycles were performed for gay couples. A clinical pregnancy was confirmed in 454 GS for an 86% clinical pregnancy rate. 80% of the gay couples achieved a live birth after one GS/ED cycle. Data obtained from the clinical chart review: patients traveled from 54 countries and 47 US states; 80% learned about GS/ED from the internet and media outlets, 7% from GS/ED agencies, 4% from peers and 9% from other patients. 96% stated some official statistics in a report (along the lines of the CDC Clinic Success Rates Report) as being the most authoritative guidance missing from their data search. CONCLUSIONS: In experienced hands, gestational surrogacy/egg donation is a highly effective treatment for gay couples in terms of family building. These patients deserve and should be able to rely on official statistical data in order to make a logical and informed decision in regards to their choice of the most appropriate treatment facility for their needs, just as other patients researching ART treatments are afforded.

EARLY PREGNANCY 1 O-85 Monday, October 19, 2015 11:15 AM THE EFFECT OF A PUBLICLY FUNDEDED NORTH AMERICAN IVF PROGRAM WITH MANDATED SINGLE EMBRYO TRANSFER ON MATERNAL ANTENATAL ADMISSION RATES. M. Dahan,a T. Shaulov,b S. Belisle.c aMcGill University, Montreal, QC, Canada; bMcGill University Health Centre, Montreal, QC, Canada; cUniversity of Montreal, Montreal, QC, Canada. OBJECTIVE: To determine the effect of a drastic drop in the multiple pregnancy rate on antenatal admission of women who underwent IVF. DESIGN: A retrospective study was performed by analyzing data concerning IVF cycle outcomes and hospital admission in Quebec. Single payer government health care with IVF coverage for all women enabled to track outcome details which were gathered from the Ministry of Health and Social Services ‘‘Pro-Assis’’ database and the hospital admission database (MED ECHO). The government program has mandated single embryo transfer in most cases. MATERIALS AND METHODS: Data is presented by financial year, and involves more than 250 000 pregnancies. The government began covering IVF in august 2010. Statistical analysis was performed using Chi squared tests, odds ratios or correlation coefficients. Data is available from

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