Paternal Age Affects the Rate of Blastocyst Formation in Ovum Donation Cycles

P-52 Paternal Age Affects the Rate of Blastocyst Formation in Ovum Donation Cycles. G. Ambartsumyan,a,b M. Surrey,a H. Danzer,a D. Hill.a a Southern California Reproductive Center, Beverly Hills, CA; b Dept of Ob/Gyn. David Geffen School of Medicine at UCLA/Cedars-Sinai Medical Center, Los Angeles, CA. BACKGROUND: The relationship between maternal age and the success of assisted reproductive technology (ART) has been studied extensively. In contrast, there are few studies examining the effect of paternal age on ART outcome. The maternal genome predominantly controls the early embryonic development through the cleavage stages. Therefore, in an in vitro fertilization (IVF) cycle, one would not expect to see a major paternal affect on embryo development until the post cleavage stages when, upon the activation of the embryonic genome, male genetic contribution to the embryo occurs. OBJECTIVE(S): To evaluate the role of paternal age on the progression from a cleavage stage embryo into a blastocyst. MATERIALS AND METHOD(S): We analyzed fresh ovum donation cycles performed between February 2007 to August 2010 at Southern California Reproductive Center (SCRC). 217 cycles were analyzed for the study. The association between paternal age and blastulation rate was measured using multiple linear regression while adjusting for female age. Blastulation rate was calculated as a ratio of total blastocysts to the number of day 3 embryos. RESULT(S): A statistically significant negative correlation between paternal age and blastulation rate exists. Specifically, the blastulation rate decreases by 3% with every year of increasing paternal age (range of 30 to 60). Interestingly, the interaction between increasing donor and paternal age further affects blastulation rate significantly despite very young donor ages (mean and median of 25, range of 21 to 31). (Fig 1) The linear regression formula suggests that as donor age increases, the correlation between blastulation rate and male age becomes even more negative and this affect is only seen for donors over the age of 24. In fact, extrapolating the formula to donors of 30 years of age, the blastulation rate decreases 6% per year of paternal age. CONCLUSION(S): This study was able to demonstrate that blastulation rate in an IVF cycle decreased with every year of increasing paternal age. These findings become even more significant when extrapolated to fresh IVF cycles where the female age is generally over 30 years and may provide valuable information to be utilized in counseling patients.

Figure 1. Multiple linear regression of Logit blastulation rate as a function of male and donor age. The contribution of male age alone and the interaction between male and donor age were statistically significant with a p value of < 0.05. 4

Log Blastulation Rate

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y = -0.0229x(Male age) - 0.0088x(Donor age) - 0.0076x(Donor age-25)x(Male age-45) + 1.859

P-53 Elective Single Embryo Transfer vs. Double Embryo Transfer: Evaluation of Pregnancy and Multiple Gestation Rates. Ryan J. Heitmann, DO,a Richard O. Burney, MD, MSc,a Nancy Klein, MD,b Gregory E. Chow, MD.a a Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington; b Seattle Reproductive Medicine. Seattle, Washington. OBJECTIVE(S): To compare the pregnancy and multiple gestation pregnancy rates in in-vitro fertilization (IVF) for all patients meeting criteria for elective single embryo transfer who chose to proceed with elective single embryo transfer (eSET) or double embryo transfer (DET).

FERTILITY & STERILITYÒ

METHOD(S): Patients undergoing IVF between the dates of January 2007 through December 2008 were stratified into two groups: eSET and DET who met criteria for single embryo transfer. The primary outcome measures were overall clinical pregnancy rates and incidence of multiple gestation. Implantation rates were also compared between the two groups. RESULT(S): 479 IVF cycles were included in the study. 107 single embryo transfers were identified, of which 98 met criteria for set. Of the 367 having two embryos transferred, 89 met criteria for elective single transfer. 5 patients had three embryos transferred and were excluded from the study. The implantation rate was 64% and 74% (p¼0.269) respectively for the eSET and DET groups. The clinical pregnancy rate was significantly higher in the DET group, compared to the eSET group at 88% vs. 62% (p¼ <0.001). The live birth rate was 57% for eSET and 81% for DET (p¼ <0.001). The multiple pregnancy rate was significantly reduced in the eSET group as compared to the DET group, 2% vs. 54% (p¼ <0.001). CONCLUSION(S): Elective transfer of one embryo significantly reduces the rate of multiple pregnancies, without affecting implantation rate. Overall clinical pregnancy and live birth rates with a fresh cycle single embryo transfer were decreased when compared with double embryo transfer. LEVEL OF EVIDENCE: II

P-54 Visfatin: a Confounder of Clinical Pregnancy in Oocyte Donation Recipients. L. Rubal,a B. Rudick,a M. Wilson,a,b M. Early,b B. Kashani,a F. Stanczyk,a K. Bendikson.a a Dept of Ob/Gyn, USC, LA, CA; b Dept of Preventive Medicine, USC, LA, CA. BACKGROUND: Visfatin (VF) is an adipokine that acts predominantly as a pro-inflammatory modulator in the immune system. VF’s relationship with BMI is unclear. Obesity negatively impacts in vitro fertilization (IVF) outcomes. VF may mediate this through an inflammatory mechanism in the endometrium. OBJECTIVE: Our aim was to determine if serum VF levels are associated with clinical pregnancy (CP) in oocyte donation recipients, in whom the influences of age and embryo quality on CP have been eliminated. We also investigated whether serum VF is correlated with BMI. MATERIALS AND METHOD(S): This was a retrospective cohort study. Serum samples were collected in 65 oocyte recipients during their IVF cycle from 2005-2008. VF was measured via ELISA. CP was defined as fetal cardiac activity on ultrasound. Multivariable logistic regression was used for analysis, and to evaluate VF as a confounder (>10% change in the odds ratio) of CP. RESULT(S): Table 1 depicts descriptive characteristics. BMI range was 16.8-33.7. Serum VF (in ng/mL) was divided into three categories (VF%0.8, VF 0.9-1.99, VFR2), based on lowess plot cutpoints. There was a non-significant trend towards decreasing odds of CP with increasing VF (Table 2). VF was found to be a significant confounder of the relationship between number of embryos transferred and CP. Whereas in this study population the number of embryos transferred did not have a significant association with CP by itself (OR 1.27, 95%CI 0.58,2.8, p¼0.54), when we controlled for the percent blastomere fragmentation and VF in particular, there was a dramatic increase in the effect that number of embryos transferred had on clinical pregnancy (OR 3.84, 95%CI 1.13,13.0, p¼0.03). Serum VF was not associated with BMI in our sample. In women with normal range BMI<25 (n¼49), VF remained a confounder of number of embryos transferred on CP. However, in overweight women with BMIR25 (n¼15), VF was not a confounder. CONCLUSION(S): There was a non-significant trend toward decreased CP with higher VF. The striking shift seen in CP’s odds ratio from 1.27 to 3.84 is evidence of VF’s negative confounding effect on the relationship between number of embryos transferred and CP in subjects with normal BMI. Overweight women did not demonstrate this, perhaps because increased weight transcends other factors in its effect on CP.

TABLE 1. Descriptive Characteristics of the Study Population.

Mean age (years) Mean Body Mass Index (BMI) Mean VF (ng/mL) Mean embryos transferred

42.0 (6.2) 23.0 (3.1) 1.30 (0.89) 2.69 (0.53)

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