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Third-party reproduction and the internet: an assessment of society for assisted reproductive technology (SART) fertility clinic websites
aspiration (MUA) at the UCSF Center for Reproductive Health from 2008 to 2012. To be included, products of conception (POC) had to be evaluated by a pathologist and have identifiable villi. Chi-square analysis (PASW Statistics 18) was used to compare prevalence of AVM in spontaneous, IUI, IVF and ICSI pregnancies. A subgroup of 100 patients with valid cytogenetic results had slides further reviewed by a blinded expert pathologist, and sensitivity of AVM in predicting aneuploidy was determined. RESULTS: The prevalence of AVM was not statistically different among groups (Table 1, p¼0.09). Of the 100 patients with valid cytogenetic testing, 63% were aneuploid. Prevalence of aneuploidy did not differ by treatment type (p¼0.13). The sensitivity of AVM diagnosis in detecting chromosomal abnormalities was 11% by general pathologists and 48% by an expert pathologist, with a positive predictive value of 70% and 79%, and an overcall of 8% and 22% respectively.
illustrate that there is room for improvement in the implementation of genetic screening practices at oocyte donation facilities. The authors propose development of a consensus guideline with representatives from genetic and reproductive care professionals, which will clarify conflicting guidelines, ensuring high quality reproductive care for all parties involved. Supported by: University of Utah Graduate Program of Genetic Counseling Research Stipend; National Society of Genetic Counselors Assisted Reproductive Technology Special Interest Group Research Grant Award. P-505 Wednesday, October 22, 2014 THIRD-PARTY REPRODUCTION AND THE INTERNET: AN ASSESSMENT OF SOCIETY FOR ASSISTED REPRODUCTIVE TECHNOLOGY (SART) FERTILITY CLINIC WEBSITES. S. B. Schon, J. L. Chan, K. E. O’Neill, P. Masson. University of Pennsylvania, Philadelphia, PA.
Table 1
Age GA at MUA AVM Aneuploidy (meanSD) (meanSD) prevalence (%) prevalence (%) Spontaneous IUI IVF ICSI Total
37.0 3.9 38.1 3.4 38.4 3.4 39.1 3.9 38.2 3.8
8.1 1.3 7.9 1.1 7.5 1.1 7.8 1.4 7.8 1.3
18/77 (23) 15/93 (16) 15/60 (25) 16/130 (12) 64/360 (18)
16/25(64) 19/23 (83) 9/16 (56) 19/36 (53) 63/100 (63)
CONCLUSION: Reassuringly, the prevalence of AVM is not increased in ART pregnancies. An expert pathologic diagnosis of AVM may alert clinicians about potential chromosomal abnormalities, however improvement in diagnostic sensitivity is needed.
P-504 Wednesday, October 22, 2014 OOCYTE DONOR GENETIC SCREENING PRACTICES. E. Moyle, A. Mathiesen, E. Johnstone, R. Hulinsky. University of Utah, Salt Lake City, UT. OBJECTIVE: To assess current genetic screening practices of oocyte donor applicants in the United States. DESIGN: An electronic questionnaire was distributed to 202 oocyte donation facilities (159 fertility clinics & 43 oocyte donation agencies) to evaluate genetic screening practices and consistency with guidelines. MATERIALS AND METHODS: Contact e-mail addresses for one hundred eighty fertility clinics and seventy-three egg donor agencies were collected (a total of 253). These facilities were sent an e-mail invitation to participate in the current study regarding genetic screening practices for oocyte donors. Twenty-one clinics and thirty oocyte donation agencies were excluded based on invalid e-mail addresses or a request to be removed from the e-mail list. A reminder survey invitation was redistributed three additional times to the remaining two hundred and two facilities (159 fertility clinics & 43 egg donation agencies). The questionnaire inquired about type of facility, donor family history risk assessment, genetic testing performed on donors, genetic testing consent process, and factors influencing facility practice. The questionnaire was distributed through the online survey tool, REDCap. RESULTS: Seventy-seven responses were received. Ninety-six percent (74/77) of facilities assessed donors’ family histories and 52% (40/77) of these facilities routinely inform donors about the results of these evaluations. Eighty-eight percent (68/77) of facilities reported screening all donors for the same conditions regardless of ethnicity or family history. Sixty-four percent (49/77) of facilities provide a consultation to donors regarding the genetic screening performed. Professional organization guidelines were identified as the most influential factor on genetic screening policies at an average of 62% of facilities. CONCLUSION: The majority of facilities report professional organization guidelines are the most influential factor with regards to development of institutional policies regarding genetic screening; however, when reporting what screening is being performed it became clear that most of the facilities are not actually following current guidelines. These data
e304
ASRM Abstracts
OBJECTIVE: Despite a growing number of patients utilizing third-party reproductive options, there is little data describing the information available to these patients on the Internet. Our objective was to evaluate SART-member fertility clinic websites for the availability and quality of information on third-party reproduction. DESIGN: Cross-sectional evaluation. MATERIALS AND METHODS: Between 2/2014-4/4014, 396 SARTmember fertility clinic websites were evaluated by two independent researchers. Websites were surveyed for the following characteristics: practice location, type and size, presence of donor egg and donor embryo programs, information for donors, recipients, gestational carriers (GC) and family building for Lesbian Gay Bisexual Transgender (LGBT) couples and individuals. Chi-square tests were used to assess for differences between groups. RESULTS: 98% (387/396) of clinics had a website, of which 80% were private and 20% academic. 26% of practices performed R500 cycles/year while 74% performed <500 cycles/year. 83% of clinics offered information for egg donor recipients and 56% offered information for potential egg donors. 67% had egg donor programs, 27% had donor embryo programs, and 8% had GC availability. Larger practices were more likely to advertise donor egg programs (77% vs. 66%, p ¼ .04) and were more likely to provide information on GC (64% vs. 47%, p¼ .005). Compared with academic clinics, private practices were more likely to have donor embryo programs (30% vs. 17%, p ¼ .02), but there was no difference in donor egg availability (69 vs. 60%, p¼ .12). Of practices that have egg donor availability, 14% provided public information on donor traits. 33% of websites provided LGBT reproductive options with private more likely than academic clinics to advertise these services (35% vs. 22%, p¼ .02). Large volume practices were also more likely to advertise LGBT services (44 vs. 29%, p¼ .007). Percentage of practices in the West (49%) and Northeast (44%) providing LGBT options were the highest, as compared with the Midwest (19%) and South (20%), p< .001. CONCLUSION: There is considerable heterogeneity regarding information on third-party reproduction on patient-oriented websites. While many fertility clinic websites provide general information about third party reproduction and egg donation, there is still a significant lack of information describing family building options for LGBT individuals. There is also a significant difference in the regional distribution of practices providing this information. P-506 Wednesday, October 22, 2014 TIME-LAPSE IMAGING CLEAVAGE STAGE PARAMETERS DO NOT ENHANCE SELECTION AMONG TRADITIONALLY SELECTED HIGH QUALITY EUPLOID BLASTOCYSTS THAT IMPLANT. C. Juneau,b K. H. Hong,a M. D. Werner,a J. M. Franasiak,a K. M. Upham,b R. T. Scott, Jr.,a,b aREI, RWJ, Rutgers, Basking Ridge, NJ; bRMA NJ, Basking Ridge, NJ. OBJECTIVE: Class I data demonstrate that selection of euploid blastocysts results in enhanced implantation and delivery rates, approaching 60% for single embryo transfers. While reassuring, there are a substantial number of ‘‘optimally selected’’ embryos which fail to implant. Time-lapse imaging parameters through day 3 of development correlate with blastulation rate, but do these same parameters extend to selection between euploid blastocysts? The purpose of this study is to determine if time lapse imaging can provide meaningful data which might aid in distinguishing euploid
Vol. 102, No. 3, Supplement, September 2014
illustrate that there is room for improvement in the implementation of genetic screening practices at oocyte donation facilities. The authors propose development of a consensus guideline with representatives from genetic and reproductive care professionals, which will clarify conflicting guidelines, ensuring high quality reproductive care for all parties involved. Supported by: University of Utah Graduate Program of Genetic Counseling Research Stipend; National Society of Genetic Counselors Assisted Reproductive Technology Special Interest Group Research Grant Award. P-505 Wednesday, October 22, 2014 THIRD-PARTY REPRODUCTION AND THE INTERNET: AN ASSESSMENT OF SOCIETY FOR ASSISTED REPRODUCTIVE TECHNOLOGY (SART) FERTILITY CLINIC WEBSITES. S. B. Schon, J. L. Chan, K. E. O’Neill, P. Masson. University of Pennsylvania, Philadelphia, PA.
Table 1
Age GA at MUA AVM Aneuploidy (meanSD) (meanSD) prevalence (%) prevalence (%) Spontaneous IUI IVF ICSI Total
37.0 3.9 38.1 3.4 38.4 3.4 39.1 3.9 38.2 3.8
8.1 1.3 7.9 1.1 7.5 1.1 7.8 1.4 7.8 1.3
18/77 (23) 15/93 (16) 15/60 (25) 16/130 (12) 64/360 (18)
16/25(64) 19/23 (83) 9/16 (56) 19/36 (53) 63/100 (63)
CONCLUSION: Reassuringly, the prevalence of AVM is not increased in ART pregnancies. An expert pathologic diagnosis of AVM may alert clinicians about potential chromosomal abnormalities, however improvement in diagnostic sensitivity is needed.
P-504 Wednesday, October 22, 2014 OOCYTE DONOR GENETIC SCREENING PRACTICES. E. Moyle, A. Mathiesen, E. Johnstone, R. Hulinsky. University of Utah, Salt Lake City, UT. OBJECTIVE: To assess current genetic screening practices of oocyte donor applicants in the United States. DESIGN: An electronic questionnaire was distributed to 202 oocyte donation facilities (159 fertility clinics & 43 oocyte donation agencies) to evaluate genetic screening practices and consistency with guidelines. MATERIALS AND METHODS: Contact e-mail addresses for one hundred eighty fertility clinics and seventy-three egg donor agencies were collected (a total of 253). These facilities were sent an e-mail invitation to participate in the current study regarding genetic screening practices for oocyte donors. Twenty-one clinics and thirty oocyte donation agencies were excluded based on invalid e-mail addresses or a request to be removed from the e-mail list. A reminder survey invitation was redistributed three additional times to the remaining two hundred and two facilities (159 fertility clinics & 43 egg donation agencies). The questionnaire inquired about type of facility, donor family history risk assessment, genetic testing performed on donors, genetic testing consent process, and factors influencing facility practice. The questionnaire was distributed through the online survey tool, REDCap. RESULTS: Seventy-seven responses were received. Ninety-six percent (74/77) of facilities assessed donors’ family histories and 52% (40/77) of these facilities routinely inform donors about the results of these evaluations. Eighty-eight percent (68/77) of facilities reported screening all donors for the same conditions regardless of ethnicity or family history. Sixty-four percent (49/77) of facilities provide a consultation to donors regarding the genetic screening performed. Professional organization guidelines were identified as the most influential factor on genetic screening policies at an average of 62% of facilities. CONCLUSION: The majority of facilities report professional organization guidelines are the most influential factor with regards to development of institutional policies regarding genetic screening; however, when reporting what screening is being performed it became clear that most of the facilities are not actually following current guidelines. These data
e304
ASRM Abstracts
OBJECTIVE: Despite a growing number of patients utilizing third-party reproductive options, there is little data describing the information available to these patients on the Internet. Our objective was to evaluate SART-member fertility clinic websites for the availability and quality of information on third-party reproduction. DESIGN: Cross-sectional evaluation. MATERIALS AND METHODS: Between 2/2014-4/4014, 396 SARTmember fertility clinic websites were evaluated by two independent researchers. Websites were surveyed for the following characteristics: practice location, type and size, presence of donor egg and donor embryo programs, information for donors, recipients, gestational carriers (GC) and family building for Lesbian Gay Bisexual Transgender (LGBT) couples and individuals. Chi-square tests were used to assess for differences between groups. RESULTS: 98% (387/396) of clinics had a website, of which 80% were private and 20% academic. 26% of practices performed R500 cycles/year while 74% performed <500 cycles/year. 83% of clinics offered information for egg donor recipients and 56% offered information for potential egg donors. 67% had egg donor programs, 27% had donor embryo programs, and 8% had GC availability. Larger practices were more likely to advertise donor egg programs (77% vs. 66%, p ¼ .04) and were more likely to provide information on GC (64% vs. 47%, p¼ .005). Compared with academic clinics, private practices were more likely to have donor embryo programs (30% vs. 17%, p ¼ .02), but there was no difference in donor egg availability (69 vs. 60%, p¼ .12). Of practices that have egg donor availability, 14% provided public information on donor traits. 33% of websites provided LGBT reproductive options with private more likely than academic clinics to advertise these services (35% vs. 22%, p¼ .02). Large volume practices were also more likely to advertise LGBT services (44 vs. 29%, p¼ .007). Percentage of practices in the West (49%) and Northeast (44%) providing LGBT options were the highest, as compared with the Midwest (19%) and South (20%), p< .001. CONCLUSION: There is considerable heterogeneity regarding information on third-party reproduction on patient-oriented websites. While many fertility clinic websites provide general information about third party reproduction and egg donation, there is still a significant lack of information describing family building options for LGBT individuals. There is also a significant difference in the regional distribution of practices providing this information. P-506 Wednesday, October 22, 2014 TIME-LAPSE IMAGING CLEAVAGE STAGE PARAMETERS DO NOT ENHANCE SELECTION AMONG TRADITIONALLY SELECTED HIGH QUALITY EUPLOID BLASTOCYSTS THAT IMPLANT. C. Juneau,b K. H. Hong,a M. D. Werner,a J. M. Franasiak,a K. M. Upham,b R. T. Scott, Jr.,a,b aREI, RWJ, Rutgers, Basking Ridge, NJ; bRMA NJ, Basking Ridge, NJ. OBJECTIVE: Class I data demonstrate that selection of euploid blastocysts results in enhanced implantation and delivery rates, approaching 60% for single embryo transfers. While reassuring, there are a substantial number of ‘‘optimally selected’’ embryos which fail to implant. Time-lapse imaging parameters through day 3 of development correlate with blastulation rate, but do these same parameters extend to selection between euploid blastocysts? The purpose of this study is to determine if time lapse imaging can provide meaningful data which might aid in distinguishing euploid
Vol. 102, No. 3, Supplement, September 2014