Are reproductively competent blastocysts with poor morphological grade at an increased risk for adverse perinatal outcome?

P-178 Tuesday, October 18, 2016

P-179 Tuesday, October 18, 2016

ARE REPRODUCTIVELY COMPETENT BLASTOCYSTS WITH POOR MORPHOLOGICAL GRADE AT AN INCREASED RISK FOR ADVERSE PERINATAL OUTCOME? L. Sekhon,a,b J. Rodriguez-Purata,a J. A. Lee,a C. Briton-Jones,a A. B. Copperman.a,b a Reproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology & Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.

ANTI-MULLERIAN HORMONE(AMH) IN SERUM AND FOLLICULAR FLUID AND APOPTOSIS OF MURAL GRANULOSA AND CUMULUS CELLS IN PATIENTS UNDERGOING IVF/ ICSI. Y. Fan, L. Wei, J. Chen, Y. Shi, X. Liang. Reproductive Medical Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

OBJECTIVE: Single embryo transfer (SET) reduces IVF multiple gestations. Embryo selection is optimized by morphological grading and preimplantation genetic screening (PGS). While morphology is strongly correlated with implantation potential, it is not known whether poor morphology embryos that do implant result in defective placentation, impaired fetal growth and preterm delivery. This study sought to assess whether reproductively competent embryos with poor morphological grade have delayed perinatal sequelae. DESIGN: Retrospective cohort, case control study. MATERIALS AND METHODS: All patients with a singleton live birth after frozen-thawed SET (FET) from 2003-2015 were included. Monozygotic twins were excluded. Cycles were stratified based on the GardnerSchoolcraft grading for blastocyst expansion (BE), inner cell mass (ICM) and trophectoderm (TE). BE grade %3 (n¼10) were excluded. Age, BMI, endometrial thickness at transfer, gestational age and birthweight at delivery were recorded. Student’s t-test, chi-square, linear and binary logistic regression were used. RESULTS: A total of 420 live singleton births from frozen SETs were identified. Age, BMI, endometrial thickness at transfer, gestational age at delivery or infant birthweight were similar among morphological grading categories for BE, ICM or TE. A higher proportion of day 5 embryo transfers in expansion 4 vs. 5 and 6 groups were seen. Controlling for embryo age, birthweight was not influenced by expansion (p¼0.5), ICM (p¼0.4) or TE (p¼0.9). However, odds of low birthweight (LBW) (<2500g) was increased for expansion 4 (OR 4.7 [95% CI 1.3-30.0], p¼0.04) and 5 (OR 5.2 [95% CI 1.3-34.9], p¼0.04) blastocysts compared with 6 (Table). TE (x2¼0.8, p¼0.7) and ICM (x2¼0.9, p¼0.6) grade did not influence LBW. Morphological grade of BE, ICM and TE did not significantly influence the odds of macrosomia or preterm delivery. CONCLUSIONS: In general, transfer of an embryo deemed ‘‘poor morphological quality’’ was not associated with a decrease in gestational age at delivery or infant birthweight. While the overall incidence of LBW was low, we identified a preponderance of LBW singletons after transfer of a less expanded blastocyst. While FET enables maximal embryonic-endometrial synchrony, it is possible that less expanded, slower developing blastocysts are slightly asynchronous with endometrial receptivity, leading to defective placentation and decreased fetal growth in patients with an underlying susceptibility.

OBJECTIVE: To investigate the relationship between anti-Mullerian hormone (AMH) levels in serum and FF and apoptosis of granulosa and cumulus cells in normal ovarian reserve patients undergoing in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). DESIGN: Prospective control study. MATERIALS AND METHODS: A total of 58 women undergoing IVF/ ICSI cycle, aged <35 years old, with antral follicle count > 6, implying normal ovarian reserve, were divided into three group according to their serum AMH level before controlled ovarian hyperstimulation (COH). 17 women were in low AMH group (Group A, 1ng/ml6ng/ml). All patients were followed prospectively and their cycle outcomes were recorded. Follicular fluid(FF) samples were obtained from mature follicles during oocyte retrieval for IVF/ICSI. FF AMH and serum AMH concentrations were measured with the same automated AMH assay (Roche; Elecys). Estrodiol (E2), progesterone (P), testosterone (T) concentrations in FF were also measured by automated electrochemiluminescence immunoassay(Roche; Elecys). Mural granulosa cells were isolated from follicular fluid and cumulus cell were obtained during oocyte pick-up. Apoptosis of mural granulosa cells and cumulus cells were assessed by flow cytometry using Annexin V-FITC/PI double staining. RESULTS: There were no significant differences in baseline such as age, duration of infertility, gravity, abortion times and BMI (body mass index). Group C is associated with more antral follicle count (AFC) (p<0.001) and higher FF AMH levels (p<0.001). The number of retrieved oocytes (p<0.05) and top-quality embryos (p<0.05) were significantly higher in group C, but no significant differences were found. And there were no significant differences in total apoptosis of mural granulosa and cumulus cells among three groups. However, the percentage of early apoptotic events (annexin V+, PI-) in cumulus cells were higher in Group A than Group C. Also, T levels in FF were positive related to late apoptotic events (annexin V+, PI+) in cumulus cells (p¼0.003)and E2 levels in FF (p<0.001). CONCLUSIONS: This study suggests that high serum AMH levels are correlated with better ovarian reserve and better clinical outcomes. Also, higher AMH levels in serum or FF are associated with lower percentage of early apoptotic cells of cumulus cells. However, high levels of FF T in patients with normal ovarian reserve may relate to increased apoptosis of cumulus cells.

Perinatal outcomes stratified by blastocyst expansion

Blastocyst expansion grade Number of patients Age BMI Endometrial thickness at ET (mm) Day 5 blastocyst Day 6 blastocyst Gestational age at delivery (weeks) Preterm delivery (<37 weeks) Birthweight (g) Low Birthweight (<2500g) Macrosomia (>4500g)

e172

ASRM Abstracts

4

5

6

P value

198 35.3  4.6 22.8  3.8 9.5  2.1 52.0% (103/198)* 47.0% (93/198)* 37.9  2.4 19.7% (39/198) 3320.5  622.0 7.6% (15/198)

96 35.3  4.1 22.7  3.2 9.3  2.3 30.2% (29/96) 69.8% (67/96) 38.0  1.9 20.4% (20/98) 3312.8  617.3 8.3% (8/96)

116 36.4  3.7 23.1  4.0 9.3  1.8 27.6% (32/116) 72.4% (84/116) 40.7  26.5 14.7% (17/116) 3387.2  497.7 1.7% (2/116)*

NS NS NS <0.05 <0.05 NS NS NS <0.05

0.5% (1/198)

3.1% (3/96)

0.9% (1/116)

NS

Vol. 106, No. 3, Supplement, September 2016