As good as it gets: donor eggs and a gestational carrier

decreased but DETs were predominant and similar whether ET was Day 3 or Day 5/6. Day 5/6 ETs resulted in significantly higher LBRs per ET than Day 3 ETs. Overall, the increased rate of SET in Day 5/6 ETs likely contributed to multiple birth rates lower than the national average (26.6%)1 while maintaining high LBRs. References: Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2013 Assisted Reproductive Technology National Summary Report. Atlanta (GA): US Dept of Health and Human Services; 2015. Supported by: Study supported by EMD Serono, Inc., Rockland, MA, USA (a business of Merck KGaA, Darmstadt, Germany). O-129 Tuesday, October 18, 2016 11:45 AM INTRAUTERINE HUMAN CHORIONIC GONADOTROPIN (HCG) INFUSION PRIOR TO EMBRYO TRANSFER (ET) MAY BE DETRIMENTAL TO PREGNANCY RATE. M. Volovsky,a M. Healey,b V. B. MacLachlan,c B. J. Vollenhoven.d aMonash University, Melbourne, Australia; bUniversity of Melbourne, Malvern East, Australia; cMonash IVF, Victoria, Australia; dObstetrics and Gynaecology, Monash University, Melbourne, Australia. OBJECTIVE: The process of embryo implantation is influenced by both embryonic and endometrial factors. The receptivity of the endometrium is vital to the process and hence much attention has been given to enhancing the intrauterine environment. A hormone thought to have beneficial effects on this environment is hCG. It has been postulated that an intrauterine hCG infusion prior to ET could potentially increase implantation rates1. However, up to this point, evidence on the matter is conflicting2,3. Therefore, our aim was to investigate whether intrauterine hCG at the time of ET improves pregnancy rate. DESIGN: The study design was a matched case control study based on a standardised database from a multi-site private in vitro fertilisation clinic. MATERIALS AND METHODS: Initial analysis involved all patients including those using multiple adjuvants (n¼1153). A second analysis was performed in which no additional adjuvants other than intrauterine hCG infusions were used (n¼667). In both analyses there were two groups: an intervention group of those given an intrauterine hCG infusion, and a control group of patients receiving no infusion. Cases were matched according to the following variables: maternal age, number of embryos transferred, embryo age, tubal factor infertility, progressive number of ETs since a live birth, IVF clinic site. In the initial analysis matching also included the use of melatonin, intralipid, growth hormone, testosterone, cabergoline and filgrastim. Matching was performed with the MatchIt module in R, using the ‘‘genetic’’ method with a case control ratio of 1:2. The outcomes were defined as: chemical pregnancy, clinical pregnancy, clinical pregnancy loss and live birth. RESULTS: The sample in which adjuvants were allowed demonstrated statistically significant reductions in chemical pregnancy (OR 0.78 CI 0.63-0.96), clinical pregnancy (OR 0.71 CI 0.57-0.88) and live birth rates (OR 0.67 CI 0.53-0.86) when intrauterine hCG was given prior to ET. Analysis where no additional adjuvants were used similarly found that intrauterine hCG use produced declines in chemical pregnancy (OR 0.65 CI 0.48-0.87), clinical pregnancy (0.67 CI 0.49-0.90) and live birth rates (0.65 CI 0.46-0.93) when compared to a control group. Sub-analysis of frozen embryo transfers (FET) revealed a marked decrease in chemical pregnancy, clinical pregnancy and live birth rates in the setting of intrauterine hCG infusions in both the initial and second analyses. CONCLUSIONS: Intrauterine hCG prior to ET was shown to not only have no benefit on pregnancy outcomes but a potentially negative effect, particularly when used before FET. Hence, there is an indication for prospective randomised studies in this area. Moreover, as there is now documented potential for harm, use of hCG infusions prior to ETs should be limited to within such trials. Less may be more for some patients. References: 1. Tsampalas M, Gridelet V, Berndt S, Foidart JM, Geenen V, Perrier d’Hauterive S. Human chorionic gonadotropin: a hormone with immunological and angiogenic properties. J Reprod Immunol 2010; 85: 93-98 2. Ye H, Hu J, He W, Zhang Y, Li C. The efficacy of intrauterine injection of human chorionic gonadotropin before embryo transfer in assisted reproductive cycles: Meta-analysis. J Int Med Res. 2015 Dec; 43(6):738-46

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3. Wirleitner B, Schuff M, Vanderzwalmen P, Stecher A, Okhowat J, Hradecky L, et al. Intrauterine administration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study. Reprod Biol Endocrinol. 2015 Jul 4;13:70

O-130 Tuesday, October 18, 2016 12:00 PM AS GOOD AS IT GETS: DONOR EGGS AND A GESTATIONAL CARRIER. R. J. Chetkowski,a A. C. Eisenberg.b aAlta Bates IVF, Berkeley, CA; bAlta Bates IVF, Oakland, CA. OBJECTIVE: To compare live birth (LB) and embryo implantation (IR) rates in donor egg cycles with and without a gestational carrier (GC). Since the former treatment optimizes both embryonic and recipient-related variables while the latter approach optimizes only embryonic components, this comparison provides an estimate of the relative magnitudes of these two major components of successful outcome. DESIGN: A case control study matching anonymous compensated egg donors 2:1 for their age and year of treatment. MATERIALS AND METHODS: The study group (SG) includes 19 egg retrievals (ER) in egg donors followed by 23 embryo transfers (13 fresh and 10 frozen ETs) into screened GCs. The control group (CG) consists of 38 ERs in matched egg donors with 84 ETs (51 fresh and 33 frozen) into infertile recipients. The principal outcome measures are: 1. cumulative LB/ER calculated from both fresh and frozen ETs up to and including the first LB, but excluding any subsequent deliveries; 2. LB/ET; 3. IR defined as total # of infants/total # of embryos transferred. Additional outcome measures include: number of embryos/ET, multi-fetal pregnancies, recipients’ age, endometrial thickness, fibroids, abnormalities of uterine cavity, ease of transfer and BMI. Chi-square and t-tests are used with P<0.05 indicating significance. RESULTS: All three primary outcome measures are more favorable in the SG than in the CG: cumulative LB/ER 94.7% vs 72.2% (P¼0.041); LB/ET 78.3% vs 46.4% (P¼0.007); IR 40.0% vs 21.4% (P¼0.010). There are no significant differences between egg donors in the two groups. The number of embryos transferred (2.0 vs 2.2) and twin deliveries (27.8% vs 25.6%) are similar with no high order multiple births. GCs are younger (33.6 vs 44.0; P¼0.001), have more children (2.5 vs 0.3; P¼0.001) and a thicker lining (10.4 vs 9.5 mm; P¼0.029) than the infertile recipients. Only infertile recipients have fibroids (0% vs 40.4%; P¼0.002) and abnormal uterine cavity (0% vs. 44.2%; P¼0.001). Difficult ETs (4.3% vs 7.2%) and BMI (26.2 vs 25.8) are comparable. CONCLUSIONS: Donor eggs with a surrogate result in better outcomes than donor eggs alone as evidenced by all three measures of clinical success: cumulative LB/ER (‘‘take-home baby rate’’), LB/ET and IR. This pilot study suggests that the relative magnitudes of the embryonic and recipient-related factors are 70-75% and 20-25%, respectively. Fibroids and abnormal uterine cavity are the most common recipient-related variables which are absent in screened GCs and which may thus account in part for the observed difference in treatment outcomes. References: 1. Stafford-Bell MA, Copeland CM. Surrogacy in Australia: implantation rates have implications for embryo quality and uterine receptivity. Reprod. Fertil. Dev. 2001; 13: 99-104.

O-131 Tuesday, October 18, 2016 12:15 PM ARE WE TRANSFERRING TOO MANY EMBRYOS IN THE MOST FAVORABLE GROUP OF FRESH AUTOLOGOUS IVF CYCLES: A 2013 UPDATE. S. Keyhan,a K. S. Acharya,a C. R. Acharya,b S. J. Li,a S. J. Muasher.a aDivision of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, NC; bDept. Of Biostatistics and Bioinformatics, Duke Computational Biology and Bioinformatics, Durham, NC. OBJECTIVE: Our group has reported a high rate of non-compliance with the American Society for Reproductive Medicine/Society for Assisted Reproductive Technologies (ASRM/SART) embryo transfer (ET) guidelines in first fresh autologous cycles from 2011-2012, especially for blastocyst stage transfers. This led to an unacceptable multiple pregnancy rate (MPR) in patients <35 years. The objective of this study was to determine the noncompliance rate for first fresh IVF cycles

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