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Attitudes of Patients Undergoing In-Vitro Fertilization Toward Multifetal Pregnancy Reduction
treatment from April 2004 to September 2004, were enrolled in this study. Typical long protocol with GnRHa down regulation was employed and blood samples were drawn on the cycle day 2 for baseline hormone assessments and on the cycle day 7, the first visit after the ovulation stimulation. Results: The median values of day2 Inhibin B in pregnant and nonpregnant groups were 113.4 and 172 IU/ml, respectively. The ratios of D7/D2 inhibin B in the pregnant group were all higher than 1 but distributed widely in failed group.
Conclusion: Seifer et al. (1997) and Hall et al. (2000) suggested a threshold valve for inhibin B (45 pg/ml and 75 pg/ml, respectively) to predict follicular development and success of pregnancy. However, this cut-off valve could not be defined in our study. Interestingly, the ratio of D7/D2, indicating the increase of inhibin B concentrations, in the pregnant women was higher than 1. In contrast, the valves were showed to be lower than 1 in non-pregnant group. This phenomenon seems consistent with the theory which inhibin B is secreted by developing follicles; i.e. if the increase of inhibin B fails, it might indicate oocyte developing system and the response of ovarian stimulation and outcome of treatment would not be satisfactory. Therefore, the ratio of D7/D2 may help in predicting the poor responder and failure of pregnancy in IVF procedure. However, the threshold valve remains to be determined because of the sample number.
P-27 The Use of Preimplantation Genetic Diagnosis (PGD) for Polycystic Kidney Disease (PKD). Nadia Ouhibi,1 P. Patton1 D. Battaglia1, M. Hughes2. OHSU-Fertility Consultants1, Portland, Oregon and Genesis Genetics Institute2, Detroit, Michigan. Objective: PGD is proving to be effective for the detection of unaffected embryos when either the male or female partner has PKD (an autosomal dominant disorder). The Genesis Genetics Institute in Detroit has completed 39 cycles of IVF and PGD for the identification of affected embryos for PKD1 or PKD2 genes. From these cases, the oldest living infant is now 6 years old. Despite the number of cases performed, there exists only a single published report describing the use of PGD for this disorder (Fertil. Steril. 82: 926-929,2004). Design: Clinical Study. Setting: The IVF program at OHSU, Portland Oregon and the Genesis Genetics Institute, Detroit, Michigan. Materials and Methods: The details attendant to all cases of PGD for PKD in this series is beyond the capacity of this abstract. Therefore, we are presenting our most recent case. Single cell testing was designed and probes developed specifically for a mutation on exon 11 of PKD1 gene. The couple underwent conventional ovarian stimulation and PGD for the purpose of transferring embryos free of PKD1 exon 11 insertion Results: Of 12 embryos tested following blastomere biopsy, 6 were predicted to not have PKD1 exon 11 insertion and were suitable for transfer. Out of the 6 embryos, 3 embryos showed normal embryonic development to the blastocyst stage and the remaining 3 arrested in culture. Two embryos from this cohort were transferred resulting in an ongoing twin pregnancy. One embryo was cryopreserved. Conclusions: PGD is a viable reproductive option for individuals with PKD. The technique requires, at a minimum, the careful identification of the responsible mutation, development of accurate gene probes, and the use of technicians skilled in embryo biopsy.
S22
PCRS Abstracts
P-28 Attitudes of Patients Undergoing In-Vitro Fertilization Toward Multifetal Pregnancy Reduction. E.B. Munks, A. Edelman, J.T. Jensen, M.D. Nichols, K. Burry, P. Patton. Department of Obstetrics & Gynecology, Oregon Health & Science University. Objective: To determine attitudes of in-vitro fertilization (IVF) patients toward multifetal pregnancy reduction, and whether those attitudes change after embryo transfer. Design: Observational cohort study. Materials and Methods: Patients seeking their initial IVF consultation at University Fertility Consultants, Portland, OR between December 2002 and March 2004 were asked to participate in the study. The study consisted of two surveys: the first administered after the initial consultation, and the second survey distributed only if embryo transfer occurred. Descriptive statistics were generated for the entire cohort. Attitude toward multifetal pregnancy reduction was assessed on a 4-point likert scale. Statistical comparisons were made to numerical data using the t-test, and to categorical data using the Chi-Square test, with paired statistical tests used for comparisons between the first and second surveys. Results: Thirty-one subjects completed the survey during the study period. The majority of subjects described themselves as “pro-choice” [64.5% (20/31)], and 22.6% (7/31) described themselves as “pro-life”. Four subjects [(12.9% (4/31)] were undecided regarding their view on abortion. When subjects were asked about multifetal pregnancy reduction, 6.5% (2/31) stated they would consider reducing a twin gestation; 67.7% (21/31) stated they would consider reducing a triplet gestation, and 77.4% (24/31) stated they would consider reducing a quadruplet gestation. Overall, 22.6% (7/31) stated they would never consider reducing a multifetal pregnancy, and 77.4% (24/31) stated they would consider multifetal pregnancy reduction. “Pro-choice” subjects were significantly more likely to consider multifetal pregnancy reduction when compared to “pro-life” subjects. (p ⬍ 0.01). Undecided patients in this group were not different from “pro-choice” patients, but significantly more likely than “pro-life” patients to consider multifetal pregnancy reduction (p ⫽ 0.015). Twelve of the 31 subjects went on to embryo transfer and completed the second survey. Patient attitude toward reduction did not change significantly from the time of initial IVF consultation to after embryo transfer. Conclusions: The majority of IVF subjects are receptive to the idea of multifetal pregnancy reduction, and this view does not appear to change after embryo transfer. Subjects who are pro-choice or undecided about their views on abortion are more likely to consider multifetal pregnancy reduction.
P-29 Evaluation by Healthcare Professionals of Patient’s Understanding and Ease of Use of a Novel Pen Device for the Self-Administration of Follitropin Beta. A. Butler, R. Orr, D. Moffitt, H. Rodrigues, M. Mahony. Organon Pharmaceuticals USA Inc., Roseland, New Jersey. Background: Advances in drug-delivery systems for ovarian stimulation protocols include recent introduction of a novel pen device for self-administration of premixed ready-to-use rFSH formulation. This new delivery system is designed to be easy, convenient, accurate, timesaving, reliable method for patients to self-administer their required rFSH dose. Objective: The objective of the survey program was to obtain feedback from healthcare professionals responsible for educating patients in proper methods of administering fertility medications. Specifically, healthcare professionals were questioned about ease of patient education and callback assistance after use of the new delivery system in comparison with previous experiences with conventional syringe/vial/ampule method (syringe method). Materials and Methods: Healthcare professionals from 75 US fertility centers were being surveyed after 10 patients per site were instructed in proper use of the Pen device for self-administering follitropin beta. The survey uses 5-point Likert scale for ease in training patients in selfadministration and level of post training assistance. Additionally, various aspects of the delivery system were rated on 8-point scale of importance to the healthcare professional. Results: Presently, 14 sites have provided survey results. All surveyed healthcare professionals agreed that they received necessary educational
Vol. 83, Suppl 2, May 2005
Conclusion: Seifer et al. (1997) and Hall et al. (2000) suggested a threshold valve for inhibin B (45 pg/ml and 75 pg/ml, respectively) to predict follicular development and success of pregnancy. However, this cut-off valve could not be defined in our study. Interestingly, the ratio of D7/D2, indicating the increase of inhibin B concentrations, in the pregnant women was higher than 1. In contrast, the valves were showed to be lower than 1 in non-pregnant group. This phenomenon seems consistent with the theory which inhibin B is secreted by developing follicles; i.e. if the increase of inhibin B fails, it might indicate oocyte developing system and the response of ovarian stimulation and outcome of treatment would not be satisfactory. Therefore, the ratio of D7/D2 may help in predicting the poor responder and failure of pregnancy in IVF procedure. However, the threshold valve remains to be determined because of the sample number.
P-27 The Use of Preimplantation Genetic Diagnosis (PGD) for Polycystic Kidney Disease (PKD). Nadia Ouhibi,1 P. Patton1 D. Battaglia1, M. Hughes2. OHSU-Fertility Consultants1, Portland, Oregon and Genesis Genetics Institute2, Detroit, Michigan. Objective: PGD is proving to be effective for the detection of unaffected embryos when either the male or female partner has PKD (an autosomal dominant disorder). The Genesis Genetics Institute in Detroit has completed 39 cycles of IVF and PGD for the identification of affected embryos for PKD1 or PKD2 genes. From these cases, the oldest living infant is now 6 years old. Despite the number of cases performed, there exists only a single published report describing the use of PGD for this disorder (Fertil. Steril. 82: 926-929,2004). Design: Clinical Study. Setting: The IVF program at OHSU, Portland Oregon and the Genesis Genetics Institute, Detroit, Michigan. Materials and Methods: The details attendant to all cases of PGD for PKD in this series is beyond the capacity of this abstract. Therefore, we are presenting our most recent case. Single cell testing was designed and probes developed specifically for a mutation on exon 11 of PKD1 gene. The couple underwent conventional ovarian stimulation and PGD for the purpose of transferring embryos free of PKD1 exon 11 insertion Results: Of 12 embryos tested following blastomere biopsy, 6 were predicted to not have PKD1 exon 11 insertion and were suitable for transfer. Out of the 6 embryos, 3 embryos showed normal embryonic development to the blastocyst stage and the remaining 3 arrested in culture. Two embryos from this cohort were transferred resulting in an ongoing twin pregnancy. One embryo was cryopreserved. Conclusions: PGD is a viable reproductive option for individuals with PKD. The technique requires, at a minimum, the careful identification of the responsible mutation, development of accurate gene probes, and the use of technicians skilled in embryo biopsy.
S22
PCRS Abstracts
P-28 Attitudes of Patients Undergoing In-Vitro Fertilization Toward Multifetal Pregnancy Reduction. E.B. Munks, A. Edelman, J.T. Jensen, M.D. Nichols, K. Burry, P. Patton. Department of Obstetrics & Gynecology, Oregon Health & Science University. Objective: To determine attitudes of in-vitro fertilization (IVF) patients toward multifetal pregnancy reduction, and whether those attitudes change after embryo transfer. Design: Observational cohort study. Materials and Methods: Patients seeking their initial IVF consultation at University Fertility Consultants, Portland, OR between December 2002 and March 2004 were asked to participate in the study. The study consisted of two surveys: the first administered after the initial consultation, and the second survey distributed only if embryo transfer occurred. Descriptive statistics were generated for the entire cohort. Attitude toward multifetal pregnancy reduction was assessed on a 4-point likert scale. Statistical comparisons were made to numerical data using the t-test, and to categorical data using the Chi-Square test, with paired statistical tests used for comparisons between the first and second surveys. Results: Thirty-one subjects completed the survey during the study period. The majority of subjects described themselves as “pro-choice” [64.5% (20/31)], and 22.6% (7/31) described themselves as “pro-life”. Four subjects [(12.9% (4/31)] were undecided regarding their view on abortion. When subjects were asked about multifetal pregnancy reduction, 6.5% (2/31) stated they would consider reducing a twin gestation; 67.7% (21/31) stated they would consider reducing a triplet gestation, and 77.4% (24/31) stated they would consider reducing a quadruplet gestation. Overall, 22.6% (7/31) stated they would never consider reducing a multifetal pregnancy, and 77.4% (24/31) stated they would consider multifetal pregnancy reduction. “Pro-choice” subjects were significantly more likely to consider multifetal pregnancy reduction when compared to “pro-life” subjects. (p ⬍ 0.01). Undecided patients in this group were not different from “pro-choice” patients, but significantly more likely than “pro-life” patients to consider multifetal pregnancy reduction (p ⫽ 0.015). Twelve of the 31 subjects went on to embryo transfer and completed the second survey. Patient attitude toward reduction did not change significantly from the time of initial IVF consultation to after embryo transfer. Conclusions: The majority of IVF subjects are receptive to the idea of multifetal pregnancy reduction, and this view does not appear to change after embryo transfer. Subjects who are pro-choice or undecided about their views on abortion are more likely to consider multifetal pregnancy reduction.
P-29 Evaluation by Healthcare Professionals of Patient’s Understanding and Ease of Use of a Novel Pen Device for the Self-Administration of Follitropin Beta. A. Butler, R. Orr, D. Moffitt, H. Rodrigues, M. Mahony. Organon Pharmaceuticals USA Inc., Roseland, New Jersey. Background: Advances in drug-delivery systems for ovarian stimulation protocols include recent introduction of a novel pen device for self-administration of premixed ready-to-use rFSH formulation. This new delivery system is designed to be easy, convenient, accurate, timesaving, reliable method for patients to self-administer their required rFSH dose. Objective: The objective of the survey program was to obtain feedback from healthcare professionals responsible for educating patients in proper methods of administering fertility medications. Specifically, healthcare professionals were questioned about ease of patient education and callback assistance after use of the new delivery system in comparison with previous experiences with conventional syringe/vial/ampule method (syringe method). Materials and Methods: Healthcare professionals from 75 US fertility centers were being surveyed after 10 patients per site were instructed in proper use of the Pen device for self-administering follitropin beta. The survey uses 5-point Likert scale for ease in training patients in selfadministration and level of post training assistance. Additionally, various aspects of the delivery system were rated on 8-point scale of importance to the healthcare professional. Results: Presently, 14 sites have provided survey results. All surveyed healthcare professionals agreed that they received necessary educational
Vol. 83, Suppl 2, May 2005