- Email: [email protected]
Attributes that fellowship directors value in selection of reproductive endocrinology and infertility fellows
MATERIALS AND METHODS: We included 3303 women achieving clinical pregnancies in fresh embryo transfer cycles undergoing COH.The cut points of serum estradiol levels on hCG administration day were set between 3000 pg/mL (the 50th percentile) and 5000 pg/mL (the 90th percentile) with a step of 500 pg/mL. The primary outcome measure was the occurrence of EP.Chi-square test was used for univariate analysis.Multivariate logistic regressions were performed to estimate the independent association between each estradiol level and EP with adjustment of important confounders,including previous EPs,infertility factors, number of embryo transferred, endometrial thickness, days of stimulation, gonadotropins dosage, ovarian stimulation protocol and progesterone level on hCG day. RESULTS: EP rates between women with estradiol level above and below 3000 or 3500 pg/mL on hCG day were comparable [2.6% (44/1676) vs 2.4% (39/1627),P¼0.675;3.0% (39/1308) vs 2.2% (44/1995),P¼0.163].The EP rates in women with estradiol level above 4000, 4500 and 5000 pg/mL were significantly higher compared with that in women with estradiol level below the value respectively [3.5% (30/867) vs 2.2% (53/ 2436),P¼0.038;3.7% (24/656) vs 2.2% (59/2647),P¼0.036; 4.4% (13/295) vs 2.3% (70/3008),P¼0.029]. Multivariate logistic regression showed a similar result (summarized in table below). The risk effect exhibited statistical significance when the cut points were at 4000 pg/ml or above. The adjusted odds ratios for EP were gradually increased following the increase of serum estradiol levels from 3000 to 5000 pg/mL.
Adjusted odds ratio of EP risk influenced by different estradiol levels
Estradiol levels on hCG day (pg/mL)
AOR (95% CI)
P value
3000 3500 4000 4500 5000
1.15 (0.71-1.85) 1.48 (0.92-2.39) 1.82 (1.11-2.97) 1.82 (1.08-3.05) 1.97 (1.04-3.73)
0.570 0.110 0.018 0.024 0.038
CONCLUSION: High estradiol levels on hCG administration day during controlled ovarian hyperstimulation is associated with increased risk of EP in a dose-response manner. Women undergoing COH with estradiol levels above 4000 pg/mL need increased surveillance on EP. Controlling estradiol levels in COH treatment may be helpful in preventing EP. Supported by: China 973 Program.
may be the cause of miscarriage 1 or a finding worth causal consideration. While the mechanism and underlying etiology cannot be confirmed through SNP array testing, UPD originating from a trisomy rescue event is likely. In this cohort of samples, 94% of cases had maternal UPD; a finding Supported by the higher rate of nondisjunction in oogenesis. UPD originating from a trisomy rescue event can result in mosaicism of aneuploid chromosomes as reported here in two cases. The original aneuploidy may be the cause of the pregnancy loss, or UPD could be the sole cause by altering critical developmental pathways and/or placental function or by unmasking a lethal autosomal recessive mutation. PRACTICE MANAGEMENT P-304 Tuesday, October 21, 2014 ATTRIBUTES THAT FELLOWSHIP DIRECTORS VALUE IN SELECTION OF REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY FELLOWS. A. Kaing, A. S. Q. Kathiresan, D. Dumesic, M. Shamonki. Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA. OBJECTIVE: To investigate which attributes of Reproductive Endocrinology and Infertility (REI) fellowship applicants are most valued by fellowship program directors during the match process. DESIGN: Electronic survey. MATERIALS AND METHODS: An electronic survey administered to REI fellowship directors to determine applicant characteristics most favored in the REI fellow selection process. Characteristics were ranked on a fivepoint Likert scale, with 1 being ‘‘most important (highly likely to affect match)’’ and 5 being ‘‘least important (least likely to affect match).’’ The main outcome measure was factors highly desired by REI fellowship directors. RESULTS: The overall response rate was 61% (27/44). Objective factors ranked most important were clinical research experience (1.81 0.40), followed by training at a competitive obstetrics and gynecology residency program (1.81 0.56), and basic science research experience (2.04 0.60). Personal interview (1.15 0.40) and perceived ability to work well with others (1.27 0.45) were subjective factors considered highly favorable by REI fellowship directors. CONCLUSION: When selecting REI fellows for interviews, fellowship directors value candidates that have trained at a competitive obstetric and gynecology residency program and who have clinical or basic science research experience. When subsequently ranking fellowship applicants, however, the most important factors are those found in the interview process.
P-303 Tuesday, October 21, 2014 SINGLE NUCLEOTIDE POLYMORPHISM (SNP) BASED CHROMOSOME ANALYSIS OF PRODUCTS OF CONCEPTION (POC) SAMPLES REVEALS UNIPARENTAL DISOMY: CAUSE FOR MISCARRIAGE OR INCIDENTAL FINDING? D. Clark, M. Maisenbacher, S. Sigurjonsson, K. Paik, M. Young, B. Pettersen. Natera, Inc., San Carlos, CA. OBJECTIVE: Report on products of conception (POC) samples showing single chromosome uniparental disomy (UPD). UPD of select chromosomes has been attributed as a cause for miscarriage, but UPD can occur for any chromosome, largely due to trisomy rescue events. Unlike other methods, molecular chromosome analysis of POC samples using SNP microarray with bioinformatics allows for identification of UPD. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Review of 11,318 consecutive fresh POC samples sent to a reference lab along with maternal blood samples. Genotyping was performed using Illumina CytoSNP-12b microarray and bioinformatics. RESULTS: Fetal results were obtained on 9632 (85%) of the POC samples. 18 cases (0.2%) of UPD without aneuploidy of other chromosomes were identified. Three cases showed UPD 17, one which had evidence of mosaicism of UPD 17 with low level trisomy 17. Another case showed mosaicism involving maternal UPD 20 and monosomy 20 of maternal origin. Eight cases showed UPD 16; three cases showed UPD 22; and single cases of UPD 21, UPD 8, and UPD 4 were identified. The UPD was of maternal origin in 17 of 18 (94%) cases. CONCLUSION: SNP microarray with bioinformatics is a unique method for POC analysis that allows for detection of single chromosome UPD, which
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P-305 Tuesday, October 21, 2014 PRACTICE PATTERNS OF INFERTILITY EVALUATION AND REFERRAL AMONG GENERAL OBSTETRICIAN-GYNECOLOGISTS WITHIN A LARGE HEALTH SYSTEM: A PRELIMINARY REPORT. S. S. Rothenberg,a N. Bhatte,b S. R. Nayak,a M. N. Menke.a a Obstetrics, Gynecology and Reproductive Services, Magee Women’s Hospital of UPMC, Pittsburgh, PA; bUniversity of Pittsburgh, Pittsburgh, PA. OBJECTIVE: A growing body of literature demonstrates lack of patient knowledge regarding fertility issues. Although, generalist obstetricians and gynecologists are often the first point of contact for patients in this setting, data is lacking regarding their practice patterns. DESIGN: A cross-sectional study of generalist obstetricians and gynecologists employed at an academic medical center. MATERIALS AND METHODS: Twenty five anonymous web-based surveys were completed by generalist obstetricians and gynecologists within the academic network. Surveys utilized case scenarios to characterize components of a typical infertility evaluation in both a 29 year old and a 35 year old patient with primary infertility. For questions regarding referral, the older patient age was increased to 38 years. Chi-squared and Fisher exact tests were used for analysis. RESULTS: Ninety-two percent of physicians responded that they ‘‘prescribe clomiphene citrate for patients with infertility;’’ yet fertility counseling is not a routine component of the practice. Although 88% of respondents ‘‘assess patient desire for contraception at every annual exam,’’ only 36% ‘‘assess patient desire for fertility at every annual exam.’’ (OR 13.04, 95%CI 3.0-56.0) Most physicians would perform a semen
Vol. 102, No. 3, Supplement, September 2014
Adjusted odds ratio of EP risk influenced by different estradiol levels
Estradiol levels on hCG day (pg/mL)
AOR (95% CI)
P value
3000 3500 4000 4500 5000
1.15 (0.71-1.85) 1.48 (0.92-2.39) 1.82 (1.11-2.97) 1.82 (1.08-3.05) 1.97 (1.04-3.73)
0.570 0.110 0.018 0.024 0.038
CONCLUSION: High estradiol levels on hCG administration day during controlled ovarian hyperstimulation is associated with increased risk of EP in a dose-response manner. Women undergoing COH with estradiol levels above 4000 pg/mL need increased surveillance on EP. Controlling estradiol levels in COH treatment may be helpful in preventing EP. Supported by: China 973 Program.
may be the cause of miscarriage 1 or a finding worth causal consideration. While the mechanism and underlying etiology cannot be confirmed through SNP array testing, UPD originating from a trisomy rescue event is likely. In this cohort of samples, 94% of cases had maternal UPD; a finding Supported by the higher rate of nondisjunction in oogenesis. UPD originating from a trisomy rescue event can result in mosaicism of aneuploid chromosomes as reported here in two cases. The original aneuploidy may be the cause of the pregnancy loss, or UPD could be the sole cause by altering critical developmental pathways and/or placental function or by unmasking a lethal autosomal recessive mutation. PRACTICE MANAGEMENT P-304 Tuesday, October 21, 2014 ATTRIBUTES THAT FELLOWSHIP DIRECTORS VALUE IN SELECTION OF REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY FELLOWS. A. Kaing, A. S. Q. Kathiresan, D. Dumesic, M. Shamonki. Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA. OBJECTIVE: To investigate which attributes of Reproductive Endocrinology and Infertility (REI) fellowship applicants are most valued by fellowship program directors during the match process. DESIGN: Electronic survey. MATERIALS AND METHODS: An electronic survey administered to REI fellowship directors to determine applicant characteristics most favored in the REI fellow selection process. Characteristics were ranked on a fivepoint Likert scale, with 1 being ‘‘most important (highly likely to affect match)’’ and 5 being ‘‘least important (least likely to affect match).’’ The main outcome measure was factors highly desired by REI fellowship directors. RESULTS: The overall response rate was 61% (27/44). Objective factors ranked most important were clinical research experience (1.81 0.40), followed by training at a competitive obstetrics and gynecology residency program (1.81 0.56), and basic science research experience (2.04 0.60). Personal interview (1.15 0.40) and perceived ability to work well with others (1.27 0.45) were subjective factors considered highly favorable by REI fellowship directors. CONCLUSION: When selecting REI fellows for interviews, fellowship directors value candidates that have trained at a competitive obstetric and gynecology residency program and who have clinical or basic science research experience. When subsequently ranking fellowship applicants, however, the most important factors are those found in the interview process.
P-303 Tuesday, October 21, 2014 SINGLE NUCLEOTIDE POLYMORPHISM (SNP) BASED CHROMOSOME ANALYSIS OF PRODUCTS OF CONCEPTION (POC) SAMPLES REVEALS UNIPARENTAL DISOMY: CAUSE FOR MISCARRIAGE OR INCIDENTAL FINDING? D. Clark, M. Maisenbacher, S. Sigurjonsson, K. Paik, M. Young, B. Pettersen. Natera, Inc., San Carlos, CA. OBJECTIVE: Report on products of conception (POC) samples showing single chromosome uniparental disomy (UPD). UPD of select chromosomes has been attributed as a cause for miscarriage, but UPD can occur for any chromosome, largely due to trisomy rescue events. Unlike other methods, molecular chromosome analysis of POC samples using SNP microarray with bioinformatics allows for identification of UPD. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Review of 11,318 consecutive fresh POC samples sent to a reference lab along with maternal blood samples. Genotyping was performed using Illumina CytoSNP-12b microarray and bioinformatics. RESULTS: Fetal results were obtained on 9632 (85%) of the POC samples. 18 cases (0.2%) of UPD without aneuploidy of other chromosomes were identified. Three cases showed UPD 17, one which had evidence of mosaicism of UPD 17 with low level trisomy 17. Another case showed mosaicism involving maternal UPD 20 and monosomy 20 of maternal origin. Eight cases showed UPD 16; three cases showed UPD 22; and single cases of UPD 21, UPD 8, and UPD 4 were identified. The UPD was of maternal origin in 17 of 18 (94%) cases. CONCLUSION: SNP microarray with bioinformatics is a unique method for POC analysis that allows for detection of single chromosome UPD, which
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P-305 Tuesday, October 21, 2014 PRACTICE PATTERNS OF INFERTILITY EVALUATION AND REFERRAL AMONG GENERAL OBSTETRICIAN-GYNECOLOGISTS WITHIN A LARGE HEALTH SYSTEM: A PRELIMINARY REPORT. S. S. Rothenberg,a N. Bhatte,b S. R. Nayak,a M. N. Menke.a a Obstetrics, Gynecology and Reproductive Services, Magee Women’s Hospital of UPMC, Pittsburgh, PA; bUniversity of Pittsburgh, Pittsburgh, PA. OBJECTIVE: A growing body of literature demonstrates lack of patient knowledge regarding fertility issues. Although, generalist obstetricians and gynecologists are often the first point of contact for patients in this setting, data is lacking regarding their practice patterns. DESIGN: A cross-sectional study of generalist obstetricians and gynecologists employed at an academic medical center. MATERIALS AND METHODS: Twenty five anonymous web-based surveys were completed by generalist obstetricians and gynecologists within the academic network. Surveys utilized case scenarios to characterize components of a typical infertility evaluation in both a 29 year old and a 35 year old patient with primary infertility. For questions regarding referral, the older patient age was increased to 38 years. Chi-squared and Fisher exact tests were used for analysis. RESULTS: Ninety-two percent of physicians responded that they ‘‘prescribe clomiphene citrate for patients with infertility;’’ yet fertility counseling is not a routine component of the practice. Although 88% of respondents ‘‘assess patient desire for contraception at every annual exam,’’ only 36% ‘‘assess patient desire for fertility at every annual exam.’’ (OR 13.04, 95%CI 3.0-56.0) Most physicians would perform a semen
Vol. 102, No. 3, Supplement, September 2014