Beliefs, values, knowledge, and perspectives: which determinants influence the patient to utilize preimplantation genetic screening (PGS)?

likely to feel isolated or guilty than their fertile counter parts (pp of an effect for infertility was .48 in women and .63 in men). Men with MHT were more isolated/guilty during the first year than men without such history (mean parameter estimate for MHT ¼ .62, pp ¼ .99). Older men and women were less likely to view their miscarriage as the loss of a baby than younger men and women, though this did not reach significance. Time had a significant effect in reducing I/G, DE, and LB in women. Men’s initial impact remained constant over the course of the year except for devastation, which showed a small decrease. The couples scores were significantly correlated, albeit, the correlation coefficients were low ( r ¼ .07 - .16, pp ¼ .96 -.99) CONCLUSIONS: During the first year of loss, the impact of miscarriage is not influenced by infertility. Men with a history of grief, depression, or anxiety may experience more isolation and guilt. Women see a decrease in impact over time, where as men only see a decrease in the devastation experienced. References: 1. Swanson KM, Chen HT, Graham, JC, Wojnar DM, Petras A. Resolution of depression and grief during the first year after miscarriage: a randomized controlled clinical trial of couples-focused interventions. J Womens Health (Larchmt), 2009; 18:1245-57. 2. Huffman CS, Swanson KM, Lynn M. Measuring the meaning of miscarriage: revision of the Impact of Miscarriage Scale. J of Nurs Measurement 2014; 22: 29-45. Supported by: Funding for the original study was provided to K.M.S. by the NIH, National Institute of Nursing Research, 5 R01 NR005343. Trial registration number: NCT00194844. O-80 Monday, October 19, 2015 11:30 AM THE PREVALENCE OF ABNORMAL MAMMOGRAMS IN OVUM RECIPIENTS DOES NOT CORRELATE WITH RECIPIENT J. Rodriguez-Purata,b J. A. Lee,a AGE. S. E. Yerkes,a M. C. Whitehouse,b M. Daneyko,a B. Sandler,b,c A. B. Copperman.a,c aReproductive Medicine Associates of New York, New York, NY; bReproductive Medicine Associates of New York, New York City, NY; cObstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, NY. OBJECTIVE: Ovum recipients undergo endometrial preparation with estrogen to mimic the natural menstrual cycle. Recipients R40 years are required to complete a mammogram, but younger patients are not. The study sought to compare if the prevalence of an abnormal mammogram in ovum recipients increases with ovum recipient age. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Patients who had a mammogram prior to starting an ovum donation cycle from 2010 - 2014 were included. The following Breast Imaging Reporting and Data System (BIRADS) categories were used for reporting mammographic results: 0: incomplete (needs additional image evaluation and/or prior mammograms for comparison); 1: negative; 2: benign; 3: probably benign; 4: suspicious; 5: highly suggestive of malignancy; and 6: known biopsy (proven malignancy). Patients were segregated into two groups according to age (Group A: <40; Group B: R40). A Chi-Square test was used for statistical purposes with significance met a p<0.05. RESULTS: A total of 284 patients underwent an ovum donation cycle during the study period (Table 1). A normal mammogram (BIRADS 1, 2 or 3) was observed in 95.4% and abnormal (BIRADS 4, 5 or 6) in 4.6%. Results per BIRADS category is reported in Table 1. Prevalence was statistically similar between cohorts except in BIRADS 0.

TABLE 1. Breast Cancer Outcomes.

R40 years old

BI-RADS

0 1 2 3 4 5 6

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n¼175

n¼1282

9.4% (n¼12) 56.5% (n¼115) 28.6% (n¼40) 4.4% (n¼6) 1.0% (n¼2) 0% 0%

4.1% (n¼39) 64.3% (n¼928) 27.5% (n¼275) 2.8% (n¼26) 1.3% (n¼14) 0% 0%

ASRM Abstracts

Chi Square

p<0.05 NS NS NS NS n/a n/a

CONCLUSIONS: In the United States, breast cancer is the leading cause of cancer-related death in women ages 40 to 49 years. High endogenous estrogen levels increase the risk of breast cancer (particularly hormone receptor-positive types) in postmenopausal and premenopausal women. Screening mammography is the primary imaging modality for early detection of breast cancer and is the only method that consistently is used to prevent breast cancer-related mortality. Mammography may detect cancer 1.5 to 4 years before cancer becomes clinically evident. While those patients <40 that undergo donor egg IVF cycles are not required to have a mammogram, the cohort of patients have a similar risk of abnormal mammograms. This is significant given the current guidelines for mammograms and especially with the synthetic estrogen administered to patients. In counseling patients who are preparing for an IVF cycle, clinicians should consider obtaining a mammogram prior to starting treatment. O-81 Monday, October 19, 2015 11:45 AM THE ADVENT OF FROZEN EGG BANKS: A COMPARISON OF OUTCOMES TO FRESH DONOR EGGS. M. Y. Fung,a P. G. Dwan,a L. Hillis,a J. C. Patel,b D. L. Cunningham,c K. J. Go.a aIVF New England, Lexington, MA; bEmbryology, IVF New England, Lexington, MA; cIVFNE, Lexington, MA. OBJECTIVE: The advent of cryopreserved donor eggs (CE) to treatment options in third party reproduction may offer significant advantages to patients in terms of cost, greater choice of donors and convenience (no requirement for cycle synchronization nor adapting to donor’s preference for scheduling stimulation and retrieval). In the effort to counsel patients on the efficacy of CE vs fresh donor eggs (FE), clinical outcomes were compared for recipients of FE and CE during a continuous 18 month interval. DESIGN: Retrospective data analysis of IVF cycles of recipients of FE or CE from a single CE bank. Statstical analyses were made by Student’s t-test and Mann-Whitney U test. MATERIALS AND METHODS: Recipient cycles using FE or CE were compared for average number of eggs per cycle, fertilization rate, #embryo transfers, average # embryos transferred, pregnancy rate,and chance for the recipient to have supernumerary embryos for cryopreservation. RESULTS: 80 FE and 168 CE cycles were analyzed, with 1595 and 1171 eggs, respectively, available for the recipients (averages of 19.9 FE vs 7 CE per recipient). Insemination of FE and CE resulted in fertilization rates of 76.18.5% and 84.18.0%, (significant, p¼0.0011), and 75 and 158 embryo transfers (ET), respectively. With averages of 1.2 and 1.3 embryos per transfer (no significant difference), 49/75 FE and 91/158 CE clinical pregnancies per ET were achieved respectively (not significant, chi-squared¼1.2699, p¼0260). 72.5% of FE recipients had frozen embryos after ET compared to 51.2% of CE. CONCLUSIONS: The availability of CE through donor egg banks is a relatively new option to patients. CE can offer potentially greater choice of donors, lower cost, and more satisfaction through greater convenience with comparable pregnancy rates, but with a lower chance for CE recipients to have frozen embryos for future cycles. These data are helpful in understanding the efficacy of CE and providing useful information to patients in choosing an FE donor or purchasing CE from an egg bank.

O-82 Monday, October 19, 2015 12:00 PM BELIEFS, VALUES, KNOWLEDGE, AND PERSPECTIVES: WHICH DETERMINANTS INFLUENCE THE PATIENT TO UTILIZE PREIMPLANTATION GENETIC SCREENING (PGS)? M. B. Gebhart,a R. S. Hines,a A. D. Penman,b A. C. Holland.c aMississippi Reproductive Medicine, Flowood, MS; bThe University of Mississippi Medical Center, Jackson, MS; cThe University of Alabama at Birmingham, Birmingham, AL. OBJECTIVE: Clinics and patients are making decisions to utilize PGS. No studies have been published assessing the patient determinants considered to make the decision to use PGS. The purpose of this project is to identify the factors that influence the patient. DESIGN: Pilot, retrospective, cross-sectional study. MATERIALS AND METHODS: An invitation, with a unique link, was emailed to patients and partners (N¼266) who participated in autologous or donor IVF between October 2012-January 2015 at the study site. Content validity was Supported from four experts including an academic statistician, the medical director of the study site, an embryologist, and an academic nursing advisor.Univariate and chi-squared analysis was completed though the use of SPSS software program. A value of P¼0.05 was the identifier

Vol. 104, No. 3, Supplement, September 2015

for statistical significance. A logistical regression model was also utilized to identify significance of multi-variables. RESULTS: Responses (N¼117) were returned. The female rate was 66% (N¼88). The majority,98%, were Christian (N¼112). The majority, 88%, were college educated (N¼102) with 39% (N¼40) with some post-graduate education. Sixty-eight percent (N¼79) had no knowledge of PGS prior to their IVF cycle; however, after provider education, ninety-two percent (N¼108) correctly identified that PGS was elective and 93% (N¼109) reported their knowledge was sufficient to make an informed decision to accept or decline PGS. The additional cost of screening (P¼0.004), the provider information and influence (P¼0.0001), and social support or acceptance from partner, family, friends (P¼0.03), were the three variables affecting the decision. In a logistical regression model, additional cost (P¼0.003) and explanation from the provider (P¼0.0003) were the only significant determinants influencing the decision. Religious and ethical beliefs were important (P¼0.20), but not statistically significant nor was information regarding the disposition of abnormal embryos (P¼0.18) or the concerns regarding cryopreservation and transfer at a later date (P¼0.79). CONCLUSIONS: PGS use as an adjuvant therapy to aid in selection of the embryo with the greatest potential for success, has become readily available in many IVF clinics. Researchers have spent time, resources, and effort on the clinical benefits and limitations of PGS, yet little research on the patient perspective, knowledge, education, and awareness regarding the options and ultimate decision making capabilities of the patient. This is the first study to the authors knowledge to identify and assess the determinants of the patient decision making process when presented with the choice of PGS in a given IVF treatment cycle. Several factors contribute to the patient perceived determinants when choosing to accept or decline PGS, including cost, religious/ethical values, social influence, and the past experience of the patient. O-83 Monday, October 19, 2015 12:15 PM LESSENING THE BURDEN OF CARE: STEPPED VS. FIXED ESTRADIOL PROTOCOL FOR FROZEN EMBRYO C. M. Bergh,a T. Molinaro,a,b TRANSFER. A. B. Tepper,a a,b a P. A. Bergh. Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ; bObstetrics, Gynecology & Reproductive Sciences, RutgersRobert Wood Johnson Medical School, New Brunswick, NJ. OBJECTIVE: Simplification of cycle medication protocols without a reduction in efficacy is a key priority in lessening the patient’s burden of care. This study sought to compare frozen embryo transfer (FET) cycle outcomes between estradiol therapies using a 1mg stepped protocol or 2mg fixed protocol at cycle start. DESIGN: Retrospective database study. MATERIALS AND METHODS: Analysis was performed on 3,984 patients’ electronic medical records at Reproductive Medicine Associates of New Jersey (RMANJ) from October 9, 1999 to April 30, 2015. FET cycles using autologous oocytes and blastocyst transfers with a starting dose of either 1 or 2mg were included in this study. Gestational Carrier cycles were excluded. Chi-square and t-test were performed for our normally distributed population. The study was powered to detect a 5% difference between groups. Logistic regression was performed to control for confounders. RESULTS: There were small statistical significant differences in endometrial thickness, length of cycle and use of CCS. Implantation rates were similar between both groups. When controlling for age, CCS use, number of embryos transferred, and method of cryopreservation, there were no significant differences in clinical pregnancy (OR 0.96; 95%CI 0.79 - 1.15) nor clinical loss rate (OR 0.98; 95%CI 0.79 - 1.22).

Cycle Characteristics Stratified By Starting Estradiol Dose.

1mg. estradiol 2mg. estradiol p value Sample Size (n) Oocyte Age (years) Endometrial Thickness (mm) Length of Cycle (days) Use of Comprehensive Chromosome Screening (CCS) (%) Clinical Pregnancy Rate (%) Implantation Rate (%)

FERTILITY & STERILITYÒ

3102 34.2 9.9 12.5 53.5

882 34.2 9.6 11.8 57.4

p ¼ 0.887 p ¼ 0.000 p ¼ 0.000 p ¼ 0.041

76.7 68.7

77.0 69.5

p ¼ 0.835 p ¼ 0.618

CONCLUSIONS: Clinical pregnancy and loss rates are not impacted by using a 2 mg fixed protocol for a FET cycle. Using a standardized fixed protocol may reduce provider ordering and patient administration errors, number of monitoring visits, and improve patient compliance. As described, a fixed FET protocol may reduce the patient’s burden of care without compromising outcomes.

O-84 Monday, October 19, 2015 12:30 PM GAY SURROGACY-THE QUANDRY OF ACCESSING VERIFIABLE FACTS. D. Smotrich,a A. Botes,a X. Wang,a M. Gaona,b D. Batzofin.a a IVF, LaJolla IVF, La Jolla, CA; bEmbryology/Andrology, LaJolla IVF, La Jolla, CA. OBJECTIVE: To bring attention to the lack of verifiable data pinpointing clinics that are accommodating to LGBT patients as well as being able to easily obtain LGBT friendly legitimate and objective statistical data regarding the use and success of gestational surrogate (GS) egg donor (ED) cycles to create their families. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Retrospective review of IVF laboratory database and patients’ charts was conducted on 529 consecutive fresh GS/ED cycles performed for gay couples from January 2004 - December 2013 (a ten year period) at a private clinic in California. After May 2005 all gamete providers were subject to FDA regulations. Standard stimulation protocols, monitoring, egg retrievals and embryo transfers were performed. Embryos were created with ICSI (100%), PGD/S (75%) and blastocyst transfers (80%). A review of a subset of 200 randomly selected gay intended parents’ charts from the 529 cycles was undertaken to analyze documented comments by patients regarding their country of origin, from where they learned about GS/ED as a treatment option and what additional information would have been useful in their decision making. RESULTS: From January 2004 - December 2013, 529 fresh GS/ED cycles were performed for gay couples. A clinical pregnancy was confirmed in 454 GS for an 86% clinical pregnancy rate. 80% of the gay couples achieved a live birth after one GS/ED cycle. Data obtained from the clinical chart review: patients traveled from 54 countries and 47 US states; 80% learned about GS/ED from the internet and media outlets, 7% from GS/ED agencies, 4% from peers and 9% from other patients. 96% stated some official statistics in a report (along the lines of the CDC Clinic Success Rates Report) as being the most authoritative guidance missing from their data search. CONCLUSIONS: In experienced hands, gestational surrogacy/egg donation is a highly effective treatment for gay couples in terms of family building. These patients deserve and should be able to rely on official statistical data in order to make a logical and informed decision in regards to their choice of the most appropriate treatment facility for their needs, just as other patients researching ART treatments are afforded.

EARLY PREGNANCY 1 O-85 Monday, October 19, 2015 11:15 AM THE EFFECT OF A PUBLICLY FUNDEDED NORTH AMERICAN IVF PROGRAM WITH MANDATED SINGLE EMBRYO TRANSFER ON MATERNAL ANTENATAL ADMISSION RATES. M. Dahan,a T. Shaulov,b S. Belisle.c aMcGill University, Montreal, QC, Canada; bMcGill University Health Centre, Montreal, QC, Canada; cUniversity of Montreal, Montreal, QC, Canada. OBJECTIVE: To determine the effect of a drastic drop in the multiple pregnancy rate on antenatal admission of women who underwent IVF. DESIGN: A retrospective study was performed by analyzing data concerning IVF cycle outcomes and hospital admission in Quebec. Single payer government health care with IVF coverage for all women enabled to track outcome details which were gathered from the Ministry of Health and Social Services ‘‘Pro-Assis’’ database and the hospital admission database (MED ECHO). The government program has mandated single embryo transfer in most cases. MATERIALS AND METHODS: Data is presented by financial year, and involves more than 250 000 pregnancies. The government began covering IVF in august 2010. Statistical analysis was performed using Chi squared tests, odds ratios or correlation coefficients. Data is available from

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