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Beyond laboratory testing: data collection serves important practice management functions
Results: The total oocytes retrieved were 724 and 738 in group I and II respectively. The MII (injected) oocytes were 623 and 620 resulted in 467 and 453 2PN in group I and II. The cleavage rate and embryo grading at 48 hours showed no significant difference. However, the 6-8 cell stage embryos were 17& 11% at 48 hours (P⬍0.05) and 54 & 39% (P⬍0.01) at 72 hours, respectively. Though, the no of embryos transferred was less in group I (3.1⫾ 0.4 vs. 3.8 ⫾ 0.2;P⬍0.001) in group II, the clinical pregnancy and implantation rates were higher (30/80 vs. 25/79) and (38/213 vs. 27/250; P⬍0.05) respectively. Conclusions: The co-culture system supports the preimplantation embryo development in vitro. The significant improvement in implantation rate may be due to a possible effect on zona pellucida through a thinning or softening effect. This study presents a simplified short-term cumulus co-culture system forming acceptable type of co-culture within 24 hours, with very minimal cost and safety, being autologous.
P-541 Within subject variation of semen parameters in infertile men and normal semen donors. Brooks A. Keel, Tammie K. Schalue. Florida State Univ, Tallahassee, FL; Heartland Ctr for Reproductive Medicine, Omaha, NE. Objective: The semen analysis is thought to be the most important clinical laboratory test used in the diagnosis of male infertility. However, it is sometimes difficult to interpret results of the semen analysis due to the suspected large variation seen from one ejaculate to another. In order to determine the degree of such variation, we have measured the within subject variation of semen parameters in infertile men and have compared these findings with the variation found in normal semen donors. Design: A retrospective analysis of semen values obtained from infertile men and normal semen donors producing five or more specimens was performed. Within subject coefficients of variation (CV) and intraclass correlation coefficients (ICC) were calculated and compared between these two populations. Materials and Methods: Ejaculates (479) were obtained by masturbation from 74 men presenting to an infertility clinic (patients), and 65 normal men donating semen for an artificial insemination program (donors; 2043 ejaculates). Only subjects producing 5 or more ejaculates were evaluated. The number of ejaculates per subject ranged from 5-20 in patients and 5-136 in donors. Semen analysis was performed following 3 days of sexual abstinence using an objective, computerized multiple exposure photography system. Grand mean ⫹ SE, pooled CV, and ICC was calculated for sperm count, motility, straight-line velocity and semen volume using one-way analysis of variance (ANOVA). Results: The grand mean ⫹ SE values in patients vs. donors (respectively) were: sperm count ⫽ 73.7 ⫹ 3.0 vs. 129.4 ⫹ 1.7 million/ml; motility ⫽ 42.1 ⫹ 0.93 vs. 63.5 ⫹ 0.4%; velocity ⫽ 24.7 ⫹ 0.28 vs. 29.9 ⫹ 0.14 microns/sec; volume ⫽ 3.26 ⫹ 0.07 vs. 2.85 ⫹ 0.02 ml. These mean values were all statistically different between patients and donors (p⬍0.01 by ANOVA). Pooled within subject CV values in patients vs. donors (respectively) were: sperm count ⫽ 54.2% vs. 45.8%; motility ⫽ 34.2% vs. 22.5%; velocity ⫽ 20.1% vs. 19.9%; volume ⫽ 29.6% vs. 25.3%. The ICC values in patients vs. donors (respectively) were: sperm count ⫽ 0.684 vs. 0.457; motility ⫽ 0.574 vs. 0.423; velocity ⫽ 0.431 vs. 0.192; volume ⫽ 0.688 vs. 0.575. Conclusion: 1) As expected, sperm count, motility and velocity were significantly lower in patients compared with donors. Interestingly, semen volume was significantly reduced in donors compared to patients. 2) Within subject CVs ranged from 20-54% in patients, and were greater than donors for all parameters measured. 3) High within subject variations were especially observed in sperm counts from both patients and donors. 4) Velocity was the most stable, predictable parameter measured. These data indicate large within subject variation in sperm parameters from both patients presenting to an infertility clinic as well as normal men donating sperm for artificial insemination, and further support the need for measurement of multiple ejaculates before characterizing a man as normal or subfertile. Supported by: Women’s Research Institute, Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita.
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Abstracts
P-542 Beyond laboratory testing: Data collection serves important practice management functions. Marc Portmann, Caryl Carpenter, Barbara McGuirk, Ron Feinberg. Reproductive Assoc of Delaware, Newark, DE; Widener Univ, Chester, PA. Objective: The institution of specific workflow mechanisms to accurately track various parameters of laboratory testing can serve an important role for practice management in a private practice setting. We describe a laboratory practice management data collection “system” that: tracks laboratory volume; calculates disposable costs; monitors disposable cost-per-test and per CPT code; forecasts future laboratory testing volume and personnel needs; and estimates other potential laboratory related revenues and expenses. Design: Laboratory test volume tracking and vendor disposable cost calculations were instituted at the inception of the practice (1-1-97) and have continued through abstract submission utilizing Microsoft Excel. Laboratory expense tracking was initiated in the beginning of 1999 using Microsoft Money. Materials and Methods: Intra-office workflow had to be altered to ensure that on a daily basis all laboratory activities were monitored and tracked. On a monthly interval, laboratory test volumes are tallied by lab personnel to calculate total monthly testing volume. Microsoft Excel was used extensively to input data and setup a laboratory cost accounting system that operates dynamically. Many spreadsheets are involved, but they are externally linked with each other in cascading fashion, such that a change in the top most file will be reflected in all others down the line. Microsoft Money was used to input and track actual laboratory expenses. Again, intra-office workflow was arranged so that all laboratory related invoices and bills were triaged and given to the appropriate laboratory “controller”. Revenue and expenses were cross-checked with the practice management billing system. Results: The institution of laboratory test tracking and vendor disposable per/unit costs have formed the foundation upon which laboratory related revenues and expenses are determined. Tasks and disposable supplies utilized during the execution of each CPT related procedure were calculated and are dynamically updated monthly based on external links to other spreadsheets. As well, trends and characteristics of the laboratory testing menu are monitored. Conclusions: The evolution of a relatively simple laboratory test tracking and expense-monitoring system has given our clinic much valid information and insight into the complex interplay between medical practice and the business of medicine. To make this type of system work, complete laboratory “buy in” is important. Lab personnel are responsible for the day-to-day tracking and completion of test results. Thus, they should be active participants in reports and statistical analysis generated from the data they collect. Additionally time-series decomposition techniques can be applied to laboratory testing data to identify trends and seasonal differences in testing volume. Regression techniques can also be used to forecast testing volume that can be used to determine, for example, appropriate staffing levels. Aside from the laboratory, overall practice specific information can also be generated. Laboratory test volume may serve as an important indicator of practice growth: identifying time periods where growth is slow, on the rise, or in decline.
P-543 The fate of non-transferred embryos after day 3 assisted hatching. Marc Portmann, Linda Morrison, Lynn San-Soucie, Michael Tucker, Barbara McGuirk, Ron Feinberg. Reproductive Assoc of Delaware, Newark, DE; Georgia Reproductive Specialists, Atlanta, GA. Objective: To determine if assisted hatching (AH) on day 3 affects blastocyst formation in non-transferred (NT) penultimate embryos. Design: Retrospective analysis of 84 IVF cycles in which remaining NT embryos were observed following day 3 fresh transfer. Blastocyst formation rates were compared in day 3 AH embryos versus those without day 3 AH. Materials and Methods: Oocytes were retrieved in HTF (InVitrocare), hyaluronidased after 2 to 3 hours incubation and ICSI’ed following cumulus-corona removal. Oocytes were placed in Q1 (InVitrocare) after ICSI and cultured individually in this media until Day 3. Embryos were placed into CCM on the morning of Day 3 for extended culture. Morphologic assess-
Vol. 80, Suppl. 3, September 2003
P-541 Within subject variation of semen parameters in infertile men and normal semen donors. Brooks A. Keel, Tammie K. Schalue. Florida State Univ, Tallahassee, FL; Heartland Ctr for Reproductive Medicine, Omaha, NE. Objective: The semen analysis is thought to be the most important clinical laboratory test used in the diagnosis of male infertility. However, it is sometimes difficult to interpret results of the semen analysis due to the suspected large variation seen from one ejaculate to another. In order to determine the degree of such variation, we have measured the within subject variation of semen parameters in infertile men and have compared these findings with the variation found in normal semen donors. Design: A retrospective analysis of semen values obtained from infertile men and normal semen donors producing five or more specimens was performed. Within subject coefficients of variation (CV) and intraclass correlation coefficients (ICC) were calculated and compared between these two populations. Materials and Methods: Ejaculates (479) were obtained by masturbation from 74 men presenting to an infertility clinic (patients), and 65 normal men donating semen for an artificial insemination program (donors; 2043 ejaculates). Only subjects producing 5 or more ejaculates were evaluated. The number of ejaculates per subject ranged from 5-20 in patients and 5-136 in donors. Semen analysis was performed following 3 days of sexual abstinence using an objective, computerized multiple exposure photography system. Grand mean ⫹ SE, pooled CV, and ICC was calculated for sperm count, motility, straight-line velocity and semen volume using one-way analysis of variance (ANOVA). Results: The grand mean ⫹ SE values in patients vs. donors (respectively) were: sperm count ⫽ 73.7 ⫹ 3.0 vs. 129.4 ⫹ 1.7 million/ml; motility ⫽ 42.1 ⫹ 0.93 vs. 63.5 ⫹ 0.4%; velocity ⫽ 24.7 ⫹ 0.28 vs. 29.9 ⫹ 0.14 microns/sec; volume ⫽ 3.26 ⫹ 0.07 vs. 2.85 ⫹ 0.02 ml. These mean values were all statistically different between patients and donors (p⬍0.01 by ANOVA). Pooled within subject CV values in patients vs. donors (respectively) were: sperm count ⫽ 54.2% vs. 45.8%; motility ⫽ 34.2% vs. 22.5%; velocity ⫽ 20.1% vs. 19.9%; volume ⫽ 29.6% vs. 25.3%. The ICC values in patients vs. donors (respectively) were: sperm count ⫽ 0.684 vs. 0.457; motility ⫽ 0.574 vs. 0.423; velocity ⫽ 0.431 vs. 0.192; volume ⫽ 0.688 vs. 0.575. Conclusion: 1) As expected, sperm count, motility and velocity were significantly lower in patients compared with donors. Interestingly, semen volume was significantly reduced in donors compared to patients. 2) Within subject CVs ranged from 20-54% in patients, and were greater than donors for all parameters measured. 3) High within subject variations were especially observed in sperm counts from both patients and donors. 4) Velocity was the most stable, predictable parameter measured. These data indicate large within subject variation in sperm parameters from both patients presenting to an infertility clinic as well as normal men donating sperm for artificial insemination, and further support the need for measurement of multiple ejaculates before characterizing a man as normal or subfertile. Supported by: Women’s Research Institute, Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita.
S300
Abstracts
P-542 Beyond laboratory testing: Data collection serves important practice management functions. Marc Portmann, Caryl Carpenter, Barbara McGuirk, Ron Feinberg. Reproductive Assoc of Delaware, Newark, DE; Widener Univ, Chester, PA. Objective: The institution of specific workflow mechanisms to accurately track various parameters of laboratory testing can serve an important role for practice management in a private practice setting. We describe a laboratory practice management data collection “system” that: tracks laboratory volume; calculates disposable costs; monitors disposable cost-per-test and per CPT code; forecasts future laboratory testing volume and personnel needs; and estimates other potential laboratory related revenues and expenses. Design: Laboratory test volume tracking and vendor disposable cost calculations were instituted at the inception of the practice (1-1-97) and have continued through abstract submission utilizing Microsoft Excel. Laboratory expense tracking was initiated in the beginning of 1999 using Microsoft Money. Materials and Methods: Intra-office workflow had to be altered to ensure that on a daily basis all laboratory activities were monitored and tracked. On a monthly interval, laboratory test volumes are tallied by lab personnel to calculate total monthly testing volume. Microsoft Excel was used extensively to input data and setup a laboratory cost accounting system that operates dynamically. Many spreadsheets are involved, but they are externally linked with each other in cascading fashion, such that a change in the top most file will be reflected in all others down the line. Microsoft Money was used to input and track actual laboratory expenses. Again, intra-office workflow was arranged so that all laboratory related invoices and bills were triaged and given to the appropriate laboratory “controller”. Revenue and expenses were cross-checked with the practice management billing system. Results: The institution of laboratory test tracking and vendor disposable per/unit costs have formed the foundation upon which laboratory related revenues and expenses are determined. Tasks and disposable supplies utilized during the execution of each CPT related procedure were calculated and are dynamically updated monthly based on external links to other spreadsheets. As well, trends and characteristics of the laboratory testing menu are monitored. Conclusions: The evolution of a relatively simple laboratory test tracking and expense-monitoring system has given our clinic much valid information and insight into the complex interplay between medical practice and the business of medicine. To make this type of system work, complete laboratory “buy in” is important. Lab personnel are responsible for the day-to-day tracking and completion of test results. Thus, they should be active participants in reports and statistical analysis generated from the data they collect. Additionally time-series decomposition techniques can be applied to laboratory testing data to identify trends and seasonal differences in testing volume. Regression techniques can also be used to forecast testing volume that can be used to determine, for example, appropriate staffing levels. Aside from the laboratory, overall practice specific information can also be generated. Laboratory test volume may serve as an important indicator of practice growth: identifying time periods where growth is slow, on the rise, or in decline.
P-543 The fate of non-transferred embryos after day 3 assisted hatching. Marc Portmann, Linda Morrison, Lynn San-Soucie, Michael Tucker, Barbara McGuirk, Ron Feinberg. Reproductive Assoc of Delaware, Newark, DE; Georgia Reproductive Specialists, Atlanta, GA. Objective: To determine if assisted hatching (AH) on day 3 affects blastocyst formation in non-transferred (NT) penultimate embryos. Design: Retrospective analysis of 84 IVF cycles in which remaining NT embryos were observed following day 3 fresh transfer. Blastocyst formation rates were compared in day 3 AH embryos versus those without day 3 AH. Materials and Methods: Oocytes were retrieved in HTF (InVitrocare), hyaluronidased after 2 to 3 hours incubation and ICSI’ed following cumulus-corona removal. Oocytes were placed in Q1 (InVitrocare) after ICSI and cultured individually in this media until Day 3. Embryos were placed into CCM on the morning of Day 3 for extended culture. Morphologic assess-
Vol. 80, Suppl. 3, September 2003