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Beyond the ASRM transfer guidelines: maximum number of embryos to transfer in women ≥ 43 years of age
P-471 Wednesday, October 16, 2013 THE USE OF VAGINAL ULTRASOUND - GUIDED EMBRYO TRANSFER WITH EMPHASIS ON THE TVP CATHETER. M. M. Shaykh. Assisted Fertility Program, Jacksonville, FL. OBJECTIVE: Ultrasound-guided embryo transfer seems to improve the pregnancy rate of In Vitro Fertilization perhaps by more accurately transferring the embryos to the best endometrial location with minimal trauma. We assessed the chance of pregnancy using a catheter specifically designed for use with vaginal ultrasound. DESIGN: Retrospective study of pregnancy rates with the use of the COOK TVP catheter. MATERIALS AND METHODS: Echo tip Soft-pass Transvaginal Probe Embryo Transfer Catheter (TVP Catheter) is used. It is made from two parts fitted coaxially .The outer sheath 6.8FR in diameter and 17cms.in length, with a securing adapter and a cervical stopper, and the inner catheter of 4.4FR measuring 26.5 cms.with a stiffening cannula and an echogenic stainless-steel band at the tip. Pregnancy rates were assessed retrospectively, and compared to pregnancy rates with the use of Trans abdominal ultrasoundguided embryo transfer, done by the same physician. RESULTS: There was no difference in the pregnancy rate between using Trans abdominal and Trans vaginal ultrasound for guidance. But more importantly the use of the T.V.P catheter was associated with more comfort to the patient, due to the lack of bladder distention and unlike previous reports, it is not necessary to simultaneously place the vaginal ultrasound probe, the speculum and the catheter at the time of transfer. In addition, the physician has more confidence in the transfer, due to superb visualization, and without the need for an ultra sonographer. IVF Pregnancy Rate Using Trans-Abdominal Ultrasound-guided Embryo Transfer/Vaginal Ultrasound-guided Embryo Transfer
Patients Ages # Cycles % Pregnancy
< 35 57/97 19.32%/29.9%
35-37 11/41 33%/27.5%
Donor cycles 15/28 53.3%/35.7%
CONCLUSION: Trans vaginal ultrasound -guided embryo transfer using the COOK TVP catheter yielded a reasonably good pregnancy rate, is comfortable to the patient and is associated with great visualization. P-472 Wednesday, October 16, 2013 BEYOND THE ASRM TRANSFER GUIDELINES: MAXIMUM NUMBER OF EMBRYOS TO TRANSFER IN WOMEN R 43 YEARS OF AGE. V. Gunnala,a D. Reichman,b L. Meyer,b O. K. Davis,b Z. Rosenwaks.b aObstetrics and Gynecology, New York Presbyterian- Weill Cornell Medical College, New York, NY; bThe Ronald O. Perelman Claudia Cohen Center for Reproductive Medicine, New York Presbyterian- Weill Cornell Medical College, New York, NY. OBJECTIVE: To determine the maximum number of cleavage stage embryos that can be safely transferred in women R43 years old. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Cycles from 1/2004-4/2012 were reviewed for transfer of R5 day 3 embryos. Donor egg cycles were excluded. Clinical outcomes for patients R43 undergoing transfer with R5 embryos
# of Embryos n¼ Implantation Live birth Twin FH Triplet FH % Twin Birth n¼ Implantation Live birth Twin FH Triplet FH % Twin Birth
Age 43 5 151 7.9% 11.9% 23.5% 2.9% 22.2% Age 44 92 4.4% 10.9% 0% 0% 0%
FERTILITY & STERILITYÒ
6 129 7.0% 16.3% 23.3% 3.3% 9.5%
7 12 7.0% 16.7% 0% 0% 0%
8 6 6.3% 33.3% 50% 0% 50%
78 5.6% 7.7% 14.3% 0% 16.7%
16 0.9% 6.3% 0% 0% 0%
6 4.2% 16.7% 0% 0% 0%
Implantation, clinical pregnancy, live birth, rate of twins, and rate of higher order multiples (HOM) were analyzed, stratifying by age and number of embryos transferred. Differences between groups were assessed via ANOVA with Bonferroni adjustment, where p<0.05 was considered significant. RESULTS: 561 patients ages 43-45 were identified whose IVF cycles were characterized by transfer of 5-8 cleavage stage embryos. No patient had more than 8 embryos transferred. 45 year old patients exhibited higher day 3 FSH than 43 year old patients. There were otherwise no demographic differences between ages. Each age group had experienced an average of 3 prior IVF failures. 2/66 (3%) of pregnancies in 43 year olds were triplet gestations, one of which selectively reduced to twins, and the other spontaneously reduced to twins. Twin birth was 11.7%, 6.8%, and 0% for ages 43, 44, and 45, respectively. There were no HOM births. CONCLUSION: Transferring as many as 8 cleavage-stage embryos can be viewed as a safe option for IVF patients R43 years of age with multiple prior failures.
P-473 Wednesday, October 16, 2013 THE PREDICTIVE CRITERIA OUTCOME FOR CLINICAL PREGNANCY AFTER EMBRYO TRANSFER IN WOMEN 37 YEARS OF AGE AND OLDER. C. S. Ryu, H. E. Ryu, C. Park, K. R. Kim, E. K. Chun, S. I. Roh. Gangnam MizMedi Hospital i-Dream Research Center, Kangnam-gu, Seoul, Republic of Korea. OBJECTIVE: According to the present studies, the woman’s age and fertility have been documented to have a negative correlation. Many IVF centers have been making a lot of efforts to improve pregnancy rates in old aged women. However, in the case of the old aged women, specific predictive factors are not well known. Therefore, we analyzed our data to figure out which criteria could be predictive factors in women older than 37 years of age in IVF cycles. DESIGN: A retrospective study. MATERIALS AND METHODS: The present study included assessment of 249 IVF-ET cycles. For this study, IVF cycles for women 37 years of age and older, for Ovum Donation or with natural cycles were excluded. Fertilization was assessed 18 hours after IVF/ICSI. All embryos were checked for early cleavage at 25-27h post fertilization. Embryo transfer was performed between day 2 - 5. The biological parameters of the IVF cycle and quality of the transferred embryo were analyzed and compared in ‘Pregnancy’(PG) and ‘No pregnancy’(NPG) groups. Data were analyzed using TTEST and Chi-test. P<0.05 was considered statistically significant. RESULTS: A total of 249 patients were analyzed: 83 for PG and 166 for NPG. There were significant differences with number of oocytes retrieved per cycle (12.398.66 vs. 9.26.33, P¼0.0035). PG gave rise to significantly higher rates of fertilization (77.8 vs. 67.69%, P<0.001) and early cleavage (56.63 vs. 42.78%, P¼0.039). In case embryos of transferred, PG showed significantly higher mean number of embryos transferred (3.030.89 vs. 2.731.12, P¼0.02) and transferred high quality embryos rate (66.67 vs. 42.38%, P<0.001) than NPG. Woman’s age was no significantly differences between PG and NPG (38.294.19 vs. 39.233.17, P¼0.074). The implantation rate of PG was 41.67%. CONCLUSION: Our results showed that fertilization rate and transferred high quality embryos rate are the main predictive factors of the onset of clinical pregnancy because significant difference is high than other factors in women 37 years of age and older. P-474 Wednesday, October 16, 2013 REPORT OF TWO CASES OF OVARIAN TORSION AFTER EGG RETRIEVAL TREATED BY LAPAROSCOPIC DETORSION FOLLOWED BY SUCCESSFUL EMBRYO TRANSFER ON DAY FIVE. M. Irani,a R. Tal,a D. Seifer,b R. Grazi.b aObstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY; bReproductive Endocrinology and Infertility, Maimonides Medical Center, Brooklyn, NY. OBJECTIVE: 1)To report for the first time two cases of ovarian torsion that occurred one day and three days after egg retrieval, and were appropriately diagnosed and treated in a timely manner, followed by embryo transfer (ET) on day five of the same in vitro fertilization (IVF) cycle, resulting in successful pregnancies. 2) To determine the importance of early diagnosis of ovarian torsion as a potential complication of ovarian hyperstimulation. DESIGN: Case report. MATERIALS AND METHODS: A 41 years old (y.o) woman was diagnosed one day after egg retrieval with ovarian torsion and treated by early
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Patients Ages # Cycles % Pregnancy
< 35 57/97 19.32%/29.9%
35-37 11/41 33%/27.5%
Donor cycles 15/28 53.3%/35.7%
CONCLUSION: Trans vaginal ultrasound -guided embryo transfer using the COOK TVP catheter yielded a reasonably good pregnancy rate, is comfortable to the patient and is associated with great visualization. P-472 Wednesday, October 16, 2013 BEYOND THE ASRM TRANSFER GUIDELINES: MAXIMUM NUMBER OF EMBRYOS TO TRANSFER IN WOMEN R 43 YEARS OF AGE. V. Gunnala,a D. Reichman,b L. Meyer,b O. K. Davis,b Z. Rosenwaks.b aObstetrics and Gynecology, New York Presbyterian- Weill Cornell Medical College, New York, NY; bThe Ronald O. Perelman Claudia Cohen Center for Reproductive Medicine, New York Presbyterian- Weill Cornell Medical College, New York, NY. OBJECTIVE: To determine the maximum number of cleavage stage embryos that can be safely transferred in women R43 years old. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Cycles from 1/2004-4/2012 were reviewed for transfer of R5 day 3 embryos. Donor egg cycles were excluded. Clinical outcomes for patients R43 undergoing transfer with R5 embryos
# of Embryos n¼ Implantation Live birth Twin FH Triplet FH % Twin Birth n¼ Implantation Live birth Twin FH Triplet FH % Twin Birth
Age 43 5 151 7.9% 11.9% 23.5% 2.9% 22.2% Age 44 92 4.4% 10.9% 0% 0% 0%
FERTILITY & STERILITYÒ
6 129 7.0% 16.3% 23.3% 3.3% 9.5%
7 12 7.0% 16.7% 0% 0% 0%
8 6 6.3% 33.3% 50% 0% 50%
78 5.6% 7.7% 14.3% 0% 16.7%
16 0.9% 6.3% 0% 0% 0%
6 4.2% 16.7% 0% 0% 0%
Implantation, clinical pregnancy, live birth, rate of twins, and rate of higher order multiples (HOM) were analyzed, stratifying by age and number of embryos transferred. Differences between groups were assessed via ANOVA with Bonferroni adjustment, where p<0.05 was considered significant. RESULTS: 561 patients ages 43-45 were identified whose IVF cycles were characterized by transfer of 5-8 cleavage stage embryos. No patient had more than 8 embryos transferred. 45 year old patients exhibited higher day 3 FSH than 43 year old patients. There were otherwise no demographic differences between ages. Each age group had experienced an average of 3 prior IVF failures. 2/66 (3%) of pregnancies in 43 year olds were triplet gestations, one of which selectively reduced to twins, and the other spontaneously reduced to twins. Twin birth was 11.7%, 6.8%, and 0% for ages 43, 44, and 45, respectively. There were no HOM births. CONCLUSION: Transferring as many as 8 cleavage-stage embryos can be viewed as a safe option for IVF patients R43 years of age with multiple prior failures.
P-473 Wednesday, October 16, 2013 THE PREDICTIVE CRITERIA OUTCOME FOR CLINICAL PREGNANCY AFTER EMBRYO TRANSFER IN WOMEN 37 YEARS OF AGE AND OLDER. C. S. Ryu, H. E. Ryu, C. Park, K. R. Kim, E. K. Chun, S. I. Roh. Gangnam MizMedi Hospital i-Dream Research Center, Kangnam-gu, Seoul, Republic of Korea. OBJECTIVE: According to the present studies, the woman’s age and fertility have been documented to have a negative correlation. Many IVF centers have been making a lot of efforts to improve pregnancy rates in old aged women. However, in the case of the old aged women, specific predictive factors are not well known. Therefore, we analyzed our data to figure out which criteria could be predictive factors in women older than 37 years of age in IVF cycles. DESIGN: A retrospective study. MATERIALS AND METHODS: The present study included assessment of 249 IVF-ET cycles. For this study, IVF cycles for women 37 years of age and older, for Ovum Donation or with natural cycles were excluded. Fertilization was assessed 18 hours after IVF/ICSI. All embryos were checked for early cleavage at 25-27h post fertilization. Embryo transfer was performed between day 2 - 5. The biological parameters of the IVF cycle and quality of the transferred embryo were analyzed and compared in ‘Pregnancy’(PG) and ‘No pregnancy’(NPG) groups. Data were analyzed using TTEST and Chi-test. P<0.05 was considered statistically significant. RESULTS: A total of 249 patients were analyzed: 83 for PG and 166 for NPG. There were significant differences with number of oocytes retrieved per cycle (12.398.66 vs. 9.26.33, P¼0.0035). PG gave rise to significantly higher rates of fertilization (77.8 vs. 67.69%, P<0.001) and early cleavage (56.63 vs. 42.78%, P¼0.039). In case embryos of transferred, PG showed significantly higher mean number of embryos transferred (3.030.89 vs. 2.731.12, P¼0.02) and transferred high quality embryos rate (66.67 vs. 42.38%, P<0.001) than NPG. Woman’s age was no significantly differences between PG and NPG (38.294.19 vs. 39.233.17, P¼0.074). The implantation rate of PG was 41.67%. CONCLUSION: Our results showed that fertilization rate and transferred high quality embryos rate are the main predictive factors of the onset of clinical pregnancy because significant difference is high than other factors in women 37 years of age and older. P-474 Wednesday, October 16, 2013 REPORT OF TWO CASES OF OVARIAN TORSION AFTER EGG RETRIEVAL TREATED BY LAPAROSCOPIC DETORSION FOLLOWED BY SUCCESSFUL EMBRYO TRANSFER ON DAY FIVE. M. Irani,a R. Tal,a D. Seifer,b R. Grazi.b aObstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY; bReproductive Endocrinology and Infertility, Maimonides Medical Center, Brooklyn, NY. OBJECTIVE: 1)To report for the first time two cases of ovarian torsion that occurred one day and three days after egg retrieval, and were appropriately diagnosed and treated in a timely manner, followed by embryo transfer (ET) on day five of the same in vitro fertilization (IVF) cycle, resulting in successful pregnancies. 2) To determine the importance of early diagnosis of ovarian torsion as a potential complication of ovarian hyperstimulation. DESIGN: Case report. MATERIALS AND METHODS: A 41 years old (y.o) woman was diagnosed one day after egg retrieval with ovarian torsion and treated by early
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