Comparing assisted reproductive technology (ART) patient characteristics and treatment outcomes for US residents and non-residents with poor prognoses: an analysis of US surveillance data, 2004-2007

MATERIALS AND METHODS: A total of 245 IVF/ICSI cycles from were evaluated. All zygotes were assessed for early cleavage (EC) or no cleavage (NC) approximately 24-26 h after insemination/ICSI and separated into two groups, Group A (EC) and Group B (NC). Data from all patients who had at least 3 zygotes available were included. Embryo transfer was performed on either day 3 or day 5. Differences were analyzed and values with p<0.05 were considered significant. RESULTS: A total of 245 IVF cycles were analyzed, 138 were in Group A (56%) and 107 were in Group B (44%). In Group A 79% cycles had the embryo transfer on day 3 and 21% on day 5, whereas in Group B, 82% embryo transfer were done on day 3 and 18% on day 5. In Group A, 36% and in Group B, 32% developed to (R8 cells) on day 3 (pR0.05). In Group A, 20% and in Group B, 45% developed into blastocysts that were either transferable or cryopreserved (p<0.05). Group A had a pregnancy rate of 41% (day 3) and 51% (day 5) and in Group B pregnancy rate was 42% (day3) and 63% (day 5). Although cumulative pregnancy rates between Group A (44%) and Group B (45%) were not statistically different, pregnancy rate from day 5 transferred embryos were higher in Group B as compared to Group A (p<0.05). CONCLUSIONS: Early cleavage on day one alone is not a predictor of improved embryo quality. Both EC and NC embryos on day one develop equally into good quality embryos. NC embryos appeared to have a higher rate of blastocyst development in our laboratory and appear to have higher pregnancy rates, although overall pregnancy rates do not differ.

P-210 Tuesday, October 20, 2009 COMPARING ASSISTED REPRODUCTIVE TECHNOLOGY (ART) PATIENT CHARACTERISTICS AND TREATMENT OUTCOMES FOR US RESIDENTS AND NON-RESIDENTS WITH POOR PROGNOSES: AN ANALYSIS OF US SURVEILLANCE DATA, 2004-2007. S. Sunderam, G. S. Sentelle, J. Chang, T. Durant, G. Jeng. Women’s Health and Fertility Branch, Centers for Disease Control and Prevention, Atlanta, Ga. OBJECTIVE: The number of assisted reproductive technology (ART) cycles undertaken by US non-residents (NRs) at US ART clinics increased 79%, 980 in 2004 to 1758 in 2007. Little is known about NRs who seek ART treatment in the US. We examined differences in patient characteristics and treatment outcomes between NR and US ART users with poor prognoses. DESIGN: Retrospective cohort study using CDCs National Assisted Reproductive Technology Surveillance System (NASS). MATERIALS AND METHODS: We restricted analyses to North American, Asian, and European patients with poor prognoses, i.e. > three ART cycles during 2004-2007. NRs from Europe, Asia, Canada, and Mexico accounted for 88% of patients with poor prognoses. Patient characteristics and treatment procedures were compared across regions using chi-square tests. Logistic regression was used to assess live birth delivery rates across regions controlling for age, prior births, pregnancy loss, and type of ART procedure. RESULTS: We selected 807 NR and 44,214 US cycles with > three prior ART attempts. NR cycles were distributed as follows: Europe (36%), Asia (23%), Canada (15%), and Mexico (13%). Compared with US patients, NRs were more likely to be > 40 years (56% vs. 34%, except Mexico), have diagnoses of uterine factor (11% vs. 6.7%), and use donor eggs (56% vs. 26%). NRs were less likely to have a previous birth (34% vs. 49%) or a prior pregnancy loss (42% vs. 51%). All differences were significant at p<0.01. Live birth rates for fresh donor cycles were 42 % for Asia (adjusted odds ratio (AOR) 0.92; 95% confidence interval (CI): 0.60 – 1.40); 59% for Canada (AOR:1.73, 95%CI:0.87-3.44); 46% for Europe(AOR:1.04, 95%CI:0.69-1.57); 30% for Mexico (AOR:0.52, 95%CI:0.20-1.35) compared to 46% for US residents. CONCLUSIONS: Compared to US patients, NRs have significantly different patient characteristics indicative of poorer prognoses but did not have significantly different live birth rates. Supported by: This work was supported by the intramural budget of the CDC.

P-211 Tuesday, October 20, 2009 CAN THE OOCYTE REPAIR MALE AGE EFFECTS? ANALYSIS OF 2454 IVF CYCLE OUTCOMES. M. Esbert, M. Florensa, M. Riqueros, M. Martin, A. Ballesteros, G. Calderon. IVI-Barcelona, Barcelona, Spain. OBJECTIVE: Spermatogenesis continues into advanced ages, but meiotic errors due to aging could lead to an increase of chromosomal defects in embryos depending on the efficiency of maternal DNA repair.The present study

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Abstracts

was undertaken to examine the effect of male aging on IVF program results controlled for female age. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: 2454 cycles were included in this study. Cases were divided into six groups depending on the origin of oocytes (donor or patient), age of patients (% 35 or > 35 years old) and age of males (% 40 or > 40 years old). Number of embryos transferred per patient was the same in each group. Statistical analysis used Chi Square and ANOVA, with Bonferroni correction. RESULTS: Results of IVF outcomes are detailed in the table. CONCLUSIONS: Both female and male age have an impact on clinical outcomes. Resulting data of this study show that IVF outcomes are poorer TABLE 1

Egg donor male %40y

Egg donor male >40y

Female %35y male %40y

N 729 814 429 IVF 65.46  21.67 63.17  24.17 57.96  26.17 fertilization (%  SD) ICSI 61.05  17.99 61.84  18.13 59.82  23.86 fertilization (%  SD) 59.31a 55.20a Clinical pregnancy per ET 63.84a (%) Implantation rate (%) 48.10a 41.61b 40.19bd Miscarriage rate(%) 13.76 17.15 11.79

N IVF fertilization (%  SD) ICSI fertilization (%  SD) Clinical pregnancy per ET (%) Implantation rate (%) Miscarriage rate(%) abc

Female %35y male >40y

Female >35y male %40y

Female >35y male >40y

P

39 41.83  44.86

266 62.66  30.88

177 58.62  28.26

NS

62.74  20.89

57.34  26.01

56.56  27.19

NS

61.11ab

45.81b

38.67b

<0.05

42.59a b c

31.20cd

27.11c

<0.05

18.18

18.27

25.86

NS

Values within rows with different superscripts differ (p<0.05).

when male partner is old and that it turns the worst when both members of the couple are old. Moreover, oocyte might have a repairing role as observed in cycles where young women are analysed.

P-212 Tuesday, October 20, 2009 MATERNAL, FETAL, CHILD HEALTH COMPLICATIONS ARE INCREASED AFTER ART (ASSISTED REPRODUCTIVE TECHNOLOGY) PROPORTIONAL TO MULTIPLE GESTATION AND COMPARED TO SPONTANEOUS CONCEPTIONS. S. Kashyap, K. Parker, G. Wells. Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, SF, CA; Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada. OBJECTIVE: To investigate the fetal, maternal and/or child health complications associated with singletons, twins and tripletsþ for women of reproductive age who have undergone IVFþ/- ICSI. DESIGN: Systematic review (SR) and meta-analysis (MA) MATERIALS AND METHODS: MA Of Observational Studies in Epidemiology (MOOSE), QUality Of Reporting Of MA’s (QUOROM) and

Vol. 92., No. 3, Supplement, September 2009