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Comparison of neonatal and maternal outcomes in nulliparous women 40 years or older with spontaneous versus IVF autologous egg or IVF donor egg singleton pregnancies
RESULTS.
# of Patients Successful Fresh ET Unsuccessful Fresh ET/Successful FET
149 45
Mean E2 @ hCG 2892 pg/ml* 4228 pg/ml
* P <0.01 CONCLUSION: This data shows: 1)High E2 levels may inhibit implantation, 2)There is a statistically significant difference in E2 levels in successful vs. unsuccessful fresh ET and 3)In women with E2 > 3000 pg/ml in a fresh cycle, consideration should be given to freezing all embryos and then doing a controlled HRT/FET.
arous, multiple gestation or patients who underwent reduction to singleton were excluded. Mode of delivery, length of hospital stay, gestational age, NICU admission, birth weight and apgars were recorded. RESULTS: 184 patients met inclusion criteria. There were 106 spontaneous pregnancies, 42 IVF AE pregnancies and 36 IVF DE pregnancies. There was no significant difference in gravidity, gestational age at delivery, rate of postdates pregnancy, apgar scores, birthweight, rate of low birthweight infants, and rate of infants weighing >4kg. Those with a DE had a significantly higher rate of cesarean section than AE or spontaneous pregnancies and higher rates of NICU admission compared to spontaneous pregnancies (Table 1). While not significant, there was a trend towards increased rates of preterm delivery in the IVF and donor egg population. Outcomes.
P-255 Tuesday, October 18, 2011 DOES THE SEASONAL VARIATION IN THE DURATION OF DAYLIGHT HOURS AFFECT IN VITRO FERTILIZATION LIVE BIRTH RATES? T. D. Deutch, R. Sherbahn. Advanced Fertility Center of Chicago, Gurnee, IL. OBJECTIVE: Recent research has demonstrated that IVF outcomes may be affected by season and by vitamin D levels. Exposure to sunlight is likely greater in the summer months because of a significantly higher number of daylight hours and warmer temperatures. This phenomenon is likely more pronounced in cold weather climates. The objective of this study was to evaluate whether the duration of daylight hours impacts IVF live birth rates for women undergoing IVF in Chicago. DESIGN: Retrospective database review MATERIALS AND METHODS: Our de-identified IVF database was queried in order to identify all cycles in which both date of retrieval and live birth outcome was recorded. From 1997 to 2009, we identified 2390 cycles. We divided the cycles into 3 groups based upon age: >35, 35-39, >40. The live birth rates (LBRs) in the groups were then compared based upon the month that the retrieval was performed: extended daylight (June and July) and limited daylight (December and January). In Chicago, there is an average of 9, 10, 15 and 15 hours of daylight in December, January, June and July respectively. The z-test was used to compare live birth rates. RESULTS: Of the 2390 cycles, 764 retrievals occurred in the aforementioned months of interest. There were no statistically significant differences found in LBRs for retrievals performed in extended daylight months compared to limited daylight months. This was true for all age groups. IVF Live Birth Rates.
Total cycles Live birth rate in extended daylight months Live birth rate in limited daylight months
Age <35
35-39
>40
491 55.3% 57.3%
196 47.4% 44.4%
77 12.1% 13.6%
CONCLUSION: There was no difference in IVF LBRs in cycles performed during extended daylight months compared those performed in limited daylight months. Patients undergoing IVF in cold weather climates with limited daylight hours can be reassured. While this study indicates no effect on LBRs based on the number of daylight hours, further studies are necessary to determine what if any role vitamin D levels play in IVF outcomes. P-256 Tuesday, October 18, 2011 COMPARISON OF NEONATAL AND MATERNAL OUTCOMES IN NULLIPAROUS WOMEN 40 YEARS OR OLDER WITH SPONTANEOUS VERSUS IVF AUTOLOGOUS EGG OR IVF DONOR EGG SINGLETON PREGNANCIES. S. N. Lin, T. Singer, E. Milbank, M. Biewald, A. Grunebaum. Obstetrics and Gynecology, NewYork Presbyterian Hospital Weill Cornell Medical College, New York, NY; The Center for Reproductive Medicine and Infertility, Weill Cornell Medical College, New York, NY; Weill Cornell Medical College, New York, NY. OBJECTIVE: To compare neonatal and maternal outcomes in nulliparous patients 40 years or older with spontaneous, IVF autologous egg (AE) and IVF donor egg (DE) pregnancies. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All deliveries in women 40 years of age or older who delivered during 2009 at our institution were included. Multip-
S182
Abstracts
Age Gravidity Gestational age at delivery (days) Preterm delivery <37 weeks
Spontaneous
IVF Autologous
IVF Donor
(106)
Egg (42)
Egg (36)
p
41.3 1.9 275 5(4.7%)
41.5 2.1 274 4(9.5%)
45.3 2.4 270 6(16.7%)
< .0001 0.17 0.15 0.07
C/S Rate 53(50%) 19(45.2%) 27(75%) < .02 Length of stay postpartum (days) 3.1 2.9 4.1 < .002 Birthweight (kg) 3.36(1.095 to 4.032) 3.3(2.17 to 4.725) 3.2(1.945 to 4.025) 0.36 NICU/CCN Admission 3(2.8%) 4(9.5%) 6(16.7%) < .02
CONCLUSION: Nulliparous women at 40 years of age and older with donor egg pregnancies are more likely to delivery via cesarean section and have a longer postpartum stay and have a baby admitted to the NICU when compared to women with a spontaneous or IVF autologous egg pregnancy. Additional studies are needed to further evaluate the risks to the mother and neonate with donor egg pregnancies. P-257 Tuesday, October 18, 2011 SEX-RELATED GROWTH DIFFERENCES ARE ENHANCED IN IVF PREGNANCIES. K. E. O’Neill, M. Tuuli, A. O. Odibo, R. R. Odem, A. R. Cooper. Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO. OBJECTIVE: Previous studies in spontaneously conceived pregnancies show that male neonates are larger than female neonates. Recent data suggests these growth differences are present even in the embryo. We sought to determine if the effect of fetal sex on growth differs in pregnancies achieved by in vitro fertilization. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Singleton live births without fetal/maternal comorbidities from fertile women with spontaneous conceptions and infertile women who conceived with IVF were compared. The primary outcome was birthweight. Secondary outcomes included fetal crown rump length in the 1st trimester and biparietal diameter (BPD) in the 2nd trimester. Male and female fetal growth was compared within and between the two populations using the student’s t test. RESULTS: There were no demographic differences between the sexes within conception groups. Male fetuses were larger in midgestation and at birth in both cohorts. The difference in BPD and birthweight seen between the sexes was more pronounced in the IVF group than in the spontaneous conceptions (.2 .3 cm vs .16 .03 cm, P¼0.01 and 327 83 grams vs 151 10 grams, P<0.001 respectively). Differences Between Males and Females in IVF and Spontaneously Conceived Pregnancies.
Outcome
IVF Cohort
Fertile Spontaneous
(n ¼ 213)
Cohort (n ¼ 1150)
Male
Female
P
Male
Female
P
(n ¼ 117)
(n ¼ 96)
value
(n ¼ 588)
(n ¼ 562)
value
1st Trimester CRL (mm)
8.5 5.3
7.8 4.4
0.32
9.3 4.5
8.9 4.3
0.12
2nd Trimester BPD (cm)
4.57 0.41
4.37 0.70
0.01
4.59 0.49
4.43 0.53
<0.001
3409.8 731.4
3083.0 648.4
<0.001
3349.5 579.2
3198.5 568.9
<0.001
Birthweight (g)
Measurements reported are unadjusted means. CRL ¼ crown rump length and BPD ¼ biparietal diameter.
Vol. 96., No. 3, Supplement, September 2011
# of Patients Successful Fresh ET Unsuccessful Fresh ET/Successful FET
149 45
Mean E2 @ hCG 2892 pg/ml* 4228 pg/ml
* P <0.01 CONCLUSION: This data shows: 1)High E2 levels may inhibit implantation, 2)There is a statistically significant difference in E2 levels in successful vs. unsuccessful fresh ET and 3)In women with E2 > 3000 pg/ml in a fresh cycle, consideration should be given to freezing all embryos and then doing a controlled HRT/FET.
arous, multiple gestation or patients who underwent reduction to singleton were excluded. Mode of delivery, length of hospital stay, gestational age, NICU admission, birth weight and apgars were recorded. RESULTS: 184 patients met inclusion criteria. There were 106 spontaneous pregnancies, 42 IVF AE pregnancies and 36 IVF DE pregnancies. There was no significant difference in gravidity, gestational age at delivery, rate of postdates pregnancy, apgar scores, birthweight, rate of low birthweight infants, and rate of infants weighing >4kg. Those with a DE had a significantly higher rate of cesarean section than AE or spontaneous pregnancies and higher rates of NICU admission compared to spontaneous pregnancies (Table 1). While not significant, there was a trend towards increased rates of preterm delivery in the IVF and donor egg population. Outcomes.
P-255 Tuesday, October 18, 2011 DOES THE SEASONAL VARIATION IN THE DURATION OF DAYLIGHT HOURS AFFECT IN VITRO FERTILIZATION LIVE BIRTH RATES? T. D. Deutch, R. Sherbahn. Advanced Fertility Center of Chicago, Gurnee, IL. OBJECTIVE: Recent research has demonstrated that IVF outcomes may be affected by season and by vitamin D levels. Exposure to sunlight is likely greater in the summer months because of a significantly higher number of daylight hours and warmer temperatures. This phenomenon is likely more pronounced in cold weather climates. The objective of this study was to evaluate whether the duration of daylight hours impacts IVF live birth rates for women undergoing IVF in Chicago. DESIGN: Retrospective database review MATERIALS AND METHODS: Our de-identified IVF database was queried in order to identify all cycles in which both date of retrieval and live birth outcome was recorded. From 1997 to 2009, we identified 2390 cycles. We divided the cycles into 3 groups based upon age: >35, 35-39, >40. The live birth rates (LBRs) in the groups were then compared based upon the month that the retrieval was performed: extended daylight (June and July) and limited daylight (December and January). In Chicago, there is an average of 9, 10, 15 and 15 hours of daylight in December, January, June and July respectively. The z-test was used to compare live birth rates. RESULTS: Of the 2390 cycles, 764 retrievals occurred in the aforementioned months of interest. There were no statistically significant differences found in LBRs for retrievals performed in extended daylight months compared to limited daylight months. This was true for all age groups. IVF Live Birth Rates.
Total cycles Live birth rate in extended daylight months Live birth rate in limited daylight months
Age <35
35-39
>40
491 55.3% 57.3%
196 47.4% 44.4%
77 12.1% 13.6%
CONCLUSION: There was no difference in IVF LBRs in cycles performed during extended daylight months compared those performed in limited daylight months. Patients undergoing IVF in cold weather climates with limited daylight hours can be reassured. While this study indicates no effect on LBRs based on the number of daylight hours, further studies are necessary to determine what if any role vitamin D levels play in IVF outcomes. P-256 Tuesday, October 18, 2011 COMPARISON OF NEONATAL AND MATERNAL OUTCOMES IN NULLIPAROUS WOMEN 40 YEARS OR OLDER WITH SPONTANEOUS VERSUS IVF AUTOLOGOUS EGG OR IVF DONOR EGG SINGLETON PREGNANCIES. S. N. Lin, T. Singer, E. Milbank, M. Biewald, A. Grunebaum. Obstetrics and Gynecology, NewYork Presbyterian Hospital Weill Cornell Medical College, New York, NY; The Center for Reproductive Medicine and Infertility, Weill Cornell Medical College, New York, NY; Weill Cornell Medical College, New York, NY. OBJECTIVE: To compare neonatal and maternal outcomes in nulliparous patients 40 years or older with spontaneous, IVF autologous egg (AE) and IVF donor egg (DE) pregnancies. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All deliveries in women 40 years of age or older who delivered during 2009 at our institution were included. Multip-
S182
Abstracts
Age Gravidity Gestational age at delivery (days) Preterm delivery <37 weeks
Spontaneous
IVF Autologous
IVF Donor
(106)
Egg (42)
Egg (36)
p
41.3 1.9 275 5(4.7%)
41.5 2.1 274 4(9.5%)
45.3 2.4 270 6(16.7%)
< .0001 0.17 0.15 0.07
C/S Rate 53(50%) 19(45.2%) 27(75%) < .02 Length of stay postpartum (days) 3.1 2.9 4.1 < .002 Birthweight (kg) 3.36(1.095 to 4.032) 3.3(2.17 to 4.725) 3.2(1.945 to 4.025) 0.36 NICU/CCN Admission 3(2.8%) 4(9.5%) 6(16.7%) < .02
CONCLUSION: Nulliparous women at 40 years of age and older with donor egg pregnancies are more likely to delivery via cesarean section and have a longer postpartum stay and have a baby admitted to the NICU when compared to women with a spontaneous or IVF autologous egg pregnancy. Additional studies are needed to further evaluate the risks to the mother and neonate with donor egg pregnancies. P-257 Tuesday, October 18, 2011 SEX-RELATED GROWTH DIFFERENCES ARE ENHANCED IN IVF PREGNANCIES. K. E. O’Neill, M. Tuuli, A. O. Odibo, R. R. Odem, A. R. Cooper. Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO. OBJECTIVE: Previous studies in spontaneously conceived pregnancies show that male neonates are larger than female neonates. Recent data suggests these growth differences are present even in the embryo. We sought to determine if the effect of fetal sex on growth differs in pregnancies achieved by in vitro fertilization. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Singleton live births without fetal/maternal comorbidities from fertile women with spontaneous conceptions and infertile women who conceived with IVF were compared. The primary outcome was birthweight. Secondary outcomes included fetal crown rump length in the 1st trimester and biparietal diameter (BPD) in the 2nd trimester. Male and female fetal growth was compared within and between the two populations using the student’s t test. RESULTS: There were no demographic differences between the sexes within conception groups. Male fetuses were larger in midgestation and at birth in both cohorts. The difference in BPD and birthweight seen between the sexes was more pronounced in the IVF group than in the spontaneous conceptions (.2 .3 cm vs .16 .03 cm, P¼0.01 and 327 83 grams vs 151 10 grams, P<0.001 respectively). Differences Between Males and Females in IVF and Spontaneously Conceived Pregnancies.
Outcome
IVF Cohort
Fertile Spontaneous
(n ¼ 213)
Cohort (n ¼ 1150)
Male
Female
P
Male
Female
P
(n ¼ 117)
(n ¼ 96)
value
(n ¼ 588)
(n ¼ 562)
value
1st Trimester CRL (mm)
8.5 5.3
7.8 4.4
0.32
9.3 4.5
8.9 4.3
0.12
2nd Trimester BPD (cm)
4.57 0.41
4.37 0.70
0.01
4.59 0.49
4.43 0.53
<0.001
3409.8 731.4
3083.0 648.4
<0.001
3349.5 579.2
3198.5 568.9
<0.001
Birthweight (g)
Measurements reported are unadjusted means. CRL ¼ crown rump length and BPD ¼ biparietal diameter.
Vol. 96., No. 3, Supplement, September 2011