Compassionate Corps: creating access to IVF medications for injured veterans

sought out medical tourism in the Czech Republic, as well as the perspectives of single parents by choice. This presentation will highlight the diversity of these stories and share clips of participants detailing how their artifacts speak to their experiences. CONCLUSIONS: The intention of sharing this with the ASRM community is to facilitate more cross-talk amongst patients and physicians. Our hope is that the use of artifact-based methods may be useful to facilitate and cultivate relationships with patients to improve health-care decision making in reproductive medicine, particularly related to fertility treatment. As such, we as the speakers will articulate the need for more arts-based medical approaches to reproductive medicine. We believe this to be essential to improving access to care, as well as increasing the health literacy around the topic of fertility. References: 1. Atkinson, Sarah; Evans, Bethan; Woods, Angela; Kearns, Robin. ’The Medical’ and ’Health’ in a Critical Medical Humanities. In. Journal of Medical Humanities. 12 December 2014.

O-101 Tuesday, October 18, 2016 12:15 PM LIMITATIONS ON THE COMPENSATION OF GAMETE DONORS: A SURVEY OF PUBLIC SUPPORT AND OPINION. M. S. Lee,a L. V. Farland,b S. A. Missmer,b E. S. Ginsburg.a aDept of Obstetrics & Gynecology, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA; bDept of Epidemiology, Harvard Chan School, Boston, MA, Boston, MA.

RESULTS: Of the 1,574 respondents, 1,427 completed the survey. 51(4%) disagreed with use of IVF for any indication. 232(16%) felt egg and/or sperm donation are unacceptable practices. Of the remaining 1,185 respondents, 953(80%) were in support of and 41(4%) were against paying sperm donors; 1,063(90%) were in support of and 24(2%) were against paying egg donors; the remainder were neutral. 559(47%) supported placing a limit on sperm donor and 544(46%) on egg donor compensation. Individuals who self-identified as Republicans compared to Democrats, or had a personal knowledge of someone who had used ART, were more likely to support a limitation on both egg and sperm donation (Table). Divorced compared to married respondents were less likely to support a limit on both egg and sperm donor compensation. Men were less likely than women to support a limit on sperm donor compensation only. Participants with a yearly income of >$60,000, those with a college degree, those with a personal knowledge of someone with infertility, and Catholics compared to Protestants were more likely to support limits on egg donor compensation only. Participants without biological children and those who identified as sexual minorities were less likely to support limitations on egg donor compensation only. Age and race were not associated with support. CONCLUSIONS: The vast majority of respondents in a nationally representative sample support compensation for sperm and egg donors. Less than half of the respondents support limitations on gamete donor compensation. Supported by: Funded by a Dept of ObGyn Expanding the Boundaries Grant.

O-102 Tuesday, October 18, 2016 12:30 PM COMPASSIONATE CORPS: CREATING ACCESS TO IVF MEDICATIONS FOR INJURED VETERANS. J. A. Drum. EMD Serono, Mooresville, NC.

OBJECTIVE: ASRM recommendations regarding limitations on gamete donor compensation have been controversial. Our aim was to determine public opinion regarding gamete donor compensation, and if support varies by demographic factors. DESIGN: Cross-sectional web-based survey. MATERIALS AND METHODS: A nationally representative sample of adult U.S. residents completed an online questionnaire in February 2016. Responders who support limitations on gamete donor compensation were compared with those who were neutral or in opposition using log binomial regression, adjusted a priori for age and gender, to calculate relative risk ratios (RR) and 95% confidence intervals (CI).

OBJECTIVE: Implement program to assist wounded Veterans with IVF medications for family building where no coverage or assistance existed. DESIGN: More than 2,000 people who have served in the military have been diagnosed with infertility after suffering from major injuries. However, when active members of the U.S. military and U.S. veterans injured during service are faced with infertility, they become an underserved population. According to law, the Department of Veterans Affairs

Support for limiting gamete donor compensation based on demographic factors

Support a limit on compensating SPERM donors Characteristic Female Male Income <¼$60,000 Income>$60,000 Protestant Catholic ¼College Know someone with infertility No Yes Know someone who used ART No Yes Biological children 1 or more 0 Democrat Republican Married Divorced/widowed Heterosexual Sexual minority

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ASRM Abstracts

Support a limit on compensating EGG donors

N(%) agree

RR (CI)

N(%) agree

RR (CI)

344(52) 215(41) 345(46) 214(49) 249(48) 168(51) 342(47) 217(48)

1.00 (ref) 0.78 (0.69-0.89) 1.00 (ref) 1.08 (0.96-1.20) 1.00 (ref) 1.09 (0.95-1.25) 1.00 (ref) 1.06 (0.94-1.20)

315(48) 229(44) 325(44) 219(50) 226(43) 173(53) 310(57) 234(52)

1.00 (ref) 0.90 (0.79-1.02) 1.00 (ref) 1.15 (1.02-1.31) 1.00 (ref) 1.23 (1.07-1.42) 1.00 (ref) 1.24 (1.09-1.40)

285(44) 274(50)

1.00 (ref) 1.09 (0.96-1.26)

275(43) 269(49)

1.00 (ref) 1.14 (1.01-1.29)

327(43) 232(56)

1.00 (ref) 1.28 (1.13-1.44)

315(41) 228(55)

1.00 (ref) 1.32 (1.17-1.49)

362(48) 197(45) 212(46) 159(54) 297(51) 60(38) 519(48) 40(40)

1.00 (ref) 0.98 (0.85-1.12) 1.00 (ref) 1.20 (1.04-1.38) 1.00 (ref) 0.73 (0.58-0.90) 1.00 (ref) 0.84 (0.66-1.08)

365(49) 179(41) 208(45) 162(55) 295(50) 59(38) 509(47) 35(35)

1.00 (ref) 0.86 (0.75-0.99) 1.00 (ref) 1.22 (1.05-1.41) 1.00 (ref) 0.72 (0.58-0.90) 1.00 (ref) 0.76 (0.57-0.99)

Vol. 106, No. 3, Supplement, September 2016

is prohibited from covering in vitro fertilization treatments for injured veterans, therefore creating a gap in coverage for their fertility benefits and significant cost barriers. In July of 2014 Compassionate Corps launched to raise awareness of fertility coverage gaps and to help alleviate these cost barriers by developing a program tailored for injured U.S. veterans. MATERIALS AND METHODS: Compassionate Corps provides IVF stimulation medications at no charge for up to 2 cycles for qualifying applicants. Compassionate Corps is the first patient assistance program to completely eliminate the cost [AD1] of[AD2] fertility medications (Gonal-f, Cetrotide, & Ovidrel) for eligible U.S. Veterans who are infertile due to a service-related injury.  Patient Attested  Patient confirms that he/she/spouse is a medically retired member of the military  Patient submits his/her/spouse’s DD-214 and any medical information and records proving the service-related injury  Patient confirms that he/she/spouse has no insurance coverage for the infertility treatments or related medications needed  Physician Attested  Physician confirms that the patient has service-related injuries that have caused infertility  Physician confirms that IUI/OI would be suboptimal or impossible  Physician submits a valid prescription for an eligible drug  Medications Provided  Program is valid for a maximum of 2 cycles per calendar year  Medications are shipped to IVF clinic. RESULTS: To date, more than 80 U.S. veterans have attained access to medications for in vitro fertilization and advanced reproductive technology through the Compassionate Corps program. CONCLUSIONS: The Compassionate Corps program was designed and implemented to create access for injured U.S. Veterans who required IVF due to injuries sustained while actively serving in the military. The coverage gap that currently exists creates tremendous financial burdens and barriers to treatment for this very deserving population. The 80 approved applicants were given a chance to build a family because of Compassionate Corps when no other program existed and no legislation had been mandated to protect our heroes who bravely served their country.

DESIGN: Retrospective review of trainees’ demographic data and training evaluation forms. MATERIALS AND METHODS: All urologists who attended our MIM training program from May 2015 to April 2016 were included. Briefly, the MIM training program at our institution is a two-week training course offered to urologists interested in male infertility and held in a dedicated MIM training lab. During the first week, the trainees are taught how to manipulate basic microsurgical equipment. They practice under operating microscopes, using a latex practice card, microsurgical instruments and sutures (10-0 and 9-0). During the second week, and depending on their skill levels, the trainees perform MIM procedures, such as vasovasostomy (VV) and vasoepididymostomy (VE) in rats. Our training protocol is approved by the Institutional Review Board, and instructors provide close supervision and continuous evaluation during all phases of the training. Trainees also observe microsurgical cases performed at our institution. Evaluations of microsurgical skills are performed using a structured score form composed of 18 items, in which the lowest score is 18 points and the highest is 90 points. VV and VE patency rates are also reported. RESULTS: We identified 16 urologists that completed our MIM training program and had evaluation data available. Demographic data is shown on table 1. The average time spend in the microsurgical training lab was 72.1 (28.8) hours, and the average number of rat procedures performed per trainee was 8.9 (3.6). The patency rates for VV and VE were 90% and 73% respectively. The average final evaluation score was 67.4 ( 7.1) points, and the average improvement from baseline was 21.2 (3.5) points. No baseline characteristics were predictive of the outcomes. CONCLUSIONS: A MIM training program is an effective tool for teaching MIM skills. A well-equipped training lab provides the ideal environment for acquisition of microsurgical skills, even for experienced surgeons. References: 1. Goldstein M: The Making of a Microsurgeon. J Androl, 2006;27 (2):161 Supported by: The project was supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.

REPRODUCTIVE SURGERY 2 O-104 Tuesday, October 18, 2016 11:30 AM O-103 Tuesday, October 18, 2016 11:15 AM IMPORTANCE OF MALE INFERTILITY MICROSURGERY TRAINING. F. Neto,a B. Stone,b P. V. Bach,b B. B. Najari,a M. Feliciano,a P. S. Li,a P. N. Schlegel,a M. Goldstein.c aUrology, Weill Cornell Medical College, New York, NY; bWeill Cornell Medical College, New York, NY; cMale Reproductive Medicine, and Urology, Weill Cornell Medical College, New York Presbyteri, New York, NY. OBJECTIVE: Male infertility microsurgery (MIM) is technically and mentally challenging, and outcomes are heavily dependent on surgeon’s skills[1]. Training programs in MIM are important for acquisition and improvement of surgeon’s microsurgical skills and outcomes. In this report, we describe our MIM training program, the trainees’ profile and outcomes.

Trainees’ characteristics Age, mean years (SD) No previous experience Self-taught Basic training Fellowship Full practice Years performing microsurgery: 0-5 years Years performing microsurgery: >5 Number of MIM cases/week: 0-2 cases Number of MIM cases/week: > 2 cases Academic practice Non-academic practice setting

FERTILITY & STERILITYÒ

37.5 (6.9) 7 (43%) 6 (37%) 3 (20%) 0 0 10 (62%) 6 (38%) 11 (68%) 5 (32%) 13 (81%) 3 (19%)

UTERINE VIABILITY FOLLOWING INTERRUPTION OF THE UTERINE VEIN- A PILOT STUDY TO ASSESS ALTERNATIVE VENOUS RETURN FOR UTERINE TRANSPLANT. K. Arnolds,a B. Beran,a M. Shockley,a K. Rivas,b M. L. Sprague,a A. Tzakis,c T. Falcone,d S. Zimberg.a aGynecology, Cleveland Clinic Florida, Weston, FL; bMannheimer Foundation, Homestead, FL; cTransplant, Cleveland Clinic Florida, Weston, FL; dOB GYN, Cleveland Clinic, Cleveland, OH. OBJECTIVE: To assess uterine viability after disruption of the uterine vein (UV) for the purpose of uterine transplant. DESIGN: Prospective observational study of three female Papio hamadryas baboons undergoing interruption of the UV, cervical detachment and repair. MATERIALS AND METHODS: Three baboons underwent laparotomy during which the uterine arteries and veins were isolated and the UV was ligated and transected bilaterally. Colpotomy was performed and the cervix was reanastomosed to the vaginal cuff. Following this, Indocyanine green (ICG) was administered and the SPY Elite imaging system (Novadaq Tech Inc.) documented vascular perfusion of the uterus and the cervicovaginal (CV) junction in real time. 6 weeks postoperatively, the subjects underwent transabdominal sonography, vaginoscopy and endocervical biopsy. The baboons were released into the primate colony and observed. RESULTS: Three baboons underwent uncomplicated suture ligation and transection of the left and right uterine vein followed by colpotomy with cervicovaginal anastomosis. Near-infrared perfusion confirmed blood flow throughout the uterus and CV anastomosis in all cases. The operative time was 115  20 min. On transabdominal ultrasound 6 weeks postoperatively, a normal appearing uterus was visualized in all subjects and vascular color flow was confirmed at both ovarian and uterine vascular insertions. Vaginoscopy showed a well-healed CV anastomosis and all endocervical biopsies showed non necrotic tissue. Postoperatively, cyclical sex skin turgescence and menstruation was observed in all

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