- Email: [email protected]
Criteria to select quality blastocyst to transfer: a SART study
stratification. We aimed to develop a personalized prognostic tool that uses clinical data from prior, failed treatments to predict live birth (LB) probabilities in subsequent treatment cycles. DESIGN: We extracted IVF outcomes data from 5056 IVF cycles performed at the Stanford Hospital Clinic from 2003-08. MATERIALS AND METHODS: Using a non-deterministic approach, we generated a boosted tree model (IVFBT), by training the model with data from 1676 first cycles (C1s) from 2003-06. IVFBT was externally validated by 634 C1s from 2007-08. We further tested the ability of IVFBT to predict LB outcomes in the subsequent cycle (C2). RESULTS: We found that age alone was limited in predicting LB outcomes. Top non-redundant prognostic factors affecting LB outcome included percentage of embryos forming blastocysts, total amount of gonadotropins administered, the number of 8-cell embryos on Day 3, embryo cryopreservation. The IVFBT model was superior to the age-based control at a rate greater than 1000:1 in its ability to fit new data to predict the probability of live birth in a subsequent cycle (p<0.05). Receiver-operative characteristic analysis also showed that IVFBT increased discrimination by 17%. Finally, more than 60% of patients would receive a different yet more correct prediction of live birth outcomes in a subsequent cycle compared to an age-based prediction, and more than half of those patients were reclassified to have higher LB probabilities. CONCLUSION: We showed that data from a prior cycle could be used effectively to provide personalized LB probabilities in a subsequent cycle. Thus, the first IVF cycle is prognostic and therapeutic. Our approach may be replicated to support personalized prognostic counseling in other IVF clinics. Supported by: Stanford-Coulter Translational Research Program and NIH/ NICHD Womens Reproductive Health Research K12HD001249.
OBJECTIVE: To avoid high order pregnancy, single embryo transfer (SET) is a trend. SET not only raise the concern of patients but also fertility centers about which blastocyst to transfer. Studies claimed the stage of blastocyst, quality of inner cell mass (ICM), or quality of Trophectoderm(TRO) were sensitive indicators. But the conclusion sometimes contra-indicated each other and the sample size were small. In order to obtain reliable and sensitive indicator(s), this study utilized SART CORS big data file to examine the question. DESIGN: A retrospective study. MATERIALS AND METHODS: Totally 21601 records extracted from SART CORS database. Cases without PGD and with day 5 blastocyst transfer were used. Analyses of quality indicators were classified into 4 age groups as in SART report. There were 8230 cycles for age<35, 3887 cycles for age 3537, 2516 cycles for age 38-40, and 712 cycles for age 41-42. Indicators examined are overall grade (good, fair, poor), stage (early, expanded, and hatching blastocyst), ICM (good, fair, poor), and TRO (good, fair, poor). These indicators are correlated to the cycle outcomes,i.e. pregnancy,or live birth. Due to the recorded data are in qualitative term, the correlation analysis used both categorical and ordinal models. The strength of indicator association with pregnancy was analyzed with SAS by Analysis of Maximum Likelihood Estimates by Chi-square test. RESULTS: Table 1 is an example of analysis, detail results will be presented.
Categorical
282.77 (p<0.0001)
184.63 (p<0.001)
129.06 (p<0.001)
73.46 (p<0.0001)
O-180 Tuesday, October 26, 2010 05:30 PM
Ordinal
281.71 (p<0.0001)
126.78 (p<0.0001)
128.97 (p<0.0001)
36.78 (p<0.001)
TRENDS AND CORRELATES OF GOOD PERINATAL OUTCOMES AMONG SINGLETON INFANTS CONCEIVED THROUGH ART IN THE US, 2000-2005. T. Durant, J. E. Anderson, J. Goldfarb, M. Macaluso. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA; Cleveland Clinic Fertility Center, Society for Assisted Reproductive Technology, Beachwood, OH. OBJECTIVE: During 2000-2005, 271,270 assisted reproductive technology (ART) births occurred in the U.S.; of these 132,533 (48.9%) were singleton births. We analyzed data to evaluate trends in and correlates of the delivery of a term, normal birthweight singleton infant after ART. DESIGN: Retrospective analysis of National ART Surveillance System (NASS) data. MATERIALS AND METHODS: The outcome was defined as the delivery of a term (>37 weeks gestation), normal birthweight infant (> 2,500 grams). Data on all singleton infants born after ART during 2000-2005 and reported in NASS were assessed for trends using chi-square tests. Data from 2005 were examined for bivariate associations, and adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) were computed using multiple logistic regression. Covariates included demographic characteristics, fertility history, infertility diagnosis, type of ART treatment, number of embryos transferred, and number of fetal hearts detected during pregnancy. RESULTS: From 2000 to 2005, the percentage of singleton ART births with a good outcome decreased from 83.6% to 82.9% (p¼0.004). The odds of a good outcome were higher for women with one prior birth (AOR 1.25, 95%CI1.09-1.43), women whose reason for ART was male factor infertility (AOR 1.18, 95%CI1.08-1.28), and women who used their own fresh embryos rather than patient or donor thawed embryos (AOR 1.13, 95%CI1.03-1.23). The strongest effect was for the detection of 1 versus >1 fetal heart (AOR 1.79, 95%1.61-1.99). CONCLUSION: Birth history, certain fertility diagnoses, and embryo type affect pregnancy outcomes among ART singletons. Results indicate that singleton births resulting from singleton pregnancies do substantially better. Enhanced promotion of single embryo transfer would decrease the risk of adverse outcomes among ART singletons.
O-181 Tuesday, October 26, 2010 05:45 PM CRITERIA TO SELECT QUALITY BLASTOCYST TO TRANSFER: A SART STUDY. G. M. Grunert, C. Wun C.-C., W. Gibbons, R. C. Dunn, W.-S. A. Wun. Fertility Specialists of Houston, Houston, TX; Phmarma Inovation, Sugar LandNew York, TX; Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Partners HealthCare System, Inc., Boston, MA.
FERTILITY & STERILITYÒ
Correlation of pregnancy with quality indicators in age<35 group Overall grade
Stage
ICM
TRO
CONCLUSION: In general, the strength of indicators are following the sequence: overall grade–> stage–>Tro–>ICM. Detail results conclusion will be presented. Supported by: SART.
O-182 Tuesday, October 26, 2010 06:00 PM ANALYSIS OF ENDOMETRIAL THICKNESS IN PREDICTING OUTCOME OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER: A RETROSPECTIVE STUDY. F. P. Rodrigues, D. S. Zylbersztejn, G. M. Collier, F. M. Vigo, R. R. Filho, R. Fraietta. Human Reprodutcion Section, Universidade Federal de S~ao Paulo, S~ao Paulo, Brazil. OBJECTIVE: It is generally accepted that endometrial receptivity is critical to successful pregnancy. Indeed, endometrial thickness by ultrasonographic examination has been regarded as a prognostic parameter for successful pregnancy in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET).This study aims to evaluate the effect of endometrial thickness on clinical outcome in patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). DESIGN: A retrospective study. MATERIALS AND METHODS: Were reviewed retrospectively a total of 737 cycles of IVF/ICSI-ET at a University-based reproductive center. Only women aged from 19 to 37 years were included. The endometrial thickness was measured by ultrasonographic examination on the day of hCG administration. The data were compared by Student’s T-test, and a regression model was built to verify the effects of these two variables on the odds of pregnancy. RESULTS: In 737 studied cycles, the pregnancy rate was 36.1% (n¼266). Patients who achieved pregnancy presented a thicker endometrium (10.6 1.8mm) than those who did not (10.1 1.8mm) (p¼0.001), while age did not differ (32.4 3.4 years in the pregnant group, 32.3 3.3 in the non-pregnant group, p>0.05). Logistic regression demonstrated an OR of 0.980 for the woman’s age and 1.085 for endometrial thickness, demonstrating that increasing the woman’s age decreased the odds of pregnancy, while increasing endometrial thickness increased the odds of pregnancy. CONCLUSION: In this study we were able to observe that, when corrected for the woman’s age, patients with a thicker endometrium present an increased chance of pregnancy, suggesting that, in women with a thinner endometrium, intervention should be considered.
S53
OBJECTIVE: To avoid high order pregnancy, single embryo transfer (SET) is a trend. SET not only raise the concern of patients but also fertility centers about which blastocyst to transfer. Studies claimed the stage of blastocyst, quality of inner cell mass (ICM), or quality of Trophectoderm(TRO) were sensitive indicators. But the conclusion sometimes contra-indicated each other and the sample size were small. In order to obtain reliable and sensitive indicator(s), this study utilized SART CORS big data file to examine the question. DESIGN: A retrospective study. MATERIALS AND METHODS: Totally 21601 records extracted from SART CORS database. Cases without PGD and with day 5 blastocyst transfer were used. Analyses of quality indicators were classified into 4 age groups as in SART report. There were 8230 cycles for age<35, 3887 cycles for age 3537, 2516 cycles for age 38-40, and 712 cycles for age 41-42. Indicators examined are overall grade (good, fair, poor), stage (early, expanded, and hatching blastocyst), ICM (good, fair, poor), and TRO (good, fair, poor). These indicators are correlated to the cycle outcomes,i.e. pregnancy,or live birth. Due to the recorded data are in qualitative term, the correlation analysis used both categorical and ordinal models. The strength of indicator association with pregnancy was analyzed with SAS by Analysis of Maximum Likelihood Estimates by Chi-square test. RESULTS: Table 1 is an example of analysis, detail results will be presented.
Categorical
282.77 (p<0.0001)
184.63 (p<0.001)
129.06 (p<0.001)
73.46 (p<0.0001)
O-180 Tuesday, October 26, 2010 05:30 PM
Ordinal
281.71 (p<0.0001)
126.78 (p<0.0001)
128.97 (p<0.0001)
36.78 (p<0.001)
TRENDS AND CORRELATES OF GOOD PERINATAL OUTCOMES AMONG SINGLETON INFANTS CONCEIVED THROUGH ART IN THE US, 2000-2005. T. Durant, J. E. Anderson, J. Goldfarb, M. Macaluso. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA; Cleveland Clinic Fertility Center, Society for Assisted Reproductive Technology, Beachwood, OH. OBJECTIVE: During 2000-2005, 271,270 assisted reproductive technology (ART) births occurred in the U.S.; of these 132,533 (48.9%) were singleton births. We analyzed data to evaluate trends in and correlates of the delivery of a term, normal birthweight singleton infant after ART. DESIGN: Retrospective analysis of National ART Surveillance System (NASS) data. MATERIALS AND METHODS: The outcome was defined as the delivery of a term (>37 weeks gestation), normal birthweight infant (> 2,500 grams). Data on all singleton infants born after ART during 2000-2005 and reported in NASS were assessed for trends using chi-square tests. Data from 2005 were examined for bivariate associations, and adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) were computed using multiple logistic regression. Covariates included demographic characteristics, fertility history, infertility diagnosis, type of ART treatment, number of embryos transferred, and number of fetal hearts detected during pregnancy. RESULTS: From 2000 to 2005, the percentage of singleton ART births with a good outcome decreased from 83.6% to 82.9% (p¼0.004). The odds of a good outcome were higher for women with one prior birth (AOR 1.25, 95%CI1.09-1.43), women whose reason for ART was male factor infertility (AOR 1.18, 95%CI1.08-1.28), and women who used their own fresh embryos rather than patient or donor thawed embryos (AOR 1.13, 95%CI1.03-1.23). The strongest effect was for the detection of 1 versus >1 fetal heart (AOR 1.79, 95%1.61-1.99). CONCLUSION: Birth history, certain fertility diagnoses, and embryo type affect pregnancy outcomes among ART singletons. Results indicate that singleton births resulting from singleton pregnancies do substantially better. Enhanced promotion of single embryo transfer would decrease the risk of adverse outcomes among ART singletons.
O-181 Tuesday, October 26, 2010 05:45 PM CRITERIA TO SELECT QUALITY BLASTOCYST TO TRANSFER: A SART STUDY. G. M. Grunert, C. Wun C.-C., W. Gibbons, R. C. Dunn, W.-S. A. Wun. Fertility Specialists of Houston, Houston, TX; Phmarma Inovation, Sugar LandNew York, TX; Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Partners HealthCare System, Inc., Boston, MA.
FERTILITY & STERILITYÒ
Correlation of pregnancy with quality indicators in age<35 group Overall grade
Stage
ICM
TRO
CONCLUSION: In general, the strength of indicators are following the sequence: overall grade–> stage–>Tro–>ICM. Detail results conclusion will be presented. Supported by: SART.
O-182 Tuesday, October 26, 2010 06:00 PM ANALYSIS OF ENDOMETRIAL THICKNESS IN PREDICTING OUTCOME OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER: A RETROSPECTIVE STUDY. F. P. Rodrigues, D. S. Zylbersztejn, G. M. Collier, F. M. Vigo, R. R. Filho, R. Fraietta. Human Reprodutcion Section, Universidade Federal de S~ao Paulo, S~ao Paulo, Brazil. OBJECTIVE: It is generally accepted that endometrial receptivity is critical to successful pregnancy. Indeed, endometrial thickness by ultrasonographic examination has been regarded as a prognostic parameter for successful pregnancy in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET).This study aims to evaluate the effect of endometrial thickness on clinical outcome in patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). DESIGN: A retrospective study. MATERIALS AND METHODS: Were reviewed retrospectively a total of 737 cycles of IVF/ICSI-ET at a University-based reproductive center. Only women aged from 19 to 37 years were included. The endometrial thickness was measured by ultrasonographic examination on the day of hCG administration. The data were compared by Student’s T-test, and a regression model was built to verify the effects of these two variables on the odds of pregnancy. RESULTS: In 737 studied cycles, the pregnancy rate was 36.1% (n¼266). Patients who achieved pregnancy presented a thicker endometrium (10.6 1.8mm) than those who did not (10.1 1.8mm) (p¼0.001), while age did not differ (32.4 3.4 years in the pregnant group, 32.3 3.3 in the non-pregnant group, p>0.05). Logistic regression demonstrated an OR of 0.980 for the woman’s age and 1.085 for endometrial thickness, demonstrating that increasing the woman’s age decreased the odds of pregnancy, while increasing endometrial thickness increased the odds of pregnancy. CONCLUSION: In this study we were able to observe that, when corrected for the woman’s age, patients with a thicker endometrium present an increased chance of pregnancy, suggesting that, in women with a thinner endometrium, intervention should be considered.
S53