Cumulative live birth rate after fresh elective single blastocyst transfer and subsequent frozen single blastocyst transfer compared to initial fresh double blastocysts transfer in women aged 40-43 years

O-216 Wednesday, October 19, 2016 12:30 PM MAXIMIZING EFFICIENCY AND MITIGATING RISK: WHY PATIENTS CHOOSE PRE-IMPLANTATION GENETIC SCREENING (PGS). J. K. Blakemore,a Y. G. Kramer,b D. H. McCulloh,c J. Grifo,d K. N. Goldman.e aNew York University, New York, NY; bOBS-GYN, NYU Fertility Center, New York, NY; cObstetrics and Gynecology, New York University Fertility Center, New York, NY; dNYU Langone Medical Center, New York, NY; eObstetrics and Gynecology, New York University, New York, NY. OBJECTIVE: PGS is used clinically to enhance embryo selection in patients of advanced maternal age (AMA) and those with recurrent pregnancy loss (RPL) or recurrent IVF failure. We sought to understand if patients’ motivations for pursuing PGS are consistent with these established indications. DESIGN: Anonymous quantitative and qualitative survey. MATERIALS AND METHODS: Anonymous survey emailed confidentially to all patients who underwent their first cycle of IVF with PGS between 1/2014 and 3/2015 (n¼395). Responses are reported as percentage (%). RESULTS: 80 patients completed the survey; 7 respondents underwent PGD/PGS for single gene disorders and were excluded. The majority identified as Caucasian (77%) or Asian (19%). 26% had no insurance coverage and 18% had < 50% of expenses covered. The majority of patients identified with the following religions: Christianity (25%), Judaism (19%), Catholicism (15%) or none (16%). 86% were married. The majority were AMA (18% ages 35-37y, 32% ages 38-40, 15% ages 41-42 and 16% over age 42), but nearly 20% were <35y. The vast majority (64%) had not heard of PGS prior to their fertility consultation, 23% were referred from an outside physician, and 7% from a friend. A minority of patients pursued PGS for the indications of recurrent IVF failure (12% with > 2 prior IVF cycles) or RPL (26% had R 2 SAB). 64% of patients had not done a previous IVF cycle and 17% had been trying to conceive for under one year. 51% had zero prior miscarriages, 23% only 1 miscarriage and 33% already had 1 living child. The most common infertility diagnosis was unexplained infertility (36%). When asked the primary motivation for PGS, the most common response was ‘‘to maximize IVF efficiency and have a baby sooner’’ (36%). Only 26% cited their primary indication as previous miscarriage, 12% wanted to decrease the chance of miscarriage but had not yet had a miscarriage, 11% reported multiple failed attempts at IVF, and 14% chose PGS electively and were young, undergoing their first IVF cycle, and without prior miscarriage. 15% (n ¼ 11) reported ‘other,’ with reasons including family balancing and ‘to reduce the number of unknowns.’ 27% of patients agreed that they may be more likely to pursue pregnancy with donor eggs if unable to conceive from IVF with PGS. Overall, 94% of patients were happy they pursued PGS, regardless of their outcome, as the information they obtained was deemed valuable. CONCLUSIONS: Beyond the standard indications of advanced maternal age, recurrent IVF failure, and recurrent pregnancy loss, an increasing number of patients are using PGS as part of routine IVF to improve efficiency, reduce miscarriage and decrease the time to pregnancy. Understanding these motivations will help providers deliver appropriate support and counseling. ART: CLINICAL 3 O-217 Wednesday, October 19, 2016 11:15 AM EARLY SUBCHORIONIC BLEED (SCB) IN ASSISTED REPRODUCTIVE TECHNOLOGY (ART) PREGNANCIES DOES NOT INFLUENCE BIRTH WEIGHT. L. Nervi,a P. A. Bergh,b T. A. Molinaro.c a Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ; b RMA, Basking Ridge, NJ; cReproductive Medicine Associates of New Jersey, Eatontown, NJ. OBJECTIVE: Determine the impact of SCB in the first trimester on birth weight in ART pregnancies DESIGN: Retrospective cohort study MATERIALS AND METHODS: Records from 8,636 patients treated between January 2000 and April 2015 in a single IVF center were analyzed. All patients underwent in vitro fertilization (IVF) with blastocyst transfer, conceived, and were discharged at approximately 8 weeks of pregnancy. Pregnant patients who reported vaginal bleeding or who had a SCB visualized with transvaginal ultrasound were included as the study group with low birth weight as the primary outcome. Baseline demographics were

FERTILITY & STERILITYÒ

compared between groups using chi square and t-tests. Logistic regression was performed to control for confounders. This study was powered to detect a 3% difference between groups. RESULTS: 31.4% (2,715) of 8,636 patients had a SCB. The mean oocyte age for those with SCB was significantly lower than for those without SCB (33.1 vs 33.3, p¼0.02). The mean number of embryos replaced and number of fetuses was significantly higher for those with SCB. These differences were not clinically significant. In fresh cycles, those with SCB had a significantly higher peak estradiol and progesterone than those without SCB. Transfer type (fresh vs. frozen), preimplantation genetic screening (PGS), and high body mass index (BMI) (BMI > 30) were shown to have no significant effect on rates of SCB. SCB significantly increased the risk of having a child of low birth weight (LBW) (22.6% vs 19.7%, p<0.001). However, when analyzing only those pregnant with a singleton, SCB trended towards but did not have a significant impact on LBW (p¼0.06). SCB did not significantly increase the risk of LBW in pregnancies with multiple gestation (p¼0.9), but the incidence of SCB was higher in twin pregnancies (29.1% vs 34.8%, p<0.0001). Interestingly, patients who had fresh transfers had a significantly higher rate of delivering a child with LBW than those who had frozen transfers (26.0% vs 15.4%, p<0.001). There was no significant association between SCB and LBW after controlling for possible confounders with logistic regression. CONCLUSIONS: These data suggest that first trimester SCB in ART patients has little to no effect on the incidence of LBW. Twin pregnancies may be at a higher risk for SCB. While more studies are warranted, the results of this study may be used to reassure patients regarding the clinical significance of first-trimester SCB on pregnancy outcome after IVF.

O-218 Wednesday, October 19, 2016 11:30 AM CUMULATIVE LIVE BIRTH RATE AFTER FRESH ELECTIVE SINGLE BLASTOCYST TRANSFER AND SUBSEQUENT FROZEN SINGLE BLASTOCYST TRANSFER COMPARED TO INITIAL FRESH DOUBLE BLASTOCYSTS TRANSFER IN WOMEN AGED 40-43 YEARS. S. Tannus, A. Gilman, G. Younes, W. Son, T. Shavit, M. Dahan. McGill University, Montreal, QC, Canada. OBJECTIVE: To investigate whether fresh double blastocysts transfer (DBT) improve the live birth rate compared to fresh elective single blastocyst transfer (eSBT) and subsequent vitrified-warmed single blastocyst transfer (FBT) in women 40-43 years of age. DESIGN: Retrospective cohort study conducted at a single academic center. MATERIALS AND METHODS: Women aged R40 years, who underwent fresh eSBT where supernumerary blastocysts were available for cryopreservation and women who underwent fresh DBT between January 2011 and June 2015 were included in the study. Women with >3 previous in-vitro fertilization (IVF) cycles were excluded. Embryos were transferred on day 5. Remaining embryos of good quality (R3BB) were cryopreserved. According to our guidelines, up to 2 blastocysts can be transferred in this age group. The decision regarding the number of transferred blastocysts was made by the treating physician and couple. Outcomes of fresh and FBT cycles were analyzed. Chisquared tests and logistic regression controlling for confounders were used. RESULTS: 267 women were included, 146 underwent eSBT and 121 underwent DBT. Women with eSBT were significantly younger (40.740.8 vs. 41 0.8 years, p¼0.016) and had significantly fewer previous IVF cycles compared to women with DBT (0.50.8 vs. 11.02 cycles, p<0.001). eSBT and DBT had comparable: peak stimulated serum estradiol levels (7414 pmol/l vs. 7447 pmol/l, p¼0.26), number of metaphase II oocytes collected (9.74 vs. 9.64, p¼0.17). The live birth rate (20% vs. 26%, p¼0.20) was similar for eSBT and DBT respectively, although favoring the latter. After failed fresh eSBT, 82 women returned for a total of 91 FBT cycles. Average blastocyst quality for the eSBT, DBT and FBT did not differ. The live birth rate per cycle was (15% vs. 26%, p¼0.001) for eSBT plus FBT versus DBT respectively. However, the cumulative live birth rate did not differ between eSBT plus FBT as compared to fresh DBT (25% vs. 26%, p¼1.0) respectively. There were 6 twin deliveries after DBT and none from eSBT plus FBT (19% vs. 0%, p¼0.02) respectively. CONCLUSIONS: The practice of eSBT and subsequent vitrified-warmed blastocyst transfer in women aged 40-43 years reduces the per cycle live birth

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rate while minimizing the multiple birth rate and results in similar cumulative live birth rates, when compared to fresh DBT. Outcome implications should be discussed with patients and individualized. Given the added risk of multiple pregnancies in this age group, eSBT is preferential in women 40-43 years of age. O-219 Wednesday, October 19, 2016 11:45 AM METHOTREXATE TREATMENT OF ECTOPIC PREGNANCY DOES NOT IMPACT OVARIAN RESERVE OR CLINICAL OUTCOME, REGARDLESS OF THE DURATION OF TIME SINCE J. Rodriguez-Purata,a J. A. Lee,a EXPOSURE. L. Sekhon,a,b a a,b a M. C. Whitehouse, A. B. Copperman. Reproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology & Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. OBJECTIVE: Methotrexate (MTX) is a minimally invasive treatment for ectopic pregnancy. As it targets rapidly dividing cells, there is concern it may affect proliferating germinal cells in the ovary, ovarian reserve. Most centers recommend patients wait 2-3 months before attempting subsequent fertility treatment, It is not known whether recent MTX exposure increases the incidence of meiotic error within oocytes, contributing to embryonic aneuploidy. We sought to investigate the effect of MTX treatment and the interval of time from its administration to subsequent fertility treatment on ovarian reserve and IVF outcome. DESIGN: Retrospective cohort study, case control study MATERIALS AND METHODS: All patients who received MTX in a prior cycle and underwent subsequent IVF  ET from 2003-2016 were included. The interval of time from administration to the start of their subsequent cycle was calculated. Paired t-test compared ovarian reserve markers (day 3 FSH) and cycle parameters pre- and post-MTX. Linear and binary logistic regression were performed to identify if interval since MTX modified implantation and early pregnancy loss. RESULTS: A total of 491 patients received MTX and underwent subsequent COH (n¼339) with fresh ET (n¼279) or frozen-thawed (FET) (n¼198). The interval from MTX to subsequent cycle start, cycle characteristics and clinical outcome of COH and ET cycles are shown (Table). After controlling for the increase in patient age, FSH, egg yield and fertilization, total gonadotropin dose required and blastocyst count were similar among pre- and post-MTX COH cycles. Intercycle variation in these parameters was not correlated with the MTX time interval. PGS was performed in 51 subsequent COH cycles with a 49.2% aneuploidy rate. Controlling for oocyte age and MTX dose, aneuploidy was not correlated with MTX interval. Odds of failed implantation (OR 1.0 [95% CI 1.0-1.001], p¼0.3) and pregnancy loss (OR 1.0 [95% CI 0.9-1.0], p¼0.8) were not influenced by MTX interval. CONCLUSIONS: In agreement with the existing literature, these results suggest ovarian reserve and IVF outcomes are not compromised by MTX treatment of ectopic pregnancy. The interval of time from MTX did not impact cycle outcome or the incidence of aneuploidy. To date, this is the only study to assess embryonic aneuploidy following MTX exposure. Though the results are reassuring regarding MTX safety, large-scale, multicenter studies are required to confirm these findings.

O-220 Wednesday, October 19, 2016 12:00 PM IMPACT OF THE OXYTOCIN RECEPTOR ANTAGONIST (ATOSIBAN) ADMINISTERED SHORTLY BEFORE EMBRYO TRANSFER ON PREGNANCY OUTCOME AFTER INTRACYTOPLASMIC SPERM INJECTION (ICSI). S. A. Hebisha,a B. A. Aboelazm,a H. M. Adel,a A. I. Ahmed.b aGynecology, Alexandria University - Faculty of Medicine, Alexandria, Egypt; bObstetric and Gynecology, MFM Division, Department of Medical Genetics, Wayne State University, Detroit, MI. OBJECTIVE: To evaluate the impact of the oxytocin receptor antagonist (Atosiban) administered shortly before embryo transfer on implantation and pregnancy rates in patients undergoing intracytoplasmic sperm injection (ICSI) using long agonist protocol. DESIGN: Randomised controlled trial. MATERIALS AND METHODS: one hundred and eighty two women, prepared for intracytoplasmic sperm injection for male or tubal factor infertility, using long agonist protocol were divided randomly into two groups; Group A (n¼91) who received 7.5 mg Atosiban by slow IV injection and Group B (n¼91) who received placebo as sodium chloride 0.9% solution also by IV injection 20 minutes before embryo transfer (blastocyst stage ET). Pregnancy and implantation rates were compared among the two study groups. RESULTS: Pregnancy rate was significantly higher in group A (atosiban group) (58/91) compared to group B (44/91) ;( 63.7% vs 48.4% respectively, p¼0.037*). Also, implantation rate was significantly higher in group A (atosiban group) compared to group B ;( 45.20%, vs 34.69% respectively, P¼ (0.045*). All of the intermediate cycle parameters were also comparable. CONCLUSIONS: Atosiban in the given dose and regimen improved both implantation and ongoing pregnancy rates in patients undergoing ICSI using blastocyst stage embryo transfer. References: 1. Mansour R, Tawab N, Kamal O, El-Faissal Y, Serour A, Aboulghar M, Serour G. Intrauterine injection of human chorionic gonadotropin before embryo transfer significantly improves the implantation and pregnancy rates in in vitro fertilization/intracytoplasmic sperm injection: a prospective randomized study. Fertil Steril. 2011; 96(6):13701374.e1. 2. Hong KH, Forman EJ, Werner MD, Upham KM, Gumeny CL, Winslow AD, Kim TJ, Scott RT Jr. Endometrial infusion of human chorionic gonadotropin at the time of blastocyst embryo transfer does not impact clinical outcomes: a randomized, double-blind, placebocontrolled trial. Fertil Steril. 2014; 102(6):1591-1595.e2. 3. Goto S, Kadowaki T, Hashimoto H, Kokeguchi S, Shiotani M. Stimulation of endometrium embryo transfer (SEET): injection of embryo culture supernatant into the uterine cavity before blastocyst transfer can improve implantation and pregnancy rates. Fertil Steril. 2007; 88(5):1339-43. 4. Parikh FR, Nadkarni SG, Naik NJ, Naik DJ, Uttamchandani SA. Cumulus coculture and cumulus-aided embryo transfer increases pregnancy rates in patients undergoing in vitro fertilization. Fertil Steril. 2006; 86(4):839-47. 5. Barad DH, Yu Y, Kushnir VA, Shohat-Tal A, Lazzaroni E, Lee HJ, Gleicher N. A randomized clinical trial of endometrial perfusion with granulocyte colony-stimulating factor in in vitro fertilization cycles: impact on endometrial thickness and clinical pregnancy rates. Fertil Steril. 2014; 101(3):710-5.

Post-methotrexate ovarian stimulation and embryo transfer: demographics & cycle characteristics

Controlled ovarian stimulation (n¼339) Interval since MTX (days) Cumulative MTX dose Patient age Day 3 FSH Endometrial thickness at transfer (mm) Cumulative gonadotropin dose Oocytes retrieved Mean number of blastocysts Aneuploidy rate Implantation rate Early pregnancy loss rate

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ASRM Abstracts

359.5 +/- 378.4 (range: 64-2251) 108.1 +/- 40.3 36.9 +/- 4.5 6.4 +/- 3.9 N/A 3808.4 +/- 1448.3 12.7 +/- 7.5 (n¼4292) 2.7 +/- 3.7 (n¼927) 49.2% (n¼91/185) N/A N/A

Fresh ET (n¼279) 341.1 +/- 381.4 (range: 64-2251) 107.4 +/- 40.3 36.7 +/- 4.6 6.4 +/- 4.1 9.6 +/- 2.3 N/A N/A N/A N/A 45.8% (128/279) 25.4% (71/279)

FET (n¼152) 422.4 +/- 483.5 (range: 32-2585) 104.2 +/- 35.4 34.4 +/- 4.2 6.9 +/- 3.5 9.3 +/- 2.3 N/A N/A N/A N/A 31.7% (184/262) 18.4% (28/152)

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