Decision making by patients seeking care for fertility problems

clinical parameters as well as the deletion ratio were used to confirm the findings. RESULTS: 68.8% of oocytes matured to M1 and 51% reached M2. Mean deletion ratios in GV, M1, and M2 oocytes were 28%, 31.5% and 19.8% respectively. Oocytes arrested at M1 had higher deletion ratios than those which progressed to M2 (31.5% M1 v 19.8% M2; p-value < 0.0003). Logistic regression models incorporated the following parameters- day 2/3 fsh, day2/3 E2, total gonadotropins, number of oocytes retrieved, %GV, %M1, %M2, % atretic, total copy number, total ND4, and deletion ratio. Number of oocytes retrieved was negatively correlated with maturation in vitro as was the deletion ratio. These factors had a synergistic effect in the model. MtDNA copy number did not differ significantly different among GV, M1 and M2 stage oocytes. CONCLUSIONS: The mtDNA deletion ratio has been described in other long lived, post mitotic tissues, e.g. cardiac, as a marker for aging. This is the first report of an association between the mitochondrial deletion ratio and maturation in vitro of human oocytes. Oocytes with impaired meiotic maturation contain an increased load of mutated mtDNA. Future studies should establish whether mitochondrial deletion ratio, like mtDNA copy number, may predict competence at other stages of development.

LOW LEVEL MOSAICISM: INCIDENCE AND IMPLICATIONS ON CLINICAL PREGNANCIES. D. A. Kelk,a J. Lo,a J. Martin,b M. Hughes.c aYale Fertility Center, Yale University, Ob/Gyn, New Haven, CT; bOB/GYN Dept, Yale University, REI Section, Yale REI, New Haven, CT; cMolecular Genetics, Genesis Genetics, Plymouth, MI. OBJECTIVE: Preimplantation genetic screening (PGS) has been shown to decrease miscarriage rates and improve live birth outcomes particularly for older women where rates of aneuploidy are highest (1). As methods for PGS testing have evolved, so has awareness of embryonic mosaicism, the presence of two or more chromosomally distinct cell lines. The clinical significance of mosaicism is not well understood but mosaic embryos have resulted in healthy live births (2). However some mosaic embryos may be diagnosed as aneuploid and potentially be discarded despite an unclear potential for healthy live birth. This study examines the rate of low level mosaicism in blastocysts that were classified as euploid and the relative pregnancy rates compared with blastocysts in which no mosaicism was detected. DESIGN: Blinded prospective observational study. MATERIALS AND METHODS: A total of 155 blastocysts were biopsied and cryopreserved for 22 patients, (avg age ¼ 35.1) undergoing routine PGS with NGS (GeniSeq24 Aneuploidy Screening). PGS results were classified as either euploid (51%) or aneuploid (49%). Blastocysts for subsequent frozen embryo transfer cycles were selected based on best morphology available of those diagnosed as euploid. After confirmation of clinical pregnancy rate for all patients, the percent mosaicism for each embryo transferred was provided by the genetic testing laboratory. RESULTS: A total of 36 embryos classified as euploid were transferred to 22 patients over 26 FET cycles. Ongoing clinical pregnancies were documented in 73% of patients. Of the 36 embryos transferred, Implantation of Euploid Embryos With and Without Mosaicism Observed

Number of Embryos Implanted

Number of Embryos Not Implanted

Implantation Rate

14

8

64%

6

6

50%

20

14

59%

36% exhibited levels of mosaicism ranging from 15-45%. Due to a double embryo transfer of 1 mosaic and 1 non-mosaic embryo, implan-

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ASRM Abstracts

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No Mosaicism Observed Mosaicism Detected All Embryos

tation rates could be confirmed for 34 of the embryos transferred. Mosaic embryos had a 50% implantation rate compared to 64% for those with no mosaicism observed. This difference was not statistically significant. CONCLUSIONS: Embryos with low level mosaicism exhibited respectable implantation (50%) and clinical pregnancy (54%) rates. Although these implantation and pregnancy rates are lower than those for embryos with no mosaicism (64% and 65% respectively), the difference was not statistically significant. Dividing the euploid embryos into two groups (with and without mosaicism observed) could potentially allow for enhanced selection of embryos with the greatest reproductive potential. Further studies in this area will certainly elucidate better understanding of the clinical significance of embryo mosaicism. Reference: 1. Scott, et al., Fertil. Steril. (2013) 100:697-703(2) Greco, et al., N Engl J Med (2015) 373:2089-2090.

DECISION MAKING BY PATIENTS SEEKING CARE FOR E. A. Duthie,b FERTILITY PROBLEMS. A. Cooper,a K. D. Schoyer,b J. B. Davis,c J. Sandlow,b E. Y. Strawn,b K. E. Flynn.b a Duke University, Durham, NC; bMedical College of Wisconsin, Milwaukee, WI; cMichigan State University, Grand Rapids, MI. OBJECTIVE: To describe how couples navigate infertility treatment decisions, including how they deliberate and reach consensus on plans for family building, how they adapt their plans as treatment progresses, and how they view past decisions. DESIGN: Longitudinal, mixed-methods study on infertility decisionmaking among couples making an initial appointment with a reproductive specialist (RS) at an academic medical center in a Midwestern state without a health insurance mandate. We used interview and survey data to construct the treatment paths couples pursued considering financial and emotional resources and decision-making approaches. MATERIALS AND METHODS: Each member of 37 couples separately completed surveys and interviews up to 6 times during the year after making a first appointment; clinical data were abstracted from medical records. Data were managed/analyzed in REDCap, NVivo, and Stata. Written transcripts were systematically coded via standard procedures for content analysis (>10% double coded). RESULTS: Through analysis of 414 interviews, we found that before an initial consultation with a RS most patients and their partners viewed gaining information as a key goal in meeting with a RS. Financial resources played an important role in shaping couples’ decision-making processes, and many respondents identified finances as an important constraint. Before their first appointment, 55% of respondents identified costs associated with trying to have a child as ‘‘quite a bit’’ or ‘‘very much’’ important to their decision-making, and that percentage increased to 64% after couples met with a RS. Couples able to purchase the care they desired generally moved relatively quickly both to consensus and to acting on their preferences. In contrast, couples whose finances were more constrained often delayed pursuing treatment that they otherwise agreed they would choose or worked together to identify a second-choice alternative that was financially feasible. Even as couples moved forward with one treatment path they often had a 2nd-choice alternative already in mind, as many were aware of the uncertainty associated with any given course of treatment. Finally, when looking back over the year, many supporting partners expressed regret at not being more involved along the way. CONCLUSIONS: Understanding how couples reach consensus concerning plans for reproductive treatment holds promise to improve quality of care and increase long-term decisional satisfaction for patients and their partners. When couples first meet with a RS, most have not already made any decisions and are seeking information and advice. A key factor shaping couples’ abilities to reach agreement and proceed with treatment is their financial resources. Those who cannot afford their ‘‘first choice’’ often need the opportunity to ruminate and may appreciate input from the RS on next-best alternatives.

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