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Does the degree and speed of blastocoele re-expansion after cryopreservation and warming correlate with pregnancy rates: a retrospective cohort study
Ulsan, Republic of Korea; bEllemedi OB&GY, Changwon, Republic of Korea; c Inje University, Haeundae Paik Hospital, Busan, Republic of Korea. OBJECTIVE: Recently, with the advances of the embryo cryopreservation techniques, some studies showed that the use of frozen-thawed embryo transfer (FET) significantly improved in vitro fertilization (IVF) outcomes compared with fresh embryo transfer (ET). However, some clinicians still prefer fresh ET to FET due to experience of better outcomes with fresh ET. The purpose of this study is to compare IVF outcomes between fresh ET and FET after cryopreservation of all embryos in high responders. DESIGN: Retrospective study. MATERIALS AND METHODS: We retrospectively reviewed 717 patients experiencing high response (oocytesR20) with low starting dose of rFSH (150 IU or less) in controlled ovarian hyperstimulation (COH) IVF cycles from January 2006 to December 2012. Three groups of patients were formed. Group I: fresh ET with 20%oocytes<30, Group II : fresh ET with oocytesR30, Group III : FET with oocytesR20. RESULTS: In each group, age, number of transferred embryos, percentage of top quality embryo reflected no differences. Group I (fresh-high responder) had significantly higher ongoing pregnancy rate (PR) than Group III (all cryo-FET) [51.8%(244/471) vs. 39.9%(61/153), P¼0.007]. Group II (fresh-very high responder) had similar ongoing PR with Group III (all cryoFET) [43.0%(40/93) vs. 39.9%(61/153), P¼0.49]. Group I (fresh-high responder) had significantly higher ongoing PR than Group II (fresh-very high responder) [51.8%(244/471) vs. 43.0%(40/93), P¼0.03]. CONCLUSION: In this study, ongoing pregnancy rate of fresh ET in high responders (20%oocytes<30) was better than that of FET after cryopreservation of all embryos. However, pregnancy rate of fresh ET in very high responders (oocytesR30) was similar with FET after cryopreservation of all embryos, but decreased as compared with high responders. In conclusion, in case of very high responders, fresh ET has no benefit on PR, but only has high risk of OHSS. Therefore, clinicians must consider FET after cryopreservation of all embryos in very high responders. P-1261 Thursday, October 17, 2013 DOES THE DEGREE AND SPEED OF BLASTOCOELE RE-EXPANSION AFTER CRYOPRESERVATION AND WARMING CORRELATE WITH PREGNANCY RATES: A RETROSPECTIVE COHORT STUDY. A. J. Marren,a,b Y. Y. Tan,a,b B. S. de Vries,c M. Livingstone,a,b M. Bowman.a,b aReproductive Endocrinology and Infertility, Royal Prince Alfred Hospital for Women and Babies, Sydney, NSW, Australia; bGenea Fertility, Sydney, NSW, Australia; cObstetrics and Gynaecology, Royal Prince Alfred Hospital for Women and Babies, Sydney, NSW, Australia. OBJECTIVE: To determine whether the degree and speed of blastocoele re-expansion following cryopreservation and warming correlates with pregnancy rates and if the absence of blastocoele re-expansion is a marker of a non-viable embryo. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Setting: Hospital-affiliated assisted fertility unit. Patients: All patients who had undergone a frozen embryo transfer cycle with a single blastocyst at Royal Prince Alfred Hospital, Sydney Australia between 1 January 2007 and 31 December 2011 were considered eligible (n ¼ 973). Of these, 216 cycles were excluded. This resulted in 757 frozen embryo transfer cycles suitable for analysis. Clinical and embryology notes were retrieved. Details regarding patient demographics, stimulation cycle from which embryos were derived, frozen embryo transfer cycles, embryology, and pregnancy outcomes were recorded. Main outcome measures: The presence of a fetal heart beat at the 6 – 7 week dating ultrasound and live birth. RESULTS: Female age was the only clinical factor that had a significant inverse association with pregnancy outcome (p ¼ 0.03). Fertilisation method (p ¼ 0.02), embryo type at cryopreservation (p ¼ 0.005), embryo grade at cryopreservation (p < 0.0001), percentage of cell survival post thaw (p < 0.0001), and the degree of re-expansion (p ¼ 0.003) were the IVF and embryology factors significantly associated with pregnancy outcome. All of the above factors, apart from embryo type at cryopreservation, were included in the final logistic regression model after non-confounders were removed. A predictive model was created in order to individualise the probability that the transfer of a given embryo would result in clinical pregnancy. CONCLUSION: The degree and speed of blastocoele re-expansion post cryopreservation and subsequent warming can be used in conjunction with other parameters (female age, fertilisation method, embryology at freezing (type and grade), and percentage of cell survival post thaw) to predict pregnancy outcome.
FERTILITY & STERILITYÒ
P-1262 Thursday, October 17, 2013 EFFICACY OF ALL EMBRYO FREEZING IN PATIENTS WITH HIGH ESTRADIOL (E2) LEVEL ON THE DAY OF HCG ADMINISTRATION. T. H. Kim, W. Y. Choi, J. H. Cho, Y. S. Kim, H. H. Seok, T. K. Yoon. Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea. OBJECTIVE: High responders were defined as patients who had an E2 level of 3,000 pg/mL. Some studies of IVF-ET cycles have also suggested that high E2 levels negatively influence pregnancy outcome when using COH and this may be due to endometrial receptivity for implantation. The older women seem to be more vulnerable to the deleterious effect of high E2 levels. Therefore, the objective of this study was to evaluate the effect of E2 levels on the pregnancy outcome of IVF-ET and also compare the effect of all embryo freezing in patients with high E2 level. DESIGN: Retrospective analysis of pregnancy outcome. MATERIALS AND METHODS: This study included a total of 3261 IVFET cycles that were performed in Fertility Center of CHA Gangnam Medical Center between January 1, 2011, and December 31, 2012. First, patients were divided into 5 categories according to the level of E2. Second, patients were divided into 3 groups according to the clinical outcome of E2 level categories, more than 4,000 of E2 level; Group 1: IVF-ET cycle without embryo freezing, Group 2: IVF-ET plus cryopreserved ET cycle after failure of pregnancy from IVF-ET cycle, Group 3: Transfer cycle using all embryo cryopreservation. Cryopreserved embryo transfer was conducted in patients with pregnancy failure or cancellation in their previous cycle. RESULTS: Pregnancy rates (PR) of IVF-ETof more than 4,000 and less than 5000 pg/mL of E2 levels were lower than those in E2 level of less than 4,000 pg/ mL (44.5%(1134/505), 48.0%(445/927), 45.6%(458/209) vs. 36.1%(112/310), p<0.05). Cumulative PR of Group 2 and Group 3 in E2 level of more than 4,000 pg/mL showed higher rate compare to Group 1 (p<0.05). There was a numerical difference in Group 2 and Group 3, however, there was no significant difference between two groups (61.7% (258/418) and 55.4% (36/65)). CONCLUSION: As in the result, more than 4,000 pg/mL of E2 levels negatively affects the outcome in IVF-ET cycle. Also, all embryo freezing would be an effective treatment as it may reduce inconvenient procedure.
P-1263 Thursday, October 17, 2013 COMPARISON OF CLINICAL PREGNANCY RATES WITH SINGLE BLASTOCYST TRANSFER WHEN USING FROZEN DAY 5 OR DAY 6 EMBRYOS. C. Hibray, M. Britt, G. D. Ball, L. Davis, R. Halverson. Seattle Reproductive Medicine, Seattle, WA. OBJECTIVE: To determine if there is a significant difference in clinical pregnancy rates with frozen embryo transfer (FET) cycles when transferring a single blastocyst frozen on day 5 versus day 6. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Between December 22, 2011 and December 21, 2012, clinical pregnancy rates were evaluated for 156 FET cycles which included autologous and donor gametes. Selected FET cycles had one frozen embryo transferred from an embryo previously frozen on day 5 or day 6. The average age for the autologous embryos frozen on day 5 was 34.6 years and day 6 was 34.5 years. The morphology of the blastocysts in the study were either fair or good quality expanded or hatching blastocysts at the time of cryopreservation based on the SART embryo grading system. The cryopreservation methods used included slow freezing and vitrification using various commercially prepared media. The determination of positive clinical pregnancy was based on the presence of intrauterine gestational sac and fetal heartbeat on ultrasound. RESULTS: Day 5 FET cycles (n¼59) had a clinical pregnancy rate of 39%. Day 6 FET cycles (n¼97) had a clinical pregnancy rate of 23% (p¼0.044). CONCLUSION: Transfer of a single frozen day 5 blastocyst resulted in a significantly higher clinical pregnancy rate compared with the transfer of a frozen day 6 blastocyst. Consideration should be made when determining how many frozen blastocysts to recommend for transfer based on the day of freeze.
P-1264 Thursday, October 17, 2013 ACHIEVING PREGNANCY IN THE PREVIOUS FRESH EMBRYO TRANSFER CYCLE IS THE MOST IMPORTANT VARIABLE
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FERTILITY & STERILITYÒ
P-1262 Thursday, October 17, 2013 EFFICACY OF ALL EMBRYO FREEZING IN PATIENTS WITH HIGH ESTRADIOL (E2) LEVEL ON THE DAY OF HCG ADMINISTRATION. T. H. Kim, W. Y. Choi, J. H. Cho, Y. S. Kim, H. H. Seok, T. K. Yoon. Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea. OBJECTIVE: High responders were defined as patients who had an E2 level of 3,000 pg/mL. Some studies of IVF-ET cycles have also suggested that high E2 levels negatively influence pregnancy outcome when using COH and this may be due to endometrial receptivity for implantation. The older women seem to be more vulnerable to the deleterious effect of high E2 levels. Therefore, the objective of this study was to evaluate the effect of E2 levels on the pregnancy outcome of IVF-ET and also compare the effect of all embryo freezing in patients with high E2 level. DESIGN: Retrospective analysis of pregnancy outcome. MATERIALS AND METHODS: This study included a total of 3261 IVFET cycles that were performed in Fertility Center of CHA Gangnam Medical Center between January 1, 2011, and December 31, 2012. First, patients were divided into 5 categories according to the level of E2. Second, patients were divided into 3 groups according to the clinical outcome of E2 level categories, more than 4,000 of E2 level; Group 1: IVF-ET cycle without embryo freezing, Group 2: IVF-ET plus cryopreserved ET cycle after failure of pregnancy from IVF-ET cycle, Group 3: Transfer cycle using all embryo cryopreservation. Cryopreserved embryo transfer was conducted in patients with pregnancy failure or cancellation in their previous cycle. RESULTS: Pregnancy rates (PR) of IVF-ETof more than 4,000 and less than 5000 pg/mL of E2 levels were lower than those in E2 level of less than 4,000 pg/ mL (44.5%(1134/505), 48.0%(445/927), 45.6%(458/209) vs. 36.1%(112/310), p<0.05). Cumulative PR of Group 2 and Group 3 in E2 level of more than 4,000 pg/mL showed higher rate compare to Group 1 (p<0.05). There was a numerical difference in Group 2 and Group 3, however, there was no significant difference between two groups (61.7% (258/418) and 55.4% (36/65)). CONCLUSION: As in the result, more than 4,000 pg/mL of E2 levels negatively affects the outcome in IVF-ET cycle. Also, all embryo freezing would be an effective treatment as it may reduce inconvenient procedure.
P-1263 Thursday, October 17, 2013 COMPARISON OF CLINICAL PREGNANCY RATES WITH SINGLE BLASTOCYST TRANSFER WHEN USING FROZEN DAY 5 OR DAY 6 EMBRYOS. C. Hibray, M. Britt, G. D. Ball, L. Davis, R. Halverson. Seattle Reproductive Medicine, Seattle, WA. OBJECTIVE: To determine if there is a significant difference in clinical pregnancy rates with frozen embryo transfer (FET) cycles when transferring a single blastocyst frozen on day 5 versus day 6. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Between December 22, 2011 and December 21, 2012, clinical pregnancy rates were evaluated for 156 FET cycles which included autologous and donor gametes. Selected FET cycles had one frozen embryo transferred from an embryo previously frozen on day 5 or day 6. The average age for the autologous embryos frozen on day 5 was 34.6 years and day 6 was 34.5 years. The morphology of the blastocysts in the study were either fair or good quality expanded or hatching blastocysts at the time of cryopreservation based on the SART embryo grading system. The cryopreservation methods used included slow freezing and vitrification using various commercially prepared media. The determination of positive clinical pregnancy was based on the presence of intrauterine gestational sac and fetal heartbeat on ultrasound. RESULTS: Day 5 FET cycles (n¼59) had a clinical pregnancy rate of 39%. Day 6 FET cycles (n¼97) had a clinical pregnancy rate of 23% (p¼0.044). CONCLUSION: Transfer of a single frozen day 5 blastocyst resulted in a significantly higher clinical pregnancy rate compared with the transfer of a frozen day 6 blastocyst. Consideration should be made when determining how many frozen blastocysts to recommend for transfer based on the day of freeze.
P-1264 Thursday, October 17, 2013 ACHIEVING PREGNANCY IN THE PREVIOUS FRESH EMBRYO TRANSFER CYCLE IS THE MOST IMPORTANT VARIABLE
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