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Effect of Cervical Mucus Quantity at Time of Embryo Catheter Transfer on IVF Pregnancy Outcomes
embryo results of 38.7 years. The most common aneuploidies were for chromosomes 16 (n¼204), 22 (157), X (125), 15 (119), 21 (107), and 19 (91). CONCLUSION(S): Large studies using FISH (Munne et al. 2007) considered complex abnormalities akin to chaotic mosaics. However, by analyzing all chromosomes with aCGH, many embryos classified by aCGH as complex abnormal must be true aneuploid, as seen by their increased maternal age. The percentage of abnormal embryos does increase significantly with maternal age, as does the percentage of double aneuploids and complex abnormals. The excess of monosomies observed is not an artifact, as described in a separate abstract by Colls et al. SUPPORT: Departmental funds
P-37 Impact of Zona Opening on Day 3 Preimplantation Embryos on Clinical Pregnancy Rates in a Private Clinic Devoted to Assisted Reproductive Technology. D. Hill, C. Briton-Jones, M. Surrey, H. Danzer. ART Reproductive Center, Beverly Hills, CA. INTRODUCTION: A case cohort study comparing clinical pregnancy rates (CPR) following zona opening (ZO) by acidified Tyrodes media (ZOa) or by Class I non-contact infared laser (ZO-l) were compared not only to each other, but to patients having no form of ZO for the purpose of assisted hatching (AH), as well as those that had ZO performed by necessity for embryo biopsy /FISH- preimplantation genetic screening (ZO-l-PGS). The time period of this study corresponded to the transitional period from acidified Tyrodes media to laser as a means of zona opening in our laboratory. METHOD(S): Clinical pregnancy rate (CPR) outcomes from 1161 unselected, sequential patients undergoing in vitro fertilization-embryo transfer (IVF-ET, June 1, 2007 through June 1, 2008. AH-a was performed by eight different operators on the embryos from 150 patients, ZO-l performed by two operators on embryos from 131 patients, and ZO-l-PGS performed by seven different laser operators on the embryos of 317 patients. ZO-a and ZO-l procedures were performed on patients who were A) prior failed IVF-ET, B) >38 years old, C) grade C embryos (>30% fragmentation), or D) thickened zonae. The mean age of the ‘‘zonaopened’’ versus ‘‘non-opened’’ groups (neither including egg donor cycles) was 39.4 and 36.7 years, respectively. RESULT(S): Intervention CPR-Non- Egg Donor Cycles CPR - Donor Only ZO-a 45/150(30) ZO-l 37/131(28) ZO-l-PGS -12 chrom 47/163(29) 10/14(71) 9 chrom 17/59(29) ——— 5 chrom 34/75(45) 6/12(50) No ZO or PGS 216/477(45) 56/80(70) Using Fischer’s Exact, two-tailed test for significance, the various outcomes of the groups were compared. The pregnancy rate in zona opened, non-donor cycles was the same whether the method was ZO-a or ZO-l. Comparing rates between ZO/no donor to combined PGS/no donor cycles was also not significant. Comparing rates between ‘‘No ZO or PGS’’ to ZO +PGS was extremely statistically significant (P<0.0001). Comparing rates between PGS-donor cycles to donor cycles with no form of ZO was not significant. CONCLUSION(S): Because there was no significant difference in pregnancy rates between ZO and ‘‘no ZO’’ in egg donor cycles, neither ZO or embryo biopsy on day 3 embryos has a negative effect on pregnancy
P-38 Effect of Cervical Mucus Quantity at Time of Embryo Catheter Transfer on IVF Pregnancy Outcomes. M. Amols,a P. Hughes,a R. Gada,a D. Morbeck,a C. Coddington.a a Division of Reproductive Endocrinology and Infertility, Rochester, MN. BACKGROUND: PRemoval of cervical mucus at the time of embryo transfer has been associated with increased pregnancy rates. Previous reports focus on presence or absence of mucus. It is unknown if this association is due to plugging of the catheter, adherence of the embryos to the catheter or a marker of potential pathogens in the cervix. OBJECTIVE(S): To determine the relationship between amount of cervical mucus on the transfer catheter and embryo transfer outcomes. MATERIALS AND METHOD(S): A retrospective analysis was performed for all IVF embryo transfers conducted between January 2000 and December 2009. Included subjects were less than thirty five years of age and had cervical mucus documented at time of embryo transfer. Cervical mucus was documented by the embryologist at time of transfer as none, minimal, or significant. 2779 total embryo transfers occurred during the study period: 214 transfers had cervical mucus, of which 148 had minimal mucus
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and 66 had significant mucus. The two groups (minimal/significant) were compared and analyzed using JMP 8.0. Chi Square and Odds Ratios were performed. RESULT(S): 47 percent of subjects with significant mucus became pregnant compared to 61.5 percent of subjects with minimal mucus. Comparison of pregnancy rates between significant mucus versus minimal mucus yielded a Chi Square of 0.048 and Odds ratio of 1.82 (1.003 – 3.238). CONCLUSION(S): The quantity of cervical mucus documented at time of embryo transfer significantly affected pregnancy rate (P < 0.048). Patients were 1.8 times more likely to become pregnant when minimal cervical mucus was present at the time of embryo transfer versus significant. This difference found in pregnancy rates between significant cervical mucus and minimal cervical mucus demonstrates the importance of removing cervical mucus at the time of embryo transfer. Future studies addressing cervical mucus effect on IVF outcomes should focus on quantity in addition to the presence or absence of cervical mucus. SUPPORT: None
P-39 Incidence of Moderate to Severe Depression in Recurrent Pregnancy Loss Patients. Penny Donnely, Brooke Friedmanellie, Ruth B Lathi,. Department of Obstetrics and Gynecology, Stanford Fertility and Reproductive Medicine Center, Palo Alto, CA. OBJECTIVE(S): Recurrent pregnancy loss (RPL) affects 1-5% of reproductive age women. For many couples, the experience can lead to prolonged grief and the feeling of loss of control. Although rarely reported in the literature, the incidence of depression in women with RPL is likely to be greater than unaffected women. The objective of our current study is to determine the incidence and severity of depression in a multispecialty RPL program using the validated Beck’s Depression Inventory Questionnaire. DESIGN: Case series MATERIALS/METHOD(S): In a recurrent pregnancy loss program, a nurse and licensed marriage and family therapist screened 21 consecutive patients with recurrent pregnancy loss upon their intake to the program. Patients were defined as having recurrent pregnancy loss if they had experienced two or more spontaneous miscarriages prior to 20 weeks gestation. Each patient was administered the Beck’s Depression Inventory(BDI), which was immediately reviewed by the therapist and significant findings were immediately followed up. Our primary outcome was screening positive for depression, which is represented on the questionnaire as a score of 14 or greater. RESULT(S): The mean age was 35.8. Approximately 1/3 of patients had a previous live birth. The mean number of previous losses was 3.7, with 52.4% of patients experiencing 4 or more losses. Out of 21 patients screened, seven (33.3%) screened positive for depression with a BDI score R14, ranging from mild to severe. Four (19.0%) screened positive for moderate to severe depression, with a BDI score of R20. Of note, the survey results demonstrated that 10 of the 21 patients (47%) considered themselves as ‘‘having failed more than I should have’’ and 4 of 21 (19%) patients had experienced thoughts of killing themselves. In addition, 9 of the 21 patients (42%) sited a decrease in their interest in sex with two persons indicating much less interest in sex and two indicating a complete loss of interest. CONCLUSION(S): Depression, and specifically moderate to severe depression, is prevalent in the recurrent pregnancy loss population. The results of this pilot study show the feasibility of screening women with RPL and the importance of collaboration with mental health providers in a multispecialty approach to patients suffering from RPL.
P-40 First Attempt at Complete Sequencing of Blastocyst Biopsies for Use in PGD. B. A. Peters, R. Drmanac, P. Colls, G. Harton, A. Berkeley, S. Munne, BACKGROUND: Current techniques that analyze all chromosomal abnormalities in blastocyst biopsies still can only achieve an implantation success rate of approximately 80%. It is possible that this is in part due to array CGH, CGH, SNP arrays, and qPCR not being sensitive enough to detect potential abnormalities associated with implantation failure. The higher resolution of whole genome sequencing could help improve the implantation success rate, as well as provide much more detailed analysis of potential genetic abnormalities.
Vol. 95, No. 4, Supplement, March 15, 2011
P-37 Impact of Zona Opening on Day 3 Preimplantation Embryos on Clinical Pregnancy Rates in a Private Clinic Devoted to Assisted Reproductive Technology. D. Hill, C. Briton-Jones, M. Surrey, H. Danzer. ART Reproductive Center, Beverly Hills, CA. INTRODUCTION: A case cohort study comparing clinical pregnancy rates (CPR) following zona opening (ZO) by acidified Tyrodes media (ZOa) or by Class I non-contact infared laser (ZO-l) were compared not only to each other, but to patients having no form of ZO for the purpose of assisted hatching (AH), as well as those that had ZO performed by necessity for embryo biopsy /FISH- preimplantation genetic screening (ZO-l-PGS). The time period of this study corresponded to the transitional period from acidified Tyrodes media to laser as a means of zona opening in our laboratory. METHOD(S): Clinical pregnancy rate (CPR) outcomes from 1161 unselected, sequential patients undergoing in vitro fertilization-embryo transfer (IVF-ET, June 1, 2007 through June 1, 2008. AH-a was performed by eight different operators on the embryos from 150 patients, ZO-l performed by two operators on embryos from 131 patients, and ZO-l-PGS performed by seven different laser operators on the embryos of 317 patients. ZO-a and ZO-l procedures were performed on patients who were A) prior failed IVF-ET, B) >38 years old, C) grade C embryos (>30% fragmentation), or D) thickened zonae. The mean age of the ‘‘zonaopened’’ versus ‘‘non-opened’’ groups (neither including egg donor cycles) was 39.4 and 36.7 years, respectively. RESULT(S): Intervention CPR-Non- Egg Donor Cycles CPR - Donor Only ZO-a 45/150(30) ZO-l 37/131(28) ZO-l-PGS -12 chrom 47/163(29) 10/14(71) 9 chrom 17/59(29) ——— 5 chrom 34/75(45) 6/12(50) No ZO or PGS 216/477(45) 56/80(70) Using Fischer’s Exact, two-tailed test for significance, the various outcomes of the groups were compared. The pregnancy rate in zona opened, non-donor cycles was the same whether the method was ZO-a or ZO-l. Comparing rates between ZO/no donor to combined PGS/no donor cycles was also not significant. Comparing rates between ‘‘No ZO or PGS’’ to ZO +PGS was extremely statistically significant (P<0.0001). Comparing rates between PGS-donor cycles to donor cycles with no form of ZO was not significant. CONCLUSION(S): Because there was no significant difference in pregnancy rates between ZO and ‘‘no ZO’’ in egg donor cycles, neither ZO or embryo biopsy on day 3 embryos has a negative effect on pregnancy
P-38 Effect of Cervical Mucus Quantity at Time of Embryo Catheter Transfer on IVF Pregnancy Outcomes. M. Amols,a P. Hughes,a R. Gada,a D. Morbeck,a C. Coddington.a a Division of Reproductive Endocrinology and Infertility, Rochester, MN. BACKGROUND: PRemoval of cervical mucus at the time of embryo transfer has been associated with increased pregnancy rates. Previous reports focus on presence or absence of mucus. It is unknown if this association is due to plugging of the catheter, adherence of the embryos to the catheter or a marker of potential pathogens in the cervix. OBJECTIVE(S): To determine the relationship between amount of cervical mucus on the transfer catheter and embryo transfer outcomes. MATERIALS AND METHOD(S): A retrospective analysis was performed for all IVF embryo transfers conducted between January 2000 and December 2009. Included subjects were less than thirty five years of age and had cervical mucus documented at time of embryo transfer. Cervical mucus was documented by the embryologist at time of transfer as none, minimal, or significant. 2779 total embryo transfers occurred during the study period: 214 transfers had cervical mucus, of which 148 had minimal mucus
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Abstracts
and 66 had significant mucus. The two groups (minimal/significant) were compared and analyzed using JMP 8.0. Chi Square and Odds Ratios were performed. RESULT(S): 47 percent of subjects with significant mucus became pregnant compared to 61.5 percent of subjects with minimal mucus. Comparison of pregnancy rates between significant mucus versus minimal mucus yielded a Chi Square of 0.048 and Odds ratio of 1.82 (1.003 – 3.238). CONCLUSION(S): The quantity of cervical mucus documented at time of embryo transfer significantly affected pregnancy rate (P < 0.048). Patients were 1.8 times more likely to become pregnant when minimal cervical mucus was present at the time of embryo transfer versus significant. This difference found in pregnancy rates between significant cervical mucus and minimal cervical mucus demonstrates the importance of removing cervical mucus at the time of embryo transfer. Future studies addressing cervical mucus effect on IVF outcomes should focus on quantity in addition to the presence or absence of cervical mucus. SUPPORT: None
P-39 Incidence of Moderate to Severe Depression in Recurrent Pregnancy Loss Patients. Penny Donnely, Brooke Friedmanellie, Ruth B Lathi,. Department of Obstetrics and Gynecology, Stanford Fertility and Reproductive Medicine Center, Palo Alto, CA. OBJECTIVE(S): Recurrent pregnancy loss (RPL) affects 1-5% of reproductive age women. For many couples, the experience can lead to prolonged grief and the feeling of loss of control. Although rarely reported in the literature, the incidence of depression in women with RPL is likely to be greater than unaffected women. The objective of our current study is to determine the incidence and severity of depression in a multispecialty RPL program using the validated Beck’s Depression Inventory Questionnaire. DESIGN: Case series MATERIALS/METHOD(S): In a recurrent pregnancy loss program, a nurse and licensed marriage and family therapist screened 21 consecutive patients with recurrent pregnancy loss upon their intake to the program. Patients were defined as having recurrent pregnancy loss if they had experienced two or more spontaneous miscarriages prior to 20 weeks gestation. Each patient was administered the Beck’s Depression Inventory(BDI), which was immediately reviewed by the therapist and significant findings were immediately followed up. Our primary outcome was screening positive for depression, which is represented on the questionnaire as a score of 14 or greater. RESULT(S): The mean age was 35.8. Approximately 1/3 of patients had a previous live birth. The mean number of previous losses was 3.7, with 52.4% of patients experiencing 4 or more losses. Out of 21 patients screened, seven (33.3%) screened positive for depression with a BDI score R14, ranging from mild to severe. Four (19.0%) screened positive for moderate to severe depression, with a BDI score of R20. Of note, the survey results demonstrated that 10 of the 21 patients (47%) considered themselves as ‘‘having failed more than I should have’’ and 4 of 21 (19%) patients had experienced thoughts of killing themselves. In addition, 9 of the 21 patients (42%) sited a decrease in their interest in sex with two persons indicating much less interest in sex and two indicating a complete loss of interest. CONCLUSION(S): Depression, and specifically moderate to severe depression, is prevalent in the recurrent pregnancy loss population. The results of this pilot study show the feasibility of screening women with RPL and the importance of collaboration with mental health providers in a multispecialty approach to patients suffering from RPL.
P-40 First Attempt at Complete Sequencing of Blastocyst Biopsies for Use in PGD. B. A. Peters, R. Drmanac, P. Colls, G. Harton, A. Berkeley, S. Munne, BACKGROUND: Current techniques that analyze all chromosomal abnormalities in blastocyst biopsies still can only achieve an implantation success rate of approximately 80%. It is possible that this is in part due to array CGH, CGH, SNP arrays, and qPCR not being sensitive enough to detect potential abnormalities associated with implantation failure. The higher resolution of whole genome sequencing could help improve the implantation success rate, as well as provide much more detailed analysis of potential genetic abnormalities.
Vol. 95, No. 4, Supplement, March 15, 2011