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Effect of maternal body mass index (BMI) on assisted reproductive technology (ART) pregnancy rates and obstetric outcomes
O-267 Wednesday, October 21, 2009 5:30 PM CYCLE 1 AS PREDICTOR OF ART TREATMENT OUTCOME OVER MULTIPLE CYCLES: ANALYSIS OF LINKED CYCLES FROM THE SART CORS ONLINE DATABASE. J. E. Stern, M. B. Brown, B. Luke, E. Wantman, A. Lederman, M. D. Hornstein. Department of Ob/Gyn, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Biostatistics, University of Michigan, Ann Arbor, MI; Department of Ob/Gyn and Reproductive Biology and Department of Epidemiology, Michigan State University, East Lansing, MI; Redshift Technologies, Inc, New York, NY; Department of Ob.Gyn and Repoductive Biology, Center for Reproductive Medicine, Brigham and Women’s Hospital, Boston, MA. OBJECTIVE: To determine whether first cycle of ART predicts treatment course and outcome. DESIGN: Retrospective study of linked cycles from the SART CORS Online database. MATERIALS AND METHODS: We analyzed ART cycles of 6352 women identified after linking cycles from women residing or treated in Massachusetts and reported to SART CORS in 2004-2006. The study cohort had first cycle of treatment in 2004-05 using fresh, autologous oocytes and no reported prior fresh or frozen ART. Women were divided into 4 groups according to first cycle: I no retrieval, II retrieval, no transfer, III transfer, no embryo cryopreservation, and IV transfer plus cryopreservation. Patient and cycle characteristics for the first and subsequent cycles were compared using either a chi square test or an ANOVA. RESULTS: Patients in the four groups differed. Group I, older by 1.4 yrs than Groups II and III, had higher baseline FSH, and was more often diagnosed with diminished ovarian reserve: Group IV was younger, more often diagnosed with ovulatory disorder or tubal disease, and had lower prior gravidity than other groups. During treatment, Group IV had more oocytes retrieved than Groups II and III. Cycle 1 delivery rate was 46.1% for Group IV and 29.3% for Group III (P<0.0001). Live-birth delivery per woman for Groups I to IV over the course of multiple ART cycles was 32.1%, 38.5%, 57.7%, and 74.9% (P<0.0001). Groups I and II were most likely to eventually convert to donor egg (11.3%, 6.9%) although only 4.2% and 3.0% did so in cycle 2. Although all groups had patients with oocytes retrieved and embryos frozen in subsequent cycles, Groups II and IV were most likely to return for a frozen embryo transfer. CONCLUSIONS: Course of treatment in the first ART cycle is associated with a patient’s age and diagnosis and is related to eventual use of treatment options such as donor oocytes and different live-birth delivery rates over multiple cycles. Supported by: SART.
OUTCOME PREDICTORS - CLINICAL: ART 2 O-268 Wednesday, October 21, 2009 3:45 PM HIGHLY SIGNIFICANT IMPROVEMENT IN EMBRYO IMPLANTATION AND INCREASED LIVE BIRTH RATE ACHIEVED AFTER COMPREHENSIVE CHROMOSOMAL SCREENING: IMPLICATIONS FOR SINGLE EMBRYO TRANSFER. D. Wells, E. Fragouli, S. Alfarawaty, S. Munne, W. B. Schoolcraft, M. G. Katz-Jaffe. Reprogenetics UK, Oxford, Oxfordshire, United Kingdom; Reprogenetics, Livingston, NJ; Colorado Center for Reproductive Medicine, Lone Tree, CO. OBJECTIVE: To improve the identification of viable embryos for uterine transfer with a view to increasing implantation and birth rates. DESIGN: Prospective clinical trial. MATERIALS AND METHODS: Comparative genomic hybridization (CGH) was used to screen all 23 pairs of chromosomes for aneuploidy in over 500 blastocysts derived from 115 patients. The patients were of advanced maternal age (mean 39 years) and in most cases had at least one previous failed IVF attempt (mean failed cycles 2). RESULTS: The CGH approach underwent extensive validation prior to clinical application, confirming concordance between the biopsied trophectoderm (TE) cells and the inner cell mass. A full chromosome screen was obtained for 93% of blastocysts tested. Almost all patients (96%) had at least one normal embryo available for transfer. Currently, 42 patients have had their blastocysts transferred, with the remaining patients scheduled to receive transfers in the coming weeks. The clinical pregnancy rate stands at 86% (36/ 42). Fifteen cycles have now gone to term, giving a birth rate per cycle of 80% (versus 60% in control blastocyst transfer cycles). Even more impres-
FERTILITY & STERILITYÒ
sive was the implantation rate (fetal heart detected) which was increased from 28% in controls to 66% (54/82) in cases with CGH screening (2.4 fold increase, P<0.0003). CONCLUSIONS: We report the first births following comprehensive chromosome screening of blastocyst stage embryos. The sampling of several TE cells led to a robust diagnosis, less susceptible to problems such as chromosomal mosaicism than previous screening methods. Implantation and birth rates were exceptional (66% per embryo and 80% per cycle started respectively). These results were especially good given the poor reproductive history of the patients and were significantly better than cycles without chromosome screening. The dramatic improvement in implantation rate provides a clear indication that methods such as this will allow high pregnancy and birth rates in cycles involving single embryo transfer.
O-269 Wednesday, October 21, 2009 4:00 PM EFFECT OF MATERNAL BODY MASS INDEX (BMI) ON ASSISTED REPRODUCTIVE TECHNOLOGY (ART) PREGNANCY RATES AND OBSTETRIC OUTCOMES. B. Luke, M. B. Brown, J. E. Stern, S. A. Missmer, V. Y. Fujimoto, R. Leach. Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, MI; Biostatistics, University of Michigan, Ann Arbor, MI; Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Obstetrics, Gynecology, and Reproductive Biology, Brigham & Womens Hospital, Boston, MA; Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA. OBJECTIVE: To evaluate the effect of maternal BMI on ART pregnancy rates and obstetric outcomes. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: The study population included 50,172 ART cycles from the SART-CORS Online database for 2007 and was limited to women with both height and weight recorded. Women were categorized by their BMI as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), or obese (R30.0). Logistic regression was used to model the odds of pregnancy (presence of a gestational sac on early ultrasound) as the treatment outcome, live birth or stillbirth as the pregnancy outcome, and preterm (<37 weeks) or term (R37 weeks), as adjusted odds ratios and 95% confidence intervals, with normal weight women as the reference group. Models were adjusted for maternal age, race and ethnicity, smoking, number of embryos transferred, and infertility diagnoses. Among live births, models of prematurity were additionally adjusted for plurality. RESULTS: The odds of pregnancy were reduced for obese women (AOR 0.82, 0.77-0.87), and the odds of a live birth were reduced for both overweight (AOR 0.86, 0.78-0.96) and obese women (AOR 0.78, 0.69-0.87). The odds of a stillbirth were increased for obese women (AOR 2.50, 1.593.93). Among live births, the odds of delivery very early preterm (<29 weeks), early preterm (<32 weeks), and preterm (<37 weeks) were increased for obese women (AORs 1.59, 1.23-2.05; 1.36, 1.15-1.61; and 1.33, 1.181.50, respectively); the odds of delivery <37 weeks were also increased for overweight women (AOR 1.15, 1.04-1.28). CONCLUSIONS: Compared to normal weight women, overweight women had a lower chance of a live birth, and a greater chance of delivering <37 weeks. Obese women had a lower chance of pregnancy and live birth, and a greater chance of a stillbirth, very early preterm, early preterm, and preterm birth. Future research should focus on clarifying the underlying causes of these disparities. Supported by: SART.
O-270 Wednesday, October 21, 2009 4:15 PM WHAT DO EXCELLENT IVF PROGRAMS DO? OOCYTE RETRIEVAL, EMBRYO TRANSFER AND LUTEAL PHASE SUPPORT. M. R. Thomas, A. E. Sparks, L. L. Mains, B. J. Stegmann, G. L. Ryan, B. J. Van Voorhis. Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA. OBJECTIVE: To identify common practices among excellent IVF programs in an effort to construct an IVF best practice model. DESIGN: A cross-sectional survey. MATERIALS AND METHODS: Excellent IVF programs, determined by high singleton delivery rates (SDR), were identified using the SART database. Twelve programs performing R100 cycles/year were identified in
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OUTCOME PREDICTORS - CLINICAL: ART 2 O-268 Wednesday, October 21, 2009 3:45 PM HIGHLY SIGNIFICANT IMPROVEMENT IN EMBRYO IMPLANTATION AND INCREASED LIVE BIRTH RATE ACHIEVED AFTER COMPREHENSIVE CHROMOSOMAL SCREENING: IMPLICATIONS FOR SINGLE EMBRYO TRANSFER. D. Wells, E. Fragouli, S. Alfarawaty, S. Munne, W. B. Schoolcraft, M. G. Katz-Jaffe. Reprogenetics UK, Oxford, Oxfordshire, United Kingdom; Reprogenetics, Livingston, NJ; Colorado Center for Reproductive Medicine, Lone Tree, CO. OBJECTIVE: To improve the identification of viable embryos for uterine transfer with a view to increasing implantation and birth rates. DESIGN: Prospective clinical trial. MATERIALS AND METHODS: Comparative genomic hybridization (CGH) was used to screen all 23 pairs of chromosomes for aneuploidy in over 500 blastocysts derived from 115 patients. The patients were of advanced maternal age (mean 39 years) and in most cases had at least one previous failed IVF attempt (mean failed cycles 2). RESULTS: The CGH approach underwent extensive validation prior to clinical application, confirming concordance between the biopsied trophectoderm (TE) cells and the inner cell mass. A full chromosome screen was obtained for 93% of blastocysts tested. Almost all patients (96%) had at least one normal embryo available for transfer. Currently, 42 patients have had their blastocysts transferred, with the remaining patients scheduled to receive transfers in the coming weeks. The clinical pregnancy rate stands at 86% (36/ 42). Fifteen cycles have now gone to term, giving a birth rate per cycle of 80% (versus 60% in control blastocyst transfer cycles). Even more impres-
FERTILITY & STERILITYÒ
sive was the implantation rate (fetal heart detected) which was increased from 28% in controls to 66% (54/82) in cases with CGH screening (2.4 fold increase, P<0.0003). CONCLUSIONS: We report the first births following comprehensive chromosome screening of blastocyst stage embryos. The sampling of several TE cells led to a robust diagnosis, less susceptible to problems such as chromosomal mosaicism than previous screening methods. Implantation and birth rates were exceptional (66% per embryo and 80% per cycle started respectively). These results were especially good given the poor reproductive history of the patients and were significantly better than cycles without chromosome screening. The dramatic improvement in implantation rate provides a clear indication that methods such as this will allow high pregnancy and birth rates in cycles involving single embryo transfer.
O-269 Wednesday, October 21, 2009 4:00 PM EFFECT OF MATERNAL BODY MASS INDEX (BMI) ON ASSISTED REPRODUCTIVE TECHNOLOGY (ART) PREGNANCY RATES AND OBSTETRIC OUTCOMES. B. Luke, M. B. Brown, J. E. Stern, S. A. Missmer, V. Y. Fujimoto, R. Leach. Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, MI; Biostatistics, University of Michigan, Ann Arbor, MI; Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Obstetrics, Gynecology, and Reproductive Biology, Brigham & Womens Hospital, Boston, MA; Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA. OBJECTIVE: To evaluate the effect of maternal BMI on ART pregnancy rates and obstetric outcomes. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: The study population included 50,172 ART cycles from the SART-CORS Online database for 2007 and was limited to women with both height and weight recorded. Women were categorized by their BMI as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), or obese (R30.0). Logistic regression was used to model the odds of pregnancy (presence of a gestational sac on early ultrasound) as the treatment outcome, live birth or stillbirth as the pregnancy outcome, and preterm (<37 weeks) or term (R37 weeks), as adjusted odds ratios and 95% confidence intervals, with normal weight women as the reference group. Models were adjusted for maternal age, race and ethnicity, smoking, number of embryos transferred, and infertility diagnoses. Among live births, models of prematurity were additionally adjusted for plurality. RESULTS: The odds of pregnancy were reduced for obese women (AOR 0.82, 0.77-0.87), and the odds of a live birth were reduced for both overweight (AOR 0.86, 0.78-0.96) and obese women (AOR 0.78, 0.69-0.87). The odds of a stillbirth were increased for obese women (AOR 2.50, 1.593.93). Among live births, the odds of delivery very early preterm (<29 weeks), early preterm (<32 weeks), and preterm (<37 weeks) were increased for obese women (AORs 1.59, 1.23-2.05; 1.36, 1.15-1.61; and 1.33, 1.181.50, respectively); the odds of delivery <37 weeks were also increased for overweight women (AOR 1.15, 1.04-1.28). CONCLUSIONS: Compared to normal weight women, overweight women had a lower chance of a live birth, and a greater chance of delivering <37 weeks. Obese women had a lower chance of pregnancy and live birth, and a greater chance of a stillbirth, very early preterm, early preterm, and preterm birth. Future research should focus on clarifying the underlying causes of these disparities. Supported by: SART.
O-270 Wednesday, October 21, 2009 4:15 PM WHAT DO EXCELLENT IVF PROGRAMS DO? OOCYTE RETRIEVAL, EMBRYO TRANSFER AND LUTEAL PHASE SUPPORT. M. R. Thomas, A. E. Sparks, L. L. Mains, B. J. Stegmann, G. L. Ryan, B. J. Van Voorhis. Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA. OBJECTIVE: To identify common practices among excellent IVF programs in an effort to construct an IVF best practice model. DESIGN: A cross-sectional survey. MATERIALS AND METHODS: Excellent IVF programs, determined by high singleton delivery rates (SDR), were identified using the SART database. Twelve programs performing R100 cycles/year were identified in
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