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Embryo donation: national trends and outcomes, 2000-2013
ART - CLINICAL P-565 Wednesday, October 19, 2016 EMBRYO DONATION: NATIONAL TRENDS AND OUTCOMES, 2000-2013. J. F. Kawwass,a S. Crawford,b H. Hipp,c S. Boulet,d D. M. Kissin,e D. J. Jamieson.b aReproductive Endocrinology and Infertility, Emory University Reproductive Center (& CDC), Atlanta, GA; bCDC, Atlanta, GA; cGynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA; dCenters for Disease Control and Prevention, Atlanta, GA; eDivision of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA. OBJECTIVE: To quantify trends in donor embryo cycles in the United States, to characterize donor embryo recipients, and to report transfer, pregnancy, and birth outcomes of frozen donor embryo transfers. DESIGN: Retrospective cohort study of frozen donor embryo transfers using the National Assisted Reproductive Technology (ART) Surveillance System evaluating trends from 2000 to 2013 and outcomes from 2007-2013. MATERIALS AND METHODS: Linear and binomial regression were used to explore trends in the use of donor embryos and corresponding rates of pregnancy and live birth during 2000-2013. We investigated recipient and cycle characteristics and outcomes of frozen donor embryo transfers performed between 2007-2013, years reflective of current practice and for which age of the donor oocyte source was collected. We report rates of cancellation, intrauterine pregnancy, miscarriage, live birth, singleton live birth, twin live birth, and delivery of full term singleton infant of normal birthweight (>37 weeks, weighing >2500 grams) among donor embryo cycles. RESULTS: Among all frozen transfers between 2000 and 2013 (n¼391,662), the annual number of donor embryo transfers increased significantly from 332 to 1,374; however, the proportion of donor embryo transfers among all frozen transfers did not change significantly (2.3% to 2.6%). The overall donor embryo cycle cancellation rate prior to transfer between 2007 and 2013 was 7.1%. Among all donor embryo transfers between 2007 and 2013 (n¼6,773), 3,193 (47.2%) resulted in pregnancy and 2,589 (38.2%) resulted in a live birth. Both overall pregnancy and live birth rates per frozen donor embryo transfer increased significantly (33.3% to 49.1% and 26.5% to 40.8%, respectively) (P<.01). Among all pregnancies, 535 (16.9%) resulted in a miscarriage. Among all live births, 1,929 (74.5%) delivered a singleton of which 1,482 (76.8%) were full term and had normal birthweight. CONCLUSIONS: The increasing availability of donor embryos, low chance of cancellation, and increasing likelihood of achieving live birth can inform consumers and health care providers who are considering ART options. Collection of data surrounding donated embryo formation would allow for additional studies that can elucidate predictors of success among donor embryo transfers. P-566 Wednesday, October 19, 2016 INFECTIOUS DISEASE SCREENING OF SEMEN FOR SURROGACY CASES. A. A. Kiessling. Bedford Research Foundation, Bedford, MA. OBJECTIVE: To prevent transmission of HIV and other infectious agents to gestational carriers. DESIGN: Semen specimens collected within 7 days of blood and urine tests mandated by the Food and Drug Administration for tissue donors are screened for HIV, cytomegalovirus (CMV), bacteria and T palladium, if indicated by serology. Gestational carriers are counseled about risks and confidentiality before the embryo transfer, and tested for HIV antibodies three times after the transfer whether or not pregnancy is achieved. Babies are tested for HIV sometime during their first year of life. MATERIALS AND METHODS: Semen specimens are divided into three parts, sperm from one part are washed and cryopreserved in a vapor-phase nitrogen quarantine tank. The second part is aldehyde-preserved for immunostaining if there is an elevation in round cells. The third part is exposed to guanylate salts at a concentration to lyse pathogens and somatic cells, but not sperm heads, which are removed by centrifugation. Lysed pathogen nucleic acids are amplified by PCR (following an RT step if the pathogen has an RNA genome) and detected by a nested qPCR amplification with a pathogen-specific fluorescent probe. Sperm from specimens testing positive for HIV are discarded. CMV and bacteria status of sperm without detectable HIV is reported to the fertility clinic. Surrogates are mailed information about the specimen testing design followed by a phone consult to discuss risks, questions, and post procedure
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testing. The consult is independent of being matched with an intended parent. Surrogates are mailed HIV blood spot test kits at 3 weeks, 3 months, and 6 months after the embryo transfer which are mailed back to the SPAR lab for testing. RESULTS: Forty eight gestational carriers, 46 referred by 9 surrogacy agencies and two self referrals, had consults during 2014-2015, of whom 46 agreed to continue to embryo transfer. Fourteen fertility clinics across the U.S. cared for 86 couples, 83 of whom were gay, who underwent semen screening and FDA tissue donor testing in the Special Program of Assisted Reproduction (SPAR) pending surrogacy assignment during 2014-2015. HIV-infected men seeking surrogacy came from the U.S., the U.K, Germany, Spain, Italy, France, Isreal, Greece, China, Japan, Australia, Argentina, Brazil, Amsterdam, Russia and the Netherlands. Similar to the incidence in heterosexual men, 29% of HIV infected gay men produced at least one HIV-positive semen specimen, with 16% of semen specimens testing positive over all. All gestational carriers, and all babies born, tested negative for HIV. CONCLUSIONS: This pilot report indicates: (1) most gestational carriers willing to consider undergoing embryo transfer ultimately decide to do so for HIV-intended parents participating in the screening, testing and counseling provided by the SPAR program; (2) the majority of semen specimens produced by HIV-infected gay men on effective anti-retroviral therapy have an undetectable burden of HIV; (3) there is an increase in the number of fertility clinics caring for HIV-infected gay men seeking to parent.
P-567 Wednesday, October 19, 2016 EMBRYO CRYOPRESERVATION WITH WARMING INCREASES PREECLAMPSIA COMPARED TO FRESH EMBRYO TRANSFER. M. Barsky,a D. Wilson,b D. Bernson,c Y. Zhang,d C. K. Sites.a aObstetrics and Gynecology, Baystate Medical Center, Springfield, MA; bBaystate Health, Springfield, MA; cMassachusetts Department of Public Health, Boston, MA; dDivision of Reproductive Health, CDC, Mathematical Statistician, Chamblee, GA. OBJECTIVE: To compare preeclampsia rates, including those associated with preterm delivery, in fresh compared to cryopreserved-warmed embryo transfers. DESIGN: We used SMART Collaborative linked datasets to link ART records from the National Reproductive Surveillance System (NASS) with state-level birth certificate and maternal hospital discharge data in Massachusetts. Resident singleton births from 2005 to 2010 were included. MATERIALS AND METHODS: Descriptive statistics were compiled and stratified by the type of embryo transfer. Chi square tests were performed to determine the association between preeclampsia diagnosis and embryo transfer type. Generalized estimating equations were then fit using preeclampsia status as the outcome and type of embryo transfer as the predictor of interest. RESULTS: A total of 9,417 singleton births were identified: 7,453 following fresh non-egg donor, 1,052 following cryopreserved-warmed non- egg donor cycles, 643 following fresh egg donor, and 269 following cryopreserved-warmed egg donor cycles. The incidence of preeclampsia was 4.29% in fresh non-donor cycles vs. 7.51% in cryopreserved-warmed non-donor cycles (OR¼1.81, p<0.0001). Preeclampsia with preterm delivery was more common following transfer of cryopreserved-warmed nondonor embryos compared to transfer of fresh non-donor embryos (2.76% vs. 1.48%, OR¼1.89, p¼0.002). Preeclampsia without severe features, preeclampsia with severe features, and chronic hypertension with superimposed preeclampsia, were all more frequent following frozen embryo transfers in non-donor cycles compared to transfer of fresh non-donor embryos (2.55% vs. 3.99%, p¼0.011; 1.41% vs. 2.95%, p¼0.0006; 0.43% vs. 0.95%, p¼0.0329, respectively). In donor egg cycles, the rate of preeclampsia was not different between fresh and cryopreserved-warmed transfers (12.13% vs. 10.78%, p¼0.56), yet there was a higher rate of preeclampsia following all donor egg cycles vs. non- egg donor cycles (OR¼2.7, p¼0.0001). CONCLUSIONS: Following cycles with autologous eggs, the rate of preeclampsia including that associated with preterm delivery, is higher following cryopreserved-warmed embryo transfer compared to fresh embryo transfer in singleton gestations. The rate of preeclampsia is higher in egg donor cycles compared to non-donor cycles, but is not different between donor egg transfer types. Fresh embryo transfers should be considered when possible in couples using autologous eggs to reduce the incidence of preeclampsia with preterm delivery.
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testing. The consult is independent of being matched with an intended parent. Surrogates are mailed HIV blood spot test kits at 3 weeks, 3 months, and 6 months after the embryo transfer which are mailed back to the SPAR lab for testing. RESULTS: Forty eight gestational carriers, 46 referred by 9 surrogacy agencies and two self referrals, had consults during 2014-2015, of whom 46 agreed to continue to embryo transfer. Fourteen fertility clinics across the U.S. cared for 86 couples, 83 of whom were gay, who underwent semen screening and FDA tissue donor testing in the Special Program of Assisted Reproduction (SPAR) pending surrogacy assignment during 2014-2015. HIV-infected men seeking surrogacy came from the U.S., the U.K, Germany, Spain, Italy, France, Isreal, Greece, China, Japan, Australia, Argentina, Brazil, Amsterdam, Russia and the Netherlands. Similar to the incidence in heterosexual men, 29% of HIV infected gay men produced at least one HIV-positive semen specimen, with 16% of semen specimens testing positive over all. All gestational carriers, and all babies born, tested negative for HIV. CONCLUSIONS: This pilot report indicates: (1) most gestational carriers willing to consider undergoing embryo transfer ultimately decide to do so for HIV-intended parents participating in the screening, testing and counseling provided by the SPAR program; (2) the majority of semen specimens produced by HIV-infected gay men on effective anti-retroviral therapy have an undetectable burden of HIV; (3) there is an increase in the number of fertility clinics caring for HIV-infected gay men seeking to parent.
P-567 Wednesday, October 19, 2016 EMBRYO CRYOPRESERVATION WITH WARMING INCREASES PREECLAMPSIA COMPARED TO FRESH EMBRYO TRANSFER. M. Barsky,a D. Wilson,b D. Bernson,c Y. Zhang,d C. K. Sites.a aObstetrics and Gynecology, Baystate Medical Center, Springfield, MA; bBaystate Health, Springfield, MA; cMassachusetts Department of Public Health, Boston, MA; dDivision of Reproductive Health, CDC, Mathematical Statistician, Chamblee, GA. OBJECTIVE: To compare preeclampsia rates, including those associated with preterm delivery, in fresh compared to cryopreserved-warmed embryo transfers. DESIGN: We used SMART Collaborative linked datasets to link ART records from the National Reproductive Surveillance System (NASS) with state-level birth certificate and maternal hospital discharge data in Massachusetts. Resident singleton births from 2005 to 2010 were included. MATERIALS AND METHODS: Descriptive statistics were compiled and stratified by the type of embryo transfer. Chi square tests were performed to determine the association between preeclampsia diagnosis and embryo transfer type. Generalized estimating equations were then fit using preeclampsia status as the outcome and type of embryo transfer as the predictor of interest. RESULTS: A total of 9,417 singleton births were identified: 7,453 following fresh non-egg donor, 1,052 following cryopreserved-warmed non- egg donor cycles, 643 following fresh egg donor, and 269 following cryopreserved-warmed egg donor cycles. The incidence of preeclampsia was 4.29% in fresh non-donor cycles vs. 7.51% in cryopreserved-warmed non-donor cycles (OR¼1.81, p<0.0001). Preeclampsia with preterm delivery was more common following transfer of cryopreserved-warmed nondonor embryos compared to transfer of fresh non-donor embryos (2.76% vs. 1.48%, OR¼1.89, p¼0.002). Preeclampsia without severe features, preeclampsia with severe features, and chronic hypertension with superimposed preeclampsia, were all more frequent following frozen embryo transfers in non-donor cycles compared to transfer of fresh non-donor embryos (2.55% vs. 3.99%, p¼0.011; 1.41% vs. 2.95%, p¼0.0006; 0.43% vs. 0.95%, p¼0.0329, respectively). In donor egg cycles, the rate of preeclampsia was not different between fresh and cryopreserved-warmed transfers (12.13% vs. 10.78%, p¼0.56), yet there was a higher rate of preeclampsia following all donor egg cycles vs. non- egg donor cycles (OR¼2.7, p¼0.0001). CONCLUSIONS: Following cycles with autologous eggs, the rate of preeclampsia including that associated with preterm delivery, is higher following cryopreserved-warmed embryo transfer compared to fresh embryo transfer in singleton gestations. The rate of preeclampsia is higher in egg donor cycles compared to non-donor cycles, but is not different between donor egg transfer types. Fresh embryo transfers should be considered when possible in couples using autologous eggs to reduce the incidence of preeclampsia with preterm delivery.
Vol. 106, No. 3, Supplement, September 2016