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Establishing an algorithm to predict the age-specific number of oocytes needed to yield a blastocyst
P-610 Wednesday, November 1, 2017
P-611 Wednesday, November 1, 2017
ESTABLISHING AN ALGORITHM TO PREDICT THE AGE-SPECIFIC NUMBER OF OOCYTES NEEDED TO YIELD A BLASTOCYST. M. P. Purdy,a T. L. Jones,a C. C. Shenoy,a E. A. Stewart,a M. Hathcock,b C. Coddington.a a Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; bBiostatistics, Mayo Clinic, Rochester, MN.
WHAT PLAYS A KEY ROLE IN VITRIFIED-WARMED SINGLE BLASTOCYST TRANSFER FOR ACHIEVING PREGNANCY. A. Fukuda,a H. Matsumoto,b M. Ida,c Y. Morimoto.d aReproductive Endocrinology and Infertility, IVF Osaka Clinic, Higashiosaka City, Japan; bIVF Osaka Clinic, Higashiosaka, Japan; cIVF Osaka Clinic, Higashiosaka, Osaka, Japan; dHORAC Grand Front Osaka Clinic, Osaka, Japan.
OBJECTIVE: Counseling women on what is an adequate number of oocytes to achieve a blastocyst (blast) is difficult. Thus we aim to assess the predictors of oocyte response and establish guidelines for age-specific oocyte responder groups and blast development. DESIGN: Women, ages 18-50, who had an oocyte retrieval during 2014 and were reported to Society of Assisted Reproductive Technology (SART) were analyzed. Cycles with a freeze all, batching, or oocyte cryopreservation were excluded. MATERIALS AND METHODS: The age-specific percentiles for AFC that were published in Fertility and Sterility (Almog et al. 2011) were correlated with oocyte retrieval number. The association between co-variables (race, BMI, insemination method, infertility diagnosis) and blast development was also assessed. Co-variables were eliminated by fitting a Poisson regression model to establish blast development solely based on age and oocyte yield. Oocyte production referent group for comparison was R 50th to < 75th percentile. Our model incorporated data from Almog et al. to establish eight percentile response groups based on age and retrieval number. Then one standard error above the minimum for oocyte retrieval number and relative risk (RR) of developing a blast was determined. RESULTS: 39,343/54,150 (54.2%) patients had blast development. Significant co-variables which decreased blast production were Obesity Class 3 (BMI >40) with a RR of 0.84 and diminished ovarian reserve (RR of 0.69). Increased blast production was noted with polycystic ovary syndrome and male infertility (RR 1.1 and 1.05, respectively). Using our regression model, we developed an algorithm based on the patient’s age and oocyte yield. Once the percentile category for that patient was established, the RR of blast development was determined based on Table 1. If a patient had an oocyte yield less than the 3rd percentile or R3rd to 10th percentile for their age group the RR was 0.29 and 0.45, respectively for blast development. Women in the R90th to <97th or R97th percentile groups for their age had a RR of 1.16 and 1.24, respectively. For example, a 35 year-old that had retrieval of 14 eggs would place them in the R75th to <90th category for oocyte production in that age group. Using Table 1 of the abstract it can be established that their RR of blast development is 1.1 (1.05, 1.14).
OBJECTIVE: Assisted reproductive technology (ART) has been applied for treatment of infertility for more than 39 years. Traditionally, little attention has been focused on embryo transfer. It is often viewed as an unimportant variable in the success of an ART cycle. Many factors have been proposed to explain the disparity between embryo transfer and pregnancy rates. Pregnancy rate is not 100% even with genetically normal embryos selected by PGS. Therefore, inefficiency of embryo implantation may stem from embryo transfer technique. Therefore, the present study was conducted to clarify which factor plays a most important role to achieve pregnancy in vitrified-warmed single blastocyst transfer. DESIGN: Retrospective cohort study at private fertility special clinic. MATERIALS AND METHODS: Vitrified-warmed single blastocyst transfers of 1815 cases with the patients under 39 years old between Jan. 2013 and Dec. 2016 were applied for analyses by multivariant logistic regression test. Vitrified-warmed transfer was selected to eliminate unnecessary variant that might affect clinical outcome. Patient age (< 29, 30-34 or 35-39 years old), depth of the embryo to leave (0-3, 4-6, 7-9 or >10mm), cycle background (hormone supplemented or natural ovulation cycle), endometrium thickness (<10, 10-13, 1316 or >16mm), difficulty of transfer (difficult or normal) and endometrial pattern (leaf or tadpole) and midline echo (positive or negative) were used as variants. P value less than 0.05 was considered to be significant. RESULTS: Depth for transfer (P¼0.15; O.R¼0.97, 95%CI¼0.92-1.01), cycle back ground (P¼0.68; O.R¼0.91, 95%CI¼0.86-1.27), endometrial pattern (P¼0.66; O.R¼0.89, 95%CI¼0.55-1.46) and midline echo (P¼0.45; O.R¼1.07, 95%CI¼0.89-1.30) were not significantly dirrerent for achieving clinical pregnancy. However, patient age (P<0.0001; O.R¼0.97, 95%CI¼0.880.94), endometrial thickness (P¼0.004; O.R¼1.06, 95%CI¼1.01-1.10) and difficulty of transfer (P¼0.04; O.R¼1.46, 95%CI¼1.01-2.13) were significantly different from the other factors. CONCLUSIONS: The goal of embryo transfer is to deliver embryos to the uterine fundus in a gentle and atraumatic manner. Fastidious attention to the many details of transfer technique appears to be important for ART successful outcome. The present study suggests that not only the patient age but also endometrial thickness and difficulty of embryo transfer play a crucial role for clinical outcome. Preparation of endometrium and transfer skill are critical to achieve successful pregnancy. P-612 Wednesday, November 1, 2017
Relative Risk of Blastocyst Development Using a Poisson Regression
Diagnoses PCOS Diminished Ovarian Reserve Oocyte Production Percentile <3rd >¼3rd to <10th >¼10th to <25th >¼25th to <50th >¼75th to <90th >¼90th to <97th >¼97th
Relative Risk (95% CI)
P-value
1.11 (1.07, 1.14) 0.69 (0.66, 0.71)
<0.001 <0.001
0.29 (0.25, 0.33) 0.45 (0.42, 0.49) 0.66 (0.63 to 0.7) 0.85 (0.82, 0.89) 1.1 (1.05, 1.14) 1.16 (1.11, 1.21) 1.24 (1.19, 1.29)
<0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
CONCLUSIONS: Using SART data we are able to help predict the likelihood of blast development based on age and oocyte retrieval number. This information allows for more accurate counselling in patients that desire an embryo biopsy or blast transfer. Reference: 1. Almog, B., F. Shehata, E. Shalom-Paz, S. L. Tan & T. Tulandi (2011) Age-related normogram for antral follicle count: McGill reference guide. Fertil Steril, 95, 663-6.
e340
ASRM Abstracts
HOW DOES MORPHOLOGIC ASSESSMENT CORRELATE WITH IMPLANTATION OF EUPLOID EMBRYOS?. T. G. Nazem,a L. Sekhon,a J. A. Lee,a J. Overbey,b S. Pan,b M. Whitehouse,a M. Duke,a C. Briton-Jones,a A. B. Copperman,c D. E. Stein.d aReproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; cObstetrics and Gynecology, RMANY-Mount Sinai, New York, NY; dReproductive Endocrinology, Reproductive Medicine Associates of New York, New York, NY. OBJECTIVE: Pre-implantation genetic testing (PGT) revolutionized the embryo selection process, resulting in improved implantation and live birth rates. Without PGT, assessment of embryo morphology has been the primary method of selection, despite being subjective and not standardized. The study evaluated whether composite morphologic grade or a developmental component (expansion stage (EXP), inner cell mass (ICM), or trophectoderm (TE)) in euploid embryos undergoing frozen embryo transfer (FET) is associated with improved outcomes. DESIGN: Retrospective. MATERIALS AND METHODS: The study included autologous IVF cycles and single, euploid FET from 2012-17. A Gardner grading system was used to evaluate embryos before TE biopsy and vitrification, and after rewarming before FET. Embryos unable to be graded after rewarming were excluded. Day of embryo biopsy, vitrification and FET were included.
Vol. 108, No. 3, Supplement, September 2017
P-611 Wednesday, November 1, 2017
ESTABLISHING AN ALGORITHM TO PREDICT THE AGE-SPECIFIC NUMBER OF OOCYTES NEEDED TO YIELD A BLASTOCYST. M. P. Purdy,a T. L. Jones,a C. C. Shenoy,a E. A. Stewart,a M. Hathcock,b C. Coddington.a a Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; bBiostatistics, Mayo Clinic, Rochester, MN.
WHAT PLAYS A KEY ROLE IN VITRIFIED-WARMED SINGLE BLASTOCYST TRANSFER FOR ACHIEVING PREGNANCY. A. Fukuda,a H. Matsumoto,b M. Ida,c Y. Morimoto.d aReproductive Endocrinology and Infertility, IVF Osaka Clinic, Higashiosaka City, Japan; bIVF Osaka Clinic, Higashiosaka, Japan; cIVF Osaka Clinic, Higashiosaka, Osaka, Japan; dHORAC Grand Front Osaka Clinic, Osaka, Japan.
OBJECTIVE: Counseling women on what is an adequate number of oocytes to achieve a blastocyst (blast) is difficult. Thus we aim to assess the predictors of oocyte response and establish guidelines for age-specific oocyte responder groups and blast development. DESIGN: Women, ages 18-50, who had an oocyte retrieval during 2014 and were reported to Society of Assisted Reproductive Technology (SART) were analyzed. Cycles with a freeze all, batching, or oocyte cryopreservation were excluded. MATERIALS AND METHODS: The age-specific percentiles for AFC that were published in Fertility and Sterility (Almog et al. 2011) were correlated with oocyte retrieval number. The association between co-variables (race, BMI, insemination method, infertility diagnosis) and blast development was also assessed. Co-variables were eliminated by fitting a Poisson regression model to establish blast development solely based on age and oocyte yield. Oocyte production referent group for comparison was R 50th to < 75th percentile. Our model incorporated data from Almog et al. to establish eight percentile response groups based on age and retrieval number. Then one standard error above the minimum for oocyte retrieval number and relative risk (RR) of developing a blast was determined. RESULTS: 39,343/54,150 (54.2%) patients had blast development. Significant co-variables which decreased blast production were Obesity Class 3 (BMI >40) with a RR of 0.84 and diminished ovarian reserve (RR of 0.69). Increased blast production was noted with polycystic ovary syndrome and male infertility (RR 1.1 and 1.05, respectively). Using our regression model, we developed an algorithm based on the patient’s age and oocyte yield. Once the percentile category for that patient was established, the RR of blast development was determined based on Table 1. If a patient had an oocyte yield less than the 3rd percentile or R3rd to 10th percentile for their age group the RR was 0.29 and 0.45, respectively for blast development. Women in the R90th to <97th or R97th percentile groups for their age had a RR of 1.16 and 1.24, respectively. For example, a 35 year-old that had retrieval of 14 eggs would place them in the R75th to <90th category for oocyte production in that age group. Using Table 1 of the abstract it can be established that their RR of blast development is 1.1 (1.05, 1.14).
OBJECTIVE: Assisted reproductive technology (ART) has been applied for treatment of infertility for more than 39 years. Traditionally, little attention has been focused on embryo transfer. It is often viewed as an unimportant variable in the success of an ART cycle. Many factors have been proposed to explain the disparity between embryo transfer and pregnancy rates. Pregnancy rate is not 100% even with genetically normal embryos selected by PGS. Therefore, inefficiency of embryo implantation may stem from embryo transfer technique. Therefore, the present study was conducted to clarify which factor plays a most important role to achieve pregnancy in vitrified-warmed single blastocyst transfer. DESIGN: Retrospective cohort study at private fertility special clinic. MATERIALS AND METHODS: Vitrified-warmed single blastocyst transfers of 1815 cases with the patients under 39 years old between Jan. 2013 and Dec. 2016 were applied for analyses by multivariant logistic regression test. Vitrified-warmed transfer was selected to eliminate unnecessary variant that might affect clinical outcome. Patient age (< 29, 30-34 or 35-39 years old), depth of the embryo to leave (0-3, 4-6, 7-9 or >10mm), cycle background (hormone supplemented or natural ovulation cycle), endometrium thickness (<10, 10-13, 1316 or >16mm), difficulty of transfer (difficult or normal) and endometrial pattern (leaf or tadpole) and midline echo (positive or negative) were used as variants. P value less than 0.05 was considered to be significant. RESULTS: Depth for transfer (P¼0.15; O.R¼0.97, 95%CI¼0.92-1.01), cycle back ground (P¼0.68; O.R¼0.91, 95%CI¼0.86-1.27), endometrial pattern (P¼0.66; O.R¼0.89, 95%CI¼0.55-1.46) and midline echo (P¼0.45; O.R¼1.07, 95%CI¼0.89-1.30) were not significantly dirrerent for achieving clinical pregnancy. However, patient age (P<0.0001; O.R¼0.97, 95%CI¼0.880.94), endometrial thickness (P¼0.004; O.R¼1.06, 95%CI¼1.01-1.10) and difficulty of transfer (P¼0.04; O.R¼1.46, 95%CI¼1.01-2.13) were significantly different from the other factors. CONCLUSIONS: The goal of embryo transfer is to deliver embryos to the uterine fundus in a gentle and atraumatic manner. Fastidious attention to the many details of transfer technique appears to be important for ART successful outcome. The present study suggests that not only the patient age but also endometrial thickness and difficulty of embryo transfer play a crucial role for clinical outcome. Preparation of endometrium and transfer skill are critical to achieve successful pregnancy. P-612 Wednesday, November 1, 2017
Relative Risk of Blastocyst Development Using a Poisson Regression
Diagnoses PCOS Diminished Ovarian Reserve Oocyte Production Percentile <3rd >¼3rd to <10th >¼10th to <25th >¼25th to <50th >¼75th to <90th >¼90th to <97th >¼97th
Relative Risk (95% CI)
P-value
1.11 (1.07, 1.14) 0.69 (0.66, 0.71)
<0.001 <0.001
0.29 (0.25, 0.33) 0.45 (0.42, 0.49) 0.66 (0.63 to 0.7) 0.85 (0.82, 0.89) 1.1 (1.05, 1.14) 1.16 (1.11, 1.21) 1.24 (1.19, 1.29)
<0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
CONCLUSIONS: Using SART data we are able to help predict the likelihood of blast development based on age and oocyte retrieval number. This information allows for more accurate counselling in patients that desire an embryo biopsy or blast transfer. Reference: 1. Almog, B., F. Shehata, E. Shalom-Paz, S. L. Tan & T. Tulandi (2011) Age-related normogram for antral follicle count: McGill reference guide. Fertil Steril, 95, 663-6.
e340
ASRM Abstracts
HOW DOES MORPHOLOGIC ASSESSMENT CORRELATE WITH IMPLANTATION OF EUPLOID EMBRYOS?. T. G. Nazem,a L. Sekhon,a J. A. Lee,a J. Overbey,b S. Pan,b M. Whitehouse,a M. Duke,a C. Briton-Jones,a A. B. Copperman,c D. E. Stein.d aReproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; cObstetrics and Gynecology, RMANY-Mount Sinai, New York, NY; dReproductive Endocrinology, Reproductive Medicine Associates of New York, New York, NY. OBJECTIVE: Pre-implantation genetic testing (PGT) revolutionized the embryo selection process, resulting in improved implantation and live birth rates. Without PGT, assessment of embryo morphology has been the primary method of selection, despite being subjective and not standardized. The study evaluated whether composite morphologic grade or a developmental component (expansion stage (EXP), inner cell mass (ICM), or trophectoderm (TE)) in euploid embryos undergoing frozen embryo transfer (FET) is associated with improved outcomes. DESIGN: Retrospective. MATERIALS AND METHODS: The study included autologous IVF cycles and single, euploid FET from 2012-17. A Gardner grading system was used to evaluate embryos before TE biopsy and vitrification, and after rewarming before FET. Embryos unable to be graded after rewarming were excluded. Day of embryo biopsy, vitrification and FET were included.
Vol. 108, No. 3, Supplement, September 2017