ICSI cycles

P-555 Wednesday, October 22, 2014 ECTOPIC PREGNANCY RATE INCREASES WITH THE NUMBER OF RETRIEVED OOCYTES IN AUTOLOGOUS IVF BUT NOT IN DONOR/RECIPIENT CYCLES: AN ANALYSIS OF 109,140 CLINICAL PREGNANCIES FROM THE SART REGISTRY. K. S. Acharya,a C. R. Acharya,b M. P. Provost,a J. S. Yeh,a R. G. Steward,a J. L. Eaton,a S. J. Muasher.a aDivision of Reproductive Endocrinology and Infertility, Duke University Medical Center, Durham, NC; bDepartment of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC. OBJECTIVE: The impact of supraphysiologic hormone levels resulting from controlled ovarian stimulation on ectopic pregnancy (EP) risk is unclear. In an attempt to isolate ovarian stimulation as a potential modifier of EP risk, we used a large and recent national registry to compare EP rates between fresh autologous and donor oocyte IVF cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We used data from the 2008-2010 SART registry. Only fresh autologous and donor oocyte cycles achieving clinical pregnancy (CP) were used in our analysis. Cycles with a diagnosis of tubal infertility were excluded. Cycles were divided into 6 cohorts based on the number of oocytes retrieved, and the percentage of ectopic pregnancies (defined as ectopic or heterotopic pregnancies) were calculated (Table). A linear model was constructed to discern the relationship between the average number of oocytes per category and the EP risk per clinical pregnancy. RESULTS: There were 91,504 and 17,636 CPs reported among all autologous and donor oocyte cycles, respectively. In autologous cycles, EP rate significantly increased as oocyte yield increased (P¼0.04). This association was not found in oocyte recipients (P¼0.18).

Ectopic pregnancy rates by oocyte yield

Oocyte yield per cycle

0-5 6-10 11-15 16-20 21-25 >25 P value

% EP - Autologous cycles 1.65 1.77 1.89 1.82 1.89 1.92 0.04 % EP - Donor oocyte cycles 2.64 1.17 0.73 0.77 0.76 0.88 0.18 Note: EP - ectopic pregnancy; rates of EP are reported per 100 clinical pregnancies. P-values reflect the statistical significance of the predictive ability of the number of oocytes per category. CONCLUSION: Recent national data suggest that the rate of EP increases with higher oocyte yield in autologous but not donor oocyte IVF cycles. Further research is needed to determine if these differences can be attributed to autologous ovarian stimulation. P-556 Wednesday, October 22, 2014 YOUNG DIMINISHED OVARIAN RESERVE (DOR) PATIENTS HAVE GOOD IVF OUTCOMES. S. R. Pittenger, C.-N. Kao, M. P. Rosen, M. I. Cedars, N. D. Tran. Center for Reproductive Health, University of California, San Francisco, San Francisco, CA. OBJECTIVE: To determine if IVF success is reduced in young women with a low number of eggs retrieved. DESIGN: Retrospective chart review. MATERIALS AND METHODS: Clinical records were examined for all patients under 35 years of age undergoing IVF/ICSI with a fresh, cleavage-stage embryo transfer between January 2007 and December 2013 at our university based practice. Patients who underwent a minimal stimulation protocol were excluded. Data were collected on cycle characteristics and implantation and pregnancy outcomes. SAS was used for statistical analysis. T test and logistic regression were used for comparisons. RESULTS: 519 cycles were included in the analysis, 28 with less than 5 oocytes retrieved and 491 with 5 or more oocytes retrieved. Implantation rates (IR), pregnancy rates (PR), clinical pregnancy rates (CPR) and live birth rates (LBR) were calculated, all controlled for number of embryos transferred. Women with fewer than 5 oocytes retrieved had significantly fewer embryos transferred (ET) than those with 5 or more oocytes retrieved (1.7 vs 2.0, p<0.01). The implantation rates were not significantly different (34% vs. 36%, p¼0.95). After adjusting for the number of embryos transferred, there was no difference in the pregnancy rate, clinical pregnancy rate or live birth rate.

FERTILITY & STERILITYÒ

< 5 Oocytes

R5 Oocytes

p

28 3.18 1.68 46 43 34 39

491 14.02 2.04 57 53 36 44

p<0.01 0.75a 0.86a 0.95a 0.79a

N AVG # Eggs Retrieved AVG # ET PR (%) CPR (%) IR (%) LBR (%) a.

adjusted for number of embryos transferred

CONCLUSION: Young DOR patients who make it to retrieval have a good prognosis with IVF. While declining follicle number is associated with lower implantation and higher miscarriage rates among older women undergoing IVF, the same is not true for young women with DOR. With fewer oocytes retrieved, young DOR patients are likely to have fewer embryos for transfer, but the embryos they have, appear to have the same probability of implanting and resulting in a healthy pregnancy. Additionally, pregnancy and live birth rates following cleavage-stage transfers in this group are very good, indicating that there is still a role for day 3 transfers in an era of increasing use of extended culture. P-557 Wednesday, October 22, 2014 ESTRADIOL LEVEL AS A PARAMETER FOR OPTIMAL OVULATION TRIGGER DAY IN IVF/ICSI CYCLES. A. P. Melnick,a E. M. Murphy,a A. Khalifa,b R. Elias,a Z. Rosenwaks.a aThe Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY; bFaculty of Medicine, Alexandria University, Elazareeta, Alexandria, Egypt. OBJECTIVE: To determine whether the time interval from E2 of 400 pg/ mL to trigger has an effect on IVF cycle and pregnancy outcomes. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: IVF cycles in women younger than 35 years old with peak E2 of 1500-2500 pg/mL were analyzed. For accurate calculation of oocyte maturity, only ICSI cycles were included. hCG was used to trigger ovulation according to our center’s sliding scale. Cycles were stratified into two groups: hCG less than four days from an E2 of 400 pg/mL and hCG at least four days from an E2 of 400 pg/mL. Outcomes measured included total and mature oocyte yield, fertilization rate, implantation rate, embryo grade, blastocyst rate, and clinical pregnancy/live birth rates. Statistical analysis included c2 and t tests. P<0.05 was deemed statistically significant. RESULTS: We analyzed 965 IVF cycles from January 2006 to September 2011. Trigger occurred at less than four days from E2 of 400 pg/mL in 94 cycles and at least 4 days from E2 of 400 pg/mL in 871 cycles. The two groups were similar in terms of age, BMI, and lead follicle size at trigger. Peak E2 was significantly higher in the <4 days group. There were no differences in number of oocytes retrieved, number of mature oocytes retrieved, embryo grade, and fertilization rate. Blastocyst and implantation rates were significantly higher in the <4 days group. There was a trend toward higher clinical pregnancy and live birth rates in the <4 days group, though this did not reach statistical significance.

N Age BMI (kg/m2) Lead Follicle at HCG (mm) Peak E2 (pg/mL) #Oocytes Retrieved #Mature Oocytes Retrieved Fertilization Rate Best Embryo Grade (Day 3) Blastocysts/Cycle (%) Implantation Rate #Transferred Clinical Pregnancy/Cycle (%) Live Birth/Cycle (%)

<4 Days

R4 Days

94 30.92.7 22.65.4 18.71.5 18221.5 14.55.9 114.8 0.740.23 1.840.76 *36.2 *0.460.39 2.20.69 70 57.4

871 30.83.1 22.97.0 18.91.7 *2029404 14.05.7 10.94.9 0.730.49 1.860.77 23.7 0.370.39 2.10.69 62.8 47

*P<0.05

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CONCLUSION: In good responders, triggering ovulation less than 4 days from an estradiol level of 400 pg/mL leads to higher blastulation and implantation rates and likely higher clinical pregnancy and live birth rates. Further studies are needed to determine whether these findings hold true in other patient cohorts. P-558 Wednesday, October 22, 2014 PROSPECTIVE VALIDATION OF A TIME-LAPSE BASED ALGORITHM FOR EMBRYO SELECTION. S. Perez, I. Rubio, B. Aparicio, D. Beltran, V. Garcıa-Laez, M. Meseguer. IVF Laboratory, Instituto Universitario IVI Valencia, University of Valencia, Valencia, Spain. OBJECTIVE: To validate a published morphokinetic algorithm (Meseguer et al., 2011) for embryo selection by time-lapse technology. DESIGN: Prospective, randomized, triple blinded, controlled study. This study includes 930 patients undergoing IVF. MATERIALS AND METHODS: Patients were randomly divided into a control group (patients whose embryos developed in a conventional incubator (SI) and were assessed only by conventional morphological criteria) and a study group (in which embryos were cultured in the time-lapse monitoring system (TMS) EmbryoScope (Fertiiltech, Aahrus, DK) and were evaluated using a hierarchical morphokinetic model). The morphokinetic model establishes five embryo categories based on precise timing of cell division. Embryo implantation rate (IR) was evaluated in each morphokinetic category in the TMS group or morphological criteria in the SI group. RESULTS: We observed a direct relationship between morphokinetic categories and implantation potential in TMS group. Also a direct relationship was observed between morphology categories and implantation rates in SI.

MATERIALS AND METHODS: For objectives (a) and (b), 160 mature oocytes derived from 22 patients were injected by two practitioners. Oocytes from each patient were randomly split to be injected either using the I3 (n¼ 82) or the IntegraTI (n¼78) systems. For objective (c), two technicians (not the practioners) independently assessed the videos of 108 individual ICSIs from 17 patients with an average age of 39.4 years and average cycle number of 1.8 for four individual techniques: injection symmetry, oolemma breakage, furrow persistance and oolemma breakage. Injected oocytes were cultured in an EmbryoscopeÒ to assess PIs and morphokinetics. Continuous data (morphokinetics) were analysed using a generalised linear mixed model (assessed parameter¼ICSI rig*practitioner), with patient as the random factor. Categorical data (Performance Indicators, PIs) were assessed using Chi-square test and considered significant where p<0.05. All embryos were selected for transfer blindly in relation to treatment. RESULTS: For objective (a), PIs [fertilisation (72%vs67%), degeneration (7%vs6%), 3PN (2%vs1%), proportion of embryos with even first cell division (78%vs74%) and overall embryo utilisation rate by day 5 (63%vs52%)] were not significantly affected by treatment (I3 vs IntegraTi respectively). The proportion of embryos selected for transfer was two times higher for I3 compared to IntegraTI embryos (27%vs12%,p<0.05). The morphokinetic data indicates that the time to reach cell stages from two cells to hatching blastocyst (t2, t3, t4, t5, t6, t7, t8, tsC, tsB, tB, teB, tHB) were not significantly different between the two systems. I3 embryos had longer CC2 compared to IntegraTi embryos (meanstandard deviation: 10.75.2h vs 7.26.1h respectively,p¼0.004), and the difference in S2 was not significant (1.72.9vs3.55.5h,p¼0.06). None of the assessed parameters were affected by practitioner or ICSI technique. CONCLUSION: This study suggests that ICSI practitioner and injection techniques assessed do not affect fertilisation or embryo morphokinetics, although ICSI equipment can have an effect on embryo morphokinetics. Supported by: Research Instruments provided ICSI needles and holders for this study.

Table 1

Embryo morphokinetic category (TMS) A (n¼202) B (n¼82) C (n¼119) D (n¼58) E (n¼51)

Implantation Rate Embryo morphology Implantation (%) category (SI) Rate (%) 52.9 43.9 39.5 29.3 13.7

I (n¼72) II (n¼224) III (n¼146) IV (n¼27) V (n¼0)

38.8 35.7 24.7 11.1 -

Results were only referred to those embryos with known implantation (KID embryos). CONCLUSION: Our study has demonstrated that the embryo incubation and selection in the integrated TMS Supported by the use of a multivariable morphokinetic model improves embryo selection and the reproductive outcome in comparison with a standard incubator (SI) embryo culture and selection based exclusively on morphology. The observed increase in clinical parameters may have multiple explanations, as the increased information on embryo development for qualitative evaluation of morphology and the use of quantitative morphokinetic parameters for selecting viable embryos. This is the first prospective validation of a time-lapse based algorithm. P-559 Wednesday, October 22, 2014 ICSI PRACTITIONER, TECHNIQUE AND EQUIPMENT: DO THESE FACTORS AFFECT FERTILISATION OUTCOME, EMBRYO QUALITY OR MORPHOKINETICS? G. Danielle, M. Escriba, C. Cook, C. Hickman. Embryology, Boston Place Clinic, London, Marylebone, United Kingdom. OBJECTIVE: To establish whether ICSI factors (a) equipment (I3 vs IntegraTi, Research Instruments), (b) practitioner and (c) technique during ICSI, affect fertilisation outcome, embryo quality and morphokinetic parameters. DESIGN: This observational study was undertaken in a private IVF clinic setting as part of the validation process. A prospective blind sibling study design was used where practitioners interchanged between the ICSI equipment for a balanced design.

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ASRM Abstracts

P-560 Wednesday, October 22, 2014 THE EFFECT OF HEPATITIS B AND C ON SEMEN PARAMETERS IN ART. C. Harrity,a D. A. Vaughan,a,b E. Mocanu.a aHari Unit, Dublin, Ireland; bOb-Gyn, Tufts Medical Center, Boston, MA. OBJECTIVE: Data in the literature suggests viral infections such as HBV, HCV have a negative effect on semen parameters, although evidence is not compelling. We sought to assess semen parameters in patients with active or chronic hepatitis B, a past history of hepatitis B, or active or chronic hepatitis C undergoing ART. DESIGN: A retrospective electronic database and single chart review of all ART cycles undertaken from January 2000 through December 2012 in a single, hospital based academic ART unit in Ireland. MATERIALS AND METHODS: Between January 2000 through December 2012, all male patients seropositive for active hepatitis B (HBsAg +, anti-HBc +, IgM anti-HBc +), chronic hepatitis B (HBSAg +, anti-HBc +, IgM anti-HBc -), a past hepatitis B infection (anti-HBc +, antiHBs -) or active or chronic hepatitis C (anti-HCV +, +/- detectable HCV RNA) were identified and age matched against controls, ratio of 1:1. Semen parameters analyzed: sample volume, count, motility and morphology. SPSS v21.0 was used for statistical analysis with t-test used to compare mean with chi-squared analysis used to interpret proportions. P values represent the case compared to corresponding control value with p<0.05 considered statistically significant. RESULTS: Over the study period, 93 men were identified as having active or chronic hepatitis B, 239 with evidence of past hepatitis B infection and 152 men with evidence of active or chronic hepatitis C infection. Semen sample volume of cohort- mean 2.8cc for all patients with either active/chronic HBV, past HBV or active/chronic HCV, comparable to our control group (mean 3.1cc). Sperm count of our cohort - mean 30.2, 32.5 and 32.7 million/cc for patients with active/chronic HBV, past HBV or active/chronic HCV respectively, comparable to our control group (mean 33.7 million). Sperm motility of cohort- mean 45.8, 44.9 and 46.7 % for all patients with active/ chronic HBV, past HBV or active/chronic HCV respectively, comparable to our control group (mean 47.9%). Sperm morphology of our cohort we noted the mean to be 86.4, 92.5 and 89.6% for patients with active/chronic HBV, past HBV or active/chronic HCV respectively, comparable to our control group (mean 93.6%). None of the above differences reached statistical significance. CONCLUSION: While there is some evidence in the literature that viral infections such as hepatitis B and hepatitis C have a detrimental effect on

Vol. 102, No. 3, Supplement, September 2014