Estradiol Levels on the Day of hCG Administration and Live-Born Pregnancy Rates in Women Undergoing IVF

P-40 Estradiol Levels on the Day of hCG Administration and Live-Born Pregnancy Rates in Women Undergoing IVF. S.N. Khan,a L.B. Craig,a M.T. Zavy,a B. Zavy,a K.R. Hansen.a a Department of Ob/Gyn, University of Oklahoma Health Sciences Center, Oklahoma City, OK. BACKGROUND: Previous investigations have suggested a controversial relationship between serum estradiol levels on the day of HCG administration and pregnancy rates in women undergoing in-vitro fertilization (IVF). Some studies have suggested that high estradiol levels may have an adverse impact on pregnancy rates secondary to lower implantation rates [1]. Conversely, other studies have suggested that elevated estradiol levels and high oocyte yield are not associated with adverse IVF outcome [2]. OBJECTIVE(S): To elucidate the relationship between serum estradiol level on the day of HCG administration in women undergoing IVF treatment and live-born pregnancy rate. METHOD(S): We conducted a retrospective review of women undergoing fresh IVF treatment cycles between 2006 and 2010 at the University of Oklahoma. Patients were arbitrarily divided into three groups based on serum estradiol level on the day of HCG administration (<2000 pg/mL, n ¼ 98, 2000-4000 pg/mL, n ¼ 230, and >4000 pg/mL, n ¼ 71; total n ¼ 399). Pregnancy rates and embryo quality were compared between groups with contingency table analyses. Age and the number of embryos transferred were compared with one-way ANOVA. To control for the quality of embryos transferred, subgroup analyses were performed excluding those patients that had only poor quality embryos transferred. RESULT(S): Across the groups, the differences in pregnancy rates were statistically significant (p ¼ 0.0125), with the highest estradiol group having the highest live-born pregnancy rate (65%) compared to the intermediate and lowest estradiol groups (57% and 43%, respectively). However, the highest estradiol group also had the best quality embryos for transfer. In the subgroup analyses in which those women with poor quality embryos for transfer were excluded, there was a trend towards higher live-born pregnancy rate with higher estradiol levels; however, these differences did not reach statistical significance (p ¼ 0.52, n ¼ 338). Age and the number of embryos transferred were not significantly different between groups. CONCLUSION(S): In this investigation, higher estradiol levels on the day of HCG administration were associated with a higher live-born pregnancy rate. In the analyses excluding those women with only poor quality embryos for transfer, high estradiol levels were not associated with a negative impact on live-born pregnancy rate. References 1. Joo, B, et al., Serum estradiol levels during controlled ovarian hyperstimulation influence pregnancy outcome IVF in a concentrationdependent manner. Fertility and Sterility 2010. 93(2): p. 442–6. 2. Sharara, F, et al., High estradiol levels and high oocyte yield are not detrimental to IVF outcome. Fertility and Sterility 1999. 72(3): p. 401–5.

P-41 The Incidence of Aneuploidy Does not Significantly Increase With Advancing Paternal Age in Couples With A History of Recurrent Pregnancy Loss. P.R. Brezina,a K. Tobler,a A.T. Benner,b L. Du,b B. Boyd,b W.G. Kearns.a,b a Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins Medical Institutions, Baltimore, MD; b Genetics, Center for Preimplantation Genetics, LabCorp. Rockville, MD. OBJECTIVE(S): To determine if patients undergoing in vitro fertilization (IVF) and preimplantation genetic screening (PGS) for recurrent pregnancy loss (RPL) experienced increased rates of aneuploidy with increasing paternal age. MATERIALS AND METHOD(S): A retrospective review was conducted of all embryos that underwent PGS by 23 chromosome SNP microarrays from January 2010 to January 2011. Patients underwent standard IVF and PGS primarily due to a history of R 2 spontaneous miscarriages. Embryo biopsy was performed at either the cleavage or blastocyst stage. Sample DNA was amplified and analyzed using HumanCytoSNP-12 DNA beadchips and GenomeStudio and KaryoStudio software. Embryos derived from parents with known translocations or inversions were excluded from the study. Data was split into four patient groups based on paternal age (%30, 31-36, 37-42, 43-48, 49-54, and R55). Binomial confidence intervals for proportions were calculated. RESULT(S): 1,903 embryos from 236 clinical IVF cycles were tested. Nine percent of embryos were highly fragmented and of low quality. DNA

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amplificaition on these embryos was not possible and no molecular karyotype was obtained. There rate of morphologic fragmentation did not statistically differ between groups. There was not a significant difference in aneuploidy, ranging from 47% to 55%, in the groups of men from the ages of ‘‘%30’’ to age 54. Of note, in men R55 years of age, there was a decrease in the rate of aneuploidy to 37% (n¼19/51). Statistical significance was identified in the difference seen in men R55 years of age compared to men age 43-48(P¼0.002). No other significance was identified (Figure 1). CONCLUSION(S): Increasing paternal age has been correlated with a decrease in semen quality and increase in the percentage of sperm with abnormal DNA (Varshini 2011). However, data has not clearly shown an association between advanced paternal age and offspring with genetic defects (Fonseka 2011). Our data suggests that advancing paternal age does not significantly increase the rate of aneuploid embryos in couples with RPL. SUPPORT: None. References 1) Varshini J, et al. Poor sperm quality and advancing age are associated with increased sperm DNA damage in infertile men. Andrologia. 2011 Nov 1. [Epub ahead of print] 2) Fonseka KG, Griffin DK. Is there a paternal age effect for aneuploidy? Fig. 1.

Cytogenet Genome Res. 2011;133(2-4):280-91.

P-42 Evaluation of 571 In Vitro Fertilization (IVF) Cycels and 4,873 Embryos Using 23-Chromosome Single Nucleotide Polymorphism (SNP) Microarray Preimplantation Genetic Screening (PGS). P.R. Brezina,a K. Tobler,a A.T. Benner,b L. Du,b B. Boyd,b W.G. Kearns.a,b a Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins Medical Institutions, Baltimore, MD; b Genetics, Center for Preimplantation Genetics, LabCorp. Rockville, MD. OBJECTIVE(S): To determine the pregnancy and miscarriage rates of patients undergoing IVF and dense microarray preimplantation genetic screening (PGS) for recurrent pregnancy loss (RPL). MATERIALS AND METHOD(S): A retrospective review was conducted of all embryos that underwent PGS by 23 chromosome SNP microarrays from January 2010 to November 2011. Patients underwent standard IVF and PGS primarily due to a history of R 2 spontaneous miscarriages. Embryo biopsy was performed at either the cleavage or blastocyst stage. Sample DNA was amplified and analyzed using HumanCytoSNP-12 DNA beadchips and GenomeStudio and KaryoStudio software. Embryos derived from parents with known translocations or inversions were excluded from the study. Data was split into four patient groups based on maternal age (<35, 35-37, 38-40, >40). Microarray data was also compared to previously published flourescence in sit hybridization (FISH) PGS data from our laboratory (previously published). Binomial confidence intervals for proportions were calculated. RESULT(S): A total of 4,873 molecular karyotypes were obtained from 571 IVF cycles. The overall pregnancy rate per IVF cycle for women in this trial undergoing 23-chromosome SNP microarray PGS for RPL was 58% with a miscarriage rate of 10%. In blastocyst stage PGS, the pregnancy

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