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Factors related to embryo-endometrium asynchrony in fresh IVF cycles increase in prevalence with maternal age
OBJECTIVE: Thawed blastocyst cultured overnight before transfer suits clinical work schedule better. This study aims to compare the pregnancy outcomes when frozen blastocyst was transferred 2 to 3 hours after being thawed or 16 to 20 hours after being cultured overnight. DESIGN: Retrospectively analyze the frozen blastocyst transfer cycles which can be divided into two group based the culture duration. Endometrium preparation methods(natural cycle/NC, hormone replacement treatment/HRT or controlled ovarian stimulation/COH), blastocyst developmental stage(D5 or D6), blastocyst score are compared between groups besides demographic information. MATERIALS AND METHODS: From September of 2010 to October of 2012, there are 523 cycles included: those blastocysts transferred 2 to 3 hours after being thawed are in 0TET group(n¼247) and those cultured overnight are in 1TET group(n¼276).Chi square test for categorical variables and t-test for consecutive variables are applied. RESULTS: Compared with 0TET group, 1TET group has higher pregnancy rate/PR (57.6% vs. 56.3%), implantation rate/IR (46.3% vs. 44.1%) but less embryo transferred (1.6 vs. 1.8, P<0.001), lower miscarriage rate (9.4% vs. 12.2%) and lower multiple pregnancy rate (28.3%vs. 36.7%) with no statistical significance except number of embryo transferred. HRT as endometrium preparation method has achieved higher PR (62.8% vs. 53.0%, p¼0.027). Embryos that reached blastocyst frozen criteria at the fifth day after fertilization(D5) have higher IR than those at the sixth day (57.6% vs. 36.1%, p¼0.004). CONCLUSION: Overnight culture of thawed blastocyst before transfer does not have negative impact on the pregnancy outcomes. HRT as endometrium preparation method and D5 blastocyst transfer have better outcomes. Since D5 blastocyst have achieved considerable implantation rate, single blastocyst transfer is encouraged to avoid multiple pregnancy. Supported by: National Nature Scientific Funds of China(No: 81070495). P-479 Wednesday, October 16, 2013 FACTORS RELATED TO EMBRYO-ENDOMETRIUM ASYNCHRONY IN FRESH IVF CYCLES INCREASE IN PREVALENCE WITH MATERNAL AGE. B. S. Shapiro,a,b S. T. Daneshmand,a,b F. C. Garner,a,b M. Aguirre,a C. Hudson.a aFertility Center of Las Vegas, Las Vegas, NV; bObstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, NV. OBJECTIVE: This study determines if markers of embryo-endometrium asynchrony (day 6 blastulation and premature progesterone (P4) elevation) increase with maternal age. DESIGN: IRB-approved retrospective cohort study. MATERIALS AND METHODS: Fresh autologous cycles were examined according to maternal age, day of blastulation/transfer, premature P4 elevation (P4>1.5 ng/ml), and live birth. RESULTS: There were 1,341 qualifying fresh autologous day 5 and day 6 blastocyst transfers in the 7-year study period in patients %40 years old. The proportion of transfers performed on day 6 increased with age (P<0.0001) as did the frequency of premature P4 elevation (P¼0.0126). The proportion of asynchronous transfers (day 6 transfer or elevated P4) increased with age (P<0.0001). The risk ratios for asynchronous transfer (compared to %30 age group) were 1.23 (95% CI, 1.09-1.40) in patients 31-34 years old and 1.44 (95% CI, 1.29-1.62) in patients 35-40 years old. Multivariate logistic regression found live birth was predicted by day 5 transfer (P<0.0001) and non-elevated P4 (P¼0.0002) after controlling for age.
TABLE 1. Proportions of transfers according to synchrony markers
%30 years 31-34 years 35-40 years Transfers 419 436 Day 6 transfers (%) a 143 (34.1) 194 (44.5) Elevated P4 (%) a 96 (22.9) 110 (25.2) Asynchronous transfers (%) a 200 (47.7) 257 (58.9)
486 264 (54.3) 152 (31.3) 335 (68.9)
a¼Proportions differ significantly across age groups (P<0.05). CONCLUSION: Embryo-endometrium asynchrony in IVF cycles steadily worsens with age, corresponding with reduced live birth rates and contributing to inferior success rates in older patients.
FERTILITY & STERILITYÒ
P-480 Wednesday, October 16, 2013 MULTIPLE PREGNANCY RATE BASED ON HISTORY OF CLINICAL PREGNANCY. H. Kitasaka,a,b N. Fukunaga,a,b,c T. Yoshimura,a,b E. Kojima,a,b F. Tamura,a,b Y. Asada.a,b,c aLaboratory, Asada Ladies Nagoya Clinic, Nagoya, Aichi, Japan; bLaboratory, Asada Ladies Kachigawa Clinic, Nagoya, Aichi, Japan; cThe Asada Institute for Reproductive Medicine, Nagoya, Aichi, Japan. OBJECTIVE: Multiple pregnancy represents a serious problem in artificial reproductive technology (ART). While single embryo transfer is the most effective way to prevent multiple pregnancy in ART, two embryos are often transferred in patients with advanced age, in cases of repeated failure, and when the procedure is strongly requested by patients. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: This study examined 771 cycles (frozenthawed cycles) in which two embryos were transferred between January and December 2011. Patients were divided into two groups based on history of clinical pregnancy. Cases with two or more confirmed fetal sacs were deemed to represent multiple pregnancy. Conditions for two-embryo transfer were age R40 years or 33 embryo transfer cycles. RESULTS: Mean patient age was 38.9 4.1 years in patients with a history of clinical pregnancy (Group A; n ¼ 391) and 38.8 4.5 years in patients with no history of clinical pregnancy (Group B; n ¼ 380). Clinical pregnancy rates were 105/391 (26.9%) for Group A and 169/380 (18.2%) for Group B. Multiple pregnancy rates were 25/105 (23.8%) for Group A and 8/69 (11.6%) for Group B. Multiple birth rates were 14/25 (56.0%) for Group A and 5/8 (62.5%) for Group B. Group A showed significantly higher clinical pregnancy and multiple pregnancy rates (P < 0.05). In cases of confirmed multiple pregnancy, the percentage of transfer of two good-quality embryos was 21/25 (84.0%) in Group A and 7/8 (87.5%) in Group B. CONCLUSION: A history of clinical pregnancy indicates higher fertility, associated with increased pregnancy and multiple pregnancy rates. Deciding on a two-embryo transfer according to age, number of transfer attempts, and patient requests is inappropriate; the absence of a history of clinical pregnancy should also be considered. The patient should be apprised of the risks of multiple pregnancy with two-embryo transfer, even if she is of advanced age or has attempted transfer multiple times.
P-481 Wednesday, October 16, 2013 WHICH IS BETTER; DAY 2 OR DAY 3 EMBRYO TRANSFER IN ANTAGONIST CYCLES? G. Sahin, A. Akdogan, N. Calimlioglu, T. Dogu, E. N. Tavmergen Goker, E. Tavmergen. Ege University IVF Center, Izmir, Turkey. OBJECTIVE: To investigate the embryo transfer day effect on pregnancy rates in GnRH antagonist cycles. DESIGN: Retrospective case control study. MATERIALS AND METHODS: Total of 1531 ICSI/embryo transfer cycles which have been performed at Ege University IVF Center between Jan 2010- December 2012 were evaluated. All cycles were performed with antagonist protocol. The study group consisted of those whose age <38, basal FSH level<12 mIU/ml, first two IVF attempts, rec FSH used and day 2 or 3 embryo transfer cycles. 735 embryo transfer cycles were analyzed. Student’s t test, c2 and multivariable logistic regression analysis was used as statistical method. p<0.05 was considered as significant. RESULTS: 249 cycles were day 2 and 486 were day 3 embryo transfers. The pregnancy rates were 31.7% vs. 40.3% for day 2 and day 3 transfers, p¼0.023. The mean age, distribution of infertility etiologies, basal FSH level, dosage of recFSH, peak E2, peak endometrial thickness and number of embryo transfers were similar between the groups. The mean number of oocytes and cleaved embryos were higher in day 3 embryo group. The total group was divided based on the number of cleaved embryos as follows; group I (n¼288) which had < 5 cleaved embryos and group II (n¼447) R5 cleaved embryos. In group I pregnancy rates were not different between day 2 and day 3 transfers, 31.5% vs 31.1%, p¼0.9. In contrast in group II the pregnancy rates were significantly higher for day 3 transfers than day 2 transfers, 44.9% vs. 32%, p¼0.013. The age, basal FSH level, number of oocytes and transferred embryos were similar between day 2 and day 3 transfers for both groups. The only differences were seen in the number of cleaved embryos. Day of embryo transfer (day 3 compared to day 2) was the independent predictor on the pregnancy rates in group II, OR: 1.7 (95% CI 1.1-2.6).
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TABLE 1. Proportions of transfers according to synchrony markers
%30 years 31-34 years 35-40 years Transfers 419 436 Day 6 transfers (%) a 143 (34.1) 194 (44.5) Elevated P4 (%) a 96 (22.9) 110 (25.2) Asynchronous transfers (%) a 200 (47.7) 257 (58.9)
486 264 (54.3) 152 (31.3) 335 (68.9)
a¼Proportions differ significantly across age groups (P<0.05). CONCLUSION: Embryo-endometrium asynchrony in IVF cycles steadily worsens with age, corresponding with reduced live birth rates and contributing to inferior success rates in older patients.
FERTILITY & STERILITYÒ
P-480 Wednesday, October 16, 2013 MULTIPLE PREGNANCY RATE BASED ON HISTORY OF CLINICAL PREGNANCY. H. Kitasaka,a,b N. Fukunaga,a,b,c T. Yoshimura,a,b E. Kojima,a,b F. Tamura,a,b Y. Asada.a,b,c aLaboratory, Asada Ladies Nagoya Clinic, Nagoya, Aichi, Japan; bLaboratory, Asada Ladies Kachigawa Clinic, Nagoya, Aichi, Japan; cThe Asada Institute for Reproductive Medicine, Nagoya, Aichi, Japan. OBJECTIVE: Multiple pregnancy represents a serious problem in artificial reproductive technology (ART). While single embryo transfer is the most effective way to prevent multiple pregnancy in ART, two embryos are often transferred in patients with advanced age, in cases of repeated failure, and when the procedure is strongly requested by patients. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: This study examined 771 cycles (frozenthawed cycles) in which two embryos were transferred between January and December 2011. Patients were divided into two groups based on history of clinical pregnancy. Cases with two or more confirmed fetal sacs were deemed to represent multiple pregnancy. Conditions for two-embryo transfer were age R40 years or 33 embryo transfer cycles. RESULTS: Mean patient age was 38.9 4.1 years in patients with a history of clinical pregnancy (Group A; n ¼ 391) and 38.8 4.5 years in patients with no history of clinical pregnancy (Group B; n ¼ 380). Clinical pregnancy rates were 105/391 (26.9%) for Group A and 169/380 (18.2%) for Group B. Multiple pregnancy rates were 25/105 (23.8%) for Group A and 8/69 (11.6%) for Group B. Multiple birth rates were 14/25 (56.0%) for Group A and 5/8 (62.5%) for Group B. Group A showed significantly higher clinical pregnancy and multiple pregnancy rates (P < 0.05). In cases of confirmed multiple pregnancy, the percentage of transfer of two good-quality embryos was 21/25 (84.0%) in Group A and 7/8 (87.5%) in Group B. CONCLUSION: A history of clinical pregnancy indicates higher fertility, associated with increased pregnancy and multiple pregnancy rates. Deciding on a two-embryo transfer according to age, number of transfer attempts, and patient requests is inappropriate; the absence of a history of clinical pregnancy should also be considered. The patient should be apprised of the risks of multiple pregnancy with two-embryo transfer, even if she is of advanced age or has attempted transfer multiple times.
P-481 Wednesday, October 16, 2013 WHICH IS BETTER; DAY 2 OR DAY 3 EMBRYO TRANSFER IN ANTAGONIST CYCLES? G. Sahin, A. Akdogan, N. Calimlioglu, T. Dogu, E. N. Tavmergen Goker, E. Tavmergen. Ege University IVF Center, Izmir, Turkey. OBJECTIVE: To investigate the embryo transfer day effect on pregnancy rates in GnRH antagonist cycles. DESIGN: Retrospective case control study. MATERIALS AND METHODS: Total of 1531 ICSI/embryo transfer cycles which have been performed at Ege University IVF Center between Jan 2010- December 2012 were evaluated. All cycles were performed with antagonist protocol. The study group consisted of those whose age <38, basal FSH level<12 mIU/ml, first two IVF attempts, rec FSH used and day 2 or 3 embryo transfer cycles. 735 embryo transfer cycles were analyzed. Student’s t test, c2 and multivariable logistic regression analysis was used as statistical method. p<0.05 was considered as significant. RESULTS: 249 cycles were day 2 and 486 were day 3 embryo transfers. The pregnancy rates were 31.7% vs. 40.3% for day 2 and day 3 transfers, p¼0.023. The mean age, distribution of infertility etiologies, basal FSH level, dosage of recFSH, peak E2, peak endometrial thickness and number of embryo transfers were similar between the groups. The mean number of oocytes and cleaved embryos were higher in day 3 embryo group. The total group was divided based on the number of cleaved embryos as follows; group I (n¼288) which had < 5 cleaved embryos and group II (n¼447) R5 cleaved embryos. In group I pregnancy rates were not different between day 2 and day 3 transfers, 31.5% vs 31.1%, p¼0.9. In contrast in group II the pregnancy rates were significantly higher for day 3 transfers than day 2 transfers, 44.9% vs. 32%, p¼0.013. The age, basal FSH level, number of oocytes and transferred embryos were similar between day 2 and day 3 transfers for both groups. The only differences were seen in the number of cleaved embryos. Day of embryo transfer (day 3 compared to day 2) was the independent predictor on the pregnancy rates in group II, OR: 1.7 (95% CI 1.1-2.6).
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