- Email: [email protected]
Infertility and cancer in young women. Psychological features
laparoscopicaly pulling the fallopian tubes extracorporeally and gradual injection of the ovarian tissue in the broad ligament. After injection, the tubes wer brought back into the pelvis. Four to 6 months after the transplant procedure and in an indoor settings, the sheep were simulated by feeding them MGA 0.25 mg per day for 2 cycles for either 7 or 12 days followed by injection of 500IU after 7days or 750 IU after 12 days of PMSG. The sheep were monitored during the simulated cycles by FSH and progesterone measurements and rectal U/S. RESULTS: Following castration, FSH rose to castration levels, whereas progesterone levels became non detectable. During stimulation, 3 out of 5 sheep showed slightly positive response to stimulation showing a variable rise in serum progesterone levels, as well as endometrial thickening and follicular growth by rectal U/S follow up. CONCLUSIONS: This pilot demonstrates the possibility of vitrifying ovarian fragments in the Ohio-Cryo and their transplantation by a minimally invasive technique. However the ovarian reserve was severely compromised. Limitations include: 1- Retroperitoneal transplant site, 2- Clumping or dispersion of the grafted tissue. Supported by: RPC and Csite/ Cleveland Clinic.
OBJECTIVE: Studies conducted by this lab (Meintjes et al., 2007) showed a similar LBR probability for fresh blastocysts with inner cell mass (ICM) grades A, B, C and lower probability for grades D-F. LBR probabilities for TB grades were A-64%, B-49%, C-35% and D-13%. Based on these and other studies, blastocysts with ICM grade C or better and TB grade B or better were deemed freeze quality. The objective was to examine the effect of prefreeze TB quality on FET cyrosurvival (CS), IR and LBR to determine whether embryos with C-grade TB should routinely be frozen. DESIGN: Retrospective data analysis from 561 FET cycles from 20012007. MATERIALS AND METHODS: Blastocysts with ICM grades A, B or C (A best, F worst) and TB grades A or B (A best, D worst) were deemed freeze quality. Blastocysts with C-grade TB were frozen per physician/patient request. Blastocysts were frozen 112-140 hours post-insemination using standard 2-step glycerol-sucrose and thawed using modified glycerolsucrose 15 hours before FET. Cycles where all embryos thawed had the same prefreeze TB grade and ICM grade C or better were compared using Chi-square. RESULTS: Average embryos transferred (TRS) was similar for A-, B- and C-TB. There were no significant differences in CS, IR or LBR among the TB groups. Spontaneous pregnancy loss (SAB) appeared higher for C-grade TB, but was not significant.
P-344 Wednesday, October 21, 2009 INFERTILITY AND CANCER IN YOUNG WOMEN. PSYCHOLOGICAL FEATURES. C. Sa´ez-Mansilla, R. Costa-Ferrer, L. Carmona-Saborido, T. Sa´ez, A. Pellicer, M. Sa´nchez. Hospital Universitario Dr Peset, Valencia, Spain; IVI-Valencia, Valencia, Spain. OBJECTIVE: To assess psychological effects of infertility due to cancer treatment in young females. DESIGN: Exploratory cross-sectional study. MATERIALS AND METHODS: 40 women in fertile age, diagnosed of cancer before undergoing gonadotoxic treatment were included in the study. All patients were interviewed before ovarian cortex extraction in order to preserve their fertility, at the Valencia Program for Fertility Preservation. Interview included medical and social-demographic data, gynaecological and obstetrics history, received information concerning fertility preservation, motivation and attitudes to intervention and to maternity and alternative ways of being a mother. In addition, several questionnaires were employed in order to assess different psychological data (IES-R, BSI-18, STAXI-2, EMASP and COPE). RESULTS: The degree of concern on a scale of one to ten was 8.8. The degree of concern in all of them decreased by the fact subjected to the intervention of ovarian cortex extraction. The most frequently mentioned reason for surgery was to have children in the future (75.56%) although it was also important for them to recover the hormonal function. The experience of cancer increased the desire to have biological children at 30% of cases. Sixtyfive percent preferred (total agreement) adoption as an alternative in contrast to 20% that preferred ovum donation. High levels of social support and low levels of general and specific psychological distress (anger and symptoms of post-traumatic stress disorder) were found. Coping strategies employed by most patients were active and focused on the problem. CONCLUSIONS: Infertility problems associated with cancer treatment were a concern for those young patients who faced this disease. However it was not accompanied by significant psychological distress levels. This could be explained by the specific characteristics of our sample (undergoing fertility preservation intervention, high social support and active coping strategies and focusing on the problem). Supported by: We did not receive any support.
P-345 Wednesday, October 21, 2009 WITHDRAWN
CRYOPRESERVATION P-346 Wednesday, October 21, 2009 EFFECT OF PREFREEZE TROPHOBLAST (TR) QUALITY ON FROZEN EMBRYO TRANSFER (FET) IMPLANTATION (IR) AND LIVE BIRTH RATES (LBR). T. Ferguson, D. Ward, S. J. Chantilis, K. L. Lee, D. M. Bookout, D. G. Hammitt. ARTS, Texas Health Presbyterian Dallas, Dallas, TX; ARTS, Texas Health Presbyterian Plano, Plano, TX.
FERTILITY & STERILITYÒ
TABLE 1. Effect of TB quality at cryopreservation on FET outcomes. TB No. Grade Cycles A B C
CS (%)
49 81/91 (89.0) 485 785/901 (87.1) 27 40/45 (88.9)
Avg. No. TRS 1.63 1.59 1.52
IR (%)
Pregnancies R 1 FHB (%)
SAB (%)
LBR (%)
29/80 (36.2) 19/49 (38.8) 2/19 (10.5) 17/49 (34.7) 319/772 (41.3) 223/485 (46.0) 27/223 (12.1) 196/485 (40.4) 18/41 (43.9) 12/27 (44.4) 2/12 (16.7) 10/27 (37.0)
CONCLUSIONS: Results from this study suggest that CS, IR and LBR may be similar for A-, B- and C-TB. These data support cryopreservation of C-grade TB if the ICM is grade C or better. A larger study is needed to further examine effect of TB grade on SAB.
P-347 Wednesday, October 21, 2009 EFFICACY OF THAW, TROPHECTODERM BIOPSY, RE-CRYOPRESERVATION, AND PRE-IMPLANTATION GENETIC SCREENING ON PREVIOUSLY FROZEN BLASTOCYST EMBRYOS. K. A. Miller, K. Ferry, R. Olivares, J. Su, N. R. Treff, R. T. Scott. Reproductive Medicine Associates of NJ, Morristown, NJ; UMDNJ-Robert Wood Johnson Medical School, Morristown, NJ. OBJECTIVE: Traditionally, preimplantation genetic screening has involved the biopsy of a single blastomere from cleavage stage embryos derived from fresh or frozen IVF cycles. The objective of this study was to demonstrate that microarray based 24- chromosome aneuploidy (24-CAS) or single gene (SGS) screening can be successfully applied to previously frozen blastocyst embryos. DESIGN: Prospective cohort study. MATERIALS AND METHODS: Frozen blastocysts underwent thaw, trophectoderm (TE) biopsy and re-freeze pending 24-CAS or SGS. After postthaw re-expansion, 5-10 TE cells were biopsied from the embryos using a Zilos laser. All blastocysts that survived the biopsy procedure were re-frozen using slow freeze methodology (Menezo 1992). Frozen embryo transfers (FET) were performed in a controlled hormone replacement cycle with endometrial preparation by step-up oral estradiol dosing in the follicular phase and intra-muscular progesterone in the luteal phase. RESULTS: A total of 71 frozen blastocysts in eighteen patients were thawed, biopsied and re-frozen. Seventeen patients were evaluated for aneuploidy utilizing 24-CAS and one patient underwent SGS for cystic fibrosis. Two patients had no normal frozen blastocysts based on 24-CAS. 10 FET cycles (8 patients) have been completed (nine 24- CAS and one SGS). In these cycles, 17 embryos were thawed and 16 embryos survived (94%) and were transferred (1.6 þ 0.7 embryos; meanþSD). Five of the 10 cycles (50%) had positive cardiac activity with a 37.5% implantation rate. One patient has delivered, 3 patients are ongoing and the fifth patient’s pregnancy ended in a clinical loss. CONCLUSIONS: Frozen blastocyst embryos subjected to thaw, TE biopsy and re-cryopreservation exhibited high survival, pregnancy and implantation rates. This technology allows for comprehensive genetic screening of
S185
OBJECTIVE: Studies conducted by this lab (Meintjes et al., 2007) showed a similar LBR probability for fresh blastocysts with inner cell mass (ICM) grades A, B, C and lower probability for grades D-F. LBR probabilities for TB grades were A-64%, B-49%, C-35% and D-13%. Based on these and other studies, blastocysts with ICM grade C or better and TB grade B or better were deemed freeze quality. The objective was to examine the effect of prefreeze TB quality on FET cyrosurvival (CS), IR and LBR to determine whether embryos with C-grade TB should routinely be frozen. DESIGN: Retrospective data analysis from 561 FET cycles from 20012007. MATERIALS AND METHODS: Blastocysts with ICM grades A, B or C (A best, F worst) and TB grades A or B (A best, D worst) were deemed freeze quality. Blastocysts with C-grade TB were frozen per physician/patient request. Blastocysts were frozen 112-140 hours post-insemination using standard 2-step glycerol-sucrose and thawed using modified glycerolsucrose 15 hours before FET. Cycles where all embryos thawed had the same prefreeze TB grade and ICM grade C or better were compared using Chi-square. RESULTS: Average embryos transferred (TRS) was similar for A-, B- and C-TB. There were no significant differences in CS, IR or LBR among the TB groups. Spontaneous pregnancy loss (SAB) appeared higher for C-grade TB, but was not significant.
P-344 Wednesday, October 21, 2009 INFERTILITY AND CANCER IN YOUNG WOMEN. PSYCHOLOGICAL FEATURES. C. Sa´ez-Mansilla, R. Costa-Ferrer, L. Carmona-Saborido, T. Sa´ez, A. Pellicer, M. Sa´nchez. Hospital Universitario Dr Peset, Valencia, Spain; IVI-Valencia, Valencia, Spain. OBJECTIVE: To assess psychological effects of infertility due to cancer treatment in young females. DESIGN: Exploratory cross-sectional study. MATERIALS AND METHODS: 40 women in fertile age, diagnosed of cancer before undergoing gonadotoxic treatment were included in the study. All patients were interviewed before ovarian cortex extraction in order to preserve their fertility, at the Valencia Program for Fertility Preservation. Interview included medical and social-demographic data, gynaecological and obstetrics history, received information concerning fertility preservation, motivation and attitudes to intervention and to maternity and alternative ways of being a mother. In addition, several questionnaires were employed in order to assess different psychological data (IES-R, BSI-18, STAXI-2, EMASP and COPE). RESULTS: The degree of concern on a scale of one to ten was 8.8. The degree of concern in all of them decreased by the fact subjected to the intervention of ovarian cortex extraction. The most frequently mentioned reason for surgery was to have children in the future (75.56%) although it was also important for them to recover the hormonal function. The experience of cancer increased the desire to have biological children at 30% of cases. Sixtyfive percent preferred (total agreement) adoption as an alternative in contrast to 20% that preferred ovum donation. High levels of social support and low levels of general and specific psychological distress (anger and symptoms of post-traumatic stress disorder) were found. Coping strategies employed by most patients were active and focused on the problem. CONCLUSIONS: Infertility problems associated with cancer treatment were a concern for those young patients who faced this disease. However it was not accompanied by significant psychological distress levels. This could be explained by the specific characteristics of our sample (undergoing fertility preservation intervention, high social support and active coping strategies and focusing on the problem). Supported by: We did not receive any support.
P-345 Wednesday, October 21, 2009 WITHDRAWN
CRYOPRESERVATION P-346 Wednesday, October 21, 2009 EFFECT OF PREFREEZE TROPHOBLAST (TR) QUALITY ON FROZEN EMBRYO TRANSFER (FET) IMPLANTATION (IR) AND LIVE BIRTH RATES (LBR). T. Ferguson, D. Ward, S. J. Chantilis, K. L. Lee, D. M. Bookout, D. G. Hammitt. ARTS, Texas Health Presbyterian Dallas, Dallas, TX; ARTS, Texas Health Presbyterian Plano, Plano, TX.
FERTILITY & STERILITYÒ
TABLE 1. Effect of TB quality at cryopreservation on FET outcomes. TB No. Grade Cycles A B C
CS (%)
49 81/91 (89.0) 485 785/901 (87.1) 27 40/45 (88.9)
Avg. No. TRS 1.63 1.59 1.52
IR (%)
Pregnancies R 1 FHB (%)
SAB (%)
LBR (%)
29/80 (36.2) 19/49 (38.8) 2/19 (10.5) 17/49 (34.7) 319/772 (41.3) 223/485 (46.0) 27/223 (12.1) 196/485 (40.4) 18/41 (43.9) 12/27 (44.4) 2/12 (16.7) 10/27 (37.0)
CONCLUSIONS: Results from this study suggest that CS, IR and LBR may be similar for A-, B- and C-TB. These data support cryopreservation of C-grade TB if the ICM is grade C or better. A larger study is needed to further examine effect of TB grade on SAB.
P-347 Wednesday, October 21, 2009 EFFICACY OF THAW, TROPHECTODERM BIOPSY, RE-CRYOPRESERVATION, AND PRE-IMPLANTATION GENETIC SCREENING ON PREVIOUSLY FROZEN BLASTOCYST EMBRYOS. K. A. Miller, K. Ferry, R. Olivares, J. Su, N. R. Treff, R. T. Scott. Reproductive Medicine Associates of NJ, Morristown, NJ; UMDNJ-Robert Wood Johnson Medical School, Morristown, NJ. OBJECTIVE: Traditionally, preimplantation genetic screening has involved the biopsy of a single blastomere from cleavage stage embryos derived from fresh or frozen IVF cycles. The objective of this study was to demonstrate that microarray based 24- chromosome aneuploidy (24-CAS) or single gene (SGS) screening can be successfully applied to previously frozen blastocyst embryos. DESIGN: Prospective cohort study. MATERIALS AND METHODS: Frozen blastocysts underwent thaw, trophectoderm (TE) biopsy and re-freeze pending 24-CAS or SGS. After postthaw re-expansion, 5-10 TE cells were biopsied from the embryos using a Zilos laser. All blastocysts that survived the biopsy procedure were re-frozen using slow freeze methodology (Menezo 1992). Frozen embryo transfers (FET) were performed in a controlled hormone replacement cycle with endometrial preparation by step-up oral estradiol dosing in the follicular phase and intra-muscular progesterone in the luteal phase. RESULTS: A total of 71 frozen blastocysts in eighteen patients were thawed, biopsied and re-frozen. Seventeen patients were evaluated for aneuploidy utilizing 24-CAS and one patient underwent SGS for cystic fibrosis. Two patients had no normal frozen blastocysts based on 24-CAS. 10 FET cycles (8 patients) have been completed (nine 24- CAS and one SGS). In these cycles, 17 embryos were thawed and 16 embryos survived (94%) and were transferred (1.6 þ 0.7 embryos; meanþSD). Five of the 10 cycles (50%) had positive cardiac activity with a 37.5% implantation rate. One patient has delivered, 3 patients are ongoing and the fifth patient’s pregnancy ended in a clinical loss. CONCLUSIONS: Frozen blastocyst embryos subjected to thaw, TE biopsy and re-cryopreservation exhibited high survival, pregnancy and implantation rates. This technology allows for comprehensive genetic screening of
S185