- Email: [email protected]
Is it worth reducing twins to singletons after IVF-ET? a retrospective cohort study using propensity score matching
P-708 Wednesday, November 1, 2017
P-709 Wednesday, November 1, 2017
VANISHING TWIN SYNDROME SURVIVORS HAVE LOWER LIVE BIRTH WEIGHT COMPARED WITH SINGLETONS ARISING FROM A SINGLE GESTAL. A. Murphy,b TIONAL SAC. M. Tarakji,a N. Resetkova,c E. A. Seidler,d A. Penzias,e D. Sakkas.a aBoston IVF, Waltham, MA; bReproductive Endocrinology & Infertility, BIDMC/Harvard Medical School, Boston, MA; cBoston IVF / Beth Israel Deaconess Medical Center, Boston, MA; dReproductive Endocrinology & Infertility, BIDMC, Harvard Medical School, Boston, MA; eBoston IVF / Harvard Medical School, Waltham, MA.
IS IT WORTH REDUCING TWINS TO SINGLETONS AFTER IVF-ET? A RETROSPECTIVE COHORT STUDY USING PROPENSITY SCORE MATCHING. L. Luo, H. Jie, M. Chen, Q. Wang. The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. OBJECTIVE: To explore whether elective fetal reduction from dichorionic twins to singletons after IVF-ET (In vitro fertilization and embryo transfer) is associated with increased take-home baby rate and improved pregnancy outcome. DESIGN: A retrospective cohort study using propensity score matching. MATERIALS AND METHODS: We conducted a retrospective cohort study of dichorionic twin pregnancy after IVF-ET between 2009 and 2015. The reduced group included 77 women who underwent transvaginal elective fetal reduction between 7 to 8 weeks of gestation. The non-reduced group (n¼3589) comprised patients who were managed expectantly without elective fetal reduction (including patients with later selective fetal reduction due to fetal abnomalities, spontaneous fetal reduction after 7-8 weeks and induced labor due to maternal complications or complex fetal abnomalities). We conducted propensity score matching to control for maternal age, body mass index, infertility types and main causes of infertility. The primary assessment of pregnancy outcomes was take-home baby rate which was defined as taking home at least one live baby. Other measurements included the rates of adverse pregnancy outcome, early and late miscarriage, premature delivery as well as gestational age, birth weight and neonatal defects. RESULTS: After propensity score matching, 71 pairs (781 cases, 1:10 matched) were selected for further analyses. The take-home baby rates in the reduced group was significantly lower than in the control group (83.1% vs. 90.7%, OR0.50, 95%CI 0.27 to 1.03, P¼0.042). The adverse outcome rate in the two groups were 19.7% vs. 13.5%, P¼0.152. The miscarriage rate seems to be higher in the reduced group, but did not reach statistical significance (early miscarriage, 5.6% vs. 2.8%; late miscarriage, 7.0% vs. 5.6%; total, 12.7% vs. 8.5%). Premature delivery rate was lower in reduced group (12.7% vs. 46.3%, OR 0.17, 95%CI 0.08-0.33, P<0.001). Over 90% of premature deliveries in non-reduced group were over 32 weeks while the proportions were equal in reduced group. The median delivery age was 38 weeks and 36 weeks in reduced and non-reduced group (P<0.001). Birth weight was significantly higher in reduced group, with a median of 3.0Kg vs. 2.5Kg (P<0.001).
OBJECTIVE: A number of studies have described the obstetric outcomes of the remaining fetus produced after the other twin had vanished compared with outcomes of deliveries originating from a singleton gestational sac, but the results are mixed and contradictory. In this study we compared the live birth weight outcomes in fresh and frozen transfers between singleton deliveries originating from a single gestational sac to those initiated as twin gestational sacs. DESIGN: A case-control study of 9693 singleton deliveries after IVF fresh and frozen embryo transfer (ET) over a period of 20 years from 1996 to 2015. MATERIALS AND METHODS: Comparing the live birth weight of 706 singleton deliveries originating from a twin gestation (case group) with live birth weight of 8987 singleton deliveries originating from a single gestation (control group) in both embryo transfer methods (fresh and frozen). Statistical evaluation was performed by comparing mean singleton birth weights. RESULTS: Out of 9693 singleton deliveries, 706 (7.28%) originated from vanishing twin syndrome (VTS). Overall, the VTS singleton deliveries had a mean live birth weight that was on average 162g less when comparing with those from a single gestational sac. More specifically, a significantly lower live birth weight was seen in the fresh embryo transfer setting of VTS survivors compared to single gestations, (fresh ET: 3138 704 g versus 3298 598 g, respectively, P value < 0.001), but not in the setting of frozen embryo transfers (frozen ET: 3315 586 g versus 3431 609 g respectively, P value 0.27) (Table 1). From those singletons arising from VTS after fresh ET, 15% were of low birth weight (<2500g) compared to 8.6% of controls (P<0.05). When comparing donor outcomes no significant difference was observed in birth weight outcomes [VTS; N¼37, 3243g versus Control; N¼653, 3295g: P¼0.6]. CONCLUSIONS: Singletons originating from twin gestations had lower live birth weights than those originating from single gestations in the setting of fresh embryo transfers in homologous cycles. This data further strengthens the argument to perform elective single homologous embryo transfer. It also indicates that ART pregnancies experiencing VTS may need a more dedicated follow up of outcomes.
Comparison between VTS and single gestation live birth weights in fresh and frozen embryo transfers.
FRESH ET
FROZEN ET
VTS (N¼594)
Single Gestational Sac (N¼6963)
P-Value
VTS (N¼112)
Single Gestational Sac (N¼2024)
P-Value
3138 704
3298 598
<0.001
3315 587
3431 609
0.27
Live Birth Weight (g) (mean + SD)
Comparisons of Pregnancy outcomes BEFORE and AFTER matching
Before matching (N¼3660) Variables
P value
Reduced group (n¼71)
Non-reduced group (n¼3589)
Reduced group (n¼71)
Non-reduced group (n¼710)
>0.05
4 (5.63%) 5 (7.04%) 9 (12.67%) 5 (7.04%) 4 (5.63%) 9 (12.67%) 53 (74.6%) 62 (87.3%) 59 (83.1%) 14 (19.7%)
109 (3.04%) 160 (4.46%) 269 (7.50%) 142 (3.96%) 1557 (43.4%) 1699 (47.3%) 1670 (46.5%) 3369 (93.9%) 3361 (93.6%) 449 (12.5%)
4 (5.63%) 5 (7.04%) 9 (12.67%) 5 (7.04%) 4 (5.63%) 9 (12.67%) 53 (74.6%) 62 (87.3%) 59 (83.1%) 14 (19.7%)
20 (2.8%) 40 (5.6%) 60 (8.5%) 30 (4.2%) 299 (42.1%) 329 (46.3%) 319 (44.9%) 648 (91.3%) 644 (90.7%) 95 (13.5%)
>0.05 >0.05 >0.05 >0.05 0.00 0.00 0.00 >0.05 0.04 >0.05
Early miscarriage(<12w) Late miscarriage (>12w) Total miscarriage Preterm delivery <32 w Preterm delivery >32 w Total preterm delivery Term delivery Live Birth Take home baby Adverse outcome
e378
After matching (N¼781)
ASRM Abstracts
Vol. 108, No. 3, Supplement, September 2017
CONCLUSIONS: Dichorionic twin pregnancies after IVF-ET with elective fetal reduction were at lower risk of premature delivery after 32 weeks of gestation, but the chance of taking home at least one live baby was significantly decreased. Supported by: Funding for the study was provided by the Natural Science Foundation of Guangdong Province (No.2015A030313192) and Special fund for clinical medicine research of Chinese Medical Association (No. 16020410657) P-710 Wednesday, November 1, 2017 EFFECTIVENESS OF SINGLE VERSUS TWO OR MULTI-DOSE METHOTREXATE PROTOCOL FOR THE TREATMENT OF ECTOPIC PREGNANCY: A META-ANALYSIS. S. Alur-Gupta, L. Cooney, S. Senapati, K. T. Barnhart. University of Pennsylvania, Philadelphia, PA. OBJECTIVE: To compare the effectiveness of two-dose or multi-dose methotrexate protocols versus a single-dose protocol for the treatment of ectopic pregnancy. DESIGN: Comprehensive systematic review and meta-analysis. MATERIALS AND METHODS: PubMed and Embase were queried up to February 2017. All studies were prospective randomized controlled trials (RCTs) that compared two-dose or multi-dose methotrexate protocols to single-dose protocols for the treatment of patients with an ectopic pregnancy. Studies felt to be of poor quality by using Cochrane Collaboration’s bias assessment tool were excluded. Additional sub-group analyses were performed evaluating treatment success in subjects with a high B-HCG (>4000mIU/mL depending on the study) or a large ectopic pregnancy size (>2cm). Fixed effects metaanalysis was used to estimate the pooled risk ratio of treatment success, defined by the individual studies and evaluate the incidence of side effects and need for surgery. Random effects meta-analysis using pooled mean differences was used to compare total length of follow-up between groups. RESULTS: A total of 623 patients from 6 studies were included in the meta-analysis; 3 studies evaluated the two-dose vs. single methotrexate protocols and 3 evaluated the multi-dose vs. single methotrexate protocols. There was a trend towards increased effectiveness for both protocols when compared to the single-dose protocol (two vs. single: RR 1.09 95% CI [0.98, 1.20], multi vs. single: RR 1.08, 95% CI [0.99, 1.17]). For patients with high HCGs, the two-dose protocol was noted to be 42% more effective in achieving treatment success as compared to the single-dose (RR 1.42, 95% CI [1.00, 2.02]). The multi-dose protocol was significantly more likely to cause side effects compared to the single-dose protocol (RR 1.64 95% CI [1.15, 2.34]). Compared to the single-dose protocol, the two-dose protocol had a shorter time to resolution: -6.8 days (95% CI: -12.5, -1.0). CONCLUSIONS: All RCTs showed increased effectiveness of multidose or two-dose protocols when compared to single dose. However, individually and when combined, the CIs cross 1. Thus, we can only conclude that there is a trend towards greater success with either two-dose and multi-dose methotrexate protocols. Larger prospective randomized controlled trials need to be conducted to confirm superiority. The greater occurrence of side effects in the multi-dose protocol and the shorter follow-up time with the two-dose protocol can be incorporated into counseling patients. Supported by: R01 HD076279, HD007440
P-711 Wednesday, November 1, 2017 WRIST WORN WEARABLE SENSORS CAPTURE THE PHYSIOLOGICAL CHANGES ASSOCIATED WITH L. Falco,b EARLY PREGNANCY. M. Shilaih,a F. Kuebler,b B. Leeners.a aReproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland; bAva AG, Zurich, Switzerland. OBJECTIVE: Using wrist worn wearable sensors, we assessed the differences in temperature, pulse rate, and heart rate variability ratio in early pregnancy compared to those of non-conceptive cycle late luteal phase. DESIGN: This is an intermediate analysis of a prospective longitudinal observational study conducted at the Department of Reproductive Endocrinology at the University Hospital Zurich. We included eumenorrheic, healthy, non-pregnant women, between 20 and 40 years old, who aimed for a pregnancy. Potential behavioral confounders were self-reported by the participants using an electronic diary. MATERIALS AND METHODS: Participants wore Ava bracelet (Ava AG, Z€urich) which measures temperature, pulse rate, and heart rate variability ratio among other physiological parameters. Heart rate variability ratio is defined as the ratio between Low frequency/high frequency components resulting from the analysis of beat-to-beat variation in heart pulses. Day to day activities are known to affect all the aforementioned physiological parameters, hence, the participants wore the bracelet during sleep and the measurements were recorded. An LH home urine test was used to estimate the ovulation day. The late luteal phase was defined as ovulation+7 to the end of the cycle for the non-conceptive cycles. While for the conceptive cycles the early pregnancy period was considered as ovulation+10 to ovulation+18. The associations were evaluated using linear mixed effects models with a random intercept for the respective participant. RESULTS: We included 21 conceptive cycles and 137 non-conceptive cycles in the analysis. In comparison to the late luteal phase of nonconceptive cycles, early pregnancy was characterized by a significant increase in pulse rate (2.1 beats per minute, standard error (SE) 0.6), and a lower heart rate variability ratio (-0.15, SE 0.05). In addition, we observed an 0.2 Celsius elevation in skin temperature, however with a higher SE of 0.1, which could be due to the limited number of cases we observed. CONCLUSIONS: Current wearable sensors are capable of capturing known pregnancy associated physiological changes. Our findings could pave the way for the continuous assessment of the occurrence of pregnancy without any effort from the user and consequently add an innovative option for early pregnancy detection in a personal, clinical and scientific context. Supported by: Swiss Commission for Technology and Innovation Ava AG P-712 Wednesday, November 1, 2017 EFFECT OF CORPORA LUTEA NUMBER ON SERUM ELECTROLYTES AND CREATININE IN EARLY PREGNANCY. F. von Versen-Hoeynck,a N. K. Strauch,a R. Fleischmann,a J. Liu,b Y. Chi,c K. P. Conrad,d V. L. Baker.a aDepartment of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University, Sunnyvale, CA;
Two Dose vs. Single Protocol # Studies Treatment success Treatment success-high B-HCG group Treatment success-large mass size group Side Effects Surgery for rupture Length of follow-up (days)
FERTILITY & STERILITYÒ
Risk Ratio (RR) (95% CI)
Multi-Dose vs. Single Protocol I2 (%)
# Studies
Risk Ratio (RR) (95% CI)
I2 (%)
3 3
1.09 (0.98, 1.20) 1.42 (1.00, 2.02)
0.0 0.0
3 1
1.08 (0.99, 1.17) 1.13 (0.90, 1.41)
0.0 NA
2
1.29 (0.85, 1.96)
0.0
1
1.07 (0.88, 1.31)
NA
3 2 – 3
1.64 (1.15, 2.34)* 1.57 (0.43, 5.75) Mean difference (95% CI) -1.3 (5.4, 2.7)
0.0 0.0 – 65.8%*
3 3 – 3
1.33 (0.92, 1.84) 0.78 (0.37, 1.65) Mean difference (95% CI) -6.8 (-12.5, -1.0)*
0.0 0.0 – 94.8%*
e379
P-709 Wednesday, November 1, 2017
VANISHING TWIN SYNDROME SURVIVORS HAVE LOWER LIVE BIRTH WEIGHT COMPARED WITH SINGLETONS ARISING FROM A SINGLE GESTAL. A. Murphy,b TIONAL SAC. M. Tarakji,a N. Resetkova,c E. A. Seidler,d A. Penzias,e D. Sakkas.a aBoston IVF, Waltham, MA; bReproductive Endocrinology & Infertility, BIDMC/Harvard Medical School, Boston, MA; cBoston IVF / Beth Israel Deaconess Medical Center, Boston, MA; dReproductive Endocrinology & Infertility, BIDMC, Harvard Medical School, Boston, MA; eBoston IVF / Harvard Medical School, Waltham, MA.
IS IT WORTH REDUCING TWINS TO SINGLETONS AFTER IVF-ET? A RETROSPECTIVE COHORT STUDY USING PROPENSITY SCORE MATCHING. L. Luo, H. Jie, M. Chen, Q. Wang. The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. OBJECTIVE: To explore whether elective fetal reduction from dichorionic twins to singletons after IVF-ET (In vitro fertilization and embryo transfer) is associated with increased take-home baby rate and improved pregnancy outcome. DESIGN: A retrospective cohort study using propensity score matching. MATERIALS AND METHODS: We conducted a retrospective cohort study of dichorionic twin pregnancy after IVF-ET between 2009 and 2015. The reduced group included 77 women who underwent transvaginal elective fetal reduction between 7 to 8 weeks of gestation. The non-reduced group (n¼3589) comprised patients who were managed expectantly without elective fetal reduction (including patients with later selective fetal reduction due to fetal abnomalities, spontaneous fetal reduction after 7-8 weeks and induced labor due to maternal complications or complex fetal abnomalities). We conducted propensity score matching to control for maternal age, body mass index, infertility types and main causes of infertility. The primary assessment of pregnancy outcomes was take-home baby rate which was defined as taking home at least one live baby. Other measurements included the rates of adverse pregnancy outcome, early and late miscarriage, premature delivery as well as gestational age, birth weight and neonatal defects. RESULTS: After propensity score matching, 71 pairs (781 cases, 1:10 matched) were selected for further analyses. The take-home baby rates in the reduced group was significantly lower than in the control group (83.1% vs. 90.7%, OR0.50, 95%CI 0.27 to 1.03, P¼0.042). The adverse outcome rate in the two groups were 19.7% vs. 13.5%, P¼0.152. The miscarriage rate seems to be higher in the reduced group, but did not reach statistical significance (early miscarriage, 5.6% vs. 2.8%; late miscarriage, 7.0% vs. 5.6%; total, 12.7% vs. 8.5%). Premature delivery rate was lower in reduced group (12.7% vs. 46.3%, OR 0.17, 95%CI 0.08-0.33, P<0.001). Over 90% of premature deliveries in non-reduced group were over 32 weeks while the proportions were equal in reduced group. The median delivery age was 38 weeks and 36 weeks in reduced and non-reduced group (P<0.001). Birth weight was significantly higher in reduced group, with a median of 3.0Kg vs. 2.5Kg (P<0.001).
OBJECTIVE: A number of studies have described the obstetric outcomes of the remaining fetus produced after the other twin had vanished compared with outcomes of deliveries originating from a singleton gestational sac, but the results are mixed and contradictory. In this study we compared the live birth weight outcomes in fresh and frozen transfers between singleton deliveries originating from a single gestational sac to those initiated as twin gestational sacs. DESIGN: A case-control study of 9693 singleton deliveries after IVF fresh and frozen embryo transfer (ET) over a period of 20 years from 1996 to 2015. MATERIALS AND METHODS: Comparing the live birth weight of 706 singleton deliveries originating from a twin gestation (case group) with live birth weight of 8987 singleton deliveries originating from a single gestation (control group) in both embryo transfer methods (fresh and frozen). Statistical evaluation was performed by comparing mean singleton birth weights. RESULTS: Out of 9693 singleton deliveries, 706 (7.28%) originated from vanishing twin syndrome (VTS). Overall, the VTS singleton deliveries had a mean live birth weight that was on average 162g less when comparing with those from a single gestational sac. More specifically, a significantly lower live birth weight was seen in the fresh embryo transfer setting of VTS survivors compared to single gestations, (fresh ET: 3138 704 g versus 3298 598 g, respectively, P value < 0.001), but not in the setting of frozen embryo transfers (frozen ET: 3315 586 g versus 3431 609 g respectively, P value 0.27) (Table 1). From those singletons arising from VTS after fresh ET, 15% were of low birth weight (<2500g) compared to 8.6% of controls (P<0.05). When comparing donor outcomes no significant difference was observed in birth weight outcomes [VTS; N¼37, 3243g versus Control; N¼653, 3295g: P¼0.6]. CONCLUSIONS: Singletons originating from twin gestations had lower live birth weights than those originating from single gestations in the setting of fresh embryo transfers in homologous cycles. This data further strengthens the argument to perform elective single homologous embryo transfer. It also indicates that ART pregnancies experiencing VTS may need a more dedicated follow up of outcomes.
Comparison between VTS and single gestation live birth weights in fresh and frozen embryo transfers.
FRESH ET
FROZEN ET
VTS (N¼594)
Single Gestational Sac (N¼6963)
P-Value
VTS (N¼112)
Single Gestational Sac (N¼2024)
P-Value
3138 704
3298 598
<0.001
3315 587
3431 609
0.27
Live Birth Weight (g) (mean + SD)
Comparisons of Pregnancy outcomes BEFORE and AFTER matching
Before matching (N¼3660) Variables
P value
Reduced group (n¼71)
Non-reduced group (n¼3589)
Reduced group (n¼71)
Non-reduced group (n¼710)
>0.05
4 (5.63%) 5 (7.04%) 9 (12.67%) 5 (7.04%) 4 (5.63%) 9 (12.67%) 53 (74.6%) 62 (87.3%) 59 (83.1%) 14 (19.7%)
109 (3.04%) 160 (4.46%) 269 (7.50%) 142 (3.96%) 1557 (43.4%) 1699 (47.3%) 1670 (46.5%) 3369 (93.9%) 3361 (93.6%) 449 (12.5%)
4 (5.63%) 5 (7.04%) 9 (12.67%) 5 (7.04%) 4 (5.63%) 9 (12.67%) 53 (74.6%) 62 (87.3%) 59 (83.1%) 14 (19.7%)
20 (2.8%) 40 (5.6%) 60 (8.5%) 30 (4.2%) 299 (42.1%) 329 (46.3%) 319 (44.9%) 648 (91.3%) 644 (90.7%) 95 (13.5%)
>0.05 >0.05 >0.05 >0.05 0.00 0.00 0.00 >0.05 0.04 >0.05
Early miscarriage(<12w) Late miscarriage (>12w) Total miscarriage Preterm delivery <32 w Preterm delivery >32 w Total preterm delivery Term delivery Live Birth Take home baby Adverse outcome
e378
After matching (N¼781)
ASRM Abstracts
Vol. 108, No. 3, Supplement, September 2017
CONCLUSIONS: Dichorionic twin pregnancies after IVF-ET with elective fetal reduction were at lower risk of premature delivery after 32 weeks of gestation, but the chance of taking home at least one live baby was significantly decreased. Supported by: Funding for the study was provided by the Natural Science Foundation of Guangdong Province (No.2015A030313192) and Special fund for clinical medicine research of Chinese Medical Association (No. 16020410657) P-710 Wednesday, November 1, 2017 EFFECTIVENESS OF SINGLE VERSUS TWO OR MULTI-DOSE METHOTREXATE PROTOCOL FOR THE TREATMENT OF ECTOPIC PREGNANCY: A META-ANALYSIS. S. Alur-Gupta, L. Cooney, S. Senapati, K. T. Barnhart. University of Pennsylvania, Philadelphia, PA. OBJECTIVE: To compare the effectiveness of two-dose or multi-dose methotrexate protocols versus a single-dose protocol for the treatment of ectopic pregnancy. DESIGN: Comprehensive systematic review and meta-analysis. MATERIALS AND METHODS: PubMed and Embase were queried up to February 2017. All studies were prospective randomized controlled trials (RCTs) that compared two-dose or multi-dose methotrexate protocols to single-dose protocols for the treatment of patients with an ectopic pregnancy. Studies felt to be of poor quality by using Cochrane Collaboration’s bias assessment tool were excluded. Additional sub-group analyses were performed evaluating treatment success in subjects with a high B-HCG (>4000mIU/mL depending on the study) or a large ectopic pregnancy size (>2cm). Fixed effects metaanalysis was used to estimate the pooled risk ratio of treatment success, defined by the individual studies and evaluate the incidence of side effects and need for surgery. Random effects meta-analysis using pooled mean differences was used to compare total length of follow-up between groups. RESULTS: A total of 623 patients from 6 studies were included in the meta-analysis; 3 studies evaluated the two-dose vs. single methotrexate protocols and 3 evaluated the multi-dose vs. single methotrexate protocols. There was a trend towards increased effectiveness for both protocols when compared to the single-dose protocol (two vs. single: RR 1.09 95% CI [0.98, 1.20], multi vs. single: RR 1.08, 95% CI [0.99, 1.17]). For patients with high HCGs, the two-dose protocol was noted to be 42% more effective in achieving treatment success as compared to the single-dose (RR 1.42, 95% CI [1.00, 2.02]). The multi-dose protocol was significantly more likely to cause side effects compared to the single-dose protocol (RR 1.64 95% CI [1.15, 2.34]). Compared to the single-dose protocol, the two-dose protocol had a shorter time to resolution: -6.8 days (95% CI: -12.5, -1.0). CONCLUSIONS: All RCTs showed increased effectiveness of multidose or two-dose protocols when compared to single dose. However, individually and when combined, the CIs cross 1. Thus, we can only conclude that there is a trend towards greater success with either two-dose and multi-dose methotrexate protocols. Larger prospective randomized controlled trials need to be conducted to confirm superiority. The greater occurrence of side effects in the multi-dose protocol and the shorter follow-up time with the two-dose protocol can be incorporated into counseling patients. Supported by: R01 HD076279, HD007440
P-711 Wednesday, November 1, 2017 WRIST WORN WEARABLE SENSORS CAPTURE THE PHYSIOLOGICAL CHANGES ASSOCIATED WITH L. Falco,b EARLY PREGNANCY. M. Shilaih,a F. Kuebler,b B. Leeners.a aReproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland; bAva AG, Zurich, Switzerland. OBJECTIVE: Using wrist worn wearable sensors, we assessed the differences in temperature, pulse rate, and heart rate variability ratio in early pregnancy compared to those of non-conceptive cycle late luteal phase. DESIGN: This is an intermediate analysis of a prospective longitudinal observational study conducted at the Department of Reproductive Endocrinology at the University Hospital Zurich. We included eumenorrheic, healthy, non-pregnant women, between 20 and 40 years old, who aimed for a pregnancy. Potential behavioral confounders were self-reported by the participants using an electronic diary. MATERIALS AND METHODS: Participants wore Ava bracelet (Ava AG, Z€urich) which measures temperature, pulse rate, and heart rate variability ratio among other physiological parameters. Heart rate variability ratio is defined as the ratio between Low frequency/high frequency components resulting from the analysis of beat-to-beat variation in heart pulses. Day to day activities are known to affect all the aforementioned physiological parameters, hence, the participants wore the bracelet during sleep and the measurements were recorded. An LH home urine test was used to estimate the ovulation day. The late luteal phase was defined as ovulation+7 to the end of the cycle for the non-conceptive cycles. While for the conceptive cycles the early pregnancy period was considered as ovulation+10 to ovulation+18. The associations were evaluated using linear mixed effects models with a random intercept for the respective participant. RESULTS: We included 21 conceptive cycles and 137 non-conceptive cycles in the analysis. In comparison to the late luteal phase of nonconceptive cycles, early pregnancy was characterized by a significant increase in pulse rate (2.1 beats per minute, standard error (SE) 0.6), and a lower heart rate variability ratio (-0.15, SE 0.05). In addition, we observed an 0.2 Celsius elevation in skin temperature, however with a higher SE of 0.1, which could be due to the limited number of cases we observed. CONCLUSIONS: Current wearable sensors are capable of capturing known pregnancy associated physiological changes. Our findings could pave the way for the continuous assessment of the occurrence of pregnancy without any effort from the user and consequently add an innovative option for early pregnancy detection in a personal, clinical and scientific context. Supported by: Swiss Commission for Technology and Innovation Ava AG P-712 Wednesday, November 1, 2017 EFFECT OF CORPORA LUTEA NUMBER ON SERUM ELECTROLYTES AND CREATININE IN EARLY PREGNANCY. F. von Versen-Hoeynck,a N. K. Strauch,a R. Fleischmann,a J. Liu,b Y. Chi,c K. P. Conrad,d V. L. Baker.a aDepartment of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University, Sunnyvale, CA;
Two Dose vs. Single Protocol # Studies Treatment success Treatment success-high B-HCG group Treatment success-large mass size group Side Effects Surgery for rupture Length of follow-up (days)
FERTILITY & STERILITYÒ
Risk Ratio (RR) (95% CI)
Multi-Dose vs. Single Protocol I2 (%)
# Studies
Risk Ratio (RR) (95% CI)
I2 (%)
3 3
1.09 (0.98, 1.20) 1.42 (1.00, 2.02)
0.0 0.0
3 1
1.08 (0.99, 1.17) 1.13 (0.90, 1.41)
0.0 NA
2
1.29 (0.85, 1.96)
0.0
1
1.07 (0.88, 1.31)
NA
3 2 – 3
1.64 (1.15, 2.34)* 1.57 (0.43, 5.75) Mean difference (95% CI) -1.3 (5.4, 2.7)
0.0 0.0 – 65.8%*
3 3 – 3
1.33 (0.92, 1.84) 0.78 (0.37, 1.65) Mean difference (95% CI) -6.8 (-12.5, -1.0)*
0.0 0.0 – 94.8%*
e379