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IVF in women of 45 years and older: the largest single center cohort to date
Number of Oocytes Retrieved Outcome Number of cycles Percentage of cycles with no viable embryos available for transfer or cryopreservation Live birth per fresh embryo transfer cycle Live born child per freshly transferred embryo Surplus blastocysts vitrified per cycle with fresh transfer Estimated total live born children per retrieval cycle
1-4 338 11.8% P<0.0001 vs 5-9 oocytes
5-9 1631 2.5% P<0.0001 vs 10-19 oocytes
10-19 4374 0.7%
20-29 1673 0.6%
R30 557 0.5%
31.8% P<0.0001 vs 5-9 oocytes 24.6% P<0.0001 vs 5-9 oocytes 0.1 P¼0.001 vs 5-9 oocytes 0.37 P<0.0001 vs 5-9 oocytes
45.7% P<0.0001 vs 10-19 oocytes 36.5% P<0.0001 vs 10-19 oocytes 0.6 P<0.0001 vs 10-19 oocytes 0.76 P<0.0001 vs 10-19 oocytes
51.2%
51.5%
49.7%
43.1%
44.6%
44.8%
cryopreservation was performed using vitrification protocols at the expanded blastocyst stage (minimum ICM and trophectoderm grades of BB) on day 5 or 6 after oocyte retrieval. Potential births from the transfer of all vitrified blastocyst were estimated based on our observed birth rate (35%) per vitrified/warmed blastocyst among autologous patients in this age range. RESULTS: At total of 8,573 cycles were evaluated. Cycles with retrieval of 1-4 oocytes or 5-9 oocytes were much less likely to have viable embryos available for transfer or cryopreservation, had much lower live birth rates per fresh embryo transfer cycle, and had many fewer children per freshly transferred embryo compared to larger retrieved oocyte cohorts. The numbers of surplus blastocysts that were cryopreserved per fresh embryo transfer cycle, and the estimated total number of live born children resulting from the transfer of all fresh and cryopreserved embryos per oocyte retrieval cycle, both increased substantially with each incremental increase in the size of the retrieved oocyte cohort. CONCLUSIONS: Previous data has suggested there may be lower live birth rates with higher number of oocytes retrieved (1). The current data among this good prognosis population of patients show that live birth per fresh transfer is not adversely affected by higher oocyte retrieval numbers. Furthermore, more oocytes lead to higher numbers of vitrified embryos and ultimately higher live births per retrieval event. References: 1. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod 2011;26:1768-74. Supported by: This research was supported, in part, by Intramural research program of the Program in Reproductive and Adult Endocrinology, NICHD, NIH. O-89 Monday, October 17, 2016 12:15 PM IVF IN WOMEN OF 45 YEARS AND OLDER: THE LARGEST SINGLE CENTER COHORT TO DATE. V. Gunnala, M. Irani, Z. Rosenwaks, S. D. Spandorfer. The Ronald O. Perelman and Claudia Cohen CRM, Weill Cornell Medicine, New York, NY.
1.8 P<0.0001 vs 20-29 oocytes 1.26 P<0.0001 vs 20-29 oocytes
3.5 P<0.0001 vs R30 oocytes 1.84 P<0.0001 vs R30 oocytes
5.4 2.58
OBJECTIVE: To determine IVF outcomes in women 45 years and older using autologous oocytes. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: 1,077 fresh IVF cycles in women 45 years and older were reviewed from 1/1995-6/2015. PGD/S, natural IVF, and donor egg cycles were excluded. Patient demographics, IVF cycle characteristics, total pregnancy loss, clinical pregnancy and live birth rates were analyzed for the different age groups (age 45 n ¼773, age 46 n ¼221, age 47 n¼57, age 48 n¼22, age 49 n¼5). Fisher exact t test, Kruskal-Walis, and Chi-square were used to evaluate the data and p < 0.05 was considered significant. RESULTS: Mean age of patients in the study cohort was 45.4 0.72. 11.7% of patients did not start due to an elevated FSH or cyst and 28.5% of patients were canceled prior to oocyte retrieval. There was no difference in demographic characteristics between age groups as well as no difference in mean # of oocytes harvested (7.2 4.8) or number of embryo transferred (3.4 1.9). The overall pregnancy rate per retrieval was 17.2% (117/680), of which 82.1% (96/117) ended in a pregnancy loss. Although there was no difference in IVF outcomes between age groups, an overall clinical pregnancy rate of 8.8% (60/680) and delivery rate of 3.1% (21/680) were found. 20/21 live births were in the 45 year old group and one live birth was found in women age 46. There was no live births in any patient with % 4 oocytes retrieved. CONCLUSIONS: IVF may be a reasonable option for women age 45 with an acceptable ovarian reserve, however with very low prognosis. Patients with % 4 follicles should be counseled appropriately that based on these results positive pregnancy seems highly unlikely. O-90 Monday, October 17, 2016 12:30 PM DOES A WORSENING IN ENDOMETRIAL STRIPE PATTERN CORRELATE WITH INCREASING PROGESTERONE LEVELS IN IVF CYCLES? M. W. Healy,a H. Wolfe,b B. Yauger,b R. Chason,b N. Banks,a C. M. Owen,a A. DeCherney,a J. Csokmay,b M. J. Hill.a aNational Institutes of Health- NICHD, Bethesda, MD; bDepartment of OB/ GYN, Walter Reed National Military Medical Center, Bethesda, MD.
IVF Cycle Characteristics
age
45 (n ¼733)
46 (n¼221)
47 (n¼57)
48 (n¼22)
49 (n¼5)
p value
Parity (Median) # oocytes harvested # mature oocytes # 2PN # embryos transferred % cycle starts with no ET
0 (0-1) 7.1 4.8 5.7 4.1 4.0 3.3 3.4 1.8 32.8%
0 (0-1) 7.4 4.8 5.9 3.9 4.2 3.2 3.5 2.1 32.8%
0 (0-1) 6.3 5.0 4.7 3.6 3.1 3.0 2.9 1.7 45.1%
1 (0-2) 6.1 5.2 5.0 4.0 2.9 2.4 2.9 2.1 63.2%
0 (0-1) 16 2.8 10.5 0.7 6.5 0.7 5.0 0.0 60.0%
0.17 0.08 0.28 0.29 0.29 0.53
age
45 (n¼5/08)
Positive pregnancy/retrieval clinical pregnancy/ retrieval live birth/retrieval Total pregnancy loss (BC + SAB/total pregnancy)
FERTILITY & STERILITYÒ
21.0% 9.8% 3.9% 79.2%
46 (n¼140)
47 (n¼34)
48 (n¼8)
49 (n¼2)
p value
12.1% 6.4% 0.7% 94.1%
8.8% 2.9% 0% 100%
0% 0% 0% N/A
50% 0% 0% 100%
0.07 0.52 0.23 0.44
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1-4 338 11.8% P<0.0001 vs 5-9 oocytes
5-9 1631 2.5% P<0.0001 vs 10-19 oocytes
10-19 4374 0.7%
20-29 1673 0.6%
R30 557 0.5%
31.8% P<0.0001 vs 5-9 oocytes 24.6% P<0.0001 vs 5-9 oocytes 0.1 P¼0.001 vs 5-9 oocytes 0.37 P<0.0001 vs 5-9 oocytes
45.7% P<0.0001 vs 10-19 oocytes 36.5% P<0.0001 vs 10-19 oocytes 0.6 P<0.0001 vs 10-19 oocytes 0.76 P<0.0001 vs 10-19 oocytes
51.2%
51.5%
49.7%
43.1%
44.6%
44.8%
cryopreservation was performed using vitrification protocols at the expanded blastocyst stage (minimum ICM and trophectoderm grades of BB) on day 5 or 6 after oocyte retrieval. Potential births from the transfer of all vitrified blastocyst were estimated based on our observed birth rate (35%) per vitrified/warmed blastocyst among autologous patients in this age range. RESULTS: At total of 8,573 cycles were evaluated. Cycles with retrieval of 1-4 oocytes or 5-9 oocytes were much less likely to have viable embryos available for transfer or cryopreservation, had much lower live birth rates per fresh embryo transfer cycle, and had many fewer children per freshly transferred embryo compared to larger retrieved oocyte cohorts. The numbers of surplus blastocysts that were cryopreserved per fresh embryo transfer cycle, and the estimated total number of live born children resulting from the transfer of all fresh and cryopreserved embryos per oocyte retrieval cycle, both increased substantially with each incremental increase in the size of the retrieved oocyte cohort. CONCLUSIONS: Previous data has suggested there may be lower live birth rates with higher number of oocytes retrieved (1). The current data among this good prognosis population of patients show that live birth per fresh transfer is not adversely affected by higher oocyte retrieval numbers. Furthermore, more oocytes lead to higher numbers of vitrified embryos and ultimately higher live births per retrieval event. References: 1. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod 2011;26:1768-74. Supported by: This research was supported, in part, by Intramural research program of the Program in Reproductive and Adult Endocrinology, NICHD, NIH. O-89 Monday, October 17, 2016 12:15 PM IVF IN WOMEN OF 45 YEARS AND OLDER: THE LARGEST SINGLE CENTER COHORT TO DATE. V. Gunnala, M. Irani, Z. Rosenwaks, S. D. Spandorfer. The Ronald O. Perelman and Claudia Cohen CRM, Weill Cornell Medicine, New York, NY.
1.8 P<0.0001 vs 20-29 oocytes 1.26 P<0.0001 vs 20-29 oocytes
3.5 P<0.0001 vs R30 oocytes 1.84 P<0.0001 vs R30 oocytes
5.4 2.58
OBJECTIVE: To determine IVF outcomes in women 45 years and older using autologous oocytes. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: 1,077 fresh IVF cycles in women 45 years and older were reviewed from 1/1995-6/2015. PGD/S, natural IVF, and donor egg cycles were excluded. Patient demographics, IVF cycle characteristics, total pregnancy loss, clinical pregnancy and live birth rates were analyzed for the different age groups (age 45 n ¼773, age 46 n ¼221, age 47 n¼57, age 48 n¼22, age 49 n¼5). Fisher exact t test, Kruskal-Walis, and Chi-square were used to evaluate the data and p < 0.05 was considered significant. RESULTS: Mean age of patients in the study cohort was 45.4 0.72. 11.7% of patients did not start due to an elevated FSH or cyst and 28.5% of patients were canceled prior to oocyte retrieval. There was no difference in demographic characteristics between age groups as well as no difference in mean # of oocytes harvested (7.2 4.8) or number of embryo transferred (3.4 1.9). The overall pregnancy rate per retrieval was 17.2% (117/680), of which 82.1% (96/117) ended in a pregnancy loss. Although there was no difference in IVF outcomes between age groups, an overall clinical pregnancy rate of 8.8% (60/680) and delivery rate of 3.1% (21/680) were found. 20/21 live births were in the 45 year old group and one live birth was found in women age 46. There was no live births in any patient with % 4 oocytes retrieved. CONCLUSIONS: IVF may be a reasonable option for women age 45 with an acceptable ovarian reserve, however with very low prognosis. Patients with % 4 follicles should be counseled appropriately that based on these results positive pregnancy seems highly unlikely. O-90 Monday, October 17, 2016 12:30 PM DOES A WORSENING IN ENDOMETRIAL STRIPE PATTERN CORRELATE WITH INCREASING PROGESTERONE LEVELS IN IVF CYCLES? M. W. Healy,a H. Wolfe,b B. Yauger,b R. Chason,b N. Banks,a C. M. Owen,a A. DeCherney,a J. Csokmay,b M. J. Hill.a aNational Institutes of Health- NICHD, Bethesda, MD; bDepartment of OB/ GYN, Walter Reed National Military Medical Center, Bethesda, MD.
IVF Cycle Characteristics
age
45 (n ¼733)
46 (n¼221)
47 (n¼57)
48 (n¼22)
49 (n¼5)
p value
Parity (Median) # oocytes harvested # mature oocytes # 2PN # embryos transferred % cycle starts with no ET
0 (0-1) 7.1 4.8 5.7 4.1 4.0 3.3 3.4 1.8 32.8%
0 (0-1) 7.4 4.8 5.9 3.9 4.2 3.2 3.5 2.1 32.8%
0 (0-1) 6.3 5.0 4.7 3.6 3.1 3.0 2.9 1.7 45.1%
1 (0-2) 6.1 5.2 5.0 4.0 2.9 2.4 2.9 2.1 63.2%
0 (0-1) 16 2.8 10.5 0.7 6.5 0.7 5.0 0.0 60.0%
0.17 0.08 0.28 0.29 0.29 0.53
age
45 (n¼5/08)
Positive pregnancy/retrieval clinical pregnancy/ retrieval live birth/retrieval Total pregnancy loss (BC + SAB/total pregnancy)
FERTILITY & STERILITYÒ
21.0% 9.8% 3.9% 79.2%
46 (n¼140)
47 (n¼34)
48 (n¼8)
49 (n¼2)
p value
12.1% 6.4% 0.7% 94.1%
8.8% 2.9% 0% 100%
0% 0% 0% N/A
50% 0% 0% 100%
0.07 0.52 0.23 0.44
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