Live birth rate after fresh or frozen-thawed embryo transfers in relation to maternal age: a retrospective cochort study of 13426 cycles

Table 1. Fresh vs. Freeze-all in poor responders

No of patients Age, years +/-SD Number of embryos transferred +/- SD Implantation rate, % Pregnancy Rate, n(%) Clinical Pregnancy Rate, n(%) Ongoing Pregnancy Rate, n(%)

FRESH-GROUP

FREEZE-ALL GROUP

247 39.62 +/- 3.90 1.91 +/- 0.85 11.4% 49/247 (19.8%) 41/247(16.6%) 33/247 (13.4%)

131 39.43 +/- 3.74 1.71 +/- 0.74 12.3% 28/131 (21.4%) 23/131 (17.6%) 18/131 (13.7%)

<0.05 was considered statistically significant. Statistical analysis was done with the Statistical Package for Social Sciences (SPSS version 24.0). The main outcome measure was ongoing pregnancy rate. The secondary outcomes were implantation, pregnancy, and clinical pregnancy rates. RESULTS: IVF outcomes in fresh and freeze-all groups are expressed in Table 1 CONCLUSIONS: This is the first study evaluating the freeze-all strategy in poor responder patients. There were no differences in IVF outcomes when comparing fresh to elective frozen-thawed embryo transfer. These results suggest that in poor responders the IVF outcomes may not be improved by performing the freeze-all strategy. P-96 Tuesday, October 18, 2016 LIVE BIRTH RATE AFTER FRESH OR FROZEN-THAWED EMBRYO TRANSFERS IN RELATION TO MATERNAL AGE: A RETROSPECTIVE COCHORT STUDY OF 13426 CYCLES. X. Li, R. Huang, C. Fang, Y. Wang, X. Liang. Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. OBJECTIVE: This study aimed to assess live birth rate after fresh or frozen thawed embryo transfers in relation to maternal age for an individualized strategy for overall reproductive outcome. DESIGN: A retrospective cochort study. MATERIALS AND METHODS: All patients undergoing fresh or frozen embryo transfers from 2010 to 2015 in our unit were enrolled. Individualized controlled ovarian hyper-stimulation protocols included long GnRH agonist, GnRH antagonist and minimal stimulation protocols. 5000-10,000 IU hCG (Ovidrel, Merck Serono) was utilized for follicular maturation and oocyte retrieval performed when appropriate. Intracytoplasmic sperm injection was adopted if the concentration of motile sperm was <1
106/mL, otherwise in vitro fertilization was used. Vitrification was performed for embryo freezing. The primary outcome was Live birth rate (LBR), defined as rate of deliveries that resulted in at least one live born baby per transfer. Chisquare and binary regression analysis were used for data analysis. A P39 years. Firstly, we found frozen cycles had higher LBR than that of fresh cycles (42.62% vs.38.81%, P<0.01). As expected, in blastocyst embryo transfer, LBR was significantly higher in frozen cycles in patients older than 30 years (56.02% vs.53.71%, P¼0.106; 52.46%vs.42.93%, P<0.01; 38.11% vs. 29.27%, P<0.01; 19.38%vs.11.21%, P¼0.01 for group1-4 respectively). Nevertheless, for cleavage-stage embryo, frozen cycles had lower LBR than that of fresh cycles in all age groups (37.41% vs.49.84%, P<0.05; 35.70% vs.44.58%, P <0.01; 23.75%vs.29.09%, P¼ 0.01; 8.70% vs.10.38%, P¼0.17 for age group1-4 respectively), despite difference didn’t reached statistical significance in those over 40 years. Further multivariate analysis confirmed the above results after adjusting covariates (such as age, number of embryo transferred, embryo quality, infertility etiologies etc.). Specifically, frozen blastocyst embryo transfers in cases over 40 years had more than twice chance getting live born baby than that of fresh cycles (adjusted OR 2.18,P¼0.04). In term of miscarriage rate, no significant difference was observed between fresh and frozen cycles regardless of maternal age. CONCLUSIONS: In every age-group, frozen cleavage-stage embryo transfers had lower LBR than that of fresh cleavage-stage embryo transfers, while frozen blastocyst transfers resulted in higher LBR than that of fresh cycles, showing blastocyst was the suitable stage for cryopreservation. Frozen blastocyst transfers obtained a comparatively stabile high LBR, especially in cases over 40 years.

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ASRM Abstracts

Relative Risk (95% CI)

p value

1.10 (0.70-1.74) 1.08 (0.71-1.63) 1.06 (0.66-1.68) 1.03 (0.60-1.75)

0.651 0.053 0.758 0.725 0.814 0.918

P-97 Tuesday, October 18, 2016 ZYGOTE BANKING OFFERS POOR PROGNOSIS PATIENTS HIGH IMPLANTATION AND CLINCAL PREGNANY RATES. A. E. Batcheller,a W. B. Schoolcraft,b M. Katz-Jaffe.c aCCRM b Minneapolis, Edina, MN; Medical Director, Colorado Center for Reproductive Medicine, Lone Tree, CO; cColorado Center for Reproductive Medicine, Lone Tree, CO. OBJECTIVE: Poor prognosis in vitro fertilization (IVF) patients of advanced maternal age (AMA) and diminished ovarian (DOR) reserve of struggle with fertility treatment burn out. Additionally, while many desire more than one child, pregnancy near the end of the reproductive lifespan may negate the possibility of future conception following successful delivery of an ART conceived child. Banking euploid embryos during this critical time period may offer these patients the opportunity to expand their genetically linked family. DESIGN: Observational Study. MATERIALS AND METHODS: 532 patients identified as poor prognosis by AMH l< 1.1 ng/mL or antral follicle count <7 underwent 1-2 zygote banking cycles, followed by warming of these vitrified zygotes and culture alongside fresh zygotes resulting from the patients final retrieval, culminating in trophectoderm biopsy of all resulting blastocysts. Euploid blastocysts were transferred in a subsequent frozen embryo transfer (FET). RESULTS: Characteristics of zygote banking cycles by age listed in Table 1. 389 patients (73.1%) had euploid embryos for transfer. No blastocyst development was noted in 4.7% of patients (mean age 43.1 years). The mean age of patients with all aneuploid cycles was 41.8 years, while the mean age of patients with euploid embryos was 37.9 years. We experienced 98.7% survival of blastocysts after thaw. On average, 1.4 embryos were transferred, with an implantation rate of 67.8%, a missed abortion rate of 4.7%, and an ongoing pregnancy rate of 71.2% noted. CONCLUSIONS: Zygote banking offers poor prognosis IVF patients the opportunity to achieve high blastocyst conversion, implantation, and clinical pregnancy rates. Given that many of these patients are nearing the end of the reproductive potential, a banking strategy may allow them to increase the number of euploid blastocysts cryopreserved for multiple transfer attempts while reducing patient frustration and burn out. Notably, blastocyst conversion decreases and all aneuploid results increase dramatically after age 43. P-98 Tuesday, October 18, 2016 CLINICAL OUTCOME OF TWO POPULAR VITRIFICATION DEVICES FOR HUMAN IVF. T. Tsai H. L. Feng. Ob/Gyn, New York Presbyterian Health System Queens, Cornell University, New York, NY. OBJECTIVE: Currently, highly efficient vitrification devices for cryopreservation of human oocytes and embryos play an important role in protecting DNA integrity and consequently impacting IVF pregnancies. Two popular vitrification devices were selected for this study; the results may provide useful guidance for IVF laboratories to select the best device. DESIGN: Prospective. MATERIALS AND METHODS: 375 consecutive IVF/Donor cycles were included in the study. 1083 mature donor oocytes, 929 cleavage embryos and 695 blastocysts were vitrified 50/50 between cryotop and iVitriÒ devices. The outcomes of survival, fertilization, pregnancy, and miscarriage rates were compared. RESULTS: There were no significant differences in the survival rates of oocytes ( 98% vs 99%), cleavage stage (97% vs. 98%) and blastocyst stage (93% vs. 99%) between cryotop and iVitriÒ devices; However, the increased implantation rate ( donor eggs, 85% vs. 70%; cleavage 56% vs. 50%;

Vol. 106, No. 3, Supplement, September 2016