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Meiotic spindle transfer overcomes embryo developmental arrest in compromised oocytes: proof of concept in the mouse model
months from live birth, but do not suggest a benefit from a longer interval as has been recommended for naturally conceiving couples. Supported by: National Center for Advancing Translational Sciences, National Institutes of Health, UCSF-CTSI Grant Number UL1 TR001872. O-96 Tuesday, October 31, 2017 12:15 PM MEIOTIC SPINDLE TRANSFER OVERCOMES EMBRYO DEVELOPMENTAL ARREST IN COMPROMISED OOCYTES: PROOF OF CONCEPT IN THE MOUSE MODEL. N. L. Costa-Borges,a E. Mestres,a I. Miguel-Escalada,b R. Basalmeda,c M. Garcia,a I. Vanrell,a c d a J. Gonzalez, G. Calderon. R&D Center, Embryotools, Barcelona, Spain; b Genomic-programming Laboratory, IDIBAPS, Barcelona, Spain; cPCBPRBB Animal Facility Alliance, Barcelona, Spain; dEmbryotools, Barcelona, Spain. OBJECTIVE: The aim of this study was to evaluate whether the meiotic spindle transfer (MST) technique can improve the embryo developmental potential of compromised mouse oocytes. DESIGN: Mouse strains with divergent mitochondrial haplotypes, the hybrid B6CBAF1 and New Zealand Black (NZB), were used to collect MII oocytes. NZB spindles were transferred into enucleated B6CBAF1 oocytes. After MST, reconstructed oocytes were inseminated by ICSI, similarly to non-manipulated oocytes used as controls. Embryo development was followed up to blastocyst stage. Blastocysts from the MST and controls groups were vitrified and subsequently transferred to surrogates to follow their development to term. Pups obtained were raised up to adulthood and crossed with wild type to evaluate their health status and fertility condition. MATERIALS AND METHODS: Animal care and procedures were conducted according to protocols approved by the Ethics Committee on Animal Research of Parc Cientific of Barcelona. Oocytes were collected from 6-10 weeks-old superovulated females. MSTwas performed in manipulation medium supplemented with cytochalasin B (5mg/ml). After enucleation, karyoplasts were exposed to an inactivated Sendai virus solution to promote membrane fusion. Karyoplast-cytoplast fusion was assessed after 2h, when ICSI was performed using a Piezo-Drill actuator with sperm from B6CBAF1 males. Blastocyst transfers were performed using a non-surgical embryo transfer device. RESULTS: High karyoplast-cytoplast fusion rates (98.0%) were obtained after MST between NZB and B6CBAF1 oocytes. Survival rates after ICSI were similar between the MST group and B6CBAF1 or NZB control oocytes (97.0%, 95.4% and 98.0%, respectively; p¼0.368). Blastocyst formation rate in non-manipulated NZB control oocytes (n¼106) was very low (5%) and significantly lower than in the B6CBAF1 control group (n¼86) (72%; p<0.0001). Interestingly, when the meiotic spindle from NZB oocytes was transferred into enucleated B6CBAF1 oocytes and inseminated by ICSI (n¼146), blastocyst rates increased significantly up to 35% (p<0.0001), suggesting that B6CBAF1 cytoplasmic content can enhance NZB nuclear development above the inherent strain developmental levels. A total of 10 out of 46 (21.7%) blastocysts from the MST group and 15 out of 56 (26.7%) from the B6CBAF1 control group transferred into surrogates developed to term. Mice obtained by MST were grown and outcrossed for two generations demonstrating to be fertile and with a health and behavioural status similar to the control mice. CONCLUSIONS: Our results indicate that MST can be successfully used to overcome embryo developmental arrest in mouse oocytes. MST does not affect in vivo development and the resulting mice show a heath and behavioural status similar to controls. References: 1. RD 15-1-0011. Supported by: This study was coved with private funds and partially financed by the Acci o-Generalitat de Catalunya and the European Regional Development funds (ERDF). ORAL SESSION HEALTH DISPARITIES O-97 Tuesday, October 31, 2017 11:00 AM BRIDGING THE GAP: NATIONAL UTILIZATION OF EMERGENCY SERVICES BY TRANSGENDER PATIENTS. M. B. Moravek, R. M. Baker, E. E. Marsh, J. F. Randolph. Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
FERTILITY & STERILITYÒ
OBJECTIVE: Investigate factors surrounding emergency department (ED) visits by transgender patients. DESIGN: Retrospective cross-sectional study using a nationally representative all-payer ED database. MATERIALS AND METHODS: Data from the Nationwide ED Sample (NEDS) database was examined for ED visits coded with an ICD9 transgender diagnosis using HCUPnet [Healthcare Cost and Utilization Project (HCUP) 2006-2014. Agency for Healthcare Research and Quality, Rockville, MD] and compared to data from ED visits for patients without a transgender diagnosis. Data was analyzed using Z tests for differences in proportions and counts. RESULTS: The estimated number of patients presenting to the ED with a transgender diagnosis increased 284% (from 1507 to 5788 patients) from 2006 to 2014, while ED visits for all other diagnoses only increased 15% during the same time period. Compared to all other ED visits in 2014, patients with a transgender diagnosis were significantly more likely to be admitted from the ED (57.9 vs 14.1%, p< .001), with admission rates >50% in all 9 years examined. They were also more likely to be 18-44 years (61.9 vs 39.4%, p< .001),live in large central metropolitan areas (45.6 vs 27.8%, p< .001), present to a teaching hospital (75.2 vs 56%, p< .001) and have Medicaid insurance (38.5 vs 32%, p< .001), but were less likely to be uninsured (7.7 vs 13%, p< .001) or from the south (16.1 vs 40%, p< .001). The highest percentage of transgender patients presenting to the ED were in the Midwest (31.2%), followed by the west (29.2%), northeast (23.5%), and south (16.1%). CONCLUSIONS: Utilization of the ED by transgender patients has increased over time, although it is unclear whether this trend is due to increased social acceptability over time or federal legislation prohibiting denial of insurance claims from transgender individuals. Transgender patients were more likely to be admitted from the ED than national averages, suggesting that there is room for improvement in primary and preventative care in this patient population. Examination of patient-specific data could better inform efforts to improve care for this understudied and underserved population, and intervene prior to conditions escalating to emergency status. Supported by: University of Michigan Department of Obstetrics and Gynecology O-98 Tuesday, October 31, 2017 11:15 AM INFERTILITY KNOWLEDGE AND BELIEFS AMONG AFRICAN AMERICAN WOMEN IN AN URBAN D. McCarthy-Keith,a COMMUNITY. A. Wiltshire,a F. Yan.b aObstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA; bCommunity Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA. OBJECTIVE: 1. Assess infertility knowledge and treatment beliefs among African American women 2. Determine if there are significant differences based on demographic factors 3. Compare these results to those of other ethnicities/countries by utilizing preexisting data in the literature. DESIGN: Cross sectional survey based study. MATERIALS AND METHODS: A validated survey from the study entitled Fertility Knowledge and Beliefs about Fertility treatment: Findings from the International Fertility Decision-Making Study (FKBF-FIFDM) was adapted for our patient population with the authors’ permission. Infertility knowledge was assessed using a 13-item true/false score (range: 0100% correct). Treatment beliefs were assessed using a 5-item Likert scale from 1 (strongly disagree) to 5 (strongly agree) of positive and negative statements. Inclusion criteria consisted of female sex, age R18, English speaking, and self-identification as Black or African American. The survey was administered from 3/1/17 to 4/31/17 in the Ob/Gyn Clinic at a safety net hospital. A power analysis, using the effect size for T-test [(m1-m2)/ SD], was computed to calculate the minimal sample size required. To have 80% power, a sample size of 139 was required for this study. The data was coded, logged into excel and analyzed with the Statistical Analysis System. RESULTS: A total of 158 completed surveys were collected. Of total subjects, 50% were <34 years old and the mean age was 35. The mean fertility knowledge score was 38.15% for total subjects, which was significantly lower than the mean score of 56.9% in total subjects of the FKBF-FIFDM study (p<0.0001)1. The mean positive belief score was 1.85 and the mean negative belief score was 3.25. Those with a higher level of education (p<0.0001) and those with paid employment (p¼ 0.01) had a significantly higher level of fertility knowledge. Those who had a history of fertility treatment had a significantly stronger agreement with negative treatment beliefs (p¼0.01). There was no significant difference in infertility knowledge or
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FERTILITY & STERILITYÒ
OBJECTIVE: Investigate factors surrounding emergency department (ED) visits by transgender patients. DESIGN: Retrospective cross-sectional study using a nationally representative all-payer ED database. MATERIALS AND METHODS: Data from the Nationwide ED Sample (NEDS) database was examined for ED visits coded with an ICD9 transgender diagnosis using HCUPnet [Healthcare Cost and Utilization Project (HCUP) 2006-2014. Agency for Healthcare Research and Quality, Rockville, MD] and compared to data from ED visits for patients without a transgender diagnosis. Data was analyzed using Z tests for differences in proportions and counts. RESULTS: The estimated number of patients presenting to the ED with a transgender diagnosis increased 284% (from 1507 to 5788 patients) from 2006 to 2014, while ED visits for all other diagnoses only increased 15% during the same time period. Compared to all other ED visits in 2014, patients with a transgender diagnosis were significantly more likely to be admitted from the ED (57.9 vs 14.1%, p< .001), with admission rates >50% in all 9 years examined. They were also more likely to be 18-44 years (61.9 vs 39.4%, p< .001),live in large central metropolitan areas (45.6 vs 27.8%, p< .001), present to a teaching hospital (75.2 vs 56%, p< .001) and have Medicaid insurance (38.5 vs 32%, p< .001), but were less likely to be uninsured (7.7 vs 13%, p< .001) or from the south (16.1 vs 40%, p< .001). The highest percentage of transgender patients presenting to the ED were in the Midwest (31.2%), followed by the west (29.2%), northeast (23.5%), and south (16.1%). CONCLUSIONS: Utilization of the ED by transgender patients has increased over time, although it is unclear whether this trend is due to increased social acceptability over time or federal legislation prohibiting denial of insurance claims from transgender individuals. Transgender patients were more likely to be admitted from the ED than national averages, suggesting that there is room for improvement in primary and preventative care in this patient population. Examination of patient-specific data could better inform efforts to improve care for this understudied and underserved population, and intervene prior to conditions escalating to emergency status. Supported by: University of Michigan Department of Obstetrics and Gynecology O-98 Tuesday, October 31, 2017 11:15 AM INFERTILITY KNOWLEDGE AND BELIEFS AMONG AFRICAN AMERICAN WOMEN IN AN URBAN D. McCarthy-Keith,a COMMUNITY. A. Wiltshire,a F. Yan.b aObstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA; bCommunity Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA. OBJECTIVE: 1. Assess infertility knowledge and treatment beliefs among African American women 2. Determine if there are significant differences based on demographic factors 3. Compare these results to those of other ethnicities/countries by utilizing preexisting data in the literature. DESIGN: Cross sectional survey based study. MATERIALS AND METHODS: A validated survey from the study entitled Fertility Knowledge and Beliefs about Fertility treatment: Findings from the International Fertility Decision-Making Study (FKBF-FIFDM) was adapted for our patient population with the authors’ permission. Infertility knowledge was assessed using a 13-item true/false score (range: 0100% correct). Treatment beliefs were assessed using a 5-item Likert scale from 1 (strongly disagree) to 5 (strongly agree) of positive and negative statements. Inclusion criteria consisted of female sex, age R18, English speaking, and self-identification as Black or African American. The survey was administered from 3/1/17 to 4/31/17 in the Ob/Gyn Clinic at a safety net hospital. A power analysis, using the effect size for T-test [(m1-m2)/ SD], was computed to calculate the minimal sample size required. To have 80% power, a sample size of 139 was required for this study. The data was coded, logged into excel and analyzed with the Statistical Analysis System. RESULTS: A total of 158 completed surveys were collected. Of total subjects, 50% were <34 years old and the mean age was 35. The mean fertility knowledge score was 38.15% for total subjects, which was significantly lower than the mean score of 56.9% in total subjects of the FKBF-FIFDM study (p<0.0001)1. The mean positive belief score was 1.85 and the mean negative belief score was 3.25. Those with a higher level of education (p<0.0001) and those with paid employment (p¼ 0.01) had a significantly higher level of fertility knowledge. Those who had a history of fertility treatment had a significantly stronger agreement with negative treatment beliefs (p¼0.01). There was no significant difference in infertility knowledge or
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