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Miscarriage Rates in Women With Diminished Egg Reserve Are More Similar to Those of Their Age Peers Rather Than of Women of Advanced Reproductive Age
Methods: All patients experienced controlled ovarian hyperstimulation, followed by egg retrieval 35 h after hCG. Eggs were recovered and placed in P1 medium þ 5% HSA until insemination. Eggs were moved to a more complex medium containing 5% HSA/5% SS after ICSI or after IVF fertilization check. Embryos were evaluated on day 3 and transfered on day 3 to 5 depending on the number/quality of embryos available and the IVF history of the patient. Transfers were performed under ultrasound guidance, primarily using a Wallace catheter. Results: Age <35 yr þ donor cycles Category
n
n (%) þ b-hCG
6% CO2/air incubation [2ndQrt06] P1/G1/G2 media 49 40 (82)a [4thQrt06] Global medium 49 29 (59) 6% CO2/5% O2/90% N2 incubation [1stQrt07] Sanyo Mini 29 22 (76) [LG media] Heraeus 240 21 15 (71) Combined TG 50 37 (74) a
Age <38 yr þ donors
n (%) OngPreg
n
n (%) þ b-hCG
n (%) OngPreg
31 (63)a
75
54 (72)
42 (56)
24 (49)
65
42 (65)
33 (51)
21 (72)a
38
25 (66)
24 (63)
13 (62) 34 (68)
32 70
a
24 (75) 49 (70)
20 (63) 44 (63
Significant difference (P<.05) within column subsection.
Conclusions: Overall, both the P1/G1/G2 sequential system and the LG all-in-one medium produced good pregnancy rates under standard 6% CO2 in air conditions. In contrast, the LG system with tri-gas incubation significantly improved pregnancy outcomes by reducing SABs and biochemical pregnancies (50% decrease), resulting in higher ongoing clinical pregnancy rates. No difference was observed in the type of incubator used; however, this is one of the first reports validating the clinical effectiveness of the new Sanyo mini-incubators.
P-27 Miscarriage Rates in Women With Diminished Egg Reserve Are More Similar to Those of Their Age Peers Rather Than of Women of Advanced Reproductive Age. G. Citrino, J.H. Check, A. DiAntonio. Division of Reproduction, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, and Cooper Hospital/University Medical Center, Camden, NJ. Background: Pregnancies following in vitro fertilization (IVF) in younger women with serum follicle-stimulating hormone (FSH) >12 mIU/mL are not nearly as rare as achieving pregnancies at age 45 even with normal FSH. Objective: The objective of this study was to determine the frequency of miscarriage in women who conceive despite day 2 or 3 serum FSH >12 mIU/mL according to age, to see if miscarriage rates are similar in this group across all ages or if age rather than egg reserve determines the increased risk of miscarriage. Materials and Methods: All women undergoing IVF-ET with a serum FSH >12 mIU/mL over an 8-year time period were retrospectively evaluated, and those achieving a pregnancy as determined by ultrasound evidence of pregnancy were evaluated for subsequent miscarriage. Furthermore, for those completing the first trimester, subsequent births or terminations related to trisomy-21 were determined. Results: There were 86 clinical pregnancies in 424 ET cycles (20.3% per transfer). The distribution was 3 aged <30 years, 30 aged 30–35, 36 aged 36–40, and 17 aged >40. Miscarriages in these 4 groups were 0/3 (0%), 7/30 (23.3%), 11/36 (30.5%), and 8/17 (47.0%), respectively. Two of the 60 women who did not have a first trimester miscarriage had trisomy 21 (one aged 42.9 delivered a live baby, and the other terminated the pregnancy subsequent to the results of amniocentesis), and there was only 1 birth defect—craniosynostosis—in the baby of a 33.4-year-old woman. Conclusions: The miscarriage rate in women aged %40 with diminished egg reserve was only 26% (18/69). The rate of Down syndrome, especially in the younger patients, was not increased either. These data are consistent with the hypothesis that the majority of women with elevated day 3 serum FSH do not have an advancement of the normal egg atresia process leaving not only less but poor-quality eggs, but rather a destructive process. The remaining eggs, though much fewer in number, are from a quality standpoint more similar to those of their age peers with normal day 3 serum FSH.
S18
PCRS Abstracts
P-28 Clinical Application of Preimplantation Genetic Diagnosis (PGD) for Carriers of Chromosome Rearrangements—What Should You Expect? G. Harton, M.J. Reeves, K. Redford, M. Sands, S. Zornetzer, H. Stern. Background: Preimplantation genetic diagnosis (PGD) for couples with structural chromosome rearrangements is an accepted and effective alternative to prenatal diagnosis of an ongoing pregnancy and possible pregnancy interruption. This type of specialized diagnostic procedure is now available to most IVF centers through the use of ‘‘transport PGD,’’ where the sample is sent to a specialty genetics laboratory able to perform this high-tech testing. Clinicians in the referring center, however, are often left wondering how to counsel patients and manage expectations in complex situations such as chromosome rearrangements. Objective: The aim of this study was to determine if the overall percentage and therefore the expected number of normal/balanced embryos per case differed in PGD cycles performed for various structural chromosome rearrangements (Robertsonian translocations, balanced reciprocal translocations, and inversions). Materials and Methods: In this retrospective study, the number of normal/ balanced embryos per cycle and the overall percentage of normal embryos were assessed from PGD cycles performed for chromosome rearrangements in our laboratory. Of these 52 cycles, 35 (67.3%) were from patients in our center and 17 (32.7%) were transport PGD received from an outside center. Results: During the study, 408 embryos were biopsied and tested for known structural rearrangements. On average, there were 1.98 normal/balanced embryos per case. The number of normal/balanced embryos per cycle available for transfer was higher for Robertsonian translocations than for other structural chromosome rearrangements (3.0 vs. 1.4). Overall, the percentage of normal/balanced embryos for cycles performed for Robertsonian translocations was higher than for balanced reciprocal translocations and inversions (35.6% vs. 18.5%). In comparison, during the same time period we observed an average of 32.5% normal embryos (2.9 normal embryos per cycle) in our patients who had PGD for aneuploidy screening, primarily for advanced reproductive age. Conclusions: PGD for chromosome rearrangements is a unique class of testing that requires specialized patient counseling. In general, fewer normal embryos should be expected when PGD is performed for balanced reciprocal translocations and inversions than for Robertsonian translocations and aneuploidy. To manage patient expectations, this information needs to be discussed with them by a variety of different providers, including reproductive endocrinologists, embryologists, and genetic counselors.
P-29 Defining the Implantation Window in OD-Recipient Frozen Blastocyst Cycles. M. Hinckley, L.N. Weckstein, S.P. Willman, C.S. Sgarlata. Background: Traditional teaching dictates progesterone initiation in ODrecipient cycles on the day before or day of the donor’s egg retrieval. In so doing, embryo transfer mimics a natural cycle. Initial concerns about going beyond the implantation window with day 6 fresh transfers were allayed by high pregnancy rates in our clinic similar to day 5 transfers [72% ongoing pregnancy rate for both day 5 transfer (94/131) and day 6 transfer (13/18)]. This prompted re-evaluation of progesterone exposure in frozen OD-recipient cycles. Objective: To determine optimal progesterone exposure for OD-recipient frozen blastocyst transfers. Materials and Methods: On January 1, 2006, all OD-recipient frozen blastocyst transfers initiated progesterone 24 hours earlier than previously for transfer on the 6th day of progesterone. Cycle outcome over the past 1.5 years was compared with the previous 2.5 years. Results: Performing blastocyst embryo transfer in OD-recipient cycles on the 6th day of progesterone resulted in statistically higher clinical pregnancy rates than on the 5th day (52% vs. 23%; P<.05). Further analysis revealed a trend toward a higher biochemical pregnancy rate (50% vs. 33%) and a lower delivery rate (23% vs. 48%; P<.05) in the group transfered on the 5th day of progesterone. Subgroup analysis by the day of embryo freeze for the group of patients with 6 days of progesterone revealed a higher pregnancy rates in the groups where the day of transfer was synchronized with the day of embryo freeze (73% vs. 35%; P<.05).
Vol. 89, Suppl 2, April 2008
n
n (%) þ b-hCG
6% CO2/air incubation [2ndQrt06] P1/G1/G2 media 49 40 (82)a [4thQrt06] Global medium 49 29 (59) 6% CO2/5% O2/90% N2 incubation [1stQrt07] Sanyo Mini 29 22 (76) [LG media] Heraeus 240 21 15 (71) Combined TG 50 37 (74) a
Age <38 yr þ donors
n (%) OngPreg
n
n (%) þ b-hCG
n (%) OngPreg
31 (63)a
75
54 (72)
42 (56)
24 (49)
65
42 (65)
33 (51)
21 (72)a
38
25 (66)
24 (63)
13 (62) 34 (68)
32 70
a
24 (75) 49 (70)
20 (63) 44 (63
Significant difference (P<.05) within column subsection.
Conclusions: Overall, both the P1/G1/G2 sequential system and the LG all-in-one medium produced good pregnancy rates under standard 6% CO2 in air conditions. In contrast, the LG system with tri-gas incubation significantly improved pregnancy outcomes by reducing SABs and biochemical pregnancies (50% decrease), resulting in higher ongoing clinical pregnancy rates. No difference was observed in the type of incubator used; however, this is one of the first reports validating the clinical effectiveness of the new Sanyo mini-incubators.
P-27 Miscarriage Rates in Women With Diminished Egg Reserve Are More Similar to Those of Their Age Peers Rather Than of Women of Advanced Reproductive Age. G. Citrino, J.H. Check, A. DiAntonio. Division of Reproduction, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, and Cooper Hospital/University Medical Center, Camden, NJ. Background: Pregnancies following in vitro fertilization (IVF) in younger women with serum follicle-stimulating hormone (FSH) >12 mIU/mL are not nearly as rare as achieving pregnancies at age 45 even with normal FSH. Objective: The objective of this study was to determine the frequency of miscarriage in women who conceive despite day 2 or 3 serum FSH >12 mIU/mL according to age, to see if miscarriage rates are similar in this group across all ages or if age rather than egg reserve determines the increased risk of miscarriage. Materials and Methods: All women undergoing IVF-ET with a serum FSH >12 mIU/mL over an 8-year time period were retrospectively evaluated, and those achieving a pregnancy as determined by ultrasound evidence of pregnancy were evaluated for subsequent miscarriage. Furthermore, for those completing the first trimester, subsequent births or terminations related to trisomy-21 were determined. Results: There were 86 clinical pregnancies in 424 ET cycles (20.3% per transfer). The distribution was 3 aged <30 years, 30 aged 30–35, 36 aged 36–40, and 17 aged >40. Miscarriages in these 4 groups were 0/3 (0%), 7/30 (23.3%), 11/36 (30.5%), and 8/17 (47.0%), respectively. Two of the 60 women who did not have a first trimester miscarriage had trisomy 21 (one aged 42.9 delivered a live baby, and the other terminated the pregnancy subsequent to the results of amniocentesis), and there was only 1 birth defect—craniosynostosis—in the baby of a 33.4-year-old woman. Conclusions: The miscarriage rate in women aged %40 with diminished egg reserve was only 26% (18/69). The rate of Down syndrome, especially in the younger patients, was not increased either. These data are consistent with the hypothesis that the majority of women with elevated day 3 serum FSH do not have an advancement of the normal egg atresia process leaving not only less but poor-quality eggs, but rather a destructive process. The remaining eggs, though much fewer in number, are from a quality standpoint more similar to those of their age peers with normal day 3 serum FSH.
S18
PCRS Abstracts
P-28 Clinical Application of Preimplantation Genetic Diagnosis (PGD) for Carriers of Chromosome Rearrangements—What Should You Expect? G. Harton, M.J. Reeves, K. Redford, M. Sands, S. Zornetzer, H. Stern. Background: Preimplantation genetic diagnosis (PGD) for couples with structural chromosome rearrangements is an accepted and effective alternative to prenatal diagnosis of an ongoing pregnancy and possible pregnancy interruption. This type of specialized diagnostic procedure is now available to most IVF centers through the use of ‘‘transport PGD,’’ where the sample is sent to a specialty genetics laboratory able to perform this high-tech testing. Clinicians in the referring center, however, are often left wondering how to counsel patients and manage expectations in complex situations such as chromosome rearrangements. Objective: The aim of this study was to determine if the overall percentage and therefore the expected number of normal/balanced embryos per case differed in PGD cycles performed for various structural chromosome rearrangements (Robertsonian translocations, balanced reciprocal translocations, and inversions). Materials and Methods: In this retrospective study, the number of normal/ balanced embryos per cycle and the overall percentage of normal embryos were assessed from PGD cycles performed for chromosome rearrangements in our laboratory. Of these 52 cycles, 35 (67.3%) were from patients in our center and 17 (32.7%) were transport PGD received from an outside center. Results: During the study, 408 embryos were biopsied and tested for known structural rearrangements. On average, there were 1.98 normal/balanced embryos per case. The number of normal/balanced embryos per cycle available for transfer was higher for Robertsonian translocations than for other structural chromosome rearrangements (3.0 vs. 1.4). Overall, the percentage of normal/balanced embryos for cycles performed for Robertsonian translocations was higher than for balanced reciprocal translocations and inversions (35.6% vs. 18.5%). In comparison, during the same time period we observed an average of 32.5% normal embryos (2.9 normal embryos per cycle) in our patients who had PGD for aneuploidy screening, primarily for advanced reproductive age. Conclusions: PGD for chromosome rearrangements is a unique class of testing that requires specialized patient counseling. In general, fewer normal embryos should be expected when PGD is performed for balanced reciprocal translocations and inversions than for Robertsonian translocations and aneuploidy. To manage patient expectations, this information needs to be discussed with them by a variety of different providers, including reproductive endocrinologists, embryologists, and genetic counselors.
P-29 Defining the Implantation Window in OD-Recipient Frozen Blastocyst Cycles. M. Hinckley, L.N. Weckstein, S.P. Willman, C.S. Sgarlata. Background: Traditional teaching dictates progesterone initiation in ODrecipient cycles on the day before or day of the donor’s egg retrieval. In so doing, embryo transfer mimics a natural cycle. Initial concerns about going beyond the implantation window with day 6 fresh transfers were allayed by high pregnancy rates in our clinic similar to day 5 transfers [72% ongoing pregnancy rate for both day 5 transfer (94/131) and day 6 transfer (13/18)]. This prompted re-evaluation of progesterone exposure in frozen OD-recipient cycles. Objective: To determine optimal progesterone exposure for OD-recipient frozen blastocyst transfers. Materials and Methods: On January 1, 2006, all OD-recipient frozen blastocyst transfers initiated progesterone 24 hours earlier than previously for transfer on the 6th day of progesterone. Cycle outcome over the past 1.5 years was compared with the previous 2.5 years. Results: Performing blastocyst embryo transfer in OD-recipient cycles on the 6th day of progesterone resulted in statistically higher clinical pregnancy rates than on the 5th day (52% vs. 23%; P<.05). Further analysis revealed a trend toward a higher biochemical pregnancy rate (50% vs. 33%) and a lower delivery rate (23% vs. 48%; P<.05) in the group transfered on the 5th day of progesterone. Subgroup analysis by the day of embryo freeze for the group of patients with 6 days of progesterone revealed a higher pregnancy rates in the groups where the day of transfer was synchronized with the day of embryo freeze (73% vs. 35%; P<.05).
Vol. 89, Suppl 2, April 2008