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National assisted reproductive technology (ART) cycle linkage
vs. G1.5, 3273g). Culture medium was not significantly associated with embryo quality. CONCLUSION: Our study did not reveal a significant association between embryo culture medium and birth weight. Larger studies are needed to further elucidate this issue.
Maternal age (yrs) % nulliparous Gestational age (wks) % male Birth weight (g) Birth weight of firstborns (g) % SGA % 8-cell % with fragmentation score 0 or 1 % with asymmetry score 1
G1.3 (n¼102)
GLB (n¼53)
G1.5 (n¼43)
P value
33.0 3.8 63.7 39.3 1.4 50.0 3368 569 3329 478
32.1 3.0 64.2 39.1 1.3 54.7 3331 441 3297 454
9.8 80.4 88.2
13.2 79.3 96.2
16.3 83.7 90.7
.5 .8 .3
65.4
64.2
79.1
.2
32.6 3.4 .4 100.0 < .0001 39.1 1.6 .7 55.8 .8 3273 534 .6 3273 534 .8
Values represent mean SD
O-278 Wednesday, October 27, 2010 04:00 PM NATIONAL ASSISTED REPRODUCTIVE TECHNOLOGY (ART) CYCLE LINKAGE. B. Luke, M. B. Brown, E. Wantman, A. Lederman, W. E. Gibbons, J. E. Stern. Michigan State University, East Lansing, MI; University of Michigan, Ann Arbor, MI; Redshift Technologies, Inc., New York, NY; Baylor College of Medicine, Houston, TX; Dartmouth-Hitchcock Medical Center, Lebanon, NH. OBJECTIVE: To determine the feasibility of linking all ART cycles in the Society for Assisted Reproductive Technology Clinic Outome Reporting System (SART CORS) for 2004-08 and calculating per cycle and cumulative live birth rates. DESIGN: Historical cohort study. MATERIALS AND METHODS: Cycles reported to the SART CORS between January 1, 2004 and December 31, 2008 were included. Cycles were linked by woman’s date of birth, last name, first name, and social security number (when present); linkages across clinics also included partner’s name and sequence of ART outcomes, as needed. The following cycles were excluded from the final match: cancelled, research, no outcomes, gestational carriers, and embryo banking and no outcome reported. Cycles were limited to those up to and including the first live birth. RESULTS: During this five year period there were a total of 642,220 cycles, including two women with four live births, 237 women with three live births, 13,120 women with two live births, and 157,968 women with one live birth. After exclusions and limitations, there were 518,496 cycles among 306,565 women, resulting in 171,327 first live births. The highest live birth rate was in the first cycle (35.9%), falling progressively with each subsequent cycle.
Cumulative Live Birth Number of Live Birth Live Birth Delivery Rate Cumulative Women Deliveries Delivery Rate Live Birth at Each at Risk in in Each Cycles of ART Cycle (N) Each Cycle (N) Cycle (%) Deliveries (N) Per Woman (%) 1 2 3 4 5 6 R7
S82
110,019 36,518 14,810 5,800 2,355 1,100 725
Abstracts
306,565 122,669 50,863 21,293 9,145 4,142 3,819
35.9 29.8 29.1 27.2 25.8 26.6 19.0
110,019 146,537 161,347 167,147 169,502 170,602 171,327
35.9 47.8 52.6 54.5 55.3 55.6 55.9
CONCLUSION: This analysis demonstrates the feasibility of a national linkage of ART cycles, and the calculation of live birth rates per woman. Supported by: SART.
O-279 Wednesday, October 27, 2010 04:15 PM PREDICTING LIVE BIRTH, PRETERM AND LOW BIRTH WEIGHT INFANT AFTER IN-VITRO FERTILIZATION: A PROSPECTIVE STUDY OF 144,018 TREATMENT CYCLES. S. M. Nelson, D. A. Lawlor. Reproductive & Maternal Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom; MRC Centre for Causal Analysis in Translational Epidemiology, University of Bristol, Bristol, England, United Kingdom. OBJECTIVE: Determine the extent to which baseline couple characteristics predict live birth and adverse perinatal outcomes after assisted conception. DESIGN: Population cohort study. MATERIALS AND METHODS: We utilised the Human Fertilisation and Embryology Authority database to examine the predictors of live birth in all IVF and ICSI cycles undertaken in the UK between 2003 and 2007 (n¼144,018 cycles). For those cycles that resulted in a live singleton (n¼25,490), we determined the associates of preterm birth, low birth weight and macrosomia. RESULTS: The overall rate of at least one live birth was 23.4 per 100 cycles (95%CI: 23.2, 23.7). The odds of a live birth decreased with increasing maternal age, increasing duration of infertility, greater number of previously unsuccessful IVF treatments, when the woman’s own egg was used, when this was the second or third (as opposed to first) treatment cycle, or if the cause of infertility was not unexplained. A previous live birth due to IVF increased the odds of future success (OR 1.58, 95% CI 1.46, 1.71) more than a history of spontaneous live birth (OR 1.19, 95% CI 0.99, 1.24). Prediction of live birth was feasible with excellent calibration. Preterm birth and low birth weight were increased in younger women, if oocyte donation was required or if there was a history of pregnancy loss, irrespective of whether the pregnancy was spontaneous or after IVF. The risk of macrosomia increased with advancing maternal age and a history of previous live births. CONCLUSION: Couple and treatment specific factors significantly affect the prospect of live birth after assisted conception; these can be used to accurately predict success. Oocyte donation and the necessity for assisted conception in younger women are strongly associated with low birth weight and preterm delivery even in singleton pregnancies. Supported by: DAL works in a Centre (MRC Centre for Causal Analyses in Translational Epidemiology) that receives funding from the UK Medical Research Council (G0600705) and the University of Bristol.
O-280 Wednesday, October 27, 2010 04:30 PM ELECTIVE SINGLE BLASTOCYST TRANSFER (eSBT) ELIMINATES TWINNING WITHOUT COMPROMISING THE PREGNANCY RATE (PR) IN GOOD PROGNOSIS PATIENTS. C. M. Mullin, J. A. Grifo, A. S. Berkeley. NYU Fertility Center, New York University, New York, NY. OBJECTIVE: To determine if patients, <40 years old with or without day 5 cryopreservation(d5 cryo), compromise their PR by choosing eSBT. DESIGN: Retrospective analysis. MATERIALS AND METHODS: 2222 IVF cycles from 2004-2010 in patients <40 years old were reviewed and divided into 2 groups based on whether d5 cryo was performed, and further subdivided based on the decision to transfer 1(eSBT) or 2(2BT) blastocysts. Outcomes included #of oocytes retrieved and fertilized, blastocysts frozen/cycle, implantation rate(IR), PR, spontaneous abortion(SAB), and live birth+ongoing pregnancy(LB+OP) rates. PR was defined by presence of intrauterine fetal heart activity by ultrasound. LB+OP was defined as the #live birth events+the #patients currently clinically pregnant. t-test and Fisher’s exact test were performed for statistical analysis with p<0.05. RESULTS: eSBT eliminates twinning.
Vol. 94., No. 4, Supplement, September 2010
Maternal age (yrs) % nulliparous Gestational age (wks) % male Birth weight (g) Birth weight of firstborns (g) % SGA % 8-cell % with fragmentation score 0 or 1 % with asymmetry score 1
G1.3 (n¼102)
GLB (n¼53)
G1.5 (n¼43)
P value
33.0 3.8 63.7 39.3 1.4 50.0 3368 569 3329 478
32.1 3.0 64.2 39.1 1.3 54.7 3331 441 3297 454
9.8 80.4 88.2
13.2 79.3 96.2
16.3 83.7 90.7
.5 .8 .3
65.4
64.2
79.1
.2
32.6 3.4 .4 100.0 < .0001 39.1 1.6 .7 55.8 .8 3273 534 .6 3273 534 .8
Values represent mean SD
O-278 Wednesday, October 27, 2010 04:00 PM NATIONAL ASSISTED REPRODUCTIVE TECHNOLOGY (ART) CYCLE LINKAGE. B. Luke, M. B. Brown, E. Wantman, A. Lederman, W. E. Gibbons, J. E. Stern. Michigan State University, East Lansing, MI; University of Michigan, Ann Arbor, MI; Redshift Technologies, Inc., New York, NY; Baylor College of Medicine, Houston, TX; Dartmouth-Hitchcock Medical Center, Lebanon, NH. OBJECTIVE: To determine the feasibility of linking all ART cycles in the Society for Assisted Reproductive Technology Clinic Outome Reporting System (SART CORS) for 2004-08 and calculating per cycle and cumulative live birth rates. DESIGN: Historical cohort study. MATERIALS AND METHODS: Cycles reported to the SART CORS between January 1, 2004 and December 31, 2008 were included. Cycles were linked by woman’s date of birth, last name, first name, and social security number (when present); linkages across clinics also included partner’s name and sequence of ART outcomes, as needed. The following cycles were excluded from the final match: cancelled, research, no outcomes, gestational carriers, and embryo banking and no outcome reported. Cycles were limited to those up to and including the first live birth. RESULTS: During this five year period there were a total of 642,220 cycles, including two women with four live births, 237 women with three live births, 13,120 women with two live births, and 157,968 women with one live birth. After exclusions and limitations, there were 518,496 cycles among 306,565 women, resulting in 171,327 first live births. The highest live birth rate was in the first cycle (35.9%), falling progressively with each subsequent cycle.
Cumulative Live Birth Number of Live Birth Live Birth Delivery Rate Cumulative Women Deliveries Delivery Rate Live Birth at Each at Risk in in Each Cycles of ART Cycle (N) Each Cycle (N) Cycle (%) Deliveries (N) Per Woman (%) 1 2 3 4 5 6 R7
S82
110,019 36,518 14,810 5,800 2,355 1,100 725
Abstracts
306,565 122,669 50,863 21,293 9,145 4,142 3,819
35.9 29.8 29.1 27.2 25.8 26.6 19.0
110,019 146,537 161,347 167,147 169,502 170,602 171,327
35.9 47.8 52.6 54.5 55.3 55.6 55.9
CONCLUSION: This analysis demonstrates the feasibility of a national linkage of ART cycles, and the calculation of live birth rates per woman. Supported by: SART.
O-279 Wednesday, October 27, 2010 04:15 PM PREDICTING LIVE BIRTH, PRETERM AND LOW BIRTH WEIGHT INFANT AFTER IN-VITRO FERTILIZATION: A PROSPECTIVE STUDY OF 144,018 TREATMENT CYCLES. S. M. Nelson, D. A. Lawlor. Reproductive & Maternal Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom; MRC Centre for Causal Analysis in Translational Epidemiology, University of Bristol, Bristol, England, United Kingdom. OBJECTIVE: Determine the extent to which baseline couple characteristics predict live birth and adverse perinatal outcomes after assisted conception. DESIGN: Population cohort study. MATERIALS AND METHODS: We utilised the Human Fertilisation and Embryology Authority database to examine the predictors of live birth in all IVF and ICSI cycles undertaken in the UK between 2003 and 2007 (n¼144,018 cycles). For those cycles that resulted in a live singleton (n¼25,490), we determined the associates of preterm birth, low birth weight and macrosomia. RESULTS: The overall rate of at least one live birth was 23.4 per 100 cycles (95%CI: 23.2, 23.7). The odds of a live birth decreased with increasing maternal age, increasing duration of infertility, greater number of previously unsuccessful IVF treatments, when the woman’s own egg was used, when this was the second or third (as opposed to first) treatment cycle, or if the cause of infertility was not unexplained. A previous live birth due to IVF increased the odds of future success (OR 1.58, 95% CI 1.46, 1.71) more than a history of spontaneous live birth (OR 1.19, 95% CI 0.99, 1.24). Prediction of live birth was feasible with excellent calibration. Preterm birth and low birth weight were increased in younger women, if oocyte donation was required or if there was a history of pregnancy loss, irrespective of whether the pregnancy was spontaneous or after IVF. The risk of macrosomia increased with advancing maternal age and a history of previous live births. CONCLUSION: Couple and treatment specific factors significantly affect the prospect of live birth after assisted conception; these can be used to accurately predict success. Oocyte donation and the necessity for assisted conception in younger women are strongly associated with low birth weight and preterm delivery even in singleton pregnancies. Supported by: DAL works in a Centre (MRC Centre for Causal Analyses in Translational Epidemiology) that receives funding from the UK Medical Research Council (G0600705) and the University of Bristol.
O-280 Wednesday, October 27, 2010 04:30 PM ELECTIVE SINGLE BLASTOCYST TRANSFER (eSBT) ELIMINATES TWINNING WITHOUT COMPROMISING THE PREGNANCY RATE (PR) IN GOOD PROGNOSIS PATIENTS. C. M. Mullin, J. A. Grifo, A. S. Berkeley. NYU Fertility Center, New York University, New York, NY. OBJECTIVE: To determine if patients, <40 years old with or without day 5 cryopreservation(d5 cryo), compromise their PR by choosing eSBT. DESIGN: Retrospective analysis. MATERIALS AND METHODS: 2222 IVF cycles from 2004-2010 in patients <40 years old were reviewed and divided into 2 groups based on whether d5 cryo was performed, and further subdivided based on the decision to transfer 1(eSBT) or 2(2BT) blastocysts. Outcomes included #of oocytes retrieved and fertilized, blastocysts frozen/cycle, implantation rate(IR), PR, spontaneous abortion(SAB), and live birth+ongoing pregnancy(LB+OP) rates. PR was defined by presence of intrauterine fetal heart activity by ultrasound. LB+OP was defined as the #live birth events+the #patients currently clinically pregnant. t-test and Fisher’s exact test were performed for statistical analysis with p<0.05. RESULTS: eSBT eliminates twinning.
Vol. 94., No. 4, Supplement, September 2010