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Number of supernumerary euploid embryos from an IVF cycle correlates with an ongoing pregnancy rate after subsequent single, euploid embryo transfer (SET)
P-254 Tuesday, October 18, 2016
P-255 Tuesday, October 18, 2016
DOES FRESH EMBRYO TRANSFER ACCENTUATE THE PERINATAL RISKS OF DICHORIONIC TWIN GESTATIONS? L. Sekhon,a,b K. Shaia,a,b J. Rodriguez-Purata,a J. A. Lee,a A. B. Copperman.a aReproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
ABSTRACT WITHDRAWN
OBJECTIVE: Twins are at higher risk for fetal growth restriction and stillbirth compared to singleton gestations. Dichorionic twins, conceived spontaneously or by IVF, often have discordant growth as a consequence defective trophoblast invasion or impaired development of uteroplacental circulation. Significant birthweight (BW) discordance is associated with poor perinatal outcome. Recently, controlled ovarian hyperstimulation (COH) followed by fresh embryo transfer (ET) has been linked to defective placentation, evidenced by lower BW compared to pregnancies conceived from frozen embryo transfer (FET). While this notion has been demonstrated in studies of singleton gestations, there is limited data examining the effect of ovarian stimulation on growth and prematurity in twin gestations. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All fresh or frozen ET cycles in which patients had R2 blastocysts transferred from November 2002 to July 2015, resulting in live twin birth atR24 weeks gestation, were included. Cycles with spontaneously/selectively reduced twin gestations were excluded. Main outcome measures included gestational age at delivery, twin BW, BW discordance and the incidence of prematurity and poor growth (low/ very low/extremely low BW). Student’s t-test, chi-square and linear regression analysis were used. RESULTS: Nine hundred and fifty eight patients delivered dichorionic twins after fresh (n¼772) and frozen ETs (n¼186). Patient demographics, cycle characteristics and perinatal outcomes are listed in Table 1. Fresh ET twins had a significantly lower mean average BW (2127.8g vs. 2314.8g, <0.005) than the FET group. For every 1pg/ml increase in peak estradiol there was a 0.06g decrease in the averaged twin BW (<0.0001). The degree of BW discordance and prematurity were similar among groups. CONCLUSIONS: Similar to what is reported in singleton pregnancies, dichorionic twins conceived after fresh ET had lower BW compared with their FET cohort. However, the adverse effects on proper trophoblast invasion and placentation appeared to be mild as they did not translate into increased BW discordance, prematurity or BW <2500g. Further studies incorporating additional perinatal outcomes (ie. preeclampsia) are required to better understand the role of the endometrial hormonal milieu on placentation.
P-256 Tuesday, October 18, 2016 NUMBER OF SUPERNUMERARY EUPLOID EMBRYOS FROM AN IVF CYCLE CORRELATES WITH AN ONGOING PREGNANCY RATE AFTER SUBSEQUENT SINGLE, EUPLOID EMBRYO L. Sekhon,a,c K. Shaia,a,c TRANSFER (SET). M. Kon,a,b a a a M. C. Whitehouse, J. A. Lee, R. Slifkin, E. Flisser,a J. Klein,a M. Lederman,a L. Grunfeld,a,c T. Mukherjee,a,c B. Sandler,a,c A. B. Copperman,a,c D. E. Stein.a,b aReproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai West-Mount Sinai St. Luke’s, New York, NY; cObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. OBJECTIVE: While ongoing pregnancy rates (OPR) have been shown to be enhanced in women with supernumerary blastocysts, it is unknown how the use of preimplantation genetic screening (PGS) at transfer selection and the presence of supernumerary euploid embryos (SEEs) affect IVF cycle outcome. This study sought to determine how SEE counts affect euploid, single blastocysts transfer cycle outcome. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All patients who underwent a euploid SET between July 2011 and April 2016 were included. Cohorts were split into ‘‘Implanted’’ and ‘‘Non-Implanted’’ groups. Patients with <2 euploid embryos at the time of SET were excluded. Ongoing pregnancy rates (OPR) were correlated with SEE counts and corrected for age and diagnosis. Student’s t-test, linear and binary logistic regression analyses were performed. RESULTS: One thousand ninety-nine cycles were included in the study. Patient demographics did not differ between study cohorts. Overall, patients achieved a 60.6% implantation and 55.5% OPR. Patients who had successful implantation and an ongoing pregnancy (n¼610) had similar numbers of oocytes retrieved (17.3 +/-9.8) and blastocysts biopsied (5.9+/- 4.3) to those who did not (OR 1.008 [95% CI 0.996-1.020], p¼0.19 and OR 1.015 [95% CI 0.992-1.039], p¼0.21, respectively). SEEs were similar between cohorts (Implanted: 3.70 +/- 3.02; Non-Implanted: 3.57 +/- 3.11) (OR 1.008 [95% CI 0.97-0.049], p¼0.68). When the total of SEEs in the Implantation cohort was analyzed, the OPR was significantly increased from 46.0 % to 58.9% when patients had >4 embryos (p ¼0.0043). CONCLUSIONS: Patients with at least one SEE are likely to have a higher ongoing clinical pregnancy rate than patients with only one available embryo. This rate increases with the increased number of vitrified SEEs. Although patients who incorporate PGS prior to embryo selection during an IVF cycle have high success rates, a boost in supernumerary euploid counts further enhances positive outcome probability.
Patient demographics, cycle characteristics & perinatal outcome
Patient’s age at ET BMI Endometrial Thickness at transfer (mm) Peak E2 Number of Embryos Transferred Gestational age at delivery (wks) Length at birth (average of twins) (cm) Mean averaged birthweight of twins (g) Mean birthweight difference (g) Birthweight discordance >¼1 twin with low birthweight (<2500g)
e202
Fresh ET Twins
FET Twins
P value
33.4 4.0 24.5 5.0 11.7 3.2
33.3 3.9 23.9 4.1 10.3 6.1
NS NS NS
3415.0 1580.9 2.2 0.5
648.4 564.5 NS 2.2 0.5 NS
34.8 2.5
34.6 2.5
NS
18.3 1.5
18.3 1.7
NS
2127.8 841.1 304.2 281.7
2314.8 673.5 <0.005 306.8 253.8 NS
11.9% 11.8% NS 66.5% (513/772) 65.1% (121/186) NS
ASRM Abstracts
P-257 Tuesday, October 18, 2016 DO TRAINED REPRODUCTIVE ENDOCRINOLOGISTS DO BETTER THAN THEIR TRAINEES? COMPARING IMPLANTATION RATES AND CLINICAL PREGNANCY RATES AFTER TRANSFER OF FRESH SINGLE BLASTOCYSTS. S. Behbehani, Y. Hasson, W. Son, T. Tulandi, W. Buckett. McGill University, Montreal, QC, Canada. OBJECTIVE: To compare implantation and clinical pregnancy rates after single blastocyst transfers performed by trained reproductive endocrinologists (REs), senior trainees and junior trainees in a reproductive endocrinology and infertility fellowship program in a university teaching center. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We performed 1240 fresh single blastocyst transfers between the years 2013-2015; 723 transfers were performed by trained REs, 249 by junior trainees (first year of training in a two year program) and 219 by senior trainees (second year of training). All transfers were done under ultrasound guidance. We compared pregnancy rates (defined as a positive beta HCG result 11 days after transfer) and clinical pregnancy rates (defined as presence of an intra-uterine gestational sac on ultrasound scan at 5-6 weeks of gestation) of embryo transfers performed by attending REs or trainees.
Vol. 106, No. 3, Supplement, September 2016
P-255 Tuesday, October 18, 2016
DOES FRESH EMBRYO TRANSFER ACCENTUATE THE PERINATAL RISKS OF DICHORIONIC TWIN GESTATIONS? L. Sekhon,a,b K. Shaia,a,b J. Rodriguez-Purata,a J. A. Lee,a A. B. Copperman.a aReproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
ABSTRACT WITHDRAWN
OBJECTIVE: Twins are at higher risk for fetal growth restriction and stillbirth compared to singleton gestations. Dichorionic twins, conceived spontaneously or by IVF, often have discordant growth as a consequence defective trophoblast invasion or impaired development of uteroplacental circulation. Significant birthweight (BW) discordance is associated with poor perinatal outcome. Recently, controlled ovarian hyperstimulation (COH) followed by fresh embryo transfer (ET) has been linked to defective placentation, evidenced by lower BW compared to pregnancies conceived from frozen embryo transfer (FET). While this notion has been demonstrated in studies of singleton gestations, there is limited data examining the effect of ovarian stimulation on growth and prematurity in twin gestations. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All fresh or frozen ET cycles in which patients had R2 blastocysts transferred from November 2002 to July 2015, resulting in live twin birth atR24 weeks gestation, were included. Cycles with spontaneously/selectively reduced twin gestations were excluded. Main outcome measures included gestational age at delivery, twin BW, BW discordance and the incidence of prematurity and poor growth (low/ very low/extremely low BW). Student’s t-test, chi-square and linear regression analysis were used. RESULTS: Nine hundred and fifty eight patients delivered dichorionic twins after fresh (n¼772) and frozen ETs (n¼186). Patient demographics, cycle characteristics and perinatal outcomes are listed in Table 1. Fresh ET twins had a significantly lower mean average BW (2127.8g vs. 2314.8g, <0.005) than the FET group. For every 1pg/ml increase in peak estradiol there was a 0.06g decrease in the averaged twin BW (<0.0001). The degree of BW discordance and prematurity were similar among groups. CONCLUSIONS: Similar to what is reported in singleton pregnancies, dichorionic twins conceived after fresh ET had lower BW compared with their FET cohort. However, the adverse effects on proper trophoblast invasion and placentation appeared to be mild as they did not translate into increased BW discordance, prematurity or BW <2500g. Further studies incorporating additional perinatal outcomes (ie. preeclampsia) are required to better understand the role of the endometrial hormonal milieu on placentation.
P-256 Tuesday, October 18, 2016 NUMBER OF SUPERNUMERARY EUPLOID EMBRYOS FROM AN IVF CYCLE CORRELATES WITH AN ONGOING PREGNANCY RATE AFTER SUBSEQUENT SINGLE, EUPLOID EMBRYO L. Sekhon,a,c K. Shaia,a,c TRANSFER (SET). M. Kon,a,b a a a M. C. Whitehouse, J. A. Lee, R. Slifkin, E. Flisser,a J. Klein,a M. Lederman,a L. Grunfeld,a,c T. Mukherjee,a,c B. Sandler,a,c A. B. Copperman,a,c D. E. Stein.a,b aReproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai West-Mount Sinai St. Luke’s, New York, NY; cObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. OBJECTIVE: While ongoing pregnancy rates (OPR) have been shown to be enhanced in women with supernumerary blastocysts, it is unknown how the use of preimplantation genetic screening (PGS) at transfer selection and the presence of supernumerary euploid embryos (SEEs) affect IVF cycle outcome. This study sought to determine how SEE counts affect euploid, single blastocysts transfer cycle outcome. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All patients who underwent a euploid SET between July 2011 and April 2016 were included. Cohorts were split into ‘‘Implanted’’ and ‘‘Non-Implanted’’ groups. Patients with <2 euploid embryos at the time of SET were excluded. Ongoing pregnancy rates (OPR) were correlated with SEE counts and corrected for age and diagnosis. Student’s t-test, linear and binary logistic regression analyses were performed. RESULTS: One thousand ninety-nine cycles were included in the study. Patient demographics did not differ between study cohorts. Overall, patients achieved a 60.6% implantation and 55.5% OPR. Patients who had successful implantation and an ongoing pregnancy (n¼610) had similar numbers of oocytes retrieved (17.3 +/-9.8) and blastocysts biopsied (5.9+/- 4.3) to those who did not (OR 1.008 [95% CI 0.996-1.020], p¼0.19 and OR 1.015 [95% CI 0.992-1.039], p¼0.21, respectively). SEEs were similar between cohorts (Implanted: 3.70 +/- 3.02; Non-Implanted: 3.57 +/- 3.11) (OR 1.008 [95% CI 0.97-0.049], p¼0.68). When the total of SEEs in the Implantation cohort was analyzed, the OPR was significantly increased from 46.0 % to 58.9% when patients had >4 embryos (p ¼0.0043). CONCLUSIONS: Patients with at least one SEE are likely to have a higher ongoing clinical pregnancy rate than patients with only one available embryo. This rate increases with the increased number of vitrified SEEs. Although patients who incorporate PGS prior to embryo selection during an IVF cycle have high success rates, a boost in supernumerary euploid counts further enhances positive outcome probability.
Patient demographics, cycle characteristics & perinatal outcome
Patient’s age at ET BMI Endometrial Thickness at transfer (mm) Peak E2 Number of Embryos Transferred Gestational age at delivery (wks) Length at birth (average of twins) (cm) Mean averaged birthweight of twins (g) Mean birthweight difference (g) Birthweight discordance >¼1 twin with low birthweight (<2500g)
e202
Fresh ET Twins
FET Twins
P value
33.4 4.0 24.5 5.0 11.7 3.2
33.3 3.9 23.9 4.1 10.3 6.1
NS NS NS
3415.0 1580.9 2.2 0.5
648.4 564.5 NS 2.2 0.5 NS
34.8 2.5
34.6 2.5
NS
18.3 1.5
18.3 1.7
NS
2127.8 841.1 304.2 281.7
2314.8 673.5 <0.005 306.8 253.8 NS
11.9% 11.8% NS 66.5% (513/772) 65.1% (121/186) NS
ASRM Abstracts
P-257 Tuesday, October 18, 2016 DO TRAINED REPRODUCTIVE ENDOCRINOLOGISTS DO BETTER THAN THEIR TRAINEES? COMPARING IMPLANTATION RATES AND CLINICAL PREGNANCY RATES AFTER TRANSFER OF FRESH SINGLE BLASTOCYSTS. S. Behbehani, Y. Hasson, W. Son, T. Tulandi, W. Buckett. McGill University, Montreal, QC, Canada. OBJECTIVE: To compare implantation and clinical pregnancy rates after single blastocyst transfers performed by trained reproductive endocrinologists (REs), senior trainees and junior trainees in a reproductive endocrinology and infertility fellowship program in a university teaching center. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We performed 1240 fresh single blastocyst transfers between the years 2013-2015; 723 transfers were performed by trained REs, 249 by junior trainees (first year of training in a two year program) and 219 by senior trainees (second year of training). All transfers were done under ultrasound guidance. We compared pregnancy rates (defined as a positive beta HCG result 11 days after transfer) and clinical pregnancy rates (defined as presence of an intra-uterine gestational sac on ultrasound scan at 5-6 weeks of gestation) of embryo transfers performed by attending REs or trainees.
Vol. 106, No. 3, Supplement, September 2016