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One Pronucleus Zygotes, Derived Both from ICSI and Insemination, Rarely Develop to Quality Blastocysts and They are Significantly Less Likely to Be Frozen or Transferred
warmed oocytes during assisted reproductive technology (ART). The HOPE Registry was open to all US ART clinics offering oocyte cryopreservation. OBJECTIVE: A post hoc analysis of HOPE Registry data was conducted to compare outcomes in subjects using autologous oocytes with those using donor oocytes and using vitrification as the method for cryopreservation. MATERIALS AND METHODS: Women, aged 18–50 years, undergoing ART aiming to achieve pregnancy using autologous or donor oocytes following cryopreservation, were recruited from June 2008 until enrollment closed in September 2010. Enrolled subjects were then followed until May 2012. A post hoc analysis of data in women who received vitrified oocytes was performed; six centers (involving 85/145 [58%] subjects) were audited and regular monitoring across all centers ensured clean patient data. RESULTS: Sixteen centers participated and recruited 240 women. The analysis of vitrified oocytes included 145 subjects: 50 in the autologous group and 95 in the donor group. Oocyte age (the subject’s or donor’s age at the time oocytes were obtained), number of oocytes warmed and outcomes are shown in Table 1. Significantly fewer oocytes per cycle were warmed in the donor group. The mean number of fertilized oocytes (2PN) was not significantly different between groups. Most embryo transfers in the autologous group occurred on Day 3, whereas most in the donor group occurred on Day 5. The mean number of embryos transferred was significantly less in the donor oocyte group. Significantly more cycles in the donor group resulted in embryo cryopreservation, but there was no significant difference in mean number of embryos cryopreserved. Oocyte survival, implantation, clinical pregnancy and live birth rates were significantly higher among women receiving donor oocytes compared with those receiving autologous oocytes. CONCLUSIONS: In this post hoc analysis of HOPE registry observational data, among women using vitrified/warmed oocytes, significantly better outcomes, including clinical pregnancy and live birth rates, were achieved in cycles using donor oocytes than in those using autologous oocytes. Oocyte age was significantly lower in the donor oocyte group than in the autologous oocyte group. SUPPORT: The HOPE Registry Study was supported by EMD Serono, Inc., Rockland, MA, USA, a subsidiary of Merck KGaA, Darmstadt, Germany.
P-27 Embryonic Aneuploidy Does Not Differ Amongst Major Ethnicities as Determined by Genotyping. J. M. Franasiak, MD,a M. Olcha, MD,a D. T. Taylor, PhD,a,b N. R. Treff, PhD,a,b R. T. Scott, MD, HCLD.a,b aDivision of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Science, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA; bReproductive Medicine Associates of New Jersey, Morristown, New Jersey, USA. BACKGROUND: Ethnicity has been shown to be a factor in IVF success and differences in implantation, clinical, and ongoing pregnancies have been shown [1]. Aneuploidy is one of the best characterized barriers to ART success and, while ethnic background’s link to single gene disorders is clearly established, little information exists regarding ethnicity and whole chromosome aneuploidy in IVF. With new methods of classifying continental ethnicity utilizing genetic profiles from a select group of single nucleotide polymorphisms (SNPs), termed ancestry informed of markers (AIMs), one can be determined with more accuracy than self-reporting [2]. The rates of aneuploidy in these patient populations have not been determined. OBJECTIVE: The purpose of this study was to evaluate the relationship between genotypically determined ethnicity and embryonic aneuploidy using a validated set of AIMs. MATERIALS AND METHODS: We analyzed 2,209 patients undergoing IVF with comprehensive chromosome screening (CCS). All patients underwent IVF/ICSI and CCS after trophectoderm biopsy. Patients’ serum was genotyped using custom 32 SNP TaqManÒ OpenArrayÒ Real-Time PCR Plates selected based on previously validated data used to identify continental origin. Admixture proportions were determined using the Bayesian clustering algorithms implemented in the program STRUCTURE-v2.3 [3]. Patients were assigned to the population (European, African, East Asian, or Central/South Asian) corresponding to their greatest admixture proportion. Differences in embryonic aneuploidy were determined using an analysis of covariance (ANCOVA) while controlling for age. RESULTS: The mean number of embryos tested was 5.3 (range¼1-40) and the mode was 1. Patients’ ethnic classifications revealed European (n¼1776), African (n¼97), East Asian (n¼191), or Central/South Asian (n¼231). Age differed among ethnic groups (p¼0.001) as did aneuploidy rate: European (40.2%), African (36.8%), East Asian (43.4%), and
FERTILITY & STERILITYÒ
Central/South Asian (34.6%) (p¼0.04). This was no longer present when controlling for age (p¼0.33). CONCLUSIONS: There does not appear to be differences in embryonic aneuploidy amongst various ethnic groups in patients undergoing IVF. We used a novel approach of determining continental origin using a validated panel of AIMs as opposed to patient self-reported ethnicities. It does not appear that specific recommendations for aneuploidy screening should be made based upon ethnic background. FINANCIAL SUPPORT: None. References: 1. Sharara F., et al., Differences in in vitro fertilization (IVF) outcome between white and black women in an inner-city, university-based IVF program. Fertil Steril 2000;73:1170-3. 2. Bhide P., et al., Serum anti-Mullerian hormone levels across different ethnic groups: a cross section study. British Journal of Obstetrics and Gynaecology, 2014. Epub. 3. Kosoy, R., et al., Ancestry informative marker sets for determining continental origin and admixture proportions in common populations in America. Human Mutation, 2009. 30(1):p. 69-78.
P-28 One Pronucleus Zygotes, Derived Both from ICSI and Insemination, Rarely Develop to Quality Blastocysts and They are Significantly Less Likely to Be Frozen or Transferred. E. Goldstein, MD,a L. Kroener, MD,a D. L. Hill, PhD,b,c M. Surrey, MD,b,c H. Danzer, MD,b,c S. Ghadir, MD,b,c J. Barritt, PhD.b,c aUCLA Dept of OB/GYN, 200 Medical Plaza, Suite 220, Los Angeles, CA, 90095; bART Reproductive Center, 450 N. Roxbury Dr, Suite 520, Beverly Hills, CA 90210; cSouthern California Reproductive Center, 450 N. Roxbury Dr, Suite 500, Beverly Hills, CA 90210. BACKGROUND: Zygotes with 1 pronucleus (1PN) at fertilization check after in vitro fertilization (IVF) may be parthenogenetically activated and thus haploid, or may be diploid due to asynchronous pronuclear appearance or fusion of the male and female pronuclear membranes. Healthy live births have been reported after transfer of embryos observed as 1PN zygotes. A larger proportion of 1PN embryos produced by intracytoplasmic sperm injection (ICSI) have historically been shown to be haploid versus those formed by insemination. OBJECTIVE: This study was designed to compare the laboratory outcomes of 1PN embryos versus normally fertilized 2PN embryos. MATERIALS AND METHODS: This was a retrospective data analysis from a single large private fertility center, collected from all IVF cycles from 1/1/2009 to 6/30/2013. Insemination and ICSI cycles were analyzed separately. Cycles employing both ICSI and insemination were excluded, as were cycles with transfers on Days 2, 3 or 4. 1PN-developed blastocyst freezing and transfer rates were compared to these rates of 2PNs formed in cycles where there were no abnormally pronucleated zygotes as well as those from cycles along with 1PNs. Paired and two-sample t-tests were performed as appropriate. RESULTS: Blastocyst freeze rates and day 5 fresh transfer rates were significantly different between 1PNs and 2PNs. ICSI-derived 1PNs had lower freeze rates than insemination-derived 1PNs. There was no difference in transfer rates between 2PNs in cycles with and without 1PNs, and the freeze rates for 2PNs from the cycles with 1PNs were similar or better. Significant results are shown below.
P-29 Embryos Developing after a Failure to Visualize Pronuclei at the Time of Fertilization Check Very Rarely Produce Blastocysts to Transfer or Freeze. E. Goldstein, MD,a L. Kroener, MD,a D. L. Hill, PhD,b,c M. Surrey, MD,b,c H. Danzer, MD,b,c S. Ghadir, MD,b,c J. Barritt, PhD.b,c a UCLA Dept of OB/GYN, 200 Medical Plaza, Suite 220, Los Angeles, CA, 90095; bART Reproductive Center, 450 N. Roxbury Dr, Suite 520, Beverly Hills, CA 90210; cSouthern California Reproductive Center, 450 N. Roxbury Dr, Suite 500, Beverly Hills, CA 90210. BACKGROUND: Some oocytes, 16-20 hours after sperm exposure, appear to be unfertilized yet go on to cleave and develop as embryos. These may represent viable embryos whose pronuclei were not visible due to accelerated or retarded progression through the fertilization process.
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P-27 Embryonic Aneuploidy Does Not Differ Amongst Major Ethnicities as Determined by Genotyping. J. M. Franasiak, MD,a M. Olcha, MD,a D. T. Taylor, PhD,a,b N. R. Treff, PhD,a,b R. T. Scott, MD, HCLD.a,b aDivision of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Science, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA; bReproductive Medicine Associates of New Jersey, Morristown, New Jersey, USA. BACKGROUND: Ethnicity has been shown to be a factor in IVF success and differences in implantation, clinical, and ongoing pregnancies have been shown [1]. Aneuploidy is one of the best characterized barriers to ART success and, while ethnic background’s link to single gene disorders is clearly established, little information exists regarding ethnicity and whole chromosome aneuploidy in IVF. With new methods of classifying continental ethnicity utilizing genetic profiles from a select group of single nucleotide polymorphisms (SNPs), termed ancestry informed of markers (AIMs), one can be determined with more accuracy than self-reporting [2]. The rates of aneuploidy in these patient populations have not been determined. OBJECTIVE: The purpose of this study was to evaluate the relationship between genotypically determined ethnicity and embryonic aneuploidy using a validated set of AIMs. MATERIALS AND METHODS: We analyzed 2,209 patients undergoing IVF with comprehensive chromosome screening (CCS). All patients underwent IVF/ICSI and CCS after trophectoderm biopsy. Patients’ serum was genotyped using custom 32 SNP TaqManÒ OpenArrayÒ Real-Time PCR Plates selected based on previously validated data used to identify continental origin. Admixture proportions were determined using the Bayesian clustering algorithms implemented in the program STRUCTURE-v2.3 [3]. Patients were assigned to the population (European, African, East Asian, or Central/South Asian) corresponding to their greatest admixture proportion. Differences in embryonic aneuploidy were determined using an analysis of covariance (ANCOVA) while controlling for age. RESULTS: The mean number of embryos tested was 5.3 (range¼1-40) and the mode was 1. Patients’ ethnic classifications revealed European (n¼1776), African (n¼97), East Asian (n¼191), or Central/South Asian (n¼231). Age differed among ethnic groups (p¼0.001) as did aneuploidy rate: European (40.2%), African (36.8%), East Asian (43.4%), and
FERTILITY & STERILITYÒ
Central/South Asian (34.6%) (p¼0.04). This was no longer present when controlling for age (p¼0.33). CONCLUSIONS: There does not appear to be differences in embryonic aneuploidy amongst various ethnic groups in patients undergoing IVF. We used a novel approach of determining continental origin using a validated panel of AIMs as opposed to patient self-reported ethnicities. It does not appear that specific recommendations for aneuploidy screening should be made based upon ethnic background. FINANCIAL SUPPORT: None. References: 1. Sharara F., et al., Differences in in vitro fertilization (IVF) outcome between white and black women in an inner-city, university-based IVF program. Fertil Steril 2000;73:1170-3. 2. Bhide P., et al., Serum anti-Mullerian hormone levels across different ethnic groups: a cross section study. British Journal of Obstetrics and Gynaecology, 2014. Epub. 3. Kosoy, R., et al., Ancestry informative marker sets for determining continental origin and admixture proportions in common populations in America. Human Mutation, 2009. 30(1):p. 69-78.
P-28 One Pronucleus Zygotes, Derived Both from ICSI and Insemination, Rarely Develop to Quality Blastocysts and They are Significantly Less Likely to Be Frozen or Transferred. E. Goldstein, MD,a L. Kroener, MD,a D. L. Hill, PhD,b,c M. Surrey, MD,b,c H. Danzer, MD,b,c S. Ghadir, MD,b,c J. Barritt, PhD.b,c aUCLA Dept of OB/GYN, 200 Medical Plaza, Suite 220, Los Angeles, CA, 90095; bART Reproductive Center, 450 N. Roxbury Dr, Suite 520, Beverly Hills, CA 90210; cSouthern California Reproductive Center, 450 N. Roxbury Dr, Suite 500, Beverly Hills, CA 90210. BACKGROUND: Zygotes with 1 pronucleus (1PN) at fertilization check after in vitro fertilization (IVF) may be parthenogenetically activated and thus haploid, or may be diploid due to asynchronous pronuclear appearance or fusion of the male and female pronuclear membranes. Healthy live births have been reported after transfer of embryos observed as 1PN zygotes. A larger proportion of 1PN embryos produced by intracytoplasmic sperm injection (ICSI) have historically been shown to be haploid versus those formed by insemination. OBJECTIVE: This study was designed to compare the laboratory outcomes of 1PN embryos versus normally fertilized 2PN embryos. MATERIALS AND METHODS: This was a retrospective data analysis from a single large private fertility center, collected from all IVF cycles from 1/1/2009 to 6/30/2013. Insemination and ICSI cycles were analyzed separately. Cycles employing both ICSI and insemination were excluded, as were cycles with transfers on Days 2, 3 or 4. 1PN-developed blastocyst freezing and transfer rates were compared to these rates of 2PNs formed in cycles where there were no abnormally pronucleated zygotes as well as those from cycles along with 1PNs. Paired and two-sample t-tests were performed as appropriate. RESULTS: Blastocyst freeze rates and day 5 fresh transfer rates were significantly different between 1PNs and 2PNs. ICSI-derived 1PNs had lower freeze rates than insemination-derived 1PNs. There was no difference in transfer rates between 2PNs in cycles with and without 1PNs, and the freeze rates for 2PNs from the cycles with 1PNs were similar or better. Significant results are shown below.
P-29 Embryos Developing after a Failure to Visualize Pronuclei at the Time of Fertilization Check Very Rarely Produce Blastocysts to Transfer or Freeze. E. Goldstein, MD,a L. Kroener, MD,a D. L. Hill, PhD,b,c M. Surrey, MD,b,c H. Danzer, MD,b,c S. Ghadir, MD,b,c J. Barritt, PhD.b,c a UCLA Dept of OB/GYN, 200 Medical Plaza, Suite 220, Los Angeles, CA, 90095; bART Reproductive Center, 450 N. Roxbury Dr, Suite 520, Beverly Hills, CA 90210; cSouthern California Reproductive Center, 450 N. Roxbury Dr, Suite 500, Beverly Hills, CA 90210. BACKGROUND: Some oocytes, 16-20 hours after sperm exposure, appear to be unfertilized yet go on to cleave and develop as embryos. These may represent viable embryos whose pronuclei were not visible due to accelerated or retarded progression through the fertilization process.
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