Oocyte to baby rate: a new index of ART outcome

P-578 Wednesday, October 27, 2010 VARIATIONS IN GESTATIONAL AGE AT DELIVERY AND BIRTH WEIGHT IN INFANTS BORN AFTER ASSISTED REPRODUCTIVE TECHNOLOGIES BASED ON MATERNAL INFERTILITY DIAGNOSES. E. E. Eppsteiner, B. Stegmann, B. J. Van Voorhis, J. Blaine, A. Sparks. Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA. OBJECTIVE: Prior studies have reported lower birth weight (BW) and gestational age (GA) in pregnancies conceived with assisted reproductive technologies (ART), but have not examined the possible influence of infertility diagnoses on these outcomes. Our objective was to determine if GA at delivery and BW after ART vary by infertility diagnosis. DESIGN: Retrospective cohort of women undergoing ART from January 1, 2003 to December 31, 2008. MATERIALS AND METHODS: All women who achieved a singleton live birth following their first fresh IVF cycle were included. Multivariate analysis was performed; exposure of interest was maternal infertility diagnosis and outcomes of interest were GA and BW. Analysis was adjusted for maternal age, day of embryo transfer (day 3 vs. day 5), BMI, and previous live birth. RESULTS: The diagnosis distribution and demographic data for the 397 women included are listed in Table 1. Average GA for the cohort was 38.7 weeks (SD 2.34) with a BW of 3301.5gm (SD 633.8). These did not differ from national norms for GA or BW. We then stratified the results by infertility diagnosis. After controlling for confounders, no difference in BW or GA was seen between maternal infertility diagnoses. TABLE 1. Demographics Ovulatory

Tubal

Male Factor Dysfunction Endometriosis Factor Unexplained Combined N¼103 N¼49 N¼32 N¼61 N¼77 N¼75 Average Maternal Age (yrs)* Average Body Mass Index (cm/m2)* % with Day 5 Transfer % with Previous Live Birth Average Gestational Age (weeks) Average Birth Weight (grams)

30.2

31

33.2

32.8

32.6

31.9

25.40

31.41

26.22

28.15

24.95

27.42

66.0 12.6

67.4 24.5

65.6 21.9

55.7 47.5

62.5 29.9

57.3 21.3

38.72

38.58

38.41

38.94

38.88

38.25

3279.22

3325.23

3323.37

3411.79

3290.82

3218.26

* p value for differences among group < 0.05. CONCLUSION: Gestational age and birth weight in infants born after ART were not significantly different between maternal infertility diagnoses after controlling for maternal age, BMI, day of transfer, and history of previous live birth.

RESULTS: The patients in the antagonist group were significantly older than those in the agonist group (32.6  5.1 vs. 31.7  5, p<0.001). The duration of stimulation was significantly shorter in the antagonist cycles compared to the agonist cycles (8.7  1.7 vs. 9.5  1.5 p<0.001) whereas similar amounts of gonadotropins were used in both groups (2822.5  1240 vs. 2906  1223 p>0.05, respectively). The number of follicles reaching a diameter R 14mm, the leading follicle diameter and the number of eggs retrieved were significantly lower in the antagonist cycles than agonist cycles (9.2  3.7 vs. 10.6  4.4, p<0.001, respectively; and 19.3  1.4 vs. 20.1  1.5 p<0.01, respectively; and 9.8  3.9 vs. 10.8  4.6, p<0.01). The number of embryos transferred was 2.76  0.7 in the antagonist group and 2.77  0.6 in the agonist group (p>0.05). Clinical pregnancy and implantation rates were similar between the antagonist and agonist cycles (45.9% vs. 45.8%, p>0.05, respectively; 24.7  31.4 vs. 25.5  32.8, p>0.05, respectively). CONCLUSION: The use of GnRH antagonists is a viable alternative to GnRH agonist and comparable clinical pregnancy and implantation rates can be achieved with GnRH antagonists in normoresponder IVF patients.

P-580 Wednesday, October 27, 2010 OOCYTE TO BABY RATE: A NEW INDEX OF ART OUTCOME. G. de la Fuente, D. Agudo, M. Alonso, G. Kohls, A. Pellicer, J. Garcıa Velasco. Reproductive Medicine, IVI Madrid, Madrid, Spain. OBJECTIVE: To assess the outcome of assisted reproduction technology (ART) by using a index called oocyte to baby rate, where live babies born (LBB) are reported in relation to the number of oocytes retrieved. DESIGN: Retrospective analysis of clinical and embryological data. MATERIALS AND METHODS: Patients were subdivided by number of oocytes retrieved (1 to 5, 6 to 9, > 9 oocytes) and age (<35, 35 to 37, 38 to 40, >40 years). The analysis included all IVF and oocyte donation cycles between January and December 2008. The potential LBB from frozen embryos was estimated multiplying by 82% to give a survival rate after thawing. This was multiplied by our implantation rate (20%) to arrive to the expected live births. Protocols of ovarian stimulation used were: GnRH antagonist (67.4%), long agonist (12.9%), low-dose long agonist (9.4%) and short agonist protocol (10.3%). RESULTS: A total of 1832 oocyte retrievals (64.8% IVF and 35.2% oocyte donation cycles) were analyzed, with a total of 17,857 oocytes retrieved. The total number of embryos was 5,946 (utilization rate of 33.3%), 60.8% fresh embryo transfers and 39.2% cryopreserved. The overall oocyte to LBB and embryo to LBB rates were 5.9% and 18.3%. Oocyte to baby rate was better in donor oocyte cycles (9.3%), compared with IVF cycles (5.1%). There was a significantly higher LBB rate per oocyte in IVF patients with <6 oocytes (7.4%) in contrast to those with > 9 oocytes (4.6%) P¼0.0008. Conversely results in the donors group did not differ much (10.6%% vs 7.7%) P¼ 0.07. IVF patients younger than 35 years showed a significantly higher LBB per oocyte rate (6.0%) than those between 38 to 40 (4.5%) or older than 40 years (2.5%) P¼0.007 and P¼0.003. Results according to the stimulation protocol used did not significantly differ. CONCLUSION: Our results show a great wastage of oocyte in ART cycles. The assumption that ‘‘the more oocytes, the better’’ is contradicted by our results. Changing to milder stimulation protocols to recruit fewer oocytes should be considered.

P-579 Wednesday, October 27, 2010 COMPARISON OF IVF OUTCOMES BETWEEN GnRH ANTAGONIST AND GnRH AGONIST LONG PROTOCOLS IN NORMO RESPONDER IVF PATIENTS. O. Oktem, R. Mercan, B. Balaban, B. Urman. Women’s Health Center Assisted Reproduction Unit, American Hospital, Istanbul, Turkey. OBJECTIVE: To compare reproductive outcomes in normoresponding IVF patients undergoing ovarian stimulation with the GnRH antagonist protocol vs. GnRH agonist protocol. DESIGN: Retrospective case series. MATERIALS AND METHODS: A total of 2596 normoresponding IVF patients undergoing ovarian stimulation between 2005-2009 were included in the study. 555 of these underwent ovarian stimulation with GnRH antagonist cetrorelix acetate while the remaining 2041 were stimulated with long protocol using GnRH agonist leuprolide acetate. Patients who developed more than five follicles larger than 14 mm were classified as normo-responders. The characteristics of IVF cycles were compared between the groups. All parameters were expressed as the mean  [SD].

S260

Abstracts

P-581 Wednesday, October 27, 2010 LIVE BIRTH RATES WITH INTRAUTERINE INSEMINATION (IUI) ARE NOT COMPROMISED WHEN THE SPECIMEN IS COLLECTED INTO DILUTING MEDIA (DM) AT HOME AND DELIVERED TO THE LAB UP TO 12 HOURS LATER. R. Pyrzak, R. P. Dickey. The Fertility Institute of New Orleans, Mandeville, LA; Obstetrics and Gynecology, Louisiana State University, New Orleans, LA. OBJECTIVE: To determine if specimens for IUI collected into diluting media (DM) at home resulted in live birth rates comparable to specimens collected without DM in the office. DESIGN: Retrospective study. MATERIALS AND METHODS: Prior to IUI, patients were given the option of collecting the specimen in the office or at home, and were instructed to bring the specimen undiluted to the lab within 1 hr (n¼287 cycles). If they chose to collect at home and believed that they would be unable to deliver the sperm to the lab within 1 hr they were given 40ml of DM to dilute the semen specimen, instructions on how to use DM, and told to deliver the

Vol. 94., No. 4, Supplement, September 2010