Ovarian cortex tissue donation during routine obstetrical and gynecologic procedures

Impact of BRCA mutations on Fertility Preservation Cycle Outcomes

BRCA-negative or untested (n¼97)

BRCA-positive (n¼21)

P value

Adjusted p value a (95% CI)

33.2  3.2 22.1  3.1 16.4  7.7 10.6  5.1 79.3  16.4 8.2  4.7

32.7  2.4 23.5  5.2 11.0  8.0 7.4  5.7 74.0  24.8 5.1  4.4

0.680 0.695 0.015 0.047 0.277 0.013

0.002 (-10.6,-2.5) 0.008 (-7.2,-1.1) 0.053 (-20.1,0.2) 0.003 (-7.1,-1.5)

Age (years) BMI (kg/m2) No. of total oocytes No. of mature oocytes Fertilization rate (%) No. of embryos frozen

CONCLUSIONS: In women with breast cancer undergoing FP, BRCA mutations appear to be associated with lower oocyte and embryo yield and possibly reduced fertilization rates. Women with BRCA mutations should be counseled about the possibility of impaired outcomes with fertility preservation. Reference: 1. Titus S, Li F, Stobezki R, Akula K et al. Impairment of BRCA1-related DNA double-strand break repair leads to ovarian aging in mice and humans. Sci Transl Med. 2013;5:172ra21. Supported by: NIH (NICHD & NCI) HD05112. P-210 Tuesday, October 31, 2017 ALTERNATIVES TO HYSTERECTOMY IN SURGICAL MANAGEMENT OF UTERINE FIBROIDS: AN EQUIVALENCE ANALYSIS OF SINGLE-SITE AND MULTIPORT MYOMECTOMY. E. E. Tappy,a G. Moawad,b E. D. Abi Khalil,a J. Paek.c aObstetrics and Gynecology, George Washington University Hospital, Washington, DC; bGeorge Washington University Hospital, Washington, DC; cObstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea, Republic of. OBJECTIVE: Uterine fibroids are the most common type of pelvic tumor in women and are a leading indication for hysterectomy. For women desiring fertility preservation, development of alternative surgical techniques, namely minimally invasive myomectomy, is of upmost importance. In this study, we aim to determine the feasibility and safety of robotic single-site myomectomy in comparison to multiport myomectomy. DESIGN: Multi-center retrospective cohort study. MATERIALS AND METHODS: Clinical outcomes including estimated blood loss, total time of surgery, post-operative length of stay, intra-operative and post-operative complications were analyzed. RESULTS: The study included 261 women, 77% underwent multiport robotic myomectomies and 23% single-site myomectomies. Multiport versus single-site patient demographics differed in mean age (35.4 years versus 37.8 years, p¼0.026), BMI (27.9 versus 24.9, p <0.001), and predominant race (71.0% Black versus 55.7% Asian, p <0.001) respectively. In the same comparison, differences in fibroid characteristics existed including fibroid weight (370.2gm versus 81.5gm, p <0.001), estimated size on imaging (8.3cm versus 5.8cm, p<0.001) and number of fibroids removed (5.1 versus 2.1, p<0.001). After adjusting for demographic and clinical characteristics, single-site myomectomies demonstrated lower estimated blood loss (56.3mL versus 330.0mL, p¼0.003) and total surgical time (129.5 minutes versus 165.6 minutes, p¼0.036) compared to multiport myomectomies, but no difference in length of postoperative stay (1.0 day versus 0.7 day, p¼0.161). Overall intra-operative complications were lower for single-site myomectomies compared to multiport myomectomies (7.0% versus 0.0%, p¼0.045), however, too few complications occurred to draw meaningful conclusions between groups. When stratified based on similar fibroid characteristics, rates of intra-operative and post-operative complications were not different between myomectomy groups. CONCLUSIONS: In carefully selected patients, single-site myomectomy is a feasible and safe procedure compared to multiport myomectomies. Both surgical approaches are associated with low rates of intra-operative and postoperative complications. Further data is needed to support enhanced availability of these minimally invasive techniques to women desiring fertility preservation.

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ASRM Abstracts

P-211 Tuesday, October 31, 2017 A NON-INVASIVE METHOD FOR ASSESSING OOCYTE COMPETENCY. C. E. Wessels,a L. Penrose,b S. Prien.c aAnimal Science, Texas Tech University, Lubbock, TX; bDepartment of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Lubbock, TX; cOb/Gyn, Texas Tech University Health Sciences Center, Lubbock, TX. OBJECTIVE: Previous research from this laboratory has demonstrated a Specific Gravity Device (SGD) can be used to assess embryo quality and predict embryo future growth potential. The objective of the present study is to determine if the SGD can be used to assess oocyte competency prior to fertilization and/or cryopreservation. DESIGN: Lab based trial of experimental device. MATERIALS AND METHODS: Two hundred-sixty-six oocytes were collected from twenty-two mice. All oocytes were assessed using the SGD. Oocytes were then randomly assigned to one of four treatments: exposure to 60 C for thirty minutes, acidified media for one hour, ethylene glycol/ glycerol cryoprotectant for one hour or standard culture to serve as control. After treatment, oocytes were reassessed using the SGD and comparisons were made between oocyte descent time and treatment. To further analyze relationship between oocyte descent time and viability, ninety-eight additional oocytes were passed through SGD before and after treatment. Oocytes were stained with Coomaisse Blue to determine membrane permeability and estimate viability based on treatment. RESULTS: Oocytes treated with 60 C heat, acidified media and ethylene glycol/ glycerol cryoprotectant solution demonstrated altered descent times from control and pre-treatment oocytes (P<0.05). Oocytes exposed to heat and cryoprotectants descended more rapidly through SGD than control and pre-treatment oocytes (P<0.05). Oocytes treated with acidified media descended more slowly through SGD (P<0.05). Permeation of stain into oocytes exposed to lethal treatments confirmed changes in membrane integrity post-treatment and further indicates SGD can detect such shifts. This suggests SGD can predict competency between live and dead oocytes. CONCLUSIONS: SGD can detect shifts in oocyte density due to altered membrane permeability, which can suggest information about oocyte competency. This information can help differentiate between high and low quality fresh oocytes to help select which oocytes to freeze and result in improved oocyte cryopreservation and fertilization. Supported by: The authors would like to thank South Plains Foundation and the Laura W. Bush Institute for Women’s Health for funding of this project. P-212 Tuesday, October 31, 2017 OVARIAN CORTEX TISSUE DONATION DURING ROUTINE OBSTETRICAL AND GYNECOLOGIC M. McLaughlin,b PROCEDURES. J. Johnson,a R. Anderson,c E. Telfer.b aDepartment of Obstetrics and Gynecology, University of Colorado-Denver, Aurora, CO; bInstitute of Cell Biology and Centre for Integrative Physiology, University of Edinburgh, Edinburgh, United Kingdom; cMRC Centre for Reproductive Health, The Queen’s Medical Research Institute, Edinburgh, United Kingdom. OBJECTIVE: The objective of this study is to evaluate the incidence, safety record, and usage of ovarian cortex donation during caesarean section deliveries at the MRC Centre for Reproductive Health (MRCCRH) between 2012 and present. DESIGN: In the United States, ovarian cortical tissue collection and cryopreservation is offered for the purpose of fertility preservation prior

Vol. 108, No. 3, Supplement, September 2017

to treatment for malignancy. In our center and at others in Europe, the option to donate ovarian cortex has also been offered to disease-free obstetrical and gynecological patients, with tissue specifically allocated for research purposes. We sought to determine whether the safety of tissue collection and the utility of cortex donated for research warrants more widespread availability of donation programs. MATERIALS AND METHODS: Electronic medical record and paper chart review of ovarian cortex consent and usage at the MRC Centre for Reproductive Health was performed from 2012 - present. The complication rate was determined and use cases were categorized and quantified. RESULTS: The complication rate was found to be negligible in our study; this was interpreted to be due to the minimal vascularization of ovarian cortex and minimal bleeding upon tissue collection. Women who donated tissue during multiple caesarean sections were noted, who lacked complications in any delivery. CONCLUSIONS: Our data suggest that the benefits of this apparently safe donor process outweigh the risks and thus ovarian cortex donation for research could be considered by more centers worldwide. Benefits could include accelerated research progress and a reduction in the numbers of model organisms used. Supported by: J.J. is supported by UC-Denver Department of Obstetrics and Gynecology Research Funds. P-213 Tuesday, October 31, 2017 ASSESSMENT OF FERTILITY CLINIC WEBSITES ON OOCYTE CRYOPRESERVATION (OC). T. Zore,a,b N. Joshi,a,b S. B. Schon,c P. Masson,d J. L. Chan.b aObstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA; bOB/GYN, Division REI, Cedars-Sinai Medical Center, Los Angeles, CA; cUniversity of Michigan, Ann Arbor, MI; dUniversity of Pennsylvania, Philadelphia, PA. OBJECTIVE: Fertility preservation continues to garner increased attention as techniques for vitrification have improved and ASRM removed the experimental label from the procedure in 2012. Several major companies have publicly been reported to cover OC for their employees. Our objective was to evaluate the availability and quality of information regarding OC on Society of Assisted Reproductive Technology (SART)-member clinic websites. DESIGN: Cross-sectional evaluation. MATERIALS AND METHODS: Between 3/2017-4/2017, SART-member clinics websites were systematically examined by 2 separate reviewers. Websites were surveyed for size/type of practice, location, availability of OC and if available, indication for the procedure, cost, success rates of oocyte thawing or subsequent pregnancy rates. Chi-square tests were used to evaluate the differences between the groups. RESULTS: Of the 376 websites evaluated, 79% were private practice and 21% were academic. 30% of clinics performed > 500 cycles a year and 70% performed <500 cycles a year. 81% of clinics (304/376) offered OC. Of the clinics that performed OC, 88% offered OC for social reasons and 94% for medical indications, including cancer. 20% mentioned success of OC based on national data and 6% mentioned clinic specific success rates for OC. 17% of clinics mentioned cost of OC and only 10% mentioned that OC is not a guarantee to future fertility. Large volume clinics (>500 cycles) were more likely to offer OC compared to smaller volume (<500 cycles) clinics (95% vs 74%, p<0.001) and were more likely to specifically mention OC for social (95% vs 83%, p¼0.006) and medical indications (95% vs, 68%, p¼0.046). There was no difference between academic and private practices on whether they offer OC. More private clinics offered elective OC compared to academic clinics (91% vs 75%, p¼0.001), but there was no difference between the 2 groups in regards to offering medical OC. CONCLUSIONS: There are significant differences regarding the information available on SART- member clinic websites in relation to OC. While many clinics, regardless of size, location or practice type, offer OC, there is minimal information regarding success rates of either oocyte thawing or future pregnancy. More importantly, there were even fewer websites that specifically mention that OC is not a guarantee for to future fertility. As OC becomes more prominent in the mainstream media, it will be essential for clinics to have accurate, up to date information available to patients to appropriately manage expectations.

FERTILITY & STERILITYÒ

P-214 Tuesday, October 31, 2017 IDENTIFYING EGG FREEZING DECISION-MAKING FACTORS TO INFORM THE DEVELOPMENT OFA DECISION AID APP CALLED ’FRZMYEGGS’. S. Yee,a D. Gordon,b C. L. Librach.a,b,c aCReATe Fertility Centre, Toronto, ON, Canada; bUniversity of Toronto, Toronto, ON, Canada; cWomen’s College Hospital, Toronto, ON, Canada. OBJECTIVE: An increasing number of young women worldwide are now seeking elective egg freezing (EEF) to delay childbearing. The decision of whether or not to freeze eggs is complex. We conducted a survey study to identify key factors involved in decision-making so as to inform the development of a decision aid app called ‘FrzMyEggs’. DESIGN: A retrospective anonymous survey at an academic fertility center. MATERIALS AND METHODS: Anonymized data from the EEF program 2008-2015 were analyzed. Women who had gone through EEF and were reachable by email received an anonymous online survey. RESULTS: Of the 199 patients who underwent an EEF consultation between 2008-2015, 89 (44.7%) patients proceeded with EEF, and 14 (15.7%) completed more than 1 freezing cycle. The mean age of freezers at the time of EEF was 36.92.2. Of the 72 freezers who were reachable by email, 40 completed an anonymous survey (response rate of 55.6%). The most and the least important reasons that were driving their interest to seek EEF service, on a 5-point Likert scale, were not having a partner (3.91.6), and too busy to have children due to a demanding career (2.11.2). Two-thirds (67.5%) spent 3 or more months contemplating EEF before seeking consultation, and 40% took 3 or more months to decide on EEF after their initial consultation. 47.5% found the actual number of eggs frozen to be lower than their original expectation; 65% wished they had considered freezing their eggs at a younger age in retrospect. CONCLUSIONS: EEF is an age-sensitive procedure, yet many women in our program sought EEF after the age of 35. Over half of the woman (65%) wished they had considered freezing their eggs at a younger age in retrospect. The findings were instrumental in informing the development of an EEF decision app that we developed called ‘FrzMyEggs’. The app aims to provide users with evidence-based EEF information. It also contains two decisionmaking tools (Calculator & Decision Aid Questionnaire) to supplement medical consultation and counselling. The free FrzMyEggs app, available in iOS and Android, was launched in April 2017. In the next phase, we will pilot-test the usefulness of the app in facilitating informed decisions and reducing decision conflicts among EEF seekers. Supported by: The FrzMyEggs app project was funded by EMD Serono through a Donation for Patient Benefit and by the CReATe Fertility Centre.

P-215 Tuesday, October 31, 2017 THE IMPORTANCE OF ACCOUNTING FOR PATIENT VARIABILITY IN PREDICTIVE MODELS OF LIVE BIRTH AFTER ELECTIVE OOCYTE CRYOPRESERVATION. L. Ramirez,a J. U. Klein,a U. Franca.b aExtend Fertility, New York, NY; bBoston Children’s Hospital / Harvard University, Boston, MA. OBJECTIVE: Models to predict live birth after elective fertility preservation provide information on the average likelihood of success based on age and number of frozen oocytes. However, to adequately advise patients’ choices when preserving their fertility models need to take into account the variability in pregnancy outcomes arising from the biological variation and differences in clinical procedures in assisted reproduction treatments. The purpose of this study was to assess uncertainties associated with predictive models to provide clinicians with an additional tool better inform the increasing number of patients considering elective oocyte cryopreservation. DESIGN: Based on retrospective published data on thawing survival rates, blastocyst-formation and aneuploidy rates, and pregnancy success rate of euploid blastocysts, we extend current probabilistic models of live birth to assess the variability observed in clinical outcomes based on age and number of oocytes. MATERIALS AND METHODS: Due to the lack of current data on autologous oocyte-cryopreservation cycles, we assessed the level of uncertainty in the different components of the probabilistic models and generated mock

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