Overview of 2012 U.S. assisted reproductive technology (ART) treatment outcomes and contribution to multiple birth and preterm infants

MENA women required a lower number of stimulation days (8.7 vs 9.4, p¼0.01). CONCLUSIONS: This preliminary study suggests that there are no differences in pregnancy outcomes between MENA and Caucasian women in a sample U.S. population. This is the first study to support the categorization of MENA women under the Caucasian ethnic group for SART outcomes. A more robust analysis of MENA women with regards to IVF outcomes disparities is forthcoming.

rate was higher in the Caucasian group but not statistically significant likely secondary to inadequate power (46% vs. 31%; OR 1.95; CI [0.87,4.36]). Live birth rate after a clinical pregnancy was documented was similar between groups (86% vs. 81%; OR 0.72; CI [0.14,3.81]). CONCLUSIONS: Asian ethnicity is associated with a lower clinical pregnancy rate even when donor oocytes are used. However, they have similar live birthrates after clinical pregnancy is documented. Differences in IVF pregnancy outcomes between Asian and Caucasian patients, even with oocyte donation, are likely secondary to impaired implantation in women who self declare Asian ethnicity.

Demographics, Embryological and IVF Outcome Data of MENA vs Caucasian Women.

Age (years) BMI (kg/m^2) Male Factor PCOS/Ovulatory Tubal Factor Uterine Unexplained Infertility Antral Follicle Count Total Embryo Transfer Miscarriage Live Birth

MENAN¼49

Caucasian N¼99

P Value

31.8 25.0 57.1% N¼28 28.6%N¼14 26.5%N¼13 34.7%N¼17 4.1%N¼2 11.8 2.18 10.2%N¼5 57.1%N¼28

32.7 27.1 54.5%N¼54 41.4%N¼41 28.3%N¼28 36.4%N¼36 0%N¼0 15.1 2.17 4.0%N¼4 58.6%N¼58

0.14 0.06 0.09 0.13 0.82 0.84 0.04 0.10 0.92 0.14 0.87

References: 1. Dayal MB, Gindoff P, Dubey A, Spitzer TL, Bergin A, Peak D, et al. Does ethnicity influence in vitro fertilization (IVF) birth outcomes? Fertil Steril. 2009;91:2414-8. 2. Sharara FI, McClamrock HD. 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. Wellons MF, Fujimoto VY, Baker VL, et al. Race Matters: A Systematic Review of Racial/Ethnic Disparity in Society for Assisted Reproductive Technology(SART) Reported Outcomes Fertil Steril. 2012 Aug;98(2):406-409.

P-108 Tuesday, October 20, 2015 WHY ARE IVF PREGNANCY RATES LOWER IN WOMEN OF ASIAN ETHNICITY: AN ANALYSIS OF ETHNICITY-MATCHED OOCYTE DONOR CYCLES. K. Louie,a L. Ross,a T. Jones,a B. Rudick,b K. Chung,c K. Bendikson.d aDivision of Reproductive Endocrinology and Infertility, University of Southern California, Los Angeles, CA; b Division of Reproductive Endocrinology and Infertility, Columbia University, New York, NY; cUSC Keck School of Medicine, Los Angeles, CA; d USC Fertility, Los Angeles, CA. OBJECTIVE: To resolve controversies regarding decreased pregnancy rates in women of Asian ethnicity in comparison to Caucasian women, we sought to evaluate clinical pregnancy rates between ethnically matched Asian and Caucasian egg donation cycles. DESIGN: A retrospective cohort study. MATERIALS AND METHODS: First-time anonymous oocyte donors of Asian or Caucasian ethnicity who underwent oocyte stimulation between 2006 and 2013 that resulted in a fresh embryo transfer were identified. Only the first stimulation of egg donors and first transfers of recipients were considered. Ethnicity was self-reported by both the donor and the intended recipient. Only ethnicity matched donor-recipient pairs were included. Fisher’s exact, Wilcoxon rank-sum, binomial and multivariate logistic regression were used as appropriate for analysis. RESULTS: 39 Asian and 123 Caucasian ethnically matched oocyte donor and recipient pairs meeting inclusion criteria were identified. Baseline characteristics were similar between Asian and Caucasian donors and recipients except for BMI in donors. There were no differences in stimulation parameters. E2 levels per oocyte retrieved were higher in Asian donors. The number of embryos transferred was the same between groups (2 1 vs. 2 1; p¼0.64). The Caucasian group had significantly higher implantation rates (42%  41% vs. 21%  29%; p¼0.01) and clinical pregnancy rates (57% vs. 36%; OR 2.38; CI [1.09,5.22]) compared to the Asian group. Live birth

FERTILITY & STERILITYÒ

Donor Age Recipient Age Donor BMI Recipient BMI Total Gonadotropin (ampules) Peak E2 (pg/mL) Oocytes retrieved Mature oocytes Oocytes fertilized E2/oocyte retrieved (pg/mL)

Asian (N¼39)

Caucasian (N¼84)

Median (interquartile range)

Median (interquartile range)

P value

25 (6) 44 (8) 20 (2) 22 (3) 30 (12) 3815 (2476) 21 (13) 17 (11) 15 (12) 174 (89)

25 (6) 43 (5) 21 (3) 22 (4) 30 (29) 3650 (1854) 24 (13) 18 (10) 16 (10) 150 (70)

0.31 0.75 0.01 0.52 0.53 0.62 0.06 0.39 0.38 0.03

P-109 Tuesday, October 20, 2015 OVERVIEW OF 2012 U.S. ASSISTED REPRODUCTIVE TECHNOLOGY (ART) TREATMENT OUTCOMES AND CONTRIBUTION TO MULTIPLE BIRTH AND PRETERM INFANTS. S. Sunderam,a D. M. Kissin,b S. Crawford,a S. Folger,a D. Jamieson,a L. Warner,a W. Barfield.a aDivision of Reproductive Health, Centers for Disease Control and Prevention, Chamblee, GA; bCenters for Disease Control and Prevention, Atlanta, GA. OBJECTIVE: To report U.S. ART statistics and compare ART infant outcomes to all U.S. infant outcomes. DESIGN: Population-based retrospective analysis. MATERIALS AND METHODS: Data were obtained from CDC’s National ART Surveillance System and National Vital Statistics System. The following were calculated for each state, the District of Columbia, and Puerto Rico: number of ART procedures performed per million women of reproductive age (ART utilization), average number of embryos transferred, rates of elective single embryo transfers (eSET), as well as rates of ART-conceived multiple-birth, low birth weight, and preterm infants. The proportion of ART infants among all infants, multiple-birth, low birth weight and preterm infants was also calculated. RESULTS: Among 3,991,741 infants born in 2012 in the U.S. and Puerto Rico, 1.5 % (61,432) were conceived with ART (range: 0.2% in Puerto Rico to 5% in Massachusetts). ART utilization ranged from 323 to 7,221 procedures per million women aged 15-44 years, and was higher than the national average of 2,483 in 13 reporting areas, many of which were located in the northeast. The national eSET rate among women <35 years was 15.3% (range: 2.1% in Oklahoma to 60% in Delaware). Approximately 44%, 30%, and 35% of ART infants were multiple-birth, low birth weight, or preterm infants versus 3%, 8%, and 12% of all infants, respectively. The percentage of preterm ART infants varied from 13% among singletons to 61% among twins and 98% among triplets or higher-order multiples; comparable percentages for all infants were 10%, 57%, and 93%, respectively. Nationally, ART contributed to 20% of multiple-birth (range: 6% in Maine to 40% in Massachusetts), 6% of low birth weight (range: 1% in Puerto Rico to 15% in Massachusetts), and 5% of preterm (range: 1% in Puerto Rico to 13% in Massachusetts) infants. CONCLUSIONS: Wide variations were observed among reporting areas in the rates of ART births, utilization, eSET, and the contribution of ART to multiple-birth, low birth weight, and preterm infants. Twins and higher order infants were approximately five and seven times more likely to be preterm than were singletons for both ART and all infants. Among ART-conceived infants, greater utilization of eSET, where appropriate, could reduce the contribution of ART to multiple births and preterm delivery.

e143