Placental abnormalities in singleton pregnancies following assisted reproductive technologies (ART): the incidence of placenta accreta is increased

TABLE 1. Clinical results

Number of cycles Age(MSD)(years) Duration of infertilitySD) (years) No. of oocytes/cycle(MSD) No. of embryos/cycle(MSD) No. of good embryos No. of transferred embryos/ cycle(MSD) No. of preg (%) a,b

P-309

5% CO2, 5%O2

6% CO2, 5%O2

177 33.43.3 4.83.0 14.27.8 10.25.9 321/673(47.7)a 3.80.9 95/177(53.7)

231 33.23.6 4.83.0 14.68.2 10.56.1 553/866(63.9)b 3.70.7 112/231(48.5)

<0.05.

CONCLUSIONS: Our results with day 3 embryo transfer have shown no significant differences in clinical pregnancy rate. But in vitro culture of human embryo under 6% CO2, 5%O2 resulted in significantly better quality embryos than 5%CO2, 5%O2 conditions. It seems that for early embryonic development, 6% CO2, 5% O2 is good gas phase system. Supported by: None. P-308 IMPLANTATION FAILURES IN WOMEN UNDERGOING INFERTILITY TREATMENT WITH ART USING FRESH DONOR AND NON-DONOR OOCYTES: UNITED STATES DATA FROM 2001 TO 2005. J. G. Bromer, P. Patrizio, D. Sakkas, E. Seli. Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT. OBJECTIVE: Use of Assisted Reproductive Technologies (ART) has been steadily increasing in the United States, with 126,706 cycles started in 2005. Despite its widening application, ART remains associated with low embryo implantation rates and subsequent cycle failures that are a significant cause of physical, emotional, and financial distress for infertile couples. In this study, we determined the rate of embryo implantation failure in ART cycles using fresh donor and non-donor oocytes over a 5 year period in the United States. DESIGN: Review of ART data from the Society for Assisted Reproductive Technology (SART). MATERIALS AND METHODS: All fresh donor and non-donor ART cycles from 2001-2005 were analyzed. The total number of embryo transfers was multiplied by the average number of embryos transferred per cycle, which was then compared to the total number of live born infants in that year. The inverse of this ratio of infants born to embryos transferred was considered the rate of implantation failure. A Pearson correlation coefficient was calculated to test the association between the mean number of embryos transferrred and the rate of implantation failure. RESULTS: The number of cycles performed and outcomes data are summarized in the table. From 2001 to 2005, the average number of embryos transferred in ART cycles using fresh donor oocytes has decreased from 2.9 to 2.3. This decrease showed a significant correlation with the decrease in the rate of implantation failure from 76.5% to 67.6% (p<0.05). For non-donor cycles, there has been a smaller decrease in the number of embryos transferred (3.1 to 2.7), and no change in the rate of implantation failure (84.9% to 83.7%). Donor

2001 2002 2003 2004 2005

Non-Donor

No. embryos transferred

Implantation Failure (%)

No. embryos transferred

Implantation Failure (%)

2.9 2.7 2.6 2.4 2.3

76.5 73.1 72.0 70.1 67.6

3.1 3.0 2.9 2.7 2.7

84.9 82.2 82.9 83.5 83.7

CONCLUSIONS: More than 4/5 of embryos in cycles using fresh non-donor oocytes and more than 2/3 of embryos in cycles using fresh donor oocytes fail to implant. In 2001-2005, despite of an improvement in implantation rates in ART cycles using fresh donor oocytes, the percentage of embryos that failed to implant in cycles using non-donor oocytes remained unchanged. Improving our current embryo assessment strategies and identifying embryos with high reproductive potential will be important in decreasing implantation failures and increasing ART success rates. Supported by: None.

S210

Abstracts

PLACENTAL ABNORMALITIES IN SINGLETON PREGNANCIES FOLLOWING ASSISTED REPRODUCTIVE TECHNOLOGIES (ART): THE INCIDENCE OF PLACENTA ACCRETA IS INCREASED. B. N. Roy, D. Vallerand, C. Moy-Fung, B. M. William. Obstetrics and Gynecology, McGill University, Montreal, QC, Canada; McGill University, Montreal, QC, Canada; Pathology, McGill University, Montreal, QC, Canada. OBJECTIVE: To determine if placental abnormalities were increased in singleton pregnancies following assisted reproductive technologies (ART) compared to those from singleton spontaneous pregnancies. DESIGN: Case-controlled study. MATERIALS AND METHODS: Obstetric outcomes of all pregnancies from January 2001 to December 2005 were recorded in the McGill Obstetric and Neonatal Database (MOND). Placental features and delivery were noted at the time of delivery. Singleton pregnancies derived from ART were compared with spontaneously conceived singleton pregnancies, matched for age and parity, and also with singleton pregnancies in couples with infertility who did not undergo ART. RESULTS: The 468 singleton deliveries following ART were compared with 936 age and parity matched spontaneously conceived singleton deliveries and 202 singleton pregnancies in couples with infertility who did not undergo ART. Pregnancies derived from ART had a higher incidence of placenta acccreta (1.5%-7/468) compared to the control group without infertility (0.21%-2/936) and the non-ART group with infertility (0% - 0/202). However, no difference was noted in manual removal of placenta, placental weight, placental infarction, circumvallate placenta, chorangioma, advanced villous maturation, or placental vasculopathy in the different groups. CONCLUSIONS: We report a higher incidence of placenta accreta in singleton pregnancies following ART. These results may be due in part to the techniques associated with ART rather than the underlying infertility. TABLE 1. Demographic Data

ART (n¼468) Mean (SD) gestational 35.1 (4.7) age (years) Mean (SD) gestational 271.5 (19.1) age at delivery (days) Mean (SD) birth weight 3273.7 (676.8) (grams) Mean (SD) birth weight 0.998 (0.134) ratio Median (IQR) parity 0 (0-1) Median (IQR) aborta 0 (0-1)

Matched controls (n¼936)

Infertility without ART (n¼202)

35.1 (4.6)

33.1 (4.6)

274.4 (15.8)

273.10(19.7)

3342.2 (601.2)

3301.3 (693.3)

0.999 (0.141)

0.993 (0.142)

0 (0-1) 0 (0-1)

0 (0-1) 0 (0-1)

TABLE 2. Placenta characteristics

ART (N¼468) Mean (SD) placental 663 (165) weight (grams) Incidence of placental 6 (1.3%) previa (n,%) Incidence of placental 5 (1.1%) abruption (n,%) Incidence of placental 7 (1.5%) accreta (n,%) Incidence of placenta 0 (0%) percreta (n,%)

Matched controls (N¼936)

Infertility without ART (N¼202)

650 (145)

681 (153)

9 (0.9%)

0 (0%)

9 (0.9%)

1 (4.9%)

1 (0.1%)

0 (0%)

0 (0%)

0 (0%)

Supported by: None. P-310 PRETERM DELIVERIES THAT RESULT FROM ART-ASSOCIATED MULTIPLE PREGNANCIES IN THE UNITED STATES: A COST ANALYSIS. J. G. Bromer, E. Seli. Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT. OBJECTIVE: Current success rates with Assisted Reproductive Technology (ART) are attained largely through the simultaneous transfer of multiple embryos, at the risk of multiple pregnancies. Consequently, while only 1% all

Vol. 90, Suppl 1, September 2008