Planning for the future: how many eggs do patients need to harvest to achieve their fertility goals?

Relative risk of donor cycle outcomes by paternal and recipient age in first cycles (n¼4309)

Recipient age <35 35-39 40-44 45+ Paternal age <35 35-39 40-44 45-49 50+

Clinical Pregnancy RR (p value)

Livebirth RR (p value)

Spontaneous abortion RR (p value)

REF 0.93 (0.12) 0.95 (0.23) 0.90 (0.05)

REF 0.88 (0.03) 0.88 (0.02) 0.82 (<0.01)

REF 1.14 (0.58) 1.38 (0.17) 1.45 (0.14)

REF 1.00 (0.91) 0.97 (0.56) 0.99 (0.84) 0.98 (0.72)

REF 1.00 (0.99) 0.95 (0.39) 0.97 (0.67) 0.98 (0.82)

REF 1.15 (0.52) 1.17 (0.46) 1.07 (0.78) 1.12 (0.65)

further reduced likelihood of livebirth (RR¼0.82, P¼0.003). Taking recipient age into account, none of the paternal age categories had reduced likelihood of livebirth compared to those < 35 (P¼0.80). CONCLUSIONS: In this large cohort of oocyte donor cycles, increasing paternal age was associated with poorer semen quality; however, increasing paternal age was not associated with pregnancy. Conversely, increasing recipient age was associated with poorer clinical pregnancy rates, live birth rates, and SAB rates. Poorer outcomes related to increasing recipient age were independent of paternal age and oocyte quality and warrant further investigation. Supported by: This research was supported, in part, by the Intramural Research Program of NICHD.

P-571 Wednesday, October 19, 2016 SUBENDOMETRIAL VASCULARITY AND HIGH SENSITIVE CREACTIVE PROTEIN IN PATIENTS WITH UNEXPLAINEDINFERTILITY UNDERGOING ENDOMETRIAL SCRATCHING PRIOR TO INTRAUTERINE INSEMINATION. H. Hamza,a M. Rezk,b A. Saad.c a Obstetrics and Gynecology, Faculty of Medicine - Menoufia University, Berket el Sabaa - Menofiya, Egypt; bObstetrics and Gynecology, Faculty of Medicine - Menoufia University, Menofiya, Egypt; cObstetrics and Gynecology, Faculty of Medicine - Menoufia University, Shebin el Kom - Menofiya, Egypt. OBJECTIVE: to assess the correlation between subendometrial vascularity, high-sensitive C-reactive protein (HS-CRP) and endometrial scratching in patients with unexplained infertility undergoing intrauterine insemination (IUI). DESIGN: A randomized controlled trial included a total of 146 couples with unexplained infertility.Sample size The assumed total sample size of the study was actually calculated according to a proposed type I error of 5% with an expected difference between rates of clinical pregnancy in study groups of 10%. Type II error was proposed to be 20% (b ¼ 20%) hence the power was set at (1-b, 80%). Accordingly, 72 women were needed in each group. Randomization and blinding Enrolled patients were randomly assigned into two groups according to the method of intervention. Randomization in 1:1 ratio was carried out using computer-generated simple random tables.Clinical trial registration number at Pan African Clinical Trials

Registry (http://www.pactr.org). PACTR201509001264171 Date of registration: 2015/09/12. MATERIALS AND METHODS: Patients were randomly allocated into two groups: group 1 comprised 72 women who underwent endometrial scratching in the luteal phase of a spontaneous menstrual cycle; and group 2 included 74 women who underwent a placebo procedure. HS-CRP was measured 48 hours after scratching with transvaginal Doppler studies performed on the day of hCG administration followed by IUI. Primary outcome was clinical pregnancy rate. RESULTS: There were statistically significant differences between the two groups regarding the serum level of HS-CRP (p<0.001), endometrial thickness (p<0.001), positive vascularization pattern (p<0.001) and clinical pregnancy rate (p<0.001) being higher in the study (scratching) group. Serum level of HS-CRP higher than 1.5 mg/L, endometrial thickness greater than 7 mm and the presence of subendometrialedometrial vascularization were associated with higher chance of achieving pregnancy. CONCLUSIONS: endometrial scratching induces a state of endometrial inflammation and increases the clinical pregnancy in couples with unexplained infertility undergoing IUI. Further studies are warranted to confirm or refute these findings. P-572 Wednesday, October 19, 2016 PLANNING FOR THE FUTURE: HOW MANY EGGS DO PATIENTS NEED TO HARVEST TO ACHIEVE THEIR FERTILITY GOALS? A. Coates,a,b E. Mounts,a A. Kung,c B. J. Bankowski,a S. Munne.d aOregon Reproductive Medicine, Portland, OR; bSchool of Biosciences, University of Kent, Canterbury, United Kingdom; cReprogenetics, Portland, OR; dReprogenetics, Livingston, NJ. OBJECTIVE: To establish the number of mature eggs needed to create one euploid blastocyst according to maternal age. This metric can be extrapolated to estimate how many eggs may be required to potentially complete a family of more than one child. DESIGN: Retrospective single center data analysis. MATERIALS AND METHODS: Retrospective data analysis of embryos generated as part of clinical IVF cycles and tested for aneuploidy using high resolution Next Generation Sequencing (hrNGS). The total number of mature eggs retrieved for each maternal age group was divided by the final number of euploid blastocysts available post-biopsy, resulting in the number of mature eggs retrieved per euploid blastocyst. Blastocysts with an inconclusive result were omitted from the analysis which accounted for 2.5% of the total number of blastocysts available. RESULTS: *as 90% of vitrified eggs survive the warming process then one would need 10% extra mature eggs to compensate for any post warm losses. CONCLUSIONS: As maternal age increases so does the number of eggs anticipated to be needed to result in one euploid blastocyst. As the live birth rate per euploid blastocyst is around 65% (own data) the number of embryos projected to achieve the goal of one live born child would be approximately a minimum of 2. This equation is useful when counselling patients vitrifying eggs for fertility preservation, to facilitate an informed decision regarding the number of egg retrieval cycles they may require to achieve their future fertility goals. This would also apply to infertile patients to aid in planning the number of cycles it may take for them to complete their family. It also illustrates the effects of delaying reproduction without fertility preservation. Supported by: Oregon Reproductive Medicine.

HS-CRP, ultrasound parameters and outcome of IUI

Study group (n¼72)

Control group (n¼74)

Student t-test

P-value

HS-CRP (mg/L) 1.890.87 0.510.39 12.42 <0.001 Endometrial thickness(mm) 9.81.9 7.11.4 9.79 <0.001 Positive vascularization pattern 42 16 19.04* <0.001 OR 5.1 (95%CI:2.46-10.48) Clinical pregnancy rate 38 9 25.75* <0.001 OR 8.1 (95%CI:3.5-18.64) -Single 32 8 -Multiple 6 1 *Chi square test, HS-CRP¼High sensitive C-reactive protein, IUI¼Intrauterine insemination, OR¼Odd’s ratio, 95% CI¼Confidence interval at 95%.

e322

ASRM Abstracts

Vol. 106, No. 3, Supplement, September 2016

Donor egg (25)

<30

30-34

35

36

37

38

39

40

41

42

43

44-46

# cycles 534 47 169 75 68 81 86 101 92 81 37 27 25 Ave # M2/cycle 21.8 15.7 15.2 14.2 16.3 13 12 11.3 13 12.2 12.8 11.2 8.5 Ave # embryos 7.6 6.4 5.6 5.2 6.2 5.1 4.7 3.7 4.1 3.6 4 2.7 2 biopsied/ cycle Ave # euploid/ 5.6 4.5 3.7 3.5 3.8 2.9 2.2 1.6 1.6 1.3 1.1 0.6 0.1 cycle # mature eggs 3.9 (7.8) 3.4 (6.8) 4 (8) 4 (8) 4.3 (8.6) 4.5 (9) 5.5 (11) 7.3 (14.6) 8.1 (16.2) 9.7 (19.4) 11.3 (22.6) 19 (38) 71 (142) to make one euploid blastocycst (# to make 1 child) Number of egg 4.29 3.74 4.4 4.4 4.73 4.95 6.05 8.03 8.91 10.67 11.4 20.9 78.1 needed if using frozen eggs:* P-573 Wednesday, October 19, 2016 PATIENTS PREFER SUBCUTANEOUS PROGESTERONE OVER VAGINAL ADMINISTRATION. UNEXPECTED RESULTS OF A E. Ninchritz,b PROSPECTIVE TRIAL. A. Gosalvez-Vega,a,b aa E. Fernandez-Sanchez. Unit of Reproductive Medicine, Hospital Universitario Quir onsalud Madrid, Pozuelo de Alarcon. Madrid, Spain; bUniversidad Europea de Madrid, Villaviciosa de Odon, Spain. OBJECTIVE: To determine if subcutaneous or transvaginal progesterone are preferred by patients after the use of both, based on the influence on their sexual life, global comfort and interference on their normal activities. DESIGN: An open-label crossover study to determine patient’s preference for luteal phase support between ProlutexÒ and UtrogestanÒ for vitrified embryo transfer treatment. As we could not find any similar study, a 10 item questionnaire was developed (global comfort, easiness, unexpected problems, local inconvenients, self confidence, feeling dirty, interference with home activities, interference with work, interference with sexual activity, global preference) with 5 possible answers (much better vaginal, better vaginal, similar, better subcutaneous, much better subcutaneous). MATERIALS AND METHODS: 45 patients under estrogen treatment for frozen embryo transfer were asked to use subcutaneous progesterone for 7 days (ProlutexÒ aqueous preparation of progesterone 25mg, once a day) and another 7 days of transvaginal natural micronized progesterone (Utrogestan 200Ò 400 mg every 12 h). After completing both treatments patients were asked to fulfill a questionnaire with 10 items related with their feelings and preferences about subcutaneous and vaginal routes. As the study is focused on patient’s acceptance, no medical or clinical results were recorded, RESULTS: Unexpectedly, subcutaneous progesterone was preferred in all categories. Strongest preferences were found in better genital hygiene (87%) frecuency of use (82%) and less sexual interference (78%). Medium preferences in feeling secure of not losing product (62%) and interference in home (60%) or laboral activity (60%). Also was preferred in confort (56%) less negative symptoms (51%) and easiness of administration (44%). Finally, 73% will choose subcutaneous route if offered. Main questions and answers are showed in Table 1.

CONCLUSIONS: As opposite as we previously assumed, subcutaneous progesterone is clearly preferred to vaginal route in patients that have used both treatments. We suggest that discomfort of vaginal route is being underestimated. P-574 Wednesday, October 19, 2016 NONCOMPLIANCE WITH ASRM/SART GUIDELINES CONTINUES TO BE HIGH IN 2013 COMPARED TO 2011-2012 IN DONOR OOCYTE CYCLES WITH BLASTOCYST TRANSFER. K. S. Acharya,a S. Keyhan,b C. R. Acharya,c S. J. Li,d e a S. J. Muasher. Duke University Obstetrics and Gynecology, Duke University Obstetrics and Gynecology, Durham, NC; bObstetrics and Gynecology, Reproductive Endocrinology and Infertility Fellow, Durham, NC; cDept. Of Biostatistics and Bioinformatics, Duke Computational Biology and Bioinformatics, Durham, NC; dObstetrics and Gynecology - Duke Fertility Center, Duke University Medical Center, Durham, NC; eDuke University, Chapel Hill, NC. OBJECTIVE: ASRM/SART published guidelines in 2013 for the number of embryos to transfer in IVF. In donor oocyte IVF with donor age <35, the recommendation is for single embryo blastocyst transfer. Our group previously found a >70% noncompliance rate with this guideline for 20112012. With the newest available 2013 SART data (2014 data not available at time of submission), we sought to determine trends in embryo transfer noncompliance in donor IVF cycles to determine whether compliance has improved over time and the implications of this on multiple pregnancy rates. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: 12,998 donor-oocyte IVF cycles with fresh blastocyst transfer were analyzed. Cycles were excluded if donor age was >35 years old. Cycles were classified as noncompliant if >1 blastocyst was transferred. Main outcomes were the percentage of noncompliant cycles in 2011-12 vs 2013 as well as the MPR (R2 fetal heart beats on ultrasound) in each of these time frames. P-values were obtained from t-tests and chisquare test and were adjusted for multiple comparisons using the Benjamini-Hochberg method.

Vaginal versus subcutaneous routes. (p<0,05 in all rows)

Confortable Easiness Local disconfort Frecuency Lost of product Feeling dirty Home activity Interference Laboral activity interference Sexual interference

FERTILITY & STERILITYÒ

Much better Vaginal

Better Vaginal

8 (18%) 6 (13%) 3 (7%) 0 0 1 (2%) 1 (2%) 1 (2%) 0

7 (16%) 9 (20%) 6 (13%) 2 (4%) 3 (7%) 0 2 (4%) 0 0

Similar

Better Subcutaneous

Much better Subcutaneous

5 (11%) 10 (22%) 13 (29%) 6 (13%) 14 (31%) 5 (11%) 15 (33%) 17 (38%) 10 (22%)

13 (29%) 15 (33%) 14 (31%) 15 (33%) 18 (40%) 15 (33%) 12 (27%) 12 (27%) 14 (31%)

12 (27%) 5 (11%) 9 (20%) 22 (49%) 10 (22%) 24 (53%) 15 (33%) 15 (33%) 21 (47%)

e323