Pregnancy outcomes of single versus double embryo transfer in women with a congenital unicornuate uterus

P-267 Tuesday, October 18, 2016 PREGNANCY OUTCOMES OF SINGLE VERSUS DOUBLE EMBRYO TRANSFER IN WOMEN WITH A CONGENITAL UNICORNUATE UTERUS. X. Li,a Y. Ouyang,b Y. Yi.b aReproductive and Genetic Hospital of CITIC-Xiangya, Chang-sha, China; bInstitute of Reproductive & Stem Cell Engineering, Central South University, Changsha, China. OBJECTIVE: To investigate the effects of single embryo transfer (ET) and double ET on pregnancy outcomes in women with a unicornuate uterus. DESIGN: Retrospective analysis. MATERIALS AND METHODS: The pregnancy outcomes of 300 infertility patients with a unicornuate uterus and got clinical pregnancy via in vitro fertilization (IVF)-ET from January 2012 to May 2015 were analyzed. The rates of embryo implantation, live birth, transfer cycle pregnancy, clinical pregnancy and multiple pregnancy were compared between single and double ET using chi-squared test; comparisons of pregnancy outcomes were made between singleton pregnancy via single ET (A group) and via double ET (B group), and between singleton pregnancy of A group and twin pregnancy via double ET (C group) using two-sample t-test, chi-squared test or fisher exact test. RESULTS: There were a total of 377 transfer cycles in the 300 cases, including 53 single ET cycles which obtained 23 cases of singleton pregnancy and 324 double ET cycles which obtained 126 cases of singleton pregnancy, 74 cases of twin pregnancy and 3 cases of triple pregnancy. 35 cases of spontaneous/selective reduction were excluded from analysis. Comparison of the IVF treatment outcomes based on single or double ET, the rates of transfer cycle pregnancy (43.4%(23/53) vs. 62.7%(203/324), p¼0.008), clinical pregnancy (46.8%(22/47) vs. 76.7%(194/253), p<0.001) and multiple pregnancy in single ET were all significantly lower. While the rates of embryo transplantation (43.4%(23 /53) vs. 43.1%(279/648), p¼0.962) and live birth (37.7%(20/53) vs. 48.4%(157/324), p¼0.147) had no significant differences. There were no significant difference in pregnancy outcomes between A and B group (p¼0.741). When comparing the pregnancy outcomes of A and C group, the differences were significantly different (P¼0.002): the rates of early pregnancy loss (8.7%(2/23) vs. 14.3%(6/42)), late miscarriage (4.3%(1/23) vs. 16.7%(7/42), and preterm delivery (13.0%(3/23) vs. 42.9%(18/42) in A group were all lower; in addition, the gestational weeks at delivery (38.11.9 vs. 35.22.9; p<0.001) and birth weight (3.10.5vs. 2.20.6, kg; p<0.001) in A group were both significantly higher. Although the rates of term low birth weight infant (0 (0/17) vs. 18.2%(4/22); p¼0.118) and perinatal mortality (0 (0/20) vs. 10.7%(6/56); p¼0.331) were both lower in A than C group but didn’t reach significant level (Table). CONCLUSIONS: Single ET could obtain similar rates of embryo implantation and live birth as double ET. Singleton pregnancy via single ET can not only gain better pregnancy outcomes than twin pregnancy via double ET, but also reduce the risk of multiple pregnancy. Therefore, single ET is recommended in women with a unicornuate uterus during IVF-ET. P-268 Tuesday, October 18, 2016 ELECTIVE SINGLE EMBRYO TRANSFER CRITERIA SHOULD BE APPLIED TO FROZEN EMBRYO TRANSFER CYCLES. M. R. Freeman,a M. Hinds,a K. G. Howard,a J. Howard,a G. Hill.b aOvation Fertility, Nashville, TN; bNashville Fertility Center, Nashville, TN. OBJECTIVE: To evaluate the outcomes for eSET (elective single embryo transfer) and eDET (elective double embryo transfer) in frozen embryo transfer cycles.

DESIGN: Retrospective study. MATERIALS AND METHODS: Data analysis of ongoing pregnancy and live birth rates, multiple pregnancy rates, and implantation rates (+fetal heart motion/# embryos transferred) of patients who qualified for eSET (<35 years old at the time of cryopreservation; > 1 cryopreserved blastocyst in storage) and who self-elected either eSET or eDET in 391 frozen embryo transfer (FET) cycles occurring between 2011 and 2015. FET outcomes were evaluated according to the patients’ election to have preimplantation genetic screening (PGS) or not (PGS patient; non-PGS patient) or fresh cycle outcome (negative outcome; pregnant and delivered in fresh cycle). Proportion data were analyzed using Fisher’s exact test; P< 0.05 was considered to be statistically significant. RESULTS: There were no statistically significant differences observed in ongoing pregnancy and live birth rates in FET for eSET vs. eDET in any of the patient groups evaluated. Multiple pregnancy rates were significantly decreased in all eSET groups (0 - 5%), compared to eDET groups (30 - 44%). Implantation rates were significantly higher for eSET vs. eDET in non-PGS patients (53% vs. 40%), but failed to reach a significant difference in the other groups. CONCLUSIONS: Similar ongoing pregnancy and live birth rates can be maintained while reducing the occurrence of multiple gestations with eSET compared to eDET in FET cycles. This is important since fewer fresh embryo transfers are being done due to the increase in PGS and IVF cycle management. If two or more cryopreserved blastocysts are available, eSET in FET cycles will provide additional future FET attempts while decreasing multiple pregnancy complications and fetal loss. Furthermore, eSET represents a significant potential cost savings since current estimates for delivery of twins is five times, and triplets is 20 times the cost of delivery of a singleton1. References: 1. Lemos EV, Zhang D, Van Voorhis BJ, Hu H. Healthcare expenses associated with multiple pregnancies versus singletons in the United States. Am J Obstet Gynecol 2013;209(6):586. P-269 Tuesday, October 18, 2016 STRATEGIC IMPLEMENTATION OF EXTENDED CULTURE RESULTS IN DIFFERENT CLINICAL OUTCOMES COMPARED TO ROUTINE BLASTOCYST CULTURE IN DONOR CYCLES. V. Libby,a S. Babayev,a B. G. Reed,a K. Doody.b aUT Southwestern Medical Center, Dallas, TX; bCenter for Assisted Reproduction, Bedford, TX. OBJECTIVE: This study aims to compare laboratory and clinical outcomes in donor cycles between clinics that use an algorithm to determine whether cleavage embryos versus blastocyst stage embryos will be used versus clinics that do all blastocyst transfers. DESIGN: Retrospective Cohort Study MATERIALS AND METHODS: All fresh and frozen donor embryo transfers in the SART database from 2004 to 2013 were reviewed. Years were separately analyzed for each clinic. Clinics were grouped according to the percentage of blastocyst transfers with greater than or equal to 95% termed ‘‘Day 5’’ clinics and those with <95% as algorithm-based clinics. 392,080 patients from 444 clinics in 3230 distinct clinic-years were reviewed. Of Day 5 clinics, 2,446 patients underwent fresh and 1,478 underwent frozen donor embryo transfers from 298 distinct clinic-years. Among algorithm-based clinics, 45,296 patients underwent fresh and 22,592 underwent frozen embryo transfers from 5,080 clinic-years. Patient and cycle characteristics and birth outcomes were included in the analysis. The main outcome measures were pregnancy, live birth, multiple gestation, birth weight, neonatal death, and gender rates.

eSET vs. eDET in FET cycles

Patient Group PGS Patients Non-PGS Patients Negative, biochemical, or miscarriage in fresh cycle Pregnant & delivered in fresh cycle

# Embryos transferred

# Transfers

Ongoing/ delivered (%)

Singleton

Multiple (%)

Implantation Rate (%)

1 2 1 2 1

76 42 79 194 20

38 (50) 27 (64) 41 (52)4 117 (60)4 10 (50)7

37 16 40 79 10

1 (3) 12 (44) 1 (2)5 38 (32)5 08

39/76 (51)3 40/84 (48)3 42/79 (53)6 155/388 (40)6 10/20 (50)9

2 1 2

129 41 38

51 21 15

22 (30)8 1 (5)11 8 (35)11

73 (57)7 22 (54)10 23 (61)10

95/258 (37)9 23/41 (54)12 31/76 (41)12

Fisher’s Exact Test: 1P¼0.176 2P¼0.0001 3P¼ 0.75 4P¼0.225 5P¼0.0001 6P¼ 0.034 7P¼1.0 8P¼0.056 9P¼ 0.24 10P¼0.65 11P¼0.022 12P¼0.124

FERTILITY & STERILITYÒ

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