Prospective, randomized trial on the effect of laser assisted hatching on frozen-thawed embryo transfer cycles

O-49 Monday, October 14, 2013 05:30 PM PROSPECTIVE, RANDOMIZED TRIAL ON THE EFFECT OF LASER ASSISTED HATCHING ON FROZEN-THAWED EMBRYO TRANSFER CYCLES. I. De Croo,a F. Vanden Meerschaut,a S. Van Steelandt,b E. Van den Abbeel,a P. De Sutter.a aDepartment for Reproductive Medicine, Ghent University Hospital, Ghent, Oost-Vlaanderen, Belgium; b Department for Applied Mathematics and Computer Science, Ghent University, Ghent, Oost-Vlaanderen, Belgium. OBJECTIVE: To compare pregnancy and embryo implantation rate of frozen-thawed embryo transfer cycles at the cleavage stage using laser assisted hatching (LAH) versus not using laser assisted hatching. DESIGN: Prospective, randomized study and blinded for patient and gynaecologist. MATERIALS AND METHODS: This study was approved by the Institutional Board of the Ethical Committee of the Ghent University Hospital. All couples with a first frozen-thawed embryo transfer after a fresh embryo transfer were invited to participate in this study. Patients with a previous assisted hatching cycle were excluded. The study was performed between February 2008 and April 2013. Embryos were thawed one day before embryo transfer. Immediately before transfer, patients were randomized to either the test group or the control group according to a computerized randomization list. Treatment assignment was stratified over four binary covariates (number of embryos transferred, cryoprotectant (Dimethylsulfoxide or 1,2 Propanediol), patient’s age and artificially induced or spontaneous cycle). Laser assisted hatching was perfomed with a non-contact 1.48-mmdiode laser system (ZilosÒ, Research Instruments) on an inverted microsope. The zona pellucida was opened for a distance of 45
. Statistical analysis was performed by Chi-Square (significance was set at 0.05). RESULTS: A total of 294 FET were randomized to either the LAH-group (n ¼ 146) or to the control group (n ¼ 148). In the LAH group, pregnancy rate (pos hCG) per transfer was 22.6% versus 32.4% in the control group (p ¼ 0.0593, NS). Implantation rate per embryo transferred however was significantly lower in the LAH-group as compared to the control group (14.9% versus 23.6%; p ¼ 0.0278). CONCLUSION: Laser assisted hatching has an adverse effect on the implantation potential of frozen-thawed cleavage stage embryos and should not be used as a stategy to improve frozen-thawed embryo transfer outcome. O-50 Monday, October 14, 2013 05:45 PM THE ASSOCIATION BETWEEN EMBRYO CRYODAMAGE AND OUTCOMES OF CRYOPRESERVED BLASTOCYST TRANSFER FOLLOWING SLOW FREEZING AND VITRIFICATION. S. K. Shipley,a K. S. Richter,a D. K. Ginsburg,b J. Lim,a E. D. Levens,a M. J. Levy.a aShady Grove Fertility Reproductive Science Center, Rockville, MD; bSchool of Medicine and Health Sciences, The George Washington University, Washington, DC. OBJECTIVE: Cryopreservation enables storage and later transfer of excess embryos produced through in vitro fertilization but not used in fresh transfers. However, the freeze-thaw process generally causes some damage. The purpose of this study was to evaluate the association between observable cryodamage and embryo viability. DESIGN: Retrospective chart review. MATERIALS AND METHODS: All transfers of autologous frozenthawed blastocysts from January 2003 through April 2012 at a single fertility practice were reviewed. Cryopreservation was by either slow freeze (SF) or vitrification (VIT). Only fully expanded good quality blastocysts were cryopreserved. Cryodamage was quantified as the percentage of blastomeres remaining intact after thaw. Viability was assessed by pregnancy and birth resulting from transfers of single blastocysts according to observable cryodamage, subdivided according to cryopreservation method. RESULTS: Among 2752 cycles with transfer of 4704 SF embryos and 1591 cycles with transfer of 2453 VIT embryos, observable cryodamage was higher with SF (89% vs 95% intact, P<0.0001, t-test). For both SF and VIT, greater cryodamage was associated with significantly lower pregnancy and birth rates (P<0.0001 for all, logistic regression). Among embryos with comparable observable cryodamage, pregnancy and birth rates were significantly lower for SF vs VIT.

S16

ASRM Abstracts

Clinical pregnancy / live birth per transfer of single frozen-thawed blastocysts

Intact %

SF (n¼1063)

VIT (n¼787)

100* 95-99* 90-94* 75-89 <75

40% / 31% 37% / 27% 27% / 19% 15% / 11% 3% / 1%

58% / 46% 52% / 40% 47% / 33% 19% / 13% 17% / 0%

*

P%0.005 for all comparisons of SF vs VIT (c2).

CONCLUSION: More observable cryodamage is associated with lower success rates for transfers of frozen-thawed blastocysts. Less observable cryodamage results from VIT vs SF. Among embryos with comparable observable cryodamage, success rates are significantly higher for VIT vs SF, suggesting that compared to SF, VIT results in less damage that is undetectable through microscopic examination. OVARIAN STIMULATION - ART I O-51 Monday, October 14, 2013 04:00 PM INDIVIDUALIZATION OF CONTROLLED OVARIAN STIMULATION USING ANTI-MULLERIAN HORMONE AS A BIOMARKER OF OVARIAN RESPONSE MAXIMIZES THE BENEFICIAL EFFECTS OF TREATMENT AND MINIMIZES COMPLICATION AND RISKS. R. B. F. Leao, F. Y. Nakano, S. C. Esteves. Androfert Andrology and Human Reproduction Clinic, Campinas, S~ao Paulo, Brazil. OBJECTIVE: To determine the usefulness of anti-Mullerian hormone (AMH) to identify women at risk of excessive and poor response in controlled ovarian stimulation (COS) for in vitro fertilization (IVF) and the clinical impact of applying individualized COS strategies in these subsets of patients. DESIGN: Prospective and comparative study. MATERIALS AND METHODS: A group of 131 women undergoing conventional COS after pituitary down-regulation for IVF were studied to define the best cut-off points of AMH, using ROC analysis, to discriminate excessive (R20 oocytes retrieved) and poor response (%4 oocytes retrieved). Subsequently, a different group of 118 women were assessed using AMH before starting COS and treatment strategy was individualized according to AMH results (iCOS). Mild stimulation using daily doses (112.5 to 150 IU) of rechFSH or rec-hFSH combined with rec-hLH supplementation (375 IU total daily dose) were given to patients identified as at risk of excessive and poor response, respectively. Outcomes were compared between the groups who received conventional and iCOS using chi-square and Fisher’s exact tests. RESULTS: ROC analysis revealed that 2.1 and 0.82 were the best cut-off points to discriminate excessive and poor responders, respectively, with an accuracy of approximately 0.88. After iCOS, fewer patients had excessive (14.3%) or poor response (46.6%) in each subgroup of risk compared with the counterparts using conventional COS (39.3% and 72.5%, respectively; p¼0.02). Cycle cancellation (10% vs. 22.5%) and OHSS (4.8% vs. 14.3%) rates were reduced after iCOS, but not significantly. Clinical/ongoing pregnancy rates were similar between subgroups after and before iCOS (excessive responders: 55.6% vs. 57.1%; poor responders: 35% vs. 36.4%). CONCLUSION: AMH results can accurately discriminate IVF patients at risk of excessive or poor response to COS. Individualization of COS according to AMH is an effective tool to significantly minimize complications and risks while maintaining sustainable pregnancy results. O-52 Monday, October 14, 2013 04:15 PM RE-DEFINING THE EFFECT OF EXOGENOUS LH ACTIVITY (exLH) IN FOLLICULAR STIMULATION: AN ANALYSIS OF 10,280 CYCLES VALIDATING THE IMPORTANCE OF exLH IN PREVENTING A PREMATURE RISE IN PROGESTERONE (P). M. D. Werner,a,b E. J. Forman,a,b K. H. Hong,a,b R. T. Scott, Jr.a,b a Reproductive Endocrinology and Infertility, Robert Wood Johnson Medical School, Basking Ridge, NJ; bReproductive Medicine Associates of NJ, Basking Ridge, NJ. OBJECTIVE: Elevated late follicular P levels prior to surge are associated with poor ART outcomes. The rises are commonly attributed to excessive endogenous or exogenous LH stimulation. While excessive LH effect may

Vol. 100, No. 3, Supplement, September 2013