- Email: [email protected]
Results of art without PGD among patients with reciplocal translocation and robertosonian translocation
O-149 Tuesday, October 18, 2016 12:15 PM
Day 3 ‘‘no result’’embryos reanalyzed at blastocyst stage
Test group
35 120 54% 43% 3%
35 12222 56% 41% 3%
Average age N Euploid Abnormal No result
Diagnosis’’ (N¼ 41) - also referred to as ‘‘no result’’ after the initial biopsy and were subsequently rebiopsied for repeat aCGH testing were included in this analysis (n¼120). As a control group, 12,222 blastocyst were analyzed from patients (similar to the test group) who underwent aCGH testing between 2012 to February 2016. RESULTS: The results attained from the analysis of all blastocyst with the same average age (35yrs) and time frame (control group) was concordant to the blastocysts rebiobpsied from the ‘‘non conclusive’’ blastomeres. CONCLUSIONS: This observed concordance between the control and the experimental group suggests that the plausible explanation for the ‘‘no result’’ diagnosis primarily originates from anuclear or apoptotic cells, damaged cells during biopsy, or faulty biopsy, but not an intrinsic problem of the embryo. The majority of blastomeres that were rebiopsied on day 5/ 6 received a diagnosis, and of those, they showed very similar rates of euploidy as the control group, indicating that these embryos are equally competent genetically, and should not be discarded but rebiopsied. O-148 Tuesday, October 18, 2016 12:00 PM RESULTS OF ART WITHOUT PGD AMONG PATIENTS WITH RECIPLOCAL TRANSLOCATION AND ROBERTOSONIAN TRANSLOCATION. A. Yoshida, M. Kobayashi, K. Sano, K. Sakakibara, M. Tanaka. Kiba Park Clinic, Tokyo, Japan. OBJECTIVE: Chromosome abnormality is one of the major causes of infertility. In Japan, only PGD regarding patients with severe genetic disorders and balanced translocations experienced with recurrent abortion are permitted. The purpose of this study is to compare results of ART without PGD between reciprocal translocation and Robertsonian translocation. DESIGN: This is a retrospective analysis of clinical outcome between January of 1999 and July of 2014. MATERIALS AND METHODS: Thirty-nine reciprocal translocations (29 men and 10 women) and 24 Robertsonian translocations (21men and 3 women) were enrolled in the study. Among 29 couples with men’s reciprocal translocation, 61 fresh embryo transfers and 33 frozen-thawed embryo transfers were performed. Among 10 couples with women’s reciprocal translocation, 14 fresh embryo transfers and 8 frozen-thawed embryo transfers were performed. On the other hand, among 21 couples with men’s Robertsonian translocation, 38 fresh embryo transfers and 29 frozen-thawed embryo transfers were performed. Among 10 couples with women’s Robertsonian translocation, 4 fresh embryo transfers and one frozen-thawed embryo transfer were performed. RESULTS: The clinical pregnancy rate per embryo transfer among couples with men’s reciprocal translocation was comparable with that among couples with women’s reciprocal translocation (26.6% vs 27.3%). The delivery rate per embryo transfer among couples with men’s reciprocal translocation was also comparable with that among couples with women’s reciprocal translocation (14.9% vs 13.6%). On the other hand, the clinical pregnancy rate per embryo transfer among couples with men’s Robertsonian translocation was comparable with that among couples with women’s Robertsonian translocation (40.3% vs 40.0%). The delivery rate per embryo transfer among couples with men’s Robertsonian translocation was also comparable with that among couples with women’s Robertsonian translocation (31.3% vs 40.0%). Next, the clinical pregnancy rate per embryo transfer among couples with reciprocal translocation was comparable with that among couples with Robertsonian translocation (26.7% vs 40.3%). The abortion rate per embryo transfer among couples with reciprocal translocation was also comparable with that among couples with Robertsonian translocation (21.4% vs 12.5%). However, the delivery rate per embryo transfer among couples with reciprocal translocation was significantly lower than that among couples with Robertsonian translocation (14.7% vs 31.9%: P<0.01). CONCLUSIONS: In the case of performing ART without PGD, the delivery rate per embryo transfer among couples with reciprocal translocation was significantly lower than that among couples with Robertsonian translocation.
e60
ASRM Abstracts
IS PREIMPLANTATION GENETIC SCREENING WITH FROZEN SINGLE EMBRYO TRANSFER SUPERIOR TO FRESH IN-VITRO FERTILIZATION WITH ELECTIVE SINGLE EMBRYO TRANSFER IN A GOOD PROGNOSIS POPULATION? A. Schufreider,a D. McQueen,b J. Mathews,c J. Liebermann,c M. L. Uhler,d E. C. Feinberg.e aThe University of Chicago, Chicago, IL; bUniversity of Illinois Chicago, Chicago, IL; cFertility Centers of Illinois, Chicago, IL; dReproductive Endocrinology and Infertility, Fertility Centers of Illinois, Warrenville, IL; eFertility Centers of Illinois, Highland Park, IL. OBJECTIVE: Elective single embryo transfer (eSET) in a highly selected population offers excellent clinical pregnancy rates with low rates of multiple gestation. Preimplantation genetic screening (PGS) is increasingly utilized, but whether it is superior to eSET in a good prognosis population has yet to be determined. Our objective was to compare pregnancy outcomes in good prognosis patients who utilized PGS versus those who underwent a fresh IVF cycle with eSET. DESIGN: Retrospective matched cohort study. MATERIALS AND METHODS: IRB approval was obtained. Women <38yo undergoing autologous IVF with single embryo transfer between 2012-2015 were included. eSET was offered to women <38yo with <2 prior failed cycles and >1 high quality blastocyst on day 5. Outcomes with eSET were compared to outcomes with PGS followed by frozen transfer of a single euploid embryo (PGS/sFET). eSET patients were matched to PGS/sFET patients by age and date of embryo transfer with a 3:1 ratio. The primary outcome was ongoing pregnancy rate (OPR) at 20 weeks gestation. Odds ratios (OR) used eSET as the reference group. RESULTS: 237 women were included: 172 (72.6%) eSET and 65 (27.4%) PGS/sFET. There were no significant demographic differences between groups (Table 1). There was no significant difference in clinical pregnancy rate (CPR) between PGS/sFET and eSET, 58.5% vs. 61.6%, OR 0.88 (95% CI 0.49-1.57). There was also no significant difference in OPR between PGS/sFET and eSET, 44.6% vs 55.8%, OR 0.64 (95% CI 0.36-1.13). There was a significantly higher spontaneous abortion rate with PGS/sFET compared to eSET, 23.7% vs. 7.5%, OR 3.80 (95% CI 1.34-10.74). In patients <35yo, there was a trend toward a lower OPR in PGS/sFET compared to eSET, 44.7% vs 62.3%, P¼0.09. In patients 35-37 years old, the OPR was similar between groups, 44.4% vs 43.1%, P¼0.92. CONCLUSIONS: Outcomes with PGS/sFET were not superior to eSET in this population. In women <38yo who underwent fresh IVF with careful visual selection of the single best embryo on day 5, ongoing pregnancy rates were similar to women who underwent PGS/sFET with euploidy as guidance for embryo selection. Surprisingly, there was a significantly higher miscarriage rate in women <38 undergoing PGS/sFET, which needs to be examined in a larger study. While the use of PGS may confer other benefits, it was not found to increase ongoing pregnancy rates in a good prognosis population. Table 1. Group Characteristics (N¼237)
Mean Age yrs (SD) Mean BMI kg/m2 (SD) Mean Day 3 FSH (SD) Smoking Clinical Pregnancy Rate (CPR) Ongoing Pregnancy Rate (OPR) Biochemical Loss Rate Spontaneous Abortion Rate
PGS/sFET (n¼65)
eSET(n¼172)
p-value
33.4 (3.0) 25.1 (5.7) 8.4 (3.2) 2/65 (3.1%) 38/65 (58.5%)
33.1 (2.8) 25.5 (6.4) 8.2 (4.1) 13/172 (7.6%) 106/172 (61.6%)
0.47 0.66 0.72 0.25 0.76
29/65 (44.6%)
96/172 (55.8%)
0.16
8/46 (17.4%) 9/38 (23.7%)
12/118 (10.2%) 8/106 (7.5%)
0.29 0.01
O-150 Tuesday, October 18, 2016 12:30 PM IVF PATIENTS OVER AGE 39 EXPERIENCE DECREASED COST EFFECTIVENESS AND LIVE BIRTH RATES WITH PREIMPLANTATION GENETIC SCREENING: A DECISION ANALYTIC MODEL AND COST EFFECTIVENESS ANALYSIS. W. Salem, J. R. Ho, K. A. Bendikson, K. Chung, R. Paulson. University of Southern California, Los Angeles, CA.
Vol. 106, No. 3, Supplement, September 2016
Day 3 ‘‘no result’’embryos reanalyzed at blastocyst stage
Test group
35 120 54% 43% 3%
35 12222 56% 41% 3%
Average age N Euploid Abnormal No result
Diagnosis’’ (N¼ 41) - also referred to as ‘‘no result’’ after the initial biopsy and were subsequently rebiopsied for repeat aCGH testing were included in this analysis (n¼120). As a control group, 12,222 blastocyst were analyzed from patients (similar to the test group) who underwent aCGH testing between 2012 to February 2016. RESULTS: The results attained from the analysis of all blastocyst with the same average age (35yrs) and time frame (control group) was concordant to the blastocysts rebiobpsied from the ‘‘non conclusive’’ blastomeres. CONCLUSIONS: This observed concordance between the control and the experimental group suggests that the plausible explanation for the ‘‘no result’’ diagnosis primarily originates from anuclear or apoptotic cells, damaged cells during biopsy, or faulty biopsy, but not an intrinsic problem of the embryo. The majority of blastomeres that were rebiopsied on day 5/ 6 received a diagnosis, and of those, they showed very similar rates of euploidy as the control group, indicating that these embryos are equally competent genetically, and should not be discarded but rebiopsied. O-148 Tuesday, October 18, 2016 12:00 PM RESULTS OF ART WITHOUT PGD AMONG PATIENTS WITH RECIPLOCAL TRANSLOCATION AND ROBERTOSONIAN TRANSLOCATION. A. Yoshida, M. Kobayashi, K. Sano, K. Sakakibara, M. Tanaka. Kiba Park Clinic, Tokyo, Japan. OBJECTIVE: Chromosome abnormality is one of the major causes of infertility. In Japan, only PGD regarding patients with severe genetic disorders and balanced translocations experienced with recurrent abortion are permitted. The purpose of this study is to compare results of ART without PGD between reciprocal translocation and Robertsonian translocation. DESIGN: This is a retrospective analysis of clinical outcome between January of 1999 and July of 2014. MATERIALS AND METHODS: Thirty-nine reciprocal translocations (29 men and 10 women) and 24 Robertsonian translocations (21men and 3 women) were enrolled in the study. Among 29 couples with men’s reciprocal translocation, 61 fresh embryo transfers and 33 frozen-thawed embryo transfers were performed. Among 10 couples with women’s reciprocal translocation, 14 fresh embryo transfers and 8 frozen-thawed embryo transfers were performed. On the other hand, among 21 couples with men’s Robertsonian translocation, 38 fresh embryo transfers and 29 frozen-thawed embryo transfers were performed. Among 10 couples with women’s Robertsonian translocation, 4 fresh embryo transfers and one frozen-thawed embryo transfer were performed. RESULTS: The clinical pregnancy rate per embryo transfer among couples with men’s reciprocal translocation was comparable with that among couples with women’s reciprocal translocation (26.6% vs 27.3%). The delivery rate per embryo transfer among couples with men’s reciprocal translocation was also comparable with that among couples with women’s reciprocal translocation (14.9% vs 13.6%). On the other hand, the clinical pregnancy rate per embryo transfer among couples with men’s Robertsonian translocation was comparable with that among couples with women’s Robertsonian translocation (40.3% vs 40.0%). The delivery rate per embryo transfer among couples with men’s Robertsonian translocation was also comparable with that among couples with women’s Robertsonian translocation (31.3% vs 40.0%). Next, the clinical pregnancy rate per embryo transfer among couples with reciprocal translocation was comparable with that among couples with Robertsonian translocation (26.7% vs 40.3%). The abortion rate per embryo transfer among couples with reciprocal translocation was also comparable with that among couples with Robertsonian translocation (21.4% vs 12.5%). However, the delivery rate per embryo transfer among couples with reciprocal translocation was significantly lower than that among couples with Robertsonian translocation (14.7% vs 31.9%: P<0.01). CONCLUSIONS: In the case of performing ART without PGD, the delivery rate per embryo transfer among couples with reciprocal translocation was significantly lower than that among couples with Robertsonian translocation.
e60
ASRM Abstracts
IS PREIMPLANTATION GENETIC SCREENING WITH FROZEN SINGLE EMBRYO TRANSFER SUPERIOR TO FRESH IN-VITRO FERTILIZATION WITH ELECTIVE SINGLE EMBRYO TRANSFER IN A GOOD PROGNOSIS POPULATION? A. Schufreider,a D. McQueen,b J. Mathews,c J. Liebermann,c M. L. Uhler,d E. C. Feinberg.e aThe University of Chicago, Chicago, IL; bUniversity of Illinois Chicago, Chicago, IL; cFertility Centers of Illinois, Chicago, IL; dReproductive Endocrinology and Infertility, Fertility Centers of Illinois, Warrenville, IL; eFertility Centers of Illinois, Highland Park, IL. OBJECTIVE: Elective single embryo transfer (eSET) in a highly selected population offers excellent clinical pregnancy rates with low rates of multiple gestation. Preimplantation genetic screening (PGS) is increasingly utilized, but whether it is superior to eSET in a good prognosis population has yet to be determined. Our objective was to compare pregnancy outcomes in good prognosis patients who utilized PGS versus those who underwent a fresh IVF cycle with eSET. DESIGN: Retrospective matched cohort study. MATERIALS AND METHODS: IRB approval was obtained. Women <38yo undergoing autologous IVF with single embryo transfer between 2012-2015 were included. eSET was offered to women <38yo with <2 prior failed cycles and >1 high quality blastocyst on day 5. Outcomes with eSET were compared to outcomes with PGS followed by frozen transfer of a single euploid embryo (PGS/sFET). eSET patients were matched to PGS/sFET patients by age and date of embryo transfer with a 3:1 ratio. The primary outcome was ongoing pregnancy rate (OPR) at 20 weeks gestation. Odds ratios (OR) used eSET as the reference group. RESULTS: 237 women were included: 172 (72.6%) eSET and 65 (27.4%) PGS/sFET. There were no significant demographic differences between groups (Table 1). There was no significant difference in clinical pregnancy rate (CPR) between PGS/sFET and eSET, 58.5% vs. 61.6%, OR 0.88 (95% CI 0.49-1.57). There was also no significant difference in OPR between PGS/sFET and eSET, 44.6% vs 55.8%, OR 0.64 (95% CI 0.36-1.13). There was a significantly higher spontaneous abortion rate with PGS/sFET compared to eSET, 23.7% vs. 7.5%, OR 3.80 (95% CI 1.34-10.74). In patients <35yo, there was a trend toward a lower OPR in PGS/sFET compared to eSET, 44.7% vs 62.3%, P¼0.09. In patients 35-37 years old, the OPR was similar between groups, 44.4% vs 43.1%, P¼0.92. CONCLUSIONS: Outcomes with PGS/sFET were not superior to eSET in this population. In women <38yo who underwent fresh IVF with careful visual selection of the single best embryo on day 5, ongoing pregnancy rates were similar to women who underwent PGS/sFET with euploidy as guidance for embryo selection. Surprisingly, there was a significantly higher miscarriage rate in women <38 undergoing PGS/sFET, which needs to be examined in a larger study. While the use of PGS may confer other benefits, it was not found to increase ongoing pregnancy rates in a good prognosis population. Table 1. Group Characteristics (N¼237)
Mean Age yrs (SD) Mean BMI kg/m2 (SD) Mean Day 3 FSH (SD) Smoking Clinical Pregnancy Rate (CPR) Ongoing Pregnancy Rate (OPR) Biochemical Loss Rate Spontaneous Abortion Rate
PGS/sFET (n¼65)
eSET(n¼172)
p-value
33.4 (3.0) 25.1 (5.7) 8.4 (3.2) 2/65 (3.1%) 38/65 (58.5%)
33.1 (2.8) 25.5 (6.4) 8.2 (4.1) 13/172 (7.6%) 106/172 (61.6%)
0.47 0.66 0.72 0.25 0.76
29/65 (44.6%)
96/172 (55.8%)
0.16
8/46 (17.4%) 9/38 (23.7%)
12/118 (10.2%) 8/106 (7.5%)
0.29 0.01
O-150 Tuesday, October 18, 2016 12:30 PM IVF PATIENTS OVER AGE 39 EXPERIENCE DECREASED COST EFFECTIVENESS AND LIVE BIRTH RATES WITH PREIMPLANTATION GENETIC SCREENING: A DECISION ANALYTIC MODEL AND COST EFFECTIVENESS ANALYSIS. W. Salem, J. R. Ho, K. A. Bendikson, K. Chung, R. Paulson. University of Southern California, Los Angeles, CA.
Vol. 106, No. 3, Supplement, September 2016