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The blastocoele stage and trophectoderm morphology grade predict the pregnancy rate of blastocyst transfers
MATERIALS AND METHODS: Included in the study were agonist (n¼206) and antagonist (n¼43) down regulated cycles. All patients received both HP-hMG (MenopurÒ) and HP-FSH (BravelleÒ) in an approximate 1:1 ratio (i.e an LH/FSH ratio of 0.5) from day one of stimulation. Only cycles with blastocyst transfers were included. RESULTS: Characteristics of the study population were as follows (mean SD): age ¼ 33.2 years 4.2 (range 21-42 years), BMI ¼ 24.0 4.3, stimulation days ¼ 9.7 0.7, total FSH dose (IU) ¼ 1541 521, total HP-hMG dose (IU) ¼ 1359 582, oocytes ¼ 13.7 5.5, MII ¼ 10.2 4.2, 2PN ¼ 8.5 3.2, peak E2 ¼ 2356.35 1888.73 pg/ml, and peak P4 ¼ 0.96 0.63. Cycles were divided into peak (day of hCG administration) P4 %1.5 ng/ml compared to P4 >1.5 ng/ml. The incidence of PPR was 16.4%. The implantation rate, clinical and ongoing pregnancy rates were comparable between groups. To analyze the association among variables associated with increased P4 levels, linear regression was performed. BMI, peak E2 levels on the day of hCG administration, and number of retrieved oocytes were associated with PPR. CONCLUSIONS: Despite a 16.4% incidence of PPR, elevated peak P4 levels were not associated with a negative effect on IVF outcomes following a stimulation strategy employing HP-hMG and HP-FSH at a 0.5 LH/FSH ratio. The use of HP-hMG may protect against a potential negative effect of elevated P4 on implantation in fresh autologous blastocyst transfers.
%1.5 ng/ml (n¼208)
>1.5 ng/ml (n¼41)
P
1.9 0.7 229/406 (57%) 154/208 (74%)
1.8 0.5 45/75 (59%) 28/41 (68%)
0.254 0.753 0.572
144/208 (69%)
27/41 (66%)
0.809
Reference: Warner et al, Fertil Steril 2014. Supported by: VCRM. P-318 Tuesday, October 20, 2015 WITHDRAWN P-319 Tuesday, October 20, 2015 CHANGES IN SINGLETON LIVE BIRTH WEIGHTS IN A LARGE IVF PRACTICE OVER AN 18 YEAR PERIOD. K. Maas,a,b E. Galkina,c K. Thornton,a,b D. Sakkas.b aBeth Israel Deaconess Medical Center, Boston, MA; bBoston IVF, Waltham, MA; cBiomedical Engineering and Biotechnology, University of Massachusetts Lowell, Lowell, MA. OBJECTIVE: The fetal origins hypothesis suggests that some diseases originate in utero owing to adaptations made by the fetus to the environment it encounters. This has allowed live birth weights (LBW) to be used as a surrogate marker of these in utero environmental encounters. It has been shown that babies born from IVF in a thaw cycle have higher LBW on average compared with those born from a fresh cycle. It has also been hypothesized that embryo culture media can impact LBW. Clinical IVF practices including stimulation protocols, medication dosing, medication types, transfer day, and cycle monitoring have evolved significantly since the inception of IVF. The IVF laboratory including incubators, culture media, culture devices and the introduction of micromanipulation techniques has also changed significantly over time. The objective of this study is to investigate the association between singleton LBW over an 18 year period in a large academic IVF clinic in the US over time after autologous in vitro fertilization (IVF) in both fresh and frozen cycles. DESIGN: Retrospective cohort study of 7332 singleton live births from patients who underwent autologous fresh or frozen IVF cycles at Boston IVF between 1996 and 2013. MATERIALS AND METHODS: 6265 fresh and 1067 frozen cycles were analyzed. One way ANOVA and t-tests were performed to compare average LBW in autologous fresh and frozen cycles as well as average LBW per cycle type over time. Six month increments were compared over the study period.
e214
ASRM Abstracts
P-320 Tuesday, October 20, 2015 THE BLASTOCOELE STAGE AND TROPHECTODERM MORPHOLOGY GRADE PREDICT THE PREGNANCY RATE OF BLASTOCYST TRANSFERS. M. Funabiki, S. Taguchi, T. Hayashi, Y. Tada, Y. Iwaki, M. Karita, T. Takano, N. Amano, F. Saji, L. K. Young, Y. Nakamura. Oak Clinic, Osaka, Japan.
Table 1.
Embryos transferred Implantation rate Clinical pregnancy/ cycle started LB/cycle started
RESULTS: A total of 7332 singleton deliveries were included from the fresh and frozen cycles. The mean LBW SD in fresh cycle and frozen cycle cohorts were 3282 620g (3267-3298g) and 3456 600g (3420-3492g) respectively. ANOVA and t-tests demonstrated a statistically significant mean difference (173g, p<0.001) between LBW in fresh versus frozen cycles. ANOVA also demonstrated no statistically significant difference in singleton LBW from fresh cycles over 6 month intervals or in the LBW of singletons from frozen cycles over 6 month intervals. There was no significant difference in LBW over time when day 3 or 5 transfers were assessed in fresh or frozen transfers. Additionally, no difference in LBW was found when comparing slow freezing and vitrification. CONCLUSIONS: Live birth weights in fresh cycles are significantly lower than those from frozen cycles. Our study validates the observation that fresh and frozen LBW differ however, it also shows that regardless of the many changes made in clinical care and laboratory practice over time LBW has remained constant. This suggests that changes in IVF practice may have little impact on overall LBW.
OBJECTIVE: The effect of blastocoele stage, trophectoderm (TE) morphology grade, and inner cell mass (ICM) morphology grade on the pregnancy rate in blastocyst transfers is controversial. Therefore, we have estimated the effects of these parameters. DESIGN: Prospective cohort study. MATERIALS AND METHODS: A prospective study was performed from January 2013 to March 2015 and included 843 patients (median age 35.6 years) with infertility in our clinic. Furthermore, embryos were obtained with the patients’ informed consent and were cultured to blastocyst stage (Day 5 - Day 7) before their use in blastocyst transfers. The primary outcome in the present study was the clinical pregnancy rate. Statistical analyses were conducted using univariate and multiple regression analyses. Significance was defined as p<0.05. RESULTS: The pregnancy rate was 32.1 % in the present study. Univariate regression analysis showed that the blastocoele stage (P<0.001) and TE morphology grade (P¼0.001) to be correlated with pregnancy rate. There was no significant association between the ICM grade and pregnancy rate (P¼0.97). Multiple logistic regression analysis showed that blastocoele stage (P¼0.0002) and TE morphology grade (P¼0.002) were significantly associated with pregnancy rate but that patient age (P¼0.22), the number of blastocyst transfers (P¼0.80) and ICM morphology grade (P¼0.29) were not. CONCLUSIONS: Blastocoele stage and TE grading, but not ICM grading, are significantly correlated with the pregnancy rate for blastocyst transfers. P-321 Tuesday, October 20, 2015 DISCORDANT ANTIMULLERIAN HORMONE (AMH) AND FOLLICLE STIMULATING HORMONE (FSH) AND PREGNANCY S. L. Mumford,a K. Devine,b OUTCOMES. T. Plowden,a K. S. Richter,b A. DeCherney,a S. Beall.b aNICHD, NIH, Bethesda, MD; b Shady Grove Fertility Reproductive Science Center, Rockville, MD. OBJECTIVE: A woman’s ovarian reserve is predictive of outcomes during in vitro fertilization (IVF). Specifically, FSH and AMH are associated with the number of expected oocytes retrieved and clinical pregnancy rates. FSH and AMH often correlate in their reflection of ovarian reserve, with high FSH and low AMH predicting poor ovarian response. However, when results are discordant, it is unclear how to counsel patients. This study was designed to evaluate IVF outcomes in women with discordant FSH and AMH levels. DESIGN: Cohort study of IVF cycles carried out from Jan 2012 - Dec 2013. MATERIALS AND METHODS: All autologous IVF cycles with available baseline FSH and AMH levels were included. Women were grouped into 4 categories: 1) high FSH and normal AMH, 2) normal FSH and low AMH, 3) high FSH and low AMH, and 4) normal FSH and AMH (reference). High FSH was defined as >12 IU/mL and low AMH was defined as < 1 ng/ mL. Repeated measures ANOVA was used to evaluate association of FSH and AMH with total gonadotropin dose, oocyte yield and number of embryos
Vol. 104, No. 3, Supplement, September 2015
%1.5 ng/ml (n¼208)
>1.5 ng/ml (n¼41)
P
1.9 0.7 229/406 (57%) 154/208 (74%)
1.8 0.5 45/75 (59%) 28/41 (68%)
0.254 0.753 0.572
144/208 (69%)
27/41 (66%)
0.809
Reference: Warner et al, Fertil Steril 2014. Supported by: VCRM. P-318 Tuesday, October 20, 2015 WITHDRAWN P-319 Tuesday, October 20, 2015 CHANGES IN SINGLETON LIVE BIRTH WEIGHTS IN A LARGE IVF PRACTICE OVER AN 18 YEAR PERIOD. K. Maas,a,b E. Galkina,c K. Thornton,a,b D. Sakkas.b aBeth Israel Deaconess Medical Center, Boston, MA; bBoston IVF, Waltham, MA; cBiomedical Engineering and Biotechnology, University of Massachusetts Lowell, Lowell, MA. OBJECTIVE: The fetal origins hypothesis suggests that some diseases originate in utero owing to adaptations made by the fetus to the environment it encounters. This has allowed live birth weights (LBW) to be used as a surrogate marker of these in utero environmental encounters. It has been shown that babies born from IVF in a thaw cycle have higher LBW on average compared with those born from a fresh cycle. It has also been hypothesized that embryo culture media can impact LBW. Clinical IVF practices including stimulation protocols, medication dosing, medication types, transfer day, and cycle monitoring have evolved significantly since the inception of IVF. The IVF laboratory including incubators, culture media, culture devices and the introduction of micromanipulation techniques has also changed significantly over time. The objective of this study is to investigate the association between singleton LBW over an 18 year period in a large academic IVF clinic in the US over time after autologous in vitro fertilization (IVF) in both fresh and frozen cycles. DESIGN: Retrospective cohort study of 7332 singleton live births from patients who underwent autologous fresh or frozen IVF cycles at Boston IVF between 1996 and 2013. MATERIALS AND METHODS: 6265 fresh and 1067 frozen cycles were analyzed. One way ANOVA and t-tests were performed to compare average LBW in autologous fresh and frozen cycles as well as average LBW per cycle type over time. Six month increments were compared over the study period.
e214
ASRM Abstracts
P-320 Tuesday, October 20, 2015 THE BLASTOCOELE STAGE AND TROPHECTODERM MORPHOLOGY GRADE PREDICT THE PREGNANCY RATE OF BLASTOCYST TRANSFERS. M. Funabiki, S. Taguchi, T. Hayashi, Y. Tada, Y. Iwaki, M. Karita, T. Takano, N. Amano, F. Saji, L. K. Young, Y. Nakamura. Oak Clinic, Osaka, Japan.
Table 1.
Embryos transferred Implantation rate Clinical pregnancy/ cycle started LB/cycle started
RESULTS: A total of 7332 singleton deliveries were included from the fresh and frozen cycles. The mean LBW SD in fresh cycle and frozen cycle cohorts were 3282 620g (3267-3298g) and 3456 600g (3420-3492g) respectively. ANOVA and t-tests demonstrated a statistically significant mean difference (173g, p<0.001) between LBW in fresh versus frozen cycles. ANOVA also demonstrated no statistically significant difference in singleton LBW from fresh cycles over 6 month intervals or in the LBW of singletons from frozen cycles over 6 month intervals. There was no significant difference in LBW over time when day 3 or 5 transfers were assessed in fresh or frozen transfers. Additionally, no difference in LBW was found when comparing slow freezing and vitrification. CONCLUSIONS: Live birth weights in fresh cycles are significantly lower than those from frozen cycles. Our study validates the observation that fresh and frozen LBW differ however, it also shows that regardless of the many changes made in clinical care and laboratory practice over time LBW has remained constant. This suggests that changes in IVF practice may have little impact on overall LBW.
OBJECTIVE: The effect of blastocoele stage, trophectoderm (TE) morphology grade, and inner cell mass (ICM) morphology grade on the pregnancy rate in blastocyst transfers is controversial. Therefore, we have estimated the effects of these parameters. DESIGN: Prospective cohort study. MATERIALS AND METHODS: A prospective study was performed from January 2013 to March 2015 and included 843 patients (median age 35.6 years) with infertility in our clinic. Furthermore, embryos were obtained with the patients’ informed consent and were cultured to blastocyst stage (Day 5 - Day 7) before their use in blastocyst transfers. The primary outcome in the present study was the clinical pregnancy rate. Statistical analyses were conducted using univariate and multiple regression analyses. Significance was defined as p<0.05. RESULTS: The pregnancy rate was 32.1 % in the present study. Univariate regression analysis showed that the blastocoele stage (P<0.001) and TE morphology grade (P¼0.001) to be correlated with pregnancy rate. There was no significant association between the ICM grade and pregnancy rate (P¼0.97). Multiple logistic regression analysis showed that blastocoele stage (P¼0.0002) and TE morphology grade (P¼0.002) were significantly associated with pregnancy rate but that patient age (P¼0.22), the number of blastocyst transfers (P¼0.80) and ICM morphology grade (P¼0.29) were not. CONCLUSIONS: Blastocoele stage and TE grading, but not ICM grading, are significantly correlated with the pregnancy rate for blastocyst transfers. P-321 Tuesday, October 20, 2015 DISCORDANT ANTIMULLERIAN HORMONE (AMH) AND FOLLICLE STIMULATING HORMONE (FSH) AND PREGNANCY S. L. Mumford,a K. Devine,b OUTCOMES. T. Plowden,a K. S. Richter,b A. DeCherney,a S. Beall.b aNICHD, NIH, Bethesda, MD; b Shady Grove Fertility Reproductive Science Center, Rockville, MD. OBJECTIVE: A woman’s ovarian reserve is predictive of outcomes during in vitro fertilization (IVF). Specifically, FSH and AMH are associated with the number of expected oocytes retrieved and clinical pregnancy rates. FSH and AMH often correlate in their reflection of ovarian reserve, with high FSH and low AMH predicting poor ovarian response. However, when results are discordant, it is unclear how to counsel patients. This study was designed to evaluate IVF outcomes in women with discordant FSH and AMH levels. DESIGN: Cohort study of IVF cycles carried out from Jan 2012 - Dec 2013. MATERIALS AND METHODS: All autologous IVF cycles with available baseline FSH and AMH levels were included. Women were grouped into 4 categories: 1) high FSH and normal AMH, 2) normal FSH and low AMH, 3) high FSH and low AMH, and 4) normal FSH and AMH (reference). High FSH was defined as >12 IU/mL and low AMH was defined as < 1 ng/ mL. Repeated measures ANOVA was used to evaluate association of FSH and AMH with total gonadotropin dose, oocyte yield and number of embryos
Vol. 104, No. 3, Supplement, September 2015