The effect of alcohol consumption on in vitro fertilization (IVF) live birth rates

O-173 Tuesday, October 20, 2009 6:00 PM NO DIFFERENCE IN THE ANEUPLOIDY RATE OF CLEAVAGE STAGE EMBRYOS IN GONADOTROPIN RELEASING HORMONE ANTAGONISTS (GNRH-ANT) CYCLES WHEN COMPARED TO THE AGONISTS (GNRH-A) CYCLES. H. F. Moustafa, B. Rizk, M. M. Farrag, M. S. Mulekar, H. Kort, Z. P. Nagy. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, AL; Department of Mathematics & Statistics, University of South Alabama, Mobile, AL; Reproductive Biology Associates, Atlanta, GA; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. OBJECTIVE: Many studies have documented a slight decrease in the clinical pregnancy rates with the use of GnRH-ant when compared to GnRH-a cycles. It is possible that the transient arrest of follicular growth after GnRH-ant administration and subsequent rescue by exogenous gonadotrophins can lead to subtle genomic disruption. This study aims at comparing the aneuploidy rate of cleavage embryos during GnRH-ant cycles to the rate of aneuploidy in GnRH-a cycles. DESIGN: Retrospective study. MATERIALS AND METHODS: 445 IVF cycles in which preimplantation genetic diagnosis was performed for women with ages between 27- 44 were included in this study. The rate of aneuploidy in day 3 embryos was evaluated in 3 stimulation groups. The first group was the short (Flare) protocol and included 200 patients. The second group was the long luteal suppression protocol which included 123 patients and the third group was the GnRH-ant protocol and included 122 patients. Embryos were biopsied on day 3, and fixed cells were tested with 9 chromosomal probes (13, 15, 16, 17, 18, 21, 22, X and Y). One-way ANOVA was used to compare the means and Chi-square test was used to compare the rates for the 3 groups. Five percent level was used to determine significance of results. RESULTS: Patients were classified according to age into groups to eliminate the effect of age as a confounder. The number of retrieved oocytes in the flare group was significantly lower when compared to long lupron and GnRH-ant groups in the different age groups (P¼ 0.0001). There was no significant difference in the aneuploidy rate between any of the stimulation groups (67%, 68% and 63% for the first through the third group respectively). There was no statistically significant difference in the number of transferred embryos, clinical pregnancy rate, or live birth rate when subgroup analysis was done. CONCLUSIONS: This study shows that the aneuploidy rate of cleavage stage embryos is not different with the use of GnRH antagonists compared to GnRH agonists during ovarian stimulation.

OUTCOME PREDICTORS - CLINICAL: ART 1 O-174 Tuesday, October 20, 2009 4:15 PM IS ELECTIVE DAY FOUR EMBRYO TRANSFER AS GOOD AS DAY FIVE EMBRYO TRANSFER? M. E. Abdallah, M. P. Diamond, F. N. Shamma. Division of REI, Dept of OBGYN, Wayne State University/ Detroit Medical Center, Detroit, MI; IVF Michigan, Rochester Hills, MI. OBJECTIVE: IVF outcome is thought to be improved with day 5 (D5) compared to day 3 embryo transfer (ET), however, little is known about the difference between D5 and day 4 (D4) ET. DESIGN: Retrospective study of IVF cycles performed by a single physician where ET was electively performed on D4 or D5, depending on the day of the week the retrieval occurred. MATERIALS AND METHODS: Charts were reviewed for patient’s age, infertility cause, retrieved and fertilized oocytes number, ET day, transferred embryos number and grade, implantation, pregnancy and viable pregnancy rates. ET was done on D4 or D5 if there were more than 3 embryos in culture. The implantation, pregnancy and viable pregnancy rates were compared between all ET at D4 vs. D5. Then the same analysis was performed only when the ET was at morula stage on D4 or balstocyct stage on D5. RESULTS: A total of 485 cycles were analyzed, 133 D4 ET and 352 D5 ET. The 2 groups did not differ in the infertility cause or number and grade of embryos transferred. D5 group significantly differed from D4 group in patient’s age (33.5 y vs. 35 y, p¼0.01), mature oocytes retrieved and fertilized (11.6 and 8.9 vs. 9.4 and 6.9, respectively, p<0.001) and diminished ovarian reserve (15.1% vs. 25.6%, p¼0.007). D5 had higher implantation rate (48% vs. 36%, p¼0.007). The pregnancy and viable pregnancy rates were higher in

FERTILITY & STERILITYÒ

D5 (71% and 63% vs. 51% and 45%, p<0.001). A logistic regression model controlling for covariates showed an odds ratio (OR) for pregnancy of 2.01 (p¼0.001) with D5 compared to D4 ET. 444 cycles had ET at morula (97) or blastocyst (347) stage at D4 or D5, respectively. Compared to D4, D5 had higher implantation, (49% vs. 33%, p<0.001), pregnancy (72% vs. 46%, p<0.001) and viable pregnancy (64% vs. 41%, p<0.001) rates. Logistic regression showed OR of 2.77 (p<0.001) for pregnancy with D5 blastocyst compared to D4 morula ET. CONCLUSIONS: Day 5 ET may be superior to day 4 ET in implantation, pregnancy and viable pregnancy rates. D5 ET, when possible, would be favored to D4 ET.

O-175 Tuesday, October 20, 2009 4:30 PM SUCCESSFUL PREGNANCY FOLLOWING STRONTIUM CHLORIDE (SRCL2) ACTIVATION OF OOCYTE IN COUPLES WITH REPEATED FAILURE OF FERTILIZATION USING INTRACYTOPLASMIC SPERM INJECTION (ICSI). J.-W. Kim, J.-L. Choi, S.-Y. Lee, S.-H. Yoon, J.-H. Jung, J.-H. Lim. Maria Fertility Hospital, Songpa-gu, Seoul, Republic of Korea. OBJECTIVE: Fertilization failure after ICSI has been a difficult problem to solve for a long time. The purpose of this study was to examine whether oocyte activation with SrCl2 for couples who showed low fertilization rate after calcium ionophore treatment could improve their fertilization, embryonic development and clinical outcomes. DESIGN: Prospective study. MATERIALS AND METHODS: This study was conducted in a private fertility hospital, between May 2007 and March 2009, a total of eight couples who showed low fertilization rate after conventional ICSI in the first cycles were included in this study. In the second cycles, oocytes were exposed to 10 mM of calcium ionophore for 30 min after ICSI. When the results of fertilization were not satisfactory in the cycles, oocytes were artificially activated by 10 mM SrCl2 for 60 min after ICSI for the third attempts. The fertilization was examined 18 h later after ICSI, and embryos with two pronuclei and two polar bodies were considered to be normally fertilized. Embryos were transferred on day 3 or 5 after oocyte retrieval. The surplus embryos that developed to the blastocyst stage were cryopreserved. RESULTS: Ten mM SrCl2 had markedly the increase of the fertilization rate compared with conventional ICSI or 10 mM of calcium ionophore (57.7% vs. 34.1% or 31.2%, respectively). There was no significant difference in the proportions of good-quality embryos on day 3. The rate of surplus embryos developed to the blastocyst stage was higher in 10 mM SrCl2 containing medium compared with that in conventional ICSI or 10 mM of calcium ionophore containing medium (16.1% vs. 0% or 9.1%, respectively). A total of four successful pregnancies were attained after SrCl2 oocyte activation, of which three healthy children were born with normal physical profile, and the others are ongoing. CONCLUSIONS: These results suggest that artificial oocyte activation with SrCl2 increase the fertilization rate in cases of low fertilization rate after conventional ICSI or calcium ionophore treatment.

O-176 Tuesday, October 20, 2009 4:45 PM THE EFFECT OF ALCOHOL CONSUMPTION ON IN VITRO FERTILIZATION (IVF) LIVE BIRTH RATES. B. V. Rossi, M. D. Hornstein, D. W. Cramer, S. A. Missmer. Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA. OBJECTIVE: To determine if alcohol use at the initiation of IVF is associated with livebirth rate. DESIGN: Prospective cohort study. MATERIALS AND METHODS: Men and women completed a self-administered questionnaire before their first IVF cycle. Subjects reported alcohol amount, frequency, and type (beer, wine (red or white), liquor) typically consumed. Discrete survival analyses were applied to calculate the odds ratio (OR) and 95% confidence interval (CI) for livebirth associated with alcohol intake (yes/no and categorically by duration and type), accounting for multiple cycles per couple and for potential confounding by cigarette use, body mass index, and age. RESULTS: 2,574 couples contributed 5,363 cycles among whom the mean women’s age was 354 and men’s 376. 11% of women and 16% of men

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were obese (R30kg/m), 50% of women were parous, 36% of women (mean packyears(pk)¼3) and 33% of men (pk¼3) were ever smokers. 56% of women and 34% of men drank less than 1 alcoholic drink per week, while 4% of women and 5% of men drank at least daily. In women, any alcohol use was associated with a significant decrease in livebirth (table), with the strongest decrease with white wine (OR¼0.50 daily vs
Effect of alcohol use on livebirth

Alcohol frequency
Women

Men

1.0(ref) 0.85(0.74-0.99) 1.0(ref) 0.86(0.74-1.00) 0.79(0.53-1.18)

1.0(ref) 0.87(0.75-1.01) 1.0(ref) 0.89(0.76-1.04) 0.74(0.55-1.00)

OR(95% CI) CONCLUSIONS: Within this cohort, alcohol use by women or men was associated with a decrease in livebirth rate. Thus, alcohol abstinence may be beneficial during IVF. Ongoing analyses include intermediate cycle outcomes and intracouple alcohol correlations. Supported by: NIH grant HD32153.

O-177 Tuesday, October 20, 2009 5:00 PM INSURANCE COVERAGE AND IVF OUTCOMES IN USA: ANALYSIS OF RECENT TRENDS IN PATIENTS YOUNGER THAN 35 YEARS OLD. J. R. Martin, J. G. Bromer, P. Patrizio. Reproductive Endocrinology and Infertility, Dept OB/GYN, Yale University School of Medicine, New Haven, CT. OBJECTIVE: As of 2006, only 6 states mandate insurance coverage for IVF. Over the last 10 years, the number of embryos transferred in women <35 decreased from 3.9 to 2.3, while the LBR increased from 28.7% to 38.8%. We investigated whether mandated insurance coverage impacted IVF outcomes in an era of increasing success rates, and whether states without coverage still have high rates of multiples despite the decreasing numbers of embryos transferred. DESIGN: Retrospective analysis SART-reported IVF cycle outcomes in 2006. MATERIALS AND METHODS: All non-donor fresh IVF cycles reported to SART in women <35 in 2006 were analyzed for: LBR per cycle start and transfer, cancellation rate, number of embryos transferred, and twin, triplet, and multiple LBR. 6 states mandate R 2 cycles of IVF coverage: CT, IL, MA, MD, NJ, and RI. Outcomes from mandated states were compared to states without any mandate for coverage of fertility services. Mann Whitney U and Chi-square test were used for statistical analysis. RESULTS: 28,772 cycles were analyzed: 11,468 in IVF-mandated and 17,304 in non-mandated states. In non-mandated states the LBR per cycle and transfer, cancellation rate, number of embryos transferred, twin and multiple LBR were all significantly higher.

LBR per cycle LB per Transfer Cancellation Rate Number of Embryos Twin LBR Triplet LBR Multiple LBR

Full Coverage

No Coverage

P Value

37.7% 43.8% 7.0% 2.21 31.4% 3.4% 33.2%

39.5% 45.9% 8.1% 2.31 33.6% 3.7% 34.6%

.002 < .001 < .001 < .001 .001 .19 .01

CONCLUSIONS: IVF remains an expensive treatment option for those with infertility and only 6 states mandate full insurance coverage. States without IVF coverage have a higher LBR, cancellation rate, and multiple (twin) LBR, associated with more embryos transferred per cycle. Competi-

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Abstracts

tion for high success rates and financial pressure from patients drive the transfer of more embryos with subsequent increases in multiple pregnancy rates in states without mandated coverage.

O-178 Tuesday, October 20, 2009 5:15 PM THE EFFECT OF MATERNAL BODY MASS INDEX (BMI) AND OOCYTE SOURCE ON ASSISTED REPRODUCTIVE TECHNOLOGY (ART) PREGNANCY RATES AND OBSTETRIC OUTCOMES. B. Luke, M. B. Brown, J. E. Stern, S. A. Missmer, R. E. Leach, V. Y. Fujimoto. Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, MI; Biostatistics, University of Michigan, Ann Arbor, MI; Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Obstetrics, Gynecology, and Reproductive Biology, Brigham and Womens Hospital, Boston, MA; Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA. OBJECTIVE: To evaluate the effect of maternal BMI and oocyte source (autologous versus donor) on ART pregnancy rates and obstetric outcomes. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: The study population included 33,433 ART cycles from the SART-CORS Online database for 2007 and was limited to women with height and weight recorded and fresh transfers only. Women were categorized by their BMI as normal weight (18.5-24.9), overweight (25.0-29.9), or obese (R30.0). Logistic regression was used to model the odds of clinical intrauterine gestation as the treatment outcome, live birth as the pregnancy outcome, and preterm (<37 weeks) for singleton live births or early preterm (<33 weeks) for multiple live births, as adjusted odds ratios (AOR) and 95% confidence intervals, with autologous oocyte use as the reference group. Models were adjusted for maternal age, race and ethnicity, smoking, number of embryos transferred, and infertility diagnoses. Among live births, models of prematurity were additionally adjusted for number of fetal heartbeats on early ultrasound. RESULTS: Regardless of BMI group, women using donor oocytes were significantly older, more likely to be diagnosed with diminished ovarian reserve or male factor infertility, and were less likely to smoke, although smoking rates paralleled increasing BMI. With the use of donor oocytes, the odds of pregnancy (AORs 4.41, 4.72, and 4.75, respectively) and a live birth (AORs 2.32, 3.12, and 2.27, respectively) were significantly increased for all three BMI groups. The magnitude of the increase was strikingly similar across all three BMI groups. The odds of preterm birth among singletons and early preterm birth among multiples were not significantly affected by oocyte source for any of the BMI groups. CONCLUSIONS: The use of donor oocytes significantly increases the chances of achieving a pregnancy and a live birth outcome, even in the presence of increasing maternal obesity. Supported by: SART.

O-179 Tuesday, October 20, 2009 5:30 PM IMPACT OF SUPPRESSION AND STIMULATION ON ANTRAL FOLLICLE COUNT (AFC). N. D. Tran, M. I. Cedars, M. P. Rosen. Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA. OBJECTIVE: Having an accurate AFC prior to an IVF cycle is useful in predicting the number of eggs retrieved. It is often observed that AFC at baseline, following suppression treatment prior to stimulation, is different than that observed prior to suppression. The aim of this study is to determine the impact of suppression on AFC and egg number retrieved. DESIGN: Retrospective. MATERIALS AND METHODS: 1492 charts were reviewed. Within 6 months of starting a cycle, all patients had AFC done in the absence of medications. AFC was repeated before stimulation while patients were on OCP/ Lupron, OCP, Lupron, or Estrace. The number of AFC and eggs from each patient was analyzed. To focus on those for whom a change might be significant, 360 patients with initial AFC less than 20 and 104 patients with AFC difference > 4 between initial and suppression were selected for subgroup analyses. RESULTS: There was a decline of -3.62, -1.91, -1.33, and -0.67 in AFC while patients were on OCP/Lupron, OCP, Lupron, and Estrace. Analysis

Vol. 92., No. 3, Supplement, September 2009