What patients can expect for percentage of embryos biopsied and normal embryos available for fresh blastocyst transfer when undergoing trophectoderm biopsy with 24-chromosome genetic analysis

RESULTS: 10 patients had oocytes thawed, ICSI was performed and embryos assessed until day 6. Full, good quality blastocysts that exhibited differentiation had TE biopsy done on day 5, 6 or occasionally day 7. Of these, 4 had transfers done following overnight PGD and 2 have on-going pregnancies. Another 6 cycles had blastocysts re-vitrified following TE biopsy and an FET in a subsequent cycle with 3 positive pregnancies and 2 ongoing. 26 cycles of previously frozen embryos were thawed with 13 cycles having rush PGD and ET with 6 pregnancies resulting 5 of which are ongoing. 13 cycles had blastocysts vitrified following TE biopsy with the euploid blastocysts transferred in a second FET cycle with 7 pregnancies resulting and 6 ongoing. CONCLUSION: Though this is a small data set, this clearly shows that oocytes and embryos can be serially vitrified, thawed, biopsied and re-vitrified and thawed again, all the while maintaining their viability. This procedure provides an option for patients who did not initially desire PGD testing but then changed their mind for a variety of reasons, including a fresh transfer that resulted in an abnormal embryo implanting which then was either aborted or required a D&C. This procedure allows for oocytes or embryos, previously cryopreserved, to be thawed and tested for euploid status prior to transfer. P-166 Tuesday, October 15, 2013 WHAT PATIENTS CAN EXPECT FOR PERCENTAGE OF EMBRYOS BIOPSIED AND NORMAL EMBRYOS AVAILABLE FOR FRESH BLASTOCYST TRANSFER WHEN UNDERGOING TROPHECTODERM BIOPSY WITH 24-CHROMOSOME GENETIC ANALYSIS. J. Barritt,a S. Munne,b M. Surrey,a,c H. Danzer,a,c S. Ghadir,a,c D. Hill.a aART Reproductive Center, Beverly Hills, CA; bReprogenetics, Livingston, NJ; cSouthern California Reproductive Center, Beverly Hills, CA. OBJECTIVE: Trophectoderm biopsy with 24 chromosome microarraycomparative genomic hybridization (aCGH) for preimplantation genetic diagnosis (PGD) is a clinically validated procedure to select chromosomally normal embryos for a fresh transfer during an IVF cycle. The expectation of the percentage of embryos that will be available for biopsy on Day 5, and how many cases result in normal embryos available for fresh blastocyst transfer has to our knowledge yet to be investigated. DESIGN: Retrospective data analysis at a private fertility practice. MATERIALS AND METHODS: A total of 128 trophectoderm biopsy aCGH cycles were evaluated between August 2010 and 2012. Patients were undergoing IVF cycles with PGD for a variety of reasons and all consented to retrospective research analysis. Data were analyzed for A) the number of cases that had biopsy, B) the number of embryos that were available for trophectoderm biopsy, and C) the number of cycles that had a normal embryo available for a fresh transfer. RESULTS: Of the 128 cycles, eight (6.3%) had no embryos available for biopsy on D5 or D6 of culture, and biopsy was canceled. In the 120 remaining cycles, a total of 677 embryos were biopsied, a mean of 5.2 per cycle. However, only 379 embryos (56%) were developed to a stage able to be biopsied on Day 5 of culture. In this highly varied patient population, only 53 cycles (41%) received a fresh transfer of normal embryos, with an average transfer of 1.4 embryos. CONCLUSION: Fresh embryo transfer following trophectoderm biopsy of embryos analyzed by aCGH is now clinically available. However, patient expectations must be managed for a possible cycle cancellation rate of 6.3%, for only 56% of embryos being developed to a stage able to be biopsied on D5 and only 41% of the initiated PGD cycles resulting in fresh embryo transfer of at least one normal embryo. These cumulative findings from a single practice demonstrate the need for significant pre-cycle counseling of all patients undergoing PGD with trophectoderm biopsy and aCGH analysis.

P-167 Tuesday, October 15, 2013 PREGNANCY RATES FOLLOWING FRESH DAY 6, FRESH DAY 7 OR FROZEN EMBRYO TRANSFER (FET) OF EUPLOID BLASTOCYSTS AFTER MICRO-ARRAY COMPARATIVE GENOMIC HYBRIDIZATION (aCGH) ANALYSIS. J. Barritt,a D. Hill,a M. Surrey,a,b S. Tormasi,c L. Kerr,c S. Munne.c aART Reproductive Center, Beverly Hills, CA; bSouthern California Reproductive Center, Beverly Hills, CA; cReprogenetics, Livingston, NJ. OBJECTIVE: Comprehensive chromosome analysis with arrays (aCGH) coupled with blastocyst biopsy has proven to increase pregnancy rates for patients undergoing PGD. However, it is unclear if it is best to do fresh transfer or an FET of euploid embryos. This study aims to compare fresh Day 6, fresh

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ASRM Abstracts

Day 7 and FET transfers of euploid embryos to determine if there are differences between the three approaches. DESIGN: Retrospective observational study at a private fertility clinic. MATERIALS AND METHODS: Blastocyst biopsy was performed on the morning of Day 5 for those embryos that reached blastocyst and on the morning of Day 6 for those only reaching blastocyst on Day 6. The biopsies were sent to a reference laboratory for aCGH analysis. The original PGD testing laboratory initially required an overnight shipment and therefore results and embryo transfer (ET) could only be performed fresh on Day 7 or required an FET, until another branch of the PGD laboratory opened locally, at which time ET could be performed either fresh on Day 6 or in an FET. There were no differences in maternal age or number of euploid embryos between FET, Day 6 or Day 7 ET. RESULTS: See Table.

No ET Cycles Mean Maternal Age Average Blastocysts Biopsied Abnormal Embryos Pregnancy Rate

FET

Fresh Day 6 ET

Fresh Day 7 ET

106 41.4 2.1

69 36.7 5.9

41 36.6 5.8

13 35.3 4.6

100% N/A

46.5% 46%

44.9% 61%

37.2% 15%

CONCLUSION: These results indicate a trend towards better pregnancy rates with fresh Day 6 transfer, and a very significant detrimental effect of replacing fresh on Day 7 (p<0.004). These findings indicated that fresh embryo transfer can be a more economical approach than freezing all blastocysts, provided that the window of implantation is not bypassed with a delay in ET. P-168 Tuesday, October 15, 2013 PREIMPLANTATION GENETIC DIAGNOSIS AT BLASTOCYST STAGE BY ARRAY COMPARATIVE GENOMIC HYBRIDIZATION. ERROR RATE DETERMINATION. P. Colls,a A. Coates,b A. Peters,c B. Acacio,d M. Roche,e T. Otani.e aReprogenetics LLC, Livingston, NJ; bOregon Reproductive Medicine, Portland, OR; cSIRM New Jersey Fertility Clinic, Asbury, NJ; dAcacio Fertility Center, Laguna Niguel, CA; eReprogenetics Japan, Kobe, Japan. OBJECTIVE: To determine the error rate of Array Comparative Genomic Hybridization (aCGH) in Preimplantation Genetic Diagnosis (PGD) of blastocysts. DESIGN: Reanalysis. MATERIALS AND METHODS: Fourty blastocysts from 16 PGS cycles previously diagnosed as abnormal on PGD with aCGH were fixed on slides for quality control purposes and reanalyzed by FISH for chromosomes X,Y,8,13,14,15,16,17,18,20,21,22 plus any other chromosome found to be abnormal in the original aCGH analysis. On average, 19 cells per blastocyst were analyzed. RESULTS: Of the 40 blastocyst reanalyzed, 31(77.5%) showed concordance for at least one of the abnormalities found in PGD, in 7(17.5%), more than 30% of the cells presented the abnormality found in PGD the rest of the cells being normal, 1(2.5%) showed other abnormalities than the ones found in PGD and 1(2.5%) did not present the abnormality found in PGD. Overall, 39 (97.5%) out of 40 embryos reanalyzed were classified as abnormal, consistent with the original diagnosis of abnormality obtained in the PGD analysis. One embryo showed normal results after reanalysis while it was diagnosed as monosomy 11 in the PGD test, thus giving an error rate of 2.5%. CONCLUSION: The error rate of aCGH in PGD at blastocyst stage is 2.5%, which is similar to that found in day-3 analysis and that obtained with FISH. Mosaicism was present in 17.5% of the embryos, a lower rate than on day-3 embryos analysis. PGD on day-5 has several advantages over day 3-biopsy such as yielding higher pregnancy rates and being less detrimental, but it is not completely exempt of mosaicism causing errors.

P-169 Tuesday, October 15, 2013 CHARACTERIZATION OF TROPHECTODERM (TE) BIOPSY B. Devkota,a A. Lonczak,a CELL NUMBER. X. Tao,a M. Lebiedzinski,a R. T. Scott, Jr.,a,b N. R. Treff.a,b aReproductive Medicine

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