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Which is better; day 2 or day 3 embryo transfer in antagonist cycles?
OBJECTIVE: Thawed blastocyst cultured overnight before transfer suits clinical work schedule better. This study aims to compare the pregnancy outcomes when frozen blastocyst was transferred 2 to 3 hours after being thawed or 16 to 20 hours after being cultured overnight. DESIGN: Retrospectively analyze the frozen blastocyst transfer cycles which can be divided into two group based the culture duration. Endometrium preparation methods(natural cycle/NC, hormone replacement treatment/HRT or controlled ovarian stimulation/COH), blastocyst developmental stage(D5 or D6), blastocyst score are compared between groups besides demographic information. MATERIALS AND METHODS: From September of 2010 to October of 2012, there are 523 cycles included: those blastocysts transferred 2 to 3 hours after being thawed are in 0TET group(n¼247) and those cultured overnight are in 1TET group(n¼276).Chi square test for categorical variables and t-test for consecutive variables are applied. RESULTS: Compared with 0TET group, 1TET group has higher pregnancy rate/PR (57.6% vs. 56.3%), implantation rate/IR (46.3% vs. 44.1%) but less embryo transferred (1.6 vs. 1.8, P<0.001), lower miscarriage rate (9.4% vs. 12.2%) and lower multiple pregnancy rate (28.3%vs. 36.7%) with no statistical significance except number of embryo transferred. HRT as endometrium preparation method has achieved higher PR (62.8% vs. 53.0%, p¼0.027). Embryos that reached blastocyst frozen criteria at the fifth day after fertilization(D5) have higher IR than those at the sixth day (57.6% vs. 36.1%, p¼0.004). CONCLUSION: Overnight culture of thawed blastocyst before transfer does not have negative impact on the pregnancy outcomes. HRT as endometrium preparation method and D5 blastocyst transfer have better outcomes. Since D5 blastocyst have achieved considerable implantation rate, single blastocyst transfer is encouraged to avoid multiple pregnancy. Supported by: National Nature Scientific Funds of China(No: 81070495). P-479 Wednesday, October 16, 2013 FACTORS RELATED TO EMBRYO-ENDOMETRIUM ASYNCHRONY IN FRESH IVF CYCLES INCREASE IN PREVALENCE WITH MATERNAL AGE. B. S. Shapiro,a,b S. T. Daneshmand,a,b F. C. Garner,a,b M. Aguirre,a C. Hudson.a aFertility Center of Las Vegas, Las Vegas, NV; bObstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, NV. OBJECTIVE: This study determines if markers of embryo-endometrium asynchrony (day 6 blastulation and premature progesterone (P4) elevation) increase with maternal age. DESIGN: IRB-approved retrospective cohort study. MATERIALS AND METHODS: Fresh autologous cycles were examined according to maternal age, day of blastulation/transfer, premature P4 elevation (P4>1.5 ng/ml), and live birth. RESULTS: There were 1,341 qualifying fresh autologous day 5 and day 6 blastocyst transfers in the 7-year study period in patients %40 years old. The proportion of transfers performed on day 6 increased with age (P<0.0001) as did the frequency of premature P4 elevation (P¼0.0126). The proportion of asynchronous transfers (day 6 transfer or elevated P4) increased with age (P<0.0001). The risk ratios for asynchronous transfer (compared to %30 age group) were 1.23 (95% CI, 1.09-1.40) in patients 31-34 years old and 1.44 (95% CI, 1.29-1.62) in patients 35-40 years old. Multivariate logistic regression found live birth was predicted by day 5 transfer (P<0.0001) and non-elevated P4 (P¼0.0002) after controlling for age.
TABLE 1. Proportions of transfers according to synchrony markers
%30 years 31-34 years 35-40 years Transfers 419 436 Day 6 transfers (%) a 143 (34.1) 194 (44.5) Elevated P4 (%) a 96 (22.9) 110 (25.2) Asynchronous transfers (%) a 200 (47.7) 257 (58.9)
486 264 (54.3) 152 (31.3) 335 (68.9)
a¼Proportions differ significantly across age groups (P<0.05). CONCLUSION: Embryo-endometrium asynchrony in IVF cycles steadily worsens with age, corresponding with reduced live birth rates and contributing to inferior success rates in older patients.
FERTILITY & STERILITYÒ
P-480 Wednesday, October 16, 2013 MULTIPLE PREGNANCY RATE BASED ON HISTORY OF CLINICAL PREGNANCY. H. Kitasaka,a,b N. Fukunaga,a,b,c T. Yoshimura,a,b E. Kojima,a,b F. Tamura,a,b Y. Asada.a,b,c aLaboratory, Asada Ladies Nagoya Clinic, Nagoya, Aichi, Japan; bLaboratory, Asada Ladies Kachigawa Clinic, Nagoya, Aichi, Japan; cThe Asada Institute for Reproductive Medicine, Nagoya, Aichi, Japan. OBJECTIVE: Multiple pregnancy represents a serious problem in artificial reproductive technology (ART). While single embryo transfer is the most effective way to prevent multiple pregnancy in ART, two embryos are often transferred in patients with advanced age, in cases of repeated failure, and when the procedure is strongly requested by patients. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: This study examined 771 cycles (frozenthawed cycles) in which two embryos were transferred between January and December 2011. Patients were divided into two groups based on history of clinical pregnancy. Cases with two or more confirmed fetal sacs were deemed to represent multiple pregnancy. Conditions for two-embryo transfer were age R40 years or 33 embryo transfer cycles. RESULTS: Mean patient age was 38.9 4.1 years in patients with a history of clinical pregnancy (Group A; n ¼ 391) and 38.8 4.5 years in patients with no history of clinical pregnancy (Group B; n ¼ 380). Clinical pregnancy rates were 105/391 (26.9%) for Group A and 169/380 (18.2%) for Group B. Multiple pregnancy rates were 25/105 (23.8%) for Group A and 8/69 (11.6%) for Group B. Multiple birth rates were 14/25 (56.0%) for Group A and 5/8 (62.5%) for Group B. Group A showed significantly higher clinical pregnancy and multiple pregnancy rates (P < 0.05). In cases of confirmed multiple pregnancy, the percentage of transfer of two good-quality embryos was 21/25 (84.0%) in Group A and 7/8 (87.5%) in Group B. CONCLUSION: A history of clinical pregnancy indicates higher fertility, associated with increased pregnancy and multiple pregnancy rates. Deciding on a two-embryo transfer according to age, number of transfer attempts, and patient requests is inappropriate; the absence of a history of clinical pregnancy should also be considered. The patient should be apprised of the risks of multiple pregnancy with two-embryo transfer, even if she is of advanced age or has attempted transfer multiple times.
P-481 Wednesday, October 16, 2013 WHICH IS BETTER; DAY 2 OR DAY 3 EMBRYO TRANSFER IN ANTAGONIST CYCLES? G. Sahin, A. Akdogan, N. Calimlioglu, T. Dogu, E. N. Tavmergen Goker, E. Tavmergen. Ege University IVF Center, Izmir, Turkey. OBJECTIVE: To investigate the embryo transfer day effect on pregnancy rates in GnRH antagonist cycles. DESIGN: Retrospective case control study. MATERIALS AND METHODS: Total of 1531 ICSI/embryo transfer cycles which have been performed at Ege University IVF Center between Jan 2010- December 2012 were evaluated. All cycles were performed with antagonist protocol. The study group consisted of those whose age <38, basal FSH level<12 mIU/ml, first two IVF attempts, rec FSH used and day 2 or 3 embryo transfer cycles. 735 embryo transfer cycles were analyzed. Student’s t test, c2 and multivariable logistic regression analysis was used as statistical method. p<0.05 was considered as significant. RESULTS: 249 cycles were day 2 and 486 were day 3 embryo transfers. The pregnancy rates were 31.7% vs. 40.3% for day 2 and day 3 transfers, p¼0.023. The mean age, distribution of infertility etiologies, basal FSH level, dosage of recFSH, peak E2, peak endometrial thickness and number of embryo transfers were similar between the groups. The mean number of oocytes and cleaved embryos were higher in day 3 embryo group. The total group was divided based on the number of cleaved embryos as follows; group I (n¼288) which had < 5 cleaved embryos and group II (n¼447) R5 cleaved embryos. In group I pregnancy rates were not different between day 2 and day 3 transfers, 31.5% vs 31.1%, p¼0.9. In contrast in group II the pregnancy rates were significantly higher for day 3 transfers than day 2 transfers, 44.9% vs. 32%, p¼0.013. The age, basal FSH level, number of oocytes and transferred embryos were similar between day 2 and day 3 transfers for both groups. The only differences were seen in the number of cleaved embryos. Day of embryo transfer (day 3 compared to day 2) was the independent predictor on the pregnancy rates in group II, OR: 1.7 (95% CI 1.1-2.6).
S287
CONCLUSION: In the antagonist cycles, day 3 embryo transfers have higher pregnancy chances than day 2 transfers, when have at least 5 cleaved embryos. P-482 Wednesday, October 16, 2013 OUTCOMES AND INCREMENTAL COSTS FOLLOWING 1, 2, OR 3+ EMBRYO TRANSFERS IN IN-VITRO FERTILIZATION PREGNANCIES: A VERMONT EXPERIENCE. O. J. Carpinello,a R. S. Raj,a P. R. Casson,a C. A. Jones.b aObstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, Vermont; b Global Health Economics Unit of the Vermont Center for Clinical and Translational Science and Department of Surgery, University of Vermont College of Medicine, Burlington, VT. OBJECTIVE: To determine the immediate financial impact of adverse pregnancy outcomes based on # of embryos transferred during IVF and calculate the incremental cost per baby gained. DESIGN: Retrospective cohort study utilizing the embryo transfer (ET) data following IVF, linked to an electronic delivery database at the same center. MATERIALS AND METHODS: Patients: 116 women conceived and delivered (152 babies) by IVF at the same academic medical center during the period 2007-2011. Main Outcome Measures: Gestational age at delivery, low birth weight (LBW) term births and cesarean section rates compared between single ET (SET) vs. double ET (DET) and triple or quadruple ET (T/QET). Associated costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per baby gained were calculated and adjusted for inflation through 2012. RESULTS: The highest prematurity and cesarean section rates were found in DET, while the lowest rates were found in SET. Premature singletons increased as the # of embryos transferred per cycle increased: 6.3% (SET), 9.1% (DET) and 10.0% (T/QET), as did cesarean sections for singleton births conceived from >1 transferred embryo: 26.7% (SET), 36.6% (DET), and 47.1% (T/QET). 3.9% of DET and 9.1% of T/QET were LBW at term. The relative risks were not statistically significant due to the small numbers in each cohort. The extrapolated costs per cohort were $639,279, $1,568,316 and $1,112,278 for SET, DET, T/QET, respectively. When calculated incrementally, each baby gained was estimated to cost an additional $23,226 for DET and $17,518 for T/QET. CONCLUSION: By attempting to assist with conception through multiple ET, hospitals and society accrue inordinate bills due to the associated adverse pregnancy outcomes that surround iatrogenic multiple births. Even singleton pregnancies resulting from multiple ET could be at a higher risk for adverse outcomes with consequent escalation in cost. The incremental costs per baby gained do not support multiple ET when repeat SET is an option. P-483 Wednesday, October 16, 2013 OPTIMIZATION OF THE EMBRYO TRANSFER IN IVF. K. Lattes,a M. Fors,b C. Brassesco,a R. Carreras,c M. A. Checa.c aCIRH, Clinica Corachan, Barcelona, Spain; bMaster Internacional en Medicina Reproductiva, Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain; c Departamento de Obstetricia y Ginecologıa, Hospital del Mar, Univarsidad Aut onoma de Barcelona, Barcelona, Spain. OBJECTIVE: Value the policy of embryo transfer along the last 12 years (9.932 fresh embryo transfers) trying to optimize the percentage of pregnancy associated to a diminution of the multiple pregnancies. DESIGN: Study of the percentage of all embryo transfer, as well as the pregnancy rate and the percentage of multiple pregnancies in 12 consecutive years. It was also evaluated the number of embryo reductions and their reason to be. MATERIALS AND METHODS: Since 2000, 11149 infertile couples underwent IVF treatment in our clinic. In this study 9932 cycles that perform fresh embryo transfer were included. Patients were classified into different groups according to the number of embryos transferred and their provenance (own eggs vs. donated eggs). The percentage of single, double and triple transfers per year was analyzed and so was its percentage of pregnancy, as well as the percentage of single, double and triple pregnancies. The same percentage was analyzed when the single and double embryo transfer was elective. Also the number of embryo reductions was analyzed and its percentage according to the number of embryos transferred (n¼22).
S288
ASRM Abstracts
RESULTS: Despite the drastic diminution the triple embryo transfers (2012: 7%) and the increase of single embryo transfers (2012: 25%) its observed a clear increase in pregnancy rates and a diminution of the multiple pregnancies over the years. Concerning to embryo reductions (22 between the 2001 and 2012) 6 of the 9 cases realized between the years 2008 and 2012 where done because two embryos where transferred and there was triple pregnancy (with monochorionic monoamniothic, that were reduced because of the risk of fetal-fetus transfusion). CONCLUSION: Thanks to the incorporation of new technologies, methodology improvement and qualified workers along these years, we have increased the pregnancy rate although the number of embryos transferred per cycle has been reduced progressively. Therefore, there is less risk of multiple pregnancy and so embryo reductions are less required. P-484 Wednesday, October 16, 2013 EFFECT OF BLASTOCYST STAGE AND GRADE ON SUCCESSFUL EMBRYO TRANSFER. C. Harrity,a D. Vaughan,a,b G. Emerson,a E. Mocanu.a aThe Hari Unit, Rotunda Hospital, Dublin, Ireland; bObstetrics and Gynaecology, Tufts Medical Center, Boston, MA. OBJECTIVE: Blastocyst stage embryo transfer has been made possible by advances in cell culture techniques. Potential advantages include better embryo-endometrium synchronicity and improved embryo selection, leading to higher implantation rates. The stage and grade of embryo are factors that may have a role in predicting the chances of successful embryo transfer. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Fresh cycle transfers of day 5 or 6 embryos between May 2008 and January 2013 were identified, and all single embryo transfers were selected for inclusion. Embryo stage and grade were recorded, and pregnancy outcome was identified. Data was analysed using the appropriate statistical test. RESULTS: A total of 1034 single balstocyst transfers were performed in the study period, 975 on day 5 and 59 on day 6, with pregnancy rates of 46.4% and 30.5% respectively (p¼0.003). The composition of embryo stage in the group was 15.7% early blastocyst (ErB), 34.4% blastocyst (B), 32.4% expanded blastocyst (ExB), 12.2% hatching blastocyst (HB), and 5.2% cavitating morula. Pregnancy rates per embryo transfer were as follows: ErB: 32.5%, B: 44.9%, ExB: 53.4%, HB 55.6%, CM: 16.7%. The odds ratio for a clinical pregnancy following embryo transfer with an expanded compared to early blastocyst is 2.40 (95% CI 1.62 3.55, p<0.0001). Trophectoderm grade also has a significant impact on success, with pregnancy rates 56.8% for grade A, 48.2% for grade B, and 28.6% for grade C. CONCLUSION: Blastocyst stage and grade have an important role in predicting the likelihood of a clinical pregnancy, and can provide useful information when counselling patients around the time of embryo transfer. P-485 Wednesday, October 16, 2013 SINGLE BLASTOCYST TRANSFER OF A MINIMUM GRADE CAN ACHIEVE COMPARABLE PREGNANCY RATES AS DUAL TRANSFER OF CLEAVAGE STAGE EMBRYOS WHILE SIGNIFICANTLY REDUCING THE MULTIPLE PREGNANCY RATE. B. J. Link, J. Fleetham, P. Przybylski, M. Sullivan, C. Greene, C. Lindsay. Regional Fertility Program Inc., Calgary, AB, Canada. OBJECTIVE: To determine the minimum blastocyst grade that will enable a Single Embryo Transfer (SET) to produce a comparable pregnancy rate as a Dual Embryo Transfer (DET) on Day 3 without the same risk of twins. DESIGN: A retrospective analysis of 1304 embryo transfers at the Regional Fertility Program (RFP) between 2009-2012 (922 DETs from 2009-2010, 382 SETs from 2011-2012). MATERIALS AND METHODS: Data was gathered from patients aged % 37 years and oocyte donor cycles were excluded. Blastocyst grades from the 2011-2012 SETs and respective pregnancy rates were compared in order to deduce a minimum grade to achieve acceptable results. The results from SETs of this grade were then compared to the 2009-2012 DETs with regards to pregnancy and twin rates. The DETs of two blastocysts that did not have the minimum grade were compared to these groups as well. Chi-square analysis was used to compare pregnancy and twin rates in all groups.
Vol. 100, No. 3, Supplement, September 2013
TABLE 1. Proportions of transfers according to synchrony markers
%30 years 31-34 years 35-40 years Transfers 419 436 Day 6 transfers (%) a 143 (34.1) 194 (44.5) Elevated P4 (%) a 96 (22.9) 110 (25.2) Asynchronous transfers (%) a 200 (47.7) 257 (58.9)
486 264 (54.3) 152 (31.3) 335 (68.9)
a¼Proportions differ significantly across age groups (P<0.05). CONCLUSION: Embryo-endometrium asynchrony in IVF cycles steadily worsens with age, corresponding with reduced live birth rates and contributing to inferior success rates in older patients.
FERTILITY & STERILITYÒ
P-480 Wednesday, October 16, 2013 MULTIPLE PREGNANCY RATE BASED ON HISTORY OF CLINICAL PREGNANCY. H. Kitasaka,a,b N. Fukunaga,a,b,c T. Yoshimura,a,b E. Kojima,a,b F. Tamura,a,b Y. Asada.a,b,c aLaboratory, Asada Ladies Nagoya Clinic, Nagoya, Aichi, Japan; bLaboratory, Asada Ladies Kachigawa Clinic, Nagoya, Aichi, Japan; cThe Asada Institute for Reproductive Medicine, Nagoya, Aichi, Japan. OBJECTIVE: Multiple pregnancy represents a serious problem in artificial reproductive technology (ART). While single embryo transfer is the most effective way to prevent multiple pregnancy in ART, two embryos are often transferred in patients with advanced age, in cases of repeated failure, and when the procedure is strongly requested by patients. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: This study examined 771 cycles (frozenthawed cycles) in which two embryos were transferred between January and December 2011. Patients were divided into two groups based on history of clinical pregnancy. Cases with two or more confirmed fetal sacs were deemed to represent multiple pregnancy. Conditions for two-embryo transfer were age R40 years or 33 embryo transfer cycles. RESULTS: Mean patient age was 38.9 4.1 years in patients with a history of clinical pregnancy (Group A; n ¼ 391) and 38.8 4.5 years in patients with no history of clinical pregnancy (Group B; n ¼ 380). Clinical pregnancy rates were 105/391 (26.9%) for Group A and 169/380 (18.2%) for Group B. Multiple pregnancy rates were 25/105 (23.8%) for Group A and 8/69 (11.6%) for Group B. Multiple birth rates were 14/25 (56.0%) for Group A and 5/8 (62.5%) for Group B. Group A showed significantly higher clinical pregnancy and multiple pregnancy rates (P < 0.05). In cases of confirmed multiple pregnancy, the percentage of transfer of two good-quality embryos was 21/25 (84.0%) in Group A and 7/8 (87.5%) in Group B. CONCLUSION: A history of clinical pregnancy indicates higher fertility, associated with increased pregnancy and multiple pregnancy rates. Deciding on a two-embryo transfer according to age, number of transfer attempts, and patient requests is inappropriate; the absence of a history of clinical pregnancy should also be considered. The patient should be apprised of the risks of multiple pregnancy with two-embryo transfer, even if she is of advanced age or has attempted transfer multiple times.
P-481 Wednesday, October 16, 2013 WHICH IS BETTER; DAY 2 OR DAY 3 EMBRYO TRANSFER IN ANTAGONIST CYCLES? G. Sahin, A. Akdogan, N. Calimlioglu, T. Dogu, E. N. Tavmergen Goker, E. Tavmergen. Ege University IVF Center, Izmir, Turkey. OBJECTIVE: To investigate the embryo transfer day effect on pregnancy rates in GnRH antagonist cycles. DESIGN: Retrospective case control study. MATERIALS AND METHODS: Total of 1531 ICSI/embryo transfer cycles which have been performed at Ege University IVF Center between Jan 2010- December 2012 were evaluated. All cycles were performed with antagonist protocol. The study group consisted of those whose age <38, basal FSH level<12 mIU/ml, first two IVF attempts, rec FSH used and day 2 or 3 embryo transfer cycles. 735 embryo transfer cycles were analyzed. Student’s t test, c2 and multivariable logistic regression analysis was used as statistical method. p<0.05 was considered as significant. RESULTS: 249 cycles were day 2 and 486 were day 3 embryo transfers. The pregnancy rates were 31.7% vs. 40.3% for day 2 and day 3 transfers, p¼0.023. The mean age, distribution of infertility etiologies, basal FSH level, dosage of recFSH, peak E2, peak endometrial thickness and number of embryo transfers were similar between the groups. The mean number of oocytes and cleaved embryos were higher in day 3 embryo group. The total group was divided based on the number of cleaved embryos as follows; group I (n¼288) which had < 5 cleaved embryos and group II (n¼447) R5 cleaved embryos. In group I pregnancy rates were not different between day 2 and day 3 transfers, 31.5% vs 31.1%, p¼0.9. In contrast in group II the pregnancy rates were significantly higher for day 3 transfers than day 2 transfers, 44.9% vs. 32%, p¼0.013. The age, basal FSH level, number of oocytes and transferred embryos were similar between day 2 and day 3 transfers for both groups. The only differences were seen in the number of cleaved embryos. Day of embryo transfer (day 3 compared to day 2) was the independent predictor on the pregnancy rates in group II, OR: 1.7 (95% CI 1.1-2.6).
S287
CONCLUSION: In the antagonist cycles, day 3 embryo transfers have higher pregnancy chances than day 2 transfers, when have at least 5 cleaved embryos. P-482 Wednesday, October 16, 2013 OUTCOMES AND INCREMENTAL COSTS FOLLOWING 1, 2, OR 3+ EMBRYO TRANSFERS IN IN-VITRO FERTILIZATION PREGNANCIES: A VERMONT EXPERIENCE. O. J. Carpinello,a R. S. Raj,a P. R. Casson,a C. A. Jones.b aObstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, Vermont; b Global Health Economics Unit of the Vermont Center for Clinical and Translational Science and Department of Surgery, University of Vermont College of Medicine, Burlington, VT. OBJECTIVE: To determine the immediate financial impact of adverse pregnancy outcomes based on # of embryos transferred during IVF and calculate the incremental cost per baby gained. DESIGN: Retrospective cohort study utilizing the embryo transfer (ET) data following IVF, linked to an electronic delivery database at the same center. MATERIALS AND METHODS: Patients: 116 women conceived and delivered (152 babies) by IVF at the same academic medical center during the period 2007-2011. Main Outcome Measures: Gestational age at delivery, low birth weight (LBW) term births and cesarean section rates compared between single ET (SET) vs. double ET (DET) and triple or quadruple ET (T/QET). Associated costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per baby gained were calculated and adjusted for inflation through 2012. RESULTS: The highest prematurity and cesarean section rates were found in DET, while the lowest rates were found in SET. Premature singletons increased as the # of embryos transferred per cycle increased: 6.3% (SET), 9.1% (DET) and 10.0% (T/QET), as did cesarean sections for singleton births conceived from >1 transferred embryo: 26.7% (SET), 36.6% (DET), and 47.1% (T/QET). 3.9% of DET and 9.1% of T/QET were LBW at term. The relative risks were not statistically significant due to the small numbers in each cohort. The extrapolated costs per cohort were $639,279, $1,568,316 and $1,112,278 for SET, DET, T/QET, respectively. When calculated incrementally, each baby gained was estimated to cost an additional $23,226 for DET and $17,518 for T/QET. CONCLUSION: By attempting to assist with conception through multiple ET, hospitals and society accrue inordinate bills due to the associated adverse pregnancy outcomes that surround iatrogenic multiple births. Even singleton pregnancies resulting from multiple ET could be at a higher risk for adverse outcomes with consequent escalation in cost. The incremental costs per baby gained do not support multiple ET when repeat SET is an option. P-483 Wednesday, October 16, 2013 OPTIMIZATION OF THE EMBRYO TRANSFER IN IVF. K. Lattes,a M. Fors,b C. Brassesco,a R. Carreras,c M. A. Checa.c aCIRH, Clinica Corachan, Barcelona, Spain; bMaster Internacional en Medicina Reproductiva, Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain; c Departamento de Obstetricia y Ginecologıa, Hospital del Mar, Univarsidad Aut onoma de Barcelona, Barcelona, Spain. OBJECTIVE: Value the policy of embryo transfer along the last 12 years (9.932 fresh embryo transfers) trying to optimize the percentage of pregnancy associated to a diminution of the multiple pregnancies. DESIGN: Study of the percentage of all embryo transfer, as well as the pregnancy rate and the percentage of multiple pregnancies in 12 consecutive years. It was also evaluated the number of embryo reductions and their reason to be. MATERIALS AND METHODS: Since 2000, 11149 infertile couples underwent IVF treatment in our clinic. In this study 9932 cycles that perform fresh embryo transfer were included. Patients were classified into different groups according to the number of embryos transferred and their provenance (own eggs vs. donated eggs). The percentage of single, double and triple transfers per year was analyzed and so was its percentage of pregnancy, as well as the percentage of single, double and triple pregnancies. The same percentage was analyzed when the single and double embryo transfer was elective. Also the number of embryo reductions was analyzed and its percentage according to the number of embryos transferred (n¼22).
S288
ASRM Abstracts
RESULTS: Despite the drastic diminution the triple embryo transfers (2012: 7%) and the increase of single embryo transfers (2012: 25%) its observed a clear increase in pregnancy rates and a diminution of the multiple pregnancies over the years. Concerning to embryo reductions (22 between the 2001 and 2012) 6 of the 9 cases realized between the years 2008 and 2012 where done because two embryos where transferred and there was triple pregnancy (with monochorionic monoamniothic, that were reduced because of the risk of fetal-fetus transfusion). CONCLUSION: Thanks to the incorporation of new technologies, methodology improvement and qualified workers along these years, we have increased the pregnancy rate although the number of embryos transferred per cycle has been reduced progressively. Therefore, there is less risk of multiple pregnancy and so embryo reductions are less required. P-484 Wednesday, October 16, 2013 EFFECT OF BLASTOCYST STAGE AND GRADE ON SUCCESSFUL EMBRYO TRANSFER. C. Harrity,a D. Vaughan,a,b G. Emerson,a E. Mocanu.a aThe Hari Unit, Rotunda Hospital, Dublin, Ireland; bObstetrics and Gynaecology, Tufts Medical Center, Boston, MA. OBJECTIVE: Blastocyst stage embryo transfer has been made possible by advances in cell culture techniques. Potential advantages include better embryo-endometrium synchronicity and improved embryo selection, leading to higher implantation rates. The stage and grade of embryo are factors that may have a role in predicting the chances of successful embryo transfer. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Fresh cycle transfers of day 5 or 6 embryos between May 2008 and January 2013 were identified, and all single embryo transfers were selected for inclusion. Embryo stage and grade were recorded, and pregnancy outcome was identified. Data was analysed using the appropriate statistical test. RESULTS: A total of 1034 single balstocyst transfers were performed in the study period, 975 on day 5 and 59 on day 6, with pregnancy rates of 46.4% and 30.5% respectively (p¼0.003). The composition of embryo stage in the group was 15.7% early blastocyst (ErB), 34.4% blastocyst (B), 32.4% expanded blastocyst (ExB), 12.2% hatching blastocyst (HB), and 5.2% cavitating morula. Pregnancy rates per embryo transfer were as follows: ErB: 32.5%, B: 44.9%, ExB: 53.4%, HB 55.6%, CM: 16.7%. The odds ratio for a clinical pregnancy following embryo transfer with an expanded compared to early blastocyst is 2.40 (95% CI 1.62 3.55, p<0.0001). Trophectoderm grade also has a significant impact on success, with pregnancy rates 56.8% for grade A, 48.2% for grade B, and 28.6% for grade C. CONCLUSION: Blastocyst stage and grade have an important role in predicting the likelihood of a clinical pregnancy, and can provide useful information when counselling patients around the time of embryo transfer. P-485 Wednesday, October 16, 2013 SINGLE BLASTOCYST TRANSFER OF A MINIMUM GRADE CAN ACHIEVE COMPARABLE PREGNANCY RATES AS DUAL TRANSFER OF CLEAVAGE STAGE EMBRYOS WHILE SIGNIFICANTLY REDUCING THE MULTIPLE PREGNANCY RATE. B. J. Link, J. Fleetham, P. Przybylski, M. Sullivan, C. Greene, C. Lindsay. Regional Fertility Program Inc., Calgary, AB, Canada. OBJECTIVE: To determine the minimum blastocyst grade that will enable a Single Embryo Transfer (SET) to produce a comparable pregnancy rate as a Dual Embryo Transfer (DET) on Day 3 without the same risk of twins. DESIGN: A retrospective analysis of 1304 embryo transfers at the Regional Fertility Program (RFP) between 2009-2012 (922 DETs from 2009-2010, 382 SETs from 2011-2012). MATERIALS AND METHODS: Data was gathered from patients aged % 37 years and oocyte donor cycles were excluded. Blastocyst grades from the 2011-2012 SETs and respective pregnancy rates were compared in order to deduce a minimum grade to achieve acceptable results. The results from SETs of this grade were then compared to the 2009-2012 DETs with regards to pregnancy and twin rates. The DETs of two blastocysts that did not have the minimum grade were compared to these groups as well. Chi-square analysis was used to compare pregnancy and twin rates in all groups.
Vol. 100, No. 3, Supplement, September 2013