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j.fertnstert.2017.07.1006

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Supported by: The Center for Human Reproduction and The Foundation
for Reproductive Medicine.
P-618 Wednesday, November 1, 2017
ELECTIVE SINGLE BLASTOCYST TRANSFER (ESBT)
IN WOMEN OF ADVANCED MATERNAL AGE (AMA,
OVER 39 YEARS) - A VIABLE OPTION?. J. Hasson,a
S. Behbehani,b
T. Shavit,a
W. Son,c
T. Tulandi,d
W. Buckett.a aMcGill University, Montreal, QC, Canada; bObstetrics and gynecology, McGill University, montreal, QC, Canada; cMcGill University,
Monteral, QC, Canada; dObstetrics and Gynecology, McGill University,
Montreal, QC, Canada.
OBJECTIVE: Most studies evaluating the efficacy of single embryo transfer (SET) compared its outcome with that of multiple embryo transfer
(MET). Further, data on the efficacy of SET in AMA is scarce and conclusions are mostly based on transfer of cleavage stage embryos or embryos
that underwent preimplantation genetic screening (PGS). We aimed to evaluate the efficacy of eSBT in patients of AMA and compare its results with
obligatory SBT (oSBT) in the same age group.
DESIGN: A prospective cohort study performed at a single academic center between January 2012 and June 2015.
MATERIALS AND METHODS: All cycles (331) with transfer of an
autologous fresh single blastocyst of good quality (Gardner’s grade R
3bb) in women of AMA (39-43 years old) were included. Cycles with transfer of fair/poor quality blastocysts, MET cycles, cycles using donor oocytes,
vitrified-warmed embryo transfers or cleavage-stage embryo transfers were
excluded. Embryos were not tested for aneuploidy by PGS before transfer.
Following provincial guidelines and clinic policy, SET is mandatory.
Accordingly, excess blastocysts of adequate quality were vitrified on day
5 or 6.
RESULTS: In 216 (65%) fresh SBT cycles, eSBT was performed with
vitrification of surplus blastocysts (mean vitrified blastocysts 2.31.5). In
115 (35%) fresh SBT cycles, no excess blastocysts were available for
vitrification and obligatory SBT was performed (oSBT). Patients’ demographic parameters were comparable (age, BMI, gravidity, infertility
duration, basal FSH and AFC). Clinical pregnancy rate per transfer
(defined as intra-uterine fetal heart activity) was significantly higher in
eSBT compared to oSBT (40% vs 21%, p<0.001; RR 2.35, 95% CI
1.4-4.2). Live birth rate tended to be higher in eSBT (25.5% vs 16.2%,
p¼0.05). Multivariate logistic regression analysis revealed that age and
the presence of surplus blastocysts were the only significant variables
associated with clinical pregnancy after adjusting for BMI, AFC, total gonadotropins dose and stimulation days, peak estradiol level, endometrial
thickness, number of oocytes and infertility duration (adjusted RR 2.8,
95% CI 1.1-7.4 for surplus blastocysts and RR 0.5, 95% CI 0.3-0.8 for
age). The number of surplus vitrified blastocysts was also significantly
associated with higher clinical pregnancy rate. There were no multiple
pregnancies in the study groups.
CONCLUSIONS: Elective SBT is a viable option in AMA. The presence
and number of surplus blastocysts may serve as prognostic factors and aid
physicians with the decision to transfer a single embryo. This paradigm
may reduce multiple pregnancies and increase cumulative pregnancy rate
by using the vitrified blastocysts in future cycles.
P-619 Wednesday, November 1, 2017
CUMULATIVE LIVE-BIRTH RATE WITH REPEAT IN
VITRO FERTILIZATION TREATMENT CYCLES OF
CHINESE ADVANCED AGE WOMEN. F. Gu, S. Ruan,
Y. Xu, C. Zhou. Center for Reproductive Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
OBJECTIVE: With introduction of the universal two-child policy in
China, increasing number of advanced age women seek helps from reproductive medical centers.However,most of them have to receive repeat treatments
to achieve pregnancy because of low live-birth rate(LBR) in single cycle. The
aim of the study is to determine the extent to which repeat cycles continue to
increase the likelihood of a live-birth in advanced age women. China needs
their own data to estimate the effectiveness of ART treatment and guide clinical decision-making.
DESIGN: Prospective study.
MATERIALS AND METHODS: We linked data from the database of
Reproductive Centre of the First Affiliated Hospital of Sun Yet-sen Univer-
FERTILITY & STERILITYÒ
sity. Female agedR35 years old and had their first IVF/ICSI cycle between
2009 to 2015 were included and followed until Dec 2016. A cycle is
defined as an episode of ovarian stimulation and all subsequent fresh and
frozen embryo transfers. LBR per cycle and cumulative live-birth
rates(CLBR) across all cycles in each age subgroup were analyzed. Opitmal and conservative CLBR were estimated assuming that women who discontinued IVF treatments would have live-birth rate similar to those
continuing treatments(opitmal) or would have a live-birth rate of zero(conservative).
RESULTS: A total of 3486 patients who received 5050 ovarian stimulation cycles were enrolled. In all women the LBR for the first cycle was
32.1% (95%CI:30.6, 33.7). The CLBR continued to increase up to the
fourth, with 48.5%(47.2,49.9)of women achieving a live birth by the fourth
cycle. For women aged 35-37, the LBR for the first cycle was41.0% ((95%
CI:38.8, 43.2), which continued to increase up to the fourth achieving an
optimal and conservative estimated CLBR of 71.1% (68.1, 74.2) and
52.1%(50.1,54.1).For women age 38-39,the first cycle LBR dropped to
29.6(95%CI:26.4,32.8), with four cycles achieving an optimal and conservative estimated CLBR of 54.6% (51.6,57.6) and 39.0%(36.1, 41.9).LBR in
age 40-42 subgroup further declined to 16.0% (95%CI:13.1, 19.0) in the
first cycle. Four cycles achieved CLBR of 34.7% (32.1, 37.2) and 23.8%
(21.1, 26.5) respectively. For women older than 42 years old, all rates
within each cycle were less than 4% and there was no upward trend in
consecutive cycles.
CONCLUSIONS: The CLBR after four cycles were 48.5% in
advanced age women, with significant variations by age. Women
younger than 42 years old would achieve increasing LBR after repeated
treatments beyond three to four cycles. However,the prognosis for
women older than 42 is disappointing despite of repeated attempts.
Data of our research can be used as reference for ART counseling of
Chinese advanced age women.
P-620 Wednesday, November 1, 2017
IMPACT OF TRIGGER MEDICATION ON ANEUPLOIDY RATES. J. Thorne, L. A. Kaye, A. Bartolucci,
C. A. Benadiva, J. Nulsen, L. Engmann. Dept. of Reproductive
Endocrinology & Infertility, University of Connecticut Health
Center, Farmington, CT.
OBJECTIVE: It is unknown whether trigger medication affects chromosomal integrity. We compared aneuploidy rates in in vitro fertilization
(IVF) cycles utilizing preimplantation genetic screening (PGS) and triggered
with either human chorionic gonadotropin (hCG) or gonadotropin-releasing
hormone agonist (GnRHa).
DESIGN: Retrospective cohort study.
MATERIALS AND METHODS: 272 cycles performed at a large university-based center during a four-year period were evaluated. IVF cycles with planned PGS and triggered with either hCG (n¼177) or
GnRHa (n¼95) were included for analysis. PGS was performed by
either array Comparative Genomic Hybridization or Next-Generation
Sequencing. PGS results were reported as euploid, aneuploid or
mosaic, and embryos with no diagnosis were excluded. The primary
outcome was rate of aneuploid embryos. Secondary outcomes included
rate of euploidy and mosaicism. Patients were further stratified by age.
Student’s t-test and Mann-Whitney test were used to assess continuous
variables. Chi-square was used to assess categorical variables. Multivariate linear regression was performed to control for potential confounding variables. A p-value <0.05 was considered statistically
significant.
RESULTS: Utilization of PGS platforms was similar between groups.
There were significant differences in age (38.73.6 vs. 35.24.7),
AMH level (1.91.5 vs. 4.94.5), previous IVF cycles (1.51.4 vs.
0.61.2), total FSH dose (3594.51456 vs. 2245.9865), total hMG
dose (1351962 vs. 545650), peak serum estradiol level (21471004
vs. 29171207), and oocytes retrieved (11.86.6 vs. 19.910.0) between
hCG and GnRHa trigger, respectively. Aneuploidy rates were higher in
the hCG group compared to the GnRHa group (53.8% vs. 41.9%,
p<0.01), however this difference was no longer significant when
controlled for the above putative factors using multivariate linear regression analysis (p¼0.19). Moreover, there was no difference in aneuploidy
rates when we excluded patients over 40 (42.7% vs. 34.6%, p¼0.06) and
stratified by age (Table). Rates of mosaicism did not differ among all patients (14.7% vs. 20.5%, p¼0.07).
CONCLUSIONS: No difference was appreciated in aneuploidy rates between cycles triggered with either hCG or GnRHa.
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