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NURSING
P-115 Tuesday, October 9, 2018 6:30 AM
A COMBINATION PROTOCOL OF VITAMIN D, PRED-
NISONE, ASPIRIN, AND VITAMIN B-FOLATE COM-
PLEX IMPROVES ONGOING PREGNANCY RATES IN
PATEINTS WITH RECURRENT PREGNANCY LOSS
OR MULTIPLE FAILED EUPLOID SINGLE EMBRYO TRANSFER
CYCLES. C. Pratt,
a
I. Levin,
a
K. Bergin,
b
L. Nargi,
a
J. B. Davis.
aa
Re-
productive Medicine Associates of New York, New York, NY;
b
Albany Med-
ical Center, Albany, NY.
OBJECTIVE: While preimplantation genetic testing (PGT) is increasingly
being utilized to identify euploid embryos and to improve the likelihood of
successful outcomes, many patients still experience recurrent pregnancy
loss (RPL) and/or repeated implantation failure (RIF). Patients who experi-
ence RPL and/or RIF must cope with physical and emotional distress. Repro-
ductive immunologists often utilize combination medication therapies to
treat patients with RPL and RIF, however, these protocols often are not
well supported by evidence-based research. This study evaluated the clinical
outcomes for RIF and RPL patients who were treated with a specific combi-
nation protocol.
DESIGN: Retrospective, cohort study.
MATERIALS AND METHODS: The study included patients who under-
went single, euploid frozen embryo transfers (FET) with the combination
medication therapy from 2014 - 2018. The combination medication protocol
includes: Vitamin D, Prednisone, Aspirin and a Vitamin-B12/Vitamin B6/
Folate (CBF) complex. Patients with a history of R2 failed euploid, single
embryo transfers (SET), R3 clinical spontaneous abortions (SAB), or a
combination of 2 SABs and 1 failed SET were included in the analysis.
Only patients who utilized autologous oocytes were included.
RESULTS: A total of 54 IVF-FET cycles meeting criteria were included.
Patient average age was 35.74 years old (range: 24 - 44). Upon review of the
cycle outcomes, a total of 79.62% (n¼43/54) achieved positive clinical preg-
nancy rates. Of those who attained a positive clinical pregnancy, 72.09%
(n¼31/43) reached at least 8 weeks gestation. Of those who passed the 8-
week gestation period, 74.19% (23/31) reached their estimated date of deliv-
ery and 91.30% of those (n¼21/23) achieved live birth. A total of 14.81%
(n¼8/54) cycles resulted in clinical pregnancy loss and 7.41% (n¼4/54) re-
sulted in biochemical pregnancy loss. Finally, 20.38% (n¼11/54) cycles re-
sulted in negative pregnancy tests.
CONCLUSIONS: While the etiology of RPL and RIF are not well under-
stood, our study sought to identify an affordable and minimally invasive
alternative treatment regimen. Due to the high levels of anxiety and distress
associated with failed euploid embryo transfer cycles and spontaneous abor-
tions, we sought to develop a new viable treatment strategy. Although the
study was limited by sample size and design, the results were encouraging
and future randomized control trials should be done to provide further sup-
port for this combination-medication treatment protocol.
P-116 Tuesday, October 9, 2018 6:30 AM
PRE-IMPLANTATION GENETIC SCREENING (PGS) IN
DONOR OOCYTE IVF CYCLES: A PRACTICE
SURVEY. K. R. Hammond,
a
C. A. Long,
a
N. A. Cataldo.
b
a
America Institute of Reproductive Medicine, Birmingham,
AL;
b
UAB School of Public Health, Birmingham, AL.
OBJECTIVE: To survey the practices and recommendations regarding
pre-implantation genetic screening (PGS) among oocyte donation IVF pro-
grams.
DESIGN: Voluntary one-page questionnaire survey.
MATERIALS AND METHODS: At an April, 2018, US third-party repro-
duction conference, professional attendees were offered a 1-page question-
naire on the practice recommendations for PGS, the reasons recipients
choose PGS in their program, and the role of embryo sex (selection) in
deciding for PGS. Descriptive and comparative statistical analyses were per-
formed.
RESULTS: US respondents offering PGS were nurses (79%), physicians
(11%), and other/not stated (10%) from 71 practices offering oocyte-donor
(OD) IVF. There was a broad geographic distribution (26 states). Only one
program responding did not offer PGS and was excluded from further anal-
ysis. In 2017, respondents performed 4-900 OD-IVF cycles [median 55, in-
terquartile range (IQR) 36-146]. PGS was generally recommended by 31% of
these programs. The primary reason endorsed by programs as to why recip-
ients choose to have PGS performed was to achieve a higher pregnancy rate
(61%), followed by elective sex selection (25%) and avoidance of transmit-
ting X-linked traits (8%). Recurrent pregnancy loss was the primary reason
PGS was chosen in 3% of programs. A recommendation for PGS was nega-
tively associated with endorsing elective sex selection as the primary reason
for PGS (p¼0.05). Disclosure of embryo sex was according to patient pref-
erence in 73% of programs; on the other hand, 23% stated that their program
routinely disclosed embryo sex, while 4% routinely did not. PGS performed
for elective sex selection was offered by 43% of programs responding.
Neither practice pattern of embryo sex disclosure nor offering PGS solely
for sex selection was associated with a general practice recommendation
for PGS. Only 36% of programs ever preferentially choose an embryo based
on its sex, rather than its quality; this policy was concordant with offering
PGS solely for sex selection (p¼0.0003). Recipients are afforded the oppor-
tunity to choose the sex of the embryo(s) being replaced in 74% of practices
responding.
CONCLUSIONS: In 2017, the vast majority of US programs surveyed
offer PGS as an option for patients undergoing donor oocyte IVF, although
the majority did not recommend its general use. While disclosure of embryo
sex was responsive to recipient desires, the majority of programs did not offer
PGS solely for sex selection or choose an embryo preferentially based on its
sex.
P-117 Tuesday, October 9, 2018 6:30 AM
IMPACT OF VITRIFIED EGG BANKING ON DONOR
OOCYTE SOURCE: IS RECRUITMENT BY PRAC-
TICES A DYING ART? K. R. Hammond,
a
C. A. Long,
a
N. Cataldo.
ba
America Institute of Reproductive Medicine, Bir-
mingham, AL;
b
Epidemiology, UAB School of Public Heath, Birmingham,
AL.
OBJECTIVE: To survey the source(s) of donor oocytes currently used by
US programs, and the impact of oocyte vitrification (VIT) and commercial
egg banks (CEB) on in-house donor recruitment.
DESIGN: Voluntary one-page questionnaire survey.
MATERIALS AND METHODS: At an April, 2018, US third-party repro-
duction conference, professional attendees were offered a 1-page question-
naire on the source(s) of donor oocytes their program uses, availability of
onsite VIT, actual or planned discontinuation of onsite recruitment, and
perceived benefits of using CEB oocytes. Data were analyzed using descrip-
tive and comparative statistics.
RESULTS: US respondents were from 72 practices offering oocyte-donor
(OD) IVF with broad geographic distribution (27 states). They were nurses
(79%), physicians (11%), and other/not stated (10%). In 2017, they per-
formed 4 to 900 OD-IVF cycles [median 55, interquartile range (IQR) 36-
146].
Fresh oocytes were used in 60% of cycles (median; IQR 12-90%); 14% of
programs never use fresh oocytes. VIT-warmed eggs were used in 30% of cy-
cles (median; IQR 5-75%); 14% never used warmed oocytes. Embryos
created by another facility were used by 24% of programs reporting, for a
mean of only 1% of their cycles.
Use of in-house donor recruitment showed bimodal frequency; only 11%
of programs recruited all, and only 17% none, of their donors. The proportion
of in-house recruited donors was not related to practice volume. Agency-
found donors (AD) were used by 51% of programs in under 5% of their cy-
cles; only 13% used AD in 90% or more of their cycles. The proportion of
cycles using AD was also not related to practice volume. Oocyte VIT is per-
formed by 40% of practices for their own later use. CEB were used never by
23% of practices and in 80% or more of cycles by 14%. The proportion of
cycles using a CEB was not related to practice volume. No practice has
stopped in-house recruiting in favor of CEB use, and only 3% plan to stop
in the next year. Practices offering use of a CEB utilize one (44%), two
(24%) or three or more banks (24%).
Respondents’ preferred egg sources were from their own recruitment
(38%), a bank (19%), or no preference (36%). When asked who benenfits
most from using a CEB, 52% cited the CEB, 43% the recipient, 10% the
donor, and 10% the coordinator (12% multiple responses). While no associ-
ation was found between preferring EB-sourced eggs and belief that banks,
not donors, recipients, or coordinators, benefit the most from CEB use, a
trend was found suggesting an association between preferring recruited-
donor-sourced eggs and the belief that banks benefit the most from CEB
use (p¼0.13).
FERTILITY & STERILITY
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