P-267 Tuesday, October 18, 2016
MATERIALS AND METHODS: Data analysis of ongoing pregnancy and
PREGNANCY OUTCOMES OF SINGLE VERSUS DOUBLE EM-
BRYO TRANSFER IN WOMEN WITH A CONGENITAL UNICORN-
UATE UTERUS. X. Li,a Y. Ouyang,b Y. Yi.b aReproductive and Genetic
Hospital of CITIC-Xiangya, Chang-sha, China; bInstitute of Reproductive &
Stem Cell Engineering, Central South University, Changsha, China.
OBJECTIVE: To investigate the effects of single embryo transfer (ET) and
double ET on pregnancy outcomes in women with a unicornuate uterus.
DESIGN: Retrospective analysis.
MATERIALS AND METHODS: The pregnancy outcomes of 300 infer-
tility patients with a unicornuate uterus and got clinical pregnancy via in vitro
fertilization (IVF)-ET from January 2012 to May 2015 were analyzed. The
rates of embryo implantation, live birth, transfer cycle pregnancy, clinical
pregnancy and multiple pregnancy were compared between single and dou-
ble ET using chi-squared test; comparisons of pregnancy outcomes were
made between singleton pregnancy via single ET (A group) and via double
ET (B group), and between singleton pregnancy of A group and twin preg-
nancy via double ET (C group) using two-sample t-test, chi-squared test or
fisher exact test.
RESULTS: There were a total of 377 transfer cycles in the 300 cases,
including 53 single ET cycles which obtained 23 cases of singleton pregnancy
and 324 double ET cycles which obtained 126 cases of singleton pregnancy,
74 cases of twin pregnancy and 3 cases of triple pregnancy. 35 cases of spon-
taneous/selective reduction were excluded from analysis. Comparison of the
IVF treatment outcomes based on single or double ET, the rates of transfer
cycle pregnancy (43.4%(23/53) vs. 62.7%(203/324), p¼0.008), clinical preg-
nancy (46.8%(22/47) vs. 76.7%(194/253), p<0.001) and multiple pregnancy
in single ET were all significantly lower. While the rates of embryo transplan-
tation (43.4%(23 /53) vs. 43.1%(279/648), p¼0.962) and live birth
(37.7%(20/53) vs. 48.4%(157/324), p¼0.147) had no significant differences.
There were no significant difference in pregnancy outcomes between A and B
group (p¼0.741). When comparing the pregnancy outcomes of A and C
group, the differences were significantly different (P¼0.002): the rates of
early pregnancy loss (8.7%(2/23) vs. 14.3%(6/42)), late miscarriage
(4.3%(1/23) vs. 16.7%(7/42), and preterm delivery (13.0%(3/23) vs.
42.9%(18/42) in A group were all lower; in addition, the gestational weeks
at delivery (38.11.9 vs. 35.22.9; p<0.001) and birth weight (3.10.5vs.
2.20.6, kg; p<0.001) in A group were both significantly higher. Although
the rates of term low birth weight infant (0 (0/17) vs. 18.2%(4/22);
p¼0.118) and perinatal mortality (0 (0/20) vs. 10.7%(6/56); p¼0.331) were
both lower in A than C group but didn’t reach significant level (Table).
CONCLUSIONS: Single ET could obtain similar rates of embryo implan-
tation and live birth as double ET. Singleton pregnancy via single ET can not
only gain better pregnancy outcomes than twin pregnancy via double ET, but
also reduce the risk of multiple pregnancy. Therefore, single ET is recommen-
ded in women with a unicornuate uterus during IVF-ET.
P-268 Tuesday, October 18, 2016
ELECTIVE SINGLE EMBRYO TRANSFER CRITERIA SHOULD
BE APPLIED TO FROZEN EMBRYO TRANSFER CYCLES.
M. R. Freeman,a M. Hinds,a K. G. Howard,a J. Howard,a G. Hill.b aOvation
Fertility, Nashville, TN; bNashville Fertility Center, Nashville, TN.
OBJECTIVE: To evaluate the outcomes for eSET (elective single embryo
transfer) and eDET (elective double embryo transfer) in frozen embryo trans-
fer cycles.
eSET vs. eDET in FET cycles
# Embryos
Patient Group transferred # Transfers
PGS Patients 1 76
2 42
Non-PGS Patients 1 79
2 194
Negative, biochemical, or 1 20
miscarriage in fresh cycle
2 129
Pregnant & delivered in fresh cycle 1 41
2 38
Fisher’s Exact Test: 1P¼0.176 2P¼0.0001 3P¼ 0.75 4P¼0.225 5P¼0.0001 6P¼ 0.034 7P¼1.0 8P¼0.056 9P¼ 0.24 10P¼0.65 11P¼0.022 12P¼0.124
FERTILITY & STERILITYÒ
DESIGN: Retrospective study.
live birth rates, multiple pregnancy rates, and implantation rates (+fetal heart
motion/# embryos transferred) of patients who qualified for eSET (<35 years
old at the time of cryopreservation; > 1 cryopreserved blastocyst in storage)
and who self-elected either eSET or eDET in 391 frozen embryo transfer
(FET) cycles occurring between 2011 and 2015. FET outcomes were evalu-
ated according to the patients’ election to have preimplantation genetic
screening (PGS) or not (PGS patient; non-PGS patient) or fresh cycle
outcome (negative outcome; pregnant and delivered in fresh cycle). Propor-
tion data were analyzed using Fisher’s exact test; P< 0.05 was considered to
be statistically significant.
RESULTS: There were no statistically significant differences observed in
ongoing pregnancy and live birth rates in FET for eSET vs. eDET in any of the
patient groups evaluated. Multiple pregnancy rates were significantly decreased
in all eSET groups (0 - 5%), compared to eDET groups (30 - 44%). Implantation
rates were significantly higher for eSET vs. eDET in non-PGS patients (53%
vs. 40%), but failed to reach a significant difference in the other groups.
CONCLUSIONS: Similar ongoing pregnancy and live birth rates can be
maintained while reducing the occurrence of multiple gestations with eSET
compared to eDET in FET cycles. This is important since fewer fresh embryo
transfers are being done due to the increase in PGS and IVF cycle manage-
ment. If two or more cryopreserved blastocysts are available, eSET in FET
cycles will provide additional future FET attempts while decreasing multiple
pregnancy complications and fetal loss. Furthermore, eSET represents a sig-
nificant potential cost savings since current estimates for delivery of twins is
five times, and triplets is 20 times the cost of delivery of a singleton1.
References:
1. Lemos EV, Zhang D, Van Voorhis BJ, Hu H. Healthcare expenses asso-
ciated with multiple pregnancies versus singletons in the United States.
Am J Obstet Gynecol 2013;209(6):586.
P-269 Tuesday, October 18, 2016
STRATEGIC IMPLEMENTATION OF EXTENDED CULTURE
RESULTS IN DIFFERENT CLINICAL OUTCOMES COMPARED
TO ROUTINE BLASTOCYST CULTURE IN DONOR CYCLES.
V. Libby,a S. Babayev,a B. G. Reed,a K. Doody.b aUT Southwestern Medical
Center, Dallas, TX; bCenter for Assisted Reproduction, Bedford, TX.
OBJECTIVE: This study aims to compare laboratory and clinical out-
comes in donor cycles between clinics that use an algorithm to determine
whether cleavage embryos versus blastocyst stage embryos will be used
versus clinics that do all blastocyst transfers.
DESIGN: Retrospective Cohort Study
MATERIALS AND METHODS: All fresh and frozen donor embryo
transfers in the SART database from 2004 to 2013 were reviewed. Years
were separately analyzed for each clinic. Clinics were grouped according
to the percentage of blastocyst transfers with greater than or equal to 95%
termed ‘‘Day 5’’ clinics and those with <95% as algorithm-based clinics.
392,080 patients from 444 clinics in 3230 distinct clinic-years were re-
viewed. Of Day 5 clinics, 2,446 patients underwent fresh and 1,478 under-
went frozen donor embryo transfers from 298 distinct clinic-years. Among
algorithm-based clinics, 45,296 patients underwent fresh and 22,592 under-
went frozen embryo transfers from 5,080 clinic-years. Patient and cycle char-
acteristics and birth outcomes were included in the analysis. The main
outcome measures were pregnancy, live birth, multiple gestation, birth
weight, neonatal death, and gender rates.
Ongoing/ Implantation
delivered (%) Singleton Multiple (%) Rate (%)
38 (50) 37 1 (3) 39/76 (51)3
27 (64) 16 12 (44) 40/84 (48)3
41 (52)4 40 1 (2)5 42/79 (53)6
117 (60)4 79 38 (32)5 155/388 (40)6
10 (50)7 10 08 10/20 (50)9
73 (57)7 51 22 (30)8 95/258 (37)9
22 (54)10 21 1 (5)11 23/41 (54)12
23 (61)10 15 8 (35)11 31/76 (41)12
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