O-72 Monday, October 25, 2010 05:15 PM
Among the minor malformations, an increased of
A COMPARISON OF IVF TRIPLETS; ELECTIVELY VS. SPONTA-
NEOUSLY REDUCED TO TWIN GESTATIONS. B. Ata, S. L. Tan,
L. J. Rasillo, S. Sukhdeo, W. Y. Son, M. H. Dahan. McGill Reproductive Cen-
tre, Dept. of Obstetrics and Gynecology, McGill University, Montreal, QC,
Canada; Instituto Medica Fertil, San Luis Potosi, Mexico.
OBJECTIVE: To assess the obstetric outcome of IVF triplets.
DESIGN: Retrospective cohort study.
MATERIALS AND METHODS: 76 out of 80 IVF triplet pregnancies con-
ceived at McGill University between 1997 and 2009 who had complete fol-
low up data were included. Outcomes of pregnancies continued as triplets
(TR), electively reduced to twins (ER), and spontaneously reduced to twins
(SR) were analyzed and compared to IVF twin pregnancies (TW) using AN-
OVA & Chi square tests.
RESULTS: Mean female ages were similar for (33.6  4.7, 35.0  4.0,
33.8  3.1, and 33.9  4.3 years, p ¼ 0.35). Mean gestational age at delivery
was similar for ER, SR and TW groups, 34.5, 34.3, 35.5 weeks, respectively
(p ¼ 0.35), while TR were delivered earlier, 28.9  7 weeks (p <0.01).De-
liveries %31 wks, 32-36 wks and R37 wks gestational ages (GA) are pre-
sented in the Table.
Gestational age at delivery
Triplets Triplets
electively reduced spontaneously
GROUP Triplets to twins reduced to twins Twins
LIVE BIRTH 22 (57.9) 3 (13.0) 3 (20.0) 60 (12.3)
%31 weeks (%)
LIVE BIRTH 16 (42.1) 9 (39.1) 6 (40.0) 167 (34.1)
32 – 36 weeks (%)
LIVE BIRTH 0 (0) 11 (47.8) 6 (40.0) 263 (53.7)
R37 weeks (%)
Overall p ¼ 0.01; when triplets are excluded p ¼ 0.96, spontaneous vs elec-
tive reduction p ¼0.96.
TR are more likely to deliver %31 wks than are the other groups and less
likely to deliver at R37 wks (<0.01). ER and SR are likely to be delivered at
similar GA (p¼0.96) and did not differ from TW (p¼0.96). Comparing larg-
est child born of the set, birth weights were similar across all groups for pre-
term deliveries, however among term deliveries ER was lighter (2300g) than
SR (3031g) or TW (2944g) (p<0.01).
CONCLUSION: Elective fetal reduction to twins decreases deliveries
%31 wks GA and encourages delivery R37 wks. ER and SR result in deliv-
eries at similar gestational ages with equivalent rates of prematurity, but chil-
dren from ER are more likely to have growth restriction.
O-73 Monday, October 25, 2010 05:30 PM
EPIGENETIC RISKS IN ASSISTED REPRODUCTIVE TECHNOLO-
GIES (ART): RESULTS FROM A FRENCH COHORT COMPOSED
OF 15,162 CHILDREN CONCEIVED BY IN VITRO FERTILIZA-
TION OR INTRACYTOPLASMIC SPERM INJECTION. G. B. Viot,
S. Epelboin, F. Olivennes. Genetique, Maternite Port-Royal, Paris, France;
Gynecologie-Obstetrique, Hôpital Bichat, Paris, France; Gynecologie-
Obstetrique, Cabinet Prive, Paris, France.
OBJECTIVE: Several reports have suggested an increased risk of imprint-
ing disorders after ART. The aim of our study was to confirm or not this hy-
pothesis.
DESIGN: We report the results of a long term survey of 15 162 French
children born after IVF or ICSI. We estimate the risk of major or minor con-
genital malformations and we define the prevalence of imprinting disorders.
MATERIALS AND METHODS: The study was prospective, from 2003 to
2007 including 15 162 infants recruited by a French Association called
‘‘FOLLOW-UP – AMP vigilance’’ composed of 33 centers. Medical data
were collected from birth to the age of 4 years.
RESULTS: In this cohort, 643 (4.24%) and 1 717 (11.32%) had respec-
tively experienced a major or minor congenital malformation (vs 2-3% and
20% respectively in the general population). This higher rate of major mal-
formations was partly due to an excess of cardiopathies and malformations
S22 Abstracts
in the urogenital system.
angioma was found (2.4% vs 0.5%).
Six children presented with a Beckwith-Wiedemann syndrome (BWS).
This risk is six times higher than expected. This syndrome is secondary to
the dysregulation of the imprinted 11p15 region. The unique defect found
in this cohort was a decreased methylation of KvDMR1 on maternal alleles,
leading to a KCNQ1OT biallelic expression.
Five children presented with a retinoblastoma, which is 4,5 times higher
than expected. All cases were bilateral and sporadic. We identified for
each of them 2 mutations arising from somatic events in retinal cell, without
germline alterations.
CONCLUSION: From this large multicentric survey of ART-born chil-
dren, we observed an excess of major malformations. The rate of angioma
was also significantly increased. We suggested an increased prevalence of
BWS and retinoblastoma, two diseases influenced by epigenetics. More in-
vestigations will be necessary to understand the relationship between embryo
culture media, ovarian stimulation, cryopreservation, indications of ART and
imprinting disorders.
O-74 Monday, October 25, 2010 05:45 PM
PATIENT INTEREST IN AN INCENTIVIZED SINGLE EMBRYO
TRANSFER PROGRAM AT THE UNIVERSITY OF UTAH.
J. A. Dorais, S. E. Gurtcheff, C. Milroy, A. Hammoud, M. Gibson,
C. M. Peterson. Department of Obstetrics and Gynecology, University of
Utah, Salt Lake City, UT; Department of Obstetrics and Gynecology, Divi-
sion of Reproductive Endocrinology and Infertility, University of Utah,
Salt Lake City, UT.
OBJECTIVE: To report patient interest in an incentivized elective single
embryo transfer (ESET) program in a selected patient population at an aca-
demic IVF center.
DESIGN: Prospective, Non-Randomized Trial.
MATERIALS AND METHODS: Select patients undergoing in-vitro
fertilization were offered participation in an elective single embryo
transfer program beginning April 2009. Patients age less than 35 with
no history of decreased ovarian reserve, prior failed IVF, or uterine
anomaly were followed prospectively. Those who met specific criteria
for embryo quality and number on day five post retrieval were offered
an incentive (waived embryo cryopreservation and frozen embryo trans-
fer fees) to elect single embryo transfer. Subjects whose embryos did
not meet study criteria were also offered single embryo transfer, but
without the study incentive. Descriptive statistics with historical controls
are presented.
RESULTS: During the year of the incentive program (April 2009-10), 102
patients met initial criteria and agreed to be followed prospectively. Eighty-
two (80%) voiced interest in elective single embryo transfer after hearing
about the program. Sixty-four participants have undergone fresh embryo
transfer since program inception. Of these, 19 met all criteria for the incen-
tive program on the day of transfer, and 16/19 (84%) chose ESET. Seventy
percent (45/64) of patients failed to meet criteria for the incentive program,
but 4/45 (9%) still chose ESET without the incentive. In women age <35
years, a total of 20/195 (10%) elected to transfer a single fresh embryo com-
pared to 2/206 (1%) in the 12 months immediately prior (risk difference 0.09,
p<0.001).
CONCLUSION: Patient acceptance of elective single embryo transfer was
improved during the time of the incentive program. Use of ESET was greater
in both incentivized and non-incentivized patients when compared to histor-
ical controls.
Supported by: The Andrology & IVF Laboratories and the Division of Re-
productive Endocrinology and Infertility at the University of Utah Health
Sciences Center.
O-75 Monday, October 25, 2010 06:00 PM
DEFINING CELL FATE AND EMBRYONIC GENOME ACTIVA-
TION BY GLOBAL SINGLE-CELL CDNA ANALYSIS OF BLASTO-
MERES FROM 5 TO 8-CELL HUMAN EMBRYOS. A. Galán,
D. Montaner, M. E. Póo, V. Ruiz, D. Valbuena, C. Simón. Valencia Node
of the Spanish Stem Cell Bank, Prince Felipe Research Centre (CIPF), Valen-
cia, Spain; Bioinformatics Department, Prince Felipe Research Centre
(CIPF), Valencia, Spain.
OBJECTIVE: To determine blastomere fate and embryonic genome acti-
vation (EGA) at 5 to 8-cell stage embryos by global gene expression profile in
single blastomeres.
Vol. 94., No. 4, Supplement, September 2010