POSTER SESSION: LATE-BREAKING ABSTRACTS P-931 3:30 PM Wednesday, October 21, 2020 LINZAGOLIX MAY ADDRESS THE LONG-TERM P-930 3:30 PM Wednesday, October 21, 2020 TREATMENT NEEDS OF WOMEN WITH UTERINE FI- BROIDS (UF) WHO HAVE CONTRAINDICATIONS TO EFFICACYAND SAFETY OF LINZAGOLIX (LGX) FOR HORMONAL ADD-BACK THERAPY (ABT): RESULTS THE TREATMENT OF HEAVY MENSTRUAL FROM TWO PHASE 3 RANDOMIZED CLINICAL BLEEDING (HMB) DUE TO UTERINE FIBROIDS TRIALS. Linda D. Bradley, MD,1 Erica E. Marsh, MD, MSCI, FACOG,2 (UF): RESULTS FROM TWO PHASE 3 RANDOMIZED Elizabeth Garner, MD, MPH.3 1Cleveland Clinic Cleveland, OH; 2University CLINICAL TRIALS. Elizabeth A. Stewart, MD,1 Hugh S. Taylor, of Michigan, Ann Arbor, MI; 3ObsEva Inc, Boston, MA. MD,2 Robert N. Taylor, MD, PhD,3 Jacques Donnez, PhD, MD,4 Elke Bestel, MD,5 Jean-Pierre Gotteland, PhD,5 Andrew Humberstone, OBJECTIVE: GnRH antagonists comprise a new class of orally active med- PhD,5 Elizabeth Garner, MD, MPH.6 1Mayo Clinic Department of OB/ ications that dose-dependently reduce estradiol (E2) levels, allowing partial sup- GYN Reproductive Endocrinology and Infertility, Rochester, MN; 2Yale pression for symptom relief of estrogen-driven conditions without the bone University School of Medicine, New Haven, CT; 3University of Utah Health, (BMD) loss seen with full suppression. A GnRH antagonist developed using a Salt Lake City, UT; 4Polyclinique Urbain V (ELSAN Group), Brussels, full suppression dose that requires use of hormonal ABT was recently approved Belgium; 5ObsEva SA, Plan-les-Ouates, Switzerland; 6ObsEva Inc, Boston, for the treatment of UF. Its labeling lists obesity, hypertension, and dyslipidemia MA. as ABT contraindications associated with higher risks of thrombotic, stroke and cardiac events, which disproportionately affect black women. Given the propen- OBJECTIVE: To assess the efficacy and safety of LGX, an oral GnRH re- sity of black women to develop severe UF, availability of a GnRH antagonist that ceptor antagonist, administered with and without hormonal add-back therapy can be used long-term without ABT is important. (ABT: 1 mg estradiol/0.5 mg norethindrone acetate), for the treatment of Linzagolix (LGX) is a GnRH antagonist being developed for UF treat- HMB and other symptoms of UF. ment. In addition to a high dose (200 mg) with ABT (1 mg E2/0.5 mg DESIGN: PRIMROSE 1 (USA, n¼526) and PRIMROSE 2 (Europe NETA), a low dose (100 mg) without (w/o) ABT is being assessed as a po- and USA, n¼511) are randomized, double-blind, placebo-controlled tential long-term treatment option for women with ABT contraindications. Phase 3 trials, with essentially identical design, investigating the effi- DESIGN: PRIMROSE 1 (P1; US, n¼526) and PRIMROSE 2 (P2; Europe/ cacy and safety of LGX ABT once daily for 52 weeks. We report US, n¼511) are randomized, double-blind, placebo-controlled Phase 3 trials results up to 24-weeks for PRIMROSE 1 and up to 52-weeks for PRIM- investigating the efficacy and safety of LGX 100 mg and 200 mg once daily, ROSE 2. with and w/o ABT. Here we present results from 24 weeks (wks) (P1 and P2) MATERIALS AND METHODS: Participants had HMB (> 80 mL and 52 wks of treatment (P2) with the 100 mg dose w/o ABT. menstrual blood loss [MBL]/cycle) due to UF and excluded if they MATERIALS AND METHODS: Inclusion criteria included having UF had significant risk of osteoporosis. Subjects were randomized to 1 and Heavy Menstrual Bleeding (HMB) (> 80 mL menstrual blood loss of 5 treatments: placebo, LGX 100 mg, LGX 100 mg + ABT, LGX [MBL]/cycle). The primary endpoint was HMB reduction defined as % 80 200 mg, LGX 200 mg + ABT. PRIMROSE 2 subjects randomized to mL MBL (by alkaline hematin method) and R 50% reduction at wk 24. Sec- placebo or LGX 200 mg were crossed-over to 200 mg LGX + ABT af- ondary endpoints included amenorrhea, hemoglobin (Hb), pain, and quality ter 24 weeks. of life (QoL). Safety endpoints included BMD and adverse events (AEs). The primary efficacy endpoint was reduction in alkaline-hematin Calcium/vitamin D were not provided. documented HMB to % 80 mL MBL and a reduction of R 50% at RESULTS: The 100 mg w/o ABT dose was studied in 191 women, 64% 24 weeks. Secondary endpoints included amenorrhea, time to reduced (P1) and 4% (P2) of whom were black; results were similar across the studies. MBL/amenorrhea, days of uterine bleeding, hemoglobin, pain, uterine P1 and P2 responder rates (RRs) were statistically significantly better than and fibroid volume and quality of life. Safety endpoints included bone pbo, at 56.4% (p¼0.003) and 56.7% (p%0.001), respectively, with an RR mineral density (BMD) assessed centrally using Dual Energy X-ray of 53.2% in P2 at wk 52. Amenorrhea rates were 34.0% (p<0.001) and Absorptiometry and adverse events (AE). Calcium/vitamin D were 38.3% (p¼0.009), respectively, and in P2 at 52 wks, 39.2%. MBL reduction not provided nor recommended in the trials. was rapid, with 60% mean % change from baseline within the first 4 wks of Individual active vs placebo efficacy comparisons were conducted using a treatment. Statistically significant improvements in pain, Hb levels and QoL 0.0125 significance level to account for multiplicity. were also observed. RESULTS: PRIMROSE 1 subjects had a mean age of 42 years and 63% Week 24 mean % BMD changes were -2.0% [95% CI: -3.3, -0.8] and were Black. The mean baseline MBL was 199 mL. HMB at week 24 was -2.1% [95% CI: -2.6, -1.5] for P1 and P2, respectively, with additional significantly (p%0.003) reduced in all active treatment groups compared -0.3% mean change at wk 52 in P2. AEs occurring in > 5% of women to placebo. Responder rates were 35, 56, 67, 71 and 75% in the placebo, were hot flushes (6.0%/14.1%; pbo: 6.7%/3.8%), headache (8.0%/4.0%; 100 mg, 100 mg + ABT, 200 mg and 200 mg + ABT groups, respectively. pbo 5.8%/5.7%), and anemia (1.0%/19.2%; pbo: 3.8%/10.5%) in P1 and PRIMROSE 2 subjects had a mean age of 43 years and 5% were Black. P2, respectively. In the 100 mg w/o ABT arm, one drug-related serious AE The mean baseline MBL was 218 mL. HMB at week 24 was significantly (hypertension) (HTN) was observed. (p<0.001) reduced in all active treatment groups compared to placebo. CONCLUSIONS: LGX 100 mg w/o ABT significantly improved HMB Responder rates were 29, 57, 77, 78 and 94% in the respective groups, and and other UF symptoms, with low AE rates and minimal associated BMD were maintained at 52 weeks. loss that showed evidence of plateauing after 24 wks. This regimen has the In both trials, significant improvements compared to placebo were unique potential to address the needs of black women with UF, many of observed for key secondary endpoints, including pain and QoL, at whom have ABT contraindications. week 24. Mean % loss in BMD ranged from 0–2% after 24 weeks in all active treatment groups except 200 mg LGX without ABT (3–4%). The rate of BMD loss slowed between weeks 24 and 52. The most com- P-932 3:30 PM Wednesday, October 21, 2020 mon AE, hot flushes, were reported in 32–35% of subjects in the LGX 200 mg without ABT group and less than 15% in the other active treat- IS COVID-19 A SEXUALLY TRANSMITTED DISEASE? ment groups at week 24. A SYSTEMATIC REVIEW. Tomer Tur-Kaspa, CONCLUSIONS: Once daily LGX 100 and 200 mg, both with or without Grace Hildebrand, BA, David Cohen, MD, Ilan Tur-Kaspa, ABT significantly improved HMB and other symptoms of uterine fibroids at MD. Institute for Human Reproduction (IHR) Chicago, IL. 24 weeks and these improvements were maintained at 52 weeks. An effective OBJECTIVE: SARS-CoV-2 has led to a rapidly spreading COVID-19 GnRH antagonist treatment without hormonal ABT could be important for global pandemic. From a public health perspective, it is crucial to determine up to 50% of patients who may have contraindications to hormonal ABT. if SARS-CoV-2 is sexually transmitted and its possible effects on human Limited BMD loss in the LGX 200 mg with ABT and LGX 100 mg without reproduction. ABT arms suggests these dosing regimens could be suitable for longer-term DESIGN: A systematic review of English publications to July 15, 2020, treatment. was conducted according to PRISMA guidelines. A search in PubMed, SUPPORT: The work was funded by ObsEva SA. NIH iCite COVID-19 portfolio, Cochrane Library, and Google Scholar
FERTILITY & STERILITYÒ e527 databases was conducted for SARS-CoV-2 and COVID-19 with fertility, frozen cycles, respectively, while 73.6% reported a R75% IUI case reduc- reproduction, testes, seminal, prostatic and vaginal fluids, and in cervical tion. 3.7% of clinics reported no reduction in case volume. smears. The focus of this review is sexual transmission by vaginal inter- Among clinics that stopped or reduced services, 69.5% cited government- course. Fecal-oral transmission has been discussed by others. mandate as a reason for closing, 31.1% due to employer concern for the MATERIALS AND METHODS: The search revealed 1,107 publications health and safety of staff, 35.4% due to patient concerns, and 34% due to con- after removal of duplicates, which were reviewed for eligibility by examining cerns regarding possible effects of COVID-19 on pregnancy. Lack of PPE titles and abstracts. 141 full-text articles were reviewed and evaluated by two was only acknowledged by 5.3% as a reason for closure. The most cited pro- independent reviewers. 57 studies were included in this review based on rele- visions planned prior to re-opening include increased hand sanitization vance, including 14 studies which tested the male and female reproductive (87%), spacing between appointments (86%), COVID symptom screening tracts for SARS-CoV-2 RNA. (84.3%), and temperature checks (71.6%). Among clinics that continued op- RESULTS: COVID-19 may have detrimental effects on male reproduction erations, the most cited provisions that were implemented included hand by inducing orchitis and decreased testosterone levels, sperm count, and sanitizing (63%), symptom screening (60.4%), spacing between appoint- motility. No study investigated its effects on female fertility. No epidemio- ments (56.9%), and temperature checks (52.7%). Interestingly, 37% of logical investigation to date has suggested COVID-19 is a sexually trans- clinics that stayed open did not report additional hand sanitization measures mitted disease (STD). The lack of co-expression of ACE2 receptors and and 39.6% did not screen patients and staff for COVID symptoms. the TMPRSS2 modulatory protein, needed for SARS-CoV-2 cell entry, in Finally, 93.6% of respondents supported additional provisions for patient testicular cells, sperm, and oocytes, supports rejection of the hypothesis counselling including risk of cycle cancellation if a patient or provider tests pos- that gametes transmit SARS-CoV-2. 14 molecular detection studies of itive for COVID-19 (85.6%) and possible risks of COVID-19 on adverse preg- SARS-CoV-2 RNA in the male reproductive tract (in testicular biopsies, sem- nancy outcomes (69.9%), miscarriage (67.2%), and fetal anomalies (58.9%). inal and prostatic fluids), and the lower female reproductive tract (in vaginal CONCLUSIONS: COVID-19 resulted in a substantial reduction in IVF fluids and cervical smears) were published. Only 1 out of 7 studies found pos- cycles, despite significant implications for such a delay on the probability itive SARS-CoV-2 RNA tests in seminal fluid (6 out of 143 total men). Inter- of having a child. Data suggests that there remains room for improvement estingly, all seminal fluids of 7 men that demonstrated orchitis-like among clinics that remained open to decrease transmission using accepted symptoms, identified in 2 other studies, tested negative. All 28 prostatic fluids procedures. Interestingly, clinics that stayed open were less aggressive at im- tested negative. Only 1 out of 11 postmortem testicular biopsies tested pos- plementing protective provisions than clinics that closed. itive, but electron microscopy found no viral particles in the testes. In women, all 35 cervical smears tested negative and only 1 case report described a pos- itive SARS-CoV-2 RNA result in vaginal fluid (1 out of 58 total women). All P-934 3:30 PM Wednesday, October 21, 2020 together, sexual transmission of SARS-CoV-2 has not been confirmed. CONCLUSIONS: Based on the current world published information, PREDICTING CUMULATIVE LIVE BIRTH BEFORE COVID-19 is not an STD. This information is important for clinicians, guide- THE FIRST AND SECOND COMPLETE CYCLE OF lines for public health, FDA guidelines for gamete and tissue donor eligi- IVF: A POPULATION-BASED STUDY OF LINKED CY- CLE DATA FROM 79,512 WOMEN. David J. McLernon, bility, and for fertility treatments. Universal precautions, practiced in 1 1 2 clinical settings and in IVF laboratories to prevent transmission of known PhD, Edwin Amalraj Raja, MSc, PhD, Valerie L. Baker, MD, Kevin J. Doody, M.D.,3 Paul C. Lin, M.D.,4 David B. Seifer, MD,5 or unknown viral infections, are adequate and sufficient at this time. We sug- 6 7 gest that recovered patients of COVID-19, especially those with infertility, Amy E. Sparks, PhD, James P. Toner, Jr., MD, PhD, Ethan Wantman, MBA,8 Siladitya Bhattacharya, MD., FRCOG,1 Bradley J. Van Voorhis, should be evaluated for their ovarian and testicular function. Prospective lon- 9 1 2 gitudinal follow up studies are warranted. MD. University of Aberdeen, Aberdeen, United Kingdom; Johns Hopkins Fertility Center, Lutherville, MD; 3CARE Fertility, Bedford, TX; 4Seattle SUPPORT: Supported in part by the Institute for Human Reproduction 5 6 (IHR), Chicago, IL. Reproductive Medicine, Seattle, WA; Yale University, Orange, CT; Univer- sity of Iowa Center for Advanced Reproductive Care, Iowa City, IA; 7Emory University, Atlanta, GA; 8Redshift Technologies, Inc., New York, NY; 9Uni- P-933 3:30 PM Wednesday, October 21, 2020 versity of Iowa, Iowa City, IA.
TRENDS IN FERTILITY PRACTICE DURING OBJECTIVE: To develop prediction models that can estimate the cumula- THE COVID-19 PANDEMIC: A GLOBAL SURVEY tive probability of live birth over three complete cycles of IVF. OF 299 CLINICS REPRESENTING 228,500 IVF DESIGN: A retrospective cohort study. CYCLES. Justin Tan, MD, MPH,1 Michael H. Dahan, M.D.,2 MATERIALS AND METHODS: Linked fresh and frozen cycle data from Mustafa Baris Ata, M.D.,3 Suresh Nair, MD,4 Zeev Shoham, MD,5 women who underwent IVF (including intracytoplasmic sperm injection) in Seang Lin Tan, MD, MBA.2 1University of British Columbia, Vancouver, BC, 2014-2016 were extracted from the Society for Assisted Reproductive Technol- Canada; 2Division of REI, McGill University and OriginElle Fertility Clinic ogy Clinic Outcome Reporting System database. Discrete time logistic regression and Women’s Health Centre, Montreal, QC, Canada; 3Koc University School was used to develop two models to predict cumulative live birth over three com- of Medicine, Istanbul, Turkey; 4Seed of Life Fertility & Women’s Care Medical plete cycles of IVF. A complete cycle was defined as all fresh and frozen-thawed Centre, Singapore, Singapore; 5Kaplan Medical Center, Rehovot, Israel. embryo transfers originating from one episode of ovarian stimulation. The pre- treatment model estimates the chance of live birth before starting treatment using OBJECTIVE: The COVID-19 pandemic is an unprecedented health crisis couple characteristics, while the post-treatment model revises predictions using that has affected IVF practices globally and recommendations by local health updated information before the second complete cycle. Potential predictors authorities and reproductive medicine societies vary widely. Hence, the pur- were female age, body mass index (BMI), serum anti-Mullerian hormone pose of this study was to compare regional responses to the COVID-19 (AMH), previous full-term birth, male infertility, tubal factor, diminished ovarian pandemic among infertility clinics and gain insight into the extent of practice reserve, polycystic ovaries, endometriosis, uterine factor and unexplained infer- modifications. tility. The post-treatment model also included number of eggs. Age, BMI and DESIGN: Self-administered online survey. AMH were modelled as restricted cubic splines due to their non-linear relation- MATERIALS AND METHODS: Between March–June 2020, a multiple- ship with probability of live birth. To assess optimism in model discrimination choice 11-question survey was distributed through the IVF-worldwide online and calibration, internal validation using 300 bootstrap samples was done. network (https://ivf-worldwide.com/survey/infertility-treatment-during- RESULTS: Of 79,512 women who underwent 103,270 complete cycles, covid-19-pandemic.html). Responses were screened for completeness and 36,850 (46.3%) had a live birth from the first complete cycle, and cumula- duplicate clinics. tively, 44,172 (55.6%) had a live birth over three complete cycles. Factors RESULTS: Responses from 299 clinics representing 228,500 IVF cycles that were predictive of live birth in the pre-treatment model included female were received, with respondents distributed across all 5 continents (34.8% age (35 vs 25 years, adjusted odds ratio 0.62, 95% confidence interval 0.59 to Europe, 25.1% Asia, 18.1% South America, 15.4% North America, 5.3% Af- 0.66), BMI (35 vs 25, 0.81, 0.77 to 0.84), previous full-term birth (1.13, 1.09 rica, and 1.3% Australia/New Zealand). to 1.17), male infertility (1.21, 1.18 to 1.25), uterine factor infertility (0.85, 86.6% of respondents reported that their reproductive medicine society 0.80 to 0.91), unexplained infertility (1.20, 1.15 to 1.25) and serum AMH released pandemic-specific recommendations for a complete (53.8%) or par- (5 vs 2.4ng/mL, 1.23, 1.18 to 1.27). The post-treatment model included these tial shutdown (23.7%), which was higher than limits imposed by health au- factors as well as egg number (15 vs 9, 1.34, 1.25 to 1.44). The C-statistic for thorities (32.5 and 19.7%, respectively). With respect to changes in IVF case all models was between 0.70 and 0.72. Internal validation showed no over- volume, 76.6% and 80% of clinics reported a R75% reduction in fresh and optimism in discrimination or calibration performance. In a 36-year-old e528 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 woman with unexplained infertility, no previous live births, BMI of 25 and P-936 3:30 PM Wednesday, October 21, 2020 AMH of 2ng/L, our pre-treatment model predicts a 51% chance of live birth over her first complete cycle (82% over three complete cycles). If the first DOES ENDOMETRIAL SCRATCH INJURY HELPS IN treatment is unsuccessful and the same woman starts a second cycle at 38 IMPROVING REPRODUCTIVE OUTCOMES OF years old with AMH ¼ 1.5ng/mL, our post treatment model estimates her INTRA-UTERINE INSEMINATION TREATMENT? A chance of live birth at 21% after the second complete cycle and 40% over RANDOMISED CONTROLLED TRIAL. Navdeep Kaur the second and third complete cycles. Ghuman, MBBS, M.S. (Obstetrics and Gynaecology), DNB Obstetrics and CONCLUSIONS: These novel prediction models show accurate perfor- Gynaecology), FMAS, Pratibha Singh, MBBS, MS(O&G), Sunil Raikar, manceandareavailabletopatientsandclinicsfreeofchargeatsart.org. We antic- MBBS, MS(O&G), Priya Singhmor, MBBS. All India institute of Medical ipate that by providing individualised chances of success at two critical stages of Sciences, Jodhpur, Jodhpur, India. IVF, they will help couples prepare emotionally and financially for IVF. SUPPORT: This study was funded by the Society for Assisted Reproduc- OBJECTIVE: Current evidence suggests that endometrial injury improves tive Technology. clinical pregnancy rate while having no effect on miscarriages in women un- dergoing IVF/ICSI. However, there is no substantial evidence to advocate the use of endometrial injury to benefit the outcomes of IUI treatment. Addition- P-935 3:30 PM Wednesday, October 21, 2020 ally, there is no clear consensus about the ideal timing, underlying mecha- nism and optimum intensity of endometrial injury required. The study ENDOMETRIOSIS AND ADVERSE PREGNANCY OUT- examines the effect of intentional endometrial injury/scratch in the early pro- COMES: A POPULATION-BASED COHORT liferative phase of stimulated cycle on reproductive outcomes (clinical and STUDY. Maria P. Velez, MD, PhD, Leah Bahta, BSc, ongoing pregnancy rates and miscarriage occurrence) of intra-uterine insem- Jessica Pudwell, MSc, MPH, Rebecca J. Griffiths, BSc, ination treatment (IUI). Susan Brogly, PhD, MSc, Olga Bougie, MD, MPH. Queen’s University, DESIGN: This prospective, randomized control interventional study was Kingston, ON, Canada. conducted in a tertiary level teaching institution from April 2018 to February 2020. OBJECTIVE: To assess the risk of adverse pregnancy outcomes in women TRIAL REGISTRATION NUMBER: CTRI/2018/04/013501 with endometriosis. MATERIALS AND METHODS: 150 eligible couples requiring IUI treat- DESIGN: Population-based retrospective cohort study using universal ment who agreed to participate were randomly allocated on 1:1 basis to either health care databases from Ontario, Canada. control or intervention group. The trial participants received up to 3 cycles MATERIALS AND METHODS: All singleton pregnancies with an esti- ovulation induction with clomiphene citrate and intra-uterine insemination. mated date of confinement between October 2006 and February 2014 were In addition, women in intervention group were subjected to endometrial eligible for inclusion. Endometriosis was determined based on a surgical scratch injury on day 6-7 of their stimulated cycle. 154 cycles in control and/or medical diagnosis (defined as an in-hospital surgery with a diagnosis arm and 128 cycles in intervention group were analyzed for clinical preg- code of ICD9-617 or ICD10-N80 and/or two medical consults billed as nancy, miscarriages and pain experienced by the women during endometrial ICD9-617). Log-binomial models were used to calculate risk ratios between scratch injury using the statistical package SPSS (version 21). endometriosis exposure and pregnancy outcomes. Models were adjusted for RESULTS: Similar cumulative clinical pregnancy rates (12.5% Vs 13.6%, age, parity, BMI, smoking, income, rurality, medical history, history of infer- RR 1.21, 95% CI 0.44-3.37, p¼0.713), biochemical pregnancy rates (17.1% tility and use of Assisted Reproductive Technology (ART- IVF/ICSI). vs 22.9%, RR 1.43, CI 0.59-3.47, p¼0.421) and ongoing pregnancy rates RESULTS: A total of 19,099 women with and 768,350 women without a (10.93% Vs 11.47%, RR 1.05, CI 0.35-3.21, p¼924) were observed in con- history of endometriosis were identified in the cohort. The mean age of endo- trol and intervention arms. Likewise, the relative risk of miscarriage occur- metriosis diagnosis was 26.6 years ( 5.8) with a mean time until pregnancy rence in the intervention arm was 1.32 (95% CI 0.39-4.32, p¼1.000) of 5.6 years ( 4.3). Compared to women without endometriosis, women which was not statistically different from control group. Mean pain score with endometriosis were older at delivery [33.0 ( 4.9) vs. 30.0 (SD 5.6)], of 6.93 on numerical pain rating scale was experienced by women whilst hav- had a higher rate of infertility diagnosis (57% vs. 16%), history of fibroids ing endometrial scratch injury. (9% vs 2%), and use of ART (8% vs. 0.9%), all p-values <0.001. A higher CONCLUSIONS: There is insufficient evidence to defend the use of endo- proportion of women with endometriosis received antenatal care by an metrial scratch injury in intra-uterine insemination treatment, as it is moder- Obstetrician (79% vs 73%), with a greater mean number of visits coded as ately painful and have uncertain beneficial influence on reproductive a high-risk prenatal assessment (1.1% vs. 0.08%), all p-values <0.001. In outcomes. the adjusted models, endometriosis was associated with a greater risk of pre- SUPPORT: The study received funds from the institution as per institu- term birth, caesarean delivery, placenta previa, and other placental disorders tional norms to procure consumables. No funding was received from any in- and a reduced risk for induction and a small for gestational age baby (Table). dividual or external funding agency.The authors do not have any conflicts of CONCLUSIONS: Endometriosis is associated with adverse pregnancy out- interest to declare. comes. Future studies should consider care plans and interventions to decrease the risk of adverse pregnancy outcomes in women with endometriosis. P-937 3:30 PM Wednesday, October 21, 2020
TABLE. Pregnancy outcomes in women with history of endometriosis INFLAMMATION IN RESPONSE TO SATURATED FAT compared to women with no endometriosis INGESTION IN NORMAL WEIGHT WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) DOES Outcome Adjusted RR (95% CI) p-value NOT DEPEND ON THE PRESENCE OF ABDOMINAL ADIPOSITY (AA). Frank Gonz alez, M.D.,1 Robert V. Considine, Hypertensive Disorders of Pregnancy 0.98 (0.91 - 1.05) 0.55 Ph.D.,2 Ola A. Abdelhadi, M.D., Ph.D.,3 Anthony J. Acton, Jr., B.S.2 1Uni- Stillbirth 1.25 (0.98 - 1.58) 0.08 versity of Illinois at Chicago College of Medicine, Chicago, IL; 2Indiana < Small for Gestational Age ( 10%) 0.92 (0.87 - 0.98) 0.01 University School of Medicine, Indianapolis, IN; 3University of California < < Preterm Birth ( 37 weeks) 1.14 (1.07 - 1.21) 0.001 at Davis, Davis, CA. Induction 0.97 (0.95 - 0.99) 0.01 C-Section 1.11 (1.08 - 1.14) <0.001 OBJECTIVE: Lipid-stimulated inflammation is increased in PCOS inde- Placenta Previa 1.82 (1.58 - 2.10) <0.001 pendent of obesity.1 We evaluated the effect of saturated fat ingestion on nu- Placenta Abruption 1.23 (0.99 - 1.53) 0.06 clear factor-kB (NFkB) activation, inhibitory-kB(IkB) protein content and Other Placental Disorders 1.94 (1.37 - 2.74) <0.001 tumor necrosis factor-a (TNFa) mRNA content from mononuclear cells Postpartum Hemorrhage 1.03 (0.90 - 1.19) 0.64 (MNC) of normal weight women with PCOS with and without AA, Uterine Atony 0.86 (0.64 - 1.15) 0.30 compared with normal weight body composition-matched ovulatory con- trols; and their relationship with HCG-stimulated ovarian androgen secretion and insulin sensitivity. DESIGN: Cross-sectional study MATERIALS AND METHODS: We studied 14 normal weight women SUPPORT: Canadian Institutes of Health Research (CIHR) with PCOS (7 with & 7 without AA) diagnosed on the basis of oligo-amen- orrhea and hyperandrogenemia and 14 normal weight ovulatory controls (7
FERTILITY & STERILITYÒ e529 with & 7 without AA) ages 18-40. AAwas defined as the % ratio of truncal fat RESULTS: The isolated UCMSC-exos had a typical cup-shaped to total body fat measured by DEXA that was 2SD above the mean of controls morphology with a monolayer membrane, expressed the specific exoso- without AA. NFkB activation, IkB protein content and TNFa mRNA content mal markers Alix, CD63, and TSG101 and were approximately 60 to were respectively quantified by electrophoretic mobility assay, Western blot- 200 nm in diameter. The rats in group2 had a significantly thicker ting and RT-PCR in MNC isolated from blood samples drawn fasting and 2, 3 endometrial lining and exhibited higher expression of cytokeratin, vi- and 5 hours after dairy cream ingestion (100 ml). Androgens were measured mentin than that of group3 (P < .05), which were similer with group by RIA from blood samples drawn fasting and 24, 48 and 96 hours after HCG 1. The amount of fibrosis, VEGF were similar between group1 and 2. administration (5000 IU). Insulin sensitivity was derived by ISOGTT. In group2, comparing to group3, show less fibrosis but upregulated RESULTS: Compared with controls, the change from baseline (%) in VEGF staining and Bcl-2 level was observed, while Caspase-3 level NFkB activation and TNFa mRNA content increased (p<0.02) and IkB pro- was downregulated(P < .05). tein content decreased (p<0.0001) in both PCOS groups at 2 hours (NFkB– CONCLUSIONS: UCMSC-Exos improved the proliferation of endome- with AA: 27 4 vs. 4 5, without AA: 23 4 vs. -17 1; TNFa – with AA: trium. UCMSC-Exos upregulated VEGF, Bcl-2 level as well as downregu- 23 6vs. -13 3, without AA: 26 9 vs. -8 9; IkB – with AA: -35 2 vs. lated Cleaved Caspase-3 level and activated the PTEN/AKT signaling 18 5, without AA: -30 4 vs. 17 5) and 3 hours (NFkB – with AA: pathway to regulate the proliferation and antiapoptosis. Thus, UCMSC- 25 4 vs. 2 4, without AA: 20 4 vs. -16 1; TNFa – with AA: 25 12 Exos could be used as a potential treatment to promote endometrial repair. vs. -14 3, without AA: 29 15 vs. -14 6; IkB – with AA: -41 2 vs. References: Khan Z, Goldberg JM. Hysteroscopic Management of 23 6, without AA: -35 5 vs. 20 5), and returned to baseline at 5 hours Asherman’s syndrome. J Minim Invasive Gynecol. 2018;25(2):218–28. (NFkB – with AA: 1 1 vs. 0 1, without AA: 1 1 vs. -1 1; TNFa – with Hooker AB, De LR, Pm VDV, et al. Prevalence of intrauterine adhesions AA: 2 12 vs. -7 4, without AA: 2 6 vs. -3 6; IkB – with AA: -1 1 vs. after the application of hyaluronic acid gel after dilatation and curettage in 1 1, without AA: -1 1 vs. 1 1). Compared with controls, both PCOS women with at least one previous curettage: shortterm outcomes of a multi- groups exhibited greater (p<0.05) HCG-stimulated area under the curve center, prospective randomized controlled trial. Fertil Steril. (AUC) for testosterone (T) (with AA: 6466 775 vs. 3858 531, without 2017;107(5):1223–31. AA: 6157 1026 vs. 3064 587) and androstenedione (A) (with AA: Cousins FL, Murray A, Esnal A, Gibson DA, Critchley HOD, Saunders 501 35 vs. 307 24, without AA: 516 38 vs. 300 36). For the combined PTK. Evidence from a mouse model that epithelial cell migration and mesen- groups, the lipid-stimulated incremental AUC (iAUC) for NFkB activation chymal–epithelial transition contribute to rapid restoration of uterine tissue and TNFa mRNA content was positively correlated with HCG-stimulated integrity during menstruation. PLoS One. 2014;9:e86378. androgen AUC (NFkB–T:r¼0.53, p<0.006; A: r¼0.62, p<0.0009; Santamaria X, Mas A, Cervello I, Taylor H, Simon C. Uterine stem cells: TNFa –T:r¼0.41, p<0.05; A: r¼0.55, p<0.004). ISOGTT was negatively from basic research to advanced cell therapies. Hum Reprod Update. correlated with the lipid-stimulated iAUC for NFkB activation (r¼ -0.39, 2018;24(6):673–93. p<0.05) and TNFa mRNA content (r¼ -0.48, p<0.02), and positively corre- Khatri M, Richardson LA, Meulia T. Mesenchymal stem cellderived lated with the lipid-stimulated iAUC for IkB protein content (r¼0.53, extracellular vesicles attenuate influenza virus-induced acute lung injury in p<0.006). a pig model. Stem Cell Res Ther. 2018;9(1):17. CONCLUSIONS: Lipid-stimulated NFkB activation and TNFa mRNA SUPPORT: None content are increased and lipid-stimulated IkB protein content is decreased in PCOS independent of AA. We speculate that this proinflammatory phe- nomenon in PCOS promotes hyperandrogenism and insulin resistance, and P-939 3:30 PM Wednesday, October 21, 2020 is further perpetuated by AA. References: Gonz alez F, Considine RV, Abdelhadi OA, Acton AJ. Inflam- COVID-19 PANDEMIC EFFECT ON EARLY PREG- mation triggered by saturated fat ingestion is linked to insulin resistance and NANCY – ARE MISCARRIAGE RATES ALTERED, IN hyperandrogenism in polycystic ovary syndrome. J Clin Endocrinol Metab ASYMPTOMATIC WOMEN?. Keren Rotshenker Olshinka, M.D.,1 Alexander Volodarsky-Perel, M.D.,2 Namaa Steiner, 2020;105:e2152–67. 1 1 1 1 SUPPORT: NIH grant R01 DK-107605 to F.G. MD, Eryn Sarah Rubenfeld, M.D., Michael H. Dahan, M.D. Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, Montreal, QC, Canada; 2Division of Reproductive Endocrinology and P-938 3:30 PM Wednesday, October 21, 2020 Infertility, McGill University Health Care Centre, Montreal, QC, Canada.
EXOSOMES DERIVED FROM HUMAN UMBILICAL OBJECTIVE: To evaluate the effect of the COVID-19 pandemic state on st CORD MESENCHYMAL STEM CELLS PROMOTE early, 1 trimester pregnancies, in light of a link described between war- PROLIFERATION OF ENDOMETRIAL STROMAL induced stress and adverse pregnancy outcomes. CELL. Yajie Chang, Master,1 Yingying Liu, Master,2 DESIGN: Retrospective cohort study conducted in a University fertility Xiaolan Li, M.D.3 1The Sixth Affiliated Hospital of Sun Yat-sen University, center. ST Guangzhou, China; 2The Research Center of Reproductive Medicine, The MATERIALS AND METHODS: All 1 trimester viability scans done 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; 3Labo- since the COVID-19 shut down, March13-May 6, 2020 (Study group), ratory of Reproductive Endocrinology, The Research Center of Reproductive and between March 1-May 17, 2019 (pre-pandemic Control), were re- st Medicine, The 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, viewed. Early 1 trimester pregnancy outcomes (Viable pregnancy, Ar- China. rested pregnancy including biochemical pregnancy loss and miscarriage, and ectopic pregnancy (EP)) were measured. A multivar- OBJECTIVE: To investigate whether the exsomes derived from Umbilical iate analysis was performed to control for significant confounders. Po- cord mesenchymal stem cells (UCMSCs) could improve the regeneration of wer analysis revealed that a sample size of 58 patients per group has a endometrium in an experimental model of thin endometrium. 90% power with a 15% difference in outcomes and a¼5%. The study DESIGN: Randomized, control trial, animal research. group denied symptoms of COVID-19. MATERIALS AND METHODS: UCMSCs were isolated and character- RESULTS: 113 women were scanned in the study, and 172 in the control ized. UCMSC-exos were extracted by differential ultracentrifugation and periods (5-11 weeks gestational age). The groups had similar demographics, identified by western blots, transmission electron microscopy, and nano- gestational history, fertility diagnosis and treatment characteristics (Table). particle tracking analysis. A thin endometrium rat model was established No significant differences were noted in the rate of recurrent pregnancy by infusing ethanol into the uterine cavity of Sprague-Dawley rats. In all, loss (RPL). Viable clinical pregnancy rates were not different between the 24 rats with thin endometrium and 12 normal rats were divided into 3 groups (76.1% vs. 80.2% in the pandemic and pre-pandemic groups p¼ groups: (1) normal group, (2) experimental group transplanted with 0.41). No significant difference was seen in number of 1st trimester miscar- UCMSC-exos into uterine cavity, and (3) control group transplanted riage (14.2% vs 12.8% p¼0.76), biochemical pregnancies (3.5% vs 1.7% with saline into the uterine cavity. Three rats were killed at time 0 h, 7 p¼0.34), or in total miscarriage rate (22.1% vs 16.9% p¼0.32), nor in EP d, 14 d and 28 d and bilateral uterus were obtained at each time points rates (0.9% vs 2.3% p¼0.36) for the subseqent experiments. Morphological changes were determined Mean serum TSH levels were higher in the control but fell in the normal by hematoxylin-eosin staining or Masson staining.The amount of fibrosis, range for both groups. Use of donor sperm was higher in the control and vascularisation, inflammation and immunohistochemical staining with may have favored lower miscarriage rates in that group. vascular endothelial growth factor (VEGF), Bcl-2 and Caspase-3 level CONCLUSIONS: The COVID-19 pandemic environment does not seem were evaluated in the endometrial tissues. to affect early first-trimester miscarriage rates in asymptomatic patients. e530 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 tected in hair and 3.68 ng/ml (95%CI 2.79-4.56) in plasma in age-group <25 yrs. This is in contrast to the age group >39 years, within which a Pre-pandemic mean of 3.02 pg/ml (95%CI 2.19-3.85) AMH detected in hair and 0.92 ng/ Characteristic Study(n¼113) Control (n¼172) P-value ml (95%CI 0.43-1.41) in plasma samples. AMH in hair did not significantly associate with measurements in plasma (effect size 0.19, p value 0.0852). Female Age, Years, 36.5 4.5 37.2 5.4 0.28 AMH measured in hair correlated with age more strongly than plasma mean SD AMH (p-value ¼1.26 x10-5 (hair), p-value 0.088 (plasma)). AMH levels RPL History, N(%) 15 (13.3) 15 (8.7) 0.22 in hair were also strongly associated with AFC when corrected for hair Fertility diagnosis, N(%) weight, with an effect size of 3.75 (95% CI: 1.7; 5.8), and P value of Unexplained 24 (21.4) 32 (19.6) 0.21 0.0168. Progesterone was measured via ELISA (n¼76 in hair, n¼91 in Male Factor 36 (32.1) 58 (35.6) plasma) via ELISA. The association between progesterone in plasma and Tubal factor 5 (4.5) 11 (6.8) hair was significant (p value of 0.0298, p value of 0.013 when adjusted for Polycystic ovarian 21 (18.8) 25 (15.3) hair weight). syndrome CONCLUSIONS: We found that progesterone and AMH could be Decreased ovarian reserve 23 (20.5) 20 (12.3) detected in human hair samples, and levels of AMH in hair were posi- Endometriosis 1 (0.9) 4 (2.5) tively associated with maternal age and antral follicle count. The Base line testing, stronger association of AMH in hair versus plasma with age and median(IQR) AFC suggests that, though AMH is relatively stable during the AMH ng/ml 2.5 (1.0 – 4.4) 2.5 (1.2 – 5.4) 0.75 monthly cycle, acute measurements of AMH may have variability TSH mIU/L 1.3 (0.9 – 1.8) 1.7 (1.2 – 2.3) 0.001 that may make measurement via hair samples of greater utility for as- Antral follicular 16 (9 – 29) 14 (9 – 25) 0.27 sessing reproductive health. Hair is a medium that can accumulate count (AFC) biomarkers over several weeks, while serum is an acute matrix that Total motile sperm 18 (6 – 43) 12 (5 – 47) 0.23 can represent only current levels. Detection of steroid hormones in count, median(IQR) hair has been used in neuroendocrinological studies in human and an- Sperm donation, N (%) 2 (1.8) 17 (9.9) 0.01 imals. However AMH measurements in hair are not currently em- Pregnancy, N (%) ployed for clinical purposes. In addition to this benefit, assessing Spontaneous 34 (30.1) 54 (31.4) 0.97 reproductive hormone via a non-invasive method may allow an IUI 34 (30.1) 51 (29.7) increased adoption of the use of these hormones in addressing repro- IVF 45 (39.8) 67 (38.9) ductive health. ICSI (percentage of IVF 31 (79.5) 52 (77.6) 0.82 patients) Blastocyst transferred 39 (86.7) 56 (83.6) 0.65 P-941 3:30 PM Wednesday, October 21, 2020
FOLLICULAR-PHASE SINGLE-DOSE GNRH AGONIST PROTOCOL VS GNRH ANTAGONIST PRO- TOCOL IN PATIENTS WITH REPEATED IVF P-940 3:30 PM Wednesday, October 21, 2020 FAILURE. Rui Huang, MD, PhD, Xing Yang, Ph.D., QUANTITATIVE DETECTION OF BIOLOGICALLY Qian Li, Master. The Sixth Affiliated Hospital of Sun Yat-sen University, RELEVANT ANTI-MULLERIAN HORMONE (AMH) Guangzhou, China. AND PROGESTERONE IN HUMAN HAIR 1 1 OBJECTIVE: To compare the clinical outcomes between follicular-phase SAMPLES. Alice K. Crisci, BS, Brian Ring, PhD, 2 3 single-dose gonadotropin-releasing hormone (GnRH) agonist protocol and Sarthak Sawarkar, MS, Yolanda Cabello, PhD, Laura Garcia-Calvo, 2 4 5 GnRH antagonist protocol in patients with repeated IVF failure. PhD, Maria Hebles Duvison, PhD, Carmen Ochoa Marieta, MD, 6 DESIGN: Retrospective analysis. Maria Jose Figueroa-Garcia, Embryologist, Laura Garc ıa De Miguel, Gy- 7 1 2 MATERIALS AND METHODS: The IVF cycles conducted on 764 pa- necologist, Santiago Munne, PhD, Manuel Alvarez-Rodr ıguez, PhD, 8 1 2 tients with repeated IVF failure (No. of previous failed IVF cycle>¼2) Manel Lopez-Bejar, PhD. MedAnswers, San Pedro, CA; Universitat 3 and normal ovarian reserve (AMH >1.1ng/ml) from Jun. 2017 to Dec. Autonoma de Barcelona, Barcelona, Spain; Hospital Ruber Juan Bravo, Ma- 4 5 2019 were included in this retrospective cohort study. The follicular-phase drid, Spain; Ginemed Sevilla, Sevilla, Spain; CER Santander, Santa Cruz 6 single-dose GnRH agonist protocol, in which 3.75 mg Triptorelin was admin- de Bezana, Spain; HC Marbella International Hospital, Marbella, Spain; 7 8 istrated on cycle day 2 and exogenous gonadotropin (Gn) was initiated 4 Clinica Tambre, Madrid, Spain; Western University of Health Sciences, weeks later, was applied in 303 patients and GnRH antagonist protocol uti- Pomona, CA. lized in the remaining 461 patients. The clinical outcomes, including stimu- OBJECTIVE: Anti-Mullerian Hormone (AMH) and progesterone are used lation duration, total dose of exogenous Gn, No. of oocytes retrieved, No. of as biomarkers in assessing fertility and readiness for assisted reproductive transferrable embryos, clinical pregnancy rate and miscarriage rate between < procedures, usually measured in blood samples. The objective of this study the two groups were compared respectively. P 0.05 was considered as sta- was to determine if biologically relevant quantities of AMH and progesterone tistical significance. in human hair samples could be assessed. RESULTS: No significant difference was observed in basic characteristics DESIGN: The study design was prospective in nature. A total of (n¼152) between two groups. Comparing with the antagonist group, both the stimu- human female participants between the ages of 18-65 years were included in lation duration and the total Gn dose were significantly longer and higher the study over a period of 10 months (recruitment ongoing). in the agonist group. More oocytes and transferrable embryos were obtained, MATERIALS AND METHODS: Sample collection was performed in a and the clinical pregnancy rate per fresh embryo transfer cycle was signifi- clinical setting, with blood and hair samples collected from patients. Hair fol- cantly higher in the agonist group. The basic and cycle characteristics licles were not required, with a minimum of 100mg of hair cut from the par- were listed in the following table. ticipants. A doctor or a clinical technician measured the antral follicle count CONCLUSIONS: In patients with repeated IVF failure, follicular-phase (AFC) by ultrasound. Biologically active AMH and progesterone was ex- single-dose GnRH agonist protocol resulted in a significantly higher clinical tracted from hair using a proprietary method. Hormone presence in hair pregnancy rate than antagonist treatment, implying that single-dose GnRH extract was confirmed in a set of samples using Western Blotting. Hormones agonist treatment may offer additional benefits for this specific group of pa- tients. were measured in plasma and hair extract by ELISA. ^ RESULTS: AMH was detected via ELISA (n¼95 in hair, 42 in plasma), SUPPORT: This work was supported by theA Natural Science Founda- and confirmed on a set of samples via western blots on denatured gel with tion of Guangdong Province (No.2019A1515011764). bands at 70kDa. An average level of 9.37 pg/ml (95%CI 6.77-12) was de-
FERTILITY & STERILITYÒ e531 GnRH agonist protocol (n¼303) GnRH antagonist protocol (n¼461) P value
Age (y) 33.61 3.58 33.95 3.94 0.231 BMI (Kg/m2) 22.20 5.49 22.03 2.94 0.186 Infertility duration (y) 5.67 3.26 5.36 3.31 0.209 AMH (ng/ml) 3.29 2.08 3.39 3.18 1.000 No. of previous IVF cycles 2.62 1.04 2.62 1.33 0.952 Gn initiation dose (IU) 235.07 58.80 229.00 59.36 0.164 Stimulation duration (d) 11.02 1.85 8.49 1.45 <0.01 Dose of Gn (IU) 2633.45 783.82 1937.08 586.31 <0.01 No. of oocytes retrieved 12.12 5.95 9.79 6.44 <0.01 No. of transferrable embryos 4.24 3.50 3.57 3.23 <0.01 No. of good-quality embryos 3.30 3.12 2.82 2.96 0.03 No. of embryos transferred 1.79 0.51 1.84 0.44 <0.01 No. of cycles with fresh embryo transfer 181 197 Clinical pregnancy rate (%) 53.60 34.01 <0.01 Miscarriage rate (%) 20.62 14.93 0.354
P-942 3:30 PM Wednesday, October 21, 2020 CONCLUSIONS: The angle at which point of hatching originates vis- a-vis the ICM greatly influences IVF outcomes. Thus, in addition to morpho- THE POSITION OF POINT OF HATCHING (POH) AND metric evaluation of blastocyst, it is imperative to assess the angle of POH as ITS ANGLE VIS-A-VIS THE INNER CELL MASS IS A a selection criteria so as to minimize the chances of missed abortion and to ROBUST CRITERIA FOR SELECTION OF HATCHING enhance live birth rates in IVF cycles. BLASTOCYST FOR ENHANCED LIVE BIRTH RATES References: nil IN IVF CYCLES. Bindu N. Chimote, M.Sc., M.Phil, Ph.D.(Biochemis- SUPPORT: None try); M.Sc. Clinical Embryology (Leeds-UK),1 Nishad N. Chimote, M.Sc.,2 Amogh N. Chimote, M.D.,2 Riju A. Chimote, M.D.,2 Natchandra Manoharrao Chimote, M.Sc., Ph.D.3 1Consultant Clinical P-943 3:30 PM Wednesday, October 21, 2020 Embryologist, Nagpur, India; 2Vaunshdhara Fertility Centre, Nagpur, India; 3Scientific Director, Vaunshdhara Fertility Centre, Nagpur, India. DIAGNOSTIC EFFICIENCY OF BLASTOCYST CUL- TURE MEDIUM IN NONINVASIVE PREIMPLANTA- OBJECTIVE: Hatching of blastocyst from zona pellucida is extremely TION GENETIC TESTING (NIPGT). Jingbo Chen, essential for implantation and live birth. It has been arbitrarily believed M.D. candidate,1 Lei Jia, PhD,1 Shujing He, MM,2 that the point of hatching (POH) should be diagonally opposite the inner Cong Fang, Ph.D.1 1Reproductive Medicine Research Center, Sixth Affili- cell mass (ICM). However, there is no documentation yet of the impact of ated Hospital of Sun Yat-sen University, Guangzhou, China; 2The Sixth angle of POH vis- a-vis ICM on the implantation (IR) and live birth rates Affiliated hospital of Sun Yat-Sen University, Guangzhou, China. (LBR) in vitro. We aimed at measuring the actual angle of POH and evalu- ating its correlationship with IVF outcomes. OBJECTIVE: To evaluate the diagnostic efficiency of spent blastocyst cul- DESIGN: Retrospective analysis of single hatching blastocyst transfer cy- ture medium (BCM) in noninvasive preimplantation genetic testing (niPGT) cles carried out from 2014 to 2019. To avoid any bias due to blastocyst qual- by comparing the karyotype concordance with corresponding inner cell mass ity, we retrospectively included cycles involving transfer of only Grade AA (ICM) among initial trophectoderm (TE) biopsy, TE re-biopsy and BCM or Grad AB hatching blastocysts. The angle formed between the imaginary sampling. tangent from the midpoint of ICM arc and the line from this ICM midpoint DESIGN: Re-analysis aneuploid/mosaic blastocysts donated for research to POH, drawn on the photographic image of blastocyst, constituted our by couples. angle of POH. Cycles were classified into three groups on the basis on angle MATERIALS AND METHODS: A total of 26 blastocysts with aneuploid POH as Group A (0-30 ), Group B (31-60 ) and Group C (61-90 ). (n¼23) or mosaic diagnosis (n¼3) were donated for research from 12 cou- MATERIALS AND METHODS: Serum bhCG was measured on day 8 ples with indications of preimplantation genetic testing for chromosomal post blastocyst transfer. A bhCG value > 25 mIU/ml was considered as pos- structural rearrangements (PGT-SR) or preimplantation genetic testing for itive indication of pregnancy. Gestational sac with foetal cardiac activity on aneuploidy (PGT-A), at Reproductive Medicine Research Center of the Sixth ultrasound at 6th week gestation confirmed clinical pregnancy. Missed abor- Affiliated Hospital of Sun Yat-Sen University, from July 2018 to July 2019. tion was defined as a spontaneous loss of cardiac activity after 6 weeks gesta- TE and ICM were biopsied (5-10 cells) in a routine procedure; TE was re- tion. IR and LBR were also evaluated. Data was analysed using the graph pad biopsied (more than 10 cells) at other sites of trophectoderm compartment. prism V software. P<0.05 was considered significant. The statistical power The MALBAC single-cell whole genome amplification (WGA) method of our study is >85%. was used to amplify DNA from all cells and BCM samples. Embryos were RESULTS: An overall comparison between pregnant and non-pregnant diagnosed as euploid, aneuploid or mosaic by NGS results. Embryos were groups showed no significant difference in the angle of POH (56 vs. 53). classified as mosaic if the level of mosaicism ranged from 40% to 70%, while However, interesting results were obtained when transfer cycles were classi- less than 40% was labeled as euploid and more than 70% as aneuploid. But fied on the basis of POH angle. Of the total 2350 hatching blastocysts eval- for chr13, chr16, chr18 and chr21 chromosomes, the criterion for mosaicism uated, n¼440 (18.7%), n¼800 (34%) and n¼1110 (47%) belonged to Group was set to be 30%. The primary outcomes of this study, concordance rates A, Groups B and Group C respectively. The clinical pregnancy rate differed with ICM biopsies, were compared among groups (initial TE biopsies, TE significantly between the 3 groups (20.45% vs. 36.25% vs. 37.4%, One way re-biopsies and BCM samples). The karyotype concordance of each two ANOVA p<0.0001) respectively. groups was defined as the presence of the same abnormal chromosome, espe- Significant differences were observed (Group C >Group B >Group A) in cially in the target chromosome in different testing results compared. The degree of blastocyst expansion (One way ANOVA p¼0.0068) and gradation clinical concordance of all four samples was defined as the concordance in of trophoblastic (TE) cells (p<0.0001) whereas there was no difference in embryo diagnosis, such as uniform aneuploid or not. To assess the diagnostic ICM grades between the 3 groups. efficiency of BCM sample, false positive rate (FPR), false negative rate The IR was significantly lower (20%, p<0.0001) in Group A compared to (FNR), sensitivity, specificity, accuracy, positive predictive value (PPV) that in Groups B and C. Although the implantation rates in both Groups B and and negative predictive value (NPV) were calculated according to the corre- C were comparable (36 vs. 38%, p>0.05); the rates of missed abortion were sponding ICM results. Statistical analyses were performed with the Chi- significantly higher in Group B compared to Group C (5 vs. 1.8%, Square test, Yates’ correction, or Fisher’s exact test accordingly when p<0.0001). The live birth rates were significantly higher in Group C comparing frequencies or proportions. All statistical analysis was performed compared to Group B (37% vs. 30%, p¼0.031). using SPSS 22.0. P<0.05 was considered as significant. e532 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 RESULTS: For 23 embryos diagnosed as aneuploid by initial TE biopsy, DNB,1 Swapneil R. Parikh, DNB,3 Firuza Rajesh Parikh, MD DNB 78.3% of initial TE samples, 87.0% of TE re-biopsies and 78.3% of BCM PhD.1 1Jaslok Hospital and Research Centre, Mumbai, India; 2Genexplore samples were concordant with corresponding ICM samples (P>0.05); but Diagnostics and Research Centre, Ahmedabad, India; 3Kasturba Hospital for 3 mosaic embryos, the concordance rates with ICM of these three groups of Infectious Diseases, Mumbai, India. were 0%, 100% and 100% (P<0.05), respectively. With the corresponding ICM result as the true result, sensitivity of both niPGT-A and initial TE OBJECTIVE: To identify novel and unique diagnostic markers for the were 100%; but the FPR of initial TE was higher than that of niPGT-A presence of Genital Tuberculosis (GTB). (100% vs. 0, P¼0.100). DESIGN: Infertile women suspected of GTB were included in the study. CONCLUSIONS: NiPGT-A using spent BCM had similar diagnostic effi- An array of tests including endometrial biopsies for TB culture, nested a b ciency as TE-biopsy PGT-A. And in case of mosaic embryos, niPGT-A using TB-PCR, Immunocytochemistry, TNF alpha, P27, 1 3integrins and evalua- BCM may be more reliable for predicting the karyotypes of ICM than initial tion of CD138 and endoscopy including either laparoscopy and or hysteros- TE biopsy. copy was carried out. Those confirmed with GTB by two or more parameters SUPPORT: National Natural Science Foundation of China (81871214 were considered as TB positive and those with either one or none of the pa- and 81801449) and National Key R&D Program of China rameters positive were considered to be TB negative. Expressional analysis (2017YFC1001603). was performed on the same sample of the endometrial biopsy that had been collected. Pathway analysis to establish markers associated with TB and integrated pathways differentially associated to normal physiology P-944 3:30 PM Wednesday, October 21, 2020 were mapped. MATERIALS AND METHODS: A total of 97 samples were subjected to FIBROTIC CHANGES IN TRANSGENDER OVARIES diagnostic tests mentioned above. Results were tabulated to differentiate be- DUE TO TESTOSTERONE EXPOSURE. Anamika Ratri, tween TB positive and TB negative samples. Based on the screening tests, 34 BA, Riley Mickelsen, BS, Meredith Gray, MD, samples were positive and 63 were negative. All these samples were sub- Nika C. Gloyeske, MD, Courtney A. Marsh, MD, MPH, jected to custom designed gene expression analysis by microarray technique Lane K. Christenson, PhD. University of Kansas Medical Center, Kansas using Agilent G3 scanner and results were analysed on GeneSpring 14.9 soft- City, KS. ware (Strand Lifescience). Data was normalized and those with fold chain more than 2 were considered for further analysis. Expression fold change OBJECTIVE: Transgender men (TGM) undergo extensive testosterone (T) of TB positive samples was compared to TB negative samples with respect exposure as part of gender conformation therapy. Androgens have well known to focused inflammatory pathway analysis comprising of 1052 genes. impactsontheHPGaxisaswellasdirecteffectsontheovary.Reportsconflict Through literature survey, a total of 1052 genes were identified as associated on whether TGM ovaries have characteristics of PCOS, which can also heighten with inflammatory pathways and data of expression analysis was compared T levels in the patient. Elevated androgens and aging can both increase collage- to these genes. nization of the ovary. In this study, we evaluated ovarian morphologic differences RESULTS: Bioinformatics analysis of the study revealed that 129 genes in young and old TGM patients, examining fibrosis of the tissue. Ovarian fibrosis were differentially regulated in TB positive endometrial tissue as compared could impede ovulation, which may lead to problems with fertility. to TB negative endometrial tissue. Further, expression of 47 genes was sta- DESIGN: Ovarian fibrosis in TGM was compared to age-matched cisgen- tistically significant and considered for further pathways and marker identi- % der (CG) ovaries. All patients were divided into two age groups, young ( 35 fication analysis. Results showed that apart from innate immune response > yr) and old ( 36 yr). Fibrosis was detected by histological quantitation of pathways like MAPK and cytokine pathways, we observed that genes picrosirius red (PSR) staining. involved in cell migration, Adhesion-Extravasation, G-protein coupled re- MATERIALS AND METHODS: Ovaries from young and old TGM patients ceptor pathways were also altered in TB positive endometrium thus, explain- ¼ (n 5/3, respectively) were collected during gender confirming surgeries. ing the associated infertility. ¼ Ovaries from young and old CG donors (n 3/4, respectively) were obtained CONCLUSIONS: Early detection of GTB is important in salvaging repro- from patients undergoing oophorectomy for benign reasons. All samples were ductive potential. GTB has a detrimental impact on female fertility. However collected following KUMC IRB approval. Ovaries were fixed in 4% formalde- its diagnosis by conventional methods is at times difficult in this form of ex- m hyde, processed and embedded in paraffin. 7 m-thick histological sections tra-pulmonary TB and delay in diagnosis can negatively impact on future were stained with 0.1% PSR/0.1% Fast Green. Four randomly selected cortical fertility. The present study has identified novel markers in the form of differ- areas of each ovarian section were imaged at 10x using bright field microscopy. ential expression of 52 genes involved not only in classical inflammatory PSR staining intensities were quantified using ImageJ per NIH recommended response pathways but pathways associated with inflammatory dysfunction < methodology. One-Way AVOVA (p 0.05) followed by LSD means separation in GTB. tests were completed using SPSS program. To correct for heterogeneity of vari- ance, data was log transformed. RESULTS: Young (29 2.0yr) and old (40.0 0.7yr) TGM patients under- P-946 3:30 PM Wednesday, October 21, 2020 went 34.8 4.2mo and 40.6 39.2mo of T-therapy, respectively; note one old TGM patient was exposed for 119mo. Age matched young and old CG pa- EMBRYONIC EVENTS AND NOT UTERINE EVENTS tients were 31 2.0 and 36 0.5yr of age. Ovarian PSR staining levels in ARE ASSOCIATED WITH PREGNANCY OUTCOMES young TGM patients were higher (292,184 122,991 p<0.05) compared to IN A DECEASED DONOR UTERUS TRANSPLANT PRO- young CG donors (39,154 14,643). Ovaries from old TGM also showed GRAM: PRELIMINARY RESULTS. Elliott G. Richards, increased PSR staining, (98,775 17,887) compared to old CG MD,1 Marjan Attaran, M.D.,2 Cynthia M. Austin, M.D,2 (34,359 5,540; p<0.05). TGM ovaries had few large follicles, which were Cristiano Quintini, MD,3 Andreas G. Tzakis, MD,3 Tommaso Falcone, atretic, whereas CG ovaries typically contained a few large healthy follicles. M.D.4 1Cleveland Clinic Foundation, Cleveland, OH; 2Cleveland Clinic, CONCLUSIONS: This study establishes quantitatively that long-term testos- Beachwood, OH; 3Cleveland Clinic, Cleveland, OH; 4Cleveland Clinic, Cleve- terone exposure increases collagen deposition within young and old TGM land, OH. ovarian tissue compared to CG age matched tissues. Our findings indicate a lack of multiple follicles in TGM ovaries, which diverges from several prior ob- OBJECTIVE: Uterus transplantation is an emerging treatment for absolute servations that TGM ovaries exhibited a PCOS-like morphology. Increased num- uterine factor infertility. The majority of uterus transplants to date have uti- ber of subjects will clarify whether age of TGM and duration of T-therapy lized living donors (LDs). Only a few sporadic case reports exist with impacts the extent of ovarian fibrosis. By understanding the time frame of ovarian deceased/cadaveric donors (DDs), an approach with prolonged graft fibrosis, this may give TGM greater control over fertility as they transition. ischemia times. Our objective is to determine whether pregnancy rates are SUPPORT: None similar in DD to LD uterus transplantation. DESIGN: Prospective trial of DD uterus transplantation. MATERIALS AND METHODS: Candidates with absolute uterine factor P-945 3:30 PM Wednesday, October 21, 2020 infertility underwent extensive screening and testing. In vitro fertilization was performed prior to uterus transplantation. DDs were matched to potential NOVEL AND UNIQUE KEY MARKERS IN THE IN- recipients by ABO compatibility and CMV status. First embryo transfers FLAMMATORY PATHWAYS FOR GENITAL TUBER- were attempted at six months post-transplant. 1 CULOSIS (GTB). Madhavi M. Panpalia, MS, RESULTS: Eight DD uterus transplantations in total were attempted, with 1 2 Trupti Mehta, DGO, DNB, Shiva Chettiar, Ph.D., four patients achieving pregnancy (two with live born children by cesarean 2 1 Alpesh Patel, Ph.D., Sapna Agarwal, MD, Jyotshna Palgamkar, DGO, hysterectomy and two with ongoing pregnancies), two additional patients
FERTILITY & STERILITYÒ e533 with uterus still in situ but with recurrent implantation failures, and two pa- CONCLUSIONS: Four months of CAT or IAT did not change telomere tients experiencing postoperative complications necessitating graft hysterec- length and inflammation in PCOS. Both protocols are important treatment tomy prior to embryo transfer attempt. For those achieving pregnancy, the strategies for women with PCOS, reducing anthropometric indexes and hy- average baseline anti-mullerian hormone was 4.9 3.0, compared to perandrogenism, and the CATwas effective in the control of lipid parameters 1.3 0.1 for the non-pregnant group. The average number of frozen embryos in PCOS. prior to transplant was 8.5 (6.62 frozen blasts per IVF cycle) in the pregnant References: Mario FM, Graff SK, Spritzer PM. Habitual physical activity group and 5.0 (1.88 frozen blasts per IVF cycle) in the nonpregnant group. is associated with improved anthropometric and androgenic profile in PCOS: All donors were multiparous except two (one recipient with recurrent im- a cross-sectional study. J Endocrinol Invest. 2017;40(4):377-384. plantation failure and one with early graft loss). Average cold ischemia Pedroso DC, Miranda-Furtado CL, Kogure GS, et al. Inflammatory bio- time in minutes was 255 115 in the pregnant group and 324 47 in the markers and telomere length in women with polycystic ovary syndrome. non-pregnant group. All six patients with graft survival had onset of menses Fertility and sterility. 2015;103(2):542-547 e542. within 34 days of transplant. Average endometrial thickness at embryo trans- Williams DM, Buxton JL, Kantomaa MT, Tammelin TH, Blakemore AIF, fer was 9.8 1.9 mm in the pregnant group and 10.3 1.7 mm in the non-preg- J€arvelin MR. Associations of Leukocyte Telomere Length With Aerobic and nant group. The average total number of transfers performed was 1.25 0.5 in Muscular Fitness in Young Adults. Am J Epidemiol. 2017;185(7):529-537. the pregnant group and 4 1.4 transfers thus far in the nonpregnant group. SUPPORT: FAPESP, Fundac¸~ao de Amparo a Pesquisa do Estado de S~ao CONCLUSIONS: Our series is the largest trial of DD uterus transplanta- Paulo with the grant 2015/14031-0 (RMR) and fellowship 2012/11069-9 tion to date. Preliminary data show similar rates of key success milestones (CLMF) (graft survival, pregnancy, live birth) as in LD series. DD recipients with mul- tiple implantation failures had poorer IVF outcomes pre-transplant, suggest- ing that failures to conceive are due to embryo factors and not endometrial P-948 3:30 PM Wednesday, October 21, 2020 function. Given this, candidates for uterus transplantation should meet strin- gent criteria of number of cryopreserved blastocysts before undergoing a DEVELOPMENT AND VALIDATION OF A NOVEL uterus transplant procedure. MAIL-IN SEMEN ANALYSIS SYSTEM AND THE COR- RELATION BETWEEN ONE HOUR AND DELAYED SEMEN ANALYSIS TESTING. Mary Katherine Sam- 1 2 3 4 P-947 3:30 PM Wednesday, October 21, 2020 plaski, MD, Owen Falk, MS, Stan Honig, MD, David Shin, MD, William J. Matthews, BS,5 James Smith, MD, MS.6 1University of Southern CONTINUOUS AND INTERMITTENT AEROBIC California, Los Angeles, CA; 2Fellow, San Francisco, CA; 3Yale University, TRAINING DID NOT CHANGE TELOMERE LENGTH, New Haven, CT; 4Hackensack University Medical Center, Hackensack, NJ; ALTHOUGH IT REDUCES HYPERANDROGENISM 5Fellow Health Inc., San Francisco, CA; 6University of California, San Fran- AND ANTROPOMETRIC INDEXES IN POLYCYSTIC cisco UCSF, San Francisco, CA. OVARY SYNDROME. Cristiana Libardi M. Furtado, PhD,1 Victor Barbosa Ribeiro, PhD,2 Daiana CC. Pedroso, PHD,3 OBJECTIVE: To compare the results of standard one hour and delayed Gislaine S. Kogure, PhD,4 Rui A. Ferriani, MD, PhD,4 semen analysis (SA) testing to establish the effectiveness of a novel mail- Rodrigo T. Calado, MD, PhD,4 Rosana M. dos Reis, MD, PhD.4 1Federal in SA system. University of Ceara, Fortaleza, Brazil; 2Federal Institute of S~ao Paulo, DESIGN: Prospective cohort. Jacare ı, Brazil; 3FERTILITY CENTER OF RIBEIRAO~ PRETO - CEFERP, MATERIALS AND METHODS: Men undergoing SA in the San Fran- RIBEIRAO PRETO, Brazil; 4Ribeir~ao Preto Medical School, University of cisco Bay Area were recruited for SA testing with social media advertise- S~ao Paulo, Ribeir~ao Preto, Brazil. ments. One-hour SA (World Health Organization 5th edition), then repeat SA testing (on the same sample) was performed, at multiple time points OBJECTIVE: To evaluate the effects of continuous (CAT) and intermittent over 52 hours utilizing a novel technique for maintaining sperm viability. (IAT) aerobic exercises on telomere length and the implications on anthropo- RESULTS: 164 subjects were recruited with a subset of 26 for the valida- metric, hormonal and metabolic parameters of PCOS. tion portion of the study. One hour SA on 104 ejaculates from these 26 pa- DESIGN: Randomized controlled clinical trial. tients demonstrated mean semen volume 2.82 ml (SD 1.08 ml), sperm MATERIALS AND METHODS: 87 PCOS women were stratified concentration of 75.0 million/ml (SD 36.6 million/ml), total motility of randomly according to body mass index (BMI) into CAT (n¼28), IAT 59.8% (SD 9.1%), and normal morphology of 11% (SD 2.7%). With up (n¼29) and non-training control group (n¼ 30). Aerobic exercises were per- to 52 hours of observation and 4 subsequent SA measurements per ejaculate, formed on a treadmill, three times per week for four months. Telomere length sperm concentration was found to remain stable, motility declined by 0.39% was evaluated using qPCR and anthropometric, hormonal and metabolic pa- per hour, and normal morphology declined by 0.1% per hour (Table 1. rameters were measured, before and after 16-week of training or observation. Measured 1 hour and calculated motility (correlation coefficient (CC) Statistical analyses were carried out using SAS 9.0 software. 0.87) and morphology (CC 0.82) were strongly correlated. The low coeffi- RESULTS: CATand IAT did not change telomere length or the inflamma- cient of variation within concentration (3.9%), motility (3.0%), and tory biomarkers homocysteine and c-reactive protein after 16 weeks of morphology (4.7%) measurements exceeded minimal FDA standards training in PCOS. However, a negative correlation was observed between (10.0%) for SA testing. telomere length and age (p¼0.0324) and BMI (p¼0.0192). Booth exercises CONCLUSIONS: This novel, mail-in, CLIA-approved SA testing system reduced waist circumference (CAT, p¼0.045 and IAT, p¼0.014) and testos- demonstrates a high degree of correlation between 1-hour SA testing and de- terone levels (CAT, p¼0.032 and IAT, p¼0.019). Specifically, CAT reduced layed SA testing. This test was highly reproducible with coefficient of vari- hip circumference (p¼0.032) and cholesterol (p ¼ <0.01) and low-density ation exceeding current FDA standards for sperm concentration, motility and lipoprotein levels (LDL, p¼0.03), and IAT decreased the waist-hip ratio morphology. This test is particularly applicable given recent needs for social (p¼0.012) and free androgen index (p¼0.037). In the controls, WC distancing, concerns for rising prevalence of male infertility and possible pa- (p¼0.049) and total cholesterol (p¼0.010) increased after the observation tient concerns regarding privacy and embarrassment with face-to-face period. communication with a medical laboratory staff. Reliable home produced,
TABLE 1. Baseline Semen Parameters and Mean Change Per Hour with Repeated Measurements up to 52 Hours from Production (N¼ 104 ejaculates from 26 subjects) Mean Median Min Max Mean Change per Hour* 95% CI**
Volume (ml) 2.82 2.5 1.5 6.0 N/A N/A Concentration (million sperm/ml) 75.0 74.4 9.3 162.0 0.05 -0.09 0.19 Motility (%) 59.8 61 34 77 -0.39% -0.044% -0.35% Normal Morphology (%) 11 11 5 18 -0.10 -0.11% -0.09%
*Samples incubated in 5ml sperm media at random moderate temperatures. Semen analysis performed at least 3 times up to 52 hours after production. **Concentration P¼0.29; Motility P < 0.0001; Morphology P < 0.0001 e534 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 mail-in testing may increase access to SA testing and allow a reproductive MATERIALS AND METHODS: Women with history of subfertility were specialist to address any identified abnormalities in a timely manner. recruited from the Royal Women’s Hospital and Melbourne IVF in Australia. Clinical outcomes were followed up for at least 3.5 years. Participant were then assigned into recurrent implantation failure (RIF) group or control P-949 3:30 PM Wednesday, October 21, 2020 group. We defined RIF as absence of pregnancy after >3 embryo transfers (ETs) with high quality embryos or the transfer of R10 cleavage stage em- ABSENCE OF COVID-19 VIRUS WITHIN AN ACTIVE IVF bryos (or R5 blastocysts) in multiple transfers. Controls were women who LABORATORY USING STRICT PATIENT SCREENING had been pregnant within the last 2 years or who had conceived during the AND SAFETY CRITERIA. Sandeep K. Rajput, PhD,1 1 1 follow-up period after participation in the study. Shaihla A. Khan, PhD, Benjamin B. Goheen, BS, Endometrial biopsy and venesection were performed at LH plus 6 (+/- 1 Heidi J. Engelhorn, MS,1 Deirdre M. Logsdon, M.S.,1 Courtney K. Grimm, 1 1 1 1 day). Gene expression array of the endometrium was performed using Illu- MS, Rebecca Kile, MS, Rachel C. West, PhD, Ye Yuan, PhD, mina Human HT-12 v4.0. DNA isolated from blood samples was analysed William B. Schoolcraft, MD,2 Rebecca L. Krisher, PhD,1 Jason E. Swain, 2 1 2 on HumanCoreExome chips and Infinium PsychArray. Gene expression PhD, HCLD. CCRM Colorado, Lone Tree, CO; CCRM Fertility Network, data was normalized for cycle stage. Lone Tree, CO. RESULTS: There were 31 participants in the control group, and 41 partic- ipants in the RIF group. Participants in the RIF group had significantly more OBJECTIVE: In the early stages of the COVID-19 pandemic, most IVF previous unsuccessful ETs (p¼0.00), higher total number of embryos trans- clinics stopped the majority of patient treatment cycles to minimize the risk of ferred (p¼0.00) and shorter average menstrual cycle length (p¼0.04). No disease transmission. When ASRM and other professional societies recommen- other significant differences were noted between the two groups. ded resumption of treatments, procedures were put into place to ensure patient Initial DGE analysis showed significant differences in expression of some and staff safety. However, the risk of SARS-CoV-2 viral exposure and potential genes between the control and RIF groups after correction for cycle stage. cross contamination within the IVF laboratory remains largely unclear. The However, after correcting for multiple testing, there were no genes with objective of this study was to assess the true risk of exposure to SARS-CoV-2 significantly different expression between the two groups (FDR ¼ 0.9999). in an active IVF laboratory when strict patient screening procedures are in place. The top 100 differentially expressed genes from the RIF group were DESIGN: Prospective analysis. compared with a published gene expression signature for endometrial recep- MATERIALS AND METHODS: Prior to restarting IVF treatments, a tivity (Koot et al. 2016). Two common genes were identified - SMAD9 and COVID-19 safety protocol was implemented. Patients and staff were required NR5A2.Na€ıve calculation showed that these two genes were likely not sig- to wear masks, fill out a symptom-based questionnaire daily, have their temper- nificant, and due solely to chance. ature taken, and practice social distancing in patient waiting areas. Each female 52 endometrial samples from this study were incorporated in a larger patient undergoing transvaginal oocyte retrieval (TVOR) was required to have a cohort of endometrial samples for endometrial eQTL analysis (Fung et al. negative SARS-CoV-2 RNA test 3-4 days prior to the procedure. Male partners 2018). Five cis-eQTLs were identified – PIGP, MYOM2, RER1, POLR2J, were not tested. All cases examined utilized ICSI. The first tube of follicular fluid SCHIP1 in the top 100 differentially expressed genes for the RIF group. aspirated during TVOR (FF), culture media drops following removal of embryos CONCLUSIONS: Our results demonstrate in conjunction with the pub- on day 5 (M), and vitrification solution (VS) after blastocyst cryopreservation lished literature that no consistently reproducible endometrial genes linked were analyzed. Self-inactivating replication incompetent lentivirus particles con- to implantation failure have yet been identified. The identification of true ge- taining the single stranded viral RNA genome were immediately inoculated into netic association requires a large sample size and replication in different pop- each sample after collection as a positive control for viral RNA stability, prior to ulations. RIF due to reduced uterine receptivity is not a common occurrence, direct RNA isolation (M, VS) or sample concentration (FF). For FF, cell debris hence recruitment of subjects with true endometrial implantation failure is was removed by centrifugation and filtration (0.22 um) prior to concentration challenging. of virus particles with an Amicon filter. RNA was isolated using the optimized References: 1. Koot YEM, van Hooff SR, Boomsma CM, van Leenen D, QIAamp viral RNA minikit, RNA quantity and quality determined, and cDNA Groot Koerkamp MJA, Goddijn M, et al. An endometrial gene expression synthesized using SuperScript IV VILO master mix. A multiplex TaqMan-based signature accurately predicts recurrent implantation failure after IVF. Scien- qPCR assay was developed for SARS-CoV-2 and lentivirus RNA (detection limit tific Reports. 2016;6:19411. 5 SARS-CoV-2 copies/qPCR reaction and 50 viral copies/2 mL sample), and 2. Fung JN, Mortlock S, Girling JE, Holdsworth-Carson SJ, Teh WT, Zhu used to test all diagnostic samples. SARS-Cov2 synthetic RNA and lentivirus Z, et al. Genetic regulation of disease risk and endometrial gene expression RNA were used as an RT-qPCR positive control. Samples with no amplification highlights potential target genes for endometriosis and polycystic ovarian of lentivirus genome were removed from the analysis (false negative). syndrome. Scientific reports. 2018;8(1):11424-. RESULTS: In total, culture medium from 30 patients, vitrification solution from 98 patients, and follicular fluid from 156 patients were analyzed. All samples were negative for the presence of SARS-CoV-2 viral RNA. P-951 3:30 PM Wednesday, October 21, 2020 CONCLUSIONS: With stringent safety protocols in place, including pa- tient testing and use of ICSI, the presence of SARS-CoV-2 RNA can be PERFLUORINATED COMPOUND (PFC) EXPOSURE IN avoided in the IVF laboratory. Importantly, this study does not indicate OVARIAN GRANULOSA CELLS ALTERS GAP JUNC- that virus from an actively infected patient cannot be found in follicular fluid TION GENE EXPRESSION. Henry P. Mishek, Medical or make its way into the IVF lab. However, it does provide reassurance that Student, Kendra L. Clark, PhD, John S. Davis, PhD. University with proper patient testing and safety measures, cross-contamination of the of Nebraska Medical Center, Omaha, NE. virus between gametes and embryos (including within liquid nitrogen storage dewars), as well as exposure of embryologists, is minimal. OBJECTIVE: Perfluorinated compoundc (PFCs) are synthetic chemicals that are persistent in the environment and bioaccumulate in humans and an- imals. These substances are ubiquitous in drinking water, cookware, stain re- P-950 3:30 PM Wednesday, October 21, 2020 pellents, food storage, packing materials, and cosmetics. Perfluorooctanoic acid (PFOA) is the most commonly detected PFC and has been associated TRANSCRIPTOMIC AND GENOMIC SEARCH OF with reduced fecundity and infertility. Ovarian gap junctions facilitate the ENDOMETRIAL RECEPTIVITY MARKERS IN transfer of various nutrients, ions, metabolites, and nucleotides between WOMEN WITH RECURRENT IMPLANTATION follicular cells and the oocyte. It is possible that PFOA mediates its effects FAILURE. Wan Tinn Teh, MBBS, MRMed, FRANZCOG, by disrupting gap junction intracellular communication (GJIC) between PhD,1 Peter AW. Rogers, BSc, PhD.2 1Melbourne IVF, East Melbourne, 2 granulosa cells or altering expression of gap junction-related genes. In this VIC, Australia; University of Melbourne, Parkville, VIC, Australia. experiment, we aim to determine the effects of perfluorooctanoic acid (PFOA) exposure on connexin-43 (CX43) gene expression and GJIC in gran- OBJECTIVE: The primary aim was to perform differential gene expres- ulosa cells. sion (DGE) of endometrium to identify receptivity genes that are associated DESIGN: This study utilized a dye coupling method to assess GJIC in with implantation failure. The secondary aim was to interrogate recent endo- HGrC1 cells, an immortalized human granulosa cell line, after 24-hour metrial genome-wide association studies (GWAS) data to identify expression (24h) exposure to environmentally relevant concentrations of PFOA. quantitative trait loci (eQTLs) for receptivity genes that had been identified MATERIALS AND METHODS: Previous work in this lab has shown that through the DGE study. environmentally relevant concentrations (1-10 mM) of PFOA stimulate DESIGN: Transcriptomic and genomic studies of secretory phase endo- HGrC1 cell proliferation as early as 24 hours. Therefore, we utilized metrium.
FERTILITY & STERILITYÒ e535 concentrations of 1mM, and 10mM to assess GJIC with the vehicle dimethyl leic acids used as supplements in T4-LC/FA medium were promptly detected sulfoxide (DMSO, <0.1%) used as control. Cells were grown to confluence in the oocytes and seem contribute to better preserving membrane phospho- and then treated with PFOA for 24h. Luciferase Yellow (LY) and Rhoda- lipids during cell equilibration. mine-dextran (RhoD) dyes were loaded into cells using the scrape load tech- References: 1. De Lima CB, Ferreira CR, Milazzotto MP, Sobreira TJP, nique. Cells were incubated with the dyes for 5 minutes with subsequent Vireque AA, Cooks RG.Comprehensive lipid profiling of early stage oocytes washes to remove any residual dye, fixed, then imaged with confocal micro- and embryos by MRM profiling. Mass Spectrom. 2018 Dec;53(12):1247- scopy. The degree of dye migration was assessed using ImageJ. RNAwas iso- 1252. https://doi.org/10.1002/jms.4301. lated and real-time qPCR was performed to quantify CX43 gene expression. SUPPORT: Coordination for the Improvement of Higher Education RESULTS: Preliminary results showed that treatment with 10 mM PFOA Personnel (CAPES), Finance Code: 001 (process n. A^ 88887.371487/2019- significantly (P < 0.025) reduced the distance traveled by the dye compared 00); Foundation to Support Teaching, Research, and Assistance (FAEPA) with vehicle treated controls. qPCR analysis determined that 1mM PFOA at Clinical Hospital, Faculty of Medicine of Ribeir~ao Preto, University of induced a 2.1-fold increase in CX43 transcripts relative to vehicle control. S~ao Paulo; Invitra Assisted Reproductive Technologies LTDA. Brazilian Na- CONCLUSIONS: Few studies have been reported using environmentally tional Council for Scientific and Technological Development (CNPq), (pro- relevant concentrations of PFOA to elucidate the relationship between PFOA cess n. 305173/2019-7), Trial registration number: CEUA-FMRP/USP-107/ exposure and impaired ovarian processes. This study uses concentrations that 2017. are relevant to levels reported in human serum. Initial results indicate that PFOA reduces GJIC which may affect granulosa and follicle function. The increase in CX43 mRNA suggests a possible compensatory mechanism in P-953 3:30 PM Wednesday, October 21, 2020 response to PFOA exposure. IDENTIFICATION AND CHARACTERIZATION OF HU- MAN ENDOMETRIAL STROMA CELL-DERIVED P-952 3:30 PM Wednesday, October 21, 2020 EXOSOMES BY PROFILING THE PROTEIN COMPONENTS. Eing-mei Tsai, MD, PhD,1 ChiaYi Hsu, RELATIONSHIP BETWEEN THE DURATION OF PhD.2 1Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 2No. EQUILIBRATION STEP OF THE VITRIFICATION AND 100, Shih-Chung 1, Kaohsiung, Taiwan. CHANGES ON ABUNDANCE AND COMPOSITION OF OOCYTE MEMBRANE LIPIDS. Thalita S. Berteli, MSc,1 OBJECTIVE: To characterize and investigate the exosomes composition Eduardo D. Borges, MSc,1 Caroline M. Da Luz, MSc,1 present in the pathogenesis of endometriosis. Christina R. Ferreira, PhD,2 Paula A. Navarro, MD, PhD,1 DESIGN: We collect and purified exosomes that were derived from human Alessandra A. Vireque, PhD.3 1Faculty of Medicine of Ribeir~ao Preto - USP, eutopic and ectopic endometrioal stromal cells (EuESCs and EcESCs). We Ribeir~ao Preto, Brazil; 2Purdue University - Metabolite Profiling Facility, employed a proteomic approach to profile the protein composition of ESCs Bindley Bioscience Center, IN; 3Invitra – Assisted Reproductive Technologies and comparison the EuESCs-exos and EcESCs-exos protein to evaluate the LTD, Supera Innovation and Technology Park, Ribeir~ao Preto-SP, Brazil. role of exosomes on endometriosis pathogenesis. MATERIALS AND METHODS: Exosomes were isolated from ESCs cul- OBJECTIVE: Volumetric damages and cytotoxicity due to cryoprotec- ture supernatant by a combination of differential centrifugation. ESCs-exos tants exposure are time-sensitive in the vitrification process and can trigger obtained were extensively characterized using western blot to identify spe- the lipid remodeling of the plasma membrane. Here, we investigate the ef- cific exosomal markers，transmission electron microscopy (TEM), and fects of exposure time to equilibration solution (ES) on membrane lipid pro- nanoparticle tracking analysis (NTA) to identify specific exosomal structure file of C57BL/6J mice oocytes using MRM-profiling, a sensitive exploratory and size. The proteomics profiling of exosomes derived from ESCs via method for lipidomics of oocytes and embryos1. We also assessed the effects UPLC-MS/MS. Identified exosomes protein were analysed using Ingenuity of supplementing ES with antioxidants and unsaturated fatty acids. Experi- Pathway Analysis (IPA) to determine the associated functions and pathways. mental groups included oocytes equilibrated with Irvine Scientific (IRV), a We performed the XTT assays, migration assay and angiogenesis to examine commercial standard vitrification medium; Tvitri-4 (T4) produced in small the function of exosome protein. scale for research by INVITRAÒ, and Tvitri-4 supplemented with L-carni- RESULTS: A total of 105 proteins were identified from EuESCs-exos and tine (LC) and oleic and linoleic fatty acids (FA) (T4-LC/FA; Patent n. EcESCs-exos by UPLC- MS/MS analysis. Among these, 36 proteins were BR102019013697-9). different in EcESCs-exos compared to EuESCs-exos. We noted that ANXA2 DESIGN: Experimental study. was as one of the potential candidate expression protein in EcESCs-exos. The MATERIALS AND METHODS: Oocytes were randomly divided in 7 identified proteins were subjected to IPA for pathway prediction and function an- groups: non-exposed (NE) and exposed to either 10-minute equilibration notations. The data showed that ANXA2 were closely associated with cell step (ES10) according to the manufacturer’s procedure or 7-minute equilibra- morphology, amino acid metabolism, cell cycle, cell to cell signaling and inter- tion step (ES7), using IRV, T4, or T4-LC/FA media. After equilibration, oo- action, and cellular assembly and organization. The data show that ANXA2 was cytes were washed in methanol: H2O and lipids extracted with methanol. high expression in EcESCs-exos, suggesting that exos-ANXA2 were association Diluted lipid extracts were flow injected into the triple quadrupole spectrom- with endometriosis. We found that exos-ANXA2 increased cell growth, motility eter with electrospray ionization (ESI). Relative ion intensities were used for and angiogensis. It indicated that exos-ANXA2 was involved in regulating endo- univariate (ANOVA, fold-change, t-test, volcano plot) and multivariate anal- metriosis. Our data suggest the function of ANXA2 mediated by exosomes can ysis (PCA, PLS-DA, cluster analysis). Most informative lipids were sorted regulate cell proliferation and motility of ESCs, which can imply in endometri- out using statistical significance of p<0.05 or partial least square discrimi- osis pathogenesis. nant analysis (PLS-DA) variables of importance (VIP) scores>1. CONCLUSIONS: In conclusion, we demonstrate a function of ANXA2 in RESULTS: One-way ANOVA showed PC (38:8) differently represented endometriosis pathogenesis mediated by exosomes, and through regulation among NE, ES7 and ES10 groups, upregulated in T4-LC/FA oocytes. In of the ERK/STAT3 pathway and angiogenesis in endometriosis. ES7 groups, two by two comparisons between IRV, T4 and T4-LC/FA using SUPPORT: This work is supported by MOST Taiwan [grant number 108- volcano plot (p-value%0.05; fold-changeR2.0) detected 4, 5, and 4 signifi- 2314-B-037-069-MY3]. cant lipids between IRV vs. T4, IRV vs. T4-LC/FA, and T4 vs. T4-LC/FA, respectively, with the PEo(36:1) overrepresented in IRV (fold-change¼12.5). In ES10 groups, were detected 11, 19 and 4 lipids differentially represented P-954 3:30 PM Wednesday, October 21, 2020 among IRV vs. T4, IRV vs. T4-LC/FA, and T4 vs. T4-LC/FA, respectively. PLS-DAVIP scores identified in IRVoocytes 8 free- fatty acids, phosphatidy- IMPACT OF ADJUVANT CHEMOTHERAPY OR letanolamine PEo(36:1), phosphatidylcholines PCo(32:0) and PC(36:3), TAMOXIFEN ALONE ON THE OVARIAN RESERVE phosphatidylserines PS(14:1), PS(16:0), PS(30:2), PSo(40:5), and phospha- OF YOUNG WOMEN WITH BREAST CANCER: A PRO- SPECTIVE LONGITUDINAL STUDY. Kutluk H. Oktay, tidylinositols PI(22:4) and PI(40:8) among the top features, whereas unsatu- 1 2 3 rated PC and SM predominated in T4 and T4-LC/FA oocytes. Significant M.D., Ph.D., Volkan Turan, M.D., Giuliano Bedoschi, MD, Enes Taylan, MD,1 Heejung Bang, PhD,4 Maura Dickler, MD,5 lipids observed between T4 and T4-LC/FA pointed oleic (18:1) and linoleic 5 1 (18:2) acids upregulated in T4-LC/FA oocytes exposed for 10 min to ES. Shari Goldfarb, MD. Yale University School of Medicine, New Haven, CT; 2Memorial Bahcelievler Hastanesi, CT; 3Ribeiaro Preto School of Med- CONCLUSIONS: The duration of the equilibration phase changed the 4 5 abundance and composition of membrane lipids. Phospholipids were upregu- icine, CT; UC Davis, New Haven, CA; Memorial Sloan Kettering Cancer lated at 10-minute exposure to ES, except in IRVoocytes. The oleic and lino- Center, New York, NY. e536 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 OBJECTIVE: To determine the longitudinal impact of adjuvant chemo- US. They were asked to select which of two embryos to transfer from each therapy and tamoxifen-only treatments on the ovarian reserve recovery pat- set. The same 200 sets of embryos, but with indication of which embryo in terns of women with breast cancer by using a ultra-sensitive Anti-Mullerian each set had been identified by the algorithm was then distributed and they Hormone (AMH) assay. were again asked to select which to transfer. Paired t-test and receiver oper- DESIGN: Multi-Center Prospective Longitudinal. ating curves were performed in Stata to compare the percent of embryos with MATERIALS AND METHODS: One-hundred.-and-forty-two women successful implantation selected by embryologist visual assessment alone to with a primary diagnosis of breast cancer were prospectively followed those selected with aid of the algorithm. with serum AMH assessments before the initiation, and 12, 18 and 24 months RESULTS: Embryologists provided with AI results selected embryos after the completion of adjuvant chemotherapy or the start of tamoxifen-only which successfully implanted in 76.5% of cases compared to 69.5% for those treatment. The chemotherapy regimens were classified into Anthracycline- selected using visual assessments alone (p<0.019). All 14 embryologists Cyclophosphamide-based (AC-based) and Cyclophosphamide-Metho- improved in their ability to select embryos with the aid of the AI algorithm trexate+5-Fluorouracil (CMF). Longitudinal data were analyzed by mixed with a mean percent improvement of 11.1% (range 1.4% to 15.5%). Accu- effects model for treatment effects over time, adjusting for baseline age racy of selection improved after addition of AI as well. The AUC (95% and BMI. CI) for embryo selection by an embryologist alone compared to the same RESULTS: Both chemotherapy regimens resulted in significant decline in embryologist with AI was 0.69 (0.62-0.75) and 0.76 (0.70-0.82) respectively ovarian reserve compared to the tamoxifen-only treatment (p<0.0001 either (p<0.016). There were no differences in degree of improvement by embry- regimen vs. tamoxifen for overall trend). The AMH levels sharply declined at ologist level of experience (junior, intermediate, senior). 12 months and the level of decline did not differ between the two chemo- CONCLUSIONS: The incorporation of an AI framework for blastocyst se- therapy groups (p¼0.53).There was no significant recovery from 12 to 18 lection enhanced the performance of trained embryologists in identifying and 18 to 24 months after the completion of AC-based or CMF regimens PGT-A euploid embryos destined to implant. A large randomized controlled (p¼0.97). While the mean/median AMH level was 0.34/0.09 ng/dl at the trial is warranted to confirm that embryologists in combination with AI can 12-month time point, it was 0.40/0.06 ng/dl and 0.42/0.07 ng/dl at 18- and improve in-vitro fertilization outcomes by selecting embryos with higher im- 24-month time points for the AC-based regimens group. These values were plantation potential than the current method of visual assessments alone. 0.11/0.03, 0.12/0.02 and 0.20/0.03 at the 3 time points for the CMF group. References: 1. Hariton E, Dimitriadis I, Kanakasabapathy MK, Thiruma- These mean levels are substantially below the threshold for normal ovarian laraju P, Gupta R, Pooniwala R, Souter I, Rice ST, Bhowmick P, Ramirez LB, reserve, which is generally 1.1 ng/mL or higher for the age group. AMH Boehnlein L, Swain, JE, Curchoe CL, Bormann CL, Shafiee H. A deep levels remained undetectable in 20% (15/76) vs. 38% (5/13) of women in learning framework outperforms embryologists in selecting day 5 euploid the AC-based regimens vs. CMF groups at 24 months (p¼0.16 from Fisher blastocysts with the highest implantation potential. Fertility and Sterility. exact test). In contrast, tamoxifen-only treatment did not significantly alter 2019:112(3), e77-e78. the age-adjusted serum AMH levels over the 24-month follow up. Likewise, SUPPORT: SUPPORT: This work was partially supported by the Brig- the use of adjuvant tamoxifen following AC-based regimens did not affect ham Precision Medicine Developmental Award (Brigham Precision Medi- AMH recovery. cine Program, Brigham and Women’s Hospital), Partners Innovation CONCLUSIONS: Our study is the first to assess ovarian reserve changes Discovery Grant (Partners Healthcare), and R01AI118502, and with serum AMH in a prospective longitudinal fashion, with multiple time R01AI138800. points up to 24-month post-completion of chemotherapy, and in comparison with tamoxifen-only treatments. It shows that both AC-based regimens and CMF significantly compromise ovarian reserve, without a recovery beyond P-956 3:30 PM Wednesday, October 21, 2020 12 months post-chemotherapy. In contrast, tamoxifen-only treatment does not alter serum AMH levels. The latter also indicates that the ovarian reserve OLDER OLIGOASTHENOZOOSPERMIC MEN HAVE of women who are on long-term tamoxifen treatment can be reliably assessed ALTERED TELOMERE BIOLOGY AND LESS CHAN- by serum AMH. This study provides novel information which will be useful CES THAN CONTROLS FOR ASSISTED REPRODUC- in counseling young women with breast cancer for fertility preservation and TIVE TECHNOLOGY OUTCOMES (ART). Isabel Cordova-Oriz, MSc,1 Raquel Garc ıa-Panadero, MSc,2 in assessing post-chemotherapy ovarian damage and recovery. 2 3 SUPPORT: This study was supported by RO1 HD053112 from the Eunice Guillermo De Alba, MSc, Alberto Pacheco, PhD, Carlos Balmori, MD,4 Lucı´a Chico-Sordo, MSc,1 Alba M. Polonio, MSc,1 Kennedy Shriver. National Institute of Child Health and Human Develop- 5 2 ment (NICHD), and National Cancer Institute. Marta Medrano, B.Sc, Juan A. Garcia-Velasco, MD, PhD, Elisa Varela, PhD5 1IVI Foundation, IIS La Fe, Valencia, Spain; 2IVI Madrid, Rey Juan Carlos University, Madrid, Spain; 3IVIRMA Madrid, Madrid, Spain; 4Rey 5 P-955 3:30 PM Wednesday, October 21, 2020 Juan Carlos University, IVI Madrid, Madrid, Spain; IVI-RMA Madrid, Rey Juan Carlos University, Madrid, Spain. SHOULD THERE BE AN ‘‘AI’’ IN TEAM?: EMBRYOLOGISTS IMPROVE SELECTION OF HIGH OBJECTIVE: The male factor accounts for half of the infertility cases that IMPLANTATION POTENTIAL EMBRYOS WITH request ART. Beyond known causes, such as genetic, metabolic, endocrine, THE AID OF AN ARTIFICIAL INTELLIGENCE infectious or anatomic, new pathways could enlighten the 30% unexplained ALGORITHM. Victoria W. Fitz, MD, MSCR,1 cases of male infertility. Because the telomere pathway affects organ func- Manoj Kumar Kanakasabapathy, MS,2 Prudhvi Thirumalaraju, BS,2 tion, due to telomere attrition with age, it is a good candidate to explain idio- Leslie B. Ramirez, PhD,3 JasonE.Swain,PhD,HCLD,4 pathic infertility. Telomeres consist of DNA tandem repeats, which are bound Carol Lynn Curchoe, PhD, TS (ABB),5 Kaitlyn E. James, PhD,1 by a protein complex, known as shelterin, which localize at the ends of linear Irene Dimitriadis, MD,1 Irene Souter, MD,1 CharlesL.Bormann,PhD,1 chromosomes, safeguarding chromosome integrity. While in somatic differ- Hadi Shafiee, PhD.2 1Massachusetts General Hospital, Harvard Medical School, entiated cells telomere lenght (TL) decreases with age, spermatozoa show Boston, MA; 2Brigham and Women’s Hospital, Harvard Medical School, Bos- long telomeres. The objective of the study is to evaluate whether the telomere ton, MA; 3Extend Fertility, New York, NY; 4CCRM Fertility Network, Lone pathway is associated with low quality sperm parameters and ARToutcomes. Tree, CO; 5San Diego Fertility Center, San Diego, CA. DESIGN: Analytic prospective cohort study. MATERIALS AND METHODS: 80 males were recruited between 2018 OBJECTIVE: A deep learning artificial intelligence (AI) algorithm has and 2019 from IVIRMA Madrid. The cohort includes two different age been demonstrated to outperform embryologists in identifying euploid em- groups, younger than 25 and older than 40, composed of normozoospermics bryos destined to implant with an accuracy of 75.3% (1). While initial AI se- (NZ) or oligoasthenozoospermics (OAZ) men (25 people per group). Leuko- lection results are promising, this method of selection is completely driven by cytes and spermatozoa were extracted and then, evaluated for TL and TRF1 an algorithm and does not factor in the visual assessment of an embryologist. levels by Quantitative Fluorescent In Situ Hybridization followed by image Our aim was to evaluate the performance of highly trained embryologists in acquisition using high resolution confocal microscope. CY3-fluorescent in- selecting top quality day 5 euploid blastocysts with and without the aid of a tensity (telomeres) was analyzed with the Definiens software. Seminal and deep learning algorithm. IVF s parameters were assessed according to IVIRMA standard protocols. DESIGN: Before and after. RESULTS: In blood, a tendency to higher TL in young NZ compared with MATERIALS AND METHODS: A non-overlapping series of 200 sets of OAZ was observed. In addition, a lower percent of long telomeres was Day 5 euploid embryo images with known implantation outcomes was observed in OAZ (30% vs 45.26%, p ¼ 0.015). Interestingly, a trend towards distributed to 14 highly trained embryologists from multiple centers in the telomere lengthening with age was observed in NZ spermatozoa from both
FERTILITY & STERILITYÒ e537 age groups. TL was similar in young groups while in older groups TL was consequences, were patients invited by email, on the 16th of June 2020, to statistically significantly different (134.6 15.95 a.u vs 113.6 12,99 participate in an online questionnaire study (T1). Consenting participants a.u, NZ and OAZ respectively, p ¼ 0.035). Moreover, an accumulation of provided demographic information and completed the validated FertiQoL critically short telomeres was found in older OAZ (3.28 % vs 11.68 %, NZ and SCREENIVF questionnaires. and OAZ respectively; p ¼ 0.043). To analyse telomere protection, TRF1 Mean scores were compared using the Paired-Samples T Test, while the levels were studied. In blood, younger OAZ showed lower levels of TRF1 McNemar test was used on paired nominal data. (317.3 49.93 a.u vs 267.7 40.02 a.u, NZ and OAZ respectively; p ¼ RESULTS: From the 336 invited patients, 120 responded. More women 0.010) and accumulated a higher percent of low TRF1 levels at telomeres (n¼79) than men (n¼41) agreed to participate in the study. Of the 120 par- (16.9% vs 25.22 %, p ¼ 0.001). Regarding ART outcomes, a lower rate of ticipants, 72 (60%) completed the SCREENIVF at T0. We analyzed the dif- fertilization per Metaphase II oocytes (0.358 0.072 vs 0.811 0.019, p ference between scores at T0 and T1 of those 72 participants. At T1, the mean < 0.0001) and a higher rate of abortion (0.277 0.188 vs 0.014 0.014, score of the SCREENIVF was higher in the domains Anxiety, (mean score T0 p ¼ 0.032) was found in older OAZ after intracytoplasmic sperm injection 4.0 3.2 vs T1 5.3 3.5, p¼0.002), and Helplessness (mean score T0 using donor oocytes and transfer. 10.7 3.0 vs T1 12.7 4.7, p<0.001). There was no significant difference CONCLUSIONS: OAZ patients have a shorter systemic TL already detect- in the domains Social support and Acceptance. In the domain depression, able at young age and also patent in sperm at older ages, possibly due to telomere the mean score was higher at T0 (mean score T0 6.2 4.7 vs T1 3.7 3.2, unprotection with low levels of TRF1. Therefore, in OAZ patients, alteration of p<0.001). The number of participants scoring high at risk of emotional telomere biology could cause the premature aging of the reproductive system. distress on the different domains of the SCREENIVF was higher at risk on Additionally, older OAZ had worse ARToutcomes in contrast with NZ, suggest- T0 (29.2% vs 11.1%, p¼0.011). ing that correct TL maintenance is a potential molecular marker of sperm quality During COVID-19 pandemic, the total score of the FertiQoL off all partic- to consider at older ages, before performing ART. ipants was 71.1( 12.5). Women had lower total FertiQoL scores (68.7 References: 1. Jungwirth A, Giwercman A, Toumaye H et al., European 11.4) than men (75.8 13.8; P ¼ 0.003); this was true for each domain Association of Urology Working Group on Male Infertility, 2012, European (except Relational). association of urology guidelines on male infertility: the 2012 update, Eur CONCLUSIONS: This study shows the impact of the COVID-19 Urol, 62, pp. 324-332. pandemic on emotional distress, especially revealed by more feelings of anx- 2. Brake A, Peeters K, Punjabi U and Dewilde S, 2018, A search for mo- iety and helplessness. Meanwhile, patients’ level of depression showed a lecular mechanisms underlying male idiopathic infertility, Reproductive decrease in times of pandemic compared to the time of the first consultation. BioMedicine Online, 36, pp. 327-339. Those results might be explained with the thought that due to the pandemic 3. Martinez P and Blasco MA, 2011, Telomeric and extra-telomeric roles there is more loss of control (i.e. related to anxiety) than loss of hope (i.e. for telomerase and the telomere-binding proteins, Nature reviews; 11, pp. related to depression). We need to address the increased feelings of anxiety 161-176. and helplessness in our patients. 4. Jørgensen PB, Fedder J, Koelvraa S and Graakjaer J, 2013, Age-depen- dence of relative telomere length profiles during spermatogenesis in man, Maturitas, 75, pp. 380-385. P-958 3:30 PM Wednesday, October 21, 2020 ASSOCIATIONS AMONG MORPHOLOGICAL PA- P-957 3:30 PM Wednesday, October 21, 2020 RAMETERS, CLINICAL FACTORS AND EUPLOID BLASTOCYST FORMATION. Jo~ao Paolo Bilibio, PhD,1 THE IMPACT OF THE COVID-19 PANDEMIC IN TERMS P^anila Longhi Lorenzzoni, MsC,2 Arivaldo Jos e Conceic¸~ao OF QUALITY OF LIFE AND DISTRESS IN INFERTILITY, Meireles, PhD.3 1Federal University of Par a, Bel em, Brazil; 2Federal Univer- A QUESTIONNAIRE STUDY. Simone Cornelisse, MD, sity of Rio Grande do Sul, Porto Alegre, Brazil; 3Pronatus Human Reproduc- Dagmar E. Besselink, MD, Merel Sabine Vos, BSc, tion Clinic, Bel em, Brazil. Aleida G. Huppelschoten, MD, PhD, Didi DM Braat, Proffesor, and Chris M. Verhaak, Professor (Associate) Radboud University Medical Centre, OBJECTIVE: To evaluate the association among embryonic morpholog- Nijmegen, Netherlands. ical parameters, clinical factors and euploid blastocyst formation. DESIGN: Prospective cohort study. OBJECTIVE: The COVID-19 pandemic has an impact on daily life as well MATERIALS AND METHODS: There were a total of 430 blastocyst em- as fertility care. Evidence supports the notion that infertility causes substan- bryos that underwent PGT-A by next-generation sequencing (NGS) from 135 tial emotional distress and has a significant impact on a person’s quality of patients who underwent intracytoplasmic sperm injection (ICSI) during the life. The effects of the COVID-19 pandemic on experiencing emotional study period, June 2018 to June 2019. Embryo biopsy occurred on D5 or distress in subfertile patients compared with their pre pandemic situation D6 according to the blastocyst morphology. Only blastocyst embryos with are unclear. In this study the impact of the restrictive consequences of a visible inner cell mass and with a degree of expansion greater than 2 COVID-19 in terms of emotional distress and infertility related quality of were submitted to biopsy. After embryo biopsy, all fragments were sent for life is investigated, by comparing the pre pandemic emotional distress in a PGT-A. After the results were obtained, statistical analysis was performed cohort of men and women at time of the first consultation in our fertility to assess the association of the risk of aneuploidy with the characteristics clinic with distress and quality of life during the COVID-19 pandemic. of embryonic development and the couple’s clinical infertility factors. DESIGN: An online questionnaire study regarding couples with an indica- RESULTS: Of 422 blastocysts, 200 (47.4%) were euploid, and 222 tion for IVF, whose treatment was, due to the restrictive measures of the (52.6%) were aneuploid. Women over 38 years old were more likely to COVID-19 pandemic, interrupted or postponed without knowledge of the form aneuploid embryos (OR: 3.4, CI: 2.2-5.4, P<0.001). Poor ovarian length of time. reserve (OR: 3.3, P<0.001), increased male age (39.0 versus 40.7, MATERIALS AND METHODS: Pre pandemic, all patients in our clinic P¼0.019), and decrease in the percentage of sperm with normal morphology received the SCREENIVF questionnaire during their first consult as a stan- (2.5% vs. 1.9%, P¼0.047) were associated with aneuploidy. Type C troph- dard procedure (T0). After closure of our clinic in March due to the restrictive oectoderm (TE) and type C inner cell mass type were associated with a
TABLE 1. Predictive value, likelihood ratio, sensitivity, and specificity for diagnosis of embryo aneuploidy Pretest prevalence PPV NPV LR+ LR- Sensitivity (%) Specificity (%)
Two factors Maternal age > 38 years + ICM type C 52.6 81.8 49.6 4.0 0.9 12.0 97.0 Maternal age > 38 years + 52.6 88.6 51.4 7.0 0.8 17.4 97.5 TE type C Three factors Maternal age > 38 years + TE type C + 52.6 85.0 48.8 5.1 0.9 7.6 98.6 ICM type C
PPV: Positive predictive value; NPV: Negative predictive value; LR: Likelihood ratio; ICM: Inner cell mass; TE: Trophoectoderm. e538 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 high risk of embryo aneuploidy with an OR of 4.1 (CI: 2.2-7.7, P<0.001) and OBJECTIVE: Endometriosis has a debilitating impact on women’s lives, (OR: 1.7, CI: 1.01-3.0, P¼0.048), respectively. Logistic regression analysis including severe pain, infertility and interference with daily life. For most revealed maternal age and type C TE as the main risk factors for aneuploidy. women with endometriosis, the diagnosis is often missed, misdiagnosed Among combinations of factors (table 1), the best marker for the risk of aneu- and it is usually takes years before the right diagnosis is made. The first ploidy was maternal age above 38 years combined with an embryo with step in alleviating the adverse sequelae on endometriosis is to promptly trophoectoderm type C, which had a positive predictive value of 88.6% and accurately diagnose it. Unfortunately, there is usually a delay especially and specificity of 97.5%. in women with lower socioeconomic background as the diagnosis is made surgically. Our study is to evaluate the positive predictive value (PPV) of Nezhat Endometriosis Advisor CONCLUSIONS: The trophoectoderm and inner cell mass type C are the mobile application questionnaire as a noninvasive screening test for the major embryo risk factors for aneuploidy, explaining approximately 71% and diagnosis of endometriosis in patients experiencing severe or chronic pelvic 60% of the risk, respectively. Among clinical factors, advanced maternal and pain, recurrent pregnancy loss, or unexplained infertility. paternal age (greater than 38 and 36 years, respectively), antral follicle (< 5), DESIGN: Retrospective study design. and low percentage of sperm with normal morphology increased the risk of MATERIALS AND METHODS: Retrospective cohort study at a univer- embryonic aneuploidy. sity-affiliated private practice. Inclusion criteria were women who had no previous surgical diagnosis of endometriosis who utilized the app and was scheduled for laparoscopic surgery due to history. Patients then underwent P-959 3:30 PM Wednesday, October 21, 2020 laparoscopic surgery with an indication of diagnosing and treatment of suspected endo- IS UNIVERSAL SCREENING OF IVF PATIENTS FOR metriosis. The primary outcome SARS-COV-2 JUSTIFIED? Daniel S. Seidman, MD,1 measured was the PPV of Nezhat Endometriosis Advisor mobile applica- Arik Kahane, MD,2 Adrian Shulman, MD,1 Eyal Schiff, tion questionnaire to the MD,1 Tal Shavit, MD1 1Assuta Medical Center, Ramat-Ha- surgical diagnoses of endometriosis. Statistical analysis was performed us- chayal, Tel-Aviv, Israel; 2Assuta Medical Center, Rishon LeZion, Israel. ing SPSS v.25.0. RESULTS: 30 patients met the inclusion criteria so far for our on going OBJECTIVE: Resuming all ART treatments in Israel, following the study. 95.0% of patients who had a screening test result of 90% or more COVID-19 lockdown put into effect on March 22, 2020, was fraught with on the app, had a surgical pathology confirmed diagnosis of endometriosis. concern, as the pandemic is still raging. One of the safety measures imple- However 100% of the patients who had a screen result of >90% on the mented was universal screening for SARS-CoV-2 of all ART patients. Our app, had visual diagnosis of endometriosis at different stages at the time of aim was to assess the usefulness of this measure. surgery. The 8% who did not have pathological confirmation of endometri- DESIGN: Cohort study. osis, had fibrosis diagnosed which may be due to late presentation of endo- MATERIALS AND METHODS: All women initiating ART treatment metriosis example burnt out endometriosis presentation. The PPV of the st from May 1 , through July 17, 2020, at one of the two IVF Units of the As- screening questionnaire for endometriosis was 95.0%. In patients with app suta Medical Centers, were required to undergo screening with nasopharyn- scores between 75-90%, pathology confirmed endometriosis 80% of times. geal swabs and a quantitative polymerase-chain-reaction test to detect Few patients who had diagnostic surgery despite low scores, endometriosis SARS-CoV-2 infection. All women with symptoms of Covid-19 or those was confirmed in less than 10% of the cases. All patients had complete res- with recent exposure to an infected person were not allowed to commence olution or improved symptomatology after surgery. ART treatment. Since almost all of the IVF cycles performed at our centers CONCLUSIONS: Nezhat Endometriosis Advisor mobile application are fully covered by the Israeli national health insurance, treatment is very questionnaire has a high PPV of 95% for diagnosing endometriosis and can accessible, and thus we believe that our sample is representative of the coun- help identify a patient population that may require surgical treatment for pel- try’s COVID-19 prevalence. vic pain or unexplained infertility. This will be helpful as it may lead to RESULTS: A total of 4,259 asymptomatic women underwent ART treat- earlier presentation of endometriosis which will help with treatment and ments at the Assuta Medical Centers, 2,787 ovum pick-ups and and 1,472 management. This is also very beneficial to patients in lower socioeconomic frozen embryo transfers. Overall, 23 women (0.54%) tested positive for demographics who may not have easy access to healthcare and may other- SARS-CoV-2. The rate of women who tested positive was similar in our wise suffer for a long time with pain or infertility before a diagnosis is IVF center in Tel-Aviv, 11 of 2,299 women (0.48%), and in our more south- made. More research is needed to determine the continued accuracy of the ern Rishon Lezion center, 12 of 1,970 (0.61%). An additional 11 women had app in different patient population and demographics. to cancel their IVF treatment as their male partner was tested positive for References: 1) Nezhat C, Vang N, Tanaka PP, Nezhat C. Optimal Manage- SARS-CoV-2. Only a fifth of the positive patients came from cities declared ment of Endometriosis and Pain. Obstet Gynecol 2019; 134:834-839. by the Ministry of Health as Covid-19 hotspots. 2) Nezhat C, Nezhat F, Nezhat C. Endometriosis: ancient disease, ancient CONCLUSIONS: Our use of universal SARS-CoV-2 testing in all ART pa- treatments. Fertility and Sterility 2012; 98:S1- S62. tients initiating ART treatment revealed that at this point in the pandemic in cen- 3) Agarwal SK, Chapron C, Giudice LC, et. al. Clinical diagnosis of endo- tral Israel, one in 200 asymptomatic women starting an ART treatment cycle was metriosis: a call to action AJOG 2019; 220:354e.1 - 354e.12. positive for SARS-CoV-2. This ratio is approximately 10 times lower than the current rate among women screened in Israel due to Covid-19 related symptoms or exposure to a positive person. The potential benefit of universal testing for P-961 3:30 PM Wednesday, October 21, 2020 Covid-19 includes the ability to protect patients and health care staff during these challenging times by lowering the risk of novel coronavirus exposure in the ART A COMPREHENSIVE COVID-19 RISK MITIGATION clinic. However, universal screening may burden the limited testing resources STRATEGY FOR SAFE PATIENT CARE AND STAFF and may lead to less vigilant use of personal protective measures. WELLNESS DURING A GLOBAL 1 SUPPORT: None PANDEMIC. Mandy G. Katz-Jaffe, PhD, Lauren Henry, BS,1 Nathan McCubbin, BS,1 Rachel Tucci, BS,1 Rachel S. Mann, BS, MS,1 Susanna McReynolds, PhD,1 William B. Schoolcraft, MD2 1Colorado P-960 3:30 PM Wednesday, October 21, 2020 Center for Reproductive Medicine, Lone Tree, CO; 2CCRM Colorado, Lone Tree, CO. CAN WE DIAGNOSIS ENDOMETRIOSIS WITH A PHONE APP? NEZHAT ENDOMETRIOSIS ADVISOR OBJECTIVE: In the midst of the COVID-19 epidemic and the estimation MOBILE APPLICATION AS A PREDICTOR FOR that the vast majority of the population remains susceptible to SARS-CoV-2 ENDOMETRIOSIS IN PATIENTS EXPERIENCING infection, a comprehensive risk mitigation strategy to identify asymptomatic PELVIC PAIN, INFERTILITY OR UNEXPLAINED and pre-symptomatic carriers is key to providing safe clinical care during INFERTILITY. Janelle M. Jackman, MBBS,1 Anuj Vaid, BA,2 fertility treatment. The objective of this study was to evaluate the efficiency Shruti Agarwal, DO,1 Azadeh Nezhat, MD,3 Camran Nezhat, MD.3 1Cam- of a combined triage protocol and molecular testing for active SARS-CoV-2 ran Nezhat Institute, Center for Special Minimally Invasive and Robotic sur- viral infection for both patients and staff from a multi-site IVF network. gery, Stanford University Medical Center, Palo Alto, CA; 2Drexel University, DESIGN: Prospective study. Philadelphia, PA; 3Camran Nezhat Institute, Center for Special Minimally MATERIALS AND METHODS: A symptomatic triage was performed Invasive and Robotic surgery, Stanford University Medical Center, Univer- whereby all patients were contacted by phone for the presence of COVID- sity of California San Francisco, Palo Alto, CA.
FERTILITY & STERILITYÒ e539 19 symptoms or if they had been in contact with someone suspected or TABLE (1). confirmed to be positive for the virus. Only patients determined to be at G1 (n¼10) G2 (n¼ 30) P value low risk for COVID-19 were allowed to enter the clinic for fertility treatment. Both patients and staff were required, upon arrival at the clinic, to wear a TEX101 (ng/ml) 13.5 (7.5-22.3) 9.8 (2.8-18.2) 0.014 mask, complete a symptom-based questionnaire, record body temperature, FSH (mIU/ml) 5.1 (3.5-9.2) 13.9 (3.5-31.2) 0.001 and keep a safe social distance of more than 6 feet at all times. Any individual O LH (mIU/ml) 4.2 (2.4-6.5) 6.3 (2.7-27) 0.01 recording a fever over 100.4 F and/or two or more symptoms was instructed Total testosterone 5.1 (2.2-13) 4.5 (1.9-10.8) 0.818 to stay/return home for self-quarantine. Specimen collection for viral (nmol/L) screening involved an anterior nare sampling method and storage in a FDA approved viral transport medium. Viral RNA was isolated using the Data are expressed as median (range). MagMAXÔ Viral/Pathogen II (MVP II) Nucleic Acid Isolation Kit (Thermo Area under curve using ROC was 0.76 and a cut-off value of R9.9 ng/ml Fisher Scientific). Molecular testing for active SARS-CoV-2 viral RNA showed sensitivity of 90% and specificity of 57% in pre-operative TEX- infection was performed using the FDA emergency use authorized TaqPathÔ 101 prediction of recovery of sperms. RT-PCR COVID-19 test (Thermo Fisher Scientific) for every patient within 3-5 days prior to oocyte retrieval or an attempt to achieve a pregnancy, and for all staff bi-weekly. Positive cases were reported to each respective local State CONCLUSIONS: Pre-operative seminal TEX-101 can be used as a pre- Health Department. dictor for recovery of sperms in the ejaculate after varicocelectomy in men RESULTS: Of the 2,074 patients tested for COVID-19 between May with NOA and palpable varicocele. and July 2020 across nine fertility clinics in the US, only 3 (0.15%) NCT04397887. were found to be positive for SARS-CoV-2 viral RNA infection. In all References: Ragab M.W., Kliesch S. (2017) Varicocele. In: Simoni M., cases the patients were asymptomatic and passed the triage protocol. Huhtaniemi I. (eds) Endocrinology of the Testis and Male Reproduction. PCR testing of staff bi-weekly identified 6 positive cases. All but Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-44441- one indicated having one or two mild symptoms. There were no re- 3_38 corded community transmissions among either patients to staff or be- Esteves SC, Miyaoka R, Roque M, Agarwal A. Outcome of varicocele tween staff members. repair in men with nonobstructive azoospermia: systematic review and CONCLUSIONS: A comprehensive risk mitigation strategy that includes meta-analysis. Asian J Androl. a combined triage protocol, safe social distancing and molecular testing for 2016;18(2):246–53. https://doi.org/10.4103/1008-682X.169562. active SARS-CoV-2 viral RNA infection in both patients and staff enables Korbakis D, Schiza C, Brinc D, et al. Preclinical evaluation of a TEX101 early detection and isolation of infected asymptomatic or pre-symptomatic protein ELISA test for the differential diagnosis of male infertility.A^ BMC individuals, thereby creating a safe environment for patient care and staff Med. 2017;15(1):60. Published 2017 Mar 23. https://doi.org/10.1186/ welfare during the global COVID-19 pandemic. s12916-017-0817-5 SUPPORT: None
P-962 3:30 PM Wednesday, October 21, 2020 P-963 3:30 PM Wednesday, October 21, 2020
SEMINAL TEX-101 MAY PREDICT RESTORATION OF EFFECT OF HORMONAL CONTRACEPTION ON ILLNESS SEVERITY IN WOMEN WITH POSITIVE SPREMATOGENESIS AFTER VARICOCELECTOMY 1 IN AZOOSPERMIC MEN WITH PALPABLE SARS-COV2 TESTS. Vaidehi Mujumdar, MD, 1 Ariel T. Levy, MD,2 Rachel Madding, BA,3 VARICOCELE. Ahmed Mohamed El Guindi, M.D, 1 4 Mina Saad, MSc,1 Zeinab Nour, M.D,2 Hamed Abdallah Hamed, M.D,1 Vincenzo Berghella, MD, Johanna Quist-Nelson, MD, 1 1 2 William D. Schlaff, MD,1 Brent C. Monseur, MD, ScM5 1Thomas Jefferson Mohamed Wael Ragab, M.D Cairo University, Cairo, Egypt; Cairo Uin- 2 versity, Cairo, Egypt. University Hospital, Philadelphia, PA; Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY; 3Sidney Kimmel Medical Col- OBJECTIVE: around 40% of men with non-obstructive azoospermia lege at Thomas Jefferson University, Philadelphia, PA; 4University of North (NOA) and palpable varicocele may benefit from varicocelectomy with Carolina, Chapel Hill, Chapel Hill, NC; 5Stanford Hospitals and Clinics, appearance of sperms in ejaculate. Testicular histopathology predicts the Sunnyvale, CA. outcome of varicocelectomy and men with hypospermatogenesis or late maturation arrest have better prognosis compared to men with early matura- OBJECTIVE: To evaluate if hormonal contraception affects illness tion arrest or Sertoli cell only (SCO) syndrome. severity in SARS-CoV2 positive women. Testis expressed protein (TEX-101) is a seminal plasma protein that shed DESIGN: Retrospective cohort study. from testicular germ cells and it has been found to be significantly lower in MATERIALS AND METHODS: Chart review of reproductive age (12-49 men with SCO in compare with other NOA subtypes. yo) women who tested positive for SARS-CoV2 at a tertiary medical center We aimed to assess the predictive role of seminal TEX-101 in recovery of from March 28-April 27, 2020. Exclusion criterion was pregnancy. Women sperms in ejaculate after varicocelectomy. using hormonal contraception were compared to patients not using hormonal DESIGN: Prospective cohort. contraception. Patients were not contacted to confirm contraception. The MATERIALS AND METHODS: Forty male patients with NOA and primary outcome was hospital admission rate. Secondary outcomes included palpable bilateral varicocele were subjected to seminal TEX-101 by ELISA a composite score for illness severity and clinical signs of infection (Table 1). (Wuhan Fine Biotech Co., Ltd. China), serum gonadotropins and total testos- Multivariable logistic regression was used to control for differences at terone evaluation, followed by sub-inguinal microsurgical varicocelectomy. baseline. Results are reported as adjusted odds ratio (aOR) with a 95% < Two seminal analyses were performed in 3- and 6-months follow-up periods confidence interval (CI). Calculated p values 0.05 were statistically to assess appearance of sperms in ejaculate. significant. Mann Whitney test was used to compare pre-operative seminal TEX-101, RESULTS: A total of 2044 women were screened for SARS-CoV2. Of the FSH, LH and testosterone between the group of men with observed sperms in 132 positive women, 46 used hormonal contraception: levonorgestrel ¼ ¼ ejaculate during follow-up (group 1) and men with persistent azoospermia IUD (n 9; 19.6%), injectable progestin (n 2; 4.35%), oral progestin ¼ ¼ ¼ (group 2). Receiver operating curve (ROC) test was used to calculate a (n 3; 6.52%), oral contraceptive (n 24; 52.1%), transdermal patch (n 4; ¼ cut-off value and diagnostic indices (sensitivity and specificity) of pre-oper- 8.70%), vaginal ring (n 4; 8.70%) and 86 did not use hormonal ative seminal TEX101. contraception. The rate of hospitalization for SARS-CoV2 was low for users RESULTS: After varicocelectomy, spermatozoa were found in the ejacu- and non-users of hormonal contraception (2.3% vs. 3.8%, respectively) late of 10/40 (25%) through the follow-up (7 patients at the 3-months follow- and was not statistically different between groups. There was no up and additional 3 patients at 6-months follow-up). In these ten patients difference between the rate of symptoms and clinical signs of infection (G1), no significant differences were observed in pre-operative testicular vol- between groups. ume or serum testosterone levels in compare with patients with persistent CONCLUSIONS: Sex hormones may play a significant role in azoospermia during follow-up period (G2). regulating immune response and can impact disease state. We provide Pre-operative seminal TEX-101 was significantly higher in G1 in compare preliminary evidence that use of hormonal contraception does not have a with G2 (p¼0.014), while serum FSH and LH were significantly higher in G2 significant effect on the illness severity in SARS-CoV2 as measured by (p¼0.001, p¼0.01 respectively), as shown in table (1). hospitalization. e540 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 TABLE 1. Primary and secondary outcomes Hormonal contraception (n¼ 44)a Not on hormonal contraception (n¼79)a Adjusted OR (95% CI)
Primary Outcome Hospital admission 1 (2.3) 3 (3.8) 0.99 (0.68-1.44) Clinical Signs Composite score of illness severityb 1 (2.3) 2 (2.5) 0.98 (0.67-1.43) Heart rate > 100 beats/min 4 (9.1) 3 (3.8) 0.99 (0.68-1.45) Respiratory rate > 22 breaths/min 1 (2.3) 1 (1.3) 0.97 (0.67-1.42) Urine output < 0.5 mL/kg/hr 1 (2.3) 1 (1.3) 0.97 (0.66-1.42) Lactate > 3 mmol/L 0 0 c Temperature > 100.4 F 6 (13.6) 8 (10.1) 0.98 (0.67-1.42) WBC > 12,000 or < 4,000 / mm^3 00 c Intubation 0 0 c
Data are shown as n/N (%) unless otherwise specified a n¼2&n¼7 patients excluded in the hormonal vs. not hormonal groups, respectively, due to no data on hospital admission b Components of the composite: hypoxia (O2 < 94%), > than 50% lung involvement on imaging, respiratory failure, respiratory shock, multiorgan dysfunction, death c Unable to perform logistic regression due to cells with 0 counts
fied-analysis using case-only study-approach revealed no effect of TLR-2/ TIMP-2 polymorphisms on M. tb.-positive infertile patients (N¼100) with P-964 3:30 PM Wednesday, October 21, 2020 thin endometrium <6.0 mm; recombinant Granulocyte-Colony-Stimu- lating-Factor infusion (300 mcg) significantly increased endometrium thick- TOLL-LIKE RECEPTOR-2 AND TISSUE INHIBITOR ness (p>0.05). TLR-2 and TIMP-2 genetic variants modulated the risk in OF MATRIX METALLOPROTEINASE-2 GENETIC infertile patients who smoked/chewed tobacco (55% tobacco-users) with VARIANTS AS PREDICTORS OF TOBACCO-MEDI- borderline association (p¼0.046); TLR-2 ins/del genotype showed strong as- ATED FEMALE INFERTILITY AMONGST MYCOBAC- ¼ ¼ TERIUM TUBERCULI sociation (OR 1.9 [95%CI 1.1-3.3]) with tobacco-usage in infertile -POSITIVE ASIAN INDIAN women with M. tb.-positivity. Overall, the study demonstrated lack of asso- COHORT. Saumya Pandey, M.Sc., Ph.D. Indira IVF Hospital, Udaipur, ciation between TLR-2 and TIMP-2 gene-polymorphisms and infertility sus- India. ceptibility in women of Asian Indian ethnicity. OBJECTIVE: Tobacco-consumption is a significant predictor of meta- CONCLUSIONS: The study highlighted the significance of TLR-2/TIMP- bolic-perturbations in female reproductive physiology, including endometri- 2 genetic variants in tobacco-mediated infertility susceptibility in Asian In- osis/stillbirths/miscarriages/infertility worldwide. Targeting Toll-like dian women providing fascinating avenues for future development of receptor-2 and Tissue Inhibitor of Matrix Metalloproteinase-2 genetic poly- TLR-2/TIMP-2 predictive biomarkers in stratifying M. tb.-positive infertile morphisms in demystifying the underlying genetic/cellular/molecular basis patient-populations. of tobacco-mediated female infertility amongst Asian Indian cohort is an im- SUPPORT: None munotherapeutically attractive strategy for cost-effective infertility manage- ment. This study aimed to evaluate the role of TLR-2(-196 to -174del) and P-965 3:30 PM Wednesday, October 21, 2020 TIMP-2 (-418G>C) [rs8179090] gene-polymorphisms in susceptibility to tobacco-mediated infertility amongst Asian Indian women. PRETERM BIRTH SUBTYPES BY FERTILITY STATUS DESIGN: Prospective case-control (1:1) hospital-based study. AND FERTILITY TREATMENT: A POPULATION- MATERIALS AND METHODS: 100 Asian Indian Mycobacterium tuber- BASED COHORT STUDY. Yimin P. Wang, MSc,1 > 1 2 culi-positive infertility patients ( 35 years) and 100 unrelated/age-matched/ Jessica Pudwell, MSc, MPH, Joel G. Ray, MD, MSc, M. tb.-negative/married (parity: 2-4 children) female controls of similar Yingwei Peng, PhD,1 Maria P. Velez, MD, PhD1 1Queen’s University, King- ethnicity were enrolled (sample-size calculation using Quanto); M. tb.-posi- ston, ON, Canada; 2St. Michael’s Hospital, Toronto, ON, Canada. tivity was assessed using Gene-Expert/TB-Gold PCR-testing. Endometrial thickness was determined using Color-Doppler imaging. Genomic DNA OBJECTIVE: To evaluate preterm birth (PTB) subtypes, according to both extraction from peripheral blood samples collected from study subjects fertility status and infertility treatment (IT). (N¼200) was carried out using salting-out method. TLR-2/TIMP-2 genotyp- DESIGN: Retrospective cohort study using linkage of universal health da- ing was performed using polymerase chain reaction-based restriction frag- tabases from Ontario, Canada. ment length polymorphism. Self-reported tobacco-usage was ascertained MATERIALS AND METHODS: Included were all singleton births, using bilingual Questionnaire in English/Hindi dialects. Statistical data-anal- April 2006-March 2014. Exposure categories were defined as sponta- ysis was performed using multivariate logistic regression analysis with Bon- neous conception (reference); subfertility (history of an infertility con- ferroni’s corrections for multiple comparisons in stratified subgroups (SPSS sult billed as ICD-9 code 628 in the absence of IT); non-invasive IT ver.16.0). (ovulation induction or intrauterine insemination); and invasive IT RESULTS: The findings demonstrated no significant association between (IVF or ICSI). PTB outcome subtypes were classified as spontaneous TLR-2 (-196 to -174del) and TIMP-2 (-418G>C) gene-polymorphisms and or provider-initiated (iatrogenic). Modified Poisson regression gener- risk of developing M. tb.-mediated infertility in the study-population; strati- ated risk ratios (RR) for the association between exposure categories
TABLE. Risk of preterm birth subtypes according to exposure by fertility status and fertility treatment Relative risk of preterm birth (95% CI)
Exposure category Any preterm birth Spontaneous preterm birth Provider-initiated preterm birth
Spontaneous conception 1.00 (ref) 1.00 (ref) 1.00 (ref) Subfertility 1.16 (1.13 to 1.20) 1.15 (1.10 to 1.19) 1.23 (1.16 to 1.31) Non-invasive IT 1.27 (1.17 to 1.36) 1.19 (1.09 to 1.31) 1.48 (1.29 to 1.69) Invasive IT 1.63 (1.52 to 1.75) 1.40 (1.27 to 1.53) 2.35 (2.09 to 2.64)
FERTILITY & STERILITYÒ e541 and risk of PTB. Models were adjusted by inverse probability weight- P-967 3:30 PM Wednesday, October 21, 2020 ing, accounting for age, parity, obesity, smoking, hypertension, dia- betes, income quintile, rurality and immigration status. SHEDDING LIGHT ON THE PSYCHOLOGICAL AND RESULTS: A total of 723,810 deliveries were included, of which 646,926 DEMOGRAPHIC PREDICTORS OF GAY AND (88.3%) were by spontaneous conceptions; 68,822 (9.4%) in women with BISEXUAL MEN’S DESIRE FOR PARENTHOOD AND subfertility; 9024 (1.2%) by non-invasive IT; and 8038 (1.1%) by invasive PREFERRED TIMING OF 1 IT. IT exposed women were significantly more likely to be older, nulliparous, PARENTHOOD. Hoi Yan Celia Chan, PhD, Yuen Kiu Georgina So, 2 2 1 obese, and have diabetes and chronic hypertension. PTB rates were 6.0% in MSc, Yu Te Huang, PhD The University of Hong Kong, Hong Kong, 2 women with spontaneous conceptions, 7.7% in those with subfertility, 8.0% Hong Kong; The University of Hong Kong. with non-invasive IT, and 10.8% following invasive IT. Compared to women who had spontaneous conception, the RR of any PTB rose by degree of IT OBJECTIVE: In spite of improved accessibility of ART to parenthood in invasiveness (see Table). This was especially so for the outcome of pro- some parts of the world, sexual minority individuals still face significant psy- vider-initiated PTB (Table). chosocial barriers in actualising their desire to become parents. Having inter- CONCLUSIONS: Infertility, and its treatments, are associated with a nalized negative beliefs about homosexuals and lacking social support from higher risk PTB, especially provider-initiated PTB. Accordingly, strategies LGBT communities are detrimental to the mental well-being of sexual mi- to reducing the risk of provider-initiated PTB are recommended. nority individuals. However, little is known whether these factors influence SUPPORT: Canadian Institutes of Health Research (CIHR) gay and bisexual men’s decision to parent. The study addressed how internal- ized homophobia, minority stress, and connectedness with the LGBT com- munity influenced Taiwanese gay and bisexual men’s desire for and P-966 3:30 PM Wednesday, October 21, 2020 preferred timing of parenthood? DESIGN: A cross-sectional online survey was conducted in May 2018, the PLOIDY STATUS AND DEVELOPMENTAL POTEN- time before legalisation of same-sex marriage in Taiwan. 1,381 Taiwanese TIAL OF HUMAN BLASTOCYSTS CONTAINING men self-identified as either gay or bisexual were recruited. NONDIVIDING BLASTOMERES OR MATERIALS AND METHODS: Primary outcomes of interest were FRAGMENTATION. Yimin Shu, MD, PhD, Jun Yang, whether respondents wish to have children (yes vs. no) and whether they Ph.D. Wake Forest University School of Medicine, Winston Salem, NC. wish to children before or after 35 years. Importance of childbearing, inter- nalized homophobia, minority stress, LGBT community connectedness, and OBJECTIVE: Nondividing blastomeres are arrested cells that are a select set of demographic variables were treated as predictor variables and excluded from developing embryos and remain outside the developing blas- entered into two hierarchical binary logistic regression models for estimation tomeres at morula stage, leading to decreased blastocyst formation and blas- of parenthood desire and timing of parenthood, respectively. tocyst quality. Although remaining developing cells try to compensate the RESULTS: Overall 74% of respondents reported a desire to have children. cell loss, very little data is available regarding its ploidy status and further Wanting children was associated with being bisexual (b¼0.94, p<.001), developmental potential. having a university degree (b¼0.69, p<.01), and being in a more satisfactory DESIGN: This retrospective data analysis involved infertility patients un- relationship among those who have a partner (b¼0.04, p<.001). Higher dergoing PGT-A through NGS in an academic IVF Program between January perceived importance of childbearing to the self (b¼1.49, p<.001), the rela- 2015 and February 2020. tionship with one’s partner (b¼0.40, p<.01) and parents (b¼0.25, p<.01), MATERIALS AND METHODS: Artificial shrinkage of blastocoel by but not importance of childbearing to one’s partner, was associated with laser during the biopsy process allows us an opportunity to carefully observe greater odds of wanting children. While controlling for these variables, the presence and extent of nondividing blastomeres/fragmentation under higher levels of internalized homophobia uniquely predicted greater parent- zona pellucida. We define a nondividing blastomere as an embryonic cell ar- hood desire (b¼0.03, p<.05), while minority stress and LGBT community rested during the first four embryonic divisions (2- to 16-cell stage). To connectedness were not significant predictors. A second set of analyses differentiate fragmented polar bodies from real embryo fragmentation, were performed to examine factors associated with the preference to delay only blastocysts with 10% or above fragmentation were defined as frag- parenthood. Age is the only demographic factor predicting the wish to delay mented embryos. Biopsied trophectoderm cells were analyzed with NGS parenthood (b¼0.16, p<.001). Respondents who reported higher levels of by CooperGenomics. The primary outcome measures are euploid/aneuploid community connectedness with the LGBT community had a greater ten- rates. Clinical outcomes following transfer of euploid embryos were also dency to wish to have children after the age of 35 (b¼0.07, p<.01). Neither investigated. Embryo implantation was defined as detection of a gestational perceived importance of childbearing, internalized homophobia or minority sac and fetal heart beat. stress played a role in predicting the wish to delay parenthood. RESULTS: Among 2891 biopsied blastocysts from 512 PGT-A cycles CONCLUSIONS: Gay and bisexual men’s desire for and preferred timing of 427 patients, 1945 did not have nondividing blastomere/fragmenta- of parenthood are influenced respectively by levels of internalized stigma and tion (67.3%) and 946 had (32.7%). Blastocysts without nondividing connectedness with the LGBT community. More systematic efforts should be blastomeres had a significantly higher chance to be euploid (48.9% directed at exploring factors that underline gay and bisexual men’s perceived vs 40.6%, p < 0.001). This trend was also observed for each age group self-competence as parents, paying particular attention to internalized homo- (<35, 35-37, 38-40, and >¼41). On the other hand, higher percentage phobia and LGBT community connectedness affecting parenthood decisions. of euploid embryos containing nondividing blastomeres had complex References: Nil chromosomal abnormalities (3 or more chromosomal abnormalities) SUPPORT: Nil (17.4% vs 10.2%). Embryo implantation rate of those euploid blasto- cysts without nondividing blastomeres was significantly higher than those with nondividing blastomeres (70.0% (255/366) vs 57.3% (75/ P-968 3:30 PM Wednesday, October 21, 2020 131), p<0.01). More euploid blastocysts without nondividing blasto- meres implanted for each patient group (<35, 35-37, >¼38) (73.0%, RELATIONSHIP BETWEEN TEMPORAL CHANGES OF 72.0%, and 60.2% respectively) as compared to those with nondividing ENDOMETRIAL BLOOD FLOW IMPEDANCE IN A blastomeres/fragmentation (66.1%, 55.6%, and 40% respectively) but NATURAL AND HORMONE REPLACEMENT CYCLE their differences were not significant. Among the 28 euploid blastocysts AND PREDICTION OF PREGNANCY DURING VITRI- with fragmentation, 19 implanted (67.9%). However, when there were 3 FIED-WARMED EMBRYO TRANSFER. Toshifumi Takahashi, M.D., or more nondividing blastomeres in an euploid blastocyst, implantation Kuniaki Ota, M.D. Fukushima Medical University, Fukushima, Japan. rate (14/32, 43.8%) significantly decreased as compared to those with 1 or 2 nondividing blastomeres (42/74, 56.8%). OBJECTIVE: Frozen-thawed embryo transfer (ET) is performed in a nat- CONCLUSIONS: Our results showed that embryos with arrested ural or hormone replacement therapy (HRT) cycle for endometrial prepara- nondividing blastomeres can maintain euploid and result in live births. tions. However, how to determine which endometrial preparation method However, its further developmental potential is compromised if re- is suitable for the individual is unknown.This study was to examine the rela- maining developing cells could not efficiently compensate the early tionship between the temporal changes in endometrial blood flow impedance cell loss. Our findings provide new insights regarding the extent to during natural and HRT cycles and clinical outcomes in vitrified-warmed ET. which blastocysts containing arrested blastomeres are capable of pro- DESIGN: A single-center retrospective observational cohort study. ducing ongoing pregnancies. MATERIALS AND METHODS: This study was approved by the institu- SUPPORT: None. tional review board of the Fukushima Medical University. This study e542 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 included a total of 60 women, 28 with natural and 32 with HRT cycles, who P value¼0.36,NS) between both groups. Though, clinical pregnancy rate underwent vitrified-warmed ET. Uterine radial artery resistance index (RA- was slightly higher in dual trigger group but difference was not significant. RI) was measured during the natural and HRT cycles at the early follicular CONCLUSIONS: Dual trigger improves the no. and proportion of MII oo- phase, days of the human chorionic gonadotropin trigger during a natural cy- cytes as compared to hCG trigger alone in normal responder group. The cle or start of progesterone administration during the HRT cycle, and the day promising effect of dual trigger in improving oocyte maturity may potentially of ET. The association between the RA-RI at the different measurement point be utilized in improving IVF cycle outcome. Further larger prospective trials and the pregnancy were examined in the natural and HRT cycles by univar- are needed for validation of beneficial effect of dual trigger in normal iate analysis and multivariate logistic analysis. Receiver-operating character- responder patient in future. istic analysis was used to determine the cut-off value of the RI with respect to pregnancy in natural and HRT cycles. The area under the curves (AUC) and their 95% confidence intervals (CI) were calculated. P-970 3:30 PM Wednesday, October 21, 2020 RESULTS: The clinical pregnancy rates of the natural and HRT cy- cles were 32.1% and 34.4%, respectively. In the univariate analysis, IMPACT OF 2008 AND COVID-19 ECONOMIC RECES- the RA-RI at the early follicular phase was significantly lower in the SIONS ON FERTILITY TREATMENTS AND LIVE BIRTHS. Fady I. Sharara, M.D.,1 Piotr Gromski, PhD,2 pregnant group than that in the non-pregnant group in the natural but 3 4 not HRT cycle (P¼0.04). In the multivariate logistic analysis, the Andrew D. A. C. Smith, PhD, Deborah A. Lawlor, PhD, Scott M. Nelson, MD, PhD2 1Virginia Center for Reproductive Medicine, Re- RA-RI at the early follicular phase was an independent predictive fac- 2 3 ¼ ston, VA; University of Glasgow, Glasgow, United Kingdom; University of tor for pregnancy in the natural but not HRT cycle (P 0.02). The odds 4 ratio for pregnancy was 0.7 (95% CI, 0.52–0.95) when the levels of the West of England, Bristol, United Kingdom; MRC Integrative Epidemi- RA-RI at the early follicular phase was increased by 0.01 in the natural ology Unit at the University of Bristol, Bristol, United Kingdom. cycle. With the natural cycle, the area under the receiver-operating OBJECTIVE: The economic and reproductive medicine response to the characteristic curves for the RA-RI at the early follicular phase with COVID-19 pandemic in the United States has reduced the affordability a threshold of 0.68 was 0.75 (95% CI, 0.57–0.93). The positive predic- and accessibility of fertility care. We sought to determine the impact of the tive and negative predictive values were 0.53 (95% CI, 0.37–0.59) and 2008 financial and the COVID-19 recession on fertility treatments and cumu- 0.92 (0.74–0.99), respectively. lative live-births. CONCLUSIONS: With the natural cycle, the RA-RI at the early follicular DESIGN: prospective projection modeling. phase was associated with pregnancy, and this might have a potential in pre- MATERIALS AND METHODS: We examined annual US natality, CDC dicting pregnancy in vitrified-warmed ET cycles. Our findings suggest that IVF cycle activity and live birth data from 1999 to 2018 encompassing RA-RI at the early follicular phase might be an effective and useful tool in 3,286,349 treatment cycles, to estimate the age-stratified reduction in IVF cy- choosing natural or HRT cycles for vitrified-warmed ET. This provides a cles undertaken after the 2008 financial recession, with forward quantitative clue to the individualization of the choice of an endometrial preparation modelling of IVF cycle activity and cumulative live-births for 2020 to 2023. method during the frozen-thawed ET. RESULTS: The financial recession of 2008 caused a four-year plateau in fertility treatments with a predicted 53,026 (95% CI 49,581 to 56,471) fewer IVF cycles and 16,872 P-969 3:30 PM Wednesday, October 21, 2020 (95% CI 16,713 to 17,031) fewer live births. A similar scale of economic recession would cause 67,386 (95% CI: 61,686 to 73,086) fewer IVF cycles ‘‘EVALUATION OF DUAL TRIGGER (GNRH AGONIST between 2020 and 2023, with women younger than 35 years overall under- PLUS HCG) VS HCG IN IMPROVING IVF CYCLE taking 22,504 (95% CI 14,320 to 30,690) fewer cycles, as compared to OUTCOME IN NORMAL RESPONDER GROUP- A 4,445 (95% CI 3,144 to 5749) fewer cycles in women over the age of 40 PROSPECTIVE RANDOMIZED CLINICAL years. This equates to overall 25,143 (95% CI: 22,408 to 27,877) fewer pre- STUDY. Ritika Gupta, MBBS, DNB (OBGY) FELLOWSHIP IN REPRO- dicted live-births from IVF, of which only 490 (95% CI 381 to 601) are antic- DUCTIVE MEDICINE,1 Sanjay Makwana, MBBS, MS, DIPLOMA IN 2 3 1 ipated to occur in women over the age of 40 years. REPRODUCTIVE MEDICINE, Rahul K. Sen, MSC, PHD FELLOW, CONCLUSIONS: The COVID-19 recession could have a profound impact VASUNDHARA HOSPITAL AND FERTILITY CENTER, JODHPUR, IN- 2 on US IVF live-birth rates in young women, further aggravating pre-existing DIA, GURUGRAM, India; MEDICAL DIRECTOR VASUNDHARA declines in total fertility rates. HOSPITAL AND FERTILITY CENTER, JODHPUR, INDIA, JODHPUR, SUPPORT: None India; 3chief embryologist, vasundhara hospital, jodhpur, JODHPUR, India.
OBJECTIVE: To assess role of Dual trigger (GnRH agonist plus Human P-971 3:30 PM Wednesday, October 21, 2020 chorionic gonadotropin) vs Human chorionic gonadotropin (hCG) in opti- mizing GnRH antagonist IVF- ICSI cycle outcome in normal responder ALTERED FOLLICULAR FLUID MICRO RNA PRO- group. FILES IN POLYCYSTIC OVARIAN SYNDROME MAY DESIGN: A Prospective randomized clinical study. SERVE AS PREDICTIVE BIOMARKERS OF OOCYTE MATERIALS AND METHODS: Normal responder patients were allo- MATURATION STAGE. Tamar Matitashvili, MD,1 cated in two groups: case group who has received dual trigger (GnRH agonist Sezgi Arpag, MSc,2 Seifeldin Sadek, MD,1 Gerard Celia, Jr., PhD,1 (Triptorelin 0.2 mg) + rec-HCG (Ovitrel 250 mg) and control group who has Laurel Stadtmauer, MD, PhD,1 Anca Dobrian, PhD2 1Jones Institute, Nor- received rec-hCG (Ovitrel 250 mg) only for ovulation trigger. Follicular aspi- folk, VA; 2Eastern Virginia Medical School, Norfolk, VA. ration was done 35 hr after trigger. Outcome variables measured were no. of follicles > 15 mm on trigger day, no. of COCs retrieved, no. of M II oocytes OBJECTIVE: Our objective was to define extracellular vesicle’s (EV) retrieved, proportion of MII Oocyte (MII oocyte/ total no of oocyte), no. of miRNA cargo in follicular fluid (FF) of polycystic ovarian syndrome day 3 good quality embryos, positive b -hCG cases, implantation rate, clin- (PCOS) and control patients to determine: potentially novel mechanistic ical pregnancy rate (CPR). pathways responsible for oocyte maturation and to establish correlations be- RESULTS: Total 100 patients were included for study: 50 in study and 50 tween EV miRNA cargo and oocyte maturation stage that could lead to dis- in control group. Both groups were similar in terms of age (28.62 vs 28.54, covery of novel biomarkers. P¼ NS), BMI (24.27vs 24.49, P¼NS), AMH (2.53vs2.69, P¼NS), AFC DESIGN: Prospective pilot study. (11.48vs12.02, P ¼NS). There was no significant difference in duration MATERIALS AND METHODS: Our study included 6 women diagnosed and etiology of infertility, length of stimulation and no. of follicles > 15 with PCOS based on Rotterdam criteria and 6 non-PCOS controls matched mm on trigger day between case and control group. Total no. of OCC for age and BMI. Patients in both groups were on the standard gonadotropin retrieved in case and control group was 10.92 2.59 and 10.54 2.96 respec- releasing hormone antagonist protocol for controlled ovarian stimulation. tively. There was no significant (p>0.7) difference in no. of oocytes between FF was obtained from the first punctured follicle in each ovary during dual and hCG trigger group(P value¼0.7, NS). There was significantly higher oocyte retrieval, and further processed for isolation of small EVs using a no. of MII oocytes (7.24 2.60 vs 6.68 2.28, P value¼0.02) in dual trigger as commercially available kit. Following RNA extraction, miRNA composition compared to hCG trigger group. Proportion of MII oocytes (65.62 vs 62.85, was quantitated using the nanoString nCounter FLEX Analysis platform. Oo- P¼ 0.03) was significantly higher in dual trigger group. There was no signif- cytes isolated from each of the individual follicles were scored for maturity icant difference in no. day 3 embryos (5.42vs 4.82, P value¼0.25,NS), im- staging, after the removal of cumulus cells. Comparisons between the two plantation rate (23.56 vs 21.35, P value¼0.07,NS) and CPR(36.73 vs 34.7, groups were performed using the Kruskal-Wallis test and correlations
FERTILITY & STERILITYÒ e543 between miRNA expression and clinical parameters were done using Spear- Scarborough, ME, USA), following FDA-Emergency Use Authorization pro- man’s non-parametric test. tocols. IRB approval was obtained from WIRB Protocol #20201490. RESULTS: In vitro fertilization cycle (IVF) characteristics, number of oo- RESULTS: From 339 asymptomatic individuals tested, the percentage of cytes and blastocytes were not statistically different between the PCOS and non-informativity was 0 for RT-PCR and 0.6% (2 out of 339) for the IgG test. control groups. FF-EVs were similarly in numbers and total amount of Only those individuals with informative results for both tests (n¼ 337) are mRNA cargo. Out of 828 human miRNAs screened in the FF, expression presented. of 19 miRNAs were above the detection limit. 7 miRNAs (miR-502-5p, CONCLUSIONS: In the population investigated, our results suggest that miR-603, miR-548aa, miR-548t-3p, miR-1246, miR-548n, miR-627-5p the impact of the pandemic is far from reaching the level required to achieve and miR-4531) were exclusively found in PCOS samples and 2 miRNAs herd immunity (i.e., 50% of a population). Therefore, transmission remains a (miR-21-5p and miR-411-5p) were detectable in the non- PCOS group risk since potential infectivity is present in 0.6% of the asymptomatic popu- only. MiR-1253 and miR-302d-3p were present in both groups and were lation tested. This figure was maintained despite their different geographical significantly lower in the PCOS group (p<0.03). locations and the adherence to CDC guidelines of the IVF clinics involved. Using ingenuity pathway analysis (IPA) we identified 3930 potential Interestingly, the two PCR+ individuals were IgG + suggesting virus persis- miRNA-regulated target genes. One of the validated target genes of miR- tence or reinfection that, if tested by serology alone, would be considered im- 302d-3p is FOXL-2, which is upregulated in the presence of miR-302d-3p. mune. These results together with the high incidence of naive individuals FOXL-2 is a transcription factor known to be involved in ovarian develop- draws attention for the implementation of a consistent program of testing ment. Knockout of FOXL-2 leads to formation of cystic follicles with an for COVID19 as a means of preventing reemerging outbreaks in our fertility androgen predominant environment, which is a feature of PCOS. centers. To examine association between follicular fluid EV-miRNAs and oocyte maturity we compared FF samples that had metaphase II (MII) oocytes to those that had metaphase I (MI) or germinal vesicle. FF that contained MI P-973 3:30 PM Wednesday, October 21, 2020 oocytes had less miR-302d-3p compared to samples with MII oocytes (p<0.01). IMPACT OF ENDOCRINE DISRUPTOR LEVELS CONCLUSIONS: MiR-302d-3p level in EVs of FF might become a poten- FOUND IN URINE AND FOLLICULAR FLUID ON CLINICAL PARAMETERS OF IVF PATIENTS IN A tial biomarker used to predict oocyte maturity or fertilization rate in IVF sub- 1 jects, including PCOS patients. Future studies focused on miR-302d-3p in EUPLOID SET/FET CYCLE. Andrea Palomar, MSc, Roberto Gonzalez-Martin, MSc,1 Caroline Zuckerman, BS,2 oocyte development and further validation of this EV miRNA in FF could 2 2 lead to a promising new biomarker to predict fertility rates or oocyte quality. Christine V. Whitehead, BSN, RN, Richard Thomas Scott, Jr., MD, Francisco Dominguez, Ph.D.1 1IVI Foundation - ISSLaFe Biomedical This and other miRNAs can also reveal new pathways responsible for oocyte 2 maturation arrest in PCOS patients. Research Institute, Valencia, Spain,; IVI RMA New Jersey, Basking Ridge, NJ.
P-972 3:30 PM Wednesday, October 21, 2020 OBJECTIVE: Exposure to certain exogenous compounds associated with lifestyle habits has become a risk factor that could threaten reproductive suc- SARS-COV-2 HERD IMMUNITY, INFECTIVE AND cess. This heterogeneous group of compounds known as endocrine disruptors NA€IVE INCIDENCE IN FERTILITY CLINICS AFTER (ED), which are present in the patient’s daily intake, such as phytoestrogens PANDEMIC LOCKDOWN. A MULTICENTER (daidzein, genistein), parabens (beauty products) and phthalates (daily use STUDY. Russell A. Foulk, MD,1 Denny Sakkas, PhD,2 plastics) play a major role in infertility-related problems. As there is a press- Refik Kayali, PhD,3 Diana Valbuena, MD, PhD,4 Carlos Simon, MD, ing need to investigate the effect EDs have on human reproduction, this PhD,5 Juliana Cuzzi, PhD3 1Utah Fertility Center, Pleasant Grove, UT; 2Bos- research aimed to detect a set of non-persistent ED in urine and follicular ton IVF, Waltham, MA; 3Igenomix US, Miami, FL; 4Igenomix, Paterna (Va- fluid (FF) samples of women undergoing infertility treatment to establish lencia), Spain; 5Igenomix Foundation, INCLIVA, Valencia, Spain; its impact on IVF clinical parameters. Department of Obstetrics and Gynecology, Valencia University, valencia, DESIGN: 60 patients attending IVI-RMA New Jersey undergoing an Spain; Department of Obstetrics and Gynecology, BIDMC, Harvard Univer- euploid single frozen embryo transfer (SET/FET) after PGT-A analysis sity, Boston, MA- USA Boston, U.S.A., Valencia, Spain. were included in this study. All patients recruited were age 18 to 42 years old and had a BMI of 18.5 to 29.9 kg/m2. Urine collected at oocyte retrieval OBJECTIVE: COVID19 was declared a global pandemic by the WHO in and FETas well as FF from patients were analysed by liquid chromatography March, 2020 and lockdown was imposed to a third of the world’s population. coupled to mass spectometry (HPLC-MS) for mono(2-ethylhexyl) phthalate Now, determining the transmission potential and immune status among shel- (MEHP), methyl-paraben (m-Par), propyl-paraben (p-PAR), daidzein and tering in place asymptomatic patients and clinical staff resuming their activ- genistein. These measurements were correlated with pre-implantation IVF ity is crucial. Here, we report herd immunity, infective, and na€ıve incidence clinical parameters. for SARS-CoV-2 after the lockdown period, among asymptomatic medical MATERIALS AND METHODS: Patients included underwent PGT- personnel and patients in two US ART centers located in states with different SET/FET cycles following standard protocols. Measurements of ED COVID19 incidences. levels in FF and urine collected at two different time-points were per- DESIGN: Prospective multicenter study (ClinicalTrials.gov formed by HPLC-MS (Triple Quad 1290-6460, Agilent) with internal NCT04466644). standards for each compound tested. Urine ED levels were normalized MATERIALS AND METHODS: A total of 339 asymptomatic individuals by creatinine and measured by Jaffe reaction (R&D Systems). Number (personnel and patients) were analyzed from June 18 to July 30, 2020 in two of oocytes retrieved, oocyte maturation, fertilization, blastocyst devel- ART centers reopening after lockdown following CDC safety guidelines. In opment and aneuploid rates were correlated with ED levels using Pois- Clinic A (Utah Fertility Center), located in a low prevalence State (312 cases sonregressionmodels. per 100,000 on 06/01/2020), 154 individuals were analyzed. In clinic B (Bos- RESULTS: Among all compounds and clinical outcomes analyzed, only ton IVF), in a high prevalence scenario (Massachusetts, 1,462 cases per MEHP levels show an outstanding relative effect on the number of oocytes 100,000 on 06/01/2020), 185 individuals were tested. Asymptomatic individ- recovered in patients. Specifically, MEHP found in FF showed the highest uals attending or working in the indicated clinics were tested by RT-PCR on relative effect over number of oocytes recovered (-31.37; [95% CI: -53.57, nasopharyngeal swab for SARS-CoV-2 RNA detection (Thermofisher, Wal- -9.17]; p¼0.0056). This effect is also observable in urine collected at the tham, MA, USA), and for IgG quantification on blood samples (Abbott Inc, oocyte retrieval (-9.37 [-17.15, -1.59]; p¼0.0182). The impact of MEHP levels is maintained in urine collected at the time of embryo transfer, although the relative effect is lower (-1.16; [-2.65, 0.32]; p¼0.1247) possibly due to its non-persistent nature. No significant effect was found in fertiliza- € TABLE 1. Incidence of immune, infective, and naıve individuals for COVID19. tion, blastocyst development or aneuploid rates in these patients. IMMUNE INFECTIVE NA€IVE CONCLUSIONS: This study suggests that among all EDs found in urine RT-PCR (-)/ IgG(+) RT-PCR (+) RT-PCR (-)/IgG (-) and FF of the patients, high levels of MEHP correlates with fewer retrieved oocytes, thus threatening the chances of reproductive success. Urine and FF levels of MEHP at the time of oocyte retrieval may indicate the damaging ef- CLINIC A 0.65% (1/154) 0.65% (1/154) 98.7% (152/154) fect of this compound on oocyte development. Therefore, it is essential to CLINIC B 2.2% (4/183) 0.5% (1/183) 97.3% (178/183) reduce the patient’s exposure to this kind of compound during ovarian e544 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 stimulation to minimize its impact on the number of oocytes retrieved to ages of 35 to 39 years. Increased maternal age may also affect maternal allow maximum optimization of IVF treatments. and fetal health, leading to permanent chronic conditions. Fertility literature SUPPORT: This research is supported by predoctoral contract for training has suggested that female fertility and reproduction biology awareness is in research into health (PFIS; PI/00009), APOTIP/2018/010, Miguel Servet poor. This is especially true for women in lower socioeconomic groups Contract (CPII18/00002) and ISCIII FIS project (PI17/00931) and minorities who may not have access to health care education. This study aimed to look at fertility awareness in women at a single NYC community hospital. P-974 3:30 PM Wednesday, October 21, 2020 DESIGN: An anonymous cross sectional survey administered in an OB- GYN clinic at a single NYC community hospital. MAYAUTOIMMUNE DISEASE BE A PREDICTOR FAC- MATERIALS AND METHODS: An anonymous cross sectional survey TOR OF INFERTILITY IN WOMEN WITH was administered at an OBGYN clinic between April and July 2019. Patients ENDOMETRIOSIS? Larissa Milani Coutinho, Doctorate participated voluntarily and their participation implied consent. They were student, Gabriel Duque Pannain, Medical doctor, asked a series of 28 fertility related questions and all information was anon- ~ Luzia Ribeiro Nasser Salomao, Medical doctor Universidade Federal de ymous. Inclusion criteria was all willing women at the clinic over the age of Juiz de Fora, JUIZ DE FORA, Brazil. 18 years old. Statistical analysis utilized descriptive statistics, the Students t- test for equality of means and linear regression. Probability outcomes <0.05, OBJECTIVE: Although endometriosis physiopathology has not been were statistically significant. totally clarified yet, it must be a multifactorial disease and immune pathways RESULTS: There were 66 patients who participated in the survey. African may take part of the onset and progression of the disease. A recent meta-anal- Americans ethnicity made up 66% of the patients, 24% were Hispanic and ysis has suggested that patients with endometriosis are at higher risk to have 10% comprised of Caucasian, Middle Eastern and Asian. Around 92% had at least one other immune condition, such as rheumatoid arthritis (RA), auto- greater than high school education. The majority of patients,73% knew immune thyroid disorder (ATD), inflammatory bowel disease (IBD). Maybe that complications increased in pregnancies in women greater than 35 years. the high levels of inflammation related to endometriosis might be associated However, an alarming 28% believed that age did not affect fertility and 59% to an imbalance of immune response. Infertility is a frequent consequence of of them stated if they knew, they would have began childbearing earlier. Pa- endometriosis. Although the mechanisms capable to explain endometriosis- tients with a history of infertility were slightly more knowledgable on age and associated infertility remain obscure, studies have shown that inflammatory infertility but this difference was not statistically significant. Our results and immune factors may take a role in the process as well. We aimed to inves- showed that nulliparous patients were less educated about age of decreased tigate whether autoimmune diseases could be associated to the occurrence of fertility (0% vs 13%) compared to multiparous patients, however overall infertility in patients with endometriosis. there was a low correct response to this question (11%). DESIGN: A retrospective study was performed at a Public University Hos- CONCLUSIONS: Our results show that there is a need for greater educa- pital, by analyzing medical records of all the 162 patients with a diagnosis of tion regarding the decline in fertility in women with respect to age and other endometriosis, followed up in the Endometriosis specific outpatient clinic, factors that affect fertility. This will assist in women being able to make well since its creation, in February 2017, until March 2020. informed family planning decisions. Factors such as our race, ethnicity and MATERIALS AND METHODS: After excluding patients with other socioeconomic status should not play a role in health care access or educa- causes of infertility aside endometriosis, patients that had never tried to tion. More research is needed to fully understand the barriers to health and conceive and those who had achieved pregnancy after a surgical treatment, health education as well to determine ways to decrease health disparities the remaining patients were divided in two groups: fertile (n¼61) and infer- and ensure patients are knowledgeable about their fertility and health. tile (n¼86). The two groups were analyzed for socio demographic variables References: Lundsberg, L. S., Pal, L., Gariepy, A. M., Xu, X., Chu, M. as well as features related to the disease and the association with autoimmune C., Illuzzi, J. L. (2014). Knowledge, attitudes, and practices regarding disease. Among autoimmune diseases, we observed patients with hypothy- conception and fertility: a population-based survey among reproductive- roidism (5), type 1 diabetes (4), ulcerative colitis (2) and rheumatoid arthritis age United States women. Fertil Steril. 101(3): p767-74. (1). Mac Dougall, K., Beyene, Y., Nachtigall, R. D. (2013). Age shock: mis- RESULTS: It was a sample composed by 162 women aged between 19 and perceptions of the impact of age on fertility before and after IVF in women 53 years old with an average age of 35.2 years and standard deviation of 7.23. who conceived after age 40. Human Reproduction, 28 (2): p350–356. After analyzing the two groups, we calculated logistic regression to verify Mathews T, Hamilton B. (2009). Delayed childbearing: more women are whether it is possible to correlate the variable presence of autoimmune dis- having their first child later in life. NCHS Data Brief, National Center for ease with the infertility outcome. For autoimmune disease, the confidence in- Health Statistics, pg. 21. terval was from 1.194 to 17.802 to 95% with a p-value of 0.027, corroborating that there is a correlation between autoimmune diseases and infertility in patients in this sample. We also calculated the prevalence ratio P-976 3:30 PM Wednesday, October 21, 2020 in these patients, which was higher in patients with autoimmune disease than in those without (mean of 1.527, being 1.439 the lower and 1.615 the upper CLINICIAN TRAINING NEEDS IN REPRODUCTIVE bound with 95% confidence interval). HEALTH COUNSELING FOR SEXUAL AND GENDER CONCLUSIONS: Despite of the scarcity of data associating endometri- MINORITY AYA WITH CANCER. Gwendolyn P. Quinn, osis and autoimmune disease, the coexistence of such conditions might be Ph.D.,1 Amani Sampson, B.A.,1 Ash B. Alpert, M.D.,2 related to a greater difficult in achieving pregnancy. Maybe patients present- Rhyan Jenifer Toledo, BA,1 Megan E. Sutter, PhD,3 Paige W. Lake, ing both diagnosis should be advised to pay special attention to their repro- MPH,4 Matthew B. Schabath, Ph.D.,4 Susan T. Vadaparampil, Ph.D.4 ductive plans, by avoiding postponing either natural attempt to get pregnant 1NYU Langone School of Medicine, New York, NY; 2URMC, Rochester, or fertility treatments when indicated. For those women with no current plans NY; 3NYU Langone Health, New York, NY; 4Moffitt Cancer Center, Tampa, to conceive, an interesting strategy would be to offer the possibility of per- FL. forming social oocyte cryopreservation. SUPPORT: No financial support was given. OBJECTIVE: Adolescent and young adults (AYA) with cancer have distinct psychosocial needs, with reproductive health being a chief concern. Reproductive health includes fertility, contraception, romantic relationships, P-975 3:30 PM Wednesday, October 21, 2020 body image, sexuality and disease prevention. Along with the unique needs of AYAswith cancer, health disparities exist among sexual and gender minor- ASSESSING FERTILITY AWARENESS IN WOMEN IN AN ity (SGM) AYAs, and there is a gap in clinician training. Our NCI-funded INNER NEW YORK CITY HOSPITAL. Janelle M. Jackman, R25 Enriching Communication skills for Health professionals in Oncofertil- MBBS,1 Fernando Polanco, MD,2 Shelena Ali-Bynom, M.D., 3 3 1 ity (ECHO) provides reproductive health communication training to psychol- M.P.H, Natasha Fievre, MD Camran Nezhat Institute, Center ogists, social workers, nurses, and physician assistants who provide care for for Special Minimally Invasive and Robotic surgery, Stanford University Medical 2 3 AYA people diagnosed with cancer. To refine our curriculum to address the Center, New York, CA; Providence Hood River Hospital, Hood River, OR; The unique needs of SGM AYAs with cancer, we conducted a survey of prior Brooklyn Hospital Center, Brooklyn, NY. ECHO trainees to evaluate knowledge and comfort in obtaining sexual orien- tation and gender identity (SOGI) information from patients and providing OBJECTIVE: Maternal age is the single most important determinant of reproductive health counseling. fertility. Ovarian function declines as women age and fertility naturally de- clines around mid-thirties.However childbearing has increased between the
FERTILITY & STERILITYÒ e545 DESIGN: A 28-item electronic survey was distributed to 601 prior ECHO the month (-0.9% 95% CI -1.8, 0.1) and 2 weeks (-0.8 95% CI -1.6, 0.0) prior trainees. to antral follicle scan. The negative association between average maximum MATERIALS AND METHODS: Quantitative items assessed: SOGI data temperature and AFC was stronger among women who had their antral fol- collection at their institution; SGM AYA cancer-related health knowledge; licle scans performed November through June, where average maximum adequacy of ECHO training for SGM AYAs; desire for additional training; temperatures ranged from 0 to 23 C, rather than during the summer months comfort discussing reproductive health with SGMs; and confidence in knowl- (July-October). Exposure to a heatwave in the 3 months prior to AFC was edge of SGM health needs (pre- and post-survey). Response options ranged associated with a -7.2% (95% CI -14.9, 1.3) lower AFC while exposure to from 1¼strongly agree to 5¼strongly disagree, or ‘prefer not to answer. Total a cold spell was associated with a 14.3% (95% CI 2.0, 28.2) higher AFC. knowledge score was computed and ranged from 0¼no correct responses to CONCLUSIONS: Exposure to higher than average temperatures, particu- 7¼all correct. Self-perceived comfort and confidence were assessed with re- larly outside of the summer months, were associated with lower ovarian gard to specific patient subgroups (i.e., gay/lesbian; bisexual/queer; and reserve. These preliminary results raise concern that rising ambient temper- trans/nonbinary patients). Four open-ended items invited respondents to atures worldwide may result in accelerated reproductive aging among describe personal experiences, reservations, and suggestions for improving women. SGM AYA cancer care. Quantitative responses were summarized with SUPPORT: This work was funded in part by P30ES000002, descriptive statistics. Paired t-tests were used to analyze changes in confi- R01ES009718, R01ES022955, and R00ES026648 from NIEHS and RD- dence. Content analysis was applied to qualitative responses. 834798 and RD-83587201 from US EPA. RESULTS: Of the 346 who completed the survey (58% response rate), only 7.4% correctly answered all knowledge questions (M¼3.76, SD¼1.72). One-third thought ECHO training adequately addresses SGM P-978 3:30 PM Wednesday, October 21, 2020 needs, and the majority (89%) wanted additional training in SGM reproduc- tive health. Confidence in knowledge of SGM health was neutral in all sub- A CROSS-SECTIONAL SURVEY OF TAIWANESE GAY groups prior to survey completion (M¼3.05, SD¼1.02), but reduced AND BISEXUAL MEN’S PARENTHOOD DESIRES D ¼ ¼ < AND PREFERRED MEANS OF FAMILY significantly for bisexual/queer ( M -0.21 t(307) 4.70, p .001) and trans- 1 D ¼ ¼ ¼ FORMATION. C. Chan, PhD, Yuen Kiu Georgina So, gender/nonbinary health( M -0.12 t(307) 2.66, p .008). Open-ended re- 2 1 2 sponses focused on experiences caring for SGM AYAs with cancer; training MSc The University of Hong Kong, Hong Kong, Hong Kong; The Univer- needs; and appreciation for the survey. sity of Hong Kong. CONCLUSIONS: Results demonstrate a need to refine ECHO curriculum OBJECTIVE: Desires for parenthood and knowledge about the means to to include SGM reproductive health concerns and strong desire for SGM con- parenthood are important determinants of reproductive behaviours. Despite tent among trainees. We are developing a module to improve reproductive ARTand adoption becoming more accessible in select parts of the world, sex- health communication for the care of SGM AYAs with cancer and survivors. ual minority individuals consistently report lower desire for parenthood and SUPPORT: NCI 3R25CA142519-09S1 anticipated higher levels of stigma surrounding parenthood than did hetero- sexual individuals. While there is a burgeoning literature on parenthood ori- P-977 3:30 PM Wednesday, October 21, 2020 entations, attitudes and demographic composition among same-sex couples, gay men, and, to a larger extent, bisexual men, are significantly under-repre- IMPACT OF AMBIENT TEMPERATURE ON OVARIAN sented. The study investigated the parenthood desires and preferred methods RESERVE AMONG WOMEN FROM A FERTILITY of family formation among Taiwanese gay and bisexual men before legaliza- CLINIC. Audrey Jane Gaskins, ScD,1 Lidia Mı´nguez- tion of same-sex marriage in Taiwan. Alarcon, PhD,2 Trang M. VoPham, PhD, MS,3 DESIGN: A cross-sectional online survey was administered to Taiwanese Jaime E. Hart, ScD,2 Jorge E. Chavarro, MD, Sc.D.,2 men who self-identified as gay or bisexual recruited through social media. Joel David Schwartz, PhD,2 Irene Souter, MD,4 Russ Hauser, MD, MPH, Data collection took place before legalization of same-sex marriage in Sc.D.,2 Francine Laden, ScD2 1Emory Rollins School of Public Health, At- Taiwan in May 2018. lanta, GA; 2Harvard T.H. Chan School of Public Health, Boston, MA; 3Fred MATERIALS AND METHODS: Respondents completed an online sur- Hutchinson Cancer Research Center, Seattle, WA; 4MGH Fertility Center vey with a list of items relating to their parenthood desires, preferred and Harvard Medical School, Boston, MA. method(s) of family formation, and reproductive awareness for respondents who endorsed surrogacy and ART as a preferred method. Men who self-iden- OBJECTIVE: In most mammalian species, heat stress caused by high tified as transgender, queer and asexual were precluded from analyses due to ambient temperatures has a deleterious effect on reproductive function small cell sizes, yielding a final sample of 1,381 men. Variables were including impaired follicular growth. Recent climate projections predict compared between age and other demographic groups using independent- that heat waves will increase in frequency, intensity, and duration, necessi- samples t-tests or chi-squared tests. tating the need to better understand the relationship between temperature RESULTS: Respondents were on average 27, the majority were homosexual, and reproductive health in humans. Our objective was to determine the effect employed, university-educated, and non-religious. Among the 1,023 (74%) re- of ambient temperature and extreme weather events on antral follicle growth spondents who desire to have children, they desire to have two children, and to among women attending an infertility clinic. have the first child at 32 years and the last child no later than 43 years. Adoption DESIGN: Our prospective cohort study included 632 women attending the was the most preferred method of family formation (83%), followed by surro- Massachusetts General Hospital Fertility Center (2005-2015) who had an gacy and ART (73%) and marriage with an opposite sex (12%). Surrogacy and antral follicle count (AFC) measured with transvaginal ultrasonography. medically assisted reproduction is more frequently desired among men aged MATERIALS AND METHODS: We collected data on the daily average, 35 or above (82% in men aged >35 vs. 69% in men aged 18-24, p<.05), and maximum, minimum, and apparent temperatures at a woman’s residential among men who preferred to have the first child after 35 years (77% first child address for the 90 days prior to their antral follicle scan using information after 35 years vs. 61% first child before 35 years, p<.05). However, among those from the Parameter-elevation Regressions on Independent Slopes Model at who preferred surrogacy and assisted reproduction, only 6% had ever received a4km2 resolution. Heatwaves and cold spells were defined as R3 consecu- semen analysis, and over 17% had no knowledge of the legality of surrogacy ar- tive days where the maximum temperature exceeded the 99th or fell below the rangements in Taiwan. Further, bisexual men were more likely than homosexual 1st percentile for the region, respectively. We evaluated the association of mentoendorsemarriagewithanoppositesexasapreferredmethodoffamily AFC with ambient temperature and extreme weather events using Poisson formation (36% vs. 6%, p<.001).Preferredmethodoffamilyformationisnot regression, adjusting for relative humidity, fine particulate matter exposure, correlated with relationship status or education level. age, education, smoking status, year and month of AFC, and diagnosis of CONCLUSIONS: The majority of gay and bisexual men wish to have chil- diminished ovarian reserve and ovulation disorders. dren via adoption or surrogacy and ART albeit reporting low reproductive RESULTS: High ambient temperatures during 3 months prior to antral fol- awareness. The rarity of fertility-optimising behaviours and inadequate licle scan (corresponding to exposure during the preantral to preovulatory awareness of legality issues in this Taiwanese sample highlights the impor- stages of follicular development) were associated with lower AFC. Specif- tance for accessible fertility- and treatment-/adoption-related resources ically, a 1 C increase in average maximum temperature was associated among sexual minority communities. with a -1.6% (95% CI -2.8, -0.4) lower AFC. Associations remained nega- References: Nil tive, but were attenuated, for average maximum temperature exposure in SUPPORT: Nil
e546 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 P-979 3:30 PM Wednesday, October 21, 2020 does not vary significantly with age and we did not observe differences regarding gender or blood group. However, we found that individuals with NOVEL INDICES FOR THE EVALUATION OF negative rhesus (Rh) factor had a slightly greater risk of being seropositive OBESITY IN ERECTILE DYSFUNCTION (RR 2.5 [129-2.13]) than those Rh positive. There are no differences in the PATIENTS. Sujith M. Jose, MBBS, MS, MCh, percentage of people in the active phase of the disease depending on the Vaibhav Vishal, MBBS, MS, MCh, Alphonse Jithin Jayan, geographical area (RR 0.8 [0.43-1.52]). However, when we analysed the MBBS, MS, MCh. Urology Resident, calicut, India. data according to time, the rate of positive individuals does not vary throughout the weeks in region A, while for the region B the incidence of OBJECTIVE: The association between Metabolic Syndrome (MetS) and IgM drops significantly (p¼0.003) from the first week of the study (3.7%) erectile dysfunction(ED) is bidirectional. Inflammatory mediators from the to the last (0.0%), which would indicate decline of the virus transmission visceral fat induce oxidative damages in the penile microvasculature result- over time. When we analysed the seropositivity rate according the partner’s ing in ED. Waist circumference(WC) is not a reliable indicator of visceral fat serological status, the data showed that there is approximately 10 times more as it includes subcutaneous fat also. Greater prevalence of MetS in Asian men incidence of being positive IgG in couples than in random population. compared to African-American men with the same WC is due to the rela- CONCLUSIONS: We show that in areas with higher prevalence of the dis- tively higher levels of visceral fat in them. Visceral Adiposity Index (VAI) ease, the percentage of IgM positive individuals is also higher. Also, there is a and Lipid Accumulation Product (VAP) are novel indices that include func- greater risk of being infected when the couple is already seropositive. No dif- tional parameters along with anthropometric parameters and gives better ferences were observed according the age and there is higher prevalence in assessment of visceral adipose dysfunction.The purpose of the study is to Rh-negative individuals. investigate the potential link between these novel indices and ED severity. DESIGN: Observational Cross-sectional study. MATERIALS AND METHODS: In this study,ED patients were divided into mild ED group (score >11) and severe ED group (score %11) based P-981 3:30 PM Wednesday, October 21, 2020 on International index of Erectile Function-5 scores. WC, Body Mass Index(- IDENTIFICATION OF NOVEL MUTATIONS IN CANDI- BMI) and lipid profile were obtained and VAI, LAP were calculated using DATE GENES ASSOCIATED WITH POLYCYSTIC formulas, VAI¼WC/[39.68+(1.88 BMI] triglycerides/1.03 1.31/high OVARY SYNDROME (PCOS) IN WOMEN WITH ARAB density lipoprotein and LAP¼[WC–65 ] triglycerides.Mean, standard devi- ETHNICITY. Maha Al-Khaduri, MD FRCSC,1 ation and p values were calculated using appropriate formulas and p val- Fatima Ahmed Al Kindi, Bsc, Msc,2 Yahya Tamimi, Msc, Phd,2 ue<0.05 was accepted as statistically significant. Ammar Hamed Nomani, Bsc,2 Yahya M. Al-Farsi, MD Phd.2 1College of RESULTS: Of 116 men included in the study, 60 had mild ED and 56 had Medicine, Sultan Qaboos University, Muscat, Oman; 2College of Medicine, severe ED. Mean age was 51.83 6.2 for mild ED group and 52.16 5.8 for Sultan Qaboos University, Al Khodh, Oman. severe ED group. Mean VAI was statistically significantly higher in severe ED group compared to mild ED group (8.452 2.33 vs 4.753 1.52 ;p OBJECTIVE: There is a genetic component to the etiology of Polycystic < 0.001). Mean LAP was also significantly higher in severe ED group Ovary Syndrome (PCOS) with candidate genes identified by Genome-wide < (89.427 31.48 vs 52.21 29.96;p 0.001). Interesting, difference in WC( studies in Chinese and European populations. However, in Middle Eastern ¼ 95.5 9.5 vs 95 8.5 ; p 0.146) and BMI( 26.48 3.72 vs 24.67 4.15; populations, where genes are expected to be concentrated due to prevalence ¼ p 0.363)was not statistically significant among two groups.Mean serum of consanguineous marriages, this is not yet explored. To our knowledge this estradiol level showed a statistically significant difference among two groups is the first study analyzing 11 candidate genes by exome sequencing in < (110.4 43.8 vs 99.87 45.7 ; p 0.001). women of Arab ethnicity diagnosed with PCOS. CONCLUSIONS: VAI and LAP have stronger correlation with ED DESIGN: Prospective case control study. severity than single antrapometric tools.Severe ED patients have higher MATERIALS AND METHODS: A sample size of 49 cases and 49 con- estradiol level compared to mild and moderate ED patients due to their higher trols was estimated for a significance level of 5% at 60% power, with visceral fat and VAI. Considering the simplicity and reliability, these novel minor allele frequencies of 12% and 1% in cases and controls respec- indices should be included in the evaluation of obese ED patients. tively with a 1:1 ratio. We recruited 50 cases and 50 controls (Omani women) from the Gynecology clinic at Sultan Qaboos University Hospi- tal in Oman. All cases fulfilled the Rotterdam criteria for PCOS. Con- P-980 3:30 PM Wednesday, October 21, 2020 trols were randomly selected from non-pregnant women within RISK FACTOR ANALYSIS FOR SARS-COV-2 SERO- reproductive age who were not diagnosed with PCOS. Genetic disorders, POSITIVITY WITHIN ASSISTED congenital adrenal hyperplasia, androgen secreting tumors, Cushing syn- REPRODUCTIVE. Nicol as Prados, PhD MSc,1 drome, and hyperprolactinemia were excluded. The data collected Cristina Gonz alez-Ravina, PhD,2 Vanessa Vergara, MD,1 included family history of PCOS, parental consanguinity, biochemical Javier Herrero, MSc,1 Mar ıa Cruz, PhD,1 Antonio Requena, PhD, MD.1 laboratory test results, physical examination and pelvic ultrasound find- 1IVIRMA Global Headquarters, Madrid, Spain; 2IVIRMA Global Headquar- ings. Targeted Exome Sequencing using a custom gene panel of 11 genes ters, Sevilla, Spain. [LEPR, THADA, LHCGR, FSHR, YAP1, SUOX, DENND1A, VDR, VEGFA, CYP1A1, KISS1] was conducted on DNA extracted from blood OBJECTIVE: Making decisions about how to fight the SARS-CoV-2 samples of cases and controls then data was analyzed using ANNOVAR pandemic without completely disrupting our activity requires better tools software to identify variants with a frequency less than 1%. that inform the extent of transmission. Understanding risk factors of virus RESULTS: Family history of PCOS was significantly higher among cases susceptibility could help us to establish intervention policies. The objective (46.9%) than controls (16.0%), P¼0.001. Parental consanguinity was preva- of our work is to assess risk factors and seroprevalence in our patients in order lent in both cases (26.6%) and controls (38%). Infertility, an-ovulation, Lu- to plan evidence-based strategies. teinizing hormone, anti-Mullerian hormone, total Testosterone and Thyroid DESIGN: Multicenter retrospective, anonymized cohort analysis per- Stimulating Hormone (TSH) were significantly higher among cases formed in 11 private clinics belonging to the IVIRMA group in Spain. (P<0.05). There was an association between TSH and fasting insulin MATERIALS AND METHODS: Between April 27th and June 26th, 2020, (OR¼1.30). We found three nonsynonymous variants in the LEPR gene, 6140 individuals undergoing an assisted reproductive treatment were tested two of which were predicted by SIFT software to be harmful (pathogenic). for SARS-CoV-2. Before tested, a symptomatic triage had been carried out In the THADA gene, one nonsynonymous mutation, found in three patients and only patients classified with a negative triage attended the clinic for was predicted to be pathogenic, in addition to one novel non-frameshift dele- further testing. SARS-CoV-2 specific IgG and IgM antibodies in serum tion found in one patient. A controversial novel nonsynonymous variant was were detected using EDI Novel Coronavirus COVID-19 ELISA kit (Epitope found in the LHCGR gene, predicted as neutral, and disease-causing muta- Diagnostics, USA) according to the manufacturer’s instructions. We divided tion by SIFT software, and mutation tester, respectively. Another nonsynon- our clinics into two different geographic areas: region A (seroprevalence ymous variant was found to be novel, and pathogenic in the FSHR gene. <5%) and region B (seroprevalence >5%) based on the results obtained in Moreover, in the YAP1 gene, a nonsynonymous variant was detected and pre- our population. Statistical analyses were performed using the Statistical dicted by SIFT and other software to be neutral (nonpathogenic). Two non- Package for Social Sciences 19.0 (IBM Corporation, Armonk, NY, USA). synonymous variants were found in the SUOX gene, with one of the RESULTS: Of the 6140 persons tested for SARS-CoV-2, 4470 (72.8%) variants reported in Clinvar with uncertain significance related to sulfite ox- were women and 1670 (27.2%) men. Over the course of the study, 42 idase deficiency condition. The other variant was found to be tolerated with (0.7%) tested positive for SARS-CoV-2 IgM antibodies. Seropositivity no effect on protein function.
FERTILITY & STERILITYÒ e547 CONCLUSIONS: We report Novel mutations in THADA, LHCGR and P-983 3:30 PM Wednesday, October 21, 2020 FSHR genes in Omani women of Arab ethnicity diagnosed with PCOS. References: 1. Al Khaduri, M., Al Farsi, Y., Al Najjar, T. A. A. and Gowri, EVALUATING THE UTILITY OF A GLOBAL WEBINAR V. (2014) Hospital-based prevalence of polycystic ovarian syndrome among FOR MENTORING MEDICAL STUDENTS AND OB- 1 Omani women, Middle East Fertility Society Journal. Middle East Fertility GYN RESIDENTS IN REI. Eliana Fine, BA, 2 Society, 19(2): 135–138. https://doi.org/10.1016/j.mefs.2013.06.006 Valerie Rose Libby, MD, MPH, Eduardo Hariton, MD, 3 4 5 2. Al-Fazari, M., Sulaiman, M. A., Al-Farsi, Y., Al-Khaduri, M. M. and MBA, Kamaria C. Cayton Vaught, MD, Kelsey L. Anderson, MD, 6 7 8 Waly, M. I. (2017) Assessment of Risk Factors Related to Nutrition and Di- Serena H. Chen, M.D., Eric J. Forman, M.D., Kenan Omurtag, MD, 9 1 etary Intake among Omani Women with Polycystic Ovarian Syndrome, EC Bradley Scott Trivax, MD. Renaissance School of Medicine at Stony Brook 2 Nutrition, 12.1: 18–28. University, Stony Brook, NY; Shady Grove Fertility, Atlanta, GA, Atlanta, 3 3. Sulaiman, M. A. H., Al-Farsi, Y. M., Al-Khaduri, M. M., Waly, M. I., GA; University of California, San Francisco, Department of Obstetrics and 4 Saleh, J. and Al-Adawi, S. (2017) Psychological burden among women Gynecology, San Francisco, CA; Johns Hopkins University School of Med- 5 with polycystic ovarian syndrome in Oman: A case-control study, Interna- icine, Lutherville, MD; Washington University in St. Louis, St. Louis, MO; 6 tional Journal of Women’s Health, 9: 897–904. https://doi.org/10.2147/ Division of Reproductive Medicine, IRMS at St Barnabas, Livingston, NJ; 7 8 IJWH.S145383. Medical and Laboratory Director, New York, NY; Washington University 9 4. Sulaiman MA, Al-Farsi YM, Al-Khaduri MM, Saleh J, Waly MI. Poly- St Louis School of Medicine, St. Louis, MO; Stony Brook University Hos- cystic ovarian syndrome is linked to increased oxidative stress in Omani pital, Commack, NY. women.A^ Int J Womens Health. 2018;10:763-771. Published 2018 Nov 28. https://doi.org/10.2147/IJWH.S166461 OBJECTIVE: The aim of this study is to evaluate the effectiveness of a live 5. ISLAM, M. M. (2012) THE PRACTICE OF CONSANGUINEOUS Q&Awebinar on improving trainees’ access to mentorship and knowledge of MARRIAGE IN OMAN: PREVALENCE, TRENDS AND DETERMI- the path to becoming a reproductive endocrinology and infertility (REI) NANTS, Journal of Biosocial Science. 2012/02/09. Cambridge University physician. Press, 44(5): 571–594. https://doi.org/DOI: 10.1017/S0021932012000016. DESIGN: Prospective Paired Cohort Study. 6. Jones, M. R. and Goodarzi, M. O. (2016) Genetic determinants ofA^ MATERIALS AND METHODS: US and international medical students polycystic ovary syndrome: progress and future directions, Fertility and Ste- and OBGYN residents participated in a global live Q&A webinar featuring rility. Elsevier Inc., 106(1): 25–32. https://doi.org/10.1016/j.fertnstert.2016. REI physicians and fellows. Webinar surveys were given and a total of 161 04.040. pre-webinar and 73 post-webinar surveys were reviewed. After application SUPPORT: Internal research grant by College of Medicine at Sultan Qa- of exclusion criteria, 70 pre- and post-webinar surveys were compared. boos University in Oman. Paired nonparametric tests (Wilcoxon Signed-Rank Test) were performed to assess whether post-webinar knowledge was significantly different from pre-webinar knowledge. P-982 3:30 PM Wednesday, October 21, 2020 RESULTS: In total, 268 people registered for the webinar and 162 at- tended live (60%). The majority of the 70 respondents who completed PREGNANCY OUTCOMES IN FEMALE PATIENTS both surveys were female (90%) and MD medical students (80%). Of the re- EXPOSING TO CYCLOSPORIN VERSUS TACROLI- spondents, only 31% reported their home institution had an REI fellowship MUS AS PRIMARY IMMUNOSUPPRESSION AFTER program and 37% an affiliated REI office. Only 34% had previously shad- SOLID ORGAN TRANSPLANTATION: A SYSTEMATIC owed an REI physician and 23% had rotated in an REI office. Thirty-three REVIEW AND META-ANALYSIS. Jingjie Li, M.D,1 Pan Chen, PhD,2 percent reported it was not easy and 13% it was extremely not easy to find Xiaojiao Gong, Bachelor,2 Xiaoyan Liang, M.D.1 1the Sixth Affiliated Hos- research opportunities within the field of REI in medical school or residency, pital, Sun Yat-sen University, Guangzhou, China; 2the First Affiliated Hospi- while 14% reported it was easy, and 39% unsure. Seventy-seven percent re- tal, Sun Yat-sen University, Guangzhou, China. ported receiving minimal advice about a career in REI from their medical school or residency program, while 22% reported receiving some advice, OBJECTIVE: Tacrolimus and cyclosporin are both calcineurin inhibitors and 1% extensive advice. (CNIs) recommended as first-line immunosuppressants for solid organ trans- After the webinar, participants were more likely to report that social media plantation, we aim to compare the influences of tacrolimus and cyclosporin can be utilized by trainees to connect with REI physicians to find networking on pregnancy outcomes for female transplant recipients. and mentoring opportunities (P ¼ .022) and they were more likely to use so- DESIGN: Systematically review of observational studies comparing preg- cial media (ex. Instagram) to network with physicians and potential mentors nancy outcomes of tacrolimus and cyclosporin as primary immunosuppres- (P ¼ .041). When asked to what extent they agree that their interest in REI sion after solid organ transplantation. increased due to this webinar, 39% strongly agreed, 43% agreed, 13% MATERIALS AND METHODS: A comprehensive literature search was were unsure, and 6% disagreed. conducted between January 1, 2000 and March 20, 2020 according to the Overall, after the webinar, more trainees reported a better understanding of database of PubMed, EMBASE, and Web of Science. The following combi- what the field of REI entails (P ¼ <.00001), the path required to become an nation of text terms was searched in [Title]: Transplant / Transplants / Grafts / REI (P ¼ <.00001), opportunities to find mentors in the field of REI (P ¼ Graft / Transplantations / Transplantation, and Pregnancy / Pregnancies / <.00001), opportunities at medical school or residency conducive to Gestation / Pregnant / Gravidity / Gravidities. Weighted mean difference learning more about REI (P ¼ <.00001), and applying for rotations in the (WMD) and odds ratio (OR) was calculated to compare continuous and field of REI (P ¼ <.00001). dichotomous variables respectively with 95% confidence intervals (CIs). CONCLUSIONS: Most medical students and OBGYN residents have dif- Publication bias was estimated by funnel plots. Quality of study was assessed ficulty finding mentorship and research opportunities within the field of REI according to the modified Newcastle-Ottawa scale. as many institutions do not provide trainees with opportunities to learn about RESULTS: 24 observational studies including a total of 1492 pregnant the specialty. Awebinar featuring REI physicians and fellows can provide the post-transplant recipients were identified in our analysis. Tacrolimus-treated much-needed mentorship for trainees to help increase their interest in REI recipients experienced lower risk of gestational hypertension (44.6% vs and provide them with advice regarding pursuing a career in the field. Addi- 29.0%; OR:1.58; 95% CI,1.20-2.08; P < 0.01) and infections (24.7% vs tionally, trainees can utilize social media to connect with REI physicians and 13.6%; OR:1.87; 95% CI, 1.25-2.80; P < 0.01). Cyclosporin-treated recipi- fellows to find mentorship, research, and networking opportunities within the ents showed a lower incidence of abortions (16.7% vs 25.5%; OR: 0.59; 95% specialty. CI, 0.41-0.86; P < 0.01), gestational diabetes (2.3% vs 9.3%; OR: 0.24; 95% SUPPORT: None CI, 0.13-0.44; P < 0.00001) and cesarean section (41.7% vs 48.8%; OR:0.71; 95% CI, 0.54-0.93; P ¼ 0.01). Additionally, cyclosporin performed better regarding the live birth rate (78.4% vs 70.8%; OR: 1.43; 95% CI, 1.08- P-984 3:30 PM Wednesday, October 21, 2020 1.87; P ¼ 0.01). There were no significant differences in the incidences of preeclampsia, postpartum rejection, preterm delivery and low birth weight. OOCYTE VITRIFICATION CAN ALTER OOCYTE AND CONCLUSIONS: Cyclosporin is safer in delivery outcomes, while tacro- EMBRYO REPAIR PROCEEDS IN CONFRONTING limus is associated with lower risk of maternal complications except gesta- WITH SPERM DNA DAMAGE. Niloofar Khajedehi, 1 2 tional diabetes. MSc, Leila Rashki Ghaleno, Ph.D. student, 2 3 1 SUPPORT: Chinese Universities Scientifc Fund of Sun Yat-sen Univer- Rouhollah Fathi, Ph.D., Hamid Gourabi, Ph.D. Department of Molecular sity（NO.19ykpy04） Genetics, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and culture, Tehran, Tehran, Iran (Islamic Republic e548 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 Parameters Untreated Sperm 0.2 LD50 treated Sperm 0.3 LD50 treated Sperm
Round spermatids 44.47 10.55a 35.29 16.89b 37.05 15.51b Elongated spermatids 36.84 11.97a 31.04 16.67b 28.89 12.98b Spermatogonial stem-cells 10.89 5.90 12.44 6.17 12.36 6.40 Concentration (M/ml) 10.72 5.77 7.13 3.47 6.34 2.30 Non-vitrified Oocytes Fertilization rate (%) 96.42 9.44 96.77 6.32 89.11 16.16 Blastocyst rate (%) 56.01 18.40 32.40 20.04 21.80 14.58 Vitrified Oocytes Fertilization rate (%) 96.75 8.59 86.84 18.61 93.67 11.71 Blastocyst rate (%) 27.26 18.91 13.54 12.92 9.66 13.30
of); 2Department of Embryology, Reproductive Biomedicine Research Cen- of using the cVAS app during IUD insertion and to compare these measure- ter, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Tehran, ments to a traditional VAS. Iran (Islamic Republic of); 3Department of Genetic, Reproductive Biomed- DESIGN: Prospective observational study. icine Research Center, Royan Institute for Reproductive Biomedicine, MATERIALS AND METHODS: We recruited 33 patients who were 18 ACECR, Tehran, Tehran, Iran (Islamic Republic of). years of age or older having an IUD insertion. Patients were oriented to the cVAS app prior to the procedure. During the procedure, the patient OBJECTIVE: Oocyte vitrification has different effects on mitochondrial held the tablet, with the app loaded, and traced their finger along the line function, gene expression and overexpression of repair proteins after vitrifi- throughout the procedure according to the pain level experienced. Procedure cation and warming. Examining the capability of vitrified oocyte to repair milestones were logged on a synchronized app by a research assistant in the sperm DNA fragmentation was the main objective of this research. room and data was sent to a secure database. After the procedure, patients DESIGN: Non-vitrified and vitrified Cumulus-Oocyte-Complexes indicated overall pain on a paper-based 100 mm VAS and provided qualita- (COCs), were inseminated with Intact and two models of DNA fragmented tive data about the amount of pain experienced and ease of use of the app. sperms. Subsequent embryo development was followed until blastocyst Without reviewing patient data, the provider who performed the procedure stage. Pursuit of repair procedure was done by following changes in Rad51 indicated the overall pain the patient experienced during the procedure on expression between different groups in zygote and blastocyst stage. a paper-based 100 mm VAS. A cVAS pain score was calculated for each pa- MATERIALS AND METHODS: Male mice were intraperitoneally in- tient by graphing the level of pain recorded on the app on the y-axis and time jected with tert-Butyl hydroperoxide (tBHP) with 0.2 and 0.3 LD50 dosages on the x-axis. Area under the curve (AUC) was calculated and correlated with for 14 days. Testis and epididymal sperm assessed by histology and TUNEL the patient reported VAS, provider estimated VAS, and maximum pain re- assay analysis. Obtained COCs from superovulated mice were vitrified and corded on the cVAS app. saved in LN2 on Cryotop for 2 weeks. Following warming, COCs were RESULTS: Of the 33 patients enrolled, 28 provided enough data for anal- inseminated by DNA fragmented sperms. Expression level of Rad51 was as- ysis (5 had missing or incomplete data). Mean procedure time was 4.94 mi- sessed with qRT-PCR in zygote and blastocyst stage. nutes (sd¼4.60, range 1.48 to 20.8). Mean overall patient reported and RESULTS: Decreasing number of round and elongated spermatids and provider estimated VAS was 40.8 mm (sd¼24.3, range 5.5 to 98.0) and increasing number of spermatogonial stem cells, also decreasing sperm con- 41.0 mm (sd¼23.0, range 1.0 to 94.0), respectively. Mean maximum cVAS centration of both treated groups indicated that tBHP injection reduced score recorded was 56.5 mm (sd¼28.1, range 12 to 100) and mean AUC meiosis division. Sperm DNA fragmentation index in both treated groups was 7005.8 (sd¼6394.7, range 462.6 to 21919.3). Patient reported VAS score was more than 20%, but in untreated group was less than 20%. Fertilization correlated strongly with AUC (r¼0.53). Maximum cVAS score correlated rate was not different between the groups; although, both sperm DNA dam- moderately with AUC (r¼0.47). Provider estimated VAS score correlated age and oocyte vitrification led to significant decrease in blastocyst forma- weakly with AUC (r¼0.15). AUC correlated well with the amount of pain pa- tion. Moreover, zygotes derived from 0.3 LD50 sperms crossed with non- tients reported qualitatively. All patients found the app easy to use. vitrified oocytes down-regulated Rad51; in contrast, 0.3 LD50 sperm with CONCLUSIONS: While this pilot app requires further refinement, the vitrified oocyte up-regulated the same gene. In blastocyst stage, 0.3 LD50 AUC represents a novel and accurate representation of patient pain levels. sperms with non-vitrified oocytes up-regulated Rad51; on the other hand, Using the cVAS in studies to investigate interventions to decrease pain this gene was down-regulated in 0.3 LD50 sperms fertilized with vitrified oo- with IUD insertion could result in the development of better techniques to cytes (P-value<0.05). All data showed by mean SD. reduce pain and improve patient satisfaction. CONCLUSIONS: Oocyte vitrification and sperm DNA damage not only reduce blastocyst formation but also altered sperm repair Rad51 gene expres- sion. P-986 3:30 PM Wednesday, October 21, 2020
DIFFERENT PROTEOMICS ANALYSIS INDICATES P-985 3:30 PM Wednesday, October 21, 2020 METFORMIN AS A NOVEL THERAPY TO AMELIO- RATE ENDOMETRIAL RECEPTIVITY OF ESTABLISHING PAIN SCALES FOR GYNECOLOGIC ENDOMETRIOSIS. Xin Huang, Doctor,- Wei Huang, PROCEDURE USING A NOVEL VAS Professor,2 Li Xiao, Doctor,3 Ying Long, Doctor.3 1West China Second Hos- 1 1 APP. Lauren Y. C. Au, BA, Wakako Horiuchi, BS, pital; Key Laboratory of Birth Defects and Related Diseases of Women and 1 2 Jasmine Tyson, MS, Mary Tschann, PhD, MPH, Children, Ministry of Education, Sichuan University, Chengdu, China; 2West 1 1 2 Bliss Kaneshiro, MD, MPH. University of Hawaii, Honolulu, HI,; Society China Second University Hospital of Sichuan University, Chengdu, China; of Family Planning, Denver, CO. 3-.
OBJECTIVE: The pain experienced during procedures like intrauterine OBJECTIVE: Endometriosis reduces female fecundity, decreased endo- device (IUD) insertion, is a function of both the level of pain experienced metrial receptivity should be responsible for the pathogenesis. Metformin in- and the duration the pain is felt. Some interventions may diminish the level hibited the growth of ectopic lesions, while the effect of metformin on of pain but prolong the procedure. In these instances, whether a given inter- eutopic endometrium of endometriosis has not been reported. This study vention provides benefit to the patient is difficult to assess. Researchers often aims to identify whether metformin can ameliorate endometrial receptivity use a traditional visual analog scale (VAS) where a patient makes a mark of women with endometriosis and endometriosis model mice. along a line to indicate the level of pain they experience, but these measure- DESIGN: Compare protein expression of eutopic endometrium of mini- ments only provide a snapshot of the patient’s pain. The continuous VAS mal/mild endometriosis patients after 2 months treatment of Metformin (cVAS) app records both pain scores and the duration of time an individual (1000mg/d) and verify biomarkers associated endometrial receptivity that experiences various levels of pain. Our goal was to understand the feasibility upregulated after Metformin treatment.
FERTILITY & STERILITYÒ e549 MATERIALS AND METHODS: Protein expressions profile of eutopic Moving forwards, as Covid-19 continues to cause uncertainty, it is clear that endometrial tissues from participants with minimal/mild endometriosis in fertility clinics should offer an additional psychological aspect to care, providing secretory phase were analyzed by liquid chromatography coupled to tandem regular, updated information that matches patient preferences to their needs. mass spectrometry (LC-MS/MS) based proteomics with data-independent The authors are aware of the limitations and reason for caution with this acquisition (DIA) workflow. Up-regulated endometrial receptivity associated study. Only five Instagram accounts were analysed. Therefore, only a small markers were screened out after metformin treatment in paired endometria. amount of data was available, with a particular user segment, which may not Parallel reaction monitoring (PRM) and immunochemistry were used for be indicative of the whole population. validation these markers. Endometria of endometriosis mice model on day 4 of pseudopregnancy were used for measured above screened markers, P-988 3:30 PM Wednesday, October 21, 2020 LIF and integrin avb3 expression. RESULTS: Compared to baseline, 149 differentially expressed proteins COVID CONCEPTION CATASTROPHE?: THE EXPE- were detected in the endometria after metformin therapy. Insulin-like growth RIENCE OF FERTILITYIQ USERS. Christina E. Boots, factor-binding protein 7 (IGFBP-7), a-antitrypsin (AAT), apolipoprotein D MD, MSCI,1 Anu Venkatesh, BS,1 Jake Anderson, MBA,2 (ApoD), Rho GDP-dissociation inhibitor 1 (Rho-GDI), brain form glycogen Lauren Citro, BSN, RN,2 Angela K. Lawson, Ph.D.3 1North- phosphorylase (PYGB) and Cathepsin B (CTSB) that associated with endo- western Feinberg School of Medicine, Chicago, IL; 2FertilityIQ, San Fran- metrial receptivity had up-regulated after metformin therapy (P<0.05); while cisco, CA; 3Northwestern University Feinberg School of Medicine, the expressions of those protein had no significant change in non-received Department of Obstetrics and Gynecology, Division of Reproductive Endo- controls. Up-regulated expression of IGFBP-7 and ApoD had been validated crinology and Infertility, Chicago, CA. by PRM. IGFBP-7 and integrinb3 were up-regulated after metformin treat- ment in endometria of endometriosis mice model during window of implan- OBJECTIVE: To assess concern about COVID-related clinic exposure, tation. pregnancy risks, and treatment cancellations in a sample of infertility patients CONCLUSIONS: Our study revealed that metformin may ameliorate across the United States. expression of proteins related to endometrial receptivity in women with min- DESIGN: Analysis of a cross-sectional survey. imal/mild endometriosis and endometriosis mice model. Metformin could be MATERIALS AND METHODS: FertilityIQ, an online educational plat- used as potentially novel therapy to improve endometrial receptivity of infer- form, surveyed its 53,600 users via email between 05/27/2020-06/30/2020 tile women with endometriosis. to better understand their experiences with the delay of fertility care due to SUPPORT: The study was funded by National Key R&D Program of the COVID-19 pandemic. 13,490 email recipients opened the email and China (Grant number: 2017YCF1001200). 1,730 women participated in the survey. Survey questions included the collection of demographic information (i.e., U.S. state of residence, age, gender, fertility diagnosis, and annual household income) and both quantita- P-987 3:30 PM Wednesday, October 21, 2020 tive and qualitative questions about fertility and the COVID-19 pandemic. RESULTS: Two thirds of respondents were 31-40 years old. Of the women ASSESSING THE CHANGE IN INFERTILITY PA- who responded, 43% were planning to start treatment immediately and 35% TIENT’S SOCIAL MEDIA USE DURING COVID-19 were actively undergoing fertility treatment when the pandemic began. RELATED CLINIC CLOSURES. Julie Morgan, MSc.,1 2 3 1 Twenty-one percent chose to delay their own treatment and 58% had treatment Andreia Trigo, MSc, Kate Davies, BSc. All About Infertility postponed by their providers. Of the 943 women whose clinic delayed their treat- Ltd, United Kingdom; 2Andreia Trigo Consulting Ltd, United Kingdom,; ¼ ¼ 3 ment, 86% (n 809) felt sad, but 67% (n 630) agreed with the delay. Women Your Fertility Journey Ltd, United Kingdom. with a higher income were more likely to agree with the decision to postpone (P¼ 0.019). In addition, women with diminished ovarian reserve were more likely to BACKGROUND: Instagram is a popular app and social media networking feel sad about the COVID-related treatment delays (P ¼ 0.007); age was associ- platform that is utilised by patients to obtain and share health information. ated with feelings of anger due to the delay (P ¼ 0.03) and being ‘‘highly con- OBJECTIVE: To assess whether infertility patients changed or altered cerned’’ that the delay would affect pregnancy outcomes (P ¼ 0.006). Overall, their user engagement on Instagram in the time period around fertility clinic 46% of women were comfortable undergoing treatment during the pandemic, closure and reopening during the Covid-19 pandemic. while 39% were unsure. Half of all women were ‘‘somewhat concerned’’ about DESIGN: Content Analysis. pregnancy risks and 19% were ‘‘not concerned’’. Additionally, 38% were ‘‘not MATERIALS AND METHODS: The Instagram native insights analytics concerned’’ about exposure to COVID in the clinic, whereas 59% were ‘‘highly tool was used to analyse five social media accounts used by three independent concerned’’about treatment cancellation. The vast majority of women felt it was Fertility Nurse Consultants in the United Kingdom (UK). Posts were exam- ‘‘highly important’’that their clinic practice social distancing (71%). In regards to ined between 1/03/20 - 02/07/20 for comments, likes, reach, profile visits, the financial burden, 33% of women were ‘‘highly concerned’’ about paying for sharing and saving, growth and engagement, together with audience subdivi- treatment during the economic downturn whereas 29% were ‘‘not concerned’’. sion by gender, age and geography. Importantly, 44% of women were ‘‘highly concerned’’about their partner not be- RESULTS: 436 posts were identified, saved by users 388 times generating ing present during their treatment. 1834 profile visits. Average increases were noted in: followers 266%, com- CONCLUSIONS: As expected, the majority of women were concerned and ments 700%, likes 225%, reach 311% and user engagement 176%. Users sad about delays in their fertility treatment during the COVID pandemic. Con- were 89.2 % female and 10.8% male, predominantly from the UK, United cerns include pregnancy risk, exposure risk, and having their partners present States and Portugal. The age demographic was: Female < 24 years < 4%, > during their care. Both age and a diagnosis of diminished ovarian reserve were 25 – 34 years 43%, 35 – 44 years 41.8%, 45 – 54 years 6.8%, 55 years associated with emotional distress by these delays. A wide spectrum exists in 4.4% and Male < 24 Years 8.6%, 25 – 34 years 33.2%, 35 – 44 years > the number of women with and without these concerns, and thus, additional ed- 37%, 45 – 54 years 11.8%, 55 years 9.4%. ucation is needed for these patients to ensure their understanding of COVID Posts with the highest user engagement contained factual information exposure and potential pregnancy risks. Lastly, we recommend the provision regarding fertility clinics closure and reopening, validating increased anxiety of emotional support to fertility patients affected by the cancellation of fertility concerning the impact of delay on chances of conception and managing negative care and/or ongoing distress due to the COVID-19 pandemic. thinking and uncertainty. Recurring themes in patients’ comments related to in- formation provided by fertility clinics. For example, ‘I called my clinic yesterday and all I got was we have absolutely no idea’, ‘we haven’t heard a peep from our P-989 3:30 PM Wednesday, October 21, 2020 clinic since lock down’, ‘I just want to hear from my clinic if they are opening or not’, ‘I am normally pretty resilient but this has floored me’. CHROMOSOMAL STRUCTURAL REARRANGE- As a result of increased user engagement and direct messaging, all five so- MENTS IN COUPLES DOES NOT INFLUENCE THE cial media accounts posted daily to keep up with demand. They also partic- RATE OF MOSAICISM IN THEIR ipated in homogeneous podcasts, commenced support webinars and engaged EMBRYOS. Shujing He, MM,1 Lei Jia, PhD,2 with followers in real time weekly Instagram Live sessions. One account Yida Wang, bachelor,2 Zhiqiang Zhang, master’s degree,3 Cong Fang, commenced a support group which had a 95% weekly engagement rate. Ph.D.,2 Xiao-yan Liang, M.D., Ph.D.3 1The Sixth Affiliated hospital of CONCLUSIONS: The results of this study indicate that Infertility patients Sun Yat-Sen University, Guangzhou, China; 2Reproductive Medicine increasingly relied on Instagram to manage their expectations surrounding Research Center, Sixth Affiliated Hospital of Sun Yat-sen University, treatment suspension, which they perceived as providing information and a Guangzhou, China; 3The Sixth Affiliated Hospital of Sun Yat-sen University, support network that they felt was missing from their health provider. Guangzhou, China. e550 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 OBJECTIVE: To investigate whether the rate of mosaicism in preimplan- MATERIALS AND METHODS: The HCUP-NIS is comprised of hospital tation embryos is influenced by the chromosomal structural rearrangements inpatient stays submitted by institutions throughout the entire country and is in couples and the sex of the translocation carrier in preimplantation genetic representative of 20% of admissions to US hospitals across 48 states and testing (PGT). the District of Columbia. A multivariate logistic analysis was done adjusting DESIGN: A single center retrospective study performed between June for any statistically significant confounding effect (p<0.05). 2018 and June 2020. RESULTS: While the risks of preterm premature rupture of membranes, MATERIALS AND METHODS: The study included the data analysis of preterm delivery (aOR 1.22 CI 0.77-1.93), placental abruption (aOR 1.08 754 blastocysts from 231 couples detected with Next Generation Sequen- CI 0.37-3.15), and PIH (aOR 1.01 CI 0.69-1.48) were not higher in smoking cing(NGS). The cut-off values for reporting mosaic levels in our laboratory PCOS subjects, a significant association between smoking and diabetes mel- ranged from 40% to 70% . litus (both GDM (aOR 1.46; 95%CI 1.01-2.10) and pregestational diabetes According to the couples’ chromosome karyotype, blastocysts were mellitus (6.5% vs. 4.0%, p¼0.003)) was detected. There were no significant divided into three groups: reciprocal translocation carriers(N¼442), Robert- statistical differences in the rate of operative vaginal delivery or cesarean sec- sonian translocation carriers(N¼104), and couples with normal tion. Risks of maternal infections and thrombotic complications and neonatal karyotype(N¼208). The mean female age in all groups was similar and sta- outcomes (small for gestational age, intrauterine fetal demise and congenital tistically non-significant(30.6 4.1, 31.2 2.7 and 31.0 5.0 for reciprocal anomalies) were comparable. translocation carriers, Robertsonian translocation carriers and couples with CONCLUSIONS: Among women with PCOS who smoke the risk of normal karyotype, 30.5 4.0 and 30.9 4.4 for male and female carriers). Sta- gestational diabetes is increased; however, the expected decrease in PIH tistical analyses were performed with IBM SPSS statistics 22.0 (SPSS, Inc., and specifically preeclampsia did not occur possibly due to the inherent risks Chicago, IL). Independent-Sample T test and Chi-square test was used as of the syndrome itself. appropriate. All statistical analysis was performed using SPSS 22.0. P<0.05 was defined as a statistically significant difference. RESULTS: The mosaicism rate of reciprocal translocation carriers, Rob- P-991 3:30 PM Wednesday, October 21, 2020 ertsonian translocation carriers and couples with normal karyotype were 4.30%(19/442), 10.58%(11/104) and 6.73%(12/208), respectively. There LINE 1 COPY NUMBER DECREASES AND TELO- was no statistical significance in the mosaicism rate of reciprocal transloca- MERE LENGTH INCREASES WITH AGING IN SPERM CELLS. Thalita S. Berteli, MSc,1 Fang Wang, PhD,1 tion carriers and couples with normal karyotype (4.30% vs. 6.73%, 2 1 ¼ Paula A. Navarro, MD, PhD, Fabiana B. Kohlrausch, Ph.D, P 0.118). And Robertsonian translocation carriers were not statistically 3 1 prone to have more mosaic embryos than couples with normal karyotype David L. Keefe, MD. New York University, Langone Medical Center, 2 ~ ~ (10.58% vs. 6.73%, P¼0.238). New York, NY; Ribeirao Preto Medical School, University of Sao Paulo, ~ 3 When considering the sex of the translocation carrier, in reciprocal trans- Ribeirao Preto, Brazil; NYU Grossman School of Medicine, New York, NY. location group, the mosaicism rate of male carriers and female carriers was OBJECTIVE: Telomeres, repetitive sequences and associated proteins 5.19%(14/270) and 2.86%(5/172) respectively without statistical differ- which cap and protect chromosome ends, undergo attrition with age in ence(P¼0.250). The mosaicism rate of male Robertsonian translocation car- most tissues, providing an aging clock. Unlike other tissues, sperm telomeres riers and female Robertsonian translocation carriers was 14.55%(8/55) and increase rather than decrease with paternal age. The function of age-related 6.12%(3/49) respectively, and there was no statistical significance, sperm telomere elongation remains poorly understood. In yeast, mice and hu- too(P¼0.163). mans, telomeres can cause reversible silencing of genes, called the telomere CONCLUSIONS: The frequency of mosaic embryos was not influenced position effect (TPE). We hypothesize that telomere elongation may help by the chromosomal structural rearrangements in couples. Chromosomal suppress Long Interspersed Nuclear Element 1 (L-1), a retrotransposon translocation carriers generated more aneuploidy embryos, but they did not which becomes active in the germ line and can contribute to human genetic tend towards generating more mosaic embryos compared with couples variation and genomic instability. Here we compare L-1 copy number in with normal karyotype. And the sex of the translocation carrier did not influ- sperm samples from older and younger men to investigate the effect of ence the mosaicism rate, too. The possible reason is that reciprocal or Rob- paternal age and telomere elongation on L-1. ertsonian translocation may not lead to errors in mitotic divisions during DESIGN: Prospective case-control study. embryo early development. MATERIALS AND METHODS: Sperm samples (n¼25) were donated for SUPPORT: Medical Scientific Technology Research Foundation of research by consenting men, aged 32-55, undergoing treatment at NYU Lan- Guangdong Province of China (A2020226); National Natural Science Foun- gone Fertility Center (NYUFC). Baseline semen parameters were evaluated, dation of China (81801449). and samples processed by swim-up. Sperm genomic DNA was obtained us- ing DNeasy Blood & Tissue Kit, QIAGENÒ following manufacturer’s rec- P-990 3:30 PM Wednesday, October 21, 2020 ommended protocol, with an additional lysis step using X2 buffer (20 mM Tris-Cl, pH 8.0, 20 mM EDTA, 200 mM NaCl, 4% SDS); 80 mM dithiothrei- THE EFFECT OF SMOKING ON PREGNANCY COM- tol (DTT) and 12.5 mL/mL Proteinase K. Average sperm telomere length PLICATIONS IN WOMEN WITH THE POLYCYSTIC (STL) was assayed by mmqPCR and L-1 copy number by qPCR. Linear OVARIAN SYNDROME (PCOS): A STUDY OF ALMOST regression with Pearson Correlation Coefficient characterized the relation- 15,000 WOMEN. Ido Feferkorn, MD,1 Ahmad Badeghiesh, ships between age, STL and L-1 copy number. Comparisons between old M.D. , MPH,2 Haitham Baghlaf, MD, MPH,3 Michael H. Dahan, M.D.1 1Di- (age R 45 years) and young men (age % 40 years) were performed by t- vision of Reproductive Endocrinology and Infertility, McGill University test or Wilcoxon Test using GraphPad Prism 8 software. P-value < 0.05 Health Care Center, Montreal, QC, Canada; 2Division of REI, McGill Uni- was considered significant. 2 versity and OriginElle Fertility Clinic and Women’s Health Centre, Mon- RESULTS: STL was positively correlated with age (r ¼ 0.2851; p ¼ treal, QC, Canada; 3McGill University, Montreal, QC, Canada. 0.006), as previously reported. STL from older (age R 45 years, n: 5; Mean: 1.398 0.3715) was significantly longer than younger men (age % OBJECTIVE: The risk of pregnancy complications in patients PCOS is 40 years, n: 13, Mean: 0.9749 0.1319) (p ¼ 0.0002 Wilcoxon Test). L1 increased, including; pregnancy induced hypertension, preeclampsia, pre- copy number in sperm decreased significantly with paternal age (r2 ¼ term birth and gestational diabetes mellitus (GDM). In the non PCOS popu- 0.1585; p ¼ 0.048). T-test showed this effect was even more pronounced lation, prenatal smoking is associated with preterm birth, placental abruption, when comparing old (age R 45 years, n¼5; Mean: 0.8505 0.1176) vs. intra-uterine growth restriction and an inverse relationship with pregnancy young men (age % 40 years, n¼13, Mean: 1.012 0.0885) (p < 0.0001). induced hypertension (PIH). It remains unclear whether an association be- CONCLUSIONS: We confirm increasing sperm telomere length with tween smoking and GDM exists with studies reporting confliction results. advancing paternal age. L1 copy number, in contrast, decreases significantly We sought to investigate whether there is an association between pregnancy with paternal age, as sperm telomeres lengthen. Telomere elongation in the complications and smoking in women with PCOS. male germ line may represent a surveillance mechanism to repress retro DESIGN: This is a retrospective population-based study utilizing data transposition and maintain genomic instability. De repression of L-1 has from the HCUP-NIS over 11 years from 2004 to 2014. A dataset of all deliv- been implicated in neuropsychiatric syndromes, so it will be of interest to eries between 2004 and 2014 inclusively was created. Each patient was determine whether failure of this mechanism contributes to the paternal included only once. Women with PCOS were identified; of them 631 smokers age effect on neuropsychiatric syndromes. and 14,251 none smokers.
FERTILITY & STERILITYÒ e551 SUPPORT: Coordination for the Improvement of Higher Education ically different sets of cells in the body has not conclusively demonstrated Personnel (CAPES, Finance Code: 001, Brazil; Grant number change with age, we analyzed if there is a change in mosaic embryos with 88887.371487/2019-00 to TSB), Brazilian National Council for Scientific age. and Technological Development (CNPq, Brazil; Grant number 204747/ DESIGN: A retrospective analysis was performed to determine if the 2018-0 to FBK) and the Stanley H. Kaplan Fund of the NYU Grossman percent of mosaicism was related to maternal age when undergoing an in vi- School of Medicine (to DLK). tro fertilization cycle (IVF) using Preimplantation Genetic Testing-Anue- ploidy (PGT-A) with Next Generation Sequencing (NGS). MATERIALS AND METHODS: Mosaic results were obtained for 2,597 P-992 3:30 PM Wednesday, October 21, 2020 embryos that underwent biopsy from 1/2019 to 6/2020 at two IVF centers. Patient age was separated into four categories: <35, 35-37, 38-40, and ADULT WEIGHT CHANGE IN RELATION TO SEMEN >40. All embryos were tested by using NGS and reports were given to the QUALITY AMONG MEN ATTENDING AN ACADEMIC 1 provider as euploid, aneuploid, mosaic or no results. The standard cut-off FERTILITY CENTER. Vibha Singhal, MD, > < 2 3 1 for reporting mosaicism was 20% abnormal cells in a sample and 80% Irene Souter, MD, Jorge E. Chavarro, MD, Sc.D. MGH abnormal. Statistical analysis was performed by chi-square testing and Co- Weight Center, Boston, MA; 2Massachusetts General Hospital, Harvard 3 chran-Armitage trend test, assessing for a linear trend in the proportions Medical School, Boston, MA; Harvard School of Public Health, Boston, across the age groups. MA. RESULTS: Based on 2,597 embryos biopsied, 121 (5%) were noted to be mosaic. Mosaicism based on age demonstrated: <35 age group, 78/1,414 OBJECTIVE: In adults, obesity is associated with changes in some semen (6%), 35-37 age group, 26/567 (5%), 38-40 age group, 10/375 (3%), and parameters especially sperm concentration. Most obesity related complica- > 40 age group, 7/234 (3%). When comparing the four groups p¼0.0611 tions are influenced by the duration of obesity and age of onset. However, for chi-square test and p¼0.0095 for Cochran-Armitage test for trend. it is unclear if the degree of weight change during adult life has any impact on semen parameters. To address this question, we examined the association between weight changes during adult life and semen parameters. TABLE 1. Mosaic samples compared to non-mosaic samples based on age DESIGN: Cohort Study. <35 35-37 38-40 >40 Total MATERIALS AND METHODS: We recruited men in subfertile couples presenting to the Massachusetts General Hospital Fertility Center. Partici- Mosaic 78 (6%) 26 (5%) 10 (3%) 7 (3%) 121 (5%) pants filled standardized questionnaires and provided a semen samples on Not Mosaic 1,336 541 365 234 2,476 site. We calculated weight change since age 18 years as the difference be- Total 1414 567 375 241 2,597 tween current measured weight and self-reported weight at age 18 years, and classified men as weight stable (+2 to -2 kg), weight loss (<-2kg), weight gain below the median (+2 to 14kg) and weight gain above the median (>+14kg). We computed odds ratios (95%CI) of semen parameters below WHO reference limits using logistic regression adjusted for age, smoking CONCLUSIONS: We generally think of genetic abnormalities in the form status and abstinence time and separately for current and age 18 years of an all or nothing process but based on the timing of genetic changes there body mass index (BMI). Last, we evaluated whether associations differed ac- can be discordance of cell types leading to mosaicism. Many studies have cording to BMI at age 18. demonstrated that abnormal meiotic division increases substantially with RESULTS: We examined 845 men who were mainly Caucasian maternal age, but this has not been demonstrated for mosaic changes. With (86.6%), had a median (IQR) age of 36 (33-40) years, BMI of 27 the development of PGT-A with NGS we can assess mosaic rates and trend (25-30) kg/m2, and weight change since age 18 years of 14 (8-22) with increasing age. In this large multi-site study, we determined that there kg. Compared to men with stable weight, men who lost weight had is a trend toward decreasing mosaic rates with maternal age. (odds ratio [95%CI]) 3.2 (1.1-9.6) higher odds of low sperm SUPPORT: None morphology and 4.9 (1.6-15) higher odds of low motility. These esti- mates did not change substantially in models additionally controlling for current BMI or BMI at age 18 years. Men who had gained weight P-994 3:30 PM Wednesday, October 21, 2020 also had increased odds of semen parameters below WHO reference limits, but these estimates did not reach statistical significance. In AN EVALUATION OF COMMERCIAL FERTILITY models stratified by BMI at age 18 years, men who were overweight APPS: ALGORITHMIC PREDICTIONS AND USERS’ or obese at age 18 years and subsequently lost weight had a greater PERCEPTIONS. Mayara Costa Figueiredo, MS,1 odds of sperm morphology (6.3 [0.9-40]) and motility (10.8 [1.6-71]) H. Irene Su, M.D., M.S.C.E.,2 Yunan Chen, PhD.1 1University below WHO reference limits compared to men who were overweight/ of California, Irvine, Irvine, CA; 2University of California San Diego, La obese at age 18 and did not lose weight, whereas the relations of Jolla, CA. weight loss with morphology and motility were substantially weaker among men who were normal weight at age 18: 2.2 [0.4-11] and 1.8 OBJECTIVE: Fertility apps have been increasingly used to predict ovula- [0.3-9.9], respectively. tion and fertile window, but it is unclear how these predictions are made (e.g., CONCLUSIONS: Weight loss during adulthood among men with over- what indicators are used, how cycles are calculated) and how users perceive weight/obesity at age 18 years is associated with increased odds of below and trust them. The goal of this study is to evaluate current commercially reference sperm morphology and motility in men attending an academic available fertility apps focusing on their algorithmic feedback and users’ ex- fertility center. This finding is consistent with literature of semen abnormal- periences. More often patients are bringing apps to clinical appointments, so ities after weight loss surgery which suggests, at best, no benefit and in some it becomes critical to analyze the type of support apps offer and how patients cases harm of weight loss on markers of spermatogenesis. An important lim- interact with their predictions. itation of the study is the lack of information on the modality and rate of DESIGN: We evaluated 30 best rated fertility apps obtained from the two weight loss and if it was associated with any nutritional deficiencies. Clari- main app stores, analyzing algorithmic feedback, app features, and user re- fying the implications of these findings for future fertility of young men views of the selected apps. with obesity is critical. MATERIALS AND METHODS: Each app was evaluated using a single dataset simulating four months of regular fertility cycles, including data for period dates, temperature, ovulation, and cervical mucus. Two re- P-993 3:30 PM Wednesday, October 21, 2020 searchers inputted the data in each app, analyzing how different types of data may visibly change the predictions of ovulation date and fertile window. BLASTOCYST MOSAIC RATES DEMONSTRATE A Finally, user reviews from the app stores were qualitatively analyzed to sur- DECREASING TREND WITH MATERNAL face users’ experiences and perceptions of interacting with the fertility pre- AGE. Liz R. Dulle, BS,1 Jessi Anderson, MPH,1 dictions. MacKenzie Purdy, MD.2 1Vios Fertility Institute, Chicago, IL; RESULTS: Predictions varied considerably among apps. The first day of 2Vios Fertility Institute, Swansea, IL. the fertile window varied by five days, with 13 apps predicting the same start day. Ovulation day varied by five days, with 19 apps predicting the same day OBJECTIVE: Since chromosomal abnormalities increase drastically with and 2 apps not providing predictions. Length of fertile window ranged from 3 maternal age while mosaicism, which occurs when there are 2 or more genet- to 14 days (mean¼7.167, sd¼2.036). The start day of periods affected the e552 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 fertility predictions of 29 out of 30 apps (96.66%). Among the 30 apps, 20 of patients who transferred 2 euploid embryos achieved 1 LB and 13.1% provided ovulation tracking features but entering ovulation data only affected achieved 2 LB (Table 1). The likelihood of 1 LB and 2 LB increased to the prediction of 13 apps (65%). Similarly, temperature and cervical mucus 92.5% and 39.7% after 3 FETs, and to 97.9% and 71.7% after 4 FETs, respec- tracking were present in 25 and 22 apps but entering temperature and mucus tively. data affected predictions in only 6 (24%) and 1 app (4.54%) respectively. The CONCLUSIONS: The goal of achieving two live births increased by 81% analysis of app reviews suggests users have mixed reactions towards the when 4 embryos were transferred compared to 3, indicating that patients who apps, some fully trust algorithmic predictions, but many are confused about desire two children would be advised to bank at least 4-5 euploid embryos. how the apps make predictions and why the predictions are incorrect Patient-focused decision support tools are now possible due to big data; a comparing to the results of OPKs, or inconsistent with other fertility apps calculator will be built incorporating patient-specific factors to determine they use. how many euploid embryos patients should bank in order to achieve their CONCLUSIONS: Our study reveals substantial inconsistencies in fertility desired family size. predictions among the popular fertility apps we reviewed. Other than period References: 1. SART 2017 National Data dates, most data tracked by users do not lead to changes in predictions, which suggests that indicators that may require daily and disciplined work are not used. Our analysis show that the lack of clear description of what data are P-996 3:30 PM Wednesday, October 21, 2020 used in making fertility predictions can cause potential tracking burden, distrust of fertility technologies, or over-trust in predictions that may not TIMING OF INITIATING GNRH ANTAGONIST DOWN- be accurate. These issues may further affect users’ fertility experiences and REGULATION IN IVF CYCLES AFFECTS CLINICAL their interactions with healthcare providers. This study shows fertility tech- OUTCOMES OF PCOS PATIENTS. Li Yujie, Doctor. nologies have to be designed more transparent with regard to their algo- Sixth Affliated Hospital of Sun Yat-sen University. rithmic feedback and to make the uncertainty intrinsic to fertility more OBJECTIVE: Whether the timing of use of gonadotropin-releasing hor- visible to users. mone (GnRH) antagonist down-regulation for IVF cycles affects pregnancy outcomes of polycystic ovary syndrome (PCOS) patients? P-995 3:30 PM Wednesday, October 21, 2020 DESIGN: Retrospective cohort study of 1008 PCOS patients undergoing first IVF cycles using GnRH antagonist protocol from January, 2014 to DEVELOPING A DECISION SUPPORT TOOL TO December, 2019 DETERMINE OPTIMAL NUMBER OF EUPLOID EM- MATERIALS AND METHODS: According to the dominant follicle size BRYOS BANKED TO ACHIEVE A DESIRED FAMILY on the day of GnRH antagonist administration, the included patients were SIZE. Devora Aharon, MD,1 Cory Weinfeld, MS,2 divided into three groups: Group A, dominant follicle diameter (DFD) ＜ Alan B. Copperman, MD,1 Erkan Buyuk, MD.1 1Icahn School of Medicine 10mm; Group B, 10mm%DFD ＜14mm; Group C, DFD R14mm. The pa- at Mount Sinai, New York, NY; 2Reproductive Medicine Associates of New rameters regarding demographic and clinical characteristics, ovarian stimu- York, New York, NY. lation characteristics, clinical outcomes including number of oocytes retrieved, top quality embryo number, clinical pregnancy rate, live birth OBJECTIVE: As women get older, the likelihood for pregnancy de- rate, etc were compared among different groups. creases: the chance of live birth (LB) after one IVF cycle at the age of 40 RESULTS: The age, anti-Mullerian hormone level and body mass index is 23%, but it declines to 4% at the age of 43, an 83% decrease.1 This poses were comparable among different groups. Total FSH dosage of Group A a challenge in particular for women above 35 who desire more than one child. (1492.7IU) was more than Group B (1292.7IU) and Group C (1243.6IU). After delivery of the first baby, the chance for pregnancy through a new IVF Group A needed longest FSH stimulation duration and GnRH antagonist cycle will most likely be decreased. Ideally, women would bank the total duration (9.6days, 5.1days, respectively), then group B (8.9days, 4.8days, number of euploid embryos needed to complete their family at a younger respectively), then group C (8.27days, 3.4days, respectively). Progesterone age. It is currently unknown how many euploid embryos need to be frozen level on HCG day was higher in group B (1.00ng/ml) than in group A for patients to achieve their ideal number of children. The aim of this study (0.88ng/ml) and group C (0.75ng/ml). The number of oocytes retrieved is to develop a decision support tool to inform patients about the number of was highest in group B (18.3), then group A (16.3) and the lowest in group euploid embryos that would result in a high likelihood of achieving their C (14.5). The number of fertilization embryos, transferable embryos, top- desired family size. quality embryos and blastocysts in group B (10.8, 8.7, 7.2, 3.1, respectively) DESIGN: Retrospective cohort study. were more than in group C (8.5, 7.2, 5.9, 1.6, respectively), while comparable MATERIALS AND METHODS: All patients who underwent single in group A (9.7, 8.2, 6.8, 3.3, respectively). Following the patients’ first em- euploid frozen-thawed embryo transfer (FET) from January 2013 through bryo transfer (ET) cycles, although there were no significant differences in October 2019 were included. The probabilities of one and 2 LB according the rate of chemical pregnancy, clinical pregnancy nor live birth in fresh or to cumulative number of single euploid FET performed were calculated. frozen ET cycles, the live birth rate of group C was the lowest (fresh ET, Data were stratified by SART age group. Events of monozygotic splitting frozen ET: group A, 50.0%, 52.7%;group B, 48.0%, 54.7%;group C, that resulted in twin LB were counted as 2 LB. 46.5%, 46.3%, respectively). RESULTS: 4,169 single euploid FET cycles were included in the study. CONCLUSIONS: For PCOS patients, initiating GnRH antagonist Overall, 69% of patients who attempted for one baby achieved a LB, and when dominant follicle diameter between 10mm to 14mm could 67% of patients who attempted for two children achieved two LB. 78.8% reduce FSH dosage, shorten FSH stimulation duration, retrieve more
TABLE 1. Likelihood of achieving 1 or 2 LB according to number of euploid single FET performed SART group A (<35) B (35-37) C (38-40) D (41-42) E (>42) All patients
Euploid SET # 1 LB 2 LB 1 LB 2 LB 1 LB 2 LB 1 LB 2 LB 1 LB 2 LB 1 LB 2 LB 1 52.1% 0.7% 49.9% 0.9% 50.4% 0.7% 48.4% 0.8% 49.4% 1.5% 50.6% 0.8% 2 80.8% 11.2% 78.4% 12.7% 77.5% 15.7% 76.0% 14.3% 75.9% 13.3% 78.8% 13.1% 3 93.8% 36.1% 93.2% 44.7% 91.2% 40.4% 92.0% 42.5% 87.2% 30.9% 92.5% 39.7% 4 98.6% 75.0% 97.9% 74.1% 97.6% 71.0% 97.1% 67.8% 96.7% 60.0% 97.9% 71.7% 5 99.5% 91.5% 99.5% 93.0% 88.9% 99.1% 84.3% 97.8% 81.8% 99.2% 89.6% 6 97.3% 99.9% 98.2% 100% 91.8% 99.4% 90.3% 99.8% 96.6% 7 99.9% 99.1% 99.9% 98.9% 8 99.9% 99.1% 99.9% 99.2% 9 100% 100% 100% 100%
FERTILITY & STERILITYÒ e553 oocytes, get more top-quality embryos and achieve higher live birth MATERIALS AND METHODS: One hundred and eighty-two elective rate in IVF cycles. single frozen blastocyst transfers after preimplantation genetic testing for aneuploidy (PGT-A) and mtDNA content assessment via next gen- eration sequencing (NGS) were performed between May 2016 and P-997 3:30 PM Wednesday, October 21, 2020 October 2019. Euploid blastocysts for transfer were selected based on standard morphological criteria and independently of the mtDNA IDENTIFICATION OF WOMEN AT HIGH RISK FOR content result. Blastocysts transferred were grouped according to the GYN HEREDITARY CANCERS MADE 1 value of a mtDNA content score (MS) as following: group A (MS SIMPLE. Bailey Gill McGuinness, MD, John Wagner, < ¼ ¼ ¼ 2 1 2 18.19, N 30), group B (MS 18.19 to 24.15, N 55) and group MD. NYU Winthrop Hospital, Mineola, NY; Huntington C(MS¼ 24.15to50.58,N¼ 94). Three of the studied blastocysts Hospital, Huntington, NY. had MS > 50.58 and were excluded from the study. Study groups were comparable regarding patients’ age, indication for PGT-A and OBJECTIVE: The purpose of this project was to create and trial a proportion of good quality blastocysts. Student’s t and Chi-squared screening form to be used in the out-patient setting to identify high-risk car- tests were used as appropriate. riers for GYN hereditary cancer genes, such as BRCA, Lynch Synd., etc. This RESULTS: No differences were observed between groups regarding im- screening tool can be applied in internal medicine, OB/GYN and subspe- plantation, clinical and ongoing pregnancies and miscarriage rates (table 1). cialties, like REI. Early identification of genetic carriers allows for the oppor- tunity to use PGT to prevent transfer of embryos carrying cancer genes when undergoing IVF. TABLE 1. Outcomes results between groups The form identifies women who qualify for hereditary cancer screening Study groups A B C and referrals to breast health programs (BHP) for consultation, increased sur- veillance, chemo-prophylaxis or prophylactic surgery. Several genetics com- Implantation 43.3 (13/30) 45.4 (25/55) 37.2 (35/94) panies promote forms that simplify the National Comprehensive Cancer Clinical Pregnancies 43.3 (13/30) 43.6 (24/55) 35.1 (33/94) Network (NCCN) guidelines for hereditary GYN cancer screening, such as Miscarriages 15.3 (2/13) 12.5 (3/24) 18.2 (6/33) this form. However, this is the only available form that combines NCCN Ongoing pregnancies 36.7 (11/30) 38.2 (21/55) 28.7 (27/94) guidelines with the Gail Model, which calculates a women’s lifetime breast cancer risk. DESIGN: Quality improvement project. MATERIALS AND METHODS: Stage 1: The form was used in an OB/ GYN office in East Northport, NY for one month. During this time, feedback CONCLUSIONS: Our study did not find any differences in mtDNA con- from attendings, staff and patients was used to edit the form until the form tent with regards to embryo implantation or pregnancy outcomes. A bigger was deemed not only accurate but user-friendly. sample size would be crucial to confirm these preliminary results. Stage 2: The form was introduced at an OB/GYN practice in Garden City, NY. Success of the form was measured by the number of patients identified who met criteria either for genetic testing or for referral to the local BHP, P-999 3:30 PM Wednesday, October 21, 2020 defined by an elevated Gail Model score. 6-week control (4/8/19 to 5/17/ 19) and study (5/21/19 to 7/5/19) periods were compared. THE SUPPRESSIVE EFFECT OF CELASTROL ON Descriptive statistics were performed. GROWTH OF ENDOMETRIOSIS IN VITRO IS ASSOCI- RESULTS: During the control period prior to introduction of the form, ATED WITH ANTAGONISM OF ESTROGEN RECEP- there were 171 annual and new-patient visits, of which zero patients were TOR ACTIVITY. Jingjie Li, M.D,1 Pan Chen, PhD,2 identified as candidates for genetic testing or referred to the BHP. During Jiayu Lin, Bachelor,1 Xiaoyan Liang, M.D.1 1the Sixth Affiliated Hospital, the 6-week period following introduction of the form, 197 annual and Sun Yat-sen University, Guangzhou, China; 2the First Affiliated Hospital, new-patient visits were performed and 141 of these patients (71%) were Sun Yat-sen University, Guangzhou, China. screened with the form. One patient was unable to complete the form due to lack of family history. 11% of patients met criteria for referral to genetic OBJECTIVE: Celastrol is a quinine methide triterpenoid derived from the counselors for testing and 7.8% of patients met criteria for referral to the root of Trypterigium Wilfordii, which has been used in the oriental medical BHP. settings to treat various inflammatory and neurodegenerative disorders. We Physicians described the form as a tool to learn the NCCN guidelines. The firstly explored its role in the growth of endometriosis in vitro. form generated income for physicians who coded and billed for performing DESIGN: Pharmacologic interventions in primary cultured human endo- cancer screening or genetic counseling. Patients benefitted from appropriate metriotic stromal cells. referrals with significant clinical implications. Both patients and physicians MATERIALS AND METHODS: Primary cultured human endometriotic described the form as simple to complete and navigate. stromal cells were prepared from ectopic endometrium of 15 patients with CONCLUSIONS: Identification of women at high risk for GYN hereditary endometriosis undergoing laparoscopy at the Sixth affiliated Hospital of cancers allows for appropriate referrals to genetic counselors for testing and Sun Yat-sen University from January 2018 to May 2020. The cells were incu- to BHPs for cancer screening and prevention. Identifying genetic carriers bated with Celastrol at concentrations of 0.1mM, 1mM and 10mM for 24 prior to undergoing IVF is vital due to available technology, such as PGT, hours, and the cell viability, proliferation ability and apoptosis were detected to prevent transfer of carrier positive embryos. This form proves to be by MTT assay, BrdU incorporation assay and Caspase-Glo luminescent- user-friendly, accurate, income generating, and clinically relevant, as evi- based assays respectively. Dual luciferase activity assay with transient trans- denced by continued use of this form beyond completion of the study. fection of an ERE-tk-Luc reporter was applied in measuring the effect of Ce- lastrol on estrogen receptor (ER) activation. RESULTS: Celastrol dose-dependently inhibited the viability of human P-998 3:30 PM Wednesday, October 21, 2020 primary endometriotic stromal cells, and 35.2 % of cell viability was observed at 10mM of Celastrol. Similarly, the Brdu assay proved that MITOCHONDRIAL DNA CONTENT IS NOT A USEFUL the cells proliferation ability was also inhibited by Celastrol METHOD TO PREDICT THE REPRODUCTIVE dose-dependently, with 34.8% decrease seen in 10mM. Furthermore, OUTCOME OF EUPLOID BLASTOCYSTS. Celastrol induced a significant upregulation of caspase-3 activity in Mariana Gomez Pena,~ BSc,1 Laura J. Kopcow, MD,1 1 2 endometriotic stromal cells, and 3.61 folds of maximum increase was Fabio L. Sobral, Physician, Marcos Horton, Physician, observed at 10mM. Besides, the dual luciferase reporter gene assay 1 1 ~ Mercedes Papayannis, BSc, Evelyn De Martino, BSc, Ignacio De Zuniga, demonstrated that Celastrol inhibited activation of ER in a 3 ~ 1 1 1 Physician, Alejandro Oubina, Physician, Claudio Bisioli, MSc. Pregna Me- dose-dependent manner, and 10mM of Celastrol led to 12.7% of ER dicina Reproductiva, Buenos Aires, Argentina; 2Juncal 3490, CABA, Argentina; 3 activity as compared to that in vehicle group. Pregna medicina reproductiva, Buenos Airesl, Argentina. CONCLUSIONS: Celastrol inhibits the cell viability and proliferation, while induces the apoptosis of human primary endometriotic stromal cells. OBJECTIVE: To evaluate if the assessment of mitochondrial DNA The effects are associated with the antagonism of ER activity. (mtDNA) content is a useful tool to predict implantation and pregnancy per- SUPPORT: Chinese Universities Scientifc Fund of Sun Yat-sen Univer- formance in frozen euploid blastocysts transfer cycles. sity（NO.19ykpy04） DESIGN: Retrospective comparative study. e554 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 P-1000 3:30 PM Wednesday, October 21, 2020 DESIGN: This study utilized a quantitative, exploratory, cross-sectional design. WOMEN WITH ENDOMETRIOSIS-ASSOCIATED MATERIALS AND METHODS: Healthcare providers (e.g., physicians, INFERTILITY HAVE DECREASED LIVE BIRTH RATES nurse practitioners, clinic coordinators, pharmacists, social workers, nurses) AFTER FROZEN EMBRYO TRANSFER – ANALYSIS OF - were recruited from CF Foundation accredited clinics throughout the United THE "EIVF’’ DATABASE. Alex Finlinson, MD, States and via snowball sampling. Participants completed a web-based, anon- 2 3 4 1 Henok G. Woldu, PhD, Judy E. Stern, PhD, Albert L. Hsu, MD. The Cen- ymous FP survey with 39 items that took approximately 30 minutes to com- ter For Health Analytics For National and Global Equity, Columbia, MO; plete. Participants received $20 for their participation. The descriptive 2 3 Dartmouth-Hitchcock, Lebanon, NH; Department of Obstetrics and Gyne- statistics were provided using R software. cology; University of Missouri, Columbia, MO; 4-. RESULTS: Fifty healthcare providers completed the survey (Mage¼ 40.8, SD¼11.1). The majority of the healthcare providers were female (n¼45). OBJECTIVE: To determine whether women with surgically-confirmed Despite the fact that 92% (n¼46) of the providers felt that FP discussions endometriosis have decreased live birth rates after frozen embryo transfers should be standard for all female patients with CF, 28% (n¼14) of providers (FETs), compared with either male factor or tubal factor infertility. reported that FP topics were not discussed with female patients with CF at DESIGN: Retrospective analysis FETs in Massachusetts between 2003- any age. Most providers felt that initiation of FP discussions was the respon- 2019, from the ‘‘eIVF’’ database. sibility of the healthcare team (n¼34), but some felt that patients should MATERIALS AND METHODS: FET cycles in women with surgically- initiate the FP discussions (n¼11). Lack of knowledge (n¼17) and lack of confirmed endometriosis were compared with those in couples with either time (n¼12) were the two most substantial barriers to FP discussions by male factor infertility or tubal factor infertility. Women were only classified healthcare providers. According to the providers, the two best facilitators as endometriosis if they had a surgical record of endometriosis of the uterus, for FP discussions in clinic would be having national guidelines or standards ovary, fallopian tube, pelvic peritoneum, or rectovaginal septum. Any (n¼41) and integrating partnerships with sexual and reproductive health spe- women who were noted to have clinical endometriosis that was not surgically cialists (n¼39) as part of comprehensive CF care delivery. Having educa- confirmed, were excluded from analysis. tional materials to foster FP discussions between providers and patients For the male factor analysis, couples with both endometriosis and male was another facilitator reported (n¼50). Healthcare providers preferred hav- factor infertility were excluded; similarly, for the tubal factor analysis, cou- ing educational information and resources shared via online format (n¼46) ples with both endometriosis and tubal factor infertility were excluded; this and written pamphlets (n¼44). resulted in different numbers of patients with surgically-confirmed endome- CONCLUSIONS: Fertility preservation counseling is an important part of triosis in these two analyses. Mean ages and BMI between the two groups comprehensive care for women with CF; however, many women do not were compared using the two sample t-test. Chi-square test and multivariable receive FP information. This national sample of CF healthcare providers re- logistic regression were used to assess differences in live birth rates between ported that they lacked the knowledge and time to discuss FP with their pa- surgically-confirmed endometriosis and either male factor or tubal factor tients. Removing the barriers and optimizing the facilitators to encourage FP infertility. Odds Ratios (OR) and 95% CI of the ORs were extracted from discussions between women with CF and their providers will broaden these the fitted models. Two sided alpha level of 0.05 was used to determine statis- women’s reproductive options by facilitating fully informed decision making tical significance. to improve overall health outcomes. RESULTS: We compared 3,441 FET cycles in women with surgically- SUPPORT: This study was supported by a grant from the National Insti- confirmed endometriosis to 11,510 FET cycles in couples with male factor tute of Child Health and Health Development. infertility; groups had similar average age (35.1 vs 35.0, P¼0.1947) and BMI (25.7 in both groups, P¼0.527). Women with surgically-confirmed endometriosis had a 25% chance of live birth, compared with a 37% chance P-1002 3:30 PM Wednesday, October 21, 2020 of live birth with male factor infertility (P<0.0001). Adjusting for age and BMI, the odds of live birth was 76% higher in male factor infertility (OR HUMAN PAPILLOMAVIRUS INFECTION GENOTYPE ¼1.76, 95% CI [1.61-1.91]), compared to women with surgically-confirmed IN INFERTILE WOMEN AND ITS IMPACT ON REPRO- endometriosis. DUCTIVE OUTCOMES OF INTRAUTERINE We compared 2,995 FET cycles in women with surgically-confirmed INSEMINATION. Yujie Li, Doctor. Sixth Affiliated Hospi- endometriosis to 4,558 cycles in couples with tubal factor infertility. The tal of Sun Yat-sen University. chance of live birth was 24% for surgically-confirmed endometriosis vs ¼ OBJECTIVE: The purpose of this study was to evaluate the prevalence, 28% for the tubal factor infertility group (P 0.0011). Adjusting for age genotype of HPV infection in women attending assistant reproductive treat- and BMI, the odds of live birth were 26% higher in women with tubal factor ment and to assess the relationship between HPV infection and outcome of infertility (OR 1.26, 95% CI [1.13-1.41]), in comparison to surgically- intrauterine insemination (IUI). confirmed endometriosis. DESIGN: A observational study in a tertiary hospital in southern China CONCLUSIONS: Compared with either male factor or tubal factor infer- MATERIALS AND METHODS: During December 2019 and July 2019, tility, surgically-confirmed endometriosis is associated with lower odds of cervical-swab samples were collected for detecting HPV from 1743 infertile live birth in couples undergoing FET. women seeking for assistance at the assisted reproductive technology center References: n/a (ART). 28 HPV genotypes were detected, including 18 high-risk HPV SUPPORT: n/a (hrHPV) genotypes (types 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73 and 82), and 10 low-risk HPV (lrHPV) genotypes (types 6, P-1001 3:30 PM Wednesday, October 21, 2020 11, 40, 42, 43, 44, 54, 61, 81 and 83). We evaluated the prevalence of HPV in infertile women and evaluated associations between HPV and IUI THE STATE OF FERTILITY PRESERVATION COUN- reproductive outcome. SELING FOR WOMEN WITH CYSTIC FIBROSIS RE- RESULTS: 181 (10.38%) of the 1743 infertile women tested positive for PORTED BY CYSTIC FIBROSIS HPV. Of these, 117 (64.64%) tested positive only for high-risk subtypes, PROVIDERS. Sigrid Ladores, PhD, RN, PNP, CNE, 51 (28.18%) tested positive only for low-risk subtypes, and 13 (7.18%) tested FAAN, Leigh Ann Bray, PhD, RN, CNL, Janet Brown, MSN, RN, positive for both high- and low-risk subtypes. Overall, 7.46% of all patients Caitlin Campbell, BSN, RN, Peng Li, PhD, Jessica Corcoran, PhD, tested (130/1743) were positive for a high-risk type. The most common CRNP, CPNP-PC. University of Alabama at Birmingham, Birmingham, AL. HrHPV genotype was HPV52 (2.29%), followed by HPV16 (1.03%), HPV58 (0.98%), HPV51 (0.80%). For the LrHPV genotypes, the most com- OBJECTIVE: Fertility preservation (FP) counseling is part of comprehen- mon type was HPV44 (1.15%), followed by HPV81 (0.57%), HPV42 sive care provided to women of childbearing age undergoing oncologic treat- (0.52%).The prevalence of HPV infection was higher in the age group of ments; however, this is not standard for patient populations with other 41-50 years (14.94%) than in the age group of 21-30 years (9.33%) and chronic conditions. The purpose of this study was to examine the current state 31-40 years (9.73%). For women undergoing IUI, the chemical pregnancy of FP counseling for women with cystic fibrosis (CF) from the perspective of rate of hrHPV infection group (27.27%), lrHPV infection group (25.0%) their healthcare providers, with the goal of identifying the gaps, barriers, and were higher than non-HPV infection group (12.85%). facilitators to implementation of counseling in clinical practice. This knowl- CONCLUSIONS: 10.38% of the infertile women tested positive for HPV,of edge can lead to the development of FP guidelines for women with CF and these 71.82% were positive for a high-risk type. The most common HPV geno- enhance shared decision making by broadening their reproductive options. type was HPV52 for HrHPV and HPV44 for the LrHPV. For those undergoing IUI, HPV infected women benefit more than non-HPV infected women.
FERTILITY & STERILITYÒ e555 P-1003 3:30 PM Wednesday, October 21, 2020 measures, were separated by month of treatment and compared with patients from the corresponding month in the prior year (January 2019 through June AURKC PATHOGENIC SINGLE NUCLEOTIDE VARI- 2019). Patient age, AMH, days gonadotropin, #oocytes retrieved, #oocytes ANTS ARE NOT INCIDENT IN ABORTED FETUSES matured, #fertilized, #blastocysts, and #euploid embryos were compared us- 1 WITH ANEUPLOIDY. Amin - Khosravani, Researcher, ing Student’s T-test. 2 Masood Bazrgar, Assistant Professor, Maryam Eslami, Assis- RESULTS: 1881 patients were compared over the parallel six-month pe- 3 2 1 tant Professor, Amir Amiri-Yekta, Sr., Associate Professor. Faculty of riods. Clinic visits were markedly decreased over the months of March and Advanced Science and Technology, Tehran, Iran (Islamic Republic of); April of 2020, when the pandemic was at its peak in NYC and treatments 2 Reproductive Biomedicine Research Center, Tehran, Iran (Islamic Republic were suspended as per the ASRM pandemic guidelines. There were no dif- 3 of); Applied Biotechnology Research Center, Tehran, Iran (Islamic Repub- ferences in age, AMH, #oocytes retrieved, #mature oocytes, or #fertilized be- lic of). tween the two years. In April of 2020 there were significantly more blastocysts per patient, as compared to April of 2019, however, in May OBJECTIVE: AURKC pathogenic single nucleotide variants are not inci- and June of 2020 there were significantly fewer euploid embryos per patient, dent in aborted fetuses with aneuploidy as compared to May and June of 2019 (see table). DESIGN: A main cause of infertility is recurrent miscarriage; additionally CONCLUSIONS: In the months following the end of the COVID-19 a considerable portion of miscarriages occur due to chromosomal abnormal- treatment suspension, there were no apparent differences in patient ities with/without risk of aneuploidy recurrence. characteristics or the quantitative responses to stimulation. However, Although fetal aneuploidy is associated with maternal age, it is incident in there was a significant qualitative difference as expressed in the num- young women. AURKC protein kinase is an essential factor in the cell cycle ber of euploid embryos. It remains unclear if or how the pandemic is and its dysfunction can reduce the accuracy of chromosome segregation. related to this difference. MATERIALS AND METHODS: We collected 50 DNA samples of aborted fetuses with confirmed aneuploidy by QF-PCR and/or array CGH method. In order to rule out advanced maternal age as a contributing factor in fetal aneuploidy, samples from mothers older than 36 years were not P-1005 3:30 PM Wednesday, October 21, 2020 included. We focused on two pathogenic single nucleotide variants (SNVs) DOES CULTURING EMBRYOS IN THE TIME LAPSE of the Exons 5 and 6 of AURKC gene in Exon 6, rs397515484 and INCUBATOR IMPROVE THE EMBRYO QUALITY rs121908654 using Sanger sequencing method by analyzing the results AND PREGNANCY OUTCOME DURING IVF/ICSI with FinchTV software. TREATMENT? Alex C. Varghese, Ph.D,1 Maria Teresita RESULTS: In 50 samples, there was no evidence of heterozygosity and ho- Lao, MSc,1 Nnenna Maduabum, MD,2 Essam S. N. Michael, M.D., mozygosity of rs397515484 and rs121908654 pathogenic SNVs FRCSC,1 Kannamannadiar Jayaprakasan, Ph.D.3 1Astra Fertility Clinic, CONCLUSIONS: Considering that the targeted mutations were not Mississauga, ON, Canada; 2University of Nottingham, Nottingham, United observed in 50 samples, these SNVs (rs397515484 and rs121908654) do Kingdom; 3Department of Obstetrics and Gynaecology, Derby, United not seem to be prioritized for future screening of aneuploidy origin in parents Kingdom. with a history of abortion due to aneuploidy. OBJECTIVE: To evaluate whether the use of time-lapse incubator (TLI) improve embryo quality and IVF outcome in comparison to standard tri- P-1004 3:30 PM Wednesday, October 21, 2020 gas benchtop incubator. DESIGN: A retrospective study in a tertiary fertility unit. COVID-19 AND ART OUTCOMES. Isaac J. Chamani, < M.D.,1 David H. McCulloh, Ph.D.,2 James A. Grifo, MD, MATERIALS AND METHODS: Women aged 40 years undergoing IVF 3 4 1 treatment from Jan 2018 to June 2019 were included. Poor responders with PhD, Frederick L. Licciardi, M.D. Baylor College of Med- < icine, Houston, TX; 2NYU Langone Fertility Center, New York, 4 oocytes retrieved and those needed treatment with surgical sperm NY; 3NYU Langone Prelude Fertility Center, New York, NY; 4NYU Langone retrieval for severe male factor were excluded. Mature oocytes, retrieved Health, New York, NY. from 297 patients, were inseminated. Inseminated oocytes were cultured to the blastocyst stage either using a TLI (GERI Plus) with a single step media ¼ OBJECTIVE: The ongoing COVID-19 pandemic has disrupted the normal (n 188) or in a conventional Planer BT-37 Bench top incubator with sequen- ¼ methods of communication used by physicians and patients, as well as the tial culture and Day-3 media change (n 109). 161 participants underwent standard protocols and procedures by which medical clinics operate. fresh embryo transfer with one (70.2%) or two (29.8%) embryos. The Pandemic related stresses may have also influenced patient’s fertility goals outcome measures were usable blastocysts, proportion of top quality cleav- and/or their ovarian response. We questioned whether these changes resulted age stage embryos and blastocysts, pregnancy rates and live birth rates. in any unanticipated effects in the treatments and outcomes of ART patients. The Mann Whitney-U test was used to compare the demographics and the DESIGN: Retrospective cohort. Chi-square test and the relative risk analysis were used to compare binary MATERIALS AND METHODS: Patients who underwent GnRH-antago- outcome variables. nist IVF cycles from January 2020 through June 2020 at NYU Fertility Cen- RESULTS: The mean ( SD) age of the participants were similar in the ter, a period in New York City over which the COVID-19 pandemic escalated study and the control groups (33.1 3.8 vs 32.8 3.8 years). Table 1 shows and life in the city drastically changed as a result of new social distancing the comparison of outcome variables. Day-3 compaction rate and the
Year N Age AMH #Oocytes #Mature #Fertilized #Blasts #Euploid
January 2019 190 37.1 2.8 14.8 8.4 6.5 3.2 2.0 2020 235 36.5 2.7 15.7 7.9 6.0 3.2 2.1 February 2019 159 36.6 2.8 15.7 9.2 7.1 3.7 2.7 2020 194 36.9 2.6 15.8 8.7 6.6 3.3 2.1 March 2019 177 36.9 2.4 13.2 7.5 5.6 3.2 2.2 2020 90 36.6 2.8 15.0 6.9 5.1 2.7 2.3 April 2019 169 36.6 2.6 16.0 8.2 6.2 3.0* 2.2 2020 34 36.8 2.5 15.3 11.4 8.1 5.1* 3.0 May 2019 141 36.7 2.4 16.1 8.7 6.5 3.5 2.4* 2020 170 36.5 2.6 15.3 9.0 6.6 3.5 1.2* June 2019 160 37.0 2.4 14.9 7.5 5.6 3.0 2.3* 2020 176 36.5 2.4 14.4 7.0 5.4 2.7 1.0*
*indicates p < .05 for comparison between 2019 and 2020 values e556 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 GERI Plus(n¼188) PLANER (n¼109) P-value
Gr.I & II embryos on D-3 80.9% 85.46% 0.24 1637/2022 1005/1176 Compaction on D-3 19.88% 5.44% <0.001 402/2022 64/1176 Useable Blastocysts 64.59% 62.33% 0.27 1306/2022 733/1176 Top quality blastocysts (AA, AB, BA) 13.80% 6.03% <0.001 279/2022 71/1176 CPR (sET+dET)* 31/64 (48.4%) 31/71 (43.6%) 0.58 LBR (sET+dET)* 29/64 (45.3%) 26/71 (36.6%) 0.31 CPR (sET)* 25/48 (52.0%) 15/44 (34.0%) 0.82 LBR (sET)* 23/48 (47.9%) 14/44 (31.8%) 0.12
*Pregnancy outcome data not available for all the participants. proportion of top-quality blastocysts were higher in the TLI group. However, Embryos were cultured till the blastocyst stage and the percentage of the pregnancy and live birth rates were similar. excellent quality blastocyst formed per oocyte was recorded. All the blasto- CONCLUSIONS: While the proportion of compacted embryos on day 3 cysts were vitrified and embryo transfer was performed after two months. and of top-quality blastocysts developed were higher with TLI culture sys- The clinical pregnancy rate per embryo transfer was calculated in each group. tem, the live birth rates were similar between the two groups, albeit a better The data was compared using unpaired t-test, with the help of SPSS software trend with TLI. A large randomized trial is warranted to evaluate this version 21. research question further. RESULTS: No microbial growth was detected in both the groups. The levels of VOC, PM, Blastocyst formation and clinical pregnancy rate is tabu- lated. P-1006 3:30 PM Wednesday, October 21, 2020 CONCLUSIONS: The addition of a cold plasma based air purification sys- tem to the culture laboratory with an existing HVAC system significantly re- IMPROVEMENT IN THE BLASTOCYST FORMATION duces the VOC levels and results in a significant increase in the blastocyst AND SUBSEQUENT CLINICAL PREGNANCY RATES formation and clinical pregnancy rates. It could be an adjunct in the labora- FOLLOWING THE USE OF COLD-PLASMA BASED tory in these COVID times where there is an increased use of VOC releasing AIR PURIFICATION SYSTEM IN THE EMBRYO CUL- sanitizers. TURE LABORATORY. Satish Manohar Patki, Sr. M.D.,1 Rajvi H. Mehta, Ph.D.2 1Patki Hospital, IVF Consultant, Kolhapur, India; 2 Trivector Boimed LLP, Mumbai, India. P-1007 3:30 PM Wednesday, October 21, 2020
OBJECTIVE: To study the effect of installation of a cold-plasma based QUALITY OF ONLINE INFORMATION PROVIDED BY air purification system in the embryo culture laboratory on the quality of FERTILITY CLINIC WEBSITES: COMPLIANCE WITH air and the effect on the blastocyst formation and subsequent clinical preg- BRAZILIAN MEDICAL COUNCIL (CFM) AND AMER- nancy rate. ICAN SOCIETY FOR REPRODUCTIVE MEDICINE DESIGN: After clearance by our Institutional Ethical Committee, a cold- (ASRM) GUIDELINES. Marcia C. Ferreira, MD, PhD, plasma based air purification system was installed in the embryo culture lab- Caio Nobuyoshi Koga, Medical student, Marcela Chagas Lima Mussi, Med- oratory which already had a well-maintained Heating Ventilation Air-Condi- ical student, Pollyanna Faria Fradico, Medical student, Marcia M. Carneiro, tioning (HVAC) System. The ambient air quality, with specific reference to MD, PhD. UNIVERSIDADE FEDERAL DE MINAS GERAIS, Belo Hori- microbial contamination, volatile organic compounds (VOC) and particulate zonte, Brazil. matter (PM) was compared before and after the installation of this air purifi- cation system. The blastocyst formation rate and clinical pregnancy rates was OBJECTIVE: To evaluate fertility clinic websites registred in the11th also compared during these two time frames. Report of the National Embryo Production System Platform (SisEmbrio MATERIALS AND METHODS: A portable Novaerus NV-1050 air puri- 2017) in Brazil regarding their compliance with the 2004 American Society fication system which consists of cold plasma technology along with acti- for Reproductive Medicine (ASRM) and the Brazilian Medical Council vated carbon and HEPA filters was installed in embryo culture laboratory. (CFM) guidelines for advertising and to survey the general features of their The microbial count was determined weekly while the VOC and PM counts websites and social media. were monitored daily at the same time of the day. DESIGN: Cross-sectional study. 410 patients underwent IVF procedures during 6 months. Of these, 199 pa- MATERIALS AND METHODS: We performed a cross-sectional online tients underwent IVF before (Group I) and 211 patients (Group II) after the evaluation to obtain data on the SiSembrio registered clinics websites using installation of Novaerus air purification system. Patient characteristics such 2004 ASRM guidelines for advertising (Success rates published; Presence of as age, indication for IVF, ovarian stimulation protocol, fertilization tech- data to support success rate ;Comparison marketing; Live birth rate (LBR) niques, embryo culture conditions, embryo transfer techniques and luteal reported ;Method of calculating LBR; LBR for time period given ;Success support were similar in both the groups. rates based on age and diagnosis; Experimental/Investigational nature of
Parameter Group I Group II Significance level/P Value
Mean Particle Matter Count 200 (SD 11.25) 195 (SD 10.37) 0.245 Mean VOC levels(ppb) 12.2 (SD 3.2) 7.5 (SD 2.6) 0.003 Mean Blastocyst formation rate 45.5 % (SD 6.9) 60.5 % (SD 5.3) 0.0009 Mean Clinical pregnancy rate 53.26% (SD 8.9) 66.35% (SD 7.1) 0.001
FERTILITY & STERILITYÒ e557 procedure defined) and compliance with CFM guidelines (practice director P-1009 3:30 PM Wednesday, October 21, 2020 visible with respective council number; no information on treatments’ costs, no photos of patients shown nor success stories with patient identification) IS BLASTOCYST DEVELOPMENTAL RATE A GOOD for advertisement. The general characteristics of these fertility clinics web- PREDICTOR OF ONGOING PREGNANCY RATE IN sites and their social media were also assessed. EUPLOID BLATOCYSTS? Silvia De Frutos S anchez, 1 1 2 RESULTS: All 163 SiSEmbrio-registered clinics were evaluated; 155 MSC, Marta Ariza Lopez, MSC, Fernando Bronet, PhD, 1 1 (95,1%) had functional websites (8 public, 153 private, 8 public, 2 no infor- Eva Mar ıa Martinez, MSC, Maria Gaytan, PhD, 1 3 1 mation).Social media participation was as follows: WhatsApp 87(87;53.3%) Ma Del Carmen Nogales, MSC, Ma Jos e de los Santos, PhD. IVI RMA 2 3 Facebook (143 ;87.7%) and Instagram (135;82.8%) while 84 (51.5%) had Madrid, Madrid, Spain; IVI Madrid, Madrid, Spain; IVIRMAValencia, Va- other social media (YouTube, Linkedin and Twitter). Regarding CFM recom- lencia, Spain. mendations only 49 (31.6%) displayed a registered director, 84(54.1%) showed patients photos either on their sites and/or social media as well as OBJECTIVE: To determine whether onoing pregnancy rate (OPR) is success stories. No clinic announced prices and only one offered an exclusive affected by bastocyst developmental rate (trophoectoderm biopsy on day 5 treatment. Success rates were published on 51(32.9%) and only 18(11.6%) or on day 6) in euploid embryos with the same morphological quality. used their own data whereas 7 (4.5%) displayed success rates by age. No DESIGN: Retrospective, observational and multicenter cohort study. clinic showed LBR. All clinics offered IVF and 131 explained the procedure MATERIALS AND METHODS: Patients who underwent PGT-A or PGT- to patients. Social fertility preservation was offered by 127(81.9%) and on- SR cycles, dated from May 2016 to February 2019, in IVI Madrid, IVI Va- cofertility by 122 (78.7%). Preimplantation genetic diagnosis was available lencia and IVI Barcelona were included. A total of 5648 euploid embryos in 85 (54.8%), oocyte donation in 67(43.25), surrogacy in 51 (32.9%) and (biopsied on day 5 and on day 6) were divided into six different grups accord- semen donation in 44 (28.4%) and only 35 (22.6%) had andrologists. ing to their morphological quality, wich are further divided acording to the CONCLUSIONS: Online Information provided by fertility clinics in biopsy day. Statistical program SPSS was used to find significant differences Brazil is heterogeneous. A significant proportion of the SisEmbrio-registered in OPR among analized groups (Table 1). fertility clinics websites do not follow some aspect of ASRM and CFM All biopsied blastocysts were hatching or hatched. Blastocysts were guidelines for advertising. As websites and social media are widely used divided as followed: 427 in Group 1 (AA), 792 in Group 2 (AB/BA), 2921 by patients to obtain health information, increased dissemination and aware- in Group 3 (BB), 1477 in Group 4 (BC/CB/CC), 21 in Group 5 (AC) and ness of the guidelines is highly recommended. 10 in Group 6 (CA). SUPPORT: None RESULTS:
OPR OPR P-1008 3:30 PM Wednesday, October 21, 2020 DAY 5 DAY 6 p N (D5+D6)
PREDICTING PROBABILITY OF CUMULATIVE LIVE GROUP 1 BH(i) AA 55,50% 50,48% ns 427 BIRTH BASED ON BOTH BASELINE INFORMATION GROUP 2 BH(i) 56,76% 51,28% ns 792 AND PROTOCOLS OF CONTROLLED OVARIAN AB/BA STIMULATION. Jing Liu, Prof., Qi Wan, Dr., GROUP 3 BH(i) BB 53,90% 46,23% 0,0455 2921 Jihua Huang, Dr., Xingyu Lv, Dr., Xiangqian Meng, Dr., Huan Xu, Dr., GROUP 4 BH(i) 45,26% 34,68% <0,0001 1477 Ying Zhong, Prof. Chengdu Xi’nan Gynecology Hospital, Chengdu, China. BC/CB/CC OBJECTIVE: To develop a prediction model for the probability of cumu- GROUP 5 BH(i) AC 40% 33,33% ns 21 lative live birth from one initiated assisted reproductive technology (ART) GROUP 6 BH(i) CA 50% 33,33% ns 10 cycle based on couples’ baseline characteristics and controlled ovarian stim- ulation (COS) protocols. Therefore, we sought to create a clinical prediction model for counseling and COS protocol selection. CONCLUSIONS: Excelent and good blastocysts (Groups 1 and 2) have DESIGN: A retrospective cohort study. similar OPR, regardless the day of the biopsy. However, average and poor MATERIALS AND METHODS: From Jan 2012 to Mar 2016, all women blastocysts (groups 3 and 4) showed lower OPR on Day 6. We can conclude at age of 19-39 years old with at least 5 antral follicle count (AFC) underwent that blastocyst developmental rate can affect OPR only when the morpholog- just one complete ART cycle with long GnRH-agonist, depot GnRH-agonist, ical embryo qality is average or poor. modified long GnRH agonist and GnRH-antagonist protocols in Chengdu *As the number of embryos included in Groups 5 and 6 were too small, Xi’nan Gynecology Hospital were included, and followed up to Mar 2018. they have not been considered for conclusions. Couples with chromosome abnormality were excluded. Cumulative live birth was defined as first live birth resulting from one initiated ART cycle, including cycles in which fresh and/or frozen embryos were transferred, until P-1010 3:30 PM Wednesday, October 21, 2020 one delivery with a live birth occurs or until all embryos are used, whichever occurs first. A multivariate stepwise logistic regression model was used to PROOF OF CONCEPT OF A TREATMENT FOR HU- predict the probability of cumulative live birth. The accuracy of the model MAN OOCYTE MATURATION ARREST;TRANSVAGI- was then tested using a receiver operating characteristic curve (ROC). NAL OVARIAN NEEDLE INJURY PRECEEDING RESULTS: 6862 patients with 6862 complete ART cycle were enrolled LETROZOLE PRIMING IN VITRO with a 72.89% overall cumulative live birth rate (CLBR), namely 5002 cycles MATURATION. Safak Hatirnaz, MD,1 Ebru Hatirnaz, MD,1 cumulatively had live birth. Predictors in the model were female’s age (-0.07, Alper Basbug, MD,2 Michael H. Dahan, M.D.,3 Kaan Hatirnaz, LICENCE_ 95% CI:-0.09 -0.05, P<0.001), height (0.06, 95% CI:0.05 0.08, P<0.001), STUDENT.4 1Medicana International Hospital, Samsun, Turkey; 2DUZCE€ weight (-0.01, 95% CI:-0.02 0.00 , P¼0.005), duration of infertility (-0.06, UNIVERSITY, DUZCE,€ Turkey; 3Division of Reproductive Endocrinology 95% CI:-0.08 -0.04 , P<0.001), number of previous ART cycle (-0.60, 95% and Infertility, McGill University Health Care Center, Montreal, QC, Can- CI:-0.79 -0.41 , P<0.001), basal AFC (0.08, 95% CI:0.07 0.09, P<0.001), ada; 4ONDOKUZ MAYIS UNIVERS_ ITY_ SCHOOL OF SCIENCE,_ SAM- basal FSH (-0.09, 95% CI:-0.12 -0.06, P<0.001) and COS protocols [long SUN, Turkey. GnRH-agonist (reference category), depot GnRH-agonist (-0.08, 95% CI:- 0.64 0.48, P¼0.785), modified long GnRH agonist (-0.69, 95% CI:- OBJECTIVE: We aim to present the proof of concept of a novel targeted 0.96 -0.43 , P<0.001), GnRH-antagonist protocols (-0.12, 95% CI:- treatment strategy; transvaginal ovarian needle injury (TVOI) preceeding le- 0.71 0.47, P¼0.696)]. The area under the curve (AUC) for ROC was 0.708. trozole priming in vitro oocyte maturation (Letrozole IVM) for women CONCLUSIONS: This model provides a scientific predicting method for suffering from repeated in vitro fertilization failures due to oocyte maturation probability of cumulative live birth, thus help doctors give patients more ac- arrest (OMA). curate counseling and select more suitable COS protocol. DESIGN: This study is designed as a proof of concept study. SUPPORT: This study was supported by the China Health Promotion MATERIALS AND METHODS: 7 cases were treated with TVOI-Letro- Foundation’s ART Research Program of Young and Middle-aged Physicians. zole IVM protocol.
e558 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 TVOI –Letrozole IVM protocol was desinged to address all mechanisms er, despite these poorer biomarkers of ovarian response HP-hMG can involved in the maturation arrest process of oocytes. improve the efficiency of the cycle since there are no significant differences TVOI is the puncture under mild sedation or anesthesia with a 17 gauge in the usable blastocyst rate in any of the ratios analyzed. Clinical outcomes aspiration needle with 10-20 punctures in each ovary.This procedure can are also significantly better for HP-hMG vs rFSH: clinical pregnancy (57.1% be performed 1-6 months before letrozole priming IVM procedure.The vs 54.1% p¼0.045) and live birth (45.8% vs 42.1% p¼0.043) rates, respec- aim of TVOI is to activate the follicles from the primordial follicular pool tively. and to distrupt any inhibiting factors if present in the ovary CONCLUSIONS: We can establish the possibility that the LH activity Letrozole,an aromatase inhibitor induces endogenous FSH secretion sec- mainly provided by hCG of postmenopausal origin only, might improve ondary to the reduced estrogen levels. The resultant increased androgens the proficiency of the cycle. The HP-hMG group got a more effective MII/ may promote follicular/oocyte growth and maturation. oocyte ratio. In addition, the initial differences in the number of oocytes IVM was selected as the treatment of choice in cases with OMA because retrieved with rFSH disappeared, as there were no differences in usable blas- unknown intrafollicular factors can be hypothesized to either promote tocyst rate according to the number of retrieved oocytes, MII or fertilized oo- apoptosis of the oocytes or may cause oocyte maturation issues. cytes. We might also assume the hCG-driven LH activity improves embryo The combination of these methods was named as TVOI-Letrozole IVM quality, since stimulation with HP-hMG significantly increases clinical out- protocol comes not only in clinical pregnancy rate but in live birth rate, which is ulti- SPSS 23.0 (IBM Corporation, Armonk, NY, USA) was used for the statis- mately the parameter that determines the true success of the treatment. HP- tical analysis of the data.The quantitative data were expressed as median and hMG vs rFSH data of well-designed randomized control trials can be here range (minimum–maximum) and categorical variables were expressed as confirmed in antagonist setting in a real-world scenario. number (%). SUPPORT: No RESULTS: Seven out of fifteen women completed their TVOI-Letrozole IVM cycles. The clinical and laboratory course of all participants(including treated and P-1012 3:30 PM Wednesday, October 21, 2020 untreated patients) were shown in Table 1. One woman with two IVF failures due to OMA a the MI stage gave birth to UTILIZATION OF GONADOTROPIN-RELEASING a healthy baby. HORMONE AGONIST (GNRHA) TRIGGER IN GNRH Another women with seven failed IVF attemts due to Mixed OMA( GV,MI ANTAGONIST CYCLES: DOES THE TIME INTERVAL and immature MII oocytes) gave birth to a healthy baby. FROM LAST ANTAGONIST ADMINISTRATION MATTER? Anat Hershko Klement, MD,1 Efrat Esh Broder, MD,1 Embryo transfer was succesfully performed in a woman with mixed OMA 1 1 who had five times failed IVF history but pregnancy can not be achieved. Amy Solnica, RN MSN, Hananel G. E. Holzer, MD, Judith Frei, RN MSN,2 Jigal Haas, M.D.,2 Raoul Orvieto, MD.2 1Hadassah Mt. Scopus, In one woman with a history of five failed IVF attempts dueto MI OMA 2 was treated with our protocol but we failed to achive MI-MII transition in the Hebrew university, Jerusalem, Israel; Sheba medical center, Tel Aviv this case. university, Ramat Gan, Israel. In a woman with a family history of ZP1 mutation,we applied TVOI and OBJECTIVE: To evaluate the efficiency of GnRHa trigger in GnRH antag- letrozole priming IVM for diagnostic purpose and zona free oocytes without onist cycles with regard to the time interval from the last antagonist admin- any maturation (GV OMA) was determined. istration to trigger injection. In one woman with Primary amenorrea with normal AMH value our pro- DESIGN: A cohort encompassing two IVF clinics was assembled: we tocol managed to retrieve one GVand one MI oocytes for the first time in her included GnRH antagonist IVF cycles in which GnRH agonist (GnRHa) life but failed to mature the eggs. trigger was used alone for final oocyte maturation or GnRHa trigger as a sur- In one woman with 4 failed IVF attempts due to mixt OMA ,one oocyte rogate trigger along with hCG (dual trigger). Oocyte retrieval took place 36 was succesfully fertilized for the first time but arrested at PN stage. hours after trigger injection. One clinic adhered to a 12-14 hour interval be- CONCLUSIONS: OMA is accepted to be untreatable by autologous oo- tween last antagonist administration and trigger, while the other clinic prac- cytes currently .Targeted treatment like TVOI-Letrozole IVM may show in ticed shorter intervals. overcoming OMA in selected cases.Studies are warranted to clarify mecha- MATERIALS AND METHODS: All cycles were assessed retrospectively nisms of OMA and of how TVOI Letrozole functions.This case series pre- and analyzed according to the time interval between the last GnRH antago- sents the first livebirths with autologous oocytes in OMA. nist exposure to the triggering injection time. Group1 included patients with a SUPPORT: No fInancial_ support for this study 12-14 hour interval, Group 2 included patients with an 8-10 hour interval and Group 3 included patients with a 4-6 hour interval. LH levels were measured 12 hours post trigger injection. The study was approved by a local Institu- P-1011 3:30 PM Wednesday, October 21, 2020 tional Review Board. RESULTS: 78 patients were included in Group 1, 164 in Group 2, and 54 HP-HMG IN MONOTHERAPY IMPROVES CLINICAL in Group 3. Roughly 40% of patients were triggered by the dual trigger and ı OUTCOMES IN YOUNG WOMEN. Mar a Cruz, PhD, statistical analysis was split according to the triggering modality in order to Maria Eugenia Ruiz, PhD. IVIRMA Global Headquarters, Ma- avoid the bias related to the use of agonist trigger in cases prone to OHSS. For drid, Spain. the entire study population, mean and median post-trigger LH levels were 66.7 41.4 mIU/ml, 61.2 4 mIU/ml respectively. No previous data exists OBJECTIVE: To evaluate the efficacy of HP-hMG ovarian stimulation in regarding post trigger LH level in respect to the antagonist schedule: we young women to tailor ART protocols to meet patient needs and improve the found that LH levels were significantly higher in group 2 (55.8 28.5 Group likelihood of a positive outcome in real world setting. 1, 77.0 49.4 Group 2, 59.2 29.5 Group 3, p¼ 0.01), but no correlation be- DESIGN: Multicenter retrospective, anonymized cohort analysis per- tween the absolute LH level to the number of oocytes retrieved or to the formed in 11 Spanish clinics from the IVI group. oocyte maturation rate (p¼ 0.4 and 0.6 respectively) for both triggering mo- MATERIALS AND METHODS: Study population:women < 38 years old dalities. In a multivariate Poissonian model for oocyte number, neither time receiving monotherapy with HP-hMG (n¼1744) or rFSH (n¼3316). Patients interval from antagonist, nor absolute LH levels were significant predictors underwent short GnRH antagonist protocol, 0.25 mg daily doses from day 6 < a b for the outcome, while age, as expected, was (p 0.001). of stimulation. On day cycle 2/3, they received daily rFSH / or HP-hMG, CONCLUSIONS: GnRH antagonist administration timing before GnRH with FSH:LH activity ratio 1:1. Initial doses were based on weight and BMI agonist trigger does not seem to affect the triggering efficiency in intervals according to the experience of clinicians. . A single dose of 0.1 mg GnRH between 14 to 4 hours prior to the GnRH agonist utilization. In these time in- agonist was used for triggering. Embryo transfer was performed on day 3 tervals, the conventional 0.2 mg GnRH agonist dose is sufficient for displac- or 5 where applicable. ANOVA and Chi-squared statistical analysis was per- ing the GnRH antagonist and triggering final follicular maturation. To the formed. best of our knowledge, this is the first study looking into the efficiency of RESULTS: Assuming the limitations of the study design, we observed sig- < GnRHa trigger in GnRH antagonist cycles, with regard to the time interval nificant differences in age (33.1 0.1 vs 34.1 0.2 y, p 0.001), AMH levels from the last antagonist administration to trigger injection. Further prospec- (3.7 0.4 vs 2.9 0.5 ng/ml, p¼0.002) and AFC (14.1 2.0 vs 12.7 1.5 fol- ¼ tive randomized controlled studies are warranted to support our conclusion. licles, p 0.031) favoring rFSH vs HP-hMG group. Number of retrieved oo- SUPPORT: None cytes was significantly higher with rFSH vs HP-hMG (13.1 0.4 vs 10.0 0.3, p<0.001). as well as MII (9.2 0.5 vs 7.1 0.2, p<0.001). Howev-
FERTILITY & STERILITYÒ e559 P-1013 3:30 PM Wednesday, October 21, 2020 center. Ninety-five heterosexual couples undergoing fresh ICSI cycles were evaluated. WHEN AND WHERE DURING COVID-19: THE EF- MATERIALS AND METHODS: Metal levels (lead Pb, cadmium Cd, FECT OFAT-HOME SEMEN COLLECTION ON SPERM arsenic As, mercury Hg, barium Ba, and uranium U) in semen and blood sam- PARAMETERS, FERTILIZATION RATE, AND BLAS- ples from male partners were analyzed using Ion-Coupled Plasma-Mass TOCYST RATE. Caitlin R. Sacha, MD, Stylianos Vagios, Spectrometry (ICP-MS; Agilent 7500 ce, Agilent Technologies, Germany) MD, Karissa C. Hammer, MD, Victoria W. Fitz, MD, MSCR, equipped with cell dynamic range. Adjusted associations between paternal Irene Souter, MD, Charles L. Bormann, PhD. MGH Fertility Center and Har- concentrations of metals and embryo-level outcomes (embryo quality/frag- vard Medical School, Boston, MA. mentation score, cleavage, and implantation) were evaluated using multiple linear regression models and natural log transformed metal data. Associa- OBJECTIVE: In order to maintain social distancing and reduce risk of tions between paternal exposure and reproductive endpoints (live births) transmission of coronavirus disease 2019 (COVID-19) amongst patients at were investigated using modified Poisson regression employing a sandwich an academic fertility center, semen collection for semen analyses and treat- variance estimator after adjusting for co-variates. ments such as intrauterine insemination (IUI) and in vitro fertilization (IVF), RESULTS: High blood Cd, As and U levels in men were associated with were converted to ‘‘at home.’’ Our aim was to assess whether at-home semen significantly lower proportions of cleaved embryos (b ¼ -0.30; 95% CI: collection altered sperm parameters, fertilization rates, or day 5 usable qual- -0.11, -0.02; P ¼ 0.01) (b ¼ -0.26; 95% CI: -0.16, -0.11; P ¼ 0.02) ity blastocyst rates in patients undergoing IVF. (b ¼ -0.22; 95% CI: -0.24, -0.02; P ¼ 0.05), respectively. Counterintuitively, DESIGN: Retrospective cohort study. paternal blood and semen Pb concentrations were positively associated MATERIALS AND METHODS: Semen parameters and embryo out- with higher embryo implantation (b ¼ 0.26; 95% CI: 0.01, 0.22; P ¼ 0.03) comes were compared in 42 patients between their IVF cycle prior to (b ¼ 0.25; 95% CI: 0.03, 0.14; P ¼ 0.04), respectively. Semen U COVID-19 (on-site ‘‘clinic’’ collection) and their subsequent cycle after concentrations were also positively associated with embryo implantation COVID-19 protocols necessitated ‘‘at-home’’ collection. On-site collection (b ¼ 0.27; 95% CI: 0.01, 0.19; P ¼ 0.03). Paternal metal concentrations in was performed in a room adjacent to the andrology laboratory, and process- both body compartments did not predict the likelihood of livebirth in ICSI ing occurred within approximately 30 minutes. The post-COVID-19 collec- treatment cycles. tions were performed at home with the standard specimen cup, delivered to CONCLUSIONS: These findings highlight the potential effects of sperm the andrology laboratory within 2 hours of collection, and then processed. Pa- metal exposure on embryo efficiency indicators after ICSI, laying support tient demographics, semen parameters, fertilization rate (number of 2 pronu- to possible molecular pathways which could impact specific pre- and post- clear embryos/number metaphase II oocytes), and day 5 usable quality implantation embryonal events. This may point to the likelihood of a trans- blastocyst rate (number transferable and freezable blastocysts/number 2 pro- generational effect of paternal exposure to pollutants with long-term bearing nuclear embryos) in fresh transfer cycles were compared between clinic and on obstetrical and postnatal outcomes. These results also underline a para- at-home collections from each patient with a paired T-test. The effect of time doxical favorable association between specific metal pollutants at low-expo- between semen production and processing on sperm parameters and embryo sure levels and some reproductive outcomes, shedding light on different outcomes was assessed with linear regression modeling. pattern effects through pathophysiologic pathways unique to each trace RESULTS: Mean male age was 38.1 years in the clinic group and 38.9 < element. Whereas counseling of women is common practice in fertility years in the at-home group (p 0.001). On average, men were abstinent care, this study emphasizes the importance of paternal health on reproductive for 2.9 days (SD 1.3) in the clinic group and 3.3 days (SD 3.6) in the at- ¼ outcomes in ICSI treatment cycles and the need for more male partner inclu- home group (p 0.576). Mean time to semen processing was 34.0 minutes sive counseling in fertility practice. (SD 11.4) in the clinic group and 78.7 minutes (SD 28.5) in the at-home SUPPORT: Medical Practice Plan MPP - American University of Beirut group (p < 0.001). Semen concentration, percent motility, total motile count, and forward progression score were similar between the clinic and at-home groups. While there was no change in sperm parameters by the amount of P-1015 3:30 PM Wednesday, October 21, 2020 time to processing in clinic samples, those collected at home demonstrated an increase in motility of 0.357% (p ¼ 0.002), an increase in total motile COMPARISON OF THE EMBRYO QUALITY OBTAINED count by 1.6 million (p ¼ 0.007), and an increase in forward progression AFTER AN UNSTIMULATED AND STIMULATED CY- score of 0.01 (p ¼ 0.006) for each extra minute from production to process- CLE IN THE SAME INFERTILE PATIENT UNDERGO- ing. There were no differences in mean fertilization rates (clinic 77.0%, SD ING IN VITRO FERTILIZATION. Elena Labarta, MD 22.5 vs. at-home 77.9%, SD 18.2; p ¼ 0.813) or usable day 5 blastocyst rates PhD,1 Cristina Rodriguez-Varela, M.Sc,1 Marcos Meseguer, PhD,1 (clinic 47.2%, SD 21.3 vs. at-home 54.6%, SD 24.8; p ¼ 0.218). Longer time Lorena Bori, M.Sc,1 Arantza Delgado, PhD,2 Amparo Mercader, PhD,1 between semen production and processing had no effect on fertilization rates Bel en Aparicio-Ruiz, PhD,1 Ernesto Bosch, MD, PhD.1 1IVI-RMA, Valencia, or day 5 usable quality blastocyst rates. Spain; 2Embryologist, Valencia, Spain. CONCLUSIONS: Our data suggest that at-home semen collection within 2 hours of processing does not negatively impact sperm parameters or em- OBJECTIVE: To analyze if ovarian stimulation increases the rate of aneu- bryo outcomes within the same patient. Therefore, at-home collection is a ploidy compared to what occurs in the natural basal state. reasonable alternative to on-site collection in clinics seeking to encourage We compared the probability of a MII oocyte becoming an euploid blasto- increased social distancing of patients during the COVID-19 pandemic. cyst in a natural and stimulated cycle in the same patient. SUPPORT: None DESIGN: Prospective cohort study comparing embryo quality after a modified natural (MNC) and a stimulated cycle (SC) in the same infertile IVF patient. Registration Number: NCT03128580. P-1014 3:30 PM Wednesday, October 21, 2020 MATERIALS AND METHODS: Patients provided written informed con- sent prior to any procedure. No exogenous gonadotropins were given in the PATERNAL EXPOSURE TO NON-ESSENTIAL HEAVY MNC. The requirement to continue in the study was to obtain at least one MII METALS AFFECTS EMBRYO EFFICIENCY INDICA- oocyte in the MNC. The SC consisted of a fixed combo GnRH antagonist pro- TORS IN INTRACYTOPLASMIC SPERM INJECTION tocol with a daily dose of 225 IU of rFSH and 75 IU of hp-HMG. In both cy- (ICSI) CYCLES: EVIDENCE IN FAVOR OF A PARA- cles, ovulation was triggered 36h prior to oocyte retrieval with triptoreline DOXICAL EFFECT. Johnny Awwad, M.D., HCLD, Carol Sukhn, (0.1mg) when at least one (MNC) or 3 follicles (SC) >¼17 mm were PhD, Akram Ghantous, PhD, Nour Assaf, BS, Ghazi Zaatari, MD. Amer- observed. ican University of Beirut Medical Center, Beirut, Lebanon. Embryo quality was assessed through morphological (following the ASE- BIR criteria), morphokinetic (by time-lapse technology) and genetic evalua- OBJECTIVE: While preconception health remains an essential compo- tion (using NGS for the embryo chromosomal analysis). nent of fertility counseling, the association between paternal exposure to pol- Student’s t tests and ANOVAwere used for quantitative variables, for com- lutants and reproductive endpoints in intracytoplasmic sperm injection parisons between 2 or more than 2 groups, respectively. c2 was used for cat- (ICSI) cycles remains uncertain and poorly explored. The primary aim of egorical variables. Correlation between quantitative variables was evaluated this study was to address this existing data gap and generate hypotheses by by Pearson’s correlation analysis. P-value<0.05 is considered statistically identifying associations between paternal levels of non-essential metals in significant. blood and semen, and reproductive endpoints in ICSI cycles. Sample size was calculated assuming a 5% difference in the % of euploid DESIGN: This is a prospective cohort study of heterosexual couples un- embryos/ MII in favor of the MNC. Assuming that at least 2 MII oocytes are dergoing ICSI treatment using autologous oocytes at a university fertility e560 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 obtained in the SC, 70 patients were needed to reach a statistical power of P-1017 3:30 PM Wednesday, October 21, 2020 80% and a 95% confidence level in a single-tailed test where the upper limit of the CI excludes a 10% difference (80 patients considering a 15% loss rate). INCREASED AVERAGE OF SPERM HEAD AREA After an interim analysis, the study was discontinued after a stochastic (ASHA) IS A NOVEL SPERM PARAMETER ASSOCI- curtailment analysis. ATED WITH HIGHER INCIDENCE OF SPERM 1 RESULTS: From 54 recruited patients, 40 obtained MII oocytes in both ANEUPLOIDY. Miguel Ruiz-Jorro, MD, MSc, PhD, 1 cycles. Intra-patient comparison showed a similar proportion of euploid em- Minerva Ferrer-Buitrago, BSc, PhD, Juan Jesus Bataller-S anchez, BSc, 1 1 bryos per MII oocyte (16.1% in MNC and 18.6% in SC; p>0.05). The num- MSc, Antonio Barber a-Alberola, MSc, Xavier Vendrell-Monton, BSc, 2 1 1 ber of oocytes needed to obtain one euploid blastocyst was 6.2 MII in MNC PhD, Carmen Calatayud-Lliso, MD, MSc, PhD. CREA. Medicina de la 2 and 5.4 MII in SC (p¼0.68). Aneuploidy rates were 64.7% vs 52.4%, respec- Reproduccion S.L., Valencia, Spain; Ascires Sistemas Genomicos, Pa- tively (p¼0.30). terna-Valencia, Spain. No differences were observed in the morphological classification (p¼0.89), whereas morphokinetic evaluation showed that tPNf, t3, t5, t6, OBJECTIVE: To evaluate the association between the average sperm head t7, t8, t9+,tSC, and t5-t2 were significantly faster in the SC (p<0.05). area (ASHA) and altered sperm aneuploidy rate in male infertility. The mean number of euploid embryos was significantly higher in the SC DESIGN: A total of 147 patients who showed normal sperm aneuploidy (2.4 vs 0.2; p¼0.000). A linear relation was found between the number of oo- rates were used as a control to determine the cut-off value for ASHA. A retro- cytes and the number of euploid blastocysts obtained (R¼0.659; 0¼0.00). spective study was further performed to calculate the incidence of sperm CONCLUSIONS: Ovarian stimulation has no negative effect on oocyte aneuploidy in infertile patients with a suspected risk of sperm aneuploidy: Recurrent implantation failure or pregnancy loss (RIF; RPL), or testicular and embryo quality. Aneuploidy rate, the number of MII needed to obtain ¼ an euploid blastocyst, and embryo quality are comparable between the natu- failure (Study Group 1; n 250). The intra-patient variability of ASHA was ral and the stimulated cycle. The implication of the faster division times compared to other sperm parameters: concentration, motility and observed in the SC is yet to be determined. morphology. Moreover, the sperm aneuploidy rate was prospectively as- sessed in a total of 22 patients with increased ASHA values, who showed Ovarian stimulation offers a significantly higher number of euploid em- bryos without diminishing embryo quality. normal testicular function, normal FSH values (4,81 2,83 mUI/ml), and SUPPORT: Research grant award from FINOX (Forward initiative 2016) absence of RIF or RPL. Sample size was adjusted to detect at least 30 % dif- ference in sperm aneuploidy rate compared to published data in reference population of infertile men (15.0 %), and for a power calculation of 95. P-1016 3:30 PM Wednesday, October 21, 2020 MATERIALS AND METHODS: All participants signed an informed con- sent form. ASHA cut-off value was established according to the value at REDUCTION OF BACTERIAL COLONY FORMING percentile 95. Chi-squared statistic was used to asses frequency distribution. UNITS IN AN OBSTETRICS OPERATION THEATRE Two semen samples were analyzed per patient according to WHO-V-manual. USING COLD-PLASMA BASED DIELECTRIC BAR- Sperm concentration, motility, morphology and ASHA were evaluated using RIER DISCHARGE AIR PURIFICATION the CASMA software ISAS. Samples were stained using the Diff-quick kit. SYSTEM. Milind RAMCHANDRA. Ubale, M.D,1 Rajvi H. Mehta, Sperm aneuploidy was determined by FISH analysis (5 chromosomes) using Ph.D.2 1Rajiv Gandhi Medical College & Chatrapati Shivaji Maharaj Hospi- Metafer-4 software. tal, Thane, India; 2Trivector Boimed LLP, Mumbai, India. RESULTS: ASHA cut-off value was established as R14,8 mm2 in the con- trol group. Group 1 revealed an increased incidence of altered FISH (41.2%) OBJECTIVE: To evaluate the effectiveness of the cold-plasma based compared to the reference value (15.0%). The mean ASHA value in group 1 dielectric barrier discharge (CP-DBD) based air purification system on the was 12.9 1.3 mm2, whereas the mean ASHA value in the subgroup of pa- number of bacterial colony forming units in an obstetrics operation theatre tients with altered FISH was 13.2 1.4 mm2. ASHA values showed lower (OBOT). intra-patient variability (p<0.002) and higher positive predictive value to DESIGN: Air samples were taken to determine the bacterial load before detect altered FISH (73.9%) than other sperm parameters such as concentra- and 7, 14 and 21 days after the installation of the CP-DBD based air purifi- tion (56.5%), total sperm count (58.8%) and morphology (46.7%). The pre- cation system in the OBOT; the unit was switched off on Day 21 and air sam- dictive value of ASHA to detect sperm aneuploidy was further validated in a ples were taken on Day 28. The number of bacterial colony forming units prospective analysis (Group 2). Sperm parameters in group 2 were: concen- were compared on different days to determine the effect of the CP-DBD tration (20.8 26.5 million sperm/ ml), % total motility (45.0 14.6) and % air purification system on the bacterial load. normal morphology (1.6 0.7). The mean ASHA value in group 2 was 15.2 MATERIALS AND METHODS: This study was carried out in the OBOT 0.6 mm2, and the incidence of sperm aneuploidy was significantly of a municipal public hospital. Air samples were taken from the OBOT (Pre, increased compared to the reference value of 15.0% (p<0.05). Day 0) at 0, 1, 2, and 4 hours. The CP-DBD based air purification system No- CONCLUSIONS: Our study describes ASHA as a sperm parameter with vaerus-1050 was installed in the OBOT and air samples were taken at 0, 1, 2 low intra-patient variability. Prospective data revealed that patients present- and 4 hours on Day 7, 14, 21 days (Post). The Novaerus unit was switched off ing with idiopathic infertility, who show ASHA values > 14,8 mm2 have a after taking the samples on Day 21 and 4 air samples at 0, 1, 2 and 4 were high risk to carry chromosomal aberrations in sperm. Our results indicate taken on Day 28. The number of individuals present in the OBOT on that that altered ASHA is an indicator to request a FISH analysis from the first particular day was also noted. The air samples were cultures on Blood sperm evaluation. agar and Sabouraud’s Dextrose agar plates and incubated at at 370 C for These findings provide new insights in the field of androgenetics and male 48 hours and 30 days respectively. The number of bacterial colony forming infertility, since ASHA might contribute to reduce the time to advise PGT-A, units for each air sample were determined in the Blood agar as well as Sab- and consequently, the time to conceive in some infertile couples. ourauds Dextrose Agar plates. The data for Day 0, 7, 14, 21 and 30 was tabu- References: Fluorescent in situ hybridization ofA^ human sperm: diagnos- lated and and compared. tics, indications, and therapeutic implicationsRamasamy, Ranjith et al.Fertil- RESULTS: There was significant reduction in bacterial colony count /ml ity and Sterility, Volume 102, Issue 6, 1534 - 1539 in post- I compared to pre-I air sampling. Fluctuation in post- I colony count at 0 ,1, 2, 4 hours was observed during each intervention day that is on 0, 7, 14, 21 days. However in all intervention days the 4 hours CFU showed reduc- P-1018 3:30 PM Wednesday, October 21, 2020 tion in bacterial colony counts as compared to 0 hour colony count. At day 28, there was increase in colony counts at every reading (0, 1, 2, 4 hours) PREGNANCY LOSS RATES AFTER SINGLE, EUPLOID as compared readings taken on day 0, 7, 14, 21 days when air purifier was FROZEN-THAWED EMBRYO TRANSFER IN THE 1 2 operational. The mean CFU decreased from 21 on Day 0 to 10, 7, 5 on COVID-19 ERA. Eric Flisser, MD, Devora Aharon, MD, 1 2 1 Day 7, 14 and 21 respectively. After switching off the CP-DBD air purifica- Dmitry Gounko, MA, Alan B. Copperman, MD. Reproduc- 2 tion system, the mean CFU increased to 18 on Day 28. tive Medicine Associates of New York, New York, NY; Icahn School of CONCLUSIONS: The results indicate that continuous usage of cold Medicine at Mount Sinai, New York, NY. plasma based air purifier system can decrease and consistently maintain low microbial load in the operation theaters. This system would be very use- OBJECTIVE: Data on the impact of COVID-19 on early pregnancy is extremely limited, and patients and practitioners remain cautious about initi- ful in OBOTs of public hospitals which work 24 x 7 and therefore are higher 1-4 risk of microbial contamination. ating pregnancy in areas of high SARS-CoV-2 transmission. In April 2020,
FERTILITY & STERILITYÒ e561 during the peak of the pandemic, the prevalence of COVID-19 among New OBJECTIVE: To assess the effect of the total motile sperm count (TMSC) York State residents was estimated to be 22.7%, consisting largely of asymp- on the success of controlled ovarian stimulation (COH) and intra uterine tomatic infection.5 If SARS-CoV-2 is pathogenic to early pregnancy, an in- insemination (IUI) in women 38-42 years-of-age. Current literature suggests crease in loss might be expected given this high transmission. The women 35-40 years of age have no pregnancies when TMSC%5mil at COH/ objective of this study is to determine if an increase in early pregnancy IUI [1, 2]. loss occurred in patients undergoing single euploid frozen embryo transfer DESIGN: Retrospective cohort study, included women who underwent (FET) during the height of the COVID-19 pandemic. IUI with stimulation at a University Reproductive Centre between 2009- DESIGN: Retrospective cohort study. 2018. MATERIALS AND METHODS: The study took place at an academic ter- MATERIALS AND METHODS: A database from all women aged 38-42 tiary care center with offices throughout New York City. All single euploid years old who underwent IUI with stimulation at a University Reproductive FET cycles performed from January-May of 2017-2020 were included. Cy- Centre between 2009-2018. Including stimulation with clomiphene citrate, cles with FET in 2017-2019 were compared to those with FET performed in letrozole or gonadotropins and divided into TMSC 5.01-10.0 mil and the corresponding time period in 2020. Baseline characteristics included age, %5.00 mil. The main outcome was clinical pregnancy rate, defined as fetal oocyte age, AMH, BMI, and endometrial thickness. Pregnancy loss rate heart beat by ultrasound, per stimulation cycle. Statistics were compared (PLR), or loss after the presence of serum bhCG R2.5 mIU/mL, and clinical with multivariate logistic regression, t-tests or chi-squared tests. pregnancy loss rate (CLR), loss after a gestational sac was seen on ultra- RESULTS: A total of 397 cycles of IUI were included, of which, 190 cy- sound, were compared between January-May, 2017-2019 and January- cles with TMSC 5.01-10.0 and two hundred and seven cycles with TMSC May, 2020, in aggregate as well as for each corresponding month individu- %5.00. There were no statistical differences in the basic characteristics be- ally. Comparative statistics and multivariable logistic regression were used. tween the two groups including: age (P¼0.2), gravidity (P¼0.7), parity RESULTS: 2629 single euploid FET cycles were included in the study: (P¼0.6), basal FSH (P¼0.2), basal E2 (P¼0.4), antral follicular count 2070 from Jan-May, 2017-2019 and 559 from Jan-May, 2020. Positive (P¼0.5) and the number of mature follicles stimulated (P¼0.2). As designed, pregnancy rates were 73.7% in January-May, 2017-2019 and 77.6% in TMSC was 7.6 1.5 mil in the first group and 2.4 1.6 mil in the second January-May, 2020. Baseline characteristics were similar. No differences group (P<0.0001). The clinical pregnancy rate per cycle in the 5.01-10.00 were seen in PLR or CLR when comparing FET from January-May, TMSC group was 9.5 % vs. 3.4% when TMSC%5.00 (P¼0.01). When eval- 2017-2019 to FET from January-May, 2020. No differences were seen in uating only women 40-42 years of age (99 women in the 5.01-10.00 TMSC PLR or CLR when comparing individual months in 2017-2019 to 2020. group and 95 in the group of TMSC%5.00); the pregnancy rates were not sta- On multivariable logistic regression, when controlling for oocyte age, tistically different between the two groups (7% vs. 7.3%, P¼ 0.082), nor was AMH, BMI, and endometrial thickness, FET in January-May 2017-2019 the clinical pregnancy rate (5% VS. 5.2%, P¼0.7). was associated with a higher odds of pregnancy loss compared to CONCLUSIONS: Women 38-39 years-of-age have poorer outcomes at January-May 2020 (OR 1.32, 95% CI 1.02-1.73, p¼.039). No difference COH/IUI when TMSC %5 million than if it is greater. Once a woman is was seen in CLR between these groups (OR 1.34, 95% CI 0.92-1.97, 40 years of age this effect is lost. With mild male factor infertility, women p¼.13). No differences were seen in PLR or CLR comparing each month 38-39 years of age have respectable outcomes at COH/IUI. Clinical preg- individually in the two time periods. nancy rates are just 5% irrelevant of sperm quality in women 40-42 years CONCLUSIONS: This data is reassuring that early pregnancy loss rates of age performing COH/IUI with male factor infertility. were not increased during widespread SARS-CoV-2 transmission. A References decrease in PLR in January-May 2020 compared to prior years might be 1. Ahmed Badawy, M.D.,a AbouBakr Elnashar, M.D.,b and Mohamed El- attributable to selection against treatment of patients with known risk factors totongy, M.D.a Effect of sperm morphology and number on success of intra- for severe infection. While in the absence of universal screening for SARS- uterine insemination. Fertility and Sterility.Vol. 91, No. 3, March 2009 CoV-2, which at the time was neither available nor recommended, this data 2. Hammed Akanji Tijani & Siladitya Bhattacharya (2010) The role of in- does not exclude a possible impact of infection on pregnancy loss, it suggests trauterine insemination in male infertility, Human Fertility, 13:4, 226-232. that screening patients for elevated temperature, symptoms, and exposure https://doi.org/10.3109/14647273.2010.533811 may be effective in maintaining established early pregnancy success rates. This data may help guide clinics in regions experiencing a surge in virus transmission. P-1020 3:30 PM Wednesday, October 21, 2020 SUPPORT: None References GNRH ANTAGONIST PROTOCOL WAS SUPERIOR TO 1. Kasraeian M, Zare M, Vafaei H, et al. COVID-19 pneumonia and preg- MILD STIMULATION PROTOCOL IN CONTROLLED OVARIAN STIMULATION IN PATIENTS WITH nancy; a systematic review and meta-analysis [published online ahead of € print, 2020 May 19]. J Matern Fetal Neonatal Med. 2020;1-8. https://doi. DISCORDANCE BETWEEN ANTI-MULLERIAN HOR- org/10.1080/14767058.2020.1763952 MONE CONCENTRATION AND ANTRAL FOLLICLE 2. Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of COUNT. Meng Rao, MD., Shuhua Zhao, Ph.D, Li Tang, MD. The First pregnant women admitted to hospital with confirmed SARS-CoV-2 infection Affiliated Hospital of Kunming Medical University, Kunming, China. in UK: national population based cohort study. BMJ. 2020;369:m2107. Pub- OBJECTIVE: To evaluate the laboratory and clinical outcomes between lished 2020 Jun 8. https://doi.org/10.1136/bmj.m2107 GnRH antagonist and mild stimulation protocols in patients with discordance 3. Galang RR, Chang K, Strid P, et al. Severe Coronavirus Infections in between anti-Mullerian€ hormone (AMH) concentration and antral follicle Pregnancy: A Systematic Review [published online ahead of print, 2020 count (AFC). Jun 16]. Obstet Gynecol. 2020;10.1097/AOG.0000000000004011. https:// DESIGN: Retrospective cohort. doi.org/10.1097/AOG.0000000000004011 MATERIALS AND METHODS: This study was conducted in the Repro- 4. ASRM Patient management and Clinical Recommendations During the ductive Medical Center of the First Affiliated Hospital of Kunming Medical Coronavirus (COVID-19) Pandemic Update #6 (7/10/2020-8/10/2020) University during Jan 2016 to Dec 2019. This study included 130 infertile 5. Rosenberg ES, Tesoriero JM, Rosenthal EM, et al. Cumulative inci- couples with female AMH<1.1 ng/mL and AFCR7，65 couples received dence and diagnosis of SARS-CoV-2 infection in New York [published on- GnRH antagonist protocol and another 65 age and BMI-matched couples line ahead of print, 2020 Jun 17]. Ann Epidemiol. 2020;S1047-2797(20) received mild stimulation protocol treatment.Laboratory and clinical out- 30201-5. https://doi.org/10.1016/j.annepidem.2020.06.004 comes were compared between GnRH antagonist cycles and mild stimula- tion cycles. The primary outcomes included the no. of aspirated oocytes P-1019 3:30 PM Wednesday, October 21, 2020 and cumulative clinical pregnancy rate. The secondary outcomes included the cycle cancellation rate and the no. of good-quality embryos. IS COH /IUI AN EFFECTIVE TREATMENT IN OLDER RESULTS: During the study period, a total of 220 patients received 303 WOMEN AND MALE PARTNERS WITH DECREASED GnRH antagonist and mild stimulation cycles in our reproductive center. TOTAL MOTILE SPERM COUNTS? Einav kadour- 130 cycles (65 in each group) were enrolled by using propensity score match- Peero, MD,1 Namaa Steiner, MD,1 Russell Frank, M.D.,2 ing with age and BMI. Mean female age in GnRH antagonist and mild stim- Maryam al Shatti, MD,1 Jacob Ruiter, MD,1 Michael H. Dahan, M.D.1 1Di- ulation groups were 36.2 and 36.4 years, respectively (p¼0.84). Mean male vision of Reproductive Endocrinology and Infertility, McGill University age (37.0 vs. 38.0 years), female BMI (23.5 vs. 23.3 kg/m2), AMH (0.76 vs. Health Care Center, Montreal, QC, Canada; 2McGill University Health 0.74 ng/mL) and AFC (8.8 vs. 8.4) were all similar between these two groups Centre, Montreal, QC, Canada. (p¼0.37, 0.73, 0.58 and 0.25, respectively). After adjusting for a series of e562 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 potential demographical and clinical confounders, we found 2.1 more oo- Women in rFSH+rLH group had higher clinical pregnancy rate (44.0% vs cytes were aspirated in GnRH antagonist cycles compared with mild stimu- 32.4%, P¼0.521) but showed no significant difference compared with lation cycles [adjusted mean (95% CI): 4.7(4.2-5.3) vs. 2.8(2.4-3.2), rFSH group. p<0.001]. Good-quality embryos were also significantly more in GnRH CONCLUSIONS: Supplementation of rLH was suggested to bring more oo- antagonist cycles than mild stimulation cycles [1.6 (1.2-2.2) vs. 1.1(0.8- cytes and embryos and it might potentially increase the clinical pregnancy rate. 1.5), p¼0.014]. The cycle cancellation rate was non-significantly lower in Our data supports rLH supplementation improves controlled ovarian hyperstim- in GnRH antagonist cycles than mild stimulation cycles (0% vs. 3.1%, ulation outcome in women with low LH concentration (% 4 IU/l) during mid- p¼0.13). The cumulative clinical pregnancy rate in GnRH antagonist cycles and late-follicular phase. Further studies are needed to confirm these findings. was higher than that in mild stimulation cycles [30.0% (20.0%-42.7%) vs. 21.8% (13.8%-33.8%), whereas the difference was non-significant (p¼0.29). CONCLUSIONS: We concluded that GnRH antagonist protocol may be SUPPORT: This work was supported by Chengdu Science and technol- superior to mild stimulation protocols in women with low AMH (<1.1 ng/ ogy project (2019-YF05-00250-SN). mL) but moderate AFC (R7). Due to the retrospective nature and the limited no. of sample size, population and multi-center based study and RCTs are warranted to provide stronger evidence. P-1022 3:30 PM Wednesday, October 21, 2020 SUPPORT: This study was supported by the China Health Promotion Foundation’s ART Research Program of Young and Middle-aged Physicians. IN VITRO FERTILIZATION OUTCOMES OF BLACK PATIENTS COMPARED TO WHITE PATIENTS IN A MIDWEST COHORT. Jean-Claire Powe Dillon, MD, 1 1 P-1021 3:30 PM Wednesday, October 21, 2020 MPH, Caitlin Elizabeth Martin, MD, MS, Patricia T. Jimenez, MD,2 Joan Riley, PhD, HCLD,3 Kenan Omurtag, RECOMBINANT LUTEINIZING HORMONE (LH) SUP- MD.4 1Washington University School of Medicine, St. Louis, MO; 2Wash- PLEMENTATION IMPROVES CONTROLLED ington University in St. Louis, Saint Louis, MO; 3Washington University OVARIAN HYPERSTIMULATION OUTCOME IN in St. Louis, St. Louis, MO; 4Washington University St Louis School of Med- WOMEN WITH LOW LH CONCENTRATION DURING icine, St. Louis, MO. MID- AND LATE-FOLLICULAR PHASE. Tian Tang, M.D., Yuechao Lu, M.D., Junliang Guo, M.D., Wei Huang, Professor. West China OBJECTIVE: To identify disparities in IVF cycle outcomes and parame- Second Hospital; Key Laboratory of Birth Defects and Related Diseases of ters between black and white patients at a single center. Women and Children, Ministry of Education, Sichuan University, Chengdu, DESIGN: Retrospective cohort study China. MATERIALS AND METHODS: Data from 2016-2019 was obtained from clinical records at Washington University in St Louis. Women undergoing OBJECTIVE: To examine the role of rLH supplementation in patients un- their first fresh IVF cycle at the clinic were included. All analyses were per- dergoing assisted reproductive technology (ART). We therefore compared formed with IBM SPSS Statistics software (version 26). The data was the effect of rFSH vs rFSH+rLH on controlled ovarian hyperstimulation analyzed using chi-square, Fisher’s exact test, or student’s T-test where (COH) characteristics and ART cycle outcome. appropriate. Multinomial logistic regression was used for assessing live birth DESIGN: A retrospective cohort study was conducted for all cases on ART rate, controlling for body mass index (BMI) and age. cycle outcome with the use of either rFSH or rFSH+rLH. RESULTS: There were 1054 white patients (93.6%) and 72 black patients MATERIALS AND METHODS: From January 2018 to January 2019, 163 (6.4%) identified. The mean age was similar for black patients compared to patients (52 with rLH and 111 without rLH) were enrolled in this study : 1. white patients (34.4 years vs. 33.3 years, p ¼ 0.083). The mean BMI was sta- Main causes of infertility attributable to tubal, idiopathic, or male factors; tistically higher for black patients when compared to white patients (31.3 vs. Regular menstrual cycle; Normal uterine cavity. 2. Serum levels of LH (Fol- 27.7, p < 0.001). Tubal factor (33.3% vs. 12.2%, p < 0.001) and uterine fac- licle reached 12mm of the ovarian cycle) %4 IU/l. 3.Underwent COH utiliz- tor (6.9% vs. 1.1%, p¼ 0.003) infertility was more common amongst black ing GnRH-antagonist protocol. Propensity score matching (PSM) was used patients compared to white patients. The stimulation regimens for IVF to reduce confounding, baseline characteristics between two groups were were similar between groups. Black patients were statistically more likely matched. The primary outcome measures were number of oocytes retrieved to use preimplantation genetic testing of their embryos (n¼6, 8.3% vs. and number of embryos available. The secondary outcome measure is clin- n¼23, 2.2%, p¼0.008). Black women were more likely to have more em- ical pregnancy rate in fresh embryo transfer cycle. bryos available to freeze compared to white patients (4.36 vs. 3.41 embryos, RESULTS: PSM resulted in 98 patients (49 in each group) for analysis. p ¼ 0.001), however the live birth rate was lower amongst black patients Baseline characteristics, including age, BMI, AMH, basal FSH, basal LH, compared to white patients, which persisted when controlling for BMI and LH on day of stimulation start, LH on day of follicle reach 12mm and LH age (n¼15, 20.8% vs. n¼352, 33.4%, AOR 0.510 95% CI 0.279-0.930, p on day of triggering, did not differ significantly between two groups. Women ¼ 0.030). The number of patients whose pregnancies resulted in spontaneous accepted rFSH+rLH for stimulation had significantly higher number of oo- abortions were not statistically different amongst both groups (black n¼5, cytes retrieved (12.24 8.13 vs 8.27 5.98, P¼0.007) and higher number 6.9% vs. white n¼65, 6.2%, p¼0.799). of embryos available (4.20 2.75 vs 2.98 2.47, P¼0.022) than rFSH alone. CONCLUSIONS: Despite advances in reproductive medicine, disparities exist between black and white patients undergoing IVF. In a midwestern cohort, despite freezing more embryos, the live birth rate was overall lower in black women undergoing their first IVF cycle at our center compared to rFSH alone rFSH+rLH white women, when controlling for BMI and age. Risk factors for poorer pregnancies outcomes were identified to be higher in our black patients, (n¼49) (n¼49) P value such as BMI and uterine factor, however additional analysis needs to be completed to identify these relationships further. Black patients were more Baseline Characteristics likely to have embryos to cryopreserve and use preimplantation genetic AGE 31.67 4.86 31.45 5.22 0.826 testing when compared to white patients, which warrants investigation of cu- BMI 21.78 2.89 21.18 2.46 0.274 mulative live birth rate amongst the groups. A subanalysis of insurance AMH 4.71 4.44 4.68 4.86 0.977 coverage on this new cohort will also provide needed socioeconomic insights LH on day of follicle 1.51 0.83 1.45 0.96 0.745 related to access and outcomes. reach 12mm Basal FSH 5.98 3.12 7.24 4.69 0.123 P-1023 3:30 PM Wednesday, October 21, 2020 Basal LH 7.44 10.19 6.17 4.57 0.431 LH on day of stimulation 4.55 4.14 3.69 2.68 0.237 WHERE DO CRYOPRESERVED EMBRYOS END UPAF- start TER A POSITIVE PREGNANCY TEST? Edgardo Young, LH on day of triggering 5.72 29.52 1.93 2.52 0.373 Jr., PhD,1 Laura Isa, Medical Doctor,1 Sofia Garcia Argibay, Outcome Measures Medical Doctor,1 Mar ıaP ıa Zappacosta Villarroel, Medical Number of oocytes retrieved 8.27 5.98 12.24 8.13 0.007 Doctor,1 Roberto Inza, Medical Doctor,1 Alberto Valcarcel, PhD.2 1IFER, Number of embryos available 2.98 2.47 4.20 2.75 0.022 Ciudad Autonoma de Buenos Aires, Argentina; 2IFER, Ciudad Autonoma pregnancy rate (%) 32.35 (11/34) 44 (11/25) 0.521 de Buenos Aires, Argentina.
FERTILITY & STERILITYÒ e563 AGE DESTINATION LBR MR P
<35 (n ¼ 93) Not used Embryos 46/68 (67,6%) 4/25 (16%) p <0,0001 Used Embryos Taken to unknown site 5/22 (22,7%) 1/21 (4,8%) p ¼ 0,1853 Taken to another center 1/21 (4,8%) Embryo transfer 17/22 (77,3%) 19/21 (90,5%) p ¼ 0,4121 35-39 (n¼ 103) Not used Embryos 43/63 (68,3%) 7/40 (17,5%) p <0,0001 Used Embryos Taken to unknown site 4/20 (20%) 3/33 (9%) p ¼ 0,4048 Taken to another center 3/20 (15%) 2/33 (6%) p ¼ 0,3536 Donation 1/20 (5%) Embryo transfer 20/12 (60%) 28/33 (84,8%) p ¼ 0,0541 >40 (n¼ 49) Not used Embryos 17/31 (54%) 1/18 (5,5%) p <0,0006 Used Embryos Taken to unknown site 6/14 (42,8%) 1/17 (5,88%) p ¼ 0,0281 Embryo transfer 14/8 (57%) 16/17 (94,1%) p ¼ 0,0281
OBJECTIVE: To report what happens with vitried surplus embryos after RESULTS: Multivariate analyses revealed that female age, female body IVF in patients with a positive pregnancy test, carrying out an analysis ac- mass index (BMI), antral follicle count (AFC), male infertility, uterine factor cording to age and final evolution of the pregnancy. infertility, and basal serum follicle stimulating hormone (FSH) level were DESIGN: Retrospective descriptive study. significant factors for CLBR in low prognosis patients. An area under the MATERIALS AND METHODS: We analyzed 245 embryo transfer cy- receiver operating characteristic curve (AUC) in the prediction model was cles, performed between January 2013 to December 2017, in 235 patients 0.70 (95% CI 0.68 to 0.72) in the training cohort. The validation set showed with a positive pregnancy test and who vitried surplus embryos. All the pa- good discrimination with an AUC of 0.68 (95% CI 0.65 to 0.71). Addition- tients underwent treatment with their own oocytes. The variables studied ally, Hosmer-Lemeshow chi-square statistic was 5.931 (P ¼ 0.655). were: age, miscarriage rate (MR) and live birth rate (LBR). We compared CONCLUSIONS: We developed and validated a nomogram to predict the destination of the cryopreserved embryos according to the patient’s age CLBR in low prognosis patients using a single center database in China. and pregnancy evolution. Statistical analysis was performed with Fisher’s The validated nomogram to predict CLBR could be a potential tool for exact test. IVF counselling in low prognosis patients. RESULTS: 20% of the IVF cycles (n¼49) were performed in women older than 40 years, 42% between 35 and 39 (n ¼103) and 38% in women younger than 35 (n¼ 94). Average age was 35.8 4.1 years. 859 embryos were cry- P-1025 3:30 PM Wednesday, October 21, 2020 opreserved (3.5 1.9 cryopreserved embryos/patient). Average search time for surplus embryos was 20.5 17.9 months, rising to 36.9 14.9 months APPLICATION OF THE CRYOPIECE SYSTEM FOR CRYOPRESERVATION OF RARE HUMAN after delivery and decreasing to 8.7 7.8 months after miscarriage 1 2 < SPERMATOZOA. Wenlong Su, MS, Lei Jia, PhD, (P 0.0001). Up to date there are 118 (48.2%) patients whose cryopreserved 3 4 embryos have not been transferred yet. Signficant differences were found in Shujing He, MM, Zhiqiang Zhang, master’s degree, Cong Fang, Ph.D.,2 Xiao-yan Liang, PhD.4 1Sixth Affiliated hospital of the three groups in using the cryopreserved embryos according to whether or 2 not they had delivery. Sun Yat-Sen University, Guangzhou, China; Reproductive Medicine Research Center, Sixth Affiliated Hospital of Sun Yat-sen University, CONCLUSIONS: Half of the surplus cryopreserved embryos in assisted Guangzhou, China; 3The Sixth Affiliated hospital of Sun Yat-Sen University, reproductive technologies are not transferred. Regardless of the age of the pa- Guangzhou, China; 4The Sixth Affiliated Hospital of Sun Yat-sen University, tient, all groups showed the same behavior regarding the utilization of the Guangzhou, China. cryopreserved embryos after delivery. It is essential to advise couples who perform assisted reproductive technologies, with a good probability of suc- OBJECTIVE: To investigate the clinical efficacy of cryopiece system for cess (regardless of the patient’s age), about the responsibility that embryonic cryopreserving rare human spermatozoa from patients with severe male-fac- cryopreservation entails. Argentine legislation has limitations regarding the tor infertility. availability of cryopreserved surplus embryos. We believe that Public Health DESIGN: Retrospective study. policies related to this issue should be re evaluated based on these results. MATERIALS AND METHODS: Cryopreservation of small numbers of SUPPORT: None human spermatozoa with cryopiece system was performed at the Reproduc- tive Medicine Center of the sixth affiliated hospital of Sun Yat-Sen Univer- sity between August 2019 and July 2020. Cryopreservation procedure was P-1024 3:30 PM Wednesday, October 21, 2020 as follows: The liquefied ejaculated semen or testicular tissue which was dissected with two 1 mL-syringe needles, was centrifuged at 300g for 5 NOMOGRAM FOR THE CUMULATIVE LIVE BIRTH min. And the re-suspended deposit was loaded on the micro-strips. Sperma- RATE IN LOW PROGNOSIS PATIENTS ACCORDING tozoa were captured using ICSI injection pipette and added to 0.5mL droplet TO POSEIDON CRITERIA: A RETROSPECTIVE of cryoprotective solution on a cryopiece. After holding upon liquid nitrogen COHORT STUDY OF 4494 PATIENTS IN vapor for 15 min, the cryovial with a cryopiece was plunged into liquid nitro- CHINA. Pengfei Qu, Ph.D, Wenhao Shi, M.D. Northwest Women’s and gen. On the day of oocyte retrieval, the cryopiece was placed on the ICSI dish Children’s Hospital, Xi’an, China. with 37 C immediately. The recovery rate, fertilization rate and clinical out- comes were analyzed to evaluate the clinical efficacy of cryopiece system. OBJECTIVE: A small number of prediction model have been previously RESULTS: In total, 125 spermatozoa from 7 patients (44% motile) were developed to predict the success of infertility treatment. However, the studies vitrified. 107 spermatozoa were warmed for ICSI; the sperm recovery was of prediction model for low prognosis patients are limited. The aim of this study 100%. The motile sperm rate per recovered spermatozoa was 31.4%. The was to develop and validate a nomogram for the cumulative live birth rate 2PN fertilization rate was 60.9%, the cleavage rate was 85.7% and the rate (CLBR) in low prognosis patients using a single center database in China. of transferable embryo on D3 was 60.9%. The clinical pregnancy rate DESIGN: Retrospective cohort study. following fresh embryo transfer was 100% (2/2). MATERIALS AND METHODS: We reviewed the clinical data of 4494 CONCLUSIONS: Hence, we draw the conclusion that the cryopiece sys- low prognosis patients according to POSEIDON criteria who underwent in tem was a simple constructed and highly efficient carrier that used for vitri- vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment fication of small numbers of human spermatozoa in micro-droplets. between 2014 and 2018 at Assisted Reproduction Center of Northwest SUPPORT: Medical Scientific TechnologyA^ Research Foundation of Women’s and Children’s Hospital, Northwest China. Of the eligible partici- GuangdongA^ Province of China (A2020226); National Natural Science pants, 70% were randomly assigned to the training set, while the remaining Foundation of China (81871214); NationalA^ Key R&D Program of China 30% were assigned to the external validation set. Multivariate analysis using (2017YFC1001603) the Logistic regression model was performed. e564 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 P-1026 3:30 PM Wednesday, October 21, 2020 known neurologic sequelae in patients or first-degree family members. The Z+ group had a clinically significant higher incidence of mosquito bites OLEANOLIC ACID INHIBITS PROLIFERATION AND than the Z- group, although without statistically significance. In addition, ANGIOGENESIS AND PROMOTES APOPTOSIS IN HU- semen analysis parameters and hormone levels showed no differences be- MAN ENDOMETRIOTIC STROMAL CELLS. Jingjie Li, tween the groups. 1 2 1 1 M.D, Pan Chen, PhD, Xiaoyan Liang, M.D. the Sixth Affil- CONCLUSIONS: The prevalence of serum IgG anti-ZIKVantibodies was 2 iated Hospital, Sun Yat-sen University, Guangzhou, China; the First Affiliated high in this cohort of fertile men, despite a low prevalence of ZIKV infection Hospital, Sun Yat-sen University, Guangzhou, China. symptoms. There was no statistical difference in semen parameters or hor- mone between the groups. Screening of all male infertility patients should OBJECTIVE: Oleanolic acid (OA) is a pentacyclic triterpenoid that has be considered in areas with high risk of exposure to Zika Virus. long been used as an effective drug in treating hepatitis, but its role in endo- SUPPORT: None metriosis remains unclear, our study aims to investigate the effect of OA in endometriosis progression in vitro. DESIGN: Pharmacologic interventions in human endometriotic stromal P-1028 3:30 PM Wednesday, October 21, 2020 cells. MATERIALS AND METHODS: Patients with ovarian endometriosis un- DESCRIPTIVE DIFFERENCES IN FERTILITY TREAT- dergoing laparoscopy were recruited at the Sixth affiliated Hospital of Sun MENT USAGE AFTER THE START OF THE COVID-19 Yat-sen University from January 2018 to May 2020. Primary human endo- PANDEMIC: A PILOT STUDY - FEELINGS ABOUT metriotic stromal cells that isolated from ectopic endometrium (endometri- INFERTILITY IN RESPONSE TO THE COVID-19 otic tissue, n¼12) were exposed to 20mM, 40mM, 60mM and 80mMofOA EPIDEMIC (FIRE). Ijeoma N. Iko, M.D., Amanda Adeleye, M.D., for 24 h. MTT assay, BrdU incorporation assay and Caspase-Glo lumines- A. Musa Zamah, M.D., Ph.D. The University of Chicago, Chicago, IL. cent-based assay were performed to detect cell growth and apoptosis. Enzyme-linked immunosorbent assay was carried out to measure expression OBJECTIVE: Prior research has demonstrated that economic health has of vascular endothelial growth factor (VEGF). an influence on the utilization of assisted reproductive technology (ART). RESULTS: OA reduced the viability of stromal cells in a dose-depen- It is indisputable that the United States (US) economy has been negatively dent manner, 60 and 80 mM of UA treatment led to a decrease in the endo- impacted by the novel coronavirus (COVID-19) pandemic. However, there metriotic stromal cell viability to 64.2% and 53.3%, respectively (p＜ is limited data on how the pandemic has affected patient interest in fertility 0.05), as compared to the viability in the vehicle. BrdU assay confirmed treatment and limited data on how concern about infectious disease and phys- that the growth inhibition effect of OA started at 40 mM and increased ical health may affect family building decisions. We hypothesized that there up to 80 mM (22.5% of that in the vehicle group). Caspase-3 activity would be a decrease in interest in fertility treatments due to the COVID-19 was also promoted dose-dependently, and 2.3-, 5.8-, 18.7-, and 89.6- pandemic. The aim of this pilot study was to assess if the experience of fold of increase were found in the four concentration groups. Besides, COVID-19 in the US has influenced intentions to pursue fertility treatment. OA inhibited the secretion of the proangiogenic factor VEGF in endo- DESIGN: Prospective internet-based survey. metriotic stromal cells, 40mM, 60mM and 80mM of OA remarkably down- MATERIALS AND METHODS: An internet based survey, administered regulated the levels of VEGF in supernatants by 29.5%, 44.7% and 73.6%, through Redcap was used to assess demographics, concern about COVID- respectively. 19, fertility treatment prior to and after statewide lockdowns which became CONCLUSIONS: OA plays a role in suppressing the survival of human widespread on March 15th 2020. The pilot survey was administered June 1st endometriotic stromal cells by inhibiting proliferation and angiogenesis to July 31st 2020 to infertile participants between the ages of 18-43 years. The and promoting apoptosis. CloudResearch platform was used to recruit participants and administer the SUPPORT: Chinese Universities Scientifc Fund of Sun Yat-sen Univer- survey. COVID-19 related questions were derived from the validated COVID sity（NO.19ykpy04） concern survey. Summary statistics are presented. Institutional Review Board approval was obtained. RESULTS: The pilot survey was completed by 55 participants (female P-1027 3:30 PM Wednesday, October 21, 2020 ¼46, 83.6%; male¼9, 16.4%) from 23 states. The mean age was 29.6 years (+/- 7.6). The majority were White (78%), non-Hispanic (92.7%), with vary- ZIKA VIRUS INFECTION AND MALE FERTILITY ing education levels, 45.5% (25/55) with some college education, 20% with a TWO YEARS AFTER A MAJOR OUTBREAK: PRELIM- bachelor’s degree (11/55) and 14.5% with graduated education (8/55). The 1 INARY FINDINGS. Filipe Tenorio Lira Neto, MD MSc, majority of participants were ‘‘somewhat concerned’’ that they would lose 1 Marina Cadena Matta, PhD, Alexandre de Freitas Cavalcanti their current job in the next 12 months (41.4%). While the majority believed 1 1 Filho, MS, Leuridan Cavalcante Torres, Sr., PhD, Peter N. Schlegel, that COVID-19 had spread widely in the US (32.7%) and had ‘‘inflicted 2 2 2 1 M.D., Shuibing Chen, PhD, Gilbert J. Wise, MD. Instituto de Medicina serious damage in the area that’’ they lived (38.2%), most individuals felt 2 Integral Prof. Fernando Figueira, Recife, Brazil; Weill Cornell Medicine, that they could protect themselves from the virus (48.2%). New York Presbyterian Hospital, New York, NY. Prior to the pandemic, 29.1% (n¼16) participants sought ovulation induc- tion medications, 16.4% (n¼9) sought intrauterine insemination and 9.1% OBJECTIVE: Evaluate the effects of the ZIKVepidemic in the male repro- sought (n¼5) in vitro fertilization (IVF). The remainder of patients were ductive function in a cohort of fertile men two years after a major outbreak in contemplating treatment. After the pandemic, 13 patients were no longer Brazil. interested in fertility treatment. The majority of patients, 53% (n¼7) stated DESIGN: Cross-sectional study. ‘‘I am worried about the coronavirus/COVID-19’’ as the primary reason MATERIALS AND METHODS: We enrolled 39 fertile men who at- they discontinued treatment, compared to several other reasons including tended the urology an outpatient clinic at Recife - Brazil for vasectomy. spontaneous conception, financial concerns, and lack of partner support. All subjects completed an epidemiological questionnaire, underwent stan- CONCLUSIONS: COVID-19 is an important consideration for people dard semen analysis, sexual hormone levels measurement, and ZIKV sero- who discontinue treatment; however, it may not deter the majority of patients logic tests. Based on their serologic tests results, subjects were divided in who seek care. Data is part of an ongoing larger prospective study. two groups, a ZIKV negative (Z-) group and a ZIKV positive group (Z+). References Epidemiological, clinical and laboratory variables were compared between ^ both groups. 1. Kiatpongsan, S., Huckman, R.S., Hornstein,A M.D. The Great Reces- RESULTS: There were 25 (64%) ZIKV positive subject based on positive sion, insurance mandates, and the use of in vitro fertilization services in serum IgG anti-ZIKV antibodies; no subject showed IgM anti-ZIKV anti- the United States. Fertil Steril. 103, 448-454 (2015). bodies or viral RNA by PCR in semen samples. There were no significant 2. Conway, L. G., III, Woodard, S. R., & Zubrod, A. (2020, April 7). Social differences between the groups regarding demographic and clinical data, Psychological Measurements of COVID-19: Coronavirus Perceived Threat, but a few variables deserve mention. Overall, only 7 subjects reported Government Response, Impacts, and Experiences Questionnaires. ZIKV infection symptoms in the last two years, a small number compared 3. McFadden, S. M., Malik, A. A., Aguolu, O. G., Willebrand, K. S., & to the overall prevalence of ZIKVof positive serologic test. The proportion Omer, S. B. (2020). Perceptions of the Adult US Population regarding the of participants that reported symptoms was higher in the Z+ group when Novel Coronavirus Outbreak Questionnaire. compared to the Z- group (24% and 7% respectively). Fever, myalgia, head- SUPPORT: None ache and cutaneous rash were the symptoms described. There were no
FERTILITY & STERILITYÒ e565 P-1029 3:30 PM Wednesday, October 21, 2020 gestational age at diagnosis ranged between 5 weeks and 5 days to 13 weeks and 6 days. All diagnoses were made by ultrasound. Fetal heartbeat was pre- DIFFERENT TREATMENT MODALITIES FOR MAN- sent in 10 cases (37.03%). The most commonly used method for first-line AGEMENT OF CAESAREAN SCAR ECTOPIC PREG- treatment was medical treatment. A total of 14 patients (51.85%) were NANCY: A SINGLE-CENTER treated with systemic methotrexate (MTX), Three (11.1 %) intra-sac and sys- 1 EXPERIENCE. Dania Al-Jaroudi, MD, MHA, temic MTX, and Two (7.4 %) intra-cardiac potassium chloride (KCl) along 2 Saeed Marzoq Baradwan, MD, SBOG, ABOG, MRCPI, MRCOG2, with systemic MTX, five (18.51%) cases had expectant management, one 3 1 Saud Aboudi, MBBS. King Fahad Medical City, Riyadh, Saudi Arabia. case initially treated with Laparotomy Wedge resection, and one case treated Reproductive Endocrine and Infertility Medicine Department, Riyadh, Saudi with Uterine artery embolization (UAE) and systemic MTX. A total of 20 2 Arabia; Health Plus Fertility and Women’s Health Center, Jeddah, Saudi (74.07%) patients were treated successfully with first-line treatment. Seven 3 Arabia; Department of Obstetrics and Gynecology, King Fahad Medical (25.92%) patients needed additional second line treatment. Among them, City, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia. only one case had surgical intervention. None of the women in medical treat- ment group experienced any side effects. Overall, the mean b -hCG resolu- OBJECTIVE: This study aims to evaluate the outcomes of the different tion time was 60.85 days (range, 28 - 95 days). treatment modalities used in CSP treatment at a single center. CONCLUSIONS: The treatment of CSP should be individualized based DESIGN: This is a retrospective case series study that was conducted; all on risk factors. Diagnosis and management of CSP need expertise and a women who diagnosed with CSP between January 2013 and November 2019 multidisciplinary approach to prevent complications. Early diagnosis and in Women’s Specialized Hospital, King Fahad Medical City. management of cesarean scar ectopic pregnancy remains the mainstay for MATERIALS AND METHODS: The clinical characteristics, diag- a successful outcome. nosis, different treatment modalities, and clinical outcomes were SUPPORT: NONE analyzed. RESULTS: Twenty-seven cases of CSP were identified during the study period. The mean maternal age was 36.55 years (range, 23-47 years). The
e566 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020