Patient preferences regarding social media use in an REI practice

Patient preferences regarding social media use in an REI practice

Table 1. Fresh vs. elective FET in normal responders - sub-group analysis Group 1(12-15 oocytes) Fresh No of patients Age, years +/- SD Retrieved ooc...

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Table 1. Fresh vs. elective FET in normal responders - sub-group analysis

Group 1(12-15 oocytes) Fresh No of patients Age, years +/- SD Retrieved oocytes +/- SD No of embryos transferred +/- SD Implantation Rate, % Pregnancy Rate, % ClinicalPregnancy Rate, % Ongoing Pregnancy Rate, % Relative Risk Ongoing PregnancyFreeze-all vs Fresh

Group 2(8-11 oocytes)

Freeze-all (p)

Fresh

Freeze-all (p)

Fresh

Freeze-all (p)

69 109 172 140 282 166 33.20 +/- 5.16 33.81 +/- 3.70 (p¼0.400) 34.98 +/- 4.74 34.32 +/- 4.72 (p¼0.221) 36.55 +/- 4.35 35.78 +/- 4.15 (p¼0.066) 13.26 +/- 1.13 13.44 +/- 1.13 (p¼0.305) 9.33 +/- 1.12 9.29 +/- 1.13 (p¼0.798) 5.51 +/- 1.08 5.48 +/- 1.07 (p¼0.811) 2.28 +/- 0.68

2.25 +/- 0.56 (p¼0.770)

2.28 +/- 0.73

2.18 +/- 0.71 (p¼0.099)

2.34 +/- 0.81

2.22 +/- 0.60 (p¼0.067)

16.6% 39.1% 33.3%

28.6% (p¼0.039) 56.9% (p¼0.021) 53.2% (p¼0.009)

19.6% 43.0% 40.1%

26.5% (p¼0.038) 55.0% (p¼0.035) 51.4% (p¼0.047)

17.4% 39.4% 34.7%

18.2% (p¼0.490) 41.6% (p¼0.647) 36.7% (p¼0.671)

31.9%

47.7% (p¼0.035)

34.9%

47.1% (p¼0.029)

30.1%

31.3% (p¼0.793)

1.50 (1.01-2.23)

1.35 (1.03-1.77)

O-180 Tuesday, October 18, 2016 12:30 PM VITRIFICATION AND THAWING OF PREIMPLANTATION EMBRYOS DOES NOT AFFECT PERINATAL N. Herlihy,a,b J. Rodriguez-Purata,a OUTCOME. L. Sekhon,a,b J. A. Lee,a B. Sandler,a,b D. E. Stein,a,c A. B. Copperman.a,b aReproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology & Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; cObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai West-Mount Sinai St. Luke’s, New York, NY. OBJECTIVE: Some studies suggest that patients undergoing IVF with fresh embryo transfer have increased incidence of preterm deliveries and growth restriction. Much of this has been attributed to multiple embryo transfer and thus multiple gestation, as well as effects from supraphysiologic estrogen levels associated with transfers in fresh COH cycles. Singleton fetuses born from frozen-thawed embryo transfers are larger than those born from fresh ET’s. We set out to compare singleton live births from fresh versus frozen ET in synthetic, donor oocyte (OD) cycles to evaluate whether the increased birthweight found in FET cycles was a associated with the vitrification process. DESIGN: Retrospective cohort study MATERIALS AND METHODS: OD recipients that underwent synthetic, hormonal endometrial preparation followed by a single, fresh or frozen ET resulting in live birth, from 2003-2015, were included. Monozygotic twins were excluded. All embryos were derived from fresh donor oocytes and transferred at the blastocyst stage. Main outcome measures included gestational age at delivery and birthweight. Student’s t-test, chi-square, linear and binary logistic regression analysis were performed. RESULTS: One hundred forty eight SETs (fresh ET: n¼79; FET: n¼69) were identified. Baseline demographics, cycle characteristics and perinatal Baseline demographics, cycle characteristics and perinatal outcome

Frozen-thawed OD ET

P value

43.3  4.9 27.2  3.5 24.0  4.0 9.8  2.4

44.0  4.0 27.5  3.5 25.6  5.6 9.2  2.2

NS NS NS NS

682.6  501.6 37.7  2.8 22.8% (18/79)

605.7  450.1 37.9  1.3 18.8% (13/69)

NS NS NS

Fresh OD ET Patient’s age at ET Oocyte’s age Recipient’s BMI Endometrial Thickness at ET (mm) Peak E2 Gestational age at delivery Preterm delivery (<37 weeks) Birthweight Low Birthweight (<2500g) Normal Birthweight (2500-4200g) Macrosomia (>4500g)

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Group 3(4-7 oocytes)

ASRM Abstracts

3292.1  589.8 3419.6  498.4 NS 6.3% (5/79) 4.3% (3/69) NS 84.8% (67/79) 89.9% (62/69) NS 2.5% (2/79)

0% (0/69)

NS

1.04 (0.78-1.38)

outcome are shown in Table 1. There was no significant difference in gestational age at delivery, infant birthweight or height in the fresh vs. frozen ET groups. After controlling for oocyte age, recipient age and BMI, the odds of preterm delivery (OR 1.3 [95% CI 0.6-2.8], p¼0.56), low birthweight (OR 1.5 [95% CI 0.3-6.4], p¼0.60), normal birthweight (OR 0.5 [95% CI 0.11.6], p¼0.24) and macrosomia (OR 1.0 [95% CI 0.99-1.0], p¼0.56) were similar among fresh vs. frozen ET. CONCLUSIONS: Singleton live births from fresh and frozen donor-egg derived embryo transfers were similar in gestational age at delivery, infant size and birthweight. These finding reassure clinicians and patients that exposure of the screened blastocyst to the vitrification and thawing process has no effect on perinatal outcome. Furthermore, this finding suggests that the primary driver of reduced birthweight seen in infants conceived from fresh ET is the supraphysiologic hormonal milieu associated with controlled ovarian hyperstimulation. ACCESS TO CARE 3 O-181 Wednesday, October 19, 2016 11:15 AM PATIENT PREFERENCES REGARDING SOCIAL MEDIA USE IN AN REI PRACTICE. D. E. Broughton, K. M. Cipolla, E. Jungheim, K. Omurtag. Obstetrics and Gynecology, Washington University, St. Louis, MO. OBJECTIVE: To query patients regarding preferences for the use of social media platforms in their reproductive endocrinology and infertility (REI) practice. DESIGN: Survey study of patients seeking care at a large university based REI practice. MATERIALS AND METHODS: All patients checking in for an appointment at our REI practice were offered the opportunity to complete the anonymous survey from October 2015 to February 2016. Surveys were returned to the front desk upon completion. RESULTS: A total of 40 patients filled out the survey, with 28 (70%) fully completing it. Of surveyed patients, 35% had previously undergone IVF. Patients with two or more miscarriages comprised 12.5% of the study population. A large majority of surveyed patients, 82.5%, felt that social media provided additional benefit to infertility patients. Of survey participants, 55% reported using Instagram compared with only 20% using Twitter. Only 12.5% of respondents reporting accessing Facebook more than 14 times daily, which is the national average derived from prior studies of social media use. The survey queried patients as to whether they would be interested in seeing posts on certain topics. The topics of interest to the largest majority of patients were ‘‘Education regarding fertility testing and treatment’’ (95%), ‘‘Myths and facts about infertility’’ (92.5%), ‘‘Meet the staff posts’’ (90%) and ‘‘Patient success stories’’ (90%). The topic of interest to the fewest patients was ‘‘You and your partner: when couples disagree’’ (60%). We then asked patients to rank the topics in order of interest, and the results are presented in Table 1. When asked if they would be interested in seeing newborn

Vol. 106, No. 3, Supplement, September 2016

Social Media Topics Ranked in Order of Patient Interest

Rank in Order of Interest 1 2 3 4 5 6 7 8 9 10 11

Topic Education regarding fertility testing and treatment Patient success stories Managing stress: relaxation techniques Support groups/meetings information Research studies taking place in REI Myths and facts about infertility Surviving the ‘‘Two Week Wait’’ Tips for talking about infertility with friends and family Meet the staff posts and photos You and your partner: when couples disagree Newborn pictures and birth announcements of our patients

pictures or birth announcements on social media, 65% responded in the affirmative while 35% responded negatively. If they were successful with infertility treatment, 78% of people would feel comfortable with the clinic posting a picture of their infant. CONCLUSIONS: Patients support the use of social media by infertility practices and feel this service provides benefit to them. There is interest in social media addressing a breadth of infertility topics, with fertility education and patient success stories being most popular. Patients were less interested in seeing newborn picture postings. Instagram may be a better choice of platform than Twitter given higher rates of use in our patient population. O-182 Wednesday, October 19, 2016 11:30 AM OUTCOMES FROM A UNIVERSITY-BASED, LOW COST IVF PROGRAM PROVIDING ACCESS OF CARE TO A SOCIOCULTURALLY DIVERSE URBAN COMMUNITY. Y. Anaya, M. Noel, H. Cakmak, C. N. Herndon, M. Cedars. Center for Reproductive Health, UCSF, San Francisco, CA. OBJECTIVE: Over 35 years since the first live birth, IVF remains a highly complex and costly treatment with staggering disparities in access to care, both within the U.S. and abroad. In 2010, a program was initiated in the University of California, San Francisco (UCSF) REI fellowship program to provide basic access to ART to a socioculturally diverse, low-income urban population served by the university. We report on outcomes from this low cost and low complexity IVF program utilizing mild stimulation approaches and simplified protocols. DESIGN: Prospective, non-randomized cohort study MATERIALS AND METHODS: Patients were recruited from a university-affiliated county hospital serving a low-resource, largely immigrant population. All patients received a basic infertility evaluation and counseling prior to referral for IVF. Patients were non-randomly allocated to one of four mild stimulation protocols: clomiphene/letrozole alone, two clomiphene/letrozole-based protocols involving sequential or flare addition of low dose gonadotropins, and low dose gonadotropins alone. UCSF REI fellows managed all aspects of cycle preparation, monitoring, oocyte retrieval, and embryo transfer under an attending preceptor. Retrieval was undertaken under local anesthesia and laboratory interventions were minimized. All embryo transfers were performed on day 2 or 3. RESULTS: Between 2010 and 2015, 56 patients initiated 120 fresh stimulation cycles and 32 frozen transfer cycles, of which 83 and 30 cycles were

completed, respectively. Most common causes of infertility were anovulation and tubal factor. The mean age of patients was 32.5  3.6 years with reported 5.4  3.8 years duration of infertility. IVF and lab outcomes are presented in Table 1. Number of oocytes retrieved ranged from 2.3 to 4.6, depending on the protocol used. An average of 1.1 embryos were transferred (range 1-2). Ongoing pregnancy rates in clomiphene/letrozole alone, sequential, flare, and low dose gonadotropin arms were 27% (6/22), 30% (3/10), 31% (15/ 48), and 0% (0/3), respectively. Ongoing pregnancy rate in frozen transfer cycles was 27% (8/30). Cancellation rate was 30.8%, due to single dominant follicle (54%), spontaneous ovulation (16%), or no response (30%). In the 83 cycles that went to retrieval, oocytes were retrieved in 94% and embryos were transferred in 88%. There was only a single instance of multiple gestation (twins). No complications were observed. CONCLUSIONS: Use of mild stimulation protocols, simplified monitoring, and minimized laboratory-handling protocols achieved excellent pregnancy rates in a low resource, socioculturally diverse infertile population. O-183 Wednesday, October 19, 2016 11:45 AM SPERM WASHING FOR HIV SERODISCORDANT COUPLES USING DOUBLE DENSITY GRADIENT WITH SWIM UP FOR INTRAUTERINE INSEMINATION: DEFINING FAVORABLE MALE AND FEMALE FACTORS FOR ACHIEVING SUCCESSFUL PREGNANCY. L. Z. Safier, J. Y. Hsu, L. C. Grossman, M. V. Sauer, N. C. Douglas. Columbia University Medical Center, New York, NY. OBJECTIVE: To determine factors associated with achieving pregnancy in HIV serodiscordant couples treated with sperm washing and intrauterine insemination (SW-IUI) when the male partner is HIV-infected and the female partner is treated with pre-exposure prophylaxis (PrEP) anti-retroviral therapy. DESIGN: Retrospective cohort analysis. MATERIALS AND METHODS: HIV serodiscordant couples (male HIV+) who have undergone SW-IUI at Columbia University from 6/2014 2/2016 were included. Male participants had CD4 counts >250 cells/mm3, undetectable HIV load for >3 months, medical clearance, were adherent to highly active antiretroviral therapy, and had a semen analysis (SA) within 3 months of initiating SW-IUI demonstrating a total motile count (TMC) of > 10 million. Females were <40 years (yrs) old (median 34, IQR 31.2 35 yrs) with patent fallopian tubes and normal ovarian reserve (anti-M€ullerian hormone >1.0 ng/mL). Couples reported safe-sex practices with condoms. Women were prescribed PrEP (emtricitabine/tenofovir disoproxil fumarate) for 3 days (day before, during and after) the IUI. Demographics, female ovarian reserve, cycle type, and male baseline and post-washing SA results were compared in couples that achieved pregnancy to those with no resultant pregnancy. Mann Whitney U and Fischer’s exact tests were used. There was no difference in female age or ovarian reserve in couples that achieved pregnancy as compared to those that did not. For males, there was no difference in age or years since HIV diagnosis between the groups. Baseline SA revealed a greater TMC in couples that achieved pregnancy (145 million) as compared to those that did not (32.8 million, P<0.05). RESULTS: Ten couples completed 24 cycles of SW-IUI. Overall fecundability rate was 5/24 (20.8%). All women who achieved pregnancy did so during the 1st or 2nd SW-IUI cycle. In comparing individual cycles resulting in pregnancy (n¼5) to non-pregnant cycles (n¼19), initial TMC was greater in the pregnancy group compared to those without resultant pregnancy [Table 1]. After sperm washing, there was a trend toward a higher TMC in samples that resulted in pregnancy. In cycles achieving pregnancy, women were more often in natural cycles compared to cycles empirically stimulated with clomiphene citrate. All women were HIV negative at follow-up testing. CONCLUSIONS: SW-IUI appears to be a safe and effective method of conception for well-selected HIV serodiscordant couples. Initial SA TMC

IVF and lab outcomes stratified by stimulation protocol

Stimulation Protocol

Age, years (SD)

Average dose of gonadotropins, IU (SD)

32.6 (3.2)

NA

Clomiphene or Letrozole only (n¼22) Sequential (n¼10) Flare (n¼48) Gonadotropins only (n¼3)

FERTILITY & STERILITYÒ

30.4 (4.3) 33.3 (3.4) 32.4 (2.1)

477.3 (260.4) 719.7 (234.9) 1300 (567.9)

Average number of oocytes retrieved (SD)

Oocyte recovery rate, oocytes retrieved/ follicles R13mm (SD)

Total fertilization proportion, 2PN/oocytes retrieved (SD)

2.3 (2.3)

0.78 (0.52)

0.71 (0.33)

3.1 (2.2) 4.6 (2.6) 4.3 (3.2)

0.83 (0.65) 0.97 (0.48) 0.83 (0.15)

0.63 (0.38) 0.59 (0.3) 0.56 (0.1)

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