Elective Fertility Preservation Research Articles

O-074 Dual trigger is not superior to GnRH Agonist alone for final oocyte maturation in elective fertility preservation. A Randomized Controlled Trial

Abstract Study question Is Dual trigger for final oocyte maturation associated with a higher number of mature (MII) oocytes compared to GnRH-a trigger alone in elective fertility preservation? Summary answer Adding hCG to GnRH-a for triggering final oocyte maturation does not increase the number of MII oocytes in elective fertility preservation cycles. What is known already Triggering final oocyte maturation represents a key step in ovarian stimulation. In good prognosis patients undergoing oocyte cryopreservation, the current standard approach involves the administration of a single bolus of GnRH-agonist 36 hours before the pick-up. Previous studies have shown a higher number of MII oocytes when Dual Trigger (hCG+ GnRH-a) is performed, compared to recombinant human chorionic gonadotropin (rhCG) alone. Nevertheless, a notable gap exists in the literature, as no studies have investigated the potential additional benefit in final oocyte maturation when dual trigger is compared to GnRH-a alone. Study design, size, duration This is a randomized controlled superiority trial including elective oocyte cryopreservation cycles performed in a University Hospital. A total of 109 women were enrolled in this study between October 2021 to April 2023 with a 1:1 allocation. Eligible patients were ≤40 years old, with an antral follicular count (AFC)<20 and anti-Mullerian hormone (AMH)≤3ng/ml. Patients were randomized to final oocyte maturation triggering with Triptorelin 0,2mg or a dual trigger (Triptorelin 0.2 mg + 250 ug rhCG). Participants/materials, setting, methods Controlled ovarian stimulation was performed using 225-300IU/day of rFSH alfa or beta, or equivalent rFSH delta (15-20μg), tailored to ovarian reserve and BMI. LH surge was suppressed through a progestin-primed ovarian stimulation (PPOS) protocol, with oral administration of micronized progesterone (200mg daily) from the beginning of ovarian stimulation until the trigger day. The primary outcome was the number of MII oocytes. Comparisons are presented as estimated mean difference (EMD) and corresponding 90% confidence interval (CI). Main results and the role of chance Overall, 104 patients were analyzed, 51 in the Dual trigger group and 53 in the control arm (GnRH-a). We found no statistically significant differences in the number of retrieved oocytes comparing Dual Trigger group (8.71 ± 4.90) and GnRH-a group (9.51 ± 5.19). Similarly, the number of MII oocytes demonstrated no significant differences, with 6.86 ± 4.40 in the Dual Trigger group compared to 7.87±4.40 in the GnRH-a group (EMD -1.01 [90%CI: -2.44;0.43]). Exploring the hormonal profile there were no notable variations in estradiol levels (2064.60 ± 890.50 pg/ml vs. 2494.41 ± 1341.05 pg/ml), progesterone levels (7.78 ± 3.88 ng/ml vs. 8.94 ± 5.10 ng/ml), LH (56.28 ± 26.83 IU/L vs. 63.41 ± 32.50 IU/L), and FSH (31.14 ± 7.86 IU/L vs. 31.53 ± 9.89 IU/L) on the day following the trigger. Notably, neither group exhibited any case of Ovarian Hyperstimulation Syndrome (OHSS). Limitations, reasons for caution The sample size was calculated to detect differences on the number of MII oocytes. Therefore, results for secondary outcomes (number of oocytes retrieved and hormonal profile) should be interpreted with caution. Wider implications of the findings Adding hCG to GnRH-a for triggering final oocyte maturation does not confer any additional benefits in elective fertility preservation in term of MII oocytes compared to the administration of GnRH-a alone. Trial registration number NCT04992468

Machine learning for predicting elective fertility preservation outcomes

This retrospective study applied machine-learning models to predict treatment outcomes of women undergoing elective fertility preservation. Two-hundred-fifty women who underwent elective fertility preservation at a tertiary center, 2019–2022 were included. Primary outcome was the number of metaphase II oocytes retrieved. Outcome class was based on oocyte count (OC): Low (≤ 8), Medium (9–15) or High (≥ 16). Machine-learning models and statistical regression were used to predict outcome class, first based on pre-treatment parameters, and then using post-treatment data from ovulation-triggering day. OC was 136 Low, 80 Medium, and 34 High. Random Forest Classifier (RFC) was the most accurate model (pre-treatment receiver operating characteristic (ROC) area under the curve (AUC) was 77%, and post-treatment ROC AUC was 87%), followed by XGBoost Classifier (pre-treatment ROC AUC 74%, post-treatment ROC AUC 86%). The most important pre-treatment parameters for RFC were basal FSH (22.6%), basal LH (19.1%), AFC (18.2%), and basal estradiol (15.6%). Post-treatment parameters were estradiol levels on trigger-day (17.7%), basal FSH (11%), basal LH (9%), and AFC (8%). Machine-learning models trained with clinical data appear to predict fertility preservation treatment outcomes with relatively high accuracy.

Is there a preferred time interval between gonadotropin-releasing hormone (GnRH) agonist trigger and oocyte retrieval in GnRH antagonist cycles? A retrospective cohort of planned fertility preservation cycles

BackgroundThe ideal time frame between gonadotropin-releasing hormone (GnRH) agonist (GnRHa) trigger administration and oocyte retrieval in GnRH antagonist cycles has not been well studied. Our goal was to evaluate the effect of this time interval on oocyte yield and oocyte maturation rate in GnRH antagonist cycles designated for non-medical (“planned”) oocyte cryopreservation.MethodsWe conducted a retrospective cohort study including patients who underwent elective fertility preservation, using the GnRH antagonist protocol and exclusively triggered by GnRH-agonist. We focused on the effect of the trigger-to-retrieval time interval on oocyte yield and maturation rate, while also incorporating age, body mass index (BMI), anti-Müllerian hormone (AMH) levels, basal Follicle-Stimulating Hormone (FSH) levels, as well as the type and dosage of gonadotropin FSH medication.Results438 cycles were included. Trigger-to-retrieval time interval ranged from 32.03 to 39.92 h. The mean oocyte yield showed no statistically significant difference when comparing retrievals < 36 h (n = 240, 11.86 ± 8.6) to those triggered at ≥ 36 h (n = 198, 12.24 ± 7.73) (P = 0.6). Upon dividing the cohort into four-time quartiles, no significant differences in the number of retrieved oocytes were observed (P = 0.54). Multivariate regression analysis failed to reveal any significant associations between the interval and the aforementioned variables.ConclusionsThe GnRHa trigger to oocyte retrieval interval range in our cohort did not significantly affect oocyte yield and maturation rate.

Attitudes and Barriers to Planned Family Building among Professionals and Trainees in Radiation Oncology

The timing of residency training often coincides with peak biological fertility. However, family building is frequently deferred and may lead to unanticipated infertility. The attitudes and barriers to family planning are not well described among medical professionals and trainees in radiation oncology (RO). The Society for Women in Radiation Oncology (SWRO) conducted an electronic survey among practicing physicians, physicists, and residents between January and February 2023, using email and social media as recruitment tools. The survey questions queried demographics, family planning, fertility. Frequencies of responses were summarized using descriptive statistics. On interim analysis, 147 responses were collected; 123 (89.8%) were SWRO members. Gender identities reported were female (136, 93.2%), male (7, 4.8%), nonbinary or gender diverse (2, 1.4%), and transgender female (1, 0.7%). 95 (64.6%) respondents were age 35 or younger. The majority were practicing physicians (72, 49.0%) followed by RO residents (45, 30.6%), medical physicists (17, 11.6%), medical students, (5, 3.4%), and medical physics residents (4, 2.7%). Most respondents agreed that their reproductive timeline had been impacted by medical training (106, 76.3%). Of those who deferred parenthood due to training or career, 40 (36.7%) were dissatisfied with their choice and 33 (30.2%) were satisfied. 129 (92.8%) reported not receiving any information about fertility preservation during training. Only 65 (47.4%) felt they had a mentor with whom they could approach to discuss family planning. Overall, 84 (60.4%) expressed concern about their fertility and 34 (24.5%) had previously undergone fertility testing. 16 (11.5%) completed at least one cycle of elective fertility preservation and 12 (8.6%) were planning to do so. 39 (28.1%) had considered elective fertility preservation but not pursued it, while 65 (46.8%) had not considered it. Among those two groups, the common reported barriers to accessing fertility services were financial burden (n = 28, 28.6%), lack of awareness of available options (n = 12, 12.2%), difficulty accessing fertility services (n = 6, 6.1%), and difficulty finding time during training (n = 4, 4.1%). Insurance coverage for elective fertility preservation was fully or partially covered by insurance for 12 (8.8%), not covered for 53 (38.7%), and 72 (52.6%) were uncertain of their coverage. The study highlights the impact of training on family building plans of medical professionals in RO. Despite high levels of concern about fertility, few respondents received education about fertility options in training and a limited number had access to mentors to discuss this issue. Significant barriers exist to accessing fertility services, including knowledge gaps about insurance coverage, highlighting a need for further exploration of these barriers and advocacy for improved family planning support for those in RO who desire it.

P-399 Oocyte vitrification does not impair clinical outcomes in women of advanced maternal age. An analysis of 1268 cycles using fresh and vitrified oocytes

Abstract Study question Does oocyte vitrification impair clinical outcomes in women of advanced maternal age (AMA, &amp;gt;35 years old)? Summary answer Up to the age of 39 years, clinical outcomes were comparable amongst cycles using fresh and vitrified oocytes. What is known already Primarily recommended for young women, oocyte vitrification is the most efficient method for elective fertility preservation. Nevertheless, various social and economic circumstances often compel women to undergo fertility preservation when already at an AMA. Recent studies in mouse suggest that AMA increases the vulnerability of oocytes to molecular and subcellular damage during vitrification, ultimately compromising embryo viability and implantation potential. However, the effects of oocyte vitrification on human preimplantation development and clinical outcomes in women of AMA currently remain unknown. Study design, size, duration This is a retrospective cohort single-center study. We compared outcomes of 1268 patients undergoing their first fresh ICSI cycle using autologous fresh (n = 1087) or vitrified oocytes (n = 181), performed between January 2019 and October 2022. All vitrified oocytes were obtained following elective fertility preservation for age-related fertility decline. Outcomes were stratified according to maternal age at oocyte pick-up: control group (≤35) and AMA groups (36-37, 38-39 and ≥40 years). Participants/materials, setting, methods We compared outcomes between fresh and vitrified oocytes across matching maternal age groups. These included fertilization rates, proportion of viable embryos on day 3, clinical pregnancy and live birth rates. Univariate and multivariate analyses (2-contrast linear and logistic regression) were used to establish correlations. Analyses were adjusting for sperm origin (partner or donor), day of transfer (3 or 5), number of embryos transferred and endometrial age. All p values &amp;lt;0.05 were considered significant. Main results and the role of chance Sperm donation and homologous cycles were equally distributed among the study groups (45% sperm donor and 55% male partner across the entire cohort). In our cohort, blastocyst transfer was performed less frequently in older women, 23.8% for women ≥40 years compared to 45.6% for women ≤35 years (p &amp;lt; 0.0001). When comparing oocyte status across matching maternal age groups, fertilization rates were ∼10% lower when vitrified oocytes were used (p &amp;lt; 0.05). Our adjusted analysis confirmed this negative impact of oocyte vitrification on fertilization rates. Oocyte vitrification also affected ongoing cleavage, as the proportion of viable embryos on day 3 was significantly lower across all groups when vitrified oocytes were used (p &amp;lt; 0.05). Nevertheless, this effect did not translate to clinical pregnancy rates, which were comparable across all maternal age groups regardless of oocyte status. As expected, live birth rate decreased steadily with advancing maternal age (from 38.5% in women ≤35 to 15.0% in women ≥40). While our adjusted analysis showed a negative effect of oocyte vitrification on live birth rates for patients ≥40 (OR: 0.60, 95%CI: 0.18-2.06), we observed no such effect in AMA patients ≤39 years. Limitations, reasons for caution The main limitation of this study is its retrospective design. The low number of women ≥40 undergoing fertility presentation (n = 39) warrants careful interpretation. Our results cannot be generalized to all patient populations and indications for fertility preservation. Wider implications of the findings Clinical outcomes were comparable between fresh and vitrified oocytes up to the age of 39 years. While oocyte vitrification before 35 years old remains the most established and effective method for preventing age-related fertility decline, our findings offer a valuable clinical resource for counselling AMA patients considering elective fertility preservation. Trial registration number Not applicable

The ticking “biological clock”: Reproductive assistance, costs, and elective fertility preservation in female oncologists and trainees.

11001 Background: Women in medicine are often in training during their peak fertility years. Many women defer childbearing until after training due to career concerns; in consequence, female physicians experience a higher rate of infertility than the general population. Experiences of infertility among female physicians and attitudes towards fertility preservation have not been well described. Methods: A novel 39 question survey was designed after comprehensive literature review to collect cross-sectional data on attitudes toward family planning and utilization of assisted reproductive technology (ART) among self-identified US female oncologists of all career levels. Descriptive statistics summarized frequencies of responses. Results: A total of 1005 responses were collected from female oncologists, of which 811 (81%) were attending/practicing physicians and 194 (19%) were trainees (192 residents/fellows and 2 medical students). 32% reported experiencing infertility. Of these 318 women, 9% reported no out-of-pocket expenses for ART while 39% spent more than $10,000 and 20% spent ≥$30,000. Side effects from infertility treatment required missing work for 22% and another 25% suffered mental health concerns related to infertility. Elective cryopreservation of eggs or embryos was reported by 6% of attendings and 4% of trainees. Among the 25 attendings who reported plans/desire to undergo fertility preservation in the future, most (76%) were unsure of feasibility. This was similarly reported in 72% of the 32 trainees with plans/desire to pursue fertility preservation. More trainees than practicing physicians (73% vs 65%) felt that fertility preservation should be discussed during medical training. Similarly, more trainees than attendings (58% vs 47%) felt that fertility concerns have a negative influence of their decision on when to start a family. While only 5% of all respondents reported using fertility preservation, an additional 6% were planning/considering using it and 21% felt that it would have benefitted them had it been available and affordable during training. Of the group that felt it would have been beneficial, 52% had experienced infertility. Conclusions: A third of surveyed female oncologists report experiencing infertility. Those that seek reproductive assistance can incur significant out of pocket costs with treatment related effects that can disrupt work or cause mental health concerns. Although fertility preservation was used by very few, one in five felt it could have been helpful to them if it was available and affordable. These results underscore the need to better support women in medicine to reduce the impact of infertility for female oncologists.

Medroxyprogesterone acetate: an alternative to GnRH-antagonist in oocyte vitrification for social fertility preservation and preimplantation genetic testing for aneuploidy

Research questionCan medroxyprogesterone acetate (MPA) be used as a pituitary suppressor instead of a gonadotrophin releasing hormone (GnRH) antagonist during ovarian stimulation in elective fertility preservation and preimplantation genetic testing for aneuploidy (PGT-A) cycles? DesignA multicentre, retrospective, observational, cohort study conducted in 11 IVIRMA centres affiliated to private universities. Of a total of 1652 cycles of social fertility preservation, 267 patients were stimulated using a progestin-primed ovarian stimulation protocol (PPOS), and 1385 patients received a GnRH antagonist. In the PGT-A cycles, 5661 treatments were analysed: 635 patients received MPA and 5026 patients received GnRH antagonist. A further 66 fertility preservation and 1299 PGT-A cycles were cancelled. All cycles took place between June 2019 and December 2021. ResultsIn the social fertility preservation cycles, the number of mature oocytes vitrified in MPA was similar to the number of those treated with an antagonist, a trend that was seen regardless of age (≤35 or >35 years). In the PGT-A cycles, no differences were found in number of metaphase II, two pronuclei, number of biopsied embryos (4.4 ± 3.1 versus 4.5 ± 3.1), rate of euploidy (57.9% versus 56.4%) or ongoing pregnancy rate (50.4% versus 47.1%, P = 0.119) between the group receiving MPA versus a GnRH antagonist, whereas the clinical miscarriage rate was higher in the antagonist group (10.4% versus 14.8%, P = 0.019). ConclusionsAdministration of PPOS yields similar results to GnRH antagonists in oocytes retrieved, rate of euploid embryos and clinical outcome. Hence, PPOS can be recommended for ovarian stimulation in social fertility preservation and PGT-A cycles, as it allows greater patient comfort.

FERTILITY PRESERVATION INSURANCE COVERAGE IN PROFESSIONAL SCHOOLS

To evaluate professional schools’ provision of elective fertility preservation (FP) coverage and determine if there are patterns in FP coverage by professional school type (medical, business, law), geographic region, or by presence/absence of mandated coverage laws in states.

Female physician infertility: the lack of adequate insurance coverage

There is a recent decrease in fertility rates among the general population in the United States. Female physicians, who are seeking assisted reproductive technology at growing rates often because of delayed childbearing while completing medical training, are included in this statistic. With more than 340,000 practicing female physicians within the United States, female physician infertility is especially relevant. However, despite the increasing number of female physicians seeking assisted reproductive technology, there is a lack of access to adequate insurance coverage for this higher-risk patient subset. This commentary reviewed the importance of increasing infertility rates among female physicians, the associated economic burden, limited insurance coverage, and disparities in access to infertility insurance coverage. Recent studies suggest that up to 25% of female physicians are seeking assisted reproductive technology. Currently, 1 cycle of assisted reproductive technology, or egg retrieval, is estimated at approximately $19,000, with many people needing multiple cycles. Many top academic institutions do not offer enough infertility benefits to cover 1 egg retrieval cycle and the often prerequisite, less invasive procedures. Among those seeking oocyte or embryo cryopreservation for elective fertility preservation, few institutions offer coverage. Addressing and highlighting limited and variable institutional infertility coverage are crucial to gaining equal and accessible reproductive care for female physicians.

P-715 (In)fertility perceptions in a cohort of 1569 women

Abstract Study question Which are the perceptions and knowledge regarding female fertility and infertility of Spanish women? Summary answer Infertility carries a social stigma that prevents women from sufficient knowledge or professional aid to take their reproductive choices adequately. What is known already Infertility is a pathology that remains on an invisible plane for society. It is estimated that up to a third of all IVF cycles performed due to low ovarian reserve would be avoidable if women had received sufficient information at the right time. The factors that mainly contribute to this phenomenon are the marked social stigma that it entails, the lack of knowledge regarding tools, possibilities and real expectations in fertility and the low socio-sanitary involvement regarding tasks and campaigns to increase social awareness in this specific field. Study design, size, duration This is a cross-sectional study carried out using a population-based survey to identify different attitudes, knowledge and opinions regarding fertility and infertility. The survey was made public on April 30, 2019 and closed on May 10, 2019. Participants/materials, setting, methods A total of 1569 Spanish women answered all the questions included in the survey. No response or subject participation was excluded from the study. The platform used to create the questionnaire was Google Forms, which anonymizes the responses automatically. Data processing was performed using RStudio, an integrated development for R scripting. Main results and the role of chance Up to 1231 women had not had children at the time of the survey and 46% (566) of these cohort were either worried or very concerned about not being able to conceive naturally in the future. Also, 71% (871) of the same cohort were willing to have children of their own. In addition, 65% (1015) among those surveyed though that infertility had an important social stigma. With respect to gynecological health, 89% (1376) of women surveyed had had at least a gynecologic check-up at the time of answering the survey. However, up to 78% (921) of this cohort had never consulted their gynecologist regarding female fertility. Women surveyed were asked to predict the age at which conceiving a child both naturally and via assisted reproductive techniques started to become difficult. Respondents predicted that age to be 36.74 (IC95% [36.52, 36.96]) years and 39.79 (IC95% [39.58, 40.01]) years, respectively. Plus, 86% (1328) of women surveyed were in favor of elective fertility preservation and up to 72% (1127) thought that the Spanish State should either cover or aid economically this process. Finally, up to 72% (1115) of them thought they lacked important information to take their reproductive choices adequately. Limitations, reasons for caution Participants in the survey were exclusively contacted virtually. Even with the number of responses obtained and due to the descriptive nature of this study, it might not be representative of Spanish female society regarding the topics addressed. Also, the results here presented might not be extrapolable to other populations. Wider implications of the findings Considering the data presented in this work, education in fertility should start as soon as possible, ideally in high school. Finally, reproductive autonomy is being able to choose whether to have or not to have children, but the key is to always be able to make that decision. Trial registration number Not applicable

Progesterone-primed ovarian stimulation in oocyte donation: a model for elective fertility preservation?

Research questionDoes type of LH peak suppression (progesterone-primed ovarian stimulation [PPOS] versus gonadotrophin releasing hormone [GnRH] antagonist) affect oocyte competence, embryo development and live birth rates in recipients of vitrified donated oocytes? DesignRetrospective cohort study conducted between 2016 and 2018, involving 187 recipient cycles of donated vitrified oocytes. Oocyte donors were stimulated under LH suppression with desogestrel for PPOS (DSG group) or ganirelix GnRH antagonist (ANT group). Recipients younger than 50 years received vitrified oocytes from DSG donation cycles (DSG-R) or ANT donation cycles (ANT-R). ResultsA mean of 10.07 ± 3.54 oocytes per recipient were warmed (survival rate of 80.7%), and 5.90 ± 2.89 were fertilized (fertilization rate 72.6%). Out of 187 recipients, 168 achieved embryo transfers. No significant differences were found in warming survival rates, fertilization rates and embryo development between DSG-R and ANT-R groups. Ninety-four clinical pregnancies and 81 live births were achieved. No statistically significant differences were found in clinical pregnancy rates (47.7% versus 52.5, P = 0.513) and live birth rates (39.5% versus 46.5%, P = 0.336) per recipient cycle between DSG-R and ANT-R, respectively. Multivariable logistic regression was applied to assess the effect of treating oocyte donors. Live birth rate adjusted for associated factors was not statistically different between vitrified oocytes from DSG or ANT (OR 0.74, 95% CI 0.37 to 1.47). ConclusionReproductive outcomes of recipients of vitrified oocytes are not affected by donor PPOS treatment. PPOS is suitable for suppressing LH peak in elective fertility preservation and in freeze-all strategies.

Fertility Benefits at Top U.S. Medical Schools

Background: Female physicians have a higher prevalence of infertility compared with the general population. Physician well-being can be significantly impacted by the physical and emotional challenges associated with this, including the high cost of fertility treatments, which are often not covered by health insurance. There are limited data on the current state of fertility coverage available for physicians. This study examines fertility insurance benefits offered for faculty at top U.S. medical schools. Methods: Between March and April 2021, we reviewed fertility benefits at medical schools ranked in the top 14 for research as identified by the US News & World Report 2021. The summary plan descriptions of benefits were collected from each institution's human resources (HR) website and direct phone call to HR representatives. We examined descriptions of coverage for fertility services including evaluation, treatments, medications, maximum lifetime coverage, and whether a formal diagnosis of infertility was required for benefit eligibility. Results: Fourteen institutions offer benefits for fertility evaluation and 13 offer benefits for treatment. Of the 13 institutions that offer treatment coverage, 11 cover in vitro fertilization, with 6 having limits on the number of cycles. Twelve offer medication coverage. Ten institutions specified maximum lifetime coverage for treatments and medications, ranging from $10,000 to $100,000. Only 1 school provided coverage for elective fertility preservation, and none covered surrogacy expenses. Half of the schools are in states where fertility benefits are mandated. Conclusion: There is wide variation in fertility benefits offered at top medical schools across the country. Many schools offered coverage for fertility evaluation and treatments; however, majority had restrictions and limitations to the benefits, suggesting that there is still inadequate coverage provided. This study's selected sample also does not reflect other medical schools across the country, which may not be as well-resourced in their provision of fertility benefits.

COMPARISON OF DISPOSITION DECISIONS OF ELECTIVE FERTILITY PRESERVATION VERSUS FERTILITY TREATMENT PATIENT POPULATIONS UTILIZING ASSISTED REPRODUCTIVE TECHNOLOGIES

The objective of this study is to compare surplus oocyte or embryo disposition decisions in the elective fertility preservation (FP) and fertility treatment (FT) populations. Retrospective cohort study conducted at a single academic medical center. Patients who underwent ART cycles between January and December 2019 were included. Demographic, occupational and insurance data were collected from medical records and disposition decisions at age 50 and at death were gathered from consent forms completed prior to cycle initiation. Disposition options include disposal, donation to research, transfer to a storage facility, or reassignment of ownership. Descriptive statistics were reported as mean ± (SEM) for continuous variables and percentages for categorical variables. All continuous variables were compared using Mann-Whitney test, and categorical variables were compared using Fisher’s exact test or Chi-square test. A p-value<0.05 was considered statistically significant. All statistical analyses were done using GraphPad Prism software. When investigating disposition decisions at age 50, the elective FP population predominantly elected to donate oocytes to research while the FT population elected to discard supernumerary embryos (OR 0.5667 [0.3905-0.8315], p=0.0032). As such, the elective FP population predominantly chose non-disposal disposition decisions compared to the FT population (OR 0.2914 [0.2060-0.4131], p<0.0001). An analysis of disposition decisions at death showed that there was no difference in the proportion of each population that discarded versus donated to research. When comparing disposal to any other decision, FT patients were more likely to discard while elective FP patients elected non-disposal decisions (OR 0.3540 [0.2520-0.4996], p<0.0001). Both populations had a majority that elected other options than donation to research, however a significantly higher proportion did so within the elective FP population (OR 0.6721 [0.4879-0.9416], p=0.0236). The FT population represents a group of infertility patients, in contrast to the elective FP population who are mostly unaware of their fertility status at the time of cycle start. The odds that elective FP patients donate to research compared to FT patients reflects a differential value placed on oocytes compared to embryos in these two populations. This phenomenon touches on the perceived “moral status” held by an embryo that oocytes do not, that in turn influences patients’ desire for these to be a substrate for research. Furthermore, the increased odds of the FT population to dispose embryos than the elective FP population to dispose oocytes implies that in the case of oocytes, FP patients are more comfortable with gamete use in research or reassignment of ownership while FT patients want to retain full control of embryo fate.

P-740 Socio-cultural and clinical implications of ‘routine’ AMH testing in India: Insights from an interview study with the healthcare professionals (HCPs)

Abstract Study question How do Indian healthcare professionals describe their clinical experience with and perspectives on AMH testing in Indian women seeking fertility treatments including fertility preservation? Summary answer The HCPs cautioned against AMH testing as a screening tool in presumed fertile Indian women due to its anticipated impact on women’s arranged-marriage prospects. What is known already AMH test is being increasingly used to assess women’s ovarian reserve (OR) while planning fertility treatments or to guide decisions about fertility preservation (FP). There is weak evidence suggesting that serum AMH level and fertility treatment outcomes vary in different population groups. Surveys with women in reproductive age (e.g. the US, Ireland, the Netherlands) indicate that a majority wants to know their OR to aid reproductive decision making. As yet, both globally and in an Indian context, there are only few qualitative studies exploring the views of HCPs on the OR assessment in clinical practice and its socio-cultural implications. Study design, size, duration This paper reports the findings of an exploratory qualitative research aimed at understanding whether and how elective fertility preservation could influence reproductive autonomy of Indian women. Between June 2018 and April 2019, IVF specialists and obstetricians practicing in ten cities across five Indian states were interviewed in English (language commonly spoken) using a semi-structured interview guide. The discussion about OR assessment with AMH-testing was initiated by the participants indicating its significance in their clinical practice. Participants/materials, setting, methods The study sample included 17 male and 15 female HCPs, the majority (18/32) was practicing in Mumbai. Twenty-six of them were in private practice while six worked as OBGYNs in publicly funded teaching hospitals. Twenty-six participants were interviewed in their clinics and the remaining six using Skype or telephone. After several rounds of immersive reading, the interview sections on OR and AMH-test were analyzed inductively using Braun and Clarke’s thematic analysis. Main results and the role of chance Several participants reported that many of their patients present with decreased OR (DOR) at a younger age and need higher dosages of hormones for ovulation induction compared to the dosages mentioned in international guidelines. They corroborated this experience with a few peer-reviewed articles indicating a six-years age difference in OR of Indian women undergoing IVF compared to Spanish women. A majority of participants advocated for the rational use of OR assessment in IVF patients but warned against its indiscriminate use or interpretation out of context due to concerns about overdiagnosis of ovarian factor infertility and overtreatment with IVF with donor eggs. Although the physicians who had performed elective FP perceived AMH test as a simple, affordable and empowering tool to guide FP decisions, most participants were critical of using AMH-test as a screening tool in young, presumed fertile women completing university education. They were concerned that a diagnosis of DOR as a result of such screening in this population in the Indian context will adversely impact women’s chances of marriage and might further increase pressure on women to get married and complete their childbearing early even if they are not ready for it. Limitations, reasons for caution This is the first qualitative study assessing views of Indian HCPs on AMH testing. These results are indicative rather than a representation of views of Indian HCPs. Almost half of the contacted HCPs did not respond to interview requests; we do not know whether they had different views. Wider implications of the findings The insights on clinical implications of AMH testing in India are relevant to other societies beyond the Euro-American and Australian context where AMH testing will increase in the future. The socio-cultural implications of ‘routine’ AMH testing in India urges us to be aware of similar implications in other cultural contexts. Trial registration number Not applicable

P–740 Socio-cultural and clinical implications of ‘routine’ AMH testing in India: Insights from an interview study with the healthcare professionals (HCPs)

Abstract Study question How do Indian healthcare professionals describe their clinical experience with and perspectives on AMH testing in Indian women seeking fertility treatments including fertility preservation? Summary answer The HCPs cautioned against AMH testing as a screening tool in presumed fertile Indian women due to its anticipated impact on women’s arranged-marriage prospects. What is known already AMH test is being increasingly used to assess women’s ovarian reserve (OR) while planning fertility treatments or to guide decisions about fertility preservation (FP). There is weak evidence suggesting that serum AMH level and fertility treatment outcomes vary in different population groups. Surveys with women in reproductive age (e.g. the US, Ireland, the Netherlands) indicate that a majority wants to know their OR to aid reproductive decision making. As yet, both globally and in an Indian context, there are only few qualitative studies exploring the views of HCPs on the OR assessment in clinical practice and its socio-cultural implications. Study design, size, duration This paper reports the findings of an exploratory qualitative research aimed at understanding whether and how elective fertility preservation could influence reproductive autonomy of Indian women. Between June 2018 and April 2019, IVF specialists and obstetricians practicing in ten cities across five Indian states were interviewed in English (language commonly spoken) using a semi-structured interview guide. The discussion about OR assessment with AMH-testing was initiated by the participants indicating its significance in their clinical practice. Participants/materials, setting, methods The study sample included 17 male and 15 female HCPs, the majority (18/32) was practicing in Mumbai. Twenty-six of them were in private practice while six worked as OBGYNs in publicly funded teaching hospitals. Twenty-six participants were interviewed in their clinics and the remaining six using Skype or telephone. After several rounds of immersive reading, the interview sections on OR and AMH-test were analyzed inductively using Braun and Clarke’s thematic analysis. Main results and the role of chance Several participants reported that many of their patients present with decreased OR (DOR) at a younger age and need higher dosages of hormones for ovulation induction compared to the dosages mentioned in international guidelines. They corroborated this experience with a few peer-reviewed articles indicating a six-years age difference in OR of Indian women undergoing IVF compared to Spanish women. A majority of participants advocated for the rational use of OR assessment in IVF patients but warned against its indiscriminate use or interpretation out of context due to concerns about overdiagnosis of ovarian factor infertility and overtreatment with IVF with donor eggs. Although the physicians who had performed elective FP perceived AMH test as a simple, affordable and empowering tool to guide FP decisions, most participants were critical of using AMH-test as a screening tool in young, presumed fertile women completing university education. They were concerned that a diagnosis of DOR as a result of such screening in this population in the Indian context will adversely impact women’s chances of marriage and might further increase pressure on women to get married and complete their childbearing early even if they are not ready for it. Limitations, reasons for caution This is the first qualitative study assessing views of Indian HCPs on AMH testing. These results are indicative rather than a representation of views of Indian HCPs. Almost half of the contacted HCPs did not respond to interview requests; we do not know whether they had different views. Wider implications of the findings: The insights on clinical implications of AMH testing in India are relevant to other societies beyond the Euro-American and Australian context where AMH testing will increase in the future. The socio-cultural implications of ‘routine’ AMH testing in India urges us to be aware of similar implications in other cultural contexts. Trial registration number Not applicable

Number needed to freeze: cumulative live birth rate after fertility preservation in women with endometriosis

Research questionHow does the number of oocytes used affect the cumulative live birth rate (CLBR) in endometriosis patients who had their oocytes vitrified for fertility preservation? DesignRetrospective observational study including data from 485 women with endometriosis who underwent fertility preservation from January 2007 to July 2018. Survival curves and Kaplan–Meier plots were used to analyse the CLBR according to the number of vitrified oocytes used. Endometriosis curves were compared with plots developed using elective fertility preservation (EFP) patients as control group. Log-rank, Breslow and Tarone–Ware tests were used to compare the survival curves. ResultsThe CLBR increased as the number of oocytes used per patient rose, reaching 89.5% (95% confidence interval [CI] 80.0–99.1%) using 22 oocytes. Higher outcomes were observed in young women (≤35 years old versus >35 years old). In the younger group, the CLBR was 95.4% (95% CI 87.2–103.6%) using approximately 20 oocytes versus 79.6% (95% CI 58.1–101.1%) in older women (log-rank [Mantel–Cox] P = 0.002). The mean age was higher in EFP patients (37.2 ± 4.9 versus 35.7 ± 3.7; P < 0.001). The outcome was better in the endometriosis group as compared with EFP: a CLBR of 89.5% (95% CI 80.0–99.1%) versus 59.9% (95% CI 51.4–68.6%) when 22 oocytes were used (log-rank [Mantel–Cox] P < 0.00001). ConclusionThe probability of live birth increases as the number of oocytes used increases in patients with endometriosis, but better outcomes were observed among young women. The information provided here may be of interest to both patients and treating physicians for counselling purposes.

Oocyte Cryopreservation: Retrospective Analysis Of 5 Years Experience

OBJECTIVE: To analyze demographic and clinical data of patients who resorted to oocyte freezing between January 2014 and December 2018. STUDY DESIGN: Patients who applied to the Reproductive Endocrinology and Infertility Unit of Ankara University School of Medicine between January 2014 and December 2018 with the request of oocyte freezing were included in this study. The files and computer records of the patients were analyzed retrospectively and sociodemographic, clinical and laboratory data were evaluated. RESULTS: A total of 46 cycles were recorded in 40 patients over a 5-year period. The main indications were low ovarian reserve and/or advanced age (68.3%) and malignancy diagnosis (31.7%). There was a significant difference between elective fertility preservation and oncofertility preservation (Onco-FP) groups in terms of the age (38.4±4.7 vs 28.4±6.1; p=0.001). There was a significant difference between two groups in favor of oncofertility group in terms of anti-Mullerian hormone level, basal follicle-stimulating hormone level, antral follicle count, trigger day estradiol (E2) level, number of obtained oocytes, MII oocytes, and frozen oocytesCONCLUSION: According to our study, the most prominent oocyte cryopreservation indication was advanced age and/or low ovarian reserve. The number of oocytes collected from patients in the Onco-FP group and thus the number of frozen oocytes was significantly higher than in the elective fertility preservation group, due to younger ages and better ovarian reserve in the Onco-FP group. Abdominal administration of the technique is particularly important for virgin patients in our country. Oocyte freezing is a fertility protection method available in a wide range of indications for reproductive-aged women.

National survey on the opinions of French specialists in assisted reproductive technologies about social issues impacting the future revision of the French Bioethics laws

IntroductionFrance is known for its conservative and unique position in assisted reproductive technologies (ARTs). At the eve of the future revision of French Bioethics laws, we decided to conduct a national survey to examine the opinions of French specialists in ARTs about social issues. Material and methodsDescriptive study conducted in May 2017 in a university teaching hospital using an anonymous online questionnaire on current issues in ARTs. The questionnaire was sent by email to 650 French ARTs specialists, both clinicians and embryologists. ResultsAfter 3 reminders, 408 responses were collected resulting in a participation rate of 62.7% (408/650). Concerning pre-implantation genetic testing, 80% of the physicians were in favor of expanding the indications, which in France are presently limited to incurable genetic diseases. Authorizing elective Fertility Preservation was supported by 93.4% of the specialists, but without social coverage for 86.3% of them. Concerning gamete donation, 77.4% of the French ARTs specialists were in favor of giving a financial compensation to donors, 92% promoted preserving their anonymity and 80.9% were against a directed donation. ARTs for single heterosexual women were supported by 63.4% of the French specialists and by 72.5% for lesbian couples. The legalization of surrogacy was requested by 55.2%. DiscussionPending the revision of the French Bioethics laws, this survey provides an overview of the opinion of the specialists in ARTs on expanding ARTs for various social indications.Because of the evolution of social values, a more liberal and inclusive ART program is desired by the majority of ART specialists in France.

Elective oocyte cryopreservation: can we expand the women’s reproductive lifespan?

Objective. Oocyte cryopreservation is being offered to women who wish to defer childbearing. Elective oocyte cryopreservation provides women the possibility to prevent involuntary childlessness due to age-related infertility. The purpose of this review is to summarize recent data regarding the outcomes and economic implications of elective oocyte cryopreservation. Recent findings. Oocyte vitrification has comparable in vitro fertilization (IVF) outcomes as fresh oocytes. Although evidence about the outcomes of IVF cycles in the population who undergoes elective oocyte vitrification is limited, new studies are starting to emerge. The age at retrieval and the number of available oocytes are the most important factors that improve a woman’s chance of having a baby. Biologically, the ideal age of cryopreserving is <35 years old. However, the majority of studies show that elective fertility preservation is more cost-effective at 37-38 years old. When counseling women who take into consideration postponing motherhood, they should be informed of the complications associated with pregnancy at an advanced maternal age. Conclusions. Elective oocyte cryopreservation is a strategy that helps women gain the reproductive autonomy they need for deferring childbearing. Given the increasing interest toward elective oocyte cryopreservation, clinicians need to properly counsel and inform women about the limitations of this procedure. Oocyte vitrification does not guarantee success, but increases the likelihood of having a child later in life.

Oocyte Cryopreservation in Oncological Patients: Eighteen Years Experience of a Tertiary Care Referral Center.

Objective: The aim of the present study is to report our experience on elective women fertility preservation before cancer treatment.Study Design: This is a single-center retrospective observational study, including all patients who underwent elective fertility preservation before oncological treatment between January 2001 and March 2019 at our Institute.Results: Of a total of 568 women who received fertility counseling, 244 (42.9%) underwent 252 oocyte retrieval cycles after controlled ovarian stimulation for cryopreservation. The majority of patients were diagnosed with breast cancer (59.9%), followed by women affected by Hodgkin's and non-Hodgkin's lymphoma (27.4%). A minority comprised patients diagnosed with other malignancies that affected soft tissues (2.8%), ovary borderline type (2.4%), digestive system (1.6%), leukemia (1.6%), uterine cervix (1.2%). The remaining 3.1% were affected by other cancer types. The mean age of the cohort was 31.3 ± 6.4 years and the mean oocyte retrieval was 13.5± 8.4. Of 11 women who returned to attempt a pregnancy, three performed two thawed cycles. We obtained four pregnancies from 24 embryo transfers (Pregnancy Rate 36.4% for couple): two miscarriages and two live births. Overall, 95.7% of oocytes are still in storage.Conclusions: A close collaboration between Cancer and Fertility Center in a tertiary care hospital is essential to provide a good health service in oncological patients. Offering fertility preservation is no longer considered optional and must be included in every therapeutic program for women who receive an oncological diagnosis in their reproductive age. Oocyte cryopreservation appears to be a good opportunity for fertility preservation. Our results, although they are obtained in a small sample, are encouraging, even if only 4.5% of patients returned to use their gametes.