IVF Pregnancy Research Articles

OP02.03: Maternal and fetal hemopexin and α1‐microglobulin levels differ in pre‐eclampsia IVF pregnancies depending on the presence of corpus luteum

OP02.03: Maternal and fetal hemopexin and α₁‐microglobulin levels differ in pre‐eclampsia IVF pregnancies depending on the presence of corpus luteum

VP01.02: Double trouble: case of heterotopic cervical pregnancy managed non surgically

We report the case of a 45-year-old primigravida with 19 years of primary infertility conceived by 2nd cycle of IVF pregnancy, was referred to our institution for a viability scan due to off and on vaginal spotting. Ultrasound demonstrated concomitant viable intrauterine pregnancy and coexistent viable cervical pregnancy of 8–9 weeks of gestation (figure 1a, b) giving the diagnosis of the Heterotopic cervical pregnancy. The patient was counselled about the potential hemorrhage and other risks involved with a cervical pregnancy. Decision for non-surgical transvaginal ultrasound-guided intervention was taken for instillation of potassium chloride and methotrexate into the fetal node of the cervical pregnancy and within 1 minute resulted in asystole (figure 2). Repeat ultrasound showed viable intrauterine pregnancy. The patient had a regular antenatal follow up and a healthy male child weighing 2.3kgs was delivered by Caesarean section at 36 + 4 weeks of gestation. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Myoinositol versus metformin pretreatment in GnRH-antagonist cycle for women with PCOS undergoing IVF: a double-blinded randomized controlled study

Objective To study the effects of myoinositol (Myo) in comparison to metformin (Met), in reducing the risk of OHSS and improving ART outcome in PCOS women undergoing IVF. Design Double-blinded randomized controlled trial (CTRI/2018/05/014196). Setting ART Clinic, AIIMS, New Delhi patients: 102 infertile PCOS women undergoing IVF cycles were enrolled after evaluating for eligibility and allotted as 50 in group 1 (Myo) and 52 in group 2 (Met) after randomization. Interventions Recruited patients received Myo 2 g twice daily (group 1) and Met 850 mg twice daily (group 2). Pre- and post-treatment clinical (menstrual pattern, BMI), hormonal profile (LH, FSH, testosterone, prolactin [PRL], and AMH), biochemical parameters (HOMA IR, fasting glucose, and insulin), ovarian with antral follicle count (AFC) and side effect profile were assessed. After 3 months of therapy, patients were recruited for IVF cycle by antagonist protocol was involving controlled ovarian stimulation, cycle monitoring, oocyte recovery, insemination of oocytes and follow up with fertilization, cleavage, transfer of good grade cleavage embryos, or blastocysts pregnancy outcomes and OHSS incidence and medications was continued until the day of OPU. Main outcome measures Primary outcome was OHSS and clinical pregnancy rate including spontaneous, IVF, and cumulative pregnancy rate including FET. Secondary outcome was ART outcomes and the change in biochemistry and hormonal profile between groups and inter group after medications at 12 weeks. Results Incidence of OHSS (Myo 5 (10.0) (n = 50), Met 10 (20.0) (n = 50) p .07) was not statistically different between groups. Clinical pregnancy rate (Myo 18 (36.0) (n = 50), Met 9 (18.0) (n = 50) p .04) cumulative pregnancy rate including FET (Myo 16 (43.2) (n = 37) vs. Met 10) 22.7) (n = 44) p .05) and spontaneous conception (prior to IVF) Myo 13 (26.0) (n = 50), Met 6 (12.0) (n = 50) p .07) was significantly high in Myo group. No between group difference in ovarian stimulation outcomes including duration and dosage of gonadotropins, E2, P4 levels, number of follicles >14 mm on day of trigger. Number of oocytes retrieved and grade of maturity were similar between groups. Fertilization, cleavage and number of good grade embryos were significantly higher in Myo group. However, implantation rate and number of embryos for freezing were similar between groups. Myo had improvement in fasting insulin, HOMA, Sr.AMH, and SHBG suggesting decreased insulin resistance Conclusions Myo is equally beneficial as Met in reducing the risk of OHSS and has better ART outcome in PCOS women undergoing antagonist cycles.

Thawing day 3 embryos and culturing to day 5 may be a better method for frozen embryo transfer.

Does thawing cleavage embryos and culturing them for transfer as blastocysts improve pregnancy and perinatal outcomes compared to transferring thawed blastocysts? Retrospective, observational cohort study performed at two assisted reproductive technology centers, 2014 to 2020. A total of 450 patients with 463 thawed embryo transfer cycles were divided into 2 groups according to the embryonic developmental stage at cryopreservation and transfer: 231 thawed blastocysts (day 5 group) and 232 thawed cleavage embryos that were cultured for 2days and transferred as blastocysts (day 3-5 group). The two groups were compared for demographics, routine parameters of IVF treatment, pregnancy rates, and perinatal outcomes. Multivariable logistic regression analysis for ongoing pregnancy and delivery demonstrated that the day 3-5 group had a greater likelihood of achieving ongoing pregnancy and delivery compared to the day 5 group (OR 1.58, 95%CI 1.062-2.361, p = 0.024). Perinatal outcomes were comparable between the three groups. Our results support culturing post-thaw cleavage embryos for 2days and transferring them as blastocysts to increase chances of ongoing pregnancy and delivery.

PREDICTORS OF PREECLAMPSIA IN IVF PREGNANCIES: PERI-IMPLANTATION BETA-HUMAN CHORIONIC GONADOTROPIN AND ENDOMETRIOSIS

Placentation abnormalities have been associated with IVF pregnancies, although this is poorly understood. Preeclampsia (PE) is thought to be due to dysfunctional trophoblastic invasion into maternal decidua. Peri-implantation bHCG may serve as a marker within this process, and endometriosis is a condition that may disrupt it. To investigate the underlying etiologies of this association, we looked at maternal infertility diagnosis of endometriosis and initial bHCG levels following embryo transfer (ET) via review of EPIC electronic medical record (EMR) of all IVF pregnancies between 2013 and 2020 conceived and ultimately delivered within our healthcare system to examine patient and IVF cycle characteristics that may predict a risk for PE. A total of 352 IVF pregnancies (maternal ages 26-45) were included in our retrospective, nested, case-control study. We utilized ICD-10 codes of infertility diagnoses (specifically: endometriosis, thyroid condition, uterine factor and PCOS) amongst cases of PE and those unaffected by any diagnosis of placental dysfunction. Relationships between peri-implantation serum bHCG levels (initial lab, day 7-16 after ET) and infertility diagnoses with PE were examined between singleton and twin pregnancies. Univariable analyses examined the relationship of patient and cycle characteristics between cases and controls. Multivariable logistic regression analysis examined the relationship between peri-implantation bHCG levels and infertility diagnosis with risk for PE after adjusting for patients' age at ET, multiplicity of gestation, and interval between ET and first bHCG level. Stata V 16.1 was used for analyses. Of the 352 pregnancies followed from IVF-ET to delivery, 78% were singletons. Median bHCG levels in singleton and twins respectively were 248 U and 419 U (25th and 75th percentile range 149-348 and 246-709 respectively). Mean maternal age at ET was 35 years (+/- 4). Proportions of infertility diagnoses were 10% endometriosis, 24% PCOS, 10% uterine factor, and 41% hypothyroidism. Endometriosis diagnosis showed a 2x greater risk of PE compared to other infertility etiologies, a relationship that held on multivariable analysis (OR= 2.32, 95% CI 1.04-5.15) and was most robust in twin gestations (OR 6.0, 95% CI 1.3-26.6). Diagnoses of PCOS, hypothyroidism, and uterine factor did not relate to risk of PE. Peri-implantation bHCG levels were significantly higher in pregnancies with PE compared to controls (p=0.046); on multivariable analyses, higher bHCG levels had a greater likelihood for PE (p=0.08 for the entire cohort, p=0.049 for twins). PE is more common in IVF pregnancies with maternal diagnosis of endometriosis regardless of multiplicity of gestation and with elevated earliest bHCG level in twin pregnancies.

HOW DOES IVF CONCEPTION AFFECT PREGNANCY COMPLICATIONS IN AN OLDER COHORT OF WOMEN?

Age is a risk factor for pregnancy complications. Women at least 38 years old are at increased risk of many issues, including hypertensive disorders, gestational diabetes, placentation abnormalities, abruption, blood transfusion, cesarean section and fetal demise, among others. The need for IVF to conceive is also a risk factor for pregnancy complications. Therefore, we attempted to explore the risks in IVF pregnancies in women of advanced maternal age (38-43 years old).

EFFECT OF ASPIRATION WITH POLICRESULEN COAGULATION OF ISTHMOCELE ON IVF OUTCOME IN INFERTILE PATIENTS UNDERGOING IVF TREATMENT

This study was performed to investigate the effect of aspiration with policresulen coagulation (APOC) of the large isthmocele after previous cesarean section delivery on IVF outcome in infertile women undergoing IVF-ET treatment. A total of 87 consecutive IVF-ET cycles in 87 infertile patients with large isthmocele with residual myometrial thickness (RMT) less than 3mm who underwent IVF-ET between May 2018 and March 2021 was included in this retrospective cohort study. In 45 patients of 87, APOC was performed immediately after oocyte pick-up (OPU) in IVF-ET cycles. Forty-two patients who did not receive APOC were served as controls. In all subjects, GnRH antagonist protocol was used for COS. IVF results and pregnancy outcome were compared between the APOC and control groups. Mean values were expressed as mean±standard deviation (SD). Student’s t-test was used to compare mean values. Chi-square test and Fisher’s exact test were used to compare fraction. Statistical significance was defined as P<0.05. All analyses were performed by using SPSS statistical package for Windows, version 11.0 (SPSS Inc, Chicago, IL). The demographic characteristics of subjects were comparable between the APOC and control groups. Incidence of intracavitary fluid (ICF) on the day of OPU was also similar in the two groups. There were no differences in the two groups with respect to total dose and days of gonadotropins used for COS, and the numbers of oocytes retrieved, mature oocytes retrieved, fertilized oocytes and grade 1 or 2 embryos. Clinical pregnancy rate (CPR) seemed to be higher in the study, but the difference did not achieve the statistical significance (P = .077). However, embryo implantation rate was significantly higher in the APOC group of 28.4% (23/81) compared with 15.0% (12/80) in the control group (P = .040). Miscarriage rate was similar in the two groups. APOC treatment performed immediately after OPU is an effective and safe procedure to increase embryo implantation rates in infertile patients with large isthmocele undergoing IVF-ET.

WHAT IS THE UPPER LIMIT OF BMI FOR IVF SUCCESS BEFORE DECLINE?

There are reports that increasing Body Mass Index (BMI) is a pandemic problem. In the US, females during their reproductive years are 25% overweight and 23% obese (Sarais et al, 2016; Wang et al, 2007). Elevation of BMI contributes to poor IVF pregnancy outcomes (Kawwass et al, 2016) and obstetric outcomes (Dickey et al, 2013). For patient consultation, “What is the upper limit of BMI before the success rates plunge down?” becomes an important part of the conversation.

DO EARLY HCG DYNAMICS AFTER EMBRYO TRANSFER DIFFER BASED ON DAY OF EMBRYO BIOPSY?

Serum HCG threshold levels and rate of rise are established predictors of successful pregnancy in IVF embryo transfer cycles. While prior studies on HCG dynamics in early IVF pregnancies have accounted for factors such as stage of embryo development, these studies have not accounted for the speed of embryo development. Day 7 embryos have been shown to have reduced implantation potential.1 However, no study has yet to review the relationship between day 7 embryo transfer and the level of HCG secretion when early pregnancy is achieved. The objective of this study is to compare initial HCG levels and the rate of HCG increase between day 5, 6, and 7 single, euploid frozen embryo transfers (FET). The study included patients who underwent a single, euploid FET, from January 2012 to March 2021. Initial serum HCG levels were reviewed on day 9 post FET, and if positive, the rate of HCG rise, by day 11, was noted. FET cycles were stratified by day of embryo biopsy and cryopreservation (Group A: Day 5; Group B: Day 6; Group C: Day 7). Baseline demographics were compared and analyzed by ANOVA and Kruskal-Wallis. A logistic regression was then performed to evaluate the differences in HCG levels when controlling for Patient Age, Oocyte age, BMI, AMH, BAFC, day 3 FSH, and endometrial thickness at progesterone initiation. A total of 1,707 single euploid FETs were included and separated into three groups: Group A (n = 1,104), Group B (n = 577), and Group C (n = 26). The mean serum HCG value on day 9 after ET was 168.7 in Group A, 143.0 in Group B, and 94.8 in Group C. Initial HCG level and the percent of HCG rise was significantly different between the three groups (p < 0.0001). Day 5 embryos had a significantly higher absolute difference in HCG levels, from day 9 to day 11, compared with day 6 embryos (OR 1.41 [95% CI 1.23-1.75]) and day 7 embryos (OR 4.74 [95% CI 2.16-10.40]). The percent rise of HCG between days 9 and 11 in day 5 embryos was significantly lower than day 7 embryos (OR 2.36 [95% CI 1.079-5.16]), but was similar compared with day 6 embryos (OR 1.19 [95% CI 0.955-1.48]). The HCG dynamics of early pregnancies from a single, euploid FET, are significantly impacted by the day of embryo development. Our findings show that reproductively competent day 7 embryos have lower initial HCG levels, but then a higher rate of HCG rise compared with faster growing day 5/6 embryos. The increased rate of HCG rise in day 7 embryos may reflect a mechanism such as compensation for a delayed activation of the embryonic transcriptome which these slower growing embryos are able to overcome to be able to successfully implant.

Analysis of Delivery in Singleton Pregnancies Achieved by In Vitro Fertilization

BACKGROUND: Birth after IVF is increasingly observed in modern obstetrics, so knowledge of its features is of paramount importance for clinical practice. &#x0D; AIM: The purpose of our study was to compare IVF and spontaneous singleton pregnancies in terms of cesarean section rate, operative vaginal birth rate, induction of labor, manual removal of the placenta in vaginal births, severe PPH and need for blood transfusion after delivery.&#x0D; &#x0D; MATERIAL AND METHODS: We conducted a retrospective study at "Maichin Dom" University Hospital in Sofia, Bulgaria for the period from January 2013 to December 2017 and analyzed 402 singleton IVF pregnancies and compared them with 523 spontaneous singleton pregnancies &#x0D; &#x0D; RESULTS: We found a significantly higher rate of cesarean sections in IVF compared to spontaneous pregnancies [OR 1.73; 95% CI 1.4-2.14; p&lt;0.001]. Vaginal delivery after IVF is associated with a higher incidence of operative vaginal delivery than spontaneous pregnancies [OR 2.27; 95% CI 1.14 - 4.52; p=0.018]. No statistical differences in rates of labor induction and manual removal of the placenta between two groups were estimated (p&gt;0.05). Severe PPH and blood transfusions were three times higher in patients after IVF undergoing a cesarean section than in those with spontaneous singleton pregnancies [OR 3.0; 95% CI 1.11 - 8.11; p=0.018].&#x0D; &#x0D; CONCLUSION: IVF singleton pregnancies are associated with a higher risk of cesarean section as well as some obstetric complications. Obstetricians should treat these pregnancies with caution in order to reduce cesarean section rate and improve the outcome.

P–383 Cytogenetic analysis of products of conception from miscarriages following natural conception and IVF pregnancy: a comparative study

Abstract Study question Do cytogenetic results from products of conception from miscarriages differ from patients conceiving by natural conception versus IVF? Summary answer: Cytogenetic results were similar, with no statistical difference from miscarriages following natural conception and assisted conception. What is known already Cytogenetic sampling of products of conception (POC) following recurrent miscarriages (RM) are recommended to rule out parental chromosomal rearrangements. The RCOG recommends cytogenetic testing in cases of recurrent miscarriages (3 consecutive miscarriages). However some units routinely request cytogenetic analysis following a single miscarriage following an IVF pregnancy. There is no evidence to support the routine sampling of POCs following assisted conception. Study design, size, duration: Retrospective cohort study of 117 cytogenetic samples, followed up by the outcome of parental karyotyping if applicable. Patients were categorised based on mode of conception into natural conception (NC) with recurrent miscarriages (≥3) or one miscarriage following IVF. Data collected between 2018–2020. Primary Outcome measure: Presence and type of cytogenetic abnormality; individual parental targeted G-band karyotyping result. Participants/materials, setting, methods: A total of 117 cytogenetic results were reviewed, of which 35 were unsuitable for analysis due to contamination (Total n = 79: NC = 60, IVF = 19). Main results and the role of chance: Cytogenetic analysis showed abnormal results in 59% of miscarriages following natural conception and 53% of miscarriages from IVF pregnancy (p = 0.46). Abnormal cytogenetic results were mainly sporadic. Trisomy 16 was the commonest abnormality in both groups. Others included Trisomy 15, 22, 21, 8, 13, 5, 9, 10, 14, 18, single X (Turner’s), all occurring in the same frequency in both groups. As expected 35 out of 45 abnormal cytogenetic results occurred with a maternal age greater than 35 years. One couple from the NC group were referred to a geneticist for a Trisomy 9 imbalance. All other parental karyotyping results were normal. Limitations, reasons for caution This study contains a small sample size, and would benefit from further data collection to account for a percentage of samples being inadequate for analysis. Wider implications of the findings: Cytogenetic results were similar from miscarriages following natural conception and assisted conception. IVF does not increase the risk of miscarriage from abnormal embryonic karyotype. Routine cytogenetic testing following one miscarriage in patients undergoing IVF is not cost effective. Trial registration number Not applicable

P–762 Preeclampsia in pregnancies resulting from oocyte donation, IVF or natural conception. A systematic review and meta-analysis

Abstract Study question What is the prevalence of preeclampsia (PE) in pregnancies after oocyte donation (OD) compared to natural conception (NC) and to IVF with autologous oocytes? Summary answer PE prevalence in singleton pregnancies after OD was five times higher than in NC and almost three times higher than after IVF with autologous oocytes. What is known already: The indication for OD is expanding to lesbian women requesting shared lesbian motherhood. Previous reviews showed that the risk of PE is higher in pregnancies after OD than after IVF with autologous oocytes and natural conception. Classification on severity of PE is lacking as is the relationship with known risk factors such as maternal age and multiple gestations. Furthermore the actual prevalence of PE following in pregnancies resulting from OD is not known. Study design, size, duration Systematic review and meta-analysis. A literature search was performed using the following databases: PubMed, EMBASE and CINAHL, OpenGrey and Greynet from January 1980 through July 2020. Participants/materials, setting, methods We included retrospective and prospective cohort studies. The study population consisted of pregnancies after OD and NC or IVF and data had to be available about prevalence of PE. We compared the risk of (severe) PE in OD versus NC and IVF pregnancies, subgrouped by parity and maternal age. We calculated individual and pooled odds ratios (OR) and prevalence estimates with 95% CI using a random effect model, while heterogeneity was assessed by the I2. Main results and the role of chance We included 28 studies comprising of 7131 OD pregnancies, 1.139.540 NC pregnancies and 72.763 IVF pregnancies were available for analysis. The risk of PE and severe PE was increased in OD pregnancies compared to NC pregnancies (pooled OR of all subgroups: 5.09, 95% CI: 4.29 – 6.04; I2 = 19% and OR: 7.42 (95% CI: 4.64–11.88; I2 = 49%). The pooled adjusted OR for PE was 3.24 (95% 2.74 – 3.83) for OD versus natural pregnancies.The risk of PE and severe PE was increased in OD pregnancies compared to IVF pregnancies (pooled OR of all subgroups: 2.96, 95% CI: 2.49 – 3.51; I2 = 51% and OR: 2.97, 95% CI: 2.15 – 4.11; I2 = 0%). The pooled adjusted OR for PE was 2.67 (95% 2.28 – 3.13) for OD versus IVF.The pooled prevalence of PE in singleton pregnancies after OD was 10.7% (95% CI 6.6 – 15.5) compared to 4.1% (95% CI 2.7 – 5.6) after IVF and 2% (95% CI 1.0 – 3.1) after NC. The prevalence in multiple pregnancies was 27.8% (95% CI 23.6 –32.2) after OD, 9.7% (95% CI 6.2 – 13.9) after IVF and 7.5% (95% CI 7.2 – 7.8) after NC. Limitations, reasons for caution The precise definition of PE is still a matter of debate. The different criteria could have affected the prevalence estimate. Wider implications of the findings: Nearly one in six women will suffer PE after OD. Women who can conceive naturally i.e. shared lesbian motherhood, should be discouraged to turn to OD. In women with premature ovarian failure factors that increase risk of PE should be avoided. We suggest therefore single embryo transfer. Trial registration number Not applicable

P–194 Impact of cryopreservation duration on pregnancy outcomes of vitrified-warmed blastocysts transfer using an open-device system

Abstract Study question Is there a negative effect of long-term cryopreservation upon pregnancy outcomes after transfer of vitrified-warmed blastocysts stored in an open-device system? Summary answer Prolonged cryopreservation of vitrified blastocysts up to 24 months increased the incidences of clinical pregnancy, ongoing pregnancy, and live birth, while decreased early miscarriage rate. What is known already Vitrification is adopted as the dominant approach for cryopreservation of human oocytes and embryos. However, little is known about the potential effect of prolonged storage after vitrification on the genomic integrity and metabolism of embryos. Several studies have sought to decipher the effect of cryopreservation duration on IVF pregnancy outcomes, but few were confined to vitrification and the results were inconsistent. Study design, size, duration This retrospective study included 6722 patients undergoing their first vitrified-warmed blastocyst transfer (VBT) cycles from January 2015 to June 2019 in a single fertility center in South China. The study was approved by the hospital’s Ethics Committee. Participants/materials, setting, methods A total of 6722 eligible patients were divided into five groups according to the storage duration after vitrification: Group I: 0–3 months; Group II: 3–6 months; Group III: 6–12 months; Group IV: 12–24 months; Group V: 24–36 months. The IVF pregnancy outcomes were compared between groups. Multivariate logistic regression was conducted to evaluate the independent effect of storage duration on pregnancy outcomes. Main results and the role of chance The odds of clinical pregnancy outcomes were similar from Group 1 to 4. However, the chance of clinical pregnancy (Group 1 as reference; Group 2: adjusted odds ratio (aOR)= 1.04, 95% CI 0.93–1.17; Group 3: aOR = 1.02, 95% CI 0.84–1.25; Group 4: aOR = 0.93, 95% CI 0.66–1.31; Group 5: aOR = 0.54, 95% CI 0.38–0.76) , ongoing pregnancy (Group 2: aOR=0.99, 95% CI 0.89–1.11; Group 3: aOR = 0.94, 95% CI 0.77–1.14; Group 4: aOR = 0.87, 95% CI 0.62–1.22; Group 5: aOR = 0.41, 95% CI 0.29–0.60), and live birth rate (Group 2: aOR=1.00, 95% CI 0.89–1.12; Group 3: aOR = 0.98, 95% CI 0.81–1.19; Group 4: aOR = 0.91, 95% CI 0.65–1.27; Group 5: aOR = 0.46, 95% CI 0.32–0.66) significantly decreased, while the early miscarriage rate (Group 2: aOR=1.11, 95% CI 0.92–1.35; Group 3: aOR =1.25, 95% CI 0.92–1.70; Group 4: aOR = 1.33, 95% CI 0.77–2.31; Group 5: aOR = 2.42, 95% CI 1.36–4.31) significantly increased as the storage duration increased up to 24–36 months. Limitations, reasons for caution The primary limitation of this study was its retrospective nature. Besides, as all these data come from a single IVF treatment center, the results should be confirmed by a larger multicenter study. Wider implications of the findings: Our study provides more evidence about the negative impact of long-term storage of vitrified embryos on the clinical outcome. Clinicians should adapt FET strategies based on the embryo storage duration. Trial registration number Not applicable

Cardiac remodeling in fetuses conceived by ARTs: fresh versus frozen embryo transfer.

Do fetuses from frozen embryo transfer (FET) present signs of cardiac remodeling and suboptimal function similar to those observed in fetuses from fresh embryo transfer (ET)? Fetuses from both fresh ET and FET present signs of fetal cardiac remodeling and suboptimal function, with more pronounced changes after fresh ET as compared to FET. Our group and others have previously demonstrated that fetuses and children conceived by ARTs present cardiac remodeling and suboptimal function. These fetuses show dilated atria, more globular and thicker ventricles, reduced longitudinal motion, and impaired relaxation. Cardiac changes were already present in utero and persisted after birth. Most of the ART fetuses included in previous publications were from fresh ET. However, singletons from FET have different perinatal outcomes compared to those from fresh ET. There are no previous studies comparing cardiac morphology and function between fetuses following fresh and FET. This is a prospective cohort study of 300 singleton pregnancies recruited from 2017 to 2020, including 100 spontaneously conceived (SC) pregnancies, 100 fetuses conceived by IVF with FET, and 100 fetuses conceived by IVF with fresh ET. Fetal structural and functional echocardiography was performed in all pregnancies. Pregnancies conceived by IVF were recruited from a single assisted reproduction center, ensuring homogeneity in IVF stimulation protocols, endometrial preparation for FET, laboratory procedures, and embryo culture conditions. SC pregnancies from fertile couples were selected from the general population and matched to IVF pregnancies by maternal age. Epidemiological and perinatal outcomes were collected in all cases. Fetal echocardiography was performed at 28-33 weeks of pregnancy to assess cardiac structure and function in all pregnancies. All echocardiographic comparisons were adjusted by maternal age, nulliparity, birthweight centile, preeclampsia, and prematurity. Parental age, ethnicity, body mass index and smoking were similar among the study groups. Median gestational age at echocardiography and estimated fetal weight were similar in all study groups. Both fresh ET and FET groups showed similar fetal echocardiographic changes, with more pronounced features in the fresh ET as compared to FET pregnancies. Fetuses conceived by IVF showed larger atria (right atria-to-heart ratio: fresh ET mean 18.1% (SD 3.2) vs FET 18.0% (3.9) vs SC 17.3% (3.2); linear tendency P-value <0.001), more globular ventricles (right ventricular sphericity index: fresh ET 1.62 (0.29) vs FET 1.61 (0.25) vs SC 1.68 (0.26); <0.001) and thicker myocardial walls (relative wall thickness: fresh ET 0.79 (0.21) vs FET 0.74 (0.22) vs SC 0.65 (0.25); <0.001) as compared to SC pregnancies. Both fresh ET and FET groups also had signs of suboptimal systolic and diastolic function, with reduced tricuspid annular systolic peak velocity (fresh ET 7.17 cm/s (1.22) vs FET 7.41 cm/s (1.19) vs SC 7.58 cm/s (1.32); <0.001) and increased left myocardial performance index (fresh ET 0.53 (0.08) vs FET 0.53 (0.08) vs SC 0.50 (0.09); <0.001) as compared to SC pregnancies. The cardiac changes reported here are subclinical, with most cardiovascular indexes lying within normal ranges. Although echocardiographic changes are recognized as potential cardiovascular risk factors, their association with the long-term cardiovascular disease remains to be proven. The observed milder fetal cardiac features in FET fetuses cannot condition the choice of this technique and must be considered together with the global perinatal results related to these gestations. The identification of cardiac remodeling in fetuses conceived by IVF with fresh ET and FET represents an opportunity for early detection. Future studies are warranted to study the potential long-term consequences of these findings. This project has been partially funded with support from the Erasmus + Programme of the European Union (Framework Agreement number: 2013-0040). This publication reflects the views only of the author, and the Commission cannot be held responsible for any use, which may be made of the information contained therein. Additionally, the research leading to these results has received funding from 'la Caixa' Foundation under grant agreement LCF/PR/GN18/10310003, the Instituto de Salud Carlos III (PI15/00130, PI17/00675, PI18/00073) integrated into the Plan Nacional de I + D+I and cofinanced by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER) 'Una manera de hacer Europa', Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK) and AGAUR 2017 SGR grant n° 1531. The authors declare no conflicts of interest. N/A.

Effect of oxidative stress in semen, follicular fluid and embryo culture medium on the outcome of assisted reproduction

Background: Although many advances have been made in the field of assisted reproduction, the clinical outcomes remain less than desirable. Oxidative stress has been recently blamed on both male and female partners. Aim of the work: To study the effect of oxidative stress in semen, follicular fluid and embryo culture medium on the outcome of assisted reproduction. Patients and methods:Fifty couples with unexplained infertility were subjected to a combined treatment of IVF and ICSI. Oxidative stress was evaluated by measuring the oxidative-reduction potential (ORP) in the semen sample, follicular fluid pool and spent culture medium of individually IVF cultured embryos Results: ORP in native semen was found to be a good predictor of fertilization and clinical pregnancy in IVF with a cut-off point of 1.57 and 0.75mV/106 sperm/ml, respectively. There was a positive and highly significant correlation between ORP levels in follicular fluid pool and the fertilization rate(r= 0.4217; P=0.002288), but there was no statistically significant difference between ORP in the follicular fluid pool of women who became pregnant and those who did not (P = 0.997425). In addition, the mean ORP in spent culture medium of women who became pregnant (215.78 mV/ml ± 38.52) was lower than in those who did not become pregnant (229.22 mV/ml ± 31.56) but the difference was also not statistically significant (P = 0.3170). Conclusions: ORP in native semen and spent culture medium in IVF are good predictors of fertilization and clinical pregnancy and that ORP in the follicular fluid is not.

960-P: The Usefulness of CGMS in Identifying and Treating Suboptimal Blood Glucose Patterns in In Vitro Fertilization Pregnancies with Normal OGTT and Increased Amniotic Fluid

IVF pregnancies have an increased incidence of polyhydramnios. Increased amniotic fluid has been considered an indicator to test the mother for Gestational Diabetes Mellitus. Furthermore, IVF pregnancies are associated with a higher prevalence of GDM. In this study, suboptimal BG patterns were detected by CGMS in 19 singleton IVF pregnancies with a 4 quadrant Amniotic Fluid Index (AFI) ≥20cm and a normal OGTT. Clinical characteristics include the following; age: 35±3.7 years, BMI: 25.2±3.8 kg/m2, OGTT: 0’=83.6±7.3, 60’=157.5±19.3, 120’=129±30 mg/dL, HbA1c: 5.3±0.2%, Hadlock (BPD-HC-AC-FL) percentile: 59.7±12.1%, AFI: 21.7±1.6 cm, U/S polyhydramnios confirmation: 21.1±4.7 week. A blind recording of BG patterns was accomplished using a CGMS for 7 days. Mean Sensor BG: 104.2±5 mg/dL, time&amp;gt;120 mg/dL: 221±61 min/24h, time&amp;lt;63 mg/dL: 93.2±81 min, Fasting BG: 90.7±6 mg/dL, 1h-Postprandial BG: 116.6±11 mg/dL, CV: 18.6±3. Mitigation of polyhydramnios was obtained through tight glycemic control using insulin therapy (mean dosage: 32±10.7 IU). Insulin treatment was adjusted to reach the BG target &amp;lt;95 fasting and &amp;lt;120 mg/dL 1-h postprandial. After a treatment duration of 8-weeks, the AFI in 16 of the cases was reduced to less than the 20cm threshold. The decrease noted in the other 3 cases did not reach a level below the 20cm threshold. Pregnancy outcome; Week of delivery: 37.4±1.5, birth weight: 2990±425 g, Small for Gestational age: 2 cases, Large for Gestational age: 1 case, Caesarean Section: 84.2%, there were no cases of congenital malformations. Increased amniotic fluid maybe an indicator of abnormal BG patterns in IVF pregnancies. CGMS is a useful technology to identify suboptimal BG levels which the OGTT may be unable to detect. Timely insulin treatment targeting tight glycemic control could assist in decreasing amniotic fluid. Aggressive and prompt GDM screening in IVF pregnancies is recommended. Disclosure P. Thomakos: None. C. Baretto: None. C. S. Zoupas: None.

Obstetrical and Neonatal Outcomes of 3,028 Singletons Born After Advanced ART Techniques: Ejaculated Sperm Intracytoplasmic Sperm Injection, Artificial Oocyte Activation, in Vitro Maturation and Testicular Sperm Extraction

Background: To evaluate obstetrical and neonatal outcomes of singletons conceived after advanced assisted reproductive technology (ART) techniques: conventional IVF pregnancies (C-IVF), ejaculated sperm intracytoplasmic sperm injection (ICSI), assisted oocyte activation (AOA), in vitro maturation (IVM), and testicular sperm extraction (TESE). Methods: The subjects were 3,028 singletons who were born after fresh or frozen embryo transfer. The subjects were separated into five groups: C-IVF ([Formula: see text]), ICSI ([Formula: see text]), AOA ([Formula: see text]), IVM ([Formula: see text]), and TESE ([Formula: see text]). We evaluated obstetrical and neonatal outcomes calculating the adjusted odds ratio (AOR) using multivariable logistic regression analyses for fresh and frozen embryos and for cleavage and blastocyst transfer. The C-IVF group was used as a background control for the ICSI group. Moreover, the TESE, AOA, and IVM groups were compared to the ICSI group to evaluate the effects of the ICSI procedure itself. Results: The incidence of perinatal complications was significantly lower in the ICSI-fresh group ([Formula: see text], 95% CI: 0.10–0.83, [Formula: see text]). Regarding sex ratio, the IVM was significantly associated with sex ratio imbalance toward female in both fresh and frozen groups ([Formula: see text], 95% CI: 0.10–0.96, [Formula: see text], 95% CI: 0.07–0.98, [Formula: see text]). On the other hand, there were no significant differences in preterm birth rate, low birth weight rate and congenital abnormalities rate between conventional IVF, ICSI, and the other groups. Conclusions: There were no negative effects on obstetrical and neonatal outcomes between conventional IVF and ICSI. Although this was a limited sample size study, advanced ART technologies such as AOA, IVM, and TESE also seem to have a low risk of adverse impact on obstetrical and neonatal outcomes but may have a slight impact on sex ratio.

Pregnancy, delivery, and neonatal outcomes among women with irritable bowel syndrome (IBS) an evaluation of over 9 million deliveries

Objective Evaluate the associations between irritable bowel syndrome (IBS) and pregnancy, delivery, and neonatal outcomes, using a population database cohort. Methods We conducted a retrospective analysis utilizing the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database over 11 years from 2004 to 2014. A delivery cohort was created using ICD-9 codes. ICD-9 code 564.1 was used to extract the cases of IBS. Pregnant women with IBS (study group) were compared to pregnant women without IBS (control). A multivariate logistic regression model was used to adjust for statistically significant variables (p value <.05). Results There were a total of 9,096,788 deliveries during the study period. Of those, 8962 pregnant women were found to have IBS. The prevalence of IBS increased from 47.96 to 172.68 per 100,000 women during the study period. Compared to the control group, women with IBS were more likely to be Caucasian, older, have higher incomes and private insurance plans (p < .0001, in all cases). In addition, they were more likely to be obese, smokers, hypertensive, IVF pregnancies, have multiple gestations, thyroid disorders, chronic interstitial cystitis, fibromyalgia and have psychiatric disorders (p < .0001 in all cases). Women with IBS were more likely to experience pregnancy-induced hypertension (aOR 1.11, 95% CI 1.02–1.21), preeclampsia (aOR 1.23, 95% CI 1.09–1.38), deep venous thrombosis (aOR 2.26, 95% CI 1.12–4.57), and gestational diabetes (aOR 1.1, 95% CI 1.002–1.22) compared to the non-IBS group. Congenital anomalies were encountered in 1.7% of the IBS group compared to 0.4% in the control group (aOR 2.57, 95% CI 2.13–3.09). Conclusion When controlling for confounding effects, IBS is associated with an increased risk for preeclampsia, DVT and increased risk for congenital malformation.

895 Maternal and neonatal outcomes associated with preimplantation genetic testing in IVF twin pregnancies

The impact of preimplantation genetic testing (PGT) on pregnancy outcomes with twin gestations is not well known. The objective of this study was to determine whether PGT is associated with adverse maternal and neonatal outcomes in twin pregnancies conceived using vitro fertilization (IVF). Retrospective cohort of multiple gestations conceived via IVF and delivered within a university health system between January 2014 and August 2019. Higher-order multiple gestations (triplet or higher) and cases with missing outcome data were excluded. Adverse maternal outcomes, i.e. hypertensive disorders of pregnancy, abnormal placentation, preterm birth, and adverse neonatal outcomes were compared between twin pregnancies conceived after transfer of one or two PGT screened euploid embryos versus untested embryos. Statistical analysis included use of Chi-square and Wilcoxon rank sum tests, as well as multivariate backwards-stepwise logistic regression, with significance defined as P value < 0.05. Data was presented as adjusted Odds Ratios (OR) with 95% confidence intervals (95% CI). Of 145 twin pregnancies, 43 (29.7%) were conceived following euploid embryo transfer and 102 (70.3%) were conceived following untested embryo transfer. Women who underwent PGT had a significantly lower mean body mass index compared to those that did not (Table 1). Use of donor egg and IVF cycle type (fresh vs. frozen) also differed between the two groups (Table 1). After adjusting for potential confounders, there was no significant difference between the two groups with respect to adverse maternal outcomes or in adverse neonatal outcomes (Table 2). Our data suggest no increase in adverse maternal or neonatal outcomes associated with PGT in twin IVF pregnancies. While our findings are reassuring, future studies utilizing larger cohorts of twin pregnancies are needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Non-invasive Prenatal Test - A Pilot Pan-India Experience of an Indian Laboratory

Background: Serum-based tests are considered to be a very affordable screening option for pregnant women. The non-invasive prenatal test (NIPT), among prenatal screening for chromosomal aneuploidies has a sensitivity of >99%. The focus of this report is to present an overview of NIPT outcome from samples tested in our national laboratory over a period of six months. Materials and Methods: NIPT was done by whole genome shot gun sequencing and a total of 513 pregnant women were tested in our laboratory. The samples were analyzed for reporting on risk of trisomy 21, 18 and 13 as well as sex chromosome aneuploidies. Results: A total of 513 blood samples were received for NIPT testing and 9.3% were cancelled at the pre-analytical stage. Frequency of routine and IVF pregnancies was detected to be 83% and 12% respectively. Frequency of high risk including trisomy 21, trisomy 18 and sex chromosome aneuploidies was detected to be at 3.0% respectively. A total of 7% of cases which were reported high risk by serum screening were detected to be low risk by NIPT. Conclusion: NIPT is an efficient aneuploidy screening tool as it studies fetal DNA and our analysis indicates that the same can be beneficial in screening for fetal chromosomal risk with high sensitivity to identify cases which need confirmatory tests.