Society For Assisted Reproductive Technology Research Articles

Live Birth After Oocyte Donation In Vitro Fertilization Cycles in Women With Endometriosis

Although multiple mechanisms have been proposed to explain the infertility related to endometriosis, there are no conclusive data on the association of endometriosis with endometrial receptivity. The oocyte donation model in assisted reproduction technology (ART) cycles can clarify this issue. To explore the association of a history of endometriosis with ART outcomes in recipients of oocyte donation. In this systematic review and meta-analysis, electronic databases were searched from inception until August 31, 2023, using combinations of relevant keywords. Moreover, we retrieved data from the databases of the Society for Assisted Reproductive Technology (SART) in the US and the Human Fertilization and Embryology Authority (HFEA) in the United Kingdom. Observational studies were included if they investigated the impact of endometriosis on ART outcomes with donor oocytes. Publicly available data related to ART from various sources were gathered, and a retrospective aggregate and nonaggregate analysis using registries of in vitro fertilization cycles with oocyte or embryo donation was conducted. The primary outcome was live birth rate (LBR) following oocyte donor cycles. The effect measures of comparisons between groups are presented as odds ratios (ORs) with a 95% CI. This study analyzed 7212 oocyte donation cycles from 4 studies for the meta-analysis, along with 162 082 cycles from 2 registries (137 182 from SART and 24 900 from HFEA). No significant differences between the groups were observed in the meta-analysis of published data after adjusting for confounding factors (OR, 0.54; 95% CI, 0.19-1.57). A statistically significant lower LBR was identified in women with endometriosis when analyzing the aggregate data from SART and HFEA databases (OR, 0.89; 95% CI, 0.81-0.97). This study found a modest decrease in LBR among women with a history of endometriosis, although only results from the pooled analysis of registry data and not those from the meta-analysis reached statistical significance. These findings suggest that a marginal impairment of uterine receptivity may contribute to infertility mechanisms in women affected by endometriosis.

Utilization of Cryopreserved Oocytes in Patients With Poor Ovarian Response After Planned Oocyte Cryopreservation

Poor ovarian response (POR) to stimulation may impact patients' desire or need to utilize cryopreserved oocytes for family building in the future. These findings, captured by Society for Assisted Reproductive Technology (SART) national data, underscore the need for tailored counseling and further research into the decision-making processes influencing oocyte utilization. To examine the association of ovarian response to stimulation and the number of vitrified oocytes with the likelihood and timing of patients returning for oocyte utilization following planned oocyte cryopreservation (OC). This cohort study used data in the SART Clinical Outcome Reporting System for patients in US fertility clinics and data was used for eligible patients who underwent planned OC from January 2014 through December 2020. Data were analyzed from November 2022 to June 2023. The association between number of oocytes cryopreserved on return rate to utilize cryopreserved oocytes and the time from vitrification to warming. A total of 67 893 autologous oocyte freezing cycles were performed in the US between 2014 and 2020, among 47 363 patients (mean [SD] age, 34.5 [4.7] years). Of these, 6421 (13.5%) were classified as patients with POR, with fewer than 5 oocytes vitrified across all ovarian stimulation cycles. A total of 1203 patients (2.5%) returned for oocyte warming and utilization. The rate of return was significantly higher in the POR group, with 260 (4.0%) returning compared with 943 (2.3%) in the normal responder group (P < .001). This trend was most notable in the age 30 to 34 years (warm cycle, 46 of 275 [16.7%] vs no warm cycle, 982 of 11 743 [8.4%]; P < .001) and age 35 to 39 years groups (warm cycle, 124 of 587 [21.1%] vs no warm cycle, 3433 of 23 012 [14.9%]; P < .001). The time elapsed from vitrification to warming was comparable between patients with POR (mean [SD], 716.1 [156.1] days) and normal responders (803.8 [160.7] days). A multivariate analysis adjusted for age, clinic region in the US, body mass index, and history of endometriosis was conducted to identify factors associated with the utilization of oocytes. The analysis revealed that having fewer than 5 oocytes vitrified was associated with higher odds of utilizing oocytes (OR, 1.52; 95% CI, 1.32-1.76). This cohort study reveals a distinct pattern in the utilization of cryopreserved oocytes among patients undergoing planned OC in the US. Despite the increase in number of patients pursuing OC, there is a notably low rate of return to utilize previously vitrified oocytes; notably, patients with POR are more likely to return, although the time to return is similar to those with normal ovarian response.

Low E-visibility of embryologists on fertility clinic websites: a web-based cross-sectional study.

This study assessed the visibility of embryologists on fertility clinic websites among Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member clinics. During a 1-month interval (March 2022), all Society for Assisted Reproductive Technology (SART) and the Human Fertilisation and Embryology Authority (HFEA) member fertility clinic websites were evaluated. The professional representation of the primary care team was examined including specialties, the presence of headshots, and biographies. A total of 446 fertility clinic websites were scanned in the search. The embryology team has the least common professional identification by their names (53.58%) compared to gynecology clinicians (96.21%, p < 0.001) and nurses (55.58%, p < 0.001). This trend also applies to other types of professional identifiers, such as headshots and biographies. Professional headshots of embryologists (50.34%) were less prominent than those of gynecology clinicians (93.51%, p < 0.001). A similar trend was observed in the biographies of the embryology team (47.20%) compared to gynecology clinicians (95.08%, p < 0.001). The present study revealed that embryologists have low professional visibility on fertility clinic websites. Fertility clinics may prioritize enhancing the online visibility of their embryology laboratory team. This approach could potentially enhance the recognition of their team, foster transparency, and provide accessible information about the skills and expertise of healthcare professionals involved in the treatment process.

Validation of prognosis-based in vitro fertilization grant selection criteria

To validate a prognosis-based scoring system for invitro fertilization (IVF) grant allocation. Retrospective cohort study. A 501(c)(3) nonprofit foundation that awards donated IVF cycles and grants to those with demonstrated financial need. In contrast to lottery-based or subjective allocation systems, applications are scored according to medical prognostic criteria in addition to personal characteristics. Grant recipients from 2015 to2019. None. Live birth rate (LBR) and cumulative LBR (CLBR) among grant recipients were compared with 2019 Society for Assisted Reproductive Technology (SART) national averages. A total of 435 applications were reviewed, with 59 grants awarded for 51 autologous IVF cycles, 6 donor oocyte cycles, and 2 gestational carrier cycles, resulting in 39 live births after initial embryo transfer (LBR 61.9%) and 43 CLBRs (CLBR 72.9%). Among autologous cycles, the mean (±SD=3.9 years) age was 31.8 years, and LBR and CLBR were 62.8% and 68.6% vs. 28.2% and 37.1% among all autologous SART cycles, respectively. A subanalysis of grant recipients aged <35 years (n=39) revealed LBR and CLBR of 66.7% and 74.4% vs. 40.7% and 47.8% among autologous SART cycles aged <35 years, respectively. A scoring system incorporating medical criteria identified IVF grant applicants with a high likelihood of achieving a LB. Although most IVF grant programs select recipients through a lottery or personal characteristics, a prognosis-based scoring system should be considered to maximize LBR in a limited resource setting.

REI clinics and fellowship training-a national snapshot to improve access to reproductive care.

To analyze the geographic distribution of REI fellowships and clinics across the USA and to strategize ways to improve patient access to care. Cross-sectional study using population data obtained from publicly available United States Census Bureau, Society for Assisted Reproductive Technology (SART), and National Resident Matching Program websites. Outcomes include the number of REI clinics, REI fellowship-trained physicians, and REI fellowship programs. In 2020, there were 643 assisted reproductive technology (ART) clinics reporting to SART and 1351 fellowship-trained REI physicians. Most clinics are located in the south (n = 209); however, the northeast has the highest density of REI clinics. Out of 301,316 in vitro fertilization (IVF) cycles in the USA in 2020, northeastern states initiated the most cycles (n = 93,565), and Midwestern states initiated the fewest cycles (n = 50,000). The northeast has the most REI physicians per million women aged 20-44 years (42.4) while the Midwest has the lowest ratio (19.5). There are fewer REI physicians per million women aged 20-44 years in states with a lower proportion of patients with health insurance (r = 0.56, 95% confidence interval ([CI] 0.34-0.73) and in states with a lower average income per resident (r = 0.65, 95% CI 0.46-0.79). Most of the 49 accredited REI fellowship programs in the USA are in the northeast (n = 18), and there are fewest in the south (n = 10) and west (n = 10). Access to REI care has large geographic disparities from a clinic, physician, and training program perspective. Creative solutions are needed to remedy this problem.

O-240 Does embryo categorisation by existing artificial intelligence, morphokinetic, or morphological embryo selection models correlate with blastocyst euploidy rates?

Abstract Study question Does embryo categorization by existing artificial intelligence, morphokinetic, or morphological embryo selection models correlate with blastocyst euploidy? Summary answer Our results show that existing blastocyst scoring models correlate with ploidy status. What is known already A previous study suggested that morphokinetic parameters should not be used yet as a surrogate for PGT-A to determine embryo ploidy in vitro. As for predicting pregnancy likelihood, AI models have been proposed for predicting ploidy status. Discrimination performance in terms of AUC has been reported of up to 0.80 when including metadata such as maternal age, and 0.63 when AI predictions were made based on time-lapse images alone. However, as the studies only looked at models trained for ploidy prediction, it is unclear how existing blastocyst scoring systems would perform at discriminating euploids and aneuploids. Study design, size, duration A total of 834 patients, 3,573 blastocysts were retrospectively analyzed. The cycles were stratified into five maternal age groups according to the Society for Assisted Reproductive Technology (SART) age groups (&amp;lt; 35, 35–37, 38–40, 41–42, and &amp;gt;42 years). The quality and scoring of embryos were assessed by iDAScore v1.0 (iDA, Vitrolife, Sweden), KIDScoreTM D5 v3 (KS; Vitrolife), and Gardner grading (GG). Participants/materials, setting, methods Embryos were cultured in the EmbryoScope+ and EmbryoScopeFlex (Vitrolife). iDA was automatically calculated using the iDAScore model running on the EmbryoViewer (Vitrolife). KS was calculated in EmbryoViewer after annotation of the required parameters. ICM and TE were annotated according to the Gardner grading. The degree of expansion in all blastocysts was Grade 4 due to our freezing policy. Furthermore, Gardner's scores were stratified into four grades (A: AA, B: AB BA, C: BB, D: others). Main results and the role of chance At first, the correlation between all assessment methods and euploid rates were analyzed using a trend-test. Euploidy rates significantly correlated with iDA in each age group (p = 0.035 for age &amp;lt;35 years, p &amp;lt; 0.001 for all other age groups) and decreased progressively with increasing maternal age in each score group. Furthermore, euploidy rates were significantly correlated with KS (P &amp;lt; 0.0001), except in the youngest age group (p = 0.07). They decreased progressively with increasing maternal age in each score group. Similarly, euploidy rates were significantly correlated with GG (P &amp;lt; 0.0001), except in the youngest age group (p = 0.06). They decreased progressively with increasing maternal age in each score group. Secondly, the performance of the euploidy prediction for each embryo scoring model was compared using the area under the curve (AUC) of the receiver operating characteristic curve. The AUCs for euploid prediction of iDA, KS, and GG for all ages were 0.666, 0.655, and 0.642, respectively. iDA and KS were significantly higher than Gardner grading (iDA vs. GG: p = 0.004; KS vs. GG: p = 0.02). Additionally, there was no significant difference between iDA and KS. Limitations, reasons for caution It was based on minimal stimulation and the use of natural cycle for IVF treatment, which involved only insemination by ICSI. Furthermore, the blastocyst assessment models that we tested were initially developed for pregnancy prediction and not for the prediction of the chromosomal status of an embryo. Wider implications of the findings Existing blastocyst assessment models that reflect blastocyst viability in view of implantation potential to some extent correspond with ploidy status. Therefore, existing blastocyst scoring models can be used to support the decision for embryo biopsy and/or to reduce the patient’s cost by deciding on which embryo(s) to biopsy. Trial registration number not applicable

MP48-15 ARE UROLOGISTS UNDERREPRESENTED ON FERTILITY CLINIC WEBSITES? A WEB-BASED ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP48-15 ARE UROLOGISTS UNDERREPRESENTED ON FERTILITY CLINIC WEBSITES? A WEB-BASED ANALYSIS Bassel Bachir, Lina El Taha, and Fadi Choucair Bassel BachirBassel Bachir More articles by this author , Lina El TahaLina El Taha More articles by this author , and Fadi ChoucairFadi Choucair More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infertile couples invariably use the internet to seek different fertility clinics and explore their fertility options. Online information about healthcare providers has made self-referral popular among patients. As there is almost an equal distribution of male and female factor infertility, this information is vital for both partners. To this end, the objective of this study was to identify the visibility of male infertility specialists (urologists) on fertility clinic websites, as compared to other team members. METHODS: Information was retrieved from two publicly available online registries. The Society for Assisted Reproductive Technology (SART) in the United States and the Human Fertilization and Embryology Authority (HFEA) in the United Kingdom. We examined all available websites, looking especially at the online representations of the different team members. RESULTS: A total of 447 clinic websites were analyzed. Out of those websites, only 36 (8%) included the profiles of male infertility specialists (urologists). In contrast, the overwhelming majority of websites, 429 (96%) included the profiles of female infertility specialists (Reproductive Endocrinology and Infertility specialists). Male infertility specialists were also grossly underrepresented compared to other clinic staff members including nurses, 249 (55.7%, p<0.0001), embryology lab directors, 208 (46.5%, p<0.0001), administrative staff, 177 (39.6%, p<0.0001) and embryologists ,133 (29.7%, p<0.0001). CONCLUSIONS: Urologists specialized in male infertility are profoundly underrepresented on fertility clinic websites, despite the fact that male factor infertility accounts for almost half of all infertility cases. Addressing this shortcoming can help fertility clinics attract more patients through a higher visibility of all care team members involved. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e661 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bassel Bachir More articles by this author Lina El Taha More articles by this author Fadi Choucair More articles by this author Expand All Advertisement PDF downloadLoading ...

Recurrence risk and risk factors for monozygotic twin and triplet birth in over 65,000 single-embryo transfers.

To determine the recurrence risk and risk factors for monozygotic splitting after elective single-embryo transfers (eSET). A retrospective cohort study was performed investigating 65,664 eSET cycles that resulted in a clinical pregnancy as reported in the Society for Assisted Reproductive Technology (SART) Clinical Outcomes Reporting System (CORS) between 2004 and 2017. Monozygosity was defined as more than one fetal heart tone by the first-trimester ultrasound and concordant sex at live birth. The primary outcome was recurrence risk, with recurrence defined as one patient having two or more cycles of eSET resulting in monozygotic multiples. The secondary objective was to identify factors associated with smonozygotic splitting, using a multivariable logistic regression model and a stepwise purposeful model selection. There were 1355 (2.05%) pregnancies that resulted in two or more fetal heart tones after SET, including 840 monozygotic twins and triplets at birth. Recurrence occurred in two cases-0.0001% of patients with multiple eSET cycles. One case resulted from embryos created from a single cohort with intracytoplasmic sperm injection (ICSI), assisted hatching (AH), and blastocyst transfers. The second case resulted from donor egg embryos with ICSI and blastocyst transfers. Risk factors associated with monozygotic live birth were blastocyst transfer (OR 1.23, 95% CI 1.04-1.47, P = 0.0176) and AH (OR 1.23, 95% CI 1.05-1.44, P = 0.0081). Recurrence of monozygotic live births in eSET was very rare. Blastocyst transfer and AH were confirmed to be risk factors for monozygotic live births, while ICSI, PGT, and FET do not appear to be associated.

Live-Birth Outcomes Among Women With Infertility and Anti-Müllerian Hormone Levels of 0.3 ng/mL or Lower.

To estimate the live-birth rate per in vitro fertilization (IVF) cycle and after cumulative infertility treatment among patients with anti-müllerian hormone (AMH) levels of 0.3 ng/mL or lower. We conducted a retrospective cohort study at a single academic center of patients with infertility and AMH levels of 0.3 ng/mL or lower who initiated one or more IVF cycles (2013-2019). Exclusion criteria included prior chemotherapy, hormonal contraceptive use within 3 months of AMH level measurement, and severe male factor infertility. Patients were stratified by Society for Assisted Reproductive Technology (SART) age group. The primary outcome was live-birth rate per IVF cycle. Live-birth outcomes were compared with the 2018 SART National Summary Report for live births per single intended oocyte retrieval, with proportion difference (PD) and 95% CI reported. A total of 978 patients were included. The median (interquartile range) number of cycles initiated was 2 (1-3). With the first initiated cycle, the live-birth rate for those with AMH levels of 0.3 ng/mL or lower was significantly lower in each age category compared with the SART live-birth rate per single initiated cycle (younger than 35 years: 26.2% vs 55.6%, PD 29.4%, 95% CI 20.9-37.9%; 35-37 years: 15.9% vs 40.8%, PD 24.9%, 95% CI 19.0-30.9%; 38-40 years: 12.6% vs 26.8%, PD 14.3%, 95% CI 10.2-18.3%; 41-42 years: 4.7% vs 13.4%, PD 8.7%, 95% CI 5.9-11.6%; older than 42 years: 1.2% vs 4.1%, PD 2.9%, 95% CI 1.5-4.3%). In patients aged 35-37, 38-40, 41-42, and older than 42 years, the cumulative live-birth rate after up to three initiated cycles was comparable with the SART live-birth rate per single initiated cycle but remained significantly lower in patients younger than age 35 years (PD 16.8%, 95% CI 7.3-26.2%). After all treatments were included (cumulative IVF, ovulation induction, and unassisted cycles), live-birth rates were similar to SART live-birth rates per single initiated cycle in all age groups. Compared with national outcomes, patients with AMH levels of 0.3 ng/mL or lower had a significantly lower chance of live birth after their first initiated cycle. However, the cumulative live-birth rate after up to three initiated cycles was comparable with national live-birth outcomes per single initiated cycle in patients aged 35 years or older. In patients younger than age 35 years, only when all IVF and non-IVF treatment cycles were included did the cumulative live-birth rate become comparable with the national rate per single IVF cycle.

Anti-Müllerian Hormone and Follicle-Stimulating Hormone Are Poor Independent Predictors of Live Birth After Assisted Reproductive Technology.

To query if anti-Müllerian hormone (AMH) and/or follicle-stimulating hormone (FSH) predict live birth at the University of Colorado Advanced Reproductive Medicine (CU ARM). This was a retrospective analysis using the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System database at CU ARM from 2017 to 2019 to identify the pregnancy outcomes of the initial fresh or frozen embryo transfer (FET) and their corresponding AMH and FSH. Fisher's exact tests were used to identify differences in pregnancy outcome by age group, and area under the receiver operator characteristic curves was used to quantify live birth prediction. A total of 1083 records from 557 patients were reviewed. After only including the first autologous transfer, 270 cycles were analyzed. Overall live birth (L/B) rate was 58.15% (157/270), which declined with increasing age group (p ≤ 0.01). Although AMH significantly decreased with increasing age (p < 0.001), it was not associated with pregnancy outcome (3.54ng/mL vs. 3.41ng/mL, p = 0.56); this relationship was unchanged after controlling for age in logistic regression models (p = 0.52). FSH was also not significantly related to pregnancy outcome (7.00IU/L vs 6.00IU/L, p = 0.15), and this relationship did not change after controlling for age (p = 0.61). Using AUC, the only variable predictive of live birth was age (p = 0.002). AMH and FSH are not associated with the probability of live birth. Only age was significantly associated with live birth in this series. AMH and FSH should therefore be used cautiously when counseling patients about ART outcomes.

GONADOTROPIN UTILIZATION DATA CAN BE USED AS AN INDICATOR OF US ASSISTED REPRODUCTIVE TECHNOLOGY (ART) MARKET DYNAMICS

National summaries produced by the Centers for Disease Control (CDC) and Society for Assisted Reproductive Technology (SART) are instructive in highlighting ART use trends but lag the market by 2-years. Here we explore gonadotropin utilization metrics as a surrogate and more proximate marker to assess US ART utilization. Resultant forecasts may be valuable for anticipating demand and better ensuring availability of resources.

O-175 Failed thaw cycles (FThC) as a key performance indicator (KPI): accounting for patient diagnosis and preimplantation genetic testing (PGT)

Abstract Study question Does the presence of a specific infertility diagnosis, in addition to PGT, impact FThC and live birth rate (LBR)? Summary answer Infertility diagnoses (Dx) and PGT should be taken into consideration when developing and/or evaluating FThC KPIs. What is known already FThC (ie, percentage of thaw procedures that failed to produce any embryos suitable for transfer) has been suggested as a KPI for laboratory competency in freezing/thawing procedures. Previous analyses showed that PGT (including testing for aneuploidy, monogenic/single gene defects, and structural chromosome rearrangements) was associated with improved proportions of FThC and LBRs. Here, we examined whether the presence of specific Dx could further impact the extent of improvement related to PGT on FThC and LBR. Study design, size, duration Retrospective real-world data analyses were performed using 6 years of available data from the Society for Assisted Reproductive Technology (SART) United States Registry between 2014–2019. Data analyses, including a descriptive review, focused on the following 5 Dx: diminished ovarian reserve (DOR), endometriosis (E), ovulatory dysfunction (OD), male factor (MF), and unknown factor (UF). These Dx were chosen based on the high prevalence of thaw cycles and/or historical difficulty to treat. Participants/materials, setting, methods A total of 9393 thaw cycles were analyzed, including the first transfer ≥12 months after retrieval, second transfer, or later transfers, given the database output limitation (fresh and frozen transfers taking place &amp;lt;12 months combined). Fisher’s Chi Square was used to identify differences between PGT use over time, as well as FThC stratified by age and PGT status. Linear regression was used to determine test of trend over time for LBRs. Main results and the role of chance FThC improved for all Dx from 2014 to 2019, except for OD. PGT use increased significantly from 2014 to 2019 for all Dx (p &amp;lt; 0.0001), with the greatest increase observed for DOR (10.40% vs 40.52%), UF (6.97% vs 36.20%), and MF (4.68% vs 28.67%). With PGT, across Dx, only DOR showed significant difference in the proportion of FThC from 2014 to 2019 (4.37% to 0.39%; p &amp;lt; 0.0001), compared with data without PGT (1.77% to 1.60%; p = 0.8043). Patients with DOR had the highest average proportion of FThC (all years: PGT, 0.98%; non-PGT, 1.69%). Patients with UF had the lowest average proportion of FThC with PGT, followed by those with E and MF; however, over time, the proportion of FThC for these three Dx significantly changed without PGT (2014 vs 2019): UF, 1.17% vs 0.55% (p = 0.0008); E, 1.82% vs 0.55% (p = 0.0108); MF, 1.56% vs 0.64% (p &amp;lt; 0.0001). Interestingly, OD showed no significant difference over time regardless of PGT status. LBRs for all Dx improved over time (p &amp;lt; 0.0001), with higher LBR observed with versus without PGT (DOR, 47.13% vs 30.19%; E, 49.83% vs 40.84%; MF, 51.74 vs 43.74%; UF, 47.88% vs 41.13%; OD, 42.77% vs 39.42%). Consistent with FThC, OD showed the smallest improvement in LBR. Limitations, reasons for caution Lower numbers of FThC with PGT may limit interpretability. Presence of specific Dx in this dataset did not exclude other Dx. Clinics should review internal data to develop FThC KPI values. In the absence of internal data, SART data could be used as a reference, considering patient/cycle factors and confounders. Wider implications of the findings This is the first study evaluating the impact of specific Dxs and PGT on FThC. FThC as a KPI can guide embryo thawing performance goals and help set clinicians and patients’ expectations regarding the percentage of FThC along with a specific Dx and PGT status. Trial registration number Not applicable

Telehealth provider experience in reproductive endocrinology and infertility clinics during the COVID-19 pandemic and beyond

PurposeTo assess telehealth services offered by reproductive endocrinology and infertility specialists and to gauge provider experiences with incorporating telehealth into their practices.MethodsA 16-question web-based survey on use of telehealth was distributed to Society for Assisted Reproductive Technology (SART) clinics and to Society for Reproductive Endocrinology and Infertility (SREI) members. Clinic demographic data, telehealth descriptive data, and provider satisfaction with use of telehealth were assessed. Results were collected via Survey Monkey.ResultsA total of 1160 individuals (330 SART clinic contacts and 830 SREI members) were reached via email with an 18.6% (216) survey response rate. All respondents indicated that they offer telehealth visits. Several telehealth platforms were used, with Zoom (62.7%) and telehealth through the clinic’s electronic medical record platform (34.8%) being the most common. The majority of participants (87.0%) anticipate they will offer telehealth visits after the COVID-19 pandemic. Roughly two-thirds (64.4%) of respondents anticipate fewer telehealth visits after the pandemic because of logistics, cost, and patient/provider preference. Nearly all providers are either “very satisfied” (66.2%) or “somewhat satisfied” (31.0%) with telehealth overall.ConclusionTelehealth enabled safe patient-provider interactions throughout the COVID-19 pandemic. While only one-third of survey respondents offered telehealth services before the pandemic, nearly all providers express satisfaction with telehealth and anticipate they will offer telehealth services henceforth.

Predicting personalized cumulative live birth following in vitro fertilization

To develop invitro fertilization (IVF) prediction models to estimate the individualized chance of cumulative live birth at two time points: pretreatment (i.e., before starting the first complete cycle of IVF) and posttreatment (i.e., before starting the second complete cycle of IVF in those couples whose first complete cycle was unsuccessful). Population-based cohort study. National data from the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System. Based on 88,614 women who commenced IVF treatment using their own eggs and partner's sperm in SART member clinics. Not applicable. The pretreatment model estimated the cumulative chance of a live birth over a maximum of three complete cycles of IVF, whereas the posttreatment model did so over the second and third complete cycles. One complete cycle included all fresh and frozen embryo transfers resulting from one episode of ovarian stimulation. We considered the first live birth episode, including singletons and multiple births. Pretreatment predictors included woman's age (35 years vs. 25 years, adjusted odds ratio 0.69, 95% confidence interval 0.66-0.73) and body mass index (35 kg/m2 vs. 25 kg/m2, adjusted odds ratio 0.75, 95% confidence interval 0.72-0.78). The posttreatment model additionally included the number of eggs from the first complete cycle (15 vs. 9 eggs, adjusted odds ratio 1.10, 95% confidence interval 1.03-1.18). According to the pretreatment model, a nulliparous woman aged 34 years with a body mass index of 23.3 kg/m2, male partner infertility, and an antimüllerian hormone level of 3 ng/mL has a 61.7% chance of having a live birth over her first complete cycle of IVF (and a cumulative chance over three complete cycles of 88.8%). If a live birth is not achieved, according to the posttreatment model, her chance of having a live birth over the second complete cycle 1 year later (age 35 years, number of eggs 7) is 42.9%. The C-statistic for all models was between 0.71 and 0.73. The focus of previous IVF prediction models based on US data has been cumulative live birth excluding cycles involving frozen embryos. These novel prediction models provide clinically relevant estimates that could help clinicians and couples plan IVF treatment at different points in time.

PREGNANCY OUTCOMES AFTER PGT-A BY RACE: MISCARRIAGE, LOW BIRTHWEIGHT, AND PRETERM BIRTH

To evaluate the associations between race, PGT-A use, and rates of miscarriage, low birthweight, and preterm birth. This was a retrospective cohort study using national Society for Assisted Reproductive Technology (SART) data from 2014-2016. Autologous first embryo transfers in women 18-50 years-old were included. Embryo transfer type was categorized as PGT-A tested, fresh untested, and thawed untested. Only cycles resulting in singleton gestations were included for analyses on preterm birth and low birthweight. Low birthweight was defined as <2,500 grams. Age groups were defined as: 18-34, 35-37, 38-40, 41-50 yrs. Of the 110,843 first embryo transfers, 64,331 (58%) resulted in a clinical pregnancy and 53,880 (49%) resulted in a live birth of at least one infant. Miscarriage rate was significantly lower from cycles using PGT-A (13.5%) compared to both fresh (14.7%) and frozen (17.1%) untested embryos (p<0.0001). African American women had the highest miscarriage rates regardless of PGT-A use. Whereas white women had a 13.5% rate of miscarriage after PGT-A, African American women had a 22.4% rate (p<0.0001). Hispanic women had a slightly higher rate of miscarriage (16.9%), but this difference was not statistically significant. Among all cycles, miscarriage rates increased with increasing age, but this was less pronounced with PGT-A use. In multivariate regression for PGT-A cycles, only the oldest age group (41-50) had a statistically significant increased risk of miscarriage compared to the youngest group (OR 1.25; 95% CI 1.06-1.48, p=0.009). African American women had 80% greater odds of miscarriage (OR 1.80; 95% CI 1.34-2.42, p=0.0001) than white women. Among 42,811 singleton live births, preterm birth was lower for cycles after PGT-A (16.6%) than for either fresh (18.3%) or frozen (17.4%) untested embryo transfers (p=0.01). Among women using PGT-A, African American women had the highest rate of preterm birth (24%), followed by Hispanic women (23%). Cycles after PGT-A use were less likely to have a low birthweight infant (6.6%) than either fresh (9.8%) or frozen (7.8%) untested cycles (p<0.001). Among cycles after PGT-A use, African American women had the highest rate of low birthweight infants (13%), over twice that of white women (5.9%) (p<0.001). PGT-A use is associated with reduced rates of miscarriage, preterm birth, and low birthweight infants. However, African American women using this technology still had significantly higher rates of these pregnancy outcomes. Limitations of this study include the fact that approximately 40% of women had unknown race; it is unknown what proportion of prematurity was iatrogenic; and that medical comorbidities predisposing to prematurity and low birthweight are unknown.

THE AGE AND BY WHOM A DONOR-CONCEIVED PERSON RECEIVES INFORMATION SIGNIFICANTLY EFFECTS THEIR EXPERIENCE

The Society for Assisted Reproductive Technology (SART) recommends that the impact in children following gamete donation should be a top priority for future infertility research. We sought to identify factors that influence the experience of being a donor-conceived person (DCP). A survey was disseminated to adult DCP through the Donor Sibling Registry (DSR). The survey included questions about donor type, relationship with the donor and half-siblings and their overall satisfaction with being a DCP. Appropriate bivariate statistics were used to compare characteristics of those with a positive/neutral vs. negative DCP experience. 529 people completed the survey. Most felt “neutral” (31.6%), “positive” (26.3%) or “very positive” (20.8%) about being a DCP regardless of donor type (p=0.39). Those with a neutral/positive experience were less likely to have a college degree (66.2% vs 80.5%, p=0.003), be married (33.9% vs 53.1%, p<0.001) and have children (29.8% vs 44.2%, p=0.004). While most found out about being a DCP after age 18 (63.4%), those with a positive experience were more likely to “have always known” (40.7% vs. 21.2%, p<0.001) and be told by a family member (75.2% vs. 60.2%, p=0.004). Those with a positive experience were not more likely to consider the donor a relative (46.4% vs 37.0%, p=0.39) or have an ongoing relationship with one or more half-siblings from the same donor (24.5% vs 24.1%, p=0.94). Additionally, there was no difference in the current self-reported satisfaction with the donor relationship (77.0 vs. 64.5, p=0.09). However, a negative experience being a DCP was associated with having medical complications due to lack of a complete health history (30.0% vs. 64.6%, p<0.001). DCP are more likely to have positive feelings surrounding their conception if they are told at a young age by a family member and have regularly updated and accessible medical information.

TELEHEALTH PROVIDER EXPERIENCE IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY CLINICS DURING THE COVID-19 PANDEMIC AND BEYOND

To assess Telehealth services offered by Society for Assisted Reproductive Technology (SART) member clinics and provider experiences with incorporating Telehealth into reproductive endocrinology and infertility practices.

The role of preimplantation genetic testing for aneuploidy in a good prognosis IVF population across different age groups

ABSTRACT Preimplantation genetic testing for aneuploidy is associated with increased pregnancy success and reduced miscarriage in women 35 years and older when embryos are available for transfer. In this retrospective cohort study our objective was to evaluate if this holds true in good prognosis patients and across all age groups. Data were obtained from the Society for Assisted Reproductive Technology between 2014–2015. We included only the first single frozen embryo transfer where indication for corresponding ‘stimulation/freeze-all cycle’ was for reducing risk of ovarian hyperstimulation syndrome and performance of PGT-A for selecting euploid embryos. Our main outcomes were live birth and miscarriage rates. Among <35 age group, no difference in LBR was observed between cycles who underwent single embryo FET using non-PGT-A tested vs. tested embryos (51.7% vs. 50.9%, aOR 1.03, 95% CI 0.87–1.21). Additionally, the miscarriage rates (8.7% vs. 8.8%, aOR 0.97, 95% CI 0.72–1.30) were not different. Among 35–37 years old, no difference was observed between non-PGT-A tested and tested groups in LBR (50.4% vs. 54.7%, aOR 1.26, 95% CI 0.96–1.67) or miscarriage rates (8.3% vs. 10%; aOR 1.11, 95% CI 0.68–1.82). Similarly, among > 37 year old, no difference was observed between non-PGT-A tested and tested groups in LBR (48.1% vs. 53.2%, aOR 1.27, 95% CI 0.8–2.02) and miscarriage rates (6.2% vs. 8.5%, aOR1.34, 95% CI 0.52–3.43). To conclude, PGT-A tested embryos did not improve LBR and miscarriage rates in a good prognosis IVF population across all age groups. Abbreviations: PGT-A: preimplantation genetic testing for aneuploidy; FET: frozen embryo transfer; LBR: live birth rate; OHSS: ovarian hyperstimulation syndrome; SART: society for assisted reproductive technology

Comparing prediction of ongoing pregnancy and live birth outcomes in patients with advanced and younger maternal age patients using KIDScore\u2122 day 5: a large-cohort retrospective study with single vitrified-warmed blastocyst transfer

BackgroundThe KIDScore™ Day 5 (KS-D5) model, version 3, is a general morphokinetic prediction model (Vitrolife, Sweden) for fetal heartbeat prediction after embryo transfer that was developed based on a large data set that included implantation results from a range of clinics with different patient populations, culture conditions and clinical practices. However, there was no study to comparing their pregnancy and live birth prediction ability among different maternal age. The aim of this study is to analyze the performance of KS-D5 in predicting pregnancy and live birth in various maternal age groups after single vitrified-warmed blastocyst transfer (SVBT).MethodsA total of 2486 single vitrified-warmed blastocyst transfer (SVBT) cycles were analyzed retrospectively. Confirmed fetal heartbeat positive (FHB+) and live birth (LB+) rates were stratified by Society for Assisted Reproductive Technology (SART) maternal age criteria (< 35, 35–37, 38–40, 41–42 and ≥ 43 years of age). Within each age group, the performance of the prediction model was calculated using the AUC, and the results were compared across the age groups.ResultsIn all age groups, the FHB+ rates decreased as the KIDScore decreased (P < 0.05). Conversely, the AUCs increased as the maternal age increased. The AUC of the < 35 age group (0.589) was significantly lower than the AUCs of the 41–42 age group (0.673) and the ≥43 age group (0.737), respectively (P < 0.05). In all age groups, the LB+ rates decreased as the KIDScore decreased (P < 0.05). Conversely, the AUCs increased as the maternal age increased. The AUC of the ≥43 age group (0.768) was significantly higher than the AUCs of other age groups (P < 0.05; < 35 age group = 0.596, 35–37 age group = 0.640, 38–40 age group = 0.646, 41–42 age group = 0.679).ConclusionsIn the present study, we determined that the KIDScore model worked well for prediction of pregnancy and live birth outcomes in advanced age patients.

Society for Assisted Reproductive Technology advertising guidelines: How likely are member clinics to maintain compliance after resolving their violations?

ObjectiveTo evaluate the Society for Assisted Reproductive Technology (SART) member in vitro fertilization centers' compliance with SART’s advertising guidelines after delayed correction of previous violations.DesignRetrospective cohort study.SettingInternet.Patient(s)None.Intervention(s)None.Main Outcome Measure(s)Clinics that were cited for noncompliance with SART advertising guidelines in 2019 and exceeded the two-week grace period in correcting their violations were studied. These clinics were rereviewed in 2020, at least 6 months after their initial citation, for violations of SART advertising guidelines in all six categories: supplemental data noncompliance, link to SART Clinical Summary Report and disclaimer statement missing, unsubstantiated claims, statements denigrating other clinics, and claims of superiority.Result(s)In 2019, 44 (27%) of 161 of clinics reviewed by the SART advertising committee had at least one violation that was eventually resolved but not within the two-week grace period. On rereview in 2020, one clinic had not renewed its SART membership and 10 (23%) of the remaining 43 clinics were noted to have violations at the subsequent review. Improper presentation of supplemental data was the most common violation category in both the initial review, 32 (73%) of 44 clinics, and on rereview, 7 (70%) of 10 clinics cited a second time for violations.Conclusion(s)Of the in vitro fertilization clinics with previous violations with delayed correction in 2019, 77% were subsequently compliant when reevaluated in 2020, indicating that advertising committee disciplinary and educational measures were largely effective. The most common citation for both years was maintaining consistent and transparent supplemental data on their websites.