Pregnancy outcomes in very advanced maternal age pregnancy

Pregnancy outcomes in very advanced maternal age pregnancy

ART - CLINICAL P-472 Wednesday, October 24, 2012 DO SMOKERS WITH NORMAL OVARIAN RESERVE HAVE ADVERSE IVF OUTCOMES? DATA FROM THE FASTT AND FORT-T TRI...

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ART - CLINICAL

P-472 Wednesday, October 24, 2012 DO SMOKERS WITH NORMAL OVARIAN RESERVE HAVE ADVERSE IVF OUTCOMES? DATA FROM THE FASTT AND FORT-T TRIALS. E. H. Goldstein, M. B. Goldman, J. L. Fung, R. H. Reindollar. Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH. OBJECTIVE: Active smoking has been associated with decreased fecundity, longer time to conception, early menopause and lower IVF pregnancy rates. Smokers have a higher prevalence of abnormal clomiphene challenge tests and require higher doses of gonadotropins. This study was designed to determine whether smoking or exposure to second-hand tobacco smoke (STS), in women with normal ovarian reserve (CD 3 FSH < 15 mIU/ml and estradiol < 100 pg/ml) is associated with lower pregnancy rates and IVF cycle parameters. DESIGN: Data from FASTT (ages 21-39, n¼503 couples) and FORT-T (ages 38-42, n¼154 couples) randomized clinical trials. MATERIALS AND METHODS: Current, past, or never smoking, and STS exposure were taken from study questionnaires. Smoking status and STS exposure were examined in relation to: 1) day 3 FSH and estradiol; 2) IVF parameters (gonadotropin dose, peak estradiol, total number of oocytes, mature oocytes, 2pn and ‘‘high quality’’ embryos, and number transferred and frozen); and 3) clinical and live birth pregnancy rates. For categorical variables, Fisher’s exact test, and for continuous variables, Student’s t-, analysis of variance, Mann-Whitney U, and Kruskal-Wallis tests were used. RESULTS: 28.3% of women reported positive cigarette smoking (>100 cigarettes per lifetime). 19.7% were current smokers. 16.2% were exposed to STS. Ever smokers differed from never smokers by being more likely Caucasian (94.5% vs. 84%, P¼0.0002) and less likely nulligravid (47% vs. 59.9%, P¼0.0036). Among groups, baseline FSH was not, but day 3 estradiol was significantly different (P¼0.04). Live birth rates were not significantly different (56.3% vs. 61.2%) for ever vs. never smokers or any subcategory. Significant differences were not observed for clinical pregnancy rates or any of the other markers of ovarian reserve. CONCLUSION: Smoking may not have a deleterious effect on IVF outcome parameters if the patient demonstrates normal ovarian reserve by liberal ovarian reserve testing. Supported by: Funded by NIH grants R01 HD038561 and R01 HD044547. P-473 Wednesday, October 24, 2012 PREGNANCY OUTCOMES IN VERYADVANCED MATERNAL AGE PREGNANCY. C. J. Chung, S. Jackson, M. Pisarska, C. Alexander, K. Gregory. Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA; Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA; Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA; Maternal Fetal Medicine, Obstetrix Medical Group, Overland Park, KS. OBJECTIVE: Today there is trend toward delaying childbirth, which may lead to increased risk for adverse birth outcomes. Most research has focused on women R35; however more recently, interest has been directed to the very advanced maternal age (vAMA, R45 years old). As many of these pregnancies are the result of assisted reproductive technology (ART) and there is increasing interest in understanding short and long-term outcomes of ART, our purpose was to determine if ART predisposes to increased adverse outcomes in the vAMA women. DESIGN: Retrospective Cohort Study. MATERIALS AND METHODS: A retrospective cohort study of all women R45 years old delivering at a large institution between 2000-2010. Primary outcome was method of delivery and maternal complications. Secondary outcomes were related to the neonate. Higher order gestations were excluded. Categorical and continuous testing was performed with chi square, Fischer’s exact, and student t’s test respectively. RESULTS: There were 472 vAMA women who delivered during the study period. There were 378 singleton pregnancies (193 spontaneous and 185 IVF). There were 94 twins pregnancies (8 spontaneous and 86 IVF). For singleton gestations, women conceived via IVF were slightly older (45.6 vs 47, P<0.05), more likely to be Caucasian (75.6% vs 88.1%, P<0.002), have a longer hospital stay (3.2 days vs 4.2 days, <0.01), and deliver by Cesarean (49.7% vs 75.1%, P<0.001). IVF singleton pregnancies were more likely to undergo primary elective Cesarean sections (9.4% vs 25.4%, P<0.02). However, there were no differences in fetal outcomes. For twins, there was no difference in the maternal or fetal outcomes evaluated.

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CONCLUSION: These findings suggest that vAMA women with IVF singleton gestations have higher incidence of Cesarean delivery, particularly primary elective cesarean deliveries. Further research is needed to ascertain whether IVF pregnancy, in and of itself, is an independent risk factor for Cesarean delivery.

P-474 Wednesday, October 24, 2012 EFFECTS OF LONG-ACTING GnRH-a COMBINED WITH TRANSVAGINAL ULTRASOUND-GUIDED OVARIAN ENDOMETRIAL CYST ASPIRATION ON THE PREGNANCY OUTCOMES OF IN VITRO FERTILIZATION OF EMBRYO TRANSFER. Y. Guo,a N. Lu,b Y. Sun.c aReproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; bReproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; cReproductive Medical Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China. OBJECTIVE: To obeserve the effects of long-acting gonadotropin-releasing hormone agonist (GnRH-a) combined with transvaginal ultrasoundguided ovarian endometrial cyst aspiration on the pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET) in the infertile patients with ovarian endometrial cyst. DESIGN: The 134 patients with ovarian endometrial cyst who underwent long-acting GnRH-a combined with transvaginal ultrasound-guided cyst aspiration and IVF-ET were served as experimental group. The 102 patients with ovarian endometrial cyst who underwent GnRH-a and IVF-ET were served as control group. MATERIALS AND METHODS: After ART treatment, the cyst size, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), number of ovum pick-up, fertility rate, cleavage rate, high-quality embryo rate, implantation rate, clinical pregnancy rate and abortion rate were compared between the two groups. RESULTS: In experimental group, 138 ovarian endometrial cysts of 134 patients all disappearred after long-acting GnRH-a combined with three times of transvaginal ultrasound-guided ovarian endometrial cyst aspiration. In the 102 patients of control group, of 114 ovarian endometrial cysts, 34 disapearred after GnRH-a, 48 were decreased by 2/3, 19 were decreased by 1/3 and 13 were unchanged. The level of serum FSH on gonadotropin (Gn) initiation day, abortion rate were significantly lower in experimental group than in control group. The level of serum E2 on the day of human chorionic gonadotropin (HCG) administration, the number of ovarian follicles with 14 mm or more, the number of retrieved oocytes, high-quality embryo rate, implantation rate and clinical pregnancy rate were higher in experimental group than in control group (all P<0.05). CONCLUSION: GnRH-a combined with transvaginal ultrasound-guided ovarian endometrial cyst aspiration can obtain better therapeutic effects and pregnancy outcomes in infertile patients with ovarian endometrial cyst who underwent IVF-ET. Supported by: The school scientific research fund.

P-475 Wednesday, October 24, 2012 THE ASSOCIATION OF SOME THROMBOPHILIC GENES MUTATIONS WITH PREGNANCY LOSSES IN MOLDAVIAN WOMEN POPULATION. V. Mosin,a N. Usurelu,a D. Badicean,a S. Garaeva,b N. Sorici,a V. Sacara.a aNational Center of Reproductive Health and Medical Genetics, Chisinau, Republic of Moldova; bInstitute of Physiology and Sanocreatology of Academy of Science of Republic of Moldova, Chisinau, Republic of Moldova. OBJECTIVE: The aim was to evaluate the role of thrombophilic and folate metabolizing genes in the etiology of RPL(recurrent pregnancy losses) and SA(spontaneous abortion) after IVF. DESIGN: The frequency of studied polymorphisms and their association with RPL and SA after IVF were appreciated in a case control study. MATERIALS AND METHODS: A group of 84 women with RPL and SA after IVF(lot I) and a control group of 46 women with at least 2 normal gestations and no history of abortion (lot II) were selected. The 6 main thrombophilic and folate metabolizing genes mutations (FV G1691A (Leiden mutation), FII G20210A, MTHFR C677T, MTHFR A1298C, MTRR A66G, MTR A2756G) were identified by specific PCR-RFLP analysis. The women from lot I were also investigated for the blood and urine amino

Vol. 98, No. 3, Supplement, September 2012