Faculty Bibliography

Objective: Though the ability of an AMH result to predict ovarian reserve is debated[1], patient interest in their own fertility is growing. Our objective was to understand the social media content surrounding the search term: AMH level.
Material(s) and Method(s): This is a retrospective cohort study of the use of term "AMH level" on Google Trends (GO) and #AMHlevel/ #AMHlevels on Instagram (IG) from 1/1/2019 to 12/31/2021. On IG, all single user posts in the "most recent" search function were included. Posts were characterized by author type (fertility clinic/ FC, influencer, provider, patient/parent), content, and tone (positive, negative, neutral). Likes per post and total account followers were quantified to calculate percent of likes (PL) and assess activity. Chi square and ANOVA was used with p-value < 0.05 considered significant.
Result(s): On IG, the term "#AMHlevel" was mentioned in 196 posts and #AMHlevels in 161 posts. Hashtag use increased over time, with amounts of 59 (16.5%), 121 (33.9%) and 177 (49.6%) respectively by year (Table 1). Mean number of likes, followers and PL was 93.7 +/- 558.3, 2953.3 +/- 12762.1 and 4.7 +/- 6.3 respectively. PL was not associated with author type (p-value=0.487). Positive and negative posts received a higher PL compared to neutral (6.8 v 6.4 v 3.8, p=0.00). Mean PL also varied by content (Celebrity Story 10.0 +/- 16.6, Patient Story 6.2 +/- 6.2, Personal Story 5.6 +/- 5.8, Support 4.5 +/- 3.0, Literature 1.4 +/- 1.4 p-value = 0.012) On GO, "AMH level" was most searched in May - August 2021 and least in April 2019 and 2020. Within the USA, it was most utilized in New York, California, Texas, and Florida in descending order. Overall use has remained consistent over time (m=0.009).
Conclusion(s): Use of #AMHlevel/s on Instagram, especially by FCs, has grown. Activity on influencer and celebrity posts has also grown. Comparatively, searches of "AMH Level" on GO has remained mostly unchanged, possibly showing a shift away from search engines and towards social media for information. Impact Statement: This is the first study to characterize the use of search terms related to AMH levels on social media. As access and attention to AMH levels rises, it is important to understand where patients are receiving their information. [Formula presented] REFERENCES:: 1. Moolhuijsen LM, Visser JA. Anti-Mullerian hormone and ovarian reserve: update on assessing ovarian function. The Journal of Clinical Endocrinology & Metabolism. 2020 Nov 1;105(11):3361-73.
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Objective: Data regarding the chance of more than one LB from oocyte cryopreservation (OC) is lacking. We reviewed outcomes from patients (pts) with >=1 LB from thawed autologous oocytes (AOs) to examine: 1) how many have inventory (AOs or resultant euploid/untested/no result embryos), and 2) embryo transfer (ET) outcomes after 1^st LB.
Material(s) and Method(s): We reviewed all pts who thawed AOs at our center in 2006-2021 and had >=1 resultant LB. Pts were excluded if OC was performed for a medical reason, as research, due to lack of sperm or a natural disaster, with embryo banking or for gestational carrier use.
Result(s): 191 pts had >=1 LB (median # OC cycles 1, median age at 1^st OC 37 years (y), median # cryopreserved AOs 18, median # AOs thawed before 1^st LB 15). After LB, 61% of pts (n=117) had inventory and 39% (n=74) did not; see table. Among pts with inventory, 12% (n=14) discarded or donated, 3% (n=4) transported out and 10% (n=12) consumed all inventory as of 1/2022. 22% of pts with inventory (n=26) had >=1 ET after LB. Among these pts, 21 thawed embryos (median # thawed 1, range 1-2), 4 thawed AOs (median # thawed 11, range 5-40) and 1 thawed both AOs + embryos (15 AOs + 4 embryos). Median time from the ET that led to 1^st LB and next ET was 26 months (range 15-57) and median age at next ET was 44y (range 37-53). This ET resulted in: implantation rate of 63% (19/30), spontaneous abortion rate of 16% (3/19) and ongoing pregnancy (OP) + LB rate of 58% (15/26); 1 pregnancy was terminated for monozygotic twins. Among pts who had a LB from this ET, 66% (10/15) had remaining inventory and 33% (5/15) did not. Among pts who did not have a LB from this ET, 45% (5/11) had remaining inventory and 54% (6/11) did not; 5 of these unsuccessful pts returned for another ET and 2 had a LB. In total, 16 pts had 2 ETs result in OP/LB and 1 pt had 3 ETs result in LB. 10 more pts had >=2 children from a single ET (9 twins, 1 triplet); thus, we report 27 pts with >=2 children from OC. Among pts with >=2 children, median # OC cycles was 1 (range 1-8), median age at 1^st OC was 37y (range 34-41), median # cryopreserved AOs was 20 (range 5-102) and median # thawed AOs was 19 (range 5-58).
Conclusion(s): Most pts (61%) had inventory after their 1^st LB from OC, and most pts (65%) who returned for ET after LB achieved another OP/LB. Further research must explore pts' thoughts regarding OC inventory after LB and its associated storage fees. Impact Statement: OC can help pts achieve their ideal family size, even if >1 child. [Formula presented] Support: None.
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Objective: Planned OC is increasing; yet, there is a lack of thaw data to provide an accurate estimate of CLBR.¹ We reviewed our AO thaws to determine CLBR by age and #AOs.
Material(s) and Method(s): We reviewed AO thaws at our academic center from 2004-2021. Inclusion criteria: 1) >=1 live birth (LB)/ongoing pregnancy (OP) >12 weeks, or 2) all AOs + embryos from OC consumed. Exclusion criteria: 1) OC for a medical reason, as research, due to lack of sperm or a natural disaster, combined with embryos or for gestational carrier use, or 2) AOs/embryos from OC transported out before a LB. Primary outcome was CLBR (LB + OP). Patients (pts) were stratified by age and #AOs or metaphase II oocytes (M2s) thawed. If pts had >=1 OC cycle, we calculated a weighted age: [SIGMA (#AOs thawed x age at OC)] / [#AOs thawed]. Statistics included multiple logistic regression (MLR), Fischer's exact test, and chi-squared test (p<0.05 significant).
Result(s): 548 pts (median age at OC 38y, range 28-45y; 151 weighted ages used) underwent 767 OC (location: 90% our center, 9% elsewhere, 2% both; method: 77% vitrification, 4% slow cooling, 19% both), 604 thaw and 465 transfer cycles. 40% (n=218) of pts had >=1 LB/OP, resulting in 221 babies + 30 OPs. See table for CLBRs. In pts of all ages and <38y, CLBR increased as #AO/M2s thawed increased from 0-10 to 11-20 to >20 (p<0.03). In pts 38-39y, CLBR was lower if 0-10 vs. 11-20 or >20 AOs were thawed (p<0.01), but was similar if 11-20 vs. >20 AOs (p=0.34) or M2s (p=0.13) were thawed. In pts >=40y, CLBR did not differ based on #AOs (p=0.81) or M2s thawed (p=0.17). For pts with any # or >20 AO/M2s thawed, CLBR was higher in pts <38y and 38-39y vs. pts >=40y (p<0.04). In a MLR model adjusting for effect of age on #AOs, age and age-independent #AOs were predictive of LB.
Conclusion(s): CLBR increases as more AO/M2s are thawed. OC at <38y has a CLBR of ~50%, a reasonable rate in younger pts at an ideal age for OC. Impact Statement: Pts who freeze >20 AOs at <38y can expect >=70% CLBR based on actual outcomes. This is the largest report to date of AO thaw outcomes from a single U.S. center. [Formula presented] REFERENCES:: 1 Practice Committee of the American Society for Reproductive Medicine. Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline. Fertil Steril. 2021 Jul;116(1):36-47.
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Objective: E2P is a technique for IVF protocols in poor responders to reduce cycle cancelation due to elevated FSH as well as increase stimulation response. Yet data is inconsistent on the impact on clinical pregnancy rates.¹ We sought to evaluate if E2P increases euploidy rates in IVF with PGTA.
Material(s) and Method(s): This is a retrospective cohort study of IVF cycles with PGTA from 3/2020-12/2021 at a single academic fertility center. E2P cycles were compared to age and AMH matched controls (CON) (1:2 ratio). The primary outcome was number of euploid embryos. Secondary outcomes were cycle start follicle stimulation hormone level (FSH), total gonadotrophin (GND) dose, number oocytes, mature oocytes (MII), fertilization rate (2PN), and number of embryos biopsied (BX). Mann Whitney and Chi-square tests were performed (p<0.05 significant). Data is reported in median (range) and percentages.
Result(s): 337 E2P cycles were compared to 674 CON. There were fewer microdose lupron (MCD) cycles in E2P patients (E2P: 88% antagonist (ANT), 12% MCD vs CON: 76% ANT, 24% MCD, p<0.01). Similar cancelation rates [E2P: 14% (47/337) vs CON: 12% (82/674), p=0.42] and poor blast formation (defined as nothing for biopsy) [E2P: 18% (60/337) vs CON: 15% (103/674), p=0.24] were seen between groups. Number of euploid embryos were similar across all SART age groups except for 38-40 years (y), with fewer euploids in E2P (Table). Cycle start FSH was lower and total GND dose was higher for E2P (p<0.05). Other cycle outcomes were not different.
Conclusion(s): E2P is a viable tool for PGTA freeze all cycles, but does not improve euploidy rate; larger studies are necessary to determine if E2P produces fewer euploids in >38y. Impact Statement: E2P cycles require higher GND dose without increased yield in euploid embryos. [Formula presented] Support: None REFERENCES: 1. Orvieto R. Pretreatment: Does it improve quantity or quality? Fertil Steril. 2022 Apr;117(4):657-663. Epub 2022 Mar 5. PMID:.
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Objective: Infertility affects >100 million people worldwide; improving FC access is essential, especially for low socioeconomic and minority groups. In NYC's public hospital system, patients (pts) are referred to a fellow-led reproductive endocrinology and infertility (REI) clinic that provides consults, work-ups and ultrasound-monitored controlled ovarian hyperstimulation and ovulation induction (OI). REI referrals (REF) are in high demand limiting appointment (appt) availability¹ with new pts waiting >5 months. We developed a QIP to identify pts for OI counseling and initiation in GYN clinic.
Material(s) and Method(s): REI fellows screened all REFs, and scheduled eligible pts in GYN. QIP criteria: age <38 years (y); anti-Mullerian hormone (AMH) >2ng/mL; normal prolactin, thyroid function and hemoglobin A1C; no known reproductive issues/comorbidities requiring high risk obstetrics; <3 prior OI cycles. Eligible pts received early follicular letrozole 2.5mg for 5 days (d) in GYN and were then followed in REI's OI program. Non-eligible pts were scheduled in REI. To assess effectiveness, we retrospectively compared all REF outcomes from PRE-(3/1/21-5/31/21) to POST-(9/1/21-11/30/21) QIP as of 2/14/22. A transition period (6/1/21-8/31/21) was excluded. Primary outcome was time from REF to scheduled appt. Secondary outcomes included time from REF to OI prescription/cycle start. Statistics included Mann-Whitney, Chi-square, Fischer's exact and Two-sample t tests (p<0.05 significant).
Result(s): PRE (n=121) and POST (n=102) REFs had similar median ages [36 (interquartile range (IQR): 32-39) PRE vs 35y (IQR: 31-40) POST, p=0.73], ethnic/racial identity [56.2% (68/121) PRE vs 53.9% (55/102) POST Hispanic (p=0.79); 34.7% (42/121) PRE vs 30.4% (31/102) POST Black (p=0.59)], and rates of no prior FC [88.4% (107/121) PRE vs 93.1% (95/102) POST, p=0.15]. QIP identified pts for GYN who were younger [median age 29 (IQR: 27-33) vs 38y (IQR: 33-41), p<0.01], had higher AMHs [median 3.065 (IQR: 2.315-4.883) vs 1.230 ng/mL (IQR: 0.513-3.630), p<0.01], and had fewer comorbidities [100% (19/19) vs 72.5% (50/69), p<0.01] compared to REI. After QIP implementation, median time from REF to scheduled appt decreased from PRE 151 (IQR: 125-173) to POST 98d (IQR: 73-137) (p<0.01). For pts seen in clinic thus far, median time from REF to OI prescription decreased from 150 (IQR: 122-173) to 82d (IQR: 63-119) (p<0.01) and to 1st follicle check from 202 (IQR: 159-221) to 107d (IQR: 98-115) (p<0.04). In the POST cohort, 86.3% (88/102) of REFs had visits scheduled, with 21.6% (19/88) in GYN and 78.4% (69/88) in REI. OI was started at initial visit for 61.5% (8/13) of GYN pts vs 25.8% (8/31) of REI pts (p<0.04). 38.5% (5/13) of GYN pts met criteria for QIP, but were pending >1 blood test, while 51.6% (16/31) of REI pts were pending further work-up.
Conclusion(s): Our QIP expedited FC for all pts by reducing the time from REF to scheduled fertility appt by 35% (median of 53d) and to OI prescription/cycle start by nearly 45% (medians of 68d/95d). Impact Statement: Similar OI pathways could improve access to FC for underserved populations in broader practice settings. REFERENCES: 1 Blakemore JK, Maxwell SM, Hodes-Wertz B, Goldman KN. Access to infertility care in a low-resource setting: bridging the gap through resident and fellow education in a New York City public hospital. J Assist Reprod Genet. 2020 Jul;37(7):1545-1552.
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Objective: Several patient populations prefer to avoid TV monitoring for comfort or to prevent dysphoria. The purpose of this study is to compare TA and TV ultrasound as a means of determining cycle trigger timing and predicting oocyte maturity based on scans performed during ART cycles in this patient population.
Material(s) and Method(s): This was a retrospective cohort study of 59 patients who underwent >= 1 ART cycle at a single academic center. The study group consisted of patients who preferred TA monitoring based on any of 3 following inclusion criteria: 1) if they were virginal, 2) identified as transgender or 3) had a diagnosis of vaginismus. The control group included patients within this cohort that had no preference for TA imaging and thus underwent exclusive TV imaging. Demographics and variables included age, body mass index (BMI), antral follicle count (AFC) and anti-mullerian hormone (AMH), day 2 estradiol (D2 E2) and follicle-stimulating hormone (FSH) levels, # scans per cycle, # stimulation days per cycle, estimated # follicles and follicle sizes at trigger, # eggs retrieved, and oocyte maturity rate. Primary outcomes were 1) % difference between estimated # follicles at trigger and # oocytes retrieved, 2) # oocytes retrieved, and 3) % maturity. Secondary outcomes included % difference between AFC and # oocytes retrieved. Kolmogorov-Smirnov test was used to determine normality with independent sample t-tests and Mann Whitney U-Tests were used where appropriate with p<0.05 considered significant.
Result(s): 59 patients (n=18 TA; n= 41 TV) were included in the analysis. 27.1% (n=9 TA; 7 TV) were virginal, 50.8% (6 TA; 24 TV) had vaginismus and 37.3% (10 TA; 12 TV) identified as transgender. Some patients met 2 criteria (virginal + vaginismus, transgender + virginal, or transgender + vaginismus). Patients in the TA group were significantly younger than those in the TV group (26.2 TA v 37.8 years TV, p<0.001). Median BMI (22.4 TA v 23.7 kg/m² TV, p=0.26) and AMH (2.9 TA v 2.7 ng/mL TV, p=0.99) were similar. There was no statistical significance in mean AFC (12.8 +/- 9.2 TA, 13.6 +/- 8.2 TV, p=0.18). Patients in both groups had similar median D2 E2 (32.0 TA v 41.1 TV pg/mL, p=0.23) and FSH (5.6 TA v 7.2 mIU/mL TV, p=0.23), # scans per cycle (5 TA v 5 TV, p=0.88), and # stimulation days (11 TA v 11 TV, p=0.74). The TA group had higher mean E2 at trigger (3488.5 +/- 1087.0 TA, 2566.1 +/- 1416.1 pg/mL TV, p<0.002). There was no significant difference between estimated # follicles at trigger and # oocytes retrieved (17.7 +/- 31.4% TA, 6.7 +/- 38.0% TV; p= 0.29). Mean # oocytes (21.3 +/- 10.8 TA, 15.9 +/- 8.8 TV, p= 0.05) and median % mature oocytes (0.89 TA, 0.83 TV; p= 0.12) were also similar. Median % difference between AFC and # oocytes retrieved was not significantly different (0.68 TA, 0.82 TV; p= 0.18).
Conclusion(s): TA and TV imaging do not differ in their ability to predict FP cycle characteristics, oocytes retrieved or oocyte maturity rate. TA imaging may offer an acceptable alternative for patients uncomfortable with TV imaging during FP. Impact Statement: TA monitoring for oocyte cryopreservation does not adversely affect oocyte yield in patients with preference against TV imaging.
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Objective: The use of GnRH-a trigger in antagonist controlled ovarian hyperstimulation (COH) cycles has increased due to its enhanced safety profile. However, response, as measured by the serum LH level post trigger, vary considerably^1-6. We investigated the impact of serum LH response to GnRH-a trigger in antagonist COH cycles on oocyte yield, oocyte maturity, blastocyst formation, PGT-A and pregnancy outcomes.
Material(s) and Method(s): This is a retrospective cohort study in a single university-based fertility center of all GnRH-antagonist COH cycles utilizing GnRH-a alone or in combination with 1000u of human chorionic gonadotropin (hCG) for trigger from 2017 to 2020. An optimal response to GnRH-a trigger was defined as LH >= 40 mIU/mL and suboptimal response was defined as LH < 40 mIU/mL on the morning after trigger. Subanalyses with responses of LH >= 15 mIU/mL and LH < 15 mIU/mL were also performed. Primary outcomes included oocyte yield, oocyte maturity rate, blastocyst formation rate, euploidy rate, aneuploidy rate and simple mosaic rate. Secondary outcomes included biochemical pregnancy rate (BPR), spontaneous abortion rate (SABR) and ongoing/pregnancy live birth rate (OP/LBR). Primary and secondary outcomes were also stratified by age, race and BMI. Descriptive statistics (median +/- range for continuous variables), Mann Whitey U and Fisher's Exact tests were performed accordingly with p<0.05 defined as significant.
Result(s): This study included 3,833 retrieval cycles with 1,435 single thawed euploid embryo transfers (STEET) among 2,618 patients. Ten percent (351/3446) of retrieval cycles had suboptimal and 90% (3446/3833) had optimal response to GnRH-a trigger. There was no difference in median oocyte yield (16 vs 17 oocytes per cycle, p=0.92), or oocyte maturity (77% vs 76%, p=0.43), fertilization (76% vs 77%, p=0.48) and blastocyst formation (51% vs 52%, p=0.88) rates by response. There were no significant differences in the rate of euploidy (35% vs 39%, p=0.55), aneuploidy (51% vs 47%, p=0.56) and simple mosaic (11% vs 11%, p=1) between groups. Seven percent (102/1435) of STEETs utilized embryos from a cycle with suboptimal response and 93% (1333/1435) from optimal response to GnRH trigger. There were no significant differences in BPR [19/44 (14%) vs 164/1907 (9%), p=0.2], SABR [11/144 (8%) vs 152/1907 (8%), p=1] and OP/LBR [85/144 (59%) vs 1127/1907 (59%), p=1]. No differences in pregnancy outcomes were found in the subanalyses of LH >= and < 15 mIU/mL and when data were stratified by SART age ranges, race and BMI.
Conclusion(s): A suboptimal response to GnRH-a trigger (LH < 40) is not associated with lower oocyte yield, oocyte maturity rate, blastocyst rate, euploidy rate or worse pregnancy outcomes compared to an optimal response (LH >= 40). Additional studies with larger cohorts are needed to further investigate these findings and with different thresholds of response. Impact Statement: A suboptimal LH response to GnRH-a trigger may not predict poor cycle outcomes. Providers should not hesitate to use GnRH-a trigger, especially in patients with identifiable risk factors for ovarian hyperstimulation syndrome (OHSS)⁷. Support: None.
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Objective: When counseling patients regarding the use of PGT-A, it is unclear whether ploidy rates among INF pts who undergo PGT-A are comparable to FT pts¹. Our objective was to evaluate PGT-A outcomes in FT compared to INF pts.
Material(s) and Method(s): This is a retrospective cohort study of the first IVF cycle of all FT pts (pts without a diagnosis of infertility) who underwent PGT-A at one academic center from 2016-2021. Pts were 3-to-1 matched by age and # of oocytes retrieved to the first cycle of INF controls. Primary outcome was euploidy rate, defined as #euploids per #biopsied blastocysts. Secondary outcomes were % mature oocytes (M2), 2PN fertilization rate, blastocyst formation rate (BFR), and # of euploid, aneuploid, and mosaic embryos. BMI, AMH, day 2 FSH and E2, total gonadotropin (GND) dose, and stimulation days were compared. Subgroup analyses compared % mosaic, aneuploid, and no diagnosis embryos. Statistical analysis included Mann-Whitney U, Fisher's exact, Chi squared tests, and multiple linear regression (p<0.05 significant).
Result(s): 283 FT pts (reason for PGT-A: 64% embryo banking, 36% single gene disorders) were matched to 849 INF pts. Median age, AMH, and day 2 E2 were equivalent among groups (p>0.1). In FT pts, median day 2 FSH was higher (6.9 vs. 6.5, p<0.01) and median BMI was lower (22.1 vs. 22.5, p<0.05). FT pts received higher median doses of GNDs (3450 vs. 3150 IUs, p<0.01), but had similar median stimulation days (p=0.19). Median number of oocytes retrieved, M2s retrieved, and biopsied blastocysts did not differ among groups (p>0.29); nor did %M2s or BFR (p>0.06). 2PN fertilization was higher in FT pts (77.7 vs. 76.2%, p<0.05). See Table for PGT-A outcomes. Euploidy rate was higher in FT pts; among non-euploid embryos, INF pts had lower aneuploidy and higher mosaicism rates. The % of pts with >1 euploid embryo was similar in both groups. A multiple linear regression model continued to show the relationship between % euploid in FT vs. INF groups, while controlling for other significant covariates (BMI, total GNDs used, day 2 FSH, and 2PN fertilization rate).
Conclusion(s): FT pts had higher euploidy rates than INF pts, suggesting that infertility is associated with a lower euploidy rate. However, among non-euploid embryos, FT pts had higher aneuploidy and lower mosaicism rates compared to INF pts. An equivalent % of FT and INF pts yielded >1 euploid embryo. Impact Statement: FT pts undergoing PGT-A can be counseled that they may have a higher euploidy rate, but INF pts are just as likely to yield >1 euploid embryo. [Formula presented] Support: No financial support to disclose. REFERENCES: Kort JD, McCoy RC, Demko Z, Lathi RB. Are blastocyst aneuploidy rates different between fertile and infertile populations?. J Assist Reprod Genet. 2018;35(3):403-408.
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Objective: Patients with 5 or fewer follicles during IVF face a difficult choice: should they cancel the cycle or proceed to retrieval? Limited data exist to guide this decision. This study evaluates LBRs for retrievals with <=5 follicles at trigger.
Material(s) and Method(s): This retrospective cohort study from an academic fertility center reviewed all IVF cycles yielding <=10 oocytes from 2016-2020. Cycles were included if <=5 follicles measuring >=14 mm were verified at trigger. The primary outcome was rate of ongoing pregnancy or live birth per retrieval (LBR) after fresh or frozen transfer. Secondary outcomes were number of oocytes, mature oocytes (M2s), 2 pronuclear zygotes (2PNs), blastocysts for transfer or biopsy and euploid blastocysts (if preimplantation genetic testing for aneuploidy (PGT) was used). Statistics included Chi-squared, Fisher's exact and Kruskal Wallis tests (p<0.05 significant).
Result(s): 1502 cycles (900 with PGT) from 972 patients were included. Median age was 40 years (y) (range: 26-48). See table for outcomes. Mean oocytes, M2s, 2PNs, blastocysts and euploids differed by follicle number (FN) (p<0.001). Across all ages, there were differences in LBR associated with FN (p<0.001). For patients <35y, LBR did not differ by FN. In the 35-37y group, LBR with 2, 3 or 4 follicles was lower than LBR with 5 (p<0.01). In the 38-40y group, LBR with 3 follicles was lower than LBR with 4 or 5 (p<0.02). In the 41-42y group, LBR with 2 or 3 follicles was lower than LBR with 5 (p<0.02). In the >42y group, LBR with 4 follicles was lower than LBR with 5 (p<0.03). There were no other differences in LBR by FN.
Conclusion(s): We provide clear, specific outcomes for patients with <=5 follicles at trigger. As expected, LBR is higher with more follicles. Our data can guide patients with <=5 follicles as they weigh the emotional, physical and financial costs of retrieval. Impact Statement: Our results can help patients with 5 or fewer follicles decide whether to cancel or proceed to retrieval. Patients with <=3 follicles can be counseled that LBR is likely less than 20% if 35-40 years old and likely 5% or less if 41 years or older. [Formula presented]
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PURPOSE/OBJECTIVE:To assess assisted reproductive technology (ART) outcomes in patients with one ovary compared to two ovaries. METHODS:We performed a retrospective cohort study of all patients with one ovary who underwent ≥ 1 ART cycle between 2012 and 2020 at a large university-affiliated fertility center. Patients were 3-to-1 matched with two ovary controls during the same period. Primary outcome was metaphase II oocytes (MIIs) retrieved per cycle. Secondary outcomes included ovarian reserve markers, laboratory outcomes, and live birth rates (LBRs). RESULTS:A total of 104 one ovary patients (158 cycles; median age 35.5 years) were matched to 312 two ovary patients (474 cycles; median age 35.0 years). In one ovary patients, anti-Mullerian hormone was lower (median 1.1 vs. 2.2, p < 0.01) and day 2 follicle-stimulating hormone was higher (median 7.4 vs. 6.2, p < 0.01). One ovary patients yielded median 7.5 MIIs and 10 oocytes per cycle, fewer than two ovary patients (11.0 and 14.5, respectively; p < 0.01). However, one ovary patients had ≥ 50% the MII and oocyte yield of two ovary patients (Z > 5.8, p < 0.01). Fertilization and blastocyst formation rates, euploidy rate, and rate of ≥ 1 embryo for transfer were equivalent between groups (p > 0.40). Among the one and two ovary groups, LBRs per transfer (45.8% vs. 46.6%, p = 1.00) and per patient who underwent transfer (68.3% vs. 73.9%, p = 0.55) were equivalent. CONCLUSION/CONCLUSIONS:One ovary patients yielded fewer MIIs and oocytes than two ovary patients, but had ≥ 50% the yield of two ovary patients, suggesting a compensatory mechanism in oocyte yield in the solitary ovary. One and two ovary patients had equivalent LBRs.