ABSTRACT
OBJECTIVE: The rise of the SARS-CoV-2 pandemic and temporary closures of fertility centers made the effect on POC cycles uncertain but garnered national attention1,2. We sought to assess the impact of the pandemic on POC cycles in a pandemic epicenter. MATERIALS AND METHODS: This is a retrospective cohort study of all POC cycles at an academic fertility center in New York City from 1/1/2019- 12/31/2020. Primary outcomes were number of POC patients (pts) and cycles. Secondary outcomes were pt relationship status, payment method, AMH, and cycle parameters;with subgroup analyses by age groups. We also examined the relationship between monthly number of POC cycles and national SaRS-CoV-2 cases. Statistical analyses included z-score analysis, Mann-Whitney, and Chi-squared, with p<0.05 significant. RESULTS: Despite a 5.5 week center closure in 2020, POC pts increased 14% and POC cycles increased 16% from 2019 to 2020 (Table), with a 32% increase seen between June-Dec, 2020 . There was a 28% increase in POC pts <37yo in 2020 (252 pts vs. 323 pts, p<0.04) and no change in pts >37yo in 2020 (p=0.9). Relationship status did not differ between years (16% partnered, 76% single, 8% unknown in 2019 vs. 16% partnered, 73% single, 11% unknown in 2020;p=0.6). Fewer patients in 2020 had insurance coverage (16% vs. 24%, p<0.001). AMH was higher in 2020 (2.3 vs. 2.1, p<0.03), but days of stimulation, oocytes retrieved, oocytes frozen, total gonadotropins, and maximum estradiol (E2) were not different (Table). While national SARS-CoV-2 cases peaked in April, July, and November 2020, monthly POC cycles at our center did not decrease with surges in SARS-CoV-2 after our center reopened in May (p=0.24). In 2020 there were 23 cycles cancelled, none due a positive SARS-CoV-2 test. CONCLUSIONS: POC volume increased at our center in 2020, especially in young patients, despite center closures and SARS-CoV-2 surges. IMPACT STATEMENT: More young people pursued POC despite the SARS-CoV-2 pandemic. Further research is needed to understand POC pt motivations and experiences during a pandemic. (Table Presented).
ABSTRACT
OBJECTIVE: There has been significant uncertainty surrounding the COVID-19 pandemic and its effect on human reproduction which resulted in a temporary suspension of ART treatments in early stages of the pandemic. The ACE2 receptor used by the virus to infect pulmonary cells is also found in reproductive organs and has fueled speculation as to whether the disease can be sexually transmitted and whether it can cause infertility. Non-viral issues (e.g., pandemic related psychological stress, alternate methods of communication and interaction, and new clinic procedures) may also worsen outcomes. We sought to determine whether clinical outcomes following the frozen embryo transfer (FET) of a euploid embryo were different during the COVID-19 pandemic in 2020 when compared to prior to the pandemic in 2019. MATERIALS AND METHODS: Patients who tested negative for COVID-19 and underwent FET of a single euploid embryo at NYU Fertility Center in NYC over January 2020 through September 2020 were separated by treatment month and compared with patients from the corresponding month in 2019. Patient's age at cycle start and age at freeze were compared using Student's T-Test. Potential cycle outcomes included intrauterine pregnancy (IUG), biochemical pregnancy (Biochem), and no pregnancy, and outcomes were compared between the two years using contingency Chi Square. RESULTS: 1,044 patients were compared over the corresponding months. 558 transfers from 2019 and 486 patients from 2020, with no patients in April of 2020. There were no differences noted in patient's age at cycle start, or age at cryopreservation, between any of the months across the two years. Analysis of outcomes following FET further revealed no statistically significant differences between any of the months over the two years, X2 = 14.64, p > 0.05. Post hoc analyses comparing the combined months of March, April and May, or the combined 9-month periods, were also not statistically significant (X2 = 0.042, p > 0.05;X2 = 1.68, p > 0.05;respectively). CONCLUSIONS: In patients who tested negative for COVID-19, there were no differences in treatment outcomes following FET's when comparing patients treated during the COVID pandemic with those who were treated prior to the pandemic. IMPACT STATEMENT: Providers and patients can be reassured that with proper testing and sanitizing techniques FET outcomes remained unaffected by the pandemic. (Table Presented).
ABSTRACT
OBJECTIVE: COVID-19 has affected nearly every facet of modern life, and has left many wondering what implications, if any, the virus has on reproductive health. Increased levels of psychological stress, concern for viral contamination in embryology labs, and reports of decreased male fertility following COVID infection, have also been thought to contribute negatively to ART outcomes.We sought to determine whether the pandemic resulted in any differences in IVF/OOF outcomes. MATERIALS AND METHODS: Patients who tested negative for COVID-19 and underwent GnRH-antagonist IVF and OOF cycles from January 2020 through December 2020 at NYU Fertility Center, a period marked by the COVID-19 pandemic, were separated by month of treatment and compared with patients from the corresponding month in the prior year. In patients with multiple cycles over this time period, only the first cycle was used. Patient age, AMH, #oocytes retrieved, #oocytes matured, #fertilized, #blastocysts, and #euploid embryos were compared using Student's T-test. RESULTS: 2,467 patients were compared. While the number of cycles were remarkably decreased over March and April of 2020 (59 and 25 respectively), the total number of cycles were very similar for the entire year (1,239 in 2019;1,228 in 2020). There were no consistently significant differences in age, AMH, #oocytes retrieved, #oocytes matured, #blastocysts formed, or #euploid embryos formed, between the two years. CONCLUSIONS: Despite initial concerns, and prior research suggesting otherwise, we did not detect any consistent quantitative or qualitative differences in retrieval outcomes amongst COVID negative patients receiving care during the pandemic. IMPACT STATEMENT: These results can reassure patients and their providers that IVF/OOF cycles can be continued safely during the pandemic without compromising outcomes.
ABSTRACT
Objective: The ongoing COVID-19 pandemic has disrupted the normal methods of communication used by physicians and patients, as well as the standard protocols and procedures by which medical clinics operate. Pandemic related stresses may have also influenced patient’s fertility goals and/or their ovarian response. We questioned whether these changes resulted in any unanticipated effects in the treatments and outcomes of ART patients. Design: Retrospective cohort. Materials and Methods: Patients who underwent GnRH-antagonist IVF cycles from January 2020 through June 2020 at NYU Fertility Center, a period in New York City over which the COVID-19 pandemic escalated and life in the city drastically changed as a result of new social distancing measures, were separated by month of treatment and compared with patients from the corresponding month in the prior year (January 2019 through June 2019). Patient age, AMH, days gonadotropin, #oocytes retrieved, #oocytes matured, #fertilized, #blastocysts, and #euploid embryos were compared using Student’s T-test. Results: 1881 patients were compared over the parallel six-month periods. Clinic visits were markedly decreased over the months of March and April of 2020, when the pandemic was at its peak in NYC and treatments were suspended as per the ASRM pandemic guidelines. There were no differences in age, AMH, #oocytes retrieved, #mature oocytes, or #fertilized between the two years. In April of 2020 there were significantly more blastocysts per patient, as compared to April of 2019, however, in May and June of 2020 there were significantly fewer euploid embryos per patient, as compared to May and June of 2019 (see table). [Formula presented] Conclusions: In the months following the end of the COVID-19 treatment suspension, there were no apparent differences in patient characteristics or the quantitative responses to stimulation. However, there was a significant qualitative difference as expressed in the number of euploid embryos. It remains unclear if or how the pandemic is related to this difference.
ABSTRACT
Objective: Previous work by our group (1) showed that the rate of chromosomal mosaicism decreases with maternal age. However, the types of chromosomes involved, as well as the types of chromosomal mosaicism in individual embryos, have not yet been examined. Our objective was to determine whether maternal age was associated with the rate of sex and autosomal chromosome mosaicism and the rates of various types of mosaicism. Design: Retrospective cohort study of all blastocysts that underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A) from 1/2015 to 12/2018 at our center. Materials and Methods: All patients with blastocysts that underwent trophectoderm biopsy for PGT-A via Next Generation Sequencing with ≥1 chromosome in the mosaic range (20-80%) were included. The primary outcomes were: 1) the rate of sex and autosomal chromosome mosaicism and 2) rates of segmental mosaicism, full chromosome mosaicism and complex (≥3 mosaic chromosomes) stratified by maternal age. Statistical analyses included Kruskal-Wallis (KW) and linear regression (LR) to control for paternal age, with p<0.05 considered significant. Results: 1,670 patients with 10,545 embryos biopsied overall and 3,611 embryos with ≥1 mosaic chromosome met inclusion criteria. The number of embryos biopsied decreased with maternal age (p<0.01) as expected. 3,366 (93.2%) embryos had only autosomal chromosome mosaics, which was independent of maternal age (p=0.05). Alternatively, the percent of embryos with ≥1 sex chromosome mosaic (6.8% n=245) was significantly associated with maternal age without clear trend by age group (p<0.01). Table 1 shows PGT-A results by type of mosaicism stratified by maternal age. Segmental mosaicism peaked at maternal age 35-37, while complex mosaicism increased with maternal age. Full chromosome mosaicism was similar across age groups. Conclusions: Among our embryo cohort, rates of segmental mosaicism varied and complex mosaicism increased with maternal age. These results remained significant when controlling for paternal age. The rate of sex chromosome mosaicism was associated with maternal age but may not be sufficiently powered given the low number of chromosomes. Our results provide further data for counseling patients about mosaic embryo results. [Formula presented] References: 1. An Analysis Of The Effect Of Maternal And Paternal Age On Chromosomal Mosaicism, Pacific Coast Reproductive Society Annual Conference – Cancelled by COVID-19
ABSTRACT
Objective: The diagnosis and management of CE is debated1-4. Since many patients undergoing assisted reproductive technology (ART) are only tested after treatment failure, definitive management remains imprecise. The objectives of this study were to 1) determine the prevalence of CE in infertility patients and 2) the impact of CE on euploid embryo implantation. Design: Prospective, blinded, non-selection study of patients undergoing IVF/PGT-A. Materials and Methods: All IVF/PGT-A patients cycling between 6/2019 - 3/2020 were eligible. Exclusion criteria were: 1) age 42+, 2) embryo banking/not planning ET, 3) planning untested/fresh/mosaic ET. Consented subjects underwent a standardized endometrial biopsy (EMB) at retrieval. EMB results by a single laboratory were blinded until after single euploid ET resulted in 1) +heartbeat, 2) confirmed SAB or 3) negative hCG. Primary outcome was 1) presence/absence of CE, defined as 1+ plasma cell by CD138/section and 2) ongoing pregnancy rate. Secondary outcomes included number of plasma cells/section and stratified pregnancy outcomes. Power analysis for a prevalence of 20%5 with a 95% confidence = 246 subjects. Statistical analyses included Student’s t-test, Fischer’s Exact, logistic regression with p<0.05 considered significant. Results: 104 subjects consented and underwent EMB. Seven withdrew after EMB with 97 eligible for FET. In all biopsied patients, the mean age was 36.1±3.2 years (range 28-41), 66.4% identified as Caucasian, and the most frequent infertility diagnosis was primary/unexplained infertility (42.3%). On 3/17/20, in compliance with ASRM’s COVID recommendations, all IVF/FET cycles and recruitment stopped, at which time 54/97 had undergone FET/unblinding. There were no differences in age (p=0.83), distribution of race/ethnicity (p=0.57) or infertility diagnoses (p=0.77) between transferred and untransferred patients. Due to COVID cycle stop, unblinded biopsies were reviewed for result only (not unblinded), showing 25/104 biopsies (24.0%) positive for CE with plasma cells ranging 1-34. Demographics of transferred patients showed 46 (85.2%) had a programmed ET, 50 (92.6%) with a grade 3-5Bb or higher, and a median time to ET of 56 days. Overall, 39 (72.2%) had an ongoing pregnancy. 20.4% (11/54) had CE with plasma cells ranging 1-14. Subjects with CE had an ongoing pregnancy rate of 63.6% (7/11) that was not significantly different than 74.4% (32/43) in those subjects that were CE negative (p=0.48). Logistic regression showed no difference in ongoing pregnancy when stratified by cycle type, time to ET, lining thickness, embryo day or grade, and plasma cell count. To date, the SAB rate after implantation was similar (2/7 CE positive vs. 1/32 in CE negative, p=0.07). Notably, plasma cell count had an AOR 0.822 (0.668-1.01) and the only 2 SABs seen in patients with CE had plasma cell counts >10. Conclusions: We found a baseline prevalence of roughly 24.0% in ART patients that, to date, did not affect the ongoing pregnancy rate. Further analysis with a larger cohort to examine 1) the SAB rate, 2) alternative definitions of CE, and 3) the impact of COVID are necessary. References: 1. Cicinelli, E., Matteo, M., Tinelli, R., Lepara, A., Alfonso, R., Indraccolo, U., Marrocchella, S., Greco, P. & Resta, L. (2015). Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reproduction. 30(2): 323-330. 2. Liu Y, Chen X, Huang J, Wang C, Yu M, Laird S, Li T. Comparison of the prevalence of chronic endometrisias determined by means of different diagnostic methods in women with and without reproductive failure. Fertility and Sterility. 2018;109(5): 832-8329. 3. Bouet P, El Hachem H, Monceau E, Gariepy G, Kadoch I, Sylvestre C. Chronic endometritis in recurrent pregnancy loss and recurrent implantation failure: prevalence and role of hysteroscopy and immunohistochemistry in diagnosis. Fertility and Sterility. 2016;105(1): 106-110. 4. Vitagliano A, Saccardi C, Noventa M, Di Spiezo Sardo A, S ccone G, Ciccinelli E, Pizzi S, Andrisani A, Litta PS. Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertility and Sterility. 2018;110(1): 103-112e1. 5. Masbou AK, Keefe DL, Fino ME, Hodes-Wertz B, Blakemore JK, Grifo JA. Why do euploid embryos fail to implant? The role of CD138 and chronic endometritis. Current Opinion in Gynecology and Obstetrics. 2019;2(1): 372-378.Â