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: 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