VARIATION IN CYCLE CHARACTERISTICS AMONG PATIENTS < 35 WITH A SINGLE DIAGNOSIS

BackgroundInfertile women under 35 are among those considered to have a favorable prognosis with regards to assisted reproductive technology (ART) cycles. However, although reproductive age is the best predictor of outcome with ART, this population has a heterogeneous result with regards to live birth outcomes. Cycle characteristics, e.g. fertilization and embryo development, represent a potential counseling tool with which to manage patient expectations through an ART cycle. We hypothesized that infertility diagnosis would be associated with cycle characteristics among patients with ovarian (e.g. diminished ovarian reserve/DOR), anatomic (tubal factor/TF) and unexplained infertility.ObjectiveThe purpose of this study was to evaluate cycle characteristics among patients with DOR, TF, and unexplained infertility.Materials and MethodsA retrospective chart review of fresh autologous IVF cycles in patients < 35 years of age with a single diagnosis of unexplained infertility, tubal factor, or diminished ovarian reserve (DOR) performed at an academic center between 2010 and 2019 were identified. Patients with more than one identified indication for ART were excluded from analysis. Cycle characteristics were defined as total gonadotropin dose, number of oocytes retrieved, fertilization rate and total number of embryos for transfer and cryopreservation. ANOVA with post-hoc Tukey HSD was performed on variable outcomes.ResultsA total of 332 cycles were evaluated. In cycles with women < 35 years of age with a single diagnosis, unexplained infertility (46%; 153/332 cycles) was the most common single diagnosis, followed by DOR (36%; 119/332 cycles) and TF (18%, 60/332). No differences were observed in mean ages among unexplained (31.1 +/- 7.4 years), DOR (31.1 +/- 2.7 years), and TF (30.9 +/- 2.6 years) infertility (p=0.8). DOR cycles exhibited lower AMH values (1.5 +/- 1.62 ng/ml) versus unexplained infertility (3.27 +/- 1.84 ng/ml, p=0.002), higher total FSH dose (3801 +/- 1977 versus 2090 +/- 1005 mIU/mL, p<0.001), and lower total number of oocytes retrieved (9.3 +/- 5.3 versus 15.1 +/- 7.4, p<0.0001). No difference was observed in AMH, total FSH dose, and total number of oocytes retrieved between unexplained infertility and TF cycles. No statistically significant difference was seen in fertilization rates between the three groups (p=0.2); however, total number of embryos available for either transfer or cryopreservation was highest in tubal factor patients (7.1 +/- 6.6) compared to both unexplained (4.7 +/- 3.9, p<0.01) and DOR (3.7 +/- 3.0, p<0.001).ConclusionsDespite similar markers of ovarian reserve, total number of oocytes retrieved and fertilization rates, patients with unexplained infertility exhibit lower numbers of total embryos available for transfer or cryopreservation compared to those with TF infertility. These data suggest embryonic development as a potential contributor to ART outcomes in unexplained infertility.SUPPORT: N/AReferences:McCallie, B. R., et al. Infertility diagnosis has a significant impact on the transcriptome of developing blastocysts. MHR: Basic science of reproductive medicine, 207. 23(8), 549-556. BackgroundInfertile women under 35 are among those considered to have a favorable prognosis with regards to assisted reproductive technology (ART) cycles. However, although reproductive age is the best predictor of outcome with ART, this population has a heterogeneous result with regards to live birth outcomes. Cycle characteristics, e.g. fertilization and embryo development, represent a potential counseling tool with which to manage patient expectations through an ART cycle. We hypothesized that infertility diagnosis would be associated with cycle characteristics among patients with ovarian (e.g. diminished ovarian reserve/DOR), anatomic (tubal factor/TF) and unexplained infertility. Infertile women under 35 are among those considered to have a favorable prognosis with regards to assisted reproductive technology (ART) cycles. However, although reproductive age is the best predictor of outcome with ART, this population has a heterogeneous result with regards to live birth outcomes. Cycle characteristics, e.g. fertilization and embryo development, represent a potential counseling tool with which to manage patient expectations through an ART cycle. We hypothesized that infertility diagnosis would be associated with cycle characteristics among patients with ovarian (e.g. diminished ovarian reserve/DOR), anatomic (tubal factor/TF) and unexplained infertility. ObjectiveThe purpose of this study was to evaluate cycle characteristics among patients with DOR, TF, and unexplained infertility. The purpose of this study was to evaluate cycle characteristics among patients with DOR, TF, and unexplained infertility. Materials and MethodsA retrospective chart review of fresh autologous IVF cycles in patients < 35 years of age with a single diagnosis of unexplained infertility, tubal factor, or diminished ovarian reserve (DOR) performed at an academic center between 2010 and 2019 were identified. Patients with more than one identified indication for ART were excluded from analysis. Cycle characteristics were defined as total gonadotropin dose, number of oocytes retrieved, fertilization rate and total number of embryos for transfer and cryopreservation. ANOVA with post-hoc Tukey HSD was performed on variable outcomes. A retrospective chart review of fresh autologous IVF cycles in patients < 35 years of age with a single diagnosis of unexplained infertility, tubal factor, or diminished ovarian reserve (DOR) performed at an academic center between 2010 and 2019 were identified. Patients with more than one identified indication for ART were excluded from analysis. Cycle characteristics were defined as total gonadotropin dose, number of oocytes retrieved, fertilization rate and total number of embryos for transfer and cryopreservation. ANOVA with post-hoc Tukey HSD was performed on variable outcomes. ResultsA total of 332 cycles were evaluated. In cycles with women < 35 years of age with a single diagnosis, unexplained infertility (46%; 153/332 cycles) was the most common single diagnosis, followed by DOR (36%; 119/332 cycles) and TF (18%, 60/332). No differences were observed in mean ages among unexplained (31.1 +/- 7.4 years), DOR (31.1 +/- 2.7 years), and TF (30.9 +/- 2.6 years) infertility (p=0.8). DOR cycles exhibited lower AMH values (1.5 +/- 1.62 ng/ml) versus unexplained infertility (3.27 +/- 1.84 ng/ml, p=0.002), higher total FSH dose (3801 +/- 1977 versus 2090 +/- 1005 mIU/mL, p<0.001), and lower total number of oocytes retrieved (9.3 +/- 5.3 versus 15.1 +/- 7.4, p<0.0001). No difference was observed in AMH, total FSH dose, and total number of oocytes retrieved between unexplained infertility and TF cycles. No statistically significant difference was seen in fertilization rates between the three groups (p=0.2); however, total number of embryos available for either transfer or cryopreservation was highest in tubal factor patients (7.1 +/- 6.6) compared to both unexplained (4.7 +/- 3.9, p<0.01) and DOR (3.7 +/- 3.0, p<0.001). A total of 332 cycles were evaluated. In cycles with women < 35 years of age with a single diagnosis, unexplained infertility (46%; 153/332 cycles) was the most common single diagnosis, followed by DOR (36%; 119/332 cycles) and TF (18%, 60/332). No differences were observed in mean ages among unexplained (31.1 +/- 7.4 years), DOR (31.1 +/- 2.7 years), and TF (30.9 +/- 2.6 years) infertility (p=0.8). DOR cycles exhibited lower AMH values (1.5 +/- 1.62 ng/ml) versus unexplained infertility (3.27 +/- 1.84 ng/ml, p=0.002), higher total FSH dose (3801 +/- 1977 versus 2090 +/- 1005 mIU/mL, p<0.001), and lower total number of oocytes retrieved (9.3 +/- 5.3 versus 15.1 +/- 7.4, p<0.0001). No difference was observed in AMH, total FSH dose, and total number of oocytes retrieved between unexplained infertility and TF cycles. No statistically significant difference was seen in fertilization rates between the three groups (p=0.2); however, total number of embryos available for either transfer or cryopreservation was highest in tubal factor patients (7.1 +/- 6.6) compared to both unexplained (4.7 +/- 3.9, p<0.01) and DOR (3.7 +/- 3.0, p<0.001). ConclusionsDespite similar markers of ovarian reserve, total number of oocytes retrieved and fertilization rates, patients with unexplained infertility exhibit lower numbers of total embryos available for transfer or cryopreservation compared to those with TF infertility. These data suggest embryonic development as a potential contributor to ART outcomes in unexplained infertility.SUPPORT: N/A Despite similar markers of ovarian reserve, total number of oocytes retrieved and fertilization rates, patients with unexplained infertility exhibit lower numbers of total embryos available for transfer or cryopreservation compared to those with TF infertility. These data suggest embryonic development as a potential contributor to ART outcomes in unexplained infertility.