OTHER: ART - CLINICAL I

O-163 Tuesday, October 21, 2014 04:15 PM

SHOULD WE PERSIST WITH OVULATION INDUCTION ANDINSEMINATION IN WOMEN WITH MALE FACTORINFERTILITY? C. Chatzicharalampous,a D. Patel,a N. Virji,b

J. R. Stelling,b,c M. A. Bray.a,b aObstetrics and Gynecology, The BrooklynHospital Center, Brooklyn, NY; bReproductive Specialists of New York,Mineola, NY; cObstetrics and Gynecology, Stony Brook University Schoolof Medicine, Stony Brook, NY.

OBJECTIVE: The FORT-T trial (1, 2) has demonstrated that movingquickly to IVF in women over forty leads to shorter time to pregnancy.Similar results were found on the FAST-T trial for younger women (3). How-ever, for a variety of reasons (financial, geographic or personal) not allwomen have access to IVF. We sought to determine if persistence withOvulation Induction and Intrauterine Insemination (OI/IUI) beyond three cy-cles was other than an exercise in futility in women diagnosedwith or withoutmale factor infertility.

DESIGN: A retrospective cohort study of 3203 patients who underwent7,641 OI/IUI cycles from 2001 to 2008.

MATERIALS ANDMETHODS: Women undergoing IUI/OI were group-ed by age category (20-37 and 38-42) and by ovulation induction cycle group(1-3 and 4-6). The primary outcomewas clinical pregnancy rate (CPR) whichrequired the presence of a gestational sac on sonogram. For statistical anal-ysis we used Chi-square, Fisher’s Exact test and Life-Table Analysis. A P-value<0.05 was considered statistically significant.

RESULTS: For women without male factor infertility the cumulative CPRwas, as expected, higher in young vs. older women (p<0.0001) but not signif-icantly different between cycle groups (1-3 vs. 4-6), regardless of age. Forwomen with male-factor only infertility, older women had a significantlylower cumulative CPR in the first three OI/IUI cycles. However, in cycles4-6, the older women attain equal success as the younger ones.

Clinical Pregnancy Rates by Age Group and Male-Factor Status

Male Factor Non-male

F

Age Group

ERTILITY & ST

Cycles

ERILITY�

CPR(%)

Factor CPR(%)

20-37

1-3 9.5 19.4 4-6 8.1 17.2

38-42

1-3 4.5* 12.3y 4-6 8.3 9.4y

CPR: Clinical Pregnancy Rate, * Statistically significant (p<0.05),yStatistically significant (p<0.001)

CONCLUSION: Cumulative success rates with OI/IUI are lower in allcases of male-factor only infertility. In an ideal world, IVFwould be the start-ing point for these couples. However, the equivalent success rates of olderand younger women with male factor infertility in cycles 4-6 suggests thatpersistence with IUI is not an exercise in futility in women with limited orno access to IVF. Future study is needed to determine if the improvementin cycles 4-6 is secondary to more aggressive ovulation induction.

O-164 Tuesday, October 21, 2014 04:30 PM

EFFECTIVENESS OF VIDEO-BASED TEACHING IN THE USE OFINJECTABLE FERTILITY MEDICATIONS: A RANDOMIZEDCONTROLLED PILOT STUDY. A. B. Patel, M. Matthews. Obstetrics& Gynecology, Carolinas Medical Center, Charlotte, NC.

OBJECTIVE: To determine if video-based teaching is effective for patienteducation of injectable infertility medications.

DESIGN: Prospective randomized controlled pilot study.MATERIALS AND METHODS: English-speaking infertility patients

requiring Gonal-F injections who presented to Carolinas Medical CenterWomen’s Institute were included. Patients with prior experience using inject-able medications and medical personnel were excluded. Study participantswere randomized to a video-based teaching modality (n¼24) or a standardone on one didactic session with a pharmacist experienced in injection teach-ing (n¼20). After the teaching session, participants were asked to complete a

post-test to assess their knowledge regarding Gonal-F injections. On the thirdday after starting home injections, participants completed a follow up surveyto evaluate their satisfaction with their teaching modality. The primaryoutcome assessed was performance on the post-test. Secondary outcomeswere time required for teaching and patient preference of teaching method.A chi-square or Fisher’s exact test with a 95% confidence interval was used to

analyze categorical data. For interval data, the t-test, was employed. If intervaldata was not normally distributed or the data was ordinal, the Wilcoxon ranksum test was employed. SAS Enterprise Guide�, version 5.1 was used for anal-ysis. A two-tailed p-value of less than 0.05was considered statistically significant.RESULTS: Video-based learners scored significantly higher on the post-

test comparedwith those randomized to a standard didactic session (92% cor-rect compared with 82%, P¼0.0277). On average, video-based teachingrequiring less time than a one-on-one didactic session (6.9 minutes comparedwith 10.1 minutes, P¼0.0036). Despite their performance on the post-test,72% of video-based learners would prefer a one-on-one didactic session.85% of video-based learners would prefer additional teaching compared to25% of those randomized to a didactic teaching session.CONCLUSION: Although patients preferred one-on-one injection training,

video-based teaching was more effective in educating patients on appropriateinjectable administration and a more time efficient teaching modality.

O-165 Tuesday, October 21, 2014 04:45 PM

IN VITRO FERTILIZATION (IVF) PATIENTS ONLINE BEHAV-IORS: HOW DOTHEY BROWSE THEWEB ABOUT INFERTILITYISSUES AND WHAT ARE THEY LOOKING FORONLINE? A. Futeral,a L. Dugay,b M. Stafford Bell,c J. Greindl,d

I.-J. Kadoch,e A. Ajayi,f S. Patel,g G. Baccino,h R. Nunez,i S. L. Tan.jaMedical Safari, Phillip, ACT, Australia; bFertility North, Joondalup, West-ern Australia, Australia; cCanberra Fertility Centre, Deakin, ACT, Australia;dPMA Chirec, Hopital de Braine-l’Alleud, Braine-l’Alleud, Wallonia,Belgium; eCentre PMA, Centre Hospitalier de l’Universit�e de Montr�eal,Montr�eal, QC, Canada; fNordica Fertility Centre, Ikoyi, Lagos, Nigeria;gVita Fertility Clinic, Mumbai, Maharashtra, India; hFIV Madrid, Madrid,Spain; iClinica Tambre, Madrid, Spain; jOriginelle, Montr�eal, QC, Canada.

OBJECTIVE: International study on patients online behaviors to betterunderstand and match their quest for information about infertility.DESIGN: Specific survey including 24 questions assessing participants

online behavior. Significance was set at P<0.05.MATERIALS AND METHODS: Retrospective, non-randomized, cross-

sectional study stratified across 9 centres in 6 countries from October 2013till April 2014. 744 consecutive participants answered the survey.RESULTS: 72% of participants searched online about infertility. 63% of re-

spondents browsed for 1 hour or more. Overall, 37% used mobile devices. withsignificant difference between Australia (51%) and India (20%). The mainsource of online information came from Google (59%). Content was the themost important factor while browsing (60%). Overall, when looking for infor-mation about infertility, description about treatments and emotional/psycholog-ical aspects were the leading 2 topics searched, 28 and 25%, respectively.Participants across the 6 countries consistently expressed interest for additionalinformationabout complementary treatments (35%)andemotional aspects/psy-chological advices during treatment (17%). The 2most appreciated illustrationsfor infertility were medical pictures (24%) and pictures of babies (21%).CONCLUSION: Results showed relatively consistent online behaviors

across countries. Majority of respondents spent time looking for information.Infertility being a topic not necessarily familiar to many, 63% of participantswere apparently willing to dedicate time getting more familiarized with it.Among the most common subjects searched about infertility, emotionaland psychological aspects were quite significant. This could indicate thatmany patients look for alternative approaches to cope with the emotionalburden often associated with IVF. Two factors should be influential whiledeveloping patient communication: the need for valuable content and themo-bile responsiveness of information.

O-166 Tuesday, October 21, 2014 05:00 PM

MANYCOUPLESSTILLDECLINEESETDESPITEFINANCIAL IN-CENTIVES: AN UPDATE. F. I. Sharara.a,b aVirginia Center for Repro-ductive Medicine, Reston, VA; bOB/Gyn, George Washington University,Washington, DC.

OBJECTIVE: Multiple pregnancies remain the most common cause ofmaternal, fetal, and perinatal morbidities. Strategies to increase eSET use

e57

in the US have been frustrating especially in states with no ART mandates,and patient resistance remains a major barrier to significant implementation.We sought to increase eSET adoption by offering significant financial incen-tives to offset some of the costs associated with ART.

DESIGN: Prospective, pilot study.MATERIALS AND METHODS: All women < 38 yo proceeding with

ART were consented for participation in a novel program to incentivizethem to undergo eSET, including couples with prior failed cycles, womenwith uterine fibroids or prior uterine surgery, and women with diminishedovarian reserve. Only couples with very severe male factor (testicularsperm or counts < 1 million/cc) were excluded. To date, 68 women (<38 yo) have participated in the study. All couples had an extensive consul-tation stressing the perinatal, neonatal, and maternal morbidities associ-ated with twin gestation before starting ART. Couples were providedwith free gonadotropins (Menopur), free embryo freezing of all extrablastocysts, and free storage for the first year if they agreed to have aneSET.

RESULTS: Between October 2012 and April 2014, 68 couples were con-sented for their participation in this novel program. Of the 68 couples, 41(60.3%) agreed to have an eSET after counseling. 27 couples (39.7%)declined to participate despite an extensive review of the increased morbid-ities associated with twins. Of the 68 couples, 59 cycles were completed todate, and the clinical PR was 72.9% (43/59), and ongoing/delivery PRwere 55.9% (33/59). The clinical and ongoing/delivered PR in the eSETgroup were 72.3% (27/37) and 56.8% (21/37), compared to 72.7% (16/22)and 54.5% (12/22) for the DET group (P¼NS). The incidence of twin gesta-tion in the DET group was 30% (6/20). Couples in the DET group were coun-seled again at the time of ET, and three couples underwent eSET. One case ofdichorionic-diamniotic twin gestation has been encountered to date in theeSET group.

CONCLUSION: Despite significant financial incentives and high ongoingPR, nearly 40% of couples eligible declined to have an eSET, not out of fearof lower success rate but because they want twins. By using this innovativetrial and extensive counseling before ART start, and again at the time of ET,we were able to increase our eSET rate to over 60%. Short of mandatingeSET, it seems many couples in the US will remain reluctant to have aneSET despite an excellent pregnancy rate.

Supported by: Ferring.

O-167 Tuesday, October 21, 2014 05:15 PM

INFERTILITY PATIENTS’ MOTIVATIONS FOR AND EXPERI-ENCES OF CROSS BORDER REPRODUCTIVE SERVICES(CBRS): A PARTIAL TRANS-THEORETICAL MODEL. S. Lui,E. Blyth, K. Chirema. School of Human and Health Sciences, Universityof Huddersfield, Huddersfield, West Yorkshire, United Kingdom.

OBJECTIVE: Cross border reproductive services (CBRS) is a growingphenomenon. CBRS is the travel by infertile patients from one country orjurisdiction where access to treatment is limited or unavailable to anothercountry or jurisdiction to seek infertility services. Both the American Societyfor Reproductive Medicine (ASRM, 2013) and European Society of HumanReproduction and Embryology (Pennings et al., 2008) have provided guid-ance and recommendations for CBRS. There are numerous reasons forCBRS (Pennings et al., 2008) and CBRS is an under-researched and un-der-theorised area (Inhorn and Gurtin, 2011) of health research.This studyprovided themes on the decision making process of CBRS patients and con-textualised them within a partial trans-theoretical model (Prochaska and Di-Clemente, 1983).

DESIGN: Data were collected via asynchronous email interviews.MATERIALS AND METHODS: Data regarding CBRS were collected

from 26 participants by means of asynchronous email in-depth semi-struc-tured interviews via Infertility Networks between April and November,2010. SPSS v20 was used to analyse the quantitative descriptive datawhereas NVivo 10 software aided the systematic thematic coding methodwithin a Straussian Interpretative Grounded Theory methodologicalperspective.

RESULTS: Participants’ motivations for and experiences of CBRS arecomplex. Seven stages emerged to describe patients’ CBRS journey. 1.Pre-contemplation: participants had no awareness of their own infertility;2. Contemplation: participants became aware of their infertility and facil-ities at home and of the possibility of CBRS; 3. Preparation: participants

e58 ASRM Abstracts

actively researched information about CBRS using internet/infertility net-works; 4.Action: participants took specific steps to initiate CBRS; 5:Maintenance: participants’ expectations and experiences had an importantimpact on whether or not they would continue on their CBRS journey; 6:Exit: Some participants successfully built their family. Others’ overallexperience was negative, their expectations were not met and theydecided to quit treatment; 7: Relapse: some participants re-engagedwith infertility treatment to build their family; some participants re-considering their decision regarding infertility treatment either at homeor using CBRS again.CONCLUSION: Participants have diverse motivations for and experi-

ences of CBRS. A partial trans-theoretical model could explain some ofthe decision making process in seeking CBRS.

O-168 Tuesday, October 21, 2014 05:30 PM

TOWARD A PROGRAM OF SINGLE EMBRYO TRANSFER:REDUCINGMULTIPLE GESTATION RISK USING CCS. P. Chenette,I. Ryan, C. Givens, E. Fischer, J. Conaghan. Pacific Fertility Center, SanFrancisco, CA.

OBJECTIVE: Single Embryo Transfer (SET) after Comprehensive Chro-mosome Screening (CCS) assists in multiple gestation risk reduction. Devel-opment of a clinical program.DESIGN: Retrospective.MATERIALS AND METHODS: A private IVF clinic developed a pro-

gram to reduce multiple gestation risk. After program leaders committedto the concept, a consistent message, educational materials, a lecture series,and clinical and laboratory protocols were developed encouraging SET afterCCS. Frozen embryo transfers from 2012 and 2013 were analyzed. Embryotransfer number was at physician and patient’s discretion. Primary groupingwas all FETs, CCS, and non-CCS. Secondary was age groups <35, 35-37,38-40, 41-42, >42, and OD (Ovum Donation). Comparison of transfersper year assessed patient acceptance.RESULTS: 1034 FETs were performed, CCS¼345, non-CCS¼689. Preg-

nancy ratewas all FET¼56%, CCS¼64%, non-CCS¼52%. Average numberof embryos transferred was all FET¼1.27, CCS¼1.1, non-CCS¼1.35. Mul-tiple gestation risk was all FET¼17.6%, CCS¼11.8%, non-CCS¼21.1%.From 2012 to 2013, all FETs increased 17%, CCS transfers increased260%, non-CCS transfers decreased 19%. Multiple gestation risk declinedin most groups.

FET Results

All FETs

<35

Vo

35-37

l. 102,

38-40 4

No. 3, S

1-42 >

upple

42

ment

OD

, Septe

Total

Transfers 2

80 1 53 1 51 4 0 1 2 3 98 1 034 CPR all FET 53.6% 64.7% 66.9%5 5.0%4 1.7% 51.3% 56.2% IR all FET 51.6% 63.6% 61.4%4 3.1%3 1.3% 44.9% 51.6% #ET all FET 1.22 1.20 1.37 1.28 1.33 1.29 1.27 Multiple Rate 19.3% 16.2% 22.8% 0.0% 0.0% 16.7% 17.6%

CCS

Transfers 90 72 77 2 3 1 0 73 345 CPR CCS 51.1% 69.4% 74.0%6 5.2%5 0.0% 65.8% 64.1% IR CCS 52.0% 73.3% 72.9%6 5.2%5 0.0% 65.5% 64.6% #ET CCS 1.13 1.04 1.10 1.00 1.00 1.15 1.10 Multiple Rate 17.4% 10.0% 8.8% 0.0% 0.0% 16.7% 11.8%

non-CCS

Transfers 1 90 81 74 1 7 2 3 25 689 CPR non-CCS 54.7% 60.5% 59.5%4 1.2% 0.0% 48.0% 52.2% IR non-CCS 51.5% 56.9% 53.3%2 5.0% 0.0% 40.9% 46.4% #ET non-CCS 1.26 1.35 1.65 1.65 3.00 1.32 1.35 Multiple Rate 20.2% 22.4% 40.9% 0.0% 0.0% 16.7% 21.1%

CONCLUSION: A program in SET requires a program commitment, aconsistent message, patient and staff education, and optimized clinicaland laboratory services. Patients accept this program in increasingnumbers. Pregnancy rate was improved after CCS in all ages over 35.Fewer embryos were transferred, and multiple gestation risk was reduced,after CCS in all ages. In women over 35, CCS improved the implantation

mber 2014