CONCLUSION: Cryopreservation of 2PN stages demonstrates signif- OBJECTIVE: Randomized controlled trials investigating the impact of

icant increases in embryo survival, clinical pregnancies and implantation Acupuncture on IVF outcomes have recently been reported in F&S.
rates. This may be a result of reduced cryo-injury effects on the cell Significant and/or numerically more ongoing pregnancies (O-PR) were
spindle or other cell organelles. Elective cryopreservation of pronuclear reported in patients receiving acupuncture. Over the past 3 years, we
stages and thus cancellation of embryo transfer may help to reduce the have reported similar work and have determined the optimal treatment
severity of ovarian hyperstimulation syndrome. 2PN stages thawed in numbers for acupuncture (nine treatments), impact on embryology (none
excess may still be cultured and refrozen on D-3 for subsequent embryo noted), and patient group specific outcomes (poor and good prognosis).
transfers. This pilot study reports the results of a prospective investigation of two
Supported by: None. stress hormones – Prolactin (PRL) and Cortisol (CORT). We compare
IVF patients treated with no acupuncture (controls) and those treated
with acupuncture (Ac) before, during and after their stimulation and
P-117 embryo transfer.
DESIGN: Prospective study comparing stress hormones levels, PRL and
HEALTH DISPARITIES AMONG INFERTILITY PATIENTS IN CORT, during their IVF treatments.
MIDWESTERN UNITED STATES. S. A. Missmer, M. A. Ellison, R. E. MATERIALS AND METHODS: A total of 22 patients undergoing
Leach, T. Jain. Brigham and Women’s Hospital and Harvard Medical informed consent prospectively agreed to participate in the study. Pa-
School, Boston, MA; RAND Corporation, Santa Monica, CA; Univ of tients self selected to be treated with Ac. Serum was collected from all
Illinois Medical Center, Chicago, IL. patients at the following times: new patient visit, treatment consult,
lupron start, stim start, days 0, 2, 3, 4, 5, 7, 8, 9 10, 11 of stimulation and
OBJECTIVE: To determine the role that demographic and sociocultural
pre/post hCG and at pregnancy test. An Immulite Auto Analyzer was
characteristics play in access to and opinions regarding infertility care.
DESIGN: Cross-sectional survey. used to determine PRL and CORT levels. Serum were frozen and
MATERIALS AND METHODS: 743 patients beginning treatment for batched for analysis.
infertility at a Midwestern university hospital-based fertility center com- RESULTS: Preliminary results demonstrate differences in the two
pleted a self-administered questionnaire that asked details about repro- groups. Figure 1 and Figure 2 presents a single patient’s hormone levels
ductive history, demographic and socioeconomic characteristics, health (she had both a non-Ac IVF cycle as well as a cycle in conjunction with Ac
care access, and opinions about treatment for fertility. We used uncon- treatment. Figure 3 describes the average results of 9 complete data sets.
ditional multivariable logistic and linear regression - mutually adjusting There is a trend towards higher PRL levels in patients that did not receive
for race/ethnicity, religion, education, and income - to calculate effect Ac during the stimulation phase and an elevation towards the luteal phase.
estimates and 95% confidence intervals (CI). Wald p-values were two- The CORT levels did not differ between the two groups, however a trend
sided. Multivariable model building to account for potential confounding towards lower CORT levels were noted in the patient that had both a non Ac
and stratified analyses to illuminate effect modification are currently and Ac treatment (Figure 2).
underway.
RESULTS: Study participants ranged in age from 21-56 (median ⫽
35). 41% were Caucasian, 28% African-American, 18% Hispanic. Most
(59%) had a college education or greater and a household income of
⬎$100,000 (51%). The most prevalent religious affiliation was Catholic
(39%) with 35% Protestant and 13% Agnostic. Compared to Caucasians,
African-American and Hispanic women had been attempting to conceive
for 20 months longer (p-values ⬍ 0.0001) and had traveled on average
19 fewer miles to the clinic (p-values ⬍ 0.001). Additionally they
reported that it was more difficult to get treatment due to their race
(p-values ⬍ 0.0001) or income level (p-values ⬍ 0.0001). Again,
relative to Caucasians, Hispanic women were 4 times as likely to have
been referred to the clinic by a friend or family member (p-value ⫽
0.0003), while African-Americans were 6 times more likely to have
self-referred (p-value ⫽ 0.03) as were Catholic women (p-value ⫽ 0.04).
Compared to those with a college degree, both those with only a high
school diploma and those with a graduate degree reported that it was
difficult to get treatment due to their income level (p-values ⫽ 0.02).
Overall, compared to Caucasians, African-American and Hispanic
women found it most difficult to find a doctor with whom they felt
comfortable, to get an appointment with a doctor, to take time off from
work, and to pay for treatment. When asked about concerns regarding
fertility treatment, religious doctrine was most important to Hispanics,
Catholics, those with a high school education, and those with a lower
income. Disappointing ones spouse was of greater concern to Muslim
and Hindu women, while avoiding stigmatization of infertility was of
greatest concern to Asian women - particularly of Chinese descent,
Catholic women, and those with a lower income.
CONCLUSION: While the demand for infertility treatment increases in
the United States, attention to barriers to care and social stigma surrounding
infertility must be quantified and addressed.
Supported by: None.

P-118
PROPOSED MECHANISM OF ACTION OF ACUPUNCTURE ON
IVF OUTCOMES. P. C. Magarelli, M. Cohen, D. K. Cridennda. Repro-
ductive Medicine & Fertility Center, Colorado Springs, CO.

S174 Abstracts Vol. 86, Suppl 2, September 2006


CONCLUSION: Differences were noted in patient PRL levels as a result
of Ac; lower in the stimulation phase and trending higher towards the luteal
phase. This is consistent with better IVF outcomes as reported in the
literature. There were no obvious trends noted in CORT levels in this pilot
study. It appears that one potential, western medicine, view of the improve-
ment in IVF outcomes in patients treated with Ac may be a lowering of the
PRL levels before retrieval and elevation of these levels in the luteal phase.
Supported by: None.
P-119
ECTOPIC PREGNANCY RATES WITH FROZEN COMPARED TO
FRESH BLASTOCYST TRANSFER. S. H. Jun, A. A. Milki. Stanford
Univ, Palo Alto, CA.
OBJECTIVE: Despite major advances in ART, ectopic pregnancy (EP) is
still a significant complication of IVF. As suggested by some reports in the
literature, there may be a concern for a higher EP rate in frozen embryo
transfers. In this study, we specifically compared the EP rates with frozen
and fresh blastocyst transfer (BT) in order to minimize the differences
related to both embryo and uterine stages of development.
DESIGN: Retrospective study.
MATERIALS AND METHODS: All clinical pregnancies from fresh and
frozen BT conceived in our IVF program between January of 1998 when BT
was introduced to our center and December 2005. Following controlled ovarian
hyperstimulation with either long agonist, micrdose flare agonist, or antagonist
protocols, oocytes were retrieved, fertilized then cultured. Blastocysts were
cryopreserved on day 5 or 6. All transfers were performed using a Tefcat
catheter 1-2cm short of the fundus under transabdominal ultrasound (u/s)
guidance. The transfer volume was 20-30␮l. Natural frozen BT were performed
1 week following an hCG injection given when the lead follicle reached 17mm.
Micronized progesterone (P4) supplementation at a dose of 200mg twice daily
was given vaginally starting 2 days after ovulation. Clinical pregnancies were
defined by seeing a gestational sac on transvaginal u/s or by diagnosing an EP.
Ectopic pregnancies were diagnosed by u/s or by laparoscopic visualization of
a gestational sac in the fallopian tube or by the absence of an intrauterine
gestational sac and rising ␤hCG levels following the failure of suction D&C to
reveal products of conception.
RESULTS: Out of 744 clinical pregnancies from both fresh and frozen
BT, 15 were EP (2%). Ectopic pregnancy rates were 2.8% (5/180) and
1.8%(10/564) in frozen and fresh BT, respectively (p⫽0.6). Age (36.5 vs
34.9) and number of embryos transferred (2.2 vs 2) were similar between
these two groups. The incidence of tubal disease was higher in the frozen
BT group (32.4% vs 18.3%).
CONCLUSION: The reports in the literature showing a higher EP rate in
frozen compared to fresh embryo transfers may be supported by several
theoretical explanations. Progesterone may play a role in reducing uterine
contractility during the luteal phase of the cycle. Since the level of P4 is
significantly higher in fresh cycles compared to frozen, this may result in
better uterine relaxation and prevent embryos from migrating towards the
fallopian tubes. Also, the developmental delay of thawed embryos may lead
to a longer lag period before implantation increasing the opportunity to
migrate to the fallopian tube. Furthermore, there could be a tendency to
transfer embryos to the same depth (distance from the external os) during
FERTILITY & STERILITY威
fresh and frozen transfers where the uterine size could be smaller in the
non-stimulated thaw cycle which may lead to the injection of embryos
closer to the fallopian tubes resulting in higher EP rates in frozen compared
to fresh BT. In our study, we did not find a significant difference in EP rates
between frozen and fresh BT. Still, based on theoretical considerations, it
may still be prudent for IVF practitioners to be mindful of the possibility of
a higher risk for an EP during the performance of frozen embryo transfer.
Supported by: None.
P-120
A PROSPECTIVE RANDOMIZED PILOT STUDY COMPARING
PREGNANCY RATES AND IMPLANTATION RATES WHEN EM-
BRYOS ARE SELECTED BASED ON A SINGLE DAY 3 (D.3)
SCORE VS. A GRADUATED EMBRYO SCORE (GES) PLUS SOL-
UBLE HUMAN LEUKOCYTE ANTIGEN-G (SHLA-G) EXPRES-
SION. D. J. Kotze, E. U. Snowden. SIRM, Sacramento, CA.
OBJECTIVE: In most IVF programs, the morphological characteristics
of the embryos are evaluated on the day of transfer and the embryos with the
highest morphological scores are transferred. We compared two different
embryo-scoring methods, D.3 vs. GES and found no differences in either
the pregnancy rates or the implantation rates with either scoring method.
Embryos expressing a high concentration of sHLA-G, have been shown to
improve implantation rates. The aim of this study was to compare preg-
nancy rates and implantation rates when embryos are selected based on a
single D.3 score vs. a GES score plus sHLA-G expression.
DESIGN: Prospective Randomized.
MATERIALS AND METHODS: Patients undergoing ICSI, were ran-
domized to receive embryos based on a single D.3 score or a GES score
plus sHLA-G expression. The D.3 score was based on the number of
blastomeres and the extent of fragmentation on D.3. The GES score was
based on the alignment of the nucleoli at the 2-pronuclear (2PN) stage,
early cleavage (ie cleaved or not cleaved at 26 hours after ICSI), the
number of blastomeres and the extent of fragmentation on D.3. sHLA-G
expression was monitored by assaying the culture media. Embryos were
cultured individually in 50 ␮l droplets of P-1 medium (Irvine Scientific,
Santa Ana, CA) for 44-46 hours and moved to Complete Blastocyst
Medium (Irvine Scientific, Santa Ana, CA). At this point, the P-1 culture
media drops were collected and assayed for sHLA-G, using an enzyme-
linked immunosorbent sandwich (ELISA) assay. Patients were treated by
the same physician. A human derived gonadotropin (Bravelle; Ferring
Pharmaceuticals Inc, Suffern, NY) was used in all patients. The same
embryologist did the scoring of all embryos. Embryos with the highest
D.3 score or GES score and expressing sHLA-G within an optical
density range of 0.190 ⫾ 0.006 (mean ⫾ SD) were transferred on D.3.
Analysis of variance (ANOVA) and Chi-square tests were used for
comparisons. Statistical significance was achieved if P⬍0.05.
RESULTS: Of the 100 patients studied, 42 received embryos based only on
a D. 3 score. The remaining 58 patients received embryos based on a GES score
plus sHLA-G expression. The results are shown in the table below.
Data expressed as means ⫾ SD or %
S175