The FSA Annual Conference 2016 recently held in Perth (4-7 September) is an Annual Scientific Program that supports and showcases scientific research in the field of reproductive medicine. The 2016 program titled ‘OUT WITH THE OLD AND IN WITH THE NEW!’ included over 80 clinical and scientific sessions and was attended by over 1,000 Australian and International delegates.
The expertise of Monash IVF was featured throughout the event; represented by a number of key staff and clinicians who presented findings of original research projects designed to improve patient outcomes, and the ultimate advancement of the industry.
We congratulate the FSA, our staff, clinicians and peers on a successful week and for contributing to the promotion of excellence in research and education in the field of reproductive medicine.
A summary of the Monash IVF presentation abstracts are below:
- EFFECTIVENESS OF PREIMPLANTATION GENETIC SCREENING IN WOMEN UNDERGOING IVF AT OLDER AGE; A COHORT STUDY
- ENDOMETRIAL BIOMARKERS FOR THE NON- INVASIVE DIAGNOSIS OF ENDOMETRIOSIS
- ELONVA FLARE: A NEW APPROACH FOR POOR RESPONDERS
- THE EFFECT OF ADJUVANT THERAPIES ON PREGNANCY RATES IN IVF
- PSYCHOLOGICAL CHARACTERISTICS OF PARTICIPANTS TO A VICTORIAN SURROGACY ARRANGEMENT
- DEMONSTRATION OF NURSING STAFF COMPETENCY IN FOLLICLE DIAMETER ASSESSMENT USING AN EXTERNAL QUALITY ASSURANCE PROGRAMME
EFFECTIVENESS OF PREIMPLANTATION GENETIC SCREENING IN WOMEN UNDERGOING IVF AT OLDER AGE; A COHORT STUDY
Michelle LANE1, 2, Gabor KOVACS2, Deirdre ZANDER-FOX4, Ben MOL1, 3
1 School of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
2 Monash IVF Group, Richmond, Vic, Australia
3 The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
4 Repromed Fertility Specialists, Dulwich, SA, Australia
Aim: Does Preimplantation Genetic Screening (PGS) improve pregnancy rates in women undergoing IVF as compared to transfer without screening?
Method: We performed a retrospective cohort study in one IVF center in Adelaide, South Australia. Patients were selected based on the initial intended treatment plan provided by the clinician for undergoing PGS. Single embryo transfer was used in >98% of all PGS cases. Blastocysts were biopsied at the blastocyst stage and vitrified. Biopsied cells were assessed for euploidy using next generation sequencing. We compared women who were scheduled for an IVF/ICSI in 2015 (age 30-45) and had the intention to undergo PGS to women compared to women who underwent IVF/ICSI without PGS. Cohorts were matched for female age. The cohorts were compared for clinical pregnancy with a positive heart beat at 8-10 week scan.
Results: We compared 406 women planning to have IVF/ICSI with PGS to 544 women undergoing IVF/ICSI without PGS (female age 37.0 versus 37.0 years). The median number of embryo’s screened was 2 (range 1- 15). There were 56 women who had no euploid embryo (range 1-4 embryo’s biopsied). The probability of an aneuploid embryo was 30% (19% in women 30-34.9, 27% in women 35-38.9 and 67% in women aged 39- 45). Clinical pregnancy rates on an intention to treat basis for the entire cohort were 135/407 (30%) versus 119/544 (22%) (RR 1.5, 95% CI 1.2 to 1.9). Within women aged between 30-34.9, 35-38.9 and 39-45 these rates were 38% versus 34% (RR 1.1, 95% CI 0.83 to 1.5), 29% versus 20% (RR 1.4, 95% CI 0.97 to 2,1), and 25% versus 15% (RR 1.6, 95% CI 1.04 to 2.6) (interaction P<0.05).
Conclusion: In older women undergoing IVF, PGS at the blastocyst stage is a promising technique, specifically in women >35. Interaction between age and treatment effect further suggests causality.
ENDOMETRIAL BIOMARKERS FOR THE NON- INVASIVE DIAGNOSIS OF ENDOMETRIOSIS
Devashana GUPTA1,2,3, Louise HULL4,6, Victoria NISENBLAT4,6, L MILLER3, Ian FRASER7, Patrick BOSSUYT5, Johnson N2,3,4,6
1 Monash IVF,
2 Repromed ,
3 Fertility Plus,
4 University of Adelaide,
5 University of Amsterdam,
6 Robinson Institute of Research,
7 University of NSW
Aim: Endometriosis affects about 10% of reproductive-aged women and is a costly, chronic disease. Laparoscopy is currently the gold standard diagnostic test for endometriosis with no non-invasive tests available in clinical practice that can accurately diagnose endometriosis. Available literature, reviewing the non-invasive diagnostic potential of various tests have not utilised the methodology of the Cochrane. This is the first diagnostic test accuracy review of endometrial biomarkers for endometriosis that utilises Cochrane methodologies.
Method: To determine the diagnostic accuracy of endometrial biomarkers for pelvic endometriosis, using surgical diagnosis as the reference standard. We evaluated the tests as replacement tests for diagnostic surgery and as triage tests to inform decisions to undertake surgery for endometriosis. We considered published peer-reviewed, randomised controlled or cross-sectional studies that included prospectively collected samples from reproductive-aged women suspected of having endometriosis.
Results: We included 54 studies, most of which were of poor methodological quality. Twenty-seven studies evaluated the diagnostic performance of 22 endometrial biomarkers for PROK-1, integrins, hTERT, endometrial and mitochondrial proteome, CYP19, 17βHSD2, ER-α, ER-β, IL-1R2, caldesmon, CALD-1, neural markers (PGP 9.5, VIP, CGRP, SP, NPY, NF) and CA-125. Only data for PGP 9.5 and CYP19 were available for meta-analysis which demonstrated significant diversity for the diagnostic estimates between the studies.
Conclusion: In view of the low quality of most of the included studies, the findings of this review should be interpreted with caution. Although PGP 9.5 met the criteria for a replacement test, it demonstrated considerable inter study heterogeneity in diagnostic estimates. Several other endometrial biomarkers, including endometrial proteome, 17βHSD2, IL-1R2, caldesmon and other neural markers showed promising evidence of diagnostic accuracy, but there is poor quality evidence for any clinical recommendations. Laparoscopy remains the gold standard for the diagnosis of endometriosis, and the use of any non-invasive tests should only be undertaken in a research setting.
ELONVA FLARE: A NEW APPROACH FOR POOR RESPONDERS
Peter LUTJEN1, Prue SWEETEN2,3, Handan WAND2, P. J. ATKINSON2,3, N. Khoo2, X. Wang,2 William LEDGER23
1 Monash IVF, Clayton, Australia,
2 UNSW, Sydney, Australia,
3 IVF Australia, Sydney, Australia
Objective: Elonva (corifollitropin alfa) has been extensively studied in GnRH antagonist protocols, producing comparable pregnancy and livebirth rates when compared with standard recombinant FSH preparations. We hypothesize that the unique pharmacodynamic properties of Elonva when combined with a short agonist flare cycle (Elonva Flare Protocol, EFP) will maximise FSH exposure at the critical time of antral follicle recruitment and hence lead to a higher oocyte yield and improved pregnancy rates. The objective of our study is to report the results of this novel stimulation protocol in poor responders.
Design: This retrospective study included 55 poor responder patients treated with EFP between 2012 -2016. Patients were poor responders as defined by the “Bologna Criteria” as well as having previously undergone a conventional superovulation cycle which yielded a poor response and no pregnancy.
Materials and Methods: Patients were treated with a short-acting GnRH agonist on day 2 of the natural menstrual cycle followed by Elonva on day 3. Daily gonadotropin injections were started on D7/8 after Elonva, with dosing decided by the managing physician. Cycle data were compared with the response to the most recent previous IVF cycle and results were divided into age groups: less than 40 and 40 and over. Clinical pregnancy was defined as presence of a fetal heartbeat at 6-8 weeks gestation. Outcome variables were analysed by paired t-test.
Results: Median age was 41 years (IQR: 38-42). Compared with the previous IVF cycle, EFP was associated with a statistically significant increase in mean number of oocytes collected (3.1 vs 3.9, p=0.0402), mean fertilization rate (0.27 vs 0.45, p=0.0026) and peak oestradiol concentration (3024pmol/L vs 3692pmol/L, p=0.0399). 76% of those who had no oocytes in their previous cycle had at least 1 oocyte in the EFP cycle. In age stratified analysis, these differences were stronger among those less than 40 years. In EFP vs previous IVF, fewer cycles (10 vs 24) had no oocytes collected or a failed fertilisation. 9 (16%) of the women had an ongoing pregnancy with EFP.
Conclusion: Poor responder patients are difficult to treat and the results of our novel stimulation protocol are encouraging. EFP now requires validation in a RCT.
THE EFFECT OF ADJUVANT THERAPIES ON PREGNANCY RATES IN IVF
Rachael SHIRLOW 1, Martin HEALEY 2,3,4, Michelle VOLOVSKY 1, Vivien MACLACHLAN 4, Beverley VOLLENHOVEN 1,4,5
1 Monash University, Melbourne, Australia,
2 University of Melbourne, Melbourne, Australia,
3 Royal Women’s Hospital, Melbourne, Australia,
4 Monash IVF, Melbourne, Australia,
5 Monash Health, Melbourne, Australia
Aim: Many adjuvant therapies are employed during in vitro fertilization (IVF) treatment in an attempt to improve treatment outcomes. The objective of our study was to evaluate the effect of adjuvants dehydroepiandrosterone (DHEA), melatonin, filgrastim, growth hormone (GH), testosterone and cabergoline on pregnancy and live birth rates.
Method: This is a retrospective cohort study of all embryo transfers (ETs) between 2011 and 2015 (N=29,852) from a multi-site IVF clinic. One ET was randomly chosen for each patient to avoid bias (N=11,051). Use of six adjuvant therapies was recorded. Outcomes were chemical pregnancy, clinical pregnancy, live birth and pregnancy loss. Univariate comparison of proportions was performed with Chi square testing. Logistic regression analysis was used to control for confounders, while assessing the independent effects of six adjuvant therapies.
Results: Analysis of DHEA and melatonin use demonstrated no significant effects but showed consistent trends of lower pregnancy and live birth rates. Similar, non-significant trends were observed with filgrastim use, as well as a significant increase in chemical pregnancy losses (OR 2.64 CI 1.18-5.92). Of note, GH significantly reduced chemical pregnancy (OR 0.57 CI 0.37-0.87), clinical pregnancy (OR 0.68 CI 0.40-0.98) and live birth (OR 0.55 CI 0.33-0.92) rates. Significant reduction in chemical pregnancy rates (OR 0.73 CI 0.58-0.91) was also seen with testosterone. The only adjuvant therapy showing beneficial effects was cabergoline with increased chemical pregnancy (OR 2.27 CI 1.20-4.29), clinical pregnancy (OR 1.98 CI 1.06- 3.69) and live birth (OR 2.08 CI 1.10-3.92) rates.
Conclusion: Among the adjuvants examined, there is early evidence for cabergoline to improve pregnancy and live birth rates. There is evidence that GH reduces pregnancy and live birth rates and trends to suggest DHEA, melatonin, filgrastim and testosterone may also negatively affect pregnancy and live birth rates.
PSYCHOLOGICAL CHARACTERISTICS OF PARTICIPANTS TO A VICTORIAN SURROGACY ARRANGEMENT
Sarah NOWOWEISKI1, Celia GONCALVES2, Marianne TOME1, Rita ALESI2, Jane FISHER3, John McBAIN1
1 Melbourne IVF, Melbourne, Victoria
2 Monash IVF, Melbourne, Victoria
3 Jean Hailes Foundation, Melbourne, Victoria
Aim: The aim of the current study was to identify the psychological characteristics of all parties presenting to a major Victorian ART Clinic to undergo surrogacy treatment.
Method: Commissioning women, commissioning men, surrogate women, surrogate’s partners, and egg donors were invited to complete a number of psychometric scales, measuring factors related to personality, mood, intimate relationships, attachment, social support, and the impact of infertility experiences. Descriptive statistics and one sample t-test were used to compare results with population norms or comparison groups.
Results: Fifty participants were included in the study and the relationship between parties was identified as ‘friend’ followed by ‘relative’. Commissioning couples were heavily burdened by their infertility and commissioning women reported a greater reliance on their significant other for support. Commissioning men and women, and surrogates, reported similar levels of care and control within their relationship, which is inconsistent with previous findings that commissioning women and surrogates are more dominant (Braverman & Corson, 1992). Commissioning men and women, and surrogates were likely to have secure attachment orientations; they were no more anxious in relationships than the general population and in fact, they were significantly less fearful of dependence and interpersonal intimacy. Commissioning women’s personality profiles reflected a tendency to be more affected by somatic complaints, anxiety, depression, identity problems and affective instability, which is likely related to the medical problems commonly associated with their infertility. Personality profiles of surrogate women indicated a lowered sense of selfworth, which is also inconsistent with the previous finding (Braverman & Corson, 1992) that surrogates portray more narcissistic traits.
Conclusions: This is the first study investigating the psychological characteristics of participants to an altruistic surrogacy arrangement in Victoria. The results indicate that parties possess favourable attributes in their ability to negotiate interpersonal relationships, secure attachments, and support systems, which may promote best outcomes for psychological health for all parties. Differences identified between overseas findings may relate to the non-commercial aspects of the Victorian context.
DEMONSTRATION OF NURSING STAFF COMPETENCY IN FOLLICLE DIAMETER ASSESSMENT USING AN EXTERNAL QUALITY ASSURANCE PROGRAMME
Jan MACKENZIE1, Jim STANGER2, Hassan W. BAKOS3
1,3 Next Generation Fertility, Monash IVF Group, Sydney, Australia,
2 FertAid Pty Ltd, Newcastle, Australia
Aim: The aim of this study was to assess the proficiency of nursing staff performing Follicle Diameter (FD) assessment using an online External Quality Assurance (EQA) programme; FertAid Pty Ltd.
Method: The programme contains a monthly release of >10 images collected from a video of real time FD assessment. Participants were required to nominate a slide that best reflects their estimate of the widest diameter and estimate the distance from one side of the follicle to the opposite side. Results from Next Generation Fertility (NGF) staff were compared to all other trained nursing staff enrolled in the scheme in 2014.
Results: The summary for 12 iterations are displayed in Table 1. Data include the mean and SD, %CV for both the NFG staff and all participants and a t-test for the variation between the two groups. Table 1. The comparison on FD estimations between NFG staff and all trained EQA participants.
Conclusion: There was remarkably good agreement of FD estimations between NFG staff and all other trained participants over the whole range of follicle sizes. Furthermore, there was a high level of uniformity among all participants over all follicle sizes demonstrating that nursing staff who have received appropriate training are able to provide a reliable estimate for FD for clinical use in determining the optimal time for ovulation.