1. VTF-All /PGS Effect : LBR / cycle / 1st ET
BLASTOCYST VITRIFICATION and PREIMPLANTATION GENETIC SCREENING (PGS) HAVE FACILITATED “FREEZE-ALL” CYCLES:
A CHANGE IN PRACTICE MANAGEMENT BENEFITING BOTH THE PATIENTS AND LABORATORY
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PosterPlus
RE Anderson, 1  F Garner, 2  Zozula S,1 JB Whitney, 1 B Shapiro , 2 MC Schiewe​1
1 Ovation Fertility/SCCRM, Newport Beach, CA​; 2 Ovation Fertility/FCLV, Las Vegas, NV
Introduction
Results
Materials & Methods
VTF-All /PGS Effect : LBR / cycle / 1st ET
PGS Validation
(Whitney et al., JARG 2016)
Optimization of embryo culture practices led to our highest IVF success rates across all age groups following fresh embryo transfer (ET) in Live birth rates (LBRs) per ET ranged from 75.3% for donor egg (DE) cycles to 53.2%, 55.1%, 36.8% and 20.7% for women <35 years old, years old, years old and years old, respectively, transferring a mean of 2.0 to 2.6 embryos/ET.
In the competitive world of commercial IVF in Southern California, the latter success rates were favorable, ranking in the upper 10th percentile nationally.  However, more than 1/3 of the autologous egg and 3/4 of the donor egg ETs resulted in multiple births in 2010, thus stimulating our lab to adopt the Freeze-All / SET policy we incorporate today.
Our routine laboratory procedures include ICSI, group culturing in Global™ medium + 7.5% protein supplement, tri-gas incubation, transvaginal ultrasound guided ET, and vitrification of blastocysts with microSecure (µS-VTF) in non-DMSO I.C.E. solutions (Innovative CryoEnterprises, NJ) at Ovation Fertility Newport Beach or Cryotops with DMSO/EG at Ovation Fertility Las Vegas, with or without blastocyst biopsy (BLBx). 
Trends & Discussion
Although the mean number of fresh DE embryos transferred decreased from 2.0 to 1.7 between 2010 to 2014, respectively, little change in LBR (55.8% to 56.8%) has occurred.
Conversely, a dramatic inverse trend between ET# & % implantation occurred since 2012.
The steady adoption of BLBx-PGS using aCGH, in conjunction with vitrification-all/VFET cycles is the key factor, especially evident post-2013.
For every 3 live births with fresh autologous transfers in 2015, there were 4 live births with frozen autologous transfers. That is, roughly 21,000 vs 28,000 in total across age groups. That ratio of 1.33 is triple what it was in 2012 (0.44). We expect this rapid trend has continued into 2017, as more programs adopt “freeze-all” cycles.
US Centers for Disease Control (CDC), reporting years 2014/2015
SCCRM stats:
< 35 yr old
35-37 yr old
38-40 yr old
41-42 yr old
Mean # ET     
1.1 / 1.0   
1.2 / 1.1 
1.2 / 1.1   
1.1 / 1.1  
% Implantation
rate
77.9 / 71.3
61.0 / 69.4
60.0 / 71.4
84.0 */ 64.3
% Live birth
rate/ET      
73.1 / 68.8 
66.2 / 65.7
55.0 / 69.1 
69.6 / 58.6 
% Healthy, term
singleton/ET   
56.4 / 61.3*
56.3 / 55.7
48.3 / 54.4
69.6 */ 48.3
* Highest nationally reported value that year regardless of age.
Objectives
2015, Age <35
= Median values for thawed embryos:
1.5 embryos / 45% IR
2014, Age <35
1.6 embryos / 41% IR
2012, Age <35
1.9 embryos / 28% IR
OF-NB affiliates
OF-LV affiliate
OF-NB Dr. <2015
2013, Age <35
1.8 embryos / 36% IR
Conclusions
With the implementation of clinical vitrification and progressive adoption of blastocyst biopsy/PGS, we aimed to improve the quality of patient care by routinely transferring single thawed euploid embryos, reducing miscarriages and increasing single, healthy, term live births. ​
Ovation  LOCATIO
The global adoption of highly reliable vitrification practices has facilitated significant, progressive improvements in IVF-FET outcomes over time.  In conjunction with blastocyst biopsy/PGS, single euploid embryo transfer (SEET) has optimized embryo utilization rates, and significantly elevated LBRs/cycle in women under 38 years old. Although the same trend was not significant on a per cycle basis in older women (38-42 years old), we have appreciably reduced the trauma/depression associated with pregnancy loss and treatment time interval needed to achieve the desired outcome, “one embryo - one baby”.
National average for fresh transfers
National average for fresh transfers
(national average, fresh)
(national average, fresh)
Study Design
Discussion
The annual Assisted Reproductive Technology national reports by the U.S. Centers for Disease Control (CDC) from 2010 to 2015 were used for these analyses. 
Our goal was to contrast industry trends regarding fresh DE-ET (control group) to autologous frozen ET cycles, in terms of the number of embryos transferred, implantation rate and LBR/ET, and compare how our clinical practices improved the quality of patient care.
While achieving higher success and improved moral standards of patient care with PGS comes at a greater financial cost to the patient and profit to the clinic/lab, laboratories must hire and pay more experienced embryologists to meet the demands of todays’ technology. Unfortunately, an under-supplied workforce of qualified staff may prove to be a limiting factor that requires serious attention.
By trusting our vitrification system and BL-Bx technique, we have effectively reduced twinning rates without a decline in implantation success by adopting “freeze-all” cycles with the routine transfer of single euploid blastocysts.
Disclosures: JW and REA serve as educators for Illumina. MCS developed mS-VTF without any commercial interests.