O-243 Wednesday, October 22, 2014 12:00 PM

MOST PATIENTS WOULD BENEFIT FROM MOVING MOREQUICKLY TO IVF: RESULTS FROM A COST-EFFECTIVENESSANALYSIS OF A LARGE RETROSPECTIVECOHORT. H. V. Karvir,a M. Elashoff,a D.-E. Parfitt,a

A. B. Copperman,b P. Yurttas Beim.a aCelmatix, Inc, NewYork, NY; bRepro-ductive Medicine Associates of New York, New York, NY.

OBJECTIVE: Given limited insurance coverage for many infertility treat-ments, cost is often a major driver of patient decision-making and, therefore,outcomes. Patients understandably tend to gravitate to less expensive optionsfirst, however, these options often convey lower likelihoods of success. In thisstudy, we aimed to generate personalized models to accurately predict themost cost effective strategy to achieving a live birth (LB) outcome on a pa-tient-level basis.

DESIGN: De-identified retrospective data from a large academic repro-ductive medical center (38,036 cycles; 13,086 patients).

MATERIALS AND METHODS: Using clinical metrics available beforetreatment initiation, predictive models were developed to assess a patient’spersonal chances of achieving LB over multiple cycles of self fresh/frozenembryo transfer (FET) in-vitro fertilization (IVF), donor-egg recipient(ER) fresh/FET IVF, and non-IVF fertility treatments (n-IVF). Predictedprobabilities from the three treatment options were then propagated througha decision model that simulated all possible treatment permutations over sixcycles. Inverse probability weighted cumulative cost was then used to deter-mine the most cost effective treatment plan for each patient.

RESULTS: The majority of patients in our study (72%) were treated firstwith hormonal treatments and/or inseminations prior to IVF (mean 4.6� 2.5cycles). Among these patients, 35% discontinued treatment without pro-gressing to IVF. Only 28% of patients initiated with IVF first. In contrast,our cost effectiveness analysis demonstrated that a majority of these patients(73%) would have benefitedmost from initiating IVF upfront. The remainingpatients would have benefited most from undergoing two cycles of n-IVF,followed by IVF.

CONCLUSION: The most cost effect treatment strategy for achieving aLB outcome for the majority of patients is to pursue IVF treatment upfront.Third party payers have the opportunity to use these observations to revise‘‘less before more’’ treatment strategies and consider ‘‘direct-to-IVF’’ as amore efficient paradigm. These findings have significant implications givenour observation that, all too commonly, infertility treatment does not employthe most cost effective strategy.

Supported by: Celmatix, Inc.

Donor Egg Blastocyst Transfers

FreshTransfer

FrozenTransfer

Frozen PGSTransfer

Transfers (N¼) 55 35 30Ave # embryos

transferred1.8 1.7 1.6

Clinical PregnancyRate

67.3% (37/55) 57.1% (20/35) 83.3% (25/30)

SAB Rate 10.8% (4/37) 15.0% (3/20) 8.0% (2/25)Ongoing/Delivered

Rate58.2% (32/55) 48.6% (17/35) 76.7% (23/30)

Implantation Rate 53.9% (55/102) 44.3% (27/61) 67.1% (49/73)

O-244 Wednesday, October 22, 2014 12:15 PM

IMPACT OF INSURANCE COVERAGE AND FINANCIAL INCEN-TIVES ON ESET ACCEPTANCE IN A NON-MANDATEDSTATE. F. I. Sharara.a,b aVirginia Center for Reproductive Medicine, Re-ston, VA; bOB/Gyn, George Washington University, Washington, DC.

OBJECTIVE: The use of elective single embryo transfers (eSET) in ARTwas only 15% in 2012, and significantly lags behindWestern European coun-tries where eSET is the norm. The reasons for this are many, including theabsence of universal coverage for ART, lack of patient education, desirefor twin pregnancy, financial reasons, inadequate counseling by providers,and fear of a lower success rates compared to double embryo transfers(DET). Even in mandated states, eSETutilization is suboptimal. We have de-signed an innovative trial to encourage couples undergoing ART to chooseeSET: patients were offered free HMG (Menopur), free freezing of all extraembryos, and free storage for one year (> $5,000 savings) if they agreed tohave an eSET.

DESIGN: Prospective, pilot study.MATERIALS AND METHODS: We included couples with age up to 38

yo, couples with prior failed cycles, women with uterine fibroids or prioruterine surgery, and women with diminished ovarian reserve. Only coupleswith very severe male factor (testicular sperm or counts < 1 million/cc)were excluded. To date, 68 women (< 38 yo) have participated in the study.All couples had an extensive consultation stressing the perinatal, neonatal,and maternal morbidities associated with twin gestation before startingART and again at the time of ET. All patients received daily injections ofHP-hMG (Menopur) in GnRH-a or GnRH-ant cycles, and all cycles wereblastocyst transfers. Only one cycle/patient was included. P<0.05 wasconsidered significant.

e84 ASRM Abstracts

RESULTS: Of the 68 couples, 41 (60.3%) agreed to have an eSET aftercounseling. Of the 68 couples, 30/68 (44.1%) had insurance coverage, andof these, 21 (70.0%) agreed to undergo eSET. In contrast, 38 couples wereself-pay (63.9%), and 20 (52.6%) agreed to undergo eSET (P ¼ NS). Ofthe 30 couples with insurance coverage, 26 cycles were completed to date,the clinical PR was 73.1% (19/26), and ongoing/delivery PR were 57.7%(15/26). Of those without insurance coverage, 33 completed a cycle andthe clinical PR and ongoing/delivered PR were 72.7% (24/33) and 54.5%(18/33) (P ¼ NS compared to those with insurance).CONCLUSION: By using innovative incentives and extensive counseling

we were able to increase our eSET rate in this pilot study to over 60% in anon-mandated state using ‘‘real-world’’ patients. While statistically notdifferent, couples who have insurance coverage for ARTwere more accept-ing of eSET for their initial cycle. Insurance companies need to not juststrongly encourage but to incentivize couples to proceed with eSET. Thestudy is ongoing.Supported by: Ferring.

O-245 Wednesday, October 22, 2014 12:30 PM

SELECTION OF CHROMOSOMALLY NORMAL EMBRYOS IM-PROVES EGG DONOR FROZEN TRANSFER PREGNANCYRATES. C Wagner Coughlin,a B. Kaplan,b A. Beltsos,b

K. Bauckman,c S. Munne.c aGlobal Genetics Institute, Highland Park, IL;bFCI Highland Park IVF Center, Highland Park, IL; cReprogenetics, Living-ston, NJ.

OBJECTIVE: Even in egg donor cycles, 30-40% of blastocysts are chro-mosomally abnormal. The objective of this study is to compare the outcomesin first time egg donor recipient cycles of fresh embryo transfers vs cryotransfers with or without PGS.DESIGN: Retrospective cohort study.MATERIALS AND METHODS: 120 recipients having their first donor

egg transfer were included in this study. Recipients either had a fresh transferor elective freeze all of available blastocysts. Freeze all patients elected toeither have trophectoderm biopsy performed prior to vitrification or not. Tro-phectoderm biopsy was performed on day 5 or 6 depending on degree ofexpansion. Biopsied cells were analyzed by array CGH and only euploid em-bryos were replaced. The endometrial preparation was the same in all threegroups of recipients.RESULTS: Pregnancy outcome data for donor egg recipient transfers are

shown in Table 1.

CONCLUSION: There was no difference in outcomes comparing freshtransfers and frozen transfers. Pregnancy outcomes were significantly higherin the PGS FET group compared to FET only for Pregnancy rates (p<0.05),ongoing pregnancy rates (p<0.05) and Implantation rates (p<0.025). Donoregg recipient transfers are an ideal paradigm to assess the effect of PGS dueto favorable prognosis and controlled uterine environment . In this ideal pa-tient population , PGS of donor egg embryos showed high implantation ratesand low miscarriage rates suggesting PGS may be considered for recipientpatients requesting PGS of donor egg embryos.

Vol. 102, No. 3, Supplement, September 2014