Authors
Ariella YazdaniJawaria AmirNina DesaiMeng YaoMindy S. Christianson
Topics
COVID-19 and healthcare impactsCervical Cancer and HPV ResearchPoisoning and overdose treatmentsindicated FP in SARTCORS is central to measuring national progress in reach of FP services.O-220 11:51 AM Wednesday, October 29, 20251Jawaria Amir, MD,2Nina Desai, H.C.L.D, PH.D.,3Meng Yao, MS,4Mindy S. Christianson,M.B.A., M.D.2 1Cleveland Clinic Foundation, Cleveland, OH;2ClevelandClinic Foundation, Beachwood, OH;3Cleveland Clinic, Beachwood, OH;Cleveland Clinic, Cleveland, OH.OBJECTIVE: To investigate the risks associated with controlled ovarian hyperstimulation (COH) and oocyte retrievals in the United States and to identify potential risk factors associated with an increased risk of complica tions. MATERIALS AND METHODS: The Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) was used to analyze all oocyte retrievals among females aged 18-42 years, conducted be tween the years 2016 and 2021. The primary outcome was the composite complications that included infection, hemorrhage, anesthesia complication, psychological stress, medication side effect, maternal death, hospitalization, thrombosis, adnexal torsion, and ovarian hyperstimulation syndrome (OHSS). The secondary outcome was an analysis of the individual complica tions listed in the composite outcome. Statistical analysis between contin uous measures were performed using T-tests and Wilcoxon rank sum tests. Categorical factors were compared using Pearson’s chi-square tests or Fisher’s Exact tests. Incidence rates of composite and individual complica tions were calculated for full cohort and then compared between subgroups according to the indication for oocyte retrieval: in vitro fertilization (IVF) with transfer within a year, embryo banking, oocyte cryopreservation, and oocyte donation. Mixed effect logistic model was fitted to control for cova riates and patient cluster effect. All analyses were done using SAS and a p<0.05 was considered statistically significant. RESULTS: A total of 859,415 oocyte retrieval cycles were analyzed. Overall, complications were reported among 3,374 retrievals, or 0.39% of all cycles. OHSS was the most frequently reported complication at 0.28% (n=2,420). Patient factors associated with a higher rate of complications included increased anti-Mullerian hormone (AMH), smoking, male factor infertility, polycystic ovary syndrome, and tubal factor infertility (p<0.001). Oocyte retrievals at sites in the Midwest and South had a higher rate of reported complications compared to the Northeast and West. Body mass index (BMI) was not associated with complication rates (p=0.25). Pa tients with endometriosis were significantly less likely to experience compli cations compared to those without endometriosis (p<0.001). In subgroup analysis of indication for oocyte retrieval, patient’s undergoing IVF had the highest reported total complication rate, compared with embryo banking, oocyte cryopreservation, and oocyte donation. CONCLUSIONS: COH with oocyte retrieval is associated with a low overall complication rate (0.39%), with OHSS the most frequently reported.Higher AMH, smoking, certain infertility diagnoses, and geographic region were linked to increased risk. Among procedure indications, IVF cycles car ried the highest complication rate. IMPACT STATEMENT: While oocyte retrieval cycles have an overall low rate of reported complications, individual risk assessment is essential to pro vide accurate patient counseling and set appropriate clinical expectations.O-221 12:02 PM Wednesday, October 29, 2025UNDERGOING INTRAUTERINE INSEMINATION PRIOR TO IN VITRO FERTILIZATION IS NOT COST EFFECTIVE. Kiley Hunkler, M.D., MSt, MSc,1David Boedeker, D.O., MHA,1Jing Wu, MD, MS,2Kerry S. J. Flannagan, PhD,2Micah J. Hill, DO,3Kathleen Devine, MD1Walter Reed National Military Medical Center, Bethesda, MD;Fertility, Rockville, MD;3 NIH-NICHD, Germantown, MD; 4Shady GroveFertility, Rockville, MD.OBJECTIVE: Many insurance companies require patients with unex plained infertility to undergo ovarian stimulation with intrauterine insemina tion (OS/IUI) prior to in vitro fertilization (IVF). We aimed to identify the cost effectiveness of stepwise OS/IUI prior to IVF compared to immediate IVF in the unexplained infertility population. MATERIALS AND METHODS: Using a decision tree mathematical model, we compared stepwise OS/IUI to immediate IVF in terms of the pri mary outcome of cost per live birth. We assumed a patient with unexplained infertility age 35-37, with average height and weight for all treatment arms. In the stepwise OS/IUI arm, we modeled one, two, and three OS/IUI cycles prior to IVF. After completing their assigned OS/IUI cycles, patients would move onto IVF if they did not have a live birth. Once a patient graduated to IVF or if they were assigned to immediate IVF, we assumed the patient would undergo a retrieval cycle and fresh transfer, and if they did not have a live birth then they underwent single frozen embryo transfers (FETs) until they had a live birth or exhausted all blastocysts. Those without a live birth or remaining embryos after one retrieval cycle under went a second and if needed a third retrieval cycle. Self-pay pricing at our center furnished cost inputs for OI/IUI, IVF retrieval cycle with fresh transfer, and FET costs. RESULTS: Cumulative pregnancy rates per OS/IUI cycle were calculated using internal data from our center. Probability of live birth from clinical pregnancy was calculated using published data. The Society for Assisted Reproductive Technology (SART) 2022 data yielded 3.9 embryosfor transfer and estimated probabilities of live birth persingle embryo transfer: 26.4% for the fresh embryo transfer, 44.9% for the second transfer but first FET, and 47.9% for the third and fourth transfers or second and third FETs. After completing three retrieval cycles, the probability of achieving at least one live birth was over 99% in all groups and the costs per live birth was $142,026 in the immediate IVF group, compared to $144,561, $147,016, and $149,111 in the groups who underwent one, two, and three OS/IUI cycles prior to IVF groups, respectively. After completing one retrieval cycle, the probability of live birth was 88.87% in the immediate IVF group, compared to 90.26%, 91.35%, and 92.31% in the one, two, and three OS/IUI cycles prior to IVF groups, respectively. The cost per live birth following oneYear 2016 2017 2018 2019 2020 2021Total n Median (range)* Total n Median (range)* Total n Median (range)* Total n Median (range)* Total n Median (range)* Total n Median (range)*Total cancer in US 132453 1807 (185-14508) 130561 1884 (195-14789) 132408 1882 (200-14993) 133774 1931 (212-15261) 123850 1745 (226-13942) 133346 1840 (200-14970)Walgreen utilization910 45 (0-130) 1075 47 (0-195) 1181 72 (0-188) 1355 66 (0-202) 1316 79 (0-217) 1332 93 (0-18)Gonadotoxic FP90 0 (0-55) 204 8 (0-65) 269 10 (0-110) 324 12 (0-100) 298 10 (0-91) 335 11 (0-163)Per 10,000 cancer cases per stateFERTIL STERIL® e85
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PublishedDec 1, 2025
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