transfer (ET) timing.

We sought to compare outcomes among mNC-FET with O-168 2:10 PM Tuesday, October 17, 2023
and without P4 monitoring.
MATERIALS AND METHODS: All single blastocyst mNC-FET 10/ DIENOGEST AS A FEASIBLE ALTERNATIVE FOR LU-
2021-1/2023 at a single center were prospectively evaluated. Patients with TEINIZING HORMONE SUPPRESSION IN PROGES-
uterine factor infertility were excluded. TIN-PRIMED OVARIAN STIMULATION. Buo Jia Lu,
Patients underwent baseline testing CD 1-3. A subset of patients initiated M.D., Chi-Huang Chen, MD, PhD Taipei Medical University
letrozole 5mg x 5d per physician preference. Monitoring began CD12 and Hospital, Taipei, Taiwan.
hCG trigger was administered with dominant follicle R17mm. ET timing
was determined per physician preference either with P4 monitoring (daily OBJECTIVE: The study aim was to determine whether dienogest can be
post-trigger P4 until R 5ng/mL, with ET scheduled 3d later), or without used as an alternative progestin in progestin-primed ovarian stimulation
P4 monitoring (ET scheduled 7d after hCG without further monitoring). (PPOS).
Cycle characteristics were compared between cycles with and without P4 MATERIALS AND METHODS: This retrospective study analyzed pa-
monitoring using univariate generalized linear mixed models (GLMM) ad- tient data between January 2019 and October 2020. A total of 106 patients
justing for random effects within patients. Multivariate GLMM were used under age 40 years with normal ovarian reserves were included. After treat-
to determine adjusted odds ratios (aOR) and 95% confidence intervals (CI) ment with either dienogest (n ¼ 65) or medroxyprogesterone (MPA) (n ¼
for cycle outcomes (clinical pregnancy rate ¼ CPR, spontaneous abortion 41), all patients underwent in vitro fertilization (IVF) or intracytoplasmic
rate ¼ SABR, and ongoing pregnancy rate ¼ OPR) adjusted for age, parity, insemination or social egg freezing using the freeze-all strategy. Stimulation
prior SAB or failed ET, BMI, ovulatory dysfunction, endometrial thickness, characteristics during controlled ovarian stimulation, and embryological and
and luteal support. A sub-analysis was performed among euploid transfers. pregnancy outcomes were analyzed.
RESULTS: Among n¼296 cycles, 115 used P4 monitoring. Of these, 56% RESULTS: Basic characteristics were comparable between treatment
had ET 7d after hCG, whereas 22% had ET earlier and 22% had ET later. groups. The number of oocytes retrieved was smaller in the dienogest group,
but the numbers of all cryopreserved embryos were similar. One MPA group
patient had luteinizing hormone (LH) levels of 21.23 IU/L after six days of
Cycle characteristics and outcomes
ovarian stimulation, leading to administration of 0.25 mg gonadotropin
P4 monitoring No P4 monitoring releasing hormone (GnRH) antagonist to prevent a premature LH surge. Total
N¼ 115 N¼181 stimulation days and gonadotropin doses were similar between groups. After
excluding patients who had received GnRH antagonist, the ratio of trigger
Characteristica day LH, minus baseline LH and divided by baseline LH, was significantly
Age (y)b 35.5  3.7 33.8  3.6 higher in the dienogest group (P ¼ 0.0267). There was no significant be-
Prior SAB 66 (57.4) 83 (45.9) tween-group difference in live birth rates from the first frozen–thawed em-
BMI (kg/m2) 26.1  6.4 26.3  6.0 bryo transfer cycle.
Anovulatoryb 7 (6.1) 28 (15.5) CONCLUSIONS: Dienogest may be a feasible alternative in PPOS.
Letrozoleb 61(53.0) 162 (89.5) Compared with MPA, dienogest may better suppress premature LH surges
Endometrial thickness (mm)b 9.0 (1.8) 8.4 (1.9) without compromising IVF outcomes.
Outcome, all cyclesc IMPACT STATEMENT: To the best of our knowledge, this is the first
CPR 64.3 60.2 study to compare dienogest and MPA during COH within a general patient
1.22 (0.67-2.21) Ref population. Since it was retrospective, a prospective RCT will need to deter-
SABR 5.4 12.8 mine which protocol is more effective in terms of safety and cost.
0.70 (0.17-2.94) Ref
OPR 60.9 52.5
1.31 (0.73-2.35) Ref O-169 2:20 PM Tuesday, October 17, 2023
Outcome, PGT cycles N¼89 N¼108
only (N¼197)c INTRAOVARIAN INJECTION OF PLASMA RICH IN
CPR 66.3 63.9 GROWTH FACTORS IMPROVES FOLLICLE GROWTH
1.11 (0.53-2.32) Ref AND OOCYTE QUALITY AFTER COS IN AGED
SABR 3.4 10.1 WOMEN WITH DIMINISHED OVARIAN RESERVE.
0.13 (DNC) Ref Sonia Herraiz, Ph.D.,1 Paloma Ruiz, MD,2 Ana Ballester, Bsc,2
OPR 64.0 57.4 Nicolas Garrido Puchalt, M.Sc., Ph.D.,3 Antonio Requena, MD,4 Juan A.
1.28 (0.62-2.66) Ref Garcia-Velasco, M.D., PH.D.,5 Manuel Munoz, MD PhD2 1IVI Foundation
- IIS La Fe, Valencia, Spain; 2IVIRMA ALICANTE, Alicante, Spain; 3IVI
CPR ¼ clinical pregnancy rate, SABR ¼ spontaneous abortion rate, OPR ¼ Foundation - Instituto de Investigacion Sanitaria La Fe (IIS La Fe), Valencia,
ongoing pregnancy rate. DNC ¼ did not converge. Spain; 4IVI RMA Spain, Madrid, NJ, Spain; 5IVI RMA Madrid, Madrid, Ma-
a
Mean  SD or N (%). drid, Spain.
b
Statistically different at p<0.05. OBJECTIVE: Plasma rich in growth factors (PRGF) or platelets (PRP)
c
%, aOR (95% CI). contain up to 800 types of proteins, cytokines, hormones, and growth factors.
Indeed, intraovarian PRP injection has been proposed to improve the repro-
CONCLUSIONS: CPR and OPR were higher and SABR was lower among ductive performance in diminished ovarian reserve (DOR) and POI women
cycles with P4 monitoring; however, after adjusting for confounders, these with encouraging results promoting follicle growth. Thus, we aimed to eval-
differences were not significant. uate if PRGF intraovarian optimizes the ovarian reserve but also the IVF out-
IMPACT STATEMENT: Preliminary data suggest that mNC-FET out- comes in aged DOR patients.
comes may be similar with or without P4 monitoring. Ongoing evaluation MATERIALS AND METHODS: Retrospective study including 348
among a larger cohort is warranted to evaluate the potential benefits of this women (25-45 years) who received intraovarian PRGF between 2020 and
novel transfer timing technique. 2022 at IVIRMA Alicante (Spain). The study was approved by the IRB com-
SUPPORT: None mittee of La Fe University Hospital (2112-FIVI-109-SH).

FERTILITY & STERILITYÒ e71

 Patients underwent a PRGF injection (Endoret kit; Biotechnology Institute
S.L, Spain) in both ovaries and a follow up for ovarian reserve biomarkers
(AFC, AMH) during 4 months after treatment, to evaluate follicular reactiva-
tion. Then, reproductive and IVF outcomes were compared with previous
ovarian stimulation cycles (COS) started in our clinics, when available. Study
variables were compared to basal levels with a paired t-test.
RESULTS: A total of 348 aged DOR patients (AMH: 0.290.46ng/ml;
AFC0: 2.02.2) underwent PRGF intraovarian treatment, and showed statis-
tically significant increases in AFC (AFC1: 4.13.6, p<0.0001; AFC2:
3.53.6, p<0.0001; AFC3 3.02.4, p<0.0001 and AFC4: 3.52.4, p¼NS)
during the entire follow up, compared to basal levels established before
receiving the PRGF injection.
Among all the included patients, 137 of them (39.83.8 y.o) initiate a total
of 255 COS in our clinic, after PRGF that were compared with their previous
156 COS performed before PRGF (39.73.1 y.o). Although AMH and E2
levels were significantly higher in their previous attempts (AMH: 0.70
0.94 vs. 0.460.56, p<0.013 and E2: 274.2359.5 vs. 149.3318.5,
p¼0.016), oocyte pick up was successfully developed in 70.2% and embryos
obtained in 57.6% of started COS after treatment.
With similar stimulation protocols, PRGF was able to improve the oocyte
maturation (69.4% vs. 79.8% p¼0.02), fertilization (64.7% vs.
75.2%,p¼0.035) and implantation rates (7.123.9% vs. 32.447.47.5%,
p¼0.040) in these aged DOR women. Moreover, the number of vitrified em-
bryos for future transfer (0.20.5 vs. 0.40.9, p¼0.035) and the biochemical
pregnancy rate (9.5% vs. 37.5%, p¼0.044) were also increased. Indeed,
33.3% of the achieved pregnancies after PRGF were spontaneous.
CONCLUSIONS: PRGF injection promoted follicle development since
the first follow-up allowing the initiation of COS cycles. Moreover, PRGF
showed positive effects on reproductive outcomes by improving oocyte
maturation, fertilization, implantation, and biochemical pregnancy rates.
IMPACT STATEMENT: PRGF intraovarian injection reactivates follicle
growth to perform COS and embryo obtention in a poor prognosis population
of aged patients with DOR. The effects recorded in our cohort suggest that
PRGF might improve quality and development potential of the obtained
MII oocytes. However, large clinical trials with a proper non-intervention
control group are still requested to elucidate the efficacy and mechanisms
of the technique.
SUPPORT: SH participation was supported by Instituto de Salud Carlos III
(ISCIII; C19/00141) co-funded by the European Social Fund (ESF) ‘‘Invest-
ing in your future’’).
ORAL ABSTRACT SESSION: BUSINESS OF MEDICINE
O-170 1:30 PM Tuesday, October 17, 2023
CONGENITAL ANOMALIES AFTER FIRST-
TRIMESTER DYDROGESTERONE THERAPY DUR-
ING IN VITRO FERTILIZATION. Wan Yang, Dr,1 Hon-
gbin Chi, MD,1 Rui Yang, Doctor,1 Ping Liu, MD;PhD,1 Rong
Li, M.D., PH.D.,2 Jie Qiao, MD1 1Peking University Third Hospital, Beijing,
China; 2Prof, Beijing, China.
OBJECTIVE: To analyze the presence of congenital anomalies in children
born after first-trimester dydrogesterone therapy during in vitro fertilization.
MATERIALS AND METHODS: Retrospective cohort study. Infertile
women who underwent embryo transfer between 2010 and 2018 (80,103
fresh cycles and 44,712 frozen cycles) were included. We divided the patients
into dydrogesterone-exposed group (group 1) and dydrogesterone-unex-
posed group (group 2) .
RESULTS: The number of newborns was 52,175. The total number of
congenital anomalies in group 1 was significantly lower than that in group
2 (105 [6.05&] vs. 274 [7.90&]; P ¼ 0.020). The incidence of congenital
musculoskeletal system malformations was also lower in group 1 (0.63&
vs. 1.33&; P ¼ 0.025). After adjustment, there was no significant difference
in the percentage of total congenital anomalies between the two groups (P ¼
0.972; odds ratio: 0.98; 95% CI: 0.59–1.62). However, the incidence of
congenital anomalies of the musculoskeletal system remained lower in group
1 (P ¼ 0.020; odds ratio: 0.2; 95% CI: 0.06–0.79), regardless of frozen or
fresh cycles. After adjustment, dydrogesterone was associated with an
increased incidence of genital birth defects (P ¼ 0.028; odds ratio: 8.35;
95% CI: 1.25–54.68). However, this difference disappeared when the data
were stratified by the number of frozen or fresh cycles.
CONCLUSIONS: First-trimester dydrogesterone therapy did not increase
the risk of congenital anomalies. Dydrogesterone might be associated with a
reduced incidence of congenital anomalies of the musculoskeletal system,
especially in frozen cycles.
IMPACT STATEMENT: Congenital anomalies are a critical public health
issue and should be a research priority. The underlying risk of drug-induced
birth defects cannot be ignored. Our study suggested that dydrogesterone
therapy did not increase the risk of congenital anomalies.
SUPPORT: the National Natural Science Foundation of China (grant No.
82001630).
O-171 1:41 PM Tuesday, October 17, 2023
THE VALIDATION AND IMPLEMENTATION OF A
SUCCESSFUL PATIENT RETENTION PROGRAM.
Candi Petersma, BA,1 Jynjer A. Schultz, MBA,2 Amy R.
Hall, B.S., R.Ph.,2 Kaylen Silverberg, M.D.1 1Texas Fertility
Center, Austin, TX; 2Catalyst Healthcare Marketing, Flower Mound, TX.
OBJECTIVE: Patient retention is a critical component of a successful
medical practice. While data regarding fertility patient retention is limited,
30-40% of medical patients choose not to return following an initial visit. Un-
like general medical patients, fertility patients are seeking a specific outcome
(pregnancy) in a concise period of time. Each treatment failure offers an exit
ramp, presumably resulting in greater attrition. It is also well known that it is
cheaper to retain an existing patient than to acquire a new one. Therefore, a
successful patient retention program should increase practice profitability
and improve patient access by encouraging more patients to pursue treat-
ment. Our objective is to determine if we can increase patient retention
through the design and implementation of a program to maintain and/or
re-initiate contact with patients who exhibited behavioral patterns indicating
a high risk of dropout.
MATERIALS AND METHODS: After extensive investigation, we insti-
tuted a non-refundable deposit to make an initial appointment, and a specific

Table 1. Congenital anomalies of the study cohorts

Group 1 Group 2 Adjusted

Count Rate (&) Count Rate (&) P-value P-value Odds ratio (95% CI)

newborns (n) 17,342 34,703

total birth defects (n) 105 6.05 274 7.90 0.020 0.927 0.98 (0.59, 1.62)
nervous system 9 0.52 31 0.89 0.146 0.991 0.99 (0.16, 6.15)
eye, ear, face, and neck 7 0.40 25 0.72 0.169 0.177 3.14 (0.60, 16.54)
circulatory system 37 2.13 83 2.39 0.563 0.790 1.13 (0.47, 2.68)
respiratory system 5 0.29 7 0.20 0.759 0.343 3.43 (0.27, 43.77)
cleft lip and cleft palate 13 0.75 17 0.49 0.245 0.839 0.86 (0.20, 3.78)
digestive system 6 0.35 24 0.69 0.122 0.332 2.34 (0.42, 12.97)
genital organs 8 0.46 9 0.26 0.229 0.028 8.35 (1.25, 54.68)
urinary system 6 0.35 16 0.46 0.547 0.298 0.41 (0.08, 2.20)
musculoskeletal system 11 0.63 46 1.33 0.025 0.020 0.23 (0.06, 0.79)
other congenital malformations 6 0.35 20 0.58 0.268 0.778 0.76 (0.12, 5.03)
chromosomal abnormalities 3 0.17 9 0.26 0.760 0.914 1.22 (0.03, 44.15)

e72 ASRM Abstracts Vol. 120, No. 4, Supplement, October 2023