David Walker

Maturational Asynchrony between Oocyte Cumulus-Coronal Morphology and Nuclear Maturity in Gonadotropin-Releasing-Hormone Agonist Stimulations

OBJECTIVEnTo determine oocyte meiotic maturity and asynchrony between cumulus-coronal morphology and nuclear maturity after gonadotropin-releasing hormone agonist (GnRH-a) and norethindrone-programmed stimulations.nnnDESIGNnOocyte meiotic maturity was evaluated at follicular aspiration in 4,961 oocytes after GnRH-a/follicle-stimulating hormone (FSH)/human menopausal gonadotropin stimulations (hMG) for in vitro fertilization patients and 299 oocytes after norethindrone-programmed clomiphene citrate (CC)/hMG in oocyte donors. Maturational asynchrony between the oocytes cumulus-coronal morphology and nuclear maturity was evaluated in 2,336 oocytes.nnnSETTINGnIn vitro fertilization program at the University of Iowa Hospitals and Clinics; academic tertiary care center.nnnINTERVENTIONSnAfter evaluating oocyte cumulus-coronal maturity, cumulus masses were spread to determine oocyte nuclear maturity.nnnRESULTSnFourteen percent, 17%, 50%, 17%, and 2% of oocytes were prophase I, metaphase I, metaphase II, postmature metaphase II, and atretic, respectively. Asynchrony was noted in 28% of prophase I, 71% of metaphase I, 11% of metaphase II, 45% of postmature metaphase II, 32% of atretic, and 28% of all oocytes. Significant differences were not found between GnRH-a and norethindrone-programmed stimulations in asynchrony between cumulus-coronal morphology and nuclear maturity or percentage of prophase I, metaphase I, metaphase II, postmature metaphase II, or atretic oocytes. Sixty-seven percent of oocytes possessed a polar body at retrieval. The rate of fertilization was significantly higher for metaphase II oocytes than postmature metaphase II and metaphase I oocytes > prophase I oocytes. Parthenogenetic activation tended to be highest for postmature metaphase II oocytes. Embryo cleavage was significantly higher for postmature metaphase II, metaphase II, and metaphase I oocytes than for prophase I oocytes.nnnCONCLUSIONSnThis is the first report of asynchrony between cumulus-coronal morphology and nuclear maturity at follicular aspiration in GnRH-a and norethindrone-programmed stimulations. Asynchrony was observed in 28% of oocytes. A higher percentage of oocytes possessed a polar body at egg retrieval with these stimulation regimens compared with rates reported previously for FSH, FSH/hMG, and CC/hMG stimulations.

Conditions of oocyte storage and use of noninseminated as compared with inseminated, nonfertilized oocytes for the hemizona assay

Objectives To examine differences in sperm binding to the zona and recovery of oocytes from the storage vessel after oocyte preservation for the hemizona assay (HZA) by the method currently in predominant use, salt storage at 4°C, as compared with a new method that should allow for indefinite preservation of zona receptors, dimethylsulphoxide (DMSO)/sucrose in liquid nitrogen (−196°C). A second objective was to compare sperm binding to noninseminated zona as opposed to zona from inseminated, nonfertilized oocytes and to examine whether differences in binding potential were related to the patients fertilization rate from the cycle in which the oocytes for the HZA originated. Design Binding and recovery were evaluated after 1, 2, 3, 6, 9, 12, and 17 to 25months of storage. Setting In vitro fertilization and andrology laboratories at the University of Iowa Hospitals and Clinics; academic tertiary care center. Results Binding of sperm was significantly lower for nonfertilized oocytes stored >12months in salt at 4°C than for those stored in liquid nitrogen. Binding was similar after storage for 1, 2, 3, 6, 9, and 12months. Oocyte recovery was significantly lower after storage in salt for >12months as compared with storage in liquid nitrogen. Greater variability in sperm binding was observed between matching zona halves of nonfertilized as compared with noninseminated oocytes. Nonfertilized oocytes also bound fewer total sperm than noninseminated oocytes. The number of sperm bound to noninseminated oocytes was not related to the patients fertilization rate from the cycle in which the oocytes originated. However, significantly fewer sperm bound to the zona of nonfertilized oocytes when the oocyte originated from a cycle in which the patients fertilization rate was >50%. Conclusions These results indicate that storage of oocytes in DMSO/sucrose in liquid nitrogen results in superior long-term (>12months) preservation of zona receptors for sperm binding and improves oocyte recovery as compared with salt storage at 4°C. Although noninseminated oocytes appear to be optimal for use in the HZA, nonfertilized oocytes can be used successfully if the oocytes originate from an IVF cycle in which the fertilization rate is ≤50%.

A patient-reported, non-interventional, cross-sectional discrete choice experiment to determine treatment attribute preferences in treatment-naïve overactive bladder patients in the US

Purpose Many pharmacotherapeutic treatment options are available for the symptoms of overactive bladder (OAB), each offering varying efficacy, safety, and tolerability profiles that must be carefully considered when selecting treatment. The objective of the present study was to characterize pharmacotherapy treatment preferences of individuals with symptoms of OAB and to examine how preferences differ by both patient characteristics and disease burden metrics. Patients and methods Patient preferences for OAB treatment attributes were examined using a discrete choice experiment (DCE). Attributes were identified through literature review, clinical relevance, and input from patients. Eligible respondents were required to be ≥18 years of age, have a self-reported physician OAB diagnosis or have self-reported symptoms of OAB, and be naïve to pharmacotherapy or invasive OAB treatments. A hierarchical Bayesian random-effects-only model was used to estimate the mean relative preference weights and mean relative importance scores of treatment attributes. Multivariable linear regression models with backward selection were used to analyze the differences in relative importance scores by demographic characteristics and disease burden-related metrics. Results In total, 514 individuals participated in the study. Most respondents were <65 years of age (66.0%), female (68.5%), and reported moderate/severe OAB symptoms (64.2%). Overall, respondents placed the greatest importance on drug delivery method, with a preference for oral and patches over injectables, followed by efficacy defined as reduced daytime micturition and out-of-pocket cost. Multivariable linear regression analyses revealed that females were less likely to select injectables, that symptom control of incontinence was the most important to respondents who reported greater work productivity loss, and that out-of-pocket cost was the most important to respondents with moderate/severe OAB. Conclusion OAB treatment preferences vary depending on individual patient characteristics and disease severity. Overall, drug delivery method, reduced daytime micturition, and out-of-pocket costs were the most important treatment attributes among treatment-naïve individuals with symptoms of OAB. Preferences for OAB treatment were also found to vary depending on patient demographics and disease comorbidities, which has previously not been examined.

MP32-03 THE DIRECT AND INDIRECT COSTS DUE TO WORK LOSS ASSOCIATED WITH OVERACTIVE BLADDER IN THE UNITED STATES

INTRODUCTION AND OBJECTIVES: The impact of overactive bladder (OAB) on costs due to time lost from work is not well known. The objective of this study was to quantify the direct healthcare costs and indirect costs due to work loss associated with OAB in the United States (US). METHODS: Adults 18 years of age with an OAB diagnosis or OAB prescription therapy between 1/1/2008 and 12/31/2013 were identified from the MarketScan administrative claims databases (index date1⁄4 qualifying claim date). Patients were required to have 12 months of preand 1 month of post-index continuous enrollment. Data on work loss due to absence and short-term disability (STD) were available for subsets of the overall study population. Each OAB cohort was propensity score-matched to an equivalent number of non-OAB controls. Estimates of total per-patient per-month (PPPM) direct healthcare costs, as well as estimates of indirect costs attributable to absence and STD were modeled using ordinary least squares regression. The level of statistical significance for all tests was set at 0.05. RESULTS: 110,059 OAB patients were identified, 9.8% of whom had work absence data and 49.3% had STD data. Average adjusted PPPM healthcare costs were significantly higher among OAB patients than non-OAB matched controls (

Randomized comparison of murine blastocyst cryopreservation methods

3,003.42 vs.

Association between cumulative anticholinergic burden and the occurrence of falls and fractures among patients with overactive bladder: A retrospective observational study

1,122.80, p<0.0001). Similarly, among patients with STD eligibility, those with OAB incurred significantly higher PPPM indirect costs attributable to STD compared to non-OAB controls (

The Direct and Indirect Costs Associated With Overactive Bladder Within a Commercially-Insured Population in the United States

114.23 vs.

The impact of increased mirabegron usage and decreased switching on healthcare costs and resource utilization in patients with overactive bladder in the United States: A retrospective database analysis

98.31, p1⁄40.0192) when adjusted within the framework of a two-part model. PPPM indirect costs of work loss due to absence did not differ significantly between patients with OAB and non-OAB matched control patients (

Comparison of healthcare costs and resource utilization for overactive bladder patients in the United States persisting with mirabegron treatment or switching to onabotulinumtoxin A

1,412.27 vs.

Making Sense of Zygote Grading: Simplified Zygote Grading Based on 7 Years of Data with Homologous Embryo Transfers

1,350.56, p1⁄40.4398). CONCLUSIONS: Patients with OAB incurred 2.5 times the healthcare costs of patients without OAB. OAB patients incurred more work loss and costs due to STD than non-OAB controls. Indirect costs attributable to workplace absence, however, did not differ for OAB patients and non-OAB controls.