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Clinical Decision Analysis Shows That Ovarian Reserve Testing Prior to IVF is not Useful
MET 81.5%). There were no differences with respect to implantation and pregnancy rates (Table 1). CONCLUSION: The timing of the mock embryo transfer (MET) does not affect IVF-ET implantation or pregnancy rates. Based on these results, performing a MET at the oocyte retrieval, 3-5 days prior to embryo transfer, does not have a deleterious effect on the endometrium. Supported by: None
P-325 Clinical Decision Analysis Shows That Ovarian Reserve Testing Prior to IVF is not Useful. B. Mol, D. Hendriks, F. Broekmans. Academic Medical Centre, Amsterdam, The Netherlands; UMCU, Utrecht, The Netherlands. OBJECTIVE: Meta-analysis has shown that tests for ovarian reserve, such as follicular FSH or the antral follicle count, are accurate in the prediction of ovarian reponse in an IVF programm. However, it is not known whether the accuracy of these tests is high enough to justify their use in clincal practice. We assessed the value of testing for ovarian reserve in an IVF program, incorporating patient and doctor valuation of possible outcomes. DESIGN: Preference study and decision analysis. MATERIALS AND METHODS: A decision model was developed for couples that were considering participation in an IVF program. Three strategies were evaluated: (I) treatment with IVF without prior testing, (II) withholding IVF without prior testing (III) testing for ovarian reserve, and then decide for IVF treatment in case ovarian reserve was judged to be sufficient. The outcome considered was the birth of a child. The value of this outcome was expressed on a disutility scale in units of ‘IVF cycles that were performed in vain’. Correct treatment with IVF and correct withholding IVF was considered to bring no disutility. The disutility of withholding IVF in case pregnancy would have occurred was consequently specified by the ratio of the expected distress after incorrect withholding IVF to the expected distress after incorrect performing IVF (disutility ratio). Subsequently, both subfertile couples and octers were interviewed about their valuation of both outcomes in terms of the disutility ratio. RESULTS: The value of testing for ovarian reserve depends strongly on the expected pregnancy rate after IVF as well as on the patient and doctor valuation of the incorrect decisions from testing. Subfertile couples valed the incorrect withholding of IVF 250 times as worse as the incorrect performance of IVF, whereas for doctors this ratio was 20. For realistic ranges of the success rate after IVF and for disutility ranges as were measured , treatment of all couples without testing was better than testing for ovarian reserve. CONCLUSION: Testing for ovarian reserve should not be performed routinely in current IVF programs. The disutility ratio might be an instrument to counsel individual couples on the decision to perform a prior test in clinical practice. Supported by: None
P-326 Experience With a Gestational Carrier Program in a Private Assisted Reproductive Program. D. A. Minjarez, D. Levy, E. Surrey, W. Schoolcraft. Colorado Center for Reproductive Medicine, Englewood, CO. OBJECTIVE: To review and evaluate retrospectively our experience of in vitro fertilization (IVF) and donor occyte in a gestational carrier (GC) program at the Colorado Center for Reproductive Medicine from 20012004. DESIGN: Retrospective analysis of 68 cycles of ART-gestational carriers from 2001-2004. Of these, 47 IVF-GC cycles in 44 couples were completed and 21 donor-GC cycles. MATERIALS AND METHODS: Charts were reviewed to obtain data regarding indication for GC, age of patients, stimulation protocols, number of oocytes retrieved, embryos transferred and pregnancy outcome. GC charts were reviewed to obtain data on age of the GC, parity, compensation and marital status. RESULTS: In the IVF-GC group the average age of the patient was
FERTILITY & STERILITY威
35.9 (29-42). 34% of patients were on a Lupron-40 protocol with the remaining on a Lupron/OC overlap protocol. The average numbers of oocytes retrieved were 15.2. 63.8% of patients and 36.2% of patients underwent a day 3 and day 5 transfer, respectively. The average number of embryos transferred on day 3 was 3.1 and 2.2 on day 5. The overall pregnancy rate was 74.5% with a clinical pregnancy rate of 61.7%. 44.8% of pregnancies resulted in a singleton, 48.3% in a twin gestation and 6.9% in a triplet gestation. In patients utilizing donor-GC, the average age of the patient was 44.7 (30-50). All donors were on a Lupron/OC overlap protocol. The average number of oocytes retrieved were15.7. 44.6% of cases were a day 3 transfer and 52.4% were blastocyst transfers. The average number of embryos transferred on day 3 and day 5, respectively were 3.1 and 2.2. The overall and clinical pregnancy rate was 85.7%, with 50% of pregnancies resulting in a singleton gestation. 44.4% resulted in a twin gestation and 5.6% in a triplet gestation. 57.1% of GC’s were located by agencies with 26.9% being family members. The remaining 16% were located by the patients either through the internet, attorneys or friends. The average age of the GC was 31.8 (22-40). 90.9% were married, 6.1% were single and 3.0% were divorced. The average parity was 2.65. Average compensation for GC was $18,177.00 not including family members and friends who often received little or no compensation. The most common indication for use of a GC was hysterectomy 28.6%, and uterine factor, such as Asherman’s syndrome and DES exposure (28.6%). 17.1% were due to multiple failed IVF cycles, with 5.6% of the remaining cases due to medical indications or recurrent pregnancy loss. CONCLUSION: Over the last several years, there has been an increase in the use of gestational carriers by intended parents. Gestational carriers offer, for many patients who otherwise would not be able to have children, an excellent probability of pregnancy. There is currently no available data regarding the demographics of gestational carriers or compensation. In addition, there are currently no guidelines which have been set for inclusion criteria into gestational carrier programs as well as psychological and medical clearance for GC’s. With an increase in the number of GC cases now seen, guidelines have been established at CCRM for both patients and GC’s entering our program. Supported by: None
P-327 Assisted Reproductive Treatments in Patients With Ovarian Endometriomas: Comparison of Endometriomas With Simple Basal Cysts. B. Kumbak, S. Kahraman, G. Karlikaya, H. Karagozoglu, S. Lacin, A. Guney. Istanbul Memorial Hospital, ART and Genetics Center, Istanbul, Turkey. OBJECTIVE: Approach to ovarian endometriomas prior to initiation of ART cycle and its influence on the cycle characteristics and results are still controversial. It is aimed to assess the effect of ovarian endometrioma on ART cycle characteristics and outcome. DESIGN: Retrospective study MATERIALS AND METHODS: Seventy-three patients with ovarian endometriomas of 10-50 mm who underwent IVF treatment directly were compared with 53 patients with basal ovarian simple cysts of 10-35 mm detected at the beginning of stimulation and initiated treatment without aspiration. Presence of endometrioma was confirmed by aspiration during oocyte pick-up. RESULTS: Demographic characteristics of two groups were similar except BMI which was higher in cyst group. When cycle characteristics were evaluated, gonadotropin consumption was higher in endometrioma group, but similar numbers of oocytes were retirieved in both groups. As the outcome parameters, implantation rate was found to be significantly higher in cyst group (19% in endometrioma and 28.1% in cyst group, p⫽0.02), but pregnancy and abortion rates were shown to be similar statistically. Additionally, transferred grade I embryo rates were evaluated and it was found to be better in cyst group. CONCLUSION: The presence of endometriotic cyst during ART cycle causes worsening of embryo quality and implantation rate, but does not affect the pregnancy success. Therefore, it is supported that ovarian endometrioma does not have just a mechanical effect. Supported by: None
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P-325 Clinical Decision Analysis Shows That Ovarian Reserve Testing Prior to IVF is not Useful. B. Mol, D. Hendriks, F. Broekmans. Academic Medical Centre, Amsterdam, The Netherlands; UMCU, Utrecht, The Netherlands. OBJECTIVE: Meta-analysis has shown that tests for ovarian reserve, such as follicular FSH or the antral follicle count, are accurate in the prediction of ovarian reponse in an IVF programm. However, it is not known whether the accuracy of these tests is high enough to justify their use in clincal practice. We assessed the value of testing for ovarian reserve in an IVF program, incorporating patient and doctor valuation of possible outcomes. DESIGN: Preference study and decision analysis. MATERIALS AND METHODS: A decision model was developed for couples that were considering participation in an IVF program. Three strategies were evaluated: (I) treatment with IVF without prior testing, (II) withholding IVF without prior testing (III) testing for ovarian reserve, and then decide for IVF treatment in case ovarian reserve was judged to be sufficient. The outcome considered was the birth of a child. The value of this outcome was expressed on a disutility scale in units of ‘IVF cycles that were performed in vain’. Correct treatment with IVF and correct withholding IVF was considered to bring no disutility. The disutility of withholding IVF in case pregnancy would have occurred was consequently specified by the ratio of the expected distress after incorrect withholding IVF to the expected distress after incorrect performing IVF (disutility ratio). Subsequently, both subfertile couples and octers were interviewed about their valuation of both outcomes in terms of the disutility ratio. RESULTS: The value of testing for ovarian reserve depends strongly on the expected pregnancy rate after IVF as well as on the patient and doctor valuation of the incorrect decisions from testing. Subfertile couples valed the incorrect withholding of IVF 250 times as worse as the incorrect performance of IVF, whereas for doctors this ratio was 20. For realistic ranges of the success rate after IVF and for disutility ranges as were measured , treatment of all couples without testing was better than testing for ovarian reserve. CONCLUSION: Testing for ovarian reserve should not be performed routinely in current IVF programs. The disutility ratio might be an instrument to counsel individual couples on the decision to perform a prior test in clinical practice. Supported by: None
P-326 Experience With a Gestational Carrier Program in a Private Assisted Reproductive Program. D. A. Minjarez, D. Levy, E. Surrey, W. Schoolcraft. Colorado Center for Reproductive Medicine, Englewood, CO. OBJECTIVE: To review and evaluate retrospectively our experience of in vitro fertilization (IVF) and donor occyte in a gestational carrier (GC) program at the Colorado Center for Reproductive Medicine from 20012004. DESIGN: Retrospective analysis of 68 cycles of ART-gestational carriers from 2001-2004. Of these, 47 IVF-GC cycles in 44 couples were completed and 21 donor-GC cycles. MATERIALS AND METHODS: Charts were reviewed to obtain data regarding indication for GC, age of patients, stimulation protocols, number of oocytes retrieved, embryos transferred and pregnancy outcome. GC charts were reviewed to obtain data on age of the GC, parity, compensation and marital status. RESULTS: In the IVF-GC group the average age of the patient was
FERTILITY & STERILITY威
35.9 (29-42). 34% of patients were on a Lupron-40 protocol with the remaining on a Lupron/OC overlap protocol. The average numbers of oocytes retrieved were 15.2. 63.8% of patients and 36.2% of patients underwent a day 3 and day 5 transfer, respectively. The average number of embryos transferred on day 3 was 3.1 and 2.2 on day 5. The overall pregnancy rate was 74.5% with a clinical pregnancy rate of 61.7%. 44.8% of pregnancies resulted in a singleton, 48.3% in a twin gestation and 6.9% in a triplet gestation. In patients utilizing donor-GC, the average age of the patient was 44.7 (30-50). All donors were on a Lupron/OC overlap protocol. The average number of oocytes retrieved were15.7. 44.6% of cases were a day 3 transfer and 52.4% were blastocyst transfers. The average number of embryos transferred on day 3 and day 5, respectively were 3.1 and 2.2. The overall and clinical pregnancy rate was 85.7%, with 50% of pregnancies resulting in a singleton gestation. 44.4% resulted in a twin gestation and 5.6% in a triplet gestation. 57.1% of GC’s were located by agencies with 26.9% being family members. The remaining 16% were located by the patients either through the internet, attorneys or friends. The average age of the GC was 31.8 (22-40). 90.9% were married, 6.1% were single and 3.0% were divorced. The average parity was 2.65. Average compensation for GC was $18,177.00 not including family members and friends who often received little or no compensation. The most common indication for use of a GC was hysterectomy 28.6%, and uterine factor, such as Asherman’s syndrome and DES exposure (28.6%). 17.1% were due to multiple failed IVF cycles, with 5.6% of the remaining cases due to medical indications or recurrent pregnancy loss. CONCLUSION: Over the last several years, there has been an increase in the use of gestational carriers by intended parents. Gestational carriers offer, for many patients who otherwise would not be able to have children, an excellent probability of pregnancy. There is currently no available data regarding the demographics of gestational carriers or compensation. In addition, there are currently no guidelines which have been set for inclusion criteria into gestational carrier programs as well as psychological and medical clearance for GC’s. With an increase in the number of GC cases now seen, guidelines have been established at CCRM for both patients and GC’s entering our program. Supported by: None
P-327 Assisted Reproductive Treatments in Patients With Ovarian Endometriomas: Comparison of Endometriomas With Simple Basal Cysts. B. Kumbak, S. Kahraman, G. Karlikaya, H. Karagozoglu, S. Lacin, A. Guney. Istanbul Memorial Hospital, ART and Genetics Center, Istanbul, Turkey. OBJECTIVE: Approach to ovarian endometriomas prior to initiation of ART cycle and its influence on the cycle characteristics and results are still controversial. It is aimed to assess the effect of ovarian endometrioma on ART cycle characteristics and outcome. DESIGN: Retrospective study MATERIALS AND METHODS: Seventy-three patients with ovarian endometriomas of 10-50 mm who underwent IVF treatment directly were compared with 53 patients with basal ovarian simple cysts of 10-35 mm detected at the beginning of stimulation and initiated treatment without aspiration. Presence of endometrioma was confirmed by aspiration during oocyte pick-up. RESULTS: Demographic characteristics of two groups were similar except BMI which was higher in cyst group. When cycle characteristics were evaluated, gonadotropin consumption was higher in endometrioma group, but similar numbers of oocytes were retirieved in both groups. As the outcome parameters, implantation rate was found to be significantly higher in cyst group (19% in endometrioma and 28.1% in cyst group, p⫽0.02), but pregnancy and abortion rates were shown to be similar statistically. Additionally, transferred grade I embryo rates were evaluated and it was found to be better in cyst group. CONCLUSION: The presence of endometriotic cyst during ART cycle causes worsening of embryo quality and implantation rate, but does not affect the pregnancy success. Therefore, it is supported that ovarian endometrioma does not have just a mechanical effect. Supported by: None
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