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Do antral follice counts (AFC) predict ovarian response and pregnancy outcomes in oocyte donation cycles?
methods. FLON probes allowed the reading of each round after 18 minutes instead of 2-4 hs required for the conventional method. CONCLUSIONS: The utilization of FLON probes allows a PGS diagnosis in a shorter time and lower stringency requirements that do not harm cellular DNA. This in turn makes possible a larger number of re-hybridizations and diminishes the total hybridization time from 2-4 hours to 18 minutes. This time reduction would allow, through six successive rounds, to perform the study of all human chromosomes within 10 hours of the blastomere biopsy.
RESULTS: Significant correlations were noted between AFC and #amps: r¼0.41, p¼0.007; d-3 E2 following OI: r¼0.37, p¼0.02; and pregnancy rates (PR): r¼0.32, p¼0.04, but not cycle d-5-E2: r¼0.27, p¼0.09 or peak E2: r¼0.05, p¼0.78, and clinical PR: r¼0.17, p¼0.29. Days of stimulation (DOS), cancellation rates, fertilization and implantation rates (Group 1-45%; Group 2-33%; Group 3-46%; Group 4-67%; and Group 5-57%, [p-NS]) were similar in each group. TABLE 1. Differences in groups based on AFC.
P-587 Wednesday, October 21, 2009 OPTIMAL SIZE OF THE DOMINANT FOLLICLE ON HCG INJECTION DAY OF HYPERRESPONDER WHO RECEIVED CONTROLLED OVARIAN HYPERSTIMULATION FOLLOWED BY IN VITRO MATURATION. K. A. Pak, W. D. Lee, J. H. Lim. Maria Fertility Hospital, Seoul, Korea. OBJECTIVE: We sought to determine the optimal size of the dominant follicle (DF) on hCG injection day of hyperresponder who received controlled ovarian hyperstimulation (COH) followed by in vitro maturation (IVM) for the prevention of ovarian hyperstimulation syndrome (OHSS). DESIGN: A single institution experience using a retrospective design. MATERIALS AND METHODS: We reviewed medical records of 182 patients considered hyperresponders who received COH followed by IVM for preventing OHSS between January 2002 and December 2008. Hyperresponder was defined as having R15 follicles (R10 mm) after ovarian stimulation for at least 5 days. All patients were divided into 3 groups according to the size of the DF as follows: (%12 mm (group 1, n¼58); between 12 and 14 mm (group 2, n¼91); >14 mm (group 3, n¼33). RESULTS: Numbers of total and MII oocytes retrieved, and dose of gonadotropin used significantly increased with the size of the DF (P<0.05). Clinical pregnancy rate was higher in group 2 (50.5%) than in groups 1 (29.3%) and 3 (30.3%) (P<0.05). TABLE 1. Comparison of outcomes according to the size of the dominant follicle.
No. of oocytes retrieved No. of MII oocytes Clinical pregnancy rate (%)
Group 1 (n¼58)
Group 2 (n¼91)
Group 3 (n¼33)
P value
15.7 6.3 5.0 5.9 17/58 (29.3)*
19.0 8.6* 8.0 7.2* 46/91 (50.5)
20.9 8.3* 10.3 6.8* 10/33 (30.3)*
<0.01 <0.01 <0.02
* There is no significant difference between the 2 groups with the same symbol. There was no difference in age, duration of infertility, body mass index, cause of infertility, basal serum FSH level, endometrial thickness on hCG injection day, fertilization rate, number of embryos transferred and incidence of mild to moderate OHSS among the three groups. No severe OHSS occurred in all patient. CONCLUSIONS: Theses findings suggest that the optimal size of the DF on hCG injection day may be between 12 and 14 mm of hyperresponder who received COH followed by IVM for preventing OHSS.
P-588 Wednesday, October 21, 2009 DO ANTRAL FOLLICE COUNTS (AFC) PREDICT OVARIAN RESPONSE AND PREGNANCY OUTCOMES IN OOCYTE DONATION CYCLES? A. Vrontikis, S. R. Linheim, A. J. Morales. Fertility Specialists Medical Group, San Diego, CA. OBJECTIVE: Assess predictive value (PV) of AFC and response to ovulation induction (OI) and pregnancy outcomes in GnRH-antagonist (ant) oocyte donation cycles (ODC). DESIGN: Retrospective review. MATERIALS AND METHODS: From Jan 05 to Dec 08, 142 ODC were evaluated. All cycles had similar demographics (%34 yrs and normal FSH and E2) and grouped according to AFC: Group 1:<10 (n¼27); Group 2:10-13 (n¼33); Group 3:14-17 (n¼44); Group 4:18-21 (n¼19); and Group 5:>21 (n¼19. Following a withdrawal bleed, rFSH was initiated, adjusted accordingly, and GnRH-ant begun when follicles were 12mm. hCG was given when lead follicles >18mm and aspiration performed 36 hours later. Recipients were synchronized with GnRH-agonist and fixed doses of E2/ P4. Outcomes measured include cycle stimulation characteristics and pregnancy outcomes according to AFC groups using categorical comparisons, student’s t-test, and logistic regression.
FERTILITY & STERILITYÒ
# ampules peak E2 # MII PR%/ET CP%/ET
Group 1
Group 2
Group 3
Group 4
3064 810 1936 1297 15.2 525 62 (13) 52 (11)
3124 1068 1981 1292 15.3 17.9 53 (16) 37 (11)
2696 959 2192 1386 15.4 7.9 62 (26) 62 (26)
2237 716 3018 1584 22.7 14.5 75 (12) 69 (11)
Group 5
p-value
1966 606 <0.001 3659 1759 <0.001 20.5 10.5 0.02 95 (18) 0.04 77 (15) 0.03
CONCLUSIONS: AFC is useful in predicting ovarian response in ODC in light of normal ovarian reserve biomarkers. Further studies are needed to clarify its PV in pregnancy outcomes. P-589 Wednesday, October 21, 2009 THE SEX RATIO OF BABIES BORN AFTER SINGLE EMBRYO TRANSFERS, AUSTRALIA AND NEW ZEALAND, 2002-2006. J. H. Dean, M. Chapman, E. A. Sullivan. Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, The University of New South Wales, Randwick, NSW, Australia; School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW, Australia. OBJECTIVE: To assess the effect of ART procedures on the sex ratio of babies born after single embryo transfer (SET babies). DESIGN: Retrospective study on SET babies in the Australia and New Zealand Assisted Reproductive Database (ANZARD) 2002-2006. MATERIALS AND METHODS: In total 13165 women (33.2 4.3 years) gave birth to 13368 SET babies in the study period. Factors included: fertilization procedures (IVF or ICSI), timing of SET (blastocyst or cleavage stage), type of SET (fresh or thaw), elective (transfer with 1þ stored embryos) or non-elective (transfer with 0 stored embryos) SET and plurality. ANZARD does not include data on embryo culture system or embryo selection criteria. Logistics regression was used to analyze the probability (odds ratio, OR and 95% confidence interval, CI) of male babies overall. RESULTS: Overall 51.3% male babies were born in the study cohort. When stratified by fertilization procedures more males were born following IVF (53.0%) compared to ICSI (50.0%; OR ¼ 0.89; 95% CI: 0.83-0.95). Blastocyst SET had 54.1% males (OR ¼ 1.18; 95% CI: 1.10-1.27), compared to cleavage stage SET. Elective SET had 52.3% males (1.08; 1.01-1.16), compared to non-elective SET. Fresh SET had 51.9% males (1.08; 1.011.17), compared to thaw SET. Nearly all (97.0%) babies born after SET were singletons (51.3% males) with multiples made up of twins (2.9%; 51.7% males) and triplets (0.1%; 66.7% males). A second analysis excluding male factor infertility (n ¼ 6,949) had similar results with marginally lower proportion of males born following ICSI (48.9%; 0.84; 0.76-0.93), compared to IVF; blastocyst SET had 54.8% males (1.20; 1.08-1.32), compared to cleavage stage SET; and elective SET had 53.3% males (1.12; 1.02-1.23), compared to non-elective SET. No significant effect was detected in babies born after fresh SET or thaw SET in this subgroup. CONCLUSIONS: ART procedures had significant effect on the sex ratio. There was increased likelihood of having a male following blastocyst SET; and a female following ICSI. P-590 Wednesday, October 21, 2009 ELEVATED A820C POLYMORPHISM IN HUMAN OVARY-SPECIFIC GENE UROMODULIN-LIKE 1 (UMODL1) IN IVF PATIENTS. W. Wang, H.-C. Liu, Z. He, Y. Tang, L. Ni, Z. Rosenwaks. The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY. OBJECTIVE: To examine the functional change of Umodl1 as a result of polymorphism, and establish a correlation of Umodl1 polymorphism to reduced female fertility. DESIGN: Nucleotide variations at position 820 of Umodl1, A820C and A820G, are of particular interest as they change the amino acid from a neutral Asn to charged His and Asp, respectively; which may affect granulosa cell growth. Proliferative activities of the polymorphic Umodl1 proteins were
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RESULTS: Significant correlations were noted between AFC and #amps: r¼0.41, p¼0.007; d-3 E2 following OI: r¼0.37, p¼0.02; and pregnancy rates (PR): r¼0.32, p¼0.04, but not cycle d-5-E2: r¼0.27, p¼0.09 or peak E2: r¼0.05, p¼0.78, and clinical PR: r¼0.17, p¼0.29. Days of stimulation (DOS), cancellation rates, fertilization and implantation rates (Group 1-45%; Group 2-33%; Group 3-46%; Group 4-67%; and Group 5-57%, [p-NS]) were similar in each group. TABLE 1. Differences in groups based on AFC.
P-587 Wednesday, October 21, 2009 OPTIMAL SIZE OF THE DOMINANT FOLLICLE ON HCG INJECTION DAY OF HYPERRESPONDER WHO RECEIVED CONTROLLED OVARIAN HYPERSTIMULATION FOLLOWED BY IN VITRO MATURATION. K. A. Pak, W. D. Lee, J. H. Lim. Maria Fertility Hospital, Seoul, Korea. OBJECTIVE: We sought to determine the optimal size of the dominant follicle (DF) on hCG injection day of hyperresponder who received controlled ovarian hyperstimulation (COH) followed by in vitro maturation (IVM) for the prevention of ovarian hyperstimulation syndrome (OHSS). DESIGN: A single institution experience using a retrospective design. MATERIALS AND METHODS: We reviewed medical records of 182 patients considered hyperresponders who received COH followed by IVM for preventing OHSS between January 2002 and December 2008. Hyperresponder was defined as having R15 follicles (R10 mm) after ovarian stimulation for at least 5 days. All patients were divided into 3 groups according to the size of the DF as follows: (%12 mm (group 1, n¼58); between 12 and 14 mm (group 2, n¼91); >14 mm (group 3, n¼33). RESULTS: Numbers of total and MII oocytes retrieved, and dose of gonadotropin used significantly increased with the size of the DF (P<0.05). Clinical pregnancy rate was higher in group 2 (50.5%) than in groups 1 (29.3%) and 3 (30.3%) (P<0.05). TABLE 1. Comparison of outcomes according to the size of the dominant follicle.
No. of oocytes retrieved No. of MII oocytes Clinical pregnancy rate (%)
Group 1 (n¼58)
Group 2 (n¼91)
Group 3 (n¼33)
P value
15.7 6.3 5.0 5.9 17/58 (29.3)*
19.0 8.6* 8.0 7.2* 46/91 (50.5)
20.9 8.3* 10.3 6.8* 10/33 (30.3)*
<0.01 <0.01 <0.02
* There is no significant difference between the 2 groups with the same symbol. There was no difference in age, duration of infertility, body mass index, cause of infertility, basal serum FSH level, endometrial thickness on hCG injection day, fertilization rate, number of embryos transferred and incidence of mild to moderate OHSS among the three groups. No severe OHSS occurred in all patient. CONCLUSIONS: Theses findings suggest that the optimal size of the DF on hCG injection day may be between 12 and 14 mm of hyperresponder who received COH followed by IVM for preventing OHSS.
P-588 Wednesday, October 21, 2009 DO ANTRAL FOLLICE COUNTS (AFC) PREDICT OVARIAN RESPONSE AND PREGNANCY OUTCOMES IN OOCYTE DONATION CYCLES? A. Vrontikis, S. R. Linheim, A. J. Morales. Fertility Specialists Medical Group, San Diego, CA. OBJECTIVE: Assess predictive value (PV) of AFC and response to ovulation induction (OI) and pregnancy outcomes in GnRH-antagonist (ant) oocyte donation cycles (ODC). DESIGN: Retrospective review. MATERIALS AND METHODS: From Jan 05 to Dec 08, 142 ODC were evaluated. All cycles had similar demographics (%34 yrs and normal FSH and E2) and grouped according to AFC: Group 1:<10 (n¼27); Group 2:10-13 (n¼33); Group 3:14-17 (n¼44); Group 4:18-21 (n¼19); and Group 5:>21 (n¼19. Following a withdrawal bleed, rFSH was initiated, adjusted accordingly, and GnRH-ant begun when follicles were 12mm. hCG was given when lead follicles >18mm and aspiration performed 36 hours later. Recipients were synchronized with GnRH-agonist and fixed doses of E2/ P4. Outcomes measured include cycle stimulation characteristics and pregnancy outcomes according to AFC groups using categorical comparisons, student’s t-test, and logistic regression.
FERTILITY & STERILITYÒ
# ampules peak E2 # MII PR%/ET CP%/ET
Group 1
Group 2
Group 3
Group 4
3064 810 1936 1297 15.2 525 62 (13) 52 (11)
3124 1068 1981 1292 15.3 17.9 53 (16) 37 (11)
2696 959 2192 1386 15.4 7.9 62 (26) 62 (26)
2237 716 3018 1584 22.7 14.5 75 (12) 69 (11)
Group 5
p-value
1966 606 <0.001 3659 1759 <0.001 20.5 10.5 0.02 95 (18) 0.04 77 (15) 0.03
CONCLUSIONS: AFC is useful in predicting ovarian response in ODC in light of normal ovarian reserve biomarkers. Further studies are needed to clarify its PV in pregnancy outcomes. P-589 Wednesday, October 21, 2009 THE SEX RATIO OF BABIES BORN AFTER SINGLE EMBRYO TRANSFERS, AUSTRALIA AND NEW ZEALAND, 2002-2006. J. H. Dean, M. Chapman, E. A. Sullivan. Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, The University of New South Wales, Randwick, NSW, Australia; School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW, Australia. OBJECTIVE: To assess the effect of ART procedures on the sex ratio of babies born after single embryo transfer (SET babies). DESIGN: Retrospective study on SET babies in the Australia and New Zealand Assisted Reproductive Database (ANZARD) 2002-2006. MATERIALS AND METHODS: In total 13165 women (33.2 4.3 years) gave birth to 13368 SET babies in the study period. Factors included: fertilization procedures (IVF or ICSI), timing of SET (blastocyst or cleavage stage), type of SET (fresh or thaw), elective (transfer with 1þ stored embryos) or non-elective (transfer with 0 stored embryos) SET and plurality. ANZARD does not include data on embryo culture system or embryo selection criteria. Logistics regression was used to analyze the probability (odds ratio, OR and 95% confidence interval, CI) of male babies overall. RESULTS: Overall 51.3% male babies were born in the study cohort. When stratified by fertilization procedures more males were born following IVF (53.0%) compared to ICSI (50.0%; OR ¼ 0.89; 95% CI: 0.83-0.95). Blastocyst SET had 54.1% males (OR ¼ 1.18; 95% CI: 1.10-1.27), compared to cleavage stage SET. Elective SET had 52.3% males (1.08; 1.01-1.16), compared to non-elective SET. Fresh SET had 51.9% males (1.08; 1.011.17), compared to thaw SET. Nearly all (97.0%) babies born after SET were singletons (51.3% males) with multiples made up of twins (2.9%; 51.7% males) and triplets (0.1%; 66.7% males). A second analysis excluding male factor infertility (n ¼ 6,949) had similar results with marginally lower proportion of males born following ICSI (48.9%; 0.84; 0.76-0.93), compared to IVF; blastocyst SET had 54.8% males (1.20; 1.08-1.32), compared to cleavage stage SET; and elective SET had 53.3% males (1.12; 1.02-1.23), compared to non-elective SET. No significant effect was detected in babies born after fresh SET or thaw SET in this subgroup. CONCLUSIONS: ART procedures had significant effect on the sex ratio. There was increased likelihood of having a male following blastocyst SET; and a female following ICSI. P-590 Wednesday, October 21, 2009 ELEVATED A820C POLYMORPHISM IN HUMAN OVARY-SPECIFIC GENE UROMODULIN-LIKE 1 (UMODL1) IN IVF PATIENTS. W. Wang, H.-C. Liu, Z. He, Y. Tang, L. Ni, Z. Rosenwaks. The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY. OBJECTIVE: To examine the functional change of Umodl1 as a result of polymorphism, and establish a correlation of Umodl1 polymorphism to reduced female fertility. DESIGN: Nucleotide variations at position 820 of Umodl1, A820C and A820G, are of particular interest as they change the amino acid from a neutral Asn to charged His and Asp, respectively; which may affect granulosa cell growth. Proliferative activities of the polymorphic Umodl1 proteins were
S253