FSH coasting combined with recombinant LH: a novel stimulation approach for ART

Monday, October 13, 2003 4:00 P.M. O-19 FSH coasting combined with recombinant LH: A novel stimulation approach for ART. Andre Hazout Sr., Anne Marie Junca, Paul Cohen Bacrie. Clin de la Muette, Paris, France; Lab d’Eylau, Paris, France. Objective: It is well known that FSH is the key hormone of the follicular recruitment and growth and that LH has a major role in the late follicular phase. Recombinant LH has recently become available and could be given separately from FSH. This study aims to assess the potential benefit of using rec-hFSH alone in the first part of the follicular phase followed with rec-hLH alone in the late follicular phase to mimic the physiologic cycle. Design: Prospective descriptive study in patients having normal basal hormonal status and undergoing ART. Materials and Methods: Patients received luteal phase GnRH agonist long protocol. After the down regulation confirmation by US, they received rec-hFSH at a starting dose of 100 to 300 IU depending on the patient profile.When at least one follicle with a diameter greater than 14 mm was observed, rec-hFSH was discontinued. The patient was given rec-hLH alone at a fixed daily dose of 150 IU until day hCG. Ovulation was triggered with hCG when the leading follicle reached a size of 18 mm in diameter. Results: Nineteen patients completed the treatment. Demographic characteristics were as follows: mean age of 35.1 ⫾ 3.7, basal FSH of 6.5 ⫾ 1.2 IU/l, basal LH of 5.4 ⫾ 2.1, basal inhibin B of 72 ⫾ 13 ng/ml, and MIS of 1.9 ⫾ 1.4. The mean attempt range was 2.2. Patients received a mean starting dose of 215 IU of rec-hFSH and a mean total dose of rec-hFSH of 1995 ⫾ 530 IU. An average of 283 IU of rec-hLH (Luveris(r)) was given. The mean stimulation duration was 12.0 ⫾ 1.1 days. The mean number of oocytes retrieved was 10.9 ⫾ 6.1 with a percentage of meta II oocytes of 80.4%; 6.3 ⫾ 3.9 embryos were obtained, 2.6 embryos were frozen. The mean number of embryos transferred was 2.4 resulting in a clinical pregnancy rate per OPU of 42% with an implantation rate per embryo transferred of 20.6%. This study is still ongoing. The final results will be presented at ASRM. Conclusion: This new stimulation protocol showed that rec-hLH alone at a daily dose of 150 IU in late follicular phase is able to maintain the follicular development and maturation, without any deleterious effect of clinical pregnancy rate.

test was used to assess if the 3 PN rate was dependent upon the ICSI operator. Results: After adjusting for age and the number of large follicles (⬎18 mm), the total number of days of stimulation was significant (p ⬍ 0.05). The 3 PN rate was lowest with hCG trigger between days 10-12. After adjusting for all variables, the day of hCG remained a significant predictor of 3 PN rate. The final model adjusting for age, start dose, and E2 on the day of hCG was used to derive predicted values to compare the risk of 3 PN in cases where hCG is delayed beyond the 10 –12-day window in order to increase the number of mature follicles. The predicted values indicate that in situations where hCG is delayed beyond 12 days, assuming at least 2 large follicles were already present, an increase in 3 PN rate results. Neither age, amount of gonadotropin administered, E2 on the day of hCG, the total number of oocytes retrieved, nor ICSI operator were significantly associated with 3 PN rate.

Conclusion: Utilizing the 3PN rate with ICSI as an objective marker of oocyte quality, prolonging stimulation beyond 12 days, even to increase the number of mature eggs, may adversely affect egg quality and decrease usable 2PN zygotes.

Monday, October 13, 2003 4:30 P.M.

Monday, October 13, 2003 4:15 P.M. O-21 O-20 The rate of triploid zygotes (3PN) after intracytoplasimic sperm injection (ICSI) is related to the number of days of stimulation. Mitchell P. Rosen, Anthony T. Dobson, Shehua Shen, Tracy L. Telles, Victor Y. Fujimoto, Marcelle I. Cedars. Univ of CA San Francisco, San Francisco, CA.

Endometrial impact of GnRH agonists and antagonists during the window of implantation in controlled ovarian hyperstimulation cycles. Sebastian Mirkin, Silvina Bocca, Jeng G. Hsiu, Yorgos Nikas, Roger Gosden, Sergio Oehninger. Jones Institute for Reproductive Medicine, Norfolk, VA; Second Dept of Obstetrics and Gynecology, Univ Hospital., Athens, Greece.

Objective: We have noticed an increase in 3PN rate following ICSI in women with poor oocyte quality characterized by granular cytoplasm, fragile membrane, and fragmented polar body. We suggest ICSI-3PN rate may be a more objective marker of poor oocyte quality. In order to determine if clinical parameters affect this outcome, we chose to evaluate the impact of ovarian stimulation on 3PN rate. Design: Retrospective review. Materials and Methods: Two hundred one down-regulated IVF cycles with ICSI from January 2001 to January 2003 were analyzed. A multivariate analysis was performed using the generalized linear model routines in Stata, Ver 7.0 (Stata Corporation, College Station, TX) to perform logistic regression. The models were determined by backward elimination in a guided fashion, starting with a model including all the predictors (age, day 3 FSH/ E2, start dose, total dose, oocyte number, E2 day of hCG, number of 13-17 mm, and ⬎18 mm follicles, size of the lead follicle, and stimulation days), then elimination of those that were not statistically significant one at a time guided by the previous literature and clinical experience. Tests were declared statistically significant for a two-sided p-value ⬍ 0.05. A chi-square

Objective: It has been suggested that the modified endocrine milieu resulting from controlled ovarian hyperstimulation (COH) may negatively impact the endometrium during IVF cycles. Particularly, the use of novel GnRH antagonists in certain protocols has been associated with decreased implantation. However, neither the window of implantation has been fully characterized functionally and/or structurally, nor the potential molecular mechanism(s) that may be affecting the endometrium during COH cycles using GnRH agonists or antagonists, has been elucidated. Our objective was to perform a functional and structural characterization of the endometrium during the window of implantation in COH cycles through the assessment of gene expression patterns, estrogen (ER) and progesterone receptor (PR) content, pinopod expression, and histological appearance. Design: Prospective randomized blinded research study. Materials and Methods: Luteal phase endometrial biopsies were obtained during the putative window of implantation (day 21) from (a) COH cycles of oocyte donors on hCG day ⫹9; and (b) natural cycle controls on day ⫹8 after urinary LH surge detection. Oocyte donors were stimulated with: (i) long protocol with a GnRH agonist (leuprolide acetate) and recombinant

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Abstracts

Vol. 80, Suppl. 3, September 2003