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High Pregnancy Rate of Vitrified Human Blastocysts
0.01N HCl and Carnoy’s fixative. The slides were then treated for 10mins in Pepsin solution to dissolve the remaining cytoplasm if it was necessary. The 5 chromosome probe was then applied, and FISH analysis was performed after hybridization. Results: Among the 65 aneuploid, or abnormal embryos, 46 showed uniformly one cell line. Another 13 were confirmed abnormal but had multiple abnormalities and 6 embryos have different normal nuclei mixed with abnormal ones. The mosaic embryos with normal and abnormal nuclei was 9.2% (6/65 embryos). Among the 18 diploids, or normal embryos, 4 embryos had mixed normal and abnormal blastomeres. However, none of these 4 embryos had more than 6 cells on day 3 or became arrest on day 4. The day 3 embryos that were diagnosed as normal on day 3 with adequate development had no mosaicism. Conclusions: 9.2% of the aneuploid embryos diagnosed on day 3 had normal cells. Slow/arrest embryos with normal day 3 FISH result may have abnormal blastomeres. Mosaicism can low the accuracy of single cell PGD results. And it can happen even after the biopsy if the embryo was exposed to inadequate conditions. It is unlikely this group of embryo can implant. P-2 Low-Dose Aspirin Administration During Ovarian Stimulation Adversely Influences Pregnancy Outcome in In-Vitro Fetilization/Embryo Transfer (IVF/ET) Patients. L. Zhang, S. P. Marynick, J. M. Putman. A.B. Pinto. Baylor Center for Reproductive Health, Baylor University Medical Center, Dallas, TX. Background and Significance: It has been shown that there is a transient increase in APA liters in women undergoing ovarian stimulation. Studies have shown that IVF/ET patients in general may benefit from low-dose aspirin therapy. Objective: The objective of this study was to evaluate the effect of low-dose aspirin administration on IVF/ET cycle outcome and successes rate. Materials and Methods: Retrospective comparison of IVF/ET results in the year of 1999. All patients going through IVF/ET in 1999 who were under 40 years old and had no less than two good quality embryos transferred were included in this study. Patients undergoing an IVF/ET cycle between January 1 and July 14 did not receive aspirin (Group 1). Between July 15 and December 31, 1999 patients received low-does aspirin (81 mgs) orally once a day (Group 2). Treatment of aspirin was initiated on day-21 of the cycle prior to stimulation and continued through the 8th week of pregnancy. No other protocol changes occurred during this study period. All patients were treated either with luteal phase GnRH agonist (long) protocol or micro dose flare protocol according to their cycle day 3 FSH level and previous response to ovarian stimulation. Pregnancy test was performed 14 days post egg retrieval. Serum hCG of ⬎ 10 mlU/ml was considered as a positive test. Clinical pregnancy was based on sonographic confirmation of a gestational sac at 8 weeks of pregnancy. Student-t test and Chi-square test were used for data analysis. Results: There were 45 patients in Group 1 and 38 patients in Group 2. No differences were found regarding patient age, number of embryos transferred, percent of positive hCG and clinical pregnancy rates. However, the ongoing pregnancy rate in Group 1 was 51.11% which was significant higher (P ⬍ 0.01) than in Group 2 (21.05%). The overall pregnancy loss rate in Group 1 (17.86%) was significantly lower (P ⬍ 0.01) than that in Group 2 (55.56%).
No. of Patients Age (mean ⫾ SE) No. of embryo transferred/ET No. of positive hCG (%) No. of clinical pregnancies (%) No. of ongoing pregnancies (%) No. of pregnancy lost (%)
Group 1 (No Aspirin)
Group 2 (Aspirin)
45 33.56 ⫾ 2.63 3.64 ⫹ 0.93 28 (62.22%) 25 (55.55%) 23 (51.11%) 5/28 (17.86%)
38 34.63 ⫾ 3.03 3.39 ⫾ 0.89 18 (47.37%) 15 (39.47%) 8 (21.05%) 10/18 (55.56)
Conclusion: The administration of low-dose aspirin in IVF/ET patients during ovarian stimulation and embryo transfer is associated with a significant increased miscarriage rate. Aspirin therapy should be used with caution for IVF/ET patients with no evidence of an ongoing autoimmunine process.
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PCRS Abstracts
P-3 The Psychology of Reproductive Traumas: Infertility and Pregnancy Loss. D.J. Diamond, M. Diamond. Center for Reproductive Psychology, San Diego, CA. Background: This paper will discuss the psychological impact on patients of adverse reproductive events, such as infertility, miscarriage and stillbirth. These events can be conceptualized as psychological traumas, with symptoms including flashbacks, confusion, sleep disorders, mood swings, depression and anxiety. Emotions may vacillate between sadness, anger, guilt and a profound sense of failure. The trauma complicates the patient’s multiple levels of loss, including loss of the baby, of the experience of pregnancy and birth, and of one’s sense of self as a healthy and normal adult. Fundamentally, reproductive trauma derives from the disruption to a person’s parental identity, or “reproductive story,” the unconscious narrative that people develop from childhood, when ideas of what it will be like to be a parent begin. When unrecognized, the trauma and grief reactions can compromise a patient’s ability to cope with the losses, to make constructive treatment decisions, and to work cooperatively with medical staff. Objective: The purpose of the paper is to provide insight into why patients who experience reproductive difficulties are so psychologically vulnerable. Specific suggestions for how to talk to patients about such events and their treatment will be provided, with the aim of enhancing the doctor/patient alliance and patient compliance with treatment recommendations. Materials and Methods: This paper is based on clinical experience with multiple patients who have undergone adverse reproductive events. Treatment methods include psycho-education to normalize patients’ profound sense of trauma and loss. Patients are helped to identify their reproductive stories, grieve their losses and choose medical interventions that will optimize the realization of their wishes to be parents. Results: Clinical observation and therapeutic success strongly support the usefulness of the concept of reproductive trauma, the role of complicated grief and the importance of recognizing disruptions to the reproductive story in helping patients to cope effectively with treatment. Conclusions: Patients benefit enormously from understanding the psychological impact of adverse reproductive events. The recognition of such events as both trauma and loss normalizes for both patients and doctors the wide-ranging emotions and sense of failure often experienced. When validated, patients are more able to cope and make appropriate decisions about how to become parents. P-4 High Pregnancy Rate of Vitrified Human Blastocysts. Seung W. Hong, Hyung M. Chung, Kwang Y. Cha, Thomas J. Kim. CHA Fertility Center, Los Angeles, California. College of Medicine, Pochon CHA University, Infertility Medical Center of CHA General Hospital, Seoul, Korea. Objective: With increasing use of blastocyst culture as a routine protocol in human clinical IVF, the cryopreservation of excessive human blastocysts has become an important part of infertility treatment. The objective of this study was to evaluate the clinical pregnancy of the vitrified human blastocysts on day 5 or day 6. Design: Development of a new approach to improve the clinical pregnancy rate of vitrified blastocysts Materials and Methods: Retrieved oocytes were inseminated by conventional IVF/ICSI, and cultured up to 7 days by the sequential culturing method in G1.2/G2.2 or G1.3/G2.3 media under the gas phases of 8% CO2, 5% O2 and 87% N2 at 37°C. Obtained blastocysts were first equilibrated in cryoprotectant solution containing 10% ethylene glycol at 37°C for 5min followed by introducing vitrification solution containing 38% ethylene glycol and 1M sucrose for 20 seconds. Blastocysts were then placed on the EM grid and immediately plunged to the liquid nitrogen directly. A total of 372 blastocysts were cryopreserved using vitrification technique from 88 patients. Thawing is performed according to five steps protocol with 1.0M, 0.5M, 0.25M, 0.125M, 0M of sucrose solution. The EM grids were transferred sequentially to the thawing solutions at intervals of 2.5min. Thawing was performed around 4PM the day before embryo transfer, and cultured in G2.2 or G2.3 medium overnight. Re-expanded blastocysts were judged as survival next morning and all of survived blastocysts were carried
Vol. 83, Suppl 2, May 2005
assisted hatching. Those blastocysts were transferred to the patients in the afternoon. Results: 85 of vitrified blastocysts from 22 patients were thawed. 59 out of 85 blastocysts (69.4%) were survived. Of those, 53 blastocysts were transferred to the patients. The number of blastocysts per transfer was 2.40 (⫾ 0.85). Seventeen out of 22 patients (77.2%) became pregnant and the implantation rate was 39.6% (21/53). Conclusion: Significantly high pregnancy and implantation rates of the vitrified blastocysts indicate that the vitrification technique would be a highly efficient method in clinical application of cryopreservation of supernumerary blastocysts in ART program. P-5 What is the Likelihood of Success for Biopsied Day 5 Embryos That Have Not Achieved Blastocyst Formation? L.B. Werlin, E. Marello, T.E. Nass, S. Munne. Coastal Fertility Medical Center, Irvine, California. Background and Significance: Typically blastocyst formation occurs by day 5, post oocyte retrieval. In situations where an embryo has not formed a blastocyst by day 5, many groups will not consider those embryos for transfer. We now present data that suggests that embryos that have undergone preimplantation genetic diagnosis (PGD), that have not reached blastocyst formation by day 5 still have a reasonable likelihood for implantation and achievement for successful pregnancy. Objective: In an effort to determine the viability of day 5 embryos that have not formed blastocysts, we retrospectively reviewed 36 pregnancies achieved through PGD in our program. Materials & Methods: All patients underwent controlled ovarian hyperstimulation (COH) protocols using either Lupron for down regulation or Antagon to block LH. At the appropriate time hCG 10,000 IU was administered and ultrasound guided oocyte retrieval was performed. Intracytoplasmic sperm injection (ICSI) was performed on all mature oocytes. Embryo biopsy and blastomere fixation was performed on day 3 post retrieval on all 6-8 cell embryos. Slides were then sent to Reprogenetics for fluorescence in situ hybridization (FISH) analysis for chromosomes 13, 15, 16, 17, 18, 21, 22, X and Y. Results were received day 4-5 post retrieval. Embryo transfer of only the chromosomally normal embryos was done on day 5 post retrieval. The results are shown below: Results: NONBLASTOCYST BLASTOCYST Embryos transferred Embryos implanted
31/67 (46.3%) 22/41 (53.7%)
36/67 (53.7%) 19/41 (46.3%)
TOTAL 67 (100%) 41/67 (61.2%)
Conclusions: From the data, the following conclusions may be made: 1.) Biopsied embryos transferred on day 5 that were not blastocysts achieved successful pregnancies. It is possible that the biopsy procedure may delay development in some embryos, as it has already been reported in the past (Hardy et al. 1990). However, the delay does not appear to be jeopardizing the embryos potential for implantation and ultimate successful outcome. 2.) Biopsied embryos that were blastocysts on day 5 had a slightly higher likelihood for implantation. 3.) Based on these results, patients should be encouraged to transfer previously biopsied embryos with normal karyotypes, regardless of whether or not the embryo has reached the blastocyst stage. P-6 GnRH Agonist Versus GnRH Antagonist During Controlled Ovarian Hyperstimulation (COH): Is There an Effect on Oocyte Maturity and Aneuploidy? S. Ghadir, S. Sarajari, A. Kumar, M. Li, D. Hill, H. Danzer, M. Surrey. David Geffen School of Medicine at UCLA and Cedars-Sinai Medical Center, Los Angeles, California. Background: With the advent of GnRH antagonists, another option has become available to the Reproductive Endocrinologist in the individualization of COH protocols for each patient. The divergent mechanisms used to obtain the ultimate goal of preventing the premature LH surge by GnRHagonist and GnRH-antagonist has implications on the resulting oocyte. This would have particular importance in patients 35 years and older, a popula-
FERTILITY & STERILITY威
tion known to have limited numbers of available mature oocytes and at higher risk for aneuploidy. Objective: The purpose of this study was to test the hypothesis that the mechanism of pituitary suppression during COH for IVF (i.e. antagonist vs. agonist) influences embryo quality as measured by aneuploidy. Materials and Methods: This prospective study will randomize 40 patients, ages 35 to 42 years, with day 3 FSH measurements ⬍10 mIU, to either undergo COH for IVF using a GnRHa (Lupron®, Tap Pharmaceuticals) for pituitary downregulation or a GnRH antagonist (Ganirelix Acetate, Organon Pharmaceuticals, USA, Inc.) for pituitary suppression. Following OCP therapy, all patients are to receive rFSH (Follistim®, Organon Pharmaceuticals USA, Inc.). Under the agonist protocol, patients start leuprolide acetate 40 mcg bid on the 3rd pill-free day and 150 IU rFSH bid on the 5th pill-free day. Under the antagonist protocol, patients start on 150 IU rFSH bid on the 3rd pill-free day and 250 mcg of ganirelix acetate daily when the lead follicle has reached 14 mm in size. Subsequently, the rFSH dosage is to be individualized depending on the response. Preimplantation genetic diagnosis (PGD) will be performed to assess chromosomes 13, 18, 21, X, and Y on all embryos amenable to biopsy for aneuploidy screening. Parameters assessed include age, FSH, days of stimulation, and total Follistim® dosage. Outcome measures were number of oocytes retrieved, percent oocytes fertilized, percent abnormal embryos and pregnancy outcome. Results: These data represent the initial 21 patients who have proceeded through the study. In the ganirelix acetate arm (8 patients), mean number of ocoytes retrieved were 6.2, 3.7 (59.7%) oocytes fertilized, and 3.3 embryos were analyzed by PGD per cycle. Similarly, in the leuprolide acetate arm (13 patients), mean number of oocytes retrieved were 8.2, 4.3 (52.4%) oocytes fertilized, and 4.1 embryos were analyzed by PGD per cycle. Both groups yielded almost identical rates of abnormal embryos, 57.7% and 61.3% for Ganirelix and leuprolide, respectively. On average, per cycle, the number of normal (pgd) embryos that were available for transfer was, 1.8 in Lupron and 1.1 in Ganirelix. Of those patients proceeding through stimulation (intent-to-treat group), 38.0% in the Ganirelix group and 15.4% in the leuprolide group had positive pregnancy tests (⫹hCG). Conclusions: Though, this study has yet to reach its completion, the data thus far do not suggest that the mechanism of pituitary suppression, either by an antagonist’s competitive inhibition or an agonist-mediated down regulation, effects genomic quality as measured by aneuploidy. In fact, though sufficient data has not been accumulated to make any conclusions, the trend in pregnancy rates reveals that, at a minimum, antagonist suppression is equivalent to agonist down regulation. Support: This study has been supported by an unrestricted educational grant from Organon Pharmaceuticals, USA. P-7 Comparison of In Vitro Fertilization (IVF) Outcomes in Patients Treated with Highly Purified Urinary Follicle Stimulating Hormone (HP-Ufsh) Plus Human Menopausal Gonadotropins (hMG) or Follitropin ␣ (r-hFSH) Plus hMG. Denny Sakkas, Ph.D, Westley Anderson, Aydin Arici, M.D. Department of Obstetrics and Gynecology, Yale University School of Medicine. Objective: Urine-derived gonadotropin products are generally less expensive than their recombinant counterparts. The decision to use less expensive drugs does not necessarily translate into overall cost-effectiveness which incorporates both costs and outcomes. The objective of this study was to compare the laboratory and clinical outcomes for IVF patients treated with HP-uhCG/hMG versus r-hFSH/hMG in our practice. Design: A retrospective review of all patients undergoing a standard IVF protocol during a six-month period from November 2002 to May 2003. Materials and Methods: Eighty one IVF patients were down regulated using leuprolide acetate (Lupron®) in a standard long luteal protocol. Patients selected the gonadotropin products to be used in their treatment. When criteria for down regulation were met (estradiol [E2] levels ⬍50 pg/mL), patients initiated controlled ovarian stimulation (COS) with either 150-300 IU/day of HP-uFSH (Bravelle®) and 75 IU of hMG (Repronex®) (n⫽19) or 150-300 IU/day r-hFSH (Gonal-f®) and 75 IU of hMG (Repronex®) (n⫽62). After five days of treatment the gonadotropin dose was adjusted, according to response. When the leading follicle reached ⬎18 mm and two others ⬎16 mm, 10,000 IU of urinary human chorionic gonadotropin (Profasi®/Novarel®/Pregnyl®) was given. Oocyte retrieval was performed 34-36 hours later.
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No. of Patients Age (mean ⫾ SE) No. of embryo transferred/ET No. of positive hCG (%) No. of clinical pregnancies (%) No. of ongoing pregnancies (%) No. of pregnancy lost (%)
Group 1 (No Aspirin)
Group 2 (Aspirin)
45 33.56 ⫾ 2.63 3.64 ⫹ 0.93 28 (62.22%) 25 (55.55%) 23 (51.11%) 5/28 (17.86%)
38 34.63 ⫾ 3.03 3.39 ⫾ 0.89 18 (47.37%) 15 (39.47%) 8 (21.05%) 10/18 (55.56)
Conclusion: The administration of low-dose aspirin in IVF/ET patients during ovarian stimulation and embryo transfer is associated with a significant increased miscarriage rate. Aspirin therapy should be used with caution for IVF/ET patients with no evidence of an ongoing autoimmunine process.
S14
PCRS Abstracts
P-3 The Psychology of Reproductive Traumas: Infertility and Pregnancy Loss. D.J. Diamond, M. Diamond. Center for Reproductive Psychology, San Diego, CA. Background: This paper will discuss the psychological impact on patients of adverse reproductive events, such as infertility, miscarriage and stillbirth. These events can be conceptualized as psychological traumas, with symptoms including flashbacks, confusion, sleep disorders, mood swings, depression and anxiety. Emotions may vacillate between sadness, anger, guilt and a profound sense of failure. The trauma complicates the patient’s multiple levels of loss, including loss of the baby, of the experience of pregnancy and birth, and of one’s sense of self as a healthy and normal adult. Fundamentally, reproductive trauma derives from the disruption to a person’s parental identity, or “reproductive story,” the unconscious narrative that people develop from childhood, when ideas of what it will be like to be a parent begin. When unrecognized, the trauma and grief reactions can compromise a patient’s ability to cope with the losses, to make constructive treatment decisions, and to work cooperatively with medical staff. Objective: The purpose of the paper is to provide insight into why patients who experience reproductive difficulties are so psychologically vulnerable. Specific suggestions for how to talk to patients about such events and their treatment will be provided, with the aim of enhancing the doctor/patient alliance and patient compliance with treatment recommendations. Materials and Methods: This paper is based on clinical experience with multiple patients who have undergone adverse reproductive events. Treatment methods include psycho-education to normalize patients’ profound sense of trauma and loss. Patients are helped to identify their reproductive stories, grieve their losses and choose medical interventions that will optimize the realization of their wishes to be parents. Results: Clinical observation and therapeutic success strongly support the usefulness of the concept of reproductive trauma, the role of complicated grief and the importance of recognizing disruptions to the reproductive story in helping patients to cope effectively with treatment. Conclusions: Patients benefit enormously from understanding the psychological impact of adverse reproductive events. The recognition of such events as both trauma and loss normalizes for both patients and doctors the wide-ranging emotions and sense of failure often experienced. When validated, patients are more able to cope and make appropriate decisions about how to become parents. P-4 High Pregnancy Rate of Vitrified Human Blastocysts. Seung W. Hong, Hyung M. Chung, Kwang Y. Cha, Thomas J. Kim. CHA Fertility Center, Los Angeles, California. College of Medicine, Pochon CHA University, Infertility Medical Center of CHA General Hospital, Seoul, Korea. Objective: With increasing use of blastocyst culture as a routine protocol in human clinical IVF, the cryopreservation of excessive human blastocysts has become an important part of infertility treatment. The objective of this study was to evaluate the clinical pregnancy of the vitrified human blastocysts on day 5 or day 6. Design: Development of a new approach to improve the clinical pregnancy rate of vitrified blastocysts Materials and Methods: Retrieved oocytes were inseminated by conventional IVF/ICSI, and cultured up to 7 days by the sequential culturing method in G1.2/G2.2 or G1.3/G2.3 media under the gas phases of 8% CO2, 5% O2 and 87% N2 at 37°C. Obtained blastocysts were first equilibrated in cryoprotectant solution containing 10% ethylene glycol at 37°C for 5min followed by introducing vitrification solution containing 38% ethylene glycol and 1M sucrose for 20 seconds. Blastocysts were then placed on the EM grid and immediately plunged to the liquid nitrogen directly. A total of 372 blastocysts were cryopreserved using vitrification technique from 88 patients. Thawing is performed according to five steps protocol with 1.0M, 0.5M, 0.25M, 0.125M, 0M of sucrose solution. The EM grids were transferred sequentially to the thawing solutions at intervals of 2.5min. Thawing was performed around 4PM the day before embryo transfer, and cultured in G2.2 or G2.3 medium overnight. Re-expanded blastocysts were judged as survival next morning and all of survived blastocysts were carried
Vol. 83, Suppl 2, May 2005
assisted hatching. Those blastocysts were transferred to the patients in the afternoon. Results: 85 of vitrified blastocysts from 22 patients were thawed. 59 out of 85 blastocysts (69.4%) were survived. Of those, 53 blastocysts were transferred to the patients. The number of blastocysts per transfer was 2.40 (⫾ 0.85). Seventeen out of 22 patients (77.2%) became pregnant and the implantation rate was 39.6% (21/53). Conclusion: Significantly high pregnancy and implantation rates of the vitrified blastocysts indicate that the vitrification technique would be a highly efficient method in clinical application of cryopreservation of supernumerary blastocysts in ART program. P-5 What is the Likelihood of Success for Biopsied Day 5 Embryos That Have Not Achieved Blastocyst Formation? L.B. Werlin, E. Marello, T.E. Nass, S. Munne. Coastal Fertility Medical Center, Irvine, California. Background and Significance: Typically blastocyst formation occurs by day 5, post oocyte retrieval. In situations where an embryo has not formed a blastocyst by day 5, many groups will not consider those embryos for transfer. We now present data that suggests that embryos that have undergone preimplantation genetic diagnosis (PGD), that have not reached blastocyst formation by day 5 still have a reasonable likelihood for implantation and achievement for successful pregnancy. Objective: In an effort to determine the viability of day 5 embryos that have not formed blastocysts, we retrospectively reviewed 36 pregnancies achieved through PGD in our program. Materials & Methods: All patients underwent controlled ovarian hyperstimulation (COH) protocols using either Lupron for down regulation or Antagon to block LH. At the appropriate time hCG 10,000 IU was administered and ultrasound guided oocyte retrieval was performed. Intracytoplasmic sperm injection (ICSI) was performed on all mature oocytes. Embryo biopsy and blastomere fixation was performed on day 3 post retrieval on all 6-8 cell embryos. Slides were then sent to Reprogenetics for fluorescence in situ hybridization (FISH) analysis for chromosomes 13, 15, 16, 17, 18, 21, 22, X and Y. Results were received day 4-5 post retrieval. Embryo transfer of only the chromosomally normal embryos was done on day 5 post retrieval. The results are shown below: Results: NONBLASTOCYST BLASTOCYST Embryos transferred Embryos implanted
31/67 (46.3%) 22/41 (53.7%)
36/67 (53.7%) 19/41 (46.3%)
TOTAL 67 (100%) 41/67 (61.2%)
Conclusions: From the data, the following conclusions may be made: 1.) Biopsied embryos transferred on day 5 that were not blastocysts achieved successful pregnancies. It is possible that the biopsy procedure may delay development in some embryos, as it has already been reported in the past (Hardy et al. 1990). However, the delay does not appear to be jeopardizing the embryos potential for implantation and ultimate successful outcome. 2.) Biopsied embryos that were blastocysts on day 5 had a slightly higher likelihood for implantation. 3.) Based on these results, patients should be encouraged to transfer previously biopsied embryos with normal karyotypes, regardless of whether or not the embryo has reached the blastocyst stage. P-6 GnRH Agonist Versus GnRH Antagonist During Controlled Ovarian Hyperstimulation (COH): Is There an Effect on Oocyte Maturity and Aneuploidy? S. Ghadir, S. Sarajari, A. Kumar, M. Li, D. Hill, H. Danzer, M. Surrey. David Geffen School of Medicine at UCLA and Cedars-Sinai Medical Center, Los Angeles, California. Background: With the advent of GnRH antagonists, another option has become available to the Reproductive Endocrinologist in the individualization of COH protocols for each patient. The divergent mechanisms used to obtain the ultimate goal of preventing the premature LH surge by GnRHagonist and GnRH-antagonist has implications on the resulting oocyte. This would have particular importance in patients 35 years and older, a popula-
FERTILITY & STERILITY威
tion known to have limited numbers of available mature oocytes and at higher risk for aneuploidy. Objective: The purpose of this study was to test the hypothesis that the mechanism of pituitary suppression during COH for IVF (i.e. antagonist vs. agonist) influences embryo quality as measured by aneuploidy. Materials and Methods: This prospective study will randomize 40 patients, ages 35 to 42 years, with day 3 FSH measurements ⬍10 mIU, to either undergo COH for IVF using a GnRHa (Lupron®, Tap Pharmaceuticals) for pituitary downregulation or a GnRH antagonist (Ganirelix Acetate, Organon Pharmaceuticals, USA, Inc.) for pituitary suppression. Following OCP therapy, all patients are to receive rFSH (Follistim®, Organon Pharmaceuticals USA, Inc.). Under the agonist protocol, patients start leuprolide acetate 40 mcg bid on the 3rd pill-free day and 150 IU rFSH bid on the 5th pill-free day. Under the antagonist protocol, patients start on 150 IU rFSH bid on the 3rd pill-free day and 250 mcg of ganirelix acetate daily when the lead follicle has reached 14 mm in size. Subsequently, the rFSH dosage is to be individualized depending on the response. Preimplantation genetic diagnosis (PGD) will be performed to assess chromosomes 13, 18, 21, X, and Y on all embryos amenable to biopsy for aneuploidy screening. Parameters assessed include age, FSH, days of stimulation, and total Follistim® dosage. Outcome measures were number of oocytes retrieved, percent oocytes fertilized, percent abnormal embryos and pregnancy outcome. Results: These data represent the initial 21 patients who have proceeded through the study. In the ganirelix acetate arm (8 patients), mean number of ocoytes retrieved were 6.2, 3.7 (59.7%) oocytes fertilized, and 3.3 embryos were analyzed by PGD per cycle. Similarly, in the leuprolide acetate arm (13 patients), mean number of oocytes retrieved were 8.2, 4.3 (52.4%) oocytes fertilized, and 4.1 embryos were analyzed by PGD per cycle. Both groups yielded almost identical rates of abnormal embryos, 57.7% and 61.3% for Ganirelix and leuprolide, respectively. On average, per cycle, the number of normal (pgd) embryos that were available for transfer was, 1.8 in Lupron and 1.1 in Ganirelix. Of those patients proceeding through stimulation (intent-to-treat group), 38.0% in the Ganirelix group and 15.4% in the leuprolide group had positive pregnancy tests (⫹hCG). Conclusions: Though, this study has yet to reach its completion, the data thus far do not suggest that the mechanism of pituitary suppression, either by an antagonist’s competitive inhibition or an agonist-mediated down regulation, effects genomic quality as measured by aneuploidy. In fact, though sufficient data has not been accumulated to make any conclusions, the trend in pregnancy rates reveals that, at a minimum, antagonist suppression is equivalent to agonist down regulation. Support: This study has been supported by an unrestricted educational grant from Organon Pharmaceuticals, USA. P-7 Comparison of In Vitro Fertilization (IVF) Outcomes in Patients Treated with Highly Purified Urinary Follicle Stimulating Hormone (HP-Ufsh) Plus Human Menopausal Gonadotropins (hMG) or Follitropin ␣ (r-hFSH) Plus hMG. Denny Sakkas, Ph.D, Westley Anderson, Aydin Arici, M.D. Department of Obstetrics and Gynecology, Yale University School of Medicine. Objective: Urine-derived gonadotropin products are generally less expensive than their recombinant counterparts. The decision to use less expensive drugs does not necessarily translate into overall cost-effectiveness which incorporates both costs and outcomes. The objective of this study was to compare the laboratory and clinical outcomes for IVF patients treated with HP-uhCG/hMG versus r-hFSH/hMG in our practice. Design: A retrospective review of all patients undergoing a standard IVF protocol during a six-month period from November 2002 to May 2003. Materials and Methods: Eighty one IVF patients were down regulated using leuprolide acetate (Lupron®) in a standard long luteal protocol. Patients selected the gonadotropin products to be used in their treatment. When criteria for down regulation were met (estradiol [E2] levels ⬍50 pg/mL), patients initiated controlled ovarian stimulation (COS) with either 150-300 IU/day of HP-uFSH (Bravelle®) and 75 IU of hMG (Repronex®) (n⫽19) or 150-300 IU/day r-hFSH (Gonal-f®) and 75 IU of hMG (Repronex®) (n⫽62). After five days of treatment the gonadotropin dose was adjusted, according to response. When the leading follicle reached ⬎18 mm and two others ⬎16 mm, 10,000 IU of urinary human chorionic gonadotropin (Profasi®/Novarel®/Pregnyl®) was given. Oocyte retrieval was performed 34-36 hours later.
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