- Email: [email protected]
Low-dose gonadotropins for ovulation induction
P-563
P-565
EARLY ESTRADIOL IN EGG DONOR CYCLES IS A GOOD PREDICTOR OF OVARIAN RESPONSE AND RISK OF OVARIAN HYPERSTIMULATION SYNDROME. A. R. Lami, I. Mazzanti, J. Su~ nol, J. Garcıa, F. Marina, S. Marina. Gynaecology, CEFER, Barcelona, Spain.
PREGNANT AND NON-PREGNANT IVF-ET CYCLES YIELD ADEQUATE ENDOMETRIAL DEVELOPMENT REGARDLESS OF SERUM ESTRADIOL LEVELS. M. E. Dean, D. Frankfurter, M. Dayal, A. K. Dubey, D. Peak, P. R. Gindoff. Obstretics and Gynecology, George Washington University, Washington, DC.
OBJECTIVE: To assess prognostic value of serum estradiol (SE) on day 4 of controlled ovarian stimulation (COS) in the first cycle of eggs donors referred to the ovarian response and risk of ovarian hyperstimulation syndrome (OHSS). DESIGN: Retrospective study of first eggs donor cycles from January 2005 to December 2006. MATERIALS AND METHODS: The SE was evaluated on day 4 of COS with short protocol with an agonist of GnRH in 409 cycles of egg donors. Determined as Group A (low response), N ¼ 81 (19, 80%) made up of 64 cycles (15, 64%) cancelled due to hypo-response plus 17 cycles (4, 15%) in which less than 6 MII oocytes were obtained. Determined as Group B (normal response), N ¼ 328 cycles (80, 19%) in which 6 o more MII oocytes were obtained. Out of 409 cycles, only on 345 cycles (84, 36%) transvaginal oocyte retrieval was performed, 64 cycles (15, 64%) were cancelled. These 345 cycles were divided into : Group I (high risk of OHSS) N ¼ 30 in cycles with SE on the day of HCG greater than 4000 pg/ml and Group II (low risk of OHSS) N ¼ 315 (91, 31%) when the SE on the day of HCG was less than 4000 pg/ml. Statistical analysis was done by chi square and ANOVA. RESULTS: The SE on day 4 of the COS of Group A and B was 175,82 pg/ml 154,33 vs. 309,96 pg/ml 198,01 respectively with a P¼0.001, which is statistically significant. If we would have considered a value of 65 pg/ml.of SE on day 4 of the COS as an indicator of cycle cancellation for low response, we could have decreased the percentage of donors that continued the COS and was cancelled later on for hypo response or the donors with less than 6 MII oocytes, from 19,80% to 14,18%. The SE on day 4 of the COS of Group I and II was 456,16 pg/ml. 245,10 vs. 294,34 pg/ml 189,65 respectively, with a P¼0,001, which is statistically significant. A value of 320 pg/ml of SE on day 4 of COS is a good predictor as high risk of OHSS. CONCLUSIONS: The SE on day 4 of COS of egg donors who perform a short protocol with an agonist of GnRH is a good predictor of the cancellation rate due to low response, of low retrieval of mature oocytes and of risk of OHSS. With a value of SE less than 65 pg/ml it is advised to cancel the cycle, which would allow to anticipate the cancellation of the cycle with hypo response or decrease the number of cycles with less than 6 MII oocyte. A value of SE more than 320 pg/ml is a good predictor of high risk of OHSS. Supported by: Institute Reproductive CEFER.
OBJECTIVE: Appropriate development of the endometrium is essential for embryo implantation. For IVF, the most widely utilized markers for uterine receptivity include endometrial thickness and the presence of a tri-laminar pattern. This study examines the relationship between IVF cycle outcome, ovarian stimulation and endometrial development. DESIGN: Retrospective observational study. MATERIALS AND METHODS: All initial, fresh, non-donor IVF-ET cycles between 01/01/01–12/31/04 were assessed. Transvaginal sonographic assessment of the endometrium for thickness and morphology was carried out during the stimulation phase of the IVF cycle. Groups were compared using Pearsons correlation coefficient, binary logistic regression and Chisquares.
P-564 LOW-DOSE GONADOTROPINS FOR OVULATION INDUCTION. D. L. Gehlbach, J. E. Sturgeon, J. L. Fellers, K. S. Langmade. Midwest Reproductive Center, PA, Olathe, KS. OBJECTIVE: To describe a modified low-dose gonadotropin protocol for ovulation induction in anovulatory women. DESIGN: Descriptive. MATERIALS AND METHODS: The records of all women undergoing ovulation induction using low-dose gonadotropins between 5–04 and 4–07 were reviewed; patients with hypothalamic amenorrhea were excluded. Typical starting doses of gonadotropins were 50–75 IU and the dose was increased by 25 IU or less every 3–4 days as determined by follicular size and serum estradiol level. Intrauterine insemination was timed by hCG injection when the lead follicle reached 17 mm or greater. The luteal phase was supported by vaginal micronized progesterone 200 mg BID. RESULTS: Sixty-eight patients of median age 29 with anovulation underwent 158 cycles of ovulation induction using low-dose gonadotropins. The median duration of stimulation was 10 days with a total gonadotropin dosage of 625 IU. The clinical pregnancy rate was 25.3%. Three cycles were cancelled due to over-response and one at a patient’s request, for a cancellation rate of 2.5%. The multiple pregnancy rate was 12.5% and consisted solely of twins. CONCLUSIONS: This modified low-dose gonadotropin protocol provides an effective and efficient method for ovulation induction while limiting the risk of multiple gestation. Supported by: None.
S294
Abstracts
TABLE. Summary
Pregnant (n ¼ 68) Peak Estradiol (pg/ml) Endometrial Thickness (mm) Tri-laminar Cycles (%) Number of Days to Tri-laminar Number of Days After First Tri-laminar
Not Pregnant (n ¼ 209) P-value
2152.0 11.70 98.5 7.67
1703.8 11.30 98.1 7.67
0.003* 0.249 0.98 0.99
4.22
4.20
0.95
*P%0.003. RESULTS: A total 277 first IVF-ET cycles were conducted. 68 cycles resulted in a pregnancy while 209 did not. Groups did not differ with regards maximum endometrial thickness, the presence or absence of a tri-laminar pattern, rate at which a tri-laminar pattern was reached, the length of time a tri-laminar pattern was observed, the duration of stimulation or the number of eggs and embryos attained. Groups did differ with regards to patient age, peak estradiol and the number of embryos transferred (34.3 vs. 35.4 yrs P¼0.03; 2152.0 vs. 1703.8 pg/ml P¼0.003; 2.8 vs. 2.3 P¼0.001 for Pregnant and Not-Pregnant Groups respectively). No correlation between endometrial thickness and either pregnancy outcome (r ¼ 0.07; P¼0.247) or peak estradiol was observed (r ¼ 0.06; P¼0.254). An endometrial thickness of >7.5mm and a tri-laminar pattern was noted even with peak E2 levels of 300 pg/ml. CONCLUSIONS: There appears to be no difference between pregnant and non pregnant patients with regards to multiple sonographic measures of endometrial development during IVF-ET. Despite differences in peak estradiol levels, pregnant and non-pregnant cycles did not differ with regards to endometrial thickness or endometrial pattern. These findings imply that modest estradiol concentrations are sufficient to support adequate endometrial development and calls into question the need for exogenous estradiol supplementation during IVF-ET cycles. Supported by: None. P-566 THE OUTCOME OF DIFFERENT DOSE GNRH AGONIST SUPPRESSION ON IN VITRO FERTILIZATION-EMBRYO TRANSFER (IVF-ET) CYCLE OUTCOME IN PATIENTS WITH STAGE III/IV ENDOMETRIOSIS. C. Ma, J. Qiao, P. Liu, G. Chen. Center for Reproductive Medicine, PeKing University Thire Hospital, Beijing, China. OBJECTIVE: To evaluate the efficacy of different dose of GnRH agonist hormonal suppression on IVF-ET outcome in the patients with moderate or severe endometrosis. DESIGN: Retrospective study in tertiary university hospital encompassing the time period January 1, 2003December 30, 2006. MATERIALS AND METHODS: Chinese women for IVF-ET with a primary diagnosis of stages III to IV endometriosis surgically confirmed and their first cycles in our center were included. Group I (61 patients) received standard COH employing mid-luteal phase GnRHa down regulation. Group II (35 patients) received monthly GnRHa 3.75 mg IM 2 followed by ovarian hyperstimulation. Group III (44 patients) received monthly GnRH agonist 3.75 mg IM 3 followed by ovarian hyperstimulation. All patients received
Vol. 88, Suppl 1, September 2007
P-565
EARLY ESTRADIOL IN EGG DONOR CYCLES IS A GOOD PREDICTOR OF OVARIAN RESPONSE AND RISK OF OVARIAN HYPERSTIMULATION SYNDROME. A. R. Lami, I. Mazzanti, J. Su~ nol, J. Garcıa, F. Marina, S. Marina. Gynaecology, CEFER, Barcelona, Spain.
PREGNANT AND NON-PREGNANT IVF-ET CYCLES YIELD ADEQUATE ENDOMETRIAL DEVELOPMENT REGARDLESS OF SERUM ESTRADIOL LEVELS. M. E. Dean, D. Frankfurter, M. Dayal, A. K. Dubey, D. Peak, P. R. Gindoff. Obstretics and Gynecology, George Washington University, Washington, DC.
OBJECTIVE: To assess prognostic value of serum estradiol (SE) on day 4 of controlled ovarian stimulation (COS) in the first cycle of eggs donors referred to the ovarian response and risk of ovarian hyperstimulation syndrome (OHSS). DESIGN: Retrospective study of first eggs donor cycles from January 2005 to December 2006. MATERIALS AND METHODS: The SE was evaluated on day 4 of COS with short protocol with an agonist of GnRH in 409 cycles of egg donors. Determined as Group A (low response), N ¼ 81 (19, 80%) made up of 64 cycles (15, 64%) cancelled due to hypo-response plus 17 cycles (4, 15%) in which less than 6 MII oocytes were obtained. Determined as Group B (normal response), N ¼ 328 cycles (80, 19%) in which 6 o more MII oocytes were obtained. Out of 409 cycles, only on 345 cycles (84, 36%) transvaginal oocyte retrieval was performed, 64 cycles (15, 64%) were cancelled. These 345 cycles were divided into : Group I (high risk of OHSS) N ¼ 30 in cycles with SE on the day of HCG greater than 4000 pg/ml and Group II (low risk of OHSS) N ¼ 315 (91, 31%) when the SE on the day of HCG was less than 4000 pg/ml. Statistical analysis was done by chi square and ANOVA. RESULTS: The SE on day 4 of the COS of Group A and B was 175,82 pg/ml 154,33 vs. 309,96 pg/ml 198,01 respectively with a P¼0.001, which is statistically significant. If we would have considered a value of 65 pg/ml.of SE on day 4 of the COS as an indicator of cycle cancellation for low response, we could have decreased the percentage of donors that continued the COS and was cancelled later on for hypo response or the donors with less than 6 MII oocytes, from 19,80% to 14,18%. The SE on day 4 of the COS of Group I and II was 456,16 pg/ml. 245,10 vs. 294,34 pg/ml 189,65 respectively, with a P¼0,001, which is statistically significant. A value of 320 pg/ml of SE on day 4 of COS is a good predictor as high risk of OHSS. CONCLUSIONS: The SE on day 4 of COS of egg donors who perform a short protocol with an agonist of GnRH is a good predictor of the cancellation rate due to low response, of low retrieval of mature oocytes and of risk of OHSS. With a value of SE less than 65 pg/ml it is advised to cancel the cycle, which would allow to anticipate the cancellation of the cycle with hypo response or decrease the number of cycles with less than 6 MII oocyte. A value of SE more than 320 pg/ml is a good predictor of high risk of OHSS. Supported by: Institute Reproductive CEFER.
OBJECTIVE: Appropriate development of the endometrium is essential for embryo implantation. For IVF, the most widely utilized markers for uterine receptivity include endometrial thickness and the presence of a tri-laminar pattern. This study examines the relationship between IVF cycle outcome, ovarian stimulation and endometrial development. DESIGN: Retrospective observational study. MATERIALS AND METHODS: All initial, fresh, non-donor IVF-ET cycles between 01/01/01–12/31/04 were assessed. Transvaginal sonographic assessment of the endometrium for thickness and morphology was carried out during the stimulation phase of the IVF cycle. Groups were compared using Pearsons correlation coefficient, binary logistic regression and Chisquares.
P-564 LOW-DOSE GONADOTROPINS FOR OVULATION INDUCTION. D. L. Gehlbach, J. E. Sturgeon, J. L. Fellers, K. S. Langmade. Midwest Reproductive Center, PA, Olathe, KS. OBJECTIVE: To describe a modified low-dose gonadotropin protocol for ovulation induction in anovulatory women. DESIGN: Descriptive. MATERIALS AND METHODS: The records of all women undergoing ovulation induction using low-dose gonadotropins between 5–04 and 4–07 were reviewed; patients with hypothalamic amenorrhea were excluded. Typical starting doses of gonadotropins were 50–75 IU and the dose was increased by 25 IU or less every 3–4 days as determined by follicular size and serum estradiol level. Intrauterine insemination was timed by hCG injection when the lead follicle reached 17 mm or greater. The luteal phase was supported by vaginal micronized progesterone 200 mg BID. RESULTS: Sixty-eight patients of median age 29 with anovulation underwent 158 cycles of ovulation induction using low-dose gonadotropins. The median duration of stimulation was 10 days with a total gonadotropin dosage of 625 IU. The clinical pregnancy rate was 25.3%. Three cycles were cancelled due to over-response and one at a patient’s request, for a cancellation rate of 2.5%. The multiple pregnancy rate was 12.5% and consisted solely of twins. CONCLUSIONS: This modified low-dose gonadotropin protocol provides an effective and efficient method for ovulation induction while limiting the risk of multiple gestation. Supported by: None.
S294
Abstracts
TABLE. Summary
Pregnant (n ¼ 68) Peak Estradiol (pg/ml) Endometrial Thickness (mm) Tri-laminar Cycles (%) Number of Days to Tri-laminar Number of Days After First Tri-laminar
Not Pregnant (n ¼ 209) P-value
2152.0 11.70 98.5 7.67
1703.8 11.30 98.1 7.67
0.003* 0.249 0.98 0.99
4.22
4.20
0.95
*P%0.003. RESULTS: A total 277 first IVF-ET cycles were conducted. 68 cycles resulted in a pregnancy while 209 did not. Groups did not differ with regards maximum endometrial thickness, the presence or absence of a tri-laminar pattern, rate at which a tri-laminar pattern was reached, the length of time a tri-laminar pattern was observed, the duration of stimulation or the number of eggs and embryos attained. Groups did differ with regards to patient age, peak estradiol and the number of embryos transferred (34.3 vs. 35.4 yrs P¼0.03; 2152.0 vs. 1703.8 pg/ml P¼0.003; 2.8 vs. 2.3 P¼0.001 for Pregnant and Not-Pregnant Groups respectively). No correlation between endometrial thickness and either pregnancy outcome (r ¼ 0.07; P¼0.247) or peak estradiol was observed (r ¼ 0.06; P¼0.254). An endometrial thickness of >7.5mm and a tri-laminar pattern was noted even with peak E2 levels of 300 pg/ml. CONCLUSIONS: There appears to be no difference between pregnant and non pregnant patients with regards to multiple sonographic measures of endometrial development during IVF-ET. Despite differences in peak estradiol levels, pregnant and non-pregnant cycles did not differ with regards to endometrial thickness or endometrial pattern. These findings imply that modest estradiol concentrations are sufficient to support adequate endometrial development and calls into question the need for exogenous estradiol supplementation during IVF-ET cycles. Supported by: None. P-566 THE OUTCOME OF DIFFERENT DOSE GNRH AGONIST SUPPRESSION ON IN VITRO FERTILIZATION-EMBRYO TRANSFER (IVF-ET) CYCLE OUTCOME IN PATIENTS WITH STAGE III/IV ENDOMETRIOSIS. C. Ma, J. Qiao, P. Liu, G. Chen. Center for Reproductive Medicine, PeKing University Thire Hospital, Beijing, China. OBJECTIVE: To evaluate the efficacy of different dose of GnRH agonist hormonal suppression on IVF-ET outcome in the patients with moderate or severe endometrosis. DESIGN: Retrospective study in tertiary university hospital encompassing the time period January 1, 2003December 30, 2006. MATERIALS AND METHODS: Chinese women for IVF-ET with a primary diagnosis of stages III to IV endometriosis surgically confirmed and their first cycles in our center were included. Group I (61 patients) received standard COH employing mid-luteal phase GnRHa down regulation. Group II (35 patients) received monthly GnRHa 3.75 mg IM 2 followed by ovarian hyperstimulation. Group III (44 patients) received monthly GnRH agonist 3.75 mg IM 3 followed by ovarian hyperstimulation. All patients received
Vol. 88, Suppl 1, September 2007