Mild stimulation versus antagonist protocol in patients ≥43years old undergoing intracytoplasmic sperm injection

correlated with the risk for late follicular P rise in ART cycles, with the highest risk in cycles utilizing no exLH. Increased risk was also present when exLH:exFSH was either below 0.3 or over 0.6. Given that patients with different intrinsic ovarian responsiveness have varied intra-follicular milieus and gonadotropin sensitivity, it is possible that optimal exLH:exFSH might vary amongst them. This study seeks to determine if the exLH:exFSH varies amongst patients based on their ultimate ovarian responsiveness. DESIGN: Retrospective. MATERIALS AND METHODS: All patients undergoing their 1st IVF cycle at our center using a GnRH antagonist or down regulation GnRH agonist protocol were included. Patients were categorized by number of mature oocytes retrieved: LR %4; NR 5-19; and HR R20. Absolute P levels as well as the proportion of patients with P>1.5 ng/dL (published threshold) were evaluated using ROC followed by contingency table analyses. RESULTS: 10,280 IVF cycles were studied. Premature P rise was greatest in HR (N¼2789; 33%; RR¼3), intermediate in NR (N¼7003; 27%; RR¼2.5) and lowest in LR (N¼480; 11%; RR¼1) (P<0.0001). In all three groups an exLH:exFSH of <0.3 or >0.6 had the highest risk for a premature elevation in P (p<0.0001). In stimulations providing the lowest risk of premature P rise (0.3-0.6), the prevalence of this was lowest in LR (7%), intermediate in NR (15%), and highest in HR (27%) (P<0.0001). CONCLUSION: In all response groups, despite differing follicular responsiveness, absent or inadequate exLH is associated with late follicular elevations in P sufficient to induce suboptimal outcomes. Similarly, excessive exLH effect may be detrimental. Optimization of this stimulation parameter may be attained by using a ratio of 0.3-0.6 exLH:exFSH for all response groups. P-444 Tuesday, October 15, 2013 MILD STIMULATION VERSUS ANTAGONIST PROTOCOL IN PATIENTS R43YEARS OLD UNDERGOING INTRACYTOPLASMIC SPERM INJECTION. N. Dokuzeylul, M. Onal, M. Acet, S. Kahraman. ART and Reproductive Genetics Unit, Istanbul Memorial Hospital, Istanbul, Turkey. OBJECTIVE: To determine whether the mild stimulation(MS) or the antagonist protocol(AP) works better in patients R43 years old undergoing ICSI. DESIGN: Retrospective review. MATERIALS AND METHODS: From January 2005 to January 2012, 1047 women R43 years of age had ICSI therapy performed using either MS (n¼201) or AP (n¼846) in our unit. Primary end-points were implantation rate(IR) and clinical pregnancy rates. Data was analyzed using Student’s t-test and Chi-square as appropriate on an intention to treat basis.

RESULTS: The two groups had similar demographic characteristics. The number of retrieved oocytes, MII oocytes, 2PN embryos and the number of transferred embryos were significantly lower in MS group(p<0.0001). The mean duration of stimulation and E2 level on hCG day was significantly higher in AP(p<0.0001). The endometrial thickness on hCG day was significantly thicker in AP (p<0.0001).Total dose of gonadotropins required for stimulation was significantly higher in AP (p<0.0001). The cancellation rate was significantly higher in MS group(p¼0.0043). Clinical pregnancy rates and ongoing pregnancy rates were significantly lower in MS (p¼0.0253 and p¼0.0286)respectively. IR and live-birth rates were similar between two groups. CONCLUSION: This study demonstrates that the use of antagonist protocol provides better ART outcomes than MS in womenR 43 years. P-445 Tuesday, October 15, 2013 CLOMIPHENE CITRATE VERSUS LETROZOLE PROTOCOLS IN PATIENTS R 40 YEARS OLD UNDERGOING INTRACYTOPLASMIC SPERM INJECTION. N. Dokuzeylul, M. Onal, M. Acet, S. Kahraman. ART and Reproductive Genetics Unit, Istanbul Memorial Hospital, Istanbul, Turkey. OBJECTIVE: To determine whether clomiphene citrate(CC) or letrozole protocol works better in patients R40 years old undergoing ICSI. DESIGN: Retrospective review. MATERIALS AND METHODS: From January 2003 to January 2012, 484 women R40 years of age had ICSI therapy performed using either CC (n¼390) or letrozole (n¼94) stimulation protocol in our unit. Primary endpoints were implantation rate(IR) and clinical pregnancy rates. Data was analyzed using Student’s t-test and Chi-square as appropriate on an intention to treat basis. RESULTS: Results are presented in Table 1.The two study groups had similar demographic characteristics. The number of retrieved oocytes,MII oocytes, 2PN embryos and the number of transferred embryos were similar between two groups.Also,the mean duration of stimulation and the mean total dose of gonadotropins required for stimulation were similar between two groups. The mean E2 level on hCG day was significantly higher in cc group(p<0.0001).The endometrial thickness on hCG day was significantly thinner in cc group than in letrozole group(p¼0.0022). The cancellation rate was significantly higher in cc group(p¼0.0498).No differences were observed in IR, clinical pregnancy

TABLE 1. Comparion of two groups

TABLE 1. Comparion of two groups

Antagonist (N¼846) Age BMI E2 on hCG day Endometrial thickness on hCG day Total dose of gonadotropin Total duration of stimulation Number of oocytes retrieved M2 2PN ET # IR(%) Cancellation rate(%) CPR/ET(%) OPR/ET(%) LBR/ET(%) Miscarriage/ET(%)

S276

Mild stimulation (N¼201)

p

44.421,54 44.511.61 0.4605 27.084,30 27.034.36 0.8825 1544.00801.49 616.64402.29 <0.0001 11.053.11 7.852.44 <0.0001 3090.211579.021525.171006.51<0.0001 7.962.13

5.322.52

<0.0001

4.424.44

2.401.88

<0.0001

3.403.37 3.022.79 1.810.84 6.67 25.05 11.67 6.15 4.10 10.09

1.931.37 1.641.30 1.510.89 3.53 35.32 4.61 0.76 0.76 6.92

<0.0001 <0.0001 <0.0001 0.1254 0.0043 0.0253 0.0286 0.1068 0.3262

ASRM Abstracts

Age Endometrial thickness on hCG day E2 on hCG day Total dose of gonadotropin Total duration of stimulation Number of oocytes retrieved M2 2PN # ET IR(%) Cancellation(%) CPR/ET (%) OPR/ ET(%) LBR/ET(%) Miscarriage/ET(%)

CC(N¼390)

LETROZOLE (N¼94)

42.482.17 7.902.33

42.092.01 8.671.33

P 0.1134 0.0022

741.27519.72 365.78298.66 <0.0001 1540.721054.57 1494.84866.42 0.6959 5.502.60

5.872.78

0.2224

2.832.51

2.871.77

0,8840

2.342.25 2.061.72 1.650.83 6.63 34.61 9.80 5.09 4.70 9.01

2.121.21 1.951.12 1.580.52 5.30 23.40 8.33 5.55 5.55 6.94

0,3601 0.5552 0,4351 0.7675 0.0498 0.8225 0.8838 0.7595 0.8110

rates, miscarriage rates, ongoing pregnancy rates and live-birth rates between two groups.

Vol. 100, No. 3, Supplement, September 2013