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The utility of effort prior to IVF for patients with decreased ovrian reserve: a retrospective review of IVF outcomes
programme. Collected oocytes were matured as described by Chian. Due to personal reasons matured oocytes had to be cryopreserved. After one year, oocytes were warmed and fertilized with ICSI. Embryo transfer was performed on day two. RESULTS: Nine immature oocytes were retrieved, from which six reached metaphase II (MII) status at 24 hours (82% maturation rate), undergoing vitrification. Four oocytes survived thaw (67% survival rate) and fertilised following intracytoplasmic sperm injection (ICSI) (100% fertilization rate). Four embryos were transferred on day two. A single intrauterine pregnancy was identified at seven gestational weeks (25% implantation rate). A healthy baby girl was delivered at 38 gestational weeks. CONCLUSIONS: IVM followed by oocyte cryopreservation is, according to our results, a viable alternative to preserve fertility in those patients in whom conventional controlled ovarian stimulation is contraindicated. Supported by: Private practice.
A-6 FSH RECEPTOR POLYMORPHISMS IN A POPULATION OF INFERTILE WOMEN AND CONTROLS. G. Donarini, U. Omodei, D. Dordoni, E. Marchina, S. Barlati, M. Gennarelli. Materno Infantile, University of Brescia, Spedali Civili di Brescia, Brescia, Italy; Scienze Biomediche e Biotecnologie, Univ. Brescia, Spedali Civili di Brescia, Brescia, Italy. OBJECTIVE: Two single nucleotide polymorphisms at position 680 and 307 of the FSH receptor gene have been associated with infertility and ovarian response in IVF. The aim of this study was to examine the frequency distribution of FSH receptor polymorphisms in infertile patients and controls and to correlate these polymorphisms with the outcome of IVF cycle. DESIGN: Case-control study. MATERIALS AND METHODS: 86 IVF infertile patients undergoing ovarian stimulation in a long suppression protocol and 60 fertile controls were included in the study. Fertile patients included were enrolled among women who delivered and had no history of infertility. Blood samples were obtained and DNA was analyzed to determine the FSH receptor genotype. Among IVF cycle: basal FSH levels, number of antral follicles, number of preovulatory follicles (>15mm), number of retrieved oocytes, duration of stimulation (days), number of transfer embryo, pregnancy rate and amount of FSH were assessed and correlated with genotypes. RESULTS: No statistically significant differences in the distribution of polymorphisms were found among the group of infertile women and controls. Basal FSH levels, number of antral follicles, number of preovulatory follicles (>15mm), number of retrieved oocytes and number of transfered embryos was comparable between infertile patients with different FSH receptor genotype. However, patients who carry TT (thr-thr) and NN (asn-asn) genotype need fewer days of ovarian stimulation to oocyte retrieval. (TT: 9,07 days, p¼0,028; NN: 9,08 days, p¼0,037). A trend of better pregnancy rate in the AA genotype carrying patients was found, although not statistically significant. The dose of FSH required for a successful stimulation was similar in the two polymorphisms. CONCLUSIONS: FSH receptor genotype is not different between infertile and fertile patients. TT and NN genotype acchieve a significantly higher ovarian response. There is a not significant trend for better pregnancy rate in AA subgroup patients. Our results seem to support some role of FSH receptor polymorphism in infertile patients: the clinical relevance of this factor is however probably low. Supported by: None.
A-7 THE UTILITY OF EFFORT PRIOR TO IVF FOR PATIENTS WITH DECREASED OVRIAN RESERVE: A RETROSPECTIVE REVIEW OF IVF OUTCOMES. M. L. Matthews, R. Usadi, P. Marshburn, M. Papadakis, B. Hurst. Obstetrics and Gyneocology, Carolinas Medical Center, Charlotte, NC; Carolinas Medical Center, Charlotte, NC. OBJECTIVE: The infertility diagnosis of diminished ovarian reserve represents an increasing population of patients who pursue assisted reproduction. The goal of pre-cycle ovarian reserve testing prior to IVF is to offer patients predictive value for their chance of conceiving with IVF. Our objective is to determine the utility of the Exogenous FSH Ovarian Reserve Test (EFORT) prior to IVF for patients with decreased ovarian reserve as measured by a basal FSH of 15 mIU/ml or greater. DESIGN: A retrospective review.
FERTILITY & STERILITYÒ
MATERIALS AND METHODS: All IVF patients <44 years old with FSH levels between 15 mIU/ml and 25 mIU/ml between 1/1/07 and 12/ 31/07 were reviewed. EFORT was performed to detect a rise of serum estradiol from baseline (DE2) of 30 pg/ml or greater 24 hours after administration of 300 units of recombinant FSH. The main outcome measures include EFORT DE2, per cycle ongoing pregnancy rates, and IVF cycle cancellation rates. RESULTS: Twenty five patients with basal FSH greater than or equal to 15 mIU/ml and less than or equal to 25 mIU/ml were offered IVF. EFORT was performed on 17 patients, and 4 patients (23.5%) had a DE2 of 30pg/ml or greater. Of these 4 patients, 3/4 proceeded to IVF and 2/3 conceived and had term deliveries. Of the 8 patients who did not receive an EFORT, all attempted IVF but there were no live births. Three of 8 patients (37.5%) were cancelled due to poor ovarian response (<3 mature follicles), the remaining 5 went to oocyte retrieval and 2/5 conceived but miscarried. CONCLUSIONS: EFORT is clinically useful in predicting IVF cycle outcome and likelihood of cycle cancellation in poor prognosis women with markedly reduced ovarian reserve. The majority of patients with FSH elevations >15 mIU/ml will not pass an EFORT. However, if an appropriate estradiol rise is demonstrated by EFORT, the cycle cancellation rate is low and pregnancy is possible. Supported by: None.
A-8 IVF CYCLES WITH 3 OR LESS MATURE OOCYTES RETRIEVED: WHAT SHOULD THE PATIENT EXPECT IN TERMS OF OUTCOME? J. Liebermann, J. M. Matthews, A. J. Erman, S. R. Sanchez, A. J. Barker, E. J. Pelts. Fertility Centers of Illinois, Chicago, IL. OBJECTIVE: Over the past 3 years our practice has observed an increased number of patients who respond poorly to regular ovarian stimulation in terms of the number of mature oocytes retrieved (15-20%). To test the efficiency of IVF cycles with lower numbers of mature oocytes retrieved, we examined the cycle characteristics of cycles with 3 or less mature oocytes to predict successful pregnancy. DESIGN: A retrospective analysis of IVF cycles in which 3 or less mature oocytes were retrieved in a large IVF program. MATERIALS AND METHODS: 798 IVF cycles with 3 or less mature oocytes per oocyte retrieval (OR) between January 2005 and December 2007 were included in this study. MII oocytes were defined as oocytes where the first polar body was visible. The oocytes were fertilized using ICSI and cultured in Sage sequential media. Finally, we examined the subsequent development of the injected oocytes after ICSI from fertilization to the blastocyst stage. RESULTS: Cycle characteristics: No. of cycles Age (Mean SEM) Average E2 level at day of hCG application No. of oocytes per patient retrieved Total number of oocyte retrieved No. of matured oocytes No. of matured oocytes @ ICSI No. of normal fertilized oocytes No. of cleaved embryos No. of embryos with 6 or more blastomeres on day 3 No. of of blastocysts No. of blastocysts suitable for cryopreservation No. of cycles with no ET No. of day 3 transfers No. of day 5 transfers Mean number embryos transferred Total number of embryos transferred No. of pregnancies with positive hCG No. of clinical pregnancies No. of embryos implanted No. of ongoing pregnancies
798 37.0 4.2 1480.2 4.7 3.3 3778 1535 (40.6%) 2181 (57.7%) 1428 (65.5%) 1329 (93.1%) 766 (53.5%) 100 (7.0%) 24 (24%) 201 (25.2%) 561 (94.0%) 35 (6.0%) 1.7 1045 144 (24.0%) 116 (19.4%) 140 (13.4%) 96 (82.8%)
CONCLUSIONS: Our data indicates the following: (1) cycles with 3 or less mature oocytes upon retrieval provides good embryonic development, but a reduced chance of having extended culture and therefore the majority of these cycles will end with a Day 3 ET; (2) a higher chance of ET
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A-6 FSH RECEPTOR POLYMORPHISMS IN A POPULATION OF INFERTILE WOMEN AND CONTROLS. G. Donarini, U. Omodei, D. Dordoni, E. Marchina, S. Barlati, M. Gennarelli. Materno Infantile, University of Brescia, Spedali Civili di Brescia, Brescia, Italy; Scienze Biomediche e Biotecnologie, Univ. Brescia, Spedali Civili di Brescia, Brescia, Italy. OBJECTIVE: Two single nucleotide polymorphisms at position 680 and 307 of the FSH receptor gene have been associated with infertility and ovarian response in IVF. The aim of this study was to examine the frequency distribution of FSH receptor polymorphisms in infertile patients and controls and to correlate these polymorphisms with the outcome of IVF cycle. DESIGN: Case-control study. MATERIALS AND METHODS: 86 IVF infertile patients undergoing ovarian stimulation in a long suppression protocol and 60 fertile controls were included in the study. Fertile patients included were enrolled among women who delivered and had no history of infertility. Blood samples were obtained and DNA was analyzed to determine the FSH receptor genotype. Among IVF cycle: basal FSH levels, number of antral follicles, number of preovulatory follicles (>15mm), number of retrieved oocytes, duration of stimulation (days), number of transfer embryo, pregnancy rate and amount of FSH were assessed and correlated with genotypes. RESULTS: No statistically significant differences in the distribution of polymorphisms were found among the group of infertile women and controls. Basal FSH levels, number of antral follicles, number of preovulatory follicles (>15mm), number of retrieved oocytes and number of transfered embryos was comparable between infertile patients with different FSH receptor genotype. However, patients who carry TT (thr-thr) and NN (asn-asn) genotype need fewer days of ovarian stimulation to oocyte retrieval. (TT: 9,07 days, p¼0,028; NN: 9,08 days, p¼0,037). A trend of better pregnancy rate in the AA genotype carrying patients was found, although not statistically significant. The dose of FSH required for a successful stimulation was similar in the two polymorphisms. CONCLUSIONS: FSH receptor genotype is not different between infertile and fertile patients. TT and NN genotype acchieve a significantly higher ovarian response. There is a not significant trend for better pregnancy rate in AA subgroup patients. Our results seem to support some role of FSH receptor polymorphism in infertile patients: the clinical relevance of this factor is however probably low. Supported by: None.
A-7 THE UTILITY OF EFFORT PRIOR TO IVF FOR PATIENTS WITH DECREASED OVRIAN RESERVE: A RETROSPECTIVE REVIEW OF IVF OUTCOMES. M. L. Matthews, R. Usadi, P. Marshburn, M. Papadakis, B. Hurst. Obstetrics and Gyneocology, Carolinas Medical Center, Charlotte, NC; Carolinas Medical Center, Charlotte, NC. OBJECTIVE: The infertility diagnosis of diminished ovarian reserve represents an increasing population of patients who pursue assisted reproduction. The goal of pre-cycle ovarian reserve testing prior to IVF is to offer patients predictive value for their chance of conceiving with IVF. Our objective is to determine the utility of the Exogenous FSH Ovarian Reserve Test (EFORT) prior to IVF for patients with decreased ovarian reserve as measured by a basal FSH of 15 mIU/ml or greater. DESIGN: A retrospective review.
FERTILITY & STERILITYÒ
MATERIALS AND METHODS: All IVF patients <44 years old with FSH levels between 15 mIU/ml and 25 mIU/ml between 1/1/07 and 12/ 31/07 were reviewed. EFORT was performed to detect a rise of serum estradiol from baseline (DE2) of 30 pg/ml or greater 24 hours after administration of 300 units of recombinant FSH. The main outcome measures include EFORT DE2, per cycle ongoing pregnancy rates, and IVF cycle cancellation rates. RESULTS: Twenty five patients with basal FSH greater than or equal to 15 mIU/ml and less than or equal to 25 mIU/ml were offered IVF. EFORT was performed on 17 patients, and 4 patients (23.5%) had a DE2 of 30pg/ml or greater. Of these 4 patients, 3/4 proceeded to IVF and 2/3 conceived and had term deliveries. Of the 8 patients who did not receive an EFORT, all attempted IVF but there were no live births. Three of 8 patients (37.5%) were cancelled due to poor ovarian response (<3 mature follicles), the remaining 5 went to oocyte retrieval and 2/5 conceived but miscarried. CONCLUSIONS: EFORT is clinically useful in predicting IVF cycle outcome and likelihood of cycle cancellation in poor prognosis women with markedly reduced ovarian reserve. The majority of patients with FSH elevations >15 mIU/ml will not pass an EFORT. However, if an appropriate estradiol rise is demonstrated by EFORT, the cycle cancellation rate is low and pregnancy is possible. Supported by: None.
A-8 IVF CYCLES WITH 3 OR LESS MATURE OOCYTES RETRIEVED: WHAT SHOULD THE PATIENT EXPECT IN TERMS OF OUTCOME? J. Liebermann, J. M. Matthews, A. J. Erman, S. R. Sanchez, A. J. Barker, E. J. Pelts. Fertility Centers of Illinois, Chicago, IL. OBJECTIVE: Over the past 3 years our practice has observed an increased number of patients who respond poorly to regular ovarian stimulation in terms of the number of mature oocytes retrieved (15-20%). To test the efficiency of IVF cycles with lower numbers of mature oocytes retrieved, we examined the cycle characteristics of cycles with 3 or less mature oocytes to predict successful pregnancy. DESIGN: A retrospective analysis of IVF cycles in which 3 or less mature oocytes were retrieved in a large IVF program. MATERIALS AND METHODS: 798 IVF cycles with 3 or less mature oocytes per oocyte retrieval (OR) between January 2005 and December 2007 were included in this study. MII oocytes were defined as oocytes where the first polar body was visible. The oocytes were fertilized using ICSI and cultured in Sage sequential media. Finally, we examined the subsequent development of the injected oocytes after ICSI from fertilization to the blastocyst stage. RESULTS: Cycle characteristics: No. of cycles Age (Mean SEM) Average E2 level at day of hCG application No. of oocytes per patient retrieved Total number of oocyte retrieved No. of matured oocytes No. of matured oocytes @ ICSI No. of normal fertilized oocytes No. of cleaved embryos No. of embryos with 6 or more blastomeres on day 3 No. of of blastocysts No. of blastocysts suitable for cryopreservation No. of cycles with no ET No. of day 3 transfers No. of day 5 transfers Mean number embryos transferred Total number of embryos transferred No. of pregnancies with positive hCG No. of clinical pregnancies No. of embryos implanted No. of ongoing pregnancies
798 37.0 4.2 1480.2 4.7 3.3 3778 1535 (40.6%) 2181 (57.7%) 1428 (65.5%) 1329 (93.1%) 766 (53.5%) 100 (7.0%) 24 (24%) 201 (25.2%) 561 (94.0%) 35 (6.0%) 1.7 1045 144 (24.0%) 116 (19.4%) 140 (13.4%) 96 (82.8%)
CONCLUSIONS: Our data indicates the following: (1) cycles with 3 or less mature oocytes upon retrieval provides good embryonic development, but a reduced chance of having extended culture and therefore the majority of these cycles will end with a Day 3 ET; (2) a higher chance of ET
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