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50 MITOCHONDRIA AND DEVELOPMENTAL COMPETENCE
Innovations in Assisted Reproductive Technologies microdomain organization between the mouse and human may explain why the former is penetrable at MII while the human is penetrable at the GV stage, and why the site of penetration precludes the region of the oolemma surrounding the first polar body in the mouse but not in the human. Studies of normal and failed sperm penetration for MII human oocytes, and for embryos that arrest during early cleavage can be related to the organization of lipid/protein microdomains. The findings suggest that the reorganization of the oolemma is coordinated with nuclear maturation in the mouse, and together with cytoplasmic maturation, represents a third element of the oocyte maturation process that leads to the acquisition of developmental competence. 50 MITOCHONDRIA AND DEVELOPMENTAL COMPETENCE J. Van Blerkom. Department of Molecular, Cellular and Developmental Biology, University of Colorado, Boulder, Colorado, USA The role of mitochondria in the establishment and maintenance of developmental competence for the oocyte and preimplantation stage embryo has recently become an area of intense interest in studies of early mammalian development in general, and as fundamental factor in the success of human embryogenesis, in particular. While most studies have focused on their bioenergetic function, i.e., ATP generation, emerging data also indicates roles in the regulation of cytoplasmic redox state and the normal functioning of signaling pathways, and of certain transcription factors and protein kinases. In addition to these activities, results will be presented which indicate that stage-specific changes in levels of ATP generation are differentially localized and utilized in the maturing oocyte and early embryo, which suggests that how cellular ‘power’ is distributed during early development may be as critical a determinant of competence than are total mtDNA and ATP content. 51 ANTI-MULLERIAN HORMONE IS A PREDICTIVE MARKER IN ASSISTED REPRODUCTIVE TECHNOLOGY A. Volpe, A. La Marca. Mother-Infant Department, Section of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Modena, Italy Anti-mullerian hormone (AMH) represents ovarian follicular pool and could be a useful marker of ovarian reserve. The clinical application of AMH measurement has been proposed in the prediction of quantitative and qualitative aspects in assisted reproductive technologies (ART). Literature database were systematically searched for studies published until 2008. Search criteria relevant to AMH, ovarian reserve, ovarian response to gonadotrophin stimulation were used. AMH seems to be a better marker in predicting ovarian response to controlled ovarian stimulation than age of the patient, FSH, estradiol and inhibin B. A similar performance for AMH and antral follicular count has been reported. In clinical practice, AMH measurement may be useful in the prediction of poor response and cycle cancellation, and also of hyper-response and ovarian hyperstimulation syndrome. In conclusion, a possible role for AMH measurement could be the individualization of treatment strategies in order to reduce the clinical risk of ART along with optimized treatment burden. Cost/benefit balance of its use in ovarian reserve testing is mandatory.
S21 52 FIRST EXPERIENCE OF PATIENT FRIENDLY IVF PROGRAMS: MINIMAL STIMULATION, MINIMAL MEDICAL INTERVENTIONS, MINIMAL COMPLICATIONS Y.V. Voznesenskaya, S.A. Yakovenko. “Altravita” IVF Clinic, Moscow, Russia C.I.S The success of in-vitro fertilisation (IVF) treatment depends on adequate follicle recruitment by using controlled ovarian stimulation with gonadotrophins. Failure to recruit adequate follicles is called ’poor response’. Various treatment protocols have been proposed that are targeted at this cohort of women, aiming to increase their ovarian response. According to S. Teramoto, O. Kato (2007), clomiphene, an isomeric component of clomiphene citrate, acts antagonistically to the oestradiol receptor at the hypothalamus level, inhibiting both negative and positive feedback, and resulting in the induction of ovarian stimulation and suppression of ovulation. The minimal ovarian stimulation protocol takes full advantage of these characteristics of clomiphene citrate. The aim of the study was mastering mild stimulation IVF in women with poor pregnancy prognosis with clomiphene in Altravita clinic. Fifty-three patients (average age 37.8±5.0 yrs, Day 3 follicle-stimulating hormone (FSH) 12.6±7.5 IU/l, antral follicle count 6.8±3.9) were included in our study basing on the presence of at least one of the following criteria: poor response in earlier IVF protocols (<6 oocytes), 0% blastocyst rate, age 39 yrs, Day 3 FSH >9 IU/l, anti-M¨ ullerian hormone (AMH) <1 ng/ml, or repeated implantation failure (3). In this group of patients, we performed minimal stimulation with clomifene citrate (50 mg daily) and recombinant human FSH (50 100 IU daily) with ET in the following cycle. We obtained 120 mature oocytes (2.3 oocytes per patient); 77 embryos (1.4 per patient) were vitrified (6 blastocysts, 51 Day 3 and 20 Day 2 cleavage stage embryos). Cryopreservation was unfeasible in 33% of the cases owing to the absence of suitable oocytes or embryos. In 40 frozen embryo transfer cycles supported by HRT we obtained 14 singleton pregnancies (34%) with no cases of ectopic pregnancy; 2 pregnancies (5%) ended in miscarriage. 53 CLOMIPHENE CITRATE FOR POOR RESPONDER WOMEN UNDERGOING IVF/ICSI TREATMENT CYCLES: RANDOMISED CONTROLLED STUDY M.A.F.M. Youssef, I.A. Mohsen, S. Khattab, H. El Ashmawi, A. Darwish, I. Aboul Foutouh. Egyption International Fertility center IVF, Egypt Background: One of the most frustrating problems in IVF today is the low pregnancy rate in women with poor ovarian response. Poor responders are estimated to comprise approximately 9 24% of IVF/ICSI patients. Patient and Method: Randomised controlled blind study, 70 poor responders women aged 20 42 years, with a history of 1ry or 2ry infertility were included. Poor response was defined by the number of dominant follicles on HCG day and number of mature oocytes <3 or cycle cancellation due to poor ovarian response. Patients were randomized to receive either GnRH antagonist plus clomiphene (study group) or GnRH agonist plus HMG (Control group) using computer-generated random numbers concealed in opaque envelopes. Results: There were no significant differences between the two groups in the baseline characteristics. There was no evidence of significant differences between the two groups in the cycle cancellation rates, and the number of mature follicles, total oocytes
S21 52 FIRST EXPERIENCE OF PATIENT FRIENDLY IVF PROGRAMS: MINIMAL STIMULATION, MINIMAL MEDICAL INTERVENTIONS, MINIMAL COMPLICATIONS Y.V. Voznesenskaya, S.A. Yakovenko. “Altravita” IVF Clinic, Moscow, Russia C.I.S The success of in-vitro fertilisation (IVF) treatment depends on adequate follicle recruitment by using controlled ovarian stimulation with gonadotrophins. Failure to recruit adequate follicles is called ’poor response’. Various treatment protocols have been proposed that are targeted at this cohort of women, aiming to increase their ovarian response. According to S. Teramoto, O. Kato (2007), clomiphene, an isomeric component of clomiphene citrate, acts antagonistically to the oestradiol receptor at the hypothalamus level, inhibiting both negative and positive feedback, and resulting in the induction of ovarian stimulation and suppression of ovulation. The minimal ovarian stimulation protocol takes full advantage of these characteristics of clomiphene citrate. The aim of the study was mastering mild stimulation IVF in women with poor pregnancy prognosis with clomiphene in Altravita clinic. Fifty-three patients (average age 37.8±5.0 yrs, Day 3 follicle-stimulating hormone (FSH) 12.6±7.5 IU/l, antral follicle count 6.8±3.9) were included in our study basing on the presence of at least one of the following criteria: poor response in earlier IVF protocols (<6 oocytes), 0% blastocyst rate, age 39 yrs, Day 3 FSH >9 IU/l, anti-M¨ ullerian hormone (AMH) <1 ng/ml, or repeated implantation failure (3). In this group of patients, we performed minimal stimulation with clomifene citrate (50 mg daily) and recombinant human FSH (50 100 IU daily) with ET in the following cycle. We obtained 120 mature oocytes (2.3 oocytes per patient); 77 embryos (1.4 per patient) were vitrified (6 blastocysts, 51 Day 3 and 20 Day 2 cleavage stage embryos). Cryopreservation was unfeasible in 33% of the cases owing to the absence of suitable oocytes or embryos. In 40 frozen embryo transfer cycles supported by HRT we obtained 14 singleton pregnancies (34%) with no cases of ectopic pregnancy; 2 pregnancies (5%) ended in miscarriage. 53 CLOMIPHENE CITRATE FOR POOR RESPONDER WOMEN UNDERGOING IVF/ICSI TREATMENT CYCLES: RANDOMISED CONTROLLED STUDY M.A.F.M. Youssef, I.A. Mohsen, S. Khattab, H. El Ashmawi, A. Darwish, I. Aboul Foutouh. Egyption International Fertility center IVF, Egypt Background: One of the most frustrating problems in IVF today is the low pregnancy rate in women with poor ovarian response. Poor responders are estimated to comprise approximately 9 24% of IVF/ICSI patients. Patient and Method: Randomised controlled blind study, 70 poor responders women aged 20 42 years, with a history of 1ry or 2ry infertility were included. Poor response was defined by the number of dominant follicles on HCG day and number of mature oocytes <3 or cycle cancellation due to poor ovarian response. Patients were randomized to receive either GnRH antagonist plus clomiphene (study group) or GnRH agonist plus HMG (Control group) using computer-generated random numbers concealed in opaque envelopes. Results: There were no significant differences between the two groups in the baseline characteristics. There was no evidence of significant differences between the two groups in the cycle cancellation rates, and the number of mature follicles, total oocytes