7 The outcome of IVM babies

Abstracts because of the considerable inter-individual variability of ovarian response. The optimum starting dose can adjusted according to age, antral follicle count and body mass index, and nomograms have been proposed to predict the best starting dose for individual patients both in IUI and IVF/ICSI. The purpose of further ovarian monitoring is to ensure safe practice in reducing the incidence and severity of OHSS and to optimize the timing of hCG administration. Ultrasound monitoring provides information on ovarian response by ascertaining the number and sizes of developing follicles. The average number of ultrasound scan monitoring is about one for IUI and two to three for IVF/ICSI. Monitoring hormonal levels of estradiol is also a traditional practice although there is no evidence from randomized trials to support that it improves pregnancy rate, nor it decreases the occurrence of OHSS compared to ultrasound monitoring alone. Nevertheless, clinical guidelines dealing with cycle cancellation or coasting are based upon estradiol levels. It is recommended to cancel IUI cycles when estradiol levels are higher than 800 to 1000 pg/ml and to coast FSH administration in IVF/ICSI cycles with substantial risk of OHSS until estradiol level falls below 2500 pg/ml. Monitoring LH levels is useful in IUI cycles to adapt the timing of insemination to the occurrence of a spontaneous LH surge, a phenomenon observed in up to 25% of stimulated cycles. However the occurrence of LH surge is 10 fold lowered without impairing pregnancy rates by systematic administration of GnRH antagonists when the size of the dominant follicle is larger than 14 mm. Taken together, all these data outline the central role of ultrasound monitoring to make ovarian stimulation an efficient and safe therapeutic in ART. Therefore, quality management for ultrasound monitoring and prescription training are necessary. 7 The outcome of IVM babies R.C. Chian Department of Obstetrics and Gynecology, McGill University, Montreal, Canada Introduction: Initial oocyte in vitro maturation (IVM) treatment was performed for women infertility with polycystic ovary syndrome (PCOS), and then IVM technology was expanded to treat the over responders and the poor responders for gonadotropin stimulation. It has been estimated that more than 2,000 babies born with IVM treatment in the worldwide, and the clinical pregnancy and implantation rates were approximately 30 35% and 10 15% per embryo transfer, respectively (Chian et al., 2004). Although it has been believed that IVM treatment is not associated with any additional risk in terms of obstetric outcomes and congenital abnormalities (Buckett et al., 2007), it was based on a small number of live births at one fertility center. In this study, we performed a large scale survey for IVM babies born in the worldwide. Methods: Data were collected from the worldwide with where IVM babies born. Congenital abnormality, gestational age,

S97 birth weight, Apgar scores, cord pH, growth restriction, pregnancy complications, mode of delivery, and multiple pregnancy were analyzed. WHO Neonatal Database was used as control. Results: A total of 1501 IVM babies born world widely were analyzed. The data showed that congenital abnormality, Apgar scores, cord pH, growth restriction, and pregnancy complications were comparable with the control database. Conclusions: Based on the data collected, it seems that IVM treatment is not associated with any additional risk in terms of congenital abnormalities for the IVM babies. 8 Poor responders M.E. Coccia, F. Rizzello Department of Science for the Woman and Child’s Health, University of Florence, Florence, Italy Introduction: Nowadays no universal definition for poor responder is accepted. Owing to a general consensus, women with poor response to ovarian stimulation or those with low ovarian reserve are included in this group. The estimated incidence of poor response to ovarian stimulation ranges from 9% to 24%. Methods: Here, the authors provide a review of the current literature about poor responders. Definitions, suggested protocols of Controlled Ovarian Hyperstimulation (COH), and results are discussed. Results: The poor responder patient was originally described as a patient achieving a peak estradiol level <300 pg/mL after standard IVF protocol of stimulation. Afterwards, additional clinical characteristics, hormonal markers and ultrasound parameters have been employed. Poor ovarian response to COH can be attributable to a number of causes, including age, history of endometriosis, previous ovarian surgery, early ovarian aging. Several COH protocols and adjuvant treatments (steroids, progestins, L-arginine) have been proposed for the management of the poor responder: long protocol with large doses of gonadotropins, with a maximum FSH dose of 450 UI/day; short protocol, flare-up; minidose of GnRH agonist; clomiphene/hMG; large doses of clomiphene without hMG; GnRH antagonist. There are still inadequate randomised controlled trials of robust quality to compare obtained results. Conclusions: Future studies on poor responders should be based on a standard, universally accepted definition. Results about suggested strategies will take into account the poor responding causes. For younger poor responders, age confers better oocyte quality and thus improved pregnancy outcomes as compared with older patients.