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A Cocktail of GnRH Agonist and Urinary hCG to Trigger LH Surge in GnRH Antagonist -IVF Cycles Yields Higher Pregnancy Rates
OBJECTIVE: This study investigates the source of constant progesterone secretion responsible of primary amenorrhea. DESIGN: Case report. MATERIALS AND METHODS: A young woman, 20 years old, was referred to our department to explore primary amenorrhea. Physical examination revealed a female phenotype with normal secondary sex characteristics. Her BMI was 19, she had no hirsutism nor hypertension. Hormonal tests showed at first low Estradiol (E2⫽18 ng/ml), testosterone (0.25 ng/ ml), delta-4-androstenedione (1.1 ng/ml) with low basal FSH and LH, responding normally to GnRH stimulation, respectively (FSH: 1.9 IU/l3 3 IU/l, LH: 1.5 IU /l3 9 IU/l). Pelvic ultrasound showed normal ovarian volume (right ovary: 25x17 mm, left ovary: 24x12 mm) with normal uterus but atrophic endometrium. RESULTS: Hypothalamic hypogonadism was suggested but the level of progesterone was curiously consistently high (between 3 and 5 ng/ml). This secretion of progesterone was not stimulated by corticotropin (0.25 mg IV) nor suppressed by dexamethazone (8 mg orally). Adrenal tomodensitometry was normal. This excluded adrenal production of progesterone due to congenital adrenal hyperplasia. The ovarian vein catheterization detected a gradient between the right ovarian vein and peripheral blood. The level of progesterone was not diminished nor stimulated by the administration of long-acting agonist GnRH suggesting an autonomous secretion. Pulsatile LH secretion, evaluated every 10 minutes for 4 hours, was absent. A few months later, pelvic ultrasound controls detected a right ovary hyerechogen nodule growing slowly. Fine-needle aspiration of this solid mass under ultrasound control contained a high concentration of progesterone (246 ng/ml), indicating that it was probably the origin of progesterone secretion. This was confirmed by a fall in the level of progesterone (0.1 ng/ml) after right ovariectomy. The patient presented a normal ovulatory cycle in the month after surgery. Histopathological examination of the tumor found a Leydig cell tumor characterized by uniform cells with large central nuclei, abundant vacuolated eosinophilic cytoplasm and immuno-marking by Calretinine. CONCLUSION: As far as we know, this is the first documented case of primary amenorrhea due to isolated secretion of progesterone by a Leydig cell tumor. Supported by: None
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medicated group and younger aged women were 2.7 (CI ⫽1.7-4.3) and 0.92 (CI ⫽0.89-0.96) respectively. CONCLUSION: Cycle day 3 FSH and E2 levels are popular screening tools for predicting success in IVF. In general, higher FSH and E2 (⬎15 IU/L and ⬎80 pg/ml, respectively) levels are considered strong predictors of poor IVF outcomes. In our study Day 3 FSH and E2 levels in the final cycle cannot be used as markers to predict PR in women undergoing OI in IUI cycles. Supported by: Ferring Pharmaceuticals, educational funding Organon, educational funding Serono, Inc., educational funding Martin Feuerman, Biostatistics P-31 A Cocktail of GnRH Agonist and Urinary hCG to Trigger LH Surge in GnRH Antagonist -IVF Cycles Yields Higher Pregnancy Rates. M. A. Akman, H. F. Erden, N. Ciray, M. Bahceci. German Hospital, Istanbul, Turkey. OBJECTIVE: Despite all the studies done so far, there is still a suspicion of lower pregnancy rates in IVF cycles in which GnRH antagonists were administered. GnRH antagonists permit the administration of GnRH agonists to trigger endogenous LH surge which could be more physiologic, so more effective. In this study, we aim to see the impact of GnRH agonisthCG administration compared to hCG administration alone to the outcome. DESIGN: Retrospective analysis. MATERIALS AND METHODS: In IVF cycles of GnRH antagonist administration there were 393 cycles in which GnRH agonist of 0.2 mg triptorelin sc. together with 5000 IU of hCG im. injections were given between June 2004 and December 2004. We compared these cycles with the GnRH antagonist cycles in which 10.000 IU hCG im. alone was given between January 2004-May 2004 (479 cycles). In both groups, the gonadotropins were started on day 2, multiple daily GnRH antagonist of 0.25 mg cetrorelix sc. was administered once the leading follicle reached 14 mm in size. Thirty-five hours after the hCG alone or with GnRH agonist oocyte collection was performed and later luteal phase was supported with 100 mg progesterone in oil daily. RESULTS: In GnRH agonist-u-hCG group there was a higher pregnancy rate compared to the hCG alone group. See Table I.
Day 3 Follicle Stimulating Hormone (FSH) and Estradiol (E2): Could These Values be used as Markers to Predict Pregnancy Outcomes in Women Undergoing Ovulation Induction (OI) Therapy With Intrauterine Insemination (IUI) Cycles? C. M. Mullin, B. Trivax, M. Baxter, N. Virji, M. Saketos, G. San Roman. Winthrop University Hospital, Mineola, NY; Reproductive Specialists of New York, Mineola, NY; State University of New York, Stony Brook, NY. OBJECTIVE: To determine the predictive value of day 3 FSH and E2 levels on pregnancy rates (PR) in women undergoing OI therapy with IUI cycles. DESIGN: A retrospective analysis of day 3 FSH and E2 levels in 806 patients undergoing OI with 1875 (IUIs) cycles for infertility treatment. MATERIALS AND METHODS: Women undergoing OI with IUI from January 2004 to December 2004 were analyzed for clinical PR. Clinical pregnancy was defined as the presence of an intrauterine sac documented by ultrasound. Patients in this study using medications (Clomiphene, FSH, and/or Metformin) were compared with those not on these medications. The predictive value of day 3 FSH and E2 on PR was determined by multiple logistic regression, controlling for both age and medication, with FSH and E2 as the continuous predictors. Lastly, FSH and E2 values were dichotomized (⬍15 vs. ⱖ 15, ⬍80 vs. ⱖ 80, respectively) to determine their predictive value on PR. RESULTS: Average age of patients treated was 35.4⫾5 years; mean number of IUI cycles was 2.3 per patient. PR per cycle was 9.2% whereas PR per patient was 20.4%. When controlling for age and medication, analysis using logistic regression showed that day 3 FSH and/or E2 levels were not statistically significant in predicting clinical PR (p values were 0.36 and 0.28, respectively) and PR were as follows: FSH ⬎15 vs. ⬍15 was 15.4% and 23%, respectively, and E2 ⬎80 vs. ⬍80 was 14.6% vs. 21.7%, respectively. Furthermore, the multiple logistic regression analysis showed that the medicated group and younger women were statistically significant predictors of PR (p ⬍ 0.0001 for both factors). The odds ratio for the
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Abstracts
CONCLUSION: In GnRH antagonist IVF cycles the administration of GnRH agonist and u-hCG yields higher pregnancy rates compared to u-hCG alone. Supported by: None P-32 The Effect of Estrogen Supplementation on the Endometrium and Pregnancy Rate Among Infertile Women Treated With Clomifene Citrate: A Meta-Analysis. R. F. Torres, A. E. Habana, L. G. Tansengco. Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of the Philippines- Philippine General Hospital, Manila, Philippines; Department of Obstetrics and Gynecology, University of the Philippines- Philippine General Hospital, Manila, Philippines. OBJECTIVE: To determine the effectiveness of the addition of estrogen during clomifene citrate induced ovulation cycles among infertile women in
Vol. 84, Suppl 1, September 2005
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medicated group and younger aged women were 2.7 (CI ⫽1.7-4.3) and 0.92 (CI ⫽0.89-0.96) respectively. CONCLUSION: Cycle day 3 FSH and E2 levels are popular screening tools for predicting success in IVF. In general, higher FSH and E2 (⬎15 IU/L and ⬎80 pg/ml, respectively) levels are considered strong predictors of poor IVF outcomes. In our study Day 3 FSH and E2 levels in the final cycle cannot be used as markers to predict PR in women undergoing OI in IUI cycles. Supported by: Ferring Pharmaceuticals, educational funding Organon, educational funding Serono, Inc., educational funding Martin Feuerman, Biostatistics P-31 A Cocktail of GnRH Agonist and Urinary hCG to Trigger LH Surge in GnRH Antagonist -IVF Cycles Yields Higher Pregnancy Rates. M. A. Akman, H. F. Erden, N. Ciray, M. Bahceci. German Hospital, Istanbul, Turkey. OBJECTIVE: Despite all the studies done so far, there is still a suspicion of lower pregnancy rates in IVF cycles in which GnRH antagonists were administered. GnRH antagonists permit the administration of GnRH agonists to trigger endogenous LH surge which could be more physiologic, so more effective. In this study, we aim to see the impact of GnRH agonisthCG administration compared to hCG administration alone to the outcome. DESIGN: Retrospective analysis. MATERIALS AND METHODS: In IVF cycles of GnRH antagonist administration there were 393 cycles in which GnRH agonist of 0.2 mg triptorelin sc. together with 5000 IU of hCG im. injections were given between June 2004 and December 2004. We compared these cycles with the GnRH antagonist cycles in which 10.000 IU hCG im. alone was given between January 2004-May 2004 (479 cycles). In both groups, the gonadotropins were started on day 2, multiple daily GnRH antagonist of 0.25 mg cetrorelix sc. was administered once the leading follicle reached 14 mm in size. Thirty-five hours after the hCG alone or with GnRH agonist oocyte collection was performed and later luteal phase was supported with 100 mg progesterone in oil daily. RESULTS: In GnRH agonist-u-hCG group there was a higher pregnancy rate compared to the hCG alone group. See Table I.
Day 3 Follicle Stimulating Hormone (FSH) and Estradiol (E2): Could These Values be used as Markers to Predict Pregnancy Outcomes in Women Undergoing Ovulation Induction (OI) Therapy With Intrauterine Insemination (IUI) Cycles? C. M. Mullin, B. Trivax, M. Baxter, N. Virji, M. Saketos, G. San Roman. Winthrop University Hospital, Mineola, NY; Reproductive Specialists of New York, Mineola, NY; State University of New York, Stony Brook, NY. OBJECTIVE: To determine the predictive value of day 3 FSH and E2 levels on pregnancy rates (PR) in women undergoing OI therapy with IUI cycles. DESIGN: A retrospective analysis of day 3 FSH and E2 levels in 806 patients undergoing OI with 1875 (IUIs) cycles for infertility treatment. MATERIALS AND METHODS: Women undergoing OI with IUI from January 2004 to December 2004 were analyzed for clinical PR. Clinical pregnancy was defined as the presence of an intrauterine sac documented by ultrasound. Patients in this study using medications (Clomiphene, FSH, and/or Metformin) were compared with those not on these medications. The predictive value of day 3 FSH and E2 on PR was determined by multiple logistic regression, controlling for both age and medication, with FSH and E2 as the continuous predictors. Lastly, FSH and E2 values were dichotomized (⬍15 vs. ⱖ 15, ⬍80 vs. ⱖ 80, respectively) to determine their predictive value on PR. RESULTS: Average age of patients treated was 35.4⫾5 years; mean number of IUI cycles was 2.3 per patient. PR per cycle was 9.2% whereas PR per patient was 20.4%. When controlling for age and medication, analysis using logistic regression showed that day 3 FSH and/or E2 levels were not statistically significant in predicting clinical PR (p values were 0.36 and 0.28, respectively) and PR were as follows: FSH ⬎15 vs. ⬍15 was 15.4% and 23%, respectively, and E2 ⬎80 vs. ⬍80 was 14.6% vs. 21.7%, respectively. Furthermore, the multiple logistic regression analysis showed that the medicated group and younger women were statistically significant predictors of PR (p ⬍ 0.0001 for both factors). The odds ratio for the
S162
Abstracts
CONCLUSION: In GnRH antagonist IVF cycles the administration of GnRH agonist and u-hCG yields higher pregnancy rates compared to u-hCG alone. Supported by: None P-32 The Effect of Estrogen Supplementation on the Endometrium and Pregnancy Rate Among Infertile Women Treated With Clomifene Citrate: A Meta-Analysis. R. F. Torres, A. E. Habana, L. G. Tansengco. Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of the Philippines- Philippine General Hospital, Manila, Philippines; Department of Obstetrics and Gynecology, University of the Philippines- Philippine General Hospital, Manila, Philippines. OBJECTIVE: To determine the effectiveness of the addition of estrogen during clomifene citrate induced ovulation cycles among infertile women in
Vol. 84, Suppl 1, September 2005