A new algorithm to predict ovarian age combining clinical, biochemical and 3D-ultrasonographic parameters

analysis was performed using SPSS software, version 17.0 (SPSS, Chicago, IL, USA. RESULTS: There was no significant difference between the two groups in demographic and baseline data including age (26.7
5.9 years vs. 27.4
5.7 years, , duration and type of infertility, body mass index (27.9
3.9 vs. 28.6
3.4), ovarian volume (14.1 .
3.1 cm3 vs. 15.9 _ 3.4 cm3, AFC, basal FSH( 5.3
1.7 vs 4.9
2.1 and AMH(8.4
1,3 vs 9.1
2.2 ).All operative procedures were completed successfully without complications. Pelvic evaluation during LOD revealed patent tubes with no masses or endometriosis in both groups. After LOD, at the one month follow up serum AMH levels and AFC showed a significant reduction in both groups than preoperative values. AMH, AFC, basal FSH and ovarian volume were more reduced in adjusted than fixed ovarian drilling group with no significant statistical difference. Similarly, at the six month follow up, there were no significant differences between the 2groups as regards all the studied parameters. CONCLUSION: Adjusted ovarian drilling based on ovarian volume has a better reproductive outcome with no detrimental effect on the ovarian reserve. P-14 Tuesday, October 21, 2014 A NEW ALGORITHM TO PREDICT OVARIAN AGE COMBINING CLINICAL, BIOCHEMICAL AND 3D-ULTRASONOGRAPHIC PARAMETERS. R. Venturella,a D. Lico,a A. Sarica,b M. P. Falbo,c E. Gulletta,c M. Cannataro,b F. Zullo.a aObstetrics and Gynecology, Magna Graecia University of Catanzaro, Catanzaro, Italy; bSchool of Informatics and Biomedical Engineering-Bioinformatics Laboratory, Magna Graecia University of Catanzaro, Catanzaro, Italy; cChair of Clinical Pathology, Magna Graecia University of Catanzaro, Catanzaro, Italy. OBJECTIVE: Ovarian reserve is a crucial parameter for guiding women’s and gynecologist’s choices but it is not yet assessable. A reliable test is urgently needed. We aim to create a multimodal evaluation of ovarian reserve and design a new algorithm able to predict ovarian age (OvAge) with an intuitive, universally accepted and reproducible output. DESIGN: Prospective observational study. MATERIALS AND METHODS: 652 healthy women, 18 to 55 years age, 29 women with clinical suspect of premature ovarian failure (POF) and 29 women with PCOS were prospectively enrolled. In all women data on AMH, FSH, Estradiol, 3D Antral Follicle Count, ovarian volume, Vascularization Index, Flow Index and Vascularization Flow Index between day 1 and day 4 of menstrual cycle were collected. A Generalized Linear Model (GLM) was realized. The predictors variables were assessed by backward stepwise multiple regression. Backward selection of parameters was applied. The variables reaching the statistical significance in multivariate regression analysis were then used in the calculation for the final optimal model chosen using the Akaike information criterion. RESULTS: Among the 10 models studied, the best-fitting is GLM#2** and the best equation is: OvAge ¼ 48.05-3.14*AHM+0.07*FSH1.55*AFC-0.11*FI+0.23*VI+0.2*AMH*AFC+0.04*FSH*AFC. With this model, in women enrolled as healthy controls a high level of fit between chronological age and OvAge was shown whereas in POFs and PCOS patients a significant difference between these two parameters was shown, indicating that the our algorithm is able to recognize pathological deviation from normal ovarian function. CONCLUSION: The innovation introduced by our algorithm is that the final output is not a generic definition of good or poor ovarian reserve, like others single tests already do. Our test answers with a number. It will be useful for the gynecologist to guide patients’ reproductive attempts and to reduce the rate of unnecessary surgeries and for women for guiding their reproductive and working planning.

P-15 Tuesday, October 21, 2014 APROACHS TO THE TREATMENT OF SMALL ENDOMETRIOMARELATED INFERTILITY INCLUDE THE USE ASSISTED REPRODUCTION TECHNIQUES. A. Takashima, N. Takeshita, A. Usui, K. Otaka, T. Kinoshita. Department of Obstetrics and Gynecology, Toho University Medical Center Sakura Hospital, Sakura, Chiba, Japan. OBJECTIVE: Endometriosis may be involved in the worsening of oocyte quality. The commonly accepted view is that ovarian endometrioma and its surgical treatment may cause quantitative, but not qualitative injury to the ovarian reserve. The best treatment of small (less than 4cm) endometrioma-related infertility has yet to be defined. Thus, the objective of the pre-

FERTILITY & STERILITYÒ

sent study was to evaluate the potential impact of quantitative and qualitative IVF outcome in unilateral small ovarian endometrioma. DESIGN: Prospetrospective study. The study was set in a university hospital. 118 IVF candidates undergoing Clomiphene citrate ovarian hyperstimulation with unilateral small ovarian endometrioma from January 2010 to December 2013. MATERIALS AND METHODS: Ages, BMI, menstrual cycle days, tumor size, serum levels of anti-m€ullerian hormone (AMH), FSH and E2 was observed as baseline clinical characteristics of patients. We evaluated and compared the antral follicle count (AFC), number of follicular flushings, oocytes in metaphase II retrieved, oocyte retrieved, percentage of blastcyst obtained, high-quality blastocyst, pregnancy rate from the ovary with endometioma and as well the contralateral intact ovary. Blastocysts were graded according to the Gardner criteria on day 5. The data were examined for differences by Wilcoxon-Mann-Whitney U test or c 2analysis. RESULTS: Baseline clinical characteristics of patients were age;40.4
0.9(32-44), size of cyst;30.3
1.4(22-38)mm, AMH 1.75
0.3(<0.16-4.7)ng/ml, Day3 FSH 5.8
0.6(2.6-10.1)mIL/mL. The mean AFC, number of follicular flushings, oocytes retrieved and embryos obtained were significantly lower in the endometial ovary as compared with the corresponding values in the contralateral intact ovary. No significant differences were found in the rate of blastcyst retrieved, high-quality bastcyst retrieved and pregnancy rate. Comparing IVF outcome in endometrioma and in the comtralateral intact ovary

nonendometrioma endometrioma P-value Antral follicle count Number of follicular flushings Number of oocytes in metaphase II retrieved Number of embryo obtained blastcyst obtained(%) high-quality blastocyst obtained(%) Clinical pregnancy rate (%)

1.2
0.5 1.1
0.3

2.0
0.4 1.6
0.7

<0.05 <0.05

0.7
0.3

1.3
0.3

<0.05

0.4
0.2 33.3 14.2

0.8
0.2 25.0 22.2

<0.05 NS NS

11.1

14.2

NS

Note: Values are mean
SD. NS¼not significnt.

CONCLUSION: Small endometrioma appear to cause a damage in ovarian reserve, but not qualitative injury through IVF/ET. P-16 Tuesday, October 21, 2014 A NOVEL MARKER OF OVARIAN RESERVE: ANTRAL FOLLICLE COUNT IN THE LARGEST DIMENSION OF THE OVARY. A. M. Vance,a C. R. Gracia,a M. D. Sammel,b A. Fisher,a a aa C. Miller, L. Lechtenberg. Reproductive Endocrinology & Infertility, University of Pennsylvania, Philadelphia, PA; bBiostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA. OBJECTIVE: Total antral follicle count (tAFC) has been shown to be a useful measure of ovarian reserve in a variety of populations including cancer survivors [1]. However, tAFC is not a routine measure obtained when ultrasounds are performed outside of ART. Cross-sectional images of the ovaries however are obtained routinely and antral follicles in the largest dimension (AFC-LD) of the ovary can be easily counted. This study will assess how well AFC-LD predicts ovarian reserve using tAFC and AMH as gold standard measures in cancer survivors and healthy controls. DESIGN: Prospective cohort study in recently diagnosed cancer patients, cancer survivors and controls. MATERIALS AND METHODS: Early follicular phase transvaginal ultrasound assessment of tAFC and AFC-LD, as well as serum levels of FSH, E2, and AMH were obtained. A gold standard for ovarian reserve was defined as tAFC>¼10 and AMH>¼1ng/ml. Statistical analysis included one-way ANOVA, Chi-square, logistical regression and Spearman rank coefficients. Test characteristics and ROC analysis were used to quantify performance of AFCLD. RESULTS: Serum and ultrasound measures of ovarian reserve were assessed in 29 newly diagnosed cancer patients, 55 cancer survivors and 58 healthy controls. Mean age was 29.57, 26.10 and 26.35 respectively and

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