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Administration of intravenous albumin around the time of oocyte retrieval to prevent ovarian hyperstimulation syndrome: a meta-analysis
CONCLUSIONS: Early pregnancy villus gotten from mutiplefetal pregnancy reduction in ART revealed a methylation status at chromosome 15q11-13 identical to the methylation patterns in the normal control,we do not find assisted reproduction technology have effects on methylation status at chromosome 15q11-13. Supported by: National key basic research development plan of China.(2007CB948104).
P-407 CHARACTERIZATION OF THE REDUCED PREGNANCY RATES WITH IVF IN ASIAN-AMERICANS. I. D. Harris, K. J. Purcell, M. Schembri, D. Adamson. Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA; Fertility Physicians of Northern California, San Jose, CA; Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, Fertility Physicians of Northern California, Palo Alto, CA. OBJECTIVE: To determine which variables predict poor IVF outcome and explain the differences in outcomes between Asian and Caucasian patients. DESIGN: Retrospective chart review from a community based IVF program. MATERIALS AND METHODS: A secondary data analysis was performed of infertile couples who underwent IVF from 2002-2004. Inclusion criteria were: 1) that the study cycle was conducted entirely at FPMG; and 2) that the patient self-identified as Asian-American or Caucasian. Exclusion criteria were: 1) oocyte donation; 2) failed stimulation; 3) failed fertilization; 4) cycle cancellation due to ovarian hyperstimulation syndrome; or 5) patients undergoing oocyte donor cycles. Initial descriptive statistics were performed to determine if the two groups varied with respect to patient characteristics, therapeutic intervention, or embryo quantity and quality. Independent models were then constructed for each patient group, Asian and Caucasian, setting the outcome variable as on-going pregnancy. RESULTS: 257 patients met the restrictive requirements, 109 (40.8%) Asian-Americans and 158 (59.2%) Caucasians. There were no significant differences in the mean age, day 3 FSH, diagnosis of male infertility, total number of 2PN embryos generated, or number of embryos transferred. Asian-Americans did have higher peak estradiol levels (3425 vs. 3041, p¼0.03) and endometrial thickness (11.03 vs. 10.16, p<0.01), but produced fewer lead follicles than Caucasians (4.09 vs. 4.68, p¼0.05). However, when ICSI cycles were compared, Asian-American produced significantly more 2PN embryos than Caucasians (73% vs 67%, p¼0.03), but continued to have lower clinical pregnancy (30.2% vs. 42.4%, OR¼0.59 [0.35-0.988]) and live birth rates (22.9% vs 34.1%, OR¼0.57 [0.33-0.998]). CONCLUSIONS: The variables that predict IVF outcome seem to be different for Asian and Caucasian populations. With the exception of diminished ovarian reserve, Asian-Americans have worse outcomes than Caucasian women for every infertility diagnosis, despite performing better than Caucasians on several stimulation parameters. This underscores the importance of studying ethnic groups independently to improve clinical management strategies leading to equivalent expected outcomes for different racial groups. Supported by: None.
P-408 DOES EARLY FOLLICULAR SERUM PROLACTIN LEVELS EFFECT IVF CYCLE OUTCOMES? G. Sahin, A. Akdogan, C. Y. Sanhal, R. Levi, E. Tavmergen, E. N. Tavmergen Goker. Family Planning&Infertil Res&Treatment C., Ege University, Izmir, Turkey; Obstetrics and Gynecology, Ege University, Izmir, Turkey. OBJECTIVE: The aim of this study was to evaluate the effect of high early follicular phase serum prolactin levels on ovarian stimulation dynamics and outcomes in patients undergoing in vitro fertilization treatment. DESIGN: Retrospective analysis. MATERIALS AND METHODS: A total of 1009 patients who undergone IVF treatment, during 2006-2008 were analyzed. Basal prolactin, FSH, LH and E2 levels were measured in IVF cycles just before ovarian stimulation. Controlled ovarian stimulation was performed using the daily
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Abstracts
GnRH antagonist and recombinant FSH preparates. Patient with high basal FSH levels (R18 mIU/ml) and older than 42 years of ages were excluded. Patients were cathegorized into two groups; study group (n¼205); with PRL levels R 25 ng/mL, and the control group (n¼804); with normal PRL levels (<25 ng/mL). IVF cycle outcome parameters were evaluated. RESULTS: 1009 couples with different infertility etiologies included in this study. 911 embryo transfer cycle was performed. There were no significant differences seen in the age, infertility duration, basal LH levels, basal E2 levels, TSH, FT4, FT3, thyroid antibody levels between two groups. Basal FSH levels were significantly lower in the study group. Although there were no statistically differences, total dosage of recFSH was lower in study group than control group. Also daily dosage of rec FSH was significantly lower. The pregnancy rates were similar (39.2% vs 41.7%) in both groups. Results are given in Table.1. It has been shown that there is a negative correlation between PRL and basal FSH (p<0.01). Also the negative correlation was shown between PRL and total dosage of gonadotropins used (p<0.05) and daily dosage of gonadotrophins(p<0.01). CONCLUSIONS: These data confirm that there is a negative correlation between PRL and FSH levels. PRL may play beneficial effect on ovarian stimulation in IVF cycles. TABLE 1.
Means
Study Group(n¼205)
Control Group(n¼804)
p values
32.64.6 7.02.7 5.42.4 50.426.4 34.712.9 1.91.6 2267682 31664 7.21.3 1382902 9.77.4
33.24.7 7.73.0 5.32.6 47.516.9 14.54.8 1.71.0 2370733 32768 7.31.4 1353933 8.87.1
0.10 0.001* 0.61 0.13 <0.001* 0.08 0.06 0.03* 0.40 0.68 0.12
7.86.0 2.60.7
7.35.9 2.50.7
0.27 0.25
39.2%
41.7%
0.16
Age B.FSH B.LH B.E2 B.PRL TSH Total recFSH dose Daily recFSH dose Days of Stimulation Peak E2 No.of retrieved oocytes No.of MII oocytes No.of transferred embryos Pregnancy Rate Supported by: None.
P-409 ADMINISTRATION OF INTRAVENOUS ALBUMIN AROUND THE TIME OF OOCYTE RETRIEVAL TO PREVENT OVARIAN HYPERSTIMULATION SYNDROME: A META-ANALYSIS. S. J. An, B. C. Jee, C. S. Suh, S. H. Kim, Y. M. Choi, S. Y. Moon. Seoul National University Bundang Hospital, Seongnam, Korea; College of Medicine, Seoul National University, Seoul, Korea. OBJECTIVE: To determine the effectiveness of intravenous albumin around the time of oocyte retrieval to prevent ovarian hyperstimulation syndrome (OHSS). DESIGN: A meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS: A literature search of the National Library of Medicine and the National Institutes of Health(PubMed), MEDLINE and Cochrane Controlled Trials Register was performed from 1990 to 2007. We found 10 RCTs evaluating the preventable value of albumin infusion around the time of oocyte retrieval in IVF patients with a high risk of developing OHSS. A meta-analysis was performed using Review Manager (RevMan ver. 4.2 for Windows, The Nordic Cochrane Centre, Copenhagen, Denmark) in which the main outcome was incidence of severe OHSS. We performed subcategorizing control groups into saline and no treatment, and compared the outcome in albumin group and each separated control group. RESULTS: The incidence of severe OHSS was 5.9% (50/848) in albumin group and 7.6% (74/972) in saline or no treatment groups. There
Vol. 90, Suppl 1, September 2008
was no significant difference between two groups either by fixed (RR 0.79, 95% CI 0.57-1.10) or random effect model (RR 0.82, 95% CI 0.53-1.28). TABLE 1. The incidence of severe OHSS between albumin and control groups
Study (subcategory)
albumin (n/N)
control (n/N)
weight (%)
rate and embryo grading (p<0.001). Basal FSH level did not affect oocyte quality. CONCLUSIONS: The routinary use of pDA to detect basal stromal blood flow combined with AMH levels seems to be superior to AMH alone to predict both oocyte quality and developmental competence. Supported by: None.
RR (95% CI)
Saline Shoham et al. (1994) Ng et al. (1995) Ben-Chetrit et al. (2001) Gokmen et al. (2001) Isikoglu et al. (2007) Subtotal
0/16 2/49 4/46
4/15 10/158 1/41
6.74 6.88 1.54
0.10 (0.01-1.79) 0.64 (0.15-2.84) 3.57 (0.42-30.62)
P-411
0/82 8/38 14/231
4/83 6/37 25/334
6.50 8.84 30.49
0.11 (0.01-2.06) 1.30 (0.50-3.38) 0.75 (0.40-1.41)
HIGH PROTEIN CONCENTRATION IS BENEFICIAL IN MOUSE BLASTOCYST CRYOPRESERVATION. L. M. Wagley, L. S. Noble. Assisted Reproduction Laboratory, Southwest Center Reproductive Health, El Paso, TX; Reproductive Endocrinology, Southwest Center for Reproductive Health, El Paso, TX.
No treatment Shalev et al. (1995) Isik et al. (1996) Koike et al. (1999) Panay et al. (1999) Bellver et al. (2003) Subtotal Total
0/22 0/27 13/43 0/37 23/488 36/617 50/848
4/18 1/28 21/55 0/49 23/488 49/638 74/972
7.16 2.14 26.78
0.09 (0.01-1.60) 0.35 (0.01-8.12) 0.79 (0.45-1.39) not estimable 1.00 (0.57-1.76) 0.81 (0.55-1.19) 0.79 (0.57-1.10)
33.42 69.51 100.00
using fixed effect model CONCLUSIONS: Although the amount of albumin administered and the criteria for selecting patients with a risk of OHSS were different in 10 RCTs, the combined data presented in this meta-analysis do not support a benefit for intravenous albumin around the time of oocyte retrieval in preventing OHSS. Supported by: None.
P-410 BASAL OVARIAN STROMAL BLOOD FLOW, ANTRAL FOLLI¨ LLERIAN HORMONE LEVEL ARE CLES COUNT AND ANTI-MU ASSOCIATED WITH OOCYTE QUALITY IN STIMULATED CYCLES. A. Salerno, A. Nazzaro. Physiopathology of Human Reproduction, ‘‘G. Rummo’’ Hospital, Benevento, Italy; Physiopathology of Human Reproduction, ‘‘G. Rummo’’ Hospital, Via dell’Angelo, 1, Italy. OBJECTIVE: To evaluate whether cycle day 3 basal ovarian blood flow, antral follicle count and anti-Mu¨llerian hormone (AMH) level are useful tools to predict diminished oocyte quality and developmental incompetence in infertile women. DESIGN: A total of 162 consecutive ICSI patients were enrolled in the study and subdivided into three groups according to their basal AMH level percentiles: group 1 <25th, group 2 >25th <75th, group 3 >75th percentiles. In all women basal ovarian blood flow was evaluated by three dimensional (3D)powerDoppler angiography (pDA) and a total antral follicles count was obtained from 3D ovarian volumes in both ovaries. MATERIALS AND METHODS: A GE730 Voluson machine was used to obtain ovarian 3D volumes. Basal ovarian blood flow was evaluated by the VOCALÔ program set to glass-body mode. Pulsatility indexes were as well measured. Total antral follicles count (tAFC) was obtained by the NICHE program. Oocyte morphology, fertilization rate and embryo quality were evaluated in the three groups. Basal FSH, LH and estradiol levels were also measured. RESULTS: Cycle cancellation rate was correlated either with AMH levels (p<0.05) either with stromal blood flow (p<0.002), whereas tAFC alone did not (p>0.05). AMH groups 1 (<1.60 ng/ml) and group 3 (>4.50 ng/ml) showed lower quality oocytes (dark central granulation, increased viscosity, aggregation of smooth endoplasmic reticulum, increased vitelline space) compared with the group 2 (1.60-4.50 ng/ml). The number of competent oocytes dropped to zero in case of undetectable stromal blood flow indipendentely from AMH levels (p<0.001). tAFC did not seemed to affect oocyte quality p(>0.05) but the number (p<0.05). Undetectable stromal blood flow but not AMH levels affect fertilization
FERTILITY & STERILITYÒ
OBJECTIVE: To compare survival and blastocoel expansion, which was used as an indicator of viability, in the freezing and thawing of mouse blastocysts with high and low protein concentrations. The effect of mismatching the protein concentrations between the freeze and thaws was investigated. DESIGN: Prospective research experiment in Mice. MATERIALS AND METHODS: Commercially frozen two cell mice were thawed and cultured in sequential media for 72 hours. All blastocysts obtained on the morning of the third day were frozen in either high protein(20%) or low protein(5%) solutions by the method of Veeck et al(2004). Later mice were either thawed in high or low protein solutions by the same method. Four treatment groups were obtained in this mannner with both matching and mismatching protein solutions and the four groups were observed at three time points. Survival and expansion rates were recorded by observation on a Nikon T2000 inverted microscope. RESULTS: A total of 400 mouse blastocysts were frozen and thawed. No differences could be detected between groups immediately post thaw. Within 2 hours, the groups with the lower protein freeze showed lower expansion rates(45% vs70%). This difference was maintained after 24 hours in culture(71% vs 93%). After 24 hours in culture the group which had the low protein freeze and thaw had the lowest expansion rates at 59% and the group with the best expansion rate at 96% was the group with the high protein feeze and thaw. Mismatched thaws still had higher expansion rates than the low protein group(59% vs 83% vs 91%). CONCLUSIONS: High protein in both the freeze and thaw of the Veeck et al (2004) method provided the best blastocoel expansion rates in the mouse. Even mismatched protein solutions provided better results than when only low protein was used. Protein at the concentration of 20% either in the freeze or thaw imparts a beneficial effect on mouse cryopreservation and may provide a mechanism for improving survival rates in human embryo thaws even if they were frozen in low protein. Protein has been theorized to provide a protective effect in the freezing and thawing of embryos and several freezing protocols utilize this. Softening of the zona may occur, allowing embryos to expand and hatch easier leading to better viability. Supported by: None.
P-412 COMPARISON OF NUMBER OF CELL AT THE TIME OF CONFIRMATION OF EARLY CLEAVAGE IS USEFUL CRITERIA IN SELECTING GOOD EMBRYOS. H. Miyata, T. Tomiyama, N. Fukutomi, J. Matsuba, A. Koizumi, M. Yokota. Osaka New ART Clinic, Osaka, Japan. OBJECTIVE: Early cleavage is one of the useful criteria in selecting good embryos. However, some embryos are three or more cells at the time of confirmation of early cleavage. We investigated if these embryos had different growth and pregnancy rates compared with two cells or one cell embryos. DESIGN: Retrospective clinical study.
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P-407 CHARACTERIZATION OF THE REDUCED PREGNANCY RATES WITH IVF IN ASIAN-AMERICANS. I. D. Harris, K. J. Purcell, M. Schembri, D. Adamson. Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA; Fertility Physicians of Northern California, San Jose, CA; Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, Fertility Physicians of Northern California, Palo Alto, CA. OBJECTIVE: To determine which variables predict poor IVF outcome and explain the differences in outcomes between Asian and Caucasian patients. DESIGN: Retrospective chart review from a community based IVF program. MATERIALS AND METHODS: A secondary data analysis was performed of infertile couples who underwent IVF from 2002-2004. Inclusion criteria were: 1) that the study cycle was conducted entirely at FPMG; and 2) that the patient self-identified as Asian-American or Caucasian. Exclusion criteria were: 1) oocyte donation; 2) failed stimulation; 3) failed fertilization; 4) cycle cancellation due to ovarian hyperstimulation syndrome; or 5) patients undergoing oocyte donor cycles. Initial descriptive statistics were performed to determine if the two groups varied with respect to patient characteristics, therapeutic intervention, or embryo quantity and quality. Independent models were then constructed for each patient group, Asian and Caucasian, setting the outcome variable as on-going pregnancy. RESULTS: 257 patients met the restrictive requirements, 109 (40.8%) Asian-Americans and 158 (59.2%) Caucasians. There were no significant differences in the mean age, day 3 FSH, diagnosis of male infertility, total number of 2PN embryos generated, or number of embryos transferred. Asian-Americans did have higher peak estradiol levels (3425 vs. 3041, p¼0.03) and endometrial thickness (11.03 vs. 10.16, p<0.01), but produced fewer lead follicles than Caucasians (4.09 vs. 4.68, p¼0.05). However, when ICSI cycles were compared, Asian-American produced significantly more 2PN embryos than Caucasians (73% vs 67%, p¼0.03), but continued to have lower clinical pregnancy (30.2% vs. 42.4%, OR¼0.59 [0.35-0.988]) and live birth rates (22.9% vs 34.1%, OR¼0.57 [0.33-0.998]). CONCLUSIONS: The variables that predict IVF outcome seem to be different for Asian and Caucasian populations. With the exception of diminished ovarian reserve, Asian-Americans have worse outcomes than Caucasian women for every infertility diagnosis, despite performing better than Caucasians on several stimulation parameters. This underscores the importance of studying ethnic groups independently to improve clinical management strategies leading to equivalent expected outcomes for different racial groups. Supported by: None.
P-408 DOES EARLY FOLLICULAR SERUM PROLACTIN LEVELS EFFECT IVF CYCLE OUTCOMES? G. Sahin, A. Akdogan, C. Y. Sanhal, R. Levi, E. Tavmergen, E. N. Tavmergen Goker. Family Planning&Infertil Res&Treatment C., Ege University, Izmir, Turkey; Obstetrics and Gynecology, Ege University, Izmir, Turkey. OBJECTIVE: The aim of this study was to evaluate the effect of high early follicular phase serum prolactin levels on ovarian stimulation dynamics and outcomes in patients undergoing in vitro fertilization treatment. DESIGN: Retrospective analysis. MATERIALS AND METHODS: A total of 1009 patients who undergone IVF treatment, during 2006-2008 were analyzed. Basal prolactin, FSH, LH and E2 levels were measured in IVF cycles just before ovarian stimulation. Controlled ovarian stimulation was performed using the daily
S244
Abstracts
GnRH antagonist and recombinant FSH preparates. Patient with high basal FSH levels (R18 mIU/ml) and older than 42 years of ages were excluded. Patients were cathegorized into two groups; study group (n¼205); with PRL levels R 25 ng/mL, and the control group (n¼804); with normal PRL levels (<25 ng/mL). IVF cycle outcome parameters were evaluated. RESULTS: 1009 couples with different infertility etiologies included in this study. 911 embryo transfer cycle was performed. There were no significant differences seen in the age, infertility duration, basal LH levels, basal E2 levels, TSH, FT4, FT3, thyroid antibody levels between two groups. Basal FSH levels were significantly lower in the study group. Although there were no statistically differences, total dosage of recFSH was lower in study group than control group. Also daily dosage of rec FSH was significantly lower. The pregnancy rates were similar (39.2% vs 41.7%) in both groups. Results are given in Table.1. It has been shown that there is a negative correlation between PRL and basal FSH (p<0.01). Also the negative correlation was shown between PRL and total dosage of gonadotropins used (p<0.05) and daily dosage of gonadotrophins(p<0.01). CONCLUSIONS: These data confirm that there is a negative correlation between PRL and FSH levels. PRL may play beneficial effect on ovarian stimulation in IVF cycles. TABLE 1.
Means
Study Group(n¼205)
Control Group(n¼804)
p values
32.64.6 7.02.7 5.42.4 50.426.4 34.712.9 1.91.6 2267682 31664 7.21.3 1382902 9.77.4
33.24.7 7.73.0 5.32.6 47.516.9 14.54.8 1.71.0 2370733 32768 7.31.4 1353933 8.87.1
0.10 0.001* 0.61 0.13 <0.001* 0.08 0.06 0.03* 0.40 0.68 0.12
7.86.0 2.60.7
7.35.9 2.50.7
0.27 0.25
39.2%
41.7%
0.16
Age B.FSH B.LH B.E2 B.PRL TSH Total recFSH dose Daily recFSH dose Days of Stimulation Peak E2 No.of retrieved oocytes No.of MII oocytes No.of transferred embryos Pregnancy Rate Supported by: None.
P-409 ADMINISTRATION OF INTRAVENOUS ALBUMIN AROUND THE TIME OF OOCYTE RETRIEVAL TO PREVENT OVARIAN HYPERSTIMULATION SYNDROME: A META-ANALYSIS. S. J. An, B. C. Jee, C. S. Suh, S. H. Kim, Y. M. Choi, S. Y. Moon. Seoul National University Bundang Hospital, Seongnam, Korea; College of Medicine, Seoul National University, Seoul, Korea. OBJECTIVE: To determine the effectiveness of intravenous albumin around the time of oocyte retrieval to prevent ovarian hyperstimulation syndrome (OHSS). DESIGN: A meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS: A literature search of the National Library of Medicine and the National Institutes of Health(PubMed), MEDLINE and Cochrane Controlled Trials Register was performed from 1990 to 2007. We found 10 RCTs evaluating the preventable value of albumin infusion around the time of oocyte retrieval in IVF patients with a high risk of developing OHSS. A meta-analysis was performed using Review Manager (RevMan ver. 4.2 for Windows, The Nordic Cochrane Centre, Copenhagen, Denmark) in which the main outcome was incidence of severe OHSS. We performed subcategorizing control groups into saline and no treatment, and compared the outcome in albumin group and each separated control group. RESULTS: The incidence of severe OHSS was 5.9% (50/848) in albumin group and 7.6% (74/972) in saline or no treatment groups. There
Vol. 90, Suppl 1, September 2008
was no significant difference between two groups either by fixed (RR 0.79, 95% CI 0.57-1.10) or random effect model (RR 0.82, 95% CI 0.53-1.28). TABLE 1. The incidence of severe OHSS between albumin and control groups
Study (subcategory)
albumin (n/N)
control (n/N)
weight (%)
rate and embryo grading (p<0.001). Basal FSH level did not affect oocyte quality. CONCLUSIONS: The routinary use of pDA to detect basal stromal blood flow combined with AMH levels seems to be superior to AMH alone to predict both oocyte quality and developmental competence. Supported by: None.
RR (95% CI)
Saline Shoham et al. (1994) Ng et al. (1995) Ben-Chetrit et al. (2001) Gokmen et al. (2001) Isikoglu et al. (2007) Subtotal
0/16 2/49 4/46
4/15 10/158 1/41
6.74 6.88 1.54
0.10 (0.01-1.79) 0.64 (0.15-2.84) 3.57 (0.42-30.62)
P-411
0/82 8/38 14/231
4/83 6/37 25/334
6.50 8.84 30.49
0.11 (0.01-2.06) 1.30 (0.50-3.38) 0.75 (0.40-1.41)
HIGH PROTEIN CONCENTRATION IS BENEFICIAL IN MOUSE BLASTOCYST CRYOPRESERVATION. L. M. Wagley, L. S. Noble. Assisted Reproduction Laboratory, Southwest Center Reproductive Health, El Paso, TX; Reproductive Endocrinology, Southwest Center for Reproductive Health, El Paso, TX.
No treatment Shalev et al. (1995) Isik et al. (1996) Koike et al. (1999) Panay et al. (1999) Bellver et al. (2003) Subtotal Total
0/22 0/27 13/43 0/37 23/488 36/617 50/848
4/18 1/28 21/55 0/49 23/488 49/638 74/972
7.16 2.14 26.78
0.09 (0.01-1.60) 0.35 (0.01-8.12) 0.79 (0.45-1.39) not estimable 1.00 (0.57-1.76) 0.81 (0.55-1.19) 0.79 (0.57-1.10)
33.42 69.51 100.00
using fixed effect model CONCLUSIONS: Although the amount of albumin administered and the criteria for selecting patients with a risk of OHSS were different in 10 RCTs, the combined data presented in this meta-analysis do not support a benefit for intravenous albumin around the time of oocyte retrieval in preventing OHSS. Supported by: None.
P-410 BASAL OVARIAN STROMAL BLOOD FLOW, ANTRAL FOLLI¨ LLERIAN HORMONE LEVEL ARE CLES COUNT AND ANTI-MU ASSOCIATED WITH OOCYTE QUALITY IN STIMULATED CYCLES. A. Salerno, A. Nazzaro. Physiopathology of Human Reproduction, ‘‘G. Rummo’’ Hospital, Benevento, Italy; Physiopathology of Human Reproduction, ‘‘G. Rummo’’ Hospital, Via dell’Angelo, 1, Italy. OBJECTIVE: To evaluate whether cycle day 3 basal ovarian blood flow, antral follicle count and anti-Mu¨llerian hormone (AMH) level are useful tools to predict diminished oocyte quality and developmental incompetence in infertile women. DESIGN: A total of 162 consecutive ICSI patients were enrolled in the study and subdivided into three groups according to their basal AMH level percentiles: group 1 <25th, group 2 >25th <75th, group 3 >75th percentiles. In all women basal ovarian blood flow was evaluated by three dimensional (3D)powerDoppler angiography (pDA) and a total antral follicles count was obtained from 3D ovarian volumes in both ovaries. MATERIALS AND METHODS: A GE730 Voluson machine was used to obtain ovarian 3D volumes. Basal ovarian blood flow was evaluated by the VOCALÔ program set to glass-body mode. Pulsatility indexes were as well measured. Total antral follicles count (tAFC) was obtained by the NICHE program. Oocyte morphology, fertilization rate and embryo quality were evaluated in the three groups. Basal FSH, LH and estradiol levels were also measured. RESULTS: Cycle cancellation rate was correlated either with AMH levels (p<0.05) either with stromal blood flow (p<0.002), whereas tAFC alone did not (p>0.05). AMH groups 1 (<1.60 ng/ml) and group 3 (>4.50 ng/ml) showed lower quality oocytes (dark central granulation, increased viscosity, aggregation of smooth endoplasmic reticulum, increased vitelline space) compared with the group 2 (1.60-4.50 ng/ml). The number of competent oocytes dropped to zero in case of undetectable stromal blood flow indipendentely from AMH levels (p<0.001). tAFC did not seemed to affect oocyte quality p(>0.05) but the number (p<0.05). Undetectable stromal blood flow but not AMH levels affect fertilization
FERTILITY & STERILITYÒ
OBJECTIVE: To compare survival and blastocoel expansion, which was used as an indicator of viability, in the freezing and thawing of mouse blastocysts with high and low protein concentrations. The effect of mismatching the protein concentrations between the freeze and thaws was investigated. DESIGN: Prospective research experiment in Mice. MATERIALS AND METHODS: Commercially frozen two cell mice were thawed and cultured in sequential media for 72 hours. All blastocysts obtained on the morning of the third day were frozen in either high protein(20%) or low protein(5%) solutions by the method of Veeck et al(2004). Later mice were either thawed in high or low protein solutions by the same method. Four treatment groups were obtained in this mannner with both matching and mismatching protein solutions and the four groups were observed at three time points. Survival and expansion rates were recorded by observation on a Nikon T2000 inverted microscope. RESULTS: A total of 400 mouse blastocysts were frozen and thawed. No differences could be detected between groups immediately post thaw. Within 2 hours, the groups with the lower protein freeze showed lower expansion rates(45% vs70%). This difference was maintained after 24 hours in culture(71% vs 93%). After 24 hours in culture the group which had the low protein freeze and thaw had the lowest expansion rates at 59% and the group with the best expansion rate at 96% was the group with the high protein feeze and thaw. Mismatched thaws still had higher expansion rates than the low protein group(59% vs 83% vs 91%). CONCLUSIONS: High protein in both the freeze and thaw of the Veeck et al (2004) method provided the best blastocoel expansion rates in the mouse. Even mismatched protein solutions provided better results than when only low protein was used. Protein at the concentration of 20% either in the freeze or thaw imparts a beneficial effect on mouse cryopreservation and may provide a mechanism for improving survival rates in human embryo thaws even if they were frozen in low protein. Protein has been theorized to provide a protective effect in the freezing and thawing of embryos and several freezing protocols utilize this. Softening of the zona may occur, allowing embryos to expand and hatch easier leading to better viability. Supported by: None.
P-412 COMPARISON OF NUMBER OF CELL AT THE TIME OF CONFIRMATION OF EARLY CLEAVAGE IS USEFUL CRITERIA IN SELECTING GOOD EMBRYOS. H. Miyata, T. Tomiyama, N. Fukutomi, J. Matsuba, A. Koizumi, M. Yokota. Osaka New ART Clinic, Osaka, Japan. OBJECTIVE: Early cleavage is one of the useful criteria in selecting good embryos. However, some embryos are three or more cells at the time of confirmation of early cleavage. We investigated if these embryos had different growth and pregnancy rates compared with two cells or one cell embryos. DESIGN: Retrospective clinical study.
S245