AMH level in follicular fluid and serum may predict outcome of IVF-ET in PCOS patients

40.7%, 16.2% in normal group; 30.8%, 33.3% in overweight group and 16.7%, 50.0% in obese group, respectively. The IR was statistically lower in obese group, compared with underweight group (P¼ 0.04). The MR was not statistically different between all groups. Overweight group and underweight group were not related to an impaired implantation of FET. The results showed no significant difference among the four groups in the average age, the average endometrial thickness at embryo transfer. The serum progesterone was statistically lower in obese group, compared with underweight group and normal BMI group (P < 0.05). CONCLUSIONS: Obesity(30¼
P-798 ENDOMETRIAL SAMPLING BEFORE CONTROLLED OVARIAN STIMULATION IN ICSI PATIENTS WITH HIGH-ORDER IMPLANTATION FAILURE. A. Raziel, S. Friedler, M. Schachter, D. Strassburger, O. Bern, R. Ron-El. IVF and Infertility Unit, Assaf Harofeh Medical Center, Tel-Aviv, Israel. OBJECTIVE: A substantial number of patients still experience implantation failure, defined as the repeated transfer of embryos to a normal uterus without achieving implantation and pregnancy. Our aim was to evaluate the value of luteal phase endometrial biopsies before ovarian hyperstimulation, to improve pregnancy rates, in a selected group of patients with high-order ICSI failure. DESIGN: A patient self selected comparative study. MATERIALS AND METHODS: From January 2002 and October 2007 endometrial sampling before the following ICSI trial were offered to 110 patients with implantation failure (R4 ICSI trials and R12 transferred embryos). Endometrial sampling was performed at the 21st and 26th cycle day with use of a biopsy catheter (Pipelle) at the following ICSI treatment (Pipelle group). Another group of 110 patients with implantation failure but without prior intervention, matched for age and number of transferred embryos, served as control group. The various parameters examined were patients’ chracteristics, hormonal profile during COH, laboratory and pregnancy outcome. RESULTS: The mean age of the patients in the Pipelle group was 335.1y, their day 3 FSH and LH were 6.32.7 and 5.73.2 IU/L compared with 324.2y, 5.91.8 and 4.72.7 IU/L, in the control group, respectively. Of 220 endometrial biopsies one case of acute PID was found. A mean number of 209.0 embryos (range12-35) at 7.23.6 previous ICSI cycles (range414) were performed in the Pipelle group compared with 164.9 embryos (range11-39) and 5.71.0 cycles (range4-11) in the control (p<0.01). The number of hMG ampoules needed, treatment duration and serum E2 and P4 level on hCG day were similar in both groups. A mean number of 146.9 follicles, 10.86 injected oocytes, 7.54 fertilizations and 3.50.9 transferred embryos were available in the Pipelle group compared with 12.4.4.6 follicles, 9.34 oocytes, 63.1 fertilizations and 3.80.6 transferred embryos in the control group. A notably high pregnancy rate was found in the Pipelle group (28%, 16% ongoing) compared with 12% (8% ongoing) in the control group (Chi-square p<0.01). The abortion rate was 42% in the Pipelle group and 28% in the control(NS). CONCLUSIONS: A notably high clinical pregnancy rate was found by the use of endometrial sampling in patients with high order implantation failure. If similar results will be found in larger groups of patients, one should consider using endometrial biopsy as another empiric treatment modality for patients with high-order repeated failures in ICSI. Supported by: None.

P-799 AMH LEVEL IN FOLLICULAR FLUID AND SERUM MAY PREDICT OUTCOME OF IVF-ET IN PCOS PATIENTS. M. N. Yin, S. L. Chen. Reproductive Medicine Center of South Hospital, Southern Medical University, Guangzhou, China. OBJECTIVE: To determine whether the antimullerian hormone (AMH) level in follicular fluid and serum is associated with clinical characteristic

FERTILITY & STERILITYÒ

and pregnancy outcome in PCOS patients during in vitro fertilization (IVF) cycles. DESIGN: A prospective study. MATERIALS AND METHODS: Serum and follicular fluid were obtained from 64 women undergoing IVF/ICSI-ET in Center for Reproductive Medicine of Nanfang Hospital during 2007 to January 2008. The patients were divided into two groups according to the Rotterdam criteria for diagnosis of PCOS. Two study groups were identified: PCOS (30 patients) and control group (34 patients). The long luteal phase down regulation and controlled ovarian hyperstimulation protocol were used for all the patients in IVF cycles. Serum and follicles fluid samples were collected on the day of oocyte retrieval. The AMH levels in the serum and follicular fluid were assayed by a commercially available nzyme-linked immunosorbent assay (ELISA) kit. RESULTS: There were no statistically significant differences between the PCOS group and the control group in mean age, infertility duration, body mass index (BMI), or levels of LH/FSH and T (P>0.05). Moreover, neither the fertilization rate, cleavage rate, rate of high-quality embryo, implantation rate,pregnancy rate nor abortion rate and ongoing pregnancy rate were detected significant differences between PCOS group and control group(P>0.05). Despite a significantly lower total gonadotropin dose, a significantly higher antral follicles and serum E2 level was attained in PCOS group compared to the control group(P<0.05). The recovery rates of oocytes in PCOS group were lower than that in control group(P<0.05). The AMH level in serum and follicle fluid was significantly higher in PCOS group than that in control group(P<0.05).The AMH levels in follicular fluid from the pregnant patients were statistically significantly higher than from the non-pregnant patients between the two groups(P<0.05). The AMH levels in follicular fluid significantly correlated with implantation rate in PCOS group and control group(P<0.05). CONCLUSIONS: The AMH level in serum and follicle fluid was related to the number of basal antral follicles but not to oocyte quantity. AMH may predicted the outcome of pregnancy after IVF-ET. Thus, AMH could be a prediction marker for embryo implantation. Supported by: National key basic research development plan of China.(2007CB948104).

P-800 RESTRICTED EXPRESSION OF A NOVEL GESTATION-DEPENDENT GENE AT THE MATERNAL: EMBRYONIC INTERFACE. Y. Kanda, L. Zhang, J. K. Pru. Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA. OBJECTIVE: We previously established that approximately 1500 genes were differentially regulated in the uterine decidua of murine pregnancy (day 7) compared to the mechanically stimulated deciduoma of pseudopregnancy. The purpose of this study was to establish an expression profile for a novel gestation-dependent gene that we have named decidual restricted gene 1, or Drg1. DESIGN: RT-PCR and in situ hybridization analyses were used to study expression of Drg1 mRNA in pregnant and pseudopregnant female mice. MATERIALS AND METHODS: RT-PCR was used to assess Drg1 expression in decidual (days 4-9 of pregnancy) and deciduomal (day 7 of psuedopregnancy) tissues. In addition to these endometrial tissues, other organs of the female reproductive tract, as well as 11 non-reproductive organs were collected for mRNA isolation. To obtain deciduomal tissue, female mice were placed with vasectomized males. On day 4 of pseudopregnancy, sesame oil was infused intraluminally and decidualized stromal tissue was isolated 72 hours later for RNA isolation. In situ hybridization was used to identify the spatial expression of Drg1 at the implantation site on days 4, 7 and 9 of pregnant and day 7 of pseudopregnant using 35S labeled cRNA probes. All experiments were completed in at least triplicate. RESULTS: Drg1 expression was restricted to the endometrial stroma and could not be detected in any of the other organs tested. Likewise, Drg1 was not expressed in other organs of the female reproductive tract at any stage of development. Within the uterus, Drg1 expression remained spatially confined to the stromal compartment and temporally restricted to early gestation. Further, Drg1 was up-regulated in response to the embryo, whereas deciduomal tissue of psuedopregnancy remained void of Drg1 expression. CONCLUSIONS: Due to the confined expression of Drg1 to the gestational uterine stromal compartment, we hypothesize that this gene is functionally important for early pregnancy. Ongoing studies in our laboratory

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