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Antral Follicle Count and Ovarian Volume Predict IVF Outcome
Ovarian Hyperstimulation for In Vitro Fertilization and Embryo Transfer. 1,2S. H. Kim, 1S. Y. Ku, 1,2B. C. Jee, 1,2C. S. Suh, 1,2S. Y. Moon, 1 J. Y. Lee. 1Department of Obstetrics and Gynecology, College of Medicine, 2Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea. Purpose: To verify whether the blood flow impedance of ovarian stromal artery in transvaginal color Doppler ultrasonography predicts the outcomes of in vitro fertilization and embryo transfer (IVF-ET). Materials and Methods: A total of 99 infertile patients undergoing controlled ovarian hyperstimulation (COH) with GnRH agonist and gonadotropins for IVF-ET was recruited for the study. Transvaginal color Doppler ultrasonographic examinations were performed using a Combison 530 (Medison, Korea) equipped with a 5.5 MHz transvaginal probe. Pulsatility index (PI) was evaluated in bilateral ovarian stromal arteries on the starting day of COH(PI1) and the day of hCG administration (PI2). The patients were classified into three groups by mean PI1, PI2, and DPI(PI2–PI1), respectively, and the outcomes of IVF-ET were analyzed and compared. Results: There was no significant difference in the clinical characteristics of the pregnant (n550) and nonpregnant (n549) groups. PI1 on the starting day of COH was 1.80 6 0.94 (mean 6 S.D.), PI2 on the hCG day was 1.50 6 0.76, and DPI was 0.29 6 0.22. There were no significant differences in the duration of COH, total dosage of gonadotropins for COH, serum E2 level, number of follicles on the hCG day, number of oocytes retrieved or fertilized in vitro, and number of embryos transferred between their respective PI1, PI2, and DPI values. However, the pregnancy rate was significantly reduced in the higher PI1 and PI2 groups than in the lower groups (p,0.05, p,0.05). Significant positive correlations were also found between PI1 and PI2 and the total dosage of gonadotropins for COH (Y 5 0.483X 1 27.1, r 5 0.052, p,0.05; Y 5 0.877X 1 26.6, r 5 0.075, p,0.05). Conclusion: This study suggests that the color Doppler ultrasonographic index (PI) of ovarian stromal artery during COH may be useful for predicting the success of IVF-ET in infertile patients.
P-255 Body Mass Index (BMI) Is Inversely Related to Intrafollicular hCG Levels and Pregnancy Rates of IVF Patients. 1K. P. Jones, 1H. H. Hatasaka, 1C. M. Peterson, 2V. Aoki, 4B. Campbell, 1,2,3,4D. T. Carrell. 1Department of Obstetrics and Gynecology, 2Department of Urology, and 3Department of Physiology, University of Utah School of Medicine, Salt Lake City, UT, and 4The Center for Reproductive Medicine, Abbott Northwestern Hospital, Minneapolis, MN. Objectives: Recent studies have indicated that decreased luteinizing hormone (LH) may result in abnormal oocyte and embryo quality. LH is responsible for initiation of the final maturation of the oocyte prior to ovulation. Standard controlled ovarian hyperstimulation includes a single injection of a supraphysiological dose (5000 –10,000 I.U.) of human chorionic gonadotropin (hCG) to cause follicular luteinization and oocyte maturation. Previous studies have shown an inverse correlation between an increased body mass index (BMI) and IVF pregnancy rates. The purpose of this study was to evaluate the potential effect of increased body mass on the intrafollicular hCG concentration, oocyte and embryo quality, and pregnancy rates of patients undergoing IVF. Design: A retrospective analysis of 247 consecutive IVF patients. Materials and Methods: Ovarian stimulation during the IVF cycle was accomplished using standard GNRH-agonist down regulation combined with recombinant follicle stimulating hormone (FSH) and urinary-derived gonadotropin controlled ovarian hyperstimulation. A single injection of 10,000 I.U. of hCG was given 36 hours prior to oocyte retrieval. Embryos were cultured in HTF medium and transferred 72 hours after retrieval. Frozen follicular fluid aspirates were thawed and pooled for each patient. The hCG concentration was determined on an aliquot of the pooled sample using the Immulite hCG assay. A retrospective chart review was conducted to evaluate the relationship between the intrafollicular hCG concentration and BMI, estradiol levels, oocyte quality, embryo quality, and pregnancy rates, and patient age. Results: A significant inverse correlation (r 5 20.353, p,0.001) was observed between the BMI and the intrafollicular hCG concentration. The mean hCG concentration was significantly decreased (p,0.001) in patients with a BMI .30 (73.6 6 8.8, n534) compared to patients with a BMI of
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20 –30 (121.4 6 6.0, n5173) or ,20 (153.2 6 11,2, n540). The clinical pregnancy rates were 17.6% (6/34), 45.1% (78/173), and 52.5% (21/40) respectively for the three groups (p,0.001). The embryo score was 15.8 6 0.3 with a BMI of 20 –30, versus 13.5 6 0.8 with a BMI .30 (p,0.05). Conclusions: These data indicate that intrafollicular hCG concentration is inversely related to BMI, and that pregnancy rate was significantly decreased when the BMI was .30. Increasing evidence indicates that decreased LH (hCG) results in a diminished oocyte and embryo quality. This study indicates a diminished IVF embryo score and pregnancy rate with a BMI .30.
P-256 Antral Follicle Count and Ovarian Volume Predict IVF Outcome. F. I. Sharara, H. D. McClamrock. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics/Gynecology, University of Maryland School of Medicine, Baltimore, MD. Objectives: Few studies have addressed the role of antral follicle count and ovarian volume in IVF. None have evaluated antral follicle count in each ovary, and whether this correlates with ovarian response and IVF outcome. Design: Prospective. Materials and Methods: 104 women (,40 yo) undergoing 137 cycles were evaluated (77 stimulated using a microdose flare and 50 using a long LL protocol) between 4/1997 and 11/1999. Patients were divided according to the number of small antral follicles (,8 mm) in each ovary on the day of gonadotropin start (,5, 5–15, .15) as previously described. Results: Both ovaries ,5 N cycles Age (years) CD3 FSH (IU/L) Ovarian V (cm3) BMI (kg/m2) Length of stimulation (days) Peak E2 (pg/ml) # Ampules # Oocytes Cancellation rate (%) # Transferred embryos Clinical PR/ET (%) IR (%)
One ,5, one 5–15
Both 5–15
39 33.5 6 3.4* 7.5 6 2.2* 3.1 6 2.0* 24.3 6 4.7*
17 34.0 6 4.1* 7.3 6 1.5* 4.3 6 1.9* 27.4 6 7.7*
55 32.7 6 3.6 6.7 6 1.3 5.6 6 2.7* 27.9 6 7.1*
10.3 6 1.6*† 1884 6 900* 57.4 6 12.5*† 11.5 6 5.5* 25.6% 3.1 6 1.4 51.7% 27.7%*†
10.6 6 1.3*† 9.4 6 1.2*† 2052 6 1179 2446 6 1226* 55.3 6 12.6*† 45.1 6 12.4*† 14.9 6 4.3* 16.4 6 7.5* 11.8% 12.7% 3.7 6 1.1 3.7 6 1.1 60.0% 39.6% 24.1% 14.6%†
One 5–15, one .15
Both ovaries .15
5 29.0 6 4.6* 6.8 6 0.8 7.0 6 3.0* 34.6 6 7.5*
11 31.5 6 3.5 5.3 6 1.1* 11.2 6 5.2* 39.4 6 11.5*
10.6 6 0.9*† 9.0 6 1.2† 3137 6 1554* 2683 6 1304* 45.6 6 18.2*† 27.1 6 3.9* 15.2 6 4.7* 18.3 6 4.9* 0 0 3.6 6 0.5 3.6 6 0.8 0 36.4% 0* 10.0%*
Conclusions: Ovarian V and the number of antral follicles were strongly related. BMI was also strongly correlated with both V and number of antral follicles. Both number of small antral follicle and ovarian V correlated with stimulation parameters and outcome. The IR and PR were lower with increasing number of small antral follicles and ovarian V most likely secondary to the detrimental effect of increasing BMI. Only two cases of moderate OHSS were noted (none since 5/1997). Both ovarian V and number of antral follicles can be prospectively used to tailor ovarian stimulation prior to initiation of gonadotropins.
P-257 The Use in Daily Clinical Practice of Recombinant FSH (Follitropin-a; Gonal-F 75 IU) in Ovulation Induction (OI) Prior to Intrauterine Insemination (IUI): Follow-Up Study in 1000 Cycles. 1M. Ridao, on behalf of the Collaborative Group. 1Instituto de Investigacio´n en Servicios de Salud, 46003 Valencia, Spain. Objectives: Analyze the cycle characteristics, monitoring resources used (ultrasound scans; US) and effectiveness of treatment consisting in ovulation induction (OI) with human recombinant FSH (rFHS) in daily clinical practice, according to dosage and regimes specified in the European summary of product characteristics (SmPC) for rFSHs. Design: Follow up study of OI cycles, prior to IUI, performed between January 1998 and November 1999 in 44 clinics, in which rFSH 75 IU (follitropin a; Gonal-Ft) was used as the starting dose of choice. A specific case report form was used.
Vol. 74, No. 3, Suppl. 1, September 2000
P-255 Body Mass Index (BMI) Is Inversely Related to Intrafollicular hCG Levels and Pregnancy Rates of IVF Patients. 1K. P. Jones, 1H. H. Hatasaka, 1C. M. Peterson, 2V. Aoki, 4B. Campbell, 1,2,3,4D. T. Carrell. 1Department of Obstetrics and Gynecology, 2Department of Urology, and 3Department of Physiology, University of Utah School of Medicine, Salt Lake City, UT, and 4The Center for Reproductive Medicine, Abbott Northwestern Hospital, Minneapolis, MN. Objectives: Recent studies have indicated that decreased luteinizing hormone (LH) may result in abnormal oocyte and embryo quality. LH is responsible for initiation of the final maturation of the oocyte prior to ovulation. Standard controlled ovarian hyperstimulation includes a single injection of a supraphysiological dose (5000 –10,000 I.U.) of human chorionic gonadotropin (hCG) to cause follicular luteinization and oocyte maturation. Previous studies have shown an inverse correlation between an increased body mass index (BMI) and IVF pregnancy rates. The purpose of this study was to evaluate the potential effect of increased body mass on the intrafollicular hCG concentration, oocyte and embryo quality, and pregnancy rates of patients undergoing IVF. Design: A retrospective analysis of 247 consecutive IVF patients. Materials and Methods: Ovarian stimulation during the IVF cycle was accomplished using standard GNRH-agonist down regulation combined with recombinant follicle stimulating hormone (FSH) and urinary-derived gonadotropin controlled ovarian hyperstimulation. A single injection of 10,000 I.U. of hCG was given 36 hours prior to oocyte retrieval. Embryos were cultured in HTF medium and transferred 72 hours after retrieval. Frozen follicular fluid aspirates were thawed and pooled for each patient. The hCG concentration was determined on an aliquot of the pooled sample using the Immulite hCG assay. A retrospective chart review was conducted to evaluate the relationship between the intrafollicular hCG concentration and BMI, estradiol levels, oocyte quality, embryo quality, and pregnancy rates, and patient age. Results: A significant inverse correlation (r 5 20.353, p,0.001) was observed between the BMI and the intrafollicular hCG concentration. The mean hCG concentration was significantly decreased (p,0.001) in patients with a BMI .30 (73.6 6 8.8, n534) compared to patients with a BMI of
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Abstracts
20 –30 (121.4 6 6.0, n5173) or ,20 (153.2 6 11,2, n540). The clinical pregnancy rates were 17.6% (6/34), 45.1% (78/173), and 52.5% (21/40) respectively for the three groups (p,0.001). The embryo score was 15.8 6 0.3 with a BMI of 20 –30, versus 13.5 6 0.8 with a BMI .30 (p,0.05). Conclusions: These data indicate that intrafollicular hCG concentration is inversely related to BMI, and that pregnancy rate was significantly decreased when the BMI was .30. Increasing evidence indicates that decreased LH (hCG) results in a diminished oocyte and embryo quality. This study indicates a diminished IVF embryo score and pregnancy rate with a BMI .30.
P-256 Antral Follicle Count and Ovarian Volume Predict IVF Outcome. F. I. Sharara, H. D. McClamrock. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics/Gynecology, University of Maryland School of Medicine, Baltimore, MD. Objectives: Few studies have addressed the role of antral follicle count and ovarian volume in IVF. None have evaluated antral follicle count in each ovary, and whether this correlates with ovarian response and IVF outcome. Design: Prospective. Materials and Methods: 104 women (,40 yo) undergoing 137 cycles were evaluated (77 stimulated using a microdose flare and 50 using a long LL protocol) between 4/1997 and 11/1999. Patients were divided according to the number of small antral follicles (,8 mm) in each ovary on the day of gonadotropin start (,5, 5–15, .15) as previously described. Results: Both ovaries ,5 N cycles Age (years) CD3 FSH (IU/L) Ovarian V (cm3) BMI (kg/m2) Length of stimulation (days) Peak E2 (pg/ml) # Ampules # Oocytes Cancellation rate (%) # Transferred embryos Clinical PR/ET (%) IR (%)
One ,5, one 5–15
Both 5–15
39 33.5 6 3.4* 7.5 6 2.2* 3.1 6 2.0* 24.3 6 4.7*
17 34.0 6 4.1* 7.3 6 1.5* 4.3 6 1.9* 27.4 6 7.7*
55 32.7 6 3.6 6.7 6 1.3 5.6 6 2.7* 27.9 6 7.1*
10.3 6 1.6*† 1884 6 900* 57.4 6 12.5*† 11.5 6 5.5* 25.6% 3.1 6 1.4 51.7% 27.7%*†
10.6 6 1.3*† 9.4 6 1.2*† 2052 6 1179 2446 6 1226* 55.3 6 12.6*† 45.1 6 12.4*† 14.9 6 4.3* 16.4 6 7.5* 11.8% 12.7% 3.7 6 1.1 3.7 6 1.1 60.0% 39.6% 24.1% 14.6%†
One 5–15, one .15
Both ovaries .15
5 29.0 6 4.6* 6.8 6 0.8 7.0 6 3.0* 34.6 6 7.5*
11 31.5 6 3.5 5.3 6 1.1* 11.2 6 5.2* 39.4 6 11.5*
10.6 6 0.9*† 9.0 6 1.2† 3137 6 1554* 2683 6 1304* 45.6 6 18.2*† 27.1 6 3.9* 15.2 6 4.7* 18.3 6 4.9* 0 0 3.6 6 0.5 3.6 6 0.8 0 36.4% 0* 10.0%*
Conclusions: Ovarian V and the number of antral follicles were strongly related. BMI was also strongly correlated with both V and number of antral follicles. Both number of small antral follicle and ovarian V correlated with stimulation parameters and outcome. The IR and PR were lower with increasing number of small antral follicles and ovarian V most likely secondary to the detrimental effect of increasing BMI. Only two cases of moderate OHSS were noted (none since 5/1997). Both ovarian V and number of antral follicles can be prospectively used to tailor ovarian stimulation prior to initiation of gonadotropins.
P-257 The Use in Daily Clinical Practice of Recombinant FSH (Follitropin-a; Gonal-F 75 IU) in Ovulation Induction (OI) Prior to Intrauterine Insemination (IUI): Follow-Up Study in 1000 Cycles. 1M. Ridao, on behalf of the Collaborative Group. 1Instituto de Investigacio´n en Servicios de Salud, 46003 Valencia, Spain. Objectives: Analyze the cycle characteristics, monitoring resources used (ultrasound scans; US) and effectiveness of treatment consisting in ovulation induction (OI) with human recombinant FSH (rFHS) in daily clinical practice, according to dosage and regimes specified in the European summary of product characteristics (SmPC) for rFSHs. Design: Follow up study of OI cycles, prior to IUI, performed between January 1998 and November 1999 in 44 clinics, in which rFSH 75 IU (follitropin a; Gonal-Ft) was used as the starting dose of choice. A specific case report form was used.
Vol. 74, No. 3, Suppl. 1, September 2000