ICSI?

Materials/Methods: A prospectively maintained database of patient information associated with each ART cycle was utilized. Data including ovarian stimulation variables, fertilization variables, embryo transfer variables, and pregnancy outcome variables without patient identifiers were transferred to Statistica software for analysis. Cycles were categorized with regard to decisions about cancellation for poor response, continuation with increased dosages of gonadotropins, continuation with same dosages of gonadotropins, continuation with reduced dosages of gonadotropins, or cancellation for exaggerated response with risk of ovarian hyperstimulation syndrome. Results: In a cohort of 225 ART cycles, 133 involved the administration of a daily low-dose aspirin beginning prior to the start of gonadotropin treatment. There were no differences in the cancellation rate (p ⫽ 0.73), cycle category distribution (p ⫽ 0.79), and ovarian responses (p from 0.12 to 0.86) to gonadotropin dosages between groups. The groups were similar in age of female partner and in primary infertility diagnosis. The advent of aspirin use in our program is confounded with the advent of other changes in culture media and methods of monitoring embryo transfer. Significantly (p ⬍0.0001) fewer embryos were transferred into patients using aspirin to produce the same pregnancy (p ⫽ 0.12) and implantation (p ⫽ 0.13) rates; a result potentially related to these programmatic modifications. Conclusions: Observations in a clinical practice setting do not support a beneficial role of daily low-dose aspirin treatment on variables associated with ovarian stimulation for patients undergoing ART cycles. Supported by: Funding provided from the Mary Jane Noble Foundation.

Objective: Use of antagonist instead of agonist in IVF cycles is purported to reduce the length of suppression, and is therefore ideal for the poor responder patient population where excessive suppression is unnecessary. The purpose of this study was to evaluate cycle parameter outcomes between agonist and antagonist IVF cycles in our poor responders. Design: Retrospective chart review. Materials/Methods: Twenty non-randomized poor responders who completed both an agonist and an antagonist cycle between 1999 and 2002 were evaluated (N⫽40). Poor responders in our practice include women with a basal FSH ⬎⫽ 10 mIU/mL, women who require 6 ampules or more of gonadotropin stimulation per day, or who have been cancelled at least once due to poor response. Cycle parameters compared include patient age, basal FSH, # ampules of gonadotropins, peak estradiol level, number and quality of eggs, fertilization rate and clinical pregnancy as defined by intrauterine sac. Each patient served as their own control. Results: Summary of results is presented as the patient response on agonist subtracted from the patient response on antagonist with the difference analyzed by paired Students t-test. The mean age of patients in all cycles (N⫽40) was 37 ⫹/⫺ 4 years. The overall pregnancy rate in this group of poor responders was 20%. Interestingly, the number of mature eggs and the number of fertilized eggs were highly correlated in the two stimulations of the same patient. The difference in peak estradiol approaches significance (p ⫽ 0.07).

Parameter P-103 Are additional hMG necessary with GnRH antagonists in IVF/ICSI? Catherine Rongieres, Daniela Meistermann, Laurence Moreau, Christiane Wittemer, Jeanine Ohl, Israel Nisand. CMCO Hosp, Schiltigheim, France. Objective: The use of GnRH antagonist lead the clinicians to reassess their usual monitoring criteria of ovarian response. By competitively binding the GnRH receptors, GnRH antagonists suppresses the secretion of gonadotrophins, especially LH. The objective is to evaluate if adding LH through hMG from day of Cetrotide introduction improved the pregnancy rate Design: A retrospective study Materials/Methods: Between September 2000 and January 2001, 201 patients (poor responders or having previous failure attempts with GnRH agonist) underwent ART and received single dose antagonist (Cetrorelix 3 mg). The first 115 patients were treated with rec-hFSH only (Group A), the following 86 patients received rec-hFSH then hMG from day of Cetrorelix introduction until day hCG (Group B). The statistical analysis was performed by Student-t test. Results: No difference was found in terms of age, Day 3 FSH, BMI and number of previous attempts between group A and B. Total dose of gonadotrophins and stimulation duration are comparable in both groups. Similarly, the number of oocytes and embryos obtained as well as the number of embryos transferred are equivalent. In group A, the cleavage rate was significantly higher (60% versus 52%, p ⫽ 0.05). The same trend was observed for the fertilization rate (58% in Gp A and 52% in Gp B, p ⫽ 0,11but not significant). In contrast, pregnancy and ongoing pregnancy rate per cycle were higher in group B (22,1% and 21,0% versus 17,4% and 13,0% respectively but not significant). Conclusions: These first results suggest that hMG in combination with GnRH antagonists in ART may improve the ongoing pregnancy rate in spite of a poorer fertilization and cleavage rate. Furthermore it also indicates that adding LH through hMG in order to correct the LH decrease at the time of Cetrorelix introduction may play a role on implantation. Further randomised studies are ongoing to confirm these preliminary results. Supported by: None.

P-104 Use of gonadotropin releasing hormone (GnRH) antagonist vs agonist in repeat stimulation cycles of poor responders. Sangita Kathleen Jindal, Cynthia Gatzen, David Barad. Montefiore Medical Ctr and Albert Einstein Coll of Medicine, Dobbs Ferry, NY.

FERTILITY & STERILITY威

Max FSH (mlU/mL) Peak Estradiol (pg/mL) # Eggs # Mature Eggs # Fertilized 2-PN # Ampules Total

Paired Differences Mean

SD

Significance

0.74 ⫺995 ⫺1.40 ⫺1.47 0.05 2.21

3.4 2254 9.16 7.40 4.17 33.99

0.36 0.07 0.50 0.40 0.96 0.78

Conclusions: This small data set indicates that these poor responders had similar stimulation response and clinical outcomes when treated with either agonist or antagonist supression. This suggests that IVF protocols using antagonist can be used as an alternative in this subset of our patients, although they should be counseled about a suboptimal chance for pregnancy. A larger randomized study is recommended. Supported by: Montefiore Medical Center.

P-105 Is endometrial thickness, assessed on the day of HCG administration, predictive of ongoing pregnancy in patients undergoing intrauterine insemination after ovarian stimulation with clomiphene citrate? Efstratios Michail Kolibianakis, Human Mousavi Fatemi, Kaan Osmanagaoglu, Jan Evenepoel, Andre Van Steirteghem, Paul Devroey. Ctr for Reproductive Medicine, Dutch-Speaking Brussels Free Univ, Brussels, Belgium.

Objective: To assess the predictive value of endometrial thickness, measured on the day of HCG administration, on the achievement of ongoing pregnancy in patients undergoing intrauterine insemination after ovarian stimulation with clomiphene citrate (CC). Design: Prospective study (ongoing). Materials/Methods: Until today 80 patients undergoing ovarian stimulation with clomiphene citrate have been included. Patients were stimulated with either 50 (n⫽25) or 100 mg (n⫽55) of clomiphene citrate from day 3 to day 7 of the menstrual cycle. Andrological infertility was present in 13 patients while a female factor in 8 patients. No male or female factor infertility was present in the remaining patients. Endometrial thickness was assessed on the day of HCG with three consecutive measurements at the point of maximal thickness. Intrauterine insemination was performed 36 hours following HCG administration and luteal phase was supported with vaginal progesterone. The mean age of the patients included in the study was 33.1 ⫾ 0.5 years. Twenty one ongoing pregnancies have been achieved until today. Results: The interval in days between the last dose of CC and hCG

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