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Cabergoline for poor responders. A new approach
THURSDAY,
SEPTEMBER 7
ranged from l-4 embryos. We had 3 ongoing pregnancies out of 20 patients 15% per cycle and 23% per transfer. Conclusion: These preliminary results indicate that administration of cyclic hormonal treatment for poor responders may increase their responsiveness to stimulation protocols. The mechanism might be at the cellular level, stimulating and increasing the number of hormonal receptors at the cell membrane. Further trials should be attempted for proper assessment of the statistical significance of these encouraging results.
FC4.11.05 A PROSPECTIVE RANDOMISED STUDY TO ASCERTAIN IF GONADOTROPHINS WITH DIFFERING FSH:LH RATIOS AFFECT OOCYTE MATURATION, FERTILISATION AND OUTCOME IN ASSISTED CONCEmION CYCLES RE HI Abdalla, JW Studd, IVF Unit, Lister Hospital, London, UK Objectives: Purer forms of follicle stimulating hormone (FSH) are now being used in controlled ovarian hyperstimulation to improve oocyte maturation, fertilisation, embryo quality and hence outcome. The aim of this study was to ascertain if gonadotrophins containing more exogenous luteinising hormone (LH) affected outcome. Design: A prospective, randomised study involving 153 couples undertaking assisted conception treatment. All entered had to fulfil the criteria of: age < 37; <5 attempts at assisted conception and normal semen parameters. Materials and Methods: All patients underwent pituitary downregulation in a long protocol followed by controlled super-ovulation with 15Oiu of each gonadotrophin. 153 couples were randomly allocated to three groups to receive gonadotrophins with ratio of FSH:LH 1:O;l:l; and 3:l. Prior to egg collection all patients received HCG. The outcome measures were total number of ampoules used, number of oocytes collected, fertilisation rate and pregnancy rate. Results: There was equal distribution between all 3 groups for age, duration and cause of infertility, the treatment type - in vitro fertilisation (IVF) or gamete intra fallopian tube transfer (GIFT) and the number transferred. The clinical pregnancy rates were 40.0% (FSH:LH l:O), 40.4% (FSH:LH 1:l) and 31.4% (FSH:LH 3:l). There was no significant difference in any of the other outcome measures. Conclusion: The study failed to show that increased exogenous luteinising hormone adversely affects outcome.
FC4.11.06 CABERGOLINE FOR POOR RESPONDERS. A NEW APPROACH H. Shawky, Dept. OBIGYN, ART Unit, Nile Badrawi Hospital, Cairo, Egypt. Objectives: Cabergoline is a potent dopaminergic agent that interacts with dopamine receptors. It has a positive effect in improving the uterine blood flow (Fertility & Sterility Vol. 71, No 2, February 1999). The aim of this study is to detect the effect of Cabergoline in euoprolactinemic poor responders under running ICSI. Patients and Methods: 18 patients are enrolled in this study. Their age group (36-39 years). They all had normal prolactin levels, borderline FSH levels, and poor response to long protocol of ovarian stimulation for ICSI. All patients underwent the routine steps foe ICSI program. Hormonal concentration profile (FSH, LH, prolactin) was done in addition to assessment of uterine & ovarian blood flow, at the day starting the analogue, 2”d day of the cycle, day of oocyte retrieval. Cabergoline 0.5mg orally (one tab) was given once per week starting from the same day of the analogue ending one week after the day of embryo transfer. Results: The results of this study were compared with the results of the previous trial of these patients done within 3 months before but without using Cabergoline. The cancellation rate before the usage of Cabergoline was 85%, but after Cabergoline it was decreased to 69%. Mean number of follicles per patient was 2, but with Cabergoline it became 3. Decrease in uterine and ovarian pulsatility index. Other parameters that were also compared were: hormonal level variations, number of amps used, mean days of stimulation, fertilization, implantation, and pregnancy rates.
41
Conclusion: Cabergoline is a useful drug to be added to the protocols of poor responders as it improves most of the parameters, (blood flow, hormonal levels, number of occytes. Etc.), leading to a better outcome.
FC4.11.07 OOCYTE RETRIEVAL RATE THROUGH REPEATED CONTROLLED OVARIAN HYPERSTIMULATION CYCLES IN DONORS. Calinara C.‘, Vargas G. I, Cuneo S. I, Rodriguez M. I, Simdn C. I,‘, Pellicer A. I,‘, Remohi .I. I,’ ‘Institute Valenciano de Infertilidad, ‘Dpt. of Pediatrics, Obstetrics and Gynecology, Valencia University School of Medicine, Valencia, Spain. Introduction: Oocyte donation has become a common treatment modality for a large spectrum of infertility conditions. The purpose of this study was to determine the effect of the repetition of the controlled ovarian stimulation (COH) by assessing the oocyte retrieval rate through repeated cycles of COH in donors. Material and methods: A retrospective analysis of data from donors who underwent multiple retrievals. The table shows the characteristics of the patients through the cycles. The statystical analysis used was a Pearson’s partial linear correlation, controlled by age, days of stimulation, and dosis of gonadotropins used for COH, of all of the donors through all their cycles.
‘mean f SD Results: 286 donors consented to at least two cycles. Statystical analysis showed a significative (r’
50
40
30 ’
*Cl
t
cvo!e
Graphic 1. Linear correlation between the number of cycles and the number of oocytes retrieved (each dot and rod correspond to a case).
SEPTEMBER 7
ranged from l-4 embryos. We had 3 ongoing pregnancies out of 20 patients 15% per cycle and 23% per transfer. Conclusion: These preliminary results indicate that administration of cyclic hormonal treatment for poor responders may increase their responsiveness to stimulation protocols. The mechanism might be at the cellular level, stimulating and increasing the number of hormonal receptors at the cell membrane. Further trials should be attempted for proper assessment of the statistical significance of these encouraging results.
FC4.11.05 A PROSPECTIVE RANDOMISED STUDY TO ASCERTAIN IF GONADOTROPHINS WITH DIFFERING FSH:LH RATIOS AFFECT OOCYTE MATURATION, FERTILISATION AND OUTCOME IN ASSISTED CONCEmION CYCLES RE HI Abdalla, JW Studd, IVF Unit, Lister Hospital, London, UK Objectives: Purer forms of follicle stimulating hormone (FSH) are now being used in controlled ovarian hyperstimulation to improve oocyte maturation, fertilisation, embryo quality and hence outcome. The aim of this study was to ascertain if gonadotrophins containing more exogenous luteinising hormone (LH) affected outcome. Design: A prospective, randomised study involving 153 couples undertaking assisted conception treatment. All entered had to fulfil the criteria of: age < 37; <5 attempts at assisted conception and normal semen parameters. Materials and Methods: All patients underwent pituitary downregulation in a long protocol followed by controlled super-ovulation with 15Oiu of each gonadotrophin. 153 couples were randomly allocated to three groups to receive gonadotrophins with ratio of FSH:LH 1:O;l:l; and 3:l. Prior to egg collection all patients received HCG. The outcome measures were total number of ampoules used, number of oocytes collected, fertilisation rate and pregnancy rate. Results: There was equal distribution between all 3 groups for age, duration and cause of infertility, the treatment type - in vitro fertilisation (IVF) or gamete intra fallopian tube transfer (GIFT) and the number transferred. The clinical pregnancy rates were 40.0% (FSH:LH l:O), 40.4% (FSH:LH 1:l) and 31.4% (FSH:LH 3:l). There was no significant difference in any of the other outcome measures. Conclusion: The study failed to show that increased exogenous luteinising hormone adversely affects outcome.
FC4.11.06 CABERGOLINE FOR POOR RESPONDERS. A NEW APPROACH H. Shawky, Dept. OBIGYN, ART Unit, Nile Badrawi Hospital, Cairo, Egypt. Objectives: Cabergoline is a potent dopaminergic agent that interacts with dopamine receptors. It has a positive effect in improving the uterine blood flow (Fertility & Sterility Vol. 71, No 2, February 1999). The aim of this study is to detect the effect of Cabergoline in euoprolactinemic poor responders under running ICSI. Patients and Methods: 18 patients are enrolled in this study. Their age group (36-39 years). They all had normal prolactin levels, borderline FSH levels, and poor response to long protocol of ovarian stimulation for ICSI. All patients underwent the routine steps foe ICSI program. Hormonal concentration profile (FSH, LH, prolactin) was done in addition to assessment of uterine & ovarian blood flow, at the day starting the analogue, 2”d day of the cycle, day of oocyte retrieval. Cabergoline 0.5mg orally (one tab) was given once per week starting from the same day of the analogue ending one week after the day of embryo transfer. Results: The results of this study were compared with the results of the previous trial of these patients done within 3 months before but without using Cabergoline. The cancellation rate before the usage of Cabergoline was 85%, but after Cabergoline it was decreased to 69%. Mean number of follicles per patient was 2, but with Cabergoline it became 3. Decrease in uterine and ovarian pulsatility index. Other parameters that were also compared were: hormonal level variations, number of amps used, mean days of stimulation, fertilization, implantation, and pregnancy rates.
41
Conclusion: Cabergoline is a useful drug to be added to the protocols of poor responders as it improves most of the parameters, (blood flow, hormonal levels, number of occytes. Etc.), leading to a better outcome.
FC4.11.07 OOCYTE RETRIEVAL RATE THROUGH REPEATED CONTROLLED OVARIAN HYPERSTIMULATION CYCLES IN DONORS. Calinara C.‘, Vargas G. I, Cuneo S. I, Rodriguez M. I, Simdn C. I,‘, Pellicer A. I,‘, Remohi .I. I,’ ‘Institute Valenciano de Infertilidad, ‘Dpt. of Pediatrics, Obstetrics and Gynecology, Valencia University School of Medicine, Valencia, Spain. Introduction: Oocyte donation has become a common treatment modality for a large spectrum of infertility conditions. The purpose of this study was to determine the effect of the repetition of the controlled ovarian stimulation (COH) by assessing the oocyte retrieval rate through repeated cycles of COH in donors. Material and methods: A retrospective analysis of data from donors who underwent multiple retrievals. The table shows the characteristics of the patients through the cycles. The statystical analysis used was a Pearson’s partial linear correlation, controlled by age, days of stimulation, and dosis of gonadotropins used for COH, of all of the donors through all their cycles.
‘mean f SD Results: 286 donors consented to at least two cycles. Statystical analysis showed a significative (r’
50
40
30 ’
*Cl
t
cvo!e
Graphic 1. Linear correlation between the number of cycles and the number of oocytes retrieved (each dot and rod correspond to a case).