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Coasting may effect endometrial thickness and outcome
P-215 Obstetric outcome of patients with polycystic ovary syndrome treated by in vitro maturation and in vitro fertilization and embryo transfer. K. Y. Cha, L. S. Park, H. Kwon, M. K. Chung, H. M. Chung, T. K. Yoon. Infertility Medical Center of CHA General Hospital, CHA Research Institute, Pochon CHA University, Seoul, Republic of Korea. OBJECTIVE: To assess the obstetric outcome of pregnancies resulting from in-vitro maturation (IVM) and in-vitro fertilization and embryo transfer (IVF-ET) of immature oocytes retrieved from women with polycystic ovarian syndrome (PCOS). DESIGN: Prospective observational study. MATERIALS AND METHODS: Patient(s): One hundred and thirty-nine women undergoing 203 in-vitro oocyte maturation treatment cycles. Intervention(s): Immature oocyte recovery from unstimulated ovaries. In-vitro oocyte maturation (IVM) and fertilization. Fresh embryo transfer and assessment of obstetrical outcomes in the pregnant women. Main outcome Measure(s): Pregnancy and obstetric outcome. RESULTS: Fourty-one pregnancies were obtained in 187 embryo transfers, resulting in a pregnancy rate (PR) of 21.9%. Except for 3 cases lost to follow up in these pregnancies, the abortion rate (AR) and live birth rate (LBR) were 36.8%(14/38) and 63.2% (24/38). The mean gestational age and mean birth weight at delivery for singletons was 38.4⫾2.0 weeks [range:33⬃41.6 weeks] and 3252⫾516gm [range:1750⬃4100gm], respectively. For twins this was 36.7⫾1.9 weeks [range:34.6⬃39weeks] and 2361⫾304gm [range:1900⬃2990gm], respectively. Pregnancy complications occurred in 5 cases (13.2%), this included preterm labor (n⫽3) and placenta previa (n⫽2). Two cases (5.3%) had a major congenital anomaly diagnosed by ultrasonography. CONCLUSION: The abortion rate, gestational age and birth weight at delivery, and obstetric complications of pregnancies conceived by IVM-ET were comparable to those of other women with PCOS being treated by conventional IVF-ET. IVM followed by IVF-ET appears to be a useful treatment option for women with PCOS, thus avoiding the risk of OHSS. Supported by: This work was supported by a grant from the INTERDISCIPLINARY RESEARCH PROGRAM of the KOSEF (1999 –2-205– 002-5).
P-216 Coasting may effect endometrial thickness and outcome. M. Aygun, F. Vanlioglu, G. Karlikaya, H. Karagozoglu, B. Kumbak, S. Kahraman. Istanbul Memorial Hospital, Istanbul, Turkey. OBJECTIVE: Gonadotropin withholding (coasting) has been offered to patients as a promising method for the prevention of cycle cancellations as well as complications associated with severe ovarian hyperstimulation syndrome (OHSS). However, the data on coasting regarding embryo development and implantation is still limited and controversial. During the coasting period, endometrium receptivity may be altered due to changes in endometrium thickness. In the present study, we aimed to determine the prognostic value of the alterations in endometrial thickness in relation to the coasting duration to predict implantation and clinical outcomes. DESIGN: Retrospective study MATERIALS AND METHODS: 86 ART cycles undergoing coasting, ranging from 1 to 7 days, were included in the study. Women with apparent endometrial pathologies were excluded. The difference between the maximum endometrial thickness, observed at the onset or during the coasting period, and that of the thickness on the day of HCG administration were noted. The cut-off value for this difference was determined using a receiver operating characteristic (ROC) curve. The values were then compared with
FERTILITY & STERILITY威
the implantation and pregnancy rates in order to determine whether changes in thickness had an effect RESULTS: : In 86 ART cycles, 45 clinical pregnancies resulted with 86 gestational sacs. A cut-off value for endometrial thickness difference (ETD) was found to be 1.8 mm, with the sensitivity of 92% and the specificity of 31% (ROC). According to this value, cycles were grouped: 71 patients were in group A (ETD ⬍1.8 mm) and 15 patients were in group B (ETDⱖ1.8 mm). The female age, body mass index, number of metaphase II oocytes, fertilization rates, rate of the grade I embryos on day 3, maximum endometrial thickness, number of transferred embryos between the two groups were not significantly different. There were higher peak estradiol values (5483 vs. 7061 pg/ml, p⬍0.05) and a longer coasting period (2.1 vs. 4 days, p⬍0.001) in group B. 267 embryos in Group A and 51 embryos in Group B were transferred. Clinical pregnancy (59.1% vs. 20%) and implantation rates (24.3% vs. 7.8%) were significantly higher in group A (p⬍0.05). In group A, 36 ongoing pregnancies (50.7%) and in group B, 3 ongoing pregnancies (20%) were achieved (p⬍0.05). CONCLUSION: Coasting is used as a preventive method against OHSS and cycle cancellation. But the effect of the coasting period on implantation and pregnancy rates in ART cycles has not been clearly defined. Fertilization rates and embryo developments seem similar in coasting periods regardless of duration. In our study we observed that the thickness of the endometrium decreased during the coasting period in some patients. Clinical pregnancy and implantation rates are lower when endometrial thickness is decreased (ⱖ 1.8 mm) during the coasting period. Coasting with higher estradiol values for a longer period may have an impact on the implantation rates by changing the endometrial receptivity. Supported by: None
P-217 Donor age does not impact the success of oocyte donation cycles. E. Flisser, L. M. Kump, L. C. Krey, F. Licciardi. Program for In Vitro Fertilization, Reproductive Surgery and Infertility, New York University School of Medicine, New York, NY. OBJECTIVE: Characteristics of oocyte donors can be selected to optimize success rates. Parameters that might have affected the success of these cycles, including gravity and parity, have been excluded as significant predictors of outcome. Previous studies suggest an inverse relationship between donor age and pregnancy rates. The goal of this study is to reassess the impact of donor age on recipient clinical pregnancy rate. DESIGN: Retrospective cohort analysis in a university-based oocyte donation program. MATERIALS AND METHODS: We analyzed 705 consecutive anonymous oocyte donation cycles from 1995–2003. The outcome parameter, clinical pregnancy, was defined as the presence of fetal cardiac activity on first trimester transvaginal ultrasound exam. Oocyte donors were categorized by age (range 21–32 years; mean ⫾ SD: 25.7 ⫾ 3.1) at the start of the stimulation cycle. When ⱖ 12 oocytes were retrieved, oocytes were often randomly distributed between two recipients. Consequently, the data was evaluated by donor age on a per retrieval (n⫽705) and a per transfer (n⫽1128) basis. Statistical significance by multivariate logistic regression was determined using SigmaStat©. RESULTS: Multivariate logistic regression revealed no statistically significant association between donor age and pregnancy outcome on a per retrieval or per transfer basis.
CONCLUSION: Donor age from 21–32 years does not affect clinical pregnancy rates in recipients of oocyte donation cycles. Recipients should not be discouraged from accepting donors who are in their late 20’s or early 30’s. Supported by: None.
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P-216 Coasting may effect endometrial thickness and outcome. M. Aygun, F. Vanlioglu, G. Karlikaya, H. Karagozoglu, B. Kumbak, S. Kahraman. Istanbul Memorial Hospital, Istanbul, Turkey. OBJECTIVE: Gonadotropin withholding (coasting) has been offered to patients as a promising method for the prevention of cycle cancellations as well as complications associated with severe ovarian hyperstimulation syndrome (OHSS). However, the data on coasting regarding embryo development and implantation is still limited and controversial. During the coasting period, endometrium receptivity may be altered due to changes in endometrium thickness. In the present study, we aimed to determine the prognostic value of the alterations in endometrial thickness in relation to the coasting duration to predict implantation and clinical outcomes. DESIGN: Retrospective study MATERIALS AND METHODS: 86 ART cycles undergoing coasting, ranging from 1 to 7 days, were included in the study. Women with apparent endometrial pathologies were excluded. The difference between the maximum endometrial thickness, observed at the onset or during the coasting period, and that of the thickness on the day of HCG administration were noted. The cut-off value for this difference was determined using a receiver operating characteristic (ROC) curve. The values were then compared with
FERTILITY & STERILITY威
the implantation and pregnancy rates in order to determine whether changes in thickness had an effect RESULTS: : In 86 ART cycles, 45 clinical pregnancies resulted with 86 gestational sacs. A cut-off value for endometrial thickness difference (ETD) was found to be 1.8 mm, with the sensitivity of 92% and the specificity of 31% (ROC). According to this value, cycles were grouped: 71 patients were in group A (ETD ⬍1.8 mm) and 15 patients were in group B (ETDⱖ1.8 mm). The female age, body mass index, number of metaphase II oocytes, fertilization rates, rate of the grade I embryos on day 3, maximum endometrial thickness, number of transferred embryos between the two groups were not significantly different. There were higher peak estradiol values (5483 vs. 7061 pg/ml, p⬍0.05) and a longer coasting period (2.1 vs. 4 days, p⬍0.001) in group B. 267 embryos in Group A and 51 embryos in Group B were transferred. Clinical pregnancy (59.1% vs. 20%) and implantation rates (24.3% vs. 7.8%) were significantly higher in group A (p⬍0.05). In group A, 36 ongoing pregnancies (50.7%) and in group B, 3 ongoing pregnancies (20%) were achieved (p⬍0.05). CONCLUSION: Coasting is used as a preventive method against OHSS and cycle cancellation. But the effect of the coasting period on implantation and pregnancy rates in ART cycles has not been clearly defined. Fertilization rates and embryo developments seem similar in coasting periods regardless of duration. In our study we observed that the thickness of the endometrium decreased during the coasting period in some patients. Clinical pregnancy and implantation rates are lower when endometrial thickness is decreased (ⱖ 1.8 mm) during the coasting period. Coasting with higher estradiol values for a longer period may have an impact on the implantation rates by changing the endometrial receptivity. Supported by: None
P-217 Donor age does not impact the success of oocyte donation cycles. E. Flisser, L. M. Kump, L. C. Krey, F. Licciardi. Program for In Vitro Fertilization, Reproductive Surgery and Infertility, New York University School of Medicine, New York, NY. OBJECTIVE: Characteristics of oocyte donors can be selected to optimize success rates. Parameters that might have affected the success of these cycles, including gravity and parity, have been excluded as significant predictors of outcome. Previous studies suggest an inverse relationship between donor age and pregnancy rates. The goal of this study is to reassess the impact of donor age on recipient clinical pregnancy rate. DESIGN: Retrospective cohort analysis in a university-based oocyte donation program. MATERIALS AND METHODS: We analyzed 705 consecutive anonymous oocyte donation cycles from 1995–2003. The outcome parameter, clinical pregnancy, was defined as the presence of fetal cardiac activity on first trimester transvaginal ultrasound exam. Oocyte donors were categorized by age (range 21–32 years; mean ⫾ SD: 25.7 ⫾ 3.1) at the start of the stimulation cycle. When ⱖ 12 oocytes were retrieved, oocytes were often randomly distributed between two recipients. Consequently, the data was evaluated by donor age on a per retrieval (n⫽705) and a per transfer (n⫽1128) basis. Statistical significance by multivariate logistic regression was determined using SigmaStat©. RESULTS: Multivariate logistic regression revealed no statistically significant association between donor age and pregnancy outcome on a per retrieval or per transfer basis.
CONCLUSION: Donor age from 21–32 years does not affect clinical pregnancy rates in recipients of oocyte donation cycles. Recipients should not be discouraged from accepting donors who are in their late 20’s or early 30’s. Supported by: None.
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