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Comparison of FSH and FSH-hMG regimen in GnRH antagonist using controlled ovarian stimulation protocol
CONCLUSION: Mixed hMG/ FSH protocols result in a higher incidence of premature P rise as compared to FSH alone in GnRH agonist cycles, but not when GnRH antagonists were used. The choice of gonadotropins is important in reducing the probability of premature P rise in GnRH agonist cycles.
CONCLUSION: The prevalence of an ES % 6 in CC/IUI cycles was 23%. There was no difference in the pregnancy rates between endometrial thickness % 6mm or > 6 mm. Interestingly, there were no live births in CC/IUI cycles with ES < 5.9 mm, suggesting that suboptimal endometrial development CC/IUI cycles should prompt transition to alternate therapies.
P-449 Tuesday, October 15, 2013
P-451 Tuesday, October 15, 2013
COMPARISON OF FSH AND FSH-HMG REGIMEN IN GnRH ANTAGONIST USING CONTROLLED OVARIAN STIMULATION PROTOCOL. T. Fujiwara, C. Tabata, O. Tsutsumi. Center for Human Reproduction and Gynecologic Endoscopy, Sanno Hospital, Minato-ku, Tokyo, Japan.
COMPARISON OF ASSISTED REPRODUCTIVE TECHNOLOGY OUTCOMES IN INFERTILE WOMEN WITH POLYCYSTIC OVARY SYNDROME: GnRH AGONIST VS GnRH ANTAGONIST CYCLES. I. Zidi jrah, F. Atig, S. Meddeb, H. Khairi, A. Saad, M. Ajina. Unity of Reproductive Medicine, University Hospital Farhat Hached, Sousse, Tunisia.
OBJECTIVE: While FSH is essential in controlled ovarian stimulation (COS), the clinical necessity of LH is unclear. We examined if the presence of LH in COS affects the endocrine condition or harvested oocytes/embryos status. DESIGN: Retrospective case study in a single hospital. MATERIALS AND METHODS: Totally 480 patients who underwent assisted reproductive technology (ART) with GnRH antagonist (GnRH ant) protocol between August 2008 and May 2012 were retrospectively analyzed. Infertility patients with ART indication were started with a daily FSH injection from day 2-3 of a menstruation. When lead follicle reached 14-15 mm in mean diameter, GnRHant was added. Either FSH was then continued (group F) or changed to hMG (group H), which included LH activity. All data including hormones (FSH, LH, estradiol (E2), progesterone (P4)) from baseline through adding GnRHant to the end of COS, AMH, antral follicle count (AFC), endometrial thickness (Em), and retrieved oocytes/embryos status (number, maturation and fertilization rates, morphologically good embryo number) were collected from the clinical records for between-group comparison. This study had been approved by IRB. RESULTS: Background factors were identical in both groups. In the end of COS, hormone levels including LH, E2, P4, and Em did not differ in both groups. There was no difference in mean follicle diameter, number of retrieved oocytes or fertilized eggs, number/rate of mature oocytes, rate of fertilization, subtotal gonadotropin dose or days of administration before GnRHant addition. However, the total and subtotal of gonadotropin dose after GnRHant addition was greater in group H. Also, when subgroup with less than five in AFC, a significantly higher number of mature oocytes were obtained in group F (p<0.05). CONCLUSION: In COS with GnRHant protocol change to hMG after starting GnRHant seems unnecessary. When AFC is less than five it is preferable to continue FHS to yield more mature oocytes. P-450 Tuesday, October 15, 2013 WHAT IS THE PREVALENCE OF SUBOPTIMAL ENDOMETRIAL DEVELOPMENT IN CLOMPIHENE CITRATE (CC) CYCLES WITH INTRAUTERINE INSEMINATION (IUI), AND WHAT IS THE IMPACT ON CYCLE OUTCOME? S. A. Davila Garza,b S. Torrealday,a L. Doherty,a P. Patrizio.a aObstetrics, Gynecology, and Reproductive Sciences, Yale Fertility Center, New Haven, CT; bInstituto para el Estudio de la Concepcion Humana, Colonia Obispado, Monterrey, Mexico. OBJECTIVE: To identify the prevalence of thin endometrial lining (<6 mm), characteristics of patients affected, and pregnancy outcomes in CC/ IUI cycles. DESIGN: Retrospective analysis. MATERIALS AND METHODS: 87 patients who underwent 167 CC/IUI cycles between January 2009 and June 2012 were reviewed. Patients were subdivided into two groups: Those with endometrial stripe (ES) % 6 mm or ES R 6.1 mm on the day of hCG trigger. Patient demographics and cycle outcomes were assessed. Statistical analysis was performed with the student’s t-test and c2 test for continuous and categorical variables, respectively. RESULTS: There were no significant differences in age, day 3 gonadotropin values, AMH, or antral follicle count (AFC) between the two groups. Women with ES % 6 on the day of hCG trigger had a significantly lower body mass index (22.5 vs. 27.5, p<0.001), and higher estradiol concentrations (576 vs. 450, p<0.001) than women with ES R 6.1 mm. The prevalence of ES of %6 mm was 23%. The pregnancy rates (PR) were 11% in the % 6mm group, and 13% in the > 6.1mm groups (NS, p¼0.77). No pregnancies or live births occurred with an ES < 5.1 mm and <5.9 mm, respectively.
S278
ASRM Abstracts
OBJECTIVE: To assess the effectiveness of ovarian stimulation protocols (GnRH agonist and GnRH antagonist) on assisted reproductive technology (ART) outcomes in patients with polycystic ovary syndrome (PCOS) trying to conceive. DESIGN: Retrospective study included a total of 102 infertile women with PCOS. MATERIALS AND METHODS: Our patients were classified in two groups: GnRH agonist protocol group (50 cycles) and GnRH antagonist protocol group (52 cycles). RESULTS: The mean number of retrieved oocytes was 7.23.6 in the antagonist group vs. 8.34.1 in the agonist group (p>0.05). No differences were observed in fertilization rate, segmentation rate, number of good quality embryos and pregnancy rate in the agonist and antagonist protocols. Duration of stimulation (10 vs. 11days, P¼0.01), total gonadotrophin required (19 vs. 23 ampoules, P¼0.002) and E2 concentration on hCG day (2280 vs. 3123pg/ ml, p¼0.006) were significantly lower in the antagonist compared with agonist protocol. CONCLUSION: Our study suggests that the GnRH antagonist protocol is the best treatment for patients with PCOS undergoing ART as it is associated with a similar pregnancy rate, lower risk of ovarian hyperstimulation syndrome, lower gonadotrophin requirement and shorter duration of stimulation, compared with GnRH agonist. P-452 Tuesday, October 15, 2013 REPRODUCTIVE POTENTIAL OF MATURE MII OOCYTES FOLLOWING NATURAL CYCLE IVF / MINIMAL OVARIAN STIMULATION: ANALYSIS OF 2876 TREATMENT CYCLES FROM A SINGLE JAPANESE CENTER. S. Kawachiya, D. Bodri, M. Kondo, R. Kato, T. Matsumoto. Kobe Motomachi Yume Clinic, Kobe, Hyogo, Japan. OBJECTIVE: In previous studies oocyte utilization following conventional ovarian stimulation was found to be constantly low (<5%) and has declined even further (<1%) in >37 years-old women. Although it was suggested that mild ovarian stimulation could yield better quality eggs to date there are no large-scale analyses on the reproductive potential of MII oocytes following mild IVF. DESIGN: Single-center retrospective review performed between November 2008-December 2011. MATERIALS AND METHODS: Live birth rate per mature oocyte was calculated according to five female age categories (26-34, 35-37, 38-40, 41-44, 45-52 years) and three ovarian response categories: minimal (1 MII), moderate (2-5 MII) or high (6-20 MII) oocyte yield. RESULTS: A total of 4111 MII eggs (mean 1.41.9, range: 0-20) originated from 2876 treatment cycles (in 727 consecutive infertile patients) and resulted in 966 (34%) embryo transfers and 274 (10%) live births. In younger age groups (<35 and <38 years) the oocyte utilization rate was remarkably high for the single-egg group, was somewhat lower in the moderate ovarian response group and was considerably lower in case of high ovarian response. In older age groups (>37) the differences in oocyte utilization rates according to ovarian response categories were closer to those observed after conventional IVF. Live birth rate per mature oocyte according to female age and oocyte response categories
Age group 1 MII 2-5 MII 6-20 MII
26-34 25% 13.4% 6.7%
35-37 16.7% 13.5% 7.4%
38-40 8.8% 7.9% 4.9%
41-44 2% 1.5% 4.1%
45-52 0% 0% 0%
Vol. 100, No. 3, Supplement, September 2013
CONCLUSION: The prevalence of an ES % 6 in CC/IUI cycles was 23%. There was no difference in the pregnancy rates between endometrial thickness % 6mm or > 6 mm. Interestingly, there were no live births in CC/IUI cycles with ES < 5.9 mm, suggesting that suboptimal endometrial development CC/IUI cycles should prompt transition to alternate therapies.
P-449 Tuesday, October 15, 2013
P-451 Tuesday, October 15, 2013
COMPARISON OF FSH AND FSH-HMG REGIMEN IN GnRH ANTAGONIST USING CONTROLLED OVARIAN STIMULATION PROTOCOL. T. Fujiwara, C. Tabata, O. Tsutsumi. Center for Human Reproduction and Gynecologic Endoscopy, Sanno Hospital, Minato-ku, Tokyo, Japan.
COMPARISON OF ASSISTED REPRODUCTIVE TECHNOLOGY OUTCOMES IN INFERTILE WOMEN WITH POLYCYSTIC OVARY SYNDROME: GnRH AGONIST VS GnRH ANTAGONIST CYCLES. I. Zidi jrah, F. Atig, S. Meddeb, H. Khairi, A. Saad, M. Ajina. Unity of Reproductive Medicine, University Hospital Farhat Hached, Sousse, Tunisia.
OBJECTIVE: While FSH is essential in controlled ovarian stimulation (COS), the clinical necessity of LH is unclear. We examined if the presence of LH in COS affects the endocrine condition or harvested oocytes/embryos status. DESIGN: Retrospective case study in a single hospital. MATERIALS AND METHODS: Totally 480 patients who underwent assisted reproductive technology (ART) with GnRH antagonist (GnRH ant) protocol between August 2008 and May 2012 were retrospectively analyzed. Infertility patients with ART indication were started with a daily FSH injection from day 2-3 of a menstruation. When lead follicle reached 14-15 mm in mean diameter, GnRHant was added. Either FSH was then continued (group F) or changed to hMG (group H), which included LH activity. All data including hormones (FSH, LH, estradiol (E2), progesterone (P4)) from baseline through adding GnRHant to the end of COS, AMH, antral follicle count (AFC), endometrial thickness (Em), and retrieved oocytes/embryos status (number, maturation and fertilization rates, morphologically good embryo number) were collected from the clinical records for between-group comparison. This study had been approved by IRB. RESULTS: Background factors were identical in both groups. In the end of COS, hormone levels including LH, E2, P4, and Em did not differ in both groups. There was no difference in mean follicle diameter, number of retrieved oocytes or fertilized eggs, number/rate of mature oocytes, rate of fertilization, subtotal gonadotropin dose or days of administration before GnRHant addition. However, the total and subtotal of gonadotropin dose after GnRHant addition was greater in group H. Also, when subgroup with less than five in AFC, a significantly higher number of mature oocytes were obtained in group F (p<0.05). CONCLUSION: In COS with GnRHant protocol change to hMG after starting GnRHant seems unnecessary. When AFC is less than five it is preferable to continue FHS to yield more mature oocytes. P-450 Tuesday, October 15, 2013 WHAT IS THE PREVALENCE OF SUBOPTIMAL ENDOMETRIAL DEVELOPMENT IN CLOMPIHENE CITRATE (CC) CYCLES WITH INTRAUTERINE INSEMINATION (IUI), AND WHAT IS THE IMPACT ON CYCLE OUTCOME? S. A. Davila Garza,b S. Torrealday,a L. Doherty,a P. Patrizio.a aObstetrics, Gynecology, and Reproductive Sciences, Yale Fertility Center, New Haven, CT; bInstituto para el Estudio de la Concepcion Humana, Colonia Obispado, Monterrey, Mexico. OBJECTIVE: To identify the prevalence of thin endometrial lining (<6 mm), characteristics of patients affected, and pregnancy outcomes in CC/ IUI cycles. DESIGN: Retrospective analysis. MATERIALS AND METHODS: 87 patients who underwent 167 CC/IUI cycles between January 2009 and June 2012 were reviewed. Patients were subdivided into two groups: Those with endometrial stripe (ES) % 6 mm or ES R 6.1 mm on the day of hCG trigger. Patient demographics and cycle outcomes were assessed. Statistical analysis was performed with the student’s t-test and c2 test for continuous and categorical variables, respectively. RESULTS: There were no significant differences in age, day 3 gonadotropin values, AMH, or antral follicle count (AFC) between the two groups. Women with ES % 6 on the day of hCG trigger had a significantly lower body mass index (22.5 vs. 27.5, p<0.001), and higher estradiol concentrations (576 vs. 450, p<0.001) than women with ES R 6.1 mm. The prevalence of ES of %6 mm was 23%. The pregnancy rates (PR) were 11% in the % 6mm group, and 13% in the > 6.1mm groups (NS, p¼0.77). No pregnancies or live births occurred with an ES < 5.1 mm and <5.9 mm, respectively.
S278
ASRM Abstracts
OBJECTIVE: To assess the effectiveness of ovarian stimulation protocols (GnRH agonist and GnRH antagonist) on assisted reproductive technology (ART) outcomes in patients with polycystic ovary syndrome (PCOS) trying to conceive. DESIGN: Retrospective study included a total of 102 infertile women with PCOS. MATERIALS AND METHODS: Our patients were classified in two groups: GnRH agonist protocol group (50 cycles) and GnRH antagonist protocol group (52 cycles). RESULTS: The mean number of retrieved oocytes was 7.23.6 in the antagonist group vs. 8.34.1 in the agonist group (p>0.05). No differences were observed in fertilization rate, segmentation rate, number of good quality embryos and pregnancy rate in the agonist and antagonist protocols. Duration of stimulation (10 vs. 11days, P¼0.01), total gonadotrophin required (19 vs. 23 ampoules, P¼0.002) and E2 concentration on hCG day (2280 vs. 3123pg/ ml, p¼0.006) were significantly lower in the antagonist compared with agonist protocol. CONCLUSION: Our study suggests that the GnRH antagonist protocol is the best treatment for patients with PCOS undergoing ART as it is associated with a similar pregnancy rate, lower risk of ovarian hyperstimulation syndrome, lower gonadotrophin requirement and shorter duration of stimulation, compared with GnRH agonist. P-452 Tuesday, October 15, 2013 REPRODUCTIVE POTENTIAL OF MATURE MII OOCYTES FOLLOWING NATURAL CYCLE IVF / MINIMAL OVARIAN STIMULATION: ANALYSIS OF 2876 TREATMENT CYCLES FROM A SINGLE JAPANESE CENTER. S. Kawachiya, D. Bodri, M. Kondo, R. Kato, T. Matsumoto. Kobe Motomachi Yume Clinic, Kobe, Hyogo, Japan. OBJECTIVE: In previous studies oocyte utilization following conventional ovarian stimulation was found to be constantly low (<5%) and has declined even further (<1%) in >37 years-old women. Although it was suggested that mild ovarian stimulation could yield better quality eggs to date there are no large-scale analyses on the reproductive potential of MII oocytes following mild IVF. DESIGN: Single-center retrospective review performed between November 2008-December 2011. MATERIALS AND METHODS: Live birth rate per mature oocyte was calculated according to five female age categories (26-34, 35-37, 38-40, 41-44, 45-52 years) and three ovarian response categories: minimal (1 MII), moderate (2-5 MII) or high (6-20 MII) oocyte yield. RESULTS: A total of 4111 MII eggs (mean 1.41.9, range: 0-20) originated from 2876 treatment cycles (in 727 consecutive infertile patients) and resulted in 966 (34%) embryo transfers and 274 (10%) live births. In younger age groups (<35 and <38 years) the oocyte utilization rate was remarkably high for the single-egg group, was somewhat lower in the moderate ovarian response group and was considerably lower in case of high ovarian response. In older age groups (>37) the differences in oocyte utilization rates according to ovarian response categories were closer to those observed after conventional IVF. Live birth rate per mature oocyte according to female age and oocyte response categories
Age group 1 MII 2-5 MII 6-20 MII
26-34 25% 13.4% 6.7%
35-37 16.7% 13.5% 7.4%
38-40 8.8% 7.9% 4.9%
41-44 2% 1.5% 4.1%
45-52 0% 0% 0%
Vol. 100, No. 3, Supplement, September 2013