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Comparison of outcomes between controlled ovarian stimulation with GnRH-agonist vs GnRH-antagonist for in vitro fertilization cycles in women with polycystic ovarian syndrome
stimulating hormone (FSH) and estradiol (E2) in 123 IVF cycles (93 infertility patients). An embryo score was calculated that incorporated the blastomere number and grading, with a larger number indicating superior embryo quality. Embryos not transferred with an embryo score > 4 were cryopreserved. This score corresponded to an embryo with at least 6 cells and a grade of 3 or better. Statistical testing was performed using correlation analysis and receiver operating characteristic (ROC) curves. RESULTS: Fertilization correlated with AMH (r¼0.553, P<0.01), age (r¼-0.456, P<0.01), and FSH (r¼-0.279, P<0.01). It did not correlate with IB (P¼0.172) or E2 (P¼0.133). Because only 3 cycles had no fertilization, receiver operating characteristic (ROC) curves were not constructed. Embryo score correlated with age (r¼-0.257, P<0.01), AMH (r¼0.223, P<0.01), and E2 (r¼-0.206, P<0.02) but not with FSH (P¼0.188) or IB (P¼0.306). For the prediction of an embryo score >4, ROC curve analysis demonstrated an area under the curve (AUC) for age (AUC¼0.739; P<0.001), AMH (AUC¼0.654; P¼<0.001), E2 (AUC¼0.637; P¼0.03), FSH (AUC¼0.556; P¼0.37), and IB (AUC¼0.515; P¼0.82). Number of cryopreserved embryos correlated with AMH (r¼0.364, P<0.01), age (r¼-0.273, P<0.01), E2 (r¼-0.271, P<0.01), FSH (r¼-0.201, P<0.02), but not with IB (-0.023, P¼0.811). ROC curve analysis demonstrated that cryopreservation was predicted by AMH (AUC¼0.682; P<0.001), age (AUC¼0.660; P<0.001), E2 (AUC¼0.646; P¼0.002), FSH (AUC¼0.605; P¼0.03), but not with IB (AUC¼0.516; P¼0.78). CONCLUSIONS: AMH correlated with embryo quality, fertilization, and the number of cryopreserved embryos. It was also highly predictive of superior embryo quality and the opportunity to cryopreserve embryos. Age was also consistently predictive of the outcomes analyzed. Supported by: Repromedix Corporation completed all AMH, FSH, and inhibin B assays for this study free of charge. The samples were deidentified and coded so that Repromedix Corporation and its employees were blinded. No specific de-identified study information or data, other than coded numerical assay results were available to Repromedix Corporation.
P-373 MEASURING SERUM HCG LEVELS BETWEEN HCG INJECTION AND EGG RETRIEVAL IS AN EFFECTIVE APPROACH TO AVOIDING ‘‘EMPTY FOLLICLE SYNDROME’’. J. G. Head, N. M. Giannios, S. J. Weil, J. H. Liu, W. W. Hurd. Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH; Obstetrics and Gynecology, University Hospitals Case Medical Center, Cleveland, OH. OBJECTIVE: Failure to retrieve eggs from apparently mature follicles (Empty Follicle Syndrome or EFS) has been reported in 0.6%-7% of in vitro fertilization (IVF) cycles. Most cases of EFS occur because sufficient serum hCG (human chorionic gonadotropin) levels are not attained due to patient or pharmaceutical errors. One method to prevent this occurrence is to document appropriate serum hCG values between the time of hCG injection and attempted egg retrieval. Our objective was to examine the efficacy of this approach and to determine the range of hCG levels consistent with appropriate ovulation triggering in IVF patients. DESIGN: Retrospective cohort. MATERIALS AND METHODS: We reviewed 272 fresh IVF cycles performed between June 2006 and April 2008. Women were treated with standard luteal leuprolide acetate (LA), microdose flare LA or ganirelix with the addition of FSH (follicle stimulating hormone) with or without LH (luteinizing hormone) prior to ovulation triggering with intramuscular urinary hCG (7,500-10,000 IU). Patients were excluded if their IVF cycle was incomplete or canceled. Serum hCG levels were measured 8-12 hours after hCG injection. Primary outcomes were oocyte number and number of mature oocytes per mature follicle (>14mm). Other outcomes included embryo number and implantation. Correlation coefficients and Chi-squared tests were used to analyze the relationship of hCG level and these outcomes. RESULTS: Of 272 fresh IVF cycles, 174 cycles (in 151 patients) met our criteria. Mean age was 34.44.5 years, and mean BMI was 25.35.6 kg/ M2. In one patient, hCG was undetectable 12 hours after injection. When questioned, she acknowledged confusion about mixing the injection. This patient received a second hCG injection, and 20 mature oocytes were retrieved 35 hours later. In the remaining patients, serum hCG levels 8-12 hrs after administration were 191108 IU/mL (range 47-647 IU/mL). The
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Abstracts
hCG concentration negatively correlated with BMI (R2¼-0.3, P<0.0001), but was unrelated to age (P¼0.087). There was no correlation of hCG values with number of mature oocytes retrieved, number of follicles >14mm, the ratio of mature oocytes to follicles >14 mm, number of embryos, or implantation rate. CONCLUSIONS: Routine measurement of hCG the day after triggering can avoid EFS due to incorrect hCG administration prior to egg retrieval. Levels of hCG as low as 47 IU/mL the day after IM injection appeared to indicate adequate ovulation triggering. Serum hCG levels at 8-12 hours did not correlate with treatment outcome. Supported by: None.
P-374 COMPARISON OF OUTCOMES BETWEEN CONTROLLED OVARIAN STIMULATION WITH GNRH-AGONIST VS GNRH-ANTAGONIST FOR IN VITRO FERTILIZATION CYCLES IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME. S. Segal, I. Glatstein, S. Pang, K. Go, R. Carson, R. Ezcurra. Reproductive Science Center, Lexington, MA; EMDSerono, Rockland, MA. OBJECTIVE: To determine if there is a difference in outcome in patients with PCOS who underwent COS with Gonadotropin/GnRH-agonist vs Gonadotropin/GnRH-antagonist protocols for IVF. DESIGN: Retrospective clinical case-series. MATERIALS AND METHODS: We evaluated the outcome of IVF in patients diagnosed with PCOS who underwent IVF with Gonadotropin/ GnRH-agonist protocol (n¼720), compared to Gonadotropin/GnRH-antagonist protocol (n¼48). Cycle data analyzed included patient age, infertility diagnosis, BMI, number of days of oral contraceptive pills, total dose of gonadotropin administered, number of stimulation days and number of follicles >12 mm. Data from the day of hCG administration included cycle day, estradiol (E2), luteinizing hormone (LH) and progesterone (P4) levels. Outcome data analyzed included number of oocytes, di-pronucleate (2PN) eggs, number of morphologically good embryos, number of embryos transferred, number of embryos frozen, cycle cancellation rate and clinical pregnancy rates. The outcomes were evaluated using ANOVA statistical analysis. P value <0.05 was considered statistically significant. RESULTS: Our data shows that PCOS patients who underwent COS with Gonadotropin/GnRH-antagonist had a lower E2 level, a higher number of 2PN eggs and a higher number of morphologically good embryos. CONCLUSIONS: Controlled ovarian stimulation with Gonadotropin/ GnRH-antagonist protocol in PCOS patients is associated with a higher number of 2PN eggs, a higher number of morphologically good embryos, and similar clinical pregnancy rates compared to a Gonadotropin/GnRH-agonist protocol. TABLE 1.
Cycles BMI OCP Days Total FSH Total hMG Stimulation Days Follicles >12 mm E2pg/mL P4 ng/mL LHmIU/mL # Oocytes 2PN Day 3 good embryos ET Embryos Cryo ancellation Cycles Pregnancy/Cycle Pregnancy/ET
GnRH-agonist
GnRH-antagonist
720 31.1 3.9 26.0 18.8 2796 1396 73 610 9.9 0.1 10.9 8.3 2115 1229 0.58 2.3 0.80 1.2 12.0 6.6 7.1 4.8 1.5 2.1 1.7 0.8 1.2 3.2 75/720 (10%) 34/720 (47%) 34/605 (56%
48 33.4 4.1 23.8 9.9 2557 1594 559 788 10.3 0.4 11.3 8.9 1521 175 0.75 0.6 0.951.1 13.8 9.8 8.6 5.9 2.3 3.1 1.8 0.9 2.0 3.1 8/48 (17%) 18/48 (37%) 18/40 (45%)
P value 0.5 0.2 0/2 0/0002 0.4 0.7 0.001 0.6 0.4 0.06 0.03 0.02 0.8 0.9 0.2 0.4
Supported by: None.
Vol. 90, Suppl 1, September 2008
P-373 MEASURING SERUM HCG LEVELS BETWEEN HCG INJECTION AND EGG RETRIEVAL IS AN EFFECTIVE APPROACH TO AVOIDING ‘‘EMPTY FOLLICLE SYNDROME’’. J. G. Head, N. M. Giannios, S. J. Weil, J. H. Liu, W. W. Hurd. Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH; Obstetrics and Gynecology, University Hospitals Case Medical Center, Cleveland, OH. OBJECTIVE: Failure to retrieve eggs from apparently mature follicles (Empty Follicle Syndrome or EFS) has been reported in 0.6%-7% of in vitro fertilization (IVF) cycles. Most cases of EFS occur because sufficient serum hCG (human chorionic gonadotropin) levels are not attained due to patient or pharmaceutical errors. One method to prevent this occurrence is to document appropriate serum hCG values between the time of hCG injection and attempted egg retrieval. Our objective was to examine the efficacy of this approach and to determine the range of hCG levels consistent with appropriate ovulation triggering in IVF patients. DESIGN: Retrospective cohort. MATERIALS AND METHODS: We reviewed 272 fresh IVF cycles performed between June 2006 and April 2008. Women were treated with standard luteal leuprolide acetate (LA), microdose flare LA or ganirelix with the addition of FSH (follicle stimulating hormone) with or without LH (luteinizing hormone) prior to ovulation triggering with intramuscular urinary hCG (7,500-10,000 IU). Patients were excluded if their IVF cycle was incomplete or canceled. Serum hCG levels were measured 8-12 hours after hCG injection. Primary outcomes were oocyte number and number of mature oocytes per mature follicle (>14mm). Other outcomes included embryo number and implantation. Correlation coefficients and Chi-squared tests were used to analyze the relationship of hCG level and these outcomes. RESULTS: Of 272 fresh IVF cycles, 174 cycles (in 151 patients) met our criteria. Mean age was 34.44.5 years, and mean BMI was 25.35.6 kg/ M2. In one patient, hCG was undetectable 12 hours after injection. When questioned, she acknowledged confusion about mixing the injection. This patient received a second hCG injection, and 20 mature oocytes were retrieved 35 hours later. In the remaining patients, serum hCG levels 8-12 hrs after administration were 191108 IU/mL (range 47-647 IU/mL). The
S232
Abstracts
hCG concentration negatively correlated with BMI (R2¼-0.3, P<0.0001), but was unrelated to age (P¼0.087). There was no correlation of hCG values with number of mature oocytes retrieved, number of follicles >14mm, the ratio of mature oocytes to follicles >14 mm, number of embryos, or implantation rate. CONCLUSIONS: Routine measurement of hCG the day after triggering can avoid EFS due to incorrect hCG administration prior to egg retrieval. Levels of hCG as low as 47 IU/mL the day after IM injection appeared to indicate adequate ovulation triggering. Serum hCG levels at 8-12 hours did not correlate with treatment outcome. Supported by: None.
P-374 COMPARISON OF OUTCOMES BETWEEN CONTROLLED OVARIAN STIMULATION WITH GNRH-AGONIST VS GNRH-ANTAGONIST FOR IN VITRO FERTILIZATION CYCLES IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME. S. Segal, I. Glatstein, S. Pang, K. Go, R. Carson, R. Ezcurra. Reproductive Science Center, Lexington, MA; EMDSerono, Rockland, MA. OBJECTIVE: To determine if there is a difference in outcome in patients with PCOS who underwent COS with Gonadotropin/GnRH-agonist vs Gonadotropin/GnRH-antagonist protocols for IVF. DESIGN: Retrospective clinical case-series. MATERIALS AND METHODS: We evaluated the outcome of IVF in patients diagnosed with PCOS who underwent IVF with Gonadotropin/ GnRH-agonist protocol (n¼720), compared to Gonadotropin/GnRH-antagonist protocol (n¼48). Cycle data analyzed included patient age, infertility diagnosis, BMI, number of days of oral contraceptive pills, total dose of gonadotropin administered, number of stimulation days and number of follicles >12 mm. Data from the day of hCG administration included cycle day, estradiol (E2), luteinizing hormone (LH) and progesterone (P4) levels. Outcome data analyzed included number of oocytes, di-pronucleate (2PN) eggs, number of morphologically good embryos, number of embryos transferred, number of embryos frozen, cycle cancellation rate and clinical pregnancy rates. The outcomes were evaluated using ANOVA statistical analysis. P value <0.05 was considered statistically significant. RESULTS: Our data shows that PCOS patients who underwent COS with Gonadotropin/GnRH-antagonist had a lower E2 level, a higher number of 2PN eggs and a higher number of morphologically good embryos. CONCLUSIONS: Controlled ovarian stimulation with Gonadotropin/ GnRH-antagonist protocol in PCOS patients is associated with a higher number of 2PN eggs, a higher number of morphologically good embryos, and similar clinical pregnancy rates compared to a Gonadotropin/GnRH-agonist protocol. TABLE 1.
Cycles BMI OCP Days Total FSH Total hMG Stimulation Days Follicles >12 mm E2pg/mL P4 ng/mL LHmIU/mL # Oocytes 2PN Day 3 good embryos ET Embryos Cryo ancellation Cycles Pregnancy/Cycle Pregnancy/ET
GnRH-agonist
GnRH-antagonist
720 31.1 3.9 26.0 18.8 2796 1396 73 610 9.9 0.1 10.9 8.3 2115 1229 0.58 2.3 0.80 1.2 12.0 6.6 7.1 4.8 1.5 2.1 1.7 0.8 1.2 3.2 75/720 (10%) 34/720 (47%) 34/605 (56%
48 33.4 4.1 23.8 9.9 2557 1594 559 788 10.3 0.4 11.3 8.9 1521 175 0.75 0.6 0.951.1 13.8 9.8 8.6 5.9 2.3 3.1 1.8 0.9 2.0 3.1 8/48 (17%) 18/48 (37%) 18/40 (45%)
P value 0.5 0.2 0/2 0/0002 0.4 0.7 0.001 0.6 0.4 0.06 0.03 0.02 0.8 0.9 0.2 0.4
Supported by: None.
Vol. 90, Suppl 1, September 2008