Diminished ovarian reserve is not independently associated with clinical reproductive loss in pregnancies achieved by assisted reproductive technologies (ART)

embryos, also contributing to lower BW and gestational age (P < 0.05). No significant difference was noted in the methylation status of H19, PEG1, and KvDMR1 among different conception methods (IVF, ICSI and natural conception groups) (P > 0.05). Boxplot analysis indicated that two IVF-conceived babies showed aberrant hypermethylation patterns of H19 gene (65.2% methylation and 75.0% methylation, respectively); two ICSI-conceived babies (from sibling twins) showed aberrant hypomethylation patterns of KvDMR1 (5.4% methylation and 4.5% methylation, respectively), and their father was infertile due to severe oligozoospermia. CONCLUSION: Abnormal methylation patterns were detected in normal phenotype babies conceived by ART, which may due to imprinting errors in sperm/oocytes cells or as a result of in vitro embryo culture. Further investigation to determine whether the imprinted gene expression can be regulated by other mechanisms in addition to DNA methylation would be beneficial. Supported by: The National Key Basic Research Development Plan of China (973 Program) (2007CB948104). P-241 Tuesday, October 18, 2011 DIMINISHED OVARIAN RESERVE IS NOT INDEPENDENTLY ASSOCIATED WITH CLINICAL REPRODUCTIVE LOSS IN PREGNANCIES ACHIEVED BY ASSISTED REPRODUCTIVE TECHNOLOGIES (ART). K. S. Moon, K. S. Richter, A. U. Emarievbe, J. H. Segars, E. A. Widra. Program in Reproductive and Adult Endocrinology, The Eunice Kennedy Shriver National Institute for Child Health and Human Development, NIH, Bethesda, MD; Shady Grove Fertility Reproductive Science Center, Rockville, MD; Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC. OBJECTIVE: Prior studies have suggested that women with diminished ovarian reserve (DOR) are at higher risk for reproductive loss, independent of age. These studies, however, did not distinguish very early losses from losses after clinical detection of an intrauterine pregnancy (IUP). Here we examined the rate of reproductive loss after sonographic identification of an IUP in a cohort of women with DOR compared to women with normal ovarian reserve undergoing ART. DESIGN: Retrospective cohort. MATERIALS AND METHODS: The study cohort consisted of all fresh autologous ART cycles that resulted in a first singleton clinical IUP (sonographic identification of a single gestational sac at approximately 6-7 weeks gestational age) from Jan-Dec 2009 at a single fertility practice, verified by chart review. DOR was defined by basal serum FSH R14 IU/L. Patients were excluded if no FSH level was measured within one year of the cycle analyzed or if the patient had only one ovary. Patients were grouped by FSH <8, 813.9, or R14 IU/L. RESULTS: 851 subjects met the inclusion criteria. Live birth rates did not differ among FSH groups (P¼0.53, X2), but women in the elevated FSH groups were significantly older (P<0.0001, ANOVA). In a multiple logistic regression model including both age and FSH, age was positively and highly significantly correlated with SAb (b ¼ 0.099, P<0.0001), while FSH was non-significantly correlated with SAb (b ¼ -0.006, P¼0.85). FSH (IU/L) # OF SUBJECTS AGE (YEARS) CLINICAL PREGNANCY LOSS

<8

8-13.9

R14

605 33.5 24.3%

221 35.0 28%

25 35.6 28.%

CONCLUSION: After adjusting for age, there was no relationship between basal serum FSH concentration and pregnancy loss greater than 6-7 weeks gestational age in women achieving IUP through ART. The higher pregnancy loss rates previously reported in women with DOR may be due to loss prior to 6-7 weeks gestational age. Supported by: This research was supported, in part, by the NIH Intramural Program in Reproductive and Adult Endocrinology, NICHD. P-242 Tuesday, October 18, 2011 A THICKENED ENDOMETRIAL STRIPE ON DAY 2 OF ANTAGONIST PROTOCOLS DOES NOT AFFECT IVF OUTCOMES. E. Mok-Lin, A. Aelion Brauer, O. Davis. Center for Reproductive Medicine and Infertility, Weill Cornell Medical College, New York, NY. OBJECTIVE: It has been shown that a thickened baseline endometrial stripe (ES) in GnRH agonist down-regulated IVF cycles results in lower preg-

S178

Abstracts

nancy rates. The significance of a thickened ES on day 2 of antagonist protocols has not yet been reported. The objective is to compare IVF outcomes in women with a thickened ES on day 2 to those with ES %5mm. DESIGN: Retrospective study. MATERIALS AND METHODS: Patients who underwent antagonist IVF cycles without OCP or E2 patch priming between 1/1/06-12/31/10 were identified. Patients with a delayed start date, progesterone >1ng/ml or ovarian cysts were excluded. COH with FSH and hMG was performed in a standard protocol. HCG was administered when there were at least 2 follicles R17mm and retrieval was performed 35 hours later. The main outcome measures were pregnancy, ongoing/delivered and failed pregnancy rates. Other outcomes included: peak E2 level, units of gonadotropins, number of oocytes retrieved, number of embryos transferred, and implantation rate. Statistical analyses included Student’s t-test, c2 and one-way ANOVA tests. P<0.05 was deemed statistically significant. RESULTS: 1545 IVF cycles met criteria; 985 cycles had a baseline ES % 5mm (mean 3.8, range 0.7-5mm) and 560 cycles had an ES >5mm (mean 6.6, range 5.1-14.3mm). Baseline characteristics were similar between the groups and there were no differences in implantation or pregnancy rates. Further analysis comparing cycles started with ES %5mm, 5-7mm, 7-9mm and >9mm also showed no differences in cycle or pregnancy outcomes. Cycle and pregnancy outcomes ES%5mm ES 5-7mm ES 7-9mm ES>9mm (n ¼ 985) (n ¼ 405) (n ¼ 111) (n ¼ 44) p-value Mean # oocytes retrieved Mean # embryos transferred % Implantation % +BHCG % Ongoing/delivered

10.2 3.2 17.4 44.2 24.4

9.6 3.0 16.2 44.9 25.8

10.1 3.2 19.3 49.4 31.5

10.7 3.0 17.1 44.4 33.3

0.28 0.41 0.81 0.82 0.34

CONCLUSION: A thickened ES on day 2 of antagonist cycles does not affect IVF outcomes. These patients should begin COH on day 2 without a need for delay. P-243 Tuesday, October 18, 2011 EFFICACY OF NUVARING VERSUS ORAL CONTRACEPTIVE PILLS (OCP) IN ACHIEVING HYPOTHALAMIC-PITUITARYOVARIAN (HPO) AXIS SUPPRESSION IN EGG DONOR IN VITRO FERTILIZATION (IVF) CYCLES. R. L. Thomas, L. M. Halvorson, B. R. Carr, K. M. Doody, K. J. Doody. Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, TX. OBJECTIVE: Successful donor egg IVF depends on effective suppression of the HPO axis to allow cycle synchronization of donors and recipients. Daily self-administration of OCPs is often used to facilitate cycle programming and scheduling. This approach may be hampered by lack of patient compliance. NuvaRing, a three week sustained release estrogen-progestin vaginal ring, may be placed after onset of menses by physician or nursing personnel. The objective of our study was to compare NuvaRing to OCPs for HPO axis suppression in egg donor cycles. DESIGN: Retrospective study of egg donation cycles from the Center for Assisted Reproduction (CARE). MATERIALS AND METHODS: Inclusion criteria were first cycles for egg donors participating in GnRH antagonist protocol IVF between 2004 and 2009 (n ¼ 64). All patients underwent ultrasonographic and laboratory evaluation at CARE. OCPs or NuvaRing were continued until the day prior to gonadotropin initiation. Data was collected from electronic medical records. Blood samples drawn prior to gonadotropin initiation were analyzed for serum FSH and LH levels. RESULTS: 25 women were treated with OCPs and 39 women received NuvaRing. Prior to gonadotropin initiation, the endometrial thickness and serum estradiol were 5.61 +/- 2.62 mm and 33.64 +/- 19.85 pg/mL in the OCP group and 5.95 +/- 2.42 mm and 36.57 +/- 24.25 pg/mL in the NuvaRing group, respectively (P¼0.60 and P¼0.62). Average serum FSH and LH were 1.70 +/- 1.92 and 1.66 +/- 2.48 mIU/mL in the OCP group and 1.70 +/- 1.62 and 1.15 +/- 1.41 mIU/mL in the NuvaRing group, respectively (P¼0.99 and P¼0.30). No significant differences were found for gonadotropin requirement, peak estradiol, maximal endometrial thickness, number of oocytes retrieved, or number of normally fertilized embryos. CONCLUSION: NuvaRing is effective for HPO axis suppression in donor egg IVF cycles and associated with cycle characteristics similar to those observed with OCP treatment. NuvaRing may provide an important advantage over OCPs due to improved patient compliance.

Vol. 96., No. 3, Supplement, September 2011