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Does the Addition of Letrozole in a GnRH Antagonist Protocol Offer Any Benefit in Low Response?
least 2 follicles were ⱖ17mm in mean diameter; oocyte retrieval was performed ⬃36 h later. Cycles were compared for duration of stimulation and of GnRH-ant administration (when indicated); estradiol (E2) level (pg/mL) on day of hCG administration; number of 75IU ampoules used, of oocytes retrieved, and of 2-pronuclei embryos (2-PN) embryos created; and the E2/oocyte retrieved. Patients were categorized by type of stimulation cycle. Statistical significance (P⬍0.05) was determined by paired t-test, Wilcoxon Signed Rank Test, Fisher’s Exact Test and 2 test using SigmaStat©. RESULTS: The duration between cycles (mean days⫾SE) was: long protocol (336⫾126, range 128-689), microdose flare (307⫾76, range 57-1061), and GnRH-ant (186⫾25, range 30-742.) Although live birth rates were not significantly different for the long protocol (1/4 vs. 1/4, P⫽1.00) or microdose protocol (1/17 vs. 5/17, P⫽0.18), the live birth rate was significantly higher when 600IU was given with the GnRH-ant protocol (2/40 vs. 9/40, P⬍0.05).
CONCLUSION: There was a statistically significant difference in the number of oocytes retrieved and 2-PN embryos in the GnRH-ant cycles, and although small, they were clinically significant, since there was also a resulting significant difference in live births. Although no statistical difference was observed for the other protocols, this is likely to be related to the small sample size. Therefore, increasing the dosage of gonadotropins from 450IU to 600IU can increase the number of live births in patients who are low responders. Supported by: None.
P-484 Short Versus Long Gonadotropin Releasing Hormone Analogue Suppression Protocols for Superovulation in Intra Cytoplasm Sperm Injection Patients > 40 Years. M. Sbracia, A. Farina, R. Poverini, F. Morgia, M. Schimberni. CERM, Rome, Italy; BInstitute of Histology and Medical Embryology University of Bologna, Bologna, Italy; Bioroma, Rome, Italy. OBJECTIVE: The following study was conducted to determine in older patients which protocols of GnRH agonist suppression work better, long protocol or short protocol. DESIGN: We conducted a controlled randomized study in a single private IVF centre. MATERIALS AND METHODS: 220 women more than 39 years old undergoing IVF in our private Centre were selected for this study. The women, at their first IVF cycle, were randomized into two study groups using a computer generated number sequence: 110 cases were treated with a long protocol and 110 patients were treated with a short protocol for controlled ovarian hyperstimulation. The main outcome measure were: days of stimulation, E2 at the day of hCG, amount of FSH administered, number of oocytes collected, number of embryos obtained, pregnancy rate, implantation rate. RESULTS: Patients treated with a long protocol showed a significantly higher number of oocytes retrieved, number of embryos obtained and a higher pregnancy rate both for cycle and transfer with respect to the short
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protocol patients. The other parameter evaluated did not show any statistically significant differences. CONCLUSION: Our study showed that the long protocol performed better in older women than the short protocol. Our findings evidenced that the flare-up in older women may be detrimental. Supported by: None
P-485 Does the Addition of Letrozole in a GnRH Antagonist Protocol Offer Any Benefit in Low Response? A. Guille´n, A. Pacheco, A. Midsuf, S. Rabada´n, A. Requena, J. A. Garcı´a Velasco. Instituto Valenciano de Infertilidad, Madrid, Spain. OBJECTIVE: Low ovarian response in IVF is a major concern to the clinician. Letrozole, by increasing intraovarian androgens may enhance the expression of FSH receptor and thus, improve the ovarian response in COH. We evaluated the use of aromatase inhibitor, letrozole, as adjuvant treatment with a GnRH antagonist protocol in IVF patients with a previous long protocol canelled due to low response. DESIGN: The regimen started on day 2 of the cycle with 225 IU rFSH plus 150 IU hMG, and letrozole 2.5 mg/day during the first five days of stimulation. Daily antagonist was introduced when leading follicle reached 14 mm. MATERIALS AND METHODS: Sixty-seven IVF patients with a previous long protocol cancelled due to low response were included in this retrospective study in 2004. Patients were selected irrespective basal FSH and age, and stratified accordingly. RESULTS: According to age, 18 patients were under 34 years (31.4⫾1.97; FSH 10.57⫾5.78), 34 patients between 34-39 (36.73⫾1.97; FSH 9.54⫾3.96), 8 patients between 40-41 (40.37⫾0.51; FSH 11.98⫾4.8), and finally 7 patients were ⱖ42 (42.57⫾1.13;FSH 7.2⫾3.42). Respectively, cancellation rate due to no ovarian response or no embyo transfer was 44.4%, 29.4%, 75% and 57.1%; the number of retrieved oocytes were 5.7, 5.3, 6.0 and 6.3; and implantation/pregnancy rate 29.4/30%, 28.8/34.7%, 0/0% and 16.6/33.3%. According to FSH level, data were obtained for 64 patients. 36 patients had a basal FSH ⱕ10 ( FSH 6.76⫾2.02; Age 36.86⫾3.79), 11 patients had FSH between 10-12 (FSH 10.83⫾0.84, Age 34.9⫾3.36), and 17 patients had a basal FSH ⬎12 (FSH 15.94⫾3.68, Age 36.29⫾4.08). Respectively, cancellation rate due to no ovarian response or no embyo transfer was 33%,27.2% and 52.9%; the number of retrieved oocytes were 5.5, 5.6, and 5.1; and implantation/pregnancy rate 20.9/31.8%, 37.5/50% and 23.0/42.8%. CONCLUSION: Adding 2.5 mg of letrozole to high dose rFSH/hMG antagonist protocol offers an attractive alternative to patients with a previous cancelled IVF cycle due to low response. Age seems to be a more accurate predictive factor to low responders in pre-treatment counselling. Supported by: None
P-486 The Effect of the Length of the Follicular Phase on Pregnancy Outcome Following Single Embryo Transfer (ET) in Hypergonadotropic Women. B. Katsoff, A. Nazari, J. H. Check, C. Wilson, J. K. Choe, J. W. Krotec. UMDNJ, Robert Wood Johnson Med. School, Marlton, NJ. OBJECTIVE: Though women undergoing in vitro fertilization-embryo transfer (IVF-ET) with elevated day 3 serum FSH do not have a good pregnancy outcome following traditional controlled ovarian hyperstimulation (COH), they seem to do much better with minimal or no gonadotropin stimulation despite single ET. The aim of the present study was to determine the effect of the length of the follicular phase on pregnancy outcome in this group. DESIGN: Retrospective review. MATERIALS AND METHODS: A 7 year retrospective review was conducted on women with decreased egg reserve as manifested by elevated day 3 serum follicle stimulating hormone (FSH) levels, a decreased antral follicle count by sonography, and usually a previous history of poor response to gonadotropin stimulation. Oocyte retrievals were performed without any or with minimal stimulation with gonadotropins (maximum 600 IU per cycle). Only women aged ⱕ39 were included. The clinical (ultrasound
Vol. 84, Suppl 1, September 2005
CONCLUSION: There was a statistically significant difference in the number of oocytes retrieved and 2-PN embryos in the GnRH-ant cycles, and although small, they were clinically significant, since there was also a resulting significant difference in live births. Although no statistical difference was observed for the other protocols, this is likely to be related to the small sample size. Therefore, increasing the dosage of gonadotropins from 450IU to 600IU can increase the number of live births in patients who are low responders. Supported by: None.
P-484 Short Versus Long Gonadotropin Releasing Hormone Analogue Suppression Protocols for Superovulation in Intra Cytoplasm Sperm Injection Patients > 40 Years. M. Sbracia, A. Farina, R. Poverini, F. Morgia, M. Schimberni. CERM, Rome, Italy; BInstitute of Histology and Medical Embryology University of Bologna, Bologna, Italy; Bioroma, Rome, Italy. OBJECTIVE: The following study was conducted to determine in older patients which protocols of GnRH agonist suppression work better, long protocol or short protocol. DESIGN: We conducted a controlled randomized study in a single private IVF centre. MATERIALS AND METHODS: 220 women more than 39 years old undergoing IVF in our private Centre were selected for this study. The women, at their first IVF cycle, were randomized into two study groups using a computer generated number sequence: 110 cases were treated with a long protocol and 110 patients were treated with a short protocol for controlled ovarian hyperstimulation. The main outcome measure were: days of stimulation, E2 at the day of hCG, amount of FSH administered, number of oocytes collected, number of embryos obtained, pregnancy rate, implantation rate. RESULTS: Patients treated with a long protocol showed a significantly higher number of oocytes retrieved, number of embryos obtained and a higher pregnancy rate both for cycle and transfer with respect to the short
S326
Abstracts
protocol patients. The other parameter evaluated did not show any statistically significant differences. CONCLUSION: Our study showed that the long protocol performed better in older women than the short protocol. Our findings evidenced that the flare-up in older women may be detrimental. Supported by: None
P-485 Does the Addition of Letrozole in a GnRH Antagonist Protocol Offer Any Benefit in Low Response? A. Guille´n, A. Pacheco, A. Midsuf, S. Rabada´n, A. Requena, J. A. Garcı´a Velasco. Instituto Valenciano de Infertilidad, Madrid, Spain. OBJECTIVE: Low ovarian response in IVF is a major concern to the clinician. Letrozole, by increasing intraovarian androgens may enhance the expression of FSH receptor and thus, improve the ovarian response in COH. We evaluated the use of aromatase inhibitor, letrozole, as adjuvant treatment with a GnRH antagonist protocol in IVF patients with a previous long protocol canelled due to low response. DESIGN: The regimen started on day 2 of the cycle with 225 IU rFSH plus 150 IU hMG, and letrozole 2.5 mg/day during the first five days of stimulation. Daily antagonist was introduced when leading follicle reached 14 mm. MATERIALS AND METHODS: Sixty-seven IVF patients with a previous long protocol cancelled due to low response were included in this retrospective study in 2004. Patients were selected irrespective basal FSH and age, and stratified accordingly. RESULTS: According to age, 18 patients were under 34 years (31.4⫾1.97; FSH 10.57⫾5.78), 34 patients between 34-39 (36.73⫾1.97; FSH 9.54⫾3.96), 8 patients between 40-41 (40.37⫾0.51; FSH 11.98⫾4.8), and finally 7 patients were ⱖ42 (42.57⫾1.13;FSH 7.2⫾3.42). Respectively, cancellation rate due to no ovarian response or no embyo transfer was 44.4%, 29.4%, 75% and 57.1%; the number of retrieved oocytes were 5.7, 5.3, 6.0 and 6.3; and implantation/pregnancy rate 29.4/30%, 28.8/34.7%, 0/0% and 16.6/33.3%. According to FSH level, data were obtained for 64 patients. 36 patients had a basal FSH ⱕ10 ( FSH 6.76⫾2.02; Age 36.86⫾3.79), 11 patients had FSH between 10-12 (FSH 10.83⫾0.84, Age 34.9⫾3.36), and 17 patients had a basal FSH ⬎12 (FSH 15.94⫾3.68, Age 36.29⫾4.08). Respectively, cancellation rate due to no ovarian response or no embyo transfer was 33%,27.2% and 52.9%; the number of retrieved oocytes were 5.5, 5.6, and 5.1; and implantation/pregnancy rate 20.9/31.8%, 37.5/50% and 23.0/42.8%. CONCLUSION: Adding 2.5 mg of letrozole to high dose rFSH/hMG antagonist protocol offers an attractive alternative to patients with a previous cancelled IVF cycle due to low response. Age seems to be a more accurate predictive factor to low responders in pre-treatment counselling. Supported by: None
P-486 The Effect of the Length of the Follicular Phase on Pregnancy Outcome Following Single Embryo Transfer (ET) in Hypergonadotropic Women. B. Katsoff, A. Nazari, J. H. Check, C. Wilson, J. K. Choe, J. W. Krotec. UMDNJ, Robert Wood Johnson Med. School, Marlton, NJ. OBJECTIVE: Though women undergoing in vitro fertilization-embryo transfer (IVF-ET) with elevated day 3 serum FSH do not have a good pregnancy outcome following traditional controlled ovarian hyperstimulation (COH), they seem to do much better with minimal or no gonadotropin stimulation despite single ET. The aim of the present study was to determine the effect of the length of the follicular phase on pregnancy outcome in this group. DESIGN: Retrospective review. MATERIALS AND METHODS: A 7 year retrospective review was conducted on women with decreased egg reserve as manifested by elevated day 3 serum follicle stimulating hormone (FSH) levels, a decreased antral follicle count by sonography, and usually a previous history of poor response to gonadotropin stimulation. Oocyte retrievals were performed without any or with minimal stimulation with gonadotropins (maximum 600 IU per cycle). Only women aged ⱕ39 were included. The clinical (ultrasound
Vol. 84, Suppl 1, September 2005