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Effectiveness of Using Estradiol-GnRH Antagonist Protocol with Unsuccessful Oral Contraceptive Pill-GnRH Antagonist Protocol Cases (full term pregnancies had not resulted) in In-Vitro Fertilization (IVF) Cycles
number of embryos transferred were significantly higher in the estradiol cycles (mean number of oocytes retrieved : 4.9⫾3.6 vs 6.5⫾3.8, p⬍0.05, two pronuclei rate : 44.8% vs 59.2%, p⬍0.01, mean number of embryos transferred: 1.7⫾0.6 vs 2.2⫾0.7, p⬍0.01). The endometrial thickness at embryo transfer was pill cycle 11.8⫾2.2, and estradiol cycle 11.6⫾1.9. No statistical differences were noted between the two cycles. The clinical pregnancy rate (FHM) was significantly higher for the estradiol cycle compared to the pill cycle (Pregnancy rate: 0% vs 29.2%, p⬍0.01). CONCLUSION: Instead of using oral contraceptive pills, using estradiol from the middle of the luteal phase made the number of oocytes picked up and the fertilization rate increase, and an adequate pregnancy rate was obtained for poor responders whose medical treatment is difficult. It was thought that it is necessary to select an ovarian stimulation protocol carefully to obtain a good pregnancy rate from the first cycle of IVF. Controlled randomized studies with larger sample sizes may serve to confirm these results. Supported by: None
Monday, October 17, 2005 6:00 p.m. O-109 condition does not possibly necessitate addition of exogenous LH activity of either rLH or low-dose rHCG in microdose cycles. Supported by: None
Monday, October 17, 2005 5:45 p.m. O-108 Effectiveness of Using Estradiol-GnRH Antagonist Protocol with Unsuccessful Oral Contraceptive Pill-GnRH Antagonist Protocol Cases (full term pregnancies had not resulted) in In-Vitro Fertilization (IVF) Cycles. A. Yoshida, M. Kakinuma, T. Matsuba, K. Seida, H. Suzuki, M. Tanaka. Kiba Park Clinic, Tokyo, Japan. OBJECTIVE: Ovarian stimulation protocols that uses GnRH antagonist have various methods such as not using any medication in the prior cycle, a method including taking oral contraceptive pills from day 3 of menstruation in the prior cycle, a method with estradiol from the middle of the luteal phase in the prior cycle, and so on. The purpose of using oral contraceptive pills and estradiol is to reduce the unevenness of the sizes of the antral follicle just before ovarian stimulation so that oocyte pick-up can be carried out with follicles that are nearly the same sizes. However, oral contraceptive pills sometimes increase the proportion of oocyte pick-up cancellations or reduce the numbers of oocytes picked up due to low ovarian reaction when the pills are used for poor responders. In this examination, we considered the effectiveness in cases of carrying out GnRH antagonist protocol through using estradiol in the cycle prior to ovarian stimulation in cases that had not achieved good results even when GnRH antagonist protocol was carried out while using oral contraceptive pills in the cycle prior to ovarian stimulation. DESIGN: Retrospective evaluation using the patient’s previous IVF stimulation attempts as a historical control. MATERIALS AND METHODS: The subjects were 48 cases on whom IVF was carried out (96 cycles: 48 cycles with oral contraceptive pill-GnRH antagonist protocol and 48 cycles with estradiol-GnRH antagonist protocol). All the cases had been unsuccessful even though the antagonist protocol using oral contraceptive pill had been carried out (full term pregnancies had not resulted). Regarding the ovulation induction method, an oral contraceptive pill was used for between 7 and 14 days from day 3 of menstruation in the cycle prior to extracting the eggs. In contrast, two tablets of estradiol were taken per day from the middle of the luteal phase in the prior cycle until day 2 of menstruation in the cycle of ovarian stimulation. RESULTS: No statistical differences were noted between the two cycles for the mean age (pill cycle 37.1⫾2.8 vs estradiol cycle 37.5⫾2.8). The mean FSH levels were significant lower in the estradiol cycle (11.6⫾4.3 vs 3.6⫾2.0, p⬍0.01). No statistical differences were noted between the two cycles for the total antral follicle number (5.4⫾2.7 vs 5.0⫾3.1). However, the mean number of oocytes retrieved, the two pronuclei rates and the mean
FERTILITY & STERILITY威
Oral Contraceptive (OC) Pre-treatment Does not Influence Oocyte Yield in Poor Responders Undergoing Gonadotropin Releasing Hormone (GnRH) Antagonist Cycles for In Vitro Fertilization (IVF). J. K. Min, P. Claman. University of Ottawa, Ottawa, ON, Canada. OBJECTIVE: Concern exists over the potential suppressive effects of OC’s in poor responders undergoing controlled ovarian stimulation for IVF⫾ICSI. However, studies examining outcomes of OC pre-treatment are limited, particularly in GnRH antagonist cycles. The aim of this study is to ascertain the impact of OC pre-treatment in poor responders undergoing GnRH antagonist IVF cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All GnRH antagonist (Ganirelix acetate, Organon Canada) IVF cycles initiated in poor responders at the University of Ottawa IVF program between January 1, 2003 and December 31, 2004 were identified for analysis. Criteria for poor response were prior cancelled IVF cycles for insufficient stimulation (⬍3 follicles), previous poor oocyte yield (ⱕ3 oocytes retrieved) or poor ovarian reserve testing (basal FSH ⱖ10 IU/l or antral follicle count ⬍7). Mean duration of OC pre-treatment was 18 days (range: 11 to 28). Recombinant FSH (300-450 IU/day) was initiated two to four days following onset of spontaneous menses or four to five days after the last tablet of a low-dose OC. Ganirelix acetate, 0.25 mg/day was started when the lead follicle reached 12 mm in diameter or when estradiol was ⱖ1000 pmol/L. Human menopausal gonadotropins, one 75 IU ampule per day was added with the initiation of the GnRH antagonist. Highly purified hCG 10,000 IU sc was administered when the lead follicle was ⱖ18 mm in diameter and half the cohort was above 15 mm. Oocyte retrieval was conducted 36 hours later. Embryo transfer was performed on day three (if ⬍5 fertilized oocytes on day 1 or ⬍4 viable embryos on day 2) or five following oocyte retrieval. Cycles with and without OC pre-treatment were compared with respect to: cancellation rates, gonadotropin requirements, mature oocytes at retrieval, fertilization rates, and clinical pregnancy and implantation rates. Continuous data were analyzed using t-tests and Mann-Whitney Rank Sum tests where appropriate. Categorical data were analyzed using Chi-square and Fisher Exact tests. RESULTS: A total of 105 cycles in 88 women were identified for analysis. Fifty-three cycles with and 52 cycles without OC pre-treatment were compared. The groups were similar in baseline characteristics including infertility diagnosis, age, basal FSH and antral follicle count. There were no significant differences in the number of mature (4.2 versus 3.7 oocytes, p⫽0.41) or fertilized (2.6 versus 2.8, p⫽0.59) oocytes retrieved with and without OC pre-treatment. Cancelled retrievals [9.4% (5/53) versus 5.8% (3/52), p⫽0.72] and cancelled embryo transfers [10.4% (5/48) versus 18.4 (9/49), p⫽0.39] were also similar with and without OC. Clinical pregnancy rates per cycle initiated [30.2% (16/53) versus 26.9% (14/52), p⫽0.83] and implantation rates [20.8% (15/72) versus 20.5% (16/78), p⫽0.96] were also not significantly different with and without OC pre-treatment. A sub-group analysis of 65 cycles in women with prior cycle cancellation or poor oocyte yield demonstrated similar finding. CONCLUSION: OC pre-treatment in poor responders undergoing GnRH
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Monday, October 17, 2005 6:00 p.m. O-109 condition does not possibly necessitate addition of exogenous LH activity of either rLH or low-dose rHCG in microdose cycles. Supported by: None
Monday, October 17, 2005 5:45 p.m. O-108 Effectiveness of Using Estradiol-GnRH Antagonist Protocol with Unsuccessful Oral Contraceptive Pill-GnRH Antagonist Protocol Cases (full term pregnancies had not resulted) in In-Vitro Fertilization (IVF) Cycles. A. Yoshida, M. Kakinuma, T. Matsuba, K. Seida, H. Suzuki, M. Tanaka. Kiba Park Clinic, Tokyo, Japan. OBJECTIVE: Ovarian stimulation protocols that uses GnRH antagonist have various methods such as not using any medication in the prior cycle, a method including taking oral contraceptive pills from day 3 of menstruation in the prior cycle, a method with estradiol from the middle of the luteal phase in the prior cycle, and so on. The purpose of using oral contraceptive pills and estradiol is to reduce the unevenness of the sizes of the antral follicle just before ovarian stimulation so that oocyte pick-up can be carried out with follicles that are nearly the same sizes. However, oral contraceptive pills sometimes increase the proportion of oocyte pick-up cancellations or reduce the numbers of oocytes picked up due to low ovarian reaction when the pills are used for poor responders. In this examination, we considered the effectiveness in cases of carrying out GnRH antagonist protocol through using estradiol in the cycle prior to ovarian stimulation in cases that had not achieved good results even when GnRH antagonist protocol was carried out while using oral contraceptive pills in the cycle prior to ovarian stimulation. DESIGN: Retrospective evaluation using the patient’s previous IVF stimulation attempts as a historical control. MATERIALS AND METHODS: The subjects were 48 cases on whom IVF was carried out (96 cycles: 48 cycles with oral contraceptive pill-GnRH antagonist protocol and 48 cycles with estradiol-GnRH antagonist protocol). All the cases had been unsuccessful even though the antagonist protocol using oral contraceptive pill had been carried out (full term pregnancies had not resulted). Regarding the ovulation induction method, an oral contraceptive pill was used for between 7 and 14 days from day 3 of menstruation in the cycle prior to extracting the eggs. In contrast, two tablets of estradiol were taken per day from the middle of the luteal phase in the prior cycle until day 2 of menstruation in the cycle of ovarian stimulation. RESULTS: No statistical differences were noted between the two cycles for the mean age (pill cycle 37.1⫾2.8 vs estradiol cycle 37.5⫾2.8). The mean FSH levels were significant lower in the estradiol cycle (11.6⫾4.3 vs 3.6⫾2.0, p⬍0.01). No statistical differences were noted between the two cycles for the total antral follicle number (5.4⫾2.7 vs 5.0⫾3.1). However, the mean number of oocytes retrieved, the two pronuclei rates and the mean
FERTILITY & STERILITY威
Oral Contraceptive (OC) Pre-treatment Does not Influence Oocyte Yield in Poor Responders Undergoing Gonadotropin Releasing Hormone (GnRH) Antagonist Cycles for In Vitro Fertilization (IVF). J. K. Min, P. Claman. University of Ottawa, Ottawa, ON, Canada. OBJECTIVE: Concern exists over the potential suppressive effects of OC’s in poor responders undergoing controlled ovarian stimulation for IVF⫾ICSI. However, studies examining outcomes of OC pre-treatment are limited, particularly in GnRH antagonist cycles. The aim of this study is to ascertain the impact of OC pre-treatment in poor responders undergoing GnRH antagonist IVF cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All GnRH antagonist (Ganirelix acetate, Organon Canada) IVF cycles initiated in poor responders at the University of Ottawa IVF program between January 1, 2003 and December 31, 2004 were identified for analysis. Criteria for poor response were prior cancelled IVF cycles for insufficient stimulation (⬍3 follicles), previous poor oocyte yield (ⱕ3 oocytes retrieved) or poor ovarian reserve testing (basal FSH ⱖ10 IU/l or antral follicle count ⬍7). Mean duration of OC pre-treatment was 18 days (range: 11 to 28). Recombinant FSH (300-450 IU/day) was initiated two to four days following onset of spontaneous menses or four to five days after the last tablet of a low-dose OC. Ganirelix acetate, 0.25 mg/day was started when the lead follicle reached 12 mm in diameter or when estradiol was ⱖ1000 pmol/L. Human menopausal gonadotropins, one 75 IU ampule per day was added with the initiation of the GnRH antagonist. Highly purified hCG 10,000 IU sc was administered when the lead follicle was ⱖ18 mm in diameter and half the cohort was above 15 mm. Oocyte retrieval was conducted 36 hours later. Embryo transfer was performed on day three (if ⬍5 fertilized oocytes on day 1 or ⬍4 viable embryos on day 2) or five following oocyte retrieval. Cycles with and without OC pre-treatment were compared with respect to: cancellation rates, gonadotropin requirements, mature oocytes at retrieval, fertilization rates, and clinical pregnancy and implantation rates. Continuous data were analyzed using t-tests and Mann-Whitney Rank Sum tests where appropriate. Categorical data were analyzed using Chi-square and Fisher Exact tests. RESULTS: A total of 105 cycles in 88 women were identified for analysis. Fifty-three cycles with and 52 cycles without OC pre-treatment were compared. The groups were similar in baseline characteristics including infertility diagnosis, age, basal FSH and antral follicle count. There were no significant differences in the number of mature (4.2 versus 3.7 oocytes, p⫽0.41) or fertilized (2.6 versus 2.8, p⫽0.59) oocytes retrieved with and without OC pre-treatment. Cancelled retrievals [9.4% (5/53) versus 5.8% (3/52), p⫽0.72] and cancelled embryo transfers [10.4% (5/48) versus 18.4 (9/49), p⫽0.39] were also similar with and without OC. Clinical pregnancy rates per cycle initiated [30.2% (16/53) versus 26.9% (14/52), p⫽0.83] and implantation rates [20.8% (15/72) versus 20.5% (16/78), p⫽0.96] were also not significantly different with and without OC pre-treatment. A sub-group analysis of 65 cycles in women with prior cycle cancellation or poor oocyte yield demonstrated similar finding. CONCLUSION: OC pre-treatment in poor responders undergoing GnRH
S45