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Effects of dehydroepiandrosterone (DHEA) in women with diminished ovarian reserve (DOR) on functional ovarian reserve in 3 consecutive IVF cycles, as assessed by oocyte yields and pregnancy rates
RESULTS: For all ages and for normal and poor responders combined the clinical PR/transfer was 33.4% (248/743) for women receiving all FSH for COH vs. 39.7% (423/1066) when LH was added (P¼.007). The viable PRs were 28.3% vs. 35.5% (P¼0.0016) and the live delivered PRs were 25.8% vs. 32.3% (P¼0.0038). Evaluating separately the poor responders, the clinical, viable, and live delivered PRs for the all FSH group was 25.5% (103/404), 20.5% (83/404), and 17.8% (72/404) vs. 26.4% (60/ 227), 22.5% (51/227), and 20.3% (16/227) for LH/FSH group (chi-square analysis, P¼NS). CONCLUSION: Addition of LH to FSH improves pregnancy rates in normal responders using a traditional high dose FSH COH protocol with a GnRH antagonist. Using mild stimulation for women with diminished ovarian reserve adding LH does not seem to matter.
P-527 Wednesday, October 19, 2011 IVF OUTCOMES FOLLOWING GNRH AGONIST FLARE AND GNRH ANTAGONIST STIMULATION PROTOCOLS IN YOUNG LOW RESPONDERS UNDERGOING THEIR FIRST IVF CYCLE. A. N. Imudia, S. T. McLellan, C. Veiga, D. L. Wright, T. L. Toth, A. K. Styer. Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA. OBJECTIVE: To investigate if a specific low responder controlled ovarian hyperstimulation (COH) protocol results in superior pregnancy outcomes in anticipated low responder women of favorable age groups (< 38 yo) during first fresh IVF attempt. DESIGN: Retrospective cohort study in a tertiary academic center. MATERIALS AND METHODS: A total of 1164 consecutive IVF cycles were reviewed from Jan 05 - Dec 10. All 322 initial fresh IVF attempts utilizing low responder protocol [GnRH antagonist (ANT) or GnRH agonist flare (FL)] were reviewed. Low responders were defined by ovarian reserve testing (Basal FSH and AFC) and protocols chosen by the patient’s physician. Patient demographics, IVF cycle characteristics, and pregnancy outcomes of both groups were analyzed using SPSS. RESULTS: Two hundred seventy-two IVF cycles were analyzed according to inclusion criteria [ANT-N ¼ 146 (53.7%); FL-N ¼ 126 (46.3%)] and 85.7% of the cycles went to ET (ANT ¼ 89.7 and FL ¼ 81.0%). Respective demographic characteristics including mean age, BMI, number of prior superovulation/intrauterine inseminations, gravidity, and parity were similar between both groups. The AFC was higher (7.06 2.36 vs. 8.87 3.15, P<0.0001) and day 3 FSH level lower (10.40 3.80 vs. 8.17 2.32, P<0.0001) in the ANT group. After controlling for day 3 AFC and FSH, the ANT group demonstrated a greater ovarian response and produced higher quality embryos compared to FL group. The overall clinical pregnancy and live birth rates in both groups were similar but subanalysis of the patients younger than 36 years old revealed that cycles of ANT group were more likely to result in live birth than the FL group [23 (42.6%), vs.12(22.2%), P¼0.02]. CONCLUSION: When controlling for ovarian reserve testing in women of favorable age prognosis groups, a specific subgroup of women < 36 years of age with anticipated low responder status demonstrated superior ovarian response, embryo cohort quality and pregnancy outcomes with ANT protocol compared to FL during first fresh IVF attempt.
MATERIALS AND METHODS: 70 poor responders women aged 20-42 years, with a history of 1ry or 2ry infertility were included. Poor response was defined by the number of dominant follicles on HCG day and number of mature oocytes <3 or cycle cancellation due to poor ovarian response in a previous cycle. Patients were randomized to receive either clomophene citrate and HP HMG from cd -7 plus GnRH antagonist (mild stimulation group) or GnRH agonist plus HP HMG (standard stimulation group) RESULTS: The clinical pregnancy rate per women randomized was higher in the mild stimulation group (OR: 1.68, 95% CI: 0.40-8.55), however, the difference was not statistically significant. There was an evidence of significant reduction in treatment duration (8.5 2.7 vs.12.5 2.4 day, P<.0001), the gonadotrophin consumption (25.4 8.1vs. 50 4.5, P<.0001) with more than 50% cost reduction of the treatment cycle in favour of the mild stimulation group. The cancellation rate,number of mature follicles, total oocytes obtained and endometrial thickness at day of HCG was comparable between both groups. Although, the number of embryos transferred was significantly higher for the mild stimulation group (2.32 0.58 versus 1.50 0.83, P<.0001), the implantation rates were similar between the two groups. CONCLUSION: Our study demonstrates that mild ovarian stimulation strategy might have a place in the treatment of poor responder women undergoing IVF/ICSI treatment becuse it is likely to be cheaper and is possibly more patient friendly .
P-529 Wednesday, October 19, 2011 EFFECTS OF DEHYDROEPIANDROSTERONE (DHEA) IN WOMEN WITH DIMINISHED OVARIAN RESERVE (DOR) ON FUNCTIONAL OVARIAN RESERVE IN 3 CONSECUTIVE IVF CYCLES, AS ASSESSED BY OOCYTE YIELDS AND PREGNANCY RATES. D. H. Barad, A. Kim. Center for Human Reproduction, New York, NY; Foundation for Reproductive Medicine, New York, NY; Department of Obstetrics, Gynecology and Women’s Health and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: To assess DHEA effects on consecutive IVF cycles in relationship to length of DHEA supplementation. DESIGN: Cohort study. MATERIALS AND METHODS: We identified 141 women on DHEA supplementation because of DOR who had at least 3 consecutive IVF cycles (microdose agonist + 450-600 IU of gonadotropins daily). They were separated into those with % 100 (n ¼ 52, Group 1) and > 100 days (n ¼ 89, Group 2) of supplementation, and further stratified for poor prognosis DOR (AMH % 1.05 ng/mL) and better prognosis patients (AMH > 1.05 ng/mL, Fertil Steril 2010;94:2824-7). RESULTS: The Table summarizes outcomes.
AMH DHEA Oocytes (Mean SD)
IVF
MILD OVARIAN STIMULATION FOR WOMEN WITH POOR OVARIAN RESPONSE UNDERGOING IVF/ICSI TREATMENT CYCLES; RANDOMIZED CONTROLLED STUDY. M. A. F. M. Youssef, I. Khalil, S. Khattab, I. Aboulfotouh, M. van Wely, F. van der Veen. Egyptian International Fertility IVF Center (EIFC-IVF), Cairo, Egypt; Center for Reproductive Medicine (CVV)- Acadmic Medical Center- University of Amsterdam, Amsterdam, Netherlands. OBJECTIVE: To evaluate the efficacy of mild ovarian stimulation strategy, based on the combined administration of oral clomiphene citrate (CC) plus HMG from cycle day 7, and GnRH antagonist administration (fixed protocol) for poor responders elected for ART compared with the outcome of a standard ovarian stimulation strategy. DESIGN: Randomized controlled study, using computer-generated random numbers with concealed opaque envelopes.
FERTILITY & STERILITYÒ
> 1.05 ng/mL
Group 2
#1 #2 #3
% 100 days > 100 days 3.3 3.81,2 5.9 5.6 4.5 4.02,3 6.8 7.1 5.4 5.51,3 6.2 5.7
#1 #2 #3
2.6 3.24 3.9 3.9 4.5 4.9
4.5 4.74 4.6 4.6 4.3 4.1
#1 #2 #3
6.7 4.6 7.4 3.35 9.8 6.1
9.9 6.0 12.7 9.15 11.3 6.4
% 1.05 ng/mL P-528 Wednesday, October 19, 2011
Group 1
P-value 1
0.004 0.047 3 0.085 (N.S.) 2
4
0.017
5
0.021
CONCLUSION: This study, for the first time, demonstrates that DHEA in milder DOR is more effective. Severe DOR reaches maximal effectiveness of DHEA within ca. 100 days, while milder forms continue improvements considerably beyond 100 days. Pregnancy rates remain respectable and stable for at least 3 consecutive IVF cycles. Supported by: The Foundation for Reproductive Medicine and intramural research funds from the Center for Human Reproduction - New York.
S263
P-527 Wednesday, October 19, 2011 IVF OUTCOMES FOLLOWING GNRH AGONIST FLARE AND GNRH ANTAGONIST STIMULATION PROTOCOLS IN YOUNG LOW RESPONDERS UNDERGOING THEIR FIRST IVF CYCLE. A. N. Imudia, S. T. McLellan, C. Veiga, D. L. Wright, T. L. Toth, A. K. Styer. Massachusetts General Hospital Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital/Harvard Medical School, Boston, MA. OBJECTIVE: To investigate if a specific low responder controlled ovarian hyperstimulation (COH) protocol results in superior pregnancy outcomes in anticipated low responder women of favorable age groups (< 38 yo) during first fresh IVF attempt. DESIGN: Retrospective cohort study in a tertiary academic center. MATERIALS AND METHODS: A total of 1164 consecutive IVF cycles were reviewed from Jan 05 - Dec 10. All 322 initial fresh IVF attempts utilizing low responder protocol [GnRH antagonist (ANT) or GnRH agonist flare (FL)] were reviewed. Low responders were defined by ovarian reserve testing (Basal FSH and AFC) and protocols chosen by the patient’s physician. Patient demographics, IVF cycle characteristics, and pregnancy outcomes of both groups were analyzed using SPSS. RESULTS: Two hundred seventy-two IVF cycles were analyzed according to inclusion criteria [ANT-N ¼ 146 (53.7%); FL-N ¼ 126 (46.3%)] and 85.7% of the cycles went to ET (ANT ¼ 89.7 and FL ¼ 81.0%). Respective demographic characteristics including mean age, BMI, number of prior superovulation/intrauterine inseminations, gravidity, and parity were similar between both groups. The AFC was higher (7.06 2.36 vs. 8.87 3.15, P<0.0001) and day 3 FSH level lower (10.40 3.80 vs. 8.17 2.32, P<0.0001) in the ANT group. After controlling for day 3 AFC and FSH, the ANT group demonstrated a greater ovarian response and produced higher quality embryos compared to FL group. The overall clinical pregnancy and live birth rates in both groups were similar but subanalysis of the patients younger than 36 years old revealed that cycles of ANT group were more likely to result in live birth than the FL group [23 (42.6%), vs.12(22.2%), P¼0.02]. CONCLUSION: When controlling for ovarian reserve testing in women of favorable age prognosis groups, a specific subgroup of women < 36 years of age with anticipated low responder status demonstrated superior ovarian response, embryo cohort quality and pregnancy outcomes with ANT protocol compared to FL during first fresh IVF attempt.
MATERIALS AND METHODS: 70 poor responders women aged 20-42 years, with a history of 1ry or 2ry infertility were included. Poor response was defined by the number of dominant follicles on HCG day and number of mature oocytes <3 or cycle cancellation due to poor ovarian response in a previous cycle. Patients were randomized to receive either clomophene citrate and HP HMG from cd -7 plus GnRH antagonist (mild stimulation group) or GnRH agonist plus HP HMG (standard stimulation group) RESULTS: The clinical pregnancy rate per women randomized was higher in the mild stimulation group (OR: 1.68, 95% CI: 0.40-8.55), however, the difference was not statistically significant. There was an evidence of significant reduction in treatment duration (8.5 2.7 vs.12.5 2.4 day, P<.0001), the gonadotrophin consumption (25.4 8.1vs. 50 4.5, P<.0001) with more than 50% cost reduction of the treatment cycle in favour of the mild stimulation group. The cancellation rate,number of mature follicles, total oocytes obtained and endometrial thickness at day of HCG was comparable between both groups. Although, the number of embryos transferred was significantly higher for the mild stimulation group (2.32 0.58 versus 1.50 0.83, P<.0001), the implantation rates were similar between the two groups. CONCLUSION: Our study demonstrates that mild ovarian stimulation strategy might have a place in the treatment of poor responder women undergoing IVF/ICSI treatment becuse it is likely to be cheaper and is possibly more patient friendly .
P-529 Wednesday, October 19, 2011 EFFECTS OF DEHYDROEPIANDROSTERONE (DHEA) IN WOMEN WITH DIMINISHED OVARIAN RESERVE (DOR) ON FUNCTIONAL OVARIAN RESERVE IN 3 CONSECUTIVE IVF CYCLES, AS ASSESSED BY OOCYTE YIELDS AND PREGNANCY RATES. D. H. Barad, A. Kim. Center for Human Reproduction, New York, NY; Foundation for Reproductive Medicine, New York, NY; Department of Obstetrics, Gynecology and Women’s Health and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: To assess DHEA effects on consecutive IVF cycles in relationship to length of DHEA supplementation. DESIGN: Cohort study. MATERIALS AND METHODS: We identified 141 women on DHEA supplementation because of DOR who had at least 3 consecutive IVF cycles (microdose agonist + 450-600 IU of gonadotropins daily). They were separated into those with % 100 (n ¼ 52, Group 1) and > 100 days (n ¼ 89, Group 2) of supplementation, and further stratified for poor prognosis DOR (AMH % 1.05 ng/mL) and better prognosis patients (AMH > 1.05 ng/mL, Fertil Steril 2010;94:2824-7). RESULTS: The Table summarizes outcomes.
AMH DHEA Oocytes (Mean SD)
IVF
MILD OVARIAN STIMULATION FOR WOMEN WITH POOR OVARIAN RESPONSE UNDERGOING IVF/ICSI TREATMENT CYCLES; RANDOMIZED CONTROLLED STUDY. M. A. F. M. Youssef, I. Khalil, S. Khattab, I. Aboulfotouh, M. van Wely, F. van der Veen. Egyptian International Fertility IVF Center (EIFC-IVF), Cairo, Egypt; Center for Reproductive Medicine (CVV)- Acadmic Medical Center- University of Amsterdam, Amsterdam, Netherlands. OBJECTIVE: To evaluate the efficacy of mild ovarian stimulation strategy, based on the combined administration of oral clomiphene citrate (CC) plus HMG from cycle day 7, and GnRH antagonist administration (fixed protocol) for poor responders elected for ART compared with the outcome of a standard ovarian stimulation strategy. DESIGN: Randomized controlled study, using computer-generated random numbers with concealed opaque envelopes.
FERTILITY & STERILITYÒ
> 1.05 ng/mL
Group 2
#1 #2 #3
% 100 days > 100 days 3.3 3.81,2 5.9 5.6 4.5 4.02,3 6.8 7.1 5.4 5.51,3 6.2 5.7
#1 #2 #3
2.6 3.24 3.9 3.9 4.5 4.9
4.5 4.74 4.6 4.6 4.3 4.1
#1 #2 #3
6.7 4.6 7.4 3.35 9.8 6.1
9.9 6.0 12.7 9.15 11.3 6.4
% 1.05 ng/mL P-528 Wednesday, October 19, 2011
Group 1
P-value 1
0.004 0.047 3 0.085 (N.S.) 2
4
0.017
5
0.021
CONCLUSION: This study, for the first time, demonstrates that DHEA in milder DOR is more effective. Severe DOR reaches maximal effectiveness of DHEA within ca. 100 days, while milder forms continue improvements considerably beyond 100 days. Pregnancy rates remain respectable and stable for at least 3 consecutive IVF cycles. Supported by: The Foundation for Reproductive Medicine and intramural research funds from the Center for Human Reproduction - New York.
S263