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Endometrin vs. progesterone in oil for luteal phase support with in vitro fertilization
CONCLUSION: Patients who had E2 levels <1500pg/mL on the hCG day and lower E2 levels compared to retrieved oocytes in a long GnRH agonist protocol are required additional luteal phase support such as hCG and E2. hCG supplementation is sufficient for luteal phase support without OHSS.
TABLE 1. Comparison of study and control groups
Basal FSH Duration of therapy(days) Total amount of hMG(IU) No. of dominant follicles(>16mm) Clinical pregnancy rate(%) Ongoing pregnancy rate(%) Interval between IUI and next menstruation(days)
Study group (n¼69)
Control group (n¼71)
8.2 2.5 10.1 1.4
7.4 1.9 10.1 1.4
NS NS
9.9 3.4
9.4 2.8
NS
4.2 3.3
5.0 3.4
NS
20.3
19.7
NS
15.9
15.5
NS
14.7 1.8
12.6 2.3
<0.001
CONCLUSION: The results show that luteal phase support with vaginal progesterone gel in the ovarian stimulation and IUI cycles in does not improve pregnancy rate. More data from variable other regimen of luteal phase support are necessary to investigate the role of luteal support in IUI cycles.
P-289 Tuesday, October 26, 2010 THE BEST LUTEAL PHASE SUPPORT PROTOCOL FOR PATIENTS WHO HAD E2 LEVELS <1500 PG/ML ON THE hCG DAY IN A LONG GnRH AGONIST CYCLES. Y. H. Jung, Y. Y. Kim, M. H. Kim, J. D. Cho. OB/GYn, Ellemedi Infertility Clinic, Changwon, GyeongNam, Republic of Korea. OBJECTIVE: To identify the best protocol for luteal phase support, only progesterone (P), P with hCG or P with hCG plus 6 mg oral estradiol (E2) valerate was treated into patients who had E2 levels <1500 pg/mL on the hCG day in a long GnRH agonist cycles. DESIGN: A prospective study. MATERIALS AND METHODS: 124 patients who underwent IVF/ICSIET in a long GnRH agonist cycles had E2 levels <1500 pg/mL on the hCG day or lower E2 levels compared to no. of retrieved oocytes were supported luteal phase by three protocols. Each protocol divides Group I (P only, n¼42) with IM P 50 mg/day from OPU day (day 0), Group II (P+hCG, n¼41) plus hCG 2000 IU SC on day 0, 2, 4 and Group III (P+hCG+E2, n¼39) plus 6mg/ day oral E2. RESULTS: Patients in group I, II and III were similar age, E2 levels on the day hCG, no. of retrieved oocytes, no. of ET, endometrium thickness, miscarrige and OHSS rate. Clinical pregnancy and implantation rates, respectively, were significantly higher in group II and III than in group I (P<0.05). However, Group II and III didn’t find significant differences.
P-290 Tuesday, October 26, 2010 ENDOMETRIN VS. PROGESTERONE IN OIL FOR LUTEAL PHASE SUPPORT WITH IN VITRO FERTILIZATION. J. K. Park, G. Couchman, W. Meyer. Carolina Conceptions, Raleigh, NC. OBJECTIVE: To evaluate clinical pregnancy rates and implantation rates in IVF cycles with a vaginal progesterone insert (Endometrin) compared to progesterone in oil for luteal phase support. DESIGN: Retrospective case control study. MATERIALS AND METHODS: From May 2007 through February 2010, all fresh non-donor IVF cycles were reviewed for the use of Endometrin starting the day after oocyte retrieval. For each subject using Endometrin, two control subjects were found that were matched by age and baseline AMH (Anti Mullerian Hormone) levels. Twenty seven subjects were identified that had matched controls. T test, chi square, and poisson regression were used to compare baseline characteristics where appropriate. Clinical pregnancy rates were compared using logistic regression, while implantation rates were compared using linear regression. For both comparisons, regression analysis was performed while controlling for age, AMH level, number of embryos transferred, and stage of embryos at transfer (cleavage vs blastocyst). RESULTS: Cases and controls were similar with respect to age, AMH, number of embryos transferred, and percent of embryos transferred as blastocysts. Clinical pregnancy rates and implantation rates were not significantly different between those who used Endometrin vs IM progesterone.
Endometrin vs. IM Progesterone
Endometrin (n¼27) Age (mean SD) 35.0 4.1 AMH (mean SD) 3.3 3.9 # Embryos transferred 2.4 0.93 (mean SD) % Blastocysts 51.9 Clinical pregnancy 66.7% rate Implantation rate 46.0% 43.2% (mean SD)
IM Progesterone (n¼54)
p value
34.9 4.0 3.3 3.8 2.9 0.89
0.97 0.90 0.2
48.1 63.0%
0.75 0.45
34.8% 33.1%
0.15
CONCLUSION: Endometrin appears to have similar efficacy for luteal phase support compared to IM progesterone. Endometrin is an effective mode of progesterone delivery with a more patient-friendly approach. Supported by: Ferring Pharmaceuticals.
TABLE 1. IVF/ICSI cycle characteristics of the investigated groups and comparison of clinical outcome in the three groups.
Variable No. of cycles Age E2 level on day hCG(pg/mL) No. of retrieved oocytes No. of transferred embryos Endometrium thickness(mm) IR(%)* Clinical PR(%)* Miscarrige(%) Mild OHSS(%)
Group I (IM P)
Group II (IM P+hCG)
Group III (IM P+hCG+E2)
42 33.8 4.3 1182 450
41 33.4 3.4 1084 453
39 33.1 3.9 1103 489
8.1 5.7
7.6 4.7
8.1 3.9
2.8 0.5
2.9 0.4
2.9 0.5
10.6 2.1
10.9 2.3
10.7 1.7
15.7a 12(28.6)a 1(7.7) 2(4.8)
27.4b 20(48.9)b 2(8.7) 0(0)
28.8b 19(48.7)b 0(0) 1(2.4)
Means SD and % *P<0.05.
FERTILITY & STERILITYÒ
P-291 Tuesday, October 26, 2010 ESTRADIOL SUPPLEMENTATION IN INTRACYTOPLASMIC SPERM INJECTION CYCLES WITH THIN ENDOMETRIUM. B. Demir, S. Dilbaz, O. Cinar, O. Ozdegirmenci, S. Dede, U. Goktolga. IVF Unit, Etlik Zubeyde Hanim Women’s Health Teaching and Research Hospital, Ankara, Turkey. OBJECTIVE: Endometrial thickness is an important parameter for the success of intracytoplasmic sperm injection cycles (ICSI). Implantation is negatively affected with insufficient development of the endometrium prior to the embryo transfer. The objective of this study is to evaluate the effect of estradiol supplementation in patients with thin endometrium in ICSI cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: One hundred and seventeen patients with the endometrial thickness on the hCG day % 8 mm were rewieved. Estradiol supplementation was used in 57 of the patients while the remaining 60 patients were accepted as the control group. Estradiol supplementation using estradiol hemihydrate 4 mg/day was given on hCG day. Luteal phase supplementation with progesterone was started on the day
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TABLE 1. Comparison of study and control groups
Basal FSH Duration of therapy(days) Total amount of hMG(IU) No. of dominant follicles(>16mm) Clinical pregnancy rate(%) Ongoing pregnancy rate(%) Interval between IUI and next menstruation(days)
Study group (n¼69)
Control group (n¼71)
8.2 2.5 10.1 1.4
7.4 1.9 10.1 1.4
NS NS
9.9 3.4
9.4 2.8
NS
4.2 3.3
5.0 3.4
NS
20.3
19.7
NS
15.9
15.5
NS
14.7 1.8
12.6 2.3
<0.001
CONCLUSION: The results show that luteal phase support with vaginal progesterone gel in the ovarian stimulation and IUI cycles in does not improve pregnancy rate. More data from variable other regimen of luteal phase support are necessary to investigate the role of luteal support in IUI cycles.
P-289 Tuesday, October 26, 2010 THE BEST LUTEAL PHASE SUPPORT PROTOCOL FOR PATIENTS WHO HAD E2 LEVELS <1500 PG/ML ON THE hCG DAY IN A LONG GnRH AGONIST CYCLES. Y. H. Jung, Y. Y. Kim, M. H. Kim, J. D. Cho. OB/GYn, Ellemedi Infertility Clinic, Changwon, GyeongNam, Republic of Korea. OBJECTIVE: To identify the best protocol for luteal phase support, only progesterone (P), P with hCG or P with hCG plus 6 mg oral estradiol (E2) valerate was treated into patients who had E2 levels <1500 pg/mL on the hCG day in a long GnRH agonist cycles. DESIGN: A prospective study. MATERIALS AND METHODS: 124 patients who underwent IVF/ICSIET in a long GnRH agonist cycles had E2 levels <1500 pg/mL on the hCG day or lower E2 levels compared to no. of retrieved oocytes were supported luteal phase by three protocols. Each protocol divides Group I (P only, n¼42) with IM P 50 mg/day from OPU day (day 0), Group II (P+hCG, n¼41) plus hCG 2000 IU SC on day 0, 2, 4 and Group III (P+hCG+E2, n¼39) plus 6mg/ day oral E2. RESULTS: Patients in group I, II and III were similar age, E2 levels on the day hCG, no. of retrieved oocytes, no. of ET, endometrium thickness, miscarrige and OHSS rate. Clinical pregnancy and implantation rates, respectively, were significantly higher in group II and III than in group I (P<0.05). However, Group II and III didn’t find significant differences.
P-290 Tuesday, October 26, 2010 ENDOMETRIN VS. PROGESTERONE IN OIL FOR LUTEAL PHASE SUPPORT WITH IN VITRO FERTILIZATION. J. K. Park, G. Couchman, W. Meyer. Carolina Conceptions, Raleigh, NC. OBJECTIVE: To evaluate clinical pregnancy rates and implantation rates in IVF cycles with a vaginal progesterone insert (Endometrin) compared to progesterone in oil for luteal phase support. DESIGN: Retrospective case control study. MATERIALS AND METHODS: From May 2007 through February 2010, all fresh non-donor IVF cycles were reviewed for the use of Endometrin starting the day after oocyte retrieval. For each subject using Endometrin, two control subjects were found that were matched by age and baseline AMH (Anti Mullerian Hormone) levels. Twenty seven subjects were identified that had matched controls. T test, chi square, and poisson regression were used to compare baseline characteristics where appropriate. Clinical pregnancy rates were compared using logistic regression, while implantation rates were compared using linear regression. For both comparisons, regression analysis was performed while controlling for age, AMH level, number of embryos transferred, and stage of embryos at transfer (cleavage vs blastocyst). RESULTS: Cases and controls were similar with respect to age, AMH, number of embryos transferred, and percent of embryos transferred as blastocysts. Clinical pregnancy rates and implantation rates were not significantly different between those who used Endometrin vs IM progesterone.
Endometrin vs. IM Progesterone
Endometrin (n¼27) Age (mean SD) 35.0 4.1 AMH (mean SD) 3.3 3.9 # Embryos transferred 2.4 0.93 (mean SD) % Blastocysts 51.9 Clinical pregnancy 66.7% rate Implantation rate 46.0% 43.2% (mean SD)
IM Progesterone (n¼54)
p value
34.9 4.0 3.3 3.8 2.9 0.89
0.97 0.90 0.2
48.1 63.0%
0.75 0.45
34.8% 33.1%
0.15
CONCLUSION: Endometrin appears to have similar efficacy for luteal phase support compared to IM progesterone. Endometrin is an effective mode of progesterone delivery with a more patient-friendly approach. Supported by: Ferring Pharmaceuticals.
TABLE 1. IVF/ICSI cycle characteristics of the investigated groups and comparison of clinical outcome in the three groups.
Variable No. of cycles Age E2 level on day hCG(pg/mL) No. of retrieved oocytes No. of transferred embryos Endometrium thickness(mm) IR(%)* Clinical PR(%)* Miscarrige(%) Mild OHSS(%)
Group I (IM P)
Group II (IM P+hCG)
Group III (IM P+hCG+E2)
42 33.8 4.3 1182 450
41 33.4 3.4 1084 453
39 33.1 3.9 1103 489
8.1 5.7
7.6 4.7
8.1 3.9
2.8 0.5
2.9 0.4
2.9 0.5
10.6 2.1
10.9 2.3
10.7 1.7
15.7a 12(28.6)a 1(7.7) 2(4.8)
27.4b 20(48.9)b 2(8.7) 0(0)
28.8b 19(48.7)b 0(0) 1(2.4)
Means SD and % *P<0.05.
FERTILITY & STERILITYÒ
P-291 Tuesday, October 26, 2010 ESTRADIOL SUPPLEMENTATION IN INTRACYTOPLASMIC SPERM INJECTION CYCLES WITH THIN ENDOMETRIUM. B. Demir, S. Dilbaz, O. Cinar, O. Ozdegirmenci, S. Dede, U. Goktolga. IVF Unit, Etlik Zubeyde Hanim Women’s Health Teaching and Research Hospital, Ankara, Turkey. OBJECTIVE: Endometrial thickness is an important parameter for the success of intracytoplasmic sperm injection cycles (ICSI). Implantation is negatively affected with insufficient development of the endometrium prior to the embryo transfer. The objective of this study is to evaluate the effect of estradiol supplementation in patients with thin endometrium in ICSI cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: One hundred and seventeen patients with the endometrial thickness on the hCG day % 8 mm were rewieved. Estradiol supplementation was used in 57 of the patients while the remaining 60 patients were accepted as the control group. Estradiol supplementation using estradiol hemihydrate 4 mg/day was given on hCG day. Luteal phase supplementation with progesterone was started on the day
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