- Email: [email protected]
Endometriosis severity and IVF outcome
cycles that had day 5 blast ETs. Data analyzed included age, # ET’d, imp rate, clinical (clin) pg rate, clin loss rate, twin rate and high order multiple (HOM) rate. P values of the first 2 parameters were computed by unpaired t test, and pg and imp data p values were computed by Chi Square analysis. Values < 0.05 were considered statistically significant (NS ¼ not significant). RESULTS: 414 (45%) pt cycles fell into the opt group and 510 (55%) fell into the suboptgroup. 216 cycles in the opt group (52%) had a day 3 ET and 198 (48%) had a day 5 ET. In the subopt group 436 (85%) had a day 3 ET and 74 pts (15%) made the decision with their doctors to have a day 5 ET. Other results are summarized in the following table:
OPT GROUP Day 3 ET
Day 5 ET
SUBOPT GROUP Day 3 ET
Day 5 ET
Age 35.4 4.4 34.9 4.4 34.7 4.1 34.1 4.0 # ET 2.8 1.3 1.9 0.7 2.2 0.9 1.8 0.7 Imp rate 165/599 (27%) 129/387 (33%) 234/954 (24%) 39/134 (29%) Clin pg 113/216 (52%) 96/198 (48%) 183/436 (42%) 35/74 (47%) Clin loss 16/113 (14%) 9/96 (9%) 21/183 (11%) 4/35 (11%) Twin rate 47/113 (42%) 32/96 (33%) 54/183 (30%) 5/35 (14%) HOM rate 6/113 (5%) 4/96 (4%) 5/183 (3%) 1/35 (3%)
CONCLUSIONS: There is no significant difference in imp rates, clin pg or loss rates between Day 3 or Day 5 ETs in either the opt or subopt groups. The number of embryos of good quality on day 3 does not appear to affect the outcomes of Day 3 or day 5 ETs in this pt population. There is a trend for a higher twin rate in the day 3 ETs from both groups but no increase in HOM in either group on day 3 even though more embryos were ET’d. Supported by: None.
A-55 POOR OOLEMA INTEGRITY HAS A NEGATIVE IMPACT ON IVF OUTCOMES AND IS CYCLE SPECIFIC. S. G. Derman, H. Ahmed, L. Hoover. Princeton IVF, Lawrenceville, NJ. OBJECTIVE: We have noticed a subset of patients have a higher rate of oocyte degeneration following ICSI. The purpose of this study is determine if these patients have a different outcomes, and whether this phenomenon is unique to the patient or the cycle. DESIGN: Retrospective case review. MATERIALS AND METHODS: Patient charts and laboratory records for all patients who underwent ICSI in 2006-7 were reviewed. Cycles were divided into normal and poor oolema integrity groups, as determined by a single embryologist. In normal cycles, the oolema offered resistance to the ICSI needle and displayed a track from the pipette. Poor cycles were those in which the oolema offered no resistance, and no track was seen. The groups were compared for age, number of oocytes retrieved, percent mature, fertilization rate, degeneration rate, number of embryos transfered, percent of cycles with cryopreservation, pregnancy rate, clinical pregancy rate and implantation rate. RESULTS: The normal and poor groups did not differ with regards to age, number of oocytes, number of embryos transfered. The normal group had higher rates of oocyte maturity (87% vs 80.2%), fertilization (77.9% vs 56%), oocyte cryopreservation (49.1% vs 13.8%), pregnancy rate (41.2% vs 32.1%), clinical pregnancy rate (29% vs 14.3%) and implantation rate (15.8% vs 9.2%). The poor group had higher rates of oocyte degeneration (24.6% vs 5.7%). CONCLUSIONS: There exists a subgroup of cycles with poor oolema integrity, and when noted, poor oolemma integrity indicates a potential for lower pregnancy rates and fewer embryos available for cryopreservation. As there were several patients with cycles in both groups, one can conclude that this phenomenon is cycle specific, but not necessarily patient specific. Factors which may account for these differences such as stimulation protocol, basal FSH, diagnosis and BMI have yet to be ellucidated. Supported by: None.
S408
Abstracts
A-56 ENDOMETRIOSIS SEVERITY AND IVF OUTCOME. G. Agnani, A. Collin, X. Dellis, P. Lagre, C. Souquet, C. Roux. Service de Gynecologie Obstetrique, CHU St Jacques, Besanc¸on, France. OBJECTIVE: The aim of this study was to evaluate the impact of endometriosis on In Vitro Fertilization (IVF) outcome, focusing on the initial surgical approach, surgical difficulties, and ovarian reserve. DESIGN: Retrospective review of 200 consecutive first oocyte retrievals in patients with endometriosis. MATERIALS AND METHODS: Severity of endometriosis (3 subgroups) was evaluated during the first laparoscopy. Subgroup A: superficial peritoneal and ovarian implants. Subgroup B: endometrioma (diameter R 5mm) without deeply infiltrating endometriosis. Subgroup C: deeply infiltrating endometriosis involving the bladder, sigmoid, uterosacral ligaments or vagina. Male infertility and anovulation were excluded. Surgical treatment was always performed before IVF by surgeons who were not necessarily specialized in endometriosis. Follicular count was estimated just before the first IVF attempt. RESULTS: Subgroups A, B, and C were comparable when we considered female age, BMI, duration of infertility, sperm concentration, basal FSH level, endometrioma diameter before laparoscopy (groups B & C), follicular count, oocyte number, embryo number, and classical parameters of stimulation. The percentage of laparotomies and ovarian cystectomies was similar in subgroups B and C. Total top quality embryo number and top quality transferred embryo number were significantly lower in group C (p<0.05). Clinical pregnancy rate was significantly lower in group C (group A: 42%, group B: 50%, group C: 5.9%, p<0.001). Early complications after IVF gradually increased with the severity of endometriosis (group A: 5%, group B: 20%, group C: 38%, p<0.001). The surgical approach including a second look offered the best results (p<0.01). Clinical pregnancy rate was also significantly influenced by total embryo number (p<0.01), top quality embryo number, top quality transferred embryo number (p<0.001), detection of endometrioma before stimulation (p<0.02), and BMI (p<0.02). In a multivariate logistic regression including top quality transferred embryo number, endometriosis subgroups, BMI, and also age, basal FSH level, and follicular count, three variables were selected: top quality transferred embryo number, endometriosis subgroups, and detection of an endometrioma. CONCLUSIONS: As opposed to recent studies which minimize the impact of endometriosis on IVF results, our study suggested that the persistence of active lesions is more deleterious than mild follicular destruction. Supported by: None.
A-57 IMPROVING OOCYTE COMPETENCE WITH FSH AT TIME OF HCG TRIGGER: A RANDOMIZED CONTROLLED TRIAL. J. D. Lamb, J. R. Sandler, L. Jalalian, S. Shen, M. I. Cedars, M. P. Rosen. Dept. of ObGyn and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; University of California, San Francisco, San Francisco, CA. OBJECTIVE: We hypothesize the induction of final oocyte maturation via modification of ovulation trigger with the addition of FSH at the time of hCG will improve developmental competence of the oocyte. DESIGN: Double-blind randomized controlled trial, interim analysis. MATERIALS AND METHODS: Subjects undergoing a long agonist protocol were randomized by sealed envelope allocation to FSH (6 amps) vs placebo at the time of hCG. For each subject, two dominant follicles were aspirated individually and follicular fluid (FF) was collected. Oocytes recovered were handled and cultured individually throughout ICSI and subsequent laboratory procedures. Clinical and laboratory characteristics were recorded, and serum and FF hormone levels were measured with duplicates. Follicular size was extrapolated by follicular volume. The rate of nuclear maturation was assessed by metaphase II oocyte per follicle >12mm. Data were analyzed both at cycle and follicle level using Chi square and Student’s t test as appropriate, and analysis was done on an intention to treat basis. RESULTS: To date, 69 subjects have completed cycles after randomization. Seven were excluded for either estradiol level at time of hCG >4500pg/mL, or failure to use study drug. There were no differences
Vol. 90, Suppl 1, September 2008
OPT GROUP Day 3 ET
Day 5 ET
SUBOPT GROUP Day 3 ET
Day 5 ET
Age 35.4 4.4 34.9 4.4 34.7 4.1 34.1 4.0 # ET 2.8 1.3 1.9 0.7 2.2 0.9 1.8 0.7 Imp rate 165/599 (27%) 129/387 (33%) 234/954 (24%) 39/134 (29%) Clin pg 113/216 (52%) 96/198 (48%) 183/436 (42%) 35/74 (47%) Clin loss 16/113 (14%) 9/96 (9%) 21/183 (11%) 4/35 (11%) Twin rate 47/113 (42%) 32/96 (33%) 54/183 (30%) 5/35 (14%) HOM rate 6/113 (5%) 4/96 (4%) 5/183 (3%) 1/35 (3%)
CONCLUSIONS: There is no significant difference in imp rates, clin pg or loss rates between Day 3 or Day 5 ETs in either the opt or subopt groups. The number of embryos of good quality on day 3 does not appear to affect the outcomes of Day 3 or day 5 ETs in this pt population. There is a trend for a higher twin rate in the day 3 ETs from both groups but no increase in HOM in either group on day 3 even though more embryos were ET’d. Supported by: None.
A-55 POOR OOLEMA INTEGRITY HAS A NEGATIVE IMPACT ON IVF OUTCOMES AND IS CYCLE SPECIFIC. S. G. Derman, H. Ahmed, L. Hoover. Princeton IVF, Lawrenceville, NJ. OBJECTIVE: We have noticed a subset of patients have a higher rate of oocyte degeneration following ICSI. The purpose of this study is determine if these patients have a different outcomes, and whether this phenomenon is unique to the patient or the cycle. DESIGN: Retrospective case review. MATERIALS AND METHODS: Patient charts and laboratory records for all patients who underwent ICSI in 2006-7 were reviewed. Cycles were divided into normal and poor oolema integrity groups, as determined by a single embryologist. In normal cycles, the oolema offered resistance to the ICSI needle and displayed a track from the pipette. Poor cycles were those in which the oolema offered no resistance, and no track was seen. The groups were compared for age, number of oocytes retrieved, percent mature, fertilization rate, degeneration rate, number of embryos transfered, percent of cycles with cryopreservation, pregnancy rate, clinical pregancy rate and implantation rate. RESULTS: The normal and poor groups did not differ with regards to age, number of oocytes, number of embryos transfered. The normal group had higher rates of oocyte maturity (87% vs 80.2%), fertilization (77.9% vs 56%), oocyte cryopreservation (49.1% vs 13.8%), pregnancy rate (41.2% vs 32.1%), clinical pregnancy rate (29% vs 14.3%) and implantation rate (15.8% vs 9.2%). The poor group had higher rates of oocyte degeneration (24.6% vs 5.7%). CONCLUSIONS: There exists a subgroup of cycles with poor oolema integrity, and when noted, poor oolemma integrity indicates a potential for lower pregnancy rates and fewer embryos available for cryopreservation. As there were several patients with cycles in both groups, one can conclude that this phenomenon is cycle specific, but not necessarily patient specific. Factors which may account for these differences such as stimulation protocol, basal FSH, diagnosis and BMI have yet to be ellucidated. Supported by: None.
S408
Abstracts
A-56 ENDOMETRIOSIS SEVERITY AND IVF OUTCOME. G. Agnani, A. Collin, X. Dellis, P. Lagre, C. Souquet, C. Roux. Service de Gynecologie Obstetrique, CHU St Jacques, Besanc¸on, France. OBJECTIVE: The aim of this study was to evaluate the impact of endometriosis on In Vitro Fertilization (IVF) outcome, focusing on the initial surgical approach, surgical difficulties, and ovarian reserve. DESIGN: Retrospective review of 200 consecutive first oocyte retrievals in patients with endometriosis. MATERIALS AND METHODS: Severity of endometriosis (3 subgroups) was evaluated during the first laparoscopy. Subgroup A: superficial peritoneal and ovarian implants. Subgroup B: endometrioma (diameter R 5mm) without deeply infiltrating endometriosis. Subgroup C: deeply infiltrating endometriosis involving the bladder, sigmoid, uterosacral ligaments or vagina. Male infertility and anovulation were excluded. Surgical treatment was always performed before IVF by surgeons who were not necessarily specialized in endometriosis. Follicular count was estimated just before the first IVF attempt. RESULTS: Subgroups A, B, and C were comparable when we considered female age, BMI, duration of infertility, sperm concentration, basal FSH level, endometrioma diameter before laparoscopy (groups B & C), follicular count, oocyte number, embryo number, and classical parameters of stimulation. The percentage of laparotomies and ovarian cystectomies was similar in subgroups B and C. Total top quality embryo number and top quality transferred embryo number were significantly lower in group C (p<0.05). Clinical pregnancy rate was significantly lower in group C (group A: 42%, group B: 50%, group C: 5.9%, p<0.001). Early complications after IVF gradually increased with the severity of endometriosis (group A: 5%, group B: 20%, group C: 38%, p<0.001). The surgical approach including a second look offered the best results (p<0.01). Clinical pregnancy rate was also significantly influenced by total embryo number (p<0.01), top quality embryo number, top quality transferred embryo number (p<0.001), detection of endometrioma before stimulation (p<0.02), and BMI (p<0.02). In a multivariate logistic regression including top quality transferred embryo number, endometriosis subgroups, BMI, and also age, basal FSH level, and follicular count, three variables were selected: top quality transferred embryo number, endometriosis subgroups, and detection of an endometrioma. CONCLUSIONS: As opposed to recent studies which minimize the impact of endometriosis on IVF results, our study suggested that the persistence of active lesions is more deleterious than mild follicular destruction. Supported by: None.
A-57 IMPROVING OOCYTE COMPETENCE WITH FSH AT TIME OF HCG TRIGGER: A RANDOMIZED CONTROLLED TRIAL. J. D. Lamb, J. R. Sandler, L. Jalalian, S. Shen, M. I. Cedars, M. P. Rosen. Dept. of ObGyn and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; University of California, San Francisco, San Francisco, CA. OBJECTIVE: We hypothesize the induction of final oocyte maturation via modification of ovulation trigger with the addition of FSH at the time of hCG will improve developmental competence of the oocyte. DESIGN: Double-blind randomized controlled trial, interim analysis. MATERIALS AND METHODS: Subjects undergoing a long agonist protocol were randomized by sealed envelope allocation to FSH (6 amps) vs placebo at the time of hCG. For each subject, two dominant follicles were aspirated individually and follicular fluid (FF) was collected. Oocytes recovered were handled and cultured individually throughout ICSI and subsequent laboratory procedures. Clinical and laboratory characteristics were recorded, and serum and FF hormone levels were measured with duplicates. Follicular size was extrapolated by follicular volume. The rate of nuclear maturation was assessed by metaphase II oocyte per follicle >12mm. Data were analyzed both at cycle and follicle level using Chi square and Student’s t test as appropriate, and analysis was done on an intention to treat basis. RESULTS: To date, 69 subjects have completed cycles after randomization. Seven were excluded for either estradiol level at time of hCG >4500pg/mL, or failure to use study drug. There were no differences
Vol. 90, Suppl 1, September 2008