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Estradiol Level on Day of HCG Does Not Correlate With Pregnancy Rate in GnRH Antagonist IVF-ET Cycles
CONCLUSION: Our study suggests that formula seems to be highly effective in preventing OHSS earlier. OHSS risks equal or higher than 50% after formula application, seems to be indicative to r-FSH dose adjustment and consequently, seems to avoid efficiently the OHSS development. Maybe the fact of follicle recruitment happens on days 3, 4 and 5 of menstrual cycle, these days though to be more important to prevent OHSS. Further studies involving different COS protocols should be done to confirm our conclusions. Supported by: None
Regression analysis identified variables that were statistically significant (p ⬍ 0.05) to the model’s predictive value including paternal testosterone level, sperm count, total motility, use of microsurgical epididymal sperm extraction (MESA) and whether MESA was fresh or thawed. Other factors that were significant were the presence of antisperm antibodies, what class they belonged to, and the subcellular localization of antibody binding.
P-344 Predictors of Embryo Fragmentation and Outcome Following Fragment Removal in IVF. J. C. Skorupski, M. Keltz, D. Stein, K. Bradley. St. Luke’s Roosevelt Hospital, New York, NY. OBJECTIVE: To assess predictors of embryo fragmentation in in vitro fertilization (IVF) as well as to compare cycle outcomes between low grade embryos subjected to defragmentation and high grade embryos not undergoing defragmentation. DESIGN: A retrospective, case-control trial MATERIALS AND METHODS: We evaluated age, basal follicle stimulating hormone and estradiol levels, the number of retrieved oocytes and fertilization rates on 327 non-donor, fresh in vitro fertilization cycles. Outcome assessments following defragmentation included rates of implantation, clinical pregnancy, spontaneous abortion and live birth. RESULTS: Increased age and lower number of oocytes and embryos were associated with embryo fragmentation. Lower grade embryos after defragmentation yielded rates of implantation, clinical pregnancy, live birth, spontaneous abortion and fetal defects equivalent to high grade embryos CONCLUSION: Fragmented embryos that undergo fragment removal result in equivalent clinical outcomes to high grade, non-defragmented embryos. Supported by: None
P-345 Predicting Outcomes for Intracytoplasmic Sperm Injection. A. V. Kshirsagar, L. Murthy, L. Chelu, D. Lamb, L. Ross, C. Niederberger. The Department of Urology, The University of Illinois at Chicago, Chicago, IL; Scott Department of Urology, Baylor College of Medicine, Houston, TX. OBJECTIVE: To predict fertilization in intracytoplasmic sperm injection cases (ICSI). DESIGN: Fertilization is the desired goal of ICSI and various factors can influence this outcome. We developed models to predict fertilization rate (FR) in ICSI, with the intent to aid the clinical practitioner. MATERIALS AND METHODS: 528 cases of ICSI cycles from a university center were reviewed. 4 different computational modeling techniques were used to analyze the data. 3 linear based models included logistic regression (LR), linear support vector machine (LSVM) analysis, and radial support vector machine (RSVM) analysis. These were compared to one another and to an artificial neural network (NNET): a nonlinear method of analysis. The methods were modeled using neUROn⫹⫹, a set of C⫹⫹ programs developed using the Cygwin (Red Hat) GNU C⫹⫹ port for Windows (Microsoft) distributed across Pentium (Intel) platforms. The optimal architecture for NNET was determined when additional nodes led to overlearning. Reverse regression analysis (RR) using Wilk’s Generalized Likelihood Ratio test revealed statistically significant patient variables (p ⬍0.05) in predicting successful fertilization. The cases were randomized to a modeling set of 328 and a cross-validation set of 200 with outcome frequencies preserved in both sets. 3 outcome thresholds were set: if FR ⬎ 0% (signifying if any fertilization occurred), if FR ⱖ 25%, or if FR ⱖ50 %. The 4 models were separately evaluated for the ability to predict each of the 3 outcome thresholds: if FR ⬎ 0%, if FR ⱖ 25%, or if FR ⱖ50 %. RESULTS: LR had the highest ROC for predicting if any fertilization would occur (FR ⬎ 0%). 2 separate RSVM models had the highest ROC for predicting fertilization rates of ⱖ 25% or ⱖ 50%, respectively. (Table 1) NNET had the lowest ROC of all the models regardless of which 3 fertilization thresholds it was attempting to predict. The relationship between these ICSI variables and FR is best described in a linear relationship.
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Abstracts
CONCLUSION: These models provide new insights into the parameters that can impact successful fertilization in ICSI. Linear analysis provided better predictive value than the nonlinear NNET. Use of the LR model can predict the probability if any fertilization will occur. Furthermore, the first RSVM model can predict ⱖ 25% and application of the second RSVM model can predict ⱖ50%. This information can facilitate more accurate planning of the number of cycles needed and will allow patients to be better counseled. Supported by: Supported in part by P01 HD 36289 to DJL and CN from the National Institutes of Health
P-346 Estradiol Level on Day of HCG Does Not Correlate With Pregnancy Rate in GnRH Antagonist IVF-ET Cycles. M. Jurema, A. Blazar. Women and Infants’ Hospital, Providence, RI. OBJECTIVE: Controversy exists regarding the impact of peak estradiol level on pregnancy outcome following IVF-ET using GnRH agonist protocols. In our experience, we have consistently noted a favorable impact of even relatively high levels of estradiol (⬎3500 pg/mL) on day of HCG on pregnancy rates. The relationship between day of HCG estradiol levels and pregnancy outcome in GnRH antagonist protocols for IVF-ET is much less defined. The purpose of this study was to examine the association between estradiol levels on day of HCG and pregnancy rates in IVF-ET cycles using a GnRH antagonist protocol. This study was conducted during the same time interval that we have observed a beneficial effect of increasing estradiol on GnRH agonist cycle outcome. DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 330 IVF-ET cycles were identified as using a GnRH antagonist protocol for prevention of premature luteinization. In general, these patients underwent controlled ovarian hyperstimulation without downregulation using recombinant FSH (range 150 to 600 IU/day) starting on day 2-4 of their menstrual cycles. A daily dose of 0.25mg of a GnRH antagonist was initiated once the lead follicle reached 13-14mm in diameter. HCG (10,000 units) was administered when at least 2 follicles reached 17 mm in diameter and oocyte retrieval was performed 36 hours later. Embryo transfer was performed between days 2 and 6 after retrieval. Data were stratified by intervals of 1000 pg/ml of serum estradiol concentration. The mean patient age, day 3 FSH, cycle number, number of eggs obtained, number of embryos transferred, estradiol level on day of HCG, and pregnancy rates were compared among the estradiol groups. Values are presented as mean ⫾ SD. ANOVA was used to compare the means. RESULTS: The mean patient age was 37.0 ⫾ 4.1 years, number of IVF cycles was 2.9 ⫾ 1.9, day 3 FSH was 7.8 ⫾ 3.7 IU/L, mean estradiol on HCG day was 1699.3 ⫾ 968.5 pg/mL, number of eggs retrieved per cycle was 10.4 ⫾ 7.3, number of embryos transferred was 2.5 ⫾ 1.2, and the pregnancy rate per retrieval was 21.0 ⫾ 0.4 %. As expected, the mean number of eggs retrieved increased while day 3 FSH decreased significantly (P⬍.05) with ascending 1000 pg/ml increments of estradiol concentration. However, there were no differences in mean age, cycle number, number of embryos transferred or pregnancy rates among the estradiol groups (Figure 1). CONCLUSION: Unlike GnRH agonist protocols, the pregnancy rate of
Vol. 84, Suppl 1, September 2005
CONCLUSION: Although there is correlation between Inhibin B and number of retrieved oocyte, but Inhibin B don’t have a high sensitivity and specificity and P.P.V and N.P.V in determining of poor responder and possibility of clinical and chemical pregnancy. Supported by: None P-348 Can IVF Cycle Cancellation be Predicted Using the Antral Follicle Count in Poor Responders? M. McIlveen, J. Skull, W. Ledger. The Jessop Wing, Sheffield, United Kingdom; The University of Sheffield Department of Reproductive Medicine, Sheffield, United Kingdom.
IVF-ET using a GnRH antagonist protocol is not associated with the level of estradiol on day of HCG. Supported by: None. P-347 The Role of Day 5 Inhibin on Predicting Outcome of ART. E. S. Tehrani Nejad, E. Azimi Neko, N. Gholi Nejad, M. Ashrafi, B. H. Rashidi, E. Amirchaghmaghi. Royan Institute, Tehran, Iran (Islamic Republic of); Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of); Faculty of Medicine, Tehran University of Medical Sciences,, Tehran, Iran (Islamic Republic of); Endocrinology and Female Infertility, Royan Institute, Tehran, Iran (Islamic Republic of); Valiasr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of); Endocrinology and Female Infertility Department, Royan Institute, Tehran, Iran (Islamic Republic of). OBJECTIVE: Several methods have been used to predict ovarian reserve and IVF outcome, in response to gonadotropin stimulation. It is proved that day 3 basal FSH level is the most useful method, in that a poorer IVF outcome is associated with higher levels of the hormone even within the normal range also some studies suggested that day 5 Inhibin B is correlated with the number of mature follicle (⬎14m), retrieved and fertilized oocyte. The main purpose of this study is estimation of predictive value of day 5 Inhibin B in number of oocyte in ART cycle. The other purpose is estimation of sensitivity, specificity, positive and negative predictive value of Inhibin B in predicting of clinical pregnancy in ART cycle, and determining of relation between Inhibin B and number of retrieved oocyte, mature follicle (⬎14mm), fertilized oocyte, clinical pregnancy, cancelled cycle and number of hyper stimulation syndrome. DESIGN: Descriptive analytic study MATERIALS AND METHODS: In this, 108 patients(aged 20-35 years, with tubal or male factor or unexplained infertility, 20⬍BMI⬍28 kg/m2, normal FSH level in previous cycle, without endocrine abnormality such as PCOs)undergoing IVF or ICSI cycles in Royan institute and Valiasr reproductive health research center were studied. Inhibin B was measured on 5th day of menstrual cycle. Standard long protocol was used for ovarian stimulation. RESULTS: There was statistically significant correlation between Inhibin B and number of mature follicle (⬎14mm), BMI, number of retrieved oocyte, transferred embryo and chemical pregnancy. Furthermore there was meaningful correlation between Inhibin B and poor response (oocyte number ⬍4) and ovarian hyper stimulation( follicle numberⱖ20) but there was no significant correlation between Inhibin B and dose of gonadotropin that used, days of stimulation, cancelled cycles and clinical pregnancy. Analysis of Roc curve showed that in cut off point of 100pg/ml, Inhibin B has %54 sensitivity, %52 specificity, %24 positive predictive value and %79 negative predictive value for clinical pregnancy. Furthermore in cut off point of 283 pg/ml, Inhibin B 283pg/ml has %77 sensitivity, %30 specificity, %76.7 negative predictive value and %31.2 positive predictive value for poor response.
FERTILITY & STERILITY威
OBJECTIVE: To evaluate whether AFC can predict the outcome of superovulation in a group of women with a history predictive of a poor response. DESIGN: Prospective cohort study. MATERIALS AND METHODS: Women expected to have a poor response to superovulation were prospectively enrolled at the start of an IVF cycle. Criteria for inclusion in the study were: age over 39 years &/or a basal FSH ⬎10 IU/L on any occasion &/or a previous poor response to stimulation (4 oocytes or less). All women had a transvaginal ultrasound examination with an AFC and FSH measurement on day 2 of the treatment cycle. The AFC measured the total number of antral follicles 2-10mm in both ovaries. All women had a short GnRH agonist “flare” protocol with a fixed dose of 250 IU rFSH (Puregon). The main outcome measures were cycle cancellation or a poor response (4 or less oocytes collected). Pregnancy rates were also evaluated.Chi square tests, Fisher’s exact test and receiver operating curve analysis were used where applicable. RESULTS: 87 women were enrolled; 20 aged over 39 years, 22 with a previous poor response, 23 with an FSH ⬎10IU/L & 22 women who fulfilled more than 1 criteria. The mean age was 37.2 (Range 26-44) years. 47/87 (54%) patients enrolled responded poorly. An AFC of less than 5 was more likely to result in a poor response (22/29) than an AFC of 5 or more (25/58) {P⫽ 0.004; LR 3.62}. The area under the receiver-operating curve (ROC) was 0.736. An AFC of less than 5 was also associated with a higher likelihood of cycle cancellation due to a poor response {P⫽ 0.04; LR ⫽2.0}. However an AFC of less than 5 was not associated with a reduced chance of pregnancy. Clinical pregnancy rates {per cycle started} were 6/29 (20.6%) of patients with an AFC ⬍5 compared with 5/58 (8.6%) of those with an AFC of ⱖ5 (p⫽0.11). FSH levels were not predictive of poor response or of likelihood of pregnancy. This was true both for basal FSH levels in the index cycle and for the highest recorded FSH. Women who fulfilled 2 or more of the inclusion criteria had lower pregnancy rates (1/22 {4.5%}) versus those with only one reason for being included (10/65 {15.3%}; P⫽0.17). None of the women ⬎39 years with a raised FSH had an ongoing pregnancy (0/12); whereas 3/23 (13%) of the women ⬎39 with a normal FSH had an ongoing pregnancy {P⫽0.27}. The overall pregnancy rates were poor with only 11/87 (12.6%) clinical pregnancies and 8/87 (9.2%) ongoing pregnancies per cycle started. CONCLUSION: Although an AFC may help to identify women who will have a poor response it does not help to identify those who will ultimately achieve a pregnancy (or not). A high number of these patients were ultimately poor responders, suggesting that prediction of ‘poor response’ can be made from clinical criteria. Measurement of AFC does not appear to be of clinical utility in predicting cycle outcome in this group of patients. As found previously, a raised FSH on any occasion is not useful in predicting either poor response or pregnancy. Supported by: None P-349 Prognostic Factors Affecting the Outcomes of Oocyte Donation Cycles. S. H. Yoon, S. Y. Ku, S. H. Kim, Y. M. Choi, J. G. Kim, S. Y. Moon. Dongguk University International Hospital, Goyang-si Gyeonggi-do, Republic of Korea; College of Medicine Seoul National University Hospital, Seoul, Republic of Korea. OBJECTIVE: Oocyte donation cycle has been a useful model for the assessment of potential factors affecting human pregnancy, such as oocyte quality or uterine receptivity. The purpose of this study was to investigate the variable clinical factors affecting the outcomes of oocyte donation cycles.
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Regression analysis identified variables that were statistically significant (p ⬍ 0.05) to the model’s predictive value including paternal testosterone level, sperm count, total motility, use of microsurgical epididymal sperm extraction (MESA) and whether MESA was fresh or thawed. Other factors that were significant were the presence of antisperm antibodies, what class they belonged to, and the subcellular localization of antibody binding.
P-344 Predictors of Embryo Fragmentation and Outcome Following Fragment Removal in IVF. J. C. Skorupski, M. Keltz, D. Stein, K. Bradley. St. Luke’s Roosevelt Hospital, New York, NY. OBJECTIVE: To assess predictors of embryo fragmentation in in vitro fertilization (IVF) as well as to compare cycle outcomes between low grade embryos subjected to defragmentation and high grade embryos not undergoing defragmentation. DESIGN: A retrospective, case-control trial MATERIALS AND METHODS: We evaluated age, basal follicle stimulating hormone and estradiol levels, the number of retrieved oocytes and fertilization rates on 327 non-donor, fresh in vitro fertilization cycles. Outcome assessments following defragmentation included rates of implantation, clinical pregnancy, spontaneous abortion and live birth. RESULTS: Increased age and lower number of oocytes and embryos were associated with embryo fragmentation. Lower grade embryos after defragmentation yielded rates of implantation, clinical pregnancy, live birth, spontaneous abortion and fetal defects equivalent to high grade embryos CONCLUSION: Fragmented embryos that undergo fragment removal result in equivalent clinical outcomes to high grade, non-defragmented embryos. Supported by: None
P-345 Predicting Outcomes for Intracytoplasmic Sperm Injection. A. V. Kshirsagar, L. Murthy, L. Chelu, D. Lamb, L. Ross, C. Niederberger. The Department of Urology, The University of Illinois at Chicago, Chicago, IL; Scott Department of Urology, Baylor College of Medicine, Houston, TX. OBJECTIVE: To predict fertilization in intracytoplasmic sperm injection cases (ICSI). DESIGN: Fertilization is the desired goal of ICSI and various factors can influence this outcome. We developed models to predict fertilization rate (FR) in ICSI, with the intent to aid the clinical practitioner. MATERIALS AND METHODS: 528 cases of ICSI cycles from a university center were reviewed. 4 different computational modeling techniques were used to analyze the data. 3 linear based models included logistic regression (LR), linear support vector machine (LSVM) analysis, and radial support vector machine (RSVM) analysis. These were compared to one another and to an artificial neural network (NNET): a nonlinear method of analysis. The methods were modeled using neUROn⫹⫹, a set of C⫹⫹ programs developed using the Cygwin (Red Hat) GNU C⫹⫹ port for Windows (Microsoft) distributed across Pentium (Intel) platforms. The optimal architecture for NNET was determined when additional nodes led to overlearning. Reverse regression analysis (RR) using Wilk’s Generalized Likelihood Ratio test revealed statistically significant patient variables (p ⬍0.05) in predicting successful fertilization. The cases were randomized to a modeling set of 328 and a cross-validation set of 200 with outcome frequencies preserved in both sets. 3 outcome thresholds were set: if FR ⬎ 0% (signifying if any fertilization occurred), if FR ⱖ 25%, or if FR ⱖ50 %. The 4 models were separately evaluated for the ability to predict each of the 3 outcome thresholds: if FR ⬎ 0%, if FR ⱖ 25%, or if FR ⱖ50 %. RESULTS: LR had the highest ROC for predicting if any fertilization would occur (FR ⬎ 0%). 2 separate RSVM models had the highest ROC for predicting fertilization rates of ⱖ 25% or ⱖ 50%, respectively. (Table 1) NNET had the lowest ROC of all the models regardless of which 3 fertilization thresholds it was attempting to predict. The relationship between these ICSI variables and FR is best described in a linear relationship.
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Abstracts
CONCLUSION: These models provide new insights into the parameters that can impact successful fertilization in ICSI. Linear analysis provided better predictive value than the nonlinear NNET. Use of the LR model can predict the probability if any fertilization will occur. Furthermore, the first RSVM model can predict ⱖ 25% and application of the second RSVM model can predict ⱖ50%. This information can facilitate more accurate planning of the number of cycles needed and will allow patients to be better counseled. Supported by: Supported in part by P01 HD 36289 to DJL and CN from the National Institutes of Health
P-346 Estradiol Level on Day of HCG Does Not Correlate With Pregnancy Rate in GnRH Antagonist IVF-ET Cycles. M. Jurema, A. Blazar. Women and Infants’ Hospital, Providence, RI. OBJECTIVE: Controversy exists regarding the impact of peak estradiol level on pregnancy outcome following IVF-ET using GnRH agonist protocols. In our experience, we have consistently noted a favorable impact of even relatively high levels of estradiol (⬎3500 pg/mL) on day of HCG on pregnancy rates. The relationship between day of HCG estradiol levels and pregnancy outcome in GnRH antagonist protocols for IVF-ET is much less defined. The purpose of this study was to examine the association between estradiol levels on day of HCG and pregnancy rates in IVF-ET cycles using a GnRH antagonist protocol. This study was conducted during the same time interval that we have observed a beneficial effect of increasing estradiol on GnRH agonist cycle outcome. DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 330 IVF-ET cycles were identified as using a GnRH antagonist protocol for prevention of premature luteinization. In general, these patients underwent controlled ovarian hyperstimulation without downregulation using recombinant FSH (range 150 to 600 IU/day) starting on day 2-4 of their menstrual cycles. A daily dose of 0.25mg of a GnRH antagonist was initiated once the lead follicle reached 13-14mm in diameter. HCG (10,000 units) was administered when at least 2 follicles reached 17 mm in diameter and oocyte retrieval was performed 36 hours later. Embryo transfer was performed between days 2 and 6 after retrieval. Data were stratified by intervals of 1000 pg/ml of serum estradiol concentration. The mean patient age, day 3 FSH, cycle number, number of eggs obtained, number of embryos transferred, estradiol level on day of HCG, and pregnancy rates were compared among the estradiol groups. Values are presented as mean ⫾ SD. ANOVA was used to compare the means. RESULTS: The mean patient age was 37.0 ⫾ 4.1 years, number of IVF cycles was 2.9 ⫾ 1.9, day 3 FSH was 7.8 ⫾ 3.7 IU/L, mean estradiol on HCG day was 1699.3 ⫾ 968.5 pg/mL, number of eggs retrieved per cycle was 10.4 ⫾ 7.3, number of embryos transferred was 2.5 ⫾ 1.2, and the pregnancy rate per retrieval was 21.0 ⫾ 0.4 %. As expected, the mean number of eggs retrieved increased while day 3 FSH decreased significantly (P⬍.05) with ascending 1000 pg/ml increments of estradiol concentration. However, there were no differences in mean age, cycle number, number of embryos transferred or pregnancy rates among the estradiol groups (Figure 1). CONCLUSION: Unlike GnRH agonist protocols, the pregnancy rate of
Vol. 84, Suppl 1, September 2005
CONCLUSION: Although there is correlation between Inhibin B and number of retrieved oocyte, but Inhibin B don’t have a high sensitivity and specificity and P.P.V and N.P.V in determining of poor responder and possibility of clinical and chemical pregnancy. Supported by: None P-348 Can IVF Cycle Cancellation be Predicted Using the Antral Follicle Count in Poor Responders? M. McIlveen, J. Skull, W. Ledger. The Jessop Wing, Sheffield, United Kingdom; The University of Sheffield Department of Reproductive Medicine, Sheffield, United Kingdom.
IVF-ET using a GnRH antagonist protocol is not associated with the level of estradiol on day of HCG. Supported by: None. P-347 The Role of Day 5 Inhibin on Predicting Outcome of ART. E. S. Tehrani Nejad, E. Azimi Neko, N. Gholi Nejad, M. Ashrafi, B. H. Rashidi, E. Amirchaghmaghi. Royan Institute, Tehran, Iran (Islamic Republic of); Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of); Faculty of Medicine, Tehran University of Medical Sciences,, Tehran, Iran (Islamic Republic of); Endocrinology and Female Infertility, Royan Institute, Tehran, Iran (Islamic Republic of); Valiasr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of); Endocrinology and Female Infertility Department, Royan Institute, Tehran, Iran (Islamic Republic of). OBJECTIVE: Several methods have been used to predict ovarian reserve and IVF outcome, in response to gonadotropin stimulation. It is proved that day 3 basal FSH level is the most useful method, in that a poorer IVF outcome is associated with higher levels of the hormone even within the normal range also some studies suggested that day 5 Inhibin B is correlated with the number of mature follicle (⬎14m), retrieved and fertilized oocyte. The main purpose of this study is estimation of predictive value of day 5 Inhibin B in number of oocyte in ART cycle. The other purpose is estimation of sensitivity, specificity, positive and negative predictive value of Inhibin B in predicting of clinical pregnancy in ART cycle, and determining of relation between Inhibin B and number of retrieved oocyte, mature follicle (⬎14mm), fertilized oocyte, clinical pregnancy, cancelled cycle and number of hyper stimulation syndrome. DESIGN: Descriptive analytic study MATERIALS AND METHODS: In this, 108 patients(aged 20-35 years, with tubal or male factor or unexplained infertility, 20⬍BMI⬍28 kg/m2, normal FSH level in previous cycle, without endocrine abnormality such as PCOs)undergoing IVF or ICSI cycles in Royan institute and Valiasr reproductive health research center were studied. Inhibin B was measured on 5th day of menstrual cycle. Standard long protocol was used for ovarian stimulation. RESULTS: There was statistically significant correlation between Inhibin B and number of mature follicle (⬎14mm), BMI, number of retrieved oocyte, transferred embryo and chemical pregnancy. Furthermore there was meaningful correlation between Inhibin B and poor response (oocyte number ⬍4) and ovarian hyper stimulation( follicle numberⱖ20) but there was no significant correlation between Inhibin B and dose of gonadotropin that used, days of stimulation, cancelled cycles and clinical pregnancy. Analysis of Roc curve showed that in cut off point of 100pg/ml, Inhibin B has %54 sensitivity, %52 specificity, %24 positive predictive value and %79 negative predictive value for clinical pregnancy. Furthermore in cut off point of 283 pg/ml, Inhibin B 283pg/ml has %77 sensitivity, %30 specificity, %76.7 negative predictive value and %31.2 positive predictive value for poor response.
FERTILITY & STERILITY威
OBJECTIVE: To evaluate whether AFC can predict the outcome of superovulation in a group of women with a history predictive of a poor response. DESIGN: Prospective cohort study. MATERIALS AND METHODS: Women expected to have a poor response to superovulation were prospectively enrolled at the start of an IVF cycle. Criteria for inclusion in the study were: age over 39 years &/or a basal FSH ⬎10 IU/L on any occasion &/or a previous poor response to stimulation (4 oocytes or less). All women had a transvaginal ultrasound examination with an AFC and FSH measurement on day 2 of the treatment cycle. The AFC measured the total number of antral follicles 2-10mm in both ovaries. All women had a short GnRH agonist “flare” protocol with a fixed dose of 250 IU rFSH (Puregon). The main outcome measures were cycle cancellation or a poor response (4 or less oocytes collected). Pregnancy rates were also evaluated.Chi square tests, Fisher’s exact test and receiver operating curve analysis were used where applicable. RESULTS: 87 women were enrolled; 20 aged over 39 years, 22 with a previous poor response, 23 with an FSH ⬎10IU/L & 22 women who fulfilled more than 1 criteria. The mean age was 37.2 (Range 26-44) years. 47/87 (54%) patients enrolled responded poorly. An AFC of less than 5 was more likely to result in a poor response (22/29) than an AFC of 5 or more (25/58) {P⫽ 0.004; LR 3.62}. The area under the receiver-operating curve (ROC) was 0.736. An AFC of less than 5 was also associated with a higher likelihood of cycle cancellation due to a poor response {P⫽ 0.04; LR ⫽2.0}. However an AFC of less than 5 was not associated with a reduced chance of pregnancy. Clinical pregnancy rates {per cycle started} were 6/29 (20.6%) of patients with an AFC ⬍5 compared with 5/58 (8.6%) of those with an AFC of ⱖ5 (p⫽0.11). FSH levels were not predictive of poor response or of likelihood of pregnancy. This was true both for basal FSH levels in the index cycle and for the highest recorded FSH. Women who fulfilled 2 or more of the inclusion criteria had lower pregnancy rates (1/22 {4.5%}) versus those with only one reason for being included (10/65 {15.3%}; P⫽0.17). None of the women ⬎39 years with a raised FSH had an ongoing pregnancy (0/12); whereas 3/23 (13%) of the women ⬎39 with a normal FSH had an ongoing pregnancy {P⫽0.27}. The overall pregnancy rates were poor with only 11/87 (12.6%) clinical pregnancies and 8/87 (9.2%) ongoing pregnancies per cycle started. CONCLUSION: Although an AFC may help to identify women who will have a poor response it does not help to identify those who will ultimately achieve a pregnancy (or not). A high number of these patients were ultimately poor responders, suggesting that prediction of ‘poor response’ can be made from clinical criteria. Measurement of AFC does not appear to be of clinical utility in predicting cycle outcome in this group of patients. As found previously, a raised FSH on any occasion is not useful in predicting either poor response or pregnancy. Supported by: None P-349 Prognostic Factors Affecting the Outcomes of Oocyte Donation Cycles. S. H. Yoon, S. Y. Ku, S. H. Kim, Y. M. Choi, J. G. Kim, S. Y. Moon. Dongguk University International Hospital, Goyang-si Gyeonggi-do, Republic of Korea; College of Medicine Seoul National University Hospital, Seoul, Republic of Korea. OBJECTIVE: Oocyte donation cycle has been a useful model for the assessment of potential factors affecting human pregnancy, such as oocyte quality or uterine receptivity. The purpose of this study was to investigate the variable clinical factors affecting the outcomes of oocyte donation cycles.
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