Factors impacting endometrial thickness (EMT) and outcomes in letrozole intrauterine insemination (IUI) cycles

transfer of three or more morphologically good day 3 embryos and/or day 5 blastocysts (3BB or above according to Gardner scoring system). MATERIALS AND METHODS: The infertile women with a history of RIF underwent endometrial biopsy. CE was histopathologically diagnosed using immunohistochemistry for the plasmacyte marker CD138. Following the antibiotic treatment for CE, second-look/third-look endometrial biopsy and immunohistochemistry was performed to assess histopathologic cure rate. The cumulative live birth rate in the following embryo transfer cycles were prospectively compared between the treated RIF/CE group and the RIF/non-CE group (infertile women with RIF but not CE). RESULTS: Three hundred thirty-five women met the diagnostic criteria of RIF. CE was diagnosed in 34.6% (116/335) of infertile women with a history of RIF. Of them, 115 patients (99.1%) desired for antibiotic treatment. The cumulative histopathologic cure rate of CE was 92.2% (106/115) following the first-line treatment (oral doxycycline, 200 mg/day, 14 days), and 99.1% (114/115) following the second-line treatment (a combination of oral metronidazole, 500 mg/day, 14 days and oral ciprofloxacin 400 mg/day, 14 days). The cumulative live birth rate in the first embryo transfer cycle (p ¼ 0.044, odds ratio 1.69) and three embryo transfer cycles (p ¼ 0.039, odds ratio 1.67) was significantly higher in the treated RIF/CE group (32.2%, 36/115 and 37.4%, 43/115, respectively) than in the RIF/non-CE group (22.0%, 45/205 and 26.3%, 54/205, respectively). CONCLUSIONS: In this prospective observational study, we found CE in about one-third of infertile women with a history of RIF. The histopathologic cure rate and live birth rate following antibiotic treatment are encouraging in these patients. P-368 Wednesday, October 19, 2016 DIFFERENTIAL EFFECT OF OVARIAN HYPERSTIMULATION ON THE SERUM PROGESTERONE LEVEL, EMBRYO QUALITY AND PREGNANCY RATES: AN ANALYSIS OF 3,767 IVF CYCLES. O. Oktem,a,b K. Yakin,a,b A. Isiklar,b B. Balaban,b B. Urman.a,b aObstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey; bWomen’s Health Center Assisted Reproduction Unit, American Hospital, Istanbul, Turkey. OBJECTIVE: To investigate if there is any differential subgroup effect of ovarian stimulation on serum progesterone (P) level at ovulation trigger, embryo quality and pregnancy rates. DESIGN: A non-interventional, retrospective cohort data of a single center. MATERIALS AND METHODS: 3,767 IVF cycles with GnRH agonist long protocol were included. Of these 2,971 were fresh and the remaining 796 were frozen ET IVF cycles. Nine different evenly spaced intervals were constructed for serum P level on the hCG day (<0.5/0.5-0.9/1-1.4/ 1.5-1.9/2-2.4/2.5-2.9/3-3.4/3.5-3.9/4-4.5ng/mL). Then, the IVF cycles in each of these P intervals were further divided into low (< 6 oocytes), normo (6-12 oocytes) and high-responders (>12 oocytes). RESULTS: The CPR [from 45.7% to 23% (p¼0.03)] and IR [from 17.1% to 7.6% (p<0.01)] declined in a gradual and continuous fashion with the progressive rise of serum P on the hCG day from <0.5 to the 4.0-4.4ng/mL interval in the fresh cycles. Such a decrease was not observed in the CPR (62.5% vs. 65.4%, p>0.05) and IR (24.8% vs. 24.2%, p>0.05) of the frozen cycles. Serum P was significantly associated with the success of pregnancy (OR (95%CI): 0.80 (0.73-0.88), p<0.001) in the fresh but not in the frozen cycles (0.88 (0.75-1.31), p>0.05). In the subgroup analysis of the fresh cycles, elevation of serum P level from <0.5 to the 4.0-4.4ng/mL interval caused a drastic decline in the CPR of the normo-responders (52.7% vs. 16.6%, respectively, p¼0.02) but not in the high-responders (52.1% vs. 33.3%, respectively, p¼0.33). In the low-responders, a smaller rise from <0.5 to 2.0-2.4ng/mL was sufficient to decrease the CPR from 24.4% to zero. On multivariate logistic regression analysis the threshold intervals detrimental to the pregnancy success were 1.5-1.9 for the low-responders, and 2.0-2.4 and 3.0-3.4 ng/mL for the normo and high-responders, respectively. The high-responders continued to produce grade-1 embryos in increasing numbers until serum P reaches the 3.0-3.4ng/mL interval whereas the corresponding intervals for the low and normo-responders were 2.0-2.4 and 2.5-2.9 ng/mL, respectively. Overall, there was a positive impact of the number of good-quality embryos transferred (up to 3) on the chance of pregnancy [(OR (95%CI): 1.25 (1.17-1.34), p<0.001)]. This effect was gradually diminished with rising serum P level and finally was lost at 3.0-3.4 ng/ mL in the high-responders, and 2.5-2.9 and 2.0-2.4 ng/mL intervals in the normo and low-responders, respectively. CONCLUSIONS: The detrimental effect of premature rise in serum P on the endometrial receptivity may begin gradually and still allow the implanta-

e244

ASRM Abstracts

tion of good-quality embryos. This may also explain why high-responders are more capable of deterring the deleterious effect of premature rise in serum P on the pregnancy success than low and normo-responders. P-369 Wednesday, October 19, 2016 FACTORS IMPACTING ENDOMETRIAL THICKNESS (EMT) AND OUTCOMES IN LETROZOLE INTRAUTERINE INSEMINATION (IUI) CYCLES. K. A. Green,a M. Evans,b I. Sasson,c A. S. Vale,d A. DeCherney,a K. Devine,e E. A. Widra,e M. J. Hill.a aNIH- NICHD, Bethesda, MD; bOklahoma State University, Broken Arrow, OK; cShady Grove Fertility of PA, Wayne, PA; dLankenau Medical Center, Wynnewood, PA; eShady Grove Fertility Center, Washington, DC. OBJECTIVE: To examine the effects of letrozole IUI cycle characteristics on EMT and clinical pregnancy. DESIGN: Retrospective cohort. MATERIALS AND METHODS: IUI cycles from 2014-2015 in which letrozole was used alone or in combination with gonadotropins were identified. Analyzed variables included: letrozole alone vs. in combination with gonadotropins, exogenous estrogen use for endometrial development, patient age, serum estradiol (E2) concentration, number of follicles >14mm on day of hCG trigger, and postwash total motile sperm (TMS) count. The relationships between these variables and both EMT and clinical pregnancy were assessed. Statistical associations were determined using GEE models and ROC curves. RESULTS: Of 890 cycles analyzed, 533 had EMT measured two days before IUI. The number of follicles >14mm was positively associated with EMT (P<0.003) and exogenous estrogen use was negatively associated with EMT (P<0.001), likely because patients with a thin endometrium were given supplementation. Serum E2 was not associated with EMT. Adjusted models demonstrated a positive association between both the number of follicles >14mm (OR 1.36, P¼0.009) and TMS (OR 1.01, P¼0.02) with clinical pregnancy. ROC curves showed that follicle number predicted clinical pregnancy (AUC¼0.6, P¼0.008), whereas EMT (AUC¼0.52) and serum E2 (AUC¼0.54) did not. In adjusted GEE models, age, serum E2, EMT, estrogen use, and gonadotropin use were not associated with clinical pregnancy. Clinical pregnancy rates were similar at any EMT >4mm, regardless of whether exogenous estrogen or gonadotropins were administered in addition to letrozole (Table). The sample size for EMT %4mm was too small to make any conclusions within this subgroup. Endometrial Thickness and Clinical Pregnancy Rate in Letrozole IUI Cycles

EMT (mm) %4 5 6 7 8 9 10 11 12 R13

N

Clinical Pregnancy Rate

7 11 46 83 129 104 60 44 21 28

0% 17% 17% 21% 13% 17% 15% 13% 15% 13%

CONCLUSIONS: EMT in letrozole IUI cycles was not associated with clinical pregnancy when >4mm. The addition of exogenous estrogen or gonadotropins did not significantly affect EMT or clinical pregnancy. Only the number of follicles and TMS were associated with clinical pregnancy. P-370 Wednesday, October 19, 2016 FERTILITY OUTCOMES IN WOMEN WITH HYPOPITUITARISM (HP) WHO UNDERGO ART TREATMENT. J. Rodriguez-Purata,a L. Sekhon,a,b J. A. Lee,a M. C. Whitehouse,a A. B. Copperman,a,b B. Sandler.a,b aReproductive Medicine Associates of New York, New York, NY; bObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. OBJECTIVE: Patients with HP face many reproductive challenges. A number of studies evaluating these patients reported sub-optimal outcomes both in terms of PRs and pregnancy outcome. While new-age fertility advancements have been thought to improve treatment outcome for these

Vol. 106, No. 3, Supplement, September 2016