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Female reproductive capabilities in CSE of chromosome 9 pericentric inversion 46xx (p11q13) (case report)
OBJECTIVE: This study aimed to examine the outcome of unstimulated IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) cycles offered to a subfertile Irish population in an academic ART unit. DESIGN: We performed a retrospective case series of natural IVF/ICSI cycles in couples attending this unit between 01.01.2011 and 31.12.12, and pregnancy outcomes were analysed. MATERIALS AND METHODS: Natural IVF/ICSI was offered as an alternative to closure or egg donation to patients with a previous poor response to stimulation, low ovarian reserve or poor embryo quality. Treatment monitoring was with serial transvaginal ultrasound scans and serum luteinising hormone (LH). Human chorionic gonadotrophin (hCG) trigger was given when follicular size reached 17mm without an LH surge. Oocyte collection was performed 32-36 hours later unless an LH surge occurred when oocyte retrieval was done the next day. RESULTS: Thirty-five natural cycles were performed for 19 couples. Median female age was 36 years. The majority (52%) had previously demonstrated poor response to stimulation or had been stopped for failed stimulation, 14% had low ovarian reserve while 20% had poor embryo quality in previous cycles. Twenty cycles (57%) resulted in oocyte collection. The remaining 43% were stopped due to no follicular recruitment (60%), premature ovulation (27%) or unfavourable endometrium (6%). An oocyte was identified in 85% of all collections. Fertilisation rate per oocyte collection was 86% (ICSI-92%, IVF-80%) while transfer rate per cycle started was 40%. Clinical pregnancy rate per cycle started and clinical pregnancy rate per embryo transfer were 6% and 14%, respectively. CONCLUSION: Acceptable pregnancy rates can be achieved after IVF and ICSI in natural cycles, a potential option for couples reaching the end of the line, where the previous ART treatment has failed or poor response was evident. We are exploring offering this treatment to young patients where a severe male factor is present.
P-1076 Thursday, October 17, 2013 PARADIGM SHIFT IN THE TREATMENT OF INFERTILITY: MULTIDISCIPLINARY AS A NEW AND SUCCESSFUL TREND IN ASSISTED REPRODUCTIVE TECHNOLOGIES. A. Vereczkey, Csajbok, M. Csenki, E. Margittai. Versys Clinics Z. K osa, S. Savay, E. Human Reproduction Institute, Budapest, Hungary. OBJECTIVE: High-quality care for patients faced with infertility should be based on complex treatment offered by the fertility clinic and continuous analyses of patients’ feedback reports. There is a new trend in the services of infertility clinics worldwide: some centers give full range of medical services. The so called ‘‘multidisciplinary’’, or ‘‘complex’’ approach involve many specialties besides gynecology and in vitro fertilization. DESIGN: We aimed to study infertility care from the patients’ viewpoint to obtain in-depth insights into their perspective on infertility care. MATERIALS AND METHODS: We have evaluated patient’s tendency to participate on the offered consultations and examinations, and content analysis was conducted after the process. The data of 763 patients were analyzed who attended our clinic from July 2010 – March 2013. RESULTS: The majority of the average 168 visits/month on the clinic was gynecological checkups (123,3 visit/month). This was followed by visits at endocrinologist (15,7 visit/month) and genetics (13,9 visit/month) consultations. Patients attended less frequently internist, andrologist and psychologist (5.7, 5.4, 4.3 visit/month). The complex approach resulted in a high clinical pregnancy rate (36,9 %) in the last 6 months. Patients’ content analysis was performed after the treatment, which gave a very high satisfaction with the services (98 % would recommend the clinic and were fully satisfied). CONCLUSION: The Versys Clinics Human Reproduction Institute was founded with a purpose of giving a full range of services for patients suffering from infertility, with a multidisciplinary approach being pioneer in Central Europe. Its central idea is that infertility is not any more under the control only of gynecology; many other specialties should be involved. Because of the need of multidisciplinary approach, IVF clinics should take into consideration to change their strategy and give full range of services.
P-1077 Thursday, October 17, 2013 FEMALE REPRODUCTIVE CAPABILITIES IN CSE OF CHROMOSOME 9 PERICENTRIC INVERSION 46XX (p11q13) (CASE REPORT). M. Janelidze, T. Charkviani, T. Barbaqadze, N. Kuchuhidze, L. Chkonia. OBGYN, Georgian American Reproductive Medical Center ReproART, Tbilisi, Select State, Georgia.
FERTILITY & STERILITYÒ
OBJECTIVE: The inversion of chromosome 9 from the point of view of classical genetics is considered as a normal polymorphism. However, there is an evidence that in couples with infertility this kind of chromosome 9 is more common. In addition there is evidence that pericentric inversion more likely increases the risk of chromosomal rearrangements than paracentric inversion. DESIGN: In August of 2012 patient S.A. aproached our clinic shehas chromosome 9 pericentric inversion 46xx (p11q13). At the age of 16 menarche was induced. Last two years she has not taken any medication. Accordingly, during this period she had amenorrhea. At the same month we prescribed Femoston 2/10. About a month later tests showed the following: FSH-1.81mlU / L; LH-2, 93mlU / L; E2-280, 1pg/ml; Free testosterone -0, 3 pg / ml. MATERIALS AND METHODS: Two months later ultrasound showed that the body of the uterus is – 39x26x44, volume - 24 cm3, length of the uterus neck - 35mm, endometrium is expressed weakly, the right ovary – 24x12x18, volume – 3cm3, left ovary – 24x11x14, volume – 2cm3; At November hysteroscopy – polypectomy has been done. RESULTS: Since February of 2013 patient S.A. along with taking Femoston 2/10 was treated with letrozole, gonadotropins (Fostimon, Menopur, Choriomon). Then she undergo artificial insemination and on March 19 pregnancy was revealed. CONCLUSION: Up to present the progress of pregnancy is normal. Supported by: 11 weeks Ongoing pregnancy is Supported by Progesteron microdose Aspirin and Folic aid 600mkg. P-1078 Thursday, October 17, 2013 INCREASED LIVE BIRTHS AMONG PATIENTS USING INTAMUSCULAR VERSUS VAGINAL PROGESTERONE FOR LUTEAL PHASE SUPPORT DURING FROZEN BLASTOCYST K. S. Richter,b K. Devine,a,b TRANSFER. R. J. Heitmann,a,b J. McKeeby,b A. H. DeCherney,a E. A. Widra.b aProgram in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD; bShady Grove Fertility Reproductive Science Center, Rockville, MD. OBJECTIVE: To compare live births in patients receiving intramuscular (IM) versus vaginal progesterone for luteal phase support during frozen blastocyst transfer (FBT) cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All autologous, FBT cycles from January 2003 to April 2012 using either IM or vaginal progesterone replacement in the luteal phase were evaluated. Slow freeze FBT outcomes were analyzed separately from vitrified FBTs. Chi square and student’s t-tests were used as appropriate. Multiple logistic regression was performed to adjust for potential confounders including patient age, day of embryo cryopreservation, number of blastocysts transferred, and percentage of intact cells upon thaw. RESULTS: 4536 FBT cycles were analyzed. In slow freeze cycles, IM progesterone was associated with higher clinical pregnancy (p<0.01) and live birth (p<0.01). This association remained statistically significant (p<0.01) upon multiple logistic regression analysis. In patients using vitrified embryos, IM progesterone was also associated with higher live birth (p< 0.05). This association was maintained upon multiple logistic regression analysis (p<0.05). Day of embryo cryopreservation and percentage of intact cells upon thaw did not differ between progesterone groups.
Slow freeze Transfers Age at Cryo Number Transferred Implantation Clinical Pregnancy Live Birth Vitrification Transfers Age at Cryo Number Transferred Implantation Clinical Pregnancy Live Birth
IM Progesterone
Vaginal Progesterone
p value
2614 33.6 1.7 25.3% 35.4% 25.6%
198 33.1 1.6 16.8% 24.2% 17.2%
0.10 <0.01 <0.01 <0.001 <0.01
1515 33.6 1.6 47.2% 58.5% 45.3%
209 34.8 1.5 43.1% 51.7% 36.1%
<0.001 <0.05 0.17 0.063 <0.05
S459
P-1076 Thursday, October 17, 2013 PARADIGM SHIFT IN THE TREATMENT OF INFERTILITY: MULTIDISCIPLINARY AS A NEW AND SUCCESSFUL TREND IN ASSISTED REPRODUCTIVE TECHNOLOGIES. A. Vereczkey, Csajbok, M. Csenki, E. Margittai. Versys Clinics Z. K osa, S. Savay, E. Human Reproduction Institute, Budapest, Hungary. OBJECTIVE: High-quality care for patients faced with infertility should be based on complex treatment offered by the fertility clinic and continuous analyses of patients’ feedback reports. There is a new trend in the services of infertility clinics worldwide: some centers give full range of medical services. The so called ‘‘multidisciplinary’’, or ‘‘complex’’ approach involve many specialties besides gynecology and in vitro fertilization. DESIGN: We aimed to study infertility care from the patients’ viewpoint to obtain in-depth insights into their perspective on infertility care. MATERIALS AND METHODS: We have evaluated patient’s tendency to participate on the offered consultations and examinations, and content analysis was conducted after the process. The data of 763 patients were analyzed who attended our clinic from July 2010 – March 2013. RESULTS: The majority of the average 168 visits/month on the clinic was gynecological checkups (123,3 visit/month). This was followed by visits at endocrinologist (15,7 visit/month) and genetics (13,9 visit/month) consultations. Patients attended less frequently internist, andrologist and psychologist (5.7, 5.4, 4.3 visit/month). The complex approach resulted in a high clinical pregnancy rate (36,9 %) in the last 6 months. Patients’ content analysis was performed after the treatment, which gave a very high satisfaction with the services (98 % would recommend the clinic and were fully satisfied). CONCLUSION: The Versys Clinics Human Reproduction Institute was founded with a purpose of giving a full range of services for patients suffering from infertility, with a multidisciplinary approach being pioneer in Central Europe. Its central idea is that infertility is not any more under the control only of gynecology; many other specialties should be involved. Because of the need of multidisciplinary approach, IVF clinics should take into consideration to change their strategy and give full range of services.
P-1077 Thursday, October 17, 2013 FEMALE REPRODUCTIVE CAPABILITIES IN CSE OF CHROMOSOME 9 PERICENTRIC INVERSION 46XX (p11q13) (CASE REPORT). M. Janelidze, T. Charkviani, T. Barbaqadze, N. Kuchuhidze, L. Chkonia. OBGYN, Georgian American Reproductive Medical Center ReproART, Tbilisi, Select State, Georgia.
FERTILITY & STERILITYÒ
OBJECTIVE: The inversion of chromosome 9 from the point of view of classical genetics is considered as a normal polymorphism. However, there is an evidence that in couples with infertility this kind of chromosome 9 is more common. In addition there is evidence that pericentric inversion more likely increases the risk of chromosomal rearrangements than paracentric inversion. DESIGN: In August of 2012 patient S.A. aproached our clinic shehas chromosome 9 pericentric inversion 46xx (p11q13). At the age of 16 menarche was induced. Last two years she has not taken any medication. Accordingly, during this period she had amenorrhea. At the same month we prescribed Femoston 2/10. About a month later tests showed the following: FSH-1.81mlU / L; LH-2, 93mlU / L; E2-280, 1pg/ml; Free testosterone -0, 3 pg / ml. MATERIALS AND METHODS: Two months later ultrasound showed that the body of the uterus is – 39x26x44, volume - 24 cm3, length of the uterus neck - 35mm, endometrium is expressed weakly, the right ovary – 24x12x18, volume – 3cm3, left ovary – 24x11x14, volume – 2cm3; At November hysteroscopy – polypectomy has been done. RESULTS: Since February of 2013 patient S.A. along with taking Femoston 2/10 was treated with letrozole, gonadotropins (Fostimon, Menopur, Choriomon). Then she undergo artificial insemination and on March 19 pregnancy was revealed. CONCLUSION: Up to present the progress of pregnancy is normal. Supported by: 11 weeks Ongoing pregnancy is Supported by Progesteron microdose Aspirin and Folic aid 600mkg. P-1078 Thursday, October 17, 2013 INCREASED LIVE BIRTHS AMONG PATIENTS USING INTAMUSCULAR VERSUS VAGINAL PROGESTERONE FOR LUTEAL PHASE SUPPORT DURING FROZEN BLASTOCYST K. S. Richter,b K. Devine,a,b TRANSFER. R. J. Heitmann,a,b J. McKeeby,b A. H. DeCherney,a E. A. Widra.b aProgram in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD; bShady Grove Fertility Reproductive Science Center, Rockville, MD. OBJECTIVE: To compare live births in patients receiving intramuscular (IM) versus vaginal progesterone for luteal phase support during frozen blastocyst transfer (FBT) cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All autologous, FBT cycles from January 2003 to April 2012 using either IM or vaginal progesterone replacement in the luteal phase were evaluated. Slow freeze FBT outcomes were analyzed separately from vitrified FBTs. Chi square and student’s t-tests were used as appropriate. Multiple logistic regression was performed to adjust for potential confounders including patient age, day of embryo cryopreservation, number of blastocysts transferred, and percentage of intact cells upon thaw. RESULTS: 4536 FBT cycles were analyzed. In slow freeze cycles, IM progesterone was associated with higher clinical pregnancy (p<0.01) and live birth (p<0.01). This association remained statistically significant (p<0.01) upon multiple logistic regression analysis. In patients using vitrified embryos, IM progesterone was also associated with higher live birth (p< 0.05). This association was maintained upon multiple logistic regression analysis (p<0.05). Day of embryo cryopreservation and percentage of intact cells upon thaw did not differ between progesterone groups.
Slow freeze Transfers Age at Cryo Number Transferred Implantation Clinical Pregnancy Live Birth Vitrification Transfers Age at Cryo Number Transferred Implantation Clinical Pregnancy Live Birth
IM Progesterone
Vaginal Progesterone
p value
2614 33.6 1.7 25.3% 35.4% 25.6%
198 33.1 1.6 16.8% 24.2% 17.2%
0.10 <0.01 <0.01 <0.001 <0.01
1515 33.6 1.6 47.2% 58.5% 45.3%
209 34.8 1.5 43.1% 51.7% 36.1%
<0.001 <0.05 0.17 0.063 <0.05
S459