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Follicular Maturation and Oocyte Cryopreservation in a Turner Variant with Premature Ovarian Failure
and ultrasound identified 15 (33.3%) vs. only 1 of 8 hydrosalpinges were identified in women without Chlamydia exposure. These data suggest that there may be a different etiology for hydrosalpinges with negative chlamydia exposure, e.g., possible adhesions at the terminal end of the tube without chronic infection. Further studies are needed to determine if salpingectomy may not be so important to improve fecundity in this minority group. SUPPORT: None.
P-30 The Effect of Oocyte Reserve on Pregnancy Rates Per Oocyte Harvest in Women Aged 36-39. J. H. Check,a,b A. Whetstone,c J. K. Choe,b R. Cohen.d aCooper Medical School of Rowan University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, NJ; bUMDNJ, Robert Wood Johnson Med. School at Camden, Cooper Hosp./Univ. Med. Cntr., Dept. OB/GYN, Div. Repro. Endo. & Infertility, Camden, NJ; cUMDNJ-SOM, Department of Obstetrics and Gynecology, Stratford, NJ; dPhiladelphia College of Osteopathic Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA. BACKGROUND: Many IVF centers find poor pregnancy outcome when performing IVF-ET in women with diminished ovarian reserve when using conventional or high dosage FSH protocols. However, with mild FSH stimulation pregnancy rates per embryo transfer in these women have been shown to be only slightly less than age peers with normal egg reserve. Recently, data was presented showing only a 15% reduction in live delivered pregnancy rates in women % age 35. However, evaluating a different category, i.e., the pregnancy rate per oocyte harvest (which is the pregnancy rate from a given oocyte retrieval where one can use all embryos fresh or frozen before proceeding to another IVF-ET cycle was 50% less. OBJECTIVE(S): To compare pregnancy rates per embryo transfer and pregnancy rate per oocyte harvest in women aged 36-39. MATERIALS AND METHOD(S): Retrospective review of IVF-ET cycles over a 10 year period in women having the oocyte retrieval between the ages of 36-39. Two groups were compared – those with normal oocyte reserve with day 3 serum FSH %11 mIU/mL and those with diminished oocyte reserve (day 3 serum FSH R12 mIU/mL). Conventional or mild FSH stimulation dosage may have been used for the normal reserve group but only mild stimulation for low reserve group. Only gonadotropin releasing hormone (GnRH) antagonist protocols were compared. Women with a serum estradiol >50 pg/mL were excluded. RESULT(S): Women with normal oocyte reserve had a total of 971 fresh ETs with 427 frozen ETs giving a total of 1398 ETs. Women with diminished oocyte reserve had 492 fresh ETs and 62 frozen ETs for a total of 554 transfers. For the normal reserve group the clinical, viable, and live delivered PRs per fresh ET were 37.3% (362/971), 32.5% (315/971) and 30.7% (298/971). For low egg reserve the PRs were 30.5% (150/492), 26.8% and 22.2%, respectively. For normal reserve the live delivered pregnancy rates per oocyte harvest was 47.2% (411/971) vs. 25.0% (123/492) for those with diminished oocyte reserve. CONCLUSION(S): Thus similar to data using younger women, having normal oocyte reserve only increases the live delivered pregnancy rate per transfer by 20%. Similar to younger women normal oocyte reserve doubles the chance for a live baby when comparing pregnancy rates per oocyte harvest mainly related to an increased number of non-selected embryos from frozen ET. SUPPORT: None.
P-31 Follicular Maturation and Oocyte Cryopreservation in a Turner Variant with Premature Ovarian Failure. J. H. Check,a,b R. Cohen,c J. K. Choe,b A. DiAntonio.b aCooper Medical School of Rowan University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, NJ; bUMDNJ, Robert Wood Johnson Med. School at Camden, Cooper Hosp./Univ. Med. Cntr., Dept. OB/GYN, Div. Repro. Endo. & Infertility, Camden, NJ; cPhiladelphia College of Osteopathic Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA.
FERTILITY & STERILITYÒ
BACKGROUND: A technique was described almost 30 years ago in which by lowering elevated serum follicle stimulating hormone (FSH) with either exogenous estrogen or by gonadotropin releasing hormone (GnRH) agonists (and later GnRH antagonists) one could restore sensitivity of the few remaining follicles to endogenous or exogenous gonadotropins. Thus ovulation and successful pregnancies were achieved even in women in apparent premature menopause and there have been numerous case reports over the 30 years. There has been however no reports of ever inducing ovulation in a woman whose premature menopause was related to Turner’s syndrome. OBJECTIVE(S): To determine if it is possible to allow follicular maturation in a Turner variant with two years of secondary amenorrhea and apparent premature menopause and to proceed with oocyte retrieval and cryopreservation. MATERIALS AND METHOD(S): A 22-year-old woman whose karyotype was 46XX/45X and whose FSH was 95.6 mIU/mL and serum estradiol (E2) <15pg/mL was treated with 20 micrograms of ethinyl estradiol (which does not measure in the ELISA test for serum E2). She was observed with serial blood tests for sera FSH, LH and E2. RESULT(S): On day 34 of ethinyl estradiol treatment a mature follicle of 18mm was achieved with a serum E2 of 251pg/mL. A metaphase I oocyte with many vacuoles was retrieved 34 hours later. It was cryopreserved with vitrification. CONCLUSION(S): Follicular maturation by restoring follicular sensitivity by lowering FSH and thus up-regulating down-regulated FSH receptors has been demonstrated in a Turner variant. This is the first world report of this accomplishment. It would be less likely to work in a woman with Turner’s with primary amenorrhea and sexual infantilism. For the patient’s sake it is hoped several years from now when she has selected her life partner the frozen oocyte will fertilize upon thawing and will produce a live baby. She is planning on attempting this procedure again and freeze oocytes as long as we keep allowing a follicle to mature by this technique. SUPPORT: None.
P-32 Frequency of Live Deliveries Despite at Least One Human Chorionic Gonadotropin Beta Subunit Failing to Double in Two Days. J. H. Check,a,b R. Chern,b C. Dietterich.b aCooper Medical School of Rowan University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, NJ; bUMDNJ, Robert Wood Johnson Med. School at Camden, Cooper Hosp./Univ. Med. Cntr., Dept. OB/GYN, Div. Repro. Endo. & Infertility, Camden, NJ. BACKGROUND: A previous study at our infertility center evaluated 158 consecutive pregnancies. There were 22 slow rising beta-hCG levels with at least one serum level which did not double in 2 days up to a 10,000 mIU/mL. There were 16 of the 22 pregnancies that showed fetal viability at 8 weeks but not at 12. The other 6 failed to show fetal viability at 8 weeks. OBJECTIVE(S): To determine how frequently one finds fetal viability and a live delivery despite at least one human chorionic gonadotropin beta subunit not doubling in 2 days at least once up to 10,000 mIU/mL and yet still having a live delivery. MATERIALS AND METHOD(S): All pregnancies achieved in our practice were prospectively serially evaluated up to 10,000 mIU/mL for hCG. First assessment was at 2 years (the study began January, 2003). Failing to identify one case fulfilling these criteria it was decided to continue the study and terminate it when one case of a successful pregnancy was found or failure to find a case in 10 years whichever came first. RESULT(S): After 8 ½ years and 7,166 pregnancies a case was found with inadequate doubling time of hCG occurred but the woman delivered a live baby. The woman was age 35 with primary infertility. Her first beta-hCG subunit was taken 15 days from conception (treated with clomiphene citrate and luteal phase progesterone (P) support). The Table shows the beta-hCG subunit levels beginning 15 days from conception. The first level that did not rise appropriately was from day 21 to 23 days post-conception only rising from 2,161 to 3,037.1. Though the doubling time was off a serum betahCG level of 3037 was not inappropriate for 23 days post-conception. However, the next level obtained one week later of 8,125 mIU/mL was not only inappropriate for 2 ½ doublings but was inappropriate for 30 days post-conception. Nevertheless she did deliver a live baby. There were 1,035 pregnancies that did not complete the first trimester and 384 showed a viable fetus at 8
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P-30 The Effect of Oocyte Reserve on Pregnancy Rates Per Oocyte Harvest in Women Aged 36-39. J. H. Check,a,b A. Whetstone,c J. K. Choe,b R. Cohen.d aCooper Medical School of Rowan University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, NJ; bUMDNJ, Robert Wood Johnson Med. School at Camden, Cooper Hosp./Univ. Med. Cntr., Dept. OB/GYN, Div. Repro. Endo. & Infertility, Camden, NJ; cUMDNJ-SOM, Department of Obstetrics and Gynecology, Stratford, NJ; dPhiladelphia College of Osteopathic Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA. BACKGROUND: Many IVF centers find poor pregnancy outcome when performing IVF-ET in women with diminished ovarian reserve when using conventional or high dosage FSH protocols. However, with mild FSH stimulation pregnancy rates per embryo transfer in these women have been shown to be only slightly less than age peers with normal egg reserve. Recently, data was presented showing only a 15% reduction in live delivered pregnancy rates in women % age 35. However, evaluating a different category, i.e., the pregnancy rate per oocyte harvest (which is the pregnancy rate from a given oocyte retrieval where one can use all embryos fresh or frozen before proceeding to another IVF-ET cycle was 50% less. OBJECTIVE(S): To compare pregnancy rates per embryo transfer and pregnancy rate per oocyte harvest in women aged 36-39. MATERIALS AND METHOD(S): Retrospective review of IVF-ET cycles over a 10 year period in women having the oocyte retrieval between the ages of 36-39. Two groups were compared – those with normal oocyte reserve with day 3 serum FSH %11 mIU/mL and those with diminished oocyte reserve (day 3 serum FSH R12 mIU/mL). Conventional or mild FSH stimulation dosage may have been used for the normal reserve group but only mild stimulation for low reserve group. Only gonadotropin releasing hormone (GnRH) antagonist protocols were compared. Women with a serum estradiol >50 pg/mL were excluded. RESULT(S): Women with normal oocyte reserve had a total of 971 fresh ETs with 427 frozen ETs giving a total of 1398 ETs. Women with diminished oocyte reserve had 492 fresh ETs and 62 frozen ETs for a total of 554 transfers. For the normal reserve group the clinical, viable, and live delivered PRs per fresh ET were 37.3% (362/971), 32.5% (315/971) and 30.7% (298/971). For low egg reserve the PRs were 30.5% (150/492), 26.8% and 22.2%, respectively. For normal reserve the live delivered pregnancy rates per oocyte harvest was 47.2% (411/971) vs. 25.0% (123/492) for those with diminished oocyte reserve. CONCLUSION(S): Thus similar to data using younger women, having normal oocyte reserve only increases the live delivered pregnancy rate per transfer by 20%. Similar to younger women normal oocyte reserve doubles the chance for a live baby when comparing pregnancy rates per oocyte harvest mainly related to an increased number of non-selected embryos from frozen ET. SUPPORT: None.
P-31 Follicular Maturation and Oocyte Cryopreservation in a Turner Variant with Premature Ovarian Failure. J. H. Check,a,b R. Cohen,c J. K. Choe,b A. DiAntonio.b aCooper Medical School of Rowan University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, NJ; bUMDNJ, Robert Wood Johnson Med. School at Camden, Cooper Hosp./Univ. Med. Cntr., Dept. OB/GYN, Div. Repro. Endo. & Infertility, Camden, NJ; cPhiladelphia College of Osteopathic Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA.
FERTILITY & STERILITYÒ
BACKGROUND: A technique was described almost 30 years ago in which by lowering elevated serum follicle stimulating hormone (FSH) with either exogenous estrogen or by gonadotropin releasing hormone (GnRH) agonists (and later GnRH antagonists) one could restore sensitivity of the few remaining follicles to endogenous or exogenous gonadotropins. Thus ovulation and successful pregnancies were achieved even in women in apparent premature menopause and there have been numerous case reports over the 30 years. There has been however no reports of ever inducing ovulation in a woman whose premature menopause was related to Turner’s syndrome. OBJECTIVE(S): To determine if it is possible to allow follicular maturation in a Turner variant with two years of secondary amenorrhea and apparent premature menopause and to proceed with oocyte retrieval and cryopreservation. MATERIALS AND METHOD(S): A 22-year-old woman whose karyotype was 46XX/45X and whose FSH was 95.6 mIU/mL and serum estradiol (E2) <15pg/mL was treated with 20 micrograms of ethinyl estradiol (which does not measure in the ELISA test for serum E2). She was observed with serial blood tests for sera FSH, LH and E2. RESULT(S): On day 34 of ethinyl estradiol treatment a mature follicle of 18mm was achieved with a serum E2 of 251pg/mL. A metaphase I oocyte with many vacuoles was retrieved 34 hours later. It was cryopreserved with vitrification. CONCLUSION(S): Follicular maturation by restoring follicular sensitivity by lowering FSH and thus up-regulating down-regulated FSH receptors has been demonstrated in a Turner variant. This is the first world report of this accomplishment. It would be less likely to work in a woman with Turner’s with primary amenorrhea and sexual infantilism. For the patient’s sake it is hoped several years from now when she has selected her life partner the frozen oocyte will fertilize upon thawing and will produce a live baby. She is planning on attempting this procedure again and freeze oocytes as long as we keep allowing a follicle to mature by this technique. SUPPORT: None.
P-32 Frequency of Live Deliveries Despite at Least One Human Chorionic Gonadotropin Beta Subunit Failing to Double in Two Days. J. H. Check,a,b R. Chern,b C. Dietterich.b aCooper Medical School of Rowan University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, NJ; bUMDNJ, Robert Wood Johnson Med. School at Camden, Cooper Hosp./Univ. Med. Cntr., Dept. OB/GYN, Div. Repro. Endo. & Infertility, Camden, NJ. BACKGROUND: A previous study at our infertility center evaluated 158 consecutive pregnancies. There were 22 slow rising beta-hCG levels with at least one serum level which did not double in 2 days up to a 10,000 mIU/mL. There were 16 of the 22 pregnancies that showed fetal viability at 8 weeks but not at 12. The other 6 failed to show fetal viability at 8 weeks. OBJECTIVE(S): To determine how frequently one finds fetal viability and a live delivery despite at least one human chorionic gonadotropin beta subunit not doubling in 2 days at least once up to 10,000 mIU/mL and yet still having a live delivery. MATERIALS AND METHOD(S): All pregnancies achieved in our practice were prospectively serially evaluated up to 10,000 mIU/mL for hCG. First assessment was at 2 years (the study began January, 2003). Failing to identify one case fulfilling these criteria it was decided to continue the study and terminate it when one case of a successful pregnancy was found or failure to find a case in 10 years whichever came first. RESULT(S): After 8 ½ years and 7,166 pregnancies a case was found with inadequate doubling time of hCG occurred but the woman delivered a live baby. The woman was age 35 with primary infertility. Her first beta-hCG subunit was taken 15 days from conception (treated with clomiphene citrate and luteal phase progesterone (P) support). The Table shows the beta-hCG subunit levels beginning 15 days from conception. The first level that did not rise appropriately was from day 21 to 23 days post-conception only rising from 2,161 to 3,037.1. Though the doubling time was off a serum betahCG level of 3037 was not inappropriate for 23 days post-conception. However, the next level obtained one week later of 8,125 mIU/mL was not only inappropriate for 2 ½ doublings but was inappropriate for 30 days post-conception. Nevertheless she did deliver a live baby. There were 1,035 pregnancies that did not complete the first trimester and 384 showed a viable fetus at 8
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