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Is there prognostic value in early cleavage (EC) assessment for patients 40 years and older?
P-180 Tuesday, October 20, 2009 ORGANOCHLORINE COMPOUNDS IN URBAN FERTILE AND INFERTILE WOMEN. A. M. X. Bastos, M. do Carmo Borges Souza, G. L. Almeida Filho, T. M. Krauss, T. Pavesi, L. E. Silva. Ginecologia e Obstetrıcia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Ginecologia e Obstetrıcia, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; ENSP - FIOCRUZ, Rio de Janeiro, Brazil. OBJECTIVE: The aim of this study was to identify and to quantify the levels of organochlorine compounds in an urban infertile women group compared to fertile ones trying to detect endocrine disruptor effects. DESIGN: case-control study MATERIALS AND METHODS: We studied women looking for infertility treatment (study group: n¼15) and those that spontaneously became pregnant (control group: n¼21).Blood samples were obtained to quantify the levels of serum concentrations of diclorodifeniltricloroetano (DDT), diclorodifeniltricloroetileno (DDE), hexaclorobenzeno (CCB) and polychlorinated biphenyls (PCBs 138, 153 and 180) through capillary gas chromatography. In the study group serum levels of progesterone was measured. RESULTS: The organochlorine pp DDE, the main metabolite of DDT was detected in 100% (15/15) of women in the study group and in 95.3% (20/21) of control group with significant difference (p¼0,001). The PCBs 138,153 and 180,detected in all patients of the study group, had a negative correlation with the progesterone levels. In the control group the congeners 138 and 153 were detected in 85.7% (18/21) of the patients while the 180 was detected in 71.4% (15/21), (Table 1). The main etiology for infertility were: 33.3% of tubal factor, 20% of ovulatory dysfunction and 20% of both tubal and ovarian. TABLE 1. Levels of organochlorine analyzed
Organochlorine Pesticides HCB ppDDE ppDDT PCBs 138 153 180
n
Control Group
n
Study Group
7 20 5
0.090.10 0.880.81 0.660.14
7 15 2
0.200.37 3.023.57 9.1211.88
18 18 15
0.060.08 0.070.06 0.070.05
15 15 15
0.070.07 0.070.05 0.080.06
Values are expreseed as mean DP CONCLUSIONS: The urban population is exposed to the most prevalent organochlorine compounds. Our results suggest a negative correlation between the presence of organochlorine and the plasma levels of progesterone.
plus mild was 0.853 0.100 and that of moderate plus severe 1.151 0.105 (p¼0.042). Values are mean S.E. CONCLUSIONS: This study showed that serum BPA concentrations were higher in larger leiomyoma group (moderate plus severe) than smaller group (mild plus control). This suggests that the serum BPA may be related to the leiomyoma growth. Supported by: This study was supported by Korean endocrne disruptor risk ealuation project.
P-182 Tuesday, October 20, 2009 IS THERE PROGNOSTIC VALUE IN EARLY CLEAVAGE (EC) ASSESSMENT FOR PATIENTS 40 YEARS AND OLDER? K. E. Tucker, C. A. M. Jansen. IVF, Reinier de Graaf Group, Voorburg, ZH, Netherlands. OBJECTIVE: We increasingly see more older ART patients, but note that ongoing pregancy rates (PR) drop at R41 years. Since transferring embryos (ET) from a cohort þEC generally results in more pregnancies, we wanted to see if EC remains predictable for IVF/ICSI patients 40 and older. DESIGN: Retrospective, non-randomised study. MATERIALS AND METHODS: 305 IVF/ICSI patients from our center, R40 years of age (August, 2003 – March, 2009), were included. Embryos were evaluated Day 1 after follicular aspiration (FA) for fertilization and then later that day for EC. Mostly,1 or 2 good quality embryos ( EC) were transferred on Day 2 or 3. Pregnancy was defined as a positive urine test 15 days after FA and embryo development was monitored by transvaginal ultrasound at 4, 7 and 10 weeks after ET. Analysed values with p< .05 were significant. Select data are expressed as mean SD. RESULTS: Two main groups of patients were analysed: Patients 40 (Group 1; n¼138) and R41 years old (Group 2; n¼167). Each group was further subdivided after EC assessment: Those not checked for EC (Control: Group 1: NC; n¼41, Group 2: NC; n¼50), those with no EC embryos (Group 1: -EC; n¼62, Group 2: -EC; n¼72) and those with R 1 embryo in the cohort with EC (Group 1: þEC; n¼35, Group 2: þEC; n¼45). In Group 1, þEC patients received significantly fewer embryos than those from the -EC group (1.8 .4 vs. 1.97 .54; p< .03), whereas patients from Group 2: þEC received the most at ET (2.11 .38; p< .05). PR, implantation rate (IR), IR with heartbeat (þHB) and ongoing IR were higher for Group 1: þEC (48.6, 27.0, 22.0 and 17.5%) compared to Group 1: -EC (22.6, 11.5, 8.2 and 6.6%, respectively; p< .046). PR, IR and þHB were not different in Group 2. Delivery rates were also not different in Group 2: NC and Group 2: -EC (18.0 vs. 12.5%), but surprisingly, there were no ongoing pregnancies in Group 2: þEC. CONCLUSIONS: EC remains highly prognostic for a postive pregnancy outcome in patients 40 years old. Notably, above this age, there is no benefit of EC assessment.
P-181 Tuesday, October 20, 2009
P-183 Tuesday, October 20, 2009
SERUM BISPHENOL – A CONCENTRATIONS FROM THE LEIOMYOMA PATIENTS. M. Han, I.-J. Choi, M. Cha, J.-M. Kim. Obstetrics and Gynecology, Dong-A University, College of Medicine, Busan, Korea; Anatomy and Cell Biology, Dong-A University, College of Medicine, Busan, Korea.
ENVIRONMENTAL PHTHALATES AND BISPHENOL A DO NOT PREFERENTIALLY ACCUMULATE IN HUMAN FOLLICULAR FLUID. S. P. Krotz, S. A. Carson, C. Tomey, J. Witmyer, J. E. Buster. Division of Reproductive Endocrinology & Infertility, Women & Infants’ Hospital of RI/Brown University, Providence, RI; AXYS Analytical Services Ltd, Sydney, BC, Canada.
OBJECTIVE: To investigate whether the serum concentration of bisphenol-A (BPA) are related to the leiomyoma growth. DESIGN: Case-control study MATERIALS AND METHODS: The leiomyoma patients were divided into three groups, such as mild (n¼38), moderate (n¼33) and severe (n¼30) group according to the size and symptom. The mild group was defined as the presence of at least one or two leiomyomas under 3cm in diameter. The moderate group was defined as the presence of 3 to 5 cm leiomyoma. The severe group was defined as the presence of above 5cm leiomyoma. The control (n¼30) group was defined as the absence of any leiomyoma. The identification and diameter measurements of leiomyoma were performed by ultrasonography. Serum BPA concentrations were measured by Liquid chromatography and mass spectrometry (LC/MS). RESULTS: Excepting three extraordinary high levels from two control patients and one moderate patient, the mean values of leiomyoma groups were 0.774 0.135 ng/ml (mild, n¼38), 1.064 0.141 ng/ml (moderate, n¼32) and 1.244 0.157 ng/ml (severe, n¼30) (p¼0.066). The value of control group (n¼28) was 1.015 0.146 ng/ml. Comparing four groups into two groups like control plus mild and moderate plus severe, the mean of control
S138
Abstracts
OBJECTIVE: To test the hypothesis that preferential accumulation of environmental phthalates and bisphenol A, present in medical plastics, occurs in the human ovarian microenvironment DESIGN: Laboratory sample analysis MATERIALS AND METHODS: Discarded follicular fluid from 5 women exposed to medical plastics for 3 weeks while undergoing IVF was collected in 120 ml jars with Quinn’s Advantage media during oocyte retrieval. The jars were submitted to AXYS labs (Sydney, B.C.) and extracted for phthalates and bisphenol A with AXYS method MLA-059 (Kato et al, Anal Chem 2005). Using High-Performance Liquid Chromatography, samples were measured for Monomethyl phthalate, Monoethyl phthalate, Mono-nbutyl phthalate, Monobenzyl phthalate, Mono-2-ethylhexyl phthalate, Mono-(2-ethyl-5-oxohexyl) phthalate, Mono-(2-ethyl-5-hydroxyhexyl) phthalate and Bisphenol A. One sample was spiked with the seven phthalates and four samples were spiked with d6 bisphenol A to serve as a control. Concentrations of phthalates and bisphenol A were compared to minimum levels in the literature shown to have a detrimental impact on in vitro oocytes from laboratory animals.
Vol. 92., No. 3, Supplement, September 2009
Organochlorine Pesticides HCB ppDDE ppDDT PCBs 138 153 180
n
Control Group
n
Study Group
7 20 5
0.090.10 0.880.81 0.660.14
7 15 2
0.200.37 3.023.57 9.1211.88
18 18 15
0.060.08 0.070.06 0.070.05
15 15 15
0.070.07 0.070.05 0.080.06
Values are expreseed as mean DP CONCLUSIONS: The urban population is exposed to the most prevalent organochlorine compounds. Our results suggest a negative correlation between the presence of organochlorine and the plasma levels of progesterone.
plus mild was 0.853 0.100 and that of moderate plus severe 1.151 0.105 (p¼0.042). Values are mean S.E. CONCLUSIONS: This study showed that serum BPA concentrations were higher in larger leiomyoma group (moderate plus severe) than smaller group (mild plus control). This suggests that the serum BPA may be related to the leiomyoma growth. Supported by: This study was supported by Korean endocrne disruptor risk ealuation project.
P-182 Tuesday, October 20, 2009 IS THERE PROGNOSTIC VALUE IN EARLY CLEAVAGE (EC) ASSESSMENT FOR PATIENTS 40 YEARS AND OLDER? K. E. Tucker, C. A. M. Jansen. IVF, Reinier de Graaf Group, Voorburg, ZH, Netherlands. OBJECTIVE: We increasingly see more older ART patients, but note that ongoing pregancy rates (PR) drop at R41 years. Since transferring embryos (ET) from a cohort þEC generally results in more pregnancies, we wanted to see if EC remains predictable for IVF/ICSI patients 40 and older. DESIGN: Retrospective, non-randomised study. MATERIALS AND METHODS: 305 IVF/ICSI patients from our center, R40 years of age (August, 2003 – March, 2009), were included. Embryos were evaluated Day 1 after follicular aspiration (FA) for fertilization and then later that day for EC. Mostly,1 or 2 good quality embryos ( EC) were transferred on Day 2 or 3. Pregnancy was defined as a positive urine test 15 days after FA and embryo development was monitored by transvaginal ultrasound at 4, 7 and 10 weeks after ET. Analysed values with p< .05 were significant. Select data are expressed as mean SD. RESULTS: Two main groups of patients were analysed: Patients 40 (Group 1; n¼138) and R41 years old (Group 2; n¼167). Each group was further subdivided after EC assessment: Those not checked for EC (Control: Group 1: NC; n¼41, Group 2: NC; n¼50), those with no EC embryos (Group 1: -EC; n¼62, Group 2: -EC; n¼72) and those with R 1 embryo in the cohort with EC (Group 1: þEC; n¼35, Group 2: þEC; n¼45). In Group 1, þEC patients received significantly fewer embryos than those from the -EC group (1.8 .4 vs. 1.97 .54; p< .03), whereas patients from Group 2: þEC received the most at ET (2.11 .38; p< .05). PR, implantation rate (IR), IR with heartbeat (þHB) and ongoing IR were higher for Group 1: þEC (48.6, 27.0, 22.0 and 17.5%) compared to Group 1: -EC (22.6, 11.5, 8.2 and 6.6%, respectively; p< .046). PR, IR and þHB were not different in Group 2. Delivery rates were also not different in Group 2: NC and Group 2: -EC (18.0 vs. 12.5%), but surprisingly, there were no ongoing pregnancies in Group 2: þEC. CONCLUSIONS: EC remains highly prognostic for a postive pregnancy outcome in patients 40 years old. Notably, above this age, there is no benefit of EC assessment.
P-181 Tuesday, October 20, 2009
P-183 Tuesday, October 20, 2009
SERUM BISPHENOL – A CONCENTRATIONS FROM THE LEIOMYOMA PATIENTS. M. Han, I.-J. Choi, M. Cha, J.-M. Kim. Obstetrics and Gynecology, Dong-A University, College of Medicine, Busan, Korea; Anatomy and Cell Biology, Dong-A University, College of Medicine, Busan, Korea.
ENVIRONMENTAL PHTHALATES AND BISPHENOL A DO NOT PREFERENTIALLY ACCUMULATE IN HUMAN FOLLICULAR FLUID. S. P. Krotz, S. A. Carson, C. Tomey, J. Witmyer, J. E. Buster. Division of Reproductive Endocrinology & Infertility, Women & Infants’ Hospital of RI/Brown University, Providence, RI; AXYS Analytical Services Ltd, Sydney, BC, Canada.
OBJECTIVE: To investigate whether the serum concentration of bisphenol-A (BPA) are related to the leiomyoma growth. DESIGN: Case-control study MATERIALS AND METHODS: The leiomyoma patients were divided into three groups, such as mild (n¼38), moderate (n¼33) and severe (n¼30) group according to the size and symptom. The mild group was defined as the presence of at least one or two leiomyomas under 3cm in diameter. The moderate group was defined as the presence of 3 to 5 cm leiomyoma. The severe group was defined as the presence of above 5cm leiomyoma. The control (n¼30) group was defined as the absence of any leiomyoma. The identification and diameter measurements of leiomyoma were performed by ultrasonography. Serum BPA concentrations were measured by Liquid chromatography and mass spectrometry (LC/MS). RESULTS: Excepting three extraordinary high levels from two control patients and one moderate patient, the mean values of leiomyoma groups were 0.774 0.135 ng/ml (mild, n¼38), 1.064 0.141 ng/ml (moderate, n¼32) and 1.244 0.157 ng/ml (severe, n¼30) (p¼0.066). The value of control group (n¼28) was 1.015 0.146 ng/ml. Comparing four groups into two groups like control plus mild and moderate plus severe, the mean of control
S138
Abstracts
OBJECTIVE: To test the hypothesis that preferential accumulation of environmental phthalates and bisphenol A, present in medical plastics, occurs in the human ovarian microenvironment DESIGN: Laboratory sample analysis MATERIALS AND METHODS: Discarded follicular fluid from 5 women exposed to medical plastics for 3 weeks while undergoing IVF was collected in 120 ml jars with Quinn’s Advantage media during oocyte retrieval. The jars were submitted to AXYS labs (Sydney, B.C.) and extracted for phthalates and bisphenol A with AXYS method MLA-059 (Kato et al, Anal Chem 2005). Using High-Performance Liquid Chromatography, samples were measured for Monomethyl phthalate, Monoethyl phthalate, Mono-nbutyl phthalate, Monobenzyl phthalate, Mono-2-ethylhexyl phthalate, Mono-(2-ethyl-5-oxohexyl) phthalate, Mono-(2-ethyl-5-hydroxyhexyl) phthalate and Bisphenol A. One sample was spiked with the seven phthalates and four samples were spiked with d6 bisphenol A to serve as a control. Concentrations of phthalates and bisphenol A were compared to minimum levels in the literature shown to have a detrimental impact on in vitro oocytes from laboratory animals.
Vol. 92., No. 3, Supplement, September 2009