IVF outcomes and prevalence of abnormal ovarian reserve tests in women 35 or younger

TABLE 1. Clinical outcomes stratified by basal antral follicle count (BAFC).

THE SOCIETY FOR ASSISTED REPRODUCTIVE TECHNOLOGY

Group 1: Group 2: Group 3: BAFC 8 - 20 BAFC 21 - 30 BAFC > 30 p-value

O-8 Monday, October 19, 2009 4:15 PM IVF OUTCOMES AND PREVALENCE OF ABNORMAL OVARIAN RESERVE TESTS IN WOMEN 35 OR YOUNGER. T. D. Deutch, R. Sherbahn. Advanced Fertility Center of Chicago, Gurnee, IL. OBJECTIVE: There is currently a debate in the literature as to whether or not ovarian reserve testing should be offered to women % 35 seeking infertility treatment. Our goal was to determine the prevalence of abnormal FSH levels and/or abnormal antral follicle counts (AFC) in women % 35 undergoing IVF treatment. In addition, we sought to evaluate the IVF outcomes in cycles with one or more abnormal ovarian reserve tests. DESIGN: Retrospective database review MATERIALS AND METHODS: Our de-identified IVF database was queried in order to identify all cycles for women % 35 where both an AFC and FSH level was recorded. We identified 1380 cycles. We created four groups using the following criteria: normal (FSH<10 and AFC>9), abnormal FSH (FSHR10), abnormal AFC (AFC<10), and abnormal FSH and AFC (FSHR10 and AFC<10). The prevalence of abnormal FSH levels and AFCs in our population was determined. The IVF outcomes were compared between the groups with at least one abnormal test and the normal group using the z-test and t-test where appropriate. RESULTS: See the table below. Prevalence and IVF Outcomes

Normal FSH Abnormal Abnormal Abnormal FSH and AFC FSH AFC and AFC Number Prevalence Pregnancy Rate Live Birth/Ongoing Pregnancy Rate Pregnancy Loss Rate No ET Rate Mean Age

1091 79% 63% 56%

124 9% 44%1 35%1

199 14% 41%1 34%1

34 2% 21%1 9%1

20% 1% 30.9

34%2 6%2 31.71

30%3 7%1 31.91

73%1 9%2 31.4

1

p< .001 p< .01 3 p< .05, ET-Embryo Transfer 2

CONCLUSIONS: We found that IVF outcomes were significantly inferior in cycles in which at least one ovarian reserve test was abnormal. Both AFC and FSH levels were abnormal in only 2.5% of the cycles. However, the pregnancy loss rate was extremely high in this group and the pregnancy rates were extremely low especially given these patients’ young age. Ovarian reserve testing using FSH levels and antral follicle counts are appropriate in women under 35 seeking infertility treatment.

O-9 Monday, October 19, 2009 4:30 PM TREATMENT MODIFICATION BASED ON BASAL ANTRAL FOLLICLE COUNT MAINTAINS HIGH PREGNANCY RATES WHILE PREVENTING OHSS IN EGG DONOR IVF. B. M. Berger, D. Ezcurra. Boston IVF/Harvard Medical School, Waltham, MA; EMD Serono, Inc., Rockland, MA. OBJECTIVE: To compare the results of donor egg IVF after treatment modification based on basal antral follicle count (BAFC). DESIGN: Retrospective cohort observational study. MATERIALS AND METHODS: We analyzed data from oocyte donors treated between Jan. 1, 2006 and Dec. 31, 2007. Using a GnRH antagonist protocol, gonadotropins were initiated at a dose of 150–450 IU of r-hFSH (based on BAFC), and 75 IU of r-hLH (LuverisÒ) daily. Gonadotropins were injected as a single daily injection by mixing the r-hFSH and r-hLH in the same vial. A stratified analysis by BAFC was done using ANOVA (continuous data) and Chi Squared tests (categorical data). The results are expressed as mean  SD or percentages, as appropriate. RESULTS: See Table 1.

FERTILITY & STERILITYÒ

Total cycles [ 249 143 Age (yrs) 27.9  3.9 Basal antral 15.2  3.2 follicle count Total IU FSH 2990  1313 Total IU LH 996  437 # follicles > 14mm 13.2  5.5 Peak E2 (pg/mL) 1273  955 # oocytes total 17.3 7.8 # MII oocytes 14.7  7.2 # embryos frozen 3.4  0.8 1.9  0.3 # embryos transferred Clinical pregnancy 58.6% rate

66 26.2  3.9 25.5  2.8

40 26.9  2.8 38.3  4.6

<0.01 <0.01

2351  912 783  304 15.6  6.5 993  830 18.8  8.2 16.2  7.7 3.5  0.8 1.9  0.4

2052  671 684  223 14.7  6.6 768  608 17.0  7.5 14.5  6.4 4.3  0.4 1.9  0.3

<0.01 <0.01 <0.01 <0.01 0.40 0.39 0.50 0.91

58.5%

58.6%

0.99

CONCLUSIONS: Modification of the initial and subsequent r-hFSH dose yields similar clinical outcomes in oocyte donors with a significantly lower BAFC (p<0.01). In donors with a high BAFC (>30), this management strategy minimizes the risk of OHSS (1/249). Supported by: This work was supported by EMD Serono, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), Rockland, MA.

O-10 Monday, October 19, 2009 4:45 PM ONGOING PREGNANCY RATES WITH CORIFOLLITROPIN ALFA/GONADOTROPHIN-RELEASING HORMONE (GNRH) ANTAGONIST REGIMEN ARE NOT IMPACTED BY ENDOGENOUS LUTEINIZING HORMONE (LH) LEVELS. A. Leader, H. Witjes, B. Mannaerts, K. Gordon ENGAGE Investigators. The Ottawa Fertility Centre, University of Ottawa, Ottawa, ON, Canada; Schering-Plough Research Institute, Schering-Plough, Oss, Netherlands; Schering-Plough Global Medical Affairs, Schering-Plough, Kenilworth, NJ. OBJECTIVE: A retrospective analysis of a corifollitropin alfa trial (ENGAGE) investigated the impact of endogenous LH levels on clinical outcome. Over 750 patients undergoing in vitro fertilization at 34 study sites were treated in the corifollitropin alfa group with a standard GnRH antagonist protocol, which resulted in an ongoing pregnancy rate (OPR) of 38.9% per started cycle. DESIGN: Phase 3, multicenter, multinational, randomized, double-blind, double-dummy, active-controlled, noninferiority clinical trial. MATERIALS AND METHODS: Ovarian stimulation was started on cycle day 2-3 (stimulation day 1) with a single dose of 150 mg corifollitropin alfa, followed by a maximum dose of 200 IU/d recombinant follicle-stimulating hormone from stimulation day 8 onwards. On stimulation day 5, Ganirelix Acetate was initiated at 0.25 mg/d and human chorionic gonadotropin was given when 3 follicles reached R17 mm. Serum LH levels were measured in samples collected on days 1 (prior to stimulation), 5, 8 and were used to stratify women into 3 categories: P75. RESULTS: Percentile values and OPR by serum LH level on stimulation day 1, 5, 8 Ongoing pregnancy rate Stimulation day 1 5 8

P25, P75 of serum LH (IU/L) 3.39, 5.82

Stats

N/n (%) 95%CI 1.18, 4.19 N/n (%) 95%CI <0.622*, 1.58 N/n (%) 95%CI


P25-P75

>P75

176/62 (35.2) 28.2-42.8 181/68 (37.6) 30.5-45.1 216/77(35.6) 29.3-42.4

358/133 (37.2) 32.1-42.4 363/132 (36.4) 31.4-41.5 316/125 (39.6) 34.1-45.2

177/72 (40.7) 33.4-48.3 181/79 (43.6) 36.3-51.2 176/68 (38.6) 31.4-46.3

* More than one fourth of patients had a value below the LLOQ and were all included in the
S3