Low dose human chorionic gonadotropin may be a cost effective alternative to human menopausal gonadotropin for ovarian stimulation during in vitro fertilization cycles

P-390 Tuesday, October 15, 2013 LOW DOSE HUMAN CHORIONIC GONADOTROPIN MAY BE A COST EFFECTIVE ALTERNATIVE TO HUMAN MENOPAUSAL GONADOTROPIN FOR OVARIAN STIMULATION DURING IN VITRO FERTILIZATION CYCLES. T. Pakrashi,a H. Baydoun,b S. Taylor,a S. Bocca,a L. Stadtmauer,a O. Sergio.a aObstetrics and Gynecology, EVMS/Jones Institute of Reproductive Medicine, Norfolk, VA; bPublic Health, EVMS, Norfolk, VA. OBJECTIVE: The addition of Luteinizing Hormone (LH) activity to Follicle Stimulating Hormone (FSH) during in vitro fertilization (IVF) augments folliculogenesis. Administering LH using human menopausal gonadotropin (hMG) during IVF cycles adds to cost. We sought to explore if low-dose human chorionic gonadotropin (hCG) is a viable alternative to hMG, by comparing the effect of hCG versus hMG on ovarian stimulation and pregnancy rates. DESIGN: Retrospective cohort study of women undergoing IVF cycles at an academic center. MATERIALS AND METHODS: All IVF cycles (n¼55) from 53 patients who underwent fresh, autologous day 2 or 3 embryo transfer cycles from July-December 2012 were analyzed. Either low-dose hCG or hMG was used for ovarian stimulation along with recombinant FSH (rFSH), with pituitary downregulation using either gonadotropin releasing hormone agonist or antagonist. Univariate and multivariate analyses were performed to compare the hCG versus (vs.) hMG groups using Student’s t-test and chi-square test. A multiple regression model was used to calculate propensity scores for each cycle and randomization was performed. Pregnancy rates were compared between the patients exposed to hCG vs. hMG. RESULTS: The two groups of patients exposed either to hCG (n¼19) or hMG (n¼36) were similar in age, BMI, gravidity, IVF cycle attempts, baseline day 3 FSH, total gonadotropin dose, number of oocytes retrieved, number of oocytes in Metaphase II, number of embryos transferred, and percentage positive serum b hCG. Those exposed to hCG were more likely to be non-parous (p¼0.01), have higher peak estradiol level (p¼0.01), and required fewer days of stimulation (p¼0.001). Multiple regression analyses demonstrated no significant difference in pregnancy rates between the hCG vs. hMG groups. (RR¼1.18, 95% CI 0.78, 1.79). CONCLUSION: Low-dose hCG and rFSH either in conjunction with a GnrH agonist or antagonist for pituitary downregulation maybe a viable and less expensive option for IVF when compared to hMG and rFSH. P-391 Tuesday, October 15, 2013 REALTIME AND QUANTITATIVE ASSESSMENT OF THE EFFECTS OF DIFFERENT OVARIAN STIMULATION PROTOCOLS ON THE PROLIFERATION AND CELL CYCLE KINETICS OF GRANULOSA CELLS USING A NEW IMPEDENCE-BASED SYSTEM. O. Oktem,a M. Muftuoglu,b F. Senbabaoglu,b B. Urman.a aObstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey; bBiochemistry, Koc University School of Medicine, Istanbul, Turkey. OBJECTIVE: xCelligence is a new system that allows real-time quantitative analysis of cell proliferation, viability and cytotoxicity by measuring electrical impedance across interdigitated micro-electrodes integrated on the bottom of tissue culture plates. We aimed in this study to analyze the growth characteristics of granulosa cells stimulated with different ovarian stimulation protocols using this new system. DESIGN: A controlled in vitro study. MATERIALS AND METHODS: Immortalized granulosa cells (SIGC) were cultured in 96-well E-96 plate (7000 cells/well) and treated with different stimulation protocols as shown in the table. Rec-FSH (GonalF), GnRH agonist (Leuprolide acetate) and GnRH antagonist (Cetrorelix acetate) were used at doses that correspond to their serum or intrafollicular concentrations. Cell proliferation was monitored for every 30 min for 120 h. The results were expressed by normalized cell index (CI). RESULTS: Rec-FSH induced proliferation of granulosa cells in a dosedependent manner compared to unstimulated control cells. The cells stimulated with rec-FSH exhibited higher mitotic activity and reached the log and plateau phases of growth earlier than unstimulated cells. Their number at the end of the culture was significantly higher than unstimulated ones. Addition of either leuprolide acetate or cetrorelix to FSH at the indicated doses did not influence the growth rate of the cells compared to those stimulated with only rec-FSH.

S260

ASRM Abstracts

Proliferative index of granulosa cells stimulated with different protocols

Groups Untreated control FSH 12 mIU/mL FSH 25 mIU/mL FSH 50 mIU/mL FSH (50mIU/mL)+Cetrorelix (5ng/mL) FSH (50mIU/mL)+Leuprolide (50ng/mL)

CI (0 hr)

CI (120hr)

0,810.02 0.850.01 0.840.02 0.860.02 0.850.01 0.800.04

5.260.02* 7.610.04 7.710.01 7.930.03 7.900.02 7.190.03

*:p<0.05. CONCLUSION: This system might be a useful tool for studies in reproduction. As a broader application of these findings a wide variety of drugs or chemicals can be quantitatively analyzed for their mitogenic or cytotoxic effects on granulosa cells. P-392 Tuesday, October 15, 2013 TRIGGER TYPE AND STIMULATION PROTOCOL DO NOT IMPACT THE PRESENCE OF MULTINUCLEATED EMBRYOS DETECTED BY TIME LAPSE IMAGING. K. J. Holoch, E. Soto, R. Flyckt, J. Goldberg, N. Desai. Cleveland Clinic Fertility Center, Beachwood, OH. OBJECTIVE: Preliminary data using real time observation of embryo development have suggested variations in the incidence of multinucleation between different protocols for controlled ovarian hyperstimulation. We sought to explore this possible connection in a large cohort of human embryos imaged during fresh cycles of in vitro fertilization. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: 1145 embryos from 121 patients were evaluated using an EmbryoScopeÒ time-lapse incubator. Patients had completed standard controlled ovarian hyperstimulation cycles using either a GnRH agonist or GnRH antagonist protocol. Final oocyte maturation was triggered with either leuprolide acetate (LA) or human chorionic gonadotropin (HCG). Selection criteria for participation were age <40 years and 7 to 12 oocytes retrieved. Exclusion criteria included the use of donor eggs or prenatal genetics. Using time lapse imaging, the presence or absence of multinucleation in developing embryos was identified and tested for an association with stimulation protocol and/or trigger medication type with Fisher’s exact test. RESULTS: Of 121 patients studied, 96 (79%) versus 25 (21%) underwent GnRH agonist versus antagonist cycles, respectively. 75 (62%) versus 46 (38%) underwent HCG trigger versus LA trigger. Patients were 33.8  3.8 years old. There was no difference in the occurrence of multinucleation for patients stimulated with agonist versus antagonist cycles (p¼0.76). Similarly, trigger medication type did not significantly impact the incidence of multinucleation (p¼1.0). Additionally, the percent of multinucleated embryos per patient did not relate to either stimulation protocol or trigger type. CONCLUSION: In contrast to initial reports from other centers, our findings do not demonstrate an association between medication choices for stimulation and/or trigger shot and the presence of multinucleated embryos. P-393 Tuesday, October 15, 2013 A PROSPECTIVE RANDOMISED CONTROLLED STUDY OF SERUM ANTI-MULLERIAN HORMONE (AMH) AS A PREDICTIVE MARKER OF OVARIAN HYPERSTIMULATION SYNDROME (OHSS) IN IVF-ICSI CYCLES. M. Singh,a R. Singh,b aInfertility, Bhopal Test-Tube-Baby Centre, Bhopal, MP, India; bInfertility, Bhopal TestTube-Baby Centre, Bhopal, MP, India OBJECTIVE: The objective of this prospective randomised controlled study was to determine whether serum Anti Mullerian Hormone (AMH) level can predict ovarian hyperstimulation syndrome (OHSS) prior to the selection of controlled ovarian stimulation (COS) protocols. DESIGN: A total of 380 IVF-ICSI cycles at our centre from 2007 to 2012 were prospectively studied. The patients in the study underwent a long GnRH-Agonist or an Antagonist protocol after randomisation using a computer generated list. MATERIALS AND METHODS: Baseline hormone profile and AMH were determined on day-2. The ovarian response was monitored using transvaginal ultrasound on a daily basis until the day of hCG administration. Blood sampling for estradiol (E2) level was performed after five days of

Vol. 100, No. 3, Supplement, September 2013