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Lower serum hCG levels after ovidrel® administration do not reflect compromised oocyte maturation in donor oocyte IVF cycles
gonadotropin stimulation started. Serum AMH levels were measured twice simultaneously using two different immunoassays: Beckman Coulter Immunotech(BC, Marseille France) and Diagnostic Systems Laboratories(DSL, Webster TX) kits. Correlation between AMH levels measured by the two kits was analyzed. Receiver operating characteristic(ROC) curve analysis was performed and cut-off values for COH outcomes in AMH levels were evaluated for each kit. RESULTS: AMH levels measured by the two kits were similar and significantly correlated each other(r¼0.967, p<0.001; regression equation BC¼1.102 x DSL -0.042). Concentrations of AMH measured by both kits were significantly correlated with COH outcomes such as, number of oocytes, and estradiol level on hCG day. Both AMH levels performed well in prediction of pregnancy, poor response, and cycle cancellation. TABLE 1. Results of the ROC curve analysis of serum AMH concentration discriminating COH outcomes.
Outcome
Methods
Ongoing pregnancyy AMH BC AMH DSL Poor responsex AMH BC AMH DSL Cycle cancellation AMH BC AMH DSL
Cut-off Sensitivity Specificity (ng/mL) (%) (%) 3.02 3.28 1.08 1.01 0.78 0.66
62.5 62.5 95.0 95.9 97.8 98.5
67.9 72.9 76.5 80.4 75.7 86.5
AUC (95% CI)* 0.694 (0.599 – 0.789) 0.708 (0.616 – 0.799) 0.881 (0.812 – 0.951) 0.901 (0.837 – 0.965) 0.922 (0.853 – 0.991) 0.948 (0.892 – 1.004)
AMH BC: AMH by Beckman Coulter assay; AMH DSL: AMH by DSL assay. * All values are significant (p <0.001). y pregnancy maintained after 12 weeks of gestation. x % 3 oocytes retrieved. CONCLUSIONS: Our data suggest that the two assays for AMH measurements provide similar results. Serum AMH levels measured by the two kits both could be used as COH outcome predictors with similar reference values. Supported by: None. P-338 SUCCESSFUL CYCLE OUTCOMES OF SEVERELY HYPERSTIMULATED ICSI PATIENTS WITH LONG LUTEAL LEPROLIDE ACETATE PROTOCOL PRETREATED WITH ORAL CONTRACEP¨ ztu¨rk Turhan, A. Ayrim, TIVE PILL BY EARLY COASTING. N. O Z. C. Iltemir Duvan, A. Pekel. Obstetrics and Gynecology, Fatih University Medical School, Ankara, Turkey. OBJECTIVE: Coasting is an effective way of avoiding cycle cancellation, while decreasing the risk of severe OHSS. Coasting is reported to result in fewer eggs retrived and embryos produced when compared with non-coasting cycles. Our aim was to describe the influence of early coasting strategy on cycle outcomes in the GnRH-analog (GnRHa) long luteal protocol cycles pretreated with oral contraceptive pill. DESIGN: This is a retrospective analysis of ICSI patients in the Fertility Management Unit of Fatih University Medical School. MATERIALS AND METHODS: The women had been downregulated according to the long protocol with GnRHa after oral contraceptive-pretreated cycle. Gonadotrophins at a dosage of 150-450 IU was initiated when serum E2 concentrations fell below 50 pg/ml. The starting regimen was fixed for the first 3 days and thereafter the dose of gonadotrophins was adjusted according to the individual ovarian response. When at least three follicles reached 17 mm in diameter, HCG was administered. Coasting was applied in cycles where E2 serum concentrations were >3000 pg/ml in the presence of growing follicles are of an intermediate size (12–16 mm) with fewer than three follicles >17 mm. HCG was administered when serum E2 concentrations had dropped below 4500 pg/l and at least 3 follicles reached 17 mm in diameter. RESULTS: Out of 316 ovarian stimulation cycles, in 39 (12.3%) severely hyperstimulated cycles early coasting were performed (Group A). The remaining 277 patients formed the non-coasting group (Group B). The clinical characteristics of the two groups were similar with respect to the womans age, body mass index and duration and cause of infertility. The volumes of both ovaries were significantly higher in Group A. The mean total dose and duration of administration of gonadotrophins and the mean serum estradiol concentrations on the day of HCG administration were similar in both groups. The mean number of oocytes retrieved was similar but the mean number of mature (M2) oocytes was significantly higher in group B. The fertilization and cleavage rates and the mean numbers of embryos transferred were not different in both groups. Embryos were transferred in 27/31 cycles
S220
Abstracts
in group A and in 185/277 cycles in group B. There was no significant difference in clinical pregnancy rates (37% vs 35%) between groups. CONCLUSIONS: Early coasting can be used successfully in GnRHa long luteal protocol cycles pretreated with oral contraceptive pill for management of the hyperresponding patients. Supported by: Fatih University. P-339 LOWER SERUM HCG LEVELS AFTER OVIDRELÒ ADMINISTRATION DO NOT REFLECT COMPROMISED OOCYTE MATURATION IN DONOR OOCYTE IVF CYCLES. N. C. Douglas, B. Yu, J. G. Wang, G. S. Nakhuda, M. V. Sauer, M. H. Thornton II. Obstetrics and Gynecology, Columbia University, New York, NY. OBJECTIVE: Recombinant hCG (r-hCG, OvidrelÒ, Serono Inc.) and urinary hCG (u-hCG) have been used to promote final oocyte maturation for IVF. Successful embryo implantation following IVF using donated oocytes requires synchronization of the recipient’s endometrium with the donor’s controlled ovarian hyperstimulation. Recipients initiate progesterone supplementation the day after their oocyte donor has injected hCG. To document compliance, we measure serum hCG levels 12-14 hours after donor self-administration. For ease of administration and improved patient tolerance, use of subcutaneous (SC) OvidrelÒ instead of intramuscular (IM) u-hCG was initiated. However, a decrease in serum hCG levels was noted. We sought to determine if lower hCG levels associated with OvidrelÒ were associated with any measurable detrimental effects on the oocytes or resulting embryos. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Oocyte donors (n¼100) underwent pituitary desensitization with a GnRH agonist followed by controlled ovarian hyperstimulation with a standard gonadotrophin dose (FSH 150U þ hMG 75U). Dosage adjustments were made in cases of excessive ovarian response. When lead follicles reached R 18mm, donors were instructed to inject either uhCG (10000 IU) IM or OvidrelÒ (250 mg) SC. Serum hCG levels were measured by ELISA. A Spearman’s correlation test was used to determine the relationship between serum hCG and BMI. Mean values for total number of oocytes, number of mature occytes, fertilization rates, and recipients’ clinical pregnancy rates were compared using unpaired t tests. RESULTS: After administration of u-hCG, serum hCG levels correlated negatively with BMI (r ¼ -0.25, p <0.05). No correlation was noted after OvidrelÒ injection.
Age (yr) BMI (kg/m2) Peak estradiol (pg/mL) Serum hCG (mIU/mL) [median] Total # of oocytes Mature oocytes Fertilization rate Clinical pregnancy rate
u-hCG (n¼85)
OvidrelÒ (n¼15)
25.7 þ/- 0.3 21.3 þ/- 0.2 3203 þ/- 107 220.7 þ/- 11.2 [191]
25.8 þ/- 0.7 20.7 þ/- 0.5 3819 þ/- 505 113.4 þ/- 14.7* [117]
20.3 þ/- 0.7 16.8 þ/- 0.7 66 þ /- 0.2% 63%
20.9 þ/- 2.8 16.2 þ/- 2.8 65 þ/- 0.1% 67%
* p < 0.05. CONCLUSIONS: Serum hCG levels after u-hCG injection were correlated with BMI. OvidrelÒ injection resulted in significantly lower serum hCG levels and these levels did not correlate with BMI. Despite lower serum hCG levels, all clinical outcome parameters were statistically identical. Thus, SC OvidrelÒ can be reliably used for oocyte donation. Supported by: None. P-340 PROGNOSTIC INDICATORS FOR FRESH IVF OUTCOMES IN WOMEN R 43 YEARS OLD: WHAT CAN WE LEARN FROM OUR SUCCESSES? M. Luna, A. B. Copperman, L. Chuang, M. Duke, L. Grunfeld, J. Barritt. Reproductive Medicine Associates of New York, New York, NY; Reproductive Medicine Associates of New York, New York, NY. OBJECTIVE: To determine the clinical and laboratory characteristics associated with successful IVF outcomes for patients R43 years old. DESIGN: Retrospective data analysis. MATERIALS AND METHODS: All patients R43 undergoing a fresh autologous IVF cycle from August 2002 to March 2008 were included for
Vol. 90, Suppl 1, September 2008
Outcome
Methods
Ongoing pregnancyy AMH BC AMH DSL Poor responsex AMH BC AMH DSL Cycle cancellation AMH BC AMH DSL
Cut-off Sensitivity Specificity (ng/mL) (%) (%) 3.02 3.28 1.08 1.01 0.78 0.66
62.5 62.5 95.0 95.9 97.8 98.5
67.9 72.9 76.5 80.4 75.7 86.5
AUC (95% CI)* 0.694 (0.599 – 0.789) 0.708 (0.616 – 0.799) 0.881 (0.812 – 0.951) 0.901 (0.837 – 0.965) 0.922 (0.853 – 0.991) 0.948 (0.892 – 1.004)
AMH BC: AMH by Beckman Coulter assay; AMH DSL: AMH by DSL assay. * All values are significant (p <0.001). y pregnancy maintained after 12 weeks of gestation. x % 3 oocytes retrieved. CONCLUSIONS: Our data suggest that the two assays for AMH measurements provide similar results. Serum AMH levels measured by the two kits both could be used as COH outcome predictors with similar reference values. Supported by: None. P-338 SUCCESSFUL CYCLE OUTCOMES OF SEVERELY HYPERSTIMULATED ICSI PATIENTS WITH LONG LUTEAL LEPROLIDE ACETATE PROTOCOL PRETREATED WITH ORAL CONTRACEP¨ ztu¨rk Turhan, A. Ayrim, TIVE PILL BY EARLY COASTING. N. O Z. C. Iltemir Duvan, A. Pekel. Obstetrics and Gynecology, Fatih University Medical School, Ankara, Turkey. OBJECTIVE: Coasting is an effective way of avoiding cycle cancellation, while decreasing the risk of severe OHSS. Coasting is reported to result in fewer eggs retrived and embryos produced when compared with non-coasting cycles. Our aim was to describe the influence of early coasting strategy on cycle outcomes in the GnRH-analog (GnRHa) long luteal protocol cycles pretreated with oral contraceptive pill. DESIGN: This is a retrospective analysis of ICSI patients in the Fertility Management Unit of Fatih University Medical School. MATERIALS AND METHODS: The women had been downregulated according to the long protocol with GnRHa after oral contraceptive-pretreated cycle. Gonadotrophins at a dosage of 150-450 IU was initiated when serum E2 concentrations fell below 50 pg/ml. The starting regimen was fixed for the first 3 days and thereafter the dose of gonadotrophins was adjusted according to the individual ovarian response. When at least three follicles reached 17 mm in diameter, HCG was administered. Coasting was applied in cycles where E2 serum concentrations were >3000 pg/ml in the presence of growing follicles are of an intermediate size (12–16 mm) with fewer than three follicles >17 mm. HCG was administered when serum E2 concentrations had dropped below 4500 pg/l and at least 3 follicles reached 17 mm in diameter. RESULTS: Out of 316 ovarian stimulation cycles, in 39 (12.3%) severely hyperstimulated cycles early coasting were performed (Group A). The remaining 277 patients formed the non-coasting group (Group B). The clinical characteristics of the two groups were similar with respect to the womans age, body mass index and duration and cause of infertility. The volumes of both ovaries were significantly higher in Group A. The mean total dose and duration of administration of gonadotrophins and the mean serum estradiol concentrations on the day of HCG administration were similar in both groups. The mean number of oocytes retrieved was similar but the mean number of mature (M2) oocytes was significantly higher in group B. The fertilization and cleavage rates and the mean numbers of embryos transferred were not different in both groups. Embryos were transferred in 27/31 cycles
S220
Abstracts
in group A and in 185/277 cycles in group B. There was no significant difference in clinical pregnancy rates (37% vs 35%) between groups. CONCLUSIONS: Early coasting can be used successfully in GnRHa long luteal protocol cycles pretreated with oral contraceptive pill for management of the hyperresponding patients. Supported by: Fatih University. P-339 LOWER SERUM HCG LEVELS AFTER OVIDRELÒ ADMINISTRATION DO NOT REFLECT COMPROMISED OOCYTE MATURATION IN DONOR OOCYTE IVF CYCLES. N. C. Douglas, B. Yu, J. G. Wang, G. S. Nakhuda, M. V. Sauer, M. H. Thornton II. Obstetrics and Gynecology, Columbia University, New York, NY. OBJECTIVE: Recombinant hCG (r-hCG, OvidrelÒ, Serono Inc.) and urinary hCG (u-hCG) have been used to promote final oocyte maturation for IVF. Successful embryo implantation following IVF using donated oocytes requires synchronization of the recipient’s endometrium with the donor’s controlled ovarian hyperstimulation. Recipients initiate progesterone supplementation the day after their oocyte donor has injected hCG. To document compliance, we measure serum hCG levels 12-14 hours after donor self-administration. For ease of administration and improved patient tolerance, use of subcutaneous (SC) OvidrelÒ instead of intramuscular (IM) u-hCG was initiated. However, a decrease in serum hCG levels was noted. We sought to determine if lower hCG levels associated with OvidrelÒ were associated with any measurable detrimental effects on the oocytes or resulting embryos. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Oocyte donors (n¼100) underwent pituitary desensitization with a GnRH agonist followed by controlled ovarian hyperstimulation with a standard gonadotrophin dose (FSH 150U þ hMG 75U). Dosage adjustments were made in cases of excessive ovarian response. When lead follicles reached R 18mm, donors were instructed to inject either uhCG (10000 IU) IM or OvidrelÒ (250 mg) SC. Serum hCG levels were measured by ELISA. A Spearman’s correlation test was used to determine the relationship between serum hCG and BMI. Mean values for total number of oocytes, number of mature occytes, fertilization rates, and recipients’ clinical pregnancy rates were compared using unpaired t tests. RESULTS: After administration of u-hCG, serum hCG levels correlated negatively with BMI (r ¼ -0.25, p <0.05). No correlation was noted after OvidrelÒ injection.
Age (yr) BMI (kg/m2) Peak estradiol (pg/mL) Serum hCG (mIU/mL) [median] Total # of oocytes Mature oocytes Fertilization rate Clinical pregnancy rate
u-hCG (n¼85)
OvidrelÒ (n¼15)
25.7 þ/- 0.3 21.3 þ/- 0.2 3203 þ/- 107 220.7 þ/- 11.2 [191]
25.8 þ/- 0.7 20.7 þ/- 0.5 3819 þ/- 505 113.4 þ/- 14.7* [117]
20.3 þ/- 0.7 16.8 þ/- 0.7 66 þ /- 0.2% 63%
20.9 þ/- 2.8 16.2 þ/- 2.8 65 þ/- 0.1% 67%
* p < 0.05. CONCLUSIONS: Serum hCG levels after u-hCG injection were correlated with BMI. OvidrelÒ injection resulted in significantly lower serum hCG levels and these levels did not correlate with BMI. Despite lower serum hCG levels, all clinical outcome parameters were statistically identical. Thus, SC OvidrelÒ can be reliably used for oocyte donation. Supported by: None. P-340 PROGNOSTIC INDICATORS FOR FRESH IVF OUTCOMES IN WOMEN R 43 YEARS OLD: WHAT CAN WE LEARN FROM OUR SUCCESSES? M. Luna, A. B. Copperman, L. Chuang, M. Duke, L. Grunfeld, J. Barritt. Reproductive Medicine Associates of New York, New York, NY; Reproductive Medicine Associates of New York, New York, NY. OBJECTIVE: To determine the clinical and laboratory characteristics associated with successful IVF outcomes for patients R43 years old. DESIGN: Retrospective data analysis. MATERIALS AND METHODS: All patients R43 undergoing a fresh autologous IVF cycle from August 2002 to March 2008 were included for
Vol. 90, Suppl 1, September 2008