- Email: [email protected]
Luteal phase estradiol (E2) and progesterone (P) profiles differ between conception and non-conception in-vitro fertilization-embryo transfer (IVF-ET) cycles utilizing pituitary down-regulation.
P-418 The role of preparatory cycles in ovum recipients: A retrospective study. S. H. Jun, C. Racowsky, J. H. Fox, M. D. Hornstein. Brigham and Women’s Hosp, Boston, MA. Objective: Preparatory cycles for egg donation recipients are often performed to demonstrate endometrial adequacy of the recipient before undergoing the actual egg donation cycle. This study was undertaken to see if preparatory cycles affected in vitro fertilization (IVF) outcome in ovum donation recipients. Design: A retrospective study examining 94 consecutive ovum donation recipients undergoing their first egg donation cycle at Brigham and Women’s Hospital between January 1998 and September 2000. Materials/Methods: Out of 94 ovum recipients included in this study, 52 of them underwent preparatory cycles. These cycles were carried out with Lupron, estrogen and progesterone. Endometrial biopsies were performed on days 10 –12 of progesterone supplementation and endometrial dating of at least 23 days was considered adequate. In some of the patients undergoing preparatory cycles, the endometrial stripe was measured by transvaginal ultrasound on days 18 –21 of estrogen therapy. The main outcome measure was an ongoing pregnancy of at least 12 weeks gestation or a live birth. Results: Pregnancy rates in women with and without preparatory cycles were 40.4% (21/52) and 47.6% (20/42), respectively. Among ovum recipients who underwent preparatory cycles, the percentages of adequate endometrial biopsies in pregnant versus nonpregnant groups were 76.2% (16/21) and 83.3% (25/30), respectively. In patients with endometrial stripes ⱖ7 mm by transvaginal ultrasound, 88.9% (24/27) of the biopsies were considered adequate. And in those ⬍7 mm, 72.7% (8/11) were considered adequate. All results showed no statistical significance. Conclusions: The practice of performing preparatory cycles in egg donation recipients is used on the assumption that confirmation of endometrial adequacy may result in improved pregnancy rates. This study failed to demonstrate improved pregnancy rates in women undergoing preparatory cycles for egg donation. In addition, our results showed that there was no correlation between adequate endometrial biopsies and higher pregnancy rates as well as no significant association between histologic findings and endometrial thickness in women who underwent both biopsy and ultrasound. More studies in the future will be necessary to further support our findings.
P-419 Cytogenetic study of couples and their children born after intracytoplasmic sperm injection (ICSI). L. Martelli, A. C. Nassr, V. M. Motta, R. L. Baruffi, L. A. Laureano, J. G. Franco. Ctr for Human Reproduction Sinha´ Junqueira Maternity Fdn, Ribeirao Preto, Brazil. Objective: Cytogenetic study is an important tool in the investigation of fertility and chromosomal abnormalities are considered to be major contributors to the genetic risks of the ICSI procedure. The rate of abnormal karyotypes in infertile couples and in pregnancies conceived through ICSI is presumably increased, with the incidence ranging from 0.5 to 7.3%, depending on the sample and especially on the methodology used by different groups. The aim of the present study was to determine the incidence of chromosomal abnormalities in couples and their children born after ICSI using a protocol of cytogenetic investigation. Design: A cytogenetic investigation in couples and their children born after ICSI procedure. Materials/Methods: The sample consisted of 45 couples undergoing ICSI (Group I) and 70 children (36 boys and 34 girls) born to them after this procedure (Group II). The mean age of the women was 34 years (range 27– 46 yr) and the mean age of the men was 41 years (range 27– 61). Chromosomal analysis was performed on cultures of peripheral blood lymphocytes by standard methods including GTG, CBG and high resolution bandings. The protocol included the analysis of 100 metaphases per case for mosaicism exclusion. The F.I.S.H. technique was used when necessary. Results: In Group I, two men and two women (4/90 ⫽ 4.4%) presented a major chromosome aberration. One case showed a 46,X,del (Yq) karyotype and three cases presented gonosomal mosaicisms: one patient with 47,XYY/46,XY and two patients with 45,X/47,XXX/46,XX. In Group II, three children (3/70 ⫽ 4.2%) showed abnormal karyotypes: one 45,X, one mosaic 47,XY,⫹mar/46,XY and one structural aberration, 46, X, del (Yq),
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transmitted by the father. Structural variants (15ps⫹) or polymorphisms involving the centromeric heterochromatin of chromosomes 1, 9 and Y were detected in 9 cases (10%) of Group I and in 9 cases (12.8%) of Group II. Conclusions: The results obtained after cytogenetic investigation of couples submitted to ICSI agree with those reported in the literature, demonstrating that the most frequent chromosome-related causes of infertility are sex chromosome abnormalities. The percentage of de novo chromosomal aberrations in the children of the present series was 2.85%; however, additional studies are needed to state that there is a higher prevalence of gonosomal aberrations after treatment with ICSI. The protocol used to exclude mosaicism in the two Groups rules out the hypothesis that the cause of the increased frequency of sex chromosome aneuploidy is due to parental mosaicism.
P-420 Frequency of monozygotic twinning associated with in vitro fertilization and embryo transfer (IVF-ET). W. L. Gentry, M. A. Henry, E. S. Critser. Advanced Fertility Group, Indianapolis, IN; Reproductive Care of Indiana, Indianapolis, IN; Clarian Health Partners, Indianapolis, IN. Objective: To assess the frequency of monozygotic twinning after IVFET. Design: A retrospective review of all in vitro fertilization procedures resulting in an embryo transfer procedure from January 1, 1997 through December 31, 2000. Materials/Methods: One thousand and sixty five IVF-ET records were reviewed. Each record was classified as to day of transfer (day 3 vs. day 5/6). Ultrasound data confirming an intrauterine gestational sac was used to determine intrauterine pregnancy (IUP). Number of documented beating hearts was compared to number of gestational sacs to indicate the presence of a monozygotic twin. Data were analyzed by Fisher’s Exact Test. Results: Six hundred and six transfers were performed on day 3, resulting in 213 (36%) IUPs. Four hundred and fifty nine transfers were performed on day 5/6, resulting in 236 (51%) IUPs. There was only one documented monozygotic twin amongst pregnancies established with day 3 transfer as compared to 16 monozygotic pregnancies resulting from day 5/6 transfer (p ⬍ .01). One of the 16 monozygotic pregnancies involved a monozygotic triplet. Day 5/6 transfers which included at least one top quality blastocyst had a higher (p ⬍ .01) pregnancy rate (112/168; 66%) as compared to day 5/6 transfers with no top quality blastocysts (102/206; 49.5%). Monozygotic twin rates tended (p ⬍ .06) to be lower when the transfer included a top quality blastocyst (4/112; 3.5%) as compared to transfers with no top quality blastocysts (11/202; 10.7%). Day 5/6 transfers with no blastocysts had a lower pregnancy rate (22/85; 26% IUP) with one (1/22;4.5%) monozygotic pregnancy.
Day 3 Day 5/6
IVF-ET
IUP
Monozygotic twinning
696 459
213 (36%) 236 (51%)
1 (0.5%) 16 (6.7%)
Conclusions: These data suggest that current practice involving day 5/6 embryo transfer may have a greater risk for monozygotic pregnancies. Each program should rigorously evaluate their own data in order to best counsel patients for risks associated with multiple pregnancy.
P-421 Luteal phase estradiol (E2) and progesterone (P) profiles differ between conception and non-conception in-vitro fertilization-embryo transfer (IVF-ET) cycles utilizing pituitary down-regulation. S. Ben-Ozer, S. Eisenkop, M. Vermesh. The Ctr for Fertility and Gynecology, Tarzana, CA; Women’s Cancer Ctr, Tarzana, CA. Objective: 1) To characterize the relationship between luteal E2 and P dynamics and cycle outcome and 2) to identify a luteal E2 level or E2:P ratio predictive of pregnancy in IVF-ET utilizing pituitary down-regulation. Design: A prospective clinical study of patients undergoing IVF at our institution between 8/00 –11/00. 74 patients satisfied the inclusion criteria [age ⱕ43 years, weight within 20% of ideal, fresh IVF-ET with own
Vol. 76, No. 3, Suppl. 1, September 2001
oocytes, normal prolactin and thyroid function, successful pituitary downregulation (E2 ⬍40 pg/ml), at least four follicles ⱖ16 mm with E2 ⱖ150 pg/ml/follicle, endometrium ⱖ7 mm, embryo availability, absence of severe ovarian hyperstimulation]. Only the first cycle was included if there were multiple cycles. IRB approval was not required as the protocol did not vary from our routine. Materials/Methods: Mid-luteal pituitary down-regulation was achieved with leuprolide acetate (0.5–1.0 mg) and followed by ovarian stimulation with human menopausal gonadotropins. Transvaginal oocyte aspiration was performed 36 hours after human chorionic gonadotropin (hCG, 10,000 IU) was administered, and embryos were transferred three days later. P support (50 mg IM daily) began on the evening of aspiration. Day zero signifies ovulation, i.e. oocyte retrieval. Study days correspond to day of hCG injection, ET, and early, mid, and late-luteal phase. Serum E2 and P levels were obtained by chemiluminescence on days –2, ⫹3, ⫹7, ⫹11 and hCG was determined on day ⫹14. E2:P ratios were calculated. Statistical analysis for pregnant (n ⫽ 39) vs. non-pregnant (n ⫽ 35) cycles and clinical (n ⫽ 33) vs. negative/non-clinical pregnancies (n ⫽ 41) was done with two-tail group t, chi-square or Mann-Whitney tests as applicable. Results: Pregnant vs. non-pregnant cycles were similar in baseline and in-vitro parameters, except for cryopreservation. Mean E2 was significantly higher on day ⫹11 for pregnant vs. non-pregnant cycles (257 ⫾ 251 vs. 57 ⫾ 40 pg/ml; P ⬍ 0.0001), and for clinical pregnancies vs. negative/nonclinical pregnancy cycles (238 ⫾ 200 vs. 57 ⫾ 40 pg/ml; P ⬍ 0.0001). Mean P was not statistically related to cycle outcome. Mean E2:P ratios for pregnant vs. non-pregnant cycles were dramatically higher on day ⫹11 (P ⬍ 0.0001) and marginally higher on day ⫹3 (P ⫽ 0.03). Mean E2:P for clinical pregnancies vs. negative/non-clinical pregnancy cycles were significantly higher only on day ⫹11 (P ⬍ 0.0001). In non-pregnant cycles, mean E2 on day ⫹11 plus 3 standard deviations (99% about the mean) was below 200 pg/ml (range 16 –199). E2 level ⬎200 pg/ml on luteal day ⫹11 was highly predictive of conception. Conclusions: According to our data, late-luteal E2 level and E2:P ratio are predictive of pregnancy following IVF-ET with pituitary down-regulation. An E2 level ⬎200 pg/ml on luteal day ⫹11 is highly predictive of conception.
P-422 A prospective randomized study of vigorous flushing of cervical canal with culture medium prior to embryo transfer. K. Kyono, N. Fukunaga, K. Haigo, A. Yoshida, S. Tokuda, H. Kamiyama. Lady’s Clin Kyono, Furukawa, Japan; Kiba Park Clin, Tokyo, Japan. Objective: The aim of this prospective randomized study was to evaluate if vigorous flushing of the cervical canal prior to embryo transfer has an effect on clinical pregnancy rates in patients undergoing in vitro fertilization (IVF) and embryo transfer (ET). Design: Prospective two center randomized study. Materials/Methods: 184 patients attending our IVF-ET program were allocated alternatively to one of two groups. In the first group (group A), embryo transfer was effected after removing the cervical mucous with a tuberculin syringe and cleaning the cervix with a cotton swab soaked with culture medium.In the second group (group B), embryo transfer was effected after removing the cervical mucous with a tuberculin syringe followed by vigorous washing of the cervical canal using the same medium.There were no statistically significant differences between both groups regarding the age of the patients (34.0 ⫾ 4.4 in group A, 35.3 ⫾ 4.6 in group B, p ⫽ 0.053) or the number of embryos replaced (2.8 ⫾ 0.9 in group A, 2.9 ⫾ 1.1 in group B, p ⫽ 0.475) or uterine endometrial thickness at the time of ET (11.6 ⫾ 2.2 in group A, 11.5 ⫾ 2.1 in group B, p ⫽ 0.744). The same replacement catheter was used in all patients (Kitazato Supply Co., Japan). Results: Twenty six pregnancies resulted in group A (28.0%) compared to 28 pregnancies in group B (30.8%). This difference is not statistically significant (Chi-Squared analysis ⫽ 0.175, p ⫽ 0.675). Conclusions: Vigorous flushing of cervical canal with culture medium at the time of ET does not have an effect on clinical pregnancy rates. But,we must be very careful to do not put culture medium into the uterine cavity, because we did not succeed in pregnancy in such cases.
FERTILITY & STERILITY威
CLINICAL FEMALE INFERTILITY AND GYNECOLOGY P-423 Chlamydia trachomatis (CT) testing practices in a commercially insured population. J. Armstrong, S. Leeds, H. Sangi-Haghpeykar. Baylor College of Medicine, Houston, TX. Objective: Little data is available on the prevalence of CT in commercially insured female populations. However, it is assumed that the infection is significantly underdiagnosed in this group. A major factor in the underdiagnosis of infection is inadequate behavioral and sexual risk factor ascertainment by clinicians and, possibly, the failure to test patients considered to be high-risk for infection. The purpose of this study is to examine the prevalence of CT testing in a commercially insured female population and to examine factors that may be associated with testing. Design: A retrospective chart review. Materials/Methods: Medical records of 600 commercially insured women ages 15–25 presenting for ambulatory obstetrical and gynecological care to a suburban private practice were reviewed. Information on demographic, reproductive, sexual, and contraceptive practices, as well as risk status for STDs was collected. Patients considered at high-risk for CT infection were those with any of the following characteristics: sexually active women ⬍20 years of age, new or multiple sexual partners in the past 12 months, past history or treatment of a STD, past or current partner with a history of a STD, non-use of condoms, or presenting complaint suggestive of pelvic infection. These risk factors are part of the screening guidelines of the Centers for Disease Control and Prevention (CDC) or the American College of Obstetricians and Gynecologists (ACOG). Univariate and multivariate logistic regression analysis, and chi-square tests were performed to summarize data. Results: The overall rate of testing was 82 of 600 patients (13.6%). Risk factors for CT infection were documented in 165 patients (27.5%), of whom 51 (30.9%) were tested. High-risk women were more likely to be tested than women without documented risk factors (OR ⫽ 5.8, p ⬍ .0001). Specific risk factors associated with CT testing were: male gender of physician (OR ⫽ 2.7, p ⫽ .0005), problem-related visit type as compared to routine/ annual examinations (OR ⫽ 2.8, p ⫽ .002), prior pregnancy (OR ⫽ 2.3, p ⫽ .0007), presenting complaints suggestive of pelvic infection (OR ⫽ 9.9, p ⬍ .0001), sexual activity in the past 12 months (OR ⫽ 12.3, p ⫽ ⬍.0001), new sexual partner in past 12 months (OR ⫽ 8.8, p ⫽ .006), history of STD in past 12 months (OR ⫽ 4.1, p ⫽ .0007), and sexual activity in women ⬍20 years of age (OR ⫽ 4.8, p ⬍ .0001). Thirty-six percent of sexually active women ⬍20 years of age were tested as compared to 22% of the entire sexually active study group. The estimated prevalence of infection was 4.9% (4 out of 82 patients) in the study population. Among the 4 patients with positive tests, all had at least one established risk factor for CT. Conclusions: The overall rate of CT testing among commercially insured women is low (13.6%). Although the rate of testing is higher among patients with identified risk factors (31%), testing practices fail to conform to established screening guidelines. The underlying reasons for the failure to test patients identified as high-risk requires further investigation. Supported by: Texas Department of Health.
P-424 Axillary oophoropexy for girls receiving abdominal/pelvic radiation with over 20 year follow-up. M. R. Laufer, J. Upton, S. Schuster, H. Grier, S. Emans, L. Diller. Children’s Hospital/Brigham & Women’s Hospital/ Dana Farber Cancer Institute/Harvard Medical Sch, Boston, MA; Children’s Hospital/Harvard Medical Sch, Boston, MA; Dana Farber Cancer Institute/ Harvard Medical Sch, Boston, MA. Objective: To describe the technique of axillary oophoropexy utilized for girls undergoing high dose abdominal and pelvic radiation therapy and assess reproductive endocrine outcome. Design: A case series. Materials/Methods: Three girls (Subjects 1, 2, and 3) ages 5, 2, and 1 year underwent surgical resection for Wilms tumor. In a subsequent operation each had an oophoropexy to the axillary region. Subjects 1 and 2 had slices of the ovary placed in the area of the triceps and deltoid muscle, respectively. Subject 3 had microanastomosis of the blood vessels of the ovary to branches of the anterior axillary blood vessels. Each subject then received
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P-419 Cytogenetic study of couples and their children born after intracytoplasmic sperm injection (ICSI). L. Martelli, A. C. Nassr, V. M. Motta, R. L. Baruffi, L. A. Laureano, J. G. Franco. Ctr for Human Reproduction Sinha´ Junqueira Maternity Fdn, Ribeirao Preto, Brazil. Objective: Cytogenetic study is an important tool in the investigation of fertility and chromosomal abnormalities are considered to be major contributors to the genetic risks of the ICSI procedure. The rate of abnormal karyotypes in infertile couples and in pregnancies conceived through ICSI is presumably increased, with the incidence ranging from 0.5 to 7.3%, depending on the sample and especially on the methodology used by different groups. The aim of the present study was to determine the incidence of chromosomal abnormalities in couples and their children born after ICSI using a protocol of cytogenetic investigation. Design: A cytogenetic investigation in couples and their children born after ICSI procedure. Materials/Methods: The sample consisted of 45 couples undergoing ICSI (Group I) and 70 children (36 boys and 34 girls) born to them after this procedure (Group II). The mean age of the women was 34 years (range 27– 46 yr) and the mean age of the men was 41 years (range 27– 61). Chromosomal analysis was performed on cultures of peripheral blood lymphocytes by standard methods including GTG, CBG and high resolution bandings. The protocol included the analysis of 100 metaphases per case for mosaicism exclusion. The F.I.S.H. technique was used when necessary. Results: In Group I, two men and two women (4/90 ⫽ 4.4%) presented a major chromosome aberration. One case showed a 46,X,del (Yq) karyotype and three cases presented gonosomal mosaicisms: one patient with 47,XYY/46,XY and two patients with 45,X/47,XXX/46,XX. In Group II, three children (3/70 ⫽ 4.2%) showed abnormal karyotypes: one 45,X, one mosaic 47,XY,⫹mar/46,XY and one structural aberration, 46, X, del (Yq),
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Abstracts
transmitted by the father. Structural variants (15ps⫹) or polymorphisms involving the centromeric heterochromatin of chromosomes 1, 9 and Y were detected in 9 cases (10%) of Group I and in 9 cases (12.8%) of Group II. Conclusions: The results obtained after cytogenetic investigation of couples submitted to ICSI agree with those reported in the literature, demonstrating that the most frequent chromosome-related causes of infertility are sex chromosome abnormalities. The percentage of de novo chromosomal aberrations in the children of the present series was 2.85%; however, additional studies are needed to state that there is a higher prevalence of gonosomal aberrations after treatment with ICSI. The protocol used to exclude mosaicism in the two Groups rules out the hypothesis that the cause of the increased frequency of sex chromosome aneuploidy is due to parental mosaicism.
P-420 Frequency of monozygotic twinning associated with in vitro fertilization and embryo transfer (IVF-ET). W. L. Gentry, M. A. Henry, E. S. Critser. Advanced Fertility Group, Indianapolis, IN; Reproductive Care of Indiana, Indianapolis, IN; Clarian Health Partners, Indianapolis, IN. Objective: To assess the frequency of monozygotic twinning after IVFET. Design: A retrospective review of all in vitro fertilization procedures resulting in an embryo transfer procedure from January 1, 1997 through December 31, 2000. Materials/Methods: One thousand and sixty five IVF-ET records were reviewed. Each record was classified as to day of transfer (day 3 vs. day 5/6). Ultrasound data confirming an intrauterine gestational sac was used to determine intrauterine pregnancy (IUP). Number of documented beating hearts was compared to number of gestational sacs to indicate the presence of a monozygotic twin. Data were analyzed by Fisher’s Exact Test. Results: Six hundred and six transfers were performed on day 3, resulting in 213 (36%) IUPs. Four hundred and fifty nine transfers were performed on day 5/6, resulting in 236 (51%) IUPs. There was only one documented monozygotic twin amongst pregnancies established with day 3 transfer as compared to 16 monozygotic pregnancies resulting from day 5/6 transfer (p ⬍ .01). One of the 16 monozygotic pregnancies involved a monozygotic triplet. Day 5/6 transfers which included at least one top quality blastocyst had a higher (p ⬍ .01) pregnancy rate (112/168; 66%) as compared to day 5/6 transfers with no top quality blastocysts (102/206; 49.5%). Monozygotic twin rates tended (p ⬍ .06) to be lower when the transfer included a top quality blastocyst (4/112; 3.5%) as compared to transfers with no top quality blastocysts (11/202; 10.7%). Day 5/6 transfers with no blastocysts had a lower pregnancy rate (22/85; 26% IUP) with one (1/22;4.5%) monozygotic pregnancy.
Day 3 Day 5/6
IVF-ET
IUP
Monozygotic twinning
696 459
213 (36%) 236 (51%)
1 (0.5%) 16 (6.7%)
Conclusions: These data suggest that current practice involving day 5/6 embryo transfer may have a greater risk for monozygotic pregnancies. Each program should rigorously evaluate their own data in order to best counsel patients for risks associated with multiple pregnancy.
P-421 Luteal phase estradiol (E2) and progesterone (P) profiles differ between conception and non-conception in-vitro fertilization-embryo transfer (IVF-ET) cycles utilizing pituitary down-regulation. S. Ben-Ozer, S. Eisenkop, M. Vermesh. The Ctr for Fertility and Gynecology, Tarzana, CA; Women’s Cancer Ctr, Tarzana, CA. Objective: 1) To characterize the relationship between luteal E2 and P dynamics and cycle outcome and 2) to identify a luteal E2 level or E2:P ratio predictive of pregnancy in IVF-ET utilizing pituitary down-regulation. Design: A prospective clinical study of patients undergoing IVF at our institution between 8/00 –11/00. 74 patients satisfied the inclusion criteria [age ⱕ43 years, weight within 20% of ideal, fresh IVF-ET with own
Vol. 76, No. 3, Suppl. 1, September 2001
oocytes, normal prolactin and thyroid function, successful pituitary downregulation (E2 ⬍40 pg/ml), at least four follicles ⱖ16 mm with E2 ⱖ150 pg/ml/follicle, endometrium ⱖ7 mm, embryo availability, absence of severe ovarian hyperstimulation]. Only the first cycle was included if there were multiple cycles. IRB approval was not required as the protocol did not vary from our routine. Materials/Methods: Mid-luteal pituitary down-regulation was achieved with leuprolide acetate (0.5–1.0 mg) and followed by ovarian stimulation with human menopausal gonadotropins. Transvaginal oocyte aspiration was performed 36 hours after human chorionic gonadotropin (hCG, 10,000 IU) was administered, and embryos were transferred three days later. P support (50 mg IM daily) began on the evening of aspiration. Day zero signifies ovulation, i.e. oocyte retrieval. Study days correspond to day of hCG injection, ET, and early, mid, and late-luteal phase. Serum E2 and P levels were obtained by chemiluminescence on days –2, ⫹3, ⫹7, ⫹11 and hCG was determined on day ⫹14. E2:P ratios were calculated. Statistical analysis for pregnant (n ⫽ 39) vs. non-pregnant (n ⫽ 35) cycles and clinical (n ⫽ 33) vs. negative/non-clinical pregnancies (n ⫽ 41) was done with two-tail group t, chi-square or Mann-Whitney tests as applicable. Results: Pregnant vs. non-pregnant cycles were similar in baseline and in-vitro parameters, except for cryopreservation. Mean E2 was significantly higher on day ⫹11 for pregnant vs. non-pregnant cycles (257 ⫾ 251 vs. 57 ⫾ 40 pg/ml; P ⬍ 0.0001), and for clinical pregnancies vs. negative/nonclinical pregnancy cycles (238 ⫾ 200 vs. 57 ⫾ 40 pg/ml; P ⬍ 0.0001). Mean P was not statistically related to cycle outcome. Mean E2:P ratios for pregnant vs. non-pregnant cycles were dramatically higher on day ⫹11 (P ⬍ 0.0001) and marginally higher on day ⫹3 (P ⫽ 0.03). Mean E2:P for clinical pregnancies vs. negative/non-clinical pregnancy cycles were significantly higher only on day ⫹11 (P ⬍ 0.0001). In non-pregnant cycles, mean E2 on day ⫹11 plus 3 standard deviations (99% about the mean) was below 200 pg/ml (range 16 –199). E2 level ⬎200 pg/ml on luteal day ⫹11 was highly predictive of conception. Conclusions: According to our data, late-luteal E2 level and E2:P ratio are predictive of pregnancy following IVF-ET with pituitary down-regulation. An E2 level ⬎200 pg/ml on luteal day ⫹11 is highly predictive of conception.
P-422 A prospective randomized study of vigorous flushing of cervical canal with culture medium prior to embryo transfer. K. Kyono, N. Fukunaga, K. Haigo, A. Yoshida, S. Tokuda, H. Kamiyama. Lady’s Clin Kyono, Furukawa, Japan; Kiba Park Clin, Tokyo, Japan. Objective: The aim of this prospective randomized study was to evaluate if vigorous flushing of the cervical canal prior to embryo transfer has an effect on clinical pregnancy rates in patients undergoing in vitro fertilization (IVF) and embryo transfer (ET). Design: Prospective two center randomized study. Materials/Methods: 184 patients attending our IVF-ET program were allocated alternatively to one of two groups. In the first group (group A), embryo transfer was effected after removing the cervical mucous with a tuberculin syringe and cleaning the cervix with a cotton swab soaked with culture medium.In the second group (group B), embryo transfer was effected after removing the cervical mucous with a tuberculin syringe followed by vigorous washing of the cervical canal using the same medium.There were no statistically significant differences between both groups regarding the age of the patients (34.0 ⫾ 4.4 in group A, 35.3 ⫾ 4.6 in group B, p ⫽ 0.053) or the number of embryos replaced (2.8 ⫾ 0.9 in group A, 2.9 ⫾ 1.1 in group B, p ⫽ 0.475) or uterine endometrial thickness at the time of ET (11.6 ⫾ 2.2 in group A, 11.5 ⫾ 2.1 in group B, p ⫽ 0.744). The same replacement catheter was used in all patients (Kitazato Supply Co., Japan). Results: Twenty six pregnancies resulted in group A (28.0%) compared to 28 pregnancies in group B (30.8%). This difference is not statistically significant (Chi-Squared analysis ⫽ 0.175, p ⫽ 0.675). Conclusions: Vigorous flushing of cervical canal with culture medium at the time of ET does not have an effect on clinical pregnancy rates. But,we must be very careful to do not put culture medium into the uterine cavity, because we did not succeed in pregnancy in such cases.
FERTILITY & STERILITY威
CLINICAL FEMALE INFERTILITY AND GYNECOLOGY P-423 Chlamydia trachomatis (CT) testing practices in a commercially insured population. J. Armstrong, S. Leeds, H. Sangi-Haghpeykar. Baylor College of Medicine, Houston, TX. Objective: Little data is available on the prevalence of CT in commercially insured female populations. However, it is assumed that the infection is significantly underdiagnosed in this group. A major factor in the underdiagnosis of infection is inadequate behavioral and sexual risk factor ascertainment by clinicians and, possibly, the failure to test patients considered to be high-risk for infection. The purpose of this study is to examine the prevalence of CT testing in a commercially insured female population and to examine factors that may be associated with testing. Design: A retrospective chart review. Materials/Methods: Medical records of 600 commercially insured women ages 15–25 presenting for ambulatory obstetrical and gynecological care to a suburban private practice were reviewed. Information on demographic, reproductive, sexual, and contraceptive practices, as well as risk status for STDs was collected. Patients considered at high-risk for CT infection were those with any of the following characteristics: sexually active women ⬍20 years of age, new or multiple sexual partners in the past 12 months, past history or treatment of a STD, past or current partner with a history of a STD, non-use of condoms, or presenting complaint suggestive of pelvic infection. These risk factors are part of the screening guidelines of the Centers for Disease Control and Prevention (CDC) or the American College of Obstetricians and Gynecologists (ACOG). Univariate and multivariate logistic regression analysis, and chi-square tests were performed to summarize data. Results: The overall rate of testing was 82 of 600 patients (13.6%). Risk factors for CT infection were documented in 165 patients (27.5%), of whom 51 (30.9%) were tested. High-risk women were more likely to be tested than women without documented risk factors (OR ⫽ 5.8, p ⬍ .0001). Specific risk factors associated with CT testing were: male gender of physician (OR ⫽ 2.7, p ⫽ .0005), problem-related visit type as compared to routine/ annual examinations (OR ⫽ 2.8, p ⫽ .002), prior pregnancy (OR ⫽ 2.3, p ⫽ .0007), presenting complaints suggestive of pelvic infection (OR ⫽ 9.9, p ⬍ .0001), sexual activity in the past 12 months (OR ⫽ 12.3, p ⫽ ⬍.0001), new sexual partner in past 12 months (OR ⫽ 8.8, p ⫽ .006), history of STD in past 12 months (OR ⫽ 4.1, p ⫽ .0007), and sexual activity in women ⬍20 years of age (OR ⫽ 4.8, p ⬍ .0001). Thirty-six percent of sexually active women ⬍20 years of age were tested as compared to 22% of the entire sexually active study group. The estimated prevalence of infection was 4.9% (4 out of 82 patients) in the study population. Among the 4 patients with positive tests, all had at least one established risk factor for CT. Conclusions: The overall rate of CT testing among commercially insured women is low (13.6%). Although the rate of testing is higher among patients with identified risk factors (31%), testing practices fail to conform to established screening guidelines. The underlying reasons for the failure to test patients identified as high-risk requires further investigation. Supported by: Texas Department of Health.
P-424 Axillary oophoropexy for girls receiving abdominal/pelvic radiation with over 20 year follow-up. M. R. Laufer, J. Upton, S. Schuster, H. Grier, S. Emans, L. Diller. Children’s Hospital/Brigham & Women’s Hospital/ Dana Farber Cancer Institute/Harvard Medical Sch, Boston, MA; Children’s Hospital/Harvard Medical Sch, Boston, MA; Dana Farber Cancer Institute/ Harvard Medical Sch, Boston, MA. Objective: To describe the technique of axillary oophoropexy utilized for girls undergoing high dose abdominal and pelvic radiation therapy and assess reproductive endocrine outcome. Design: A case series. Materials/Methods: Three girls (Subjects 1, 2, and 3) ages 5, 2, and 1 year underwent surgical resection for Wilms tumor. In a subsequent operation each had an oophoropexy to the axillary region. Subjects 1 and 2 had slices of the ovary placed in the area of the triceps and deltoid muscle, respectively. Subject 3 had microanastomosis of the blood vessels of the ovary to branches of the anterior axillary blood vessels. Each subject then received
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