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Maximum Basal FSH Predicts Clinical Pregnancy Rate With IUI Cycles With Gonadotropins but not Clomiphene Citrate
CONCLUSIONS: In the assessment of predictors for ART-outcome, ROC-analysis using the AUC is misleading to the clinician. Based on our simulations, we plead for the use of data on calibration in addition to or even instead of ROC-analysis. Supported by: None P-292 Maximum Basal FSH Predicts Clinical Pregnancy Rate With IUI Cycles With Gonadotropins but not Clomiphene Citrate. B. R. Witt. Greenwich Fertility and IVF Center, Greenwich, CT. OBJECTIVE: To assess the utility of maximum historical baseline FSH (FSHmax) as a predictor of clinical pregnancy in IUI cycles with clomiphene citrate (CC-IUI) or gonadotropins (COH-IUI). DESIGN: Retrospective analysis of all IUI cycles performed between July 2003 and March 2005 in a solo infertility practice. MATERIALS AND METHODS: Patient records were analyzed for demographics, day 2 or 3 FSH (basal FSH) and estradiol (E2), FSHmax, type of stimulation, total motile sperm counts, and clinical pregnancies (CP, presence of fetal heart activity). IUI cycles were analyzed based on type of stimulation and age groups (Group 1⫽age ⬍ 38, Group 2⫽ age ⱖ 38). Statistical analysis performed with SPSS software using receiver operating characteristic (ROC) curve analysis and Chi-square analysis. RESULTS: 84 patients underwent 144 CC-IUI cycles and 61 patients underwent 105 COH- IUI cycles. Using ROC curve analysis, FSHmax was predictive of CP per cycle only among COH-IUI cycles (area under curve (AUC) 0.677, p⫽0.029) and not in CC-IUI cycles. The utility of basal FSH for the cycle approached significance (AUC 0.650, p⫽0.064) but basal E2 was not predictive. FSHmax was also useful as a predictor of cumulative CP per patient in COH-IUI cycles (AUC 0.712, p⫽0.017) as was basal FSH (AUC 0.693, p⫽0.029) but basal E2 was not predic-
tive. Figure 1 depicts the ROC curve for cumulative pregnancy. There was a statistically higher (p⬍0.05) cumulative CPR among all patients when FSHmax ⬍10 (27/99⫽27%) vs. FSHmax ⱖ10 (5/44⫽11%), (Figure 2). CONCLUSIONS: FSHmax is predictive of CPR and cumulative CPR in COH-IUI cycles but not in CC-IUI cycles. Basal FSH is predictive of cumulative CPR only in COH-IUI cycles. FSHmax should be used in counseling patients undergoing COH-IUI. Supported by: None
P-293 The Evaluation of Withholding Gonadotropins (Coasting) Effects on the Outcome of In-Vitro Fertilization Cycles. M. Owj, E. Tehrani Negad, E. Amirchaghmaghi, Z. Ezabadi, A. Baghestani. Royan institute, Tehran, Iran (Islamic Republic of); Tehran University, Tehran, Iran (Islamic Republic of). OBJECTIVE: Ovarian hyper stimulation syndrome (OHSS) is a rare life threatening complication of controlled ovarian stimulation for in vitro fertilization (IVF ). To reduce this risk several approaches have been used. Withholding gonadotropin administration or coasting is one of the most effective and popular methods used to prevent OHSS. However the effect of coasting on the number and quality of oocyte and embryo is still controversial. In addition, the duration of coasting seems to be a prognostic factor for the outcome of IVF. The purpose of this study was to evaluate the coasting effects on the cycle outcome in patients undergoing in vitro fertilization DESIGN: Retrospective study MATERIALS AND METHODS: Sixty-seven patients undergoing coasting were evaluated in Royan research center between May 2002 and June 2003.The study was approved by our Institutional Review Board and University of Jahad Ethics committee. After signing informed consent forms, all patients underwent standard long protocol with GnRH analogue and HMG and then in vitro fertilization and embryo transfer ( IVF-ET ). Coasting was considered when estradiol level was more than 3000 pg/ml and the number of follicle ⬎10 in each ovary. HCG was administered whenever estradiol reached ⱕ 3000 pg/ml and then IVF-ET program was carried out. According to coasting period, patients were divided in two groups: (coasting period ⱕ 3 days and coasting period ⬎ 3 days). Statistical comparisons were performed using student t test and Fisher exact test. P value ⬍0.05 was considered as significant level. RESULTS: There were no significant differences between two groups in mean age, BMI, percent of PCOS (poly cystic ovarian syndrome) patients, number of HMG ampoules and stimulation duration. A total number of retrieved oocytes decreased significantly in patients with more than 3 days of coasting( 6.2 ⫾ 4.2 vs. 9.5⫾5.3 )(P value⫽0.04).Also the number of high quality oocytes decreased in this group; however they did not reach to significant levels (5.1 ⫾.2.9 vs. 7.6 ⫾ 4.7) (P value ⫽ 0.06) There were no significant differences between two groups in fertilization and pregnancy rate. None of patients developed severe OHSS. CONCLUSIONS: This study reveals that coasting effectively prevents OHSS however long coasting period (⬎3 days) has negative effect on the number of oocytes, although the fertilization and pregnancy rates do not be affected. Prospective randomized study comparing coasting with other procedures is recommended. Supported by: None
P-294 Bioactive FSH May Have Value as a Marker for Ovarian Reserve in Patients With Elevated Serum FSH and Normal Basal Antral Follicle Counts. J. Klein, L. Grunfeld, A. B. Copperman, S. Pollak, B. Sandler, J. Lustbader. RMA-NY, White Plains, NY; RMA-NY, New York, NY; Columbia University Medical Center, Department of Ob/Gyn, New York, NY. OBJECTIVE: To evaluate the bioactivity of FSH in women with paradoxically high serum immunoactive basal FSH levels and otherwise “normal” ovarian reserve as determined by ultrasound screening and response to gonadotropin stimulation. DESIGN: Case Series at a large academic reproductive center.
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tive. Figure 1 depicts the ROC curve for cumulative pregnancy. There was a statistically higher (p⬍0.05) cumulative CPR among all patients when FSHmax ⬍10 (27/99⫽27%) vs. FSHmax ⱖ10 (5/44⫽11%), (Figure 2). CONCLUSIONS: FSHmax is predictive of CPR and cumulative CPR in COH-IUI cycles but not in CC-IUI cycles. Basal FSH is predictive of cumulative CPR only in COH-IUI cycles. FSHmax should be used in counseling patients undergoing COH-IUI. Supported by: None
P-293 The Evaluation of Withholding Gonadotropins (Coasting) Effects on the Outcome of In-Vitro Fertilization Cycles. M. Owj, E. Tehrani Negad, E. Amirchaghmaghi, Z. Ezabadi, A. Baghestani. Royan institute, Tehran, Iran (Islamic Republic of); Tehran University, Tehran, Iran (Islamic Republic of). OBJECTIVE: Ovarian hyper stimulation syndrome (OHSS) is a rare life threatening complication of controlled ovarian stimulation for in vitro fertilization (IVF ). To reduce this risk several approaches have been used. Withholding gonadotropin administration or coasting is one of the most effective and popular methods used to prevent OHSS. However the effect of coasting on the number and quality of oocyte and embryo is still controversial. In addition, the duration of coasting seems to be a prognostic factor for the outcome of IVF. The purpose of this study was to evaluate the coasting effects on the cycle outcome in patients undergoing in vitro fertilization DESIGN: Retrospective study MATERIALS AND METHODS: Sixty-seven patients undergoing coasting were evaluated in Royan research center between May 2002 and June 2003.The study was approved by our Institutional Review Board and University of Jahad Ethics committee. After signing informed consent forms, all patients underwent standard long protocol with GnRH analogue and HMG and then in vitro fertilization and embryo transfer ( IVF-ET ). Coasting was considered when estradiol level was more than 3000 pg/ml and the number of follicle ⬎10 in each ovary. HCG was administered whenever estradiol reached ⱕ 3000 pg/ml and then IVF-ET program was carried out. According to coasting period, patients were divided in two groups: (coasting period ⱕ 3 days and coasting period ⬎ 3 days). Statistical comparisons were performed using student t test and Fisher exact test. P value ⬍0.05 was considered as significant level. RESULTS: There were no significant differences between two groups in mean age, BMI, percent of PCOS (poly cystic ovarian syndrome) patients, number of HMG ampoules and stimulation duration. A total number of retrieved oocytes decreased significantly in patients with more than 3 days of coasting( 6.2 ⫾ 4.2 vs. 9.5⫾5.3 )(P value⫽0.04).Also the number of high quality oocytes decreased in this group; however they did not reach to significant levels (5.1 ⫾.2.9 vs. 7.6 ⫾ 4.7) (P value ⫽ 0.06) There were no significant differences between two groups in fertilization and pregnancy rate. None of patients developed severe OHSS. CONCLUSIONS: This study reveals that coasting effectively prevents OHSS however long coasting period (⬎3 days) has negative effect on the number of oocytes, although the fertilization and pregnancy rates do not be affected. Prospective randomized study comparing coasting with other procedures is recommended. Supported by: None
P-294 Bioactive FSH May Have Value as a Marker for Ovarian Reserve in Patients With Elevated Serum FSH and Normal Basal Antral Follicle Counts. J. Klein, L. Grunfeld, A. B. Copperman, S. Pollak, B. Sandler, J. Lustbader. RMA-NY, White Plains, NY; RMA-NY, New York, NY; Columbia University Medical Center, Department of Ob/Gyn, New York, NY. OBJECTIVE: To evaluate the bioactivity of FSH in women with paradoxically high serum immunoactive basal FSH levels and otherwise “normal” ovarian reserve as determined by ultrasound screening and response to gonadotropin stimulation. DESIGN: Case Series at a large academic reproductive center.
S254
Abstracts
Vol. 84, Suppl 1, September 2005