Menopausal Symptoms Are Associated With the Quality of Life of Midlife Women

Conclusion: GnRH agonist is effective in triggering oocyte maturation in patients with PCOS or previous high responders. Further randomized studies are required to evaluate its effectiveness in preventing OHSS in these patients. P-41 The Probability of Conception After Embryo Transfer Using Fresh or Cryo-Thawed Multicellular Embryos. L. Engmann, L. Siano, D. Schmidt, J. Nulsen, D. Maier, C. Benadiva. The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut Health Center, Farmington, Connecticut, USA. Background: A successful cryopreservation program offers several advantages to the couple because it is relatively less expensive and less invasive than a fresh in-vitro fertilization (IVF) cycle. There is, however, much debate as to whether cryo-thaw replacement cycles are less successful than fresh IVF cycles. Objective: To evaluate whether the probability of conception after embryo transfer using fresh or cryo-thawed multicellular embryos is similar. Materials and Methods: This is a retrospective comparative study of implantation and conception rates in multicellular embryo replacement cycles using either cryo-thawed embryos or fresh embryos between January 1999 and December 2003 at a tertiary university IVF center. The data consisted of 114 cycles of women who underwent day 3 cryo-thaw multicellular embryo replacement cycles (Group 1) and 276 cycles of women who underwent day3 fresh muticellular embryo replacement cycles that resulted in cryopreservation of excess embryos (Group 2). The main outcome variables were implantation rate, clinical pregnancy rate and ongoing pregnancy/birth rate. The two groups were compared using chi-squared test and t-test for categorical and continuous variables respectively. Results: The mean age of the patients was similar between the two groups. The thaw survival rate in the cryo-thaw group was 84.5%. There were more embryos transferred in Group 1 compared with Group 2 (2.6 ⫾ 0.8 versus 2.2 ⫾ 0.5, P⬍0.01). Implantation rate (29% versus 39.1%, P⬍0.01) was lower in Group 1 compared to Group 2. The clinical pregnancy rate (58.8% versus 62.3%) and ongoing pregnancy/birth rate (54.4% versus 55.8%) were similar between Groups 1 and 2. Although the ongoing multiple pregnancy/birth rates were similar between the groups, there was a trend toward a higher triplet rate in Group 1 (4.8%) compared to Group 2 (2.6%), although the difference was not significant. Conclusion: The probability of conception after a cryo-thaw cycle is as successful as that of a fresh embryo transfer cycle. However, this might have been achieved by the transfer of more embryos in the cryo-thaw group with a resultant increase in the triplet rate. P-42 Combined Gamete or Zygote Intrafallopian Transfer (GIFT or ZIFT) and In Vitro Fertilization-Embryo Transfer (IVF-ET) in Women With Prior Failed Cycles: Significantly Improved Success Rates Compared With GIFT or ZIFT Alone. E. Mor, M. Vermesh. The Center for Fertility and Gynecology, Tarzana, California. Introduction: The roles of GIFT and ZIFT have recently been diminished as laboratory and transfer techniques in IVF-ET have improved. However, data on combination treatment of GIFT or ZIFT with IVF-ET are lacking. Objective: To assess whether combination treatment of GIFT/IVF or ZIFT/IVF offers any benefit over GIFT or ZIFT alone in women with prior failed IVF. Material & Methods: From January 1997 through December 2000, 56 patients with a prior history of at least one failed IVF cycle underwent a total of 62 tubal transfer procedures, following standard ovarian hyperstimulation and egg retrieval. Of those, 42 cycles were of combined GIFT/ IVF (35 cycles in 30 patients) or ZIFT/IVF (7 cycles in 7 patients), and 20 cycles were of GIFT (11 cycles in 10 patients) or ZIFT (9 cycles in 9 patients) only. In combined procedures, laparoscopic tubal gamete or zygote transfer was followed with trans-cervical ET of day-3 embryos three or two days later, respectively. Patients underwent a GIFT or combined GIFT/IVF procedure unless intracytoplasmic sperm injection was necessary, in which case a ZIFT or combined ZIFT/IVF was performed. For the purpose of comparing the number of embryos transferred, a 75% fertilization rate was assumed for all GIFT cycles. Statistical analysis was by Chi Square and Student’s t test.

FERTILITY & STERILITY威

Results: Mean age and number of prior failed IVF cycles were similar between patients undergoing combined GIFT/IVF or ZIFT/IVF (34.5 ⫾ 4.1 years, 1.9 ⫾ 1.2 cycles) and those undergoing GIFT or ZIFT alone (36.1 ⫾ 4.1 years, 1.8 ⫾ 1.7 cycles, p⫽NS). Combined procedures resulted in a significantly higher mean number of total embryos transferred (tubes ⫹ uterus), compared with GIFT or ZIFT alone (5.9 ⫾ 1.0 versus 4.3 ⫾ 1.6 embryos, p⬍0.01). Compared with GIFT or ZIFT only cycles, patients undergoing a combined GIFT/IVF or ZIFT/IVF procedure had a significantly higher clinical pregnancy rate (69.0% versus 30.0%, OR⫽5.2, p⬍0.01), delivery rate (57.1% versus 30.0%, OR⫽3.1, p⬍0.05), and implantation rate (19.4% versus 7.2%, OR⫽3.1, p⬍0.01). Combined cycles had a 37.9% twin and 10.3% triplet gestation rate. There were no multiple gestations in GIFT or ZIFT only cycles. Conclusion: In this study, in women with prior IVF failure, combined GIFT/IVF or ZIFT/IVF resulted in significantly higher clinical pregnancy, delivery, and implantation rates compared with GIFT or ZIFT alone.

P-43 Is There Any Correlation Between Age, BMI, Follicular Size and Dosage in Clomiphene Citrate/Intra-Uterine Insemination Cycles in Predicting Pregnancy Outcomes? M. Sulit, Z. Rosenwacks. The Center For Reproductive Medicine and Infertility, The New York Presbyterian Hospital Weill Medical College Cornell Medical Center, New York, NY USA. Objective: To determine whether a relationship exists between age, BMI, follicular size and dosage in clomiphene citrate/intrauterine insemination (CC/IUI) cycles in predicting pregnancy outcomes. Design: Retrospective, observational study. Materials/Methods: All patients (n⫽252) between 26-42 years old, BMI (range 18-39.5), and with normal ovarian function, treated with CC/IUI and induced ovulation with uhCG, from 01/07/03 to 12/14/03 were included in the study. Patients were treated with initial dosage of 50 or 100 mg of clomiphene citrate for 5 days starting on day 3 of the menstrual cycle. Transvaginal ultrasound was performed at mid cycle to define the optimum time for triggering ovulation. When the main follicle was /18 mm, 5,000 (greater than 3 mature follicles) or 10,000 (3 or less mature follicles) USP units of u-hCG was administered by intramuscular injection that same day, and the IUI procedure was scheduled for the next day. Data collected included age, BMI, follicle size, CC dose, ultrasound measurements of the follicles and pregnancy results. Statistical analysis was done using ChiSquare test of association, logistic regression and/or the Fisher’s exact test as required. Results: Clinical pregnancies were achieved in 69 cycles (27.4%). When age, BMI, follicle size and CC dose were analyzed as independent variables, no statistical significance was seen between these factors and pregnancy rates (p-value⫽⬎.0.05) (p⫽0.9847). However, a significant association between pregnancy and CC dose was observed (p⫽0.0412). Conclusions: Based on these results, it is not possible to use patient age, BMI or follicle size as predictors of pregnancy outcome in CC/IUI cycles. However, the dose of CC and pregnancy are significantly related. Higher pregnancy rates were seen in patients treated with CC 50 mg versus 100 mg. Although this finding was demonstrated, we need to consider that most of the patients that failed 50 mg dosing regimen then received 100 mg. Supported by: None.

P-44 Menopausal Symptoms Are Associated With the Quality of Life of Midlife Women. B.J. Bankowski1, L.M. Gallicchio1, M.K. Whiteman2, H.A. Zacur1, J.A. Flaws2. 1The Johns Hopkins University School of Medicine, Division of Reproductive Endocrinology & Infertility, Baltimore, MD. 2The University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore, Maryland. Background: The menopausal transition creates numerous challenges for the psychosocial health of women. Although previous studies have begun to examine which factors, including hormone replacement therapy (HRT) and menopausal symptoms, are associated with quality of life (QOL) in this period, little information is currently available on which to base interventions.

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Objective: To examine which factors are associated with low self-scoring on the Cantril’s Ladder of Life, a validated measure of QOL in midlife women. Materials & Methods: A cross-sectional study of 1129 midlife women aged 40-60 years living in the Baltimore metropolitan region was conducted. All participants completed an extensive mailed survey that assessed lifestyle, menopausal status/symptoms, medical characteristics, self-reported health, and QOL. Associations between QOL and menopausal status, selected symptoms (hot flashes, sore joints, incontinence, irritability, mood swings, headache), self-reported health, and depression were assessed using univariate analysis and ANOVA. Polytomous logistic regression was used to examine the association between QOL and menopausal symptoms while controlling for age, self-reported health, and depression. Results: Mean QOL scores did not differ by menopausal status. Low QOL was associated with all selected symptoms, except hot flashes. A dose-response relationship was observed between low QOL score and the frequency of symptoms (p ⬍ 0.0001). Furthermore, low QOL was associated with poor self-reported health (OR 7.78; 95% CI 2.24, 27.05), fair self-reported health (OR 3.21; 95% CI 2.20, 4.70), and depression (OR 1.76; 95% CI 1.31, 2.37). After controlling for potential confounders (selfreported health and depression) in regression analysis, a low QOL score was still associated with irritability (OR 1.37, 95% CI 1.03, 1.82) and mood changes (OR 1.60, 95% CI 1.21, 2.13) but was no longer significantly associated with hot flashes (OR 1.10; 95% CI 0.84, 1.45), headaches (OR 1.12; 95% CI 0.98, 1.29), leaky urine (OR 1.09; 95% CI 0.84, 1.41), or stiff joints (OR 0.97; 95% CI 0.74, 1.26). Conclusions: QOL was associated with the presence and frequency of menopausal symptoms, particularly irritability and mood swings. These data suggest that the QOL of midlife women may be improved with greater attention to the psychosocial issues of menopause. Support: NIH AG18400

P-45 Improved Pregnancy Outcome for Women with Decreased Ovarian Oocyte Reserve and Advanced Reproductive Age by Performing In Vitro Fertilization-Embryo Transfer. J.H. Check, J.R. Liss, J.W. Krotec, J.K. Choe, UMDNJ, Robert Wood Johnson Med. School, Melrose Park, Philadelphia. Background: Previous studies have found a much worse prognosis for women with elevated day 3 serum follicle stimulating hormone (FSH) levels in the age range of 38-45 in both in vitro fertilization (IVF) cycles and non-IVF cycles compared to younger women with elevated FSH. Objective: To determine if IVF-embryo transfer (ET) results in a higher pregnancy rate (PR) in this older group vs. correcting follicular maturation, sperm-mucus interaction problems, and correcting luteal phase defects without IVF. Materials and Methods: All women ages 38 to 45 with a day 3 serum FSH of ⬎15 mIU/mL seeking infertility help during a given time period were evaluated as to pregnancy outcome (clinical or ongoing/delivered pregnancy past the first trimester). The pregnancy outcome was determined for the first 3 cycles of treatment (unless a pregnancy occurred first) and was stratified as to whether IVF-ET was performed or not. Women with tubal factor or severe male factor problems required IVF-ET whereas those with patent tubes and normal semen parameters could choose IVF or not. In general the women having IVF performed were minimally stimulated with 75 IU of gonadotropins per day up to, (but less commonly), 225 IU/day. Results: A comparison between hypergonadotropic females treated without or with IVF-ET is seen in the table below. The difference in delivered pregnancies did not quite reach significance (p⫽.092, Fisher’s exact test). Three of 4 non-IVF pregnancies miscarried. The IVF group had 3 miscarriages and 1 ectopic pregnancy.

Number Average age Average serum FSH (mIU/mL) No. pregnant 3 cycles No. viable pregnancy Viable pregnancy rate/3 cycles

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PCRS Abstracts

Non-IVF group

IVF group

34 41.0 ⫹ 2.3 29.6 ⫹ 13.0 1 1 2.9% (1/34)

33 40.7 ⫹ 2.0 22.6 ⫹ 7.4 5 5 15.1% (5/33)

Conclusion: The 2.9% viable PR in 3 cycles in this group of women of advanced reproductive age and hypergonadotropia was similar to the previous findings of 5.5% in 6 cycles. In vitro fertilization-ET seems to improve the likelihood of success in this most difficult group. Obviously, the use of donor oocytes would produce a much higher chance of successful conception but this option is not always preferable for personal reasons.

P-46 The Importance of Blastomere Number, Fragmentation and Symmetry as Determined by Evaluation of Outcome of Single Embryo Transfer (ET). Jerome H. Check, M.D., Ph.D., Donna Summers-Chase, M.S., Wei Yuan, Ph.D., Holly Barci, B.S., Danya Brittingham, B.S., UMDNJ, Robert Wood Johnson Med. School at Camden, Cooper Hosp./Univ. Med. Cntr., Dept. OB/GYN, Div. Repro. Endo. & Infertility, Camden, NJ. Background: Interpretation of studies on the importance of the number of blastomeres, degree of fragmentation, and symmetry of embryos in predicting successful pregnancy is frequently hampered by the transfer of multiple embryos without uniform morphologic characteristics. Objective: To evaluate independently the effect of these 3 embryo morphologic parameters following single embryo transfers (ETs) by retrospective cohort analysis. Materials and Methods: A review was made of all single fresh ET performed from 1997 to 2003 in women with elevated serum follicle stimulating hormone (FSH) (⬎12 mIU/mL) on day 3 of menstrual cycle. The patients received no or minimal stimulation with gonadotropins. Pregnancy rates (PRs) were evaluated according to blastomere number (ⱕ4, grp 1; 5, grp 2; 6, grp 3; 7,group 4; ⱖ8, cells grp 5), fragmentation (A⫽0%, B⫽1-25%, and C⫽⬎25% fragmentation) and symmetry (I⫽most, II⫽intermediate, and III⫽worst symmetry. Embryo transfers and morphologic evaluation were performed on day 3. Results: The clinical and ongoing/delivered PRs according to blastomere number, fragmentation and symmetry are seen in the table below.

Blastomere number Group 1 (n⫽17) Group 2 (n⫽14) Group 3 (n⫽14) Group 4 (n⫽17) Group 5 (n⫽25) Fragmentation index Group A (n⫽12) Group B (n⫽67) Group C (n⫽8) Symmetry Group I (n⫽18) Group II (n⫽59) Group III (n⫽10)

Clinical pregnancy rate

Delivered pregnancy rate

11.8% 21.4% 35.7% 17.6% 32.0%

11.8% 14.3% 28.6% 17.6% 28.0%

22.2% 27.1% 10.0%

22.2% 22.0% 10.0%

22.2% 27.1% 10.0%

22.2% 22.0% 10.0%

Since only 1 embryo was transferred the implantation rates equal the clinical PR. Conclusions: These data show a trend for lower PRs when an embryo is at the extremes of poorest quality of a given morphologic parameter, i.e., only 4 or less blastomeres by day 3, ⬎25% fragmentation, or the worst symmetry. Nevertheless the worst morphologic parameters still resulted in delivered PRs of 11.8%, 12.5%, and 10.0%, respectively. Thus these data suggest that all embryos no matter how poor the quality have at least half of the chance of resulting in a baby compared to morphologic superior embryos and transfer back of these embryos to the female partner rather than discarding them would increase the overall PR from a given embryo harvest.

P-47 Pregnancy Outcome Following Frozen Embryo Transfer (ET) According to Age in Women Deferring Fresh ET Because of Risk of Ovarian Hyperstimulation Syndrome. J.H. Check, C. Wilson, B. Katsoff,

Vol. 83, Suppl 2, May 2005