N-acetyl cysteine: could it be an effective adjuvant therapy in ICSI cycles

5.3 vs 7.6  5.7 for the oocytes, and 3.7  3.2 vs 4.1  3.6 for the embryos). The pregnancy rate is similar in the groups (global pregnancy rate: 28.6% vs 27.9%) even if we compare the transfert of one top embryo (37% vs 34.8%). The number of cycles with at least one top embryo is similar between the 2 groups. CONCLUSIONS: In this study, the number of oocytes and embryos is lower in the E2 GnRH-ant arm than in the GnRH-a arm, but the pregnancy rate is similar possibly due to the use of E2 pre-treatment which improve follicle cohort harmonization as already suggested. Moreover, the E2 pre-treatment allows a IVF programming as already shown for the natural cycle. Supported by: None. P-737 N-ACETYL CYSTEINE: COULD IT BE AN EFFECTIVE ADJUVANT THERAPY IN ICSI CYCLES. E. A. Elgindy, A. M. El-Huseiny, M. I. Mostafa, A. M. Gaballah, T. A. Ahmed. Obstetrics & Gynecology, Zagazig University Hospitals, Cairo, Egypt; Obstetrics & Gynecology, Cairo University Hospitals, Cairo, Egypt; Clinical Pathology, Zagazig University Hospitals, Zagazig, Egypt. OBJECTIVE: To evaluate the effectiveness of NAC as an adjuvant to COH in ICSI cycles using the long agonist protocol. Furthermore, study the effect of NAC on granulosa cell apoptosis. DESIGN: Randomized controlled study. MATERIALS AND METHODS: 76 patients undergoing their first ICSI cycle due to male factor infertility.Participants were randomly assigned to receive either the standard long protocol (group A, 38 women) or long protocol and NAC (1200 mg daily, starting with HMG till the HCG day, group B, 38 women). Determination of granulose cell apoptosis (on retrieval day) was done, using AnnexinV-Propidium iodide in flow cytometry. RESULTS: The 2 groups were balanced in respect of the patients and ICSI cycles characteristics. There was no statistically significant difference between the two protocols regarding the number of retrieved oocytes, mature oocytes, fertilized oocytes, cleaved embryos or good quality embryos. Early and late apoptosis were lower in group B (median¼1.7% & 2.5% respectively) than in group A (1.9% & 3.7% respectively) but statistically insignificant. Clinical pregnancy rate was higher in group B (52.6%) than in group A (47.4%) but statistically insignificant. Irrespective of the used protocol, there was significant negative correlation between fertilization rate and the % of early(r¼-0.492,P<0.001)and late apoptosis (r¼-0.504,P<0.001)as well as significant negative correlation between the number of good quality embryos and the % of early(r¼-0.305,P¼0.007) and late apoptosis(r¼-0.399,P<0.001). Pregnants had higher statistical significant decrease in early and late apoptosis (median¼1.1%& 0.86% respectively) than non-pregnants (median¼5.9%& 14.4%respectively, p < 0.001). Statistical analysis: Data were described as mean  SD, median (range) or frequencies & percentages. Comparisons were carried out by Mann Whitney, Chi square, Fisher exact tests. Correlations were done using Pearson or Spearman equations. P < 0.05 was considered statistically significant. CONCLUSIONS: NAC appears to be an ineffective adjuvant to the long protocol in ICSI cycles done for male infertility. Higher doses and longer duration of use should be investigated. Furthermore, granulosa cell apoptosis may be an important prognosticator for ICSI cycles outcome. Supported by: None. P-738 USE OF MELOXICAM FOR OHSS PREVENTION. V. A. Basconi, E. T. Young, G. Van Thillo, M. Vilela, R. Quintana, D. A. Paz. Gynecology, IFER, Buenos Aires, Capital Federal, Argentina; Biology, IFIBYNE Conicet U.B.A. Instituto Molecular de Neur, Buenos Aires, Capital Federal, Argentina. OBJECTIVE: Vascular endothelial growth factor (VEGF) plays a central role in Ovarian hyperstimulation syndrome (OHSS) by increasing vascular permeability. Recently, we have demonstrated a beneficial effect of meloxicam by reducing ovarian weight and VEGF expression associated with OHSS in a rat model. This effect may be mediated by the Ciclooxigenase2 (COX-2), which is inhibited by meloxicam. The objective is to assess the role of Meloxican in OHSS prevention in oocyte donors. DESIGN: Prospective randomized study. MATERIALS AND METHODS: 36 oocyte donors with OHSS risk after COH were randomized to either receive expectant clinical management and support (group 1, n¼18), or Meloxicam treatment (15 mg/daily orally

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for 8 days starting on the day of oocyte retrieval) (Group 2, n¼18). All donors met standard ASRM screening criteria (with written informed consent signed, age between 21 and 30 years, and basal FSH levels % 12 IU/ l). OHSS risk parameters as inclusion criteria were: R 10 follicles at least 14 mm per ovary and E2 levels R 2500 pg/ml on hCG day. All patients used agonist GnRh luteal phase protocol, with rFSH 250 IU/daily for 4 days followed by equal dose of hMG for ovarian stimulation. Both groups were clinically, hematologically and biochemically followed for signs and symptoms of OHSS and received supportive measures as required. Blood samples for VEGF measurement were obtained on the day of hCG and 7 days later. RESULTS: Mean age, BMI, oocytes retrieved and estradiol levels were comparable between both groups as well as plasma VEGF concentrations on hCG day (19.1  8.9 pg/ml and 24.6  12.1 pg/ml for Groups 1 and 2 respectively, NS); although seven days after hCG, VEGF plasma levels were significantly lower in the treatment group (22.3  10.9 pg/ml vs 13.7 6.3 pg/ml for Groups 1 and 2 respectively; p<0.05). Additionally, we found less OHSS symptoms in Group 2 patients (4/18 with slight abdominal distention; 2/18 with mild ascites), while in Group 1 their symptoms persisted unchanged or slightly worse on day 7 (14/18 with slightly abdominal distention; 12/18 presenting ascitis). CONCLUSIONS: Our results suggest a beneficial effect of meloxicam in the prevention and treatment of OHSS and its complications in ART cycles when no embryos are transferred. More studies are necessary in order to analyze the risk-benefit ratio of meloxicam administration in IVF embryo-tranfer cycles, since its use has been related to an antiimplantatory effect. Supported by: None. P-739 COMPARISON OF SHORT 7-DAY AND LONG GONADOTROPIN RELEASING HORMONE AGONIST PROTOCOLS IN THE CONTROLLED OVARIAN STIMULATION FOR IN VITRO FERTILIZATION. Y.-P. Li, J.-M. Zhang, J. Liu, D.-E. Liu, N.-H. Liu, X.-H. Chen. Reproductive Center of Xiangya Hospital, Central South University, Changsha, Hunan, China; State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China. OBJECTIVE: To compare the effects on controlled ovarian stimulation and pregrancy outcomes of a short 7-day gonadotropin-releasing hormone agonist (GnRHa) protocol(7-day protocol)and a GnRHa long protocol (long protocol) as part of controlled ovarian stimulation regimens during in vitro fertilization and embroy transfer (IVF-ET) treatment. DESIGN: Prospective randomized controlled study. MATERIALS AND METHODS: One hundred and forty six infertile patients with tubal factor who accepted IVF-ET treatment from July to November 2007 were included in this study. 7-day protocol group (n¼68): GnRHa (decapeptyl, Ferring) was injected 0.1 mg daily from day 2 of the menstrual cycle to day 8. At the same time gonadotropin (Gn) was injected daily from day 3. Long protocol group(n¼78): GnRHa (diphereline, Ferring)was injected 1.88 mg singly in the mid-luteal phase of previous menstrual cycle. Once the patient was down regulated, gonadotropin injection was started. On the day of human chorionic gonadotrophin (hCG) injection, serum luteinizing hormone (LH), estradiol (E2) and progesterone (P) were measured by electrochemiluminescence immunoassay. RESULTS: The level of serum progesterone on the day of hCG injection was lower in the 7-day protocol group comparing with the long protocol group (0.580.51ng/ml vs 0.830.54ng/ml, P< 0.05).There were no significant differences in the levels of serum LH, E2, E2 per oocyte and E2 per mature follicle on the day of hCG injection. Patients in the 7-day protocol group were stimulated for a shorter period (8.971.45 d vs 11.411.43 d, P< 0.05), injected fewer Gn ampoules (1851.65616.96 IU vs 2726.44769.28 IU, P< 0.05),comparing with patients in the long protocol group. When comparing the results in the numbers of oocytes retrieved (14.746.72 vs 16.478.90), fertilization rate (77.94% vs 77.74%), cleaved embryos rate (94.11% vs 96.10%), top-quality embryos rate (60.68% vs 58.85%), implantation rate (25% vs 33.12%), pregnancy rate (50.00% vs 52.56%) and clinical abortion rate (5.88% vs 14.34%), the 7-day protocol group was similar to those of the long protocol group (P >0.05). CONCLUSIONS: The short 7-day GnRHa protocol and GnRHa long protocol had equal effects on controlled ovarian stimulation and pregrancy outcomes for in vitro fertilization and embroy transfer treatment. Patients who received the short 7-day GnRHa protocol required fewer ampoules of gonadotropin and shorter periods of treatment than those who received the GnRHa long protocol. Supported by: None.

Vol. 90, Suppl 1, September 2008