- Email: [email protected]
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(32/304)} and better birth/ongoing pregnancy rate {35.8 % (28/78) vs 22.0 % (22/100)}, although without reaching statistical significance. There were no differences between groups regarding the total embryo average quality (54.7 ⫾ 19.9 vs 47.3 ⫾ 19.6), the average quality of the transferred embryos (15.9 ⫾ 4.8 vs 14.6 ⫾ 5.4) and the abortion rate {17.6 % (6/34) vs 18.5 % (5/27)}. CONCLUSION: The presence of early cleaved embryos after frozen/ thawed pronuclear oocytes cycles appears to be a good prognosis factor of pregnancy. Supported by: None.
Wednesday, October 25, 2006 4:45 pm CONCLUSION: A clear and independent association is seen between the preponderance of liveborn female singletons following IVF-ET and the protocol for controlled ovarian hyperstimulation used during the cycle, namely agonist suppression and HMG stimulation. Associations between polyploidy in sibling embryos and female sex following IVF-ET is of interest, as is the association between tubal disease & the higher odds for the birth of a male singleton. Hypotheses are being developed to explain how these variables significantly predict the birth of female singletons in our IVF practice. Supported by: None.
Wednesday, October 25, 2006 4:30 pm O-274 EARLY CLEAVAGE IN FROZEN/THAWED PRONUCLEAR OOCYTES. A. Valcarcel Sr., M. Tiveron, M. Gomez Pen˜a, R. Quintana, E. Young, C. Bisioli. Instituto de Ginecologia y Fertilidad (IFER), Buenos Aires, Argentina. OBJECTIVE: Early visualization of zygote first cleavage (“early cleavage”) has been proposed as an additional, simple and non-invasive way to detect which embryos are more suitable for transfer. Information reported on fresh cycles have shown an association between embryo early cleavage and improved pregnancy rates in assisted reproductive technologies (ART). In frozen embryo transfer cycles, where the dynamics of embryo cleavage after thawing can change dramatically, there is some lack of such information. The aim of this study was to determine wether the transfer of embryos derived from frozen/thawed pronuclear oocytes displaying early cleavage (EC) results in improved pregnancy rates. DESIGN: Prospective study. MATERIALS AND METHODS: Material and methods: Data were analysed from a total of 178 ART cycles where cryopreservation at the pronuclear stage was performed from November 2003 to November 2005. Zygotes were cryopreserved 18 hours after insemination following a slow protocol using 1,2-Propanediol as cryoprotectant. After thawing, first cleavage of thawed pronuclear oocytes was recorded 11 hours post-thawing (29 hours after insemination). Embryos were cultured up to day 3 in sequential medium and transferred. The average embryo quality was estimated as the ratio between a cumulative embryo score (Hum Reprod 1992; 7:117-9) and the total number of embryos transferred. Two groups of patients were compared: those with at least one EC frozen/thawed embryo (Group A, n⫽78) and those with no frozen/thawed embryos showing EC (Group B, n⫽100). There were no differences regarding the proportion of IVF/ICSI cycles (18:60 vs 33:67), women age (mean ⫾ SD) (32.5⫾3.1 vs 33.5⫾3.8), number of pronuclear oocytes cryopreserved per patient (3.9⫾0.8 vs 3.6⫾0.9) and number of frozen/thawed embryos transferred (3.3⫾0.5 vs 3.1⫾0.7) between groups A and B respectively. Statistical analysis was performed using the Student’s t test or the exact Fisher’s test as appropriate. RESULTS: Patients with faster embryos produced a better clinical pregnancy rate per transfer {43.6 % (34/78) vs 27.0 % (27/100), p⬍0.05}. Group A shows a better implantation rate {15.4 % (41/266) vs 10.5 %
FERTILITY & STERILITY威
O-275 INCREASED DEGREE OF EMBRYO MULTINUCLEATION IN OTHERWISE NORMAL APPEARING EMBRYOS IS ASSOCIATED WITH A CORRESPONDING INCREASE IN CHROMOSOME ABNORMALITIES. M. Duke, J. Kramer, J. Barritt, A. B. Copperman, B. Levy, R. Scott Jr. Reproductive Medicine Associates of New York, New York, NY; Reproductive Medicine Associates of New Jersey, Morristown, NJ. OBJECTIVE: Embryos containing multinucleated (MN) blastomeres are considered morphologically and chromosomally abnormal and generally are not transferred despite scattered reports of births from embryos with 100% MN blastomeres. The objective of this study was to evaluate individual blastomeres for chromosomal abnormalities using fluorescence in-situ hybridization (FISH) in multinucleated, but otherwise morphologically normal embryos. DESIGN: Prospective study. MATERIALS AND METHODS: Embryos were assessed on days 2 and 3 of culture for total blastomeres and presence of multinucleation. Embryos from patients under 40 years old were included when the day 3 assessment revealed 6-10 blastomeres, some multinucleation and no other dysmorphic characteristics. The embryos were disaggregated and each blastomere fixed individually on day 3. Chromosome analysis was performed by 9 chromosome FISH (13, 15, 16, 17, 18, 21, 22, X, Y). Results were classified into two groups: normal diploid or abnormal. Embryos were categorized by the percent of MN blastomeres (1-25, 26-50, 51-75, 76-100%) and the number of chromosomally normal blastomeres. Statistical analysis was performed using the chi-square test. RESULTS: A total of 33 embryos from 18 patients (averge age 32.3 ⫹/-5.9) were analyzed. Nuclei were present in 93.8% (257/274) of blastomeres. Chromosome abnormalities were found in 73.5% (189/257) of blastomeres. Mononucleated blastomeres from MN embryos were diploid significantly more often (55/124, 30.7%) than their sibling MN blastomeres (13/65, 16.7%, p⬍0.02). The prevalence of chromosomally normal blastomeres significantly decreased as the percent of multinucleation increased on both assessment days (see table). When there were ⱕ50% MN blastomeres in an embryo on day 2 or day 3, the percent of chromosomally normal blastomeres in those embryos was 33% and 29%, respectively. When ⬎50% of blastomeres were MN, on day 2 only 2% were chromosomally normal (p⬍0.0001) and on day 3 none were normal (p⬍0.005).
CONCLUSION: Embryos are assessed for morphological characteristics such as multinucleation to illuminate any indication of chromosomal composition and reproductive potential. It is not surprising that mononucleated blastomeres, even from MN embryos, had a significantly lower incidence of
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chromosomal abnormalities compared to their sibling MN blastomeres. When examining the degrees of multinucleation, as shown in Table I, it is interesting that there is little difference in the percent of chromosomally normal blastomeres in embryos with ⬎ or ⱕ 50% multinucleation. This study demonstrates that embryos with greater than 50% MN blastomeres, regardless of the day multinucleation is observed, have a significantly lower probability of containing any chromosomally normal blastomeres. These findings demonstrate the importance of carefully assessing embryo multinucleation as it proves to be a crucial morphological marker for predicting embryonic potential. Supported by: Serono.
OVARIAN STIMULATION: ART Wednesday, October 25, 2006 3:00 pm O-276 THE USE OF GONADOTROPIN RELEASING HORMONE (GNRH) AGONIST TO INDUCE OOCYTE MATURATION IN HIGH-RISK PATIENTS UNDERGOING IVF REDUCES THE RISK OF OVARIAN HYPERSTIMULATION SYNDROME (OHSS) - A PROSPECTIVE RANDOMIZED CONTROLLED STUDY. L. Engmann, A. Diluigi, D. Schmidt, J. Nulsen, D. Maier, C. Benadiva. The Center for Advanced Reproductive Services, Univ of Connecticut Health Center, Farmington, CT. OBJECTIVE: To compare the incidence of OHSS and implantation rates among high-risk patients who used either GnRH agonist (study group) or hCG (control group) to trigger oocyte maturation. DESIGN: Prospective randomized clinical trial at a tertiary university center. MATERIALS AND METHODS: We recruited 66 patients ⬍ 40 years of age undergoing their first cycle of IVF with either polycystic ovarian syndrome (PCOS) or PCO morphology (PCOM) on ultrasound or those undergoing a subsequent cycle with a history of previous high response. Patients in the study group (n⫽34) were pretreated with oral contraceptive pills (OCPs) for 21 days. Daily GnRH antagonist, ganirelix 0.25mg subcutaneously (SQ), was commenced once the leading follicle was ⱖ 14mm in diameter. Patients in the control group (n⫽32) were pretreated with OCPs for 25 days, and GnRH agonist, leuprolide acetate (LA), was commenced on the 21st day of the OCPs. Both groups received recombinant follicle stimulating hormone (Follistim, Organon) for ovarian stimulation. Induction of oocyte maturation was achieved with either LA, 1mg SQ (study group) or hCG, 3,300-10,000IU SQ (control group). This was followed by oocyte retrieval and day-3 embryo transfer. Both groups received intramuscular (IM) progesterone (P), 50mg daily, and in addition patients in the study group received 3 estradiol patches (0.1mg each) every other day. Transdermal estradiol patches and the IM P dose were adjusted accordingly if serum E2 and P were ⱕ 200pg/mL and 20ng/mL respectively. Patients returned 7 days after oocyte retrieval for evaluation of indices of OHSS. The main outcome variables were incidence of OHSS and implantation rate. The Chi-squared test and t-test were used for categorical and continuous variables respectively. Analysis of OHSS was based on an intention to treat. Analyses of other outcome variables were based on per protocol analyses. RESULTS: 66 patients were initially randomized and 1 patient in the study group did not commence treatment and was excluded from the study. 3 patients in each group discontinued intervention prior to trigger of oocyte maturation. They were included in the intention to treat analyses but excluded from the per protocol analyses. There were no differences between the two groups in the mean age, baseline FSH or cause of infertility. The outcome of ovarian stimulation is shown in Table 1. None of the patients in the study group developed OHSS as compared to 15.6% (5/32, P⬍0.05) of the patients in the control group. There were no significant differences in the implantation, clinical pregnancy and ongoing pregnancy rates between the two groups.
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Abstracts
CONCLUSION: Final results of this study have shown that the use of GnRH agonist trigger in high-risk patients is effective in apparently eliminating the risk of OHSS without adversely affecting implantation rates. This should therefore be the protocol of choice for high-risk patients undergoing IVF treatment. Supported by: Unrestricted educational grant from Organon Pharmaceuticals.
Wednesday, October 25, 2006 3:15 pm O-277 LUPRON TRIGGER EXPERIENCE IN GNRH ANTAGONIST ART CYCLES: NOT A PANACEA. J. P. Toner, A. L. Denis, L. A. Hasty, S. Carpenter, W. Bates. Atlanta Center for Reproductive Medicine, Atlanta, GA. OBJECTIVE: To determine the ability of a GnRH agonist to trigger final egg maturation and reduce the risk of ovarian hyperstimulation in GnRHantagonist controlled IVF and Donor Egg cycles. DESIGN: Retrospective Cohort. MATERIALS AND METHODS: A “Lupron Trigger” was used in 85 cases from June 2004 until October 2005 when the risk of OHSS was judged to be high. A single dose of Lupron (leuprolide acetate) 2 mg was given SC (in place of hCG 5,000 IU) 35 hours before planned egg retreival. Luteal support was begun the day after egg retrieval (progesterone (P4) 50 mg IM daily and estradiol (E2) 2 mg PO bid). Fifteen cycles were Egg Donor; 70 were standard IVF. In 17 cases a prior cycle in which hCG had been used as a trigger was available for comparison (of which 7 were donor egg cycles). Results are given as mean ⫾ standard deviation. RESULTS: At the time of the trigger, E2 was 3821 pg/mL (⫾1327) and the number of follicles larger than 10 mm was 29.6 (⫾9.7). The morning after the Lupron Trigger, the mean LH was 54.2 IU/L (⫾29.9) and P4 was 8.9 ng/mL (⫾4.5). After use of a Lupron Trigger: 1. None of the 85 cases developed any degree of OHSS despite being high risk. 2. In three cases there was an aberrant surge response [case 1: LH 2.2 IU/L, P4 12.8 ng/mL, 22 eggs but none fertilized; case 2: LH 8.0 IU/L, P4 5.5 ng/mL, 23 eggs of which only 2 were mature; case 3: LH 10 IU/L, P4 1.2 ng/mL, no eggs from first 5 aspirates]. In 6 other cases, despite an adequate surge response, many fewer than expected eggs were obtained (n⫽3: 9 eggs from 23 large follicles, 20 from 50, 24 from 60), or few were mature (n⫽4: 2 of 23, 0 of 23, 4 of 21, 11 of 20), and/or few fertilized (n⫽5: 3 of 11, 1 of 9, 2 of 11, 1 of 16, 1 of 24). 3. In the fresh IVF cycles with transfer (n⫽57), implantation rate was 16.9%, 44% had a clinical pregnancy, 33% miscarried, and 29% have ongoing or delivered pregnancies. However, these disappointing outcomes were not seen in either the Donor Egg cases (of 15 transfers, the implantation rate was 63%; 77% became clinical pregnant and none have miscarried) or the subsequent cryo-thaw cycles of the initial IVF cases (of 13 transfers, the implantation rate was 59.4%; 76.9% became pregnant and 61.5% are ongoing or delivered). 4. The paired analysis (n⫽17) showed lower egg yield in the Lupron Trigger cases (58% of follicles 13 mm or larger yielded an egg) vs. the hCG trigger cases (79%).
Vol. 86, Suppl 2, September 2006
Wednesday, October 25, 2006 4:45 pm CONCLUSION: A clear and independent association is seen between the preponderance of liveborn female singletons following IVF-ET and the protocol for controlled ovarian hyperstimulation used during the cycle, namely agonist suppression and HMG stimulation. Associations between polyploidy in sibling embryos and female sex following IVF-ET is of interest, as is the association between tubal disease & the higher odds for the birth of a male singleton. Hypotheses are being developed to explain how these variables significantly predict the birth of female singletons in our IVF practice. Supported by: None.
Wednesday, October 25, 2006 4:30 pm O-274 EARLY CLEAVAGE IN FROZEN/THAWED PRONUCLEAR OOCYTES. A. Valcarcel Sr., M. Tiveron, M. Gomez Pen˜a, R. Quintana, E. Young, C. Bisioli. Instituto de Ginecologia y Fertilidad (IFER), Buenos Aires, Argentina. OBJECTIVE: Early visualization of zygote first cleavage (“early cleavage”) has been proposed as an additional, simple and non-invasive way to detect which embryos are more suitable for transfer. Information reported on fresh cycles have shown an association between embryo early cleavage and improved pregnancy rates in assisted reproductive technologies (ART). In frozen embryo transfer cycles, where the dynamics of embryo cleavage after thawing can change dramatically, there is some lack of such information. The aim of this study was to determine wether the transfer of embryos derived from frozen/thawed pronuclear oocytes displaying early cleavage (EC) results in improved pregnancy rates. DESIGN: Prospective study. MATERIALS AND METHODS: Material and methods: Data were analysed from a total of 178 ART cycles where cryopreservation at the pronuclear stage was performed from November 2003 to November 2005. Zygotes were cryopreserved 18 hours after insemination following a slow protocol using 1,2-Propanediol as cryoprotectant. After thawing, first cleavage of thawed pronuclear oocytes was recorded 11 hours post-thawing (29 hours after insemination). Embryos were cultured up to day 3 in sequential medium and transferred. The average embryo quality was estimated as the ratio between a cumulative embryo score (Hum Reprod 1992; 7:117-9) and the total number of embryos transferred. Two groups of patients were compared: those with at least one EC frozen/thawed embryo (Group A, n⫽78) and those with no frozen/thawed embryos showing EC (Group B, n⫽100). There were no differences regarding the proportion of IVF/ICSI cycles (18:60 vs 33:67), women age (mean ⫾ SD) (32.5⫾3.1 vs 33.5⫾3.8), number of pronuclear oocytes cryopreserved per patient (3.9⫾0.8 vs 3.6⫾0.9) and number of frozen/thawed embryos transferred (3.3⫾0.5 vs 3.1⫾0.7) between groups A and B respectively. Statistical analysis was performed using the Student’s t test or the exact Fisher’s test as appropriate. RESULTS: Patients with faster embryos produced a better clinical pregnancy rate per transfer {43.6 % (34/78) vs 27.0 % (27/100), p⬍0.05}. Group A shows a better implantation rate {15.4 % (41/266) vs 10.5 %
FERTILITY & STERILITY威
O-275 INCREASED DEGREE OF EMBRYO MULTINUCLEATION IN OTHERWISE NORMAL APPEARING EMBRYOS IS ASSOCIATED WITH A CORRESPONDING INCREASE IN CHROMOSOME ABNORMALITIES. M. Duke, J. Kramer, J. Barritt, A. B. Copperman, B. Levy, R. Scott Jr. Reproductive Medicine Associates of New York, New York, NY; Reproductive Medicine Associates of New Jersey, Morristown, NJ. OBJECTIVE: Embryos containing multinucleated (MN) blastomeres are considered morphologically and chromosomally abnormal and generally are not transferred despite scattered reports of births from embryos with 100% MN blastomeres. The objective of this study was to evaluate individual blastomeres for chromosomal abnormalities using fluorescence in-situ hybridization (FISH) in multinucleated, but otherwise morphologically normal embryos. DESIGN: Prospective study. MATERIALS AND METHODS: Embryos were assessed on days 2 and 3 of culture for total blastomeres and presence of multinucleation. Embryos from patients under 40 years old were included when the day 3 assessment revealed 6-10 blastomeres, some multinucleation and no other dysmorphic characteristics. The embryos were disaggregated and each blastomere fixed individually on day 3. Chromosome analysis was performed by 9 chromosome FISH (13, 15, 16, 17, 18, 21, 22, X, Y). Results were classified into two groups: normal diploid or abnormal. Embryos were categorized by the percent of MN blastomeres (1-25, 26-50, 51-75, 76-100%) and the number of chromosomally normal blastomeres. Statistical analysis was performed using the chi-square test. RESULTS: A total of 33 embryos from 18 patients (averge age 32.3 ⫹/-5.9) were analyzed. Nuclei were present in 93.8% (257/274) of blastomeres. Chromosome abnormalities were found in 73.5% (189/257) of blastomeres. Mononucleated blastomeres from MN embryos were diploid significantly more often (55/124, 30.7%) than their sibling MN blastomeres (13/65, 16.7%, p⬍0.02). The prevalence of chromosomally normal blastomeres significantly decreased as the percent of multinucleation increased on both assessment days (see table). When there were ⱕ50% MN blastomeres in an embryo on day 2 or day 3, the percent of chromosomally normal blastomeres in those embryos was 33% and 29%, respectively. When ⬎50% of blastomeres were MN, on day 2 only 2% were chromosomally normal (p⬍0.0001) and on day 3 none were normal (p⬍0.005).
CONCLUSION: Embryos are assessed for morphological characteristics such as multinucleation to illuminate any indication of chromosomal composition and reproductive potential. It is not surprising that mononucleated blastomeres, even from MN embryos, had a significantly lower incidence of
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chromosomal abnormalities compared to their sibling MN blastomeres. When examining the degrees of multinucleation, as shown in Table I, it is interesting that there is little difference in the percent of chromosomally normal blastomeres in embryos with ⬎ or ⱕ 50% multinucleation. This study demonstrates that embryos with greater than 50% MN blastomeres, regardless of the day multinucleation is observed, have a significantly lower probability of containing any chromosomally normal blastomeres. These findings demonstrate the importance of carefully assessing embryo multinucleation as it proves to be a crucial morphological marker for predicting embryonic potential. Supported by: Serono.
OVARIAN STIMULATION: ART Wednesday, October 25, 2006 3:00 pm O-276 THE USE OF GONADOTROPIN RELEASING HORMONE (GNRH) AGONIST TO INDUCE OOCYTE MATURATION IN HIGH-RISK PATIENTS UNDERGOING IVF REDUCES THE RISK OF OVARIAN HYPERSTIMULATION SYNDROME (OHSS) - A PROSPECTIVE RANDOMIZED CONTROLLED STUDY. L. Engmann, A. Diluigi, D. Schmidt, J. Nulsen, D. Maier, C. Benadiva. The Center for Advanced Reproductive Services, Univ of Connecticut Health Center, Farmington, CT. OBJECTIVE: To compare the incidence of OHSS and implantation rates among high-risk patients who used either GnRH agonist (study group) or hCG (control group) to trigger oocyte maturation. DESIGN: Prospective randomized clinical trial at a tertiary university center. MATERIALS AND METHODS: We recruited 66 patients ⬍ 40 years of age undergoing their first cycle of IVF with either polycystic ovarian syndrome (PCOS) or PCO morphology (PCOM) on ultrasound or those undergoing a subsequent cycle with a history of previous high response. Patients in the study group (n⫽34) were pretreated with oral contraceptive pills (OCPs) for 21 days. Daily GnRH antagonist, ganirelix 0.25mg subcutaneously (SQ), was commenced once the leading follicle was ⱖ 14mm in diameter. Patients in the control group (n⫽32) were pretreated with OCPs for 25 days, and GnRH agonist, leuprolide acetate (LA), was commenced on the 21st day of the OCPs. Both groups received recombinant follicle stimulating hormone (Follistim, Organon) for ovarian stimulation. Induction of oocyte maturation was achieved with either LA, 1mg SQ (study group) or hCG, 3,300-10,000IU SQ (control group). This was followed by oocyte retrieval and day-3 embryo transfer. Both groups received intramuscular (IM) progesterone (P), 50mg daily, and in addition patients in the study group received 3 estradiol patches (0.1mg each) every other day. Transdermal estradiol patches and the IM P dose were adjusted accordingly if serum E2 and P were ⱕ 200pg/mL and 20ng/mL respectively. Patients returned 7 days after oocyte retrieval for evaluation of indices of OHSS. The main outcome variables were incidence of OHSS and implantation rate. The Chi-squared test and t-test were used for categorical and continuous variables respectively. Analysis of OHSS was based on an intention to treat. Analyses of other outcome variables were based on per protocol analyses. RESULTS: 66 patients were initially randomized and 1 patient in the study group did not commence treatment and was excluded from the study. 3 patients in each group discontinued intervention prior to trigger of oocyte maturation. They were included in the intention to treat analyses but excluded from the per protocol analyses. There were no differences between the two groups in the mean age, baseline FSH or cause of infertility. The outcome of ovarian stimulation is shown in Table 1. None of the patients in the study group developed OHSS as compared to 15.6% (5/32, P⬍0.05) of the patients in the control group. There were no significant differences in the implantation, clinical pregnancy and ongoing pregnancy rates between the two groups.
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Abstracts
CONCLUSION: Final results of this study have shown that the use of GnRH agonist trigger in high-risk patients is effective in apparently eliminating the risk of OHSS without adversely affecting implantation rates. This should therefore be the protocol of choice for high-risk patients undergoing IVF treatment. Supported by: Unrestricted educational grant from Organon Pharmaceuticals.
Wednesday, October 25, 2006 3:15 pm O-277 LUPRON TRIGGER EXPERIENCE IN GNRH ANTAGONIST ART CYCLES: NOT A PANACEA. J. P. Toner, A. L. Denis, L. A. Hasty, S. Carpenter, W. Bates. Atlanta Center for Reproductive Medicine, Atlanta, GA. OBJECTIVE: To determine the ability of a GnRH agonist to trigger final egg maturation and reduce the risk of ovarian hyperstimulation in GnRHantagonist controlled IVF and Donor Egg cycles. DESIGN: Retrospective Cohort. MATERIALS AND METHODS: A “Lupron Trigger” was used in 85 cases from June 2004 until October 2005 when the risk of OHSS was judged to be high. A single dose of Lupron (leuprolide acetate) 2 mg was given SC (in place of hCG 5,000 IU) 35 hours before planned egg retreival. Luteal support was begun the day after egg retrieval (progesterone (P4) 50 mg IM daily and estradiol (E2) 2 mg PO bid). Fifteen cycles were Egg Donor; 70 were standard IVF. In 17 cases a prior cycle in which hCG had been used as a trigger was available for comparison (of which 7 were donor egg cycles). Results are given as mean ⫾ standard deviation. RESULTS: At the time of the trigger, E2 was 3821 pg/mL (⫾1327) and the number of follicles larger than 10 mm was 29.6 (⫾9.7). The morning after the Lupron Trigger, the mean LH was 54.2 IU/L (⫾29.9) and P4 was 8.9 ng/mL (⫾4.5). After use of a Lupron Trigger: 1. None of the 85 cases developed any degree of OHSS despite being high risk. 2. In three cases there was an aberrant surge response [case 1: LH 2.2 IU/L, P4 12.8 ng/mL, 22 eggs but none fertilized; case 2: LH 8.0 IU/L, P4 5.5 ng/mL, 23 eggs of which only 2 were mature; case 3: LH 10 IU/L, P4 1.2 ng/mL, no eggs from first 5 aspirates]. In 6 other cases, despite an adequate surge response, many fewer than expected eggs were obtained (n⫽3: 9 eggs from 23 large follicles, 20 from 50, 24 from 60), or few were mature (n⫽4: 2 of 23, 0 of 23, 4 of 21, 11 of 20), and/or few fertilized (n⫽5: 3 of 11, 1 of 9, 2 of 11, 1 of 16, 1 of 24). 3. In the fresh IVF cycles with transfer (n⫽57), implantation rate was 16.9%, 44% had a clinical pregnancy, 33% miscarried, and 29% have ongoing or delivered pregnancies. However, these disappointing outcomes were not seen in either the Donor Egg cases (of 15 transfers, the implantation rate was 63%; 77% became clinical pregnant and none have miscarried) or the subsequent cryo-thaw cycles of the initial IVF cases (of 13 transfers, the implantation rate was 59.4%; 76.9% became pregnant and 61.5% are ongoing or delivered). 4. The paired analysis (n⫽17) showed lower egg yield in the Lupron Trigger cases (58% of follicles 13 mm or larger yielded an egg) vs. the hCG trigger cases (79%).
Vol. 86, Suppl 2, September 2006