- Email: [email protected]
Oocyte retrieval rate through repeated identical controlled ovarian stimulation cycles in donors.
Design: Retrospective and comparative study (June 1997 to January 2001). Materials/Methods: Immature oocytes were cultivated in HTF medium supplemented with 0,075 IU FSH and 0,5 IU LH/ml medium. Observations were made on every 4 hours during the first 24 hours after aspiration. Fertilization were checked 12/20 hours after ICSI and 24 hours later, to evaluate the embryo quality. Results: Of 469 ICSI cycles (382 patients), in 316 (252 patients) Puregon was administered and in 153 cycles (130 patients) Gonal-F was used. 372 cycles (79,3%) have shown immature oocytes, being 253 (80,1%) from Puregon and 119 (77,8%) from Gonal-F. Results of oocytes IVM in ICSI cycles. Main outcome results
Conclusions: It is biologically plausible that elevated day 2 estradiol reflects disorded ovarian function. In the present trial a population at risk for reduced ovarian reserve was studied in the cycle of stimulation. If estradiol exceeded 80 pg/mL, 50% of cycles were associated with non-structural ovarian cysts or persistent luteal function and treatment was deferred. In cycles proceeding to treatment, outcome was unimpaired for day 2 estradiol ranging from 10 –100 pg/mL. However, small sample size in increments beyond 80 pg/mL severely limited power. If elevated day 2 estradiol is associated with a reduced IVF prognosis, the threshold is 80 pg/mL. At this threshold, derangements of the early follicular phase are frequently observed.
P-51 Is it necessary to perform a basal ultrasonography (US) prior to ovulation induction? C. Ruhlmann, G. Terrado, R. E. Nicholson, A. Cattaneo, E. D. Rolla, D. Gnochi. Unidad de Fertilidad San Isidro, San Isidro, Argentina. Objective: To evaluate the frequency of basal residual ovarian cysts in an infertile population and its association with different infertility parameters. Design: Prospective ongoing observational study. Materials/Methods: Sixty women were consecutively enrolled at a private infertility clinic. A transvaginal US was performed in 221 cycles before starting ovulation induction (OI) at day 2 to 5. All studies were done by two experienced ultrasonographists with a Panther Ultrasound Scanner Type 2002 ADI, B-K Medical. A basal ovarian cyst over 10 mm in its mean diameter was considered as a residual follicle (RF). For statistical analysis Student’s t-test and Fisher’s exact test were performed as appropriate. Results: Thirty seven patients had at least once a residual cyst (37/76, 61.7%). In 76/221 cycles ( 34.4%) a basal cyst over 10 mm was found; over 15 mm in 57 cycles (25.8%), and over 20 mm in 41 cycles (18.5%), respectively. Global PR per patient was 50% (30/60). No difference in the PR was found between patients that had at least once a RF (20/37, 54.1%) and patients that never had a RF diagnosed at the basal ultrasound (10/23, 43.1%), respectively. No pregnancy was achieved in a cycle were an ovarian cyst over 10 mm was evidenced at basal US. Conclusions: According to the present results a residual ovarian follicle is a frequent finding among infertile women selected for OI therapy. A basal US should be recommended before starting OI.
P-52 Comparisons of two recombinant follicle stimulating hormone (Gonal-F versus puregon) on oocyte behavior in in vitro maturation (IVM). A. Iaconelli Jr, L. M. Rossi-Ferragut, C. C. Rocha, A. Medeiros, T. Aoki, E. Borges Jr. Fertility-Assisted Reproduction Ctr, Sao Paulo, Brazil. Objective: Compare the action of two human FSH-r (Gonal-F/SERONO and Puregon/ORGANON), in ovarian stimulation for ART on results of IVM oocytes and embryo quality.
FERTILITY & STERILITY威
Age ⫾ SD IU FSH Follicles/oocytes MII MI/MI-MII/MI-MII injected PI/PI-MII/P-MII injected MI-MII 2PN/% cleavage PI-MII 2PN/% cleavage Good embryos (MI to MII) Good embryos (PI to MII)
Puregon
Gonal-F
34,3 ⫾ 3 34,3 ⫾ 2,9 2440 2325 5439/3597 2948/1972 2474 (68,7%) 1361 (69,0%) 290 (8,1%)/221(76,2%)*/184 106 (5,4%)/66 (62,3%)/38 (83,3%)* (57,6%) 566 (15,7%)/282 (49,8%)**/ 359 (18,2%)/139 (38,7%)/61 240 (85,1%)* (43,8%) 82 (44,6%)/67,1 15 (39,5%)/86,6* 80 (33,3%)/72,5
19 (31,1%)/100*
57,3%
73,3%*
66,3%*
52,6%
* P ⬍ 0,05 and ** p ⫽ 0,05 (Student “t” test).
Conclusions: Both Gonal-F and Puregon were equally and highly effective in stimulation offering a large number of oocytes. Better results of IVM were obtained with Puregon. Once matured, oocytes from Gonal-F, provided higher cleavage rates. However, when PI-MII oocytes in Puregon, better embryos were gotten. On the other hand, MI-MII injected oocytes using Gonal-F seems to form better embryos. Gonal-F probably induces premature or aberrant oocyte reprogramming, impairing the IVM. Different behavior in response to different hormones isoforms in oocyte microenvironment was discerned. Puregon remain much more time circulating and have the opportunity to recruit slowly all of growing follicles. Our data suggest that IVM protocols must be reviewed based on induction type. More FSH should be add in culture medium when isoforms less acidic were used during the stimulation and some cells that surrounded oocytes should be maintained. Being ovarian tissue cryopreservation associated with IVM a new perspective in ART, these concepts must be considered. Finally, a mixture of both isoforms should be use in an induction protocol, like in normal female reproductive physiology. Supported by: Fertility-Assisted Reproduction Center, Sa˜o Paulo, Brazil.
P-53 Oocyte retrieval rate through repeated identical controlled ovarian stimulation cycles in donors. C. Caligara, J. Navarro, F. Camargo, C. Simo´n, A. Pellicer, J. Remohı´. Inst Valenciano de Infertilidad, Sevilla, Spain; Inst Valenciano de Infertilidad, Valencia, Spain; Inst Valenciano de Infertilidad, Dept of Pediatric, Obstetrics and Gynecology, Univ of Valencia, Valencia, Spain. Objective: To assess whether repetitive controlled ovarian stimulation (COS) cycles may alter the ovarian response in oocyte donors. Design: Retrospective study in a private reproductive medicine clinic. Materials/Methods: Seventy-seven young, healthy women aged 18 to 35 years with two or more cycles with an identical COS, as for number of stimulation days; type and doses of analogue used; type and daily doses of gonadotrophins, were studied. Eighteen of them underwent three identical COS cycles. An intragroup ANOVA was used to compare outcomes in the same woman through the repeated cycles. Results: In the group of 77 donors who underwent two COS cycles, mean age ⫾ SD was 25,1 ⫾ 4,5 and 25,6 ⫾ 4,4 years for the first and second cycle respectively. Gonadotrophins were administered for 9,5 ⫾ 1 day (mean ⫾
S129
SD), using 1934 ⫾ 722 UI of FSH. 19,4 ⫾ 7,7 oocytes were retrieved in the first cycle, and 18,7 ⫾ 6,4 in the second. Immature oocytes were 0,7 ⫾ 1,6 and 0,8 ⫾ 2,2 for the first and second cycle, respectively. Atresic oocytes were 0,2 ⫾ 0,5 and 0,007 ⫾ 0,3. Values for the group who had three cycles are shown in Table 1. No differences were found in the number of mature oocytes, neither in immature or atresic oocytes, in two or three identical COS cycles.
lation response and clinical outcomes observed in this study were comparable to those reported from our center using a GnRH agonist protocol. This suggests that COH-IVF protocols with ganirelix can be used safely in this age group. In addition, these patients may also benefit from the convenience and cost reduction of shorter stimulation cycles. Supported by: The Johns Hopkins University School of Medicine.
Table 1. COS characteristics in donors with 3 cycles (n ⫽ 18).
P-55
Cycle 1
Cycle 2
Cycle 3
Donor agea 24,8 ⫾ 4,4 25,2 ⫾ 4,4 25,7 ⫾ 4,3 Days of gonadotrophin 9,7 ⫾ 0,6 9,7 ⫾ 0,6 9,7 ⫾ 0,6 a administration a Doses of FSH (in IU) 1920 ⫾ 540 1920 ⫾ 540 1920 ⫾ 540 Retrieved mature oocytesa,b 20,2 ⫾ 6,8 19,3 ⫾ 6,8 19,6 ⫾ 8,7 Retrieved immature oocytesa,c 0,6 ⫾ 1,4 1,2 ⫾ 4,0 1,2 ⫾ 2,9 Retrieved atresic oocytesa,d 0,2 ⫾ 0,5 0,005 ⫾ 0,2 0,4 ⫾ 0,9 a
mean ⫾ SD. b p ⱖ 0,84. c p ⱖ0,73. d p ⱖ 0,22.
Conclusions: Retrieved oocyte rate in young, healthy voluntary donors is maintained through repeated COS cycles. This suggests that successive stimulation cycles do not impair ovarian response in this selected group of women.
P-54 Beneficial use of ganirelix in controlled ovarian hyperstimulation (COH) cycles in older women undergoing in vitro fertilization (IVF). M. W. Jurema, M. N. Posada, N. J. Bracero, N. P. Vlahos, J. E. Garcia. Div of Reproductive Endocrinology and Infertility, Dept of Gynecology and Obstetrics, Johns Hopkins Univ Sch of Medicine, Baltimore, MD. Objective: Published data describing the use of GnRH antagonists in COH-IVF protocols has been limited to a population of infertile women ⱕ38 years of age. Hence, a study was designed to evaluate the role of ganirelix in COH-IVF protocols in women ⱖ38 years of age. Design: Retrospective study. Materials/Methods: Fifty-one patients ⱖ38 years of age enrolled in our fertility center from July to December 2000 to undergo COH-IVF using a GnRH antagonist (ganirelix) protocol. All patients met the following criteria for initiation of gonadotropin stimulation: cycle day 2 serum follicular stimulating hormone (FSH) concentration ⬍13 mIU/ml and estradiol (E2) concentration between 20 and 60 pg/ml. A screening transvaginal ultrasound was performed to exclude the presence of follicles or any significant pathology. According to protocol, recombinant FSH (300 IU) and human menopausal gonadotropins (150 IU) were administered for the first 4 days. Thereafter, gonadotropin doses were adjusted according to ovarian response as determined by serial ultrasounds and E2 concentrations. A daily dose of ganirelix (0.25 mg SQ) was administered once the leading follicle had reached a diameter of 14 mm or when serum LH concentration exceeded 10 mIU/L. Human chorionic gonadotropin (10,000 IU IM) was given when at least 3 follicles had reached 18 mm in diameter. Oocyte retrieval followed 36 hours later. Transcervical embryo transfers were performed 72 hours (day 3) after retrieval. We evaluated cycle characteristics, stimulation response and clinical outcomes in this group of patients. Results: The mean age of patients was 41.0 ⫾ 1.9 years. The mean day 2 serum FSH, LH and E2 levels were 7.4 ⫾ 2.2 mIU/L, 3.3 ⫾ 1.8 mIU/L and 38.8 ⫾ 19.7 pg/mL, respectively. Seventy-one cycles were initiated, 10 (14%) were cancelled and 5 (7%) did not undergo embryo transfer. The average duration of gonadotropin stimulation was 9 ⫾ 2 days and the average number of days of treatment with ganirelix was 5 ⫾ 1. The mean peak E2 concentration was 1170 ⫾ 682 pg/mL. The mean number of oocytes retrieved was 6.4 ⫾ 3.9 with a fertilization rate of 75%. This procedure resulted in a median of 2 (range 0-10) 6-8 cell embryos per patient available for transfer on day 3. The mean number of total embryos transferred per patient was 2.7 ⫾ 1.3 resulting in an implantation rate of 6%. Clinical pregnancy rate was 10% (7/71) per initiated cycle and 12% (7/56) per embryo transfer. Conclusions: To our knowledge this is the first report describing the use of ganirelix in COH-IVF cycles for women ⱖ38 years of age. The stimu-
S130
Abstracts
Serum oestradiol/FSH ratio to predict poor responders among patients undergoing IVF and ICSI. C. Manna, A. Rahman, G. Grimaldi, V. Unfer, H. Sallam. Genesis Ctr for Human Reproduction, Rome, Italy; Alexandria Fertility Ctr, Alexandria, Egypt. Objective: The aim of this work was to evaluate the plasma E2/FSH ratio as an index of ovarian stimulation response and a predictor of poor response in patients undergoing IVF and ICSI treatment, compared to plasma E2 or FSH alone. Design: Stepwise regression analysis in a group of patients attending ART procedures in year 2000. Materials/Methods: A total of 47 female patients attending the assisted conception unit for IVF or ICSI treatment were studied, consisting of 8 patients who responded poorly and 39 patients with good response to ovarian stimulation. Plasma E2, serum FSH, and E2/FSH ratio were measured and calculated in daily blood samples obtained on days 1 to 7 of ovarian stimulation. Results: Stepwise regression analysis revealed that the number of oocytes retrieved was significantly dependent on the E2/FSH ratio measured on day 3 of ovarian stimulation (R2 ⫽ 0.551; P ⬍ 0.05). Comparing the values of E2, FSH and E2/FSH ratio in the poor responders (n ⫽ 8) to those in the good responders (n ⫽ 39) revealed that statistically significant differences between both groups regarding E2/FSH ratio started on day 2 of ovarian stimulation (P ⬍ 0.05). Statistically significant differences between both groups regarding plasma E2 started on day 3 of ovarian stimulation (P ⬍ 0.005), while significant differences between both groups regarding plasma FSH levels started on day 4 of ovarian stimulation (P ⬍ 0.05). An E2/FSH value of ⬍6 on day 4 of ovarian stimulation was associated with a 100% sensitivity and a 87.2% specificity in predicting cycle cancellation. Conclusions: It is concluded that E2/FSH ratio is a better index of ovarian stimulation response compared to either plasma E2 or FSH alone among patients treated with IVF or ICSI and can give an earlier index to predict cycle cancellation in poor responders. Supported by: Personal Research.
P-56 Does measurement of ovarian stromal blood flow by color Doppler predict IVF outcome? V. Isaza, J. Garcı´a-Velasco, J. Martinez-Salazar, A. Requena, A. Landazabal, C. Simo´n. IVI-Madrid, Madrid, Spain; IVIMadrid, Madrid, Spain; Inst Valenciano de Infertilidad, Valencia, Spain. Objective: To study the predictive value of ovarian stromal blood flow (OSBF) measured by Doppler after pituitary suppression in ovarian response to controlled ovarian hyperstimulation (COH) and IVF outcome. Design: Prospective, observational study, that included 105 IVF cycles from March 1 to December 31, 2000. Materials/Methods: Patients received a long protocol for pituitary suppression, had a normal FSH level (⬍10) and had no ovarian cysts. Their mean age was 30.4 ⫾ 0.6. A vaginal ultrasound was performed on day 1,2 or 3 of menses, to ascertain ovarian quiescence and OSBF indices were studied in both ovaries. Blood flow velocity waveforms (BFVW) were recorded on paper for subsequent analysis. Both ovaries were measured in their three-dimensional diameters, ovarian volume was calculated by the formula: V ⫽ D1 ⫻ D2 ⫻ D3 ⫻ 0.523 and the total count of antral follicles was registered. Then, COH was started as previously described (Simo´n et al, Fertil Steril 1998;70:234 –9), without considering the ultrasound measurements. When ⱕ4 follicles were found, the cycle was cancelled due to low response (LR). Patients were allocated in two groups, according to whether ovarian stromal BFVW were obtained bilaterally by Doppler ultrasound (Group 1, n ⫽ 82) or in Group 2 (n ⫽ 23) when no BFVW could be measured in one or both ovaries, because no stromal blood flow could be detected.
Vol. 76, No. 3, Suppl. 1, September 2001
Conclusions: It is biologically plausible that elevated day 2 estradiol reflects disorded ovarian function. In the present trial a population at risk for reduced ovarian reserve was studied in the cycle of stimulation. If estradiol exceeded 80 pg/mL, 50% of cycles were associated with non-structural ovarian cysts or persistent luteal function and treatment was deferred. In cycles proceeding to treatment, outcome was unimpaired for day 2 estradiol ranging from 10 –100 pg/mL. However, small sample size in increments beyond 80 pg/mL severely limited power. If elevated day 2 estradiol is associated with a reduced IVF prognosis, the threshold is 80 pg/mL. At this threshold, derangements of the early follicular phase are frequently observed.
P-51 Is it necessary to perform a basal ultrasonography (US) prior to ovulation induction? C. Ruhlmann, G. Terrado, R. E. Nicholson, A. Cattaneo, E. D. Rolla, D. Gnochi. Unidad de Fertilidad San Isidro, San Isidro, Argentina. Objective: To evaluate the frequency of basal residual ovarian cysts in an infertile population and its association with different infertility parameters. Design: Prospective ongoing observational study. Materials/Methods: Sixty women were consecutively enrolled at a private infertility clinic. A transvaginal US was performed in 221 cycles before starting ovulation induction (OI) at day 2 to 5. All studies were done by two experienced ultrasonographists with a Panther Ultrasound Scanner Type 2002 ADI, B-K Medical. A basal ovarian cyst over 10 mm in its mean diameter was considered as a residual follicle (RF). For statistical analysis Student’s t-test and Fisher’s exact test were performed as appropriate. Results: Thirty seven patients had at least once a residual cyst (37/76, 61.7%). In 76/221 cycles ( 34.4%) a basal cyst over 10 mm was found; over 15 mm in 57 cycles (25.8%), and over 20 mm in 41 cycles (18.5%), respectively. Global PR per patient was 50% (30/60). No difference in the PR was found between patients that had at least once a RF (20/37, 54.1%) and patients that never had a RF diagnosed at the basal ultrasound (10/23, 43.1%), respectively. No pregnancy was achieved in a cycle were an ovarian cyst over 10 mm was evidenced at basal US. Conclusions: According to the present results a residual ovarian follicle is a frequent finding among infertile women selected for OI therapy. A basal US should be recommended before starting OI.
P-52 Comparisons of two recombinant follicle stimulating hormone (Gonal-F versus puregon) on oocyte behavior in in vitro maturation (IVM). A. Iaconelli Jr, L. M. Rossi-Ferragut, C. C. Rocha, A. Medeiros, T. Aoki, E. Borges Jr. Fertility-Assisted Reproduction Ctr, Sao Paulo, Brazil. Objective: Compare the action of two human FSH-r (Gonal-F/SERONO and Puregon/ORGANON), in ovarian stimulation for ART on results of IVM oocytes and embryo quality.
FERTILITY & STERILITY威
Age ⫾ SD IU FSH Follicles/oocytes MII MI/MI-MII/MI-MII injected PI/PI-MII/P-MII injected MI-MII 2PN/% cleavage PI-MII 2PN/% cleavage Good embryos (MI to MII) Good embryos (PI to MII)
Puregon
Gonal-F
34,3 ⫾ 3 34,3 ⫾ 2,9 2440 2325 5439/3597 2948/1972 2474 (68,7%) 1361 (69,0%) 290 (8,1%)/221(76,2%)*/184 106 (5,4%)/66 (62,3%)/38 (83,3%)* (57,6%) 566 (15,7%)/282 (49,8%)**/ 359 (18,2%)/139 (38,7%)/61 240 (85,1%)* (43,8%) 82 (44,6%)/67,1 15 (39,5%)/86,6* 80 (33,3%)/72,5
19 (31,1%)/100*
57,3%
73,3%*
66,3%*
52,6%
* P ⬍ 0,05 and ** p ⫽ 0,05 (Student “t” test).
Conclusions: Both Gonal-F and Puregon were equally and highly effective in stimulation offering a large number of oocytes. Better results of IVM were obtained with Puregon. Once matured, oocytes from Gonal-F, provided higher cleavage rates. However, when PI-MII oocytes in Puregon, better embryos were gotten. On the other hand, MI-MII injected oocytes using Gonal-F seems to form better embryos. Gonal-F probably induces premature or aberrant oocyte reprogramming, impairing the IVM. Different behavior in response to different hormones isoforms in oocyte microenvironment was discerned. Puregon remain much more time circulating and have the opportunity to recruit slowly all of growing follicles. Our data suggest that IVM protocols must be reviewed based on induction type. More FSH should be add in culture medium when isoforms less acidic were used during the stimulation and some cells that surrounded oocytes should be maintained. Being ovarian tissue cryopreservation associated with IVM a new perspective in ART, these concepts must be considered. Finally, a mixture of both isoforms should be use in an induction protocol, like in normal female reproductive physiology. Supported by: Fertility-Assisted Reproduction Center, Sa˜o Paulo, Brazil.
P-53 Oocyte retrieval rate through repeated identical controlled ovarian stimulation cycles in donors. C. Caligara, J. Navarro, F. Camargo, C. Simo´n, A. Pellicer, J. Remohı´. Inst Valenciano de Infertilidad, Sevilla, Spain; Inst Valenciano de Infertilidad, Valencia, Spain; Inst Valenciano de Infertilidad, Dept of Pediatric, Obstetrics and Gynecology, Univ of Valencia, Valencia, Spain. Objective: To assess whether repetitive controlled ovarian stimulation (COS) cycles may alter the ovarian response in oocyte donors. Design: Retrospective study in a private reproductive medicine clinic. Materials/Methods: Seventy-seven young, healthy women aged 18 to 35 years with two or more cycles with an identical COS, as for number of stimulation days; type and doses of analogue used; type and daily doses of gonadotrophins, were studied. Eighteen of them underwent three identical COS cycles. An intragroup ANOVA was used to compare outcomes in the same woman through the repeated cycles. Results: In the group of 77 donors who underwent two COS cycles, mean age ⫾ SD was 25,1 ⫾ 4,5 and 25,6 ⫾ 4,4 years for the first and second cycle respectively. Gonadotrophins were administered for 9,5 ⫾ 1 day (mean ⫾
S129
SD), using 1934 ⫾ 722 UI of FSH. 19,4 ⫾ 7,7 oocytes were retrieved in the first cycle, and 18,7 ⫾ 6,4 in the second. Immature oocytes were 0,7 ⫾ 1,6 and 0,8 ⫾ 2,2 for the first and second cycle, respectively. Atresic oocytes were 0,2 ⫾ 0,5 and 0,007 ⫾ 0,3. Values for the group who had three cycles are shown in Table 1. No differences were found in the number of mature oocytes, neither in immature or atresic oocytes, in two or three identical COS cycles.
lation response and clinical outcomes observed in this study were comparable to those reported from our center using a GnRH agonist protocol. This suggests that COH-IVF protocols with ganirelix can be used safely in this age group. In addition, these patients may also benefit from the convenience and cost reduction of shorter stimulation cycles. Supported by: The Johns Hopkins University School of Medicine.
Table 1. COS characteristics in donors with 3 cycles (n ⫽ 18).
P-55
Cycle 1
Cycle 2
Cycle 3
Donor agea 24,8 ⫾ 4,4 25,2 ⫾ 4,4 25,7 ⫾ 4,3 Days of gonadotrophin 9,7 ⫾ 0,6 9,7 ⫾ 0,6 9,7 ⫾ 0,6 a administration a Doses of FSH (in IU) 1920 ⫾ 540 1920 ⫾ 540 1920 ⫾ 540 Retrieved mature oocytesa,b 20,2 ⫾ 6,8 19,3 ⫾ 6,8 19,6 ⫾ 8,7 Retrieved immature oocytesa,c 0,6 ⫾ 1,4 1,2 ⫾ 4,0 1,2 ⫾ 2,9 Retrieved atresic oocytesa,d 0,2 ⫾ 0,5 0,005 ⫾ 0,2 0,4 ⫾ 0,9 a
mean ⫾ SD. b p ⱖ 0,84. c p ⱖ0,73. d p ⱖ 0,22.
Conclusions: Retrieved oocyte rate in young, healthy voluntary donors is maintained through repeated COS cycles. This suggests that successive stimulation cycles do not impair ovarian response in this selected group of women.
P-54 Beneficial use of ganirelix in controlled ovarian hyperstimulation (COH) cycles in older women undergoing in vitro fertilization (IVF). M. W. Jurema, M. N. Posada, N. J. Bracero, N. P. Vlahos, J. E. Garcia. Div of Reproductive Endocrinology and Infertility, Dept of Gynecology and Obstetrics, Johns Hopkins Univ Sch of Medicine, Baltimore, MD. Objective: Published data describing the use of GnRH antagonists in COH-IVF protocols has been limited to a population of infertile women ⱕ38 years of age. Hence, a study was designed to evaluate the role of ganirelix in COH-IVF protocols in women ⱖ38 years of age. Design: Retrospective study. Materials/Methods: Fifty-one patients ⱖ38 years of age enrolled in our fertility center from July to December 2000 to undergo COH-IVF using a GnRH antagonist (ganirelix) protocol. All patients met the following criteria for initiation of gonadotropin stimulation: cycle day 2 serum follicular stimulating hormone (FSH) concentration ⬍13 mIU/ml and estradiol (E2) concentration between 20 and 60 pg/ml. A screening transvaginal ultrasound was performed to exclude the presence of follicles or any significant pathology. According to protocol, recombinant FSH (300 IU) and human menopausal gonadotropins (150 IU) were administered for the first 4 days. Thereafter, gonadotropin doses were adjusted according to ovarian response as determined by serial ultrasounds and E2 concentrations. A daily dose of ganirelix (0.25 mg SQ) was administered once the leading follicle had reached a diameter of 14 mm or when serum LH concentration exceeded 10 mIU/L. Human chorionic gonadotropin (10,000 IU IM) was given when at least 3 follicles had reached 18 mm in diameter. Oocyte retrieval followed 36 hours later. Transcervical embryo transfers were performed 72 hours (day 3) after retrieval. We evaluated cycle characteristics, stimulation response and clinical outcomes in this group of patients. Results: The mean age of patients was 41.0 ⫾ 1.9 years. The mean day 2 serum FSH, LH and E2 levels were 7.4 ⫾ 2.2 mIU/L, 3.3 ⫾ 1.8 mIU/L and 38.8 ⫾ 19.7 pg/mL, respectively. Seventy-one cycles were initiated, 10 (14%) were cancelled and 5 (7%) did not undergo embryo transfer. The average duration of gonadotropin stimulation was 9 ⫾ 2 days and the average number of days of treatment with ganirelix was 5 ⫾ 1. The mean peak E2 concentration was 1170 ⫾ 682 pg/mL. The mean number of oocytes retrieved was 6.4 ⫾ 3.9 with a fertilization rate of 75%. This procedure resulted in a median of 2 (range 0-10) 6-8 cell embryos per patient available for transfer on day 3. The mean number of total embryos transferred per patient was 2.7 ⫾ 1.3 resulting in an implantation rate of 6%. Clinical pregnancy rate was 10% (7/71) per initiated cycle and 12% (7/56) per embryo transfer. Conclusions: To our knowledge this is the first report describing the use of ganirelix in COH-IVF cycles for women ⱖ38 years of age. The stimu-
S130
Abstracts
Serum oestradiol/FSH ratio to predict poor responders among patients undergoing IVF and ICSI. C. Manna, A. Rahman, G. Grimaldi, V. Unfer, H. Sallam. Genesis Ctr for Human Reproduction, Rome, Italy; Alexandria Fertility Ctr, Alexandria, Egypt. Objective: The aim of this work was to evaluate the plasma E2/FSH ratio as an index of ovarian stimulation response and a predictor of poor response in patients undergoing IVF and ICSI treatment, compared to plasma E2 or FSH alone. Design: Stepwise regression analysis in a group of patients attending ART procedures in year 2000. Materials/Methods: A total of 47 female patients attending the assisted conception unit for IVF or ICSI treatment were studied, consisting of 8 patients who responded poorly and 39 patients with good response to ovarian stimulation. Plasma E2, serum FSH, and E2/FSH ratio were measured and calculated in daily blood samples obtained on days 1 to 7 of ovarian stimulation. Results: Stepwise regression analysis revealed that the number of oocytes retrieved was significantly dependent on the E2/FSH ratio measured on day 3 of ovarian stimulation (R2 ⫽ 0.551; P ⬍ 0.05). Comparing the values of E2, FSH and E2/FSH ratio in the poor responders (n ⫽ 8) to those in the good responders (n ⫽ 39) revealed that statistically significant differences between both groups regarding E2/FSH ratio started on day 2 of ovarian stimulation (P ⬍ 0.05). Statistically significant differences between both groups regarding plasma E2 started on day 3 of ovarian stimulation (P ⬍ 0.005), while significant differences between both groups regarding plasma FSH levels started on day 4 of ovarian stimulation (P ⬍ 0.05). An E2/FSH value of ⬍6 on day 4 of ovarian stimulation was associated with a 100% sensitivity and a 87.2% specificity in predicting cycle cancellation. Conclusions: It is concluded that E2/FSH ratio is a better index of ovarian stimulation response compared to either plasma E2 or FSH alone among patients treated with IVF or ICSI and can give an earlier index to predict cycle cancellation in poor responders. Supported by: Personal Research.
P-56 Does measurement of ovarian stromal blood flow by color Doppler predict IVF outcome? V. Isaza, J. Garcı´a-Velasco, J. Martinez-Salazar, A. Requena, A. Landazabal, C. Simo´n. IVI-Madrid, Madrid, Spain; IVIMadrid, Madrid, Spain; Inst Valenciano de Infertilidad, Valencia, Spain. Objective: To study the predictive value of ovarian stromal blood flow (OSBF) measured by Doppler after pituitary suppression in ovarian response to controlled ovarian hyperstimulation (COH) and IVF outcome. Design: Prospective, observational study, that included 105 IVF cycles from March 1 to December 31, 2000. Materials/Methods: Patients received a long protocol for pituitary suppression, had a normal FSH level (⬍10) and had no ovarian cysts. Their mean age was 30.4 ⫾ 0.6. A vaginal ultrasound was performed on day 1,2 or 3 of menses, to ascertain ovarian quiescence and OSBF indices were studied in both ovaries. Blood flow velocity waveforms (BFVW) were recorded on paper for subsequent analysis. Both ovaries were measured in their three-dimensional diameters, ovarian volume was calculated by the formula: V ⫽ D1 ⫻ D2 ⫻ D3 ⫻ 0.523 and the total count of antral follicles was registered. Then, COH was started as previously described (Simo´n et al, Fertil Steril 1998;70:234 –9), without considering the ultrasound measurements. When ⱕ4 follicles were found, the cycle was cancelled due to low response (LR). Patients were allocated in two groups, according to whether ovarian stromal BFVW were obtained bilaterally by Doppler ultrasound (Group 1, n ⫽ 82) or in Group 2 (n ⫽ 23) when no BFVW could be measured in one or both ovaries, because no stromal blood flow could be detected.
Vol. 76, No. 3, Suppl. 1, September 2001