P-233 Presence of blood on the embryo transfer (ET) catheter is associated with a reduced in vitro fertilization (IVF) pregnancy rate (PR)

hCG injection (DO). Data were analyzed by ANOVA and least-squares linear regression. Results: SHBG levels were lower in FFs yielding immature (GVBD) ova (32.7 _ 8.3 vs 67.2 _+ 6.5 nmol/1 for mature; p < 0.05) and were higher in FFs yielding poor quality ova (70.6 + 7.8 vs 54.0 _+ 8.7 nmol/1 for good quality). SHBG levels determined in FFs and in sera obtained at OPU showed close correlation (P < 0.001), levels in serum being consistently higher than in FFs. Levels of E2 did not differ between oocyte maturity categories. In stimulated patients serum E2 was maximum at D + I then decreased to a trough on D + 3. Levels of SHBG in serum of stimulated patients were constant through to D - 1 (near 60 nmol/1), after which levels rose steeply for 3 days to a plateau (near 130 nmol/1). Because SHBG values are cresting at follicle maturity (near D + 2) and E2 levels are approaching a nadir, the ratio SHBG:E2 in serum was further analyzed as a potentially sensitive index of optimum timing for injection ofhCG in COH patients. Average SHBG:E2 values declined to minimum values at D - 1, and increased ca. 10-fold by D + 3. When analyzed with respect to pregnancy outcome, average SHBG:E2 values in serum on DO were lower in pregnant patients (0.047 _ 0.004 vs 0.073 _+ 0.008, p < 0.01). In unstimulated patients, serum SHBG levels did not change significantly during ovulatory menstrual cycles. Conclusion: With respect to rising serum SHBG levels between D - 1 and D + 2, and the close association between levels of SHBG in serum and FF, the higher levels of SHBG in FF yielding poor quality oocytes are consistent with post-maturity. Lower levels of SHBG in FF yielding immature oocytes are also consistent with the established SHBG changes in serum. The low average SHBG:E2 ratio on DO in pregnant patients indicates that, on average, induction of final oocyte maturity was induced too late in the patients who did not conceive. As the patterns of change of SHBG and of E2 in serum were not parallel, determination of SHBG in serum may provide a sensitive index of follicle maturity in COH patients independent of serum E2. The potential role for SHBG as an index of follicle maturity will be of particular value in these patients in whom the LH surge has been suppressed by GnRH analogue therapy.

P-233 P r e s e n c e o f B l o o d o n t h e E m b r y o T r a n s f e r (ET) C a t h e t e r is A s s o c i a t e d With a R e d u c e d In V i t r o Fert i l i z a t i o n (IVF) P r e g n a n c y R a t e (PR). 1V. T. Goudas, 2D. G. Hammit, 1M. A. Damario, 1D. R. Session, 2A. P. Singh, 1D. A. Dumesic. 1Department of Obstetrics and Gynecology, The Mayo Clinic, Rochester, MN and SDepartment of Obstetrics and Gynecology, The Mayo Clinic, Scottsdale, AZ. Objective: Conflicting reports exist about the association between bleeding during ET and PR with IVF. The purpose of this study was to examine whether blood found inside or outside the transfer catheter after ET affects pregnancy rates. Design: Retrospective cohort study.

Materials and Methods: 354 ETs performed in 307 patients from January 1994 to June 1996 at the Mayo Clinic were studied. Blood found on the catheter after ET was assigned a semi-quantitative score by microscopic examination (0, no blood; 1, minimal blood; 2, significant blood). Univariate analysis and multivariate step-wise logistic regression were used to examine the association between blood on the ET catheter and IVF-ET outcome. Results: Of the 354 ETs, 312 (88.1%) were completed with one attempt, while more than one attempt was necessary if embryos were A) retained in the ET catheter (N = 18), B) the transfer attempt exceeded 120 seconds (N = 25) or C) both A and B occurred (N = 1). Three hundred seventeen ETs (89.5%) had 3 or 4 embryos per transfer, while 37 (10.5%) had 1 or 2 embryos per transfer, for a mean of 3.5 embryos per transfer. One hundred seventy four ETs resulted in clinical pregnancies, for a 49.1% PR per transfer and a 24.8% implantation rate (IR). Blood outside the catheter occurred in 5.9% (N = 21) of ETs (2.2% [N = 8], minimal; 3.7% [N = 13], significant blood). Blood inside the catheter occurred in 16.9% (N = 60) of ETs (10.2% [N = 26], minimal; 7.9% [N = 34], significant blood). Blood outside the ET catheter was associated with a significantly lower PR per transfer compared to no blood (no blood, 51.3% [N = 171]; minimal blood, 25% [N = 2]; significant blood, 7.7%, [N = 1], P < 0.005). Blood outside the ET catheter decreased the probability of pregnancy with an adjusted Odds Ratio of 7.4 (95% confidence interval, 2.1-26). Blood inside the ET catheter had no effect on PR per transfer (no blood, 50% [N = 147]; blood present, 45% [N = 27], P = non significant). In ETs uncomplicated by bleeding, type of catheter had no effect on PR per transfer (Wallace-Edwards, 55.6%, [128 of 230 ETs]; Marrs, 34.7%, [8 of 23 ETs]; Casmed, 53.8%, [7 of 13 ETs], P = non significant). Conclusion: Blood found outside but not inside the transfer catheter is associated with a significantly decreased PR during IVF-ET. Techniques that prevent bleeding at the time of ET should have a beneficial effect on the success rates of IVF-ET.

P-234 Is t h e R e l a t i o n s h i p B e t w e e n S e r u m P r o g e s t e r o n e a n d IVF O u t c o m e D i f f e r e n t B e t w e e n H u m e g o n ® a n d P e r g o n a l ® S t i m u l a t e d Cycles? D. I)oan, M. S. Canez, R. H. Messer, S. D. Prien. Dept Ob/Gyn, Texas Tech University Health Sciences Center, Lubbock, TX. Objectives: Measuring serum progesterone (P) on the day of human chorionic gonadotropin (hCG) administration for prediction of in vitro fertilization (IVF)-cycle outcome remains controversial. Studies have suggested that P of ->.9 ng/mL on the day of hCG correlated with cycle failure. However, studies from this and other laboratories dispute this relationship. In 1995 a second human menopausal gonadotropin (hMG), Humegon®, with a slightly altered chemical formulation (including added hCG to increase the luteinizing hormone-like activity of the compound) became available in the United States. An increase in luteinizing hormone-like activity might lead to an inAbstracts

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