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P-279 A prospective randomized study of the use of assisted hatching in IVF-ET patients with high day-3 FSH. Increased clinical pregnancy rate with assisted hatching but high rate of miscarriages
Results: Stratification for age resulted in three groups: 26 to 30 yrs.; 31 to 35 yrs. and 36 to 40 yrs. The median and range for duration of the infertility was 63 [26-172] months. The median waiting time till the first IVF treatment was 15.1 months [2.7-42.7]. Twenty-five treatmentindependent ongoing pregnancies occurred on the waitinglist, being 17.8% of the patients. The treatment-independent monthly fecundity rates on the waiting list in the above mentioned groups were respectively 1.2%; 1.4% and 0.9%. Thirty-eight pregnancies (37.6%) were obtained in 101 couples due to IVF. The pregnancy rates for IVF were respectively 18.5%; 20.5% and 9.8% per treatment cycle. Discussion: Although a reasonable number of couples got an ongoing pregnancy without treatment on the waiting list within two years, the results of IVF per treatment cycle for couples with longstanding unexplained infertility were much better than the fecundity rates while waiting. It is a matter of debate whether couples with idiopathic infertility should enter the IVF programme immediately after finishing their infertility work-up. However, for all age groups the added value of IVF is substantial. Therefore IVF is an efficient treatment for longstanding unexplained infertility and it should be considered in all age groups.
P-278 Comparison of Cumulutive P r e g n a n c y Rate After ICSI Treatment by Infertility Factor and Origin of Injected Spermatozoa. 1j. H. Jun, 1C. K. Ira, 1j. W. Kim, ~H. K. Byun, 1M. H. Han, 2E. C. Paik, 2M. K. Koong, 2I. P. Son, 2I. S. Kang. 1Infertility Research Laboratory, Cheil Medical Research Institute; 2Dept. of OB/GYN, Samsung Cheil Hospital & Women's Healthcare Center, Seoul, Korea. Objectives: Cumulative pregnancy rate (CPR), often used to assess fertility treatment efficacy and can be used for more comprehensive overview of the IVF-ET program. The objective of this study was to estimate the ultimate probability of pregnancy per couple that could be achieved with multiple cycles of intracytoplasmic sperm injection (ICSI) treatment and to compare the CPR by infertility factor and origin of injected spermatozoa. Design: Retrospective analysis of clinical data. Patients and Methods: During 1994-1996, 980 couples underwent 1,374 cycles of ICSI treatment in our IVF-ET center. The patients were divided into four groups by infertility factor: male factor (579 patients), female factor (223 patients), multiple factor (60 patients) and idiopathic infertility (118 patients). The male factor infertility were divided into two subgroups by origin of injected spermatozoa: ejaculated sperm (317 patients) and epididymal or testicular sperm (262 patients). CPR of ongoing pregnancy was calculated using life table analysis. Between-group differences were tested by the log rank test. Results: Overall CPR of ICSI treatment for cycles 1 to 6 were 31.5%, 54.0%, 65.9%, 68.4%, 77.4% and 77.4%, respectively. CPR following up to three cycles were: male factor 69.4%, female factor 52.3%, multiple factor 47.3%
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Abstracts
and idiopathic 79.1%. The CPR of male and idiopathic infertility were significantly (p<0.05) higher than that of multiple. In the male factor infertility, CPR related to origin of injected spermatozoa was significantly (p<0.05) higher in the group of epididymal or testicular sperm (78.9%) than that of ejaculated sperm (61.6%). Conclusions: The calculation of CPR in ICSI treatments shows that ongoing pregnancy rate levels off after the fifth treatment cycle. Infertility factor and origin of injected sperm significantly affects CPR after ICSI treatment. These CPR data are useful for consultation with advising an infertile couple about the probability of successful pregnancy in ICSI treatment.
P-279 A Prospective Randomized Study of the Use of Assisted Hatching in IVF-ET Patients With High Day3 FSH. Increased Clinical Pregnancy Rate With Assisted Hatching but High Rate of Miscarriages. F. Olivennes, 1A. Hazout, 1M. Dumont, C. Righini, C. Bertrand, R. Frydman. Dept of Ob-Gyn, A. B6cl~re Hospital, Clamart, France; 1Clinique P. Cherest Nenilly, France. Aim of the Study: To study the interest of assited hatching in patient with high day-3 FSH in vitro fertilization. Patients and Design: Infertile patients with high day-3 FSH (>8 UI/I; normal 2 - 6 ui/1) were prospectively randomized between classical IVF-ET and assisted hatching. 79 patients are presented as preliminary data on this ongoing study. Treatments Procedures: Controlled ovarian stimulation was obtained with a agonist low-dose protocol using leuprolide acetate started on day 20 until hCG. Stimulation was obtained using 4 ampules of hMG started after 13 days of the GnRH-a if desensitization was confirmed. Monitoring was done with E2 plasmatic levels and ultrasounds Triggering of ovulation was performed with 10.000 UI of hCG when usual criterias for oocytes maturation were observed. Assisted hatching was performed using a solution of acidified Tyrode on day-3 post fertilization. Natural progesterone was administered vaginally for luteal support. Results: No difference were observed between the assisted hatching and control groups as far as age, length of infertility, E2 on hCG day, number of ampules, fertilization rate and mean number of embryo transferred. Clinical pregnancy rates (PR) was significantely higher in the assisted hatching group (27,0%) as compared to the control group (7,1%). However the miscarriages rate was very high (in the hatching group (40%). Conclusion: Patients with high day-3 FSH have a poor prognostic as far as IVF outcome. Assisted hatching as been proposed to increased the pregnancy rates of these patients. We observed a higher clinical PR using assisted hatching in these patients in a prospective randomized study. However, the poor oocyte quality of these patients might explain the low pregnancy rates observed and might explain the high rate of miscarriage in our study. Assisted hatching could therefore increase the chance of these patients to have a clinical pregnancy, but miscarriage rate is high, probably related to poor oocyte and embryo quality.
P-278 Comparison of Cumulutive P r e g n a n c y Rate After ICSI Treatment by Infertility Factor and Origin of Injected Spermatozoa. 1j. H. Jun, 1C. K. Ira, 1j. W. Kim, ~H. K. Byun, 1M. H. Han, 2E. C. Paik, 2M. K. Koong, 2I. P. Son, 2I. S. Kang. 1Infertility Research Laboratory, Cheil Medical Research Institute; 2Dept. of OB/GYN, Samsung Cheil Hospital & Women's Healthcare Center, Seoul, Korea. Objectives: Cumulative pregnancy rate (CPR), often used to assess fertility treatment efficacy and can be used for more comprehensive overview of the IVF-ET program. The objective of this study was to estimate the ultimate probability of pregnancy per couple that could be achieved with multiple cycles of intracytoplasmic sperm injection (ICSI) treatment and to compare the CPR by infertility factor and origin of injected spermatozoa. Design: Retrospective analysis of clinical data. Patients and Methods: During 1994-1996, 980 couples underwent 1,374 cycles of ICSI treatment in our IVF-ET center. The patients were divided into four groups by infertility factor: male factor (579 patients), female factor (223 patients), multiple factor (60 patients) and idiopathic infertility (118 patients). The male factor infertility were divided into two subgroups by origin of injected spermatozoa: ejaculated sperm (317 patients) and epididymal or testicular sperm (262 patients). CPR of ongoing pregnancy was calculated using life table analysis. Between-group differences were tested by the log rank test. Results: Overall CPR of ICSI treatment for cycles 1 to 6 were 31.5%, 54.0%, 65.9%, 68.4%, 77.4% and 77.4%, respectively. CPR following up to three cycles were: male factor 69.4%, female factor 52.3%, multiple factor 47.3%
S226
Abstracts
and idiopathic 79.1%. The CPR of male and idiopathic infertility were significantly (p<0.05) higher than that of multiple. In the male factor infertility, CPR related to origin of injected spermatozoa was significantly (p<0.05) higher in the group of epididymal or testicular sperm (78.9%) than that of ejaculated sperm (61.6%). Conclusions: The calculation of CPR in ICSI treatments shows that ongoing pregnancy rate levels off after the fifth treatment cycle. Infertility factor and origin of injected sperm significantly affects CPR after ICSI treatment. These CPR data are useful for consultation with advising an infertile couple about the probability of successful pregnancy in ICSI treatment.
P-279 A Prospective Randomized Study of the Use of Assisted Hatching in IVF-ET Patients With High Day3 FSH. Increased Clinical Pregnancy Rate With Assisted Hatching but High Rate of Miscarriages. F. Olivennes, 1A. Hazout, 1M. Dumont, C. Righini, C. Bertrand, R. Frydman. Dept of Ob-Gyn, A. B6cl~re Hospital, Clamart, France; 1Clinique P. Cherest Nenilly, France. Aim of the Study: To study the interest of assited hatching in patient with high day-3 FSH in vitro fertilization. Patients and Design: Infertile patients with high day-3 FSH (>8 UI/I; normal 2 - 6 ui/1) were prospectively randomized between classical IVF-ET and assisted hatching. 79 patients are presented as preliminary data on this ongoing study. Treatments Procedures: Controlled ovarian stimulation was obtained with a agonist low-dose protocol using leuprolide acetate started on day 20 until hCG. Stimulation was obtained using 4 ampules of hMG started after 13 days of the GnRH-a if desensitization was confirmed. Monitoring was done with E2 plasmatic levels and ultrasounds Triggering of ovulation was performed with 10.000 UI of hCG when usual criterias for oocytes maturation were observed. Assisted hatching was performed using a solution of acidified Tyrode on day-3 post fertilization. Natural progesterone was administered vaginally for luteal support. Results: No difference were observed between the assisted hatching and control groups as far as age, length of infertility, E2 on hCG day, number of ampules, fertilization rate and mean number of embryo transferred. Clinical pregnancy rates (PR) was significantely higher in the assisted hatching group (27,0%) as compared to the control group (7,1%). However the miscarriages rate was very high (in the hatching group (40%). Conclusion: Patients with high day-3 FSH have a poor prognostic as far as IVF outcome. Assisted hatching as been proposed to increased the pregnancy rates of these patients. We observed a higher clinical PR using assisted hatching in these patients in a prospective randomized study. However, the poor oocyte quality of these patients might explain the low pregnancy rates observed and might explain the high rate of miscarriage in our study. Assisted hatching could therefore increase the chance of these patients to have a clinical pregnancy, but miscarriage rate is high, probably related to poor oocyte and embryo quality.