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P-61
time of oocyte retrieval in poor responders. This was compared to conventional oocyte retrieval in normal responders. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Eight hundred and forty six patients undergoing ovarian hyperstimulation for IVF enrolled in our program between July 7, 2002 and February 2, 2006 were included in this analysis. Stimulation protocols included lupron down-regulation, microdose lupron, and antagonists using a mixed FSH and hMG protocol. Final follicular maturation was achieved with 10,000 IU u-hCG. Oocyte retrieval was scheduled 34-36 hours following hCG administration. Poor responders were patients with less than 8 mature follicles (⬎14mm) on day of hCG. In poor responders, a double lumen needle follicular irrigation protocol was used. Each follicle was punctured and irrigated individually at the time of retrieval with an additional 1-3 milliliters of sterile media to maximize oocyte release from the follicle wall. Conventional oocyte retrieval was completed in all other patients. Statistical analysis was done using ANOVA for continuous data and Chi Square for categorical data; statistical significance was set at p⬍0.05. RESULTS: The characteristics of IVF cycles utilizing follicle irrigation with a double lumen needle protocol were compared to those undergoing conventional oocyte retrieval. (Table 1). Results are expressed as mean ⫾ SD or percentages, as appropriate. There was a statistically significant difference in age as expected by inclusion criteria (poor responders). Normal responders who underwent conventional oocyte retrieval produced a statistically significant higher ratio of 2PN’s per mature follicle compared to poor responders.
MATERIALS AND METHODS: Fifty-six patients who failed to conceive in at least two previous IVF-ET cycles with a normal uterine cavity on hysterosalpingography were included in this study. They were divided into two groups: group A (n⫽28) had office hysteroscopy and group B (n⫽28) did not. The main outcome measures were cumulative pregnancy and live birth rates of two IVF-ET cycles following the office hysterosocpy. Total duration between hysteroscopy and following IVF-ET cycles was less than 1 year. The statistical analyses were carried out using SPSS software package and Fisher’s exact or Mann-Whitney U tests were used where appropriate. RESULTS: There were no differences in baseline characteristics and controlled ovarian hyperstimulation (COH) outcomes between the two groups. Pregnancy rate (28.6% vs. 17.9%) and live birth rate (17.6% vs. 10.7%) tended to be higher in group A in the first following cycle after office hysteroscopy. Cumulative pregnancy and live birth rates after two following cycles showed similar results (39.3% vs. 21.4%; 21.4% vs. 14.3%). In group A, abnormal hysteroscopic findings did not have significant effects on the pregnancy rates.
CONCLUSION: The results of our study suggest that individual follicle irrigation in poor responders does not increase the quantity of oocytes retrieved in relation to the amount of mature follicles detected at ultrasound. The number of MII oocytes retrieved per follicle ⬎14mm and ultimate 2PN development was not increased compared to normal responders. Improved follicular and oocyte physiology in normal responders is the likely explanation for these findings. This follicllar irrigation protocol in poor responders did not increase mature oocyte yield, but did increase the time of oocyte retrieval, and the overall cost. In conclusion irrigating follicles in an effort to increase oocyte yield was not an effective intervention. Supported by: None.
P-61 EFFECTS OF ENDOMETRIAL EVALUATION WITH OFFICE HYSTEROSCOPY IN IVF-ET PATIENTS WITH REPEATED FAILURES. Y. Chung, C. Suh, Y. Choi, J. Kim, S. Moon, S. Kim. Seoul National Univ, Seoul, Republic of Korea. OBJECTIVE: One of the most consistent factors for the success of in vitro fertilization and embryo transfer (IVF-ET) is known to be the quality of the embryos. However, the significance of embryo quality in determining pregnancy rates should not be considered apart from endometrial receptivity. Failure of conception despite repeated transfers of apparently goodquality embryos is a significant clinical problem in practice. This study was conducted to evaluate the efficacy of office hysteroscopy in IVF-ET patients who repeatedly failed to conceive despite transfer of good-quality embryos. DESIGN: Retrospective comparative study.
S152
Abstracts
CONCLUSION: Endometrial evaluation with office hysteroscopy in patients who repeatedly failed to conceive seems to improve pregnancy and live birth rates. These results seem to be independent of hysteroscopic uterine findings. Further prospective randomized studies in a larger scale will be necessary to confirm these findings. Supported by: None.
Vol. 86, Suppl 2, September 2006
MATERIALS AND METHODS: Fifty-six patients who failed to conceive in at least two previous IVF-ET cycles with a normal uterine cavity on hysterosalpingography were included in this study. They were divided into two groups: group A (n⫽28) had office hysteroscopy and group B (n⫽28) did not. The main outcome measures were cumulative pregnancy and live birth rates of two IVF-ET cycles following the office hysterosocpy. Total duration between hysteroscopy and following IVF-ET cycles was less than 1 year. The statistical analyses were carried out using SPSS software package and Fisher’s exact or Mann-Whitney U tests were used where appropriate. RESULTS: There were no differences in baseline characteristics and controlled ovarian hyperstimulation (COH) outcomes between the two groups. Pregnancy rate (28.6% vs. 17.9%) and live birth rate (17.6% vs. 10.7%) tended to be higher in group A in the first following cycle after office hysteroscopy. Cumulative pregnancy and live birth rates after two following cycles showed similar results (39.3% vs. 21.4%; 21.4% vs. 14.3%). In group A, abnormal hysteroscopic findings did not have significant effects on the pregnancy rates.
CONCLUSION: The results of our study suggest that individual follicle irrigation in poor responders does not increase the quantity of oocytes retrieved in relation to the amount of mature follicles detected at ultrasound. The number of MII oocytes retrieved per follicle ⬎14mm and ultimate 2PN development was not increased compared to normal responders. Improved follicular and oocyte physiology in normal responders is the likely explanation for these findings. This follicllar irrigation protocol in poor responders did not increase mature oocyte yield, but did increase the time of oocyte retrieval, and the overall cost. In conclusion irrigating follicles in an effort to increase oocyte yield was not an effective intervention. Supported by: None.
P-61 EFFECTS OF ENDOMETRIAL EVALUATION WITH OFFICE HYSTEROSCOPY IN IVF-ET PATIENTS WITH REPEATED FAILURES. Y. Chung, C. Suh, Y. Choi, J. Kim, S. Moon, S. Kim. Seoul National Univ, Seoul, Republic of Korea. OBJECTIVE: One of the most consistent factors for the success of in vitro fertilization and embryo transfer (IVF-ET) is known to be the quality of the embryos. However, the significance of embryo quality in determining pregnancy rates should not be considered apart from endometrial receptivity. Failure of conception despite repeated transfers of apparently goodquality embryos is a significant clinical problem in practice. This study was conducted to evaluate the efficacy of office hysteroscopy in IVF-ET patients who repeatedly failed to conceive despite transfer of good-quality embryos. DESIGN: Retrospective comparative study.
S152
Abstracts
CONCLUSION: Endometrial evaluation with office hysteroscopy in patients who repeatedly failed to conceive seems to improve pregnancy and live birth rates. These results seem to be independent of hysteroscopic uterine findings. Further prospective randomized studies in a larger scale will be necessary to confirm these findings. Supported by: None.
Vol. 86, Suppl 2, September 2006