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P-63
P-62
P-63
WHAT IS THE PREFERRED METHOD FOR TIMING NATURAL CYCLE FROZEN-THAWED EMBRYO TRANSFER? A. Weissman, A. Ravhon, G. Biran, D. Levin, H. Nahum, D. Levran. Wolfson Medical Center, Holon, Israel.
DIFFERENCES IN CLINICAL APPLICATION OF SERUM ESTRADIOL LEVELS ON HCG DAY BETWEEN GNRH ANTAGONIST AND GNRH AGONIST CYCLES. Y. Ku, C. Suh, Y. Choi, J. Kim, S. Moon, S. Kim. Dept of Obstetrics and Gynecology, Coll of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National Univ, Seoul, Republic of Korea.
OBJECTIVE: Simplification of IVF is a constant goal for both patients and the caring team. Little attention has been given with this respect to frozen embryo transfer (FET) cycles . In ovulatory patients, FET can be done during a spontaneous natural cycle (NC). For synchronization between the endometrium and embryos, the day of egg retrieval corresponds to the day of ovulation in the NC, and embryos are thawed and transferred accordingly. Patient monitoring prior to NC-FET consists of serial blood and ultrasound testing until detection of ovulation. Alternatively, hCG may be used for triggering ovulation in presence of a mature follicle. The later approach may potentially simplify the process by saving the patients and the clinic the time and expenses involved with the extra visits necessary for documentation of ovulation. The aim of our study was to compare between ovulation triggering by hCG versus expectant follow-up until the documentation of ovulation in patient preparation for NC-FET in terms of the number of visits in the clinic and cycle outcome. DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 133 NC-FET cycles carried out in our unit during the years 2004-2005 were analyzed. Group A included 71 cycles that were monitored until documentation of ovulation. Criteria for ovulation diagnosis included 1. a drop in serum E2 level compared to the previous test. 2. a rise in serum P level ⬎1.5 ng/mL. 3. Disappearance or typical change in the shape of the lead follicle. Group B included 61 cycles where ovulation was triggered by hCG. Criteria for hCG administration included 1. A lead follicle ⬎17 mm in diameter 2. serum E2⬎150 pg/mL 3. serum P level ⬍ 1 ng/mL. In both groups, endometrial thickness ⱖ7 mm was considered mandatory for proceeding with embryo thawing. Assignment for expectant management or ovulation triggering was done according to physician’s preference. The main outcome measure was the number of visits in the clinic. The secondary outcome measures included clinical and ongoing pregnancy/delivery rates per cycle and per transfer. RESULTS: Patients in groups A and B were similar in terms of demographic characteristics and reproductive history. Clinical and laboratory cycle parameters were also similar for both groups (table). The number of visits in group B was significantly reduced as compared to group A (3.5⫾1.8 vs. 4.4⫾1.4, p⬍0.0001). Pregnancy rates per cycle (group A 29.6%; group B 32.8%), per transfer (Group A 33.9%; Group B 37%) and ongoing pregnancy/delivery per transfer (Group A 27.4%; Group B 31.5%) were all comparable.
CONCLUSION: In patients undergoing NC-FET, triggering ovulation by hCG can significantly reduce the number of visits necessary for cycle monitoring without an adverse effect on cycle outcome. Triggering ovulation can increase both patients’ convenience and the cost-effectiveness of the cycle. It can be also used for convenient planning of the transfer day. A randomized, prospective study exploring further this approach is currently under way. Supported by: None.
FERTILITY & STERILITY威
OBJECTIVE: Prediction of ovarian response using serum estradiol (E2) can help to evaluate the risk of ovarian hyperstimulation syndrome (OHSS). The numbers of oocytes retrieved and mature follicles are known to be correlated with serum E2 level on hCG day. There have been many studies on the correlation between serum E2 levels on hCG day and ovarian response in controlled ovarian hyperstimulation (COH) cycles using GnRH agonist (GnRHa). However, such data are not available for GnRH antagonist (GnRHant) cycles at present. This is the first study that assessed the E2 levels per mature follicle in GnRHant cycles and compared with GnRHa cycles. DESIGN: Retrospective comparative study. MATERIALS AND METHODS: A total of 194 eligible patients were included. Serum E2 level was measured using radioimmunoassay on hCG day of flexible GnRHant multiple-dose protocol cycles (n⫽94) and GnRHa long protocol cycles (n⫽100). Correlations between the numbers of follicles of various sizes and mature oocytes were analyzed to determine the cut-off value of the size of mature follicle. We calculated serum E2 level per mature follicle and per retrieved oocyte for each follicle size. Chi square, Student’s t-test and linear regression analyses were conducted as appropriate, and p⬍0.05 was considered significant.
RESULTS: There were no significant differences in terms of clinical characteristics such as age, body mass index and basal serum FSH levels between the two groups. The number of follicles 1015 mm was not significantly different between the two protocols, however, the number of follicles ⱖ16 mm was significantly lower in GnRHant cycles (3.9 ⫾ 1.8 vs. 5.3 ⫾ 2.6, p⬍0.001). The cut-off of mature follicle was determined as 12 mm. Serum E2 levels per mature follicle (236.8 ⫾ 111.4 vs. 201.1 ⫾ 119.1 pg/ml, p⫽0.038) and per oocyte retrieved (245.9 ⫾ 189.5 vs. 197.9 ⫾ 106.5 pg/ml, p⫽0.037) were significantly higher in GnRHant cycles. CONCLUSION: Serum E2 levels per mature follicle and per oocyte retrieved were significantly higher in GnRHant cycles. The distribution of the size of follicles on hCG day was different between GnRHant and GnRHa cycles. Serum E2 level used for the evaluation of OHSS risk in GnRHa cycles may not be appropriate in GnRHant cycles, and different coasting criteria may be necessary for GnRHant cycles. Supported by: None.
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P-63
WHAT IS THE PREFERRED METHOD FOR TIMING NATURAL CYCLE FROZEN-THAWED EMBRYO TRANSFER? A. Weissman, A. Ravhon, G. Biran, D. Levin, H. Nahum, D. Levran. Wolfson Medical Center, Holon, Israel.
DIFFERENCES IN CLINICAL APPLICATION OF SERUM ESTRADIOL LEVELS ON HCG DAY BETWEEN GNRH ANTAGONIST AND GNRH AGONIST CYCLES. Y. Ku, C. Suh, Y. Choi, J. Kim, S. Moon, S. Kim. Dept of Obstetrics and Gynecology, Coll of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National Univ, Seoul, Republic of Korea.
OBJECTIVE: Simplification of IVF is a constant goal for both patients and the caring team. Little attention has been given with this respect to frozen embryo transfer (FET) cycles . In ovulatory patients, FET can be done during a spontaneous natural cycle (NC). For synchronization between the endometrium and embryos, the day of egg retrieval corresponds to the day of ovulation in the NC, and embryos are thawed and transferred accordingly. Patient monitoring prior to NC-FET consists of serial blood and ultrasound testing until detection of ovulation. Alternatively, hCG may be used for triggering ovulation in presence of a mature follicle. The later approach may potentially simplify the process by saving the patients and the clinic the time and expenses involved with the extra visits necessary for documentation of ovulation. The aim of our study was to compare between ovulation triggering by hCG versus expectant follow-up until the documentation of ovulation in patient preparation for NC-FET in terms of the number of visits in the clinic and cycle outcome. DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 133 NC-FET cycles carried out in our unit during the years 2004-2005 were analyzed. Group A included 71 cycles that were monitored until documentation of ovulation. Criteria for ovulation diagnosis included 1. a drop in serum E2 level compared to the previous test. 2. a rise in serum P level ⬎1.5 ng/mL. 3. Disappearance or typical change in the shape of the lead follicle. Group B included 61 cycles where ovulation was triggered by hCG. Criteria for hCG administration included 1. A lead follicle ⬎17 mm in diameter 2. serum E2⬎150 pg/mL 3. serum P level ⬍ 1 ng/mL. In both groups, endometrial thickness ⱖ7 mm was considered mandatory for proceeding with embryo thawing. Assignment for expectant management or ovulation triggering was done according to physician’s preference. The main outcome measure was the number of visits in the clinic. The secondary outcome measures included clinical and ongoing pregnancy/delivery rates per cycle and per transfer. RESULTS: Patients in groups A and B were similar in terms of demographic characteristics and reproductive history. Clinical and laboratory cycle parameters were also similar for both groups (table). The number of visits in group B was significantly reduced as compared to group A (3.5⫾1.8 vs. 4.4⫾1.4, p⬍0.0001). Pregnancy rates per cycle (group A 29.6%; group B 32.8%), per transfer (Group A 33.9%; Group B 37%) and ongoing pregnancy/delivery per transfer (Group A 27.4%; Group B 31.5%) were all comparable.
CONCLUSION: In patients undergoing NC-FET, triggering ovulation by hCG can significantly reduce the number of visits necessary for cycle monitoring without an adverse effect on cycle outcome. Triggering ovulation can increase both patients’ convenience and the cost-effectiveness of the cycle. It can be also used for convenient planning of the transfer day. A randomized, prospective study exploring further this approach is currently under way. Supported by: None.
FERTILITY & STERILITY威
OBJECTIVE: Prediction of ovarian response using serum estradiol (E2) can help to evaluate the risk of ovarian hyperstimulation syndrome (OHSS). The numbers of oocytes retrieved and mature follicles are known to be correlated with serum E2 level on hCG day. There have been many studies on the correlation between serum E2 levels on hCG day and ovarian response in controlled ovarian hyperstimulation (COH) cycles using GnRH agonist (GnRHa). However, such data are not available for GnRH antagonist (GnRHant) cycles at present. This is the first study that assessed the E2 levels per mature follicle in GnRHant cycles and compared with GnRHa cycles. DESIGN: Retrospective comparative study. MATERIALS AND METHODS: A total of 194 eligible patients were included. Serum E2 level was measured using radioimmunoassay on hCG day of flexible GnRHant multiple-dose protocol cycles (n⫽94) and GnRHa long protocol cycles (n⫽100). Correlations between the numbers of follicles of various sizes and mature oocytes were analyzed to determine the cut-off value of the size of mature follicle. We calculated serum E2 level per mature follicle and per retrieved oocyte for each follicle size. Chi square, Student’s t-test and linear regression analyses were conducted as appropriate, and p⬍0.05 was considered significant.
RESULTS: There were no significant differences in terms of clinical characteristics such as age, body mass index and basal serum FSH levels between the two groups. The number of follicles 1015 mm was not significantly different between the two protocols, however, the number of follicles ⱖ16 mm was significantly lower in GnRHant cycles (3.9 ⫾ 1.8 vs. 5.3 ⫾ 2.6, p⬍0.001). The cut-off of mature follicle was determined as 12 mm. Serum E2 levels per mature follicle (236.8 ⫾ 111.4 vs. 201.1 ⫾ 119.1 pg/ml, p⫽0.038) and per oocyte retrieved (245.9 ⫾ 189.5 vs. 197.9 ⫾ 106.5 pg/ml, p⫽0.037) were significantly higher in GnRHant cycles. CONCLUSION: Serum E2 levels per mature follicle and per oocyte retrieved were significantly higher in GnRHant cycles. The distribution of the size of follicles on hCG day was different between GnRHant and GnRHa cycles. Serum E2 level used for the evaluation of OHSS risk in GnRHa cycles may not be appropriate in GnRHant cycles, and different coasting criteria may be necessary for GnRHant cycles. Supported by: None.
S153