- Email: [email protected]
P-753
P-753 RECOMBINANT LUTEINIZING HORMONE SUPPLEMENTATION TO RECOMBINANT FOLLICLE-STIMULATION HORMONE DURING INDUCED OVARIAN STIMULATION IN THE GNRH-AGONIST PROTOCOL: A META-ANALYSIS. R. L. Baruffi, A. L. Mauri, C. G. Petersen, M. Cavagna, J. B. Oliveira, J. G. Franco Jr. Center for Human Reproduction Prof Franco Junior, Ribeirao Preto - S.P., Brazil; Faculdade de Medicina da Universidade de Santo Amaro, Santo Amaro - S.P., Brazil. OBJECTIVE: The aim of this study is to compare the efficacy of recombinant LH supplementation to recombinant follicle-stimulation hormone during controlled ovarian stimulation in GnRH-agonist protocol for IVF/ICSI cycles DESIGN: Meta-analysis. MATERIALS AND METHODS: Search strategies included on-line surveys of databases (MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and OVID) from 1990 to 2006. There was no language restriction and grey literature was included. The following Medical Subject Headings and text words were used: ovarian stimulation, recombinant FSH (r-FSH), recombinant LH (r-LH), GnRH-agonist (GnRHa), and randomized controlled trial. The primary outcomes were the number of days of stimulation, the total dose of r-FSH administered, serum estradiol levels on the day of HCG administration, the number of oocytes retrieved and the number of mature oocytes (MII). The secondary outcomes were clinical pregnancy rate (CPR) per oocyte retrieval, implantation rate and miscarriage rate. The Breslow-Day statistic, Cochran Q and I2 (inconsistency) were used to determine homogeneity and the combinability of the trials. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference-WMD). The StatsDirect® statistical software (Cheshire, UK) was used for data analysis. RESULTS: Four trials fulfilled the inclusion criteria (Tarlatzis et al 2006, Humaidan et al 2004, Marrs et al 2004, Lisi et al 2002). In 3 trials, the pituitary down-regulation with GnRH-a started in the mid-luteal phase of the preceding cycle and one started in the beginning of the menstrual cycle. All trials compared ovarian stimulation with r-FSH alone (control group) versus ovarian stimulation with r-FSH ⫹ r-LH (study group). In all trials, r-LH was initiated in the late follicular phase. When the meta-analysis was carried out we observed advantages for the LH supplementation protocol with respect to a fewer days of stimulation (p⬍0.0001; WMD:-0.198, 95% CI: -0.24, -0.16), a fewer total dose of r-FSH administered (p⬍0.0001; WMD:-192, 95% CI:-220, -164) and a higher serum estradiol levels on the day of HCG administration (p⬍0.0001; WMD: 49.4, 95% CI: 38.4, 60.4). However, these differences were not observed in number of oocyte retrieval (p:0.37; WMD:0.03, 95% CI: -0.03, 0.09), number of mature oocytes (p⫽0.95; WMD:0.016, 95% CI: -0.46, 0.50), the CPR per oocyte retrieval (p:0.52; OR 1.1, 95% CI: 0.85, 1.42), the implantation rate (p:0.06; OR:1.35 95% CI: 0.99, 1.83) and miscarriage rate (p:0.23; OR 0.52, 95% CI: 0.21, 1.3). CONCLUSION: In the IVF/ICSI cycles with GnRH-a protocol the use r-LH supplementation to r-FSH takes a reduction in the stimulate period, fewer dose of r-FSH and a higher level of estradiol in the day of HCG. However, cycles with or without r-LH supplementation give similar number of oocytes (retrieved and mature) and achieve similar pregnancy, implantation and miscarriages rates. Supported by: None
P-754 1353 CONTROLLED OVARIAN STIMULATION (COH)/ INTRAUTERINE INSEMINATION (IUI) CYCLES: IS THERE ANY CORRELATION BETWEEN THE NUMBER OF FOLLICLES >16MM AND THE SERUM ESTRADIOL LEVEL AT THE TIME OF TRIGGERING IN PREDICTING PREGNANCY OUTCOMES? M. T. Sulit, D. Ezcurra, Z. Rosenwaks. The Center for Reproductive Medicine and Infertility, New York, NY; Medical Affairs Dpt., RH, Serono. Inc,, Rockland, MA. OBJECTIVE: To determine whether a relationship exist between the number of follicles ⬎16mm and the serum estradiol level at the time of triggering in predicting pregnancy outcomes. DESIGN: Retrospective analysis.
FERTILITY & STERILITY威
MATERIALS AND METHODS: We examined 1353consecutive COH cycles from January 2004 to December 2005, at the University -based fertility center. Tubal patency was documented by HSG or laparoscopy. Infertility diagnoses included: unexplained, PCOS, endometriosis, male factor, hypothalamic amenorrhea, recurrent abortion, decreased ovarian reserve, advanced maternal age, and tubal factor or uterine factor. On day 2 or 3 of their menstrual cycles, patients underwent laboratory assessment of estradiol (E2), FSH, and LH levels, and ultrasound to assess the endometium lining and the ovaries. COH was initiated utilizing 75IU-450IU of recombinant or urinary FSH or hMG or both. After two nights of stimulation, E2 levels were evaluated. Subsequent monitoring of serum E2, LH alone or, with ultrasounds were performed and gonadotropins were titrated accordingly. HCG dose (urinary hCG, IM or 250 mcg of recombinant hCG, SC) determined by the E2 level and the number of follicles, was administered when leading follicle was ⬎16mm. Progesterone suppositories were started on third or on fifth day following the IUI. In this analysis we compared the number of follicles ⬎16mm and the peak estradiol level at the time of triggering for pregnant group (P) versus non -pregnant group (NP). Data collected included: cycle number, age, BMI, total amount r-hFSH utilized, peak estradiol levels, number of lead follicles ⬎16mm on the day of hCG, number of patients with positive beta hCG fourteen days after insemination and number of patients with a confirmed clinical pregnancy by ultrasound. Data was analyzed utilizing JMP 6.0 Statistical analysis was done using two sample T-test for equality of variances. Statistical significance was set up at a p-value ⬍0.05. RESULTS: The pregnant group had a mean number of 1.78⫾0.98 follicles with lower and upper limits of 1.67-1.89; the non-pregnant group had 1.61⫾0.86 follicles, with mean lower and upper limits of 1.56-1.66 (pvalue⫽ 0.0071). On average, the pregnant group produced 0.172 more follicles greater16mm size than the non-pregnant group. The 95% confidence interval for this difference ranges from 0.058 to 0.287. In relation with the peak of estradiol level, the pregnant patients reached serum levels of 593.35⫾344.43 pcg/ml with mean lower and upper limits of 554.48632.22 pcg/ml, when compared with the non-pregnant patients, 541.02⫾298.19 pcg/ml and 522.95-559.08 pcg/ml, (p-value⫽ 0.0013). On average the pregnant group had 52.33pcg/ml higher than the non-pregnant group. The 95% confidence interval for this difference ranges from 112.83 to 91.84 pcg/ml. CONCLUSION: Our results suggest that higher number of follicles ⬎16mm and a higher peak estradiol level at the time of triggering have resulted successful pregnancy outcomes for our COH/IUI cycle patients Supported by: None.
P-755 RECOMBINANT LUTEINIZING HORMONE SUPPLEMENTATION TO RECOMBINANT FOLLICLE-STIMULATION HORMONE DURING INDUCED OVARIAN STIMULATION IN THE GNRH-ANTAGONIST PROTOCOL: A META-ANALYSIS. J. B. Oliveira, A. L. Mauri, C. G. Petersen, M. Cavagna, R. L. Baruffi, J. G. Franco Jr. Center for Human Reproduction Prof Franco Junior, Ribeirao Preto S.P., Brazil; Faculdade de Medicina da Universidade de Santo Amaro, Santo Amaro - S.P., Brazil. OBJECTIVE: The aim of this study is to compare the efficacy of recombinant LH supplementation to recombinant follicle-stimulation hormone during controlled ovarian stimulation in GnRH-antagonist protocol for IVF/ICSI cycles DESIGN: Meta-analysis. MATERIALS AND METHODS: Search strategies included on-line surveys of databases (MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and OVID) from 1990 to 2006. There was no language restriction and grey literature was included. The following Medical Subject Headings and text words were used: ovarian stimulation, recombinant FSH (r-FSH), recombinant LH (r-LH), GnRH antagonist, and randomized controlled trial. The primary outcomes were the number of days of stimulation cycle, the total dose of r-FSH administered, serum estradiol levels on the day of HCG administration, the number of oocytes retrieved and the number of mature oocytes (MII). The secondary outcomes were clinical pregnancy rate (CPR) per oocyte retrieval, implantation rate and miscarriage rate. The Breslow-Day statistic, Cochran Q and I2 (inconsistency) were used to determine homogeneity and the combinability of the trials. The fixed effects model was used for odds ratio (OR) and effect size
S413
P-754 1353 CONTROLLED OVARIAN STIMULATION (COH)/ INTRAUTERINE INSEMINATION (IUI) CYCLES: IS THERE ANY CORRELATION BETWEEN THE NUMBER OF FOLLICLES >16MM AND THE SERUM ESTRADIOL LEVEL AT THE TIME OF TRIGGERING IN PREDICTING PREGNANCY OUTCOMES? M. T. Sulit, D. Ezcurra, Z. Rosenwaks. The Center for Reproductive Medicine and Infertility, New York, NY; Medical Affairs Dpt., RH, Serono. Inc,, Rockland, MA. OBJECTIVE: To determine whether a relationship exist between the number of follicles ⬎16mm and the serum estradiol level at the time of triggering in predicting pregnancy outcomes. DESIGN: Retrospective analysis.
FERTILITY & STERILITY威
MATERIALS AND METHODS: We examined 1353consecutive COH cycles from January 2004 to December 2005, at the University -based fertility center. Tubal patency was documented by HSG or laparoscopy. Infertility diagnoses included: unexplained, PCOS, endometriosis, male factor, hypothalamic amenorrhea, recurrent abortion, decreased ovarian reserve, advanced maternal age, and tubal factor or uterine factor. On day 2 or 3 of their menstrual cycles, patients underwent laboratory assessment of estradiol (E2), FSH, and LH levels, and ultrasound to assess the endometium lining and the ovaries. COH was initiated utilizing 75IU-450IU of recombinant or urinary FSH or hMG or both. After two nights of stimulation, E2 levels were evaluated. Subsequent monitoring of serum E2, LH alone or, with ultrasounds were performed and gonadotropins were titrated accordingly. HCG dose (urinary hCG, IM or 250 mcg of recombinant hCG, SC) determined by the E2 level and the number of follicles, was administered when leading follicle was ⬎16mm. Progesterone suppositories were started on third or on fifth day following the IUI. In this analysis we compared the number of follicles ⬎16mm and the peak estradiol level at the time of triggering for pregnant group (P) versus non -pregnant group (NP). Data collected included: cycle number, age, BMI, total amount r-hFSH utilized, peak estradiol levels, number of lead follicles ⬎16mm on the day of hCG, number of patients with positive beta hCG fourteen days after insemination and number of patients with a confirmed clinical pregnancy by ultrasound. Data was analyzed utilizing JMP 6.0 Statistical analysis was done using two sample T-test for equality of variances. Statistical significance was set up at a p-value ⬍0.05. RESULTS: The pregnant group had a mean number of 1.78⫾0.98 follicles with lower and upper limits of 1.67-1.89; the non-pregnant group had 1.61⫾0.86 follicles, with mean lower and upper limits of 1.56-1.66 (pvalue⫽ 0.0071). On average, the pregnant group produced 0.172 more follicles greater16mm size than the non-pregnant group. The 95% confidence interval for this difference ranges from 0.058 to 0.287. In relation with the peak of estradiol level, the pregnant patients reached serum levels of 593.35⫾344.43 pcg/ml with mean lower and upper limits of 554.48632.22 pcg/ml, when compared with the non-pregnant patients, 541.02⫾298.19 pcg/ml and 522.95-559.08 pcg/ml, (p-value⫽ 0.0013). On average the pregnant group had 52.33pcg/ml higher than the non-pregnant group. The 95% confidence interval for this difference ranges from 112.83 to 91.84 pcg/ml. CONCLUSION: Our results suggest that higher number of follicles ⬎16mm and a higher peak estradiol level at the time of triggering have resulted successful pregnancy outcomes for our COH/IUI cycle patients Supported by: None.
P-755 RECOMBINANT LUTEINIZING HORMONE SUPPLEMENTATION TO RECOMBINANT FOLLICLE-STIMULATION HORMONE DURING INDUCED OVARIAN STIMULATION IN THE GNRH-ANTAGONIST PROTOCOL: A META-ANALYSIS. J. B. Oliveira, A. L. Mauri, C. G. Petersen, M. Cavagna, R. L. Baruffi, J. G. Franco Jr. Center for Human Reproduction Prof Franco Junior, Ribeirao Preto S.P., Brazil; Faculdade de Medicina da Universidade de Santo Amaro, Santo Amaro - S.P., Brazil. OBJECTIVE: The aim of this study is to compare the efficacy of recombinant LH supplementation to recombinant follicle-stimulation hormone during controlled ovarian stimulation in GnRH-antagonist protocol for IVF/ICSI cycles DESIGN: Meta-analysis. MATERIALS AND METHODS: Search strategies included on-line surveys of databases (MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and OVID) from 1990 to 2006. There was no language restriction and grey literature was included. The following Medical Subject Headings and text words were used: ovarian stimulation, recombinant FSH (r-FSH), recombinant LH (r-LH), GnRH antagonist, and randomized controlled trial. The primary outcomes were the number of days of stimulation cycle, the total dose of r-FSH administered, serum estradiol levels on the day of HCG administration, the number of oocytes retrieved and the number of mature oocytes (MII). The secondary outcomes were clinical pregnancy rate (CPR) per oocyte retrieval, implantation rate and miscarriage rate. The Breslow-Day statistic, Cochran Q and I2 (inconsistency) were used to determine homogeneity and the combinability of the trials. The fixed effects model was used for odds ratio (OR) and effect size
S413