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RESULTS: Evolution of cycle outcome parameters is shown in table 1. Total of 19,557 embryos were replaced with a mean number of 2.7 ⫾ 0.9 embryos replaced per transfer. A progressive decrease was observed with each successive period resulting in significantly less number of embryos replaced when compared with the previous period (p⬍0.001). Despite reducing the number of embryos transferred an increase in clinical and ongoing pregnancies were achieved. Increase in clinical PR was statistically significant between group 1 and group 2 (p⬍0.05), and between group 2 and group 3 (p⬍0.05), but was similar between group 3 and group 4 (p⬎0.05). No statistically significant difference was detected in miscarriage, ectopic pregnancy and twin pregnancy rates during the four periods studied. However, in association with the decreased number of embryos transferred (in group 3 and 4), a significant reduction in multiple pregnancy rates were observed in group 3 and 4. Cumulative PR after 3 and 5 cycles were 87% and 96.8%, respectively. Cumulative pregnancy rates did not differ significantly among different indications for oocyte donation and age groups. Concerning the origin and quality of semen utilized, CPRs did not differ significantly among ejaculated, epididymal or testicular sperm.

status, endometriosis, semen characteristics), the main cycle characteristics (down regulation, controlled ovarian hyperstimulation) oocyte recovery, laboratory results and cycle outcome. Two groups were constituted, one with cycles treated with hMG, and the second with r-FSH. At this step, patients receiving both types of drugs or with spontaneous cycles were excluded. Those two groups were compared on all the patients’ characteristics, to analyze the factors implicated in the medical choice, but not on the efficacy results, since the hypothesis was that patients were not similar and the drug administration was not randomized. The statistical analysis was done using the SAS software, with tests adapted to the studied variables nature, and a p value at 0.05 for significance. RESULTS: The final population of the study was composed of 15,000 cycles, of which 24% received hMG. Women treated with hMG represented 27.5% of IVF cycles and 22.1% of ICSI cycles. The group receiving hMG was constituted of women older than the other (35.7 [SD⫽4.4] vs. 34.2 [4.5], p⬍0.001). There were more women aged more than 35 years (60.4 % vs. 45.4%, p⬍0.001), and aged more than 40 (22.9% vs. 13.3%, p⬍0.001). Men were also older, even if the difference was smaller (37.0 [5.8] vs. 36.3 [5.8], p⬍0.01). There was no difference in infertility duration (5.6 [2.7] in hMG group vs. 6.5 [3.1], p⫽0.59). The number of previous ART cycles was higher in the hMG group (1.3 [1.5] vs 1.0 [1.3]. In conventional IVF, there were more blocked tubes (42.7% vs. 36.4%, p⬍0.01), more endometriosis (7.2% vs. 5.0%, p⫽0.02). The percentage of male infertility and of unexplained infertility were similar (respectively 44.9% vs. 45.8%, p⫽0.64 and 14.0% vs. 11.6%, p⫽0.09). In patients treated by ICSI, those without male infertility were more frequent in the r-FSH group (19.8% vs. 12.1%, p⬍0.001). CONCLUSION: Clearly, the patients’ characteristics have an influence on the medical choice of the drug used for COH. This must be carefully taken in account when comparing the results of those products in non randomized observational studies. Supported by: Laboratoire Ferring, Gentilly, France.

P-88 CONCLUSION: Oocyte donation offers high pregnancy rates to infertile women who require this treatment alternative. Over a period of 10 years, significant improvement in cycle outcome parameters such as IR, clinical and ongoing PRs were achieved. Over the years, we have reduced the number of embryos transferred and achieved a significant decrease in high order pregnancy rates without a compromise in CPRs. Similar CPR’s were observed regardless of recipient age, indication for oocyte donation and sperm origin. Supported by: None.

P-87 COMPARATIVE PROFILE OF ART PATIENTS TREATED WITH HMG OR RECOMBINANT FSH. FRENCH EXPERIENCE. J. De Mouzon, The collaborative ART study group. INSERM U569, Le KremlinBicetre, France. OBJECTIVE: Since several years, recombinant FSH (r-FSH) have been replacing urinary products in controlled ovarian hyperstimulation (COH), particularly in ART, because of hypothezised advantages on safety and efficacy, which resulted in a large increase of cycles cost. However, several recent meta-analyses were unable to find any difference in terms of pregnancy rate (PR), and no specific safety risk was ever demonstrated for urinary products. Moreover, the beneficial role of LH activity has been analyzed in many studies, leading to use more widely hMG. In this debate, it was useful to better understand the reasons related to the medical choice of one type of drug or the other. DESIGN: French multicenter study carried in 20 voluntary centers. Retrospective analysis of clinical data routinely collected in their medical files in 2003 and 2004 . MATERIALS AND METHODS: 20 centers were recruited on the following criteria: routine use of hMG (more than 10% of the cycles), willingness to participate, existence of computerized routine data on IVF. A form was designed, including the patients’ age, the infertility characteristics (infertility duration, past history of pregnancy, ovulation quality, tubal

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Abstracts

ASSISTED REPRODUCTION AND THE POOR RESPONDER: CURRENT TECHNOLOGIES PERMIT SATISFACTORY PREGNANCY RATES. J. Garrisi, N. A. Cekleniak, S. H. Chen, K. M. Ferry, R. H. Walmsley, M. G. Garrisi. Institute for Reproductive Medicine and Science at Saint Barnabas, West Orange, NJ. OBJECTIVE: Poor ovarian response limits the success of in vitro fertilization and embryo transfer (IVF-ET). Consequently, patients who are not expected to develop more than 4-6 follicles are frequently encouraged to consider ovum donation, and initiated IVF cycles are commonly cancelled when fewer than 5 oocytes are expected to be retrieved. In this study we assessed the effectiveness of IVF treatment of younger (⬍40) and older poor responders in comparison to patients with normal ovarian responses to stimulation. DESIGN: A retrospective analysis of 444 patients with four or fewer oocytes and 9209 patients with 5 or more oocytes who underwent IVF over a 10 year period from 1995 to 2005. MATERIALS AND METHODS: Patients were considered poor responders if 4 or fewer oocytes were collected in an IVF cycle. The decision was made to continue an IVF cycle despite a poor response to ovarian stimulation if it was considered that a better response was unlikely in a subsequent stimulation. Patients were informed that the likelihood of pregnancy was reduced compared to patients with normal responses. Patients undergoing pre-implantation genetic diagnosis (PGD) were excluded from this study. RESULTS: Predictably, the pregnancy rate increases as more oocytes are available for IVF (Table 1); for patients with 1-4 oocytes the pregnancy rate ranges from approximately 10% to 25%. The overall clinical pregnancy rate (positive fetal heart) for patients with 4 oocytes or fewer was 21.4% (95/444) Taken together, low responders under 40 had a higher chance of pregnancy than those over 40 (68/288, 23.6% vs. 27/156, 17.3%; p⬍0.025). While the over-40 pregnancy rate was lower for each number of oocytes retrieved, it was only statistically lower for patients with 4 oocytes retrieved (43/143, 30.1% vs. 11/66, 16.7%); p⬍0.05). Also, the implantation rate for patients with ⬍5 oocytes was significantly lower than those with ⱖ 5 oocytes (131/610, 21.5% vs. 6843/25093, 27.3%; p⬍0.01).

Vol. 86, Suppl 2, September 2006

CONCLUSION: The reduced pregnancy rate in patients with fewer than 5 oocytes is expected based on the increased likelihood of fertilization failure eliminating embryo transfer, and the reduced benefit of embryo selection prior to transfer. The reduction in implantation rate also suggests the possibility that embryos from poor responders are less likely to implant. Although pregnancy rates are reduced in poor responders, the expectation of pregnancy is sufficient to warrant continuation of treatment for appropriately-counseled patients. Supported by: None.

P-89 DAY 2 EMBRYO TRANSFER MIGHT BE A BETTER STRATEGY IN SELECTED COUPLES WITH LESS THAN THREE EMBRYOS. O. Taskın, M. Erman Akar, M. Simsek, M. Ozekinci, A. Ekin, B. Sever. Akdeniz Univ School of Medicine, Antalya, Turkey. OBJECTIVE: To evaluate the effect of extended embryo culture in cycles with less than three embryos DESIGN: Retrospective. MATERIALS AND METHODS: Ninety five patients younger than 40 years of age who had developed less than three embryos between January 2005 and February 2006 were included in the study. All oocytes and embryos were cultured in sequential media from Vitrolife(IVF-20, G1.2 and G2.2; Scandinavian IVF Science AB, Goteborg Sweden).Statistical analysis of the results was performed using the X2 and student’s t test and p⬍0.05 was considered statistically significant. RESULTS: In the groups of 2-day and 5-day culture, embryo transfer was performed in 88% and in 42% of cycles respectively. The total implantation rate per created embryo and the pregnancy rate per cycle was higher in the day2 group(16% vs12%),(19% vs15%) respectively , however the difference was not statistically significant. CONCLUSION: Extended culture of embryos allows better selection of embryos, but may decrease their capacity for implantation in cycles with fewer than three embryos. Prospective randomized studies with a larger group of patients are needed to make further conclusions. Supported by: None.

P-90 COMPARISON OF CRYOPRESERVATION OUTCOME WITH GONADOTROPIN-RELEASING HORMONE AGONISTS OR ANTAGONISTS IN THE CONTROL OVARIAN HYPERSTIMULATION CYCLES. C. Ma, J. Qiao, P. Liu, C. Wang. Peking University Third Hospital, Beijing, China. OBJECTIVE: To compare the pregnancy rates and implantation rate of frozen-thawed embryos obtained either in a GnRH agonist protocol , or in an antagonist protocol. DESIGN: Retrospective data analysis. MATERIALS AND METHODS: From April 2003 to October 2004, 60 women who underwent IVF-ET received GnRH antagonist Cetrotide protocol in Peking University Third Hospital. 26 women who were not preg-

FERTILITY & STERILITY威

nant after fresh embryo transfer had more embryos frozen. Meanwhile 26 women with GnRH agonist long protocol and 22 women with GnRH agonist short protocol who were not pregnant after fresh embryo transfer had more embryos frozen. From August 2003 to September 2005, These women received freezen-thawed embryos transferred. There were totaly 40 freezen-thawed embryos transferred cycles in GnRH antagonist protocol, 39 cycles in long protocol and 35 cycles in short protocol stimulation under pituitary suppression with the GnRH agonist. RESULTS: Implantation rates in the freeze-thaw cycles of were 15.6% (GnRH antagonist Cetrotide group) , 20.6% (GnRHa long protocol group) and 10.4% (GnRHa short protocol group) respectively. The clinical Pregnancy rates in GnRHa long-protocol cycles (41.0%) and antagonist protocol cycles (37.5%) were more than 35%. These pregnancy rates were quite exciting. The clinical pregnancy rate of GnRHa short protocol was 22.9%. The abortion rate were similar independent of whether they resulted from the GnRHa long-protocol cycles (12.5%) and GnRHa short protocol (12.5%) or from the antagonist protocol cycles (20%) . CONCLUSION: The potential to implant of freezen-thawed embryos is independent of GnRH agonist or GnRH antagonist protocols. That probably means GnRH antagonist Cetrodide don’t impair the embryo quality in IVF-ET. Supported by: Serono Pharmaceutical Limited.

P-91 PREVIOUS PREGNANCY IN OOCYTE DONORS IS ASSOCIATED WITH A TREND TOWARD INCREASED PREGNANCY RATES. B. W. Rackow, A. J. Duleba, A. Arici, E. Seli. Yale Univ, New Haven, CT. OBJECTIVE: Approximately 10,000 assisted reproduction cycles with donor oocytes are performed annually in the United States. Donor selection criteria usually include age and serum FSH level as predictors of ovarian reserve, while the effect of donor pregnancy history on outcome remains uncertain. We hypothesized that donors with a history of pregnancy are associated with increased pregnancy rates compared with nulligravid donors. We also investigated the hypothesis that a successful first donor cycle is predictive of success in future cycles. DESIGN: All women who anonymously donated oocytes between January 1, 2004 and March 31, 2006 at an academic center were identified (n ⫽ 50), and all of their donor cycles since 2000 (n ⫽ 123) were retrospectively evaluated. MATERIALS AND METHODS: Oocyte donors age 21 to 32 years with normal serum FSH level and normal hormonal, infectious, genetic, and psychological evaluation underwent standard ovarian hyperstimulation with gonadotropin releasing hormone agonist (GnRHa) down-regulation, followed by gonadotropin stimulation. Intracytoplasmic sperm injection was performed as indicated. All recipients underwent gynecologic, medical, and psychological evaluation. Endometrial preparation involved GnRHa downregulation for recipients with ovarian function, and oral micronized 17␤estradiol and intramuscular progesterone-in-oil. Ultrasound-guided embryo transfer (ET) was performed on day 3 or 5. If conception occurred, estradiol and progesterone were continued until 10 weeks. Clinical pregnancy was defined by ultrasound visualization of fetal cardiac activity. Multiple variables were analyzed with respect to cycle outcome: donor age, FSH level, pregnancy history, maximum estradiol level, number of oocytes retrieved, outcome of first donor cycle, and recipient age. Statistical analysis was performed using Chi square with Yates correction. RESULTS: Fifty women donated oocytes 1 to 7 times (mean 2.3) during the study period. A total of 123 cycles and 119 ETs were performed, achieving a 78.2% pregnancy rate and a 66.4% live birth rate per transfer. Evaluation of each donor’s first cycle revealed a 76% pregnancy rate (38/50) and a 62% live birth rate (31/50). When first cycles were analyzed by donor pregnancy history, compared with nulligravid donors (n ⫽ 26), gravid donors (n ⫽ 24) showed a trend toward higher pregnancy rates (83% vs. 69%) and live birth rates (75% vs. 50%). When compared with all first donation cycles, donors with successful first cycles showed a trend toward higher pregnancy and live birth rates with all subsequent cycles (82% vs. 76%, and 71% vs. 62%). However, these differences did not reach statistical significance (p⬎0.05). Donor age, FSH level, maximum estradiol level, number of oocytes retrieved, and recipient age were not significantly associated with pregnancy outcome. CONCLUSION: Oocyte donors with previous pregnancy demonstrated a trend toward higher rates of recipient pregnancy and live birth. Similarly,

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