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P-883
P-881 LACK OF ASSOCIATION BETWEEN POLYCYSTIC OVARY SYNDROME AND EMBRYONIC ANEUPLOIDY. A. Weghofer, S. Munne, S. Chen, D. Barad, J. Cohen, N. Gleicher. Yale Univ Medical School, New Haven, CT; Reprogenetics LLC, West Orange, NJ; Saint Barnabas Medical Center, Livingston, NJ; The Center for Human Reproduction, New York, NY. OBJECTIVE: Polycystic ovary syndrome (PCOS) is associated with high oocyte yield, poor oocyte quality, low fertilization rate and an increased risk of spontaneous pregnancy loss. The purpose of this study was to determine whether this ‘poor’ overall oocyte and embryo quality is reflective of higher aneuploidy rates in women with PCOS. DESIGN: Retrospective cohort study MATERIALS AND METHODS: Two-hundred-ninety-two women, aged 27-45 years, undergoing controlled hyperstimulation with gonadotropins for in vitro fertilization (IVF) and consecutive preimplantation genetic diagnosis (PGD) for chromosomes X, Y, 13, 15, 16, 17, 18, 21 and 22. PCOS patients and controls, the latter with tubal factor and idiopathic infertility, were matched for age. RESULTS: Women with PCOS demonstrated similar overall percentages of euploid embryos (46.6%⫾29.0) when compared to controls (47.4%⫾29.8). However, the significantly higher oocyte yield in PCOS patients (22.8⫾9.6 vs. 15.8⫾6.9, p⬍0.01) resulted in significantly higher absolute numbers of euploid embryos (3.2⫾2.1 vs. 2.3⫾1.6, p⬍0.01). When stratified for age (⬍ 38 years and ⱖ 38 years) and egg numbers (10-20 and ⬎20), euploidy rates still did not vary between study and control patients. High responder PCOS patients showed, however, significantly reduced clinical (44.9% vs. 62.9%, p⬍0.05) and ongoing pregnancy rates (40.4% vs. 60.0%, p⬍0.05) compared to high responder controls. All other subgroups revealed comparable pregnancy and miscarriage rates and similar cleavage stage morphology. CONCLUSION: Women with polycystic ovarian disease are not at increased risk for embryonic aneuploidy in the course of in vitro fertilization treatment. Indeed, due to larger oocyte numbers, overall, they produce more euploid embryos, but have lower pregnancy rates after high oocyte yields. The mechanism for this decline in implantation needs to be further evaluated. Supported by: None
P-882 TRANSVAGINAL ENDOSCOPY AND ELECTROCAUTERY OF THE OVARIAN CAPSULE IN PCO PATIENTS. S. Gordts, P. Puttemans, S. Gordts, M. Valkenburg, R. Campo, I. Brosens. L.I.F.E., Leuven, Belgium. OBJECTIVE: The aim of the study is to evaluate the feasibility of drilling of the ovarian capsule using the technique of transvaginal laparoscopy and evaluate possible advantage to standard laparoscope DESIGN: retrospective analysis of results in a tertiairy private referral center MATERIALS AND METHODS: Anovulatory women with PCOS, with failure of ovulation induction with clomiphene or gonadotrophines, were referred for electrocautery of the ovarian capsule using a transvaginal endoscopic access. Access to the pelvis is gained through a simple needle puncture of the pouch of Douglas using a specially developed needle-trocar system(Storz,Tuttlingen). During the procedure a continuous flow of pre warmed Ringer lactate solution is used. Electrocautery was performed using an Erbotom ICC 350 (Erbe,Belgium). For the purpose of drilling of the ovarian capsule, we use a 5 Fr bipolar needle (Storz, Tuttlingen). On each ovary 5-10 punctures were created preferentially at the antero-lateral side of the ovary. The 5 Fr. bipolar needle is gently pushed against the ovarian surface and current is activated with an energy output of 70 watts. The procedure was carried out ambulatory in a one day clinic setting. Cycle evaluation was performed 8-10 weeks after the procedure. RESULTS: A transvaginal electrocautery was performed in 39 patients with a mean age of 30.38 y (⫾ 3.8), mean BMI 29.4 (⫾ 9.7) and a mean duration of infertility of 26.5 m ( ⫾ 2.6). Additional female pathology was detected in 12 patients of whom 10 (83%) represented uterine pathology. Recurrence of spontaneous cycle after drilling occurred in 14 pat ( 36 %); 10patients needed an ovulation induction treatment with a combined regime
S462
Abstracts
of 100mg/d clomiphene citrate for four days and HMG 75 IU/d starting on day 6 of the cycle. In 7 of these patients the ovulation induction was combined with IUI. IVF was performed in 17 patients, mostly due to aberrant semen parameters (n⫽10). Or failure of ovulation induction. In total 26 patients became pregnant after the procedure with a mean duration of 7.2 months (⫾ 5,4) between the onset of pregnancy and the intervention. Eight patients were lost of follow up and considered as negative. Spontaneous pregnancy occurred in 6 of the 8 patients resuming a normal ovulatory cycle after drilling.(43%); of those patients needing a COH, 8 became pregnant(80%) and of the 17 patients referred to our IVF program, 12 resulted in a pregnancy(70,5%). There were no multiple pregnancies and only one of the pregnancies ended in a spontaneous abortion. CONCLUSION: Our experience showed the feasibility of electrocautery of the ovarian capsule through transvaginal laparoscopy with results comparable with those obtained through standard laparoscopy. The advantages of the transvaginal approach are multiple: it offers a direct access to the ovarian surface without need for extra manipulation, it is of major advantage in obese patients avoiding difficulties of entrance at standard laparoscopy; there is no need of extreme Trendelenburg and a pneumoperitoneum with high intraabdominal pressure; it is easy to perform with a very low morbidity enabling the patient to resume work the day after. In case of clomiphene resistant PCO, this technique is to be preferred above a difficult and long lasting ovulation induction with gonadotrophines or a to liberal referral to IVF. Supported by: None P-883 USEFULNESS OF SERUM DAY 3 ESTRADIOL LEVELS IN PCO PATIENTS UNDERGOING IVF. A. Requena, A. Guillen, J. MartinezSalazar, J. Serna, A. Pacheco, J. Garcia-Velasco. Instituto Valenciano de Infertilidad, Madrid, Spain. OBJECTIVE: To evaluate whether the determination of serum estradiol (E2) on day 3 ovarian stimulation in PCO patients undergoing an assisted reproduction treatment (ART) can be useful in order to better customize a milder ovarian stimulation and reduce the risk of ovarian hyperstimulation (OHSS) DESIGN: Prospective, observational study MATERIALS AND METHODS: We included 308 PCO patients diagnosed according to the Rotterdam criteria. The stimulation protocols used were: a) long protocol with GnRH agonist (trypotorelin) with initial doses of 0,1 mg/day, and diminished to 0.05mg/day after ovarian quiescence and until the day of HCG administration; b) antagonist protocol (Ganirelix) started when a follicle larger than 14 mm was observed. Ovarian stimulation was done with recombinant FSH to an initial dose of 150 UI per day for the first two days of treatment. This dose was modified depending on day 3 serum E2 levels, following this criteria: ⬍ 60 pg/ml: dose was increased to 200 UI per day; 60-100 pg/ml: dose was maintained; and ⬎100 pg/ml: Dose was reduced to 100 UI per day. Next control of COH was performed on the 5th with ultrasound scan. RESULTS: Out of the total, 203 patients (65.9%) were stimulated with GnRH agonist and 105 (34.5%) with a GnRH antagonist. Estradiol levels on day 3 were divided in quartile: Quartile 1: ⬍ 50,25 pg/ml; Quartile 2: 50,25-84,99 pg/ml; Quartile 3: 85,00-136,00 pg/ml; Quartile 4 ⬎ 136 pg/ml. No significant differences were found among different quartiles on either number of oocytes obtained or serum estradiol levels on the day of hCG administration. Lineal regression modelling shows that only BMI is acting as an independent variable with a negative correlation with the number of oocytes. CONCLUSION: Early day 3 serum estradiol evaluation in PCO patients may help in obtaining milder stimulations with similar number of oocytes obtained independently of the type of GnRH analogue used. Supported by: None P-884 GLUCOSE CONSUMPTION AND TOTAL PROTEIN PRODUCTION BY PREIMPLANTATION EMBRYOS IN WOMEN WITH THE POLYCYSTIC OVARY SYNDROME. H. N. Sallam, Y. El-Kassar, A. Hany Abdel-Rahman, A. Agameya, A. Farrag, A. Shams. Alexandria Univ, Alexandria, Egypt; Alexandria Fertility Center, Alexandria, Egypt.
Vol. 86, Suppl 2, September 2006
P-882 TRANSVAGINAL ENDOSCOPY AND ELECTROCAUTERY OF THE OVARIAN CAPSULE IN PCO PATIENTS. S. Gordts, P. Puttemans, S. Gordts, M. Valkenburg, R. Campo, I. Brosens. L.I.F.E., Leuven, Belgium. OBJECTIVE: The aim of the study is to evaluate the feasibility of drilling of the ovarian capsule using the technique of transvaginal laparoscopy and evaluate possible advantage to standard laparoscope DESIGN: retrospective analysis of results in a tertiairy private referral center MATERIALS AND METHODS: Anovulatory women with PCOS, with failure of ovulation induction with clomiphene or gonadotrophines, were referred for electrocautery of the ovarian capsule using a transvaginal endoscopic access. Access to the pelvis is gained through a simple needle puncture of the pouch of Douglas using a specially developed needle-trocar system(Storz,Tuttlingen). During the procedure a continuous flow of pre warmed Ringer lactate solution is used. Electrocautery was performed using an Erbotom ICC 350 (Erbe,Belgium). For the purpose of drilling of the ovarian capsule, we use a 5 Fr bipolar needle (Storz, Tuttlingen). On each ovary 5-10 punctures were created preferentially at the antero-lateral side of the ovary. The 5 Fr. bipolar needle is gently pushed against the ovarian surface and current is activated with an energy output of 70 watts. The procedure was carried out ambulatory in a one day clinic setting. Cycle evaluation was performed 8-10 weeks after the procedure. RESULTS: A transvaginal electrocautery was performed in 39 patients with a mean age of 30.38 y (⫾ 3.8), mean BMI 29.4 (⫾ 9.7) and a mean duration of infertility of 26.5 m ( ⫾ 2.6). Additional female pathology was detected in 12 patients of whom 10 (83%) represented uterine pathology. Recurrence of spontaneous cycle after drilling occurred in 14 pat ( 36 %); 10patients needed an ovulation induction treatment with a combined regime
S462
Abstracts
of 100mg/d clomiphene citrate for four days and HMG 75 IU/d starting on day 6 of the cycle. In 7 of these patients the ovulation induction was combined with IUI. IVF was performed in 17 patients, mostly due to aberrant semen parameters (n⫽10). Or failure of ovulation induction. In total 26 patients became pregnant after the procedure with a mean duration of 7.2 months (⫾ 5,4) between the onset of pregnancy and the intervention. Eight patients were lost of follow up and considered as negative. Spontaneous pregnancy occurred in 6 of the 8 patients resuming a normal ovulatory cycle after drilling.(43%); of those patients needing a COH, 8 became pregnant(80%) and of the 17 patients referred to our IVF program, 12 resulted in a pregnancy(70,5%). There were no multiple pregnancies and only one of the pregnancies ended in a spontaneous abortion. CONCLUSION: Our experience showed the feasibility of electrocautery of the ovarian capsule through transvaginal laparoscopy with results comparable with those obtained through standard laparoscopy. The advantages of the transvaginal approach are multiple: it offers a direct access to the ovarian surface without need for extra manipulation, it is of major advantage in obese patients avoiding difficulties of entrance at standard laparoscopy; there is no need of extreme Trendelenburg and a pneumoperitoneum with high intraabdominal pressure; it is easy to perform with a very low morbidity enabling the patient to resume work the day after. In case of clomiphene resistant PCO, this technique is to be preferred above a difficult and long lasting ovulation induction with gonadotrophines or a to liberal referral to IVF. Supported by: None P-883 USEFULNESS OF SERUM DAY 3 ESTRADIOL LEVELS IN PCO PATIENTS UNDERGOING IVF. A. Requena, A. Guillen, J. MartinezSalazar, J. Serna, A. Pacheco, J. Garcia-Velasco. Instituto Valenciano de Infertilidad, Madrid, Spain. OBJECTIVE: To evaluate whether the determination of serum estradiol (E2) on day 3 ovarian stimulation in PCO patients undergoing an assisted reproduction treatment (ART) can be useful in order to better customize a milder ovarian stimulation and reduce the risk of ovarian hyperstimulation (OHSS) DESIGN: Prospective, observational study MATERIALS AND METHODS: We included 308 PCO patients diagnosed according to the Rotterdam criteria. The stimulation protocols used were: a) long protocol with GnRH agonist (trypotorelin) with initial doses of 0,1 mg/day, and diminished to 0.05mg/day after ovarian quiescence and until the day of HCG administration; b) antagonist protocol (Ganirelix) started when a follicle larger than 14 mm was observed. Ovarian stimulation was done with recombinant FSH to an initial dose of 150 UI per day for the first two days of treatment. This dose was modified depending on day 3 serum E2 levels, following this criteria: ⬍ 60 pg/ml: dose was increased to 200 UI per day; 60-100 pg/ml: dose was maintained; and ⬎100 pg/ml: Dose was reduced to 100 UI per day. Next control of COH was performed on the 5th with ultrasound scan. RESULTS: Out of the total, 203 patients (65.9%) were stimulated with GnRH agonist and 105 (34.5%) with a GnRH antagonist. Estradiol levels on day 3 were divided in quartile: Quartile 1: ⬍ 50,25 pg/ml; Quartile 2: 50,25-84,99 pg/ml; Quartile 3: 85,00-136,00 pg/ml; Quartile 4 ⬎ 136 pg/ml. No significant differences were found among different quartiles on either number of oocytes obtained or serum estradiol levels on the day of hCG administration. Lineal regression modelling shows that only BMI is acting as an independent variable with a negative correlation with the number of oocytes. CONCLUSION: Early day 3 serum estradiol evaluation in PCO patients may help in obtaining milder stimulations with similar number of oocytes obtained independently of the type of GnRH analogue used. Supported by: None P-884 GLUCOSE CONSUMPTION AND TOTAL PROTEIN PRODUCTION BY PREIMPLANTATION EMBRYOS IN WOMEN WITH THE POLYCYSTIC OVARY SYNDROME. H. N. Sallam, Y. El-Kassar, A. Hany Abdel-Rahman, A. Agameya, A. Farrag, A. Shams. Alexandria Univ, Alexandria, Egypt; Alexandria Fertility Center, Alexandria, Egypt.
Vol. 86, Suppl 2, September 2006