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Predicting pregnancy outcome from early obstetrical ultrasound in patients undergoing intrauterine insemination (IUI)
antagonist arm (CET), 16 patients received follitropin alfa and cetrorelix. Cetrorelix 0.25 mg was administered when the lead follicle was 12 to 14 mm. Twenty-three patients were treated with mid-luteal leuprolide acetate (LUP) and received either follitropin alfa or beta. All patients had OPU from 34 –36 hours after u-hCG 10,000 U was administered. A statistical analysis was completed using Statpro and Jump software with a Student t-test and a Chi-square for independence. Determination of baseline parameters such as age, number of previous cycles, total r-FSH dose, and stimulation days were compared. A comparison of number of follicles ⬎ 15 mm, the peak estradiol (E2) level, number of oocytes, and the number metaphase II (MII) oocytes was completed. Pregnancy rates were compared using Chi square test (p⬍0.05). RESULTS: Patients in both groups were similar in age. The CET patients had a significantly higher number of ART attempts but significantly fewer days of stimulation and total r-hFSH dose. No difference was noted for outcomes in terms of peak E2, follicles ⬎ 15 mm, number of oocytes retrieved, number of MII oocytes, or clinical pregnancy rates. CONCLUSION: Regardless of the protocol utilized, cetrorelix or midluteal leuprolide, patients had similar clinical outcomes. However, due to shorter treatment cycles and the use of less medication, cetrorelix cycles may ultimately be more cost-effective. Prospective, randomized studies are needed to confirm the findings of this analysis. aAlbano, et al., Human Reprod 2000:15;526. bFelberbaum, et al., Human Reprod 2000:15;1015. Supported by: Serono, Inc.
P-564 Incorporating surgical sperm extractions into an in vitro fertilization (IVF) operating room ⴚ A multidisciplinary approach. M. Baracewicz, E. Ginsburg. Brigham and Women’s Hospital, Boston, MA. OBJECTIVE: To evaluate the efficacy of a multidisciplinary approach to incorporate surgical sperm retrieval procedures, i.e., testicular sperm extraction (TESA), and percutaneous epididymal sperm aspiration (PESA), into the existing operations of an IVF surgical suite. DESIGN: Retrospective chart review of cases done April 1, 2003 through April 30, 2004 MATERIALS AND METHODS: Interviews were conducted with members of the IVF team including embryologists, nurses, anesthesiologists, and urologists. A plan for communication among IVF team members was established. Nurses and surgical technicians were trained about preoperative, intraoperative, and postoperative care of men undergoing these procedures. A written procedure was developed for nurses circulating in the operating room (OR). Preoperative and postoperative orders were developed for surgical sperm retrieval procedures undertaken in the IVF suite. Institutional Review Board approval was obtained for using medical records for the purpose of analyzing sperm extractions done between April 2003 and April 2004. The number of procedures, type of anesthesia used, and length of preoperative, operating room, and recovery times were noted for cases with located records. RESULTS: Table 1: Data Collection for Surgical Sperm Extraction
P-563 Predicting pregnancy outcome from early obstetrical ultrasound in patients undergoing intrauterine insemination (IUI). G. Saphier, G. Paoletti-Falcone. Reproductive Science Center of Boston, Waltham, MA. OBJECTIVE: In our practice, one of the most common questions posed by patients at the time of their early obstetrical ultrasound is, “What is my chance of miscarriage now?” Though there are national statistics on the likelihood of miscarriage we were interested to look at the infertility population and specifically at our own population. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We retrospectively analyzed 287 pregnant patients who had undergone IUI cycles using either clomiphene citrate or human menopausal gonadotropins (hMG) stimulation between August 1, 2001 and July 31, 2003. Patients were evaluated based on 5 variables: number of sacs, heart rate, crown-rump length (CRL), average gestational size and yolk sac. Only patients whose pregnancy outcome data was available were included in the sample. Binary logistic regression using Fisher’s scoring optimization technique was performed using JMP 5.01 software. Each variable was evaluated independently by keeping all the other variables constant. This methodology allowed each variable to be compared independently to the study population. RESULTS: The probabilities of having a live birth for every unit increase in the measurements of each variable analyzed, increases1.03 times for age, 2.00 for number of sacs, 1.08 for heart rate, 1.21 for size of gestational sac, and decreases 0.61 for crown-rump length, and 0.22 for size of yolk sac respectively. Thus, as the CRL and yolk measurements increase, the odds of having a live birth decreases. Inversely as, number of sacs, heart rate and size of gestational sac increases the odds of having a live birth also increases. CONCLUSION: There is an increased likelihood of delivering live babies for patients undergoing IUI when a greater number and size of gestational sacs are present, and when the baby’s heart rate is faster than for patients whose fetuses have a larger crown-rump and yolk sac measurement. Supported by: None
FERTILITY & STERILITY威
* IVGA ⫽ Intravenous General Anesthesia LMA ⫽ Laryngeal Mask Airway GETA ⫽ General Endotracheal Anesthesia Table 2: Mean ⫾ SD time of Surgical Sperm Extraction in the IVF OR vs the Main OR (mins).
There was no statistically significant difference of operative variables between cases performed in the main OR verses the IVF suite. (P⬎0.05 for each analysis.) CONCLUSION: Incorporating surgical sperm extractions into an IVF OR has several practical advantages. The proximity of the embryology lab to the IVF operating room was a benefit for embryology staff and the surgeon, who could be informed about epididymal sample quality within minutes. Ability to schedule cases as needed, without relying on the availability of the main hospital OR was a major benefit for the IVF and urology physicians. Coordination of discharge between a woman undergoing an egg retrieval, and her male partner undergoing sperm retrieval, was more efficient because they were both recovering in the same area. Supported by: None
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P-564 Incorporating surgical sperm extractions into an in vitro fertilization (IVF) operating room ⴚ A multidisciplinary approach. M. Baracewicz, E. Ginsburg. Brigham and Women’s Hospital, Boston, MA. OBJECTIVE: To evaluate the efficacy of a multidisciplinary approach to incorporate surgical sperm retrieval procedures, i.e., testicular sperm extraction (TESA), and percutaneous epididymal sperm aspiration (PESA), into the existing operations of an IVF surgical suite. DESIGN: Retrospective chart review of cases done April 1, 2003 through April 30, 2004 MATERIALS AND METHODS: Interviews were conducted with members of the IVF team including embryologists, nurses, anesthesiologists, and urologists. A plan for communication among IVF team members was established. Nurses and surgical technicians were trained about preoperative, intraoperative, and postoperative care of men undergoing these procedures. A written procedure was developed for nurses circulating in the operating room (OR). Preoperative and postoperative orders were developed for surgical sperm retrieval procedures undertaken in the IVF suite. Institutional Review Board approval was obtained for using medical records for the purpose of analyzing sperm extractions done between April 2003 and April 2004. The number of procedures, type of anesthesia used, and length of preoperative, operating room, and recovery times were noted for cases with located records. RESULTS: Table 1: Data Collection for Surgical Sperm Extraction
P-563 Predicting pregnancy outcome from early obstetrical ultrasound in patients undergoing intrauterine insemination (IUI). G. Saphier, G. Paoletti-Falcone. Reproductive Science Center of Boston, Waltham, MA. OBJECTIVE: In our practice, one of the most common questions posed by patients at the time of their early obstetrical ultrasound is, “What is my chance of miscarriage now?” Though there are national statistics on the likelihood of miscarriage we were interested to look at the infertility population and specifically at our own population. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We retrospectively analyzed 287 pregnant patients who had undergone IUI cycles using either clomiphene citrate or human menopausal gonadotropins (hMG) stimulation between August 1, 2001 and July 31, 2003. Patients were evaluated based on 5 variables: number of sacs, heart rate, crown-rump length (CRL), average gestational size and yolk sac. Only patients whose pregnancy outcome data was available were included in the sample. Binary logistic regression using Fisher’s scoring optimization technique was performed using JMP 5.01 software. Each variable was evaluated independently by keeping all the other variables constant. This methodology allowed each variable to be compared independently to the study population. RESULTS: The probabilities of having a live birth for every unit increase in the measurements of each variable analyzed, increases1.03 times for age, 2.00 for number of sacs, 1.08 for heart rate, 1.21 for size of gestational sac, and decreases 0.61 for crown-rump length, and 0.22 for size of yolk sac respectively. Thus, as the CRL and yolk measurements increase, the odds of having a live birth decreases. Inversely as, number of sacs, heart rate and size of gestational sac increases the odds of having a live birth also increases. CONCLUSION: There is an increased likelihood of delivering live babies for patients undergoing IUI when a greater number and size of gestational sacs are present, and when the baby’s heart rate is faster than for patients whose fetuses have a larger crown-rump and yolk sac measurement. Supported by: None
FERTILITY & STERILITY威
* IVGA ⫽ Intravenous General Anesthesia LMA ⫽ Laryngeal Mask Airway GETA ⫽ General Endotracheal Anesthesia Table 2: Mean ⫾ SD time of Surgical Sperm Extraction in the IVF OR vs the Main OR (mins).
There was no statistically significant difference of operative variables between cases performed in the main OR verses the IVF suite. (P⬎0.05 for each analysis.) CONCLUSION: Incorporating surgical sperm extractions into an IVF OR has several practical advantages. The proximity of the embryology lab to the IVF operating room was a benefit for embryology staff and the surgeon, who could be informed about epididymal sample quality within minutes. Ability to schedule cases as needed, without relying on the availability of the main hospital OR was a major benefit for the IVF and urology physicians. Coordination of discharge between a woman undergoing an egg retrieval, and her male partner undergoing sperm retrieval, was more efficient because they were both recovering in the same area. Supported by: None
S335