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rec-FSH for IVF: A Randomized Clinical Trial
GnRH antagonist rescue had to be administered in 17 patients (3.2%) for a mean of 2 days to suppress an impending LH surge, prior to hCG administration. Compared to rest of group 3 (Lupron-Depot), there was no significant difference regarding treatment outcomes or cycle characteristics. Despite significantly lower number of retrieved and mature (MII) oocytes in group 2 (GnRH antagonist), there was no statistically significant difference in implantation or pregnancy rates or in the rate of pregnancy loss compared to the other two groups. CONCLUSION: Low-dose Lupron-Depot is effective in adequately preventing premature, endogenous LH surge with very low failure rate that could be rescued with GnRH antagonists, without affecting the treatment outcome. Such low dose was not accompanied by the major drawback previously reported with such convenient protocol, i.e. increasing the amount and duration of gonadotropins required for adequate COH due to an overt pituitary suppression. However, further studies are required to define the best patient population that would most benefit from such protocol. Supported by: None P-474 Follicle Recruitment During Controlled Ovarian Hyperstimulation (COH) for IVF Treatment Cycles Provides Comparable Outcomes to Natural Cycle Follicle Recruitment. V. Abdelmassih, D. Dozortsev, M. Diamond, R. Abdelmassih. Clı´nica e Centro de Pesquisa em Reproduc¸a˜o Humana Roger Abdelmassih, Sa˜o Paulo, Brazil; Clinica e Centro de Pesquisa em Reproduc¸a˜o Humana Roger Abdelmassih, Sa˜o Paulo, Brazil; Wayne State University, Detroit, MI. OBJECTIVE: It has been previously shown that the success rate of IVF treatment is dependent on several factors and yields a clinical pregnancy rate around 35% in general. Several types of ovarian stimulation have been described; the period of time between the unsuccessful IVF cycle and a new IVF attempt is of at least 30 days and normally with at least one natural cycle interval. The concern of an impaired response immediately after an unsuccessful IVF cycle is the main reason for time lag between the cycles. It has been previously demonstrated that for ovulation induction, there is no difference in the outcome when you do treatment cycle without interval (Diamond MP, Fertility and Sterility,1985). GnRH antagonist (Cetrotide®) provides the possibility to start a short ovarian stimulation protocol immediately after the patient’s menses with a negative beta-HCG. To reduce patients anxiety and stress caused by the negative result, we decided to assess the efficacy of the use of GnRH antagonist (Cetrotide®) in a ovarian stimulation short protocol, starting on day 2 of menstruation immediately following an unsuccessful IVFcycle. DESIGN: Retrospective study MATERIALS AND METHODS: A total of 7 patients who underwent ovarian stimulation using a short protocol with GnRH antagonist (Cetrotide®) for IVF/ICSI cycles and embryo transfer started immediately after an unsuccessful IVF cycle. The variables, which were analyzed included the number of injected oocytes, number and quality (fragmentation percentage) of embryos transferred, clinical pregnancy rate and implantation rate. RESULTS: In the cycles with GnRH antagonist (Cetrotide®), the mean injected oocytes per patient was 9.8 and the number of embryos transferred was 3.4. The clinical pregnancy rate was 57.1% (4/7). The implantation rate was 20.8% (5/24). The number of embryos transferred was 3.4, and the quality (A ⫹ B) of the embryos transferred was 3.2 per patient. There were no differences in these parameters when compared with previous cycles in which GnRH agonist was administered.
a viable alternative and should be considered in some cases, especially those in which anticipating a new cycle is more convenient or desirable. Supported by: None. P-475 Progesterone Versus Progesterone Combined With Estradiol as Luteal Support in Cycles Stimulated With GnRH Antagonist/rec-FSH for IVF: A Randomized Clinical Trial. H. Mousavi Fatemi, E. M. Kolibianakis, M. Camus, H. Tournaye, A. Van Steirteghem, P. Devroey. AZVUB, 1020-Brussels, Belgium. OBJECTIVE: To compare ongoing pregnancy rates under two different modes of luteal supplementation [progesterone vs. progesterone ⫹ estradiol (E2)] in cycles stimulated with GnRH antagonist and rec-FSH for IVF. DESIGN: Randomized, single center, two arm clinical trial. Currently, 123 patients undergoing ovarian stimulation for IVF have been recruited in this ongoing trial. MATERIALS AND METHODS: Stimulation was performed with a 200 IU fixed dose of rec- FSH starting on day 2 of the cycle. Daily GnRH antagonist 0.25mg was initiated on day 6 of stimulation. Final oocyte maturation was achieved by administration of 10.000 IU of hCG as soon as ⱖ 3 follicles ⱖ 17 mm were detected by ultrasound. Oocyte retrieval was carried out 36 hours after hCG administration. Following conventional IVF or ICSI; 1-2 embryos were transferred on day 3 of in-vitro culture. Luteal phase was supplemented in 60 patients with vaginal administration of 600mg natural micronised progesterone (progesterone group) in three separate doses starting one day after oocyte retrieval and was continued until 7 weeks of gestation if pregnancy was achieved. Sixty three patients received an identical luteal phase supplementation with progesterone, but in addition received daily estradiol-valerate 2x2mg per os, starting one day after oocyte retrieval and continued until day 12 post oocyte pick-up (progesterone/E2 group). The main outcome measure was ongoing pregnancy at 12 weeks per started cycle. Fisher’s exact test or MannWhitney-U t-test was used for statistical analysis. Statistical significance was defined as p⬍0.05 and results are presented as mean ⫾ SEM or proportion, 95% CI as appropriate. RESULTS: No differences were observed between the two groups of luteal supplementation regarding indication for IVF treatment. In addition, as shown in Table 1, no differences were observed between the two groups in the mean age at initiation of stimulation, in the number of previous IVF trials, in the Body Mass Index, in the duration of stimulation, in the total dose of FSH, in the number of oocytes retrieved, in the number of embryos transferred or in the number of embryos cryopreserved. Ongoing pregnancy per started cycle did not differ significantly between the two groups (progesterone group: 28.3%, 95% CI: 17.4-41.4 vs. progesterone/E2 group: 22.2%, 95% CI: 12.7-34.4). Table 1. Characteristics of the two groups of luteal support compared (differences were not significant).
CONCLUSION: Addition of estradiol to progesterone in the luteal phase after stimulation with rec- FSH and GnRH antagonist does not appear to increase the probability of pregnancy. Supported by: None
CONCLUSION: These results demonstrate that follicle recruitment during controlled ovarian hyperstimulation (COH) for IVF treatment cycles provides comparable outcomes of natural cycle follicle recruitment. The use of GnRH antagonist immediately after unsuccessful IVF cycle treatment is
S322
Abstracts
P-476 Observational Study of the Influence of Duration of Coasting and Drop in Serum Estradiol Levels on IVF Outcome. C. Kailasam, P. E. Wilson, H. M. Collyer, J. Jenkins. University of Bristol, Bristol, United Kingdom.
Vol. 84, Suppl 1, September 2005
a viable alternative and should be considered in some cases, especially those in which anticipating a new cycle is more convenient or desirable. Supported by: None. P-475 Progesterone Versus Progesterone Combined With Estradiol as Luteal Support in Cycles Stimulated With GnRH Antagonist/rec-FSH for IVF: A Randomized Clinical Trial. H. Mousavi Fatemi, E. M. Kolibianakis, M. Camus, H. Tournaye, A. Van Steirteghem, P. Devroey. AZVUB, 1020-Brussels, Belgium. OBJECTIVE: To compare ongoing pregnancy rates under two different modes of luteal supplementation [progesterone vs. progesterone ⫹ estradiol (E2)] in cycles stimulated with GnRH antagonist and rec-FSH for IVF. DESIGN: Randomized, single center, two arm clinical trial. Currently, 123 patients undergoing ovarian stimulation for IVF have been recruited in this ongoing trial. MATERIALS AND METHODS: Stimulation was performed with a 200 IU fixed dose of rec- FSH starting on day 2 of the cycle. Daily GnRH antagonist 0.25mg was initiated on day 6 of stimulation. Final oocyte maturation was achieved by administration of 10.000 IU of hCG as soon as ⱖ 3 follicles ⱖ 17 mm were detected by ultrasound. Oocyte retrieval was carried out 36 hours after hCG administration. Following conventional IVF or ICSI; 1-2 embryos were transferred on day 3 of in-vitro culture. Luteal phase was supplemented in 60 patients with vaginal administration of 600mg natural micronised progesterone (progesterone group) in three separate doses starting one day after oocyte retrieval and was continued until 7 weeks of gestation if pregnancy was achieved. Sixty three patients received an identical luteal phase supplementation with progesterone, but in addition received daily estradiol-valerate 2x2mg per os, starting one day after oocyte retrieval and continued until day 12 post oocyte pick-up (progesterone/E2 group). The main outcome measure was ongoing pregnancy at 12 weeks per started cycle. Fisher’s exact test or MannWhitney-U t-test was used for statistical analysis. Statistical significance was defined as p⬍0.05 and results are presented as mean ⫾ SEM or proportion, 95% CI as appropriate. RESULTS: No differences were observed between the two groups of luteal supplementation regarding indication for IVF treatment. In addition, as shown in Table 1, no differences were observed between the two groups in the mean age at initiation of stimulation, in the number of previous IVF trials, in the Body Mass Index, in the duration of stimulation, in the total dose of FSH, in the number of oocytes retrieved, in the number of embryos transferred or in the number of embryos cryopreserved. Ongoing pregnancy per started cycle did not differ significantly between the two groups (progesterone group: 28.3%, 95% CI: 17.4-41.4 vs. progesterone/E2 group: 22.2%, 95% CI: 12.7-34.4). Table 1. Characteristics of the two groups of luteal support compared (differences were not significant).
CONCLUSION: Addition of estradiol to progesterone in the luteal phase after stimulation with rec- FSH and GnRH antagonist does not appear to increase the probability of pregnancy. Supported by: None
CONCLUSION: These results demonstrate that follicle recruitment during controlled ovarian hyperstimulation (COH) for IVF treatment cycles provides comparable outcomes of natural cycle follicle recruitment. The use of GnRH antagonist immediately after unsuccessful IVF cycle treatment is
S322
Abstracts
P-476 Observational Study of the Influence of Duration of Coasting and Drop in Serum Estradiol Levels on IVF Outcome. C. Kailasam, P. E. Wilson, H. M. Collyer, J. Jenkins. University of Bristol, Bristol, United Kingdom.
Vol. 84, Suppl 1, September 2005