Prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improve the clinical pregnancy rate in intrauterine insemination treatment

CONCLUSION: In our study population, clinical pregnancy rates in women <35 with unexplained infertility undergoing their first CC/IUI cycle were no different with the higher initial CC dose. Contrary to the traditional practice of using 100 mg of CC in all couples, a starting dose of 50 mg in couples with female age <35 may be considered. The finding of statistically significantly increased rates of biochemical pregnancies on the lower CC starting dose warrants further prospective investigation. P-500 Wednesday, October 22, 2014 PROLONGED PITUITARY DOWN-REGULATION WITH GONADOTROPIN-RELEASING HORMONE AGONIST IMPROVE THE CLINICAL PREGNANCY RATE IN INTRAUTERINE INSEMINAP.-C. Ma,a M.-I. Hsu,b TION TREATMENT. S.-Y. Shen,a,b C.-R. Tzeng.a aDepartment of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; bDepartment of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taipei City, Taiwan. OBJECTIVE: Although GnRH agonist administration in the luteal phase has been documented not to improve pregnancy rate, it is not clear that does the use of GnRH agonist prior to the IUI treatment cycle in the early follicular phase improve pregnancy outcome in intrauterine insemination (IUI) cycles. DESIGN: Single center, retrospective data analysis. MATERIALS AND METHODS: A total of 506 patients with IUI cycles from Center of Reproductive Medicine, Taipei Medical University Hospital, Taiwan (January 2012 to December 2012) were retrospectively enrolled. Of them, 334 patients (66.0%) had completed IUI cycles with regular follow-up. Clinical characteristics such as age, the use of GnRH agonist prior to the IUI treatment cycle in the early follicular phase, pregnancy rate, clinical presentation of endometriosis, numbers of large follicles, the level of E2 and P4 on ovulation day and endometrial thickness were analyzed. RESULTS: Patients were divided into two groups according to whether the use of GnRH agonist or not. For those patients treated with GnRH agonist, the pregnancy rate significantly increased, compared with those without GnRH agonist treatment. (13.8% vs. 33.9%, p¼0.001). In univariate analysis, the use of GnRH agonist, large follicles and clinical presentation of endometriosis were significantly associated with the pregnancy rate. After multivariate logistic regression analysis, including use of GnRH agonist or note, age, large follicle numbers, clinical presentation of endometriosis or not, the use of GnRH agonist was the only one independent factor for the pregnancy rate (Odd ratio 2.65, P¼0.002). CONCLUSION: Prolonged pituitary down-regulation with gonadotropinreleasing hormone agonist improves the clinical pregnancy rate in intrauterine insemination treatment. P-501 Wednesday, October 22, 2014 LOW EFFICACY OF H-IUI TREATMENT CYCLES IN WOMEN OVER FORTY YEARS OLD: DATA FROM NATIONAL ITALIAN ART REGISTER 2005-2012. G. Scaravelli, V. Vigiliano, R. De Luca, R. Spoletini, L. Speziale, S. Bolli, S. Fiaccavento, P. D’Aloja. ART Italian National Registry, National Center for Epidemiology Surevillance and Health Promotion, National Health Institute, Rome, RM, Italy. OBJECTIVE: To determine the efficacy of H-IUI cycles in women of different age class groups. DESIGN: Retrospective analysis of 246.487 H-IUI cycles from 403 clinics collected from the Italian National ART register from 2005-2012. MATERIALS AND METHODS: All the H-IUI treatments cycles performed in Italy collected from the National ART Register each year from 2005 to 2012 among women of different age class groups were analyzed by treatments indications, pregnancies and live birth rates. Data were statistically analysed using SPSS statistic 17.0. RESULTS: During the study period, pregnancy rates from patients aged 40-42 and over 43 years old were 6,6% and 3,0% respectively, significantly lower than those from women younger than 34 years (13,5%) and aged 35-39 (9,8%). Out of 246.487 H-IUI cycles analysed, nearly 20.0 % (46.979) of the H-IUI cycles were performed on women over forty years old. Overall the number of multiple pregnancies was

FERTILITY & STERILITYÒ

9,7%. and the number of babies born after these infertility treatments was 17.248. CONCLUSION: The low efficacy of H-IUI treatment cycles in women over forty years old, observed in such a large number of cycles, suggests that the appropriateness of this kind of procedures for women over forty years old should be dicussed with greater accuracy. P-502 Wednesday, October 22, 2014 CULTUREING PERIODS OF THAWED BLASTOCYSTS UNTIL EMBRYO TRANSFER:CLINICAL OUTCOME. E. Yumioka, H. Chinen, H. Moriyama, K. Nonomura, S. Senkyu, A. Uchida. Uchida Clinic, Matsueshi, Shimane-Ken, Japan. OBJECTIVE: We have conventionally cultured thawed blastocysts for over 3 hours until embryo transfer. However, some reports showed that pregnancy rate would be improved by shortening culturing period until embryo transfer after thawing. DESIGN: In this study, we tried to determine whether pregnancy rate would be affected by culturing period after thawing frozen blastocysts. MATERIALS AND METHODS: Between Dec. 2008 and Dec. 2013, 293 patients received frozen blastocysts transfer in our hospital (570 cycles: cIVF 356 cycles, ICSI 214 cycles). Among them, clinical pregnancy rate was compared by different culturing periods (culture of thawing blastocysts before transfer; over 3 hours (R3h) vs. within 3 hours (<3h) ) in each c-IVF and ICSI cycles. In addition, the influence of quality of transferred blastocysts (Gardner classification; over BB or under BB) and the day of frozen (D5 or D6) were also compared. RESULTS: In the c-IVF cycles, we found no significant differences in pregnancy rate between R3h culture and <3h culture [36.0% (72/200) (R3h) vs. 35.9%(56/156)( <3h)]. Pregnancy rates in each quality of blastocysts (BB or under BB) were not significantly different by different culture period ( BB: 39.7%(56/141) (R3h) vs. 42.4%(42/99) ( <3h); under BB: 27.1%(16/59) (R3h) vs. 24.6%(14/57) ( <3h)] . The day of blastocyst frozen was not influenced to the pregnancy rates[Day5: 40.9%(67/ 164) (R3h) vs. 39.3%(48/122) ( <3h); Day6: 13.9%(5/36) (R3h) vs. 23.5%(8/34) ( <3h)]. In the ICSI cycles, no significant differences were observed in pregnancy rate between R3h culture and <3h culture after blastocysts thawing [41.7%(45/108) (R3h) vs. 34.9%(37/106) ( <3h)]. Quality of blastocysts was not correlated to the clinical pregnancy rates [BB: 47.4%(37/78) (R3h) vs. 44.3%(27/61) ( <3h); under BB: 26.7%(8/30) (R3h) vs. 22.2%(10/45) ( <3h) ]. Although the outcomes of D5 frozen blastocysts were not changed by the periods of culture after thawing in ICSI cycles [41.6%(32/77) (R3h) vs. 42.6%(29/68) ( <3h)], clinical pregnancy rate in D6 frozen blastocysts which were cultured over 3 h after thawing were significantly higher than the blastocysts which were cultured within 3 h after thawing [41.9%(13/31) (R3h) vs. 21.1%(8/ 38) ( <3h), p<0.05]. Because average age of patient in this group (D6 frozen, culture over 3h) was lower than the average age in another group (D6 frozen, culture within 3h), this difference might be the cause of patient age. CONCLUSION: Our study showed that the pregnancy rate was not altered by the periods of culture after blastocyst thawing. Our study is ongoing. P-503 Wednesday, October 22, 2014 ABNORMAL VILLOUS MORPHOLOGY IN ABORTUS SPECIMENS IS NOT INCREASED IN ART PREGNANCIES. G. Ekpo,a J. Rabban,b P. Rinaudo.a aCenter for Reproductive Health, University of California San Francisco, San Francisco, CA; bPathology Department, University of California San Francisco, San Francisco, CA. OBJECTIVE: Increased incidences of placenta previa, abnormal cord insertion and abruption have been described following ART. Anecdotal experience suggests that abnormal villous morphology (AVM) is diagnosed more frequently in abortuses following ART. AVM specimens have a partial mole-like morphology and equivalent staining, but do not share the fully developed features of a partial mole. Further, AVM seems more frequent in aneuploid pregnancies. The objectives of this study were to determine the prevalence of AVM in ART pregnancies compared to non-ART pregnancies, and the ability of AVM to predict chromosomal abnormalities. DESIGN: Retrospective Cohort Study. MATERIALS AND METHODS: We identified 360 failed 1st trimester intrauterine pregnancy that were managed with manual uterine

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