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Results of ICSI With Fresh Epididymal or Testicular Semen. French Register Fivnat Experience
p,0.02). There was a negative correlation between BW and maternal weight. Women in Group O were larger than Group U (p,0.01), but there was no difference in outcome parameters between the groups. Normal weight women (BMI ,25 Kg/m2) had the longest pregnancies, and heaviest babies (absolute weight and weight for gestational age) whilst obese women (BMI .29 Kg/m2) had the shortest pregnancies and lowest BW. Body mass and SHBG correlated as in the normal population, but within the overweight mothers, those with lower SHBG (#30 nmol/L) tended to deliver babies with higher BWs (3.12 Kg 6 0.73) than mothers with SHBG values .30 (2.63 Kg 6 1.02; P 5 0.07). Conclusions: Singleton pregnancies following OI/IUI result in high rates of low birth weight, pre-term delivery, small for gestational age and perinatal loss. Regardless of the cause of infertility, obese women had a tendency to deliver babies earlier than normal-weight women. The more insulin resistant women (lower SHBG) were less prone to low BW deliveries.
P-241 Results of ICSI With Fresh Epididymal or Testicular Semen. French Register Fivnat Experience. B. Rossin-Amar, L. Janny, J. L. Pouly, M. Bajirova, A. Bachelot, J. de Mouzon. Fivnat and INSERM U292, Le Kremlin-Biceˆtre, France. Objectives: Intra Cytoplasm Semen Injection has reached more than 40% of the French IVF activity. However, many questions are still opened concerning its consequences on the fetus and newborn health, particularly when semen was obtained after surgical procedure. Design: A large prospective cohort was selected from the French IVF register Fivnat, and followed until birth of the conceived babies. Patients and Methods: All the ovum pick-up (OPU) realized from 1994 to 1997, using semen obtained from the epididymis or the testis and registered in Fivnat were selected (2388 ICSI resulting in 570 pregnancies). Then, cycles using frozen semen were then excluded. Thus 2 groups were constituted according to the semen origin, epididymal (group A, n51108) or testicular (group B, n5670). The groups were compared for the main infertility and cycle characteristics and for newborn health. Result: There was no difference between the 2 groups in age (respectively 31.5 6 4.4 and 32.0 6 4.5 for women and 35.3 6 6.6 and 35.9 6 6.5 for men). The total dose of gonadotropin was the same for the 2 groups. The number of injected oocytes was higher in group A compared to group B (respectively 8.9 6 5.3, and 7.7 6 4.8, p,0.001). The fertilization rate and the number of fertilized embryos were lower in group B (respectively 47.6% and 3.6 6 2.8, vs. 53.9% and 4.3 6 3.0). However, the number of transferred embryos was not statistically different (respectively 2.56 6 0.87 and 2.54 6 0.96), and the same was true for the per OPU clinical pregnancy rate (23.8% vs. 22.1%). The delivery rate per pregnancy was lower in the testicular group (72.1% vs. 83.8%, p,0.05), because of an increase in spontaneous and medical abortions and in ectopic pregnancies. There was no significant difference in multiplicity, in prematurity, in low birthweight and in perinatal mortality. The proportion of babies with malformation or genetic abnormality was slightly higher compared to conventional IVF or to ICSI with ejaculated semen (3.8% vs. 2.0% and 2.8%), and there was no significant difference between the 2 groups. There was no specific abnormality. Conclusion: ICSI with testicular semen was associated with a lower fertilization rate and a higher premature pregnancy termination. The proportion of babies showing a malformation or a genetic abnormality was slightly increased in the 2 study groups, compared with conventional IVF or ICSI with ejaculated semen. However, the numbers were still too low to get certitude and there is still a need for further evaluation.
Design: Patients data have been collected prospectively and stored in a relational database since 1991. Materials and Methods: We identified a total 3868 of IVF/ICSI cycles performed between January ’93 and December ’99 of which 283 cycles (8%) where a laparoscopic diagnosis of pelvic endometriosis was made. The remaining number of cycles (2302) who had no evidence of pelvic endometriosis served as a control group. COH was carried out using our standard long protocol. HCG was administered when there were at least three follicles $18mm. Trans-vaginal follicular aspiration was performed 34 –36 hours later. Data are presented as mean 6 SD. Statistical significance was set at P,0.05. Results: The two groups were matched in terms of age, basal day 3 FSH levels, duration of infertility and number of previous IVF cycles and mean number of gonadotrophins ampoules used to start stimulation. Stimulation characteristics were not significantly different in both groups. The mean total number of ampoules (38.9 6 17.9 vs. 38.3 6 27.1) required for stimulation was not significantly different. The number of pre-ovulatory follicles (12.9 6 6.1 vs. 14.4 6 7.0) and eggs obtained (8.0 6 5.0 vs. 9.0 6 5.1) were significantly lower in the endometriosis compared with the control group. The endometriosis and the control group had a mean of 2.0 6 1.0 embryo transferred. No significant differences were found in the cycle cancellation (15.2 vs. 15.1%) or the pregnancy rates/cycle (25.8 vs. 22.9) for the study and control groups respectively. Conclusions: The clinical outcome of assisted conception treatment appears to be comparable in the endometriosis and the control group. P-243 Day 2 Versus Day 5 Transfer With Equal Number of Embryos: A Controlled “Matched-Pair” Analysis. M. Ha¨berle, M. Beyeler, Ph. Scheurer, M. K. Hohl. Department Gynecology and Obstetrics, Kantonsspital Baden, Switzerland. Objective: The effectiveness of blastocyst culture and transfer in sequential media has been demonstrated by Gardner et al in a prospective randomized trial. A day 5 transfer of 2.2 blastocysts gave similar pregnancy rates as a day 3 transfer of 3.7 embryos in patients with more than 10 oocytes. Since several other authors advocated in these patients no differences in pregnancies between an elective transfer of 2 embryos compared with 3 the question rises wether there would be an difference in the outcome of day 5 transfer compared with day 2 transfer with an equal number of embryos. Design: A retrospective, controlled “matched-pair” analysis. Materials and Methods: Our first consecutive 42 patients in 1998 with a transfer of a maximum of 2 blastocysts at day 5 were matched with 42 patients with a day 2 transfer in 1996. Both groups were equal in age, indication, ivf or icsi and the number of transferred embryos. We analyzed the number of oocytes, fertilization rate, implantation and pregnancy rates. Results: In day 5 transfer patients we found 13.5 oocytes in day 2 transfer patients 11. Fertilization rate was 67% resp 57% and the implantation and pregnancy rates were 30.7% and 40.5% resp 16.8% and 26.2%. There were no statistical differences in both groups except the fertilization rate (p. 0.028 in favor of day 5 patients). Conclusion: There is a trend to better implantation and pregnancy results in day 5 transfer compared to day 2 transfer with equal number of embryos in good prognosis patients. This trend would reach statistical significance at a sample size of 360 patients in each group.
ART: PREIMPLANTATION GENETICS Tuesday, October 24, 2000
P-242
P-244
Effect of Pelvic Endometriosis on the Outcome of Assisted Conception Treatment. Y. Khalaf, A. Taylor, R. Hart, C. T. Yeong, R. Burston, P. Braude. Assisted Conception Unit, St. Thomas’ Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
Chromosome Abnormalities in Spare Preimplantation Embryos From In Vitro Maturation (IVM) Cycles. A. M. Ao, M. Bielanska, R. C. Chian, S. L. Tan. McGill University, Royal Victoria Hospital, Department of Obstetrics and Gynecology, Montreal, Quebec, Canada.
Objectives: The impact of pelvic endometriosis on the outcome of assisted conception remains controversial. The objective of this study was to evaluate the effect of pelvic endometriosis on the outcome of ovarian stimulation for assisted conception.
Objectives: Recently, advances have been made to treat women with polycystic ovarian syndrome (PCOS)-related infertility by in-vitro maturation (IVM) technology. Unlike the embryos resulting from IVF/ICSI cycles, embryos produced by IVM originate from immature oocytes, which had
S172
Abstracts
Vol. 74, No. 3, Suppl. 1, September 2000
P-241 Results of ICSI With Fresh Epididymal or Testicular Semen. French Register Fivnat Experience. B. Rossin-Amar, L. Janny, J. L. Pouly, M. Bajirova, A. Bachelot, J. de Mouzon. Fivnat and INSERM U292, Le Kremlin-Biceˆtre, France. Objectives: Intra Cytoplasm Semen Injection has reached more than 40% of the French IVF activity. However, many questions are still opened concerning its consequences on the fetus and newborn health, particularly when semen was obtained after surgical procedure. Design: A large prospective cohort was selected from the French IVF register Fivnat, and followed until birth of the conceived babies. Patients and Methods: All the ovum pick-up (OPU) realized from 1994 to 1997, using semen obtained from the epididymis or the testis and registered in Fivnat were selected (2388 ICSI resulting in 570 pregnancies). Then, cycles using frozen semen were then excluded. Thus 2 groups were constituted according to the semen origin, epididymal (group A, n51108) or testicular (group B, n5670). The groups were compared for the main infertility and cycle characteristics and for newborn health. Result: There was no difference between the 2 groups in age (respectively 31.5 6 4.4 and 32.0 6 4.5 for women and 35.3 6 6.6 and 35.9 6 6.5 for men). The total dose of gonadotropin was the same for the 2 groups. The number of injected oocytes was higher in group A compared to group B (respectively 8.9 6 5.3, and 7.7 6 4.8, p,0.001). The fertilization rate and the number of fertilized embryos were lower in group B (respectively 47.6% and 3.6 6 2.8, vs. 53.9% and 4.3 6 3.0). However, the number of transferred embryos was not statistically different (respectively 2.56 6 0.87 and 2.54 6 0.96), and the same was true for the per OPU clinical pregnancy rate (23.8% vs. 22.1%). The delivery rate per pregnancy was lower in the testicular group (72.1% vs. 83.8%, p,0.05), because of an increase in spontaneous and medical abortions and in ectopic pregnancies. There was no significant difference in multiplicity, in prematurity, in low birthweight and in perinatal mortality. The proportion of babies with malformation or genetic abnormality was slightly higher compared to conventional IVF or to ICSI with ejaculated semen (3.8% vs. 2.0% and 2.8%), and there was no significant difference between the 2 groups. There was no specific abnormality. Conclusion: ICSI with testicular semen was associated with a lower fertilization rate and a higher premature pregnancy termination. The proportion of babies showing a malformation or a genetic abnormality was slightly increased in the 2 study groups, compared with conventional IVF or ICSI with ejaculated semen. However, the numbers were still too low to get certitude and there is still a need for further evaluation.
Design: Patients data have been collected prospectively and stored in a relational database since 1991. Materials and Methods: We identified a total 3868 of IVF/ICSI cycles performed between January ’93 and December ’99 of which 283 cycles (8%) where a laparoscopic diagnosis of pelvic endometriosis was made. The remaining number of cycles (2302) who had no evidence of pelvic endometriosis served as a control group. COH was carried out using our standard long protocol. HCG was administered when there were at least three follicles $18mm. Trans-vaginal follicular aspiration was performed 34 –36 hours later. Data are presented as mean 6 SD. Statistical significance was set at P,0.05. Results: The two groups were matched in terms of age, basal day 3 FSH levels, duration of infertility and number of previous IVF cycles and mean number of gonadotrophins ampoules used to start stimulation. Stimulation characteristics were not significantly different in both groups. The mean total number of ampoules (38.9 6 17.9 vs. 38.3 6 27.1) required for stimulation was not significantly different. The number of pre-ovulatory follicles (12.9 6 6.1 vs. 14.4 6 7.0) and eggs obtained (8.0 6 5.0 vs. 9.0 6 5.1) were significantly lower in the endometriosis compared with the control group. The endometriosis and the control group had a mean of 2.0 6 1.0 embryo transferred. No significant differences were found in the cycle cancellation (15.2 vs. 15.1%) or the pregnancy rates/cycle (25.8 vs. 22.9) for the study and control groups respectively. Conclusions: The clinical outcome of assisted conception treatment appears to be comparable in the endometriosis and the control group. P-243 Day 2 Versus Day 5 Transfer With Equal Number of Embryos: A Controlled “Matched-Pair” Analysis. M. Ha¨berle, M. Beyeler, Ph. Scheurer, M. K. Hohl. Department Gynecology and Obstetrics, Kantonsspital Baden, Switzerland. Objective: The effectiveness of blastocyst culture and transfer in sequential media has been demonstrated by Gardner et al in a prospective randomized trial. A day 5 transfer of 2.2 blastocysts gave similar pregnancy rates as a day 3 transfer of 3.7 embryos in patients with more than 10 oocytes. Since several other authors advocated in these patients no differences in pregnancies between an elective transfer of 2 embryos compared with 3 the question rises wether there would be an difference in the outcome of day 5 transfer compared with day 2 transfer with an equal number of embryos. Design: A retrospective, controlled “matched-pair” analysis. Materials and Methods: Our first consecutive 42 patients in 1998 with a transfer of a maximum of 2 blastocysts at day 5 were matched with 42 patients with a day 2 transfer in 1996. Both groups were equal in age, indication, ivf or icsi and the number of transferred embryos. We analyzed the number of oocytes, fertilization rate, implantation and pregnancy rates. Results: In day 5 transfer patients we found 13.5 oocytes in day 2 transfer patients 11. Fertilization rate was 67% resp 57% and the implantation and pregnancy rates were 30.7% and 40.5% resp 16.8% and 26.2%. There were no statistical differences in both groups except the fertilization rate (p. 0.028 in favor of day 5 patients). Conclusion: There is a trend to better implantation and pregnancy results in day 5 transfer compared to day 2 transfer with equal number of embryos in good prognosis patients. This trend would reach statistical significance at a sample size of 360 patients in each group.
ART: PREIMPLANTATION GENETICS Tuesday, October 24, 2000
P-242
P-244
Effect of Pelvic Endometriosis on the Outcome of Assisted Conception Treatment. Y. Khalaf, A. Taylor, R. Hart, C. T. Yeong, R. Burston, P. Braude. Assisted Conception Unit, St. Thomas’ Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
Chromosome Abnormalities in Spare Preimplantation Embryos From In Vitro Maturation (IVM) Cycles. A. M. Ao, M. Bielanska, R. C. Chian, S. L. Tan. McGill University, Royal Victoria Hospital, Department of Obstetrics and Gynecology, Montreal, Quebec, Canada.
Objectives: The impact of pelvic endometriosis on the outcome of assisted conception remains controversial. The objective of this study was to evaluate the effect of pelvic endometriosis on the outcome of ovarian stimulation for assisted conception.
Objectives: Recently, advances have been made to treat women with polycystic ovarian syndrome (PCOS)-related infertility by in-vitro maturation (IVM) technology. Unlike the embryos resulting from IVF/ICSI cycles, embryos produced by IVM originate from immature oocytes, which had
S172
Abstracts
Vol. 74, No. 3, Suppl. 1, September 2000