Safe and effective first line therapy for women with unexplained infertility in real clinic practice

P-223 Tuesday, October 23, 2012

Comparison of GnRHa versus HCG for oocyte triggering

HCG triggering (n¼361)

GnRHa triggering (n¼173)

Age (y) 37.234.95 37.774.77 BMI (kg/m2) 22.332.66 22.072.82 Antral Follicle Count 3.182.04 3.331.71 E2 level on DayhCG 793.48516.72 709.56388.26 (pg/ml) No. of oocyte retrieved 1.931.56 1.381.16 Oocyte recovery rate 82.54% 79.87% Normal fertilization rate 66.47% 67.64% No. of transferrable 1.311.05 1.060.69 embryo Clinical pregnancy rate 31/134 (23.13%) 9/35 (25.71%) Lutein cyst formation 26/116 (21.55%) 11/76 (14.47%) rate

P value 0.229 0.301 0.396 0.0593 0.000 0.303 0.740 0.006 0.749 0.219

CONCLUSION: The same results in oocyte recovery rate, normal fertilization rate and clinical pregnancy rate demonstrated that GnRHa oocyte triggering is as efficient as HCG, and a decreasing tendency in cyst formation rate in subsequent cycle was associated with GnRHa triggering.

P-222 Tuesday, October 23, 2012 SAFE AND EFFECTIVE FIRST LINE THERAPY FOR WOMEN WITH UNEXPLAINED INFERTILITY IN REAL CLINIC PRACTICE. A. Fukui,a R. Fukuhara,a H. Kimura,b S. Fujii,c H. Mizunuma.a aObstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; bObstetrics and Gynecology, National Hirosaki Hospital, Hirosaki, Aomori, Japan; cTachizaki Ladies Clinic, Aomori, Japan. OBJECTIVE: The objective of this study was to compare the patients’ responses to the clomiphene citrate (CC) and 37.5IU r-hFSH protocols for the treatment of unexplained infertility in ovulation induction (OI). DESIGN: A prospective, unblinded, randomized controlled multi-center study. MATERIALS AND METHODS: Unexplained infertility women with normal menstrual period, the age<40, basal FSH and LH<10mIU/mL, BMI<18-28kg/m2 and gave consent to this study were included. The PCOS patients were excluded. The patients were randomized to CC group (CC 50mg/day for 5 days from Day 5) or r-hFSH group (r-hFSH 37.5IU/day from Day 5). The primary endpoint was the changes of serum FSH and E2 levels in each group. The number of follicles and the serum FSH and E2 levels were also assessed. RESULTS: Patients (n¼22; 55 cycles) were randomized to CC group (n¼12; 25 cycles) or r-hFSH group (n¼10; 26 cycles). There were no significant differences in the patient characteristics (age, serum LH, FSH, PRL, E2 and T levels). No incidence of OHSS and multiple pregnancies were reported. Per protocol analysis revealed that the serum FSH level in CC group decreased at week 1 and at hCG injection, while rhFSH group showed increase at week 1 and reduction at hCG injection. The changes were not significant. The number of follicles in CC group was 1.60.8 (meanSD), and that in r-hFSH group was 1.20.5. The CC group demonstrated lower FSH level and higher E2 level at hCG injection (FSH level; CC: 4.41.8mIU/ml, r-hFSH: 6.53.5mIU/ml, P¼0.057 and E2 level; CC: 609.1284.5pg/ml, r-hFSH: 357.1183.3pg/ml, P<0.01). CONCLUSION: This study showed that the patients treated with 37.5IU rhFSH exhibited acceptable changes of serum hormone levels. It was also demonstrated that the number of follicles and E2 level at the time of hCG injection were lower in r-hFSH group patients, suggesting this may be the safer treatment for unexplained infertility women undergoing ovulation induction than CC treatment.

FERTILITY & STERILITYÒ

SHORT GnRH-A PROTOCOL EVERY OTHER DAY VERSUS DAILY LONG GnRH-A PROTOCOL IN PATIENTS UNDERGOING IN VITRO FERTILIZATION. C. A. R. Iaconelli,a R. S. Rodrigues,a A. S. Setti,b S. Resende,c A. Iaconelli, Jr.,a,b E. Borges, Jr.,a,b,c aFertility - Assisted Fertilization Center, Sao Paulo, SP, Brazil; bSapientiae Institute - Educational and Research Center in Assisted Reproduction, Sao Paulo, SP, Brazil; cFertility - Assisted Fertilization Center, Campo Grande, MS, Brazil. OBJECTIVE: To compare two GnRH-a protocols for pituitary blockage in normoresponders patients undergoing ICSI. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Data of ICSI cycles performed in 92 patients younger than 35 years were included in this study. In the control group (n¼66) pituitary blockage with Leuprolide acetate was started at the 22nd day of the previous cycle. After pituitary desensitization recombinant FSH administration was started. In the short GnRH-a group (short agonist protocol every other day, n¼26) pituitary blockage was started on the first day of the menstrual cycle, with administration of Triptorelin acetate every other day followed by the administration of recombinant FSH on day 3 of the cycle. When patients presented at least two follicles R14mm upon scan the rhCG microdose was started. The endpoints were ovarian response to COS, implantation and pregnancy rates. RESULTS: There were no significant differences between the short GnRH-a and control groups regarding female age, number of follicles, oocytes retieved, mature oocytes and high quality embryos rate. The total dose of FSH administered was significantly lower in the short GnRH-a group (1413245 IU vs 2230454 IU, P<0.001). Estradiol levels on the day of hCG trigger were significantly higher in the short GnRH-a group (44622473 pg/mL vs 24801503 pg/mL, P¼0,006) as compared to the control group. A total of 22 patients (84.6%) in the short GnRH-a group and 52 (78.8%) in the control group underwent embryo transfer. Implantation and pregnancy rates were significantly higher in the control group (31,5% vs 9,1%, P<0.011 and 40.7% vs 9.1%, P<0.004, respectively). CONCLUSION: In normoresponders patients, pituitary suppression with a short GnRH-a every other day requires significantly less gonadotropin, however, it is associated with lower implantation and clinical pregnancy rates, as compared to the group using long GnRH-a.

P-224 Tuesday, October 23, 2012 ANTI-MULLERIAN HORMONE EVALUATION AND INITIAL OVARIAN RESPONSE IN AN APPARENTLY GOOD PROGNOSIS POPULATION TREATED BY INTRACYTOPLASMIC SPERM R. Ramanah,a A.-S. Tholozan,a INJECTION. G. Agnani,a A.-L. Dubourdeau,a A. Berdin,a F. Mauny.b aGynaecology and Obstetrics, University of Besanc¸on, Besanc¸on Cedex, Doubs, France, Metropolitan; b Statistics Department, University of Besanc¸on, Besanc¸on Cedex, Doubs, France, Metropolitan. OBJECTIVE: To evaluate the ability of anti-mullerian hormone (AMH) to predict ovarian response in a selected population treated by intracytoplasmic sperm injection (ICSI). DESIGN: A prognostic study. MATERIALS AND METHODS: Data from a total of 100 first attempts were studied. The inclusion criteria included, among others, basal mass index<35, age<38,antral follicle count (AFC, 3-8 in diameter) between 14 and 30, FSH<10 IU/L estimated at the beginning of a non stimulated cycle. A long analog protocol was used, and ovarian stimulation was initiated by 200 international Units of recombinant follicle-stimulating hormone per day. The first estradiol (E2) evaluation was performed on day 4. Treatment was not modified when E2 concentration on day 4 was between 0.5 and 1 mmol/L. The measurement of AMH was determined by the enzyme linked immuneabsorbent assay provided by Immunotech Beckman Coulter. AMH concentration remained unknown to the clinical team until the end of the attempt. RESULTS: In this population AMH varied from 8 to 78 pmol/L. AMH and AFC were significantly correlated with E2 on day 4 and with E2 at the end of the stimulation. In a multiple linear regression analysis,only AMH remained

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