Sperm capacitation index (SCI) predicts pregnancy outcome with controlled ovarian hyperstimulation (COH) + intrauterine insemination (IUI)

Design: Case controlled study in a university affiliated IVF center. Materials/Methods: All donor oocyte cycles, including intracytoplamic sperm injection (ICSI), using ganirelix or a long protocol with leuprolide for LH suppression from January 1, 2001 through December 31, 2001 performed in a university-affliliated IVF center were evaluated. Thirty-one women began 32 cycles utilizing leuprolide followed by recombinant FSH. Twelve women underwent oocyte preparation with recombinant FSH and ganirelix began when follicular development reached 14 mm. All women were pretreated with oral contraceptives for 14 –21 days. Cycle characteristics assessed included days and total dose of FSH, number of oocytes retrieved and fertilized. Implantation and clinical pregnancy rates were compared using the Chi-square and Fisher Exact Test, repectively. Results: Leuprolide was initiated in 32 cycles; 2 were cancelled due to poor stimulation. Twelve cycles were started and completed in the ganirelix group. No premature LH surges occurred. Mean duration of stimulation was 9.2 (SD 1.455) days in the leuprolide group and 9.4 (SD 1.261) with ganirelix. Median number of oocytes retrieved was 13.5 (SD 7.577) (range 3–35) with leuprolide and 16.5 (SD 5.233) (range 6 –24) in the ganirelix group. Median number of oocytes fertilized were 9.0 (SD 4.715) and 10.0 (SD 3.576), respectively. The ganirelix group used on average 2400 IU FSH (SD 442.5) and 2100 IU FSH [SD 570.0 with leuprolide. Pregnancy occurred in 20/32 cycles (62.5%) in the leuprolide group and 6/12 (50%) ganirelix cycles [p ⫽ 0.48]. Within the agonist group, 78 embryos were transferred with ultrasound indentification of 28 gestational sacs, and an implantation rate of 35.9% The ganirelix group had an implantation rate of 38.0% [11 gestational sacs/ 29 embryos][p ⫽ 0.94]. Conclusions: Ganirelix is an effective method for LH suppression in donor cycles. When compared to cycles using the long protocol of leuprolide, donor oocyte cycles using ganirelix are shorter and produce similar pregnancy and implantation rates. Supported by: Partial support provided by Organon, Inc. P-11 Relationship between serum LH and IVF outcome in cycles with a GnRH antagonist (Cetrorelix). Ernesto Bosch, Ivan Valencia, Juana Crespo, Carlos Simon, Jose´ Remohi, Antonio Pellicer. Inst Valenciano de Infertilidad, Valencia, Spain. Objective: To relate serum LH levels during ovarian stimulation to IVF outcome in cycles where a GnRH antagonist was used to prevent the LH surge. Design: Prospective cohort study. Follow up of cycles according to serum LH levels the day of hCG. Materials/Methods: Ninety eight cycles of ovarian stimulation for IVFICSI with at least one embryo transferred performed in our institution between October 1st, 2001 and January 31st, 2002 were included. All patients received 0.25 mg daily of a GnRH antagonist (Cetrorelix) either from day 6 of stimulation or when a leading follicle was 14 mm in diameter, until the day that hCG was administered. FSH alone or with HMG were used for ovarian stimulation. Serum LH was determined the day that hCG was administered. To relate LH levels with IVF outcome, the distribution was divided in three groups according to Tuckeys hinges (percentiles 25 and 75). Age, number of oocytes collected, fertilization rate, number of transferred embryos and implantation, and pregnancy rates were analyzed. Analysis of variance was used. Results: Serum LH the day of hCG was 1.28 ⫾ 0.21 (CI 95%: 0.86 –1.70) mUI/ml. Tuckeys hinges were: percentile 25 ⫽ 0.50 mUI/ml; percentile 75 ⫽ 1.32 mUI/ml. IVF outcome is shown in Table. IVF outcome according to Serum LH the day of hCG Serm LH (mUI/ml)

Age

# oocytes

% # embryos % % fertilization transferred pregnancy implantation

ⱕ0.5 33.4 ⫾ 3.6 18.9 ⫾ 9.5 (n ⫽ 32) 0.5–1.32 32.7 ⫾ 4.5 14.1 ⫾ 7.6 (n ⫽ 40) 1.32 36.6 ⫾ 3.4 (*) 9.9 ⫾ 7.9 (*) (n ⫽ 26) p 0.001 0.008

61.9

2.3 ⫾ 1.1

31

16.4

70.5

2.9 ⫾ 0.9

50

24.5

62.4

2.1 ⫾ 1.5 (*) 19 (*)

N.S.

0.027

0.032

12.1 (*) 0.044

(*)Statistically significant when compared to the group with LH ⫽ 0.5–1.32 mUI/ml

FERTILITY & STERILITY威

Conclusions: In ovarian stimulation with GnRH antagonists for IVF, patients whose serum LH at the end of stimulation was in the interquartile range (between percentile 25 and 75, ⬎0.5 mUI/ml and ⱕ1.32 mUI/ml) showed a better IVF outcome with higher implantation and pregnancy rates. The highest levels of serum LH were present in older patients, with lower response, and poorer outcome. Analysis with longer series to confirm these findings is needed. If confirmed, developing more flexible antagonist regimens with modulation of LH levels during ovarian stimulation and taking into account individual patient characteristics, could improve the clinical outcome in cycles where a GnRH antagonist is used. Supported by: None provided.

P-12 Sperm capacitation index (SCI) predicts pregnancy outcome with controlled ovarian hyperstimulation (COH) ⴙ intrauterine insemination (IUI). Deborah C. Merryman, Sara E. Stringfellow, Katie E. Dalton, Virginia L. Houserman, Cecil A. Long, Kathryn L. Honea. ART Program of Alabama, Birmingham, AL. Objective: The Sperm Penetration Assay (SPA) evaluates aspects of the ability of human sperm to complete certain processes necessary to achieve fertilization using zona-free hamster oocytes. There is controversy regarding the correlation between the SPA and fertilization of human oocytes or pregnancy outcome. An abnormal SPA is a good predictor of IVF ⫹ ICSI pregnancy outcome, but does not affect fertilization rates (Merryman, et al, ASRM abstract #P313, Orlando, FL, 2001). The SCI is the quantitative measurement of the SPA (average number of sperm penetrations per oocyte). Our objective was to determine the SCI score predictive of COH ⫹ IUI outcome. Clinical pregnancy per treatment cycle used as the outcome measurement. Design: A retrospective study comparing the outcome of cycles with COH ⫹ IUI for the year 2001 in which patients had an SPA performed. SPAs were performed by Baylor College of Medicine, Houston, TX. Materials/Methods: The data consisted of 214 COH ⫹ IUI cycles in which patients had an SPA performed. Eighty-eight cycles had an SCI ⱕ5 (“possibly impaired by” Baylor standards) while 126 cycles had a normal SCI (⬎5). Patients with an SCI ⱕ5 initially may have had a repeat SPA with chymotrypsin preparation (CTP). The highest SCI obtained was used for the analysis. COH ⫹ IUI was carried out by conventional methods. If CTP improved SCI, sperm prep for IUI included CTP. Fisher exact test was used to test for differences between SCI groups. Table 1. Fertilization rates for different groups of patients based upon the cut-off values Sperm Capacitation Index (SCI) COH/IUH Cycles Clinical Pregnancies Clinical Pregnancy per Cycle

0–5 88 8 9%*

5 126 25 20%*

Total 214 33 15%

* P ⬍ .05 Results: Patients were grouped according to SCI: ⱕ5 and ⬎5. The clinical pregnancy rate (CPR) per cycle was 9% (8/88) when SCI was ⱕ5 and 20% (25/126) when SCI was ⬎5 (p ⬍.05). There were no clinical pregnancies in cycles with an SCI ⬍1 (0/17). A trend towards a decrease in CPR was seen when SCI was 1–5 (8/71, 11%) vs. ⬎5. A trend towards a decrease in CPR was noted for patients age ⱖ35 as compared to patients age ⬍35. Conclusions: (1) Patients with an impaired SCI of ⱕ5 have a significantly decreased clinical pregnancy rate per COH ⫹ IUI cycle as compared to patients with SCI ⬎5. (2) Routine screening of SCI is indicated for pregnancy rate prediction for patients undergoing COH ⫹ IUI. Supported by: Not applicable.

P-13 Assessment of endometrial leukemia inhibitory factor (LIF) levels by uterine flushing at the time of egg retrieval in IVF-ET. Francois J. Olivennes, Nathalie Le´ de´ e-Bataille, Marise Samama, Jean-Luc Taupin, Gerard Chaouat, Rene Frydman. Hosp Antoine Be´ cle`re, Clamart, France;

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