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Statistical analysis of morphologic characteristics of oocytes which factors might effect these features and which characteristics might play important role during fertilization? a prospective study
CONCLUSIONS: MDF use in IVF yielded no differences in cycle outcome when compared to LL among good prognosis patients. Contrary to previous findings, MDF may be effectively used in good prognosis patients and has a potential cost savings advantage. Supported by: This research was supported, in part, by RBMB/NICHD/ NIH; Bethesda, MD.
P-93 STATISTICAL ANALYSIS OF MORPHOLOGIC CHARACTERISTICS OF OOCYTES WHICH FACTORS MIGHT EFFECT THESE FEATURES AND WHICH CHARACTERISTICS MIGHT PLAY IMPORTANT ROLE DURING FERTILIZATION? A PROSPECTIVE STUDY. R. G. Aktas, C. Gazi, N. Arat, K. Sofuoglu, T. Cetinkaya, N. Tug. IVF Center, Zeynep Kamil Women and Children Health Hospital, Istanbul, TR, Turkey. OBJECTIVE: To examine the association between morphologic characteristics of oocytes and i) women’s age, ii) type of stimulation protocol, iii) duration of ovarian stimulation iii) serum E2 levels, iv) fertilization rate, v) PN scoring. DESIGN: All patients who underwent IVF treatment between January 1st and April 25th 2007 were included. MATERIALS AND METHODS: After evaluation of morphologic criteria listed in Table I; these characteristics were classified according to women’s age, stimulation protocol, duration of ovarian stimulation, serum E2 levels on the day of hCG administration, fertilization rates and PN scores. Pearson chi-square test or Likelihood Ratio chi-square test were used. RESULTS: From 153 cycles, 1586 oocytes were retrieved. 1380 of these oocytes were MII oocytes. 603 MII oocytes were classified as normal. Rest of it contained one or more anomalies. Statistical meaningful results were summarised at Table 1. TABLE Increased Abnormal oocytes Cytoplasmic abnormalities Homogenous granularity Central granularity
Vacuolisation Refractile Bodies
SER
PVS anomalies WidePVS PV Debris PB anomalies Fragmented PB
Flat PB Round PB Two PB ZP anomalies Thin ZP
Thick ZP
Dark ZP Membrane abnormality Shape abnormality
37 years-old [(54.9%; P¼0.002) E2 1500 pg [(88.3%; P¼0.0001) 37 years-old [(78.1%, P¼0.0001), E2 1500 pg [(80.2%, P¼0.007) 13 day ovarian stimulation (15.2%; P¼0.009) Antagonist protocol (80.6%; P¼0.018),12 day ovarian stimulation (12.9%; P¼0.009) 37 years-old [(61.9%; P¼0.047), Long protocol (83.3%, P¼0.038)
Abstracts
* *
No fertilization (84.8%; P¼0.002) *
P-94 FOLLICULAR OXIDATIVE PREDOMINANCE AS A FUNCTION OF MATERNAL AGE AND ITS EFFECT ON IVF OUTCOME. S. Kar, L. Samanta, G. B. N. Chainy. KAR Clinic IVF Centre, Kar Clinic, Bhubaneswar, Orissa, India; Dept. of Biotechnology, Utkal University, Bhubaneswar, Orissa, India. OBJECTIVE: Prooxidative environment of Graafian follicle has been reflected in pregnancy outcome of patients undergoing IVF. However, there exist a difference in opinion with regard to level of oxidative end products and total antioxidant capacity of the follicular fluid of pregnant and non-pregnant women undergoing ART. In general, it can not be ruled out that intensified peroxidation in Graafian follicle may be a factor compromising the normal development of the oocyte and the role of reactive oxygen species in aging process is well established. The impact of age on intrafollicular markers of oxidative stress has not been fully elucidated. The objective of the present study was to find out the impact of age on the intrafollicular redox milieu and the consequent outcome in women undergoing ART. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Follicular fluid from 86 IVF/ICSI patients were utilized for the measurement of thiobarbituric acid reactive substances (TBARS) along with the activities of superoxide dismutase and catalase, the enzymes that ofer first line of defence against reactive oxygen species. The data were correlated with number of eggs retrieved, number of embryos formed and 14th day serum beta-hCG level. Multiple logistic regression analysis was carried out to find correlation (if any) between the variables. RESULTS: The results indicate that maternal age in inversely correlated with number of aggs retrieved (Y þ 17.46 – 0.33x, r ¼ 0.295, P<0.005), number of embryos formed (Y ¼ 7.78 – 0.14x, r ¼ 0.298, P<0.005) and positively correlated with the level of TBARS (Y ¼ 0.23x 5.32, r ¼ 0.63, P<0.59510). When the ratio of superoxide to catalase activities were plotted against age, a progressive increase was noticed. However, no significant difference was noticed between the mean age of pregnant and non-pregnant women and the level of TBARS and antioxidant enzyme activities. CONCLUSIONS: The results of the present study suggested that ageing affects the prooxidant/antioxidant balance inside the pre-ovulatory ovarian follicle by inducing intrafollicular oxidative stress. It is also imperative that mere comparison of mean age and mean oxidative stress status of the follicular fluid of pregnant and non-pregnant women would give any conclusion regarding the impact of oxidative stress on folliculogenesis as a function of maternal age. Supported by: None. P-95
No fertilization (78.6%; P¼0.002)
E2 1000 pgY(26.7%; P¼0.0001) 13 day ovarian stimulation (9.%; P¼0.044) * 37 years-old [(70.1%; P¼0.0001), 12 day ovarian stimulation (13.1%; P¼0.019) * * *
*
37 years-old [(100%; P¼0.0001), E2 1500 pg Y(66.8%; P¼0.05) 37 years-old [(70.7%; P¼0.036), E2 1500 pg [(92.7%; P¼0.002) * * *
*
* No statistical meaningful difference.
S140
No fertilization (55.8%; P¼0.043)
CONCLUSIONS: We demonstrate which might cause an increase at certain abnormalities in oocyte structure and which anomalies are associated with low fertilization rate. Supported by: None.
* * *
* * *
*
* * *
ARE PARASITES CAPABLE OF INVADING FOLLICULAR FLUID? Z. R. Hubayter, C. J. Alexander, K. Thrift, Y. Zhao, L. A. Kolp, J. A. Garcia. Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD. OBJECTIVE: The mosquito vectors responsible for the transmission of filariasis are not prevalent in the U.S. Adult filarial worms inhabit lymphatics may cause chronic inflammation leading to edema of the breast, vulva and pelvic organs. Microfilariae can invade the placenta and fetus and cause perinatal complications. This study reports an unusual finding within follicular fluid and may increase awareness of rare pathogens that may surround the oocyte. DESIGN: A case report. MATERIALS AND METHODS: In a tertiary medical center, a 41yo from Cameroon underwent IVF for unexplained infertility. The patient underwent oocyte retrieval and each follicle was apirated into different tubes. The needle was flushed in between each aspiration; three oocytes were obtained. The average measurements of the worms seen were the following: length: 262.4 mm, head 5.44 mm, middle 8.24 mm and tail 2.42 mm. Other interventions performed included endometrial washings and biopsy; no transfer was performed. One embryo was cryopreserved. RESULTS: Multiple wormlike organisms were seen adjacent to the oocyte and the cumulus complex as depicted in Figure 1. Each follicle was infested with dynamic microfilariae. The follicular fluid and endometrial washings were cultured and Wucheria Bancrofti microfilariae was identified. An endometrial biopsy revealed chronic endometritis with plasma cells and rare eosinophils.
Vol. 88, Suppl 1, September 2007
P-93 STATISTICAL ANALYSIS OF MORPHOLOGIC CHARACTERISTICS OF OOCYTES WHICH FACTORS MIGHT EFFECT THESE FEATURES AND WHICH CHARACTERISTICS MIGHT PLAY IMPORTANT ROLE DURING FERTILIZATION? A PROSPECTIVE STUDY. R. G. Aktas, C. Gazi, N. Arat, K. Sofuoglu, T. Cetinkaya, N. Tug. IVF Center, Zeynep Kamil Women and Children Health Hospital, Istanbul, TR, Turkey. OBJECTIVE: To examine the association between morphologic characteristics of oocytes and i) women’s age, ii) type of stimulation protocol, iii) duration of ovarian stimulation iii) serum E2 levels, iv) fertilization rate, v) PN scoring. DESIGN: All patients who underwent IVF treatment between January 1st and April 25th 2007 were included. MATERIALS AND METHODS: After evaluation of morphologic criteria listed in Table I; these characteristics were classified according to women’s age, stimulation protocol, duration of ovarian stimulation, serum E2 levels on the day of hCG administration, fertilization rates and PN scores. Pearson chi-square test or Likelihood Ratio chi-square test were used. RESULTS: From 153 cycles, 1586 oocytes were retrieved. 1380 of these oocytes were MII oocytes. 603 MII oocytes were classified as normal. Rest of it contained one or more anomalies. Statistical meaningful results were summarised at Table 1. TABLE Increased Abnormal oocytes Cytoplasmic abnormalities Homogenous granularity Central granularity
Vacuolisation Refractile Bodies
SER
PVS anomalies WidePVS PV Debris PB anomalies Fragmented PB
Flat PB Round PB Two PB ZP anomalies Thin ZP
Thick ZP
Dark ZP Membrane abnormality Shape abnormality
37 years-old [(54.9%; P¼0.002) E2 1500 pg [(88.3%; P¼0.0001) 37 years-old [(78.1%, P¼0.0001), E2 1500 pg [(80.2%, P¼0.007) 13 day ovarian stimulation (15.2%; P¼0.009) Antagonist protocol (80.6%; P¼0.018),12 day ovarian stimulation (12.9%; P¼0.009) 37 years-old [(61.9%; P¼0.047), Long protocol (83.3%, P¼0.038)
Abstracts
* *
No fertilization (84.8%; P¼0.002) *
P-94 FOLLICULAR OXIDATIVE PREDOMINANCE AS A FUNCTION OF MATERNAL AGE AND ITS EFFECT ON IVF OUTCOME. S. Kar, L. Samanta, G. B. N. Chainy. KAR Clinic IVF Centre, Kar Clinic, Bhubaneswar, Orissa, India; Dept. of Biotechnology, Utkal University, Bhubaneswar, Orissa, India. OBJECTIVE: Prooxidative environment of Graafian follicle has been reflected in pregnancy outcome of patients undergoing IVF. However, there exist a difference in opinion with regard to level of oxidative end products and total antioxidant capacity of the follicular fluid of pregnant and non-pregnant women undergoing ART. In general, it can not be ruled out that intensified peroxidation in Graafian follicle may be a factor compromising the normal development of the oocyte and the role of reactive oxygen species in aging process is well established. The impact of age on intrafollicular markers of oxidative stress has not been fully elucidated. The objective of the present study was to find out the impact of age on the intrafollicular redox milieu and the consequent outcome in women undergoing ART. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Follicular fluid from 86 IVF/ICSI patients were utilized for the measurement of thiobarbituric acid reactive substances (TBARS) along with the activities of superoxide dismutase and catalase, the enzymes that ofer first line of defence against reactive oxygen species. The data were correlated with number of eggs retrieved, number of embryos formed and 14th day serum beta-hCG level. Multiple logistic regression analysis was carried out to find correlation (if any) between the variables. RESULTS: The results indicate that maternal age in inversely correlated with number of aggs retrieved (Y þ 17.46 – 0.33x, r ¼ 0.295, P<0.005), number of embryos formed (Y ¼ 7.78 – 0.14x, r ¼ 0.298, P<0.005) and positively correlated with the level of TBARS (Y ¼ 0.23x 5.32, r ¼ 0.63, P<0.59510). When the ratio of superoxide to catalase activities were plotted against age, a progressive increase was noticed. However, no significant difference was noticed between the mean age of pregnant and non-pregnant women and the level of TBARS and antioxidant enzyme activities. CONCLUSIONS: The results of the present study suggested that ageing affects the prooxidant/antioxidant balance inside the pre-ovulatory ovarian follicle by inducing intrafollicular oxidative stress. It is also imperative that mere comparison of mean age and mean oxidative stress status of the follicular fluid of pregnant and non-pregnant women would give any conclusion regarding the impact of oxidative stress on folliculogenesis as a function of maternal age. Supported by: None. P-95
No fertilization (78.6%; P¼0.002)
E2 1000 pgY(26.7%; P¼0.0001) 13 day ovarian stimulation (9.%; P¼0.044) * 37 years-old [(70.1%; P¼0.0001), 12 day ovarian stimulation (13.1%; P¼0.019) * * *
*
37 years-old [(100%; P¼0.0001), E2 1500 pg Y(66.8%; P¼0.05) 37 years-old [(70.7%; P¼0.036), E2 1500 pg [(92.7%; P¼0.002) * * *
*
* No statistical meaningful difference.
S140
No fertilization (55.8%; P¼0.043)
CONCLUSIONS: We demonstrate which might cause an increase at certain abnormalities in oocyte structure and which anomalies are associated with low fertilization rate. Supported by: None.
* * *
* * *
*
* * *
ARE PARASITES CAPABLE OF INVADING FOLLICULAR FLUID? Z. R. Hubayter, C. J. Alexander, K. Thrift, Y. Zhao, L. A. Kolp, J. A. Garcia. Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD. OBJECTIVE: The mosquito vectors responsible for the transmission of filariasis are not prevalent in the U.S. Adult filarial worms inhabit lymphatics may cause chronic inflammation leading to edema of the breast, vulva and pelvic organs. Microfilariae can invade the placenta and fetus and cause perinatal complications. This study reports an unusual finding within follicular fluid and may increase awareness of rare pathogens that may surround the oocyte. DESIGN: A case report. MATERIALS AND METHODS: In a tertiary medical center, a 41yo from Cameroon underwent IVF for unexplained infertility. The patient underwent oocyte retrieval and each follicle was apirated into different tubes. The needle was flushed in between each aspiration; three oocytes were obtained. The average measurements of the worms seen were the following: length: 262.4 mm, head 5.44 mm, middle 8.24 mm and tail 2.42 mm. Other interventions performed included endometrial washings and biopsy; no transfer was performed. One embryo was cryopreserved. RESULTS: Multiple wormlike organisms were seen adjacent to the oocyte and the cumulus complex as depicted in Figure 1. Each follicle was infested with dynamic microfilariae. The follicular fluid and endometrial washings were cultured and Wucheria Bancrofti microfilariae was identified. An endometrial biopsy revealed chronic endometritis with plasma cells and rare eosinophils.
Vol. 88, Suppl 1, September 2007