The experience of 152 hyper responders in corifollitropin alfa without GnRH antagonist protocol: comparable incidence of ovarian hyperstimulation syndrome with normal responders

biomarker for assessing ovarian reserve as part of evaluation for women considering IVF. Access AMH is not available in the US and this abstract is not intended as off-label promotion of any Beckman Coulter product. Supported by: Beckman Coulter, Inc. P-313 Tuesday, October 31, 2017 THE EXPERIENCE OF 152 HYPER RESPONDERS IN CORIFOLLITROPIN ALFA WITHOUT GNRH ANTAGONIST PROTOCOL: COMPARABLE INCIDENCE OF OVARIAN HYPERSTIMULATION SYNDROME WITH NORMAL RESPONDERS. M. Chuang, Y. Peng, M. Lee, Y. Huang. Stork Fertility Center, Hsinchu, Taiwan. OBJECTIVE: To evaluate the incidence of ovarian hyperstimulation syndrome (OHSS) in potential hyper ovarian responders in corifollitropin alfa without routine GnRH antagonist protocol. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Two hundred fifty donors aged 20 - 34 years with anti-M€ ullerian hormone (AMH) S2.5 ng/mL were included. According to the number of retrieved oocyte, all donors were divided into two subgroups: normal (retrieved 8-20 oocytes, n¼98) and hyper (retrieved >20 oocytes, n¼152) responders. The hormone levels were monitored for determining whether other additional injections (r-LH or/and r-FSH) were necessary after one corifollitropin alfa shot. Oocyte maturation was achieved by GnRH agonist administration and the oocyte pick-up (OPU) was performed at 36 hours after triggering. The diagnosis of OHSS was based on both clinical symptoms and laboratory results including four key indicators: WBC (Cumm), PLT (103/Cumm), Hb (gm/dL) and Hct (%). The following clinical outcomes from recipients were also analyzed. RESULTS: In hyper responders, significantly higher levels of body weight (52.2 kg vs. 54.0 kg), AMH (6.1 ng/ mL vs. 9.9 ng/ mL), AFC (13.2 vs. 15.4), basal LH (4.0 mIU/ mL vs. 5.4 mIU/ mL), peak E2 (2979 pg/mL vs. 5259 pg/ mL) and retrieved oocytes (15.5 vs. 30.4) were observed. The two groups were comparable in age (24.7 vs. 24.5), basal E2 (38.6 pg/mL vs. 42.4 pg/ mL), peak LH (3.8 mIU/mL vs. 3.5 mIU/ mL)maturation rate (MR , 75.9 % vs. 74.5 %) and total supplemented dosage of r-FSH (496.1 IU vs. 447.2 IU) and r-LH (241.1 IU vs. 249.2 IU). For evaluation of OHSS incidence, the pre-and post-OPU laboratory results including WBC, PLT, Hb and Hct, were monitored, and no clinical significance was found. Therefore, the degrees of OHSS were mainly classified by the clinical symptoms. There were no significant difference in the incidences of mild or moderate OHSS between normal and hyper responders (mild: 6.1% vs. 5.9%, p¼0.95 ; moderate: 5.1% vs. 9.2%, p¼0.21 ). Under this stimulation protocol, most of cases occurred OHSS were mild or moderate in both groups. In addition, the clinical outcomes did not differ between normal and hyper responders. CONCLUSIONS: Accordingly, the most concern of corifollitropin alfa administration is the possibility of relatively higher incidence of OHSS in hyper responders. In this study, the results revealed that the incidence of OHSS is no significantly different between normal and hyper responders even without GnRH antagonist administration. Therefore, with well-monitoring, this patient-friendly protocol, less injection, is also suitable for the potential hyper responders.

RESULTS: The normal fertilization rates (78.4% vs 70.1%, p < 0.01) and cleavage rates (100% vs 93.7%, p < 0.01) in patients that underwent intra cytoplasmic sperm injection (ICSI) and the normal fertilization rates (73.9% vs 63.8%, p < 0.05) and good quality blastocyst formation rates (56.5% vs 35.8%, p < 0.05) in patients that underwent IVF were significantly higher in group L. The clinical pregnancy rates (IVF: 50.0% vs 36.4%, ICSI: 46.2% vs 38.5%) in group S tended to be lower, but not significantly. CONCLUSIONS: If matured oocytes from a small follicle developed to form an embryo that is transferable, its competence could be the same as that of an embryo derived from a large follicle. Hence, matured oocytes retrieved from small follicles along with those from large follicles can increase the pregnancy rates per treatment cycle in natural and mild stimulation IVF. P-315 Tuesday, October 31, 2017 THE EFFECT OF DIOSMIN ON PREVENTING OVARIAN HYPERSTIMULATION SYDROME. W. Zhu,a T. Li,a Y. Guo,b C. Fang.a aReproductive Medicine Research Center, The Sixth Affiliated Hospital, Sun Yat—sen University, Guangzhou, China; bReproductive center, Reproductive Medicine Research Center, The Sixth Affiliated Hospital, Sun Yat—sen University, Guangzhou, China. OBJECTIVE: To evaluate the effect of diosmin on the incidence and severity of OHSS (ovarian hyperstimulation syndrome) and to investigate the value of diosmin in prevention and treatment of OHSS. DESIGN: A randomized controlled clinical study. MATERIALS AND METHODS: Clinical data of 146 patients with high risk of OHSS after controlled ovarian hypersimulation in our center from September 2016 to December 2016 were analyzed. Patients were randomly divided into two groups. Tablet diosmin 1000mg was prescribed twice a day for a period of 10 days in the study group(n¼74). The patients in the control group used the similar therapy without diosmin. The incidence and severity of OHSS in both groups were compared. RESULTS: There was no significant difference between two groups in age, body mass index(BMI), total dosage of gonadotropin and number of oocytes retrieved. The incidence of moderate to severe OHSS in the study group was significantly higher than the control group(6.16% vs 13.44%). Four patients in the control group needed paracentesis during therapy. There was no paracentesis performed and no severe OHSS occurred in the study group. CONCLUSIONS: Diosmin can effectively prevent OHSS and reduce the incidence and severity of moderate to severe OHSS.

Comparison of the severity of OHSS

OHSS(n) Moderate to severe OHSS(n) Paracentesis(n)

Diosmin Group

Control Group

58/74 5/74* 0/5

65/72 14/72* 4/14

P-314 Tuesday, October 31, 2017 COMPETENCE OF MATURE OOCYTES FROM SMALL FOLLICLES IN NATURAL AND MILD STIMULATION IN VITRO FERTILIZATION. S. Osato, A. Koike, H. Ito, M. Nakata, H. Fujita, T. Abe. Shinjuku ART Clinic, Tokyo, Japan. OBJECTIVE: The aim of this study was to investigate the competence of matured oocytes retrieved from small follicles compared with those from large follicles in natural and mild stimulation in vitro fertilization (IVF). DESIGN: Retrospective cohort study MATERIALS AND METHODS: A total of 315 patients under 39 years of who underwent age 453 cycles of natural and mild stimulation IVF were enrolled between March and July 2016. Matured ( MetaphaseII) oocytes were divided into two groups, those retrieved from small follicles (follicle fluid < 1.0 mL) as group S, and those from large follicles (follicle fluid > 3.0 mL) as group L. The primary outcomes measured were the rates of normal fertilization and cleavage, clinical pregnancy rates after fresh cleavage stage embryo transfer, and good quality blastocyst formation rates.

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ASRM Abstracts

P-316 Tuesday, October 31, 2017 USE OF DYDROGESTERONE DURING CONTROLLED OVARIAN HYPERSTIMULATION IN NORMAL OVULATORY WOMEN TREATED FOR IN VITRO FERTILIZATION OR INTRACYTOPLASMIC SPERM INJECTION TREATMENTS. X. Zhu Y. Fu. Shanghai 9th People’s Hospital, Shanghai, China. OBJECTIVE: Progesterone soft capsule (brand name Utrogestan) has recently been demonstrated to be an effective oral alternative for preventing premature LH surges during controlled ovarian hyperstimulation (COH), with optimal pregnant outcomes in frozen-thawed embryo transfer (FET) cycles. However, side effects including dizziness, sleepiness, vertigo, nausea or vomiting were observed in some patients when Utrogestan was taken orally, especially in the morning. Therefore, it appears mandatory to explore some kind of progesterone preparation with minimal side effects. Dydrogesterone (brand name: Duphaston), a synthetic progesterone, does not interfere with

Vol. 108, No. 3, Supplement, September 2017