- Email: [email protected]
The Impact of Intramural Fibroids on Clinical Pregnancy in Donor IVF Cycles
(3441 ⫾ 629 vs. 3383 ⫾ 525) or twin birth weight (2501 ⫾ 664 vs. 2469 ⫾ 631) and singleton gestational age (38.2 ⫾ 2.3 vs. 38.9 ⫾ 2.1) or twin gestational age (35.6 ⫾ 2.9 vs. 35.6 ⫾ 3.1) for surrogates and infertility patients respectively. A comparison of these birth weights to gestational age-specific regional and national data revealed that neither group was significantly different than median values for the general obstetrical population. The singleton pre-term delivery rate and percentage of small and large for gestational age infants in the two populations were also not statistically different. CONCLUSION: When the potential effects of egg quality and of uterine effects resulting from ovarian stimulation are eliminated, the previously reported effects of IVF on birth weight and gestational age were no longer seen, irrespective of infertility history. This data, then, would suggest that any deleterious effects of IVF on these obstetrical outcomes result either from an effect of controlled ovarian stimulation on the intrauterine environment and/or from the reduced oocyte quality seen in many infertile patients. Supported by: None
Monday, October 17, 2005 6:15 p.m. O-120 The Impact of Intramural Fibroids on Clinical Pregnancy in Donor IVF Cycles. P. Klatsky, D. E. Lane, V. Y. Fujimoto. UCSF, San Francisco, CA. OBJECTIVE: Previous studies have attempted to evaluate the impact of intramural fibroids on IVF outcome and found varied results. Because fibroids tend to increase in prevalence with increasing age, it is challenging to adequately control for the effect of diminished ovarian reserve in these studies. As a result, we conducted a pilot study in the form of a retrospective chart review to examine the effect of intramural fibroids on the outcome of donor in vitro fertilization (IVF) studies. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We analyzed data from all donor IVF cycles conducted between September 1, 2002 and March 31, 2005. We excluded known donors from the analysis. Saline hysterosonograms were evaluated for the presence of intramural uterine fibroids that did not distort the endometrial cavity. All IVF donors underwent a long-luteal lupron protocol of ovarian stimulation. Recipients were treated with transdermal estrogen and intramuscular progesterone replacement. Clinical pregnancy was the primary outcome and we examined implantation rate as a secondary outcome. Data analysis was conducted using Stata 8.0. We performed linear regression analysis and logistic regression analysis to examine the outcomes of clinical pregnancy and implantation rate, respectively. Predictor variables in both models included the presence of fibroids, ethnicity, donor age, fibroid size, previous treatments for fibroids, presence of male factor infertility and antral follicle count (AFC). AFC was logarithmically transformed to achieve normality. RESULTS: One hundred and forty-two donor IVF cycles were reviewed. Fibroids were present in 27.% (36) of the recipient population and absent in the remaining 73% (99). 106 recipients (73%) had not undergone any treatment, 34 (23%) had undergone one fibroid related surgical procedure, and 5 (3%) had undergone two such procedures. Fibroid size ranged from 0.4-8.4 cm in the recipients who underwent embryo transfer. The mean (⫾SD) anonymous donor age was 26.0⫾3.7 years and a t-test demonstrated no difference in the donor age of recipients with and without fibroids. The mean (⫾SD) AFC was 12.1⫾10.8 at baseline. The implantation rate (IR) in the fibroid group was 37% and in the non-fibroid group was 43%. T-test demonstrated that this difference was non-significant. In the final logistic regression model, neither the presence of fibroids, fibroid size or surgical treatment of fibroids impacted the dichotomous outcome of clinical pregnancy. In the model examining the secondary outcome of implantation rate, fibroid presence, size and surgical treatment did not impact implantation rate. CONCLUSION: Multiple studies in the IVF literature have evaluated the impact of intramural fibroids with conflicting outcomes. However, it has been challenging to adequately control for the effect of age in these analyses. Here we present a pilot model to evaluate the impact of fibroids on IVF outcome isolated from the influence of diminished ovarian reserve.
S50
Abstracts
Future larger prospective studies are needed to further examine this phenomenon in donor IVF cycles. Supported by: None.
PROCEDURES AND TECHNIQUES-CLINICAL: ART Monday, October 17, 2005 3:45 p.m. O-121 When to Perform ICSI/ET Cycle After Hysteroscopic Surgery for Uterine Septum? M. Berkkanoglu, M. Isikoglu, K. Ozgur. Antalya IVF, Antalya, Turkey. OBJECTIVE: We aimed to find out whether it is good to perform ICSI/ET cycle just after hysteroscopic resection of uterine septum and whether there is a best period to perform ICSI/ET cycle after hysteroscopic resection of uterine septum. DESIGN: Retrospective cohort study from May 6, 2003 to January 1, 2005 MATERIALS AND METHODS: The study group included 176 infertile women who had undergone hysteroscopic resection for uterine septum and then underwent ICSI cycles. The clinical outcomes including pregnancy rates (positive HCG), clinical pregnancy rates (positive fetal cardiac activity) and implantation rates were compared between the cases (Group A: 89 women) having ICSI/ET cycle within 2 months after hysteroscopic resection for uterine septum, the cases (Group B: 63 women) having ICSI/ET cycle 3 or 4 months after hysteroscopic resection for uterine septum and the cases (Group C: 24 women) having ICSI/ET cycle 4 months after hysteroscopic resection for uterine septum followed by ICSI/ET cycle. KruskallWallis test and Chi-square test were used for statistical comparisons. RESULTS: There was no difference in age, number of FSH ampuls, peak E2 level, and number of embryos transferred between group A , group B and group C. In addition, there was no difference in the pregnancy rate, the clinical pregnancy rate and the implantation rate between group A, group B and group C. The demograhic and characteristic data and outcome parameters are depicted in the table.
CONCLUSION: The best method to correct uterus septum is its hysteroscopic resection. Hysteroscopic exicision of uterus septum leaves an injured area within the endometrial caity which is rapidly covered by nearby healthy endometrium. We have shown that starting ICSI/ET cycle just after the hysteroscopic procedure does not result in any impairment in implantation or pregnancy rate compared to those started 2 or more months after the operation. Therefore, if an ICSI/ET cycle is planned after hysteroscopic resection of uterine septum, there is no need for a waiting period to start the cycle. Supported by: None
Vol. 84, Suppl 1, September 2005
Monday, October 17, 2005 6:15 p.m. O-120 The Impact of Intramural Fibroids on Clinical Pregnancy in Donor IVF Cycles. P. Klatsky, D. E. Lane, V. Y. Fujimoto. UCSF, San Francisco, CA. OBJECTIVE: Previous studies have attempted to evaluate the impact of intramural fibroids on IVF outcome and found varied results. Because fibroids tend to increase in prevalence with increasing age, it is challenging to adequately control for the effect of diminished ovarian reserve in these studies. As a result, we conducted a pilot study in the form of a retrospective chart review to examine the effect of intramural fibroids on the outcome of donor in vitro fertilization (IVF) studies. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We analyzed data from all donor IVF cycles conducted between September 1, 2002 and March 31, 2005. We excluded known donors from the analysis. Saline hysterosonograms were evaluated for the presence of intramural uterine fibroids that did not distort the endometrial cavity. All IVF donors underwent a long-luteal lupron protocol of ovarian stimulation. Recipients were treated with transdermal estrogen and intramuscular progesterone replacement. Clinical pregnancy was the primary outcome and we examined implantation rate as a secondary outcome. Data analysis was conducted using Stata 8.0. We performed linear regression analysis and logistic regression analysis to examine the outcomes of clinical pregnancy and implantation rate, respectively. Predictor variables in both models included the presence of fibroids, ethnicity, donor age, fibroid size, previous treatments for fibroids, presence of male factor infertility and antral follicle count (AFC). AFC was logarithmically transformed to achieve normality. RESULTS: One hundred and forty-two donor IVF cycles were reviewed. Fibroids were present in 27.% (36) of the recipient population and absent in the remaining 73% (99). 106 recipients (73%) had not undergone any treatment, 34 (23%) had undergone one fibroid related surgical procedure, and 5 (3%) had undergone two such procedures. Fibroid size ranged from 0.4-8.4 cm in the recipients who underwent embryo transfer. The mean (⫾SD) anonymous donor age was 26.0⫾3.7 years and a t-test demonstrated no difference in the donor age of recipients with and without fibroids. The mean (⫾SD) AFC was 12.1⫾10.8 at baseline. The implantation rate (IR) in the fibroid group was 37% and in the non-fibroid group was 43%. T-test demonstrated that this difference was non-significant. In the final logistic regression model, neither the presence of fibroids, fibroid size or surgical treatment of fibroids impacted the dichotomous outcome of clinical pregnancy. In the model examining the secondary outcome of implantation rate, fibroid presence, size and surgical treatment did not impact implantation rate. CONCLUSION: Multiple studies in the IVF literature have evaluated the impact of intramural fibroids with conflicting outcomes. However, it has been challenging to adequately control for the effect of age in these analyses. Here we present a pilot model to evaluate the impact of fibroids on IVF outcome isolated from the influence of diminished ovarian reserve.
S50
Abstracts
Future larger prospective studies are needed to further examine this phenomenon in donor IVF cycles. Supported by: None.
PROCEDURES AND TECHNIQUES-CLINICAL: ART Monday, October 17, 2005 3:45 p.m. O-121 When to Perform ICSI/ET Cycle After Hysteroscopic Surgery for Uterine Septum? M. Berkkanoglu, M. Isikoglu, K. Ozgur. Antalya IVF, Antalya, Turkey. OBJECTIVE: We aimed to find out whether it is good to perform ICSI/ET cycle just after hysteroscopic resection of uterine septum and whether there is a best period to perform ICSI/ET cycle after hysteroscopic resection of uterine septum. DESIGN: Retrospective cohort study from May 6, 2003 to January 1, 2005 MATERIALS AND METHODS: The study group included 176 infertile women who had undergone hysteroscopic resection for uterine septum and then underwent ICSI cycles. The clinical outcomes including pregnancy rates (positive HCG), clinical pregnancy rates (positive fetal cardiac activity) and implantation rates were compared between the cases (Group A: 89 women) having ICSI/ET cycle within 2 months after hysteroscopic resection for uterine septum, the cases (Group B: 63 women) having ICSI/ET cycle 3 or 4 months after hysteroscopic resection for uterine septum and the cases (Group C: 24 women) having ICSI/ET cycle 4 months after hysteroscopic resection for uterine septum followed by ICSI/ET cycle. KruskallWallis test and Chi-square test were used for statistical comparisons. RESULTS: There was no difference in age, number of FSH ampuls, peak E2 level, and number of embryos transferred between group A , group B and group C. In addition, there was no difference in the pregnancy rate, the clinical pregnancy rate and the implantation rate between group A, group B and group C. The demograhic and characteristic data and outcome parameters are depicted in the table.
CONCLUSION: The best method to correct uterus septum is its hysteroscopic resection. Hysteroscopic exicision of uterus septum leaves an injured area within the endometrial caity which is rapidly covered by nearby healthy endometrium. We have shown that starting ICSI/ET cycle just after the hysteroscopic procedure does not result in any impairment in implantation or pregnancy rate compared to those started 2 or more months after the operation. Therefore, if an ICSI/ET cycle is planned after hysteroscopic resection of uterine septum, there is no need for a waiting period to start the cycle. Supported by: None
Vol. 84, Suppl 1, September 2005