- Email: [email protected]
What are determinants of the oocyte degeneration rate after intracytoplasimic sperm injection (ICSI)?
Embryos transferred Chemical pregnancies Clinical pregnancies Ongoing pregnancies
Sham acupuncture
Standard acupuncture
2.8 ⫾ 1.97 3 3 3
2.6 ⫾ 1.31 7 5 4
a
statistically significant p⬍0.05 Note: Results reported as mean ⫾ SD where applicable. Conclusions: Our study shows a significantly lower amount of gonadotropins used when IVF is combined with standard acupuncture. A 70% pregnancy rate was also achieved with standard acupuncture and IVF, compared to 25%. Larger prospective trials are necessary.
O-5 What are Determinants of the Oocyte Degeneration Rate After Intracytoplasimic Sperm Injection (ICSI)? M.P. Rosen, A.T. Dobson, S. Shen, T.L. Telles, V.Y. Fujimoto, M.I. Cedars Division of Reproductive Endocrinology and Infertility, University of California San Francisco, San Francisco, CA. Background and Significance: Interest has evolved in determining the factors associated with oocyte degeneration after ICSI. Limited reports indicated that oocyte degeneration was associated with the ICSI technique. Objective: This purpose of this study was to determine whether oocyte degeneration was technician dependent in an experienced laboratory. Baseline characteristics and physician-adjustable ovarian stimulation variables were also evaluated. Design: Prospective study. Materials and Methods: Six thousand seven hundred eighty-nine intracytoplasmic injection procedures were analyzed to determine whether the oocyte degeneration rate was technician dependent. 230 independent, downregulated cycles were examined to assess which predictors may be associated with the oocyte degeneration rate. Multivariate analyses were performed using the generalized linear model routines in Stata, Ver 7.0 (Stata Corporation, College Station, TX) to perform logistic regression allowing for clustering by cycle. The models were determined by backward elimination in a guided fashion, starting with a model including all the predictors (ICSI technician, stripping technician, baseline characteristics (age, day 3 FSH/ E2, AFC), physician-adjustable variables (start dose, total dose, number of mature oocytes retrieved, E2 on day of hCG, predicted E2/large follicle, number of 13–17mm (medium) and ⱖ18mm (large) follicles on the day of hCG, size of the lead follicle), then eliminating those that were not statistically significant one at a time guided by the previous literature and clinical experience. Tests were declared statistically significant for a twosided p-value ⬍ 0.05. Results: Neither the ICSI technician nor the stripping technician was a determinant of the oocyte degeneration rate. However, the day 3 FSH, number of mature oocytes retrieved, and E2/large follicle were significant independent predictor of oocyte degeneration rate. The day 3 FSH was positively associated with the degeneration rate, and the number of mature oocytes retrieved and the predicted E2/large follicle were negatively associated with the degeneration rate. Physician-adjustable variables were not associated with the degeneration rate. numdeg
Coef.
Age AFC Day 3 E2 # MII Oocytes Day 3 FSH Start Dose Total Dose Pred E2 _cons
.0065215 .0019983 .0036408 ⫺.0335009 .0437193 .0255645 ⫺.0081025 ⫺.0023453 ⫺2.003593
Std. Err.
z
.0239428 0.27 .0152647 0.13 .0023179 1.57 .0142233 ⫺2.36
P⬎兩z兩
[95% Conf. Interval]
0.785 0.896 0.116 0.019
⫺.0404056 .0534486 ⫺.0279199 .0319165 ⫺.0009023 .0081838 ⫺.0613781 ⫺.0056237
.0218811 2.00 0.046 .0008332 .0866053 .1411229 0.18 0.856 ⫺.2510313 .3021603 .0112635 ⫺0.72 0.472 ⫺.0301787 .0139736 .0008457 ⫺2.77 0.006 ⫺.0040029 ⫺.0006878 .8960944 ⫺2.24 0.025 ⫺3.759906 ⫺.2472804
Pred E2 ⫽ E2 day of hCG/(#medium follicles * 0.75 ⫹ #large follicles) (Standard errors scaled using square root of Pearson X2-based dispersion).
S12
PCRS Abstracts
Conclusion: The ICSI or stripping technician did not impact the oocyte degeneration rate. The data suggests that oocyte degeneration is a function of oocyte aging and physicians cannot alter the inherent occyte degeneration rate within a down-regulated cycle.
O-6 A Comparison Between a Fixed Versus a Flexible GnRH Protocal in IVF Cycles. Leo M Bonaventura, M.D., Glen Adaniya, PhD Midwest Reproductive Medicine, Indianapolis, IN. Background and Significance: To date protocols incorporating a GnRH antagonist in IVF cycles have been based either on using a fixed day of administration of the antagonist or on a specific follicle size to start the antagonist. Objective: This clinical study compared two different GnRH antagonist protocols. One protocol used the standard fixed starting day for the antagonist, and the second protocol looked at a flexible starting day for the antagonist based on serum LH. Pregnancy rates were compared. Materials and Methods: The fixed day protocol group (Group 1) included 65 patients receiving r-hFSH (Gonal-f) 150 IU twice a day, starting day 3 of the menstrual cycle. On day 8 of the cycle, E2, LH, P4 and pelvic ultrasound were obtained. Cetrorelix 0.25mg treatment was initiated on day 8 of cycle and given daily until follicular maturation occurred (4 follicles at 20mm) r-hCG 250mcg was then given. Egg retrieval was performed at 36 hrs. Embryo transfer occurred at 72 hrs under ultrasound guidance. The luteal phase was managed starting day of embryo transfer with progesterone gel (Crinone 8% progesterone gel) twice a day. Additionally, 60 mcg of r-hCG was given on the day of embryo transfer and every 72 hrs for two more doses. A pregnancy test was obtained 12 days after transfer. Group 2 included 76 patients and the same gonadotropin regimen was used. Day 8 of the cycle the same monitoring was performed. In this group cetrorelix 0.25 mg was started only if serum LH was 5 IU or greater. If LH was less than 5 IU then LH and P4 were checked every 48 hrs and cetrorelix started when the LH reached 5 IU or greater. When follicular maturation was reached r-hCG 500 mcg was given. Egg retrieval, embryo transfer and the luteal phase were handled the same as Group I. Results: Table Table I Number Age (yrs) IVF Attempts Day 1 E2 Day 8 E2 Day 8 LH LH day antagonist Start P4 day antagonist start E2 Day hCG LH Day hCG Number embryos transferred Pregnancy rate
Group 2
Group 1
76 33.7 2.0 33.2 pg/mL 617.5 pg/mL 7.5 IU 7.4 IU
65 34.7 2.5 40.5 pg/mL 554.3 pg/mL 2.4 IU 2.4 IU
NS NS NS NS p 0.001 p 0.001
0.95 ng/dL
0.98 ng/dL
NS
1804.5 pg/mL 1.7 IU 2.6
1431.2 pg/mL 1.4 IU 2.4
NS NS NS
33/76 ⫽ 43%
14/65 ⫽ 21.5%
p 0.021
Conclusions: The use of a flexible start for the GnRH antagonist cetrorelix was superior to the standard fixed day antagonist regimen. The pregnancy rate of Group 2 was twice that of Group 1, 43% versus 21.5% respectively.
O-7 Comparison of Human-Derived Menotropin Versus Recombinant Follicle Stimulating Hormone In In Vitro Fertilization Cycles Utilizing GnRH Antagonist. M.X. Ransom, A.J. Garcia, A. Shilad. Saint Joseph’s Hospital & Medical Center, Paterson, NJ. Background: Although many studies have been published comparing hMG to rFSH with a GnRH agonist, information is lacking for similar comparisons using a GnRH antagonist.
Vol. 81, Suppl. 3, April 2004
Sham acupuncture
Standard acupuncture
2.8 ⫾ 1.97 3 3 3
2.6 ⫾ 1.31 7 5 4
a
statistically significant p⬍0.05 Note: Results reported as mean ⫾ SD where applicable. Conclusions: Our study shows a significantly lower amount of gonadotropins used when IVF is combined with standard acupuncture. A 70% pregnancy rate was also achieved with standard acupuncture and IVF, compared to 25%. Larger prospective trials are necessary.
O-5 What are Determinants of the Oocyte Degeneration Rate After Intracytoplasimic Sperm Injection (ICSI)? M.P. Rosen, A.T. Dobson, S. Shen, T.L. Telles, V.Y. Fujimoto, M.I. Cedars Division of Reproductive Endocrinology and Infertility, University of California San Francisco, San Francisco, CA. Background and Significance: Interest has evolved in determining the factors associated with oocyte degeneration after ICSI. Limited reports indicated that oocyte degeneration was associated with the ICSI technique. Objective: This purpose of this study was to determine whether oocyte degeneration was technician dependent in an experienced laboratory. Baseline characteristics and physician-adjustable ovarian stimulation variables were also evaluated. Design: Prospective study. Materials and Methods: Six thousand seven hundred eighty-nine intracytoplasmic injection procedures were analyzed to determine whether the oocyte degeneration rate was technician dependent. 230 independent, downregulated cycles were examined to assess which predictors may be associated with the oocyte degeneration rate. Multivariate analyses were performed using the generalized linear model routines in Stata, Ver 7.0 (Stata Corporation, College Station, TX) to perform logistic regression allowing for clustering by cycle. The models were determined by backward elimination in a guided fashion, starting with a model including all the predictors (ICSI technician, stripping technician, baseline characteristics (age, day 3 FSH/ E2, AFC), physician-adjustable variables (start dose, total dose, number of mature oocytes retrieved, E2 on day of hCG, predicted E2/large follicle, number of 13–17mm (medium) and ⱖ18mm (large) follicles on the day of hCG, size of the lead follicle), then eliminating those that were not statistically significant one at a time guided by the previous literature and clinical experience. Tests were declared statistically significant for a twosided p-value ⬍ 0.05. Results: Neither the ICSI technician nor the stripping technician was a determinant of the oocyte degeneration rate. However, the day 3 FSH, number of mature oocytes retrieved, and E2/large follicle were significant independent predictor of oocyte degeneration rate. The day 3 FSH was positively associated with the degeneration rate, and the number of mature oocytes retrieved and the predicted E2/large follicle were negatively associated with the degeneration rate. Physician-adjustable variables were not associated with the degeneration rate. numdeg
Coef.
Age AFC Day 3 E2 # MII Oocytes Day 3 FSH Start Dose Total Dose Pred E2 _cons
.0065215 .0019983 .0036408 ⫺.0335009 .0437193 .0255645 ⫺.0081025 ⫺.0023453 ⫺2.003593
Std. Err.
z
.0239428 0.27 .0152647 0.13 .0023179 1.57 .0142233 ⫺2.36
P⬎兩z兩
[95% Conf. Interval]
0.785 0.896 0.116 0.019
⫺.0404056 .0534486 ⫺.0279199 .0319165 ⫺.0009023 .0081838 ⫺.0613781 ⫺.0056237
.0218811 2.00 0.046 .0008332 .0866053 .1411229 0.18 0.856 ⫺.2510313 .3021603 .0112635 ⫺0.72 0.472 ⫺.0301787 .0139736 .0008457 ⫺2.77 0.006 ⫺.0040029 ⫺.0006878 .8960944 ⫺2.24 0.025 ⫺3.759906 ⫺.2472804
Pred E2 ⫽ E2 day of hCG/(#medium follicles * 0.75 ⫹ #large follicles) (Standard errors scaled using square root of Pearson X2-based dispersion).
S12
PCRS Abstracts
Conclusion: The ICSI or stripping technician did not impact the oocyte degeneration rate. The data suggests that oocyte degeneration is a function of oocyte aging and physicians cannot alter the inherent occyte degeneration rate within a down-regulated cycle.
O-6 A Comparison Between a Fixed Versus a Flexible GnRH Protocal in IVF Cycles. Leo M Bonaventura, M.D., Glen Adaniya, PhD Midwest Reproductive Medicine, Indianapolis, IN. Background and Significance: To date protocols incorporating a GnRH antagonist in IVF cycles have been based either on using a fixed day of administration of the antagonist or on a specific follicle size to start the antagonist. Objective: This clinical study compared two different GnRH antagonist protocols. One protocol used the standard fixed starting day for the antagonist, and the second protocol looked at a flexible starting day for the antagonist based on serum LH. Pregnancy rates were compared. Materials and Methods: The fixed day protocol group (Group 1) included 65 patients receiving r-hFSH (Gonal-f) 150 IU twice a day, starting day 3 of the menstrual cycle. On day 8 of the cycle, E2, LH, P4 and pelvic ultrasound were obtained. Cetrorelix 0.25mg treatment was initiated on day 8 of cycle and given daily until follicular maturation occurred (4 follicles at 20mm) r-hCG 250mcg was then given. Egg retrieval was performed at 36 hrs. Embryo transfer occurred at 72 hrs under ultrasound guidance. The luteal phase was managed starting day of embryo transfer with progesterone gel (Crinone 8% progesterone gel) twice a day. Additionally, 60 mcg of r-hCG was given on the day of embryo transfer and every 72 hrs for two more doses. A pregnancy test was obtained 12 days after transfer. Group 2 included 76 patients and the same gonadotropin regimen was used. Day 8 of the cycle the same monitoring was performed. In this group cetrorelix 0.25 mg was started only if serum LH was 5 IU or greater. If LH was less than 5 IU then LH and P4 were checked every 48 hrs and cetrorelix started when the LH reached 5 IU or greater. When follicular maturation was reached r-hCG 500 mcg was given. Egg retrieval, embryo transfer and the luteal phase were handled the same as Group I. Results: Table Table I Number Age (yrs) IVF Attempts Day 1 E2 Day 8 E2 Day 8 LH LH day antagonist Start P4 day antagonist start E2 Day hCG LH Day hCG Number embryos transferred Pregnancy rate
Group 2
Group 1
76 33.7 2.0 33.2 pg/mL 617.5 pg/mL 7.5 IU 7.4 IU
65 34.7 2.5 40.5 pg/mL 554.3 pg/mL 2.4 IU 2.4 IU
NS NS NS NS p 0.001 p 0.001
0.95 ng/dL
0.98 ng/dL
NS
1804.5 pg/mL 1.7 IU 2.6
1431.2 pg/mL 1.4 IU 2.4
NS NS NS
33/76 ⫽ 43%
14/65 ⫽ 21.5%
p 0.021
Conclusions: The use of a flexible start for the GnRH antagonist cetrorelix was superior to the standard fixed day antagonist regimen. The pregnancy rate of Group 2 was twice that of Group 1, 43% versus 21.5% respectively.
O-7 Comparison of Human-Derived Menotropin Versus Recombinant Follicle Stimulating Hormone In In Vitro Fertilization Cycles Utilizing GnRH Antagonist. M.X. Ransom, A.J. Garcia, A. Shilad. Saint Joseph’s Hospital & Medical Center, Paterson, NJ. Background: Although many studies have been published comparing hMG to rFSH with a GnRH agonist, information is lacking for similar comparisons using a GnRH antagonist.
Vol. 81, Suppl. 3, April 2004