Abstracts of the 25th Annual Meeting of ESHRE, Amsterdam, the Netherlands, 28 June 1 July, 2009
similar between the two groups compared (2.3+0.6 vs. 2.4+0.6, respectively;
p 0.85).
Ongoing pregnancy rates per randomized patient were not significantly
different between patients who started stimulation after the occurrence of men-
struation (38.0%) as compared to those who started after two weeks of agonist
administration (30.8%) (rate difference: 7.2, 95% CI: 210.9 to 24.8).
Conclusion: In the long luteal agonist protocol, initiation of stimulation at
occurrence of menstruation is associated with a significantly shorter duration
of agonist administration and does not appear to compromise pregnancy rates
as compared to initiation of stimulation after two weeks of agonist
administration.
P-342 Poster IVF-ICSI in HIV positive and sero-discordant couples:
results of five-years of experience
P. Santulli1, N. Chopin1, C. Patrat2, L. Marcellin1, J.P. Wolf2, C. Chapron1,
D. de Ziegler1
1 P-343 Poster
Cochin-Saint-Vincent De Paul, Service de Gynecologie et Medecine De La
Reproduction, Paris Cedex 14, France, 2Cochin-Saint-Vincent De Paul, Bio-
logie de la Reproduction, Paris Cedex 14, France
Introduction: Couples whishing to conceive in whom both or only one
member is HIV positive (sero-discordant) have been commonly offered
various forms of assisted reproductive treatments (ART) and are referred to
IVF/ICSI for cause, or after sets of failed insemination cycles. In the past,
there were grounds to suspect that these patients outcome was mediocre to
the point of querying the astuteness and cost-effectiveness of such practices.
Ohl et al. reported a disappointingly low pregnancy rate of 9.1%/transfer in
sero-positive women (HR 2003;18:1244 9). The arresting reasons put forth
for explaining the poorer outcomes in HIV positive patients included the
putative effects of the disease, its treatment and that of associated
environmental factors such as an increased exposure to toxics like tobacco
and other pollutants. Conversely, more recent reports that primarily emanate
from one single North American group tend to invalidate the concern for
lower results in HIV-positive patients but yet, underscores the risk of multiple
gestation in these patients (Sauer FS 2008 ahead of press). In other to clarify
this debated issue, we undertook to review the outcome of all IVF/ICSI
performed at our institution from 1/2003 to 12/2007 in couples in whom one
or both members were HIV positive and compared the results to sets of age-
matched controls.
Material and Methods: we studied: (i) 24 cycles performed in 17 HIV positive
couples, (ii) 68 cycles in 57 couples whose female partner was HIV positive and
(iii) 102 cycles in 87 women whose male partner was HIV positive. These study
groups were compared to 3 sets of corresponding age-matched controls that
included 55/51, 189/171 and 292/261 cycles-couple pairs, respectively. Statisti-
cal comparisons were done with Students t-test, Fishers exact test and Chi-
square test, when appropriate.
Results: The mean age of each study group was 35.4, 34.2 and 34.3, respect-
ively. Women who were HIV-positive in groups i and ii had larger body
mass indexes at 25.5 and 24.2, respectively than the values of 22.8 and 22.9
observed in age-matched controls. The incidence of smoking was lower in
HIV positive women at 0% and 3.5% in groups i and ii, as compared to
10.2% and 10.3%, respectively in age-matched controls. There were no differ-
ences in the incidence of menstrual irregularities, tubal and male factor inferti-
lity as well as in baseline FSH, E2 and total antral follicle count (AFC) between
the 3 study groups and their age-matched controls. At 29.1%, the cancellation
rates were higher in HIV positive couples than in age-matched controls (7.3%).
A similar trend existed in sero-discordant couples, without reaching statistical
significance. There were no differences in the amount of gonadotropin used,
duration of simulation, peak E2 levels, endometrial thickness, number of
oocytes retrieved and embryos obtained in any of the groups. At 12% per retrie-
vals, the clinical pregnancy rate was lower in HIV positive couples as compared
41.2% in their age-matched controls. A similar trend was observed for the preg-
nancy rates observed in groups ii and iii (26.3% and 23.0%, respectively) as
compared to controls (36.3% and 36.6%, respectively) without reaching stat-
istical significance.
Conclusion: Pregnancy rates obtained in sero-discordant couples are encoura-
ging in spite of a trend for lower results, as compared to age-matched controls.
i138
The low pregnancy rates and high cancellation rates observed in HIV-positive
couples are disconcerting however and lead to query whether these couples
might not have benefited from a prompter referral to IVF/ICSI. Taken together,
our results call therefore for added vigilance for detecting occult forms of
ovarian failure in HIV-positive and sero-discordant couples with at times,
more expeditious referrals to IVF.
POSTER
ART, CLINICAL: PREGNANCY
Prospective evaluation of the protein C global assay
during pregnancy following assisted reproduction
J.S. Younis1, M. Shukha2, G. Sarig3, I. Izhaki4, M. Ben-Ami5, B. Brenner6
1
Poriya Medical Center, Reproductive Medicine Unit affiliated to the Faculty
of Medicine the Technion Haifa, Tiberias, Israel, 2Poriya Medical Center,
Reproductive Medicine Unit, Tiberias, Israel, 3Rambam Medical Center,
Thrombosis and Hemostasis Unit affiliated to the Faculty of Medicine the
Technion Haifa, Haifa, Israel, 4Haifa University, Department of Evolutionary
and Environmental Biology, Haifa, Israel, 5Poria MedicalCenter, Reproduc-
Downloaded from humrep.oxfordjournals.org by guest on July 20, 2011
tive Medicine Unit affiliated to the Faculty of Medicine the Technion Haifa,
Tiberias, Israel, 6Rambam MedicalCenter, Thrombosis and Hemostasis Unit
affiliated to the Faculty of Medicine the Technion Haifa, Haifa, Israel
Introduction: Protein C global (PCGL) is a novel screening assay that is highly
predictive of Protein C anticoagulation pathway abnormalities. Most thrombo-
philias associated with placental vascular complications during pregnancy has
also been related to the Protein C pathway. As well, conceptions achieved fol-
lowing assisted reproduction (ART) have been shown to have a high rate of
gestational complications. Therefore, our objectives were to prospectively
evaluate the PCGL in infertile women conceiving following ART and to
compare its level to fertile women conceiving spontaneously.
Materials & Methods: Seventy-six infertile women conceiving consecutively
following ART in our unit were prospectively evaluated. The control group
comprised forty-seven fertile women conceiving spontaneously. Sixty-two
women in the study had singletons and 12 had twins, while all women in the
control group had singleton pregnancies. The PCGL assay was performed in
all women of the study and control groups on four occasions; during the
first, second and third trimester as well as six weeks or more following delivery
(baseline). The normal level of PCGL was defined as .0.8. None of the women
in the study and control groups had a thrombotic phenomenon or a gestational
vascular complication in the past. As well, none of the women in the two groups
were known to have an acquired or congenital thrombophilias or were under
heparin treatment.
Results: Interestingly, the mean baseline level of PCGL was significantly
lower in the study group as related to the control group corresponding to
0.88+0.21 and 1.10+0.13, respectively. Moreover, PCGL was significantly
lower in the study as related to the control group during the first (0.79+0.15
versus 0.87+0.10) and second trimesters (0.72+0.10 versus 0.79+0.21) of
pregnancy. A lower level of PCGL was also seen in the third trimester but
the difference was not significant. As well, lower PCGL during pregnancy
were encountered in singleton as well as twin gestations of the study group
as related to the control group. Mode of treatment (fresh versus frozen/
thawed cycles) and mode of fertilization (IVF versus ICSI) did not affect
PCGL during the three trimesters of pregnancy.
Conclusions: Infertile women conceiving following ART have a lower base-
line PCGL level as compared to fertile women. Moreover, PCGL level
during ART pregnancies are significantly lower than in pregnant fertile con-
trols. These results support the notion the infertile women conceiving following
ART are a priori at a higher risk to develop pregnancy complications. It is poss-
ible that PCGL could be employed as a screening test to detect infertile women
that are prone to develop pregnancy complications.