childhood outcomes, even after controlling for the effects of advanced need for curettage ⬍14 d post treatment
reatment due to excessive bleeding or
maternal age, prematurity, and multiple births.
Supported by: NICHD
Tuesday, October 19, 2004
2:30 P.M.
O-198
A comparison of down-regulation vs. antagonist protocols in ovum
donor ccycles. M. Feinman, R. Boostanfar, A. Le, C. Gao. Huntington
Reproductive Center, Westlake Village, CA.
OBJECTIVE: Some concerns have been raised regarding the potential
negative effects of GnRH antagonists on ovum quality. This study seeks to
compare the outcomes in ovum donor cycles when donors used traditional
down-regulation protocols, compared to using newer antagonist protocols.
DESIGN: Retrospective case-control study by chart review.
MATERIALS AND METHODS: Ninety-seven women underwent an
ovum donor cycle between 2002–2003. Sixty-six donors were treated with
leuprolide acetate, while taking oral contraceptives(OC), and then com-
menced gonadotropin therapy (225–300U) after stopping the pills. Thirty-
one donors used similar doses of gonadotropins 5 days after stopping OC
and added one of the two brands of GnRH antagonists when 14mm follicles
were seen on sonogram. Recipients used OC and leuprolide, when appro-
priate, and intramuscular estradiol valerate and combinations of progester-
one in oil and vaginal suppositories to create mock cycles synchronized to
the donor cycles. Outcome parameters of eggs received, embryos trans-
ferred, pregnancy rates, and implantation rates were compared in the two
groups. Student’s t-test and chi square were used for statistical analysis.
RESULTS: Down-regulation cycles produced a mean of 13.9 eggs with
2.3 embryos transferred per cycle, compared to 12.4 eggs and 2.5 embryos
in the antagonist group. These were statistically similar. The ongoing
pregnancy rate in the leuprolide group was 30/66 (45%) vs. 17/31 (55%) in
the antagonist group. In the down-regulation group, 41/157 (26%) of the
embryos implanted, while the recipients in the antagonist group experienced
a 22/65 (34%) implantation rate. These differences were not statistically
significant.
CONCLUSION: Ovum donor cycles using traditional down-regulation
protocols and GnRH antagonist protocols for the donors produce similar
results. Concerns over the potential detrimental effects of agonists on egg
quality are not supported by our results. The increased convenience and
patient acceptance of the antagonists make these drugs the preferred method
of preventing LH surges in the donors.
Supported by: Huntington Reproductive Centers of California
Tuesday, October 19, 2004
2:45 P.M.
O-199
A randomized prospective study comparing the effectiveness of four
protocols for treatment of first trimester spontaneous abortion. R.
Machtinger, D. Stockheim, A. Shulman, M. Dulitzki, E. Schiff, D. S.
Seidman. Sheba Medical Center, Tel Hashomer, Israel.
OBJECTIVE: Our aim was to compare the effectiveness of four protocols
for the treatment of spontaneous abortions using misoprostol alone or
following pretreatment with mifepristone.
DESIGN: A prospective randomized non-blinded controlled trial.
MATERIALS AND METHODS: We prospectively enrolled 205 consec-
utive women who were diagnosed as having blighted ovum or spontaneous
abortion with a CRL of less than 9 w gestation. The patients were random-
ized after signing an informed consent to receive orally either 600 mg
mifepristone followed 48 hrs later by misoprostol 400 mcg orally (Group 1),
600 mg mifepristone followed 48 hrs later by misoprostol 800 mcg vagi-
nally(Group 2), 400 mcg misoprostol followed 48 hrs later by a second dose
of 400 mcg misoprostol, both orally (Group 3) and 800 mcg misoprostol
followed 48 hrs later by a second dose of 800 mcg misoprostol, both
vaginally (group 4). Women who did not bleed 3 hours after ingesting the
orally misoprostol received a repeat dose. Follow up included transvaginal
ultrasound and evaluation of clinical symptoms. Early failure was defined as
S80 Abstracts
remaining gestational products. Late surgical evacuation, usually following
one period, was performed because of suspected residual tissue on sono-
graphic assessment usually in the presence of prolonged bleeding.
RESULTS: The mean⫾SD patients’ age was 32.2⫾5.7. The success rate,
determined as no need for surgical evacuation and reasons for intervention
are shown in the table below. In group 1 an emergency curettage was
required in one patient due to maternal fever. No cases of excessive bleeding
or need for blood transfusion occurred.
CONCLUSION: Misoprostol administered vaginally was as effective as
the oral route and may be associated with less frequent side effects such as
nausea and diarrhea, but is less convenient to administer and pills may
occasional slip from the vagina. Mifepristone is an expensive drug and did
not reduce the failure rate. Medical treatment seems to be a good option for
women with an early miscarriage who want to avoid surgical evacuation.
Supported by: Mifepristone provided as a non limited gift by A. Lapidot.
Tuesday, October 19, 2004
3:00 P.M.
O-200
Acupuncture and good prognosis IVF patients: Synergy. P. C. Magar-
elli, D. K. Cridennda, M. Cohen. Reproductive Medicine & Fertility Center,
Colorado Springs, CO; East Winds Acupuncture, Inc., Colorado Springs,
CO.
OBJECTIVE: To determine the role of electro stimulation acupuncture
and traditional combined with auricular acupuncture on IVF outcomes in
good prognosis patients.
DESIGN: Retrospective case controlled clinical study. Acupuncture Con-
sortium for treatment standardization. Reproductive Endocrinology & In-
fertility IVF Private Practice and Traditional Chinese Medicine Acupunc-
ture Clinics.
MATERIALS AND METHODS: One hundred fourteen infertile patients
undergoing controlled ovarian hyperstimulation with gonadotropins and
GnRH agonist and antagonist for IVF-ET (2001 to 2003) in private practice
IVF clinic. Only IVF patients with normal Day 3 FSH, normal uterine artery
pulsatility indices, sperm morphologies over 7% normal by Kruger Strict
Criteria and good response to ovarian hyperstimulation protocols (i.e., E2
over 2000 pg/ml) were analyzed.Intervention (s): Electrostimulation acu-
puncture -- reduction of Pulsatility Index (PI) of the uterine artery and
Traditional combined with Auricular acupuncture -- Pre/Post embryo trans-
fer protocols were used alone or in combination and resultant pregnancy
outcomes were measured after IVF treatments. Main Outcome Measure(s):
Cycles were grouped according to those that received No Acupuncture
(Non-Ac) and those that received either one or both acupuncture treatments
(Ac). Comparisons were made between Acupuncture treated IVF patients
and Non ⫺ Acupuncture treated IVF patients in clinical pregnancies,
ongoing pregnancies and birth outcomes. The statistics used for this analysis
included; Tests for normal distribution: chi-square test, Kolmogorov-Smir-
nov Test Unpaired T-tests Stepwise Multiple regression Variance ratio test
(F-Test) One-Way analysis of variance (ANOVA) with Student-Newman-
Keuls (SNK) test for pair wise comparison of subgroups.
RESULTS: Total IVF cases 114, 53 with Acupuncture (Ac) and 61
without Acupuncture (Non-Ac). Demographics, Infertility Diagnoses, and
Treatment Protocols were statistically the same between both groups and by
design, the following parameters were similar: Sperm Morphology; Peak
Day 3 FSH; Average Pulsatility Index; Peak E2 at hCG; and Post hCG P4.
These parameters earned the designation of Good Prognosis group. Preg-
Vol. 82, Suppl. 2, September 2004
nancy rates (PR) and Miscarriage rates (SAB) were statistically improved at
the p ⬍ 0.05 levels in those patients that received Acupuncture (51% v 36%
PR and 8% v 20% SAB in the AC v Non-Ac groups). There were no ectopic
pregnancies in the Ac group and 9% in the Non-Ac group, p ⬍ 0.008.
Finally, Birth rates (BR) per cycle start and per pregnancy were significantly
higher in the Ac group, with 23% more births/pregnancy significant at the
p ⬍ 0.05 level.
CONCLUSION: The use of adjunctive therapies in IVF protocols is
gaining popularity. In previously published data, Acupuncture was reserved
for Poorer Prognosis patients and enhanced outcomes were observed. In this
study, we demonstrated that Good Prognosis patients would also benefit
from inclusion of published Acupuncture protocols. This is also the first
publication of Birth outcome data in Acupuncture treated IVF patients.
Acupuncture significantly increased birth outcomes; it significantly de-
creased ectopic pregnancies and miscarriage rates. These data uniquely
support a definitive role of both Electrostimulation and Traditional com-
bined with Auricular Acupuncture in IVF in Good Prognosis IVF patients.
Supported by: None.
REPRODUCTIVE ENDOCRINOLOGY AND
INFERTILITY
Tuesday, October 19, 2004
2:00 P.M.
O-201
A study comparing a single dose of 25mg of letrazole given on day 3 of
menstrual cycle with a daily dose of 5mg of letrazole given between day
3 and day 7 of menstrual cycle in patients with unexplained infertility ⴚ
Prospective randomized double blind trial. M. M. Biljan, D. D. Tkalec,
H. Lachgar. The Montreal Fertility Centre, Montreal, PQ, Canada.
OBJECTIVE: Letrazole is usually given either in a dose of 2.5 or 5.0 mg
for five days, starting from day 3 of the menstrual cycle. It would be more
convenient for patients if the same effect could be achieved by giving a
single dose of medication on day 3 of menstrual cycle. In this trial we
investigated the difference in follicular and endometrial development as
well as changes in FSH, estradiol and the period required to achieve
follicular development between a single dose and multi-dose treatment with
letrazole in patients with unexplained infertility.
DESIGN: Prospective double blind randomized study.
MATERIALS AND METHODS: Patients with unexplained infertility
who had no previous fertility treatment were randomized following a
trans-vaginal ultrasound scan performed between day 1 and 3 of the men-
strual cycle to exclude the presence of ovarian cysts. An initial blood test
was performed at the same time. The patients were given a calendar to
record any side-effects of treatment. Follow up ultrasound scans were
performed on day 9 and thereafter as required until the largest follicle
reached 18 mm in mean diameter. Thereafter, ovulation was triggered with
10.000 IU of b-hCG and a single insemination was performed exactly 36
hours later. Additional blood tests were performed on day 9 and on the day
of b-hCG administration.
RESULTS: In the period between December 2003 and March of 2004, 20
patients were randomized. There was no difference in the median age
(Median Difference (MD) ⫽ 0.5 years 95% Confidence Interval (CI)⫽
-1.7 ⫺ 3 years), duration of infertility (MD⫽12.6 months (CI⫽-6 ⫺ 24
months), FSH (MD⫽0.9 IU/L CI⫽-0.6 -2.4) or estradiol levels (MD⫽29
pmol/L CI⫽-17 ⫺ 59 pmol/L) between two groups. There was no difference
in estradiol (MD⫽106.5 pmol/L (CI⫽-138 ⫺ 545 pmol/L), FSH levels
(MD⫽-0.3 IU/L CI⫽-1.6 ⫺ 3.1 IU/L), total number of follicles recruited
(MD⫽0 CI⫽-2 ⫺ 3), number of follicles ⬎14 mm (MD⫽0 CI⫽-1 ⫺ 1),
follicles ⬎ 18 mm (MD⫽0 CI⫽0 ⫺ 1) or endometrial thickness (MD⫽0.1
mm CI⫽-2.2 ⫺ 2.3 mm) on day 9 of menstrual cycle. Additionally, there
was no difference in estradiol (MD⫽72.5 pmol/L (CI⫽-225 ⫺ 388 pmol/L),
FSH levels (MD⫽0.5 IU/L CI⫽-1 ⫺ 2.8 IU/L), total number of follicles
recruited (MD⫽0 CI⫽-1 ⫺ 1), number of follicles ⬎14 mm (MD⫽0
CI⫽-1 ⫺ 1), follicles ⬎ 18 mm (MD⫽0 CI⫽-1 ⫺ 1) or endometrial
thickness (MD⫽0 mm CI⫽-1.4 ⫺ 1.1 mm) on the day of b-hCG adminis-
tration. Median duration of treatment in both groups was 11.5 days (MD⫽0
days (CI⫽-2 ⫺ 3 days). Finally no difference in side-effect score was
observed between the two groups (MD⫽1.5 points (CI⫽ -7 ⫺ 7).
CONCLUSION: A single dose of treatment with 25 mg of letrazole
FERTILITY & STERILITY威
yields similar follicular recruitment, endometrial thickness and hormonal
levels to those achieved following 5 mg of letrazole given over a period of
5 days. Moreover, a single dose of medication does not increase frequency
or severity of side-effects. Due to its simplicity, a single dose of 25 mg of
letrazole should be considered as a useful alternative to a multidose treat-
ment in patients with unexplained infertility.
Supported by: None
Tuesday, October 19, 2004
2:15 P.M.
O-202
Increased incidence of chromosomal abnormalities in embryos from
polycystic ovarian syndrome patients. C. Vidal, C. Rubio, J. Crespo, C.
Simon, J. Remohi, A. Pellicer. INSTITUTO VALENCIANO DE INFER-
TILIDAD, Valencia, Spain.
OBJECTIVE: Increased rates of first trimester pregnancy losses have
been reported in polycystic ovarian syndrome (PCOS) patients. Increased
PAI-1 levels, hyperinsulinaemia-driven, homocysteinaemia and increased
body weight have been described as contributors to the high miscarriage
rates in these women. To study the incidence of chromosomal abnormalities
on day 3 embryos from PCOS patients included in a preimplantational
genetic diagnosis (PGD) programme. To check if the selection of euploid
embryos for transfer can diminish pregnancy loss rates in these patients.
DESIGN: Retrospective study from January 2000 to March 2004.
MATERIALS AND METHODS: PGD was performed in 12 PCOS
patients because of previous implantation failures or recurrent miscarriages
(n⫽ 87 embryos). Couples with sperm account ⬍5 millions spermatozoa/
ml, abnormal Fish spermatozoa and ⫽38 years of age were excluded.
Pregnancy, implantation and miscarriage rates were compared with a con-
trol group of 18 pgd cycles for sex linked diseases carried out during the
same period (⬍38 years). ␹2 test was used for statistical comparisons.
RESULTS: An increased rate of abnormal embryos were found
(* P⬍0.001). When euploid embryos for 13, 15, 16,28,21,22,X and Y
chromosomes were transferred , all pregnancies had a successful outcome.
CONCLUSION: Higher incidence of chromosomal abnormalities were
observed in a cohort of polycystic ovarian syndrome patients compared to
normal patients. These increased rate of chromosomal abnormalities would
be responsible of the high miscarriage rates observed in these patients.
Preimplantational genetic diagnosis could be offered to these women when
an assisted reproduction technique is employed, particularly in cases of
previous failed cycles.
Supported by: None
Tuesday, October 19, 2004
2:30 P.M.
O-203
All women with Polycystic Ovary Syndrome (PCOS) should be
screened for Metabolic Syndrome (MS). M. P. Bochner, E. M.
Hollinrake, S. M. Markham, B. J. Vanvoorhis, D. H. Jagasia, A. Dokras.
University of Iowa Hospitals and Clinics, Iowa City, IA.
OBJECTIVE: PCOS is the most common endocrine disorder in women
of reproductive age. MS is a cluster of risk factors that, when coexisting,
confer an increased risk of Coronary Heart Disease (CHD). We hypothesize
that women with PCOS are at an increased risk for having MS and hence for
developing CHD. Our study aims to determine the incidence of MS in
PCOS women compared to controls, and to identify biochemical parameters
S81