OBJECTIVE: The purpose of this study was to evaluate the possible rela- tionships between endometrial thickness and clinical outcome of IVF/ICSI treatment ...
P-331 PREDICTING FACTORS FOR ENDOMETRIAL THICKNESS AND ITS EFFECT ON ASSISTED REPRODUCTIVE TECHNOLOGY (ART) SUCCESS, BASED ON ANALYSIS OF 1,552 IVF/ICSI CYCLES. M. Kavrut, G. Karlikaya, H. Karagozoglu, A. Ersahin, M. Acet, S. Kahraman. Memorial Hospital, ART and Genetics Center, Istanbul, Turkey. OBJECTIVE: The purpose of this study was to evaluate the possible relationships between endometrial thickness and clinical outcome of IVF/ICSI treatment, and investigate predicting factors for endometrial thickness retrospectively. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: A retrospective analysis was conducted of 1,552 IVF/ICSI cycles between January 1, 2006- December 31, 2006. Cycles were divided into four groups based on endometrial thickness, for statistical analyses we used Pearson correlations, ROC, Multiple logistic regression analyses and Chi-square. The main outcome measures were endometrial thickness, implantation rates (IR), miscarriage rates (MR), pregnancy (PR) and clinical pregnancy rates (CPR) and live birth rate (LBR). RESULTS: Endometrial thickness decreased as age increased especially below 40 years, endometrial thickness was higher in long protocol than antagonist protocol and also higher in male factor infertility than other etiologies. The pregnancy rate improved as endometrial thickness increased. There was marginally significant trend toward decreasing rates of missed abortion with increasing endometrial thickness. We found 5% percentile endometrial thickness at 7 mm and 95% percentile at 14 mm. When we take 7 mm endometrial thickness as a cut-off level for predicting pregnancy, sensitivity was 97,9% but spesitivity was 3,9% and positive predictive value was 56% negative predictive value 60% (p¼0.047). TABLE 1. Treatment outcome according to endometrial thickness
LBR CPR PR MR IR
below 6mm
6-8 mm
8,1-14 mm
2/13¼0,15 3/13¼0,23 0/13¼0 2/20¼0,10
11/111¼0,10 48/111¼0,43 55/111¼0,49 14/111¼0,13 49/265¼0,19
189/1297¼0.15 653/1297¼0,50 724/1297¼0,56 87/1297¼0,06 837/3235¼0,26
above 14mm P value 17/131¼0,13 69/131¼0,52 79/131¼0,60 6/131¼0,05 96/319¼0,30
0,37 0,034 0,038 0,049 0,004
CONCLUSIONS: Increased endometrial thickness is associated with improved treatment outcome but this association was dependent on patient age, etiology of infertility, stimulation protocol, peak E2 level and number of oocyte. Endometrial thickness was negatively influenced by age and positively influenced by oestradiol level. No adverse effect of a thickened endometrium was demonstrated on pregnancy rates in IVF/ ICSI cycles. The sensitivity of endometrial thickness predicting pregnancy is high but the spesivity is low. Supported by: None. P-332 IS ENDOMETRIAL RECEPTIVITY INFLUENCED BY AGE OR AMENORRHEA’S LENGTH OF THE RECIPIENT IN AN OOCYTE-DONATION PROGRAM? M. A. Vilela, V. A. Basconi, L. Ponte, L. Sabatini, A. Valcarcel, G. L. Marconi. Gynaecology, IFER, Buenos Aires, Capital Federal, Argentina. OBJECTIVE: An oocyte-donation program includes patients with a wide range of age and different diagnosis such as repeated IVF failed implantation or premature ovarian failure. Some of these patients have regular menstrual cycles and some of them are in amenorrhea or with hormone replace therapy. The objective is to evaluate if oocyte-donation outcome is influenced by age or amenorrea’s length of the recipient. DESIGN: Prospective cohort analysis. MATERIALS AND METHODS: We include all the fresh oocyte-donation procedures performed between January 2005 and December 2006 in our center. Patients were classified as: Category 1 if the cause of the procedure was premature ovarian failure with amenorrhea for more than 1 year (n¼104), and Category 2 if the cause was repeated IVF failure due to bad ovarian response in patients with regular menstrual cycles (n¼268). Both categories of recipients were also stratified by age in Group A: less than 36 years (n¼62),
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Group B: between 36 and 40 (n¼84) and Group C: more than 40 years old (n¼226). Clinical pregnancy rate (CPR) was the primary endpoint. Statistical analysis was performed with chi2 and ANOVA tests for categorical data and t test for continuous parametric data. RESULTS: For the whole oocyte-donation cycles analysed (n¼372), the average number of inseminated oocytes and transferred embryos per patient was similar for both categories. Clinical pregnancy rate and abortion rate showed no significant differences between both categories [Clinical pregnancies: Category 1: 58/104 (CPR: 55.8 %), Category 2: 125/268 (CPR: 46.6 %) NS; Abortion rate: Category 1: 10/58 (17.2 %), Category 2: 20/125 (16 %), NS]. Furthermore, when these categories were stratified by age, CPR showed no difference in patients with amenorrhea [CPR in Category 1: Group A: 10/ 16 (62.5 %), Group B: 4/6 (66.6%), and Group C: 44/82 (53.6%), NS]. However, for Category 2 (regular menstrual cycles) a significant decrease in CPR was shown for older recipients [CPR in Category 2: Group A: 33/46 (71.7%), Group B: 47/78 (60.3%), and Group C: 45/144 (31.2%); p 15 mm in diameter) was collected and equal volume from each follicle was pooled. Estradiol, progesterone along with AMH concentration and protein content of the pooled FF were measured. Retrieved oocytes and resultant embryos were graded as per gradual embryo scoring method. D3 or D5 embryo transfer was done in 196 cycles. Day 14 serum b hCG level > 25 mIU /ml was considered as positive indication of pregnancy. Two weeks later, fetal sac with cardiac activity on transvaginal sonography was considered as clinical pregnancy. Statistical analysis of the data for three groups viz. low, medium and high as per < 25, 25 -75 and > 75 percentile of FF AMH was done. Student t test to differentiate pregnant and nonpregnant groups, P value, one way ANOVA to compare variance in three groups of FF AMH concentration, correlation coefficient, receiver operator characteristic (ROC) was done to establish cutoff values of FF AMH to predict embryo quality and pregnancy outcome. RESULTS: Out of 72 clinical pregnancies obtained in196 embryo transfers, 70 pregnancies occurred in low and medium FF AMH groups irrespective of age and poor or good responders. The Pearson r for pregnancy outcome in low and medium FF AMH groups was 0.7812 and 0.5923 as compared to -0.7354 in high FF AMH group (P value < 0.0001). The FF E2 showed inverse correlationship with FF AMH concentration (r ¼ - 0.5624). A better oocyte and embryo quality was found in lower levels of AMH in follicular fluid (34.9 13.2 ng / g protein) as compared to higher levels of AMH levels (58.2 9.8 ng/g protein). ROC AUC of FF AMH for pregnancy outcome was observed as 87 % (sensitivity of 90.9 % and specificity of 71.4 %) with cutoff value < 27 ng/g protein where likelihood ratio was 1.0. CONCLUSIONS: Lower values of FF AMH favored higher FF E2 concentrations with a better oocyte and embryo quality resulting in positive pregnancy outcome in ART cycles. Supported by: None. P-334 IN VITRO FERTILIZATION IN WOMEN UNDER 35. C. A. Rowland, D. A. Grainger, L. M. Frazier. Gynecology and Obstetrics, Emory University, Atlanta, GA; Obstetrics and Gynecology, University of Kansas - Wichita, Wichita, KS. OBJECTIVE: Although outcomes of in vitro fertilization (IVF) in women over the age of 35 have been well documented, less is known regarding
Vol. 90, Suppl 1, September 2008
