Aromatase inhibitor co-treatment with gonadotropin reduces the dose of gonadotropn and peak estradiol level without compromising IVF outcomes in high responder patients

Abstract

WITHDRAWN E2 (pg/ml) on hCG day 3850 765 4272 1508 1.5 ng/ml) or low (P4 3000 pg/ml on the hCG day). Patients were stimulated with daily doses of 100-150 UI of recombinant FSH (Puregon , MSD) starting on day 2-3; GnRH antagonist was added when the leading follicle reached a diameter of 14 mm (Cetrotide, 0.25 mg/day, Merck-Serono) and a single bolus of 250 mg of rhCG (Ovitrelle, Merck-Serono) was administered to induce oocyte maturation. FERTILITY & STERILITY Chi-squared test and ANOVA were applied to detect statistical differences; p<0.05 was considered statistically significant. RESULTS: Regarding the influence of progesterone concentration on clinical outcomes in presence of high estradiol levels, we did not find significant differences in any of the clinical variables analyzed. However, we observed statistical differences in E2 and P4 levels on the day of hCG between the two groups of the study. CONCLUSION: Our data suggest that in high responder women with estradiol levels over 3000 pg/ml, progesterone levels do not affect IVF results. We confirmed the close link between E2 and P4 as we observed that high E2 levels are significant correlated with high P4 levels. These results lead us to conclude that, regardless the progesterone levels attached during the cycle in high responders, clinical outcomes are not affected. O-358 Wednesday, October 16, 2013 04:45 PM COMPARING THE EFFICACYAND SAFETY OF GnRH AGONIST (LEUPROLIDE) WITH HCG TRIGGER VERSUS GnRH ANTAGONIST (GANIRELIX)WITHTRIPTORELIN TRIGGER IN PATIENTS OFPCODUNDERGOING IVFTREATMENT. R. Sharma, F. Rehman, N. Nakshtramalini. IVF and Reproductive Medicine, Max Hospital, New Delhi, India. OBJECTIVE: To determine the ideal protocol for PCOD patients undergoing IVF treatment. DESIGN: Retrospective analysisJan 2010 –Jan 2013. MATERIALS AND METHODS: 70 PCOS patients (according to Rotterdam criteria), who underwent IVF/IVF-ICSI cycles between Jan 2010 – Jan 2013 were evaluated retrospectively for the type of protocol used, amount and duration of gonadotrophin use, cost, no.of oocytes, fertilization rate, cleavage rate,embryo quality, clinical pregnancy rate and complication rate. RESULTS: The profiles of the patients in both groupswere comparable. Cost was almost same in both groups though there was reduction in the total amount of gonadotrophins used in the antagonist cycles. There was Reduction in the treatment days with analogue in the antagonist group (average 4.5 in antagonist versus 21 days in the agonist group). Duration of stimulation (9.5 versus 11.2 days) and total gonadotrophin required (1425 versus 1680 IU) were lower in the antagonist compared with agonist protocol. Mean no. of oocytes (COC’s) were less,(16.26 in the antagonist group versus 19.45 in the agonist group) therefore mean number of fertilized oocytes and consequent no. of embryos per patient were less in the antagonist group though fertilization rate(57.17%versus 58.09%) and cleavage rate(88.53%versus89.38%) were similar. There was no evidence of a statistically significant difference in clinical pregnancy rate between the two groups (36.66%in antagonist group versus 37.5%in the agonist group). There was significantly lower incidence of OHSS in the antagonist group. In agonist group, 3 patients had severeOHSS; due towhich embryo transfer had to be postponed .In antagonist group no patient had severe OHSS. In antagonist group one patient had empty follicles at the time of Oocyte retrieval with no embryos to transfer subsequently. CONCLUSION: The use of GnRH antagonists may be considered more advantageous because of more patient comfort and decreased risk of OHSS with good clinical outcome in high responder patients. O-359 Wednesday, October 16, 2013 05:00 PM THE FIRST SUCCESSFUL LIVE BIRTH FOLLOWING PREIMPLANTATION GENETIC DIAGNOSIS FOR TYPE I CITRULLINEMIA USING POLYMERASE CHAIN REACTION. C.-H. Kim, K.-H. Lee, J.-H. Cho, J.-M. Kim, G.-H. Kim, H.-W. Yoo. Obstetrics