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Clinical and economic analysis of rescue ICSI cycles

DGYE-2010-0311.R2 4

Shehata, Fady (contact); Shalom-Paz, Einat; Alshalati, Jana; Jimenez, Luis; Son, Weon-Young; Holzer, Hananel; Tan, Seang Lin; Almog, Benny

Objective: To identify clinical and embryological factors that may predict successes in rescue intra-cytoplasmic sperm injection (ICSI) cycles (after total fertilization failure has occurred) and to evaluate the cost effectiveness of rescue ICSI strategy. Additionally, follow-up of 20 rescue ICSI pregnancies is reported.

Design: Retrospective analysis of total fertilization failure cycles.

Setting: University-based tertiary medical center

Material and Methods: In total, 92 patients who had undergone conventional in-vitro fertilization (IVF) cycles with total fertilization failure were included. The patients were divided into two subgroups: those who conceived through rescue ICSI and those who did not.

Results: The pregnant members of the rescue ICSI subgroup were found to be significantly younger (32.9±4.2 vs. 36.3±4.5 respectively, p=0.0035,) and to have better-quality embryos than those who did not conceive (cumulative embryo score: 38.3±20.4 vs. 29.3±14.7, p=0.025). Cost effectiveness analysis showed 25% reduction in the cost per live birth when rescue ICSI is compared to cycle cancellation approach. The pregnancies follow-up did not show adverse perinatal outcome.

Conclusions: Rescue ICSI is an option for salvaging IVF cycles complicated by total fertilization failure. Success in rescue ICSI was found to be associated with younger age and higher quality of embryos. Furthermore, the cost effectiveness of rescue ICSI in terms of total fertilization failure was found to be worthwhile

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Symmetry in number of retrieved oocytes between two ovaries: a possible predictor of IVF outcome

DGYE-2010-0309.R1 4 pag

Ku, Seung-Yup (contact); CHOE, SEUNG AH; JEE, BYUNG CHUL; SUH, CHANG SUK; KIM, SEOK HYUN; CHOI, YOUNG MIN; KIM, JUNG GU; MOON, SHIN YONG

Abstract: Objective. To examine the relationship between the ratio of difference in number of retrieved oocytes from the two ovaries to total number of oocytes (difference ratio, |NRO-NLO|/NTOTAL) and in vitro fertilization (IVF) outcome.

Methods. Retrospective review of medical record for infertility patients with intact two ovaries who had undertaken controlled ovarian stimulation (COS) and IVF cycles in Seoul National University Hospital was conducted. Characteristics and IVF outcomes were compared according to the difference ratio (|NRO-NLO|/NTOTAL) using student t-test and χ2 test. To adjust for the effect of confounding factors, binary logistic regression test was performed.

Results. When the study population was divided according to the difference ratio by cut-off value of 0.4, patients with difference ratio less than 0.4 showed significantly higher pregnancy rate (25.7% vs. 17.1%, P=.021). A significant correlation was noted between the difference ratio and achievement of pregnancy after adjustment for patient’s age and total number of top quality embryos transferred (adjusted OR=0.40, 95% CI 0.19-0.83, P=.014).

Conclusions. The difference ratio of retrieved oocytes in patients with intact two ovaries was observed to have prognostic value in IVF cycles.

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Does 75 IU difference improve the cycle performance in poor responders? : Comparison of daily 375 vs 450 IU gonadotrophin doses

DGYE-2010-0241.R1 6

Demir, Berfu (contact); Dilbaz, Serdar; Cinar, Ozgur; Dede, Suat; Aydin, Sevim; Beydilli, Gülay; Goktolga, Umit

Abstract: Objective: To compare the efficacy on the cycle performance of 375 vs 450 IU/day gonadotrophin on the microdose flare-up protocol in poor responders.

Study design: A total of 91 poor responder patients who were treated with the microdose flare up protocol were enrolled in this study. Group 1 (n=40) was stimulated with 375 IU/day gonadotrophin. Group 2 (n=51) was stimulated with 450 IU/day gonadotrophin. Main outcome measurements were accepted as the results of controlled ovarian hyperstimulation, implantation, clinical pregnancy and live birth rates.

Results: Baseline characteristics are similar between the two groups. Higher number of oocyte cumulus complexes and lower total gonadotrophin requirement were noted in the Group 1 compared with the Group 2. Number of metaphase II oocytes and implantation rates were similar between the groups. A trend toward higher clinical pregnancy and live birth rate was observed in the Group 1 but these results did not reach statistical significance.

Conclusions: Total gonadotrophin costs are lower using the 375 IU/day gonadotrophin compared to the 450 IU/day in poor responders. Additional 75 IU/day does not give any improvement neither embryology nor pregnancy outcomes.

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Cervical twin ectopic pregnancy after IVF-ET: Case report

DGYE-2010-0242.R2 3

Youssef, Mohamed (contact); Aboulfoutouh, Ismail; Mady, Amir; Zakaria, Ahmed; Khattab, Sherif

Abstract: Introduction: cervical twin ectopic pregnancy after IVF-ET is rare and catastrophic complication. However, here is no consensus on the best treatment strategy. Patient and Method: case report of cervical twin ectopic pregnancy after IVF-ET treated by transvaginal ultrasound guided aspiration plus systemic single injection of methotrexate, which followed by full term delivery in next IVF-ET cycle. Conclusion: transvaginal ultrasound-guided aspiration and systemic methotrexate administration can be safely and easily used to treat cervical ectopic pregnancies and to preserve the fertility of the patient without any major complications

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Oral micronized progesterone combined with vaginal progesterone gel for luteal support

DGYE-2010-0282.R1 4 pag

Tomic, Vlatka (contact); Tomic, Jozo; Zigmundovac Klaic, Djurdja

Abstract: The aim of the present study was to compare the efficacy and satisfaction rate of combined therapy of oral micronized progesterone capsules and vaginal progesterone gel versus monotherapy with vaginal progesterone gel in luteal support.

A case-control study was performed on a total number of 370 women aged <45 years undergoing IVF-ET treatment. The patients received either combination of Crinone 8% vaginal gel, 90mg daily dose, and Utrogestan oral capsules 3 x 100mg, or Crinone 8% vaginal gel, 90mg daily. Progesterone supplementation begun on the day of oocyte retrieval and continued until pregnancy was tested and in the case of pregnancy until week 8.

The comparable rates of ongoing pregnancies were noted with use of combined-progesterone therapy (39.5%) and progesterone-monotherapy (33.5%).

Abortion rate (6.4% vs. 15.6%) was significantly lower with the use of combined therapy. Tolerability and satisfation of both supplements was almost equal but bleeding occurred more frequently in the progesterone-monotherapy group.

In conclusion, the efficacy, satisfaction and tolerability of combined and vaginal progesterone supplements were comparable, but bleeding in early pregnancy and abortion rate presented more frequently with the use of vaginal progesterone.

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