ART - CLINICAL

P-497 Wednesday, October 22, 2014

DOWOMENWITHUNILATERAL FALLOPIANTUBEBLOCKAGENEED ASSISTED REPRODUCTIVE TECHNOLOGY TREATMENTAS THE PRIMARY TREATMENT OPTION? R. Uemura,a

Y. Yokota,a M. Yokota,a H. Yokota,a S. Sato,a M. Nakagawa,a

Y. Araki.b aYokota Maternity Hospital, Maebashi, Gunma, Japan; bThe Insti-tute for Advanced Reproductive Medical Technology, Fujimi, Maebashi,Gunma, Japan.

OBJECTIVE: Before conducting our study, we did not have a definitiveanswer regarding whether women with unilateral fallopian tube blockagecould achieve a satisfactory pregnancy rate without ART. Therefore,treatment of unilateral fallopian tube blockage was a topic in need ofevaluation regarding whether ART should be the primary treatment op-tion.

DESIGN: In 2011, the outpatients in our ART clinic underwent HSG forinfertility screening. The patients were divided to two groups, normal andabnormal (hydrosalpinx, adhesions, and blockage) by HSG; retrospectivepregnancy rates of the two groups were then compared.

MATERIALS ANDMETHODS: The study group comprised 515 womendesirous of pregnancy. HSG was conducted using an oil contrast agent. Wedivided the two groups in regard to whether the HSG was normal orabnormal. Subsequently, we evaluated the pregnancy rates of two groups:those with and those without ART.

RESULTS: The 515 women were diagnosed with either primary infer-tility (381 of 515; 74.0%) or secondary infertility (134 of 515; 26.0%).Normal HSG women comprised 418 of 515 (81.2%), and abnormalHSG women comprised 97 of 515 (18.8%). The pregnancy rate of thenormal HSG group was 177/418 (42.3%). The rate of the unilateral fal-lopian blockage group was 26/67 (38.8%); this difference was not statis-tically significant. Therefore, when a patient was diagnosed withunilateral fallopian tube blockage, we did not employ ART as the firsttreatment option. This was because we found no benefit to using ARTas the primary treatment option. For 3 of the 26 pregnant patients withunilateral fallopian tube closure, ultrasonography suggested that ovulationoccurred from the contralateral ovary. Among the 26 pregnancies, 2 mul-tiple pregnancies, 3 spontaneous abortions, and 3 ectopic pregnanciesoccurred.

CONCLUSION: For patients with unilateral fallopian tube blockage, ARTis not indicated as a primary treatment option because the pregnancy rate isnot significantly different between hysterosalpingography (HSG) normal pa-tients and unilateral fallopian tube blockage patients.

P-498 Wednesday, October 22, 2014

HOWCANWE INCREASE THE PREGNANCY RATES IN PATIENTSTREATEDWITH INTRAUTERINE INSEMINATION(IUI)? P.-C. Ma,a

S.-Y. Shen,b C.-W.Wang,a C.-R. Tzeng.a,c aObstetrics and Gynecology, TaipeiMedical University Hospital, Taipei, Taiwan; bObstetrics and Gynecology,TMU-Wan Fang, Taipei, Taiwan; cObstetrics and Gynecology, Taipei MedicalUniversity, Taipei, Taiwan.

OBJECTIVE: IUI has been implicated in the treatment of infertile femalepatient. The objective of this study was to access the efficacy of IUI and iden-tify the predictive factors led to higher pregnancy rates by single variableanalysis.

DESIGN: Retrospective analysis of patients with controlled ovarian stim-ulation (COS) and IUI treatment in a university hospital.

MATERIALS ANDMETHODS: From 2011 to 2013, a total of 2140 cy-cles of COS and IUI treatment were included. The analysis of the preg-nancy rates were based on age of patient, years of infertility, serumAnti-Mullerian Hormone(AMH) level, indication, medication of COS,E2, progesterone levels and endometrial thickness at time of HCG admin-istration, timing of insemination after HCG, and sperm count for insemi-nation.

RESULTS: The overall pregnancy rate was 24.9%(533/2140), abortionrate was 25.9%. For single variable analysis the pregnancy rate was respec-tively 13.0%, 27.6%, 33.1%, 29.9% for AMH%2, 2-4, 4-6, andR6(p<0.001). For indication analysis the pregnancy rate was 27.5% forendometriosis, 25.0% for male factor, 33.5% for PCOS and 9.9% foradvanced patient’s age, respectively (p<0.001). The pregnancy rate was

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33.5%, 30.0%, 20.4% and 9.6% for patient’s age%30, 31-35, 36-40 andR40, respectively. The pregnancy rate was significantly higher in ultra-long protocol (29.0%) and flare up protocol (37.8%)than other proto-col(19.1%)(p<0.001). The pregnancy rate of 20.7% was significantlylower for E2 levels% 500pg/mL compared with 29.2% for E2 lev-elsR500pg/mL, respectively(p<0.001). The insemination time of 36-40hours post HCG trigger also achieved better pregnancy outcome of27.3%, compared with 13.4% of other time frame(<36hrs or>40hrs)(p<0.05). Sperm countR10x106/mL compared with <10x106/mL also showed significantly higher pregnancy rate (26.2%vs.11.6%), re-spectively(p<0.001). Higher pregnancy rate was observed when endome-trial thickness R8mm(25.9%).CONCLUSION: This data examine the possible role of stratified

every variable related to higher pregnancy rate in IUI patients. We confirmthat AMHR2ng/mL, ultra-long protocol, in patients with endometriosisand PCOS, age%35, insemination after 36-40hours post HCG, spermcountR10x106/mL, endometrial thicknessR8mm and E2R500pg/mL attime of HCG, all are parameters of important contributing factors and signif-icantly related to achieve higher likelihood of pregnancy.

P-499 Wednesday, October 22, 2014

CLOMIPHENE CITRATE (CC) STARTING DOSE IN INTRAUTER-INE INSEMINATION (IUI) CYCLES FOR WOMEN UNDER AGE35 WITH UNEXPLAINED INFERTILITY: IS HIGHERBETTER? A. L. Park, T. Q. Pham, L. Craig, K. Hansen, R. A. Wild,A. M. Quaas. Obstetrics and Gynecology, University of Oklahoma HealthSciences Center, Oklahoma City, OK.

OBJECTIVE: To compare the effectiveness of 50 vs. 100 mg of CC in CC/IUI cycles in women <35 with unexplained infertility with respect to preg-nancy outcomes in the first treatment cycle.DESIGN: Case series.MATERIALS AND METHODS: All consecutive couples with female

age <35 and a diagnosis of unexplained infertility treated with CC/IUIat a dose of 50 or 100 mg at the physician’s discretion from July 2012to April 2014 were included. Unexplained infertility was defined as atleast unilateral tubal patency, normal ovarian reserve, ovulatoryfemale partner and total motile sperm count of >10 million. Patientswith multiple inseminations during the same treatment cycle and thoseusing frozen sperm were excluded. The primary outcome was clinicalpregnancy rate (heartbeat on ultrasound at 6-9 weeks gestation) inthe first treatment cycle. Secondary outcomes were biochemical preg-nancy (positive serum pregnancy test with no heartbeat on early ultra-sound), multiple pregnancy, and ectopic pregnancy rates. Statisticalanalysis was performed using Chi Square, Fisher’s exact test and Stu-dent’s t-test.RESULTS: Of the 100 patients meeting inclusion criteria, 48 were treated

with 50 mg, and 52 with 100 mg of CC. Demographic and clinical character-istics are listed in Table 1. Clinical pregnancies occurred in 6 of 48 women(12.5%) in the 50 mg group and 7 of 52 women (13.5%) in the 100 mg group(NS). Rates of biochemical pregnancieswere 8/48 (16.7%) and 1/52 (1.9%) inthe 50 mg and 100 mg group, respectively (p¼0.01). There were no multipleor ectopic pregnancies in the study population.

Table 1: Patient characteristics and clinical outcomes by dose

Patients treated Patients treated

Vol. 10

with 50 mg(n¼48)

2, No. 3, Supp

with 100 mg(n¼52)

lement, Septem

P value

Age (mean)

29.4 29.8 p¼0.16 BMI (mean) 25.6 27.0 P¼0.20 Antral follicle count (mean) 22.9 20.3 P¼0.36 Clinical pregnancy rate

(%, first cycle)

12.5 13.5 P¼0.89

Biochemical pregnancy rate(%, first cycle)

16.7

1.9 P¼0.01

Multiple pregnancy rate(%, first cycle)

0

0 n/a

Ectopic pregnancy rate(%, first cycle)

0

0 n/a

ber 2014

CONCLUSION: In our study population, clinical pregnancy rates inwomen <35 with unexplained infertility undergoing their first CC/IUI cyclewere no different with the higher initial CC dose. Contrary to the traditionalpractice of using 100 mg of CC in all couples, a starting dose of 50 mg incouples with female age <35 may be considered. The finding of statisticallysignificantly increased rates of biochemical pregnancies on the lower CCstarting dose warrants further prospective investigation.

P-500 Wednesday, October 22, 2014

PROLONGED PITUITARY DOWN-REGULATION WITH GONAD-OTROPIN-RELEASING HORMONE AGONIST IMPROVE THECLINICAL PREGNANCY RATE IN INTRAUTERINE INSEMINA-TION TREATMENT. S.-Y. Shen,a,b P.-C. Ma,a M.-I. Hsu,b

C.-R. Tzeng.a aDepartment of Obstetrics and Gynecology, Taipei MedicalUniversity Hospital, Taipei Medical University, Taipei City, Taiwan; bDe-partment of Obstetrics and Gynecology, Wan Fang Hospital, Taipei MedicalUniversity, Taipei, Taipei City, Taiwan.

OBJECTIVE: Although GnRH agonist administration in the luteal phasehas been documented not to improve pregnancy rate, it is not clear that doesthe use of GnRH agonist prior to the IUI treatment cycle in the early follic-ular phase improve pregnancy outcome in intrauterine insemination (IUI)cycles.

DESIGN: Single center, retrospective data analysis.MATERIALS ANDMETHODS: A total of 506 patients with IUI cycles

from Center of Reproductive Medicine, Taipei Medical University Hospi-tal, Taiwan (January 2012 to December 2012) were retrospectivelyenrolled. Of them, 334 patients (66.0%) had completed IUI cycles withregular follow-up. Clinical characteristics such as age, the use of GnRHagonist prior to the IUI treatment cycle in the early follicular phase, preg-nancy rate, clinical presentation of endometriosis, numbers of large folli-cles, the level of E2 and P4 on ovulation day and endometrial thicknesswere analyzed.

RESULTS: Patients were divided into two groups according to whetherthe use of GnRH agonist or not. For those patients treated with GnRHagonist, the pregnancy rate significantly increased, compared with thosewithout GnRH agonist treatment. (13.8% vs. 33.9%, p¼0.001). In univar-iate analysis, the use of GnRH agonist, large follicles and clinicalpresentation of endometriosis were significantly associated with thepregnancy rate. After multivariate logistic regression analysis, includinguse of GnRH agonist or note, age, large follicle numbers, clinicalpresentation of endometriosis or not, the use of GnRH agonist was theonly one independent factor for the pregnancy rate (Odd ratio 2.65,P¼0.002).

CONCLUSION: Prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improves the clinical pregnancy rate in intrauter-ine insemination treatment.

P-501 Wednesday, October 22, 2014

LOW EFFICACY OF H-IUI TREATMENT CYCLES IN WOMENOVER FORTY YEARS OLD: DATA FROM NATIONAL ITALIANART REGISTER 2005-2012. G. Scaravelli, V. Vigiliano, R. De Luca,R. Spoletini, L. Speziale, S. Bolli, S. Fiaccavento, P. D’Aloja. ART ItalianNational Registry, National Center for Epidemiology Surevillance andHealth Promotion, National Health Institute, Rome, RM, Italy.

OBJECTIVE: To determine the efficacy of H-IUI cycles in women ofdifferent age class groups.

DESIGN: Retrospective analysis of 246.487H-IUI cycles from 403 clinicscollected from the Italian National ART register from 2005-2012.

MATERIALS AND METHODS: All the H-IUI treatments cycles per-formed in Italy collected from the National ART Register each year from2005 to 2012 among women of different age class groups were analyzedby treatments indications, pregnancies and live birth rates. Data were statis-tically analysed using SPSS statistic 17.0.

RESULTS: During the study period, pregnancy rates from patientsaged 40-42 and over 43 years old were 6,6% and 3,0% respectively,significantly lower than those from women younger than 34 years(13,5%) and aged 35-39 (9,8%). Out of 246.487 H-IUI cycles analysed,nearly 20.0 % (46.979) of the H-IUI cycles were performed on womenover forty years old. Overall the number of multiple pregnancies was

FERTILITY & STERILITY�

9,7%. and the number of babies born after these infertility treatmentswas 17.248.CONCLUSION: The low efficacy of H-IUI treatment cycles in women

over forty years old, observed in such a large number of cycles, suggeststhat the appropriateness of this kind of procedures for women over forty yearsold should be dicussed with greater accuracy.

P-502 Wednesday, October 22, 2014

CULTUREINGPERIODSOFTHAWEDBLASTOCYSTSUNTIL EM-BRYO TRANSFER:CLINICAL OUTCOME. E. Yumioka, H. Chinen,H.Moriyama, K. Nonomura, S. Senkyu, A. Uchida. Uchida Clinic, Matsue-shi, Shimane-Ken, Japan.

OBJECTIVE: We have conventionally cultured thawed blastocysts forover 3 hours until embryo transfer. However, some reports showed that preg-nancy rate would be improved by shortening culturing period until embryotransfer after thawing.DESIGN: In this study, we tried to determine whether pregnancy rate

would be affected by culturing period after thawing frozen blastocysts.MATERIALS ANDMETHODS: Between Dec. 2008 and Dec. 2013, 293

patients received frozen blastocysts transfer in our hospital (570 cycles: c-IVF 356 cycles, ICSI 214 cycles). Among them, clinical pregnancy ratewas compared by different culturing periods (culture of thawing blastocystsbefore transfer; over 3 hours (R3h) vs. within 3 hours (<3h) ) in each c-IVFand ICSI cycles. In addition, the influence of quality of transferred blasto-cysts (Gardner classification; over BB or under BB) and the day of frozen(D5 or D6) were also compared.RESULTS: In the c-IVF cycles, we found no significant differences in

pregnancy rate between R3h culture and <3h culture [36.0% (72/200)(R3h) vs. 35.9%(56/156)( <3h)]. Pregnancy rates in each quality of blas-tocysts (BB or under BB) were not significantly different by different cul-ture period ( BB: 39.7%(56/141) (R3h) vs. 42.4%(42/99) ( <3h); underBB: 27.1%(16/59) (R3h) vs. 24.6%(14/57) ( <3h)] . The day of blasto-cyst frozen was not influenced to the pregnancy rates[Day5: 40.9%(67/164) (R3h) vs. 39.3%(48/122) ( <3h); Day6: 13.9%(5/36) (R3h) vs.23.5%(8/34) ( <3h)]. In the ICSI cycles, no significant differences wereobserved in pregnancy rate between R3h culture and <3h culture afterblastocysts thawing [41.7%(45/108) (R3h) vs. 34.9%(37/106) ( <3h)].Quality of blastocysts was not correlated to the clinical pregnancy rates[BB: 47.4%(37/78) (R3h) vs. 44.3%(27/61) ( <3h); under BB:26.7%(8/30) (R3h) vs. 22.2%(10/45) ( <3h) ]. Although the outcomesof D5 frozen blastocysts were not changed by the periods of culture afterthawing in ICSI cycles [41.6%(32/77) (R3h) vs. 42.6%(29/68) ( <3h)],clinical pregnancy rate in D6 frozen blastocysts which were culturedover 3 h after thawing were significantly higher than the blastocysts whichwere cultured within 3 h after thawing [41.9%(13/31) (R3h) vs. 21.1%(8/38) ( <3h), p<0.05]. Because average age of patient in this group (D6frozen, culture over 3h) was lower than the average age in another group(D6 frozen, culture within 3h), this difference might be the cause of pa-tient age.CONCLUSION: Our study showed that the pregnancy rate was not altered

by the periods of culture after blastocyst thawing. Our study is ongoing.

P-503 Wednesday, October 22, 2014

ABNORMAL VILLOUS MORPHOLOGY IN ABORTUS SPECI-MENS IS NOT INCREASED IN ART PREGNANCIES. G. Ekpo,a

J. Rabban,b P. Rinaudo.a aCenter for Reproductive Health, University of Cal-ifornia San Francisco, San Francisco, CA; bPathology Department, Univer-sity of California San Francisco, San Francisco, CA.

OBJECTIVE: Increased incidences of placenta previa, abnormal cordinsertion and abruption have been described following ART. Anecdotalexperience suggests that abnormal villous morphology (AVM) is diag-nosed more frequently in abortuses following ART. AVM specimenshave a partial mole-like morphology and equivalent staining, but do notshare the fully developed features of a partial mole. Further, AVM seemsmore frequent in aneuploid pregnancies. The objectives of this studywere to determine the prevalence of AVM in ART pregnancies comparedto non-ART pregnancies, and the ability of AVM to predict chromosomalabnormalities.DESIGN: Retrospective Cohort Study.MATERIALS AND METHODS: We identified 360 failed 1st

trimester intrauterine pregnancy that were managed with manual uterine

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