Conclusion: These data support the hypothesis that higher hCG levels aremore likely to have ongoing pregnancies and also more likely to havemultiple gestation pregnancies, consistent with previously reported results withday 2 or day 3 transfer of cleaved embryos. However, with blastocyst transfer,total hCG levels are increased compared to day 2 or day 3 transfer. Overallspontaneous miscarriage rate was similar for day 3 and day 5 transfer.

Monday, October 23, 20002:30 P.M.

O-015

Flare Versus Mid-luteal Phase Down-Regulation in Women Over40—Is There a Difference? J. E. Copeland, M. R. Fluker, A. A. Yuzpe.Genesis Fertility Centre, Vancouver, BC, Canada.

Objective: The initial rise in endogenous gonadotropin secretion inducedwith a flare protocol may improve follicular recruitment and may beparticularly advantageous for women over 40. However, there are theoret-ical concerns about the adverse effects of high follicular phase luteinizinghormone (LH) levels on oocyte and embryo quality. We compared theeffects of a follicular phase flare protocol with a traditional luteal phasedown-regulation (DR) protocol in women$40 years of age undergoingtheir first cycle of IVF or ICSI.

Design: Retrospective analysis.Materials and Methods: All first treatment cycles in women$40 years

undergoing IVF or ICSI from 01/97 to 12/99 were analyzed. All cycles in1997 involved DR, all cycles in 1999 used a flare, with a mixture ofprotocols in 1998 when the flare protocol was empirically introduced intoour program. All women had day 3 FSH levels#15 IU/L and none hadprevious gonadotropin treatment that may have influenced choice of proto-col. Down-regulation was achieved using nafarelin acetate 200mg BIDintranasally from cycle day 22 onwards, followed by 150–225 IU FSHdaily. Flare protocols involved 500mg buserelin acetate sc from cycle day3 onwards plus 225 IU FSH daily from day 5.

Results:

Age

Days

FSH

IU FSH/

cycle Oocytes

Em-

bryos CES*

Clin

Preg/ET

Live

births

Flare

(n565) 41.71 .2† 101 .3‡ 20161 124‡ 7.41 .5 5.11 .4 721 3.7‡

12/62

(19.4%)

9/62

(14.5%)

DR

(n548) 41.11 .2 131 .4 25001 138 7.51 .7 5.51 .5 571 4.2

10/47

(21.3%)

5/47

(10.6%)

* Cumulative embryo score5 sum of (blastomeres3 embryo score [15 poor;4 5 excellent]).† Mean6 SEM.‡ p,0.05 vs. DR.

Conclusions: Despite theoretical concerns regarding an adverse effect ofhigh LH levels in the early follicular phase, use of a flare protocol in women$40 years was not associated with a reduction in fertilization rates, embryoquality (CES), clinical pregnancy rates or live birth rates. However, the flareprotocol resulted in significantly faster stimulation requiring fewer units ofFSH to achieve similar numbers of oocytes and embryos. The resultingreduction in cost and time commitment for the patient and the subsequentdecrease in nursing time and monitoring costs suggest appreciable practicalbenefits from the flare protocol. A prospective, randomized controlledclinical trial would be needed to verify these results.

Monday, October 23, 20002:45 P.M.

O-016

Comparison of Semen Characteristics and Pregnancy Rates UsingWashed Versus Unwashed Donor Sperm for Intrauterine Insemination(IUI). E. W. Baker, C. J. Chow, A. A. Yuzpe, M. R. Fluker. GenesisFertility Centre, Vancouver, BC, Canada.

Objective: Many commercial sperm banks offer washed frozen donorsemen specimens that are convenient and ready to use, albeit more costly.If the staff and facilities are available, less expensive unwashed specimens

can be purchased, thawed and washed prior to use. Our objective was tocompare semen characteristics and pregnancy rates associated with washedand unwashed specimens used for donor insemination (DI) in a group ofwomen with proven fertility.

Design: Retrospective review of women conceiving at least once in aprivate fertility clinic from 1/96–12/99.

Materials and Methods: 179 women conceived 215 clinical pregnanciesfollowing 845 DI cycles. All women were healthy with no significantfertility factors aside from treatable ovulatory disorders. Single IUIs oc-curred 2–24 hours following documentation of a serum (n5397) or urinary(n5448) LH surge. In 16 cycles, a second IUI was performed 24 hours laterat the patients’ request. Unwashed samples were thawed and prepared usingHEPES-HTF with 10% synthetic serum substitute. Motility and total motilesperm count (TMC) were assessed prior to IUI.

Results:

Age (y) TMC 3 106 % Motility

Clinicalpregnancies/

cycle

Washed (n5240) 35.26 4.1 28.96 14.1 47.96 11.2 67/240 (28%)Unwashed (n5605) 34.76 4.7 20.86 10.8* 41.96 11.7* 148/605 (25%)

* p,0.001 vs washed.

Of 215 clinical pregnancies, only one occurred with a TMC#7 million andthree with motility#20%. Although TMC and motility were significantlyhigher in washed samples, 96% of all samples were above the threshold of7 million TMC and 20% motility. Pregnancy rates did not differ withadditional increments in TMC or motility, or between washed and un-washed samples.

Conclusions: Most sperm banks offer both washed and unwashed sam-ples. Despite differences in TMC and motility, most washed and unwashedspecimens are of good quality and produce similar pregnancy rates whenused in healthy, fertile women. Patients and clinics can therefore chooseeither the convenience of washed samples or the cost saving of unwashedsamples without concern about compromising pregnancy rates.

Monday, October 23, 20003:00 P.M.

O-017

Successful Management of Improper Self-Administration of HumanChorionic Gonadotropin (hCG) Prior to Oocyte Retrieval. A. L. Sebesta,D. Marek, M. Langley, K. M. Doody, K. J. Doody. Center for AssistedReproduction, Bedford, TX.

Objective: To evaluate the outcome of an in-vitro fertilization (IVF) cyclein which a patient of good prognosis, self-administered an improper dose ofhCG (Profasi, Serono) prior to oocyte retrieval.

Design: Case report.Materials and Methods: A thirty-one year old patient was presented for an

initial IVF cycle following diagnosis of male factor and failed pregnancyattempts by intercourse. Prior to the start of the cycle, the patient wasinstructed on proper self-administration of injectable medication. The pa-tient underwent down regulation with the gonadotropin releasing hormoneanalog, Lupront (TAP) prior to controlled ovarian hyper-stimulation with22.5 amps of Gonal-Ft (Serono). Cycle response was evaluated periodicallywith Estradiol levels drawn after start of Gonal-Ft. Estradiol blood levelson Day 3, 5, 7, 9 and 10 were recorded as 271, 780, 1565, 4185 and 5595pg/ml (Immulite, DPC) respectively. Initial attempted oocyte retrieval oc-curred 36–39 hours post assumed Human Chorionic Gonadotropin (hCG)administration. No oocytes were recovered from right ovary and the re-trieval was halted. A hCG blood level was obtained in the recovery roomand a negative result was indicated (,1.00 mIU/ml). Upon review of themedication vials, it was recognized that only 1/10 of the instructed dose ofhCG had been self-administered. The patient was informed to repeat hCGadministration and was scheduled for oocyte retrieval 36–39 hours postrepeat hCG administration. At the second retrieval, 12 oocytes were recov-ered. Insemination was performed 38–42 hours post hCG using intracyto-plasmic sperm injection (ICSI). Fertilized oocytes were cultured for fivedays using sequential media (G1.2, G2.2, IVF Science). Transfer was

S6 Abstracts Vol. 74, No. 3, Suppl. 1, September 2000