Group I there was total failure of fertilization following insemination in 4 ofthe 23 patients, and none with ICSI. In Group II, 1 of 19 patients failedfertilization by insemination, with no failures in the ICSI group. Whentested by a McNemar’s paired analysis, fertilization failure was not found tobe significantly different in the two groups (p,0.125; p51, respectively).

Conclusions: 1) In patients with unexplained infertility, higher fertiliza-tion rate was achieved when ICSI was compared to conventional insemi-nation. 2) No such benefit could be demonstrated for patients with border-line semen parameters. 3) The use of ICSI in these patients rescued 5 of 42cycles (12%). This benefit did not reach statistical significance. Utilizationof the ICSI-split or an all-ICSI approach in cases of unexplained infertilitymay result in increased fertilization rate and rescue of cycles that wouldhave otherwise failed.

P-366

Oocyte Numbers, Fertilization (IVF) Rates of Recovered Oocytes, andPregnancy Rate in 1035 Cycles of Controlled Ovarian Hyperstimula-tion (COH) With FSH Alone (Urinary FSH [uFSH], Purified uFSH[hpFSH] or Recombinant FSH [rFSH]); or With FSH and UrinaryGonadotropins (hMG). B. A. Stone, J. M. Vargyas, G. E. Ringler,J. Greene, R. P. Marrs. California Fertility Partners, Santa Monica CA.

Objectives: There is ongoing debate regarding the importance of FSHpurity, and need for LH, during COH of patients following pituitary down-regulation. This study analyses oocyte yields and IVF rates after COH withFSH alone, or with FSH and hMG. Age interactions are also examined.

Design: Retrospective analysis of outcomes of 1035 IVF cycles in anART center.

Materials and Methods: Patients started COH on the 3rd day of the cyclefollowing down-regulation. Initial gonadotropin dosages were 4 amps/day,reviewed following 5 days. Oocyte retrieval (OPU) was scheduled 34hrafter the leading follicle(s) reached 18 mm diameter, and serum estradiolapproached 250 pg/mL/follicle.15 mm diameter. Oocytes were insemi-nated 3–5 hours after OPU, and fertilization checked 17–18 hrs later.Results were analyzed by 2-way ANOVA (Stim3 Age).

Results: Values in the following table are average6 SEM (15–221cycles/cell).

Age uFSH uFSH1hMG

# Oocytes #40 18.36 1.3 14.46 0.6Fertilization(%) 61.46 3.5 60.26 2.1# Oocytes .40 18.36 1.9 12.96 0.7Fertilization(%) 73.66 3.9 66.16 2.1

hpFSH hpFSH1hMG rFSH rFSH1hMG

15.36 0.6 14.26 1.0 13.96 1.6 10.16 0.870.76 2.5 66.86 3.5 70.96 3.7 71.96 4.413.86 0.8 10.46 0.9 12.66 3.0 12.56 1.872.46 2.4 58.16 4.5 78.76 1.6 50.66 9.9

Average numbers of embryos transferred following IVF were similar for allgroups (near 3.6/patient), and pregnancy rates did not differ significantlybetween groups within each age category (near 48%,40 yrs; near 40% forpatients.40 yrs). Oocyte yields decreased as the purity of the FSH in-creased (P,0.05), independent of patient age. Substitution of FSH withhMG also decreased oocyte yields (P,0.05), an effect which diminished asthe purity of the FSH increased. Fertilization rates were directly related tothe purity of the FSH. Substitution of FSH with hMG did not impact thesevalues in younger patients, but decreased fertilization rates for older patients(P,0.01).

Conclusions: Purer forms of FSH therefore yielded lower numbers ofoocytes with greater fertilization potential. Substitution of hMG for FSHdecreased oocyte yield, compounded in patients.40 yrs by lower fertili-zation rates. Pregnancy outcomes indicate that, within age categories, thequality of transferred embryos was not impacted by FSH purity or bydiffering FSH:LH ratios.

P-367

Progesterone Gel (Crinonet8%) is More Comfortable Than Progester-one Suppositories (Utrogestt) for Luteal Phase Support and Results inComparable Pregnancy Rates: Results of a Prospective, RandomizedStudy. 1M. Ludwig, 1P. Schwartz,1B. Babahan,2A. Katalinic, 1M. Bals-Pratsch,1K. Diedrich. 1Department of Gynecology and Obstetrics and2Department of Social Medicine, Medical University of Lu¨beck, Germany.

Objectives: Luteal phase support (LPS) is an essential part of ovarianstimulation procedures especially in IVF cycles. Previous work has demon-strated that progesterone is equally efficient for LPS compared to single ormultiple injections of hCG or a combination of hCG and progesterone.Vaginal progesterone, however, has less side effects, especially a lower riskof developing ovarian hyperstimulation syndromes. A direct comparison ofdifferent progesterone preparations for vaginal administration has not beenpublished until now. Crinonet 8% offers—for the first time—a once dailyadministration of a preparation, which is directly designed for this route.Utrogestt, which is widely used for vaginal administration, is originallydesigned for oral use.

Design: Prospective, randomized study to compare the efficiacy andpatients comfort using either progesterone gel (Crinonet 8%, Serono Phar-ma GmbH, Munich, Germany) or progesterone suppositories (Utrogestt,Dr. Kade, Berlin, Germany) for LPS in IVF and IVF/ICSI cycles.

Materials and Methods: 126 patients were prospectively randomized.Crinonet8% was administered as a single vaginal application per day usinga specially designed vaginal applicator. Utrogestt was administered vagi-nally three times daily with two suppositories each time (600 mg/d). 47randomly selected, non-pregnant patients (Crinonet 8%, n521; Utrogestt,n526) were interviewed after completion of LPS for their experience with thesepreparations. Statistics were calculated using Mann-Whitney-test orx2-test.

Results: 73 and 53 patients were randomized to receive either Crinonet

8% or Utrogestt, respectively. Demographic factors were comparable andnot statistically significant different. The number of cycles with recFSH(Gonal F 75, Serono Pharma GmbH) and cycles using a long LHRH agonistprotocol or a multiple dose antagonist protocol using Cetrotidet (ASTAMedica AG & Serono Pharma GmbH) for Crinonet 8% and Utrogestt

cycles were in the same range. There was no statistically significant differ-ence between the rates of clinical abortions (n53, 15.8% vs. n51, 10.0%)or rates of ongoing clinical pregnancies per embryo transfer in the Crinonet

8% group (n518, 24.7%) and the Utrogestt group (n59, 17.0%). Patientsfelt significantly more comfortable using Crinonet 8% compared to Utro-gestt, since less complaints with vaginal discharge (p,0.01), and lessapplication difficulties (p,0.05) were reported, as was easier (p,0.05) andless time consuming (p,0.01).

Conclusion: Crinonet 8% has the advantage of only being administeredas a once daily application. Clinical ongoing pregnancy rates are slightlyhigher in the Crinonet 8% group (24.7% vs. 17.0%), but this difference wasnot statistically significant. Crinonet 8% was significantly more comfortablefor the patients when compared to Utrogestt.

P-368

Human Growth Hormone (H.G.H.)-An Age Related Co-Factor inA.R.T. D. B. Goldstein, L. H. Sasaran, C. Ogrin, J. Zhang. Brooklyn/WestSide Fertility Center, New York, NY.

Objectives: H.G.H. was administered in cases in which the response togonadotropin ovulation induction (O.I.) and/or the endometrial growthunder the influence of H.R.T. for A.R.T. was suboptimal. The response to O.I.was reflected in the number of mature oocytes aspirated at I.V.F. while theendometrial growth in mm was measured in Frozen Embryo Transfer (F.E.T.)cycles. Previous studies performed in order to improve or rescue failed I.V.F.cycles did not show convincing data favoring H.G.H. supplementation.

Design: A prospective study was performed on all patients with lowI.G.F-I and poor response to O.I. (less than 4 mature oocytes aspirated atI.V.F.) and/or lack of endometrial growth on H.R.T. (less or equal to 6 mm)for frozen embryo transfer (F.E.T.). Patients were administered 0.1mgH.G.H. (IM) daily for 8 weeks prior and during the new A.R.T. cycle.

Materials and Methods: During a 28 month study 39 patients withsuboptimal response to O.I. for I.V.F. were found to have low I.G.F.-I. Theywere divided into two groups; GRI (n522) were 35 years or younger andGrII (n517) were over 36 years old. There were 14 patients with a lack of

S210 Abstracts Vol. 74, No. 3, Suppl. 1, September 2000