Rotunda-Virk Center For Human Reproduction, Jalandhar, India. OBJECTIVES: To compare the pregnancy outcomes of intramuscular. Progesterone versus oral ...
MATERIALS AND METHODS: All women underwent GnRH agonist suppression and controlled ovarian stimulation with exogenous gonadotropins. Ultrasound-guided transvaginal follicle aspiration was performed 36 hr after hCG administration for autologous IVF cycles and 34 hr after hCG administration for egg donation cycles. Recipients of donated oocytes were synchronized using oral contraceptive pills (OCP) and Lupron down-regulation (LDR) followed by an oral Estrace and intramuscular (IM) Progesterone (EP) protocol. Embryo transfers were all performed 3 days after egg retrieval. Luteal support was achieved with only IM progesterone in all autologous IVF cycles, and with a combination of oral Estrace and IM progesterone in all recipients of donor oocytes. At 12 days following embryo transfer, serum hCG level of each patient was determined by a fluoroimmunometric assay system. Serum hCG values for viable and nonviable pregnancies were compared by Student’s t test. RESULTS: The median D12 hCG concentrations were 167.00 IU/L and 223.0 IU/L for singleton autologous and egg donation pregnancies, respectively. Patients with singleton pregnancies that resulted from fresh autologous embryo transfers had significantly lower median D12 hCG levels (p⬍0.01) than patients with singleton pregnancies resulting from egg donation cycles. Twin pregnancies resulting from autologous IVF cycles had a median D12 hCG concentration of 306.8 IU/L which was also significantly lower (p⫽0.005) than 418 IU/L, the D 12 serum hCG concentrations in twin pregnancy of egg donation IVF cycles. CONCLUSION: Serum hCG concentrations on D 12 after embryo transfer were significantly higher in pregnant recipients of donated oocytes than in autologous IVF pregnancies. Our data suggests that embryo implantation may occur sooner in egg donation cycles compared to autologous IVF cycles. Supported by: None.
OUTCOME PREDICTORS-CLINICAL: ART P-171 The comparison of pregnancy outcomes of intramuscular progesterone versus oral dydrogesterone for luteal phase support in donor egg IVF recipient cycles. G. N. Allahbadia, K. Kaur, K. Kadam, S. Virk, G. Gandhi, S. Gosrani. Rotunda-The Center For Human Reproduction, Mumbai, India; Rotunda-Virk Center For Human Reproduction, Jalandhar, India. OBJECTIVES: To compare the pregnancy outcomes of intramuscular Progesterone versus oral Dydrogesterone for luteal phase support in donor egg recipient cycles. DESIGN: Prospective Multicentric Comparative Study. MATERIALS AND METHODS: From January 2002 to June 2003, 94 consecutive recipients (Group A) in our Donor Egg IVF Program were given Intramuscular Progesterone (Injection Gestone, Ferring Pharmaceuticals, India) 100mg/day for 15 days beginning from a day prior to the Egg Donor’s Oocyte Retrieval. This intramuscular Progesterone was continued in the same dose until 13 weeks of gestation if the serum beta hCG was positive. From July 2003 to September 2003, 30 consecutive recipients (Group B) in our Egg Donation Program were given Oral Dydrogesterone(Tablet Duphaston, Solvay Pharma India Ltd) 10mg three times a day for 15 days beginning from a day prior to the Egg Donor’s Oocyte Retrieval. This oral Dydrogesterone was continued in the same dose until 13 weeks of gestation if the serum beta hCG was positive as in Group A. Patients in both the groups received the same type of Estradiol Replacement therapy using oral Estradiol valerate. The Laboratory techniques , culture media and consumables used in both groups were the same and all the embryo transfers were done by the first author using ultrasound guidance. The Biochemical Pregnancy Rate/Cycle, the Clinical Pregnancy Rate/Cycle, the Multiple Gestation Rate/Cycle , the Implantation Rate/Embryo Transferred and the Abortion Rate/Cycle were compared between the two groups. RESULTS: There were no statistically significant differences in the studied parameters between the two groups; although the recipients in the Duphaston group (Group B) had a marginally higher Clinical Pregnancy Rate/Cycle of 53.33% as compared to 47.87% in Group A.
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CONCLUSION: The route of post-transfer progesterone administration does not appear to affect the pregnancy rate in a well established Donor Egg IVF Program. Comparable results can be achieved with both intramuscular & oral therapy. However, the oral Dydrogesterone administration for luteal phase support in Donor Egg IVF Recipient cycles is associated with fewer side-effects and greater patient adherence and satisfaction.
P-172 Oocyte donation outcomes in agonist and antagonist cycles. A. StyneGross, D. B. Shapiro, S. Schneider, S. Barrick. Emory University School of Medicine, Atlanta, GA; Reproductive Biology Associates, Atlanta, GA. OBJECTIVE: To analyze outcomes in an established donor oocyte program using GnRH antagonists and agonists for LH suppression in controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). DESIGN: A retrospective analysis comparing the use of GnRH antagonists and agonists for LH suppression in donors undergoing COH for IVF. MATERIALS AND METHODS: 76 patients aged 21–31 years were recruited for oocyte donation. 134 cycles were treated with either antagonist or agonist-based COH. Stimulations in the antagonist group started on the fifth day after pretreatment with oral contraceptives. Recombinant FSH (Follistim™; Organon Inc., Roseland, NJ or Gonal F®; Serono, Rockland, MA) was started at doses ranging from 150 – 450 IU. Many cycles in both groups were done in combination with LH addback (Repronex™;Ferring Pharmaceuticals Inc., Suffern, NY or dilute Ovidrel™; Serono). Ganirelix (Antagon™; Organon Inc.), 250 g per day was started when the lead follicle was 1.3 cm or estradiol was greater than 400 pg/ml. In no case was antagonist started after day 7. Agonist down-regulation occurred with luteal phase leuprolide (Lupron; TAP Pharmaceuticals Inc., Lake Forest, Illinois). COH was initiated once down regulation was achieved. Monitoring for both groups was the same, with serum estradiol and ultrasound performed at regular intervals until 3 follicles reached 1.8 cm in mean diameter. Human chorionic gonadotropin (hCG, Pregnyl™; Organon Inc. or Ovidrel™; Serono) was administered when ripe diameters were achieved. Egg retrieval was performed 37 hours after hCG by transvaginal ovarian puncture. Insemination was performed using IVF or intra-cytoplamic sperm injection (ICSI). Donor recipients were placed on agonist down regulation followed by sequential estradiol and progesterone supplementation for endometrial preparation. Two or three embryos were replaced on day 3 after retrieval. Progesterone in oil, 50 mg, was given intramuscularly once a day for luteal support. Pregnancy was recorded with viability past the 10th week. RESULTS: Pregnancy rates were similar in antagonist and agonist cycles (63% vs. 54% respectively; P⬎0.05). The number of cryopreserved embryos were similar (8.1 ⫾ 7.2 antagonist vs. 6.4 ⫾ 6.5 agonist; P⬎0.05). Peak estradiol was higher in the agonist group (3052 ⫾ 1344 vs. 2479 ⫾ 1175), though antagonist cycles had a larger percentage of 8 cell embryos (33.5% vs. 23.5%; p⬍0.05). Multiple pregnancy rates were the same in both groups (21.9% antagonist vs. 21.4% agonist; P⬎0.05). CONCLUSION: Antagonist-based cycles for oocyte donation have similar outcomes to those based on GnRH agonist. Though peak estradiol is typically lower in antagonist cycles, the percentage of high quality embryos appears higher in this group. Given the well-documented shorter total duration of antagonist cycles, with fewer days of injections, antagonist cycles should be considered as the first choice protocol for oocyte donors. Supported by: None.
Vol. 82, Suppl. 2, September 2004
