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CONCLUSION: AMH is predictive of live birth and ovarian reserve as CONCLUSION: Adding Cimicifugae Racemosae to Clomiphene induc-

measured by the number of oocytes retrieved in IVF in both infertile women tion cycles with timed intercourse in polycystic ovarian syndrome improves
(Group A) and population of women representative of the general population. cycle outcomes and pregnancy rates.
(Group C). This is an argument for the use of AMH as an ovarian screening test.
O-188 Tuesday, October 18, 2011 04:30 PM
R. Huang, C. Fang. IVF Center, The Sixth Affiliated Hospital of Sun Yat-sen
University, Guangzhou, Guangdong, China.
DURING IVF TREATMENT. L. Mohiyiddeen, W. Newman, B. Mulugeta,
H. McBurney, S. Roberts, L. Nardo. Reproductive Medicine, St. Mary’s Hos- OBJECTIVE: To evaluate the effect of ibuprofen in NC-IVF and Mini-IVF
pital, Manchester, Lancashire, United Kingdom; Genetic Medicine, St. cycles.
Mary’s Hospital, Manchester, Lancashire, United Kingdom; Department of DESIGN: Retrospective study.
Clinical Statistics, University of Manchester, Manchester, Lancashire, MATERIALS AND METHODS: Eighty patients with diminished ovarian
United Kingdom. reserve and at least one failed COH-IVF cycle who underwent 79 NC-IVF
and 124 Mini-IVF cycles between 6/2010 and 3/2011 were included. Oral ad-
OBJECTIVE: 1) To evaluate the association of FSH receptor polymor-
ministration of ibuprofen (300mg three times daily for two days) started from
phism and ovarian response.
HCG-Day to OPU-Day in 24 NC-IVF and 38 Mini-IVF cycles.The cancella-
2) To evaluate the association between FSHR gene SNP and current
tion rate before oocyte retrieval, oocyte recovery rate, mature oocyte rate,
markers of ovarian reserve (AMH, Antral Follicle Count, FSH).
normal fertilization rate and good-quality embryo rate in cycles of NC-IVF
DESIGN: Prospective observational study.
or Mini-IVF with and without ibuprofen were compared respectively. Statis-
MATERIALS AND METHODS: Study included 421 patients and 80
tical analysis was performed c2 and Fisher’s exact tests, P<0.05 value was
healthy controls.Blood tests were taken on the day 2-3 of the cycle for the considered statistically significant.
assessment of baseline hormones and for DNA extraction. Genotypes for RESULTS: In Mini-IVF cycles, normal fertilization rate was 71.2% with
FSHR p.Asn680Ser were determined using the pre-designed TaqMan allelic ibuprofen and 86.0% without ibuprofen (P<0.05). And no statistical differ-
discrimination assays. Genotypes at position 307 were also determined. In
ence could be found for other cycle parameters.
view of linkage disequilibrium analysis was done with reference to position
680 on exon 10 of FSH receptor gene.
RESULTS: Frequency distribution of alleles at position 680 was compara- Comparison of cycle parameters with and without ibuprofen in NC-IVF or Mini-
ble in the subjects and control. The number of oocytes retrieved was compa- IVF cycles respectively
rable between patients with three different FSH receptor genotypes. The total NC-IVF Mini-IVF
amount of gonadotrophin used was also similar in all the three groups. A lo-
gistic regression analysis showed no significant difference in the distribution No No
of genotypes when poor response group was compared with the group with Ibuprofen ibuprofen p Ibuprofen ibuprofen p
normal response (OR ¼ 0.79; CI ¼ 0.49 to 1.26). Also linear regression
Cancellation rate 8.3% (2/24) 20.0% (11/55) NS 2.6% (1/38) 5.8% (5/86) NS
test did not show significant association with FSHR gene polymorphisms before oocyte
when compared with markers of ovarian reserve like AMH, AFC and FSH. retrieval
CONCLUSION: FSHR genotype was not associated with ovarian re- Oocyte 77.3% (17/22) 79.6% (35/44) NS 78.4% (29/37) 84.0% (68/81) NS
sponse in patients undergoing IVF. No association was noted when FSHR ge- recovery rate
Mature 85.0% (17/20) 90.9% (40/44) NS 82.5% (52/63) 77.0% (114/148) NS
notypes were compared with markers of ovarian reserve. When exploring oocyte rate
candidate genes and therapy outcome, the multigenic nature of complex traits Normal 88.2% (15/17) 70.0% (28/40) NS 71.2% (37/52) 86.0% (98/114) <0.05
is ignored. The outcome of controlled ovarian stimulation could be depen- fertilization
dent on several interacting genes. Perhaps undertaking GWAS in patients Good-quality 80.0% (12/15) 57.1% (16/28) NS 61.5% (32/52) 72.5% (71/98) NS
with poor response or severe ovarian hyperstimulation syndrome may help embryos rate
identify further genes.
Supported by: Central Manchester University Hospitals NHS Trust
CONCLUSION: The administration of ibuprofen may reduce the inci-
dence of spontaneous ovulation in both NC- and Mini-IVF cycles. The nor-
OVARIAN STIMULATION – POOR RESPONDERS: ART mal fertilization rate decreased in Mini-IVF cycles with ibuprofen, but no
such phenomenon could be found in NC cycles. Further prospective research
is required to confirm the results of this study.
O-187 Tuesday, October 18, 2011 04:15 PM Supported by: National Natural Science Foundation,China (Grant No.
30973202)and Guangdong Provincial Fund of Industry,Education and Acad-
emy (GrantNo.2008B090500194).
TRIAL. A. Y. Shahin. Obstetrics and Gynecology, Women’s Health Center, O-189 Tuesday, October 18, 2011 04:45 PM
Assiut, Egypt.
OBJECTIVE: Owing to their potential to act as estrogen receptor modula- MAL TESTOSTERONE PRETREATMENT IN POOR RESPONDERS
tors and interfere with aromatase enzyme in animal studies, Phytoestrogens TREATED WITH GNRH ANALOGUES AND GONADOTROPHINS
may be useful as part of ovulation induction for PCOS. FOR IN-VITRO FERTILIZATION: A META-ANALYSIS. C. A. Venetis,
DESIGN: Prospective randomized non-blinded clinical trial. J. Bosdou, E. Kolibianakis, K. Toulis, D. Goulis, B. C. Tarlatzis. Unit for Hu-
MATERIALS AND METHODS: Patients < 35 years, presenting with in- man Reproduction, 1st Dept. of OB/Gyn, Medical School, Aristotle Univer-
fertility and PCOS, were included and randomly allocated to either group I sity of Thessaloniki, N. Efkarpia, Thessaloniki, Greece.
(Clomiphene Citrate) or group II (Clomiphene Citrate plus Cimicifugae
Racemosae). Primary outcome was pregnancy rate. Secondary outcomes in- OBJECTIVE: To evaluate the effect of transdermal testosterone pretreat-
cluded ovulation, midcycle serum estradiol and LH as well as mid-luteal se- ment in poor responders undergoing ovarian stimulation for in-vitro fertiliza-
rum progesterone. tion (IVF).
RESULTS: Analysis included 98 patients in group I vs. 96 patients in group DESIGN: Systematic review and meta-analysis.
II. Both groups were matched regarding demographics and basic data. Signif- MATERIALS AND METHODS: A computerized literature search in
icant differences were elicited when comparing days until HCG injection (15.0 MEDLINE, EMBASE, CENTRAL and ISI Web of Science electronic data-
 1.7 vs. 12.0  1.9, P¼0.91), Endometrial thickness (mm) (8.5  1.9 vs. 12.5 bases was performed independently by two reviewers until December 2010
 1.9, P<0.001), serum levels of midluteal and midcycle estradiol (P<0.001, in order to identify randomized controlled trials (RCTs) evaluating testoster-
figure 2), LH (IU/ml) (P<0.001) as well as mid luteal progesterone (P<0.001). one pretreatment in poor responders undergoing ovarian stimulation for IVF.
PE plus CC group had significantly higher clinical pregnancies per cycle (33/ The main outcome measure was achievement of pregnancy per patient ran-
192 (17.2%) vs. 71/204 (34.8%), P<0.01), compared to the CC only group. domized, expressed as clinical pregnancy (evidence of intrauterine sac

S56 Abstracts Vol. 96., No. 3, Supplement, September 2011

with fetal heart activity at 6-8 weeks of gestation) or as live birth. Secondary nizing hormone (rLH) addition in poor responders undergoing ovarian
outcome measures included duration of gonadotrophin stimulation, total stimulation for in-vitro fertilization (IVF) using recombinant follicle stim-
dose of gonadotrophins required for ovarian stimulation and the number of ulating hormone (rFSH) and gonadotropin releasing hormone (GnRH)
cumulus oocyte complexes (COCs) retrieved. analogues.
RESULTS: Two eligible RCTs were identified including a total of 145 pa- DESIGN: Systematic review and meta-analysis.
tients evaluating testosterone pretreatment in the form of testosterone gel. A MATERIALS AND METHODS: A literature search was performed in
statistically significant decrease in gonadotrophin consumption (Weighted MEDLINE, EMBASE, CENTRAL and ISI Web of Science until December
mean difference-WMD: -446 IU, 95% CI: -600 to -291) and in the duration 2010 aiming to identify all relevant randomized controlled trials. Studies in-
of stimulation (WMD: -0.8 days, 95% CI: -1.3 to -0.3) was observed in the cluding asymmetrical co-interventions were excluded. Primary outcome
testosterone pretreatment group. Moreover, significantly more COCs were measure was clinical pregnancy at 6-8 weeks of gestation. Secondary out-
retrieved (WMD: +1.5, 95% CI: +0.9 to +2.1) from patients pretreated come measures were total amount of rFSH required, duration of stimulation,
with testosterone as compared to those who were not. number of cumulus oocytes (COCs) retrieved and estradiol levels on the day
A significant increase of +15% (95% CI: +3.0 to +26.0) in clinical pregnancy of human chorionic gonadotrophin (hCG).
rates was detected in patients who received testosterone pretreatment, which was RESULTS: Seven studies were eligible for this systematic review and
accompanied by an increase in live birth rates of +11% (95% CI: + 0.3 to +22.0). meta-analysis including 603 patients. By synthesizing the results of these
CONCLUSION: Testosterone pretreatment in poor responders undergoing studies it was shown that no significant differences were present between
ovarian stimulation for IVF is associated with a significant increase both in poor responders who were treated with rLH and those who were not, regard-
the probability of clinical pregnancy, as well as of live birth. ing duration of gonadotrophin stimulation, total dose of gonadotrophins re-
quired for ovarian stimulation and serum E2 levels on the day of hCG.
Significantly less COCs were retrieved from patients who received rLH as
O-190 Tuesday, October 18, 2011 05:00 PM compared to those who did not (WMD: -0.20 COCS, 95% CI: -0.37 to
OBESITY AND ELEVATED FOLLICULAR FLUID (FF) LEPTIN -0.04). A non-significant increase of 6.5% in clinical pregnancy rates was
LEVELS NEGATIVELY CORRELATE WITH ANTRAL FOLLICLE present in patients who received rLH as compared to those who did not
MINISHED OVARIAN RESERVE. E. Buyuk, J. Younger, H. J. Lieman, CONCLUSION: Currently, based on the best available evidence, addition
S. K. Jindal, M. J. Charron. Reproductive Endocrinology and Infertility, Ob- of rLH in poor responders undergoing ovarian stimulation for IVF using
stetrics and Gynecology and Women’s Health, Montefiore Institute for Re- rFSH and GnRH analogues does not seem to increase the probability of clin-
productive Medicine and Health, Albert Einstein College of Medicine, ical pregnancy. However, given the magnitude of the rate difference and the
Bronx, NY; Biochemistry, Obstetrics and Gynecology and Women’s Health, confidence interval, further studies are needed for solid conclusions to be
Albert Einstein College of Medicine, Bronx, NY. drawn.

OBJECTIVE: To evaluate the effects of elevated body mass index (BMI)

and FF leptin levels on ovarian reserve marker AFC and ovarian response
during controlled ovarian hyperstimulation (COH)-IVF in women with nor-
mal (NOR) and diminished ovarian reserve (DOR). O-192 Tuesday, October 18, 2011 05:30 PM
¼ 73, DOR ¼ 16) undergoing COH-IVF. Women with PCOS were excluded. BRYO TRANSFER CANCELLATION RATE? C. M. Gomes,
DOR was defined as a historical maximum day 3 FSH >10 IU/L. FF leptin E. L. A. Motta, J. R. Alegretti, M. Nichi, P. A. Hassun, P. C. Serafini,
and adiponectin levels were measured by ELISA and correlated with AFC T. S. Domingues. Huntington Medicina Reprodutiva, S~ao Paulo, Brazil; Dis-
and the number of oocytes retrieved. Pearson correlation, Spearman rank cor- ciplina de Ginecologia, Faculdade de Medicina da Universidade de S~ao
relation and multivariate regression analyses were used. Paulo, S~ao Paulo, Brazil; Departamento de Ginecologia, Universidade Fed-
RESULTS: There was a strong negative correlation between BMI and AFC eral de S~ao Paaulo, S~ao Paulo, Brazil; Genesis Genetics Brasil, S~ao Paulo,
(r ¼ 0.54, P¼0.036) and BMI and the number of oocytes retrieved (r ¼ Brazil.
0.51, P¼0.04) in women with DOR, but not in women with NOR (r ¼
0.2, P¼0.07 and r ¼ 0.07, P¼0.6, respectively). Similarly, we found OBJECTIVE: To investigate whether women with low ovarian reserve
a strong negative correlation between FF leptin levels and AFC (r ¼ 0.53, evaluated by serum levels of anti-mullerian hormone (AMH) have a higher
P¼0.04) and FF leptin levels and the number of oocytes retrieved (r ¼ cancelation of embryo transfer (ET) due to aneuploidies of biopsied embryos
0.65, P¼0.007) in women with DOR, but not in women with NOR (r ¼ assessed by comparative genomic hybridization (CGH) array technology.
0.2, P¼0.08 and r ¼ 0.01, P¼0.9, respectively). The strong negative cor- DESIGN: Prospective observational study.
relation between FF leptin levels and the number of oocytes retrieved per- MATERIALS AND METHODS: Embryo biopsies were carried out with
sisted after controlling for age and total gonadotropin used (b ¼ 0.62, CGH-array technique and performed in both D (day) 3 and D5 of in vitro cul-
P¼0.016) among women with DOR. Similar negative correlations were found ture. Euploid embryos were transferred on D5 and D6. AMH serum levels
between FF leptin/adiponectin ratio and AFC and the number of oocytes re- were measured by immunoassay within 3 months of IVF treatment. Women’s
trieved in women with DOR but not in women with NOR (data not shown). age, AMH levels and aneuploidies in biopsied embryos were the endpoints.
CONCLUSION: We report for the first time that elevated BMI and asso- Student’s t test or Mann-Whitney’s U test were used where appropriate. Sig-
ciated elevated FF leptin levels correlate negatively with AFC and ovarian nificance was attained at P<0.05.
response only in women with DOR. We speculate that obesity-induced alter- RESULTS: Embryo biopsy was performed in 345 embryos derived
ations in ovarian milieu further diminishes the quantity of oocytes, a phenom- from 122 women who had mean age of 38  4 years and mean AMH
enon that becomes clinically more apparent in women with already levels of 1.7  1.4 ng/mL. Mean number of embryos biopsied per women
decreased ovarian reserve. was 3  1.4. Sixty two women had ET cancellation due to aneuploidies
Supported by: The Department of Obstetrics and Gynecology of Albert in all embryos. Mean AMH levels of these women were 1.3  1.2ng/mL.
Einstein College of Medicine. Women who had euploid embryos had a mean AMH levels of 2.2 
1.5ng/mL (P¼0.041).Mean age of women who had an embryo transfer
was 36  3.5 years versus 39  3.4 years for those who had a cancella-
O-191 Tuesday, October 18, 2011 05:15 PM
tion of ET (p < 0.0001). Women under 36 years who had an AMH >
ADDITION OF RECOMBINANT LH IN POOR RESPONDERS UN- 1.15ng/mL had an ET cancellation rate of 30%, which was not statically
DERGOING OVARIAN STIMULATION WITH RECOMBINANT different from women above 36 years with an AMH >1.15ng/mL who
FSH AND GNRH ANALOGUES FOR IN VITRO FERTILIZATION: had an ET cancellation rate of 50% (P¼0.63). On the other hand, if
A SYSTEMATIC REVIEW AND META-ANALYSIS. C. A. Venetis, AMH level was <1.15ng/mL in women above 36 years ET cancellation
E. M. Kolibianakis, J. Bosdou, K. Toulis, D. G. Goulis, B. C. Tarlatzis. 1st rate was 78%.
Dept. of OB/Gyn, Unit for Human Reproduction, Aristotle University of CONCLUSION: The chance of having an embryo transfer cancellation
Thessaloniki, Medical School, N. Efkarpia, Thessaloniki, Greece. due to chromosomal abnormalities in all embryos biopsied with CGH array
technique is correlated with lower AMH levels. This fact is most likely due to
OBJECTIVE: The aim of this systematic review and meta-analysis is to a lower oocyte quality which is associated with to a reduced ovarian reserve
summarize the existing evidence regarding the effect of recombinant lutei- expressed by levels of AMH under 1.15ng/mL.