Monday, October 20, 1997

C l i n i c a l F e m a l e I n f e r t i l i t y a n d G y n e c o l o g y

P-001

A R e v i e w o f 544 C l o m i p h e n e Ci trate Cyc les With hCG-Timed I n t r a u t e r i n e I n s e m i n a t i o n (cc/hCG/ IUI). S. W. Trout. Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood John- son Medical School, New Brunswick, NJ.

Objectives: To review our cc/hCG/IUI cycles to deter- mine ultrasound and patient parameters that predict suc- cessful treatment.

Design: A retrospective analysis of all cc/hCG/IUI cycles done through the University Center for Reproductive En- docrinology and Fertility in 1995.

Materials and Methods: All cc/hCG/IUI cycles per- formed in 1995 with fresh sperm were reviewed. Patient, ultrasound, and cycle specific data were recorded. Cycles resulting in pregnancy were then compared to those that did not result in pregnancy.

Results: There were 544 cycles of cc/hCG/IUI performed. From these 544 cycles there were 43 clinical pregnancies (8%), 6 blighted ova (1%), 4 ectopic pregnancies (0.7%), and 3 biochemical pregnancies (0.5%). The average age of those who became pregnant and those who did not was identical (33 years old). There was no significant difference in the duration of their infertility. Among the patients with endometriosis, there was only one pregnancy (p < 0.05 for endometriosis hindering the achievement of preg- nancy). There were no other significant differences for any of the other diagnoses. Patients who became pregnant were more likely to have higher parity (p < 0.05).

When the day-of-hCG ultrasound data were examined, there was a statistically significant increase in the number of 18-20 mm follicles seen (p < 0.005) in the cycles that resulted in pregnancy. There was a trend towards more 21 to 23 mm follicles (p = 0.07). When the total number of follicles on the ultrasound was compared, there were more follicles in the pregnancy cycles (p < 0.05) with the vast majority having three or more follicles. There were no pregnancies when the endometrial lining had a homo- geneous pattern. The thickness of the lining, however, had no significant effect. There was a highly significant differ- ence (p < 0.00000005) in the total number of motile sperm inseminated in pregnancy vs. non-pregnancy cycles.

Conclusions: The regimen of cc/hCG/IUI has a clinical pregnancy rate of 8% per cycle. Couples with low sperm counts or endometriosis may be poor candidates, while multiparous couples may be the ideal candidates. The goal of therapy should be to generate three or more follicles, and the ultrasound criteria for giving hCG should include a trilaminar lining and follicles in the 18-20 mm range.

P - 0 0 2

D i s t u r b a n c e s in t h e Late L u t e a l - - E a r l y Fo l l i cu lar P h a s e T r a n s i t i o n in Infer t i l e W o m e n o f A d v a n c e d R e p r o d u c t i v e Age.*lR. Buyalos, "2S. Daneshmond, ,2p. Brzechffa. Departments of Ob/Gyn, University of Ken-

tucky School of Medicine, Lexington, KY 1 and UCLA School of Medicine, Los Angeles, CA 2.

An elevation in basal serum [day 2 or 3] FSH concentra- tions portend a poor prognosis for pregnancy with con- trolled ovarian hyperstimulation (COH) and intrauterine insemination (IUI). However, clinical experience demon- strates that low pregnancy rates and a poor response to COH are observed in many women receiving this therapy despite normal basal FSH levels. Follicular recruitment is initiated in the late luteal phase of the proceeding cycles. A monotrophic rise in FSH in the late luteal phase can induce an increase in estradiol (E2) production by the gran- ulosa resulting in a reciprocal decrease in day 3 FSH lev- els. We prospectively measured basal E2 and basal FSH levels in 101 women -> 38 years of age (range 38-47 yrs) prior to undergoing COH/IUI treatment. Basal levels of E2, FSH, and pregnancy rates (per treatment cycle and per women) after 324 treatment cycles are shown below:

Clinical Live Birth Live Birth E2 FSH Pts Pregnancy Rate per Rate per

(pg/mL) (mIU/mL) (n) Rate per Cycle Cycle Woman

<-80 -<13 79 11.6% (29/249) 9.2% (23/249) 29.1% (23/79) >80 and/or >13 22 4.0% (3/75) 0% (0/75) 0% (0/22)

Results: 1) All live births occurred in women with basal E2 -< 80 pg/ml and FSH - 13 mIU/mL. 2) the live birth rate per cycle (p < 0.01) and per woman (p = 0.01) were higher in patients with normal basal levels of both E~ and FSH. 3) 11.9% of women with normal basal FSH (~13 mIU/mL) had elevated basal E2 levels (>80 pg/mL), and no live births occurred in this group of women. 4) The mean chronological age was similar in patients with nor- mal and elevated basal E2 and FSH levels, (p ~ 0.3).

Conclusions: Basal E2 in combination with FSH im- proves the ability to predict fecundity in older women re- ceiving COH/IUI. Alterations in E2-FSH dynamics occur in women of advanced reproductive age with diminished fertility potential.

P - 0 0 3

B i la tera l V i sua l D i s t u r b a n c e s in P a t i e n t s o n Clomi- p h e n e Ci trate Ar ise F r o m the Centra l N e r v o u s Sys- tem. 1p. Claman, 2D. Zackon, 3p. Casson, 2E. Casson. 1'3Di- visions of Reproductive Medicine, Departments of Obstetrics & Gynecology and 2University of Ottawa Eye Institute, iUniversity of Ottawa, Ottawa ON., Canada and 3Baylor College of Medicine, Houston, TX.

Objective: To study the etiology of visual side effects seen on clopmiphene citrate.

Design: We assessed visual performance in 4 women between the ages of 31 and 37 who were under treatment for infertility with clomiphene citrate.

Materials and Methods: Two patients were being treated for oligovoulation secondary to PCOD, one patient for Luteal Phase Deficiency and one patient for Idiopathic Infertility. Doses were: 50 mg cycle days 3-7; 100 mg days 3-7; 100 mg days 3-9; 200 mg days 3-9. All patients had

Abstracts $93