significantly higher in unexplained group (p<0.01).
Tubal factor group had compared to Gn-ant cycles of the patients (1170660 IU vs 2073710 IU,
significantly higher serum sFasL but lower follicular fluid sFasL and TAC
levels when compared to unexplained group (p<0.05).
CONCLUSION: Our results suggest that antiapoptotic and antioxidant ac-
tivity are impaired in patients undergoing IVF due to tubal factor, endometri-
osis, PCOS and unexplained infertility. Prospective larger studies are needed
to clarify this relation.
Supported by: This study Supported by Grant No: 02/2011-36 Gazi Uni-
versity, Ankara, Turkey.
P-1249 Thursday, October 17, 2013
LOCAL INJURY TO THE ENDOMETRIUM ENHANCES CLINICAL
PREGNANCY RATE IN PATIENTS UNDERGOING IN VITRO
FERTILIZATION (IVF)/INTRACYTOPLASMIC SPERM INJEC-
TION (ICSI). Y.-W. Chang,a H.-Y. Li,a,b,c W.-H. Li,a C.-M. Juang,a,b,c
P.-H. Wang,a,b,c K.-C. Chao.a,b aDepartment of Obstetrics and Gynecology,
Taipei Veterans General Hospital, Taipei, Taiwan; bDepartment of Obstetrics
and Gynecology, National Yang-Ming University School of Medicine, Tai-
pei, Taiwan; cInstitute of Clinical Medicine, National Yang-Ming University,
Taipei, Taiwan.
OBJECTIVE: To investigate the influence of local injury to the endome-
trium on pregnancy rate among IVF/ICSI patients.
DESIGN: Retrospective analysis.
MATERIALS AND METHODS: Three hundred and ninety-two good
responder patients equal or less than 40 years old undergoing IVF/ICSI be-
tween September 2011 and December 2012 were recruited and divided
into control group (n¼260), mild local injury of endometrium group
(n¼75) and complete local injury of endometrium group (n¼57). No endo-
metrial injury was performed in patients of control group. Local endometrial
injuries were performed in the luteal phase of the preceding cycle. In patients
of mild local injury of endometrium group, the endometrial surface was
scratched for two times by a sounding probe. In patients of complete local
injury of endometrium group, hysteroscopy and dilatation/curettage were
performed. Chi-Square test was used to evaluate the clinical pregnancy
rate in different groups. Binary logistic regression was used to adjust for
the potential confounders of age, embryo quality and day of embryo transfer
(ET; D2/D3 and D5). P<0.05 was considered statistically significant.
RESULTS: There were no significant differences among the control and
complete local injury of endometrium groups in terms of the age of the pa-
tients, baseline antral follicle count (AFC), progesterone level at trigger,
number and quality of embryos transferred and day of embryo transfer. After
adjusting for age, embryo quality and day of embryo transfer, clinical preg-
nancy rate was significantly higher in mild local injury of endometrium group
and complete local injury of endometrium group than in control group
(37.3% vs. 45.33% vs. 57.89% for control, mild local injury of endometrium
and complete local injury of endometrium groups, respectively, P¼0.014).
CONCLUSION: Either mild or complete local endometrial injuries per-
formed in the luteal phase of the preceding cycle significantly increases
the clinical pregnancy rate in IVF/ICSI patients.
P-1250 Thursday, October 17, 2013
LETROZOLE IN POOR RESPONDERS: A COMPARATIVE STUDY
WITH PREVIOUS CYCLES. A. Ersahin, B. Gorgen, S. Kahraman. As-
sisted Reproductive Technologies and Reproductive Genetics Center, Memo-
rial Hospital, Istanbul, Turkey.
OBJECTIVE: We aim to compare IVF outcomes of sequential use of Le-
trozole and rFSH (Let-ant) with only rFSH (Gn-ant) of the same patients with
poor ovarian response.
DESIGN: Retrospective, case-control study.
MATERIALS AND METHODS: Thirty patients who had undergone Gn-
ant stimulation followed by Let-ant protocol were retrospectively identified.
In the first Gn-ant protocol COS was achieved by the use of 337112.5 IU
rFSH starting on the 2nd day of the menstrual cycle. In the Let-ant protocol, pa-
tients received letrozole 5mg daily starting on the 2nd day of the menstrual cy-
cle for five days combined with 22471.2 IU rFSH starting on the 4th day of the
cycle. In both groups the pituitary blockage was achieved with the use of the
GnRH antagonist cetrorelix in a flexible protocol. The ICSI outcomes were
compared between the groups. Student t-test and chi square analysis were used.
RESULTS: Patients included were R40 years old and number of mean pre-
vious cycles was 4.57 2.4. The amount of rFSH administered and estradiol
levels on the day of hCG trigger were significantly lower in the Let-ant cycles
S508 ASRM Abstracts
P<0.001 and 290217 pg/mL vs 13571050 pg/mL, P<0.001). Number of
oocytes retrieved and mature oocytes were significantly lower after Let-ant
protocol compared to Gn-ant protocol (3.22.1 vs 5.83.5, P<0.05 and
2.21.7 vs 3.51.9, P<0.05). However, fertilization rates (%95 vs %80,
P<0.001), the rate of at least one top-quality embryo transferred (%80 vs %
50, P<0.001) and clinical pregnancy rates (%22 vs %11, P<0.001) were
higher with Let-ant protocol compared to Gn-ant protocol. The implantation
rates after Let-ant and Gn-ant protocols were 17% and %6.6, respectively.
CONCLUSION: The use of letrozole associated to gonadotropins is a suit-
able protocol for COS in women with poor ovarian response, being not only
cost-saving but also efficient resulting in satisfactory implantation and preg-
nancy rates compared to Gn-ant protocol.
P-1251 Thursday, October 17, 2013
DAY 3 FSH IS INVERSELY CORRELATED WITH SERUM DHEAS
LEVEL IN PATIENTS UNDERGOING IVF. D. E. Ikhena,a
A. Kallen,b P. H. Kodaman,b L. Pal.b aDepartment of Obstetrics and Gyne-
cology, University of Massachusetts Medical School, Worcester, MA; bDe-
partment of Obstetrics, Gynecology, and Reproductive Sciences, Yale
University School of Medicine, New Haven, CT.
OBJECTIVE: Given that circulating DHEAS levels decline with aging and
that DHEA supplementation has been suggested to improve ovarian response
in women with evidence of diminished ovarian reserve, we aimed to assess
whether endogenous DHEAS levels relate to ovarian reserve, response and
IVF outcomes.
DESIGN: Prospective observational study. This study was approved by the
institutional review board at Yale University School of Medicine.
MATERIALS AND METHODS: Early follicular phase serum DHEAS
levels were assessed in addition to markers of ovarian reserve (FSH, AMH,
E2) in cycles of non-PCOS women (n¼53) undergoing IVF. Patient specific
information (age, ethnicity, BMI, infertility diagnosis), and IVF cycle param-
eters (gonadotropin dose, use of GnRH agonist vs. antagonist, duration of
ovarian stimulation, peak E2 level, number of follicles and eggs retrieved,
fertilization, implantation and clinical pregnancy rates) were obtained from
patient records. Relationships between serum DHEAS levels, ovarian
response and cycle outcomes were assessed using multivariable analyses.
RESULTS: The mean age and BMI for the population were 34.7 years and
27.3 kg/m2, respectively. An inverse correlation was observed between day 3
serum DHEAS and FSH levels (r -0.31, p¼0.03) and this relationship was in-
dependent of age, BMI and smoking status (b coefficient -0.01, p¼0.03). No
relationship was seen between serum DHEAS levels and AMH nor with IVF
cycle response or outcome.
TABLE 1.
Day 3 FSH Coefficient P value 95% Confidence Interval
DHEAS 0.011 0.033 -0.020, -0.001
Age 0.246 0.000 0.128, 0.364
BMI 0.025 0.751 -0.025, 0.133
Smoking 15.154 0.000 11.434, 18.874
CONCLUSION: Our findings suggest that endogenous DHEAS levels may
inversely relate to at least one parameter reflective of ovarian reserve, i.e.
endogenous FSH. Implications of endogenous DHEAS for ovarian response
to exogenous gonadotropins or to IVF outcome, as well as potential mecha-
nisms relating DHEAS to FSH levels, are unclear and merit further study.
P-1252 Thursday, October 17, 2013
ECTOPIC PREGNANCY RATES IN DAY 3 VERSUS DAY 5 EMBRYO
TRANSFERS IN FRESH IVF CYCLES. A. S. Q. Kathiresan,a,b
M. Rodriguez,b E. Wang,a,b M. D. Pisarska,a,b D. Hill,c C. Alexander.a,b
a
Obstetrics and Gynecology, University of California, Los Angeles, Los
Angeles, CA; bObstetrics and Gynecology, Cedars Sinai Medical Center,
Los Angeles, CA; cART Reproductive Center, Beverly Hills, CA.
OBJECTIVE: Some studies have suspected that day 5 embryo transfers
(ET) may be associated with lower ectopic rates; however, the few studies
Vol. 100, No. 3, Supplement, September 2013