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Immediate post-transfer voiding does not affect pregnancy rates. Eliz-abeth Russell, Melanie Acosta, Sharon Grunfeld, Kristin Beer, JeanneGraziano, Tanmoy Mukherjee. Reproductive Medicine Assoc of NY, Newyork, NY.

Objective: As transabdominal ultrasound guided embryo transfer be-comes more common, the need for immediate post transfer voiding alsoincreases. While a full bladder provides the necessary acoustic window forproper abdominal sonography, and greatly improves embryo transfer tech-nique, the added patient discomfort following the procedure must be re-lieved in some cases by immediate voiding. A number of patients expressedconcern that the discomfort of a full bladder or immediate voiding jeopar-dized their clinical outcome. We undertook this study to examine theconsequences of immediate post transfer voiding on success rate.

Design: Retrospective analysis of 80 consecutive embryo transfers in alarge metropolitan IVF center.

Materials and Methods: Embryo transfer records of 80 consecutive cases(8/02-10/02) were reviewed. Voiding information was collected from nurs-ing records. Patients undergoing fresh self, cryo self, fresh donor oocyte andcryo donor oocyte were included. Patients are routinely instructed to remainrecumbent for 20 min after embryo transfer. At that point they are permittedto use the lavoratory. In cases where patient discomfort required immediatevoiding, a bedpan was provided. Patients were instructed to urinate in thebedpan while remaining in the recumbent position. Parametric data wasassessed by the Student’s t-test, non parametric data was analyzed by Chisquare testing. Small cell frequencies were analyzed by Fisher’s exact test.

Results: Of 80 transfers analyzed, 18 patients required immediate posttransfer voiding. The success rate as determined by two consecutive risinghCG levels in the immediate voiding group per embryo transfer was 77%(14/18, positive pregnancy test/embryo transfer*), the success rate in theroutine voiding group was 72% (45/62). No significant difference was notedin age, duration of stimulation and, multiple pregnancies between the twogroups. This similarity was consistent for both fresh and cryopreservedembryo transfers.

Conclusion: Immediate voiding post embryo transfer does not diminishsuccess rate. Neither the increased abdominal pressure(Valsalva maneuver)needed to elevate the pelvis nor position change necessary to utilize thebedpan diminished success rate. Also the increased vesicular discomfortassociated with the need for immediate voiding does not affect IVF success.Patients may reassured that immediate voiding does not affect IVF outcome.

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Follicle number after 5 days of stimulation as a predictor of oocyte yieldfor in vitro fertilization. Karen R. Hammond, Sejal P. Dharia, Michael P.Steinkampf. Univ of Alabama at Birmingham, Birmingham, AL.

Objective: Assessment of ovarian reserve has become an integral com-ponent of the pretreatment evaluation for in vitro fertilization (IVF). Thepurpose of this study was to determine whether the follicle number on thefirst monitoring visit after initiating gonadotropin stimulation could be usedas a predictor of oocyte yield in IVF.

Design: Retrospective study in an academic reproductive technologyprogram.

Materials and Methods: The medical records of all IVF cycles performedbetween January 1, 2000 and March 31, 2003 were reviewed. Only patientswho underwent down-regulation with leuprolide acetate followed by go-nadotropin administration (a combination of r-FSH and HMG) who com-pleted an oocyte retrieval were included in the analysis. A transvaginalultrasound (measuring both ovaries and the largest 4 follicles on each ovaryin three perpendicular planes and noting the total number of follicles) andestradiol levels were performed to confirm down-regulation, after 5 days ofgonadotropin administration, and every one to three days, as appropriate.Statistical analyses were performed using t-tests and univariate and multi-variate regression analysis.

Results: A total of 241 cycles were included in the analysis. The meanpatient age was 33.1 years (range19-42), antral follicle count at baseline was13.1 (range 0-41), and the baseline ovarian volume was 9.7 cm3 (range2.5-63.1). The mean initial gonadotropin dose was 5.2 ampules per day(range 2-10). The mean serum estradiol level after 5 days of stimulation was623.5 pg/mL (range 25-6,008) and the mean follicle number on that day was18.2 (range 0-50). The mean length of gonadotropin stimulation was 9.4days (range 5-17), and the mean number of oocytes retrieved was 15.4(range 3-37). The follicle number after 5 days of stimulation was a betterpredictor of oocyte yield (R2 � 0.55, P � 0.001) than patient age (R2 �0.13, P � 0.001), baseline antral follicle count (R2 � 0.13, P � 0.0001), orovarian volume at baseline ultrasound (R2 � 0.026, P � 0.087). The serumestradiol level after 5 days of stimulation gave intermediate predictive value(R2 � 0.28, p � 0.0001). When multivariate analysis of patient age,baseline antral follicle count and ovarian volume, and follicle number after5 days of stimulation was performed, only patient age and follicle numberafter 5 days of stimulation remained as independent predictors of oocyteyield.

Conclusion: The number of follicles observed after 5 days of ovarianstimulation is highly predictive of oocyte yield in IVF cycles.

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Is there a true difference in the amount of drug delivered using differ-ent brands of 1 ml syringes versus the pen-injector device? ShiraBenson, G. Scot Hamilton, Mathias Gysler. ISIS Regional Fertility Ctr,Mississauga, ON, Canada.

Objective: An area of prominent concern for nurses is teaching patients toinject their medications in a precise manner to insure they receive the fulldose of the prescribed drug. Both technique and injection device are criticalelements in this process, as the vast majority of infertility medications areadministered by injection. In late 2001, a new device for drug administra-tion, the Puregon Pen(r) (a pen-injector), was introduced in the Canadianmarket. An earlier report from the sponsor suggested that the actual amountof rFSH injected with a standard syringe was 18% less than anticipatedwhen compared to the pen-injector(1). Based on this study the pen-injectoris characterized as a precision device which delivers an exact dose andtherefore, on average, delivers 18% more FSH per injection than a conven-tional syringe. Considering an average 10-day ART protocol using 225IU/day, 2250 IU would be injected in total. According to the 18% wastepresumption, 405 IU would not be delivered if syringes are used. Thisdifference equates to more than 1.5 missed doses, which could negativelyimpact treatment outcome. Therefore, if the wastage claim is true, mostpatients have been under-dosed and have paid for more drug than theyreceived. The objective of this study is to test the theory that the syringes are18% less precise than the pen-injector for drug delivery.

Design: Comparative trial.Materials and Methods: Two conventional brands of 1 mL syringes

(Becton Dickinson [BD] and Monoject(r) with detachable 27G � 1/2 inchneedle) and one customized 1 mL syringe (Serono/Terumo with fixed27G � 1/2 inch needle) were compared to the Puregon Pen injector withdetachable 29G � 1/2 inch needle. To compare the delivery capacity of thesyringes with the pen-injector, the pen was calibrated to deliver 0.5 mL (425IU) of FSH solution from the enclosed cartridge. The delivered solution wasweighed in a highly sensitive AX204 Mettler Toledo-Sartorius balance.Each of the three syringes was used to aspirate 0.5 mL of the same liquidFSH solution, and the volume delivered by each syringe was weighed andcompared with the volume delivered by the pen-injector. Each measurementwas repeated 5 times and a mean value was calculated.

Results: The data obtained from these measurements are presented below.No statistically significant difference was observed when comparing thevolume weights delivered by each device.

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