Abstracts of the 15th Annual meeting of the ESHRE, Tours, France 1999
infections are frequently quoted, and more especially semen
infections with Chlamydia trachoma tis. Our objective was to
look for the presence of C.trachomatis in semen of male
members of infertile couples and correlate the results with
semen analysis to evaluate the impact of infection on sperm
quality.
Materials and methods: Semen samples of 103 men were
tested for C.trachomatis by means of a commercial polymerase
chain reaction (PCR) test, Cobas Amplicor. Semen samples
were also analysed for routine parameters such as volume,
sperm count, motility, viability and morphology and leukocytospermia
Results: Semen specimens were categorized as negative (92
patients) or positive (11 patients) for C.trachomatis. The
comparison of semen characteristics between infected or noninfected men showed a significant (P = 0.03) decrease of
typic forms of spermatozoa (31% versus 44%). The sperm
concentration was 22X 106/ml in the positive group
and 61 X 106/ml in the negative group. This difference was
statistically significant (P = 0.06). There was no relationship
between IVF results (cleavage rate and pregnancy rate) and
the occurrence of C.trachomatis.
Conclusion: In our series, PCR is one of the best methods
to detect C.trachomatis in semen before IVF. We found
a relationship between sperm quality and the presence of
C.trachomatis in semen.
R-144. Antiphospholipid antibodies in infertile couples
with two consecutive miscarriages after in-vitro
fertilization and embryo transfer
Egbase p.E. I,3, Al Sharhan M. I , Diejomaoh M. 2 and
Grudzinskas J.G.3
lIVF Centre, Maternity Hospital, Kuwait, 2Kuwait University
and 3The Royal London School of Medicine & Dentistry,
London, UK
Introduction: Whereas antiphospholipid antibodies (APA),
namely the lupus anticoagulant (LA) and anticardiolipin (aCL),
have become routine in the evaluation of women having
recurrent abortion, there is no agreement amongst reports in
the literature that such tests should be performed on all invitro fertilization (IVF) patients as they are probably a poor
predictor of IVF cycle outcome. But should consideration be
given to performing APA in all patients in whom their IVF
treatment cycles end in one or two clinical miscarriages? This
study investigated the prevalence of APA in infertile couples
who conceived having undergone IVF or intracytoplasmic
injection (ICSI)-embryo transfer but miscarried on two
consecutive occasions compared with two control groups of
women: non-infertile women with recurrent abortion (three or
more consecutive miscarriages of natural conceptions and
women with primary infertility undergoing their first IVF or
ICSI treatment cycle.
Materials and methods: A retrospective analysis of the case
records of 1027 treatment cycles in 682 women with oocyte
retrieval procedures for conventional IVF or ICSI-embryo
transfer from January 1995 to December 1997 at a tertiary
IVF Centre was carried out. 16 women (group 1) with
two consecutive clinical abortions of pregnancies before 20
completed weeks of gestation conceived after repeat conventional IVF or ICSI-embryo transfer were evaluated for APA
in the period of 3-6 months after the last abortion. The control
population (group 2) was 42 consecutive non-infertile women
with recurrent miscarriages (three or more consecutive abortions) who registered at the recurrent abortion clinic and 60
consecutive women (group 3) with primary infertility (no
previous pregnancies) undergoing their first IVF or ICSI
treatment cycle in the 3-6 months when the APA was being
evaluated in group 1 (study group). Blood samples were taken
according to approved protocols and evaluated for the presence
of aCL using the enzyme-linked immunosorbent assay method;
and LA was detected using prothrombin time, activated partial
thromboplastin time, kaolin clotting time, diluted Russell's
viper venom time and tissue thromboplastin inhibition test.
Patients were considered to be APA seropositive when the
aCL (lgG and/or IgM), LA or both were shown to be positive
on two occasions at least 6-8 weeks apart. The statistical
differences in seropositivity in the three groups of patients
were compared using the X2-test.
Results: The mean age, cause and duration of infertility
(group 1 and 3) and the live births and abortions (group 1
and 2) were similar in relevant groups. The peripheral blood
karyotype was normal in all patients in the three groups. The
number of APA seropositive patients with two consecutive
abortions after repeat IVF or ICSI in group 1 (4/6) and in
non-infertile women with three or more recurrent abortions in
group 2 (9/42) were similar (25.0 versus 21.4%), P = 0.77.
The difference was statistically significant when either group 1
or group 2 women was compared with the women with primary
infertility being treated with first IVF or ICSI cycle in group 3
(25.0 versus 6.6%, P = 0.033; 21.42 versus 6.6%, P = 0.027).
Conclusion: Opinion differs as to whether two pregnancy
losses should be included in the definition, as the efficacy of
commencing investigations after two losses has not been
established. The results of this study suggest that the occurrence
of two consecutive miscarriages (rather than three or more
pregnancy losses) after repeat IVF or ICSI defines a subset of
IVF patients for whom we would advise routine APA screening
prior to further assisted reproduction treatment.
R-145. A comparison of spontaneous abortion rates in
women with asymptomatic versus symptomatic
subchorionic haematomas during the first trimester
Check J.H., Choe J.K. and Nazari A.
UMDNJ, Robert Wood Johnson Medical Hospital at
Camden, Cooper Hospital/University Medical Center, Dept
Ob/Gyn, Div. Rep rod. Endo. & Infertility, Camden, NJ, USA
Introduction: One of the causes of spontaneous abortion
(SAB) is a deficiency of progesterone during the early first
trimester especially during the time that the major production
of this hormone is by the corpus luteum of pregnancy. However,
343
Abstracts of the 15th Annual Meeting of the ESHRE, Tours, France 1999
despite aggressive progesterone supplementation some pregnant women have bleeding and cramping and many of the
patients are found to have a subchorionic haematoma. Furthermore, some asymptomatic pregnant women are also found to
have subchorionic haematomas. The study presented here
compared the SAB rate in women who were symptomatic
versus asymptomatic. Furthermore, the study evaluated whether
there was any greater adverse effect of these haematomas
in pregnancies following in-vitro fertilization (IVF) versus
pregnancies achieved without IVF.
Materials and methods: Serum progesterone levels were
carefully monitored at least once per week and sera levels
were maintained at a level of at least 35 ng/ml by the use of
various combinations of progesterone vaginal suppositories
or cream, intramuscular progesterone, or oral micronized
progesterone. All ultrasounds were done transvaginally using
an Apogee 800 unit equipped with a 7.5 MHz endovaginal
transducer. The size (volume), site (supracervical versus
fundus-corpus), and gestational age when first detected, were
recorded.
Results: There were 35 patients who conceived following IVF
with a subchorionic haematomas compared to 34 with a
symptomatic subchorionic haematoma. The mmimum,
maximum and median ages were 28--43, 35 years for the
former and 25--49, 34.5 for the latter. All 35 asymptomatic
women had haematomas <5 ml, but so did the large majority of
symptomatic patients (31/34, 91.1%). The minimum, maximum
and median gestational ages when the haematoma was first seen
were 4.86-11.0, 7.0 weeks for the asymptomatic versus 4.8610.6, 6.93 for symptomatic patients. The location of the
haematoma was corpus-fundus in 85.2% of asymptomatic
patients versus 83.8% of symptomatic women. The large
majority of asymptomatic and symptomatic patients resolved
their haematoma (94.3 versus 88.2%). The minimum, maximum and median ages at which the haematomas resolved
were 6.57--40, 11.57; for asymptomatic versus 8.4316.57, 11.29; for those with symptomatic haematomas. There
were three SAB (8.6%) in those with asymptomatic haematomas and three (8.8%) with symptomatic ones. For non-IVF
pregnancies there were 40 versus 14 patients with asymptomatic versus symptomatic haematomas. Minimum, maximum,
median ages 22--41, 32.5 versus 22--40, 32.5. Ninety-five
versus 85.7% were <5 ml. Median gestational age first
seen 7.86 versus 6.71. 82.8 versus 92.3% were corpusfundus. 92.5 versus 78.5% resolved. The minimum, maximum
and median ages at which the haematomas resolved were 6.2919.86, 11.86 versus 7.71-21.86, 11.57 weeks. SAB were found
in 3/40 (7.5%) asymptomatic patients versus 1/13 (7.1%) for
symptomatic patients. Combining both groups the SAB
were 8.0 versus 8.3%.
Conclusions: The presence of subchorionic haematomas are
not associated with high rates of first trimester SAB in
progesterone-treated women whether conception occurred
following IVF or not. The study was not designed to determine
if the use of progesterone helps to lower the rate of SAB.
344
R-146. Routine use in daily clinical practice of combined
treatment of ovulation induction with recombinant
follicle stimulating hormone and artificial insemination
Collaborative Group (correspondence to Ridao M.)
Instituto de investigacion en Servicios de Salud, Valencia,
Spain
Introduction: We aimed to analyse the patient characteristics,
the resources used and effectiveness of treatment consisting
of artificial insemination post-ovulation induction with the
latest generation of follicle stimulating hormone (recombinant
FSH: rFSH).~
Materials and methods: A retrospective collection of clinical
data concerning ovulation induction cycles performed between
January and April, 1998, a period following the availability in
Spain of the first recombinant FSH preparation (follitropin o;
Gonal-F®; Laboratorios Serono, SA, Madrid, Spain). Data
were solicited through a specific questionnaire covering the
patients' age, cause of infertility treated and treatment characteristics. A total of 24 clinics throughout the nation provided
information.
Results: Information was collected on 500 cycles. Distribution
by patients' ages was as follows: <25 years (0.9%); 25-29
(21.6%); 30-34 (51.6%); 35-39 (22.2%); 40--44 (2.3%); 4549 (1.4%). Causes of infertility were: male factor, 40%;
anovulation, 35.4%; unilateral tubal factor, 12%; cervical
factor, 9.6%; unexplained infertility, 7.6%; endometriosis, 5.4%; uterine factor, 3.4%; immunological factor, 3%;
luteal phase deficiency, 1%. Primary infertility accounted
for 81.3% of the cases and secondary infertility accounted
for 18.7%. In 5.7% of the cases treatment started on day 2 of
the cycle, in 72.2% on day 3, in 9% on day 4, in 10.7% on
day 5 and in 2.4% on day 6. The usual starting dose was one
ampoule (75 IV of rFSH), as recommended in the summary
of product characteristics. All of the cycles (100%) were
monitored through ultrasound (100% follicular monitoring;
67.8% study of endometrium). Oestradiol was checked
in 44.2% of the cycles. A single ultrasound examination was
performed in 32% of the cycles, two examinations were
performed in 27%, three were performed in 23%, four in 9%
and five or more in 9%. The average number of days of
stimulation was 8.6 (SD 3.41); and the total number of
ampoules administered was 9.11 (SD 4.44). After stimulation
the average number of follicles > 16 mm was 1.27 (SD 1.32)
and 1.27 (SD 1.32) > 10< 16 mm in diameter, with an
endometrial thickness of 9.10 mm. The cancellation rate
was 6% (3% hyper-response, 2.6% hypo-response, 0.4% dropouts). Day on which human chorionic gonadotrophin (HCG)
was administered: 12.5 (SD 2.9); day of primary insemination: 13.6 (SD 3.2). In 82.6% of the cases, insemination was
with the partner's semen, and in 12.2%, with donor semen.
Although programmed for insemination, 5.2% of the cycles
were completed with programmed coitus. In 80.8% and 19.2%
one or two inseminations were performed, respectively. Insemination was with an average of 15.4 (SD 8.1) X10 6 spermatozoa. Luteal phase support was administered in 64% of the
cycles (17.3% with HCG and 82.7% with progesterone).
Hyperstimulation was detected in 1% of the cycles (mild or