MATERIALS AND METHODS: We reviewed the outcome of ine contractions, but also decreases the ability of the uterus
ses the ability of the uterus to perform an ef-
Day 5 embryo transfer (ET) made using fresh embryos (fresh group,
633 cycles) and frozen and thawed blastocysts transfer following
assisted hatching (AH) using blastocysts with grade C TE by Gardner’s
score (frozen-thawed group, 44 cycles) between January 1, 2008
and December 31, 2010. Blastocysts judged as grade C for TE
development were classified by embryo morphology into two groups:
fragmented group (R20% fragmentation) and unfragmented group
(<20% fragmentation). All embryos had R6 cells and uniform blasto-
meres on Day 3. Change of TE grade and successful implantation rate
were assessed for the frozen-thawed group. Blastocysts with grade C
TE prior to freezing were evaluated for TE grade prior to ET and observed
for changes in TE by removing the fragments induced by AH (25% of
zona drilling).
RESULTS: Blastocysts with grade C TE development appeared with sig-
nificantly higher frequency in the fragmented group 26.4% (47/178) than in
the unfragmented group 7.6% (93/1219). Blastocysts of grade C TE changed
to TE grades A or B (21/44; 47.7%), grade C (16/44; 34.1%), or ‘‘shrink’’ (7/
44; 15.9%). Successful implantation rate was 38.1% (8/21), 12.5% (2/16),
and 0.0% (0/7), respectively.
CONCLUSION: Our results suggest that fragmentation adversely affects
TE grade. Because fragmentation removal by AH improves TE grade and im-
plantation rate, it is possible that the quality of blastocysts with grade C TE
was improved by the further processing. Furthermore, blastocysts with grade
C TE are suitable for embryo transfer.
IMPLANTATION
P-242 Tuesday, October 23, 2012
EFFECTS OF BARUSIBAN, A SELECTIVE OXYTOCIN
ANTAGONIST, ON UTERINE CONTRACTILITY IN THE LUTEAL
PHASE AFTER CONTROLLED OVARIAN
STIMULATION. H. Visnova,a R. A. Pierson,b M. Mrazek,c
J. A. Garcıa-Velasco,d C. Blockeel,e J.-C. Arce.f aClinic for Assisted Repro-
duction, IVF CUBE, Prague, Czech Republic; bObstetrics Gynecology and
Reproductive Sciences, College of Medicine, University of Saskatchewan,
Saskatoon, SK, Canada; cLighthouse, ISCARE IVF, Prague, Czech Repub-
lic; dReproductive Endocrinology, IVI Madrid, Madrid, Spain; eCentre for
Reproductive Medicine, University Hospital Brussels, Brussels, Belgium;
f
Reproductive Health, Global Clinical R&D, Ferring Pharmaceuticals,
Copenhagen, Denmark.
OBJECTIVE: To evaluate the effects of barusiban on uterine cont-
ractions (UC).
DESIGN: Double-blind RCT (ClincalTrial.gov NCT01043120).
MATERIALS AND METHODS: Oocyte donors were randomized
to receive barusiban (IV bolus 20 mg, IV infusion 19 mg; total duration
60 min) (N¼49) or placebo (saline) (N¼50) two days after oocyte re-
trieval. Transvaginal ultrasound (TVU) recordings of a continuous cine-
loop image of at least 5 min were obtained pre-dosing, 30 min after start
of dosing (30 min; main time point), immediately after a mock
embryo transfer (MET0min) performed 40 min after start of dosing, and
10 min and 1h after end of dosing. Frequency of UC, direction of the
waves and ability to complete uterine wave propagation were determined
by a blinded assessor, using a computer-assisted time series motion anal-
ysis software.
RESULTS: At 30 min, a significant mean decrease in frequency of 0.58
UC/min was found with barusiban vs placebo (P¼0.014). The proportion
of subjects with ability to complete wave propagation was similar for baru-
siban and placebo at pre-dosing (95% vs 98%), but significantly lower with
barusiban compared to placebo at 30 min (39% vs 70%, P¼0.006) and at
MET0min (29% vs 60%, P¼0.004). There was no significant difference be-
tween groups in direction of wave at any time point. The predominant direc-
tion of the wave at pre-dosing was cervical (from fundus to cervix) (73%),
rather than convergent/focal (8%), no activity (5%), fundal (2%) or not evalu-
able (12%). The direction of the wave changed progressively as a result of the
TVU with primarily cervical (41%) or convergent/focal (39%) at 30 min after
start of dosing, and mainly convergent/focal at MET0min (64%), at 10 min
(63%) and 1h (53%) after end of dosing.
CONCLUSION: Barusiban modifies uterine contractility in the luteal
phase after controlled ovarian stimulation by reducing the frequency of uter-
FERTILITY & STERILITYÒ
ficient full contraction by reducing uterine wave propagation.
Supported by: Ferring Pharmaceuticals.
P-243 Tuesday, October 23, 2012
THE EFFECT OF TRANSVAGINAL ENDOMETRIAL PERFUSION
WITH GRANULOCYTE COLONY-STIMULATING FACTOR
(G-CSF). Y. Y. Kim, Y. H. Jung, J. D. Jo, M. H. Kim, Y. J. Yoo,
S. Kim. Ellemedi OB/GYn, Changwon, Gyoung Nam, Republic of Korea.
OBJECTIVE: We often see patients with a thin endometrium in spite of
treatments with the vitamin E, sildenafil citrate, etc. It may be caused by im-
pairment of the normal process of endometrial growth. Improving endome-
trial growth in patients with a thin endometrium is very difficult. In order
to investigate the effectiveness of transvaginal endometrial perfusion with
granulocyte colony-stimulating factor(G-CSF), we administered this cyto-
kine in women with recurrent IVF failure due to poor endometrial develop-
ment.
DESIGN: Prospective clinical study.
MATERIALS AND METHODS: For the purpose of these trials 62 pa-
tients were studied for whom two IVF-ET cycles failed in which two or
more good-quality embryos were transferred. Hysteroscopies were per-
formed to detect endouterine abnormalities after the first failed IVF-ET cy-
cles in all patients. Patients were divided into two groups by intrauterine
synechea(Group A (n¼34): only poor endometrial development, Group
B(n¼28): severe uterine synechea). G-CSF (filgrastim 300m/1mL) to im-
prove endometrial thickness was direct administered by slow intrauterine in-
fusion using embryo transfer catheter on the day of hCG. Endometrial
thickness was assessed on the day of hCG administration and embryo trans-
fer. Pregnancy and implantation rates were evaluated.
RESULTS: Group A achieved an endometrial expansion
(6.31.4/8.71.2) in 85.2%(29/34) on the embryo transfer day, while
Group B(0/28) did not(6.11.3/6.51.4). The ongoing pregnancy and im-
plantation rates were significantly higher in Group A(47.0% and 29.4%, re-
spectively), than in Group B(3.5% and 1.7%).
CONCLUSION: Transvagial endometrial perfusion with granulocyte
colony-stimulating factor(G-CSF) enhanced endometrial development in
patients without synechea. The ongoing pregnancy and implantation rates
were significantly higher. Unfortunately, in patients with intrauterine syn-
echea did not achieve an endometrial expansion. Further studies are
needed to show conclusively the effectiveness of transvagial endometrial
perfusion with G-CSF.
P-244 Tuesday, October 23, 2012
EFFECT OF TAKING A ONE TIME INJECTION OF 1MG LEUPRO-
LIDE ACETATE 3 DAYS AFTER EMBRYO TRANSFER ON PREG-
NANCY OUTCOME AND LEVEL OF FIRST BETA HUMAN
CHORIONIC GONADOTROPIN (b-hCG) LEVEL. J. H. Check,a,b
J. K. Choe,a D. Brasile,a R. Cohen,c D. Summers-Chase.a aDept. OB/
GYN, Div. Repro. Endo. & Infertility, UMDNJ, Robert Wood Johnson
Med. School at Camden, Camden, NJ; bDept. OB/GYN, Div. Repro.
Endo. & Infertility, Cooper Medical School of Rowen University, Camden,
NJ; cDept. OB/GYN, Philadelphia College of Osteopathic Medicine,
Philadelphia, PA.
OBJECTIVE: To determine if injecting 1mg leuprolide acetate (LA) in the
mid-luteal phase will improve pregnancy outcome following embryo trans-
fer.
DESIGN: Prospective cohort comparison.
MATERIALS AND METHODS: 1 of 3 in vitro fertilization-embryo trans-
fer (IVF-ET) cycles using a gonadotropin releasing hormone antagonist pro-
tocol was supplemented with 1mg LA 3 days after ET. There was no
restriction for day 3 follicle stimulating hormone (FSH) levels. The data
were stratified according to 4 age groups. Chi-square analysis was used for
comparison.
RESULTS: The clinical and ongoing/delivered pregnancy rates (PRs) ac-
cording to age up to%42 is seen in Table 1. For age>43 the clinical and live
pregnancy rates were 8.7% (2/23) and 4.3% without LA vs. 25% (2/8) and
12.5% with LA. The average 1st beta-hCG was 192.5 without and 137.3
with LA. Implantation rates were 3.4% and 8.3%, respectively. The clinical
and live delivered PRs were higher in all 4 age groups in those using LA.
S183