Univ Hosp of Wales, Cardiff, United Kingdom; Assisted Conception Unit,Birmingham, United Kingdom.

Objective: Many reports confirm that the presence of a hydrosalpinxsignificantly impairs IVF outcome. Women with hydrosalpinges benefitfrom salpingectomy prior IVF treatment. an alternative, simple method justas vaginal aspiration of hydrosalpinx fluid (HSF) has also shown benefit,although the evidence is based on retrospective studies. The aim of thisstudy was to test the hypothesis that vaginal ultrasound-guided HSF aspi-ration during egg collection would improve IVF outcome.

Design: Prospective randomised controlled trial in a tertiary referralcentre.

Materials and Methods: Patients were included if they were undergoingIVF/ICSI treatment and had a hydrosalpinx demonstrable on transvaginalultrasound scan. Fifty-one patients were assigned to one of two treatmentarms (aspiration group 26, non aspiration group 25) by using sealed opaqueenvelops. All patients underwent the same clinical protocol consisting ofluteal phase GnRH agonist down regulation followed by fixed dose gonad-otropin stimulation. In the aspiration group patients, the aspiration of thehydrosalpinx was performed at the end of the egg collection. The data wasanalysed using non-parametric and Chi-square tests.

Results: Both groups were comparable in terms of age, aetiology ofinfertility, stimulation regimen, number and quality of embryos transferred.No significant effect of HSF aspiration was seen on pregnancy rate. Therelevant results are summarised in the table below.

Conclusion: Although our small sample of randomised patients withhydrosalpinges did not reveal a significant difference in the clinical preg-nancy rate or miscarriage rate, as these are preliminary results, it is plannedto continue the study.

ART: CLINICAL: OTHER

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The value of genetic counseling evaluation of egg donors. KristiFordham, Denise Ramsey, Sucheta Bhatt. Genzyme Genetics, Miami, FL.

Objective: This study addresses the importance of obtaining and evalu-ating a 3-generation pedigree during the egg donor selection process.

Design: The study compiled the reported family history from egg donorsobtained during genetic counseling sessions.

Materials and Methods: The patients used in this study were potential eggdonors referred for genetic counseling for family history evaluation anddiscussion of genetic screening to determine their suitability as egg donors.All donors were seen by either active candidate or board certified geneticcounselors during either telephone or face to face counseling sessions. Thegenetic counselors obtained family history data through a combination of agenetic family history and pregnancy questionnaire and the construction ofa three-generation pedigree. All family history data was entered into aclinical database.

Results: A total of 152 egg donors were included in the current study.34% (52) of the donors reported no significant family history. 66% (100) ofthe donors reported a total of 238 relatives with conditions that could posea genetic risk for the donor or for future offspring. Medical histories weredivided into five sub-categories: physical birth defects, developmental de-lay, Mendelian disorder, mental illness and common adult-onset disorders.There were 14 (0.5%) relatives reportedly affected with a physical birthdefect, including congenital heart defect and cleft lip and/or palate. Thepresence of a physical birth defect such as congenital heart defect or cleft lipand/or palate could be associated with a risk for a syndrome such aschromosome 22q11 deletion. There were 17 (0.7%) relatives reportedlyaffected with some type of developmental delay, including mental retarda-tion, autism and Down’s syndrome. A history of autism and mental retar-

dation such as that reported in a half brother or uncle increases the risk tothe donor for conditions including fragile X syndrome. There were 5 (0.2%)relatives affected with a Mendelian disorder, including dwarfism, color-blindness and sickle cell anemia. There were 14 (0.5%) relatives affectedwith mental illness, including schizophrenia and bipolar disease. Finally,there were 152 (64%) relatives with reported family history for commonadult-onset conditions including breast cancer, heart disease and coloncancer. The evaluation of family histories with mental illness or commonadult-onset conditions such as breast cancer will allow for identification offamilies at significantly higher risk due to multiple affected family mem-bers.

Conclusion: The ASMR has established guidelines for “Minimal geneticscreening for gamete donors”. These guidelines specifically outline types ofdisorders that would exclude gamete donors, if these disorders affect thedonor or first-degree relatives. The current study outlines the fact that theremay be significant family history found in relatives more distant thanfirst-degree that can impact genetic risk for the donor. While these reportedhistories should not immediately exclude these donors, they require furtherconsideration. The use of genetic counselors will allow for thorough geneticfamily history evaluation that goes beyond the “minimal genetic screening”required by the ASRM.

P-37

Relationship of follicular fluid growth factors with IVF outcome. Mo-hamed Bedaiwy, Tamer M. Said, Ashok Agarwal, Eleonora Pasqualotto.Cleveland Clin Fdn, Cleveland, OH; Conception Ctr for Human Reproduc-tion, Caxias Do Sul, Brazil.

Objective: The role of cytokines and growth factors in the ovulatoryprocess is increasingly evident. The objective of this study was to evaluatethe levels of TGF- B1, TGF- B2, and VEGF in the periovulatory FF duringIVF cycles.

Design: A prospective study.Materials and Methods: Follicular fluid from 23 women was obtained

while they underwent oocyte retrieval for IVF. We measured the concen-trations of TGF- B1, TGF- B2, and VEGF in FF using quantative ELISAkits and compared the levels among women who became pregnant and thosewho did not.

Results: We were not able to detect TGF- B1 and TGF- B2 in the FF ofall cycles. The patients were grouped according to FF VEGF vlaues intogroup A �1000 pg/mL and group B �1000 pg/mL. Pregnancy rate was27% in group A as compared to 50% in group B. Both pregnant andnon-pregnant patients were comparable regarding age, parity, ovarian stim-ulation parameters, fertilization rates, and embryo freezing rates (table).Good quality embryos were significantly higher in group A as compared togroup B (p � 0.02).

Conclusion: High levels of VEGF in the periovulatory FF may beassociated with low quality of the developing embryos derived from thiscycle. Further studies involving high number of cycles are needed to verifythese data.

*P value �0.05 considered significant between the 2 groups.

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Fertilization outcome of Metaphase I oocytes following intra-cytoplas-mic sperm injection. Ivan Huang, Richard R. Chacon, Vicken Sahekian,Lisa Standing, Brigid Jordan, Omid Khorram. Harbor-UCLA Medical Ctr,Torrance, CA; Pacific Fertility Ctr, Los Angeles, CA.

Objective: Previous work has compared the variable success of ICSIusing in vitro matured Metaphase I (MI) to Metaphase II (MII) oocytes, with

S132 Abstracts Vol. 80, Suppl. 3, September 2003

most studies showing lower fertilization rates for these oocytes as comparedto MII oocytes. There is scant data in the literature on the results of directinjection of the MI oocytes without prior in vitro maturation to MII oocytes.The objective of this study was to compare the fertilization outcome ofoocytes which were in the MI stage at the time of ICSI with MII oocyteswith the goal of determining whether MI oocytes should be injected at all.

Design: Retrospective chart review.Materials and Methods: ICSI data from a large Los Angeles fertility

center was reviewed (12/2001 – 12/2002). Controlled ovarian hyperstimu-lation was performed using a combination of human menopausal gonado-tropin (HMG) and recombinant FSH following a long GnRH agonist pro-tocol of down-regulation. Data from a total of 149 ICSI cycles wascollected. A total of 1834 oocytes were retrieved, denuded and examined forviability and maturity. All viable MI and MII oocytes underwent ICSI andwere examined for subsequent fertilization. Comparison of ICSI outcomesbetween the MI and MII groups were done using the Chi-square test.

Results: Of a total of 1834 oocytes retrieved, there were 174 (9.5%) MI,and 1467 (80%) MII oocytes. The remainder of the oocytes consisted ofnon-usable atretic oocytes 41 (2.2%) and 149 (8.1%) germinal vesicles. All174 MI oocytes and 1467 M-II oocytes underwent ICSI with results asshown below in Table I. Significance was found in all outcome parameterswith more MII oocytes achieving fertilization (69% vs 21%, P � 0.001),lower death rates for MII oocytes following ICSI (7.4% vs 21%, P � 0.001),higher polyspermy rates in MI oocytes (2.1% vs. 6.3%, P � 0.003) andmore MI oocytes with 1PN (0.9% vs. 4.6%, P �0.001).

Conclusion: While MII oocytes consist of the majority of the retrievedoocytes post ovarian stimulation and are the ideal source for ICSI, immatureMI oocytes still constitute a sizeable portion of the oocytes retrieved.Therefore although fertilization outcomes for the MI oocytes are lower thantheir MII counterpart, direct fertilization of the MI oocyte without in vitromaturation to MII may be considered to increase the number of embryosavailable for transfer in cycles with low number of MII oocytes retrieved. Itremains to be determined if there is a significant advantage in in vitromaturing MI oocytes versus their direct injection as performed in this study.

P-39

The prognosis for patients with a cancelled IVF cycle. Gary Fruhman,Lewis Krey, Frederick Licciardi. NYU, New York, NY.

Objective: To investigate the prognosis for pregnancy after one cancelledIVF cycle.

Design: A descriptive retrospective review.Material and Methods: Computerized office records were queried for

patients who had a cancelled cycle during 1999 and 2000. A database wascreated and information was entered on all subsequent attempts of thesepatients. Pregnancy rate is defined as the presence of fetal heart activity.

Results: A total of 162 patients had one IVF cycle cancelled and went onto try again, many more than once. Of 302 subsequent IVF cycles, theoverall pregnancy rate was 15.6%, 20.9% in women 40 and under, and 10%in women 41 or older.

Of the 162 cancelled patients, 40.8% ultimately became pregnant: 46/142(32.2%) with IVF and 16/142 (11.3%) with DE. DE represented 5.8% of thepregnancies in women who had a second attempt, but it represented 67% ofthe pregnancies in those who became pregnant on their 4th or 5th attempt.

Twenty patients were cancelled due to elevated FSH and/or estradiollevels on day 3. When success of their next cycle was examined, 7 werecancelled again for elevated day 3 results, 2 were cancelled for cysts on day3, 2 achieved retrieval but no pregnancy, 1 had an IVF pregnancy and 2were successful with DE.

Conclusions: When informing a patient that her IVF cycle she should be

reassured that “all the news is not bad” as an IVF pregnancy after acancelled cycle is possible. As expected, patients 40 and under fare betterthan patients over 40. Being cancelled for elevated day 3 hormones is anominous sign, as the per-start pregnancy rate in the next cycle is only 5.5%.Patients utilize donor eggs increasingly as subsequent IVF attempts fail.

P-40

Does smoking cessation normalize ovarian response in women under-going in vitro fertilization? Karen R. Hammond, Sejal P. Dharia, MichaelP. Steinkampf. Univ of Alabama at Birmingham, Birmingham, AL.

Objective: It is well known that women who smoke cigarettes have alower response to gonadotropins during in vitro fertilization (IVF) treatmentthan nonsmokers. The purpose of this study was to determine whethersmoking cessation eliminates this deleterious effect of smoking on ovarianfunction.

Design: Retrospective case-control study in an academic reproductivetechnology program.

Materials and Methods: Smoking history, infertility diagnoses, and dataon ovarian response to gonadotropins were abstracted from the medicalrecords of all IVF cycles performed between January 1, 2000 and March 31,2003. Twenty-five former smokers (EVER) who had ceased cigarette usefor approximately three months before beginning IVF treatment werematched with at least three control patients of comparable age and infertilitydiagnosis who had never smoked (NEVER). Ovarian response to gonado-tropins between these two groups was compared using t-tests and contin-gency table analysis. Smoking cessation before IVF treatment was con-firmed by random serum cotinine assays.

Results: The two groups were comparable with respect to patient age(EVER: 35.5 y, NEVER: 35.0 y; P�0.38), the distribution of infertilitydiagnoses, the initial daily gonadotropin doses (EVER: 5.5 amps; NEVER:5.3 amps, P�0.51), and the length of ovarian stimulation (EVER: 9.4 days,NEVER: 9.4 days, P�0.97). However, ex-smokers had a lower antralfollicle count at baseline (EVER: 8.5, NEVER: 11.9; P�0.007), lowerserum estradiol level on the day of hCG administration (EVER: 1,755pg/mL, NEVER: 2,529 pg/mL; P�0.03), and a smaller number of oocytesretrieved (EVER: 11.5, NEVER: 15.7; P�0.015). Although the number ofembryos obtained was comparable (EVER: 7.4, NEVER: 8.4; P�0.52), themean number of 8-cell embryos obtained on day 3 after egg retrieval waslower in ex-smokers (EVER: 0.88, NEVER: 1.4; P�0.034).

Conclusion: Cessation of smoking for three months does not normalizethe ovarian response to gonadotropins in women undergoing in vitro fertil-ization treatment.

P-41

Post-wash sperm motility as a predictor of in vitro fertilization rate inpatients without a diagnosis of male infertility. Wendy Y. J. Chang, AlanH. DeCherney, Mark W. Surrey, David L. Hill. David Geffen. UCLA Schof Medicine, Los Angeles, CA; ART Reproductive Ctr, Beverly Hills, CA.

Objective: To determine whether motility after sperm washing is predic-tive of fertilization rates in vitro. To identify patients without known malefactor infertility who may benefit from intracytoplasmic sperm injection(ICSI) directly.

Design: Retrospective study.Materials and Methods: One hundred eleven consecutive couples with

excellent ovarian response undergoing in vitro fertilization and embryotransfer from January 1, 2002, to April 23, 2003. Inclusion criteria includednormal semen analysis parameters (total motility count � 40 x 106) mater-nal age less than or equal to 35; excellent ovarian response characterized bygreater than 10 oocytes retrieved resulting in greater than or equal to 4 MIIoocytes. Exclusion criteria included primary diagnosis of male infertility;history of prior poor in vitro fertilization; ovarian hyperstimulation syn-drome (OHSS) and history of two or more failed IVF cycles.

Patients were matched for age, ovarian response, and number of MIIoocytes retrieved. All semen specimens were processed in a standardfashion using density-gradient, single-layer 90% ISOlate (Irvine Scientific,

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