Oct 19, 2005 - IVF/ICSI Cycles. G. N. Allahbadia, K. S. Kadam, Y. P. Mhatre, S. Arora,. K. Kaur. Rotunda - The Center For Human Reproduction, Mumbai, India.
Subjects reported being counseled by a range of health care professionals including assisted reproduction (ART) specialist physicians (53%), ART physicians and nurses (13%), ART nurses only (4%), and genetic counselors (16%). Several subjects reported that more than one health care professional counseled them while 14% reported having no formal counseling/education session prior to using PGD. While the majority of subjects had difficulty comprehending the technical specifics of fluorescence in situ hybridization (FISH), they did understand that using PGD with FISH does not eliminate the possibility of having a child with a chromosome disorder (90%), and that this procedure can detect disorders such as Down syndrome (94%). In addition, the majority of subjects were informed that PGD using FISH does not eliminate the chance that a child could have a condition such as cystic fibrosis (71%) or epilepsy (90%). Of note is that only 41% of subjects appeared to understand chromosomal mosaicism. A significant proportion of patients do not clearly comprehend the specific types of inherited disorders that can be detected by the procedures used in their treatment or how PGD applies to their reproductive goals. Study subjects indicated that being informed about PGD is important to their decision-making to use this technology and the majority of patients report that they are using Internet resources for additional information about PGD. CONCLUSION: The findings suggest that there are both strengths and weaknesses in patient knowledge regarding basic genetics and procedures associated with PGD. Many patients who have undergone PGD treatment do not appear to fully comprehend the risks and limitations associated with this technology. It is important for patients to comprehend the risks and limitations of PGD so that they can have realistic expectations of the procedure and therefore give appropriate informed consent. Genetic counseling strategies for PGD therefore need to be improved in order to protect both patients and fertility clinics. Since 80% of subjects believe that understanding both the procedural information and basic genetics is important in their decision making, it is clear that future studies are necessary to identify which counseling strategies are most effective for counseling patients about PGD. Information gathered from this study indicate that personalized genetic counseling sessions supported by multi-media educational resources may be optimal for educating prospective patients so that they can fully comprehend the risks, benefits, and limitations of PGD. Supported by: None
CLINICAL FEMALE INFERTILITY AND GYNECOLOGY Wednesday, October 19, 2005 3:00 p.m. O-311 The Role of Cabergoline in Hyperprolactinemic Patients Undergoing IVF/ICSI Cycles. G. N. Allahbadia, K. S. Kadam, Y. P. Mhatre, S. Arora, K. Kaur. Rotunda - The Center For Human Reproduction, Mumbai, India. OBJECTIVE: Bromocriptine has been used since a number of years for the treatment of hyperprolactinemic patients. However, patient compliance and side-effects led doctors to search for a better alternative. A recently launched long acting dopaminergic drug, cabergoline, has been reported to be highly effective in these patients. A better patient compliance and fewer side effects was reported by patients on cabergoline. In this prospective study, an attempt was made to study the role of Cabergoline in hyperprolactinemic patients undergoing IVF/ICSI cycles. DESIGN: Prospective , randomized, comparative study. MATERIALS AND METHODS: A comparative, randomized, singlecentre trial was done on patients with hyperprolactinemia undergoing IVF/ ICSI cycles. The patients were divided into two groups, Group A (cabergoline group, n⫽28) and Group B(bromocriptine group, n⫽30) . A dose of cabergoline 0.5mg twice a week (Caberlin, Sun Pharma, India) and bromocriptine 1.25mg twice a day (Sicryptin, Serum Institute, India) was administered to the patients in Group A and Group B respectively. The response was evaluated at 4 weeks and 8 weeks subsequently from the start of the treatment. The efficacy and safety was evaluated on the basis of normalization of prolactin levels, normalization of menstrual cycle, disappearance of galactorrhoea and adverse effects with each of these medications. The clinical pregnancy rate in the both the arms of the study was also evaluated. RESULTS: Normoprolactinemia was achieved in 4 weeks in 26/28patients (92.86%) on cabergoline whilst only 23/30 ( 76.67%) patients on
FERTILITY & STERILITY威
bromocriptine had normal prolactin levels by the 4th week. 25/28 patients (89.57%) had disappearance of galactorrhoea in Group A while only 22/30 (73.33%) patients in Group B reported disappearance of galactorrhoea. Normalization of menses was observed in 22/28(78.57%) and 20/30 (66.67%) in Group A and Group B respectively. There were very few adverse effects recorded in cabergoline group (8/28,28.57%) as compared to the bromocriptine group(21/30, 70%). The clinical pregnancy rate per cycle was 35.71% and 26.6% in the cabergoline and bromocriptine group respectively. Six patients who were previously on bromocriptine therapy before coming to our Center were put on cabergoline during the study and of those four conceived. CONCLUSION: Cabergoline is a very effective drug for lowering of prolactin levels in hyperprolactinemic patients and is very efficacious , better tolerated and much more safe drug than the reference compound, bromocriptine. Supported by: None
Wednesday, October 19, 2005 3:15 p.m. O-312 Adjunctive Use of an Oral Contraceptive (OC) and a Reduced Dose of a GnRH Antagonist for COH/IUI. D. R. Meldrum, A. L. Wisot, B. Yee, G. F. Rosen, D. L. Cassidenti, G. Garzo. Reproductive Partners Medical Group, Redondo Beach, CA; Reproductive Partners Medical Group, La Jolla, CA. OBJECTIVE: In preparation for IVF, a long GnRH agonist protocol provides for scheduling of procedures, synchronization of follicles, prevention of premature luteinization (PL), and prevention of premature ovulation of mature follicles. Although COH/IUI cycles are commonly started day 2 of the cycle, selection of the dominant follicle may already be underway. Pretreatment with an OC synchronizes follicles and has been shown to block the occurrence of an LH surge in a subsequent COH cycle (Gonen Y, Fertil Steril 1990). A study with COH/IUI (Manzi DL, Fertil Steril 1995) has shown that about one-third of cycles demonstrate PL, with a very low success rate and a high rate of miscarriage and improved RESULTS with use of a GnRH agonist in the next cycle. We therefore chose to evaluate COH/IUI following OC, with half of the usual dose of the GnRH antagonist, ganirelix (G) to prevent PL and premature release of follicles. DESIGN: Pilot trial. MATERIALS AND METHODS: Thirteen women (mean age and body weight 34.5 and 136.5) with unexplained infertility or male factor with weight between 110 and 180 pounds and a day 3 FSH less than 10 IU/ml. having their first COH/IUI cycle took OC for 14 to 21 days. Beginning on the fourth day after OC, rFSH (follitropin beta), 75-225 IU was selfadministered daily using a multidose pen. G, 0.125 mg, was administered each morning starting at a lead follicle mean diameter of 14 mm. HCG was given in the evening when there were at least two follicles of 17 mm mean diameter or greater, and IUI was done on the following two mornings. RESULTS: The mean starting dose of rFSH was 161.5 IU. G was given for a mean of 3.5 days. HCG was given after 10.1 days of stimulation with 5.9 follicles over 12 mm. Five women have ongoing pregnancies (38.5%). UTZ showed two sacs in three women, with one of those evolving to one viable fetus. Serum LH levels will be assessed. CONCLUSION: A high rate of ongoing pregnancy was achieved in this small ongoing study with COH preceded by OC and with adjunctive use of a GnRH antagonist. The high number of follicles and twin implantations are consistent with a synchronizing effect of OC and excellent oocyte quality. Based on this initial experience, we have reduced the starting dose to 75-100 IU. The low dose of FSH should offset the additional cost of G. The use of OC is also helpful in scheduling procedures around career activities. A large prospective randomized trial will be necessary to demonstrate a better clinical outcome compared with COH alone. Supported by: Organon USA, Inc.
Wednesday, October 19, 2005 3:30 p.m. O-313 Pain Relief of Hysterosalpingography by Prior Uterine Cervical Application of Lidocaine/Prilocaine Cream. G. Liberty, M. Gal, E. Mazaki, T.
S127
