THE ROLE OF METFORMIN IN INDUCTION OF OVULATION IN OBESE INFERTILE PATIENTS WITH POLYCYSTIC OVARY SYNDROME

Investigation of the intrauterine cavity and tubal patency is indicated for many clinical conditions in gynecology. Despite the varied diagnostic options such as hysteroscopy and laparoscopy, hysterosalpingography is still an important and complementary examination in the early evaluation of infertility. The technique of HSG is quite simple, less invasive, more convenient, and provide reliable information about the uterine cavity, tubal patency, lesions, congenital anomalies and different types of intrauterine defects at less cost. Other than diagnostic, it can be therapeutic at time. Utilization of proper procedure can provide valuable diagnostic information and limit technical errors. A variety of technical problems may occur during HSG. These may relate to instrumental malfunction, anatomic abnormalities, artifacts or functional disturbances, and patient discomfort causing termination of the examination. The technical difficulties of HSG with an emphasis on the ways of facing problems are addressed in this presentation.


P784
Technical problems of hysterosalpingography F. Ahmadi, G. Shahrzad, F. Zafarani, A. Vosough. Department of Reproductive Imaging, Reproductive Medicine Research Center, Royan Institute, ACECR, Tehran, Iran Investigation of the intrauterine cavity and tubal patency is indicated for many clinical conditions in gynecology. Despite the varied diagnostic options such as hysteroscopy and laparoscopy, hysterosalpingography is still an important and complementary examination in the early evaluation of infertility. The technique of HSG is quite simple, less invasive, more convenient, and provide reliable information about the uterine cavity, tubal patency, lesions, congenital anomalies and different types of intrauterine defects at less cost. Other than diagnostic, it can be therapeutic at time. Utilization of proper procedure can provide valuable diagnostic information and limit technical errors. A variety of technical problems may occur during HSG. These may relate to instrumental malfunction, anatomic abnormalities, artifacts or functional disturbances, and patient discomfort causing termination of the examination. The technical difficulties of HSG with an emphasis on the ways of facing problems are addressed in this presentation.

P785
The role of Metformin in induction of ovulation in obese infertile patients with polycystic ovary syndrome

F. Al-Dahhan
Objective: To find the effective method of induction of ovulation; in obese infertile patients with polycystic ovary syndrome. Study design: Prospective case -control study. Setting: Infertility clinic of Basra Maternity and Child hospital. Material and Method: 60 obese, hirsute infertile patients for more than two years; with ultrasound findings of polycystic ovary syndrome, subjected to the following investigations: Serum LH, FSH, Testosterone, Prolactin &fasting blood sugar. All investigations were carried on early follicular phase of the cycle. Patientsw were divided randomly into two groups: Group A and group B. All patients received clomiphene citrate 50-150 mg for five consecutive days beginning on day 5 of the cycle. The patients with group B also received 500 mg of Metformin tablet three times daily for 6 months. Ovulation -which assessed by transvaginal folliculometry, and ovarian artery Doppler velocimetry;triggered with hCG when one or more follicle measuring ≥18 mm in diameter, and blood flow indices of the active ovary; showing the dominant follicles were good; on ultrasonic examination. Ovulation response and pregnancy rate were assessed in both groups. Results:Results obtained from this study pointed out the beneficial effect of Metformin on ovulation induction in obese hirsute women with PCOS. Conclusion: PCOS remains an enigmatic disease. Once considered relatively benign, PCOS is implicated in medical disorders related to hyperinsulinism and hyperandrogenemia. Restoring fertility and treating abnormal hair growth remain important considerations in the physical and psychological health of reproductive-age women. Metformin has shown greatpromise in the treatment of insulinresistant PCOS, but whether it would benefit all women who have PCOS remains unclear. Weight loss is the most important primary recommendation that can be made in the treatment of PCOS. Methods: A retrospective study has evaluated 224 infertile women that have been seen at Human Reproduction ambulatory of HSL-PUCRS. In comparison of both methods, the statistical analysis has searched the sensitivity, specificity, positive predictive value (VPP), negative predictive value (VPN), kappa coefficient (CK) and likelihood ratio (LR). Results: While evaluating the tubal factor the HSG has demonstrated a sensitivity of 81.3%, specificity of 86.7%, VPP of 87.2%, VPN of 80.7% and diagnostic accuracy of 83.9%. The CK was moderate (0.55) and the positive LR was 6.11. In the peritoneal factor analysis HSG has showed a sensitivity of 88%, specificity of 20%, VPP of 71%, VPN of 43% and diagnostic accuracy of 67%. CK has demonstrated good concordance between both methods (0.6) and the LR was neutral 1.1. Conclusions: HSG has demonstrated high diagnostic performance in evaluation of tubal factor, that in addition to the clinical investigation can lead to less invasive procedures. However, regarding the peritoneal factor, HSG has showed high sensitivity but low specificity, which does not allowed guaranteeing the absence of peritoneal pathology only by HSG. So, regarding the choice of diagnostics methods is the individual analysis of each patient into the infertility context that helps the better option decision.

P787
GnRH agonist versus GnRH antagonist: What is the effect on pregnancy rate?

E. Bastu, B. Baysal. Istanbul University School of Medicine
Objective: To compare the effects of GnRH agonist and GnRH antagonist on pregnancy rates. Methods: 458 women that had embryo transfers in Istanbul University School of Medicine have been analyzed. Comparative data was gathered on pregnancy rates, FSH dosage, numbers of follicles, retrieved ooctyes and transferred embryos. Results: GnRH agonist showed strong association with numbers of follicles, retrieved ooctyes and transferred embryos (p < 0.01). It has showed significant association with hCG(+) pregnancy (p < 0.05). GnRH antagonist showed significant association with tuboperitoneal, ovarian, endometriosis, multiple and unexplained infertility (p < 0.05). The sample groups were non-randomized and the average age of patients that received GnRH antagonist was higher. This is important, because age can affect the quality of the ovary and the response. Conclusions: Several studies have compared GnRH analogues in terms of clinical pregnancy outcome and did not find a statistically significant difference. Secondary outcomes suggested that in GnRH antagonist fewer ooctye complexes were retrieved and less OHSS was observed. On the basis of current evidence, to achieve higher rate of pregnancy, the analogue of first choice is not clear. Considering data, GnRH antagonist might be a good choice due to reduction in occurrence of OHSS. However, research is necessary on the probability of live births in patient groups such as patients with endometriosis and poor ovarian reserve. Objectives: During treatment of infertile women with gonadotropins some degree of ovarian hyperstimulation may occur. While mild OHSS has no clinical significance, severe OHSS is a life threatening condition. A lot of strategies are used to prevent and treat this condition. OHSS is caused by increased vascular permeability through ovarian hypersecretion of vascular endothelial growth factor (VEGF)-activating VEGF receptor 2 (VEGFR-2). Recent studies from Valencian Infertility Institute motivated us to use cabergoline in prevention of developing of severe OHSS. Materials and Methods: Starting from November 2006 cabergoline has been used in the treatment of 17 women identified as highrisk patients for developing severe OHSS. All patients received cabergoline starting from hCG administration, except for one patient to whom cabergoline was given on the 3rd day after hCG administration. The dose of cabergoline was 0.5 mg per day and duration of treatment was 8 days. All patients have been carefully monitored every day of hospitalization. Results: During medication with cabergoline all of patients were in very good clinical condition, with symptoms and clinical, ultrasound and biochemical signs of OHSS in regression. All of patients had the successful embryotransfer and consecutive clinical pregnancies were detected in 8 patients. Conclusions: Our first clinical experiences in using cabergoline to treat patients under the risk of severe OHSS show that cabergoline improves clinical conditions of these patients without influencing the success of embryotransfer.

Aim of investigation:
To analyze the effect of long and short protocol of stimulation on the outcome of IVF and ICSI procedure in the patients with PCOS. Material and Methods: Clinical investigation was performed as a prospective study at The Frauenklinik der Justus-Liebig-Universitat in Giesen (Germany). The study comprised 103 (122 cycles) patients with PCOS included in the programme of in vitro fertilization (IVF and ICSI).

Results of investigation:
Following the aspiration, the mean number of obtained follicles in the group of patients with a long stimulation protocol (X = 9.3) was significantly higher (p < 0.05) than in the group with a short stimulation protocol (X = 6.8). The number of biochemical, clinical and realized pregnancies in relation to the total number of cycles in both investigated groups was not statistically significant. The incidence of abortions in the patients with a long protocol N = 3 (5%), did not significantly differ from the patients with a short protocol N = 3 (11.5%). Conclusions: The administration of a long stimulation protocol in the patients with PCOS included in the programme of IVF And ICSI/ET, showed a tendency of better success in realization of conception and decrease of the abortion rate relative to the short protocol. The short protocol of stimulation was useful in the PCOS patients with weaker response to the stimulation in previous cycles.

P790
Correlation between infertility and rapid sperm head decondensation after lysis challenge P. Ransom, P. Chan, J. Corselli, J. Jacobson, W. Patton. Gynecology and Obstetrics Dept., Loma Linda Univ. School of Med., Loma Linda, CA 92354, USA Introduction: Apoptotic human sperm cells are not distinguishable from healthy sperm by conventional microscopy leading to incorrect diagnoses. Dying sperm exhibit subtle disrupted membranes with phosphotidylserine translocating from the inner to outer membranes. Assessment of rapid head decondensation after lysis reagents would help identify males with predominance of apoptotic sperm. The hypothesis was that rapid sperm head decondensation was associated with infertility. The objective was to analyze the different levels of sperm head decondensation after lysis reagent exposure.

Conclusions:
The results suggested that sperm from the infertile group had weak membranes that rapidly dissolved to decondense sperm DNA content. Fertile sperm heads showed more granularity suggesting the presence of noncondensed nucleosomes. Interestingly, fertile sperm exhibited higher percentages of compacted heads when challenged by lysis reagents but significance was not reached. Clinical significance in this study included demonstrating a link between rapid sperm decondensation and infertility. Upcoming research will involve testing other lysis reagents in support of the development of a rapid and reliable male fertility test.

P791
Ozone therapy as a component in the treatment of tubal factor female infertility R. Chandra-D'Mello 1 , G. Grechkanev 2 . 1 Dr. Rajani's Clinic, Baku, Azerbaijan, 2 Nizhegorod State Medical Academy, Nizhny Novgorod, Russia Aim: To increase efficiency of treatment of tubal factor female infertility by including ozone therapy as a component.

Materials and Methods:
We investigated 120 women with tubal factor infertility. All of them underwent laparoscopic corrective surgery to reinstate the tubal patency. They were divided into 2 groups each consisting of 60 patients. The First group was administered ozone therapy as part of the pre-operative and postoperative care. The Second group, however did not receive ozone therapy. The degree of endogenous intoxication was ascertained by the content of medium mass molecules (MMM), fibrinogen and C-reactive protein (CRP). The intensity of lipid peroxidation (LP) was determined by the levels of molecular products: primarydiene (DC) and triene conjugates (TC) and final -Schiff bases (SB). The total antioxidant activity (TAOA) of the serum was determined by the change in the fluorescence of induced chemi-luminescence in 30 seconds. Results: Although patients in both the groups had an uncomplicated post-operative period, yet laboratory analysis of POL parameters revealed presence of endogenous intoxication. Obviously, the increased post-operative levels in comparison to the pre-operative levels of MMM, DC, TC and SB was caused by surgical stress. As a result of ozone therapy the raised levels of the parameters of endogenous intoxication and molecular products of POL decreased accompanied by an increase in TAOA. In the Second group, the parameters did normalize but much later. Observation of patients of both the groups for a year revealed that after administering rehabilitation measures including ozone therapy (rectal insufflations), the incidence of uterine pregnancy was increased by 1.5 times. Conclusion: The usage of ozone therapy (rectal insufflations) as part of post-operative treatment of patients who had undergone reconstructive surgery on the fallopian tubes betters the results of treatment. This effect is apparently due to the systemic