SELECTED ORAL COMMUNICATION SESSION, SESSION 60: CHILDREN’S HEALTH Wednesday 6 July 2011 10:00 – 11:45

Abstracts of the 27th Annual Meeting of ESHRE, Stockholm, Sweden, 3 July – 6 July, 2011 Results: Interestingly neither AD, nor T resulted to be statistically lower on YLR and ALR patients when compared with the control group of egg donors (AD = 198.5 ± 171.8, 157.9 ± 218.9, and 224.6 ± 312.7 nM, (T = 20.6 ± 9.7, 20.2 ± 9.3, and 29.8 ± 31.8 nM), respectively. On the contrary in the group of ALR patients, lower intrafollicular E2 concentration (1298 ± 963, 1927 ± 960 and 2071 ± 1275 nM) and higher FSH level (6.1 ± 4.0, 3.6 ± 1.7, and 4.6 ± 2.6 mIU/ml) were found when compared to control and YLR groups respectively. Conclusions: With the exception of FSH and E2, the intrafollicular androgenic levels in low responder patients were not different with regards to the control group. These results may support the idea that more than an insufficiency on androgen substrate, low responder patients, specially the aged subgroup, may have an inferior aromatase activity as is shown by the significant lower E2 concentration observed in this subgroup. Also, the supposed lower number of FSH receptors on the granulosa cells of low responder women may explain the higher concentration of free FSH detected in the preovulatry follicles of ALR patients. Research supported by IMPIVA IMIDTG/2008/26. O-227 High AMH-values do not correlate with the risk of ovarian hyperstimulation syndrome after IVF-treatments Introduction: Anti-Müllerian Hormone (AMH) is considered a marker for ovarian reserve, and is used to estimate the response to ovarian stimulation in an IVF/ICSI-treatment. By using the AMH-value as a guide to adjust the dose of gonadotropins used in the stimulation, one can try to minimize the risk of complications, especially Ovarian Hyperstimulation Syndrome (OHSS). In our department, the starting dose is reduced to 112.5 IU per day instead of the standard dose (150 IU/day) when AMH is higher than 4 μg/L. The aim of the present study is to evaluate whether this policy succeeds in reducing the incidence of severe OHSS. Materials and Methods: A retrospective observational study was carried out based on the database of the Department of Reproductive Medicine of the University Hospital of Ghent. The following parameters were extracted from the database: date of birth of the patient, AMH-value, outcome of the treatment cycle, including a positive pregnancy test, the need for coasting, the occurrence of OHSS and cancelling of the cycle. Results: A total of 1654 treatment cycles was evaluated. Three groups could be distinguished: serum AMH ≤ 2 μg/L, 2 - 4 μg/L, and > 4 μg/L. AMH-values in the high ranges were additionally subdivided into smaller groups ( > 4 and ≤ 6, > 6 and ≤ 8, > 8 and ≤ 10, > 10 and ≤ 12, > 12 μg/L). Furthermore, stratification based on age was performed ( ≤ 35, between 35 and 40 en ≥ 40 years of age). The global risk of severe OHSS (including admission to hospital) was 0.6 % in the population studied (10/1654). 60% of all cases occurred in patients with AMH-values between 8 and 10 μg/L. Nine out of 10 cases were reported in women at the age of 35 or younger, in whom the starting dose of gonadotropins was reduced according to protocol. In this subgroup, the risk of OHSS appeared to be the highest at an AMH between 4 and 6 (1.24%) and between 8 and 10 μg/L (6.59%). Coasting was considered necessary mainly in the group of patients with AMH values ranging from 4 to 6 μg/L, from 8 to 10 μg/L and higher than 12μg/L, regardless of age. Conclusions: The data seem to suggest that there is no clear linear correlation between high serum AMH-values and the risk of ovarian hyperstimulation syndrome. Although AMH is a meaningful marker in estimating which patients can be considered as “poor responders”, it has little predictive value in the high ranges. Additionally, in this series of patients, reduction of the starting dose of gonadotropins from a normal starting dose of 150 IU per day to a slightly decreased dose of 112.5 IU/day in patients with high AMH-values does not seem to be able to prevent OHSS. O-228 Role of vascular endothelial cell growth factor (VEGF) and angiopoietins (ANGPTs) in ovarian hyperstimulation syndrome (OHSS) I. de Zúñiga1, D. Colaci1, F. Sobral1, C. Bisioli1, L. Scotti2, D. Abramovich2, M. Tesone2, F. Parborell2 1 PREGNA, Reproductive Medicine, Buenes Aires, Argentina Introduction: Moderate to severe OHSS has been calculated to occur in 0.2% to 2% of all ovarian stimulation cycles. Risk factors include low body weight, high follicle count, polycystic ovary syndrome, previous OHSS and elevated serum estradiol. VEGF is clearly implicated in the pathogenesis of OHSS, and it seems to be the principal mediator of the action of hCG. In women who develop OHSS, VEGF is expressed and produced by granulosa-lutein cells, released into the follicular fluid in response to hCG, and in turn, it induces capillary permeability. The ANGPTs/Tie-2 system acts in concert with VEGF. ANGPT1 is necessary to stabilize blood vessels and ANGPT2 acts as a natural antagonist for ANGPT1. The balance between the ANGPT1/ANGPT2 ratio and VEGF expression is important for angiogenesis in the ovary. However, up to now, the possible involvement of ANGPTs in OHSS is unknown. Our objectives were to analyze: 1) the effect of VEGF inhibition in a rat model of OHSS on follicular and luteal development and 2) a possible involvement of ANGPTs in this model and in patients with high probability of developing OHSS when undergo ART. Material and Methods: OHSS group (hyperstimulated immature Sprague Dawley rats) received excessive doses of pregnant mare serum gonadotropin (PMSG, 50 UI/day) injected for 4 consecutive days (from 21 to 24 days old), followed by human chorionic gonadotropin (hCG, 25 UI, on the 25 days old). OHSS + TRAP group (TRAP-treated hyperstimulated immature rats) received the same doses of gonadotropins as OHSS group and then received 1 ug Trap (recombinant mouse-soluble VEGF receptor 1/Fc Chimera) in 5 ul of PBS with 0.1% BSA under the ovarian bursa at the same day of hCG. Rats were sacrificed 48 hs post hCG. Histological features of sectioned ovaries were assessed in hematoxilin and eosin stained slides. Corpora lutea (CLs) were isolated by microdissection under the microscope and then proteins were extracted for western blot. In addition, levels of ANGPT1 and Tie-2 were measured by ELISA assay in follicular fluid (FF) of control and OHSS women. Results: In the OHSS group, TRAP increased the number of atretic follicles (OHSS: 0.39 ± 0.25 vs OHSS + TRAP: 9.18 ± 1.39, %FAtr/ovary; p < 0.001) and decreased the number of CLs (OHSS: 72.10 ± 4.33 vs OHSS + TRAP: 55.26 ± 3.85, %CL/ovary; p < 0.05) and cysts (OHSS: 7.36 ± 0.66 vs OHSS + TRAP: 3.64 ± 1.29, %Cyst/ovary; p < 0.01). In addition, TRAP decreased the ovarian weight in OHSS group respect to the OHSS group without treatment (OHSS: 0.22 ± 0.01 vs OHSS + TRAP: 0.19 ± 0.01, g.; p < 0.05). In isolated CLs from OHSS group, the ratio ANGPT1/A (...truncated)