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FSA FREE COMMUNICATIONS-IVF CLINICALFSA FREE COMMUNICATIONS-IVFCLINICALTHE EFFECT OF LH PRIMING PRIOR TO OVARIAN STIMULATION WITHFSH IN GnRHa TREATED WOMENPeter Benny Anoma Gooneratne and Sue HurdNew Zealand Centre for Reproductive Medicine, St Georges Medical Centre, Christchurch, NewZealand.Evidence suggests that when desensitisation is achieved with ·long acting GnRH analogues more FSH isrequired to stimulate follicle growth than when short acting analogues are used. We have hypothesised thatthe effect ofthe profound desensitisation could be reversed by LH administration prior to the use ofFSH andallow improved cycle quality.61 cycles were studied in a randomised placebo controlled trial. All received 200J.1g buserelin twice daily for14 days from day 21 ofthe cycle. They received either placebo or 150iu LH (Lhadi) for the last 5 days ofdesensitisation. Buserelin was then reduced to 200llg daily and stimulation with recombinent FSH (GonalF)was started at the indicated dosage for that woman. Oocyte recovery was preformed when at least 3 follicleswere greater than 17mm.53 cycles that fulfilled protocol criteria proceeded to embryo transfer. Comparison between LH group andplacebo group showed no significant differences in; FSH dosages 29.0 75iu amps vs 32.5 in placebo, peakestradiol 5.9 vs 5.8 nmolll, oocytes recovered 11.6 vs 11.2, or cleaving embryos 6.2 vs 4.9 (p=0.17)The embryos in the LH group were significantly more advanced at day 2 p=O.021 X2 test and significantlymore were ofsuitable quality to be frozen in the LH group, 42 (28%) vs 19 (13.2%) p=0.006.Ofthe 53 women who had embryo transfers there was no difference in the number oflive births, LH group 5+ 1frozen embryo birth, placebo group 5 live births.We concluded that LH priming does not increase the number ofoocytes recovered for IVF but in this studyappeared to improve embryo quality.Study sponsored by Serono Aust, Pty Ltd.A RETROSPECTIVE REVIEW OF LUTEAL PHASE HORMONE CONCENTRATIONS INWOMEN USING DIFFERENT FORMS OF LUTEAL SUPPORT FORASSISTEDREPRODUCTIONMazen Rawashdeh, Lija Arthur; 'Howard Smith, Peter illingworth'Department ofReproductive Medicine, Westmead Hospital.Current evidence suggests that the choice of luteal support between progesterone and hCG has limited effect on ARTconception rates provided sufficient progesterone is administered. (Akande etal, 1996). However many patientsrepoItdifficulty and discomfort in using progesterone pessaries. In this study, hormone concentrations were investigated in ol1derto check the absorption and hormonal consequences ofluteal support in a group ofwomen undergoing ART.All women were treated by standard ART long-downregulation protocol. HCG (1500 ill at three day intervals) was usedfor luteal support unless there was evidence ofovarian hyperstimulation (>10, OOOpmol/L oestradio~ >15 oocytes collected,clinical suggestion or past history of OHSS) in which case progesterone pessaries (200mg x2 per day) were used. Allwomen located geographically close (n=I44) to the Westmead Fertility Centre, had a serum sample collected between Days7 and 10 ofthe luteal phase and stored for later assay. Each sample was assayed for progesterone, oestradiol and inhibin A.According to this protocol, 45 women used progesterone pessaries (10 conceived) and 99 women used hCG (21 conceived).The progesterone concentrations in the group using progesterone pessaries ranged from 47-742 nmollL (median 81nmol/L).The progesterone concentrations in the women using hCG ranged from 38-2525nmollL (median 376nmollL). 87 (87%) ofthe women receiving hCG had progesterone concentrations in excess of the reference range (mean+ 2SD) for thephysiological menstrual cycle while 21 (48%) of the women receiving progesterone pessaries had progesteroneconcentrations in excess of the reference. The inhibin A concentrations in the group using progesterone pessaries variedfrom 4-649pg/mL (median 47pg/mL) and ranged from 16-1 I18pg/mL (median 272) in the group using hCG support. In thegroup using progesterone pessaries, 10 women (22.7%) had inhibin A concentrations below the reference range for thenormal menstrual cycle.Conclusions:All women using progesterone pessaries were found to have progesterone concentrations that are at least in thephysiological range with only a few having extreme supra-physiological concentrations. Most women using hCG lutealsupport have significantly supra-physiological progesterone concentrations. Endogenous luteal hormone output issuppressed in approximately 23% of women using progesterone pessaries with some cases exhibiting no detectableendogenous luteal function. The clinical significance ofthese endocrine variations is not clear.126127