effect accross all trials. The pooled results (odds ratio (OR) and crudeaggregate pregnancy rates (PR)) and their confidence intervals (CI) areshown in the table.

Conclusions: Although a trend towards higher singleton pregnancy ratewas observed with recombinant hCG, the meta-analysis only had sufficientpower (80%) to detect a difference of 10% in the singleton pregnancy rateover a control event rate of 16%. Smaller differences may exist but wereundetectable with the sample size currently available. The upper confidencelimit indicates that a clinically significant improvement in singleton preg-nancy rate is possible and further RCTs will be required to test thishypothesis. In the absence of a deleterious effect on outcome, recombinanthCG is an attractive alternative to urinary hCG because of its purity.

Supported by: None.

P-95

Comparison of intracytoplasmic sperm injection pregnancy rates inEastern Indian and Caucasian women. Collin Smikle, Susan P. Willman,Denise Walker, Kristin Ivani. Reproductive Science Ctr of the San Fran-cisco Bay Area, San Ramon, CA.

Objective: To compare the outcome differences in East Indian andCaucasian women who were treated with Intracytoplasmic Sperm Injection.

Design: Retrospective chart review of East Indian patients using casecontrols from the Caucasian patient population.

Materials/Methods: Pregnancy rate was the main outcome variable as-sessed in a chart review of East Indian and Caucasian women undergoing invitro fertilization and intracytoplasmic sperm injection from January 2000to March 2002.

Results: There were 41 East Indian and 328 Caucasian women �35 yearsof age who underwent their first cycle of in vitro fertilization and intracy-toplasmic sperm injection (ICSI) during this period. Treatment cyclesevaluated were first IVF cycles with embryo transfer performed at 72 hours.Intracytoplasmic sperm injection was performed for oligoasthenospermia in108 of 328 treatment cycles (32.9%) of the Caucasian group and 24 of 41treatment cycle (58.5%) in the East Indian group; p �.0491. Comparingonly ICSI cycles using fresh ejaculate sperm, the pregnancy rates were 37%(40/108) in the Caucasian vs. 12.5%(3/24)in the East Indian group; p �.02.There were no differences in the number of days of gonadotropin therapy,peak estradiol levels, number of oocytes recovered, fertilization rate, num-ber of embryos transferred, nor embryo quality as assessed by morphologyand cell division (cumulative embryo score (CES). Number of surplusembryos cryopreserved (cryo) was also evaluated as an indirect indicator ofembryo quality and there was no difference.

Conclusions: A higher incidence of male factor infertility requiring ICSIas an intervention was observed in the East Indian population. This studyconfirms an earlier observation that Eastern Indian women demonstrate asignificantly lower clinical pregnancy rate as compared to Caucasianwomen undergoing ART. This lower pregnancy rate is not predicted by theage of the female partner, ovarian response, or embryo morphology. Furtherstudies are needed to identify the factors that may contribute to the observeddiscrepancy.

Supported by: Reproductive Science Center of the San Francisco BayArea and IntegraMed.

ART: OVARIAN STIMULATION

P-96

Progesterone elevation during GnRH antagonists cycles in IVF ad-versely affects pregnancy and implantation rates. Ivan Valencia,Ernesto Bosch, Carlos Simon, Carlos Troncoso, Jose Remohi, AntonioPellicer. Inst Valenciano de Infertilidad, Valencia, Spain.

Objective: Premature luteinization has always been controversial in IVFcycles. Subtle P4 elevations (� 0.9 ng/ml) have been recently describedduring the late follicular phase in GnRH antagonists cycles. Therefore, theobjective of this study was to analize the incidence and effect of prematureluteinization in GnRH antagonists cycles for IVF using the various defini-tions listed in the literature and to define cut-off values for clinical use.

Design: Retrospective study.Materials/Methods: All GnRH antagonists cycles from October 2001 to

February 2002 that had a serum E2, LH and P4 level on hCG injection daywere included. No distinction was made between day 6 or 14 mm folliclecriteria to start the antagonist. Premature luteinization was define as a P4 toE2 ratio �1 (P4 ng/ml � 1000/E2 pg/ml), as a P4 level�1 ng/ml and as aP4 level �1.2 ng/ml. Cycles with and without premature luteinization werecompared for age, day 3 basal hormones, serum E2, p4 level and LH, andnumber of mature (�16 mm) follicles on hCG day, mature oocytes re-trieved, total FSH dose, total HMG dose, days of antagonists use, days ofovarian stimulation and number of embryos transferred. Pregnancy wasdefined as the presence of a gestational sac with fetal hearbeat. Implantationrate was defined as the number of fetal heartbeats over the number ofembryos transfered. Statistical analysis was done using the Fisher exact test,Mann-Whiney test, logistic regression anaylisis and ROC curve as appropi-ate.

Results: Ninety-two ART cycles were studied over a 5 month period. Tencycles did not have embryos transferred. The incidence of premature lu-teinization, pregnancy and implantation rates are despicted in Table 1. Nodifference was found in age, day 3 basal hormones, LH on hCG day, numberof mature folicle and number of mature oocyte retrieved. A statisticallysignificant difference was found in the total FSH dose, total HMG dose,days of stimulation and in the days of antagonists use in all 3 cut-offsgroups. No LH surges (�10 U) were noted in any cycle on hCG day.Logistic regression analysis showed the P4 level to be significantly corre-lated to the outcome (-1.283 p � 0.002). P4 level and P4/E2 ratio areasunder the ROC curve were 0.695 and 0.601 with the difference beenstatistically different (p � 0.048) The ROC curve showed a P4 level of �1.2ng/ml as the most efficient cut-off criteria to discriminated between thepregnant and no pregnant cycles with a 85.2% sensitivity, 47.3% specificity,51.9% positive predictive value and 82.7% negative predictive value.

Three criteria for premature luteinization and cycle outcome

P4/E2 ratio P4 level ng/ml

�1 �0.9 �1 �0.9 �1.2 �1.1

Cycles 19 73 45 47 37 55No. of Transfers 16 66 40 42 33 49Incidence 20.6 48.9 40.2Pregnancy rate per transfer (%) 18.7 36.4 20 45.2* 18.2 42.9*Implantation rate (%) 7.32 18.53 10.3 22.3* 9.3 21*

* p less than 0.05

Conclusions: Premature luteinization during GnRH antagonists IVF cy-cles is a frequent event and adversely affects the pregnancy and implanta-tion rate basically disturbing endometrial receptivity. P4 elevations are notcaused by LH escapes and reflects the mature granulosa cell response tocontinued and prolonged exogenous FSH exposure. A P4 level �1.2 ng/mlis the best cut-off criteria for an adverse outcome. A randomized trial isunder way to confirm these results and to find the best approach in cases ofpremature luteinization.

Supported by: IVI Valencia.

P-97

Oocyte recruitment in IVF patients with limited ovarian reserve(LOR), maximizing quality of ooctyes and embryos. Douglas ChapmanDaly, Cheryl L. Daly, David Mayo, Andrew Jacobs. Grand Rapids Fertility& IVF and the Dept of Ob/Gyn of Medical Education and Research Councilof Grand Rapids and Michigan State Univ Coll of Human Medicine, GrandRapids, MI; Grand Rapids Fertility & IVF, Grand Rapids, MI.

Objective: Quality embryos derived from quality oocytes lead to preg-nancy. Patients with LOR can not respond to FSH stimulation with largenumbers of oocytes. Oocyte quality is more important in these patients. Wewondered if the hormonal environment during the weeks pre-inductioneffected oocyte quality. We wished to evaluate an induction protocolutilizing 2mg estradiol(E2)in the luteal phase of the preparation cyclefollowed by FSH(300IU) starting cycle day(CD)2, and late follicular gani-relix acetate with 375IU FSH/150IU LH (E2/nat) versus our establishedprotocol of pre-induction birth control pills followed by microdose leupro-lide and 300IU FSH/75IU LH (BCP/micr).

S148 Abstracts Vol. 78, No. 3, Suppl. 1, September 2002