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Records from 239 infertile patients attending the assisted reproductive unit at the Department of Obstetrics and Gynecology, General Hospital St. Poelten, Austria, from January 2003 to May 2004 were reviewed. Only those who completed the IVF/ICSI – ET cycle and had a pregnancy test in our laboratory 18 days after ovulation induction were included. Mean (± SD) patient age in this study population was 32.7 ± 3.97 years (range 18–41). Fourty-nine clinical pregnancies were achieved in 239 cycles (118 conventional IVF and 121 ICSI) after ET and a clinical pregnancy rate of 21.0 % per ET was determined. When stratified by diagnostic category, 106 patients had tubal disease (44.4%), 38 had endometriosis (5.4%), 13 had polycystic ovary syndrome (15.9%), 18 had unexplained infertility (7.5%), and 64 had male factor infertility (26.8%). For some patients, more than one infertility factor was assigned. ICSI was indicated for prior failed IVF fertilization(s) and male factor infertility as defined by severe semen abnormalities where semen analysis showed a sperm count of
In this study, two controlled ovarian hyperstimulation protocols were used: 61 women were treated with a conventional long protocol using a combination of intranasal buserelin (Suprecur®, Hoechst, Frankfurt, Germany) at a dose of 0.15 mg, 3 times daily from the midluteal phase of the cylce preceding the treatment cycle followed by rFSH (Puregon®, N.V. Organon, Oss, The Netherlands). Additionally, 178 women were treated with rFSH (Puregon®, N.V. Organon, Oss, The Netherlands) starting on day 2 of the menstrual cycle. From day 6–7 of the index cycle, 0.25 mg of ganirelix (Orgalutran®, N.V. Organon, Oss, The Netherlands) was administered daily as a subcutaneous injection up to and including the last day of rFSH administration. Serum concentration of E2 (pg/mL) and transvaginal ultrasound were used to monitor follicular growth. Ovulation was triggered by i.m. administration of 10,000 IU of hCG (Profasi®, Serono, Switzerland) when the mean follicular cohort diameter reached 19 mm. Ovulation induction (OI) was the beginning of the luteal phase and was designated as OI day 0. Oocyte retrieval was carried out transvaginally under ultrasound guidance 34–36 h after OI. Previous studies have described ICSI and IVF procedures in detail [1,10]. Fertilization rate was defined as the proportion of oocytes resulting in two pronuclei (2pn) formation; only metaphase II oocytes were counted in IVF/ICSI cycles. Transfer was carried out 4 days after OI (OI +4 days), 5 days after OI (OI +5 days) or 7 days after OI (OI +7 days). Normally cleaved embryos were replaced under ultrasound guidance using a K-soft 5001 catheter (Cook, Queensland, Australia). All patients had luteal support with Utrogestan vaginal capsules 2 × 100-mg capsules, twice a day (Viatris Pharma, Vienna, Austria) beginning on the day of embryo transfer. Patients with less than an E2 level ®, N.V. Organon, Oss, The Netherlands). Venous blood samples were collected on the morning of oocyte retrieval and on the day of ET. Serum E2 and P concentrations were measured via electrochemiluminescence immunoassay "ECLIA" (Roche Elecsys, Roche Diagnostics, Mannheim, Germany). For E2, inter- and intra-assay coefficients of variation on high concentration control (high E2: 1018 pg/mL) were 2.8 and 1.9%, respectively. For P (high P: 30.2 ng/mL), the inter- and intra-assay coefficients of variation were 5.5 and 2.7%, respectively. The ratio of E2/P was calculated for conception and non-conception cycles as defined below.
Single serum β-hCG measurement was performed on specimens obtained by peripheral veinpuncture 18 days after OI. Transvaginal ultrasound examination was performed at 8 weeks' gestation to identify clinical pregnancy, defined as the presence of a cardiac action on ultrasound scan. A conception established only on biochemical serum data was defined as preclinical abortion . Supplementary P was continued until 8 weeks of gestation.
Statistic Package for Social Sciences (SPSS v 10.0 for Windows, Chicago, IL) software was used for data analysis. Statistical significance was assessed using the Student t-test and χ2 test as appropriate. One-way analysis of variance (ANOVA) was used to test significant difference between groups. Hormonal data were log-transformed to correct for skewness prior to statistical analysis and values in the three groups were compared using the nonparametric Kruskal-Wallis test. Significance was interpreted as p
From this, receiver operating characteristic (ROC) curves were developed to depict probability of true-positive results (sensitivity) as a function of false-positive results (1 -specificity). Sensitivity and specificity were calculated for all determined ratios of the decision axis and combined with the area under the curve (AUC). The AUC (sensitivity/1 - specificity) format approach was used to confirm test adequacy (AUC near 1) or inadequacy (AUC near 0.5).
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