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Laparoscopic surgery for the removal of endometriomas is still a very common practice in the field of reproductive medicine. Although endometriomas per se may be detrimental to the ovarian reserve, the current evidence points toward an even lower ovarian reserve after surgery. Additionally, a reduced response of the ovaries to gonadotrophins has been described in different studies after surgical removal of endometriomas. The quality of the oocytes retrieved in IVF cycles is not improved after surgery. Patients going through an operative procedure might extend the time to pregnancy. Surgery should be envisaged only in specific circumstances such as pelvic pain or difficult access to growing follicles but not offered to every single patient with endometrioma-associated infertility.

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Final oocyte maturation using GnRH-agonist trigger in a GnRH-antagonist protocol is increasingly common, as ovarian hyperstimulation syndrome is almost completely avoided. However, this approach might lead to reduced pregnancy rates due to severe luteolysis. This proof of concept study evaluated the extend of luteolysis by measuring progesterone levels 48 hours after oocyte retrieval in 51 patients, who received GnRH-agonist trigger for final oocyte maturation in a GnRH-antagonist protocol due to the risk of ovarian hyperstimulation syndrome. It was shown, that luteolysis after GnRHa-trigger differs greatly among patients, with progesterone levels ranging from 13.0 ng/ml to ≥ 60.0 ng/ml, 48 hours after oocyte retrieval. Significant positive correlations could be demonstrated between progesterone levels and the number of ovarian stimulation and suppression days (p = 0.006 and p = 0.002 respectively), the total amount of medication used for ovarian suppression (p = 0.015), the level of progesterone on the day of final oocyte maturation (p = 0.008) and the number of retrieved oocytes (p = 0.019). Therefore it was concluded, that luteolysis after GnRH-agonist trigger is patient-specific and also luteal phase support requires individualization. Longer stimulation duration as well as a higher level of progesterone on the day of final oocyte maturation and more retrieved oocytes will result in higher levels of progesterone 48 hours after oocyte retrieval.

OBJECTIVE: To compare the flexible GnRH antagonist and the GnRH agonist long protocol in patients at high risk of OHSS undergoing IVF.DESIGN: Single-centre open label randomized prospective study. MATERIALS AND METHODS: The study included 144 women who had moderate or severe OHSS or had been at risk of OHSS during their first IVF/ICSI cycle with a mid-luteal long GnRH agonist plus gonadotrophin stimulation protocol. Patients were randomized to receive either cetrorelix 0.25 mg/day starting on day 3 of the menstrual cycle (antagonist group) or triptorelin 0.1 mg/day starting on day 21 of the menstrual cycle (agonist group). Ovarian stimulation was achieved with rFSH initiated on day 3 of the cycle at the maximal dose of 150 IU; the dose was adjusted depending on ovarian response. Embryo transfer was performed 2 or 3 days after oocyte retrieval. Luteal phase support was started on the day of oocyte retrieval using micronised progesterone vaginal gel.RESULTS: The two groups were similar in mean age, duration of infertility, body mass index, baseline FSH, total amount of rFSH administered and proportion of patients undergoing intracytoplasmic sperm injection. When oocyte maturation was triggered, the levels of E2 were lower in the antagonist group than in the agonist group (p<0.001). The number of cancelled cycles was significantly higher in the GnRH agonist group than in the GnRH antagonist group (9 versus 1, p¼0.022). The total number of oocytes retrieved, the number of metaphase II oocytes retrieved and the fertilization rate were similar in the two groups (p¼0.602, p¼0.621 and p¼0.946). Clinical pregnancy rate per initiated cycle was similar in the the two groups (p¼0.457); live birth rate per initiated cycle was 23.6% in the antagonist group and 26.4% in the agonist group (p¼0.700).CONCLUSION: When compared with the GnRH agonist protocol, the flexible GnRh antagonist protocol is associated with a similar pregnancy rate with a reduction in the number of cycles cancelled because of the risk of OHSS.O-93 Monday, OBJECTIVE: Recently, controversy has arisen regarding the use of oral contraceptive pill and the impact on implantation rates in patients undergoing IVF/ICSI. This debate is still open as cycle scheduling is a common practice in most units. Thus, we decided to compare cycle outome after scheduling with the standard long protocol versus the use of OCPs in patients undergoing GnRH antagonist cycles.DESIGN: Prospective, randomized, controlled trial. MATERIALS AND METHODS: Regular cycling women under 39 years, <3 previous IVF attempts were enrolled in this trial. Previous low response to COH, ovarian surgery or PCO were excluding factors. A total of 115 patients received OCP (0.030 EE/0.15 desogestrel) for 12 to 16 days, and COH was started on day 5 post-pill; similarly, 113 patients received long protocol from day 20-22 of the previous cycle. Patients were randomized at the time of cycle planning, according to a computerized random number list by a nurse coordinator.RESULTS: Groups were comparable in age (34.1...