with their doctor included having a child at diagnosis (adjusted odds ratio(OR), 95% confidence interval (CI): 1.7, 1.3-2.1), being younger at diagnosisversus being aged 30-35 (aged 20-24: 1.5, 1.0-2.1; aged 25-29: 1.1, 0.8-1.4),being African American versus being white (1.2, 0.9-1.6), and not beingtreated with chemotherapy or radiation (3.1, 2.4-4.1). These ORs and 95%CIs were similar in a model restricted to women treated with chemotherapyor radiation. Among women who discussed fertility, 6% of those with a childand 19% of those without were referred to a specialist.

CONCLUSION: Over half of reproductive-age women with cancer do notdiscuss fertility with a doctor before treatment, and even fewer are referred toa specialist. Some women, especially those aged 20-24, may not be gettingthe information they need to make informed decisions about fertility preser-vation prior to cancer treatment.

Supported by: NICHD 5R01HD066059.

P-70 Tuesday, October 15, 2013

GnRH AGONISTS AND ANTAGONISTS IN CYCLOPHOSPHA-MIDE-INDUCED OVARIAN DAMAGE: FRIEND OR FOE? H. A.Parlakgumus,a E. B. Kilicdag,a F. Bolat,b B. Haydardedeoglu,a

A. Parlakgumus.c aObstetrics and Gynecology, Baskent University, Adana,Turkey; bPathology, Baskent University, Adana, Turkey; cGeneral Surgery,Baskent University, Adana, Turkey.

OBJECTIVE: To determine whether GnRH agonist(GnRHa) or antago-nist(GnRHant) administration protects the ovarian follicles from cyclophos-phamide(Cyc) induced damage and whether the processes were mediated byAMH.

DESIGN: Experimental study.MATERIALS AND METHODS: The control group had intraperitonea-

l(ip) saline injection. The GnRHa group had a single subcutaneous(sc) leu-prolide acetate(LA, 1 mg/kg) 28 days prior to a ip saline. The GnRHantgroup received a single ip cetrorelix acetate(CA, 0.1 mg/kg) 1 h prior to ipsaline. The Cyc group had an ip Cyc(75 mg/kg) at day 28. The GnRHa +Cyc group had sc LA(1 mg/kg) 28 days prior to ip Cyc(75 mg/kg). TheGnRHant + Cyc group had an ip CA(0.1 mg/kg) 1 h prior to an ip Cyc(75mg/kg). After oophorectomy on day 35,primordial follicles(PMFs) werecounted and AMH expression was assessed by H score. Kruscal Wallistest, c2 test or Fisher Exact test were used in statistical analysis. p<0.05was considered statistically significant.

RESULTS: The Cyc(p¼0.003) and GnRHant(p¼0.003) groups had fewerPMFs than the control group. GnRHa+Cyc, GnRHant+Cyc and Cyc groupshad similar numbers of PMFs. The H score was lower in the GnRHa(p<0.001), GnRHant(p¼0.003), and Cyc(p¼0.002) groups than in controls.H scores of GnRHa+Cyc(p¼0.01) and GnRHant +Cyc(p¼0.002) groupswere lower than Cyc group.

Follicle counts and H score according to the study groups.

Control GnRHa GnRHant Cyc GnRHa+ GnRHant+

S

168 A

(n¼11) (

SRM A

n¼11)

bstract

(n¼11)

s

(n¼11) C

yc(n¼11) C yc(n¼11)

Primordialfollicles

5

.1� 2.9 5 �4.9 2.7�1.7a 3�2.4a 4.5�4 2.9�2.5a

HScore 3

.7�0.3 2 �1.4a 3.2�0.6a 3 �0.9a 1.4�1.4b 1�1.4b

Data are given as mean � standard deviation.a p<0.05 when compared to control group.b p<0.05 when compared to cyc group.

CONCLUSION: Neither GnRHa nor GnRHant protect PMFs againstdamage from Cyc exposure. GnRHant itself reduces the number of PMFs,destroying rather than protecting PMFs. Changes in AMH expression suggestthat GnRHa, GnRHant, and Cyc may be AMH-dependent.

Supported by: This study was Supported by Baskent University researchfund.

P-71 Tuesday, October 15, 2013

SLEEP DISTUBANCES HIGH IN PATIENTS SEEKING FERTILITYPRESERVATION. M. E. Pavone,a J. Hirshfeld-Cytron,b A. Lawson,a

K. Smith,a S. C. Klock.a aObstetrics and Gynecology, Northwestern Univer-sity, Chicago, IL; bFertility Centers of Illinois, Orland Park, IL.

OBJECTIVE: Sleep has been shown to have a key role in an increasingnumber of medical diseases, yet the impact of sleep on infertile patients re-mains unknown. This is a pilot study to assess the frequency of disturbedsleep in patients undergoing IVF for infertility compared to fertility preser-vation (FP) patients with a concurrent cancer diagnosis.DESIGN: Prospective, multicenter survey.MATERIALS AND METHODS: 57 IVF and 32 FP patients completed a

pre-treatment sleep questionnaire of which 50 IVF and 32 FP patients alsocompleted a post-treatment questionnaire. Demographic and IVF stimulationinformation were also collected.RESULTS: Pre-treatment, FP patients had a significantly higher sleep

disturbance score compared to IVF controls (P<.001). At the time ofretrieval we found that compared to pre-treatment scores, IVF patients re-ported significantly higher sleep problems (P¼.003). Sleep problem scoresin patients undergoing fertility preservation did not significantly change dur-ing treatment, however they continued to be significantly higher than patientsundergoing IVF for infertility.CONCLUSION: FP patients report higher baseline problems with sleep

compared to IVF patients. However, in contrast to FP patients, IVF patientsreported an increase in sleep problems during treatment. Research iswarranted which examines the cause of sleep problems in both FP and IVFpatients. This work is on-going to determine the role sleep may have onIVF outcomes and the impact of treatment directed to sleep dysfunction.

Supported by: K12HD050121 and U54HD076188 (MEP).

P-72 Tuesday, October 15, 2013

CLINICAL USE OF VITRIFIED OOCYTES AMONG AUTOLO-GOUS IN VITRO FERTILIZATION (IVF) PATIENTS: A THREEYEAR REVIEW. J. H. Lim,a,b M. A. Stout,a K. A. Milne,a

K. S. Richter,a E. E. Levens,a M. J. Tucker.a,c aShady Grove ReproductiveScience Center, Rockville, MD; bDonor Egg Bank USA, Rockville, MD;cGeorgia Reproductive Specialists, Atlanta, GA.

OBJECTIVE: Successful cryostorage of vitrified oocytes has introduced atherapeutic option giving young women pursuing higher education, begin-ning a career or facing life-threatening disease the opportunity to preservetheir fertility while postponing motherhood. Oocyte cryostorage also avoidsmost of the ethical issues associated with creating embryos that may never beused.DESIGN: Retrospective review.MATERIALS ANDMETHODS: Autologous oocyte cryopreservation cy-

cles performed by a private IVF center from June 2009 to December 2012were reviewed. A proven oocyte vitrification protocol (7.5% EG+DMSO,followed by 15% EG+DMSO+sucrose) using commercially available mediain conjunction with an ‘open’ vitrification carrier was employed. Warmingwas performed using stepwise dilutions of sucrose. Surviving oocytes wereinseminated by intracytoplasmic sperm injection (ICSI). Average age ofwomen at the time of oocyte collection and vitrification was 34.9 yrs.RESULTS: 542 oocytes from 63 patients were thawed, with 477 (88%)

surviving. Following ICSI, 356 oocytes displayed normally fertilization(2PN, 75%). Embryo transfer (ET) was performed in 59 cycles with cancel-lation of 4 cycles due to inadequate embryo development. From 59 ETs (1.9embryos/ET) there were 33 clinical pregnancies and implantation rates were56% and 44% respectively. For comparison, among fresh oocyte cycles (<35yrs) from January 2010 to December 2012 (n¼ 2666) resulting clinical preg-nancy and implantation rates were 56% and 49%.CONCLUSION: This review provides clinical staff and patients with

valuable information as to the efficiency of oocyte cryopreservation allow-ing informed decisions to be made. While sample size is limited, clinicalpregnancy and implantation rates are comparable to fresh cycles. Theseresults are similar to published reports of donor oocyte banking, and sug-gest that vitrification of autologous oocytes provides similar outcomes andmay greatly reduce surplus embryos and ethical issues in some patientpopulations.

P-73 Tuesday, October 15, 2013

EFFECT OF FETAL CALF SERUM AND BOVINE SERUMALBUMIN ON IN VITRO DEVELOPMENT OF BOVINE PREAN-TRAL FOLLICLES DURING THREE-DIMENSIONAL CUL-TURE. M. P. Bernuci, A. C. J. S. Rosa-e-Silva, L. Batista, C. Garcia,J. O. Campos, M. F. S. S�a. Gynecology and Obstetrics, Faculty ofMedicine of Ribeir~ao Preto of S~ao Paulo University, Ribeir~ao Preto, S~aoPaulo, Brazil.

Vol. 100, No. 3, Supplement, September 2013

OBJECTIVE: To evaluate the effect of bovine serum albumin (BSA) andfetal calf serum (FCS) on in vitro development of bovine preantral follicles.

DESIGN: Bovine preantral follicles were studied individually duringencapsulated three-dimensional culture.

MATERIALS AND METHODS: Bovine preantral follicles (150 to250 mm in diameter) were mechanically isolated from ovaries obtained inlocal slaughterhouse, encapsulated into alginate (0.25% w/v), and culturedfor 21 days at 20% O2 in TCM199 supplemented with BSA (n ¼ 26) orFCS (n ¼ 27) at concentration of 3mg/mL. Follicle development was evalu-ated on the basis of survival, antral cavity formation, oocyte diameter in-crease and the presence of healthy cumulus-oocyte complexes. Data wereanalyzed using Student’s t-tests.

RESULTS: A greater percentage of viable follicles was observed in BSAthan FCS (39, and 7%, respectively, P< 0.05). The rate of antrum formationwas higher in BSA than in the FCS (19 and 11%, respectively, P< 0.05). Nodifference in oocyte diameter (90 to 110 mm) was detected, however the per-centages of retrieved healthy cumulus-oocyte complexes were higher in BSAthan FCS (38.5, and 18.5%, respectively, P < 0.05).

CONCLUSION: The data present herein suggest that BSA offers a betterprotein source than FCS for the in vitro development of alginate-encapsu-lated bovine preantral follicles.

Supported by: This project received financial support from two governa-mental brazilian agencies FAPESP (Fundac~ao de Amparo �a Pesquisa doEstado de S~ao Paulo) and CNPq (Conselho Nacional de DesenvolvimentoCient�ıfico e Tecnol�ogico).

P-74 Tuesday, October 15, 2013

DIRECT INJECTION OF METHOTREXATE PRESERVESFERTILITY IN PATIENTS WITH ECTOPIC PREGNANCY INLOWER UTERINE SEGMENT. T. Honda, R. Honda,M. Yamaguchi, K. Uchino, T. Ohba, H. Katabuchi. Obstetrics and Gynecol-ogy, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

OBJECTIVE: Ectopic pregnancy in lower uterine segment is rare, causedby a cesarean scar or uterine cervix implantation. Recently, management hasbeen shifted from a surgical approach to a more conservative treatment forthese patients. The objective of this study was to evaluate the fertilityoutcome after direct injection of methotrexate (MTX) to the ectopic preg-nancy in lower uterine segment.

DESIGN: Retrospective analysis.MATERIALS AND METHODS: We performed a retrospective analysis

of pregnancy by collecting records of patients with lower uterine segmentpregnancy (7with cesarean scar pregnancy and 9 with cervical pregnancy)managed at Kumamoto University Hospital, Kumamoto, Japan, betweenApril 2005 and March 2012. All patients were treated with direct injectionof MTX under transvaginal ultrasound guidance promptly after diagnosis.The serum hCG level was followed until it was decreased to the non-pregnantrange with periodic observation by transvaginal ultrasound.

RESULTS: The mean age of the 7 patients with cesarean scar pregnancywas 32.3�4.4 years old (range 25-38 years old), and for the 9 patientswith cervical pregnancy, it was 32.3�3.7 years old (range 26-37 yearsold). In the methotrexate treatment group, no patients had serious postoper-ative hemorrhage to be required hysterectomy or transarterial embolization.In the case of cesarean scar pregnancy, 6 of 7 patients desired subsequentpregnancy. Among them, pregnancy was achieved in 5 patients (7 cycles),1 had a repeated cesarean scar pregnancy, 1 had a miscarriage, and 5 resultedin term delivery. Meanwhile, 6 of 9 patients with cervical pregnancy wishedsubsequent pregnancy; finally, 1 had a miscarriage and 3 resulted in termpregnancy.

CONCLUSION: MTX local injection therapy is an effective manage-ment option for preserving the fertility of women with lower uterine ectopicpregnancy.

P-75 Tuesday, October 15, 2013

FERTILITY PRESERVATION BY CONTROLLED OVARIAN HY-PERSTIMULATION (COH) WITHOUT LETROZOLE IN YOUNGBREAST CANCER PATIENTS BEFORE ADJUVANT CHEMO-THERAPY: PRELIMINARY RESULTS. C. Decanter,a C. Delesalle,a

B. Leroy-Martin,c L. Keller,c D. Dewailly,a A. Mailliez.b aReproductiveMedicine, Lille University Hospital, Jeanne de Flandre IVF Center, Lille,France; bBreast Cancer Unit, Oncologic Center of Oscar Lambret, Lille,France; cReproductive Biology, Lille University Hospital, Lille, France.

FERTILITY & STERILITY�

OBJECTIVE: Few studies have addressed the issue of COH for fertilitypreservation in breast cancer patients. Letrozole is currently required in orderto limit the estrogen levels increase. In France, the use of letrozole in this spe-cific area is not allowed. The aim of this study is to evaluate the benefit/risk ofthe ovarian stimulation without letrozole for oocyte freezing in young breastcancer patients undergoing adjuvant chemotherapy.DESIGN: Prospective observational study.MATERIALS AND METHODS: A total of 45 young breast cancer

patients were prospectively included before adjuvant chemotherapy. The in-clusion criteria for being eligible to COH were: age under 40, complete sur-gery, absence of metastases. Lymph node status, presence of hormonalreceptors, BRCA 1/2 were not exclusion criteria. COH protocol consistedin the association of r-FSH and antagonist with a GnRh agonist triggering.r-FSH starting dose varied from 150 to 450 IU. Patients were then enrolledin a systematic oncologic and reproductive follow-up for 3 consecutive years.RESULTS: 13 patients declined the proposal of fertility preservation and 4

were not eligible because of suspect uptakes during positron emission tomog-raphy. 28 patients underwent COH. Mean age was 30.3 +/-3.4. Mean r-FSHdose was 271 +/- 92 IU. The average number of days of supra-physiologicE2 levels (i-e triggering day - day 6) was 5 +/-1. Peak E2 levels ranged from149 to 5314 pg/ml with a mean of 1793 +/- 1173 pg/ml. An average of 10oocytes+/- 5.6was retrieved. Themeannumber of vitrified oocyteswas respec-tively 7 +/-4.9. Time between surgery and chemotherapy was 46.6 days (18-69). Mean duration of follow-up after the end of chemotherapy was 10 months+/- 11. No recurrences were observed during the study period. There was onecase of moderate OHSS and 3 cycle cancellations for insufficient response.CONCLUSION: To date, no oncologic adverse effects were noted. These

preliminary results have to be confirmed in a larger population through amuch long-term follow-up.

P-76 Tuesday, October 15, 2013

SIMPLIFIED CYCLE MANAGEMENT FOR BREAST CANCER PA-TIENTS UNDERGOING FERTILITY PRESERVATION WITH THELETROZOLE-FSH STIMULATION PROTOCOL. G. Bedoschi,a,b

V. Turan,a,b F. Moy,a K. Oktay.a,b aObstetrics and Gynecology, New YorkMedical College, Valhalla, NY; bInnovation Institute for Fertility Preserva-tion and In Vitro Fertilization, New York, NY.

OBJECTIVE: Ovarian stimulation can be time consuming, costly, andemotionally stressful for women who are recently diagnosed with cancer.Our objective was to determine if a simplified approach to Letrozole-FSHprotocol could be developed.DESIGN: Secondary analysis of a prospectively collected database.MATERIALS AND METHODS: Fifty consecutive women diagnosed

with breast cancer stage% 3 with normal ovarian reserve underwent ovarianstimulation with letrozole (5mg/day) starting on cycle day (CD) 2 and rFSH150-450 IU on CD 4. Patients were divided into two groups according towhether there were changes in recombinant FSH dose during the cycle.GnRH antagonist (GnRHa, 250 mg/d) was administered daily when thelead follicle size reached 14-mm in mean diameter and was continued untilthe trigger with a GnRH agonist (Leuprolide acetate, 1 mg).RESULTS: The mean age was 37.6 � 2.8 years with 10.6 � 0.6 days of

ovarian stimulation. AGnRHawas initiated on the 6.6� 0.6 th day of ovarianstimulation. rFSH dose remained constant in 64% of patients. Only in 14.4%of the cycles FSH dose was altered prior to antagonist administration. Themean stimulation length in patients who required a change in the rFSHdose was similar to those with constant dose (11.0 � 1.1 vs. 10.4 � 1.1days, p¼ 0.131). A similar % of patients in the former group had a decreaseor increase in their FSHr doses (45.5% vs. 55.5%) and this change was by%75 units. None experienced moderate/severe OHSS.CONCLUSION: The Letrozole-FSH cycles require no or minimal dose

manipulation, since the risk of OHSS is negligible due to lack of pregnancyattempt and GnRH agonist trigger. Accordingly, we propose the followingpractical stimulation protocol: baseline US and blood work on D-2, repeaton SD 6 to evaluate if dose change is needed and start antagonist, and returnSD 10 for trigger decision.Supported by: NIH R01 HD053112 and R21 HD061259.

P-77 Tuesday, October 15, 2013

CANWE PRESERVE FERTILITY IN A FEMALE TOMALE TRAN-GENDER AFTER A LONG TERM TESTOSTERONE TREATMENT-CASEREPORT. Y. S. Gidoni, A. Raziel, D. Strassburger, E. Kasterstein,I. Ben-Ami, R. Ron-El. IVF and Infertility Unit, Assaf Harofeh MedicalCenter, Rishon Lezion, Beer Yaacov, Israel.

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