Abstracts of the 15th Annual Meeting of the ESHRE, Tours, France 1999 with urinary preparations (644 ± 47 IV; 86.5 ± 4 IV per day; P < 0.05 and P < 0.005 respectively). Furthermore, at the time of human chorionic gonadotrophin administration, both total FSH dose and the ratio defined by this FSH dose and the number of dominant follicle (> 16 mm in diameter) were significantly lower in group 2 than in group 1 (817 ± 43 IV versus 992 ± 69 IV; P < 0.05 and 703 ± 48 versus 875 ± 76; P < 0.05 respectively). At any time, plasma oestradiol values were equivalent and rates of monofollicular development or pregnancy were identical in both groups (76.9 versus 75.6% and 34.6 versus 35.1% in groups 1 and 2 respectively). 14.45-15.00 0-231. Evidence that follistatin secretion is not regulated by LH or FSH Fawzy M. I , Harrison R.F. I , Knight P.G.2 , Groome N.3, Evans L.W.3 , Robertson W.R.4 and Lambert A. 4 1Human Assisted Reproduction Unit, Rotunda Hospital, Dublin 1, 2Animal and Microbial Sciences, University of Reading, RG62AJ, 3Biological and Molecular Sciences, Oxford Brookes University, Oxford OX3 OBP and "Unlversity Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford OX3 9DU, UK Introduction: Follistatin, a single chain glycoprotein which exists as a variety of molecular forms (molecular weight 3244 kDa) and is encoded by two mRNAs, functions as a binding protein for activin and to a lesser extent inhibin. Follistatin mRNA is expressed in a wide variety of tissues. The ovary (granulosa and theca) contains the highest amount of follistatin mRNA but other sources include the liver, kidney, muscle, uterus, brain, pancreas, testis, pituitary and adrenal gland. Little is known about the control of follistatin secretion and, as part of a larger study, we investigated this in response to gonadotrophins containing increasing amounts of luteinizing hormone (LH) in women undergoing in-vitro fertilization (IVF) treatment. Materials and methods: We examined the changes in the circulating concentrations of follistatin in women down-regulated with buserelin and receiving one of four different gonadotrophins: Humegon (75:75 IV/ampoule of LH:FSH; Hum), Normegon (25:75 IV/ampoule of LH:FSH; Norm), Orgafol (1:75 IV/ampoule of LH:FSH; Org) or recombinant follicle stimulating hormone (FSH) (75 IV/ampoule of FSH alone: Puregon and Gonal-F, rFSH). Ethical Committee approval was obtained. Puregon and Gonal-F are similar with respect to their physiochemical and biological characterization 128 Results: Pre-treatment concentrations of LH, FSH, oestradiol, inh A, inh Band follistatin were similar in the four groups «2.6 IV/I, <3.7 IVIl, <0.08 nmol/l, <0.01 ng/ml, <0.05 ng/ ml and < 1.4 ng/ml) as were the units of FSH given (22302950 IV), length of treatment (9.1-9.7 days) and number of follicles of > 14 mm diameter on the day of human chorionic gonadotrophin (HCG) administration (14-17). Daily treatment with the gonadotrophins promoted a progressive increase (P < 0.05) in serum FSH (15-19 IV/I), inh A (1.3-1.5 ng/ml) and inh B (1.3-1.9 ng/ml) in the four groups. Peak oestradiol concentrations (nmolll) were variable (7.84, Hum; 6.04, Norm, 7.25, Org and 5.04, rFSH). In contrast follistatin concentrations were unaltered (P > 0.05) from basal (1.051.42 ng/ml) to peak (1.46-1.98 ng/ml) in any of the four groups. The range of the fold changes in secretion from basal to peak concentrations were 180-318 (inh A, P < 0.05), 3871 (inh B, P < 0.05) and 1.5-1.9 (follistatin, P > 0.05) for the four groups. Conclusion: While the relative contribution of the ovaries to circulating follistatin concentrations is not known, these results suggest that ovarian secretion of follistatin is not regulated by FSH or LH, in contrast to inh A, inh B and oestradiol which are clearly gonadotrophin-dependent. 15.00-15.15 0-232. Follicular levels of active renin, prorenin, and angiotensin II at the time of the oocyte pick-up in ICSI cycles Delbaere A. I , Gervy-Decoster C. 2 , Bergmann P.J.M.3 , Van den Bergh M. I and Englert Y.I 'Fertility Clinic, 2RIA Laboratory, Hopital Erasme; 3RIA Laboratory, Brugmann Hospital, Free University of Brussels, Belgium Introduction: Although an ovarian production for angiotensin II (Ang II) is now clearly established, its synthesis pathway and its role within the ovary are still controversial. The aim of the present study was to characterize the components of the renin-angiotensin system (RAS) in the follicle at the time of the oocyte pick-up for IVF and to analyse their variations according to the follicle size, the follicular steroid levels, and the nuclear maturation stage of the corresponding oocyte. Materials and methods: One hundred and thirteen samples of follicular fluid (FF) from 23 consecutive patients undergoing ICSI and presenting otherwise normal ovulatory cycles were analysed. For each patient, FF up to a maximum of six were chosen as follows: the two first follicles :::::;2 ml, the two first follicles >2 ml and :::::;4 ml, and the two first follicles >4 ml. Only FF containing an oocyte were investigated. Oocytes were denuded and classified into three groups according to their Downloaded from https://academic.oup.com/humrep/article-abstract/14/Suppl_3/128/2914195 by guest on 26 May 2020 Conclusion: Altogether these data confirm previous reports that recombinant FSH is more effective than urinary preparations to stimulate follicular growth in patients with chronic anovulation. They also show for the first time that the FSH dose required to achieve follicular selection (FSH dose threshold) is significantly lower when using recombinant FSH than urinary FSH. They suggest that monitoring of ovulation must be adjusted to FSH preparations according to different bioavailability. and clinical efficacy. This was the first IVF cycle the women had received; they were of similar age (--34 years) and length of infertility (--4 years) and randomized to receive Hum (n = 13), Norm (n = 11), Org (n = 15) and rFSH (n = 16). The secretory profiles of Immunoactive inhibin A, B (inh A, B) and oestradiol were also compared in the four groups. Abstracts of the 15th Annual meeting of the ESHRE, Tours, France 1999 nuclear maturation stage: presence of the germinal vesicle (n = 7), metaphase I (n = 3) and metaphase II (n = 96). Prorenin, active renin, Ang II, 17~-oestradil, progesterone, testosterone, and androstenedione concentrations were measured in the FF and in the plasma. Conclusions: (i) The present study confirms Ang II as an intraovarian peptide and strongly supports renin as a key enzyme in its synthesis pathway. (ii) The positive correlation between the plasma levels of prorenin and the total number of follicles supports the ovarian origin of the circulating prorenin, while Ang II generated in the ovary seems to have no or little influence on the circulating Ang II levels, thereby avoiding potential adverse distance effects on the volaemia and electrolytic homeostasis. (iii) The negative correlation observed between FF levels of the RAS components and progesterone supports a local inhibitory effect of Ang lIon progesterone synthesis as previously shown in vitro in other species. (iv) FF levels of the RAS components did not differ significantly according to the oocyte maturation stage, but the low proportion of immature oocytes requires further investigation to draw firm conclusions on this particular point. Surgery 2 Wednesday 30 June 1999 Room 04-Hall 4 + 5 14.00-14.15 0-233. The influence of an intraoperative rupture of ovarian tumours on the prognosis of patients with ovarian cancer Siebzehnrtibl E., Klein T., Licht P. and Kissler S. Universitiits Frauenklinik Erlangen, Universitiitsstr: 21-23, D-91054 Erlangen, Germany Introduction: The influence of an intraoperative rupture of malignant ovarian cysts on the prognosis of patients with Materials and methods: For the study the operation records and the patient files were analysed and the follow-up data collected from our ambulance or from the gynaecologists of the patients. All the operations were performed as laparotomies and we defined three groups of patients. Group 1 consisted of the patients with a stage Ia cancer (n = 26), group 2 were the patients with intraoperative rupture of the tumour (n = 18) and group 3 the patients with stage Ic (n = 11). The average follow-up time was 81.2 months, with a minimum of 60, and a maximum of 120 months. Survival and recurrence-free survival were calculated using Kaplan-Meier live table analysis. Results: Group 5 year survival (%) Recurrence-free 5 year survival (%) FlOG Ia FIGG Ic (due to rupture) FlOG Ic 73 67 45 70 50 29 There was no statistical significant difference between the groups. Conclusion: Even if our data show no difference between the survival rates in the different groups, we see an evident drop in the survival between stage Ic and stage Ia. The survival of patients with stage Ic due to rupture is close to that of patients with stage Ia. We conclude therefore that an intraoperative rupture of the tumour does not influence the prognosis of patients with ovarian cancer in FIGO stage I. 14.15-14.30 0-234. Effect of laparoscopic myomectomy in in-vitro fertilization (IVF) outcome in patients with failed cycles prior to surgery Diaz 1.1, Navarro J. 1, Vergara F.1, Alvarez J.C. 1, Simon C. 1,2, Pellicer A. 1,2 and Remohi J. 1,2 'Instituto Valenciano de Infertilidad (IVI), and 2Department of Paediatrics, Obstetrics and Gynaecology, Valencia University School of Medicine, Valencia, Spain Introduction: Uterine myomata have been associated with infertility and poor outcome in assisted reproduction techniques (ART). The aim of this study was to compare IVF outcome before and after laparoscopic myomectomy. Materials and methods: Seven patients underwent 14 IVF cycles before and 10 cycles after laparoscopic surgery, in which the presence of one or more intramural myomata was the only attributable cause of failed implantation prior to 129 Downloaded from https://academic.oup.com/humrep/article-abstract/14/Suppl_3/128/2914195 by guest on 26 May 2020 Results: FF levels of prorenin, active renin, and Ang II were 10-30-fold higher than the corresponding plasma levels (P < 0.001). FF levels of prorenin and active renin were correlated with Ang II FF levels (P < 0.001). Plasma prorenin levels were 10-fold higher than the plasma laboratory norms and directly correlated with the total number of follicles (P < 0.001). Conversely, plasma Ang II levels were within the normal laboratory range and were not correlated with the total number of follicles. There was a negative correlation between the FF volume and the FF levels of active renin (P < 0.05) and of prorenin (P < 0.001). FF levels of active renin, prorenin, and Ang II were negatively correlated with FF levels of progesterone (P < 0.001 for active renin and prorenin, and P < 0.05 for Ang II). FF levels of prorenin, active renin and Ang II were not statistically different according to the oocyte nuclear maturation stage. FIGO stage I ovarian cancer is still controversial. While laparoscopists often declare that an intraoperative rupture has no influence, many oncologists warn about the consequences for the prognosis of the patients, if the tumour has to be regraded from stage Ia to Ic due to iatrogenic spilling during the surgery. To clarify this question a long-term follow-up is necessary. We therefore retrospectively analysed the followup of 55 patients with ovarian cancer FIGO I, who were operated on between 1984 and 1991.