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Conservative surgical treatment of focal adenomyosis by robot-assisted laparoscopic adenomyomectomy
and rituxamib was recommended. A consultation regarding FP was requested given the potential for ovarian failure associated with alkylating agents. The ensuing discussion involving the medical teams included obtaining consent for minors, ascertainment of the medical risks associated with FP, estimation of long term intact survival of the patient and logistical planning associated with ovarian stimulation and egg retrieval in an intubated patient. The multidisciplinary team was in favor of FP but the family ultimately declined because of the potential medical risks of retrieval given her severe anemia. CONCLUSION: The decision to proceed with FP in minors with complex medical issues requires a multi-disciplinary approach to assess the medical and ethical issues related to the individual case.
P-81 Tuesday, October 15, 2013 PREGNANCY AFTER THE EMBRYO TRANSFER DEVELOPED FROM UNFERTILIZED OOCYTES FROZEN FOR THE FERTILITY PRESERVATION BEFORE THE CHEMOTHERAPY OF ACUTE MYELOID LEUKEMIA. Y. Fujino, Y. Nakamura, E. Wakimoto, K. Koike, J. Ueda, M. Matsumoto. Fujino Ladies Clinic, Suita, Osaka, Japan. OBJECTIVE: To report the first successful pregnancy and delivery with cryopresereved unfertilized oocytes for the fertility preservation of a patient who had chemotherapy due t acute myeloid leukemia (AML). DESIGN: Case report. MATERIALS AND METHODS: Single woman(36 y.o.) was diagnosed as AML and had ovarian stimulation for her fertility preservation with Clomiphene citrate at 50mg a day was given from cycle day 3 up to the day of ovulation induction and hMG injection was added on cycle days 8 and 10 according to follicular responses. Oocytes retrieval was performed 32 hours later after GnRH analogue nasal spray as a flare-up effect. As a result, 6 unfertilized matured oocytes were cryopreserved using with the vitrification kit (Equilibration solution contained of 7.5% EG and 7.5% DMSO, Vitrification solution contained of 15% EG and 15 % DMSO). RESULTS: At an interval of six years, after the complete remission of AML by the cyclic chemotherapy using with gonadotoxic agents, and marriage in 42 y.o., 2 frozen unfertilized oocytes were thawed with Vitrification kit (Thawing solutions contained of 1M and 0.5M sucrose) and fertilized with ICSI using her husband’s sperm. Fertilized embryos were cultured to blastocyst stage in sequential media. One blastocyst was transferred into uterus and resulted in pregnancy. Her pregnancy course was smooth and fetal growth was well. She delivered a healthy female baby by Cesarean section (3294 gr. Apgar score: 9/9) at the 38 gestational weeks. CONCLUSION: The pregnancy and delivery case of embryo transfer originated from unfertilized oocytes is very rare in the worldwide. On the other hand, the fertility preservation in reproductive age is appeared as an integral field of a cancer treatment. This is the first report of pregnancy and delivery using with frozen unfertilized oocytes for the fertility preservation of serious leukemia patient in the world. Our finding suggests that the oocytes cryopreservation may be considered as an effective strategy for the preservation of women’s fertility. P-82 Tuesday, October 15, 2013 ABSTRACT WITHDRAWN
DESIGN: A retrospective chart review of all eligible patients was done. MATERIALS AND METHODS: The research group included 12 sarcoma patients who underwent fertility preservation procedure (‘‘ovarian protection’’ with GnRh agonist, ovarian tissue cryopreservation, oocytes cryopreservation, and embryos cryopreservation). In most women a combination of several fertility preservation techniques was used. RESULTS: Mean age of patients was 26 years and 67% had no children. 58% had bone sarcoma and 42% had soft tissue sarcoma. Mean LH, FSH and day 3 E2 levels were above the normal range. The number of antral follicles was under the threshold indicating low ovarian reserve and mean Anti-Mullerian Hormone levels were near that threshold. Sub-division of the research group, according to the basic disease, revealed preserved or almost preserved ovarian reserve among soft tissue sarcoma patients and low ovarian reserve among woman with bone sarcoma. CONCLUSION: Soft tissue sarcoma patients demonstrate an ovarian reserve that allows response to fertility treatments after chemotherapy. In this sub-group a surgical procedure like ovarian tissue cryopreservation may not be justified and GnRH analog protective treatment could be sufficient; while bone sarcoma patients demonstrate low post treatment ovarian reserve, a finding that may justify fertility preservation procedure, like IVF and embryos cryopreservation with or without oocyte cryopreservation, before radio-chemotherapy. Every patient should be consulted regarding the potential risks of chemotherapy and choose for herself whether to perform fertility preservation procedure. A multi-centered, prospective study is needed to establish the best fertility preservation aproach.
P-84 Tuesday, October 15, 2013 CONSERVATIVE SURGICAL TREATMENT OF FOCAL ADENOMYOSIS BY ROBOT-ASSISTED LAPAROSCOPIC ADENOMYOMECTOMY. S. Kim, S. Y. Kang, J. Y. Min, S. Kwak, Y.-J. Chung, J. H. Kim. Seoul St.Mary’s Hospital, Seoul, Republic of Korea. OBJECTIVE: to evaluate the effects of robot-assisted laparoscopic adenomyomectomy as a minimally invasive and conservative surgical treatment option to preserve fertility for patients with focal adenomyosis and severe dysmenorrhea unresponsive to medical treatment. DESIGN: Retrospective analysis of 3 cases of robot-assisted laparoscopic adenomyomectomy. MATERIALS AND METHODS: Three patients with focal adenomyosis with severe dysmenorrhea were selected. Their symptoms were not relieved through NSAIDS or GnRH agonists, but they were nullipara and wished to preserve fertility. We performed robot-assisted laparoscopic adenomyomectomy. Each women underwent pelvic MRI preoperatively for more accurate diagnosis and localization of the adenomyoma. RESULTS: Each woman had 5cm, 2cm, 4cm sized adenomyoma on posterior uterine body, respectively. These adenomyomas were removed using scissors and tenaculum forceps. All the patients were recovered without complication, and discharged within 3 days after operation. Postoperatively, symptoms of all three patients were completely resolved. CONCLUSION: For reproductive age patients suffering dysmenorrhea due to focal adenomyosis unresponsive to medical treatment but wishing future childbearing, robot-assisted laparoscopic adenomyomectomy should be considered as a treatment modality.
P-85 Tuesday, October 15, 2013 P-83 Tuesday, October 15, 2013 FERTILITY PRESERVATION IN FEMALE SARCOMA PATIENTS. Y. Hasson, A. Slotser, T. Cohen, A. Carmon, A. Amit, F. Azem. Racine IVf Unit, Tel-Aviv, Israel. OBJECTIVE: To assess ovarian reserve, after radio-chemotherapy treatments in sarcoma patients that underwent fertility preservation procedures.
FERTILITY & STERILITYÒ
FERTILITY PRESERVATION IN A PTIENT WITH BREAST AND UTERINE CERVIX CANCER: WHEN THE LIGHTENING STIKES MORE THAN TWICE! F. Azem, T. Cohen, A. Carmon, A. Amit, I. Wagman. Racine IVf Unit, Tel Aviv, Israel. OBJECTIVE: To describe cancers and myltuple gertility options in one single patient. DESIGN: Case report. MATERIALS AND METHODS: A 31 years single parient was diagnised as suffering from breast cancer. Prior to chemotherapy she
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P-81 Tuesday, October 15, 2013 PREGNANCY AFTER THE EMBRYO TRANSFER DEVELOPED FROM UNFERTILIZED OOCYTES FROZEN FOR THE FERTILITY PRESERVATION BEFORE THE CHEMOTHERAPY OF ACUTE MYELOID LEUKEMIA. Y. Fujino, Y. Nakamura, E. Wakimoto, K. Koike, J. Ueda, M. Matsumoto. Fujino Ladies Clinic, Suita, Osaka, Japan. OBJECTIVE: To report the first successful pregnancy and delivery with cryopresereved unfertilized oocytes for the fertility preservation of a patient who had chemotherapy due t acute myeloid leukemia (AML). DESIGN: Case report. MATERIALS AND METHODS: Single woman(36 y.o.) was diagnosed as AML and had ovarian stimulation for her fertility preservation with Clomiphene citrate at 50mg a day was given from cycle day 3 up to the day of ovulation induction and hMG injection was added on cycle days 8 and 10 according to follicular responses. Oocytes retrieval was performed 32 hours later after GnRH analogue nasal spray as a flare-up effect. As a result, 6 unfertilized matured oocytes were cryopreserved using with the vitrification kit (Equilibration solution contained of 7.5% EG and 7.5% DMSO, Vitrification solution contained of 15% EG and 15 % DMSO). RESULTS: At an interval of six years, after the complete remission of AML by the cyclic chemotherapy using with gonadotoxic agents, and marriage in 42 y.o., 2 frozen unfertilized oocytes were thawed with Vitrification kit (Thawing solutions contained of 1M and 0.5M sucrose) and fertilized with ICSI using her husband’s sperm. Fertilized embryos were cultured to blastocyst stage in sequential media. One blastocyst was transferred into uterus and resulted in pregnancy. Her pregnancy course was smooth and fetal growth was well. She delivered a healthy female baby by Cesarean section (3294 gr. Apgar score: 9/9) at the 38 gestational weeks. CONCLUSION: The pregnancy and delivery case of embryo transfer originated from unfertilized oocytes is very rare in the worldwide. On the other hand, the fertility preservation in reproductive age is appeared as an integral field of a cancer treatment. This is the first report of pregnancy and delivery using with frozen unfertilized oocytes for the fertility preservation of serious leukemia patient in the world. Our finding suggests that the oocytes cryopreservation may be considered as an effective strategy for the preservation of women’s fertility. P-82 Tuesday, October 15, 2013 ABSTRACT WITHDRAWN
DESIGN: A retrospective chart review of all eligible patients was done. MATERIALS AND METHODS: The research group included 12 sarcoma patients who underwent fertility preservation procedure (‘‘ovarian protection’’ with GnRh agonist, ovarian tissue cryopreservation, oocytes cryopreservation, and embryos cryopreservation). In most women a combination of several fertility preservation techniques was used. RESULTS: Mean age of patients was 26 years and 67% had no children. 58% had bone sarcoma and 42% had soft tissue sarcoma. Mean LH, FSH and day 3 E2 levels were above the normal range. The number of antral follicles was under the threshold indicating low ovarian reserve and mean Anti-Mullerian Hormone levels were near that threshold. Sub-division of the research group, according to the basic disease, revealed preserved or almost preserved ovarian reserve among soft tissue sarcoma patients and low ovarian reserve among woman with bone sarcoma. CONCLUSION: Soft tissue sarcoma patients demonstrate an ovarian reserve that allows response to fertility treatments after chemotherapy. In this sub-group a surgical procedure like ovarian tissue cryopreservation may not be justified and GnRH analog protective treatment could be sufficient; while bone sarcoma patients demonstrate low post treatment ovarian reserve, a finding that may justify fertility preservation procedure, like IVF and embryos cryopreservation with or without oocyte cryopreservation, before radio-chemotherapy. Every patient should be consulted regarding the potential risks of chemotherapy and choose for herself whether to perform fertility preservation procedure. A multi-centered, prospective study is needed to establish the best fertility preservation aproach.
P-84 Tuesday, October 15, 2013 CONSERVATIVE SURGICAL TREATMENT OF FOCAL ADENOMYOSIS BY ROBOT-ASSISTED LAPAROSCOPIC ADENOMYOMECTOMY. S. Kim, S. Y. Kang, J. Y. Min, S. Kwak, Y.-J. Chung, J. H. Kim. Seoul St.Mary’s Hospital, Seoul, Republic of Korea. OBJECTIVE: to evaluate the effects of robot-assisted laparoscopic adenomyomectomy as a minimally invasive and conservative surgical treatment option to preserve fertility for patients with focal adenomyosis and severe dysmenorrhea unresponsive to medical treatment. DESIGN: Retrospective analysis of 3 cases of robot-assisted laparoscopic adenomyomectomy. MATERIALS AND METHODS: Three patients with focal adenomyosis with severe dysmenorrhea were selected. Their symptoms were not relieved through NSAIDS or GnRH agonists, but they were nullipara and wished to preserve fertility. We performed robot-assisted laparoscopic adenomyomectomy. Each women underwent pelvic MRI preoperatively for more accurate diagnosis and localization of the adenomyoma. RESULTS: Each woman had 5cm, 2cm, 4cm sized adenomyoma on posterior uterine body, respectively. These adenomyomas were removed using scissors and tenaculum forceps. All the patients were recovered without complication, and discharged within 3 days after operation. Postoperatively, symptoms of all three patients were completely resolved. CONCLUSION: For reproductive age patients suffering dysmenorrhea due to focal adenomyosis unresponsive to medical treatment but wishing future childbearing, robot-assisted laparoscopic adenomyomectomy should be considered as a treatment modality.
P-85 Tuesday, October 15, 2013 P-83 Tuesday, October 15, 2013 FERTILITY PRESERVATION IN FEMALE SARCOMA PATIENTS. Y. Hasson, A. Slotser, T. Cohen, A. Carmon, A. Amit, F. Azem. Racine IVf Unit, Tel-Aviv, Israel. OBJECTIVE: To assess ovarian reserve, after radio-chemotherapy treatments in sarcoma patients that underwent fertility preservation procedures.
FERTILITY & STERILITYÒ
FERTILITY PRESERVATION IN A PTIENT WITH BREAST AND UTERINE CERVIX CANCER: WHEN THE LIGHTENING STIKES MORE THAN TWICE! F. Azem, T. Cohen, A. Carmon, A. Amit, I. Wagman. Racine IVf Unit, Tel Aviv, Israel. OBJECTIVE: To describe cancers and myltuple gertility options in one single patient. DESIGN: Case report. MATERIALS AND METHODS: A 31 years single parient was diagnised as suffering from breast cancer. Prior to chemotherapy she
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