Determining Optimal Time Interval Between Operative Hysteroscopy for Intrauterine Adhesions and Transfer of Single Euploid Embryos

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Interventions: After sonographic evaluation of the IUD location, as well as gestational age and vitality, patients were transferred to the OR. All 7 IUD removals were performed in vaginoscopic approach without any anesthesia or cervical dilation using 3.5mm Gynecare Versascope (Ethicon). Prior to the procedure, all patients received a single dose of intravenous prophylactic antibiotic (Cefamezine), vagina was washed with an antiseptic solution. After clear intrauterine view was achieved using 0.9% normal saline solution, instillation of fluid was stopped in order to decrease the risk for hydro-dissection of the gestational tissue. IUD was removed using semirigid 5F grasping forceps (Karl-Stortz, Tuttlingen, Germany). Ultrasound examination at the end of procedure was performed to ensure fetal pulse. Measurements and Main Results: All IUD were copper covered, timing of IUD extraction was between 6-9 weeks of gestation. All 7 pregnancies carried on after the procedure. In our cohort, all 7 women delivered at term (37-42 weeks). All deliveries were spontaneous vaginal deliveries of healthy babies at appropriate weight for gestational age (2859-3756gr). No marked complications during pregnancy or delivery were noted. Conclusion: Hysteroscopic removal of IUD in the first trimester is a safe procedure not linked to major adverse pregnancy outcomes. This procedure should be offered to gravid women in the first trimester who desire to preserve pregnancy. Open Communications 3: Hysteroscopy (11:00 AM — 12:45 PM) 11:21 AM Determining Optimal Time Interval Between Operative Hysteroscopy for Intrauterine Adhesions and Transfer of Single Euploid Embryos Chan CW,*,1 Petrini A,2 McCarter K,3 Pereira N,2 Spandorfer S4. 1 Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY; 2The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY; 3Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY; 4The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY *Corresponding author. Study Objective: There is limited data assessing optimal timing between operative hysteroscopy for intrauterine adhesions (IUAs) and embryo transfer (ET). Prior studies have demonstrated an association between IUAs and infertility. This study aims to assess whether increasing time intervals between hysteroscopy for IUAs and ET affects pregnancy outcomes in the ideal study group of those undergoing euploid frozen ET. Design: Retrospective cohort. Setting: Academic center. Patients or Participants: 375 women undergoing hysteroscopy prior to single euploid ET over a 3 year period. Interventions: hysteroscopy for IUAs and single euploid ET. Measurements and Main Results: 55.6% (n=99) had a diagnosis of IUAs and 44.4% (n=79) had normal intrauterine findings. Patients were stratified based on number of menstrual cycles (1, 2, or 3 cycles) between hysteroscopy and ET and categorized by outcome of pregnant, not pregnant, and ongoing pregnancy. Student’s and nonparametric t-tests, and Chi-square tests were used with p < 0.05. There was no difference in baseline demographics between groups. In those undergoing hysteroscopy for IUAs, 68.7% were pregnant overall and 46.5% were ongoing. There were an insufficient number of patients undergoing ET 1 menstrual cycle after hysteroscopy for intrauterine adhesions to draw conclusions in this group. There was no difference in the pregnancy rate between groups who underwent ET after 2 or 3 menstrual cycles from hysteroscopy for IUAs as compared to those who waited a longer period or as compared to those who underwent diagnostic hysteroscopy. These same findings were also confirmed for the rate of ongoing pregnancy between groups.

S27 Conclusion: The time between hysteroscopy for IUAs and single euploid ET did not have an effect on pregnancy outcome. Clinicians can proceed with ET as early as in the second menstrual cycle after hysteroscopy for IUAs. Further research is needed to examine patients undergoing ET in shorter intervals given small sample size. Open Communications 3: Hysteroscopy (11:00 AM — 12:45 PM) 11:28 AM Transvaginal Laparoscopic Resection of Large Abdominal Mass Burnett AF*. ob/gyn, University of Arkansas for Medical Sciences, Little Rock, AR *Corresponding author. Video Objective: To demonstrate transvaginal laparoscopic removal of 22 cm adnexal mass. Setting: 60 year old woman with 22 cm mass. Interventions: transvaginal laparoscopic hysterectomy and bso with drainage and removal of large mass. Conclusion: this is a safe alternative to transabdominal laparoscopy resulting in less pain, quicker recovery and better cosmesis. Open Communications 3: Hysteroscopy (11:00 AM — 12:45 PM) 11:35 AM Reproductive and Obstetric Outcomes Following Operative Hysteroscopy for Treatment of Retained Products of Conception: Does Time from Surgery to Conception Matter? Chill HH, Safrai M,* Karavani G, Cohen A, Bahar R, Shveiky D, Shushan A. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel *Corresponding author. Study Objective: To evaluate reproductive and obstetric outcomes following operative hysteroscopy for treatment of retained products of conception (RPOC). We also investigated the effect of time interval between operative hysteroscopy and pregnancy on these outcomes. Design: Retrospective cohort study. Setting: The study was conducted at the gynecology department of a tertiary teaching hospital between January 2012 and December 2016. Patients or Participants: Women who underwent operative hysteroscopy for treatment of RPOC and who became pregnant following the procedure. Interventions: All women in the study underwent operative hysteroscopy with resection of RPOC. Measurements and Main Results: Demographic, pre-operative, intraoperative, post-operative, reproductive and obstetric data were retrieved from electronic medical records. All patients were contacted via telephone questionnaire during which data regarding reproductive and obstetric outcomes of the pregnancy following the surgical procedure were collected. To determine the effect of time interval between operative hysteroscopy and pregnancy on reproductive and obstetric outcomes the cohort was divided into two groups: women who conceived 6 months or less following surgery and women who conceived more than 6 months after operative hysteroscopy. Eighty-two women who underwent operative hysteroscopy for treatment of RPOC and who conceived later were included. Mean time from women’s attempt to conceive to conception was 4.32 (SD=5.31) months. Conception rate was 84.2% at 6 months and reached 92.7% at 12 months postsurgery. Miscarriage rate for the consecutive pregnancy following hysteroscopy was 16.7% and delivery rate was 83.3%. Two cases of obstetric complications including one case of retained placenta and one case of