- Email: [email protected]
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their potential to preserve fertility. The higher IVM rates in oocytes exposed to letrozole is intriguing and further investigation is needed to determine whether this is a direct effect of letrozole or low estradiol levels. Given the improving success rates with in vitro maturation, this increase in the yield of mature oocytes is likely to translate into higher probability of pregnancy post chemotherapy. Supported by: None.
CLINICAL FEMALE INFERTILITY AND GYNECOLOGY Wednesday, October 25, 2006 3:00 pm O-230 PATHOPHYSIOLOGICAL FEATURES OF THIN ENDOMETRIUM. H. Tamura, I. Miwa, K. Taniguchi, K. Shimamura, A. Takasaki, N. Sugino. Yamaguchi Univ Graduate School of Medicine, Ube, Japan; Saiseikai-Shimonoseki General Hospital, Shimonoseki, Japan. OBJECTIVE: An adequate growth of the endometrium is necessary for successful implantation. A number of reports have shown that thin endometrium is associated with low implantation rates, suggesting that poor growth of the endometrium is an important factor for implantation failure. However, the pathophysiology of the thin endometrium is not clarified. Recently, several investigators have shown that uterine blood flow is closely associated with endometrial growth. In order to search the pathophysiological features that are characteristic of thin endometrium, we examined uterine blood flow, growth of glandular epithelium, vascular development, and angiogenic factors in the thin endometrium and normal endometrium. DESIGN: A prospective observational study. MATERIALS AND METHODS: Fifty-eight patients with normal menstrual cycles were recruited into the study. The patients were classified into two groups; normal endometrium group (endometrial thickness ⬎ 8 mm, n ⫽ 47) and thin endometrium group (endometrial thickness ⬍ 8 mm, n ⫽ 11). Blood flow impedance in uterine arteries (UA) and radial arteries (RA), which are upper-extremity of uterine arteries that cross the myometrium was assessed during the menstrual cycle (early follicular phase, late follicular phase and mid-luteal phase) by transvaginal color and pulsed Doppler ultrasound and expressed as resistance index (RI). The endometrial biopsy specimens obtained in the mid-luteal phase were immunostained for CD34 to quantify the number of blood vessels within a unit area (0.318 mm2/ field). The area of glandular epithelium was measured within the same unit area. Expression of vascular endothelial growth factor (VEGF) in the endometrium was examined by Western blotting. RESULTS: RA-RI in the thin endometrium group was significantly higher than that in the normal endometrium group throughout the menstrual cycle. There was no change in UA-RI and RA-RI throughout the menstrual cycle in the both groups. The number of blood vessels and the area of glandular epithelium were significantly lower in the thin endometrium group than those in the normal endometrium group. VEGF expression of the thin endometrium group was significantly lower than normal endometrium group. CONCLUSION: This is the first report showing the pathophysiological features of the thin endometrium, which are low uterine blood flow, impaired growth of glandular epithelium, low angiogenic factor and impaired angiogenesis. Since low uterine blood flow was found in the early follicular phase, it is suggested that low uterine blood flow impairs the growth of glandular epithelium and VEGF production, and causes poor angiogenesis, which in turn makes uterine blood flow worse. The present study may raise a possible mechanism to understand the pathophysiology of the thin endometrium. Supported by: None.
Wednesday, October 25, 2006 3:15 pm O-231 FEBRILE BUT NONFOCAL: TOWARDS COST-EFFECTIVE EVALUATION OF THE MYOMECTOMY FEVER. E. A. Rybak, A. J. Polotsky, T. Woreta, S. M. Hailpern, R. E. Bristow. Albert Einstein College
FERTILITY & STERILITY威
of Medicine, Bronx, NY; Johns Hopkins Medical Institutions, Baltimore, MD. OBJECTIVE: The 1982 Collaborative Review of Sterilization Study reported a 32% rate of febrile morbidity among postoperative abdominal hysterectomy patients. Subsequent published series comparing morbidity between hysterectomy and myomectomy patients demonstrate substantial variation - 12% to 67% - in the rates of postoperative fever among the myomectomy cohort, likely attributable to disparate criteria used to define fever. These studies offer conflicting evidence regarding the alleged association of myomectomy with postoperative fever. We investigated the association of myomectomy with postoperative febrile morbidity by comparing the relative proportion of nonfocal febrile morbidity among postoperative myomectomy patients versus hysterectomy patients. DESIGN: Retrospective cohort study at an academic institution. MATERIALS AND METHODS: Using the diagnosis code for uterine leiomyoma, the study identified 591women aged 18-55 having undergone hysterectomy (n⫽341) or myomectomy (n⫽250). Sample size calculation with 90% power to detect a 15% absolute difference in febrile morbidity required 189 patients in each group. Postoperative fever was defined as any temperature ⱖ38.0°C occurring more than 4 hours postoperatively. A focal fever required a positive laboratory or radiologic finding. Univariate analysis using chi-square and t-tests was performed to compare both total postoperative fever rates and the relative proportion of nonfocal fever in each group. Multivariate logistic regression was used to assess potentially confounding variables. Statistical analysis was performed using Stata 9.1. RESULTS: There was no statistically significant difference in the overall rate of postoperative fever between myomectomy (39.2%) and hysterectomy (39.3%) patients. However, myomectomy patients had a significantly higher proportion of fever that was nonfocal (85.7%) compared to patients who underwent a hysterectomy (68.7%, P⫽0.003). Among all febrile postoperative patients with focal findings, 46% had a culture-proven urinary tract infection, 29% atelectasis, and 9% pneumonia. Myomectomy patients were younger (aged 37.7 vs 43.8, P⫽0.0001), of lower parity (36% multiparous vs 76%, P⫽0.001), lower BMI (27.6 vs 29.1, P⫽0.01), less likely to present with medical comorbidity (27.6% vs 50.6%, P⬍0.001), and more likely to have their surgery performed by a subspecialist (64.1% vs 40.3%, P⫽0.001) compared to hysterectomy patients. Multivariate logistic regression demonstrated that myomectomy was an independent predictor of nonfocal fever compared to hysterectomy, with a 70% reduction in the rate of focality among postoperative myomectomy patients with fever (OR 0.30, 95% CI 0.12-0.75, P⫽0.01). Likewise, an increase in BMI raised the likelihood of focal findings by 6% per unit BMI (OR 1.06, 95% CI 1.01-1.10, P⫽0.03). CONCLUSION: Myomectomy is an independent predictor of nonfocal postoperative fever compared to hysterectomy. This finding confirms the existence of the clinical entity of ”myomectomy fever“. Given the disparate likelihood of focal febrile morbidity, clinicians may consider simplifying the fever evaluation of postoperative myomectomy patients. Supported by: Supported in part by NIH 5 T32 HD040135-0 (to AJP).
Wednesday, October 25, 2006 3:30 pm O-232 TREATING PRIMARY DYSMENORRHEA WITH A CHINESE HERB FORMULA, FOUR-AGENTS-DECOCTION. J. Liu, L. Liang, K. Lin, Y. Liu, T. Tsai, L. Wang. Tri-Service General Hospital , Natioal Defense Medical Center, Taipei, Taiwan; Div of Clinical Research, National Health Research Institutes, Taipei, Taiwan; Taipei Municipal Zhongxiao Hospital, Taipei, Taiwan. OBJECTIVE: Four-Agents-Decoction (Si Wu Tang) is a traditional Chinese herbal formula widely used for relieving menstrual discomforts for many years, especially in Chinese and Asian populations. We assessed its effectiveness in treating primary dysmenorrhea by a rigorous clinical trial. DESIGN: a Randomized Placebo-controlled Clinical Trial. MATERIALS AND METHODS: Randomized, double-blind, placebocontrolled clinical trial was conducted between 2001 and 2004 enrolling 78 primary dysmenorrheic women after screening 326 women from colleges in the Taipei metropolitan area of Taiwan. Women had organic lesions were excluded, determined by non-invasive pelvic ultrasonography and normal
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CLINICAL FEMALE INFERTILITY AND GYNECOLOGY Wednesday, October 25, 2006 3:00 pm O-230 PATHOPHYSIOLOGICAL FEATURES OF THIN ENDOMETRIUM. H. Tamura, I. Miwa, K. Taniguchi, K. Shimamura, A. Takasaki, N. Sugino. Yamaguchi Univ Graduate School of Medicine, Ube, Japan; Saiseikai-Shimonoseki General Hospital, Shimonoseki, Japan. OBJECTIVE: An adequate growth of the endometrium is necessary for successful implantation. A number of reports have shown that thin endometrium is associated with low implantation rates, suggesting that poor growth of the endometrium is an important factor for implantation failure. However, the pathophysiology of the thin endometrium is not clarified. Recently, several investigators have shown that uterine blood flow is closely associated with endometrial growth. In order to search the pathophysiological features that are characteristic of thin endometrium, we examined uterine blood flow, growth of glandular epithelium, vascular development, and angiogenic factors in the thin endometrium and normal endometrium. DESIGN: A prospective observational study. MATERIALS AND METHODS: Fifty-eight patients with normal menstrual cycles were recruited into the study. The patients were classified into two groups; normal endometrium group (endometrial thickness ⬎ 8 mm, n ⫽ 47) and thin endometrium group (endometrial thickness ⬍ 8 mm, n ⫽ 11). Blood flow impedance in uterine arteries (UA) and radial arteries (RA), which are upper-extremity of uterine arteries that cross the myometrium was assessed during the menstrual cycle (early follicular phase, late follicular phase and mid-luteal phase) by transvaginal color and pulsed Doppler ultrasound and expressed as resistance index (RI). The endometrial biopsy specimens obtained in the mid-luteal phase were immunostained for CD34 to quantify the number of blood vessels within a unit area (0.318 mm2/ field). The area of glandular epithelium was measured within the same unit area. Expression of vascular endothelial growth factor (VEGF) in the endometrium was examined by Western blotting. RESULTS: RA-RI in the thin endometrium group was significantly higher than that in the normal endometrium group throughout the menstrual cycle. There was no change in UA-RI and RA-RI throughout the menstrual cycle in the both groups. The number of blood vessels and the area of glandular epithelium were significantly lower in the thin endometrium group than those in the normal endometrium group. VEGF expression of the thin endometrium group was significantly lower than normal endometrium group. CONCLUSION: This is the first report showing the pathophysiological features of the thin endometrium, which are low uterine blood flow, impaired growth of glandular epithelium, low angiogenic factor and impaired angiogenesis. Since low uterine blood flow was found in the early follicular phase, it is suggested that low uterine blood flow impairs the growth of glandular epithelium and VEGF production, and causes poor angiogenesis, which in turn makes uterine blood flow worse. The present study may raise a possible mechanism to understand the pathophysiology of the thin endometrium. Supported by: None.
Wednesday, October 25, 2006 3:15 pm O-231 FEBRILE BUT NONFOCAL: TOWARDS COST-EFFECTIVE EVALUATION OF THE MYOMECTOMY FEVER. E. A. Rybak, A. J. Polotsky, T. Woreta, S. M. Hailpern, R. E. Bristow. Albert Einstein College
FERTILITY & STERILITY威
of Medicine, Bronx, NY; Johns Hopkins Medical Institutions, Baltimore, MD. OBJECTIVE: The 1982 Collaborative Review of Sterilization Study reported a 32% rate of febrile morbidity among postoperative abdominal hysterectomy patients. Subsequent published series comparing morbidity between hysterectomy and myomectomy patients demonstrate substantial variation - 12% to 67% - in the rates of postoperative fever among the myomectomy cohort, likely attributable to disparate criteria used to define fever. These studies offer conflicting evidence regarding the alleged association of myomectomy with postoperative fever. We investigated the association of myomectomy with postoperative febrile morbidity by comparing the relative proportion of nonfocal febrile morbidity among postoperative myomectomy patients versus hysterectomy patients. DESIGN: Retrospective cohort study at an academic institution. MATERIALS AND METHODS: Using the diagnosis code for uterine leiomyoma, the study identified 591women aged 18-55 having undergone hysterectomy (n⫽341) or myomectomy (n⫽250). Sample size calculation with 90% power to detect a 15% absolute difference in febrile morbidity required 189 patients in each group. Postoperative fever was defined as any temperature ⱖ38.0°C occurring more than 4 hours postoperatively. A focal fever required a positive laboratory or radiologic finding. Univariate analysis using chi-square and t-tests was performed to compare both total postoperative fever rates and the relative proportion of nonfocal fever in each group. Multivariate logistic regression was used to assess potentially confounding variables. Statistical analysis was performed using Stata 9.1. RESULTS: There was no statistically significant difference in the overall rate of postoperative fever between myomectomy (39.2%) and hysterectomy (39.3%) patients. However, myomectomy patients had a significantly higher proportion of fever that was nonfocal (85.7%) compared to patients who underwent a hysterectomy (68.7%, P⫽0.003). Among all febrile postoperative patients with focal findings, 46% had a culture-proven urinary tract infection, 29% atelectasis, and 9% pneumonia. Myomectomy patients were younger (aged 37.7 vs 43.8, P⫽0.0001), of lower parity (36% multiparous vs 76%, P⫽0.001), lower BMI (27.6 vs 29.1, P⫽0.01), less likely to present with medical comorbidity (27.6% vs 50.6%, P⬍0.001), and more likely to have their surgery performed by a subspecialist (64.1% vs 40.3%, P⫽0.001) compared to hysterectomy patients. Multivariate logistic regression demonstrated that myomectomy was an independent predictor of nonfocal fever compared to hysterectomy, with a 70% reduction in the rate of focality among postoperative myomectomy patients with fever (OR 0.30, 95% CI 0.12-0.75, P⫽0.01). Likewise, an increase in BMI raised the likelihood of focal findings by 6% per unit BMI (OR 1.06, 95% CI 1.01-1.10, P⫽0.03). CONCLUSION: Myomectomy is an independent predictor of nonfocal postoperative fever compared to hysterectomy. This finding confirms the existence of the clinical entity of ”myomectomy fever“. Given the disparate likelihood of focal febrile morbidity, clinicians may consider simplifying the fever evaluation of postoperative myomectomy patients. Supported by: Supported in part by NIH 5 T32 HD040135-0 (to AJP).
Wednesday, October 25, 2006 3:30 pm O-232 TREATING PRIMARY DYSMENORRHEA WITH A CHINESE HERB FORMULA, FOUR-AGENTS-DECOCTION. J. Liu, L. Liang, K. Lin, Y. Liu, T. Tsai, L. Wang. Tri-Service General Hospital , Natioal Defense Medical Center, Taipei, Taiwan; Div of Clinical Research, National Health Research Institutes, Taipei, Taiwan; Taipei Municipal Zhongxiao Hospital, Taipei, Taiwan. OBJECTIVE: Four-Agents-Decoction (Si Wu Tang) is a traditional Chinese herbal formula widely used for relieving menstrual discomforts for many years, especially in Chinese and Asian populations. We assessed its effectiveness in treating primary dysmenorrhea by a rigorous clinical trial. DESIGN: a Randomized Placebo-controlled Clinical Trial. MATERIALS AND METHODS: Randomized, double-blind, placebocontrolled clinical trial was conducted between 2001 and 2004 enrolling 78 primary dysmenorrheic women after screening 326 women from colleges in the Taipei metropolitan area of Taiwan. Women had organic lesions were excluded, determined by non-invasive pelvic ultrasonography and normal
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