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Reproductive Performance in Women Who Failed to Conceive after Laparoscopic Surgery for Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 INFERTILITY 460 Reproductive Performance in Women Who Failed to Conceive after Laparoscopic Surgery for Endometriosis Albornoz JA, Fernandez E, Duque G, Fernandez C. Obstetrics and Gynecology, Unit of Reproductive Medicine, Clinica Las Condes, Santiago, RM, Chile Study Objective: To assess ovarian response, oocyte maturity, fertilization rate, embryo quality, implantation and pregnancy rates in ART cycles of women with ovarian or deep infiltrating pelvic endometriosis who failed to conceive after laparoscopic surgery and to compare to tubal factor as controls. Design: Retrospective analysis of 71 ICSI cycles performed between 2004 and 2008. Setting: Center of Reproductive Medicine. Patients: Twenty-four ART cycles in 23 endometriosis patients and 47 cycles in 40 tubal factors patients. Severe male factor was ruled out and ICSI was performed in order to assess oocyte maturity. Intervention: Laparoscopic surgery for endometriosis, either unilateral or bilateral ovarian cystectomy for endometriomas or bilateral utero-sacral ligament resection for deep pelvic endometriosis. Measurements and Main Results: There were no differences in the mean number of follicles (11.5 vs. 11), oocytes (8.2 vs. 8.2), metaphase II oocytes (6 vs. 6.6) embryos transferred (2.45 vs. 2.53) and good quality embryos transferred (1.7 vs. 1.49) between endometriosis and tubal factor. Nevertheless, FSH dose required for COH was significantly higher in endometriosis patients (2831 IU vs. 2421 IU; p 0.026) and fertilization rate was lower in endometriosis compared to controls (61.6% vs. 78.8%; p 5 0.018). No significant differences were found in implantation and pregnancy rates between endometriosis and tubal factor (21.2% vs. 14.4%; p 5 0.39 and 36% vs. 29.9%; chi2 5 0.29). Comparison of the outcomes in different types of endometriosis, showed lower number of follicles, oocytes, metaphase II oocytes and implantation rates in ovarian endometriosis (9 vs. 12.8; 6.6 vs. 9; 5.6 vs. 6.2; 8.3% vs. 26%) compared to deep pelvic endometriosis, however this data did not reach statistical significance. Conclusion: Reproductive performance in ART in endometriosis in terms of oocyte quality and pregnancy rates is not different than tubal factor, however ovarian response to gonadotropin stimulation and lower fertilization rate might reflect a decrease in fertility potential, explaining failure to conceive after laparoscopic surgery.
461 Altered Uterine Contractility Pattern in Woman Affected by Chronic Endometritis Cicinelli E, Pinto V, Colafiglio G, Saliani N, Pastore A, Secundo F. Dept. IV Clinic Ob/Gyn, DIGON, University of Bari, Policlinico di Bari, Bari, Italy Study Objective: The uterus shows wavelike activity (WA) throughout the menstrual cycle. Transvaginal sonography (TVS) has made it possible to study the movements of the subendometrial layers of the myometrium. Several WA patterns have been described. Inadequate uterine contractility may lead to ectopic pregnancies, miscarriages, retrograde bleeding with dysmenorrhea and endometriosis. Design: Subendometrial WA was studied by TVS, throughout 35 ovulatory cycles in 35 nulliparous patients with endometritis. Analysis was focused on the presence of WA, considering the wave types and their frequency in periovulatory and midluteal phase. A 3 minutes transvaginal sagittal scan of the uterus was recorded. Data were compared with a control group of 30 cycling, age-matched, healthy volunteers observed at the same representative stages.
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Setting: University centre. Patients: Thirty five nulliparous patients with endometritis. Intervention: In 35 nulliparous patients with endometritis, subendometrial WA was studied by TVS. Measurements and Main Results: During the periovulatory phase, in the endometritis group the WA pattern showed, retrograde (30.8%), antegrade (23.8%), opposing (23.8%), not propagated (7.7%), retrograde/not propagated (7.7%) and absent (7.7%) motility. In the control group, retrograde (87.5%) and opposing (12.5%) WA were distinguished. As regards the retrograde motility the difference was statistically significant. In this phase the frequency of contractions was higher in the control group (2.38 vs. 2.12 contractions/minute). In both the groups, during the midluteal phase, most of the waves disappeared and their frequency was similar. In this phase, in patients with endometritis the WA pattern was not propagated (50%), opposing (40%) and antegrade/opposing (10%). In no case an absent WA was ascertained. In healthy volunteers the WA was not propagated in 50%, opposing in 33.3% and absent in 16.7% of the cases. Conclusion: In the periovulatory phase, patients with endometritis did not show a normal retrograde WA and their frequency was lower. In the midlutel phase no significant differences were described.
462 Effect of Ultra-Long Protocol with GnRH Agonist on the Result of In Vitro Fertilization in Women with Severe Endometriosis Kim SC, Joo JK, Na YJ, Lee KS. Obstetrics and Gynecology, School of Medicine, Pusan National University, Pusan, Republic of Korea Study Objective: The purpose of this study was to assess the usefulness of long-term pre-treatment with GnRH agonist on the outcome of in vitro fertilization in women with severe endometriosis. Design: Prospective study on the effect of long-term pretreatment with GnRHa of infertile women with severe endometriosis. Setting: Department of obstetrics and gynecology, pusan national university hospital. Patients: Thirty-seven infertile women with severe endometriosis who were diagnosed and staged by laparoscopy or laparotomy. Intervention: Patients were divided into study group (ultra-long GnRHa protocol) and control group (routine IVF treatment with long or ultrashort GnRHa protocols). All patients had previously been confirmed by surgery two to three months before the study was begun. Measurements and Main Results: A significantly higher level of serum estradiol on the day of hCG administration occurred in the study group compared with control group (p!0.05). There was no statistically significant difference in the amount of gonadotropins required, number of days of gonadotropin administration, progesterone level on the day of hCG administration, number of oocytes retrieved, fertilization rate and number of embryos replaced per cycle between two groups. Significantly higher clinical pregnancy rate per cycle occurred in study groups compared with control group (p!0.05). Conclusion: A significantly higher level of serum estradiol on the day of hCG administration occurred in the study group compared with control group (p!0.05). There was no statistically significant difference in the amount of gonadotropins required, number of days of gonadotropin administration, progesterone level on the day of hCG administration, number of oocytes retrieved, fertilization rate and number of embryos replaced per cycle between two groups. Significantly higher clinical pregnancy rate per cycle occurred in study groups compared with control group (p!0.05).
463 A Case of Heterotopic Pregnancy after In Vitro Fertilization and Embryo Transfer in Bilateral Salpingectomy Patient Kim JH. Obstetrics & Gynecology, The Catholic University of Korea, Seoul, Republic of Korea
461 Altered Uterine Contractility Pattern in Woman Affected by Chronic Endometritis Cicinelli E, Pinto V, Colafiglio G, Saliani N, Pastore A, Secundo F. Dept. IV Clinic Ob/Gyn, DIGON, University of Bari, Policlinico di Bari, Bari, Italy Study Objective: The uterus shows wavelike activity (WA) throughout the menstrual cycle. Transvaginal sonography (TVS) has made it possible to study the movements of the subendometrial layers of the myometrium. Several WA patterns have been described. Inadequate uterine contractility may lead to ectopic pregnancies, miscarriages, retrograde bleeding with dysmenorrhea and endometriosis. Design: Subendometrial WA was studied by TVS, throughout 35 ovulatory cycles in 35 nulliparous patients with endometritis. Analysis was focused on the presence of WA, considering the wave types and their frequency in periovulatory and midluteal phase. A 3 minutes transvaginal sagittal scan of the uterus was recorded. Data were compared with a control group of 30 cycling, age-matched, healthy volunteers observed at the same representative stages.
S125
Setting: University centre. Patients: Thirty five nulliparous patients with endometritis. Intervention: In 35 nulliparous patients with endometritis, subendometrial WA was studied by TVS. Measurements and Main Results: During the periovulatory phase, in the endometritis group the WA pattern showed, retrograde (30.8%), antegrade (23.8%), opposing (23.8%), not propagated (7.7%), retrograde/not propagated (7.7%) and absent (7.7%) motility. In the control group, retrograde (87.5%) and opposing (12.5%) WA were distinguished. As regards the retrograde motility the difference was statistically significant. In this phase the frequency of contractions was higher in the control group (2.38 vs. 2.12 contractions/minute). In both the groups, during the midluteal phase, most of the waves disappeared and their frequency was similar. In this phase, in patients with endometritis the WA pattern was not propagated (50%), opposing (40%) and antegrade/opposing (10%). In no case an absent WA was ascertained. In healthy volunteers the WA was not propagated in 50%, opposing in 33.3% and absent in 16.7% of the cases. Conclusion: In the periovulatory phase, patients with endometritis did not show a normal retrograde WA and their frequency was lower. In the midlutel phase no significant differences were described.
462 Effect of Ultra-Long Protocol with GnRH Agonist on the Result of In Vitro Fertilization in Women with Severe Endometriosis Kim SC, Joo JK, Na YJ, Lee KS. Obstetrics and Gynecology, School of Medicine, Pusan National University, Pusan, Republic of Korea Study Objective: The purpose of this study was to assess the usefulness of long-term pre-treatment with GnRH agonist on the outcome of in vitro fertilization in women with severe endometriosis. Design: Prospective study on the effect of long-term pretreatment with GnRHa of infertile women with severe endometriosis. Setting: Department of obstetrics and gynecology, pusan national university hospital. Patients: Thirty-seven infertile women with severe endometriosis who were diagnosed and staged by laparoscopy or laparotomy. Intervention: Patients were divided into study group (ultra-long GnRHa protocol) and control group (routine IVF treatment with long or ultrashort GnRHa protocols). All patients had previously been confirmed by surgery two to three months before the study was begun. Measurements and Main Results: A significantly higher level of serum estradiol on the day of hCG administration occurred in the study group compared with control group (p!0.05). There was no statistically significant difference in the amount of gonadotropins required, number of days of gonadotropin administration, progesterone level on the day of hCG administration, number of oocytes retrieved, fertilization rate and number of embryos replaced per cycle between two groups. Significantly higher clinical pregnancy rate per cycle occurred in study groups compared with control group (p!0.05). Conclusion: A significantly higher level of serum estradiol on the day of hCG administration occurred in the study group compared with control group (p!0.05). There was no statistically significant difference in the amount of gonadotropins required, number of days of gonadotropin administration, progesterone level on the day of hCG administration, number of oocytes retrieved, fertilization rate and number of embryos replaced per cycle between two groups. Significantly higher clinical pregnancy rate per cycle occurred in study groups compared with control group (p!0.05).
463 A Case of Heterotopic Pregnancy after In Vitro Fertilization and Embryo Transfer in Bilateral Salpingectomy Patient Kim JH. Obstetrics & Gynecology, The Catholic University of Korea, Seoul, Republic of Korea