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Resident experience on reproductive endocrinology and infertility (REI) rotations affects perceived knowledge
with the decrease in estrogen levels, results in relative androgen excess as the menopausal transition progresses (Torrens JI et al 2009). However, little is known about the trend of these hormonal changes in young women with primary ovarian insufficiency (POI). Here we investigate whether after the onset of menstrual irregularity the hormonal changes of these young women follow the same trend as in the natural menopausal transition. DESIGN: Cross-sectional study. MATERIALS AND METHODS: We evaluated women aged 18 to 42 with spontaneous 46, XX POI (n¼145) after they had been off hormone replacement therapy for at least two weeks. Serum free testosterone was measured by equilibrium dialysis and estradiol by competitive chemiluminescence immunoassay. We examined the relationship between reported time since onset of menstrual irregularity and serum estradiol and testosterone levels by using ANOVA after adjusting for age. RESULTS: At mean (SD) age of 31.6 5.5 years, patients had experienced 88.5 69.7 (range 3.3-299.8) months of menstrual irregularity. Mean estradiol and free testosterone level was 38.0 41.6 (range 5.0340.0) pg/ml and 2.4 1.1 (range 0.2-6.3) pg/ml, respectively. Neither serum estradiol nor free testosterone level was significantly correlated with the duration of menstrual irregularity (r¼0.01, p¼0.9; and r¼0.10, p¼0.24, respectively). CONCLUSION: Unlike the natural menopausal transition, mean serum free testosterone and estradiol levels in women with 46, XX POI remain relatively stable as the time since onset of menstrual irregularity lengthens. This, combined with the findings of a broad range of serum values, characterizes this disorder as one in which intermittent and unpredictable ovarian function may extend for many years. Supported by: NICHD Intramural Research Program in Reproductive and Adult Endocrinology, NIH.
P-306 Wednesday, October 27, 2010 RESIDENT EXPERIENCE ON REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY (REI) ROTATIONS AFFECTS PERCEIVED KNOWLEDGE. A. Z. Steiner, M. A. Fritz, C. K. Sites, C. Coutifaris, B. R. Carr, K. Barnhart. Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; Obstetrics and Gynecology, Baystate Medical Center, Springfield, MA; Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA; Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX. OBJECTIVE: Obstetrics and Gynecology resident scores on the REI section of the annual in-training exam are declining. Resident exposure to REI varies by program. The objective of this study was to determine if duration and quality of REI rotations are associated with resident satisfaction and perceived REI knowledge. DESIGN: Retrospective analysis of anonymous survey. MATERIALS AND METHODS: An anonymous, multiple-choice survey was provided to 4744 examinees during the 2008 Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination. The survey queried residents’ experiences on their REI rotation, satisfaction with the quality and duration of the REI rotation, and knowledge of REI. Logistic regression was used to assess the relationship between components of the REI rotation and self-reported knowledge of REI. RESULTS: In total 4670 residents (98%) completed the survey. Forty percent of residents described their knowledge of REI as poor. Fewer weeks dedicated to REI increased the risk of self-reported poor knowledge (P<0.001). Required vacation during the REI rotation and non-REI coverage more than two times a week was associated with more than a 60% increase in risk of poor knowledge (Odds Ratio (OR) 1.67, 95% Confidence Interval (CI): 1.15-2.47 and OR 1.64, 95% CI: 1.15-2.36, respectively), while three hours of didactics per week were associated with a 73% reduction in risk (OR 0.27, 95% CI: 0.18-0.39). The impact of time on the REI rotation on resident knowledge of REI differed by postgraduate year (Ptest of interaction¼0.06) with the effect stronger in earlier postgraduate years. CONCLUSION: A significant number of residents perceive their knowledge of REI to be poor. Conflicting commitments during the REI rotation results in both lower satisfaction and lower levels of perceived knowledge. There is the potential to improve resident knowledge of REI by limiting non-REI coverage and night-call and including more didactics. Supported by: Society for Reproductive Endocrinology and Infertility.
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Abstracts
P-307 Wednesday, October 27, 2010 ¨ LUNILATERAL OOPHORECTOMY FAILS TO ALTER ANTI-MU LERIAN HORMONE/ANTRAL FOLLICLE COUNT RATIO, SUGGESTING UNCHANGED PER-FOLLICLE AMH PRODUCTION IN THE REMAINING OVARY. M. W. Grynberg, V. K. Genro, M. Ho¨her, V. Gallot, R. Frydman, R. Fanchin. Ob-Gyn and Reproductive Medicine, Hoˆpital Antoine Beclere, Clamart, France. OBJECTIVE: Growing evidence indicates that menopausal onset is remarkably not advanced in women having undergone unilateral oophorectomy early in life, suggesting that compensating mechanisms are at play in initial follicle recruitment. As AMH probably is also implicated in this latter process, and its serum levels reflect the number of growing and non-growing follicles, we decided to investigate whether per-follicle AMH production is altered in unilaterally oophorectomized patients. DESIGN: Prospective study. MATERIALS AND METHODS: 230 infertile, non-PCOS, non-endometriosis women, 20-43 years of age, having a single remaining ovary as a result of unilateral oophorectomy (One Ovary group; n¼ 30) or two ovaries (Control group) (n¼200) were studied. In both groups, serum AMH and number and size of antral follicles (3-12 mm) were measured on cycle day 3. In an effort to assess per-follicle AMH production, we calculated the ratio serum AMH levels/antral follicle count (AFC) and the strength of the correlation between both parameters. RESULTS: Whereas median AMH levels and AFC were markedly lower in the One Ovary group than in the Control group (1.1 (0.21-3.56) vs. 2.22 (0.04-6.19) ng/mL, P<0.001; 7 (1-14) vs. 13 (2-24) follicles, P<0.001), respectively, per-follicle AMH levels remained similar in both groups (0.19 0.1 vs. 0.18 0.02 ng/mL/follicle, respectively). In addition, correlation between AMH and AFC was unaffected in patients the One ovary group (r¼0.77; P <0.001) as compared to the Control group (r¼0.67; P<0.001). CONCLUSION: That both the strength of the correlation between serum AMH levels and AFC and the ratio between the two parameters remained comparable in the One Ovary and Control groups is not consistent with the presumable implication of AMH in the mechanisms that drive follicle loss in unilaterally oophorectomized patients.
P-308 Wednesday, October 27, 2010 HYPOXIA-INDUCIBLE FACTOR-1a (HIF-1a) OVEREXPRESSION INDUCES PREECLAMPSIA-LIKE MANIFESTATIONS IN PREGNANT MICE. R. Tal, A. Shaish, I. Barshack, S. Polak-Charcon, A. Afek, D. Harats. The Bert W. Strassburger Lipid Center, Sheba Medical Center, Tel Aviv, Israel; Vascular Biogenics Ltd., Or Yehuda, Israel; Institute of Pathology, Sheba Medical Center, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY. OBJECTIVE: Preeclampsia affects 5-8% of pregnancies, causing substantial fetal and maternal morbidity and mortality. HIF-1a is a transcription factor upregulated in preeclamptic placentas. However, its role in preeclampsia is unknown. Our objective was to test the hypothesis that HIF-1a overexpression would induce preeclamptic manifestations in pregnant mice. DESIGN: Ten weeks old C57BL/6J pregnant mice were injected via tailvein on gestational day 8 with either adenovirus expressing HIF-1a (CMVHIF) (n¼12), luciferase (CMV-Luc) (n¼8) or saline (n¼8). MATERIALS AND METHODS: Blood pressure and urinary protein were measured at regular intervals. Fetal and placental weights were recorded following mice sacrifice on day 18. In addition, blood was collected for complete blood count and chemistry analysis and various organs were extracted for histological analysis. RESULTS: CMV-HIF mice had significantly elevated blood pressure compared to CMV-Luc or saline controls (104.5 6.6 vs. 87.1 3.0 vs. 85.7 4.15 mmHg, p<0.05). In addition, marked proteinuria (2-fold) was measured in CMV-HIF mice compared to controls. Placental and fetal weights of CMVHIF mice were significantly decreased compared to controls, and their placental histology revealed calcifications and vascular abnormalities. Consistent with preeclampsia, electron microscopy analysis demonstrated glomerular endotheliosis in CMV-HIF mice vs. normal histology in controls. Moreover, liver enzymes were significantly elevated while complete blood count and smear revealed microangiopathic hemolytic anemia and thrombocytopenia in CMV-HIF mice vs. controls, consistent with HELLP-like (hemolysis, elevated liver enzymes, low platelets) syndrome. Serum levels of soluble vascular endothelial growth factor receptor-1 and soluble endoglin
Vol. 94., No. 4, Supplement, September 2010
P-306 Wednesday, October 27, 2010 RESIDENT EXPERIENCE ON REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY (REI) ROTATIONS AFFECTS PERCEIVED KNOWLEDGE. A. Z. Steiner, M. A. Fritz, C. K. Sites, C. Coutifaris, B. R. Carr, K. Barnhart. Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; Obstetrics and Gynecology, Baystate Medical Center, Springfield, MA; Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA; Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX. OBJECTIVE: Obstetrics and Gynecology resident scores on the REI section of the annual in-training exam are declining. Resident exposure to REI varies by program. The objective of this study was to determine if duration and quality of REI rotations are associated with resident satisfaction and perceived REI knowledge. DESIGN: Retrospective analysis of anonymous survey. MATERIALS AND METHODS: An anonymous, multiple-choice survey was provided to 4744 examinees during the 2008 Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination. The survey queried residents’ experiences on their REI rotation, satisfaction with the quality and duration of the REI rotation, and knowledge of REI. Logistic regression was used to assess the relationship between components of the REI rotation and self-reported knowledge of REI. RESULTS: In total 4670 residents (98%) completed the survey. Forty percent of residents described their knowledge of REI as poor. Fewer weeks dedicated to REI increased the risk of self-reported poor knowledge (P<0.001). Required vacation during the REI rotation and non-REI coverage more than two times a week was associated with more than a 60% increase in risk of poor knowledge (Odds Ratio (OR) 1.67, 95% Confidence Interval (CI): 1.15-2.47 and OR 1.64, 95% CI: 1.15-2.36, respectively), while three hours of didactics per week were associated with a 73% reduction in risk (OR 0.27, 95% CI: 0.18-0.39). The impact of time on the REI rotation on resident knowledge of REI differed by postgraduate year (Ptest of interaction¼0.06) with the effect stronger in earlier postgraduate years. CONCLUSION: A significant number of residents perceive their knowledge of REI to be poor. Conflicting commitments during the REI rotation results in both lower satisfaction and lower levels of perceived knowledge. There is the potential to improve resident knowledge of REI by limiting non-REI coverage and night-call and including more didactics. Supported by: Society for Reproductive Endocrinology and Infertility.
S182
Abstracts
P-307 Wednesday, October 27, 2010 ¨ LUNILATERAL OOPHORECTOMY FAILS TO ALTER ANTI-MU LERIAN HORMONE/ANTRAL FOLLICLE COUNT RATIO, SUGGESTING UNCHANGED PER-FOLLICLE AMH PRODUCTION IN THE REMAINING OVARY. M. W. Grynberg, V. K. Genro, M. Ho¨her, V. Gallot, R. Frydman, R. Fanchin. Ob-Gyn and Reproductive Medicine, Hoˆpital Antoine Beclere, Clamart, France. OBJECTIVE: Growing evidence indicates that menopausal onset is remarkably not advanced in women having undergone unilateral oophorectomy early in life, suggesting that compensating mechanisms are at play in initial follicle recruitment. As AMH probably is also implicated in this latter process, and its serum levels reflect the number of growing and non-growing follicles, we decided to investigate whether per-follicle AMH production is altered in unilaterally oophorectomized patients. DESIGN: Prospective study. MATERIALS AND METHODS: 230 infertile, non-PCOS, non-endometriosis women, 20-43 years of age, having a single remaining ovary as a result of unilateral oophorectomy (One Ovary group; n¼ 30) or two ovaries (Control group) (n¼200) were studied. In both groups, serum AMH and number and size of antral follicles (3-12 mm) were measured on cycle day 3. In an effort to assess per-follicle AMH production, we calculated the ratio serum AMH levels/antral follicle count (AFC) and the strength of the correlation between both parameters. RESULTS: Whereas median AMH levels and AFC were markedly lower in the One Ovary group than in the Control group (1.1 (0.21-3.56) vs. 2.22 (0.04-6.19) ng/mL, P<0.001; 7 (1-14) vs. 13 (2-24) follicles, P<0.001), respectively, per-follicle AMH levels remained similar in both groups (0.19 0.1 vs. 0.18 0.02 ng/mL/follicle, respectively). In addition, correlation between AMH and AFC was unaffected in patients the One ovary group (r¼0.77; P <0.001) as compared to the Control group (r¼0.67; P<0.001). CONCLUSION: That both the strength of the correlation between serum AMH levels and AFC and the ratio between the two parameters remained comparable in the One Ovary and Control groups is not consistent with the presumable implication of AMH in the mechanisms that drive follicle loss in unilaterally oophorectomized patients.
P-308 Wednesday, October 27, 2010 HYPOXIA-INDUCIBLE FACTOR-1a (HIF-1a) OVEREXPRESSION INDUCES PREECLAMPSIA-LIKE MANIFESTATIONS IN PREGNANT MICE. R. Tal, A. Shaish, I. Barshack, S. Polak-Charcon, A. Afek, D. Harats. The Bert W. Strassburger Lipid Center, Sheba Medical Center, Tel Aviv, Israel; Vascular Biogenics Ltd., Or Yehuda, Israel; Institute of Pathology, Sheba Medical Center, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY. OBJECTIVE: Preeclampsia affects 5-8% of pregnancies, causing substantial fetal and maternal morbidity and mortality. HIF-1a is a transcription factor upregulated in preeclamptic placentas. However, its role in preeclampsia is unknown. Our objective was to test the hypothesis that HIF-1a overexpression would induce preeclamptic manifestations in pregnant mice. DESIGN: Ten weeks old C57BL/6J pregnant mice were injected via tailvein on gestational day 8 with either adenovirus expressing HIF-1a (CMVHIF) (n¼12), luciferase (CMV-Luc) (n¼8) or saline (n¼8). MATERIALS AND METHODS: Blood pressure and urinary protein were measured at regular intervals. Fetal and placental weights were recorded following mice sacrifice on day 18. In addition, blood was collected for complete blood count and chemistry analysis and various organs were extracted for histological analysis. RESULTS: CMV-HIF mice had significantly elevated blood pressure compared to CMV-Luc or saline controls (104.5 6.6 vs. 87.1 3.0 vs. 85.7 4.15 mmHg, p<0.05). In addition, marked proteinuria (2-fold) was measured in CMV-HIF mice compared to controls. Placental and fetal weights of CMVHIF mice were significantly decreased compared to controls, and their placental histology revealed calcifications and vascular abnormalities. Consistent with preeclampsia, electron microscopy analysis demonstrated glomerular endotheliosis in CMV-HIF mice vs. normal histology in controls. Moreover, liver enzymes were significantly elevated while complete blood count and smear revealed microangiopathic hemolytic anemia and thrombocytopenia in CMV-HIF mice vs. controls, consistent with HELLP-like (hemolysis, elevated liver enzymes, low platelets) syndrome. Serum levels of soluble vascular endothelial growth factor receptor-1 and soluble endoglin
Vol. 94., No. 4, Supplement, September 2010