Alternatives to hysterectomy in surgical management of uterine fibroids: an equivalence analysis of single-site and multiport myomectomy

Impact of BRCA mutations on Fertility Preservation Cycle Outcomes

BRCA-negative or untested (n¼97)

BRCA-positive (n¼21)

P value

Adjusted p value a (95% CI)

33.2  3.2 22.1  3.1 16.4  7.7 10.6  5.1 79.3  16.4 8.2  4.7

32.7  2.4 23.5  5.2 11.0  8.0 7.4  5.7 74.0  24.8 5.1  4.4

0.680 0.695 0.015 0.047 0.277 0.013

0.002 (-10.6,-2.5) 0.008 (-7.2,-1.1) 0.053 (-20.1,0.2) 0.003 (-7.1,-1.5)

Age (years) BMI (kg/m2) No. of total oocytes No. of mature oocytes Fertilization rate (%) No. of embryos frozen

CONCLUSIONS: In women with breast cancer undergoing FP, BRCA mutations appear to be associated with lower oocyte and embryo yield and possibly reduced fertilization rates. Women with BRCA mutations should be counseled about the possibility of impaired outcomes with fertility preservation. Reference: 1. Titus S, Li F, Stobezki R, Akula K et al. Impairment of BRCA1-related DNA double-strand break repair leads to ovarian aging in mice and humans. Sci Transl Med. 2013;5:172ra21. Supported by: NIH (NICHD & NCI) HD05112. P-210 Tuesday, October 31, 2017 ALTERNATIVES TO HYSTERECTOMY IN SURGICAL MANAGEMENT OF UTERINE FIBROIDS: AN EQUIVALENCE ANALYSIS OF SINGLE-SITE AND MULTIPORT MYOMECTOMY. E. E. Tappy,a G. Moawad,b E. D. Abi Khalil,a J. Paek.c aObstetrics and Gynecology, George Washington University Hospital, Washington, DC; bGeorge Washington University Hospital, Washington, DC; cObstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea, Republic of. OBJECTIVE: Uterine fibroids are the most common type of pelvic tumor in women and are a leading indication for hysterectomy. For women desiring fertility preservation, development of alternative surgical techniques, namely minimally invasive myomectomy, is of upmost importance. In this study, we aim to determine the feasibility and safety of robotic single-site myomectomy in comparison to multiport myomectomy. DESIGN: Multi-center retrospective cohort study. MATERIALS AND METHODS: Clinical outcomes including estimated blood loss, total time of surgery, post-operative length of stay, intra-operative and post-operative complications were analyzed. RESULTS: The study included 261 women, 77% underwent multiport robotic myomectomies and 23% single-site myomectomies. Multiport versus single-site patient demographics differed in mean age (35.4 years versus 37.8 years, p¼0.026), BMI (27.9 versus 24.9, p <0.001), and predominant race (71.0% Black versus 55.7% Asian, p <0.001) respectively. In the same comparison, differences in fibroid characteristics existed including fibroid weight (370.2gm versus 81.5gm, p <0.001), estimated size on imaging (8.3cm versus 5.8cm, p<0.001) and number of fibroids removed (5.1 versus 2.1, p<0.001). After adjusting for demographic and clinical characteristics, single-site myomectomies demonstrated lower estimated blood loss (56.3mL versus 330.0mL, p¼0.003) and total surgical time (129.5 minutes versus 165.6 minutes, p¼0.036) compared to multiport myomectomies, but no difference in length of postoperative stay (1.0 day versus 0.7 day, p¼0.161). Overall intra-operative complications were lower for single-site myomectomies compared to multiport myomectomies (7.0% versus 0.0%, p¼0.045), however, too few complications occurred to draw meaningful conclusions between groups. When stratified based on similar fibroid characteristics, rates of intra-operative and post-operative complications were not different between myomectomy groups. CONCLUSIONS: In carefully selected patients, single-site myomectomy is a feasible and safe procedure compared to multiport myomectomies. Both surgical approaches are associated with low rates of intra-operative and postoperative complications. Further data is needed to support enhanced availability of these minimally invasive techniques to women desiring fertility preservation.

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ASRM Abstracts

P-211 Tuesday, October 31, 2017 A NON-INVASIVE METHOD FOR ASSESSING OOCYTE COMPETENCY. C. E. Wessels,a L. Penrose,b S. Prien.c aAnimal Science, Texas Tech University, Lubbock, TX; bDepartment of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Lubbock, TX; cOb/Gyn, Texas Tech University Health Sciences Center, Lubbock, TX. OBJECTIVE: Previous research from this laboratory has demonstrated a Specific Gravity Device (SGD) can be used to assess embryo quality and predict embryo future growth potential. The objective of the present study is to determine if the SGD can be used to assess oocyte competency prior to fertilization and/or cryopreservation. DESIGN: Lab based trial of experimental device. MATERIALS AND METHODS: Two hundred-sixty-six oocytes were collected from twenty-two mice. All oocytes were assessed using the SGD. Oocytes were then randomly assigned to one of four treatments: exposure to 60 C for thirty minutes, acidified media for one hour, ethylene glycol/ glycerol cryoprotectant for one hour or standard culture to serve as control. After treatment, oocytes were reassessed using the SGD and comparisons were made between oocyte descent time and treatment. To further analyze relationship between oocyte descent time and viability, ninety-eight additional oocytes were passed through SGD before and after treatment. Oocytes were stained with Coomaisse Blue to determine membrane permeability and estimate viability based on treatment. RESULTS: Oocytes treated with 60 C heat, acidified media and ethylene glycol/ glycerol cryoprotectant solution demonstrated altered descent times from control and pre-treatment oocytes (P<0.05). Oocytes exposed to heat and cryoprotectants descended more rapidly through SGD than control and pre-treatment oocytes (P<0.05). Oocytes treated with acidified media descended more slowly through SGD (P<0.05). Permeation of stain into oocytes exposed to lethal treatments confirmed changes in membrane integrity post-treatment and further indicates SGD can detect such shifts. This suggests SGD can predict competency between live and dead oocytes. CONCLUSIONS: SGD can detect shifts in oocyte density due to altered membrane permeability, which can suggest information about oocyte competency. This information can help differentiate between high and low quality fresh oocytes to help select which oocytes to freeze and result in improved oocyte cryopreservation and fertilization. Supported by: The authors would like to thank South Plains Foundation and the Laura W. Bush Institute for Women’s Health for funding of this project. P-212 Tuesday, October 31, 2017 OVARIAN CORTEX TISSUE DONATION DURING ROUTINE OBSTETRICAL AND GYNECOLOGIC M. McLaughlin,b PROCEDURES. J. Johnson,a R. Anderson,c E. Telfer.b aDepartment of Obstetrics and Gynecology, University of Colorado-Denver, Aurora, CO; bInstitute of Cell Biology and Centre for Integrative Physiology, University of Edinburgh, Edinburgh, United Kingdom; cMRC Centre for Reproductive Health, The Queen’s Medical Research Institute, Edinburgh, United Kingdom. OBJECTIVE: The objective of this study is to evaluate the incidence, safety record, and usage of ovarian cortex donation during caesarean section deliveries at the MRC Centre for Reproductive Health (MRCCRH) between 2012 and present. DESIGN: In the United States, ovarian cortical tissue collection and cryopreservation is offered for the purpose of fertility preservation prior

Vol. 108, No. 3, Supplement, September 2017