- Email: [email protected]
Anthropometric variation in ovulatory and anovulatory infertility
cytogenetic testing of POC to become a more helpful diagnostic tool. Finding an abnormal karyotype makes testing for other causes of pregnancy loss unnecessary and may prevent unindicated and sometimes harmful immune, anticoagulant or surgical therapies, which are frequently offered in the absence of cytogenetic information or in the presence of false negative 46XX results. Supported by: None.
P-115 Fertility and pregnancy outcome following hypogastric artery ligation for severe post-partum hemorrhage. Jacky Nizard, Ludivine Barinque, Rene´ Frydman, Herve´ Fernandez. Hosp Antoine Be´ cle`re, Clamart, France. Objective: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. The technique has been described long ago and is used especially when the haemorrhage occurs during caesarean section. Nevertheless, little is known on the fertility and the pregnancy outcome following hypogastric artery ligation Design: We studied the fertility and pregnancies outcome in women who required hypogastric artery ligation for severe post-partum haemorrhage in our hospital from January 1989 to February 2002 Materials/Methods: The fertility and pregnancy outcome parameters were retrieved from medical files and telephone interviews Results: 68 patients required hypogastric ligation on this 13 years period. 17 patients had 21 pregnancies with 13 term deliveries, 2 ectopic pregnancies, 3 miscarriages, and 3 abortions. 28 patients did not want a new pregnancy, one patient did not want to answer our interview. The lost rate is 34 %. No patient had infertility and pregnancy was obtained in less than 18 most once desired. Pregnancy outcome was normal. 54 % of deliveries were vaginal. In 3 cases, patients had a beginning of post-partum haemorrhage easily treated medically Conclusions: Hypogastric artery ligation for post-partum haemorrhage is not responsible for secondary infertility. Following pregnancies do not suffer complications from the ligation. The important pelvic vascular anastomosis probably prevent tissue suffering and functional alteration. This work is the largest series of pregnancies following hypogastric artery ligation Supported by: None provided.
P-116 Pregnancy outcome, once viability is ascertained, is not associated with endometrial thickness on day of hCG in patients with polycystic ovarian syndrome (PCOS) or other infertility diagnoses undergoing controlled ovarian hyperstimulation (COH). Seth Feigenbaum, Liberato Mukul, Sekou Kelsey, Nydia Lovell, Nancy Zinn, Dobie Edmunds. The Permanente Medical Group, Kaiser San Francisco Medical Ctr, San Francisco, CA; The Permanente Medical Group, Kaiser South San Francisco Medical Ctr, South San Francisco, CA. Objective: The putative increased incidence of miscarriage in women with PCOS may be related to alterations of the endometrium. Both endogenous and exogenous hormones can affect histologic and sonographic appearance, and regulation of factors important for implantation and ongoing pregnancy. We asked whether endometrial thickness on dhCG can predict differences in pregnancy outcomes (liveborn vs. miscarriage) between PCOS and other patients undergoing COH. Design: Prospective cohort study in a tertiary REI teaching center. Materials/Methods: 163 consecutive patients achieving a viable pregnancy were prospectively enrolled. PCOS patients were oligo-anovulatory, without ovulatory progesterone, who failed to ovulate or conceive with clomiphene citrate, had evidence of either hyperandrogenism or hyperandrogenemia and all had polycystic appearing ovaries on endovaginal sonography (EVS). Comparison patients were ovulatory, had one or more diagnoses of unexplained infertility, mild male factor, pelvic factor or mildly diminished ovarian reserve. All patients had at least one open tube. Patients with total motile inseminates between 5 and 20 million/ml underwent washed intrauterine insemination. Endometrial thickness was measured on dhCG with EVS (Acuson 128) using a 5 mHz transducer. Viability was determined at 6w 3d to 7w 2d by hCG-adjusted LMP. Pregnancy outcome was determined by reviewing medical records. Data were analyzed using
FERTILITY & STERILITY威
SAS. Fisher’s exact test was used to analyze classification versus outcome data and t-test was used for continuous variables. Significance for p ⬍0.05 was tested using two-tailed distributions. Results: Outcome records were available for all patients having early clinical pregnancy. Patients having only a biochemical pregnancy, early pregnancy loss prior to the 6 –7 weeks exam, or a missed abortion, e.g, blighted ovum or no fetal cardiac activity at EVS visit for viability, were not included in this analysis. Mean ages were: PCOS ⫽ 33.1, other infertility ⫽ 36.7, (p ⫽ 0.001). 31% of patients had PCOS and 69% had other diagnoses. 5.1% of PCOS and 10.8% of comparison patients experienced pregnancy loss subsequent to the EVS for viability. Endometrial thickness on dhCG was: PCOS ⫽ 10.2 mm, SD 1.7; other patients ⫽ 10.1 mm, SD 2.5 (p ⫽ n.s.). No differences were seen for thickness within either infertility group related to chances of subsequent SAB or live birth. Conclusions: This pilot study suggests that once a viable pregnancy is attained, chances of subsequent pregnancy loss in either group are small, but not negligible. Additionally, endometrial thickness on dhCG does not appear to differ between pregnant PCOS and comparison patients undergoing COH. Endometrial thickness and pregnancy outcomes within each group were also not different. Some limits of this pilot study are that only patients with viable pregnancies were included. Patients with pre-clinical pregnancy losses were not. Inclusion of these patients may influence the prognostic utility of this EVS measure. Patients with pre-clinical losses are being examined and will be included in a separate analysis in this presented paper.
P-117 Anthropometric variation in ovulatory and anovulatory infertility. Neelam Potdar, James Ojidu, O. A. Odukoya. Scunthorpe Gen Hosp, Scunthorpe, UK. Objective: The anthropometric measurements of body mass index(BMI), waist circumference(WC) and waist hip ratio(WHR) are probably associated with anovulation. However it has been suggested that distribution of fat may be clinically more relevant than the degree of obesity (Bengsston et al 1993). This study aims to look at the clinical association between BMI and WC, and ovulatory dysfuction in infertile women. Design: This is a review of case notes of 52 women who attended the infertility clinic from 1998 to 2002. Materials/Methods: Height, weight, body mass index, waist circumference were measured for all patients at first attendance to the outpatient clinic. BMI was calculated as weight/height square. WC was measured just above the anterior superior iliac spine. BMI equal or ⬎25 and WC equal or ⬎85cm were considered as cut off points. Serum gonadotrophins and days 21 and 28 progesterone levels were estimated for all patients. They were classified into 2 groups of ovulatory and anovulatory cycles. The anovulatory were further subdivided into those with and without polycystic ovarian disease(PCOD: biochemical or ultrasound criteria). Results: The women in the study were aged between 20 to 44 years. Of the 52 subfertile women,21 had ovulatory cycles and 31 were anovulatory. Thirteen (41.9%) of the anovulatory patients had PCOD and 18 non-PCOD. In the ovulatory group there were nine patients with a BMI equal or ⬎25 while the corresponding number was 16 in the anovulation group. Waist circumference but not BMI was statistically significant between ovulatory and anovulatory groups (p ⫽ 0.02;CI ⫽ 1.2–20.3). Anovulatory PCOD tend to have a higher BMI (p ⫽ 0.04; CI ⫽ 1.3–33.6) and a significantly more WC (p ⫽ 0.008;CI ⫽ 2.1– 64) compared with non-PCOD anovulatory women.Waist circumference measurement was significantly smaller in the ovulatory compared with anovulatory PCOD(p ⫽ 0.001). Conclusions: This study suggested that site distribution of fat such as central obesity as measured by WC is associated with anovulatory infertility (more so in PCOD) than the commonly used BMI measurement. Such android obesity is associated with insulin resistance contributary to hyperinsulinemia and chronic anovulation (Foreyt et al 1998). In an environment where women are often reluctant to be weighed in the clinic setting determination of waist circumference is a simple measurement to identify overweight and obese patients who are more likely to have anovulatory subfertility. An effort towards weight reduction is associated with improvement in menstrual function and pregnancy rates (Clark et al 1998). Increased BMI is a predictor of fat mass while the site distribution of fat is a clinical alert signal for predicting ovulatory dysfunction as shown in this study. These measurements are currently being correlated to serum biochemical profile.
S155
Supported by: References: 1. Calle Bengtsson, et al. Association of serum lipid concentrations and obesity with mortality in women: 20 year follow up of participants in prospective population study in Gothenburg, Sweden. BMJ 1993; 307:1385– 8. 2. Foreyt JP. Poston WS 2nd.Obesity a never ending cycle? (Review).International Journal of Fertility and Womens Medicine,1998;111– 6. 3. Clark AM.Thornley B.Tomlinson L. Galletley C. Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Human Reproduction, 1998;1502–5.
P-118 Prevalence, presentation and management of ovarian pregnancies—A comparison between two decades. Arieh Raziel, Eitan Mordechai, Schevah Friedler, Morey Schachter, Moty Panski, Rafi Ron-El. Assaf Harofeh Medical Ctr, Beer Yaacov, Israel. Objective: To compare the prevalence, presentation diagnostic modalities and management of 37 ovarian pregnancies in one institution during two time periods, 1990 –2000 and 1971–1989. Design: Retrospective case control study comparing 17 cases of ovarian pregnancy from 1990 –2000, to 20 ovarian pregnancies diagnosed between 1971–1989, at Assaf Harofeh Medical Center, Zerifin, Israel. Materials/Methods: All records “coded” as “ectopic pregnancy”, during the above time periods were reviewed to ensure that all diagnoses of ovarian pregnancy were correctly assigned. Diagnosis of ovarian pregnancy was also ensured by review of the pathological reports from surgical material in all ectopic pregnancies. Results: Seventeen ovarian pregnancies, diagnosed between 1990 –2000, comprised (17/634) 2.6% of all ectopic pregnancies, 1:3500 of all live births leading to a mean ovarian pregnancy per year of 1.5, as opposed to (20/647) 3.1% of all ectopic pregnancies, 1:3600 of all live births and a mean 1.1 ovarian pregnancy rate per year in the previous period. Presenting symptoms were similar to those of tubal pregnancies including circulatory collapse which was present in 4/17(23%) of patients in the 1990 –2000 time period and in 6/20 (30%) in the previous period. Diagnosis was verified by laparoscopy according to Spigelberg’s critera. In the present decade, Douglas puncture, for diagnostic purposes, was practically abandoned. Wedge resection by laparotomy was the treatment of choice in the past, and after 1994 it was performed exclusively by laparoscopy. When an ovarian pregnancy was diagnosed, intrauterine device (IUD) was present in 65% of the patients and in 73% of the fertile women compared with higher rates in the previous period (90% and 100%, respectively). Conclusions: The absolute number of ovarian pregnancies in the last decade increased when compared with the previous 19 years, however the prevalence rate per delivery was stable. Patients still present in circulatory collapse despite modern diagnostic modalities. Douglas puncture has no clinical diagnostic benefits. Laparoscopy is invaluable, as diagnosis and treatment can be carried out as a single treatment. Laparoscopic wedge resection is the treatment of choice. The relation between IUD use and ovarian pregnancies is still strong.
P-119 Study on early prediction of ovarian hyperstimulation syndrome during hMG-hCG treatment using a damped oscillation rheometer. Kohzo Aisaka, Misa Doi, Seiichiro Obata, Takaya Watanabe, Fumiko Ooka, Manabu Kaibara. Hamada Hosp, Tokyo, Japan; Teikyo Univ, Tokyo, Japan. Objective: It is well known that ovarian hyperstimulation syndrome (OHSS) is a common but sometimes serious side effect during hMG-hCG treatment. Present study was performed to elucidate whether OHSS was predictable during hMG administration by precise measurement of the early stage of the blood coagulation using a damped oscillation rheometer (DOR). Design: Blood samplings were performed during hMG administration and the time of the onset of blood coagulation in a very early stage (Ti) was measured with the DOR. Materials/Methods: Twenty-five cases of severe hypothalamic anovulations were subjected in this study under an enough informed consent. Clomiphene citrate was not effective in all of the subjects. Then, 150iu of hMG (PergonalTM) was administered from the third day of the menstrual
S156
Abstracts
cycle under the monitoring of the transvaginal ultrasonography. The dosage of hMG was increased up to 450iu/day until the diameters of main follicles grew at least 20mm, and 5000 to 10000iu of hCG was administered for the ovulation induction. The subjected patients were divided into two groups by their clinical courses after hCG administration; OHSS (⫹): 11 cases, group A, and OHSS (-): 14 cases, group B. Blood samples were corrected at the beginning, 5th day after hMG administration, and before hCG administration. And the onset of coagulation (Ti) was measured with a high sensitivity DOR using whole blood. Prothrombin time (PT), hematocrit (Ht) values and serum estradiol levels were also examined at the same time. Results: There was almost no change in PT during hMG administration. Ht values tended to increase, but no significant change was observed between group A and B (5th day; 45.6⫹/⫺4.9 vs. 45.3⫹/⫺4.5%, before hCG administration; 48.0⫹/⫺5.1 vs. 47.5⫹/⫺5.6%). Serum estradiol levels increased during hMG treatment (5th day; 356.2⫹/⫺78.4 vs. 362.5⫹/ ⫺81.2pg/ml), and there was a significant change before hCG administration (1887.1⫹/⫺510.0 vs. 1563.8⫹/⫺477.9pg/ml, p ⬍0.05). Ti values were more sensitive, and a significant change was observed even in the 5th day after hMG administration (19.2⫹/⫺3.3 vs. 24.4⫹/⫺3.8min, p ⬍0.02). Conclusions: It is concluded that the occurrence of the OHSS may be predictable from the early stage of the hMG administration by the measurement of Ti values using the high sensitive DOR. Supported by: No support.
P-120 Intramural leiomyomata which enlarge during controlled ovarian hyperstimulation (COH) for IVF have individual characteristics. Hulusi B. Zeyneloglu, B. Handan Ozdemir, Bulent Haydardedeoglu, Sertac A. Batioglu. Baskent Univ, Dept of Obstetrics and Gynecology, Ankara, Turkey; Baskent Univ, Dept of Pathology, Ankara, Turkey. Objective: A recent prospective study has shown that intramural leiomyomata may halve the chances of ongoing pregnancies following assisted reproduction, although controversy exists in the literature. We aimed to define a subgroup of patients with intramural leiomyomata who would have different characteristics during IVF cycle. Design: Retrospective case control study Materials/Methods: During the last 2 years, 272 consecutive patients were recruited into IVF/ICSI program after exclusion of those patients with intramural leiomyomata ⬎5 cm or submucosal leiomyomata who subsequently underwent surgical removal before the IVF/ICSI program. A routine saline hysterosonography was performed to rule out endometrial cavity abnormality. After long luteal GnRH-a suppression protocol, COH was provided with recombinant FSH or urinary FSH. After oocyte retrieval, IVF or ICSI procedures were performed according to the indication. Oocytes and embryos were cultured in IVF, G1 and G2 media, (Vitrolife, Sweden) until day 3 embryo transfer. Pregnancy was defined as the observation of the fetal heart activity on ultrasonography. A control leiomyoma group was formed from 15 consecutive patients who had myomectomies for intramural leiomyomata ⬍5 cm. These patients did not undergo a recent infertility treatment. The age of these patients were similar to the IVF/ICSI patients with leiomyomata. Results: There were 23 patients with intramural leiomyomata ⬍5 cm. The pregnancy rate/cycle of the patients who had leiomyomata (26.1%; 6/23) was not statistically different from that of patients without leiomyoma (38.1%), (p ⫽ 0.357). However, all of the pregnancies occurred to patients with leiomyomata ⱕ2 cm, regardless of the age factor. In 6 patients, ultrasonographic findings were consistent with an increase of at least 30% in the mean diameters of the leiomyomata during GnRH-a suppression and COH. One patient chose to abandon the treatment and underwent immediate myomectomy. One other patient completed oocyte retrieval, however, all embryos were frozen and transferred after the surgery, but she developed an unembryonic pregnancy. The other four patients received embryo transfer in the fresh cycle in which they could not conceive despite good embryo quality and then they immediately had their leiomyomas removed surgically. The pathological examination of leiomyomata of these patients showed varied degeneration and minimal inflammatory cell infiltration. Three of four patients showed focal hypercellularity and they had increased mitotic figures fewer than 5/10HPF (cellular leiomyoma), one patient showed mitotically active leiomyoma which the number of mitotic figures was between 6 to 8 in different areas of the leiomyoma. Last patient had surgery in another hospital and pathology report was cellular leiomyoma.
Vol. 78, No. 3, Suppl. 1, September 2002
P-115 Fertility and pregnancy outcome following hypogastric artery ligation for severe post-partum hemorrhage. Jacky Nizard, Ludivine Barinque, Rene´ Frydman, Herve´ Fernandez. Hosp Antoine Be´ cle`re, Clamart, France. Objective: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. The technique has been described long ago and is used especially when the haemorrhage occurs during caesarean section. Nevertheless, little is known on the fertility and the pregnancy outcome following hypogastric artery ligation Design: We studied the fertility and pregnancies outcome in women who required hypogastric artery ligation for severe post-partum haemorrhage in our hospital from January 1989 to February 2002 Materials/Methods: The fertility and pregnancy outcome parameters were retrieved from medical files and telephone interviews Results: 68 patients required hypogastric ligation on this 13 years period. 17 patients had 21 pregnancies with 13 term deliveries, 2 ectopic pregnancies, 3 miscarriages, and 3 abortions. 28 patients did not want a new pregnancy, one patient did not want to answer our interview. The lost rate is 34 %. No patient had infertility and pregnancy was obtained in less than 18 most once desired. Pregnancy outcome was normal. 54 % of deliveries were vaginal. In 3 cases, patients had a beginning of post-partum haemorrhage easily treated medically Conclusions: Hypogastric artery ligation for post-partum haemorrhage is not responsible for secondary infertility. Following pregnancies do not suffer complications from the ligation. The important pelvic vascular anastomosis probably prevent tissue suffering and functional alteration. This work is the largest series of pregnancies following hypogastric artery ligation Supported by: None provided.
P-116 Pregnancy outcome, once viability is ascertained, is not associated with endometrial thickness on day of hCG in patients with polycystic ovarian syndrome (PCOS) or other infertility diagnoses undergoing controlled ovarian hyperstimulation (COH). Seth Feigenbaum, Liberato Mukul, Sekou Kelsey, Nydia Lovell, Nancy Zinn, Dobie Edmunds. The Permanente Medical Group, Kaiser San Francisco Medical Ctr, San Francisco, CA; The Permanente Medical Group, Kaiser South San Francisco Medical Ctr, South San Francisco, CA. Objective: The putative increased incidence of miscarriage in women with PCOS may be related to alterations of the endometrium. Both endogenous and exogenous hormones can affect histologic and sonographic appearance, and regulation of factors important for implantation and ongoing pregnancy. We asked whether endometrial thickness on dhCG can predict differences in pregnancy outcomes (liveborn vs. miscarriage) between PCOS and other patients undergoing COH. Design: Prospective cohort study in a tertiary REI teaching center. Materials/Methods: 163 consecutive patients achieving a viable pregnancy were prospectively enrolled. PCOS patients were oligo-anovulatory, without ovulatory progesterone, who failed to ovulate or conceive with clomiphene citrate, had evidence of either hyperandrogenism or hyperandrogenemia and all had polycystic appearing ovaries on endovaginal sonography (EVS). Comparison patients were ovulatory, had one or more diagnoses of unexplained infertility, mild male factor, pelvic factor or mildly diminished ovarian reserve. All patients had at least one open tube. Patients with total motile inseminates between 5 and 20 million/ml underwent washed intrauterine insemination. Endometrial thickness was measured on dhCG with EVS (Acuson 128) using a 5 mHz transducer. Viability was determined at 6w 3d to 7w 2d by hCG-adjusted LMP. Pregnancy outcome was determined by reviewing medical records. Data were analyzed using
FERTILITY & STERILITY威
SAS. Fisher’s exact test was used to analyze classification versus outcome data and t-test was used for continuous variables. Significance for p ⬍0.05 was tested using two-tailed distributions. Results: Outcome records were available for all patients having early clinical pregnancy. Patients having only a biochemical pregnancy, early pregnancy loss prior to the 6 –7 weeks exam, or a missed abortion, e.g, blighted ovum or no fetal cardiac activity at EVS visit for viability, were not included in this analysis. Mean ages were: PCOS ⫽ 33.1, other infertility ⫽ 36.7, (p ⫽ 0.001). 31% of patients had PCOS and 69% had other diagnoses. 5.1% of PCOS and 10.8% of comparison patients experienced pregnancy loss subsequent to the EVS for viability. Endometrial thickness on dhCG was: PCOS ⫽ 10.2 mm, SD 1.7; other patients ⫽ 10.1 mm, SD 2.5 (p ⫽ n.s.). No differences were seen for thickness within either infertility group related to chances of subsequent SAB or live birth. Conclusions: This pilot study suggests that once a viable pregnancy is attained, chances of subsequent pregnancy loss in either group are small, but not negligible. Additionally, endometrial thickness on dhCG does not appear to differ between pregnant PCOS and comparison patients undergoing COH. Endometrial thickness and pregnancy outcomes within each group were also not different. Some limits of this pilot study are that only patients with viable pregnancies were included. Patients with pre-clinical pregnancy losses were not. Inclusion of these patients may influence the prognostic utility of this EVS measure. Patients with pre-clinical losses are being examined and will be included in a separate analysis in this presented paper.
P-117 Anthropometric variation in ovulatory and anovulatory infertility. Neelam Potdar, James Ojidu, O. A. Odukoya. Scunthorpe Gen Hosp, Scunthorpe, UK. Objective: The anthropometric measurements of body mass index(BMI), waist circumference(WC) and waist hip ratio(WHR) are probably associated with anovulation. However it has been suggested that distribution of fat may be clinically more relevant than the degree of obesity (Bengsston et al 1993). This study aims to look at the clinical association between BMI and WC, and ovulatory dysfuction in infertile women. Design: This is a review of case notes of 52 women who attended the infertility clinic from 1998 to 2002. Materials/Methods: Height, weight, body mass index, waist circumference were measured for all patients at first attendance to the outpatient clinic. BMI was calculated as weight/height square. WC was measured just above the anterior superior iliac spine. BMI equal or ⬎25 and WC equal or ⬎85cm were considered as cut off points. Serum gonadotrophins and days 21 and 28 progesterone levels were estimated for all patients. They were classified into 2 groups of ovulatory and anovulatory cycles. The anovulatory were further subdivided into those with and without polycystic ovarian disease(PCOD: biochemical or ultrasound criteria). Results: The women in the study were aged between 20 to 44 years. Of the 52 subfertile women,21 had ovulatory cycles and 31 were anovulatory. Thirteen (41.9%) of the anovulatory patients had PCOD and 18 non-PCOD. In the ovulatory group there were nine patients with a BMI equal or ⬎25 while the corresponding number was 16 in the anovulation group. Waist circumference but not BMI was statistically significant between ovulatory and anovulatory groups (p ⫽ 0.02;CI ⫽ 1.2–20.3). Anovulatory PCOD tend to have a higher BMI (p ⫽ 0.04; CI ⫽ 1.3–33.6) and a significantly more WC (p ⫽ 0.008;CI ⫽ 2.1– 64) compared with non-PCOD anovulatory women.Waist circumference measurement was significantly smaller in the ovulatory compared with anovulatory PCOD(p ⫽ 0.001). Conclusions: This study suggested that site distribution of fat such as central obesity as measured by WC is associated with anovulatory infertility (more so in PCOD) than the commonly used BMI measurement. Such android obesity is associated with insulin resistance contributary to hyperinsulinemia and chronic anovulation (Foreyt et al 1998). In an environment where women are often reluctant to be weighed in the clinic setting determination of waist circumference is a simple measurement to identify overweight and obese patients who are more likely to have anovulatory subfertility. An effort towards weight reduction is associated with improvement in menstrual function and pregnancy rates (Clark et al 1998). Increased BMI is a predictor of fat mass while the site distribution of fat is a clinical alert signal for predicting ovulatory dysfunction as shown in this study. These measurements are currently being correlated to serum biochemical profile.
S155
Supported by: References: 1. Calle Bengtsson, et al. Association of serum lipid concentrations and obesity with mortality in women: 20 year follow up of participants in prospective population study in Gothenburg, Sweden. BMJ 1993; 307:1385– 8. 2. Foreyt JP. Poston WS 2nd.Obesity a never ending cycle? (Review).International Journal of Fertility and Womens Medicine,1998;111– 6. 3. Clark AM.Thornley B.Tomlinson L. Galletley C. Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Human Reproduction, 1998;1502–5.
P-118 Prevalence, presentation and management of ovarian pregnancies—A comparison between two decades. Arieh Raziel, Eitan Mordechai, Schevah Friedler, Morey Schachter, Moty Panski, Rafi Ron-El. Assaf Harofeh Medical Ctr, Beer Yaacov, Israel. Objective: To compare the prevalence, presentation diagnostic modalities and management of 37 ovarian pregnancies in one institution during two time periods, 1990 –2000 and 1971–1989. Design: Retrospective case control study comparing 17 cases of ovarian pregnancy from 1990 –2000, to 20 ovarian pregnancies diagnosed between 1971–1989, at Assaf Harofeh Medical Center, Zerifin, Israel. Materials/Methods: All records “coded” as “ectopic pregnancy”, during the above time periods were reviewed to ensure that all diagnoses of ovarian pregnancy were correctly assigned. Diagnosis of ovarian pregnancy was also ensured by review of the pathological reports from surgical material in all ectopic pregnancies. Results: Seventeen ovarian pregnancies, diagnosed between 1990 –2000, comprised (17/634) 2.6% of all ectopic pregnancies, 1:3500 of all live births leading to a mean ovarian pregnancy per year of 1.5, as opposed to (20/647) 3.1% of all ectopic pregnancies, 1:3600 of all live births and a mean 1.1 ovarian pregnancy rate per year in the previous period. Presenting symptoms were similar to those of tubal pregnancies including circulatory collapse which was present in 4/17(23%) of patients in the 1990 –2000 time period and in 6/20 (30%) in the previous period. Diagnosis was verified by laparoscopy according to Spigelberg’s critera. In the present decade, Douglas puncture, for diagnostic purposes, was practically abandoned. Wedge resection by laparotomy was the treatment of choice in the past, and after 1994 it was performed exclusively by laparoscopy. When an ovarian pregnancy was diagnosed, intrauterine device (IUD) was present in 65% of the patients and in 73% of the fertile women compared with higher rates in the previous period (90% and 100%, respectively). Conclusions: The absolute number of ovarian pregnancies in the last decade increased when compared with the previous 19 years, however the prevalence rate per delivery was stable. Patients still present in circulatory collapse despite modern diagnostic modalities. Douglas puncture has no clinical diagnostic benefits. Laparoscopy is invaluable, as diagnosis and treatment can be carried out as a single treatment. Laparoscopic wedge resection is the treatment of choice. The relation between IUD use and ovarian pregnancies is still strong.
P-119 Study on early prediction of ovarian hyperstimulation syndrome during hMG-hCG treatment using a damped oscillation rheometer. Kohzo Aisaka, Misa Doi, Seiichiro Obata, Takaya Watanabe, Fumiko Ooka, Manabu Kaibara. Hamada Hosp, Tokyo, Japan; Teikyo Univ, Tokyo, Japan. Objective: It is well known that ovarian hyperstimulation syndrome (OHSS) is a common but sometimes serious side effect during hMG-hCG treatment. Present study was performed to elucidate whether OHSS was predictable during hMG administration by precise measurement of the early stage of the blood coagulation using a damped oscillation rheometer (DOR). Design: Blood samplings were performed during hMG administration and the time of the onset of blood coagulation in a very early stage (Ti) was measured with the DOR. Materials/Methods: Twenty-five cases of severe hypothalamic anovulations were subjected in this study under an enough informed consent. Clomiphene citrate was not effective in all of the subjects. Then, 150iu of hMG (PergonalTM) was administered from the third day of the menstrual
S156
Abstracts
cycle under the monitoring of the transvaginal ultrasonography. The dosage of hMG was increased up to 450iu/day until the diameters of main follicles grew at least 20mm, and 5000 to 10000iu of hCG was administered for the ovulation induction. The subjected patients were divided into two groups by their clinical courses after hCG administration; OHSS (⫹): 11 cases, group A, and OHSS (-): 14 cases, group B. Blood samples were corrected at the beginning, 5th day after hMG administration, and before hCG administration. And the onset of coagulation (Ti) was measured with a high sensitivity DOR using whole blood. Prothrombin time (PT), hematocrit (Ht) values and serum estradiol levels were also examined at the same time. Results: There was almost no change in PT during hMG administration. Ht values tended to increase, but no significant change was observed between group A and B (5th day; 45.6⫹/⫺4.9 vs. 45.3⫹/⫺4.5%, before hCG administration; 48.0⫹/⫺5.1 vs. 47.5⫹/⫺5.6%). Serum estradiol levels increased during hMG treatment (5th day; 356.2⫹/⫺78.4 vs. 362.5⫹/ ⫺81.2pg/ml), and there was a significant change before hCG administration (1887.1⫹/⫺510.0 vs. 1563.8⫹/⫺477.9pg/ml, p ⬍0.05). Ti values were more sensitive, and a significant change was observed even in the 5th day after hMG administration (19.2⫹/⫺3.3 vs. 24.4⫹/⫺3.8min, p ⬍0.02). Conclusions: It is concluded that the occurrence of the OHSS may be predictable from the early stage of the hMG administration by the measurement of Ti values using the high sensitive DOR. Supported by: No support.
P-120 Intramural leiomyomata which enlarge during controlled ovarian hyperstimulation (COH) for IVF have individual characteristics. Hulusi B. Zeyneloglu, B. Handan Ozdemir, Bulent Haydardedeoglu, Sertac A. Batioglu. Baskent Univ, Dept of Obstetrics and Gynecology, Ankara, Turkey; Baskent Univ, Dept of Pathology, Ankara, Turkey. Objective: A recent prospective study has shown that intramural leiomyomata may halve the chances of ongoing pregnancies following assisted reproduction, although controversy exists in the literature. We aimed to define a subgroup of patients with intramural leiomyomata who would have different characteristics during IVF cycle. Design: Retrospective case control study Materials/Methods: During the last 2 years, 272 consecutive patients were recruited into IVF/ICSI program after exclusion of those patients with intramural leiomyomata ⬎5 cm or submucosal leiomyomata who subsequently underwent surgical removal before the IVF/ICSI program. A routine saline hysterosonography was performed to rule out endometrial cavity abnormality. After long luteal GnRH-a suppression protocol, COH was provided with recombinant FSH or urinary FSH. After oocyte retrieval, IVF or ICSI procedures were performed according to the indication. Oocytes and embryos were cultured in IVF, G1 and G2 media, (Vitrolife, Sweden) until day 3 embryo transfer. Pregnancy was defined as the observation of the fetal heart activity on ultrasonography. A control leiomyoma group was formed from 15 consecutive patients who had myomectomies for intramural leiomyomata ⬍5 cm. These patients did not undergo a recent infertility treatment. The age of these patients were similar to the IVF/ICSI patients with leiomyomata. Results: There were 23 patients with intramural leiomyomata ⬍5 cm. The pregnancy rate/cycle of the patients who had leiomyomata (26.1%; 6/23) was not statistically different from that of patients without leiomyoma (38.1%), (p ⫽ 0.357). However, all of the pregnancies occurred to patients with leiomyomata ⱕ2 cm, regardless of the age factor. In 6 patients, ultrasonographic findings were consistent with an increase of at least 30% in the mean diameters of the leiomyomata during GnRH-a suppression and COH. One patient chose to abandon the treatment and underwent immediate myomectomy. One other patient completed oocyte retrieval, however, all embryos were frozen and transferred after the surgery, but she developed an unembryonic pregnancy. The other four patients received embryo transfer in the fresh cycle in which they could not conceive despite good embryo quality and then they immediately had their leiomyomas removed surgically. The pathological examination of leiomyomata of these patients showed varied degeneration and minimal inflammatory cell infiltration. Three of four patients showed focal hypercellularity and they had increased mitotic figures fewer than 5/10HPF (cellular leiomyoma), one patient showed mitotically active leiomyoma which the number of mitotic figures was between 6 to 8 in different areas of the leiomyoma. Last patient had surgery in another hospital and pathology report was cellular leiomyoma.
Vol. 78, No. 3, Suppl. 1, September 2002