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Caesarean section and tubal infertility: is there an association?
CONCLUSIONS: Oral DIM at 2 mg/kg/day is well tolerated with no significant toxicity. We observed a high rate of clinically significant improvement in confirmed CIN 2 or 3 lesions in this RCT. Current surgical treatments may cause cervical stenosis, bleeding and preterm delivery with approximately 10% recurring CIN. Medical therapy or observation may be a reasonable alternative. Supported by: BioResponse, Boulder, CO.
Monday, October 15, 2007 4:15 pm O-45 CAESAREAN SECTION AND TUBAL INFERTILITY: IS THERE AN ASSOCIATION? L. Saraswat, M. Porter, S. Bhattacharya, S. Bhattacharya. Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, United Kingdom; Dugald Baird Centre for Research on Women’s Health, University of Aberdeen, Aberdeen, United Kingdom. OBJECTIVE: To explore the association between exposure to caesarean section and subsequent tubal infertility. DESIGN: A case control study. MATERIALS AND METHODS: Cases for this study included all women attending the Aberdeen Fertility Clinic between 1989 and 2005 with secondary infertility caused by tubal factor (presence of one or both blocked tubes diagnosed by either hysterosalpingography or laparoscopy and dye test). Women with history of previous tubal surgery or sterilization were excluded. The cases were matched with controls from the Aberdeen Maternity and Neonatal Databank by year of their first delivery. The controls included all women who had one previous live-birth (index delivery) followed by another and hence proven fertility. The incidence of caesarean section in the index delivery was noted in both the cases and controls. The Statistical Package for Social Scientists (SPSS version 14) for Windows was used to facilitate data analysis. Cases and controls were first compared in terms of age, smoking habits, history of appendectomy, ovarian surgery, PID, ectopic pregnancy, miscarriage, termination and previous caesarean section by univariate analysis and crude Odds Ratios with 95% confidence intervals calculated. Normally distributed continuous variables were expressed as mean with standard deviation and compared by independent samples t test. Categorical variables were compared using the Chi-square test. A probability value of %0.05 was considered statistically significant. Statistically significant variables on univariate analysis were entered into a binary logistic regression model to generate adjusted odds ratios with 95% confidence intervals. RESULTS: A total of 220 women with secondary infertility due to a tubal factor problem were compared with 18,376 fertile women (experienced a previous viable pregnancy followed by another live-birth during the same time period when the infertile women were trying to conceive) in terms of exposure to caesarean section. After adjusting for confounding factors, there was no difference in the incidence of exposure to caesarean section between the two groups (adjusted odd’s ratio 1.27 (95% CI 0.90, 1.78) and P¼0.16). However age (adjusted OR 1.2, 95% CI 1.2, 1.3), history of PID (adjusted OR 17.3, 95% CI 10.9, 27.6) and previous ectopic pregnancy (adjusted OR 12.8, 95% CI 7.1, 23.1) were found to be predictive of future tubal infertility. CONCLUSIONS: The risk of secondary infertility due to tubal disease is not increased in women with previous caesarean section. Supported by: None.
Monday, October 15, 2007 4:30 pm O-46 EXOGENOUS FOLLICLE STIMULATING HORMONE AND RISK OF ANEUPLOIDY. L. K. Shahine, A. A. Milki, L. M. Westphal, R. B. Lathi. Reproductive Endocrinology and Infertility, Stanford University, Palo Alto, CA. OBJECTIVE: Exogenous FSH is frequently used in the treatment of infertility. High rates of aneuploidy are seen when preimplantation genetic diagnosis is performed after ovarian stimulation in all ages, however the etiology is not clear. Animal studies have shown that exposure to exogenous FSH leads to chromosome dysfunction in oocytes, thus providing a possible
FERTILITY & STERILITYÒ
link between elevated levels of FSH and increased risk of aneuploidy. We examine the rate of aneuploidy in missed abortions in relation to exposure to exogenous FSH in the follicular phase of the menstrual cycle in which patients conceive. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Patients with cytogenetic evaluation of products of conception from a missed abortion at a University Infertility practice from January 1999 through December 2006 were identified. Data collected included patient age, obstetric history, method of conception, ovarian stimulation with FSH, and cytogenetic results from products of conception (POC). Rate of aneuploidy was compared between a control group of patients with a history of infertility who conceived naturally and a study group of patients with a history of infertility who conceived with FSH treatment, including intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles. RESULTS: 219 patients met inclusion criteria. See Table 1 for results. 67% of all patients had an abnormal karyotype diagnosed on POC from a missed abortion; the rate of aneuploidy was 78% in the control group and 64% in the study group. This difference was not statistically significant (P value >0.05). In the study group, 30 patients had an IUI with an average age of 35.3 and a 57% aneuploidy rate, and 138 patients had an IVF cycle with an average age of 37.6 and a 67% aneuploidy rate. Recurrent pregnancy loss (RPL, 3 or more miscarriages) was seen in 9% of all patients, 24% in the control group and 4% in the study group, however the rate of aneuploidy did not change if these patients were excluded. CONCLUSIONS: In this study, the incidence of abnormal results in the cytogenetic analysis of POC was not higher in pregnancies conceived with FSH stimulation compared to spontaneous conceptions in infertility patients. This suggests that exogenous FSH exposure does not increase the risk of aneuploidy. Further studies are still needed to examine this relationship. TABLE 1.
Number of Patients Average Age in Years Abnormal Karyotype Overall Abnormal Karyotype Cases without RPL
Natural Conception
FSH Exposure
Total
49 37.7 78%
168 36.5 64%
219 37.4 67%
73%
66%
67%
Supported by: None.
Monday, October 15, 2007 4:45 pm O-47 A MULTICENTER, PROSPECTIVE, RANDOMIZED, OPEN COMPARATOR STUDY ON THE TREATMENT OF OVULATORY MENORRHAGIA WITH TRANEXAMIC ACID AND NORETHISTERONE IN MAINLAND CHINA. Y. Zhang, F. He, S. Li, Z. Cao, S. Lv, J. Lu. Obs/Gyn, Peking Union Medical College Hospital, Beijing, China; Obs/Gyn, Huaxi Hospital of Sichuan University, Chengdu, Sichuan, China; Obs/Gyn, First Affiliated Hospital of Xi’an Communication University, Xi’an, Shanxi, China; Obs/Gyn, Beijing Chaoyang Hospital of Capital Medical College, Beijing, China. OBJECTIVE: To compare the safety and efficacy of tranexamic acid (TA) and norethisterone (NET) for the treatment of ovulatory menorrhagia in patients in mainland China. DESIGN: Multicenter, prospective, randomized, open comparator study of TA and NET in Chinese patients with ovulatory menorrhagia. MATERIALS AND METHODS: One hundred and six patients with proven ovulatory menorrhagia from the gynecologic clinics of four teaching hospitals located in three cities of mainland China were enrolled into the study between July 2004 and March 2006. Patients were randomly allocated into one of two therapeutic regimens: TA 1g tid during menstrual cycle day (D) 1–5 (57 patients, aged 34.39 7.61 years), or NET 5 mg bid on D19–26 (49 patients, aged 36.41 6.60 years). The drugs were administered for two consecutive cycles, after which the drugs were withdrawn and patients were followed-up for one more cycle. Data on menstrual blood loss (estimated by
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Monday, October 15, 2007 4:15 pm O-45 CAESAREAN SECTION AND TUBAL INFERTILITY: IS THERE AN ASSOCIATION? L. Saraswat, M. Porter, S. Bhattacharya, S. Bhattacharya. Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, United Kingdom; Dugald Baird Centre for Research on Women’s Health, University of Aberdeen, Aberdeen, United Kingdom. OBJECTIVE: To explore the association between exposure to caesarean section and subsequent tubal infertility. DESIGN: A case control study. MATERIALS AND METHODS: Cases for this study included all women attending the Aberdeen Fertility Clinic between 1989 and 2005 with secondary infertility caused by tubal factor (presence of one or both blocked tubes diagnosed by either hysterosalpingography or laparoscopy and dye test). Women with history of previous tubal surgery or sterilization were excluded. The cases were matched with controls from the Aberdeen Maternity and Neonatal Databank by year of their first delivery. The controls included all women who had one previous live-birth (index delivery) followed by another and hence proven fertility. The incidence of caesarean section in the index delivery was noted in both the cases and controls. The Statistical Package for Social Scientists (SPSS version 14) for Windows was used to facilitate data analysis. Cases and controls were first compared in terms of age, smoking habits, history of appendectomy, ovarian surgery, PID, ectopic pregnancy, miscarriage, termination and previous caesarean section by univariate analysis and crude Odds Ratios with 95% confidence intervals calculated. Normally distributed continuous variables were expressed as mean with standard deviation and compared by independent samples t test. Categorical variables were compared using the Chi-square test. A probability value of %0.05 was considered statistically significant. Statistically significant variables on univariate analysis were entered into a binary logistic regression model to generate adjusted odds ratios with 95% confidence intervals. RESULTS: A total of 220 women with secondary infertility due to a tubal factor problem were compared with 18,376 fertile women (experienced a previous viable pregnancy followed by another live-birth during the same time period when the infertile women were trying to conceive) in terms of exposure to caesarean section. After adjusting for confounding factors, there was no difference in the incidence of exposure to caesarean section between the two groups (adjusted odd’s ratio 1.27 (95% CI 0.90, 1.78) and P¼0.16). However age (adjusted OR 1.2, 95% CI 1.2, 1.3), history of PID (adjusted OR 17.3, 95% CI 10.9, 27.6) and previous ectopic pregnancy (adjusted OR 12.8, 95% CI 7.1, 23.1) were found to be predictive of future tubal infertility. CONCLUSIONS: The risk of secondary infertility due to tubal disease is not increased in women with previous caesarean section. Supported by: None.
Monday, October 15, 2007 4:30 pm O-46 EXOGENOUS FOLLICLE STIMULATING HORMONE AND RISK OF ANEUPLOIDY. L. K. Shahine, A. A. Milki, L. M. Westphal, R. B. Lathi. Reproductive Endocrinology and Infertility, Stanford University, Palo Alto, CA. OBJECTIVE: Exogenous FSH is frequently used in the treatment of infertility. High rates of aneuploidy are seen when preimplantation genetic diagnosis is performed after ovarian stimulation in all ages, however the etiology is not clear. Animal studies have shown that exposure to exogenous FSH leads to chromosome dysfunction in oocytes, thus providing a possible
FERTILITY & STERILITYÒ
link between elevated levels of FSH and increased risk of aneuploidy. We examine the rate of aneuploidy in missed abortions in relation to exposure to exogenous FSH in the follicular phase of the menstrual cycle in which patients conceive. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Patients with cytogenetic evaluation of products of conception from a missed abortion at a University Infertility practice from January 1999 through December 2006 were identified. Data collected included patient age, obstetric history, method of conception, ovarian stimulation with FSH, and cytogenetic results from products of conception (POC). Rate of aneuploidy was compared between a control group of patients with a history of infertility who conceived naturally and a study group of patients with a history of infertility who conceived with FSH treatment, including intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles. RESULTS: 219 patients met inclusion criteria. See Table 1 for results. 67% of all patients had an abnormal karyotype diagnosed on POC from a missed abortion; the rate of aneuploidy was 78% in the control group and 64% in the study group. This difference was not statistically significant (P value >0.05). In the study group, 30 patients had an IUI with an average age of 35.3 and a 57% aneuploidy rate, and 138 patients had an IVF cycle with an average age of 37.6 and a 67% aneuploidy rate. Recurrent pregnancy loss (RPL, 3 or more miscarriages) was seen in 9% of all patients, 24% in the control group and 4% in the study group, however the rate of aneuploidy did not change if these patients were excluded. CONCLUSIONS: In this study, the incidence of abnormal results in the cytogenetic analysis of POC was not higher in pregnancies conceived with FSH stimulation compared to spontaneous conceptions in infertility patients. This suggests that exogenous FSH exposure does not increase the risk of aneuploidy. Further studies are still needed to examine this relationship. TABLE 1.
Number of Patients Average Age in Years Abnormal Karyotype Overall Abnormal Karyotype Cases without RPL
Natural Conception
FSH Exposure
Total
49 37.7 78%
168 36.5 64%
219 37.4 67%
73%
66%
67%
Supported by: None.
Monday, October 15, 2007 4:45 pm O-47 A MULTICENTER, PROSPECTIVE, RANDOMIZED, OPEN COMPARATOR STUDY ON THE TREATMENT OF OVULATORY MENORRHAGIA WITH TRANEXAMIC ACID AND NORETHISTERONE IN MAINLAND CHINA. Y. Zhang, F. He, S. Li, Z. Cao, S. Lv, J. Lu. Obs/Gyn, Peking Union Medical College Hospital, Beijing, China; Obs/Gyn, Huaxi Hospital of Sichuan University, Chengdu, Sichuan, China; Obs/Gyn, First Affiliated Hospital of Xi’an Communication University, Xi’an, Shanxi, China; Obs/Gyn, Beijing Chaoyang Hospital of Capital Medical College, Beijing, China. OBJECTIVE: To compare the safety and efficacy of tranexamic acid (TA) and norethisterone (NET) for the treatment of ovulatory menorrhagia in patients in mainland China. DESIGN: Multicenter, prospective, randomized, open comparator study of TA and NET in Chinese patients with ovulatory menorrhagia. MATERIALS AND METHODS: One hundred and six patients with proven ovulatory menorrhagia from the gynecologic clinics of four teaching hospitals located in three cities of mainland China were enrolled into the study between July 2004 and March 2006. Patients were randomly allocated into one of two therapeutic regimens: TA 1g tid during menstrual cycle day (D) 1–5 (57 patients, aged 34.39 7.61 years), or NET 5 mg bid on D19–26 (49 patients, aged 36.41 6.60 years). The drugs were administered for two consecutive cycles, after which the drugs were withdrawn and patients were followed-up for one more cycle. Data on menstrual blood loss (estimated by
S17