Combined treatment of ovarian endometriomas: assessment of efficacy and influence on ovarian reserve status

suggests that endometrial cells transported retrograde through the fallopian tubes implant on peritoneal mesothelial cells (PMCs) to initiate the early endometriotic lesions. Our previous studies have shown that menstrual endometrial epithelial cells (EECs) from women with endometriosis demonstrate increased adherence to PMCs compared to similar cells from women without endometriosis. Han et. al. emphasized the importance of estrogen receptor- beta (ER-b) in the growth of the endometriotic lesion and showed that overexpression of ER-b increased invasion in endometriotic cells (1). Here, we examine the effect of ER-b knockdown on the attachment menstrual EECs to PMCs. DESIGN: In vitro studies MATERIALS AND METHODS: EECs were immortalized using a telomerase vector. Immortalized cells and parental cells were characterized by genotyping and expression of ER-b as well as other epithelial cell markers. ER-b was knocked-down in immortalized EECs using lentivirus-mediated shRNA transduction. ER-b knockdown was confirmed by RTqPCR and Western analysis. EEC cells with or without ER-b knockdown were used to assess attachment to PMCs in an established in vitro assay (2). Results were analyzed with student t- test. RESULTS: Primary and immortalized cells were 46XX, cytokeratin positive, and vimentin negative confirming their epithelial origin. ER-b knockdown EECs had a significant decrease in attachment compared to parental cells (p¼0.02). CONCLUSIONS: These findings demonstrate that ER-b knockdown decreases attachment of immortalized EECs to PMCs. Taken together with previous studies demonstrating that overexpression of ER-b increased invasion of endometriotic lesions suggests that ER-b plays a role in the development of the early endometriotic lesion. References: 1. Han SJ, Jung SY, Wu SP, et al. Estrogen Receptor B Modulates Apoptosis Complexes and the Inflammasome to Drive the Pathogenesis of Endometriosis. 2015 Cell Nov 5; 163 (4): 960-74 2. Lucidi RS, Witz CA, Chrisco M, et al. A novel in vitro model of the early endometriotic lesion demonstrates that attachment of endometrial cells to mesothelial cells is dependent on the source of endometrial cells. 2005 Fertil Steril Jul; 84(1): 16-21 Supported by: American Society for Reproductive Medicine (JK), KL2 TR001118 (JK), Endometriosis Foundation of America (JK) P-242 Tuesday, October 31, 2017 DIAGNOSIS OF ENDOMETRIOSIS BY OPTICAL COHERENCE TOMOGRAPHY AND TWO PHOTON LUMINESCENCE. A. G. Cabe,a J. E. McLaughlin,b A. E. Estrada,c T. Hoyt,a X. Yang,a P. T. Valente,b,d B. Cox,e T. E. Milner,c M. D. Feldman,a R. D. Robinson.b aCardiology, University of Texas Health Science Center at San Antonio, San Antonio, TX; b Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX; cBiomedical Engineering, University of Texas at Austin, Austin, TX; dPathology, University of Texas Health Science Center at San Antonio, San Antonio, TX; eObstetrics and Gynecology, Seven Oaks Women’s Center, Methodist Hospital, San Antonio, TX. OBJECTIVE: To correlate the diagnostic ability of optical coherence tomography and two-photon luminescence (OCT-TPL) to histology in endometriosis. DESIGN: Prospective multicenter cohort study MATERIALS AND METHODS: Women with clinically suspected endometriosis undergoing gynecologic laparoscopy were consented and enrolled. The surgeon excised suspected endometriosis lesions and a sample that they did not think was endometriosis. The lesions were imaged ex-vivo using glands for OTC and hemosiderin for TPL as optical markers for endometriosis. The samples underwent histologic examination. Sensitivity, specificity and negative and positive predictive values were calculated. A receiver operating characteristic (ROC) curve was established to analyze the prediction of endometriosis by OCT-TPL. RESULTS: Twenty-five women were enrolled in the study. Fifty-eight samples were collected from a total of 19 women with visually suspected endometriosis. Endometriosis was histologically diagnosed in 13 of 25 women (52%) and in 30 of 58 samples (52%). Glands, stoma and hemosiderin were present in 33%, 52% and 86% of the confirmed endometriosis samples, respectively. Clinical suspicion of endometriosis had a sensitivity of 97%, specificity of 50%, positive predictive value of 67%, and negative predictive value of 93%. In an additional 16 samples the surgeon was unsure of the diagnosis of endometriosis and of these the histologic diagnosis was

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ASRM Abstracts

made in 19% (3/16). Forty of the 58 samples were analyzed ex vivo using OCT-TPL. OCT-TPL had a sensitivity of 90%, specificity of 100%, positive predictive value of 100% and negative predictive value of 90% compared to histologic diagnosis. The OCT-TPL ROC curve was significantly more predictive of endometriosis than the clinical impression ROC curve (area under the curve: 0.952 vs 0.767, p¼0.0124). CONCLUSIONS: Diagnosis of endometriosis by OCT-TPL may result in fewer false positive results with improved negative and positive predictive values as compared to clinical impression. OCT-TPL is useful in predicting the presence or absence of endometriosis. Supported by: The Clayton Foundation for Research P-243 Tuesday, October 31, 2017 COMBINED TREATMENT OF OVARIAN ENDOMETRIOMAS: ASSESSMENT OF EFFICACY AND INFLUENCE ON OVARIAN RESERVE STATUS. S. Solskyy,a A. Chubatyy,a V. Solskyy.b aChair of OB/GYN #2, National Medical University, Kiev, Ukraine; bInsitute of Pediatrics, Obstetrics and Gynecology Academy of Medical Sciences of Ukraine, Kiev, Ukraine. OBJECTIVE: To assess efficacy of combined treatment in patients with ovarian endometriomas and influence of this treatment on ovarian reserve status. DESIGN: Prospective study. MATERIALS AND METHODS: 126 patients with ovarian endometriomas were included in the study. Unilateral endometriomas were observed in 83,2% of cases, bilateral - in 16,8 %. All patients did undergo laparoscopy. In vast majority of cases (93,65%) cyst capsule enucleation was performed. After surgery and histological confirmation of diagnosis all women were proposed anti-relapse treatment with GnRH-agonists. 94 patients agreed to proposed treatment (Group I) and 32 refused (Group II). Assessment of ovarian reserve status was performed based on ultrasound results and level of antimullerian hormone (AMH) before surgery and in 3-4 months after antirelapse treatment in Group I and in 6 months after surgery in Group II. RESULTS: Patients in Group I (n¼94) did receive injection of triptorelin 3,75 mg every 28 days during 4-6 months after surgery. All of them were under our observation also during 2 years after completion of anti-relapse treatment. Frequency of ovarian endometriosis recurrence in this group was only 3,2% (4 patients) during entire observation period. At the same time during same period of time in Group II (n¼32) recurrence was observed in 21,87% of cases (7 patients), all of which did require repeat surgery. Two of those 7 endometriomas occurred in the same ovary as initially and 5 - in the opposite. Evaluation of ovarian reserve status did show its slight decrease (up to 15%) in both groups, at the same time difference was not statistically significant between Groups I and II. CONCLUSIONS: Treatment of ovarian endometriomas mandatory should be combined, to include laparoscopic surgery at the first stage, followed by anti-relapse treatment after receipt of histological diagnosis confirmation. triptorelin or similar medications should be considered as reliable choice as they allow to minimize the probability of disease recurrence - combined surgical treatment of ovarian endometriomas not showing substantial negative impact on ovarian reserve status. P-244 Tuesday, October 31, 2017 DYSREGULATED GENES INVOLVED IN IMPLANTATION FAILURE IN WOMEN WITH ENDOMETRIOSIS. K. D. Nayar, M. Saxena, M. Singh, R. Ahuja, M. Gupta, G. Kant, N. Sharma, D. Nayar. Akanksha IVF Centre, New Delhi, India. OBJECTIVE: In most women, endometriosis leads to infertility. Infertility in women with endometriosis may be due to poor embryo implantation. A number of mechanisms are associated in preparing the endometrium for implantation such as cell proliferation, cellular differentiation, immunological response, apposition and production of growth factors. These processes along with the genes involved may be altered in women with endometriosis. DESIGN: A prospective case-control study was conducted to assess expression of dysregulated genes contributing to implantation failure, in eutopic endometrium of women with endometriosis compared to that of women without endometriosis. MATERIALS AND METHODS: Eutopic endometrial biopsies in midluteal phase from 14 women with endometriosis and 13 women without endometriosis were obtained by Pipelle curette between 31 March 2016

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