- Email: [email protected]
Comparison chemical, clinical pregnancy rate, live birth rate and obstetric outcome in fresh versus frozen embryo transfer in in vitro fertilization cycles
EMAS2017 / Maturitas 100 (2017) 93–202
P071 The effect of chronic vulvar dystrophy on urinary continence in patients at climacterium Elvira Bratila 1 , Monica Cirstoiu 1 , Claudia Mehedintu 1 , Costin Berceanu 2 , Roxana Bohiltea 1 , Oana Toader 1 , Diana-Elena Comandasu 1,∗ 1
‘Carol Davila’ University of Medicine and Pharmacy, Obstetrics Gynecology, Bucharest, Romania 2 Craiova University of Medicine and Pharmacy, Obstetrics Gynecology, Craiova, Romania Chronic dystrophy is the growth of abnormal skin on the vulva, its causes being lichen sclerosus, with thin vulvar skin lesions and squamous hyperplasia with thick tegument. Lichen appears as discolored, translucent irregular areas of skin on/around the labia especially in women at climacterium. It can cause from lack of clinical manifestations to intense itching and progressive vulvar pain. Squamous hyperplasia transforms vulvar skin thick with white elevations causing intense itching. We examined a number of 22 climacteric patients, aged between 52 and 73 diagnosed with vulvar dystrophy in the interval 2014–2016. Urinary incontinence was diagnosed in 90% of them: 36% presented stress urinary incontinence, 40% mixed incontinence (vulvar dystrophy being a factor in the continence impairment), while in 22% of the cases the main etiology of the disease was the severe alteration of the vulvar anatomy. The 5 cases presenting important distortion of the external genital organ anatomy included partial labial adhesion or complete labial fusion caused by chronic dystrophy and required surgical intervention. The etiology in the appearance of labial adherences is thought to be inflammation of the labia with denudation of the superficial layer which heals by fibrosis causing adhesions. Labial fusion in menopause is a rare condition which in addition to chronic dystrophy has other two risk factors: relative hyperandrogenism associated with lack of estrogens and chronic urinary tract infections (UTI). Regarding recurrent UTIs, they represent both a risk factor and a consequence of labial fusion, the urine dribbling through the labial adherence over the external urethral orifice and draining through the vagina. Labial fusion affecting urinary continence is an uncommon phenomenon in postmenopausal women. The prognosis is good with surgical treatment, while estrogen and corticosteroid topic application should be used as prophylaxis for recurrence. http://dx.doi.org/10.1016/j.maturitas.2017.03.171 P072 Relationship between delivery modes and genitourinary syndrome among postmenopausal women Parvin Salehinejad 1,∗ , Parvin Abedi 2 , Masoomeh Yaralizadeh 2 1 Kerman Medical University, Kerman, Islamic Republic of Iran 2 Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran
Objectives: Many postmenopausal women suffer from vaginal atrophy due to the lack of estrogen. This study aimed to evaluate the relationship between mode of delivery and genitourinary syndrome among postmenopausal women. Methods: This was a case-control study in which 125 postmenopausal women were recruited (65 with a history of normal vaginal delivery and 60 with a history of cesarean section).
169
Data were collected through a socio-demographic questionnaire and a check list for assessing signs and symptoms of genitourinary syndrome. Subjective symptoms of vaginal atrophy (dryness, dyspareunia, itching, burning and paleness), pH of vagina and maturation index were assessed and recorded. Data were analysed using chi-square and independent t-test. Results: 50.8% of women in the normal vaginal delivery (NVD) group had vaginal pH 5–5.49 compared to the 40% in the cesarean section (C/S) group (p < 0.001). The maturation index was significantly better in the NVD group (42.7 ± 6.34) compared to the C/S group (24.08 ± 8.2) (p < 0.001). All symptoms of vaginal atrophy including (paleness, dryness, itching, dyspareunia and burning) were significantly less in the normal vaginal delivery group compared to the cesarean section group (p < 0.05). Conclusion: Postmenopausal women with a history of normal vaginal delivery were less likely to have genitourinary syndrome compared to the women with history of cesarean section. Other prospective studies can explore this relationship better. http://dx.doi.org/10.1016/j.maturitas.2017.03.172 P074 Comparison chemical, clinical pregnancy rate, live birth rate and obstetric outcome in fresh versus frozen embryo transfer in in vitro fertilization cycles Behnaz Khani Robati 1,∗ , Gholamreza Dashti 2 , Helia Kamal 3 , Niloofar Mirhosseini 4 , IVF patients 1 Isfahan University of Medical School, Ob/Gyn, Isfahan, Islamic Republic of Iran 2 Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran 3 Isfahan University of Medical School, Isfahan, Islamic Republic of Iran 4 Pharmacy Faculty, Budapest, Hungary
Introduction: There is inadequate investigation about results of two methods of IVF via fresh or freeze thawed embryo transfer so this study was done to compare pregnancy rate, live birth rate, obstetrics and prenatal complications in singleton pregnancies after these two methods. Material and methods: In this retrospective cohort study 559 women who were referred to infertility clinic of Shahid Behshti hospital in Isfahan and another private clinic were recruited. According to patient situation they received fresh or freeze thawed embryos. Obstetrical outcomes were assessed by calling and interviewing patients who became pregnant. Results: The results showed that in 303 frozen cycles there were 70 alive pregnancy in compare with 256 fresh embryo transfer who had 46 alive pregnancy (p = 0.04). Singleton pregnancy after transfer of frozen thawed embryo was associated with more preterm labor in compare with fresh embryo transfer (p = 0.03). Data analysis showed that other obstetrics outcome such as gestational hypertension, gestational diabetes, ante partum hemorrhage, I UGR, LBW, admission to NICU was the same in both groups. Conclusion: Although the fresh embryo transfer is the commonest way in IVF cycles, Results of our study showed that rate of live birth with freeze thawed embryo transfer was more and rate of pregnancy complication and prenatal outcomes were the same.
170
EMAS2017 / Maturitas 100 (2017) 93–202
Keywords: IVF, Fresh embryo, Freeze thawed embryo, Infertility, Obstetrics outcome http://dx.doi.org/10.1016/j.maturitas.2017.03.174 P075 Relative importance of the different components of the Bologna criteria for predicting poor ovarian response in assisted reproduction Hang Wun Raymond Li ∗ , Tak Ming Cheung, William Shu Biu Yeung, Pak Chung Ho, Ernest Hung Yu Ng University of Hong Kong, Department of Obstetrics and Gynaecology, Pokfulam, Hong Kong, China Introduction: The Bologna criteria published in 2011 defined poor ovarian response (POR) in women undergoing in-vitro fertilisation (IVF) treatment by 2 out of the 3 criteria: advanced maternal age and/or other clinical risk factor for POR (Bologna 1), 3 or less oocytes retrieved in a previous IVF cycle with conventional stimulation protocol (Bologna 2) and abnormal ovarian reserve test (Bologna 3). This retrospective analysis aims at evaluating the relative importance of the three criteria in prediction of POR and live-birth outcome. Methods: Data on 132 women undergoing the second IVF treatment cycle in Queen Mary Hospital, Hong Kong, between January 2012 and June 2015, who fulfilled the Bologna criteria for POR, were retrieved and analysed. In this study, women aged ≥40 years and/or having history of endometriosis or ovarian surgery were classified as Bologna 1; those having 3 or less oocytes retrieved in the previous IVF cycle stimulated with a starting gonadotrophin dose of 150 IU or above were taken as Bologna 2, while those with antral follicle count ≤6 were classified as Bologna 3. The number of retrieved oocytes and utilizable embryos, pregnancy rate as well as live-birth rate were the primary outcome measures. Results: Subjects with Bologna 1 + 2 (n = 12) had significantly more retrieved oocytes and utilizable embryos compared to those with Bologna 2 + 3 (n = 49) or Bologna 1 + 2 + 3 (=26) (p < 0.05), but not Bologna 1 + 3 (n = 45). There was no significant between-group difference in pregnancy rate. However, those with Bologna 1 + 2 + 3 had significantly worse live-birth rate (0%) compared to those with Bologna 1 + 2 (33.3%, p < 0.05) or Bologna 1 + 3 (15.6%, p < 0.05). Conclusions: Poor ovarian responders fulfilling different combinations of the Bologna criteria had different IVF outcomes. The best ovarian response and live-birth rate were observed in those with Bologna 1 + 2 with normal antral follicle count, and the worse in those in those fulfilling all three criteria. http://dx.doi.org/10.1016/j.maturitas.2017.03.175 P076 The association between interleukin-10 (IL-10) -592C/A, -819T/C, -1082G/A promoter polymorphisms and endometriosis Andrei Mihai Malutan ∗ , Razvan Ciortea, Ciprian Porumb, Radu Florin Mocan-Hognogi, Dan Mihu ’Iuliu Hatieganu’ University of Medicine and Pharmacy, 2nd Obstetrics and Gynecology Department, Cluj-Napoca, Romania Purpose: Endometriosis has an incidence reaching up to 50% in infertile women. Cytokine-mediated immune responses seem to
play an important role in endometriosis pathogenesis, but still the etiology and pathophysiology remain unclear. In the current study we tried to investigate whether there is a relationship between IL10 genetic polymorphism, serum levels of IL-10 and the presence of advanced endometriosis. Methods: The presence of IL-10 592C/A, 819T/C, 1082G/A promoter polymorphisms and IL-10 serum levels were investigated in advanced endometriosis patients compared to healthy controls. Genomic DNA was extracted from peripheral blood leukocytes and further analyzed by PCR. Results: IL-10 serum levels were significantly higher in endometriosis group compared to controls (1.48, 0.68, p < 0.001). We observed a significant association between IL-10 592C/C and 819C/C genotypes, presence of C alleles and an increased risk of endometriosis. No difference was observed in IL-10 serum levels corresponding to different alleles or genotypes. Conclusion: Our results suggest that IL-10 592A/C and 819T/C promoter polymorphisms confer susceptibility to endometriosis. No associations were found between the IL-10 1082A/G polymorphism and susceptibility to endometriosis. http://dx.doi.org/10.1016/j.maturitas.2017.03.176 P077 Abdominal wall endometriosis: Prevalence and clinical spectrum Sungyob Kim Jeju National Uni. Hospital, Jeju, Republic of Korea The purpose of our study was to evaluate the prevalence and clinical findings including radiologic features of abdominal wall endometriosis. A retrospective search of our institution’s database over a 10year period was performed. We found 68 surgically proven cases of abdominal wall endometriosis. All patients had undergone sonography including power Doppler examination. Additional CT was performed in 54 patient. The clinical data were analyzed, and the imaging studies were reviewed by radiologists. All patients had a history of at least one prior cesarean section. All presented with focal pain near the surgical scar, which was cyclic in three patients. 61 patients presented with a palpable mass near the scar. Sonography detected 65 lesions within the abdominal wall, with a mean diameter of 28 mm. All lesions were hypoechoic, vascular, and solid, with some cystic changes in one. The calculated frequency of abdominal wall endometriosis is approximately 0.9% of all women who had a cesarean delivery. Abdominal wall endometriosis frequently presents with noncyclic symptoms. Imaging findings of a solid mass near a cesarean section scar strongly suggest its diagnosis. http://dx.doi.org/10.1016/j.maturitas.2017.03.177
P071 The effect of chronic vulvar dystrophy on urinary continence in patients at climacterium Elvira Bratila 1 , Monica Cirstoiu 1 , Claudia Mehedintu 1 , Costin Berceanu 2 , Roxana Bohiltea 1 , Oana Toader 1 , Diana-Elena Comandasu 1,∗ 1
‘Carol Davila’ University of Medicine and Pharmacy, Obstetrics Gynecology, Bucharest, Romania 2 Craiova University of Medicine and Pharmacy, Obstetrics Gynecology, Craiova, Romania Chronic dystrophy is the growth of abnormal skin on the vulva, its causes being lichen sclerosus, with thin vulvar skin lesions and squamous hyperplasia with thick tegument. Lichen appears as discolored, translucent irregular areas of skin on/around the labia especially in women at climacterium. It can cause from lack of clinical manifestations to intense itching and progressive vulvar pain. Squamous hyperplasia transforms vulvar skin thick with white elevations causing intense itching. We examined a number of 22 climacteric patients, aged between 52 and 73 diagnosed with vulvar dystrophy in the interval 2014–2016. Urinary incontinence was diagnosed in 90% of them: 36% presented stress urinary incontinence, 40% mixed incontinence (vulvar dystrophy being a factor in the continence impairment), while in 22% of the cases the main etiology of the disease was the severe alteration of the vulvar anatomy. The 5 cases presenting important distortion of the external genital organ anatomy included partial labial adhesion or complete labial fusion caused by chronic dystrophy and required surgical intervention. The etiology in the appearance of labial adherences is thought to be inflammation of the labia with denudation of the superficial layer which heals by fibrosis causing adhesions. Labial fusion in menopause is a rare condition which in addition to chronic dystrophy has other two risk factors: relative hyperandrogenism associated with lack of estrogens and chronic urinary tract infections (UTI). Regarding recurrent UTIs, they represent both a risk factor and a consequence of labial fusion, the urine dribbling through the labial adherence over the external urethral orifice and draining through the vagina. Labial fusion affecting urinary continence is an uncommon phenomenon in postmenopausal women. The prognosis is good with surgical treatment, while estrogen and corticosteroid topic application should be used as prophylaxis for recurrence. http://dx.doi.org/10.1016/j.maturitas.2017.03.171 P072 Relationship between delivery modes and genitourinary syndrome among postmenopausal women Parvin Salehinejad 1,∗ , Parvin Abedi 2 , Masoomeh Yaralizadeh 2 1 Kerman Medical University, Kerman, Islamic Republic of Iran 2 Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran
Objectives: Many postmenopausal women suffer from vaginal atrophy due to the lack of estrogen. This study aimed to evaluate the relationship between mode of delivery and genitourinary syndrome among postmenopausal women. Methods: This was a case-control study in which 125 postmenopausal women were recruited (65 with a history of normal vaginal delivery and 60 with a history of cesarean section).
169
Data were collected through a socio-demographic questionnaire and a check list for assessing signs and symptoms of genitourinary syndrome. Subjective symptoms of vaginal atrophy (dryness, dyspareunia, itching, burning and paleness), pH of vagina and maturation index were assessed and recorded. Data were analysed using chi-square and independent t-test. Results: 50.8% of women in the normal vaginal delivery (NVD) group had vaginal pH 5–5.49 compared to the 40% in the cesarean section (C/S) group (p < 0.001). The maturation index was significantly better in the NVD group (42.7 ± 6.34) compared to the C/S group (24.08 ± 8.2) (p < 0.001). All symptoms of vaginal atrophy including (paleness, dryness, itching, dyspareunia and burning) were significantly less in the normal vaginal delivery group compared to the cesarean section group (p < 0.05). Conclusion: Postmenopausal women with a history of normal vaginal delivery were less likely to have genitourinary syndrome compared to the women with history of cesarean section. Other prospective studies can explore this relationship better. http://dx.doi.org/10.1016/j.maturitas.2017.03.172 P074 Comparison chemical, clinical pregnancy rate, live birth rate and obstetric outcome in fresh versus frozen embryo transfer in in vitro fertilization cycles Behnaz Khani Robati 1,∗ , Gholamreza Dashti 2 , Helia Kamal 3 , Niloofar Mirhosseini 4 , IVF patients 1 Isfahan University of Medical School, Ob/Gyn, Isfahan, Islamic Republic of Iran 2 Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran 3 Isfahan University of Medical School, Isfahan, Islamic Republic of Iran 4 Pharmacy Faculty, Budapest, Hungary
Introduction: There is inadequate investigation about results of two methods of IVF via fresh or freeze thawed embryo transfer so this study was done to compare pregnancy rate, live birth rate, obstetrics and prenatal complications in singleton pregnancies after these two methods. Material and methods: In this retrospective cohort study 559 women who were referred to infertility clinic of Shahid Behshti hospital in Isfahan and another private clinic were recruited. According to patient situation they received fresh or freeze thawed embryos. Obstetrical outcomes were assessed by calling and interviewing patients who became pregnant. Results: The results showed that in 303 frozen cycles there were 70 alive pregnancy in compare with 256 fresh embryo transfer who had 46 alive pregnancy (p = 0.04). Singleton pregnancy after transfer of frozen thawed embryo was associated with more preterm labor in compare with fresh embryo transfer (p = 0.03). Data analysis showed that other obstetrics outcome such as gestational hypertension, gestational diabetes, ante partum hemorrhage, I UGR, LBW, admission to NICU was the same in both groups. Conclusion: Although the fresh embryo transfer is the commonest way in IVF cycles, Results of our study showed that rate of live birth with freeze thawed embryo transfer was more and rate of pregnancy complication and prenatal outcomes were the same.
170
EMAS2017 / Maturitas 100 (2017) 93–202
Keywords: IVF, Fresh embryo, Freeze thawed embryo, Infertility, Obstetrics outcome http://dx.doi.org/10.1016/j.maturitas.2017.03.174 P075 Relative importance of the different components of the Bologna criteria for predicting poor ovarian response in assisted reproduction Hang Wun Raymond Li ∗ , Tak Ming Cheung, William Shu Biu Yeung, Pak Chung Ho, Ernest Hung Yu Ng University of Hong Kong, Department of Obstetrics and Gynaecology, Pokfulam, Hong Kong, China Introduction: The Bologna criteria published in 2011 defined poor ovarian response (POR) in women undergoing in-vitro fertilisation (IVF) treatment by 2 out of the 3 criteria: advanced maternal age and/or other clinical risk factor for POR (Bologna 1), 3 or less oocytes retrieved in a previous IVF cycle with conventional stimulation protocol (Bologna 2) and abnormal ovarian reserve test (Bologna 3). This retrospective analysis aims at evaluating the relative importance of the three criteria in prediction of POR and live-birth outcome. Methods: Data on 132 women undergoing the second IVF treatment cycle in Queen Mary Hospital, Hong Kong, between January 2012 and June 2015, who fulfilled the Bologna criteria for POR, were retrieved and analysed. In this study, women aged ≥40 years and/or having history of endometriosis or ovarian surgery were classified as Bologna 1; those having 3 or less oocytes retrieved in the previous IVF cycle stimulated with a starting gonadotrophin dose of 150 IU or above were taken as Bologna 2, while those with antral follicle count ≤6 were classified as Bologna 3. The number of retrieved oocytes and utilizable embryos, pregnancy rate as well as live-birth rate were the primary outcome measures. Results: Subjects with Bologna 1 + 2 (n = 12) had significantly more retrieved oocytes and utilizable embryos compared to those with Bologna 2 + 3 (n = 49) or Bologna 1 + 2 + 3 (=26) (p < 0.05), but not Bologna 1 + 3 (n = 45). There was no significant between-group difference in pregnancy rate. However, those with Bologna 1 + 2 + 3 had significantly worse live-birth rate (0%) compared to those with Bologna 1 + 2 (33.3%, p < 0.05) or Bologna 1 + 3 (15.6%, p < 0.05). Conclusions: Poor ovarian responders fulfilling different combinations of the Bologna criteria had different IVF outcomes. The best ovarian response and live-birth rate were observed in those with Bologna 1 + 2 with normal antral follicle count, and the worse in those in those fulfilling all three criteria. http://dx.doi.org/10.1016/j.maturitas.2017.03.175 P076 The association between interleukin-10 (IL-10) -592C/A, -819T/C, -1082G/A promoter polymorphisms and endometriosis Andrei Mihai Malutan ∗ , Razvan Ciortea, Ciprian Porumb, Radu Florin Mocan-Hognogi, Dan Mihu ’Iuliu Hatieganu’ University of Medicine and Pharmacy, 2nd Obstetrics and Gynecology Department, Cluj-Napoca, Romania Purpose: Endometriosis has an incidence reaching up to 50% in infertile women. Cytokine-mediated immune responses seem to
play an important role in endometriosis pathogenesis, but still the etiology and pathophysiology remain unclear. In the current study we tried to investigate whether there is a relationship between IL10 genetic polymorphism, serum levels of IL-10 and the presence of advanced endometriosis. Methods: The presence of IL-10 592C/A, 819T/C, 1082G/A promoter polymorphisms and IL-10 serum levels were investigated in advanced endometriosis patients compared to healthy controls. Genomic DNA was extracted from peripheral blood leukocytes and further analyzed by PCR. Results: IL-10 serum levels were significantly higher in endometriosis group compared to controls (1.48, 0.68, p < 0.001). We observed a significant association between IL-10 592C/C and 819C/C genotypes, presence of C alleles and an increased risk of endometriosis. No difference was observed in IL-10 serum levels corresponding to different alleles or genotypes. Conclusion: Our results suggest that IL-10 592A/C and 819T/C promoter polymorphisms confer susceptibility to endometriosis. No associations were found between the IL-10 1082A/G polymorphism and susceptibility to endometriosis. http://dx.doi.org/10.1016/j.maturitas.2017.03.176 P077 Abdominal wall endometriosis: Prevalence and clinical spectrum Sungyob Kim Jeju National Uni. Hospital, Jeju, Republic of Korea The purpose of our study was to evaluate the prevalence and clinical findings including radiologic features of abdominal wall endometriosis. A retrospective search of our institution’s database over a 10year period was performed. We found 68 surgically proven cases of abdominal wall endometriosis. All patients had undergone sonography including power Doppler examination. Additional CT was performed in 54 patient. The clinical data were analyzed, and the imaging studies were reviewed by radiologists. All patients had a history of at least one prior cesarean section. All presented with focal pain near the surgical scar, which was cyclic in three patients. 61 patients presented with a palpable mass near the scar. Sonography detected 65 lesions within the abdominal wall, with a mean diameter of 28 mm. All lesions were hypoechoic, vascular, and solid, with some cystic changes in one. The calculated frequency of abdominal wall endometriosis is approximately 0.9% of all women who had a cesarean delivery. Abdominal wall endometriosis frequently presents with noncyclic symptoms. Imaging findings of a solid mass near a cesarean section scar strongly suggest its diagnosis. http://dx.doi.org/10.1016/j.maturitas.2017.03.177