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Falloposcopic tuboplasty (FT) Is a novel, patient friendly and effective treatment for tubal factor infertility
O-304 Wednesday, October 27, 2010 04:30 PM FALLOPOSCOPIC TUBOPLASTY (FT) IS A NOVEL, PATIENT FRIENDLY AND EFFECTIVE TREATMENT FOR TUBAL FACTOR INFERTILITY. M. Komai, C. Komatsubara, K. Sugihara, A. Haruki, A. Fukuda, Y. Morimoto. IVF Osaka Clinic, Higashi-Osaka, Osaka, Japan; IVF Namba Clinic, Osaka, Japan. OBJECTIVE: Tubal factor is a major cause of female infertility. The narrowest portion of the human fallopian tube, extending from the uterotubal ostium to the ampullary-isthmic junction is vulnerable to pathogenic organisms and often causes infertility by occlusion (Oc) or stenosis (St). FT is the procedure of transcervical balloon tuboplasty and can be performed outpatient bases. Although ART has been used for tubal factor as standard treatment, we apply FT as an initial treatment. The present study was conducted to evaluate whether outpatient FT is effective to recover tubal patency and achieve pregnancy from our experience of 1500 cases. DESIGN: One thousand patients with tubal Oc and/or St either unilaterally or bilaterally diagnosed by hysterosalpingography were treated by FT from January, 2002 through Decemmber, 2008. Pregnancy outcomes of those patients were analyzed retrospectively at private setting infertility clinic. MATERIALS AND METHODS: Indications for FT were tubal lesions. Patients were followed by conventional infertility treatments such as timed intercourse or IUI for at least 6 months. Success of FT procedures and subsequent pregnancy were analyzed. RESULTS: One thousand four hundred eighty seven out of 1500 patients (99.1%) were treated successfully with FT. Overall pregnancy rate after FT was 36.5%. Thirty eight point three percent of patients with bilateral tubal lesions (Oc&Oc; 303pt., Oc&St; 336pt and St&St; 443pt.) and 30.9% of patients with unilateral tubal lesion (Oc; 196pt. and St; 222pt.) achieved pregnancy. Pregnancy and condition of tubal linings were as follows; post inflammation image: 28.0%, adhesions: 28.2% and other abnormalities: 23.3%. CONCLUSION: FT could be performed out patient bases and achieved acceptable pregnancy rate (36.5%) for tubal factor infertility. Moreover, FT is not only bringing natural pregnancies, but also patient friendly procedure. The present study has proven that outpatient FT could be the first option for tubal factor infertility patients before IVF.
O-305 Wednesday, October 27, 2010 04:45 PM EFFECTS OF MYOMECTOMY ON IN VITRO FERTILIZATION OUTCOMES. M. Catenacci, T. Falcone, B. Nutter. The Cleveland Clinic Foundation, Cleveland, OH. OBJECTIVE: Although some types of myomas may negatively influence IVF outcome it is unclear if surgical removal improves outcome. The primary aim of this study is to look at the effects of myomectomy on In Vitro Fertilization (IVF) outcomes. DESIGN: This was a retrospective chart review of patients who had a myomectomy and subsequently went on to have IVF. A control group was chosen who had IVF during the same time period without a history of myoma or myomectomy. 42 patients were evaluated. MATERIALS AND METHODS: Data was collected from electronic medical records. Inclusion criteria included women with a previous open, laparoscopic or hysteroscopic myomectomy that subsequently underwent IVF. A separate control group of women, without a history of myomectomy, which underwent IVF, were used for comparison. A two to one ratio of cases and controls was used. Comparisons were drawn using either Wilcoxon’s rank sum test, or Student’s t-test. Categorical measures are summarized by frequencies and percentages and compared using Fisher’s exact test. Multivariate analyses used linear mixed effects models to account for repeated cycles in some patients. RESULTS: Univariate analyses do not indicate that there is evidence of a difference in the number of follicles aspirated, eggs fertilized, or days of stimulation for those patients who had a previous myomectomy and those who did not (p ¼ 0.62; p ¼ 0.63; and p ¼ 0.89, respectively). No difference between groups among other patient characteristicswere found. Pregnancy outcomes were not significantly different. Linear modeling found no significant effects on IVF outcomes. Patients with previous myomectomy had 1.64 fewer aspirated follicles, (95% CI -5.29 to 1.93), 1.07 fewer eggs fertilized (95% CI -3.49 to 1.64). and required 0.29 days more stimulation (95% CI -1.16 to 1.51).
S90
Abstracts
CONCLUSION: Our study failed to find any significant difference in IVF outcome after myomectomy compared to control. These results indicate that myomectomy does not have a negative influence on IVF outcome.
O-306 Wednesday, October 27, 2010 05:00 PM MONOPOLAR ELECTROSURGERY THROUGH SINGLE PORT LAPAROSCOPY MAY RESULT IN VISCERAL BURNS. B. Abu-Rafea, G. A. Vilos, O. Al-Obeed, A. AlSheikh. Obstetrics and Gynecology, General Surgery, Pathology, King Saud University, Riyadh, Central, Saudi Arabia; Obstetrics and Gynecology, The University of Western Ontario, London, ON, Canada. OBJECTIVE: Monopolar electrosurgery compared with other energy sources is associated with unique inherent risks and complications due to inadvertent direct and/or capacitive coupling or insulation failure of instruments. These dangers become particularly important with the re-emergence of single-port laparoscopy which requires close proximity and crossing of multiple intra-abdominal instruments. Our objective is to determine the effects of monopolar electrosurgery on various tissues/organs during simulated single-port laparoscopic surgery in vitro and in vivo. DESIGN: Simulation in dry lab using liver from pigs and sheep and bowel and liver of anesthetized animals (one dog, one pig) in two university affiliated teaching hospitals and animal facilities. MATERIALS AND METHODS: We used Valleylab Force 2 and FX electrosurgical generators (ESU) at power outputs of 40-60 watts and both high and low voltage (coag & cut) waveforms and 3 commercially available single port devices. The effect on tissue was recorded by pictures and video camera and graded visually and histologically using H&E. RESULTS: During activation of any standard monopolar laparoscopic instrument, capacitive coupled currents resulting in visible tissue burn (blanching) were noted by other adjacent instrument (graspers, etc) including metallic suction/irrigation cannulae and the laparoscope itself. Histopathology confirmed trans mural thermal damage reaching the mucosal surface of small bowel. With prolonged activation of the ESU the capacitive coupled corona discharge caused rapid insulation breakdown of the electrode instrument resulting in direct coupling to adjacent instruments and more severe burn to the contacted tissue/organ. CONCLUSION: During single port laparoscopy and use of monopolar RF, the proximity and crossing of instruments generates capacitive and/or direct coupled currents which may cause visceral burns. Supported by: The Infertility Research Chair at the College of Medicine, King Saud University.
O-307 Wednesday, October 27, 2010 05:15 PM HYSTEROSCOPY IS EFFECTIVE TOOL TO DETECT AND TREAT THE ABNORMALITIES OF UTERINE CAVITY OF IMPLANTATION FAILURE PATIENTS IN IVF FROM OUR EXPERIENCE OF 200 CASES. K. Sugihara, T. Himeno, M. Ida, A. Haruki, A. Fukuda, Y. Morimoto. IVF Osaka Clinic, Higashi-Osaka, Osaka, Japan; IVF Namba Clinic, Osaka, Japan. OBJECTIVE: Abnormality of the uterine cavity is a cause of implantation failure in in vitro fertilization. Out patient hysteroscopy is a diagnostic tool to detect abnormalities of the uterine cavity and subsequent operative hysteroscopy can be used as a therapeutic tool. The present study was conducted to evaluate whether hysteroscopy is effective tool to diagnose and treat the patients with implantation failure in IVF from the experience of 200 cases. DESIGN: Retrospective study at private setting infertility clinic. MATERIALS AND METHODS: Two hundred patients with implantation failure were diagnosed and treated by hysteroscopy from 2005 through 2009. Hysteroscopy was performed on the patients of repeated IVF failures with good embryos transferred. The 200 patients were classified into three groups. GroupI was no abnormalities in the uterine cavity whereas GroupII had abnormal findings. GroupII was sub classified into GroupIIa and GroupIIb. GroupIIa was the patients with no further treatment, GroupIIb was treated with operative hysteroscopy. Patients were followed by IVF-ET at least one year. RESULTS: Abnormal hysteroscopic findings were observed in 80 cases (40%). Abnormal findings in diagnostic hysteroscopy were as follows;
Vol. 94., No. 4, Supplement, September 2010
O-305 Wednesday, October 27, 2010 04:45 PM EFFECTS OF MYOMECTOMY ON IN VITRO FERTILIZATION OUTCOMES. M. Catenacci, T. Falcone, B. Nutter. The Cleveland Clinic Foundation, Cleveland, OH. OBJECTIVE: Although some types of myomas may negatively influence IVF outcome it is unclear if surgical removal improves outcome. The primary aim of this study is to look at the effects of myomectomy on In Vitro Fertilization (IVF) outcomes. DESIGN: This was a retrospective chart review of patients who had a myomectomy and subsequently went on to have IVF. A control group was chosen who had IVF during the same time period without a history of myoma or myomectomy. 42 patients were evaluated. MATERIALS AND METHODS: Data was collected from electronic medical records. Inclusion criteria included women with a previous open, laparoscopic or hysteroscopic myomectomy that subsequently underwent IVF. A separate control group of women, without a history of myomectomy, which underwent IVF, were used for comparison. A two to one ratio of cases and controls was used. Comparisons were drawn using either Wilcoxon’s rank sum test, or Student’s t-test. Categorical measures are summarized by frequencies and percentages and compared using Fisher’s exact test. Multivariate analyses used linear mixed effects models to account for repeated cycles in some patients. RESULTS: Univariate analyses do not indicate that there is evidence of a difference in the number of follicles aspirated, eggs fertilized, or days of stimulation for those patients who had a previous myomectomy and those who did not (p ¼ 0.62; p ¼ 0.63; and p ¼ 0.89, respectively). No difference between groups among other patient characteristicswere found. Pregnancy outcomes were not significantly different. Linear modeling found no significant effects on IVF outcomes. Patients with previous myomectomy had 1.64 fewer aspirated follicles, (95% CI -5.29 to 1.93), 1.07 fewer eggs fertilized (95% CI -3.49 to 1.64). and required 0.29 days more stimulation (95% CI -1.16 to 1.51).
S90
Abstracts
CONCLUSION: Our study failed to find any significant difference in IVF outcome after myomectomy compared to control. These results indicate that myomectomy does not have a negative influence on IVF outcome.
O-306 Wednesday, October 27, 2010 05:00 PM MONOPOLAR ELECTROSURGERY THROUGH SINGLE PORT LAPAROSCOPY MAY RESULT IN VISCERAL BURNS. B. Abu-Rafea, G. A. Vilos, O. Al-Obeed, A. AlSheikh. Obstetrics and Gynecology, General Surgery, Pathology, King Saud University, Riyadh, Central, Saudi Arabia; Obstetrics and Gynecology, The University of Western Ontario, London, ON, Canada. OBJECTIVE: Monopolar electrosurgery compared with other energy sources is associated with unique inherent risks and complications due to inadvertent direct and/or capacitive coupling or insulation failure of instruments. These dangers become particularly important with the re-emergence of single-port laparoscopy which requires close proximity and crossing of multiple intra-abdominal instruments. Our objective is to determine the effects of monopolar electrosurgery on various tissues/organs during simulated single-port laparoscopic surgery in vitro and in vivo. DESIGN: Simulation in dry lab using liver from pigs and sheep and bowel and liver of anesthetized animals (one dog, one pig) in two university affiliated teaching hospitals and animal facilities. MATERIALS AND METHODS: We used Valleylab Force 2 and FX electrosurgical generators (ESU) at power outputs of 40-60 watts and both high and low voltage (coag & cut) waveforms and 3 commercially available single port devices. The effect on tissue was recorded by pictures and video camera and graded visually and histologically using H&E. RESULTS: During activation of any standard monopolar laparoscopic instrument, capacitive coupled currents resulting in visible tissue burn (blanching) were noted by other adjacent instrument (graspers, etc) including metallic suction/irrigation cannulae and the laparoscope itself. Histopathology confirmed trans mural thermal damage reaching the mucosal surface of small bowel. With prolonged activation of the ESU the capacitive coupled corona discharge caused rapid insulation breakdown of the electrode instrument resulting in direct coupling to adjacent instruments and more severe burn to the contacted tissue/organ. CONCLUSION: During single port laparoscopy and use of monopolar RF, the proximity and crossing of instruments generates capacitive and/or direct coupled currents which may cause visceral burns. Supported by: The Infertility Research Chair at the College of Medicine, King Saud University.
O-307 Wednesday, October 27, 2010 05:15 PM HYSTEROSCOPY IS EFFECTIVE TOOL TO DETECT AND TREAT THE ABNORMALITIES OF UTERINE CAVITY OF IMPLANTATION FAILURE PATIENTS IN IVF FROM OUR EXPERIENCE OF 200 CASES. K. Sugihara, T. Himeno, M. Ida, A. Haruki, A. Fukuda, Y. Morimoto. IVF Osaka Clinic, Higashi-Osaka, Osaka, Japan; IVF Namba Clinic, Osaka, Japan. OBJECTIVE: Abnormality of the uterine cavity is a cause of implantation failure in in vitro fertilization. Out patient hysteroscopy is a diagnostic tool to detect abnormalities of the uterine cavity and subsequent operative hysteroscopy can be used as a therapeutic tool. The present study was conducted to evaluate whether hysteroscopy is effective tool to diagnose and treat the patients with implantation failure in IVF from the experience of 200 cases. DESIGN: Retrospective study at private setting infertility clinic. MATERIALS AND METHODS: Two hundred patients with implantation failure were diagnosed and treated by hysteroscopy from 2005 through 2009. Hysteroscopy was performed on the patients of repeated IVF failures with good embryos transferred. The 200 patients were classified into three groups. GroupI was no abnormalities in the uterine cavity whereas GroupII had abnormal findings. GroupII was sub classified into GroupIIa and GroupIIb. GroupIIa was the patients with no further treatment, GroupIIb was treated with operative hysteroscopy. Patients were followed by IVF-ET at least one year. RESULTS: Abnormal hysteroscopic findings were observed in 80 cases (40%). Abnormal findings in diagnostic hysteroscopy were as follows;
Vol. 94., No. 4, Supplement, September 2010