- Email: [email protected]
Kansas physician attitudes and practice patterns relating to oncology patients and fertility preservation
load and seal and provide a safe closed environment for specimen storage. Excellent viability rates were obtained for mature oocytes, embryos and blastocysts.
P-42 Tuesday, October 26, 2010 KANSAS PHYSICIAN ATTITUDES AND PRACTICE PATTERNS RELATING TO ONCOLOGY PATIENTS AND FERTILITY PRESERVATION. T. Von Wald, L. Frazier, A. Paschal, L. Hopper, D. Grainger. Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS; Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, KS. OBJECTIVE: To examine physician attitudes and practice patterns related to fertility preservation (FP) among licensed oncologists (hematology-oncology, pediatric oncology, radiation oncology, and gynecologic oncology) practicing in Kansas (KS). DESIGN: Cross-sectional study examining four areas of FP: knowledge, practice patterns, perceived barriers, and attitudes. MATERIALS AND METHODS: A 29-item survey was distributed via postal mail to all licensed oncologists in the state of KS; the response rate was 29% (58/200). Of the 58 surveys returned, 49 (84.4%) met inclusion criteria. Proportions were analyzed by Pearson’s Chi-square or Fisher’s exact tests. Non-parametric data were analyzed by calculating Spearman correlation coefficients, Mann- Whitney, or Kruskal-Wallis tests where appropriate. RESULTS: The 2006 American Society of Clinical Oncology (ASCO) guidelines on FP are utilized by 26.5% (95% CI 14.1 – 38.9%) of respondents. Those respondents who utilize the guidelines were also more likely to feel comfortable discussing FP, more likely to discuss the impact of cancer on future fertility, refer patients to an infertility specialist, and provide educational material to patients regarding FP (p < .05). Approximately half (59%, 95% CI 45.4 – 72.9%) of physicians agreed that the established methods for FP are sperm banking, oophoropexy, and embryo cryopreservation. Male respondents were more likely to agree that lack of time was a major barrier for FP discussion compared to female respondents (14.7% vs. 0%, p < .01). Male respondents were more likely to agree that treating the cancer is more important than pursuing FP as compared to female respondents (64.2% vs. 25%, p¼ .01). CONCLUSION: Approximately one-quarter of licensed oncologists in Kansas report following the 2006 ASCO guidelines with regard to FP. Nearly 40% of oncologists disagree or are unsure about the established methods for FP. There appear to be gender differences in regards to perceived barriers for discussing FP and attitudes towards FP in cancer patients.
P-43 Tuesday, October 26, 2010 GONADOTROPIN-RELEASING HORMONE ANALOG CO-TREATMENT FOR PRESERVATION OF OVARIAN FUNCTION DURING GONADOTOXIC CHEMOTHERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS. M. A. Bedaiwy, A. M. Abou-Setta, N. Desai, W. Hurd, S. A. El-Nashar, T. Falcone. Department of OB/GYN, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, Edmonton, AB, Canada; Department of OB/GYN, Assiut University Hospitals., Assiut, Egypt; OB/Gyn, The Cleveland Clinic Foundation, Cleveland, OH. OBJECTIVE: With the advances made in chemotherapeutic options, women are living longer, but may develop premature ovarian failure (POF) due to the side-effects of gonadotoxic chemotherapy. We wished to determine if gonadotropin-releasing hormone (GnRH) analog co-treatment with chemotherapy provides better reproductive outcomes for this population. DESIGN: Metaanalysis. MATERIALS AND METHODS: Electronic/ hand searches (e.g. MEDLINE, EMBASE, CENTRAL) till January 2010 were performed to identify randomized trials (RCTs) comparing GnRH co-treatment to chemotherapy alone in premenopausal women. The primary outcome was the incidence of POF following treatment. The secondary outcomes were the incidence of women with resumption of ovulation, POF after an initial normal cycle, normal cycles but abnormal markers of ovarian reserve, spontaneous occurrence of pregnancy after treatment and time to
S106
Abstracts
re-establishment of menstruation. Data was extracted to allow for an intention-to-treat analysis. RESULTS: Twenty-eight RCTs were identified, but only six met the inclusion criteria. Data was only available for the incidence of women with new onset of POF, resumption of ovulation, or occurrence of pregnancy. The incidence of POF or resumption of ovulation both demonstrated a significant difference in favor of the GnRH co-treatment [(O.R¼ 0.11, 95% CI¼ 0.03-0.43) and O.R¼ 4.04, 95% CI¼ 1.04-15.72, respectively]. The occurrence of spontaneous pregnancy showed no significant difference between GnRH co-treatment and the control groups (O.R¼ 0.26; 95% CI¼ 0.03-2.52). CONCLUSION: Evidence from RCTs suggests a beneficial role of GnRH co-treatment with chemotherapy in premenopausal women. Even so, more well-designed and powered trials are needed to address all possible outcomes and strengthen the body of evidence.
P-44 Tuesday, October 26, 2010 EFFICIENCY OF USING VITRIFIED DONOR OOCYTES FROM CRYOPRESERVED OOCYTE BANK. Y. Shu, W. Peng, J. Zhang. New Hope Fertility Center, New York, NY. OBJECTIVE: Splitting a cohort of fresh donor oocytes among several recipients is an effective practice in reducing the cost of donor oocyte treatment. Compared to fresh donor oocytes, cryopreserved donor oocytes are more convenient for a recipient since no synchronization is needed between recipient and donor. We evaluated the efficiency of vitrified donor oocytes from oocyte bank. DESIGN: Retrospective study. MATERIALS AND METHODS: We reviewed the outcome of all patients with transferred embryos being derived from vitrified donor oocytes between Jan 2008 and Dec 2009. Fresh donor oocytes were equilibrated in 7.5% EG + 7.5% DMSO for 5 min and then transferred to vitrfication solution (15% EG + 15% DMSO) and loaded on to the tip of Crytop. For warming, vitrified oocytes were directly immersed into 37 C 1.0 mol/l sucrose solution for 1 min. Oocytes were then transferred into 0.5 mol/l sucrose solution for 3 min, after which warmed oocytes were washed and cultured for 3-4 h before ICSI. In some cases, surplus good quality embryos after transfer were re-vitrified. RESULTS: A total of 289 vitrified donor oocytes were warmed from oocyte bank for 67 recipients, with an average number of 4.3 vitrified oocytes being thawed per cycle. The oocyte survival rate is 94.1% (272/289). Normal fertilization was observed in 197 oocyte (72.4%), among them 186 cleaved (94.4%). The average number of embryos replaced per transfer cycle is 1.26(101 embryos replaced in 80 transfer cycles). In 13 cases, patient came back to initiate a frozen cycle with revitrified embryos after a failed IVF. Clinical pregnancy was achieved in 30 cases, with pregnancy rates per oocyte warming and per transfer was 37.5% and 44.8% respectively. CONCLUSION: Vitrification was an effective approach to establish a cryopreserved oocyte bank. Considering the relatively small number of oocytes thawed per recipient cycle (4.3 per thaw), a 40% clinical pregnancy rate is acceptable. Cryopreserved oocyte bank provides more flexibility for those who want to use donor oocytes.
P-45 Tuesday, October 26, 2010 LAPAROENDOSCOPIC SINGLE SITE (LESS) GONADAL SPARING SURGERY. M. A. Bedaiwy, P. F. Escobar. Department of Obstetrics and Gynecology, Case Western Resrve University, Cleveland, OH; Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, OH. OBJECTIVE: To present our initial experience with a ‘‘laparo-endoscopic single site’’ (LESS) technique for treating tubal or ovarian benign pathology with gonadal preservation. DESIGN: Prospective series. MATERIALS AND METHODS: This study was conducted in a tertiary care referral center. Since September, 2009, 11 patients with ovarian pathologies and one patient with distal tubal cystic lesions were treated using the LESS technique. The LESS technique was performed exclusively through an umbilical incision using a single three-channel port and flexible laparoscopic instrumentation. In each case, a multichannel port was inserted transperitoneally through a 1.5-2 cm umbilical incision.
Vol. 94., No. 4, Supplement, September 2010
P-42 Tuesday, October 26, 2010 KANSAS PHYSICIAN ATTITUDES AND PRACTICE PATTERNS RELATING TO ONCOLOGY PATIENTS AND FERTILITY PRESERVATION. T. Von Wald, L. Frazier, A. Paschal, L. Hopper, D. Grainger. Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS; Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, KS. OBJECTIVE: To examine physician attitudes and practice patterns related to fertility preservation (FP) among licensed oncologists (hematology-oncology, pediatric oncology, radiation oncology, and gynecologic oncology) practicing in Kansas (KS). DESIGN: Cross-sectional study examining four areas of FP: knowledge, practice patterns, perceived barriers, and attitudes. MATERIALS AND METHODS: A 29-item survey was distributed via postal mail to all licensed oncologists in the state of KS; the response rate was 29% (58/200). Of the 58 surveys returned, 49 (84.4%) met inclusion criteria. Proportions were analyzed by Pearson’s Chi-square or Fisher’s exact tests. Non-parametric data were analyzed by calculating Spearman correlation coefficients, Mann- Whitney, or Kruskal-Wallis tests where appropriate. RESULTS: The 2006 American Society of Clinical Oncology (ASCO) guidelines on FP are utilized by 26.5% (95% CI 14.1 – 38.9%) of respondents. Those respondents who utilize the guidelines were also more likely to feel comfortable discussing FP, more likely to discuss the impact of cancer on future fertility, refer patients to an infertility specialist, and provide educational material to patients regarding FP (p < .05). Approximately half (59%, 95% CI 45.4 – 72.9%) of physicians agreed that the established methods for FP are sperm banking, oophoropexy, and embryo cryopreservation. Male respondents were more likely to agree that lack of time was a major barrier for FP discussion compared to female respondents (14.7% vs. 0%, p < .01). Male respondents were more likely to agree that treating the cancer is more important than pursuing FP as compared to female respondents (64.2% vs. 25%, p¼ .01). CONCLUSION: Approximately one-quarter of licensed oncologists in Kansas report following the 2006 ASCO guidelines with regard to FP. Nearly 40% of oncologists disagree or are unsure about the established methods for FP. There appear to be gender differences in regards to perceived barriers for discussing FP and attitudes towards FP in cancer patients.
P-43 Tuesday, October 26, 2010 GONADOTROPIN-RELEASING HORMONE ANALOG CO-TREATMENT FOR PRESERVATION OF OVARIAN FUNCTION DURING GONADOTOXIC CHEMOTHERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS. M. A. Bedaiwy, A. M. Abou-Setta, N. Desai, W. Hurd, S. A. El-Nashar, T. Falcone. Department of OB/GYN, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, Edmonton, AB, Canada; Department of OB/GYN, Assiut University Hospitals., Assiut, Egypt; OB/Gyn, The Cleveland Clinic Foundation, Cleveland, OH. OBJECTIVE: With the advances made in chemotherapeutic options, women are living longer, but may develop premature ovarian failure (POF) due to the side-effects of gonadotoxic chemotherapy. We wished to determine if gonadotropin-releasing hormone (GnRH) analog co-treatment with chemotherapy provides better reproductive outcomes for this population. DESIGN: Metaanalysis. MATERIALS AND METHODS: Electronic/ hand searches (e.g. MEDLINE, EMBASE, CENTRAL) till January 2010 were performed to identify randomized trials (RCTs) comparing GnRH co-treatment to chemotherapy alone in premenopausal women. The primary outcome was the incidence of POF following treatment. The secondary outcomes were the incidence of women with resumption of ovulation, POF after an initial normal cycle, normal cycles but abnormal markers of ovarian reserve, spontaneous occurrence of pregnancy after treatment and time to
S106
Abstracts
re-establishment of menstruation. Data was extracted to allow for an intention-to-treat analysis. RESULTS: Twenty-eight RCTs were identified, but only six met the inclusion criteria. Data was only available for the incidence of women with new onset of POF, resumption of ovulation, or occurrence of pregnancy. The incidence of POF or resumption of ovulation both demonstrated a significant difference in favor of the GnRH co-treatment [(O.R¼ 0.11, 95% CI¼ 0.03-0.43) and O.R¼ 4.04, 95% CI¼ 1.04-15.72, respectively]. The occurrence of spontaneous pregnancy showed no significant difference between GnRH co-treatment and the control groups (O.R¼ 0.26; 95% CI¼ 0.03-2.52). CONCLUSION: Evidence from RCTs suggests a beneficial role of GnRH co-treatment with chemotherapy in premenopausal women. Even so, more well-designed and powered trials are needed to address all possible outcomes and strengthen the body of evidence.
P-44 Tuesday, October 26, 2010 EFFICIENCY OF USING VITRIFIED DONOR OOCYTES FROM CRYOPRESERVED OOCYTE BANK. Y. Shu, W. Peng, J. Zhang. New Hope Fertility Center, New York, NY. OBJECTIVE: Splitting a cohort of fresh donor oocytes among several recipients is an effective practice in reducing the cost of donor oocyte treatment. Compared to fresh donor oocytes, cryopreserved donor oocytes are more convenient for a recipient since no synchronization is needed between recipient and donor. We evaluated the efficiency of vitrified donor oocytes from oocyte bank. DESIGN: Retrospective study. MATERIALS AND METHODS: We reviewed the outcome of all patients with transferred embryos being derived from vitrified donor oocytes between Jan 2008 and Dec 2009. Fresh donor oocytes were equilibrated in 7.5% EG + 7.5% DMSO for 5 min and then transferred to vitrfication solution (15% EG + 15% DMSO) and loaded on to the tip of Crytop. For warming, vitrified oocytes were directly immersed into 37 C 1.0 mol/l sucrose solution for 1 min. Oocytes were then transferred into 0.5 mol/l sucrose solution for 3 min, after which warmed oocytes were washed and cultured for 3-4 h before ICSI. In some cases, surplus good quality embryos after transfer were re-vitrified. RESULTS: A total of 289 vitrified donor oocytes were warmed from oocyte bank for 67 recipients, with an average number of 4.3 vitrified oocytes being thawed per cycle. The oocyte survival rate is 94.1% (272/289). Normal fertilization was observed in 197 oocyte (72.4%), among them 186 cleaved (94.4%). The average number of embryos replaced per transfer cycle is 1.26(101 embryos replaced in 80 transfer cycles). In 13 cases, patient came back to initiate a frozen cycle with revitrified embryos after a failed IVF. Clinical pregnancy was achieved in 30 cases, with pregnancy rates per oocyte warming and per transfer was 37.5% and 44.8% respectively. CONCLUSION: Vitrification was an effective approach to establish a cryopreserved oocyte bank. Considering the relatively small number of oocytes thawed per recipient cycle (4.3 per thaw), a 40% clinical pregnancy rate is acceptable. Cryopreserved oocyte bank provides more flexibility for those who want to use donor oocytes.
P-45 Tuesday, October 26, 2010 LAPAROENDOSCOPIC SINGLE SITE (LESS) GONADAL SPARING SURGERY. M. A. Bedaiwy, P. F. Escobar. Department of Obstetrics and Gynecology, Case Western Resrve University, Cleveland, OH; Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, OH. OBJECTIVE: To present our initial experience with a ‘‘laparo-endoscopic single site’’ (LESS) technique for treating tubal or ovarian benign pathology with gonadal preservation. DESIGN: Prospective series. MATERIALS AND METHODS: This study was conducted in a tertiary care referral center. Since September, 2009, 11 patients with ovarian pathologies and one patient with distal tubal cystic lesions were treated using the LESS technique. The LESS technique was performed exclusively through an umbilical incision using a single three-channel port and flexible laparoscopic instrumentation. In each case, a multichannel port was inserted transperitoneally through a 1.5-2 cm umbilical incision.
Vol. 94., No. 4, Supplement, September 2010