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Laparoscopic ovarian cystectomy and coagulation in bilateral endometriomas in same patients
62% became pregnant following the procedure, and there was a 74% live birth rate. This correlates to our earlier study of 30 patients where 96% had return to normal menses, and 53% were able to conceive after treatment (Thomson A. et al. Fert Stert 2007;87: 405-410). There were no complications from the procedure. CONCLUSIONS: Hysteroscopic synechiolysis under image-intensifier control appears to be a safe and effective treatment for Asherman’s syndrome. Supported by: None.
FEMALE REPRODUCTIVE SURGERY P-167 MANAGEMENT AFTER HYSTEROSCOPIC METROPLASTY: WITH OR WITHOUT INTRAUTERINE DEVICE (IUD) INSERTION AND ESTROGEN ADMINISTRATION. E. A. Tonguc, T. Var, N. Yilmaz, S. Batioglu. Reproductive Endocrinology, Zekai Tahir Burak Women’s Health Hospital, Ankara, Turkey. OBJECTIVE: To investigate effects of intrauterine device (IUD) and estrogen, both separately and in combination after hysteroscopic metroplasty. DESIGN: Prospective randomized controlled study. MATERIALS AND METHODS: A hundred patients who were diagnosed with a uterine septum at the Department of Reproductive Endocrinology in our hospital, enrolled in this study were assigned into four groups. Patients in Group I did not receive any treatment, while those in Group II were treated with cyclical hormone replacement therapy (HRT). Patients in Group III had an IUD inserted, while those in Group IV had IUD inserted combined with HRT. All patients were re-evaluated for uterine cavity adhesions by office hysteroscopy. All new pregnancies occurring during this period were recorded. RESULTS: Intrauterine adhesion development rates for the untreated, IUD þ HRT and the IUD groups were 5.3%, 12% and 10.5%, respectively. None of the patients in the HRT group had any intrauterine adhesions. There was no statistically significant difference between the groups in terms of intrauterine adhesions. The difference between groups regarding ongoing pregnancies was statistically not significant. CONCLUSIONS: This study demonstrated any added benefit of postoperative IUD and/or HRT use in the prevention of intrauterine adhesions or ongoing pregnancies after hysteroscopic metroplasty. Supported by: None.
P-168 WITHDRAWN
eighteen (40%) healthy infants were delivered at term with a mean birth weight 3330 þ 377 g. Nine additional pregnancies (20%) are on-going. Twelve first trimester spontaneous abortions (27%) and six induced abortions (13%) occurred in thirteen women. Of the eighteen women who already delivered, eleven (60%) had vaginal deliveries. Four significant postpartum complications occurred, two after vaginal delivery one case each of uterine revision and endometritis and two following cesarean section, a severe postpartum hemorrhage and ARDS following intraoperative myomectomy and a neonatal lung collapse. CONCLUSIONS: This first report on reproductive outcomes following MRgFUS demonstrates that women who undergo MRgFUS treatment for clinically significant uterine fibroids can achieve successful pregnancies and deliver healthy babies at term. Future studies will further examine the role and the long-term safety of MRgFUS. These results suggest that the self-imposed initial limitation on MRgFUS for women who plan future pregnancies should be reevaluated. Supported by: Some of the women included in this study underwent MRgFUS as part of clinical studies Supported by Insightec Co. (Haifa, Israel).
P-170 LAPAROSCOPIC OVARIAN CYSTECTOMY AND COAGULATION IN BILATERAL ENDOMETRIOMAS IN SAME PATIENTS. S. Batioglu, T. Var, E. A. Tonguc, I. Kahyaoglu. Reproductive Endocrinology, Zekai Tahir Burak Women’s Health Hospital, Ankara, Turkey. OBJECTIVE: To compare the extent of damage on ovarian tissue inflicted by laparoscopic ovarian cystectomy and bipolar cauterization in patients with bilateral endometriomas without surgeon and patients variability. DESIGN: Clinical prospective study. MATERIALS AND METHODS: Baseline number of follicles of 48 patients with bilateral endometriomas was determined by transvaginal ultrasonography, before they underwent surgery. The patients then had both cauterization and cystectomy performed on either side for their endometriomas. Transvaginal ultrasonography was repeated post operatively, and both the number of follicles and ovarian volumes were recorded. RESULTS: A decrease in baseline follicle numbers was observed after both procedures. While the baseline follicle number was 5.581.13 before cystectomy, after the procedure this number fell to 3.671.26 (p¼0.001). Similarly, the number of baseline follicles fell from 5.420.77 to 4.750.60 after cauterization (p¼0.02). When the post procedure follicle numbers for both procedures were taken into consideration, a significantly greater decrease in follicle numbers was found to have occurred after cystectomy when compared to cauterization (p¼0.001). Post-procedure ovarian volumes were 6.271.95 and 9.87 2.01 after cystectomy and cauterization, respectively (p¼0.001). All p-values were statistically significant. CONCLUSIONS: Although both procedures resulted in significant decreases in baseline follicle numbers, the decrease in both baseline follicle numbers and ovarian volume was more extensive with cystectomy than after cauterization. Supported by: None.
P-169 PREGNANCIES AND DELIVERIES AFTER MR-GUIDED FOCUSED ULTRASOUND SURGERY (MRGFUS) FOR THE CONSERVATIVE TREATMENT OF SYMPTOMATIC UTERINE FIBROIDS. FOR THE MRGFUS STUDY GROUP. J. Rabinovici, E. E. Stewart. Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel; Obstetrics and Gynecology, Mayo Clinic, Rochester, MN. OBJECTIVE: Uterine fibroids can impair fertility and pregnancy outcome. Currently, myomectomy is the treatment of choice for clinically significant uterine fibroids for women who desire fertility. MR-guided focused ultrasound surgery (MRgFUS) is a method for the conservative non-invasive treatment of clinically significant uterine fibroids. The aim of the current study was to characterize pregnancies that occurred after MRgFUS treatment. DESIGN: Prospective follow-up of all reported pregnancies. MATERIALS AND METHODS: We report all known pregnancies following MRgFUS for uterine fibroids to centers world-wide. Each center contacted the relevant patient and obtained information about her pregnancy course, delivery and complications. RESULTS: Forty-five pregnancies occurred in 42 subjects (mean age: 37 þ 4.6 years, time to conception: 0 to 30 months after MRgFUS). to date,
FERTILITY & STERILITYÒ
P-171 LAPAROSCOPY WITH EXTENSIVE EXCISION OF DEEP INFILTRATIVE ENDOMETRIOSIS BEFORE IN VITRO FERTILIZATION SIGNIFICANTLY INCREASES THE LIKELIHOOD OF PREGNANCY. P. H. M. Bianchi, P. C. Serafini, E. L. A. Motta, T. S. Domingues, A. M. Rocha, R. M. A. Pereira. Department of Gynecology, Faculdade de Medicina - Universidade de Sa˜o, Sa˜o Paulo, Brazil; Huntington Medicina Reprodutiva, Sa˜o Paulo, Brazil. OBJECTIVE: To compare the outcomes of IVF/ICSI treatment in women with deep infiltrative endometriosis (DIE) before and after radical laparoscopy (RLSC) with extensive excision of DIE. DESIGN: Patient self-randomized prospective study. MATERIALS AND METHODS: One hundred and seventy nine infertile women (% 38 yo) with symptoms and/or signs of endometriosis underwent transvaginal sonography (TVS) after bowel preparation as part of the DIE screening, since this technique has an overall accuracy R85%. Thorough counseling was carried out in 2 comprehensive visits to all women with TVS and offered 2 treatment options: group A – IVF/ICSI or group
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FEMALE REPRODUCTIVE SURGERY P-167 MANAGEMENT AFTER HYSTEROSCOPIC METROPLASTY: WITH OR WITHOUT INTRAUTERINE DEVICE (IUD) INSERTION AND ESTROGEN ADMINISTRATION. E. A. Tonguc, T. Var, N. Yilmaz, S. Batioglu. Reproductive Endocrinology, Zekai Tahir Burak Women’s Health Hospital, Ankara, Turkey. OBJECTIVE: To investigate effects of intrauterine device (IUD) and estrogen, both separately and in combination after hysteroscopic metroplasty. DESIGN: Prospective randomized controlled study. MATERIALS AND METHODS: A hundred patients who were diagnosed with a uterine septum at the Department of Reproductive Endocrinology in our hospital, enrolled in this study were assigned into four groups. Patients in Group I did not receive any treatment, while those in Group II were treated with cyclical hormone replacement therapy (HRT). Patients in Group III had an IUD inserted, while those in Group IV had IUD inserted combined with HRT. All patients were re-evaluated for uterine cavity adhesions by office hysteroscopy. All new pregnancies occurring during this period were recorded. RESULTS: Intrauterine adhesion development rates for the untreated, IUD þ HRT and the IUD groups were 5.3%, 12% and 10.5%, respectively. None of the patients in the HRT group had any intrauterine adhesions. There was no statistically significant difference between the groups in terms of intrauterine adhesions. The difference between groups regarding ongoing pregnancies was statistically not significant. CONCLUSIONS: This study demonstrated any added benefit of postoperative IUD and/or HRT use in the prevention of intrauterine adhesions or ongoing pregnancies after hysteroscopic metroplasty. Supported by: None.
P-168 WITHDRAWN
eighteen (40%) healthy infants were delivered at term with a mean birth weight 3330 þ 377 g. Nine additional pregnancies (20%) are on-going. Twelve first trimester spontaneous abortions (27%) and six induced abortions (13%) occurred in thirteen women. Of the eighteen women who already delivered, eleven (60%) had vaginal deliveries. Four significant postpartum complications occurred, two after vaginal delivery one case each of uterine revision and endometritis and two following cesarean section, a severe postpartum hemorrhage and ARDS following intraoperative myomectomy and a neonatal lung collapse. CONCLUSIONS: This first report on reproductive outcomes following MRgFUS demonstrates that women who undergo MRgFUS treatment for clinically significant uterine fibroids can achieve successful pregnancies and deliver healthy babies at term. Future studies will further examine the role and the long-term safety of MRgFUS. These results suggest that the self-imposed initial limitation on MRgFUS for women who plan future pregnancies should be reevaluated. Supported by: Some of the women included in this study underwent MRgFUS as part of clinical studies Supported by Insightec Co. (Haifa, Israel).
P-170 LAPAROSCOPIC OVARIAN CYSTECTOMY AND COAGULATION IN BILATERAL ENDOMETRIOMAS IN SAME PATIENTS. S. Batioglu, T. Var, E. A. Tonguc, I. Kahyaoglu. Reproductive Endocrinology, Zekai Tahir Burak Women’s Health Hospital, Ankara, Turkey. OBJECTIVE: To compare the extent of damage on ovarian tissue inflicted by laparoscopic ovarian cystectomy and bipolar cauterization in patients with bilateral endometriomas without surgeon and patients variability. DESIGN: Clinical prospective study. MATERIALS AND METHODS: Baseline number of follicles of 48 patients with bilateral endometriomas was determined by transvaginal ultrasonography, before they underwent surgery. The patients then had both cauterization and cystectomy performed on either side for their endometriomas. Transvaginal ultrasonography was repeated post operatively, and both the number of follicles and ovarian volumes were recorded. RESULTS: A decrease in baseline follicle numbers was observed after both procedures. While the baseline follicle number was 5.581.13 before cystectomy, after the procedure this number fell to 3.671.26 (p¼0.001). Similarly, the number of baseline follicles fell from 5.420.77 to 4.750.60 after cauterization (p¼0.02). When the post procedure follicle numbers for both procedures were taken into consideration, a significantly greater decrease in follicle numbers was found to have occurred after cystectomy when compared to cauterization (p¼0.001). Post-procedure ovarian volumes were 6.271.95 and 9.87 2.01 after cystectomy and cauterization, respectively (p¼0.001). All p-values were statistically significant. CONCLUSIONS: Although both procedures resulted in significant decreases in baseline follicle numbers, the decrease in both baseline follicle numbers and ovarian volume was more extensive with cystectomy than after cauterization. Supported by: None.
P-169 PREGNANCIES AND DELIVERIES AFTER MR-GUIDED FOCUSED ULTRASOUND SURGERY (MRGFUS) FOR THE CONSERVATIVE TREATMENT OF SYMPTOMATIC UTERINE FIBROIDS. FOR THE MRGFUS STUDY GROUP. J. Rabinovici, E. E. Stewart. Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel; Obstetrics and Gynecology, Mayo Clinic, Rochester, MN. OBJECTIVE: Uterine fibroids can impair fertility and pregnancy outcome. Currently, myomectomy is the treatment of choice for clinically significant uterine fibroids for women who desire fertility. MR-guided focused ultrasound surgery (MRgFUS) is a method for the conservative non-invasive treatment of clinically significant uterine fibroids. The aim of the current study was to characterize pregnancies that occurred after MRgFUS treatment. DESIGN: Prospective follow-up of all reported pregnancies. MATERIALS AND METHODS: We report all known pregnancies following MRgFUS for uterine fibroids to centers world-wide. Each center contacted the relevant patient and obtained information about her pregnancy course, delivery and complications. RESULTS: Forty-five pregnancies occurred in 42 subjects (mean age: 37 þ 4.6 years, time to conception: 0 to 30 months after MRgFUS). to date,
FERTILITY & STERILITYÒ
P-171 LAPAROSCOPY WITH EXTENSIVE EXCISION OF DEEP INFILTRATIVE ENDOMETRIOSIS BEFORE IN VITRO FERTILIZATION SIGNIFICANTLY INCREASES THE LIKELIHOOD OF PREGNANCY. P. H. M. Bianchi, P. C. Serafini, E. L. A. Motta, T. S. Domingues, A. M. Rocha, R. M. A. Pereira. Department of Gynecology, Faculdade de Medicina - Universidade de Sa˜o, Sa˜o Paulo, Brazil; Huntington Medicina Reprodutiva, Sa˜o Paulo, Brazil. OBJECTIVE: To compare the outcomes of IVF/ICSI treatment in women with deep infiltrative endometriosis (DIE) before and after radical laparoscopy (RLSC) with extensive excision of DIE. DESIGN: Patient self-randomized prospective study. MATERIALS AND METHODS: One hundred and seventy nine infertile women (% 38 yo) with symptoms and/or signs of endometriosis underwent transvaginal sonography (TVS) after bowel preparation as part of the DIE screening, since this technique has an overall accuracy R85%. Thorough counseling was carried out in 2 comprehensive visits to all women with TVS and offered 2 treatment options: group A – IVF/ICSI or group
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