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M052 CHARACTERISTICS OF SOLUBLE INTERCELLULAR ADHESION MOLECULE-1 IN THE SERUM OF PATIENTS WITH ENDOMETRIOSIS
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
model (HOMA-IR) was used to assess insulin resistance under basal conditions. Methods: This was a prospective study. Results: Although the body mass index was not statistically different between PCOS and control women, Metabolic Syndrome evaluated by the IDF 2005 consensus was detected in 12.5% of PCOS women. 38.9% % of PCOS patients presented an abdominal circumference ≥80 mm. Our study did not reveal any high triglycerides blood concentration (≥150 mg/dL) neither in women with PCOS nor in control women, although the difference rate of triglycerides between the two groups had been statistically significant (57.12±21.6 vs 48.53±12.87, p < 0.05). Conclusions: Metabolic Syndrome is a common feature in Congolese women affected by PCOS. Further research is required to assess triglycerides levels in Congolese woman. M050 ACTION OF MELATONIN ON THE OVARIAN GENE EXPRESSION OF PINEALECTOMIZED RATS J.M. Soares1 , C.C. Maganhin1 , C. da S. Ferreira1 , L.F. Fuchs Portugal2 , R.S. Sim˜oes2 , M. de J. Sim˜oes3 , E.C. Baracat2 . 1 Gynecology, Federal University of S˜ ao Paulo, S˜ ao Paulo, S˜ ao Paulo, Brazil; 2 University of S˜ ao Paulo, S˜ ao Paulo, S˜ ao Paulo, Brazil; 3 University Federal of S˜ ao Paulo – Morphology and Genetics, S˜ ao Paulo, S˜ ao Paulo, Brazil Objectives: to evaluate the ovarian gene expression after melatonin reposition on the adult female pinealectomized rats. Materials: Thirty pinealectomized female rats (Rattus norvegicus albinus). Methods: The animals were divided into two treatment groups: GI – control that received vehicle (n = 15); GII – experimental that received melatonin reposition (10 mg/animal), during consecutive 60 days. After that, all animal were sacrificed under anesthesia and the ovaries were removed and prepared for RNA extraction and the samples were submitted to cDNA microarray procedure using the Kit GeneChi® Rat Genome 230 2.0 Array of Affymetrix, following the manufacture instructions. The procedures were repeated three times. The results were normalized and confirmed by GeneChi® Operating software (Affymetrix Inc., Santa Clara, CA, USA) and NAChip Analyzer (dChip) software (www.dchip.org). We considered as positive or negative, when the data of experimental group were three times different than control one. Results: 100 and 27 genes of the experimental were up and down regulated, compared to control group, respectively. In relation to steroidogenesis, inhibin beta-A (INHBA), follistatin (FST), gremlin 2, cysteine knot superfamily, homolog (Xenopus laevis) (GREM2) were up regulated and the following gene were down regulated: prostaglandin D2 synthase (brain) (PTGDS), Rab40b, member RAS oncogene family (RAB40B). Conclusions: Our results suggested that melatonin reposition interfered with ovarian gene expression of pinealectomized rats and may influence the expression of genes related to steroidogenesis. M051 QUALITY OF LIFE IN WOMEN WITH ENDOMETRIOSIS F.R. Nunes1 , J.M. Ferreira1 , L.G. Bahamondes1 . 1 Department of Obstetrics and Gynecology – School of Medicine, University of Campinas – UNICAMP, Campinas, S˜ ao Paulo/Campinas, Brazil Objectives: To evaluate the quality of life in women suffering from endometriosis. Materials: A total of 165 women with surgically and histopathologically confirmed endometriosis (endometriosis group – EG) and 200 women without a history of endometriosis and no endometriosisrelated symptoms (control group – CG) were included. In the EG group there were 67 women with minimal (I) or mild (II) stages of endometriosis and 98 with moderate (III) or severe (IV) stages. We excluded women who in the last three months previous to entering in the study were users of psychotropic or illicit drugs.
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Methods: To assess the quality of life it was used the Short Form 36 questionnaire (SF-36), which is divided into 8 subscales: physical functioning, role limitations (physical problems), bodily pain, general health, vitality, social functioning, role limitations (emotional problems), and mental health. Each SF-36 subscale is scored from 0 to 100, with 100 being the best score possible. The study was approved by the IRB and all volunteers signed an informed consent. The Mann-Whitney test was used for the statistical analysis. Results: The average age and body mass index of the groups were 34.5±5.6 years and 25.6±4.4 kg/m2 for EG and 33.1±6.4 years and 25.8±4.4 kg/m2 for CG, respectively. There were significant differences in all SF-36 subscales. The average score for physical function was 87.3±27.6 for CG and 72.9±38.3 for EG (p < 0.001), for role limitations (physical problems) was 95.3±10.3 for CG and 91.8±12.2 for EG (p = 0.001), for bodily pain was 66.9±21.8 for CG and 53.9±21.6 for EG (p < 0.001), general health was 77.9±22.2 for CG and 66.6±25.8 for EG (p < 0.001), vitality was 62.4±21.9 for CG and 56.8±22.1 for EG (p = 0.019), social functioning was 80.8±25.9 for CG and 69.9±28.6 for EG (p < 0.001), role limitations (emotional problems) was 76.3±37.2 for CG and 63.8±42.8 for EG (p = 0.003), and for mental health was 68.7±20.8 for CG and 63.1±20.5 for EG (p = 0.007). Conclusions: The quality of life in women suffering from endometriosis is worse than women without the disease. M052 CHARACTERISTICS OF SOLUBLE INTERCELLULAR ADHESION MOLECULE-1 IN THE SERUM OF PATIENTS WITH ENDOMETRIOSIS W. Lin1 . 1 Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China Objectives: To evaluate the role of soluble intercellular adhesion molecule-1 (sICAM-1) in the development of endometriosis (EM) and to probe its diagnostic value for EM with combined serum detection of CA125 and EMAb. Materials: From 2009 to January 2011, there were 57 cases of admitted EM patients, confirmed by laparoscopy or laparotomy following pathological exanimation. aged 21 to 48 years. Methods: We conducted clinical retrospective analysis for one-year postoperative EM patients and healthy control women by dynamic immunological monitoring sICAM-1 and CA125 and EMAb level. Results: The positive rates of sICAM-1 and CA125 and EMAb in EM patient’s serum were remarkably higher than those of healthy control group, and there was obvious significance (p = 0.006, p = 0.008, p = 0.002). Higher levels of sICAM-1 and CA125 in EM patient’s serum tend to be positively related with clinical stage (r = 0.617, P = 0.001; r = 0.532, P = 0.002). However, positive rate of EMAb was not related with clinical stage, and there was no statistical significance (r = 0.246, P = 0.076). Compared with preoperative levels, sICAM-1 and CA125 and EMAb in one-month postoperative EM patient’s serum kept unchanged, and there was no statistical significance (p = 0.061, p = 0.341, p = 0.733). In threemonth postoperative patient’s serum, sICAM-1and CA125and EMAb showed lower levels, there was remarkable statistical significance (p = 0.002, p = 0.030). Conversely, there was no significance for lower EMAb level, compared with preoperative status (p = 0.276). sICAM-1 and CA125and EMAb levels in six-month and one-year postoperative stage approached healthy controls. The sensitivity rates in diagnosing EM in serum sICAM-1, CA125 and EMAb were respectively 78.95%, 66.67% and 63.15%. The specificity rates in sICAM-1, CA125 and EMAb were respectively 83.33%, 80.00% and 83.33%. Sensitivity and specificity rates in diagnosing EM among combined detection were 60.87% and 100%. Conclusions: sICAM-1 level in EM patient’s serum was remarkably higher than healthy control level, and sICAM-1 level tend to be positively related with clinical stage. sICAM-1 may participate in development and pathological progress of endometriosis. After
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Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
three-month of surgical and drug treatment, sICAM-1and CA125 remained lower levels, and approached health status. Postoperative monitoring of sICAM-1 and CA125 level play a key role in treating and prognosticating EM. Immunological detection of sICAM-1 and CA125 level in patient’s serum is a feasible method, and it has a potential diagnostic value for EM. M053 EVIDENCE-BASED THERAPY FOR INFERTILITY ASSOCIATED WITH EARLY STAGE ENDOMETRIOSIS M.S. Gad1 , M.H.H. Badroui2 . 1 Obstetrics & Gynecology, Faculty of Medicine, El-Menoufia University, Shbeenelkoom, Egypt, 2. Obstetrics & Gynecology, Al-Azhar University, Egypt Objectives: To demonstrate the usefulness of evidence based therapy in the management of infertile women with minimal or mild endometriosis. Setting: Gynecology Endoscopic Units in El Menoufia University Hospital and Infertility clinic at a private hospital. Design: A randomized prospective clinical trial. The study included 41 infertile women with laparoscopically confirmed endometriosis, stage I or II of the revised AFS classification. Twenty women were randomly allocated to resection or ablation of visible endometriosis during laparoscopy (Group I), and Twenty-one Women to diagnostic laparoscopy only (Group II). The base line distribution of subjects was similar in the two groups. Follow-up data were collected for 18 months after laparoscopy or up to 20 weeks of pregnancy. If pregnancy did not occur within 18 months of randomization in both groups, 3 cycles of superovulation with intrauterine insemination (IUI) were done as a co-treatment. Methods: Twenty women were randomly allocated to resection or ablation of visible endometriosis during laparoscopy (Group I), and Twenty-one Women to diagnostic laparoscopy only (Group II). The base line distribution of subjects was similar in the two groups. Follow-up data were collected for 18 months after laparoscopy or up to 20 weeks of pregnancy. If pregnancy did not occur within 18 months of randomization in both groups, 3 cycles of superovulation with intrauterine insemination (IUI) were done as a co-treatment. Results: By the end of the study, a total of 19/41 women (46.3%) conceived and no abortion occurred. Pregnancies occurred in 7/25 women (28%) in-group I and in 5/21 women (23.8%) in-group II by the end of 18 months follow up. The 3 cycles of superovulation and IUI resulted in an additional 9 pregnancies in both groups, 5/13 in group I (38.5%) and 4/11 in-group II (36.4%). Conclusions: – Therapy for endometriosis associated infertility is currently in transition from experience-oriented practice to an evidence based one. RCTs are considered the “gold standard” for judging whether a new intervention does more good than harm. – Compared with laparoscopy alone, resection or ablation of early stage endometriosis increases the likelihood of pregnancy in infertile women. – As superior results occurred from superovulation and IUI, it should be the initial therapy or at least a co-treatment for laparoscopic surgery in women with early stage endometriosis that does not involve oviducts. M054 PROGESTOGEN-ONLY CONTRACEPTIVE PILL COMPARED WITH COMBINED ORAL CONTRACEPTIVE IN THE TREATMENT OF PAIN SYMPTOMS CAUSED BY ENDOMETRIOSIS IN PATIENTS WITH MIGRAINE WITHOUT AURA M. Morotti1 , E. Buccelli1 , R. Valentino1 , P.L. Venturini1 , S. Ferrero1 . 1 Obstetric and Gynecology, University of Genoa, Genoa, Italy Objectives: The aim of the study is to compare the efficacy of progestogen-only contraceptive pill and combined oral contraceptives (COCs) in treating endometriosis-related pain symptoms in patients with migraine without aura.
Materials: This prospective patients preference trial included 59 patients with pain symptoms caused by rectovaginal endometriosis and migraine without aura. Methods: Subjects of the study received either desogestrel pill (P) or COC for six months. Results: Three women in group P (10.3%, 3/29) and 9 women in group COC (30.0%, 9/30) withdrew because of adverse effects (p = 0.121). When compared with baseline values, the intensity of chronic pelvic pain and dyspareunia were significantly decreased at 6-month treatment both in group P (p = 0.001) and in group COC (p = 0.001). At 6-month treatment, the number of migraine attacks was significantly lower in comparison with baseline in the group P (p = 0.001), while it was not reduced in the group COC (p = 0.523). Duration of headache pain and pain intensity did not significantly differ between baseline and 6-month treatment in the study two groups. 61.5% (16/26) of the women in group P were satisfied or very satisfied after 6 months of treatment compared with 42.8% (9/21) in group COC (p = 0.326). Conclusions: When pregnancy is not desired, COC or P treatment may be administered to symptomatic patients with rectovaginal endometriosis and migraine without aura. Both the drugs efficaciously relieve endometriosis-related pain symptoms, however P is better tolerated than COC. This study supports the use of the progestogen-only contraceptive pill in women with rectovaginal endometriosis and coexisting migraine without aura. M055 PERTUBATION WITH LIGNOCAINE AS A NEW TREATMENT OF DYSMENORRHEA DUE TO ENDOMETRIOSIS: A RANDOMISED CONTROLLED TRIAL K. Wickstrom1 , G. Edelstam1 . 1 Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden Objectives: Endometriosis is a chronic inflammatory disease of unknown aetiology that can cause severe dysmenorrhea. Lignocaine has anti-inflammatory properties and exerts effect on nerve endings and intra-peritoneal macrophages. In fertility therapy, lignocaine has increased the pregnancy rate when pertubated pre-ovulatorily (Edelstam et al., 2008). An unexpected positive side effect of this fertility treatment in patients with endometriosis was reduced dysmenorrhea spontaneously reported by the patients who did not achieve pregnancy (Edelstam et al., 2001). The objective of the present study was to further evaluate the effect of pertubation with Ringer-Lignocaine on dysmenorrhea in women with endometriosis. Materials: A double-blind randomised controlled trial was carried out at three sites in Stockholm, Sweden. Eligible patients had endometriosis as diagnosed by laparoscopy, dysmenorrhoic pain > VAS 50 mm (visual analogue scale) and patent Fallopian tubes. The study patients were randomised sequentially to preovulatorily pertubations with placebo (n = 18) or study treatment (n = 24) during three consecutive menstrual cycles. The pertubation procedure comprised passing study solution through the uterine cavity and the Fallopian tubes via an intra cervical balloon catheter. Methods: The effect on pain was evaluated with VAS scales before and after the treatments and up to nine menstrual cycles after the last pertubation. Success was defined as a reduction of ≥50% on the VAS scale after the third perturbation. The success rate between the treatment and the placebo group was compared with Fisher’s exact test. Results: In the Intention To Treat analysis, the success rate was 41.7% (10 of 24) in the treatment group compared to 16.7% (3 of 18) in the placebo group (p = 0.10, 95% CI −7.26 to 36.2%). In the Per Protocol analysis, the proportion of subjects with success in the treatment group was 45% (9 of 20) compared to 7.1% (1 of 14) in the placebo group (p = 0.024, 95% CI −2.61 to 44.8%). Of the nine patients in the lignocaine group that fulfilled the criteria for success after three pertubations, four (44%) had an effect persisting after nine months. The treatments were well tolerated.
model (HOMA-IR) was used to assess insulin resistance under basal conditions. Methods: This was a prospective study. Results: Although the body mass index was not statistically different between PCOS and control women, Metabolic Syndrome evaluated by the IDF 2005 consensus was detected in 12.5% of PCOS women. 38.9% % of PCOS patients presented an abdominal circumference ≥80 mm. Our study did not reveal any high triglycerides blood concentration (≥150 mg/dL) neither in women with PCOS nor in control women, although the difference rate of triglycerides between the two groups had been statistically significant (57.12±21.6 vs 48.53±12.87, p < 0.05). Conclusions: Metabolic Syndrome is a common feature in Congolese women affected by PCOS. Further research is required to assess triglycerides levels in Congolese woman. M050 ACTION OF MELATONIN ON THE OVARIAN GENE EXPRESSION OF PINEALECTOMIZED RATS J.M. Soares1 , C.C. Maganhin1 , C. da S. Ferreira1 , L.F. Fuchs Portugal2 , R.S. Sim˜oes2 , M. de J. Sim˜oes3 , E.C. Baracat2 . 1 Gynecology, Federal University of S˜ ao Paulo, S˜ ao Paulo, S˜ ao Paulo, Brazil; 2 University of S˜ ao Paulo, S˜ ao Paulo, S˜ ao Paulo, Brazil; 3 University Federal of S˜ ao Paulo – Morphology and Genetics, S˜ ao Paulo, S˜ ao Paulo, Brazil Objectives: to evaluate the ovarian gene expression after melatonin reposition on the adult female pinealectomized rats. Materials: Thirty pinealectomized female rats (Rattus norvegicus albinus). Methods: The animals were divided into two treatment groups: GI – control that received vehicle (n = 15); GII – experimental that received melatonin reposition (10 mg/animal), during consecutive 60 days. After that, all animal were sacrificed under anesthesia and the ovaries were removed and prepared for RNA extraction and the samples were submitted to cDNA microarray procedure using the Kit GeneChi® Rat Genome 230 2.0 Array of Affymetrix, following the manufacture instructions. The procedures were repeated three times. The results were normalized and confirmed by GeneChi® Operating software (Affymetrix Inc., Santa Clara, CA, USA) and NAChip Analyzer (dChip) software (www.dchip.org). We considered as positive or negative, when the data of experimental group were three times different than control one. Results: 100 and 27 genes of the experimental were up and down regulated, compared to control group, respectively. In relation to steroidogenesis, inhibin beta-A (INHBA), follistatin (FST), gremlin 2, cysteine knot superfamily, homolog (Xenopus laevis) (GREM2) were up regulated and the following gene were down regulated: prostaglandin D2 synthase (brain) (PTGDS), Rab40b, member RAS oncogene family (RAB40B). Conclusions: Our results suggested that melatonin reposition interfered with ovarian gene expression of pinealectomized rats and may influence the expression of genes related to steroidogenesis. M051 QUALITY OF LIFE IN WOMEN WITH ENDOMETRIOSIS F.R. Nunes1 , J.M. Ferreira1 , L.G. Bahamondes1 . 1 Department of Obstetrics and Gynecology – School of Medicine, University of Campinas – UNICAMP, Campinas, S˜ ao Paulo/Campinas, Brazil Objectives: To evaluate the quality of life in women suffering from endometriosis. Materials: A total of 165 women with surgically and histopathologically confirmed endometriosis (endometriosis group – EG) and 200 women without a history of endometriosis and no endometriosisrelated symptoms (control group – CG) were included. In the EG group there were 67 women with minimal (I) or mild (II) stages of endometriosis and 98 with moderate (III) or severe (IV) stages. We excluded women who in the last three months previous to entering in the study were users of psychotropic or illicit drugs.
S547
Methods: To assess the quality of life it was used the Short Form 36 questionnaire (SF-36), which is divided into 8 subscales: physical functioning, role limitations (physical problems), bodily pain, general health, vitality, social functioning, role limitations (emotional problems), and mental health. Each SF-36 subscale is scored from 0 to 100, with 100 being the best score possible. The study was approved by the IRB and all volunteers signed an informed consent. The Mann-Whitney test was used for the statistical analysis. Results: The average age and body mass index of the groups were 34.5±5.6 years and 25.6±4.4 kg/m2 for EG and 33.1±6.4 years and 25.8±4.4 kg/m2 for CG, respectively. There were significant differences in all SF-36 subscales. The average score for physical function was 87.3±27.6 for CG and 72.9±38.3 for EG (p < 0.001), for role limitations (physical problems) was 95.3±10.3 for CG and 91.8±12.2 for EG (p = 0.001), for bodily pain was 66.9±21.8 for CG and 53.9±21.6 for EG (p < 0.001), general health was 77.9±22.2 for CG and 66.6±25.8 for EG (p < 0.001), vitality was 62.4±21.9 for CG and 56.8±22.1 for EG (p = 0.019), social functioning was 80.8±25.9 for CG and 69.9±28.6 for EG (p < 0.001), role limitations (emotional problems) was 76.3±37.2 for CG and 63.8±42.8 for EG (p = 0.003), and for mental health was 68.7±20.8 for CG and 63.1±20.5 for EG (p = 0.007). Conclusions: The quality of life in women suffering from endometriosis is worse than women without the disease. M052 CHARACTERISTICS OF SOLUBLE INTERCELLULAR ADHESION MOLECULE-1 IN THE SERUM OF PATIENTS WITH ENDOMETRIOSIS W. Lin1 . 1 Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China Objectives: To evaluate the role of soluble intercellular adhesion molecule-1 (sICAM-1) in the development of endometriosis (EM) and to probe its diagnostic value for EM with combined serum detection of CA125 and EMAb. Materials: From 2009 to January 2011, there were 57 cases of admitted EM patients, confirmed by laparoscopy or laparotomy following pathological exanimation. aged 21 to 48 years. Methods: We conducted clinical retrospective analysis for one-year postoperative EM patients and healthy control women by dynamic immunological monitoring sICAM-1 and CA125 and EMAb level. Results: The positive rates of sICAM-1 and CA125 and EMAb in EM patient’s serum were remarkably higher than those of healthy control group, and there was obvious significance (p = 0.006, p = 0.008, p = 0.002). Higher levels of sICAM-1 and CA125 in EM patient’s serum tend to be positively related with clinical stage (r = 0.617, P = 0.001; r = 0.532, P = 0.002). However, positive rate of EMAb was not related with clinical stage, and there was no statistical significance (r = 0.246, P = 0.076). Compared with preoperative levels, sICAM-1 and CA125 and EMAb in one-month postoperative EM patient’s serum kept unchanged, and there was no statistical significance (p = 0.061, p = 0.341, p = 0.733). In threemonth postoperative patient’s serum, sICAM-1and CA125and EMAb showed lower levels, there was remarkable statistical significance (p = 0.002, p = 0.030). Conversely, there was no significance for lower EMAb level, compared with preoperative status (p = 0.276). sICAM-1 and CA125and EMAb levels in six-month and one-year postoperative stage approached healthy controls. The sensitivity rates in diagnosing EM in serum sICAM-1, CA125 and EMAb were respectively 78.95%, 66.67% and 63.15%. The specificity rates in sICAM-1, CA125 and EMAb were respectively 83.33%, 80.00% and 83.33%. Sensitivity and specificity rates in diagnosing EM among combined detection were 60.87% and 100%. Conclusions: sICAM-1 level in EM patient’s serum was remarkably higher than healthy control level, and sICAM-1 level tend to be positively related with clinical stage. sICAM-1 may participate in development and pathological progress of endometriosis. After
S548
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
three-month of surgical and drug treatment, sICAM-1and CA125 remained lower levels, and approached health status. Postoperative monitoring of sICAM-1 and CA125 level play a key role in treating and prognosticating EM. Immunological detection of sICAM-1 and CA125 level in patient’s serum is a feasible method, and it has a potential diagnostic value for EM. M053 EVIDENCE-BASED THERAPY FOR INFERTILITY ASSOCIATED WITH EARLY STAGE ENDOMETRIOSIS M.S. Gad1 , M.H.H. Badroui2 . 1 Obstetrics & Gynecology, Faculty of Medicine, El-Menoufia University, Shbeenelkoom, Egypt, 2. Obstetrics & Gynecology, Al-Azhar University, Egypt Objectives: To demonstrate the usefulness of evidence based therapy in the management of infertile women with minimal or mild endometriosis. Setting: Gynecology Endoscopic Units in El Menoufia University Hospital and Infertility clinic at a private hospital. Design: A randomized prospective clinical trial. The study included 41 infertile women with laparoscopically confirmed endometriosis, stage I or II of the revised AFS classification. Twenty women were randomly allocated to resection or ablation of visible endometriosis during laparoscopy (Group I), and Twenty-one Women to diagnostic laparoscopy only (Group II). The base line distribution of subjects was similar in the two groups. Follow-up data were collected for 18 months after laparoscopy or up to 20 weeks of pregnancy. If pregnancy did not occur within 18 months of randomization in both groups, 3 cycles of superovulation with intrauterine insemination (IUI) were done as a co-treatment. Methods: Twenty women were randomly allocated to resection or ablation of visible endometriosis during laparoscopy (Group I), and Twenty-one Women to diagnostic laparoscopy only (Group II). The base line distribution of subjects was similar in the two groups. Follow-up data were collected for 18 months after laparoscopy or up to 20 weeks of pregnancy. If pregnancy did not occur within 18 months of randomization in both groups, 3 cycles of superovulation with intrauterine insemination (IUI) were done as a co-treatment. Results: By the end of the study, a total of 19/41 women (46.3%) conceived and no abortion occurred. Pregnancies occurred in 7/25 women (28%) in-group I and in 5/21 women (23.8%) in-group II by the end of 18 months follow up. The 3 cycles of superovulation and IUI resulted in an additional 9 pregnancies in both groups, 5/13 in group I (38.5%) and 4/11 in-group II (36.4%). Conclusions: – Therapy for endometriosis associated infertility is currently in transition from experience-oriented practice to an evidence based one. RCTs are considered the “gold standard” for judging whether a new intervention does more good than harm. – Compared with laparoscopy alone, resection or ablation of early stage endometriosis increases the likelihood of pregnancy in infertile women. – As superior results occurred from superovulation and IUI, it should be the initial therapy or at least a co-treatment for laparoscopic surgery in women with early stage endometriosis that does not involve oviducts. M054 PROGESTOGEN-ONLY CONTRACEPTIVE PILL COMPARED WITH COMBINED ORAL CONTRACEPTIVE IN THE TREATMENT OF PAIN SYMPTOMS CAUSED BY ENDOMETRIOSIS IN PATIENTS WITH MIGRAINE WITHOUT AURA M. Morotti1 , E. Buccelli1 , R. Valentino1 , P.L. Venturini1 , S. Ferrero1 . 1 Obstetric and Gynecology, University of Genoa, Genoa, Italy Objectives: The aim of the study is to compare the efficacy of progestogen-only contraceptive pill and combined oral contraceptives (COCs) in treating endometriosis-related pain symptoms in patients with migraine without aura.
Materials: This prospective patients preference trial included 59 patients with pain symptoms caused by rectovaginal endometriosis and migraine without aura. Methods: Subjects of the study received either desogestrel pill (P) or COC for six months. Results: Three women in group P (10.3%, 3/29) and 9 women in group COC (30.0%, 9/30) withdrew because of adverse effects (p = 0.121). When compared with baseline values, the intensity of chronic pelvic pain and dyspareunia were significantly decreased at 6-month treatment both in group P (p = 0.001) and in group COC (p = 0.001). At 6-month treatment, the number of migraine attacks was significantly lower in comparison with baseline in the group P (p = 0.001), while it was not reduced in the group COC (p = 0.523). Duration of headache pain and pain intensity did not significantly differ between baseline and 6-month treatment in the study two groups. 61.5% (16/26) of the women in group P were satisfied or very satisfied after 6 months of treatment compared with 42.8% (9/21) in group COC (p = 0.326). Conclusions: When pregnancy is not desired, COC or P treatment may be administered to symptomatic patients with rectovaginal endometriosis and migraine without aura. Both the drugs efficaciously relieve endometriosis-related pain symptoms, however P is better tolerated than COC. This study supports the use of the progestogen-only contraceptive pill in women with rectovaginal endometriosis and coexisting migraine without aura. M055 PERTUBATION WITH LIGNOCAINE AS A NEW TREATMENT OF DYSMENORRHEA DUE TO ENDOMETRIOSIS: A RANDOMISED CONTROLLED TRIAL K. Wickstrom1 , G. Edelstam1 . 1 Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden Objectives: Endometriosis is a chronic inflammatory disease of unknown aetiology that can cause severe dysmenorrhea. Lignocaine has anti-inflammatory properties and exerts effect on nerve endings and intra-peritoneal macrophages. In fertility therapy, lignocaine has increased the pregnancy rate when pertubated pre-ovulatorily (Edelstam et al., 2008). An unexpected positive side effect of this fertility treatment in patients with endometriosis was reduced dysmenorrhea spontaneously reported by the patients who did not achieve pregnancy (Edelstam et al., 2001). The objective of the present study was to further evaluate the effect of pertubation with Ringer-Lignocaine on dysmenorrhea in women with endometriosis. Materials: A double-blind randomised controlled trial was carried out at three sites in Stockholm, Sweden. Eligible patients had endometriosis as diagnosed by laparoscopy, dysmenorrhoic pain > VAS 50 mm (visual analogue scale) and patent Fallopian tubes. The study patients were randomised sequentially to preovulatorily pertubations with placebo (n = 18) or study treatment (n = 24) during three consecutive menstrual cycles. The pertubation procedure comprised passing study solution through the uterine cavity and the Fallopian tubes via an intra cervical balloon catheter. Methods: The effect on pain was evaluated with VAS scales before and after the treatments and up to nine menstrual cycles after the last pertubation. Success was defined as a reduction of ≥50% on the VAS scale after the third perturbation. The success rate between the treatment and the placebo group was compared with Fisher’s exact test. Results: In the Intention To Treat analysis, the success rate was 41.7% (10 of 24) in the treatment group compared to 16.7% (3 of 18) in the placebo group (p = 0.10, 95% CI −7.26 to 36.2%). In the Per Protocol analysis, the proportion of subjects with success in the treatment group was 45% (9 of 20) compared to 7.1% (1 of 14) in the placebo group (p = 0.024, 95% CI −2.61 to 44.8%). Of the nine patients in the lignocaine group that fulfilled the criteria for success after three pertubations, four (44%) had an effect persisting after nine months. The treatments were well tolerated.