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Methotrexate Success Rates in Progressing Ectopic Pregnancies: A Reappraisal
S78
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S45–S90
Conclusion: Laparoscopy is the treatment of choice in infertile women with endometriosis. Patient’s age, time after laparoscopy and the presence of preoperative pain are prognostic factors. Tubal surgery significantly increases the postoperative pregnancy rate. Peak incidence of pregnancies occurred within 6 months from surgery. 263
Open Communications 13 - Reproduction (2:21 PM - 2:26 PM)
Fertiloscopic Ovarian Drilling in PCOS Patient: A 280 Cases Serie Watrelot AA, Chauvin G. H^opital Natecia, Lyon, Rhone, France Study Objective: To evaluate the interest of fertiloscopic ovarian drilling in Infertile Polycystic ovarian syndrom(PCOS) patients. Design: Ovarian drilling was performed prospectively in infertile patients presenting PCOS according to Rotteredam criteria. Setting: Ovarian drilling was proposed as a second line treatment after failure of Clomiphene citrate. All patients were treated in a private IVF and Reproductive surgery center in France. Patients: between 2005 and 2013, 280 patients were enrolled in this study . All patients have a PCOS syndrome and an history of infertility of at least one year. All patients were primary infertility aged between 23 and 35. Intervention: ovarian drilling was performed trough fertiloscopy.We have previously described Fertiloscopy as a combination of hydropelviscopy,dye test, salpingoscopy and hysteroscopy performed in the same time for pelvic evaluation in infertile women. Fertiloscopy is usually performed in an ambulatory setting and often practiced under local anesthesia. Due to the ovarian drilling, all procedures were performed ambulatory but under general anesthesia. Measurements and Main Results: Pregnancy rate (PR) 6 months after ovarian drilling was the primary result. Additionally complications and acceptability of the technique were evaluated. PR after 6 months was of 61% , with 38% of the case where pregnancy was obtained spontaneously. In 23% of cases ovarian additional simulation was necessary (either by clomiphene citrate or FSH) the average time to obtain pregnancy was rather fast (3,8months). Miscarriage rate was 14,4% No multiple pregnancy, and no ovarian hyper stimulation were observed Lastly no complication occurred in this serie, and the acceptability was noticed as very acceptable by 91% of the patients. Conclusion: Ovarian drilling trough fertiloscopy is a mini-invasive reliable and safe technique. The PR obtained is very good similar to ovarian drilling performed by standard laparoscopy but pregnancy occurred in a faster manner. Therefore we believe that ovarian drilling should be proposed systematically after clomiphene citrate failure in PCOS patients. 264
Success rates for MTX treatment according to b-hCG level (IU/L). b-hCG level Number of Number of *Success (IU/ML) cases failures Rate (%) 0-500
106
4
96.23
500-1000 1000-1500 1500-2000 2000-2500 2500-3500 3500-4500 >4500 Total
82 54 43 37 36 22 29 409
5 5 5 9 9 6 10 53
93.90 90.74 88.37 75.68 75.00 72.73 65.52 87.04
* P \ 0.0001
stable progressing ectopic pregnancies received methotrexate (50 mg/m2 of body surface).Laparoscopy and salpingectomy was performed in cases of Methotrexate treatment failure. Measurements and Main Results: We measured the success and failure rates for Methotrexate treatment in correlation to b-hCG level. 1083 women were candidates for ‘‘watchful waiting’’ (b-hCG follow-up). Spontaneous resolution and decline of b-hCG levels occurred in 674 patients (39.5%), whereas 409 (24.0%) women had stable or increasing bhCG levels and were treated with methotrexate. In 356 (87.0%) treatment was successful while 53 women (13.0%) required laparoscopic salpingectomy. Compared to prompt administration of Methotrexate, our protocol resulted in lower overall success rates for all levels of b-hCG in women with progressing ectopics: 75% in women with b-hCG levels between 2500-3500 mIU/mL, and 65% in those with b-hCG level higher than 4500 mIU/mL. A mathematical model was found describing the failure rates for Methotrexate in correlation with b-hCG levels.
Open Communications 13 - Reproduction (2:27 PM - 2:32 PM)
Methotrexate Success Rates in Progressing Ectopic Pregnancies: A Reappraisal Cohen A, Almog B, Zakar L, Gil Y, Amer-Alshiek J, Bibi G, Ostrovsky L, Levin I. Department of Gynecology, Tel Aviv Sourasky Medical Center Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Study Objective: To determine the success rates of methotrexate in progressing ectopic pregnancies and to correlate them with b-hCG levels. Design: Retrospective cohort study. Setting: Tertiary university-affiliated medical center. Patients: 409 women who were diagnosed with progressing extra-uterine pregnancy between January 2001 and June 2013. Intervention: Daily b-hCG follow-up was performed to determine progressing of the ectopic pregnancy.Women with hemodynamically
Conclusion: The success rates for Methotrexate treatment in progressing ectopic pregnancies after daily follow-up of b-hCG is lower than previously reported. This reflects redundant administration of Methotrexate in cases where the ectopic pregnancy will eventually resolve spontaneously. 265
Open Communications 13 - Reproduction (2:33 PM - 2:38 PM)
Laparoscopic-Assisted Cericovaginal Reconstruction with Free Anterolateral Thigh Flap for Two Patients with Cervicovaginal Atresia Yi X, Hua K. Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S45–S90
Conclusion: Laparoscopy is the treatment of choice in infertile women with endometriosis. Patient’s age, time after laparoscopy and the presence of preoperative pain are prognostic factors. Tubal surgery significantly increases the postoperative pregnancy rate. Peak incidence of pregnancies occurred within 6 months from surgery. 263
Open Communications 13 - Reproduction (2:21 PM - 2:26 PM)
Fertiloscopic Ovarian Drilling in PCOS Patient: A 280 Cases Serie Watrelot AA, Chauvin G. H^opital Natecia, Lyon, Rhone, France Study Objective: To evaluate the interest of fertiloscopic ovarian drilling in Infertile Polycystic ovarian syndrom(PCOS) patients. Design: Ovarian drilling was performed prospectively in infertile patients presenting PCOS according to Rotteredam criteria. Setting: Ovarian drilling was proposed as a second line treatment after failure of Clomiphene citrate. All patients were treated in a private IVF and Reproductive surgery center in France. Patients: between 2005 and 2013, 280 patients were enrolled in this study . All patients have a PCOS syndrome and an history of infertility of at least one year. All patients were primary infertility aged between 23 and 35. Intervention: ovarian drilling was performed trough fertiloscopy.We have previously described Fertiloscopy as a combination of hydropelviscopy,dye test, salpingoscopy and hysteroscopy performed in the same time for pelvic evaluation in infertile women. Fertiloscopy is usually performed in an ambulatory setting and often practiced under local anesthesia. Due to the ovarian drilling, all procedures were performed ambulatory but under general anesthesia. Measurements and Main Results: Pregnancy rate (PR) 6 months after ovarian drilling was the primary result. Additionally complications and acceptability of the technique were evaluated. PR after 6 months was of 61% , with 38% of the case where pregnancy was obtained spontaneously. In 23% of cases ovarian additional simulation was necessary (either by clomiphene citrate or FSH) the average time to obtain pregnancy was rather fast (3,8months). Miscarriage rate was 14,4% No multiple pregnancy, and no ovarian hyper stimulation were observed Lastly no complication occurred in this serie, and the acceptability was noticed as very acceptable by 91% of the patients. Conclusion: Ovarian drilling trough fertiloscopy is a mini-invasive reliable and safe technique. The PR obtained is very good similar to ovarian drilling performed by standard laparoscopy but pregnancy occurred in a faster manner. Therefore we believe that ovarian drilling should be proposed systematically after clomiphene citrate failure in PCOS patients. 264
Success rates for MTX treatment according to b-hCG level (IU/L). b-hCG level Number of Number of *Success (IU/ML) cases failures Rate (%) 0-500
106
4
96.23
500-1000 1000-1500 1500-2000 2000-2500 2500-3500 3500-4500 >4500 Total
82 54 43 37 36 22 29 409
5 5 5 9 9 6 10 53
93.90 90.74 88.37 75.68 75.00 72.73 65.52 87.04
* P \ 0.0001
stable progressing ectopic pregnancies received methotrexate (50 mg/m2 of body surface).Laparoscopy and salpingectomy was performed in cases of Methotrexate treatment failure. Measurements and Main Results: We measured the success and failure rates for Methotrexate treatment in correlation to b-hCG level. 1083 women were candidates for ‘‘watchful waiting’’ (b-hCG follow-up). Spontaneous resolution and decline of b-hCG levels occurred in 674 patients (39.5%), whereas 409 (24.0%) women had stable or increasing bhCG levels and were treated with methotrexate. In 356 (87.0%) treatment was successful while 53 women (13.0%) required laparoscopic salpingectomy. Compared to prompt administration of Methotrexate, our protocol resulted in lower overall success rates for all levels of b-hCG in women with progressing ectopics: 75% in women with b-hCG levels between 2500-3500 mIU/mL, and 65% in those with b-hCG level higher than 4500 mIU/mL. A mathematical model was found describing the failure rates for Methotrexate in correlation with b-hCG levels.
Open Communications 13 - Reproduction (2:27 PM - 2:32 PM)
Methotrexate Success Rates in Progressing Ectopic Pregnancies: A Reappraisal Cohen A, Almog B, Zakar L, Gil Y, Amer-Alshiek J, Bibi G, Ostrovsky L, Levin I. Department of Gynecology, Tel Aviv Sourasky Medical Center Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Study Objective: To determine the success rates of methotrexate in progressing ectopic pregnancies and to correlate them with b-hCG levels. Design: Retrospective cohort study. Setting: Tertiary university-affiliated medical center. Patients: 409 women who were diagnosed with progressing extra-uterine pregnancy between January 2001 and June 2013. Intervention: Daily b-hCG follow-up was performed to determine progressing of the ectopic pregnancy.Women with hemodynamically
Conclusion: The success rates for Methotrexate treatment in progressing ectopic pregnancies after daily follow-up of b-hCG is lower than previously reported. This reflects redundant administration of Methotrexate in cases where the ectopic pregnancy will eventually resolve spontaneously. 265
Open Communications 13 - Reproduction (2:33 PM - 2:38 PM)
Laparoscopic-Assisted Cericovaginal Reconstruction with Free Anterolateral Thigh Flap for Two Patients with Cervicovaginal Atresia Yi X, Hua K. Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China