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O-129 Multifetal pregnancy reduction—a possible risk factor for periventricular leukomalacia in premature newborns
body and rheumatoid factor were excluded from our study. The study group comprised 28 (23.3%) euthyroid women who were positive for TPOA, TGA or both. Ninty-two euthyroid women without ATA served as control. Results were analysed with linear regression analysis, Student's t-test, Mann-Whitney U test, Kruscal-Wallis ANOVA, )i2 test and Fisher's exact test. Results: There were no significant differences between study and control groups in patient characteristics such as age, infertility duration and hormonal profile. There were also no significant differences between two groups with respect to the number of retrieved oocytes, fertilization rate, number of embryos frozen and number of embryos transferred. There were no correlations between ATA (TPOA and TGA) titers and fertilization rate. The clinical pregnancy rate (PR) per cycle was significantly lower in the study group, with 21.7% (4~) compared with 39.4% (~-~j 52 in the control group. The biochemical PR per cycle and miscarriage rate were significantly higher in the study group, 15.2% (~) and 40.0% (~) compared with 4.5% (~--~2)and 9.6% (~) in the control group. In the study group, both TPOA and TGA titers were significantly higher in the biochemical pregnancy group than in the clinical pregnancy group or non-pregnancy group. In 10 women with ATA who achieved pregnancy following IVF-ET, both TPOA and TGA titers were significantly higher in the miscarriage group than in the ongoing/delivery group. Conclusions: ATAs in euthyroid women with tubal or unexplained infertility have an association with poor pregnancy outcome of IVF-ET treatment.
O-128 Superovulation With a High Gonadotrophin Dose for In Vitro Fertilization. ~H. Lashen, 2W. Ledger, 2A. Bernal, 2B. Evans, 2D. Barlow. 1Obstetrics & Gynaecology Department, Birmingham University, Birmingham Women's Hospital, Birmingham B15 2TG, UK. 2John Radcliffe Hospital, Oxford, UK. Objectives: Ovarian response to controlled hyperstimulation is a decisive factor in the success of in vitro fertilization (IVF) treatment. The effect of gonadotrophin dose on the response is controversial. We investigated the effect of increasing the gonadotrophin dose on ovarian response in the same patient. Design: Retrospective analysis of the IVF data of the patients who had 2 cycles of treatment (no longer than 2 years apart), in the period from 4/1987 to 7/1996, with a higher dose in cycle two. All the patients were treated in Oxford Fertility Unit. Materials & methods: The patients were stratified according to age, ovarian response & the gonadotrophin dose in the first cycle. Age: ~ & > 33 years old. Response: low (<6 follicles), intermediate (6-12), & high (>12 follicles) responders. Dose: <225 IU FSH & 225/300 IU FSH flat dose. The main outcome measure was the number of follicles, eggs & embryos & serum oestradiol (E2) on hCG day. Paired t-test was used to compare the outcome measures in cycles one & two. p<0.05 was considered significant. Results: 244 patients were included in the study. The S64
Abstracts
protocol was consistent during the period of the study; patients were started on 150 IU FSH unless they had a raised basal FSH level or >37 years of age. Age: patients in both age groups, (n=118-<33 & 126>33), had a significantly higher number of follicles, eggs, & embryos & higher E2 levels in cycle two. Response: both low (n=66) & intermediate (n=145) responders produced significantly more follicles, eggs & embryos & had higher E2 levels in cycle two. However, the high (n=33) responders had a similar response in cycle two except for E2 which was significantly higher in cycle two. Dose: patients who received <225 IU FSH (n=175) in cycle one produced more follicles, eggs, & embryos & had higher E2 levels in cycle two, while those who received 225 or 300 IU FSH (n--69) in cycle one showed no significant difference in cycle two, except for E2 which was significantly higher. In all the groups, the gonadotrophin dose was significantly higher in cycle two while the duration of stimulation was not significantly different. Conclusions: High dose protocols for the use of gonadotrophin for superovulation are becoming increasingly costly as highly purified urinary & recombinant preparations are introduced. Our results indicate that there is little to be gained by exceeding a starting dose of 300 IU, even in those who responded poorly in previous assisted reproduction cycles.
O-129 Multifetal P r e g n a n c y R e d u c t i o n - - a Possible Risk Factor for Periventricular Leukomalacia in Premature Newborns. 1E. Geva, 2L. Lerner-Geva, 1A. Amit, 3Z. Stavorovsky, 2B. Modan, 2L. Freedman, 1I. Yovel, 1M. P. David, 1j. B. Lessing. IIVF Unit, Serlin Maternity Hospital; 2Dept of Clinical Epidemiology, The Chaim Sheba Medical Center, and ~Dept of Radiology, Tel Aviv Sourasky Medical Center, all affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Israel. Objectives: Periventricular leukomalacia (PVL) has been associated with prematurity and twin pregnancies. Selective multifetal pregnancy reduction (MFPR) appears to be an efficacious method for improving outcome among multiple pregnancies. We investigated the possible role of MFPR as a risk factor for the development of PVL. Design: Case-control study. Materials and Methods: The study population comprised 1,401 consecutive preterm infants who were born between J a n u a r y 1, 1994 and December 31, 1995 at the Serlin Maternity Hospital, and admitted to the intensive care nursery of the hospital. With regard to MFPR, premature infants who developed PVL (cases) were compared to premature infants who did not develop PVL (controls). Results: Fourteen premature infants developed PVL. Of these, 28.6% (four infants) were exposed to MFPR, compared to 1.9% exposures among the controls, giving an odds ratio (OR) of 20.9 (95% confidence interval ([CI] = 5 . 5 79.4). Adjustment of this OR for in-vitro fertilization (IVF) treatment (OR= 18.6; CI= 1.8-140.3), for twinning (OR=6.3; CI=1.3-30.3), and for both IVF treatment and twinning simultaneously (OR=8.5; CI=1.7-42.2), did not explain all the observed associations of PVL with MFPR.
Conclusions: Our data suggest that MFPR may constitute an additional risk factor for PVL among premature infants, irrespective of twinning.
W e d n e s d a y , O c t o b e r 22, 1997 2:00 P.M. to 5:00 P.M.
A. T h e S o c i e t y o f R e p r o d u c t i v e S u r g e o n s O-130 The Effects of Twisted Ischemic Adnexa Managed by Detorsion on Ovarian Viability and Histology: An Ischemia-Reperfusion Rodent Model. 10. Taskin, 1M. Birincioglu, 1A. Aydin, 1A. Buhur, 1F. Burak, 2j. M. Wheeler. Dept of Ob & Gyn/Pathology, lInonu University Medical School, Malatya, Turkey, 2Texas Women's Hospital, Houston, TX. Objective: To examine the effects of adnexal torsion on long-term ovarian histology and radical scavenger activity and subsequent viability following the detorsion of twisted ischemic adnexa. Design: Prospective controlled follow-up study in a primate center of an university clinic. Materials and Methods: Adnexal torsion/occlusion was created by twisting the adnexa for 3 times and fixing on to the side wall or by applying vascular clips in cycling female rats at 70 days of age. Following an ischemia period of 4, 8, 12, 18, 24, 36 hours (n:10 each group), the twisted adnexas are surgically removed and fixed. In the second groups of rats (n:10 each group) following the above ischemia periods, the torsion/occlusion were relieved by detwisting or removing the vascular clips. Then the animals were allowed to reperfuse for a week and adnexas were extirpated. Both after ischemia and reperfusion the removed adnexas are histologically examined and the tissue levels of radical scavengers (glutatione peroxidase(GSHPx), superoxide dismutase(SOD), catalase(CAT)) and glutathione(GSH) were determined in homogenized ovarian tissues. All the samples were studied simultaneously in the same assay and the laboratory was blinded to the treatment groups. Units of these enzymes were expressed as #tools or nmols of substrates transformed/rain per mg of protein respectively. Results: Regardless of the ischemia time, all the twisted adnexas were in black-bluish appereance. Despite the gross ischemic/hemorrhagic features, histologic sections revealed negligible changes with intact ovarian structure similar to controls in 4 - 2 4 h r groups. Though decreased compared to controls, the change in tissue levels of GSHPx, SOD, CAT, GSH was not significant in 4 - 2 4 h r groups(P>0.05). Only 36 hr group showed prominent congestion on all sections and significant decrease in all radical scavenger levels studied. While no long-term reperfusion injury was observed histologically in 4 - 2 4 h r groups, 36 hr group ended with adnexal necrosis. Conclusion: Our findings support the importance of early diagnosis and conservative surgical management (detorsion) in adnexal torsion. Lack of histologic changes
and unimpaired radical scavenger metabolism are consistent with the recent data that vascular compromise is caused by venous or lymphatic stasis in early torsion and adnexal integrity is not correlated with gross ischemic appereance. Thus providing evidence to adnexal resistance against ischemia.
O-131 The Effects of Seprafilm T M and Interceed R (TC7) Adh e s i o n Barriers on the Early Phases of Peritoneal Wound Repair. S.M. Dethlefsen, C. J. Nickers0n, D. S. Garlick, J. W. Burns, R. Miller, E. Rowe, L. MacKinney, A. Gilligan, K.C. Skinner. Biomaterials and Surgical Products Research, Genzyme Corporation, Cambridge, MA. Objective: Seprafilm T M Bioresorbable Membrane is currently being used to reduce the incidence of wound adhesions after abdominal and gynecological surgery. Extensive in vitro and in vivo studies have shown it to be non-toxic, non-immunogenic and biocompatible to the peritoneal surfaces. The effects of oxidized-regenerated cellulose Interceed R barrier (Johnson and Johnson Medical, Inc.) have similarly been evaluated during the peritoneal wound healing process. In this study, we have compared the effects of Seprafilm T M membrane and Interceed R barrier on damaged and undamaged peritoneum following injury. Design: A prospective, randomized and blinded study in an experimental surgical wound healing model was designed to compare Seprafilm T M membrane and Interceed ~ barrier. Materials and Methods: Anesthetized adult female Sprague-Dawley rats underwent laparotomies and ceca were abraded at four separate sites. The surgical groups per time point (n=3 per group) were: laparotomy with no abrasion, laparotomy with abrasion and no treatment, and Seprafilm T M membrane (5cm×5cm) or Interceed R barrier (5cm×5cm) placed on abraded and non-abraded ceca. Tissues were removed from non-surgically treated animals and used as baseline controls. The cecum and surrounding peritoneal tissues were harvested at 6 hours and days 1, 3, 5 and 7 following surgery. Tissues were processed for light microscopy and paraffin sections stained with hematoxylin and eosin were graded blindly for the presence of a tissue response. Results: Six hours following surgery, large numbers of neutrophils were localized to the injured cecum and surrounding peritoneum of all treated and non-treated animals that underwent cecal abrasion. On day 3, neutrophil activity was reduced and was replaced by increased numbers of macrophages. Macrophage numbers were greater in injured and non-injured animals treated with Interceed R barrier than in animals treated with Seprafilm T M membrane, and remained so through day 7. However, in animals that underwent surgery without treatment, macrophage numbers remained well below the level of those animals treated with Seprafilm T M membrane and Interceed R barrier. A limited number of multi-nucleated foreign body giant cells were observed at day 7, primarily Abstracts
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O-128 Superovulation With a High Gonadotrophin Dose for In Vitro Fertilization. ~H. Lashen, 2W. Ledger, 2A. Bernal, 2B. Evans, 2D. Barlow. 1Obstetrics & Gynaecology Department, Birmingham University, Birmingham Women's Hospital, Birmingham B15 2TG, UK. 2John Radcliffe Hospital, Oxford, UK. Objectives: Ovarian response to controlled hyperstimulation is a decisive factor in the success of in vitro fertilization (IVF) treatment. The effect of gonadotrophin dose on the response is controversial. We investigated the effect of increasing the gonadotrophin dose on ovarian response in the same patient. Design: Retrospective analysis of the IVF data of the patients who had 2 cycles of treatment (no longer than 2 years apart), in the period from 4/1987 to 7/1996, with a higher dose in cycle two. All the patients were treated in Oxford Fertility Unit. Materials & methods: The patients were stratified according to age, ovarian response & the gonadotrophin dose in the first cycle. Age: ~ & > 33 years old. Response: low (<6 follicles), intermediate (6-12), & high (>12 follicles) responders. Dose: <225 IU FSH & 225/300 IU FSH flat dose. The main outcome measure was the number of follicles, eggs & embryos & serum oestradiol (E2) on hCG day. Paired t-test was used to compare the outcome measures in cycles one & two. p<0.05 was considered significant. Results: 244 patients were included in the study. The S64
Abstracts
protocol was consistent during the period of the study; patients were started on 150 IU FSH unless they had a raised basal FSH level or >37 years of age. Age: patients in both age groups, (n=118-<33 & 126>33), had a significantly higher number of follicles, eggs, & embryos & higher E2 levels in cycle two. Response: both low (n=66) & intermediate (n=145) responders produced significantly more follicles, eggs & embryos & had higher E2 levels in cycle two. However, the high (n=33) responders had a similar response in cycle two except for E2 which was significantly higher in cycle two. Dose: patients who received <225 IU FSH (n=175) in cycle one produced more follicles, eggs, & embryos & had higher E2 levels in cycle two, while those who received 225 or 300 IU FSH (n--69) in cycle one showed no significant difference in cycle two, except for E2 which was significantly higher. In all the groups, the gonadotrophin dose was significantly higher in cycle two while the duration of stimulation was not significantly different. Conclusions: High dose protocols for the use of gonadotrophin for superovulation are becoming increasingly costly as highly purified urinary & recombinant preparations are introduced. Our results indicate that there is little to be gained by exceeding a starting dose of 300 IU, even in those who responded poorly in previous assisted reproduction cycles.
O-129 Multifetal P r e g n a n c y R e d u c t i o n - - a Possible Risk Factor for Periventricular Leukomalacia in Premature Newborns. 1E. Geva, 2L. Lerner-Geva, 1A. Amit, 3Z. Stavorovsky, 2B. Modan, 2L. Freedman, 1I. Yovel, 1M. P. David, 1j. B. Lessing. IIVF Unit, Serlin Maternity Hospital; 2Dept of Clinical Epidemiology, The Chaim Sheba Medical Center, and ~Dept of Radiology, Tel Aviv Sourasky Medical Center, all affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Israel. Objectives: Periventricular leukomalacia (PVL) has been associated with prematurity and twin pregnancies. Selective multifetal pregnancy reduction (MFPR) appears to be an efficacious method for improving outcome among multiple pregnancies. We investigated the possible role of MFPR as a risk factor for the development of PVL. Design: Case-control study. Materials and Methods: The study population comprised 1,401 consecutive preterm infants who were born between J a n u a r y 1, 1994 and December 31, 1995 at the Serlin Maternity Hospital, and admitted to the intensive care nursery of the hospital. With regard to MFPR, premature infants who developed PVL (cases) were compared to premature infants who did not develop PVL (controls). Results: Fourteen premature infants developed PVL. Of these, 28.6% (four infants) were exposed to MFPR, compared to 1.9% exposures among the controls, giving an odds ratio (OR) of 20.9 (95% confidence interval ([CI] = 5 . 5 79.4). Adjustment of this OR for in-vitro fertilization (IVF) treatment (OR= 18.6; CI= 1.8-140.3), for twinning (OR=6.3; CI=1.3-30.3), and for both IVF treatment and twinning simultaneously (OR=8.5; CI=1.7-42.2), did not explain all the observed associations of PVL with MFPR.
Conclusions: Our data suggest that MFPR may constitute an additional risk factor for PVL among premature infants, irrespective of twinning.
W e d n e s d a y , O c t o b e r 22, 1997 2:00 P.M. to 5:00 P.M.
A. T h e S o c i e t y o f R e p r o d u c t i v e S u r g e o n s O-130 The Effects of Twisted Ischemic Adnexa Managed by Detorsion on Ovarian Viability and Histology: An Ischemia-Reperfusion Rodent Model. 10. Taskin, 1M. Birincioglu, 1A. Aydin, 1A. Buhur, 1F. Burak, 2j. M. Wheeler. Dept of Ob & Gyn/Pathology, lInonu University Medical School, Malatya, Turkey, 2Texas Women's Hospital, Houston, TX. Objective: To examine the effects of adnexal torsion on long-term ovarian histology and radical scavenger activity and subsequent viability following the detorsion of twisted ischemic adnexa. Design: Prospective controlled follow-up study in a primate center of an university clinic. Materials and Methods: Adnexal torsion/occlusion was created by twisting the adnexa for 3 times and fixing on to the side wall or by applying vascular clips in cycling female rats at 70 days of age. Following an ischemia period of 4, 8, 12, 18, 24, 36 hours (n:10 each group), the twisted adnexas are surgically removed and fixed. In the second groups of rats (n:10 each group) following the above ischemia periods, the torsion/occlusion were relieved by detwisting or removing the vascular clips. Then the animals were allowed to reperfuse for a week and adnexas were extirpated. Both after ischemia and reperfusion the removed adnexas are histologically examined and the tissue levels of radical scavengers (glutatione peroxidase(GSHPx), superoxide dismutase(SOD), catalase(CAT)) and glutathione(GSH) were determined in homogenized ovarian tissues. All the samples were studied simultaneously in the same assay and the laboratory was blinded to the treatment groups. Units of these enzymes were expressed as #tools or nmols of substrates transformed/rain per mg of protein respectively. Results: Regardless of the ischemia time, all the twisted adnexas were in black-bluish appereance. Despite the gross ischemic/hemorrhagic features, histologic sections revealed negligible changes with intact ovarian structure similar to controls in 4 - 2 4 h r groups. Though decreased compared to controls, the change in tissue levels of GSHPx, SOD, CAT, GSH was not significant in 4 - 2 4 h r groups(P>0.05). Only 36 hr group showed prominent congestion on all sections and significant decrease in all radical scavenger levels studied. While no long-term reperfusion injury was observed histologically in 4 - 2 4 h r groups, 36 hr group ended with adnexal necrosis. Conclusion: Our findings support the importance of early diagnosis and conservative surgical management (detorsion) in adnexal torsion. Lack of histologic changes
and unimpaired radical scavenger metabolism are consistent with the recent data that vascular compromise is caused by venous or lymphatic stasis in early torsion and adnexal integrity is not correlated with gross ischemic appereance. Thus providing evidence to adnexal resistance against ischemia.
O-131 The Effects of Seprafilm T M and Interceed R (TC7) Adh e s i o n Barriers on the Early Phases of Peritoneal Wound Repair. S.M. Dethlefsen, C. J. Nickers0n, D. S. Garlick, J. W. Burns, R. Miller, E. Rowe, L. MacKinney, A. Gilligan, K.C. Skinner. Biomaterials and Surgical Products Research, Genzyme Corporation, Cambridge, MA. Objective: Seprafilm T M Bioresorbable Membrane is currently being used to reduce the incidence of wound adhesions after abdominal and gynecological surgery. Extensive in vitro and in vivo studies have shown it to be non-toxic, non-immunogenic and biocompatible to the peritoneal surfaces. The effects of oxidized-regenerated cellulose Interceed R barrier (Johnson and Johnson Medical, Inc.) have similarly been evaluated during the peritoneal wound healing process. In this study, we have compared the effects of Seprafilm T M membrane and Interceed R barrier on damaged and undamaged peritoneum following injury. Design: A prospective, randomized and blinded study in an experimental surgical wound healing model was designed to compare Seprafilm T M membrane and Interceed ~ barrier. Materials and Methods: Anesthetized adult female Sprague-Dawley rats underwent laparotomies and ceca were abraded at four separate sites. The surgical groups per time point (n=3 per group) were: laparotomy with no abrasion, laparotomy with abrasion and no treatment, and Seprafilm T M membrane (5cm×5cm) or Interceed R barrier (5cm×5cm) placed on abraded and non-abraded ceca. Tissues were removed from non-surgically treated animals and used as baseline controls. The cecum and surrounding peritoneal tissues were harvested at 6 hours and days 1, 3, 5 and 7 following surgery. Tissues were processed for light microscopy and paraffin sections stained with hematoxylin and eosin were graded blindly for the presence of a tissue response. Results: Six hours following surgery, large numbers of neutrophils were localized to the injured cecum and surrounding peritoneum of all treated and non-treated animals that underwent cecal abrasion. On day 3, neutrophil activity was reduced and was replaced by increased numbers of macrophages. Macrophage numbers were greater in injured and non-injured animals treated with Interceed R barrier than in animals treated with Seprafilm T M membrane, and remained so through day 7. However, in animals that underwent surgery without treatment, macrophage numbers remained well below the level of those animals treated with Seprafilm T M membrane and Interceed R barrier. A limited number of multi-nucleated foreign body giant cells were observed at day 7, primarily Abstracts
$65