- Email: [email protected]
O-5 Laparoscopic assisted versus abdominal myomectomy
to be more progressively motile sperm after injection and recovery when 1 or 3sp were inserted without PVP. Although no difference was observed when 5sp were encapsulated, more (Pc.001) bent neck defects occurred post-injection using PVP. A significant increase in structural defects was also observed postinjection of 1 or 3sp in PVP. These changes in sperm morphology may influence sperm freezability. A comparative freezing trial is ongoing to optimize single sperm freezing for clinical use. PI1 SO015 0282(99)00022-9
o-4 The Use of Frozen Semen to Avoid HIV Transmission by Donor Insemination: A Cost-Effectiveness Analysis. M. Payne, D.K. Owens, E.J. Lamb. Stanford University, Departments of Gynecology and Obstetrics, Health Research and Policy, and Internal Medicine, Stanford, CA. The American Society for Reproductive Medicine guidelines, intended to reduce the spread of HIV by donor insemination, require the exclusive use of frozen-thawed semen. Antibody testing for HIV is repeated after 3 months to detect infected potential donors in a window period with negative antibody tests. The guidelines effectively define a standard of care so that few physicians offer the option of fresh semen to obtain a higher pregnancy rate. Strict adherence to the guidelines abrogates a patient’s right to trade a small loss of safety for something of value. We followed the recommendations of Panel on Cost-Effectiveness in Health and Medicine regarding quality adjusted life years (QALY) and discounting. The base case is a 30-year-old woman with no female infertility factors who plans to use donor insemination because her husband is azoospermic. We used a 27-state Markov model allowing probabilities and utilities to change over time during a lifetime follow-up. We used Decision Analysis by TreeAge 3.0 and Microsoft Excel. From the literature, we chose values for the uncertainties in the model, the central ones being: (1) probability of pregnancy per cycle, (2) probability of the woman contracting HIV from donor insemination, and (3) probability of vertical transmission of HIV from mother to fetus. If all 80,000 women having donor insemination in the United States each year chose to use fresh semen, the mean cost per live birth would be about $11,000 versus about $26,000 for frozen. Because the risk of HIV infection is extremely small (one each 15 years with fresh semen versus one every 1,144 years using frozen semen), medico-legal costs would need to exceed $2.25 billion for each woman with donor-transmitted HIV to equalize the costs. Life expectancy is nearly identical for users of fresh and frozen but because there would be about 17,000 more births annually with fresh semen. The mean quality adjusted life expectancy would be higher for fresh (18.5 QALY) than for frozen (17.6 QALY) semen. The marginal cost effectiveness of the use of fresh semen is $l,888/QALY. PII SOO15-0282(99)00023-O
O-5 Laparoscopic Assisted Versus Abdominal Myomectomy. J.M. Goldberg, T. Falcone, B. Amundson, L. Bradley. Department of Gynecology and Obstetrics, The Cleveland Clinic Foundation, Cleveland, OH. Objective: We sought to compare postoperative recovery following laparoscopic assisted myomectomy with conventional open abdominal myomectomy.
8s
PCRS Abstracts
Methods: A case control study was performed with frequency matching of 2 abdominal to 1 laparoscopic assisted myomectomy based on the weight of the myomas excised. Laparoscopic assisted myomectomy involved laparoscopic dissection of the myoma from the uterus followed by extraction of the myoma specimen and repairing the uterine defect through a minilaparotomy incision. Estimated blood loss (EBL), hospital length of stay (LOS), and the percentage of patients requiring narcotic analgesics postoperatively and the hours of use were recorded and analyzed with a t-test, Wilcoxon rank-sum test, or chi square test as appropriate. Results: 51 abdominal myomectomies were matched to 25 laparoscopic assisted myomectomies. There were no differences in the age, height, weight, body mass index, parity, uterine size, prior surgery, surgical indication, or other surgical interventions.
Myoma wt (g) EBL (ml) Lupron use (%) Narcotics Narcotics
LOS (hrs)
use (%) use (hrs)
Abdominal
LS assisted
P
153.7 IT 138.5 355.0 2 417 77.3% 98.0% 29.6 + 17.8 65.7 I! 26
189.0 -t 121 367.0 2 286 21.1% 77.7% 15.7 2 13.4 39.9 Ifr 23
NS NS 0.015 0.006 0.001 0.001
There were no differences in the incidence of blood transfusions or postoperative morbidity including fever. Conclusion: Laparoscopic assisted myomectomy caused less postoperative pain and allowed for a more rapid hospital discharge. PI1 SOOlS-0282(99)00024-2
O-6 The Correlation and Prognostic Value of Two Salpingoscopic Scoring Systems in Predicting Reproductive Outcome. S.T. Daneshmand, M. Surrey, E. Surrey. Reproductive Medicine and Surgery Associates, Beverly Hills, CA; Department of Obstetrics and Gynecology, UCLA School of Medicine, Los Angeles, CA. Objective: Several salpingoscopic scoring systems have been proposed to assess the degree of tubal disease. We studied the correlation between two salpingoscopic scoring systems and their prognostic value in predicting reproductive outcome.. Design: Prospective clinical trial in a tertiary care, universityaffiliated, infertility practice. Methods: Forty-two women with suspected tubal disease underwent flexible salpingoscopy at laparoscopy. Findings of salpingoscopies were scored by two investigators using two classifications: (I) Brosens and Putemans, 1989, (class I-V) and (2) Kerin et al., 1992, modified by scoring the ampullary and fimbrial segments, with moderate to severe disease associated with scores >12. A mean score for the tubes was used in the analysis. The relationship between the scores and the cumulative pregnancy rates (CPR) was calculated using life table analysis. Cox (proportional hazard) regression models were used to control for endometriosis, ovulation induction (01), and age. The correlation between the scoring systems was assessed by the Spearman rank method. Pregnancy was defined as ultrasound-confirmed intrauterine fetal cardiac activity. Male factor patients were excluded. Results: The median age was 35.5 years. Median follow-up was 17.5 months. Twenty-four percent (10/42) of the patients had endometriosis and 21% (9/42) underwent ovulation induction after the procedure. The mean Kerin and Brosen scores were 14.5 and 2 in the 32 nonpregnant patients vs. 15 and 2 in the 10 pregnant patients. Based on life table analysis, patients with Kerin scores of >15 had a 25% CPR and those with Kerin scores that wer >15 had a 15% CPR. Those with a Brosen score of <2 had a 21% CPR and Vol. 71, No. 4, Suppl. 1, April
1999
o-4 The Use of Frozen Semen to Avoid HIV Transmission by Donor Insemination: A Cost-Effectiveness Analysis. M. Payne, D.K. Owens, E.J. Lamb. Stanford University, Departments of Gynecology and Obstetrics, Health Research and Policy, and Internal Medicine, Stanford, CA. The American Society for Reproductive Medicine guidelines, intended to reduce the spread of HIV by donor insemination, require the exclusive use of frozen-thawed semen. Antibody testing for HIV is repeated after 3 months to detect infected potential donors in a window period with negative antibody tests. The guidelines effectively define a standard of care so that few physicians offer the option of fresh semen to obtain a higher pregnancy rate. Strict adherence to the guidelines abrogates a patient’s right to trade a small loss of safety for something of value. We followed the recommendations of Panel on Cost-Effectiveness in Health and Medicine regarding quality adjusted life years (QALY) and discounting. The base case is a 30-year-old woman with no female infertility factors who plans to use donor insemination because her husband is azoospermic. We used a 27-state Markov model allowing probabilities and utilities to change over time during a lifetime follow-up. We used Decision Analysis by TreeAge 3.0 and Microsoft Excel. From the literature, we chose values for the uncertainties in the model, the central ones being: (1) probability of pregnancy per cycle, (2) probability of the woman contracting HIV from donor insemination, and (3) probability of vertical transmission of HIV from mother to fetus. If all 80,000 women having donor insemination in the United States each year chose to use fresh semen, the mean cost per live birth would be about $11,000 versus about $26,000 for frozen. Because the risk of HIV infection is extremely small (one each 15 years with fresh semen versus one every 1,144 years using frozen semen), medico-legal costs would need to exceed $2.25 billion for each woman with donor-transmitted HIV to equalize the costs. Life expectancy is nearly identical for users of fresh and frozen but because there would be about 17,000 more births annually with fresh semen. The mean quality adjusted life expectancy would be higher for fresh (18.5 QALY) than for frozen (17.6 QALY) semen. The marginal cost effectiveness of the use of fresh semen is $l,888/QALY. PII SOO15-0282(99)00023-O
O-5 Laparoscopic Assisted Versus Abdominal Myomectomy. J.M. Goldberg, T. Falcone, B. Amundson, L. Bradley. Department of Gynecology and Obstetrics, The Cleveland Clinic Foundation, Cleveland, OH. Objective: We sought to compare postoperative recovery following laparoscopic assisted myomectomy with conventional open abdominal myomectomy.
8s
PCRS Abstracts
Methods: A case control study was performed with frequency matching of 2 abdominal to 1 laparoscopic assisted myomectomy based on the weight of the myomas excised. Laparoscopic assisted myomectomy involved laparoscopic dissection of the myoma from the uterus followed by extraction of the myoma specimen and repairing the uterine defect through a minilaparotomy incision. Estimated blood loss (EBL), hospital length of stay (LOS), and the percentage of patients requiring narcotic analgesics postoperatively and the hours of use were recorded and analyzed with a t-test, Wilcoxon rank-sum test, or chi square test as appropriate. Results: 51 abdominal myomectomies were matched to 25 laparoscopic assisted myomectomies. There were no differences in the age, height, weight, body mass index, parity, uterine size, prior surgery, surgical indication, or other surgical interventions.
Myoma wt (g) EBL (ml) Lupron use (%) Narcotics Narcotics
LOS (hrs)
use (%) use (hrs)
Abdominal
LS assisted
P
153.7 IT 138.5 355.0 2 417 77.3% 98.0% 29.6 + 17.8 65.7 I! 26
189.0 -t 121 367.0 2 286 21.1% 77.7% 15.7 2 13.4 39.9 Ifr 23
NS NS 0.015 0.006 0.001 0.001
There were no differences in the incidence of blood transfusions or postoperative morbidity including fever. Conclusion: Laparoscopic assisted myomectomy caused less postoperative pain and allowed for a more rapid hospital discharge. PI1 SOOlS-0282(99)00024-2
O-6 The Correlation and Prognostic Value of Two Salpingoscopic Scoring Systems in Predicting Reproductive Outcome. S.T. Daneshmand, M. Surrey, E. Surrey. Reproductive Medicine and Surgery Associates, Beverly Hills, CA; Department of Obstetrics and Gynecology, UCLA School of Medicine, Los Angeles, CA. Objective: Several salpingoscopic scoring systems have been proposed to assess the degree of tubal disease. We studied the correlation between two salpingoscopic scoring systems and their prognostic value in predicting reproductive outcome.. Design: Prospective clinical trial in a tertiary care, universityaffiliated, infertility practice. Methods: Forty-two women with suspected tubal disease underwent flexible salpingoscopy at laparoscopy. Findings of salpingoscopies were scored by two investigators using two classifications: (I) Brosens and Putemans, 1989, (class I-V) and (2) Kerin et al., 1992, modified by scoring the ampullary and fimbrial segments, with moderate to severe disease associated with scores >12. A mean score for the tubes was used in the analysis. The relationship between the scores and the cumulative pregnancy rates (CPR) was calculated using life table analysis. Cox (proportional hazard) regression models were used to control for endometriosis, ovulation induction (01), and age. The correlation between the scoring systems was assessed by the Spearman rank method. Pregnancy was defined as ultrasound-confirmed intrauterine fetal cardiac activity. Male factor patients were excluded. Results: The median age was 35.5 years. Median follow-up was 17.5 months. Twenty-four percent (10/42) of the patients had endometriosis and 21% (9/42) underwent ovulation induction after the procedure. The mean Kerin and Brosen scores were 14.5 and 2 in the 32 nonpregnant patients vs. 15 and 2 in the 10 pregnant patients. Based on life table analysis, patients with Kerin scores of >15 had a 25% CPR and those with Kerin scores that wer >15 had a 15% CPR. Those with a Brosen score of <2 had a 21% CPR and Vol. 71, No. 4, Suppl. 1, April
1999