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O195 The orientation of the polar body during ICSI influences fertilization rate and embryo development
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
identified (66). The mean follow up was 3.8 and 9.2 years respectively. The demographic data, clinical diagnosis, tumor size, histology, hormone receptors, treatment and survival were review and compared. Results: The incidence of PABC in our center is 7.2/10,000. The highest frequency (52%) appeared during the postpartum period. There was a 7% of induced abortions, 14% spontaneously miscarriaged, 44% had a vaginal delivery and 35% a Caesarean section. The mean age at presentation was 35.38 years (±4.8) in PABC, and 36.73 (±6.6) in non-PABC (NS). The main clinic in both groups was a clinical nodule, 82% and 80% of PABC and non-PABC, no statiscally significant differences were found. The stages are higher in PABC, being 31.8% advanced (EIII and EIV) in PABC front 13.2% in non-PABC (p < 0.05). Infiltrating ductal carcinoma was identified as the predominant histology in both groups (74.5% PABC vs 73.4% non-PABC). 62% of PABC had radical surgery compared to 50% of patients with non-PABC (p < 0.05). Regarding prognostic factors, 27.3% of PABC were grade III versus 15.6% of non-PABC. Of women with PABC, 36.1% were ER negative, 44.4% PR negative and 34.6% Her2Neu + compared with 25%, 27.1% and 33.3%, respectively of non-PABC pacients. Finally, positive lymph nodes were found in 49% of PABC, versus 35.9% non-PABC (NS). The survival rate at 5 years for PABC was 68%. Disease-free survival at 5 years was 82% for PABC and 94% for non-PABC. Conclusions: In our series PABC is higher than that found in literature (1 to 3/10,000) because of the older age of pregnant women, especially in the last five years. The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, hormone receptor negativity, grade III tumor, as well as a delay in diagnosis with a higher rate of advanced stages. O193 Maternal and perinatal outcome in patients with severe systolic dysfunction due to cardiac infectious disease M. Custodio, M. Bortolotto, A. Waissman, L. Yamakami, M. Zugaib. Medical School of S˜ ao Paulo University Objective: Evaluate maternal and fetal outcome in patients with severe left ventricle systolic dysfunction due to cardiac infectious disease, followed in a tertiary-care hospital. Methods: We retrospectively evaluated 6 pregnant women with severe systolic dysfunction, defined as an ejection fraction<40%. Three had Chagas disease, and the other three rheumatic fever. Follow-up data included functional class evaluation, occurrence of cardiac and obstetric events, labor data and neonatal outcome. Cardiac events were defined as new onset of arrhythmias, stroke, pulmonary thrombosis, pulmonary edema, cardiac arrest, and death. Results: The mean ejection fraction was 28.8±5.98%. Three patients were in the NYHA class III, and 3 in class I or II on presentation. Five patients had deteriorated during pregnancy. One single patient presented pulmonary edema. Two of the three patients with class III on presentation had a good evolution during pregnancy, and the other one had preterm delivery due to worsening symptoms. There were 2 vaginal deliveries and 6 cesarean sections. Small-forgestational-age birthweight occurred in 4 pregnancies. There was no maternal or neonatal death. Conclusions: Newborns from pregnancy in patients with severe left ventricle systolic dysfunction due to infectious disease showed great frequency of low birthweight. It is important to follow these women in a tertiary-care hospital, because they frequently present clinical deterioration.
O194 Vulval intraepithelial neoplasia – immunotherapy phase II clinical trials S. Daayana1 , U. Winters1 , P. Stern2 , H. Kitchener1 . 1 St Mary’s Hospital, 2 Paterson Institute for Cancer Research Objectives: Human papillomavirus (HPV) associated vulval intraepithelial Neoplasia (VIN) is a difficult condition to treat. To improve the management of VIN, we undertook 2 phase II trials using an immunomodulator cream – imiquimod followed by either photodynamic therapy (PDT) or therapeutic HPV vaccination (TACIN). Methods: Twenty women with VIN were recruited in each trial; majority has long-standing disease and were heavily pre-treated. Biopsy, blood samples and HPV testing occurred at 0, 10, 20 and 52 wk. Primary outcome was response at 52 wk. Conclusion: Clinical Results: A clinical response was 50% or more reduction in the size of marker lesions on vulvoscopy. At wk 52 in the imiquimod/PDT and imiquimod/TA-CIN trials 60% and 79% clinical response was noted respectively. Immunological results: Treatment is characterised by increased local infiltration of CD4, CD8 T cells but in non-responders (failure to clear VIN on vulvoscopy and histology) this is accompanied by increased T-regulatory cells whereas in the responders (clearance of VIN on vulvoscopy and histology) these are significantly lower. In the imiquimod/PDT trial, responders had significantly increased pre-existing proliferative responses to HPV16. However, there was no stimulation of HPV immunity with treatment. In the imiquimod/TA-CIN trial, treatment appears to stimulate HPV immunity. 12 women made a significant proliferative response to HPV16 following TA-CIN of whom 9 were responders and 3 nonresponders. Imiquimod followed by PDT or TA-CIN show promise as nonsurgical therapies for VIN. As a correlation between pre-existing HPV response, response to vaccination and clinical response was noted, any therapeutic anti-HPV treatment could be very valuable. O195 The orientation of the polar body during ICSI influences fertilization rate and embryo development G. Anifandis, K. Dafopoulos, N. Chalvatzas, A. Tzavella, I. Messinis. Department of Ob/Gyn, Medical School, University of Thessalia, Larissa, Greece Objective: The purpose of the study was to investigate the effect of the orientation of the polar body (PB) relative to the opening of the injection needle during sperm injection on the fertilization rate (FR) and embryo development in women undergoing IVF-ET treatment. Materials and Subjects: The present study included 50 couples undergoing 50 ICSI cycles. All 50 women were allocated to one of the four groups on the basis of PB orientation. In group A, all MII oocytes (n = 68) were injected with their PB at 6 o’clock, group B (n = 62) with their PB at 7 o’clock, group C (n = 62) with their PB at 11 o’ clock and group D (n = 70) with their PB at 12 o’clock. Following fertilization score, morphological grade of all embryos was assessed three days post-oocyte retrieval. Results: Group C demonstrated higher fertilization rate (69.5+6.5%) as compared to the other groups (group A: 66.1+6.8%, group B: 55.1+6.8%, group D: 57+6%) (p < 0.001). Transferred embryos derived from oocytes of group C were of higher quality score (6.9+0.64) than those of the rest groups (group A: 5.6+0.77, group B: 5.2+0.76, group D: 5.2+0.72) (p < 0.001). Conclusions: The injection of oocytes at 11 o’clock results in a significantly higher proportion of good quality embryos. It is suggested that position of the polar body during ICSI relative to the presumed location of the meiotic spindle significantly impacts fertilization and high-quality embryo development.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
identified (66). The mean follow up was 3.8 and 9.2 years respectively. The demographic data, clinical diagnosis, tumor size, histology, hormone receptors, treatment and survival were review and compared. Results: The incidence of PABC in our center is 7.2/10,000. The highest frequency (52%) appeared during the postpartum period. There was a 7% of induced abortions, 14% spontaneously miscarriaged, 44% had a vaginal delivery and 35% a Caesarean section. The mean age at presentation was 35.38 years (±4.8) in PABC, and 36.73 (±6.6) in non-PABC (NS). The main clinic in both groups was a clinical nodule, 82% and 80% of PABC and non-PABC, no statiscally significant differences were found. The stages are higher in PABC, being 31.8% advanced (EIII and EIV) in PABC front 13.2% in non-PABC (p < 0.05). Infiltrating ductal carcinoma was identified as the predominant histology in both groups (74.5% PABC vs 73.4% non-PABC). 62% of PABC had radical surgery compared to 50% of patients with non-PABC (p < 0.05). Regarding prognostic factors, 27.3% of PABC were grade III versus 15.6% of non-PABC. Of women with PABC, 36.1% were ER negative, 44.4% PR negative and 34.6% Her2Neu + compared with 25%, 27.1% and 33.3%, respectively of non-PABC pacients. Finally, positive lymph nodes were found in 49% of PABC, versus 35.9% non-PABC (NS). The survival rate at 5 years for PABC was 68%. Disease-free survival at 5 years was 82% for PABC and 94% for non-PABC. Conclusions: In our series PABC is higher than that found in literature (1 to 3/10,000) because of the older age of pregnant women, especially in the last five years. The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, hormone receptor negativity, grade III tumor, as well as a delay in diagnosis with a higher rate of advanced stages. O193 Maternal and perinatal outcome in patients with severe systolic dysfunction due to cardiac infectious disease M. Custodio, M. Bortolotto, A. Waissman, L. Yamakami, M. Zugaib. Medical School of S˜ ao Paulo University Objective: Evaluate maternal and fetal outcome in patients with severe left ventricle systolic dysfunction due to cardiac infectious disease, followed in a tertiary-care hospital. Methods: We retrospectively evaluated 6 pregnant women with severe systolic dysfunction, defined as an ejection fraction<40%. Three had Chagas disease, and the other three rheumatic fever. Follow-up data included functional class evaluation, occurrence of cardiac and obstetric events, labor data and neonatal outcome. Cardiac events were defined as new onset of arrhythmias, stroke, pulmonary thrombosis, pulmonary edema, cardiac arrest, and death. Results: The mean ejection fraction was 28.8±5.98%. Three patients were in the NYHA class III, and 3 in class I or II on presentation. Five patients had deteriorated during pregnancy. One single patient presented pulmonary edema. Two of the three patients with class III on presentation had a good evolution during pregnancy, and the other one had preterm delivery due to worsening symptoms. There were 2 vaginal deliveries and 6 cesarean sections. Small-forgestational-age birthweight occurred in 4 pregnancies. There was no maternal or neonatal death. Conclusions: Newborns from pregnancy in patients with severe left ventricle systolic dysfunction due to infectious disease showed great frequency of low birthweight. It is important to follow these women in a tertiary-care hospital, because they frequently present clinical deterioration.
O194 Vulval intraepithelial neoplasia – immunotherapy phase II clinical trials S. Daayana1 , U. Winters1 , P. Stern2 , H. Kitchener1 . 1 St Mary’s Hospital, 2 Paterson Institute for Cancer Research Objectives: Human papillomavirus (HPV) associated vulval intraepithelial Neoplasia (VIN) is a difficult condition to treat. To improve the management of VIN, we undertook 2 phase II trials using an immunomodulator cream – imiquimod followed by either photodynamic therapy (PDT) or therapeutic HPV vaccination (TACIN). Methods: Twenty women with VIN were recruited in each trial; majority has long-standing disease and were heavily pre-treated. Biopsy, blood samples and HPV testing occurred at 0, 10, 20 and 52 wk. Primary outcome was response at 52 wk. Conclusion: Clinical Results: A clinical response was 50% or more reduction in the size of marker lesions on vulvoscopy. At wk 52 in the imiquimod/PDT and imiquimod/TA-CIN trials 60% and 79% clinical response was noted respectively. Immunological results: Treatment is characterised by increased local infiltration of CD4, CD8 T cells but in non-responders (failure to clear VIN on vulvoscopy and histology) this is accompanied by increased T-regulatory cells whereas in the responders (clearance of VIN on vulvoscopy and histology) these are significantly lower. In the imiquimod/PDT trial, responders had significantly increased pre-existing proliferative responses to HPV16. However, there was no stimulation of HPV immunity with treatment. In the imiquimod/TA-CIN trial, treatment appears to stimulate HPV immunity. 12 women made a significant proliferative response to HPV16 following TA-CIN of whom 9 were responders and 3 nonresponders. Imiquimod followed by PDT or TA-CIN show promise as nonsurgical therapies for VIN. As a correlation between pre-existing HPV response, response to vaccination and clinical response was noted, any therapeutic anti-HPV treatment could be very valuable. O195 The orientation of the polar body during ICSI influences fertilization rate and embryo development G. Anifandis, K. Dafopoulos, N. Chalvatzas, A. Tzavella, I. Messinis. Department of Ob/Gyn, Medical School, University of Thessalia, Larissa, Greece Objective: The purpose of the study was to investigate the effect of the orientation of the polar body (PB) relative to the opening of the injection needle during sperm injection on the fertilization rate (FR) and embryo development in women undergoing IVF-ET treatment. Materials and Subjects: The present study included 50 couples undergoing 50 ICSI cycles. All 50 women were allocated to one of the four groups on the basis of PB orientation. In group A, all MII oocytes (n = 68) were injected with their PB at 6 o’clock, group B (n = 62) with their PB at 7 o’clock, group C (n = 62) with their PB at 11 o’ clock and group D (n = 70) with their PB at 12 o’clock. Following fertilization score, morphological grade of all embryos was assessed three days post-oocyte retrieval. Results: Group C demonstrated higher fertilization rate (69.5+6.5%) as compared to the other groups (group A: 66.1+6.8%, group B: 55.1+6.8%, group D: 57+6%) (p < 0.001). Transferred embryos derived from oocytes of group C were of higher quality score (6.9+0.64) than those of the rest groups (group A: 5.6+0.77, group B: 5.2+0.76, group D: 5.2+0.72) (p < 0.001). Conclusions: The injection of oocytes at 11 o’clock results in a significantly higher proportion of good quality embryos. It is suggested that position of the polar body during ICSI relative to the presumed location of the meiotic spindle significantly impacts fertilization and high-quality embryo development.