- Email: [email protected]
P-332
P-330 DOES THE AIR BUBBLE PLACEMENT AND THE EASE OF ET CORRELATE WITH PREGNANCY RATES? F. I. Sharara, M. G. Collins II, A. Bendus, G. Abdo. Virginia Center for Reproductive Medicine, Reston, VA; Ferring Pharmaceuticals Inc., Suffern, NY. OBJECTIVE: The exact placement of the embryos in relation to the uterine fundus at the time of ET, and the ease of ET, remain a matter of debate. Utilizing ultrasound guidance with a full bladder, ET is easier to perform, and the location of the air bubble can be measured accurately in relation to the uterine fundus. DESIGN: Retrospective comparative. MATERIALS AND METHODS: A retrospective review of 163 ART cycles (IVF/ICSI, FET, donor egg cycles) performed from 10/03 to 4/06 was done. All embryo transfers were performed by one operator (FIS) under ultrasound guidance using a Wallace or Cook echo-tip catheters. The distance of the embryo transfer bubble from the fundus was recorded. The ease or difficulty of the ET was recorded. The parameters evaluated were: cycle number, age, weight, height, diagnosis, stage of embryos at transfer, number of embryos transferred, ease of transfer (scale 1-4, 4⫽most difficult), distance of embryo transfer bubble from the fundus (cm), endometrial thickness (cm) at the time of embryo transfer, number of gestational sacs, and the number of live births. A t-test was performed to test for significance for: number of embryos transferred, distance of the embryo transfer bubble, endometrial thickness and the ease of embryo transfer in relation to pregnancy. A P⬍0.05 was considered significant. Cycles with more than one bubble (N⫽15) were excluded. RESULTS: Of the 120 cycles analyzed, 75 resulted in pregnancies (62.5%) with 66 (55%) as clinical pregnancies with gestational sacs and heartbeats identifiable on ultrasound. A total of 120 cycles (mean age⫽34.2 years) had a single ET bubble identified that did not migrate to the fundus in fresh non-donor cycles. The mean (⫾SD) distance of the ET bubble was 1.49 ⫾ 0.56 cm for those transfers not resulting in a pregnancy (45/120⫽37.5%), and 1.35 ⫾ 0.50 cm for those transfers resulting in a pregnancy (75/120⫽62.5%). These values were not statistically significant, nor were the mean number of embryos transferred (2.22 ⫾ 0.70 non-pregnant compared with 2.31 ⫾ 0.75 pregnant) and the mean endometrial thickness at the time of embryo transfer (10.24 ⫾ 2.04 cm non-pregnant compared with 10.75 ⫾ 1.96 cm pregnant), or between age and BMI. However, the mean ease of ET was significant (1.47 ⫾ 0.87 for the non-pregnant compared with 1.11 ⫾ 0.53 for the pregnant cycles) (P⫽0.0145). CONCLUSION: There was a significant correlation between ease of ET and PR, but not with embryo placement in relation to the fundus and PR. Supported by: None
P-331 SURVEY OF EMBRYO QUALITY ASSESSMENT - FROM ART CENTERS WITHIN THE UNITED STATES. J. Hubbard, D. Ezcurra, G. Briley, E. Grotjan, J. Schertz, R. Basuray. Serono, Inc, Rockland, MA. OBJECTIVE: Conduct a survey of ART laboratories in the US to assess which key morphologic criteria are commonly used to select presumptively viable embryos) for transfer. DESIGN: Prospective survey. MATERIALS AND METHODS: Surveys were distributed to ART laboratories by e-mail or direct visit. One survey per center was included for analysis. For the survey, data was collected on time/day of embryo assessment (Day 1, 2, 3, 5 or 6) and what criteria is used to categorize the embryo as “best” for each assessment performed. In addition, participants were asked if they felt any of the currently known metabolomic, proteomic, genomic tests for embryo assessment have potential for routine use in selecting the best quality embryo(s) for transfer in the future.
S258
Abstracts
RESULTS: Surveys were analyzed from 78 ART laboratories across the United States for the assessment of the “best” embryo for transfer. Results are presented as percentage of participants, Table 1. As to the future application of metabolomic, proteomic and genomic tests for embryo viability assessment, 38.9%, 50.0% and 77.8% participants respectively, responded that their importance was high.
CONCLUSION: Results from our Embryo Quality Assessment Survey revealed that most ART laboratories use many criteria to assess embryo development and morphology to optimize the selection of growing embryo(s) or blastocyst(s) for transfer. It appears that embryo selection criteria for transfer is not standardized within the United States, which may make the interpretation of published results difficult, and direct application into one’s own center problematic, especially when different selection criteria are utilized. Furthermore, a perception exists among survey participants that future application of metabolomic, proteomic or genomic may hold answers to the current inability to confidently select a single embryo with the highest implantation potential. Supported by: None
P-332 EVALUATING THE RESULT OF MICROBIAL CULTURE AT THE TIME OF EMBRYO TRANSFER AND OUTCOME OF INTRACYTOPLASMIC SPERM INJECTION(ICSI) IN MEHR INFERTILITY INSTITUTE. M. Mehrafza, M. Jafari, A. Hosseini, A. Haydarzadeh, R. Aram, M. Oudi. Mehr Infertility Center, Rasht, Iran (Islamic Republic of). OBJECTIVE: The cervix often is colonized by potentially pathogenic microorganism that can be introduced into the uterine cavity or contaminate embryos during ET. The consequences of this septic milieu on the outcome of embryo implantation are unclear. This study was carried out to investigate the effect of microbial flora of the cervix at the time of embryo transfer on ICSI outcome. DESIGN: Prospective clinical trial. MATERIALS AND METHODS: This descriptive and analytic study. By using embryo transfer catheter tips, endo-cervical samples of 260 women who underwent intra-cytoplasmic sperm injection (ICSI) were collected. After embryo was transferred, the specimen was taken from about 3cm of transferred catheter that was cut and put in selective culture media. After incubation in special conditions by using current bacteriological methods; bacteria in the samples were isolated and characterized .Pregnancy rate was confirmed by measurement of -hCG in serum. Some confounding variables (sperm quality, age, duration and cause of infertility, embryo quality) were controlled. After data collection analysis carried out with T-test, chi squares test and multiple logistic regression by using statistical software SPSS.10. (P⬍0.05 was considered significant) RESULTS: The results showed that overall PR by ICSI procedure was 40%(104 out of 260 cycles).The mean age of women was 31.6⫾6.2 years. The most common cause of infertility was related to male factor (46.2%).The mean infertility duration was 7.7⫾5.5 years. The most embryos were A (85%). The group whose culture specimen was sterile 246 (94.6%) and the one whose culture specimen was infected 14 (5.4%).
Vol. 86, Suppl 2, September 2006
Pregnancy rate in patients with and without positive culture were 4.8% and 95.2%, respectively. There was no significant difference. Multiple logistic regressions showed no significant effect of female’s age, duration of infertility, cause of infertility, sperm parameters(count-morphology- motility),number of oocyte, number of MII, number of cleaved, number of ET, embryo quality and microbial culture in the outcome of ICSI but there was significant relation between female age in PR. CONCLUSION: It’s appears that the presence of microbial flora of the cervix on ET catheters isn’t associated with poor ICSI-ET outcome Supported by: The study was supported by Mehr Infertility Institute
ENDOMETRIOSIS P-333 EXPRESSION OF CYCLINB1, CDC2 AND POLO-LIKE KINASE1 IN ECTOPIC AND EUTOPIC ENDOMETRIUM OF ENDOMETRIOSIS. L. Tang, T. H. Zhou, J. Z. Sheng, R. H. He, C. Y. Zhou, H. F. Huang. zhejiang university, Hangzhou, China; Univ of Calgary, Calgary, AB, Canada. OBJECTIVE: To investige the possible roles of cyclin B1,cdc2 and polo-like kinase1(plk1) in the pathogenesis of endometriosis. DESIGN: We analysed the expression of cyclinB1,cdc2 and plk1 in human ectopic and eutopic endometrium of endometriosis by western blotting, RT-PCR and immunohistochemistry. MATERIALS AND METHODS: Three group patients were studied : ectopic endometrium tissues from women with endometriosis , eutopic endometrium tissues from women with and without endometriosis. Western blotting, RT-PCR and immunohistochemistry were employed. Blood samples were obtained for measurement of serum estradiol (E2), progesterone(P) and follicular stimulation hormone(FSH) at the same day of tissue biopsy. Linear regression was used to analyze correlation between cyclinB1and plk1 expression and serum levels of E2 , P and FSH. RESULTS: CyclinB1,cdc2 and plk1 were detected expression in all eutopic and ectopic endometrium tissues throughout menstruation cycle. In proliferative phase, the expression level of cyclinB1 and plk1in ectopic endometrium from women with endoetriosis was significantly higher than in eutopic endometrium from these with and without endometriosis (p⬍0.05). But no significant difference was found in secretory phases between the expression levels of cyclinB1and plk1 in ectopic endometrium from women with endometriosis and the eutopic endometrium from these with and without endometriosis in (p⬎0.05). No significant difference was found in eutopic endometrium cyclinB1 and plk1 expression levels between from these with and without endometriosis both in proliferative and secretory phases (p⬎0.05). In proliferative phase, positive correlation was found between the expression levels of cyclinB1 and plk1 in ectopic endometrium from women with endometriosis and the serum levels of E2 and FSH. Negative correlation was found between the expression levels of cyclinB1 and plk1 in ectopic endometrium from women with endometriosis and the serum levels of P. In secretory phase, no correlation was found between the expression levels of cyclinB1 and plk1 in ectopic endometrium from women with endometriosis and the serum levels of E2 ,P and FSH. The cyclinB1 ,cdc2 and plk1 staining were investigated location mostly in nucleus of luminal, stromal and glandular cells in proliferative phase and in cytoplasm in secretory phase by immnochemistory. CONCLUSION: Increased expression of cyclinB1 and plk1 in ectopic endometrium may be involved in the pathogenesis of endometriosis.They might be new biomarkers for diagnosis and prognosis of endometriosis and possible new targets for treatment of endometriosis. Supported by: No financial support.
P-334 ENDOMETRIOSIS INVESTIGATIONS AND DIAGNOSIS PRIOR TO OVARIAN INDUCTION (OI) OR INTRAUTERINE INSEMINATION (IUI) IN CLINICAL PRACTICE. J. Pouly, C. Avril, J. BellaischAllart. Clermont-Ferrand Hospital, Reproductive Medicine Unit, ClermontFerrand, France; Saint Antoine Clinic, Reproductive Medicine Unit, Bois Guillaume, France; Jean Rostand Hospital, Reproductive Medicine Unit, Se`vres, France.
FERTILITY & STERILITY威
OBJECTIVE: Endometriosis diagnosis is essentially based on direct or indirect evidence of ectopic endometrium implantation. There is an apparent increased incidence of infertility in endometriosic patients. A large French prospective survey was carried out in women undergoing OI or IUI using questionnaires aiming at identifying medical practices. Investigations and diagnosis of endometriosis are detailed in this abstract. DESIGN: Prospective physician’s questionnaire. MATERIALS AND METHODS: A questionnaire was sent to gynaecologists and ART specialists. Each physician had to recruit 3 patients undergoing OI or IUI. Before starting ovarian stimulation, all physicians had to collect data on endometriosis diagnosis (baseline status). Diagnosis of endometriosis was confirmed by symptoms, clinical findings, pelvic ultrasonography and/or laparoscopy. A total of 1050 questionnaires were collected from 318 gynaecologists between January 2005 and November 2005. RESULTS: A workup for endometriosis was performed in only 571 (54%) of the 1050 patients. Endometriosis was ruled out in 450 cases (79 %) and confirmed in 99 (17 %) cases. In the remaining cases (n⫽22) the answer was unclear. For the 450 patients for whom endometriosis was ruled out, the conclusion was drawn mainly from the absence of symptom (78 %, n⫽353), a normal clinical examination (74 %, n⫽331) and a normal pelvic ultrasonography (74 %, n⫽333) or combination of the 3 criteria (52 %, n⫽233). Finally this conclusion was made through a laparoscopy in only 27 % (n⫽121) of the cases. For the 99 patients for whom endometriosis was concluded, diagnosis was made during a laparoscopy in 87 % (n⫽86) of the cases. In the other cases the diagnosis was assessed on the echographic findings. Of the 549 patients (for whom investigations and diagnosis had been assessed), a laparoscopy (or a fertiloscopy) was performed only in 38 % (n⫽207) of the cases. In these latter patients, an endometriosis was found in 41.5 % (n⫽86) of the cases. In the 99 patients with endometriosis, endometriosic lesions were as follow: superficial endometriosis (38 %, n⫽38), adhesions (41 %, n⫽41), endometriomas (28 %, n⫽28), rectovaginal nodules (13 %, n⫽13), and possibly multiple lesions. The endometriosis was graded as stage 1 in 31 % (n⫽31) of the cases, 2 in 26 % (n⫽26), 3 in 7 % (n⫽7), 4 in 3 % (n⫽3) and unknown in 32 % (n⫽32). Of the 86 patients with endometriosis diagnosed by laparoscopy, 43 (50 %) were clinically asymptomatic, had normal clinical findings and normal pelvic ultra-sonography. CONCLUSION: Only half of patients treated by OI and/or IUI were investigated for endometriosis, a laparoscopy (or a fertiloscopy) was performed in only 38 % of these patients. While, 50% of endometriosic patients diagnosed by laparoscopy do not have any symptoms, absence of endometriosis relies mostly on normal clinical finding clinics and pelvic ultrasonography and rarely on a laparoscopy. This study suggests that the diagnosis of endometriosis is generally poorly made and therefore, seems to be largely underestimated. Supported by: Serono
P-335 SERUM AND PERITONEAL CORRELATION OF INTERLEUKIN-18 (IL-18) IN INFERTILE WOMEN WITH ENDOMETRIOSIS. J. S. Cunha-Filho, C. L. Glitz, G. Berton, M. Senger, F. M. Freitas, E. P. Passos. Hospital de Clı´nicas de Porto Alegre, Porto Alegre, Brazil. OBJECTIVE: We propose to evaluate if the IL-18 serum/peritoneal fluid correlation differ in women with endometriosis compared to women without endometriosis. DESIGN: Cross-sectional prospective study. MATERIALS AND METHODS: 34 infertile patients with mild/minimal endometriosis and 22 controls (fertile patients submitted to tubal ligation). Serum dosages of IL-18 and peritoneal dosages of IL-18 were collected. RESULTS: The groups were not different in terms of age and BMI. There were no differences also between dosages of IL-18 in serum and peritoneal fluid of infertile women with endometriosis and control group: 290.85 ⫾ 46.24 pg/ml x 374.21 ⫾ 88.23 pg/ml and 391.07 ⫾ 31.99 x 373.42 ⫾ 34.5, respectively. We found a positive association between serum and peritoneal IL-18 in patients with endometriosis (r⫽0.722, P⫽0.004) and in the control group (r⫽0.851, P⫽0.001). Both correlation coefficients were not statistically different (P⬎0.05).
S259
P-331 SURVEY OF EMBRYO QUALITY ASSESSMENT - FROM ART CENTERS WITHIN THE UNITED STATES. J. Hubbard, D. Ezcurra, G. Briley, E. Grotjan, J. Schertz, R. Basuray. Serono, Inc, Rockland, MA. OBJECTIVE: Conduct a survey of ART laboratories in the US to assess which key morphologic criteria are commonly used to select presumptively viable embryos) for transfer. DESIGN: Prospective survey. MATERIALS AND METHODS: Surveys were distributed to ART laboratories by e-mail or direct visit. One survey per center was included for analysis. For the survey, data was collected on time/day of embryo assessment (Day 1, 2, 3, 5 or 6) and what criteria is used to categorize the embryo as “best” for each assessment performed. In addition, participants were asked if they felt any of the currently known metabolomic, proteomic, genomic tests for embryo assessment have potential for routine use in selecting the best quality embryo(s) for transfer in the future.
S258
Abstracts
RESULTS: Surveys were analyzed from 78 ART laboratories across the United States for the assessment of the “best” embryo for transfer. Results are presented as percentage of participants, Table 1. As to the future application of metabolomic, proteomic and genomic tests for embryo viability assessment, 38.9%, 50.0% and 77.8% participants respectively, responded that their importance was high.
CONCLUSION: Results from our Embryo Quality Assessment Survey revealed that most ART laboratories use many criteria to assess embryo development and morphology to optimize the selection of growing embryo(s) or blastocyst(s) for transfer. It appears that embryo selection criteria for transfer is not standardized within the United States, which may make the interpretation of published results difficult, and direct application into one’s own center problematic, especially when different selection criteria are utilized. Furthermore, a perception exists among survey participants that future application of metabolomic, proteomic or genomic may hold answers to the current inability to confidently select a single embryo with the highest implantation potential. Supported by: None
P-332 EVALUATING THE RESULT OF MICROBIAL CULTURE AT THE TIME OF EMBRYO TRANSFER AND OUTCOME OF INTRACYTOPLASMIC SPERM INJECTION(ICSI) IN MEHR INFERTILITY INSTITUTE. M. Mehrafza, M. Jafari, A. Hosseini, A. Haydarzadeh, R. Aram, M. Oudi. Mehr Infertility Center, Rasht, Iran (Islamic Republic of). OBJECTIVE: The cervix often is colonized by potentially pathogenic microorganism that can be introduced into the uterine cavity or contaminate embryos during ET. The consequences of this septic milieu on the outcome of embryo implantation are unclear. This study was carried out to investigate the effect of microbial flora of the cervix at the time of embryo transfer on ICSI outcome. DESIGN: Prospective clinical trial. MATERIALS AND METHODS: This descriptive and analytic study. By using embryo transfer catheter tips, endo-cervical samples of 260 women who underwent intra-cytoplasmic sperm injection (ICSI) were collected. After embryo was transferred, the specimen was taken from about 3cm of transferred catheter that was cut and put in selective culture media. After incubation in special conditions by using current bacteriological methods; bacteria in the samples were isolated and characterized .Pregnancy rate was confirmed by measurement of -hCG in serum. Some confounding variables (sperm quality, age, duration and cause of infertility, embryo quality) were controlled. After data collection analysis carried out with T-test, chi squares test and multiple logistic regression by using statistical software SPSS.10. (P⬍0.05 was considered significant) RESULTS: The results showed that overall PR by ICSI procedure was 40%(104 out of 260 cycles).The mean age of women was 31.6⫾6.2 years. The most common cause of infertility was related to male factor (46.2%).The mean infertility duration was 7.7⫾5.5 years. The most embryos were A (85%). The group whose culture specimen was sterile 246 (94.6%) and the one whose culture specimen was infected 14 (5.4%).
Vol. 86, Suppl 2, September 2006
Pregnancy rate in patients with and without positive culture were 4.8% and 95.2%, respectively. There was no significant difference. Multiple logistic regressions showed no significant effect of female’s age, duration of infertility, cause of infertility, sperm parameters(count-morphology- motility),number of oocyte, number of MII, number of cleaved, number of ET, embryo quality and microbial culture in the outcome of ICSI but there was significant relation between female age in PR. CONCLUSION: It’s appears that the presence of microbial flora of the cervix on ET catheters isn’t associated with poor ICSI-ET outcome Supported by: The study was supported by Mehr Infertility Institute
ENDOMETRIOSIS P-333 EXPRESSION OF CYCLINB1, CDC2 AND POLO-LIKE KINASE1 IN ECTOPIC AND EUTOPIC ENDOMETRIUM OF ENDOMETRIOSIS. L. Tang, T. H. Zhou, J. Z. Sheng, R. H. He, C. Y. Zhou, H. F. Huang. zhejiang university, Hangzhou, China; Univ of Calgary, Calgary, AB, Canada. OBJECTIVE: To investige the possible roles of cyclin B1,cdc2 and polo-like kinase1(plk1) in the pathogenesis of endometriosis. DESIGN: We analysed the expression of cyclinB1,cdc2 and plk1 in human ectopic and eutopic endometrium of endometriosis by western blotting, RT-PCR and immunohistochemistry. MATERIALS AND METHODS: Three group patients were studied : ectopic endometrium tissues from women with endometriosis , eutopic endometrium tissues from women with and without endometriosis. Western blotting, RT-PCR and immunohistochemistry were employed. Blood samples were obtained for measurement of serum estradiol (E2), progesterone(P) and follicular stimulation hormone(FSH) at the same day of tissue biopsy. Linear regression was used to analyze correlation between cyclinB1and plk1 expression and serum levels of E2 , P and FSH. RESULTS: CyclinB1,cdc2 and plk1 were detected expression in all eutopic and ectopic endometrium tissues throughout menstruation cycle. In proliferative phase, the expression level of cyclinB1 and plk1in ectopic endometrium from women with endoetriosis was significantly higher than in eutopic endometrium from these with and without endometriosis (p⬍0.05). But no significant difference was found in secretory phases between the expression levels of cyclinB1and plk1 in ectopic endometrium from women with endometriosis and the eutopic endometrium from these with and without endometriosis in (p⬎0.05). No significant difference was found in eutopic endometrium cyclinB1 and plk1 expression levels between from these with and without endometriosis both in proliferative and secretory phases (p⬎0.05). In proliferative phase, positive correlation was found between the expression levels of cyclinB1 and plk1 in ectopic endometrium from women with endometriosis and the serum levels of E2 and FSH. Negative correlation was found between the expression levels of cyclinB1 and plk1 in ectopic endometrium from women with endometriosis and the serum levels of P. In secretory phase, no correlation was found between the expression levels of cyclinB1 and plk1 in ectopic endometrium from women with endometriosis and the serum levels of E2 ,P and FSH. The cyclinB1 ,cdc2 and plk1 staining were investigated location mostly in nucleus of luminal, stromal and glandular cells in proliferative phase and in cytoplasm in secretory phase by immnochemistory. CONCLUSION: Increased expression of cyclinB1 and plk1 in ectopic endometrium may be involved in the pathogenesis of endometriosis.They might be new biomarkers for diagnosis and prognosis of endometriosis and possible new targets for treatment of endometriosis. Supported by: No financial support.
P-334 ENDOMETRIOSIS INVESTIGATIONS AND DIAGNOSIS PRIOR TO OVARIAN INDUCTION (OI) OR INTRAUTERINE INSEMINATION (IUI) IN CLINICAL PRACTICE. J. Pouly, C. Avril, J. BellaischAllart. Clermont-Ferrand Hospital, Reproductive Medicine Unit, ClermontFerrand, France; Saint Antoine Clinic, Reproductive Medicine Unit, Bois Guillaume, France; Jean Rostand Hospital, Reproductive Medicine Unit, Se`vres, France.
FERTILITY & STERILITY威
OBJECTIVE: Endometriosis diagnosis is essentially based on direct or indirect evidence of ectopic endometrium implantation. There is an apparent increased incidence of infertility in endometriosic patients. A large French prospective survey was carried out in women undergoing OI or IUI using questionnaires aiming at identifying medical practices. Investigations and diagnosis of endometriosis are detailed in this abstract. DESIGN: Prospective physician’s questionnaire. MATERIALS AND METHODS: A questionnaire was sent to gynaecologists and ART specialists. Each physician had to recruit 3 patients undergoing OI or IUI. Before starting ovarian stimulation, all physicians had to collect data on endometriosis diagnosis (baseline status). Diagnosis of endometriosis was confirmed by symptoms, clinical findings, pelvic ultrasonography and/or laparoscopy. A total of 1050 questionnaires were collected from 318 gynaecologists between January 2005 and November 2005. RESULTS: A workup for endometriosis was performed in only 571 (54%) of the 1050 patients. Endometriosis was ruled out in 450 cases (79 %) and confirmed in 99 (17 %) cases. In the remaining cases (n⫽22) the answer was unclear. For the 450 patients for whom endometriosis was ruled out, the conclusion was drawn mainly from the absence of symptom (78 %, n⫽353), a normal clinical examination (74 %, n⫽331) and a normal pelvic ultrasonography (74 %, n⫽333) or combination of the 3 criteria (52 %, n⫽233). Finally this conclusion was made through a laparoscopy in only 27 % (n⫽121) of the cases. For the 99 patients for whom endometriosis was concluded, diagnosis was made during a laparoscopy in 87 % (n⫽86) of the cases. In the other cases the diagnosis was assessed on the echographic findings. Of the 549 patients (for whom investigations and diagnosis had been assessed), a laparoscopy (or a fertiloscopy) was performed only in 38 % (n⫽207) of the cases. In these latter patients, an endometriosis was found in 41.5 % (n⫽86) of the cases. In the 99 patients with endometriosis, endometriosic lesions were as follow: superficial endometriosis (38 %, n⫽38), adhesions (41 %, n⫽41), endometriomas (28 %, n⫽28), rectovaginal nodules (13 %, n⫽13), and possibly multiple lesions. The endometriosis was graded as stage 1 in 31 % (n⫽31) of the cases, 2 in 26 % (n⫽26), 3 in 7 % (n⫽7), 4 in 3 % (n⫽3) and unknown in 32 % (n⫽32). Of the 86 patients with endometriosis diagnosed by laparoscopy, 43 (50 %) were clinically asymptomatic, had normal clinical findings and normal pelvic ultra-sonography. CONCLUSION: Only half of patients treated by OI and/or IUI were investigated for endometriosis, a laparoscopy (or a fertiloscopy) was performed in only 38 % of these patients. While, 50% of endometriosic patients diagnosed by laparoscopy do not have any symptoms, absence of endometriosis relies mostly on normal clinical finding clinics and pelvic ultrasonography and rarely on a laparoscopy. This study suggests that the diagnosis of endometriosis is generally poorly made and therefore, seems to be largely underestimated. Supported by: Serono
P-335 SERUM AND PERITONEAL CORRELATION OF INTERLEUKIN-18 (IL-18) IN INFERTILE WOMEN WITH ENDOMETRIOSIS. J. S. Cunha-Filho, C. L. Glitz, G. Berton, M. Senger, F. M. Freitas, E. P. Passos. Hospital de Clı´nicas de Porto Alegre, Porto Alegre, Brazil. OBJECTIVE: We propose to evaluate if the IL-18 serum/peritoneal fluid correlation differ in women with endometriosis compared to women without endometriosis. DESIGN: Cross-sectional prospective study. MATERIALS AND METHODS: 34 infertile patients with mild/minimal endometriosis and 22 controls (fertile patients submitted to tubal ligation). Serum dosages of IL-18 and peritoneal dosages of IL-18 were collected. RESULTS: The groups were not different in terms of age and BMI. There were no differences also between dosages of IL-18 in serum and peritoneal fluid of infertile women with endometriosis and control group: 290.85 ⫾ 46.24 pg/ml x 374.21 ⫾ 88.23 pg/ml and 391.07 ⫾ 31.99 x 373.42 ⫾ 34.5, respectively. We found a positive association between serum and peritoneal IL-18 in patients with endometriosis (r⫽0.722, P⫽0.004) and in the control group (r⫽0.851, P⫽0.001). Both correlation coefficients were not statistically different (P⬎0.05).
S259