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P-439
broids appear to influence the fertility of women between the ages of 26 to 45. In addition, it appears that the earlier that woman have myomectomy surgery the greater the likelihood of post-surgery fertility. Finally, myomectomy surgery is most beneficial for women with primary and secondary infertility as the indication for surgery Supported by: None
P-439 THE USE OF LAPAROSCOPIC NEEDLE ROUND LIGAMENT SHORTENING PROCEDURE (UPLIFT) PRIOR TO EMBRYO TRANSFER. P. M. Ahlering. Sher Institute for Reproductive Medicine, St Louis, Creve coeur, MO. OBJECTIVE: to describe the use of the UPLIFT device in patients with severe retroverted uterus to facilitate IVF/ET. DESIGN: case reports Patients: 2 cases in which the women had severe retroversion of the uterus is association with prior caesarean section in other pregnancies. They had both failed IVE ET before, performed due to seer male factor in each case, secondary to intra-cervical loss of the embryos during very difficult US guided ET. The 2 females had prior exaggerated uterine retroversion whereby the cervix was fixed at the site of prior caesarean section incision in the area of the bladder flap in addition to the usual cervical anatomic fixation at the cardinal ligament insertion to the upper vaginal cuff. Thus a severe angulation was created at the upper cervix, in the area of the internal os. During prior ET, despite standard methods to correct the issue (cervical tenaculum, flexible catheter use, etc) embryos were lost in the cervix. Setting: private practice MATERIALS AND METHODS: The UPLIFT device is a needle in trocar device that is guided externally through a 2mm vertical incision above the anterior superior iliac spine, in the area of the internal inguinal ring as seen via laparoscopy internally. The needle is thread throguh the round ligament exiting just proximal to its uterine attachment. A single suture is grasped and retracted through the ligament and tied externally forming a supportive fascial bridge. IVF ET was done one month later in these patients post procedure. RESULTS: In the post procedure follow up, the uterine retroversion was completely relieved, normalizing the uterine anatomical position. Both patients tolerated the outpatient procedure nicely. The subsequent IVF/ET in each patient was smooth and uncomplicated, resulting in ongoing pregnancies currently in the second trimester. One singleton and one twin gestation. This UPLIFT technique is a useful tool for correcting uterine retroversion in such cases, especially if prior difficult US guided ET. CONCLUSION: This UPLIFT technique is a simple, useful laparoscopic tool for correcting severe uterine retroversion in such cases, especially if prior difficult US guided ET. Supported by: None
FT treatment was 34.5% (71/212) over a follow-up period of 4 months to 2 years. Most pregnancy occurred within the 6 months of treatment. Within 71 pregnancy cases, one ectopic pregnancy had occurred. Pregnancy rate didn’t decrease under the age of 40 years. In bilateral tubal stenosis, the level of damaged tubal lumen is connected with the following low pregnancy out comes (7.1%). Both Chlamydia infection and damaged tubal each portion were not related to the pregnancy rate. There was no difference in the pregnancy rate between normal and abnormal findings of uterotubal ostium with hysterofiberscopy. CONCLUSION: This FT technique is useful for the patients with tubal infertility. FT is recommended to the selected patients with tubal infertility below 40 years old before conducting IVF. Patients who had abnormal tubal folds almost allover the tube were observed with lower pregnancy rate following FT. Therefore it is recommended to reconsider the therapeutic plan for these patients at an early stage after FT. Supported by: None
P-441 INVESTIGATION OF OFTEN REPORTED TEN PERCENT HYSTEROSCOPY FLUID OVERFILL: IS THIS ACCURATE? C. Nezhat, D. Fisher. Nezhat Medical Center, Atlanta, GA. OBJECTIVE: The purpose of this study was to measure the volume and mass of irrigation fluid bags to assess the overfill of three common types of hysteroscopy irrigation fluids, 0.9% Normal Saline, 3% Sorbitol, and 1.5% Glycine to challenge the often quoted standard of assumption that overfill may be as high as 10% of the bag’s volume. DESIGN: Comparative descriptive design. MATERIALS AND METHODS: Ten cases of irrigation fluid were obtained from the company. The volume and weight of drained fluid from 18 bags of 2000mL 0.9% Normal Saline, 12 bags 3000mL 3% Sorbitol, 8 bags of 3000mL 1.5% Glycine, and 4 bags of 5000mL 0.9% Normal Saline were measured. Institutional Review Board exemption was obtained. RESULTS: By volume, depending on the type of the fluids tested, the maximum overfill was observed to be between 3.3-5.0%. For confirmation, each bag was also weighed and found to have a maximum overfill between 2.8-5.6%, dependent on the volume and type of fluid measured. These findings were then compared to the manufacturer-provided overfill range of 1.5-6.0%. CONCLUSION: A key component of hysteroscopic complications such as fluid overload and severe dilutional hyponatremia are due to the failure to anticipate and quickly recognize fluid deficits. Contrary to assertions over the last 25 years that overfill is 10% or higher as a rule, it appears more reasonable to assume that (1) the degree of overfill is contingent upon the type and volume of fluid used; and (2) is more likely closer to 2.8-5.6%. Supported by: All materials used in the study were donated by the respective companies.
P-440 CLINICAL OUTCOMES FOLLOWING FALLOPOSCOPIC TUBOPLASTY(FT) FOR TUBAL INFERTILITY. S. Kokeguchi, J. Watanabe, M. Matsunaga, S. Goto, M. Shiotani. Hanabusa Women‘s Clinic, Kobe City, Hyogo, Japan. OBJECTIVE: Falloposcopic Tuboplasty(FT) has been established as a highly useful, less invasive and novel treatment for women with tubal infertility. The aim of this study was to evaluate the pregnancy outcome with in patient’s category, such as age, damaged lesion of tubal parts, Chlamydia infection, uterotubal ostium lesion by hysterofiberscopy and folds in the tubal lumen by FT. Another aim was within what month most pregnancy occurs after successful FT. DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 206 women with confirmed bilateral or unilateral occlusion and stenosis were studied. These patients had been diagnosed by hysterosalpingogram at least twice. Patients with hydrosalpinges, male factor and high FSH were excluded from this study. Lesions in the tubal lumen were observed falloposcopically during retrograde imaging after complete cannulation with the linear everting catheter system. RESULTS: FT successfully accessed 97% (206/212). There were no operative and postoperative complications. The rate of pregnancy following
FERTILITY & STERILITY威
P-442 LAPAROSCOPIC TRANSABDOMINAL ISTHMIC CERCLAGE IN A CASE OF CERVICAL AGENESIS AND A SUCCESSFUL PREGNANCY WITH ICSI: A CASE REPORT. Y. Karaman, B. Bingol, Z. Gunenc. Metropolitan Florence Nightingale Hospital, Istanbul, Turkey. OBJECTIVE: To construct a laparoscopic transabdominal isthmic cerclage in a patient with cervical agenesis. DESIGN: A case report. MATERIALS AND METHODS: A 39-year-old woman diagnosed with primary infertility due to cervical agenesis was admitted to our hospital because of recurrent ART failures. She underwent three operations for acute abdominal pain due to endometriosis and pyometra. There was a tiny fistula-like opening at the level of the isthmus, through which menstrual blood passed. Three ICSI attempts with transmyometrial transfer failed in three different IVF centres. We performed a laparoscopic transabdominal isthmic cerclage to prevent a miscarriage due to a clinical condition similar to cervical insufficiency and then an ICSI procedure was performed. RESULTS: We delivered a healthy baby weighing 3200 grams by Caesarean section. We left the cerclage in place for subsequent pregnancies. CONCLUSION: To the best of our knowledge, this is the first report of laparoscopic isthmic cerclage for prevention of a clinical condition similar
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P-439 THE USE OF LAPAROSCOPIC NEEDLE ROUND LIGAMENT SHORTENING PROCEDURE (UPLIFT) PRIOR TO EMBRYO TRANSFER. P. M. Ahlering. Sher Institute for Reproductive Medicine, St Louis, Creve coeur, MO. OBJECTIVE: to describe the use of the UPLIFT device in patients with severe retroverted uterus to facilitate IVF/ET. DESIGN: case reports Patients: 2 cases in which the women had severe retroversion of the uterus is association with prior caesarean section in other pregnancies. They had both failed IVE ET before, performed due to seer male factor in each case, secondary to intra-cervical loss of the embryos during very difficult US guided ET. The 2 females had prior exaggerated uterine retroversion whereby the cervix was fixed at the site of prior caesarean section incision in the area of the bladder flap in addition to the usual cervical anatomic fixation at the cardinal ligament insertion to the upper vaginal cuff. Thus a severe angulation was created at the upper cervix, in the area of the internal os. During prior ET, despite standard methods to correct the issue (cervical tenaculum, flexible catheter use, etc) embryos were lost in the cervix. Setting: private practice MATERIALS AND METHODS: The UPLIFT device is a needle in trocar device that is guided externally through a 2mm vertical incision above the anterior superior iliac spine, in the area of the internal inguinal ring as seen via laparoscopy internally. The needle is thread throguh the round ligament exiting just proximal to its uterine attachment. A single suture is grasped and retracted through the ligament and tied externally forming a supportive fascial bridge. IVF ET was done one month later in these patients post procedure. RESULTS: In the post procedure follow up, the uterine retroversion was completely relieved, normalizing the uterine anatomical position. Both patients tolerated the outpatient procedure nicely. The subsequent IVF/ET in each patient was smooth and uncomplicated, resulting in ongoing pregnancies currently in the second trimester. One singleton and one twin gestation. This UPLIFT technique is a useful tool for correcting uterine retroversion in such cases, especially if prior difficult US guided ET. CONCLUSION: This UPLIFT technique is a simple, useful laparoscopic tool for correcting severe uterine retroversion in such cases, especially if prior difficult US guided ET. Supported by: None
FT treatment was 34.5% (71/212) over a follow-up period of 4 months to 2 years. Most pregnancy occurred within the 6 months of treatment. Within 71 pregnancy cases, one ectopic pregnancy had occurred. Pregnancy rate didn’t decrease under the age of 40 years. In bilateral tubal stenosis, the level of damaged tubal lumen is connected with the following low pregnancy out comes (7.1%). Both Chlamydia infection and damaged tubal each portion were not related to the pregnancy rate. There was no difference in the pregnancy rate between normal and abnormal findings of uterotubal ostium with hysterofiberscopy. CONCLUSION: This FT technique is useful for the patients with tubal infertility. FT is recommended to the selected patients with tubal infertility below 40 years old before conducting IVF. Patients who had abnormal tubal folds almost allover the tube were observed with lower pregnancy rate following FT. Therefore it is recommended to reconsider the therapeutic plan for these patients at an early stage after FT. Supported by: None
P-441 INVESTIGATION OF OFTEN REPORTED TEN PERCENT HYSTEROSCOPY FLUID OVERFILL: IS THIS ACCURATE? C. Nezhat, D. Fisher. Nezhat Medical Center, Atlanta, GA. OBJECTIVE: The purpose of this study was to measure the volume and mass of irrigation fluid bags to assess the overfill of three common types of hysteroscopy irrigation fluids, 0.9% Normal Saline, 3% Sorbitol, and 1.5% Glycine to challenge the often quoted standard of assumption that overfill may be as high as 10% of the bag’s volume. DESIGN: Comparative descriptive design. MATERIALS AND METHODS: Ten cases of irrigation fluid were obtained from the company. The volume and weight of drained fluid from 18 bags of 2000mL 0.9% Normal Saline, 12 bags 3000mL 3% Sorbitol, 8 bags of 3000mL 1.5% Glycine, and 4 bags of 5000mL 0.9% Normal Saline were measured. Institutional Review Board exemption was obtained. RESULTS: By volume, depending on the type of the fluids tested, the maximum overfill was observed to be between 3.3-5.0%. For confirmation, each bag was also weighed and found to have a maximum overfill between 2.8-5.6%, dependent on the volume and type of fluid measured. These findings were then compared to the manufacturer-provided overfill range of 1.5-6.0%. CONCLUSION: A key component of hysteroscopic complications such as fluid overload and severe dilutional hyponatremia are due to the failure to anticipate and quickly recognize fluid deficits. Contrary to assertions over the last 25 years that overfill is 10% or higher as a rule, it appears more reasonable to assume that (1) the degree of overfill is contingent upon the type and volume of fluid used; and (2) is more likely closer to 2.8-5.6%. Supported by: All materials used in the study were donated by the respective companies.
P-440 CLINICAL OUTCOMES FOLLOWING FALLOPOSCOPIC TUBOPLASTY(FT) FOR TUBAL INFERTILITY. S. Kokeguchi, J. Watanabe, M. Matsunaga, S. Goto, M. Shiotani. Hanabusa Women‘s Clinic, Kobe City, Hyogo, Japan. OBJECTIVE: Falloposcopic Tuboplasty(FT) has been established as a highly useful, less invasive and novel treatment for women with tubal infertility. The aim of this study was to evaluate the pregnancy outcome with in patient’s category, such as age, damaged lesion of tubal parts, Chlamydia infection, uterotubal ostium lesion by hysterofiberscopy and folds in the tubal lumen by FT. Another aim was within what month most pregnancy occurs after successful FT. DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 206 women with confirmed bilateral or unilateral occlusion and stenosis were studied. These patients had been diagnosed by hysterosalpingogram at least twice. Patients with hydrosalpinges, male factor and high FSH were excluded from this study. Lesions in the tubal lumen were observed falloposcopically during retrograde imaging after complete cannulation with the linear everting catheter system. RESULTS: FT successfully accessed 97% (206/212). There were no operative and postoperative complications. The rate of pregnancy following
FERTILITY & STERILITY威
P-442 LAPAROSCOPIC TRANSABDOMINAL ISTHMIC CERCLAGE IN A CASE OF CERVICAL AGENESIS AND A SUCCESSFUL PREGNANCY WITH ICSI: A CASE REPORT. Y. Karaman, B. Bingol, Z. Gunenc. Metropolitan Florence Nightingale Hospital, Istanbul, Turkey. OBJECTIVE: To construct a laparoscopic transabdominal isthmic cerclage in a patient with cervical agenesis. DESIGN: A case report. MATERIALS AND METHODS: A 39-year-old woman diagnosed with primary infertility due to cervical agenesis was admitted to our hospital because of recurrent ART failures. She underwent three operations for acute abdominal pain due to endometriosis and pyometra. There was a tiny fistula-like opening at the level of the isthmus, through which menstrual blood passed. Three ICSI attempts with transmyometrial transfer failed in three different IVF centres. We performed a laparoscopic transabdominal isthmic cerclage to prevent a miscarriage due to a clinical condition similar to cervical insufficiency and then an ICSI procedure was performed. RESULTS: We delivered a healthy baby weighing 3200 grams by Caesarean section. We left the cerclage in place for subsequent pregnancies. CONCLUSION: To the best of our knowledge, this is the first report of laparoscopic isthmic cerclage for prevention of a clinical condition similar
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