P-423 EFFECTS OF LOWER DOSE ESTROGEN/PROGESTIN THERAPY ON METABOLIC PROFILE, CLIMATERIC SYMPTOMS, WEIGHT AND BODY MASS INDEX. F. Ayala A, M. Reyes, M. Castaneda D, A. Morales M, O. Vidal, J. Vazquez M. University Center of Reproductive Medicine, Hospital Universitario, UANL, Monterrey, NL, Mexico. OBJECTIVE: To evaluate the effects of hormone therapy with 1 mg 17b estradiol and 0.125 mg trimegestone administered orally on glicemia, lipid profile, Blatt-Kupperman scale, MenQOL scale, body weight and body mass index in healthy postmenopausal women. DESIGN: Prospective, descriptive. TABLE. Means and mean differences in measured variables before and after therapy
Variable
Baseline After 6 months Difference (mean) (mean) (baseline-6 months) P value
BK Scale 40 MenQOL scale 78.3 Satisfaction degree 64.1 Triglycerides 128.9 Total cholesterol 201.3 LDL-cholesterol 119.5 HDL-cholesterol 54.1 Blood glucose 92.1 Body weight 66.6 BMI 27.3
8 5.3 86.5 168 200.2 117.7 51.1 92.8 65.6 26.9
32 73.4 22.5 36.06 1.44 1.57 2.6 0.5 1 0.41
<0.0001 <0.0001 <0.0001 0.007 0.715 0.655 0.058 0.64 0.203 0.225
t Student test. MATERIALS AND METHODS: Sixty eight healthy postmenopausal women, with intact uterus, between 45 and 55 years old recieved lower dose estrogen progestin hormone therapy. Blood glucose, lipid profile, body weight, body mass index, Blatt-Kupperman scale score, MenQOL scale score and satisfaction degree were measured at tha begining of the study and after six months of therapy. Paired t student test was used. RESULTS: Mean age of the patients included was 50.8 (3.08) years. After six moths of treatment no difference was observed in metabolic profile parameters but triglycerides (P<0.007). Climateric indexes improved (P<0.0001) as well as satisfaction degree (P<0.0001) (Table 1). CONCLUSIONS: There was an important improvement in climateric index with low dose estrogen/progestin therapy measured by Blatt-Kupperman and MenQOL scales. There was a significant increase in triglycerides after six months of treatment. No changes were observed in body weight, body mass index, blood glucose and other parameters in lipid profile. Supported by: Wyeth. P-424 INCREASED CHANCES OF PREGNANCY INDUCED HYPERTENSION, GESTATIONAL DIABETES AND PREMATURE BIRTHS IN EGG DONATION RECIPIENTS. G. Fassolas, L. Semiao, A. L. Sgarbi, M. Riboldi, A. Massaguer, E. Motta. Huntington Reproductive Medicine, Sao Paulo, SP, Brazil. OBJECTIVE: An increasing number of women are delaying childbirth until an age when their fertility has significantly declined. Oocyte donation provides the opportunity for these women to successfully conceive. However, most investigators have noted an increased rate of obstetric and perinatal complications in women who got pregnant at or beyond the edge of reproductive age. In this study, we aim to assess the chances of pregnancy induced hypertension (PIH), gestational diabetes, premature births and abortions in egg donation recipients. DESIGN: Retrospective case-control study. MATERIALS AND METHODS: Women who had standard indication for oocyte donation were matched with an egg donor whose cycle was synchronized with that of the potential recipient, prior to the donor’s undertaking ovarian hyperstimulation and transvaginal ultrasound-directed follicle aspiration. The recipients who got pregnant in this ovodonation program from 2002 to 2006 were included in Group A. Overall information on pregnancy, delivery and puerperium were collected from medical files and personal interviews and the outcomes were compared with those of infertility patients at similar age to donors and that had pregnancies (group B). Association be-
FERTILITY & STERILITYÒ
tween groups and complications were assessed by Chi-square test and chances of developing associated complications were calculated by binary logistic regression. Levels of P%0.05 were considered significant. RESULTS: Seventy five recipients had pregnancies during the studied period and were included on group A. Their age was higher (42 0.52 years old; Mean SE) than women on group B (n ¼ 74; 29 0.35 years old). No complications other than pregnancy induced hypertension (PIH), prematurity, and gestational diabetes were significant associated to any group. Occurrence of PIH (R n ¼ 12; C n ¼ 5) was associated to group A. Recipients had 3.45 more chances of developing PIH than controls. Group A (n ¼ 9) tended to be associated to gestational diabetes (P¼0.07) and they have 3 times more chances of developing this endocrinopathy than B (n ¼ 4; P¼0.08). The chances of premature births were higher in group A (n ¼ 18) than in group B (n ¼ 11) (odds ratio¼2.43; P¼0.046) and abortion was not associated to neither groups. CONCLUSIONS: The risk of PIH and premature labor is higher in oocyte donation pregnancies, but the perinatal outcomes are favorable, thus egg donation recipients should be warned about risks and monitored for these complications. Supported by: None.
P-425 DOCUMENTED RELIEF OF VULVOVAGINAL ATROPHY SYMPTOMS USING A RESPONDER ANALYSIS. J. A. Simon, H. Hait, K. Z. Reape. Department of Obstetrics and Gynecology, Geroge Washington University School of Medicine, Washington, DC; Duramed Research, Inc., Bala Cynwyd, PA. OBJECTIVE: To evaluate the effect of synthetic conjugated estrogens, B, 0.3-mg tablets (SCE-B, ENJUVIAÔ) on the proportion of patients reporting reduction or complete elimination of vulvovaginal atrophy (VVA) symptoms. DESIGN: In a multicenter, double-blind, placebo-controlled clinical trial, 125 postmenopausal females with VVA were treated with SCE-B 0.3 mg daily for up to 12 weeks. MATERIALS AND METHODS: Patients rated 6 symptoms (vaginal dryness, irritation/itching, soreness, difficulty passing urine, dyspareunia, bleeding after intercourse) on a 4-point scale (none, mild, moderate, severe, or not applicable). For each of the 6 symptoms, the proportion of patients who reported each symptom as moderate or severe at baseline with a reduction in severity to mild or none by the end of treatment was determined for both treatment groups. Also, comparison of the proportion of patients reporting complete elimination of the symptom (severity rating of ‘‘none’’) by the end of treatment was performed. RESULTS: A more favorable proportion of SCE-B patients compared with placebo reported improvement in each symptom, with strong statistical significance seen for vaginal dryness (P<.0001) and dyspareunia (P¼.0005). For each symptom considered moderate or severe at baseline, the proportion of SCE-B patients with complete elimination of the symptom was consistently greater than for placebo, with statistical significance observed for dryness (P<.0001), irritation (P¼.0002), difficulty passing urine (P¼.002), and dyspareunia (P¼.0089). CONCLUSIONS: Responder analyses demonstrated a beneficial effect of SCE-B 0.3 mg daily compared with placebo in the proportion of patients reporting a reduction in severity or complete elimination of moderate-to-severe symptoms of VVA. Supported by: None.
P-426 PAST USE OF ORAL CONTRACEPTIVES AND HORMONE REPLACEMENT THERAPY IN WOMEN WITH ANGIOGRAPHIC CORONARY ARTERY DISEASE: A CASE-CONTROL STUDY. M. F. Silva de Sa´, R. B. Pava˜o, J. A. Marin-Neto, C. S. Vieira. Department of Gynaecology and Obstetrics, University of Sa˜o Paulo, Ribeira˜o Preto School of Medicine, Ribeira˜o Preto, Sa˜o Paulo, Brazil; Cardiology Division, Department of Internal Medicine, University of Sa˜o Paulo, Ribeira˜o Preto School of Medicine, Ribeira˜o Preto, Sa˜o Paulo, Brazil. OBJECTIVE: To evaluate the relationship between past use of hormone replacement therapy (HRT)/ oral contraceptives (OC) and angiographic coronary artery disease (CAD). DESIGN: A case-control study.
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MATERIALS AND METHODS: All women who were submitted to coronary angiography from January to December 2004 at the University Hospital, Ribeira˜o Preto School of Medicine (Brazil), were enrolled in this study and divided into two groups: with and without CAD. For the purposes of these analyses, coronary artery disease was defined as equal or greater than 70% luminal diameter stenosis in at least one epicardial coronary artery. The reproductive status was obtained from the medical records with a detailed questionnaire. We used unpaired t test, Fisher exact test or Qui-Square to compare the variables. RESULTS: Data were available for 203 of 383 patients who were submitted to angiocoronariography. Compared to patients without CAD (n ¼ 119), patients with CAD (n ¼ 84) were older (CAD: 62.8 11.1 years vs. no-CAD 53.1 12.1 years; P<0.0001), had a higher frequency of multiparity (CAD: 84% vs. no-CAD: 68%; P¼0.03) and a higher proportion of them was menopausal (CAD:97% vs. no-CAD:79%; P¼0.0009). The frequency of HRT use was higher among patients without CAD (CAD:28% vs. noCAD:56%), with the use of HRT being associated with a lower risk for CAD [odds-ratio: 3.2 (1.2–8.3)]. The use of OC was not associated with a significant reduction of risk for CAD and the frequency of OC use did not differ between groups. There was no difference in the time of use of HRT or OC between CAD and no-CAD patients (HRT use: CAD ¼ 4.9 4.2 years vs. no-CAD ¼ 2.7 2.1 years; P¼0.07; time of OC use: CAD ¼ 8.8 6.7 years vs. no-CAD ¼ 6.1 4.1 years; P¼0.08). CONCLUSIONS: HRT but not OC use is associated with a reduced risk for CAD. Supported by: Fundac¸a˜o de Amparo a` Pesquisa do Estado de Sa˜o Paulo (FAPESP, Foundation for the Support of Research in the State of Sa˜o Paulo).
SEXUALITY
P-428 EFFICACY OF TOLTERODINE EXTENDED RELEASE (TER) FOR PATIENT-REPORTED OUTCOMES (PROs) IN SEXUALLY ACTIVE POSTMENOPAUSAL WOMEN WITH OVERACTIVE BLADDER (OAB) AND URGENCY URINARY INCONTINENCE (UUI). G. Bachmann, J. T. Wang, J. D. Morrow, T. Bavendam. University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ; Pfizer Inc, New York, NJ. OBJECTIVE: To evaluate the efficacy of TER on PROs in sexually active, postmenopausal women with OAB. DESIGN: Double-blind, placebo (PBO)–controlled trial of TER. MATERIALS AND METHODS: This was a post hoc analysis of data from the subset of postmenopausal women with self-reported OAB (R8 voids, R3 urgency-related voids, and a mean R0.6 UUI episodes per 24 h) for R3 mo. Subjects were sexually active (self defined) and in a relationship with a man for R6 mo. Subjects were randomized to TER (4 mg) or PBO for 12 weeks. At baseline and week 12, subjects completed the Patient Perception of Bladder Condition (PPBC) and Overactive Bladder Questionnaire (OAB-q), which has a Symptom Bother scale and a health-related quality of life (HRQL) scale comprising 4 domains. Subjects also completed the Sexual Quality of Life Questionnaire-Female (SQOL-F) and Pelvic Organ Prolapse/ Urinary Incontinence Sexual Function (PISQ). RESULTS: Of the safety population, 51% (n ¼ 211) of women were postmenopausal. After 12 weeks, intent-to-treat postmenopausal women who received TER showed statistically significantly greater improvements on the PPBC vs. PBO; twice as many TER vs. PBO-treated subjects showed major improvement (Figure). Subjects who received TER also showed significant improvements on all scales/domains of the OAB-q except Social Interaction. The treatment difference was significant for the PISQ but not the SQOL-F (Table 1); the SQOL-F may be less sensitive to the OAB-specific impact on sexual quality of life in these women.
P-427 ANXIETY AND SEXUAL STRESS IN MEN AND WOMEN UNDERGOING INFERTILITY TREATMENT. B. D. Peterson, C. R. Newton, T. Feingold. Department of Psychology, Chapman University, Orange, CA; Reproductive Endocrinology and Infertility, London Health Sciences Centre, London, ON, Canada. OBJECTIVE: To better understand the specific nature of the relationship between anxiety and sexual infertility related stress in men and women. DESIGN: The study used a prospective study design involving consecutively referred patients at a university-affiliated teaching hospital. MATERIALS AND METHODS: The sample for this study was composed of men and women diagnosed with infertility and referred to a universityaffiliated teaching hospital for in vitro fertilization (IVF) and intrauterine insemination (IUI). Study measures included the Fertility Problem Inventory (FPI) and the Beck Anxiety Inventory (BAI). Independent samples t-tests, Pearson correlation coefficients, and standardized betas from linear regression analyses were used for statistical analyses. A total of 306 women and 295 men participated in the study. Three hundred forty-eight (58%) of the participants were scheduled to undergo IVF treatments, and 253 (42%) of participants were scheduled to undergo IUI treatment. RESULTS: Women reported greater anxiety and sexual infertility stress when compared to men. However, men and women showed a similar patterns in the way anxiety symptoms were related to sexual infertility stress with subjective anxiety and autonomic anxiety having the strongest relationship. Anxiety symptoms accounted for a significant proportion of the variance in sexual infertility stress for both sexes and predicted sexual stress to a considerable degree in men as anxiety symptoms explained 21% of the variance in sexual infertility related stress for men and 14% for women. CONCLUSIONS: Although this study found that there is more similarity than difference in how men and women experience anxiety and sexual infertility stress, the strong linkage between anxiety and sexual stress in men was surprising since males tend to report less sexual stress and also less anxiety. Sexual stress among men experiencing infertility may be more closely tied to performance anxiety rather than to a more general deterioration in sexual satisfaction associated with infertility. A recommendation for couples might include relaxing their schedule or taking a break from scheduled sexual activity. In addition, physicians can assist patients by providing basic education regarding the relationship between anxiety and sexual infertility stress, and by referring couples reporting heightened levels of sexual stress to mental health professionals who are knowledgeable about infertility-specific stress. Supported by: None.
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Abstracts
Figure
TABLE. OAB-q, SQOL-F, and PISQ Results*
Instrument QAB-q Symptom Bother Total HRQL Concern Coping Sleep Social Interaction SQOL-F Total PISO Total
Treatment Difference{
P Value
10.9 (3.2) 9.3 (2.8) 12.3 (3.3) 10.6 (3.2) 7.4 (3.6) 3.9 (2.1)
0.0008 0.001 0.0003 0.001 0.0424 0.0613
4.2 (2.5) 2.9 (1.3)
0.0898 0.0237
*One outlier was excluded from the analysis based on the UUI endpoint after statistical and clinical evaluation. y Lease squares mean (SD): positive score changes indicate improvement for all items except Symptom Bother.
Vol. 88, Suppl 1, September 2007