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Routine office Hysteroscopy with Endometrial Biopsy in an Infertility Clinic
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Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157
435 Concomitant Common Femoral Deep Vein Thrombosis, Pulmunary Embolus and Bilateral Tubo-Ovarian Abscesses Following IVF Treatment in a Patient with a Fibroid Uterus and Bilateral Endometriomas Singer T, Barnhard Y, Johnson L, Filmar G, Divon MY. Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY Study Objective: Educational. Design: Case report. Setting: Community Hospital. Patients: A 44 year-old patient presented 3 weeks following IVF treatment with nausea, vomiting, diarrhea, fever and abdominal pain radiating to her right shoulder. She was tachycardic, tachypneic, with diffuse abdominal tenderness and bilateral leg edema. Her pelvic exam revealed a large fibroid uterus. An elevated white count and negative BHCG were noted. Prior to the initiation of two unsuccessful IVF cycles, the patient was diagnosed with a large posterior fibroid and bilateral ovarian masses suspicious for endometriomas. The patient declined surgical treatment. Her fertility workup revealed an FSH of 6.6 and AMH of 1.8. Four embryos were transferred on each IVF cycle. Upon presentation a pelvic CT scan confirmed large, bilateral, complex adnexal masses with a posterior subserosal fibroid and a small amount of ascites.
An MRI revealed a complex rim-enhancing fluid collection within the adnexal masses bilaterally suggestive of a tubo-ovarian abscess. On Ultrasound doppler she was found to have a right common femoral vein thrombosis. A spiral CT angiogram revealed a right pulmonary embolus. Treatment was initiated with subcutaneous Lovenox and IV antibiotics. Transvaginal drainage of the adnexal masses was performed. The fluid cultures demonstrated E. coli. As the patient improved clinically, the drains were removed and she was discharged home 17 days after admission with Coumadin and IV antibiotics. A month later, the patient was readmitted with fever and abdominal pain. An IVC filter was inserted with subsequent bilateral salpingectomy and a 10 cm left ovarian abscess resection. Due to the patients’ desire to maximize her fertility, the right ovary and uterus were left intact. Six months later the IVC filter was removed and Coumadin stopped. The patient expressed interest in conceiving using her partner’s sperm and a donor egg. Intervention: N/A Measurements and Main Results: N/A Conclusion: This case emphasizes the importance of patient selection and counseling prior to initiation of IVF treatment.
436 Routine office Hysteroscopy with Endometrial Biopsy in an Infertility Clinic Ueno J,1 Ikeda F,1 Carvalho FM,2 Souza E,1 Wolff P.1 1Clinica GERA, Sa˜o Paulo, Brazil; 2Filomena M. Carvalho Anatomia Patolo´gica, Sa˜o Paulo, Brazil Study Objective: To evaluate the role of diagnostic hysteroscopy with endometrial biopsy in infertile patient work up. Design: Retrospective study. Setting: Infertility and gynecologic endoscopy private clinic. Patients: The mean age was 35,64 (25 e 47 year). Fifty-four patients underwent to diagnostic office hysteroscopy from august 2004 to September 2008. Intervention: All patients were infertile and haven’t had this hysteroscopy before. First author performed the exams in proliferative phase. Aspirative endometrial biopsy usually was done immediately after the hysteroscopy. Measurements and Main Results: Alterations that could cause infertility or IVF implantation fail were found in 22 out of 54 (40.7%) patients. Endometrial polyps 50% (11/22); endocervical polyps 31.8% (7/22); endometrits 27.3% (6/22); cervical canal estenosis 9,1 (2/22), complex hyperplasia without atipia 4.5% (1/22). Conclusion: Routine diagnostic Office hysteroscopy with biopsy could diagnose uterine alterations in 22 infertile patients (40.7%) that could be the cause of infertility or implantation fail.
LAPAROSCOPIC SURGERIES (EXCEPT HYSTERECTOMIES) 437 Predictors of Non-Adherence to Proper Post Operative Follow Up in Patients with Tubal Ectopic Pregnancy Undergoing Conservative Surgical Treatment Abdallah ME,1,2 Victory R,1 Ambler D,2 Diamond MP,1,2 Berman J.2 1 Division of REI, Dept of OBGYN, Wanyne State University, Detroit, MI; 2 Obstetrics and Gynecology, Wayne State University, Detroit, MI Study Objective: To determine predicting factors for noncompliance with proper post operative follow up in patients with tubal ectopic pregnancy (EP) undergoing salpingostomy. Design: Retrospective analysis of 712 consecutive EP patients treated between January 2000 and February 2005. Setting: University teaching hospital, Detroit, Michigan. Patients: 56 patients with EP undergoing conservative surgical treatment. Intervention: Salpingostomy via laparoscopy or laparotomy. Measurements and Main Results: 464 patients underwent surgical treatment of EP; 56 had salpingostomy (12%), 45 via laparoscopy (80%),
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157
435 Concomitant Common Femoral Deep Vein Thrombosis, Pulmunary Embolus and Bilateral Tubo-Ovarian Abscesses Following IVF Treatment in a Patient with a Fibroid Uterus and Bilateral Endometriomas Singer T, Barnhard Y, Johnson L, Filmar G, Divon MY. Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY Study Objective: Educational. Design: Case report. Setting: Community Hospital. Patients: A 44 year-old patient presented 3 weeks following IVF treatment with nausea, vomiting, diarrhea, fever and abdominal pain radiating to her right shoulder. She was tachycardic, tachypneic, with diffuse abdominal tenderness and bilateral leg edema. Her pelvic exam revealed a large fibroid uterus. An elevated white count and negative BHCG were noted. Prior to the initiation of two unsuccessful IVF cycles, the patient was diagnosed with a large posterior fibroid and bilateral ovarian masses suspicious for endometriomas. The patient declined surgical treatment. Her fertility workup revealed an FSH of 6.6 and AMH of 1.8. Four embryos were transferred on each IVF cycle. Upon presentation a pelvic CT scan confirmed large, bilateral, complex adnexal masses with a posterior subserosal fibroid and a small amount of ascites.
An MRI revealed a complex rim-enhancing fluid collection within the adnexal masses bilaterally suggestive of a tubo-ovarian abscess. On Ultrasound doppler she was found to have a right common femoral vein thrombosis. A spiral CT angiogram revealed a right pulmonary embolus. Treatment was initiated with subcutaneous Lovenox and IV antibiotics. Transvaginal drainage of the adnexal masses was performed. The fluid cultures demonstrated E. coli. As the patient improved clinically, the drains were removed and she was discharged home 17 days after admission with Coumadin and IV antibiotics. A month later, the patient was readmitted with fever and abdominal pain. An IVC filter was inserted with subsequent bilateral salpingectomy and a 10 cm left ovarian abscess resection. Due to the patients’ desire to maximize her fertility, the right ovary and uterus were left intact. Six months later the IVC filter was removed and Coumadin stopped. The patient expressed interest in conceiving using her partner’s sperm and a donor egg. Intervention: N/A Measurements and Main Results: N/A Conclusion: This case emphasizes the importance of patient selection and counseling prior to initiation of IVF treatment.
436 Routine office Hysteroscopy with Endometrial Biopsy in an Infertility Clinic Ueno J,1 Ikeda F,1 Carvalho FM,2 Souza E,1 Wolff P.1 1Clinica GERA, Sa˜o Paulo, Brazil; 2Filomena M. Carvalho Anatomia Patolo´gica, Sa˜o Paulo, Brazil Study Objective: To evaluate the role of diagnostic hysteroscopy with endometrial biopsy in infertile patient work up. Design: Retrospective study. Setting: Infertility and gynecologic endoscopy private clinic. Patients: The mean age was 35,64 (25 e 47 year). Fifty-four patients underwent to diagnostic office hysteroscopy from august 2004 to September 2008. Intervention: All patients were infertile and haven’t had this hysteroscopy before. First author performed the exams in proliferative phase. Aspirative endometrial biopsy usually was done immediately after the hysteroscopy. Measurements and Main Results: Alterations that could cause infertility or IVF implantation fail were found in 22 out of 54 (40.7%) patients. Endometrial polyps 50% (11/22); endocervical polyps 31.8% (7/22); endometrits 27.3% (6/22); cervical canal estenosis 9,1 (2/22), complex hyperplasia without atipia 4.5% (1/22). Conclusion: Routine diagnostic Office hysteroscopy with biopsy could diagnose uterine alterations in 22 infertile patients (40.7%) that could be the cause of infertility or implantation fail.
LAPAROSCOPIC SURGERIES (EXCEPT HYSTERECTOMIES) 437 Predictors of Non-Adherence to Proper Post Operative Follow Up in Patients with Tubal Ectopic Pregnancy Undergoing Conservative Surgical Treatment Abdallah ME,1,2 Victory R,1 Ambler D,2 Diamond MP,1,2 Berman J.2 1 Division of REI, Dept of OBGYN, Wanyne State University, Detroit, MI; 2 Obstetrics and Gynecology, Wayne State University, Detroit, MI Study Objective: To determine predicting factors for noncompliance with proper post operative follow up in patients with tubal ectopic pregnancy (EP) undergoing salpingostomy. Design: Retrospective analysis of 712 consecutive EP patients treated between January 2000 and February 2005. Setting: University teaching hospital, Detroit, Michigan. Patients: 56 patients with EP undergoing conservative surgical treatment. Intervention: Salpingostomy via laparoscopy or laparotomy. Measurements and Main Results: 464 patients underwent surgical treatment of EP; 56 had salpingostomy (12%), 45 via laparoscopy (80%),