- Email: [email protected]
The effect of myomectomy on in vitro fertilization-embryo transfer (IVF-ET) cycle outcome: the oocyte donation model
stages. One protein spot was significantly increased in women with stage I/II (n ⫽ 6) compared with those with stage III/IV (n ⫽ 17) (p ⬍ 0.05). Five protein spots were significantly increased in women with stage III/IV compared with those with stage I/II (p ⬍ 0.05). Conclusion: These preliminary data, to our knowledge, define for the first time the proteome of PF and plasma in women with endometriosis. Pathological changes related to different stages of endometriosis seem to be reflected in the proteomic patterns of PF. These findings pave the way for a more detailed characterization of the structure and function of the identified protein spots.
Monday, October 13, 2003 5:00 P.M. O-91 P53 perturbations in endometriosis detected by quantitative real-time PCR: Further evidence of late somatic DNA alterations. Farideh Z. Bischoff, Dianne Dang, Alfred Poindexter, Dorothy Mitchell-Leef, John E. Buster, Joe Leigh Simpson. Baylor Coll of Medicine, Houston, TX; Southern Fertility Institure, Atlanta, GA. Objective: Although essentially a benign disease, endometriosis shares several features with malignancy, including local invasion of tissues and metastasis to distant organs. Thus, the multistep pathway resulting in cellular transformation is considered a valid model to investigate underlying genetic cause in endometriosis. In previous studies, we utilized fluorescent in situ hybridization (FISH) techniques to demonstrate that perturbations of chromosome 17 in general and the p53 locus in particular occur frequently in severe/late-stage endometriosis (Shin et al., 1997; Kosugi et al., 1999). Although FISH provides an attractive approach for single-cell analysis to detect somatic alterations in cells specifically localized to endometriotic lesions, the approach is not only tedious and labor-intensive but also limited by the availability and cost of fluorescently labeled probes. Alternatively, we employed quantitative real-time PCR for more accurate high-throughput assessment of aberrations involving p53 copy number in normal and endometriotic tissue specimens. Design: To examine matched normal blood and endometriotic DNA for quantitative differences in p53 and GAPDH (control locus) copy number compared to normal blood DNA from unaffected women. Methods: Under IRB approval, we obtained fresh surgical tissue specimens and a peripheral blood sample from 22 women undergoing extirpation of advanced stage disease. As a control group, peripheral blood from 28 unaffected women undergoing tubal ligation was also collected. DNA from all tissue specimens was extracted using the QIAamp DNA purification kit. Real-time quantitative PCR (TaqMan Assay; Applied Biosystems) to detect conserved sequences within exon 1 of the p53 gene was performed using the GeneAmp 7700 Sequence Detection System. The ubiquitous autosomal glyceraldehyde-3-phosphate dehydrogenase (GAPDH) locus served as an internal control for PCR efficiency and was used to normalize the values for p53 sequence copies detected. Thus, normalized values reflect the ratio of p53 to GAPDH copies detected. In a normal cell, a normalized value of 1.0 would be expected since both p53 and GAPDH would each contribute two copies. Results: Among control-unaffected cases, normalized mean of 1.003 existed for the p53 locus. No significant differences (P ⬎0.485) in the normalized values for p53 were observed between the unaffected controls and endometriosis subjects (peripheral blood). However, significant (P⬍0.008) loss or gain of p53 sequences was detected in 17 of 22 (77%) endometriotic tissue specimens. In 13 of the 17 cases, variable gain in p53 sequences was observed (2- to 589-fold greater compared to GAPDH). However, in the remaining 4 cases, loss in p53 sequences was observed, 0.5-fold compared to GAPDH. Conclusion: Our results support the role of non-random somatic alterations involving the p53 locus in the pathogenesis of most cases (77%) of late/sever stage endometriosis. The perturbations could be either gain or loss of p53, consistent with mutation of p53 being not an initial event but a late step. Although the sensitivity of this approach is similar to that of FISH, real-time PCR is semi-automated, allowing for high-throughput evaluation of many more genes and/or chromosomal regions. Therefore, real-time PCR provides an improved method for candidate gene screening at both the DNA and RNA level in endometriosis.
FERTILITY & STERILITY威
REPRODUCTIVE SURGERY Monday, October 13, 2003 2:00 P.M. O-92 The hysteroscopic correction of an incomplete uterine septum may have a positive impact on IVF outcome. Kemal Ozgur, Mete Isikoglu, Sergio Oehninger, Levent Donmez. Antalya IVF Ctr, Antalya, Turkey; Jones Institute, Eastern Virginia Medical Sch, Norfolk, VA; Akdeniz Univ Dept of Public Health, Antalya, Turkey. Objective: Complete or incomplete septum represents 22% of the Mullerian anomalies, and is the most frequent symptomatic uterine malformation. The effect of an incomplete septum has not been investigated in an infertile population. In a previous study we have reported on the measurement of incomplete septum using transvaginal ultrasonography in a nonselected infertile population (1). In this study we examined the potential effect of a hysteroscopic incision of the incomplete septum on the outcome of IVF. Design: A total of 235 women presenting to our center were prospectively studied. Materials and Methods: Measurement of the Fm (Fundal myometrial thickness) and Cm (Cornual myometrial thickness) by transvaginal sonography (TvUSG) and sonohysterography (SHG) was performed with 7,5 MHz transvaginal transducer. Fm was measured at midsagittal plane while both the fundal and the cervical ends of the uterus were imaged on the screen. By sweeping the transducer from midline to lateral fornix at midsagital section, Cm was measured where the myometrium is the thinnest. Transverse sections were also evaluated for a double-lumen appearance. The patients were divided into two groups according to sonohysterographic measurements of Fm-Cm. Group 1 consisted of 119 patients with Fm-Cm values ⱕ5 mm who underwent hysteroscopic incision. The hysteroscopy procedure was performed under general anesthesia and L type coagulation electrode with a hysteroscopic resectoscope was used (Karl Storz, Germany). Group 2 consisted of 116 control patients with Fm-Cm values ⬍5 mm who did not have incision. Clinical pregnancy and miscarriage rates were documented. The study was approved by the institutional review board. Results: In the history there were more abortions in group 1 compared to group 2, 17 (14,20%) versus 7 (6,03%) (p ⫽ 0,04). At least one previous IVF failure history was also more frequent in group 1, 39 (32.7 %) vs 24 (20.6%) (p ⫽ 0.04). However, the study showed that the IVF outcome results were similar in both groups regarding the clinical pregnancy and pregnancy loss; 57 (47,80%) vs 54 (46,50%) (p ⫽ 0,83) and 6 (10,52%) vs 11 (20,3%) (p ⫽ 0,19), respectively. Two patients had postoperative intracavitary collection that resolved with intrauterine aspiration. We have not seen any uterine wall perforation or infection. Conclusion: This is the first study investigating the impact of hysteroscopic correction of an incomplete septum in an ART program. According to our findings it was evident that the history of pregnancy loss and the history of IVF failure was more frequent in the incomplete septum group when compared with the normal group. Importantly, we have also found similar pregnancy outcome after the incision of the incomplete septum compared to the normal group. However larger prospective randomized controlled studies are needed to prove the positive effect of correction of incomplete septum on ART outcome. 1. ESHRE 2003 meeting, Madrid, Spain, poster presentation.
Monday, October 13, 2003 2:15 P.M. O-93 The effect of myomectomy on in vitro fertilization-embryo transfer (IVF-ET) cycle outcome: The oocyte donation model. Eric S. Surrey, Debra A. Minjarez, John M. Stevens, William B. Schoolcraft. Colorado Ctr for Reproductive Medicine, Englewood, CO. Objective: Previous investigators have reported that the presence of submucosal (SM) or intramural (IM) leiomyomata (leio) may exert an adverse effect on IVF-ET cycle pregnancy and/or implantation rates (EldarGeva et al, Fertil Steril 1998;70:687-91;Hart et al, Hum Reprod 2001;16: 2411-17;Surrey et al, Fertil Steril 2001;75:405-10). The impact of precycle
S35
myomectomy (myo) on these parameters has not been extensively evaluated and is the goal of the current investigation. In an effort to more adequately control for age-related variability in oocyte quality, an oocyte donation (ED) model has been employed. Design: Retrospective case-controlled trial in a tertiary care assisted reproductive technology program. Materials and Methods: Consecutive patients who underwent ED with fresh ET performed between 1/1/00 and 12/31/02 were evaluated.All recipients underwent routine pre-cycle ultrasound and office hysteroscopic evaluation. Patients with SM leio underwent pre-cycle hysteroscopic (HSC) myomectomy (group I). A second group with either large SM leio with significant IM extension or with IM leio that distorted, impinged upon, or immediately abutted the endometrial cavity with ⬍2 mm of normal myometrium underwent myomectomy by laparotomy (LAP) (group II). All procedures were performed by one of the authors. A control group consisted of all other ED patients without such lesions who underwent a fresh ET during this time period (group III). The only exclusions were those who did not undergo fresh ET. Controlled ovarian hyperstimulation, oocyte aspiration (OPU), insemination, and culture techniques as well as criteria for day 3 vs. 5 ET have been previously described (Gardner et al, Hum Reprod 1998;13:3434-40). Serum hCG levels were obtained 14 days after OPU and initial pregnancy ultrasound was performed 2 weeks thereafter. Data analysis: Student’s group t tests and Chi square analysis as appropriate. Ongoing pregnancy rate (OPR): number of intrauterine pregnancies with cardiac activity/number ET procedures. Implantation rate (IR): number of intrauterine gestational sacs with cardiac activity/ total number of embryos transferrred. Biochemical pregnancy rate (Bio): number of ⫹ hCG tests in the absence of an ongoing pregnancy/number ET procedures. Results: Results are displayed in Table 1 below and expressed as mean ⫾ SEM unless otherwise indicated.
* p ⬍ 0.05 vs. Gr. II ⫹p ⬍ 0.01 vs. Gr. I Conclusion: Myomectomy performed by HSC or LAP for SM or IM leio that impinge upon or distort the uterine cavity regardless of size result in ongoing pregnancy, implantation, and early pregnancy loss rates after oocyte donation that were similar to controls. The importance of pre-cycle uterine cavity evaluation cannot be overemphasized.
Monday, October 13, 2003 2:30 P.M. O-94 Abdominal myomectomy: Risk factors for intraoperative and postoperative complications. Ben E. Montgomery, Michael J. Glassner, Charles J. Dunton. The Lankenau Hosp, Wynnewood, PA. Objective: To characterize preoperative and intraoperative risk factors for complications associated with abdominal myomectomy. Design: Retrospective cohort review. Materials and Methods: The medical records of 331 patients having undergone abdominal myomectomy by a single operator from March 1994 to November 2002 were reviewed. Potential risk factors for operative and postoperative complications included race, number of fibroids, total fibroid weight, largest fibroid, prior abdominal surgery, prior abdominal myomectomy, uterine size, and patient weight. Outcome measures included length of hospital admission, requirement for blood transfusion, operative estimated blood loss (EBL), operative and postoperative complications, and duration of operative procedure. Results: Estimated Student’s t tests were used to determine statistical significance among the outcome measures EBL, length of admission, and duration of operative procedure. After univariate analysis, race (black versus white), number of fibroids greater than 10, prior abdominal surgery, prior abdominal myomectomy, and uterine size greater than 20 weeks were
S36
Abstracts
found to significantly increase EBL, length of hospital admission, and the duration of operative procedure (p ⬍ 0.05). Only 10 major intraoperative and postoperative complications occurred in the study group (3.0%), and only four patients required blood transfusions (1.2%). Secondary to the small number of intraoperative and postoperative complications and blood transfusions, Fisher’s exact test was used to determine statistical significance among these two outcome measures. More than 10 fibroids and black race were noted to significantly increase the incidence of intraoperative and postoperative complications (p ⬍ 0.05). At the time of this writing, data is undergoing multivariate analysis. The multivariate analyses will account for the correlations among the patients’ baseline variables. Multiple regression will be used for the variables EBL, length of admission, and duration of operative procedure. Logistic regression will be used to analyze data regarding the number of blood transfusions and intraoperative and postoperative complications.
Conclusion: Abdominal myomectomy is a relatively safe procedure to treat uterine fibroids. There are, however, several preoperative risk factors that may identify women at risk for intraoperative and postoperative complications.
Monday, October 13, 2003 2:45 P.M. O-95 Asherman’s syndrome: Etiologic factors, patterns of pregnancy loss, and treatment results. Results from an international registry. Steven F. Palter, Poly Spyrou. Reproductive Medicine and Surg Ctr, Syosset, NY. Objective: To characterize the clinical features of Asherman’s syndrome (AS-intrauterine synechiae) etiologic risk factors, patterns of pregnancy loss, and patterns of menstruation, before and after treatment and treatment results. Design: Online registry of surgically confirmed cases of Asherman’s syndrome with follow-up questionnaires. Materials and Methods: Subjects were members of an international patient support group. Data was collected by submission to an online registry of cases. Patients diagnosed by their treating physician downloaded a standard questionnaire and the questions were answered in conjunction with the treating physician. By design the patients were treated worldwide. Two hundred ninety-seven women confirmed with AS by hysteroscopy or imaging representing the world’s largest data-set of AS cases comprised the subjects. The questionnaire queried them on clinical features pre- and post-treatment. Results: The vast majority of cases of AS followed either a full-term pregnancy or a pregnancy loss. Most patients (93%) previously conceived however pregnancy loss was extremely common— only 61% achieved a live-born child before treatment. First trimester losses were the most common and were more frequent than would be expected (49% of all pregnancies). Similarly, second and third trimester losses were four times more common than would be expected (8.5% of all pregnancies). Five and one-half percent of women had the loss of a multiple gestation pregnancy.
Vol. 80, Suppl. 3, September 2003
Monday, October 13, 2003 5:00 P.M. O-91 P53 perturbations in endometriosis detected by quantitative real-time PCR: Further evidence of late somatic DNA alterations. Farideh Z. Bischoff, Dianne Dang, Alfred Poindexter, Dorothy Mitchell-Leef, John E. Buster, Joe Leigh Simpson. Baylor Coll of Medicine, Houston, TX; Southern Fertility Institure, Atlanta, GA. Objective: Although essentially a benign disease, endometriosis shares several features with malignancy, including local invasion of tissues and metastasis to distant organs. Thus, the multistep pathway resulting in cellular transformation is considered a valid model to investigate underlying genetic cause in endometriosis. In previous studies, we utilized fluorescent in situ hybridization (FISH) techniques to demonstrate that perturbations of chromosome 17 in general and the p53 locus in particular occur frequently in severe/late-stage endometriosis (Shin et al., 1997; Kosugi et al., 1999). Although FISH provides an attractive approach for single-cell analysis to detect somatic alterations in cells specifically localized to endometriotic lesions, the approach is not only tedious and labor-intensive but also limited by the availability and cost of fluorescently labeled probes. Alternatively, we employed quantitative real-time PCR for more accurate high-throughput assessment of aberrations involving p53 copy number in normal and endometriotic tissue specimens. Design: To examine matched normal blood and endometriotic DNA for quantitative differences in p53 and GAPDH (control locus) copy number compared to normal blood DNA from unaffected women. Methods: Under IRB approval, we obtained fresh surgical tissue specimens and a peripheral blood sample from 22 women undergoing extirpation of advanced stage disease. As a control group, peripheral blood from 28 unaffected women undergoing tubal ligation was also collected. DNA from all tissue specimens was extracted using the QIAamp DNA purification kit. Real-time quantitative PCR (TaqMan Assay; Applied Biosystems) to detect conserved sequences within exon 1 of the p53 gene was performed using the GeneAmp 7700 Sequence Detection System. The ubiquitous autosomal glyceraldehyde-3-phosphate dehydrogenase (GAPDH) locus served as an internal control for PCR efficiency and was used to normalize the values for p53 sequence copies detected. Thus, normalized values reflect the ratio of p53 to GAPDH copies detected. In a normal cell, a normalized value of 1.0 would be expected since both p53 and GAPDH would each contribute two copies. Results: Among control-unaffected cases, normalized mean of 1.003 existed for the p53 locus. No significant differences (P ⬎0.485) in the normalized values for p53 were observed between the unaffected controls and endometriosis subjects (peripheral blood). However, significant (P⬍0.008) loss or gain of p53 sequences was detected in 17 of 22 (77%) endometriotic tissue specimens. In 13 of the 17 cases, variable gain in p53 sequences was observed (2- to 589-fold greater compared to GAPDH). However, in the remaining 4 cases, loss in p53 sequences was observed, 0.5-fold compared to GAPDH. Conclusion: Our results support the role of non-random somatic alterations involving the p53 locus in the pathogenesis of most cases (77%) of late/sever stage endometriosis. The perturbations could be either gain or loss of p53, consistent with mutation of p53 being not an initial event but a late step. Although the sensitivity of this approach is similar to that of FISH, real-time PCR is semi-automated, allowing for high-throughput evaluation of many more genes and/or chromosomal regions. Therefore, real-time PCR provides an improved method for candidate gene screening at both the DNA and RNA level in endometriosis.
FERTILITY & STERILITY威
REPRODUCTIVE SURGERY Monday, October 13, 2003 2:00 P.M. O-92 The hysteroscopic correction of an incomplete uterine septum may have a positive impact on IVF outcome. Kemal Ozgur, Mete Isikoglu, Sergio Oehninger, Levent Donmez. Antalya IVF Ctr, Antalya, Turkey; Jones Institute, Eastern Virginia Medical Sch, Norfolk, VA; Akdeniz Univ Dept of Public Health, Antalya, Turkey. Objective: Complete or incomplete septum represents 22% of the Mullerian anomalies, and is the most frequent symptomatic uterine malformation. The effect of an incomplete septum has not been investigated in an infertile population. In a previous study we have reported on the measurement of incomplete septum using transvaginal ultrasonography in a nonselected infertile population (1). In this study we examined the potential effect of a hysteroscopic incision of the incomplete septum on the outcome of IVF. Design: A total of 235 women presenting to our center were prospectively studied. Materials and Methods: Measurement of the Fm (Fundal myometrial thickness) and Cm (Cornual myometrial thickness) by transvaginal sonography (TvUSG) and sonohysterography (SHG) was performed with 7,5 MHz transvaginal transducer. Fm was measured at midsagittal plane while both the fundal and the cervical ends of the uterus were imaged on the screen. By sweeping the transducer from midline to lateral fornix at midsagital section, Cm was measured where the myometrium is the thinnest. Transverse sections were also evaluated for a double-lumen appearance. The patients were divided into two groups according to sonohysterographic measurements of Fm-Cm. Group 1 consisted of 119 patients with Fm-Cm values ⱕ5 mm who underwent hysteroscopic incision. The hysteroscopy procedure was performed under general anesthesia and L type coagulation electrode with a hysteroscopic resectoscope was used (Karl Storz, Germany). Group 2 consisted of 116 control patients with Fm-Cm values ⬍5 mm who did not have incision. Clinical pregnancy and miscarriage rates were documented. The study was approved by the institutional review board. Results: In the history there were more abortions in group 1 compared to group 2, 17 (14,20%) versus 7 (6,03%) (p ⫽ 0,04). At least one previous IVF failure history was also more frequent in group 1, 39 (32.7 %) vs 24 (20.6%) (p ⫽ 0.04). However, the study showed that the IVF outcome results were similar in both groups regarding the clinical pregnancy and pregnancy loss; 57 (47,80%) vs 54 (46,50%) (p ⫽ 0,83) and 6 (10,52%) vs 11 (20,3%) (p ⫽ 0,19), respectively. Two patients had postoperative intracavitary collection that resolved with intrauterine aspiration. We have not seen any uterine wall perforation or infection. Conclusion: This is the first study investigating the impact of hysteroscopic correction of an incomplete septum in an ART program. According to our findings it was evident that the history of pregnancy loss and the history of IVF failure was more frequent in the incomplete septum group when compared with the normal group. Importantly, we have also found similar pregnancy outcome after the incision of the incomplete septum compared to the normal group. However larger prospective randomized controlled studies are needed to prove the positive effect of correction of incomplete septum on ART outcome. 1. ESHRE 2003 meeting, Madrid, Spain, poster presentation.
Monday, October 13, 2003 2:15 P.M. O-93 The effect of myomectomy on in vitro fertilization-embryo transfer (IVF-ET) cycle outcome: The oocyte donation model. Eric S. Surrey, Debra A. Minjarez, John M. Stevens, William B. Schoolcraft. Colorado Ctr for Reproductive Medicine, Englewood, CO. Objective: Previous investigators have reported that the presence of submucosal (SM) or intramural (IM) leiomyomata (leio) may exert an adverse effect on IVF-ET cycle pregnancy and/or implantation rates (EldarGeva et al, Fertil Steril 1998;70:687-91;Hart et al, Hum Reprod 2001;16: 2411-17;Surrey et al, Fertil Steril 2001;75:405-10). The impact of precycle
S35
myomectomy (myo) on these parameters has not been extensively evaluated and is the goal of the current investigation. In an effort to more adequately control for age-related variability in oocyte quality, an oocyte donation (ED) model has been employed. Design: Retrospective case-controlled trial in a tertiary care assisted reproductive technology program. Materials and Methods: Consecutive patients who underwent ED with fresh ET performed between 1/1/00 and 12/31/02 were evaluated.All recipients underwent routine pre-cycle ultrasound and office hysteroscopic evaluation. Patients with SM leio underwent pre-cycle hysteroscopic (HSC) myomectomy (group I). A second group with either large SM leio with significant IM extension or with IM leio that distorted, impinged upon, or immediately abutted the endometrial cavity with ⬍2 mm of normal myometrium underwent myomectomy by laparotomy (LAP) (group II). All procedures were performed by one of the authors. A control group consisted of all other ED patients without such lesions who underwent a fresh ET during this time period (group III). The only exclusions were those who did not undergo fresh ET. Controlled ovarian hyperstimulation, oocyte aspiration (OPU), insemination, and culture techniques as well as criteria for day 3 vs. 5 ET have been previously described (Gardner et al, Hum Reprod 1998;13:3434-40). Serum hCG levels were obtained 14 days after OPU and initial pregnancy ultrasound was performed 2 weeks thereafter. Data analysis: Student’s group t tests and Chi square analysis as appropriate. Ongoing pregnancy rate (OPR): number of intrauterine pregnancies with cardiac activity/number ET procedures. Implantation rate (IR): number of intrauterine gestational sacs with cardiac activity/ total number of embryos transferrred. Biochemical pregnancy rate (Bio): number of ⫹ hCG tests in the absence of an ongoing pregnancy/number ET procedures. Results: Results are displayed in Table 1 below and expressed as mean ⫾ SEM unless otherwise indicated.
* p ⬍ 0.05 vs. Gr. II ⫹p ⬍ 0.01 vs. Gr. I Conclusion: Myomectomy performed by HSC or LAP for SM or IM leio that impinge upon or distort the uterine cavity regardless of size result in ongoing pregnancy, implantation, and early pregnancy loss rates after oocyte donation that were similar to controls. The importance of pre-cycle uterine cavity evaluation cannot be overemphasized.
Monday, October 13, 2003 2:30 P.M. O-94 Abdominal myomectomy: Risk factors for intraoperative and postoperative complications. Ben E. Montgomery, Michael J. Glassner, Charles J. Dunton. The Lankenau Hosp, Wynnewood, PA. Objective: To characterize preoperative and intraoperative risk factors for complications associated with abdominal myomectomy. Design: Retrospective cohort review. Materials and Methods: The medical records of 331 patients having undergone abdominal myomectomy by a single operator from March 1994 to November 2002 were reviewed. Potential risk factors for operative and postoperative complications included race, number of fibroids, total fibroid weight, largest fibroid, prior abdominal surgery, prior abdominal myomectomy, uterine size, and patient weight. Outcome measures included length of hospital admission, requirement for blood transfusion, operative estimated blood loss (EBL), operative and postoperative complications, and duration of operative procedure. Results: Estimated Student’s t tests were used to determine statistical significance among the outcome measures EBL, length of admission, and duration of operative procedure. After univariate analysis, race (black versus white), number of fibroids greater than 10, prior abdominal surgery, prior abdominal myomectomy, and uterine size greater than 20 weeks were
S36
Abstracts
found to significantly increase EBL, length of hospital admission, and the duration of operative procedure (p ⬍ 0.05). Only 10 major intraoperative and postoperative complications occurred in the study group (3.0%), and only four patients required blood transfusions (1.2%). Secondary to the small number of intraoperative and postoperative complications and blood transfusions, Fisher’s exact test was used to determine statistical significance among these two outcome measures. More than 10 fibroids and black race were noted to significantly increase the incidence of intraoperative and postoperative complications (p ⬍ 0.05). At the time of this writing, data is undergoing multivariate analysis. The multivariate analyses will account for the correlations among the patients’ baseline variables. Multiple regression will be used for the variables EBL, length of admission, and duration of operative procedure. Logistic regression will be used to analyze data regarding the number of blood transfusions and intraoperative and postoperative complications.
Conclusion: Abdominal myomectomy is a relatively safe procedure to treat uterine fibroids. There are, however, several preoperative risk factors that may identify women at risk for intraoperative and postoperative complications.
Monday, October 13, 2003 2:45 P.M. O-95 Asherman’s syndrome: Etiologic factors, patterns of pregnancy loss, and treatment results. Results from an international registry. Steven F. Palter, Poly Spyrou. Reproductive Medicine and Surg Ctr, Syosset, NY. Objective: To characterize the clinical features of Asherman’s syndrome (AS-intrauterine synechiae) etiologic risk factors, patterns of pregnancy loss, and patterns of menstruation, before and after treatment and treatment results. Design: Online registry of surgically confirmed cases of Asherman’s syndrome with follow-up questionnaires. Materials and Methods: Subjects were members of an international patient support group. Data was collected by submission to an online registry of cases. Patients diagnosed by their treating physician downloaded a standard questionnaire and the questions were answered in conjunction with the treating physician. By design the patients were treated worldwide. Two hundred ninety-seven women confirmed with AS by hysteroscopy or imaging representing the world’s largest data-set of AS cases comprised the subjects. The questionnaire queried them on clinical features pre- and post-treatment. Results: The vast majority of cases of AS followed either a full-term pregnancy or a pregnancy loss. Most patients (93%) previously conceived however pregnancy loss was extremely common— only 61% achieved a live-born child before treatment. First trimester losses were the most common and were more frequent than would be expected (49% of all pregnancies). Similarly, second and third trimester losses were four times more common than would be expected (8.5% of all pregnancies). Five and one-half percent of women had the loss of a multiple gestation pregnancy.
Vol. 80, Suppl. 3, September 2003