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The First Pregnancy in an Allograft Uterus in the Sheep Model
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51 procedure duration length was 99 vs. 102 minutes in the control vs. Sepraspray groups respectively, with the median number of fibroids removed being 2 in each group, and fibroid weights of 134 103 vs. 113 161, respectively.
There were no related AEs or serious AEs identified in the Sepraspray treated women. Conclusion: Laparoscopic application of Sepraspray following myomectomy in this pilot study was associated with a trend toward reduction in postoperative adhesion development. With an encouraging safety profile, further evaluation is warranted. 47
Open Communications 3dReproductive Issues (12:23 PM d 12:28 PM)
The First Pregnancy in an Allograft Uterus in the Sheep Model Ramirez ERR,1 Nessetti Ramirez DK,1 Nessetti M,3 Ramirez HA,1 Khatamee M.5 1Obstetrics and Gynecology, Saint Johns Regional Medical Center, Oxnard, CA; 2Obstetrics and Gynecology, Saint Elizibeth Medical Center, Lincoln, NE; 3Family Practice, Crieghton University Medical Center, Lincoln, NE; 4Obstetrics and Gynecology, University of La Salle, Pasadena, TX; 5Obstetrics Gynecology Infertility, New York University, New York, NY Study Objective: The purpose of this project is to produce a pregnancy in an allograft uterus in the sheep model. Different variables such as uterine placental blood flow, fetal growth, cyclosporine through levels, histological studies and embryo transfer methods were assessed. Design: Pilot Study. Setting: Universidad De La Salle Bogota, Colombia. Patients: Sixteen Adult African Sheep with history of previous pregnancies. Intervention: Uterine Transplantation through a minilaparotomy incision with the application of a 900e500 modified Mobius retractor device. Measurements and Main Results: The short-term effects of warm and cold tissue ischemia were quantified and uterine tissue reperfusion was analyzed after vascular reanastomosis. The ovine model was preferred since the anatomical landmarks and vascular anatomy are comparable to human with the exception of a bicornuate uterus in the sub-primate model. A modified surgical procedure was applied to our uterine allotransplanted sheep (n-16) as previously described in a recent publication by Ramirez et al, 2007. Tissue rejection was managed with cyclosporine therapy and vascular patency and uterine tissue viability were assessed by histological studies. Cryopreserved and fresh embryos were distributed evenly into each uterine horn at two different intervals; one immediately after the uterine transplant procedure (n-10) and the others at three months post-uterine transplantation (n-6). In the first group, one ectopic pregnancy resulted after placement of a fresh embryo. In the second group, two pregnancies were achieved after the transfer of two frozen embryos. One sheep miscarried at 52 days gestation as a result of progesterone insufficiency and the second sheep is currently pregnant. Conclusion: This is the first reported case in the literature documenting the first pregnancy in an allgraft uterus in the ewe. Our pilot study demonstrates that a pregnancy can be achieved after a successful uterine transplant in the ewe. 48
Open Communications 3dReproductive Issues (12:29 PM d 12:34 PM)
Systematic Fertiloscopy in Infertile Patient with Normal Hysterosalpingography. Review of a 2500 Cases Continuous Serie Watrelot AA. Centre de Chirurgie Gynecologique, Hopital Prive Natecia, Lyon, France
S15
Study Objective: To demonstrate the need to practise endoscopic evaluation of the pelvis in infertile patient even if non invasive test are seen as normal. Design: We have performed a fertiloscopy in every infertile patient with normal hysterosalpingography(HSG) prior to refer them to ART (Artificial Reproductive Technique) between 1998 and 2008. a six month follow up was done. Setting: Private Hospital specialized in reproductive surgery and IVF (In Vitro Fertilization). Patients: To be enrolled in the study patients had to be infertile for a period of at least 2 years. HSG practised less than 1 year before has to be considered as normal. All the other infertility basic test had also to be considered as normal It was proposed systematically to the patients to have an endoscopic evaluation in order to decide the best therapeutical strategy. Intervention: The five step of fertiloscopy were systematically practised (i.e. hydropelviscopy,dye test, salpingoscopy, microsalpingoscopy and hysteroscopy). Measurements and Main Results: According to the findings, The patients were divided in 4 groups: Group 1 normal macroscopic findings but abnormal tubal mucosa,Group 2 abnormal findings and abnormal tubal mucosa, Group 3 normal findings and normal tubal mucosa, Group 4 abnormal findings but normal tubal mucosa. Subsequently, patients from Group 1 and 2 were referred to IVF patients from Group 3 were referred to IIU and patients from Group 4 have has pelvic surgery to treat the abnormalities founded. Interestingly the pregnancy rate in group 1 and 2 (IVF group) and Group 4 (surgery group) were similar (31.2% vs 33.4%) after 6 month if follow up. Group 3 (IIU group) obtained a 20.6% pregnancy rate after 6 months which is consistent after 3 IIU cycles. Conclusion: Fertiloscopy is an interesting tool to decide the best therapeutic option, IVF, IIU or surgery. Reproductive surgery is still a valid option, similar to IVF, if the selection is accurately performed.
49
Open Communications 3dReproductive Issues (12:35 PM d 12:40 PM)
Reduced Fertilization in Subfertile Women with Endometriomas in Association with Deep Infiltrative Endometriosis Bianchi PHM,1,2 Serafini P,1,2 Pereira RMA,1,3 Zanatta A,1 Motta ELA,1,4 Baracat EC.2 1Huntington Medicina Reprodutiva, Sa˜o Paulo, Brazil; 2 Disciplina de Ginecologia, Universidade de Sa˜o Paulo, Sa˜o Paulo, Brazil; 3Materclin, Londrina, Parana´, Brazil; 4Departamento de Ginecologia, Universidade Federal de Sa˜o Paulo, Sa˜o Paulo, Brazil Study Objective: To isolate the effect of endometriomas alone on assisted reproduction treatments through a comparison of in vitro fertilization outcomes between patients with sonographic signs of deep infiltrative endometriosis (DIE) with and without endometriomas, provided that endometriomas are considered markers of DIE. Design: Retrospective study. Setting: Private infertility clinic and University of Sa˜o Paulo in Sa˜o Paulo, Brazil. Patients: Subfertile patients with symptoms and sonographic signs of DIE that prefer to undergo in vitro fertilization instead of performing laparoscopic surgery. Patients were divided into group A (women with DIE-associated infertility without sonographic signs of endometriomas; n 5 53) and group B (patients with sonographic signs of DIE and endometriomas; n 5 13). Intervention: All IVFs follow a standard long ovarian stimulation protocol, oocyte harvesting, fertilization by ICSI, embryo culture and transference on day 3. Measurements and Main Results: Eighty two IVF/ICSI cycles (1.7 0.9 cycles/patient) were performed in group A and 20 IVF/ICSI cycles (1.6 0.7 cycles/patient) in group B. Endometriomas’ mean size was 3 1.6 cm; 3 patients had bilateral endometriomas. Patients’ age (Group A 5 33 3; Group B533 2.5 years; p 5 0.59), body mass index (Group A 5 21 2.2; Group B 5 21 1.8 kg/m2; p 5 0.99), infertility duration (Group A 5 28 18; Group B 5 24 14 months; p 5 0.5) and the number of DIE lesions (Group A: 2.5 0.9; Group B: 2.4 1.5; p 5 0.82) were similar between groups. Total dose of recombinant FSH
There were no related AEs or serious AEs identified in the Sepraspray treated women. Conclusion: Laparoscopic application of Sepraspray following myomectomy in this pilot study was associated with a trend toward reduction in postoperative adhesion development. With an encouraging safety profile, further evaluation is warranted. 47
Open Communications 3dReproductive Issues (12:23 PM d 12:28 PM)
The First Pregnancy in an Allograft Uterus in the Sheep Model Ramirez ERR,1 Nessetti Ramirez DK,1 Nessetti M,3 Ramirez HA,1 Khatamee M.5 1Obstetrics and Gynecology, Saint Johns Regional Medical Center, Oxnard, CA; 2Obstetrics and Gynecology, Saint Elizibeth Medical Center, Lincoln, NE; 3Family Practice, Crieghton University Medical Center, Lincoln, NE; 4Obstetrics and Gynecology, University of La Salle, Pasadena, TX; 5Obstetrics Gynecology Infertility, New York University, New York, NY Study Objective: The purpose of this project is to produce a pregnancy in an allograft uterus in the sheep model. Different variables such as uterine placental blood flow, fetal growth, cyclosporine through levels, histological studies and embryo transfer methods were assessed. Design: Pilot Study. Setting: Universidad De La Salle Bogota, Colombia. Patients: Sixteen Adult African Sheep with history of previous pregnancies. Intervention: Uterine Transplantation through a minilaparotomy incision with the application of a 900e500 modified Mobius retractor device. Measurements and Main Results: The short-term effects of warm and cold tissue ischemia were quantified and uterine tissue reperfusion was analyzed after vascular reanastomosis. The ovine model was preferred since the anatomical landmarks and vascular anatomy are comparable to human with the exception of a bicornuate uterus in the sub-primate model. A modified surgical procedure was applied to our uterine allotransplanted sheep (n-16) as previously described in a recent publication by Ramirez et al, 2007. Tissue rejection was managed with cyclosporine therapy and vascular patency and uterine tissue viability were assessed by histological studies. Cryopreserved and fresh embryos were distributed evenly into each uterine horn at two different intervals; one immediately after the uterine transplant procedure (n-10) and the others at three months post-uterine transplantation (n-6). In the first group, one ectopic pregnancy resulted after placement of a fresh embryo. In the second group, two pregnancies were achieved after the transfer of two frozen embryos. One sheep miscarried at 52 days gestation as a result of progesterone insufficiency and the second sheep is currently pregnant. Conclusion: This is the first reported case in the literature documenting the first pregnancy in an allgraft uterus in the ewe. Our pilot study demonstrates that a pregnancy can be achieved after a successful uterine transplant in the ewe. 48
Open Communications 3dReproductive Issues (12:29 PM d 12:34 PM)
Systematic Fertiloscopy in Infertile Patient with Normal Hysterosalpingography. Review of a 2500 Cases Continuous Serie Watrelot AA. Centre de Chirurgie Gynecologique, Hopital Prive Natecia, Lyon, France
S15
Study Objective: To demonstrate the need to practise endoscopic evaluation of the pelvis in infertile patient even if non invasive test are seen as normal. Design: We have performed a fertiloscopy in every infertile patient with normal hysterosalpingography(HSG) prior to refer them to ART (Artificial Reproductive Technique) between 1998 and 2008. a six month follow up was done. Setting: Private Hospital specialized in reproductive surgery and IVF (In Vitro Fertilization). Patients: To be enrolled in the study patients had to be infertile for a period of at least 2 years. HSG practised less than 1 year before has to be considered as normal. All the other infertility basic test had also to be considered as normal It was proposed systematically to the patients to have an endoscopic evaluation in order to decide the best therapeutical strategy. Intervention: The five step of fertiloscopy were systematically practised (i.e. hydropelviscopy,dye test, salpingoscopy, microsalpingoscopy and hysteroscopy). Measurements and Main Results: According to the findings, The patients were divided in 4 groups: Group 1 normal macroscopic findings but abnormal tubal mucosa,Group 2 abnormal findings and abnormal tubal mucosa, Group 3 normal findings and normal tubal mucosa, Group 4 abnormal findings but normal tubal mucosa. Subsequently, patients from Group 1 and 2 were referred to IVF patients from Group 3 were referred to IIU and patients from Group 4 have has pelvic surgery to treat the abnormalities founded. Interestingly the pregnancy rate in group 1 and 2 (IVF group) and Group 4 (surgery group) were similar (31.2% vs 33.4%) after 6 month if follow up. Group 3 (IIU group) obtained a 20.6% pregnancy rate after 6 months which is consistent after 3 IIU cycles. Conclusion: Fertiloscopy is an interesting tool to decide the best therapeutic option, IVF, IIU or surgery. Reproductive surgery is still a valid option, similar to IVF, if the selection is accurately performed.
49
Open Communications 3dReproductive Issues (12:35 PM d 12:40 PM)
Reduced Fertilization in Subfertile Women with Endometriomas in Association with Deep Infiltrative Endometriosis Bianchi PHM,1,2 Serafini P,1,2 Pereira RMA,1,3 Zanatta A,1 Motta ELA,1,4 Baracat EC.2 1Huntington Medicina Reprodutiva, Sa˜o Paulo, Brazil; 2 Disciplina de Ginecologia, Universidade de Sa˜o Paulo, Sa˜o Paulo, Brazil; 3Materclin, Londrina, Parana´, Brazil; 4Departamento de Ginecologia, Universidade Federal de Sa˜o Paulo, Sa˜o Paulo, Brazil Study Objective: To isolate the effect of endometriomas alone on assisted reproduction treatments through a comparison of in vitro fertilization outcomes between patients with sonographic signs of deep infiltrative endometriosis (DIE) with and without endometriomas, provided that endometriomas are considered markers of DIE. Design: Retrospective study. Setting: Private infertility clinic and University of Sa˜o Paulo in Sa˜o Paulo, Brazil. Patients: Subfertile patients with symptoms and sonographic signs of DIE that prefer to undergo in vitro fertilization instead of performing laparoscopic surgery. Patients were divided into group A (women with DIE-associated infertility without sonographic signs of endometriomas; n 5 53) and group B (patients with sonographic signs of DIE and endometriomas; n 5 13). Intervention: All IVFs follow a standard long ovarian stimulation protocol, oocyte harvesting, fertilization by ICSI, embryo culture and transference on day 3. Measurements and Main Results: Eighty two IVF/ICSI cycles (1.7 0.9 cycles/patient) were performed in group A and 20 IVF/ICSI cycles (1.6 0.7 cycles/patient) in group B. Endometriomas’ mean size was 3 1.6 cm; 3 patients had bilateral endometriomas. Patients’ age (Group A 5 33 3; Group B533 2.5 years; p 5 0.59), body mass index (Group A 5 21 2.2; Group B 5 21 1.8 kg/m2; p 5 0.99), infertility duration (Group A 5 28 18; Group B 5 24 14 months; p 5 0.5) and the number of DIE lesions (Group A: 2.5 0.9; Group B: 2.4 1.5; p 5 0.82) were similar between groups. Total dose of recombinant FSH