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The future of IVF: vitrified-warmed blastocyst transfer
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Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Results: In a total of 130 patients who underwent surgical treatment due to suspicious ovarian tumors, 104 presented a final histological diagnosis of ovarian Cancer, 9 characterized as borderline and 14 were negative for malignancy. The sensitivity and specificity of frozen section for patients with benign tumors amounted to 77.8% and 95.8% respectively, while ovarian malignancy the percentage reaches 96.8% and 95.8%. Regarding borderline malignant tumors the sensitivity and specificity of the frozen section reached 57.1% and 89.1% respectively. Out of a total of 130 patients, 43 (33.1%)patients younger than 55 years old were diagnosed with ovarian Cancer at a percentage of 33.1%, while the percentage following regular follow ups in the gynecological and oncology clinic reaches 28.6%. Conclusions: The use of frozen section offers very good diagnostic accuracy in distinguishing women with malignant and benign ovarian tumors, in contrast to borderline ovarian tumors frozen section results in more diagnostic discrepancies, in relation to the final histological diagnosis is a more sensitive examination regarding benign and malignant damage, in contrast to the borderline tumors where, based on the sensitivity percentage, it constitutes a particularly precarious exam. http://dx.doi.org/10.1016/j.ejogrb.2016.07.175 Screening for gynaecological cancer Poster Presentation Endometrial stromal nodule in a woman with abnormal uterine bleeding and abdominal pain: a case report Eleftherios Klonos ∗ , L. Zepiridis, T. Theodoridis, D. Tsolakidis, G.F. Grimbizis, A. Papanikolaou, B.C. Tarlatzis First Department of Obstetrics & Gyneacology “Papageorgiou” General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece E-mail address: [email protected] (E. Klonos). The endometrial stromal nodule constitutes a particularly rare tumor in pre- or – postmenopausal women, who have undergone hysterectomy, due to intense symptoms, namely the abdominal pain and abnormal uterine bleeding [1,2,12]. A case of a patient with endometrial stromal nodule is presented, emphasizing on the therapeutic strategy and the dilemmas regarding the management and her follow-up. The immunoprofile of endometrial stromal nodule practically matches that of an endometrial stromal sarcoma [3,4,5]. However, the need for precise identification and diagnosis is critical, since outcomes in patients with stromal sarcomas are significantly worse, compared to the often-excellent outcomes in patients presenting with stromal nodule [18,19]. This fact is evident when looking at the survival statistics; there is a 90% five year survival rate for stages I and II while the corresponding figures for stages III and IV, significantly decrease, reaching 50% [7,8,14]. The diagnosis of endometrial stromal nodule is an exotic but realistic pathology for the female patient who presents with severe vaginal bleeding and abdominal pain. The therapeutic strategy is surgical. The most critical point, is the histopathology diagnosis, which has its pitfalls [11]. Following surgery and diagnosis, a frequent follow-up including imaging assessments, is necessary. It is clear that patients diagnosed with endometrial stromal nodule have an excellent prognosis. http://dx.doi.org/10.1016/j.ejogrb.2016.07.176
Assisted reproduction Oral Presentation The future of IVF: vitrified-warmed blastocyst transfer Jure Knez ∗ , Borut Kovaˇciˇc, Milan Reljiˇc Department of Reproductive Medicine and Gynaecologic Endocrinology, University Medical Centre Maribor, Maribor, Slovenia E-mail address: [email protected] (J. Knez). Introduction: The development of blastocyst vitrification has significantly changed the approach to embryo transfer. In cases where there is a high risk for developing ovarian hyperstimulation syndrome, all embryos can be vitrified and transferred in subsequent menstrual cycles. On the other hand, vitrification of surplus embryos at the time of transfer allows for higher cumulative pregnancy rates. The optimal method of endometrium preparation for frozen-thawed embryo transfer (FET) still remains uncertain. The aim of this study was to compare the outcomes of vitrified-warmed blastocyst transfers in natural and artificially prepared cycles. Methods: All vitrified-warmed blastocyst transfers performed in the years 2013 and 2014 at our IVF centre were included in this retrospective study. In women with predictable and regular ovulatory cycles, FETs were performed in natural cycles without hCG triggering. In patients with irregular and anovulatory cycles, FETs were performed in artificially prepared cycle using the combination of oestradiol and micronized progesterone without GnRH agonist suppression. Patients’ characteristics, treatment parameters and pregnancy outcomes were compared using Pearson’s Chi-squared test and Student’s t-test. Results. In the study period, 835 vitrifiedwarmed blastocyst transfers were performed in natural and 278 in artificially prepared cycles. There were no statistically significant differences in patients’ characteristics and treatment parameters between both groups, with the exception of the average number of transferred embryos (1.3 in natural cycles vs. 1.4 in artificial cycles, p < 0.05). The biochemical pregnancy rate observed was higher in artificial cycles (8.9% vs. 17.6%), but there were no statistically significant differences in clinical pregnancy rate (36.0% vs. 34.9%), implantation rate (31.3% vs. 28.9%), abortion rate (14.5% vs. 21.0%) and live birth/ongoing pregnancy rate (30.5% vs. 25.2%) in natural compared to artificial cycles. Conclusion: Vitrified-warmed blastocyst transfers in natural and artificially prepared cycles are equally successful in terms of implantation, ongoing pregnancy and live birth rate. The outcome of vitrified-warmed blastocyst transfer in natural as well as artificial cycles appears to be comparable to blastocyst transfer in fresh IVF cycles. http://dx.doi.org/10.1016/j.ejogrb.2016.07.177
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Results: In a total of 130 patients who underwent surgical treatment due to suspicious ovarian tumors, 104 presented a final histological diagnosis of ovarian Cancer, 9 characterized as borderline and 14 were negative for malignancy. The sensitivity and specificity of frozen section for patients with benign tumors amounted to 77.8% and 95.8% respectively, while ovarian malignancy the percentage reaches 96.8% and 95.8%. Regarding borderline malignant tumors the sensitivity and specificity of the frozen section reached 57.1% and 89.1% respectively. Out of a total of 130 patients, 43 (33.1%)patients younger than 55 years old were diagnosed with ovarian Cancer at a percentage of 33.1%, while the percentage following regular follow ups in the gynecological and oncology clinic reaches 28.6%. Conclusions: The use of frozen section offers very good diagnostic accuracy in distinguishing women with malignant and benign ovarian tumors, in contrast to borderline ovarian tumors frozen section results in more diagnostic discrepancies, in relation to the final histological diagnosis is a more sensitive examination regarding benign and malignant damage, in contrast to the borderline tumors where, based on the sensitivity percentage, it constitutes a particularly precarious exam. http://dx.doi.org/10.1016/j.ejogrb.2016.07.175 Screening for gynaecological cancer Poster Presentation Endometrial stromal nodule in a woman with abnormal uterine bleeding and abdominal pain: a case report Eleftherios Klonos ∗ , L. Zepiridis, T. Theodoridis, D. Tsolakidis, G.F. Grimbizis, A. Papanikolaou, B.C. Tarlatzis First Department of Obstetrics & Gyneacology “Papageorgiou” General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece E-mail address: [email protected] (E. Klonos). The endometrial stromal nodule constitutes a particularly rare tumor in pre- or – postmenopausal women, who have undergone hysterectomy, due to intense symptoms, namely the abdominal pain and abnormal uterine bleeding [1,2,12]. A case of a patient with endometrial stromal nodule is presented, emphasizing on the therapeutic strategy and the dilemmas regarding the management and her follow-up. The immunoprofile of endometrial stromal nodule practically matches that of an endometrial stromal sarcoma [3,4,5]. However, the need for precise identification and diagnosis is critical, since outcomes in patients with stromal sarcomas are significantly worse, compared to the often-excellent outcomes in patients presenting with stromal nodule [18,19]. This fact is evident when looking at the survival statistics; there is a 90% five year survival rate for stages I and II while the corresponding figures for stages III and IV, significantly decrease, reaching 50% [7,8,14]. The diagnosis of endometrial stromal nodule is an exotic but realistic pathology for the female patient who presents with severe vaginal bleeding and abdominal pain. The therapeutic strategy is surgical. The most critical point, is the histopathology diagnosis, which has its pitfalls [11]. Following surgery and diagnosis, a frequent follow-up including imaging assessments, is necessary. It is clear that patients diagnosed with endometrial stromal nodule have an excellent prognosis. http://dx.doi.org/10.1016/j.ejogrb.2016.07.176
Assisted reproduction Oral Presentation The future of IVF: vitrified-warmed blastocyst transfer Jure Knez ∗ , Borut Kovaˇciˇc, Milan Reljiˇc Department of Reproductive Medicine and Gynaecologic Endocrinology, University Medical Centre Maribor, Maribor, Slovenia E-mail address: [email protected] (J. Knez). Introduction: The development of blastocyst vitrification has significantly changed the approach to embryo transfer. In cases where there is a high risk for developing ovarian hyperstimulation syndrome, all embryos can be vitrified and transferred in subsequent menstrual cycles. On the other hand, vitrification of surplus embryos at the time of transfer allows for higher cumulative pregnancy rates. The optimal method of endometrium preparation for frozen-thawed embryo transfer (FET) still remains uncertain. The aim of this study was to compare the outcomes of vitrified-warmed blastocyst transfers in natural and artificially prepared cycles. Methods: All vitrified-warmed blastocyst transfers performed in the years 2013 and 2014 at our IVF centre were included in this retrospective study. In women with predictable and regular ovulatory cycles, FETs were performed in natural cycles without hCG triggering. In patients with irregular and anovulatory cycles, FETs were performed in artificially prepared cycle using the combination of oestradiol and micronized progesterone without GnRH agonist suppression. Patients’ characteristics, treatment parameters and pregnancy outcomes were compared using Pearson’s Chi-squared test and Student’s t-test. Results. In the study period, 835 vitrifiedwarmed blastocyst transfers were performed in natural and 278 in artificially prepared cycles. There were no statistically significant differences in patients’ characteristics and treatment parameters between both groups, with the exception of the average number of transferred embryos (1.3 in natural cycles vs. 1.4 in artificial cycles, p < 0.05). The biochemical pregnancy rate observed was higher in artificial cycles (8.9% vs. 17.6%), but there were no statistically significant differences in clinical pregnancy rate (36.0% vs. 34.9%), implantation rate (31.3% vs. 28.9%), abortion rate (14.5% vs. 21.0%) and live birth/ongoing pregnancy rate (30.5% vs. 25.2%) in natural compared to artificial cycles. Conclusion: Vitrified-warmed blastocyst transfers in natural and artificially prepared cycles are equally successful in terms of implantation, ongoing pregnancy and live birth rate. The outcome of vitrified-warmed blastocyst transfer in natural as well as artificial cycles appears to be comparable to blastocyst transfer in fresh IVF cycles. http://dx.doi.org/10.1016/j.ejogrb.2016.07.177