- Email: [email protected]
Vasectomy reversal. cost and service differences between academic institutions and private practices
Results: In Group I, although there were no improvement in left (18.5 ⫾ 3.4 to 19.5 ⫾ 6.8) and right testicular volume (19.8 ⫾ 3.5 to 20.4 ⫾ 2.9) (p ⬍ 0.05), sperm concentration (34.21 ⫾ 16.2 million/ml to 49.09 ⫾ 8.5 million/ml; p ⫽ 0.03), and sperm motility (35.3 ⫾ 22.3% to 58.4 ⫾ 18.3%; p ⫽ 0.03) significantly improved. In Group II, no changes a significant improvement was seen in the left (14.12 ⫾ 3.2 to 20.5 ⫾ 4.6; p ⫽ 0.03) and right testicular volume (14.05 ⫾ 4.8 to 20.5 ⫾ 4.1; p ⫽ 0.03), sperm concentration (15.8 ⫾ 3.6 million/ml to 14.9 ⫾ 5.9 million/ml; p ⬎ 0.05), and sperm motility (43.2 ⫾ 14.6% to 48.7 ⫾ 18.3%; p ⬎ 0.05) did not increase following the surgical procedure. Conclusions: Patients with normal FSH levels tend to improve their semen analysis following varicocelectomy. Patients with high FSH levels before varicocelectomy tend to improve their testicular volume without improvement in the semen analysis. The testicular catch-up growth after varicocele correction seen in patients with high FSH levels may not result in spermatogenesis improvement.
Wednesday, October 15, 2003 4:00 P.M. O-243 Do pathologists accurately read testis biopsies with mixed histologic patterns in the ICSI era? Matthew R. Cooperberg, Amir Jad, Imok Cha, Paul J. Turek. UCSF, San Francisco, CA. Objective: Testis sperm is routinely used for intracytoplasmic sperm injection. Testicular histology can be valuable in predicting which men are candidates for testicular sperm extraction, yet published reports have demonstrated wide discrepancies in clinicians’ ability to locate sperm in testes with commonly recognized histological patterns. We hypothesized that this variation may stem in part from inconsistencies in pathologists’ interpretations of biopsy histology. To assess this potential inter-observer variability, we reviewed the tissue slides of referred patients, and compared the interpretation of a single in-house pathologist to the reading previously made at the referring institution. Design: Prospective study of a consecutive series of male infertility patients referred to a single institution. Materials and Methods: All biopsy reviews were performed blinded to the original outside diagnosis. On review, each biopsy was assigned one of the following categories: normal pattern (NL), hypospermatogenesis (HYP), late maturation arrest (LMA), early maturation arrest (EMA), Sertoli cell only (SCO), mixed pattern (MIX), or other. Where the outside readings did not use this terminology, they were assigned to the category best fitting the recorded description. Frequencies of the various categories were compared among the original and review diagnoses. Agreement between the two diagnoses was assessed using the weighted Kappa statistic for interobserver agreement. Results: Of 127 cases reviewed, 108 (85%) had been read previously at the referring institution. The distribution of diagnoses made by the original and reviewing pathologist are presented in the Table. The weighted Kappa score for agreement between the original and review diagnoses was 0.46 (95% CI 0.33-0.60). On closer analysis of MIX cases, (those demonstrating the largest discrepancy in readings as above), the most common change in reading among these cases was from a normal outside reading to an abnormal, mixed reading (15 cases, 38%). As a result, the review resulted in a changed treatment plan in 20 of all 39 (51%) MIX cases.
Conclusion: The lack of a standardized approach to testis biopsy histological examination by pathologists may contribute to inaccurate phenotyping of male infertility. This may significantly impact on the clinical care of these patients.
FERTILITY & STERILITY威
Wednesday, October 15, 2003 4:15 P.M. O-244 Histomorphometric and cytogenetic study of human testicular aging. Mbarka Dakouane, Lucia Bicchieray, Marianne Bergere, Martine Albert, Franc¸ ois Vialard, Jacqueline Selva. CHIPS 78303 Poissy, Versailles-Saint Quentin Univ and UFR biome´ dicale des St-Pe`res, Paris, Poissy, France. Objective: Our aim was to evaluate the influence of ageing on testicular histology, and aneuploidy rate in testis postmeiotic cells. The question of the risk related to age is raised by the increased frequency of medical assisted reproduction techniques for older men. Design: We analysed 23 testicular samples of subjects aged 59-102 years for histology, spermatogenesis efficiency and meiotic abnormality rate. We examined testicular cells with fluorescence in situ hybridisation (FISH). The protocol was included in a body donation program. Materials and Methods: After a classical study of six histologic sections (20 cross sectioned tubules), a computer-assisted morphometric analysis was performed based on the following parameters: concerning the seminiferous tubules, the surface, the thickness of the basal membrane, the nucleus density (sertoli cells, spermatogonia, spermatocytes and spermatozoids); concerning the interstitial tissue: the clusters number and the surface occupied by the Leydig cells, their nucleus density. We analysed the cells by FISH, with three probe sets X,Y and 18 (Abbot°). The results were compared to a control group of testicular biopsies of 6 subjects (30-45 yrs) with obstructive azoospermy. Results: The histological study showed various alterations including: a thickening of the basal membrane, a depletion of the seminiferous epithelium with a disturbance of the sertoli cells, and scarcity of Leydig cells associated to their hypertrophy. The morphometric study confirmed the depletion of the epithelium and showed the thickening of the basal membrane concerned subjects with spermatogenesis arrest. Up until 89 years old, we could find subjects with complete spermatogenesis. The most sensitive step was the pachytene one, spermatogonia could last until 98 years old! The 23 aged men were split into 3 groups: preserved spermatogenesis (13 subjects group1), arrested spermiogenesis (4 subjects group2) and early disrupted spermatogenesis with only diploid cells (6 subjects group3). For the subjects with preserved spermatogenesis, post meiotic cells analysis (n ⫽ 4349) showed 50,7% X18, 48,2% Y18 and 1.1% of the cells with aneuploidy. For the subjects with an arrested spermiogenesis, they showed 48% X18, 38%Y18 and aneuploidy rate among spermatids(n ⫽ 98) was 14%. For the control group postmeiotic cells(n ⫽ 491) showed 50,3% X18, 49,1% Y18 and 0,6% of cells with aneuploidy. The result of group2 was different from group1 and control (p ⬍ 0,001; p ⬍ 0,0001). No relationship was found between aneuploidy rate and spermatozoa density in these series. Conclusion: We observed that a spermatogenesis was possible until an advanced age (89 years). There seemed to be an increase in the incidence of post meiotic aneuploidy when spermiogenesis had stopped. The rate of aneuploidy in the group of subjects with preserved spermatogenesis was not statistically different from the control group.
Wednesday, October 15, 2003 4:30 P.M. O-245 Vasectomy reversal. Cost and service differences between academic institutions and private practices. Helen Ahn, Spencer Land. Loyola Univ, Chicago, IL. Objective: To determine if a difference exists for the price of vasectomy reversal and if other services, such as Vasoepididymostomy (EV) and testicular sperm extraction (TESE) are offered in academic and private practice settings. Design: Telephone survey. Materials/Methods: 10 private practices and 10 academic institutions were randomly selected from around the United States. A telephone survey was conducted to determine total cost of vasectomy reversal, if VE could be performed if indicated, and if TESE was offered. Results: The cost of vasectomy reversal averaged $6438.28 (range $4700-$7300) at the private practices and $10,782.80 (range $5450-$18200)
S93
at the academic institutions. The percentage of the total cost for surgeon’s fee was 66.6% in private practice versus 49.1% at the academic centers. Only 40% of the private practices offered TESE compared to 100% of the academic centers. VE could be performed at all academic centers, but only 1 of 10 private practices offered the procedure. 40% of private practices performed the reversal in an office setting under local anesthesia. Conclusion: There is a significant difference in cost for vasectomy reversal between academic and private practice settings. However, the majority of private practices do not offer TESE or VE, whereas all the academic centers in the survey provided these services.
ART: CLINICAL: PROCEDURES AND TECHNIQUES II Wednesday, October 15, 2003 2:00 P.M. O-246 Is day 3 embryo quality indicative of day 5 blastocyst development? Comparison of clinician vs. computer selection. Evelyn Neuber, Neal Mahutte, Aydin Arici, Denny Sakkas. Yale Sch of Medicine, New Haven, CT. Objective: It is of fundamental importance for ART programs to determine the most viable embryo for transfer. At the same time the program must reduce the risk of multiple births and still maximize the chances of pregnancy for their patients. In this study we evaluate the accuracy of experienced investigators in identifying embryos on Day 3 that will result in the best subsequent blastocysts for transfer on Day 5. We then compared these results to those of a computer algorithm based on sequential embryo assessment of multiple early morphological markers. Material and Methods: One hundred eleven patients underwent a Day 5 (blastocyst stage) embryo transfer during 2001 and the first 6 months of 2002 at our ART program. From the 2001 database, 3 investigators were asked to select which embryos they would recommend for transfer based only on the embryo development stages up to Day 3, the patient’s age and her IVF/ICSI status. After analysis of their 2001 results and review of embryo scoring techniques the same investigators performed selections from the 2002 database. From the 2002 database a computer model selected 3 Day 3 embryos for Day 5 transfers based on a sequential scoring system that takes into account multiple morphological stages, beginning with pronuclear alignment, length of first cell cycle and cleavage stages (⬎4 and ⬎8 cell stage) on Day 2 and 3 of development. Results: In 2001 the best embryo available on Day 5 was successfully selected on Day 3 in just over 50% of the cases (Table 1). After analysis of the 2001 results by the three investigators there was a significant improvement in their ability to select a blastocyst with the 2002 data when one was available (p ⫽ 0.02). However, the computer model either equaled or outperformed the 3 investigators in selection performance. There was no statistically significant difference between any of the selections made by the 3 investigators.
Conclusions: Even experienced ART investigators have only a slightly better than 50% chance of selecting the best embryo based on Day 3 information. More importantly, our computer model using early embryo assessment criteria may provide a more reliable, objective way for selecting the optimal embryo for transfer on Day 3, and in addition has the potential to be a useful training and standardization tool for ART programs.
S94
Abstracts
Wednesday, October 15, 2003 2:15 P.M. O-247 Preliminary results of a prospective randomized study to assess the value of laser assisted hatching before cleavage stage embryo transfer among good-prognosis In Vitro Fertilization (IVF) patients. Jennifer Carter, James Graham, Taer Han, Alana Davis, Kevin S. Richter, Eric Widra. Shady Grove Fertility Reproductive Science Ctr, Rockville, MD. Objective: To evaluate the effect of laser assisted hatching prior to cleavage stage embryo transfer among good-prognosis IVF patients (who under current guidelines would not be treated with assisted hatching). A statistically significant benefit to hatching was found in a previous study of day 6 embryo transfers (Tucker et al. Fertil Steril 1999;72:s20-21), leading us to speculate such a difference might also be found on day 3. Design: Prospective randomized study. Materials and Methods: Criteria for eligibility were: ovulatory menstrual cycles; normal day 3 FSH; 39 years of age or younger; no more than one previous unsuccessful IVF attempt; and good quality embryos (6 or more cells per embryo on day 3 and less than 30% fragmentation). To date 91 eligible patients were enrolled following informed consent. Enrolled patients were randomly assigned (2 to 1 ratio) to either the treatment (hatching) group or the control (no hatching) group. Embryo transfers for all treatment and control cycles were performed on day 3 after oocyte retrieval. Laser assisted hatching was performed on all embryos of patients assigned to the treatment group before transfer. Implantation and pregnancy outcomes were determined based on ultrasound identification of fetal heart activity. Implantation rates were calculated for each cycle and compared between treatment and control groups by Wilcoxon rank sums test. Pregnancy rates were compared between treatment and control groups by chisquare analysis. Results: Of the 91 patients enrolled thus far, 60 were randomized to the treatment group and 31 were randomized to the control group. Implantation rates were 36.5% (95% CI: 27.3% to 45.7%) for treatment cycles versus 38.7% (95% CI: 25.9% to 51.5%) for control cycles (p ⫽ 0.59). Pregnancy rates were 60.0% (95% CI: 47.4% to 71.4%) for treatment cycles versus 64.5% (95% CI: 46.9% to 78.9%) for control cycles (p ⫽ 0.67). Conclusions: These preliminary results provide no evidence of a benefit of laser assisted hatching for good-prognosis IVF patients undergoing day 3 embryo transfer. Although differences may become apparent with a larger sample size, the current data indicate very similar implantation and pregnancy rates with or without assisted hatching. Sample sizes many times larger would be required to statistically confirm differences as small as those observed.
Wednesday, October 15, 2003 2:30 P.M. O-248 Ovarian function after autotransplantation of frozen-thawed human ovarian tissue: An experience of human ovarian grafting into two heterotopic sites. S. Samuel Kim, In-Taek Hwang, Hoi-Chang Lee, Dong Hoon Kim. Eulji Univ Sch of Medicine, Seoul, Republic of Korea. Objectives: Ovarian tissue banking is one of the promising strategies for fertility conservation in women with cancer, although its efficacy is still unknown. The aims of this study were 1) to investigate ovarian function and follicular development after heterotopic autotransplantation of frozenthawed ovarian tissue, 2) to determine the practical and efficient heterotopic sites for grafting. Design: A clinical case study. Materials and Methods: The study was approved by the institutional review board of the Eulji university hospital. A 37 year old, regularly menstruating woman was diagnosed with squamous cell carcinoma of cervix (stage Ib) and scheduled for radical hystrectomy, lymph node dissection followed by radiotherapy as treatment. She also consented to bilateral salpingoophorectomy for ovarian tissue cryopreservation. The ovaries were processed into thin cortical sections (1⫻5⫻5 mm), frozen using a slow freezing technique and stored in liquid nitrogen (⫺196°C). For autotransplantation, 40 cortical sections of stored ovarian tissue (n ⫽ 93) were
Vol. 80, Suppl. 3, September 2003
Wednesday, October 15, 2003 4:00 P.M. O-243 Do pathologists accurately read testis biopsies with mixed histologic patterns in the ICSI era? Matthew R. Cooperberg, Amir Jad, Imok Cha, Paul J. Turek. UCSF, San Francisco, CA. Objective: Testis sperm is routinely used for intracytoplasmic sperm injection. Testicular histology can be valuable in predicting which men are candidates for testicular sperm extraction, yet published reports have demonstrated wide discrepancies in clinicians’ ability to locate sperm in testes with commonly recognized histological patterns. We hypothesized that this variation may stem in part from inconsistencies in pathologists’ interpretations of biopsy histology. To assess this potential inter-observer variability, we reviewed the tissue slides of referred patients, and compared the interpretation of a single in-house pathologist to the reading previously made at the referring institution. Design: Prospective study of a consecutive series of male infertility patients referred to a single institution. Materials and Methods: All biopsy reviews were performed blinded to the original outside diagnosis. On review, each biopsy was assigned one of the following categories: normal pattern (NL), hypospermatogenesis (HYP), late maturation arrest (LMA), early maturation arrest (EMA), Sertoli cell only (SCO), mixed pattern (MIX), or other. Where the outside readings did not use this terminology, they were assigned to the category best fitting the recorded description. Frequencies of the various categories were compared among the original and review diagnoses. Agreement between the two diagnoses was assessed using the weighted Kappa statistic for interobserver agreement. Results: Of 127 cases reviewed, 108 (85%) had been read previously at the referring institution. The distribution of diagnoses made by the original and reviewing pathologist are presented in the Table. The weighted Kappa score for agreement between the original and review diagnoses was 0.46 (95% CI 0.33-0.60). On closer analysis of MIX cases, (those demonstrating the largest discrepancy in readings as above), the most common change in reading among these cases was from a normal outside reading to an abnormal, mixed reading (15 cases, 38%). As a result, the review resulted in a changed treatment plan in 20 of all 39 (51%) MIX cases.
Conclusion: The lack of a standardized approach to testis biopsy histological examination by pathologists may contribute to inaccurate phenotyping of male infertility. This may significantly impact on the clinical care of these patients.
FERTILITY & STERILITY威
Wednesday, October 15, 2003 4:15 P.M. O-244 Histomorphometric and cytogenetic study of human testicular aging. Mbarka Dakouane, Lucia Bicchieray, Marianne Bergere, Martine Albert, Franc¸ ois Vialard, Jacqueline Selva. CHIPS 78303 Poissy, Versailles-Saint Quentin Univ and UFR biome´ dicale des St-Pe`res, Paris, Poissy, France. Objective: Our aim was to evaluate the influence of ageing on testicular histology, and aneuploidy rate in testis postmeiotic cells. The question of the risk related to age is raised by the increased frequency of medical assisted reproduction techniques for older men. Design: We analysed 23 testicular samples of subjects aged 59-102 years for histology, spermatogenesis efficiency and meiotic abnormality rate. We examined testicular cells with fluorescence in situ hybridisation (FISH). The protocol was included in a body donation program. Materials and Methods: After a classical study of six histologic sections (20 cross sectioned tubules), a computer-assisted morphometric analysis was performed based on the following parameters: concerning the seminiferous tubules, the surface, the thickness of the basal membrane, the nucleus density (sertoli cells, spermatogonia, spermatocytes and spermatozoids); concerning the interstitial tissue: the clusters number and the surface occupied by the Leydig cells, their nucleus density. We analysed the cells by FISH, with three probe sets X,Y and 18 (Abbot°). The results were compared to a control group of testicular biopsies of 6 subjects (30-45 yrs) with obstructive azoospermy. Results: The histological study showed various alterations including: a thickening of the basal membrane, a depletion of the seminiferous epithelium with a disturbance of the sertoli cells, and scarcity of Leydig cells associated to their hypertrophy. The morphometric study confirmed the depletion of the epithelium and showed the thickening of the basal membrane concerned subjects with spermatogenesis arrest. Up until 89 years old, we could find subjects with complete spermatogenesis. The most sensitive step was the pachytene one, spermatogonia could last until 98 years old! The 23 aged men were split into 3 groups: preserved spermatogenesis (13 subjects group1), arrested spermiogenesis (4 subjects group2) and early disrupted spermatogenesis with only diploid cells (6 subjects group3). For the subjects with preserved spermatogenesis, post meiotic cells analysis (n ⫽ 4349) showed 50,7% X18, 48,2% Y18 and 1.1% of the cells with aneuploidy. For the subjects with an arrested spermiogenesis, they showed 48% X18, 38%Y18 and aneuploidy rate among spermatids(n ⫽ 98) was 14%. For the control group postmeiotic cells(n ⫽ 491) showed 50,3% X18, 49,1% Y18 and 0,6% of cells with aneuploidy. The result of group2 was different from group1 and control (p ⬍ 0,001; p ⬍ 0,0001). No relationship was found between aneuploidy rate and spermatozoa density in these series. Conclusion: We observed that a spermatogenesis was possible until an advanced age (89 years). There seemed to be an increase in the incidence of post meiotic aneuploidy when spermiogenesis had stopped. The rate of aneuploidy in the group of subjects with preserved spermatogenesis was not statistically different from the control group.
Wednesday, October 15, 2003 4:30 P.M. O-245 Vasectomy reversal. Cost and service differences between academic institutions and private practices. Helen Ahn, Spencer Land. Loyola Univ, Chicago, IL. Objective: To determine if a difference exists for the price of vasectomy reversal and if other services, such as Vasoepididymostomy (EV) and testicular sperm extraction (TESE) are offered in academic and private practice settings. Design: Telephone survey. Materials/Methods: 10 private practices and 10 academic institutions were randomly selected from around the United States. A telephone survey was conducted to determine total cost of vasectomy reversal, if VE could be performed if indicated, and if TESE was offered. Results: The cost of vasectomy reversal averaged $6438.28 (range $4700-$7300) at the private practices and $10,782.80 (range $5450-$18200)
S93
at the academic institutions. The percentage of the total cost for surgeon’s fee was 66.6% in private practice versus 49.1% at the academic centers. Only 40% of the private practices offered TESE compared to 100% of the academic centers. VE could be performed at all academic centers, but only 1 of 10 private practices offered the procedure. 40% of private practices performed the reversal in an office setting under local anesthesia. Conclusion: There is a significant difference in cost for vasectomy reversal between academic and private practice settings. However, the majority of private practices do not offer TESE or VE, whereas all the academic centers in the survey provided these services.
ART: CLINICAL: PROCEDURES AND TECHNIQUES II Wednesday, October 15, 2003 2:00 P.M. O-246 Is day 3 embryo quality indicative of day 5 blastocyst development? Comparison of clinician vs. computer selection. Evelyn Neuber, Neal Mahutte, Aydin Arici, Denny Sakkas. Yale Sch of Medicine, New Haven, CT. Objective: It is of fundamental importance for ART programs to determine the most viable embryo for transfer. At the same time the program must reduce the risk of multiple births and still maximize the chances of pregnancy for their patients. In this study we evaluate the accuracy of experienced investigators in identifying embryos on Day 3 that will result in the best subsequent blastocysts for transfer on Day 5. We then compared these results to those of a computer algorithm based on sequential embryo assessment of multiple early morphological markers. Material and Methods: One hundred eleven patients underwent a Day 5 (blastocyst stage) embryo transfer during 2001 and the first 6 months of 2002 at our ART program. From the 2001 database, 3 investigators were asked to select which embryos they would recommend for transfer based only on the embryo development stages up to Day 3, the patient’s age and her IVF/ICSI status. After analysis of their 2001 results and review of embryo scoring techniques the same investigators performed selections from the 2002 database. From the 2002 database a computer model selected 3 Day 3 embryos for Day 5 transfers based on a sequential scoring system that takes into account multiple morphological stages, beginning with pronuclear alignment, length of first cell cycle and cleavage stages (⬎4 and ⬎8 cell stage) on Day 2 and 3 of development. Results: In 2001 the best embryo available on Day 5 was successfully selected on Day 3 in just over 50% of the cases (Table 1). After analysis of the 2001 results by the three investigators there was a significant improvement in their ability to select a blastocyst with the 2002 data when one was available (p ⫽ 0.02). However, the computer model either equaled or outperformed the 3 investigators in selection performance. There was no statistically significant difference between any of the selections made by the 3 investigators.
Conclusions: Even experienced ART investigators have only a slightly better than 50% chance of selecting the best embryo based on Day 3 information. More importantly, our computer model using early embryo assessment criteria may provide a more reliable, objective way for selecting the optimal embryo for transfer on Day 3, and in addition has the potential to be a useful training and standardization tool for ART programs.
S94
Abstracts
Wednesday, October 15, 2003 2:15 P.M. O-247 Preliminary results of a prospective randomized study to assess the value of laser assisted hatching before cleavage stage embryo transfer among good-prognosis In Vitro Fertilization (IVF) patients. Jennifer Carter, James Graham, Taer Han, Alana Davis, Kevin S. Richter, Eric Widra. Shady Grove Fertility Reproductive Science Ctr, Rockville, MD. Objective: To evaluate the effect of laser assisted hatching prior to cleavage stage embryo transfer among good-prognosis IVF patients (who under current guidelines would not be treated with assisted hatching). A statistically significant benefit to hatching was found in a previous study of day 6 embryo transfers (Tucker et al. Fertil Steril 1999;72:s20-21), leading us to speculate such a difference might also be found on day 3. Design: Prospective randomized study. Materials and Methods: Criteria for eligibility were: ovulatory menstrual cycles; normal day 3 FSH; 39 years of age or younger; no more than one previous unsuccessful IVF attempt; and good quality embryos (6 or more cells per embryo on day 3 and less than 30% fragmentation). To date 91 eligible patients were enrolled following informed consent. Enrolled patients were randomly assigned (2 to 1 ratio) to either the treatment (hatching) group or the control (no hatching) group. Embryo transfers for all treatment and control cycles were performed on day 3 after oocyte retrieval. Laser assisted hatching was performed on all embryos of patients assigned to the treatment group before transfer. Implantation and pregnancy outcomes were determined based on ultrasound identification of fetal heart activity. Implantation rates were calculated for each cycle and compared between treatment and control groups by Wilcoxon rank sums test. Pregnancy rates were compared between treatment and control groups by chisquare analysis. Results: Of the 91 patients enrolled thus far, 60 were randomized to the treatment group and 31 were randomized to the control group. Implantation rates were 36.5% (95% CI: 27.3% to 45.7%) for treatment cycles versus 38.7% (95% CI: 25.9% to 51.5%) for control cycles (p ⫽ 0.59). Pregnancy rates were 60.0% (95% CI: 47.4% to 71.4%) for treatment cycles versus 64.5% (95% CI: 46.9% to 78.9%) for control cycles (p ⫽ 0.67). Conclusions: These preliminary results provide no evidence of a benefit of laser assisted hatching for good-prognosis IVF patients undergoing day 3 embryo transfer. Although differences may become apparent with a larger sample size, the current data indicate very similar implantation and pregnancy rates with or without assisted hatching. Sample sizes many times larger would be required to statistically confirm differences as small as those observed.
Wednesday, October 15, 2003 2:30 P.M. O-248 Ovarian function after autotransplantation of frozen-thawed human ovarian tissue: An experience of human ovarian grafting into two heterotopic sites. S. Samuel Kim, In-Taek Hwang, Hoi-Chang Lee, Dong Hoon Kim. Eulji Univ Sch of Medicine, Seoul, Republic of Korea. Objectives: Ovarian tissue banking is one of the promising strategies for fertility conservation in women with cancer, although its efficacy is still unknown. The aims of this study were 1) to investigate ovarian function and follicular development after heterotopic autotransplantation of frozenthawed ovarian tissue, 2) to determine the practical and efficient heterotopic sites for grafting. Design: A clinical case study. Materials and Methods: The study was approved by the institutional review board of the Eulji university hospital. A 37 year old, regularly menstruating woman was diagnosed with squamous cell carcinoma of cervix (stage Ib) and scheduled for radical hystrectomy, lymph node dissection followed by radiotherapy as treatment. She also consented to bilateral salpingoophorectomy for ovarian tissue cryopreservation. The ovaries were processed into thin cortical sections (1⫻5⫻5 mm), frozen using a slow freezing technique and stored in liquid nitrogen (⫺196°C). For autotransplantation, 40 cortical sections of stored ovarian tissue (n ⫽ 93) were
Vol. 80, Suppl. 3, September 2003