- Email: [email protected]
Vitamin D deficiency is predictive of depressive symptoms in women with polycystic ovary syndrome (PCOS)
O-34 Monday, October 17, 2011 05:15 PM ARE INCREASED LEVELS OF SELF-REPORTED PSYCHOSOCIAL STRESS, ANXIETY AND DEPRESSION ASSOCIATED WITH FERTILITY PROBLEMS? C. D. Lynch, R. Sundaram, G. M. Buck Louis, K. J. Lum, C. Pyper. Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH; Division of Epidemiology, Statistics and Prevention Research, NICHD/NIH, Rockville, MD; National Perinatal Epidemiology Unit, University of Oxford, Oxford, England, United Kingdom; Department of Biostatistics, Johns Hopkins Bloomberg Public Health, Baltimore, MD. OBJECTIVE: To assess the association between self-reported measures of stress, anxiety, depression and related constructs and fertility problems as measured by time to pregnancy (TTP) and estimates of the day-specific probabilities of pregnancy (DSPP). DESIGN: Prospective cohort study of women trying to conceive. MATERIALS AND METHODS: Women were followed for up to 6 menstrual cycles or until pregnancy. Participants completed standardized questionnaires on day six of the first cycle including: Hospital Anxiety and Depression Scale, Perceived Stress Scale (PSS), State-Trait Anxiety Inventory, the Medical Outcomes Study Social Support Survey, Pearlin’s Mastery Scale, and Rosenberg’s Self-Esteem Scale. The PSS was repeated on day six of each cycle. Of the 370 women enrolled, 339 (92%) had complete data for analysis. TTP was examined using discrete-time Cox Proportional Hazards models. DSPP effects were assessed using Bayesian methods. RESULTS: Among the 339 women, 207 (61%) became pregnant during the study, 69 (20%) did not become pregnant, and 63 (19%) withdrew. Women who became pregnant were on average slightly younger than those who did not become pregnant and were more likely to report having previously delivered a live-born infant (52% versus 41%). There were no differences in the scores of the psychosocial instruments completed at baseline between women who did and did not get pregnant. After controlling for maternal age, parity, months trying to conceive prior to enrollment, caffeine use while trying, and frequency of intercourse, we found no association between any of the self-reported psychosocial questionnaire data and TTP or DSPP. CONCLUSION: Self-reported psychosocial stress, anxiety, and depression were not associated with fertility problems. Any adverse effect of stress or psychological disturbance on fertility does not appear to be detectable via self-administered questionnaire. Supported by: Intramural research program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
O-35 Monday, October 17, 2011 05:30 PM IMPROVING QUALITY OF LIFE FOR FEMALE CANCER SURVIVORS: IMPORTANCE OF PRE-TREATMENT ONCOLOGY CONSULTATION. J. M. Letourneau, E. Ebbel, A. Katz, J. F. Smith, P. F. Katz, M. P. Rosen. Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; Department of Urology, University of California, San Francisco, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA. OBJECTIVE: To determine the relationship between addressing more reproductive health issues during pre-treatment oncology consultation and quality of life (QoL) in young female cancer survivors. DESIGN: Cross-sectional survey. MATERIALS AND METHODS: We contacted 2532 women from the California Cancer Registry (randomly sampled; diagnosed from 19932007; ages 18-40 at diagnosis; written/electronic survey (English/Spanish); mailed on rolling basis), with: 1) Leukemia, 2) Lymphoma, 3) Breast cancer, and 4) GI cancers. Surveys were utilized to explore the relationship between 10 core reproductive health issues (side effects on monthly cycles, risk of treatment causing early menopause, side effects on ability to have a baby, and several others) and post-treatment QoL outcomes. Quality of life measures included the Decision Regret Score (DRS), Satisfaction with Life Scale (SWLS), World Health Organization QoL (WHOQoL-BREF), and Reproductive Concerns Scale (RCS). Linear regression was used to assess the relationship between number of core issues discussed and quality of life. RESULTS: 1041 (41%) of women responded and 918 reported treatment with potential to affect fertility. 61% of patients reported receiving some counseling about post-treatment fertility issues, yet 59% reported receiving counseling about less than half of the 10 core reproductive health issues. The associations between addressing more reproductive health issues during counseling and quality of life are shown in the table.
FERTILITY & STERILITYÒ
QoL if more reproductive issues addressed.
Result Lower Regret Higher Satisfaction Higher WHOQoL Lower Reproductive Concerns More Satisfaction (Cancer Care/Fertility Care)
P-Value <0.01 0.26 <0.01 <0.01 <0.01
CONCLUSION: This is the first study to quantify psychosocial outcomes for female cancer survivors, based on breadth of discussion of fertilityrelated issues. These data suggest the more reproductive health issues an oncologist can discuss before cancer treatment, the higher a patient’s posttreatment QoL. Supported by: NIH/NCRR/OD UCSF-CTSI TL1 RR024129.
O-36 Monday, October 17, 2011 05:45 PM THE PATIENT HEALTH QUESTIONNAIRE (PHQ) IS A POOR PSYCHOLOGICAL SCREENING TOOL IN IN VITRO FERTILIZATION (IVF) PATIENTS. N. R. Whitlow, G. L. Ryan, S. P. Stuart. Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA; Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA. OBJECTIVE: Infertility diagnosis and treatment is often associated with psychological distress. Two years ago, depression screening using the PHQ (a 9-question self-reported depression scale) was instituted for all women presenting to our IVF clinic. Provider reviewers noted few positive responses, even from those clearly distressed at their visit. Other research suggests increased stress and decreased self-esteem, but not clinical psychopathology, related to infertility. Our goal in this study was to formally assess how often our IVF patients showed evidence of possible depression using this screening tool. DESIGN: Retrospective chart review. MATERIALS AND METHODS: Records were reviewed for all new female IVF patients seen between 4/20/09 - 12/30/10. Results were coded for major depressive syndrome or other depressive syndrome using validated coding algorithms. Summary statistics were performed. RESULTS: Results were available for 321/419 (77%) new patients. Median age was 33. 87% were Caucasian, and 95% were married. PHQ scores ranged from 1-16 (maximum possible: 27). Mean was 1.6, median was 1, and mode was 0. Based on the original PHQ authors’ criteria, 3/321 (0.9%) patients screened positive for major depressive disorder and 5/321 (1.6%) for other depressive disorder. By comparison, in an unselected historical sample of primary care patients, 10% screened positive for major depressive disorder and 6% for other depressive disorder. CONCLUSION: Our new IVF patients rarely screen positive for depression using the PHQ. In fact, scores were substantially lower than expected even when compared to a general population. This is likely due to a social desirability bias that can be seen in infertility populations, as women feel they must ‘‘prove’’ parenting fitness. Women may also under-report symptoms as ‘‘depression’’ since they feel they have a cause (infertility) for distress. Future efforts must be made to identify a better screening tool for psychological distress in this population. Supported by: WRHR program at the U. of Iowa.
O-37 Monday, October 17, 2011 06:00 PM VITAMIN D DEFICIENCY IS PREDICTIVE OF DEPRESSIVE SYMPTOMS IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS). A. D. Moore, S. H. Naqvi, S. Latif, D. Setukavala, K. Bevilacqua, L. Pal. Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT; University of Connecticut, Storrs, CT; Kasturba Medical College, Mangalore, India; Albert Einstein College of Medicine & Montefiore Medical Center, Hartsdale, NY. OBJECTIVE: To assess a relationship between vitamin D status and depressive symptoms in women with PCOS. DESIGN: Retrospective study.
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MATERIALS AND METHODS: In patients seeking specialist reproductive endocrinology care for symptoms relating to PCOS, serum 25OHD levels were assessed. A validated 9 item Patient health Questionnaire (PHQ) allowed assessment of depressive symptoms (score 0-4, Not depressed; 5-9 Mild; 10-14 Moderate; 15-19 Moderately severe and 20-27 as Severe depressive symptoms). Relationship between serum 25OHD (continuous as well as dichotomized at <20ng/ml vs. higher) & depression (PHQ score>4) and with moderate-severe depression (PHQ score>10) were assessed using multivariable linear and logistic regression analyses after adjusting for age, overweight body habitus, family history of depression and symptoms of acne, hirsutism and oligomenorrhea. RESULTS: Serum 25OHD and PHQ scores were available for 51 patients meeting criteria for PCOS. 20/51 (39%) met PHQ criteria for depression (PHQ>4) with 9/51 (17%) meeting criteria for moderate to severe depression (PHQ> ¼ 10). An inverse correlation was observed between serum 25OHD and PHQ scores (r -0.24, P¼0.08). Patients with serum 25OHD<20ng/ml were almost 4 times more likely to meet criteria for depression (PHQ>4, OR 3.47, 95% CI 0.78-16.19, P¼0.056). On adjusted analyses, serum 25OHD<20 was an independent predictor of PHQ score (AR2 0.19, b 4.24); women with 25OHD<20ng/ml were 6 times more likely to score >4 (OR 6.51, 95% CI 1.29- 32.91, P¼0.023) and 18 times more likely to score >10 (OR 18.28 1.03-325.19, P¼0.048). CONCLUSION: Vitamin D deficiency is identified as a risk factor for depressive symptoms in women with PCOS.
IMAGING AND ART IMAGING O-38 Monday, October 17, 2011 04:15 PM CERVICAL EVALUATION BY VIRTUAL HYSTEROSALPINGOGRAPHY BEFORE EMBRYO TRANSFER. M. Baronio, P. Carrascosa, C. Capunay, J. Vallejos, A. Vasconcelos, S. Papier. CEGYR, Ciudad Aut onoma de Buenos Aires, Buenos Aires, Argentina; Diagnostico Maipu, Vicente Lopez, Buenos Aires, Argentina. OBJECTIVE: To compare cervical catheter test and virtual hysterosalpingography (VHSG) in the evaluation of cervix before embryo transfer. DESIGN: Prospective controlled study. MATERIALS AND METHODS: We evaluated 33 consecutive patients with history of infertility. All patients were nulliparous and they had not history of cervical surgery. With the full baldder, prior to the VHSG CT scan, a gynecologist performed a cervical test with a Wallace catheter. The cervical patency, grade of resistance and uterus position were assessed. Then, patients underwent VHSG performed with a 256-slice CT scanner. CT images were evaluated by a radiologist, and the cervical patency, uterocervical angle and the presence of cervical pathology were determined. RESULTS: There was a good correlation (r ¼ 0,87) in cervical patency evaluation between both methods. Unsuccessful cervical catheter test was observed in 13 patients (39%). In these patients, VHSG detected cervical polyp in 2, cervical synequiae in 1, sinuous cervical canal in 3, and normal cervix in 7, but the uterocervical angle was < 60 . In 95% of patients with successful cervical test, the uterocervical angle was > 60 . CONCLUSION: VHSG findings correlate with cervical catheter test in the evaluation of cervical patency. VHSG provides anatomic information useful to identify the probable cause of failure of embryo transfers and prevent them.
O-39 Monday, October 17, 2011 04:30 PM INTER-OBSERVER REPRODUCIBILITY OF FOLLICULAR COHORT MEASUREMENTS BY TWO- AND THREE-DIMENSIONAL SONOGRAPHY: A PROSPECTIVE EVALUATION IN 30 OOCYTE DONORS. A. Rodriguez, D. Bodri, J. J. Guillen, B. Luhr, V. Vernaeve, O. Coll. Reproductive Medicine, Eugin Clinic, Barcelone, Barcelona, Spain. OBJECTIVE: The present prospective study aimed at measuring inter-observer reliability of follicular cohort measurements performed during ovarian stimulation of oocyte donors wit. 3D sonography. DESIGN: Comparative observational study. MATERIALS AND METHODS: 30 oocyte donors between 18-35 years, stimulated with the GnRH antagonist protocol were included in a prospective study in a private infertility centre between May and November 2010. A GE Voluson i ultrasound was used. Each donor was asked and agreed to undergo a repeat examination. The number of follicles and their size was counted in
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Abstracts
one of the ovaries with 2D and in the 3D. For the statistical evaluation of inter-observer reproducibility of 2D and 3D measurements each follicular cohort was simply represented as the total number of follicles R10 and R18mm. One-way ANOVA test was applied for differences in total follicular counts. Inter-observer reproducibility was evaluated by Pearson correlates and by calculating intraclass correlation coefficients (ICC). RESULTS: For operator pair N 1 no significant differences were observed in the count of follicles of R10 mm (5.4 4.1 versus 6.7 4.2, P¼0.39 and 6.8 4 versus 5.8 4.5, P¼0.53) and R18mm (0.8 1.5 versus 0.5 1, P¼0.56 and 0.6 0.9 versus 0.3 0.6, P¼0.24) for 2D and 3D technique, respectively. Similarly, for operator pair N 2 no significant differences were observed in the count of follicles of R10 mm (6.7 4.8 versus 7.7 5.7, P¼0.0.61 and 7.7 7.4 versus 7.9 6.6, P¼0.0.94) and R18mm (0.7 1.1 versus 0.7 1, P¼0.87 and 0.9 1.5 versus 0.6 1.0, P¼0.55). Calculation of R10 mm follicular count comparing 2D with 3D, the Pearson correlation coefficients increased from 0.815 to 0.934 and from 0.922 to 0.975 for operator pair N 1 and 2. Similarly ICC increased from 0.783 to 0.906 and from 0.931 to 0.983. CONCLUSION: Good inter-observer agreement was reached both by the 2D and 3D scanning techniques. However for both operator pairs this agreement was higher using 3D scanning. Supported by: The sponsor of this study has been Fundacio Privada EUGIN. O-40 Monday, October 17, 2011 04:45 PM ROLE OF HYSTEROSCOPY IN DIAGNOSIS OF SUBTLE UTERINE ANOMALIES IN PATIENTS WITH NORMAL HYSTEROSALPINGOGRAPHY. N. Kalia, O. Abuzeid, M. Ashraf, M. I. Abuzeid. Division of Reproductive Endocrinology and Infertility, Dept. of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI; Dept. of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI. OBJECTIVE: Hysterosalpingogram (HSG) is an initial screening tool for evaluation of the uterus and the fallopian tubes. Although saline infusion hysterogram with 3-D US and diagnostic hysteroscopy (DH) are now the gold standard for evaluation of uterine factors, including subtle uterine septum and arcuate uterus, HSG is still being used for evaluation of such patients. The purpose of this study is to determine the role of HSG in the diagnosis of subtle incomplete uterine septum or an arcuate uterus in patients presenting with infertility and/or recurrent pregnancy loss. DESIGN: Retrospective Study. MATERIALS AND METHODS: All patients (840) who presented to our unit with infertility and/or recurrent pregnancy loss (1992 - 2008) and subsequently underwent HSG and DH, were studied. The findings on HSG with respect to the appearance of the endometrial cavity were compared to the findings on DH. RESULTS: Two hundred ninety two patients (34.8%) were found to have either a subtle incomplete uterine septum (71.6%) or an arcuate uterus (28.4%) on hysteroscopy. In 141 (16.8%) patients, a septum was found on both HSG and DH. In 14 patients (1.7%), the HSG was negative when DH was positive. In 151 patients (18%), HSG was negative and the DH was positive. In 534 (63.6%) patients, both studies were negative. The ability of HSG to detect such subtle uterine anomalies had a sensitivity of 47%, a specificity of 97%, a positive predictive value of 91%, and a negative predictive value of 78%. When we compared the overall population studied to those with arcuate uterus alone, or incomplete uterine septum alone, with respect to sensitivity, specificity, and both positive and negative predictive values, the results were similar. CONCLUSION: This study suggests that when the clinical presentation of the patient suggests uterine factors, HSG alone should not be used to rule out arcuate uterus or subtle incomplete uterine septum. Hysteroscopy appears to be the gold standard before ruling out such anomalies.
O-41 Monday, October 17, 2011 05:00 PM ASSISTED REPRODUCTIVE TECHNOLOGIES AND UTILIZATION OF ANTENATAL ULTRASOUND. R. Kudesia, S. T. Chasen. Obstetrics & Gynecology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Maternal-Fetal Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY. OBJECTIVE: Our objective was to determine whether pregnancies conceived via ARTs are associated with higher utilization of antenatal ultrasound. DESIGN: Case-control.
Vol. 96., No. 3, Supplement, September 2011
O-35 Monday, October 17, 2011 05:30 PM IMPROVING QUALITY OF LIFE FOR FEMALE CANCER SURVIVORS: IMPORTANCE OF PRE-TREATMENT ONCOLOGY CONSULTATION. J. M. Letourneau, E. Ebbel, A. Katz, J. F. Smith, P. F. Katz, M. P. Rosen. Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; Department of Urology, University of California, San Francisco, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA. OBJECTIVE: To determine the relationship between addressing more reproductive health issues during pre-treatment oncology consultation and quality of life (QoL) in young female cancer survivors. DESIGN: Cross-sectional survey. MATERIALS AND METHODS: We contacted 2532 women from the California Cancer Registry (randomly sampled; diagnosed from 19932007; ages 18-40 at diagnosis; written/electronic survey (English/Spanish); mailed on rolling basis), with: 1) Leukemia, 2) Lymphoma, 3) Breast cancer, and 4) GI cancers. Surveys were utilized to explore the relationship between 10 core reproductive health issues (side effects on monthly cycles, risk of treatment causing early menopause, side effects on ability to have a baby, and several others) and post-treatment QoL outcomes. Quality of life measures included the Decision Regret Score (DRS), Satisfaction with Life Scale (SWLS), World Health Organization QoL (WHOQoL-BREF), and Reproductive Concerns Scale (RCS). Linear regression was used to assess the relationship between number of core issues discussed and quality of life. RESULTS: 1041 (41%) of women responded and 918 reported treatment with potential to affect fertility. 61% of patients reported receiving some counseling about post-treatment fertility issues, yet 59% reported receiving counseling about less than half of the 10 core reproductive health issues. The associations between addressing more reproductive health issues during counseling and quality of life are shown in the table.
FERTILITY & STERILITYÒ
QoL if more reproductive issues addressed.
Result Lower Regret Higher Satisfaction Higher WHOQoL Lower Reproductive Concerns More Satisfaction (Cancer Care/Fertility Care)
P-Value <0.01 0.26 <0.01 <0.01 <0.01
CONCLUSION: This is the first study to quantify psychosocial outcomes for female cancer survivors, based on breadth of discussion of fertilityrelated issues. These data suggest the more reproductive health issues an oncologist can discuss before cancer treatment, the higher a patient’s posttreatment QoL. Supported by: NIH/NCRR/OD UCSF-CTSI TL1 RR024129.
O-36 Monday, October 17, 2011 05:45 PM THE PATIENT HEALTH QUESTIONNAIRE (PHQ) IS A POOR PSYCHOLOGICAL SCREENING TOOL IN IN VITRO FERTILIZATION (IVF) PATIENTS. N. R. Whitlow, G. L. Ryan, S. P. Stuart. Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA; Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA. OBJECTIVE: Infertility diagnosis and treatment is often associated with psychological distress. Two years ago, depression screening using the PHQ (a 9-question self-reported depression scale) was instituted for all women presenting to our IVF clinic. Provider reviewers noted few positive responses, even from those clearly distressed at their visit. Other research suggests increased stress and decreased self-esteem, but not clinical psychopathology, related to infertility. Our goal in this study was to formally assess how often our IVF patients showed evidence of possible depression using this screening tool. DESIGN: Retrospective chart review. MATERIALS AND METHODS: Records were reviewed for all new female IVF patients seen between 4/20/09 - 12/30/10. Results were coded for major depressive syndrome or other depressive syndrome using validated coding algorithms. Summary statistics were performed. RESULTS: Results were available for 321/419 (77%) new patients. Median age was 33. 87% were Caucasian, and 95% were married. PHQ scores ranged from 1-16 (maximum possible: 27). Mean was 1.6, median was 1, and mode was 0. Based on the original PHQ authors’ criteria, 3/321 (0.9%) patients screened positive for major depressive disorder and 5/321 (1.6%) for other depressive disorder. By comparison, in an unselected historical sample of primary care patients, 10% screened positive for major depressive disorder and 6% for other depressive disorder. CONCLUSION: Our new IVF patients rarely screen positive for depression using the PHQ. In fact, scores were substantially lower than expected even when compared to a general population. This is likely due to a social desirability bias that can be seen in infertility populations, as women feel they must ‘‘prove’’ parenting fitness. Women may also under-report symptoms as ‘‘depression’’ since they feel they have a cause (infertility) for distress. Future efforts must be made to identify a better screening tool for psychological distress in this population. Supported by: WRHR program at the U. of Iowa.
O-37 Monday, October 17, 2011 06:00 PM VITAMIN D DEFICIENCY IS PREDICTIVE OF DEPRESSIVE SYMPTOMS IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS). A. D. Moore, S. H. Naqvi, S. Latif, D. Setukavala, K. Bevilacqua, L. Pal. Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT; University of Connecticut, Storrs, CT; Kasturba Medical College, Mangalore, India; Albert Einstein College of Medicine & Montefiore Medical Center, Hartsdale, NY. OBJECTIVE: To assess a relationship between vitamin D status and depressive symptoms in women with PCOS. DESIGN: Retrospective study.
S11
MATERIALS AND METHODS: In patients seeking specialist reproductive endocrinology care for symptoms relating to PCOS, serum 25OHD levels were assessed. A validated 9 item Patient health Questionnaire (PHQ) allowed assessment of depressive symptoms (score 0-4, Not depressed; 5-9 Mild; 10-14 Moderate; 15-19 Moderately severe and 20-27 as Severe depressive symptoms). Relationship between serum 25OHD (continuous as well as dichotomized at <20ng/ml vs. higher) & depression (PHQ score>4) and with moderate-severe depression (PHQ score>10) were assessed using multivariable linear and logistic regression analyses after adjusting for age, overweight body habitus, family history of depression and symptoms of acne, hirsutism and oligomenorrhea. RESULTS: Serum 25OHD and PHQ scores were available for 51 patients meeting criteria for PCOS. 20/51 (39%) met PHQ criteria for depression (PHQ>4) with 9/51 (17%) meeting criteria for moderate to severe depression (PHQ> ¼ 10). An inverse correlation was observed between serum 25OHD and PHQ scores (r -0.24, P¼0.08). Patients with serum 25OHD<20ng/ml were almost 4 times more likely to meet criteria for depression (PHQ>4, OR 3.47, 95% CI 0.78-16.19, P¼0.056). On adjusted analyses, serum 25OHD<20 was an independent predictor of PHQ score (AR2 0.19, b 4.24); women with 25OHD<20ng/ml were 6 times more likely to score >4 (OR 6.51, 95% CI 1.29- 32.91, P¼0.023) and 18 times more likely to score >10 (OR 18.28 1.03-325.19, P¼0.048). CONCLUSION: Vitamin D deficiency is identified as a risk factor for depressive symptoms in women with PCOS.
IMAGING AND ART IMAGING O-38 Monday, October 17, 2011 04:15 PM CERVICAL EVALUATION BY VIRTUAL HYSTEROSALPINGOGRAPHY BEFORE EMBRYO TRANSFER. M. Baronio, P. Carrascosa, C. Capunay, J. Vallejos, A. Vasconcelos, S. Papier. CEGYR, Ciudad Aut onoma de Buenos Aires, Buenos Aires, Argentina; Diagnostico Maipu, Vicente Lopez, Buenos Aires, Argentina. OBJECTIVE: To compare cervical catheter test and virtual hysterosalpingography (VHSG) in the evaluation of cervix before embryo transfer. DESIGN: Prospective controlled study. MATERIALS AND METHODS: We evaluated 33 consecutive patients with history of infertility. All patients were nulliparous and they had not history of cervical surgery. With the full baldder, prior to the VHSG CT scan, a gynecologist performed a cervical test with a Wallace catheter. The cervical patency, grade of resistance and uterus position were assessed. Then, patients underwent VHSG performed with a 256-slice CT scanner. CT images were evaluated by a radiologist, and the cervical patency, uterocervical angle and the presence of cervical pathology were determined. RESULTS: There was a good correlation (r ¼ 0,87) in cervical patency evaluation between both methods. Unsuccessful cervical catheter test was observed in 13 patients (39%). In these patients, VHSG detected cervical polyp in 2, cervical synequiae in 1, sinuous cervical canal in 3, and normal cervix in 7, but the uterocervical angle was < 60 . In 95% of patients with successful cervical test, the uterocervical angle was > 60 . CONCLUSION: VHSG findings correlate with cervical catheter test in the evaluation of cervical patency. VHSG provides anatomic information useful to identify the probable cause of failure of embryo transfers and prevent them.
O-39 Monday, October 17, 2011 04:30 PM INTER-OBSERVER REPRODUCIBILITY OF FOLLICULAR COHORT MEASUREMENTS BY TWO- AND THREE-DIMENSIONAL SONOGRAPHY: A PROSPECTIVE EVALUATION IN 30 OOCYTE DONORS. A. Rodriguez, D. Bodri, J. J. Guillen, B. Luhr, V. Vernaeve, O. Coll. Reproductive Medicine, Eugin Clinic, Barcelone, Barcelona, Spain. OBJECTIVE: The present prospective study aimed at measuring inter-observer reliability of follicular cohort measurements performed during ovarian stimulation of oocyte donors wit. 3D sonography. DESIGN: Comparative observational study. MATERIALS AND METHODS: 30 oocyte donors between 18-35 years, stimulated with the GnRH antagonist protocol were included in a prospective study in a private infertility centre between May and November 2010. A GE Voluson i ultrasound was used. Each donor was asked and agreed to undergo a repeat examination. The number of follicles and their size was counted in
S12
Abstracts
one of the ovaries with 2D and in the 3D. For the statistical evaluation of inter-observer reproducibility of 2D and 3D measurements each follicular cohort was simply represented as the total number of follicles R10 and R18mm. One-way ANOVA test was applied for differences in total follicular counts. Inter-observer reproducibility was evaluated by Pearson correlates and by calculating intraclass correlation coefficients (ICC). RESULTS: For operator pair N 1 no significant differences were observed in the count of follicles of R10 mm (5.4 4.1 versus 6.7 4.2, P¼0.39 and 6.8 4 versus 5.8 4.5, P¼0.53) and R18mm (0.8 1.5 versus 0.5 1, P¼0.56 and 0.6 0.9 versus 0.3 0.6, P¼0.24) for 2D and 3D technique, respectively. Similarly, for operator pair N 2 no significant differences were observed in the count of follicles of R10 mm (6.7 4.8 versus 7.7 5.7, P¼0.0.61 and 7.7 7.4 versus 7.9 6.6, P¼0.0.94) and R18mm (0.7 1.1 versus 0.7 1, P¼0.87 and 0.9 1.5 versus 0.6 1.0, P¼0.55). Calculation of R10 mm follicular count comparing 2D with 3D, the Pearson correlation coefficients increased from 0.815 to 0.934 and from 0.922 to 0.975 for operator pair N 1 and 2. Similarly ICC increased from 0.783 to 0.906 and from 0.931 to 0.983. CONCLUSION: Good inter-observer agreement was reached both by the 2D and 3D scanning techniques. However for both operator pairs this agreement was higher using 3D scanning. Supported by: The sponsor of this study has been Fundacio Privada EUGIN. O-40 Monday, October 17, 2011 04:45 PM ROLE OF HYSTEROSCOPY IN DIAGNOSIS OF SUBTLE UTERINE ANOMALIES IN PATIENTS WITH NORMAL HYSTEROSALPINGOGRAPHY. N. Kalia, O. Abuzeid, M. Ashraf, M. I. Abuzeid. Division of Reproductive Endocrinology and Infertility, Dept. of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI; Dept. of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI. OBJECTIVE: Hysterosalpingogram (HSG) is an initial screening tool for evaluation of the uterus and the fallopian tubes. Although saline infusion hysterogram with 3-D US and diagnostic hysteroscopy (DH) are now the gold standard for evaluation of uterine factors, including subtle uterine septum and arcuate uterus, HSG is still being used for evaluation of such patients. The purpose of this study is to determine the role of HSG in the diagnosis of subtle incomplete uterine septum or an arcuate uterus in patients presenting with infertility and/or recurrent pregnancy loss. DESIGN: Retrospective Study. MATERIALS AND METHODS: All patients (840) who presented to our unit with infertility and/or recurrent pregnancy loss (1992 - 2008) and subsequently underwent HSG and DH, were studied. The findings on HSG with respect to the appearance of the endometrial cavity were compared to the findings on DH. RESULTS: Two hundred ninety two patients (34.8%) were found to have either a subtle incomplete uterine septum (71.6%) or an arcuate uterus (28.4%) on hysteroscopy. In 141 (16.8%) patients, a septum was found on both HSG and DH. In 14 patients (1.7%), the HSG was negative when DH was positive. In 151 patients (18%), HSG was negative and the DH was positive. In 534 (63.6%) patients, both studies were negative. The ability of HSG to detect such subtle uterine anomalies had a sensitivity of 47%, a specificity of 97%, a positive predictive value of 91%, and a negative predictive value of 78%. When we compared the overall population studied to those with arcuate uterus alone, or incomplete uterine septum alone, with respect to sensitivity, specificity, and both positive and negative predictive values, the results were similar. CONCLUSION: This study suggests that when the clinical presentation of the patient suggests uterine factors, HSG alone should not be used to rule out arcuate uterus or subtle incomplete uterine septum. Hysteroscopy appears to be the gold standard before ruling out such anomalies.
O-41 Monday, October 17, 2011 05:00 PM ASSISTED REPRODUCTIVE TECHNOLOGIES AND UTILIZATION OF ANTENATAL ULTRASOUND. R. Kudesia, S. T. Chasen. Obstetrics & Gynecology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Maternal-Fetal Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY. OBJECTIVE: Our objective was to determine whether pregnancies conceived via ARTs are associated with higher utilization of antenatal ultrasound. DESIGN: Case-control.
Vol. 96., No. 3, Supplement, September 2011