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Results: Activation rate in group A was 42.9% (21/49), significantly lower than those in group B, group C, and group D (69.0% 75.4%, P 0.05).

Two thirds of activated oocytes (n 21) in group A displayed one pronuclear (PN) and two polar bodies (PB) (1PN 2PB). In contrast in group C and group D oocytes with two pronuclei and two polar bodies (2PN 2PB) were found as the predominant pattern. The cleavage rates in group A, group B, and group C were 81.0% (17/21), 82.8% (24/29) and 88.4% (38/43) respectively, much higher than that in group D (19.2%, 5/26) (P 0.01). On the third day after electrical stimulation, 17.6% (3/17), 29.2% (7/24), 31.4% (11/35) of activated oocytes progressed to 8-cell stage in group A, group B and group C respectively. Table1.

6.1 cm3, p 0.007). This difference was however less relevant (mean percentage of reduction 23%, 95% Confidence Interval: 6% - 40%) and resulted related to the dimension of the enucleated cyst. Conclusions: Laparoscopic excision of ovarian cysts is associated with a significant reduction of the ovarian reserve. The damage could not be merely ascribed to the amount of ovarian tissue that may be removed during surgery. Further studies are required to clarify whether the damage is related to the surgical procedure or to the previous presence of a cyst.

Wednesday, October 15, 2003 2:15 P.M.
O-214 Recurrence of hydrosalpinges after cuff neosalpingostomy in a poor prognosis population. Aykut Bayrak, Djana Harp, Peyman Saadat, Eliran Mor, Richard J. Paulson. Univ of Southern CA Keck Sch of Medicine, Los Angeles, CA. Objective: The presence of hydrosalpinges has been shown to adversely affect embryo implantation during IVF. Consequently, hydrosalpinges are treated with salpingectomy or neosalpingostomy prior to IVF. Whereas some patients prefer the option of neosalpingostomy and even poor prognosis cases may derive some pregnancy benefit from patent oviducts, many hydrosalpinges recur after neosalpingostomy and additional surgery may be required. The objective of this study was to determine the recurrence rate of hydrosalpinges after cuff neosalpingostomy in poor prognosis candidates. Materials and Methods: Twenty-seven poor-prognosis patients underwent cuff neosalpingostomy for the treatment of hydrosalpinx between February 1999-June 2002. All had a post-operative hysterosalpingogram or a secondlook laparoscopy to evaluate tubal patency. All patients were evaluated with chlamydia trachomatis titer and pre-operative hysterosalpingogram. Mean (range) age in the study group was 36.5 years (21-43 years). Mean (range) duration of infertility was 6.7 years (2-19 years). Even though only 10 patients (37%) reported a history of a sexually transmitted disease, 22 out of 27 (81%) had positive chlamydia trachomatis titer, 16 patients had bilateral hydrosalpinx, 7 had unilateral hydrosalpinx and 4 patients had unilateral hydrosalpinx with contralateral patency. Results: There were 14 laparoscopic bilateral cuff neosalpingostomies, 9 laparoscopic unilateral cuff neosalpingostomies contralateral salpingectomy and 4 cuff neosalpingostomies via laparotomy myomectomy. The findings of tubal patency post-operatively are as follows: Of 16 patients with bilateral hydrosalpinx, 8 patients had recurrent bilateral hydrosalpinx, 4 had unilateral hydrosalpinx with contralateral patency and 4 had bilateral patency. Of the 7 patients with unilateral hydrosalpinx, 4 had recurrent hydrosalpinx and 3 had tubal patency. Of the four patients with unilateral hydrosalpinx and contralateral patency, 2 had bilateral hydrosalpinx, 1 had unilateral hydrosalpinx and 1 patient had bilateral patency. 19 of 27 patients (70%) had unilateral or bilateral recurrence of hydrosalpinx. Of the 43 tubes that were cuffed, 16 had persistent patency (37%). One patient became pregnant after surgery (3.7%). Conclusion: In a poor prognosis population undergoing neosalpingostomy for hydrosalpinges, tubal patency and pregnancy rates were 30% and 5%, respectively. Most patients had recurrence of hydrosalpinx after cuff neosalpingostomy, thus requiring additional surgery, such as salpingectomy prior to IVF. In a population with poor prognosis hydrosalpinges, salpingectomy should be the preferred treatment for hydrosalpinx prior to IVF.

Conclusion: Human oocytes at different ages can be effectively activated by electrical stimulation. Though comparable activation rates were obtained for oocytes at different ages, activation patterns and embryo developmental competence differed significantly. Electrical activation may have some application in improving fertilization rate in clinical IVF. Supported by: Natural Science Foundation of Guangdong Province NO 022874.

THE SOCIETY OF REPRODUCTIVE SURGEONS Wednesday, October 15, 2003 2:00 P.M.
O-213 Does laparoscopic excision of ovarian cysts significantly affect ovarian reserve? Insights from in vitro fertilization cycles. Edgardo Somigliana, Guido Ragni, Francesca Benedetti, Walter Vegetti, Raffaella Borroni, PierGiorgio Crosignani. Infertility Unit, Dept Obstet Gynecol, Univ of Milan, Milano, Italy; Infertility Unit, Milano, Italy. Objective: Residual ovarian function after laparoscopic excision of ovarian cysts is a major and still unsolved topic. Ultrasonographic evaluation of ovarian response to ovulation stimulation represents a simple and still poorly employed tool to assess residual ovarian function of an operated ovary. The few currently available studies on this topic have produced conflicting results. The aim of the present study was to evaluate the response to ovarian stimulation in patients who previously underwent monolateral excision of ovarian cysts. Design: The ovarian response to ovulation stimulation in the operated ovary and in the contralateral intact gonad was compared. Moreover, factors that may influence the severity of the damage were also investigated. Materials and Methods: Data from patients referring to the Infertility Unit of the Department of Obstetrics and Gynecology of the University of Milan and selected for in vitro fertilization (IVF) or Intracytoplasmatic sperm injection (ICSI) between January 2001 and December 2002 were reviewed. We included patients who previously underwent laparoscopic excision of a monolateral ovarian cyst regardless of the histology and the dimension of the cyst. The operated ovary and the contralateral intact ovary were compared in term of number of follicles with a mean diameter 15 mm at the time of human Chorionic Gonadotropin administration. Basal volume of the two ovaries before initiating the stimulation was also compared. Paired Student t test was used to investigate differences between operated and contralateral ovaries. Results: A total of 37 patients and 53 cycles were identified. The number of follicles 15 mm resulted 4.4 2.6 and 1.9 1.4 in the control ovary and in the previously operated ovary, respectively (p 0.001). This drop corresponded to a mean reduction of 56% (95% Confidence Interval: 39% - 73%). This reduction did not seem to be related to the histology or to the dimension of the excised ovarian cyst. The basal volume of the operated ovary resulted also statistically significant reduced (7.4 5.5 cm3 vs 9.6

Wednesday, October 15, 2003 2:30 P.M.
O-215 1,000 Office hysteroscopies for infertility: Feasibility and findings. Mary D. Hinckley, Amin A. Milki. Stanford Univ Sch of Medicine, Stanford, CA. Objective: In the evaluation of the uterine cavity, hysteroscopy offers the best diagnostic accuracy while allowing for simultaneous correction of pathology but has traditionally been performed under general anesthesia in an operating room setting. Practitioners may therefore be reluctant to perform hysteroscopy without a high index of suspicion when hysterosal-



Vol. 80, Suppl. 3, September 2003

When performed under flouroscopy it caused a delay in therapy in 5 cases. In these 13 patients. a significant percentage of patients are found to have uterine pathology. unselected. made no difference in predicting the histology or in therapy in 1 case and predicted the histology in 1 case. Results: In 13 of 102 (12.M. Materials and Methods: From 1981 until 1999 235 cases of TCA were performed by one of the authors (PMcC) for occlusive and non-occlusive proximal tubal disease. Cannulations were classified with respect to prediction of the histologic diagnosis. FERTILITY & STERILITY S83 . Pathology was not available in one case. Conclusion: Therefore in patients with chronic genital spotting and no sonographic intrauterine abnormality who have old past abortion history. Interestingly TCA could be performed in all 22 cases on the right but only 8 on the left. Design: This study is a descriptive case series as determined by a retrospective chart review of patients who underwent TCA following tubal cannulation. 2003 3:00 P. Other pathology included: submucous fibroids (3%). Patients with known submucous fibroids greater than 1. and a paracervical block with 1% lidocaine was used. No procedures were aborted secondary to patient intolerance. Ruben Alvero. Patients were given oral premedication with diazepam. All procedures were completed without complications. When performed under laparoscopic guidance it predicted the histology in 8 (%) cases. was detrimental (duplicate uterus not diagnosed. hysteroscopy was performed. The mean time from cannulation to TCA was 10. degenerated placentas were confirmed histologically. Chonnam Univ Medical Sch. O-218 A curriculum and performance assessment tool for saline sonohysterography. Wednesday.1% of the cases. Julie Luterzo. This database was updated to evaluate therapeutic outcomes including ectopic pregnancy (EP) and intrauterine pregnancy (IUP). Endometrial polyps are found most frequently.D.9% and a gynaecologist under laparoscopic guidance in 59. Results: There were 22 patients identified in the database. The genital spotting of these entire 13 patients were completely subsided after hysteroscopic removal of degenerated placental tissue. All hysteroscopies were performed during oral contraceptive use with a rigid twenty degree 5-mm hysteroscope equipped with an operative channel for the use of grasping forceps. or coaxial bipolar electrode. Univ of British Columbia. The ability of cannulation to predict the correct histologic diagnosis and/or be of benefit to therapy is inconsistent. and was beneficial in 1 (final pathology no histologic abnormality) case. was detrimental to fertility in 2 (EPs) cases.6 months (S. routine hysteroscopic examination is necessary for early exact diagnosis and proper treatment. October 15. October 15. Jason Parker. retained products. and whether it expedited or delayed therapy. Kwangju. Materials and Methods: The study was performed in 102 patients with chronic genital bleeding or spotting who have past abortion history more than 3 months ago but no intrauterine sonographic abnormality. and it can be found only on hysteroscopy. acetaminophen with hydrocodone. The pathology results are summarized in Table I. retained products of conception (0. 2003 2:45 P. Graham. Design: Retrospective study. O-216 Tubal cornual anastamosis following failed tubal canalization. and septi. Materials and Methods: One thousand consecutive infertility patients scheduled for IVF underwent routine office hysteroscopy between January 1998 and March 2003 by the authors. However small placental fragment may cause only chronic genital spotting for more than 3 months without any sonographic intrauterine abnormality. Peter McComb.9 months). adhesions. EP) in 2 cases. the duration from abortion to hysteroscopic operation was average 7. The mean number of pregnancies prior to cannulation was 1. Conclusions: TCA is an effective mode of treatment. and patient tolerance during the procedure were noted. If small placenta-like mass was visible on hysteroscopy. intramuscular ketorolac. Therefore the purpose of this study is to determine the necessity of routine hysteroscopy on patients with chronic genital spotting and past abortion history but no intrauterine sonographic abnormity. There were 2 subsequent EPs. 8.3%). with smaller numbers of fibroids. Cannulation was performed on the right tube in 17 cases and left tube in 14 cases (bilaterally 9 cases). Canada. BC. scissors. Prospectively collected standardized fertility data were entered into a database at the time of consultation and before discharge from hospital. Wednesday.5 cm were excluded from this study since they were treated in an operating room setting. James A. These abnormalities may likely impair the success of future treatment cycles. 2003 2:00 P. Sung-Tack Oh. Conclusion: In an infertile patient population where hysteroscopy is performed routinely prior to IVF.7%). O-217 Hysteroscopic evaluation for chronic genital spotting in patients with past abortion history and without sonographic abnormality.pingogram and sonohysterogram are easily performed in an office setting. caused a delay in therapy in 2 cases. and a paracervical block with 1% lidocaine until the last year of the study when an alternative regimen of diazepam. Results: Sixty-two percent of patients were found to have a normal uterine cavity. septum (0. A radiologist performed cannulation in 40. cies. Thirty-two percent were found to have endometrial polyps.M. In these patients. October 15. it was completely removed and confirmed histologically. The median age at time of cannulation was 31. IVF population. Khalid Awartani. Five patients subsequently had intrauterine pregnancies. Republic of Korea. Design: Prospective study at a University Hospital. intramuscular analgesia with meperidine. Objective: Usually large placental fragment retention after abortion cause acute bleeding or spotting within 1-2 months after it. One EP followed an IUP. Objective: To assess the role of tubal cannulation that was followed by tubal cornual anastomosis (TCA) with respect to whether it enhanced the histologic diagnosis. The objective of this study was to review the findings and feasibility of office-based diagnostic and operative hysteroscopy in a large. and whether therapy was expedited or delayed according to definitions set prior to review of the charts.6 months (range 0-54 months). Vancouver. polypoid endometrium (0.5%). Operative findings. Patient tolerance and the feasibility of operative correction simultaneous with diagnosis make office hysteroscopy an ideal procedure with minimal risk to the patient. The mean time of infertility prior to TCA was 43 months (range 10-144). Alicia Armstrong.3%). and the pathology was treated in all patients.45 (range 0-5) with 3 term pregnan- NURSES IN REPRODUCTIVE MEDICINE PROFESSIONAL GROUP Wednesday. intrauterine adhesions (3%). complications.7%) patients. and bicornuate uterus (0.3 (range 24-41).M.