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A Case Report on Treatment of Infertility Due to Premature Ovarian

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A Case Report on Treatment of Infertility Due to Premature Ovarian WORKSHOPS Wednesday, 07 September 2011, 13:00 - 16:30 W01 Diagnostic and operative hysteroscopic office surgery Stefano Angioni Abstract not available at the time of printing W02 Female sexual dysfunction: what gynaecologists should know! Johannes Bitzer Abstract not available at the time of printing W03 Obesity and reproduction Reynir Tomas Geirsson Abstract not available at the time of printing W04 Surgery in urogynecology the contemporary view Pallavi Latthe(1), Gunnar Lose(2), Douglas G Tincello(3), Søren Brostrøm(1), Søren Gräs(1) (1) Birmimgham Women's Hospital, Department of Urogynaecology, Birmingham, UK (2) Herlev Hospital, Department of Obstetrics and Gynecology. 63 C7F, Herlev, Copenhagen, Denmark (3) University of Leicester, Department of Obstetrics and Gynaecology, Leicester, UK Surgery for pelvic floor dysfunction in women have evolved in the last decades, especially since the introduction in the 1990'ies of synthetic slings for the treatment of stress urinary incontinence. The retropubic loose mid-urethral macroporous monofilament slings (e.g. TVT) revolutionized the surgical treatment of stress urinary incontinence, and have emerged as the new gold standard. However, copy-cat products and novel approaches (e.g. transobturatror and single-incision slings) were rapidly and successively introduced to the market without proper evidence to support their use. Furthermore, due to the marketing success and ease of use of the mid-urehral 'sling kits', the concept of synthetic vaginal implants was expanded to the more problematic area of pelvic organ prolapse. Recently, level 1 evidence have emerged on both new sling-types and vaginal prosthesis, and will be discussed in this workshop. Furthermore, the future role of novel approaches such as robotic surgery and stem cell therapy in urogynecological surgery will be discussed. This will be an interactive and evidence-based workshop, with a clinical and hands-on approach, aiming to provide participants with an updated view on the current state-of-the-art in the field. W05 Gynecological ultrasound Nicholas Raine-Fenning Abstract not available at the time of printing OPENING LECTURES Thursday, 08 September 2011, 09:00 - 11:00 OL Environment & reproduction Tina Kold Jensen, NE Skakkebaek Rigshospitalet, Department of Growth and Reproduction, Copenhagen, Denmark Within recent decades adverse trends in male reproductive health have become increasingly evident. In many countries the incidence of testicular cancer has been growing along with an apparent increase in incidences of congenital malformations in the male reproductive tract and a decline in sperm quality. It has been hypothezed that these conditions may represent a syndrome of disorders, called testicular dysgenesis syndrome (TDS), which results from a disturbance of the development of the testes during fetal life. A similar female syndrome; Ovarian Dysgenesis Syndrome has been suggested although the evidence is more limited probably because it is more difficult to measure female reproductive health). The etiology of TDS is unclear, but the apparent rapid decline in male reproductive health during a short time span suggests changes in lifestyle and environmental factors rather than genetic factors as likely causes. In particular, there is concern about environmental chemicals with endocrine-disrupting properties, (EDCs) which are suspected of having the ability to disturb the development of reproductive organs during fetal life. EDCs are widely detected as pollutants in food because of contamination of food processing and packaging materials. They include bisphenol which is used in production of polycarbonate plastic and has been found to leak from heated plastic baby bottles into the formula milk and from can lining, phthalates which are widely used as plastic softeners in cosmetics and paint, and perfluorinated chemicals which are used as indus¬trial surfactants in many products eg.non-stick pans and rain clothes. OL Human preantral follicles: isolation, characterization and potential future clinical applications Claus Yding Andersen University Hospital of Copenhagen, Laboratory of Reproductive Biology, Section 5712, Copenhagen, Denmark The functional unit of the ovary is the follicle, which consist of an oocyte surrounded by somatic cells - the so called granulosa cells - and a basal membrane. The follicles are formed during fetal life and enter a resting stage as primordial follicles. Once formed follicles are destined to develop to maturity containing a fertilizable oocyte or to degenerate which will happen to the vast majority. However the original pool or store of follicles cannot be replenished later on. So during a woman's entire fertile life she will draw on the pool of follicles created during fetal life. When she reaches menopause the pool will be exhausted and she will no longer be able to become pregnant. The mechanisms that regulate recruitment of follicles from the dormant pool into the active growth phase are just now starting to be elucidated. In addition, to nourish and support the development of a fertile oocyte, the somatic cells of the follicle also undertake a number of hormonal activities to support the reproductive success of the potential embryo resulting from the enclosed oocyte. The follicles secretes oestradiol, one of the main female sex hormones and from the mid-follicular phase of the menstrual cycle more than 90 percent of all the circulating oestradiol derives from the selected follicle that will ovulate. Therefore, a shortage of follicles will lead to cessation of menstrual cycle as observed in connection with menopause. Infertility treatment using assisted reproduction technologies secures the growth of follicles and only shortly prior to ovulation will the fully mature oocyte be retrieved for fertilization in vitro. Due to the long developmental phase from the resting stage to the mature preovulatory follicle lasting several months, it has proven very difficult to culture isolated human follicles for such a long period. Alternatively in vitro maturation of follicles could have been envisioned as a new way of treating infertility. However, new research is now starting to understand the mechanisms that regulate growth of early stage follicles and mechanisms that either accelerate or slow down development has been identified. Substances that release the brake on follicular development have been identified and it is possible to activate the pool of resting follicles by using so-called PTEN inhibitors. This allows the activation of large number of follicles, which in mice have been shown to result in healthy offspring. Furthermore, this may allow an accelerated growth of such follicles in vitro. In our group we perform fertility preservation in women facing gonadotoxic treatment due to a malignant disease by cryopreservation of the ovarian cortical tissue. After treatment women who became menopausal can have their tissue transplanted back and regain ovarian function and fertility. However, the medulla tissue is discharged but do contain a low number of follicles. We have recently developed a technique to isolate human preantral follicles from this tissue. This has allowed us to study the early stages of human folliculogenesis and perform studies on the culture of such follicles. These recent results and the long term perspectives of these new findings also in a clinical setting will be presented. PLENARY LECTURES Thursday, 08 September 2011, 17:30 - 18:00 PL01 Cardiovascular disease: Focus on the gender specific difference. Sven O Skouby Herlev Hospital, University of Copenhagen, Department of Obstetrics and Gynecology, Herlev, Copenhagen, Denmark CVD may differ in men and women with respect to epidemiology, diagnosis, management, and prognosis. Several studies have found that women hospitalised with an acute myocardial infarction (AMI) had higher unadjusted short-term mortality rates than men. Older age more frequent comorbidities and less aggressive management are hypothesized as the major reasons contributing to the poorer prognosis in women. More than twice as many women die from cardiovascular disease as from all forms of cancer combined. Evaluation for suspected coronary disease differs in women because of frequently misleading results provided by treadmill testing without imaging. Gender differences have been observed in treatment practices, but since more is not necessarily better in this setting, the optimal approach for women has yet to be established. Opportunities remain for the physician to work in partnership with the patient for early intervention in women with symptoms of coronary artery disease, including responding to chest pain. Compared with men, premenopausal women are protected from CVD; however, once postmenopausal, women rapidly catch up. Although hormones, or the lack thereof, are an obivous causative factor in postmenopausal women´s CVD disorders, there are interesting variables including blod pressure and lipid changest, that may play a role in these events. Which ever factors are involved, more attention must be paid to postmenopausal women to reduce the impact of their CVD risk factors. Previous understandings of impact Hormonal therapy (HT) after the menopause and derived from observational studies, mechanistic studies of the relationship between hormone replacement therapy and the benefit/risk ratio in prevention of coronary disease in menopausal women have been challenged by the results of randomized trials from the last decade. PL02 Worldwide IVF on
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