VIDEO ABSTRACT SESSION 1 gence of the 4K3D ORBEYE VOM has the potential to revolutionize MIM. In this video, we aimed to demonstrate a comparison of various visual parameters between the ORBEYE VOM and the SOM. We also conducted an V-01 10:00 AM Saturday, October 17, 2020 animal study to evaluate the surgical experience and efficacy of the VOM. METHODOLOGY: The depth of field, working distance, and operative NON-INVASIVE SELECTION OF SINGLE SPERM field were compared between the 4K3D OBYEYE VOM (Olympus/Sony) WITH HIGH DNA INTEGRITY FOR and the SOM. Four vasovasostomies (VVs) and four vasoepididymostomies 1 1 ICSI. Zhuoran Zhang, PhD, Changsheng Dai, MASc, (VEs) were performed on Wistar male adult rats using the 4K3D ORBEYE 1 2 Guanqiao Shan, MASc, Khaled Abdalla, MASc, VOM. Data on operating time to anastomotic completion and patency rates 2 2 Iryna Kuznyetsova, PhD, Clifford Lawrence Librach, MD, Keith Jarvi, were collected. 3 1 1 2 MD, Yu Sun, PhD University of Toronto, Toronto, ON, Canada; CReATe CONCLUSIONS: The 4K3D ORBEYE VOM provides high-end on- 3 Fertility Centre, Toronto, ON, Canada; University of Toronto, School of screen visualization, coupled with enhanced ergonomics and overall surgical Medicine, Toronto, ON, Canada. experience. The ORBEYE VOM has a depth of field three times greater than seen with the SOM at magnifications of x15 and lower, due to its higher im- OBJECTIVE: To develop a quantitative and non-invasive technique for se- age and video quality with quick zoom-in, auto-focus, and zero on-screen la- lecting single sperm with high DNA integrity for ICSI. tency capabilities. A larger operative field and a more comprehensive METHODOLOGY: In ICSI, embryologists qualitatively select sperm by working distance (200-550mm vs. 250mm) were also seen on the VOM. subjectively observing sperm motility and morphology. The DNA quality The ORBEYE VOM proved to be non-inferior to the SOM in fine anastomo- of the selected individual sperm is not known. We first tested the DNA quality ses, characteristic of MIM. The average operating time to complete an anas- of the sperm selected by embryologists following the WHO qualitative tomosis for VVs and VEs was 37 and 33 minutes, respectively, with superior criteria. Three embryologists selected sperm from the same sample and the patency rates for all procedures. This VOM possesses the potential to DNA integrity of the selected sperm was measured with comet assay on in- improve surgical safety and efficiency by reducing postural fatigue and eye dividual sperm. Indeed, the selected sperm had low DNA fragmentation < strain, which surgeons experience with the SOM. In addition, it can signifi- (p 0.01 compared to sample population). However, manual selection is cantly facilitate teamwork and teaching through its high-resolution screens highly subjective, and the results varied significantly among embryologists and zero-latency images. (p<0.01). In order to eliminate subjectivity, we have developed a software that automatically selects sperm using quantitative criteria. To establish the quantitative selection criteria, we first developed computer V-03 10:16 AM Saturday, October 17, 2020 vision algorithms to measure each individual sperm’s 9 motility (velocity, linearity etc.) and 9 morphology (head size etc.) parameters. The measure- FERTILITY-PRESERVING, SURGICAL MANAGE- ment is on live sperm without invasive staining. Then the same sperm was MENT OF A CESAREAN SCAR ECTOPIC transferred for DNA measurement using the comet assay. We have collected PREGNANCY. Christine Hur, MD, Miguel Luna Russo, a dataset of 440 individual sperm. For each sperm, its motility, morphology MD, Cara R. King, DO, MS. Cleveland Clinic, Cleveland, OH. and DNA fragmentation data were recorded. With the collected data, we then established our quantitative criteria. Our criteria were based on the WHO OBJECTIVE: The objective of this video is to highlight a fertility-preser- quantitative criteria, but we modified the morphology criteria using our ving surgical technique for the management of cesarean scar ectopic preg- data on live sperm without staining. For motility, considering that WHO cri- nancy. terion (VSLR25 mm/s) was defined for semen analysis instead of for ICSI METHODOLOGY: A video description of the surgical technique used to where PVP was used to slow down sperm motion, we scaled the motility cri- manage the cesarean scar ectopic pregnancy of a 28-year-old G6P4014 with terion by measuring sperm velocity change from semen to PVP. We trans- desires future fertility preservation. ferred 30 individual sperm from raw semen to ICSI medium supplemented CONCLUSIONS: This video highlights a surgical technique which allows with PVP, and the velocity of individual sperm decreased to almost the for the laparoscopic removal of a cesarean scar ectopic pregnancy with the same ratio (0.5). The new motility criterion was determined (VSLR13.5 concurrent repair of the uterine defect. It reviews strategies to restore normal mm/s). The quantitative criteria were first tested on our collected dataset anatomy, minimize loss and allow for healing in order to allow for and reduced the DNA fragmentation by 50%. future fertility. The quantitative criteria were built into our automated sperm selection software, and compared to manual qualitative sperm selection. From each new sample, both the software and three embryologists selected good sperm. V-04 10:24 AM Saturday, October 17, 2020 The software outperformed all three embryologists. Compared to the best RESOLUTION OF AFTER COIL embryologist, the software further reduced the DNA fragmentation by EMBOLIZATION OF VARICOCELE WITH ROBOTIC 30%. The software also showed smaller standard deviation and provided RESECTION OF GONADAL VEIN. more consistent selection results. Evaluation of ICSI outcomes using sperm Johnathan Doolittle, MD, Viraj Maniar, MD, Peter N. Dietrich, MD, selected by the software is underway. CONCLUSIONS: The developed automation technique is able to non-in- Jay I. Sandlow, MD, Scott Johnson, MD, Jagan K. Kansal, MD, MBA. vasively and quantitatively select single sperm with high DNA integrity Medical College of Wisconsin, Milwaukee, WI. without disturbing ICSI flow. Computer vision and quantitative selection OBJECTIVE: Chronic pain in the region of varicocele embolization is not improve the DNA quality of the selected sperm, and eliminate the subjec- well described and can be a challenging symptom for a urologist to manage. tivity in manual qualitative selection. Metallic coils from embolization are unable to be removed, leaving limited options for treatment after failing conservative measures. It is important to counsel patients of this potential complication when determining the best op- V-02 10:08 AM Saturday, October 17, 2020 tion for varicocele repair. To our knowledge, there are no reported cases of NEW ERA OF MALE MICROSURGERY: gonadal vein excision for chronic abdominal pain after coil embolization. 4K3D ORBEYE VIDEO OPERATING METHODOLOGY: A 63-year-old male presented nine months after coil MICROSCOPY. Huixing Chen, M.D. Ph.D., embolization. His testicular pain resolved but he reported new left sided Russell P. Hayden, M.D., Omar Al Hussein Alawamlh, M.D., abdominal pain following coil embolization for a large left varicocele. After Peter N. Schlegel, M.D., Marc Goldstein, M.D., Philip S. Li, M.D. Center failing conservative measures including non-steroidal anti-inflammatory for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, drugs, antibiotics and prednisone, he was referred to urology for further New York Presbyterian Hospital, New York, NY. workup and to discuss treatment options. On presentation, the patient re- ported pain on the left side of his abdomen consistent with the location to OBJECTIVE: Early adaptations of the 2-Dimensional (2D) video oper- gonadal vein. After extensive counseling that surgical removal may not alle- ating microscope (VOM) have shown to have better ergonomics, flexibility, viate his pain, robotic gonadal vein excision was offered, and the patient elec- and versatility compared to the standard operating microscope (SOM) in ted to proceed. The video illustrates the robotic excision of the left gonadal male infertility microsurgery (MIM). However, the low resolution, 2D vein. Coils were easily visualized through the wall of the vessel. While mild view, and depth of field were significant limitations. Therefore, the emer- edema of the surrounding tissue in the retroperitoneum was noted, extensive

FERTILITY & STERILITYÒ e517 inflammation was not present, leading to an uncomplicated dissection. The V-07 10:44 AM Saturday, October 17, 2020 coil-containing gonadal vein was able to be excised in its entirety. The patient was discharged on post-operative day one with only non-steroidal pain med- SURGICAL REPAIR OF A CESAREAN SCAR DEFECT ications. Six weeks post operatively, the patient reported no complications, USING A VAGINAL APPROACH. Abigail C. Mancuso, 1 1 1 and almost complete resolution of his preoperative pain. MD, Erin Maetzold, MD, Joseph T. Kowalski, MD, 2 1 CONCLUSIONS: To our knowledge, this is the first case report demon- Bradley J. Van Voorhis, MD. University of Iowa Hospitals 2 strating the surgical removal of the gonadal vein for treatment of chronic and Clinics, Iowa City, IA; University of Iowa, Iowa City, IA. abdominal pain after varicocele embolization. After failing conservative measures, this may present another viable treatment option to address this OBJECTIVE: To discuss the signs and symptoms of a cesarean scar defect difficult complication in a select group of patients. and describe the techniques for the repair of a cesarean scar defect using a SUPPORT: None vaginal approach. METHODOLOGY: We demonstrate a case of a 32-year-old patient with a symptomatic cesarean scar defect desiring surgical repair. Repair of the ce- V-05 10:31 AM Saturday, October 17, 2020 sarean scar defect was successfully completed using a vaginal approach. CONCLUSIONS: There are several surgical approaches used for the A NOVEL ROBOTIC ENDOSCOPIC DEVICE USED repair of cesarean scar defect including hysteroscopic and laparoscopic FOR OPERATIVE HYSTEROSCOPY: ASHERMAN’S repair. We have found the vaginal approach to be an expeditious and excellent SYNDROME. Lara Harvey, MD MPH,- way to access these defects that often occur low at the level of the . It is Richard Hendrick, PhD,2 Neal P. Dillon, PhD,- Evan Blum, important to carefully dissect off the bladder to avoid bladder injury and BS,3 Lauren Branscombe, MS,3 Scott J. Webster, PhD,3 perform cystoscopy at the conclusion of the case to ensure bladder injury Ted L. Anderson, MD PhD.4 1Virtuoso Surgical, Nashville; 2Virtuoso Surgi- did not occur. The vaginal approach avoids the need for abdominal incisions cal, Inc., Nashville, TN; 3Virtuoso Surgical, Nashville, TN; 4---. leading to quick postoperative healing and high patient satisfaction. References: Erikson SS, Van Voorhis BJ. second- OBJECTIVE: To trial the use of a novel robotic endoscope prototype for ary to cesarean scar diverticuli: Report of three cases. Obstet Gynecol 1999. the application of Asherman’s syndrome in a uterine tissue model. 93(5):802-805. METHODOLOGY: The robotic endoscope prototype consists of two arms made of concentric tubes that fit through a standard 23Fr endoscopic sheath. VIDEO ABSTRACT SESSION 2 This allows a surgeon to have two-handed capabilities with a variety of endo- scopic instruments as well as improved ergonomics. Previous pilot studies V-08 10:00 AM Sunday, October 18, 2020 have examined the use of this device for hysteroscopic polypectomy and removal of retained intrauterine device. SURGICAL MANAGEMENT OF UNDESCENDED LEFT CONCLUSIONS: The endoscopic robot was successful in lysing simu- OVARY AND RUDIMENTARY UTERINE lated intrauterine adhesions in a porcine tissue model in a fluid environment. HORN. 1 The device allows two handed surgical technique for hysteroscopic applica- Lauren Elizabeth Verrilli, MD, Addison William Alley, MD,2 Joseph M. Letourneau, MD.1 1University of tions. Further study on the utility of this device for gynecologic applications 2 is needed. Utah, Salt Lake City, UT; University of Arizona College of Medicine - Phoenix, Phoenix, AZ. SUPPORT: This study was funded by Virtuoso Surgical OBJECTIVE: To describe a rare Mullerian anomaly and review important embryologic origins of the female reproductive tract as well as surgical man- V-06 10:38 AM Saturday, October 17, 2020 agement of a maldescended ovary and rudimentary uterine horn. PELVIC CAUSING HYDRO- METHODOLOGY: This is the case of a 26-year-old G0 with chronic pel- NEPHROSIS. Karine Matevossian, DO,1 Rachel Yoon, vic pain and three years of conservative management who ultimately under- MD,1 Kirsten Sasaki, M.D.,2 Charles E. Miller, M.D.3 1Advo- went a laparoscopic resection of a maldescended left ovary and uterine horn. cate Lutheran General Hospital, Park Ridge, IL; 2Advocate CONCLUSIONS: While conservative management remains the standard of Lutheran General Hospital, Naperville, IL; 3The Advanced Gynecologic Sur- care for managing cyclical secondary to Mullerian anomalies, sur- gery Institute/The Advanced IVF Institute, Charles E. Miller, MD & Associ- gery remains an option for patients refractory to this treatment. We present sur- ates, Naperville, IL. gical planning and technique for performing a laparoscopic unilateral salpingoophorectomy and resection of rudimentary uterine horn and malde- OBJECTIVE: Step by step narrated demonstration of ureterolysis. scended left ovary. METHODOLOGY: 51 year old female who presents with left sided pelvic References: pain and hydronephrosis/hydroureter. The patient was positioned in the dor- Ireo, Eghoihunu, et al. ‘‘Laparoscopic Management of Maldescended sal lithotomy position in adjustable Allen stirrups. A three port laparoscopic Ovary Presenting with Recurrent Acute Abdomen.’’ Gynecology and Mini- approach was used. The patient underwent a laparoscopic excision of endo- mally Invasive Therapy., vol. 7, no. 2, pp. 74–77. metriosis with bilateral ureterolysis. Ombelet W, Stroef F, Grieten M, Verswijvel G, Hinoul P, de Jongea E. Uni- CONCLUSIONS: Laparoscopic excision of endometriosis can be techni- cornuate and undescended ovary: Diagnostic and therapeutic implica- cally challenging and time consuming. A conservative approach with ureter- tions. J Obstet Gynecol India. 2005;55:339–44. olysis generally resolves the patient’s pain. The imaging of choice in Allen JW, Cardall S, Kittijarukhajorn M, Siegel CL. Incidence of ovarian diagnosing ureteral complications of endometriosis is MRI. Cystoscopy maldescent in women with mullerian duct anomalies: Evaluation by MRI. post surgery can help assess ureteral function but does not guarantee that AJR Am J Roentgenol. 2012;198:W381–5. thermal injury has not occurred. Moore, K, Persaud, V, Torchia, M. Urogenital System. The Developing References: Human, 12, 223-262.e1  Covidien internal report #R0047634 rev A., Internal testing comparing the Van Voorhis B.J., Dokras A., and Syrop C.H.: Bilateral undescended ovaries: ThunderbeatÔ* (seal and cut mode) and SonicisionÔ (min. mode) on isolated association with infertility and treatment with IVF. Fertil Steril 2000; 74: pp. 1041 vessels. Nov 18, 2013. Acute porcine study report: comparison of various SUPPORT: N/A competitor devices versus Covidien SonicisionÔ, LigaSureÔ LF1637, and LigaSureÔ LF1737 Devices. November 11 & 18, 2013; December 9, 2013.  Ghezzi, F, Cromi A, Bergamini, V, Serati, M, Sacco A, Mueller, MD. V-09 10:06 AM Sunday, October 18, 2020 Outcome of laparoscopic ureterolysis for ureteral endometriosis. Fertil A NEW PIEZO DRILL FOR HUMAN Steril. 2006;86:418-422. ICSI. Changsheng Dai, MASc,1 Alexander Lagunov,  Ghezzi, F, Cromi A, Bergamini, V, Bolis P. Management of ureteral MSc,2 Zhuoran Zhang, PhD,1 Guanqiao Shan, MASc,1 endometriosis: areas of controversy. Current Opinion in Ob and Gyn. 3 4 2007;19:319-324. Jason E. Swain, PhD, HCLD, William B. Schoolcraft, MD, Tom Hannam, MD,5 Yu Sun, PhD.1 1University of Toronto, Toronto, ON,  Schimpf, MO, Gottenger EE, Wagner JR. Universal ureteral stent place- 2 3 ment at hysterectomy to identify ureteral injury: a decision analysis. Gynae- Canada; CCRM Toronto, Toronto, ON, Canada; CCRM Fertility Network, Lone Tree, CO; 4Colorado Center for Reproductive Medicine, Lone Tree, cological Surgery. 2008;115;9:1151-1158. CO; 5Hannam Fertility Centre, Toronto, ON, Canada. SUPPORT: none e518 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 OBJECTIVE: To develop a new piezo-ICSI device that is compatible with removed to prevent disruption or trauma to the tissue graft. For those with standard ICSI setup and capable of reducing oocyte deformation and prevent- segmental vaginal agenesis, the Foley may be advanced into the uterus and ing cytoplasm aspiration during ICSI. balloon inflated to further stabilize the utero-vaginal anastomosis. METHODOLOGY: In standard ICSI, oocytes often suffer large deforma- CONCLUSIONS: Our novel inflatable vaginal stent is useful to surgeons tion before penetration, which may damage the spindle and other cellular or- performing a McIndoe vaginoplasty for vaginal agenesis with or without a ganelles. Furthermore, cytoplasm is aspirated into the micropipette to break uterus because it is compliant with OR procedures, as it is constructed the oolemma, which disrupts the local cytoskeleton of the oocyte. To facili- from supplies that are accessible in most OR settings. Moreover, it is ra- tate oocyte penetration, piezo drills were developed by using piezoelectric dio-opaque, adjustable in size, and effective in applying circumferential pres- actuators to generate micropipette vibration. However, existing piezo drills sure for graft adherence. We prefer this inflatable vaginal stent to a rigid use a flat-tipped micropipette (vs. standard sharp ICSI micropipette); addi- dilator in the first week of tissue healing to allow for easy insertion and tionally, to reduce micropipette’s lateral vibration, which is perpendicular removal of the stent without disrupting the tissue graft, to help prevent tissue to the oocyte penetration direction, damping fluid such as mercury is required necrosis, and to provide a fluid drainage port during graft adherence. We in the operation of existing piezo drills, which raises biosafety concerns. The recommend this device as an ideal option for surgeons to consider when per- new piezo drill we developed uses a standard sharp-tipped ICSI micropipette forming a McIndoe vaginoplasty. and requires no damping fluid. It is readily mounted on a standard micropi- References: pette holder within 10 seconds and easily operated by pressing a footswitch. Chan JL, Levin PJ, Ford BP, Stanton DC, Pfeifer SM. Vaginoplasty with To reduce undesired lateral vibration, flexure beams were designed in the autologous buccal mucosa fenestrated graft in two patients with vaginal piezo drill to guide and constrain the motion of micropipette only along agenesis: a multidisciplinary approach and literature review. J Minim Inva- the oocyte penetration direction. The driving signals were optimized by sive Gynecol 2017;24(4):670–6. removing resonant frequencies with a bandpass filter. Experiments were per- SUPPORT: None formed on hamster and human oocytes by penetration with and without the piezo drill. For hamster oocytes, evaluation metrics included oocyte defor- mation and survival rate of penetrated oocytes after 12 hours’ incubation. V-11 10:17 AM Sunday, October 18, 2020 For human oocytes, oocyte deformation and aspirated cytoplasm volume were quantitatively evaluated. OHVIRA: FERTILITY SPARING SINGLE-STAGE SUR- GICAL MANAGEMENT. Abigail L. Bernard, MD,1 CONCLUSIONS: The developed new piezo drill decreased hamster 2 m m Vaishnavi Purusothaman, MD, MA, Linnea R. Goodman, oocyte deformation from over 50 m to around 5 m, and increased the sur- 1 1 2 vival rate of the hamster oocytes after penetration to 92.5% (vs. 77.5% MD. University of North Carolina, Raleigh, NC; University without piezo drill and 95% for the control group). Tests on human oocytes of North Carolina, Chapel Hill, NC. revealed that the piezo drill reduced human oocyte deformation by 10 times OBJECTIVE: Obstructed hemivagina and ipsilateral renal anomaly, or and broke oolemma without aspirating any cytoplasm (vs. >2,000 mm3 aspi- OHVIRA, is a rare, obstructive Mullerian duct anomaly comprised classi- rated cytoplasm without piezo drill), with 100% success rate in oocyte pene- cally of the triad of an obstructed hemivagina, ipsilateral , tration. The use of the new piezo drill in ICSI can potentially reduce oocyte and uterine didelphys. This video is a review of the background, diagnostic damage by reducing oocyte deformation (thus stress) and minimizing distur- imaging, and surgical management of this condition, as well as video footage bance to the cytoplasm in the oocyte. Clinical trials are ongoing to quantify of the fertility sparing, single-stage technique performed at a university hos- its benefit in improving fertilization rate, blastocyst rate and embryo quality. pital. METHODOLOGY: Single-stage vaginoplasty was started with a physical V-10 10:10 AM Sunday, October 18, 2020 exam displaying a fluctuant vaginal mass arising from the right side wall of the . Next, a syringe was used to aspirate the contents of this mass to CREATIONOFA NOVEL INFLATABLE VAGINAL STENT confirm that this was in fact the hematocolpos as suspected. Once confirmed, FOR MCINDOE VAGINOPLASTY. Phillip A. Romanski, electrocautery was used to incise the mass to create an opening large enough MD, Pietro Bortoletto, MD, Samantha Pfeifer, M.D. Weill Med- to drain the and then electrocautery was used to extend the ical College of Cornell University, New York, NY. incision caudally. Digital palpation was done to assess the extent of the longitudinal and the position of the right cervix. Next, septum OBJECTIVE: To develop a novel inflatable vaginal stent for use in McIn- transection with the LigaSureTM device was achieved. As resection doe vaginoplasty that can be constructed using standard operating room (OR) continued, the cervix on the right was able to be visualized. The use of bipolar supplies. cautery allowed the surgeons to excise the vaginal septum with everted edges METHODOLOGY: A McIndoe vaginoplasty is a surgical procedure that to minimize the risk of re- or fusion. The eversion was accomplished is performed to create a neovagina in patients with complete or segmental without requiring any additional sutures, which improved the ease of the vaginal agenesis. A cavity is dissected to form the neovagina, and a tissue procedure and decreased operative time. graft is placed. A stent is then delicately inserted into the cavity to keep CONCLUSIONS: The OHVIRA diagnosis requires a high index of suspi- the graft in place and promote graft adherence to the dissected space. cion by the clinician. Single-stage surgical vaginoplasty should be employed Traditionally, a vaginal stent may be created in the OR by placing surgical when technically feasible, but a two-stage procedure can be done when infec- sponges inside a condom. However, many ORs have restrictions on equip- tion or anatomic challenges are present. Hemi-hysterectomy should be ment that can be brought into the OR, as well as restrictions against leaving avoided when possible, as ipsilateral fertility can recover once the obstruc- non-radio-opaque equipment ‘‘in’’ the patient. This device fills the need for a tion is removed. stent that is compliant with OR procedures and is radio-opaque, functional, References: and can be used for patients with and without a functional uterus. The device 1. Purslow, C. E. (1922). A Case of Unilateral Haematokolpos, Haemato- is modelled after an effective inflatable vaginal stent that was previously metra and Haematosalpinx. BJOG: An International Journal of Obstetrics commercially available, but is no longer produced. and , 29(4), 643–643. https://doi.org/10.1111/j.1471-0528. An inflatable vaginal stent has multiple advantages compared to a rigid 1922.tb16100.x dilator in that it 1) is deflatable so that it does not cause trauma to the delicate 2. Chan, Y., Jayaprakasan, K., Zamora, J., Thornton, J., Raine-Fenning, N., tissue graft during insertion, removal, or repositioning; 2) is firm enough to & Coomarasamy, A. (2011). The prevalence of congenital uterine anomalies press the tissue graft against the dissected vaginal space, but is soft enough in unselected and high-risk populations: a systematic review. Human Repro- to decrease the risk of pressure necrosis or urethral damage; and 3) has a duction Update, 17(6), 761–771. https://doi.org/10.1093/humupd/dmr028 drainage port to prevent the build-up of fluid that could interfere with tissue 3. Byrne, J., Nussbaum-Blask, A., Taylor, W. S., Rubin, A., Hill, M., Odon- healing. nell, R., & Shulman, S. (2000). Prevalence of mullerian duct anomalies de- We have developed an inflatable vaginal stent that incorporates all of these tected at ultrasound. American Journal of Medical Genetics, 94(1), 9–12. unique properties and can be easily constructed using sterile OR supplies. https://doi.org/10.1002/1096-8628(2000090494:1<9::aid-ajmg3>3.0.co;2-h The construction of this device requires: a silicone Foley catheter, sterile 4. Smith, N. A., & Laufer, M. R. (2007). Obstructed hemivagina and ipsi- foam sponges from a vaginal prep kit, a sterile radio-opaque sponge, a sterile lateral renal anomaly (OHVIRA) syndrome: management and follow-up. vaginal ultrasound probe cover, a 60cc catheter tip syringe, a long Kelly, a Fertility and Sterility, 87(4), 918–922. https://doi.org/10.1016/j.fertnstert. ruler, scissors, 0-vicryl suture, and sterile gloves. 2006.11.015 Once inserted, the stent can be left in place for 5-7 days post-operatively, 5. Gholoum, S., Puligandla, P. S., Hui, T., Su, W., Quiros, E., & Laberge, during the critical time of graft adherence. It can then be deflated and gently J.-M. (2006). Management and outcome of patients with combined vaginal

FERTILITY & STERILITYÒ e519 septum, bifid uterus, and ipsilateral renal agenesis (Herlyn-Werner-Wunder- sue. Entry into the endometrial cavity identifies the lower border of excision. lich syndrome). Journal of Pediatric Surgery, 41(5), 987–992. https://doi.org/ Closure without tension requires multiple layers. 10.1016/j.jpedsurg.2006.01.021 CONCLUSIONS: Surgery for requires careful pre- 6. Han, B., Herndon, C. N., Rosen, M. P., Wang, Z. J., & Daldrup-Link, H. operative planning. Excision of diffuse adenomyosis often results in (2010). Uterine didelphys associated with obstructed hemivagina and ipsilat- entry into the endometrial cavity. Closure of extensive defects is eral renal anomaly (OHVIRA) syndrome. Radiology Case Reports, 5(1), required. 327. https://doi.org/10.2484/rcr.v5i1.327 References: 7. Kapczuk, K., Friebe, Z., Iwaniec, K., & Ke˛dzia, W. (2018). Obstructive 1. Adenomyosis incidence, prevalence and treatment: United States popu- Mullerian€ Anomalies in Menstruating Adolescent Girls: A Report of 22 lation-based study 2006-2015.Yu O, Schulze-Rath R, Grafton J, Hansen K, Cases. Journal of Pediatric and Adolescent Gynecology, 31(3), 252–257. Scholes D, Reed SD - Am. J. Obstet. Gynecol. - January 15, 2020;MEDLINE https://doi.org/10.1016/j.jpag.2017.09.013 is the source for the citation and abstract for this record 8. Ugurlucan, F. G., Dural, O., Yasa, C., Kirpinar, G., & Akhan, S. E. 2. Rosai, J., Ackerman, L. V., Goldblum, J. R., Lamps, L. W., McKenney, (2020). Diagnosis, management, and outcome of obstructed hemivagina J. K., & Myers, J. L. (2018). Rosai and Ackerman’s surgical pathology. Phil- and ipsilateral renal agenesis (OHVIRA syndrome): Is there a correlation be- adelphia: Elsevier. tween MRI findings and outcome? Clinical Imaging, 59(2), 172–178. https:// 3. Habiba, M., Gordts, S., Bazot, M., Brosens, I., & Benagiano, G. (2020). doi.org/10.1016/j.clinimag.2019.11.013 Exploring the challenges for a new classification of adenomyosis. Reproduc- 9. Haddad, B., Barranger, E., & Paniel, B. (1999). Blind hemivagina: long- tive BioMedicine Online, 40(4), 569-581. https://doi.org/10.1016/j.rbmo. term follow-up and reproductive performance in 42 cases. Human Reproduc- 2020.01.017 tion, 14(8), 1962–1964. https://doi.org/10.1093/humrep/14.8.1962 4. Osada, H. (2018). Uterine adenomyosis and adenomyoma: The surgical approach. Fertility and Sterility, 109(3), 406-417. https://doi.org/10.1016/j. fertnstert.2018.01.032 V-12 10:24 AM Sunday, October 18, 2020

VAGINAL ULTRASOUND PROBE FOR ABDOMINAL V-14 10:37 AM Sunday, October 18, 2020 OOCYTE RETRIEVAL: DEMONSTRATION OF A DO’S AND DON’TS FOR SURGICAL MANAGEMENT NOVEL APPROACH. Jacquelyn Shaw, MD,1 2 1 OF TYPE 2 UTERINE FIBROIDS IN THE ART Frederick L. Licciardi, M.D. NYU Langone Prelude Fertility 1 2 PATIENT. Salomeh M. Salari, MD MS, Center, New York, NY; NYU Langone Health, New York, NY. 2 2 1 Rhea Chattopadhyay, MD, Rebecca Flyckt, MD. University 2 OBJECTIVE: The efficacy and safety of use of the transvaginal ultrasound Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals probe for percutaneous abdominal oocyte retrieval in patients with limited Fertility Center/Case Western Reserve University, Beachwood, OH. 1-2 vaginal access has been established in prior studies, but the technique OBJECTIVE: Fibroids may impact fertility via multiple proposed mech- has not been demonstrated widely. anisms. Submucosal fibroids in particular may contribute to infertility, recur- METHODOLOGY: This video uses a patient case to explain and demon- rent pregnancy loss, and lower implantation rates with embryo transfer. The strate the technique of percutaneous transabdominal oocyte retrieval with the surgical approach to managing submucosal myomas is guided by FIGO stag- transvaginal ultrasound probe in a patient without vaginal access to her ing. Although hysteroscopic myomectomy may be an appealing option, ovaries. Patient consent was obtained prior to creation of the video. incomplete resection is a risk with type 2 myomas. The objective of this video CONCLUSIONS: Abdominal oocyte aspiration using a high frequency is to describe the effectiveness of laparoscopic myomectomy for complete transvaginal ultrasound probe should be considered in patients with ovaries surgical resection of type 2 fibroids in assisted reproductive technology inaccessible vaginally. It is safe, effective and an easily skill to acquire. (ART) patients. References: 1. Baldini D, Lavopa C, Vizziello G, Sciancalepore AG, Mal- METHODOLOGY: We present here a case-based review of an infertility vasi A. The safe use of transvaginal ultrasound probe for transabdominal patient seen for second opinion. This patient had undergone treatment with oocyte retrieval in patients with vaginally inaccessible ovaries. Front oral fertility medications combined with intrauterine insemination followed Womens Healt. 2018; 3(2):1-3. by multiple IVF treatments. During the course of her prior IVF cycles, she 2. Sekhon L, Said T, Del Valle A. Percutaneous transabdominal oocyte underwent hysteroscopic myomectomy x 2, with a hysteroscopic resection retrieval using vaginal ultrasound probe: A novel, effective and safe method procedure for a single fibroid prior to each embryo transfer. She was diag- for oocyte retrieval in patients with vaginally inaccessible ovaries. Fertil nosed with recurrent implantation failure and subsequently underwent prena- Steril. 2014; 101(2) Supplement. tal genetic testing for aneuploidy (PGTA), with an endometrial receptivity SUPPORT: There was no financial support for creation of this video. assay (ERA) as the planned next step. Our evaluation demonstrated residual type 2 myoma with < 20% endometrial cavity involvement and laparoscopic V-13 10:30 AM Sunday, October 18, 2020 treatment of this myoma resulted in spontaneous pregnancy. In this video, we discuss the FIGO classifications of fibroids which were SURGICAL MANAGEMENT OF ADENOMYOSIS: developed based on location and cavity involvement. We review laparoscopic LAPAROSCOPIC ADENOMYOSIS RESEC- versus hysteroscopic surgical approaches. Though hysteroscopy is desirable TION. Kaia Schwartz, MD,1 Elliott G. Richards, MD,2 due to lack of invasiveness, cost, shorter operating times and faster return to Tommaso Falcone, M.D.3 1Clevleand Clinic Foundation, attempting to conceive, in the case of type 2 fibroids, a laparoscopic approach CLEVELAND, OH; 2Cleveland Clinic, Cleveland, OH; 3Cleveland Clinic, is often the most appropriate. There is no evidence to support shaving ‘‘thetip cleveland, OH. of the iceberg’’ hysteroscopically, as the intramural component will continue to encroach into the endometrial cavity until it is completely removed. OBJECTIVE: To demonstrate the steps required for surgical removal of CONCLUSIONS: Submucosal fibroids can both distort and invade into the diffuse adenomyosis. in a symptomatic woman desiring future fertility. endometrial cavity, thus contributing to infertility and failed embryo transfer METHODOLOGY: De-identified video footage was obtained and edited with assisted reproductive technologies (ART). When type 2 fibroids are to reflect key components of the procedure. Preoperative imaging is a critical incompletely removed, embryo transfer may not be successful. By fully in determining the surgical approach and for setting expectations for the sur- removing type 2 fibroids laparoscopically, the endometrial cavity is opti- gical outcome. In this case preoperative imaging revealed diffuse adenomyo- mized for successful pregnancy implantation either by spontaneous concep- sis of the posterior wall extending from to serosa. This case was tion or ART. performed by laparoscopic assisted technique. Five mm trocars were placed References: in the typical fashion. A suprapubic gel-point access platform was used to 1. Benecke C, Kruger TF, et al. Effect of fibroids on fertility in patients un- extract lesions and to aid in suturing areas that required extensive re-approx- dergoing assisted reproduction. A structured literature review. Gynecol Ob- imation. stet Invest. 2005;59(4):225-230. https://doi.org/10.1159/000084513 At surgery no pseudo-capsule exists so tissue planes are arbitrary. Typi- 2. Pritts E, Parker W, Olive D. Fibroids and infertility: an updated system- cally, a sub-serosal dissection is the upper border and continued laterally until atic review of the evidence. Fertil Steril. 2009;91:1215–23. somewhat normal is identified. This border is not well defined. 3. Desai P, Patel P. Fibroids, infertility and laparoscopic myomectomy. J The dissection is directed towards the endometrium which entry is unavoid- Gynecol Endosc Surg. 2011;2(1):36-42. https://doi.org/10.4103/0974-1216. able. Lesions are often excised is pieces as there is typically no cohesive tis- 85280 e520 ASRM Abstracts Vol. 114, No. 3, Supplement, September 2020 4. Practice Committee of the American Society for Reproductive Medi- OH; 3UH Fertility Center, REI Division; 4UH MacDonald Women’s Hospi- cine. Removal of myomas in asymptomatic patients to improve fertility tal, Cleveland, OH. and/or reduce miscarriage rate: a guideline. Fertil Steril. 2017;108(3):416- 425. https://doi.org/10.1016/j.fertnstert.2017.06.034 OBJECTIVE: The aim of this instructional video is to help further educate 5. Munro, Malcolm G. et al. The FIGO classification of causes of abnormal Reproductive Endocrinology and Infertility (REI) physicians on how to uterine bleeding in the reproductive years. Fertil Steril. 2011;95 (7): 2204 - assemble cornual cannulation equipment and as well as how to perform 2208.e3 cornual re-cannulation surgery for patients with prox- 6. Holub Z. Laparoscopic myomectomy: Indications and limits. Ceska imal tubal occlusion. Gynekol. 2007;72:64–8 METHODOLOGY: The video includes a step by step instruction for the SUPPORT: none assembly of a hysteroscopic catheterization system for cornual cannulation. This is followed by a demonstration of how to perform a cornual tubal re-can- nulation using this cannulation system and includes both hysteroscopic and V-15 10:44 AM Sunday, October 18, 2020 laparoscopic views. CONCLUSIONS: Due to the fact that fertility coverage is not SURGICAL MANAGEMENT OF PROXIMAL TUBAL mandated in the majority of states across the United States, we feel OCCLUSION: A VIDEO GUIDE FOR CORNUAL it is important to provide surgical alternatives to infertility patients 1 CANNULATION. Kathryn D. Coyne, MD, affected by tubal factor when applicable, such as patients with proximal 2 3 Channing Burks, MD, Rebecca Flyckt, MD, James H. Liu, tubal occlusion. The goal of this video is to educate REI physicians on 4 1 2 M.D. University Hospitals Cleveland Medical Center, OH; University how to surgically manage proximal tubal occlusion with cornual cannu- Hospitals Fertility Center/Case Western Reserve University, Beachwood, lation.

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