Abstracts of 16th Congress of Iranian Society for Reproductive Medicine of the fibroids. Surgical methodology and use of A- Oral Presentations medical adjuvant therapy was reviewed. Results: Most of the evidence that associates 1- Infertility, Gynecology fibroids and infertility is from observational series using the patients as their own controls and from O-1 meta-analysis of these series. Myomectomy by Prognostic models in infertility any access route (laparotomy, laparoscopy, or hysteroscopy) confers subsequent pregnancy rates Al-Inani H. ranging from 10-75%. Mode of access does not Department of Obstetrics and Gynecology, Cairo seem to influence subsequent pregnancy rates. University, Giza, Egypt. Myomectomy has also been associated with a E-mail: [email protected] reduction in spontaneous pregnancy losses. Conclusion: The available evidence suggests that There is a strong need for distinction between fibroids that distort the endometrial cavity couples with a relatively good prognosis and couples (whether submucosal or intramural) appear to with poor fertility prospects. Clinical experience or adversely affect fertility and should be removed. ‗gut-feeling‘ of clinicians was the only available Further investigation is required to conclusively ‗tool‘. Comparison of the predictions made by demonstrate a cause-effect relationship. In clinicians based on clinical experience addition, the optimal surgical technique and the demonstrated a substantial reproducibility of the usefulness of adjuvant medical therapy require assessment of spontaneous conception chances, but further study. a very slight to fair reproducibility of the Key words: Fibroids, Infertility, Surgical technique. assessment of IVF-ET success rates, thereby demonstrating the need for models that predict the O-3 outcome of IVF-ET. The present talk will discuss Understanding endometriosis first: the chance of spontaneous pregnancy for subfertile couples and second: the chance of Evers JLH. success of different treatment modalities including Department of Obstetrics and Gynecology, Maastricht IVF and ICSI University, Maastricht, Netherlands. Key words: Spontaneous pregnancy, Subfertile couples, IVF, E-mail: [email protected] ICSI. This lecture will show that it is reasonable to O-2 conclude that there exists no or only very limited Fibroids and infertility robust evidence today for endometriosis per se causing subfertility, that there is no support for the Sanders B. contention that medical treatment of minimal and Department of Obstetrics and Gynecology, Vancouver, mild endometriosis improves pregnancy chances in British Columbia, Canada. E-mail: [email protected] subfertile couples, and finally that there is statistical evidence for a slight beneficial effect of Introduction: The role of fibroids in reproduction surgical removal of the lesions, but that the clinical remains controversial. The mechanism of effect is relevance of this is only limited and that the effect unknown but proposed theories include may be short-lived. The same holds true for occult dysfunctional uterine contractility, impairing disease: no evidence exists to support the sperm migration and ovum transport, alteration in contention that medical treatment of occult the vascularity of the endometrium adversely endometriosis improves pregnancy chances in affecting implantation and placentation, and by subfertile couples. Although statistical evidence tubal occlusion. Fibroids have been associated does exist for a slight beneficial effect of surgical with both infertility and spontaneous pregnancy removal of minimal and mild lesions, the clinical loss. However, the evidence for causal relevance of less severe forms of endometriosis, relationship is less than ideal. i.e. occult disease, is undefined. Occult disease can Materials and Methods: A review of the current (and should) not be removed. Medical treatment IVF, reproductive surgery and obstetric literature will render minimal and mild disease only involving the association of fibroids with fertility temporarily invisible, allowing the lesions to re- was undertaken. An attempt was made to stratify emerge with time; surgical treatment can only the information according to the size and location remove visible lesions but will inevitably leave Iranian Journal of Reproductive Medicine, Vol. 8, Suppl. 1, Winter 2010 1 Abstracts of 16th Congress of Iranian Society for Reproductive Medicine behind dozens, if not hundreds of invisible (occult) In lower genital tract infections, an adequate ones, which after removal of the visible lesions, immune response is considered essential to clear may develop into minimal (visible) endometriosis the pathogen to prevent its ascendance to the upper and proceed from there. The problem remains to genital tract. Most women show an adequate identify those women whose minimal and mild immune response to CT infection, but some have endometriosis will develop into moderate and an inadequate response and may develop persistent severe disease with adhesion and endometrioma infections ascending to the upper genital tract and formation to such an extent that fertility will be increasing the risk for tubal factor infertility. Host affected. On the long run, all treatments are immune factors are considered determinants of the necessarily (theoretically and in practice) deemed course of CT infections, and genetic variations in to be ineffective, also in patients with visible TLR and NOD genes may affect the risk for disease since, if anything, they will leave behind persistence of infections and the development of numerous occult lesions, and, more importantly, late sequelae. A positive CAT is indicative of a they will leave the genetic predisposition and previous infection but not of a persistent infection. pathophysiological mechanism unaffected that lead Measuring serological markers of persistence, of to the development of endometriosis in the first which CRP seems promising, in CAT positive place. The disease will recur with time. The main women may identify a subgroup of infertile question then is: will the patient succeed in women with the highest risk of tubal pathology. achieving a pregnancy in the interval during which Key words: Chlamydia trachomatis, Infection, Infertility. therapy has temporarily reduced the disease to its occult form? O-5 Key words: Endometriosis, Pregnancy, Subfertility. Outpatient management of ovarian hyperstimulation O-4 Chlamydia and infertility Fluker M. Genesis Fertility Center, Vancouver, British Columbia, Land JA. Canada. Department of Obstetrics and Gynaecology, University E-mail: [email protected] Medical Center Groningen, Groningen, Netherlands. E-mail: [email protected] Introduction: Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of The majority of Chlamydia trachomatis (CT) gonadotropin administration. We developed a lower genital tract infections in women is systematic protocol for minimizing the risk of asymptomatic, but may give rise to pelvic OHSS in IVF cycles, followed by early outpatient inflammatory disease and tubal infertility. The intervention aimed at avoiding hospitalization and reference standard for diagnosing tubal pathology minimizing the progression and complications of in infertile women is laparoscopy with tubal OHSS. testing. However, laparoscopy is an invasive and Materials and Methods: Strategies to reduce the expensive procedure, requiring general anaesthesia risk of OHSS included individualized FSH doses, and operating facilities. reducing the ovulatory dose of hCG and Owing to these disadvantages, laparoscopy is withholding gonadotropins to allow E2 levels to unsuitable to be applied as a screening procedure decrease before hCG administration. If OHSS on a large scale. It would be preferable to estimate developed, we promoted active outpatient the risk of tubal pathology before laparoscopy and intervention in the early stages of OHSS, including to select only high-risk patients for this procedure. vigilant fluid management at home, early For the risk assessment of tubal pathology in outpatient paracentesis and judicious colloid infertile women CT IgG antibody testing (CAT) in replacement. serum is widely used. Results: Moderate to severe OHSS developed in CAT is an inexpensive and non-invasive screening <2% of IVF cycles over a 12 year period (1997- test, but its predictive value for tubal factor 2009). Nearly all cases developed >10 days after infertility has limitations. Clinicians should be hCG administration, and all such women were aware of factors known to affect the diagnostic pregnant. Affected patients monitored daily accuracy of CAT (as the antigenic composition of weight, abdominal circumference, fluid intake and the test used, and the definition of tubal factor 24h urine output measurements at home. infertility applied). Outpatient transvaginal paracentesis was 2 Iranian Journal of Reproductive Medicine, Vol. 8, Suppl. 1, Winter 2010 Abstracts of 16th Congress of Iranian Society for Reproductive Medicine performed for ascitic fluid pockets > 5-6cm. above 0.005 and the difference they have upon the Oliguria and hemoconcentration were treated by postoperative pregnancy rate are not significant. oral rehydration and hydroxyethyl starch infusion Conclusion: To those who have uterine myomas, at the time of paracentesis. Hospitalization was myomectomy may be an option for treatment, rarely needed for symptoms unresponsive to because postoperative pregnancy rate seems to outpatient management. increase