F. Cammilli

Sonographic diagnosis of a large and deep endometrioma of the uterine cervix

We present a rare case of endometriosis of the cervix. Transvaginal sonography showed a 35‐mm cyst in the cervix with diffuse, low‐level internal echoes. Transvaginal sonography‐guided aspiration with a 17‐gauge needle was performed, yielding a very thick chocolate‐colored fluid. Cytological examination of the fluid revealed the presence of endometrial cells. Symptoms resolved after aspiration and no recurrence has developed.

Role of Infection in In Vitro Fertilization Treatment

Abstract: With the increasing demand for assisted reproductive techniques (ARTs), it is important to consider how to manage infection. Three main positive factors that contribute to successful in vitro fertilization (IVF) cycles are maternal age, the ovarian hyperstimulation protocol used, and the number and quality of transferred embryos. Negative factors include contamination and infection. This paper describes the issues relating to infection during IVF and proposes guidelines to control infection and to increase laboratory safety.

OC09: Does laparoscopic cystectomy for bilateral endometriomas affect ovarian reserve? Insight from b‐FSH and ovarian response to gonadotrophin stimulation for ART

of deep pelvic endometriosis in our population was 45%, and this probability of disease nose to 87% with a positive test and decreased to 9% with a negative test. Conclusions: The use of our ultrasonographic modified approach shows good accuracy in the detection of endometriosis in all locations evaluated. In the detection of vaginal endometriosis this technique shows a high specificity and sensitivity. On the contrary, a good specificity associated with lower sensitivity is obtained in the diagnosis of deep endometriosis of the uterosacral ligaments and rectovaginal septum. In the detection of anterior deep endometriosis, this approach shows a good accuracy only in the detection of vesicular endometriosis and not in the evaluation of the entire anterior pouch.

P29.08: The role of sonohysterography in diagnostic management in recurrent pregnancy loss patient

Objectives: To evaluate the criteria of early diagnosis and the role of conservative management in the treatment of cervical pregnancies. Methods: We made a retrospective analysis of all cervical ectopic pregnancies diagnosed in our department from January 2001 to December 2005. The diagnosis of cervical pregnancy was made by transvaginal ultrasound (empty uterine cavity, distended/enlarged cervix, gestational sac below the level of internal os, negative ‘sliding sign’, peritrophoblastic blood flow on Doppler evaluation). Data about medical history were recorded in all cases. Serum human chorionic gonadotropin (hCG) levels were evaluated at time of diagnosis and during the follow-up until resolution. Conservative management was obtained with administration of systemic (50 mg/m2) and/or intra-amniotic (50 mg) methotraxate. After three months from the treatment all patients underwent an hysteroscopic evaluation of cervical canal and uterine cavity. Results: Five cases of ectopic pregnancy were diagnosed during the study period. No risk factors were found in patients medical history. Sonographic diagnosis was between 7 and 10 weeks of gestation. Serum hCG levels at diagnosis were between 4446 and 10 087 IU/L. Two cases were successfully treated with systemic and intraamniotic administration of methotrexate, three case were managed successfully with a single dose of intra-amniotic metothrexate. Serum hCG levels started to decrease from day 4 after the treatment. No early or late complications occurred. All patients were followed up until serum hCG levels were < 5 IU/L. Hysteroscopic evaluation confirmed absence of sinechiae/lesions at the level of cervical implant of ectopic pregnancy in all patients. Conclusion: Early diagnosis of cervical pregnancy allows a conservative fertility-sparing management that is effective and safe.

OP11.08: Transvaginal ultrasound versus magnetic resonance in the study of under‐diagnosed endometriosis: adenomyosis and deep endometriosis

Objectives: To compare the efficacy of multi-step hysterosalpingo contrast sonographic (HyCoSy)-based triage for the assessment of tubal patency with X-ray hysterosalpingography (HSG) and laparoscopy (LPS) in an outpatient office infertility program. Methods: Infertile patients are routinely examined by HyCoSy during the proliferative phase to asses tubal patency. The first step was based on a 2D-HyCoSy using saline mixed with air. If tubal patency was doubtful, patients underwent a 2D-HyCoSy using Sonovue (Bracco Diagnostics, Inc.) as contrast media and Contrast-Tuned Imaging. In doubtful cases this second procedure was performed during the same examination with the same catheter (8Fr–Nelaton). These cases underwent as confirmative test either HSG or LPS. Sensitivity and specificity of this multi-step HyCoSy compared to HSG and LPS was calculated by statistical analysis. Results: In 68 patients tubal patency was assessed at saline–air HyCoSy (69%). We report the results of this multi-step HyCoSy in the remaining 30 doubtful cases (59 tubes) compared to HSG (34 tubes)–LPS (25 tubes) (Table). The six discordant occluded tubes proved patent at LPS, similarly the one discordant patent at HyCoSy was found occluded at LPS. Therefore sensitivity and specificity of contrast-HyCoSy when compared to HSG were both 100%. Sensitivity and specificity at LPS were 87% and 60%, respectively.