S. Giunchi

Clinical experience and applications of oocyte cryopreservation

Oocyte cryopreservation is a viable solution for the ethical problems related to embryo storage, and the only available technique for preservation of fertility in women who have to undergo chemo- or radiotherapy. The main problems with oocyte cryopreservation are concerned with the survival rate and the fertilization rate. Recently the introduction of the intracytoplasmic sperm injection (ICSI) led to an increase in the fertilization rate. The success achieved with the first case treated encouraged us to set up a clinical trial on human oocyte cryopreservation. In the first stage of the study, 23 women with tubal infertility were enrolled. Superovulation was induced and 375 oocytes were retrieved; of these 338 oocytes were frozen. The survival rate was 59.5% and was independant of the duration of cryopreservation or the presence of cumulus. The normal fertilization rate was 64.4%, and only 7.5% of fertilizations were abnormal. A total of 90.8% of fertilized oocytes cleaved. A mean of 3.1+/-1.3 embryos per patient were transferred. Three pregnancies were achieved. In the second stage of our investigation, more patients were enrolled and similar results were observed. Sixteen pregnancies were achieved. A further stage of the investigation involved the fertilization of frozen oocytes with frozen sperm and even these resulted in a pregnancy. Our study demonstrated that pregnancies can also be achieved when frozen eggs are fertilized by testicular and epididymal sperm. As a consequence of the success of our investigations, a program of oocyte cryopreservation for oncological patients has been initiated in our centre. In our opinion, oocyte cryopreservation is, at present, a safe and efficient technique as documented by the birth of several healthy children.

Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies

OBJECTIVE To assess the accuracy of three-dimensional (3D) ultrasound in the diagnosis of congenital uterine anomalies. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Nulliparae with three or more consecutive miscarriages. INTERVENTION(S) All women underwent 3D transvaginal ultrasound study of the uterine cavity. MAIN OUTCOME MEASURE(S) Women with negative ultrasound findings subsequently underwent office hysteroscopy, whereas a combined laparoscopic-hysteroscopic assessment was performed in cases of suspected Müllerian anomaly. RESULT(S) A specific Müllerian malformation was sonographically diagnosed in 54 women of the 284 included in the study group. All negative ultrasound findings were confirmed at office hysteroscopy. Among the women with abnormal ultrasound findings, the presence of a Müllerian anomaly was endoscopically confirmed in all. Concordance between ultrasound and endoscopy around the type of anomaly was verified in 52 cases, including all those with septate uterus and two out of three with bicornuate uterus. CONCLUSION(S) Volume transvaginal ultrasound appears to be extremely accurate for the diagnosis and classification of congenital uterine anomalies and may conveniently become the only mandatory step in the assessment of the uterine cavity in patients with a history of recurrent miscarriage.

Three‐dimensional transvaginal sonography in local staging of cervical carcinoma: description of a novel technique and preliminary results

To evaluate the feasibility of three‐dimensional multiplanar sonography in the local staging of cervical carcinoma.

Three-dimensional power Doppler sonography in the diagnosis of arteriovenous malformation of the uterus.

Arteriovenous malformations (AVMS) are uncommon vascular lesions that may arise in the myometrial layer of the uterus, causing menometrorrhagia. 1 - 3 As reported previously, they are amenable to sonographic detection, 4 - 8 although Doppler ultrasound examinations are not always able to distinguish true AVMs from other types of vascular lesions of the uterus. X-ray angiography is commonly required to confirm the diagnosis and to establish the appropriate treatment.7-9 In this case, 3-dimensional (3D) power Doppler sonography was valuable in diagnosing a true AVM of the uterus.

Neonatal hypoxic-ischemic encephalopathy in apparently low risk pregnancies: Retrospective analysis of the last five years at the University of Bologna

Objective. To provide recent figures on the occurrence of neonatal hypoxic-ischemic encephalopathy (NHIE) from a Teaching Hospital. Study Design. A retrospective case–control study was conducted in a tertiary level university hospital with more than 3000 deliveries annually. Twenty-four cases of NHIE that occurred in apparently low-risk pregnancies were analysed and compared to a group of controls for the most common labor variables. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results. Of 15,371 apparently low-risk deliveries, 24 cases of NHIE were observed (0.16%), with perinatal death or cerebral palsy occurring in nine of these cases (0.06%). The following intra-partum variables were significantly more common in cases than in controls: stained amniotic fluid (OR: 7.50; 95% CI:1.77–31.79), maternal fever (none in the control group), abnormal CTG (OR: 253.0; 95% CI: 26.70–2397), persistent occiput posterior (OR: 15.67; 95% CI: 2.25–104.53) and operative delivery (OR: 3.98; 95% CI: 1.39–11.33). Conclusion. The incidence of NHIE is considerably low in a Tertiary care Centre.

Laparoscopic treatment of interstitial twin pregnancy.

OBJECTIVE To describe a conservative management by laparoscopy of an unusual interstitial twin pregnancy. DESIGN Case report. SETTING University hospital. PATIENT(S) A 27-year-old woman, pregnant at 6th week of amenorrhea with interstitial twin pregnancy. INTERVENTION(S) The woman was submitted to two- and three-dimensional transvaginal ultrasound and to diagnostic hysteroscopy. Subsequently, we performed a laparoscopic procedure: conical exeresis of the uterine cornu using a monopolar hook without involving the uterine cavity. MAIN OUTCOME MEASURE(S) Conservation of the uterus, fertility preservation. RESULT(S) Successful conservative treatment of interstitial twin pregnancy. CONCLUSION(S) Conservative laparoscopic surgery can be used successfully in hemodynamically stable patients with an interstitial pregnancy.

Imaging in gynecological disease (13): clinical and ultrasound characteristics of endometrioid ovarian cancer

To describe the clinical and ultrasound characteristics of ovarian pure endometrioid carcinomas.

Imaging in gynecological disease: clinical and ultrasound characteristics of ovarian clear cell carcinoma

To describe the clinical and ultrasound characteristics of ovarian pure clear cell carcinoma.

OP29.05: The importance of papillary projection in a small unilocular‐solid cyst

Objectives: To evaluate, sonographic, power-Doppler features and histological findings in cases of small unilocular-solid cyst in a normal-size ovary. Methods: All consecutive women with small ovarian unilocularsolid cyst in normal-size ovary detected by transvaginal ultrasound, were included in the study. Patients had either follow-up ultrasound examination every three months or underwent surgical removal of the cyst. CA 125 was also evaluated. Histological findings were reviewed. Results: A total of 45 cases were identified. The median age of the patients was 48 years (range 25–77). CA 125 was elevated (> 35 UI/mL) in 6/45 (13%) cases. The median size of the cyst was 18 mm (range 11–30). The vascularization was present in 20/45 (44%) cases. 15/45 (33%) women received followup ultrasound examination every three month. 30/45 (67%) undervent laparoscopic removal of the cyst. Hystological diagnosis of malignancy (three carcinoma, and six borderline tumors) was recorded in 9/45 (20%) cases and of benign lesion in 21/45 (47%). Conclusions: These data suggest that the presence of a papillary projection is more important than the size of the cyst. Small unilocular solid cysts even in a normal-size ovary have substantial risk of malignancy.

OC10.02: Common transvaginal sonographic features of adnexal/ovarian torsion

Objectives: Pulsed tissue Doppler is a technique to record fetal myocardial wall movements with extremely high temporal resolution. Applicable measurements of cardiac performance indexes as TD-Tei Index or mechanical atrioventricular conduction times require knowledge of the exact length of cardiac time intervals as short as 30–50 ms. This requires meticulously fine tuning of the ultrasound parameters and high performance ultrasound equipment.The effect of two different ultrasound machines used to record fetal cardiac tissue Doppler traces on the results was analysed. Methods: Fetal cardiac tissue Doppler traces where obtained on 176 patients, who attended our institute for routine ultrasound scanning for fetal abnormalities or routine assessment of fetal growth. Ultrasound equipment used was either: Philips IU22, vision 2009 (P) or General Electrics E8, BT08 (G). Td-Tei index, the corresponding z-scores, medians and variance where compared. Results: Mean TD-Tei Index was 0.597 (P) and 0.587 (G) variance of TD-Tei Index was 0.009 and 0.008 mean Z-score of TD-Tei Index was 0.167 and −0.115 variance of Z-score of TD-Tei Index was 0.984 and 0.826 mean isovolaemic contraction time was 50.54 and 51.17 variance of isovolaemic contraction time was 116.4 and 109.3 mean isovolaemic relaxation time was 48.28 and 52.12 variance of isovolaemic relaxation time was 70.68 and 93.54 Conclusions: There where only minor differences in the means for fetal cardiac time intervals and their corresponding indices. In the variance of parameters measured with the two different ultrasound systems there were also no significant differences. The used equipment in our setup did not influence the results.