Intramural Myomas Research Articles

Thinking in context: Fibroids-to-uterine volume ratio in pre-surgical fertility evaluation for intramural fibroids

ObjectiveTo explore the utility of the total fibroids-to-uterine volume (FTUV) ratio as a simple, preoperative tool to assist in counseling patients seeking pregnancy who are undergoing myomectomy for intramural (IM) fibroids. Study designThis is an historical cohort study on reproductive-aged patients seeking pregnancy who underwent laparotomic myomectomy for intramural fibroids from January 2017 to December 2021. Only G3 to G5 fibroids, according to the 2011 International Federation of Gynecology and Obstetrics (FIGO) classification, were included. Pre-operative transvaginal ultrasound (TVUS) was performed to measure the volume of intramural myomas (diameter1*diameter2*diameter3*0.52) and to calculate their total volume. The total fibroids-to-uterine volume (FTUV) ratio was calculated as the proportion of the uterine volume occupied by the sum of IM fibroids volumes. ResultsA total of 166 women with pre-surgical TVUS evaluation of IM fibroids were included, with a mean age of 36.22 ± 5.15 years. The FTUV ratio was identified as a positive predictor of clinical pregnancy after surgery (adjOR, 1.04; 95 % CI, 1.02–1.06; p = 0.0001), whereas age showed a negative association (adjOR, 0.90; 95 % CI, 0.83–0.98; p = 0.012). Endometrial cavity distortion prior to surgery was also positively associated with pregnancy post-surgery (adjOR, 3.50; 95 % CI, 1.51–8.08; p = 0.003). Consistent results were found for live births, with the FTUV ratio being a significant positive predictor of live birth after surgery (adjOR, 1.03; 95 % CI, 1.01–1.05; p = 0.001) and age showing a negative association (adjOR, 0.88; 95 % CI, 0.80–0.96; p = 0.004). Parity prior to surgery also positively impacted live birth post-surgery (adjOR, 2.65; 95 % CI, 1.30–5.40; p = 0.007). An FTUV ratio threshold of 53.39 % accurately predicted clinical pregnancy in 68.46 % of cases (sensitivity of 71.70 % and specificity of 66.67 %). For live births, a higher FTUV ratio threshold of 59.21 % predicted outcomes accurately in 69.13 % of cases (sensitivity of 65.85 % and specificity of 70.37 %). ConclusionThe use of the FTUV ratio in pre-operative ultrasound evaluation of IM fibroids may improve counseling for patients desiring to conceive after myomectomy. By providing a personalized assessment of the amount of myometrial volume occupied by fibroids, the FTUV ratio can help predict fertility outcomes after surgery, enabling better-informed decisions and treatment planning.

P-761 Four-dimensional ultrasound using an electronic probe to guide embryo transfer: a feasibility study

Abstract Study question Is four-dimensional ultrasound (4D-US) guided embryo transfer feasible and safe? Summary answer 4D trans-abdominal US with electronic probe is feasible and safe and justifies a formal study for non-inferiority to two-dimensional ultrasound (2D-US) for embryo transfer guidance. What is known already The use of 2D-US to guide embryo transfer is the usual procedure (Eshre/ASRM guidelines, evidence A), and investigations of the benefits of 3D and 4D-US have been inconclusive. 3D-US can locate the embryo flash in the coronal plane immediately after performing embryo transfer but furnishes only retrospective information. 4D-US requires two operators at transfer, and there has been slow image acquisition and poor image quality, not allowing satisfactory comparison of accuracy and precision with other methods. Study design, size, duration Using a high-end ultrasound device (Voluson E10, GE Healthcare, Zipf, Austria) with an electronic 3D-4D probe (eM6C G2), a prospective observational trial with 29 women undergoing mock embryo transfer in a private infertility clinic was performed between October 2023 and January 2024. Exclusion of subjects included BMI greater than 35 (3 cases) and an intramural myoma that impeded 4D-US visualization (3 cases). Participants/materials, setting, methods Two operators expert in U/S performed each procedure. Electronic probe settings were adapted for each subject. To simulate the embryo transfer, a Wallace catheter containing air and fluid was inserted and monitored transabdominally by 4D-US using the electronic probe. The catheter was observed until it reached 1 cm from the fundus and the embryo flash (bubble) identified. Entrance through the cervix was controlled by 2D and 4D. Main results and the role of chance The following variables were recorded: age, BMI, cycle day, use of hormones, endometrial thickness, position of the uterus, presence of fibroids, image quality, difficulty of entrance, visualization of the cervix. The 23 subjects had the following characteristics: mean age 39±6.4, BMI 24.14±4.4. Image quality was optimal in 18 patients and due to a retroverted uterus was suboptimal in 5 subjects. Cannulation of the cervix was difficult in 1. Eight patients were on birth control pills and 15 were on day 6-10 of spontaneous cycles. The mean endometrial thickness was 7.13±3mm. Mean hysterometry was 7.10±0.9mm. Visualization of the cervix with 4D-US was good in 12 subjects, fair in 7 and poor in 4. Visualization of the catheter in the cavity with 4D-US was good in 16 subjects, fair in 2 and poor in 5. The embryo flash was adequately visualized by 4D-US in 18 subjects and less well in 5. Catheter position was correctly identified by comparison 3D-US in 20/23 subjects. There were no adverse effects during or following the procedure. Limitations, reasons for caution Patients with poor image quality, due to obesity, retroverted uterus or fibroids, are not candidates for this technique. The need for two operators limits the practicability of the procedure, increasing the need to show its superiority over the usual practice before it could be adopted clinically. Wider implications of the findings 4D-US for embryo placement is feasible and safe. Studies that compare the accuracy and precision of 4D-US vs 2D-US to guide embryo transfer and the cost/benefit ratio of 4D ultrasound guided embryo transfer are in order.. Trial registration number not applicable for non-clinical trials

Deciphering endometrial dysfunction in patients with uterine myoma using endometrial organoids: a pilot study

Research questionWhat influence does an intramural myoma have on the endometrium, and how is this mediated? DesignEndometrium was collected from 13 patients with non-cavity-distorting intramural myomas (diameter ≤4 cm; International Federation of Gynecology and Obstetrics type 4) and 13 patients without myomas undergoing hysterectomy for benign cervical diseases with a similar clinical baseline. Endometrial organoids were established in vitro and induced to reach the secretory phase by oestrogen and progesterone. Transcriptome sequencing was conducted on endometrial organoids in both untreated and secretory stages from three individuals with myomas and three control participants. Immunofluorescence and real-time quantitative PCR (RT-qPCR) were performed on endometrial organoids from another 10 myoma patients and 10 control patients for validation. ResultsThe data revealed abnormally increased hormone receptor (PGR) levels in the untreated endometrial organoids with myomas, resulting in potentially abnormal glandular and vascular development. The aberrant responses to oestrogen and progestogen prompted further investigation into the secretory phase. The secretory endometrial organoids with myomas exhibited greater changes in acetyl-α-tubulin, ODF2 and TPPP, demonstrating likely decreased cilia, and COL6A1, used as a marker for increased extracellular matrix (ECM) modelling. Both untreated and secretory endometrial organoids with myoma showed an up-regulation of genes and pathways related to ECM mechanotransduction. The expression pattern of receptivity-related genes was disturbed in endometrial organoids with myoma. ConclusionsThis study is the first to reveal that intramural myomas create an abnormal hormonal and mechanical environment in the untreated and secretory endometrial organoids. The intramural myomas negatively impacted gene expression relating to endometrial glands, blood vessels, cilia and ECM, indicating that intramural myomas impair endometrial decidualization and receptivity.

The Update on the Role of Cesarean Myomectomy in an Old Primigravida with Huge and Painful Myoma: a Challenging Case for Fertility-Preserving Surgery

Abstract There is no established protocol for reducing maternal and perinatal morbidities in myoma during pregnancy. The opinions regarding performing myomectomy during cesarean section have been inconsistent and hot topic of discussion. The recent trends regarding the pro and cons outcomes are caused by potential risk of massive hemorrhage, repeat operation and anesthesia, less time away from work, prolong duration of operation and hospital stay, need of transfusion, increased overall cost, and morbidity. We presented a case of 42-year-old primigravida at 37-38 weeks of singleton live pregnancy with intramural myoma, and then performed successfully cesarean section and myomectomy without complication. The results of the operation showed a safe outcome when performed by an experienced obstetrician and selective case, and helped maintain fertility sparing in the future. Keywords: Uterine myoma, Cesarean myomectomy, Old primigravida

Emergency Caesarean Section in a Patient with HELLP Syndrome and Intramural Myoma: A Case Report

Introduction: The syndrome of HELLP, often a complication of severe pre-eclampsia, is influenced by factors like multiparity, advanced maternal age, and potential genetic associations. Intramural Myoma have been linked to a 44% increased risk of hypertension in pregnant women, potentially contributing to the initiation and progression of pre-eclampsia, particularly due to their rapid expansion during pregnancy. This study reported a patient with intramural myoma and HELLP Syndrome in 35-36 weeks of gestation age. Case Presentation: A 40-year-old woman in her 35-36 weeks of gestation sought emergency care at General Hospital Dr. Saiful Anwar Malang due to escalating severe headaches. As a third-time expectant mother with a history of five antenatal visits, she presented with elevated blood pressure (219/110 mmHg), a BMI of 32 kg/m2, and various concerning findings, leading to a diagnosis of impending eclampsia, severe preeclampsia (HELLP syndrome), fetal distress, severe hypoalbuminemia, intrauterine growth restriction (IUGR), and other complications. The patient underwent an urgent cesarean section, revealing an intramural uterine myoma, followed by bilateral ligation of uterine arteries to address bleeding and myomectomy. Postoperatively, she received a magnesium sulfate infusion, her blood pressure stabilized at 143/92 mmHg and Hemoglobin 12,40 g/dl. Conclusion: Intramural myoma increases the risk of preeclampsia during pregnancy. Emergency C-section is an effective measure to address complications for both the mother and the baby, and bilateral ligation of uterine arteries can minimize surgical bleeding.

Reproductive medicine news. Digest of publications for 2023, issue 2

This issue of reproductive medicine news presents the second part of most relevant meta-analyses, reviews, prospective researches data, as well as innovative methods in the treatment of diseases of the reproductive system, presented in leading international periodicals in 2023. The briefly formulated list of topics contains such actual problems as: influence of active growing intramural myoma on IVF outcomes; birth rate after treatment of cancer and haemopoietic stem cell transplantation; chromosomal, gestational and neonatal outcomes of mosaic embryos with verified aneuploidy; artificial intelligence using in process of sperm selection for assisted reproductive technologies and personalized probiotic therapy of vaginal dysbiosis.

Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

ObjectiveThis study aimed to introduce a novel laparoscopic haemostasis for myomectomy and investigate the independent risk factors for uterine fibroid recurrence.DesignA retrospective cohort study.SettingFollowing strengthening the reporting of observational studies...

Characteristics associated with blood transfusion among women undergoing laparoscopic myomectomy: a National Surgical Quality Improvement Program study

Uterine fibroids are the most common benign tumors that affect females. A laparoscopic myomectomy is the standard surgical treatment for most women who wish to retain their uterus. The most common complication of a myomectomy is excessive bleeding. However, risk factors for hemorrhage during a laparoscopic myomectomy are not well studied and no risk stratification tool specific for identifying the need for a blood transfusion during a laparoscopic myomectomy currently exists in the literature. This study aimed to identify risk factors for intraoperative and postoperative blood transfusion during laparoscopic myomectomies and to develop a risk stratification tool to determine the risk for requiring a blood transfusion. This was a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. Women who underwent a laparoscopic (conventional or robotic) myomectomy were included. Women who received 1 or more blood transfusions within 72 hours after the start time of a laparoscopic myomectomy were compared with those who did not require a blood transfusion. A multivariable analysis was performed to identify risk factors independently associated with the risk for transfusion. Two risk stratification tools to determine the need for a blood transfusion were developed based on the multivariable results, namely (1) based on preoperative factors and (2) based on preoperative and intraoperative factors. During the study period, 11,498 women underwent a laparoscopic myomectomy. Of these, 331(2.9%) required a transfusion. In a multivariable regression analysis of the preoperative factors, Black or African American and Asian races, Hispanic ethnicity, bleeding disorders, American Society of Anesthesiologists class III or IV classification, and a preoperative hematocrit value ≤35.0% were independently associated with the risk for transfusion. Identified intraoperative factors included specimen weight >250 g or ≥5 intramural myomas and an operation time of ≥197 minutes. A risk stratification tool was developed in which points are assigned based on the identified risk factors. The mean probability of transfusion can be calculated based on the sum of the points. We identified preoperative and intraoperative independent risk factors for a blood transfusion among women who underwent a laparoscopic myomectomy. A risk stratification tool to determine the risk for requiring a blood transfusion was developed based on the identified risk factors. Further studies are needed to validate this tool.

A State of Septic Shock Revealing a Pyomyoma as An Exceptional Complication Post Abortum

Pyomyoma is a pyogenous infection of a leiomyoma and occurs when a leiomyoma under goes infarction and subsequent infection. It is a rare, yet potentially fatal complication of uterine leiomyoma. We report the case of a 42-year-old tunisian woman,20 weeks of gestation, who presented with rupture of membrane. In her ultrasonography, in 20 weeks of gestation, she had 18 cm × 16 cm sub-mucosal to intramural myoma and a normal fetus. a cesarean section was performed for suspected chorioamniotitis with a failed induction. Seven days later, she presented with fever and lower abdominalpain. In physical examination, she had blood pressure:100/70mmHg, pulse rate: 110 beats per minute and temperature:39.5°C. She had tenderness on uterus and uterine height was 24 weeks. Ultrasonography showed a hetero-echoic mass (18 cm × 16 cm × 12 cm) in posterior side of uterus and endometrial thickness was 8 mm. With diagnosis of endometritis or infected myoma, she was admitted and received intravenous.

Uterine Leiomyomas and Infertility: A Comparison of National and International Guidelines.

Uterine leiomyomas are the most common benign tumors of the female genital track, causing various symptoms and problems, including a possible impact on fertility.The relationship between fibroids and infertility has long been a debate among gynecologists. Management of fibroids in women with otherwise unexplained infertility worldwide lacks standardized, evidence-based guidelines. Therefore, a review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Collège National des Gynécologues et Obstétriciens Français, and the American Society of Reproductive Medicine was conducted. There is agreement among all guidelines that the effect of fibroids on fertility is related to their position in the uterus and the alteration of the endometrial cavity. However, whether surgical intervention (laparotomy, laparoscopy, or hysteroscopy) is required varies among committees. More specifically, for submucous myomas, all guidelines agree that surgical intervention is needed. On the other hand, regarding intramural myomas, there is no consensus on what the approach may be. Novel treatments such as uterine artery embolization (UAE) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) should only be used in clinical trial settings. Nevertheless, all guidelines agree that medical management of fibroids further delays efforts to conceive and has no role as a stand-alone treatment of fibroids; though, the use of GnRH analogues preoperatively can be useful to improve anemia and/or reduce fibroid volume. There is a need for updated international protocols to be introduced, in order to help clinicians dealing with fibroids and infertility to better suggest the optimal treatment.

THU525 Atypical Presentation Of Parathyroid Carcinoma In The Lungs

Abstract Disclosure: J.N. Jacinto: None. O. Reyes: None. M. Cating-Cabral: None. R. Santiago: None. J. Andal: None. A 66-year-old female with a history of parathyroid adenoma underwent partial parathyroidectomy and thyroidectomy of the right lobe in 2006. She has the following comorbidities: pre-diabetes, hypertension, multiple liver cysts, medullary nephrocalcinosis and nephrolithiasis, ureterolithiasis and uterine intramural myoma. She also has a strong familial disposition of endocrine tumors. During the last quarter of 2018, parathyroid hormone and calcium levels were elevated and parathyroid imaging revealed an adenoma on the posteromedial aspect of the left thyroid lobe. Removal of the adenoma was offered but insisted on medical treatment. In 2022, she was admitted for subarachnoid hemorrhage due to fall. There was an incidental finding of a lung mass with minimal pleural effusion on the right lung lobe. PET-scan revealed five FDG-avid nodules (SUV up to 9.6) with the largest in the right middle lobe measuring 2 x 2 x 2 cm. Percutaneous needle biopsy was performed which showed a tumor with fairly uniform cells in organoid nests and solid clusters. By immunohistochemistry (IHC), the tumor cells were diffusely and strongly positive for CK and GATA-3; focally positive for chromogranin and synaptophysin; and negative for TTF-1, Pax-8, and S100. This was signed out as an epithelial tumor with neuroendocrine features; the differential diagnosis includes pulmonary neuroendocrine tumor versus metastasis from the prior parathyroid lesion. She subsequently underwent completion thyroidectomy and video-assisted thoracoscopic surgery. The lung wedge resections both showed tumors with similar morphology and IHC staining pattern as the biopsy. Additional stains were also performed to rule out other entities, which were all negative (CK7, CK20, CD56, mammaglobin, GCDFP-15, TTF-1, S100, ER, Pax-8, HSA, and SALL-4). The Ki-67 proliferation index was 17.26%. Because the overall findings were not definitive, comprehensive genomic profiling by next generation sequencing (NGS) was recommended and subsequently performed. NGS showed gene alteration in CDC73, with a variant allele frequency of 50%; this finding has been documented in parathyroid carcinoma. Pre-operative parathyroid hormone levels remained unchanged (408 to 397 pg/ml) despite surgery. Currently, there is no available targeted therapy to address her genomic alteration. Hyperparathyroidism-jaw tumor syndrome was entertained. The multidisciplinary team advised en-bloc resection of the lung tumor and additional gene testing for family members. She opted for palliative care and is on cinacalcet for her hyperparathyroidism. Presentation: Thursday, June 15, 2023

Spontaneous Transformation of Intramural Myoma into Peduncle During Cesarean Section in a 33-year Woman: A Case Report

We report a 33 years multipara pregnant woman who presented with vaginal bleeding due to intramural myoma and preeclampsia. After cesarean section, the myoma changed to the peduncle type and entered the internal space from the inner thickness of the uterus. This infrequent phenomenon made it easier to operate and remove the myoma within a few hours after the cesarean section. Finally, the mother and baby were discharged from the hospital safely after a few days.

Uterine and Tubal Findings of Infertile Women in the Reproductive Age Group

Infertility affects approximately 10% of the world’s population and has been termed the 5th highest serious global disability by the World Health Organization WHO, (2018). It is defined as the inability of a couple to achieve pregnancy after 1 year of regular sexual intercourse of at least thrice a week or after an achieved pregnancy. Fertility declines with age in both men and women, but the effects of age are greatly pronounced in women due to multifactorial causes in women. Hysterosalpingography (HSG) is the radiographic examination of the uterus and fallopian tubes and is regarded as the gold standard for assessing the fallopian tubes, providing accurate information on their patency and shape. Limitations to hysterosalpingography are seen in identifying uterine factors affecting fertility in most findings. Other radiographic examinations such as the ultrasound scans should be used alongside in evaluating findings of infertility as it gives precise description of the outline of the uterus and can capture intramural myoma which isn't easily seen on hysterosalpingogram scans hence the importance of combining these radiographic evaluations. The result showed that the commonest pathological tubal finding on infertility using Hysterosalpingography evaluations is Bilateral Tubal Occlusion (27.8%) while the commonest pathological uterine findings seen using ultrasound evaluation is Uterine Myoma (24.1%). Predominant age group was 32-37 years. This also showed that there is positive correlation between Age and Infertility type.

Clinical outcome analysis of intramural myoma greater than 8 cm in diameter removed during caesarean section: a retrospective study

ObjectiveTo explore the safety and efficiency of endometrial myomectomy (EM) and Serosal myomectomy (SM) for the removal of intramural myoma greater than 8 cm in diameter during cesarean section.MethodsRetrospective analysis and follow-up were used, and 190 cases of pregnancy complicated with uterine myoma from Jan. 2017 to May 2022 in Ningbo Women’s and Children’s Hospital were collected, 130 cases of caesarean myomectomy as study group, 64 cases of EM as study group A, 66 cases of SM as study group B, 33 cases with uterine fibroids removed before suturing the uterine incision as study group B1, 33 cases with uterine incision sutured followed by removal of fibroids as study group B2, 60 cases of Caesarean section alone as control group. To compare perioperative conditions between and within groups.Results① Operation time, postoperative exhaust time, pre- and post-operative haemoglobin drop, intraoperative blood loss were all more than those of the control group in the study group (68.65 ± 11.87 vs 56.17 ± 9.18 min, 21.04 ± 4.98 vs 17.03 ± 1.3 h, 1.27 ± 0.59 vs 1.09 ± 0.43 g/dl, 613 ± 221 vs 532 ± 156 ml, P < 0.001, P < 0.001, P = 0.025, P = 0.011). ② For type III and V fibroids, the time of myoma removal, postoperative exhaust and pre- and post-operative haemoglobin drop and intraoperative blood loss in study group A were less than those in study group B (18.02 ± 3.89 vs 20.19 ± 5.32 min, 18.83 ± 2.57 vs 23.93 ± 6.84 h, 600 ± 194 vs 730 ± 277 ml, 1.20 ± 0.57 vs 1.59 ± 0.70 g/dl, P = 0.036, P < 0.001, P = 0.014, P = 0.008); For type IV uterine fibroids, only postoperative exhaust time was less in Study Group A than in Study Group B (19.27 ± 2.2 vs 21.35 ± 3.23 h, P = 0.016). ③ Time of myoma removed was less in study group B1 than in study group B2 (18.24 ± 4.53 vs 20.7 ± 4.59 min, P = 0.033).ConclusionIt is safe and feasible to remove interstitial myomas larger than 8 cm in diameter during caesarean section. EM has the advantage of shorter operation time and less intraoperative bleeding, SM, in a way that the myoma is removed before suturing the uterine incision, can shorten the myomectomy time. It can benefit the patients more.

Gonadotropin-Releasing Hormone agonist (GnRH-a) Pretreatment before Hormone Replacement Therapy Does Not Improve Reproductive Outcomes of Frozen–Thawed Embryo Transfer Cycle in Older Patients with Intrauterine Fibroid: A Retrospective Cohort Study

Surgery in elder patients with intermural fibroids delays pregnancy, and GnRH-a can shrink uterine fibroids to a certain extent; therefore, for geriatric patients with fibroids, determining whether GnRH-a pretreatment before frozen-thawed embryo transfer (FET) can improve its success rate remains to be studied. We conducted this study to research whether GnRH-a pretreatment before hormone replacement treatment (HRT) could optimize the reproductive outcomes compared with others preparations in geriatric patients with intramural fibroids. According to the endometrial preparation, patients were divided into a GnRH-a-HRT group, a HRT group and a natural cycle (NC) group. The live birth rate (LBR) was the first outcome, and the clinical pregnancy outcome (CPR), the miscarriage rate, the first trimester abortion rate and the ectopic pregnancy rate were the secondary outcomes. A total of 769 patients (aged 35 years or older) were included in this study. No significant difference was observed in the live birth rate (25.3% vs. 17.4% vs. 23.5%, p = 0.200) and the clinical pregnancy rate (46.3% vs. 46.1% vs. 55.4%, p = 0.052) among the three endometrial preparation regimens. In this study, for the geriatric patient with the intramural myoma, the pretreatment with GnRH-a did not show any advantage over the NC and HRT preparation groups before the FET, and the LBR was not significantly increased.

An Observational Study of Treatment Outcomes of Uterine Myoma among Clients who had Undergone Invitro Fertilization at a Public Center in Addis Ababa, Ethiopia

Background: - For clients undergoing invitro-fertilization(IVF) there is no consensus regarding the management of non-cavity distorting Intramural myoma Objective: To assess the prevalence and treatment outcomes of IVF clients with uterine myoma. Methods: A 2-year (April 1 2019-April 1,2021) chart review was conducted for 1300 infertile women who had undergone IVF. Categorical data were summarized in proportion, and continuous data were summarized using mean, median, and standard deviation where appropriate. Bivariate logistic regression was conducted to assess the association between predictor variables and the outcome variable (clinical pregnancy). P-Value &lt; 0.05 was taken to be significant Results: Of the total 1,300 IVF clients, 282 (21.7%) cases were diagnosed to have myoma. Among the 13 cases of cavity distorting intramural myoma who underwent IVF without myomectomy, all were negative for clinical pregnancy, whereas among the 60 cases of cavity distorting myoma who had pre-IVF myomectomy followed by IVF, 16 (26.7%) were positive for clinical pregnancy. This difference was not statistically significant (P=0.160). Among 138 cases of non-cavity distorting Intramural Myoma who had undergone IVF without pre-IVF myomectomy, 38 (27.5%) had clinical pregnancy. In contrast, among 19 cases who had undergone pre-IVF myomectomy followed by IVF, only 2 (10.5%) had a clinical pregnancy. This difference was not statistically significant (P=0.160). Conclusion: While not statistically significant, conducting pre-IVF myomectomy for cavity distorting myomas improves clinical pregnancy, while pre-IVF Myomectomy does not improve clinical pregnancy for women with non-cavity distorting myoma. we recommend further research with a larger sample size

Use of High-Intensity Focused Ultrasound (HIFU) in Treating Uterine Fibroids: A Case Report

Summary Uterine fibroids are the most common benign uterine tumours in women of reproductive age. They can present with different symptoms, including menorrhagia, cramping lower abdominal pain, bloating, urinary/bowel symptoms, spotting, and infertility. Management could be medical and surgical. Other options include uterine artery embolization and non-invasive treatment with high-intensity focused ultrasound (HIFU). We present a case of a 32-year-old woman with menorrhagia and severe pelvic pain. Ultrasound examination revealed an intramural myoma measuring 93x98x87 mm. The patient signed informed consent for HIFU ablation of the fibroid. Three months after the procedure, an MRI scan showed the fibroid had shrunk to 75% of its original size with dimensions 32x35x29. After six months, she became pregnant and gave birth to a healthy infant at 38-weeks gestation with caesarean section, at which point the fibroid measured 2 cm. HIFU is an alternative to surgical therapies and is highly beneficial in women wishing for future pregnancies. Preserving the option for future pregnancies in patients with uterine fibroids is only one of its benefits and might be the key solution for these women. HIFU treatment of uterine fibroids is an innovative approach. It should be encouraged: it is widely adopted in similar cases where it has positively impacted the treatment of uterine fibroids.

Safety analysis of cesarean myomectomy in twin pregnancies with intramural myomas

Objective: To estimate the safety of myomectomy in twin pregnant women with intramural myomas during cesarean section. Methods: The clinical data of 145 cases of twin pregnancies with intramural myomas who were delivered by cesarean section in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from June 2013 to December 2021 were collected. Maternal demographics, fibroids' characteristics, maternal and fetal outcomes were compared between groups of cesarean section with myomectomy (myomectomy group, 49 cases) and cesarean section only (non-myomectomy group, 96 cases). Results: Compared with non-myomectomy group, myomectomy group had significantly prolonged operative time [50.0 minutes (37.5-57.5 minutes) vs 40.0 minutes (35.0-50.0 minutes), respectively; P=0.007] and significantly longer postoperative hospital stay [4.0 days (3.0-4.0 days) vs 3.0 days (3.0-4.0 days), respectively; P=0.047). Other maternal and fetal outcomes such as estimated blood loss, hemoglobin difference, postpartum hemorrhage, blood transfusion, B-Lynch structure, uterine artery ligation, postoperative fever and neonatal Apgar score showed no significant differences (all P>0.05). For intramural myomas <5 cm, there were no significant differences in maternal and fetal outcomes between myomectomy group and non-myomectomy group (all P>0.05). For intramural myomas ≥5 cm, operative time [55.0 minutes (40.0-60.0 minutes) vs 42.5 minutes (40.0-50.0 minutes), respectively; P=0.019] was significantly prolonged, postoperative hospital stay [4.0 days (4.0-5.0 days) vs 4.0 days (3.0-4.0 days), respectively; P=0.048] was significantly longer in myomectomy group than non-myomectomy group, but there were no significant differences in other maternal and fetal outcomes (all P>0.05). Conclusion: For twin pregnancies with intramural myomas, it is safe and feasible to remove intramural myomas during cesarean section by experienced obstetricians.

LBSUN288 Improved Glycemic Control Following Oophorectomy In A Post-menopausal Woman With Ovarian Hyperthecosis

Abstract Introduction While androgens are associated with decreased risk for type 2 diabetes in males, the opposite is seen in females. Despite this, a "chicken or the egg" argument exists regarding hyperandrogenism and insulin resistance in women. Ovarian hyperthecosis, a condition that mostly affects post-menopausal women, causes androgen excess due to hyperplasia of the theca interna of the ovaries. Akin to polycystic ovarian syndrome, it is associated with obesity and insulin resistance. We describe a case of ovarian hyperthecosis in a woman with type 2 diabetes with improved glycemic control following oophorectomy. Case A 63-year-old post-menopausal female with a history of autoimmune hepatitis, primary biliary cirrhosis, and chronic pancreatitis presented for recently diagnosed type 2 diabetes, discovered on routine point-of-care Hemoglobin A1c (HbA1c) testing in December 2020 (HbA1c 7.1%, weight: 86 kg). In January, she started repaglinide which was titrated to 2 mg with meals, also that month started prednisone for autoimmune hepatitis. Despite tapering doses of prednisone, her hyperglycemia paradoxically worsened and persisted following completion in June. In May, HbA1c was 7.8%. In August, she endorsed hirsutism, present for 2 years but worsening over the past few months. Labs showed elevated total testosterone (508 ng/dL), free testosterone (32.7 pg/mL), and androstenedione (305 ng/dL), with normal sex hormone binding globulin. DHEA-S was low (28.9 ug/dL, range: 29.4-220.5), midnight salivary cortisol was elevated (0.12 mcg/dL; range: &amp;lt;0. 09), and morning serum ACTH and cortisol were within normal range, with appropriate suppression to dexamethasone. Estradiol was above post-menopausal range (68.1 pg/mL; range: &amp;lt;6. 0-54.7). FSH and LH were within the post-menopausal range, with an approximate 1: 1 ratio. A pelvic ultrasound revealed two intramural myomas and a simple cyst of the right ovary, but otherwise unremarkable. She underwent bilateral salpingo-oophorectomy in October 2021. Post-surgical total testosterone was 27 ng/dL. Surgical pathology revealed unremarkable fallopian tubes and bilateral stromal hyperplasia and hyperthecosis of the ovaries. At one month follow-up, HbA1c was 6.5%, weight decreased from 89 kg pre-surgery to 86, and she endorsed improved hirsutism but frequent hypoglycemia on repaglinide 2 mg with meals. Repaglinide was decreased to 0.5 mg with meals. Three months later, HbA1c was 6.3% with unchanged weight. Conclusion Improved glycemic control, corresponding with timing of oophorectomy but not discontinuation of steroids, suggests insulin resistance in this case may be due to hyperandrogenism. Though some studies and case reports suggest hyperandrogenism causes insulin resistance, others suggest the contrary. The relationship between androgens and insulin sensitivity is likely complex, and further research is necessary. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

EFFECT OF NON-CAVITY–DISTORTING INTRAMURAL MYOMAS ON PREGNANCY OUTCOMES IN EUPLOID FROZEN EMBRYO TRANSFER CYCLES: A PROSPECTIVE STUDY

We sought to evaluate the impact of non-cavity–distorting intramural myomas on pregnancy outcomes in an ideal study group: patients undergoing frozen embryo transfer (FET) of a single euploid blastocyst.