scientific program • symposia - American Society for Reproductive ...

V-7 12:15 PM
WHAT DO PATIENTS THINK ABOUT FERTILITY PRESERVATION?
S. J. Silber. Infertility Center of St. Louiss, St. Luke’s Hospital, St.
Louis, MO.
OBJECTIVE: To gain the perspective of women about
whether to freeze ovarian tissue if they are about to
undergo sterilizing cancer treatment, or for women who are
concerned about their biological clock.
DESIGN: We have interviewed a series of women to get
the patient’s perspective on the controversy of whether to
freeze ovarian tissue in women of reproductive age who are
about to undergo otherwise sterilizing cancer treatment, or
even women who are just concerned about the passage of
time and the ticking of their biological clock.
MATERIALS AND METHODS: The patients, if informed, virtually
all wished to do this, but their oncologists were virtually
all either against or agreed grudgingly. Many now sterile
women regretted being rushed into cancer therapy before
having an ovary frozen and safely stored for the future. The
majority of women, even non-cancer patients, preferred
ovary freezing as a single procedure to multiple cycles of
ovarian stimulation and egg retrieval.
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ART, UROLOGY AND PATIENT EDUCATION
Moderators: TBD
V-8 12:33 PM
MICROSCOPIC SUBINGUINAL VARICOCELECTOMY: THE
EXCLUSION TECHNIQUE.
E. Y. Ko, K. C. Baker, E. S. Sabanegh. Center for Male Fertility,
Cleveland Clinic, Cleveland, OH.
OBJECTIVE: To demonstrate a simple exclusion technique to
isolate and protect vital cord structures (i.e. vas deferens,
arteries, lymphatic channels) from dilated veins during
microscopic subinguinal varicocelectomy.
DESIGN: In this video, salient surgical techniques of the
exclusion modification to the microsurgical subinguinal
varicocelectomy are described.
The surgical incision is made just below the external ring. A
drain is passed behind the spermatic cord after mobilization.
The excess drain is trimmed leaving an arrowhead
configuration on the ends. This allows for easy drain passage
through the cord structures for exclusion. A micro-handheld
doppler unit is used to differentiate between arterial and
venous flow. Progressive dissection allows for exclusion
of non-venous structures, which are protected via drain
manipulation. The active dissection continues anterior to the
drain. At the end of the procedure, there should be minimal
tissue anterior to the drain, with all vital structures excluded
posterior to the drain. The drain is then removed and the
spermatic cord replaced back into its normal anatomic
position.
Since July 2006, we have performed 163 procedures in
a single surgeon series. There have been no hydroceles
or injuries to the vas deferens or arteries requiring surgical
repair.
MATERIALS AND METHODS: The exclusion technique is a
simple and unique method for excluding the vas deferens,
arteries, and lymphatics away from the site of active
dissection and protecting them inadvertent injury.
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VIDEO PROGRAM
97
V-9 12:40 PM
URINARY CATHETERIZATION IN A PATIENT WITH FEMALE
GENITAL MUTILATION.
A. Rouzi, N. Sahly. Obstetrics And Gynecology, King
Abdulaziz University Hospital, Jeddah, Western, Saudi Arabia.
OBJECTIVE: This Video illustrates how urinary catheterization
is carried out in a severely mutilated woman.
DESIGN: After placing the patient in supine or lithotomy
position; we expose the genital area. A lubricated Sims
Speculum was inserted underneath the circumcised area
then lifted in an upward direction thus exposing the Urethra.
The urinary catheter was then inserted into the urethra under
direct vision and fixated.
MATERIALS AND METHODS: In The West due to lack of
familiarity with Female Genital Mutilation, Pre-pregnancy
and Antenatal deinfibulation is recommended because of
the inability to perform maternal examination, inadequate
monitoring of labor by Internal means, and inability to do
urinary catheterization.
However, in countries where Female Genital Mutilation is
common, Urinary catheterization is being done by all health
care providers including midwives.
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V-10 12:43 PM
MULTIPHOTON MICROSCOPY: A POTENTIAL TOOL TO GUIDE
MICRODISSECTION TESTICULAR SPERM EXTRACTION.
R. Ramasamy1, J. Sterling2, E. S. Fisher1, S. Mukherjee2,
P. Li1, P. N. Schlegel1. 1Department of Urology, Weill
Cornell Medical College, New York, NY; 2Department of
Biochemistry, Weill Cornell Medical College, New York, NY.
OBJECTIVE: Microdissection testicular sperm extraction
(TESE) has replaced conventional testis biopsies for men
with non-obstructive azoospermia and has become first
line of treatment. The current problem is that, the decision
to retrieve tubules is solely based on appearance and
there is no guarantee that the tubules removed contain
sperm. Multiphoton microscopy (MPM) user a laser and
enables label-free, immediate visualization of many biologic
processes in live tissue at subcellular resolution.
DESIGN: A busulfan Sertoli-cell only model was used to study
different testicular histopathologies with MPM. In order to
assess the risk of photodamage, sperm DNA fragmentation
in testis biopsies imaged at different laser intensities was
assessed using TUNEL assay.
MATERIALS AND METHODS: MPM can identify the presence of
spermatogenesis within a seminiferous tubule in fresh tissue
without use of exogenous labels. Using a DNA fragmentation
assay, we assessed that sperm from tubules imaged with
MPM had minimal DNA fragmentation at laser intensities
needed to distinguish tubules with and without sperm. MPM
thus has the potential to facilitate real-time visualization of
spermatogenesis in humans, and aid in clinical applications
such as testicular sperm extraction for men with infertility.
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