Myomectomy over forties Karamustafaoğlu Balcı B, Yasa C, Dural O, Bastu E, Gungor Ugurlucan F, Topuz S, Orhan Sungur M, Özkan Seyhan T Istanbul University, Istanbul Faculty of Medicine, Department of Obstetrics and Gynecology

Introduction The surgical treatment of fibroids in women aged 40 years or more remains a challenge. Myomectomy is chosen in infertile women or in women who wish future fertility, however, the benefit remains debatable.

The aim of this study was to evaluate the fertility results of women who had myomectomy surgery in her forties for fertility preservation.

Material and Method - 1 Retrospective study, Istanbul University, Istanbul Faculty of Medicine, Study group; all women who had myomectomy surgery in her forties between January 2013 and April 2016.

Inclusion criteria were; Material and Method - 2 Inclusion criteria were; being 40-49 years old, having myomectomy surgery for any indication, having at least 1-year follow-up information for pregnancy status and accepting to participate to the study.

Material and Method -3 The data about age, gravidity, parity, medical and surgical history, information about the surgery and clinic follow-up in early postoperative days are distracted from medical records.

Material and Method - 4 Phone interviews are conducted. Verbal informed consent is obtained. The patients are asked whether they had any pregnancy after the myomectomy surgery and whether they experienced any other gynecologic problem that required surgery.

Results - 1 82 women. Mean age was 43.67 ± 5.06 (range 40-49). 60 women were nulliparous (73.17%). Mean parity of the parous women (n:22) was 1.64±1.1 (range 1–5).

Results - 2 13 patients - Hysteroscopy. 57 patients - Laparotomy, 11 patients - Laparoscopy. One patient was planned to have LS myomectomy but had necessitated a laparoconversion. 69 patients who had abdominal surgery for myomectomy are considered as women wishing to preserve childbearing capacity.

Results - 3 Mean of 1.71 ± 1.27 fibroids removed (range 1-9). 7 patients had uterus myomatosus . 22 units of packed Red Blood Cells and 13 units of fresh frozen plasma were transfused. 3 patients were taken to the ICU after surgery. Mean hospital stay was 2.63 ± 0.7 days postoperatively (range 1-30).

Results - 4 Follow-up period ranged from 12 months to 54 months (mean 26.47 ± 10). 69 patients were wishing to preserve childbearing capacity. Data of 61 of 69 patients (88.41%) 13 single, 2/48 spontaneous pregnancy abortion 7 – IVF cycles – 14 cycle 1 pregnancy abortion

Results – 5 69 patients were wishing to preserve childbearing capacity. 5 required another gynecologic surgery. hysteroscopic endometrial polyp removal (n:1) abdominal hysterectomy for cervical cancer stage 1B1 (n:1) laparoscopic hysterectomy for abnormal uterine bleeding, breast cancer and myoma uteri (n:3)

Conclusion The treatment of fibroids in women who desire future fertility is myomectomy but once a woman reaches the age of 35, her fertility begins to decline and the success rates of IVF treatment for women over 40 using their own oocytes are low. All the data should be discussed with the patient who will have an abdominal surgery for uterine myoma.

Low dose of gonadotropin with letrozole versus high dose of gonadotropin in patients with poor ovarian response undergoing IVF: a randomised, single-blind, prospective trial Harika Yumru, Burcin Karamustafaoglu Balci, Cenk Yasa, Ozlem Dural, Ercan Bastu, Faruk Buyru Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey

Randomised prospective trial, Poor responders, Antagonist protocol, 33 patients - 150 IU gonadotropins + letrozole 5 mg /day D3-D8. 27 patients - 300 IU gonadotropins alone. Clinical and ongoing pregnancy rates (all p>0.05). Gonadotropin use higher in 300 IU gonadotropins alone group.

Using letrozole with low doses of gonadotropins in patients with POR does not improve the pregnancy outcomes compared to high doses of gonadotropins alone. However, the addition of letrozole yields comparable pregnancy outcomes with significantly low doses of gonadotropins, so may be regarded as an effective adjuvant agent in POR patients.