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The most common reason for in vitro fertilization (IVF) cycle cancelation is a lack of quality gametes available for intracytoplasmic sperm injection (ICSI). Here we present the successful fertility treatment of the couple affected by obstructive azoospermia combined with suboptimal response to controlled ovarian stimulation. Since the conventional approach appeared ineffective to overcome both partnersˈ specific problems, the targeted interventions, namely, (1) pharmacological enhancement of sperm motility and (2) polarized light microscopy (PLM)-guided optimization of ICSI time, were applied to rescue the cycle with only immature oocytes and immotile testicular sperm retrieved. The treatment with theophylline aided the selection of viable spermatozoa derived from cryopreserved testicular tissue. When the traditional stimulation protocol failed to produce mature eggs, non-invasive spindle imaging was employed to adjust the sperm injection time to the maturational stage of oocytes extruding a polar body in vitro. The fertilization of 12 late-maturing oocytes yielded 5 zygotes, which all developed into blastocysts. One embryo was transferred into the uterus on day 5 post-fertilization, and another 3 good quality blastocysts were vitrified for later use. The pregnancy resulted in a full-term delivery of a healthy child. This case demonstrates that the individualization beyond the standard IVF protocols should be considered to maximize the chance of poor-prognosis patients to achieve pregnancy with their own gametes.

Background: Aim of this study was to assess the accuracy of transvaginal sonography (TVS) associated to Color or Power Doppler (CFD/PD) for the evaluation of size and spread of disease in cervical cancer as diagnostic tool in the preoperative evaluation. Method : All patients (pts) affected by cervical cancer were studied by TVS and CFD/PD. TVS probe was used also as a transrectal when deemed necessary. Tumor size was measured consecutively by gray scale sonography and using CFD/PD. Extension of the tumor to the parametria; to the corpus uteri, to the ovary, the bladder and the rectum was also evaluated. TVS findings were compared to gynecologic examination under anesthesia, MRI and laparoscopy and pathological specimen. Results: 20 cases were studied. 45% of pts had neoadjuvant chemotherapy. Tumor diameter measured by ultrasound correlated well with pathological specimen (r 0.82). Accuracy of the measurement was increased when tumor diameter was . 4 cm. TVS correctly diagnose the extension of disease to the bladder and to the corpus uteri in 90% of cases. Involvement of the parametria was supected by sonography in 45% of cases. Conclusions: TVS seems to be an accurate means of evaluation for tumor size and extension to adjacent organs, therefore TVS could be useful in the perioperative management of cervical cancer. F02Sonographic preoperative assessment of myometrial invasion in endometrial cancer C. Exacousto Á s, M. E. Romanini*, D. Rinaldo, C. Carusotti, D. Arduini, P. Benedetti-Panici* and C. Romanini Department of Obstet. and Gynecol., University of Tor Vergata, Rome, Italy; *Department of Gynecol., Campus Biomedico University, Rome, Italy Background: The purpose of this study was to assess the accuracy of transvaginal sonography (TVS) and Color/Power Doppler (CFD/PD) in evaluating the depth of myometrial invasion and preoperative staging of endometrial cancer. Method: All patients (pts) with histological confirmed endometrial cancer were evaluated sonographically before surgery. In all patients the endometrium was scanned by TVS to evaluate thickness, echogenicity, border, intraluminal fluid and intracavitary masses. CFD/PD were used to evaluate vessels distribution and resistance indices: Myometrial infiltration was evaluated more or less than 50%. Sonographic results were compared to histological staging obtained after surgery. Results: 53 patients were enrolled. All had endometrial thickness . 5 mm, mean thickness 19.5^10.5 mm. Myometrial invasion was , 50% in 35 pts, TVS evaluation was exact in 33 cases, with a sensitivity of 94% and a positive predictive value (PPV) of 94%. An infiltration . 50% was seen with TVS in 12 pts and was histologically confirmed in 11, with a sensitivity of 82% and PPV of 75%. Other 3 pts had a cervical infiltration, 3 had stage 3, one had stage 4. TVS evaluated correctly 48 patients with a sensitivity of 91%. Conclusions: TVS seems to be a valuable, noninvasive and unexpensive diagnostic method for the assessment of myometrial invasion. Background: The aim of this study w...

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Background: The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy. Method: A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied.Results: An increasing trend with advancing gestation was evident for the mean gestational sac (MSD) and amniotic sac (AS) diameters, trophoblastic rim, CRL and serum progesterone. The uterine, umbilical and fetal cerebral arteries PI decreased with advancing gestation. The FM yolk sac (YS) diameter and b-hCG levels showed an initial rise and a final decrease. A great interindividual variation was evident for the b-hCG titer. The YS/CRL progressively approached to 0, whereas the MSD/CRL and the AS/MSD progressively approached to 1. The corpus luteum diameter, corpus luteum arteries PI, subehorionic arteries PI, complement levels (C3 and C4), platelet count and activated partial thromboplastin time experienced minimal changes. Conclusion: First trimester normograms for multiple clinical parameters are provided. P02The first results of the ultrasound transvaginal screening in early pregnancies in Kazan city, Tatarstan, Russia In 1 January 2000 in order of Tatarstan Health Care Ministry transvaginal first trimester screening was introduced in Kazan city. All pregnant women have to be examined in one of 5 the medical centers.We present the results of six month screening for all pregnant women between 10 and 14 weeks gestation. Method: Routine transvaginal ultrasound examination included the measurement of fetal crown-rump length, nuchal translucency and estimation of fetal anatomy. Results: A total 1620 pregnant women of 10±14 weeks of gestation were examined from January till June 2000. All abnormalities were detected at the 12±13 weeks gestational ages. The increasing of nuchal translucency thickness were found in 23 cases, 7 of them chromosomal defects had, in this group in 5 cases cystic hygroma with hydrops were identified.In 12 cases structural anomalies were found: 1-body stalk anomaly, 1 case-omphalocele with liver in it, 1-holoprosencephaly with proboshisis and microphtalmia, 1-encephalocele, 3-acrania, 5-anencephaly. In the cases of holoprosencephaly and encephalocele nuchal translucency measured at 10±11 week was normal. Conclusion: Even the first results of early pregnancy transvaginal screening show its great significance in our city. The most adequate period for transvaginal screening is 12±13 weeks. P03The value of ultrasound screening for fetal abnormalities in the first trimester Objective: Evaluation of routine screening in the early pregnancy by transvaginal sonography (TVS) in an unselected population. Design and methods: A routine ultrasound examination was offered to ...