Day 1 :
Keynote Forum
Ioannis G. Papanikolaou
Humanitas University Hospital, Italy
Keynote: Improving treatment options and quality of life in breast cancer survivors: International data from fertility preserving options in breast cancer survivors and conservative interventions
Time : 10:00-11:00
Biography:
Papanikolaou is born in Athens in 1985. In 2009 he takes the Medical Degree (MD) with Excellent votation. Afterward, he is selected to participate in the 2 years Postgraduate Programme in Robotic Surgery, Minimally Invasive Surgery and Telesurgery, in the University of Athens, Medical School in Greece. The European Journal of Obstetrics, Gynecology and Reproductive Biology. He has been selected with the top votation in European Fellowship in Reproductive Medicine (EFRM) of Humanitas Fertility Center in Humanitas University, Milan, Italy
Abstract:
Breast cancer is the most frequent cancer among women. The emphasis on fertility preservation, quality of life and breast-cosmesis related issues have challenged in the last years the Subspecialty of Reproductive Endocrinology and Assisted Reproduction, as well as breast cancer surgery. Fertility preservation before gonadotoxic treatments has motivated scientific community to introduce fertility counselling in breast cancer treatment options. The need for breast conserving surgery, as well as the effort to obtain better cosmesis after surgery has leaded breast surgeons to develop oncoplastic breast conserving surgery. Oncoplastic techniques combine oncologic surgery with plastic surgery techniques. Main objective remains oncologic safety. Established goals of OPS are to broaden indications of breast conservation towards larger tumors by improving aesthetic outcomes. There is a growing demand to standardize various aspects of OPS for implementation into clinical practice. Current evidence on OPS is based on poorly designed and underpowered studies. Research efforts should focus on Level I evidence assessing oncological and aesthetic outcomes of OPS and obtained survival rates. Fertility preservation has to be offered in all young breast cancer patients. Ovarian stimulation protocols vary according to the ER status and the disease stage and biological
behavior. Treatment options have to be personalized and selected case by case
Keynote Forum
Gesine Kuespert Hearn
Idaho State University, USA
Keynote: No time, no money, no luck: Barriers to prenatal care among dalit women in rural Nepal
Time : 11:00- 12:00
Biography:
Gesine K Hearn is an Associate Professor in Sociology and the Chair of the Department of Sociology, Social Work and Criminal Justice at Idaho State University.
She received her Ph.D. in 2006 from the University Erlangen-Nuernberg, Germany. Her research interests include social determinants of health, lay and expert perceptions of health and disease, medical uncertainty, and patient self-help organizations. Her current research explores father involvement among NICU infants and socio-cultural factors in the experience and management of chronic pain and injury among athletes. She has published in the areas of medicine, health and illness, gender, and family sociology.
Abstract:
Statement of the Problem: The World Health Organization (WHO) reports that around the world, about 830 women die daily because of complications during pregnancy and childbirth. Those deaths are preventable and according to the WHO, adequate prenatal care can reduce maternal deaths. Most maternal deaths occur in developing countries, especially in rural areas. In Nepal, a large gap exists between non-dalit and dalit women in regard to maternal mortality and prenatal care. Especially rural dalits are far behind non-dalits in utilizing prenatal care. The purpose of this study was to explore rural dalit women’s prenatal practices and barriers to accessing prenatal care.
Methodology & Theoretical Orientation: This is an exploratory study of prenatal care among dalit women in rural Nepal. We interviewed eleven dalit women per phone using a semi-structured interview schedule.
Findings: Interviews revealed that lack of cultural and economic capital, unequal domestic and economic burden, and gender and caste discrimination impact the use of prenatal care. The participants carry the economic and domestic responsibilities for their families. Since the participants’ work is not paid or underpaid, it is hard for them to provide adequately for their families. The financial and domestic burden is impacting women’s health. They do not
get enough rest and food and do not have time or money to see a doctor or healer.
Conclusion & Significance: The lack of cultural and economic capital among dalit women not only explains their poverty but their lack of prenatal care. Therefore, one way or the other, the lack of prenatal care among rural dalit women is due to poverty which creates significant barriers to accessing prenatal care services. The use of prenatal care might be improved by informing women about free services and incentives, better access and transportation,
and heightened sensitivity to the situation of these women
Keynote Forum
Ioannis G. Papanikolaou
Humanitas University, Italy
Keynote: Lessons gained by training surgical skills in gynecologic endoscopy outside the operating theater by using simulators: International data
Time : 12:20-13:20
Biography:
Papanikolaou is born in Athens in 1985. In 2009 he takes the Medical Degree (MD) with Excellent votation. Afterward, he is selected to participate in the 2 years Postgraduate Programme in Robotic Surgery, Minimally Invasive Surgery and Telesurgery, in the University of Athens, Medical School in Greece. The European Journal of Obstetrics, Gynecology and Reproductive Biology. He has been selected with the top votation in European Fellowship in Reproductive Medicine (EFRM) of Humanitas Fertility Center in Humanitas University, Milan, Italy.
Abstract:
The traditional method of acquiring surgical skills by observing and assisting in surgical procedures involving
human beings has been challenged during the past several years. Lessons obtained from aviation suggested that
the use of simulators is related to reduced costs, increased efficiency in performing certain tasks and above all safety.
A shift in paradigm is also required in modern surgical training. The development of endoscopic surgery allowed for
the incorporation of medical simulators into training programmes. Surgical training with box trainers and/or virtual
reality simulators confers a significant benefit in terms of surgical skills development, increases patient safety and reduces costs. Nevertheless, the use of virtual reality simulators was significantly more expensive. Simulation training allows trainees to learn from their mistakes, to repeat surgical tasks multiple times so as to establish muscle memory, and enhance skill competency with the aid of informative feedback. Simulators are necessary for the development of the skills required to meet the specific needs of endoscopic surgery in the 21st century. Teaching hospitals should introduce simulation training programmes in order to increase efficiency, reduce costs and improve patient safety.
As medical advancements continue to transform the way we perform surgery day by day, simulation training will play a pivotal role in Gynecologic Endoscopy and every surgical specialty
- Women Health & Nursing | Abortion & Complications | Infertility
Location: Berlin-12 classroom
Chair
Ioannis G Papanikolaou
Humanitas University Hospital, Italy
Session Introduction
Maria Kathrina S B Timbol
Far Eastern University, Philippines
Title: A randomized controlled clinical trial on comparing the efficacy of soy Isoflavones and evening primrose oil in improving the symptoms of menopausal filipino women seen at the outpatient departm ent of a tertiary medical center in Quezon City
Biography:
Maria Kathrina S.B. Timbol has recently finished her residency training in Obstetrics and Gynecology. Her fondness in the field of Reproductive Medicine and
the climacteric clientele were her greatest influence in proceeding with a trial concerning one of the least tackled issues in the said field that is menopause
and its symptomatology. Born and raised in a third world country, the author sought to find efficacious alternative and natural treatments to contribute for the
improvement in the quality of life of menopausal women.
Abstract:
Background: Menopausal Hormonal Therapy (MHT) remains the treatment of choice in relieving menopausal symptoms. However, some women are at risk to developing serious effects with its use. Current alternatives to relieve menopausal symptoms include Soy Isoflavones and Evening Primrose Oil (EPO). But the available studies conducted to evaluate their efficacy remains insufficient.
Objective: To compare the efficacy of Soy Isoflavones and EPO in Improving the Symptoms of Menopausal Filipino women seen at the Outpatient Department of a Tertiary Medical Center in Quezon City.
Methodology: This is an Open-Label Randomized Controlled Clinical Trial involving 180 naturally menopause women randomized into two groups. There were 91 women who received 60mg isoflavones and 89 who took EPO 1,000mg per day for 6 months. Symptomatology was assessed using the Menopause Rating Scale (MRS) at baseline, first, third and six months of treatment.
Results: The mean age of the participants is 48 years old with a mean gravidity and parity of 2 and average of 1 to 4 years of menopause. However, after 3 months of treatment, the isoflavone group showed a significantly lower MRS score for the somatic symptoms as compared to those in the EPO group (7.0 versus 8.0, p= 0.03). The MRS score for somatic remained significantly lower for those who took isoflavones as compared EPO up to the 6th month of
treatment (6.89 versus 7.92; p=0.02). In the same period, a significantly lower score for the urogenital symptoms was also observed among women in the isoflavones arm (6.73 versus 7.60; p= 0.01). But when categorized according to
severity of symptoms, there was no significant difference in the proportion of participants distributed per category between the 2 treatment arms.
Conclusion: Soy isoflavones at 60mg per day was found to be more effective than EPO in improving somatic and urogenital symptoms.
Abi Santhosh Aprem
HLL lifecare Ltd, India.
Title: Reducing post-insertion side effects of Copper T 380A through controlled copper ion release
Time : 14:30-15:00
Biography:
Abi has completed his PhD at the age of 30 years from Mahatma Gandhi University in Polymer Chemistry. He is currently Deputy Vice President (R&D) of HLLLifecare Ltd, a premier healthcare company. He has published more than 26 papers in peer reviewed international journals and holds two international patents.
The present work is a part of the project which received the Bill and Melinda Gates Foundation (BMGF) grant challenge award worth 1 million USD ( Global
Development Grant Number OPP1067901)
Abstract:
Copper Intra uterine devices represent an important contraceptive option for nearly 160 million women worldwide. The main attraction of copper Intra Uterine Device (IUD) is that it is comparatively less expensive and highly effective (99%) over other long term methods of contraception. Major side effect related to a copper bearing IUD is increased menstrual bleeding, cramping and abdominal pain. Rates of removal of copper IUD because of bleeding and pain ranges from 1 to 17 per 100 women. Research results showed that this is due to the high corrosive rate of copper during the first few months of insertion. The present study reports the modification of an existing Intra Uterine Device (IUD) with a FDA approved polymer, poly lactic acid and poly(lactic/glycolic) acid (PLGA) to control the release of active ingredient. The side effects associated with the uncontrolled release of the active ingredient is controlled effectively by providing a safe coating of PLGA over the device which in turn increase the world wide acceptance of the device. A Phase-II, multicenter, randomized, single-blind, parallel-arm, pilot scale trial was conducted in 200 women over a period of 12 months across 10 sites in India to detect the clinical performance of coated Copper T (CCT) versus conventional Copper T(OCT) for initial bleeding and pain, post insertion of IUD. This was done using a standardized PBAC scoring system on the PBAC chart. CCT has shown promising result in our study and reduced the menstrual blood loss significantly. The study validates our hypothesis that modulation of copper release from a copper IUD using a biodegradable membrane can decrease the side effects of CCT like increased menstrual bleeding without contraceptive efficacy
Ioannis G. Papanikolaou
Humanitas University, Italy
Title: First 20 Years of Stem Cells: next generation of Reproductive and Regenerative Medicine
Time : 17:00-17:30
Biography:
Papanikolaou is born in Athens in 1985. In 2009 he takes the Medical Degree (MD) with Excellent votation. Afterward, he is selected to participate in the 2 years Postgraduate Programme in Robotic Surgery, Minimally Invasive Surgery and Telesurgery, in the University of Athens, Medical School in Greece. The European Journal of Obstetrics, Gynecology and Reproductive Biology. He has been selected with the top votation in European Fellowship in Reproductive Medicine (EFRM) of Humanitas Fertility Center in Humanitas University, Milan, Italy
Abstract:
As the topic of my Keynote Lecture suggests, I will focus on obtained outcomes from the first 20 Years of Stem Cells. It is well consolidated in recent years that research in stem cells and Regenerative Medicine is growing in scope. Translation to the clinic is heralded by the recent initiation of clinical trials with pluripotent derived cells. Unfortunately, stem cell ‘treatments’ till nowadays are currently offered to patients outside of the controlled framework of scientifically sound research and regulated clinical trials. Current evidence suggests that both physicians and patients in reproductive medicine are often unsure about stem cells therapeutic options. Stem cells are the key element for regenerative medicine. Stem cells are undifferentiated cells that often serve as a reservoir of cells to regenerate tissue in settings or injury or cell loss. Today, several studies have proved that the endometrium has progenitor stem cells that can replace all of the endometrium during each menstrual cycle. In addition, multipotent endometrial cells replace these progenitor cells when depleted. Recruitment of stem cells from outside of the uterus occurs in setting of increased demand such as ischemia or injury. Bone marrow-derived multipotent stem cells are recruited to the uterus by estrogen or injury-induced expression of the chemokine CXCL12. In the setting of overwhelming injury, especially in the setting of low estrogen levels, there may be insufficient stem cell recruitment to adequately repair the uterus resulting in conditions such as Asherman syndrome or other endometrial defects. In contrast, excessive recruitment of stem cells underlies endometriosis. Enhanced understanding of stem-cell mobilization, recruitment, and engraftment has created the possibility of improved therapy for endometrial defects and endometriosis through enhanced manipulation of stem-cell trafficking. Further, the normal endometrium is a rich source of multipotent stem cells that can be used for numerous applications in regenerative medicine beyond reproduction. A better understanding of reproductive stem-cell biology may allow improved treatment of endometrial disease such as Asherman syndrome and other endometrial receptivity defects. Inhibiting stem-cell mobilization may also be helpful in endometriosis therapy. In recent years, there is increasing evidence to suggest that endometrial derived multipotent stem cells may play a crucial role in cell therapy for regenerative medicine.
Estilla Maurer-Major
Female Health Clinic, Zurich
Title: Woman´s infertility: Recent results, new insights and perspectives
Time : 17:30-18:00
Biography:
Maurer-Major, MD, graduated at the University of Zurich 1985. After spending 6 years on widespread clinical gynecological and obstetric experience she started her work in the Unit of Gynecologic Endocrinology and Reproductive Medicine 1992. Since 2000 she runs a private fertility clinic in Zurich, although she kept at the same time collaboration with the University Clinic of Zurich, being author of numerous presentations as specialist for reproductive endocrinology.
Abstract:
After having ICSI routine for more than 20 years, recent focuses on female infertility have been the improvement of pregnancy rates in IVF and ICSI cycles, methods for fertility preservation in patients with cancer and fertility preservation in younger females in career jobs planning late motherhood. Treatment by preimplantation genetic testing and their benefit for pregnancy rate and for fetus integrity as well as genetic engineering with CRISPR-Cas9 are hot topics in discussion leading to new questions in medical and ethical fields. This lecture’s goal is to talk about the last data and remaining controversies including the last ESHRE and ASRM congress insights.
Najib Dagher
Clinica Tambre, Spain
Title: Determination of Anti-Mullerian Hormone (AMH) in fresh and frozen serum
Biography:
Najib Dagher started his medical studies in Bordeaux – France and obtained his MD degree from Odessa State Medical University where he also completed his residency in Obstetrics and Gynecology as well as REPRODUCTIVE ENDOCRINOLOGY - HUMAN REPRODUCTION - Infertility & IVF in 2006.
He obtained in July 2018 a University Diploma in “Infertility, Assisted Reproduction Technology (ART) & Endocrinology of the reproduction at Foch hospital IVF Center by the University of “Versailles Saint Quentin en Yvelines” in Paris – France for the year 2017 – 2018.
He is now a Gynecologist and fertility specialist at "Clinica Tambre" in Madrid, Spain, as well as at “IVF Lebanon” in Beirut - Lebanon
Abstract:
What is known already
Nowadays, AMH seems to be one of the most frequently used predictors of the ovarian response to ovarian stimulation and, in some cases, of the pregnancy rate. On the other hand, the low concentration of AMH is associated with an increased risk of embryonic aneuploidy in elderly women. Since the clinical importance of AMH continues to grow, different assays have been rapidly developed for its determination like the Elecsys AMH, which has been developed as automated testing systems by Roche Diagnostics. There are studies that observed a very small decrease in the AMH value in the frozen-thawed samples and is probably not clinically important. According to other studies the value of AMH increases in frozen samples.
Study design, size, duration
A total number of 43 patients were included in the study. Fresh and frozen serum (at -20ºC) from every women was used to determine AMH concentration. The study lasted from March to August 2018.
Participants/materials, setting, methods
The determination of AMH (ng/ml) will be performed on serum samples (n=43) from women obtained by centrifugation of the blood extracted at 3500 rpm for 5 minutes. For each sample AMH will be measured in fresh serum (Group 1) and frozen at -20 °C(Group 2) for one week. The apparatus that will determine these concentrations will be the cobas e411 analyzer that automates the immunoassay reactions by electrochemiluminescence (ECL). Results are expressed as mean ±SEM. Statistical analysis was performed using GraphPad Prism 5. One sample t-test was used to compare AMH in fresh versus frozen serum. A value of p<0.05 was considered statistically significant.
Mains results and the role of chance
There are no significant differences (P value= 0.9525) between AMH values in frozen (1.844 ± 0.3088) and fresh serum samples (1.871 ± 0.3132). The means were compared by one sample t-test.Regardless of the type of storage, serum AMH concentration values are reliable.
Limitations, reasons for caution
The main limitation of our study is the small number of participants. The results observed in this study should be further confirmed with a larger sample number and with different automated analyzers in order to verify if the AMH concentration change depends also on the type of immunoassay analyzer.
Wider implications of the findings
If we find the optimal and best way to determine the concentration of AMH in women's serum, without variations due to the type of sample or storage, the serum concentration of AMH could represent a useful tool to predict the outcome of an assisted reproduction treatment.
Stuti Dang
University of Miami Miller School of Medicine, USA
Title: Impact of a patient education intervention using patient portals on menopause knowledge and shared decision making
Biography:
Stuti Dang is an experienced geriatrician and researcher, and the Associate Director for Implementation and Outcomes Research in the Geriatrics Research Education and Clinical Center (GRECC) at the Miami VA Healthcare System. She has been a PI or co-investigator on multiple projects funded by the VA, NIH, and DOD for implementing care models that leverage technology for patients with complex chronic conditions and their caregivers. She has extensive expertise in care coordination and telehealth interventions for chronic disease management in the elderly. She seeks to understand the needs and need gaps of frail, older, high-need high-risk veterans and their caregivers to allow aging in place. Her funded technology projects strive to establish usability and utility of various technologies including home telehealth, video, mobile, and web-interventions, in different settings. Her projects are designed with the intent to empower patients and their caregivers to become informed partners in their health care
Abstract:
Background: Menopause can be a time of changes, women need information regarding menopause and management of associated symptoms such as hot flashes, mood instability and vaginal dryness. Although there are ways to alleviate these symptoms, many women, due to their limited knowledge related to menopause, are not aware of these treatment options nor able to determine which options would be best for them.
Methods: We developed at the Miami VA healthcare system, a project called the “My HealtheVet to Enable And Negotiate for Shared decision making” or MEANS project, an unblinded non-randomized pilot project, to deliver an educational intervention program surrounding the management of menopause. The project enrolled 269 female veterans of perimenopausal and menopausal age (45 to 60 years) at Miami VA Healthcare System. The sixmonth intervention provided educational resources on menopause and shared decision making (SDM) through the MyHealtheVet electronic portal system to women in the Miami VAHS only. Following the intervention, data regarding patient knowledge and use of the MyHealtheVet portal was collected. Besides a pre-post comparison in the intervention group, we also compared the impact of the MEANS intervention on patients at the Miami VAHS to women veterans of the same age who did not receive this intervention.
Results: At the initiation and conclusion of the study, participants completed a test assessing their knowledge of menopause. This test was scored out of 18 points, with a higher score indicating a higher level of knowledge. Score increased from 14.7+/-2.4 before the intervention to 15.8+/-1.8 after the intervention. In addition, the MEANS project increased understanding of SDM and increased use of the MyHealtheVet portal among participants.
Conclusions: These findings are promising and suggest that an educational intervention could be effective in increasing women veterans’ access to treatment for the symptoms of menopause encourage the use of this dye for
quantifying biogenic amines. Therefore, all figures of merit were calculated and the method developed was validated for the quantitative analysis of biogenic amines in different matrices.
Biography:
Christos Tsitlakidis has graduated from Hellenic Aristotle University School of Medicine. He is a Consultant Obstetrician and Gynaecologist in Pinderfields
Hospital, MidYorkshire NHS Trust, ,United Kingdom. He has published more than 6 papers in reputed journals in UK and abroad and has been member of the
RCOG.
Abstract:
Introduction: Caesarean carries the legacy of an Emperor. It is the procedure that more than any other complicated by bleeding and infection. The impacted fetus is potentially lethal. Modifying the procedure in several areas came
out of necessity to respond to new challenges that appear over last decades.
Principles: Minimise the need for assistance. Create a clean and dry procedure. Eliminate the bleeding. Operate in a controlled and calmed environment. Try and achieve natural birth simulation. Involve parents. Eradicate risk of
post natal infection
Methods: Retraction of the panniculus. Large intrabdominal packs. The Stay stitches. A dry and clean procedure. The impacted foetus. The Kiwi cup. The use of tocolysis. Natural birth simulation. Parental perception. Inspection
of incicion and repair of lower segment. Broad ligament hematomas. Compresing the uterus. Eradicate surgical site infections.
Results: We tried those modifications over 800 emergency and elective caesarean section carried out in two units in UK, over last 8 years, with excellent results
Conclusion: Caesarean still remains a ferocious procedure that can claim lives. Should we do not recognize the challenges from a changing world, the furies could become the Nemesis of our practise. It is time now to move on to Modern Obstetrics
Ioannis G. Papanikolaou
Humanitas University, Italy
Title: Robotic surgery: Is it better for reproductive surgery and gynecological oncology?
Biography:
Papanikolaou is born in Athens in 1985. In 2009 he takes the Medical Degree (MD) with Excellent votation. Afterward, he is selected to participate in the 2 years Postgraduate Programme in Robotic Surgery, Minimally Invasive Surgery and Telesurgery, in the University of Athens, Medical School in Greece. The European Journal of Obstetrics, Gynecology and Reproductive Biology. He has been selected with the top votation in European Fellowship in Reproductive Medicine (EFRM) of Humanitas Fertility Center in Humanitas University, Milan, Italy.
Abstract:
In recent years, surgical practice has been changed since the introduction of minimally invasive surgery. Laparoscopic and robotic surgery have significant advantages compared with laparotomy. Robotic technology has helped surgeons overcome many technical difficulties of conventional laparoscopic surgery. Robotics are feasible in the treatment of benign gynecologic conditions including endometriosis and uterine fibromatosis. Feasibility
is also proven for endometrial cancer along with a short learning curve. Evidence suggests longer operative times compared to laparotomy, but similar or shorter than laparoscopy. Robot dogging time increases the global length of
the procedure, but it decreases with experience. The overall morbidity rate seems lower than with other approaches. Hospital stay, postoperative pain and time to recovery are decreased when compared to laparotomy as well as to
laparoscopy for some authors. Robotics may offer significant advantages in the treatment of morbidly obese patients who represent the vast majority of endometrial cancer patients. Furthermore, robotics are a real challenge in the
treatment of pelvic endometriosis in which, surgery by laparoscopy often becomes extremely demanding and time consuming. Robotic techniques have benefits over traditional open surgery for management of endometrial cancer,
especially in the group of obese patients for whom laparoscopy presents significant limitations. The main limit for the diffusion of robotic surgery is accessibility because of its important cost, although the new systems including Da Vinci Xi are much more beneficial for a more anatomic and accurate surgery, essential in reproductive surgery and oncology