Table 1. The largest myoma removed in this series was 15 cm. An average of 2.

6
Histology myomas per patient was removed, with the majority being intramural. The
average blood loss was 123.1 mL, with the range of 30–250 mL. The average
Positive Negative operative time was 69 minutes with a range of 38–118 minutes. The average
hospital stay was 28 hours, with 79% of the patients being discharged on the
Volume (cm3) R0.5 35 3 first postoperative day. Patients returned to normal activity within an average
<0.5 64 11 of 9.7 days. There were no intraoperative, perioperative, or postoperative
Depth (cm) >0.6 15 1 complications experienced by this cohort, and all cases were completed
%0.6 84 13 robotically without the need for conversion to alternate technique.

Robotic Myomectomy N ¼ 19

BMI Average 29.6

Std 7.4
P-30
Min, max (18, 44)
A Pilot Study Evaluating the Combination of Acupuncture with Sildena- Number of fibroids* Average 2.6
fil on Endometrial Thickness. W. Yu, B. Horn, B. Acacio, D. Ni, Std 1.5
R. Quintero, M. Nouriani. Sher Institutes for Reproductive Medicine and Min, max (1, 6)
Eastern Center for Complementary Medicine, Glendale, CA. Fibroid size (cm) Average 5.7
Std 2.7
Objective: To evaluate the combined effects of acupuncture and Sildenafil Min, max (2.3, 15)
on endometrial thickness during IVF. Operation time** (min) Average 69.0
Design: Prospective self-controlled trial. Std 23.5
Setting: Private assisted reproductive technology center. Min, max (38, 118)
Patients: Four infertility patients with prior IVF failures and an inability to Blood loss (mL) Average 123.1
achieve a uterine lining of R8 mm. Std 60.0
Interventions: A series of five acupuncture treatments applied at specific Min, max (30, 250)
intervals during an IVF cycle. All other parameters were kept consistent Length of hospital stay (h) Average 28.3
with the respective patient’s prior cycle. Std 10.5
Main Outcome Measures: Endometrial thickness. Min, max (23, 48)
Results: All four subjects achieved endometrial lining thickness of >9 mm Days to normal activity Average 9.7
following the administration of acupuncture, including one patient whose lin- Std 6.4
ing did not exceed 5 mm in a previous cycle. We also noted that endometrial Min, max (5, 28)
thickness of most patients continued to increase post-hCG administration.
Conclusions: Our pilot study is consistent with previous reports that acu- *All fibroids intramural
puncture improves uterine lining measurements over previous cycles. We ** no statistically significant difference in operative time between < 4cm
combined both the Sildenafil with acupuncture since data on Sildenafil alone and >4cm fibroids
in improving endometrial thickness remains controversial, even though our Conclusion: Based on our early results of robotic assisted myomectomy,
center believes in its efficacy. However, the combination of our acupuncture we have demonstrated that this operation is feasible in patients with small-
protocol with Sildenafil may be of further benefit to those with lining issues. to-large body mass index, with fibroids ranging in size from 2–15 cm in
Because acupuncture has been shown to improve nitric oxide production, we diameter, that minimal blood loss is experienced during an operation of ac-
hypothesized that lining improvements would be related to such an increase. ceptable length with no associated morbidity. This series demonstrates that
However, we found that lining thickness improved substantially even in a pa- robotic assisted myomectomy is a safe and effective means to treat large in-
tient who had received Viagra in a previous cycle. This may suggest that acu- tramural myomata, offering the patient a minimally invasive option of care
puncture may be improving lining thickness through a mechanism with quick return to normal activity.
independent of nitric oxide. Further testing and data is necessary to verify
these results.

P-31
The Use of the Da Vinci Surgical System in Robotic Assisted Myomec-
tomy: Initial Experience in the Removal of Intramural
Myomas. L. Bonaventura, G.K. Bonaventura. N.P. Bonaventura Repro-
ductive Medicine, at Clarian North Medical Center, Carmel, IN.
Background and Significance: Myomectomy is considered the primary
surgical treatment for women with large intramural uterine myomas desiring
preservation of fertility. Historically, the most prevalent method of removal
has been via laparotomy since laparoscopic removal of subserous and intra-
mural myomas present even the skilled laparoscopic surgeon with consider-
able challenges, such as the ability to enucleate the myomas and complete
a multilayered-suture repair of the uterine wall. The advent of robotic assis-
ted laproscopic surgery has allowed one to overcome these challenges.
Objective: To demonstrate feasibility of robotic assisted myomectomy in
a heterogenous group of patients with varying BMI, myoma type, size, and
number.
Materials and Methods: A retrospective study investigating robotic assis-
ted myomectomy over a 6-month period at a single institution and a single
operator was conducted. All patients had either intramural and/or subserosal
myomas.
Results: Nineteen patients with an average body mass index of 29.6 and
average myoma size of 5.7 cm underwent robotic assisted myomectomy.
P-32
Evaluation of QD vs. BID Dosing of Gonadotropins in Patients Undergo-
ing IVF. V. Schnell, E. Zbella, W. Hummel, N. Khan, M. Perloe,
B. Webster
Objective: To determine if the administration of gonadotropins as a single
combined injection differs in efficacy when administered once a day (QD) vs.
twice a day (BID) in women undergoing IVF
Design: Multicenter, randomized, open-label, assessor-blinded, efficacy,
safety, and tolerability study.
Materials and Methods: To participate in the study, subjects could be up to
42 years old, have a BMI up to 34.0 and basal FSH up to 15 IU/L. In addition,
ICSI, assisted hatching, and co-culture were allowed. Subjects initiated
GnRH agonist therapy on day 21 of the previous cycle. Gonadotropin therapy
was done in accordance with the usual IVF protocol at each center, with the
only requirement being that a minimum of one vial of hMG (MenopurÒ) had
to be used daily in conjunction with human-derived FSH (BravelleÒ). In ad-
dition, the centers had the option of combining the FSH and hMG and admin-
istering it as one single daily injection. The dose and criteria for
administering hCG was also left to each center to follow their own protocols.
On the day of oocyte retrieval, patients were randomized to one of three treat-
ment arms for luteal support; they either received a novel effervescent vagi-
nal tablet, Endometrin, at a dose of 100 mg BID or TID, or Crinone 8% gel
(90 mg) QD.

FERTILITY & STERILITYÒ S23