teal plasma progesterone concentration of 15 ng/ml or more) and 4 became pregnant (4/17, 23.5%), three of them singletons. Two patients developed mild and one devel- oped moderate hyperstimulation, but none was admitted to hospital.

Conclusion: It is concluded that low dose alternate day HMG therapy offers a safe and more physiologic alterna- rive to conventional daily administration in patients with the PCO syndrome.

P -177

Laparoscopic Microsurgical Tubal Anastomosis: A Prospective Study. L. Lapens~e, F. Bissonnette. Dept of OB/GYN, Hospital St-Luc, University of Montreal, Mon- treal, Quebec, Canada.

Objectives: There is little guidance in the current litera- ture on the results that can be expected from a laparo- scopic microsurgical tubal anastomosis using the two to three stitch technique. The purpose of this study was to determine the reproductive outcome of women who receive a laparoscopic tubal anastomosis and then to compare it to the pregnancy rate reported with the classic microsurgical reversal of tubal sterilization by laparotomy.

Design: Ongoing prospective study. Materials and Methods: Women presenting for a rever-

sal of sterilization were considered eligible if they were < 43 years old, with normal ovulatory cycles and a normal semen analysis. Operative reports were reviewed to docu- merit the extent and type of sterilization and patients with bilateral salpingectomies or fimbriectomies were excluded. The anastomosis was performed with Vicryl 5.0 or 6.0 us- ing intracorporal knots at the position 6 and 12 o'clock or 2, 6, and 10 o'clock. Hysterosalpingography was performed to document tubal patency two or three months after the procedure in those patients not already pregnant. The fer- tility after surgical treatment was evaluated in all pa- tients with a follow up ranging from 3 to 22 months.

Results: Eighty-six patients with a mean age of 33.1 and a mean parity of 2.0 underwent laparoscopic tubal anastomosis. All patients had two operable tubes except three women who had had a unilateral salpingectomy. There were 42 isthmic-isthmic anastomosis, 17 isthmic- ampullary, 8 intramural-isthmic, 5 ampullary-ampullary, and 14 with a combination of the above. The mean opera- tive time was 66.6 minutes. Hysterosalpingography was performed two months after the surgery in 38 patients. Twenty-nine (76%) demonstrated bilateral or unilateral patency. Thirty-two women (37%) have conceived with 25 (78%) intrauterine ongoing pregnancies, 4 (12.5%) sponta- neous abortions, and 3 (9%) ectopic pregnancies.

Conclusion: Although our pregnancy rate is lower than the reported pregnancy rate for the classic microsurgical reversal of tubal sterilization, we believe that the outpa- tient laparoscopic two to three stitch tubal anastomosis will remain an alternative to the classical approach be- cause of shorter recovery period and decreased costs.

Tuesday, October 21, 1997

Mental He a l t h

P-178

Primary Care Evaluation of Mental Disorders (PRIME-MD) Screening in an Urban Reproductive Medicine Clinic. 1S. Wright, 2D. Grainger, 2B. Tjaden, iS. Preskorn. 1Department of Psychiatry and ~Department of Obstetrics and Gynecology, University of Kansas School of Medicine--Wichita, Wichita, Kansas.

Objectives: The PRIME-MD (Primary Care Evaluation of Mental Disorders) was introduced as a quick and effec- tive tool for use by primary care physicians to assist in the diagnosis of mental disorders. This study compares the results of the findings of the original study with those obtained from a homogeneous population consisting of 214 female patients seeking physician care at an urban worn- en's reproductive medicine clinic.

Design: Survey design criterion standard. Materials and Methods: Between October 1, 1996 and

December 10, 1996 each new or established female patient presenting for evaluation, excluding repeat and lab-work only patients, was offered the opportunity to participate in the study. This resulted in sample of 214 participants of which 44 patients declined to participate. All of the patients were female with an age range from 14 to 65. The participants completed the survey portion of the PRIME- MD tool and, if the initial screen was positive, the patient was personally interviewed by one of the authors trained on the usage of the PRIME-MD. The frequencies of diagno- sis generated by this process were analyzed using the Chi Square test for goodness of fit, comparing the results of the experimental populations with those obtained by the original developers of the PRIME-MD.

Results: The original developers of the PRIME-MD ob- tained data from 1000 participating patients from 31 dif- ferent primary care practitioners to determine whether the test was reliable and valid in the diagnosis of mental disorders in the patient population. The present study ex- amined the results of the same survey administered to 170 patients of a reproductive medicine clinic. The results indicate that the population of patients seen at this clinic differ significantly from those found at the initial study primary care offices. In all of the diagnosis groups which contributed to the overall difference, this study found sig- nificantly fewer diagnoses than was expected relative to normative data in dysthymia, generalized anxiety disor- der, panic disorder, and multisomatiform disorder, and significantly more in the rule out anxiety disorder due to physical disorder, medication or other drug.

Conclusions: The results of the statistical analysis indi- cate differences between the original group of participants in the PRIME-MD survey and the participants in this study. These differences may be due in part of the demo- graphic differences between the two groups. Of even greater interest clinically, however, is the fact that in the initial study 39% of the patients not known to have a mental disorder received a PRIME-MD diagnosis. Upon chart review of the population evaluated in this study,

S178 Abstracts

82% of those patients who received a PRIME-MD diagno- sis were not previously diagnosed as having a mental dis- order by their primary care provider. Therefore, reproduc- tive medicine clinics should consider screening all patients with a broad based initial diagnostic/psychiatric tool.

P - 1 7 9

C o n s i d e r a t i o n s R e g a r d i n g P s y c h o l o g i c a l Counse l - i n g D u r i n g IVF T r e a t m e n t s in a S u c c e s s f u l C e n t e r in Brazi l . D. Seibel, D. Castellotti, J. R. Alegretti, E. A. Motta. Departments Psychology, OB/GYN & Centro Hun- tington Reproducao Humana, Fed Univ, Sao Paulo, Brasil.

Objective: Infertile couples undergoing IVF treatment face high levels of anxiety, depression along with a multi- tude of psychological problems. Supportive counseling and psychological interventions have been essentially ne- glected to IVF couples in developing countries partially due to couples' financial challenges in addition to social, cultural, religious and educational background. Thus, we wished to evaluate basic perceived needs of supportive coping strategies felt by a group of patients receiving IVF treatment in our Center.

Design: Prospective study consisting of volunteered re- sponses to an anonymously distributed multiple choice and descriptive questionnaire.

Material and Methods: The IVF subjects were recruited from a private, university affiliated clinic. There were no exclusion criteria. All couples replied to the questionnaire and responses of 50 couples were analyzed.

Results: Cost-effective emotional support during the process of IVF was perceived as a necessity by all partici- pants. Over 60% of the husbands felt a need to participate in a group oriented services. Interesting was the finding that 75% of couples desired to participate in therapy ses- sions in the premises of the clinic rather than in outside facilities. While 70% of couples would prefer group ses- sions, the remaining would elect privately oriented stress reducing strategies. 60% of the couples were also able to perceive a need for continuation of counseling throughout pregnancy and childbirth.

Conclusions: The results of this survey clearly imply that there is an overwhelming need for psychological coun- seling and supportive interventions in couples undergoing IVF treatment in developing countries such as Brazil. Fur- thermore, the similarities of infertile couples' psycho-emo- tional needs transcend cultural, religious, social, educa- tional and financial issues. Group therapy as it is largely and successfully used in the US and other developed coun- tries appears to be the most inciting interventional modality.

P - 1 8 0

T h e D e s i r e for C h i l d b e a r i n g in W o m e n o f A d v a n c e d R e p r o d u c t i v e Age: F i n d i n g s in a D o n o r O o c y t e Pro- gram. 1j. L. Rosentha], 1'2R. C. Zimmermann, 2M. V. Sauer. 1Dept of Psychiatry, ~Division of Reproductive En- docrinology, Dept of OB/GYN, Columbia Presbyterian Medical Center, New York, NY.

Objective: The desire for childbearing in women of ad- vanced reproductive age (ARA), with its attendant psycho- logical, social and ethical issues, presents us with possibil- ities and dilemmas that we previously have not had to face. With one quick embryo transfer, we have forever changed the face of our theories about women's develop- ment, the psychology of reproduction, and the meaning of menopause. The children born to these mothers face a different legacy and have different psychological issues than those which the adoption literature has taught us, and the likelihood of parental death before these children reach adulthood is high. Should we be creating these cir- cumstances?

Design: Cross-sectional analysis of 30 women over the age of 45 who have a child or children as a result of donor egg (OD) therapy.

Materials and Methods: 30 women who gave birth using OD from 1989-1996 were interviewed by 2 of the authors using a semi~structured questionnaire. The response rate was 100%.

Results: When asked why they pursued OD at this par- ticular time in their lives, 20% of the women indicated that they had delayed attempts at pregnancy until they were in the late 30's for reasons including career progres- sion and/or marriage at an older age. ~ of these women reported ambivalent relationships with their own mother, effecting their feelings about motherhood. 50% of this group had conceived earlier in life, but had opted not to carry the pregnancy. 20% married a partner with children from a previous marriage who were themselves ambiva- lent about having more, thus delaying attempts at concep- tion until the possibility of a genetically-related child was precluded. 20% intended to have children in their 30's, but were struck by significant illnesses like breast or cervical cancer, delaying their attempts to conceive. 40% of the women had adult children from previous marriages; they felt that having a child with their current husband would solidify the relationship. Over half thought this was an ideal time in their lives to raise a child because they felt financially secure and were able to spend "quality time" with them. If they did not get pregnant, 27 out of 30 said they would eventually try to adopt. They were unequivocal in their desire to have and raise a child, and the group who already had adult children felt that this could provide interesting new arrangements and possibilities in ex- tended family. Practically all of the women perceive them- selves as physically more vital and emotionally more youthful than their chronological age, and while they were thoughtful about the effects of aging, they projected that in 10 years' time they would not have aged in a way that would significantly impair their functioning as a parent.

Conclusion: The desire for childbearing in women of ARA is compelling. These women have a heterogeneous group of reasons for wanting to become pregnant and have a child, all of which seem individually valid, if complex. Childbearing at an advanced age, often with already grown families, presents an implicit challenge to what we consider to be the normal life cycle, and is intriguing. For these reasons, it is particularly important that these women are seen by mental health providers who can ap-

Abstracts S179