Tri-Service General Hospital, Taipei, Taiwan; Chinese Medicine, Taipei Mu- nicipal Hospital Zhongxiao Branch, Taipei, Taiwan. OBJECTIVE: Uterine artery pulsatility index change by a traditional Chi- nese herbal formula, Four-Agents-Decoction (Si Wu Tang), treating primary dysmenorrhea. DESIGN: A randomized double-blind clinical trial. MATERIALS AND METHODS: The data of the 75 subjects were ex- tracted for this study after the primary dysmenorrhea was confirmed by a trans-abdominal ultrasonography and normal serum level of CA-125. The pain intensity data during the first five days of each menstrual cycle were collected using a horizontal unmarked visual analogue scale (VAS) of 0–10 cm (0 cm represents no pain and 10 cm denotes severe pain). Pulsa- tility indices of uterine arteries and the sizes of uterus and ovaries were mea- sured during pelvic ultrasonography in the screening and post-treatment phases. Data were extracted from the clinical trial database and matched by menstrual cycles. Pain intensity, pulsatility index of uterine artery, vital signs, and blood biochemicals were included in the analysis. Two tailed paired t-test was used to compare the difference between pre- and post-treat- ment in the two treatment groups separately with significance level set at P<.05. Spearman’s correlation was tested for associations. RESULTS: Intra-individual change in blood pressure was elevated when pain intensity and uterine artery pulsatility indices were reduced in the 75 women who had no missing values. The change in overall pain intensity by treatment was positively correlated with the changes in left PI (r ¼ .313, P¼.006) and right PI (r ¼ .214, P¼.065). Although statistically insignificant, the changes in PI were negatively correlated with the changes in systolic blood pressure as well as diastolic blood pressure. The change in overall pain score negatively correlated with the change in menstrual cycle length (r ¼.232, P¼.045); the latter was also positively correlated with the changes in systolic blood pressure (r ¼ .280, P¼.015) and diastolic blood pressure (r ¼ .180, P¼.122). CONCLUSIONS: The indirect inverse relationship of blood pressure with the uterine blood flow and pain intensity further indicates the pain improve- ment by Four-Agents-Decoction in treating primary dysmenorrhea. Uterine artery pulsatility index may also serve as an objective measure for menstrual pain. Supported by: Research grants from National Health Research Institutes, Taiwan and Tri-Service General Hospital, Taipei, Taiwan. ENDOMETRIUM P-256 IDENTIFICATION OF HOXA10 TARGETS IN IMPLANTATION. D. Vitiello, R. Pinard, H. S. Taylor. Obstetrics, Gynecology and Reproductive Sciences, Yale University Schoolof Medicine, New Haven, CT. OBJECTIVE: HOXA10 encodes a transcription factor required for endo- metrial receptivity and embryo implantation. Our objective is to identify and to characterize those molecular markers regulated by HOXA10 expression. DESIGN: Here we have identified putative HOXA10 target genes by mi- croarray analysis in a murine model. We have selected candidate genes and have verified their differential mRNA expression. Elucidation of these path- ways will allow further characterization of the molecular mechanisms gov- erning endometrial development. MATERIALS AND METHODS: Liposome-mediated gene transfection was used to deliver either a plasmid that constitutively expresses HOXA10 (pcDNA/HOXA10) or a sham control. Twenty-four hours after vaginal plug detection a laparatomy was performed and the uterine horns were in- jected with DNA/liposome. The uterus was harvest forty-eight hours later and total uterine RNA was isolated and then used to perform microarray anal- ysis employing an Affymetrix Genechip that assayed for 39,000 mouse tar- gets. Differential expression of selected targets was confirmed employing real-time PCR on the cDNA generated from the total RNA. RESULTS: Microarray analysis identified 82 statistically-significant genes regulated by HOXA10 overexpression of which 57 genes were down-regulated greater than 2-fold over control. Cellular ontogenies of differentially-expressed genes include: cell adhesion molecules, signal trans- duction factors as well as metabolic regulators. Quantitative-real time RT- PCR confirmed regulation of selected candidate genes. Examples included: clusterin, phoshoglycerate 3-dehydrogenase (PGDH), and tumor-associated calcium signal transducer 2 (TACSTD2). CONCLUSIONS: HOXA10 is necessary for blastocyst implantation, however, the molecular mechanisms that mediate this process remains elu- sive. The differential expression of HOXA10 at this critical window of implantation may lead to protean effects on gene expression. Employing this screening strategy, we have identified genes regulated by HOXA10. These regulatory relationships are identified in mouse implantation and likely function to enhance uterine receptivity. Supported by: NIH HD36887. P-257 HYSTERECTOMY AFTER NOVASURE ENDOMETRIAL ABLA- TION FAILURE OF A BRIDGE TO MENOPAUSE. A. L. Hsu, C. Bell, R. Burkman, D. Grow. Obstetrics and Gynecology, Baystate Medical Center, Springfield, MA. OBJECTIVE: To characterize the clinical and pathologic features of women undergoing hysterectomy subsequent to Novasure ablation. DESIGN: Retrospective chart review. MATERIALS AND METHODS: A retrospective chart review of patients identified by CPT/ICD-9 billing codes as having hysterectomy subsequent to Novasure endometrial ablation. Initially, patients with any endometrial abla- tion between 1999 and 2006 were identified through their billing codes. Fifty-one surgeons were identified for 1945 cases. The operative caseloads of these 51 surgeons were then reviewed to identify patients who specifically had a Novasure ablation. RESULTS: 1945 endometrial ablations were performed at Baystate Med- ical Center between 1999 and 2006. Of these, 933 were Novasure ablations. Sixty-seven hysterectomies (7.2%) were performed subsequent to a Novasure ablation, after an average of 14 months (range of 1–35 months). Menorrhagia (45%) and dysmenorrhea or pelvic pain (36%) were the predominant com- plaints leading to hysterectomy; other indications included uterine prolapse (3 cases) and cancer (4 cases). Review of pathology specimens from these 67 subjects undergoing hysterectomy revealed adenomyosis in 49% (33/67), fi- broids in 48% (32/67), endometriosis in 13% (9/67), cancer in 6% (4/67), and a bicornuate uterus in one patient. Ten months after an initial Novasure ab- lation, a second Novasure ablation was attempted prior to hysterectomy in five patients who had persistent menorrhagia; fibroids were noted in all five pathology specimens, with the hysterectomies performed an average of 10 months after the second ablation. Three cases of grade I endometrial adenocarcinoma and one case of grade III leiomyosarcoma were detected af- ter Novasure ablation, with subsequent hysterectomy occurring an average of 6 months after ablation. CONCLUSIONS: Endometrial ablation with the Novasure bipolar imped- ance device is quick, safe, cost-effective, and transitioning to an office-based procedure in our community. To our knowledge, this is the largest study of hysterectomies after Novasure ablation. The hysterectomy rate for Novasure ablation was 7.1%, compared to the 3% that has been reported previously; these hysterectomies occurred between 1 and 35 months after the initial abla- tion. Our findings suggest that preoperative imaging studies to detect submu- cous myomas, large myomas, polyps, and adenomyosis may help optimize patient selection and thereby minimize the need for subsequent hysterectomy. Supported by: Department of Obstetrics and Gynecology, Baystate Med- ical Center. P-258 ENDOMETRIUM ADVANCEMENT IN CASE OF PREMATURE LU- TEINIZATION IN GnRH ANTAGONIST CYCLES: CLEARLY PRES- ENT ON DAY 3 BUTABSENT ON DAY 5. V. Vernaeve, C. Bourgain, S. Gonzalez, F. Lucco, C. Pozzobon, A. Ballesteros. Instituto Valenciano de Infertilidad, Barcelona, Spain; Department of Pathology, University Hos- pital Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Brussels, Belgium. OBJECTIVE: In order to evaluate if the difference in pregnancy rate, ob- served between D3 and D5 replacements in case of premature luteinization in GnRH antagonist cycles, is due to a difference of endometrium advancement or to a different adaptation capacity of the embryos themselves. The purpose of this analysis was, therefore, to compare endometrial dating three and five days after oocyte retrieval. DESIGN: Prospective observational study. MATERIALS AND METHODS: Twelve oocyte donors stimulated using GnRH antagonists and having a progesterone of R1, 2 ng/ml on the day of HCG, were enrolled in the study. Endometrium biopsies were taken on the day of ovum pick-up (OPU) and on OPU þ 3 and OPU þ 5. Endometrial his- tology was analyzed prospectively with Noyes’s criteria by one observer who was blinded to the stimulation data. For assessment of endometrial matura- tion, the day of oocyte retrieval was considered the day of ovulation (day 0). FERTILITY & STERILITY Ò S193