Background. Many studies have shown significant reduction of fertility in endometriosis. Mechanisms of infertility are still not completely clear. The aim of our study is to obtain the effectiveness ...of laparoscopic treatment of infertility for different stages of endometriosis. Methods. The effectiveness of laparoscopic treatment of infertility in endometriosis was observed through a questionnaire that was sent to 281 patients (pts), who had laparoscopic treatment at the Department of Obstetrics and Gynecology Ljubljana during the period from 1999 to 2006 due to endometriosis as the only cause of infertility. 53.4 % (150/281) pts, who answered the questionnaire, were divided into group I (minimal and mild endometriosis) and group II (moderate and severe endometriosis). We established the rate of pregnancy (in total, spontaneous and ART) and compared the results between two groups. Relatively small percentage of answered questionnaires was most likely due to the fact that the questionnaires were sent to pts who were operated several years ago and did not respond or have changed their address. Because the study is still ongoing, we present partial results. Results. For 132 pts wanting to get pregnant the overall pregnancy rate was 76.5 % (101/132). The rate of pregnant pts depended on the stage of endometriosis. In group I 86.8 % (79/91) pts became pregnant – 58. 2 % (46/79) spontaneously, 41.8 % (33/79) with ART. In group II 53.6 % (22/41) pts became pregnant – 68.2 % (15/22) spontaneously, 31.8 % (7/22) with ART. The difference between groups was statistically significant (p < 0.05). Conclusions. Our results are comparable to the results found in the literature. Laparoscopic treatment of infertility is effective in all four stages of endometriosis. According to our results laparoscopic treatment has the primary role in the treatment of endometriosis-associated infertility
Background: Ultrasound examination is becoming a more and more important diagnostic tool in infertil- ity treatment. Development of ultrasound equipment offers a lot of information about the ...physiology and morphology of gynecological organs. Beside the 2D view on structures, the new 3D technology enables us to view the whole volume in all planes. 4D view enables us a 3D view in certain time, i.e. a 3D live scan. Content: Ultrasound is used in fertility management for infertility diagnostics and in following of treatment. Ultrasound in infertility diagnostics: Ultrasound is used for examination of uterus, tubes, ovaries and peritoneal cause of infertility. It can be used in different menstrual phases: proliferative, periovulatory and secretory phase. Examination of uterus: A 2D scan can measure the size of the uterus (length, width and depth) and a 2D flow (colour and power doppler). With 3D technology we can measure the whole volume with VOCAL (virtual organ computer-aided analysis) and 3D circulation with the index (VI – vascular index, FI – flow index and VFI – vascular flow index) in the uterus. A 2D scan can help us define uterine malformations, fibroids and adenomyosis to a certain extent. However, a 3D scan offers more accurate diagnosis of these malformations. Endometrium is examined separately. With 2D the width is measured and morphology and focal lesions (polyp, fibroids, adhesions) are examined. With 3D the real sagital plane for the width measurement can be defined . We can measure the volume of endometrium and subendometrium and 3D circulation in endometrium and subendometrium. The FIS (f luid instlation sonography) is very useful when examining the endometrium; saline or gel can be used for uterine instalation. We can measure and define the position of the structures in the endometrium more accurately when they are surrouned by saline or gel. We can view these structures with a surface view, similar to the one used for hysteroscopy. With this information we can explain the pathology to the patient and easily plan the surgical procedures. Examination of the tubes: With 2D US we can see the tubes in the pelvis only if there are dilatations, but sometimes it is difficult to distinguish them from the neighbouring forma- tions. With a 3D ultrasound we can define the shape and continuity of the tube and we can view the tube from different angles (inversion mode). Different contrast media are used for determining tubal patency. Tubal patency can be diagnosed with 2D HyCoSy (Hysterosal- pingo Contrast Sonografy) or 3D HyCoSy. Examination of the ovary: With the 2D ultrasound the size of ovaries is measured and the morphology of ovaries is examined. With the 3D ultrasound the volume of the ovaries, follicles, cysts and tumors can be measured. Furthermore, position of the ovaries with re- gard to their surrounding can be defined. With the 3D surface mode we can see the surface view of the inner layer of the follicle or the cyst. The volume of the liquid structures can be measured with VOCAL or sonoAVC (sono automated volume count). The number of the antral follicles strongly correlates with fertility potential markers such as FSH and AMH. Examination of peritoneum: The position of gynaecological organs and ascites are defined. Examination of vagina: Endometriotic nodules can be excluded with ultrasound. A 3D ultrasound can define the exact position of the nodule. Ultrasound in the following of infertility treatment: Before the ovarian stimulation it is mandatory to exclude pelvic pathology that can influence the stimulation. Ovarian stimulation: We follow the natural or stimulated cycles with an ultrasound in view of follicular and endometrial growth. SonoAVC offers us automatic volume count of all follicles. This information enables us to change the stimulation protocol and avoid OHSS more accurately comparing to the standard 2D technology. Oocyte puncture: US puncture is done with ultrasound-guided needle. Great vessels around the vagina and on the needle line can be avoided if colour doppler is used. With 3D surface mode good quality follicles can be identified. Embryotransfer (ET): The angle between cervical canal and corpus uteri can be mea- sured before the embryotransfer. The introduction of the ET catheter can be followed with the 2D transabdominal probe. More exact location of the catheter can be visualized with 4D US. With this method we can avoid touching the uterine fundus with the catether and avoid bleeding in the foetus surroundings. Conclusions: There is an increasing number of ultrasound machines offering us beside 2D, 3D and 4D technology. It is important to learn the applications and use them in our daily practice. The recorded volumes can be examined at any time in any plan. In any unclear pathology the recorded volume can be send for second opinion and discussed further.
Rezultati ranije sprovođenih istraživanja ukazuju na značaj so-cijalne podrške za kvalitet života pojedinca. Socijalna podrška izdvaja se kao jedan od najvažnijih protektivnih faktora u pro-cesu ...suočavanja sa brojnim životnim krizama, od kojih je jedna i neplodnost. U cilju ispitivanja značajnosti dobijene socijalne podrške od strane prijatelja, porodice i značajne osobe u per-cepciji stresa povodom neplodnosti, ispitano je 312 žena, sta-rosti od 21 do 48 godina, koje se suočavaju sa neplodnošću. Na ispitanicama je primenjena Multidimenzionalna skala percipirane socijalne podrške i Upitnik problema sa plodnošću. Ispitanice socijalnu podršku koju primaju od najbližijih procen-juju veoma zastupljenom, pri čemu se pokazalo da ispitanice najviše zastupljenom procenjuju podršku od značajne osobe, zatim porodice i na kraju prijatelja. Uzimajući u obzir dužinu suočavanja sa problemom, odnosno grupu u kojoj se ispitan-ice nalaze, dobijene su značajne razlike u percepciji podrške od strane porodice i prijatelja, ali ne i partnera. Nadalje, bez obrzira na najveću zastupljenost podrške od strane partnera, primenom regresione analize dobijeno je da smanjenju per-cipiranog stresa povodom neplodnosti u značajnoj meri dopri-nose podrška od strane prijatelja i porodice, dok se ova vrsta podrške od strane značajne osobe nije pokazala značajnim prediktorom, izuzev u domenu stresa koji se odnosi na part-nerski odnos. Dobijeni nalazi ukazuju na značaj edukovanja šire populacije o problemu neplodnosti i načinima pružanja podrške ovim parovima, kao i rad sa pojedincima i parovima na razvijanju strategija za traženje podrške od bliskih ljudi.
Text se zabývá medikalizací bezdětnosti, vyplývající z fyzické neplodnosti, skrze reprodukční technologie. Je založen na výzkumu, během nějž byly provedeno 36 hloubkových rozhovorů s lidmi (5 muži a ...31 ženami), kteří mají zkušenost s léčbou neplodnosti. Zaměřuje se na rozhodování páru ohledně léčby neplodnosti a budoucího rodičovství. Ukazuje na geneticizaci rodičovských vazeb a také na způsoby, jakými lidé léčící se pro neplodnost manipulují s různými typy rodičovství ve snaze naplnit společensky zakotvené představy o rodičovství. Věnuje se také adopci, která může být v určitém kontextu preferovanou cestou řešení neplodnosti.
Izhodišča: Kronični endometritis (KE) poteka z blagimi kliničnimi znaki in naj bi bil povezan z neplodnostjo, s ponavljajočimi se splavi in ponavljajočo se neuspelo ugnezditvijo zarodka v postopkih ...oploditve z biomedicinsko pomočjo (OBMP). Ker si mnenja o ugotavljanju in zdravljenju KE v postopkih OBMP medsebojno nasprotujejo, smo si zastavili cilj sistematično pregledati članke o vplivu zdravljenja KE na reproduktivni izid pri neplodnih ženskah v postopkih OBMP.
Metode: Pregledali smo zbirko Medline. Uporabili smo deskriptorje iz tezavra Medical subject headings (Mesh), ki so vključevali ključne besede kronični endometritis (angl. chronic endometritis) in zdravljenje (angl. treatment) ter nosečnost (angl. pregnancy). Vključili smo raziskave od januarja 1971 do marca 2022.
Rezultati: V pregled smo vključili 8 raziskav, ki so uporabile različne sheme zdravljenja. Večina raziskav je ugotavljala statistično pomembne razlike v reproduktivnem izidu po zdravljenju KE.
Zaključek: Zdravljenje KE lahko pozitivno vpliva na izid v sledečih si OBMP postopkih, vendar so še potrebne nadaljnje večje randomizirane študije.
Background. The aim of the study was to find whether children conceived through ICSI and their families differ from the children conceived in normally fertile families. Methods. The study group (SG) ...consisted of 41 children aged 3 years conceived through ICSI: 22 boys, 19 girls, 6 pairs of twins, and the control group (CG) of 41 children matched for sex, age and twin pairs. Family characteristics were assessed using a self-administered questionnaire on family characteristics, conception, pregnancy, labour and delivery, and postpartum period. The children’s development was assessed using the Developmental Čuturić Scale, and the parents filled in the questionnaire from SPP-3 on signs of inadequate child’s adaptation. The mother’s personality was assessed using the BFQ. Differences between the groups were analyzed using SPSS for Windows. Results. Comparison between the SG and CG showed the following statistically significant differences: in the SG mothers were older, the ICSI child was more frequently the only child, the mean duration of infertility treatment was 4 years, in most couples pregnancy occurred by the 3rd ICSI attempt, the family had a better socio-economic status. During the pregnancy, the SG mothers were less ambivalent towards pregnancy and the relationship between the partners improved, after delivery their psychic condition deteriorated, they were more concerned whether their child would develop normally. In the SG parents’ opinion, the quality of life improved after their baby’s birth; they described their children as more demanding and more restless. More ICSI children were cared after by their grand parents than their CG peers that mostly attended kindergarten. The development of all children was normal. Although the sum of signs of inadequate adaptation was comparable between the groups, the ICSI children demonstrated stronger intensity of individual sings. Factor analysis showed very heterogenic latent structure with many components that explained low percentage of variance; there was a clear connection between child’s signs of inadequate adaptation and maternal personality characteristics. The SG mothers achieved on BFQ a statistically lower score in agreeableness (P = 0.025) and openness (P = 0.008), and a higher score in the unsincerity scale (P = 0.001), i.e. they were more rigid, less open to diversity, less tolerant, tending more to perfection and providing more socially acceptable answers. These characteristics highly correlated with experiencing infertility as an extreme stress and were also in relationship with maternal age. Conclusions. The development of ICSI children is within the normal range; however, they tend to be at increased risk for emotional problems. There exists a strong correlation between the child’s characteristics and the mother’s personality that has been marked with the experience of infertility and their age.
Background. Endometriosis is an estrogen dependent disease that affects 5 − 20 % of women of reproductive age. Course of the disease is progressive and leads to a variety of symptoms that range from ...pain complaints to infertility. Some symptoms depend on the location of the break out. The most frequent symptoms are dysmenorrhea, dyspareunia, chronic pelvic pain and infertility. Endometriosis is also found in asymptomatic women. Clinical signs and symptoms with extrapelvic endometriosis are based on the involved organ system. Dysmenorhea may progress and begin prior to the onset of menses or become chronic and be noted throughout most of the menstrual cycle. Pain during menstrual cycle is estimated on 60–80 % of women with endometriosis. Dyspareunia is estimated on 25–50 % of women with endometriosis. It is frequently associated with rectovaginal and uterosacral ligament disease. It was established that advanced endometriosis is more frequently related to dysmenorrhea and deep dyspareunia in comparison with early disease. Chronic pelvic pain is defined as the pain that lasts 6 months and is not cyclic. In women being evaluated for pelvic pain, the diagnosis of endometriosis is made in 40–60 %, especially when it comes to deep infiltrative endometriosis. Infertility can be the only presenting symptom. The incidence of infertility in women with endometriosis is hard to establish. Some women with mild endometriosis are able to conceive, however this mild endometriosis can cause infertility. There is estimation that 20–30 % of women with endometriosis are infertile. Conclusions. Medical history is very important in recognizing the disease. Endometriosis does not threaten life but is associated with significant morbidity of women. It has a major impact on women’s health and life quality and represents a significant public health issue. Because the clinical signs and symptoms are complex and there is sometimes lack of the association between the stage of the disease and intensivity of symptoms, the disease can be diagnosed too late.
Background. We would like to emphasize some genetic causes of female infertility. Methods. The retrospective study included all women referred to Department of Obstetrics and Gynaecology, Division of ...Medical Genetics, in the period between 1994 and 2008 due to infertility. Cytogenetic studies and DNA analysis were carried out. Results. 254 women were included in genetic counselling due to irregular menstrual cycle or premature ovarian failure. Chromosome abnormalities were found in 62 (24.4 %) women, 14 women had various gene mutations. The most common abnormality was X chromosome mosaicism. Conclusions. The recognition of risk factors is the first step in the search of genetic causes of female infertility, followed by genetic counselling and diagnostic procedures.
SAŽETAK
Ciljprikazati metodu i rane ishode prvih 20 dječaka i adolescenata kod kojih je učinjena mikrokirurška varikokelektomija na Zavodu za dječju kirurgiju Kliničkoga bolničkog centra Zagreb. Ova ...metoda prema literaturnim podatcima ima najmanju učestalost recidiva i komplikacija.
Ispitanici i metodeIndikacije za mikrokiruršku operaciju jesu simptomatska varikokela, hipotrofija testisa (zahvaćeni testis volumno manji od zdravog za >20%), te poremećaj spermiograma kod adolescenata u završnom (Tanner 5) stadiju spolnog razvoja. Varikokela i hipotrofija testisa utvrđeni su kliničkim pregledom, ultrazvučnom volumetrijom i dopplerskim pregledom. Operacija se izvodi kroz rez duljine 3 – 4 cm u razini vanjskoga ingvinalnog otvora. Pacijenti su praćeni prospektivno nakon operacije, a prosječno vrijeme praćenja bilo je deset mjeseci (raspon 6 – 12 mjeseci).
RezultatiProsječno trajanje operacije bilo je 65 minuta. Svi pacijenti su otpušteni kući unutar 24 sata od operacije, a vratili su se svim aktivnostima unutar dva tjedna nakon operacije. Tijekom kontrolnih pregleda nije zabilježen recidiv varikokele, kod svih pacijenata koji su operirani zbog simptoma došlo je do nestanka tegoba, dok je kod onih koji su operirani zbog lošeg spermiograma došlo do oporavka ejakulata. Od komplikacija, jedan pacijent je imao prolaznu nelagodu kod ejakulacije. Kod jednog pacijenta je intraoperativno neželjeno podvezana testikularna arterija koja je odmah rekonstruirana termino-terminalnom anastomozom uz uredne protoke na kontrolnim dopplerskim pregledima sjemenskog snopa, bez znakova atrofije testisa.
ZaključakMikrokirurška varikokelektomija je sigurna metoda za liječenje varikokele sa visokom uspješnošću i malim brojem komplikacija.
Mateřství je v dnešních západních společnostech vnímáno jako svobodná volba, nikoli nevyhnutelný ženský úděl. Ženy se v rámci svých možných životních stylů mohou a musí rozhodovat o tom, kdy a za ...jakých podmínek se chtějí stát matkami, případně jestli vůbec chtějí. Úplná kontrola nad reprodukcí je však jen zdánlivá. Ženy ve svém rozhodování zvažují řadu faktorů, které nemohou ovlivnit. Kromě individuální touhy po dítěti do hry vstupují sociálně a kulturně definované podmínky mateřství (načasování mateřství v životní dráze ženy, stabilní rodinné uspořádání, materiální zabezpečení atd.) a biologické limity reprodukce (omezená doba plodnosti ženy a rizika spojována s mateřstvím v určitém věku). Snaha o naplnění podmínek „správného mateřství“ vede k prodlužování období dočasně chápané bezdětnosti, které může vyústit v bezdětnost celoživotní. V našem výzkumu srovnáváme výpovědi dvou skupin žen, které jsou/byly nuceny v určité fázi svého života čelit situaci, kdy jejich touha po dítěti nebyla v souladu s jinými podmínkami mateřství. V prvním případě jde o ženy, které odkládaly mateřství z důvodu absence podmínky, kterou definovaly jako nezbytnou, ve druhém případě se realizaci rodičovství postavila do cesty fyzická překážka v podobě neplodnosti. Cílem výzkumu je zjistit, jak je utvářena norma správného mateřství a jak je redefinovaná v případě, že jí není možné naplnit.
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