Background. Polycystic ovaries (PCO) are manifested either independently or as a syndrome (PCOS). They are one of the commonest endocrinopathy in women of reproductive age. Despite a variable ...clinical picture one of the leading symptoms is infertility for anovulation. Surgical treatment of the disease witnessed a revival after the introduction of minimally invasive operative laparoscopy. Various techniques of ovarian tissue destruction have been applied, the most common being laparoscopic electrocoagulation of the ovaries (LECO). The aim of this retrospective study was to assess the pregnancy rates and pregnancy outcomes following LECO.Patients and methods. From 1993 and 2000 inclusive LECO was performed at the Reproductive Unit, Department of Obstetrics and Gynecology Ljubljana in 222 infertile patients with PCO(S), in whom previous medical ovulation induction failed or in whom overreaction of the ovaries to gonadotropin treatment occurred. To the questionnaire, mailed to the patients, 185 (83.3%) responded. The evaluation of the outcome of LECO treatment involved 157 patients, since the patients who underwent in vitro fertilization (IVF-ET) treatment for other causes of infertility prior to LECO, were exclude from the analysis. LECO was performed under general endotracheal anesthesia using a 3-puncture technique. On each ovary 5– 15 (mean 10) punctures were made with a monopolar electric needle, energy of 300 W, and duration of 4 seconds. Statistical analysis was done using Chi-square test and odds ratios.Results. After LECO 99 (63.3%) of the 157 patients conceived, 56 (54.6%) spontaneously and 43 (45.4%) after additional postoperative ovarian stimulation. Pregnancy was registered in 58 (59.0%) patients with primary, and in 41 (41%) patients with secondary infertility, in 20 (57%) patients with PCO, 79 (65%) with PCOS, in 71 (64.1%) patients with a normal partner’s spermiogram, and in 28 (46.1%) patients with the partner’s oligoasthenoteratospermia of the 1st or 2nd degree. The differences were not statistically significant. Pregnancy ended with delivery in 87 (88.1%) patients, and in spontaneous abortion in 11 (11%); 1 (0.9%) pregnancy was ectopic. Singletons were born to 82 (82.9%) and twins to 5 (5.2%) patients, the latter to the patients receiving ovarian stimulation immediately after surgery. In the patients, enrolled in IVF-ET treatment for a failed hormonal and/or surgical treatment, the delivery rate per ET was 23.4% (19/48) in those with a previous LECO, and 12.9% (36/115) in those without a previous LECO (p < 0.05). No surgical complications were registered.Conclusions. LECO is an efficient treatment of infertility in patients with PCO(S). It results in high pregnancy and low spontaneous abortion rates, and reduces the risk of ovarian hyperstimulation syndrome following gonadotropin treatment.
The primary objective of the study was to evaluate the correlation between prostaglandin F2-alpha and tumour necro- sis factor-alpha concentration and that of pain experienced by patients undergoing ...thermal balloon ablation. Further- more we evaluated the correlation between the endometrial and myometrial thicknesses and the degree of pain experi- enced by patients undergoing the procedure, and in addition the correlation between PGF2-alpha, TNF-alpha and endo- metrial and myometrial thicknesses. Single-arm cohort study (Canadian Task force classification II-2). In University Medical Centre Ljubljana, outpatient setting, 40 perimenopausal women with dysfunctional uterine bleeding (DUB), un- derwent endometrial thermal balloon ablation. The thickness of the endometrium and myometrium was measured prior to surgery using a transvaginal ultrasound that provided cross-sectional images. The degree of pain was rated using the visual analogue scale (VAS) and numeric rating scale (NRS) immediately and 60 minutes after the procedure. The con- centration of PGF2-alpha and TNF-alpha in venous blood was measured prior to, at the end of and 60 minutes after the procedure. The results showed a positive correlation between the concentration of PGF2-alpha released during endo- metrial ablation and the endometrial and myometrial thickness (p>0.01), including the reported degree of pain (p> 0.01). The concentration of TNF-alpha indicates a positive correlation with the level of pain (p>0.05), but is not depend- ent on the thicknesses of the endometrium and myometrium. Endometrial thickness correlates to the degree of pain and the prostaglandin F2-alpha concentration. In clinical practice, performing the Gynecare ThermaChoice procedure im- mediately after menstruation or preoperative preparation of the endometrium using oral contraceptives enables this pro- cedure to be performed in outpatient settings and can be considered a valuable treatment option for DUB.
Background. Since in in vitro fertilization two embryos – blastocysts are routinely transferred, the twin pregnancy rates are higher than in the general population. The aim of our study was to ...evaluate the clinical results after elective single-blastocyst transfer.Methods. Retrospectively we analysed clinical results of 696 in vitro fertilization cycles. The cycles were divided into 37 cycles, in which an elective single blastocyst transfer was performed (group 1), and in 659 cycles, in which an elective double blastocyst transfer was performed (group 2). The pregnancy rates, twin pregnancy rates, and spontaneous abortion rates were compared between the two groups. Additionally we evaluated the effect of the method of in vitro fertilization (classical IVF and ICSI) and female age (< 38 years and > 38 years) on the clinical results after a single or double blastocyst transfer.Results. After an elective single or double blastocyst transfer, there was no statistically significant difference in pregnancy rates (30% vs. 46%); after a single blastocyst transfer there were no twin pregnancies, whereas after a double blastocyst transfer the pregnancy rate was 18%. After a double blastocyst transfer, the method of in vitro fertilization did not affect the twin pregnancy rate, whereas in women younger than 38 years, the twin pregnancy rate was significantly higher than in women aged > 38 years (19% vs. 6%; p < 0,05).Conclusions. Clinical results obtained after an elective single and double blastocyst transfer are comparable. By the transfer of one blastocyst twin pregnancies are avoided. Elective single blastocyst transfer is recommended in women, younger than 38 years.
TWIN PREGNANCY AFTER THE TRANSFER OF TWO EMBRYOS Lili Bačer Kermavner; Irma Virant Klun; Brigita Valentinčič Gruden ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
12/2003, Letnik:
72
Journal Article
Recenzirano
Odprti dostop
Background. Twin pregnancy rates following the transfer of two embryos in in vitro fertilization (IVF) treatment are high. Therefore, the aim of this study was to evaluate twin pregnancy rates in ...regard to the developmental stage of the embryo, patient age, and cause of infertility.Methods. A retrospective analysis involved 1222 IVF procedures. Overall pregnancy rates and twin pregnancy rates following the transfer of two blastocysts or two cleavage-stage embryos were assessed. The blastocyst group was divided into four age subgroups, and into four subgroups by the cause of infertility.Results. After the transfer of two blastocysts or two cleavagestage embryos the overall pregnancy rates (45% vs. 9%) and the twin pregnancy rates (18% vs. 5%) were significantly higher in the blastocyst group. The effects of patient age and the transfer of two blastocysts on the overall pregnancy and twin pregnancy rates were significantly greater in the subgroups of patients aged ≤ 30 years (21%) and 31–34 years (20%) than in older patients (35–38 years = 15.7%; ≥ 39 years = 9%). In the blastocyst group the twin pregnancy rate was significantly higher in patients with tubal (21%) and endocrinological causes of infertility (24.5%) than in patients with endometriosis (7%) and uterine malformations (12.5%).Conclusions. After the transfer of two blastocysts twin pregnancy rates are significantly higher in patients with tubal factor or endocrinological causes of infertility younger than 34 years. In this population of women the risk of twin pregnancy can be avoided by the transfer of a single embryo – most developed blastocyst.
Background: Endometriosis is often defined as heterogeneous immune abnormality. In accordance with the data, women with endometriosis are more frequently affected by Hashimoto's thyroiditis, systemic ...lupus erythematosus, Sjögren syndrome, rheumatoid arhritis, asthma, eczema and have increased activity of policlonal B-cells, abnormal acitvity of T- and B-lymphocytes, decreased activity of natural killer cells and presence of antiendometrial antibodies. In our study, we tried to define the disease in the context of other autoimmune diseases and determine the type of immune abnormality. Methods: In the prospective study 60 females with endometriosis were inluded in the study group and 49 healthy females in the control group. The presence of endometriosis in the complex of other autoimmune diseases was evaluated by targeted family, personal and reendomeproductive history. The type of immune abnormality was evaluated by immunological analysis on the cell level: subtypisation of lymphocytes, cytotoxic and regulatory T cells and NK cells. On the humoral level, we defined antiovary, antiendometrial and antiendothelial antibodies. The results were statistically evaluated using the Pearson's Chi-square test and Mann - Whitney test. Results: Patients with endometriosis are more frequently affected by allergies (p = 0.039). Five serums of endometriosis patients were positive for antiendothelial antibodies specifically reacting with vascular endothelium. There was statistically significant diference between the study and the control group in the proportion of regulated T lymphocytes (CD3+ CD25++) in the pherypheral blood (p = 0.025). Conclusions: We have not fully confirmed the hypothesis that women with endomeriosis have alterations in the immune response. However, the present study supports and adds important infomation to the views that immune abnormality plays an important role in the etiopathogenesis of endometriosis. On the humoral level, we showed the presence of antiendothelial antibodies reacting with vascular endothelium.
BACKGROUND Endometriosis is defined as the presence of endometrial glands and stroma within extrauterine sites. Estimations show that up to 15 % of women in their reproductive age areaffected. ...Extrauterine endometrial tissue can be found on the pelvic peritoneum, on theovaries, in the rectovaginal septum, and more rarely, in the pericardium and pleura forming three different entities: peritoneal endometriosis, ovarian endometriosis and deependometriotic nodules of the rectovaginal septum. Symptoms for endometriosis may include painful and/or heavy periods, pain during intercourse, pelvic pain, 30-50 % reducedfertility and low back pain. Pathogenesis of endometriosis is not yet fully understood. It iswell known that endometriosis is an estrogen-dependent disease, with distinctive genetic,immunological and environmental risk factors. CONCLUSIONS The review focuses on different cell processes which are disturbed in endometriosis patients. A better understanding of the molecular basis of endometriosis will aid in identification of molecular markers and novel drug targets in the future, providing better diagnostics and treatment
Prikazano je laparoskopsko zbrinjavanje lezije rektuma prigodom ekscizije žarišta duboke endometrioze rektovaginalnog septuma. Prema dostupnim literaturnim izvorima, radi se o prvoj takvoj operaciji ...na području Republike Hrvatske, kod koje je lezija rektuma kod liječenja duboke endometrioze rektovaginalnoga septuma zbrinuta u cijelosti laparoskopskim pristupom. Spomenuti pristup mnogo je poštedniji, poboljšava kvalitetu i uspješnost liječenja, te jamči i brži oporavak.
