Analysis of the relationship between MRI imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients / 中华妇产科杂志

Objective: To investigate the relationship between magnetic resonance imaging (MRI) imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients. Methods: The clinical characteristics of the adenomyosis questionnaire was self-designed. This was a retrospective study. From September 2015 to September 2020, totally 459 patients were diagnosed with adenomyosis and underwent pelvic MRI examination at Peking University Third Hospital. Clinical characteristics and treatment were collected, MRI was used to determine the lesion location, and to measure the maximum lesion thickness, the maximum myometrium thickness, uterine cavity length, uterine volume, the minimum distance between the lesion and serosa or endometrium, and whether combined with ovarian endometrioma. The difference of MRI imaging characteristics in patients with adenomyosis and its relationship with clinical symptoms and therapeutic efficacy were analyzed. Results: (1) Among the 459 patients, the age was (39.1±6.4) years. There were 376 patients (81.9%, 376/459) with dysmenorrhea. Whether patients had dysmenorrhea were related to uterine cavity length, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness, and whether patients had ovarian endometrioma (all P<0.001). Multivariate analysis suggested that ovarian endometrioma was the risk factor for dysmenorrhea (OR=0.438, 95%CI: 0.226-0.850, P=0.015). There were 195 patients (42.5%, 195/459) with menorrhagia. Whether patients had menorrhagia were related to age, whether patients had ovarian endometrioma, uterine cavity length, the minimum distance between lesion and endometrium or serosa, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness (all P<0.001). Multivariate analysis suggested that ratio of the maximum lesion thickness to the maximum myometrium thickness was the risk factor for menorrhagia (OR=774.791, 95%CI: 3.500-1.715×105, P=0.016). There were 145 patients (31.6%, 145/459) with infertility. Whether the patients had infertility were related to age, the minimum distance between lesion and endometrium or serosa, and whether patients had ovarian endometrioma (all P<0.01). Multivariate analysis suggested that young and large uterine volume were risk factors for infertility (OR=0.845, 95%CI: 0.809-0.882, P<0.001; OR=1.001, 95%CI: 1.000-1.002, P=0.009). (2) The success rate of in vitro fertilization-embryo transfer (IVF-ET) was 39.2% (20/51). Dysmenorrhea, high maximum visual analogue scale score and large uterine volume affected the success rate of IVF-ET (all P<0.05). The smaller the maximum lesion thickness, the smaller the distance between the lesion and serosa, the larger the distance between the lesion and endometrium, the smaller the uterine volume, and the smaller the ratio of the maximum lesion thickness to the maximum myometrium thickness, the better the therapeutic efficacy of progesterones (all P<0.05). Conclusions: Concomitant ovarian endometrioma increases the risk of dysmenorrhea in patients with adenomyosis. The ratio of the maximum lesion thickness to the maximum myometrium thickness is an independent risk factor for menorrhagia. Young and large uterine volume may increase the risk of infertility. Severe dysmenorrhea and large uterine volume affect the success rate of IVF-ET. The therapeutic efficacy of progesterones is relatively better when the lesion is small and far away from the endometrium.

Calidad de vida de parejas infértiles en el sector público de Chile / Quality of life of infertile couples in the public health sector in Chile

Background It is widely known that infertility and its treatment have a negative impact on patients' well-being, yet not much is known about patients' satisfaction with the quality of reproductive care. Purpose To assess the quality of life (QoL) of patients receiving medical care under the Chilean public health system. Materials and Methods The FertiQoL international questionnaire was applied to 260 patients (both sexes) referred from rural and urban areas to undergo in vitro fertilization at a major university public hospital. FertiQol evaluates QoL as a product of psychosocial well-being and treatment experience. Demographic and reproductive data were collected. Results QoL due to treatment factors was significantly lower than psychosocial well-being. Couples from lower-density areas showed markedly worse medical satisfaction than patients treated in Chile's capital. No effects on QoL were observed as a function of age, education, or type of infertility. QoL was mostly affected by duration of infertility (inverse association) and geographical zone. Marital satisfaction was the component that most contributed to personal well-being. Conclusions QoL decreased more due to extrinsic factors, particularly lack of access to reproductive care, poor organization of medical services, and deficient clinical interaction, than due to psychosocial distress. These findings call for a revision of the delivery of public fertility care to satisfy patients' needs and improve their QoL.

Another face of violence against women: Infertility

Background BtObjective: Violence against women is a widespread problem and has serious implications on women's health. Infertility, in many ways, is a very stressful condition that affect social and marital life of a couple; moreover, compared to fertile women, infertile women are twice as vulnerable against violence

Our objective was to determine the prevalence of violence and define the effect of infertility on violence on women receiving infertility treatment

Methods: Descriptive and cross-sectional study was carried out 301 infertile women between November 2015 and August 2016 in a state hospital, Izmir. Data were collected as [Sociodemographic Characteristics Form] and [Infertile Women's Exposure to Violence Determination Scale]

Results: The mean age of women was 31.77+/-5.46 years; the average duration of marriage was 6.93+/-4.53 years. About 32.5% of women stated that they have suffered from violence throughout their lives and 4.7% of women were still suffering from violence, while 5.0% of women were subjected to violence after infertility was diagnosed

Conclusion: It is an encouraging finding that infertile women have a low exposure to violence. However, despite a low violence rate, there is an increase in violence toward women who have been diagnosed with infertility

Immunohistochemical study of HLA-DR antigen in endometrial tissue of patients with endometriosis / 华中科技大学学报（医学）（英德文版）

In order to evaluate the expression of HLA-DR antigen in glandular cells in eutopic and ectopic endometrium in patients with endometriosis, 19 infertile patients with endometriosis were analyzed immunohistochemically by labelled streptavidin biotin (LSAB) method. Nineteen infertile patients without endometriosis were studied as controls. The results showed that the expression of HLA-DR antigen in the glandular cells in both eutopic and ectopic endometrium was increased significantly as compared with that in the controls (P < 0.01). It is likely that aberrant expression of HLA-DR antigen in endometriotic tissue is involved in abnormal immunogenesis of endometriosis.

Pregnancy rate following Metformin consumption in patients with PCOS under ART treatment

Infertility with an incidence of about 15% has mainly been one of the community burdens that have even been threatening to the continuity of the family life. One of the most prevalent causes of women infertility is ovarian causes particularly PCOS. Since Metformin may improve quality and increase the number of ova, and likewise increase fertilization rate via reducing the level of insulin, this study was conducted with aim of investigating responses of patients with PCOS in the cycle of ART. This was a randomized clinical trial on 100 infertile patients with PCOS who referred to Shariati Hospital in Tehran during 1999-2000. The subjects were randomly categorized in to 2 groups [A=44 and B=46 women]. Ten patients were eliminated from study due to ignoring the treatment plan. Group A received Metformin at a dose of 500 mg t.i.d in addition to induction of ovulation with long protocol. The results were analyzed using t-test and X2 and P<0.05 was considered as significant. Results showed that average level of estradiol in group A was 2159_1056pg/ml and 2842 +/- 1050 pg/ml in group B, with a significant difference [P=0.002]. We administered 23 +/- 7.6 ampules of HMG for the subject's in group A and 31.34 +/- 8.12 ampules for those in group B [P = 0.001]. The difference in number of oocytes was not significant, where as we found a significant difference in the number of germinal vesicle [P = 0.047]. There were no significant differences in course of treatment, numbers of oocytes and the number of pregnancy between 2 groups. Considering the findings of this study by using Metformin, we improve the quality of ova in patients with PCOS. This happens due to the effect of Metformin through reducing insulin resistance and hyperandrogenism in patients with PCOS leading to a prominent drop in estradiol levels in serum that in turn lowers the need for administration of HMG and result in improving oocyte quality

Stigma and infertility in Iran - coping skills

About fourty years ago Goffman [1963] in his book pointed at stigmatizing as distressing condition which harm some people in their life. He described stigma as bodily signs designed to expose something unusual and bad about the moral status of signifier. This term is used more to mean disgrace than any bodily feature, it can include the wide range of characteristics which make a person odd or seen deviant. Men or women with infertility face stigma because of unability to have their own children. In this article some factors which involve to make stigmatized situations for infertile persons have been described. Clinical observations shows that cognitive distortions has eminent effect in creating stigmatized situation for infertility. The role of cognitive modification in decreasing stigma for these persons are explained. A single case who suffered from stigmatized situation is described here and some CBT techniques for her treatment have been introduced. Some methods for stopping social pressure on infertile people suggested

Contribución al estudio de la prevalencia de la infección por clamidia en parejas con infertilidad / Contribution to the study of clamidial onfection in infertility couples

Objetivo: Establecer la prevalencia de la infección por chlamydia trachomatis en una población con problemas de la reproducción. Diseño: estudio descriptivo epidemiológico realizado entre julio de 1997 y junio de 1998. Material: A 140 parejas con problemas de reproducción, atendidas en la Unidad de Reproducción Humana del Hospital Nacional Edgardo Rebagliati Martins de EsSalud, se les tomó muestra endocervical (mujeres) o uretral (hombres) para detección de clamidia. Medidas de estudios: Detección de presencia de chlamydia trachomatis por método de inmunofluorescencia directa, IgG e IgA. Resultados: Al estudio de antígeno de clamidia por inmunofluorescencia directa, 122 (43,6 por ciento) pacientes fueron positivos, en 59,8 por ciento en ambos miembros de la pareja. La mayoría de los pacientes no presentó síntomas, en 23 por ciento no hubo alteración del espermatograma, a pesar de ser positivo a clamidia y, en las mujeres, la mayoría mostró alteraciones tubáricas a la laparoscopia y un 12 por ciento microvesículas en la serosa. Conclusión: La prevalencia de infección por clamidia en parejas con infertilidad en nuestro medio es alta, lo que debe ser considerado en los protocolos de manejo en reproducción, para diagnóstico y tratamiento, así como para tomar medidas adecuadas de prevención.

Algunos factores relacionados con el embarazo ectópico / Some factors connected with ectopic pregnancy

Se realizó un estudio retrospectivo de 256 pacientes que tuvieron el diagnóstico operatorio de embarazo ectópico en el período comprendido desde el 1ro. de enero de 1994 hasta el 31 de diciembre de 1996, ambos inclusive, en el Servicio de Ginecología del Hospital "Carlos Manuel de Céspedes", de Bayamo, provincia Granma, con el objetivo de conocer la relación de algunos factores epidemiológicos, clínicos diagnósticos y terapéuticos en esta entidad. Se estudiaron variables como: edad, paridad, factores epidemiológicos, medios diagnósticos, localización y operación realizada. Se utilizaron técnicas de estadísticas descriptivas como la del porcentaje, y de significación estadística como elChi cuadrado y la diferencia entre proporciones, tomándose como valores significativos de p - 0,01. El 37,9 porciento de las pacientes tenía entre 19 y 24 años y en este grupo de edad el 15,4 porciento había padecido de inflamación pélvica con diferencias significativas con respecto a otros grupos de edad (p - 0,01). Los factores predisponentes que aparecen en los primeros lugares fueron: inflamación pélvica, esterilidad y legrados con el 37,9; 26,6 y 19,5 porciento, respectivamente. El método más utilizado fue la punción del saco de Douglas (36,7 porciento). Las principales complicaciones fueron la anemia (62,1 porciento) y el shock hipovolémico (25,3porciento)

Estudio citogenético en individuos con trastornos de la fertilidad

Las causas de infertilidad son varias dentro de ellas se encuentra las alteraciones genéticas y citogenéticas. Se estudiaron III individuos con problemas de infertilidad y esterilidad. Se realizaron estudios citogenéticos para evaluar las alteraciones numéricas y estructurales. en relación al sexo de los individuos estudiados, las mujeres constituyeron un 63.96 por ciento con 71 individuos y los varones el 36.03 por ciento con 40 individuos en relación al total de individuos. Respecto a los diferentes problemas de infertilidad, en el grupo de mujeres se encontró 45 con cariotipo normal 46,XX. el Síndrome de Turner fue la anomalía más frecuente dentro de este se consideraron sus varios tipos. Se evidenció 2 probandas que presentaron cariotipo normal 46,XX pero con problemas de amenorrea, 2 individuos con cariotipo normal 46,XX, pero con problemas de amenorrea, 2 individuos con cariotipo normal 46,XX con variantes polimórficas 9qh+, 1 individuo con una translocación t(2;18)(q32;q22) y finalmente una mujer normal fenotipicamente que presentó cariotipo 46, XY. Dentro del grupo de hombres hubo individuos que presentaron cariotipo normal 46, XY en su mayoría; cariotipo normal 46,XY y polimórfismos Yq+; Yq-; 15ph con azoospermia. Dos individuos presentaron Síndrome de Klinefelter y 1 individuo con genitales ambiguos con cariotipo 46, XY. Se discute la importancia de la evaluación genética y el estudio citogenético en individuos con problemas de infertilidad e esterilidad.

Chlamydia trachomatis como factor de esterilidad en la pareja: proyeccion inicial / Chlamydia trachomatis as a factor in sterility of the couple

El diagnostico y tratamiento de la Chlamydia trachomatis como factor de esterilidad en la pareja humana y como causa de infertilidad en la mujer gestante, es algo mas o menos raro en la nosografia publicada y se constituia, hasta hace unos años, en un poco frecuente hallazgo en la practica de la especialidad. Sin embargo, recientemente con los medios biotecnologicos a nuestro alcance, su frecuencia, investigacion y tratamiento se han convertido en una necesidad en la metodologia de diagnostico, tanto de la pareja que no logra gestaciones, como de aquella en la que el embarazo no culmina afortunadamente. La comunicacion es una proyeccion inicial de un trabajo mayor de proxima publicacion.