Positive predictive value of clinical diagnosis of endometriosis.

OBJECTIVE: To determine the positive predictive value of the combined symptoms of severe dysmenorrhea with the sign of tenderness and/or nodularity of the cul-de-sac and/or uterosacral ligament(s) in diagnosing endometriosis clinically. MATERIAL AND METHOD: In this prospective study, 116 patients with severe dysmenorrhea, after excluding urinary and gastrointestinal disease, underwent pelvic examination by the same investigator. Women having adnexal mass on pelvic examination were excluded Tenderness, and also nodularity, of the cul-de-sac, right and left uterosacral ligament were recorded separately. The laparoscopist did not know the findings of the pelvic examination. The diagnosis of endometriosis was made visually when lesions were typical and all other lesions were biopsied. RESULTS: The prevalence of endometriosis was 78.4%. Tenderness, nodularity, tenderness and nodularity, and also tenderness or nodularity of cul-de-sac and/or uterosacral ligament(s) were all statistically significantly associated with the presence of endometriosis (P = .048, .005, .004, and .004 respectively). The positive predictive values were 85.5%, 94.0%, 94.6% and 86.7%, respectively. CONCLUSION: The positive predictive value of severe dysmenorrhea with nodularity of the cul-de-sac and/or uterosacral ligament(s) was 94.0%.

Effect of tubal ligation on pelvic endometriosis externa in multiparous women with chronic pelvic pain.

OBJECTIVE: To determine whether tubal ligation is associated with decreased prevalence and less severity of pelvic endometriosis in multiparous patients with chronic pelvic pain. MATERIAL AND METHOD: From January 1995 to April 2002, 322 chronic pelvic pain patients underwent laparoscopy. Of these, 125 patients were multiparous (parity > or = 2). Their obstetric history, present contraceptive methods and laparoscopic findings were recorded perioperatively. The medical record of each patient was reviewed and analyzed. RESULTS: Among multiparous women with chronic pelvic pain, the prevalence of endometriosis in patients with and without tubal ligation was 45.1% (23 of 51 patients) and 59.5% (44 of 74 patients), respectively. Moderate-severe endometriosis was found in 8.7% (2 of 23 patients) and 36.4% (16 of 44 patients) among patients with and without sterilization. Tubal ligation was statistically significantly associated with severity of disease [P = 0.036, Crude OR (95% CI) = 0.17 (0.02-0.85), Adjusted OR (95% CI) = 0.21 (0.04-1.08)]. There was no statistically significant relationship between tubal ligation and prevalence of endometriosis. The small sample size of the study might account for this statistical result. CONCLUSION: Nearly half of multiparous women with chronic pelvic pain and tubal ligation had endometriosis. Tubal ligation was related to less severity of disease, with statistically significant difference.

Clinical diagnosis of hirsutism in Thai women.

OBJECTIVE: To determine the cutoff score for identifying hirsute, Thai women, by using modified Ferriman-Gallwey-Lorenzo (mF-G-L) method. MATERIAL AND METHOD: Hirsutism was defined as an amount of terminal hair in the androgen-sensitive skin areas that the women themselves would consider obviously abnormal, and their mF-G-L score was above 97.5 percentile of general population. The subjects were consecutive unselected premenopausal women who came to our hospital for their yearly Papanicolaou smear check up, without any complaint. Acne and oily skin were also assessed. RESULTS: Five hundred and thirty-one women underwent a physical exam. The women who had the total hair-growth score of 0, 1 and 2 by mF-G-L method accounted for 97.8% of all the subjects. All of the 11 subjects with a total score of 3 or more considered themselves to have excessive growth of hair. None of these 11 women had acne. CONCLUSION: The authors purposed that the cutoff score to diagnose Thai hirsutism may be 3 or more by mF-G-L method.

Comparison of fecundity after second laparotomy for endometriosis to in vitro fertilization and embryo transfer.

OBJECTIVE: To study the prognosis for conception subsequent to a second conservative laparotomy for infertile patients with moderate and severe endometriosis, compared with the reproductive outcome of one cycle of in vitro fertilization and embryo transfer (IVF-ET). MATERIAL AND METHOD: From January 1990 to February 2000, 190 infertile patients had initial conservative laparotomy for pelvic endometriosis at a university hospital. All of these patients had moderate or severe endometriosis. After the failure of the initial operation to restore fertility, 32 patients requested the second operation while 24 patients underwent one cycle of IVF-ET. The cumulative pregnancy rate after the second operation was compared with the clinical pregnancy rate after one cycle of IVF-ET. RESULT: The cumulative pregnancy rate following the reoperation was 20.5% within 1 year with no additional increase in 2 and 3 years of follow up. The clinical pregnancy rate per stimulation of one cycle of IVF-ET was 12.5%. There was no statistically significant difference (P = 0.54). CONCLUSION: Despite a trend toward a higher cumulative pregnancy rate following the second conservative laparotomy, there was no statistically significant difference, when compared with one cycle of IVF-ET in moderate and severe endometriosis-associated infertile patients who had not conceived after the initial operation.