Evaluation of different diagnostic modalities of genital tuberculosis among infertile women

Objective: to estimate the frequancy of genital tuberculosis [T.B] among infertile women undergoing laparoscopic evaluation in El Minia University Hospital.-Secondly to assess different diagnostic modalities of genital T.B

Design: a prospective study

Setting: Department of Obstetrics and Gynacolgy, Department of Pathology and Department of Microbiology, Faculty of Medicine, Minia University

Methods: 150 infertile women undergoing laparoscopy were included into the study from December 2003 to September 2005, Laparoscope criteria of genital T.B were observed, any suspicious lesions for T.B. adnexities or peritonitis were biopsied, peritoneal fluid was obtained for detection of mycobacteria by automated radiometric BACTEC 460 system and culture in Lowenstein Jensen medium [L.J], lastly Whole endometrial curettage was taken for histopathology

Results: the incidence of genital T.B as diagnosed by Laparoscopy was 8% among study group, the incidence of positive patients was more among rural, low socioeconomic and low educational level patients. Both laparoscopic findings confirmed by biopsy and BACTEC showed high sensitivity and specificity [93-95%] compared to endometrial biopsy [81-83%] and culture in L.J [72-76%] for diagnosis of genital T.B. Moreover BACTEC showed shorter detection time than L.J

Conclusion: it is essential for a gynecologist working in developing countries to anticipate possibility of genital T.B in infertile patients. For the diagnosis of genital T.B the simultaneous use of BACTEC and L.J is recommended to provide maximal optimal recovery of isolates from clinical specimens. The time-Saving in BACTEC provides an excellent facility for gynecologists in patient's management

aromatase inhibitor letrozole improves the fertilization, and ongoing pregnancy rate in low responder patients undergoing IVF cycles

Objective: the aim of this study was to see the effect of adding aromatase inhibitor, letrozole to a high doses of rFSH/hMG-antagonist regimen on the number of the mature follicles, retrieved oocytes, egg's quality, clinical pregnancy rate, and rate of cycle cancellation in poor responder patients with a previous history of at least 2 cancelled IVF cycles

Study Design: this study included 83 infertile couples who had at least two cancelled IVF trials due to poor ovarian response. Those patients were divided into two groups, letrozole group, included 41 infertile couples, and control group included 43 infertile couples, and compared

Results: patients.in both groups were comparable in terms of age [37.3 +/- 1.2 versus 35.7 +/- 2.4 years], .day 3 FSH, LH, and E2 serum levels as shown in table 1. There was no significant differences among both groups regarding the number of stimulation days [10.3 +/- 0.6 versus 9.6 +/- 0.4], mean FSH/hMG dose administered [4,236 +/- 219 versus 4,463 +/- 238], and endometrial thickness [8.6 +/- 1.3 versus 9.8 +/- 0.9]. However, there were significant differences between both groups in terms of cancellation rate due to poor response [12.2% versus 34.9, p < 0.001], number of mature follicles [5.8 +/- 1.2 versus 3.4 +/- 0.6, p = 0.039], and in the number of retrieved oocytes [8.3 +/- 1.6 versus 4.2 +/- 0.6, p < 0.001]. In addition, there were significant differences in the terms of fertilization rate [86.4% versus 64.9%, p = 0.038], and in the clinical pregnancy rate [44.4% versus 25%, p = 0.36] between the two groups, however, there is no significant difference between them regarding the percentage of the multiple pregnancies [25% versus 28.6%, p = 0.43]

Conclusion: in conclusion, addition of aromatase inhibitors, letrozole in the first 10 days of the stimulation induction using a high doses of rFSH/hMG antagonist regimen, were associated with a higher number of mature follicles, less cancellation rate, more retrieved mature oocytes, and higher clinical· pregnancy rate in low responder patients with a previous history of at least 2 cancelled IVF cycles

Randomized clinical study of cryotherapy, loop electrosurgical excision and electrocautery for treatment of squamous lesions of the cervix

Objective: to compare cryotherapy, loop electrosurgical excision and electrocautery for treatment of squamous lesions of the cervix

Patients and method: Women at least 18 years old with biopsy- proven SIL, between June 2003 and December 2004. 72 patients underwent loop excision, 64 patients in the electrocuatery group and 60 patients in the cryotherapy group

Setting: Early cancer detection units of El-Minia University Hospital and Ain Shams Maternity Hospital

Intervention: Cryotherapy, loop Electrosurgical excision procedure [LEEP] and Electrocautery were done

Main outcome measures: Complication [as infections, bleeding, cervical stenosis, pain, visibility of the transformation zone and discharge] and efficacy [rate of recurrence and persistence of the lesions] of the three treatment modalities

Results: there were no statistically significant difference in complications, rate of persistence or recurrence. Risk of persistent or recurrent lesions were higher among patients with large and high grade lesions

Conclusions: the data support a high success rate with the three modalities. No differences in the complication or failure rates were detected