Endometrial polyps and their relationship in the pregnancy rates of patients undergoing intrauterine insemination.

PURPOSE: To evaluate the effect of the presence of endometrial polyps (EP) on pregnancy rates and how polypectomy could affect pregnancy rates in women scheduled for intrauterine insemination (IUI). METHODS: The study included patients who had attended the Second Department of Obstetrics and Gynecology of the University of Athens from April 2003 to October 2008 for infertility treatment and were candidates for IUI. In these women the presence of an endometrial polyp had been already diagnosed during the infertility evaluation. The study group consisted of 86 women who, following the diagnosis of endometrial polyp, had agreed to have the polyps removed hysteroscopically prior to the IUI. The control group consisted of 85 women, who despite the fact that the presence of an endometrial polyp had been previously diagnosed and its removal suggested, elected not to have the polyp removed. We used statistical analysis to check what effect the removal of the polyp had on the total number of pregnancies. RESULTS: There was a statistically significant difference in cumulative pregnancy rates between the two groups. The group that underwent polyp removal had higher pregnancy rates as compared to the one that the polyps were left intact. CONCLUSIONS: We propose that hysteroscopic polypectomy of any size appears to improve fertility in women with otherwise unexplained infertility.

Surgical management of invasive carcinoma of the vulva. A retrospective analysis and review.

PURPOSE: A retrospective study aiming to assess the survival rate, recurrence rate and complications of patients with invasive squamous cell carcinoma of the vulva. METHODS: 91 patients with invasive carcinoma of the vulva were included in the study. The following clinical factors were assessed: clinical stage, diameter of lesion, and degree of tumor differentiation. The Kaplan-Meier estimate for statistical analysis of survival was used. RESULTS: Surgery was primary treatment for 76 patients. The 5-year survival for FIGO Stage I was 93.3%, Stage II 85%, Stage III 51% and for Stage IV it was zero as estimated by the Kaplan-Meier test. Of the 52 women who underwent inguinal lymphadenectomy, 11 or 21.1% had positive nodes and four patients underwent pelvic node resection. Patients with tumor size < or = 2 cm had 16.7% positive inguinal nodes, while patients with tumor size > 2.1 cm had 29.4% of positive nodes. CONCLUSIONS: The right choice of surgical treatment after appropriate staging of the disease offers very good survival rates, while a more accurate assessment of the status of inguinal lymph nodes could reduce the extent of surgical treatment.

Clinical parameters linked with malignancy in endometrial polyps.

AIM: To investigate the association of different clinical parameters with the histological diagnosis and the prevalence of premalignant and malignant endometrial polyps. METHOD: The study included 516 cases from January 2002 to December 2006. Possible risk factors such as age, menopause status, abnormal bleeding, obesity, hypertension, diabetes mellitus, hormone therapy, use of tamoxifen and size of polyp were investigated in relation to their association with the malignant potential of endometrial polyps. RESULTS: All cases of endometrial polyps underwent hysteroscopic resection; 96.9% of the cases were benign, 1.2% premalignant and 1.9% malignant. Premalignant and malignant endometrial polyps were significantly associated with advanced age (>60 years), menopause, obesity and diabetes. The malignant polyps were analyzed to eight endometrioid, one serous and one clear cell carcinoma. CONCLUSION: The prevalence of premalignant and malignant endometrial polyps is very low. Advanced age, menopause, obesity and diabetes increase the risk of endometrial polyp malignancy.

On the structured imperfections of bulk GaSb using high resolution transmission electron microscopy.

GaSb is a promising III-V direct band gap semiconductor with sphalerite type FCC structure. Its band gap value has made it an excellent candidate for the conversion of infrared radiation to electricity. The wafers of GaSb, that were studied, originated from ingots grown with the Liquid Encapsulated Chochralski method. In all cases, Energy Dispersive X-ray Spectroscopy and Particle Induced X-ray Emission measurements demonstrated an excess of Sb. In the present work conventional transmission electron microscopy (CTEM) and high resolution electron microscopy (HRTEM) were used in order to determine the effect of the Sb excess in the structural characteristics of the material, mainly after thermal treatment. A structure model based on the ordering of the Sb antisites (Sb(Ga)) rather than the Ga vacancies (V(Ga)) is proposed for the observed modulation in small areas of the material.

Primary fallopian tube cancer--a ten year review. Clinicopathological study of 12 cases.

Primary fallopian tube cancer is the rarest of all gynecologic cancers, presenting as benign pelvic disease or more often as ovarian cancer and almost all cases are diagnosed at operation or autopsy. Primary adenocarcinoma is the most common histological type of primary tube cancer which has traditionally been managed and treated in the same manner as epithelial ovarian cancer. However, unlike ovarian cancer, fallopian tube cancer is not routinely suspected and treatment may be delayed and also seems to have a worst prognosis than ovarian cancer. We present a retrospective study involving 12 patients with primary fallopian tube cancer treated in our department. The clinicopathologic characteristics and treatment are reviewed.

Long term effects of Tibolone on postmenopausal women with uterine myomas.

OBJECTIVES: The aim of the present study is to evaluate the long term effects of Tibolone (Livial) on uterine myomas volume as well as on uterine arteries pulsatility index (PI) in postmenopausal women. METHODS: This study included 66 naturally menopausal women. Twenty of them (group A) had no uterine myomas; 23 of them (group B) had a single, asymptomatic, intramural or subserous myoma of a maximum diameter less or equal than 2 cm; 23 of them (group C) had a single, asymptomatic, intramural or subserous myoma of a maximum diameter between 2 and 5 cm. The volume of the myomas as well as the pulsatility index of the uterine arteries was assessed by transvaginal ultrasonography every 6 months after administration of Tibolone (2.5 mg daily). RESULTS: No statistically significant difference on myomas volume was found after a 3-year period of Tibolone administration. The uterine artery basal PI was significantly higher in group A compared to that of groups B and C. After 6 months of Tibolone administration the PI in group A was significantly lower compared to the basal one whereas in groups B and C was significantly higher compared to the basal value. CONCLUSIONS: Our results suggest that treating postmenopausal woman with Tibolone on a long-term basis: (a) does not increase the volume of uterine myomas and (b) has an early effect on uterine haemodynamics (decrease of PI in women without myomas and increase of PI in women with myomas).

Colposcopically directed biopsy findings in the young female.

STUDY OBJECTIVE: To evaluate the colposcopic findings of cervical alterations in the young sexually active female. DESIGN, SETTING, PARTICIPANTS: Colposcopic examination and follow-up of 51 young sexually active females aged 15-20 yr was conducted due to abnormal cytology or a suspicious abnormality of the cervix. The study was conducted at the Colposcopy Units of the 1(st) and 2(nd) Departments of Obstetrics and Gynecology, University of Athens, Greece. ONTERVENTIONS: Colposcopic examination, LEEP, conization. MEAN OUTCOME MEASURES: Biopsy, human papillomavirus (HPV) typing. RESULTS: Colposcopic examinations were within normal limits in 8 of 51 (15.7%) cases. Cervical alterations were related to HPV infection in 14 cases (27.4%), to cervical intraepithelial neoplasia (CIN) I in 15 (29.4%) cases, to CIN II in 13 (25.5%) cases, and to CIN III in 1 (2.0%) case. Of all CIN I cases, 8 of 15 (53.3%) were HPV positive, and HPV type 11, 16, 18, 31, 33, and 11& 16 were found. In CIN II cases, 5 of 13 (38.4%) were HPV positive, and HPV type 11, 16, 18, and 11 & 31 were found. In the CIN III case, only HPV type 16 was found. CONCLUSIONS: Our findings strongly confirm the necessity of obtaining cervicovaginal smears on all sexually active gynecologic and obstetric teenage patients. Colposcopy plays a major role in the evaluation of the cervix and in the treatment that should be given for any individual CIN lesion.

Bone mineral density in women with idiopathic hirsutism.

Idiopathic hirsutism is relatively uncommon, affecting approximately 6% of hirsute women. In the present study we compared the bone mineral density (BMD) of women with idiopathic hirsutism with controls. A group of 20 women diagnosed with idiopathic hirsutism was evaluated with respect to BMD and the findings were compared to those of a control group consisting of 10 normal women. Hirsutism was graded according to the Ferriman-Gallwey score and threshold was considered to be a score more than 4. There was no statistically significant difference with respect to patients' mean age, BMI and body fat composition. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), androstenedione, testosterone, free testosterone, 17 alpha-hydroxyprogesterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG) and estradiol were assessed in both groups and no statistically significant differences were found. There was no statistically significant difference with respect to bone turnover--which was evaluated by determining the serum levels of parathyroid hormone, calcium, alkaline phosphatase and osteocalcin as well as the urinary secretion of calcium and hydroxyproline, corrected for the creatinine values--between the two groups. Statistical analysis was performed using the t test for unpaired data to compare age, BMD and biochemical data, and Wilcoxon's rank test was used to compare physical activity and calcium intake. Statistical significance was defined as p < 0.05. The BMD at the level of the 2nd to 4th lumbar vertebrae (L2-L4) and the total BMD were higher in women with idiopathic hirsutism compared to those in the control group, suggesting a possible direct effect of androgens on the osseous tissue of hirsute women.

The effect of combined oral contraception with or without spironolactone on bone mineral density of hyperandrogenic women.

We studied the effect of treatment with combined oral contraception (COC) with or without spironolactone on the bone mineral density (BMD) of hyperandrogenic women. A group of 22 women (group 1) was treated with ethinylestradiol plus desogestrel for 21 days each month for 12 months, while another group of 21 patients (group 2) was treated with ethinylestradiol and desogestrel for 21 days each month plus spironolactone daily for 12 months. There was no statistically significant difference with respect to mean age, body mass index (BMI) and BMD between the two groups of patients before the treatment. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), androstenedione, total testosterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG), prolactin and estradiol were assessed in both groups and no statistically significant difference was found before treatment. Nor was there any statistically significant difference in bone turnover between the two groups. Statistical analysis was performed using the Student's t test for unpaired data to compare age, BMD and biochemical data, and statistical significance was defined as p < 0.05. The BMD before and after 12 months of treatment showed no statistically significant difference between the patients of group 1 and those of group 2, suggesting that both ethinylestradiol plus desogestrel, and ethinylestradiol and desogestrel plus spironolactone daily for 12 months at the given doses do not affect the BMD of the treated women, while the addition of spironolactone improves the efficacy of hirsutism treatment.

Evaluation of ovarian cysts following GnRH-a treatment in patients with polycystic ovarian syndrome.

The aim of this study was to evaluate the ovarian cysts appearing during GnRH-a/hMG treatment in patients with polycystic ovarian syndrome (PCOS). A total of 35 women with PCOS were included in the study. All women received 3.75 mg IM of long-acting leuprolide acetate on the first day of the menstrual cycle. On the 15th day of the menstrual cycle, transvaginal ultrasound examination (US) and determination of serum E2 were done. A total of 90 cycles were studied in this way and during these cycles, 14 (15.5%) ovarian cysts with a diameter of >/= 20 mm developed. According to the serum E2 levels, 11 cases (group A) had E2 concentrations > 35 pg/ml and 3 (group B) had serum E2 levels < 35 pg/ml. Group A patients attained a significantly larger mean size of ovarian cyst than group B patients (42 +/- 7.3 vs. 24.2 +/- 3.2 mm, p < 0.001). When the serum E2 concentrations were < 35 pg/ml, the ovarian cysts were disregarded and ovarian stimulation with gonadotropins was initiated. In case that serum E2 levels were > 35 pg/ml, the initiation of the ovarian stimulation with hMG was postponed until serum E2 levels indicated down-regulation, which was achieved after 5.8 +/- 2.9 days. In both groups the ovarian stimulation resulted in ovulatory cycles, while four pregnancies in group A and one in group B were achieved. In conclusion, our results indicate that in patients with PCOS the GnRH-a administration may cause follicular cysts at an incidence of 15.5%. These cysts do not constitute a contraindication for ovarian stimulation provided that serum E2 levels are low.

Clinical value of creatinine kinase in the diagnosis of ectopic pregnancy.

The role of creatinine kinase (CK) in the diagnosis of ectopic pregnancy was studied. We selected 56 patients divided into 4 groups. Group A consisted of 10 patients with asymptomatic tubal pregnancy, group B consisted of 11 patients with symptomatic tubal pregnancy whereas groups C and D consisted of 20 and 15 patients with normal and threatened intrauterine pregnancy, respectively. Serum samples of CK were taken from all patients on admission. No significant difference was observed in the median CK value of cases with normal pregnancy (58.5 +/- 7.24 U/1, mean +/- SE) as well as threatened abortion (73 +/- 11.43 U/1) compared to that of cases with asymptomatic 58.5 +/- 12.42 U/1) or symptomatic tubal pregnancy (59 +/- 10.08 U/1). We conclude that serum CK is not a useful biochemical marker in the diagnosis of ectopic pregnancy.

PIP: Increased serum creatinine kinase (CK) generally reflects injury of skeletal muscle. Thus, the muscular damage caused by the invasion of the trophoblast into the muscular layer of the fallopian tube in ectopic pregnancy should cause release of CK into maternal serum. The role of CK in the diagnosis of ectopic pregnancy was investigated in four groups: 10 women with asymptomatic tubal pregnancies, 11 patients with symptomatic tubal pregnancies, 20 women with normal intrauterine pregnancies, and 15 patients with threatened intrauterine pregnancies. Mean gestational age in these four groups ranged from 42.35 to 68.25 days. No significant differences in median serum CK values were detected between those with a normal pregnancy (58.5 +or- 7.24 U/l) or threatened abortion (73.0 +or- 11.43 U/l) compared with women with asymptomatic tubal pregnancy (58.5 +or- 12.42 U/l) or symptomatic tubal pregnancy (59.0 +or- 10.08 U/l). These findings indicate that serum CK is not a valid biochemical marker in the diagnosis of ectopic pregnancy. Damage to the fallopian tube wall, even in advanced ectopic pregnancy, appears to be insufficiently extensive to produce an increase in serum CK.

Treatment of idiopathic oligozoospermia with an alpha-blocker: a placebo-controlled double-blind trial.

OBJECTIVE: To evaluate the efficacy of terazosin, an alpha-blocker, for the treatment of idiopathic oligozoospermia. PATIENTS AND METHODS: Thirty couples with infertility whose only detectable abnormality was male idiopathic subfertility entered the study. The diagnosis of idiopathic subfertility in all males studied, aged 26 to 38 years (mean 28.2 years), was confirmed after exclusion of any iatrogenic, systemic, congenital, infectious, autoimmune or endocrinological cause. In order to start with a baseline value before the study, at least three semen samples were evaluated in accordance with the WHO recommendation. Before initiation of treatment, blood samples were drawn for measurement of FSH, LH, testosterone, prolactin, dihydrotestosterone, and estradiol. Fifteen randomly selected patients (Group A) received 2 mg/d of alpha-blocker (terazosin), while another 15 (Group B) were administered an identically packed placebo tablet. Both groups received therapy for 6 months. RESULTS: The mean seminal volume changed insignificantly between the two groups (4.15 +/- 1.95 vs. 4.10 +/- 1.95). There was a statistically significant increase of the sperm concentration in patients who received the alpha-blocker compared to those receiving placebo (24.76 +/- 9.45 vs. 13.15 +/- 11.55 millions/mL; P < .001). No improvement of the mean percentage of abnormal spermatozoa was observed in the treated patients, nor a statistically significant difference of sperm motility in the treated group compared to the placebo group. Side effects were not observed in the patients receiving terazosin treatment, or were so minimal that therapy was continued. The pregnancy rates did not differ between the two groups to a statistically significant degree. CONCLUSION: The administration of terazosin to patients with idiopathic oligozoospermia has a demonstrably positive effect, especially on sperm concentration.

Effect of tibolone on postmenopausal women with myomas.

OBJECTIVE: The aim of this study is to assess the effect of Tibolone (Livial) on uterine fibroids in postmenopausal women. METHODS: This study included 40 naturally postmenopausal women with at least one uterine fibroid measuring > 20 mm. All of theme were scanned by transvaginal ultrasonography. Patients were randomized into two groups. Group A (n = 20) were treated with Tibolone 2.5 mg daily for 1 year and group B (n = 20) did not received therapy. The size of the uterine fibroids was reevaluated on the end of the treatment. RESULTS: No statistically significant difference was found in the mean volume of fibroids before and after treatment with Tibolone. The administration of Tibolone resulted in an increase of fibroid volume in three patients, whereas it remained constant in the majority of the patients (70%) and decreased in three patients. CONCLUSIONS: Our results suggest that treating menopausal symptoms with Tibolone does not affect preexisting asymptomatic uterine fibroids.

Gonadotropin-releasing hormone analogue plus hormone replacement therapy for the treatment of endometriosis: a randomized controlled trial.

OBJECTIVE: The aim of this study was to determine whether or not continuous combined HRT used with GnRH-a for the treatment of endometriosis can prevent hypoestrogenic side effects associated with GnRH-a. METHODS: Forty premenopausal women with laparoscopically proven endometriosis entered the study. The patients were randomized into two groups. Group I (n = 19) received 3.75 mg i.m. leuprolide acetate (LA) every 4 weeks for 24 weeks. Group II (n = 21) received 3.7 mg LA combined with 1.25 mg oral conjugated equine estrogen (CEE) and 5 mg oral medroxyprogesterone acetate (MA). RESULTS: Total revised AFS score as well as total pelvic pain scores decreased significantly (P < .001) in both groups. However, a statistically significant difference of hot flushes and sweating was reported by women receiving LA + HRT as compared to those treated with LA alone (P < .001). Furthermore, the bone loss at the lumbar spine was 4.2% in group I compared to 0.9% in group II at the end of the study. CONCLUSIONS: This study suggests that 1.25 mg CEE + 5 mg MA is effective in preventing hypoestrogenic side effects caused by GnRH-a, while the treatment of endometriosis is not impaired.

Effects of nasal administration of calcitonin in oophorectomized women: 2-year controlled double-blind study.

OBJECTIVE: The aim of this study was to assess the effects of nasal salmon calcitonin (SCT) administration on bone turnover in ovariectomized women. METHODS: Patients who had undergone bilateral ovariectomy 7 days previously, received either calcium supplementation (1000 mg/day, together with nasal SCT (100 IU/day) (n = 19) or the same calcium supplementation together with a placebo intranasal spray daily (n = 19), for 2 years. RESULTS: In the calcium-only-treated subjects, lumbar bone mineral density (BMD) was found to have decreased significantly (P < 0.001), 6 months after surgery and remained at this level until the end of the study. In the SCT-treated group, BMD remained stable during the 1st year and then decreased gradually, reaching a statistically significant level in the 2nd year. Mean serum osteocalcin concentration was unchanged during the 1st year of SCT treatment but was significantly elevated during the 2nd year (P < 0.01). The observed rise in serum osteocalcin concentration and urinary hydroxyproline excretion during the 2nd year of treatment with SCT was accompanied by a significant rise in serum calcitonin levels (P < 0.001 after 18 months and P < 0.01 after 24 months). CONCLUSION: This study shows that continuous treatment with intranasal SCT is able to prevent the bone loss that follows ovariectomy.

Corticosteroid treatment does not improve the results of intrauterine insemination in male subfertility caused by antisperm antibodies.

AIM: To determine whether corticosteroid immunosuppression (CS) administered to the male partner together with intrauterine insemination (IUI) is preferable compared to IUI alone in treating male autoimmune subfertility. MATERIALS AND METHODS: Thirty-six couples with proven male immunological subfertility were randomly assigned to begin CS + IUI (n = 18) or IUI (n = 18) treatment and progressed alternatively to receiving each treatment modality for three cycles unless pregnancy occurred. Each couple served as their own control. The administered corticosteroid was soluble prednisolone. RESULTS: Five pregnancies were achieved with 77 cycles of CS + IUI and seven pregnancies with IUI alone. The pregnancy rates per cycle were 6.5% with CS + IUI and 9.21% with IUI, while the pregnancy rates per couple were 16.13% with CS + IUI and 21.2% with IUI alone. These rates do not differ to a statistically significant degree (P > 10%). CONCLUSIONS: The addition of corticosteroid immunosuppression does not seem to significantly enhance the pregnancy rate in couples with male autoimmune subfertility treated with IUI as compared to the treatment with IUI alone. Considering the possible side-effects of corticosteroid intake, we conclude that IUI alone might be preferable to the combination of IUI with corticosteroid administration.

Comparison of flutamide and cyproterone acetate in the treatment of hirsutism: a randomized controlled trial.

The objective of this study was to compare the efficacy of flutamide and cyproterone acetate in the treatment of hirsutism. Twenty-two women with idiopathic hirsutism were randomized to receive either flutamide or cyproterone acetate. Each patient underwent a complete gynecological examination as well as an endocrinological profile and hematological, hepatic and renal function analyses. Hirsutism scores were determined using a modified Ferriman-Gallwey scoring system. These tests were then repeated at 3 and 9 months of therapy. Eleven patients received 250 mg of flutamide twice daily and 11 patients received 100 mg of cyproterone acetate on days 5-14 of the menstrual cycle. Ferriman-Gallwey scores were decreased significantly in both groups at the end of 9 months. There was a trend towards a better response with flutamide, that did not achieve significance. Another significant difference was the increased sex hormone-binding globulin in both groups. A statistically significant decrease was also observed for the levels of testosterone on both drugs. No subject withdrew from the study due to a side-effect. The data suggest that both flutamide and cyproterone acetate were similarly effective in treatment of hirsutism, and that the pure antiandrogen flutamide is a safe, well-tolerated and effective alternative in treatment.

Pregnancy rates in gonadotrophin stimulated cycles with timed intercourse or intrauterine insemination for the treatment of male subfertility.

OBJECTIVE: To compare the pregnancy rates achieved by intrauterine insemination or timed intercourse in gonadotrophin stimulated cycles in couples whose only detectable abnormality was poor sperm quality. DESIGN: Sixty-two couples with primary or secondary infertility due to male factor entered the study. The 62 couples were randomly equally divided into two groups. Each group began one of the two treatment modalities (controlled ovarian hyperstimulation in conjunction with timed intercourse or intrauterine insemination) for three consecutive cycles and then switched to the alternative treatment after one rest cycle, if pregnancy was not achieved. RESULTS: Five pregnancies (3.9%) were achieved after 128 cycles with timed intercourse and 15 pregnancies (11.5%) after 130 cycles with intrauterine insemination. The difference was found to be statistically significant (P < 0.05). CONCLUSION: We suggest that intrauterine insemination during hMG stimulated cycles improves the pregnancy rates of couples whose only detectable abnormality is poor sperm quality.

Controlled ovarian hyperstimulation with or without intrauterine insemination for the treatment of unexplained infertility.

OBJECTIVE: To evaluate whether there are any benefits from intrauterine insemination (IUI) as opposed to timed intercourse (TI) in stimulated ovarian cycles in couples with longstanding, unexplained infertility. METHODS: Forty-six couples with diagnoses of unexplained infertility were evaluated in a crossover study after a total of 141 cycles. Sixty-seven cycles were with IUI after controlled ovarian hyperstimulation (COH) while 74 cycles were after COH and TI. RESULTS: The pregnancy rate after COH/TI was 16.7% and after COH/IUI 45.2%. Cycle fecundity however was 8.9% after COH/TI and 25.7% after COH/IUI, which is a statistically significant difference (P < 0.05). CONCLUSIONS: A trial of human menopausal gonadotropin and IUI is justified in couples with prolonged infertility of unknown cause.

Fallopian tube sperm perfusion has no advantage over intra-uterine insemination when used in combination with ovarian stimulation for the treatment of unexplained infertility.

In this prospective randomized study we treated 60 couples with unexplained infertility with a combination of ovarian stimulation and either intrauterine insemination (IUI) or fallopian sperm perfusion (FSP). In the IUI we used a volume of 0.5 ml of inseminate and in the FSP a volume of 4 ml. The demographic characteristics of the patients, the stimulation parameters and the sperm data were not statistically different between the two groups. The pregnancy rate per cycle was 16.2% in the IUI group and 14.5% in the FSP group and the pregnancy rate per woman was 40 and 36.7%, respectively (not statistically different). We conclude that IUI and FSP are equally effective in the treatment of couples with unexplained infertility.