[Laparoscopic ovarian drilling and biopsy in women with polycystic ovaries (PCOS) and infertility].

OBJECTIVES: To evaluate ovarian reserve according to results of biopsy of ovaries during laparoscopy. To investigate connections between hystologic results, drilling of ovaries and pregnancies. METHODS: We investigate prospectively 74 patients with polycystic ovaries (PCOS) and infertility. Operative laparoscopy have be done in 2006, 2008 and 2009 year in University Hospital "Maichin Dom" Sofia, Bulgaria. All patients had ovarian drilling and biopsy. RESULTS: Microscopic findings from biopsy of ovary in 74 women with PCOS were divided in 4 groups. In this investigation from 74 women with operative laparoscopy 33 patients (44.5%) were pregnant. CONCLUSION: The results of biopsy and registered pregnancies in PCOS patients is very difficult to analyse. Laparoscopic ovarian drilling and biopsy affect ovarian tissue. The ovary probably change own characteristics--ovarian metabolism and physiology are restored and this changes our clinical prognosis for a future pregnancies.

[Stromal ovary in 14 years old girl].

Struma ovarii was first described in 1899 and is extremely rare, with only 150 reported cases in the medical literature. Struma ovarii is most common between the ages of 40 and 60 years. Women with struma ovarii usually present with a pelvic mass or, less frequently, with hyperthyroidism or ascites. As in follicular tumors of the thyroid gland, the thyroid epithelium in the teratoma may be organized in a solid, embryonal or pseudotubular pattern, rather than thyroid follicles. The authors present an extremely rare case of struma ovarii in 14-year-old girl.

[Sperm parameters in male idiopathic infertility after treatment with prelox].

UNLABELLED: The diagnosis of male infertility is determinate after assessment of sperm quality and clinical study. In nearly 30% of the cases nevertheless detailed clinical and laboratory study it can't be discovered the cause and on the bases of exclusion criteria set the diagnosis idiopathic infertility. The object of our study was investigation of the group patients (n=50) with idiopathic infertility treated with Prelox and to be studied its effects on spermatozoa parameters. MATERIAL AND METHODS: The study design was double-blind, placebo-controlled, cross-over, randomized study, including introduction period (1 month), two therapeutic periods (each one of 1 month) separated with 1 month wash out period and concluding period of 1 month. There was applied a new method for treatment with mechanism of action stimulation the production cGMP of spermatozoa endothelial nitric oxide synthase (eNOS). This is not surprising achieving results show improvement of sperm quality. The methods of the study were: 1. Assessment of the conventional semen analysis (according the criteria of WHO, 1999). 2. Spermatozoa function tests. 3. Spermatozoa-cervical mucus penetration tests. RESULTS: The obtained results showed improvement of sperm quality, in the middle-aged men the therapeutic answers was better than in younger. In conclusion the therapy with Prelox improve sperm parameters in men with idiopathic infertility. Pycnogenol (one of the constituents of Prelox) has powerful antioxidative influence ameliorating spermatozoa function.

[Results of treatment with doxycyclin after diagnostic and therapeutic curettage].

In prospective study we investigated 92 patients after curettage. All women were treated with Doxycyclin immediately after curettage 2 times with 1 tablet of 100 mg every 12 hours for 3 days. With 72 of these patients we had feed-back and they were followed for signs of infection. In 49 patients (II group) emergency curettage was performed and in 23 patients (I group) a planning endometrial biopsy (Strich abrasio) was done. We noted 100% success rate in I group and 91.7% in II group with Doxycyclin for 3 days. Only in 6 patients (8.3%) of II group the continuing treatment with Doxycyclin was necessary for 6 days because of signs of infection. The use of Doxycyclin after curettage for 3 days decreases the risk of infection and only the doctor will decide the usage of antibiotic for 6 days.

[Outcome of treatment with doxycycline following diagnostic and therapeutic curettage].

In prospective study we investigated 92 patients after curettage. All women were treated with Doxycyclin immediately after curettage 2 times with 1 tablet of 100 mg every 12 hours for 3 days. With 72 of these patients we had feed-back and they were followed for signs of infection. In 49 patients (II group) emergency curettage was performed and in 23 patients (I group) a planning endometrial biopsy (Strich abrasio) was done. We noted 100% success rate in I group and 91.7% in II group with Doxycyclin for 3 days. Only in 6 patients (8.3%) of II group the continuing treatment with Doxycyclin was necessary for 6 days because of signs of infection. The use of Doxycyclin after curettage for 3 days decreases the risk of infection and only the doctor will decide the usage of antibiotic for 6 days.

[Selecting function of female genital tract in relation with spermatozoa interaction].

The present study includes 50 infertile couples followed sperm parameters: morphology and others indices for ability of penetration in ovulatory cervical mucus during 12 months. It is discussed the possibility of which spermatozoa can participate in the fertilization and the impotence and place of the female genital tract for the selection of morphologically abnormal spermatozoa before reaching the place of fertilization.

[Endometriosis--is it treatable?].

Its etiology remains uncertain, its pathogenesis disputed and its treatment poor. Most medical treatment is based on ovulation suppression and inducing amenorrhoea. New findings on the genetics, the possible roles of the environment and the immune system, intrinsic abnormalities in the endometrium and secreted products of endometriotic lesions have given explanation into the pathogenesis of this disorder and give us new trends for treatment the disease.

[Uterine endosonography with sterile serum infusion in infertile women].

UNLABELLED: Infusion of sterile serum in the uterine cavity during ultrasound examination is useful for investigation bout polyps, submucous myoma, adhesion and anatomical malformation. Examination of the patients with ultrasound is suitable to be with medicine in the infusion, menometrorrhagia sterility, all changes in the endometrium. CONTRAINDICATIONS: genital infection, pregnancy, neoplasma of cavum uteri. TECHNIQUES: investigation was between 7th and 12th day of the cycle. We used insemination catheter to put in the cervical canal. There is a syringe with infusion on the other end. The speculum was took of the vagina and put on the transducer. We performed examination of the uterus in the different scans. When the infusion was fulfilled the avum uteri we observed different findings. 24 patients with sterility were passed for ultrasound examination with sterile serum for the period of 1 year (2003--2004). We diagnosed normal cavum uteri thiken endometrium, endometrial polyp, submucous myoma amd malformation uteri.

[Gonadotropin-releasing agonist in the therapy of patients with laparoscopically confirmed endometriosis]. / Lechenie s gonadotropin rilizing agonist pri patsientki s laparoskopski dokazana endometrioza.

OBJECTIVE: To determinate the effectiveness of treatment with gonadotrophine releasing hormone agonist. METHODS: We investigated 164 patients with laparoscopy divided in two groups. Women in first group received Dipherelin 3. 75 mg /lpsen/ for 3 months. Second group had received Dipherelin 3.75 mg for 6 months. Preparation was done i.m. every 28 days. All patients in the study had endometriosis grade I-II using the AFS classification after laparoscopy. The measures according to compare in the 2 groups was as following: 1. Dysmenorhoea, dyspareunia and pelvic pain before and after treatment. 2. Rate of pregnancy. 3. Bleeding during the treatment. 4. Amenorhoea after treatment. CONCLUSIONS: After analysis of the patients in the 2 groups we decided that Dipherelin 3.75 mg is an effective treatment of sterility related to endometriosis.

[Ovarian function after oral contraception in infertile patients]. / Ovarialna funktsiia sled oralna kontratseptsiia pri patsientki sus sterilitet.

We investigated ovarian activity in 54 infertile patients. The patients took oral contraceptives for two months. Thirty-three patients (first group) took Anteovin with 0.05 mg ethinylestradiol and 21 patients took (second group) took Regulon with 0.03 mg ethinylestradiol. Follicular development was assessed by vaginal ultrasonography from 10th to 15th of menstrual cycle days. Serum progesterone levels were measured on menstrual cycle days 21 to 24. Ovarian activity after oral contraceptive during first month show follicular growth and ovulation 48.48% after Anteovin and 71.42% after Regulon /p > 0.01/. During the second month we established increase in follicular development, rising of middle of maximum follicular diameters and ovulation 71.48% after Anteovin and 85.71% after Regulon /p > 0.01/.

[Prophylaxis with tercef of infection-related complications after cesarean section]. / Profilaktika s Tercef na infektsioznite uslozhneniia sled tsezarovo sechenie.

The purpose of this prospective and case controlled study is to determine the effectiveness and safety of antibiotic prophylaxis with Tercef (ceftriaxone) in women undergoing cesarean section and to compare the results with those of 24 hours regiment of Cefazolin and also with a group without prophylaxis. The study includes 122 cases of elective and emergency CS: 41 with a single intravenous dose of 1.0 g Tercef after clamping of the umbilical cord; 41 cases of antibiotic prophylaxis with Cefazolin three times 2.0 g for 24 hours and 40 low infectious risk CS without antibiotic prophylaxis. We take in account the existing before the CS risk factors for postoperative infectious complications as: hours of PROM; length of labor, number of vaginal examinations before CS, previous sections, duration of the operation, anemia, bacteriuria and diabetes. For post CS infection-related complications we take: febrile morbidity, endometritis, wound infections, infection of urinary tract. The results show infection complication in the three groups as follow: 14.6% for tercef, 17.1% for cefazolin and 20.0% for the group without antibiotic. There is not statistically significant difference. According our study in cases of CS with increased risk of post-operative infectious complications the antibiotic prophylaxis reduce the rate of infection-related complications even below that of CS with low infectious risk. The single dose of 1 g tercef i.v. is effective and suitable in comparison with 24 hours regiment of cefazolin.

[Our 3- to 5-year experience with Anteovin]. / Nash tri-pet godishen opit s Anteovin.

Anteovin was used in the treatment of dysmenorrhoea, climax precox, dysfunctional uterine bleeding, bleeding with IUD and oral contraceptive. 247 women and adolescents for 6761 cycles were treated with Anteovin for period of 3-5 years. Results were excellent. 21 women--8.17% had side effects.

[The most suitable tests for studying chlamydial infection in women with sterility]. / Nai-podkhodiashti testove za izsledvane na khlamidialna infektsiia pri zheni sus sterilitet.

The study was carried out on 280 infertile women (185 with primary and 95 with secondary infertility), patients of the University Clinic of Gynecologic Endocrinology and Infertility, Sofia. The present study was designed to estimate which is the most suitable test for detection of chlamydial infection in women with infertility. Evidence of past chlamydial infection was determined by the presence of antichlamydial IgG antibodies by commercial ELISA test. From 196 of the patients examined, 101 were positive for antichlamydial IgG antibodies (62.7%). 84 women were examined by means of direct antigen test for Chlamydia trachomatis from the endocervix (DIF. ELISA). Tubal patient was examined by means of hysterosalpingography and/or laparoscopy. In 34 women with unilateral or bilateral tubal occlusion the endocervical direct antigen test was positive in 4 (11.8%) and in 30 women with patient tubes 2 were positive by this test (6.7) In 38 women with tubal occlusion 29 of the women with unilateral or bilateral tubal occlusion had a presence of IgG antichlamydial antibodies in their sera (76.3%) compared to 17 of 38 women with patient tubes (44.7%). The results of the present study indicate that the examination antichlamydial IgG antibodies in the sera of women with infertility has a better predictive value with regard to tubal pathology compared to the direct antigen test for detection Chlamydia trachomatis in the endocervix. Examination for latent infection or reinfection has to be carried out before the administration of more invasive methods for the management of infertility.

[The postcoital test: clinico-laboratory observations]. / Post-koitalniiat test: klinichno-laboratorni nabliudeniia.

The choice of optimal time, the technique and limitations of the post-coital test (PCT) have been described. They are of important significance for getting reliable information both concerning the cervical mucus, quality and migration of spermatozoa in female genital tract. It has been stressed that a negative PCT does not necessary exclude pregnancy. There are shown data for prognostic value of the PCT. The observation of more than 20 motility spermatozoa per HPF and higher frequency of pregnancy is common finding in comparison to low motility and number of spermatozoa in cervical mucus. The data support the hypothesis of "filtering" mechanism, excluding entrance of abnormal spermatozoa. Observing "shaking" phenomenon directs to searching immunological factor (local or systemic) against male gametes.

[Ultrasonic follow-up of the endometrium in women with sterility after Serpafar treatment]. / Ultrazvukovo proslediavane na endometriuma pri zheni sus sterilitet sled lechenie sus Serpafar.

UNLABELLED: We investigated 25 women with anovulation or defects in the follicular growth after treatment with Serpafar for period of 6 months. During the first cycle investigation is without treatment and the patients were analysed for BBT follicular maturation endometrial thickness, cervical mucus, FSH, LH. For next 5 month the patients are treated with Serpafar. We established that endometrial thickness is dynamic changes in every cycle. The comparison was done when the leading follicular diameter was 18-24 mm. CONCLUSION: There was not difference in endometrial thickness in treatment cycles nor a trend for thickness to increase or decrease. Probably the mechanism of ovulation and pregnancy rates after Serpafar is not connected with thickness of the endometrium.

[The protein profile of the cervical mucus: cyclic and ovulatory values]. / Beltuchniiat profil na tservikalnata sluz: tsiklichni i ovulatorni stoinosti.

Immunological and biochemical analysis on cervical mucus requested application of micromethods on sindle small specimens. The following micro-methods in agar gel are applied: immunoelectrophoresis--the normal cervical mucus developed by antiserum against total human serum is presented with 5 precipitin lines: prealbumin, albumin, a1-antitrypsin, transferrin and IgG. The single immunodiffusion technique in agar gel (Mancini et al., 1964) is suitable method to assess these proteins. The same diffusion method is applied for enzyme assessment with special importance like a-amilase and muraminidase (lysozyme). The assessment of these proteins shows pre-ovulatory decrease and post-ovulatory remarkable increase. These changes are not simply due to the increased water content of the cervical mucus during the fertile period but reflects estrogen effect on cervical secretions.

[Laparoscopic fenestration of the ovaries]. / Laparoskopska fenestratsiia na iaichnitsite.

The authors have performed an ovary fenestration in 220 women with primary or secondary amenorrhea. This was made with the help of instrumentation for laparoscopy and a monopolar electrodiathermic coagulator with differently shaped endings. The power supply was provided from Martin Elektrotom 2000. A spontaneous recovers of the menstruation was achieved in 36.84% of the cases as a result of the endoscopic intervention. A follows up pregnancy was achieved in 12.4% of the women. Considering the obtained results, the authors recommend the use of a laparoscopic ovary fenestration when a women with ovarian cysts is treated.

[Diagnostic laparoscopy in female sterility]. / Diagnostichna laparoskopiia pri zheni sus sterilitet.

Over a three-year period (1990-1993), a total of 410 diagnostic laparoscopies are performed. The series includes female patients with a minimum one year longstanding of sterility. Diagnostic laparoscopy is taken to be a routine method of making exact diagnosis in female sterility cases, and as a filtering procedure in forthcoming reconstructive operation or in the event of poor outlooks of eventual conception. The commonest finding is endometriosis (in 58.2 per cent), next ranking adhesions free of endometriosis (31.4 per cent) and bilateral obstruction of the uterine tubes (38.5 per cent). Endometriosis is usually located in the uterine body 27.5 per cent, uterine tubes 26.1 per cent and pelvic peritoneum 14.9 per cent.