[Effectiveness of laparoscopic ovarian "drilling" in patients with polycystic ovarian syndrome and ovarian infertility]. / Eficienta "drilling"-ului ovarian percelioscopic la pacientele cu ovare polichistice si infertilitate ovariana.

UNLABELLED: THE AIM of this study was to demonstrate the efficiency of laparoscopic ovarian drilling in the treatment of Polycystic Ovarian Syndrome (PCOS) associated with infertility. MATERIAL AND METHODS: We studied 54 patients with PCOS that also presented infertility and menorrhea. The PCOS was diagnosed by ultrasound in the 2nd Clinic of Obstetrics and Gynaecology in Iasi, using Bataglia and ASRM/ESHRE criteria. We selected 32 patients with PCOS and infertility, in which medical treatment with inductors of ovulation and Metformin failed and laparoscopy was indicated. In these patients we practiced bilateral laparoscopic ovarian drilling. RESULTS: In the next 3 months the menstrual cycle became regulated and 3 of the patients became pregnant. Other 10 patients became pregnant in the next 9 months after laparoscopic ovarian drilling. CONCLUSION: PCOS associated with infertility should be laparoscopy treated because the effect is faster and the fertility prognosis is better.

[Hysteroscopy in the diagnosis and treatment of tubal infertility]. / Histeroscopia în diagnosticul si tratamentul infertilitatii de cauza tubara.

The aim of this study is to present the authors' experience in the diagnosis and treatment of tubal proximal disease by means of hysteroscopy. The study includes 96 patients with tubal infertility to which hysteroscopy was performed in 1998-2003 in the 2nd Clinic of Obstetrics and Gynecology, Iasi. The average age was 32.5 +/- 1.2 years. The indication was proximal tubal obstruction diagnosed by hysterosalpingography or sono-hysterosalpingography. The hysteroscopy revealed lesions affecting fertility that were treated in the same operative sequence. Proximal tubal obstruction was present in 50 cases (52%): unilateral--41 cases, bilateral--9 cases. Tubal permeabilization was performed by tubal catheterization or by removing polyps, adhesion and was verified by chromo-tubation at the end of hysteroscopy and by sono-hysterosalpingography, 2 months after the intervention. When proximal tubal obstruction is suspected, hysteroscopy offers a solution by confirming the diagnosis and by efficiently treating the lesions, leading to an increased average of pregnancies.

[Contribution of laparoscopy in improving the therapy in patients with tubal infertility]. / Contributia laparoscopiei în optimizarea conduitei la pacientele cu infertilitate tubara.

The aim of this study is to estimate the advantages of laparoscopy for a correct diagnosis and an adequate treatment in cases of tubal infertility. The group of study included 141 patients, hospitalised and treated in the 2-nd Clinic of Obstetrics and Gynecology Iasi. We used diagnostic laparoscopy to elaborate the adhesion score and the tubal score. The stage of tubal lesions, estimated by these two scores, orientated the surgical technique: adhesiolysis (43.26% of cases), distal tubal reconstruction--fimbrioplasty (45.39% of cases) or neo-salpingostomy (21.98% of cases)--followed by ovarian drilling. The incidence of the uterine pregnancies obtained (30.10%) was statistically correlated with favorable prognostic factors: minimal adhesion score, minimal and moderate tubal score, type of tubal surgical reconstruction. The favorable correlation between laparoscopy and the results obtained confirms a good case selection and the possibility to use minimal invasive methods in the treatment

[Specifics of therapy of tubal infertility in patients with endometriosis]. / Particularitatile tratamentului infertilitatii tubare la pacientele cu endometrioza.

Our purpose was to define the best way of treating tubal infertility caused by endometriosis. We have studied 24 patients with tubal infertility caused by endometriosis; the etiology has been laparoscopically established in the 2nd Clinic of Obstetrics and Gynecology Iasi. The endometriosis score (r-AFS) was used to establish the therapy. We performed laparoscopic treatment when endometriosis was visible. Postoperative medical therapy (Diphereline, 3 months) was indicated; patients with ,,unpigmented endometriosis" received the same medical therapy. The rate of pregnancies in patients that had benefit of combined therapy: surgical and medical (n=9) was superior (44.4%) to that obtained in patients that were only surgical treated (n=15): 26.6% (Spearman correlation--0.6595, p < 0.0012). Endometriosis is an important etiological factor in female infertility. The pathway is mechanic as well as chemical and it justifies the combined therapy. There are better results, as fertility prognosis in patients with endometriosis that receive both, surgical and medical therapy.

[Chlamydia infections and tubal infertility]. / Infectia cu Chlamidia si infertilitatea tubara.

This is a screening study for chlamydial infections (1153 patients females). In the number of 272 cases (23.59%) chlamydial infection was confirmed by ELISA blood tests. We purpose to determine the risk factors for tubal infertility, because Chlamydia trachomatis (CT) is the most important cause of pelvic inflammatory disease (PID) and permanent tubal damage. High correlations (correlation coefficient-"r") of chlamydial infection with hygienic level (r=0.51), avoided use of condoms (r=0.58) or number of abortions (r=0.65) were noticed. Results with primary prevention through sexual education have been disappointing, so is necessary preventing or limiting sequelae of chlamydial infection, such as PID and tubal infertility.

[Sono-hysterosalpingography in the assessment of tubal infertility]. / Sonohisterosalpingografia ca metoda de evaluare a infertilitatii tubare.

The assessment of the fallopian tubes patency is an important moment in the investigation for infertility. Vaginal sonographic hydrotubation was assessed in the evaluation of uterine configuration and tubal patency. In addition, technique using "agitated" saline during transvaginal sonography was evaluated. Ultrasound was more effective in detecting abnormalities of both interstitial and distal parts of the tube compared with hysterosalpingography. Sonohysterosalpingography is cheaper, may be performed in the office and also the pelvic irradiation is avoided.