Ectopic pregnancy diagnosis in very high risk patients.

The authors analyse the effectiveness of ectopic pregnancy diagnosis in women with clinical history and high psychological motivation for treatment. The effectiveness of the diagnostic algorithm was studied in 21 women with previous history of infertility treatment (including 15 who had undergone tube surgery). The diagnostic process was begun between 20th and 25th days after the suspected conception. The only clinical symptom that the patients complained of was spotting (7 cases). The algorithm used serum HCG determination (EIA); in cases of HCG ranging between 2 mIU/ml and 1500 mIU/ml (or clinical uncertainty)-transvaginal sonography (with colour Doppler) was used. If ectopic pregnancy was suspected, laparoscopy was done. It was found that in 15 cases laparoscopic images agreed with diagnostic results; in 5 cases, the image obtained was false negative; in 1 case it was false positive. The diagnostic efficiency of sonography alone was higher than if it was correlated with HCG, but it, too, did not secure against false positive and false negative results. The conclusion was drawn that despite very high sensitivity (70%) and specificity (93%) of the diagnostic procedures used, in high-risk patients the diagnosis should be verified by laparoscopy.

[Correlation of pituitary hormones in serum of male patients with fertility problems]. / Wzajemne zaleznosci stezen hormonów przysadkowych w surowicy krwi mezczyzn z zaburzeniami plodnosci.

UNLABELLED: FSH, LH and prolactin serum levels estimations are the part of the most diagnostic procedures in andrology but there is their prediction value under discussion all the time. AIM: To judge the sensitivity of pituitary hormones serum levels estimation as the diagnostic method in male subfertility and to investigate the correlation between FSH, LH and PRL depending on their physiological or pathological ranges. MATERIAL AND METHODS: FSH, LH and PRL serum levels were estimated in 36 males with azoospermia or severe oligozoospermia (density below 5 mln sperm per milliliter) by EIA. The percentage of pathologic values for every hormones was counted. The statistic analyzes (for p. < 0.05) of correlation factor between every couple of hormones were performed in full investigated group and in subgroups which were formed in following way: A-12 men with pathologic FSH serum levels, B-9 men with pathologic LH serum levels and C-24 men with both physiologic gonadotropins serum levels. RESULTS: The percentage of FSH, LH and PRL pathologic values was in all subfertile men: 33%, 25% and 19.4% respectively. The correlation factor for FSH and LH was high in whole group (0.9484), it was the highest in both groups with FSH and LH pathologic levels (almost 1.0). In the group with physiological FSH and LH serum levels this positive correlation was significantly weak but also present (0.4107). The prolactin is completely independent without the correlation with any gonadotropins in any groups. CONCLUSIONS: 1. The sensitivity of the investigations of pituitary hormones during the diagnostic procedures of male fertility disturbances is poor. 2. Gonadotropins and prolactin infertile male serum levels are completely independent. 3. Positive correlation between FSH and LH increases in the pathological range of their values.

Zinc levels in seminal plasma and sperm density.

Zinc levels in seminal plasma were measured. The study was done on 122, random selected males from infertile couples. The atomic absorption spectrophotometer was used. Sperm density of ejaculate was also determined. These parameters were compared in subgroups: normospermic and oligospermic and in classes of variable oligospermic severity. Semen serum zinc levels in normospermic men was significantly increased as compared to oligospermic men. There were no significant differences in zinc levels between the different classes of oligospermia.

[The effect of various methods of luteal phase supplementation on serum progesterone level]. / Wplyw róznych metod suplementacji niedomogi fazy lutealnej na stezenie progesteronu w surowicy krwi pacjentki.

OBJECTIVES: Examined was the effect of luteal phase supplementation on serum progesterone level with the use of two methods: oral administration of 10 mg dydrogesterone twice daily since the detection of corpus luteum till the menstruation and intramuscular HCG administration in the dose 1500 IU every 4 days and 10 mg dydrogesterone twice daily in the same period. DESIGN: A randomized study, controlled by placebo. PATIENTS AND METHODS: 56 infertile women, with luteal phase deficiency assessed on the basis of basal body temperature (decrease shortly after the peak the luteal phase shorter than 11 days) and ovulation determined sonographically. Progesterone was evaluated by an EIA method, on the 3rd, 7th and 11th day since the corpus luteum occurred. RESULTS: The peak of progesterone concentration was assessed in the midluteal phase (7th day) in both supplemented groups, significantly higher than in the placebo group, also in group with dydrogesterone and HCG it was higher than in group with dydrogesterone alone. Progesterone concentration decrease on the 11th day after the ovulation to the values comparable with the placebo group. CONCLUSION: It has been found that both methods increase serum progesterone level in the time of an assumed implantation but they do not affect the premenstrual period if conception is not achieved.

[Endometrial changes in the ovaries during full-term pregnancy: a case report]. / Zmiany endometrialne jajników towarzyszace donoszonej ciazy--opis przypadku.

The authors described case of 27 years old female patient treated due to infertility of unknown etiology. The female was pregnant after series of intrauterine insemination. During caesarean section due to pelvic longitudinal lie the chocolate cyst and endometriosis of the ovary were found. The authors did not find any information in the literature about coincidence of endometriosis of female reproductive organs and full-term pregnancy.

[Ultrasound images of prostate and seminal vesicles in infertile male patients]. / Obrazy ultrasonograficzne gruczolu krokowego i pecherzyków nasiennych u bezdzietnych mezczyzn.

The results of clinical examinations, semen analysis and endosonographic examinations of prostate and seminal vesicles were analysed in 172 male patients treated due to infertility. Ultrasound equipment with transrectal multiplane transducers 6.5 and 7.0 MHz frequency has been used to the evaluation of size, symmetry and echostructure of prostate and the seminal vesicles. In 62% patients pathological changes have been displayed in the prostate and 32% in the seminal vesicles.

[Self concept of men from childless married couples after receiving information about sperm value]. / Samoocena mezczyzn z bezdzietnych par malzenskich po uzyskaniu informacji o wartosci nasienia.

The questionnaire included 220 men from childless married couples who referred to the Department of Reproduction and Andrology of the Medical Academy in Lublin for 4 months in 1992. The treatment period of childlessness in those couples ranged from several months to 17 years. The authors tried to establish if, and to what extent the receipt of information affected the well being and sexual life of those men. It was found out that the information and awareness of the value of own sperm resulted in the change of well being in 80.5% of the studied men. In the subjective evaluation they appeared to be more irritable in everyday life and/or their feeling about own value as men was reduced. Such changes were noticed both by those who had been informed about the proper test results as well as by those with test results varying from the standard. In almost half of the respondents (41.8%) the sexual activity was changed or the frequency of sexual satisfaction feeling was reduced. The obtained results as well as the lack of wider approach to this problem in Polish literature indicate the significance of further studies.

[Observation of some semen parameters in men with varicocele]. / Zachowanie sie niektórych parametrów nasienia u mezczyzn z zylakami powrózka nasiennego.

Among 172 examined male patients varicoceles have been found in 57.6% patients. The frequency of varicocele appearance increased according to the fall of sperm concentration. Simple relations between sperm motility and varicocele have not been observed. Larger per cent of pathological sperm forms in patients with varicoceles has been shown. In patients with varicoceles three times as frequent appearance of richer periprostatic and periseminnal blood vessels have been observed in comparison with patients without varicocele.

[Varices of the spermatic cord and endo-sonographic changes of urogenital organs in men with decreased values of certain sperm parameters]. / Zylaki powrózka nasiennego i endosonograficzne zmiany narzadów moczowo-plciowych mezczyzn z obnizona wartoscia niektórych cech nasienia.

A comparative analysis was carried out of sperm cell density, proportion of mobility and viability, and the proportion of morphologically abnormal sperm cells in 80 (74.6%) men with varices of the spermatic cord and 88 (52.4%) men without the varices. A significant shortening was observed of the viability time od the sperm cells, measured by the ability to maintain motion, in 57.5% of sperm samples from men with varices of the spermatic cord and in 39.8% of sperm samples from men without the varices. The shorter viability time was correlated with lower sperm cell density (20 million/ml) in the sperm samples. In endosonographic examinations performed at the same time, a coexistence was observed of varices and endosonographic changes in the prostate, seminal vesicles, and in a small proportion in the testicles. The coexistence of endosonographic changes and the varices was more frequently associated with decreased sperm cell density. The usefulness was demonstrated of sonographic examinations in the diagnosis and treatment of impaired fertility in men.

[Socio-familial situation of women treated for childlessness]. / Sytuacja spoleczno-rodzinna kobiet leczonych z powodu bezdzietnosci.

The documentation of the Andrology Outpatient Clinic, Institute of Obstetrics and Gynaecology, Medical Academy in Lublin from the years 1979-1989 was studied retrospectively, and 169 women were isolated who completed the treatment for childlessness. The carried out studies indicated that younger people with shorter marriage history (usually after 2-5 years) more frequently sought treatment for childlessness, especially those coming from rural areas. Greater striving for having children in married people from rural areas was expressed also by the fact that they more frequently decided to use donor semen for insemination.

[Some routine test parameters of semen taken from the male partner of infertile couples and the state of the urogenital tract (prostate, seminal vesicles, testicles, epididymis) examined by ultrasound]. / Niektóre rutynowo badane cechy nasienia mezczyzn z nieplodnych par malzenskich a stan narzadów plciowych (prostaty, pecherzyków nasiennych, jader, najadrzy) w badaniu echosonograficznym.

The authors investigated 214 men with endorectal and percutaneous scrotal sonography. These men were treated for the reason of sperm defects. The age range was 22 to 52 years. They were married for 2-10 years and infertile. The sperm was defected in respect of low percentage of motility (< or = 50%) and vitality and increased percentage of morphological abnormalities. The paper is an attempt to find the correlation between the sperm vitality and the frequency of prostate, seminal vesicles, testes and ejaculatory ducts defects. These correlations were particularly evident in sperm samples with decreased sperm concentration (1-20 mln/ml). The authors suggested the usefulness of the finding in treating the male infertility.

Sperm penetration through cervical mucus in infertile couples in relation to selected cervical factors.

One-hundred-and-fourteen women of infertile marriages with negative post-coital test (PCT) results were studied. The women were divided into three groups: those with anatomical anomalies of the cervix, abnormalities of the cervical mucus and a negative PCT and normal parameters in cervical mucus. Patients were treated with mestranol when the physicochemical characteristics of the cervical mucus were impaired. Those with antispermatozoal antibodies found by means of the Katsh test were treated with desensitizing therapy, condoms and homologous artificial insemination (AIH). Among all the patients therapy resulted in 23 pregnancies. After applying these treatments to women, 49 of them (43%) had positive PCT results.