Estrogen and progesterone receptors in endometrium in women with unexplained infertility.

AIM: The purpose of the present study is to evaluate the relationship between endometrial concentrations of estrogen and progesterone receptors throughout the menstrual cycle in women with unexplained infertility. MATERIAL AND METHODS: In forty four infertile women with unexplained infertility, biopsy of the endometrium was performed during simultaneous laparoscopy and hysteroscopy. Material was prepared for immunohistochemical staining. Forty four endometrial samples obtained from women with normal menstrual cycles were divided into four categories: early proliferative, late proliferative, early secretory and late secretory. Immunohistochemical localization of estrogen receptors (ER) and progesterone receptors (PR) was scored according to intensity of staining and proportion of cells specifically stained in glandular epithelium and stroma and results were analyzed. CONCLUSION: The early secretory phase appeared to be period of transition from the strong and ubiquitous staining for receptor characteristic of proliferative phase of endometrium to the weak, focal pattern of estrogen receptors. Progesterone receptors in early secretory phase were of strong staining and sufficient number of stained cells.

Correlation between hyperprolactinemia, MRI of hypophysis and clinical presentation in infertile patients.

UNLABELLED: The aim of the study was to investigate symptoms of hyperprolactinemia such as oligomenorrhea, amenorrhea, galactorrhea, and correlation between hyperprolactinemia and MRI of hypophysis in infertile women. MATERIAL AND METHODS: During the 10 years period, we have studied 87 patients investigated for infertility causes and with hyperprolactinemia findings, in our patients we have controled the serum prolactin levels, performed MRI of hypophysis, evaluated menstrual cycle disturbances and galactorrhea. Patients were between 20-43 of age. RESULTS: MRI of hypophysis confirmed prolactinoma (microadenoma) in 75.86% of our patients, while 24.14% had a normal MRI. Galactorrhea was demonstrated in 56.32% of patients. Oligomenorrhoea occured in 25.29%, and secondary amenorrhea in 14.94% of patients with hyperprolactinemia and infertility. The results show statistically significant difference in the average findings of serum prolactin levels on the day 8 and 21 of menstrual cycle in patients with or without microadenoma. CONCLUSIONS: Menstrual cycle disturbancies (oligomenorrhea and secondary amenorrhea) in patients with hyperprolactinemia and infertility occured in 40.33% of patients. We have noted statisctically significant correlation between the serum prolactin levels on the day 8 of menstrual cycle and the microadenoma size, which was not found on the 21 day of menstrual cycle.

Insulin resistance and lipid accumulation product in corelation to body mass index in women with polycystic ovary syndrome.

INTRODUCTION: Women with Polycystic Ovary Syndrome (PCOS) are at increased risk for cardiovascular morbidity and metabolic disorders including: dyslipidaemia, hypertension, insulin resistance, gestational diabetes, type 2 diabetes, systemic inflammation and endothelial dysfunction. The prevalence of obesity and insulin resistance in women with PCOS is significantly higher compared to the general population. Lipid accumulation product is a new, cheap and easily available predictor for metabolic syndrome both in general population and in women with PCOS. MATERIALS AND METHODS: The study included 50 patients at the Clinic of Endocrinology, Diabetes and Metabolic Disorders, Clinical Center University of Sarajevo. All patients were diagnosed with PCOS according to the Rotterdam ESHRE criteria and were divided into two groups according to their body mass index (BMI). A prospective study established the following parameters: anthropometric measurements (waist circumference, height, weight), BMI, and serum triglycerides and insulin resistance. LAP was calculated using the formula: LAP (women) = [waist circumference (cm)-58] x [triglycerides (mmol/L)]. RESULTS: Waist circumference in women with BMI < or = 24.9 kg/m2 was 31 cm lower than waist circumference in women with a BMI > 25 kg/m2. Mean triglyceride value of the patients in group BMI < or = 24.9 kg/m2 was 1.15 mmol/l lower than the mean value of triglycerides in women with a BMI > 25 kg/m2. Insulin resistance was present in 66.7% in group with BMI < or = 24.9 kg/m2, and in 75.0% in the group with BMI > 25.0 kg/m2. LAP was shown to be a marker for the differentiation of insulin-resistant and nonresistant patients with a cut-off value of 17.91. CONCLUSION: Patients with PCOS and BMI < or = 24.9 kg/m2 were significantly different from those with BMI > 25 kg/m2 in the values of body weight, waist circumference and triglycerides. There was no statistically significant difference in insulin resistance. LAP values were higher in patients in the group with BMI > 25 kg/m2. LAP was a marker for differentiation of insulin--resistant and non-resistant women with PCOS.

Laparoscopic treatment of ovarian dermoid cysts is a safe procedure.

Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of ovarian dermoid cysts in selected cases. The aim of this study was to analyze the safety of laparoscopy in ovarian dermoid cysts treatment and risk of chemical peritonitis. We report 63 cases of patients (mean age of 37) with ovarian dermoid cysts originating from the ovary, treated from 2002 to 2010. Most of the patients underwent cysts removal. In 7 patients salpingo-oophorectomy was performed. We used 15 mm trocars for removing specimens. In patients with dermoid cyst rupture peritoneal cavity was washed out thoroughly with Ringer lactate and drained for 24-48 hours. All the material extracted was sent for a histopathology examination. The diagnosis of mature ovarian dermoid cysts was confirmed in 58 (92.63%) of cases and immature ovarian dermoid cysts in 5 (7.37%) cases. Dermoid cysts were composed of tissue developed from three germinative layers in 31 (49%) patients, from two germinative layers in 25 (40%), and in 7 (11%) patients from one germinative layer. No intra or postoperative complications occurred. No signs or symptoms of chemical peritonitis were observed regardless of cystic spillage or not. We conclude that the risk of chemical peritonitis can be minimized when undertaking laparoscopic removal of ovarian dermoid cysts if the peritoneal cavity is washed out thoroughly from spillage of cyst contents. Drainage of peritoneal cavity should be performed in the patients with the ruptured dermoid cysts.

Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in infertile women?

The aim of this study was to clarify the role of simultaneous combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility. In a retrospective study, 360 infertile women underwent complete fertility evaluation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of the routine infertility evaluation. Laparoscopy and hysteroscopy were successful in 360 patients. Bilateral tubes were blocked in 18 (5%) and unilateral tubal occlusion were in 30 (8,33%) of patients. Pelvic adhesions were revealed in 40 (11,11%), and myomas in 42 (11,65%) out of that 31 (8,6%) were revealed by laparoscopy and 11 (3,05%) by hysteroscopy. Endometrial polyps were revealed in 26 (7,22%) and Syndrome Asherman in 3(0,83%) of patients. Uterine anomaly was found in 19 (5,27%) of cases and out of that septate uterus in 7 (37,15%), bicornuate uterus in 5 (26,31%), arcuate uterus in 4 (21,26%) and uterus unicornu cum cornu rudimentario in 3 (15,27%) of uterine anomalies. Endometriosis was found in 51 (14,16%), dermoid cysts in 8 (2,22%) and in 16 (4,44%) functional cysts of patients. Also, Fitz-Hugh-Curtis syndrome was revealed in 23 (6,11%) of our patients. Laparoscopy and hysteroscopy play very important role as diagnostic tools in the infertility women. Combined diagnostic simultaneous laparoscopy and hysteroscopy should be performed in all infertile patients before the treatment.

Clinical outcome and hormone profiles before and after laparoscopic electroincision of the ovaries in women with polycystic ovary syndrome.

The aim of study was to evaluate clinical outcome and hormone profiles of laparoscopic electroincision of the ovaries in women with polycystic ovary syndrome (PCOS) before and after treatment. Forty five clomiphene-citrate resistant women with polycystic ovary syndrome underwent laparoscopic electroincision of the ovaries. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), androstenedione, 17 OH progesterone and beta endorphins were recorded before and 24 hours after the treatment. Clinical and reproductive outcome and hormone profiles were analyzed. Patients were observed during 12 months period. Laparoscopic electroincision of the ovaries was successfully performed without complications in all patients. LH/FSH ratio was 1,66 24 hours after treatment. Serum levels of T, androstenedione, 17 OH progesterone, and beta endorphins were significantly reduced 24 hours after laparoscopic electroincision of the ovaries. In follow-up period 87% of patients were recorded to have regular menstrual cycles and 61% pregnancy rate was achieved spontaneously. Laparoscopic electroincision of the ovaries is an effective treatment in clomiphene-citrate resistant women with polycystic ovary syndrome. The high pregnancy rate of the procedure offers a promising management for patients with polycystic ovary syndrome.

[Vaginal application of misoprostol for labor induction after 36 weeks of pregnancy]. / Vaginalna primjena misoprostola u indukciji poroda nakon 36 nedelje trudnoce.

OBJECTIVE: The aim of this study was to confirm efficacy and safety of misoprostol in induction of labour in patients in late pregnancy. MATERIAL AND METHODS: Misoprostol 50 microg tablets were applied in the posterior vaginal fornix in 130 primigravidae which were (Bishop score 6 or <6) in late pregnancy. In the first group (61 patients), misoprostol was applied every 4 hours, while in the second group (69 patients) every 6 hours. Up to five misoprostol doses were applied. Our aim was to determine an induction delivery interval (interval from applied first dose of misoprostol until delivery), method of delivery as well as side effects which can occur using misoprostol. RESULTS: Mean value induction delivery interval was 13 hours and 39 minutes (SD = 4.21 P = 0.268) in the group where misoprostol was applied every 4 hours, and 15 hours and 44 (SD = 2.54 P = 0.206) minutes in the group where misoprostol was applied every 6 hours. The average number of misoprostol doses is 2.22 in the group where applied at 4 hours, and 2.33 at the group where applied at 6 hours. Success of induction was 97.7%. Occurrence of labor within 12 hours was 60.4% in the first group and 49.5% in the second group. Caesarean section rate was 13.11% of patients in the first group, and 11.47% of patients in the second group. Tachysystole appeared in 4.9% of patients in the first group and in 3% of patients in the second group. Hyperstimulation was noted in two cases (3%) of patients to whom misoprostol was applied every 4 hours. Labor has been completed with vacuum extractor and forceps in 5% of patients in the first group and 2.8% of patients in the second group. CONCLUSION: Insertion of misoprostol dose of 50 microg in the posterior vaginal fornix resulted in successful cervical ripening, successful labor induction, low incidence of hyperstimulation, without side effects, and labour has been completed with relative lower cesarean section rate. Misoprostol is a safe medication for both mother and baby.

Laparoscopy after previous laparotomy.

Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previous laparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.

[Pregnancy after laparoscopic treatment of ovarian endometriotic cysts]. / Trudnoce nakon laparoskopskog tretmana endometrioticnih cisti ovarija.

OBJECTIVE: The aim of study was to present the optimal laparoscopic treatment of the ovarian endometriotic cysts in patients who had been treated of sterility and to present the success of the sterility treatment. METHODS: Ovarian endometriotic cysts do not have proper reaction to hormonal supressive therapy and surgical treatment is required. Laparoscopic cystectomy of ovarian endometriotic cysts using electrocision was performed in 45 patients who previously underwent laboratory tests specific for that type of patients, as well as sperm analysis of their husbands. At the same time, potency test of the uterine tubes was performed. RESULTS: 34 patients had normal uterine tubes potency and normal semen analysis of their husbands. Out of 34 patients, 12 (35%) spontaneously got pregnant during 12 months following laparoscopic treatment. At the same period of 12 months, in 6 (13,3 %) patients recurrent ovarian cysts were discovered. CONCLUSION: Laparoscopic cystectomy of ovarian endometriotic cysts is efficient method of preserving fertility in certain number of patients. Although the laparoscopic treatment may reduce ovarian reserve, it presents a method of choice in therapy of ovarian endometriotic cysts.