Clustering Infertile Couples With Dyadic Approach: WHO-5-WBI as a Promising Tool for Assessing Psychological State.

Infertility may be associated with severe psychological burden and many couples need mental support. We used dyadic approach to identify couples with disturbed psychological condition and we tested the WHO-5 Well-Being Index (WHO-5-WBI) questionnaire as a possible, rapid screening method. Extensive psychological assessment of infertile couples was carried out with Beck's Depression Inventory, Spielberger State-Trait Anxiety Inventory, WHO-5-WBI, Symptom Check List-90 Revised Test, Fagerstrom Test for Nicotine Dependence, Alcohol Use Disorders Identification Test. Data of 128 patients (64 couples) were used in the statistical calculations. The Two-Step cluster analysis has revealed 2 groups, which could be separated supremely based on the level of experienced depression, anxiety and according to the general mental health. The WHO-5-WBI questionnaire showed consistent results while classifying couples into groups, which were formed. Our results indicate that infertility affects both spouses almost in the same extent in several psychological aspects. A cluster of couples with increased psychological burden could be clearly separated. The WHO-5-WBI questionnaire was a promising tool to screen reliably spouses based on their psychological state and identify couples that need psychological support during their fertility work-up and treatment.

[Differential diagnostic challenges of abdominal wall endometriosis from the radiologist's point of view]. / Hasfali endometriosis: differenciáldiagnosztikai nehézségek a radiológus szemszögébol.

The incidence of endometriosis, including atypical forms of the disease, has been continuously growing, thus increasingly challenging for the imaging specialists as well. We conducted a retrospective study to analyze the results of ultrasound-guided interventions between 2016 and 2018. All interventions were performed in female patients due to uncertain abdominal wall lesions at the University of Szeged, Hungary. The abdominal wall lesions were incidentally detected, one by CT, the others by ultrasound examinations. We identified 12 cases during the study period. The average age of the patients was 59 years (29-79), 8 of them had abdominal surgery in their medical history. The mean diameter of the masses was 34.4 mm (20-49 mm). Since the indication of imaging examinations was the evaluation of a known or suspected malignancy, four patients had undergone an MRI prior to the biopsy. In addition, ultrasound-guided biopsy was not performed in another two patients, and the diagnosis was established by histological examination of the surgically removed specimens. The histological examination revealed malignant primary serous epithelial tumor in one case, metastases in six cases, endometriosis in six patients and abdominal wall abscess was found in one patient. Endometriosis was more frequent in the younger patients. The likelihood of endometriosis as a cause of abdominal wall lesions of younger, premenopausal female patients is rather high, especially with obstetrical or gynaecological operations in the medical history. Ultrasound plays a primary role in the detection and therapy planning of these lesions. Orv Hetil. 2019; 160(35): 1395-1403.

Anxiety and depression symptoms in infertile men during their first infertility evaluation visit.

Objective: To assess the psychological condition of men at the start of the infertility work-up. Methods: Men seeking an infertility evaluation for the first time were recruited. Depression and anxiety symptoms and subjective psychological burden were assessed with the Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory (STAI), and a visual analog scale (VAS). Results: Data from 113 patients were analyzed. The mean age of the patients was 33.3 (range: 23-54) years, whereas the mean duration of infertility was 16.3 (range: 0-96) months. Results from the BDI and STAI were 2.24 (SD: ±3.18) and 33.74 (SD: ±8.04). Mild depressive symptoms were found in 4.5% of patients, whereas anxiety reached an abnormal level in 4.9%. There were significant correlations between the results from the BDI score and the duration of infertility (p = .024), whereas the STAI and VAS scores showed no similar connection (p = .142 and p = .261, respectively). Among patients with infertility longer than 2 years, mild depressive symptoms occurred in 23.1%. Conclusion: Among men, the levels of depressive and anxiety symptoms were low at the start of the infertility work-up. Depressive symptom levels increased significantly with the duration of infertility, whereas anxiety levels and VAS scores did not demonstrate a similar correlation.

[The role of ultrasonography in the investigation of male infertility]. / Az ultrahangmódszerek szerepe a férfimeddoség kivizsgálásában.

Unintended childlessness affects approximately 9-15% of couples in the reproductive age. It is known that a remarkable proportion of infertility is caused by the disorders of the male reproductive functions. Diagnostic imaging methods and especially ultrasonography play a crucial role in the infertility work-up, the ultrasound examination has become the method of choice for imaging in diseases affecting the testis. With the development of high resolution transducers and technology using colour Doppler, pulsed Doppler, share wave elastography and strain elastography, it is now possible to make accurate diagnoses. However, the place of the new imaging methods in the algorithm of infertility check-up should be clearly defined. Orv Hetil. 2018; 159(21): 815-822.

Evaluation of the relation between placental weight and placental weight to foetal weight ratio and the causes of stillbirth: a retrospective comparative study.

The aim of the present study was to evaluate the clinical importance of placental weight (PW) and placental weight to foetal weight (PW/FW) ratio according to maternal characteristics, pathological conditions in obstetrics and the causes of foetal death by category in stillbirths. The results of autopsies and placental histopathological examinations for 145 singleton stillbirths were reviewed retrospectively. Pathological features of the placenta were significantly associated with lower PW compared to the group with no pathological placental parameters (230 grams versus 295 grams, p = .045). Foetal growth restriction (FGR) with pre-eclampsia (PE) was accompanied by significantly lower FW, PW and PW/FW compared to FGR cases without PE (1045 grams versus 1405 grams, p = .026, 200 grams versus 390 grams, p = .006 and .19 versus .24, p = .037, respectively), whereas a similar trend was not observed in the non-FGR pregnancies complicated by PE. Oligohydramnios was accompanied by lower foetal weight compared to those who had normal amount of amniotic fluid (650 grams versus 1400 grams, p = .006). Among the clinical factors, only PE and oligohydramnios contributed to disproportionate fetoplacental growth in stillbirth, while none of the categories of stillbirth was related to unequal fetoplacental growth. Impact statement What is already known on this subject: In 27% of stillbirths, pathological features of the placenta or placental vascular bed are recorded. Underlying placental pathology contributes to foetal growth restriction (FGR) in approximately 50%. Although placental weight relative to foetal weight (PW/FW ratio) is an indicator of foetal as well as placental growth, data on PW/FW in stillbirth has not yet been published. What the results of this study add: Causes of death do not show any correlation with PW/FW ratio. Placentas derived from pregnancies complicated by pre-eclampsia (PE) and concomitant FGR are smaller and PW/FW is also diminished. Oligohydramnios is associated with an enhanced risk of restricted placental growth. FGR is not correlated with any categories of causes of death. What the implications are of these findings for clinical practice and/or further research: Sonographic follow-up of placental volume and FW can predict the stillbirth in PE complicated by FGR and oligohydramnios.

[Male hormonal contraception: past, present, future]. / Férfi hormonális fogamzásgátlás: múlt, jelen, jövo.

In certain regions of the world the enormous rate of population growth raises economic and public health concerns and widely accessible contraceptive methods would be desired. In contrast, in other countries the use of effective contraception is a question of individual preferences. Today, most of the reliable contraceptive methods are applied by women, while the options for male methods are quite limited. It is well known that significant portion of pregnancies are still unplanned and several data revealed men's willingness to take part in family planning. Based on these needs, remarkable efforts have been made to develop a suitable hormonal contraceptive agent for men. With the exogenous suppression of follicle stimulating hormone and luteinizing hormone secretion, the inhibition of the testicular testosterone production and the spermatogenesis can be achieved. In the beginning, testosterone-derivatives, or testosterone-progestin combinations were administered, later synthetic androgen agents were developed. Despite of these efforts, unfortunately, there is no safe, widely feasible male hormonal contraception to date, but in the future this goal can be achieved by solving the key hurdles. Orv Hetil. 2017; 158(46): 1819-1830.

Idiopathic male infertility related to periodontal and caries status.

OBJECTIVES: This study was undertaken to evaluate the possible correlation between the periodontal and dental status and sperm pathology in idiopathic male infertility. METHODS: The periodontal and caries status and semen quality of 199 men presented with unexplained male infertility were examined. Periodontal and dental factors were analysed by sperm pathology categories. RESULTS: A total of 106 men had normal sperm parameters, whereas 93 men had some type of spermpathology; 27.95% had oligozoospermia, 23.65% asthenozoospermia, 16.12% cryptozoospermia, 32.25% combined oligo-asthenozoospermia. Poor periodontal status was found in about half of the study group (45.7%). The DMFT index was not a significantly higher in any of the spermpathology groups. The odds ratio of calculus, bleeding on probing (BOP) and BOP at ≥50% of the teeth were significantly higher in the combined group (AOR = 1.04, AOR = 1.13, AOR = 4.92, respectively) in multivariate analyses compared to those in the normozoospermia group. Gingival bleeding in the history and urban residency were the only predictors for pathospermia shown by the logistic regression model (AORs were 1.82 and 2.26, respectively). CONCLUSIONS: Some features of poor periodontal status, as gingival bleeding in the history, presence of calculus and BOP, were associated with oligo+asthenozoospermia in men with idiopathic infertility.

Association between periodontal status and idiopathic male infertility.

About 30% of male infertility cases are idiopathic. Previous studies reported a positive correlation between deep periodontal pockets and sperm sub-motility, which suggests that periodontitis might have a role in idiopathic semen abnormality pathospermia. We evaluated correlations between periodontal infection parameters and the results of sperm analysis of men with idiopathic infertility. In this observational study, semen quality and periodontal status were analyzed for 95 otherwise healthy men attending an andrology unit for sperm analysis. Half the men in the sperm pathology and normozoospermia groups (50.8% and 50%, respectively) had poor periodontal status. Among the 95 participants, 38% had oligozoospermia, 28% had asthenozoospermia, 16% had cryptozoospermia, and 15% were classified as normozoospermic. Sperm pathology category was not associated with frequency of deep periodontal pockets or calculus. Bleeding on probing was significantly lower among men with asthenozoospermia than among those with normozoospermia. Poor periodontal status was not associated with any sperm pathology category or parameter. In contrast with previous findings, the present results indicate that pathospermia and poor semen quality are not associated with periodontal infection in men with idiopathic infertility. (J Oral Sci 58, 247-253, 2016).

Pregnancy Rate after Controlled Ovarian Hyperstimulation and Intrauterine Insemination for the Treatment of Endometriosis following Surgery.

OBJECTIVE: To compare pregnancy rate after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) with no treatment in patients with endometriosis-associated infertility treated with laparoscopy. DESIGN: A clinical cohort study. SETTING: University-level tertiary care center. PATIENTS: 238 women with various stages of endometriosis after laparoscopic treatment. INTERVENTIONS: Either COH-IUI or follow-up for 12 months. MAIN OUTCOME MEASURES: The primary outcome measures were clinical pregnancy and live birth rate. Predictive factors evaluated were female age, maternal BMI, and duration of infertility. RESULTS: The pregnancy rate attained after the integrated laparoscopy-COH-IUI approach was 53.4%, while it was significantly lower (38.5%) in the control group. Similarly, a significant difference was observed in live births (48.3% versus 34.2%). Patients with severe endometriosis were less likely to achieve pregnancy (38%) and live birth (35%) than their counterparts with milder forms (57% and 53%). CONCLUSIONS: In patients with endometriosis-based infertility, surgery followed by COH-IUI is more effective than surgery alone.

One-Year Follow-Up Results of a Multicenter, Single-Arm, Objective Performance Criteria-Controlled International Clinical Study of the Safety and Efficacy of the Minerva Endometrial Ablation System.

STUDY OBJECTIVE: To assess the safety and effectiveness of the Minerva endometrial ablation system for treating excessive uterine bleeding in premenopausal women. DESIGN: Multicenter, single-arm, objective performance criteria (OPC)-controlled international study (Canadian Task Force classification II-1). SETTING: Seven academic medical centers. PATIENTS: 105 premenopausal women symptomatic for menorrhagia secondary to dysfunctional uterine bleeding. INTERVENTION: Patients were treated using the Minerva endometrial ablation system. MEASUREMENTS AND MAIN RESULTS: Study success, based on a pictorial blood loss assessment chart (PBLAC) score ≤75, was observed in 96.2% of the patients at 1 year posttreatment. Some 69.5% of the patients experienced amenorrhea (PBLAC score 0). The mean duration of the procedure was 3.9 minutes. General anesthesia was used in 9% of cases, with the balance being performed under local and/or intravenous or spinal anesthesia regimens. No intraoperative adverse events and/or complications were reported. No patient required hysterectomy or any additional medical and/or surgical interventions to control bleeding during 1 year of follow-up. Efficacy (success) results were compared between the Minerva system and the OPC, which served as a statistical control. The OPC comprised the US Food and Drug Administration's (FDA) reported success rates of all FDA-approved endometrial ablation systems. The Minerva system had a statistically significantly superior success rate compared with the OPC control. CONCLUSION: The Minerva system was found to be safe and effective for treating patients suffering from menorrhagia. The procedure is quick and effective, does not require endometrial pretreatment, and precludes the need for additional surgical interventions to manage menorrhagia.

[Fetus, small for gestational age]. / A kis súlyú magzat.

A small for gestational age foetus is defined by the foetal weight below the 10th centile for the corresponding gestational age. However, the vast majority of these cases has no apparent underlying abnormality, while in other cases a serious causative pathological condition can be identified. The detection, follow-up and treatment of an intrauterine growth retarded, compromised foetus has great obstetric and neonatologic relevance. In this review, the causes, clinical aspects and screening methods of intrauterine growth retardation are summarized based on the most recent international guidelines. Furthermore, recommendations regarding the monitoring and the optimal timing of the labour induction of pregnancies complicated with intrauterine growth retardation are discussed.

Severe midtrimester oligohydramnios: treatment strategies.

PURPOSE OF REVIEW: Nearly 1% of pregnancies are affected by some type of midtrimester oligohydramnios. Evidence is currently accumulating that suggests the better efficacy of the new therapeutic procedures relative to conventional management. This review summarizes the available evidence. RECENT FINDINGS: The prolongation of the period between the diagnosis of oligohydramnios and delivery following amnioinfusion and amniopatch techniques appears to be strongly associated with the gestational age and whether the situation was based on rupture of the membranes or not. Case series reveal that amnioinfusion significantly improves the perinatal outcome and prolongs the pregnancy in severe second-trimester oligohydramnios in both idiopathic cases and those involving rupture of the amniotic membranes [preterm prelabor rupture of the membranes (PPROM)]. There is clear evidence of a lower frequency of perinatal complications and successfully prolonged gestation in iatrogenic PPROM after the amniopatch technique relative to population controls. SUMMARY: Identification of potentially modifiable risk factors for the successful prolongation of pregnancy complicated with midtrimester oligohydramnios, and previable PPROM is needed for the improvement of treatment strategies and prognosis. Randomized trials are needed to determine whether amniotic fluid-replenishing strategies can improve pregnancy outcomes.

Identification of causes of stillbirth through autopsy and placental examination reports.

The autopsy and placental histopathological examination results following fetal deaths were analyzed retrospectively in an attempt to explain the stillbirths that occurred from 1996 to 2010 at the Department of Obstetrics and Gynecology, University of Szeged. One hundred and forty fetal deaths were recorded in that period, i.e. a rate of 4.69 stillbirths per 1000 deliveries. The postmortem examination provided the exact cause of the fetal death in 57.9% of the cases. The most common causes were a placental insufficiency (46.9%) and an umbilical cord complication (25.9%). In the first half of the third trimester, a placental insufficiency predominated as the cause of stillbirth, whereas mainly umbilical cord complications occurred around term. In spite of the availability of the autopsy and histopathological examination results, the proportion of unexplained stillbirths in our sample was relatively high. A considerable proportion of stillbirth cases could probably be prevented by more effective screening of a placental insufficiency.

Magnetic resonance vs. sonographic imaging: diagnostics of a large congenital pulmonary airway malformation.

Sonographic scan revealed a homogenously hyperechogenic lesion in the right fetal lung with microcystic pattern by a primigravid women at 22nd weeks of gestation. A large congenital pulmonary airway malformation (CPAM) was suspected with a lesion-to-lung ratio over 90%. The microcystic image of this thoracic anomaly was moderately visible on magnetic resonance imaging (MRI) at that early stage of the pregnancy. Fetopsy confirmed the diagnosis as a pure microcystic CPAM following termination of pregnancy. A controlled prospective study could be performed to compare ultrasound as a diagnostic modality to the MRI, focusing on volumetry, signal characteristics, and follow-up/regression of fetal pulmonary malformations.

Management of severe idiopathic oligohydramnios: is antepartum transabdominal amnioinfusion really a treatment option?

OBJECTIVE: The aim of this study was an evaluation of the role of antepartum transabdominal amnioinfusion (APTA) in the management of severe idiopathic oligohydramnios with a view to improving the pregnancy outcome. METHODS: The study comprised an analysis of 20 pregnant women with severe oligohydramnios who were treated with APTA in 2009 and 2012. The pregnancy outcomes and the complications of the procedure were analysed. RESULTS: The mean gestational age at first treatment was 22 weeks 3 days. The preprocedure amniotic fluid index of <5 cm was restored by the treatment to 8 cm. More than a half of the pregnancies (66.7%, 8/12) treated with APTA finished with spontaneous abortion in the second trimester, mostly due to rupture of the membranes (as a consequence of retroamniotic filling with saline in four cases). The later the oligohydramnios developed, the higher the probability of a significant prolongation of the gestation. CONCLUSIONS: Although APTA is a useful procedure in the management of severe oligohydramnios, it may be followed by a relatively high rate of rupture of the membranes, particularly in the second trimester. Paradoxically, a higher volume of infused saline into the amniotic cavity is associated with a significantly lower risk of rupture.