Exploring factors in the decision to choose sterilization vs alternatives in rural El Salvador.

CONTEXT: To explore the factors that influence rural Salvadoran women to undergo tubal sterilization versus opting for alternative methods of family planning. EVIDENCE ACQUISITION: A moderator fluent in English and Spanish conducted eleven 90-minute focus groups consisting of 5-10 women each. Eligible women in the municipality of San Pedro Perulapan, El Salvador, were identified and recruited by local health workers. Participant demographics and information about family planning decisions were collected through detailed notes and tape-recorded sessions. The tapes were transcribed verbatim, and all data were analyzed using grounded theory procedures to identify common themes. EVIDENCE SYNTHESIS: Eighty women aged 24-45 years who had previously been sterilized participated in the study. Three major themes influenced a woman's decision to undergo sterilization instead of opting for alternative forms of family planning: (1) availability: tubal sterilization is readily available, (2) fears about side effects of other methods: these women associated negative side effects with other forms of family planning, (3) effectiveness: the women in these focus groups thought sterilization was more effective than other forms of family planning. CONCLUSIONS: This study shows that there is a lack of information, and misinformation, about other effective methods of contraception, especially the intrauterine device and oral contraceptives. Reproductive health education projects, especially those providing services in locations similar to rural El Salvador, should focus on providing accurate information about all forms of contraception, including tubal sterilization.

Acute effects of metformin therapy include improvement of insulin resistance and ovarian morphology.

OBJECTIVE: To evaluate the acute effects of metformin therapy on biochemical markers and polycystic ovarian morphology among insulin-resistant (IR) and noninsulin-resistant (NIR) patients with polycystic ovary syndrome (PCOS). DESIGN: Prospective interventional study. SETTING: Reproductive endocrinology clinic in a university hospital. PATIENT(S): Five IR and five NIR patients with PCOS. The mean age of patients was 29.5 +/- 4.8 years (range, 23-36 years). INTERVENTION: Metformin therapy, using 850 mg orally per day for 1 week. MAIN OUTCOME MEASURE(S): Serum levels of T, FSH, and LH, fasting glucose/insulin ratio, levels of anti-Müllerian hormone (AMH) and inhibin B, and antral follicle count. RESULT(S): Levels of AMH and inhibin B were statistically significantly higher in patients with PCOS compared to controls (2.81 +/- 1.79 ng/mL versus 0.95 +/- 1.17 ng/mL, and 56.24 +/- 29.39 pg/mL versus 17.89 +/- 12.87 pg/mL, respectively). Levels of AMH and inhibin B were similar among IR and NIR patients with PCOS (2.77 +/- 1.92 ng/mL versus 2.85 +/- 1.89 ng/mL, and 53.96 +/- 28.58 pg/mL versus 58.51 +/- 33.28 pg/mL, respectively). One week of metformin therapy did not alter either AMH or inhibin B levels. However, there was a statistically significant increase in glucose/insulin ratios (4.59 +/- 1.57 versus 6.35 +/- 3.6), and a significant decrease in the number of antral follicles after 1 week of metformin therapy (38.8 +/- 19.3 versus 23.1 +/- 7.4). CONCLUSION(S): Levels of AMH and inhibin B are significantly increased in patients with PCOS compared to controls, but are not associated with insulin resistance. Low-dose metformin therapy improves IR and polycystic ovary morphology, even though levels of T, AMH, and inhibin B remain unchanged.

Polypoid cystitis resulting from ovarian abscess.

We present the case of a 41-year-old woman who presented with gross hematuria, urinary urgency and frequency, and intermittent abdominal pain after vaginal hysterectomy 2 years prior. The presence of an adnexal mass was suspected by pelvic examination and confirmed by transvaginal pelvic ultrasonography. Cystoscopy with biopsy was consistent with an inflammatory bladder polyp, which was initially discovered by pelvic ultrasonography and noted to be contiguous with the adnexal mass. The patient underwent exploratory laparotomy, lysis of adhesions, left salpingoophorectomy, and transvesical resection of the bladder mass. Histology was consistent with ovarian abscess and chronic sinus tract formation that was contiguous with an inflammatory bladder polyp.