Life 20 years after unsuccessful infertility treatment.

BACKGROUND: This study explores the long-term experience of involuntary childlessness among 14 Swedish women 20 years after their infertility treatment. METHODS: In-depth interviews were conducted. RESULTS: The childlessness had had a strong impact on all the women's lives and was for all a major life theme. The effects were experienced both on a personal level and on interpersonal and social levels. Half of the women were separated, and in all but one, sexual life was affected in negative and long-lasting ways. The effects of childlessness were especially increased at the time the study was conducted, as the women's peer group was entering the 'grandparent phase'. Many coped with their childlessness by caring for others, such as the children of friends or relatives, elderly parents or animals. CONCLUSION: These findings represent a small sample, but they point towards the need for developing models of counselling and support that stimulate self-reflection and strengthen personal resources and empowerment for individuals and couples experiencing involuntary childlessness.

Reduction of post-surgical adhesions with ferric hyaluronate gel: a European study.

BACKGROUND: The objective of this study was to assess the safety and efficacy of a 0.5% ferric hyaluronate gel, in reducing adhesions in patients undergoing peritoneal cavity surgery by laparotomy, with a planned 'second-look' laparoscopy. METHODS: The study was a randomized (by computer-generated schedule), third party blinded, placebo-controlled, parallel-group design conducted at five centres in Europe. Females aged 18-46 years received 300 ml ferric hyaluronate (n = 38) or lactated Ringer's (n = 39) as an intraperitoneal instillate at the completion of surgery. At second-look 6-12 weeks later, the presence of adhesions was evaluated at 24 abdominal sites. RESULTS: Patients treated with ferric hyaluronate had significantly fewer adhesions compared with controls. When adhesions formed, they were significantly less extensive and less severe in the treated group. The American Fertility Society score for adnexal adhesions was reduced by 69% in the treatment group compared with controls. The safety profile of ferric hyaluronate-treated patients was comparable with those treated with lactated Ringer's solution. CONCLUSIONS: In conclusion, ferric hyaluronate was safe and highly efficacious in reducing the number, severity and extent of adhesions throughout the abdomen following peritoneal cavity surgery.

Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women. A randomized study.

BACKGROUND: The aim of this study was to study the value of diagnostic laparoscopy prospectively in fertile women scheduled for acute appendectomy. METHODS: For this study, 110 women, with acute abdominal pain ages 15 to 47 years, in whom the surgeon had decided to perform an appendectomy, were randomized to either open appendectomy or diagnostic laparoscopy, then open appendectomy if necessary. RESULTS: Appendicitis was diagnosed in 66% of the women after open surgery, and in 73% after laparoscopy. During laparoscopy, was appendicitis misdiagnosed in only 7% of the women, from whom the appendix unnecessarily removed, whereas 34% in the open surgery group had a healthy appendix removed. No appendicitis was missed in the laparoscopic group. The relative risk of removing a healthy appendix in open surgery was 6.6 relative risk (range, 2-21 C.I.) as compared with laparoscopy. Among the women with a healthy appendix, a gynecologic diagnosis was found in 73% after laparoscopy, as compared with 17% after open surgery. CONCLUSIONS: Laparoscopy reduces unnecessary appendectomies and improves diagnosis in fertile women.

Evaluation of regret after tubal sterilization.

Many different criteria and profiles have been suggested for the possible cause of regret and requests for reversal after tubal sterilization. Evaluation of data obtained from 2253 women who had undergone tubal sterilization showed a strong correlation between regrets and youthful age and to changes in marital situation. Previously demonstrated risk factors, such as sterilization in connection with abortion or labor were not related to regret in this study material.

Effect of intraperitoneal instillation of 32% dextran 70 on postoperative adhesion formation after tubal surgery.

The intraperitoneal instillation of 32% dextran 70 (HyskonR, Pharmacia AB, Sweden) has previously been reported to prevent the formation of postoperative adhesions. Against this background, the present study was undertaken to evaluate the efficacy of HyskonR in counteracting peritoneal adhesions following tubal microsurgery. 105 infertile women were operated upon in a prospective, randomized, controlled, double-blind, multicenter study. The intra-abdominal adhesions present from the beginning were classified by means of a standardized scoring scale and the extent of adhesions was again evaluated at follow-up laparoscopy 4-10 weeks later. A reduction in the extent of the intra-abdominal adhesions (statistically highly significant) was revealed in both the Hyskon group and the saline control group. The extent of adhesions in the Hyskon group was not lesser than in the saline group, however. The pregnancy rates in the two groups were also similar.

Treatment of cervical intraepithelial neoplasia with local excisional biopsy and cryosurgery.

One hundred and ninety-eight patients with abnormal cytologic smears had extensive diagnostic biopsy of the portio combined with endocervical curettage. Severe dysplasia or cancer in situ was found in 57 per cent of the patients. During a period of observation of 6--42 months (average 18 months) the cervical intraepithelial neoplasia (CIN) regressed in 54 per cent. Cryosurgery was used to treat 93 patients with persistent CIN after biopsy. Treatment was successful in almost 70 per cent after one single application of cryosurgery. The complications were negligible. Treatment was less successful with increasing histological severity as well as with increasing age of the patients; this applies both to biopsy and cryosurgery. Cryosurgery is significantly less effective when the CIN is of both ecto- and endocervical origin. Extensive multiple biopsies of the portio in combination with endocervical curettage performed under general anaesthesia, followed by cryosurgery with persistent cytological abnormalities, are indicated as an alternative to conization, especially in younger patients with ectocervical CIN.

Acid-base balance during laparoscopy. The effects of intraperitoneal insufflation of carbon dioxide and nitrous oxide on acid-base balance during controlled ventilation.

During laparoscopy the carbon dioxide used to achieve a pneumoperitoneum is absorbed from the peritoneal cavity into the blood. The object of the present study was to clarify certain aspects concerned with anesthetic and ventilatory techniques, mostly in connection with the comparison between the effects of insufflation of either carbon dioxide or nitrous oxide. Anesthesia included ventilation with a volume controlled ventilator in curarised patients. Respiratory volumes were calculated according to the patient's body area. The results show a sharp rise in PaCO2 and a fall in pH after intraperitoneal insufflation with carbon dioxide, while no changes were observed when nitrous oxide was used. The clinical consequences of these findings are discussed.