Optimal dose of HCG for final oocyte maturation in IVF cycles: absence of evidence?

There is an ongoing debate over the optimal dose of urinary HCG (u-HCG) that can trigger final oocyte maturation, leading to higher IVF success rate without increasing the risk of ovarian hyperstimulation syndrome (OHSS). A systematic review was conducted of all studies that compared the effect of at least two doses of u-HCG for final oocyte maturation on IVF outcomes and on the incidence of OHSS. The primary outcome was the live birth rate, and the secondary end-points were the number of oocytes retrieved, fertilization, implantation and pregnancy rates, and the incidence of OHSS. Only two amongst the six included studies were randomized controlled trials (RCT). Meta-analytic pool was not feasible due to insufficient number of studies assessing the same outcome and significant heterogeneity. The majority of studies concluded that the clinical outcomes were similar between women receiving 5000 or 10,000 IU of u-HCG. The incidence of OHSS was not reduced in the high-risk population even with lower dose of u-HCG. Until large scale RCT addressing the clinical effectiveness and the adverse outcomes related to various doses of u-HCG are conducted, the dose of u-HCG for final oocyte maturation for women referred for IVF needs to be individualized.     

Altered circulating levels of adhesion molecules at 18 weeks' gestation among women with eventual preeclampsia: indicators of disturbed placentation in absence of evidence of endothelial dysfunction?

OBJECTIVE: The purpose of this study was to investigate whether indications of activation of the maternal endothelium were present at 18 weeks' gestation in women in whom preeclampsia eventually developed. STUDY DESIGN: A total of 2190 blood samples were obtained at 18 weeks' gestation. Circulating levels of von Willebrand factor and soluble vascular adhesion molecule 1, soluble intercellular adhesion molecule 1, and E-selectin were assayed in 71 women with eventual preeclampsia and 71 control subjects. RESULTS: E-selectin and von Willebrand factor levels were similar between the 2 groups. Soluble vascular adhesion molecule 1 concentration was significantly lower in the women with eventual preeclampsia (median, 649.0 ng/mL vs 762.4 ng/mL; P <.001), whereas soluble intercellular adhesion molecule 1 concentration was significantly higher (median, 239.8 ng/mL vs 178.3 ng/mL; P <.001). CONCLUSION: We found no indications of endothelial activation at 18 weeks' gestation in women in whom preeclampsia later developed. However, decreased serum concentration of soluble vascular adhesion molecule 1 and increased serum concentration of soluble intercellular adhesion molecule 1 may reflect the disturbed placentation known to be associated with the development of preeclampsia.     

Congenital absence of the vagina: in search of the perfect solution. When,and by what technique,should a vagina be created?

PURPOSE OF REVIEW: To review the Mayer-von Rokitansky-Küster-Hauser syndrome and to address means of diagnosis, patient education and counselling. The timing of, and vast options for, creation of a functional vaginal are also discussed. RECENT FINDINGS: The diagnosis of Mayer-von Rokitansky-Küster-Hauser usually occurs during an evaluation of primary amenorrhea. Counselling and support are of great importance for affected young women and their families. Educational materials have increased with the availability of Internet web sites and there is a vast number of options for creation of a functional vagina; most international centers promote the utilization of vaginal dilators. SUMMARY: Young girls, adolescents and women with Mayer-von Rokitansky-Küster-Hauser should be offered a comprehensive evaluation, and presented with information regarding all options for management and support. Ongoing psycho-social and educational support is extremely important. International centers that focus on congenital anomalies of the reproductive tract should be developed. These centers of excellence will facilitate long-term follow up studies to improve patient care and evidence based medical options.     

The problem of hormonphobia in the practice of obstetrician–gynecologists in Kazakhstan

Abstract

Of the total number of 45–69 years old women in the Republic of Kazakhstan, the frequency of use of hormone replacement therapy (HRT) drugs does not tend to increase and remains at a low level amounting to only 0.8% in 2010 and 0.9% in 2013. Frequency of HRT drugs use among women who are obstetricians and gynecologists from different regions of Kazakhstan between the ages of 45 to 69 years old was only 10% in 2008 and 14% in 2013. The reasons for low use of HRT among obstetricians and gynecologists were associated with fear of cancer, obesity, thromboembolism and stroke. Moreover, this information is supported by other doctors, especially oncologists and endocrinologists. There is low use of different types of contraceptives for the prevention of unwanted pregnancy. Thus, contraceptives were used by 30.4% of women of reproductive age in 2000, and by 38.2% in 2012. Frequency of use of hormonal contraceptives remains at extremely low levels with a slight increase from 1.8% in 2004 to 2.2% in 2013, which has resulted in the fact that abortion remains primary birth control method. Low use of hormonal contraception methods and HRT drugs indicates hormonophobia among doctors of all specializations. There is a need to increase the knowledge of obstetrician–gynecologists, internists, cardiologists, endocrinologists, urologists, and healthy living office employees in urban clinics of modern methods of contraception, and nosotropic therapy for menopausal symptoms with the use of HRT drugs.     

The role of hysteroscopy in the diagnosis of infertility in materials of the 2nd Gynecological Clinic of the Medical Academy in Lódź

Hysteroscopy is one of the routine methods use in gynaecology for diagnosis of "uterine factor" in infertility. The range of the indications for hysteroscopy is very wide and few side effects make it relatively safe. The main aim of the study was the retrospective evaluation of hysteroscopic results among patients with infertility. Physiologic shape of the uterine cavity was diagnosed in 57.1% patients. The number of adhesions inside uterine cavity was lower than described in literature. Different pathology of uterine cavity was diagnosed as frequently as described by other authors.     

Is unilateral uterine adnexa absence a congenital developmental abnormality or posteriority? Summary of 39 cases and literature review

Purpose

A diagnosis of breast cancer is often accompanied by the fear of loss of previous body image and attractiveness. Hence, many patients opt for reconstructive surgery. This study evaluated the effects of different types of reconstructive surgery after mastectomy on the functional and psychological adjustment of patients.

Methods

In a cohort study, patients, who had breast reconstruction after mastectomy by means of four different allogenic or autologues techniques between 1999–2006 were retrospectively interviewed in person or by telephone. The questions addressed complication rates, physical complaints, functional impairments, body image outcomes, sexuality and patient satisfaction.

Results

Of 139 patients, 89 (64.7 %) completed the survey. 32 (35.9 %) patients experienced one or more postoperative complications like seroma, hematoma, infections or necrosis. 16 (20 %) and 13 (16 %) patients reported strong and moderate adverse effects on sexuality, respectively. 62 (70 %) patients indicated that they were actively included in the decision making process. Patient ratings of good or bad medical advice were associated with complication rates (p = 0.008). Patients, who evaluated their first preoperative counseling positively, reported higher consent rates when a re-reconstruction became necessary (p ≤ 0.001). Satisfaction with the functional outcome after reconstruction and satisfaction with the cosmetic result was highly correlated (p < 0.001).

Conclusions

A significant association of patient satisfaction with postoperative complications and the decision for a re-reconstruction was demonstrated. Furthermore, our results emphasize the importance of detailed preoperative counseling for women’s adjustment to reconstructive surgery.     

Contribution of cryopreservation in a mandatory SET policy: analysis of 5 years of application of law in an academic IVF center

Objective  

To analyse treatment outcomes after SET law enforcement and to evaluate the contribution of cryopreservation in a SET policy.     

The analisys of complications in forceps delivery in Institutute of Obsterics and Women Disease Medical University of Gdańsk

INTRODUCTION: The forceps are the oldest obstetrics instrument using to quickly finishing delivery in situation of imminent fetal death. Forceps delivery increase the risk of new-born and women complications AIM OF STUDY: The aim of the study was retrospective analysis of 215 forceps deliveries in Institute of Obstetrics and Gynecology, Medical University of Gdańsk between years 1991 and 2004. MATERIAL AND METHODS: 26653 deliveries took place in Institute of Obstetrics and Gynecology, Medical University of Gdańsk between years 1991 and 2004 and in 215 cases deliveries finished by forceps operations. The fetal and mothers complications were assessed. RESULTS: Percentage of forceps delivery was low 0.81%. About 30% of new-borns were born with different types of birth's complications. 16.7% of new-borns had extravasations of skin and 14.8% had subperiosteal haematoma. More than half of examined women had various injuries of their birth canal and the more common was unilateral rupture of cervix--18.6%. Conclusions: The risk of complications after forceps delivery in rather high. 37.2% of newborn and 58,1% of women had various complications after forceps delivery. Our results indicate that percentage of forceps deliveries is decreased and in the 14 years periods was only 0.81%.     

“Centers of excellence in endometriosis surgery” or “centers of excellence in endometriosis”

Centers of excellent endometriosis surgery could improve the care of women with endometriosis, especially if combined with control of the quality of the surgery performed, e.g., through systematic taping of entire interventions. Centers of excellence in endometriosis without emphasis on providing excellent surgery seem of little value and could do more harm than good.     

Analysis of twin pregnancies on the ground of women hospitalized in the Department of Reproduction and Obstetrics Medical University in Wrocław in 1995-1999

The aim of this study was the general valuation of the course and the delivery means of the twin pregnancies. The research material composed of 83 from among 5540 pregnant women hospitalized in the Department of Reproduction and Obstetrics Medical University of Wroc?aw in the years 1995-1999. The mean body mass values and the condition of the newborns have been analyzed on the ground of Apgar's scale, according to the date of delivery. In the period between 23 and 42 week of pregnancy a very high correlation between fetus' body mass and a high correlation between Apgar's scale and the pregnancy's duration has been ascertained. These values have also been estimated in particular periods: 23-27, 28-32, 33-37 and 38-42 weeks of gestation. Statistical analysis didn't indicate any difference between the mean values of Apgar's scale of the newborns from the periods of 33-37 and 38-42 weeks of gestation. There was no evidence of differences either in Apgar's scale values or in the twins' I and II body masses, as well in the whole examined group as in particular periods.     

Analysis of Proteinuria Estimation Methods in Hypertensive Disorders of Pregnancy

Purpose of the Study

The gold-standard 24-h urine collection method for protein estimation is inconvenient and is associated with a delay in laboratory analysis. This study was undertaken to compare sulphosalicylic acid test, urine dipstick test, urine protein-to-creatinine ratio with 24-h urine protein estimation in pre-eclampsia cases.

Methods

This is a comparative study and consists of a single group of 764 subjects. This study was conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of Biochemistry, JIPMER, Pondicherry, India, from February 2011 to January 2014. The subjects included were 764 pre-eclampsia women. A first voided morning sample was obtained for sulphosalicylic acid test, dipstick test, urine protein and creatinine estimation and urine culture, and subsequent urine samples were collected for the 24-h urine protein estimation.

Main Findings

For significant proteinuria, sulphosalicylic acid test with 1 + proteinuria has sensitivity, specificity, PPV and NPV of 59, 48, 39, 67, whereas with 2 + has sensitivity, specificity,PPV and NPV of 44, 88, 75 and 67%, respectively, dipstick test with 1 + proteinuria has sensitivity, specificity, PPV and NPV of 71, 52, 54 and 70%, whereas with 2 + has sensitivity, specificity,PPV and NPV of 49, 87, 75 and 69%, respectively. The spot urine protein-to-creatinine ratio and 24-h urine protein were significantly correlated (r = 0.98; p < 0.0001). The cut-off value for the protein-to-creatinine ratio as an indicator of protein excretion ≥ 300 mg/day was 0.285. The sensitivity, specificity PPV and NPV were 100, 99, 100 and 99%, respectively.

Conclusion

The spot urine protein-to-creatinine ratio is a better method for estimation of proteinuria in pre-eclampsia.