Breastfeeding and contraception use among women with unplanned pregnancies less than 2 years after delivery

Objective

To examine breastfeeding and contraceptive use after the lactational amenorrhea method (LAM) criteria were no longer met.

Methods

Two hundred and thirty-three parous Egyptian women with unplanned pregnancies less than 2 years after delivery completed a questionnaire examining breastfeeding practice and contraceptive use.

Results

The majority of women (81.5%) with unplanned pregnancies within 2 years of delivery were breastfeeding at conception. Of these women, 36.3% had used a method of contraception other than LAM compared with 60.5% of women who had weaned (P < 0.05). Among the breastfeeding women, 61.2% failed to use contraception because they believed breastfeeding would prevent pregnancy.

Conclusion

Breastfeeding women with unplanned pregnancies were less likely to have used contraception than women who had weaned, suggesting that prolonged breastfeeding contributes to unmet contraceptive need.     

Etiology and management of primary amenorrhoea: A study of 102 cases at tertiary centre

Objective

To determine the prevalence of etiologic causes of primary amenorrhea in Indian population.

Uterine Didelphys with Bilateral Cervical Agenesis in a 15-Year-Old Girl

Background

Isolated uterine didelphys requires no treatment in contrast to cervical agenesis, which requires a hysterectomy. Because of this, correct diagnosis of Müllerian anomalies is paramount for making recommendations for patient care.

Müllerian Aplasia with Severe Hematometra: A Case Report of Diagnosis and Management in a Low Resource Setting

Background

Müllerian aplasia or Mayer–Rokitansky–Küster–Hauser syndrome is described as congenital absence of the proximal vagina with or without absence of the cervix and uterus, most often recognized after the onset of primary amenorrhea.

Prospective,randomized comparison between pulsatile GnRH therapy and combined gonadotropin (FSH + LH) treatment for ovulation induction in women with hypothalamic amenorrhea and underlying polycystic ovary syndrome

Objective(s)

To compare the efficacy of pulsatile GnRH therapy versus combined gonadotropins for ovulation induction in women with both hypothalamic amenorrhoea and polycystic ovarian syndrome (HA/PCOS) according to their current hypothalamic status.

Study design

This single-centre, prospective, randomized study was conducted in the Nantes University Hospital, France. Thirty consecutive patients were treated for ovulation induction with either pulsatile GnRH therapy or combined gonadotropins (rFSH + rLH). Frequency of adequate ovarian response (mono- or bi-follicular) and clinical pregnancy rate were then compared between both groups.

Results

Ovarian response was similar in both groups with comparable frequency of adequate ovarian response (73% vs 60%), but the clinical pregnancy rate was significantly higher in the pulsatile GnRH therapy group than in the combined gonadotropin group (46% vs 0%).

Conclusions

HA/PCOS is a specific subgroup of infertile women. Pulsatile GnRH therapy is an effective and safe method of ovulation induction that can be used successfully in these patients.     

Patients with 47, XXX karyotype who experienced premature ovarian failure (POF): two case reports

Purpose

Pubertal onset and sexual development are usually normal in 47, XXX individuals; however, we report two cases of premature ovarian failure (POF) in infertile women with trisomy X.

Methods

Chromosome analysis was conducted with G-banding and fluorescence in situ hybridization using X- and Y-bearing probe. Hormonal administration was primarily Kaufmann’s treatment or long-term estradiol treatment, followed by withdrawal bleeding from estrogen and progesterone.

Results

Two patients with trisomy X, aged 31 (patient 1) and 27 years (patient 2), were diagnosed with POF due to hypergonadotropic hypogonadism. Their ovaries were small. Patient 1 had a FSH level of 44.6 mIU/ml and patient 2 had a FSH level of 74.6 mIU/ml. In patient 1, with Kaufmann’s treatment, the FSH decreased to 13.5 mIU/ml; however, follicle growth did not occur following HMG stimulation. In patient 2, FSH did not decrease despite Kaufmann’s treatment; therefore, she was given a GnRH agonist and her FSH level decreased to 7.1 mIU/ml. However, her ovaries never responded to HMG stimulation.

Conclusion

We report on two patients with a 47, XXX karyotype who became infertile due to POF. We recommend that when a patient is diagnosed with trisomy X, the possibility of POF must be strongly considered.     

Diagnosis of Polycystic Ovary Syndrome: AMH in combination with clinical symptoms

Purpose

We assessed the utility of using anti-Müllerian hormone (AMH) and clinical features of polycystic ovary syndrome (PCOS), polycystic ovarian morphology (PCOM), oligo/amenorrhea (OA), and hyperandrogenism (HA) for diagnosing PCOS, and compared their diagnostic accuracy with those of classical diagnostic systems.

Methods

A total of 606 females were admitted to a university hospital with menstrual irregularities or symptoms of hyperandrogenism were enrolled in this cross-sectional study. Fasting blood samples were collected. Pelvic and/or abdominal ultrasonography and clinical examination were performed. Patients were evaluated for the presence of PCOS according to conventional diagnostic criteria. The diagnostic performance of using serum AMH levels alone and in various combinations with the clinical features of PCOM, OA, and HA were investigated.

Results

For the diagnosis of PCOS, the combination of OA and/or HA with AMH showed 83 % sensitivity and 100 % specificity according to the Rotterdam criteria; 83 % sensitivity and 89 % specificity according to the National Institutes of Health (NIH) criteria; and 82 % sensitivity and 93.5 % specificity according to the Androgen Excess Society (AES) criteria.

Conclusions

The serum AMH level is a useful diagnostic marker for PCOS and is correlated with conventional diagnostic criteria. The combination of AMH level with OA and/or HA markedly increased the clinical scope for PCOS diagnosis and can be introduced as a possible objective criterion for the diagnosis of this disease.     

Prenatal diagnosis of skeletal dysplasia due to <Emphasis Type="Italic">FGFR3</Emphasis> gene mutations: a 9-year experience

Purpose  

Prenatal diagnosis with ultrasound findings compatible with skeletal dysplasia due to FGFR3 mutations over a 9 year period in pregnancies and abortuses.     

Anorexia nervosa: a psychiatric illness with gynecological manifestations. A survey of knowledge and practice among Greek gynecologists

Objective

Anorexia nervosa (AN) affects a large number of women, usually in their adolescence. One of the primary manifestations of the disease is menstrual irregularity, and the presence of a menstrual cycle is often used as a sign of recovery among patients. Women with AN are likely to seek medical advice from a gynecologist with regards to their period problems. The role of the gynecologist is therefore crucial in identifying and referring these patients promptly to specialised centers.

Study design

A brief anonymous questionnaire was completed by 94 gynecologists practising in Athens.

Results

Approximately half of the responders felt that the conditions were rarer than it really is, and 25% thought that the disease primarily affects women in their early twenties. Although 56% of gynecologists would not prescribe the combined oral contraceptive in women with AN in order to restore their periods, the remainder of gynecologists were in favour of prescribing hormone replacement with a view to reducing the risk of osteopenia. This is despite the fact that emerging evidence shows there is no benefit. Ten percent of gynecologists never weigh their patients during evaluation of amenorrhoea and 72% felt that their level of knowledge as far as anorexia nervosa is concerned is inadequate.

Conclusion

More education is required among gynecologists on the subject of anorexia nervosa, in order to identify and refer patients in the early stages of the disease process.     

Potassium bromate disrupts mitochondrial distribution within murine oocytes during in vitro maturation

Purpose

As disturbed mitochondrial distribution is thought to be a cause of the aging of oocytes, it was investigated whether oxidizing agents exert harmful effects on nuclear maturation and mitochondrial cluster formation in murine oocytes and whether antioxidants could rescue such harmful effects in vitro.

Methods

Oocytes were obtained from female Institute of Cancer Research mice 48 h after an intraperitoneal injection of 7.5 IU pregnant mare serum gonadotropin. The oocytes were cultured with potassium bromate, an oxidizing agent, in the presence or absence of the antioxidant, resveratrol. After 12 h, the nuclear phases and mitochondrial distribution were observed.

Results

Significantly decreased rates of metaphase II (MII) oocytes were observed with 750 μM and 1000 μM of potassium bromate, while a significant increase in abnormal mitochondrial clusters was induced at 500 μM, 750 μM, and 1,000 μM. The addition of 10 μM or 20 μM resveratrol improved both MII maturity and the cluster formation rates in the presence of potassium bromate.

Conclusions

The addition of potassium bromate reduced MII maturity rates and induced abnormal mitochondrial cluster formation. This effect was alleviated by the antioxidant, resveratrol. The in vitro model used herein is useful for investigating the functions of antioxidants in the aging of oocytes.     

Perinatal outcomes in condyloma acuminata pregnancies

Objective  

To investigate pregnancy outcome in patients with condyloma acuminata.     

Fetal loss associated with second trimester amniocentesis

Objective  

To evaluate the fetal loss rate associated with second trimester amniocentesis.     

Specific secretory phase endometrial leukocytes of women with two and more consecutive idiopathic abortions are not significantly different from healthy controls

Objective  

To analyze concentrations of endometrial leukocytes in patients with idiopathic-repeated abortions.     

Meta-analysis of the embryo freezing transfer interval

Background

The decision of whether frozen embryo transfer (FET) should be performed in the cycle immediately after OPU or at least one cycle later is controversial. FET could improve pregnancy rates in IVF; however, how much time is needed for the endometrium to return to optimal receptivity after ovarian stimulation is not known.

Methods

Electronic search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to identify studies providing data on the influence of the interval between embryo freezing (or OPU) and FET in FET cycles published between January 1, 2007, and February 1, 2020.

Main findings

Data analyzed indicated that in the immediate FET cycles, there was a trend to an increased biochemical pregnancy rate (RR = 1.08; CI = 1.00-1.18), whereas the clinical pregnancy rate was somewhat higher, but without reaching statistical significance (RR = 1.07; CI = 0.99-1.15). The live birth rate was similar in the two groups (RR = 1.05; CI = 0.95-1.15), as was the implantation rate (RR = 0.98; CI = 0.83-1.16). Stratifying by embryo stage or FET type (freeze-all or FET after failed fresh transfer) showed no differences.

Conclusion

Systematically delaying FET does not offer benefits to IVF outcomes. In addition, immediate transfer is associated with a nonsignificant trend to better clinical pregnancy rate and it also avoids the psychological effects of prolonging the stress on prospective parents.

     

Pregnancy outcome and fertility after complete uterine rupture: a report of 20 pregnancies and a review of literature

Objective  

To review the pregnancy outcome in women with previous complete uterine rupture.     

Pregnancy outcome in systemic lupus erythematosus: Asia’s largest single centre study

Aim  

To evaluate pregnancy outcome in women with systemic lupus erythematosus (SLE).     

A case with vesicouterine fistula: mini review

Aim  

The objective is to present a case with vesicouterine fistula after cesarean section.     

Increased complication rates in vaginal hysterectomy in genital tuberculosis

Purpose  

To evaluate the complication rate in women with genital tuberculosis undergoing vaginal hysterectomy.     

Tubal ligation via colpotomy or laparoscopy: a retrospective comparative study

Objective  

To compare transvaginal with laparoscopic tubal sterilization with respect to invasiveness and outcomes.