Effect of pretreatment with a levonorgestrel-releasing intrauterine system on IVF and vitrified–warmed embryo transfer outcomes in women with adenomyosis

Research questionDoes the use of a levonorgestrel-releasing intrauterine system (LNG-IUS) improve the ongoing pregnancy rate of vitrified–warmed embryo transfer in women with adenomyosis undergoing IVF?DesignThis retrospective study included 358 women with adenomyosis undergoing IVF. Of these, 134 women were enrolled in the LNG-IUS group and another 224 women were in the control group. All women were screened for adenomyosis by transvaginal ultrasound and magnetic resonance imaging (MRI). There was no significant difference in the ages of women, FSH, cause of infertility, body mass index, total dose of gonadotrophin used and number of oocytes collected between the two groups. All comparisons performed were between patients undergoing vitrified–warmed embryo transfer.ResultsStatistical differences were found in the ongoing pregnancy rates (41.8% vs 29.5%, P = 0.017) between the LNG-IUS group and control group. Logistic regression analysis showed that the odds ratio (OR) of ongoing pregnancy was significantly increased with LNG-IUS usage (adjusted OR = 1.628, 95% confidence interval 1.011–2.622). Also, differences were found in implantation rates (32.1% vs 22.1%, P = 0.005) and clinical pregnancy rates (44% versus 33.5%, P = 0.045) between the LNG-IUS group and control group.ConclusionsThe results of this study offer some support for evaluating the effect of pretreatment with LNG-IUS in women with adenomyosis in future randomized controlled trials.     

The effect of the levonorgestrel-releasing intrauterine system, Mirena® on mast cell numbers in women with endometriosis undergoing symptomatic treatment

Objectives

Mirena^® has been shown to improve symptoms in women with minimal to moderate endometriosis. The precise mechanisms for this have not been thoroughly investigated. We investigate here one possible mechanism—alteration in the number of mast cells in the endometriotic tissue.

Study design

Tissues (endometrial, endometriotic and normal peritoneal biopsies) prospectively collected from twenty-eight women with laparoscopically confirmed minimal to moderate endometriosis before and 6 months after treatment with Mirena^® were processed for immunohistochemistry for ER and PR expression followed by toluidine blue staining for mast cells. Photographs were obtained and the receptors and mast cells identified and quantified.

Results

The mean (± SEM) age of the twenty-eight women was 31 (±7.2) (range 18–42) years. Eight of the endometrial biopsies were in the proliferative phase and twenty in the secretory phase. Six months after Mirena^®, the number of mast cell expressed in the tissues decreased significantly in the eutopic (P = 0.0358) and ectopic endometrium (P = 0.0220) but not in the normal peritoneum (P > 0.05). There were no ERs or PRs found in mast cells.

Conclusion

Mirena^® causes a reduction in mast cell numbers in ectopic and eutopic endometrium in women undergoing symptomatic treatment of minimal to moderate endometriosis. This reduction could partly explain the efficacy of Mirena^® in modulating pain in these women.     

Patients’ beliefs about the causes of myomas: a pilot study from a large European city

Introduction: Patients usually develop subjective concepts about their illness, which then influences their further health behaviors and treatment decisions. This study aimed to evaluate several possible patient beliefs about the causal factors of illness, in a large sample of women seeking treatment for myomas.

Methods: From November 2011 to October 2013, all patients at a specialized myoma clinic in a large European city were surveyed about their beliefs about the causes of myomas. We used a modified version of the Patient Theory Questionnaire from Zenz et al., which presented 16 of the most common possible beliefs about the causes of myomas, and asked patients to rate them on a five-point scale of likelihood. Retrospectively, statistical analysis was performed on their answers and sociodemographic data.

Results: Data from 482 patients was included (return rate of 91.5%). The most frequent answers for possible causes were “inherited susceptibility for myomas” (67.3%), “reorganization in the body during a particular phase of life” (63.5%), “stress at work or home” (49.3%) and “an in-born tendency to react to emotional agitation with physical disorders” (41.8%). Significant differences were found for the factors of age, immigration background and self-rated knowledge about myomas.

Conclusions: It is curious that two of the four most common explanations for myomas were stress and somatization, and were endorsed by nearly half of all patients. Physicians seeing women for myomas should consider that many such patients may have further hidden reasons for seeking medical care.     

Malignant endometrial polyp in woman with the levonorgestrel intrauterine system – a case report

The levonorgestrel-releasing intrauterine system (LNG-IUS) is widely used and recommended as a reliable contraceptive. It also acts by opposing the effects of estrogen on the endometrium, thereby preventing development of endometrial hyperplasia and its possible malignant transformation. This case describes a 52-year-old multiparous amenorrhoeic patient who was seen in the gynecology outpatient department for a routine control 46?months after the insertion LNG-IUS as contraception. Hysteroscopy with a target biopsy following suspicious ultrasound scan confirmed well-differentiated endometrioid adenocarcinoma. Ultrasound scan prior to inserting LNG-IUS revealed normal 5?mm thin endometrium with the sharp edges. Uterine bleeding before the LNG-IUS insertion was regular and not excessive and the woman has remained amenorrhoeic after the LNG-IUS insertion. We present a case of the growth of a polyp-shaped endometrial carcinoma in a LNG-IUS asymptomatic user.     

Women and men’s psychological adjustment after abortion: a six months prospective pilot study

Background

The psychological impact of abortion is a controversial issue. While some studies indicate that women who had elective abortions present lower psychological distress when compared with those who had spontaneous or therapeutic abortions, other studies found abortion to be associated with significant psychological distress.

Objectives

To assess psychological adjustment (emotional disorder, trauma symptoms and couple relationship) one and six months after abortion, and gender differences regarding psychological adjustment, and to assess the moderation role of couple relationship in the effect of the etiology of abortion on emotional disorder and trauma symptoms.

Methods

Women (n=50) with different etiologies of abortion agreed to participate, as well as 15 partners (N=65). Assessments took place one and six months after abortion. Measures included the Brief Symptoms Inventory, the Impact of Event Scale-Revised and the Relationship Questionnaire.

Results

A decrease in emotional disorder for all etiologies of abortion and an increase in perceived quality of couple relationship in therapeutic abortion were observed over time. Couple relationship moderates the effect of the etiology of abortion on trauma symptoms one month after abortion.

Conclusion

Psychological adjustment after abortion seems not to be exclusively related to its etiology, being influenced by other factors such as couple relationship.     

Italian women’s childbirth: a prospective longitudinal study of delivery predictors and subjective experience

Background: Previous research has demonstrated that negative childbirth expectations adversely influence perinatal outcomes. The current research builds on this with Italian mothers-to-be. Objective: The present study (1) explored the influence of cognitive and emotional variables on labour and delivery outcomes and (2) examined how individual characteristics, couple adjustment, and medical factors influence the childbirth experience. Method: 121 Italian primiparous women participated in a prospective longitudinal study where participants completed a set of questionnaires between the 32nd and 37th week of pregnancy and again 30–40 days post-delivery. Results: Binary logistic regression analyses revealed that women with negative childbirth expectations were three times more likely to experience an emergency C-section or an instrumental vaginal delivery. Furthermore, childbirth expectations predicted subjective birth experience. This relationship between expectations and delivery type and the subjective childbirth experience was weak while other variables (such as anxiety, depression, couple adjustment) did not significantly influence delivery type or the subjective childbirth experience. Conclusions: The weak relationship between childbirth expectations and perinatal outcomes renders it necessary to question the nature of the relationship found in previous research, especially considering inconsistencies of the literature on the subject. The current research makes it clear that further research is needed to understand better the relationship between expectations and perinatal outcomes in order to better improve the well-being of mothers-to-be during labour and delivery.     

Motivational interviewing in obese women with polycystic ovary syndrome – a pilot study

Lifestyle intervention is first line treatment in obese women with polycystic ovary syndrome (PCOS). The effect of motivational interviewing (MI) as add on to standard advice (SA) on weight loss and quality of life (QoL) has not been evaluated in obese women with PCOS. We aimed to examine whether MI as add on to SA induced higher weight loss and improved QoL in obese women with PCOS. Thirty-seven obese women with PCOS (BMI ≥30?kg/m2) were randomized to MI?+?SA (n?=?19) vs. SA (n?=?18) for six months. Anthropometric measures (BMI, waist) and questionnaires (World Health Organization-5 (WHO-5), Major Depression Index (MDI), Short Form-36 (SF-36) and PCOS-Questionnaire (PCOS-Q)) were performed at baseline and at follow-up, www.clinicaltrials.gov, NCT02924025. Twenty-eight (14?+?14) women completed the study. At baseline, 24/28 women had WHO-5 scores <67 and 12/28 women had MDI scores indicating depression. Changes in weight and QoL were similar between MI?+?SA vs. SA group. However, WHO-5 (p=.028) and MDI (p=.008) scores improved significantly in the 12/24 women with MDI scores indicating depression. MI as add on to SA did not improve QoL or weight loss. Obese women with PCOS had low QoL.     

Women without vulvodynia can have a positive ‘Q-tip test’: a cross sectional study

Background: Vulvodynia is a frequently missed pathology, often confused with vaginismus. The Q-tip test (QTT) is fundamental for the diagnosis; however, there is lack of data about its performance in asymptomatic women.

Objective: This study intended to evaluate the QTT for painful vestibular spots in asymptomatic women.

Methods: Q-tips were gently pressed at different areas of the vulvar vestibule to obtain a 0–10 score representing the pain felt. This was performed in 267 consecutive patients presenting to the gynecology outpatient clinic for reasons other than vulvovaginal complaints. A questionnaire was done to evaluate the possibility of unrecognized vulvodynia.

Results: Out of the 267 women, 18 (6.7%) fitted the diagnosis of vulvodynia and were excluded from the analysis. Of the remaining 249, 41 (16.5%) had a positive QTT. We could not find differences in the sexual activity rate between women with and without a positive QTT. No demographic differences could be found between the two groups. Only depression was more common in women with a positive QTT [31.7% (13/41) versus 10.8% (21/208), p=.001).

Conclusions: Asymptomatic women can have painful vestibular spots in the absence of vulvodynia. A positive QTT cannot be considered equivalent to vulvodynia, highlighting the need for extensive workup of these women before that diagnosis can be assumed.     

Oocyte donation in donors with levonorgestrel intrauterine device: a good match?

Research questionDoes the levonorgestrel-releasing intrauterine device (LNG-IUD) influence cumulative live birth rate (CLBR) in oocyte donor cycles?DesignRetrospective cohort study based on prospectively collected data from 1 May 2009 to 31 December 2017, without attrition, consisting of 491 consecutive cycles of vitrified oocyte donation, none lost to follow-up (unique donor–recipient pairs). All donors underwent ovarian stimulation using gonadotrophin releasing hormone (GnRH) antagonist co-treatment and GnRH agonist trigger. CLBR was chosen as primary outcome measure.ResultsIn total, 103 (21.0%) cycles were carried out in donors carrying a LNG-IUD. In 388 (79.0%) cycles, no LNG-IUD was present. After confounder-adjustment, the use of an LNG-IUD did not have a statistically significant influence on CLBR.ConclusionsThe LNG-IUD does not negatively affect CLBR.     

Ovarian reserve in young women with low birth weight and normal puberty: a pilot case–control study

Aim.?Studies indicate that women born small for gestational age (SGA) have impaired ovarian function. The origin of this ovarian dysfunction is still debatable. The aim of this study was to compare ovarian ageing between girls born appropriate for gestational age (AGA) and SGA. Therefore, we measured Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), E2, Anti-Müllerian hormone (AMH) levels and the pituitary response to endogenous Gonadotropin-releasing hormone (GnRH) in adolescent girls born SGA and AGA.

Methods.?A case–controlled pilot study consisting of seven SGA women (birth weight?<10th percentile AGA) and 13 AGA women with regular menstrual cycles, age 19.9 (±0.42). Early follicular FSH, LH, Oestradiol (E2) and AMH levels were measured. After baseline samples, 100?μg GnRH was administered intravenously and at 30, 60 and 90?min blood samples were taken to measure gonadotropin levels and to compute the response to endogenous GnRH.

Results.?Mean follicular phase LH, FSH, E2 and AMH levels did not significantly differ between young women born SGA and AGA. Furthermore, the response to endogenous GnRH showed no significant differences either.

Conclusions.?We concluded against extension of this pilot study. Based on our observations it seems unlikely that limited ovarian reserve is a predominated problem in adolescent SGA.     

A novel chromosomal translocation and heteromorphism in a female with recurrent pregnancy loss—a case study

Purpose

To evaluate the clinical, biochemical and cytogenetic analyses of a couple with reproductive failure.

Methods

A couple with a history of recurrent pregnancy loss was referred to the Institute of Genetics for cytogenetic evaluation. Chromosomal analysis of the phenotypically normal parents was done to ascertain the role of chromosomal abnormalities and offer appropriate genetic counseling. Further, advanced karyotype analysis by spectral karyotyping was also carried out in the couple and parents of the female partner.

Results

Clinical and hormonal profile of the couple revealed normal phenotypes. The ultrasound scan of the female showed normal uterus and ovaries. Chromosomal analysis of the couple revealed a normal 46, XY karyotype in the male spouse, and a unique balanced reciprocal translocation 46, XX, t(12;13) (q13;q33) + 15pstk+ chromosomal constitution in the female partner. Cytogenetic analysis of her parents revealed a similar translocation between chromosomes 12 and 13 in the father and 15pstk+ in the mother. Further, corroboration of the chromosome abnormalities was carried out by spectral karyotyping.

Conclusion

A unique and novel familial transmission of paternally derived balanced reciprocal translocation and maternally derived heteromorphism in a female with the history of recurrent pregnancy loss was reported as an original investigation.     

The treatment of severe premenstrual syndrome with goserelin with and without ‘add-back’ estrogen therapy: A placebo-controlled study

The study aimed to determine if the addition of daily low-dose oral estrogen with a cyclical progestogen given to young women using a depot gonadotropin-releasing hormone (GnRH) analog implant for the treatment of their premenstrual syndrome (PMS) would affect the clinical outcome. In a double-blind placebo-controlled study in a specialist premenstrual syndrome clinic setting ,60 women aged between 20 and 45 years were randomized to one of three treatment groups: Group A (placebo implant four weekly + placebo tablets daily) ,Group B (goserelin 3.6 mg implant four weekly + estradiol valerate 2 mg daily with norethisterone 5 mg from days 21-28 of a 28-day cycle) or Group C (goserelin 3.6 mg implant four weekly + placebo tablets daily). Differences between PMS scores at 2 ,4 and 6 months were compared with pretreatment values. There was a significant improvement in PMS scores in Group C (Zoladex + placebo) after 2 ,4 and 6 months of treatment when compared to pretreatment values and Group A (placebo + placebo). The addition of a low-dose oral estrogen with a cyclical progestogen to GnRH analog treatment (Group B) resulted in a less dramatic response when compared to pretreatment values and no significant improvement when compared to Group A (placebo + placebo) at 2 ,4 and 6 months of treatment. The addition of a low-dose oral estrogen with a cyclical progestogen to depot GnRH analog therapy in the treatment of PMS reduces the clinical response.     

A pilot study of Foley’s catheter balloon for prevention of intrauterine adhesions following breach of uterine cavity in complex myoma surgery

Purpose

During abdominal myomectomy for removal of multiple fibroids, the uterine cavity may be breached. Repair of the breach is associated with a risk of development of intrauterine adhesions. We conducted a pilot study to evaluate the effectiveness of temporary placement of a Foley’s catheter balloon inflated with 30 ml normal saline into uterine cavity at the end of surgery to prevent this complication.

Methods

Retrospective cohort study. When the uterine cavity was breached during open myomectomy, it was repaired with a No. 2-0 vicryl suture. A Foley catheter balloon was inserted into the uterine cavity at the end of the procedure, and the balloon distended with 30 ml of normal saline. The balloon was removed on the fourth post-operative day. Follow-up hysteroscopy was performed after 6 months.

Results

At the time of follow-up hysteroscopy 6 months after the myomectomy, we found no intrauterine adhesions in 16 consecutive women treated with balloon, compared to 3 out of 10 (30 %) historical controls where the balloon was not used.

Conclusion

A Foley catheter balloon inserted into the uterine cavity following breach and repair of the uterine cavity at open myomectomy appears to prevent the formation of intrauterine adhesions.     

Effects of a structured dance program in Parkinson’s disease. A Greek pilot study

IntroductionDance for Parkinson's Disease® (DfPD®) is a structured dance program that has never been evaluated in Greek PD population. This study assesses for the first time the efficacy, safety and feasibility of DfPD® program in Greek PD patients.Material and methodsA total of 16 early-to-mid-stage PD patients (50% men, aged 56 ± 12) underwent a total of 16 60-min classes of adjusted to Greek music and dance culture DfPD®, twice weekly, over 8 weeks. Assessments were performed at baseline and at the end of the study period and included quality of life (PDQ-8), depressive symptoms (BDI-II), fatigue (PFS-16), cognitive functions (MoCA), balance (BBS) and body mass index (BMI). Safety (possible falls, injuries, muscle soreness or excessive fatigue) and feasibility (technical and financial parameters, willingness for participation and continuation, recruitment rates) were also assessed.ResultsStatistically significant improvements were found in quality of life (29 ± 47%, p = 0,020), depressive symptoms (26 ± 52%, p = 0,046), fatigue (13 ± 20%, p = 0,021), cognitive functions (17 ± 23%, p = 0,010), balance (5 ± 4%, p = 0,003) and BMI (2 ± 2%, p = 0,010). No adverse events, high adherence (93,75%) and low attrition (12,5%) rates were reported.ConclusionA twice weekly 60-min DfPD® class for 8 weeks is a safe and feasible non-pharmacological complementary therapeutic intervention for Greek PD patients and may improve their quality of life, depressive symptoms, fatigue, cognitive functions, balance, and BMI. Further research on this intervention is warranted.     

Levonorgestrel hormone releasing intrauterine system (Mirena®) as a contraceptive in egg donors: case report

We report the safe use of levonorgestrel hormone releasing intra uterine system (Mirena®) as a contraceptive in egg donors during a treatment cycle. In the first case report, a 29-year-old egg donor using the Mirena coil for contraception and two egg recipients, aged 41 years and 32 years respectively underwent standard IVF treatment, oocyte retrieval in the egg donor and in vitro fertilization followed by embryo transfer in the recipient. The outcome of IVF cycle using donor eggs was satisfactory with successful pregnancy in the egg recipient. The second case involved a 34-year-old egg donor using the Mirena coil and a 44-year-old recipient. Our findings suggest that egg donors can safely use the (Mirena®) as a contraceptive device during treatment, without compromising follicular development and oocyte quality.