Evaluation of intrauterine insemination with washed spermatozoa from the husband in the treatment of infertility.

In this study, we examined the efficacy of intrauterine insemination with washed spermatozoa from the husband (AIH/IUI) in the treatment of infertility. A total of 127 treatment cycles were completed (1.95 cycles per patient). The indications for AIH/IUI were male subfertility (group I: 53 couples), cervical factor (group II: four couples), male and cervical factor (group III: six couples) and unexplained infertility (group IV: two couples). Sperm washing caused a reduction of the sperm concentration from 52 x 10(6)/ml to 44 x 10(6)/ml (P less than 0.08) and motility from 49% to 45% (P less than 0.03). Twelve pregnancies were achieved (18.5% per couple and 9.5% per cycle): eight pregnancies in group I (15.1%), one in group II (25%) and three in group III (50%). Of the 12 pregnancies, eight occurred in the first insemination cycle, three in the second and one in the third (1.4 cycles/pregnancy). Sperm motility was significantly higher in the pregnant than in the non-pregnant group (65.5% versus 46.4%, respectively; P less than 0.004), whereas no significant difference was observed in the sperm concentration between these two groups (39 x 10(6)/ml and 54 x 10(6)/ml, respectively). In conclusion, AIH/IUI is a technically easy and non-invasive procedure which offers a satisfactory pregnancy rate in selected couples with male subfertility and/or cervical factor infertility.     

Andrology: Pituitary-testicular axis in men with {beta}-thalassaemia major

Delayed puberty and hypogonadism are frequently observed inpatients with homozygous -thalassaemia. We evaluated the pituitary-testicularaxis in 30 thalassaemic men, aged from 17 to 35 years who wereregularly trans fused and underwent chelation therapy, whileemphasis was given to pituitary reserves of gonadotrophins andthe correlation of hormones with serum ferritin (SF). The investigationincluded endocrinological examination, evaluation of serum basallevels of follicle stimulating hormone (FSH), luteinizing hormone(LH), free testosterone and gonadotropbin-releasing hormone(GnRH) test and also spermiograms. According to the results,patients were divided into three groups: group A, which included18 eugonadal patients with moderately elevated SF, group B whichincluded six patients who had hypogonadotrophic hypogonadismand excessive elevation of SF, and group C, which included sixpatients characterized as intermediate, with regard to sexualmaturation and SF levels. In conclusion, -thalassaemia majorleads to variable pituitary iron overload and thus hypophysealdamage. This endocrine disturbance is becoming less frequentnowadays with early and intensive chelation therapy.     

Results after hysteroscopic management of premenopausal patients with dysfunctional uterine bleeding or intrauterine lesions

AIM: The purpose of this study was to evaluate the efficacy, safety and benefits of hysteroscopic surgery in the management of dysfunctional uterine bleeding or intrauterine lesions causing menstrual disorders in premenopausal women. METHODS: We enrolled in this study 228 patients who underwent operative hysteroscopy because of metrorrhagia due to endometrial polyps or submucous myomas diagnosed by hysterosalpingography, transvaginal ultrasound and diagnostic hysteroscopy. In addition, the study population included 27 patients who presented dysfunctional uterine bleeding resistant to medical therapy. These patients underwent total or partial transcervical resection of endometrium (TCRE). RESULTS: Operative hysteroscopy was a successful procedure in 250 of the 255 cases (98%) but it needed to be repeated in three cases with large submucous myomas of type I and II and after two polypectomies. Mean duration of the procedure was 26.1 min (range 4-58) and mean postoperative hospital stay was six hours (range 2-48 hours). There were two cases with fluid overload and five with postoperative uterine bleeding reported in this study. During postoperative follow-up (12-36 months) the majority of patients (246/255 or 96.5%) were free of symptoms. After total or partial TCRE, 23/27 patients (85.2%) reported eumenorrhea or hypomenorrhea, 2/27 (7.4%) amenorrhea and 2/27 (7.4%) metrorrhagia (due to adenomyosis). CONCLUSION: Hysteroscopic surgery is an effective and safe method for the management of benign intracavitary pathology or the treatment of dysfunctional uterine bleeding. In addition, it has the advantages of quick recovery, early return to normal activities and reduced hospital stay for the patient. Careful monitoring of the patients avoids serious complications.     

Pregnancy and oral health: utilisation of dental services during pregnancy in northern Greece

BACKGROUND: Recent studies have shown that gingivitis and periodontal infection during pregnancy represent an independent risk factor for pre-term birth. However, little is known about the prevalence and correlates of dental attendance during pregnancy. METHODS: During the first 3 days postpartum, an anonymous questionnaire was administered to 425 women in order to explore their dental condition and utilisation of dental health services during pregnancy, as well as their perceptions on the potential associations between dental care during pregnancy and pregnancy outcomes. RESULTS: Almost half of the respondents (46.8%) reported symptoms of gingivitis during their pregnancy. Pregnancy gingivitis was independently associated with non-Greek ethnicity (p=0.008), multiparity versus primiparity (p<0.005), lower economic class versus middle and upper classes (p=0.001), and the lack of routine primary dental care (p=0.005). Some 27.3% reported a visit to the dentist during their pregnancy. The majority (72.2%) believed that dental treatment during pregnancy might have a negative affect on pregnancy outcome. The presence of pregnancy gingivitis and the belief that dental treatment during pregnancy is safe were both independently associated with visiting a dentist during pregnancy (p<0.0005 for both). CONCLUSIONS: Despite the increased prevalence of dental problems among pregnant women, few women seek dental services in this population, which can be primarily attributed to women's erroneous beliefs regarding the safety of dental examination. Therefore, there is an imperative need to offer oral health education and develop preventive programs for women of reproductive age.     

Psychosocial impacts of infertility on Greek couples

Psychosocial impacts of infertility were investigated in couplesundergoing different treatment procedures in our clinic. Coupleswere interviewed in a semi-structured way by a psychologistor a psychiatrist and responded to three specially structuredquestionnaires: the Life Events Scale, the Marlowe—Crowne/TaylorScale and the Side Effect Checklist. The data were analysedin terms of demographic characteristics as well as treatmentprocedure. The psychosocial, psychosexual and emotional outcomesof their infertility problem and Greek traditional culture lawsare discussed. Stress has been identified in both sexes, depressionmostly in women, while men showed a tendency towards repressedanxiety and thus a greater risk of psychosomatic illness, afinding supported by their response to the Side Effect Checklist.Women showed a high defensive anxiety and also reported numerouspsychosomatic symptoms. These couples seem to have special needsand fears, both general and treatment specific. Very few ofour couples would be considered as severely emotionally disturbed.Women seem to have more difficulties in social adjustment. Sexualdysfunction was reported by almost half of our subjects, althoughthis was associated with a degree of deterioration in theirmarriage. Guilt feelings, particularly connected with previousabortions, seem to be torturing most women. Finally, both partnersseem to have psychological problems irrespective of the onein whom the aetiological problem was found. Moreover, traditionalrules seem to impose a special burden on people coming fromrural areas. Our results strongly support the belief that infertilecouples undergoing different treatments need psychological counsellingand supportive psychotherapy.     

Fetal abdominal subcutaneous tissue thickness measured by ultrasound at term is associated with birth weight and mode of delivery

PURPOSE: To determine if measurement of fetal abdominal subcutaneous tissue thickness (FASTT) at term can predict birth weight, mode of delivery and perinatal outcome. METHODS: A prospective study with 352 normal, singleton pregnancies in the vertex presentation examined with real-time ultrasound at 37-39 weeks' gestation. RESULTS: FASTT was positively correlated with birth weight (Pearson's, r = 0.784, p < 0.001). Fetuses with low FASTT were more likely to be delivered through normal vaginal delivery (7.8 +/- 0.1 mm), while higher FASTT was correlated with operative vaginal delivery (7.9 +/- 0.2 mm) and cesarean section (8.6 +/- 0.3 mm) (ANOVA, p = 0.034). In contrast, FASTT was not correlated with intrapartum CTG, labor duration and Apgar scores. CONCLUSIONS: In normal pregnancies, FASTT at term is positively associated with birth weight. With increasing FASTT the likelihood of operative vaginal and cesarean delivery increases. FASTT is not associated with perinatal outcome.     

Primary ovarian angiosarcoma--review of the literature and report of a case with coexisting chylothorax

BACKGROUND: Primary ovarian angiosarcoma is a very rare gynaecologic malignancy with poor prognosis and uncertain, up-to-date, treatment options. Its exact diagnosis is challenging for surgeons and difficult for pathologists. There are only a few cases reported in the international literature. CASE: We report a case of primary pure ovarian angiosarcoma with coexisting chylothorax which is, to the best of our knowledge, the first reported case. An extensive review of the literature analyzing all clinical and pathological parameters related to this condition is presented. RESULT: In spite of all therapeutic efforts, surgical and medical, prognosis of ovarian angiosarcoma remains very poor in most cases. CONCLUSION: Primary ovarian angiosarcoma is a rare and aggressive malignancy. The report of such cases is interesting in order to exchange knowledge and experience, and possibly to further improve our diagnostic and therapeutic capabilities.     

KIT protein expression in uterine sarcomas: an immunohistochemical study and review of the literature

PURPOSE: The aim of the present study was to investigate the possibility of treating uterine sarcomas with imatinib mesylate. Imatinib mesylate, a selective tyrosine kinase inhibitor, is very efficient against mesenchymal tumors of the gastrointestinal tract, known as GISTs. Imatinib mesylate acts against a tyrosine kinase encoded by the KIT gene in GISTs, and is more effective in tumors expressing this protein. METHODS: Expression of KIT was analyzed immunohistochemically (n = 12) in formalin-fixed paraffin-embedded primary uterine sarcomas. RESULTS: Using a semi-quantitative immunohistochemical score we found that KIT expression was very weak in the majority of tumors, while none of the uterine sarcomas tested showed strong expression. Overall, published studies addressing this issue in small series of uterine sarcomas yielded similar results. CONCLUSION: Current data suggest that it is unlikely that imatinib mesylate could be used effectively as a single agent in patients with uterine sarcomas.