Schistosomiasis: an unusual cause of tubal infertility

A case report of a Nigerian woman having an unusual cause oftubal infertility is presented. On histological examinationof the Fallopian tube, ova of Schistosoma haematobium enclosingliving miracidia were found in the smooth muscle layer of theFallopian tube and its mesosalpinx. Mechanisms of tubal involvementare analysed. The case indicates the need to consider schisto-somiasisas a possible aetiological factor in patients with tubal infertilitycoming from areas where the disease is endemic.     

Immunological factors in endometriosis-associated reproductive failure: studies in fertile and infertile women with and without endometriosis

Immunopathophysiological mechanisms in endometriosis-associated reproductive failure were studied in appropriate populations: infertile and fertile women with and without endometriosis. The incidence of sera positive for any of the autoantibodies tested among infertile women with endometriosis (n = 25) was similar to that observed in the three control groups [unexplained infertility patients (n = 25) and fertile women with (n = 10) and without (n = 25) endometriosis]. The mean volume of peritoneal fluid was significantly elevated in women with endometriosis (both fertile and infertile) as compared with patients without endometriosis (fertile or infertile). The concentration of peritoneal fluid leukocytes and the percentage of cells positive for macrophage markers were significantly increased and the percentage of T lymphocytes significantly decreased in infertile women with endometriosis but not in patients with unexplained infertility and fertile women with endometriosis, as compared with fertile controls without endometriosis. Macrophages from infertile patients with endometriosis had higher sperm phagocytosis than did those from infertile women without endometriosis or fertile subjects with or without endometriosis. Incidences of serum and peritoneal fluid samples embryotoxic to the in-vitro development of 2-cell mouse embryos were significantly higher in infertile patients with endometriosis than in unexplained infertility patients and fertile women with or without endometriosis. It is concluded that immunological mechanisms of endometriosis-associated infertility exist but that these peritoneal immunological factors in infertile women with endometriosis are related to their subfertility rather than to the presence of ectopic endometrial implants. This is supported by the lack of immunological abnormalities observed among fertile women with endometriosis. These immunological abnormalities are lacking in patients with unexplained infertility.      

Post-partum reclassification of glucose tolerance in women previously diagnosed with gestational diabetes mellitus.

AIMS: To re-evaluate post-partum screening; fasting plasma glucose (FPG) vs. oral glucose tolerance test (OGTT) in Caucasian women with previous gestational diabetes mellitus (GDM). METHODS: Once breast-feeding had finished, an OGTT was performed in 120 women with previous GDM. They were classified according to World Health Organization (WHO) 1985 and American Diabetes Association (ADA) 1997 criteria. The kappa-statistic measure of agreement was used to compared both diagnostic categories. A receiver-operating characteristic (ROC) curve studied the FPG as a test to detect abnormal glucose tolerance. RESULTS: Identical diabetes prevalence (2%) but quite different intermediate categories (12% impaired glucose tolerance vs. 3% impaired fasting glucose) were observed with both criteria. The kappa-statistic (scaled from 0 to 1) was 0.38 (fair agreement), P = 0.000. The ROC curve area of the FPG was 0.65. CONCLUSIONS: FPG is an unsatisfactory method of evaluating the glucose tolerance of Caucasian women with previous GDM. OGTT may be a better test for such a purpose.     

Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study

In 100 consecutive patients who were undergoing laparoscopyfor infertility (group 1, n = 52), chronic pelvic pain (group2, n = 18) or tubal sterilization (group 3, n = 30, asymptomaticfertile women), peritoneal biopsies were taken from areas ofvisually normal peritoneum of uterosacral ligaments. Twenty-sixpatients in group 1 (50%), eight patients in group 2 (44.4%)and 13 patients in group 3 (43.3%), were found to have laparoscopicevidence of endometriosis elsewhere in the pelvis. The majorityof women (80.7% in group 1, 87.5% in group 2, and 100% in group3) had stage I disease. The incidence of the distinctive appearancesof the lesions was similar in the three groups of patients and7% of all women or 15% (7/47) of those patients having endometriosisat laparoscopy had only subtle (non-‘typical’) endometrioticperitoneal lesions. Uterosacral biopsies showed the presenceof endometriotic tissue in three cases (5.7%), two cases (11%)and three cases (10%) in groups 1, 2, and 3 respectively. Oneof the two patients in group 2 and two of the three patientsin group 3 had no evidence of endometriosis at laparoscopy;thus histological study revealed the presence of endometriosisin normal peritoneum hi 11 % (5/47) of patients having macroscopicendometriosis and hi 6% (3/53) of patients without endometriosisat laparoscopy. Previous oral contraceptive users were significantlyhigher among women having macroscopic and/or microscopic endometriosisthan among women without the condition. In conclusion, our prospectivestudy shows a high prevalence (45–50%) of endometriosis(including microscopic forms) in both patients with chronicpelvic pain and asymptomatic women (fertile and infertile),thus supporting the modern concept that in many women endometriosismay be a paraphysiological condition while probably only hisome patients small amounts of endometriosis are an ‘annoyance’with implications to their reproductive health and may producesymptoms (eg. pelvic pain) and therefore should be defined asa ‘dis-ease’. Previous use of oral contraceptivesmay increase the risk of developing endometriosis.     

Acute pancreatitis associated with danazol treatment for endometriosis

Hypo-oestrogenic and anabolic/androgenic side-effects of danazolare well known by the gynaecologist and some of them are presentin > 50% of patients being treated for endometriosis. Additionally,danazol produces hepatocellular damage in 10% of women. Thepresent report describes the first case of acute pancreatitisassociated with danazol treatment of endometriosis.     

Pentoxifylline versus placebo in the treatment of infertility associated with minimal or mild endometriosis: a pilot randomized clinical trial

The present study is the first prospective randomized controlled trial of the effect of pentoxifylline on future fertility in infertile women with asymptomatic minimal or mild endometriosis. After completion of a basic infertility workup and laparoscopy, patients were entered into the study and randomly allocated to receive either a 12 month course of oral pentoxifylline (800 mg/day) (n = 30) or an oral placebo (n = 30). Those patients with other infertility factors were included in the study only if the factors were correctable and ultimately determined to be non-contributory. Life-table analysis was used to compare pregnancy rates between the two groups over a 12 month period that started immediately after laparoscopy. The 12 month actuarial overall pregnancy rates were 31 and 18.5% in the pentoxifylline and placebo groups respectively. However, this difference was not statistically significant by the chi(2)-test. Similarly, the Cox regression method showed no differences between the hazard of pregnancy in the two groups studied (odds ratio, 0.56; 95% confidence interval, 0.18-1.67). Therefore, there is no evidence from this study that immunomodulation with pentoxifylline aids fertility in those women with minimal or mild endometriosis. Further studies including more infertile patients with endometriosis are desirable in order to confirm our results.      

Non-surgical treatment of ectopic pregnancy in the sole remaining tube

We reported on three successive cases of intrauterine term pregnancyobtained in patients with an ectopic gestation in their solitaryremaining tube who were treated by three different non-surgicalconservative methods: parenteral methotrexate, local injectionof methotrexate combined with systemic administration, and expectantmanagement respectively. The opposite tube had been removedbecause of previous tubal ectopic pregnancy. The cases, whichwere at a high risk of repeated ectopic implantation, are unequivocalproof of intact function of a tube after conservative non-surgicalprocedures for ectopic pregnancy. Thus, our report adds furtherevidence favouring the feasibility, the safety and fertilitypotential of these procedures for selected unruptured tubalgestations.