Artur Bjelica

Pregnancy as a stressful life event and strategies for coping with stress in women with pregnancy-induced hypertension

INTRODUCTION Pregnancy-induced hypertension (PIH) represents an extremely important problem in perinatology. Despite numerous clinical observations and studies, the etiology and exact sequence of pathophysiological events accompanying this specific disorder have remained still unresolved. The concepts most often considered are those that include genetic, endocrine and immunological mechanisms. Besides, one can also find in the literature considerations addressing potential participation of psychologicalfactors in pregnancy-induced hypertension. MATERIAL AND METHODS The study included two groups of women--100 women with PIH and 100 of women with normal course of pregnancy, which were tested using two questionnaires concerning pregnancy as a stressful event and using strategies for coping with stress. RESULTS AND DISCUSSION Women with PIH experience pregnancy in a more stressful way than women with regular course of pregnancy. However, it is necessary to point out that respondents of both groups thought that pregnant women seek attention from everyone from their environment, and that their husbands/partners should pay special attention to them during pregnancy. The importance of relationship between partners during pregnancy and the emotional life of pregnant woman has been also examined by other researchers. These data suggest that pregnancy is an emotionally vulnerable period during which women demand special attention from the environment and especially from their husbands/partners. In view of using particular strategies to cope with stress, certain differences have been registered between the two groups of women. Namely, women with PIH utilize much more the mechanism of seeking social support and much less the mechanism of positive redefinition, compared with women with normal course of pregnancy. CONCLUSION From the psychosocial approach, pregnancy may be considered as a specific state of high emotional tension, which can represent a potent stressor. In the frame of specific reactions to stress, pregnancy as a stress-inducing situation may lead to transformation of emotional tension to biochemical and vegetative response, and thus contribute to onset of pregnancy-induced hypertension.

Effect of hysteroscopic examination on the outcome of in vitro fertilization

BACKGROUND/AIM Implantation failure after embryo transfer is one of the main problems of in vitro fertilization (IVF) and intrauterine pathologies can lead to unsuccessful outcome. The aim of this study was to determine if hysteroscopic examination of uterine cavity and consequent treatment of intrauterine lesions prior to IVF could improve the pregnancy rate in women under 38. METHODS This study included 480 patients under 38, who had undergone IVF or IVF\ICSI--embryo transfer cycles, in which one or more good quality embryos were transferred. By transvaginal sonography performed within the past 2 months, the uterus was found normal in all the patients enrolled in our IVF unit. The patients were divided into three groups: group A--with no hysteroscopic evaluation and no pathology, group B --with hysteroscopy but no pathology, and group C--with abnormal hysteroscopy finding and corresponding treatment. RESULTS The obtained results revaled no difference in the mean age, duration of infertility, number of mature oocytes in either group (p > 0.05). Clinical pregnancy rates in the groups A, B and C were 36.9%, 58.75% and 32.7%, respectively, and delivery rates were 27.5%, 48.7% and 25.7%, respectively. There was a statistically significant difference among the groups concerning pregnancy and delivery rates. CONCLUSION Considering the results of this study we could conclude that hysteroscopy, as a routine examination, should be performed before the first IVF-ET cycle in all patients thereby reducing the failures and then the costs of IVF-ET.

The phenomenon of pregnancy — a psychological view

Pregnancy is a very specific and complex period in a womans life. The accompanying changes are observed not only on the biological/physiological plane but also in her psychological and social functioning. Altered psychological functioning can occur from the very beginning to the end of pregnancy, including the postpartum period. During pregnancy, visible changes occur in the bodys appearance, as well as in femininity, affections, and sexuality, whereas the womans position and role are gaining new qualities. To a greater or lesser degree, every expectant mother experiences psychological am-bivalence, frequent mood changes from exhaustion to exaltation, emotional disturbances, and/or mixed anxiety-depressive disorder. In addition, pregnancy causes a number of specific apprehensions concerning the course and outcome, which makes the woman particularly vulnerable and requires adequate treatment, depending on the adaptive capacities of her personality. Furthermore, from a psychosocial aspect, pregnancy could be considered a specific highly emotional state, which may be a potent stressor. Perinatal maternal stress can lead to different complications that may have far-reaching consequences for both somatic and psychic functioning of the newborn. This review considers pregnancy as a complex psychological phenomenon and explores multiple changes in the womans psychological functioning in both normal and psychologically complicated courses of pregnancy.

Influence of body mass index on in vitro fertilization outcome in women with polycystic ovary syndrome

INTRODUCTION The purpose of this study was to investigate the influence of the body mass index on the outcome of in vitro fertilization in patients with polycystic ovary syndrome. MATERIAL AND METHODS The study sample consisted of 123 patients with polycystic ovary syndrome who completed their in vitro fertilization treatment at the Department of Gynecology and Obstetrics, Clinical Center Nis. Republic of Serbia, and they were retrospectively analyzed. The patients were divided by body mass index into two groups for the comparison of the findings. One group (normal weight) consi- sted ofwomenwithbodymass index ≤25 kg/in² (mean22.O8±1.90), and the other group (overweight) included women with body mass index>25 kg/in² (mean 27.65±1.47). The patients underwent either the standard long gonadotrophin-releasing hormone agonist protocol or flexible multidose gonadotrophin-releasing hormone antagonist protocol. RESULTS The normal-weight patients had a higher number of mature oncytes, significantly higher fertilization rate (p<O.OOI) and significantly higher number of the obtained embryos class I (p<O.O1) than the overweight patients. However, the implantation rate and clinical pregnancy rate were the same in both groups. CONCLUSION In the group of overweight women the numbers ofmature oocytes and good quality embryos were lower. However, since this study dealt with the patients with polycystic ovary syndrome who generally had a higher number of the obtained oocytes and embryos, this shortfall did not affect clinical pregnancy rates, which were the same in both groups. Certainly, before starting the in vitro fertilization, each infertile patient should be informed about the possible negative effect of her high body mass index on the treatment outcome.

Flexible GnRH antagonist protocol vs. long GnRH agonist protocol in patients with polycystic ovary syndrome treated for IVF: comparison of clinical outcome and embryo quality.

OBJECTIVES Polycystic ovary syndrome (PCOS) is a common endocrine disorder, primarily affecting women of the reproductive age. The aim of the study was to assess the clinical efficacy and embryo quality in flexible gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison to the long GnRH agonist protocol in PCOS women undergoing in vitro fertilization (IVF). MATERIAL AND METHODS This prospective, randomized study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Niš, Serbia, between 2013 and 2014. The treatment included either a flexible GnRH antagonist protocol (n = 45, antagonist group) or a long GnRH agonist protocol (n = 45, agonist group). RESULTS The length of the stimulation, total amount of gonadotropins used, as well as the average number of the aspirated and mature oocytes were higher in the agonists group. The endometrial thickness was also greater in the agonists group. A higher number of Class I and Class IV embryos were obtained after the agonist treatment and higher number of Class II and Class III embryos were obtained after the antagonist treatment. Pregnancy, implantation, and miscarriage rates were comparable between the groups. CONCLUSIONS The GnRH antagonist protocol in PCOS patients has a pregnancy rate comparable to that of the GnRH agonist protocol. Since this protocol has a lower rate of complications and is more convenient for patients, we believe that the GnRH antagonist protocol should be used as the first-line treatment for PCOS patients in an IVF program.

Results and experiences after 1000 IVF cycles at the Clinic for Gynecology and Obstetrics in Novi Sad

INTRODUCTION Infertility affects 15-17% of reproductive age couples in our country, and 10-15% of couples worldwide. The aim of this paper was to present results and experience gained after the first 1000 cycles of the national In Vitro Fertilization (IVF) program, to offer professional standard of work in our country and to compare it with results obtained in Europe and worldwide. MATERIAL AND METHODS The study prospectively included 1000 women who had undergone national In Vitro Fertilization program from October 2006 until November 2009 at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Novi Sad. RESULTS The analysis included 1000 in vitro fertilization cycles. Male factor infertility was the leading cause (56.9%) followed by tubal factor (45.9%). The classic method of in vitro fertilization constituted 72.3% of all cycles, while intracytoplasmic sperm injection (ICSI) method was used in 27.7% of all cycles. The average number of embryos transferred was 2.67. The cycle cancellation rate was 14.10% and the aspiration rate was 94.40%. The clinical pregnancy and live birth rate were 33.41% and 26.78% per embryo transfer respectively. DISCUSSION AND CONCLUSION The results in our study showed that in our setting there are far less intracytoplasmic sperm injection cycles compared with the European average of 66.5% of all fresh cycles, and that we transferred more embryos on average. Our success rates are comparable with those in other European countries where the clinical pregnancy rates per aspiration and per transfer for in vitro fertilization were 29 and 32.4%, respectively in the period of observation. For intracytoplasmic sperm injection, the corresponding rates were 29.9 and 33%.

[Medical abortion--modern method for termination of pregnancy].

INTRODUCTION Modern methods of medically induced abortions are being used in many countries all over the world. These methods are safe and effective when used in an appropriate way. DRUGS USED FOR MEDICAL ABORTION The most widely used regimens for drug induced abortions include antiprogestogen mifepriston followed by administration of a synthetic prostaglandin analogue--gemeprost vaginally or misoprostol orally or vaginally. When used for abortions up to 9 and 7 weeks of pregnancy, this method has efficacy up to 98%. The regimen between 9 and 12 completed weeks is still under investigation. Methods for medical abortion after 12 completed weeks since last menstrual period include several regimens and medications--combination of mifepriston and repeated doses of misoprostol, misoprostol or gemeprost alone, methotrexate, synthetic prostaglandin analogues, oxytocin and some others. MEDICAL ABORTIONS AT OUR DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, NOVI SAD, CLINICAL CENTER VOJVODINE, SERBIA Medical abortions in the second trimester were introduced at our Department of Obstetrics and Gynecology Novi Sad, Serbia, in early 1980s using prostaglandin analogues. This method was improved in year 2000 introducing two dinoprostone gels intracervically/extraaminally instead of just one, for cervical preparation before intramuscular application of carboprost thrometamine, which led to significantly shorter abortion interval. During the years 2003/2004 we took part successfully in one of the multicentric WHO projects for investigating new regimens on early medical abortions with mifepriston and misoprostol. CONCLUSIONS Modern methods of medical abortions are safe and effective for termination of unwanted pregnancies in the first and second trimester.