Katharina Walch

Implanon® versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis — a pilot study ☆

BACKGROUND Implanon has been reported to be effective in the treatment of dysmenorrhea. We compared the therapeutic efficacies of depot medroxyprogesterone acetate (DMPA) and Implanon with regard to pain relief in women with endometriosis. STUDY DESIGN In a clinical research center at a university hospital, 41 patients with dysmenorrhea, nonmenstrual pelvic pain and dyspareunia associated with histologically proven endometriosis were included in an open, prospective, randomized, controlled clinical trial. Twenty-one women were assigned by computer-generated randomization to receive Implanon, and 20 women to receive DMPA. As main outcome measures of this pilot study, we evaluated pain improvement quantified according to visual analog scale score, side effects, vaginal bleeding patterns, withdrawal rate and overall degree of satisfaction. RESULTS During a follow-up period of 1 year, we ascertained a clear improvement in pain intensity for both treatment options. After 6 months, the average decrease in pain was 68% in the Implanon group and 53% in the DMPA group. The side-effects profile and the overall degree of satisfaction after study termination were comparable for both treatment options. CONCLUSION Concerning pain relief, the therapeutic efficacy of the contraceptive implant Implanon is not inferior to that of DMPA in symptomatic endometriosis.

Interleukin-1 alpha but not interleukin-1 beta gene polymorphism is associated with polycystic ovary syndrome

Interleukin-1 (IL1) is a multifunctional cytokine and IL1-mediated inflammatory processes have been proposed to influence the processes of ovulation, fertilization and implantation. All these parameters are also affected in women with polycystic ovary syndrome (PCOS). This study investigated the association of common polymorphisms of the interleukin-1 genes (IL1A and IL1B) with the occurrence and clinical characteristics of PCOS. We evaluated one polymorphism of the IL1alpha gene (IL1A C[-889]T) and two of the IL1beta gene (IL1B promoter C[-511]T and IL1B exon 5 position +3953) in 105 Caucasian women with PCOS and 102 healthy Caucasian controls by polymerase chain reaction. For the mutated IL1A allele, allele frequencies in women with PCOS and controls were 60% and 46%, respectively, versus 40% and 54%, respectively, for the wild type allele. Allele frequencies in women with PCOS and controls were 59% (54%) and 61% (41%), respectively, for the mutated IL1B promoter (mutated IL1B exon 5) and 41% (46%) and 39% (59%), respectively, for the wild type alleles. Presence of a polymorphism in the interleukin-1alpha but not the interleukin-1beta gene was found to correlate with the occurrence of PCOS (p=0.04; odds ratio 1.8). The serum level of FSH and subsequent LH/FSH ratio correlated with the polymorphism of IL1A within the PCOS group (p=0.005 and 0.01, respectively). We have shown that a common polymorphism of the interleukin-1alpha but not interleukin-1beta gene is associated with the presence of PCOS and with clinical parameters of women affected by this condition.

Functional and anatomic results after creation of a neovagina according to Wharton-Sheares-George in patients with Mayer-Rokitansky-Küster-Hauser syndrome—long-term follow-up

OBJECTIVE To evaluate the long-term outcomes and degree of satisfaction after neovaginoplasty according to Wharton-Sheares-George in women with Mayer-Rokitansky-Küster-Hauser syndrome. DESIGN Open, monocentric follow-up study. SETTING University hospital and referral center for pediatric and adolescent gynecology. PATIENT(S) Ten patients with Mayer-Rokitansky-Küster-Hauser syndrome with neovaginas created according to Wharton-Sheares-George 3 to 77 months ago. INTERVENTION(S) Gynecologic follow-up examination, including vaginal swab, bacterial culture, Papanicolaou smear, hybrid capture test for human papillomavirus typing, biopsy, pelvic ultrasound, and 2 questionnaires concerning global quality of life and degree of sexual satisfaction. MAIN OUTCOME MEASURE(S) Satisfaction with sexual function, quality of life, length and width of neovagina, structure of vaginal epithelium, and type of bacterial colonization. RESULT(S) Functional long-term follow-up results showed a high subjective degree of general well-being and sexual satisfaction in affected women. A satisfactory neovaginal length (mean, 8.3 ± 1.06 cm; range, 7-10 cm) and width (mean, 3.3 ± 0.5 cm; range, 2.5-4 cm) was obtained. As revealed by smears and biopsy, the neovagina resembled a natural vagina with regard to type of bacterial colonization and structure of epithelium. CONCLUSION(S) The goal of any method of creating a neovagina is to provide the patient the possibility to have satisfactory sexual intercourse and to enhance well-being and quality of life. These aims can be achieved by creating a neovagina according to Wharton-Sheares-George.

Fertility awareness among medical and non-medical students: a case-control study.

BackgroundTo compare the understanding and perceptions of fertility issues among medical and non-medical University students.MethodsIn a prospective case-control study, using a 43 item questionnaire with 5 sections and 43 questions regarding personal data (8 questions), lifestyle factors (9 questions), plans on having children (5 questions), age and fertility (5 questions), and lifestyle and fertility (16 questions), knowledge of fertility and influencing factors, desired age at commencement and completion of childbearing, among male and female medical and non-medical students in their first academic year at Vienna University, Vienna, Austria were evaluated.Results340 students were included. 262/340 (77%) participants planned to have children in the future. Medical students (n = 170) planned to have fewer and later children and had a higher awareness of the impact of age on fertility than non-medical students (n = 170; estimated knowledge probability 0.55 [medical students] vs. 0.47 [non-medical students]; F (1, 336) = 5.18 and p = .024 (η p = .015). Gender did not independently affect estimated knowledge probability (F (1, 336) = 1.50 and p = .221). More female and male medical students had a positive attitude towards Assisted Reproductive Technology in case of infertility than non-medical students (47 and 55% vs. 23 and 29%, respectively; p = <.001). Medical students had a healthier lifestyle than non-medical students. A healthy lifestyle and female gender were associated with higher fertility awareness.ConclusionsMedical students have a higher awareness of fertility issues than non-medical students. Choice of academic study, gender, and personal life style are important factors affecting fertility awareness. These data may be helpful to address knowledge gaps among young non-medical Academics.

Prevalence and qualitative properties of circulating anti–human leukocyte antigen alloantibodies after pregnancy: No association with unexplained recurrent miscarriage

In pregnant women, circulating alloantibodies, triggered by exposure to paternal HLA antigens, are frequently detectable. The finding of lower alloantibody levels in women who experience spontaneous abortion (miscarriage) has led to the speculation that antipaternal antibodies could favor maintenance of pregnancy, whereas their lack poses a risk of miscarriage. Postulating a role of alloantibodies in the pathogenesis of unexplained abortion, we examined whether different categories of recurrent miscarriage (RM) can be distinguished according to prevalence or distinct qualitative properties of anti-human leukocyte antigen (HLA) antibody patterns. Sera obtained from 167 women with RM were assessed for complement- and non-complement-fixing anti-HLA alloreactivity using Luminex-based bead array technology. Women with RM had less often detectable anti-HLA class I and/or II reactivity (19%) compared with a control group of 96 multiparous women without a history of miscarriage (49%). However, analysis of different categories of RM (unknown [n = 112] versus known cause [n = 55]; primary [n = 125] versus secondary RM [n = 42]) did not reveal any differences regarding antibody prevalence, number of targeted HLA single antigens, antigen specificity, binding density, or complement-fixing ability of detected alloantibodies. Our results do not support a link between anti-HLA antibody formation and RM, and argue against a diagnostic value of alloantibody detection in the diagnostic work-up of women with RM.

Severe haematoperitoneum caused by ovarian bleeding after transvaginal oocyte retrieval: A retrospective analysis and systematic literature review

A case series of haematoperitoneum caused by ovarian bleeding after transvaginal oocyte retrieval (TVOR) is presented and all published cases summarized. In a retrospective case series, four patients with ovarian bleeding after TVOR were included. In addition, a pooled analysis of all published cases (n = 32) who underwent surgical intervention for severe haematoperitoneum caused by ovarian bleeding after TVOR was carried out. Main outcome measures were incidence, risk factors, course and intraoperative findings. In the pooled analysis, the incidence was 0.08%. The first sign of haematoperitoneum was evident in 33.3% within the first postoperative hour, and, cumulatively, in 93.3% within 24 h. The median time between TVOR and surgical intervention was 10 h. In four patients, the ovary could not be preserved, which was associated with a longer time interval between TVOR and the onset of symptoms (median 18 h versus 2.5 h; P = 0.004) as well as between TVOR and surgical intervention (median 21.5 h versus 8.5 h; 0.004). In conclusion, severe haematoperitoneum occurs in 0.08% after TVOR. Late-onset bleeding is common. A longer time interval between TVOR and surgical intervention might put a patient at risk of ovariectomy.

Overt hypothyroidism is associated with the presence of uterine leiomyoma: a retrospective analysis

OBJECTIVE A possible correlation between uterine leiomyoma and thyroid disease was reported decades ago. We aimed to evaluate the possible associations between the presence of uterine leiomyomas and (i) the presence of overt hypothyroidism, (ii) the level of anti-thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (TG-Ab), and (iii) thyroid stimulating hormone (TSH) levels. STUDY DESIGN In a retrospective study, all 215 sterile women who underwent reproductive surgery (hysteroscopy and laparoscopy/laparotomy) at our department from January 2007 to January 2011 were included. All leiomyomas suspected on gynecologic ultrasound were verified during surgery. As risk factors for uterine leiomyomas, thyroid parameters, age, African heritage, age at menarche, parity, and body mass index were included. RESULTS One or more uterine leiomyomas were found in 51 cases (23.7%). After multivariate analysis, three parameters remained significant, with African heritage the most important (odds ratio, OR, 27.80), followed by overt hypothyroidism (OR 3.10) and increasing age (OR 1.23). Larger leiomyomas were found in women with overt hypothyroidism than in those without overt hypothyroidism (median, 70 mm; range, 5-88 vs. median, 30 mm; range, 2-93, respectively; p=0.007). CONCLUSIONS Overt hypothyroidism, but not autoantibodies against the thyroid gland, was associated with the presence of uterine leiomyoma in our study.

Prevalence and severity of cyclic leg pain in women with endometriosis and in controls - effect of laparoscopic surgery

OBJECTIVE In addition to dysmenorrhea, dyspareunia, and subfertility, pain in the lower extremities has been described to be a further complaint in women affected by endometriosis, and lysis of nerve entrapment was thought to be associated with amelioration of leg pain. Therefore, we aimed to compare the prevalence of cyclic leg pain and pain intensity between women with endometriosis and without endometriosis, and to evaluate the effect of laparoscopic surgery. STUDY DESIGN Forty-four women with endometriosis and 58 controls were included in a prospective, controlled clinical trial at a University hospital/tertiary referral center. Participants were asked to complete questionnaires the day before and six to nine weeks after laparoscopy. The prevalence and intensity of leg pain and improvement after laparoscopic surgery, quantified according to a visual analog scale (VAS) score, were evaluated. We also recorded involvement of dermatomes, the presence and intensity of dysmenorrhea, and correlations between age, stage of endometriosis (rAFS-score), and preoperative VAS scores. RESULTS Before surgery, more women were affected by leg pain in the endometriosis group, compared to the control group (45.5% and 25.9%, respectively). Preoperative VAS scores for leg pain, however, were not significantly different between the two groups. A moderate correlation in the preoperative VAS scores between leg pain and dysmenorrhea was observed. After laparoscopy, we found a significant improvement in leg pain intensity in both groups. The mean difference in the VAS score for pain reduction between the study group and the control group was 0.74 (95% CI: -0.61-2.08), which was not statistically significant. CONCLUSIONS The prevalence of leg pain is increased in endometriosis, while leg pain intensity is not, compared to women without endometriosis. Laparoscopic surgery-even without preparation and decompression of nerve tissue-is associated with an improvement in pain intensity in women with endometriosis, as well as in the group without endometriosis.

Serologic markers of autoimmunity in women with recurrent pregnancy loss

Various autoimmunologic mechanisms have been shown to be involved in recurrent pregnancy loss (RPL). This study aimed to evaluate whether women with RPL have elevated serum levels of common autoimmunologic parameters.

Impaired glucose tolerance is associated with changes in clinical and biochemical parameters in women with polycystic ovary syndrome

Background. To characterize the phenotype of women with polycystic ovary syndrome with and without impaired glucose tolerance by determining various polycystic ovary syndrome‐associated clinical and laboratory parameters.