S. Konidaris

Clinical parameters linked with malignancy in endometrial polyps

Aim To investigate the association of different clinical parameters with the histological diagnosis and the prevalence of premalignant and malignant endometrial polyps. Method The study included 516 cases from January 2002 to December 2006. Possible risk factors such as age, menopause status, abnormal bleeding, obesity, hypertension, diabetes mellitus, hormone therapy, use of tamoxifen and size of polyp were investigated in relation to their association with the malignant potential of endometrial polyps. Results All cases of endometrial polyps underwent hysteroscopic resection; 96.9% of the cases were benign, 1.2% premalignant and 1.9% malignant. Premalignant and malignant endometrial polyps were significantly associated with advanced age (>60 years), menopause, obesity and diabetes. The malignant polyps were analyzed to eight endometrioid, one serous and one clear cell carcinoma. Conclusion The prevalence of premalignant and malignant endometrial polyps is very low. Advanced age, menopause, obesity and diabetes increase the risk of endometrial polyp malignancy.

Comparison of flutamide and cyproterone acetate in the treatment of hirsutism: a randomized controlled trial.

The objective of this study was to compare the efficacy of flutamide and cyproterone acetate in the treatment of hirsutism. Twenty-two women with idiopathic hirsutism were randomized to receive either flutamide or cyproterone acetate. Each patient underwent a complete gynecological examination as well as an endocrinological profile and hematological, hepatic and renal function analyses. Hirsutism scores were determined using a modified Ferriman-Gallwey scoring system. These tests were then repeated at 3 and 9 months of therapy. Eleven patients received 250 mg of flutamide twice daily and 11 patients received 100 mg of cyproterone acetate on days 5-14 of the menstrual cycle. Ferriman-Gallwey scores were decreased significantly in both groups at the end of 9 months. There was a trend towards a better response with flutamide, that did not achieve significance. Another significant difference was the increased sex hormone-binding globulin in both groups. A statistically significant decrease was also observed for the levels of testosterone on both drugs. No subject withdrew from the study due to a side-effect. The data suggest that both flutamide and cyproterone acetate were similarly effective in treatment of hirsutism, and that the pure antiandrogen flutamide is a safe, well-tolerated and effective alternative in treatment.

Effect of tibolone on postmenopausal women with myomas

OBJECTIVE The aim of this study is to assess the effect of Tibolone (Livial) on uterine fibroids in postmenopausal women. METHODS This study included 40 naturally postmenopausal women with at least one uterine fibroid measuring > 20 mm. All of theme were scanned by transvaginal ultrasonography. Patients were randomized into two groups. Group A (n = 20) were treated with Tibolone 2.5 mg daily for 1 year and group B (n = 20) did not received therapy. The size of the uterine fibroids was reevaluated on the end of the treatment. RESULTS No statistically significant difference was found in the mean volume of fibroids before and after treatment with Tibolone. The administration of Tibolone resulted in an increase of fibroid volume in three patients, whereas it remained constant in the majority of the patients (70%) and decreased in three patients. CONCLUSIONS Our results suggest that treating menopausal symptoms with Tibolone does not affect preexisting asymptomatic uterine fibroids.

Controlled ovarian hyperstimulation with or without intrauterine insemination for the treatment of unexplained infertility

Objective: To evaluate whether there are any benefits from intrauterine insemination (IUI) as opposed to timed intercourse (TI) in stimulated ovarian cycles in couples with longstanding, unexplained infertility. Methods: Forty‐six couples with diagnoses of unexplained infertility were evaluated in a crossover study after a total of 141 cycles. Sixty‐seven cycles were with IUI after controlled ovarian hyperstimulation (COH) while 74 cycles were after COH and TI. Results: The pregnancy rate after COH/TI was 16.7% and after COH/IUI 45.2%. Cycle fecundity however was 8.9% after COH/TI and 25.7% after COH/IUI, which is a statistically significant difference (P < 0.05). Conclusions: A trial of human menopausal gonadotropin and IUI is justified in couples with prolonged infertility of unknown cause.

Hysteroscopic resection of uterine septum and reproductive outcome in women with unexplained infertility.

Background/Aims: To investigate the reproductive outcome after hysteroscopic resection of uterine septum in women with septate uterus and otherwise idiopathic primary infertility. Methods: Sixty-eight patients with septate uterus and idiopathic primary infertility were included in this prospective observational study. All patients underwent hysteroscopic metroplasty with scissors under general anesthesia. Main outcome measures were clinical pregnancy rate, live birth and abortion rate at 12 months’ follow-up and at mean follow-up time. Results: At 12 months’ follow-up, the clinical pregnancy rate, the live birth rate and the abortion rate were 44% (30/68), 36.8% (25/68) and 16.6% (5/30), respectively. At total follow-up time, the overall pregnancy rate, the live birth rate and the abortion rate were 53.8% (35/65), 41.5% and 14.2% (7/35), respectively, while the stillbirth rate was 2.8% (1/35). Conclusion: Hysteroscopic metroplasty in women with septate uterus and unexplained infertility could improve clinical pregnancy rate and live birth rate in patients with otherwise unexplained infertility. If such a patient is looking for a spontaneous pregnancy, this is more likely to occur during the first 15 months following the procedure.

Fallopian tube sperm perfusion has no advantage over intra-uterine insemination when used in combination with ovarian stimulation for the treatment of unexplained infertility.

In this prospective randomized study we treated 60 couples with unexplained infertility with a combination of ovarian stimulation and either intrauterine insemination (IUI) or fallopian sperm perfusion (FSP). In the IUI we used a volume of 0.5 ml of inseminate and in the FSP a volume of 4 ml. The demographic characteristics of the patients, the stimulation parameters and the sperm data were not statistically different between the two groups. The pregnancy rate per cycle was 16.2% in the IUI group and 14.5% in the FSP group and the pregnancy rate per woman was 40 and 36.7%, respectively (not statistically different). We conclude that IUI and FSP are equally effective in the treatment of couples with unexplained infertility.

Pregnancy rates in gonadotrophin stimulated cycles with timed intercourse or intrauterine insemination for the treatment of male subfertility

OBJECTIVE To compare the pregnancy rates achieved by intrauterine insemination or timed intercourse in gonadotrophin stimulated cycles in couples whose only detectable abnormality was poor sperm quality. DESIGN Sixty-two couples with primary or secondary infertility due to male factor entered the study. The 62 couples were randomly equally divided into two groups. Each group began one of the two treatment modalities (controlled ovarian hyperstimulation in conjunction with timed intercourse or intrauterine insemination) for three consecutive cycles and then switched to the alternative treatment after one rest cycle, if pregnancy was not achieved. RESULTS Five pregnancies (3.9%) were achieved after 128 cycles with timed intercourse and 15 pregnancies (11.5%) after 130 cycles with intrauterine insemination. The difference was found to be statistically significant (P < 0.05). CONCLUSION We suggest that intrauterine insemination during hMG stimulated cycles improves the pregnancy rates of couples whose only detectable abnormality is poor sperm quality.

Role of gonadotropin-releasing hormone antagonist in the management of subfertile couples with intrauterine insemination and controlled ovarian stimulation

OBJECTIVE To assess whether the clinical pregnancy rate of patients treated with recombinant FSH and IUI can be improved by the addition of a GnRH antagonist. DESIGN Prospective, controlled study. SETTING Reproductive medicine clinic. PATIENT(S) Ninety-three patients with primary or secondary infertility. INTERVENTION(S) Patients were allocated to controlled ovarian stimulation with recombinant FSH (50-150 IU/d) only (control group, n=45) or to recombinant FSH (50-150 IU/d) plus ganirelix (0.25 mg/d, starting when the leading follicle was ≥16 mm; n=48). A single insemination was performed 36 hours after hCG was given (10,000 IU, IM) in both groups. Both groups were allowed at least three cycles. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate, premature luteinization rate, and follicular development. RESULT(S) Clinical pregnancy rate (22% vs. 11%), cumulative pregnancy rate (52% vs. 31%), and number of mature follicles (2.1±1.08 vs. 1.4±0.95) were statistically significantly higher in the ganirelix group compared with the control group. The premature luteinization rate was significantly lower in the ganirelix group (1.7% vs. 17.5%). CONCLUSION(S) The use of a GnRH antagonist in conjunction with controlled ovarian stimulation and IUI significantly increases pregnancy rates and reduces the incidence of premature luteinization.

Corticosteroid treatment does not improve the results of intrauterine insemination in male subfertility caused by antisperm antibodies

AIM To determine whether corticosteroid immunosuppression (CS) administered to the male partner together with intrauterine insemination (IUI) is preferable compared to IUI alone in treating male autoimmune subfertility. MATERIALS AND METHODS Thirty-six couples with proven male immunological subfertility were randomly assigned to begin CS + IUI (n = 18) or IUI (n = 18) treatment and progressed alternatively to receiving each treatment modality for three cycles unless pregnancy occurred. Each couple served as their own control. The administered corticosteroid was soluble prednisolone. RESULTS Five pregnancies were achieved with 77 cycles of CS + IUI and seven pregnancies with IUI alone. The pregnancy rates per cycle were 6.5% with CS + IUI and 9.21% with IUI, while the pregnancy rates per couple were 16.13% with CS + IUI and 21.2% with IUI alone. These rates do not differ to a statistically significant degree (P > 10%). CONCLUSIONS The addition of corticosteroid immunosuppression does not seem to significantly enhance the pregnancy rate in couples with male autoimmune subfertility treated with IUI as compared to the treatment with IUI alone. Considering the possible side-effects of corticosteroid intake, we conclude that IUI alone might be preferable to the combination of IUI with corticosteroid administration.

Treatment of hirsutism with combined pill containing drospirenone

The aim of the present study was to evaluate the biochemical and clinical effects of the combined pill consisting of ethinyl estradiol (EE) and drospirenone (DRSP) in hirsute patients. Fifty-two adolescents or young women from Greece were treated with 30 μg EE and 3 mg DRSP for 1 year. Hirsutism was evaluated by the Ferriman–Gallway (FG) score in the initial visit and at 3, 6 and 12 months. Follicle-stimulating hormone, luteinizing hormone, etradiol, free and total testosterone (T), sex hormone-binding globulin (SHBG), androstenedione and dehydroepiandrosterone sulfate were determined at the same intervals. Hirsutism improved and FG scores reduced to 77.4%, 67.2% and 51.8% at 3, 6 and 12 months, respectively. Plasma SHBG levels rose, while free and total T levels reduced from the third month onwards. In conclusion, the EE/DRSP pill improves hirsutism in women via antiandrogenic and antimineralocorticoid action. The biochemical manifestations of hyperandrogenism are also improved.