T. Aksu

Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease.

The incidence and fertility effects of postoperative adhesion formation after laparoscopic ovarian electrocautery or laser photocoagulation of polycystic ovaries has not been adequately analyzed. Short-interval second-look laparoscopy appears to be a useful method for addressing this issue. Employing short-interval second-look laparoscopy 3 to 4 weeks after the initial laparoscopic intervention, we were able to demonstrate adhesions in 6 of 7 patients (85%) treated with ovarian electrocautery and 8 of 10 patients (80%) submitted to laser therapy. The adhesions were amenable to laparoscopic lysis in 12 of 14 patients (85%). The subsequent conception rates within 6 months of second-look laparoscopy that were 57% and 40% in the electrocautery and the Nd:YAG laser groups, respectively, may in part be attributed to the restoration of normal pelvic anatomy during this procedure.

Laparoscopic CO2 laser uterine nerve ablation for treatment of drug resistant primary dysmenorrhea

Twenty women with drug-resistant primary dysmenorrhea were subjected to laparoscopic CO2 laser uterine nerve ablation. Menstrual pain assessed by a linear analog pain score showed a reduction of 33%, decreasing from 7.5 +/- 0.5 preoperatively to 5.0 +/- 1.7 postoperatively. The procedure was free of major complications and should be considered as a second-line therapeutic option in women who have failed medical treatment using nonsteroidal antiinflammatory agents or OCs.

CYP17 and CYP2C19 gene polymorphisms in patients with endometriosis

Endometriosis seems to be the result of a complex interaction between environmental factors and various genes. In this regard, the cytochrome subfamily 17 (CYP17) may play an important role by altering the biosynthesis of sex steroids. CYP2C19 is also an important member of the cytochrome P450 (CYP) family, and related mutations may result in an inability to fully metabolize environmental chemicals and cytokines, leading to several diseases. This study sought to determine whether there is a relationship between endometriosis and CYP17 T>C, CYP2C19 *2 and CYP2C19 *3 polymorphisms. When samples from 46 patients with endometriosis and 39 healthy controls were analysed, A2A2 type mutation of the CYP17 gene was observed to be more frequent in patients with endometriosis (34.8 versus 7.7%, P = 0.003). No association was found between the severity of endometriosis and CYP2C19 *2 or CYP2C19 *3 polymorphisms of the CYP2C19 gene. These results suggest that mutations related with sex steroid metabolism seem to have an important role in endometriosis. However, the relation between detoxification ability and endometriosis should be examined in further studies with larger sample sizes.

Single intramural leiomyoma with normal hysteroscopic findings does not affect ICSI–embryo transfer outcome

Where there is no distortion of the endo-myometrial junction, the effect of an intramural leiomyoma on reproductive performance is controversial. The current study compared the performance of patients having a single leiomyoma and intact endometrium confirmed by hysteroscopy (study group) with that of controls having intact endometrium alone in intracytoplasmic sperm injection (ICSI) cycles. A total of 61 consecutive infertile patients were retrospectively enrolled into the study group from a computerized IVF database. The control group consisted of 444 age-matched patients undergoing ICSI-embryo transfer without any endocervical or intrauterine pathology confirmed by both transvaginal ultrasonography and office hysteroscopy. The baseline characteristics, performance of ovarian stimulation and embryological data were similar between the two groups. The clinical pregnancy per embryo transfer (36 versus 38%) and implantation rate (20 versus 19%) were also comparable. Although the miscarriage rate tended to be higher in the leiomyoma group (27 versus 19%), the difference did not reach statistical significance. In conclusion, in the presence of intact endometrium, a single intramural leiomyoma does not seem to have a deleterious effect on ICSI cycles. Before ICSI is attempted, hysteroscopy may be useful for ruling out distortion of the endometrium due to leiomyoma in selected cases.

Serum and Peritoneal Fluid CA-125 Levels in Early Stage Endometriosis

Serum and peritoneal fluid (PF) CA-125 levels were assayed using the immunoradiometric assay in 17 women with minimal endometriosis and 21 control women at the time of laparoscopy. Serum levels of CA-125 were not significantly higher in women with minimal endometriosis. Minimal endometriosis was diagnosed with a 70.6% rate of sensitivity and a 71.4% rate of specificity with 16 U/ml as the upper limit of normal. PF CA-125 levels were significantly higher than serum levels but showed no significant difference between control and endometriosis patients.

Salpingoscopic findings in women with occlusive and nonocclusive salpingitis isthmica nodosa.

STUDY OBJECTIVE To characterize ampullary endosalpingeal findings in women with occlusive or nonocclusive salpingitis isthmica nodosa. DESIGN Prospective case study. SETTING Obstetrics and Gynecology Department of a University Hospital. PATIENTS Twenty women (38 tubes) with occlusive or nonocclusive salpingitis isthmica nodosa were studied. INTERVENTIONS Salpingoscopy was performed during diagnostic laparoscopy in 20 women (38 tubes) with hysterosalpingographic evidence of salpingitis isthmica nodosa. MAIN OUTCOME MEASURES Salpingoscopic findings were recorded and the patients were managed accordingly. RESULTS Of the 38 tubes 10 appeared radiographically and laparoscopically normal. Two tubes were occluded distally. Of the 26 tubes with occlusive or nonocclusive salpingitis isthmica nodosa, 5 (19.2%) showed varying degrees of endosalpingeal abnormality. Patients with abnormal salpingoscopy were regarded as having bipolar tubal disease and were referred for assisted conception. The remaining patients were scheduled for microsurgical tubal reconstruction. CONCLUSIONS One in five patients with proximal tubal disease may have ampullary endosalpingeal damage of varying degrees. However, the significance of this finding in relation to subsequent management strategies and fertility outcome is yet to be characterized.

Trigeminal schwannoma mimicking magnesium intoxication in a pregnancy complicated by severe preeclampsia

We present a case report describing a pregnancy complicated by severe preeclampsia and a trigeminal schwannoma which caused loss of consciousness, diplopia and blurred vision, which were initially thought to be signs of magnesium intoxication.

Fluid accumulation in the uterine cavity due to obstruction of the endocervical canal in a patient undergoing in vitro fertilization and embryo transfer

WD: Ultrasound-guided transcervical tubal catheterization for assisted reproduction: A learning program using laparoscopy for confirmation. Fertil Steril 1993;59:236-238 16. Hurst BS, SchlaffWD: Assisted reproduction: What role for ZIFT? Contemp Ob-Gyn 1993 (in press) 17. Visser DS, Fourie F Le R, Kruger HF: Multiple attempts at embryo transfer: Effect on pregnancy outcome in an in vitro fertilization and embryo transfer program. J Assist Reprod Genet 1993;10:37-43

The value of human menopausal gonadotropin treatment in patients with unexplained infertility

The role of multiple ovulation with human menopausal gonadotropin (HMG) in the treatment of unexplained infertility is evaluated. Of a total 73 patients with unexplained infertility, 39 received four cycles of HMG, whereas, 34 were left untreated. Eight (20.5%) women conceived during HMG treatment, in comparison to only 1 (2.9%) in the control group (P < 0.05). This study gives further credit to the value of HMG treatment for unexplained infertility.

Evaluation of the Functional Status of the Fallopian Tubes in Unexplained Infertility with Radionuclide Hysterosalpingography

The functional status of the Fallopian tubes in patients with unexplained infertility (UI) was evaluated with radionuclide hysterosalpinography (RN-HSG). The rate of bilateral tubal occlusion with RN-HSG in women with UI (3/18 = 16.7%) was considerably higher than in a group of fertile and male-infertile women (0/28 = 0%), implying that a number of cases with UI might be associated with functional rather than anatomical tubal defects. RN-HSG is a simple, innocuous and potentially useful method for assessing functional tubal occlusion, and it might give a better understanding of the functional status of the tubes in UI.