The impact of FSH receptor polimorphysm Asn680/Ser680 on controlled ovarian stimulation response in women undergoing in vitro fertilisation

Uspješnost postupka izvantjelesne oplodnje (IVF) uvelike ovisi o odgovoru jajnika na kontroliranu stimulaciju čija se adekvatnost povezuje s prisutnošću polimorfizma 2039G>A u genu za receptor folikul stimulirajućeg hormona (FSHR) kao i bazalnom koncentracijom FSH, luteinizirajućeg hormona (LH), estradioala (E2), hormona koji stimulira tireoideu (TSH) i prolaktina. Polimorfizam jedne baze (SNP) rezultira zamjenom asparagina serinom na položaju 680 u FSHR (Asn680/Ser680). Kako bi se pridonijelo rasvjetljavanju korisnosti ovog polimorfizma u predviđanju odgovora jajnika na kontroliranu stimulaciju , analiziran je genotip 211 žena podvrgnutih postupku izvantjelesne oplodnje te im je uz hormonski status određeni broj antralnih folikula. Primjenom odgovarajućih statističkih testova utvrđeno je da genotip za SNP Asn680/Ser680 u genu FSHR nije dobar prediktor ovarijske rezerve niti odgovora jajnika na kontroliranu stimulaciju, pa se genskim probirom ne mogu jednoznačno identificirati ispitanice s mogućim lošijim odgovorom na COS. Ipak, nađeno je da genotipizacija za SNP Asn680/Ser680 ima potencijalnu vrijednost za identifikaciju ispitanica mlađe dobi genotipa Ser680/Ser680 koje su predisponirane za pojačan odgovor jajnika na kontroliranu stimulaciju. Utvrđeno je također, da je najbolji neovisan prediktor ovarijske rezerve i odgovora na kontroliranu stimulaciju jajnika (eng. controlled ovarian stimulation, COS) mjeren prije započinjanja terapije, broj antralnih folikula, a da predikcijski model formiran na temelju parametara određenih prije početka COS (broj antralnih folikula, dob, indeks tjelesne mase, bazalne koncentracije FSH, E2 i TSH) zbog svoje dijagnostičke točnosti veće od dijagnostičke točnosti broja antralnih folikula (AUC 0,89 vs. 0,84) može značajno pridonijeti procjeni odgovora jajnika na kontroliranu stimulaciju. Koncentracija E2 izmjerena na dan primjene humanog korionskog gonadotropina za stimulaciju ovulacije uz veliku dijagnostičku točnost (AUC = 0,91) najbolji je neovisni prediktor odgovora na COS.The successfulness of the in vitro fertilization (IVF) largely depends on the women’s response to the controlled ovarian stimulation which adequateness has been assumed to be connected to the single nucleotide polymorphism (SNP) 2039G>A in follicle-stimulating hormone receptor gene, as well as the basal concentration of follicle –stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), thyroid-stimulating hormone (TSH) and prolactin. With the purpose to contribute to the evaluation of SNP 2039G>A in a prediction of ovarian response to the controlled stimulation, 211 women undergoing IVF were genotyped. In addition to the hormonal status determination, the number of antral follicles was estimated. Using appropriate statistical analyses it was found that genotype of SNP Asn680/Ser680 in FSHR gene is neither a good predictor of ovarian reserve nor ovarian response to the controlled stimulation. Thus, genetic screening for poor responders to the controlled ovarian stimulation (COS) is not diagnostically valuable. However, it was found that genotyping of this SNP could be potentially useful for identification of women of younger age (< 32 years) with Ser680/Ser680 genotype predisposed for hyperresponse to the controlled stimulation. It was also found that the best independent predictor of ovarian reserve and response to COS determined before the therapy application is antral follicle count (AFC), while the prediction model formed of the parameters determined before the therapy application (AFC, age, body mass index, basal concentration of FSH, E2 and TSH) based on higher diagnostic accuracy than AFC (AUC 0,89 vs. 0,84) could significantly contribute to the prediction of ovarian response to COS. E2 concentration measured on the day of the application of human chorionic gonadotropine for the stimulation of ovulation with the highest diagnostic accuracy (AUC = 0,91) is the best independent predictor of ovarian response to the controlled stimulation

Diagnostics and treatment of infertility

Neplodnost je u najnovije doba u razvijenim zemljama velik zdravstveni problem koji zahvaća otprilike 15% populacije reprodukcijske dobi. Definira se kao izostanak željene trudnoće uz redovite, nezaštićene spolne odnose u razdoblju od najmanje godinu dana. U članku su opisani uzroci neplodnosti, moderne metode za njihovu dijagnostiku te terapijske mogućnosti liječenja neplodnog para. Osnovna i neizostavna pretraga u ispitivanju neplodnosti je transvaginalni ultrazvuk. U članku su opisane mogućnosti otkrivanja pojedinih uzroka neplodnosti ovom metodom, kao i moguća dobrobit transvaginalnog ultrazvučnog pregleda uz dodatak doplera u boji i/ili trodimenzionalnog ultrazvuka. Prikazane su mogućnosti detekcije prohodnosti jajovoda, od neinvazivnih ultrazvučnih sonohisterosalpingografija do invazivnih operacijskih metoda, laparoskopije i histeroskopije, koje predstavljaju zlatni standard u dijagnostici neplodnosti. Otkrivanjem uzroka neplodnosti prilikom laparoskopije i/ili histeroskopije moguće je istovremeno i otklanjanje uzroka. Par se uključuje u postupke pomognute oplodnje ako prethodne postupke ne slijedi željena trudnoća. Izvantjelesna oplodnja u Hrvatskoj ima dugu i uspješnu tradiciju, a prvo dijete rođeno je 1983. godine. Indikacije za inseminacije su lošiji nalazi spermiograma, idiopatska neplodnost i udruženi uzroci neplodnosti. Indikacije za izvantjelesnu oplodnju su neprohodnost jajovoda, teža muška neplodnost, udruženi uzroci, idiopatska neplodnost i endometrioza. Uspješnost izvantjelesne oplodnje izražava se postotkom ostvarenih trudnoća koji se može izražavati u odnosu na započeti ciklus, na učinjenu aspiraciju oocita te, konačno, u odnosu na učinjeni transfer embrija. U našoj Klinici u razdoblju od 2001. do 2004. učinili smo 378 aspiracija s 269 učinjenih prijenosa zametaka koji su rezultirali s 96 trudnoća (25% po aspiraciji i 35% po prijenosu zametaka).Infertility represents a huge health problem in developed countries. Infertility is defined as lack of desired pregnancy with regular and contraceptive-free intercourses within a period of at least a year. It affects approximately 15% of reproductive population. This article gives the review of possible causes and modern diagnostic procedures and options in infertility treatment. The main non-invasive tool in the diagnostic algorhythm in infertile patients is transvaginal ultrasound. We present the fields of interest of this sonographic approach and the possible benefits of color Doppler and three dimensional imaging. Methods of detection of tubal patency are presented, including non-invasive methods as sonohysterosalpingography and the invasive golden standard in infertility investigation – laparoscopy and hysteroscopy. If the etiology of infertility is known then the invasive diagnostic procedures are followed by operative treatment. Laparoscopy is the standard procedure in patients with endometrosis and tubal factor. Assisted reproduction is used if previous conservative and invasive methods of treatment do not result in pregnancy. Intrauterine insemination is used in subfertile couples with proven tubal patency. In vitro fertilization is used in couples with male factor, tubal factor, endometriosis and idiopathic infertility. Success of in vitro fertilization procedures can be measured according to the started cycle, per aspiration procedure or per embryo transfer. In vitro fertilization in Croatia started only four years after the first baby was born after IVF in the world. In Sveti Duh Hospital in the period from 2001-2004 we performed 378 aspirations in stimulated cycles with 269 fresh embryo transfers which resulted in 96 pregnancies (25% per aspiration and 35% per embryo transfer)

Diagnostics and treatment of infertility

Neplodnost je u najnovije doba u razvijenim zemljama velik zdravstveni problem koji zahvaća otprilike 15% populacije reprodukcijske dobi. Definira se kao izostanak željene trudnoće uz redovite, nezaštićene spolne odnose u razdoblju od najmanje godinu dana. U članku su opisani uzroci neplodnosti, moderne metode za njihovu dijagnostiku te terapijske mogućnosti liječenja neplodnog para. Osnovna i neizostavna pretraga u ispitivanju neplodnosti je transvaginalni ultrazvuk. U članku su opisane mogućnosti otkrivanja pojedinih uzroka neplodnosti ovom metodom, kao i moguća dobrobit transvaginalnog ultrazvučnog pregleda uz dodatak doplera u boji i/ili trodimenzionalnog ultrazvuka. Prikazane su mogućnosti detekcije prohodnosti jajovoda, od neinvazivnih ultrazvučnih sonohisterosalpingografija do invazivnih operacijskih metoda, laparoskopije i histeroskopije, koje predstavljaju zlatni standard u dijagnostici neplodnosti. Otkrivanjem uzroka neplodnosti prilikom laparoskopije i/ili histeroskopije moguće je istovremeno i otklanjanje uzroka. Par se uključuje u postupke pomognute oplodnje ako prethodne postupke ne slijedi željena trudnoća. Izvantjelesna oplodnja u Hrvatskoj ima dugu i uspješnu tradiciju, a prvo dijete rođeno je 1983. godine. Indikacije za inseminacije su lošiji nalazi spermiograma, idiopatska neplodnost i udruženi uzroci neplodnosti. Indikacije za izvantjelesnu oplodnju su neprohodnost jajovoda, teža muška neplodnost, udruženi uzroci, idiopatska neplodnost i endometrioza. Uspješnost izvantjelesne oplodnje izražava se postotkom ostvarenih trudnoća koji se može izražavati u odnosu na započeti ciklus, na učinjenu aspiraciju oocita te, konačno, u odnosu na učinjeni transfer embrija. U našoj Klinici u razdoblju od 2001. do 2004. učinili smo 378 aspiracija s 269 učinjenih prijenosa zametaka koji su rezultirali s 96 trudnoća (25% po aspiraciji i 35% po prijenosu zametaka).Infertility represents a huge health problem in developed countries. Infertility is defined as lack of desired pregnancy with regular and contraceptive-free intercourses within a period of at least a year. It affects approximately 15% of reproductive population. This article gives the review of possible causes and modern diagnostic procedures and options in infertility treatment. The main non-invasive tool in the diagnostic algorhythm in infertile patients is transvaginal ultrasound. We present the fields of interest of this sonographic approach and the possible benefits of color Doppler and three dimensional imaging. Methods of detection of tubal patency are presented, including non-invasive methods as sonohysterosalpingography and the invasive golden standard in infertility investigation – laparoscopy and hysteroscopy. If the etiology of infertility is known then the invasive diagnostic procedures are followed by operative treatment. Laparoscopy is the standard procedure in patients with endometrosis and tubal factor. Assisted reproduction is used if previous conservative and invasive methods of treatment do not result in pregnancy. Intrauterine insemination is used in subfertile couples with proven tubal patency. In vitro fertilization is used in couples with male factor, tubal factor, endometriosis and idiopathic infertility. Success of in vitro fertilization procedures can be measured according to the started cycle, per aspiration procedure or per embryo transfer. In vitro fertilization in Croatia started only four years after the first baby was born after IVF in the world. In Sveti Duh Hospital in the period from 2001-2004 we performed 378 aspirations in stimulated cycles with 269 fresh embryo transfers which resulted in 96 pregnancies (25% per aspiration and 35% per embryo transfer)

Hemoperitoneum u ranoj trudnoći uzrokovan krvarenjem iz žutog tijela - prikaz slučaja

Rupture of the corpus luteum is a frequent condition in women of reproductive age. Because of abdominal pain accompanied by hemoperitoneum, ruptured corpus luteum can easily be confused with ectopic pregnancy. The management of ruptured corpus luteum depends on the symptoms and laboratory findings, and can be just observation but laparoscopy or urgent laparotomy may also be needed. Although rare, hemoperitoneum following rupture of corpus luteum in early pregnancy should always be considered in the diagnostic process. We present a patient that was admitted to our department with amenorrhea, positive ßhCG and acute abdomen. Emergency laparoscopy was performed but no ectopic pregnancy was found, just blood, coagula and a ruptured corpus luteum. The day after the surgery, intrauterine pregnancy was found on ultrasound and the pregnancy ended with term delivery.Krvarenje iz žutog tijela je česta pojava u žena reprodukcijske dobi. Zbog bolova u trbuhu praćenih hemoperitoneumom krvarenje iz žutog tijela ima sličnu kliničku sliku kao ektopična trudnoća. Postupak kod krvarenja iz žutog tijela ovisi o simptomima i laboratorijskim nalazima i može se sastojati samo od opservacije pacijentice, ali može zahtijevati i dijagnostičku laparoskopiju ili hitnu eksplorativnu laparotomiju. Hemperitoneum zbog krvarećeg žutog tijela u trudnoći je iznimno rijedak. U radu prikazujemo pacijenticu koja je primljena na naš odjel s amenorejom, pozitivnim ßhCG-om i znacima akutnog abdomena. Učinjena je hitna laparoskopija prilikom koje nije nađena ektopična trudnoća, nego krv, ugrušci i krvareće žuto tijelo. Dan nakon laparoskopije je ultrazvučno nađena intrauterina trudnoća koja je završila porođajem zdravog djeteta u terminu

Selection for high oil content in an opaque-2

A população de milho Sintético A foi submetida a três métodos de seleção para aumentar o teor de óleo dos grãos: método de seleção de progênies autofecundadas e os métodos de seleção de famílias de irmãos e meio-irmãos. A primeira geração de seleção foi feita em Lafayette, Indiana, Estados Unidos da América, no verão de 1970, e a segunda geração foi conduzida no Hawaii durante o inverno de 1971. Amostras das várias populações foram avaliadas em experimentos de blocos inteiramente casualizados no verão de 1971. De cada população foram coletados dados sobre a produção de grãos por parcela, percentagem de óleo e proteína no grão, e lisina como percentagem da proteína. Foi calculado o rendimento de óleo e lisina por hectare. A percentagem do embrião sobre o peso da semente e o teor de óleo do embrião foram obtidos para duas populações. Os seguintes resultados foram encontrados: a) os três métodos foram igualmente eficientes, aumentando a percentagem de óleo no grão numa média de 0,37% em duas gerações; b) a seleção de progênies autofecundadas mostrou um aumento significativo de 0,70 na varivel percentagem de embrião, e um aumento não significativo na percentagem de óleo do embrião; e) foi constatada uma resposta correlata entre a percentagem de proteína e a de óleo no grão, sugerindo que a seleção para maiores teores de óleo no grão pode ser usada como método para elevar o teor de proteína na população opaco-2 estudada; d) o rendimento de grão e o nível de lisina na proteína do grão não foram afetados pela seleção para óleo, no intervalo de teores de óleo estudado.The opaque-2 Synthetic A population was subjected to three methods of selection for high oil in the kernel: progeny, full-sib, and halfsib family selection. The first generation of selection was grown at Lafayette, Indiana, USA, during the summer of 1970 and the second generation was grown in Hawaii during the winter of 1971. Composite samples from the various populations formed during the selection program were evaluated in a randomized complete block experiment at Lafayette during the summer of 1971. From each population data were obtained for grain yield, percent of oil and protein in kernel and lysine as percent of protein. Yields of oil and lysine were calculated. Data for germ as percent of kernel and percent of oil in germ were obtained for two populations. The following results were obtained: 1) the three methods were equally effective for increasing oil content in kernel by an average of 0.37 percent in two generations; 2) progeny selection resulted in an increase of 0.70 in the variable germ as percent of kernel, and a nonsignificant increase in percent of oil in germ; 3) a positive correlated response in percent of protein in kernel was observed with the oil selection, suggesting that selection for oil content may be used to increase the percentage of kernel protein in the opaque-2 population studied; 4) the grain yield and lysine level of the kernel protein was not affected by the oil selection between the intervals of ou observed in this study

KUMULATIVNA STOPA TRUDNOĆA OSTVARENA NAKON PRIJENOSA ZAMETAKA U SVJEŽEM CIKLUSU I PRVOM NAREDNOM CIKLUSU S ODMRZNUTIM ZAMETCIMA: JE LI VRIJEME ZA PROMJENU PRAKSE?

The aim: was to clarify parameters that contribute to successful pregnancy outcomes from one oocyte retrieval cycle with the least procedure steps. Methods: This retrospective study included 42 stimulated IVF cycles with fresh embryo transfers (fresh ET) and the subsequent 42 frozen embryo transfer cycles (FET) performed between January 2012 and December 2015. Results: The observed clinical pregnancy rate of 21.4% in stimulated cycles with fresh embryo transfers was significantly lower compared with the pregnancy rate of 52.4% in cycles with thawed embryo transfers (p=0.015) indicating impaired endometrium quality in stimulated IVF cycles. Most of the patients (78.6%) failed to achieve pregnancy after fresh ET, but more than half of them (57.6%) succeeded to achieve pregnancy after FET. The cumulative pregnancy rate after fresh ET and the first subsequent FET was 73.8% per initiated cycle. Conclusion: The results suggest that not only the presence of supernumerary good-quality blastocysts but also a receptive endometrium is needed for a successful IVF outcome. Our findings suggest that ovarian stimulation protocol had an impact on the pregnancy rate in the fresh cycle and that a better chance of conceiving was after FET. Thus, IVF outcomes can be improved with a better embryo transfer strategy.Cilj rada je razjasniti parametre koji pridonose uspješnom ostvarivanju trudnoće iz jednog započetog postupka prikupljanja jajnih stanica uz najmanji broj postupaka koji slijede. Metode: U retrospektivnu studiju uključeno je 42 stimulirana IVF ciklusa s prijenosom svježih zametaka (“svježi ET”) i 42 ciklusa prijenosa kriopohranjenih zametaka (“FET”) učinjenih između siječnja 2012. i prosinca 2015. Rezultati: Zabilježena je značajno niža stopa kliničkih trudnoća (p=0,015) nakon prijenosa svježih zametaka u stimuliranim ciklusima (21,4 %) u usporedbi sa stopom trudnoća nakon prijenosa odmrznutih zametaka (52,4 %) što ukazuje na smanjenu kvalitetu/receptivnost endometrija u stimuliranim IVF ciklusima. Ukupna, kumulativna stopa trudnoća nakon “svježeg ET” i FET postupka iznosila je 73,8 % po započetom ciklusu. Zaključak: Rezultati ukazuju da je osim kvalitetnih blastocisti za uspješnost IVF postupka nužan i receptivni endometrij. Uočen je utjecaj protokola stimulacije jajnika u svježem ciklusu na stopu trudnoća i veća uspješnost začeća nakon FET postupka. Stoga bi se uspješnost IVF postupka mogla poboljšati boljom strategijom prijenosa zametak

ULTRASOUND EVALUTATION OF CERVIX LENGTH BY TRANSPERINEAL AND TRANSVAGINAL ROUTE IN THE SECOND AND THIRD TRIMESTER OF PREGNANCY

SAŽETAK. Cilj ovog istraživanja je ocijeniti mogućnosti primjene transperinealnog ultrazvuka u mjerenju duljine vrata maternice i ocjena izgleda unutarnjeg ušća te usporediti vrijednosti dobivene transperinealnim i transvaginalnim pristupom. Metode. U ispitivanje je uključeno 100 ispitanica s jednoplodnom trudnoćom koje u anamnezi nisu imale cervikalnu insuficijenciju, prijevremeno prsnuće ovoja ili prijevremeni porod. Podatke o duljini cerviksa dobili smo transperinealnim i transvaginalnim ultrazvučnim pregledom. Rezultati. Transperinealnim je ultrazvukom izmjerena prosječna duljina cerviksa od 37,41 mm, s 95-postotnim intervalima pouzdanosti (IP) 35,89 i 38,93 mm i standardnom devijacijom (SD) 7,66. Transvaginalnim ultrazvukom je dobivena srednja vrijednost 37,80 mm, intervali pouzdanosti od 36,34 i 39,26 mm i standardna devijacija 7,35 mm. Statističkom usporedbom spomenutih rezultata Studentovim t-testom dobili smo vrijednost p od 0,681 što je iznad granične vrijednosti p od 0,05, između ova dva pristupa ne postoje statistički značajne razlike u određivanju duljine cerviksa. Zaključak. Transperinealna ultrasonografija je usporediva s transvaginalnom u mjerenju duljine cerviksa u drugom i trećem trimestru te nudi prihvatljivu alternativu za mjerenje duljine cerviksa u ispitanica koje se protive transvaginalnom pregledu, a prihvatljiva je i u situacijama u kojima treba minimalizirati učestalost transvaginalnog pregleda kao što su prijevremeno prsnuće ovoja ili vaginalno krvarenje nepoznata uzroka.Objective. Our primary objective was to evaluate efficacy of transperineal ultrasound in assessment of cervical length in second and third trimester of pregnancy. Additionally, we wanted to compare transperineal and endovaginal approach for this purpose. Methods. One hundred patients with singleton pregnancy and without cervical insufficiency, premature membrane rupture or preterm birth in previous pregnancies were examined. Cervical length has been assessed by both transperineal and endovaginal ultrasound examination. Results. By using a transperineal approach, we measured an average cervical length of 37,41 mm, with 95-percent confidence intervals (CI) of 35,89 and 38,93 mm and standard deviation (SD) of 7,66 mm. In comparison, an endovaginal cervical measurement produced average cervix length of 37,80 mm, (CIs were 36,34 and 39,26 mm and SD was 7,35 mm). Statistical testing by Student’s t-test resulted in p-value of 0,681, thus marking results as being statistically non significantly different. Conclusion. Transperineal ultrasono¬graphic imaging of the cervix is comparable to endovaginal measurement in second and third trimester and is satisfactory alternative to an endovaginal assessment especially in patients that object to endovaginal exam. This approach is especially useful when endovaginal assessment should be avoided as in premature membrane rupture or vaginal bleeding of unknown cause

ULTRASOUND EVALUTATION OF CERVIX LENGTH BY TRANSPERINEAL AND TRANSVAGINAL ROUTE IN THE SECOND AND THIRD TRIMESTER OF PREGNANCY

SAŽETAK. Cilj ovog istraživanja je ocijeniti mogućnosti primjene transperinealnog ultrazvuka u mjerenju duljine vrata maternice i ocjena izgleda unutarnjeg ušća te usporediti vrijednosti dobivene transperinealnim i transvaginalnim pristupom. Metode. U ispitivanje je uključeno 100 ispitanica s jednoplodnom trudnoćom koje u anamnezi nisu imale cervikalnu insuficijenciju, prijevremeno prsnuće ovoja ili prijevremeni porod. Podatke o duljini cerviksa dobili smo transperinealnim i transvaginalnim ultrazvučnim pregledom. Rezultati. Transperinealnim je ultrazvukom izmjerena prosječna duljina cerviksa od 37,41 mm, s 95-postotnim intervalima pouzdanosti (IP) 35,89 i 38,93 mm i standardnom devijacijom (SD) 7,66. Transvaginalnim ultrazvukom je dobivena srednja vrijednost 37,80 mm, intervali pouzdanosti od 36,34 i 39,26 mm i standardna devijacija 7,35 mm. Statističkom usporedbom spomenutih rezultata Studentovim t-testom dobili smo vrijednost p od 0,681 što je iznad granične vrijednosti p od 0,05, između ova dva pristupa ne postoje statistički značajne razlike u određivanju duljine cerviksa. Zaključak. Transperinealna ultrasonografija je usporediva s transvaginalnom u mjerenju duljine cerviksa u drugom i trećem trimestru te nudi prihvatljivu alternativu za mjerenje duljine cerviksa u ispitanica koje se protive transvaginalnom pregledu, a prihvatljiva je i u situacijama u kojima treba minimalizirati učestalost transvaginalnog pregleda kao što su prijevremeno prsnuće ovoja ili vaginalno krvarenje nepoznata uzroka.Objective. Our primary objective was to evaluate efficacy of transperineal ultrasound in assessment of cervical length in second and third trimester of pregnancy. Additionally, we wanted to compare transperineal and endovaginal approach for this purpose. Methods. One hundred patients with singleton pregnancy and without cervical insufficiency, premature membrane rupture or preterm birth in previous pregnancies were examined. Cervical length has been assessed by both transperineal and endovaginal ultrasound examination. Results. By using a transperineal approach, we measured an average cervical length of 37,41 mm, with 95-percent confidence intervals (CI) of 35,89 and 38,93 mm and standard deviation (SD) of 7,66 mm. In comparison, an endovaginal cervical measurement produced average cervix length of 37,80 mm, (CIs were 36,34 and 39,26 mm and SD was 7,35 mm). Statistical testing by Student’s t-test resulted in p-value of 0,681, thus marking results as being statistically non significantly different. Conclusion. Transperineal ultrasono¬graphic imaging of the cervix is comparable to endovaginal measurement in second and third trimester and is satisfactory alternative to an endovaginal assessment especially in patients that object to endovaginal exam. This approach is especially useful when endovaginal assessment should be avoided as in premature membrane rupture or vaginal bleeding of unknown cause

INFLUENCE OF HYSTEROSCOPIC METROPLASTY ON APPEARANCE, ONGOING AND OUTCOME OF PREGNANCY

Cilj rada. Usavršavanjem dijagnostike, posebice ultrazvučnih i endoskopskih metoda, omogućeno je uspješno otkrivanje poremećaja u spajanju Müllerovih cijevi s posljedičnim stvaranjem septuma uterusa različite dužine i lokalizacije. Ovi poremećaji su združeni s lošim reprodukcijskim ishodom i povećanim rizikom za majku. Cilj rada je bio analizirati¬ uspješnost histeroskopske metroplastike u nastanku, tijeku i ishodu trudnoće. Ispitanice i metode rada. Skupina od 410 ispitanica s trudnoćom nastalom poslije histeroskopske metroplastike, sa srednjom vrijednosti životne dobi od 31,4 godine i srednjom vrijednosti trajanja neplodnosti 5,3 godine, podijeljena je u dvije podskupine: 1) s primarnom neplodnošću 178 i 2) sa sekundarnom neplodnošću 232 bolesnice. Rezultati. Prije histeroskopske metroplastike stopa rađanja je bila 7,6% (31 porod), sa stopom preživljenja 5,4% i perinatalnim mortalitetom 32,3%. Stopa spontanih pobačaja je bila 72,8% (169 bolesnica), od 1 do 9 po bolesnici. Ukupni broj spontanih pobačaja iznosio je 360, odnosno 86,1% od ukupnog broja 418 trudnoća ili 2,1 pobačaj po bolesnici. Stopa izvanmaternične trudnoće je bila 10,8% (25 bolesnica). U 178 ispitanica nije došlo do trudnoće unatoč poduzetom višegodišnjem liječenju neplodnosti. Poslije histeroskopske metroplastike stopa po¬roda je signifikatno porasla i dostigla 75,8%. S druge strane, stopa spontanih pobačaja je signifikantno pala na 10,4%. Stopa perinatalnog mortaliteta je pala na 2,2%, dok je stopa izvanmaternične trudnoće pala na 3,9%. Trudnoća u tijeku je 8,5%. Zaključak. Incizijom septuma kavuma uterusa postiže se poboljšanje uvjeta za implantaciju i razvoj trudnoće. Nakon histeroskopske metroplastike signifikantno raste stopa poroda, od 7,6% prije na 75,8% poslije operacije. U isto vrijeme, stopa spontanih pobačaja pala je od 72,8% prije histeroskopske metroplastike na 10,4% poslije operacije.Objective. Ultrasound diagnostics and hysteroscopic technique made a hughe progress in accurate detection of failure of fusion of the Müllerian ducts and failure of resorption of the intervening septum, which are occuring during embryologic development from 6 to 20 weeks and result in formation of uterine septa of variable lengths and positions. These congenital uterine malformations are associated with poor reproductive outome and an increased risk for mother. Hysteroscopic metroplasty is minimally invasive procedure allowing safe technique for incision of the septum. The objective was to analyze the successfulness of the hysteroscopic metroplasty in the appearance, ongoing and outcome of the pregnancy. Material and methods. The group of 410 patients with pregnancy after hysteroscopic metroplasty was evaluated.¬ The mean age of patients was 31.4 years. The mean infertile interval was 5.3 years. Before hysteroscopic metroplasty 232 patients were referred with history of pregnancy loss or complications of pregnancy. Infertility was the main complaint in 178 patients. Results. Before hysteroscopic metroplasty delivery rate in the group of 232 patients with secondary infertility¬ was 7.6%, perinatal mortality rate 32.3% and spontaneous abortion rate 72.8%; total number of miscarriagies was 360, its number ranged 1–9 in studied 169 patients. Ectopic pregnancy rate was 10.8% (25 patients). In spite of the treatment lasting several years there were no pregnancies in the group of 178 patients. After hysteroscopic metroplasty, delivery rate increased significantly and reached 75.8%. Ongoing pregnancy rate is 8.5%. On the other hand, spontaneous abortion rate decreased significantly and dropped to 10.4%. Ectopic pregnancy rate decreased to 3.9%. Perinatal mortality decreased to 2.2%. Conclusion. Pregnancy capacity of the uterine cavity is enlarged by hysteroscopic incision of the septum. Conditions for implantation and embryo development are improved. Hysteroscopic metroplasty significantly increased delivery rate, from 7.6% before to 75.8% after the procedure. Rate od spontaneous abortions decreased¬ from 72.8% before operation to 10.4% and ectopic pregnancy rate from 10.8% to 3.9%

DAVYDOV’S LAPAROSCOPY ASSISTED NEOVAGINOPLASTY

U radu su prikazana tri bolesnice s Mayer – von Rokitansky-Küster-Hauserovim sindromom koje su nakon obrade operirane laparoskopski asistiranom metodom neovaginoplastike po Davydovu. U sva tri slučaja postoperacijski tijek je bio uredan, uz zadovoljavajući kozmetski učinak, funkcionalnost pri kohabitaciji i zadovoljstvo u seksualnosti oba partnera, što i jesu glavni ciljevi stvaranja neovagine.Presentation is made of three cases of the Mayer-von Rokitansky-Küster-Hauser syndrome, operated after complete work-up by the laparoscopy assisted method of neovaginoplasty according to Davydov. In all three cases, the postoperative course was uneventful, with satisfactory cosmetic effect, functional cohabitation and sexual satisfaction in both partners, as the main goals of neovagina creation