Ovarian reserve assessment in women with different stages of pelvic endometriosis

Introduction: Endometriosis is defined as the appearance of ectopic endometrial cells outside the uterine cavity. Ectopic cells demonstrate functional similarity to eutopic cells, but structural and molecular differences are significant and manifest themselves in gene expression of the metalloproteinase genes, integrin or the Bcl-2 gene. Pelvic pain remains to be the main symptom of the disease. Endometriosis may cause dysfunction of the reproductive system and lead to infertility. Pathogenesis of infertility in endometriosis is based on its influence on the hormonal, biochemical and immunological changes in the eutopic endometrium, as well as structural damages of the ovaries and the fallopian tubes. Objectives: The aim of the study was to assess the ovarian reserve in patients with endometriosis. Material and methods: A total of 39 patients (aged 22-34 years) with different stages of endometrial changes were recruited for the study. The number of antral follicles was rated by vaginal ultrasonography and the level of FSH was measured between days 1-3 of the menstrual cycle. The stage of the disease was established after laparoscopy with the rASRM scale. Results:No statistically significant correlation between the number of follicles(AFC), the level of FSH and the stage of endometriosis was found. Conclusions: Evaluation of the number of antral follicles and measurements of the FSH level do not allow to predict the ovarian reserve in women with endometriosis

Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO_{2} laser ablation

Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach—among others, laser application—are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO(2) laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22–42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO(2) laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level

Ciąża w bliźnie po cięciu cesarskim

Pregnancy in the uterine scare after previous caesarean section is the rarest type of ectopic pregnancy. Due to the possibility of life-threatening complications, cesarean scar pregnancy (CSP) needs rapid and proper diagnosis and management. Hereby we present 3 cases of women with CSP, diagnosed and treated at the Department of Gynecology and Obstetrics of Jagiellonian University Medical College, in Krakow, in 2013, as well as literature review.Ciąża w bliźnie po cięciu cesarskim stanowi najrzadszą postać ciąży pozamacicznej. Ze względu na ryzyko wystąpienia zagrażających życiu powikłań wymaga sprawnego rozpoznania oraz leczenia. Poniżej prezentujemy 3 przypadki pacjentek z ciążą w bliźnie po cięciu cesarskim leczonych w Klinice Ginekologii SU w Krakowie w 2013 roku oraz przegląd piśmiennictwa

Male factor infertility in the Comprehensive Procreational Health Protection Program at the University Hospital in Cracow

Objectives: Quality of semen is one of the most important factors contributing to couples' chance of natural conception. There are many confirmed or potential factors that influence semen analysis results. To estimate the incidence and analyze male factor infertility. Material and methods: The retrospective observational study was in the Clinical Department of Gynecological Endocrinology and Gynecology, University Hospital in Krakow. The study included men from subfertile population, aged ≥ 18 years, without prior diagnosis and obvious cause of infertility, whose initial seminograms were used to characterize the population. Seminograms of men remaining in the follow-up were used to analyze the variability of sperm parameters in relation to lifestyle modification and the use of fertility supplements containing antioxidants. Control semen tests were performed at 1-3-month intervals. Results: The study included 870 men. In 68.5% of men, at least one abnormal sperm parameter was found and 40.7% had complex sperm abnormalities. Averaged values of sperm parameters of men from subfertile couples were within the WHO reference ranges, except for the normal morphology, whose median was 3.8%. No significant differences in the selected sperm parameters after the implementation of conservative management were observed. The percentage of pregnancies not resulting from IVF in the follow-up population was 7.7%. Conclusions: One semen sample is representative of an individual in the diagnostics of male infertility. Expectant management and lifestyle modification should not be proposed as first-line treatment when more effective procedures are available

Autotelic vs. instrumental motivation of doctors and their medical specialty choice in relation to sense of coherence

Aim. Analysis and comparison of two types of motivation (autotelic and non-autotelic) which are behind the choice of medical specialisation by doctors in relation to their sense of coherence. Method. Questionnaire method was used in the study. The study included a group of 86 graduates of the Faculty of Medicine of the Jagiellonian University, who have completed postgraduate internships at the Department of Haematology and Oncology, Department of Gynaecology of the Jagiellonian University and the L. Rydygier hospital in Krakow in 2010–2012. Statistical analyses were performed using the IBM SPSS Statistics 21. The level of significance was alpha = 0.05. Results. It has been shown that doctors are more frequently characterised by the autotelic type of motivation. It has also been proven that there is a relationship between the male sex of the surveyed doctors and their autotelic type of motivation. Moreover, it has been demonstrated that there is a correlation between the comprehensibility component of the sense of coherence and the male sex. It has been also demonstrated that there is a correlation between meaningfulness component of the sense of coherence and the choice of surgical specialisation Conclusions. Autotelic motivation prevails when choosing a medical specialty and this tendency is more noticeable in men than in women. The meaningfulness component of SoC plays a regulatory role in making career decisions related to the greater physical and mental pressure put on doctors. The observed differences in the types of motivation and the size of the components of the sense of coherence in groups of surveyed doctors – men and women – encourage further observations of these relationships on a larger population