Testicular adrenal rest tumors (TARTs) as a male infertility factor. Case report

Since testes and adrenal cortex derive from the same urogenital ridge, adrenal tissue with descending gonads may migrate in early embryonic period. Although most often ectopic tissue undergoes atrophy, in some cases, when adrenocorticotrophic (ACTH) overstimulation occurs, the adrenal remnants in the testes may become hypertrophic and form testicular adrenal rest tumors (TARTs). The growth of TARTs in the testes leads to obstruction of the seminiferous tubules which can mechanically impair the function of the gonads and cause irreversible azoospermia. We describe a patient suffering since neonatal period from congenital adrenal hyperplasia (CAH), disorder with defected pathway of cortisol production, which leads to increased ACTH production and to overstimulation of adrenal cortex. He had very poor disease control and therefore in late puberty he was diagnosed with TARTs. At the age of 19.5 he was diagnosed with azoospermia, most likely caused by TARTs. It is the first evidence of TARTs in Polish literature. Although not many cases have been published so far, the incidence of TARTs seems to be highly underdiagnosed, so it seems reasonable to consider the disease in differential diagnosis of male infertility

Planning and preparation for pregnancy among women with and without a history of infertility

Objectives: Preconception counseling, maternal health-related habits, diet, folic acid consumption, substances abuse, may all impact the outcome of pregnancy. The aim of this study was to compare the planning and preparation for pregnancy among pregnant women with and without infertility. Material and methods: A survey of health behaviors prior to and during pregnancy that could affect pregnancy outcomes, including laboratory tests performed, stimulant usage, initiation of prenatal care, and folic acid intake, was conducted among 400 pregnant women. The study group included 121 women (30.25%) diagnosed with prior infertility, while the control group included 279 women (69.74%) who did not report any problems conceiving. Results: All patients (100%) from the study group and 70,97% from the control group planned their pregnancy(p < 0.0001). Patients in the study group performed significantly more laboratory tests prior to pregnancy, including: complete blood count, urine analysis, fasting blood glucose concentration, testing for toxoplasmosis, and Pap smear, compared with the control group (p < 0.0001). There was no difference between groups regarding the knowledge of when and why folic acid supplementation is required (p > 0.05). Conclusions: Effective education of women, regarding pregnancy planning and behaviours, that may impact pregnancy outcome is still a serious challange to public health in Poland. Our study indicates that reaching general population with the education is most important to achieve best results in preconceptional care

Pregnancy in a patient with seminal hypersensitivity

We report a case of a 32-year-old woman with seminal fluid allergy and secondary infertility. She was unable to have unprotected intercourses due to hypersensitivity to the sperm of her spouse. The symptoms started after the delivery of her first child. She was referred to our division for desensitization by means of the intravaginal rush method. The patient was hospitalized for monitoring, and an intravenous line was placed. The first attempt of desensitization was unsuccessful, because of her general hypersensitivity reaction. After the second intravaginal graded challenges, with the use of whole seminal plasma, none of the allergic symptoms appeared. She conceived in a natural way within a month after the treatment. Intravaginal desensitization is an effective and convenient approach for patients with postcoital hypersensitivity reaction who wish to get pregnancy

17β-estradiol and xenoestrogens reveal synergistic effect on mitochondria of human sperm

Objectives: The aim of the study was to investigate the influence of 17β-estradiol (main endogenous estrogen) and selected xenoestrogens (genistein, bisphenol-A), individually and in combination, on the mitochondrial function of human sper­matozoa. In natural environment, human beings are exposed to multiple xenoestrogens, so their impact is combined with endogenous steroids. Material and methods: The effects of ligands on human spermatozoa were assessed regarding the following phenomena: spermatozoa vitality (propidium iodide staining), phosphatidylserine membrane translocation (staining with annexin V marked with fluorescein), mitochondrial membrane potential (using JC-1 fluorochrome), and production of superoxide anion in mitochondria (using MitoSOX RED dye). Results: Two-hour incubation of spermatozoa with 17β-estradiol, genistein, and bisphenol-A neither altered cell vitality nor stimulated phosphatidylserine membrane translocation. Incubation of spermatozoa with 17β-estradiol or bisphenol-A sepa­rately, as well as incubation with the three ligands simultaneously, resulted in altered mitochondrial membrane potential. Spermatozoa incubation with the three ligands significantly increased the mitochondrial superoxide anion level. Conclusions: It seems safe to conclude that human spermatozoa mitochondria are target cell structures for both, 17β-estradiol and xenoestrogens. The reaction to the 17β-estradiol and xenoestrogens mixture suggests a synergistic mechanism of action. Xenoestrogens may increase the sensitivity of spermatozoa to 17β-estradiol

Efektywność leczenia zespołu bólowego miednicy mniejszej metodą neurektomii przedkrzyżowej u pacjentek z i bez endometriozy

Abstract Objective: Presacral neurectomy (PSN) is used in treatment of central chronic pelvic pain (CPP); however, the confounding effect of concomitant resection of endometriosis remains uncertain. This study was undertaken to evaluate and compare the effectiveness of presacral neurectomy (PSN) in the presence and absence of endometriosis. Material and Methods: Twenty-three women with midline CPP (age 30.3+/-7.9, range 21-46) unresponsive to medical therapy were recruited to the study. Endometriosis was absent in seven and present in sixteen subjects. Laparoscopic PSN using a harmonic scalpel was performed in all subjects; simultaneous excision of endometriotic lesions was also carried out in subjects with endometriosis. Intensity of dysmenorrhoea and pelvic pain was measured by visual analogue pain scale (VAPS) at 3 and 12 months postoperatively. Results: Dysmenorrhoea decreased at 3 months by 75% (P=0.018) in those without endometriosis and by 78% (P=0.001) in those with endometriosis. At 12-months, dysmenorrhea increased in women with endometriosis (P=0.008), but not in those without endometriosis. Pelvic pain not related to menses decreased by 67% (P=0.0007) and by 87% (P=0.028), respectively, in women with and without endometriosis. Dyspareunia, declined dramatically at 3 and 12 months to a median score of 0 (the majority of subjects had no discomfort; PStreszczenie Cel pracy: Neurektomia przedkrzyżowa jest stosowana w leczeniu zespołu bólowego miednicy mniejszej, jakkolwiek sumaryczny efekt jednoczasowo przeprowadzonej resekcji ognisk endometriozy pozostaje niejasny. Prezentowana praca ma na celu porównanie skuteczności laparoskopowej neurektomii przedkrzyżowej w przypadku obecności endometriozy, oraz u chorych, u których ta choroba nie występuje. Materiał i metody: Badaniem objęto dwadzieścia trzy kobiety z centralnie zlokalizowanym przewlekłym bólem miednicy mniejszej (wiek 30,3+/-7,9; 21-46 lat), nieodpowiadającym na leczenie farmakologiczne. Endometriozę stwierdzono u 16 pacjentek. W badanej grupie wykonano laparoskopową neurektomię przedkrzyżową z zastosowaniem skalpela harmonicznego, uzupełnioną o wycięcie ognisk endometriozy w 16 w/w przypadkach. Nasilenie bólu towarzyszącego krwawieniu miesiączkowemu oraz bólu niezwiązanego z krwawieniem oceniano na podstawie wzrokowej skali bólu (VAPS) przed zabiegiem oraz po 3 i 12 miesiącach po operacji. Bolesność stosunków płciowych oceniono z zastosowaniem czterostopniowej skali. Wyniki: Po 3 miesiącach od operacji intensywność bólu związanego z krwawieniem miesiączkowym zmniejszyła się znacząco w obu grupach pacjentek (u chorych bez endometriozy o 75% (P=0,018), a w grupie z endometriozą o 78% (P=0,001). Po 12 miesiącach zaobserwowano wzrost intensywności odczuwanego bólu u kobiet z endometriozą (P=0,008), natomiast u pacjentek bez endometriozy poprawa była na niezmienionym poziomie. Odczuwalność bólu w miednicy mniejszej niezwiązanego z krwawieniem miesiączkowym zmniejszyła się na skutek operacji o 67% (P=0,0007) i o 87% (P=0,028) odpowiednio w grupie z endometriozą i bez endometriozy. Bolesność stosunków płciowych zmniejszyła się istotnie 3 miesiące po operacji i efekt utrzymywał się nadal po 12 miesiącach (większość pacjentek nie podawała żadnego dyskomfortu,

Strategies and results of oncofertility counseling in young breast cancer patients

Introduction. Breast cancer (BC) is the most common female neoplasm in Poland and worldwide, yet up to 7% of all cases is diagnosed < 40 years of age. The increased BC morbidity rate in this age group as well as hope for late maternity need special attention. Material and methods. The data concerning the number of children and further procreation needs in women (n = 68), aged 18–40, diagnosed and treated for early breast cancer at the Greater Poland Cancer Center in 2018–2019, were taken from patients’ histories by an oncologist before (neo-)adjuvant systemic therapy. Results. Out of the 68 females surveyed, aged 18–40 (median age 36), 14 (21%) were childless at the moment of diagnosis. After being informed about the therapy, prognosis, side effects and oncofertility, 12 patients (18%) decided to have a consultation with a specialist in reproductive medicine; 5 of them (7%) already had children. In 2 women (3%), hormonal stimulation in combination with tamoxifen was used; then, oocytes were collected and cryopreserved. In 19 (28%), gonadotropine analogues were added to (neo-)adjuvant chemotherapy. In 17 patients (25%) pathogenic mutations in BRCA1/2 genes were found. Conclusions. Oncofertility counseling in young BC patients should be one of the fundamental elements of complex patient care

Perinatal outcome among women undergoing in vitro fertilization procedures complicated by ovarian hyperstimulation syndrome

Objectives: The aim of the study was to assess the outcome of pregnancies after in vitro fertilization protocol (IVF), that were complicated by the ovarian hyperstimulation syndrome (OHSS). Material and methods: We examined 26 women undergoing IVF due to OHSS. Patients were divided into two groups: with early OHSS and late OHSS. All women were screened for age, Body Mass Index (BMI), number of embryos transferred, OHSS symptoms and duration of hospitalization. Pregnancy outcome was assessed by rate of miscarriages, premature deliveries and multiple gestations. We assessed also the delivery mode, birth weight of all newborns and obstetric complications. Results: Early OHSS occurred in 10 patients and late OHSS complicated the pregnancies of 16 women. 94,1% of the late OHSS cases occurred in cycles with pregnancy. The miscarriage rate was 26,9%. 38,5% of all births were premature and 26,9% of the newborns had low birth weight. Multiple pregnancies were confirmed in 46,2% of the patients, triplets mainly in women with late OHSS. No fetal anomalies were diagnosed. The most common antenatal complications were: diabetes mellitus, cholestasis and intrauterine infection. The rate of the cesarean sections was 73,8%. Conclusions: OHSS is a risk factor for miscarriage, preterm delivery, multiple gestation, obstetric complications and cesarean section. Late OHSS may be closely associated with the conception cycles

A long-term survival of 45-year old patient with primary metastatic prostate cancer - case report

W pracy przedstawiono opis przypadku 45-letniego mężczyzny z uogólnionym pierwotnie rakiem gruczołu krokowego, u którego do chwili obecnej uzyskano ponad 4-letnie przeżycie pod wpływem stosowania różnych metod leczenia paliatywnego (hormonoterapia, radioterapia, chemioterapia, leczenie wspomagające).A long-term survival of 45-year old patient with primary metastatic prostate cancer treated with various palliative therapeutic methods (hormonotherapy, radiotherapy, chemotherapy and best supportive care) is presented

Laparoscopic gonadectomy for androgen insensitivity syndrome – case report

Summary Androgen insensitivity syndrome (AIS, Morris syndrome) is an X-linked recessive disorder of sexual development caused by the mutation of the androgen receptor coding gene (locus Xq11-q12). We present a case of a 17-year-old girl diagnosed because of primary amenorrhea. Her cytogenetic analysis revealed the kariotype of 46, XY. Clinical examinations, based on the Quigley’s scale, showed features of complete AIS. Hormonal tests brought the following results: FSH – 2.81mIU/ml, LH – 13.88mIU/ml. Testosterone value met the norm for a male individual in reproductive age (7.97ng/ml). Family anamnesis revealed no episodes of genetic diseases. Due to the risk of neoplasia, the diagnosis was an indication for surgical gonads removal, which was performed laparoscopically. Histopathologic examination showed tubular adenoma with immature seminiferous tubules without spermatogenesis, and serous cysts. Patient was discharged on the next day after the operation in good general condition, and estrogen therapy was prescribed. Conclusion: Laparoscopy is an effective method in AIS treatment

Internet as a source of information about infertility among infertile patients

Objectives: Around one million couples in Poland suffer from infertility. People in reproductive age are most active Internet users. The aim of the study was to assess Internet habits of infertile patients. We checked to what extent infertile patients seek information about infertility on-line and what is their approach to the information found. Materials and Methods: 85 female patients treated for infertility for at least one year were surveyed. The anonymous questionnaire was designed by the authors of the publication. It consisted of questions related to medical history of the patients and sources of information about infertility they used. It also checked Internet activity of the patients and contained Beck’s Depression Inventory (BDI). Chi-square test and Spearman’s correlation test were used to evaluate the results. Results: The majority of patients used Internet to find information about infertility (93%); 46% of the respondent declared Internet forums to be their main source of information about it. Patients used on-line sources of information more often than stricte medical sources. Internet influenced their relation with the physician. 64% of patients verified on-line information and treatment proposed by their doctor before using them. One third of the surveyed women claimed their knowledge about infertility comes more from the Internet than the specialist who treated them. There was a positive correlation between patients who checked diagnostic or therapeutic methods proposed by their physician with depression in BDI. Conclusions: Considering the great impact of Internet forums and web pages on patient approach to diagnostics and treatment of infertility, there seems to be a need to create a professional Polish website and forum to provide the patients with reliable information about the disease