Uticaj protokola stimulacije kod policističnog ovarijalnog sindroma na ishod vantelesnog oplođenja

Polycystic ovarian syndrome (PCOS) is considered one of the most common endocrine disorders of women of reproductive age. It is characterized by chronic anovulation, signs of hyperandrogenism, polycystic appearance of ovaries and subfertility or sterility. Although polycystic ovaries are a common finding in infertile women, the exact incidence of these patients included in the in vitro fertilization program is not known. The aim of this study was to assess the effect of PCOS on the course and the outcome of in vitro fertilization; compare the characteristics of ovarian response and compare the clinical pregnancy and miscarriage rates in women with PCOS to those in women with tubal factor sterility; examine which ovarian stimulation protocol in patients with PCOS has a higher success rate and a lower risk of the occurrence of Ovarian Hyperstimulation Syndrome (OHSS); examine the effect of age, body mass index, levels of Anti-Mullerian hormone and the use of metformin on in vitro fertilization (IVF) outcomes in patients with PCOS. The research was conducted as a prospective comparative study. The study included 123 patients with PCOS and 94 patients participating IVF program due to tubal sterility. The patients were treated by a long GnRH agonist protocol, a short GnRH agonist protocol or a flexible GnRH antagonist protocol. The patients with PCOS have a higher number of the oocytes retrieved and a lower fertilization rate. Clinical pregnancy and miscarriage rates did not differ significantly between the two groups, while OHSS was present only in the group of patients with PCOS. The length of stimulation of patients with PCOS was shorter in the antagonist group, whereas the total number of aspirated oocytes was statistically significantly higher in the agonist group. Significantly higher number of the obtained embryos as well as a higher number of best quality embryos in the agonist group did not affect the clinical pregnancy rate. We have concluded that patients with PCOS achieve clinical pregnancy rates similar to those of women with tubal factor infertility. The antagonist protocol has clinical pregnancy rate comparable to that of the agonist protocol. Although there is no statistically significant difference in the incidence of OHSS, a less frequent occurrence of this serious complication has been noticed in the antagonist protocol

Subconjunctival Infection due to Dirofilaria Repens - Case Report

Summary The aim of the survey was to present the clinical course and surgical treatment of the first case of human ocular dirofilariosis on the territory of the city of Niš, in the southeast Serbia. Male patient, 57 years old, visited an ophthalmologist because of extreme swelling and redness of the eyelids of the right eye, scratches and pain in his right eye. On standard examination on biomicroscope, temporally 3 mm from the limbus, intrapalpebrally, a mobile parasite was observed in the subconjunctival space. Complete extraction of the living parasites, 13 cm long, was performed. A sample of the nematode based on morphological and morphometric characteristics was identified as Dirofilaria repens-like. The diagnosis was confirmed with molecular methods. For ocular dirofilariosis, surgical methods and complete extraction of the parasite are the only ways to achieve complete recovery

Protokół z antagonistą GnRH vs. długi protokół z agonistą GnRH u pacjentek z zespołem policystycznych jajników przygotowywanych do IVF: porównanie wyników klinicznych i jakości zarodków

Objectives: Polycystic ovary syndrome (PCOS) is a common endocrine disorder, primarily affecting women of the reproductive age. The aim of the study was to assess the clinical efficacy and embryo quality in flexible gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison to the long GnRH agonist protocol in PCOS women undergoing in vitro fertilization (IVF). Material and methods: This prospective, randomized study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Niš, Serbia, between 2013 and 2014. The treatment included either a flexible GnRH antagonist protocol (n = 45, antagonist group) or a long GnRH agonist protocol (n = 45, agonist group). Results: The length of the stimulation, total amount of gonadotropins used, as well as the average number of the aspirated and mature oocytes were higher in the agonists group. The endometrial thickness was also greater in the agonists group. A higher number of Class I and Class IV embryos were obtained after the agonist treatment and higher number of Class II and Class III embryos were obtained after the antagonist treatment. Pregnancy, implantation, and miscarriage rates were comparable between the groups. Conclusions: The GnRH antagonist protocol in PCOS patients has a pregnancy rate comparable to that of the GnRH agonist protocol. Since this protocol has a lower rate of complications and is more convenient for patients, we believe that the GnRH antagonist protocol should be used as the first-line treatment for PCOS patients in an IVF program.Cel pracy: Zespół policystycznych jajników (PCOS) jest częstym zaburzeniem endokrynologicznym, głównie dotyczącym kobiet w wieku reprodukcyjnym. Celem badania była ocena skuteczności klinicznej oraz jakości zarodków uzyskanych w protokole flexible z antagonistą GnRH w porównaniu do protokołu długiego z agonistą GnRH u kobiet z zespołem PCO poddanych zapłodnieniu pozaustrojowemu (IVF). Materiał i metoda: To prospektywne, randomizowane badanie przeprowadzono w Klinice Ginekologii i Położnictwa w Clinical Center Niš, w Serbii, w latach 2013–2014. Leczenie polegało na zastosowaniu protokołu flexible z antagonistą GnRH (n = 45) lub długiego protokołu z agonistą GnRH (n = 45). Wyniki: Długość stymulacji, całkowita liczba użytych gonadotropin, jak również średnia liczba zaaspirowanych i dojrzałych oocytów była wyższa w grupie z agonistą. Grubość endometrium była również wyższa w grupie z agonistą. Wyższą ilość zarodków klasy I i IV uzyskano po podaniu agonisty natomiast a po leczeniu antagonistą uzyskano wyższą ilość zarodków klasy II i III. Liczba uzyskanych ciąż, implantacji i poronień była porównywalna w obu grupach. Wnioski: Protokół z antagonistą GnRH u pacjentek z PCOS ma porównywalny odsetek ciąż jak protokół z agonistą GnRH. Ponieważ protokół z antagonistą GnRH ma mniejszą liczbę powikłań i jest wygodniejszy dla pacjentek, uważamy że powinien być stosowany jako leczenie pierwszego rzutu pacjentek z PCOS w programie zapłodnienia pozaustrojowego

ASSOCIATION BETWEEN HYPERPROLACTINAEMIA AND OTHER CAUSES OF FEMALE INFERTILITY

Hyperprolactinaemia is one of the major causes of reproductive axis disorders. Adequate treatment for hyperprolactinaemia is very successful in restoring ovulation, but there is still a proportion of patients unable to achieve pregnancy despite adequate control of hyperprolactinaemia. This prospective clinical trial included 104 hyperprolactinaemic patients in reproductive age: 78/104 (75%) suffered from infertility and the other 26 hyperprolactinaemic patients were still unmarried and not interested in pregnancy. Hyperpolactinaemia as the only reason for anovulation and infertility was diagnosed in 43/78 (55.12%) of our patients. In 35/78 (44.88%) patients, hyperprolactinaemia was associated with other causes of infertility: endometriosis, premature ovarian failure, PCO and insulin resistance, etc. After the appropriate treatment, mostly with bromocriptine (in 69/78 – 88.46%, alone or in combination with induction of ovulation), 35/78 (44.87%) patients achieved pregnancy. In the group of infertile patients with hyperolactinaemia as the only cause of infertility, 33/43 (76.74%) patients became pregnant, and in the group of patients who had combination of hyperprolactinaemia and other causes of infertility only 2/35 (5.71%) achieved pregnancy. The treatment of hyperprolactinaemia is obligatory in all patients with infertility. If adequate suppression of serum prolactin levels is achieved, but the pregnancy is still missing despite the fact that ovulatory cycles are established, the other causes of infertility should be searched for, and the clinician should not reject the possible existence of some unknown cause of infertility, so the patient should be referred to ART procedures which give more chances in such circumstances.Key words: Hyperprolactinaemia, infertility, bromocriptine, assisted reproductive technique

HYSTEROSCOPY BEFORE IN VITRO FERTILIZATION

In the last decade, success after in vitro fertilization process (IVF) has remained at a similar rate despite all the improvements implemented in the stimulation protocols and laboratory techniques. Hysteroscopy is a method becoming more widely used with patients after a failed IVF cycle, considering a large incidence of uterus cavum pathological states which have a negative impact on the favorable outcome. Numerous studies have provided different results on the IVF outcome with hysteroscopy performed prior to this treatment in cases with no uterus cavum pathology. The aim of the research was to examine the effect of both diagnostic and surgical hysteroscopy on the outcome of IVF.  Hysteroscopy was performed with 74 patients 30 to 50 days prior to IVF and in 33 of them (group I) some pathological state was noticed, which was treated during the same procedure. The control group (group III) included 151 patients who had IVF performed with no prior hysteroscopy. There is no statistically significant difference in the rate of post hysteroscopy implantation between I and II group when compared to the control group (20.62% vs 23.28% vs 17.31%), nor in the rate of clinical pregnancies (45.45% vs 46.34% vs 34.44%). Following the correctional treatment of uterus cavum pathological states, implantation and pregnancy rates remain at a level comparable to hysteroscopically normal medical findings. Statistically significant higher pregnancy rate is present in group I after the first IVF cycle, compared to the next IVF in the same group and in comparison to the next IVF cycle in the control group (60.00% vs 27.91%, p<0.05). Hysteroscopy is a simple and safe method allowing nearly identical rate of clinical pregnancies after a surgical treatment of uterus cavum pathological states when compared to the control group, but statistically much higher pregnancy rate if the order of IVF procedure is being compared. In cases of normal ultrasound findings and negative hysteroscopical findings, performing hysteroscopy prior to IVF does not provide significantly better results. Therefore, its routine execution is not recommended

Uticaj protokola stimulacije kod policističnog ovarijalnog sindroma na ishod vantelesnog oplođenja

Polycystic ovarian syndrome (PCOS) is considered one of the most common endocrine disorders of women of reproductive age. It is characterized by chronic anovulation, signs of hyperandrogenism, polycystic appearance of ovaries and subfertility or sterility. Although polycystic ovaries are a common finding in infertile women, the exact incidence of these patients included in the in vitro fertilization program is not known. The aim of this study was to assess the effect of PCOS on the course and the outcome of in vitro fertilization; compare the characteristics of ovarian response and compare the clinical pregnancy and miscarriage rates in women with PCOS to those in women with tubal factor sterility; examine which ovarian stimulation protocol in patients with PCOS has a higher success rate and a lower risk of the occurrence of Ovarian Hyperstimulation Syndrome (OHSS); examine the effect of age, body mass index, levels of Anti-Mullerian hormone and the use of metformin on in vitro fertilization (IVF) outcomes in patients with PCOS. The research was conducted as a prospective comparative study. The study included 123 patients with PCOS and 94 patients participating IVF program due to tubal sterility. The patients were treated by a long GnRH agonist protocol, a short GnRH agonist protocol or a flexible GnRH antagonist protocol. The patients with PCOS have a higher number of the oocytes retrieved and a lower fertilization rate. Clinical pregnancy and miscarriage rates did not differ significantly between the two groups, while OHSS was present only in the group of patients with PCOS. The length of stimulation of patients with PCOS was shorter in the antagonist group, whereas the total number of aspirated oocytes was statistically significantly higher in the agonist group. Significantly higher number of the obtained embryos as well as a higher number of best quality embryos in the agonist group did not affect the clinical pregnancy rate. We have concluded that patients with PCOS achieve clinical pregnancy rates similar to those of women with tubal factor infertility. The antagonist protocol has clinical pregnancy rate comparable to that of the agonist protocol. Although there is no statistically significant difference in the incidence of OHSS, a less frequent occurrence of this serious complication has been noticed in the antagonist protocol

Uticaj protokola stimulacije kod policističnog ovarijalnog sindroma na ishod vantelesnog oplođenja

Polycystic ovarian syndrome (PCOS) is considered one of the most common endocrine disorders of women of reproductive age. It is characterized by chronic anovulation, signs of hyperandrogenism, polycystic appearance of ovaries and subfertility or sterility. Although polycystic ovaries are a common finding in infertile women, the exact incidence of these patients included in the in vitro fertilization program is not known. The aim of this study was to assess the effect of PCOS on the course and the outcome of in vitro fertilization; compare the characteristics of ovarian response and compare the clinical pregnancy and miscarriage rates in women with PCOS to those in women with tubal factor sterility; examine which ovarian stimulation protocol in patients with PCOS has a higher success rate and a lower risk of the occurrence of Ovarian Hyperstimulation Syndrome (OHSS); examine the effect of age, body mass index, levels of Anti-Mullerian hormone and the use of metformin on in vitro fertilization (IVF) outcomes in patients with PCOS. The research was conducted as a prospective comparative study. The study included 123 patients with PCOS and 94 patients participating IVF program due to tubal sterility. The patients were treated by a long GnRH agonist protocol, a short GnRH agonist protocol or a flexible GnRH antagonist protocol. The patients with PCOS have a higher number of the oocytes retrieved and a lower fertilization rate. Clinical pregnancy and miscarriage rates did not differ significantly between the two groups, while OHSS was present only in the group of patients with PCOS. The length of stimulation of patients with PCOS was shorter in the antagonist group, whereas the total number of aspirated oocytes was statistically significantly higher in the agonist group. Significantly higher number of the obtained embryos as well as a higher number of best quality embryos in the agonist group did not affect the clinical pregnancy rate. We have concluded that patients with PCOS achieve clinical pregnancy rates similar to those of women with tubal factor infertility. The antagonist protocol has clinical pregnancy rate comparable to that of the agonist protocol. Although there is no statistically significant difference in the incidence of OHSS, a less frequent occurrence of this serious complication has been noticed in the antagonist protocol

Dysgerminoma and pregnancy

Introduction. Dysgerminomas are germ cell ovarian tumors. They affect young females, prevalently during childhood. The problem arises when dysgerminoma is diagnosed in women of reproductive age who have never given birth and require a surgical procedure. Case outline. A 28-year-old patient was admitted to hospital in week 26 of her first pregnancy. The reason for patient hospitalization was the growth of the isthmic myoma diagnosed by her obstetriciangynecologist in the primary care unit. By examining the medical history of the patient, the following was revealed: A year and a half before pregnancy she was diagnosed with left ovary dysgerminoma. The patient’s medical history led us to conclude that uterine myoma was a misdiagnosis and that the actual diagnosis was dysgerminoma of the right ovary. The surgery was performed after the fetal viability had been achieved. Conclusion. Malignant ovarian tumours may occur in young women during pregnancy and increase in size significantly in a short period of time, although their recurrence is not expected in such a short period of time after surgical treatment. This poses a great challenge for obstetricians

HUMAN OCULAR DIROFILARIOSIS: CLINICAL AND EPIDEMIOLOGICAL FEATURES

Dirofilarioses are zoonoses caused by filaria of the genus Dirofilaria, the parasites of domestic and wild animals. People are just random carriers of this parasite. In Europe, human dirofilariosis is caused by two species: Dirofilaria repens ( D. repens, also known as a species of The Old World ), usually with the superficial localization of infection, and D. immitis, which is present throughout the world, and causes, beside superficial, visceral dirofilariosis. So far, based on the data from reference literature, it can be observed that in Serbia about 34 cases of human dirofilariosis have been diagnosed and published. It is assumed that the prevalence of this parasitosis is significantly higher as our country is an endemic area for dirofilariosis in dogs and the region where species of mosquitoes, which are transitory hosts and vectors of Dirofilaria spp., are present. The clinical picture of dirofilariosis depends on the type and location of the parasite in the human body. In our country, patients diagnosed with dirofilariosis had subcutaneous or subconjunctival infection in the majority of cases. Ocular dirofilariosis may affect the orbit and the periorbital region, the skin of the eyelids, the conjunctiva, the Tenon membrane, a retrobulbar space or has an intrabulbar localization. These patients may have a severe disability, and surgery alone can be complicated due to localization. The aim of this review is to highlight the importance of this unexpected important zoonoses, with special emphasis on the importance within the ophthalmic practice

Atypical presentation of posterior reversible encephalopathy syndrome: Clinical and radiological characteristics in eclamptic patients

Posterior reversible encephalopathy syndrome (PRES) is an obstetric emergency frequently occurring in a pregnant or puerperal woman, manifested with an acute headache, consciousness impairment, seizures, and visual deficits and is associated with white matter changes predominantly affecting the posterior parietal and occipital lobes of the brain. Apart from the above-described typical location of the changes, the most common atypical location involves the brain stem and basal ganglia. Since magnetic resonance imaging (MRI) is more sensitive and specific imaging technique compared to computerized tomography, establishing the diagnosis and follow-up in patients with PRES is based mainly on MRI findings. It is particularly important not to exclude PRES as a possible diagnosis when we have the appropriate clinical presentation accompanied by the atypical radiological findings, since this clinical-radiological syndrome can often be manifested with an atypical MRI image