Differences in Incidence and Risk Factors of Infertility Between Couples Who Desire a First and Second Child: A Prospective Cohort Study

Background: With the implementation of the two-child policy in China, more couples expressed their desire to have a child. We conducted this study to evaluate the incidence and risk factors of infertility in couples intending to have a first child and second child.Methods: Couples who presented to the pre-pregnancy clinical centers were enrolled from 2013 to 2017. Participants were categorized into “first child intention” and “second child intention” groups based on the number of children they already had. Couples were followed up every three months until pregnancy or 12 months. Data regarding the sociodemographic characteristics, history of reproduction and gynecology, history of male disease, and laboratory and imaging examination results were collected. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors.Results: The overall infertility incidence was 16.95% (369/2177). The infertility incidence of “first child intention” and “second child intention” was 19.30% (355/1839) and 4.14% (14/338). The study showed great differences in infertility risk factors between two groups. Risk factors for “first child intention” infertility included advanced age (>35 years), abnormal body mass index (BMI), longer menstrual durations, endometrial polyps, polycystic ovarian syndrome (PCOS), salpingostomy, and history of mycoplasma. However, in “second child intention” group, clinical risk factor was slightly different, such as leiomyoma, higher age (>40 years).Conclusion: The incidence and risk factors of infertility are significantly different between “first child intention” group and “second child intention” group. Early and targeted intervention for couples in different groups at high risk can help reduce infertility and social burden.

Imaging and diagnostic accuracy of outpatient and inpatient hysteroscopy

Aim. To compare the results of visualisation and diagnostic accuracy during outpatient and inpatient hysteroscopy in women with endometrial disease.Materials and Methods. We performed a retrospective analysis of patients with uterine diseases who underwent outpatient hysteroscopy at Kemerovo City Clinical Hospital №4 (n = 300) or inpatient hysteroscopy within the hospitals (n = 300) in Kemerovo from 2018 to 2020. Confirmation of endometrial disease was carried out by manual vacuum aspiration.Results. Indications, imaging, and diagnostic accuracy did not differ for most endometrial diseases in outpatient and inpatient hysteroscopy, yet inpatient hysteroscopy was the option of choice in women with infertility (p = 0.035). Diagnostic accuracy of outpatient and inpatient hysteroscopy was highly concordant, albeit outpatient hysteroscopy more often revealed adenomyosis and uterine malformation and less often identified endometrial polyps.Conclusion. Outpatient and inpatient hysteroscopy are equally efficient, although outpatient hysteroscopy has its benefits in detecting adenomyosis and uterine malformation and be less informative in diagnosing endometrial polyps.

How Can We Treat Endometrial Polyp Without Using Curettage?

Introduction: Endometrial polyps are considered begin tumours that protrude inside the uterine cavity. It affects women in reproductive or in menopausal age. It can regress spontaneously or if symptomatic, it can be treated efficiently by hysteroscopy excision. Purpose: to demonstrate that endometrium polyps can be treated without using curettage but only using homeopathic medication without needing to do any invasive procedure. Methods: through two case report (47 and 57 years-old women respectively, with endometrium polyps diagnosed by routine ultrasound). Both patients were programed to do hysteroscopy. They were doing acupuncture (for treatment of low back pain and pain in the shoulder respectively) using needles and mustard seeds. I decided to prescribe for both patients a homeopathy medication called Medorrhinum to treat their miasma. In both cases, they intake the medication first with 30CHXX-20 ml. After one month, the patients need to have the second round of this medication, now with 200CHXX-20 ml. After one month from the first medication, it was possible to intake the third medication, now in 1000CHXX-20 ml. Results: the endometrial polyps disappeared completely after the intake of these medications in both patients without needing to use hysteroscopy exam. Conclusion: the use of homeopathy medication called Medorrinun was very important to recover from the endometrium polyp without the necessity in using hysteroscopy exam and do the curettage.

Association between Endometrial Polyps and Chronic Endometritis: Is It Time for a Paradigm Shift in the Pathophysiology of Endometrial Polyps in Pre-Menopausal Women? Results of a Systematic Review and Meta-Analysis

Background: Chronic endometritis (CE) and endometrial polyps (EPs) are common conditions in reproductive age women. CE is an infectious disorder of the endometrium characterized by signs of chronic inflammation at hysteroscopic and histological analyses. EPs are abnormal endometrial growths containing glands, stroma and blood vessels projecting from the lining of the uterus. During the last years, different authors have investigated the correlation between CE and EPs, with controversial results. The aim of this study was to summarize available evidence on the potential correlation between CE and EPs. Design: Systematic literature review and meta-analysis. Methods: Observational-studies were identified by searching electronic databases from their inception to September 2021. Only studies on pre-menopausal women were included. Statistical analysis was performed using MedCalc 16.4.3 (Ostend, Belgium) and Review Manager version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration). The summary measures were reported as pooled proportion or odds ratio (OR) with 95% confidence interval (CI). The primary outcome was to evaluate the prevalence of CE in women with EPs. The secondary outcome was to determine the prevalence of CD-138-positive EPs among EPs. Tertiary outcomes were to compare the prevalence of CE in women with EPs versus women with a non-polypoid endometrium and to compare the prevalence of CE in women with a single EP versus women with multiple EPs. Results: Eight observational studies (n = 3225 patients) were included in quantitative synthesis. Pooled prevalence of CE among women with EPs was 51.35% (95% CI, 27.24–75.13%). Pooled proportion of CD-138-positive EPs among EPs was 70.73% (95% CI, 55.73–83.68%). Women with EPs showed higher prevalence of CE compared to women without EPs (OR 3.07, 95% CI 1.59–5.95). Women with ≥3 EPs had higher prevalence of CE then women with a single EP (OR 3.43, 95% CI 1.83–6.46). Conclusions: In pre-menopausal women, CE and EPs may have a dependent relationship and may represent two consequent steps of a common pathological process.

Clinical application of three-dimensional transvaginal ultrasonography in the diagnosis of intrauterine adhesions

Objective The present study aimed to evaluate the diagnostic accuracy of three-dimensional transvaginal ultrasonography (3D-TVS) for intrauterine adhesions (IUA). Methods We performed a retrospective cohort study. A total of 500 women aged 19 to 46 years with uterine lesions who received treatment from the Department of Obstetrics and Gynecology were enrolled. Endometrial 3D imaging was conducted to obtain the display plane and 3D-TVS parameters. Patients also underwent hysteroscopy for a definitive diagnosis. Results For diagnosing IUA, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of 3D-TVS were 98.8%, 90.8%, 91.4%, 98.7%, and 94.8%, respectively. For diagnosing a submucosal myoma, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 88.2%, 97.9%, 88.2%, 97.9%, and 96.4%, respectively. For diagnosing endometrial polyps, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 94.7%, 96.8%, 92.9%, 97.7%, and 96.2%, respectively. Conclusions Before hysteroscopy, 3D-TVS, as a method of screening, has great value for comparing differences before and after treatment, and for evaluating therapeutic effects.

LEIOMYOMA TYPES, INCIDENCE AND CLINICAL PRESENTATION - A STUDY AT A TERTIARY CARE HOSPITAL

A cross sectional studywas conducted over a period of 15 months from 1st Jan 2020 to 31st March 2021 at Malla Reddy Hospital,a tertiary care hospital. To study the incidence of fibroids according to FIGO categorization and their clinical presentation. 38 confirmed cases of fibroid uterus in the age group 20 – 60 attending gynecology OPD were interviewed and subjected to regular gynecological examination, PAP smear, dilatation and curettage procedures. Based on the studies, 60% of these patients were subjected to total abdominal hysterectomy as a part of treatment and the intra operative findings of the specimens were noted. The leiomyomas were classified according to the histopathological and ultrasonographic findings based on FIGO categorization. Highest incidence was seen 41 to 45 years age (52.6%). Incidence of Leiomyoma types according to FIGO subclassification system were found to be Type0=5%, Type1=5%, Type2=5%, Type3=13%, Type4=30%, Type5=13%, Type6=18.6%, Type7=3.3% and Type8=5%. Multiple fibroids were more common than single fibroids. Posterior location fibroids were more common than anterior. Most common symptom was menorrhagia (73.6%) followed by spasmodic dysmenorrhea (47.3%) and metrorrhagia (26.3%), infertility and symptoms of anemia. Most common sign was pallor (58%) followed by mass per abdomen (18.4%). Incidence of associated pathology of adenomyosis (18%) ovarian cysts (8%), endometrial polyps (8%), myxoid degeneration (2.6%). The results of our study matched the existing studies.

OPTIMIZATION WAYS OF THERAPEUTIC MEASURES IN WOMEN WITH ENDOMETRIAL POLYPS AND INFERTILITY

Іntroduction. Currently, endometrial polyps (EMP)are the most common pathology of the uterine mucosa,detected in miscarriage and infertility. However, thequestion of the relationship between the mechanisms thatregulate proliferation processes and the morphofunctionaland microbiological features of the endometrium, whichare often confirmed by changes in immunohistochemicalparameters and may be important in treatment, remainsopen.The aim is to optimize the results of treatment inpatients with EMP and infertility by using antioxidantsin combination with immunomodulatory therapy andnonsteroidal anti-inflammatory drugs.Materials and methods. We examined 30 healthywomen who hadn’t had any gynecological diseases,abortions or intrauterine interventions in history and hadnot used intrauterine contraception (the control group), and60 women with EMP and infertility (the main group) byusing clinical, microbiological, bacteriological, ultrasound,hysteroscopic pathohistological and laboratory methods,statistical analysis.Results. In order to assess the effectiveness of theproposed treatment, the main group was divided into twosubgroups: the first one included 30 patients who have beenreceiving the proposed treatment and prevention algorithmand the second one with 30 patients receiving traditionaltreatment.After targeted polypectomy with the basal layer of theendometrium at the site of EMP had been provided, thepatients of the first subgroup were prescribed to take 100mg of doxycycline orally twice a day for 2 weeks and 100mg of vitamin E per day for 4 weeks in combination withimmunomodulatory therapy - cycloferon 12.5% 2.0 mlintramuscularly №10 every other day and anti-inflammatorytherapy with the appointment of rectal suppositoriescontaining non-steroidal anti-inflammatory components - 1suppository per night for 10 days.The patients of the second subgroup were prescribedtraditional antibiotic prophylaxis after hysteroscopy: 100mg of doxycycline orally twice a day for 5 days. Also, thepatients of the main group have been receiving 10 mg ofduphaston twice a day from the 11th to the 25th day of MC.The species composition of the vaginal microflora inwomen with EMP is represented mainly by anaerobic flora.Every second patient with EMP (46%; р І-ІІІ = 0,007) in theabsence of clinical symptoms, and along with a moderateor reduced number of lactobacilli, was diagnosed withopportunistic bacteria, uremicoplasma or Candida fungus.Pregnancies occurred in 9 (47%) of the 19 patients in thefirst natural menstrual cycle after polypectomy and proposedtreatment. Six (31%) women became pregnant during thefirst three menstrual cycles. The remaining patients havebeen observed during six months and were recommendedin vitro fertilization due to long-term infertility. Women ofthe main group who did not plan to get pregnant had norecurrence of EMP for two years. 19 (63.3%) patients ofthe second subgroup faced the recurrence of EMP duringtwo years of follow-up. 11 (30.5%) pregnant womengave physiological childbirth; the labor of 3 patients wascomplicated by hypotonic bleeding in the early postpartumperiod; 3 (11.1%) women are currently pregnant. In patientsof the second subgroup, pregnancy occurred in 5 (16.6%)cases only.Conclusions. The use of the developed method of EMPand infertility treatment allows to restore reproductivefunction in more than half of women. Thus, theimplementation of the method of EMP treatment indicatesits positive effect. In addition, it helps to achieve lastingremission and solves the medical and social problems ofwomen's health and motherhood.