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. / Motywacje autoteliczna vs instrumentalna lekarzy a wybór specjalizacji medycznej na tle poczucia koherencji.

OBJECTIVES: 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. METHODS: 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.

Assessment of ovarian reserve in patients with ovarian endometriosis following laparoscopic enucleation of a cyst accompanied by CO2 laser ablation or electroablation.

INTRODUCTION: Endometriosis affects about 5-15% of women in the reproductive period. One of the most important complications of pelvic endometriosis is infertility. OBJECTIVE: The assessment of ovarian endometriosis therapy with the use of combined laparoscopic techniques (cyst enucleation with electroablation/CO2 laser ablation) and their influence on the preservation of the ovarian reserve. MATERIALS AND METHOD: Fifty-eight patients aged 19-40 with diagnosed ovarian endometriosis underwent pre-surgical assessment of their ovarian reserve consisting of antral follicle count (AFC), basal ovarian volume (BOV) and FSH level. Twenty-four patients underwent laparoscopic enucleation of the cyst with CO2 laser ablation and thirty-four patients had enucleation with successive electroablation. The ovarian reserve of the patients was reassessed during follow-up assessments three and six months after surgery. RESULTS: In neither group was there a statistically significant decrease of AFC after three or six months. Additionally, in the group that underwent enucleation with electroablation, a significant drop in FSH level was observed after three months. This group was characterized by a statistically significant decrease in BOV at the three- and six-month follow-up assessments. 17% patients had ovarian relapses visible in the ultrasound scan at the six month follow-up assessment. In the group of patients who underwent enucleation with CO2 laser ablation, BOV had not changed significantly, while a high rate of ovarian relapses (39%) was observed. CONCLUSIONS: The lack of significant changes in AFC level after the surgeries suggests an initial positive evaluation of both techniques in the context of ovarian reserve preservation. The detrimental BOV decrease after enucleation with electroablation and high relapse rate after enucleation after CO2 laser ablation shows that further research is needed in order to optimize the laparoscopic techniques of endometriosis therapy.

[Cesarean scar pregnancy]. / Ciaza w bliznie po cieciu 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.

[Prevalence of HPV DNA among male sexual partners of women diagnosed with CIN and early invasive cervical cancer]. / Wystepowanie HPV DNA u partnerów seksualnych kobiet ze sródnablonkowa neoplazja szyjki macicy--CIN i wczesnoinwazyjnym rakiem szyjki macicy.

Human Papilloma Virus (HPV) infection is the most common sexually transmitted disease. Chronic HPV infection is indispensable for development of cervical intraepithelial neoplasia and cervical cancer. First data stating that HPV transmission among heterosexual partners is very common appeared in last years. The aim of this study was to estimate the HPV infection prevalence among male sexual partners of women diagnosed with subclinical HPV infection, cervical intraepithelial neoplasia and early invasive cervical cancer. The study was conducted among 289 women aged 25-60 diagnosed with CIN and cervical cancer stage IA; control group consisted of 44 women aged 28-56 HPV testing using the material from retroglandular sulcus was conducted among male sexual partners of women from the study group. Testing was performed with HC2 method. In the study group, HPV infection was stated in 218 (75.43%) women and in 6 (13.63%) in control group. HPV DNA was present in 148 (51.21%) men--sexual partners of women from the study group and only 1 (2.27%) from control group. Additionally, HPV types of high and low oncogenic potential were analyzed with regard to histological diagnosis (SPI, CIN, early invasive cervical cancer). As the analysis shows, HPV infection of male sexual partners of women diagnosed with SPI and CIN is relatively high (9.09-93.33%).

Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO2 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 CO2 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 CO2 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.

[The assessment of the dependence between antigen CA 125 and nicotinism in patients with benign ovarian tumors including endometrial cysts]. / Ocena zaleznosci poziomu antygenu Ca 125 od nikotynizmu u pacjentek z lagodnymi guzami jajników, w tym z torbielami endometrialnymi.

UNLABELLED: Cancer antigen CA-125 is a marker that is primarily used to differentiate benign from malignant tumors as well as to monitor response to ovarian cancer treatment. Taken as a separate marker, it displays low sensitivity and specificity in ovarian cancer diagnosis; however, in combination with other markers it may be successfully applied especially in postmenopausal women. Elevated CA-125 levels in blood serum indicate cancerous as well as non-cancerous diseases. Research aiming to determine environmental factors that may have influence on antigen CA-125 level, and thus on the assessment of this marker's application in gynecological and oncological diseases continues. OBJECTIVES: the aim of the present research is an attempt to estimate the influence of nicotinism on antigen CA-125 in blood serum in patients with diagnosed benign ovarian tumors including endometrial cysts. MATERIAL AND METHODS: 174 women aged 16-85 years with diagnosed benign ovarian tumor were qualified for the study. In all patients level of antigen CA-125 in blood serum was assessed preoperatively and nicotinism history was taken. Also transvaginal ultrasound was performed to obtain preliminary diagnosis. Smoking and non-smoking patients were classified into two groups, namely of those with histopathologically confirmed cysts of endometrial type and those with non-endometrial benign ovarian tumors. RESULTS: statistical analysis did not prove any dependence between the CS-125 antigen level and nicotinism in any of these groups. Also additional analysis with division into premenopausal and postmenopausal patients did not determine any statistically significant dependence. CONCLUSION: Nicotinism does not significantly influence the CA-125 antigen level in patients with benign However, the connection between the addiction severity and its influence on antigen CA-125 in blood serum cannot be excluded. ovarian tumors or endometrial cysts.

[The early abdominal pregnancy--case report]. / Wczesna ciaza ektopowa brzuszna--opis przypadku.

The abdominal ectopic pregnancies are 1-1.4% of all ectopic pregnancies. In this article we presents the case of 27-year-old patient in early abdominal pregnancy, situated in parietal peritoneum. This case justifies the need to take into account possibility of abdominal pregnancy in case of suspicion of ectopic pregnancy.

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.

The influence of surgery of cervical intraepithelial neoplasia (CIN) and cervical carcinoma on quality of life.

UNLABELLED: The aim of the study was to determine to what extent cervical intraepithelial neoplasia and cervical cancer surgery affect a woman's mental state and how does it affect her interpersonal relationships, sexual activity, family life, and her professional and social activity. The clinical material consisted of 153 women aged 20 and 47, who were diagnosed and treated by the Chair of Gynaecology and Obstetrics, Jagiellonian University Medical College in Kraków between 2006 and 2010, and were confirmed to have CIN3 and cervical carcinoma stage IA. An oryginally constructed survey form consisting of 108 questions and divided into 5 research stages was implemented. H.J. Eysenck's Personality Questionnaire, and Physical and Mental State Questionnaire KS-40. RESULTS: The diagnosis generated a change in the patients' self-images: prior to the diagnosis, 74.6% considered themselves to be completely healthy, whereas after the diagnosis was given 40.5% of respondents had the feeling of illness, and 33.3% of the moderately illness. CONCLUSIONS: The diagnosis of CIN and microinvasive cervical cancer, and surgical procedure, invokes a feeling of being unwell in a woman who previously felt completely healthy, and significantly impedes quality of life. The diagnostic-therapeutic management induces general anxiety, worry about preservation of the generative organ, sexual intercourse, fertility, changes in the dynamics of the family and in the professional field, as well as changes in interpersonal relationships.