Serbian gynecologists' and pharmacists' beliefs about emergency contraception.

Emergency contraception (EC) in Serbia is available in two products: Levonorgestel, which has nonprescription status, and Ulipristal acetate, which is a prescription-only medicine. Considering their dispensing statuses, gynecologists and pharmacists are health care professionals (HCPs) with the widest impact on EC use. Yet little is known about their beliefs and practices regarding these medicines. We surveyed 166 gynecologists (during October 2012-October 2013) and 452 community pharmacists (during January-April 2014). Results showed significant differences between these two groups, suggesting that provision of EC to users may be inconsistent. Gynecologists were more convinced than pharmacists that EC would reduce the abortion rate (86% versus 53%, p < .001). However, they were more concerned than pharmacists that easy access to EC would cause less regular contraceptive use (66% versus 29%, p < .001) and risky sexual behaviors, including initiating sexual activity at a younger age (37% versus 19%, p < .001) and having more sexual partners (33% versus 12%, p < .001). Additionally, more pharmacists than gynecologists (12% versus 2%, p < .001) said they would not provide EC to anyone under any circumstance, even to victims of sexual assault. These results indicated a need for reevaluating and establishing official guidelines for dispensing practices.

Serbian gynaecologists' views on contraception and abortion.

OBJECTIVES: To examine Serbian gynaecologists' attitudes and practices related to contraception and abortion, as the principal alternative to contraception. METHODS: A self-reported questionnaire was administered to a convenience sample of gynaecologists attending educational meetings of a medical society from October 2012 to October 2013. The data gathered were assessed by means of univariate and multivariate analyses. RESULTS: Almost half of the respondents had ethical objections and would refuse to provide certain contraceptives to patients. Two thirds of the gynaecologists (63%) considered fertility awareness methods to be a poor option for most women. Twenty-three percent objected to abortion. Those who objected to contraceptives were less likely to object to abortions (OR: 0.422). This attitude was more prevalent in Southern and Eastern Serbia, where gynaecologists were more likely to object (OR: 4.892) and to refuse to prescribe contraceptives (OR: 4.161), but less likely to object to abortion (OR: 0.278) than in other regions. CONCLUSIONS: A large proportion of Serbian gynaecologists objected to some contraceptive methods and were more in favour of abortions, especially in the least developed regions.

Androgen-Secreting Ovarian Tumors.

About 1% of ovarian tumors that comprise testicular cell types can cause hyperandrogenism followed by characteristic virilization. Androgenic group of tumors originated mainly from sex-cord stromal ovarian tumors are including steroid cell tumors, Leydig tumors, granulosa cell tumors, Sertoli cell tumors, Sertoli-Leydig cell tumors, gonadoblastomas, and some other rare forms as ovarian metastases from neuroendocrine tumors. Germline or somatic mutations in some genes like DICER1, STK11, and FOXL2 are associated with the development of some sex cord-stromal ovarian tumors. Basal serum testosterone concentrations above 7 nmol/L could indicate an androgen-secreting tumor. Other ovarian and adrenal androgens should be determined and functional endocrine testing including low-dose dexamethasone suppression test, gonadotrophin-releasing hormone (GnRH) agonist test, imaging methods, and selective venous sampling should be performed. Surgery is the first-line treatment for most of the tumors. Women who are not good surgical candidates could benefit from use of GnRH agonist to control hyperandrogenism. In some cases, chemotherapy and/or radiation therapy is required while some tumors respond on antiangiogenic agents used alone or in combination with chemotherapy. Metabolic implications and long-term outcomes of ovarian androgen-secreting tumors are unknown and require more detailed follow-up in multicentric and longitudinal clinical studies.

Changes in serum antimüllerian hormone levels in patients 6 and 12 months after endometrioma stripping surgery.

OBJECTIVE: To investigate the impact of laparoscopic endometrioma cystectomy on the ovarian reserve and to identify the most important factors that predict the ovarian reserve in patients with endometriomas. DESIGN: Prospective study. SETTINGS: Endoscopy unit of a general hospital. PATIENT(S): Fifty-four patients with unilateral (n = 37) and bilateral endometriomas (n = 17). INTERVENTIONS(S): The serum antimüllerian hormone (AMH) concentration was assessed before surgery and at 6 and 12 months after surgery. MAIN OUTCOME MEASURE(S): The primary outcome was the damage to the ovarian reserve, as assessed by the serum AMH concentration. Secondary end points were the persistence or recovery of ovarian damage after 1 year. RESULT(S): AMH concentrations decreased after the laparoscopic excision of cystic ovarian endometriomas. Before surgery and at 6 and 12 months after surgery, the concentrations were, respectively 3.07, 1.29, and 1.46 ng/mL. In the unilateral group, the median AMH levels were 3.31, 1.43, and 1.72 ng/mL, and in the bilateral group the levels were 2.55, 0.98, and 0.89 ng/mL. The serum AMH concentrations thus decreased by 53.27 ± 38.2% and 49.43 ± 38.3% at 6 and 12 months after cystectomy, respectively. CONCLUSION(S): In patients with endometriomas, the decrease in ovarian reserve occurs immediately after the excision of the endometrioma. Significant predictors of AMH values at 6 and 12 months after surgery include the baseline AMH level, patient age, and bilateral endometriomas.

Influence of sperm impact angle on successful fertilization through mZP oscillatory spherical net model.

According to the available literature, penetrating sperm creates an oblique path trough Zona pellucida (ZP)--the most outer surface of oocytes. Considering fertilization process as an oscillatory phenomenon, the influence of sperm impact angle relative to the oscillatory behavior of mouse ZP is described by using the discrete continuum mechanical model in the form of a spherical net model. A parametric frequency analysis of oscillatory behavior of knot material particles in the mouse ZP (mZP) spherical net model is conducted by using generalized Lussajous curves. The influence of impact angles of sperm cells on the corresponding knot mass particles' resultant trajectory is discussed. Favorable sperm impact angles for successful fertilization are identified.