Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse.

Structured psychiatric and sexual abuse interviews were administered to 25 women with chronic pelvic pain and a comparison group of 30 women with specific gynecological conditions. All 55 patients underwent diagnostic laparoscopy, and the results of the fiberoptic pelvic examination were objectively classified by the study gynecologist, who was blind to the psychiatric diagnoses. The patients with chronic pelvic pain showed a significantly higher prevalence of major depression, substance abuse, adult sexual dysfunction, somatization, and history of childhood and adult sexual abuse than the comparison group. There were no significant differences between the groups in severity or type of pelvic pathology.

A comparison of esterified estrogens with and without methyltestosterone: effects on endometrial histology and serum lipoproteins in postmenopausal women.

OBJECTIVE: To compare the efficacy and safety of esterified estrogens with and without methyltestosterone. METHODS: Twenty-six women participated in a double-blind randomized trial for 6 months. Outcome measures included serum total and lipoprotein-bound cholesterol, vasomotor symptoms, vaginal cytology and endometrial histology, and chemistry values. Analysis of variance and t test statistics were used to assess differences. RESULTS: After 6 months of therapy, the treatment groups were comparable with regard to symptom scores, vaginal cytology and endometrial histology scores, and clinical laboratory test values. Treatment with esterified estrogens plus methyltestosterone significantly decreased total cholesterol, high-density lipoprotein cholesterol (HDL), HDL2, HDL3, and apolipoprotein A1 compared to esterified estrogens alone. CONCLUSIONS: Esterified estrogens with or without methyltestosterone were effective at reducing menopausal symptoms and were well tolerated over 6 months of continuous treatment. A significant decrease in cholesterol and apolipoproteins in the estrogen plus methyltestosterone group suggests a potentially adverse impact on the beneficial effect normally imparted by estrogen therapy.

Successful hysteroscopic cannulation and tubal transfer of cryopreserved embryos.

Clinical trials comparing nonsurgical transfer techniques with laparoscopic directed methods are needed to determine the most successful and cost-effective approach for gamete and ET. We report the successful nonsurgical transfer of frozen-thawed embryos into the fallopian tube after our initial attempt resulting in an ongoing IUP. The process is relatively simple, safe, and avoids the risks of general anesthesia. Unlike US-guided tubal cannulation, this technique offers direct, clear visualization of the tubal ostium, assuring the desired catheter placement. As well, hysteroscopic guidance allows an accurate estimate of the depth of catheter insertion within the fallopian tube, which may be a critical factor in successful tubal deposition of gametes or embryos. Whether prolonged carbon dioxide exposure of the tubal microenvironment and/or direct endometrial trauma limits the efficacy of this technique remains to be determined. Finally, outpatient hysteroscopic directed tubal cannulation holds promise as a methodological technique that ultimately assists in the examination of the best site for embryo deposition (tubal versus uterine) and/or method of delivery (nonsurgical versus surgical).

Pregnancy after fimbriectomy reversal: results of microsurgery augmented by gamete intrafallopian tube transfer and embryo transfer.

In this study, fimbriectomy reversal resulted in a 43% intrauterine PR and a fecundability of 6.6%. The cumulative PR and the fecundability were 57% and 7.8%, respectively, when microsurgery was augmented by GIFT and embryo cryopreservation during the same treatment cycle and by subsequent embryo thaw and transfer.

PIP: Between 1986-1988, physicians at Oregon Health Sciences University in Portland, Oregon induced ovary hyperstimulation in 7 patients then performed a fimbriectomy reversal augmented by a simultaneous gamete intrafallopian tube transfer (GIFT) and embryo cryopreservation during the same treatment cycle to improve fecundability and the cumulative pregnancy rate in a cost effective way. 2 patients received 2 embryo thaw and transfers (ETTs) each (2-3 embryos/ETT) within 16-25 months after fimbriectomy. The physicians determined pregnancy rates (PRs) based on only the 1st conception that resulted from fimbriectomy, GIFT, or ETT. PRs included 14% for GIFT, 25% for ETT, and 43% for fimbriectomy. The combined PR was 57%. Fecundability matched the PRs for augmented GIFT and ETT. Monthly fecundability for just fimbriectomy stood at 6.6% whereas it stood at 7.8% when fimbriectomy, GIFT, and ETT were combined. Average ampullary width was 1.03 cm (.7-1.5 cm). 67% had distal tubal patency which was lower than reported in earlier research (83%). The lower tubal patency rate may have been due to hyperemia and edema of the tube. The 3 women who did not conceive had either bilateral tubal occlusion or abnormal spill. No one experienced an ectopic pregnancy. The fertilization rate for the 4 women who underwent in vitro fertilization and ETT stood at 90% which indicated that laparotomy did not adversely affect fertilization. Mean exposure before 1st conception following fimbriectomy was 10.5 months when the 2 women who had postoperative tubal occlusion are excluded from the analysis. The combination of microsurgery, GIFT, and embryo cryopreservation during the same treatment cycle saved the patient around 40% when compared to the cost of separate treatments in different cycles.

Medical treatment of endometriosis: a comparison of the suppressive effects of danazol and nafarelin on reproductive hormones.

OBJECTIVE: Patients with endometriosis were studied to investigate hormonal suppression by the gonadotropin-releasing hormone against nafarelin acetate compared with danazol. We hypothesized that the pattern, time course, and degree of gonadotropin and ovarian suppression would be different. DESIGN: The study included 16 patients who were randomized into one of three 6-month treatment protocols. SETTING: Patients were recruited from a university hospital setting. PATIENTS: Eligible candidates were 18 to 45 years of age, with regular menses and documented pelvic endometriosis. INTERVENTION: Six-month treatment protocols included nafarelin 800 or 400 micrograms/d, or danazol 800 mg/d. MAIN OUTCOME MEASURES: Serum estradiol (E2), progesterone (P), luteinizing hormone (LH), and follicle-stimulating hormone were determined before treatment and then monthly. Thirteen patients consented to a 12-hour hospital admission during the 5th and 6th month of treatment to determine LH pulse frequency and amplitude. RESULTS: Estradiol and P were suppressed in all groups, but E2 significantly more by nafarelin than danazol (P less than or equal to 0.01). Nafarelin, 800 micrograms, significantly depressed LH pulse amplitude compared with danazol (P less than or equal to 0.05). Two patients in the nafarelin group had the administration of their medication observed, and both demonstrated single, high-amplitude pulses immediately after administration. CONCLUSION: Nafarelin is a more potent LH and E2 suppressor than danazol, and the agonist effect of nafarelin may continue to provoke transient gonadotropin responses despite long-term therapeutic suppression.

Hysteroscopic treatment of the uterine septum: a clinician's experience.

OBJECTIVE: I reviewed my experience with the diagnosis and hysteroscopic treatment of uterine septa. STUDY DESIGN: This article is a retrospective review of cases from 1992-1999. A septate uterus was diagnosed in a total of 40 patients, and all were treated by hysteroscopic resection. RESULTS: The rate of preoperative pregnancy loss was 77.4%, and the uncomplicated delivery rate was 6.5%. After hysteroscopic septum resection 21 patients reported a total of 22 pregnancies with an 18.2% miscarriage rate and a 77.3% uncomplicated delivery rate. CONCLUSION: Hysteroscopic treatment of uterine septa is a safe, simple, and effective procedure. It can be used for all types of uterine septa, it attains optimal obstetric outcomes, and it should be undertaken whenever a uterine septum is diagnosed.

Psychiatric diagnoses and sexual victimization in women with chronic pelvic pain.

The authors evaluated 100 women scheduled for diagnostic laparoscopy (50 for chronic pain, 50 for tubal ligation or infertility evaluation) using structured psychiatric, family history, and sexual trauma interviews. Laparoscopy reports were blindly rated by a gynecologist. Compared with the nonpain group, the women with chronic pelvic pain had significantly higher current and lifetime rates of psychiatric disorders, as well as childhood and adult sexual victimization. They reported significantly higher mean numbers of somatization symptoms, but no significant differences in objective laparoscopic findings. Psychiatric disorders and sexual victimization are common in women with chronic pelvic pain and should be considered in the evaluation and treatment of these patients.