Fresh vs. frozen embryo transfers in patients with KIR Bx haplotype: impact on reproductive outcomes.

OBJECTIVE: A controversy persists over whether or not the type of embryo transfer (ET) influences reproductive outcomes. This study aimed to evaluate the reproductive outcomes of pregnant patients undergoing their first in vitro fertilization procedure and explore the influence of various KIR genotypes on these reproductive outcomes. PATIENTS AND METHODS: Prospective enrollment of patients with infertility who sought treatment at Origyn Fertility Center in Iasi, Romania, was conducted between January 2019 and March 2023. Descriptive statistics and average treatment effects (ATE) using propensity-score matching were employed to analyze our data. RESULTS: Our results indicated that both groups were homogenous regarding baseline characteristics. When we evaluated the ATE of fresh vs. frozen ET on the main outcomes, we discovered that only frozen ET significantly improved the pregnancy rates (ATE: 0.17, 95% CI: 0.04-0.30, p=0.011) and live birth rates (ATE: 0.36, 95% CI: 0.02-1.19, p=0.03). The miscarriage rates were similar between the two groups. None of the evaluated KIR genotypes had a significant influence on the ATE corresponding to fresh and frozen ET. CONCLUSIONS: KIR screening is not necessary before an IVF cycle, except for specific situations such as recurrent pregnancy loss or recurrent implantation failure.

A successful case of assisted reproduction after contamination of the culture medium with Escherichia coli.

INTRODUCTION: We report a case of successful pregnancy after in vitro fertilization culture (IVF) medium contaminated with Escherichia coli (E. coli). CASE REPORT: To remove E. coli, oocytes were isolated in a PVP-ICSI medium and then in a culture medium supplemented with gentamicin. We selected two embryos that were vitrified and frozen. In the next natural cycle, we performed the embryo transfer of 2 embryos. RESULTS: Only one pregnancy was uncomplicated until term and was completed by the live birth of a healthy baby. The child's subsequent development until the date of publication of this article is normal. CONCLUSIONS: In cases of E. coli contamination of the IVF culture medium, specific laboratory methods allow the procedure to be continued, and a healthy baby can be obtained.

THE RELEVANCE OF CYTOLOGICAL DIAGNOSTIC IN THE MAMMARY GLAND CANCER.

UNLABELLED: Breast cancer is the second leading cause of cancer death in women, while in Eastern Europe the most common form of diagnosed cancer. Out of the multiple possibilities of early detection of mammary neoplasia that have been elaborated, only mammography has proved to be a simple, efficient method and of a high sensitivity, almost 90% However, the cytological confirmation of diagnosis allows us to perform the preoperative radiotherapy treatment or poly chemotherapy. MATERIAL AND METHODS: we analyzed the informative value of these diagnosis methods in stage I mammary gland cancer (MGC). In this way, in the present paper we demonstrated that collecting samples through fine-needle aspiration biopsy allows the cytological confirmation of the diagnosis of stage I MGC in 30.7% cases. RESULTS AND DISCUSSION: In stage I MGC young patients, under 35 years, the cytological confirmation rate is 22.2% and is lower as compared to the cytological confirmation rate in patients older than 35 years which is 37.9% Also, for a tumor diameter < 0.5 cm, the prevalence of cytological confirmation was only 10.3%, while for the diameter of 0.6-1.0 cm the cytological confirmation was around 40.0%. Therefore, in order to improve the cytological diagnosis confirmation rate the tumor biopsy through the USG of the mammary glands is required. Moreover, the cytological investigation of the smear obtained by the first and second puncture was instrumental in confirming the diagnosis in 41.3% and 17.4% cases; the subsequent repetition of the punctures was not useful as it helped to confirmation of the diagnosis only in 9.3% cases. The frequency of diagnosis cytological confirmation depends on the tumor histopathological form and type of growth. CONCLUSIONS: Thus, the lowest prevalence was in the mixed forms--12.5% cases, lobular cancer--24.4% cases, while regarding the type of growth, for the rare forms the cytological confirmation rate was 7.7% and 31.5% cases for the schiros growth type.

Spontaneous Pregnancy in Subsequent Cycle After Laparoscopic Cystectomy. Case Report.

Most women will experience a cyst on the ovaries at least once, and most are painless, cause no symptoms, and are discovered during a routine pelvic exam. Large cysts that can cause symptomatology or infertility problems occur in about 8% among women of reproductive age. The current case report comes to show that laparoscopic surgery is the key for persistent organic tumors of the ovary, after a complete diagnostic of the cyst; not the expectant management or hormonal therapy, but laparoscopic cystectomy after transvaginal punction and drainage of the fluid is minimal requiring as recovery timing, medical care period, low costs, and not the least, ovarian functionality, after suppressing ovulatory function.

THE IMPORTANCE OF CLINICAL AND INSTRUMENTAL DIAGNOSTIC IN THE MAMMARY GLAND CANCER.

Breast cancer is the most common oncology disease in women and is one of the major public health issues. Worldwide, is the second leading cause of cancer death in women and cancer research is a priority in all the laboratories of the world, in terms of uncovering the appearance causes of the malignant process, understanding the mechanisms of development, but most of all, the discovery of early diagnostic methods and effective treatment. Ignorance, fear of diagnosis, lack of health education and of efficient programmes for prevention and screening could cause diagnosis of the disease to be detected in the majority of cases in advanced stages, when treatment remains only palliative and very costly, in this cases the patient's suffering being immense. In this way, regarding the clinical diagnosis in stage I mammary gland cancer, in the 496 stage I MGC patients, during the primary clinical investigation the diagnosis of stage I MGC was established only in 165 (33.3%) patients, and in 232 (46,8%) patients the diagnosis of suspicion MGC was obtained. Also, in terms of instrumental diagnosis, such as mammography, ultrasonography in mammary gland cancer stage I, it seems that in accordance with literature data the pathological process features assessment in the mammary gland is problematic especially in young age. Thus, it seems that MGC represents a polymorphic and pathogenic disease and it cannot be admitted that all subgroups of patients will obtain identical results from one tactic of treatment determined for all the patients with MGC. In this way, the concept of MGC both clinical and patho morphological, combines different cell clones depending on its microstructure and biology. As a result, the evolution of the disease, the prognosis and the effectiveness of the treatment may vary in different patients at the same stage, depending on the degree of malignancy of the tumor, its histopathological structure, the degree of expression of molecular markers identification and also immune resistance.

Species distribution and susceptibility profile to fluconazole, voriconazole and MXP-4509 of 551 clinical yeast isolates from a Romanian multi-centre study.

This is the first multi-centre study regarding yeast infections in Romania. The aim was to determine the aetiological spectrum and susceptibility pattern to fluconazole, voriconazole and the novel compound MXP-4509. The 551 isolates were identified using routine laboratory methods, matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and DNA sequence analysis. Susceptibility testing was performed using the European Committee for Antimicrobial Susceptibility Testing (EUCAST) method and breakpoints. The yeasts originated from superficial infections (SUP, 51.5 %), bloodstream infections (BSI, 31.6 %) and deep-seated infections (DEEP, 16.9 %), from patients of all ages. Nine genera and 30 species were identified. The 20 Candida species accounted for 94.6 % of all isolates. C. albicans was the overall leading pathogen (50.5 %). Lodderomyces elongisporus is reported for the first time as a fungaemia cause in Europe. C. glabrata and Saccharomyces cerevisiae, as well as the non-Candida spp. and non-albicans Candida spp. groups, showed decreased fluconazole susceptibility (<75 %). The overall fluconazole resistance was 10.2 %. C. krusei accounted for 27 of the 56 fluconazole-resistant isolates. The overall voriconazole resistance was 2.5 % and was due mainly to C. glabrata and C. tropicalis isolates. Fluconazole resistance rates for the three categories of infection were similar to the overall value; voriconazole resistance rates differed: 4 % for BSI, 3.2 % for DEEP and 1.4 % for SUP. The antifungal activity of MXP-4509 was superior to voriconazole against C. glabrata and many fluconazole-resistant isolates. There was a large percentage of non-albicans Candida isolates. A large part of the high fluconazole resistance was not acquired but intrinsic, resulting from the high percentage of C. krusei.

The prevalence of some bacterial markers in female patients undergoing an initial infertility evaluation in north-east Romania.

SCOPE: Genital infections represent one of the most important causes of infertility, affecting: fallopian tubes, endometrial mucosa, sperm parameters. The aim of this study is to evaluate the involvement of four sexually transmitted infections (STD) in the achievement of infertility and to establish the prevalence of each infectious agent in our patients. METHODS: We analyzed the presence of Chlamydia trachomatis (CT) antigen, Ureaplasma urealyticum (UU), Mycoplasma hominis (MH) and Neisseria gonorrhoeae (NG) in the endocervical secretions and Chlamydia trachomatis antibodies IgA, IgG, IgM in the serum of 125 infertile women as well as in 30 pregnant women in the 3rd trimester of pregnancy, as a control group. RESULTS. In infertile women, the prevalence rate of the four bacterial markers was: CT antigen 1/125 (0.80%), CT IgG antibodies 19/125 (15.20%), MH 6/125 (4.80%), UU 51/125 (40.80%) and NG 1/125 (0.8%). From the control group, none was positive for CT antigen, but 1/30 (3.33% of patients) was positive for CT IgA while the prevalence rate for MH and UU were 16.66% and 43.33% respectively. CONCLUSIONS: We couldn't prove any association between genital MH/UU and infertility as the prevalence was higher in the control group than in the cases, but the correlation of the CT infection with the infertility was clearly shown. However, it is necessary to perform routine tests to screen for CT, NG, UU and MH among infertile patients. The positivity for CT IgG is a marker better correlated with fallopian tube obstruction than the CT antigen.

[Sonohysterosalpingography versus hysterosalpingography in the evaluation of uterine and tubal infertility]. / Sonohisterosalpingografia versus histerosalpingografia in evaluarea infertilitatii de cauza uterina si tubara.

OBJECTIVE: The evaluation of the role of sonohysterosalpingography with saline with air as a contrast solution (HYCOSY), in the assessment of uterine cavity and tubal patency, versus hysterosalpingography (HSG) and laparoscopy with dye test combined with hysteroscopy. MATERIAL AND METHOD: Prospective study of 95 infertility patients, with ages 25-40 years (median 31), in which HYCOSY was compared with HSG regarding the diagnostic acuracy for uterine cavity pathology and tubal patency, and compared to laparoscopy with dye test combined with hysteroscopy as gold standard. RESULTS: The sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnostic of uterine cavity pathology was: HYCOSY versus hysteroscopy of 72.1%, 96.15%, 93.93% and 80.64% respectively; HSG versus hysteroscopy was 83.3%, 60.7%, 63.6% and 81.6%; both methods combined versus hysteroscopy 95.34%, 61.53%, 67.21% and 94.11%. The same parameters for the tubal patency were: HYCOSY versus dye test laparoscopy 81.39%, 87.69%, 67.30% and 97.79%; HSG versus dye test laparoscopy 61.9%, 85.3%, 56.5% and 87.9%; both methods combined versus dye test 86%, 76%, 52.9% and 94.6%. CONCLUSION: HYCOSY can be used in combination with HSG for selecting the patients that need further more invasive investigations, in order to describe uterine and tubal pathology.