Efficacy of dienogest treatment of clinical symptoms of rectovaginal endometriosis.

OBJECTIVE: The aim of this prospective, unicentric, cohort study was to evaluate the effect of dienogest use in the therapy of symptomatic endometriosis of rectovaginal septum in patients of fertile age. STUDY DESIGN: Prospective, unicentric, cohort study. SETTING: Department of Obstetrics and Gynaecology, Brno University Hospital and Masaryk University Medical School, Brno. MATERIAL AND METHODS: Prospective analysis of the group of 32 patients in reproductive age who have previously been diagnosed with endometriosis of rectovaginal septum. These patients were treated conservatively with dienogest 2 mg per day during a 24-week period. Through questionnaires and clinical assessment, we have studied the presence of symptoms like dyspareunia, diffuse pelvic pain, Biberoglu-Behrman(B-B) score assessment and subjective pain perception using Visual Analogue Scale (VAS) of pain. Data were collected at the beginning of therapy, after 4, 12 and 24 weeks of dienogest use. RESULTS: Continual use of dienogest during the 24-week period diminishes symptoms of dyspareunia by 62% (p.

Uterine microbiome and endometrial receptivity.

OBJECTIVE: Structure and correct function of endometrium is necessary for embryo implantation, pregnancy development and childbirth. It is a result of many factors - anatomical and histological structure, hormonal effects and signalling pathways at the molecular genetic level. A little known phenomenon is the presence of microorganisms on the endometrium. Traditionally, the uterine cavity was considered sterile, but new findings have been changing this view fundamentally. The aim of this work is to present new findings on endometrial microbiome and its importance for embryo implantation and development. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno; Department of Obstetrics and Gynecology, University Hospital Faculty of Medicine, Palacky University Olomouc. METHODS: PubMed was searched for articles in English indexed until 30th June 2018 with terms of „uterine microbiome analysis“ and „endometrial receptivity“. RESULTS: The vital information on bacterial colonization of endometrium brought new diagnostic methods for their detection based on ribosomal RNA analysis in 16S subunit, which are capable of detection and exact identification of bacteria that cannot be detected by classical cultivation methods. The endometrial microbiome is assumed to modulate the function of endometrial cells and local immunity system, it prevents growth of pathogenic microorganisms by its presence and production of protective substances. CONCLUSION: Endometrial microbiome seems to be important factor of endometrial receptivity.

Radiofrequency endometrial ablation - new possibility of heavy menstrual bleeding conservative treatment.

OBJECTIVE: Evaluation of radiofrequency endometrial ablation (RFEA) clinical efficacy in patients with heavy menstrual bleeding (HMB). DESIGN: Original article. SETTING: Department of Gynecology and Obstetrics, University Hospital and Masaryk University Medical School, Brno. METHODS: Study included 20 patients with HMB who had failed hormonal therapy and met the study inclusion criteria. All RFEA procedures were performed in the operating theater in general anesthesia by two experienced surgeons according to a standardized protocol. All RFEA were performed using specific disposable electrodes and radio frequency generator M-3004 (RF Medical Co., South Korea). Study outcomes were evaluated three months post-surgery included percentage of women with amenorrhoea or menstrual bleeding persistence measured by the modified Pictorial Blood Assessment Chart (PBAC) score. Furthermore, chronic pelvic pain intensity assessed by visual analogue scale (VAS), patient satisfaction (Patient Global Impression of Improvement, PGI-I score), and the incidence of complications were evaluated. RESULTS: All RFEAs were performed without operational or technical complications, the average age being operated was 43.0 ± 2.9 years and the operating time did not exceed ten minutes. In the early postoperative follow-up, patients did not require any analgesics and were all released to outpatient care the following day. Percentage of amenorrhea at three months post-treatment was 35.0%, mean PBAC score for women with menstrual bleeding was 1.8 ± 0.6. Patients satisfaction with the treatment was evaluated by 1.6 ± 0.6 on the PGI-I scale and long-term pelvic pain was on average 2.1 ± 0.8 by VAS, which counts an improvement of 31.0%. CONCLUSION: The HMB treatment with RFEA achieves good clinical results in three-month evaluation with objective and also subjective parameters. The technique is suitable for outpatient treatment and is an alternative to hysteroscopy endometrial ablation. Its wider clinical usage is limited by the high cost of the radiofrequency generator and disposable probes. Keywords heavy menstrual bleeding, hysteroscopy, radiofrequency endometrial ablation, amenorrhoea, complication.

[Medroxyprogesteron acetate use to block LH surge in oocyte donor stimulation]. / Vyuzití medroxyprogesteron acetátu k blokáde LH pri stimulaci dárkyní vajícek.

OBJECTIVE: To compare the results of ovarian stimulation with LH surge blockade by medroxyprogesterone acetate or GnRH antagonist in oocytes donors. To present current options of exogenous and endogenous progestins instead of GnRH analogues to block LH surge during ovarian stimulation. DESIGN: Retrospective study of oocyte donor cycles and literature review. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk university and University Hospital Brno. METHODS: Thirteen oocyte donors (26.8 ± 2.5 years old) were stimulated with recFSH and MPA to block the LH surge during January - October 2017. The results were compared to the previous cycle stimulated with recFSH and GnRH antagonist performed during January -December 2016. Wilcoxon´s pair test was used to test the statistics. A literature search of SCOPUS was carried out. RESULTS: In cycles with MPA blockade the average number of oocytes was 14.5 ± 5.1, in cycles with GnRH anta-gonist blockade 12.0 ± 4.5 oocytes (statistical significance p = 0.025). FSH total dose (1611 ± 327 vs. 1565 ± 322 IU), days of stimulation (9.1 ± 0.8 vs. 8.5 ± 0.9) and maximum estradiol levels (5.9 ± 2.1 vs. 6.0 ± 3.0 nmol/l) were not statistically different. Progestins are effective in blocking the LH surge during ovarian stimulation and do not affect the number and quality of collected oocytes or obtained embryos. Their adverse effect on the endometrial receptivity obstructs the embryo implantation in the same cycle. Such protocol requires total freezing and delayed transfer. Progestins can be used in a variety of stimulation protocols - progestin primed follicular phase stimulation, luteal phase stimulation with endogenous progesteron, double stimulation in follicular and luteal phase of the same cycle "duostim" in low responders. CONCLUSION: Eggs donor ovarian stimulation with MPA resulted in more oocytes than stimulation protocol with GnRH antagonist, the total dose of FSH and the length of stimulation were similar. According to current experiences progestins effectively block the LH surge and do not affect the number and quality of collected eggs and obtained embryos. Their use opens new possibilities of ovarian stimulation protocols and their flexibility. Its main constraint is that it requires total freezing and delayed transfer.