Reviews in Gynaecological Practice最新文献

This study provides a historical outline and identifies the studies that most contributed to the development of in vitro fertilization. The advances observed in the field of in vitro fertilization are associated with advances in assisted reproduction. It is known that the development of assisted reproduction techniques occurred simultaneously with that of in vitro fertilization and perhaps simultaneously with technological development in general. Endocrinologic knowledge has been associated with higher-quality ovulation induction and with the perspective of an adequate follicular development with no negative aspects for the woman and the society.

The practice of female genital mutilation (FGM) is no longer confined to African countries where still every year 2 million girls at a young age are currently subjected to surgical ablation of parts of their external genital organs. Health professionals in Western countries, especially midwives and gynaecologists, are regularly confronted not only with the sequelae of excision and infibulation but also with parents’ requests to perform FGM or to repair a widened introı̈tus. The international community condemns firmly every attempt to continue this practice whether the original one in societies promoting FGM or a minor variety to be performed under medical conditions in order to prevent worse, as sometimes recommended by compassionate or tolerant people in Western countries or asked in Africa by educated parents or by immigrant parents in Europe and America. Consequences of FGM are medical, psychological and psycho-sexual as well. General practitioners, midwives and gynaecologists should be aware of this condition and most of all of the infibulation type as it might heavily affect reproductive and urological functioning of girls and women. Women original from areas where FGM is endemic should be extensively counseled, carefully examined and closely followed up, especially during pregnancy. A detailed plan of action should be established for pregnancy, delivery and post-partum period. Detailed information and appropriate illustrations are provided on defibulation techniques and procedures during delivery. The medical profession can play an important role in raising awareness about the harmful consequences of FGM and in preventing its application.

Recombinant follicle stimulating hormone (rFSH) has been in use in the management of infertility for the past decade. It is a virtually pure compound, with excellent batch-to-batch consistency and the ability to be produced in almost limitless quantities. A historical perspective leading to the development of recombinant products will be discussed, including a review of the two-cell, two-gonadotrophin theory of folliculogenesis. The two currently available recombinant follicle stimulating hormones (follitropin α and follitropin β) will be compared with each other and with urinary follicle stimulating hormone (uFSH) preparations. This comparison will highlight their safety, efficacy and side effect profiles. The use of recombinant follicle stimulating hormone in the special cases of polycystic ovarian syndrome and hypothalamic amenorrhea will be detailed. Finally, future directions in recombinant therapy will be considered, including the creation of long-acting preparations, the development of recombinant luteinizing hormone, and the potential future availability of more convenient administration systems.

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of controlled ovarian hyperstimulation (COH). The pathophysiology of the syndrome is poorly understood and there is no reliable test to predict patients who will subsequently develop severe OHSS. The syndrome almost always presents either after hCG administration in susceptible patients or during early pregnancy, especially multifetal gestation. Despite many years of clinical experience, there are no precise methods to completely prevent severe OHSS, except by withholding the ovulation-inducing trigger of hCG. We offer a triage aimed at eliminating the occurrence of severe OHSS based on several clinical observations, including the role of GnRH-antagonist in COH protocols and the ability to transfer embryos in the blastocyst stage.

The present communication highlights some of the shortcomings of current surveillance programs as a base for understanding the prevailing epidemiological picture for sexually transmitted infections, with especial focus on genital chlamydial infections. Suggestions of how to possible improve them are given. It also discusses criteria for screening programs, incl. criteria for so called “selective screening”. The traditional groups for screening are mentioned as well as groups that have so far seldom been suggest to be subjected for such activities. The usefulness of breaking down monitored data from regional or national surveillance systems, specified to individual providers of collected data among private consultations and community clinics, even incl. subunits of the latter, is demonstrated. The difficulty in interpreting the result of diagnostic tests, particular in low-prevalence populations is put forward. The effectiveness of current recommended therapeutic regimens of Chlamydia trachomatis infections are considered in light of the notably high proportion of such recurrent and/or relapsing infections.

The saline infusion sonohysterography (SIS) procedure is a quick, and minimally invasive procedure which can be performed in the physician’s office with virtually no patient discomfort. SIS provides details of soft tissue structures as well as of the shape of the uterine cavity. This technique allows a detailed study of the uterine cavity in cases of infertility, amenorrhea, uterine anomalies and inadequate or abnormal endometrial images. In the future, SIS performed with ultrasound contrast media may replace HSG evaluation for infertility patients. Also, as the technology advances Sonohysterographic guided biopsy and excision may become possible as well. SIS is easily learned and requires little additional expenses in offices providing ultrasound services. As with any technique, no single procedure can replace our full arsenal of diagnostic choices and the decision to perform SIS must be individualized to patient selection, physician preference and experience.

A novel combined hormonal vaginal contraceptive ring (VCR) is currently commercially marketed (NuvaRing^®, NV Organon, Oss, The Netherlands). This VCR continuously releases 15 μg of ethinyl estradiol and 120 μg of etonogestrel, the active metabolite of the progestin desogestrel. The VCR is soft and flexible, with an outer diameter of 54 mm and a cross section of 4 mm. Each VCR is intended for one monthly cycle, comprising 3 weeks of ring use and 1 week ring-free period. The VCR is easily inserted at a woman’s discretion. Due to the controlled release mechanism of the contraceptive ring, steroid concentrations remain uniform throughout the cycle. Large mulicenter studies of the VCR have revealed a high contraceptive efficacy, with a Pearl Index of 0.65 and 1.18. Cycle control is excellent with irregular bleeding reported in about 5% or less of all cycles with the VCR. The most frequently reported adverse events are device-related events (e.g. foreign body sensation, coital problems and device expulsion), vaginal discomfort, headache, vaginitis and leucorrhea. The overall acceptance of the VCR is high, as 96% of patients are satisfied with the ring and 97% would recommend the ring. The VCR represents an important new option for women desiring highly effective contraception. The ease of use and exceptional cycle control all lead to high patient compliance with the VCR.