Infertility

Advances in technologies have allowed conduct of many procedures by laparoscopy and hysteroscopy. These are the essence of our specialty. Most new technologies foster improved performance. In business term, they are called sustaining technologies. In fact, most technological advances in an industry are sustaining in nature.

In minimally invasive surgery (MIS), complications can occur due to faulty instruments, surgical technique, or inadequate patient election. Surgeons who routinely perform MIS rarely encounter complications. Conversely, practicing gynecologists at large often find that certain procedures or techniques are not as safe as previously reported in the literature by the "experts." One of the reasons is that complications tend to be underreported.

The tragic events of September 11 have, to put it mildly, thrown many people off balance. On a somewhat secondary scale, our Society was affected. The 5th Regional Meeting of ISGE in conjunction with the 2nd Brazilian Congress of Gynecologic Endoscopy took place on September 12-15, 2001.

We are entering a time in the development of the discipline of gynecologic endoscopy where there is an opportunity to build bridges, both ideologically and functionally. The science and practice of endoscopy have progressed to the point where core groups of advanced endoscopic surgeons have organized themselves in every corner of the world, not only to exchange knowledge, but also to set goals and plan for the future of the field.

A fibroid is a benign tumor of the uterus. Various terms are used to refer to the tumor, such as fibromyoma, myofibroma, leiomyofibroma, fibroleiomyoma, myoma, fibroma, and fibroid. Of these, fibroid is the most common term, although myoma is more accurate.

What are Uterine Fibroids?The walls of the uterus are made of smooth muscle called myometrium, and the inside lining, with glandular tissue, is called endometrium. “Uterine fibroid” is a slang term for leiomyoma, or often simply myoma. Fibroids are benign tumors made of smooth muscle cells.

Competing for time and being able to provide timely information is one of the challenges of the 21st century. The Internet can help.

Both types of surgery are complimentary. Each has specific advantages and indications. It is an advantage to have and to be able to use both.

The female reproductive function depends on the healthy ovaries (primary reproductive organ) and genital tract organs. Infertility is one of the main gynecological problems which affect between 10-15% of females in the reproductive age.

Chronic pelvic pain affects a large number of women, and is not often optimally treated within a single specialty. It is responsible for approximately 40% of laparoscopies and 10-15% of hysterectomies in this country. In one survey of 5300 women, more than 16% noted chronic pelvic pain.

Pantaleoni first performed hysteroscopy in 1869, but it was not until the early 1970s that hysteroscopy became part of the gynecologist's armamentarium. The need for visual appraisal of the endocervix and endometrial cavity and technical advances in instrumentation increased the awareness of, and interest in, the advantages of hysteroscopic sterilization techniques.

Women with cervical intraepithelial neoplasia now have a number of treatment options including cold-knife conization, laser ablation, and loop electrosurgery but, all too often, the physician s preference is the determining factor in selection of therapy. This detailed presentation of the advantages and disadvantages of electrosurgery will help the physician to decide whether this procedure truly fits the needs of a given patient.

In this column, subject experts have been invited to provide an annotated guide to some of the most useful health sites on the Internet. In this issue Hans van der Slikke, Consultant Obstetrician at Zaandam Hospital, The Netherlands, and Chairman of the International Council of OBGYN.net, provides a guide to some of the best women's health resources now available on the Internet.

Discussion between Mark Perloe, MD, and Bruno Lunefeld, MD, on the risks associated with ovulation induction in breast cancer and ovarian cancer.

Although sperm and embryos (fertilized eggs) have been successfully frozen and subsequently thawed to create healthy children for decades, it is only recently that successful human egg freezing has become a reality.

Susan is a 58-year-old woman who saw her family physician after a few weeks of mild abdominal pain and bloating. The examination of her abdomen was normal, as was a pelvic and rectal exam. Blood tests for infection, liver and gall bladder problems were also normal.

Radiotherapy is one of the treatment modalities in the management of patients with cancer. It is highly effective in women with early stages of malignancy but it results in the loss of ovarian function.

Cervical cancer is the seventh most frequent cancer worldwide but more than 80% of cases occur in developing countries. Till date, radiation therapy with external beam and brachytherapy remains as the core treatment for most stages of cervical cancer.

Cervical cancer remains one of the greatest killers of women worldwide. It is difficult to foresee a dramatic increase in cure rate even with the most optimal combination of cytotoxic drugs, surgery, and radiation; therefore, testing of molecular targeted therapies against this malignancy is highly desirable.

Uterine Fibroids are classified by their location (see figure), which effects the symptoms they may cause and how they can be treated. Fibroids that are inside the cavity of the uterus (Submucous myomas) will often cause bleeding between periods and often cause severe cramping. Fortunately, these fibroids can usually be easily removed by a method called “hysteroscopic resection,” which can be done through the cervix without the need for an incision.

When chlamydia or gonorrhea is diagnosed in female patients, obstetricians and gynecologists should also prescribe antibiotics for the male partners. This recommendation comes from The American College of Obstetricians and Gynecologists in efforts to reduce the high reinfection rates associated with these sexually transmitted infections (STIs).

To review utilisation of elective embryo cryopreservation in the expectant management of patients at risk for developing ovarian hyperstimulation syndrome (OHSS), and report on reproductive outcome following transfer of thawed embryos.

Accurate diagnosis of uterine fibroids is essential in deciding if treatment is necessary, and planning appropriate treatment.n While a physical exam may suggest fibroids, other conditions such as ovarian cysts or adenomyosis may be mistaken for fibroids. For this reason, I routinely do an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination.

Compared to healthy women, the researchers found significantly higher serum mesothelin antigen levels in women with ovarian cancer, benign conditions, and unexplained infertility. Luborsky and colleagues further noted that mesothelin antibodies had a higher affinity in the infertility groups, especially premature ovarian failure and ovulatory dysfunction, than that in the healthy, benign, or ovarian cancer groups. Specifically, they found significantly higher positive sera in women with premature ovarian failure and ovulatory dysfunction as compared to normal sera.

Laparoscopic Myomectomy uses a small telescope placed through the belly button along with several small instruments to remove fibroids from the uterus. The technique of actually removing the fibroid from the uterus is similar to that of an abdominal myomectomy except we use small instruments placed through the abdominal wall. Once the fibroid is freed from the uterus it needs to be removed from the abdomen. In order to remove a large fibroid from a small incision we use an instrument called a morcellator, to cut it into pieces small enough to be removed through the small incisions.

Surgery in the medical office setting can confer benefits for both the physician and the patient, as it can control costs, allow for flexibility in scheduling, and increase overall convenience.

DEFINITIONExcessive blood loss sufficient to affect the general condition of the mother.INCIDENCELow parity 0.3%Para 4 or > 2%Babiszki et al, 1999

The catgut is fed through posteriorly and vertically over the fundus to lie anteriorly and vertically compressing the fundus on the left side as occured on the right.

Presented by Dr. Narayan M. Patel Prof. Emeritus, ob/gyn.muni.medical collage, Postal address: - Mahalaxmi institute of medical teaching3, shantiniketan park, Nr. S. P. Colony Ahmedabad-380014 Gujarat state (INDIA) Phone: - (079) 27682572 Email: narayanpatel1932@yahoo.com