Endometriosis

The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions.

Hirsutism: Implications, etiology, and management☆

Uterine malformations consist of a group of miscellaneous congenital anomalies of the female genital system. Their mean prevalence in the general population and in the population of fertile women is approximately 4.3%, in infertile patients approximately 3.5% and in patients with recurrent pregnancy losses approximately 13%. Septate uterus is the commonest uterine anomaly with a mean incidence of approximately 35% followed by bicornuate uterus (approximately 25%) and arcuate uterus (approximately 20%). It seems that malformed uterus and especially septate uterus is not an infertility factor in itself. However, it may have a part in the delayed natural conception of women with mainly secondary infertility. On the other hand, patients with uterine malformations seem to have an impaired pregnancy outcome even as early as their first pregnancy. Overall term delivery rates in patients with untreated uterine malformations are only approximately 50% and obstetric complications are more frequent. Unicornuate and didelphys uterus have term delivery rates of approximately 45%, and the pregnancy outcome of patients with untreated bicornuate and septate uterus is also poor with term delivery rates of only approximately 40%. Arcuate uterus is associated with a slightly better but still impaired pregnancy outcome with term delivery rates of approximately 65%. Women who have undergone hysteroscopic septum resection and have been reported in the different series comprise a highly selected group of symptomatic patients with term delivery and live birth rates of only approximately 5%. Hysteroscopic treatment seems to restore an almost normal prognosis for the outcome of their pregnancies with term delivery rates of approximately 75% and live birth rates of approximately 85%. It seems, therefore, that hysteroscopic septum resection can be applied as a therapeutic procedure in cases of symptomatic patients but also as a prophylactic procedure in asymptomatic patients in order to improve their chances for a successful delivery.

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Clinical implications of uterine malformations and hysteroscopic treatment results

An extensive literature dealing with studies on the pathophysiology of the polycystic ovary syndrome (PCO) has accumulated over the years. The great clinical and biochemical variability of PCO, as indicated in several excellent reviews over a decade ago (Goldzieher & Axelrod, 1963; Mahesh & Greenblatt, 1964; Jeffcoate, 1963; Shearman & Cox, 1966), continues as a major problem in defining this syndrome. Further, the pathogenesis of this reversible disorder remains elusive. However, recent advances in our understanding of ovarian physiology, the pathways for androgen-oestrogen secretion and metabolism, and the integrated function of the hypothalamic-hypophyseal-ovarian axis permit a rational description of the pathophysiology of the PCO syndrome. Thus, current evidence regarding the basis for the dysfunction of ovarian steroidogenesis and follicular maturation, and the aberration of gonadotropin secretion as related to the inappropriate steroid feedback system will be reviewed. The long debated issue of the possible role of adrenal androgen in the genesis and persistence of PCO syndrome will also be considered.

Robert Israel

Papers

Single luteal phase serum progesterone assay as an indicator of ovulation.

Hysteroscopic management of intrauterine adhesions

Frequency of abnormal karyotypes among abortuses from women with and without a history of recurrent spontaneous abortion

Hysteroscopic management of recurrent abortion caused by septate uterus

Monitoring techniques to predict and detect ovulation.