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001-es BibID:BIBFORM061574
Első szerző:Molnár Szabolcs (szülész-nőgyógyász szakorvos)
Cím:Effect of endometrial polyps, histology, intrauterine localization and the technique of polypectomy On Fertility / Molnar S., Torok P., Juhasz A. G., id. Orosz L., Jakab A.
Dátum:2015
Megjegyzések:BackgroundEndometrial polyps are frequently found in infertile patients, but most of them are asymptomatic. They can be effectively detected by ultrasound using contrast media or color Doppler, but the gold standard is hysteroscopy. In reproductive age, they carry low risk of malignancy. It is assumed that larger polyps hamper implantation. However, it is not clear yet, whether resection of all polyps necessarily improves the fertility, and is the polyp localization influence the implantation failure.MethodsA retrospective study of ovulatory infertile women with endometrial polyp, at whom TCRP was performed between 2006 and 2012. Time interval between operation and the first pregnancy were registered, if pregnancy occured until 2014. The aim was to evaluate whether the transcervical resection of endometrial polyps (TCRP) improves the fertility status, and polyp histology, intrauterine location, the technique of polypectomy have influence of pregnancy rate (PR) in ovulatory infertile women.ResultsFifty patients were eligible for data collection. Anovulation, tubal, male factor were excluded. TCRP was performed by resectoscop or hysteroscopically controlled curettage, hystology was examined. Polyps were categorized to localization: utero-tubal junction, anterior, posterior, lateral, multiple. PR was calculated to TCRP method, histology and location. T-test was used for differences. Twenty-seven pregnancies (54%) were registered after TCRP, 20 (40%) of them in one year. Mean time interval until conception was 12,1 (range 3-41) months. PR was similar in resectoscop and curettage group (21/37, 56% vs. 6/13, 46%). To histology, PR was higher if simple polyp was found than after polyps with hyperplasia (24/37, 65% vs. 3/13, 23%, P=0.008). There were no differences in PR, neither in time interval to conception between the groups of different polyplocalisation.ConclusionsRemoving of endometrial polyps by TCRP improves the fertility of ovulatory women, irrespective to the resection method, i.e. resectoscop or hysteroscopy controlled curettage. Pregnancy rate is higher if endometrial hyperplasia is not found in the polyp. The location of endometrial polyp in the uterine cavity does not influence the fertility. Our data supports the hypothesis, that endometrial polyps physically prevent the implantation and can be the single cause of infertility. Thus, TCRP is recommended, irrespective to polyp localization. Resectoscopy is not superior than histeroscopically controlled curettage. Fertility prognosis is worse if hyperplasia is present, otherwise the one-year PR is good. Although the minimum follow up was 2 years, longer postoperative follow and larger patients number may alter the pregnacy rates. Influence of polyp size was not examined. Fertility related life-style and enviromental factors were not examined.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idézhető absztrakt
folyóiratcikk
Endometrium
Infertility
polypectomy
hysteroscopy
Megjelenés:Gynecological Surgery. - 12 : Suppl1 (2015), p. S315 -
További szerzők:Török Péter (1975-) (szülész-nőgyógyász) Juhász Alpár Gábor (1973-) (szülész-nőgyógyász, gyermeknőgyógyász) id. Orosz László Jakab Attila (1964-) (szülész-nőgyógyász, endokrinológus)
Internet cím:Intézményi repozitóriumban (DEA) tárolt változat
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001-es BibID:BIBFORM069531
Első szerző:Török Péter (szülész-nőgyógyász)
Cím:Effects of endometrial polyps and polypectomy on infertility / Török P., Molnár S.
Dátum:2014
ISSN:1613-2076 1613-2084
Megjegyzések:Introduction: Most endometrial polyps represent focal, hyperplastic processes of the endometrium. Polyps occur most frequently in peri-and postmenopausal women, but they can be found in fertile-age, too. Endometrial polyps can be diagnosed by ultrasound, hysterocontrastsonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but the diagnostic hysteroscopy (HSC) is considered as gold-standard method, with the greatest sensitivity and specificity. Study design: A retrospective study was conducted on 383 patients between 2006 and 2012, who were suspicious about having endometrial polyp based on the ultrasonography, or according to symptoms. 143 cases were excluded by reason of incomplete documentation or negative hysteroscopic finding. In 240 cases polyps were verified during diagnostic hysteroscopy and were removed either by resectoscopy, or by curettage. Localization of polyp in the endometrial cavity was categorized into five groups: utero-tubal junction, anterior uterine wall, posterior uterine wall, lateral uterine wall, and multiple. All samples underwent histological examination. The group of infertile patients was accentuated. Results: The average age of patients was 46.16 (?SD) ? 13.67. The symptoms that indicated diagnostic hysteroscopy were abnormal uterine bleeding in 50.83% of cases, 13.75% infertility, 1.67% pelvic pain and positive finding during ultrasonographic examination were 51.67%. Polyps were excised in 70% by resectoscopic polypectomy, 30% by curettage. Less than 3% of polyps were malignant. The polyps, that were seen during hysteroscopy were confirmed by histological diagnose in 76.19% of resectoscopy cases and 68.05% of curettage cases. The difference between the two techniques in sampling precision was no significant (p=0.095). Among infertile women (n=33), with suspected endometrial polyp the average age (?SD) was 33.99?4.24. Endometrial polyp was verified by hysteroscopy in all cases. Polyp locations were as follows: utero-tubal junction 18.18%; anterior uterine wall 24.24%; posterior uterine wall 27.27%; lateral uterine wall 24.24%; and multiple 6.06%. In 72.7% of polyps resection happened by resectoscopy and in 27.3% by curettage. The effect of polypectomy for pregnancy rate was evaluated in one year period after the operation sorted by localization and histological findings, as well. Polyps were verified histological in 63.6% of cases. In histological verified polyp group the pregnancy rate after polypectomy was 52.38%, in the other group the rate was 18.18%. The difference was significant (p=0.0321). Conclusion: In this study there was no difference in pregnancy rate according to the localization of the resected polyp. According to histological verification difference in causing infertility was significant. Removing of polyps diagnosed by hysteroscopy improves the likelihood of successful conception, if removed polyp was histological confirmed as polyp.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idézhető absztrakt
endometrial polyp
diagnostic hysteroscopy
infertility
polypectomy
Megjelenés:Gynecological Surgery 11 : S1 (2014), p. 330-331. -
További szerzők:Molnár Szabolcs (1987-) (szülész-nőgyógyász szakorvos)
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Intézményi repozitóriumban (DEA) tárolt változat
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