Endometriosis surgical treatment is directed to pain relief and recovery of reproductive function by removal of implants and reconstruction of pelvic anatomy alterations. Compared with laparotomy, laparoscopic treatment of endometriosis allows shorter time of hospitalization, faster recovery, smaller incisions, more accessibility and magnification of deep recto-vaginal nodules. Laparoscopic ablation of both endometriotic implants and uterosacral nerves (LUNA) in minimal to moderate disease reduces endometriosis-associated pain compared with diagnostic laparoscopy alone. In infertility associated to endometriosis ablation of endometriotic implants and adhesiolysis improve fertility in minimal and mild endometriosis, compared with diagnostic laparoscopy. In cases of 4 cm or larger endometriomas, laparoscopic cystectomy improves fertility compared with drainage and cauterization. Laparoscop...

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Objetivo: Determinar la frecuencia y las manifestaciones clínicas de Insuficiencia Ovárica Prematura en las pacientes infértiles. Material y métodos: En un estudio retrospectivo, descriptivo, se revisaron las historias clínicas de las pacientes atendidas en el Consultorio de Infertilidad del Hospital Nacional Arzobispo Loayza (HNAL), entre enero de 1989 y marzo de 1995. Resultados: Se encontró 27 pacientes con el citado diagnóstico, de un total de 1,855 pacientes que acudieron a consulta (1.45%). Todas tuvieron valores de FSH elevado y 25pacientes tuvieron niveles bajos de estradiol. Se observó hipotrofia de genitales externos y de vagina en el 11.11%, y de mamas en el 14.8%. Se realizó biopsia ovárica a 7 pacientes, en seis de ellas se observó ausencia de folículos. El diagnóstico más frecuente fue el de Insuficiencia Ovárica Prematura Idiomática. El tratamiento...

We report an alternative surgical procedure for creating a neovagina in eight patients with agenesis of the uterus and vagina. All patients presented with primary amenorrhea and congenital absence of the uterus and vagina (Rokitanski´s syndrome) and had 18-25 years of age. In brief, a dissection of the bladder-rectal space was performed until reaching the peritoneum that was subsequently pull down with a gripper to attach it to the orifice of the neovagina at the introitus using sutures with vicryl 0. Then, by using laparoscopy, the peritoneum was closed creating the dome of the vagina. A mold of foam cover by a condom was inserted in the neovagina. Hospital stays ranged from 2-5 days, no post-operative complications were observed. Six months after, the pelvic examination showed a vagina of 6-10cm in deep with no granulation tissue. We conclude that creating a neovagina using a laparosc...

Endometriosis surgical treatment is directed to pain relief and recovery of reproductive function by removal of implants and reconstruction of pelvic anatomy alterations. Compared with laparotomy, laparoscopic treatment of endometriosis allows shorter time of hospitalization, faster recovery, smaller incisions, more accessibility and magnification of deep recto-vaginal nodules. Laparoscopic ablation of both endometriotic implants and uterosacral nerves (LUNA) in minimal to moderate disease reduces endometriosis-associated pain compared with diagnostic laparoscopy alone. In infertility associated to endometriosis ablation of endometriotic implants and adhesiolysis improve fertility in minimal and mild endometriosis, compared with diagnostic laparoscopy. In cases of 4 cm or larger endometriomas, laparoscopic cystectomy improves fertility compared with drainage and cauterization. Laparoscop...

MESSAGE FROM THE PRESIDENT

Induction of ovulation in patients with polycystic ovary syndrome. Current status of ovarian drilling. Occult ovarian failure: reproductive management. Ethical and legal aspects of assisted reproduction in Spain. Ovarian stimulation protocols and embryo quality. Low-complexity assisted fertilization.

29 cases of luteal insufficiency of 634 infertile patients Arzobispo Loayza Hospital corresponding to an incidence of 4.5% were checked. The diagnosis was made by the findings of the endometrial biopsy in 68% of cases found other factors associated with infertility. In the treatment of clomiphene, bromocriptine or 17 hydroxyprogesterone caproate, yielding 9 pregnancies (31%).

Objetivo: Determinar la prevalencia de vaginitis y vaginosis bacteriana en pacientes con flujo vaginal y su asociación con características clínicas y de laboratorio. Material y métodos: Se llevó a cabo un estudio transversal. Se estudiaron 370 pacientes que acudieron a la consulta ginecológica del Hospital Nacional Arzobispo Loayza de enero a marzo de 1998. A todas las pacientes se les tomó muestras de flujo vaginal para la medición del pH, del test de amina y la identificación microscópica de “células clave”, Trichomonas vaginalis, levaduras e hifas. Resultados: La prevalencia de infección vaginal fue de 42.2%; siendo vaginosis bacteriana la infección más frecuente (23.24%), seguido de candidiasis vaginal (16.2%) y tricomoniasis vaginal (7.8%). Vaginosis bacteriana estuvo asociada a mal olor postcoital, ausencia de signos inflamatorios en vagina, flujo vaginal b...

Objetivo: Evaluar el procedimiento de Inseminación Intrauterina (IIU) en el consultorio de Infertilidad del Hospital Nacional Arzobispo Loayza entre enero de 1995 y diciembre de 1997. Materiales y métodos: Estudio retrospectivo, descriptivo. Se revisaron las historias clínicas de pacientes infértiles sometidas a IIU con semen del esposo (IE) o de donante (ID) que cumplieron con los criterios de inclusión. Resultados: Se incluyeron 98 pacientes (190 ciclos) en el grupo de IE y 16 pacientes (33 ciclos) sometidas a ID. No hubo diferencia significativa entre gestantes y no gestantes con respecto al tipo y tiempo de infertilidad, edad, factor asociado o uso de inductores de la ovulación. Se encontró asociación entre el número total de espermatozoides móviles inseminados y gestación (p<0.05). La tasa de embarazo fue de 8.1% / paciente y de 4.7% / ciclo en las pacientes con IE y ...

29 cases of luteal insufficiency of 634 infertile patients Arzobispo Loayza Hospital corresponding to an incidence of 4.5% were checked. The diagnosis was made by the findings of the endometrial biopsy in 68% of cases found other factors associated with infertility. In the treatment of clomiphene, bromocriptine or 17 hydroxyprogesterone caproate, yielding 9 pregnancies (31%).

Retrospective study in Infertility Clinic Loayza Hospital in Lima, between January 1980 and December 1991. They include 56 infertile ovulatory dysfunction treated with clomiphene citrate for a total of 197 cycles. Thirty patients had chronic anovulation or oligo-ovulation, and 26 patients with luteal phase defect, in 83% of the first group of patients it was possible to induce ovulation, pregnancy rate being 29%. Most patients studied had peritoneal tubi factor associated with ovulatory dysfunction, factor associated with a poor prognosis for pregnancy (p <0.001). In 69% of pregnancies, these were achieved during the first three months of treatment, the required dose being 50 to 100 mg / day in 94% of cases. There were no multiple pregnancies and 1.6% of patients presented clinical data cycles of mild ovarian hyperstimulation.

Retrospective study in Infertility Clinic Loayza Hospital in Lima, between January 1980 and December 1991. They include 56 infertile ovulatory dysfunction treated with clomiphene citrate for a total of 197 cycles. Thirty patients had chronic anovulation or oligo-ovulation, and 26 patients with luteal phase defect, in 83% of the first group of patients it was possible to induce ovulation, pregnancy rate being 29%. Most patients studied had peritoneal tubi factor associated with ovulatory dysfunction, factor associated with a poor prognosis for pregnancy (p <0.001). In 69% of pregnancies, these were achieved during the first three months of treatment, the required dose being 50 to 100 mg / day in 94% of cases. There were no multiple pregnancies and 1.6% of patients presented clinical data cycles of mild ovarian hyperstimulation.

Objective: To describe the most important clinical and biochemical characteristics in patients with polycystic ovary syndrome (PCOS) treated for infertility. Design: Observational, descriptive, retrospective study. Setting: Service of Human Reproduction and Infertility, Hospital Nacional Arzobispo Loayza, Lima, Peru. Participants: Patients with diagnosis of infertility and PCOS. Interventions: Between January 1995 and December 2007, 5640 clinical histories were reviewed, 181 patients had diagnosis of infertility and PCOS, and 59 met the admission criteria. Main outcome measures: Pregnancy and abortion. Results: Mean age was 27,5; 70% of the population not achieving pregnancy had a body mass index ≥ 25; testosterone was high in 15% of successful pregnancies and in 37,5% of the unsuccessful ones; 74,2% patients ovulated with clomiphene citrate, 52,4% achieved pregnancy and 16,7% presente...

Objective: To describe the most important clinical and biochemical characteristics in patients with polycystic ovary syndrome (PCOS) treated for infertility. Design: Observational, descriptive, retrospective study. Setting: Service of Human Reproduction and Infertility, Hospital Nacional Arzobispo Loayza, Lima, Peru. Participants: Patients with diagnosis of infertility and PCOS. Interventions: Between January 1995 and December 2007, 5640 clinical histories were reviewed, 181 patients had diagnosis of infertility and PCOS, and 59 met the admission criteria. Main outcome measures: Pregnancy and abortion. Results: Mean age was 27,5; 70% of the population not achieving pregnancy had a body mass index ≥ 25; testosterone was high in 15% of successful pregnancies and in 37,5% of the unsuccessful ones; 74,2% patients ovulated with clomiphene citrate, 52,4% achieved pregnancy and 16,7% presente...

The suggestive clinical characteristics of hyperandrogenism are very common problems in women and have been related with excessive androgen production from ovaries, suprarenal glands or both. The most common identifiable cause of androgen excess is the polycystic ovary syndrome. The virilizing tumors are rare. We report the case of a postmenopausal women with virilizing signs and a left anexial mass. Testosterone 4.3ng/mL (0.2-0.95); DHEAS 56ug/dL (35-430); androstenedione: 10ng/ml (0.4-2.7); Cortisol 16ug/dL. Testosterone post dexamethasone suppression test 3.5ng/mL. Ovarian steroid cell tumors secrete great quantities of testosterone or androstenedione and differ from Leydig cell tumors in that they lack crystals of Reinke. Usually, they are benign, but 20% of malignancy has been reported. They can produce different substances. The election treatment is oophorectomy. As in our p...