N Topalski-Fistes

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[The rate of polyploid fertilization of ovocytes in in vitro fertilization in patients with an increased ovarian response].

PubMed (1994)

Nada Tаbs M Bujas Kopitović N Topalski-Fistes

Polyploid fertilization is a common cause of human embryo's early loss in in vivo (1-2%) and in in vitro fertilization (3-5%) as well. Cause of increased rate of polypoid fertilization in in vitro fertilization is multifactorial. The aim of this paper was to establish if high ovarian response to exogenous hormone stimulation of ovaries can be one of the causes of increased incidence of polyploid fertilization. The research included 125 patients from whom 568 ovocytes were obtained by ultrasound aspiratory punction of ovarian follicles. The gathered results point to the fact that exogenous ovarian stimulation and the degree of ovarian response have a significant influence on increase of polyploid fertilization's rate. Thus, in the group of patients from whom 11 or more ovocytes were obtained, the rate of polyploid fertilization amounted to 11.3%, whereas it is statistically significantly higher (p < 0.01) in regard to those in whom less important difference in the rate of polyploid fertilization considering applied schemes of ovulation's stimulation (p > 0.1) was not established nor was it established considering the age of patients (p > 0.05). Despite the fact that the rate of polyploid fertilization in in vitro conditions is higher that in the natural conception, this method of treating marital infertility opens a unique possibility to identify all irregularities considering fertilization and prevent development of such embryos on time as it happens at the very beginning of the preimplantational stage of ovum's fertilization in laboratory conditions.

Polyploid

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[Infertility and endometriosis].

PubMed (1997)

N Topalski-Fistes M Bujas M Pjević T Vejnović

The goal of this study was to set the relation between infertility and endometriosis. It included 500 infertile female patients who underwent laparoscopy in order to find out the cause of infertility. The prevalence of endometriosis in these patients was 26%, that is significantly higher than in the control group which consisted of 200 randomly chosen fertile women in whom prevalence of endometriosis was 5%. Patients with endometriosis mainly belong to the group of 25-29 years of age with a median duration of infertility of 2-4 years. Endometriosis occurs three times more often in the group of patients with primary sterility than in patients with secondary sterility. Majority of patients (71.5%) are with minimal or mild endometriosis.

Primary infertility

Female infertility

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Endometriosis and pain

Medicinski pregled (2002)

N Topalski-Fistes Milana Maticki-Sekulic Vesna Kopitović Dunja Tabs

Introduction The main symptoms of endometriosis are pain, adnexal tumor and infertility. Pelvic pain and dysmenorrhea are cardinal symptoms as well as pain upon defecation, suprapubic pain (dysuria), pain during coitus and during gynecologic examination. Pain can be caused by fibrotic reaction of the adjacent tissue, adhesions, prostaglandins produced both in endometrium inside the uterus and ectopic endometrium, and also by increased macrophages in the peritoneal fluid. Material and methods 500 infertile patients underwent the procedure of laparoscopy in order to determine the cause of infertility. The control group comprised 200 fertile women. The presence of pain in the small pelvis was compared in two groups of patients: with or without endometriosis. Correlation of pain with the stage of disease and location of endometriotic implants in the small pelvis has also been investigated. Results Endometriosis was diagnosed by laparoscopy in 26% of infertile and 5% of fertile women. The difference was statistically significant (p<0.001). Dysmenorrhea was present in 46.92% of infertile women with endometriosis and in 48.68% of women without endometriosis. The difference was not statistically significant. Dysmenorrhea was present in 30% of fertile women and in relation to infertile women, the difference was statistically significant (p<0.05), no matter if they have endometriosis or not. In relation to stages of endometriosis (the revised classification of the American Fertility Society), there is no significant difference concerning dysmenorrhea. Dysmenorrhea occurred in the first stage in 48%, in the second stage in 44.19%, in the third stage in 50% and in the fourth stage in 44.44%. The correlation coefficient ranged from -8.85 to -0.89. The correlation existed, it was high, but negative. Sensitivity, specificity and prognostic value of symptoms of dysmenorrhea have been estimated in relation to endometriosis with following results: sensitivity was 47%, specificity 51% and the prognostic value i.e. the possibility of occurrence in patients with dysmenorrhea was 25%. Localization of endometriotic foci did not affect occurrence of pain symptoms.

Dysuria

10.2298/mpns0210415t

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[Immunologic characteristics of peritoneal fluid in endometriosis].

PubMed (1996)

N Topalski-Fistes Maja Bujas M Pjević T Vejnović Ana Djordjević

Increased volume of peritoneal fluid is found more frequently in patients with endometriosis (51%) than in infertile patients without endometriosis (13%). Immunologic analysis of the peritoneal fluid shows that in patients with endometriosis the level of immunoglobulin G (IgG) increases. We analyzed 34 samples of peritoneal fluid from patients with and 13 from patients without endometriosis. The mean value of IgG in the group of patients with endometriosis was 7.73g/L and 3.94g/L in the control group. This difference is statistically significant, but there is no statistically significant difference in regard to immunoglobulin A (IgA), while it has been significant for immunoglobulin M (IgM) only in the third stage of the disease. In certain stages of illness there are no statistically significant differences in values of all three immunoglobulin types. A golden standard of immunoglobulin G in peritoneal fluid is 5g/L and in regard to this level we calculated the following: sensitivity, specificity, prognostic value and accuracy of the test. Sensitivity and positive prognostic value reached 85.3%. On the basis of these findings it can be concluded that if no endometriosis can be seen during laparascopy while the volume of peritoneal fluid is increased, immunologic analysis should be performed. If IgG values are 5g/L or higher, the patient should be treated as a patient with possible "precursor endometriosis".

Peritoneal fluid

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[Hyperprolactinemia and disorders of the menstrual cycle].

PubMed (1999)

N Topalski-Fistes Maja Bujas Milana Maticki-Sekulic S Suvacarev

The authors presented physiological conditions associated with increased prolactin values (sleep, stress, hypoglycemia, nipples stimulation, pregnancy and lactation) as well as the causes of pathological hyperprolactinemia.The results of radioimmunoassay study have been analyzed in concern to the values of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL) obtained from the serum of 100 women with increased PRL levels. The "HOECHT" sets were used for the analysis, whereas the values up to 20.9 microgrammes per litre were rated normal. The patients were distributed into 4 groups in concern to the level of PRL increase: 1st group--twenty (n = 20) patients with PRL values from 21-29.9 micrograms/l, 90 blood samples analyzed; 2nd group-forty (n = 40) patients with PRL values f; 30-49.9 micrograms/l, 183 blood samples analyzed; 3rd group--twenty (n = 20) patients with PRL values from 50-99.9 micrograms/l, 83 blood samples analyzed; 4th group--twenty patients (n = 20) with PRL values more than 100 micrograms/l, 78 blood samples analyzed. The values of FSH and LH recorded in the women with hyperprolactinemia were compared with mean values of the same hormones presented in IU/l from the follicular phase of the cycle in the control group which comprised 50 women of reproductive age having normal ovulatory menstrual cycle.The mean values of FSH and LH in the 1st group have not presented with statistically significant difference in relation to the control group. Prevalence of menstrual disorders was 30%, which was statistically significantly higher than in general population. FSH values in the 2nd group were almost the same as in the control group whereas the values of LH were significantly higher. The rate of polycistic ovary syndrome (PCOS) in this group has been significant, also the increased rate of anovulatory cycles from 30 to 67.5%. A mild increase of menstrual cycle rhythm disorders, from 35 to 40% has been recorded. The values of FSH and LH in the 3rd group were significantly lower than in the control group. The significance level was higher for FSH (p < 0.01) then LH (p < 0.05). There was a sudden increase of the cycle rhythm disorders in this group reaching 90%. The 4th group presented with significantly lower values of FSH and LH in relation to the control group, whereas the cycle rhythm disorders occurred in all patients.The obtained results were compared with the literature data and some explanations given.The values of FSH an LH were statistically significantly lower in the 3rd and 4th group. The 2nd group was characteristic for the sudden increase of the number of anovulatory cycles from 30 to 67.5%, whereas the 3rd group presented with the abrupt increase of menstrual cycle rhythm disorders, from 40 to 90%.

Galactorrhea

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[Prolactin and the menstrual cycle].

PubMed (1999)

N Topalski-Fistes Maja Bujas Milana Maticki-Sekulic S Suvacarev

In order to estimate serum prolactin levels during particular menstrual cycle phases, the authors analyzed values of follicle-stimulating hormone, luteinizing hormone and prolactin in 50 women of reproductive age with normal menstrual cycles and established ovulation. Blood samples were taken 3-5 times during follicullar, ovulatory and lutheal phase of menstrual cycle. There were 582 radioimmunoassays performed (194 per each hormone), and the upper referent value for prolactin was 20.9 ug l. The 2nd group comprised women (250) with menstrual cycle disorders (olygomenorrhea and amenorrhea) in whom involvement of hyperprolactinemia in these conditions have been done. The obtained results showed that the mean prolactin value changed in each phase of the menstrual cycle. The highest one was recorded in the periovulatory period, whereas the difference was statistically significant in relation to the follicular and lutheal phase (p < 0.05). The difference between the follicular and lutheal phase was not statistically significant, 54 (21.6%) women from the group of menstrual cycle disorders presented with increased values of prolactin.

Menstruation

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