P–497 Anxiety, depression and sexual dysfunction among women with genital diseases

Study question

How is the prevalence of anxiety, depression and sexual dysfunction among Chinese women who is suffering from genital diseases? What is the relationship among their anxiety, depression and sexual dysfunction?

Summary answer

Anxiety, depression and sexual dysfunction symptoms were self-reported by the participants. Besides, their anxiety, depression and sexual dysfunction were inter-correlated.

What is known already

Reduced sexual activity and dysfunctional problems are highly prevalent in females. Approximately 43% of American women reported experiencing sexual problems.

Women who are facing pressure on childbirth, may be more likely to have mental health problems. Some studies have shown that having gynecological disease can lead to anxiety, depression and sexual dysfunction. However, the mental health of females who are suffering from genital diseases has been little studied.

Study design, size, duration

The investigation was carried out from March to November, 2020. Participants were recruited in the Hong Kong University-Shenzhen Hospital, located in Shenzhen, China. 135 patients were approached while 116 agreed to join the survey.

Participants/materials, setting, methods

116 women (35.42±8.19 years old) with a diagnosis of fallopian tube disease, ovarian benign disease or uterine disease voluntarily filled a questionnaire which contains the Female Sexual Function Index–6 Items (FSFI–6) and the Hospital Anxiety and Depression Scale (HADS). Descriptive analysis and stepwise regression were used to present participants’ self-reported anxiety, depression, and sexual dysfunction problems, as well as the relationship among their anxiety, depression, and sexual dysfunction.

Main results and the role of chance

25% of the participants reported anxiety symptoms; 9.5% of the women reported depressive symptoms; while 37.3% reported sexual dysfunction problems. Anxiety (p < 0.001) was significantly associated with depression. Depressive symptom can significantly predict sexual dysfunction (p < 0.05) while anxiety was not associated with sexual dysfunction (p > 0.05). Targeted interventions are needed to improve the mental health status of women with genital diseases in China.

Limitations, reasons for caution

This study can only present mental health status of this population. To better show the odds ratio of mental health problems, a case-control study design is needed. Besides, future qualitative or longitudinal studies are needed to detect the risk factors for the poor mental health of women with genital diseases.

Wider implications of the findings: Reduced sexual activity and dysfunctional problems are highly prevalent in females with genital diseases. Sexuality is an important element in patients’ quality of life. For female patients with genital diseases, we should not only treat their physical symptoms, but also guide and treat patients in mental ways.

Trial registration number

ChiCTR2000031343

Comparison of antral follicle count and serum anti Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial

OBJECTIVE

To compare the proportion of women achieving a desired ovarian response following ovarian stimulation when gonadotropin dosing was determined based on antral follicle count (AFC) vs serum anti-Müllerian hormone (AMH) level, in women undergoing in-vitro fertilization (IVF) using the gonadotropin-releasing hormone (GnRH) antagonist protocol.

METHODS

This was a randomized double-blind trial carried out in a university-affiliated assisted reproduction unit. A total of 200 women undergoing their first IVF cycle using the GnRH-antagonist protocol between April 2016 and February 2018 were randomized to determination of gonadotropin dosing based on either AFC or serum AMH level measured in the pretreatment cycle 1 month before the IVF cycle. Patients underwent IVF as per our center's standard protocol. The proportion of subjects achieving a desired ovarian response, defined as retrieval of six to 14 oocytes, was compared between the two study arms. Subgroup analysis of patients with baseline AFC > 5 and those with baseline AFC ≤ 5 was performed. Concordance in AFC and AMH categorization between the pretreatment cycle and the ovarian-stimulation cycle was assessed using Cohen's kappa (κ).

RESULTS

There was no significant difference in the proportion of patients achieving a desired ovarian response between the AFC (54%) and AMH (49%) groups (P = 0.479). The median number of oocytes retrieved was nine vs seven (P = 0.070), and the median follicular output rate was 0.54 vs 0.55 (P = 0.764) in the AFC and AMH groups, respectively. Similar findings were observed on subgroup analysis of subjects with AFC ≤ 5 and AFC > 5 at the start of ovarian stimulation (P > 0.05 for all comparisons). There was moderate concordance between AFC and AMH measured in the pretreatment cycle and the stimulation cycle (κ = 0.478 and 0.587, respectively).

CONCLUSION

The proportion of women achieving a desired ovarian response following ovarian stimulation using the GnRH-antagonist protocol is similar when the gonadotropin-dosing algorithm used is based on AFC or serum AMH level. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Updated status of assisted reproductive technology activities in the Asia-Oceania region

AIM

To report on a descriptive survey on the availability, regulation and funding issues of assisted reproductive technology (ART) activities in member countries of the Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG).

METHODS

A survey questionnaire was initially sent out to representatives of the 28 member national societies of AOFOG in 2015, and final verification and compilation of data were completed in November 2017.

RESULTS

A response was received from 24 countries. Artificial insemination and in vitro fertilization treatments were available in 23 and 22 of them respectively. Of the 23 responding countries where ART activities were carried out, these were governed by legislation or national regulations in 12 of them, and 15 had a national registry, to which reporting was compulsory in 11 of them. Only Australia, Nepal, New Zealand and Saudi Arabia allowed ART treatment for both single men and women, while only Australia and New Zealand allowed ART treatment for homosexual couples. In Vietnam, ART treatment was allowed only for single women (but not men) from the same country. In Israel, only single or homosexual women but not men were allowed to receive ART treatment. Government subsidy was available for artificial insemination and in vitro fertilization treatments in 10 and 9 responding countries respectively. Compensation to gamete donors and surrogate mothers were allowed in some countries, mostly on the basis of covering the medical treatment cost and compensation for leave from work.

CONCLUSION

There is great diversity in the availability of various forms of ART treatments, their regulations and data-monitoring mechanisms, as well as funding issues, among Asian-Oceanic countries. Availability of ART activities involving donor gametes or surrogacy, or those for nonheterosexual unions, is still limited in this region.

Screening for dysglycaemia by oral glucose tolerance test should be recommended in all women with polycystic ovary syndrome

STUDY QUESTION

Should fasting glucose (FG) or an oral glucose tolerance test (OGTT) be used to screen for dysglycaemia in women with polycystic ovary syndrome (PCOS)?

SUMMARY ANSWER

A full OGTT should be recommended as the screening method for dysglycaemia in women with PCOS, regardless of BMI or family history of diabetes mellitus (DM).

STUDY DESIGN, SIZE, DURATION

A cross-sectional study on 467 Chinese women diagnosed with PCOS by the Rotterdam criteria between January 2010 to December 2013.

PARTICIPANTS, SETTING, METHODS

The study was done at a university hospital in Hong Kong. All subjects underwent a 75 g OGTT after overnight fasting. We evaluated the performance of FG alone, when compared with the full OGTT, in identifying subjects with dysglycaemia (prediabetes or DM, according to the 2010 diagnostic criteria of the American Diabetes Association).

MAIN RESULTS AND THE ROLE OF CHANCE

Of the 467 subjects, 58 (12.4%) had dysglycaemia, among which 46 (9.8%) had prediabetes and 12 (2.6%) had DM, including 4 with known DM. Of the 46 subjects with prediabetes, 25 (54.3%) had normal FG and of the 8 subjects with screened DM in this study, 1 (12.5%) had normal FG. The sensitivity of FG alone in screening for prediabetes, DM and overall dysglycaemia were 45.7, 87.5 and 48.1%, respectively, i.e. missing 54.3% of prediabetes and 12.5% of DM cases as defined by the OGTT. Among the 54 subjects with screened dysglycaemia, 20 (37.0%) had BMI < 25 kg/m(2) and 35 (64.8%) had no family history of DM.

LIMITATIONS, REASONS FOR CAUTION

We only reported on the biochemical diagnosis of DM based on a single time point. In clinical practice, confirmatory results at another time point is required for definitive diagnosis in asymptomatic subjects.

WIDER IMPLICATIONS OF THE FINDINGS

There is an ongoing debate as to whether FG or an OGTT should be used as a screening method for dysglycaemia in women with PCOS. Some guidelines also recommend glucose screening only in those who are overweight and/or having family history of diabetes (DM). There have been scarce data on this issue in the Chinese population, which the current study aims at addressing.

STUDY FUNDING/COMPETING INTERESTS

The study was supported by a research grant from the Hong Kong Obstetrical and Gynaecological Trust Fund, as well as internal research funding of the Department of Obstetrics and Gynaecology, The University of Hong Kong. All authors have no competing interests.

Role of baseline antral follicle count and anti-Mullerian hormone in the index stimulation cycle of IVF treatment in predicting outcome of subsequent frozen-thawed embryo transfers

This retrospective cohort study aims at determining whether baseline antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) level in the index stimulation cycle predict live-birth outcome in subsequent frozen-thawed embryo transfer (FET) cycles. We studied 500 women undergoing the first IVF cycle who had embryo(s) cryopreserved. The main outcome measures were live-birth in the first FET cycle and cumulative live-birth in all the FETs combined after the same stimulation cycle. Our results showed that baseline AFC and AMH level on the day before ovarian stimulation showed significant correlation. In the first FET cycle, AFC and AMH level were significantly higher in subjects attaining live-birth in the first FET cycle or cumulative live-birth from all FETs than those who did not. Both AMH and AFC were insignificant predictors of live-birth in the first FET cycle or cumulative live-birth after adjusting for age. The areas under the ROC curves for AMH, AFC and age were 0.654, 0.625 and 0.628, respectively, for predicting cumulative live-birth. In conclusion, we reported for the first time that baseline AFC and AMH in the index stimulation cycle have only modest predictive performance on cumulative live-birth in subsequent FET cycles.

Possible role of adrenomedullin in the pathogenesis of tubal ectopic pregnancy

CONTEXT

Tubal ectopic pregnancy (tEP) is currently the leading cause of pregnancy-related deaths during the first trimester. Our current knowledge on the molecular pathogenesis is limited.

OBJECTIVE

The objective of the study was to find out the possible role of adrenomedullin (ADM) in the pathogenesis of tEP.

DESIGN

This was an experimental in vitro study on oviductal tissue.

SETTING

The study was conducted at a university teaching hospital.

PATIENTS AND INTERVENTIONS

Patients included those having oviducts removed surgically during salpingectomy for tEP or hysterectomy for benign gynecological conditions. Oviductal tissues were incubated in hormonal condition mimicking early pregnancy before used for in vitro experiments.

MAIN OUTCOME MEASURES

Plasma ADM concentration, oviductal expression of ADM and its receptors, ciliary beat frequency, smooth muscle contraction were measured.

RESULTS

The ciliary beat frequency and frequency of muscle contraction were lower in the oviducts from patients with tEP than those from simulated normal pregnancy. The plasma and oviductal tissue ADM levels were also lower. The decreases in ciliary beat and frequency of contraction were restored to normal after ADM treatment.

CONCLUSIONS

The results suggest that the lower ADM level in the oviducts of tEP may lead to the decrease in ciliary beating and muscle contraction, with the result that the embryo is retained and implanted in the oviduct. Our findings explain for the first time the etiology of tubal pregnancy on the basis of an impairment of the transport of the fertilized ovum resulting from an ADM deficiency and raise the possibility of using the plasma ADM level as a predictor for tubal ectopic pregnancy.

Gonadotrophin ovulation induction is a successful treatment for World Health Organisation Group II anovulatory subfertility in women aged up to 40 and with body mass index up to 34

Gonadotrophin-induced ovulation (GnOI) is generally an effective treatment when anti-estrogen therapy is unsuccessful. It remains uncertain how appropriate it is in older and obese women. We carried out an analysis of a GnOI programme between 2000 and 2008, including 514 treatment cycles in 140 women with World Health Organisation Group II anovulation. A low-dose step-up stimulation protocol using recombinant follicle stimulating hormone (FSH) (with natural intercourse) was used throughout in the treatment of women aged up to 40 years and with body mass index (BMI) up to 34 kg/m(2), with a rigorously-applied cancellation criterion. The livebirth rates in first stimulated cycle and cumulatively over six cycles (or until pregnancy) were 19.2% and 74.2%, respectively and the multiple livebirth rate was 2.5%. There was no significant relationship between age and BMI with pregnancy rates, although higher BMI was associated with higher threshold dose and longer duration of stimulation. Anti-estrogen resistant patients attained significantly higher cumulative ongoing pregnancy rates than those who were anti-estrogen responsive. These data demonstrate that judicious administration of gonadotrophins to women with WHO Group II anovulatory subfertility can result in a good pregnancy rate with low risk of multiple pregnancy in women aged up to 40 years and with BMI of up to 34 kg/m(2).

Anti-mullerian hormone and cumulative pregnancy outcome in in-vitro fertilization

PURPOSE

To evaluate the role of Anti-mullerian hormone (AMH) in predicting cumulative pregnancy outcome during in-vitro fertilization (IVF) treatment.

METHODS

Serum AMH levels on day 6 of ovarian stimulation were taken from 180 women undergoing IVF with or without intracytoplasmic sperm injection (ICSI). The main outcome measures were ongoing pregnancy in the fresh cycle, cumulative ongoing pregnancy and ovarian response.

RESULTS

There was a trend of higher median AMH levels in subjects achieving ongoing pregnancy in the fresh IVF cycle. The median AMH levels were significantly higher in subjects attaining ongoing pregnancy cumulatively and in subjects showing ovarian hyper-response in the stimulated cycle. Areas under the ROC curves were 0.606 and 0.792 for the prediction of cumulative ongoing pregnancy and ovarian hyper-response respectively.

CONCLUSIONS

Serum AMH concentration on day 6 of stimulation was significantly higher in subjects who achieved cumulative ongoing pregnancy in IVF compared to those who did not. Serum AMH is a reasonably good predictor of ovarian hyper-response.

Expression of maspin in gestational trophoblastic disease

BACKGROUND

Maspin is a tumor suppressor gene whose expression is altered in neoplasia and malignancies of many tissues. In the human placenta, the maspin gene is expressed in trophoblastic cells and might act as an inhibitory regulator of trophoblastic invasion. Hence, in gestational trophoblastic disease (GTD), where there is increased propensity for invasion in the trophoblastic tissue, we hypothesized that maspin expression would be decreased. The present study aimed at investigating the expression of maspin in GTD and its prognostic significance.

METHODS

Using immunohistochemical staining, we firstly studied the expression of maspin in hydatidiform moles, with gestational age-matched normal first trimester placenta used as control. A total of 38 cases of hydatidiform moles were studied, including 20 complete moles (CM) and 18 partial moles (PM). Among them, 10 cases of the CM group and 8 cases of the PM group subsequently developed gestational trophoblastic neoplasia (GTN). Immunostaining was also performed on tissue from 4 cases of choriocarcinoma and 5 cases of placental site trophoblastic tumor. Reverse transcriptase-polymerase chain reaction (RT-PCR) was further performed on RNA extracted from 10 hydatidiform moles (5 with GTN and 5 without) and 6 normal first-trimester placentae.

RESULTS

In all tissue sections, nuclear expression of immunostaining signal was demonstrated, mainly in the cytotrophoblasts. The percentage of trophoblastic nuclei stained in both complete and partial moles was significantly lower than that in normal first-trimester placenta (P < 0.001). However, there was no significant difference in immunostaining between complete and partial moles (P > 0.05). There was also significantly lower expression of maspin in those cases subsequently developing GTN than those which did not (P = 0.01). Immunostaining on choriocarcinoma and placental site trophoblastic tumor showed reduced expression of maspin in all the tumor cells. Reverse transcriptase-polymerase chain reaction revealed that the expression of maspin was consistently down-regulated in all the hydatidiform mole samples.

CONCLUSIONS

Our results suggest that there is down-regulated expression of maspin in gestational trophoblastic diseases, and the down-regulation is more prominent in cases developing gestational trophoblastic neoplasia. This may play a role with prognostic significance in the pathogenesis and malignant transformation of hydatidiform moles.

Effect of local lignocaine gel application for pain relief during suction termination of first-trimester pregnancy: a randomized controlled trial

BACKGROUND

This study evaluated the effectiveness of local lignocaine gel application in pain control during first-trimester suction termination of pregnancy (STOP).

METHODS

In this prospective randomized placebo-controlled double-blind trial, 131 women undergoing STOP between 7 and 10 weeks of gestation were studied. They were computer-randomized to receive 2% lignocaine gel or placebo (KY Jelly) locally applied to the cervix 1 min before cervical manipulation/dilatation. They all had cervical priming with misoprostol and premedication with diazepam and pethidine. Pain scores on a verbal analogue scale preoperative, at cervical manipulation/dilatation, intraoperative and 1 h post-operative, as well as the patients' satisfaction level towards pain control, were compared.

RESULTS

The lignocaine gel group had significantly reduced overall intraoperative pain score compared with placebo group (P = 0.021). No significant difference in pain score between the two groups was demonstrated at other time points. Subgroup analysis revealed that the difference in overall intraoperative pain scores between the two groups was evident in the multiparous (P = 0.015) but not the nulliparous subjects.

CONCLUSION

The use of local lignocaine gel application reduces overall intraoperative pain in multiparous women undergoing first-trimester STOP preceded by misoprostol cervical priming and premedication for conscious sedation.