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We report herein findings on 181 patients, suffering from pelvic endometriosis confirmed by histology, whose main symptom was chronic pelvic pain (CPP). They attended the outpatient clinic at the 1st Department of Obstetrics and Gynaecology, Semmelweis University in Budapest, between 1 January 1995 and 1 January 2000. The extent of pelvic endometriosis was determined on the basis of the 1985 revised scoring system of the American Fertility Society (R-AFS). The short form of the McGill pain questionnaire was used for the evaluation of CPP. After the first operative intervention, therapy with a gonadotropin-releasing hormone (GnRH) analog was given for 6 months. Second-look laparoscopy was performed 8-10 weeks after the end of GnRH-analog treatment, which was followed by a non-conventionally administered, monophasic oral contraceptive (OC) treatment. In the long term, 118 patients received the non-conventionally administered, monophasic OC treatment, which contained a third-generation progestogen, to be taken continuously for at least 6 months. The other 63 patients who did not receive OC treatment for one reason or another were evaluated as a control group. We analyzed data on CPP before the first surgical intervention, then following therapy with the GnRH analog at the second-look operation, and then after 6, 12, 18 and 24 months. We also reviewed potential causes of CPP, especially focused on endometriosis. No correlation was found between the stage of endometriosis according to R-AFS score and the severity of CPP. At the 24-month follow-up after second-look laparoscopy, the non-conventionally administered monophasic OC treatment was found not only to significantly reduce pain scores, but also the required radical operative solution (hysterectomy plus bilateral adnexectomy) for CPP by OC users.

We present three rare cases of intestinal endometriosis. The patients were treated at the Endometriosis Clinic of the 1st Dept. of Obstetrics and Gynecology of the Semmelweis University, Budapest. Their main symptom besides the classic symptoms of endometriosis (dysmenorrhea, dyspareunia, pelvic pain) was the catamenial haematochesia--a subacute obstruction which became more intensive in the perimenstrum and needed medical treatment but no surgical intervention. Because of the recurrent complaints, after detailed check-up and biopsy of the obstructing intestinal endometriosis, anterior resection of the rectum was performed with endocoagulation or extirpation of other endometriosis implants of the pelvis. Depending on the severity of pre or postoperative complaints patients underwent a GnRH-analogue therapy for six months. In one patient because of the patient's age, and extensive retrocervical-deep endometriosis causing serious dyspareunia--the resection was performed with additional hysterectomy and adnexectomy (TAH). Recently the patient is on monophasic hormone replacement therapy. In the two other patients after a second-look laparoscopy with testing the lumen of the tubes treatment was started for the induction--because of infertility. We give an overview of the frequency, incidence and possible pathomechanism of pelvic endometriosis. We describe the modern diagnostic and therapeutic tools of pelvic endometriosis.

Objective: To predict pregnancy outcome and multiple gestation using a common parameter by which hCG values are made comparable independently of the day of blood sampling., Design: Retrospective study., Setting: University-based IVF program., Patients: One hundred twenty IVF pregnancies conceived between November, 1995 and August, 1999., Interventions: None., Main Outcome Measures: Early pregnancy loss (preclinical and first trimester abortions, ectopic pregnancies) or ongoing pregnancies (singleton and multiple deliveries, second trimester abortions). Day 11 hCG levels were calculated assuming an exponential increase of hCG values in early pregnancy. Receiver-operating characteristic analysis was used to determine cut-off levels with the best sensitivity and specificity for the prediction of pregnancy outcome., Results: Serum hCG levels in the group of early pregnancy loss were significantly lower than in ongoing pregnancies. A cut-off level of 50 IU/L predicts pregnancy outcome with a sensitivity of 75% and a specificity of 81%, while an hCG value >135 IU/L predicts a multiple ongoing pregnancy with a sensitivity of 80% and a specificity of 88%., Conclusion: After IVF, early pregnancy loss or multiple gestation may be predicted with high sensitivity and specificity by using cut-off values of serum hCG derived from two measurements independently of the day of blood sampling.

Background: Hyperreactio luteinalis rarely occurs in normal singleton pregnancy. About 50 such cases have been published. This case is noteworthy because it resulted in extremely enlarged ovaries and was accompanied by a hyperandrogenic state and high level of human chorionic gonadotropin., Case: A gravida was referred to our department because of large, bilateral, cystic ovaries diagnosed by ultrasonography in the 28th week of gestation. Markedly elevated levels of androgens and human chorionic gonadotropin were noted. During the following six weeks the ovarian masses enlarged, and the hyperandrogenic state worsened. Cesarean section and, because of a bleeding right adnexectomy, left ovarian resection were performed. Histology confirmed the presumed diagnosis of hyperreactio luteinalis. The placenta was unremarkable. Seventeen weeks after surgery the hormone levels were normal., Conclusion: Our case suggests the possibility that in certain cases of hyperreactio luteinalis, an idiopathic elevation of human chorionic gonadotropin, can occur even in normal singleton pregnancies. Furthermore, it calls attention to the necessity of ultrasonographic demonstration of ovaries even during late pregnancy.