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Tel Aviv, Israel

Haimov-Kochman R.,Hebrew University of Jerusalem | Haimov-Kochman R.,Women Health Center | Adler C.,Hebrew University of Jerusalem | Ein-Mor E.,Hebrew University of Jerusalem | And 2 more authors.
Israel Medical Association Journal | Year: 2012

Background: 'Religious (halachic*) infertility' results from precoital ovulation prior to immersion in a ritual bath (mikveh) 7 days after menstruation, as mandated by Jewish religious law. Previous authors recommended treatment with estradiol to postpone ovulation and enhance pregnancy rates. Objectives: To evaluate the prevalence of halachic infertility in an ultra-Orthodox Jewish community, and assess the efficacy of estradiol treatment in postponing ovulation and increasing pregnancy rates. Methods: We reviewed 88 cycles, of which 23 were control cycles and 65 estradiol-treated cycles, and analyzed the files of 23 women who were treated with 6 mg estradiol/day from day 1 for 5 days of the cycle. Results: The prevalence of precoital ovulation in the infertile population was 21%. Most of the patients (94%) ovulated before day 13 of the cycle. A short follicular phase due to low ovarian reserve or thyroid endocrinopathy was noted in 12% of the patients. While 64% of the women reported consultation with a Rabbinate authority, 68% of the patients sought medical therapy. Estradiol postponed ovulation for at least one day in 89% of the treatment cycles. Ovulation post-mikveh occurred in 73% of estradiol-treated cycles. The pregnancy rate was 12.5% per cycle and the cumulative pregnancy rate 35% per woman. Half the patients reported spotting during estradioltreated cycles, and this postponed coitus. Conclusions: Precoital ovulation is a major reason for infertility among observant couples attending fertility clinics. Estradiol treatment is effective in delaying ovulation and restoring fecundity; however, it causes some adverse effects that may decrease its effectiveness.

Kiran H.,Kahramanmaras Sutcu Imam University | Arikan D.C.,Kahramanmaras Sutcu Imam University | Arikan D.C.,Gazi University | Coskun A.,Kahramanmaras Sutcu Imam University | And 4 more authors.
Urologia Internationalis | Year: 2012

Introduction: Newly-weds choose to use contraception either to spend the first years of their marriage more freely, because of economic reasons or because of the increase in working career women. We studied the reasons for infertility and the rate of contraception use in the first years of marriage among couples with primary infertility and evaluated the use of a spermiogram as a screening test in newly-wed men. Subjects and Methods: In this cross-sectional study, 302 couples with primary infertility who were treated at our infertility clinic were included in the study. The couples were divided into 2 groups: group 1 (infertile couples who have used contraception) consisted of 67 couples and group 2 (infertile couples who did not use contraception) consisted of 235 couples. Results: Sixty-seven (22.5%) infertile couples stated that they had used no contraception in the first years of their marriage. In group 1, 35.8% of couples were diagnosed as having unexplained infertility, while 28.4% of them had male factor, 31.3% female factor and 4.5% a combination of male and female factor infertility. Sixteen men with male factor infertility used coitus interruptus (3-36 months) or condoms (6-12 months) unnecessarily. Conclusions: Infertility counseling in the early days of marriage and a spermiogram performed at that time could be beneficial for the newly-wed couples even if they do not want a child at the time. To perform a spermiogram as a screening test in all newly-wed men should be discussed. © 2011 S. Karger AG, Basel.

Davidesko S.,Ben - Gurion University of the Negev | Segal D.,Soroka Medical Center | Segal D.,Women Health Center | Peleg R.,Ben - Gurion University of the Negev
International Journal of Telemedicine and Applications | Year: 2014

Objective. To assess the use of cell phones and email as means of communication between pregnant women and their gynecologists and family physicians. Study Design. A cross-sectional study of pregnant women at routine followup. One hundred and twenty women participated in the study. Results. The mean age was 27.4 ± 3.4 years. One hundred nineteen women owned a cell phone and 114 (95%) had an email address. Seventy-two women (60%) had their gynecologist's cell phone number and 50 women (42%) had their family physician's cell phone number. More women contacted their gynecologist via cell phone or email during pregnancy compared to their family physician (P=0.005 and 0.009, resp.). Most preferred to communicate with their physician via cell phone at predetermined times, but by email at any time during the day (P<0.0001). They would use cell phones for emergencies or unusual problems but preferred email for other matters (P<0.0001). Conclusions. Pregnant women in the Negev region do not have a preference between the use of cell phones or email for medical consultation with their gynecologist or family physician. The provision of the physician's cell phone numbers or email address together with the provision of guidelines and resources could improve healthcare services. © 2014 Sharon Davidesko et al.

Selovic A.,Women Health Center | Sarac J.,Institute for Anthropological Research | Missoni S.,Institute for Anthropological Research
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2016

Objectives: To investigate changes in adipose tissue distribution using ultrasonography of the subcutaneous and preperitoneal adipose tissue during pregnancy.Methods: The sample included 400 pregnant women. The research was prospective and statistically designed as a controlled observation using a random sampling method. The adipose tissue was estimated by ultrasonography, five times during the pregnancy. The minimal thickness of the subcutaneous (Smin) and maximal thickness of the preperitoneal (Pmax) was obtained using the Suzuki method. Analysis of variance and the Bonferroni post hoc test for multiple comparisons were calculated.Results: Smin values have a decreasing trend, while Pmax values have an increasing trend, independent of the body mass index. No statistically significant differences in Smin and Pmax have been noted for the observed week intervals until the 20th pregnanacy week. Smin values for the week intervals 12 and 16, as well as for the Pmax week intervals 12, 16, and 20, were statistically significantly different when compared with the values obtained for the week intervals 32 and 37 (p < 0.05). No difference has been observed between nulliparous and multiparous pregnancies.Conclusion: The adipose tissue distribution during pregnancy shows a tendency towards a decreased accumulation of subcutaneous and increased accumulation of preperitoneal adipose tissue. © 2015 Taylor & Francis.

Bassal R.,Tel Aviv University | Bassal R.,Israel Center for Disease Control | Schejter E.,Women Health Center | Bachar R.,Women Health Center | And 7 more authors.
Archives of Gynecology and Obstetrics | Year: 2014

Purpose: This study describes the distribution and the trends of cervical abnormalities in Israel, based on Pap smear results. Methods: A retrospective analysis of cervical smears received by the Central Pathology Laboratory of Maccabi Healthcare Services between January 2005 and December 2010. Results: In total, 711,541 Pap smears were screened in the study period. Cytological abnormalities were observed in 4.78 % of the total smears screened. An increase was observed in the rate of positive results from 2.63 % in 2005 to 6.78 % in 2010 (p = 0.0026). The cervical abnormalities in the study period distributed as follows: atypical squamous cell (ASC) - 2.72 %, low-grade squamous intraepithelial lesion (LSIL) - 1.54 %, high-grade squamous intraepithelial lesion (HSIL) - 0.34 %, squamous cell carcinoma - 0.01 %, atypical glandular cells (AGC) - 0.10 %, adenocarcinoma in situ (AIS) - 0.06 % and invasive adenocarcinoma - 0.01 %. The increase was statistically significant for ASC (p = 0.0028), LSIL (p = 0.0069) and for HSIL (p = 0.0260). The mean ages at diagnosis of women with ASCUS, LSIL, HSIL, squamous cell carcinoma, AGC, AIS and adenocarcinoma were 37.8, 33.2, 38.6, 55.4, 41.1, 49.9 and 57.1 years, respectively. Conclusions: The increase in the rate of squamous cell abnormalities demonstrated in this study emphasizes the need of implementing an education and a screening program among Israeli women. HPV vaccine, sexual behavior, cytology performance and HPV test are primary and secondary prevention tools which may reduce morbidity and mortality in the future. In addition, based on the age at diagnosis of the different pathologies, the age group in which Pap test is performed in Israel should be expanded from 35-54 to 25-65 years. © 2013 Springer-Verlag Berlin Heidelberg.

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