Dragutin Sretenovic

Background: Infertility is a growing global public health concern associated with reduced quality of life and increased anxiety and depressive symptoms across diverse populations. However, factors influencing mental health in women undergoing infertility treatment remain insufficiently understood. This study aimed to assess psychological distress and identify factors associated with anxiety and depression in women receiving infertility treatment. Methods: A cross-sectional study was conducted at a leading regional infertility referral center. Women with confirmed infertility were consecutively recruited during routine visits. Psychological distress was assessed using the validated Patient Health Questionnaire-4. Demographic, reproductive, and clinical data were collected from self-report and medical records. Associations of infertility duration and age with comorbidities and other demographic variables were evaluated using appropriate parametric and nonparametric tests, and correlations were examined using Spearman’s rank coefficient. Results: The mean age was 34.9 ± 5.9 years and the median duration of infertility was 3 years. Nearly half of participants had mild psychological distress (49.3%), while 16.7% and 2.7% had moderate and severe distress, respectively; 32% screened positive for anxiety and 17.3% for depression. Longer infertility duration was significantly associated with higher depressive symptom scores, whereas other demographic and clinical variables showed no significant associations. Conclusions: Psychological distress is highly prevalent among women with infertility, with depressive symptoms increasing with longer infertility duration. These findings highlight the need for routine psychological screening and integration of mental health support into infertility care in clinical practice and long-term treatment planning, emphasizing a comprehensive, patient-centered approach to reproductive medicine.

Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN.