Hysterectomy is still the most common major operation performed by gynecologists. Having said that the incidence of hysterectomy has increased last 20 years with new minimally invasive technique. Laparoscopy assisted vaginal hysterectomy has advantage like small incision, less operative pain, quicker recovery, less hospital stay comparing to the abdominal open surgery. Objective: To compare the outcome of abdominal hysterectomy and laparoscopic vaginal hysterectomy.The study population comprised all patients who had LAVH and abdominal hysterectomy at First Maternity Hospital, from June 2013 to December 2014.The mean age of both group is same (46.2±5.3). Duration time of LAVH is approximately 2.30±-5.9minutes and of total abdominal hysterectomy is a 1.41±2.7 minute. The general blood loss during LAVH is 74.4±19 ml and during total abdominal hysterectomy is 185.2 ± 67 ml. After LAVH any patient had no complaints. After LAVH the patient stayed at the hospital for 3 days. LAVH took significantly longer operating time than TAH. Blood loss was jess during LAVH. Hospital stay after LAVH was less than TAH. Drug cost is more case LAVH.

About 10-15% of infertility among reproductive aged couples. According to the Centers for Disease Control, 1/3 of the women among 30 over aged, ½ of the women among 40 over aged women have infertility. Infertility rate is in Europe 10%,in USA 15%, in Russia 17 % (Speroff L. Endocrinology and Infertility. 2005). Female infertility is 45.6%, caused by damage to fallopian tubes is 61%, hormonal causes infertility is 30-40%. In Mongolia the report of study in 1997, infertility rate was 13.06%, report of IVF laboratory of Bayangol hospital infertility rate was 8-10% in 2010, the female infertility was 40-60%. We have first time to study female infertility risk factor among our gynecological department. Aim of study is to identify the some risk factor of female infertility We separated the women into 2 groups by fertile (normal 48 women and infertility 48 women). Hormonal findings was obtained from all women and had survey of questionnaire to risk factor. Statistical analysis did SPSS 20, data were given as mean±SD, the frequencies of the alleles and genotypes in patients and controls were compared with X2 analysis. Odds ratio (OR) and 95% confidence intervals were calculated.The mean age was 33.4±6.1 and mean years of infertility was 7.0±4.5. The primary infertility was 27.1% (n=13), secondary infertility was 72.9% (n=35). The 1.2% (n=15) were given birth, the 33.3% (n=16) had miscarriage and 58.3% (n=28) had abortion of total women. The mean BMI was 24.7±4.6 and 23% were overweight and 13% women were obesity among infertility women. The mean length of uterus was 5.1±1.1 sm, width was 4.0±0.8 sm, mean length of ovaries was 3.1±0.6 sm, mean width was 2.3±0.6 sm among infertility women. Also estradiol mean level was 41.6±22.1 pg/ml, FSH was 15.6±6.1mIU/ml, LH 5.5±1.7mIU/ml, and prolactin 14.4±10.6 ng/ml, progesteron mean level was 0.6±0.1 ng/ml among infertility women. These hormonal level was same in normal women. The risk factor of infertility were sexually transmitted disease (p=0.007, OR=7.667, CI 1.612-36.455), and curettage of uterus (p=0.024, OR=1.357, CI 1.156-1.1819). Secondary female infertility rate was (72.9%) and the women with STD 7.6 hold and women with previous had curettage of uterus will get 1.3 hold the risk of infertility.

Endometriosis is described as a chronic inflammatory disease, characterized by endometrial-like tissue, found outside the uterine cavity which cause chronic pelvic pain, infertility,dysmenorrhea. The prevalence of endometriosis is difficult to determine accurately but in asymptomatic women, the prevalence of endometriosis ranges from 2- 22 %, depending on the population studied , in infertile women 20-50 % and in those with pelvic pain, between 40-50% (Balasch, 1996; Eskenazi, 2001; Meuleman, 2009).Endometriosis is found 7-10% of reproductive agewomen and 20-90% in with chronic pelvic pain, infertility cases. Pathogenesis of endometriosis is not yet fully understood but one potential cause of the disease is retrograde menstruation which results in the deposition of endometrial tissue into the peritoneal cavity. Today a composite theory of retrograde menstruation with implantation of endometrial fragments in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted explanation for peritoneal endometriosis. Susceptibility to endometriosis is thought to depend on the complex interaction of genetic, immunologic, hormonal and environmental factors. To determine prevalence and severity of clinical symptoms, compare meta-analysis to changes the clinical value of serum CA-125 and peritoneal fluid cytology in women with endometriosis of Ulaanbaatar city. We had selected total of 60 woman with endometriosis which were registered from January to December 2014 in gynecologic clinic of First Maternity Hospital. The research group registered in questionnaire with 28 questions. During the inspection laboratory analysis of serum CA-125, ultrasound analysis and peritoneal fluid cytology were done. Assessment of pelvic pain by means of a 10-point linear analog scale / pain score/ which provided by International Pain Association. The research result was worked out by prospective method. Average age of patients 33.4±8.9. Pain location: Chronic pelvic pain 30%; Dysmenorrhea 28.3%; Dysparunea 10%; Pain during defecation 6,7%; Without pain -25%. Average level of Serum СА125 was 38.13±20.6. Location of endometriosis: adenomyosis - 8.4%, endometrioma-15% endometriotic lesion at cul de suc 68.3%, rectal involment 1.7%, tubal lesion-3.3%, combined 3,3%. 76.7% of surgery for endometriosis have done by laparoscopy and 23.3% by laparotomy. Ultrasound examination result: endometrioma d=0-2cm-1.7%, d= 3-5cm-36.2%, d=6-8cm-10.3%, d=9cm<-12.1%. Cytology result: Peritoneal fluid contains 75% of erythrocytes, mesothelial cells and it needs to further study.CONCLUSION:Most of patient /58.3%/ had chronic pelvic pain and dysmenorrhea. The severity of pain was significantly improved after operative laparoscopy. /p<0.05%/51,7% of patient had infertility problem.Value of serum CA-125 was higher in study group with large sized and not clear content ovarian endometrioma by ultrasound examination. /p<0.05%/The local environment of peritoneal fluid surrounding the endometriotic implant is immunologically dynamic and links the reproductive and immune systems. Peritoneal factors to stimulate cell growth is the most widely accepted explanation for peritoneal endometriosis. Peritoneal fluid contains a variety of free floating cells, including macrophages, mesothelial cells, lymphocytes, erythrocytes, eosinophils and mast cells. In our cytology results: peritoneal fluid contains 75% of erythrocytes, mesothelial cells.