The Comparative Effects of Myo-Inositol and Metformin Therapy on the Clinical and Biochemical Parameters of Women of Normal Weight Suffering from Polycystic Ovary Syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a multisystem reproductive-metabolic disorder and the most common endocrine cause of infertility. The objective of our study was to determine the influence of myo-inositol (MI) on insulin resistance (IR), menstrual cycle regularity, and hyperandrogenism in women suffering from PCOS with normal BMI and diagnosed IR. METHODS: We performed a prospective randomized controlled trial (RCT) that included 60 participants with PCOS who had IR and a normal BMI. Two groups were formed. A group of thirty patients received MI, and thirty patients in the control group received metformin (MET). RESULTS: A statistically significant reduction in the area under the curve (AUC) of insulin values during the oral glucose tolerance test (OGTT) was recorded in both examined groups after the applied therapy with MI and MET. The regularity of the menstrual cycle in both groups was improved in >90% of patients. A statistically significant decrease in androgenic hormones (testosterone, SHBG, free androgen index-FAI, androstenedione) was recorded in both groups and did not differ between the groups. CONCLUSIONS: Both MI and MET can be considered very effective in the regulation of IR, menstrual cycle irregularities, and hyperandrogenism in women with PCOS.

Prevalence, Risk Factors, and Pathophysiology of Nonalcoholic Fatty Liver Disease (NAFLD) in Women with Polycystic Ovary Syndrome (PCOS).

Background: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women's reproductive period of life. The presence of nonalcoholic fatty liver disease NAFLD, one of the leading causes of chronic liver disease in the Western world, is increased in women with PCOS. This review aims to present current knowledge in epidemiology, pathophysiology, diagnostics, and treatment of NAFLD in PCOS with an emphasis on the molecular basis of development of NAFLD in PCOS women. Methods: Authors investigated the available data on PCOS and NAFLD by a MEDLINE and Pub Med search during the years 1990-2021 using a combination of keywords such as "PCOS", "NAFLD", "steatohepatitis", "insulin resistance", "hyperandrogenaemia", "inflammation", "adipose tissue", and "obesity". Peer-reviewed articles regarding NAFLD and PCOS were included in this manuscript. Additional articles were identified from the references of relevant papers. Results: PCOS and NAFLD are multifactorial diseases, The development of NAFLD in PCOS women is linked to insulin resistance, hyperandrogenemia, obesity, adipose tissue dysfunction, and inflammation. There is the possible role of the gut microbiome, mitochondrial dysfunction, and endocannabinoid system in the maintenance of NAFLD in PCOS women. Conclusions: There is a need for further investigation about the mechanism of the development of NAFLD in PCOS women. New data about the molecular basis of development of NAFLD in PCOS integrated with epidemiological and clinical information could influence the evolution of new diagnostic and therapeutic approaches of NAFLD in PCOS.

[Poor Ovarian Response to Stimulation for In Vitro Fertilization].

The term "poor respond (POR) patients" is used for the group of women who respond badly to usual doses of gonadotropins in in vitro fertilization (IVF) treatments; the consequence is low pregnancy rate. A consensus was reached on the minimal criteria needed to define POR. At least two of the following three features must be present: 1. advanced maternal age (40 years or more) 2. previous POR (3 or less oocytes with a conventional stimulation protocol) 3. abnormal ovarian reserve (AMH 0.5-1.1 ng/ml or AFC 5-7).The aim is to find better therapeutic options for these patients. Increased levels of day 3 follicle stimulating hormone (FSH) and estradiol (E2), as well as decreased levels of anti-Müllerian hormone (AMH) and antral follicle count (AFC), can be used to assess ovarian reserve, as indirect predictive tests. A larger number of well designed, large scale, randomized, controlled trials are needed to assess the efficacy of different management strategies for poor responders: flare up gonadotropin releasing hormone (GnRH) agonist protocols, modified long GnRH agonist mini-dose protocols, luteal initiation GnRH agonist stop protocol, pretreatment with estradiol--GnRH antagonist in luteal phase, natural cycle aspiration or natural cycle aspiration GnRH antagonist controlled, adjuvant therapy with growth hormone or dehydroepiandrosterone (DHEA). The results of up to now used protocols are unsatisfactory and stimulation of the ovulation in poor responders remains a challenge, especially when bearing in mind that in the majority of cases the patients will be menopausal in relatively short period of time.

Fetal free thyroxine concentrations in pregnant women with autoimmune thyroid disease.

CONTEXT: Fetuses from mothers with autoimmune thyroid disease (AITD) may be affected by antithyroid antibodies, antithyroid drugs, and iodine. OBJECTIVE: The study correlated fetal free T(4) (fT4) with fetal ultrasound parameters and maternal thyroid function, thyroid antibodies, and medication dose from mothers with AITD. DESIGN AND SETTING: The study was designed as a prospective cohort study and conducted in an academic referral center. PATIENTS: Eighty-three of 85 women with AITD completed the study; 38 were treated for hyperthyroidism and 25 for hypothyroidism, and 20 were euthyroid. MAIN OUTCOME MEASURES: Outcomes were as follows: 1) fetal-fT4, TSH, ultrasound parameters (morphology, biometrics, heart rate); and 2) maternal-fT4, TSH, antithyroid drug dose, and antithyroid antibodies, thyroid peroxidase and TSH receptor (TRAK). Parameters were determined at the same time, between the 22nd and 33rd wk gestation. RESULTS: A total of 48.3% of fetuses from hyperthyroid mothers, 60% of fetuses from hypothyroid mothers, and 10% of fetuses from euthyroid mothers had elevated fT4 levels (P = 0.006). In hypothyroid mothers, the presence of both thyroid antibodies was related to fetal hyperthyroidism, whereas absence was related to fetal euthyroidism (P = 0.019). Hyperthyroid mothers (TRAK-positive, thyroid peroxidase-negative) with hyperthyroid fetuses had significantly higher mean TRAK than hyperthyroid mothers with euthyroid fetuses (13.7 vs. 3.7 IU/liter; P = 0.02). Fetal fT4 correlated weakly negatively with maternal TSH within the normal range, but not with ultrasound parameters or with antithyroid drug dose. CONCLUSION: High fetal fT4 levels were unexpectedly frequent in women with AITD, including maternal autoimmune hypo- and hyperthyroidism. Further studies are needed, as well as noninvasive methods to assess fetal thyroid function.

Hysterectomy throughout history.

Hysterectomy, which is one of the most common surgeries performed on women, dates back to ancient times. The history of hysterectomy comprises biographies of many humble men and the significant individual efforts that they made to fight the skepticism of the medical communities of their times. Many of the pioneers were ignored. Although there are a number of alternatives to hysterectomy available, it remains one of the most frequently performed gynaecological operations. The introduction of antisepsis, anaesthesia, antibiotics and blood transfusion made hysterectomy a safe procedure. Nowadays, we distinguish three different surgical approaches to hysterectomy: vaginal, abdominal and laparoscopic. The limitations of conventional laparoscopy have led to the development of robotic surgery, which has evolved over the past decade from simple adjustable arms to support cameras in laparoscopic surgery to more sophisticated four-armed machines now being in use worldwide.

[Exogenous luteinizing hormone for assisted reproduction techniques in poor response patients].

BACKGROUND/AIM: Two gonadotrophins, two cell theory refers to necessity of both gonadotrophin activities for theca and granulose cells steroidogenesis of dominant follicle. The aim of this study was to determine the influence of recombinant LH in women qualified as poor responders in the first assisted reproduction procedure (IVF), on fertility results, expressed as percentage of clinical pregnancies. METHOD: The study included 12 women, 35 years and older who were their own controls. The next trial of IVF was with the same dose of recombinant FSH and GnRH agonist, and with the same, long protocol. Recombinant LH was added in the dose of 75 IU from the 2nd to 7th day of the cycle, and 150 IU from the 8th day of the cycle to the aspiration of oocytes. RESULTS: Within the two different protocols: there was no significant difference between LH concentration in 8th and 12th day of cycle; there was no significant difference between E2 concentration on day 2nd and day 8th; there was a significant difference between E2 concentrations on day 12th; endometrial thickness was not significantly different on the day of aspiration, neither was the number of follicles and embryos. In the two patients, clinical pregnancy was detected (pregnancy rate 17%), and they delivered in term. So, a statistically significant difference between the two protocols was in the rate of clinical pregnancies. CONCLUSION: The patients with low response to a long protocol in IVF procedures had significantly better results according to the clinical pregnancy rate when the recombinant LH was added to recombinant FSH in the stimulation protocol.

Transvaginal repair of genital prolapse with polypropylene mesh using a tension-free technique.

OBJECTIVES: To assess the perioperative complications and short-term outcomes of prolapse repair using transvaginal polypropylene mesh. STUDY DESIGN: Retrospective study. In the period from April 2007 to September 2009, 67 women underwent vaginal repair with implantation of a soft mesh manufactured by Gynecare. RESULTS: All the patients had a stage 3 or stage 4 prolapse. Total mesh was used in eight patients (11.9%), isolated anterior mesh in 36 patients (53.7%) and isolated posterior mesh in 23 patients (34.4%). We reported one intraoperative bladder injury and no other serious complications. At 3 months, all the 67 patients were available for follow-up. Vaginal erosion occurred in eight patients (11.9%), shrinkage of mesh in six patients (8.7%), granuloma without exposure in four patients (5.9%), de novo urinary incontinence in three patients (4.5%) and flatus incontinence in one patient (1.5%). Failure rate was 7.5% (recurrent prolapse stage 3 or 4, even asymptomatic). CONCLUSION: Our study suggests that transvaginal polypropylene mesh applied with a tension-free technique is a safe and effective method with low intraoperative complications but with considerable potential postoperative morbidity.

[Maternal autoimmune thyroid disease and pregnancy complication].

BACKGROUND/AIM: Thyroid disorders exert a great impact on pregnancy course and outcome. The aim of the study was to investigate impact of autoimmune thyroid disorders on pregnancy course and outcome, frequency of pregnancy complications and pregnancy loss. METHODS: We followed 63 pregnancies prospectively during the period 1985-2007, 28 with hyperthyroid and 15 with hypothyroid autoimmune disorders, and 20 healthy pregnancies. Follow up included clinical, sonographic and laboratory investigations, including OGTT and postprandial glicemia. RESULTS: There was no difference between previous preterm and term labor in the observed groups (chi2 = 2.309; p > 0.05). Analysis of previous early pregnancy loss showed no significance (chi2 = 4.918; p > 0.05), including varieties of spontaneous and missed abortion (Fisher, p < 0.05). The hypothyroid patients developed gestational diabetes more frequently than the controls (chi2 = 7.638; p = 0.022), which is not the case with hyperthyroid patients (chi2 = 1.078; p > 0.05), or between the groups with thyroid disorders (chi2 = 3.619; p > 0.05). There was no difference among the groups in developing pregnancy-induced hypertension (chi2 = 1.953; p > 0.05). CONCLUSIONS: Controlling thyroid diseases reduces pregnancy complications. Development of gestational diabetes in hypothyroid patients requires controlling glycoregulation in all pregnant women with hypothyroidism.