Obesity is not a descriptive factor for oxidative stress and viscosity in follicular fluid of in vitro fertilization patients.

BACKGROUND: Obesity's impact on micro-environmental oxidative stress and follicular fluid (FF) viscosity and whether or not it has any effect on in vitro fertilization (IVF) success is a matter of debate. AIMS: In this study, our aim was to evaluate the levels of oxidative stress markers and the FF viscosity in obese and non-obese patients. METHODS: Eighty norm-responder patients undergoing IVF were prospectively grouped according to their body mass indexes (BMI). Group 1 (n = 40) and group 2 (n = 40) had BMI values of ≤24.9 and ≥25.0, respectively. Total sulfhydryl (RSH) levels (nmol/m) and the formation of thiobarbituric acid-reactive substances (malondialdehyde, or MDA) (µmol/ml) in FFs were quantified. For the first time in our study, FF viscosity with changing BMI values was also determined. RESULTS: The mean levels of MDA (µmol/ml) and RSH (nmol/ml) were not significantly different between groups (1.37 ± 0.51; 1.51 ± 0.51; p > 0.05 for MDA and 0.42 ± 0.30; 0.41 ± 0.20; p > 0.05 for RSH, respectively). Similarly, the FF viscosity (centipoise) was not different between groups (1.28 ± 0.28; 1.30 ± 0.19; p < 0.05, respectively). Independent of BMI, no correlation was found between FF levels of oxidative markers and the number of oocytes retrieved or the fertilization rates. CONCLUSIONS: In our study, we found no difference in the levels of follicular oxidative and anti-oxidative markers or the follicular fluid viscosity with changing BMI values. We also demonstrated that the levels of oxidative stress markers and the viscosity of follicular fluid did not affect clinical outcomes.

Does adenosine deaminase activity play a role in the early diagnosis of ectopic pregnancy?

Early diagnosis of ectopic pregnancy (EP) is important due to life-threatening consequences in the first trimester of pregnancy. In this study we aimed to investigate the role of adenosine deaminase (ADA) activity in the prediction of EP. Forty-one patients with unruptured ectopic pregnancy comprised the case group and forty-two first trimester pregnant women with shown foetal heart beating in ultrasound comprised the control group. The mean ADA level in EP (10.9 ± 3.0 IU/L) was higher than that in control group (9.2 ± 3.6 IU/L) (p = 0.018). Receiver operating characteristics or ROC curve identified ADA value of 10.95 IU/L as optimal threshold for the prediction of EP with 56% sensitivity and 67% specificity. High ADA levels are valuable in the early diagnosis of EP. However more comprehensive studies are required.

Resveratrol inhibits postoperative adhesion formation in a rat uterine horn adhesion model.

AIM: Adhesion formation is one of the most important problems occuring after pelvic surgery in the majority of women. The aim of this experimental study was to investigate the effects of the antioxidant resveratrol (3,5,4'-o-trihydroxystilbene) on adhesion formation in a rat uterine horn adhesion model. MATERIALS AND METHODS: Thirty Wistar-Albino female rats were randomly divided into three groups with equal numbers. In Group A, 5.9 mg/kg/day resveratrol was applied by the orogastric route for 10 days before and 20 days after surgery. In Group B, resveratrol was given only for 20 days after surgery. In the control group, no drug was applied before or after surgery. A uterine serosal injury was created using a standard technique after laparotomy in all rats. All animals were sacrificed 3 weeks after surgery and intrapelvic adhesions determined macroscopically and microscopically. RESULTS: Adhesion formation, total adhesion score and the severity of adhesions were all significantly lower in both resveratrol treatment groups than in the control group (p < 0.05). Notably, the severity of adhesions was much less in Group A in which the rats received resveratrol before and after surgical operation. CONCLUSIONS: This study suggests that 5 ± 1 mg/kg/day perioperative resveratrol administration is an effective strategy for the prevention of postoperative peritoneal adhesion formation after pelvic surgery in a rat model.

Cardiovascular risk factors in polycystic ovary syndrome.

A total of 31 women with polycystic ovary syndrome (PCOS) and 31 healthy age/body mass index matched controls were compared for serum hormones, basal and oral-glucose stimulated glucose, insulin, homocysteine, high sensitive C-reactive protein (hsCRP) and lipid levels. The women with PCOS had significantly higher serum fasting insulin, homocysteine, total cholesterol and LDL cholesterol level than controls, whereas no differences were detected in serum fasting or OGTT 60th- and 120th-minute glucose concentrations, hsCRP, HDL cholesterol, VLDL cholesterol and triglyceride levels between PCOS and control women. Insulin resistance was found in 54.8% (17/31) of PCOS patients by glucose: insulin (G/I) ratio, whereas only 29.0% (9/31) of control women (p = 0.04). Multivariate linear regression analysis revealed that only waist/hip ratio was independent determinants of G/I ratio. PCOS is associated with some biochemical and clinical risk factors for cardiovascular disease. Therefore, patients with PCOS should undergo comprehensive evaluation for recognised cardiovascular risk factors.

Effect of non-oral estrogen on risk markers for metabolic syndrome in early surgically menopausal women.

OBJECTIVE: Postmenopausal women are at an increased risk of cardiovascular disease and metabolic syndrome as many risk factors are aggravated by menopause. Elevated levels of homocysteine, triglyceride and asymmetric dimethylarginine (ADMA) have been recognized as risk factors for metabolic syndrome. The present study aimed to investigate the effect of transdermal estrogen treatment on serum levels of atherogenic amino acids, homocysteine, triglyceride, high density lipoprotein (HDL) cholesterol and ADMA in women with surgical menopause. METHODS: A prospective study was conducted in 85 surgically menopausal Turkish women at the Department of Menopause of Dr Zekai Tahir Burak Women's Health Research and Education Hospital between March 2007 and March 2008. Subjects were divided into two groups: a treatment group (Group 1) and control (Group 2). Group 1 (n = 46) received transdermal estrogen while Group 2 (n = 39) received no treatment. Body mass index (BMI) and levels of serum homocysteine, ADMA, triglyceride and HDL cholesterol were analyzed postoperatively at the first visit (baseline) and 6th months. RESULTS: The two groups did not differ in age, baseline BMI and levels of ADMA, homocysteine and triglyceride. In Group 1, values of serum ADMA, homocysteine, triglyceride and HDL cholesterol levels were not different at baseline and at the 6-month visit (p = 0.996, p = 0.564, p = 0.113 and p = 0.173, respectively). On the other hand, the baseline and the 6th month measurements of serum ADMA, homocysteine and HDL cholesterol levels were significantly different in Group 2 (p = 0.001, p = 0.001, and p = 0.023, respectively). CONCLUSION: Transdermal estrogen treatment has a protective effect against the risk factors of metabolic syndrome (homocysteine, ADMA, HDL cholesterol) in surgically menopausal patients who have undergone surgery in the early premenopausal period.

Azoospermia and cryptorchidism in a male with a de novo reciprocal t(Y;16) translocation.

An apparently balanced reciprocal translocation between the long arm of the Y chromosome and the long arm of the chromosome 16 t(Y;16)(q12;q13) is described in an infertile man with azoospermia and cryptorchidism. The patient was phenotypically normal and had bilateral inguinal hernia repair with orchidopexy at the age of 8 years. Histological examination of testicular biopsies revealed maturation arrest. Y/autosome translocations in the literature are relatively rare and mostly associated with infertility. To our knowledge, this is the sixth report about the reciprocal t(Y;16) translocation in the literature but the first presenting with cryptorchidism.

Follicular fluid vascular endothelial growth factor and tumour necrosis factor alpha concentrations in patients with endometriosis undergoing ICSI.

The aim of this study was to investigate follicular fluid vascular endothelial growth factor (VEGF) and tumour necrosis factor alpha (TNFalpha) concentrations in endometriosis, and their effect on the outcome of intracytoplasmic sperm injection (ICSI). A prospective study was performed among patients who had either a laparoscopic diagnosis of endometriosis (n = 48) or who had normal laparoscopic findings with unexplained infertility (n = 43). The number of gonadotrophin units, peak oestradiol concentrations, number of oocytes retrieved, fertilization, cleavage and pregnancy rates, and number of embryos transferred, were the main outcome measurements. There was no difference in these parameters between the two study groups. Significantly higher concentrations of VEGF were found in the endometriosis group (P = 0.031), but there was no difference in TNFalpha concentrations. No relationship was found between VEGF and TNFalpha concentrations and ICSI outcome. Despite a higher concentration of intrafollicular VEGF in the endometriosis group, it was concluded that this parameter had no predictive value with respect to ICSI outcome. In addition, intrafollicular TNFalpha concentrations were not different in the endometriosis group and there was no relationship between VEGF or TNFalpha concentrations and the outcomes measured.

Non-invasive early prenatal diagnosis using fluorescent in situ hybridization on transcervical cells: comparison of two different methods for retrieval.

OBJECTIVE: We compared the efficiencies of uterine and endocervical lavage to retrieve fetal cells from first trimester pregnancies for further analysis with fluorescent in situ hybridization (FISH). STUDY DESIGN: Transcervical cell (TCC) samples were collected at 7-10 weeks of gestations by uterine lavage (13 women) and by endocervical lavage (12 women) who were scheduled for volunteer termination of pregnancy. A sample of placenta was also obtained for cytogenetic analysis to confirm the sex or genotype in the end of the procedure. FISH was performed using probes for the chromosomes 18, X and Y in a three color hybridization protocol. The statistical analysis included chi(2)-analysis, and t-test. RESULTS: Sufficient cells were obtained in 12 of the 13 (92.3%) in uterine lavage and 10 of the 12 (83.3%) in endocervical lavage group for FISH procedures for fetal sex prediction. The mean success rate of signal detection for FISH procedure was 91.7% (range 83-97%). Fetal sex was correctly predicted in 11 of 12 (91.6%) with uterine lavage and 8 of 10 (80.0%) in endocervical lavage and the difference was statistically insignificant. CONCLUSION: This study demonstrated that there are available cells of fetal origin in the lower part of the uterus and these cells may be collected successfully as early as 7 weeks of the gestation. In addition, our results show that endocervical lavage method is as effective as uterine lavage. FISH has been successfully used to detect status of aneuploidy and sex of the fetus from TCC.

Laparoscopic plication and suspension of the round ligament for chronic pelvic pain and dyspareunia.

STUDY OBJECTIVE: To describe a technique of uterine suspension using round ligaments to relieve pain in selected patients with various degrees of uterine retroversion. DESIGN: Prospective clinical study (Canadian Task Force classification II-2). SETTING: University-based center for reproductive medicine. PATIENTS: Thirty women who underwent laparoscopy for investigation of chronic pelvic pain (CPP) and dyspareunia. INTERVENTION: Round ligaments were plicated using a modification of intracorporeal knot tying during laparoscopy. MEASUREMENTS AND MAIN RESULTS: The extent of plication was planned to elevate the uterus and bring it minimally forward. Mean +/- SD operating time was 14+/-4 minutes. Pain scores before and after surgery were 4.5+/-1.0 and 1.6+/-0.6, respectively (p<0.001). There were no complications during or after surgery. Only three women had minimal dyspareunia postoperatively, although they had anteverted uteri. One patient had severe dyspareunia that developed 7 months after surgery and continued through the second year of follow-up. Nineteen women with anteverted uteri were free of dyspareunia after 2 years. CONCLUSION: Round ligament plication is safe and effective in patients with retroverted uteri and dyspareunia or CPP.

Detection of chromosomal abnormalities by fluorescent in-situ hybridization in immotile viable spermatozoa determined by hypo-osmotic sperm swelling test.

If randomly selected immotile spermatozoa are used for intracytoplasmic sperm injection (ICSI), pregnancy rates are significantly decreased. The hypo-osmotic swelling test (HOST) is the only method available to detect the viable, but immotile spermatozoa for ICSI. However, evidence is still lacking for the chromosomal abnormalities for the normal-looking, but immotile spermatozoa positive for HOST. Sperm samples from 20 infertile men with normal chromosomal constitution were obtained. After Percoll separation, morphologically normal but immotile spermatozoa were transported individually into HOST solution for 1 min using micropipettes. Cells that showed tail curling with swelling in HOST were then transferred back into human tubal fluid solution to allow reversal of swelling. These sperm cells were fixed and processed for the multi-colour fluorescence in-situ hybridization (FISH) for chromosomes X, Y and 18. The same FISH procedure was applied for the motile spermatozoa from the same cohort, which formed the control group. The average aneuploidy rates were 1.70 and 1.54% in 1000 HOST positive immotile and motile spermatozoa respectively detected by FISH for each patient. Our results indicate that morphologically normal, immotile but viable spermatozoa have an aneuploidy rate similar to that of normal motile spermatozoa.

Endoscopic management of a case of complete septate uterus with unilateral pyometra.

We report a case with an unusual müllerian anomaly: complete uterine septum and pyometra in the right hemicavity and pyocolpos along with a longitudinal vaginal septum. A patient with recurrent low-grade fever and lower abdominal pain was admitted. Pyometra and pyocolpos were detected in the right uterine hemicavity and in the right hemivagina. The septa were resected, the cavities were irrigated, and the patient was treated with antibiotics. The patient conceived 8 months later. Patients with abnormal vaginal findings should be approached with caution; precise knowledge of urogenital anatomy and urogenital anomalies is necessary in the management of these patients.

Midtrimester termination of complicated pregnancy with oral misoprostol.

To define the mean effective dose of oral misoprostol, a PGE2 methylanalogue, for terminating midtrimester complicated pregnancy without producing significant side-effects and complications, forty-two patients with intrauterine complicated pregnancies of 14-28 weeks were treated with oral misoprostol. All patients were observed after the initial dose (200 micrograms). If there was no contraction of the uterus or no vaginal bleeding, a supplementary dose of 200 micrograms misoprostol was given once each hour, with an average total dose of 1000 micrograms being given (min. 200 micrograms, max. 1200 micrograms). Abortion was successfully induced in 39 women (92.9%); there were 3 failures (7.1%). The mean time from initial dose to abortion was 9 h. No important side-effects or complications were noted. This study demonstrated that the use of oral misoprostol is a simple, inexpensive and easy procedure for termination of second trimester complicated pregnancy.

Successful treatment of cornual pregnancy by local injection of methotrexate under laparoscopic and transvaginal ultrasonographic guidance.

This report describes a woman with cornual pregnancy, documented by ultrasonography and laparoscopy, who was successfully treated with two doses of methotrexate under laparoscopic and ultrasonographic guidance. The serum beta human chorionic gonadotropin level was 20,000 mIU/ml and increased to 43,800 mIU/ml after the first methotrexate injection and to 44,400 mIU/ml after second injection and fell precipitously to nonpregnant levels within 27 days. No side effects were experienced by the patient.

Second trimester pregnancy termination including fetal death: comparison of five different methods.

OBJECTIVE: To compare the efficacy of methods for second trimester pregnancy termination. METHODS: A prospective randomized study of women undergoing pregnancy termination between 14 and 28 weeks gestation. Three hundred and forty patients with poor cervical condition (Bishop score < or = 4) in whom one of five termination methods were used were assessed: (i) extraamniotic administration of ethacridine lactate (82 patients); (ii) intracervical prostaglandin (PG) E2 gel (100 patients); (iii) intravenous infusion of concentrated oxytocin (36 patients); (iv) vaginal misoprostol (49 patients); and (v) balloon insertion (73 patients). Oxytocin infusion was used in all but concentrated oxytocin group to augment labor, when necessary. Patients in whom effective uterine contractions and cervical dilatation was not obtained within 48 h with the primary termination method were registered as failures. RESULTS: The efficacy of each method were evaluated in terms of abortion within time. Abortion within 48 h were achieved in 98.8% (81/82) of the patients in ethacridine group; 97.3% (35/36) of the patients in concentrated oxytocin group; 90.0% (90/100) of the patients in PGE2 group; 97.2% (71/73) of the patients in balloon group; 77.5% (38/49) of the patients in misoprostol group (P = 0.000, P < 0.01, Wilcoxon (Gehan) statistic). The overall median induction-abortion interval +/- S.D. (in h) in each group were as follows: ethacridine lactate: 15.7 +/- 9.6, PGE2 gel: 20.0 +/- 14.5, concentrated oxytocin: 12.2 +/- 14.4, misoprostol: 24.0 +/- 22.2, balloon: 16.0 +/- 15.4 (one way ANOVA, P = 0.003, P < 0.01). CONCLUSION: In comparison with the five methods, the use of extraamniotic ethacridine, intravenous concentrated oxytocin, and balloon was found to provide more effective treatment than intracervical PGE2 and misoprostol in terms of achievement of abortion within 24 and 48 h.

PIP: The efficacy of 5 methods of second-trimester pregnancy termination was compared in a prospective, randomized study of 340 women admitted to a High Risk Pregnancy Unit in Ankara, Turkey, with an unfavorable cervical state. The women were between 14 and 28 weeks' gestation. Termination methods assessed included: extra-amniotic administration of ethacridine lactate (82 women), cervical ripening through use of prostaglandin (PG) E2 gel (100 women), intravenous infusion of concentrated oxytocin (36 women), intravaginal misoprostol (49 women), and balloon insertion (73 women). Oxytocin infusion was used to augment labor, where necessary, in all but the concentrated oxytocin group. The main indications for pregnancy termination were fetal death (50%) and fetal anomaly (25%). Abortion within 48 hours was achieved in 98.8% of women in the ethacridine group, 97.3% of those in the concentrated oxytocin group, 90.0% of women in the PGE2 group, 97.2% of patients in the balloon group, and 77.5% of those in the misoprostol group. The median induction-abortion intervals were: ethacridine lactate, 15.7 +or- 9.6 hours; PGE2 gel, 20.0 +or- 14.5 hours; concentrated oxytocin, 12.2 +or- 14.4 hours; misoprostol, 24.0 +or- 22.2 hours; and balloon, 16.0 +or- 15.4 hours. Overall, these results suggest that mid-trimester induced abortion with extraamniotic ethacridine, balloon application, or intravenous concentrated oxytocin are the most effective techniques and should be considered as alternatives to misoprostol and PGE2.

Oral misoprostol use in early complicated pregnancy.

Eighty-four patients with early complicated pregnancies such as intrauterine death, blighted ovum pregnancy and missed abortion were treated with oral misoprostol. If abortion did not occur, 200 micrograms misoprostol was given once an hour, with an average dose of 1000 micrograms (min 200 micrograms, max 1200 micrograms). Complete or partial abortion took place within 7.0 +/- 5.1 h in 92.5% of patients. Of the patients, 11.9% and 83.3% had complete and partial abortion, respectively, without major complications. We observed only minor side-effects such as nausea, vomiting, diarrhea, hypotension, fever, headache and abdominal pain. This study demonstrates that the use of oral misoprostol is a simple, inexpensive and easy procedure for terminating early complicated pregnancies, although additional surgical evacuation of the uterus was required in the large majority of patients.

The use of GnRH agonists in the treatment of endometriomas with or without drainage.

To assess the efficacy of GnRH-agonist therapy in the treatment of endometriomas with or without surgical intervention, 26 women with laparoscopically proven endometriomas larger than 3 cm were recruited to the study. Fourteen women with 19 endometriomas (5 bilateral), had drainage of endometrioma at initial laparoscopy. After the procedure, ovarian suppression was done with GnRH-a therapy for 6 months. The second group which consisted of 12 women, had 17 endometriomas. No surgical procedure was performed. They received only GnRH-a therapy for 6 months. On repeat laparoscopy, in the first group, the rates of decrease in ovarian AFS scores of endometriomas and complete resolution were found as 100% and 37% respectively. In the second group the response was only 18% (p < 0.0001). It was concluded that drainage of the cyst (surgical therapy) combined with postoperative GnRH-a suppression is a better treatment modality than the use of GnRH-a (medical therapy) alone for endometriomas.

Serum CA 125 levels before, during and after treatment for endometriosis.

OBJECTIVES: The aim of this study was to assess the treatment of endometriosis with a gonadotropin-releasing hormone (GnRH) agonist in terms of changes to the extent of disease and to CA 125 levels as well as to recurrence during follow-up. METHODS: The levels of serum CA 125 were evaluated in 66 patients with endometriosis diagnosed and staged by laparoscopy according to the revised American Fertility. Society classification, who received a 6-month course of a GnRH agonist. Serum CA 125 levels were measured before, during (3 and 6 months after the initiation of therapy) and 6 months after cessation of therapy. RESULTS: Patients with minimal and mild endometriosis had significantly higher mean pretreatment values than control subjects in the luteal phase of the cycle or than postmenopausal women (P < 0.05), but the overall mean value was still below 35 U/ml. Levels of CA 125 fell during treatment to those found in normal controls, but rose again after the end of treatment. The sensitivity and specificity of CA 125 were 75% and 83.3%, respectively, and its positive predictive value as a marker of recurrence was 46.36%. CONCLUSION: These data suggest that CA 125 may be a reliable indicator for monitoring the efficacy of GnRH agonist treatment of endometriosis, but its value as a predictor of recurrence is low, probably due to the suppression of all CA 125 sources such as endometrium, ovaries and implants.

Chronic pelvic pain in adolescent women. Diagnostic laparoscopy and ultrasonography.

OBJECTIVE: To evaluate the correlation of preoperative pelvic examination and ultrasonography with the laparoscopic findings in 45 adolescent women with chronic pelvic pain. STUDY DESIGN: Between January 1, 1989, and December 31, 1992, 45 adolescent women underwent diagnostic laparoscopy following a detailed clinical workup for evaluation of chronic pelvic pain. RESULTS: Thirty-five of 45 pelvic examination findings correlated with the laparoscopic findings. The predictive values of normal and abnormal findings at pelvic examination were 42.8% and 93.5%, respectively. Ultrasonography (US) correlated with laparoscopy in 39 of 45 cases. The predictive value of normal findings at US was 60%, and that of abnormal findings was 94.2%. When both pelvic examination and US were normal, 50% of cases were abnormal at laparoscopy. However, laparoscopy revealed abnormality in 100% of patients with abnormal pelvic examinations and abnormal US findings. CONCLUSION: Clinical evaluation of chronic pelvic pain, when combined with US, is highly predictive but needs confirmation, best provided by laparoscopy.

Tubal histopathology in ectopic pregnancies.

A histopathologic study in eighty six patients with ectopic pregnancy and in eighty six control patients was undertaken to evaluate the association between ectopic pregnancy and tubal pathology in our population. Fifty six (65%) and nine (10.4%) cases with chronic salpingitis (CS) were diagnosed in the study group and in the control group, respectively. This difference was statistically significant (p < 0.001). Twelve of 56 cases with chronic salpingitis were salpingitis isthmica nodosa (SIN) and no patient with SIN was observed in the control group. SIN was always concomittant with chronic salpingitis in our study. Based on these findings, we concluded that chronic salpingitis and SIN have an important role in the etiology of ectopic pregnancy in our population and SIN is significantly associated with chronic salpingitis.