Is the leptin/BMI ratio a reliable biomarker for endometriosis?

Background: The aim of this study was to analyze the concentration of leptin in peritoneal fluid and plasma and to assess their role as potential biomarkers in the diagnosis of endometriosis. Materials & methods: Leptin adjusted for BMI (leptin/BMI ratio) was measured using surface plasmon resonance imaging (SPRI) biosensors. Patients with suspected endometriosis were included in the study. Plasma was collected from 70 cases, and peritoneal fluid from 67 cases. Based on the presence of endometriosis lesions detected during laparoscopy, patients were divided into a study group and a control group (patients without endometriosis). Results: Leptin/BMI ratio in plasma did not differ between women with endometriosis and the control group (0.7159 ± 0.259 vs 0.6992 ± 0.273, p= 0,7988). No significant differences were observed in peritoneal leptin/BMI ratio levels in patients with and without endometriosis (0.6206 ± 0.258 vs 0.6215 ± 0.264, p= 0,9896). Plasma and peritoneal leptin/BMI ratios were significantly lower in women with endometriosis - related primary infertility compared to women with endometriosis without primary infertility (0.640 ± 0.502 vs 0.878 ± 0.623, p < 0.05). The difference was observed in case of primary infertility, but not in terms of the secondary one. No significant differences were noted between leptin/BMI ratio in the proliferative phase and the secretory phase (0.716 ± 0.252 vs 0.697 ± 0.288, p= 0,7785). Conclusion: The results of present study do not support the relevance of leptin concentration determination as a biomarker of the endometriosis. Due to the limited number of samples in the tested group, further studies are needed to confirm its role.

The Impact of HPV Diagnosis and the Electrosurgical Excision Procedure (LEEP) on Mental Health and Sexual Functioning: A Systematic Review.

The impact of HPV diagnosis and subsequent treatment with the electrosurgical excision procedure (LEEP) on anxiety, depression, psychosocial quality of life, and sexual functioning has not been thoroughly investigated. The aim of this review was to systematically summarize the available knowledge on this topic, according to PRISMA guidelines. Data from observational and intervention studies were analyzed. A total of 60 records were included, of which 50 papers addressed the impact of HPV diagnosis on patients' psychosocial status, while 10 studies addressed the impact of the implemented LEEP procedure on patients' mental health and sexual functioning. The results indicated a negative impact of HPV diagnosis on the occurrence of depressive and anxiety symptoms, poorer quality of life, as well as on the sexual functioning of the affected women. The results of the studies to date have not confirmed the negative impact of the LEEP procedure on mental health and sexual life, although more research is needed in this area. It is necessary to implement additional procedures to minimize anxiety and distress in patients receiving a diagnosis of HPV or abnormal cytology and to improve awareness of sexually transmitted pathogens.

The Polish women's experience and level of knowledge about fertility and its disorders - a cross-sectional study.

OBJECTIVES: To assess the experience and knowledge of Polish women up to 50 years of age about fertility and its disorders. MATERIAL AND METHODS: A self-composed questionnaire consisting of 44 questions, divided into six sections, was available in social media from January until February 2020. The answers to 13 single-choice questions were analyzed to assess the level of knowledge. Statistical analysis was performed with the use of Statistica 13.0, with p value < 0.05 considered significant. RESULTS: A total of 3,321 correctly filled out questionnaires were obtained. The average result was 8.88 out of 13 single-choice questions regarding the basics of the menstrual cycle and infertility (median 9, standard deviation [SD] 2.21). As many as 65.2% of respondents did not know which days in the cycle were fertile days. The women who had been and/or were pregnant at the time of survey, more often answered better than those, who had never given birth. They had a better mean score of 13 single-choice questions compared to those who had never been pregnant (9.02 vs 8.61, p < 0.001). Respondents who obtained information about infertility from doctors in 86.97% knew that regular intercourse meant 2-3 times per week in comparison to 79.7% of those who were not educated by medical practitioners (p < 0.0001). 69.8% respondents from the first group knew that the test of ovarian reserve existed in comparison to 55.63% of women from the second group (p < 0.0001). CONCLUSIONS: The research has shown that the knowledge about fertility and its disorders is not satisfying among Polish women.

Twin pregnancy with a partial hydatidiform mole and a coexistent live fetus. Diagnostic and therapeutic dilemmas. A case report and the review of literature.

OBJECTIVES: We report the case of a twin pregnancy with a partial hydatidiform mole and a coexistent live fetus diagnosed in a 28-year-old primipara at 15 weeks of gestation and discuss the problems associated with the ultrasound diagnosis, histopathological examination of molar tissue samples and treatment. MATERIAL AND METHODS: A systematic research of the literature was conducted in PubMed database and Cochrane Library, including case reports and case series. A new case was also discussed. We collected data regarding the patient's serum human chorionic gonadotropin (hCG) level, initial symptoms, diagnosis and treatment. RESULTS: Most of the cases reported in the literature are those of a multiple pregnancy with complete hydatidiform mole (CHM) and a coexistent live fetus. The coexistence of a twin pregnancy with partial hydatidiform mole (PHM) and a live fetus in two separate amniotic sacs is extremely rare as a partial mole usually causes miscarriage of early pregnancy. Ultrasound is an important diagnostic tool, but the correct diagnosis is made only in 68% of cases. With further histological assessment of molar specimens and biochemical assays, the rates of correct early diagnoses should increase contributing to early therapeutic decisions and fewer adverse events. CONCLUSIONS: The diagnosis, management, and monitoring of this condition will remain challenging because of its rarity. Because of that, all cases of a suspected multiple pregnancy with a hydatidiform mole and a coexistent live fetus should be referred to and managed at a tertiary center which specializes in the diagnosis and treatment of gestational trophoblastic disease.

Oxidative Stress Markers Differ in Two Placental Dysfunction Pathologies: Pregnancy-Induced Hypertension and Intrauterine Growth Restriction.

AIM: Pregnancy-induced hypertension (PIH) and intrauterine growth restriction (IUGR) are both multisystemic disorders of pregnancy that cause perinatal morbidity and mortality. Recently, researchers focused on the role of oxidative stress (OS) as a pathophysiological mechanism in the development of these pathologies. The aim of this study was to compare OS in placental-related pathologies (PIH and IUGR) and uncomplicated pregnancies. We also investigated which salivary OS markers reflect systemic oxidative status and which only reflect the state of the oral cavity. Material and Methods. A total of 104 pregnant women (n = 104; 27 with PIH, 30 with IUGR, and 47 controls) were evaluated. Malondialdehyde (MDA), total antioxidant capacity (ORAC), aldehyde dehydrogenase (ALDH), and activity of glutathione peroxidase (GPx) and glutathione transferase (GST) in plasma/whole blood and/or saliva were analysed. Dietary nutrient intake was calculated using a Semiquantitative Food Frequency Questionnaire (SFFQ). Oral health was assessed to eliminate patients with bleeding, severe periodontitis, and other dental pathologies. RESULTS: In the IUGR group, increased concentration of ORAC was observed both in saliva and plasma. Also, lower plasma levels of MDA in IUGR compared to the control group was detected. No sign of oxidative stress was confirmed in the PIH group. The examined groups did not differ regarding diet and markers of inflammation. ORAC in saliva was correlated with its level in plasma. No such correlations for MDA were observed. In the IUGR group, there were no differences in OS markers in plasma, but there was a lower ALDH level in the blood compared to the control group. It confirms OS occurrence in IUGR. In IUGR, a higher activity of salivary ALDH was probably due to worse oral health. CONCLUSION: Oxidative stress differs between IUGR and PIH groups: the presence of oxidative stress was confirmed only in the IUGR group. Salivary ORAC can be used to estimate ORAC in plasma. The activity of salivary ALDH reflects the state of the oral cavity.

Saliva, hair, tears, and other biological materials obtained non-invasively for diagnosis in pregnancy: a literature review.

As medical technology evolves, clinicians are increasingly choosing relatively painless non-invasive methods of patientdiagnosis and treatment. There are two principles behind this: greater patient comfort and lower cost. Tears, hair, saliva,urine, and faeces can replace blood for diagnosis. The varied constituents in these biological materials can serve as biomarkersfor the detection of both local and systemic diseases. In this paper, we review a range of diagnostic techniques - allusing biological material obtained via non-invasive procedure - for detecting medical conditions in pregnant women.PubMed, Medline, Embase, and the Cochrane Library were searched from January 1996 until December 2018. Forty sevenstudies were included: thirty-five original articles, nine reviews and three meta-analysis.Analysis showed that saliva, hair, tears, and other biological material - obtained via non-invasive methods - may serveas clinically informative biomarkers. These biomarkers may be used for: toxicology, psychological studies, disease detection,biomonitoring, and drug abuse. The analysis of tears, hair, saliva, urine, and faeces is a safe, noninvasive and usefuldiagnostic tool within groups of pregnant women, but further investigation is necessary to fully realize the promise ofthese novel diagnostic tools.

Oxidative stress markers in saliva and plasma differ between diet-controlled and insulin-controlled gestational diabetes mellitus.

OBJECTIVES: The aims of the study were as follows: to investigate possible differences between plasma oxidative status (OS) in late-onset GDM and well-characterized healthy pregnant women (oral health, diet); to verify the existence of possible differences between GDMG1 (diet-treated) and GDMG2 (insulin-treated GDM); to determine whether oxidative stress markers could be detected in saliva. MATERIAL AND METHODS: A total of 89 pregnant women (n = 89; 59 with GDM and 30 controls) were evaluated. Malondialdehyde (MDA), total antioxidant capacity (ORAC), inactivation of aldehyde dehydrogenase (IALDH), activity of glutathione peroxidase (GPx) and glutathione transferase (GST)) in plasma and/or saliva were analyzed. RESULTS: The activity of GPx and GST in plasma was higher in GDMG2 as compared to GDMG1 and controls. Also, in GDMG2, elevated concentrations of salivary MDA and higher IALDH were observed. In contrast, GDMG1 had higher plasma ORAC and lower GPx activity as compared to controls, probably due to low-energy diet, high in antioxidants and fibers. Salivary and plasma OS were correlated and most significant for ORAC. CONCLUSION: Oxidative stress were not observed in GDMG1 but were confirmed to be moderate in GDMG2. However, large variability of the analyzed markers in GDM groups encourages screening of all patients, regardless of the treatment option. Saliva may be considered useful for the estimation of oxidative stress levels in GDM populations.

Rapid cervical phIGFBP-1 test in asymptomatic twin pregnancies is inefficient in predicting preterm delivery prior to 34 gestational weeks.

OBJECTIVES: To assess the effectiveness of a rapid second trimester test for cervical phIGFBP-1 in the prediction of sponta-neous preterm delivery prior to 34 weeks in asymptomatic twin pregnancies. MATERIAL AND METHODS: A prospective observational study conducted on 232 twin pregnancies tested for phIGFBP-1 at 20-24 weeks of gestation. 151 patients assessed as asymptomatic, with cervical length > 25 mm at 20-24 weeks were analysed. The primary outcome was the delivery < 34 weeks of gestation. RESULTS: The spontaneous preterm delivery before completing 34 weeks occurred in 23 patients (15.2%), including 9 in dichorionic and 14 in monochorionic pregnancies. The sensitivity of phIGFBP-1 test was 0.39 and specificity 0.63 in predicting delivery before 34 gestational weeks. phIGFBP-1 had a low positive predictive value of 0.16 and high negative predictive value (0.85). Both positive and negative predictive values of delivery < 34 weeks were close to 1. CONCLUSIONS: A test for phIGFBP1 presence is not an effective additional tool for predicting preterm delivery before 34 weeks in twin gestation.

Do We Pay Enough Attention to Culture Conditions in Context of Perinatal Outcome after In Vitro Fertilization? Up-to-Date Literature Review.

Adverse perinatal outcomes in singleton IVF pregnancies have been most often explained by parental underlying diseases and so far laboratory conditions during embryo culture are still not explored well. The following review discusses the current state of knowledge on the influence of IVF laboratory procedures on the possible perinatal outcome. The role of improved media for human embryo culture is unquestionable. Addition of certain components to culture media and their effect on embryo survival and implantation rates have been taken into consideration recently and studied on animal model. Impact of media on perinatal outcome in IVF offspring has also been studied. It has been discovered that epigenetic changes and neonatal birth weight are probably associated with the use of specific culture media, as is the relation between placental size and its influence on perinatal outcome. There are still questions in the discussion about duration of embryo culture (cleavage stage versus blastocyst transfer). Some of the IVF methods, such as in vitro maturation of oocytes and freezing/thawing procedures, also require well-powered randomized controlled trials in order to define their exact impact on perinatal outcome. Constant further research is needed to assess the impact of laboratory environment on fetal and postnatal development.

Endometrial injury for women with previous in vitro fertilization failure - does it improve pregnancy rate?

Implantation failure is one of the major factors limiting success of in vitro fertilization (IVF) treatment. According to ESHRE 2009 data only 32% of fresh embryo transfers resulted in clinical pregnancies. There are many ideas to improve the treatment outcomes, endometrial injury being one of them. It has been suggested that local endometrial injury, performed either by pipelle biopsy or hysteroscopy, may increase clinical pregnancy rate. However, up to date literature is widely disparate on that subject. There is no conclusion with regard to optimal timing, the number and technique of the procedure. The following paper is the review of the evidence from clinical studies dealing with the effect of endometrial injury on the IVF outcome to guide clinical practice for this challenging problem. PubMed, Embase, the Cochrane Library using Medical Subject Headings and free text terms were searched up to June 2016 without year restriction. Though the majority of trials showed positive impact of endometrial injury on IVF outcome, there is still a lack of strong evidence to support routine local endometrial injury in women prior to IVF treatment.

Adjunctive Pessary Therapy after Emergency Cervical Cerclage for Cervical Insufficiency with Protruding Fetal Membranes in the Second Trimester of Pregnancy: A Novel Modification of Treatment.

AIM: To evaluate the effectiveness of adjunctive pessary therapy after emergency cervical cerclage (ECC) in improving perinatal outcome in cervical insufficiency with fetal membranes protruding into the vagina. MATERIAL AND METHODS: A retrospective analysis of patients treated at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2008 and 2013. The study group consisted of 15 women treated with ECC and a pessary and the control group consisted of 17 patients treated with cerclage only. RESULTS: The mean gestational age at delivery was significantly higher in the study group (34.7 versus 29.7 weeks, p = 0.03). The period between cerclage insertion and delivery was significantly longer in the study group (82.9 versus 52.1 days, p = 0.045). The mean neonatal birthweight and neonatal "discharge alive" ratio were higher in the study group, although not statistically significant (2550 g versus 1883 g, p = 0.14, and 93.3% versus 70.5%, p = 0.18, resp.). NICU hospitalization rates were comparable (33.3% versus 35.3%, p = 0.9). CONCLUSIONS: Adjunctive pessary therapy allows delaying delivery in women treated with ECC due to cervical insufficiency with protruding fetal membranes. It also seems to improve neonatal outcome, although the differences are not statistically significant. Further prospective study is required to prove these findings.

Poor responders in IVF--is there any evidence-based treatment for them?

Despite the vast experience in controlled ovarian hyperstimulation, there are still women who respond poorly to gonadotropins, which results in few oocytes at retrieval, reduced number of embryos for transfer and consequently unsatisfactory pregnancy rates. Although such patients are quite common in IVF practice, the exact prevalence of so-called "poor responders" is difficult to estimate due to the variety of applied definitions. The urgent need for an internationally accepted definition of poor ovarian response (POR) was addressed by an ESHRE Workshop held in Bologna in 2010, where the consensus was reached and criteria were finally established. The application of this uniform definition may allow a correct estimate of POR prevalence and, what is more important, designing proper trials to assess and finally compare the interventions used in POR patients. The article describes the possible physiology of POR and patient characteristics, mentions risk factors and laboratory tests of decreased ovarian reserve. Finally it reviews the possible management of POR with different stimulation protocols in the light of EBM. Basing on published meta-analyses, various additional alternatives (such as estradiol priming, the addition of rLH, growth hormone, androgens and androgen-modulating agents, aspirin) are also summarized. Despite the two decades of trying, there is still no consensus on what is best for POR. No single treatment can be recommended over another, as the evidence for all of them is insufficient. It is obvious that interventions used in POR require properly designed large randomized studies, because until now there is no evidence-based treatment for that particular group of patients.

Application of ulipristal acetate in female patients with uterine fibroids.

OBJECTIVES: Uterine fibroids are the most common benign tumors in women of reproductive age. Evidence suggest that ovarian steroid hormones, in particular, progesterone play a major role in promoting leiomyoma development and growth. For the last years there was an extensive research on selective progesterone receptor modulators and their use in therapy. Ulipristal acetate (UPA) is one of these modulators. The aim of this paper is to evaluate efficacy and safety of oral ulipristal acetate for the treatment in women with symptomatic uterine fibroids. METHODS: The study group comprised five patients with uterine fibroids. All patients received 5 mg of ulipristal acetate per day for three months. RESULTS: The total volume of fibroids decreased by 33-68%. In all patients during the administration of UPA significant reduction of menstrual bleeding was observed. Increase of endometrial thickness without clinical significance was observed in two patients. No significant side-effects were observed during the treatment period. CONCLUSIONS: 1) The volume offibroids decreased from 33 to 68%. 2) The UPA administration effectively controlled excessive bleeding. 3) Treatment with UPA may modify the scope of the surgery. 4) UPA is a well-tolerated drug.