Is there an association between serum vitamin D levels and endometrial polyps?

BACKGROUND/AIM: Anti-proliferative effects of vitamin D (VD) had been proposed previously. Herein, the authors aimed to evaluate serum 25(OH)VitD3 levels in women with endometrial polyps (EPs) and to determine whether VD deficiency is a risk factor for EP formation. MATERIALS AND METHODS: This study was designed as a controlled cross-sectional study. Forty three women with polyps constituted the study group whereas 47 of them constituted the control group. The selection criteria for the study group were hysteroscopic detection and histological confirmation of EPs. The main parameters recorded for each woman were; age, body mass index (BMI), par- ity, smoking status, co-morbidities, dressing style, dairy intake of VD-rich foods, duration of sunlight exposure, skin photo-type, serum levels of 25(OH)VitD3, calcium, phosphor, and albumin. RESULTS: The mean serum 25(OH)VitD3 level was 8.3±7.7 ng/ml in the study group and 9.3 ± 10.2 ng/ml in the control group (p = 0.583). Mean BMI was statistically significantly higher in the study group (p = 0.003). Logistic regression model showed that only significant risk factor for EPs was increased BMI (OR=1.241; 95% CI = 1.070-2.440; p = 0.004). CONCLUSION: VD deficiency is common among the reproductive age women and obesity is the most important risk factor for polyp formation. The authors believe that there is no relation between VD and EPs.

Can first trimester placental protein-13 and pregnancy-associated plasma protein-A predict pre-eclampsia in Turkish women?

The aim of study was to evaluate placental protein-13 (PP-13) and pregnancy-associated plasma protein-A (PAPP-A) in first trimester maternal serum, for predicting pre-eclampsia. A prospective case-control study included 30 pre-eclampsia patients and 90 control pregnant women. Pre-eclampsia patients were divided into two subgroups: early- and late-onset (9 vs 21), and PP-13 and PAPP-A levels were compared between the groups and the comparison of risks for pre-eclampsia were calculated. Results showed that there was a significant inverse correlation between PAPP-A and late pre-eclampsia (p = 0.003), with a cut-off value of 0.805 (ROC analysis area under curve = 0.751). There was a significant reverse correlation between PAPP-A and early pre-eclampsia (p = 0.02). There was no significant relationship between PP-13 and early pre-eclampsia, nor with late pre-eclampsia (p = 0.7, p = 0.6, respectively). It was concluded that neither of these markers can serve as a sufficient and reliable screening test of pre-eclampsia because of inadequate sensitivity in the Turkish pregnant population.

Successful water birth in a woman with vaginismus.

Vaginismus is a common sexual dysfunction. The case of a successful water birth in a woman with vaginismus is presented. Water birth should be considered as an alternative method of birth in women with vaginismus.

IL-18 and IL-18 binding protein concentrations in serum and ovarian follicular fluid do not affect in vitro fertilization outcomes in obese, overweight, and non-obese patients.

Obesity causes the specific upregulation of proinflammatory cytokines and chemokines. One of these cytokines, IL-18, has a well-known association with obesity. Our aim in this study was to test the effect of serum and intrafollicular IL-18 and IL-18 binding protein (BP) levels on in vitro fertilization outcomes in obese, overweight, and non-obese patients. Serum and pooled follicular fluid levels of IL-18, IL-18BP, and the IL-18/IL-18BP ratios were evaluated in 21 non-obese (body mass index [BMI] <25), 37 overweight (25or=30) patients undergoing in vitro fertilization. IL-18 and IL-18BP levels in serum and follicular fluid did not change with obesity. There was no correlation among serum intrafollicular IL-18, IL-18BP levels, and the number of oocytes retrieved and transferred, embryo grades or pregnancy ratios. The levels of serum and intrafollicular IL-18, IL-18BP, and the IL-18/IL-18BP ratios do not seem to be related to in vitro fertilization outcomes in obese, overweight, and non-obese patients.

Anatomic distortion of clinically normal appearing fallopian tube: to what extent does it contribute to infertility?

We analyzed whether patent but anatomically deranged tubes were more commonly encountered in infertile women than in fertile women. The fertile group consisted of 100 women who were apparently normal with respect to fertility and the infertile group consisted of 100 infertile women with no certain etiology identified. The individual tubal structure was recorded at laparoscopy and the results of the two groups were then compared. Tubal pathology was found to be significantly higher in the infertile group; however, this marked difference arose from the contribution of a significantly higher frequency of peritubal pelvic adhesions because no difference was found between the two groups regarding anatomic variations of the fallopian tube. We conclude that tubal derangement which could only be identified with laparoscopy significantly contributes to infertility.

A study of premature ovarian failure in Turkish women.

The parameters that could be responsible for or could be the end results of the premature ovarian failure were evaluated in 100 patients and compared with the same parameters of a control group consisting of 30 ovulatory healthy women with regular menstrual cycles. The incidence of premature ovarian failure was 6.6%. The mean age of the premature ovarian failure group was 39.2 +/- 4.1 years (range 30-58) whereas this was 45.6 +/- 3.1 years (range 39-52) for the control group. The mean menopausal age was 4.0 +/- 4.3 years (range 1-30). The prevalence of being a widow, divorcee or single was high in the premature ovarian failure group (p < 0.01). Of the hormonal and metabolic parameters, thyroid-stimulating hormone (TSH) and high-density lipoprotein (HDL) levels showed significant differences between the two groups (p < 0.01 and p < 0.05, respectively) and of the parameters reflecting bone metabolism, alkaline phosphatase levels showed a significant difference (p < 0.05). The bone mineral densitometric measurement values were lower in the premature ovarian failure group (p < 0.05). Because premature ovarian failure is not a rare disorder and because the patients have an early estrogen deficiency we concluded that, whatever the etiologic factor, hormone replacement therapy needs to be given as early as possible.

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.

Do the suppression criteria in GnRH-a cycles predict in vitro fertilization outcome?

The addition of gonadotropin releasing hormone analog (GnRH-a) to controlled ovarian hyperstimulation regimes has been reported to have several advantages, such as reduced cancellation rate, fewer premature luteinizations and increased clinical pregnancy rate. The aim of this study was to determine the effect of pituitary/ovarian suppression, in terms of the levels of luteinizing hormone (LH), estradiol and follicle stimulating hormone (FSH), and the duration of GnRH-a administration, on in vitro fertilization (IVF) outcome. Retrospectively, 153 IVF cycles with GnRH-a and human menopausal gonadotropin (hMG) were examined. After a minimum of 10 days of GnRH-a administration, the patients were started on hMG. The correlations were investigated between the fertilization rates, the numbers of retrieved oocytes and transferred embryos, the cancellation rates, the suppressed LH, FSH and estradiol levels, the total ampules of hMG used and the duration of GnRH-a usage. The duration of GnRH-a usage and the total ampules of hMG used were not correlated. The number of oocytes retrieved and total number of hMG ampules used showed weak correlations with suppressed levels of FSH (-0.297 and 0.285, respectively). However, the fertilization, cleavage and pregnancy rates did not correlate with the LH, FSH and estradiol levels on hMG start days. In conclusion, for selected cases, 10 days of GnRH-a administration is sufficient to suppress endogenous gonadotropin levels. Since FSH and LH are protein hormones and their bioactivity may change in a manner that is unrelated to their immunological levels, it is not necessary to measure FSH, LH and estradiol levels to detect whether suppression is adequate.

Lipid profiles in women with hirsutism and polycystic ovaries.

We examined the correlation between hyperandrogenemia and lipid profiles in 25 hirsute patients with polycystic ovary syndrome in our reproductive endocrinology outpatient clinic. Concentrations of triglycerides, low density lipoprotein cholesterol and total cholesterol were increased and concentrations of high density lipoprotein (HDL) cholesterol were decreased in women with severe hirsutism. Total and free testosterone levels were correlated with triglycerides (r = 0.72, p < 0.05; r = 0.55, p < 0.01, respectively) and HDL cholesterol (r = -0.55; p < 0.05; r = -0.68, p < 0.05, respectively). There was no correlation between levels of androstenedione, dehydroepiandrosterone sulfate or 17-OH progesterone and any parameters of the lipid profiles. In those with a luteinizing hormone/follicle stimulating hormone ratio > or = 1.5, total testosterone levels were higher than in those with a lower ratio (129.5 +/- 6.4 vs. 95.2 +/- 9.2 ng/dl, p < 0.05), HDL cholesterol levels were lower (45.2 +/- 4.2 vs. 60.4 +/- 4.8 mg/dl, p < 0.05) and triglyceride levels were higher (138.1 +/- 4.5 vs. 92.6 +/- 6.1 mg/dl, p < 0.001). We conclude that altered lipid profiles in women with hirsutism are a result of high testosterone levels.

Tamoxifen: an alternative approach in clomiphene resistant polycystic ovarian syndrome patients.

Twenty patients with ultrasound diagnosed polycystic ovaries and high luteinizing hormone levels who failed to respond to clomiphene citrate were given tamoxifen to induce ovulation. Tamoxifen 20 mg daily (group 1, n = 10) and 40 mg daily (group 2, n = 10) was given for 5 consecutive days from the third to seventh day of the cycle. Treatment was monitored by serial ultrasound scans and assessment of serum estradiol. Human chorionic gonadotrophin (hCG) was administered when at least one follicle was > 16mm and serum estradiol level was > 300 pg/ml per follicle. Ovulation was confirmed with detection of the follicular rupture ultrasonographically 2 days after hCG and midluteal progesterone levels. The ovulation rate achieved in group 2 patients was significantly higher (p = 0.01) than group 1. Three pregnancies were achieved in group 2 patients while there was no pregnancy in group 1. The only side effect was ovarian cyst formation in one patient in group 1. As a result, tamoxifen might be a good choice for clomiphene resistant patients prior to treatment with surgery or hMG.

Relationship between serum CA 125 levels, endometrial thickness and corpus luteum function in different stages of ovarian activity.

CA 125 is a cell surface antigen expressed in some derivatives of celomic epithelium, predominantly in ovarian cancer cells. However, it has also been detected in serum of healthy women and in patients with benign gynecologic diseases. The exact source or sources of the circulating levels of CA 125 and their elevations are not known. In the present study, the relationship between serum CA 125 levels, ovarian steroidogenesis and endometrial thickness is investigated at different periods: 1) mid-follicular, 2) midcycle, and 3) midluteal phases in normal cycles of fertile women, in patients stimulated for intrauterine insemination (IUI) and in patients stimulated for in vitro fertilization (IVF). Only in patients with mild and moderate ovarian hyperstimulation (OHSS) of the IVF group were luteal phase CA 125 levels (149.7 +/- 24.4 U/ml) significantly higher than midfollicular (21.2 +/- 1.9 U/ml) and midcycle phase levels (24.4 +/- 2.5 U/ml) (p < 0.001). The mean midcycle estradiol and midluteal progesterone concentrations in patients stimulated for IUI and IVF were significantly higher than those of normally cycling women (p < 0.001). Mean endometrial thickness in patients stimulated for IVF was significantly higher than in patients stimulated for IUI and normally cycling women (p < 0.001). Midluteal CA 125 levels correlated with midcycle endometrial thickness (r = 0.585, p < 0.05) and midluteal P levels (r = 0.497, p < 0.05) in patients with OHSS of IVF group. This correlation was not observed in patients who had no signs and symptoms of OHSS during stimulation for IVF and in patient stimulated for IUI and the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and endocrine features of ultrasound diagnosed polycystic ovary patients: the correlation between ovarian volume and androgen activity.

One hundred and twenty five patients with polycystic ovaries on ultrasonography and 17 controls with normal ovaries on ultrasound and regular ovulary cycles underwent clinical and endocrine evaluation. Of 125 ultrasound-diagnosed polycystic ovary patients (PCO) 49.6% complained about hirsutism, 55.2% had menstrual disturbances (46.4% oligomenorrhea, 8.8% amenorrhea), 23.2% had normal but irregular cycles and 50.4% had infertility. PCO patients had significantly higher mean serum LH, testosterone, androstenedione and DHEAS levels and higher mean ovarian volume compared with the control group. Sixty seven percent of PCO patients had enlarged ovaries and significantly higher mean serum LH, testosterone, androstenedione and DHEAS levels, compared with the PCO patients who had ovarian volume within normal range. There was a significant positive correlation between ovarian volume and serum LH, testosterone, androstenedione, DHEAS levels. Hirsutism, oligomenorrhea, irregular cycles were equally present in patients with normal ovarian volume and enlarged ovaries. These results illustrate the importance of ovarian volume measurement as an indicator of androgen production in PCO patients.