Transabdominal versus transvaginal specimen extraction in mini-laparoscopic surgery.

AIM: The objective of this study was to present our experiences of tissue extraction via the transvaginal (TV) route after a mini-laparoscopic gynecological surgery and compare them with our transabdominal (TA) specimen extraction experiences. METHODS: This prospective randomized controlled study was conducted in a tertiary care center between July 2014 and February 2016. Fifty-eight women who were undergoing mini-laparoscopy for adnexal mass removal were randomized into two groups according to the surgical specimen removal by the TV route (n = 28) or the TA route (n = 30). The main outcome measures were the postoperative incisional pain, cosmetic outcomes and overall satisfaction rate. The secondary outcome measures were additional blood loss, additional operation duration and the need for morcellation. RESULTS: The TV group had significantly lower visual analog scale scores than the TA group at 6 and 24 h postoperatively. The morcellation needs were lower in the TV group than in the TA group. Three months after the surgery, the participants scored a higher rate of overall satisfaction in the cosmetic outcomes in the TV group than in the TA group. CONCLUSION: Tissue extraction through a posterior colpotomy after mini-laparoscopic surgery may be a feasible technique for improving cosmetic results, decreasing postoperative pain and decreasing the need for morcellation when compared to TA specimen retrieval.

Arcuate artery calcification on transvaginal sonography may predict coronary artery heart disease.

Atherosclerosis is a systematic disease affecting all arteries and is the most common cause of mortality. Our aim was to evaluate the predictive value of the presence of uterine arcuate artery calcification (AAC) for coronary heart disease (CHD) in women. Seventy women presenting with angina pectoris or a finding suggestive of cardiac ischaemia in non-invasive tests, scheduled for angiography between June 2014 and July 2015 were recruited in the study. One day before the coroner artery angiography, all of the patients were examined about the presence of AAC by transvaginal ultrasonography and were classified in the presence of CHD. CHD is classified as obstructive (obstruction >70%) or as non-obstructive (obstruction <70%) according to the severity of stenosis. The association of AAC is evaluated with the presence and severity of CHD that's diagnosed by angiography. CHD was present in 87.2% of women with positive for AAC and in 4.3% of who were negative for AAC (p = .001). AAC positive women were more likely to develop obstructive CHD than non-obstructive CHD (66.6% versus 30.9%, p = .001), respectively. Sensitivity and specificity of AAC for CHD were 97.6% and 78.5%, respectively. AAC detected by transvaginal ultrasound seems to have a strong association with both presences of CHD and the severity of disease. Impact statement What is already known on this subject? Atherosclerosis affecting all arteries is the primary cause of mortality and morbidity of coronary heart disease (CHD) (Lim et al. 2011). Uterine artery calcification and its association with atherosclerosis were first reported by Camiel et al. (1967). Ozdemir et al. (2016) found a correlation between carotid artery intima thickness and the presence of uterine arcuate artery calcification (AAC). What do the results of this study add? Very few studies have been performed in this area investigating the relationship of AAC and non-invasive predictors of atherosclerosis or the relationship between arterial calcifications and cardiovascular or systemic disease. Our study is the first to evaluate the correlation between AAC and CHD confirmed using coronary artery angiography at a high sensitivity rate (97.6%). What are the implications of these findings for clinical practice and/or further research? Our study presents an alternative, easy and non-invasive method for the prediction of subclinical CHD in clinical practice. From the view of a gynaecologist, cardiology consultation of patients with AAC detected by transvaginal ultrasonography during the routine gynaecologic examination may be useful and protective against serious cardiac problems. Thus, this study is of great importance in terms of predicting when the majority of CHD patients are asymptomatic or in the subclinical phase.

Hysteroscopic evaluation of tubal peristaltic dysfunction in unexplained infertility.

It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. The aim of this study was to examine the presence of tubal peristaltic dysfunction in unexplained infertility (UI). Hysteroscopy was performed in 35 women with UI and in 37 healthy fertile women. Bilateral tubal peristalses were assessed hysteroscopically by the observation of methylene blue injection and its transport to the Fallopian tubes. Tubal patency was evaluated with laparoscopic chromopertubation. Two women in control group (6.67%) and eight women in UI group (30.77%) had no tubal peristalsis, at least one tube with normal tubal patency. The difference was statistically significant (p = .019). Tubal peristaltic dysfunction may be a hidden cause of subfertility in women with bilateral patent Fallopian tubes. There is a definite need for larger trials to identify tubal peristaltic dysfunction as a cause of UI. Impact statement What is already known on this subject? Unexplained infertility has no identified pathophysiologic basis. It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. What do the results of this study add? Tubal peristaltic dysfunction was detected in two tubes (3.70%) in a control group and nine tubes (19.57%) in women with unexplained infertility, when the tubes were patent. The difference was statistically significant (p = .012). What are the implications of these findings for clinical practice and/or further research? In cases of bilateral patent Fallopian tubes such as in unexplained infertility, tubal peristaltic dysfunction may be a hidden additional cause of subfertility.

Endometrial flushing αVß3 integrin, glycodelin and PGF2α levels for evaluating endometrial receptivity in women with polycystic ovary syndrome, myoma uteri and endometrioma.

The aim of this cross-sectional study is to compare endometrial flushing fluid levels of αVß3 integrin, glycodelin and PGF2α during the midluteal phase of the menstrual cycle of women with polycystic ovary syndrome (PCOS, n = 20), myoma uteri (n = 20) and endometrioma (n = 19) with the healthy controls (n = 20). After collecting samples at the midluteal phase of ovulatory volunteers and storing them at -80 °C, αVß3 integrin, glycodelin and PGF2α levels were analyzed using ELISA. The mean ages of the groups were 28.90 ± 5.45, 37.25 ± 2.73, 32.84 ± 6.62 and 32.15 ± 5.18 in PCOS, myoma uteri, endometrioma and control groups, respectively. The αVß3 integrin level (ng/ml) was statistically significantly higher in endometrioma group (9.70 ± 1.72, p < 0.05) as compared to myoma uteri and control groups. Similarly, glycodelin level (ng/ml) was significantly higher in endometrioma group (341.04 ± 93.32) than PCOS (p < 0.01), myoma uteri (p < 0.001) and healthy subjects (p < 0.001). Moreover, PGF2α level (350.04 ± 464.50 ng/ml) was significantly higher in PCOS group relative to myoma uteri (p < 0.001), endometrioma (p < 0.05) and control (p < 0.05) groups. In conclusion, αVß3 integrin level was significantly higher in endometrioma subjects than those with myoma uteri and control groups; glycodelin level was significantly higher in endometrioma group than other three groups, and lastly, PCOS patients had significantly higher PGF2α levels than those patients with myoma uteri, endometrioma and controls.

Saline Infusion Sonography Can Improve Outcome in Subsequent ICSI Cycles When No Intrauterine Pathology Is Detected.

OBJECTIVE: To analyze the benefits of saline infusion sonography (SIS).due to its endometrial injury effect on outcomes of subsequent intracytoplasmic sperm injection (ICSI) cycles. STUDY DESIGN: This study is a retrospective anal- ysis of 398 patients under- going ICSI cycles. The bio- chemical and clinical preg- nancy rates of 45 patients who underwent SIS prior to starting an ICSI cycle were compared to those of controls. RESULTS: Endometrial thickness was significantly higher in patients who underwent SIS (p=0.016). The biochemical pregnancy rate was statistically significant- ly higher in the SIS group than in the control group (p=0.040). The clinical pregnancy rate was 55.56% in patients who underwent SIS, while it was only 39.09% in the control group. The difference was statistically sig- nificant (p=0.037). CONCLUSION: .SIS can be used to assess the endome- trial cavity prior to ICSI cycle; moreover, SIS might be associated with improved outcomes when no intrauterine pathology is detected. Confirmation of this finding via future robust randomized trials is needed and would be useful to further guide clinical practice.

Association between red blood cell distribution width and polycystic ovary syndrome.

AIMS: The red blood cell distribution width (RDW) is being recognized as a marker of chronic inflammation and routinely reported as part of a complete blood count (CBC) without any additional costs. High levels of RDW associate with oxidative stress and cardiovascular disease risk. We aimed to investigate the relation between the level of RDW and high-sensitive C-reactive protein (hs-CRP), HOMA-IR, BMI and body fat percentage in women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: Cross-sectional and observational studies were conducted in 90 subjects with PCOS and 87 age- and BMI-matched controls. Body fat percentage, CBC, fasting serum glucose, serum insulin, hs-CRP, lipids, and total and free-testosterone levels were measured. RESULTS: RDW levels were significantly higher in the PCOS group compared with the control group (12.98 ± 0.92% versus 12.59 ± 0.84%, p = 0.004). RDW levels were positively correlated with hs-CRP, HOMA-IR and BMI. Multivariate analysis showed that high-RDW levels were associated with PCOS. Subjects with the highest quartile RDW levels were nearly 2.8 times more likely to develop PCOS compared with subjects with the lowest quartile RDW. ROC curve analysis showed that RDW levels were useful as a diagnostic marker for PCOS. The optimal cut-off value for detecting PCOS was ≥12.54% (sensitivity 67% and specificity 70%). CONCLUSIONS: RDW levels were higher in women with PCOS, and high-RDW levels were independently associated with PCOS. This link in between RDW and PCOS may be due to an underlying chronic inflammation in subjects with PCOS.

Melatonin causes regression of endometriotic implants in rats by modulating angiogenesis, tissue levels of antioxidants and matrix metalloproteinases.

PURPOSE: The aim of this study was to test if melatonin causes regression of endometriotic implants and whether it influences implant levels of superoxide dismutase (SOD), malondialdehyde (MDA), vascular endothelial growth factor (VEGF), tissue inhibitor of metalloproteinase (TIMP)-2 and matrix metalloproteinase (MMP)-9 in rats. METHODS: Endometriotic implants were introduced surgically to 20 female Wistar albino rats, which were either treated with melatonin via intraperitoneal injection for four weeks (melatonin group, n = 10) or with saline (control group, n = 10) after a second-look laparotomies. The main outcome measures included volume (mm(3)) and weight (mg) of explants and tissue levels of SOD, MDA, VEGF, TIMP-2 and MMP-9. RESULTS: Before and after treatment implant volumes of the melatonin group were decreased significantly (P < 0.01) while there was no significant difference between the pretreatment and posttreatment implant volumes of the control group. Moreover, weight (P < 0.05) and histologic score (P < 0.05) of implants of the melatonin-treated rats were significantly lower than controls. Activity of SOD and TIMP-2 staining in melatonin group was significantly higher (both P < 0.01) while there were significant reductions in implant levels of VEGF and MMP-9 in melatonin group (both P < 0.01) than controls. CONCLUSIONS: Melatonin induces the regression of endometriotic implants in rats by modulating implant levels of SOD, MDA, VEGF, MMP-9 and TIMP-2.

Nasal bone to nasal tip length ratio for describing nasal bone hypoplasia and predicting trisomy 21.

Introduction: Fetal nasal bone hypoplasia has been proven to be a strong marker for trisomy 21 during second trimester ultrasonography. Rather than evaluating the nasal bone hypoplasia according to the nomograms, it may be possible to evaluate it with a more practical and specific method. Material and methods: Retrospectively collected data were provided from the saved and stored patient data between 2012 and 2017. Nasal bone length and nasal tip length were measured and the ratio was calculated. The ratio ≤ 1/3 was defined as the threshold ratio for the definition of the marker. Nasal bone nasal tip length (NB/NL) ratio values were compared among groups with trisomy 21 and euploid fetuses. Results: A total of 59 fetuses had trisomy 21 and 2304 euploid fetuses were included in the study. The ratio of nasal bone to nasal tip length was 1/3 and below in 21/59 (35.5%) of fetuses with trisomy 21 whereas this ratio was 31/2304 (1.3%) in euploid fetuses. The difference was statistically significant (p < 0.001). Sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of nasal bone/nasal tip ratio ≤ 1/3 were 35.5%, 98.6%, 26.4 and 0.6 for Down syndrome, respectively. Conclusions: This study suggested that the nasal bone to nasal tip length ratio may be a new promising and practical sonographic marker in the second trimester genetic sonography. Although its sensitivity is not high, it seems to be more practical and specific than the evaluation of fetal nasal bone length.

Outcomes between non-IVF and IVF treatment after laparoscopic conservative surgery of advanced endometriosis with Endometriosis Fertility Index score >3.

Surgical excision of advanced endometriosis has been demonstrated to improve women's pain symptoms and quality of life in women in randomized placebo-controlled trials, but there is no strong evidence regarding the live birth rate. The revised American Fertility Society (r-AFS) classification for endometriosis has a limited predictive ability for fertility outcomes after surgery; therefore, EFI scoring has been advised for predicting conception after endometriosis surgery. No randomized controlled trials have investigated fertility outcomes in patients with advanced endometriosis after surgery. This study aimed to determine the outcomes of in vitro fertilization (IVF) or non-IVF treatments after conservative surgery for advanced endometriosis in patients with good prognosis Endometriosis Fertility Index (EFI) scores (>3). This prospective cohort study was conducted between April 2014 and April 2019 at a tertiary research hospital. In total, 113 women with suspected preoperative advanced endometriosis were enrolled in this study. A total of 90 women with advanced endometriosis underwent laparoscopic surgery. Fourteen patients with EFI score of ≤3 and 3 of them who had bilateral tubal occlusion were also excluded. Seventy-three women were included in this study. The remaining 30 women in the non-IVF group and 32 women in the IVF group were analyzed. The main outcome measures were cumulative pregnancy rates and live birth rates in both groups. Women who underwent IVF treatment were older than women (30 ±â€…3.41) who had non-IVF treatment (26.5 ±â€…3.07) after laparoscopic surgery (P < .001). The remaining baseline characteristics of the patients in both groups were similar. Clinical pregnancy, abortion, and live birth rates were similar in both the groups after 36 months of follow-up. This study demonstrated that cumulative pregnancy and live birth rates were similar to those of non-IVF or IVF treatments after conservative surgery for advanced endometriosis, if patients had good prognosis EFI scores. Furthermore, non-IVF treatments resulted in nearly the same clinical pregnancy results as IVF treatment within 1 year after surgery.

Chorionic villus sampling and preeclampsia & eclampsia: coincidence or not?

OBJECTIVES: The purpose of the study is to investigate potential association of chorionic villus sampling (CVS) with subsequent development of preeclampsia (PE) and eclampsia (E). STUDY DESIGN: The development of PE and E was compared between two groups as follows: 1- CVS group: women who underwent CVS (n = 228) and 2- Control group: maternal and gestational age matched women without invasive prenatal diagnostic procedure (n = 456). Main outcome measures were incidence of PE (mild, severe) and E. RESULTS: The incidence of PE and E was not significantly different between CVS and control groups. There was no significant difference regarding mild and severe PE development between the two groups. The incidence of early- and late-onset PE was similar in CVS and control groups. CONCLUSIONS: CVS does not appear to increase the risk of PE and E. The spontaneous elevation of trophoblastic load in the maternal circulation rather than the iatrogenic elevation through CVS may contribute to the development of PE and E.

Moistening of misoprostol tablets with acetic acid prior to vaginal administration for mid-trimester termination of anomalous pregnancy: A randomised comparison of three regimens.

OBJECTIVE: To compare the efficacy and side effects of three regimens of intravaginal misoprostol for second-trimester abortion. METHODS: A total of 118 women requiring second-trimester pregnancy termination were randomly assigned to one of three treatment groups: 400 microg 3-hourly in group A (n = 39), 600 microg 6-hourly in group B (n = 39), and 800 microg 12-hourly in group C (n = 40). Misoprostol tablets moistened with 3 ml of 5% acetic acid were placed into the posterior vaginal fornix. RESULTS: The median induction-abortion times in groups A (8 h [range: 3-64]) and B (9 h [4-81]) were significantly shorter (p < 0.01 and p < 0.05, respectively) than in group C (12.5 [3-72]). Moreover, expulsion rates within 24 hours in groups A (92.3%) and B (92.3%) were significantly higher (p < 0.05 in both cases) than that of group C (75%). Expulsion rate within 48 hours, number of tablets used, number of patients with retained placenta and side effects did not differ between groups. CONCLUSIONS: Misoprostol moistened with acetic acid is effective for second-trimester pregnancy termination when given vaginally 3-hourly, 6-hourly or 12-hourly. The former two regimens are significantly more effective than the latter.

Metformin and atorvastatin reduce adhesion formation in a rat uterine horn model.

The aim of the present study was to determine whether atorvastatin and metformin are effective in preventing adhesions in a rat uterine horn model. A total of 40 non-pregnant, female Wistar albino rats, weighing 180-210 g, were used as a model for post-operative adhesion formation. The rats were randomized into four groups after seven standard lesions were inflicted in each uterine horn and lower abdominal sidewall using bipolar cauterization. The rats were given atorvastatin 2.5 mg/kg/day, p.o. (10 rats), atorvastatin 30 mg/kg/day, p.o. (10 rats), metformin 50 mg/kg/day, p.o. (10 rats) and no treatment was applied in the control group (10 rats). The animals were killed 2 weeks later and adhesions were scored both clinically and pathologically by authors blinded to groups. One rat in the control group died before the end of the 2 week period. Total clinical adhesion scores regarding extent, severity and degree of adhesions and histopathological findings including inflammation and fibrosis were significantly lower in the metformin (P < 0.001 and P < 0.01, respectively) and atorvastatin 30 mg/kg/day (P < 0.001 and P < 0.01, respectively) groups when compared with control group. Metformin and atorvastatin are both effective for prevention of adhesion formation in a rat uterine horn model.

Synchronous primary carcinoma in 5 different organs of a female genital tract: an unusual case and review of the literature.

The occurrence of double simultaneous primary cancers of the female reproductive tract is a common event. However, the occurrence of synchronous primary quadruple gynecologic malignancies is extremely rare. In this report, the clinical and pathological findings of a 35-year-old female patient with synchronous primary gynecologic cancers regarding papillary serous carcinoma of the left ovary, microinvasive carcinoma in situ of the left and right uterine tubes, endometrial intraepithelial carcinoma of the endometrium, and endocervical carcinoma in situ of the uterine cervix were presented. To our knowledge, the patient presented is the first case in aspect of accompanying ovarian papillary serous carcinoma to bilateral tubal microinvasive carcinoma in situ, endometrial intraepithelial carcinoma, and endocervical carcinoma in situ of the uterine cervix.

Fetal cardiac examination can affect patients' preference on invasive tests: A new data on maternal anxiety indicated karyotyping.

BACKGROUND: Prenatal screening for aneuploidies has seen great changes over the last 2 decades. But there is still no non-invasive diagnostic test. Therefore, prenatal invasive procedures are still being routinely performed due to maternal anxiety. The association of cardiac anomalies and abnormal findings with aneuploidies has been known for a long time. This prospective study was done to evaluate abnormal fetal cardiac examination (FCE) findings on patients undergoing diagnostic invasive procedures due to maternal anxiety and to assess the predictive value of abnormal cardiac findings on abnormal karyotype. MATERIALS AND METHODS: Patients who underwent prenatal diagnostic invasive tests due to maternal anxiety indication between March 2013 and September 2016 were included in this study. FCE was performed in the study group immediately prior to invasive tests. Findings of fetal cardiac examination are classified as normal, major-minor cardiac anomalies and soft markers. Fetal karyotypes were compared among groups depending on cardiac findings. RESULTS: One hundred eighty-two invasive procedures were performed because of maternal anxiety during this period. There were 29 abnormal findings detected on FCE. A total of 7 abnormal karyotypes were detected. FCE was abnormal in 5 of the abnormal karyotypes (71.4%). The presence of a major cardiac anomaly was most predictive for abnormal karyotype (LR+: 96,67, LR-: 0,34). No association was detected between the presence of minor cardiac anomalies and abnormal karyotype. Normal FCE appeared to be a good predictive factor for normal karyotype (LR-: 0.20). CONCLUSIONS: This is the first study evaluating the power of early fetal cardiac examination findings on fetal aneuploidies. This study suggested that the application of fetal cardiac examination findings to genetic counseling for screening aneuploidies may be efficient on patients' preference about invasive tests. Due to the small number of abnormal findings and karyotypes detected (not the large study group), further studies on large study groups are needed to confirm these results.

Prophylactic McCall Culdoplasty by a Vaginal Approach during Mini-Laparoscopic Hysterectomy.

BACKGROUND: In gynecological surgery, one particular area of concern after hysterectomy is the risk of developing an enterocele or vaginal apical prolapse. The aims of this study were to evaluate the safety and efficacy of prophylactic McCall culdoplasty (MC) performed during mini-total laparoscopic hysterectomy (mini-TLH), as well as to compare the differences in apical support, total vaginal length (TVL), and sexual function at one and two years postoperatively. METHODS: Data were retrospectively reviewed for all women who underwent mini-TLH and mini-TLH + MC at a tertiary care center between August 2012 and January 2016 were from the hospital database. There were 18 women who underwent mini-TLH + MC and were considered as the study group, while 20 women who were treated with mini-TLH were considered as the control group. The primary outcome measures were the differences in apical support and TVL and impact on sexual function. RESULTS: After mini-TLH + MC, the apical vaginal support difference was improved by 2.2 cm. The mean difference in C point was 1.03 cm in the mini-TLH group, which was not significant at two years after the operation. The vaginal vault descent at two years after operation was more prominent in the mini-TLH group than the mini-TLH + MC groups. Apical support changes at two years after the operation were more prominent in the mini-TLH group (0.5 ± 0.6 cm) than the mini-TLH + MC group (1.9 ± 1.2 cm). CONCLUSION: Prophylactic MC by a vaginal approach during mini-TLH is safe, satisfactory, and efficient for apical support without severe morbidity.

One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials.

INTRODUCTION: To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches. MATERIAL AND METHODS: Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM. RESULTS: Three RCTs (n = 2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75 g, 2 hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77-3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27-0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56-0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22-0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16-0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29-0.84), compared to those randomized to screening with the two step approach. CONCLUSIONS: The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes.

Endometrial Flushing Tumor Necrosis Factor Alpha and Interleukin 2 Levels in Women with Polycystic Ovary Syndrome, Leiomyoma and Endometrioma: Comparison with Healthy Controls.

Introduction An important open question in the literature is whether endometrial receptivity marker levels are different in infertility related diseases than healthy women. The aim of the study is to compare the levels of interleukin two (IL-2) and tumor necrosis factor alpha (TNF-α) during the implantation window in the endometrial flushing fluid of polycystic ovary syndrome (PCOS), endometrioma, leiomyoma patients with healthy controls. Material and Methods In this case control study, after obtaining endometrial flushing fluids at mid-luteal phase of ovulatory women with PCOS (n = 20), endometrioma (n = 19), leiomyoma (n = 20) and healthy controls (n = 20), IL-2 and TNF-α levels were measured using ELISA kits in BioTek ELISA devices. Results Mean TNF-α levels (ng/mL) were similar for the PCOS (305.6, p = 0.220) and the leiomyoma group (246.3, p = 0.502) compared to healthy patients (261.1). However, the levels were higher in the endometrioma group (338.2, p = 0,004) than the control group (261.1) in a statistically significant way. Mean IL-2 levels (ng/mL) were significantly lower in the PCOS (290.9, p = 0.0005), the leiomyoma (282.9, p = 0.0002) and the endometrioma patients (229.5, p = 0.0009) than the control group (416.0). Conclusion Relative to the control group, endometrial flushing fluid TNF-α levels were significantly higher in endometrioma patients and IL-2 levels were significantly lower in PCOS, leiomyoma and endometrioma patients. In benign gynecological diseases, endometrial markers related to infertility seem to show differences in endometrial flushing fluid. Future studies might identify the reference values for these markers, and endometrial markers can be used to diagnose gynecologic disorders causing infertility.

Pimecrolimus 1% cream for pruritus in postmenopausal diabetic women with vulvar lichen simplex chronicus: a prospective non-controlled case series.

BACKGROUND: Pruritus vulvae may have a variety of causes, such as infections, dermatologic disorders or non-neoplastic/neoplastic vulvar diseases. OBJECTIVES: To investigate the efficacy and side effects of topical pimecrolimus 1% cream for pruritus vulvae. METHODS: Twelve postmenopausal diabetic women with vulvar lichen simplex chronicus were enrolled in this trial. Each patient was treated with pimecrolimus 1% cream which was applied twice daily in a thin layer to the vulvae for 3 months. Clinical examination and recording of patients' symptoms using a scoring system was performed by the same physician before, after 4 weeks and after 3 months of therapy. RESULTS: All of the patients completed the study. A substantial decrease in pruritus after treatment was reported by the patients at the 4th week (2.17+/-0.72, p<0.01) and 3rd month of treatment (0.42+/-0.92, p<0.001) when compared with the baseline score (3.75+/-0.45). Follow-up of the patients after 3 months of treatment showed that complete cure occurred in 10 patients (83.3%) and the pruritus was improved in two (16.7%) patients. CONCLUSIONS: Pimecrolimus 1% cream seems to be an effective and safe treatment modality for pruritus in postmenopausal women with vulvar lichen simplex chronicus.

Decline in ovarian reserve may be an undiagnosed reason for unexplained infertility: a cohort study.

INTRODUCTION: Unexplained infertility refers to the absence of a definable cause for a couple's failure to achieve pregnancy. Reproductive aging plays a role in pathogenesis of unexplained infertility. We investigated the results of ovarian reserve tests in unexplained infertility. MATERIAL AND METHODS: The patients were divided into two groups: unexplained infertility (n = 148) and male factor infertility (n = 112). Follicle-stimulating hormone, estradiol, inhibin b levels and anti-Müllerian hormone levels were evaluated. Antral follicle count and ovarian volume measurements were performed. RESULTS: The demographic variables were comparable. Follicle-stimulating hormone levels were higher in the unexplained infertility group than the male factor infertility group, although this difference did not reach statistical significance (p = 0.071). Estradiol levels, inhibin b concentrations and ovarian volume showed no difference between groups. However, antral follicle count was significantly lower in the unexplained infertility group than the male factor infertility group (p = 0.023). The median anti-Müllerian hormone concentrations were significantly lower in the unexplained infertility group 1.42 (0.4-6.2) than in the male factor infertility group (2.04 (0.64-8.2); p = 0.001). CONCLUSIONS: Although anti-Müllerian hormone values and antral follicle count were higher than the low thresholds, a statistically significant decline of ovarian reserve in the unexplained infertility group was found in the present study. This might be an undiagnosed reason for unexplained infertility.