Gauze packing may be a better hemostatic method to protect ovarian reserve during laparoscopic endometrioma cystectomy than conventional hemostatic methods.

PURPOSE: To compare the ovarian reserve of different hemostatic methods after laparoscopic endometrioma stripping (LES) and explore which factors may affect ovarian reserve. METHODS: Patients who underwent LES from January 2019 to December 2021 were retrospectively included. Anti-Müllerian hormone (AMH) levels were measured before, and 3 months after surgery to determine changes of serum AMH in each patient. A multivariate linear regression analysis was performed to identify significant factors that were associated with the rate of decline of serum AMH levels at month 3 after surgery. RESULTS: A total of 67 patients who underwent LES were included. Of these patients, 20 with gauze packing, 24 with bipolar dessication (BD), and 23 with suture to achieve hemostasis. The 3 groups were similar in terms of demographics, cyst diameter, and basal AMH levels, except basal hemoglobin levels. At 3 months after surgery, the decline rate of AMH levels was significantly greater in the suture and BD group compared with the gauze packing group [48.2% (interquartile range, IQR, 28.1-67.1) and 31.1% (IQR,14.6-49.1) vs. 15.1% (IQR,1.1-24.5), P = 0.001]. On multivariate regression models, significant predictors of the decline rate of serum AMH levels at 3 months after surgery were hemostatic methods (p < 0.001), basal AMH levels (p = 0.033), and lesion bilaterality (p = 0.017). CONCLUSION: Compared to BD or suturing hemostasis, gauze packing hemostasis led to less damage on ovarian reserve at 3 months after LES. Besides, hemostatic methods, bilateral endometriomas and basal ovarian reserve were independently correlated with the impairment of ovarian reserve after surgery.

Correlation of human telomerase reverse transcriptase single nucleotide polymorphisms with in vitro fertilisation outcomes.

PURPOSE: To explore whether it is possible to predict the number and quality of the embryo using a few particular hTERT SNPs. METHODS: We included 997 Han Chinese women who were genetically unrelated and underwent assisted reproduction using IVF from September 2014 to December 2015. DNA was genotyped by using TaqMan real-time quantitative PCR. RESULTS: Among the 997 patients, individuals with the CC genotype of rs2075786 had a significantly lower number of good-quality embryos than those with the TT+TC genotypes. Compared with the CT+CC genotype carriers, patients carrying the TT genotype of rs2853677 had a significantly lower number of oocytes retrieved, mature oocytes and available embryos. Among the 750 patients aged ≤ 35 years, individuals with the AA+AG genotypes of rs2853691 had a significantly higher number of good-quality embryos than those with the GG genotype. The haplotype analysis showed that the TTTG (rs2853672/rs2853669/rs2735940/rs2736108) haplotype was more likely to lead to more than three good-quality embryos in patients aged ≤ 35 years. CONCLUSIONS: Our study suggests that the hTERT SNP is associated with IVF outcomes.

The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer.

BACKGROUND: Inflammation plays an important role in the pathogenesis of ovarian cancer. This study sought to investigate the association between the preoperative c-reactive protein/albumin ratio (CRP/Alb) and oncological outcomes in ovarian cancer patients. METHODS: Two hundred patients with histologically verified ovarian cancer between June 2006 and July 2012 were retrospectively reviewed. Overall survival was evaluated by the Kaplan-Meier method and log-rank test. The significance of risk factors for overall survival was evaluated with the Cox proportional hazards model. Additionally, area under the receiver operating characteristic curve (AUC) was used to compare the predictive ability of CRP/Alb, Glasgow Prognostic Score (GPS), modified GPS (mGPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic index (PI) and prognostic nutritional index (PNI). RESULTS: The optimal cutoff value of CRP/Alb was 0.68. Increased CRP/Alb (≥0.68) was associated with advanced stage, residual tumor, ascites, elevated serum carbohydrate antigen(CA)-125 level, GPS, and mGPS (all p < 0.05). Patients with high CRP/Alb had poor overall survival compared to those with low CRP/Alb (p < 0.001). Multivariable analysis showed that CRP/Alb (Hazard Ratio (HR) 1.330, 95% confidence interval (CI) 1.131-1.564, p = 0.001), tumor stage (HR 1.577, 95% CI 1.189-2.091, p = 0.002), residual tumor (HR 2.337, 95% CI 1.518-3.597, p < 0.001) and age (HR 1.017, 95% CI 1.000-1.035, p = 0.046) were independent prognostic factors for overall survival. Additionally, the CRP/Alb showed greater AUC values at 1 year (0.692), 3 years (0.659), and 5 years (0.682) than GPS, mGPS and PNI. CONCLUSIONS: The CRP/Alb is a novel independent marker of poor prognosis among ovarian cancer patients and shows superior prognostic ability compared to the established inflammation-based prognostic indices.

Predictive value of age-specific FSH levels for IVF-ET outcome in women with normal ovarian function.

BACKGROUND: Most of infertile women with normal follicle stimulating hormone (FSH) levels and antral follicle count (AFC) at day 2-3 of the period, but poor IVF outcomes may occur when use of routine controlled ovarian stimulation. This paper is to evaluate the predictive value of age-specific FSH levels for IVF-ET outcomes in women with normal ovarian function. METHODS: A total of 1287 women undergoing their first IVF cycles were enrolled in this retrospective study. The FSH levels and AFC of all of the women were within normal ranges (FSH ≤ 12 IU/L;AFC ≥ 5). The patients were grouped by age (younger: < 33 years, medium-aged:33-37years and older:38-41years), and within each age group, the patients were subdivided by the upper limit of the 95 % confidence interval (CI) for mean FSH levels. Patients with FSH levels equal to or greater than the upper 95 % CI of FSH in each age group were included into a premature ovarian aging (POA) subgroup (younger:FSH ≥ 7.84, medium-aged: ≥8.12 and older: FSH ≥ 8.47),the remaining patients in each age group were included into a control subgroup. The outcomes of IVF-ET were compared between the POA subgroup and the control subgroup in each age group. RESULTS: In each age group, the total dose of gonadotropin(Gn) in the POA subgroups were significantly higher than those of the corresponding control subgroups. In the younger and medium-aged groups, women in the POA subgroups had significantly lower oocyte yields, frozen embryos, and higher rates of poor ovarian response(POR) than those in the corresponding control subgroups. When controlling for age, BMI and AFC, the multiple logistic regression analysis indicated the following: In each age group, the total dose of Gn was significantly correlated with POA; the oocyte yield was significantly related to POA only in the younger group; and in the whole age groups, the incidence of POR in the POA group was 2.719 times greater than in the control group (OR = 2.719, 95 % CI [1.598-4.625], P < 0.001). CONCLUSION: Basal FSH levels combined with age (age-specific FSH levels) can be used as a more accurate marker for the ovarian response in women with normal ovarian reserves undergoing IVF-ET, particularly in women ≤37 years old.

Endometriosis fertility index score maybe more accurate for predicting the outcomes of in vitro fertilisation than r-AFS classification in women with endometriosis.

BACKGROUND: Endometriosis is a common disease. The most widely used staging system of endometriosis is the revised American Fertility Society classification (r-AFS classification) which has limited predictive ability for pregnancy after surgery. The endometriosis fertility index (EFI) is used to predict fecundity after endometriosis surgery. This diagnostic accuracy study was designed to compare the predictive value of the EFI with that of the r-AFS classification for IVF outcomes in patients with endometriosis. METHODS: 199 women with endometriosis receiving IVF treatment after surgery were analysis. The EFI score and r-AFS classification in their ability to predict these IVF outcomes were compared in the same population. ROC curves were used to analyse the predictive values of the EFI and r-AFS indices for clinical pregnancy, and their accuracies were evaluated by sensitivity, specificity, and the Youden's index. RESULTS: The Area Under the Curve (AUC) of the EFI score (AUC = 0.641, Standard Error(SE) = 0.039, P = 0.001, 95% CI = 0.564-0.717, cut-off score = 6) was significantly larger than that of the r-AFS classification (AUC = 0.445, SE = 0.041, P = 0.184, and 95% CI = 0.364-0.526). The antral follicle count, oestradiol level on day of hCG, number of oocytes retrieved, number of oocytes fertilised, and number of cleaved embryos in the greater than or equal to 6 EFI score group was greater than that of the lower than or equal to 5 EFI score group, and the dose of gonadotropin of the greater than or equal to 6 EFI score group were less than that in the lower than or equal to 5 EFI score group. Implantation rate, clinical pregnancy rate, and cumulative pregnancy rate in the greater than or equal to 6 EFI score group were higher than in the lower than or equal to 5 EFI score group. CONCLUSIONS: It suggests that the EFI has more predictive power for IVF outcomes in endometriosis patients than the r-AFS classification. The clinical pregnancy rate was higher in patients with EFI greater than or equal to 6 score than with EFI lower than or equal to 5 score.

Clinical and metabolic features of polycystic ovary syndrome.

OBJECTIVE: To explore the clinical and metabolic features of Chinese women with polycystic ovary syndrome (PCOS). METHODS: The clinical data of 273 Chinese women diagnosed as having PCOS were retrospectively studied. RESULTS: Of these women 34.8% had hirsutism, 45.1% had acne, 94.1% had some menstrual abnormality, and 96.7% had typical appearances of polycystic ovaries on ultrasonographic examination. The prevalence of overweight women was 30.4%, and the prevalence of insulin resistance was 12.8% using the glucose to insulin ratio (GIR) and 21.6% using the homesostasis model assessment (HOMA). Body mass index was significantly correlated with fasting insulin level (r=0.50), GIR (r=0.37) and HOMA (r=0.53). CONCLUSION: Menstrual abnormality and polycystic ovaries were the main clinical manifestations in this cohort of Chinese women with PCOS. The prevalence of hyperandrogenism, obesity, and insulin resistance was lower in this cohort than in women from other races with the same condition. Ethnic differences needs to be considered when studying the clinical and metabolic features of women with PCOS.

[Polymorphism of catechol-O-methyltransferase gene in relation to the risk of endometrial cancer].

OBJECTIVE: The 4- and 16-hydroxylated metabolites of estrogens have been implicated in carcinogenesis, whereas its 2-hydroxylated metabolites have been shown to have antiangiogenic effects. We aimed to examine whether the polymorphisms of catechol-O-methyltransferase (COMT) involved in the estrogen metabolism are associated with endometrial cancer risk. METHODS: Polymerase chain reaction-restrictive fragment length polymorphism (PCR-RFLP) analysis was used to study the variant allele frequency distributions of COMT Val158Met genetic polymorphism in a population based case-control study with 132 endometrial cancer cases and 110 controls. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by unconditional logistic regression after adjustment for known or suspected risk factors for endometrial cancer. RESULTS: The most frequent genotype was COMT(Val/Val) (47.2%, 52/110) in control group and COMT(Val/Met) (58.3%, 77/132) in endometrial cancer group. The difference between the two groups was of statistical significance (P < 0.05). Compared with COMT(Met/Met) genotype, the COMT(Val/Val) genotype was inversely correlated with endometrial cancer risk, and the adjusted OR value was 0.262 (95% CI: 0.080 - 0.862, P = 0.027). CONCLUSIONS: Among the genotypes in women in South China, genotype COMT(Val/Val) is mostly seen, followed by COMT(Val/Met), and COMT(Met/Met) is the least in control group. The endometrial cancer susceptivity of genotype COMT(Val/Val) carriers may be lower than COMT(Met/Met) carriers.

Levonorgestrel Inhibits Human Endometrial Cell Proliferation through the Upregulation of Gap Junctional Intercellular Communication via the Nuclear Translocation of Ser255 Phosphorylated Cx43.

OBJECTS: To assess whether LNG exerts antiproliferation effects on human endometrial cells through changes of GJIC function and the phosphorylated Cx43. METHODS: Cell proliferation and apoptosis of human endometrial stromal cells (HESCs) and glandular cells (HEGCs) treated with LNG in a dose- and time-dependent manner. GJIC change and further total Cx43 and serine 368 and 255 phosphorylated Cx43 were measured. RESULTS: 5 × 10(-5) mol/L LNG revealed a time-dependent inhibition of cell proliferation and an increase of apoptosis in both HESCs and HEGCs. Furthermore, these cells demonstrated a significant GJIC enhancement upon treatment with 5 × 10(-5) mol/L for 48 hours. The effects of LNG were most noticeable in HESCs rather than in HEGCs. Associated with these changes, LNG induced a relative increase in total Cx43 in a time-dependent manner but not Ser368 phosphorylated Cx43. Moreover, laser scanning confocal microscope confirmed the increased expression of total Cx43 in the cytoplasm and, interestingly, the nuclear translocation of Ser255 phosphorylated Cx43. CONCLUSIONS: LNG likely inhibits the proliferation and promotes apoptosis in HESCs and HEGCs though an increase in gap junction permeability in vitro, which is achieved through the upregulation of Cx43 expression and the translocation of serine 255 phosphorylated Cx43 from the plasma to the nuclear compartment.

Effects of hormone replacement therapy on platelet activation in postmenopausal women.

OBJECTIVE: To assess the effects of hormone replacement therapy (HRT) on platelet activation in postmenopausal women compared with premenopausal women. METHODS: The expressions of CD41 and CD62P in fifteen postmenopausal women before and after HRT were detected using flow cytometry (FCM), with fifteen premenopausal women with a mean age of 47 years as controls. RESULTS: The expressions of CD41 and CD62P in postmenopausal women were higher than those in the control group. CD62P(%), CD62P(I) and CD41 were reduced from 36.40 +/- 5.9, 37.75 +/- 5.8, and 470.11 +/- 74.0 to 27.97 +/- 5.6, 26.64 +/- 4.9, and 303.23 +/- 72.8 after six months of HRT (P < 0.05). CONCLUSIONS: Platelet activation in postmenopausal women was higher than in premenopausal women and was reduced significantly after six months of HRT. HRT may have a favorable effect on reduction of platelet activity.

Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome.

BACKGROUND: The aims of this study were to analyse the prevalence of impaired glucose tolerance (IGT) and diabetes mellitus (NIDDM) in Chinese polycystic ovary syndrome (PCOS) patients and to assess the ability of screening tests to predict these abnormalities within this population. METHODS: A total of 102 PCOS patients were evaluated. All patients underwent oral glucose tolerance tests (OGTTs) with blood samples taken at 0, 1 and 2 h. The 2-h plasma glucose level was used to categorize subjects as having IGT or NIDDM. RESULTS: The prevalence of IGT was 20.5% and that of NIDDM was 1.9%. There was no significant relationship between BMI and 2-h plasma glucose levels. The areas under the receiver operating characteristic (ROC) curve for glucose to insulin ratio (G:I), homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were 0.702, 0.734 and 0.733 respectively. ROC analysis suggested a threshold value of 10.7 in G:I ratio (73.9% sensitivity and 59.5% specificity), a value of 2.14 in HOMA (73.9% sensitivity and 73.4% specificity) and a value of 0.34 in QUICKI (73.9% sensitivity and 73.4% specificity) for the prediction of abnormal glucose tolerance (IGT and NIDDM). CONCLUSIONS: Chinese women with PCOS are at increased risk of IGT and NIDDM. Even though G:I, HOMA and QUICKI are easier than OGTT, they could not replace the role of 2-h post-challenge plasma glucose level in the screening of IGT and NIDDM in PCOS women.