The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study.

AIM: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage. METHODS: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) ≥25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records. RESULTS: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351). CONCLUSIONS: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.

¿Afecta la infección asintomática, leve y moderada por Covid-19 en el primer y segundo trimestre los resultados del embarazo?

Objetivo : Determinar los efectos de la infección Covid-19 asintomática, leve y moderada en el primer y segundo trimestres en los resultados del embarazo. Métodos : El estudio se realizó en las gestantes que acudieron al Departamento de Perinatología de la Universidad de Ciencias de la Salud de Izmir entre octubre de 2021 y julio de 2022. Se registraron las mujeres embarazadas que presentaban infección asintomática, leve y moderada por Covid-19 en el 1º y 2º trimestre y se siguió el desarrollo de la gestación. Resultados : Un total de 437 pacientes participaron en el estudio. El número de pacientes asintomáticos, leves y moderados de Covid-19 fue de 142, 157 y 138, respectivamente. Cada grupo se analizó como subgrupo del 1º y 2º trimestre según el momento de la infección por Covid-19. La edad media de las pacientes con Covid-19 moderado era superior a la de las pacientes con Covid-19 leve/asintomático (p=0,021). Se observó que el índice de masa corporal era mayor en las pacientes con Covid-19 moderado que en las pacientes con infección leve/asintomática (p=0,048). El parto pretérmino (entre las semanas 34 y 37) fue significativamente mayor en los casos con infección moderada por Covid-19 (p=0,041). Este aumento ocurrió principalmente en pacientes con infección por Covid-19 en el 2º trimestre. No hubo modificaciones significativas en las tasas de cesárea, trastornos hipertensivos del embarazo, pérdida fetal, retraso del crecimiento intrauterino, colestasis del embarazo y diabetes gestacional. Conclusiones : Los efectos de la infección por Covid-19 al inicio del embarazo (1º y 2º trimestres) siguen siendo objeto de investigación. La infección moderada por Covid-19, especialmente en el 2º trimestre, puede provocar un aumento de la tasa de partos prematuros.

Objectives: To evaluate the effects of asymptomatic, mild and moderate Covid-19 infection in the 1st and 2nd trimesters on pregnancy outcomes. Material and methods: The study was performed among patients who applied to the Perinatology Department of Izmir University of Health Sciences, between October 2021 and July 2022. Pregnant women who had asymptomatic, mild and moderate Covid-19 infection in the 1st and 2nd trimesters were registered and their pregnancy processes were followed. Results: A total of 437 patients participated in the study. The numbers of asymptomatic, mild and moderate Covid-19 patients were 142, 157 and 138, respectively. Each group was analyzed as 1st and 2nd trimester subgroups according to the time of Covid-19 infection. The mean age of patients with moderate Covid-19 was higher than with mild/asymptomatic Covid-19 (p=0.021). Body mass index was found to be higher in patients with moderate Covid-19 compared to patients with mild/asymptomatic infection (p=0.048). Preterm labor (between 34th and 37th weeks) was significantly higher with moderate Covid-19 infection (p=0.041). This significant increase was mainly due to the preterm birth rate in patients with previous Covid-19 infection in the 2nd trimester. There was no significant change in the rates of cesarean section, hypertensive disorders of pregnancy, fetal loss, intrauterine growth restriction, cholestasis of pregnancy and gestational diabetes. Conclusions: The effects of Covid-19 infection in early pregnancy (1st and 2nd trimester) are still the subject of research. Moderate Covid-19 infection, especially in the 2nd trimester, may lead to an increase in the rate of preterm birth.

The effect of experience on the outcomes of total laparoscopic hysterectomy surgery: 1295 cases.

OBJECTIVES: To reveal the effect of surgeon's experience on the outcomes of the total laparoscopic hysterectomy (TLH) surgery. MATERIAL AND METHODS: Design: Retrospective case series. SETTING: A tertiary care university hospital. PATIENTS: 1295 cases with an indication for hysterectomy. INTERVENTIONS: Total laparoscopic hysterectomy. RESULTS: All cases were grouped according to the surgeon's experience. For 30 different surgeons, their first 20 operations constituted Group A, 21st-50th operations Group B, 51st-100th operations Group C, and their operations after the 100th surgery Group D. Demographic data and post-operative results were compared between the groups. There were no statistical differences in terms of demographic data and major complications. A statistically significant decrease was observed in the post-operative fall in hemoglobin level and the duration of hospitalization in the groups with increased experience (p = 0.021, p < 0.001, respectively). There wasn't an increase in uterine specimen weight with increased experience (p = 0.267). CONCLUSIONS: We obtained that the peak value in the learning curve cannot be evaluated according to the operation time or complication rates. Although the complication rate seems unaffected by surgical experience, concerns about complications may decrease as experience increases. Since the trend of minimally invasive surgery will continue increasingly in the next century because of higher patient comfort, all gynecologists should gain competence in endoscopic surgery.

Can the Cell-free DNA Test Predict Placenta Accreta Spectrum or Placenta Previa Totalis?

BACKGROUND: Following the discovery that fetal DNA originates from the trophoblastic cells of the placenta, the contribution of the cell-free DNA test in placenta-related obstetric complications has begun to be investigated. Compared to uncomplicated pregnancies, higher fetal fractions were detected in placenta accreta spectrum and placenta previa, which are among placenta-related obstetric complications. However, this data applies only to advanced gestational weeks. AIM: To investigate the possible predictive value of fetal fraction in cell-free DNA tests in pregnancies with placenta previa and placenta accreta spectrum in early gestational ages. MATERIALS AND METHODS: This study was conducted in women who were screened via cell-free DNA tests for common aneuploidies in the first and second trimester and subsequently diagnosed with placenta previa or placenta accreta spectrum. After the diagnosis was confirmed with a C-section, fetal fractions were retrospectively compared to a control group with a history of an uncomplicated C-section who were also previously screened by cell-free DNA test. RESULTS: The median and interquartile range (IQR) of fetal fractions for placenta previa (n=19), placenta accreta spectrum (n=7), and control groups (n=85) were 8.1 (6-10), 6.8 (6.7-10.7), and 7.1 (4.7-9.65), respectively. No statistically significant difference was observed among the three groups in terms of fetal fractions (p=0.587). CONCLUSIONS: According to our data, we did not observe any relationship between placental invasion abnormalities vs. control group or placenta previa vs. control group using the fetal fractions of the cell-free DNA test. Furthermore, we could not confirm a predictive role and/or any additional clinical contribution. We believe that future studies focusing on placental mRNA might be more helpful than cell-free fetal DNA testing.

PET Parameters are Useful in Predicting Endometrial Cancer Risk Classes and Prognosis.

AIM: We investigate the role of preoperative PET parameters to determine risk classes and prognosis of endometrial cancer (EC). METHODS: We enrolled 81 patients with EC who underwent preoperative F-18 FDG PET/CT. PET parameters (SUVmax, SUVmean, MTV, TLG), grade, histology and size of the primary tumor, stage of the disease, the degree of myometrial invasion (MI), and the presence of lymphovascular invasion (LVI), cervical invasion (CI), distant metastasis (DM) and lymph node metastasis (LNM) were recorded. The relationship between PET parameters, clinicopathological risk factors and overall survival (OS) was evaluated. RESULTS: The present study included 81 patients with EC (mean age 60). Of the total sample, 21 patients were considered low risk (endometrioid histology, stage 1A, grade 1 or 2, tumor diameter < 4 cm, and LVI negative) and 60 were deemed high risk. All of the PET parameters were higher in the presence of a high-risk state, greater tumor size, deep MI, LVI and stage 1B-4B. MTV and TLG values were higher in the patients with non-endometrioid histology, CI, grade 3 and LNM. The optimum cut-off levels for differentiating between the high and low risk patients were: 11.1 for SUVmax (AUC = 0.757), 6 for SUVmean (AUC = 0.750), 6.6 for MTV(AUC = 0.838) and 56.2 for TLG(AUC = 0.835). MTV and TLG values were found as independent prognostic factors for OS, whereas SUVmax and SUVmean values were not predictive. CONCLUSIONS: The PET parameters are useful in noninvasively differentiating between risk groups of EC. Furthermore, volumetric PET parameters can be predictive for OS of EC.

Modified posterior intravaginal slingplasty: does the additional bilateral tape attachment to the sacrospinous ligament improve the results?

INTRODUCTION: High failure and recurrent prolapse remains an important issue for pelvic organ prolapse (POP) surgery. The posterior intravaginal slingplasty (PIVS) is a minimally invasive, transperineal technique providing level I support, by creating neo-sacrouterine ligaments using a mesh. In order to reduce the POP recurrence rate, achieve a safer apical support and thereby better functional outcomes, we attached PIVS tape to the sacrospinous ligament bilaterally and compared the anatomical and functional outcomes for our modified technique versus the original PIVS. MATERIAL AND METHODS: We evaluated 368 patients, with a symptomatic pelvic organ prolapse in various grades, who had undergone a total pelvic floor reconstruction. Seventy-seven of 368 (21%) patients underwent the original PIVS, 291 (79%) patients were treated by the modified PIVS. When necessary, the following procedures were added: anterior transobturator mesh, posterior wall repair, perineal body repair and suburethral transobturator sling. All had follow-up checks for at least one year. The primary outcome was an objective cure, defined as grade 0 or grade 1 according to Baden-Walker. Secondary outcomes were prolapse recurrence, symptoms, visual analogue scales for satisfaction, quality of life, recommendation, reoperation rates and presence of complications. RESULTS: The total reconstructions we made, using each technique, were successful. We achieved an apical success rate of 97 to 96%, on average, with the modified and original IVS respectively. We found a statistically significant improvement in urge incontinence and frequency symptoms than the original PIVS with our modified technique. CONCLUSIONS: Modified PIVS in combination with concomitant procedures generates high anatomical and functional cure rates with low complications and recurrences.

Role of lymphadenectomy in disease-free and overall survival on low risk endometrium cancer patients.

OBJECTIVES: Evaluation of the effect of lymphadenectomy in disease-free and overall survival on the low risk corpus cancer. MATERIAL AND METHODS: Between 1994 and 2012, a total of 257 patients with endometrioid type, grade 1 or 2, myometrial invasion < 1/2, no intraoperative evidence of macroscopic extrauterine spread was treated surgically. Pelvic lymphadenec-tomy was performed in 184 cases, and not performed in 73 cases. RESULTS: There was no difference between two groups about tumor sizes. Also lymphovascular space invasion and histo-logic grade of two groups were similar. Omission of LA did not worsen DFS and OS in early stage low risk corpus cancer. CONCLUSIONS: Patients who have low risk corpus cancer, can be treated optimally with hysterectomy only.

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

Background/aim: This study aimed to investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy/sacrohysteropexy, laparoscopic sacrocolpopexy/sacrohysteropexy, sacrospinous ligament fixation (SSLF), and iliococcygeus fixation due to apical prolapse. Materials and methods: The present retrospective cohort study included 145 patients who underwent apical prolapse surgery performed by the same surgeons between 1/1/2011 and 30/6/2017. There were 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 13 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 3 sacrohysteropexies), 57 SSLFs, and 7 iliococcygeus fixations. Patients' short-term outcomes, perioperative complications, blood loss, operative time, and hospital stay were analyzed. Results: The mean operating time in the laparoscopic sacrocolpopexy group was 179.6 min versus 122.8, 117.3, and 107.1 min in the SSLF, abdominal sacrocolpopexy, and iliococcygeus fixation groups, respectively (P < 0.01). The hospital stay was significantly shorter in the iliococcygeus fixation group (1.86 days) when compared with that of other groups (P < 0.01). During a 6-month follow-up period, no prolapse recurrence or mesh exposure was observed in any groups. Wound complications were more frequent in the abdominal sacrocolpopexy group. However, the overall complication rate of each group did not differ significantly (P = 0.332). Conclusion: Overall, complication rates and short-term outcomes for the abdominal, laparoscopic, and vaginal surgical procedures were not statistically significantly different. However, minimally invasive approaches were associated with reduced procedural-related morbidity.

Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques.

OBJECTIVE: To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes. METHODS: In this case-control study, 412 women who underwent CVS at 11-14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution. RESULTS: The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4-2.7, P=0.008]. CONCLUSION: The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.

Urinary Incontinence in Puberty: A Rare Clinical Presentation of the Herlyn-Werner-Wunderlich Syndrome.

BACKGROUND: We report on an unusual presentation of Herlyn-Werner-Wunderlich syndrome in two 11-year-old girls within a year of menarche. The setting was a training and research hospital. CASE: We present two patients in the pubertal period with cyclic abdominal pain and urinary incontinence who received hysteroscopic septal resection. Menstrual flow was resumed and the complaints of incontinence were eliminated after the hysteroscopic resection of the vaginal septum. SUMMARY AND CONCLUSION: Overflow incontinence was completely resolved after septum resection in two patients. The risk of stricture is high in Herlyn-Werner-Wunderlich syndrome if the septum is partially excised to open the obstruction, whereas the risk of stricture is low if a complete or wide excision is performed. In the presence of abdominal pain and urinary incontinence in puberty, Herlyn-Werner-Wunderlich syndrome must be considered in the differential diagnosis, and a detailed evaluation of the urinary system and pelvic anatomy must be performed.

The effect of associated structural malformations in the prediction of chromosomal abnormality risk of fetuses with echogenic bowel.

OBJECTIVE: Our aim is to determine the frequency of chromosomal abnormalities and also to identify the role of structural malformations on the chromosomal abnormality risk among fetuses with echogenic bowel. METHODS: Over a 6-year period fetuses with echogenic bowel (FEB) were retrospectively evaluated. The pregnancies with intra-amniotic bleeding history, congenital infection, cystic fibrosis and intrauterine growth retardation were excluded from the study. Types and frequency of sonographically detected fetal malformations were identified. Chromosomal abnormality incidences according to association with soft markers and major fetal abnormalities were compared. RESULTS: Of the 281 fetuses with echogenic bowel, 105 (37.37%) were isolated, 78 (27.76%) were associated with soft markers and 98 (34.87%) were associated with major abnormalities. There were 30 (10.7%) fetuses with abnormal karyotypes. The chromosomal abnormality rate of the groups of isolated FEB, FEB + soft markers and FEB + major abnormalities were 6.7%, 7.7% and 17.4%, respectively. CONCLUSIONS: Chromosomal abnormality risk in fetuses with echogenic bowel should be evaluated according to additional sonographic findings. Association of structural malformations increases the chromosomal abnormality risk, although this risk is not significant with the presence of soft markers alone.

Mucocutaneous manifestations and the relationship to CD4 lymphocyte counts among Turkish HIV/AIDS patients in Istanbul, Turkey.

BACKGROUND/AIM: Dermatologic findings differ among countries but no sufficient data about Turkish HIV-infected patients exist in the literature. Therefore, our aim in this study was to document the dermatologic manifestations and their relationships with CD4 cell counts among HIV/AIDS patients visiting our clinic for the first time in Istanbul, Turkey. MATERIALS AND METHODS: A retrospective analysis of 306 HIV/AIDS patients (260 men, mean age: 38.3 years) was done in a tertiary hospital in Istanbul from January 2006 to September 2012. Information on age, sex, transmission routes, socioeconomic and educational status, CD4 counts, and dermatologic findings was collected retrospectively from medical records. RESULTS: Our analyses revealed at least 1 dermatologic disease in 111 of the 306 (36.2%) patients. Mean CD4 count of the patients was 393.64 cells/mm3 (range: 4-1270 cells/mm3). Oral candidiasis (12.4%), herpes zoster (5.9%), dermatophytosis (5.4%), hyperpigmentation (5.2%), and folliculitis (4.6%) were the most common skin problems. Statistically significant correlation (P < 0.05) with low CD4 cell counts was found for oral candidiasis, folliculitis, herpes zoster, hyperpigmentation, xerosis, and Kaposi's sarcoma. CONCLUSION: Dermatologic manifestations in this study were identical to those described in most studies from Asia, and there were more manifestations as the HIV infection progressed and immune functions declined.

Effect of single-dose methotrexate on ovarian reserve in women with ectopic pregnancy.

OBJECTIVE: To evaluate ovarian reserve in women with ectopic pregnancy treated with single-dose systemic methotrexate in the early post-treatment period. DESIGN: Prospective study. SETTING: Women's health education and research hospital. PATIENT (S): Eighty-two patients with ectopic pregnancy and 80 healthy women in the same age group were included in the study. Of the 82 patients, 49 with ectopic pregnancy were treated with single-dose systemic methotrexate (MTX) and 33 were treated surgically with laparoscopy or laparotomy (salpingectomy or salpingostomy). INTERVENTION(S): Ovarian reserve testing. MAIN OUTCOME MEASURE(S): Basal FSH on the 3rd day of the menstrual cycle, E2, basal antral follicle count (AFC), and ovarian volume. RESULT(S): There were no differences among the groups in terms of basal FSH, E2, AFC, and ovarian volume. CONCLUSION(S): The single-dose MTX treatment had no effect on ovarian reserve in women with ectopic pregnancy as measured by the above-mentioned parameters.

Lack of influence of pregnancy on the prognosis of survivors of thyroid cancer.

OBJECTIVE: The aim of this study is to investigate the influence of pregnancy on prognosis of thyroid cancer. METHODS: A total of 72 patients aged between 15-45 years who underwent total or subtotal thyroidectomy and subsequently radioablation were followed up under suppression. Individuals who had term pregnancies after diagnosis of cancer (group 1, n: 36) and who were non-pregnant (group 2, n:36) were included in the study. Both groups were compared in terms of scintigraphic relapse and metastasis, ultrasonographic relapse, stage change of lympadenopathy at the beginning and at the end of the study. RESULTS: Relapse was detected in 4 out of 36 pregnant patients (11.1%) and in 5 out of 36 non-pregnant patients (13.9%) with no significant difference between groups (p=1.00). Pathologic lymphadenopathy was detected in 2 out of 36 pregnant patients (5.6%) and in 2 out of 36 non-pregnant patients (5.6%) (p=1.00), and metastasis in 3 (8.3%) and in 1 (2.8%), respectively (p=0.61). While stage change was detected in only one pregnant patient (2.8%), and none of the non-pregnant again there was no significant difference (p=1.00). CONCLUSIONS: We conclude that pregnancy does not have an influence on prognosis of thyroid cancer.

Risk factors for surgery in patients with tuba-ovarian abscess.

OBJECTIVE: To determine the factors that increases the need of surgery in the treatment of tuba-ovarian abscess. MATERIAL AND METHOD: Fifty patients, who were diagnosed with tuba-ovarian abscess between January 2005 and December 2010 at Aegean Obstetrics and Gynecology Education and Research Hospital, were reviewed retrospectively. Patients were divided into two groups as Group A includes 19 patients treated medically and Group B includes 31 patients treated surgically. Patient characteristics of both groups were compared in terms of risk factors, clinical findings, abscess size and length of hospital stay. RESULTS: The mean age of the patients was 41.2 ± 10.4 (range 19-73). A statistically significant difference was found between the mean age of the patients (37.4 ± 8.6) treated medically and the mean age of the patients (43.5 ± 10.8) treated surgically (p 0.042). The patients treated medically were younger than those treated surgically. In addition, there was a statistically significant difference between the groups in terms of abscess sizes (p 0.001, 81.7 ± 38.2 and 43.5 ± 19.0 mm, respectively). Accordingly, the size of abscess was larger in the surgical treatment group. No significant difference was found between the two groups in terms of smoking status and duration of hospital stay (p 0.157, 0.085, respectively). Previous attacks of PID, history of minor uterine operation and use of IUD's were not different between the groups (p 0.166, 0.490, 0.080, respectively). CONCLUSION: Being older in age and having larger abscess size increase proceeding to surgery in patients with tuba-ovarian abscess.

Cellular blue nevus of the vulva mimicking Bartholin's gland abscess in a 15-year-old girl: a case report.

INTRODUCTION: Literature review revealed descriptions of three cellular blue nevus (CBN) in the gynecologic tract. Two of them were myometrial CBN and incidental findings in hysterectomies performed in women aged 37 and 48 years. The single ectocervical CBN involving the hymenal ring and vagina was reported in a 19-year-old woman. The other reported cases of cervical blue nevi were common type and have been localized to endocervix. CASE REPORT: Vulvar CBN in left labia majora mimicking Bartholin's gland abscess in a 15-year-old white virgin girl and also the youngest case has not been reported previously. CONCLUSION: CBN should be considered in the differential diagnosis of vulvar masses in adolescent period.

Ectopic ovary confirmed by ovarian stimulation in a case of unicornuate uterus.

OBJECTIVE: To present a case of unicornuate uterus with ipsilateral ectopic ovary and renal agenesis. DESIGN: Case report. SETTING: Research hospital. PATIENT(S): A 26-year-old woman with a 5-year history of primary infertility was admitted to our clinic. A unicornuate uterus without contralateral horn, with ipsilateral ectopic ovary and renal agenesis, was diagnosed. INTERVENTION(S): Diagnostic laparoscopy, ovarian stimulation. MAIN OUTCOME MEASURE(S): During laparoscopy, a unicornuate uterus without a contralateral horn, together with ectopic ovary, was observed. RESULT(S): We visualized the right ectopic ovary on ultrasound after ovarian stimulation. CONCLUSION(S): We present a rare clinical entity that exhibits a unicornuate uterus without a contralateral horn, with ipsilateral right ectopic ovary and renal agenesis together. We conclude that ovarian stimulation is a useful approach in the diagnosis of ectopic ovaries.

Elevated concentrations of serum ischaemia-modified albumin in PCOS, a novel ischaemia marker of coronary artery disease.

This prospective case-control study comprised 41 consecutive patients with PCOS and 41 non-PCOS control patients matched for body mass index (BMI) and age (mean age, 22.17 +/- 4.45 and 23.29 +/- 3.11 years, respectively). Serum IMA, fasting glucose, fasting insulin, homeostatic model assessment insulin resistance index (HOMA-IR), prolactin, thyroid-stimulating hormone, LH, FSH, oestradiol, total testosterone, dehydroepiandrosterone sulphate, high-density lipoprotein (HDL) cholesterol, triglyceride, 17-alpha-hydroxyprogesterone and cortisol concentrations were measured. Compared with the control group, women with PCOS had significantly higher concentrations of LH (P < 0.001), LH/FSH ratio (P < 0.001), fasting insulin (P < 0.001), HOMA (P < 0.001) and total testosterone (P = 0.031). Serum IMA concentrations in PCOS women were significantly higher than control group (0.63 +/- 0.26 versus 0.49 +/- 0.16 absorbance units, respectively, P = 0.003, 95% CI 0.05-0.24). Bivariate analysis revealed that serum IMA concentrations were only well correlated with the Ferriman-Gallwey score (r = 0.416, P = 0.007), total testosterone (r = 0.357, P = 0.022) and BMI (r = 0.3751, P = 0.016) in PCOS group. Serum IMA, which has recently been developed as a clinical marker of ongoing myocardial ischaemia, appears to be elevated in PCOS. This may be due to increased androgen concentrations observed in PCOS.