Does mid-luteal progesterone predict pregnancy in intrauterine insemination cycles following sequential clomiphene citrate and gonadotropin treatment?

This study aimed to determine whether serum mid-luteal progesterone (MLP) levels measured in the current treatment cycles of infertile women undergoing controlled ovarian hyperstimulation and intrauterine insemination following the sequential use of clomiphene citrate and gonadotropin may predict pregnancy. A total of 107 consecutive anovulatory women were included in this prospective cohort study. Patients with other causes of infertility were also excluded from the study. None of the patients received progesterone treatment for luteal phase support. The data recorded for each woman included age, body mass index, infertility type and duration, basal hormone levels, and previous and current cycle characteristics with MLP levels. Ovulation was confirmed using MLP and sonographic evaluation in all patients. An MLP level of > 3 ng/mL was regarded as a sign of ovulation. After treatment, the patients were divided into 2 groups according to the presence or absence of pregnancy, and the obtained data were compared between the groups. There were no significant differences in age, body mass index, or basal hormone levels between the 2 groups (all P > .05). However, the duration of infertility was significantly shorter in the pregnancy group (P = .003). The anovulation rate in this cohort was 18.7% (n = 20). A total of 15 (14%) were examined. MLP levels were 25.1 ± 13.8 ng/mL and 18.3 ± 14.5 ng/mL in the pregnant and nonpregnant groups, respectively (P:.089). Based on the receiver operating characteristic curve analysis, it was determined that there was no predictive value of the mid-luteal phase progesterone level for pregnancy in patients in whom ovulation was detected. Mid-luteal serum progesterone levels did not predict pregnancy in infertile women who underwent controlled ovarian hyperstimulation with sequential clomiphene citrate plus gonadotropin treatment and intrauterine insemination.

Role of serum renalase levels in predicting the presence of metabolic syndrome in patients with polycystic ovary syndrome.

OBJECTIVE: This study was designed to compare the serum renalase levels of polycystic ovary syndrome (PCOS) women with and without metabolic syndrome (MS) and those of healthy non-PCOS women. MATERIALS AND METHODS: Seventy-two patients diagnosed with PCOS and age-matched 72 healthy non-PCOS were included in the study. The PCOS group was divided into two groups as having metabolic syndrome or not. General gynecological and physical examination findings and laboratory results were recorded. Renalase levels in serum samples were determined using Enyzme-Linked ImmunoSorbent Assay method. RESULTS: Mean serum renalase level was significantly higher in PCOS patients with MS compared with both PCOS patients without MS and healthy controls. Additionally, serum renalase correlates positively with body mass index, systolic and diastolic blood pressure, serum triglyceride and homeostasis model assessment-insulin resistance values among PCOS women. However, systolic blood pressure was found to be the only significant independent factor that can affect the serum renalase levels. A serum renalase level of 79.86 ng/L had a sensitivity of 94.7% and specificity of 46.4% in discriminating PCOS patients with metabolic syndrome from healthy women. CONCLUSIONS: Serum renalase level increases in women with PCOS in the presence of metabolic syndrome. Therefore, monitoring the serum renalase level in women with PCOS can predict the metabolic syndrome that may develop.

Thiol/Disulfide Homeostasis in Patients with Molar Pregnancies.

Introduction: We aimed to investigate serum dynamic thiol and disulfide levels in patients with molar pregnancy (MP), and compare these concentrations with those of healthy pregnant women. Materials and Methods: Forty-one patients who were diagnosed with MP and 41 gestational age-matched healthy pregnant women were included in this prospective study. MP cases were separated in two groups as complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM). Demographic features and thiol/disulfide homeostasis were recorded for each woman. Results: There was a significant correlation between the decrease in the total thiol and native thiol levels in MP patients. However, no significant difference was observed between CHM and PHM groups in terms of serum disulfide levels. Conclusion: OS is increased in MPs both in complete and partial moles, as determined by thiol/disulfide analysis.

Could there be any role of thiol disulphide homeostasis and ischemia modified albumin in the pathogenesis of endometrial polyps?

OBJECTIVE: We searched thiol/disulphide homeostasis and ischemia modified albumin (IMA) in patients with and without endometrial polyp (EP) to evaluate whether there is an association between serum oxidative stress markers and EPs. METHODS: A total of 87 women were enrolled into this study. All patients were evaluated with office hysteroscopy, and then those with EPs underwent operative hysteroscopy. 43 of these women had pathologically confirmed EPs (study group) and 44 had not (control group). Fasting blood samples were obtained from the antecubital vein before the procedure in all women. Thiol/disulphide levels were analyzed with a newly developed method by Erel et al. IMA measurement was performed using an indirect method based on the colorimetric assay as previously defined. RESULTS: There were no significant differences between the 2 groups in terms of demographic characteristics including age, body mass index, and past obstetric history. Similarly no significant difference was observed regarding infertility ratio and smoking status. Native thiol, total thiol, and disulphide levels were found to be 263.6±63.3 µmol/l vs. 280.9±63.8 µmol/l (p:0.208), 296.9±64.9 µmol/l vs. 315.2±67.3 µmol/l (p:0.202), and 16.6±6.5 µmol/l vs.17.1±7.8 µmol/l ( p:0.759) in the study and control groups, respectively. There was also no significant difference with regard to serum IMA level (46.5±12.1 vs. 44.9±12.6; p: 0.539). CONCLUSION: Serum thiol/disulphide homeostasis and IMA levels have no significant effect in the pathogenesis of EPs.

The role of inflammatory markers hs-CRP, sialic acid, and IL-6 in the pathogenesis of preeclampsia and intrauterine growth restriction.

OBJECTIVE: The aim of our study was to evaluate serum high-sensitivity C-Reactive Protein (hs-CRP), sialic acid (SA), and interleukin-6 (IL-6) levels in pregnancies complicated with preeclampsia (PE) and intrauterine growth restriction (IUGR) and to compare with healthy pregnancies. MATERIALS AND METHODS: This study was conducted at a tertiary-level maternity hospital with 80 pregnant women. Fasting blood samples were taken from 44 consecutive women with pregnancies complicated by PE (n: 20) and IUGR (n: 24), and 36 were from normal pregnancies. Serum hs-CRP, SA, and IL-6 concentrations were measured in all participants. RESULTS: Serum mean hs-CRP, SA, and IL-6 levels were higher in the PE and IUGR group when compared with the control group, but this difference was statistically insignificant (P>0.05). No significant correlation was observed between these inflammatory markers (P>0.05). CONCLUSION: The serum levels of hs-CRP, SA, and IL-6 were not elevated in pregnancies complicated with PE and IUGR compared with normal pregnancies. Since pregnancy is already a process with inflammation, fluctuations in some markers related to inflammation may be masked by the gestation itself. A local subclinical inflammation may have a role in the pathogenesis of PE and IUGR rather than systemic inflammation.

Decreased ADAMTS-1, -9 and -20 levels in women with endometrial polyps: a possible link between extracellular matrix proteases and endometrial pathologies.

A disintegrin-like and metalloproteinase domain with thrombospondin-type 1 motifs (ADAMTS) protein superfamily includes 19 secreted metalloproteases. Proteolytic substrates of ADAMTS enzymes have been linked to female reproductive function. Herein, we aimed to investigate serum ADAMTS-1, -9 and -20 levels in women with and without endometrial polyps (EPs). The study group (n = 40) consisted of women who had hysteroscopically detected and histologically confirmed EPs whereas control group (n = 40) was recruited from those women without any endometrial pathology. Data recorded for every woman were as follows: age, body mass index, gravidity and parity, number of miscarriages, smoking status and serum ADAMTS-1, -9 and -20 levels. ADAMTS-1, -9 and -20 values were measured by commercially available ELISA kits. No statistically significant differences between the groups were observed in terms of demographics. There were also no statistically significant differences between the groups with regard to ADAMTS-1 and -20 levels, although both of them were lower in the study group. However, ADAMTS-9 was significantly lower in the study group compared to the controls (p = .010). The optimal cut off value of ADAMTS-9 in predicting EPs was found to be 163.2 ng/mL with 100% sensitivity and 35% specificity. In conclusion, ADAMTS-9 protein is decreased in women with EPs. Impact statement What is already known on this subject? Endometrial polyps (EPs) are common and are generally benign gynaecologic disorders. ADAMTS enzymes comprise a zinc metalloproteinase gene family that has roles in vascular biology, inflammation and especially in the control of the function and structure of the extracellular matrix (ECM). ECM plays an important role in the pathogenesis of myomas, adenomyosis and abnormal uterine bleeding, as well as EPs. There is an interest in these proteases, especially with regard to the physiology of ovulation and implantation. They are also associated with carcinogenesis and metastasis. One of the most feared consequences of EPs is the risk of malignancy. Therefore, it is important in gynaecology practice to diagnose these endometrial abnormalities. What do the results of this study add? This is the first study performed to investigate the relationship between some ADAMTS (-1, -9 and -20) proteases and uterine polyps. Our results demonstrate novel molecular mediators contributing to EPs physiopathology. What are the implications of these findings for clinical practice and/or further research? ADAMTS-9 is defined as a tumour suppressor gene in various malignancies. Decreased ADAMTS-9 protein, which is the product of this gene, may have a role in the pathogenesis of EPs. There is a need for further research that should be done with benign-malign EPs.

The role of oxidative stress markers in development of endometrial polyp.

OBJECTIVE: To evaluate the association of the oxidative stress markers in patients with endometrial polyp. METHODS: A total of forty nine patients between 28-47 years of ages who have a suspect evidence of endometrial polyp on transvaginal sonography were enrolled for the study. Hysterosonography was applied all of the patients and patients then were divided into two groups in terms of their hysteroscopic findings. Group 1(control group, n=27) defined who has no endometrial pathology and group 2 (study group, n=22) defined has one or more endometrial polyp on hysteroscopy with guided biopsy. The diagnosis was established by histopathological examination polyps. The parameters compared between groups were; age, body mass index, catalase (CAT), xsantine oxidase (XO), malondialdehyde (MDA) levels. RESULTS: There were no statistically significant differences between groups in terms of age and BMI. Catalase, xsantine oxidase and malondialdehyde levels were statically significantly different between the groups (p < 0,05). The mean of polyp diameter size were 17.95 ±0.45 mm and the number of the polyp per patient was 1.54 ± 0.67. CONCLUSION: According to our study, serum catalase, xsantine oxidase and malondialdehyde levels may be discriminative parameters for patients with endometrial polyp.

Clinical significance of serum follistatin levels in the diagnosis of ovarian endometrioma and benign ovarian cysts.

OBJECTIVE: To determine the clinical significance of serum follistatin levels in women with an ovarian endometrioma. MATERIALS AND METHODS: This is a prospective study of 89 women, 56 with an ovarian endometrioma (endometrioma group) and 33 with a benign ovarian cyst (control group) who underwent laparoscopic excision. Age, parity, body mass index, serum CA-125, serum CA 19-9, and serum follistatin levels were determined for all participants and evaluated as potential prognostic factors prior to laparoscopic cystectomy. RESULTS: There were no significant differences in demographic factors between the endometrioma group and the control group. However, serum follistatin levels were significantly higher in the endometrioma group (9350 ± 895 pg/mL vs. control group 725 ± 72 pg/mL, p < 0.05). The optimal diagnostic cut-off values (sensitivity and specificity) of CA-125, CA 19-9, and follistatin for ovarian endometrioma were 23.2 IU/mL (82.14% and 72.73%), 30.14 IU/mL (45.28% and 87.50%), and 2350 pg/mL (53.7% and 60.61%), respectively. CONCLUSION: Despite the increased serum follistatin levels in patients with ovarian endometrioma, CA-125 was determined to be a more sensitive and specific marker than follistatin for the diagnosis of ovarian endometrioma and endometriosis.

Value of the platelet to lymphocyte ratio in the diagnosis of ovarian neoplasms in adolescents.

BACKGROUND: Relationships between poor prognosis of ovarian malignancies and changes in complete blood count parameters have been proposed previously. In this work, we aimed to evaluate clinicopathologic features in adolescents with adnexal masses and sought to establish any predictive value of the platelet to lymphocyte ratio (PLR) in diagnosis. MATERIALS AND METHODS: This retrospective study was conducted on 196 adolescent females with adnexal masses. Three groups were constituted with respect to clinical or histopathology results: group 1, non-neoplastic patients (n:65); group 2, neoplastic patients (n:68); and group 3 expectantly managed patients (n:63). The main parameters recorded from the hospital database and patient files were age, body mass index (BMI), chief symptoms, diameter of the mass (DOM), tumor marker levels, complete blood count values including absolute neutrophil, lymphocyte, and platelet counts, mean platelet volume, platelet distribution width, and platecrit, surgical features, and postoperative histopathology results. RESULTS: The expectantly managed patients were younger than the other groups (p=0.007). The mean body mass index (BMI) was higher in the neoplastic group (p=0.016). Preoperative DOM, CA125, mean platelet volume and PLR were statistically significantly different between the groups (p<0.05). ROC curve analysis demonstrated that increased PLR (AUC, 0.609; p=0.011) and BMI (AUC, 0.611; p=0.011) may be discriminative factors in predicting ovarian neoplasms in adolescents preoperatively. When the cut-off point for the PLR level was set to 140, the sensitivity and specificity levels were found to be 65.7% and 57.6%, respectively. CONCLUSIONS: We suggest that beside a careful preoperative evaluation including clinical characteristics, ultrasonographic features and tumor markers, PLR may predict ovarian neoplasms in adolescents.

Does the addition of recombinant luteinizing hormone to progesterone for luteal supplementation improve IVF outcomes in high-responder patients? A preliminary randomized controlled study.

OBJECTIVE: To determine the impact of recombinant luteinizing hormone (rLH) combined with vaginal progesterone (P)for luteal supplementation on in vitro fertilization (IVF) pregnancy outcomes in high-responder patients undergoing long gonadotropin-releasing hormone (GnRH) agonist cycles. STUDY DESIGN: A total of 47 patients undergoing IVF cycles with the serum estradiol levels of > or = 2,500 pg/mL on the day of human chorionic gonadotropin administration were included in this prospective randomized study. Patients were divided into 2 treatment groups: the control group (n = 23) used luteal vaginal P, and the study group (n = 24) received a combination of vaginal P and 75 IU rLH, 4 doses every 3 days, starting on the day of embryo transfer. The main outcome measure was the clinical pregnancy rate (PR). RESULTS: The study group had 11 pregnancies (45.8%), while the control group had 6 (26.1%). There was no significant difference between the groups in clinical PRs (p = 0.15). No differences were found with respect to the implantation rate, miscarriage rate, and multiple PR. CONCLUSION: Our data show that luteal supplementation with rLH combined to vaginal P was not found to improve pregnancy outcomes in high responder patients undergoing long GnRH agonist IVF treatments.

Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome.

PURPOSE: The aim was to test a new protocol of luteal phase administration of clomiphene citrate (CC) for ovulation induction in women with polycystic ovary syndrome (PCOS). METHODS: This was a prospective, randomized, controlled trial. Two hundred and fifty-two women (cycles) with PCOS were utilized to create two groups. Patients in Group 1 (126 patients) received 100 mg of CC daily for 5 days starting on day 5 of menses, and patients in Group 2 (126 patients) received 100 mg of CC daily for 5 days starting the next day after finishing medroxyprogesterone acetate (MPA) (before withdrawal bleeding). The main outcome measures were the number of growing and mature follicles, serum E2 (in pg/mL), serum progesterone (in ng/mL) levels, endometrial thickness (in mm), pregnancy, and miscarriage rates. RESULTS: The total number of follicles and the number of follicles ≥14 mm during stimulation were significantly greater in Group 2. The endometrial thickness at the time of human chorionic gonadotrophin (hCG) administration was significantly greater in Group 2 as compared to Group 1 (7.84 ± 1.22 and 8.81 ± 0.9, respectively). Serum E2 levels were also significantly higher (p < 0.05) in Group 2 as compared to Group 1 (449.61 ± 243.45 vs. 666.09 ± 153.41 pg/mL). Pregnancy occurred in 13 patients (10.3 %) in Group 2 and in 11 patients (8.7 %) in Group 1. The difference was not statistically significant. CONCLUSION: Luteal phase administration of CC in patients with PCOS leads to increased follicular growth and endometrial thickness, which might result in a higher pregnancy rate.

Letrozole usage adjuvant to gonadotropins for ovulation induction for patients with clomiphene citrate failure.

AIM: To compare cycle properties of ovulation induction (OI) with gonadotropin alone or combined with letrozole in the patients with previous clomiphene citrate (CC) failure. METHODS: In this prospective study, 40 patients with previous at least three times CC cycle failure were evaluated. Half of them received 2.5 mg letrozole on days 3-7 of the menstrual cycle and recombinant follicle stimulating hormone (rFSH) starting on day 5. The other half of the patients received only rFSH starting on day 3. Groups were compared according to the OI duration, gonadotropin dosage, endometrial thickness, estradiol (E2) levels on day of human chorionic gonadotropin (HCG) administration and follicle count. RESULTS: Total rFSH dose, the E2 levels on the day of HCG and >18 mm follicle count was significantly lower and OI duration was significantly shorter in rFSH + letrozole group. Mean endometrial thickness was not different between groups. CONCLUSION: Adding letrozole to gonadotropin in OI cycles decreases total gonadotropin dose and induction duration without any adverse effects on endometrial thickness. Monoovulation is better achieved by adding letrozole to gonadotropin stimulation without decreasing pregnancy rates.

The effect of formoterol on peritoneal VEGF levels in rats with endometriosis.

AIM: The aim of this study is to investigate the effect of formoterol (ß2 adrenergic receptor agonist) on peritoneal VEGF levels in rats with endometriosis. MATERIALS AND METHODS: Experimental endometriosis was constituted with implantation of endometrial tissue. The implants were examined by second laparatomy and rats were divided randomly into four groups. One cc saline was applied ip to the control (C) group (n=8) daily, 22.5µg/kg/day ip formoterol was applied to the second (F) group (n=10) daily, 22.5µg/kg/day ip formoterol and 10mg/kg/day ip propranolol were applied to the third (FP) group (n=10) daily, 45µg/kg/day ip formoterol was applied to the fourth (FF) group (n=9). Before treatment and after 30 days treatment period, peritoneal VEGF levels, the volumes and histopathological properties of the implants were evaluated. RESULTS: There were significant differences in between the peritoneal VEGF levels before and after treatment in group 2(F) and group 4(FF) (p(a): 0.01, 0.01 respectively). But there were no significant changes in between the volumes of implants before and after treatment among the groups (p>0.05). There were no significant differences among the groups in histopathological parameters (p>0.05). CONCLUSION: Formoterol treatment was seen to have no effect on the volumes and histopathological structure of endometriotic implants in our study. On the other hand, based on the group 2(F) and 4's (FF) VEGF levels after the treatment, low dose or high dose formoterol may be effective with long term therapy. Formoterol may reduce the development of endometriosis.

The effects of peak and mid-luteal estradiol levels on in vitro fertilization outcome.

PURPOSES: To evaluate the role of peak E2 level and its ratio to mid-luteal E2 level on implantation and clinical pregnancy rates in patients undergoing IVF cycles. METHODS: A retrospective study was designed covering 106 patients who were admitted to IVF Unit between June and October 2008. The patients were divided into two groups with respect to peak E2 levels. Ovulation induction has been done via standard long agonist protocol. Blood samples were drawn on the day of (hCG) administration and 8 days after embryo transfer for serum E2, progesterone measurements. RESULTS: The mean peak E2 level was 2,697.4 ± 1,453 pg/ml (range 684-4,983 pg/ml. The number of retrieved oocytes, luteal E2 level, peak E2 level and E2 ratio were significantly higher in E2 >2,500 group, however, the implantation rate was significantly lower in this group. There were statistically significant differences in peak E2 levels, luteal E2 levels, retrieved oocytes, E2 ratios; of the women who got pregnant and did not get pregnant, all the above parameters were significantly higher in non-pregnant group. According to E2 ratios, the clinical pregnancy rate was highest in group 1 and significantly lowest in group 3. CONCLUSION: This study has shown that the high E2 level and mid-luteal decline of E2 which were defined as peak E2 level/mid-luteal E2 level were predictive for implantation rate in IVF cycles.

Anti-Mullerian hormone is a better marker than inhibin B, follicle stimulating hormone, estradiol or antral follicle count in predicting the outcome of in vitro fertilization.

OBJECTIVE: The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro fertilization (IVF) program. MATERIALS AND METHODS: A prospective analysis was performed in 180 patients undergoing their first IVF trial, which is being conducted at a department of assisted reproduction in a tertiary medical center. The main outcome measures were determined as age and antral follicle count as well as the serum concentrations of follicle stimulating hormone, luteinizing hormone (LH), estradiol (E2), inhibin B and AMH. The predictive power of the aforementioned measures in specifying ovarian response was determined by means of discriminate analyses. RESULTS: As expected, day 3 LH levels were significantly high in the poor responder group. The poor responders had significantly lower antral follicle counts, retrieved oocyte number, and mature oocyte counts as well as day 3 AMH levels (5.8 ± 2.32 vs. 1.8 ± 0.80 ng/ml). There was a positive correlation with antral follicle count, basal AMH, E2 and follicle count on the day of HCG administration and negative correlation with age. The AMH level was addressed as the only significant factor in determination of mature oocyte number. A cut-off point for serum AMH concentration indicating the value of 2.97 ng/ml was found to predict the poor ovarian response with a sensitivity of 100.0% and a specificity of 89.6%. However, the same cut-off point was not as predictive for the non-conception circumstance. CONCLUSION: The present study concludes that AMH is a promising biochemical marker for the prediction of ovarian response and that a cut-off point indicating the value of 2.97 ng/ml can be adopted for this prediction.

The value of urocortin and Ca-125 in the diagnosis of endometrioma.

PURPOSES: In this study, we sought to establish the value of a new molecule, urocortin (Ucn), in the diagnosis of endometrioma and compare with Ca-125 to identify superiority of urocortin. METHODS: Of the patients operated on at our hospital with the initial diagnosis of adnexal mass, 88 patients whose pathology results were endometrioma and benign ovarian cyst were included in the study. As a result of the pathological examination, the patients were assessed in two groups. Group 1 consisted of 42 cases of endometrioma and Group 2 included 46 cases of benign ovarian cyst (control group). The serum Ucn and CA 125 levels of patients were measured from the blood samples drawn prior to the operation. RESULTS: While the serum Ucn level was 4.8 ± 1.00 ng/ml in the endometrioma group, it was 4.5 ± 1.03 ng/ml in the control group (P = 0.21). The difference was statistically not meaningful. On the other hand, mean serum Ca-125 level was 43.8 U/l (11.7-251) in the endometrioma group, it was 16.5 U/l (4.3-121.1) in the control group. The difference was statistically meaningful (P = 0.001). When the cut-off point for Serum Ca-125 level was taken as 21.38, sensitivity and specificity levels were found to be 88.1 and 63%. When the cut-off point for Ucn was taken as 4.16, sensitivity was 76.2%, and specificity 45.7%. CONCLUSION: Ucn was not found to be efficient in distinguishing endometrioma from other benign ovarian cysts or to be superior to CA125 in the diagnosis of endometrioma.

Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps and its relationship to clinical parameters.

OBJECTIVE: To investigate the differences in steroid receptor expression patterns between glandular and stromal portions in endometrial polyps among premenopausal and postmenopausal patients and the relationship between the receptor expression in endometrial polyps and clinical parameters. MATERIALS AND METHODS: A total of 25 postmenopausal and 25 premenopausal patients with solitary endometrial polyp detected by office hysteroscopy were involved in the study. All patients underwent hysteroscopic polypectomy under general anesthesia or spinal anesthesia. Estrogen and progesterone expression patterns were investigated in the polyps using immunohistochemistry. The mean age was 57.6 years in postmenopausal patients and 36.9 in premenopausal patients. Average gravida, body mass index (BMI), and frequency of smokers did not differ between groups. However, the patient's age and their concomitant diseases were significantly different between premenopausal and postmenopausal patients (P = 0.01). RESULTS: Comparison in postmenopausal patients showed that glandular estrogen and progesterone receptor expression were both significantly greater than stromal estrogen and progesterone receptor expression (P = 0.037 and <0.001, respectively). Proliferative phase endometrial polyps also demonstrated significantly greater expression of progesterone receptors in glandular epithelium compared with stroma (P = 0.019). However, stromal and glandular estrogen receptor expression did not differ among premenopausal patients. There was a statistically significant correlation among stromal progesterone receptor expression, plasma estrogen and FSH level (P = 0.01). A negative correlation was found between stromal progesterone receptor expression and patient's age (P = 0. 01). CONCLUSION: Estrogen and progesterone receptor expression were lower in the stromal portion of the endometrial polyp than in the glandular portion in postmenopausal patients. Stromal progesterone receptor expression was lower in older patients and there was a relation between low estrogen hormone levels and lower stromal progesterone receptor expression.

The value of vascular endothelial growth factor, pregnancy-associated plasma protein-A, and progesterone for early differentiation of ectopic pregnancies, normal intrauterine pregnancies, and spontaneous miscarriages.

OBJECTIVE: To evaluate the capacity of vascular endothelial growth factor (VEGF), pregnancy-associated plasma protein-A (PAPP-A), and progesterone (P) to discriminate ectopic pregnancies (EP) from nonectopic ones. DESIGN: Prospective, case-controlled study. SETTING: Tertiary care center. PATIENT(S): Twenty-nine women with EP, 29 women with normal intrauterine pregnancy (nIUP), and 28 women with spontaneous miscarriage, all matched for gestational age. INTERVENTION(S): Serum samples were obtained. MAIN OUTCOME MEASURE(S): Serum concentrations of VEGF, PAPP-A, and P were measured. RESULT(S): Serum VEGF concentrations did not show statistically significant differences among women with EP (median, 55.24 pg/mL; range, 0.20-179.24), spontaneous miscarriages (median, 26.24 pg/mL; range, 0.22-365.24), and nIUP (median, 43.24 pg/mL; range, 0.86-101.24). The median level of P was significantly increased in the nIUP group (20.58 ng/mL; range, 13.9-37.04) compared with the other two groups, but there was no statistically significant difference between the spontaneous miscarriage and EP groups. Like P, PAPP-A values were also significantly higher in the nIUP group than in the other two groups, but the difference between PAPP-A values in the EP and spontaneous abortion groups was statistically insignificant. CONCLUSION(S): VEGF, PAPP-A, and P cannot be used to diagnose EPs, but PAPP-A and P can at least be used to differentiate abnormal pregnancies.