Does cabergoline administration affect endometrial VEGFR-2 expression in a rat model of ovarian hyperstimulation syndrome?

OBJECTIVE: To assess the effect of cabergoline on endometrial vascular endothelial growth factor receptor-2 (VEGFR-2) immunoexpression in an ovarian hyperstimulation syndrome (OHSS) rat model. MATERIAL AND METHODS: Twenty-one immature female Wistar rats were assigned into three groups: group 1, the control group; group 2, stimulated with gonadotropins to mimic OHSS; and group 3, in which an OHSS protocol was induced and thereafter treated with cabergoline (100 µg/kg/day). Body weight, ovarian volume, corpora lutea numbers, and endometrial VEGFR-2 expression were compared between the groups. RESULTS: Weight gain and ovarian volume were highest in the OHSS-placebo group, while cabergoline administration significantly reversed those effects (p = 0.001 and p = 0.001, respectively). VEGFR-2 stained cells were significantly lower in groups 2 and 3 compared to group 1 (p = 0.002). Although VEGFR-2 expression was lowest in group 3, the difference was not statistically significant. Corpora lutea numbers were also similar (p = 0.465). CONCLUSION: While successful implantation requires a vascularized receptive endometrium, impaired expression of VEGFR-2 and disrupted endometrial angiogenesis due to cabergoline administration may be associated with IVF failure in fresh OHSS cycles. The insignificant decrease in endometrial VEGFR-2 expression observed in this research needs to be investigated by further studies involving additional techniques such as immunoblotting and/or RT-PCR analyses.

Is there any role of interleukin-6 and high sensitive C-reactive protein in predicting IVF/ICSI success? A prospective cohort study.

OBJECTIVES: Studies have established a relationship between proinflammatory factors and implantation failure in IVF/ICSI cycles. Likewise, low-grade chronic inflammation is generally blamed for predisposing infertility. In the present study, we aimed to find a relationship between serum IL-6 and hs-CRP levels and IVF/ICSI cycle outcomes. METHODS: A total of 129 patients who consented to participate and attended the IVF unit of our department for the treatment of infertility have been enrolled in this prospective cohort study. Serum levels of high sensitive C-reactive protein and interleukin 6 have been detected at the beginning of the IVF/ICSI ovulation induction cycle. Cycle outcomes have been compared between patients with and without clinical pregnancy achievement following ART treatments. IVF/ICSI cycle outcomes of these two groups were also comparable except the number of >14 mm follicles, retrieved oocytes, metaphase II oocytes, and fertilized oocytes (2 pronuclei) which were in favor of the clinical pregnancy group. RESULTS: Mean serum hs-CRP levels were 3.08 mg/L (0.12-35.04) and 2.28 mg/L (0.09-22.52) patients with and without clinical pregnancy respectively. Mean serum IL-6 levels were 2 pg/mL (1-10.2) and 2 pg/mL (1-76.9) patients with and without clinical pregnancy respectively. Both tests were found to be statistically insignificant in predicting the success of the ART cycle in terms of implantation, clinical pregnancy, miscarriage, and live birth. CONCLUSIONS: In the present study, we have not found any significant effect of hs-CRP and IL-6 levels in the IVF cycle. However, in the light of this and previous studies, large-scale research may prove the exact influence of these markers on IVF success.

Impact of endometrioma and bilaterality on IVF / ICSI cycles in patients with endometriosis.

AIM: Endometriosis, one of the most common gynecological disorder, is a challenging disease observed in 20 %-40 % of subfertile women. Endometriomas affect 17-44 % of women with endometriosis. Because endometrioma has detrimental effects on fertility, many of these women need Assisted Reproductive Technology (ART) to conceive. In this study, we aimed to investigate the effects of endometrioma presence and impact of bilaterality over In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) outcomes. METHOD: The study was designed retrospectively. A total of 159 women enrolled in IVF / ICSI cycles were included. Patients were divided into two groups as Endometrioma group (n: 73) and control group (n:86). In Endometrioma group, subgroup analysis was performed according to whether endometrioma was unilateral or bilateral. Demographic characters, clinical and laboratory parameters were recorded. SPSS was used for analysis. RESULTS: In endometrioma group, although basal FSH levels was higher than control group, it was within normal limits, while estradiol levels was lower (p < 0.001, p 0.042, respectively). Antral follicle count (AFC), dominant follicle number, total oocyte count, MII oocyte numbers were found to be significantly lower, whereas numbers of embryos achieved, clinical pregnancy rates (PR) and live birth rates (LBR) were found to be similar.There were no statistically significant differences in terms of Antimullerian Hormon (AMH) levels, oocyte and embryo quality, the numbers of embryos achieved, PR and LBR between unilateral and bilateral endometrioma groups. CONCLUSION: This study shows that presence of endometrioma negatively effects fertility parameters albeit no significant effect over embryo quality, PR and LBR whereas bilaterality doesn't have any influence over any fertility parameters and PR.

Placenta specific protein-1 in recurrent pregnancy loss and in In Vitro Fertilisation failure: a prospective observational case-control study.

Observations from studies have provided evidence that Placenta-specific protein1 (PLAC1) is important for the establishment and maintenance of pregnancy and suggest it as a potential biomarker for gestational pathologies. The aim of this study is to investigate whether maternal serum PLAC1 levels have any impact on etiopathogenesis of recurrent pregnancy loss (RPL) and repeated implantation failure after In Vitro Fertilisation (RIF). We conducted a prospective observational case-control study in a Research Hospital. Twenty-eight patients with RPL (group 1), 30 patients with unexplained infertility and RIF (group 2), 29 fertile patients (group 3) were included. The demographic features and serum PLAC1 levels were compared. There was a significant difference in PLAC1 levels between the groups (group 1 = 19.71 + 16.55 ng/ml; group 2 = 4.82 + 1.44 ng/ml; group 3 = 0.89 + 0.62 ng/ml, respectively) (p=.001). Positive correlation was found between serum PLAC1 levels and abortion rates (r = 0.64; p=.001), a negative correlation was found between serum PLAC1 levels and live birth rates (r = -0.69; p=.001). PLAC1 might have a negative effect on implantation in RPL and RIF. There may be a subgroup of PLAC with different bioactivity. There are no relevant studies conducted among these populations, further large-scale studies are needed to assess the molecular role of PLAC1 on implantation.IMPACT STATEMENTWhat is already known about this subject? PLAC1 (placenta-specific protein-1) gene is located on the X chromosome which encodes for a protein that is thought to be important for placental development although its role has not been clearly defined. Studies in the literature have provided evidence that PLAC1 has an important role in the establishment and maintenance of pregnancy and suggest it as a potential biomarker for gestational pathologies. Several reports over the past few years have demonstrated PLAC1 expression in a variety of human tumours including lung cancers, breast cancer, hepatocellular and colorectal cancers, gastric cancers and uterine cancers.What do the results of this study add? There have been no previous studies conducted among patients with recurrent pregnancy loss (RPL) or repeated implantation failure after In Vitro Fertilisation (RIF) that have searched for any association between PLAC1 levels and implantation failure. This study has demonstrated higher PLAC1 levels in infertile women with RIF and RPL for the first time; suggesting that it could have a negative effect on implantation in these populations. PLAC1 could be detected in the serum as a biomarker that is associated with RIF and RPL. What are the implications of these findings for clinical practice and/or further research? Defining the precise role of PLAC1 during implantation will provide new insight into understanding of poor reproductive outcomes such as RIF and RPL and help in developing treatment strategies. Further large-scale studies with more patients are needed to uncover the clinical value of PLAC1 as a biomarker to predict repeated implantation failure and RPL.

GnRH agonist versus HCG triggering in different IVF/ICSI cycles of same patients: a retrospective study.

The aim of this study was to assess Gonadotropin Releasing Hormone agonist (GnRHa) trigger results of fresh in vitro fertilisation (IVF), Intracytoplasmic Sperm Injection (ICSI) cycles in high-responder patients. Thirty-six high-responder patients, undergoing GnRH antagonist protocol combined with GnRHa trigger for final oocyte maturation, were included. All cycles were autologous fresh transfer cycles. Fifteen of 36 patients had previous IVF/ICSI cycles triggered with human chorionic gonadotropin (hCG) and both cycles of these patients were compared. The mean fertilisation rate, blastocyst development and clinical pregnancy rates were 67%, 44.4% and 44.4%, respectively. The hCG and GnRHa trigger cycles of the same patients were compared as two groups (n: 15). 2PN oocyte counts were significantly higher in agonist trigger cycles (p .048). There were no differences in terms of M2 oocyte count and fertilisation rate. The blastocyst formation and clinical pregnancy rates for hCG and GnRHa trigger cycles were 33.3-66.7% and 13.3-46.7%, respectively. These results were found to be 2-fold and 3.5-fold higher, but not statistically significant. GnRHa trigger in combination with LPS is a good option for final oocyte maturation due to its good pregnancy outcomes and virtually eliminating OHSS risks.IMPACT STATEMENTWhat is already known on this subject? Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of Ovarian Hyperstimulation Syndrome (OHSS) on IVF cycles using antagonist protocol.What do the results of this study add? The main strength of this study is the comparison of different triggers in different cycles of the same patients. GnRHa trigger in combination with Luteal Phase Support (LPS) is a good option for final oocyte maturation due to its good pregnancy outcomes and virtually eliminating OHSS risks.What are the implications of these findings for clinical practice and/or further research? We suppose that GnRHa trigger combined with modified LPS is clinically more successful than Human Chorionic Gonadotropin (hCG) in regard to OHSS prevention and reproductive outcomes on fresh IVF/ICSI cycles. More extensive studies are needed to draw firm conclusions.

Relationship between seasons and pregnancy rates during intrauterine insemination. A historical cohort

ABSTRACT BACKGROUND: The underlying cause of seasonal infertility in humans is unclear, but is likely to be ­multifactorial. OBJECTIVE: The aim of our study was to compare the pregnancy rates among infertile women who underwent induced ovulation and intrauterine insemination (IUI) with the season in which the fertility treatment was performed. DESIGN AND SETTING: This retrospective cohort study was conducted on 466 patients who were treated in the reproductive endocrinology and infertility outpatient clinic of a tertiary-level women's healthcare and maternity hospital. METHODS: Retrospective demographic, hormonal and ultrasonographic data were obtained from the patients' medical records. Clomiphene citrate or gonadotropin medications were used for induced ovulation. The patients were divided into four groups according to the season (spring, winter, autumn and summer) in which fertility treatment was received. Clinical pregnancy rates were calculated and compared between these four groups. RESULTS: There were no significant differences between the seasonal groups in terms of age, infertility type, ovarian reserve tests, duration of infertility, medications used or length of stimulation. A total of 337 patients (72.3%) were treated with clomiphene citrate and 129 (27.7%) with gonadotropin; no significant difference between these two groups was observed. The clinical pregnancy rates for the spring, winter, autumn and summer groups were 15.6% (n = 24), 8.6% (n = 9), 11.5% (n = 13) and 7.4% (n = 7), respectively (P = 0.174). CONCLUSIONS: Although the spring group had the highest pregnancy rate, the rates of successful IUI did not differ significantly between the seasonal groups.

Comparison of Serum A Disintegrin and Metalloproteinase with Thrombospondin Motifs-19 Levels in Different Fertility Situations: Could It Be a Serum Marker of Ovarian Function and Oocyte Pool?

BACKGROUND/AIMS: A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) enzymes take part in extracellular matrix (ECM) remodeling which has been shown to contribute to the ovulation and follicular functions. We aimed to compare serum levels of ADAMTS-19 in patients with different fertility situations. METHODS: A total of 86 women were enrolled to this cross sectional and case-control study. Four groups were constituted with respect to women's clinical and hormonal status: group 1, women with premature ovarian failure (POF; n = 21); group 2, women with natural menopause (n = 21); group 3, women with polycystic ovary syndrome (PCOS; n = 22); and group 4, healthy fertile controls. Serum ADAMTS-19 levels and individual characteristics were compared among groups. RESULTS: -ADAMTS-19 levels were found as 36.7 ± 10.2, 40.1 ± 12.6, 46.7 ± 16.1, and 51.0 ± 18.8 ng/mL in POF, fertile, natural menopause, and PCOS groups, respectively (p = 0.012). Especially, ADAMTS-19 levels in the PCOS group were significantly higher than the POF group, as found in dual comparisons (p = 0.010). CONCLUSIONS: ADAMTS-19 was found to be higher in PCOS patients than in POF patients. This work provides a novel vantage point for function of ECM within the ovary. ADAMTS-19 may have a potential for being an important marker of ovarian function and oocyte pool.

Retrospective comparison of intracytoplasmic sperm injection outcomes of sperm retrieved from a testicular biopsy and freshly ejaculated semen in oligozoospermia.

OBJECTIVE: The aim of this study was to compare fertilisation, pregnancy rates and perinatal outcomes in patients undergoing intracytoplasmic sperm injection (ICSI) due to oligozoospermia. METHODS: A total of 166 patients with oligozoospermia who underwent an ICSI procedure were included in the study. The subjects were divided into two groups according to the sperm retrieval technique used: group 1, ejaculated semen (n=111); group 2, surgical sperm retrieval (n=55). RESULTS: Although the clinical pregnancy rate was lower in group 2, the difference was not statistically significant (36.4% vs. 42.3%, p=0.460). The difference between fertilisation and take-home baby rates of the groups were not significantly different, either (p=0.486, p=0.419, consecutively). CONCLUSION: Two different sperm retrieval techniques used for ICSI had no statistically significant difference on intracytoplasmic sperm injection outcomes in oligozoospermic patients.

Ginger (zingiber officinale) might improve female fertility: A rat model.

BACKGROUND: Ginger (Zingiber officinale) is a well known and extensively used antioxidant in traditional remedies. In this study, we aimed to investigate the effects of ginger powder on ovarian folliculogenesis and implantation in rats. METHODS: There were two study groups. In the 5-day treatment group (one estrous cycle), 100 mg ginger powder, 200 mg ginger powder or distilled water was given for 5 days to the three subgroups each containing seven rats. In the 10-day treatment group, same doses were given for 10 days (two estrous cycle) to the three subgroups each containing seven rats. At the end of the 5th and 10th days, ovarian volumes, ovarian weights, primordial follicles, antral follicles, atretic follicles, and corpus luteum counts were assessed. To evaluate the angiogenic effects of ginger, vascular endothelial growth factor (VEGF) and for the antioxidant effects of ginger endothelial nitric oxide synthase (eNOS) were examined in the ovaries and in the endometrium immunohistochemically. RESULTS: In the 5-day treatment group, antral follicle count and ovarian stromal VEGF were significantly high in the 100 mg ginger subgroup in comparison to the control group (p < 0.05). In the 10-day treatment group, endometrial VEGF and ovarian stromal eNOS were significantly high in the 100 mg ginger subgroup in comparison to the control group (p < 0.05). There was no statistically significant difference at 200 mg ginger dose both in 5-day and 10-day treatment groups. CONCLUSION: The increases in the antral follicle count and ovarian stromal VEGF in the 100 mg/5-day treatment subgroup indicate that ginger have positive effects on folliculogenesis in short term with low dose. Additionally, ginger may enhance implantation in rats in long term with low dose.

Serum 25-Hydroxy Vitamin D Levels in Turkish Adolescent Girls with Polycystic Ovary Syndrome and the Correlation with Clinical/Biochemical Parameters.

STUDY OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common endocrinopathy among female adolescents and young women. The aim of this study was to investigate the relationship between serum 25-hydroxy vitamin D (25[OH] D) levels and metabolic parameters and other characteristics of PCOS and non-PCOS adolescents. DESIGN: Case-control study. SETTING AND PARTICIPANTS: We analyzed 31 girls with PCOS as defined using the Rotterdam criteria and 35 girls were non-PCOS control participants. INTERVENTIONS AND MAIN OUTCOME MEASURES: The serum 25(OH) D level was measured. Anthropometric, clinical, endocrine, and metabolic components were determined in both groups. RESULTS: The group with PCOS showed no difference in the level of serum 25(OH) D (14.58 ± 6.15 vs 16.02 ± 7.87; P = .414). In addition to this, no significant correlations were found between serum 25(OH) D levels and endocrine or metabolic parameters in either PCOS patients or control participants. CONCLUSION: There was no difference in the level of serum 25(OH) D between PCOS patients and matched control participants. Vitamin D deficiency was common among the patients as well as in the control participants. Also, we did not find any relationship between serum 25(OH) D levels and clinical or metabolic profiles in the 2 groups.

Are there any differences between antagonist administration on days <6 and ≥6 of Controlled Ovarian Hyperstimulation on assisted reproductive technique outcomes?

BACKGROUND: The aim of this study was to investigate the cost-effectiveness of antagonist administration on stimulation on days <6 and ≥6 of COH on assisted reproductive technique (ART) outcomes. METHODS: In this retrospective cohort study, 412 patients who were admitted to the ART Department were evaluated. In group 1 (203 patients), antagonist administration was provided on days <6 of COH. For group 2 (209 patients), antagonist administration was provided on days ≥6 of COH. We preferred a flexible antagonist protocol in clinical practice and added an antagonist treatment regimen when dominant follicles were enlarged to 13 mm or the serum blood E2 was >300 pg/mL. RESULTS: There were no differences between antagonist administration on days <6 and days ≥6 of COH in terms of age, BMI, duration and etiology of infertility, AFC, serum FSH, LH, peak E2 levels, the number of MII oocytes, 2PN, FR, the number of transferred embryos, and CPR per woman. However, there were statistically significant differences between the duration of stimulation, the total gonadotropin dose required, and progesterone levels on day hCG [8.26 ± 1.83 vs 9.56 ± 1.51 (p = 0.001); 2173.71 ± 860.00 vs 2749.17 ± 1079.51 (p = 0.001); 0.75 ± 0.44 vs 0.92 ± 0.59 (p = 0.002), respectively]. CONCLUSION: Our results have demonstrated that there was no effect of antagonist administration on days <6 and ≥6 of COH on ART outcomes. However, taking cost-effectiveness into consideration, we suggest an antagonist administration on days <6 of COH since the necessary gonadotropin dose is lower.

Comparison of long-term outcomes of 50 and 100 mg rt-PA in the management of acute pulmonary thromboembolism.

BACKGROUND: Pulmonary thromboembolism (PTE) is a life-threatening disease. In this study, we aimed to evaluate long-term outcomes of the use of 50 mg recombinant tissue-type plasminogen activator (rt-PA) in the management of PTE in terms of relapse, pulmonary hypertension (PH), mortality and hemorrhage and to compare with the use of 100 mg rt-PA. METHODS: The study was designed as a retrospective cohort. Patients who were diagnosed as acute PTE and received either 50 or 100 mg rt-PA in a tertiary care hospital between 2010 and 2015 were included in the study. Rates of relapse, PH, mortality (in-hospital and long-term) and hemorrhage (major and minor) were calculated for each treatment group. RESULTS: A total 117 patients, 73 females and 44 males, were evaluated. Eighty-three patients were administered 100 mg rt-PA, and 34 were administered 50 mg rt-PA. The mean age was lower in the 100 mg group compared to the 50 mg group (61 ± 15 vs 69 ± 14 years). There was a significant decrease in PH in each group at 3 months follow-up (P < .001). Although statistically nonsignificant, the relapse rate was lower in the 50 mg rt-PA group, but the 5-year mortality rate was higher in 50 mg rt-PA group (35.2% vs 27.7%, P = .50). Mortality was associated with older age and presence of malignancy. CONCLUSIONS: Our results suggest that both doses of rt-PA have similar efficacy. The high mortality rate in the 50 mg group may have resulted from patient selection.

Sirtuin 1 Levels in Recurrent Implantation Failure / Níveis de sirtuína 1 em falhas recorrentes de implantação

Abstract Sirtuin 1 has an important role in cellular processes, including apoptosis and cellular stress. The purpose of this study was to assess serum sirtuin 1 levels in women with recurrent implantation failure (RIF). In this cross-sectional study, we included 28 women with RIF, 29 healthy women who had conceived by in vitro fertilization (IVF), and 30 women with a 1-cycle failure of IVF as controls. Human serum nicotinamide adenine dinucleotide (NAD)-dependent deacetylase sirtuin-1 (SIRT1/SIRT2L1) levels were detected using a commercial colorimetric kit. Recurrent implantation failure patients have higher sirtuin 1 levels than non-pregnant women and healthy pregnant women, but this difference did not reach statistical significance due to the low number of patients in our study. These higher sirtuin 1 levels may result from the inflammation imbalance of RIF patients. The only statistically significant correlation found was between age and sirtuin (r = 0.277, p = 0.009).

Resumo A sirtuína 1 tem importante função nos processos celulares, incluindo a apoptose e o estresse celular. O objetivo deste estudo é o de avaliar níveis de sirtuína 1 em mulheres com falhas recorrentes de implantação (FRI). Neste estudo cruzado, incluímos 28 mulheres com FRI, 29 mulheres saudáveis que deram à luz por fertilização in vitro (FIV) bem-sucedida, e 30 mulheres com 1 ciclo de FIV malsucedido como controle. Os níveis de sirtuína 1 em soro humano de desacetilase dependente de dinucleotídeo de nicotinamida adenina (DNA) (SIRT1/SIRT2L1) foram detectados usando um kit colorimétrico comercial. Pacientes com FRI tiveram níveis de sirtuína 1 superiores às pacientes grávidas e aos controles, mas esta diferença não atingiu significância estatística devido ao baixo número de pacientes envolvidos. Estes níveis mais altos de sirtuína 1 podem ser resultado da inflamação desigual em pacientes com FRI. A única correlação estatisticamente significante encontrada foi entre idade e sirtuína (r = 0,277, p = 0,009).

Effect of Obesity on Clinical Parameters and Pregnancy Rates in Women with Polycystic Ovary Syndrome Undergoing Ovulation Induction Cycles.

OBJECTIVE: To evaluate the effect of obesity on clinical parameters and pregnancy rates in infertile women with polycystic ovary syndrome (PCOS), who have undergone ovulation induction. STUDY DESIGN: This retrospective study included 177 women with PCOS who presented to our gynecological endocrinology outpatient clinic for diagnosed infertility. All of the patients initially received clomiphene citrate (CC), and if CC resistance was noted, gonadotropins were used. The patients were classified into 2 groups according to BMI (<30 kg/m2=control group and ≥30 kg/m2=study group). Pregnancy was assessed by ß-hCG levels and a visible gestational sac in the endometrium. RESULTS: The demographic and hormonal parameters were similar between the groups. The mean duration of infertility was longer in the study group (p<0.05). In the study group, cycle cancellation due to CC resistance (p=0.039) and mean baseline LH levels (p=0.026) was statistically more likely than in the control group. On follow-up, 4 (9.3%) patients in the study group had conceived and 26 (19.4%) patients in the control group had conceived (p=0.041). CONCLUSION: Obesity adversely affects pregnancy rates in women with PCOS who undergo ovulation induction cycles. Clinicians should recommend weight loss in these patients before ovulation induction.

Role of Versican and ADAMTS-1 in Polycystic Ovary Syndrome.

OBJECTIVE: ADAMTS-1 is a matrix metalloproteinase which cleaves versican in the cumulus oocyte complex under the effect of luteinizing hormone surge in the periovulatory period. Altered levels may have a role in the pathogenesis of polycystic ovary syndrome (PCOS). We aimed to determine the serum versican and ADAMTS-1 (a disintegrin and metalloproteinase with thrombospondin motif-1) levels in PCOS patients and compare the results with healthy controls. METHODS: Thirty-eight patients with PCOS and forty healthy controls aged between 15 and 22 years were included in the study. They were sampled according to their basal hormone, serum versican, and ADAMTS-1 levels. Serum versican and ADAMTS-1 levels were measured by enzyme-linked immunosorbent assay. A multivariate logistic regression model was used to identify the independent risk factors of PCOS. RESULTS: Serum versican levels were significantly decreased in the PCOS group when compared with the controls. The best versican cut-off value for PCOS was calculated to be 33.65 with 76.74% sensitivity and 52.94% specificity. Serum versican levels, homeostasis model assessment of insulin resistance index, a Ferriman-Gallwey score higher than 8, and oligomenorrhea were the strongest predictors of PCOS. Serum versican levels were significantly decreased in PCOS patients. Besides, serum ADAMTS-1 and versican levels were significantly and positively correlated with each other. CONCLUSION: Serum versican levels were significantly decreased in patients with PCOS. This suggests a possible role of versican in ovulatory dysfunction and in the pathogenesis of PCOS.

Polycystic Ovary Syndrome and Increased Soluble Tumor Necrosis Factor Like Weak Inducer of Apoptosis Levels Are Independent Predictors of Dyslipidemia in Youth.

BACKGROUND/AIMS: Dyslipidemia is common in women with polycystic ovary syndrome (PCOS) irrespective of age. Our aim was to investigate soluble tumor necrosis factor like weak inducer of apoptosis (sTWEAK), a cardiovascular risk marker in PCOS, and to determine if it is associated with dyslipidemia in youth. METHODS: A prospective-observational study was carried out including 35 PCOS patients and 35 healthy controls. Serum sTWEAK levels were measured using commercially available kits. Multiple logistic regression analysis was then performed to verify the statistically significant differences in the possible predictors of dyslipidemia. RESULTS: Serum sTWEAK levels and the percentage of women with dyslipidemia were significantly higher in the PCOS group (p = 0.024 and p < 0.001, respectively). Participants were further divided into 2 subgroups based on the presence of dyslipidemia. The percentage of women with PCOS was significantly higher in the dyslipidemic group when compared with controls; 70.7 vs. 20.7%, respectively (p < 0.001). Multiple logistic regression analysis revealed that both the presence of PCOS (OR 7.924, 95% CI 2.117-29.657, p = 0.002) and increased levels of sTWEAK (>693 pg/ml; OR 3.810, 95% CI 1.075-13.501, p = 0.038) were independently associated with dyslipidemia. CONCLUSIONS: Increased levels of both sTWEAK and PCOS were found to be independently associated with dyslipidemia in youth.

Evaluation of Oxidative Stress in Women with Polycystic Ovarian Syndrome as Represented by Serum Ischemia Modified Albumin and Its Correlation with Testosterone and Insulin Resistance.

Objective Ischemia-mediated oxidative stress and inflammation have been reported to be important contributors to the pathogenesis of polycystic ovary syndrome (PCOS). Ischemia-modified albumin (IMA) is a novel marker generated under ischemic and oxidative conditions and may reflect disease activity in distinct disease states. Therefore, we investigated whether the serum IMA levels are affected in infertile PCOS patients. Methods Forty-six patients with infertile PCOS, 30 patients with unexplained infertility, and 31 age- and body mass index (BMI)-matched controls were included in this cross-sectional study. Biochemical parameters, serum IMA levels, and their correlations with serum testosterone and insulin resistance were determined for each subject. Results In patients with infertile PCOS, the serum IMA levels were significantly elevated (p=0.003) compared with unexplained infertility patients and controls. A correlation analysis suggested that the IMA levels only correlated with the serum free testosterone levels in PCOS patients (r=0.43, p=0.028). Conclusion Elevations in the serum IMA levels in infertile PCOS patients may suggest a possible additional role of oxidative stress mechanisms in disease pathophysiology. Moreover, correlation between serum IMA and testosterone levels may influence the quality of oocytes via alterations in the balance of critical follicular fluid factors in the follicular microenvironment.

BRCA1 and BRCA2 sequence variations detected with next-generation sequencing in patients with premature ovarian insufficiency.

OBJECTIVE: Although the association between BRCA1 and BRCA2 gene mutations and breast and ovarian cancer is known, there is insufficient data about premature ovarian insufficiency (POI). However, several studies have reported that there might be a relationship between POI and BRCA1 and BRCA2 gene mutation. Therefore, in the present study, we aimed to investigate the role of BRCA1 and BRCA2 gene mutations in the etiology of POI in a Turkish population. MATERIAL AND METHODS: The cohort was classified into two groups: a study group, consisting of 56 individuals diagnosed with premature ovarian insufficiency (and who were younger than 40 years of age, had an antral follicle count <3-5, and FSH levels >12 IU/I), and a control group, consisting of 45 fertile individuals. A total of 101 individuals were analyzed by next-generation sequencing to detect BRCA1 and BRCA2 gene mutations. RESULTS: We detected four new variations (p.T1246N and p.R1835Q in BRCA1 and p.I3312V and IVS-7T>A in BRCA2) that had not been reported before. CONCLUSION: We did not find an association between the BRCA1 and BRCA2 gene mutations and premature ovarian insufficiency. However, larger, functional studies are needed to clarify the association.

Association between anti-Mullerian hormone and insulin resistance in non-obese adolescent females with polycystic ovary syndrome.

OBJECTIVE: The present study was designed to evaluate the association between anti-Mullerian hormone (AMH) and insulin resistance (IR) in non-obese adolescent females with polycystic ovary syndrome (PCOS) with and without IR. METHODS: Seventy-seven consecutive non-obese patients were recruited and distributed into three groups according to diagnoses of PCOS and IR. Group I included 27 females diagnosed with PCOS and IR, group II included 18 females diagnosed with PCOS but without IR, and group III included 32 controls without PCOS. RESULTS: Group I had significantly higher AMH levels compared to group II and group III (p < 0.012 and p < 0.000, respectively). ROC curve analyses demonstrated that the AUC, indicative of the AMH value for discriminating PCOS with IR, was 0.763, with a confidence interval of 0.607-0.920 (p = 0.004). There was a significant positive correlation between serum AMH and HOMA-IR levels in adolescent females with PCOS (p = 0.003). CONCLUSION: We found that serum AMH levels were higher in non-obese adolescent females with PCOS and IR than in PCOS patients without IR and the healthy controls. There was a significant positive correlation between AMH levels and IR in non-obese adolescent females with PCOS.

Association of clinical outcomes and complications with obesity in patients who have undergone abdominal myomectomy.

BACKGROUND: This study aimed to evaluate the association between complications and clinical parameters with obesity in 273 women who have undergone abdominal myomectomy during the study period. METHODS: The patients were classified into two groups according to body mass index (BMI) (≤30 kg/m(2) and >30 kg/m(2)). Demographic, preoperative and postoperative clinical parameters were evaluated. RESULTS: Demographic, preoperative and postoperative clinical parameters were evaluated. The results showed statistically significant differences between the obese and non-obese groups in terms of age, gravidity, diameter of fibroid (DOF), postoperative hemoglobin, duration of hospital stay, and complications. Patients in the obese group had greater DOF and complications such as hemorrhage, postoperative fever, wound infection and ileus (p < 0.05). CONCLUSION: Based on our results, we conclude that obesity adversely affects the clinical outcomes of patients who undergo abdominal myomectomy.