Ultra-Fast Vitrification: Minimizing the Toxicity of Cryoprotective Agents and Osmotic Stress in Mouse Oocyte Cryopreservation.

Globally, women have been adopting oocyte cryopreservation (OC) for fertility preservation for various reasons, such as inevitable gonadotoxic treatment for specific pathologic states and social preferences. While conventional vitrification (C-VIT) has improved the success rate of OC, challenges of possible toxicities of high-concentration cryoprotective agents and osmotic stress persist. To overcome these challenges, we evaluated the ultra-fast vitrification (UF-VIT) method, which reduces the equilibration solution stage exposure time compared to C-VIT by observing mouse oocyte intracellular organelles and embryonic development. Consequently, compared to fresh mouse oocytes, UF-VIT presented significant differences only in endoplasmic reticulum (ER) intensity and mitochondrial (MT) distribution. Meanwhile, C-VIT showed substantial differences in the survival rate, key ER and MT parameters, and embryonic development rate. UF-VIT exhibited considerably fewer negative effects on key MT parameters and resulted in a notably higher blastocyst formation rate than C-VIT. Meiotic spindle (spindle and chromosomes) morphology showed no significant changes between the groups during vitrification/warming (VW), suggesting that VW did not negatively affect the meiotic spindle of the oocytes. In conclusion, UF-VIT seems more effective in OC owing to efficient cytoplasmic water molecule extraction, osmotic stress reduction, and minimization of cell contraction and expansion amplitude, thus compensating for the drawbacks of C-VIT.

Timing of hormone therapy and its association with cardiovascular risk and metabolic parameters in 4-vinylcyclohexene diepoxide-induced primary ovarian insufficiency mouse model.

OBJECTIVE: To evaluate the effects of various initiation time points and durations of hormone therapy (HT) on cardiovascular and metabolic parameters of premenarche, primary ovarian insufficiency (POI) mouse model, induced by 4-vinylcyclohexene diepoxide. METHODS: A total of 50 mice at 4 weeks of age were developed into POI mouse model, further randomly categorized into 5 groups: control group without any intervention; no HT group with only high-fat diet (NT); group 1 with delayed estradiol treatment (T1); group 2 with on-time, continuous estradiol treatment (T2); and group 3 with on-time estradiol treatment but early stop (T3). Cardiovascular risk and metabolic parameters were measured. RESULTS: Presenting with similar body weights, blood glucose levels of T1, T2, and T3 were all significantly lower than NT (p < .001). Serum total cholesterol and insulin were also significantly lower in all HT groups than in NT, especially in T2 (p < .001). For serum low-density lipoprotein-cholesterol, only T2 resulted in the statically lower level than those of NT, T1, and T3 (p < .001). Aortic thickness was significantly increased with aggravated fibrotic change of the intima in NT, and such consequence was significantly ameliorated in HT groups, mostly lowered in T2 (p < .05). Last, serum pro-inflammatory cytokines were significantly low in the HT groups than in NT, especially in T2 with the lowest level (p < .05). . CONCLUSIONS: On-time, continuous E2 treatment immediately after a biologic estrogen deprivation event significantly reduced metabolic and cardiovascular risks in young, pre-menarche female mouse models of POI, confirming decreased serum levels of pro-inflammatory cytokines.

Effects of coenzyme Q10 on ovarian surface epithelium-derived ovarian stem cells and ovarian function in a 4-vinylcyclohexene diepoxide-induced murine model of ovarian failure.

BACKGROUND: Several studies have shown that coenzyme Q10 (CoQ10) can rescue ovarian aging and that ovarian surface epithelium (OSE)-derived ovarian stem cells (OSCs) are useful for treating infertility due to ovarian aging. However, few studies have examined the effect of CoQ10 on OSCs. This study was aimed to investigate whether CoQ10 activates OSCs and recovers ovarian function in a 4-vinylcyclohexene diepoxide (VCD)-induced mouse model of ovarian failure. METHODS: Forty female C57BL/6 mice aged 6 weeks were randomly divided into four groups (n = 10/group): a control group administered saline orally, a CoQ10 group administered 150 mg/kg/day of CoQ10 orally in 1 mL of saline daily for 14 days, a VCD group administered 160 mg/kg/day of VCD i.p. in 2.5 mL of saline/kg for 5 days, and a VCD + CoQ10 group administered VCD i.p. for 5 days injection and CoQ10 (150 mg/kg/day) orally for 14 days. After treatment, follicle counts were evaluated by hematoxylin and eosin (H&E) staining, and ovarian mRNA expressions of Bmp-15, Gdf-9, and c-Kit were examined by quantitative real-time PCR. Serum FSH, AMH, and ROS levels were also measured. Oocyte-like structure counts and the expressions of Oct-4 and MVH were also evaluated after culturing OSE for 3 weeks. In a second experiment, 32 female mice were administered CoQ10 as described above, induced to superovulate using PMSG and hCG, and mated. Numbers of zygotes and embryo development rate were examined. RESULTS: Postcultured OSE showed significant increases in the numbers of oocyte-like structure and that the expression of Oct-4 and MVH were higher in the VCD + CoQ10 group than in the VCD group (p < 0.05). Numbers of surviving follicles from primordial to antral follicles, numbers of zygotes retrieved and embryo development rate to blastocyst were significantly greater in the VCD + CoQ10 group than in the VCD group (p < 0.01). Serum AMH level and ovarian expressions of Bmp-15, Gdf-9 and c-Kit were also significantly greater in the VCD + CoQ10 group than in the VCD group (p < 0.05). In contrast, serum ROS level was significantly lower in the VCD + CoQ10 group than in the VCD group (p < 0.05). CONCLUSION: This study shows that CoQ10 stimulates the differentiation of OSE-derived OSCs and confirms that CoQ10 can reduce ROS levels and improve ovarian function and oocyte quality in mice with VCD-induced ovarian failure.

Differential expression of visfatin, leptin, stromal cell derived factor-1α, endothelial nitric oxide synthase, and vascular endothelial growth factor in human leiomyomas.

AIM: This study was aimed to understand expressions of the visfatin, leptin, stromal cell derived factor (SDF)-1α, endothelial nitric oxide synthase (eNOS), and vascular endothelial growth factor (VEGF) in human uterine leiomyomas (UL) and normal myometrium. METHOD: This study investigated expression of visfatin, leptin, SDF-1α, eNOS and VEGF in 23 uterine leiomyoma patients and 10 normal myometrium by RT-PCR and western blot. Messenger RNA transcripts of SDF-1α, eNOS, VEGF and hypoxia inducible factor-1α (HIF-1α) were analyzed according to the size of UL by real-time PCR. RESULTS: There were no significant differences in expressions of visfatin and leptin between UL compared with normal myometrium. However, expressions of eNOS, SDF-1α and VEGF were significantly higher in both intramural and subserosal UL compared with normal myometrium. The expression of SDF1-α was significantly increased in small UL (<5 cm) compared to the large UL (≥5 cm), whereas the expressions of eNOS, VEGF and HIF-1α were higher in large UL than small UL. CONCLUSIONS: This study shows that expression of SDF-1α, eNOS and VEGF were significantly higher in UL than myometrium with a different expression pattern according to the size of UL. However, expressions of visfatin and leptin had no significant differences between the two groups.

Quantitative Assessment of Endometrial Volume and Uterine Vascularity and Pregnancy Outcome in Frozen-Thawed Embryo Transfer Cycles.

OBJECTIVE: To investigate the usefulness of the endometrial volume and vascular indices in the endometrial region as an effective predictor for pregnancy outcome in frozen-thawed embryo transfer (FET). STUDY DESIGN: We evaluated 131 embryo transfer cycles in 73 infertile women. After controlled ovarian stimulation all embryos were cultured to blastocyst stage, and the blastocysts with good quality were vitrified for elective FET. On the day of FET, endometrial thickness, endometrial volume, pulsatility index (PI), and resistance index of uterine artery and endometrial-subendometrial vessels (ESVs) with zonal discrimination were evaluated by transvaginal ultrasonography in each patient. These variables were compared between pregnant and nonpregnant cycles. RESULTS: The endometrial volume was significantly higher in the pregnant group (2.32 ± 0.86, 1.96 ± 0.62 mL, p = 0.007). Also, PI of ESVs was significantly higher in the pregnant cycle (2.58 ± 1.32 and 2.05 ± 1.08, p = 0.016). The other variables were not different between the 2 groups. CONCLUSION: This study suggested that endometrial volume and the vascular indices measured in endometrial region are useful predictors of pregnancy outcome.

Differential expression of pluripotent and germ cell markers in ovarian surface epithelium according to age in female mice.

BACKGROUND: Many studies have proposed that putative ovarian stem cells (OSCs) derived from the ovarian surface epithelium (OSE) layer of adult mammalian ovaries can produce oocytes. Few studies have reported that ovaries of aged mammalian females including mice and women possess rare premeiotic germ cells that can generate oocytes. However, no studies have reported the changes of OSCs according to the age of the female. Therefore, this study evaluated pluripotent and germ cell marker expression in the intact ovary, scraped OSE, and postcultured OSE according to age in female mice. METHODS: C57BL/6 female mice of 2 age groups (6-8 and 28-31 weeks) were superovulated by injection with 5 IU equine chorionic gonadotropin (eCG). Both ovaries were removed after 48 hours and scrapped to obtain OSE. Gene expressions of pluripotent (Oct-4, Sox-2, Nanog) and germ cell markers (c-Kit, GDF-9, and VASA) were evaluated by RT-PCR. VASA and GDF-9 were immune-localized in oocyte-like structures. RESULTS: Expressions of germ cell markers in the intact ovary were significantly decreased in aged females, whereas expressions of pluripotent markers were not detected, regardless of age. Scraped OSE expression of all pluripotent and germ cell markers, except for c-Kit, was similar between both age groups. Three weeks postcultured OSE had significantly decreased expression of GDF-9 and VASA , but not c-Kit, in old mice, as compared to young mice; however there was no difference in the expression of other genes. The number of positively stained Oct-4 by immunohistochemistry in postcultured OSE was 2.5 times higher in young mice than aged mice. Oocyte-like structure was spontaneously produced in postcultured OSE. However, while that of young mice revealed a prominent nucleus, zona pellucida-like structure and cytoplasmic organelles, these features were not observed in old mice. CONCLUSIONS: These results show that aged female mice have putative OSCs in OSE, but their differentiation potential, as well as the number of OSCs differs from those of young mice.

Significant simultaneous changes in serum CA19-9 and CA125 due to prolonged torsion of mature cystic teratoma of the ovary.

Mature cystic teratoma is a common benign neoplasm of the ovary. Complications occur in approximately 20% of cases. Clinical manifestations, laboratory findings, and imaging studies can assist in making a diagnosis of ovarian torsion of mature cystic teratoma. Furthermore, serum tumor markers may be helpful for diagnosing mature cystic teratoma and its torsion and, thus, can lead to early surgical intervention. A 56-year-old woman presented with a huge pelvic mass and pelvic pain. Serum CA19-9, CA125, and carcinoembryonic antigen levels were abnormally elevated at >700 U/ml, 282.5 U/ml, and 3.94 U/ml, respectively. The tumor was surrounded by extensive adhesions and showed inflammatory changes. The serum levels of these markers returned to normal levels after surgery.

Measurement of endometrial and uterine vascularity by transvaginal ultrasonography in predicting pregnancy outcome during frozen-thawed embryo transfer cycles.

AIM: An appropriate endometrial condition and vascular supply are usually considered essential for implantation of an embryo. This study was performed to assess the role of endometrial and uterine vascularity status measurement in predicting pregnancy outcome during frozen-thawed embryo transfer cycles. MATERIAL AND METHODS: A total of 70 infertile women were recruited with controlled ovarian stimulation followed by oocyte retrieval. After in vitro fertilization or intracytoplasmic sperm injection, embryos were cultured to blastocysts and blastocysts with good quality were selected for cryopreservation. After endometrial preparation, vitrified blastocysts were thawed and assisted hatching by zona dissection was performed. On the day of embryo transfer, endometrial thickness (EMT), resistance index (RI) and pulsatility index (PI) of sub-endometrial artery (SEA) and uterine artery (UA) were obtained by transvaginal sonography. The women were divided into the pregnant and non-pregnant groups, and these variables were compared between the two groups. RESULTS: Patients' general demographic characteristics were not statistically different between the pregnant and non-pregnant groups. The overall implantation rate, clinical pregnancy rate, and ongoing pregnancy rate were 31.1%, 41.4% and 28.6%, respectively. Twenty-nine patients who conceived had average EMT, RI of SEA, PI of SEA, RI of UA, and PI of UA values of 9.15 mm, 0.91, 2.42, 0.95, and 3.37, respectively. Forty-one patients who did not conceive had average EMT, RI of SEA, PI of SEA, RI of UA, and PI of UA values of 9.31 mm, 1.01, 2.56, 0.94, and 3.00, respectively. In the two groups, none of the variables was statistically different (P > 0.05). CONCLUSIONS: EMT and blood flow index of endometrium and uterus measured by transvaginal sonography are not an effective predictor of pregnancy outcome in frozen-thawed embryo transfer cycles.

Evaluation of endometrial thickness in breast cancer patients with tamoxifen treatment - Difference between 2-dimensional ultrasonography and elastosonography.

OBJECTIVE: This study aimed to confirm the clinical significance of elastographic endometrium measurement in comparison with conventional ultrasonography for tamoxifen users with breast cancer. MATERIALS AND METHODS: In this retrospective analysis, 98 women receiving tamoxifen as postoperative breast cancer treatment were included. Patient medical charts were reviewed, and related medical, obstetric, and gynecological information and histories relevant to breast cancer were evaluated. Patient clinical imaging data included endometrial thickness measurements using both conventional ultrasonography and elastography, and the differences between these two modalities in delta values were statistically analyzed along with possible influencing factors. RESULTS: Endometrial thickness measured using 2-dimensional ultrasonography had a mean value of 5.81 mm (standard deviation [SD] = 3.09), and elastosonography showed a mean value of 3.07 mm (SD = 1.62). A paired t-test was conducted and a significant difference between them was confirmed (P-value <0.001). Logistic regression analysis revealed that age and duration of tamoxifen treatment significantly influenced the degree of difference between endometrial thickness measurements. CONCLUSIONS: Elastosonography may be a more successful and useful tool for measuring actual endometrial thickness than generalized 2-dimensional ultrasonography. In clinical cases with limited use of elastosonography and consequent inability for thorough evaluation of endometrial thickness, practitioners should exercise caution in deciding whether or not to adopt invasive diagnostic procedures, such as endometrial curettage, especially for young patients of reproductive age or those with prolonged treatment of breast cancer with tamoxifen.

Correlation of Sarcopenic Obesity on Various Cardiometabolic Risk Factors and Fracture Risk in Mid-Aged Korean Women.

OBJECTIVES: This study aimed to investigate the correlation of sarcopenic obesity with various cardiometabolic risk factors and fracture risk in middle-aged Korean women. METHODS: In this cross-sectional study, the medical records of 1,775 women who had visited Pusan National University Hospital for routine health screenings from 2010 to 2016 were reviewed. The patients were divided into four groups as follows: group 1, nonsarcopenic, nonobese (NS-NO); group 2, nonsarcopenic, obese (NS-O); group 3, sarcopenic, nonobese (S-NO); and group 4, sarcopenic, obese (S-O). Each patient was assessed based on self-reported questionnaires and individual interviews with a healthcare provider. The Fracture Risk Assessment Tool (FRAX) was used to assess bone fracture risk. RESULTS: Postmenopausal women accounted for 68.5% of the total patient population. The proportion of each group was as follows: NS-NO, 71.2%; NS-O, 17.9%; S-NO, 10.2%; and S-O, 0.7%. Statistical analysis of various parameters associated with metabolic and cardiovascular risks revealed that the S-O group had more patients with hypertension, diabetes, osteopenia, and metabolic syndrome. The FRAX scores were significantly higher in the S-O group than in other groups. CONCLUSIONS: Middle-aged women with obesity and reduced muscle mass, known as sarcopenic obesity, are at increased risk of hypertension, diabetes, and metabolic syndrome. Furthermore, sarcopenic obesity, individual cardiometabolic risks, and menopause can increase the bone fracture risk.

Decreased expressions of vascular endothelial growth factor and visfatin in the placental bed of pregnancies complicated by preeclampsia.

AIM: The aim of the present study was to examine the expression of vascular endothelial growth factor (VEGF) and visfatin in the third trimester placental bed of pregnancies with and without preeclampsia (PE). MATERIAL AND METHODS: The study group consisted of placental bed biopsy tissues obtained from pregnancies with (n = 20) and without (n = 20) PE. The normotensive controls without PE were matched for gestational age at delivery with patients with PE. The expression of VEGF and visfatin in the placental bed tissues were evaluated using reverse transcriptase-polymerase chain reaction (RT-PCR), real-time polymerase chain reaction (PCR), immunohistochemistry and Western blot. RESULTS: There was no statistical difference between the PE group and the normotensive control group in age and body mass index (BMI). The expression of VEGF and visfatin was significantly decreased in the PE group compared with the normotensive control group (P < 0.05). CONCLUSION: This study showed decreased expressions of VEGF and visfatin in the third trimester placental bed of pregnancies with PE compared with the normotensive controls. This result suggests that decreased expression of these angiogenic factors in placental bed may be associated with the pathogenesis of PE.

Effects of 17ß-estradiol on the release of monocyte chemotactic protein-1 and MAPK activity in monocytes stimulated with peritoneal fluid from endometriosis patients.

AIM: Hormones and inflammation have been implicated in the pathological process of endometriosis; therefore, we investigated the combined effects of 17ß-estradiol (E2) and peritoneal fluid obtained from patients with endometriosis (ePF) or a control peritoneal fluid (cPF) obtained from patients without endometriosis on the release of monocyte chemotactic protein-1 (MCP-1) by monocytes and the role of signaling pathways. METHODS: Monocytes were cultured with ePF and cPF in the presence of E2; the MCP-1 levels in the supernatants were then measured by ELISA. In addition, mitogen activated protein kinase (MAPK) activation was measured by Western blotting of phosphorylated proteins. RESULTS: E2 down-regulated MCP-1 release by lipopolysaccharide- or cPF-treated monocytes, but failed to suppress its release by ePF-treated monocytes. The release of MCP-1 by ePF- and cPF-treated monocytes was efficiently abrogated by p38 mitogen activated protein kinase (MAPK) inhibitors; however, the MCP-1 release by cPF-treated monocytes, but not by ePF-treated monocytes, was blocked by a MAPK kinase inhibitor. In addition, ePF and cPF induced the phosphorylation of extracellular stress regulated kinase (ERK)1/2, p38 MAPK and c-Jun N-terminal kinase (JNK). E2 decreased the phosphorylation of p38 MAPK, but not ERK1/2 in ePF-treated monocytes; however, E2 decreased the phosphorylation of p38 MAPK, ERK1/2 and JNK in cPF-treated monocytes. CONCLUSIONS: The ability of E2 to modulate MCP-1 production is impaired in ePF-treated monocytes, which may be related to regulation of MAPK activity. These findings suggest that the failure of E2 to suppress ePF-treated production of MCP-1 may be involved in the pathogenesis of endometriosis.

The effect of long zona dissection using ICSI pipettes for mechanical assisted hatching in vitrified-thawed blastocyst transfers.

OBJECTIVE: To investigate the effect of long zona dissection (LZD) compared with partial zona dissection (PZD) using ICSI pipettes for mechanical assisted hatching (AH) in vitrified-thawed blastocyst transfers. DESIGN: Prospective study. SETTING: University IVF clinic. PATIENT(S): A total of 120 women ≦ 38 years old undergone vitrified-thawed blastocyst transfers with LZD or PZD. INTERVENTION(S): The culture of all pronucleate embryos to the blastocyst stage and the selection of blastocysts ≧ grade 3BB (Gardner and Schoolcraft score), followed by vitrified-thawed blastocyst transfers with LZD (n = 60) or with PZD (n = 60) MAIN OUTCOME MEASURE(S): Complete hatching rates, implantation rates, pregnancy rates. RESULT(S): At 5 h after thawing, complete hatching rates of blastocysts were significantly higher in LZD group compared with PZD group, 52.4 % vs. 31.8 % (P = 0.001). Implantation and clinical pregnancy rates were significantly higher in LZD group compared with PZD group, 40.9 % vs. 25.7 % and 63.0 % vs. 40.0 %, respectively (P = 0.010, P = 0.011). CONCLUSION(S): LZD using ICSI pipettes for mechanical AH improves significantly complete hatching, implantation and pregnancy rates in vitrified-thawed blastocyst transfers.

Commentary on the new 2022 European Society of Human Reproduction and Embryology (ESHRE) endometriosis guidelines.

Endometriosis is a prevalent benign illness defined by the presence of endometrial glands and stroma outside of the uterine cavity, primarily on the ovary, pelvic peritoneum, and rectovaginal septum, resulting in a variety of symptoms, including dysmenorrhea and infertility. Traditionally, prolonged medical therapy has been needed in most cases since a conservative approach to surgery has usually been taken, especially in young women. In 2022, new European Society of Human Reproduction and Embryology (ESHRE) guidelines were published that present different directions for diagnosis and treatment from the past. Furthermore, the guidelines for the diagnosis and management of endometriosis are more precise and applicable than in previous editions. Thus, referring to the representative changes in the new guidelines and important updates will be beneficial for the diagnosis and management of endometriosis. This paper provides a brief overview of these developments.

Comparison of ART outcome in patients with poor ovarian response according to POSEIDON criteria.

The aim of this study is to evaluate whether the patient-oriented strategies encompassing individualized oocyte number (POSEIDON) criteria can reflect the prognosis of controlled ovarian stimulation (COS) by comparing the results of assisted reproductive technologies (ART) between four POSEIDON and normal responder (NR) groups. In total, 225 patients were included in this retrospective observational study. The patients underwent various COS protocols and in vitro fertilization or intracytoplasmic sperm injection, followed by fresh or frozen embryo transfer. Based on their clinical and demographic data, patients were divided into four groups according to the POSEIDON classification, and their ART outcomes were evaluated. Statistical analyses were performed using R version 4.0.5, and a p-value of < 0.05 was considered significant. The NR group had the highest number of total oocytes retrieved and total embryos obtained, as well as the best ART outcome in terms of clinical pregnancy rate ([CPR], 47.6%). The POSEIDON groups 1 and 2 had better COS and ART outcomes than groups 3 and 4 (CPR, 22.6%, 22.1%, 16.7%, and 4.8% in groups 1-4, respectively); the patients in group 3 were younger than those in group 2 by definition, but their CPR was lower than that of patients in group 2. When comparing young and old women with low anti-Müllerian hormone (AMH) levels, the younger group (POSEIDON group 2) had better COS and ART outcomes than their older counterparts, especially POSEIDON group 4. A binary logistic regression adjusted for body mass index (BMI) comparing the ART outcomes of patients that did not get pregnant in the POSEIDON groups compared to the NR group showed odds ratios (ORs) (95% confidence interval) of 2.938 (1.496-5.768), 3.376 (1.848-6.167), 6.801 (2.740-16.881), and 20.497 (8.284-50.713) for groups 1, 2, 3, and 4, respectively. Ovarian reserve still seems to outweigh patients' age when predicting the ART outcomes of low-responder infertile women, as suggested by the results of POSEIDON groups 2 and 3. However, when there are no differences in ovarian reserve, as in POSEIDON groups 2 and 4, younger women with low AMH have a higher probability of pregnancy than their AMH-matched older counterparts.

Is there association between thyroid stimulating hormone levels and the four phenotypes in polycystic ovary syndrome?

OBJECTIVES: The aim of this study was to determine whether the incidence of subclinical hypothyroidism (SCH) is higher in polycystic ovary syndrome (PCOS) group than the control group. Additionally, the study investigated whether serum thyroid stimulating hormone (TSH) level is associated with various clinical parameters of PCOS regarding different phenotypes of the disease. MATERIAL AND METHODS: This retrospective, case-control study included 329 PCOS patients and 162 control women who were aged between 20 and 42 years and visited the Gynecology outpatient clinic in Pusan National University Hospital from January 2014 to December 2017. PCOS patients were further classified according to their phenotypes: phenotype A as the combination of all hyperandrogenism (HA), ovulatory dysfunction (OD), and polycystic ovarian morphology (PCOM); phenotype B as the combination of HA and OD; phenotype C as the combination of HA and PCOM; and finally, phenotype D as the combination of OD and PCOM. Laboratory blood tests included follicle stimulating hormone (FSH), luteinizing hormone (LH), TSH and anti-mullerian hormone (AMH). The ovarian volume was calculated using three diameters by gynecologic ultrasonography. RESULTS: Serum TSH level was significantly higher in PCOS patients than in the control group after adjusting for age and body mass index (BMI). Serum TSH level was not related to HA and OD, but its significant association with PCOM was confirmed in comparative analysis in quartiles. The proportion of phenotype A patients increased as serum TSH level increased, while the proportion of phenotype B and D decreased. Phenotype C stayed relatively consistent with varying TSH levels. CONCLUSIONS: More numbers of patients showed elevated TSH level satisfying SCH diagnosis in PCOS group than the control group. In addition, a significant correlation between serum TSH level and different PCOS phenotypes has been observed; especially, PCOS patients with phenotype A, which displays all of HA, OD, and PCOM, tended to have the higher TSH levels than the PCOS patients with other phenotypes, requiring proper and thorough evaluation for potential endocrine disparity and according to management in such patient group.

Successful treatment of locally advanced bulky cervical cancer complicated by irreducible complete uterine prolapse: A case report.

RATIONALE: Cervical cancer complicated by irreducible complete uterine prolapse in elderly patients is extremely rare. No standard treatment has been established for these conditions. PATIENT CONCERNS: A 74-year-old woman with a 30-year history of pelvic organ prolapse presented with irreducible complete uterine prolapse and a large exophytic mass involving the cervix and vaginal wall. DIAGNOSIS: Biopsy of the mass was performed at the referring institution and showed invasive verrucous-type squamous cell carcinoma. INTERVENTIONS: A prolapsed uterus with a tumor mass could not be manually reduced. After completion of concurrent chemoradiotherapy, the tumor mass in the prolapsed uterus decreased and could be reduced manually. Subsequently, the patient underwent hysterectomy and intra-abdominal uterosacral ligament suspension. OUTCOMES: At 19 months of postoperative follow-up, the patient remained disease-free and had no evidence of vault prolapse. LESSONS: This study has important clinical implications and may provide a therapeutic strategy to address unmet medical needs in combination with locally advanced cervical cancer complicated by irreducible complete uterine prolapse. These conditions were successfully treated using a multidisciplinary approach of chemoradiotherapy followed by radical hysterectomy and uterosacral ligament suspension.

Effects of peritoneal fluid from endometriosis patients on the release of monocyte-specific chemokines by leukocytes.

PURPOSE: Chemokines have been implicated in the pathological process of endometriosis. We compared the effects of peritoneal fluid obtained from patients with endometriosis (ePF) and controls without endometriosis (cPF) on the release of monocyte-specific CC chemokines such as monocyte chemotactic protein-1 (MCP-1), regulated upon activation normal T cell expressed and secreted (RANTES), and macrophage inflammatory protein-1α (MIP-1α) by neutrophils, monocytes, and T cells. Moreover, we evaluated the correlation between the levels of chemokines in ePF and their release by these cells. METHODS: Cells were obtained from healthy young volunteers and cultured with ePF (n = 12) or cPF (n = 8). The chemokine levels in the ePF and the supernatants of cultured cells with ePF were then measured by ELISA. RESULTS: There was a positive correlation between the levels of MCP-1 and MIP-1α in ePF. The addition of ePF to the cell cultures failed to increase the release of MCP-1, RANTES, and MIP-1α when compared to cPF, but the levels of RANTES in ePF were positively correlated with the release of RANTES by ePF-treated monocytes and T cells. Moreover, there was a positive correlation between the levels of RANTES and MIP-1α released by neutrophils and between the levels of MCP-1 and MIP-1α released by T cells. Finally, the levels of RANTES released by monocyte-derived macrophages and monocytes cultured with ePF were positively correlated. CONCLUSIONS: These findings suggest that monocytes, neutrophils, and T cells release differential levels of MCP-1, RANTES, and MIP-1α in response to stimulation with ePF.

Levonorgestrel-Releasing Intrauterine System Use in Perimenopausal Women.

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective contraceptive method that has several noncontraceptive benefits. It has been used in various gynecological conditions, such as heavy menstrual bleeding, dysmenorrhea, and endometrial hyperplasia. During the perimenopausal period, hormonal fluctuations occur, and there is a high tendency for the development of several benign gynecologic diseases. Therefore, the use of LNG-IUS in perimenopausal women might be more beneficial than in women belonging to other age groups. Moreover, the insertion of LNG-IUS during the perimenopausal period could confer endometrial protection during estrogen replacement therapy. In this review, we discuss the use of LNG-IUS in perimenopausal women.

Dietary pattern and risk of endometrioma in Korean women: a case-control study.

OBJECTIVE: The aim of this study was to investigate and compare the dietary patterns of Korean women diagnosed with endometrioma or other benign ovarian cysts. METHODS: A total of 66 patients, comprising 39 patients who were surgically diagnosed with ovarian endometrioma and 27 control patients with other benign ovarian cysts, were included in this case-control study. Trained interviewers identified and interviewed the case patients and controls on the day before the laparoscopic ovarian surgery, using a semiquantitative food frequency questionnaire developed by the Ministry of Health and Welfare of Korea. Statistical analysis was performed using the Wilcoxon sum-rank test for continuous variables and the χ2 test or Fisher's exact test for categorical variables. RESULTS: The calcium intake from daily food consumption was significantly lower in patients with endometrioma than in those with other benign ovarian cysts. The dietary intakes of vitamin D, iron, and zinc were also relatively lower in patients with endometrioma than in patients with other benign ovarian cysts, although they did not reach the statistical significance threshold. CONCLUSION: The risk of endometrioma is significantly associated with a lower dietary intake of calcium. Future studies including a larger number of patients on a nationwide scale are urgently required for further clarification.