Prevalence of polycystic ovary syndrome under NIH criteria among the tenth-grade Chinese schoolgirls in Guangzhou area: a cross-sectional epidemiological survey.

BACKGROUND: Polycystic ovary syndrome (PCOS) is currently considered to have a peri-adolescence onset and continuously influence the reproductive and metabolic health of the patients, while the diagnostic criteria among adolescent population haven't been universally unified till now. This survey seeks to preliminarily evaluate the prevalence of PCOS in the tenth grade schoolgirls in Guangzhou area under NIH criteria and analyze the clinical features of adolescents with PCOS. METHODS: The cross-sectional epidemiological survey was carried out among the tenth grade schoolgirls in Guangzhou area by the method of cluster sampling. The contents of this survey included the questionnaire, physical exams and serum measurements. Until now, totally 1294 girls underwent this survey and 1095 serum samples were restored. 235 non-hirsute (mFG < 6), postmenarcheally 2-year girls were randomly selected as the control group, among which the cut-off value of biochemical hyperandrogenemia was set accordingly. The prevalence of PCOS among this population was preliminarily evaluated according to the NIH criteria. RESULTS: Along with the increase of gynecological age, the menstruations of girls was becoming more regular and the incidence of oligomenorrhea or amenorrhea was declining. Even among those who were less than 2 years after menarche, those whose menstrual cycle were longer than 90 days accounted for lower than 5%. The 95th percentile of mFG score was 6 among the girls who were < 2 years after menarche, and 5 among the girls who were > 2 years after menarche. Among the 235 healthy girls, the 95th percentile values of Testosterone (T), Free androgen index (FAI) and Androstenedione (A2) were 2.28 nmol/mL, 4.37, and 5.20 nmol/mL respectively. Based on the NIH criteria, the prevalence of PCOS in this survey was 3.86%. The prevalence of adolescent PCOS tend to slightly increase with age and gynecological age, but the difference was not statistically significant. The prevalence of PCOS among obese girls was markedly higher than that in lean girls. CONCLUSION: Based on the NIH criteria, the prevalence of PCOS among the tenth grade schoolgirls in Guangzhou area was 3.86%. The diagnosis of hyperandrogenism among adolescents should also be based on both clinical and biochemical parameters.

A Phase III randomized controlled trial of oral dydrogesterone versus intravaginal progesterone gel for luteal phase support in in vitro fertilization (Lotus II): results from the Chinese mainland subpopulation.

Lotus II, a randomized, open-label, multicenter, international study compared the efficacy and safety of oral dydrogesterone versus micronized vaginal progesterone (MVP) gel for luteal support in IVF. A prespecified subgroup analysis was performed on 239 Chinese mainland subjects from the overall study population (n = 1034), who were randomized to oral dydrogesterone 30 mg or 8% MVP gel 90 mg daily from the day of oocyte retrieval until 12 weeks of gestation. The aim was to demonstrate non-inferiority of oral dydrogesterone to MVP gel, assessed by the presence of a fetal heartbeat at 12 weeks of gestation. In the Chinese mainland subpopulation, there was a numerical difference of 9.4% in favor of oral dydrogesterone, with ongoing pregnancy rates at 12 weeks of gestation of 61.4% and 51.9% in the oral dydrogesterone and MVP gel groups, respectively (adjusted difference, 9.4%; 95% CI: -3.4 to 22.1); in the overall population, these were 38.7% and 35%, respectively (adjusted difference, 3.7%; 95% CI: -2.3 to 9.7). In both the Chinese mainland subpopulation and the overall population, dydrogesterone had similar efficacy and safety to MVP gel. With convenient oral administration, dydrogesterone has potential to transform luteal support treatment.

Oral dydrogesterone versus intravaginal micronized progesterone gel for luteal phase support in IVF: a randomized clinical trial.

STUDY QUESTION: Is oral dydrogesterone 30 mg daily non-inferior to 8% micronized vaginal progesterone (MVP) gel 90 mg daily for luteal phase support in IVF? SUMMARY ANSWER: Oral dydrogesterone demonstrated non-inferiority to MVP gel for the presence of fetal heartbeats at 12 weeks of gestation (non-inferiority margin 10%). WHAT IS KNOWN ALREADY: The standard of care for luteal phase support in IVF is the use of MVP; however, it is associated with vaginal irritation, discharge and poor patient compliance. Oral dydrogesterone may replace MVP as the standard of care if it is found to be efficacious with an acceptable safety profile. STUDY DESIGN, SIZE, DURATION: Lotus II was a randomized, open-label, multicenter, Phase III, non-inferiority study conducted at 37 IVF centers in 10 countries worldwide, from August 2015 until May 2017. In total, 1034 premenopausal women (>18 to <42 years of age) undergoing IVF were randomized 1:1 (stratified by country and age group), using an Interactive Web Response System, to receive oral dydrogesterone 30 mg or 8% MVP gel 90 mg daily. PARTICIPANTS/MATERIALS, SETTING, METHODS: Subjects received either oral dydrogesterone (n = 520) or MVP gel (n = 514) on the day of oocyte retrieval, and luteal phase support continued until 12 weeks of gestation. The primary outcome measure was the presence of fetal heartbeats at 12 weeks of gestation, as determined by transvaginal ultrasound. MAIN RESULTS AND THE ROLE OF CHANCE: Non-inferiority of oral dydrogesterone was demonstrated, with pregnancy rates in the full analysis sample (FAS) at 12 weeks of gestation of 38.7% (191/494) and 35.0% (171/489) in the oral dydrogesterone and MVP gel groups, respectively (adjusted difference, 3.7%; 95% CI: -2.3 to 9.7). Live birth rates in the FAS of 34.4% (170/494) and 32.5% (159/489) were obtained for the oral dydrogesterone and MVP gel groups, respectively (adjusted difference 1.9%; 95% CI: -4.0 to 7.8). Oral dydrogesterone was well tolerated and had a similar safety profile to MVP gel. LIMITATIONS, REASONS FOR CAUTION: The analysis of the results was powered to consider the ongoing pregnancy rate, but a primary objective of greater clinical interest may have been the live birth rate. This study was open-label as it was not technically feasible to make a placebo applicator for MVP gel, which may have increased the risk of bias for the subjective endpoints reported in this study. While the use of oral dydrogesterone in fresh-cycle IVF was investigated in this study, further research is needed to investigate its efficacy in programmed frozen-thawed cycles where corpora lutea do not exist. WIDER IMPLICATIONS OF THE FINDINGS: This study demonstrates that oral dydrogesterone is a viable alternative to MVP gel, due to its comparable efficacy and tolerability profiles. Owing to its patient-friendly oral administration route, dydrogesterone may replace MVP as the standard of care for luteal phase support in fresh-cycle IVF. STUDY FUNDING/COMPETING INTERESTS(S): This study was sponsored and supported by Abbott. G.G. has received investigator fees from Abbott during the conduct of the study. Outside of this submitted work, G.G. has received non-financial support from MSD, Ferring, Merck-Serono, IBSA, Finox, TEVA, Glycotope and Gedeon Richter, as well as personal fees from MSD, Ferring, Merck-Serono, IBSA, Finox, TEVA, Glycotope, VitroLife, NMC Healthcare, ReprodWissen, Biosilu, Gedeon Richter and ZIVA. C.B. is the President of the Belgian Society of Reproductive Medicine (unpaid) and Section Editor of Reproductive BioMedicine Online. C.B. has received grants from Ferring Pharmaceuticals, participated in an MSD sponsored trial, and has received payment from Ferring, MSD, Biomérieux, Abbott and Merck for lectures. G.S. has no conflicts of interest to be declared. A.P. is the General Secretary of the Indian Society of Assisted Reproduction (2017-2018). B.D. is President of Pune Obstetric and Gynecological Society (2017-2018). D.-Z.Y. has no conflicts of interest to be declared. Z.-J.C. has no conflicts of interest to be declared. E.K. is an employee of Abbott Laboratories GmbH, Hannover, Germany and owns shares in Abbott. C.P.-F. is an employee of Abbott GmbH & Co. KG, Wiesbaden, Germany and owns shares in Abbott. H.T.'s institution has received grants from Merck, MSD, Goodlife, Cook, Roche, Origio, Besins, Ferring and Mithra (now Allergan); and H.T. has received consultancy fees from Finox-Gedeon Richter, Merck, Ferring, Abbott and ObsEva. TRIAL REGISTRATION NUMBER: NCT02491437 (clinicaltrials.gov). TRIAL REGISTRATION DATE: 08 July 2015. DATE OF FIRST PATIENT'S ENROLLMENT: 17 August 2015.

Does reducing gamete co-incubation time improve clinical outcomes: a retrospective study.

PURPOSE: The objective of this retrospective study was to determine whether patients undergoing in vitro fertilization (IVF) benefit from reducing the gamete co-incubation time. METHODS: Patients (n = 570) were enrolled, including 281 patients in the reduced incubation time group (2-h incubation) and 289 patients in the standard IVF group (18-h incubation). RESULTS: The observed outcomes, including the clinical pregnancy rate (CPR), implantation rate (IR), live birth rate (LBR), and miscarriage rate (MR), were similar between the two groups. When the data were divided into two subgroups based on the maternal age (≤30 and >30 years), the rates of top-quality embryos (30.83 vs. 25.89 %; p = 0.028), CPR (66.67 vs. 42.11 %; p = 0.013), and IR (41.90 vs. 31.25 %, p = 0.019) of the 2-h incubation group were significantly higher in the younger subgroup. However, for older patients, only a lower MR (7.59 vs. 20.83 %; p = 0.019) was achieved. Reducing the time of incubation still improved the CPR (OR = 1.993, 95 % CI 1.141-3.480) and MR (OR = 3.173, 95 % CI 1.013-9.936) in the younger and older subgroups, respectively, after it was adjusted for potential confounders. CONCLUSIONS: Reducing incubation time improves the clinical results of IVF, although the LBR is not statistically different between the 2- and 18-h incubation time groups. And the specific clinical outcomes of reducing incubation time varied between the >30-year-old and the ≤30-year-old.

Increased GDF9 and BMP15 mRNA levels in cumulus granulosa cells correlate with oocyte maturation, fertilization, and embryo quality in humans.

BACKGROUND: Oocyte secreted factors (OSFs), including growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15), play an important role in the process of follicular development and oocyte maturation. Since OSFs are expressed in oocytes and cumulus granulosa cells, the aim of the present study was to explore whether the expression levels of GDF9 and BMP15 mRNAs in cumulus granulosa cells can be used as molecular markers for predicting oocyte developmental potential. METHODS: Cumulus cells of 2426 cumulus-oocyte complexes were collected from 196 female patients who underwent intracytoplasmic sperm injection (ICSI) and were used for mRNA detection on the egg retrieval day. Pearson correlation analysis was used to analyze the correlation between OSF expression and general physiological parameters. Partial correlation analysis was used to analyze the correlation between OSF expression and oocyte developmental potential. Covariance analysis was used to compare OSF expression among different groups. Receiver operating characteristic curves were used to examine the diagnostic value of GDF9 and BMP15 mRNA for predicting pregnancy. RESULTS: The expression levels of GDF9 and BMP15 mRNAs were significantly associated with age, body mass index (BMI), oocyte maturation, normal fertilization, and cleavage rate (P < 0.05). The expression levels of GDF9 and BMP15 mRNAs in the group with high-quality embryos were significantly higher than those in the group without high-quality embryos (P < 0.05). The expression levels of GDF9 and BMP15 mRNAs in the pregnancy group were significantly higher than those in the nonpregnancy group (P < 0.05). The cut-off value of GDF9 mRNA for predicting pregnancy was 4.82, with a sensitivity of 82% and a specificity of 64%. The cut-off value of BMP15 mRNA for predicting pregnancy was 2.60, with a sensitivity of 78% and a specificity of 52%. CONCLUSIONS: The expression levels of GDF9 and BMP15 mRNAs were closely associated with oocyte maturation, fertilization, embryo quality, and pregnancy outcome; therefore, GDF9 and BMP15 mRNAs in cumulus granulosa cells may be considered as new molecular markers for predicting oocyte developmental potential.

Association between the proportion of dominant follicles and oocyte developmental competence.

PURPOSE: To explore the optimal timing for hCG triggering by investigating the impact of different proportion of dominant follicles on the oocyte developmental competence. METHODS: One hundred ninety-eight infertile women were divided into three groups according to the proportion of dominant follicles on hCG day: (1) low: <15% (n = 66); (2) middle: 15-27% (n = 66); (3) high: >27% (n = 66). The grouping criteria were the bottom and top tertiles of the proportion of dominant follicles. RESULTS: The gonadotropin dosage, duration and maximum follicle diameter in the low proportion group were lower than those in the middle and high proportion groups. Oocyte maturation and the abnormal fertilization rate in the low proportion group were lower than those in the middle and high proportion groups. The normal fertilization rate did not differ among the three groups. The cleavage rate and number of transferable embryos in the low proportion group were significantly higher than those in the high proportion group. The high-quality embryo rate, implantation rate, and pregnancy rate in the low proportion group were significantly higher than those in the middle and high proportion groups. CONCLUSIONS: A high proportion of dominant follicles are closely associated with impaired oocyte developmental competence and low pregnancy rate. These findings suggest that follicular overgrowth induced by delayed hCG triggering may undermine oocyte developmental competence and the proportion of dominant follicles may be a potential parameters for hCG triggering.

Progress in understanding human ovarian folliculogenesis and its implications in assisted reproduction.

PURPOSE: To highlight recent progress in understanding the pattern of follicular wave emergence of human menstrual cycle, providing a brief overview of the new options for human ovarian stimulation and oocyte retrieval by making full use of follicular physiological waves of the patients either with normal or abnormal ovarian reserve. METHODS: Literature review and editorial commentary. RESULTS: There has been increasing evidence to suggest that multiple (two or three) antral follicular waves are recruited during human menstrual cycle. The treatment regimens designed based on the theory of follicular waves, to promote increased success with assisted reproduction technology (ART) and fertility preservation have been reported. These new options for human ovarian stimulation and oocyte retrieval by making full use of follicular waves of the patients either with normal or abnormal ovarian reserve lead to new thinking about the standard protocols in ART and challenge the traditional theory that a single wave of antral follicles grows only during the follicular phase of the menstrual cycle. CONCLUSIONS: The understanding of human ovarian folliculogenesis may have profound implications in ART and fertility preservation. Further studies are needed to evaluate the optimal regimens in ART based on the theory of follicular waves and to identify non-invasive markers for predicting the outcome and the potential utilities of follicles obtained from anovulatory follicular waves in ART.

[Study on the facial and body terminal hair growth in women in Guangdong by using modified Ferriman-Gallwey scoring system].

OBJECTIVE: To study growth of facial and body terminal hair of women in Guangdong province and its relationship with age, menstrual irregularities and polycystic ovary, and determine normative cut-off score of modified Ferriman and Gallwey (mFG). METHODS: A cross-sectional study was conducted on 2988 women at age of 20-45 years from 16 communities of two urban and two rural regions in Guangdong province from June 2008 to July 2009. Terminal body hair growth was assessed by using the modified Ferriman and Gallwey (mFG) scoring system. The normative cut-off value of mFG were calculated by using the K-means cluster analysis (K=2). Those women were classified into following groups, including 982 women at group of ages of 20- years, 765 women at group of 26- years, 597 women at group of 31- years, 384 women at group of 36- years, 260 women at group of 41-45 years. Due to absence or errors of medical records, some cases were excluded from this study. Based on menses irregularities (MI), polycystic ovaries (PCO), there were 488 cases in MI group, 2413 cases in normal menses group, 568 cases in PCO group, and 2207 cases in non-PCO group finally. The incidences of acne, MI, acanthosis nigricans, and polycystic ovaries were also analyzed in all the hirsute groups. RESULTS: (1) among 2988 women, it was observed 149 women (5%) with mFG≥7,314 women (10.5%) with ≥5,747 women with mFG≥2. (2) Cluster analysis identified an mFG score of 5 as the cut-off value that define abnormal hirsute in the total population and all the sub-groups with/without MI or PCO; (3) Based on age classification, it was found that increased age was associated with decreased trends of the percentile and cut-off value of hirsutism. The value of hirsutism of mFG were 6 in group of 20- years, 5 in group of 26- years, 4 in groups of 31- years, 36- years and 41-45 years. (4) The prevalence of acne, menstrual irregularities and POC were 45.5% (143/314), 73.6% (231/314), 25.8% (81/314) in total population, 25.1% (671/2674), 16.1% (431/2674), 19.8% (529/2674) in normal hair women, which reached statistical difference (P<0.05). The prevalence of acne, menstrual irregularities and acanthosis nigricans were 44.4% (130/293), 23.2% (68/293), 4.1% (12/293) in those age hirsute groups, 25.3% (681/2695), 16.2% (437/2695), 1.9% (51/2695) in normal hair women, which reached statistical difference (P<0.05). CONCLUSIONS: (1) among women in Guangdong province, mFG scoring showed decreased trends in women with increasing age. (2) An mFG score≥5 was cut-off value in diagnosis of hirsutism. (3) The hirsute women exhibited higher incidence of acne, menses irregularity, and acanthosis nigricans than those of women with normal hair growth.

Protection of CHO cells by transfer of survivin driven by ovarian-specific promoter OSP-2.

Chemotherapy is the major therapy for cancer in clinic. However, chemotherapeutic agents can harm the other tissues/organs besides cancer. Thus, there are great interests in protecting the innocents by the transfer of protective genes. There are two problems to be solved, one is the selection of protective genes and the other is the orientation of the exotic genes. Recent researches demonstrated that the principal mechanism of chemotherapeutics was through apoptosis. Hereby, introduction of anti-apoptosis genes might interrupt the processes of apoptosis to avoid side effect from chemotherapeutics. On the other hand, tissue-specific promoters, which control gene expression in a tissue-specific manner, might be an alternative tool to guarantee the location of target genes. In this research, we applied gene therapy to chemoprotection using anti-apoptosis gene survivin and ovarian-specific promoter OSP-2. The results showed that OSP-2 could specifically drive the expression of survivin in ovarian cells and survivin could protect cells via inhibiting apoptosis. This might put a light on the future of chemoprotective gene therapy.

Cloning and transcriptional activity of a novel ovarian-specific promoter from rat retrovirus-like elements.

The long terminal repeats (LTRs) are the control centers for retrovirus gene expression, which possess all of the requisite signals. It has been proved that the LTRs of Moloney murine leukemia virus (MoMLV) could constitutively activate genes in diverse cell types. Recently, a retrovirus-like element, OSP-1 (ovarian-specific promoter 1), was extracted from rat ovary according to the LTRs of MoMLV, whose name was derived from the fact of ovarian-specific transcription. It was reasonable to speculate that the tissue-specificity was acquired through mutations and that there should be abound other mutants, active or inactive. In the present study, we isolated several homologous sequences to OSP-1 and detected their function. Consequently, one of them could also drive target gene expression specifically to ovarian cell lines and was named OSP-2 which shared 98% similarity to OSP-1. On the other hand, we picked up other two closest sequences and proved them inactive, which was 97% and 95% similar to OSP-1, respectively. Sequence analysis revealed the different mutations around/within the binding sites of transcriptional factors that might play important roles in tissue-specificity. In summary, we extracted a novel ovarian-specific promoter as well as other nonfunctional mutants, which in part shed light on the study of ovarian-specific transcription. In addition, it also provided a new tool in cancer gene therapy and to create transgenic animals.

[Plasma metastin in adolescent polycystic ovary syndrome.].

OBJECTIVE: This study was designed to investigate the correlationship between plasma metastin and pathogenesis of adolescent women with polycystic ovary syndrome (PCOS). METHODS: From Jan. 2006 to Jun. 2006, 42 PCOS patients including 19 adolescent women and 23 adults with syndrome were treated in Second Affiliated Hospital of Sun Yat-Sen University. According to the range of age, those patients were divided into 19 cases in adolescent group ( 19 years). Meanwhile, 20 adolescent women were matched as controls. Blood samples were collected between day 1 and day 5 of a spontaneous bleeding episode in the PCOS groups and a menstrual cycle of the controls. The levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), free T (FT), dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), insulin, glucose, and metastin were detected from day 1 to day 5 of spontaneous bleeding or withdrawal bleeding by progesterone. On the next day, oral glucose tolerance test (75 g) and insulin release test were performed on those above patients and controls. The area under curve (AUC), the ratio of fasting blood glucose to insulin (GIR) and homeostasis model assessment insulin resistance index (HOMA-IR) were calculated. RESULTS: (1) The level of hormone: the level of LH was in (12 +/- 7) U/L in adult group and (12 +/- 8) U/L in adolescent PCOS group, which were significantly higher than (6 +/- 4) U/L in controls (P < 0.05). The level of FT was (2.3 +/- 1.2) pmol/L in adult group, which was significantly higher than (1.3 +/- 0.8) pmol/L in adolescent group and (1.1 +/- 0.5) pmol/L in control group (P < 0.05). It was observed that the level of (3.1 +/- 2.7)micromol/L in adolescent group was significantly lower than (6.3 +/- 2.7) micromol/L in control group (P < 0.05). Meanwhile, the level of FAI of 5.6 +/- 4.1 in adult group was significantly higher than 3.0 +/- 1.3 in control group (P < 0.05). No significant difference in FSH, T and SHBG levels among three groups were observed (P > 0.05). (2) Metastin and metabolism: Both the levels of fasting blood insulin, 2-hour insulin and AUC of insulin were (13 +/- 7) mU/L, (88 +/- 59) mU/L and (133 +/- 80) mUxL(-1)xmin(-1) in adolescent group, which were significantly higher than (7 +/- 3) mU/L, (57 +/- 29) mU/L and (82 +/- 34) mUxL(-1)xmin(-1) in control group. The fasting blood insulin of (13 +/- 7) mU/L in adolescent group was significantly higher than (9 +/- 5) mU/L in adult group. The level of fasting blood glucose and 2-hour glucose were (5.01 +/- 0.44) mmol/L and (6.48 +/- 1.16) mmol/L in adult group, which were significantly higher than (4.68 +/- 0.29) mmol/L and (5.44 +/- 0.83) mmol/L in control group and (4.67 +/- 0.30) mmol/L and (5.93 +/- 1.44) mmol/L in adolescent group. The glucose AUC of (9.99 +/- 1.85) mmolxL(-1)xmin(-1) in adult group was significantly higher than (8.42 +/- 1.53) mmolxL(-1)xmin(-1) in control group (P < 0.05). HOMA-IR of 2.6 +/- 2.0 in adolescent group was significantly higher than 1.4 +/- 0.7 in control group. GIR of 10 +/- 8 in adolescent group was significantly lower than 16 +/- 10 in control group (P < 0.05). The metastin level of (0.25 +/- 0.19) pmol/L in adolescent group and (0.29 +/- 0.29) pmol/L in adult group were all significantly higher than (0.18 +/- 0.23) pmol/L in control group (PPh glucose were observed (r = 0.256, 0.286 and 0.267. P = 0.044, 0.025 and 0.043). CONCLUSIONS: The expression of metastin in adolescent PCOS women was significantly higher that of normal adolescent women. The increased level of metastin might be associated with pathogenesis of adolescent women with PCOS.

[Effect of anti-Müllerian hormone on P450 aromatase mRNA expression in cultured human luteinized granulose cells].

OBJECTIVE: To investigate the effect of anti-Müllerian hormone (AMH) on hormone secretion and P450 aromatase mRNA expression from cultured human luteinized granulosa cells. METHODS: Human luteinized granulose cells were derived from 10 patients treated by in vitro fertilization-embryo transplantation (IVF-ET) in the Second Affiliated Hospital of Sun Yat-sen University from June to December 2006. Granulose cells were divided into group A, B, C, D, E depending on different concentration of AMH, testosterone group and blank group. 1x10(-7) mol/L testosterone and 1, 5, 10, 20, 50 microg/L AMH were added into the culture medium of group A, B, C, D and E. 1x10(-7) mol/L testosterone was added into the culture medium of testosterone group while no other ingredient was added into the medium of blank group. Estrogen levels in supernates were measured at 24, 48, 72 hours after cell incubation. RT-PCR was performed to detect the P450 aromatase mRNA expression in group B, C, D, E and testosterone group at 72 hours after cell incubation. RESULTS: (1) Estrogen levels in supernates of granulose cell culture at 24, 48, 72 hours were (8.529+/-0.381)x10(4), (10.977+/-0.436)x10(4), (13.309+/-0.506)x10(4) pmol/L in group A, (7.027+/-0.276)x10(4), (9.167+/-0.300)x10(4), (10.794+/-0.555)x10(4) pmol/L in group B, (6.039+/-0.226)x10(4), (7.585+/-0.548)x10(4), (8.797+/-0.518)x10(4) pmol/L in group C, (5.118+/-0.460)x10(4), (5.716+/-0.496)x10(4), (6.205+/-0.667)x10(4) pmol/L in group D, (4.932+/-0.148)x10(4), (5.323+/-0.184)x10(4), (5.629+/-0.212)x10(4) pmol/L in group E. When compared with blank group [(0.001+/-0.001)x10(4), (0.006+/-0.003)x10(4), (0.029+/-0.011)x10(4) pmol/L], the statistical differences were observed in group A, B, C, D, E (P<0.01); when compared with testosterone group [(8.418+/-0.569)x10(4), (10.841+/-0.689)x10(4), (13.301+/-0.637)x10(4) pmol/L], the statistical differences were observed in group B, C, D and E (P<0.01); statistical differences were also observed in group C, D and E when compared with group B, and also group D and E when compared with group C (P<0.01). No significant difference was observed between group D and E (P>0.05). In group A, B, C, D, E and testosterone group, the estrogen levels at 24 hours after cell culture were significantly lower than those at 48 and 72 hours (P<0.01); statistical difference was observed between estrogen levels at 48 and 72 hours (P<0.01). No significant difference was observed among 24, 48 and 72 hours in blank group (P>0.05). (2) Relative ratios of intensity of P450 aromatase/beta-actin at 72 hours of cell culture in group B, C, D and E were 0.6148+/-0.0046, 0.5156+/-0.0012, 0.4698+/-0.0027 and 0.4282+/-0.0017, respectively, which were statistically lower than that in testosterone group (0.8224+/-0.0021, P<0.01); statistical differences were also observed in group C, D and E when compared with group B, and also group D and E when compared with group C (P<0.01). No significant difference was observed between group D and E (P>0.05). CONCLUSION: It is suggested that AMH might affect estrogen synthesis by inhibiting P450 aromatose activity so that lead to hyperandrogenism microenvironment in local ovary.

[Effects of gonadotropin releasing hormone analogues on chemotherapy-induced ovarian function damage in rats].

OBJECTIVE: To investigate the effects of gonadotropin releasing hormone agonist (GnRH-a) and antagonist (GnRH-ant) on cyclophosphamide (CTX)-induced ovarian damage in rats. METHODS: Seventy-two Sprague-Dawley female rats were divided randomly into six groups, which received normal saline (NS), CTX, GnRH-a + NS, GnRH-a + CTX, GnRH-ant + NS, and GnRH-ant + CTX respectively. Levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E(2)) were measured successively by the enzyme-linked immunosorbent assay method, and half of the rats were killed in the first week and between the fourth and the fifth week after stop of medication, respectively to compare the weight of the ovaries and the number of the primordial follicles and the growth follicles. RESULTS: (1) Throughout experiment, the serum levels of FSH, LH and E(2) of the control group fluctuated slightly, while those in the CTX group kept rising. During medication treatment, compared with the control group [(118 +/- 16) microg/L, (350 +/- 35) microg/L] and the CTX group [(113 +/- 15) microg/L, (289 +/- 42) microg/L], the concentrations of LH [(42 +/- 8) - (47 +/- 7) microg/L, (31 +/- 5) - (36 +/- 7) microg/L] and FSH [(124 +/- 45) - (136 +/- 32) microg/L, (178 +/- 54) - (198 +/- 27) microg/L] in the GnRH-a groups and the GnRH-ant groups were maintained at low levels significantly and the levels of LH in the GnRH-ant groups were significantly lower than that in the GnRH-a groups, but the levels of FSH in the GnRH-ant groups were significantly higher than that in the GnRH-a groups (P < 0.05); and extremely different from the GnRH-a groups [(0.98 +/- 0.18) - (1.46 +/- 0.22) ng/L], the level of E(2) of the GnRH-ant groups [(3.58 +/- 0.43) - (3.98 +/- 0.74) ng/L] did not significantly decrease (P < 0.01). After stop of therapy, the concentrations of LH, FSH and E(2) in the GnRH-a groups and the GnRH-ant + NS group rose gradually and were similar to the levels of the control group (P > 0.05), but the levels of FSH, LH and E(2) of the GnRH-ant + CTX group rose obviously and were similar to the levels of the CTX group, especially the FSH , and the levels of LH and FSH of the GnRH-ant + CTX group [(156 +/- 12) microg/L, (520 +/- 44) microg/L] and the CTX group [(178 +/- 18) microg/L, (546 +/- 36) microg/L] were significantly higher than that of the other four groups [(121 +/- 15) - (132 +/- 13) microg/L, (335 +/- 35) - (359 +/- 26) microg/L] at the 4(th) - 5(th) week after stop of treatment (P < 0.05). (2) At the 1(st) week after stopping therapy, the GnRH-a + NS group [(12 +/- 5) mg/100 g]and the GnRH-a + CTX group [(18 +/- 8) mg/100 g] had the lowest weight of ovaries which was significantly different from the other groups [(30 +/- 9) - (37 +/- 8) mg/100 g, P < 0.05]. At the 4(th) - 5(th) week after stopping therapy, the GnRH-ant + CTX group [(22 +/- 6) mg/100 g] and the CTX group [(20 +/- 4) mg/100 g] had the lowest weight of ovaries which were significantly different from the other groups [(29 +/- 5) - (31 +/- 9) mg/100 g, P < 0.05]. (3) At the 1(st) week after stopping therapy, there were the largest number of primordial follicles [(824 +/- 45), (689 +/- 39)] and the lowest number of growth follicles [(15 +/- 1), (21 +/- 3)] in the GnRH-a + NS group and the GnRH-a + CTX group, but there were the lowest number of primordial follicles [(255 +/- 24), (343 +/- 29)] and the largest number of growth follicles [(110 +/- 21), (87 +/- 17)] in the GnRH-ant + CTX group and the CTX group. At the 4(th) - 5(th) week after stopping therapy, the number of growth follicles in the GnRH-a + NS group (58 +/- 11) and the GnRH-a + CTX group (56 +/- 16) recovered to almost the level of the control group (57 +/- 9, P > 0.05), but the number of all kinds of follicles declined significantly in the GnRH-ant + CTX group [(195 +/- 15), (36 +/- 12)] and the CTX group [(212 +/- 11), (36 +/- 9)] compared to the other four groups [(302 +/- 15) - (690 +/- 43), (44 +/- 12) - (58 +/- 11), P < 0.05]. CONCLUSION: In rat model, GnRH-a prevents the ovarian function damage induced by CTX, but GnRH-ant does not show similar protective effect.

[Diagnostic value of ovarian morphology by ultrasonography in pubertal polycystic ovary syndrome].

OBJECTIVE: To explore the ovarian morphological characteristics by ultrasonography as diagnostic criteria for pubertal polycystic ovary syndrome (PCOS). METHODS: Sixty-six adolescent PCOS patients and 27 controls were involved in this study. They underwent transrectal ultrasound during the early follicular phase or amenorrheal period (dominant follicle excluded by ultrasonography). t test and receiver operating characteristic (ROC) curve analysis were mainly used for statistical analysis. RESULTS: The mean ovarian volume (MOV), maximal ovarian volume (MaxOV) and mean follicle number (MFN) in PCOS group were all significantly greater than control group (P = 0.000). ROC curve analysis showed a satisfactory diagnostic potency for both ovarian volume and follicle number. The area under the ROC curve (AUC) was 0.914, 0.884 and 0.838 for MOV, MaxOV and MFN respectively with no statistical difference among them (P > 0.05). Setting the threshold of MOV at 6.4 cm(3) offered the best compromise between sensitivity (84.8%) and specificity (87.5%), and setting the threshold of MaxOV at 8.6 cm(3) offered the best compromise between sensitivity (75.8%) and specificity (95.2%) and setting the threshold of MFN at 8 offered the best compromise between sensitivity (86.7%) and specificity (78.3%). CONCLUSIONS: Ovarian morphology by ultrasonography yields satisfactory diagnostic accuracy for adolescent PCOS. Taking MOV >or= 6.4 cm(3) or MaxOV >or= 8.6 cm(3) or MFN >or= 8 as an ultraphonic criterion for pubertal PCOS offer the best compromise between sensitivity and specificity.

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

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

[Modified tubo-uterine implantations for proximal tubal occlusive infertility after femal sterilization with mucilago phenol].

OBJECTIVE: To explore the effects of modified tubo-uterine implantations performed on women with proximal tubal occlusive infertility after femal sterilization with mucilago phenol. METHODS: Two hundred and eight infertile women who were admitted to the Second Affiliated Hospital of Sun Yat-sen University between 1986 and 2004 were included. They all accepted modified tubo-uterine implantation after occlusion of fallopian tubes with mucilago phenol. RESULTS: It was found that the occlusions were all located in the interstitial portion or isthmic portion of the fallopian tubes. Different degrees of pelvic adhesions were found in 65 cases. Fifty-seven cases were slightly adhesive, seven cases were of moderate degree and one case was severe. One hundred and ninety-nine cases were followed up after operations (95.7%). One hundred and ninety-three women accepted hydrotubation in the following month just after the operation and 185 women were found to be unobstructed (95.8%). One hundred and forty-three women became pregnant, the pregnant rate being 71.9% (143/199). One hundred and twenty-five women had term deliveries (87.4%), three women were in early pregnancy and two in midtrimester pregnancy. Eleven women had spontaneous abortion (7.7%). Two women had tubal pregnancy (1.0%). None of the 199 cases had any signs of endometriosis. CONCLUSIONS: Modified tubo-uterine implantations are quite effective for proximal tubal occlusive infertility. It may be a favorable method for such kind of tubal occlusions.

[Making of the animal model with sterilized testes].

OBJECTIVE: To explore the methods of making an animal model with sterilized testes. METHODS: (1) X-ray local irradiation. Seventy 8-10-week-old male mice were equally divided into 6 experiment groups and a control group. The testes of the mice in the 6 experiment groups were irradiated sequentially by 1000, 1200, 1400, 1600, 1800 and 2000 cGy X-ray for 10 minutes, while those in the control group remained untreated. And then the pregnancy test was performed. (2) Cyclophosphamide injection. Forty 4-5-week-old male mice were divided into 3 experiment groups and a control group, the former treated with different doses of Cyclophosphamide via ip and the latter Natiichloridi Saline (N.S.) via i.p., followed by the pregnancy test. (3) Diphereline injection. Twenty 8-10-week-old male mice were equally divided into an experiment group and a control group, the former treated with Diphereline via ip and the latter N.S. via i.p., followed by the pregnancy test. (4) Identification by such pathologic examinations as TUNE1. technology, HE staining and immunohistochemical staining. RESULTS: (1) X-ray local irradiation. The male mice of Group 1 and 2 made their female partners pregnant respectively 10 and 15 days after the X-ray irradiation, but not those of Group 3 and 4 in our 3-month observation, and those of Group 5 and 6 died respectively 2 and 5 days after the X-ray irradiation. By comparison, the controls got their female partners pregnant within 3 days after placed together. (2) Cyclophosphamide injection. The male mice of Group 1 gained weight about 7 g and achieved pregnancy 9-14 days after drug termination, those of Group 2 gained around 4 g but failed to effect pregnancy, and those in Group 3 lost weight and died respective at 3, 4 and 5 weeks during the medication, while the controls all got their female partners pregnant within 3 days after put together. (3) Diphereline injection. The 10 male mice of the experiment group effected pregnancy 3 weeks after drug termination, while the 10 controls achieved the same result with 3 days after placed together. (4) Pathologic identification: TUNEL technology showed that apoptotic cells were occasionally seen (0.71 +/- 0.12)% in the testis tissue of the control group and remarkably increased (10.36 +/- 1.48)% in the model group, with significant difference between the two groups (P < 0.05). HE staining revealed normal testis tissues and convoluted seminiferous tubules with large numbers of germ cells in the control group, but atrophied convoluted seminiferous tubules and estranged cell linkage with only Ledig's cells but no germ cells in the model group. Immunohistochemical staining showed that the positive expression rates of CD29, Hsp90alpha and CD117 were respectively (50.30 +/- 5.2)%, (41.6 +/- 3.5)% and (73.6 +/- 3.7)% in the control group, as compared with (1.3 +/- 0.2)%, 0% and (1.6 +/- 0.3)% in the model group, with significant difference (P < 0.01). The positive expression rate of p53 was (19.7 +/- 0.8)% in the control group, significantly different from that of the model group, which was (39.4 +/- 2.9)% (P < 0.01). CONCLUSION: The animal model with sterilized testes can be made either by X-ray local irradiation of the testis or by Cyclophosphamide injection via i.p..

[Mesenchymal stem cells do not differentiate into "quasi-sperm"].

OBJECTIVE: To determine whether the surviving mesenchymal stem cells (MSCs) in the testis after transplantation can differentiate into quasi-sperm. METHODS: (1) Making an animal model with sterilized testes. Forty 4-week old white male BASB/C mice were used to establish an animal model with sterilized testes and divided randomly into an experimental and a control group. (2) Cell preparation. The MSCs from 10 gray male 129-mice were isolated, cultured and purified by Percoll density gradient centrifugation combined with the adherent method. When the MSCs grew to an adequate number, they were made into a cell suspension with NS at a concentration of 1 million cells/ml. (3) Xenogeneic transplantation of the MSCs into the testis. The MSC suspension was blindly injected into the testes of the mice in the experimental group and NS into the testes of the controls. (4) Post-transplantation observation. Forty white female BASB/C mice were adopted, each put into a box with a male mouse from the experimental group or the control group, and then observed for pregnancy. RESULTS: In the experimental group, 8 cases of pregnancy (40%) were observed at 31-46 d (38.5 d on average), the offspring all white. In the control group, only 1 case of pregnancy (5%) was seen at 45 d, the offspring all white, too. It was suggested that the MSCs of the 129-mice failed to differentiate into functional quasi-sperm and pass their genes to their offspring, as would expectedly have been presented by a mixture of black and white. The pregnancy rates of the two groups were significantly different (P < 0.05), which indicated that MSCs could promote the healing of the testis damage. CONCLUSION: MSCs cannot differentiate into quasi-sperm after heterogeneity transplantation into the testis, but can promote the healing of the testis damage.