The inflammatory markers in polycystic ovary syndrome: association with obesity and IVF outcomes.

OBJECTIVE: To investigate the inflammatory markers in polycystic ovary syndrome (PCOS) and associations of these markers with obesity and in vitro fertilization (IVF) outcomes. METHODS: A total of 292 women underwent IVF procedure either with PCOS (n = 146) or without PCOS (n = 146, age, and body mass index (BMI) matched controls) were included in the study. All patients were classified according to BMI levels (normal weight: NW, BMI <25 kg/m(2) and obese: OB, BMI ≥25 kg/m(2)). The inflammatory markers were leukocyte count, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV). RESULTS: BMI of PCOS was positively correlated with leukocyte, neutrophil, lymphocyte and MPV (p < 0.05), but negatively correlated with NLR and PLR (p < 0.05). Both NLR and PLR increased significantly in PCOS (p < 0.001). PLR increased significantly in NW-PCOS compared the NW-controls and OB-PCOS. MPV values increased only in OB-PCOS subjects. The logistic regression analyzes showed that MPV was the independent variable in PCOS to effect CPR (p = 0.000; OR 0.1; CI 0.06-0.2). CONCLUSIONS: NLR and PLR were significantly increased in all PCOS subjects compared to the BMI-matched controls. Despite PLR being decreased by adiposity, PLR increased in NW-PCOS. These results are supporting the hypothesis that PCOS is a chronic inflammatory process independent of obesity. MPV levels were independently associated with CPR in PCOS. Further prospective studies concerning inflammation and IVF outcomes of PCOS are needed.

The predictor markers of ovarian response in poor responders under 40 years of age.

OBJECTIVE: To explore the ovarian reserve markers in predicting ovarian response and pregnancy rates in poor responder patients undergoing in vitro fertilization (IVF). MATERIAL AND METHODS: A total of 140 women < 40 years with poor ovarian response (POR), who underwent IVF were included in the study. The clinical findings compared with normal responder controls (n= 250). Regression analysis was used to search the correlation between the number of the total oocyte count retrieved and independent variables as age, FSH, LH, AMH, AFC, and E2 on the hCG day. RESULTS: AUC ROC curve were AMH 0.804, AFC 0.701, E2 on hCG day 0.786, FSH 0.705, LH 0.527, and E2 0.479, age 0.707, respectively. E2 levels on hCG day and AMH levels were independent markers of POR. None of the factors were predictor of pregnancy rate. CONCLUSION: The serum E2 levels on the hCG day and AMH levels predict ovarian response, but not pregnancy rates.

In vitro fertilization outcomes in obese women under and above 35 years of age.

PURPOSE: To explore the impact of obesity on in vitro fertilization (IVF) outcomes and comparing the results with regards to age groups. MATERIALS AND METHODS: This retrospective cohort recruited 780 women that underwent IVF. Women with polycystic ovarian syndrome (PCOS) were excluded from the study. Women under and above 35 years were categorized into three groups as normal weight, overweight, and obese. The main outcome measures were ovarian response, oocyte maturity, and clinical pregnancy rates. RESULTS: Despite oocyte count and fertilization rate that decreased in both younger and older obese women, this difference was not statistically significant. After age matched-normal weight controls, the clinical pregnancy rates were significantly decreased in older obese women. On the other hand, poor ovarian response observed significantly in young obese women without effect on pregnancy rates. CONCLUSION: These results suggested that obesity in young and old women has different outcomes and different steps of IVF process may be affected.

Registries of cases with neural tube defects in Denizli, Turkey, 2004-2010.

Neural tube defects (NTD) are among the most common congenital abnormalities, with an incidence of 3 per 1000 live births in Turkey. In a study of major congenital abnormalities in the city of Denizli, Turkey, abnormalities of the central nervous system are particularly common (31.1%). The objective of this study was to develop a registry of cases with NTDs in Denizli. Cases that had been diagnosed with NTD between January 2004 and September 2010 in State Hospitals of Central Denizli were retrospectively examined. The diagnoses were established based on the ICD-10 criteria. A total of 250 subjects with NTD were identified, including 123 (49.2%) females and 127 (50.8%) males with a mean age of 13.72 ± 15.62 years (age range 1-81 years). Interestingly, spina bifida constituted a significant percentage of the cases (149 cases; 59.6%). In addition, 10 (4.0%) cases had hydrocephalus plus spina bifida. The second most common diagnosis was microcephaly, which included 70 cases (28.0%). Encephalocele was observed in only 2 cases (0.8%). Development of NTD is influenced by nutrition, socioeconomic factors, and the use of folic acid during the peri-conceptional period. Studies examining the effect of these factors on NTD in Turkey and a review of primary prevention measures are necessary.

The effects of drospirenone-ethinyl estradiol and drospirenone-ethinyl estradiol + metformin on ovarian ultrasonographic markers, body fat mass index, leptin, and ghrelin.

PURPOSE: Polycystic ovary syndrome (PCOS) is considered as the most common endocrinopathy among women of reproductive age. Oral contraceptives (OCs) and metformin are one of the main drug groups in the long-term treatment of PCOS. This study was undertaken to investigate the effects of drospirenone-ethinyl estradiol and drospirenone-ethinyl estradiol + metformin on ultrasonographic markers, body fat mass (BFM) index, leptin-ghrelin. METHODS: This was a prospective clinical study conducted at Kocaeli University Department of Obstetrics and Gynecology on 42 PCOS patients. Patients were randomly allocated into two groups [Group I (n = 22): drospirenone-ethinyl estradiol (DEE); Group II (n = 20): drospirenone-ethinyl estradiol + metformin (M)] according to Body Mass Index (BMI) findings. Patients were evaluated in terms of leptin-ghrelin, ultrasound, and body fat distribution before and 6 months after therapy. Main outcome measures were to investigate the effects of drospirenone-ethinyl estradiol and drospirenone-ethinyl estradiol + metformin on ovarian ultrasonographic markers, BFM index, leptin, and ghrelin. RESULTS: In patients with higher BMI, ovarian volume, numbers of follicles, stromal area, and echogenicity have been reported to be larger. In group II, a negative correlation between ghrelin and abdominal fat mass after treatment has been noted, whereas in group I a positive correlation between leptin and abdominal fat mass after treatment has been observed. CONCLUSIONS: Addition of metformin could have beneficial effects on abdominal fat mass. Stromal area measurement and assessment of fat mass with Dual X-ray Absorptiometry could be helpful as a quantitative way of measurement.

11ß-hydroxysteroid dehydrogenase type 1 gene expression is increased in ascending aorta tissue of metabolic syndrome patients with coronary artery disease.

11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD-1) activity and mRNA levels are increased in visceral and subcutaneous adipose tissues of metabolic syndrome subjects. We analyzed 11ß-HSD-1 expression in human epicardial adipose (EA) and ascending aorta (AA) tissues of metabolic syndrome patients and examined their contribution to the development of coronary atherosclerosis. The 11ß-HSD-1 expression was evaluated by qRT-PCR in EA and AA tissues of 20 metabolic syndrome patients with coronary artery disease (metabolic syndrome group) and 10 non-metabolic syndrome patients without coronary artery disease (controls). 11ß-HSD-1 expression was increased in EA and AA tissues of the metabolic syndrome group (4.1- and 5.5-fold, respectively). A significant positive correlation was found between 11ß-HSD-1 expression in EA tissue and waist hip ratio and 11ß-HSD-1 expression in AA tissue and body mass index, while a negative correlation was found between 11ß-HSD-1 expression in EA tissue and HDL. Expression of CD68, a macrophage marker, was significantly increased in both tissues of the metabolic syndrome group; it was 2-fold higher in AA tissue compared to EA tissue in the metabolic syndrome group. Our findings of increased expression of 11ß-HSD-1 and CD68 in AA tissue of the metabolic syndrome group lead us to suggest that they contribute to coronary atherosclerosis in metabolic syndrome. This positive correlation between obesity markers and 11ß-HSD-1 in AA and EA tissues strengthens the evidence that 11ß-HSD-1 has a role in metabolic syndrome. To the best of our knowledge, this is the first report showing 11ß-HSD-1 and CD68 expression in AA tissue of metabolic syndrome patients. We suggest that there is tissue-specific expression of 11ß-HSD-1 in metabolic syndrome and associated cardiovascular disorders.

Glutathione S-transferase P1 polymorphisms are associated with time to tumor progression in small cell lung cancer patients.

PURPOSE: Many of commonly used chemotherapeutics in lung cancer treatment are metabolized by glutathione-S transferases (GSTs). The placental isoform of GST (GSTP1) is the most abundant isoform in the lung. Polymorphisms within the GSTP1 may result in alterations in enzyme activity and change sensitivity to platinum-based chemotherapy. We investigated whether the polymorphism within the exons 5 and 6 of GSTP1 gene may change response to therapy, time to tumor progression (TTP) and overall survival in small cell lung cancer (SCLC) patients. METHODS: Ninety-four histologically confirmed patients with SCLC were enrolled in this study during 1995-2006. GSTP1 Ile105Val polymorphism in exon 5 and GSTP1 Ala- 114Val polymorphism in exon 6 were determined by using PCR-RFLP techniques. Associations between the GSTP1 polymorphisms and treatment response were evaluated using the chi-square test. Associations between the GSTP1 polymorphisms and TTP and overall survival were compared using Kaplan-Meier survival curves. RESULTS: We found no significant associations between exon 5 and exon 6 GSTP1 gene polymorphisms and response to therapy or overall survival. Patients carrying both variant exon 5 (Ile/Val or Val/Val) and variant exon 6 (Ala/Val) genotypes had significantly shorter TTP (5 vs. 8 months, p = 0.04). Moreover, patients with heterozygote exon 6 variant had presented with extensive-stage disease. CONCLUSION: No individual effect of variant alleles was found in relation to chemotherapy response, median TTP and overall survival. The carriage of both types of variant alleles may predict worse outcome.

Seroreactivity against PTEN-induced putative kinase 1 (PINK1) in Turkish patients with Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a multisystem inflammatory disorder characterized by recurrent oral ulcers, genital ulcers and ocular inflammation, as well as skin, joint, vascular, pulmonary, central nervous system (CNS) and gastrointestinal tract manifestations. The etiopathogenesis of BD has not yet been identified; but it has generally been accepted that several environmental factors may induce an inflammatory attack in genetically susceptible individuals. In this study, we aimed to identify antigens that could elicit high-titer IgG responses by the serological analysis of recombinant expression of cDNA libraries method (SEREX). METHODS: We screened a human testis cDNA library with pooled sera obtained from 4 BD patients by SEREX. Antigens that were identified with the initial analysis were selected for seroreactivity analysis of a larger group of BD patients (n=78) and controls (n=66) by serological immunoscreening. RESULTS: We observed seroreactivity against 6 antigens using the pooled sera. These included rabaptin 5 (RABPT5), PTEN-induced putative kinase 1 (PINK1), switch associated protein 70 (SWAP70), interferon-induced protein with tetratricopeptide repeats 2 (IFIT2), ankyrin repeat domain 20 family, member A1 (ANKRD20A1), and an unknown antigen. Eleven out of 82 (13.4%) BD patients were found to have antibodies elicited against PINK1 antigen, when none of the control sera showed reactivity (p=0.001). There was no significant difference in the frequency of other defined antigens between the patient and control groups. However, among BD clinical sub-groups, anti-SWAP70 antibodies were found to associate with vascular involvement. DISCUSSION: In this study, antibodies against PINK1 were found to specifically associate with BD while SWAP70 antibody was associated with clinical sub-groups of BD. Although variations in both genetic background and environmental factors may affect the outcome of serological responses, our results suggest that serological screening can be used to identify antigens that elicit antibody responses associated with BD.

Predictors of intracytoplasmic sperm injection (ICSI) outcome in couples with and without male factor infertility.

AIM: To find out the predictors of ICSI outcome. METHODS: Forty-three pregnancies in 100 consecutive ICSI cycles. RESULTS: Every 1,000 pg/ml increase in hCG-day E2 (OR = 0.46, CI: 0.25-0.83, p = 0.01) and 1% decrease in the rate of normal sperm morphology (OR = 0.81, CI: 0.67-0.98, p = 0.03) caused a significant decrease in clinical pregnancy rate and live birth rate (respectively, OR = 0.5, CI: 0.32-0.96, p = 0.03, OR = 0.66, CI: 0.5-0.86, p = 0.002) while every increase in the number of good quality embryos transferred caused a two-time increase in the clinical pregnancy rate (OR = 2.1, CI: 1.2-4, p = 0.01). On the other hand, every increase in the number of four-cell cleavage embryos (OR = 1.02, CI: 1.002-1.04, p = 0.03) and hCG-day endometrial thickness (OR = 1.6, CI: 1.15-2.24, p = 0.005) were found to increase the live birth rate. Implantation rate (m = 8.3 +/- 14.6) was significantly lower in cases with leucocytospermia (n = 33) compared to cases without leucocytospermia (n = 67, m = 17.4 +/- 24.6, p = 0.02). CONCLUSION: Leucocytospermia, hCG-day E2 level and endometrial thickness, normal sperm morphology, and number of good quality embryos are predictors of implantation, clinical pregnancy and live birth rate following ICSI.

Antiproliferative effects and insulin-like growth factor-I expression in Balb-C 3T3 fibroblasts after treatment with somatostatin and gonadotropin-releasing hormone analogs.

The present study was aimed to compare antiproliferative effects of somatostatin (SS) and gonadotropin-releasing hormone analogs (GnRHa) on a fibroblast cell line. Proliferation index, cell count, viability of the cells and insulin-like growth factor-I (IGF-I) immunoreactivity were determined after treatment with either SS (100 microM/ml), GnRHa (35 nM/ml) or SS and GnRHa of Balb-C 3T3 mouse fibroblasts. It was found that the proliferation index, cell count, viability and IGF-I immunoreactivity were not affected by GnRHa treatment as compared with no treatment (p > 0.05). Application of SS to the fibroblasts resulted in a significant reduction in proliferation index, cell count, and IGF-I immunoreactivity as compared with GnRHa treatment and no treatment, but it had no effect on cell viability. The labelling index in SS-treated cells was significantly reduced as compared with combined treatment with SS and GnRHa. In conclusion, a direct effect of GnRHa on fibroblast cells in culture could not be demonstrated. SS had direct inhibitory effects on cell proliferation possibly via inhibition of IGF-I effects without affecting cell viability.

Expression of insulin-like growth factor in the placenta of intrauterine growth-retarded human fetuses.

Many cases of intrauterine growth retardation (IUGR) are the result of placental and fetal tissue insufficiency. Insulin-like growth factor-I (IGF-I) is known to play a role in placental and fetal growth. An immunocytochemical study was performed to localize IGF-I peptides in human placenta and umbilical cords of normal (n = 3) and IUGR (n = 3) fetuses. The peripartum fetal conditions were evaluated as well. Immunoreactive IGF-I was detected in the cytotrophoblast, syncytiotrophoblast, amnion, endothelial cells of fetal capillaries and in the decidua in both normal and IUGR placental tissue. A more robust immunostaining and increased numbers of positively stained cells were found in the decidua of IUGR placenta (p < 0.001). Intense immunostaining was also found in endothelial cells, smooth muscle cells and fibroblasts of the umbilical vein. IGF-I immunoreactivity was also present in stroma (Hofbauer cells and/or fibroblasts) of IUGR villi. Our results indicate that expression of IGF-I is high in specific sites in placenta and umbilical cords, which indicates a paracrine and/or endocrine function. The increased expression of IGF-I in placenta of IUGR fetuses indicates its involvement in restoring normal growth by means of a positive feed-back mechanism.

Persistent müllerian duct syndrome. A case report.

BACKGROUND: Persistent müllerian duct syndrome is a rare form of male pseudohermaphroditism in which well-developed müllerian structures are present in an otherwise normal male with XY chromosomes. The syndrome was first described by Nilson in 1939, and almost 100 cases have been reported. CASE: A 22-year-old man presented with mild, right-sided inguinal pain and heaviness in his scrotum. He underwent right-sided inguinal exploration because of having a palpable right-sided, irreducible inguinal hernia. Two testicles with surface nodularity and a bicornuate uterus with rudimentary fallopian tubes were detected and removed as one specimen, and the hernia was repaired. CONCLUSION: Management of this syndrome is difficult because of the limited number of cases. If the diagnosis can be made before surgery, karyotyping can be useful to decide on orchiopexy or orchioectomy. In suspected cases, laparoscopy and ultrasonographic evaluation of all crytorchidic cases may be helpful for diagnosing this condition before surgery. All patients with this syndrome have a male phenotype; therefore, it is essential to preserve secondary sex characteristics. Androgen replacement therapy should be given to patients who have undergone gonadectomy and to those with low levels of testosterone.

The role of L-arginine and neutrophils on incisional wound healing.

Although arginine plays an important role in many aspects of inflammation and wound healing, the mechanism is not clear. We aimed to evaluate the effect of L-arginine administration on wound healing and neutrophil activity and on the interaction of these effects. Sixteen rats were divided into two groups: control group and L-arginine group. L-arginine was given intraperitoneally. The rats underwent incisional wounding and were killed on the 7th day of wounding. Blood neutrophil counts, neutrophil adhesivity index, tensile strengths and hydroxyproline level of skin were determined, histopathological and electron microscopical evaluation of healing was performed. Wound scores in the control group were significantly lower (p < 0.05). Hydroxyproline and collagen levels of skin were significantly increased in the L-arginine group (p < 0.05). Blood neutrophil counts and neutrophil adhesivity index in the L-arginine group were significantly increased (p < 0.05), as were the inflammatory cells in the skin. L-arginine may be used during the first phase of healing to induce inflammation in high risk patients.

Evaluation of chimerism with DNA polymorphisms in bone marrow transplantation.

Evaluation of chimeric status following allogenic BMT is an important tool for monitoring the replacement of host cells with donor cells and for determining the risk of relapse. Polymorphic DNA sequences can be used as powerful markers in identification of donor/recipient genotype differences, even between close relatives. Polymerase chain reaction (PCR) amplification of three variable number of tandem repeat (VNTR) loci and five single-locus polymorphisms (SLP) was used to identify chimerism in 40 recipient-donor pairs. Mixed chimerism was present in 11 patients, and complete chimerism in 29. This PCR method is a rapid and sensitive assay to detect engraftment and evaluate relapse potential, and thus is very useful in the clinical management of BMT patients.

Knowledge on lactational amenorrhoea and contraception in Kocaeli, Turkey.

OBJECTIVE: To determine the knowledge of women about lactational amenorrhoea and contraceptive properties of breastfeeding. DESIGN: A prospective, randomised descriptive study. SETTING: Kocaeli University School of Medicine, Department of Obstetrics and Gynecology. SUBJECTS OR PARTICIPANTS: Nine hundred and twenty-two women in their reproductive ages. INTERVENTION: A questionnaire was filled by doctors or nurses during face to face interview. MAIN OUTCOME MEASURES: There was significantly less knowledge for the importance of frequency and duration of suckling (p < 0.0001). The education increases the knowledge of lactational amenorrhoea as a interruptus contraceptive method. RESULTS: More than fifty-three per cent of women were using one of the modern contraceptive methods, 23.86% were using natural methods and 22.78% not using any family planning method. Intrauterine devices (30.15%), coitus interuptus (21.69%) and condom (16.48%) were the most common contraceptive methods. Nearly fifty-two per cent of women were not aware of the contraceptive property of breastfeeding, 25.68% of women knew lactation had a protective effect from pregnancy, 48.16%, did not know the importance of frequency and duration of suckling on fertility reducing effect of lactation. CONCLUSION: The level of knowledge on lactational amenorrhoea and frequency of suckling was significantly low in our study, especially in the illiterate group. Since efficacy of natural family planning depends on the compliance of women, education of women about lactation is very important. Family planning programmes should be focussed on breastfeeding and type of breastfeeding practices used, especially where there are no contraceptive alternatives.

PIP: This prospective, randomized, descriptive study examined the contraceptive choices and knowledge of women about lactational amenorrhea and contraceptive properties of breast-feeding in Kocaeli, India. A total of 922 women of reproductive age were surveyed, and a Chi-square test was used for data analysis. Results showed that 53.36% of the women used modern contraceptive methods, 23.86% preferred natural methods, and 22.78% were not using fertility control methods. The most commonly used contraceptive methods included IUDs (30.15%), coitus interruptus (21.69%), and condoms (16.48%). Almost 52% of the women were not aware of the contraceptive effect of breast-feeding; 25.68% knew that lactation had a contraceptive effect. Lactation was accepted as a contraceptive method by 48.16% of the women, while 51.8% of the women did not accept this type of method. Overall, the level of knowledge on lactational amenorrhea and suckling frequency was significantly low, particularly among illiterate women. Family planning programs should focus on breast-feeding as a fertility control method, especially when no contraceptive alternatives are available.

Experimental study on the role of mast cells in peritoneal adhesion formation.

OBJECTIVE: To investigate the potential role of mast cell stabilisation in the prevention of post-operative adhesions. DESIGN: Laboratory animal experiment. SETTING: University hospital, Turkey. SUBJECTS: Ninety Wistar albino rats. INTERVENTION: Under anaesthesia, a lower midline laparotomy was performed, the caecum exposed and grasped until haemorrhage occurred. The rats were divided into three groups. Group 1, 2 and 3 were intra-peritoneally administered 1 ml of saline, disodium cromoglycate 5 mg/kg in 1 ml of saline and 10 mg/kg in 1 ml of saline, respectively thirty minutes prior to laparotomy and immediately subsequent to abdominal closure. They were later sacrificed, laparotomy repeated and the presence and extent of intraabdominal adhesions evaluated. RESULTS: Adhesion scores were best in the high disodium cromoglycate dose group of rats (p < 0.05) and the number of degranulated mast cells was significantly low in this group (p < 0.05). CONCLUSION: Disodium cromoglycate may be an effective agent for attenuating adhesion formation when administered in suitable doses.

Placental expression of insulin-like growth factor-I, fibroblast growth factor-basic and neural cell adhesion molecule in pregnancies with small for gestational age fetuses.

OBJECTIVE: To investigate placental expression of insulin-like growth factor-I (IGF-I), fibroblast growth factor-basic (FGF-b) and neural cell adhesion molecule (N-CAM) regarding the pathogenesis of pregnancies with small for gestational age (SGA) fetuses. STUDY DESIGN: An immunohistochemical analysis using anti-IGF-I, anti-FGF-b and anti-N-CAM antibodies was carried out on 4% paraformaldehyde-fixed placental tissues of third trimester pregnancies complicated with SGA fetuses (n=12) and subjects exhibiting appropriately grown fetuses (n=10). Immunostaining patterns of chorionic villi and amniochorionic membranes were assessed. RESULT: IGF-I, FGF-b and N-CAM immunostainings in chorionic villi demonstrated significantly increased immunoreactivities in cytotrophoblasts of SGA cases, whereas increased IGF-I immunostaining in syncitiotrophoblasts and increased N-CAM immunostaining in capillary endothelium were noted in the same group. IGF-I, FGF-b and N-CAM immunostainings in amniochorionic membranes revealed significantly decreased IGF-I immunoreactivities in extravillous trophoblasts and increased IGF-I immunoreactivities in decidual cells of SGA cases, while significantly decreased N-CAM immunoreactivities in both decidual cells and extravillous trophoblasts were noted. FGF-b immunostaining revealed no significant differences in both extravillous trophoblasts and decidual cells of SGA cases. CONCLUSION: Increased placental expression of IGF-I, FGF-b and N-CAM may act in an autocrine and/or paracrine manner to restore the impaired trophoblastic proliferation, migration and metabolism at all gestational stages by means of a positive feedback mechanism.

Sublingual versus vaginal misoprostol for cervical ripening PRIOR TO manual vacuum aspiration under local anaesthesia: a randomized study.

OBJECTIVE: To compare the effectiveness of sublingual and vaginal misoprostol application for cervical ripening prior to manual vacuum aspiration (MVA) under local anaesthesia for voluntary termination of pregnancy between 7 and 10 weeks of gestation. MATERIALS AND METHODS: Prospective randomized study in which 72 women were randomly assigned to administration of either 400 microg vaginal misoprostol 3 hours prior to or 200 microg sublingual misoprostol 2 hours prior to the surgical procedure. We took the preoperative cervical dilatation that was achieved as the main outcome measure. The duration of the procedure, intra-operative blood loss, pain perception before and during the operation, patients' satisfaction, side effects and duration of post-operative bleeding were secondary outcome measures. RESULTS: A similar pre-operative cervical dilatation was achieved in the sublingual and the vaginal groups (6.9 +/- 1.6 mm and 6.6 +/- 1.1 mm, respectively; p = 0.3). The duration of the operation, intra-operative blood loss, and patients' satisfaction did not differ between the two groups. Pain scores were significantly higher in the sublingual group than in the vaginal group, both after administration of misoprostol (p = 0.02) and during the procedure (p = 0.02). Nausea and vaginal spotting were significantly more frequent (p = 0.01 and p = 0.003, respectively), but post-operative bleeding significantly shorter (p = 0.003) in the sublingual group. CONCLUSION: Administration of 200 microg sublingual misoprostol 2 hours before suction curettage under local anaesthesia was as effective as 400 microg vaginal misoprostol 3 hours before that procedure with regard to achieving cervical dilatation. It resulted in higher pre-operative and intra-operative pain scores without changing patients' satisfaction.