Pregnancy outcome of freeze thaw cycles of polycystic ovary syndrome patients regarding the anti-Müllerian hormone percentile.

Patients with polycystic ovary syndrome display increased levels of anti-Müllerian hormone. Frozen-thawed embryo transfer (FET) prevents ovarian hyperstimulation and results in better pregnancy outcome in PCOS patients. Therefore, we aimed to evaluate the effect of serum AMH levels on the pregnancy outcome of FET cycles in PCOS patients. 110 infertile women with PCOS who were recommended for embryo cryopreservation followed by FET. The patients' AMH levels were evaluated, and the age-related AMH percentiles were determined. The patients were then grouped according to AMH percentiles, namely, 75th-90th percentile (Group 1) and higher than the 90th percentile (Group 2).A total of 110 PCOS patients who conceived in Frozen Embryo Transfer (FET)-In-vitro Fertilisation (IVF) cycles were included in this study. The preterm delivery rates in FET cycles were higher in the group of PCOS patients with AMH levels greater than the 90th percentile than in patients in the 75th-90th percentile group (50% vs 28.8%, p = .024). In conclusion, PCOS patients with AMH levels higher than the 90th percentile had substantially higher preterm delivery rates than those with AMH levels at the 75th-90th percentile, suggesting the need for closer follow-up. Further studies are needed to elucidate the underlying mechanisms behind this correlation.IMPACT STATEMENTWhat is already known on this subject? The association of AMH levels with the risk of adverse pregnancy outcomes has been previously investigated. In women with PCOS, substantially elevated AMH levels were significantly associated with preterm birth.What do the results of this study add? Results showed that the PCOS patients with higher AMH levels and underwent assisted reproductive treatment demonstrated an increased risk of preterm labour than the PCOS patients with lower AMH levels.What are the implications of these findings for clinical practice and/or further research? In women with PCOS, substantially elevated AMH levels were significantly related to preterm birth, suggesting the need for closer follow-up in this population and the need for further studies to elucidate the underlying mechanisms behind this correlation.

The prognostic value of first-trimester cystatin C levels for gestational complications.

AIMS: This study is designed to evaluate predictive value of first-trimester cystatin C levels for long-term pregnancy complications. METHODS: The cross-sectional study population consisted of patients who admitted to outpatient clinic of a Maternity Hospital between September 2013 and December 2014. Among the 203 participants who accepted to participate in the study, 174 subjects who continued antenatal follow-up in the same clinic were included in the final analyses. Cystatin C, blood urea nitrogen, Creatinine levels and estimated glomerular filtration rates were evaluated in the first-trimester routine antenatal visit. Mode of delivery and gestational complications were noted. RESULTS: First-trimester cystatin C levels were significantly higher in cases complicated with preterm delivery and premature rupture of membrane (PROM) compared to uncomplicated ones (0.58±0.07 vs. 0.55±0.07, P=0.041, and 0.58±0.07 vs. 0.55±0.07, P=0.036). With a cutoff value of 0.505 mg/L, sensitivity of cystatin C for preterm delivery and PROM was 91.9% and specificity was 27.7% with a negative predictive value of 92.3% and a positive predictive value of 26.6%. CONCLUSION: Detection of cystatin C levels in the first trimester of pregnancy for the prediction of preterm/PROM seems as a promising preliminary data. The relatively higher first-trimester cystatin C levels in complicated pregnancies are conspicuous. The results imply that in pregnancy cystatin C might be more than a marker for renal function.

The association of osteocalcin and adiponectin with glucose metabolism in nondiabetic postmenopausal women.

BACKGROUND/AIM: This study was designed to determine if osteocalcin is associated with insulin resistance, metabolic risk factors and adiponectin levels in nondiabetic postmenopausal women. METHODS: A total of 87 menopausal nondiabetic subjects were enrolled into the study. Levels of fasting plasma glucose (FPG), insulin and serum lipids were determined. To estimate insulin sensitivity, homeostasis model assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were used. Serum total osteocalcin and adiponectin levels were measured and the features of metabolic syndrome were identified. RESULTS: The mean age of the patients was 54.7 years. Among the participants, 28.7% were obese (body mass index, BMI, ≥30). Insulin resistance was detected by HOMA-IR in 42.5% and by the QUICKI index in 63.2% of the cases. Metabolic syndrome was present in 29.8% of the patients. Neither the baseline characteristics nor the metabolic risk factors were correlated with osteocalcin or adiponectin levels (p > 0.05). When the patients were analyzed regarding BMI, osteocalcin levels were significantly lower in overweight women. Serum adiponectin levels were significantly lower in women with metabolic syndrome. CONCLUSION: No correlation between total osteocalcin and FPG, fasting insulin and insulin resistance parameters was found in nondiabetic postmenopausal women. Serum levels of adiponectin were associated with metabolic syndrome.

Sex-hormone-binding globulin early in pregnancy for the prediction of severe gestational diabetes mellitus and related complications.

AIMS: The aim of this study was to evaluate the predictive value of sex-hormone-binding globulin (SHBG) for the diagnosis of gestational diabetes mellitus (GDM), and to clarify the association between SHBG levels and GDM complications/medication requirements. MATERIAL AND METHODS: Among the participants (n = 93) who provided blood samples between 13 and 16 weeks' gestation, 30 cases subsequently developed GDM. Complications and medical interventions were noted. The best cut-off point of SHBG and diagnostic performance were calculated. RESULTS: The mean age was 28.45 ± 5.0 years. SHBG levels were lower in the GDM group (n = 30) when compared with non-GDM (n = 63) cases (<0.01). Among the GDM women, SHBG was lower in the insulin therapy group (n = 15) compared with medical nutritional therapy alone (n = 15) (P < 0.01). A good predictive accuracy of SHBG was found for GDM requiring insulin therapy (area under the curve: 0.866, 95% confidence interval: 0.773-0.959). An SHBG threshold for 97.47 nmol/L had a sensitivity of 80.0%, specificity 84.6%, positive predictive value 50.0% and negative predictive value 95.7%. The calculated odds ratio for SHBG < 97.47 nmol/L was 12.346 (95% confidence interval: 1.786-83.33). CONCLUSIONS: SHBG is valuable for screening women early in pregnancy for GDM risk; however, a standard assay for analyses and a threshold level of serum SHBG for a constant gestational week has to be determined.

Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations.

INTRODUCTION: Paraovarian or paratubal cysts (PTCs) constitute about 10 % of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion. METHODS: Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed. RESULTS: Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem. CONCLUSION: Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature.

Evaluation of serum boron levels and lipid profile in pregnancies with or without gestational diabetes.

AIMS: Animal research has demonstrated that boron has effects on triglycerides and glucose and may act as a metabolic regulator in several enzymatic systems. Gestational diabetes mellitus (GDM) is a prevalent obstetrical complication and the lack of data on maternal status of boron in normal/diabetic pregnancies, prompted us to undertake this study. METHODS: Maternal blood samples were collected during screening and diagnosis of GDM at 24-28 weeks. Serum lipids (total cholesterol, high-density cholesterol, low density cholesterol, triglycerides, lipoprotein-a, apolipoprotein-A-I and apolipoprotein-B) and boron levels were determined. Fifteen non-GDM and 19 GDM women constituted the study population. RESULTS: The mean age was 30.1±5 years. The median boron levels were 15.2 µg/L (0.0152 ppm; range, 8.4-25.4 µg/L). When GDM and non-GDM cases were compared for age, gravidity, parity, lipid profiles and serum boron levels, no significant differences were found (P>0.05). No correlation was found between lipids and boron levels. CONCLUSION: This preliminary study contributes to the limited information about the metabolic aspects of boron. Considering the evidence that boron acts as a regulator of energy substrate utilization, the effect of dietary boron on glucose metabolism deserves further research.

Ischemia modified albumin in perinatology.

Ischemia modified albumin is a novel marker of ischemia generated due to hypooxygenation and increased hydroxyl free radicals in low pH. The molecule has been licenced for clinical use as an early marker for acute coronary syndrome in cardiology. Since presence of ischemia might have serious and sometimes devastating effects in perinatology, various researches have evaluated its value in different clinical conditions. This narrative review aims to summarize the literature concerning the value of IMA in perinatology and guide for further research.

Effects of different doses of tramadol added to levobupivacaine in continuous wound infusion for postoperative pain treatment following cesarean section.

OBJECTIVE: The aim of this study was to compare the effects of two different doses of tramadol added to levobupivacaine as continuous wound infusion, on VAS scores following cesarean section. METHODS: The study was conducted in an University Hospital and was approved by the Local Ethical Committee. Sixty-five ASA I-II parturients, between 18 and 45 years were enrolled. The participants were randomized to three groups. Group T1 (n = 21) was given the study solution consisting of levobupivacaine 0.25% + tramadol 1 mg/kg. Group T2 (n = 21) was given levobupivacaine 0.25% + tramadol 2 mg/kg and Group L (n = 21) was given levobupivacaine 0.25%, subcutaneously, alone. Each patient who delivered by cesarean section was applied a triple orifice epidural catheter above rectus fascia for continious wound infiltration. VAS at rest and with 20 degrees leg lift, time to first additional analgesic, total additional analgesic consumption, side effects, and sedation scores were recorded. RESULTS: There were no statistically significant differences among groups, concerning VAS scores at rest and VAS scores at leg lift. Total amount of additional analgesics and sedation scores were also similar for three groups. CONCLUSION: Different doses of tramadol as adjunct to local anesthetics in continuous wound infiltration following cesarean section do not seem to provide superior analgesia.

Association of anti-Mullerian hormone and small-dense low-density lipoprotein cholesterol with hepatosteatosis in young lean women with and without polycystic ovary syndrome.

OBJECTIVE: To study the association of anti-Mullerian hormone (AMH) and small-dense low-density lipoprotein cholesterol (sd-LDL) with hepatosteatosis among young, lean, polycystic ovary patients. STUDY DESIGN: A prospective, case control study was carried out including 79 young lean women. Fifty-eight women with polycystic ovary syndrome (PCOS) and 21 age-and BMI-matched healthy controls were recruited. Anthropometric variables, biochemical and hormonal parameters, insulin-resistance indices, lipid profiles including sd-LDL levels and serum AMH levels were determined. Hepatic lipid content was evaluated by abdominal ultrasonography (USG). Determining the best predictor(s) which discriminate normal USG and hepatosteatosis was analyzed by multiple logistic regression analyses. Adjusted odds ratios and 95% confidence intervals were also calculated. RESULTS: PCOS patients had an increased prevalence of hepatosteatosis by 41.4% (P = 0.006) and they had significantly higher levels of sd-LDL and AMH when compared with the control group (P < 0.001). AMH and sd-LDL levels were positively and significantly associated with hepatosteatosis in young lean women with and without PCOS (OR: 2.877, 95%CI: 1.453-5.699, P: 0.02 and OR: 1.336, 95%CI: 1.083-1.648, P: 0.007, respectively). AMH and sd-LDL levels were positively correlated in PCOS patients (r = 0.626, P < 0.001). Both sd-LDL and AMH levels were the most predictive parameters for the determination of hepatosteatosis within the PCOS group. (OR: 3.347, 95%CI: 1.348-8.313, P = 0.009 and OR: 1.375, 95%CI: 1.072-1.764, P = 0.012, respectively). Statistically significant higher levels of AMH were associated with hepatosteatosis both in insulin resistance (IR) positive and IR negative PCOS patients (P < 0.001). CONCLUSION: Hepatosteatosis is common in young lean PCOS patients. Increased AMH and sd-LDL levels may independently predict hepatosteatosis in young lean women with and without PCOS.

Maternal and umbilical cord ischemia-modified albumin levels in nonreassuring fetal heart rate tracings regarding the mode of delivery.

OBJECTIVE: To evaluate umbilical cord blood ischemia-modified albumin (IMA) levels in cases of fetal distress (FD) and to explore fetal blood IMA levels regarding the route of delivery. METHODS: Umbilical cord and maternal serum IMA concentrations were assessed in term 40 cases with cesarean section (CS) due to FD, 76 cases with elective repeat CS and 85 cases with noncomplicated vaginal delivery. RESULTS: The maternal and umbilical cord IMA levels were significantly lower in vaginal deliveries when compared with CS cases either in FD or previous CS groups (p = 0.02). Although no statistically significant difference was found in IMA levels of CS groups (previous CS vs. FD), cord blood IMA levels tend to be higher in FD group. Neither demographic characteristics nor fetal outcome parameters were found to have any correlation with maternal IMA levels. However, umbilical cord IMA levels were found to be negatively correlated with 1th min Apgar scores (r = -0.143, p = 0.043). CONCLUSIONS: IMA seems to be responsive to hypoxic FD showing the highest levels in cases with severe fetal hypoxia. Higher levels of IMA in cases with elective repeat CS might indicate acute transient hypoxia and possible myocardial ischemia in these cases.

The association of urinary albumin excretion and metabolic complications in polycystic ovary syndrome.

OBJECTIVE: This study was planned to screen polycystic ovary syndrome (PCOS) women for albuminuria and to evaluate the association between urinary albumin excretion (UAE) and metabolic disturbances of PCOS. In addition, this is the first study in the literature evaluating the association between UAE and carotid intima-media thickness (CIMT) in PCOS cases. STUDY DESIGN: The study population consisted of 65 PCOS women. The study was prospectively designed and performed in a university hospital. The diagnosis of PCOS was made according to the Rotterdam criteria: exclusion criteria were hyperprolactinemia, thyroid dysfunction, adrenal dysfunction, diabetes mellitus, hypertension, and pregnancy. Blood samples were collected in the follicular phase of a menstrual cycle and serum samples were analyzed for fasting glucose, insulin, and hormone and lipid profiles. Twenty-four hour urine specimens were collected for the detection of UAE. CIMT was estimated by visual assessment of the distance between the lumen-intima and intima-adventitia interfaces. RESULTS: The mean age and BMI were 23 years and 23 kg/m(2), respectively. The median UAE was 7 mg/day (range: 0.3-154 mg/day). The median UAE as micrograms of albumin per milligram of creatinine (uACR) was 5.6 (0.28-159). Regarding the uACR cutoff value (>6.93 µg/mg), significantly higher levels of triglycerides, 17 OH-progesterone, insulin resistance (HOMA index > 2.1) and increased CIMT were present in these cases. Microalbuminuria (uACR > 25 µg/mg) was present in 6.2%. In the regression analyses serum HDL-C levels were found to be independent predictor for uACR > 2 µg/mg (OR: 0.85) and estradiol levels were the independent predicting factor for uACR > 6.93 µg/mg even after adjustments for age and BMI were performed (OR:1.02). CONCLUSIONS: UAE, expressed as uACR > 6.93 µg/mg, seems to be an associated sign of metabolic problems which might help in discriminating PCOS at risk of future CVD. Further studies are needed before routine use of albuminuria in PCOS cases for the detection of CVD risk.

Ischemia-modified albumin and cardiovascular risk markers in polycystic ovary syndrome with or without insulin resistance.

The aim of this study was to evaluate ischemia-modified albumin levels (IMA) in polycystic ovary syndrome (PCOS) cases with and without insulin resistance and the correlation of IMA with carotid intima media thickness, homocysteine, and high-sensitivity C-reactive protein levels. Significantly higher levels of IMA in young lean PCOS cases, more relevant in insulin resistant cases, indicates chronic hypoxia and oxidative stress which might play a role in the metabolic consequences in PCOS.