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Vaginitis is a common gynecological problem, nevertheless, its clinical evaluation is often insufficient. This study evaluated the performance of an automated microscope for the diagnosis of vaginitis, by comparison of the investigated test results to a composite reference standard (CRS) of wet mount microscopy performed by a specialist in vulvovaginal disorders, and related laboratory tests. During this single-site cross-sectional prospective study, 226 women reporting vaginitis symptoms were recruited, of which 192 samples were found interpretable and were assessed by the automated microscopy system. Results showed sensitivity between 84.1% (95%CI: 73.67-90.86%) for Candida albicans and 90.9% (95%CI: 76.43-96.86%) for bacterial vaginosis and specificity between 65.9% (95%CI: 57.11-73.64%) for Candida albicans and 99.4% (95%CI: 96.89-99.90%) for cytolytic vaginosis. These findings demonstrate the marked potential of machine learning-based automated microscopy and an automated pH test of vaginal swabs as a basis for a computer-aided suggested diagnosis, for improving the first-line evaluation of five different types of infectious and non-infectious vaginal disorders (vaginal atrophy, bacterial vaginosis, Candida albicans vaginitis, cytolytic vaginosis, and aerobic vaginitis/desquamative inflammatory vaginitis). Using such a tool will hopefully lead to better treatment, decrease healthcare costs, and improve patients' quality of life.
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RESEARCH QUESTION: Why are women who face poor prognoses for success in assisted reproductive technology (ART) treatment choosing to pursue procedures using their own eggs, despite receiving information that their chances of success are very low. DESIGN: Cross-sectional study based on an anonymous questionnaire distributed to women aged between 43 and 45 years, undergoing ART using their own oocytes, at six public outpatient fertility clinics and three public in-hospital IVF units in Israel between 2015 and 2016. The main outcome measure was personal estimation of chance to achieve a live birth after the current ART treatment cycle and the cumulative estimated rate after all the treatment cycles the patient intended to undergo. RESULTS: Response rate was 70.0%, with 91 participants of mean age 43.8 ± 0.7 years. Participants estimated their delivery rates after the next ART treatment cycle at 49.0 ± 31.8% (response rate 93.4%) and their cumulative delivery rates after all the ART treatments they would undergo at 57.7 ± 36.3% (response rate 90.1%). This is significantly higher than the predicted success rates of 5% and 15%, respectively (both P < 0.001), which are based on national register data. Nearly one-half of patients rated themselves as having a better than average chance of conception (47.3%). CONCLUSION: Women do not pursue futile treatments because they lack information. Despite being informed of the low success rates of conception using ART treatments, many patients of advanced maternal age have unrealistically high expectations from ART, essentially ignoring their estimated prognosis when deciding on treatment continuation. Future work should examine the psychological reasons behind continuing futile fertility treatments.
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Inutilidad Médica/psicología , Técnicas Reproductivas Asistidas/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Edad Materna , Persona de Mediana EdadRESUMEN
BACKGROUND: Environmental tobacco smoke (ETS) exposure during pregnancy can cause preterm delivery and childhood cancer. The aim of this study was to measure ETS exposure in pregnant women and in newborn infants in Israel using urinary cotinine measurements, to assess predictors of ETS exposure in these vulnerable groups, and to assess associations with birth effects (birth weight, birth length, head circumference) in newborn infants. METHODS: We analyzed urinary cotinine and creatinine in 265 non-smoking pregnant women and 97 newborns, and analyzed associations with self-reported exposure to ETS, paternal smoking, sociodemographic variables and with birth outcomes (birth weight, birth length, head circumference). RESULTS: 37.7% of pregnant women and 29.0% of infants had urinary cotinine concentrations above the level of quantification (LOQ) of 1⯵g/L, whereas 63.8% and 50.5%, respectively, had urinary cotinine concentrations above the level of detection (LOD) of 0.5⯵g/L. Median unadjusted and creatinine adjusted urinary concentrations of cotinine in pregnant women were 0.7⯵g/L, and 0.9⯵g/g creatinine, respectively, and in newborn infants were 0.5⯵g/L, and 1.3⯵g/g creatinine, respectively. We did not find an association between maternal and infant urinary cotinine level. Maternal (but not infant) urinary cotinine was significantly associated with paternal smoking (pâ¯<â¯0.05). Infant (but not maternal) cotinine above the LOQ was negatively associated with birth weight (pâ¯<â¯0.05). CONCLUSIONS: In this high socioeconomic cohort, almost a third of newborn infants born to non-smoking mothers had quantifiable levels of urinary cotinine. This is the first study showing that newborns with quantifiable urinary cotinine levels have lower birth weight.
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Peso al Nacer , Cotinina/orina , Exposición Materna , Intercambio Materno-Fetal , Contaminación por Humo de Tabaco , Adulto , Monitoreo Biológico , Estudios de Cohortes , Padre , Femenino , Humanos , Recién Nacido , Israel/epidemiología , Masculino , Madres , Embarazo , AutoinformeRESUMEN
INTRODUCTION: Maternal urinary levels of dialkyl phosphate (DAP) metabolites of organophosphate pesticides (OP) during pregnancy are associated with adverse outcomes in the offspring. Between 2012 and 2014, eighteen active OP ingredients were restricted or banned in Israel for agricultural use. AIM: We aimed to study trends of urinary DAP metabolites among pregnant women and their offspring in the era of the new regulations. METHODS: Pregnant women were recruited at 11-18 weeks of gestation and provided spot urine samples (nâ¯=â¯273). Soon after birth, neonatal urine samples were collected (nâ¯=â¯107). All urine specimens analyzed for DAP metabolites. Trends in DAP metabolites were tested using Mann-Kendall trend statistic (M-K S) and linear regression models were constructed to estimate the association between calendar period and DAP levels between September 2012 and March 2016. RESULTS: Over the study period, median maternal ∑DAP levels decreased from 248â¯nmol/L to 148â¯nmol/L. Time of recruitment was associated with a statistically significant decrease in DAP metabolites, which remained significant after multivariate adjustment. Overall, the results for the analysis of before and after June 2014 showed a significant decrease in ∑DAP of -0.198 log10 nmol/L (95%CI: -0.311,-0.084) which corresponds with a decrease of 36.6% in ∑DAP. A similar trend was found for DAP metabolites in neonatal urine. Compared to other studies, pregnant women in Jerusalem had higher ∑DAP levels, even at the end of the study period. CONCLUSION: We observed significant reductions in maternal and neonatal DAP urinary levels during the period of 2012-2016. Regulations restricting agricultural use of OP seem to be effective in reducing population exposure to OP, in an era when residential use of OP is banned.
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Contaminantes Ambientales/orina , Insecticidas/orina , Exposición Materna , Intercambio Materno-Fetal , Organofosfatos/orina , Adulto , Agricultura/legislación & jurisprudencia , Ciudades , Monitoreo del Ambiente , Femenino , Regulación Gubernamental , Humanos , Recién Nacido , Israel , Masculino , EmbarazoRESUMEN
BACKGROUND: Selection of appropriate reference charts for fetal biometry is mandatory to ensure an accurate diagnosis. Most hospitals and clinics in Israel use growth curves from the United States. Charts developed in different populations do not perform well in the Israeli population. OBJECTIVES: To construct new reference charts for fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL), using a large sample of fetuses examined at 14-42 weeks gestational age in a medical center and a community ultrasound unit located in two different regions of Israel. METHODS: Data from the medical center and the community clinic were pooled. The mean and standard error of each measure for each week was calculated. Based on these, reference charts were calculated using quantiles of the normal distribution. The performance of the reference charts was assessed by comparing the new values to empiric quantiles. RESULTS: Biometric measurements were obtained for 79,328 fetuses. Growth charts were established based on these measurements. The overall performance of the curves was very good, with only a few exceptions among the higher quantiles in the third trimester in the medical center subsample. CONCLUSIONS: We present new local reference charts for fetal biometry, derived from a large and minimally selected Israeli population. We suggest using these new charts in routine daily obstetric practice.
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Biometría/métodos , Desarrollo Fetal/fisiología , Feto/anatomía & histología , Ultrasonografía Prenatal , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Israel , Embarazo , Valores de Referencia , Estudios RetrospectivosRESUMEN
Reference charts for fetal measures are used for early detection of pregnancies that should be monitored closely. Construction of reference charts corresponds to estimation of quantiles of a distribution as a function of gestational age. Existing methods have been developed under various modeling assumptions, typically by fitting a polynomial regression to certain functionals of the distributions (e.g., mean, standard deviation, and quantiles). We use a large dataset to compare various existing methods for construction of reference charts. We also relax the assumptions of a parametric polynomial link between the distribution parameters and age and consider cubic splines and discretization of age in order to compare charts based on more flexible and simpler models, respectively. We compare the different methods using various tools and demonstrate the importance of considering performance measures calculated from age-stratified data. We also examine the question of sample size. We compare our charts to similar charts that have been recently published and emphasize that the source of an apparent heterogeneity should be investigated. We conclude that the choice of which method to use for construction of reference charts should take the following into account: available sample size, validity of normality assumption, and results of various performance measures.
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Feto/anatomía & histología , Bioestadística , Femenino , Feto/diagnóstico por imagen , Edad Gestacional , Humanos , Funciones de Verosimilitud , Modelos Estadísticos , Embarazo , Valores de Referencia , Tamaño de la Muestra , Ultrasonografía PrenatalRESUMEN
Oocyte cryopreservation for age-related fertility loss is gaining interest considering the tendency to postpone motherhood in many societies. Little is currently known about the actual efficiency of this approach. We aimed to explore ovarian response of presumably fertile women undergoing in vitro fertilization for this indication. A total of 105 women underwent 151 stimulation cycles at mean age 37.7 ± 2.4. None had known infertility. Mean daily starting FSH dose was 371 ± 110 (225-600). Mean number of mature oocytes cryopreserved at the first completed cycle was 9.7 ± 7.5 (0-43). However, 21% of started cycles were either cancelled before egg retrieval or resulted in 0-3 mature oocytes retrieved. Therefore, women considering oocyte cryopreservation for prevention of age-related fertility decline should be encouraged to perform this procedure at younger age than, preferably before 35.
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Infertilidad Femenina/prevención & control , Recuperación del Oocito , Oocitos/citología , Inducción de la Ovulación/métodos , Adulto , Criopreservación , Femenino , Hormona Folículo Estimulante/administración & dosificación , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate whether estrogen may modulate anti-müllerian hormone (AMH) expression in women. DESIGN: Prospective analysis. SETTING: Fertility clinic of tertiary university hospital. PATIENT(S): Cycling infertile women. INTERVENTION(S): Blood samples were taken at the early, middle, and late follicular phase in five groups: spontaneous cycle (n=10), ovulation induction with clomiphene-citrate (n=15) or gonadotropins (n=9), controlled ovarian hyperstimulation for IVF (COH-IVF; n=10) and in women who were treated with exogenous E2 for frozen-thawed embryo-transfer (FET) with no follicular development (n=20). MAIN OUTCOME MEASURE(S): AMH and E2 serum levels. RESULT(S): Basal serum AMH and E2 levels were similar in all groups. AMH levels were stable in all women during the follicular phase except for significant reduction in the COH-IVF group. In women in the FET group with high E2 levels, comparable to the COH-IVF group, AMH levels remained stable. CONCLUSION(S): In women, estrogen does not appear to have a direct role in AMH regulation.
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Hormona Antimülleriana/metabolismo , Estrógenos/sangre , Estrógenos/farmacología , Adolescente , Adulto , Hormona Antimülleriana/sangre , Esquema de Medicación , Estrógenos/administración & dosificación , Femenino , Fertilización In Vitro , Humanos , Infertilidad/sangre , Infertilidad/terapia , Ciclo Menstrual/sangre , Ciclo Menstrual/efectos de los fármacos , Inducción de la Ovulación , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the outcome of pregnancies in women with familial Mediterranean fever (FMF) who are taking colchicine, and to reconsider the justification for amniocentesis in these women. METHODS: The outcome of 179 pregnancies in a group of women with FMF taking colchicine was compared with the outcome of 197 pregnancies in women with FMF who did not take colchicine during pregnancy and with 312 pregnancies in another cohort of healthy pregnant women of similar age and ethnicity. RESULTS: There was no difference in the 3 groups regarding early abortions, late abortions, or congenital malformations. There was a mild trend towards a better outcome for the colchicine-treated group but these results did not reach statistical significance. CONCLUSION: Treatment with colchicine during pregnancy in patients with FMF is beneficial in controlling the disease while not affecting the outcome of the pregnancy; therefore there is no justification for recommending amniocentesis in women taking colchicine solely because of this treatment.
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Amniocentesis/estadística & datos numéricos , Colchicina/uso terapéutico , Fiebre Mediterránea Familiar/tratamiento farmacológico , Moduladores de Tubulina/uso terapéutico , Procedimientos Innecesarios , Anomalías Inducidas por Medicamentos/epidemiología , Aborto Espontáneo/epidemiología , Aborto Espontáneo/etiología , Adulto , Amniocentesis/efectos adversos , Amiloidosis/etiología , Amiloidosis/prevención & control , Cesárea/estadística & datos numéricos , Estudios de Cohortes , Colchicina/efectos adversos , Fiebre Mediterránea Familiar/complicaciones , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Moduladores de Tubulina/efectos adversos , Adulto JovenRESUMEN
The pregnancy rates after triggering of final oocyte maturation with gonadotrophin-releasing hormone (GnRH) agonist in GnRH-antagonist ovarian stimulation protocols are lower than those following triggering with human chorionic gonadotrophin (HCG). Furthermore, lower pregnancy rates following GnRH-antagonist protocols compared with long GnRH-agonist protocols have been reported. The differences might be due to an impact on oocyte number and quality or on the endometrium. If any stimulation protocol had a negative impact on oocyte quality, then further evidence of this effect would be observed following frozen-thawed embryo transfer originating from that stimulation cycle. The outcome of frozen-thawed embryo transfer was retrospectively analysed using the long protocol with triptorelin depot 3.75 mg (n = 215) or 0.1 mg/day (n = 83), or GnRH-antagonist protocol with either HCG (n = 69) or GnRH-agonist (n = 25) for final oocyte maturation. The outcomes measured were implantation rate, clinical pregnancy rate, ongoing pregnancy rate and embryo survival rate. All outcomes were similar in the four groups. It is concluded that the potential for frozen-thawed embryos to implant and develop following transfer is independent of the GnRH-analogue and the final oocyte maturation protocol used in the collection cycle. Lower IVF embryo transfer success using GnRH-antagonist/GnRH-agonist protocol does not appear to be related to an adverse effect on oocyte quality.
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Gonadotropina Coriónica/administración & dosificación , Embrión de Mamíferos/efectos de los fármacos , Hormona Liberadora de Gonadotropina/agonistas , Oocitos/efectos de los fármacos , Inducción de la Ovulación/métodos , Adulto , Protocolos Clínicos , Criopreservación , Transferencia de Embrión , Femenino , Hormona Liberadora de Gonadotropina/administración & dosificación , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Humanos , Embarazo , Índice de Embarazo , Estudios RetrospectivosRESUMEN
BACKGROUND: We evaluated basal and dynamic hormonal markers [(FSH, inhibin B, estradiol and anti-Mullerian hormone (AMH)] during the follicular phase and luteal phase of the menstrual cycle and ultrasonic ovarian morphology as predictors of IVF outcome. METHODS: Fifty-six women, aged <38 years, with normal day 3 FSH levels were included prospectively. Serum estradiol, inhibin B and AMH were measured before and 24 h after administration of 300 IU of recombinant FSH on cycle day 3-4 and during the luteal phase. Ovarian volume and antral follicle count (AFC) were evaluated on cycle day 3-4. The predictive value of oocyte number and pregnancy were assessed using uni- and multivariate analysis. RESULTS: Poor responders (<6 oocytes) had significantly lower luteal AMH levels, while high responders (>20 oocytes) had significantly higher AFC, AMH and luteal stimulated inhibin B and estradiol than normal responders. Multivariate regression analyses showed that the best models for predicting oocyte number included AFC, follicular phase AMH and stimulated inhibin B. Only AMH showed a significant difference between pregnant and non-pregnant women at both cycle phases. CONCLUSIONS: In young women (<38 years), AFC or basal AMH and stimulated inhibin B predict ovarian response for IVF. The only predictor for pregnancy is follicular or luteal phase AMH.
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Estradiol/sangre , Fertilización In Vitro , Hormona Folículo Estimulante/uso terapéutico , Glicoproteínas/sangre , Inhibinas/sangre , Ovario/diagnóstico por imagen , Hormonas Testiculares/sangre , Adulto , Hormona Antimülleriana , Recuento de Células , Femenino , Fase Folicular/fisiología , Humanos , Fase Luteínica/fisiología , Oocitos/citología , Folículo Ovárico/citología , Embarazo , Pronóstico , Resultado del Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: To evaluate the success of a simple modified vestibulectomy in treating vulvar vestibulitis. STUDY DESIGN: Fifty-nine patients with vulvar vestibulitis refractory to nonsurgical treatment underwent modified vestibulectomy. Response was defined as return to normal coitus and was graded as complete, partial or non-responsive. RESULTS: The postoperative follow-up period was 6 months-10 years. Thirty-nine (73.6%) patients reported complete response, 7 (13.2%) had partial response, and 7 (13.2%) were non-responsive to surgery. CONCLUSION: Surgery is an effective treatment for vulvar vestibulitis refractory to conservative treatment. Simple modified vestibulectomy is considerably less invasive, technically simpler and probably less time consuming. Postoperative results employing this surgical procedure are found to be in line with postoperative results reported by others who employ surgical methods that are more extensive.
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Procedimientos Quirúrgicos Ginecológicos/métodos , Vulvitis/cirugía , Adulto , Dispareunia/etiología , Dispareunia/cirugía , Femenino , Humanos , Persona de Mediana Edad , Dolor , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Complicaciones Posoperatorias , Resultado del Tratamiento , Vulva/patología , Vulvitis/complicaciones , Vulvitis/patologíaRESUMEN
BACKGROUND: Relief of climacteric symptoms is currently the main role of hormone therapy. However, vaginal bleeding complicating this therapy is among the leading causes for its early discontinuation. OBJECTIVES: To assess the effect of a vaginal ring delivering estradiol and progesterone in postmenopausal women and to determine whether continuous administration can relieve climacteric symptoms, produce an acceptable pattern of vaginal bleeding and control endometrial proliferation. METHODS: Twenty-nine postmenopausal women with an intact uterus were studied. All had climacteric symptoms. The vaginal rings contained 0.36 g estradiol and either 3.6 g progesterone (high dose progesterone) or 1.8 g (low dose progesterone), and were kept in place for 4-6 months. Serum progesterone, estradiol and estrone were measured and endometrial thickness determined. All women kept a daily diary of bleeding/spotting and completed a questionnaire on climacteric symptoms at monthly intervals. The low dose progesterone group comprised 14 women and the high dose progesterone group 15 women. RESULTS: A total of 18 patients (9 in each group) completed the study. Mean levels of estradiol, estrone and progesterone were at their peak after 2 to 4 weeks. All rings were effective in alleviating vasomotor symptoms, although there was evidence of "escape from effect" in month 6. Endometrial thickness increased in 6 of the 29 women but biopsy in each case showed no evidence of hyperplasia. Of the 18 women who completed the study, 5 had amenorrhea throughout, 7 had amenorrhea after 3 months, and the remainder had one or two bleeding episodes after 3 months. Therapy was discontinued in 11 women. CONCLUSIONS: A vaginal ring delivering estradiol and progesterone controlled climacteric symptoms, prevented endometrial proliferation, and provided an acceptable bleeding pattern. It should be viewed as a possible alternative for short-term estrogen-progesterone therapy.
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Dispositivos Anticonceptivos Femeninos , Estradiol/uso terapéutico , Posmenopausia/efectos de los fármacos , Progesterona/uso terapéutico , Adulto , Anciano , Biopsia , Dispositivos Anticonceptivos Femeninos/efectos adversos , Relación Dosis-Respuesta a Droga , Sistemas de Liberación de Medicamentos , Endometrio/efectos de los fármacos , Endometrio/patología , Estradiol/administración & dosificación , Estradiol/sangre , Estrona/sangre , Femenino , Humanos , Registros Médicos , Persona de Mediana Edad , Posmenopausia/fisiología , Progesterona/administración & dosificación , Progesterona/sangre , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Hemorragia Uterina/prevención & control , Sistema Vasomotor/efectos de los fármacosRESUMEN
BACKGROUND: Anti-Mullerian hormone (AMH) is expressed in pre- and small-antral follicles. High serum levels are found in women with polycystic ovaries (PCO), accordant with their increased content of small follicles. To evaluate the relationship between AMH, folliculogenesis and hyperandrogenism, we compared serum AMH levels between women with PCO with and without hyperandrogenism and normal controls during controlled ovarian hyperstimulation (COH). METHODS: Nineteen women with PCO and hyperandrogenism (group A), 10 women with PCO but no hyperandrogenism (group B) and 23 ovulatory women with normal ovarian morphology (group C, controls) underwent COH with the long protocol. Serum levels of AMH, estradiol, androstenedione and follicular tracking were determined before gonadotropins treatment (day 0) and every 2-4 days up to the day of HCG administration. RESULTS: AMH levels declined gradually throughout COH in the three groups, but remained higher in groups A and B compared with the controls. Significantly higher levels were found in group A compared with group B, despite comparable numbers of small follicles. Multiple regression analysis revealed that both the number of small follicles and serum androgens were correlated to AMH. CONCLUSIONS: Women with PCO have higher serum AMH levels during COH than controls. Hyperandrogenism is associated with an additional increase in AMH. It is conceivable that hyperandrogenism may reflect more severe disruption of folliculogenesis in women with PCO or may affect AMH secretion.
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Glicoproteínas/sangre , Hiperandrogenismo/sangre , Hiperandrogenismo/complicaciones , Inducción de la Ovulación , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/complicaciones , Hormonas Testiculares/sangre , Adulto , Hormona Antimülleriana , Femenino , Fertilización In Vitro , Humanos , Infertilidad/sangre , Infertilidad/etiología , Infertilidad/terapia , Masculino , Estudios ProspectivosRESUMEN
OBJECTIVE: To evaluate the outcome of pregnancies of normal women married to men with familial Mediterranean fever (FMF), some of whom took colchicine during the conception with their wives. PATIENTS AND METHODS: We followed the outcome of pregnancies and deliveries of 60 wives of FMF patients; 53 of the husbands were taking colchicine during that time. As a control group we screened the outcome of pregnancy and delivery from 230 healthy women married to healthy men. RESULTS: The 60 FMF patients- wives had 222 pregnancies, of which 206 ended in term delivery with 209 live births. Sixteen pregnancies ended in spontaneous abortions (7%). Three of the newborns in the study group were born with congenital malformations. In the control group, of 788 pregnancies, 127 ended in abortions (16%). Six of the newborns were born with congenital malformations. The rate of the late abortions (second trimester) in both groups was comparable. CONCLUSIONS: The results of our study indicates that neither FMF nor colchicine increases the rate of abortions or congenital malformations. Therefore we believe that there is no need to discontinue colchicine treatment in men with FMF before the conception with their wives.
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Aborto Espontáneo/epidemiología , Colchicina/uso terapéutico , Fiebre Mediterránea Familiar/tratamiento farmacológico , Padre , Supresores de la Gota/uso terapéutico , Adulto , Fiebre Mediterránea Familiar/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Resultado del Embarazo , Factores de RiesgoRESUMEN
BACKGROUND: Many techniques have been developed to soften the cervix to reduce complications following surgical dilatation. Progesterone inhibits myometrial contractility and its secretion during pregnancy ensures cervical competence. We used the progesterone antagonist mifepristone as a cervical ripening agent and evaluated its effect prior to office hysteroscopy. METHODS: Fifty-eight healthy non-pregnant women aged 18-50 were studied in a randomized double-blind study. They received mifepristone (200 mg) or placebo 30 h prior to hysteroscopy. A Hegar test was performed prior to drug administration and again before hysteroscopy. A visual analogue pain scale was used to assess pain. RESULTS: Medical history, physical examination and blood tests were similar in both groups, except for serum progesterone which was higher in the study group. Hegar measurement prior to drug ingestion was similar in both groups and after a mean time of 30.3 h increased in both groups. Neither the DeltaHegar measurement nor the pain scale was different in the two groups. There was also no effect of the high progesterone levels. CONCLUSIONS: Unlike its dramatic effect in the pregnant uterus, mifepristone administered 30 h prior to hysteroscopy was not effective in ripening the cervix of non-pregnant women.
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Cuello del Útero/efectos de los fármacos , Antagonistas de Hormonas/uso terapéutico , Histeroscopía , Mifepristona/uso terapéutico , Premedicación , Adulto , Método Doble Ciego , Femenino , Humanos , Histeroscopía/efectos adversos , Persona de Mediana Edad , Dolor/etiología , Dolor/fisiopatología , Dimensión del Dolor , Progesterona/sangre , Insuficiencia del TratamientoRESUMEN
BACKGROUND: The number of (trinucleotide) CAG repeats within the androgen receptor (AR) gene is inversely correlated with transcriptional activity of testosterone-target genes. Although abnormally long CAG repeats are strongly associated with male infertility, it is unclear whether CAG repeat length polymorphism can affect androgen receptor activity and sperm parameters. To explore the previously suggested association between CAG repeats and male fertility, we conducted this prospective cohort study. METHODS: We enrolled 172 men attending the IVF unit in Shaare-Zedek Medical Center. Sperm concentration, motility and morphology and the number of CAG repeats in the AR gene were measured. RESULTS: Mean CAG repeat length was greater in teratozoospermia (<14% normal forms, strict criteria) than in the normal morphology group [mean +/- 95% confidence interval (CI) 22.19 +/- 0.38 versus 21.25 +/- 0.28, P = 0.02]. Logistic regression models showed that longer CAG repeats were associated with abnormal sperm morphology [odds ratio for percentage of normal forms per unit increase in CAG repeat length 1.14 (95% CI 1.01-1.28), P = 0.04]. No association was found between CAG repeat length and sperm concentration or motility. CONCLUSIONS: We found a positive correlation between CAG repeat length and teratozoospermia. This finding validates the concept that AR function is inversely regulated by length of its CAG repeat tract.
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Infertilidad Masculina/genética , Infertilidad Masculina/patología , Receptores Androgénicos/genética , Espermatozoides/anomalías , Espermatozoides/patología , Repeticiones de Trinucleótidos/genética , Adulto , Estudios de Cohortes , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Estudios Prospectivos , Recuento de Espermatozoides , Motilidad EspermáticaRESUMEN
Cardiovascular disease is the leading cause of death of postmenopausal women in developed countries. One of the main reasons for providing hormone treatment for women was the possible prevention of ischemic heart disease (IHD). There are many cellular and molecular studies showing the effectiveness of estrogen in reducing risk factors of IHD, but none of these studies deal directly with the reduction of IHD. However, the studies that "prove" the direct effectiveness of estrogen in primary prevention of IHD are only observational studies. Doubts were raised, when two prospective, randomized, blinded studies (HERS and ERAT) were published, refuting the beneficial effect of estrogen in secondary prevention of IHD. Last July, part of the WHI study was published, showing increased risk for ischemic heart disease in patients treated with continuous combined HRT. In this era of Evidence Based Medicine, it is necessary to support decisions of treatment with prospective, randomized, blind trials. The publication of HERS I and II, ERAT and WHI, raised doubts concerning the ability of estrogen replacement treatment to be considered as primary or secondary prevention of IHD.
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Terapia de Reemplazo de Estrógeno , Isquemia Miocárdica/prevención & control , Femenino , Humanos , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To determine whether a low dose of P delivered together with E(2) from a vaginal ring on a continuous schedule can prevent endometrial proliferation and yield a bleeding pattern dominated by amenorrhea. DESIGN: Longitudinal clinical study. SETTING: Three university hospitals. PATIENT(S): Fifty-five women 45 to 75 years of age, not hysterectomized, with E(2) levels of <20 pg/mL and hot-flash incidence of two or more per day in the past week. INTERVENTION(S): A vaginal ring delivering approximately 150 microg/d of 17beta-E(2) and approximately 5 mg/d or approximately 9 mg/d of P used continuously for 4 and 6 months. MAIN OUTCOME MEASURE(S): Endometrial thickness, bleeding pattern, and hot flash incidence. RESULT(S): Endometrial proliferation was prevented by both P doses. Bleeding incidence decreased. In months 4, 5, and 6, 8 of 12 women had no bleeding. Incidence of hot flashes and night sweats decreased quickly and significantly. CONCLUSION(S): A vaginal ring delivering E(2) and a low dose of P merits further study as a method for long-term hormone replacement therapy.
Asunto(s)
Estradiol/administración & dosificación , Terapia de Reemplazo de Estrógeno/métodos , Progesterona/administración & dosificación , Adulto , Afecto/efectos de los fármacos , Combinación de Medicamentos , Sistemas de Liberación de Medicamentos , Endometrio/patología , Estradiol/efectos adversos , Estradiol/sangre , Estradiol/uso terapéutico , Femenino , Humanos , Estudios Longitudinales , Progesterona/efectos adversos , Progesterona/sangre , Progesterona/uso terapéutico , Hemorragia Uterina/prevención & control , Vagina , Enfermedades Vaginales/inducido químicamente , Enfermedades Vaginales/tratamiento farmacológico , Sistema Vasomotor/efectos de los fármacos , Sistema Vasomotor/fisiopatologíaRESUMEN
Formation of the blastocyst is one of the first morphological changes in early embryonic development. Ion transport has been shown to be crucial for blastocoele cavity formation and expansion, although the mechanisms that underlie this process are presently unknown. As a transmembrane Cl(-) channel, the cystic fibrosis transmembrane conductance regulator (CFTR) may participate in ion transport and early blastocoele formation. CFTR mRNA was detected throughout preimplantation embryo development and in the unfertilized oocyte. Immunocytochemistry disclosed the presence of CFTR protein from the 8-cell stage, reaching maximum immunoreactivity at early blastocyst stage embryos. Patch clamp electrophysiology of morulae and blastocysts demonstrated typical CFTR Cl(-) channel activities in the apical membrane of trophectoderm cells. Thus CFTR is expressed both at mRNA and protein levels in human morulae and blastocysts, and functions as a cAMP-regulated apical membrane Cl(-) channel. These data suggest that CFTR may contribute to blastocoele formation in the early human embryo.