Endometrial cytokines in patients with and without endometriosis evaluated for infertility.

OBJECTIVE: To evaluate whether endometrial molecular profiles distinguish subsets of patients according to clinical characteristics, and to infer dysregulated immune networks, by measuring cytokines, chemokines, and growth factors in endometrial biopsy specimens from a cohort of infertile women with a high incidence of endometriosis. DESIGN: Prospective cohort study. SETTING: Department of Gynecology at a university hospital. PATIENT(S): Patients undergoing laparoscopy for infertility assessment (n = 103). INTERVENTION(S): Endometrial biopsies were performed during surgery. Fertility outcome and clinical parameters were registered preoperatively and after 6 months. MAIN OUTCOME MEASURE(S): The concentrations of 48 factors in endometrial biopsy specimens were analyzed with respect to clinical status in univariate and multivariate frameworks. RESULT(S): The concentrations of 44 factors from endometrial tissues of 74 patients were suitable for analysis. Although the tissue concentrations of interleukin (IL)15, IL-7, and interferon γ-induced protein (IP)-10 were individually lower in patients with endometriosis than in those without endometriosis, the differences were not significant after multiple comparison. However, multivariate modeling incorporating covariation showed separation between subsets of endometriotic and nonendometriotic patients, based predominantly on IP-10, monocyte chemoattractant protein-1, IL-16, and IL-18; this result was independent of cycle and fertility status. Analysis restricted to endometrial tissues from the secretory phase separated endometriotic and nonendometriotic patients by a combination of IL-15, IP-10, monocyte chemoattractant protein-1, IL-16, and IL-18. This combination suggests a uterine natural killer cell defect. We found no significant correlations between endometrial cytokines and fertility outcome. CONCLUSION(S): A molecular signature in endometrial tissue was able to distinguish endometriotic from nonendometriotic patients, implicating uterine natural killer cells in endometriosis.

Peritoneal fluid cytokines related to endometriosis in patients evaluated for infertility.

OBJECTIVE: Our aim was to characterize peritoneal cytokine profiles in patients with infertility, with and without endometriosis, to illuminate potential differences in immune profiles that may reflect mechanistic differences between these two patient populations. DESIGN: Cross-sectional study. SETTING: University hospital and research center. PATIENT(S): Women undergoing laparoscopy for infertility investigation (n = 107). INTERVENTION(S): Peritoneal fluid was collected during surgery. Clinical characteristics were registered preoperatively. MAIN OUTCOME MEASURE(S): We determined the concentration of 48 different cytokines from the peritoneal fluid with multiplex immunoassays. Associations between cytokines and clinical findings were assessed with logistic regression and partial least squares discriminant analyses (PLS-DA). RESULT(S): Concentrations of SCGF-ß, IL-8, HGF, and MCP-1 were significantly higher, while IL-13 was significantly lower in the endometriosis group compared with the group without endometriosis. Multiple stepwise logistic regression identified a combination of SCGF-ß, IL-13, and G-CSF concentrations that predicted the presence of endometriosis with 86% sensitivity and 67% specificity. PLS-DA identified a class of 11 cytokines (SCGF-ß, HGF, IL-13, MCP-1, CTACK, MCP-3, M-CSF, LIF, IL-5, IL-9, and IFN-a2) that were more characteristic of endometriosis than nonendometriosis patients. CONCLUSION(S): By combining univariate and multivariate analyses, profiles of cytokines more likely to be enriched or depleted in infertility patients with endometriosis compared with those without endometriosis were identified. These findings may inform future analyses of pathophysiological mechanisms of endometriosis in infertile patients, including dysregulated Th1/Th2 response and mobilization and proliferation of hematopoietic stem cells.

[Induced abortion at home]. / Provosert abort som hjemmebehandling.

BACKGROUND: Medically induced abortion through week 9 is a well established procedure. The article concerns satisfaction among women who choose to do this at home, and possible associations between satisfaction, socio-demographic--and clinical factors. MATERIAL AND METHODS: 110 women with pregnancy duration < 7 weeks, who wished to medically terminate the pregnancy at home and presented themselves at Ullevaal University Hospital, were included in the study. The woman's satisfaction with the procedure was the main variable, but anxiety and pain were also recorded. Data were retrieved from hospital journals and questionnaires filled in before and 1 and 3 weeks after the abortion. The degree of satisfaction was recorded on a scale from 1 to 10, where 1 was not content and 10 was very content. Follow-up data were available for 105 women. RESULTS: 90 of 105 women were very content (> 7 on the satisfaction scale) with the treatment. Discomfort and pain during the abortion and marital status seemed to influence the results. The degree of pain varied much. No serious complications were observed. INTERPRETATION: The study showed a high degree of satisfaction with medically induced abortion at home early in the pregnancy. The study has a relatively small sample size and no control group, so the results on factors affecting satisfaction are uncertain. Medical abortion at home should be an opportunity for women applying for early pregnancy termination; as long as the women are well informed, are offered sufficient pain relief and a well functioning follow-up programme.

Hysteroscopic resection of symptomatic and asymptomatic endometrial polyps.

STUDY OBJECTIVE: To estimate the occurrence of malignancy and atypical hyperplasia in endometrial polyps in patients with and without symptoms. DESIGN: Retrospective registration of all patients who underwent hysteroscopic resection of endometrial polyps. Age, menopausal status, presence or absence of symptoms, any use of hormonal medication, as well as histologic diagnosis, complications, and eventual repeated surgery were documented (Canadian Task Force classification II-3). SETTING: Ullevaal University Hospital, Department of Gynecology. PATIENTS: All patients who underwent hysteroscopic resection of an endometrial polyp in our department from January 1, 2001 through March 1, 2005. INTERVENTIONS: Hysteroscopic resection of endometrial polyps. MEASUREMENTS AND MAIN RESULTS: Four hundred eleven patients were included. One hundred twenty-nine patients (31.4%) had no symptoms. The prevalence of malignancy or atypical hyperplasia was 3.2% in women with symptoms and 3.9% in those without symptoms. CONCLUSION: The prevalence of malignancy and atypical hyperplasia was found to be relatively high, indicating that symptomatic, as well as asymptomatic, endometrial polyps should be removed.