Laparoscopic Ovarian Transposition and Ovariopexy for Fertility Preservation in Patients Treated with Pelvic Radiotherapy with or without Chemotherapy.

BACKGROUND: Preservation of fertility in cancer patients of reproductive age is a concern for both the patient and the clinician. In this study, we aimed to study the effectiveness of laparoscopic ovarian transposition or ovariopexy in preserving ovarian function in women undergoing pelvic radiotherapy with or without chemotherapy for pelvic tumours. METHODS: The records of patients who underwent laparoscopic ovarian transposition or ovariopexy prior to pelvic radiation therapy between 2002 and 2018 were reviewed retrospectively. RESULTS: Thirty-nine women or adolescent girls with a diagnosis of cervical cancer (n=15), Hodgkin's lymphoma (n=6) or other types of pelvic tumours (n=18) were included in the study. The majority of patients had bilateral (n=25) or unilateral (n=8) ovarian transposition prior to radiotherapy. Nine out of 10 (90%) patients with soft tissue tumors, Ewing sarcoma or ependymoma, five out of seven (71.4%) patients with Hodgkin's lymphoma, two patients (100%) with rectal and anal cancer, and six out of 15 (40%) with cervical cancer retained ovarian function. Patients with cervical cancer, those who received concomitant chemotherapy and those older than 30 years were more likely to experience ovarian failure. Five patients conceived spontaneously and two women had four live births. CONCLUSION: Laparoscopic repositioning of the ovaries out of the radiation field in order to protect ovarian function in patients receiving radiotherapy appears to be effective in the majority of patients. The procedure seems safe and should be considered either as a sole procedure or in association with other fertility preservation methods prior to pelvic radiotherapy.

A case of rudimentary horn pregnancy diagnosed after failed attempts at pregnancy termination.

We report a case of rudimentary horn pregnancy at 12 weeks gestation with fetal demise misdiagnosed ultrasonographically as an intrauterine pregnancy in a private clinic. The patient was referred to a tertiary care hospital after failed attempts at terminating her pregnancy. A definitive diagnosis was made with ultrasonography and magnetic resonance imaging (MRI) before uterine rupture ensued. Excision of the rudimentary horn and the ipsilateral fallopian tube was carried out by laparotomy. Failure to terminate pregnancy after several attempts should alert the physician about the possibility of a uterine anomaly and a pelvic MRI scan may help in the diagnosis of a suspected rudimentary horn pregnancy.

Intrinsic factors rather than vitamin D deficiency are related to insulin resistance in lean women with polycystic ovary syndrome.

OBJECTIVE: To investigate the correlation between insulin resistance (IR) and serum 25-OH-Vit D concentrations and hormonal parameters in lean women with polycystic ovary syndrome (PCOS). PATIENTS AND METHODS: 50 lean women with PCOS and 40 body mass index (BMI) matched controls were compared in terms of fasting insulin and glucose, homeostatic model assessment insulin resistance (HOMA-IR), 25-OH-Vit D, high sensitivity C-reactive protein (hs-CRP), luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, dehydroepiandrosterone sulfate (DHEA-S), total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides and Ferriman-Gallway (FG) scores. Correlation analyses were performed between HOMA-IR and metabolic and endocrine parameters. RESULTS: 30% of patients with PCOS demonstrated IR. Levels of 25-OH-Vit D, hsCRP, cholesterol, HDL, LDL, triglyceride and fasting glucose did not differ between the study and control groups. Fasting insulin, HOMA-IR, LH, total testosterone, and DHEA-S levels were higher in PCOS group. HOMA-IR was found to correlate with hs-CRP and total testosterone but not with 25-OH-Vit D levels in lean patients with PCOS. CONCLUSIONS: An association between 25-OH-Vit D levels and IR is not evident in lean women with PCOS. hs-CRP levels do not indicate to an increased risk of cardiovascular disease in this population of patients. Because a strong association between hyperinsulinemia and hyperandrogenism exists in lean women with PCOS, it is advisable for this population of patients to be screened for metabolic disturbances, especially in whom chronic anovulation and hyperandrogenism are observed together.

Plasma levels of growth arrest specific protein 6 are increased in idiopathic recurrent pregnancy loss.

AIM: The aim of this study was to determine plasma Growth Arrest Specific Protein 6 (GAS6) protein levels in patients with unexplained recurrent pregnancy loss (RPL) and compare them to those of pregnant and to healthy non-pregnant women with a history of at least one live delivery. PATIENTS AND METHODS: A total of 205 women were included in the study. Of these, 68 were diagnosed with unexplained RPL and were not pregnant at the time of the study. The second group consisted of 67 pregnant women in the third trimester of pregnancy. The third group constituted the control group of 70 healthy non-pregnant women who had at least one live birth. Plasma levels of GAS6 protein were measured by ELISA. RESULTS: Mean plasma GAS6 levels were found to be different between RPL group and healthy non-pregnant women (12.17 ± 4.39 µg/L  and 9.18 ± 4.65, respectively, p = 0.0013). Although it was not statistically significant, plasma levels of GAS6 in the third trimester pregnant group (10.65 ± 3.74 µg/L) were found to be slightly higher than non-pregnant controls, and slightly lower than RPL group. In comparison of those with 2 or more than 2 pregnancy losses in the RPL group, there was no difference between these two subgroups in terms of GAS6 levels (12.39 ± 4.27 µg/L and 11.83 ± 4.63 µg/L, respectively, p = 0.62). CONCLUSIONS: Our findings revealed that plasma GAS6 levels were increased in patients with RPL. The prothombotic and proinflammatory nature of the GAS 6 protein makes it a likely culprit involved in the pathologic process in patients with RPL. Further studies are warranted to determine the possible role of GAS6 protein in the pathophysiology of idiopathic RPL.