Combination of hypoosmotic swelling/eosin Y test for sperm membrane integrity evaluation: correlations with other sperm parameters to predict ICSI cycles.

The objective of our study was to evaluate the accuracy of the combination of hypoosmotic swelling (HOS) and eosin Y (Ey) exclusion tests to predict the ICSI cycles' outcome and its correlations with other sperm parameters. The functional and structural integrity of sperm membrane was evaluated with the combined HOS/Ey test in 95 ICSI cycles and the results were correlated with other sperm parameters, including concentration, motility, strict morphology, and total motile sperm count. The combined HOS/Ey test was evaluated for the prediction of the ICSI cycles' outcome parameters including fertilization, cleavage, and pregnancy rates. The HOS/Ey test presented significant relationships with concentration, motility, and strict morphology (p < 0,0001) but it couldn't predict the fertilization, cleavage, and pregnancy outcomes of ICSI cycles. The combined HOS/Ey test has strong correlations with motility and strict morphology parameters of sperm samples but is not sufficiently sensitive to estimate the outcome of ICSI cycles.

Objective risk definition for endometrial lesion spectrum: a diagnostic algorithm.

OBJECTIVE: Investigations for risk definition in endometrial lesion spectrum still go on. In this study, molecular, morphometric, immunohistochemical techniques were combined with conventional morphology to realize whether an algorithm is definable for risk assessment to progress an invasive carcinoma in endometrial glandular lesion spectrum is possible. METHODS: The study was carried out on 20 benign endometria, 35 hyperplasias, and 20 adenocarcinoma cases. Clonality of glandular cells, the volume percent of endometrial stroma (VPS), PTEN inactivation, and proliferative index (PI) were evaluated. Statistical analysis was evaluated to set an objective algorithm. RESULTS: All benign tissues had polyclonal (PC), whereas all malignant tissues had monoclonal (MC) glandular epithelium. Of hyperplasias, 19 were MC, and 16 were PC. VPS value of 55% had 100% sensitivity, and 80% specificity (n=67) to distinguish MC from PC. Neither PTEN nor PI data augmented the specificity or the sensitivity of clonal distinction. CONCLUSION: Clonality and VPS values were found to be significant in differential of endometrial lesions. With this rationale, a diagnostic algorithm for endometrial risk lesions was set. This algorithm is based on HE morphology, VPS and clonality findings, and has 100% sensitivity and specificity to discriminate neoplastic endometrium from hyperplasia.

Clomiphene citrate-resistant polycystic ovary syndrome. Preventing multifollicular development.

OBJECTIVE: To determine the efficiency and comparison of two different protocols, human menopausal gonadotropin (hMG) plus gonadotropin-releasing hormone analog (GnRH-a) and low-dose hMG to reduce multifollicular development in clomiphene-resistant polycystic ovary syndrome (PCOS) patients. STUDY DESIGN: Prospective comparative and pilot study in 20 patients for 31 cycles. The first group (n = 10) was treated with buserelin acetate, 600 micrograms/d, for six weeks before ovulation induction with hMG in conventional doses for 14 cycles. The other group (n = 10) was treated only with low-dose hMG for 17 cycles. All cycles were compared in terms of the number of follicles per cycle, cycles human chorionic gonadotropin withheld, estradiol level on ovulation day, treatment duration and number of ampules used per cycle. In addition, the outcome of cycles and complications of multifollicular development, ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy were determined. RESULTS: As compared with the GnRH-a + hMG protocol, the low-dose hMG protocol yielded less multifollicular (57.1% vs. 17.6%) and more monofollicular (35.7% vs. 70.6%) development. Consequently, less OHSS (21.4% vs. 0%) and multiple pregnancy (10% vs. 0%) occurred in the low-dose group. CONCLUSION: Low-dose hMG therapy has distinct advantages in eliminating multifollicular development and related complications in clomiphene citrate-resistant PCOS patients. The addition of GnRH-a to gonadotropins does not change the incidence of multifollicular development.

Prenatal diagnosis of an uncommon syndrome: thrombocytopenia absent radius (TAR).

The prenatal diagnosis of the thrombocytopenia absent radius (TAR) syndrome using ultrasound and cordocentesis at the 34th week of gestation is established. Two basic components of the syndrome, bilateral absence of radius and thrombocytopenia at a level 12.000/mm3 were detected. No complication during the cordocentesis and delivery occurred due to thrombocytopenia. This case report, to our knowledge, is one of a limited number of cases emphasized on prenatal diagnosis of TAR syndrome in the world.

Color Doppler sonographic features of uterine arteriovenous malformations: report of two cases.

We describe the color Doppler sonographic features of uterine arteriovenous malformations in two cases. In both cases color Doppler imaging demonstrated hypervascularity throughout the arteriovenous malformation. The dominance of pale shades during both systole and diastole represented low-impedance, high-velocity flow within the lesion and a colored mosaic pattern representing turbulent flow was noted. Spectral analysis of the vessels within the lesion confirmed high-velocity flow during both systole and diastole, and a low resistance index. The spectral waveform trace also showed spectral broadening consistent with turbulence and the spectral envelope was irregular. These findings indicated the presence of numerous arteriovenous shunts and marked turbulence within the arteriovenous malformation. Spectral analysis of the venous flow revealed high flow velocities and systolic velocity peaks similar to an arterial pattern. The uterine artery velocity waveforms were characterized by high flow velocity and a low resistance index. The diagnosis of uterine arteriovenous malformation was confirmed by histological examination in both cases. The findings of these two cases suggest that color Doppler sonography may play an important role in the diagnosis of uterine arteriovenous malformations.