Circulating sex hormone binding globulin: An integrating biomarker for an adverse cardio-metabolic profile in obese pregnant women.

Sex hormone-binding globulin (SHBG) negatively associates with pre-gestational body mass index (BMI) and gestational weight gain. The link with other cardio-metabolic risk factors in pregnant women is poorly understood. Our aim was to study the association of SHBG levels with common cardio-metabolic risk parameters in pregnant woman. Serum SHBG was quantified in 291 Caucasian pregnant women (142 with normal weight, 42 with pregestational obesity, 50 with gestational obesity and 57 with pregestational plus gestational obesity) with uncomplicated pregnancies and parturition. Cardio-metabolic [C-reactive protein (CRP), blood pressure (BP), glycosylated hemoglobin (HbAc1), glucose, C-peptide, insulin, triglycerides and high molecular weight (HMW) adiponectin], and endocrine [testosterone and estradiol] parameters were also assessed. SHBG was negatively correlated with BMI, but also with CRP, BP, HbAc1, pre and post-load glucose, C-peptide, HOMA-IR, triglycerides; and positively with HMW adiponectin (all p<0.01 to p<0.0001). These associations were more robust in women with pregestational plus gestational obesity, who had lower SHBG, in comparison to normal-weight women (p<0.0001). In multivariate analyses in women with pregestational plus gestational obesity SHBG showed independent associations with CRP (ß = -0.352, p = 0.03, R2 = 8.0%), DBP (ß = -0.353, p = 0.03, R2 = 7.0%) and SBP (ß = -0.333, p = 0.04, R2 = 6.0%) independently of BMI and metabolic and endocrine parameters. SHBG is decreased in pregnant women with pregestational plus gestational obesity in association with common cardio-metabolic parameters. SHBG could represent an integrating biomarker for an adverse cardio-metabolic profile in pregnant women with pregestational plus gestational obesity.

Thyroid Hormone Receptors Are Differentially Expressed in Granulosa and Cervical Cells of Infertile Women.

BACKGROUND: Thyroid hormones are known to exert an important role in reproduction. The objective of this study was to evaluate the expression of thyroid hormone receptors (TR) in granulosa (GC) and cervical cells (CC) of infertile euthyroid women. METHODS: In a cross-sectional study, 31 consecutive infertile and 18 fertile women undergoing oocyte retrieval procedures were investigated. The expression of TRα1, TRα2, and TRß was evaluated in GCs and uterine CC from infertile and fertile euthyroid women. ß2 adrenergic receptor (ADRß2) mRNA levels and the expression of genes linked to fertility such as gremlin-1 (GREM1), hyaluronan synthase 2 (HAS2), and prostaglandin-endoperoxide synthase 2 (PTGS2) were also evaluated. RESULTS: In GCs, the expression of the thyroid hormone receptor TRα2, which exerts a dominant negative effect, increased with age in all women tested. TRα2 mRNA was increased in infertile versus fertile women, in parallel to decreased ADRß2 mRNA. As expected, the expression of genes associated with fertility (i.e., GREM1 and PTGS2) was downregulated in infertile women, in parallel to decreased ADRß2 mRNA and increased TRα2 mRNA. In uterine CCs, a positive association of ADRß2 mRNA with TRα1:TRα2 ratio was observed. Importantly, GCs from infertile women whose oocytes did not result in pregnancy had increased expression of TRα2 (p = 0.017) and lower ADRß2 (p = 0.008), GREM1 (p = 0.003), and PTGS2 (p = 0.002) mRNAs than fertile women whose oocytes resulted in pregnancy. Infertile women also showed more TRα2 (p = 0.033) mRNA in CCs than fertile women whose oocytes resulted in pregnancy. CONCLUSIONS: The expression of different markers of intracellular thyroid function is linked to fertility status.

La determinación de B-HCG el día 12 de la transferencia embrionaria como predictor del resultado gestacional en técnicas de Reproducción Asistida / B-HCG levels on day 12 after embryo transfer as a predictor of ongoing pregnancy in IVF cycles

OBJETIVOS: Encontrar un valor de β-HCG que prevea el resultado evolutivo de la gestación en una única determinación hormonal en nuestra población. Como objetivos secundarios nos planteamos valorar si ese valor tiene que ser ajustado en función del IMC y de la edad de la paciente. Ámbito: Pacientes sometidas a un ciclo FIV en nuestro centro Hospital Universitari de Girona Dr. Josep Trueta, entre julio de 2010 y diciembre de 2013. DISEÑO: Estudio retrospectivo descriptivo. MATERIAL Y MÉTODOS: Se incluyen 50 ciclos con β-HCG positiva a los 12 días de la transferencia embrionaria de un total de 139 pacientes sometidas a un ciclo FIV en nuestro centro entre julio de 2010 y diciembre de 2013. RESULTADOS: Las diferencias en el nivel de β-HCG el día 12 son estadísticamente significativas entre los diferentes grupos en función del resultado gestacional (p < 0.05). Si comparamos solamente las gestaciones viables con las gestaciones no viables las diferencias son todavía más significativas. Con una β-HCG media de 300,53 para las gestaciones viables y una B-HCG media de 88,66 para las no viables (p < 0,01). La curva ROC sugiere que un valor de β-HCG de 77 mUI/ml sería un buen nivel para prever una gestación viable, con una sensibilidad del 90,63% y una especificidad del 80%. No existen diferencias estadísticamente significativas del valor de β-HCG en función del IMC ni de la edad. CONCLUSIONES: Con un valor de β-HCG igual o superior a 77mUI/ml podemos orientar mejor a la paciente, y prever una gestación exitosa, ayudando a planificar el manejo médico así como disminuir la ansiedad materna. Este valor, además, y según nuestro estudio, no necesita ser ajustado por edad o IMC de la pacientes

OBJECTIVES: The aim of our study is to find a value of β-HCG to predict the outcome of pregnancies in a single hormone determination in our population. As secondary objectives, we will assess whether this value has to be adjusted for BMI and age of the patient. SETTING: Patients subjected to an IVF cycle at our center Hospital Universitari de Girona Dr. Josep Trueta, between July 2010 and December 2013. DESIGN: Retrospective and descriptive study. MATERIAL AND METHODS: A total of 50 cycles with a positive β-HCG the day 12 after the embryo tranfer were analyzed with respect to pregnancy outcome from a total of 139 patients subjected to an IVF cycle at our center between July 2010 and December 2013. RESULTS: The differences in the level of β-HCG at day 12 are statistically significant between different groups based on gestational outcome (p < 0,05). Comparing only viable pregnancies with nonviable pregnancies the differences are even more significant. With a β-HCG 300,53 average for viable pregnancies and average β-HCG for nonviable 88,66 (p < 0,01). The ROC curve suggests that a value of β-HCG 77 mIU / ml would be a good level to predict a viable pregnancy with a sensitivity of 90.63 % and a specificity of 80 %. There are not statistically significant differences in the value of β-HCG in terms of BMI or age. CONCLUSIONS: With a value of β-HCG of 77mUI/ml or more, we can better guide the patient and provide for a successful pregnancy, helping to plan medical management and reduce maternal anxiety. This value, in addition and according to our study, does not need to be adjusted for age or BMI of the patient

Tratamiento quirúrgico de los quistes dermoides de ovario: laparoscopia frente a laparotomía / Surgical treatment of dermoid ovarian cysts: laparoscopy vs laparotomy

Objetivo: Comparar los resultados de la cirugía del quiste dermoide de ovario (quistectomía, ooforectomía y anexectomía) mediante laparotomía y laparoscopia, especialmente relacionados con las complicaciones (rotura del quiste). Sujetos y métodos: Estudio analítico, descriptivo y retrospectivo de 91 casos de quistes dermoides operados en el Hospital Severo Ochoa de Madrid entre enero de 2001 y diciembre de 2004. Los casos se recogieron de la base de datos del servicio de anatomía patológica, los datos de éstos, de la revisión de las historias clínicas de las pacientes, y los resultados se analizaron estadísticamente mediante el paquete informático EpiInfo versión 6.0. Resultados: El 79% de las intervenciones realizadas por laparoscopia, igual tasa de complicaciones, igual riesgo de rotura del quiste en casos de quistectomía, menor estancia media en el acceso laparoscópico, menor duración de la intervención por laparotomía en casos de ooforectomía/anexectomía. Conclusiones: El tratamiento quirúrgico mediante acceso laparoscópico de los quistes dermoides de ovario es seguro, no aumenta la tasa de complicaciones y permite disminuir la estancia media. Durante la realización de la quistectomía el riesgo de rotura del quiste es igual por laparoscopia que por laparotomía

Objective: To compare the results of laparoscopy and laparotomy in teh treatment of ovarian dermoid cysts (cystectomy, oophorectomy and adenectomy, mainly those related with complications (intraoperative spillage). Subjects and methods: We analize retrospectively a case series of 91 patients with dermoid cysts treated al Hospital Severo Ochoa in Madrid, from January 2001 to Decembre 2004. Data were obtained from the pathology register and from the hospital charts, and were analized with the software EpiInfo 6.0 version. Results: 79% laparoscopic approaches, same complications rate, same intraoperative spillage risk, lower hospital stay in laparoscopic group, lower operating time in case of oophorectomy/anexectomy by laparotomy. Conclusions: Laparoscopic management of ovarian teratomas is as safe as laparotomic one. The same complications rate is observed in both groups, and lower hospital stay is achieved in laparoscopic surgery. If cystectomy is recommended intraoperative spillage risk should not contraindicate laparoscopy