Association of plasminogen activator inhibitor-type 1 (PAI-1) -675 4G/5G polymorphism with unexplained female infertility.

BACKGROUND: Infertility is a major issue of concern for couples at reproductive age.  The underlying causes of infertility remain unknown in 15-30 % of the cases. Plasminogen activator inhibitor type 1 (PAI-1), which is a major fibrinolytic factor, has been associated with increased infertility risk.  DNA variants at PAI-1, such as -675 4G/5G promoter polymorphism, have been implicated in infertility-related reproductive disorders, possibly due to a molecular mechanism involving implantation failure. This study aims to investigate the association of PAI-1 4G/5G polymorphism to otherwise unexplained female infertility in a sample of women of Greek ethnic origins. METHODS: We enrolled in this study 222 women from the population of Northern Greece; 115 women with unexplained infertility (group 1) and 107 normal fertile women (group 2). All participants were genotyped for PAI-1 -675 by real-time polymerase chain reaction. RESULTS: Our results indicate an association with the PAI-1 4G allele in our sample of women with unexplained infertility. The dominant genetic model supports the association, in contrast to the recessive genetic model. CONCLUSIONS: Our results indicate that PAI-1 4G/5G polymorphism is a promising screening factor which could potentially be a target for certain cases of unexplained female infertility. However, they should be interpreted with caution and should be validated in larger studies and diverse populations. In addition, other variants in genes involved in thrombophilia might need to be considered. HIPPOKRATIA 2017, 21(4): 180-185.

Acute urinary retention due to a uterine fibroid in a non-pregnant woman.

BACKGROUND: Uterine fibroids represent a rare cause of acute urinary retention (AUR) and most cases have been reported in pregnant women. CASE: We report the case of a non-pregnant woman who presented with AUR due to a uterine fibroid. CONCLUSION: When evaluating patients who present with severe oliguria or anuria, it is important to rule out urinary tract obstruction. Early identification of reversible causes of acute oliguria and institution of appropriate therapy are crucial to prevent the development of protracted acute renal failure. Close collaboration between gynaecologists, urologists and radiological services is required to promptly diagnose and treat uterine fibroid-associated AUR, a rare but reversible cause of acute renal failure.

Early antiplatelet and antithrombotic therapy in patients with a history of recurrent miscarriages of known and unknown aetiology.

OBJECTIVES: To assess the efficacy of early thromboprophylaxis throughout pregnancy in women with previous history of first trimester recurrent miscarriages of unknown aetiology. METHODS: Low dose aspirin and low molecular weight heparin (LMWH) were administered from the day of detection of the fetal heart up to the 37th week, in two groups of patients of known (Group A, n = 24) and unknown aetiology recurrent miscarriages (Group B, n = 27). RESULTS: The success rate (viable pregnancy >24 weeks) was high and equally effective in both Groups A and B (83.3% and 85.1%, respectively). The complications recorded (pre-eclampsia, IUGR, placenta abruptio, injection site heamatomas and skin reactions) were more prevalent in Group A but of no significant difference. No abnormal bleeding was observed during vaginal delivery or caesarean section. CONCLUSIONS: Our results reaffirm previous reports that the use of LMWH in combination with low dose aspirin throughout pregnancy is safe and effective. It was also shown that the treatment is equally effective against recurrent miscarriages in both groups of patients, of known and unknown aetiology.

Asynchronous delivery of twins and triplets with an interval period ranging from 48 hours to 19 weeks.

OBJECTIVE: To improve perinatal survival rates by prolonging the rest of the pregnancy after an abortion or extremely premature birth of one fetus in multiple pregnancies, especially in women with low fertility potential. METHODS: Following the expulsion of one fetus a cervical cerclage was applied to all patients. The placenta of the expelled fetus including a small portion of its cord after it was ligated close to the external os, was left in situ. The patients were invariably kept on bed rest until the pregnancy was completed under close observation, tocolysis and preventive antibiosis. After the 24th week of gestation corticosteroids were administered. RESULTS: The delivery interval achieved ranged between two and 135 days, the longest reported. Although the survival rate was relatively low (40%) all but one of the women (83%) managed eventually to have a live child, one with twins. CONCLUSIONS: In selected multiple pregnancies the attempt to prolong the rest or the pregnancy, following the abortion or the extremely premature birth of one fetus, seems efficacious and justified especially in women with a history of long-term infertility.

The effect of testicular seminoma in semen quality.

Although male subfertility has been reported in a variety of malignancies, most notably testicular carcinoma, the literature that refers to semen quality in males with testicular seminoma is very limited. This study was designed to evaluate the effect of testicular seminoma in semen quality and especially in its three main parameters. Semen specimens from 12 men, aged 24-38 years, with testicular seminoma before they underwent orchidectomy and adjuvant radiotherapy to the ipsilateral para-aortic and pelvic lymph nodes, and from 60 fertile men, aged 24-44 years, were studied. The results support the view that testicular seminoma exerts a deleterious effect on spermatogenesis and consequently to the three main parameters of the semen. The mechanism though of the deleterious effect of seminoma on spermatogenesis remains unclear.