Oocyte cryopreservation in a woman with mosaic Turner syndrome: a case report.

BACKGROUND: Turner syndrome (TS) is the most common sex chromosome anomaly. Spontaneous pregnancies have been reported in a small percentage of women with TS, particularly those with mosaicism. However, due to accelerated follicular atresia, the majority of TS patients undergo ovarian failure prior to or around the time of puberty. In vitro fertilization with donor oocytes and subsequent embryo transfer has been the predominant fertility option for such patients. We report a case of oocyte cryopreservation for a patient with mosaic TS including the evaluation, treatment decisions and ovarian response. CASE: A 28-year-old woman with mosaic TS and oligomenorrhea chose oocyte cryopreservation for fertility preservation. Ovarian reserve testing revealed a day 3 FSH of 4.3 mIU/mL and an antral follicle count of 40. She underwent controlled ovarian stimulation and had a vigorous response to a gonadotropin/gonadotropin-releasing hormone antagonist protocol, with a peak estradiol level of 4507 pg/mL. Transvaginal oocyte retrieval produced 15 oocytes, 13 of which met the criteria for vitrification. CONCLUSION: Oocyte cryopreservation offers TS patients a new option to preserve future fertility; however, this new technology requires extensive counseling regarding not only its investigational nature but also risks specific to it and implications for this patient population.

Adhesions in patients with chronic pelvic pain: a role for adhesiolysis?

OBJECTIVE: To review the relation between adhesions and pelvic pain and the effectiveness of adhesiolysis in pain control. DESIGN: Selective review of the literature. PATIENT(S): Patients with pelvic pain and/or undergoing adhesiolysis for pain control. RESULT(S): Intraabdominal adhesions are accepted as etiologic factors for infertility and small bowel obstruction; however, the contribution of adhesions to pelvic pain is less clear. The most common laparoscopic findings in patients with and without pelvic pain were endometriosis and adhesions. Immunohistologic studies also have shown evidence of nerve fibers in adhesions that had been removed from patients with and without pelvic pain. Multiple adhesiolysis techniques have been employed, with outcome of surgical procedures ranging from no pain relief to pain relief in 90% of patients. However, randomized trials have shown that adhesiolysis is ineffective in improving the outcome of the treatment of pelvic pain, possibly because of adhesion reformation. Interestingly, adhesions are usually not described as an etiologic factor for pelvic pain in men; this might be related to a gender difference in pain perception or the possibility that adhesions per se do not cause pain. CONCLUSION(S): The correlation between pelvic pain and adhesions is uncertain. Adhesiolysis has not been shown to be effective in achieving pain control in randomized clinical studies.

Seprafilm (modified hyaluronic acid and carboxymethylcellulose) acts as a physical barrier.

OBJECTIVE: To characterize the molecular changes that occur in normal fibroblasts, adhesion fibroblasts, and mesothelial cells as a result of exposure to modified hyaluronic acid and carboxymethylcellulose (Seprafilm). SETTING: University research laboratory. DESIGN: Human mesothelial and fibroblast cell culture. MAIN OUTCOME MEASURE(S): Multiplex reverse transcriptase polymerase chain reaction was used to examine control and Seprafilm-treated normal peritoneal fibroblasts, adhesion fibroblasts, and mesothelial cells in culture for levels of messenger RNA from molecules known to be associated with adhesion development (transforming growth factor-beta 1, type I collagen, matrix metalloproteinase-1, matrix metalloproteinase-2, tissue inhibitor of metalloproteinase-1, and tissue plasminogen activator). RESULT(S): Seprafilm treatment of normal peritoneal fibroblasts, adhesion fibroblasts and mesothelial cells did not alter the expression of markers examined. CONCLUSION(S): In the absence of a biological effect of Seprafilm on markers known to be involved in postoperative adhesion development, the ability of Seprafilm to reduce postoperative adhesions is most likely caused by its effect as a physical barrier.

Effect of oxidized regenerated cellulose (Interceed) on the expression of tissue plasminogen activator and plasminogen activator inhibitor-1 in human peritoneal fibroblasts and mesothelial cells.

OBJECTIVE: To characterize the molecular changes that occur in normal fibroblasts, adhesion fibroblasts, and mesothelial cells as a result of exposure to oxidized regenerated cellulose (Interceed; Johnson & Johnson Medical, Inc., New Brunswick, NJ). DESIGN: Control and Interceed-treated normal peritoneal fibroblasts, adhesion fibroblasts, and mesothelial cells in culture were assessed for messenger RNA levels of molecules known to be associated with adhesion development, using multiplex reverse transcriptase polymerase chain reaction (n = 4). SETTING: University research laboratory. PATIENT(S): Normal and adhesion fibroblasts and mesothelial cells. INTERVENTION(S): Exposure of cells, normal fibroblasts, adhesion fibroblasts, and mesothelial cells to oxidized regenerated cellulose. MAIN OUTCOME MEASURE(S): Real-time reverse transcriptase polymerase chain reaction expression of messenger RNA tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), and tPA-PAI-1 ratio, an indicator of overall fibrinolytic activity. RESULT(S): Interceed treatment of normal peritoneal fibroblasts, adhesion fibroblasts, and mesothelial cells results in an increased expression of tPA in mesothelial cells and an increase in the tPA-PAI-1 ratio, signifying an overall increase in fibrinolytic activity. CONCLUSION(S): Interceed, which has been shown in multiple human in vivo studies to decrease postoperative adhesion development, increases the expression of tPA and the tPA-PAI-1 ratio (an indicator of overall fibrinolytic activity), thereby promoting dissolution of fibrin and healing without adhesion development. Thus, the ability of Interceed to reduce postoperative adhesion development may be derived from both a barrier and biologic effect.

Effects of oxidized regenerated cellulose on the expression of extracellular matrix and transforming growth factor-beta1 in human peritoneal fibroblasts and mesothelial cells.

OBJECTIVE: The purpose of this study was to evaluate the potential biologic effects of oxidized regenerated cellulose, which has been shown in multiple human in vivo studies to reduce postoperative adhesion development, on the messenger RNA levels of transforming growth factor-beta1, type I collagen, type III collagen, and fibronectin. STUDY DESIGN: The oxidized regenerated cellulose was dissolved in saline solution and added to confluent, monolayer cultures of human normal fibroblasts and mesothelial cells. Control cells were maintained in media alone at the same pH. After 24 hours of treatment, total RNA was extracted from all cells. Real-time reverse transcription-polymerase chain reaction was performed to determine the relative change in messenger RNA levels of type I, type HI collagen, fibronectin, transforming growth factor-beta1, and beta-actin (housekeeping gene) in response to the oxidized regenerated cellulose treatment (n=4 cultures). Student t tests were performed for each cell type, which compared oxidized regenerated cellulose-treated cells to control cells. Calculated power for the statistically significant findings ranged from 65% to 100%. RESULTS: Transforming growth factor-beta1 messenger RNA was elevated by the oxidized regenerated cellulose treatment in the mesothelial cells by 13% (control cells, 0.562+/-0.022; oxidized regenerated cellulose-treated cells, 0.636+/-0.014; P=.03). In normal fibroblasts, transforming growth factor-beta1 messenger RNA was slightly, but not significantly, decreased in oxidized regenerated cellulose-exposed normal fibroblasts compared with controls (control cells, 0.622+/-0.062; oxidized regenerated cellulose-treated cells, 0.609+/-0.006; P=.85). Type I collagen was found to be increased by exposure to oxidized regenerated cellulose in both mesothelial cells and normal peritoneal fibroblasts. Type I collagen was increased by 23% in mesothelial cells (control cells [0.587+/-0.018] vs oxidized regenerated cellulose-treated cells [0.722+/-0.010], P=.002), and 27% in normal fibroblasts (control cells, 0.522+/-0.018, oxidized regenerated cellulose-treated cells, 0.665+/-0.009; P=.001). However, messenger RNA levels of type III collagen and fibronectin (other representative molecules of the extracellular matrix) were not altered significantly by oxidized regenerated cellulose application in vitro. CONCLUSION: Oxidized regenerated cellulose influences the expression of factors that are accepted commonly to be associated with adhesiogenesis. Oxidized regenerated cellulose increased the expression of transforming growth factor-beta1 in mesothelial cells and type I collagen in mesothelial cells and normal peritoneal fibroblasts. Minimization of these oxidized regenerated cellulose-induced molecular changes, if they occur in vivo, may improve the ability of oxidized regenerated cellulose to reduce postoperative adhesion development.