Effect of luteal-phase support on endometrial L-selectin ligand expression after recombinant follicle-stimulating hormone and ganirelix acetate for in vitro fertilization.

CONTEXT: The impact of different types of luteal phase support on endometrial receptivity after ovarian stimulation has not been investigated. OBJECTIVE: Our objective was to evaluate the impact of different luteal-phase support protocols on sex steroid levels and on endometrial expression of L-selectin ligand after ovarian hyperstimulation with a GnRH antagonist protocol. PATIENTS AND DESIGN: Seventeen oocyte donors who underwent ovarian stimulation with a recombinant FSH/ganirelix acetate protocol were randomized into three groups: group I had no luteal-phase support; group II had luteal support with micronized progesterone; and group III had luteal support with progesterone plus 17beta-estradiol. All donors had endometrial biopsies on the day of retrieval, and then 3, 5, and 10 d after retrieval. In addition, they had serum estradiol and progesterone measurements on d 3, 5, and 10. MAIN OUTCOME MEASURES: Endometrial L-selectin ligand expression was detected by immunohistochemical staining in the luminal and glandular epithelium. A histological score was used for the quantification of the immunostaining. Sex steroid levels were measured during the luteal phase. RESULTS: By d 10 after retrieval, there was a significant decrease in mean progesterone levels in group I compared with the other two groups that may reflect the expected demise of the corpus luteum. There was also a significant increase in the presence of L-selectin ligands in the luminal epithelium in group III. CONCLUSIONS: During controlled ovarian stimulation with a GnRH antagonist protocol, luteal-phase support with micronized progesterone and 17beta-estradiol seem to increase endometrial L-selectin ligand expression in the luminal endothelium.

Arteriovenous malformation in a bicornuate uterus leading to recurrent severe uterine bleeding: a case report.

BACKGROUND: Uterine arteriovenous malformations (AVMs) are rare entities that have been documented in a wide age range. Several treatment modalities have been highlighted in the literature. Uterine artery embolization appears to be effective therapy for select cases. Embolization provides an alternative to hysterectomy and the potential for future fertility. To our knowledge, only 1 other case report describes an AVM existing within a bicornuate uterus. CASE: A 31-year-old, married, Caucasian woman with a history of infertility presented with intermittent uterine hemorrhage resulting in symptomatic anemia. The patient was diagnosed with a uterine AVM existing within the left horn of a bicornuate uterus. The patient underwent uterine artery embolization, with resolution of the vascular mass and resumption of regular menstrual flow. CONCLUSION: AVM in a bicornuate uterus is rarely reported. Selective uterine artery embolization offers an effective modality of treatment.

Evaluating ventricular function with B-type natriuretic peptide in obstetric patients.

OBJECTIVE: To determine if a rapid serum assay for B-type natriuretic peptide (BNP) provides information regarding ventricular function in obstetric patients with acute dyspnea. STUDY DESIGN: A review of 17 charts for 15 patients was undertaken. Seven patients had preeclampsia, 3 had preterm labor treated with aggressive tocolysis, and 5 had underlying cardiac and/or pulmonary disease. Each presented with signs and symptoms consistent with acute dyspnea. Serum BNP levels were obtained and other standard diagnostic procedures performed. Each patient was treated based on the findings of the standard diagnostic procedures. RESULTS: For the 7 patients with preeclampsia, elevated serum BNP levels correlated with acute ventricular overload that responded to volume management and diuresis. Two patients had marked elevation of serum BNP levels and were found to have significant left ventricular dysfunction that was not apparent by standard clinical evaluation. For preterm labor patients on tocolysis and patients with underlying cardiac or pulmonary disease, serum BNP levels were elevated for 5 of 6 patients with evidence of acute volume overload. CONCLUSION: Serum BNP levels provided useful information for the clinical evaluation and management of obstetric patients with acute dyspnea. In 2 patients, more serious cardiac dysfunction was detected with BNP than with clinical evaluation alone.

Nitric oxide metabolite production in the human preimplantation embryo and successful blastocyst formation.

Eleven patients underwent controlled ovarian hyperstimulation yielding 72 embryos for evaluation. Mean nitric oxide metabolite levels in the insemination media were 2.6 times higher in embryos that progressed to blastocysts by culture day 5 than in those that did not. A comparison of the receiver operating characteristic curves between morphological predictors and nitric oxide metabolite levels revealed a trend toward a stronger association of insemination media nitric oxide metabolite with blastocyst formation.

Variations in L-selectin ligand expression in the luteal-phase endometrium after final oocyte maturation with human chorionic gonadotropin compared with a gonadotropin-releasing hormone agonist.

Final oocyte maturation was achieved by using hCG or two doses of leuprolide acetate in 16 oocyte donors after a GnRH antagonist protocol. Administration of hCG was associated with a statistical trend toward increased L-selectin ligand expression in the endometrium on postretrieval day 5, compared with the leuprolide acetate group.