[Ovarian response during IVF cycle following laparascopic cystectomy of ovarian endometrioma]

Endometrioma of ovary is one of the common diseases during reproductive age and the effect of laparoscopic cystectomy of endometrioma on infertility is still matter of debate. We designed this case control study to evaluate the ovarian response to controlled ovarian hyperstimulation during IVF [In vitro fertilization] cycle following laparoscopic unilateral cystectomy of endometrioma. In a case control study, we enrolled 30 women with history of unilateral laparoscopic cystectomy of ovarian endometrioma in stripping method who underwent IVF cycle in women Hospital, 2009-2012. The numbers of follicles in response to controlled ovarian hyperstimulation during IVF cycle in the ovary with history of unilateral laparoscopic cystectomy of endometrioma were compared with those from the contralateral ovary. The mean age [ +/- SD] of patients was 32.3 [ +/- 3.4]. The mean [ +/- SD] diameter of excised ovarian endometrioma was42.4 [ +/- 10.4] mm. Interval since ovarian surgery to induction ovulation was2.7 [ +/- 2.6] years. Mean number of follicles in the ovary with history of unilateral laparoscopic cystectomy of endometrioma was2.5 [ +/- 1.2] with the range of1 to 5 and in the control ovary 3.9 [ +/- 1.4] with the range of 1 to 6. There was significant difference in the number of follicles in the ovary with laparascopic cystectomy of endometrioma compared with opposite one [P<0.001]. Laparoscopic cystectomy for unilateral endometrioma is associated with a reduced ovarian response to controlled ovarian hyperstimulation during IVF cycle. We did not find any statistically significant difference in reduced ovarian response with regard to patients age, body mass index, size and location of the cyst, and time duration since ovarian cystectomy.

[ relationship between CRL and PAPP-A measurements in first trimester fetuses with low birth weight]

Recent studies have suggested that impaired fetal growth are indicators that may be present in the first trimester. The aim of this study was to investigate the relationship between crown-rump length [CRL] and pregnancy associated plasma protein-A [PAPP-A] measurements in first trimester for low birth weight [LBW]. This prospective cohort study were on 120 pregnant women in first pregnancy trimester, in Women's Hospital Mirza Kochak Khan in 2011-2012. Gestational age according to crown-rump length and gestational age according to last menstrual period [LMP], neonatal weight, small for gestational age, pregnancy associated plasma protein-A and low birth weight were recorded. Main outcome measures was weight and gestational age at birth. Statistical tests used included descriptive statistics, t-test, X[2] and all tests were two-tailed and differences with P<0.05 were considered to be statistically significant. Our findings showed that a total of 120 cases were included CRL Z-score and log 10 [MOM PAPP-A] were positively correlated with fetal birth weight. The mean Crown-rump length Z-score was significantly can be reduced in LBW in first trimester pregnancy. [P<0.001] Mean PAPP-A in low birth weight was [0.4 +/- 0.11 MOM], but in normal weight infants was [1.04 +/- 0.7 MOM]. [P=0.011] also mean PAPP-A in pregnant women with SGA infants is significantly less than other pregnant women [0.5 +/- 0.2 versus 1.1 +/- 0.7] [P<0.001]. Our data suggest that crown-rump length and maternal levels of PAPP-A measured during the first trimester are independent factors that influence fetal birth weight. But their predictive powers are not sufficiently good for them to be used alone for low birth weight screening.

High plasma homocysteine and insulin resistance in patients with polycystic ovarian syndrome

Polycystic ovarian syndrome [PCOS] is a common disease among women in fertility ages and cause severe insulin resistance. Hyperhomocysteinaemia is said to be among the features of PCOS that could influence its outcome. This study aimed to investigate whether hyperhomocysteinaemia exists in PCOS and if it is related to insulin resistance in the affected patients. This prospective study was carried out in a university based fertility clinic. Sixty four PCOS patients and 50 normo ovulatory controls were reviewed for fasting glucose, insulin, homocysteine, luteinizing hormone [LH], and follicle-stimulating hormone [FSH] plasma levels in the blood sample of the 3[rd] day of their menstrual cycle. Insulin resistance was determined with the fasting glucose [mmol/L] to insulin [mIU/L] ratio and HOMA-IR [Homeostasis model assessment-Insulin resistance]. Independent-samples T-test and linear regression test were utilized to analyze the obtained data. Homocysteine levels compared between PCOS patients and control group showed a significant difference. PCOS group was divided into insulin resistant [IR] [LogHOMA-IR >/= 0.57] and non insulin resistant [NIR] patients. The IR group had significantly higher homocysteine [p-value=0.02], fasting insulin and glucose levels [p-value<0.001] rather than NIR group. PCOS patients have a leaning toward hyperhomocysteinaemia and insulin resistance. Insulin resistant patients are found to have higher homocysteine level