Serum visfatin levels in non-obese women with polycystic ovary syndrome and matched controls

OBJECTIVE: The purpose of the current study was to compare the circulating levels of visfatin between women with polycystic ovary syndrome (PCOS) and those without PCOS and to assess the correlations between visfatin levels and various parameters. METHODS: This case-control study recruited 74 PCOS patients and 74 age- and body mass index (BMI)-matched controls. Serum visfatin levels were evaluated using the enzyme-linked immunosorbent assay. Women with PCOS were divided into 2 subgroups based on the presence of clinical or biochemical hyperandrogenism. The possible differences in serum visfatin levels between the hyperandrogenic and non-hyperandrogenic groups were also assessed. RESULTS: Visfatin levels in PCOS patients were similar to those in the controls. However, hyperandrogenic patients had significantly higher mean serum visfatin levels than those in non-hyperandrogenic patients (3.87 ng/mL; 95% confidence intervals [CIs], 3.09–4.85 in hyperandrogenic group vs. 2.69 ng/mL; 95% CIs, 2.06–3.52 in non-hyperandrogenic group; P=0.038). In women with PCOS, visfatin levels positively correlated with BMI (r=0.23; P=0.047) and the log free androgen index (FAI) (r=0.27; P=0.021) and negatively correlated with high-density lipoprotein (HDL) cholesterol levels (r=−0.37; P=0.025). Except for HDL cholesterol levels, these correlations were also observed in controls. CONCLUSION: Visfatin levels in PCOS patients were similar to those in the controls. However, hyperandrogenic patients showed significantly higher serum visfatin levels than those of non-hyperandrogenic patients, and visfatin had a positive linear correlation with FAI in both PCOS patients and controls.

Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women

OBJECTIVE: The aim of our study is to determine clinical factors and sonographic findings associated with endometrial hyperplasia or cancer (EH+) in premenopausal and perimenopausal women. METHODS: A total of 14,340 transvaginal ultrasonography examinations of 9,888 healthy premenopausal and perimenopausal women were included in this retrospective study. One hundred sixty-two subjects underwent endometrial biopsy based on abnormal uterine bleeding (AUB), sonographic endometrial abnormalities (thickened endometrium, endometrial mass, or endometrial stripe abnormality), or both. The clinical factors and sonographic endometrial abnormalities were evaluated with regard to EH+. RESULTS: Histologically verified EH+ was found in fourteen subjects (8.6%); ten cases of endometrial hyperplasia (EH) without atypia, three cases of EH with atypia (AEH), and one case of endometrial cancer. Neither clinical factors nor AUB were associated with EH+ (P=0.32) or AEH+ (P=0.72). Of sonographic findings, endometrial stripe abnormality was significantly associated with EH+ (P=0.003) and marginally associated with AEH+ (P=0.05), but a thickened endometrium was not associated with EH+ (P=0.43). CONCLUSION: Endometrial stripe abnormality is a significant factor to predict EH+ in healthy premenopausal and perimenopausal women with and without AUB. However, simple measurement of endometrial thickness has a limited role in this capacity.

Efficacy of oxytocin antagonist infusion in improving in vitro fertilization outcomes on the day of embryo transfer: A meta-analysis / 대한생식의학회지

OBJECTIVE: Uterine contraction induced by the embryo transfer (ET) process has an adverse effect on embryo implantation. The aim of this study was to determine the effect of oxytocin antagonist supplementation on the day of ET on in vitro fertilization outcomes via a meta-analysis. METHODS: We performed a meta-analysis of randomized controlled trials (RCTs). Four online databases (Embase, Medline, PubMed, and Cochrane Library) were searched through May 2015 for RCTs that investigated oxytocin antagonist supplementation on the day of ET. Studies were selected according to predefined inclusion criteria and meta-analyzed using RevMan 5.3. Only RCTs were included in this study. The main outcome measures were the clinical pregnancy rate, the implantation rate, and the miscarriage rate. RESULTS: A total of 123 studies were reviewed and assessed for eligibility. Three RCTs, which included 1,020 patients, met the selection criteria. The implantation rate was significantly better in patients who underwent oxytocin antagonist infusion (19.8%) than in the control group (11.3%) (n=681; odds ratio [OR], 1.92; 95% confidence interval [CI], 1.25–2.96). No significant difference was found between the two groups in the clinical pregnancy rate (n=1,020; OR, 1.57; 95% CI, 0.92–2.67) or the miscarriage rate (n=456; OR, 0.76; 95% CI, 0.44–1.33). CONCLUSION: The results of this meta-analysis of the currently available literature suggest that the administration of an oxytocin antagonist on the day of ET improves the implantation rate but not the clinical pregnancy rate or miscarriage rate. Additional, large-scale, prospective, randomized studies are necessary to confirm these findings.

Mature oocyte retrieval during laparotomic debulking surgery following random-start controlled ovarian stimulation for fertility preservation in a patient with suspected ovarian cancer

Herein, we report a case of successful mature oocyte retrieval during laparotomy after random-start controlled ovarian stimulation (COS) in a 21-year-old nulliparous woman with suspected recurrent ovarian immature teratoma. The patient had been diagnosed with stage IIIC immature teratoma two years earlier following a staging operation, including right oophorectomy and left ovarian cystectomy. And she had subsequently undergone four rounds of postoperative adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. Approximately two years after the initial surgery, she was strongly suspected of having recurrent ovarian immature teratoma on radiologic follow-up. We performed random-start COS and in vivo oocyte retrieval during laparotomic debulking surgery including left oophorectomy. Eight mature oocytes were successfully retrieved and vitrified for fertility preservation. The final pathologic diagnosis was mature cystic teratoma of the ovary and peritoneal implants consistent with gliomatosis peritonei. This is the first case report in which random-start COS and in vivo oocyte retrieval were performed.

Increased bone mineral density according to increase of skeletal muscle mass in 534 Korean women: A retrospective cohort study conducted over 2.7 years

OBJECTIVE: To determine the impact of the changes in the amount of abdominal fat, directly measured by computed tomography, body composition, and the metabolic syndrome (MetS) risk factors on the bone mineral density (BMD) of Korean women. METHODS: A retrospective cohort study involving 534 Korean women aged 29 to 78 years, who had undergone both dual-energy X-ray absorptiometry and abdominal adipose tissue analysis by computed tomography scan more than twice between January 2004 and December 2010. The changes in the BMD values were examined in association with the changes in fat amount, body composition parameters, and risk factors of MetS. RESULTS: On cross sectional analysis, there was a significant positive correlation between femoral BMD and total abdominal fat amount at the initial visit. However, the correlation disappeared when the impact of change of the fat amount on the change in BMD was analyzed over the study period. When the MetS and body composition parameters were analyzed, a significantly positive correlation was found between skeletal muscle mass and BMD. There was no significant relationship between the MetS risk factors or other body composition parameters and BMD throughout the study period after adjusting for age (time interval). CONCLUSION: Among body composition parameters, only increased skeletal muscle mass had a positive correlation with increased BMD over the study period of 2.7 years.

Vitamin D deficiency in women with polycystic ovary syndrome / 대한생식의학회지

OBJECTIVE: To investigate: the prevalence of vitamin D deficiency in Korean women with polycystic ovary syndrome (PCOS), and the relationship between vitamin D status and clinical or metabolic features in this group. METHODS: We recruited 38 women with PCOS using the Rotterdam criteria. A total of 109 premenopausal control women were matched with patients based on age and body mass index. Serum 25-hydroxy vitamin D concentrations less than 20 ng/mL were classified as frank vitamin D deficiency. Since vitamin D may play a significant role in metabolic disturbances in women with PCOS, correlations between clinical or metabolic parameters and vitamin D status were analyzed separately in patients and controls. RESULTS: Women with PCOS showed no differences in the level of 25-hydroxy vitamin D (19.6+/-6.6 ng/mL in patients vs. 20.1+/-7.4 ng/mL in controls, respectively, p=0.696) or prevalence of vitamin D deficiency (57.9% in patients vs. 56.5% in controls, respectively, p=0.880). In addition, we did not find any correlations between serum vitamin D level and clinical or metabolic profiles in either PCOS patients or controls. CONCLUSION: Our study found no differences in the absolute level of serum vitamin D between PCOS patients and matched controls. Prevalence of vitamin D deficiency was equally common among both patients and controls. Additionally, we did not find any correlations between serum vitamin D level and clinical or metabolic profiles, suggesting that the role of vitamin D in the pathogenesis of PCOS is not yet clear.

Carotid intima-media thickness in mainly non-obese women with polycystic ovary syndrome and age-matched controls

OBJECTIVE: Metabolic disturbances are well-recognized clinical features of polycystic ovary syndrome (PCOS). Carotid intima-media thickness (CIMT) has been widely used as a surrogate marker of atherosclerosis and cardiovascular disease (CVD). CIMT in women with PCOS has been investigated in many studies, but there has been only one report in the Korean population. The aim of the present study was to compare the presence of subclinical atherosclerosis in young untreated Korean women with PCOS and age-matched controls, specifically by measuring their CIMT. METHODS: CIMT was measured by one radiologist in 56 PCOS patients and 56 controls. To compare the CIMT according to PCOS phenotypes, women with PCOS were divided into two subgroups according to the presence of hyperandrogenism. RESULTS: Although PCOS patients were more obese and had higher blood pressure and insulin resistance index than the age-matched controls, the CIMT was not different between the two groups (0.49 +/- 0.09 mm in PCOS patients vs. 0.50 +/- 0.11 mm in controls, respectively, p = 0.562). When the CIMT in the control group was compared with hyperandrogenic and non-hyperandrogenic PCOS groups, also no significant differences were found. CONCLUSION: Despite the significant differences in some vascular risk factors between women with PCOS and controls, PCOS patients did not have a significantly higher CIMT (even in the hyperandrogenic subgroups). Although our study did not show the increased risk of subclinical atherosclerosis in PCOS patients, the role of CIMT continues to be investigated considering the importance of screening and monitoring CVD risk factors in women with PCOS.

Clinical Efficacy of Intraovarian Stromal Artery Doppler Ultrasonography and Serum Glycodelin Assay as Prognostic Factors of Pregnancy in Infertile Patients Undergoing In Vitro Fertilization and Embryo Transfer / 대한산부인과학회지

OBJECTIVE: To assess the clinical efficacy of intraovarian artery stromal Doppler ultrasonography and serum glycodelin (placental protein 14, PP14) as prognostic factors of pregnancy in in vitro fertilization and embryo transfer (IVF-ET) cycles. METHODS: Fifty seven infertile women undergoing IVF-ET were recruited at SNUH from April, 2003 to March, 2004. All IVF-ET patients received controlled ovarian hyperstimulation (COH) using gonadotropins with either GnRH agonist or GnRH antagonist. Doppler ultrasonographic measurements were performed by Sonoace-8800 (Medison) with 5.5 MHz transvaginal probe. Pulsatility Index (PI) of intraovarian stromal artery was evaluated on the first day of ovarian stimulation and the day of hCG administration. Blood sampling for hormonal assay including PP14 was taken at the time of the first day of ovarian stimulation, hCG administration, oocyte retrieval, and embryo transfer (ET). Serum hormonal profiles, PI, and outcomes of COH and IVF-ET were compared between clinically pregnant (n=12) and nonpregnant (n=45) groups. RESULTS: Demographic and clinical characteristics of the patients were comparable in both groups except body mass index (BMI). There was no significant correlation between BMI and serum PP14 levels or PI measured in intraovarian stromal artery. Pregnant group had significantly higher fertilization rate and larger number of cryopreserved embryos. The mean serum levels of estradiol, progesterone, LH and FSH were not different between the two groups. When compared with the nonpregnant group, serum PP14 levels were lower in the pregnant group throughout the treatment cycle, but there was no statistical significance. PI of intraovarian stromal artery on hCG day was significantly lower in the pregnant group (1.2 +/- 0.4 vs. 1.8 +/- 0.8). There was no significant correlation between serum PP14 levels and PI. CONCLUSION: This study suggests that serum PP14 levels cannot be a prognostic factor in IVF-ET. The development of more sensitive assay method is required. PI of intraovarian stromal artery on hCG day can be clinically more useful in predicting the success of IVF-ET.

Clinical Efficacy of Reduced Dose GnRH Agonist Long Protocol for Controlled Ovarian Hyperstimulation in IVF-ET Patients with High Basal Serum FSH Level / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical efficacy of half-dose and further reduced dose GnRH agonist long protocols for controlled ovarian hyperstimulation (COH) in in vitro fertilization and embryo transfer (IVF-ET) patients with high basal serum FSH level. METHODS: One hundred and two IVF-ET cycles performed in 84 infertile patients with high basal serum FSH level (FSH>10.0 mIU/mL) were included in this retrospective study. Study subjects were assigned in two groups: continuous half-dose GnRH agonist long protocol (Group A, n=63) vs. further reduced dose GnRH agonist long protocol (Group B, n=39) from half-dose at the start of GnRH agonist to 1/3 or 1/4 dose after pituitary suppression. Exogenous FSH or hMG was administered for COH in step-down mode, 4 or less embryos were transferred, and intramuscular progesterone or 8% progesterone gel was used for the luteal support. RESULTS: Serum estradiol (E2) level on hCG day was significantly higher in Group B (1,318.3 +/- 1,120.4 vs. 2,054.9 +/- 1,773.5 pg/mL, p=0.015). The number of transferable embryos was also significantly higher in Group B (2.9 +/- 1.7 vs. 3.7 +/- 2.0, p=0.027). There was no statistically significant difference in the outcomes such as the dose of gonadotropins administered, the number of oocytes retrieved, and the clinical pregnancy rate. CONCLUSION: GnRH agonist long protocol with the reduced dose from half-dose at the start to 1/3 or 1/4 of dose after pituitary suppression may be more beneficial for COH in IVF-ET patients with high basal serum FSH level. Further prospective randomized controlled study in a larger scale will be necessary to confirm this findings.

Clinical Efficacy of Reduced Dose GnRH Agonist Long Protocol for Controlled Ovarian Hyperstimulation in IVF-ET Patients with High Basal Serum FSH Level / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical efficacy of half-dose and further reduced dose GnRH agonist long protocols for controlled ovarian hyperstimulation (COH) in in vitro fertilization and embryo transfer (IVF-ET) patients with high basal serum FSH level. METHODS: One hundred and two IVF-ET cycles performed in 84 infertile patients with high basal serum FSH level (FSH>10.0 mIU/mL) were included in this retrospective study. Study subjects were assigned in two groups: continuous half-dose GnRH agonist long protocol (Group A, n=63) vs. further reduced dose GnRH agonist long protocol (Group B, n=39) from half-dose at the start of GnRH agonist to 1/3 or 1/4 dose after pituitary suppression. Exogenous FSH or hMG was administered for COH in step-down mode, 4 or less embryos were transferred, and intramuscular progesterone or 8% progesterone gel was used for the luteal support. RESULTS: Serum estradiol (E2) level on hCG day was significantly higher in Group B (1,318.3 +/- 1,120.4 vs. 2,054.9 +/- 1,773.5 pg/mL, p=0.015). The number of transferable embryos was also significantly higher in Group B (2.9 +/- 1.7 vs. 3.7 +/- 2.0, p=0.027). There was no statistically significant difference in the outcomes such as the dose of gonadotropins administered, the number of oocytes retrieved, and the clinical pregnancy rate. CONCLUSION: GnRH agonist long protocol with the reduced dose from half-dose at the start to 1/3 or 1/4 of dose after pituitary suppression may be more beneficial for COH in IVF-ET patients with high basal serum FSH level. Further prospective randomized controlled study in a larger scale will be necessary to confirm this findings.

Efficacy of Gonadotropin-releasing Hormone Antagonist and Agonist in Controlled Ovarian Hyperstimulation in IVF-ET Patients with Expected Normal Ovarian Response / 대한산부인과학회잡지

OBJECTIVE: To assess the efficacy of GnRH antagonist in controlled ovarian hyperstimulation (COH) for IVF-ET compared with GnRH agonist in infertile patients who are expected to have normal ovarian response. METHODS: This study reviewed 105 cycles of 105 women who underwent IVF-ET for the first time in SNUH from January, 2001 to October, 2003. In the study group (n=51), a daily dose of 0.25 mg of GnRH antagonist (cetrorelix or ganirelix) was administered beginning when leading follicles reached mean diameter of 13-14 mm and continued until the day of hCG injection. In the control group (n=54), patients were first desensitized with GnRH agonist (triptorelin) long protocol, which was continued during the gonadotropins treatment until the day of hCG injection. The outcome parameters of COH and IVF-ET were compared retrospectively between the two groups. Statistical analysis was performed using Student's t-test for the comparison of means, and the chi-square test where appropriate. Statistical significance was defined as p<0.05. RESULTS: General characteristics of the patients in respect to age, parity, body mass index of the two groups were comparable. In the study group, there were significant reduction in the dosages of gonadotropins used (1818.1 +/- 812.3 IU vs. 2420.2 +/- 839.2 IU)and the duration of COH (8.9 +/- 2.1 days vs. 10.9 +/- 1.6 days). The mean serum level of estradiol and endometrial thickness on hCG day were significantly lower in the study group. Number of embryos transferred and CES (cumulative embryo score) were significantly lower in the study group compared to the control group. However there were no significant differences in the number of oocytes retrieved, the fertilization, implantation, and clinical pregnancy rates, and the incidence of OHSS between the two groups. CONCLUSION: For patients who are expected to have normal ovarian response, a GnRH antagonist multiple dose protocol in flexible fashion can be used as a protocol of choice in COH for IVF-ET. This protocol showed comparable pregnancy rate as GnRH agonist long protocol. However, the mean number of gonadotropin ampules administered and the mean number of stimulation days were significantly less in the GnRH antagonist group optimizing the convenience for the patients.

Two Cases of Adenoid Cystic Carcinoma of the Bartholin's Gland / 대한산부인과학회잡지

We report two cases of adenoid cystic carcinoma of Bartholin's gland. One of these patients had positive margin on operation and is scheduled for adjuvant radiotherapy. The other was first diagnosed 13 years ago and presented with her second recurrence without distant metastasis. Adenoid cystic carcinoma of the Bartholin's gland is a rare tumor of the vulva. When diagnosed, the treatment should be individualized to the patient. When the surgical margin is found to be positive, adjuvant radiotherapy seems to be beneficial.

Two Cases of Adenoid Cystic Carcinoma of the Bartholin's Gland / 대한산부인과학회잡지

We report two cases of adenoid cystic carcinoma of Bartholin's gland. One of these patients had positive margin on operation and is scheduled for adjuvant radiotherapy. The other was first diagnosed 13 years ago and presented with her second recurrence without distant metastasis. Adenoid cystic carcinoma of the Bartholin's gland is a rare tumor of the vulva. When diagnosed, the treatment should be individualized to the patient. When the surgical margin is found to be positive, adjuvant radiotherapy seems to be beneficial.

Latex anaphylaxis during labor: case report / 대한산부인과학회잡지

Allergy to latex gloves has been described as an unusual complication during labor. However, IgE mediated hypersensitivity reaction to natural rubber have recently been identified as an international health problem. In this first case report in Korea, latex anaphylaxis during labor is described in an operating room nurse who has been continuously exposed to latex gloves. Because of the increasing frequency of latex allergy, obstetrician should take care and give more attention to the clinical history, as well as be aware of this possibility especially in high risk groups.