Evaluation of Thyroid Dysfunction in Abnormal Uterine Bleeding with Ovarian Dysfunction (AUB - O)

Introduction: Abnormal uterine bleeding with ovarian dysfunction (AUB-O) is one of the most frequently encountered conditionsin gynecology and defined as an abnormal bleeding from the uterus in the absence of organic disease of genital tract anddemonstrable extragenital cause.Aims and Objectives: The objectives of the study were to study the menstrual pattern in patients with thyroid dysfunction andto study the thyroid dysfunction from puberty to premenopausal age group in AUB-O.Results: AUB-O is one of the most frequently encountered conditions in gynecological practice which will give a descriptiveanalysis of the age distribution, the parity distribution, symptomatic distribution of AUB-O, and its association with thyroiddysfunction.Conclusion: Our study concludes that thyroid dysfunction should be considered as an important etiological factor for menstrualabnormality. Thus, biochemical evaluation of T3, T4, and thyroid-stimulating hormone estimations should be made mandatoryin AUB-O cases to detect apparent and occult thyroid dysfunction

Rosiglitazone improves ovarian dysfunction of rats with chronic low-grade inflammation induced by lipopolysaccharide / 第二军医大学学报

Objective: To detect the expression of peroxisome proliferator-activated receptor (PPAR) in ovarian tissues of rats with chronic low-grade inflammation, and to explore the effect of PPAR-γ agonist rosiglitazone on ovarian dysfunction induced by chronic low-grade inflammation. Methods: A chronic low-grade inflammation model of rats was established by intraperitoneal injection of lipopolysaccharide (LPS). Two hundred rats were randomly assigned to control group (NS group) and chronic low-grade inflammation group (LPS group), and the rats were intraperitoneally injected with normal saline and LPS, respectively. The ovarian function of rats was assessed by detecting the serum levels of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) during different stages of the estrus cycle (proestrus, estrus, metestrus and diestrus). The protein expression levels of PPAR-α, PPAR-γ and PPAR-γ in ovarian tissues were detected using Western blotting. Eighty rats of each group were randomly divided into two subgroups, which were administered intragastrically by normal saline and rosiglitazone, respectively. Fourteen days after intragastric administration, the levels of proinflammatory cytokines, including interleukin (IL)-1β, IL-6 and tumor necrosis factor α (TNF-α), in ovarian tissues and ovarian function of rats in each subgroup were observed during different stages of the estrus cycle. Results: Compared with the NS group, during different stages of the estrus cycle, the serum levels of E2 and AMH of rats in the LPS group were significantly decreased (all P < 0.05), while the serum levels of FSH and LH were significantly increased (all P < 0.05). During different stages of the estrus cycle, the expression levels of PPAR-γ in ovarian tissues were significantly decreased in the LPS group compared with the NS group (all P < 0.05), while the expression levels of PPAR-α and PPAR-δ were not significantly different between the two groups (all P < 0.05). Compared with the intraperitoneal injection of LPS intragastric administration of normal saline subgroup, during different stages of the estrus cycle, the expression levels IL-1β, IL-6 and TNF-α in ovarian tissues of rats were significantly decreased in the intraperitoneal injection of LPS intragastric administration of rosiglitazone subgroup (all P < 0.05), the serum levels of E2 and AMH were significantly increased (all P < 0.05), and the serum levels of FSH and LH were significantly decreased (all P < 0.05). Conclusion: PPAR-γ agonist rosiglitazone can attenuate LPS-induced chronic low-grade inflammatory and improve ovarian function in rats.

Postpartum uterine infection & ovarian dysfunction

Postpartum uterine infections such as metritis, endometritis and mastitis have been considered as underlying causes for ovarian dysfunction in mammals. Almost all mammals, particularly dairy animals are susceptible to postpartum uterine infections, resulting in impaired fertility and economic loss. One of the factors for low fertility in females is ovarian dysfunction, which is exhibited as impaired growth and function of ovarian follicles by the postpartum infection. Immune system of mammals provides a host defence mechanism against pathogenic microbes through the recognition of pathogen-associated molecular patterns (PAMPs) and forming inflammasomes. Like immune cells, ovarian granulosa cells also exhibit a similar pattern of cytokine gene expressions on exposure to PAMPs. Genome-wide transcriptomic approaches explored the molecular mechanisms underlying the immune function of buffalo granulosa cells during endotoxin exposure. Understanding the molecular mechanism of ovarian dysfunction due to uterine infection would be helpful to implement various strategies to handle the adverse effects of postpartum uterine disease on fertility by developing potential therapeutics. Therefore, this article focuses on key factors that are responsible for postpartum infection and particularly summarizes the molecular mechanism of infection underlying the ovarian dysfunction in dairy animals.

Effect of human placenta on ovarian function and endometrial receptivity in patients with ovarian dysfunction / 中国综合临床

Objective To investigate the effect of human placenta on ovarian function and endometrial receptivity in patients with ovarian dysfunction. Methods From January 2017 and August 2017, one hundred and twenty patients of ovarian hypofunction infertility who received therapy in Liuzhou Worker′s Hospital were selected and were randomly divided into observation group ( 60 cases) and control group ( 60 cases) ,the control group was treated with oral letrozole at the 2nd to 5th day of the menstrual cycle for 5 consecutive days,at the same time, vitamin E soft capsule was taken orally until the next menstrual cycle, the letrozole usage in the observation group was the same as that in the control group,and human placenta tablets were taken orally until the next menstrual cycle. Both groups were treated for 3 menstrual cycles continuously. The changes of luteinizing hormone (LH),follicle stimulating hormone (FSH),estradiol (E2),resistance index (RI),pulsation index (PI),endometrial thickness and shape during and after ovulation were compared between the two groups before and after treatment. The efficacy of ovulation induction,ovulation rate and pregnancy rate were compared. Results After treatment,two groups of FSH,E2 treatment were decreased significantly ( P<0. 05) ,the FSH,E2,in the observation group were significantly lower than those of the control group ((9. 62±1. 04)U/L vs. (12. 45±1. 13)U/L,(174.85±36.21)pmol/L vs. (188.69±27.92)pmol/L)(t=14.274,2.345,P<0.05),there were no obvious changes in LH in the observation group and the control group( P>0. 05);after treatment,the endometrial thickness in the observation group was significantly higher than that of the control group ((12. 25±0. 13)mm vs. (10. 97±0. 10)mm)(t=60. 452,P<0. 05); after treatment,the RI and PI of the two groups were significantly lower than those before treatment (P<0. 05),the RI,PI in the observation group were significantly lower than those of the control group ((0.54±0.03)vs. (0.59±0.03),(1.23±0.06)vs. (1.43±0.08))(t=9.129, 15. 492,P<0. 05);the total effective rate of ovulation induction in the observation group was significantly higher than that in the control group (93. 33％(56/60)vs. 75. 00％(45/60))(χ2=7. 566,P<0. 05); there was no significant difference in ovulation rate between the two groups ( P>0. 05) ,but the pregnancy rate in observation group was obviously higher than that of the control group ( 31. 67％ ( 19/60) vs. 15. 00 ( 9/60) ) (χ2=4. 658, P<0. 05 ) . Conclusion In patients with ovarian dysfunction in the application of human placenta effect is significant,which can effectively improve the ovarian function and endometrial receptivity, improve pregnancy rate,clinical application value is high.

Early menopause: A hazard to a woman’s health.

Early menopause or premature ovarian insufficiency (POI) is a common cause of infertility in women and affects about one per cent of young women. This disorder has significant psychological sequelae and major health implications. Its relevance has increased in recent years due to the fact that age of motherhood is being delayed in developed countries, with the risk of having either primary ovarian insufficiency or less possibilities of pregnancy. The main characteristics are absence of ovulation, amenorrhoea and high levels of serum gonadotropins (hypergonadotropic hypogonadism). Although the aetiology remains uncertain in most cases, several rare specific causes have been elucidated. Potential causes for POI are iatrogenic (ovarian surgery, radiotherapy or chemotherapy), environmental factors, viral infections, metabolic and autoimmune diseases, and genetic alterations. Because of the association with other autoimmune diseases, close follow up is recommended in patients with POI. The traditional indicators to evaluate ovarian ageing are age, serum hormonal levels, anti-Mullerian hormone, antral follicle count, and ultrasonography of ovaries. Hormone replacement therapy remains the mainstay of treatment, and the best chance of achieving a pregnancy is through oocyte donation. This article aims to present an overview of potential causes, clinical manifestations, and treatment options of POI.

Changes in ovarian function after radioactive iodine among patients with differentiated thyroid carcinoma at St. Luke's Medical Center / Journal of the ASEAN Federation of Endocrine Societies

OBJECTIVE: To determine the prevalence of menstrual and reproductive dysfunction among subjects who have undergone radioiodine treatment for thyroid carcinoma.METHODOLOGY: This study enrolled adult women with Differentiated Thyroid Carcinoma who received the treatment at age 40 years and below. Data was processed using SAS program and evaluated using Fischer's test and Wilcoxon test.RESULTS: The study enrolled 46 women. Three reported cycle irregularities, 4 reported changes in amount of bleeding and 1 had amenorrhea. The prevalence rate of menstrual abnormalities was 15.2%. These women received a significantly higher dose of radioactive iodine (RAI) (120 vs. 110 mCi, p = 0.0064). Eleven women tried to conceive and there were 5 births to 5 different subjects after radiation. There were no congenital anomalies and 1 miscarriage. Four women were menopausal with an average age of 44.4 years old.CONCLUSION: This study showed that the prevalence of menstrual disturbances after high dose radioactive iodine treatment among thyroid cancer patients is 15.2%. The affected group received a significantly higher dose of radioactive iodine compared to the unaffected group.

Aspectos ginecológicos e hormonais de pacientes nefropatas e transplantadas renais / Gynecologic and hormonal aspects of chronic kidney disease and transplantation

A prevalência de disfunção ovariana é alta em mulheres com doença renal crônica e parece resultar da disfunção em diversos níveis do eixo hipotálamo-hipófise-ovariano (HHO). Estas pacientes costumam apresentar ciclos irregulares, amenorréia, atraso no desenvolvimento puberal e baixa estatura. No entanto, em pacientes transplantadas renais, há uma melhora da função do eixo HHO, incluindo a melhora da fertilidade. Por isso, a contracepção após o transplante é importante e deve ter uma abordagem especializada. Ao prescrever um método contraceptivo, deve-se levar em conta a vulnerabilidade do órgão transplantado, os efeitos adversos, as interações medicamentosas, seus potenciais benefícios e malefícios e a condição clínica da paciente. O objetivo dessa revisão foi avaliar o eixo HHO das pacientes com doença renal crônica (DRC) ou transplante renal, bem como as peculiaridades da contracepção, uso de drogas e avaliação do colo uterino nessas pacientes.

The prevalence of ovarian dysfunction is high in women with CKD and seems to result from dysfunction at several levels along hypothalamic-pituitary-ovarian (HPO) axis. This situation results in menstrual disturbances or even amenorrhea, late puberty, and low stature. On the other hand, kidney transplantation can improve these abnormalities and also increase fertility. The contraception after transplantation is important and must have a specialized approach. When prescribing a contraceptive method, the vulnerability of the graft, side effects, drug interaction and clinical condition of the patient must be evaluated. The objective of this review was to evaluate the HPO axis of patients with chronic kidney disease (CKD) or kidney transplantation and the peculiarities of contraception, drug and cervical assessment in these patients.

Analysis of 100 Women with Infertility Due to Ovarian Dysfunction Who Succeeded in Delivering Live Children after Kampo Therapy Diagnosed by \lq\lqZheng\rq\rq / 日本東洋医学雑誌

To determine the Kampo therapy indications for global infertility treatment, and the criteria for objective and rational evaluation of its efficacy, we analyzed the sho (Zheng), type of ovarian dysfunction, types of Western drugs used concomitantly, length of treatment, age upon pregnancy, etc., in 100 women with infertility due to ovarian dysfunction as diagnosed by Western medicine who succeeded in becoming pregnant and giving live births, after Kampo therapies diagnosed by sho based on Hakko, Ki, Ketsu and Sui. The diagnosis of the sho in these women was compared with that in 2737 control women. Their types of sho by frequency were Kyo (51%), Shoyo (Hanhyo-Hanri) (69%), Jonetsu-Gekan (52%), Kigyaku (47%), Oketsu (71%) and Suidoku (67%). When compared to the control group, the percentage of women whose Sho was rated as Jitsu, Taiyo, Shoyo, Jonetsu-Gekan, Oketsu or Suidoku was significantly higher. The sho type Hyonetsu-Rikan was lower. The preparation sho, rated on the basis of a general assessment, was most frequently Kamishoyosan(55%). The predominant type of ovarian dysfunction was luteal dysfunction (73%), whose frequency was significantly higher than that in the control group. Of all women studied, 46% were treated with Kampo alone and 54% were treated with Kampo + Western medicine. In terms of the percentage of each type of ovarian dysfunction, there was no significant difference between the two groups. The Western drugs used in combination with Kampo therapy were hCG preparations (33%), terguride preparations (18%), clomiphene preparations (3%) and hMG preparations (6%). The period of treatment until pregnancy was significantly shorter in the Kampo alone group (5.0 ± 4.4months) than in the combined therapy group (9.5 ± 6.8months). These results allow us to make the following conclusions:1.The type of infertility indicated for Kampo medicine is infertility due to ovarian dysfunction as diagnosed by methods of Western medicine.2.Women who successfully became pregnant following Kampo medicine were often cases of Shoyo disease complicated by sho with Jonetsu-Gekan, accompanied by Kigyaku, Oketsu and Suidoku.3.Uncombined Kampo medicine may be effective in cases of severe infertility.4.If pregnancy does not occur within 5 or 6 months after the start of Kampo therapy, combined use of Western medicines should be considered.

Investigations of Two Cases Initially Diagnosed as Having Absence of Competent Ovum at \it{in vitro} Fertilization but Having Succeeded in Obtaining Live Births after Short-Term Kampo-therapy Diagnosed by \lq\lq\it{Zheng}\rq\rq / 日本東洋医学雑誌

For two infertile couples with normal tubal function and spermatogenesis, who were diagnosed with infertility attributed to lack of competent ovum with poor grade embryo in spite of having received timing therapy and step-up therapy (artificial fertilization from husband ; AIH and in vitro fertilization and embryo transfer ; IVF-ET), Kampo-only therapies diagnosed according to their “Zheng” syndrome-type consisting of one cycle of tokishigyakukagoshuyushokyoto, and two cycles of kamishoyosan and anchusan was performed. As a result, both women became pregnant and gave live births. The causes of infertility in these two cases were analyzed, and problems with step-up therapy, commonly used in Western medicine and efficacy of Kampo-therapy diagnosed according to their Zheng were evaluated from the standpoint of Western medicine.Kampo-therapy diagnosed by Zheng was found to improve the follicular and luteal functions as well as related functions. The two cases presented were diagnosed as infertile due to ovarian dysfunction on the basis of therapeutic diagnosis. The indications of IVF-ET are tubal and male infertilities, not to be ovarian dysfunctional infertility.For infertility due to ovarian dysfunction, Kampo-therapy diagnosed by Zheng with Kuoketsu and Risui effects are drugs of first choice, rather than clomiphene, which has an anti-estrogen activity.

A Study of Ovarian Dysfunction after Chemotherapy in Cancer Survivals / 대한산부인과학회잡지

OBJECTIVE: We analysed the duration of ovarian dysfunction, amenorrhea and pregnancy rate of the patients who underwent the fertility preserving surgery and adjuvant chemotherapy at the reproductive age to identify the contributing factors of ovarian dysfunction and premature menopause. METHODS: We select the 25 patients (<40 years old at diagnosis) among the 270 patients with malignant ovarian tumor who undergone conservative surgery and platinum-based adjuvant chemotherapy between the year 1985 and 2001. All patient was disease free state. Method used for follow up were physical exam, tumor markers and ultrasonography. We analysed age at diagnosis, amenorrheic period, recovery of ovarian function whether hormonal agent was used or not, times of pregnancy, times of successful pregnancy, and times of pregnancy outcome with anomaly. RESULTS: In 25 cases, patients who became pregnant had a shorter period of amenorrhea of 2.55 months compared to 20.47 months of the rest. Total times (Kur) of chemotherapy shows no difference between two groups (6.45 vs 6.33). Average age show no differences between two groups (22.43 years vs 22.9 years), but amenorrheic period increased in proportion to age at treatment and times of chemotheapy, so we can guess that ovarian dysfunction is more serious with higher age at diagnosis and many times of chemotherapy. In the group who had been pregnant, successful outcome were 7 of 9 total times of pregnancy (abortion rate was 22%), and no baby had gross anomaly. CONCLUSION: So we can guess that ovarian dysfunction is more serious with higher age at diagnosis and more times of chemotherapy.

Effect of Repeated Immobilization Stress on Ovarian Function in Female Rats / 中药新药与临床药理

Objective To observe the effects of repeated immobilization on rats ovarian function and to observe the changes of ovarian function in menopause animals.Methods Daily vaginal smears were permfored to follow the estrous cycle in adult female rats.The animals with regular cycle were exposed to the scheduled daily repeated immobilization for 15-day,which included 5 stress episodes with each episode consisting of three immobilizations (one time per day). The duration of immobilization was progressively increased with the subsequent episode. Serum levels of estradiol (E2) and progesterone (P) were measured throughout the estrous cycle before and after the stress.Results The repeated stress resulted in the disruption of the estrous cycle characterized by longer phase of diestrus or by fewer epithelium from vagina in proestrus and estrus.In the stressed rats, a significant decrease of serum E2 and an increase of P were shown throughout the cycle compared to that before stress;the normal secretion cycle was interrupted or even disappeared; changes of serum P level in some rats were similar to the menopause animals.Conclusion Repeated immobilization can cause the disruption or degeneration of ovarian function,indicating that rats with stress-induced ovarian dysfunction is an appropriate animal model for testing protective effects of agents against aging and for the diseases related to ovarian dysfunction.