Serum vitamin D levels and ovarian reserve markers in secondary amenorrhea patients: Is there a link?

Objective@#To investigate whether serum 25-hydroxyvitamin D [25(OH)D] level is associated with ovarian reserve markers in secondary amenorrhea (SA) patients. @*Methods@#Sixty-three women diagnosed with SA were recruited during 12 months from the initiation of this prospective observational study. Serum 25(OH)D levels, serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) were estimated in study participants and ovarian reserve markers were compared between participants with vitamin D deficiency and those with normal vitamin D levels. @*Results@#Of the 63 participants, 27 (42.9%) were vitamin D deficient (<20 ng/mL) and 36 (57.1%) had normal vitamin D levels. The mean AMH levels and AFC were 10.86±8.94 µ/L and 15.23±7.65 in the vitamin D deficient group, and 7.24±5.62 µ/L and 12.30±6.95 in the normal vitamin D group. Univariate and multivariate linear regression analysis of log10 transformed AMH and AFC with serum 25(OH)D adjusted for age and body mass index confirmed no association between vitamin D levels and AMH levels or AFC. There was also no correlation between serum 25(OH)D and AMH levels or AFC in all participants. However, participants with vitamin D deficiency had an increased chance of having polycystic ovarian syndrome (PCOS) as cause of SA than those with normal vitamin D levels (adjusted odds ratio, 7.559; 95% confidence interval, 1.28–44.65; P=0.026) after adjustment for clinical factors by logistic regression model. @*Conclusion@#There was no correlation between serum 25(OH)D levels and ovarian reserve markers in SA patients, but vitamin D deficiency may be linked to PCOS patients.

Serum vitamin D levels and ovarian reserve markers in secondary amenorrhea patients: Is there a link?

Objective@#To investigate whether serum 25-hydroxyvitamin D [25(OH)D] level is associated with ovarian reserve markers in secondary amenorrhea (SA) patients. @*Methods@#Sixty-three women diagnosed with SA were recruited during 12 months from the initiation of this prospective observational study. Serum 25(OH)D levels, serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) were estimated in study participants and ovarian reserve markers were compared between participants with vitamin D deficiency and those with normal vitamin D levels. @*Results@#Of the 63 participants, 27 (42.9%) were vitamin D deficient (<20 ng/mL) and 36 (57.1%) had normal vitamin D levels. The mean AMH levels and AFC were 10.86±8.94 µ/L and 15.23±7.65 in the vitamin D deficient group, and 7.24±5.62 µ/L and 12.30±6.95 in the normal vitamin D group. Univariate and multivariate linear regression analysis of log10 transformed AMH and AFC with serum 25(OH)D adjusted for age and body mass index confirmed no association between vitamin D levels and AMH levels or AFC. There was also no correlation between serum 25(OH)D and AMH levels or AFC in all participants. However, participants with vitamin D deficiency had an increased chance of having polycystic ovarian syndrome (PCOS) as cause of SA than those with normal vitamin D levels (adjusted odds ratio, 7.559; 95% confidence interval, 1.28–44.65; P=0.026) after adjustment for clinical factors by logistic regression model. @*Conclusion@#There was no correlation between serum 25(OH)D levels and ovarian reserve markers in SA patients, but vitamin D deficiency may be linked to PCOS patients.

Pulmonary embolism in a healthy woman using the oral contraceptives containing desogestrel

Venous thromboembolism is well known as one of the rare but serious adverse effects of combined oral contraceptives (COCs). The COCs with third and fourth generation progestogens were found to have higher risk of venous thrombosis than those with second generation progestogens. We present a case of pulmonary embolism in a 23-year-old nulligravid woman who was using COCs containing the third generation progestogen (desogestrel). At the time of presentation of the adverse effect, she had been using the COCs for 4 months. She had no additional risk factors for thrombosis such as smoking, surgery, tumor as well as genetic factors. This case demonstrates even young women in otherwise good health may be at risk of venous thromboembolism from low-dose formulations of COCs as an over-the-counter drug. We describe this case with a brief review of literatures.

The Occurrence of Glaucoma and Association with Serum Estradiol Level in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: To investigate the occurrence of glaucoma and association with the serum estradiol (E2) level in postmenopausal women. METHODS: We evaluated the serum E2 level, female reproductive factors and glaucoma related risk factors including intraocular pressure and optical coherence tomography (OCT) findings in 30 postmenopausal women who visited Obstetrics and Gynecology outpatient clinic. Patients who showed abnormal findings on the glaucoma screening test were classified to the glaucoma suspect group (group-G), and underwent a glaucoma confirmatory test. Serum E2 level, female reproductive and other menopausal health-related factors such as lipid profiles and bone mineral densities were analyzed in the group-G and non glaucomatous group (group-N). RESULTS: Eight out of thirty participants (26.7%) were classified to the group-G. One of them was diagnosed as having glaucoma that required treatment, and the other two were found to have early glaucomatous changes. Compared to the group-G, the group-N had a higher level of serum E2 (19.40 +/- 4.79 vs. 13.95 +/- 4.55 pg/mL) The difference, however, was not statistically significant (P = 0.525). The proportion of glaucoma suspect patients in the groups with a higher serum E2 level (> or = 20 pg/mL) and a lower serum E2 level (< 20 pg/mL) was similar (25.0 and 27.3%, P = 0.645). Multiple logistic regression analysis showed that no female reproductive factors were associated with the risk of glaucoma. CONCLUSION: Comprehensive glaucoma screening using an OCT in postmenopausal women could detect more glaucoma patients than prevalence in the similar age group. Statistical significance was not found in the association between serum E2 level and the risk of glaucoma.

Phytoestrogens and Bone Metabolism / 대한골다공증학회지

Although most gynecologists had prescribed estrogen with or without progestin for their menopausal patients before the publication of Women's health Initiative (WHI) trial findings, only 35 to 40% of women ever started hormone therapy (HT) and many discontinued it, because of perceived side effects and discomfort. HT will not likely to be regularly prescribed in the future given the recommendations by several groups against long-term use for chronic diseases after the release of the findings of the WHI. Consequently, many postmenopausal women have turned to botanical dietary supplements containing phytoestrogen as an alternative to HT. Although there are numerous studies in the literature over the last decade trying to address the efficacy of phytoestrogens on bone health in animal models and in humans, the efficacy of phytoestrogens as bone-protective agents in vivo remains unclear. Differences in the bioactivities of individual phytoestrogens, differences in bioavailability and metabolism of phytoestrogens within different study populations, and imprecise reporting of the form and dose of phytoestrogens provided in intervention studies may have leaded to the disparity in study results. However, the preventive effect of phytoestrogens for bone loss is promising. This review discusses the effects of phytoestrogens on bone metabolism and their roles on the prevention and treatment of postmenopausal osteoporosis.

Clinical characteristics of women with Mullerian anomaly: Twenty years of experience at Asan Medical Center / 대한산부인과학회지

OBJECTIVE: To investigate the clinical characteristics and reproductive outcomes of women with Mullerian anomalies. METHODS: One hundred and eighty-six patients were diagnosed with Mullerian anomalies at the Asan Medical Center from 1990 to 2009 and their clinical characteristics and reproductive outcomes were analyzed. Mullerian anomalies were categorized according to the classification by the American Fertility Society (1988). RESULTS: Mullerian anomaly was noticed in 1 in 1,326 patients (0.075%). Most cases were found in adulthood (84.9%) whereas only 15.1% cases in adolescent or pediatric period. More than 40% of cases were asymptomatic and found incidentally but others suffered from amenorrhea (12.4%), dysmenorrhea (10.8%), abnormal menstruation (10.2%), etc. Most common type of uterine anomalies was uterine didelphys (30.6%), followed by bicornuate uterus (19.4%), Mayer-Rokitansky-Kuster-Hauser syndrome (10.8%), septate uterus (9.1%) and unicornuate uterus (8.6%). On the reproductive outcomes of 251 pregnancies identified, spontaneous miscarriages and preterm labor were quite common (55.8%), and the overall live birth rate was 48.6%. When each anomaly was individually analyzed, the live birth rate was 60.0% in the arcuate uterus and 58.0% in the uterine didelphys. The unicornuate and bicornuate uterus presented a similar chance of having a living child (42.1%, 46.7%), while the septate uterus showed a relatively lower live birth rate (32.4%). CONCLUSION: Although most cases of Mullerian anomalies are diagnosed in adulthood, many patients may suffer from menstrual abnormalities, dysmenorrhea or recurrent miscarriages since adolescence. The reproductive outcomes of the arcuate uterus and uterine didelphys were better, while those of septate uterus were poor in our study.

Three cases of endometriosis of the urinary tract / 대한산부인과학회지

Endometriosis is a long term, disabling condition and a relatively common disease, affecting 5~15% of the adult female population. Endometriosis of the urinary tract, which occurs mostly bladder or ureter, is rare and accounts for 1 or 2% of cases. However, they may cause hydronephrosis and other serious complications on the involved site. We experienced one case of vesical endometriosis and two cases of ureteral endometriosis, and report these cases with a brief review of the concerned literatures.

The Association between Serum Estradiol Level and Coronary Artery Calcification in Postmenopausal Women: A Preliminary Report / 대한폐경학회지

OBJECTIVES: To estimate whether coronary artery calcification in postmenopausal women is associated with serum estradiol level. METHODS: The present study retrospectively examined the clinical records of 162 postmenopausal women who visited the Health Promotion Center for a routine checkup and underwent a multidetector CT scan of the heart. Serum estradiol level, coronary heart disease (CHD) risk factors, current hormone therapy status, and BMD of the lumbar vertebrae and femoral neck were analyzed in women with coronary artery calcium score (CACS) > or = 100 and or = 100), women with lower CACS (< 100) had a significantly higher level of serum estradiol (27.34 +/- 2.96 vs. 13.31 +/- 1.10 pg/ml, P = 0.030) and lower mean age (57.63 +/- 0.44 vs. 61.88 +/- 1.90, P = 0.037). Women with CACS < 100 were significantly more likely to have a serum estradiol level greater than 20 pg/ml (42.25 vs. 0 %, P = 0.022) and lower prevalence of hypertension (28.17 vs. 62.50%, P = 0.053, borderline significant). However, multiple logistic regression analysis showed that any factors did not have a significant association with CACS except hypertension (OR 5.831 [95% CI 1.035 to 32.85], P = 0.046). CONCLUSION: Serum estradiol level might be associated with the degree of calcification of coronary artery in postmenopausal women.

The effect of body mass index of on the outcome of in vitro fertilization and embryo transfer in patients with polycystic ovary syndrome / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the effect of body mass index (BMI) on the outcome of in vitro fertilization and embryo transfer (IVF-ET) in patients with polycystic ovary syndrome (PCOS). METHODS: Ninety-six patients with PCOS who completed their first cycle of IVF-ET were included in this retrospective study. All patients were stimulated by GnRH antagonist multi-dose protocol. The patients were divided into one of two groups on the basis of BMI > or =23 kg/m2 vs. BMI or =23kg/m2 were divided into patient group with 23 or =25 kg/m2, and these three groups were also compared in regard to the outcome of IVF-ET. RESULTS: The total amount and duration of rhFSH administration were significantly higher in PCOS women with BMI > or =23 kg/m2 than in those with BMI or =23 kg/m2 (17.4% vs 7.8%, P=0.024). When compared three group divided on the basis of BMI or =25 kg/m2, similar results were showed in women with BMI > or =25 kg/m2, although implantation rate in women with BMI > or =25 kg/m2 was lower with borderline significance (P=0.069). CONCLUSION: Obesity (BMI > or =23 kg/m2) has a detrimental effect on implantation rate and is associated with the increased total amount and duration of rhFSH administration for ovarian stimulation in IVF-ET cycle. Consequently BMI may be a predictor for IVF outcomes in patients with PCOS.

Analysis of C(-634)G polymorphism in the promotor region of the vascular endothelial growth factor gene in Korean women with endometriosis / 대한산부인과학회지

OBJECTIVE: This study was designed to investigate the association between C(-634)G polymorphism in the promotor region of vascualr endothelial growth factor (VEGF) and endometriosis. METHODS: The genomic DNA was extracted from 100 patients with surgically confirmed endometriosis and 100 control group from July 2003 to June 2004. Following extraction of genomic DNA, genotyping of C(-634)G polymorphism of VEGF gene was performed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). RESULTS: There was no significant difference in the frequency of CC genotype between the patients with endometriosis (21%) and the control group (19%). No significant difference in the frequency of allele of -634C was noted between the two groups (43.5% vs 44%), either. CONCLUSION: The C(-634)G polymorphism in the promotor region of VEGF gene is not associated with susceptibility to endometriosis in Korean women.

Clinical Review of the Etiologic Factors in Patients with Aambiguous Genitalia / 대한산부인과학회잡지

OBJECTIVE: To review and evaluate the etiologic factors in patients with ambiguous genitalia METHODS: We reviewed the medical records of the patients in whom ambiguous genitalia was identified in Asan Medical Center from Jan, 1989 to Dec, 2002. Patients with isolated cryptorchidism, isolated hypospadias, or congenital fatal anomalies involving multiple organs were excluded in our series. RESULTS: A total of 58 cases were evaluated. The most common cause was congenital adrenal hyperplasia (CAH) (18 cases, 31.0%), followed by partial androgen insensitivity syndrome (AIS) (16 cases, 27.6%), true hermaphroditism (9 cases, 15.5%), and mixed gonadal dysgenesis (5 cases, 8.6%). Morphologic abnormalities observed in patients with ambiguous genitalia were hypospadias (52.5%), clitoromegaly (47.5%), palpable gonads (45.8%), bifid scrotum (23.7%), penoscrotal transposition (22%), cryptorchidism (18.6%), vaginal wall abnormality (10.2%), and M llerian remnant (3.4%). By karyotyping, 46XX, 46XY, and Y containing mosaicism were found in 24, 22, and 9 patients, respectively. All of the 18 patients with CAH were found to have 21-hydroxylase deficiency and all cases of androgen insensitivity syndrome were partial type. CONCLUSION: These findings suggest that etiologic background might be different in patients with ambiguous genitalia in Korea.

Two Cases of Prenatal Diagnosis of 22q11.2 Deletion Syndrome (DiGeorge Syndrome) / 대한산부인과학회잡지

Before the exact location of its chromosomal abnormality was identified, 22q11.2 deletion syndrome was described as many different names depending on its presenting clinical features. Patients with this syndrome have a wide range of findings such as cardiac anomaly, abnormal face, thymic hypoplasia, cleft palate, and hypocalcemia. Cardiac involvement is a prominent feature and most of the patients have a conotruncal heart defect. 22q11.2 deletion is the most common chromosomal cause of congenital heart defect after trisomy 21. Familial transmission accounts for about 8 per cent of cases and most of the cases develop sporadically. Even in cases where this syndrome is inherited, the parents' chromosomal abnormalities are often discovered only after the deletion is suspected in their children. We describe two prenatal cases in which this syndrome was suspected by ultrasonogram and confirmed by fluorescent in situ hybridization (FISH). In both cases, there was no known prior family history of cardiac abnormalities or chromosomal abnormality. In one case, autopsy following termination further confirmed the diagnosis. In the other case, the mother was also found to have 22q11.2 deletion.