The strain rate of endometrium measured by real-time sonoelastography as a predictive marker for pregnancy in gonadotropin stimulated intrauterine insemination cycles.

AIM: Sonoelastography is an imaging technique that measures tissue strain quantitatively. This study aims to investigate whether the strain rate of endometrium measured by elastography can predict pregnancy after intrauterine insemination (IUI). METHODS: This study examined 197 gonadotropin-stimulated IUI cycles of 148 women diagnosed with unexplained infertility from February 2019 to November 2020. Endometrial thickness, pattern, and strain rate were measured by transvaginal ultrasonography immediately before the insemination. The endometrium and the parametrial tissue were selected for regions of interest, and the strain rate was calculated. The measurements were analyzed concerning the IUI outcome. RESULTS: Of the 197 IUI cycles, the pregnancy rate was 15.20% (n = 30), and ongoing pregnancy rate was 12.2% (n = 24). The mean strain rates were not different between pregnant and nonpregnant groups (2.68 ± 1.28 vs. 2.81 ± 1.32, p = 0.651). Strain rate was not predictive for pregnancy, shown by receiver operating characteristic curve analysis; the area under the curve was 0.526 (95% CI 0.413-0.639; p = 0.649). Pregnancy rates were significantly affected by the women's age and the inseminated sperm count. In multiple logistic regression analysis, the other parameters, including body mass index, anti-Müllerian hormone, endometrial thickness, endometrial strain rate, and echogenic endometrial pattern, did not significantly change the odds ratio of pregnancy. CONCLUSION: The endometrial strain rate does not significantly affect the pregnancy rates in gonadotropin stimulated IUI cycles. It appears that strain rate does not predict IUI outcome. More research is needed to evaluate the usefulness of sonoelastography in infertility treatments.

Decreased serum human leukocyte antigen-G levels are associated with gestational diabetes mellitus.

AIM: This study was designed to determine serum human leukocyte antigen-G (HLA-G) levels and establish whether serum HLA-G level is related with gestational diabetes mellitus (GDM). METHODS: Twenty-five GDM patients aged between 24 and 34 years and 24 healthy pregnant women aged between 22 and 33 years were included in this study. Health status of subjects was determined by medical history, physical, and obstetric examinations. Absence of family history for Type 2 diabetes mellitus, absence of diagnosis or clinical evidence of any major disease, and absence of medication use altering glucose metabolism constituted the inclusion criteria. GDM cases who are at their 24-28 weeks of pregnancy and who have not been using any oral hypoglycemic agents were included in GDM group. Control group consisted of healthy pregnant women at their 24-28 weeks of pregnancy. RESULTS: Women with GDM had significantly lower levels of serum HLA-G than controls. HLA-G levels were negatively correlated with all parameters of glucose metabolism including insulin (r = - 0.14; p = 0.338), fasting blood glucose (r = - 0.220; p = 0.129), 1-h oral glucose tolerance test (OGTT) blood glucose (r = - 0.18; p = 0.271), 2-h OGTT blood glucose (r = - 0.314; p = 0.172), homeostasis model assessment (r = - 0.226; p = 0.119), HbA1C (r = -0.342; p = 0.108), and WBC (r = -0.149; p = 0.307). There was a negative correlation between HLA-G and BMI (r = -0.341; p = 0.016). CONCLUSION: Decreased circulating HLA-G level is found to be associated with insulin resistance and GDM, in this study.

Serum Caspase-1 levels in women with polycystic ovary syndrome.

OBJECTIVE: Caspase-1 is implicated in several important inflammatory diseases and controls adipocyte differentiation and insulin sensitivity. Interleukin-10 (IL-10) is an anti-inflammatory cytokine and plays an important role in chronic inflammatory conditions. This study was planned to determine if there is any relationship between Caspase-1 and IL-10 levels in women with PCOS. MATERIALS AND METHODS: Forty-two women with PCOS and thirty-seven healthy controls were evaluated in this controlled clinical study. Caspase-1 and IL-10 levels, serum lipid sub-fractions, fasting glucose, fasting insulin and other hormones (gonadotropins, androgens), malondialdehyde (MDA) and glutathione (GSH) levels were measured. Homeostasis model assessment (HOMA-IR) was used to estimate insulin resistance. RESULTS: Free androgen index (FAI), HOMA-IR, MDA and Caspase-1 levels were significantly higher in subjects with PCOS. However, the women with PCOS had considerably lower GSH concentration levels than healthy subjects. Serum IL-10 levels were higher in study subjects than in controls, though it was statistically insignificant. Caspase-1 was positively associated with IL-10. CONCLUSION: These outcomes propose that Caspase-1 may have a role in triggering the processes leading to chronic low-grade inflammation in women with PCOS, independent of insulin resistance, androgen excess and oxidative stress. Nevertheless, the precise role of Caspase-1 in the pathogenesis of the disease remains to be elucidated.

Ischemia-modified albumin in preterm infants born to mothers with pre-eclampsia.

BACKGROUND: Pre-eclampsia (PE) carries an increased risk for maternal and/or fetal mortality or serious morbidity. PE is associated with ischemia and increased oxidative stress in the placenta, which may lead to modification of plasma albumin to ischemia-modified albumin (IMA). The aim of this study was to investigate IMA and hematological parameters in mothers and in premature infants in normal and in pre-eclamptic pregnancies. METHODS: Twenty-five pregnant women with PE and their premature newborns were categorized as the PE group, and 25 normotensive pregnant women and their premature newborns as the control group. Preterm infants are classified as small for gestational age (SGA) or non-SGA according to the Fenton preterm growth chart. Serum IMA, complete blood count (CBC), liver function tests (LFT), renal function tests (RFT), albumin, and C-reactive protein were measured in the mothers immediately before birth, and in the cord blood and serum of the newborns at 6 and 24 h after birth. Clinical and demographic data were recorded for both groups. RESULTS: While IMA, LFT and RFT were significantly increased in the PE group compared with the control group, albumin and CBC were significantly lower in the PE group. A total of 40% of PE newborns were SGA, 30% of whom had severe SGA (birthweight <3rd percentile). Cord IMA was significantly increased in all preterm neonates in the PE group compared with the control group. No mothers or neonates died. CONCLUSION: Serum IMA in addition to the prevalence of SGA were significantly increased in the PE group. Cord blood IMA, therefore, might be a predictive biomarker for SGA in PE pregnancies.

Comparison of the efficacy of perineal and intravaginal biofeedback assisted pelvic floor muscle exercises in women with urodynamic stress urinary incontinence.

OBJECTIVE: To assess the effectiveness of intravaginal pressure biofeedback (P-BF) and perineal electromyographic biofeedback (EMG-BF) assisted pelvic floor muscle (PFM) exercises in women with stress urinary incontinence (SUI). MATERIAL AND METHODS: Fifty-three women with SUI were randomized into three groups as follows: the Group 1 received PFM home exercise program alone (n:18); the Group 2 received PFM home exercise program plus intravaginal P-BF assisted PFM exercise program (n:17); and the Group 3 received PFM home exercise program plus perineal EMG-BF assisted PFM exercise program (n:18). Subjects were also assessed with the 1-h pad test (severity of incontinence), perineometer (PFM strength), social activity index (SAI), IIQ7 (quality of life associated with incontinence), treatment success (cure and improvement rate) and treatment satisfaction. RESULTS: A statistically significant improvement was found in all parameters for all groups at 4th week and 8th week compared to the baseline values. It was found that severity of incontinence, PFM strength, and SAI scores were significantly improved in both BF groups compared to the Group 1 at 8th week. Also, statistically higher cure and improvement rate and treatment satisfaction values were detected in both BF groups compared to the Group 1. There was no statistically significant difference between Group 2 and Group 3 in all parameters evaluated at the follow-up period. CONCLUSIONS: We conclude that both the home exercises plus intravaginal P-BF and home exercises plus perineal EMG-BF are superior to home exercises in women with SUI. Intravaginal P-BF and perineal EMG-BF were similarly effective and they can be used as their alternatives.

Serum HLA-G levels in women with polycystic ovary syndrome.

This study was designed to determine serum human leukocyte antigen-G (HLA-G) levels and establish whether serum HLA-G level is related with insulin resistance, oxidative stress, dyslipidemia and ovarian hyperandrogenism in women with polycystic ovary syndrome (PCOS). Twenty-five patients with PCOS and 23 healthy control women were evaluated in this study. Serum HLA-G, lipid fractions, glucose, insulin, malondialdehyde (MDA), glutathione (GSH), white blood cell (WBC), sex hormone-binding globulin (SHBG) and other hormone (gonadotropins and androgens) levels were measured. The estimate of insulin resistance was calculated by homeostasis model assessment (HOMA-IR). Serum luteinizing hormone (LH), total testosterone, fasting insulin, WBC levels and LH/follicle-stimulating hormone (FSH) ratio, free androgen index (FAI) and HOMA-IR values were significantly higher in patients with PCOS compared with healthy women. However, the women with PCOS had considerably lower serum FSH, SHBG, MDA, GSH and HLA-G levels than healthy subjects. HLA-G was inversely related with HOMA-IR, FAI, LH/FSH ratio and WBC, but positively with high-density lipoprotein cholesterol. Decreased serum HLA-G level may be related with insulin resistance, ovarian hyperandrogenism and oxidative stress in women with PCOS. Nevertheless, the exact role of HLA-G in the pathogenesis of the disease remains to be elucidated.

1-alpha,25-dihydroxyvitamin D3 regresses endometriotic implants in rats by inhibiting neovascularization and altering regulation of matrix metalloproteinase.

BACKGROUND: The exact pathogenesis of endometriosis has not been completely discerned. 1-alpha,25-dihydroxyvitamin D3 (1,25[OH][2]D[3]) has been shown to have an anti-angiogenic effect and extracellular matrix-proteases-degrading properties. We hypothesized that 1,25(OH)(2)D(3) may have therapeutic value in the treatment of endometriosis. METHODS: Endometrial tissue was implanted into the abdominal peritoneum of 21 Wistar albino rats; the rats were randomized into 3 groups. In Group A (simultaneous group), we simultaneously induced endometriosis and began 1,25(OH)(2)D(3) treatment. Group B rats (sequential group) were treated after endometriosis was documented. Animals in Group C (control group) were followed without any treatment after the development of endometriosis. RESULTS: Histologic score, mean volume, and weight of the explants in Group A and B were found to be significantly lower than those of the control group. Levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) immunoreactivities in Group A and B were also significantly lower compared with Group C. In contrast, intensities of immunoreactivity staining for tissue inhibitor of metalloproteinase-2 (TIMP-2) in Group A and B were significantly higher than that of the control group. CONCLUSION: 1,25(OH)(2)D(3) regresses endometriotic implants in rat models by altering implant levels of VEGF, TIMP-2, and MMP-9.

Serum Fetuin-A levels, insulin resistance and oxidative stress in women with polycystic ovary syndrome.

This study was designed to determine serum Fetuin-A levels and establish whether serum Fetuin-A level is related with insulin resistance, oxidative stress, ovarian hyperandrogenism and dyslipidemia in women with polycystic ovary syndrome (PCOS). Twenty-two patients with PCOS and twenty-one healthy control women were evaluated in this controlled clinical study. Serum Fetuin-A, lipid fractions, glucose, insulin, malondialdehyde (MDA), myeloperoxidase (MPO), glutathione (GSH), superoxide dismutase (SOD) and other hormone (gonadotropins, androgens) levels were measured. The estimate of insulin resistance was calculated by homeostasis model assessment (HOMA-R). The women with PCOS had significantly higher serum fasting glucose, insulin, luteinizing hormone (LH), MDA, Fetuin-A levels, and LH/follicle-stimulating hormone (FSH) ratio, free androgen index (FAI), HOMA-IR than healthy women. However, sex hormone-binding globulin (SHBG) and GSH levels were significantly lower in patients with PCOS compared with controls. Fetuin-A was positively correlated with insulin, HOMA-IR and FAI. Multiple regression analysis revealed that FAI was strong predictor of serum Fetuin-A level. Serum Fetuin-A level was related with insulin resistance and ovarian hyperandrogenism in women with PCOS. These results suggest that Fetuin-A may have a role in triggering the processes leading to insulin resistance and androgen excess in PCOS.

Serum calcitonin gene-related peptide levels in women with polycystic ovary syndrome.

PURPOSE: Calcitonin gene-related peptide (CGRP) is an amino acid neuropeptide with widespread expression. It has potent effects on lipid and energy metabolism. It induces insulin resistance. This study was planned to determine CGRP levels in women with polycystic ovary syndrome (PCOS). METHODS: Forty-seven women with PCOS and 34 healthy controls were evaluated in this controlled clinical study. Serum lipid sub-fractions, postprandial and fasting glucose, insulin and other hormones (gonadotropins, androgens) and CGRP levels were measured. Homeostasis model assessment (HOMA-IR) was used to estimate insulin resistance. RESULTS: Waist measurements, postprandial and fasting glucose and fasting insulin levels and free androgen index and HOMA-IR were significantly higher in subjects with PCOS. However, the women with PCOS had considerably lower high-density lipoprotein cholesterol levels than healthy subjects. Serum CGRP levels were higher in study subjects than in controls, although it was statistically insignificant. CONCLUSIONS: Serum CGRP level was not related with insulin resistance, ovarian hyperandrogenism and dyslipidemia in abdominally obese women with PCOS. These outcomes propose that CGRP may not play a pivotal role in the pathogenesis of PCOS.

Cadmium intoxication of pregnant rats and fetuses: interactions of copper supplementation.

BACKGROUND AND AIMS: Cadmium (Cd) is an industrial and environmental pollutant that was shown to be involved in the development of some diseases. Due to high amounts of Cd in cigarettes, smokers and passive smokers are exposed to high amount of Cd. We aimed to determine whether Copper (Cu) supplementation would have a protective effect against Cd intoxication in pregnant rats and their fetuses. METHODS: Experiments were performed on 27 adult female Wistar albino rats divided into three experimental groups. CdCl(2), CdCl(2) plus CuSO(4) and only drinking water was given to different groups for 21 days. We measured cadmium (Cd), malondialdehyde (MDA), reduced glutathione (GSH), myeloperoxidase (MPO), superoxide dismutase (SOD) and catalase (CAT) levels in dams' liver, dams' kidney, fetus liver, fetus kidney, and placenta of rats. RESULTS: In all tissues of Cd and Cd + Cu-treated groups, Cd levels were found to be increased significantly when compared to control group. MDA levels and MPO activities were significantly increased whereas GSH levels, activities of SOD and CAT were decreased in Cd groups when compared to control group. Cu supplementation significantly prevented the increment in MDA levels and brought MPO activities back to control levels or below. Cd-induced reductions in GSH levels and SOD activities were also prevented by Cu supplementation. An increase of CAT activity after Cu supplementation was enough to revert to the control levels in some tissues. CONCLUSIONS: Our findings suggest that Cu supplementation may have a protective effect against the Cd-induced oxidative stress in liver, kidney and placental tissues of pregnant rats and fetuses.

Sonohysterography in evaluation of Youssef's syndrome.

A 31-year-old woman with Youssef syndrome was reported. Vesicouterine fistula is responsible for the symptoms of Youssef syndrome. An easy and feasible diagnostic method of vesicouterine fistula is sonohysterography.

Endometriosis in two sisters with Glanzmann's thrombasthenia.

OBJECTIVE: To present two cases of endometriosis in patients with Glanzmann's thrombasthenia (GT) and discuss the underlying pathophysiology of endometriosis. DESIGN: Case report. SETTING: Gynecology practice in a university teaching hospital. PATIENT(S): Two sisters, aged 24 and 28 years, previously diagnosed as having GT. INTERVENTION(S): Surgical exploration. MAIN OUTCOME MEASURE(S): Pathologic examination of surgical specimens was performed. RESULT(S): A diagnosis of endometriosis was confirmed pathologically for two sisters previously diagnosed as having GT. CONCLUSION(S): Women with GT seem to represent an important human model of endometriosis from which important data on the pathophysiology of endometriosis can be acquired.

The nitroxide tempol has similar antioxidant effects as physiological levels of 17beta-oestradiol in reversing ovariectomy-induced oxidative stress in mice liver and kidney.

OBJECTIVE: Oestrogen defciency increases oxidative stress postmenopause, while tempol is an intracellular radical scavenger that interferes with the formation or effects of many radicals. We aimed to investigate the effects of oestrogen and tempol on oxidative stress parameters in the kidney and liver of ovariectomized mice. MATERIAL AND METHODS: Forty 8-week-old female Bald/c mice were divided into five groups: sham-operated, ovariectomized mice without treatment, ovariectomized mice treated with tempol, ovariectomized mice treated with 17beta-oestradiol and ovariectomized mice treated with 17beta-oestradiol and tempol. Oxidative stress in liver and kidney tissues was investigated by measuring 2-thiobarbituric acid reactive substances (TBA-RS), reduced glutathione, myeloperoxidase, superoxide dismutase and catalase levels. RESULTS: TBA-RS levels were increased and reduced glutathione, myeloperoxidase, superoxide dismutase levels were decreased in the tissues of ovariectomized mice. This effect of ovariectomy on oxidative stress parameters was opposed significantly by the administration of tempol and 17beta-oestradiol either alone or in combination. Ovariectomy reduced the kidney catalase levels, but the effect was not statistically significant (p>0.05). On the other hand, catalase levels were elevated significantly in all treatment groups compared to those of the ovariectomized group (p<0.05). CONCLUSION: These study findings demonstrate that tempol significantly opposes the oxidative stress generated by ovariectomy. This effect, which is evident in remote tissues such as liver and kidney, is comparable to that of physiological levels of oestradiol.

Effect of hormone replacement therapy on clitoral artery blood flow in healthy postmenopausal women.

INTRODUCTION: Aging and the decline of ovarian hormonal secretion during menopause may alter libido, and sexual response and functioning. The effects of hormone replacement therapy (HRT) on the genital vascular hemodynamics have been widely studied. However, there is a lack of knowledge about the effect of HRT on basal clitoral blood flow. AIM: The aims of this study were to measure clitoral artery blood flow and to determine whether HRT has a significant effect in clitoral artery blood flow in postmenopausal women. METHODS: Doppler sonography of clitoral arteries was performed in 25 postmenopausal women aged 51.3 +/- 4.5 years who had been using a continuous combined HRT (0.625 mg of conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate, in 1 tablet daily) for 2.0 +/- 1.1 years, and the clitoral artery peak systolic velocity, resistance index (RI), and pulsatility index (PI) were measured. Thirty-five postmenopausal women aged 50.0 +/- 4.2 years who had not used HRT served as a control group. MAIN OUTCOME MEASURES: Assessment of clitoral blood flow with color Doppler ultrasonography by measuring the peak systolic velocity, RI, and PI. RESULTS: Clitoral artery circulation was easily detectable by the color Doppler sonography. The clitoral artery peak systolic velocities were significantly higher in postmenopausal women taking HRT compared with the control group (11.8 +/- 5.2 cm/second vs. 15.0 +/- 5.4 cm/second, P = 0.025). CONCLUSION: HRT improves blood flow to the clitoris. A clitoral blood flow evaluation may be proposed as a potential tool to assess the impact of HRT on the genital tissues and to investigate female sexual response disorders in postmenopausal women.

Serum total L-carnitine levels in non-obese women with polycystic ovary syndrome.

BACKGROUND: Carnitine plays essential roles in energy production, oxidative stress and glucose metabolism. This study was planned to determine serum total L-carnitine levels in non-obese women with polycystic ovary syndrome (PCOS). METHODS: There were 27 non-obese women with PCOS and 30 healthy, age- and body mass index (BMI) matched controls were evaluated in this controlled clinical study. Serum lipid sub-fractions, fasting glucose, insulin and other hormones (gonadotrophins, androgens) and total L-carnitine levels were measured. Homeostasis model assessment (HOMA-IR) was used to estimate insulin resistance. RESULTS: The women with PCOS had significantly higher serum dehydroepiandrosterone sulfate, total testosterone, free androgen index (FAI), luteinizing hormone (LH), low-density lipoprotein (LDL) cholesterol, non-high density lipoprotein (HDL) cholesterol, fasting insulin levels and HOMA-IR measurement and LH/FSH ratios than healthy women. However, total L-carnitine and sex hormone-binding globulin (SHBG) levels were significantly lower in women with PCOS. L-Carnitine level was negatively correlated with FAI, but positively correlated with SHBG. Multiple regression analysis revealed that SHBG was a strong predictor of serum total L-carnitine level. CONCLUSIONS: Decreased total L-carnitine levels may be associated with hyperandrogenism and/or insulin resistance in non-obese women with PCOS. Long-term studies are needed to evaluate carnitine metabolism in PCOS, especially with regard to the molecular basis.

Endometrioid carcinoma of the endometrium with choriocarcinomatous differentiation: a case report and review of the literature.

OBJECTIVE: An endometrioid adenocarcinoma (EAC) with true trophoblastic differentiation is a rare event with a highly aggressive clinical course. CASE: We report an endometrioid adenocarcinoma of the endometrium in which there was a morphologically conventional-appearing EAC component admixed with multinucleated giant cells and large pleomorphic tumor cells that resembled a choriocarcinoma without an elevated serum level of human chorionic gonadotropin (hCG) in a 42-year-old unmarried woman with a history of abnormal uterine bleeding. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Histopathologic study of the specimen showed endometrioid adenocarcinoma extended to the deep myometrium with a focus of hemorrhagic and necrotic tumor composed of multinucleated giant cells, large pleomorphic tumor cells, suggesting choriocarcinomatous differentiation (CD). Immunohistochemical studies demonstrated intense reactivity of tumor cells for human chorionic gonadotropin (hCG) confirming the diagnosis. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. The patient was alive with no evidence of disease 6 months later. CONCLUSION: Although endometrioid adenocarcinoma with choriocarcinomatous differentiation is known to behave in a more aggressive course, this disease may have a good prognosis with a clinically indolent course when it is small, and without elevated serum hCG levels.

Laparoscopic management of a primary ectopic ovarian pregnancy and vaginal douching as a possible cause.

CASE REPORT: Ovarian pregnancy is a rarely seen form of ectopic pregnancies. We present a 34-year-old women who had a diagnosis of ovarian ectopic pregnancy based on clinical and laboratory findings. Laparoscopic surgery was performed for conservative management of the case. Risk factors are outlined and vaginal douching as a possible cause for ectopic pregnancies have been discussed. CONCLUSION: We suppose that frequent vaginal douching may be a risk factor for the development of ovarian ectopic pregnancies.

New insights into the pathophysiology of gestational diabetes mellitus: possible role of human leukocyte antigen-G.

Diabetes can develop in up to 10% of pregnant women who have not previously had the condition. This condition which usually begins in the second half of the pregnancy is called gestational diabetes mellitus (GDM). In most cases, all diabetic symptoms disappear following delivery. However, women with GDM have an increased risk of developing type 2 diabetes mellitus (DM) later in life, especially if they were overweight before the pregnancy. The cause of GDM is unknown. Although hormones present in the pregnancy, especially human placental lactogen, are thought to be responsible for the development of this condition, many questions remain to be answered. It is still not known why GDM develops in a subgroup of pregnant women. It may be possible that events leading to the development of GDM are triggered by an antigenic load which is the fetus itself. Human leukocyte antigen-G (HLA-G) expression that functions to protect the fetus from immune attack by down-regulating cytotoxic T cell responses to fetal trophoblast antigens is postulated to protect the islet cells of the pancreatic tissue also. HLA-G and nuclear factor-kappaB (NF-kappaB) interaction is suggested to be central in the events leading to GDM development. An analogy between the development of DM in some transplant patients and GDM development in a proportion of pregnancies is postulated, so that an antigenic load triggers the diabetogenic process. Further support of this hypothesis with new studies may lead to the possibility that recombinant HLA-G can be used for the prevention of diabetes in high risk patients.

Spontaneous ovarian hyperstimulation syndrome in a normal singleton pregnancy.

OBJECTIVE: It is known that most cases of ovarian hyperstimulation syndrome (OHSS) are associated with the therapies for ovulation induction. However, OHSS may rarely be associated with a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism or polycystic ovary syndrome. CASE REPORT: A case of OHSS in a woman who became pregnant naturally and who had no underlying disease is presented here. The patient was managed expectantly with no complications. CONCLUSION: Although spontaneous ovarian hyperstimulation is a rare entity, it is important to differentiate it from other causes of ovarian enlargement. Occasionally, life-threatening situations may occur, but it is usually a self-limiting process.