Combined hysteroscopic findings and 3-dimensional reconstructed coronal view of the uterus to avoid laparoscopic assessment for inpatient hysteroscopic metroplasty: pilot study.

STUDY OBJECTIVE: To assess the use of 3-dimensional (3D) reconstructed coronal view of the uterus and intraoperative hysteroscopic findings to avoid diagnostic laparoscopy during inpatient hysteroscopic metroplasty. DESIGN: Pilot study (Canadian Task Force classification II). SETTING: University hospital infertility clinic. PATIENTS: Fifty-nine patients with recurrent abortion and double uterine cavity with 3D sonographic diagnosis of septate uterus undergoing inpatient hysteroscopic metroplasty. INTERVENTIONS: Inpatient hysteroscopic treatment of septate uterus without laparoscopic diagnosis. In addition to sonographic observations, 2 intraoperative hysteroscopic criteria were used to confirm the diagnosis: visualization of muscular fibers and myometrial blood vessels. MEASUREMENTS AND MAIN RESULTS: Operative parameters (operative time and fluid absorption), complications (incomplete resection and uterine perforation), requirement for a second intervention, and shape of the uterine cavity at hysteroscopic follow-up. In 56 of 59 patients (94.9%), intervention was performed without complications, and in 3 cases, intervention was suspended because of intraoperative suspicion of bicornate uterus. These 3 patients underwent laparoscopy, which confirmed the diagnosis of septate uterus. In all cases, incision was considered sufficient. Postoperative diagnostic hysteroscopy in all patients showed a normal cavity (fundal notch <1 cm). CONCLUSIONS: Combined use of hysteroscopic confirming criteria and 3D sonography seems to be a reliable and simple strategy for characterizing the presence of septate uterus and to perform inpatient metroplasty usually without laparoscopic visualization of the uterine fundus.

Relevance of arginines in the mode of binding of H1 histones to DNA.

The mode of binding of sperm and somatic H1 histones to DNA has been investigated by analyzing the effect of their addition on the electrophoretic mobility of linear and circular plasmid molecules. Low concentrations of sperm histones do not appear to alter the electrophoretic mobility of DNA, whereas at increasing concentrations, an additional DNA band is observed near the migration origin. This band then becomes the only component at higher values. In contrast, somatic histones cause a gradual retardation in the mobility of the DNA band at low concentrations and aggregated structures are observed only at higher values. Experiments on the H1 globular domain obtained by limited proteolysis indicate that the mode of binding to DNA depends on the H1 globular domain. The arginine residues appear to be relevant for the different effects as indicated by experiments on sperm histone and on protamine with arginines deguanidinated to ornithines. The modified molecules influence DNA mobility like somatic H1s, indicating that the positive guanidino groups of arginines cannot be substituted by the positive amino groups of ornithines. Modifications of the amino groups of lysines show that these residues are necessary for the binding of H1 histones to DNA but they have no influence on the binding mode.

Leptin concentrations in the peritoneal fluid of women with ovarian endometriosis are different according to the presence of a 'deep' or 'superficial' ovarian disease.

Some studies have suggested a possible role of leptin, an active cytokine produced by adipocytes, in the pathogenesis of pelvic endometriosis. The present study was designed to assess leptin levels in the peritoneal fluid (PF) of women with the 'deep' or 'superficial' types of ovarian endometriosis. Twenty-seven women with a single ovarian endometrioma having a mean diameter between 3 and 5 cm were included in the study. Patients were divided into two groups according to the type of ovarian endometriosis: Group A (n = 11) consisted of women with 'superficial' endometriomas located at the ovarian surface; Group B (n = 16) included patients with 'deep' intra-ovarian endometriomas. Women undergoing laparoscopy for unexplained infertility and not affected by pelvic and/or ovarian endometriosis were considered as controls (Group C, n = 10). Patients with an ovarian endometrioma had significantly increased PF leptin concentrations than endometriosis-free controls (Groups A and B vs. Group C, p < 0.01). Patients with 'superficial' endometriomas had significantly higher PF leptin levels compared with patients with 'deep' endometriomas (Group A vs. B, p < 0.01). This difference remained significant after correction for the BMI; moreover, a positive correlation between PF leptin and BMI was observed in Groups B and C, but not in women with 'superficial' endometrioma (Group A). Our observations suggest that: (a) leptin could play an active role in promoting the development of 'superficial' ovarian endometriomas and (b) 'superficial' and 'deep' ovarian endometriomas could have a different pathogenesis.

Self-association of Chaetopterus variopedatus sperm histone H1-like. Relevance of arginine content and possible physiological role.

Self-association of histones H1 from calf thymus and from sperm of the marine worm Chaetopterus variopedatus was studied on native and glutaraldehyde cross-linked molecules by PAGE and by salt-induced turbidity measurements. Multiple polymers were generated by native sperm histone H1-like after glutaraldehyde cross-linking while the same treatment on its lysine- or arginine-modified derivatives and on somatic histone H1 failed to induce polymerization. This result suggests the relevance of arginine content in the formation of histone H1-like polymers particularly because Chaetopterus variopedatus and calf thymus histones H1 have similar content of lysine but different K/R ratio (2 and 15, respectively). Salt-induced turbidity experiments confirmed the high tendency of sperm histone H1-like to form oligomers, particularly in the presence of phosphate ions. Native PAGE analysis in the presence of phosphate supported this hypothesis. The reported results suggest that phosphate ions connecting lysine and arginine side chain groups contribute to the interaction of sperm histone H1-like with DNA in chromatin and play a key role in organization and stabilization of the chromatin higher order structures.

Compliance and diagnostic efficacy of mini-hysteroscopy versus traditional hysteroscopy in infertility investigation.

OBJECTIVE: The aim of this study was to compare traditional hysteroscopy with mini-hysteroscopy in terms of compliance, side effects and diagnostic efficacy. STUDY DESIGN: We prospectively considered 950 female candidates for an IVF programme. All women underwent outpatient hysteroscopy; in 602 cases (Group A) a mini-hysteroscope was employed; in 348 women (Group B) a 5-mm hysteroscope was adopted. RESULTS: Cavity findings were similar in both groups. Endometrial polyps and uterine septum seem to be more frequent in our infertile patients than in the general population. No significant differences in terms of side effects were found between the groups. Mean visual analogue pain scale score was significantly lower in the patients of Group A than in those of Group B (p<0.001). CONCLUSIONS: Office mini-hysteroscopy is a very effective diagnostic tool in an infertility work-up and is more widely accepted than traditional hysteroscopy. Routine use of the technique should be considered.

Gonadotropin-releasing hormone (GnRH) antagonist plus recombinant luteinizing hormone vs. a standard GnRH agonist short protocol in patients at risk for poor ovarian response.

Various studies have compared the efficacy of GnRH agonists (GnRH-a) and antagonists (GnRH-ant) for controlled ovarian stimulation (COS) in women undergoing IVF. Nevertheless, few data are available about the use of GnRH-ant in poor responders. Here, a flexible protocol providing a gradual increase in the dose of GnRH-ant in association with recombinant LH (rec-LH) administration is compared with the standard GnRH-a flare-up protocol in 133 women at risk for poor ovarian response. The mean number of metaphase 2 oocytes (primary end point) was significantly higher in the antagonist group (5.73 +/- 3.57 vs. 4.64 +/- 2.23, respectively; P<.05).