The relation of serum and follicular fluid leptin and ovarian steroid levels in response to induction of ovulation in in vitro fertilization cycles.

OBJECTIVE: Leptin restores energy homeostasis and regulates appetite and body weight by communicating the energy status to the central nervous system. Although there is strong evidence that leptin affects reproduction, its role in the control of reproductive physiology is little understood. STUDY DESIGN: We studied leptin concentrations in the serum and follicular fluid of 65 women undergoing ovarian hyperstimulation for in vitro fertilization (IVF). Fasting serum samples were collected (1) on the 3rd day of the cycle before IVF and (2) at the time of oocyte retrieval. Serum concentrations of leptin, estradiol (E2), progesterone, FSH, LH, prolactin, total testosterone, DHEA-SO4, and TSH and follicular fluid concentrations of leptin, E2, and progesterone were measured. RESULTS: Serum leptin values increased on average by 66.4% over basal leptin levels on the day of oocyte pick-up (OPU). A positive correlation between leptin increase and body mass index was observed. The serum leptin level was similar to that in follicular fluid o the day of OPU. E2 levels increased 34.5-fold with controlled ovarian hyperstimulation. There was a negative correlation between the increase in leptin levels and in E2 levels (P <0.05) and in the number of oocytes harvested (P <0.05). CONCLUSION: The significant increase in serum leptin levels during controlled ovarian hyperstimulation indicates a possible role of leptin in reproductive function. The increase in leptin levels is negatively correlated with ovarian response evaluated by E2 production and number of oocytes retrieved. This might be due to the reduced ovarian response through negative feedback of leptin to the ovaries at high levels.

Complete hydatidiform mole with coexistent live fetus in dichorionic twin gestation.

CASE REPORT: A 28-year-old patient gravida 3, para 2 was admitted at 16 weeks' gestation with the diagnosis of complete hydatidiform mole with coexistent live fetus (CHMCF) in dichorionic twin gestation. The betaHCG level was 530,000 mIU/ml. The pregnancy was terminated by hysterotomy. OUTCOME: Histopathologic analysis revealed a hydatidiform mole and a 17-week-old male fetus attached to the normal looking placenta by a double-vesseled cord. A final karyotype on cord blood samples confirmed normal 46 XY. Weekly performed serial betaHCG values showed declining trend and were undetectable by 10 weeks post delivery.

Ratio of middle cerebral to umbilical artery blood velocity in preeclamptic & hypertensive women in the prediction of poor perinatal outcome.

BACKGROUND & OBJECTIVES: Doppler velocimetry studies of placental and foetal circulation can provide important information regarding foetal well-being providing an opportunity to improve foetal outcome. The present study was undertaken to evaluate the role of middle cerebral to umbilical artery blood velocity waveform's systolic/diastolic ratio (MCA/UA) and biophysical profile as a predictor of perinatal outcome in hypertensive and preeclamptic pregnant women during the late third trimester. METHODS: Fifty preeclamptic pregnant women selected randomly in the last three weeks of the third trimester were stratified into two groups based on the MCA/UA ratio. All women were evaluated by foetal biophysical profile scoring. Thirty four women with foetal MCA/UA ratios > 1 and 16 with < or =1 were recruited in groups A and B respectively. The results of the ratio, and biophysical profile were evaluated with respect to the outcome of the infants and adverse perinatal outcome, defined as perinatal death, foetal cord blood gas analyses, cesarean delivery for foetal distress, admission to the neonatal intensive care unit, days in the neonatal intensive care unit (NICU) or low Apgar score. RESULTS: Rate of cesarean delivery was significantly (P<0.001) higher in group B than group A. There was a statistically significant increase in perinatal morbidity in B group. Apgar scores at 1 and 5 min were found to be lower in group B than group A. Umbilical cord blood partial oxygen pressure (pO2), partial carbon dioxide pressure (pCO2) was not different in the two groups; whereas, pH was lower in group B. In group A two neonates (5.9%) and in group B 12 neonates (75%) required admission in neonatal intensive care unit. Best cut-off levels of MCA, MCA/UA ratios were found to be 3 and 1, respectively. INTERPRETATION & CONCLUSION: The MCA/UA was valuable for predicting the outcome of preeclamptic and hypertensive pregnancies. When the ratio was <1, foetal prognosis was poor.

Asymmetric parasitic dicephalus conjoined twins.

In this report, we describe the case of a 19-year-old primigravida pregnant woman who had been hospitalized for 2 days with bleeding and a diagnosis of imminent abortion. Sonographic examination revealed a single fetus of approximately 17 weeks' gestation that initially appeared normal except for a mass on its neck. Further evaluation of the mass identified it as an anencephalic fetal head that was joined to the body with deformed cervical vertebrae. We diagnosed asymmetric parasitic dicephalus conjoined twins. The parents elected to terminate the pregnancy. Labor was induced, and the patient delivered a 20-cm, 208-g male fetus. The fetus had 4 normal limbs and a normal abdomen. Both its heads had a cleft lip, and its spine was U shaped with closed spina bifida at the spinal union in the thoracolumbar area. The patterns of conjoined twins are infinitely varied, but they can be generally classified according to standardized terms based on the anatomic site of their union. Cases of conjoined twins occur so rarely that it is important to learn as much as possible from each case.

High basal estradiol level and FSH/LH ratio in unexplained recurrent pregnancy loss.

BACKGROUND: The potential role of diminished ovarian reserve in unexplained recurrent pregnancy loss (RPL) in a retrospective comparative analysis. METHODS: Eighty women with RPL underwent routine work-up to exclude known associations of RPL. Serum FSH, LH and E(2) levels were assessed on the 3rd day of the menstrual cycle. Following investigation, 58 women failed to reveal an identifiable cause and are therefore classified as unexplained RPL. Control group consisted of women in whom the cause of abortions was known such as uterine septum and parental chromosomal abnormalities. Mean age, gravidity, parity, presence of infertility, previous number of miscarriages, duration of marriage were similar in both groups. Day 3 serum levels of FSH, E(2) and FSH: LH ratios were compared in the two groups. RESULTS: Elevated FSH concentrations were equally distributed in the unexplained RPL and control groups. Both day 3 E(2) and FSH:LH ratio were elevated in the unexplained RPL group compared with the control group ( p=0.0066 and p=0.0187 respectively). The percentage of women with elevated FSH and/or E(2) levels on day 3 were significantly higher in the unexplained RPL group than in controls ( p=0.0045). CONCLUSIONS: Unexplained RPL may be associated with diminished ovarian reserve and should be considered in the workup of RPL.

The effect of metformin treatment to ovarian response in cases with PCOS.

OBJECTIVE: To examine the effect of metformin therapy on ovarian response in clomiphene-resistant PCOS patients. DESIGN: Randomized prospective study. SETTING: Zeynep Kamil Hospital IVF Center. PATIENTS: Thirty-two female PCOS patients with clomiphene citrate resistance. INTERVENTIONS: Test group A received 2x850 mg/day metformin therapy for 8 weeks, followed by gonadotropin induction. Only gonadotropin induction was applied to Control group B. MAIN OUTCOME MEASURES: Total gonadotropin dosage, duration of gonadotropin therapy, estradiol level on HCG-day, number of follicles with >or=16 mm diameter, number of cases with hyperstimulation development, number of cancelled cycles, endometrial thickness on HCG-day, pregnancy outcome, multiple pregnancy rate. RESULTS: The total gonadotropin doses given to metformin-study group was significantly lower than the control group. In addition, duration of therapy, HCG level, plasma estradiol level on HCG-day in the study group was significantly lower than in the control group. CONCLUSIONS: Metformin therapy has led to a higher pregnancy outcome, as well as to a decrease in hyperstimulation risk, cycle cancellations, and multiple pregnancy rates with a lower gonadotropin dosage.