Effect of GnRH antagonist therapy on the expression of MUC-1 and heparin binding growth factor expression in the endometrium of hyperstimulated rats.

PURPOSE: To determine the effect of GnRH-antagonist therapy on the expression of heparin binding-epidermal growth factor (HB-EGF) and MUC-1 glycoprotein in hyperstimulated rat ovaries. METHODS: 30 female Wistar rats were divided into three groups (control, FSH and FSH+cetrorelix). Control rats were given 0.2 ml oil/saline mixture for four days beginning from the day of estrus. In the second group, 30 IU/ml purified hFSH was injected SC for four days beginning from the day of estrus. The rats of the third group were injected 30 IU FSH for four days and 10 IU cetrorelix SC for three or four days. The rats were sacrificed and the staining intensity of HB-EGF and MUC-1 of the epithelial cells and stromal cells of the endometrium of the rats was calculated by H-score. RESULTS: Slight MUC-1 immunoreactivity was seen in the epithelial and decidual cells of the control and FSH groups. In the FSH+cetrorelix group, moderate MUC-1 immunostaining appeared in the epithelial and desidual cells. In rats in the control and FSH+cetrorelix groups, HB-EGF immunoreactivity in the epithelial cells and decidual cells was moderate. Strong immunoreactivity was seen in the FSH group. When the MUC-1 H-score values were compared statistically with the control and other groups, FSH+cetrorelix immunoreactivity in epithelial and decidual cells were significantly different from control and FSH groups. HB-EGF immunoreactivity of the epithelium and decidua was similar in the control and FSH+cetrorelix groups, but epithelial and decidual immunoreactivity of the FSH group was different from the other two groups. CONCLUSION: Our findings suggest that GnRH antagonists exert direct effects on the expression of HB-EGF and MUC-1 expression in the rat endometrium.

Evaluation of VEGF in placental bed biopsies from preeclamptic women by immunohistochemistry.

OBJECTIVE: The aim of the study was to determine VEGF protein with immunohistochemical staining in placental bed biopsies of preeclamptic pregnancies in comparison to normal controls. DESIGN: Prospective cohort study. METHODS: The placental bed biopsies were obtained from 12 patients with preeclapmsia and ten patients for a control group at the time of cesarean delivery. Tissue samples of the placental bed were examined for VEGF protein distribution with avidin-biotin-peroxidase immunohistochemistry. Two blinded histopathologists were asked to score each sample for the intensity of staining and the number of cells stained in a randomly selected HPF of each sample. The resulting "H-score" was computed as a product of intensity and percent of cells stained. RESULTS: VEGF expression was significantly lower in both the myometrium and stroma of the preeclamptic group compared to the control group (77.2 +/- 25.4 vs 134 +/- 44.3, p = 0.007; 194.1 +/- 20.7 vs 170.2 +/- 17, p = 0.017, respectively). CONCLUSION: VEGF expression is significantly lower in placental bed biopsies of preeclamptic pregnancies.

Mode of delivery and pelvic floor muscle strength and sexual function after childbirth.

OBJECTIVE: To investigate the respective roles of the mode of delivery and strength of pelvic floor muscles in the sexual function of women. METHOD: Thirty-two women who were delivered vaginally and 21 women who underwent cesarean delivery at the Celal Bayar University School of Medicine Obstetrics Department were enrolled in the study, and 15 nulliparas were recruited as controls. Sexual function was assessed in all women by a validated questionnaire (the Female Sexual Function Index). Desire, arousal, lubrication, orgasm, satisfaction, and pain were measured separately, and pelvic floor muscle strength was assessed by a perineometer. Sexual function was compared among the 3 groups. The correlation between pelvic floor muscle strength and sexual function was also investigated. RESULTS: Pelvic floor muscle strength was significantly lower in the group vaginally delivered compared with the group delivered by cesarean section and the nulliparous group (P<0.05). There was no difference between the groups regarding sexual function (P>0.05), and there was also no correlation between sexual function and pelvic muscle strength. CONCLUSION: Pelvic floor muscle strength and mode of delivery did not affect sexual function in our study participants. The muscular component of female sexual function should be further investigated.

Assessment of fetal cerebral arterial and venous blood flow before and after vaginal delivery or Cesarean section.

OBJECTIVES: To compare perinatal intracranial arterial and venous blood velocity changes between healthy term neonates delivered vaginally or by Cesarean section and to correlate these changes with cord blood gases and pH values at birth. METHODS: The study involved 43 healthy term neonates who were delivered vaginally (n = 20) or by Cesarean section (n = 23). All fetuses/neonates were examined by Doppler ultrasound to obtain middle cerebral artery (MCA) and cerebral transverse sinus (Tsin) Doppler waveforms on three occasions (before delivery, and 1 h and 24 h after birth). Pulsatility index (PI) and peak systolic velocity (PSV) for MCA and Tsin were measured and compared between neonates who were delivered vaginally or by Cesarean section. Umbilical cord blood samples were analyzed for umbilical artery and vein pH, pO(2) and pCO(2) and values were correlated with MCA and Tsin Doppler indices. RESULTS: MCA-PI increased and MCA-PSV decreased at 1 h after birth, and Doppler measurements returned to predelivery values at 24 h after birth. Tsin Doppler measurements remained unchanged at 1 h and 24 h when compared to predelivery values in both the Cesarean and vaginal delivery groups. There was a negative correlation between Tsin-PI before birth and umbilical venous pH. There was a positive correlation between Tsin-PSV at 1 h after birth and umbilical vein pCO(2). CONCLUSIONS: Cerebral arterial blood velocity decreases immediately after birth and increases within 24 h, probably as part of neonatal adaptation. Cerebral venous blood velocity remains constant during the perinatal period and is likely to be regulated in a different and more complex manner than that of arterial blood velocity. Mode of delivery does not affect cerebral blood velocity.

Migration of an intrauterine contraceptive device to the sigmoid colon: a case report.

BACKGROUND: Copper T intrauterine devices (IUDs) remain the mainstay of family planning measures in developing countries, but have been associated with serious complications such as bleeding, perforation and migration to adjacent organs or omentum. Although perforation of the uterus by an IUD is not uncommon, migration to the sigmoid colon is extremely rare. Here, we report a case of migration of an IUD to the sigmoid colon. CASE REPORT: A 40-year-old woman who had an IUD (Copper T), inserted 1 month after delivery, presented, 7 months later, with secondary amenorrhea and transient pelvic cramps. Clinical findings and ultrasonographic examinations of the patient revealed an 8-week pregnancy, while laboratory tests were normal. Transvaginal ultrasonography also visualized the IUD located outside the uterus, near the sigmoid colon, as if it were attached to the bowel. The pregnancy was terminated at the patient's wish; a diagnostic laparoscopy was performed concomitantly, which showed bowel perforation owing to the migration of the IUD. The device, which was partially embedded in the sigmoid colon, was removed via laparoscopy; however, because of bowel perforation, laparotomy was performed to open colostomy. CONCLUSIONS: This case report highlights the continuing need for intra- and postinsertion vigilance, since even recent advances in IUD technique and technology do not guarantee risk-free insertion.

Relationship of follicle number, serum estradiol level, and other factors to clinical pregnancy rate in gonadotropin-induced intrauterine insemination cycles.

OBJECTIVE: To determine the characteristics associated with clinical pregnancy rate after gonadotropin-induced intrauterine insemination cycles in patients without male or tubal factor infertility. MATERIALS AND METHODS: One hundred and eighty patients undergoing controlled ovarian hyperstimulation followed by intrauterine insemination were included in the study retrospectively. The patients' files were retrospectively evaluated with respect to age, number of follicles, endometrial thickness and serum hormone levels at baseline and at the day of human chorionic gonadotropin (hCG) administration. The patients with male or unilateral tubal factor infertility were excluded from the study. RESULTS: The serum estradiol level at the day of hCG administration was not correlated with the clinical pregnancy rate (r=-0.05, p=0.481). The number of follicles was not correlated with the clinical pregnancy rate (r=-0.09, p=0.209). There was no significant difference between the clinically pregnants (n=32) and not pregnants (n=148) regarding the mean age, baseline serum levels of luteinizing hormone (LH) and estradiol, serum estradiol and LH levels at the day of hCG administration and endometrial thickness (p>0.05). Although not statistically significant, a pregnancy rate of 14.2% with less than 3 follicles > or = 18 mm is present compared to a pregnancy rate of 27.5% with at least 3 follicles > or = 18 mm and 24% with > or = 4 follicles > or = 18 mm. CONCLUSION: The clinical pregnancy rate does not seem to be affected with the number of follicles present at the time of intrauterine insemination or the serum estradiol level at the day of hCG administration in a controlled ovarian hyperstimulation cycle in non-andrologic and non-peritubal factor infertility; however, there is a clear trend towards higher pregnancy rates with higher number of follicles.

Controlled ovarian hyperstimulation and intrauterine insemination for infertility associated with endometriosis: a retrospective analysis.

OBJECTIVE: To evaluate the efficacy of controlled ovarian hyperstimulation and intrauterine insemination for infertility associated with endometriosis. MATERIAL AND METHODS: A retrospective analysis of 260 patients with the only diagnosis of endometriosis, or male factor, or tubal factor, or unexplained infertility were performed: a total of 56 patients with different stages of endometriosis, a control group consisting of 38 patients with male factor infertility, a group of 26 patients with tubal factor infertility and a group of 140 patients with others (unexplained infertility, ovulation disorders, cervical factor). Pregnancy rate, hormone levels, endometrial thickness and number of follicles were analyzed. RESULTS: Clinical pregnancy rates per patient were similar between endometriosis, male factor, tubal factor, and others including unexplained infertility, ovulation disorders and cervical factor groups (10.7%, 5.4%, 11.5%, 17.9%, respectively; p>0.05). Clinical pregnancy rates per patient were not effected between the 2 subgroups of endometriosis as minimal to mild and moderate to severe [5.1% (2/39) versus 23.5% (4/17), p=0.19]. CONCLUSION: Endometriosis did not affect the clinical pregnancy rate per patient compared to the other infertility factors. Endometriosis of various stages have no effect on the success of controlled ovarian hyperstimulation combined with intrauterine insemination.

Unilateral ectopic twin pregnancy following an IVF cycle.

We report here a 37-year-old woman who underwent ovulation induction and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment because of infertility who developed vaginal bleeding at the 6th week of gestation. Abdominal ultrasonography was insufficient to distinguish the intrauterine gestational sac. Subsequently, vaginal doppler ultrasonography detected two separate unilateral twin ectopic pregnancies with cardiac activity in both fetuses, which were operated on pelviscopically.

Bilateral jugular venous thromboembolism and pulmonary emboli in a patient with severe ovarian hyperstimulation syndrome.

We report here a case of severe ovarian hyperstimulation syndrome with massive ascites in a 25-year-old woman with a history of primary infertility after an IVF-ET cycle. At the 9th gestational week she presented with neck pain and dyspnea and duplex Doppler sonographic examination of the neck veins revealed bilateral jugular venous thrombosis. Despite prompt administration of low-molecular weight heparin, pulmonary emboli developed a few days later.