Characteristics and outcomes of in vitro fertilization in different phenotypes of polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to investigate whether polycystic ovary syndrome (PCOS) phenotype without polycystic ovaries (PCO) differs in terms of in vitro fertilization (IVF) outcomes compared with classic phenotypes. MATERIALS AND METHODS: This retrospective controlled study included 262 patients who underwent IVF treatment with an indication of unexplained or tubal factor infertility (control group), ovulatory patients with PCO morphology (group 1), PCOS phenotype with oligoanovulation and hyperandrogenemia (group 2), PCOS phenotype with PCO morphology and oligoanovulation (group 3). Outcomes and baseline characteristics of IVF-embryo transfer treatments were compared among all groups. RESULTS: PCOS phenotype without PCO morphology had similar IVF stimulation characteristics compared with classic phenotypes; however, a higher total gonadotropin dose was needed to achieve similar results compared with patients with PCO morphology with or without PCOS. Basal follicle-stimulating hormone level (beta coefficient=0.207, p=0.003), group (beta coefficient=-0.305, p<0.001) and age (beta coefficient=0.311, p<0.001) were significantly associated with the total gonadotropin dose. The number of good quality embryo on transfer day was significantly lower in patients with isolated PCO morphology and PCO morphology with oligoanovulation than in those with PCOS phenotype without PCO morphology. CONCLUSION: PCO morphology provides easier stimulation, whereas hyperandrogenemia provides better results as good quality embryos. However, the end point is similar in terms of biochemical, clinical, and ongoing pregnancy rates.

The incidence of preeclampsia in ICSI pregnancies.

OBJECTIVE: We aimed to evaluate the association between infertility etiology in ICSI pregnancies and preeclampsia; besides, we aimed to discuss the effect of the paternal factor in the pathogenesis of preeclampsia. HYPOTHESIS: We hypothesized that preeclampsia is more common in ICSI pregnancies with male factor. It is known that maternal exposure to paternal sperm cells over a time period has a protective effect against preeclampsia. Male partners with azospermia have no sperm cells in their seminal fluid, whose female partners will not be able to develop some protective immunity against preeclampsia. We hypothesized that the infertile couples with male factor (partner with azoospermia and also oligospermia) would be an ideal model to test the partner-specific protective immunity against preeclampsia, as the women had no chance to develop adequate protective immunity via the partner's sperm exposure. METHODS: This Single-center, retrospective study included 508 infertile couples admitted to our IVF center between January 2001 and March 2008. The data regarding the maternal age, etiology of the infertility, the pregnancy rates, abortus ratio and viable pregnancy rates was collected from the case files. Antenatal complications such as preeclampsia, placenta previa, abruptio placenta, premature rupture of membranes, premature labor, oligohydramnios, gestational diabetes, postmaturity, postpartum complications and neonatal outcomes were evaluated via the file records and phone interviewing. The study population was divided into two main groups according to the etiology of infertility. 301 of the study population (group 1) was infertile due to male factor and 207 of the study population (group 2) was female factor and unexplained infertility cases.Group 1 patients were divided further into two subgroups: group 1a included 56 cases in which TESE (testicular sperm extraction) was used to obtain the sperm cells as the male factor was severe and as there was no sperm cells in seminal fluid. Group 1 b consists of 245oligospermic cases who obtained sperm cells via conventional methods. RESULTS: The mean ages of women in Group one and two were 30.22±5.06 and 31.58±4.36 years respectively (p=0.001). 129 cases (42,8%) from group one and 106 cases (51,2%) from Group two ended in first trimester and early second trimester (<24 gestational weeks) pregnancy loss. In group one, only 172 cases of 301 pregnancies passed over 24 weeks of gestational age, whereas in group two, 101 cases of 207 patients passed over 24 gestational weeks. There was no significant difference between two groups regarding chemical pregnancies and early pregnancy loss (p=0.314). There was no significant difference between the groups regarding placenta previa, gestational diabetes, oligo hydramnios and intrauterine growth retardation. One one pregnancy was 1.5 times more vulnerable for preeclampsia. CONCLUSION: Pregnancies with azoospermic and oligospermic partners had an increased risk for developing preeclampsia.

Comparison of 24-hour urinary protein and protein-to-creatinine ratio in women with preeclampsia.

OBJECTIVE: To compare the spot urine protein-to-creatinine (P/C) ratio and 24-hour urine protein excretion in pregnant women with preeclampsia and also to determine the best discriminator values of the spot P/C ratios for 300 mg and 2000 mg protein per 24h. STUDY DESIGN: Prospective study of 200 pregnant women with new onset hypertension at or greater than 140/90 mmHg after 20 weeks of gestation. Women were instructed to collect urine during a 24-hour period, and after the 24-hour urine sample collection was completed a mid-stream urine specimen was obtained for P/C ratio determination. The correlation between 24-hour urine protein excretion and spot urine P/C ratio was calculated. The receiver operating characteristic (ROC) curve was used to identify the cut-off values of the spot P/C ratios for 300 mg and 2000 mg protein per 24h. Areas under ROC curves were calculated. RESULTS: There was a significant correlation between 24-hour protein excretion and the urine P/C ratio (r=0.828, p<0.0001). The cut-off P/C ratio for 300 mg per 24h was 0.28: sensitivity and specificity were 60.4% and 77.9%, respectively. The positive predictive value (PPV) was 77.5% and negative predictive value (NPV) was 60.9%. The cut-off P/C ratio for 2000 mg per 24h was 0.77: sensitivity and specificity were 96.8% and 98.6%, respectively. The PPV was 96.8% and NPV was 98.6%. Area under ROC curves for 24-hour urine total protein of 300-2000 mg/day and >2000 mg/day were 0.74 (95% CI 0.66-0.80) and 0.99 (95% CI 0.95-0.99), respectively. CONCLUSIONS: Spot P/C ratio is a poor predictor of 24-hour proteinuria but can predict proteinuria >2000 mg better than 300-2000 mg.

A comparison of misoprostol, controlled-release dinoprostone vaginal insert and oxytocin for cervical ripening.

OBJECTIVE: We compared the safety and effectiveness of oxytocin, dinoprostone and misoprostol for cervical priming. STUDY DESIGN: A total of 218 patients were enrolled to receive between one and three treatments according to physicians' options. The end points were: (1) vaginal delivery or Bishop score ≥ 8 at the end of 12 h, (2) vaginal delivery by 12 h or difference ≥ 4 between the initial and 12th hour Bishop scores. Statistical analyses were performed with ANOVA, Krustal Wallis, Scheffe, χ², Fisher, Advanced χ², and Kolmogorov-Smirnov tests. Tukey's HSD was used as a post hoc test. RESULTS: Misoprostol showed statistical significance for the rate of vaginal delivery <12 h, ≥ 8 Bishop score at the end of 12 h, and cervical change of ≥ 4 Bishop scores within 12 h (p = 0.013). CONCLUSIONS: Comparison between cases Bishop score <4 showed that misoprostol is more effective than dinoprostone and oxytocin. Considering Bishop score = 0 cases we calculated no statistical significance.

The use of standard dose of magnesium sulphate in prophylaxis of eclamptic seizures: do body mass index alterations have any effect on success?

OBJECTIVE: We anticipated that the universal use of a standard magnesium sulfate infusion to prevent eclamptic convulsions in preeclamptic patients would result in alterations in circulating magnesium levels that were negatively correlated with the patient's body mass index. We postulated that the highest failure rate with seizure prophylaxis would occur in patients with the highest body mass index. MATERIALS AND METHODS: After discarding 6 patients, this study was performed in 194 of 200 preeclamptic patients admitted to our high risk pregnancy unit between February 2000 and August 2000, who were divided into four groups determined by body mass indices. A standard magnesium sulfate infusion protocol (loading dose 4.5 g/15 minutes followed by 1.8 g/hour) was administered to 194 preeclamptic patients. One hundred and thirty-eight severe preeclamptic patients received magnesium sulfate during both antepartum and postpartum periods. The remaining 56 patients only received the therapy during the postpartum period. Serial serum magnesium levels of each groups were recorded and compared. RESULTS: The 1.8 g infusion rate produced acceptable magnesium levels in the majority of patients but most were in the lower 50% of the therapeutic range. Levels were lowest in patients with high body mass indices (this group recorded most of the subtherapeutic levels, particularly when patient were infused antepartum). Apart from 13 referred patients who had convulsed prior to admission no eclampsia occurred during the antepartum period while seizures occurred in nine women during the postpartum period. Two hours after the initiation of the therapy, magnesium levels were inversely related to the body mass index (BMI) both during the ante- and postpartum periods (Prepartum; group I: 5.97 mg/dl, group II: 4.90 mg/dl, group III: 4.35 mg/dl, group IV: 3.88 mg/dl; Postpartum; group I: 5.89 mg/dl, group II: 5.71 mg/dl, group III: 4.82 mg/dl and group IV: 4.61 mg/dl, Table 4). Although the lowest levels were detected in patients with high body mass indices, in contrast to our hypothesis, eclamptic seizures occurred in four patients with low body mass indices. Furthermore therapeutic serum magnesium levels were detected in three of these patients. There was no association between treatment failures and body mass or with magnesium levels. CONCLUSION: The infusion regimen described herein resulted in therapeutic levels in the majority of patients that correlated inversely with body mass index. However most levels fell within the lower range of what many studies consider "therapeutic" suggesting that maintenance infusion rates of at least 2-2.5 g/hour would be more appropriate. This would be particularly true in patients with body mass indices exceeding 30, where subtherapeutic levels occurred most frequently. The study's limited power prevents conclusions on outcomes but what is of interest is that eclamptic convulsions did not correlate with either body mass index or circulating plasma magnesium levels.

Effects of hormone replacement therapy on mammographic findings.

To evaluate the effects of different hormone replacement therapy (HRT) protocols on mammographic findings. One-hundred-eighty-two women in menopause were recruited for this prospective study. Breast examination was performed and four basal mammograms were obtained in all cases. Eighty of the cases received HRT by estrogen only; 40 used combined pills of estrogen plus progestagen sequentially; 44 used combined pills of estrogen plus progestagen continuously; 18 used tibolone. Breast examination and mammography were repeated after 11.6+/-2.1 months of HRT. Mammographic parenchymal density was found to be increased in all cases (17.6%). This finding was most prominent in the continuous combined estrogen plus progestagen group (25%) and the lowest in the tibolone group (5.5%). The use of estradiol resulted in more increased density than conjugated estrogen. The increase in the mammographic density is related directly with breast tenderness. Hormone replacement therapy is not contraindicated in the cases of breast disease without atypia. The increase in mammographic density was found to be higher in obese women.