Successful laparoscopic sigmoid transposition for cervicovaginal agenesis in the presence of a functioning uterus: A case series.

OBJECTIVE: This study investigated the long-term outcomes of laparascopic sigmoid cervicovaginoplasty in patients with congenital cervicovaginal atresia with a functioning uterus. METHODS: In this case series study, seven patients with cervicovaginal atresia with a functioning uterus underwent laparoscopic sigmoid cervicovaginoplasty surgery between 2016 and 2020. Mean follow-up duration was 25.9 months (2-48 months). All of the patients had regular menstrual cycles. The average length of the vagina was 8.9 cm (7.6-10.5 cm). In one patient, proximal stenosis of neovagina was observed 12 months after surgery. RESULTS: The mean age and body mass index of the patients were 18 years (12-27 years) and 19.7 (17.6-22.4), respectively. The average time period between the initiation of disease symptoms and the operation was 52.28 months (2-156 months). There were no postoperative short-term complications. We did not perform hysterectomy in our patients. None of our patients complained of signs of low anterior resection syndrome. Two patients had sexual activities without dyspareunia, postcoital bleeding, or malodorous vaginal discharge. CONCLUSION: Sigmoid cervicovaginoplasty is a safe and effective procedure with satisfactory long-term outcomes. This surgery eliminates the psychological burden of hysterectomy in these patients. Through preserving the uterus, patients may have a chance of possible future pregnancy if abdominal cerclage is performed.

Association of tissue inhibitor of metalloproteinase-3 (TIMP-3) serum level and its genetic polymorphism with pregnancy outcome of patients undergoing in vitro fertilization and embryo transfer.

OBJECTIVES: Tissue inhibitors of metalloproteinase-3 (TIMP-3) and matrix metalloproteinases (MMPs) play a major role in embryo implantation and placentation. This study aimed to investigate the relationship between TIMP-3 serum level and TIMP-3 genetic polymorphism with pregnancy outcome in patients undergoing in vitro fertilization and embryo transfer (IVF-ET). MATERIAL AND METHODS: This project included 100 infertile women who became pregnant after IVF (IVF+) and 100 infertile women who failed to conceive after IVF (IVF-). Genotyping was performed using Restriction Fragments Length Polymorphism Polymerase Chain Reaction (PCR-RFLP), and the serum level was measured by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS: The frequencies of TT, TC, and CC in the IVF+ group were 41%, 37% and 22%, respectively, while in the IVF- group were 18%, 43% and 39%, respectively. The C and T allele frequencies were 40.5% and 59.5% in the IVF+ group and 60.5% and 39.5% in IVF- group, respectively. The C allele conferred a 2.25-fold increased risk of IVF failure (OR 2.25; 95% CI 1.5-3.35; p = 0.0001). Also, there was a significant increase in TIMP-3 serum levels in the IVF- group (193.29 ± 29.50 ng/mL), which was higher than the IVF+ group (166.74 ± 17.60 ng/mL; p = 0.00002), was demonstrated. It was shown that the TT genotype is associated with decreased TIMP-3 serum levels in IVF- group (CC, CT, and TT, values were 143.19 ± 88.49 ng/mL, 117.55 ± 15.73 ng/mL, 61.17 ± 44.36 ng/mL, respectively). CONCLUSIONS: It is concluded that there is a relationship between TIMP-3 gene polymorphism and its serum concentration with IVF-ET outcome. We also suggest that the TT genotype might be involved in IVF-ET outcome.

Predictors of poor cosmesis in breast cancer patients treated with adjuvant whole breast radiation therapy plus high-dose-rate interstitial brachytherapy boost after breast conservation surgery.

Purpose: To identify patient, tumor, and treatment-related factors, which predict cosmesis in breast cancer survivors treated with adjuvant whole breast irradiation (WBI) plus high-dose-rate (HDR) multicatheter interstitial brachytherapy (MIBT) boost after breast conservation surgery. Material and methods: At least 12 months after completion of radiotherapy, cosmetic outcomes were measured both objectively with BCCT.core software (using a front view digital photograph), and subjectively according to Harvard's criteria. MIBT dose fractionation regimen was 13.6 Gy/4 fractions (bid). To evaluate the correlation between cosmetic scores and dose-volume histogram (DVH) parameters, WBI and MIBT plans were retrospectively analyzed, and ipsilateral skin and breast biologically equivalent dosimetric indices were recorded (α/ß = 3 Gy). A multivariate ordinal logistic regression model was used for statistical analysis. Results: Twenty-eight consecutive patients were enrolled into this study. The median time from completion of radiation therapy to cosmesis scoring was 18 months. In evaluation with BCCT.core software, no patient was scored as excellent. Cosmesis was good in 18%, fair in 50%, and poor in 32% of patients. According to Harvard's scale, 10.5% of patients had excellent cosmesis, and 43%, 28.5%, and 18% of patients had good, fair, and poor scores, respectively. In univariate analysis, patients with higher absolute MIBT V29Gy (cc), those treated with irradiation of regional lymphatics (odds ratio ≈ 5), and patients with larger breast volumes had statistically significant lower Harvard's scores. In the multivariate model, none of the mentioned factors remained statistically significant, except for a trend for poorer cosmesis in patients with higher absolute MIBT V29Gy (p-value = 0.066). Conclusions: Based on the results of this study, MIBT breast V29Gy, regional nodal irradiation, and larger breast volumes are the potential factors, which could predict cosmesis.

Association between Glucose Consumption and Oocyte Maturation Competence in Mice with Polycystic Ovarian Syndrome.

BACKGROUND: This study evaluated association between glucose uptake by individually cultured oocyte and their maturation competence in mice with polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: In this experimental study, PCOS and non-PCOS cumulus-oocyte complexes (COCs), and cumulus-denuded oocytes (DOs) were cultured individually and categorized in four groups: i. PCOS DOs (n=83), ii. PCOS COCs (n=35), iii. Non-PCOS DOs (n=61) and iv. Non-PCOS COCs (n=62). After the culture period, 50 µl aliquots of the spent drops were used for glucose change analysis using high performance liquid chromatography. Polar NH2 column was used for the study of carbohydrates, acetonitrile with deionized water as the solvent phase and UV as detectors. Oocyte quality (growth differentiation factor 9: GDF-9), viability [bcl-2-like protein 4 (BAX) and B-cell lymphoma2 (BCL2)], in addition to fertilization and embryonic development rates were also evaluated in relation to glucose consumption rate of each oocyte. RESULTS: Maturation rate was significantly higher in non-PCOS COCs and DOs compared to PCOS COCs (IV: 70.9% vs. II: 45.71%) and DOs (III: 67.2% vs. 1: 53.01%), respectively. There was a significant negative correlation between high glucose intake (38.17 ppm) and BCL2 gene expression (P=0.03) in PCOS COCs compared to non-PCOS COCs. There was a significant difference in the GDF-9 gene expression from PCOS DOs (0.66 ± 0.02, P=0.003) and COCs (0.37 ± 0.02, P=0.0001) compared to non-PCOS DOs and COCs, respectively. A negative correlation was also observed between quality of PCOS-DOs and -COCs with glucose intake. Non-PCOS COCs significantly showed higher rate of successful IVF and development compared to PCOS COCs (P=0.01). CONCLUSION: Based on the importance of metabolic analysis, the glucose consumption by DOs and COCs in culture medium can be a suitable criterion for their quality assessment. So that, glucose consumption may reflect oocyte maturation competence.

miR-203a-3p, ABL1 and TP63 gene expression is altered in the endometrium of women with endometriosis.

OBJECTIVE: Many genes and miRNAs have been shown to be associated with the pathogenesis of endometriosis. TP63 (p63) is implicated in lineage specification, proliferative potential, differentiation, cell death and survival. The ABL1 proto-oncogene encodes a cytoplasmic and nuclear protein tyrosine kinase implicated in cell differentiation, cell division, and cell adhesion. Moreover, hsa-miR-203a-3p was reported to play pivotal roles in tumor progression by targeting multiple genes, including ABL1 and TP63. The aim of this study was to investigate the expression of ABL1, TP63, and miR-203a-3p in endometriosis. METHODS: This study included 30 women with endometriosis (stage III: n = 12 and stage IV: n = 18) and 30 age-matched controls. Total RNA extraction and cDNA synthesis were performed, and a quantitative polymerase chain reaction technique was used to determine the expression of miR-203a-3p, TP63, and ABL1. RESULTS: TP63 and ABL1 were significantly overexpressed in stages III and IV endometriosis as compared to controls (p < .0001). Moreover, overexpression of ABL1 and TP63 was observed in stage IV compared to stage III (p = .0006 and p = .0002, respectively). Furthermore, significant increase miR-203a-3p expression has been seen in stage IV endometriosis compared to controls (p = .006). The expression of miR-203a-3p in stage III was not significant compared to stage IV and control (p = .33 and p = .43, respectively). CONCLUSION: It is concluded that miR-203a-3p, ABL1 and TP63 gene expression is altered in the endometrium of patients with endometriosis. It is also suggested that miR-203a-3p, ABL1, and TP63 might be candidate factors for the pathogenesis of endometriosis and suggesting its therapeutic potential in endometriosis.

The effect of mitochondria-targeted antioxidant MitoQ10 on redox signaling pathway components in PCOS mouse model.

PURPOSE: Considerable evidence suggests that mitochondrial dysfunction and oxidative stress contribute to the pathogenesis of Polycystic ovary syndrome (PCOS). We aimed to evaluate the effectiveness of mitochondria-targeted antioxidant, MitoQ10, on the redox signaling pathway's component in PCOS. METHOD: We assessed TXNIP, TRX, and ASK1 expression in granulosa cells (GCs) of the DHEA-induced PCOS mouse model. Female BALB/c mice in five groups of Control, DHEA, and DHEA + MitoQ10 in three doses of 250, 500, and 750 µmol/L MitoQ10 were treated for 21 days. RESULTS: Histological investigation showed a probable improvement in folliculogenesis; besides, ASK1 and TXNIP expression were significantly increased in GCs of the PCOS mouse F4Fmodel as compared to the control groups and decreased steadily in groups treated by MitoQ10. However, TRX expression showed a drop that was restored by MitoQ10 meaningfully (P ≤ 0.05). CONCLUSION: The work presented herein suggests mitochondria-targeted antioxidant, MitoQ10, have modulating effects on folliculogenesis in the ovary and also on the redox signaling pathway in GCs of PCOS mouse model which may have potential to attenuate oxidative stress and its relative damages.

The efficiency of low-dose letrozole plus clomiphene citrate for ovulation induction in intrauterine insemination cycles: A randomized clinical trial.

OBJECTIVE: To investigate if combination therapy with clomiphene citrate (CC) plus letrozole (L) was associated with a higher efficacy than L and CC alone in patients undergoing ovarian induction plus intrauterine insemination. METHODS: The present multicenter randomized controlled clinical trial was performed between 2018 and 2020. Participants were randomized into three groups: L (n = 167; 5 mg/day), CC (n = 167; 100 mg/day), and L + CC (n = 167) (2.5 mg/day + 50 mg/day) from day 3. Ovarian stimulation was continued with the appropriate dose of gonadotropins daily starting from day 8 and continued until follicular size was 20 mm or more followed by administration of human chorionic gonadotropin (10 000 IU). Semen samples were prepared by direct swim-up technique. RESULTS: In the CC group, gonadotropin dose was significantly higher but endometrial thickness was significantly lower compared with other groups. Number of follicles of 18 mm or more was significantly lower in the L group compared with the other two groups. Number of follicles less than 15 mm was meaningfully higher in the CC group compared with the other groups. In the L + CC group, total and largest follicular size, and the rates of chemical, clinical, and ongoing pregnancy, and live birth were significantly higher compared with other groups. CONCLUSION: Combination therapy with L + CC was superior to either L or CC for achieving pregnancy in women undergoing ovarian induction plus intrauterine insemination.

Association of FSHR missense mutations with female infertility, in silico investigation of their molecular significance and exploration of possible treatments using virtual screening and molecular dynamics.

This study investigated the association of A419T (rs121909661) and T449I (rs28928870) with infertility among Iranian women and possible treatments by agonizing the mutated receptor. 151 women were genotyped at A419T and T449I sites. Homology modeling, pharmacophore modeling, virtual screening, docking and molecular dynamics (MD) were performed. A419T and T449I indicated a significant and a weak association with infertility among Iranian women (P = 0.005 and P = 0.03, respectively). Significant differences found among three genotypes of A419T with FSH (P = 0.01) and LH (P < 0.0001). G-allele carriers of A419T had susceptibility to display higher FSH and LH serum levels. In silico results revealed the most potent agonists among 3041 similar compounds and MD supported this finding. Altogether, genotyping of A419T and T449I as potential markers might be helpful in prognosis and treatment of infertility. Also, a new series of potent FSHR agonists were identified for future drug development and treatment of infertility related to FSHR dysfunction.

Is it necessary to focus on morphologically normal acrosome of sperm during intracytoplasmic sperm injection?

Background & objectives: The detailed assessment of sperm morphology is important in the semen of infertile men because there is a low proportion of normal spermatozoa. One of the parameters of such sperm morphology is the acrosome, and its effect on assisted reproductive outcomes is controversial. This study was undertaken to evaluate the association between different forms of acrosome on the chromatin status and the assisted reproductive outcomes. Methods: A total of 1587 unstained sperms from 514 infertile men were captured and analyzed for different acrosome forms (normal, large, small, skew, amorphous acrosome and without acrosome) in real time during intracytoplasmic sperm injection into oocytes. The association between the percentage of sperms with atypical acrosome and head shapes and the sperm chromatin status was studied. Fertilization, zygote and embryo quality and clinical pregnancy rates were calculated for different groups of sperms. Results: The highest frequency of irregular shapes of acrosomes, such as small, large and amorphous, was observed in abnormal ellipticity, anteroposterior symmetry and angularity parameters, respectively (P <0.05). The fertilization rate of injected sperms with large (P <0.01) and small (P=0.001) acrosomes and without acrosome (P=0.001) was significantly lower in comparison with normal acrosomes. The quality of zygotes (Z3, P=0.05), embryos (grade C, P <0.05) and the pregnancy rate (P=0.001) from injected sperms with large acrosomes were significantly lower compared with normal acrosomes. Interpretation & conclusions: Our findings showed that the different sperm acrosome morphologies (e.g., large, small, and without acrosome) might negatively relate with chromatin integrity and decrease the sperm's fertility potential and pregnancy rate during intracytoplasmic sperm injection (ICSI) cycles.

Metabolic Syndrome in Patients with Polycystic Ovary Syndrome in Iran.

BACKGROUND: The prevalence of metabolic syndrome (MetS) in polycystic ovary syndrome (PCOS) has been studied in different populations, but their results were so controversial regarding Iranian women. These controversial data indicated the need for more investigation of MetS characteristics in PCOS patients in our population. So this study aimed to evaluate the clinical and laboratory characteristics and metabolic features of patients with PCOS in Rasht. MATERIALS AND METHODS: This prospective cross sectional study was conducted on 215 PCOS women who lived in Rasht, north of Iran, from March 2010 to July 2012. The participants were then divided into two groups of women with MetS (n=62) and women without MetS (n=153). The diagnosis of PCOS and MetS were based on the Rotterdam 2003 criteria and the Adult Treatment Panel III (ATP III) criteria, respectively. Demographic characteristics, fertility characteristics, family history and laboratory findings were assessed. RESULTS: The prevalence of MetS in women with PCOS was 28.8%. In PCOS women of both groups, the waist circumference (WC) exceeded 88cm in 72.6%, hypertension [systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥130/85mm Hg] was prevalent in 9.3%, fasting blood sugar (FBS) level was ≥110 mg/dl in 6%, triglycerides (Tg) level were ≥150 mg/dl in 47%, and high-density lipoprotein (HDL) level was <50 mg/dl in 86%. The values of WC, SBP, DBP, body mass index (BMI), ovarian size, Tg, cholesterol, FBS, 2-hour blood sugar, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly greater in PCOS women with MetS than women without MetS. Also HDL and luteinizing hormone (LH) levels in women with MetS were significantly lower than women without MetS. CONCLUSION: Prevalence of MetS in PCOS women was 28.8%, indicating that this value is higher than other studies conducted on PCOS women in Iran and other studies conducted on general population in Iran. PCOS women are considered as a high-risk population for MetS. The special strategies are required to prevent MetS and its associated complications in PCOS women.

An efficient method for automatic morphological abnormality detection from human sperm images.

BACKGROUND AND OBJECTIVE: Sperm morphology analysis (SMA) is an important factor in the diagnosis of human male infertility. This study presents an automatic algorithm for sperm morphology analysis (to detect malformation) using images of human sperm cells. METHODS: The SMA method was used to detect and analyze different parts of the human sperm. First of all, SMA removes the image noises and enhances the contrast of the image to a great extent. Then it recognizes the different parts of sperm (e.g., head, tail) and analyzes the size and shape of each part. Finally, the algorithm classifies each sperm as normal or abnormal. Malformations in the head, midpiece, and tail of a sperm, can be detected by the SMA method. In contrast to other similar methods, the SMA method can work with low resolution and non-stained images. Furthermore, an image collection created for the SMA, has also been described in this study. This benchmark consists of 1457 sperm images from 235 patients, and is known as human sperm morphology analysis dataset (HSMA-DS). RESULTS: The proposed algorithm was tested on HSMA-DS. The experimental results show the high ability of SMA to detect morphological deformities from sperm images. In this study, the SMA algorithm produced above 90% accuracy in sperm abnormality detection task. Another advantage of the proposed method is its low computation time (that is, less than 9s), as such, the expert can quickly decide to choose the analyzed sperm or select another one. CONCLUSIONS: Automatic and fast analysis of human sperm morphology can be useful during intracytoplasmic sperm injection for helping embryologists to select the best sperm in real time.

Polymorphisms of glutathione peroxidase 1 (GPX1 Pro198Leu) and catalase (CAT C-262T) in women with spontaneous abortion.

About 10%-15% of conceptions are lost spontaneously prior to 20 weeks. Apart from the clinical problems, genetic variations have also been proposed as a susceptibility factor to miscarriage. Glutathione peroxidase 1 (GPX1) and catalase (CAT) encode two antioxidant enzymes that detoxify H2O2 and protect the cells from oxidative damage. A functional polymorphism at codon 198 of the GPX1 gene causes a C/T substitution in exon 2, which encodes for either proline or leucine (Pro198Leu). The CAT gene has a polymorphic site in the promoter region at position -262 (C-262T) which alters the expression and enzyme blood levels, leading to some pathological clinical conditions. In this study, we evaluated the association of these two polymorphisms with the risk of spontaneous abortion. Genomic DNA from 105 cases with spontaneous abortion and 90 healthy women were genotyped using allele-specific PCR (AS-PCR) and polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP). The genetic distributions for GPX1 did not differ significantly between cases and controls (p = 0.680). However, C-262T polymorphism was significantly associated with the risk of the disease (OR, 5.50; 95% CI, 1.43-21.09; p = 0.012). In conclusion, this study indicates that CAT -262T/T genotype confers less susceptibility to spontaneous abortion, while GPX1 Pro198Leu polymorphism may not be correlated with the disease.

Evaluation of Relation between Anthropometric Indices and Vitamin D Concentrations in Women with Polycystic Ovarian Syndrome.

OBJECTIVE: To determine the association between serum 25 - hydroxy vitamin D concentration and anthropometric indices in patients with polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: This is a descriptive cross - sectional study which was carried out on women with PCOS aged 19-39 years old referred to an infertility clinic of Alzahra Hospital, Rasht, Iran during September2011- March2012. The study was conducted based on the Rotterdam criteria. Exclusion criteria were hyperandrogeniema and thyroid dysfunction. The data were gathered through an interview with focus on demographic characteristics and history of infertility. The height, weight and waist and hip circumferences were measured and BMI had been calculated. Also, blood sample had been checked to indicate the level of hydroxy vitamin D. While all statistical analyses were carried out using software package used for statistical analysis (SPSS) version 16 (SPCC Inc., Chicago, IL, USA). RESULTS: Over 68% of patients had vitamin D deficiency (Vit D<15). Level of vitamin D had a significant correlation with waist circumference (p<0.02), height (p<0.001) and waist-to-hip ratio (WHR) (p<0.007). CONCLUSION: Based on the anthropometric indices, it seems that we can predict the level of 25-hydroxyvitamin D in women with PCOS.

The relationship between vaginal bleeding in the first and second trimester of pregnancy and preterm labor.

BACKGROUND: Vaginal bleeding is a common complication during pregnancy, which is observed in about 1/4 of pregnancies and in half of cases can lead to abortion. If vaginal bleeding happens during pregnancy some adverse pregnancy outcomes, including perinatal mortality and morbidity, low birth weight and preterm delivery will be increased. OBJECTIVE: The aim of this study was to determine the relationship between vaginal bleeding and its characteristics in the first and second trimester of pregnancy and preterm labor. MATERIALS AND METHODS: This is a case-control study conducted on 440 pregnant women referred to Al-Zahra Hospital in Rasht, Iran. Data were collected by a form. The form included demographic characteristics and confounding factors, the occurrence of bleeding during pregnancy and its features. Data were analyzed by T test, chi square and logistic regression in SPSS 16. RESULTS: Findings showed that vaginal bleeding was associated with 3 times increased risk of preterm delivery (OR: 3, 1.84-4.89). Also, findings showed that bleeding characteristics including bleeding time, frequency, severity and intensity was significantly associated with preterm labor. CONCLUSION: According to significant association between vaginal bleeding and preterm delivery, it seems that performing some interventions to prevent preterm labor could be appropriate.

The impact of different time intervals between hCG priming and oocyte retrieval on ART outcomes.

BACKGROUND: Abnormal oocyte morphology has been associated with the hormonal environment to which the gametes are exposed. OBJECTIVE: In this study, we evaluated the oocytes morphology, fertilization rate, embryos quality, and implantation rate resulted of retrieved oocytes in different times after human chorionic gonadotrophin (HCG) administration. MATERIALS AND METHODS: A total of 985 metaphase II oocytes were retrieved 35, 36, 37 and 38 h after the injection of HCG as groups 1, 2, 3, and 4 respectively. Oocyte morphology was divided into (I) normal morphology, (II) extracytoplasmic abnormalities, (III) cytoplasmic abnormalities and (IV) intracytoplasmic vacuoles and in each group, oocytes were evaluated according to this classification. RESULTS: Extracytoplasmic abnormalities were encountered in 17.76% and 31.1% of these oocytes (groups 3 and 4 respectively, p=0.007) in comparison with 12.23% group 2. Cytoplasmic abnormalities in group 4 were higher than other groups. 23.88% (p=0.039) and 43.25% (p=0.089) of resulted 2PN (two pronucleus) from groups 3 and 4 showed grade Z3 respectively in comparison to group 2 (16.44%). Normal and various categories of abnormal oocytes did not differ regarding fertilization and cleavage rates (p=0.061). However, group 4 showed significant difference in the rate of embryos fragmentation (grade III and IV embryo) in comparison with group 2 (40.96% vs. 24.93%, p=0.078). The pregnancy rate was higher in G2 and G3 groups (28.5 and 24.13% respectively). CONCLUSION: Oocyte retrieval time following HCG priming affected on oocyte morphology, 2PN pattern and embryos qualities subsequently. Both good quality embryo formation and pregnancy outcomes were noticeably higher when oocytes were retrieved 36 h after HCG priming in ART program.

Role of dyslipidemia in preeclamptic overweight pregnant women.

BACKGROUND: Obesity is an independent risk factor of preeclampsia with unknown mechanism and hyperlipidemia might be a probable case of it. OBJECTIVE: The objective of this study was to determine the role of hyper-triglyceridemi in association with high prepregnancy body mass index and the risk of preeclampsia. MATERIALS AND METHODS: The authors conducted this case-control study of 42 preeclamptic and 41 normotensive overweight pregnant women. The two groups were comparable with respect to age, gestational age, and body mass index. Blood samples were collected at the time of diagnosis of preeclampsia, after 14 hour fasting to determine plasma lipid concentrations. Enzymatic photometric tests were used to determine lipid profile. Data was analyzed with independent "t-test", Chi-square and one-way ANOVA and post HOC Tukey HSD test. The statistical significance was set at 0.05 levels. RESULTS: In the subjects with preeclampsia, serum triglyceride and total cholesterol levels were significantly increased and plasma HDL-cholesterol concentrations were decreased compared with the controls, (p<0.05), but plasma LDL cholesterol levels didn't differ between the two groups. Women who developed severe preeclampsia had higher concentrations of TG and cholesterol and lower levels of HDL compared to noromotensive group. Mean TG: 375.16 vs. 202.85, p<0.001, Mean cholesterol: 245.64 vs. 214.32, p=0.04, Mean HDL: 40.80 vs. 48.95, p=0.03). CONCLUSION: We noted that dyslipidemia, particularly hypertriglyceridemia was highly correlated with prepregnancy high BMI in preeclamptic women. These findings continue to support a role for dyslipidemia in BMI related preeclampsia.

In vitro fertilized embryos do not secrete detectable HLA-G on day two.

BACKGROUND: Pregnancy is a successful transplantation. The factors evading rejection of the fetus are poorly understood. Recently an interest has grown, in HLA-G molecules as one of these factors. Since these antigens are mainly expressed on the surface of cytotrophoblasts that are in direct contact with maternal tissues, it has been suggested that these molecules may have a role in induction of immune tolerance in mothers. OBJECTIVE: to find the association of soluble HLA-G (sHLA-G) and the success of pregnancy with intracytoplasmic sperm injection (ICSI) procedure. METHODS: In this study, the supernatant of 287 individually cultured embryos corresponding to 96 women under ICSI procedure were assayed for soluble HLA-G1 and G5 by a sandwich ELISA. RESULTS: Clinical pregnancy successfully occurred in 30 of candidates. No differences in clinical parameters (age, infertility duration, stimulation regimen) were observed between pregnant and nonpregnant women under ICSI procedure. None of the embryo supernatants in either group showed any detectable sHLA-G molecules. CONCLUSION: Our results showed that detectable level of sHLA-G is not produced by day 2 embryos and such a measurement may not provide reliable information for embryo selection and estimation of pregnancy success.

A randomized trial of prostaglandin E2 gel and extra-amniotic saline infusion with high dose oxytocin for cervical ripening.

BACKGROUND: Our purpose was to compare the efficacy of extra-amniotic saline infusion plus high dose oxytocin with prostaglandin E2 intracervical gel (Dinoprostone) for preinduction cervical ripening. MATERIAL/METHODS: 166 nulliparous women with term pregnancies, vertex presentation, intact membranes and a Bishop score < or = 4 referred for labor induction were randomly assigned to receive a 0.5 mg PGE2 intracervical gel and extra-amniotic saline infusion (EASI) plus high-dose oxytocin. Changes in the Bishop scores, labor progress, various labor end points and outcomes of labor were assessed. Data were analyzed using chi2 analysis or the Student t-test. RESULTS: 151 women were studied after 15 exclusions, 75 were assigned to PGE2, and 76 to EASI. The groups were similar in age, race, indication for induction and gestational age. The EASI group had a significant improvement in Bishop score and greater dilation. The mean time to vaginal delivery was 11.4+/-4.8 hours and 18.9+/-6.4 hours for the EASI and PGE2 groups respectively (P=0.001). The cesarean delivery rate was not significantly different between the two groups (25% for the EASI group; 34.6% for the PGE2 group). The cesarean rate due to failure to progress, fetal labor intolerance, and maternal and neonatal outcomes were similar in the two groups. CONCLUSIONS: Preinduction cervical ripening with EASI plus high dose oxytocin resulted in greater changes in Bishop score, and shorter time to normal vaginal delivery than with PGE2 gel in nulliparous women, without increasing the cesarean rate due to failure to progress or fetal labor intolerance.