Blog dedicated to the continuous education in Gynecology and Endocrinology


Dehydroepiandrosterone (DHEA) supplementation increases baseline follicular phase progesterone levels

DGYE-2010-0325.R2 4

Weissman, Ariel (contact); Horowitz, Eran; Ravhon, Amir; Golan, Abraham; Levran, David

Abstract: The use of dehydroepiandrosterone (DHEA) supplementation in infertile patients with diminished ovarian reserve has become increasingly popular. It has been our observation that serum progesterone levels during the follicular phase are often increased during controlled ovarian stimulation when DHEA is co-administered. Our aim was to compare progesterone levels during the follicular phase before and during DHEA supplementation in women with diminished ovarian reserve undergoing IVF. In a case control study, we compared progesterone levels during the follicular phase in IVF cycles before and during DHEA supplementation in 15 women with diminished ovarian reserve who received 75 mg of DHEA daily. Progesterone levels on stimulation day 5 (ng/mL) (0.58±0.29 vs. 1.54 ±0.49; p<0.0001); and on the day of hCG administration (0.75+0.31 vs. 1.87±0.49; p<0.0001) were significantly higher during DHEA treatment. The number of retrieved and fertilized oocytes was similar in both groups. DHEA administration during IVF cycles in women with diminished ovarian reserve causes a significant elevation of progesterone levels without an apparent deleterious effect on cycle outcome

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Extended high dose letrozole regimen versus short low dose letrozole regimen as an adjuvant to GnRH antagonist protocol in poor responders undergoing IVF-ET

DGYE-2010-0375.R1 5

Fouda, Usama (contact); Sayed, Ahmed

Abstract: Objective. To compare the efficacy and cost-effectiveness of extended high dose letrozole regimen/HPuFSH-GnRH antagonist (GnRHant) protocol with short letrozole regimen/HPuFSH-GnRHant protocol in poor responders undergoing IVF-ET

Methods. In this randomized controlled trial ,136 women who responded poorly to GnRH agonist long protocol in their first IVF cycle were randomized into two equal groups using computer generated list and were treated in the second IVF cycle by either extended letrozole regimen ( 5mg /day during the first 5 days of cycle and 2.5 mg/day during the subsequent 3 days ) combined with HPuFSH-GnRHant protocol or short letrozole regimen (2,5 mg/day from cycle day 3 to 7 ) combined with HPuFSH-GnRHant protocol

Results. There were no significant differences between both groups with regard to number of oocytes retrieved and clinical pregnancy rate (5.39±2.08 Vs. 5.20±1.88 and 22.06% Vs. 16.18 % ,respectively ) . The total gonadotropins dose and medications cost per cycle were significantly lower in extended letrozole group (44.87±9.16 Vs. 59.97±14.91 ampoules and 616±94 Vs. 746±149 U.S Dollars ($), respectively).The cost-effectiveness ratio was 2794 $ in extended letrozole group and 4616 $ in short letrozole group

Conclusion. Extended letrozole regimen/HPuFSH-GnRHant protocol was more cost-effective than short letrozole regimen/HPuFSH-GnRHant protocol in poor responders.

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Endocannabinoid type 1 receptor gene (CNR1) polymorphisms (rs806381, rs10485170, rs6454674, rs2023239) and cardiovascular risk factors in postmenopausal women

DGYE-2010-0329 5

Łaczmański, Łukasz (contact); Milewicz, Andrej; Dunajska, Katarzyna; Jędrzejuk, Diana; Pawlak, Maurycy; Lwow, Felicja

Abstract: Introduction: The risk of cardiovascular diseases (CVD) in women increases with menopausal stage. Obesity with metabolic disorders is the most important risk factor for CVD. The incidence of this phenotype of obesity increases in postmenopausal women. The endocannabinoid system plays an important role in regulation of several metabolic pathways. The aim of this work was to investigate whether genetic variations in the cannabinoid receptor gene (CNR1) can affect cardiovascular risk factors (e.g. fat distribution, obesity, fasting glucose, lipid profile, blood pressure, and free androgen and estrogen indexes) in postmenopausal women.

Methods: The rs806381, rs10485170, rs6454674, and rs2023239 polymorphisms of the CNR1 gene were genotyped in 384 randomly selected postmenopausal Polish women (aged 50-60) using the minisequencing technique.

Results: The rs806381, rs10485170, rs6454674, and rs2023239 polymorphisms were not significantly associated with anthropometric measures (waist circumference, carbohydrate and lipid metabolism, body mass index [BMI], total fat, glucose, insulin, fasting insulin resistance index [FIRI]). However, the rs2023239 polymorphism was associated with the free androgen index (p=0.03).

Discussion: It seems that further genotyping of the endocannabinoid receptor gene cannot be used as a significant marker of predisposition to cardiovascular diseases in postmenopausal women, but it would be interesting to study this interrelation on a larger population of postmenopausal women.

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DGYE-2010-0307.R1 5

Cervellati, Carlo (contact); Pansini, Francesco; Bonaccorsi, Gloria; Bergamini, Carlo; Patella, Alfredo; Casali, Ferruccio; Fantini, Gianfranco; Pascale, Giuliana; Castaldini, Cristina; Ferrazini, Stefania; Francesca, Ridolfi; Cervellati, Giulia; Cremonini, Eleonora; Cristodoulou, Panagiota; Bagni, Bruno

Abstract: Background: The high incidence of various diseases observed in post-menopausal women has been widely associated to the decline of 17,β-estradiol (E2) occurring in correspondence of menopausal transition. One of the mechanisms suggested to explain this link takes into account the ability of E2 to counteract oxidative stress (OS) which is believed to play an important role in several pathogenic processes. Aim: To investigate whether stages of women’s life characterized by different levels of E2 influence OS. Subjects and Methods: We conducted a cross-sectional study of OS markers in 159 women subdivided in 65 pre-menopausal, 36 peri-menopausal and 58 post-menopausal classified according to the Staging of Reproductive Aging Workshop (STRAW) criteria. E2, FSH and markers of OS including hydroperoxides, thiols, uric acid, total and residual antioxidant power, were assessed. Results: After adjustment for covariates, only total antioxidant power was significantly different according to menopausal status (p<0.01), with lower value in pre- with respect peri- and post-menopausal women. No significant correlations between E2 levels and OS markers were detected. Conclusions: Endogen E2, and, consequently, its decline during menopausal transition, is not a determinant factor for OS.

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DGYE-2010-0353.R1 4 pag

Karadag-Saygi, Evrim (contact); Akyuz, Gulseren; Bizargity, Peyman; Ay, Pinar

Abstract: Background: To evaluate effect of risedronate treatment on osteoprotegerin (OPG), C-terminal cross-linking telopeptide of type 1 collagen (CTX), osteocalcin (OC), deoxypyridinoline (DPD).

Methods: Eighty postmenopausal osteoporotic patients were randomized into two groups. In first group, patients received 35 mg of risedronate once a week and calcium with vitamin D per day. In second group, patients received only calcium with vitamin D per day. Bone turnover markers were measured at baseline, 1st, 3rd and 6th months.

Results: OPG levels were significantly reduced at 1st and 6th months of treatment in both groups, but no statistically significant difference was detected between groups. In the group treated with risedronate, difference in CTX level was observed at 3th months of treatment, while a difference in DPD and OC levels were observed 6th months of treatment. The baseline OPG levels correlated with age, menopause duration and CTX levels. There was no correlation between OPG levels and the levels of the other markers during treatment.

Conclusion: The present study showed that using risedronate in treatment of postmenopausal osteoporosis causes no specific changes in OPG levels; therefore, in contrast to some of the studies in the literature OPG may not be useful marker in monitoring of bisphosphonate.

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