This month on gynecological endocrinology
- Serum vitamin B12 and homocysteine levels in pregnant women with neural tube defect
- Cumulative baby take-home rate among women with PCOS treated with IVF
- Micronucleus Frequency in Lymphocytes and 8-Hydroxydeoxyguanosine Level in Plasma of Women with Polycystic Ovary Syndrome
- Lack of association between CYP21 V281L variant and polycystic ovary syndrome in Italian women
- Assessment of diagnostic competence of plasmatic androgens on polycystic ovary syndrome based on receiver operator characteristic curves (ROC)
- Perceived control over menopausal hot flushes in mid-aged women
- Treatment of moderate to severe premenstrual syndrome with Vitex agnus castus (BNO 1095) in Chinese women
- Virilizing Sertoli-Leydig cell tumor associated with thyroid papillary carcinoma: case report and general considerations
- The influence of other than prolactin hormones on bone mineral density in women with hyperprolactinemia of various origin
- Cryopreservation and oxidative stress in reproductive cells
- Gynecologic challenging issues in the management of BRCA mutation carriers: oral contraceptives, prophylactic salpingo-oophorectomy and hormone replacement therapy
- Premature ovarian failure from current perspective
Serum vitamin B12 and homocysteine levels in pregnant women with neural tube defect
Ceyhan - DGYE-2009-0164.r1 [ID 463727]
Abstract: Objective: Aim of the study is to investigate the importance of serum vitamin B12 levels in pregnants with fetal neural tube defect.
Study Design: This study consists of 31 pregnant women having fetuses with neural tube defect. The pregnant women in the study group were selected among cases with normal folate levels. Serum vitamin B12 levels were investigated. Additionally, complete blood count, serum iron level, iron binding capacity, ferritin, folate, free T3, free T4, thyroid stimulating hormone and plasma homocysteine levels were measured. Control group consisted of 32 pregnant women who did not have a history of NTD in previous pregnancies and did not have fetuses with neural tube defect in present pregnancy. NTD was diagnosed between14- 20 gestational age. The mean gestational age of members of control group was the same as those of NTD group.
Results: There was no statistically significant difference between pregnants with neural tube defect and control group according to number of cases with vitamin B12 deficiency. Conclusion: it seems that vitamin B12 deficiency does not play a causative role in the development of fetal neural tube defect. Monitoring maternal homocystein levels might be important in understanding the etiologies of fetal neural tube defect.
Cumulative baby take-home rate among women with PCOS treated with IVF
Kuivasaari-Pirinen - DGYE-2009-0112.r1 [ID 463713]
OBJECTIVE: This study was designed to evaluate cumulative live birth rates after an in vitro fertilization (IVF) programme in polycystic ovary syndrome (PCOS) women..
SUBJECTS AND METHODS: IVF outcomes of 66 women with PCOS diagnosed via Rotterdam criteria, who failed to conceive after ovulation induction, were compared with 106 women with tubal factor infertility. One hundred and twenty-five cycles were analysed in the PCOS group and 225 cycles in the control group (1–4 cycles per woman). Results of frozen-thawed cycles, occurrence of ovarian hyperstimulation syndrome (OHSS) and drop-outs were also included.
RESULTS: Despite a lower pregnancy rate among women with PCOS vs. controls, the cumulative baby take-home rate did not differ between the groups (48.5% and 44.3%). The first cycle was the most successful cycle for living birth rate in PCOS group. One third of PCOS women, who did not continue after unsuccessful treatment, had more miscarriage but not more OHSS compared to those who continued.
CONCLUSIONS: Although the baby take-home rate was similar among women with PCOS, and controls, the outcomes of consecutive cycles were not equal. Cumulative data give more realistic information than pooled cycles.
Micronucleus Frequency in Lymphocytes and 8-Hydroxydeoxyguanosine Level in Plasma of Women with Polycystic Ovary Syndrome
Hamurcu DGYE-2009-0152.r1[ID 463723]
Polycystic ovary syndrome (PCOS) has recently been linked with genomic instability and DNA damage. The aim of our study was to test genomic damage in women PCOS, using two different methods for assessing damage in both chromosome and base level. The study was performed on 36 newly diagnosed women with PCOS and 29 healthy women as controls. The micronucleus (MN) analysis used as a biomarker of chromosomal/DNA damage was performed in peripheral lymphocytes by cytokinesis-block method.8-hydroxydeoxyguanosine (8-OHdG) levels used as a reliable marker of oxidative DNA damage was measured in plasma using an ELISA kit. We found that MN frequencies obtained from lymphocytes of the women with PCOS were significantly higher than those of controls (4.1 ± 1.0 vs 2.1 ± 0.6, p=0.001), whereas, no differences in 8-OHdG level were found between the patients with PCOS and controls (0.5 ± 0.3 vs 0.5 ± 0.2, p=0.858). These findings indicate that women with PCOS seem to have increased genomic instability, but do not appear to have oxidative DNA damage despite the increased oxidative stress associated with PCOS.
back to top...Lack of association between CYP21 V281L variant and polycystic ovary syndrome in Italian women
Pucci, Laura DGYE-2009-0223 [ID 465493]
Aim. To investigate the association between V281L CYP21 polymorphism and the hyperandrogenic phenotype of polycystic ovary syndrome (PCOS), in a cohort of 110 italian women.
Methods. The CYP21 genotype distribution was evaluated in 50 women with PCOS and 60 control subjects. Genotypes were detected using restriction fragment lenght polymorphism (RFLP) analysis performed on PCR templates from genomic DNA. Genotypes distribution was compared between groups and we considered a p-value less than 0.05 as statistically significant.
Results. The frequency of VV, VL and LL was in agreement with other populations. Nevertheless no significant association was observed between CYP21 polymorphism and the presence of PCOS in an italian cohort of women.
Conclusion. Although CYP21 gene, involved in steroidogenesis, is a candidate gene for pathogenesis of PCOS, our data suggest that V281L polymorphism is not associated with PCOS in Italian women; a larger study is needed to confirm this result.
Assessment of diagnostic competence of plasmatic androgens on polycystic ovary syndrome based on receiver operator characteristic curves (ROC).
Villarroel, Claudio DGYE-2009-0230.r1
ABSTRACT: This study was designed to assess the diagnostic potency of different androgens in hyperandrogenaemia criterion on Polycystic Ovary Syndrome (PCOS) based on ROC curves analysis.
METHODS: We evaluated 55 PCOS patients and 27 healthy fertile women (Control). Androgen evaluation included bio-available testosterone by ammonium sulphate precipitation (BAT), Free Testosterone Index (FTI), androstenedione (A), total testosterone and dehydroepiandrosterone sulphate (DHEA-S).
RESULTS: The androgen tests with the best diagnostic capacities were FTI and BAT. Although T and A had similar diagnostic potencies, A detected 5% of PCOS patients that could not be recognised by FTI, BAT (%), or T. The association of FTI, BAT (%) and A identified 96.36% of the hyperandrogenaemic patients. DHEA-S showed a wide dispersion of values and therefore poor discriminatory competence.
DISCUSSION: This study suggests that routine androgen evaluation in PCOS should include FTI, BAT and A to avoid misdiagnosis. ROC curve analysis of these tests on patients with the complete spectrum of PCOS phenotypes is needed to confirm these results
Perceived control over menopausal hot flushes in mid-aged women
Chedraui DGYE-2009-0236 [ID 463737]
Objective. To assess perceived control over menopausal HFs and determinant factors among mid-aged Ecuadorian women. Methods. Healthy women aged 40 to 59 years were assessed with the Menopause Rating Scale (MRS) and those presenting HFs were requested to fill out the Perceived Control Index (PCI) and a questionnaire containing socio-demographic data (female and partner).
Results. A total of 1,154 women participated in this study of which 56% presented HFs (n=646). According to the MRS 29.1% and 9.1% of these HFs were graded as severe and very severe, respectively. Mean age of women presenting HFs was 49.5 ± 5.2 years, with 51.9% having 12 years or less of education, 61.5% being postmenopausal and 47.2% living in high altitude. At the moment of the survey 13.9% were on hormone therapy, 12.8% on phytoestrogens and 7.1% on psychotropic drugs. There was a significant decreasing trend for PCI scores (total and difficulty in control items) from one menopausal stage to the next, with no differences observed for time since menopause onset. Despite this, logistic regression analysis determined that HF severity, as determined with the MRS, was the only single predictive factor related to lower HF perceived control (total PCI score < 38) (OR: 1.83 CI 95% [1.15-2.90], p < 0.01).
Conclusion. As determined with the PCI, HF severity was related to a lower perceived control among mid-aged women.
Treatment of moderate to severe premenstrual syndrome with Vitex agnus castus (BNO 1095) in Chinese women
MA DGYE-2009-0144.r1 [ID 463721]
Objectives: To assess efficacy of the extract of Vitex agnus castus (VAC, BNO 1095) in the treatment of Chinese women suffering from moderate to severe premenstrual syndrome (PMS).
Methods: It was a prospective randomized double-blind placebo-controlled study conducted in Chinese women. Eligible patients were randomly assigned into VAC or placebo group. Symptoms were documented with a daily rating scale with 4 symptom factors (negative affect, water retention, food cravings and pain).
Results: 67 patients were enrolled and randomly assigned to receive 1 tablet of VAC or placebo once a day. The PMSD sum score decreased from 29.38±7.63 score points at baseline to 4.28±5.76 at the 3rd cycle in the treatment group, while it decreased from 28.76±8.23 to 11.79±11.78 in the placebo group. All the 4 symptom factor scores were significantly reduced by the 3rd treatment cycle. There was significant difference in PMSD sum score, score of negative affect and water retention between 2 groups at cycle 3 (P<0.05). PMSD sum scores decreased 60% was defined as efficacy and the efficacy rate in treatment group was significantly higher than that in placebo group at the 3rd treatment cycle.
Conclusion: Vitex agnus castus extract BNO 1095 shows effective in treating moderate to severe PMS in Chinese women, especially in symptoms of negative affect and water retention.
Virilizing Sertoli-Leydig cell tumor associated with thyroid papillary carcinoma: case report and general considerations.
Poiana, Catalina DGYE-2009-0235.r1
We present a case of a Sertoli-Leydig cell tumor manifested with progressive hirsutism, frontal alopecia and secondary amenorrhea in a 46 years old female, evolving for 6 years until presentation. Serum testosterone level was 8.01 ng/mL and gonadotropic hormones were LH 8.57 mIU/mL and FSH 9.52mIU/mL. Computed tomography revealed a dense, solid, heterogeneous mass of 3.5/2.8 cm in the right ovary. Bilateral ovaryectomy and hysterectomy were performed. Histopathologycal diagnosis was of Sertoli-Leydig cell tumor with intermediate grade of differentiation. Immunohystochemical stains showed positive reaction for alpha-inhibin, calretin and for progesteron receptor. The testosterone levels dramatically decreased after surgery (0.31ng/mL) while levels of gonadotropes increased: LH 40.98mIU/mL and FSH 50.41mIU/mL. At 6 months follow-up the diagnosis of a left lobe thyroid nodule leaded to fine needle aspiration biopsy with suspicion of papillary carcinoma. Total thyroidectomy established the diagnosis of thyroid papillary carcinoma (2.17/2.18 cm) T2N0M0, stage II, followed by radioiodine administration. This is to our knowledge the first presented case of ovarian Sertoli-Leydig cell tumor associated with papillary thyroid carcinoma. This could suggest a common genetic background.
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The influence of other than prolactin hormones on bone mineral density in women with hyperprolactinemia of various origin
Bolanowski, Marek DGYE-2009-0217.r1
Hyperprolactinemia may lead to bone loss, both due to hypogonadism and other hormonal disturbances. Aim of the study was the analysis of influences of hormonal profiles associated with hyperprolactinemia on the bone mineral density (BMD) in women with hyperprolactinemia of various origin. Material and methods: The subjects were 32 patients with prolactinoma, 43 ones with functional hyperprolactinemia and 29 healthy controls. All of them were studied BMD (lumbar spine, proximal femur, forearm, total body) by DXA and their correlations with hormones levels (prolactin, estradiol, LH, FSH, SHBG, testosterone, DHEA-S, IGF-1 and i-PTH) using Spearman correlation analysis and multiple regression analysis model. Results: Correlation analysis revealed the anabolic influence of PTH on lumbar spine in women with prolactinoma, and on ultradistal radius in functional hyperprolactinemia. In multiple regression analysis, estradiol had greatest influence on lumbar spine and total body BMD. Moreover, positive influence of testosterone, SHBG on spine BMD, and of estradiol, testosterone, SHBG and DHEA-S on total body BMD were observed in patients with prolactinoma. Conclusion: Hormonal disturbances associated with hyperprolactinemia influence bone mineral density more in patients with prolactinoma than in ones with functional hyperprolactinemia.
Cryopreservation and oxidative stress in reproductive cells
Tatone DGYE-2009-0276
In spite of the optimization of cryopreservation protocols, post-thawing trauma to mammalian gametes cannot be completely avoided. Based on recent literature, cellular cryodamage in reproductive cells has been extensively characterized in terms of changes in cell structures, whereas biochemical alterations have been poorly investigated. The present paper reviews the current knowledge about the involvement of oxidative stress in frozen-thawed cells by considering the most relevant studies in sperm and oocytes. Recognizing that spermatozoa are highly susceptible to oxidative damage induced by cryopreservation, the need for further research is highlighted in order to understand whether changes in the redox state have a role in the reduced developmental potential of cryopreserved human reproductive cells.
Gynecologic challenging issues in the management of BRCA mutation carriers: oral contraceptives, prophylactic salpingo-oophorectomy and hormone replacement therapy
Gadducci, Angiolo, Biglia, Nicoletta; Cosio, Stefania; Sismondi, Piero; Genazzani, Andrea - DGYE-2010-0002[487609]
BRCA1 and BRCA2 mutation carriers have a 54-85% and 45% lifetime risk of developing breast cancer, respectively, and a 18-60% and 11-27% lifetime risk of developing ovarian cancer, respectively. Oral contraceptive [OC]s significantly reduce the risk of ovarian cancer also in BRCA1/BRCA2 mutation carriers. The association between OC use and breast cancer risk in these women is controversial. Some studies showed a modestly increased risk especially among BRCA1 mutation carriers The risk appears to be greater for women who took OCs for at least 5 years and who took OCs before age 30 years Other studies reported that duration of use before first full-term pregnancy has a positive association with breast cancer risk . Salpingo-oophorectomy reduces the risk of coelomic epithelial cancer of 80 to 95% and the risk of breast cancer of approximately 50%. BRCA1 and BRCA2 mutation carriers should be encouraged to undergo prophylactic bilateral salpingo-oophorectomy at the age of 35 to 40 years or when childbearing is complete. Short-term use of hormone replacement therapy may relieve menopausal symptoms and does not appear to affect the breast cancer risk reduction obtained with salpingo-oophorectomy.
Premature ovarian failure from current perspective
Kokcu, Arif DGYE-2010-0038[488773]
Premature ovarian failure is a syndrome characterized by amenorrhea, hypoestrogenism, and hypergonadotropinism before the age of 40. It is a disorder affecting approximately 1% of women <40 years, 1/1.000 women by the age of 30 and 1/10.000 women by the age of 20. POF is not merely an early menopause. Up to 50% of the patients with POF will have intermittent and unpredictable ovarian function which may persist for some years. Heterogeneity of POF is also reflected by the variety of possible causes, including autoimmunity, toxics, drugs, radiation, infectious as well as genetic defects. HRT remains the cornerstone of treatment and the only proven method of achieving pregnancy in these patients is by ovum donation.