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Fertil Steril. 2011 Aug;96(2):360-5. Epub 2011 Jun 29.

Incidence of endometriosis by study population and diagnostic method: the ENDO study.

Buck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J, Chen Z, Fujimoto VY, Varner MW, Trumble A, Giudice LC; ENDO Study Working Group.

Source

Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland.

Abstract

OBJECTIVE:

To estimate the incidence of endometriosis in an operative cohort of women seeking clinical care and in a matched population cohort to delineate more fully the scope and magnitude of endometriosis in the context of and beyond clinical care.

DESIGN:

Matched-exposure cohort design.

SETTING:

Surgical centers in the Salt Lake City, Utah, and San Francisco, California, areas.

PATIENT(S):

The operative cohort comprised 495 women undergoing laparoscopy/laparotomy between 2007 and 2009, and the population cohort comprised 131 women from the surgical centers’ catchment areas.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Incidence of endometriosis by diagnostic method in the operative cohort and by pelvic magnetic resonance imaged (MRI) disease in the population cohort.

RESULT(S):

Endometriosis incidence in the operative cohort ranged by two orders of magnitude by diagnostic method: 0.7% for only histology, 7% for only MRI, and 41% for visualized disease. Endometriosis staging was skewed toward minimal (58%) and mild disease (15%). The incidence of MRI-diagnosed endometriosis was 11% in the population cohort.

CONCLUSION(S):

Endometriosis incidence is dependent on the diagnostic method and choice of sampling framework. Conservatively, 11% of women have undiagnosed endometriosis at the population level, with implications for the design and interpretation of etiologic research.

Published by Elsevier Inc.

Fertil Steril. 2011 Aug;96(2):e86-9. Epub 2011 Jun 30.

Presurgical management of dysmenorrhea and endometriosis in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome.

Elliott JE, Abduljabar H, Morris M.

Source

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

Abstract

OBJECTIVE:

To report a patient with Mayer-Rokitansky-Kuster-Hauser syndrome with functional endometrium treated with preoperative continuous combined low-dose monophasic oral contraceptives.

DESIGN:

Case report.

SETTING:

University hospital.

PATIENT(S):

A 12-year-old nulligravid adolescent girl.

INTERVENTION(S):

Preoperative continuous combined low-dose monophasic oral contraceptives for 7 months, and laparoscopic resection of the rudimentary uterus and uterine horns with unilateral salpingo-oophorectomy.

MAIN OUTCOME MEASURE(S):

Relief of pain after hormonal treatment and the operative procedure.

RESULT(S):

Successful preoperative treatment of endometriosis and pain before definitive diagnosis and removal of müllerian remnants in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome.

CONCLUSION(S):

Patients with obstructive müllerian malformations with functional endometrium can be preoperatively managed with continuous combined low-dose monophasic oral contraceptives to control pain and treat endometriosis. This may permit a delay in surgical intervention to facilitate other investigations and to allow thorough counselling of the patient and her family about the implications of the diagnosis.

Fertil Steril. 2011 Aug;96(2):366-373.e8. Epub 2011 Jun 30.

Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.

Nnoaham KE, Hummelshoj L, Webster P, d’Hooghe T, de Cicco Nardone F, de Cicco Nardone C, Jenkinson C, Kennedy SH, Zondervan KT; World Endometriosis Research Foundation Global Study of Women’s Health consortium.

Source

Department of Public Health, University of Oxford, Oxford, UK; Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK.

Abstract

OBJECTIVE:

To assess the impact of endometriosis on health-related quality of life (HRQoL) and work productivity.

DESIGN:

Multicenter cross-sectional study with prospective recruitment.

SETTING:

Sixteen clinical centers in ten countries.

PATIENT(S):

A total of 1,418 premenopausal women, aged 18-45 years, without a previous surgical diagnosis of endometriosis, having laparoscopy to investigate symptoms or to be sterilized.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Diagnostic delay, HRQoL, and work productivity.

RESULT(S):

There was a delay of 6.7 years, principally in primary care, between onset of symptoms and a surgical diagnosis of endometriosis, which was longer in centers where women received predominantly state-funded health care (8.3 vs. 5.5 years). Delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia, and heavy periods) and a higher body mass index. Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis. Each affected woman lost on average 10.8 hours (SD 12.2) of work weekly, mainly owing to reduced effectiveness while working. Loss of work productivity translated into significant costs per woman/week, from US$4 in Nigeria to US$456 in Italy.

CONCLUSION(S):

Endometriosis impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.

Ann Thorac Surg. 2011 Jul;92(1):322-6.

Pneumothorax recurrence after surgery in women: clinicopathologic characteristics and management.

Alifano M, Legras A, Rousset-Jablonski C, Bobbio A, Magdeleinat P, Damotte D, Roche N, Regnard JF.

Source

Department of Thoracic Surgery, Hôtel-Dieu University Hospital, Paris V University, Paris, France.

Abstract

BACKGROUND:

Our aim was to study the clinical, surgical, and pathological characteristic of women with homolateral recurrence of pneumothorax despite previous surgery.

METHODS:

This study is a retrospective analysis of the clinical and pathological records of all consecutive women of reproductive age hospitalized in a thoracic surgery department for surgical treatment of pneumothorax recurrence despite previous surgery between 2000 and 2009.

RESULTS:

During the study period, 35 women were operated on. Their mean age was 37 years. Twenty-nine pneumothoraces (83%) were right sided. In 20 women, the recurrence occurred during the menstrual period. At initial surgery, 5 cases had been catamenial with evidence of thoracic endometriosis, 12 were catamenial with no evidence of endometriosis, 5 were noncatamenial with thoracic endometriosis, and 13 were idiopathic. At repeat surgery the figures were 18, 4, 5, and 8 cases, respectively. Repeat operation was carried out by video-assisted thoracoscopy in 13 cases, video-assisted minithoracotomy in 10, and standard thoracotomy in 12. Partial diaphragmatic resection was performed at repeat surgery in 16 patients (45.7%). Talc pleurodesis and pleural abrasion were carried out in 20 (57.1%) and 15 patients (42.9%), respectively. No major morbidity was observed. After repeat surgery, hormonal treatment was prescribed in 24 cases. Median follow-up was 40 months (range, 1.5 to 138 months). In 6 women, further homolateral recurrence of pneumothorax occurred (17.1%) and required surgery in 3 cases.

CONCLUSIONS:

Repeat surgery can be safely performed in women with recurrence of pneumothorax despite previous surgery, and frequently shows initially missed endometriosis.

Am J Pathol. 2011 Aug;179(2):880-9. Epub 2011 Jun 12.

The mTOR/AKT Inhibitor Temsirolimus Prevents Deep Infiltrating Endometriosis in Mice.

Leconte M, Nicco C, Ngô C, Chéreau C, Chouzenoux S, Marut W, Guibourdenche J, Arkwright S, Weill B, Chapron C, Dousset B, Batteux F.

Source

Laboratory of Immunology, Paris Descartes University, Hospital Cochin, Paris, France; Department of Digestive and Endocrine Surgery, Paris Descartes University, Hospital Cochin, Paris, France.

Abstract

Deep infiltrating endometriosis (DIE) is a particular clinical and histological entity of endometriosis responsible for chronic pelvic pain and infertility. Here we characterize the proliferative phenotype of DIE cells, to explore the cellular and molecular mechanisms that could explain their aggressive potential. In addition, the inhibition of mTOR/AKT pathway was tested, as a potential treatment of DIE. Included were 22 patients with DIE and 12 control patients without endometriosis. Epithelial and stromal cells were extracted from biopsies of eutopic endometrium and deep infiltrating endometriotic nodules from patients with DIE. Cell proliferation was determined by thymidine incorporation. Oxidative stress was assayed by spectrofluorometry. The ERK and mTOR/AKT pathways were analyzed in vitro by Western blot and for AKT in vivo in a mouse model of DIE. The proliferation rate of eutopic endometrial cells and of deep infiltrating endometriotic cells from DIE patients was higher than that of endometrial cells from controls. The hyperproliferative phenotype of endometriotic cells was associated with an increase in endogenous oxidative stress, and with activation of the ERK and mTOR/AKT pathways. mTOR/AKT inhibition by temsirolimus decreased endometriotic cell proliferation both in vitro and in vivo in a mouse model of DIE. Blocking the mTOR/AKT pathway offers new prospects for the treatment of DIE.

Arch Gynecol Obstet. 2011 Jun 30. [Epub ahead of print]

Clinicopathological characteristics of ovarian carcinomas associated with endometriosis.

Kondi-Pafiti A, Papakonstantinou E, Iavazzo C, Grigoriadis C, Salakos N, Gregoriou O.

Source

Pathology Laboratory, University of Athens, Athens, Greece.

Abstract

INTRODUCTION:

Substantial histopathology data provide evidence that endometriosis might be viewed as a precursor lesion of endometrioid and clear cell carcinoma of the ovary, via intermediary atypical borderline lesions. Also, genes involved in both endometriosis and epithelial ovarian cancer have been shown to play a role in the pathogenesis of endometriosis-associated ovarian carcinoma.

MATERIAL AND METHODS:

A retrospective study of 17 cases of ovarian carcinomas associated with endometriosis, diagnosed between 2000 and 2009, at Aretaieion Hospital of University of Athens, is presented. 10/17 cases in this study (58.8%) were clear cell carcinomas (CCC), 6/17 cases (35.3%) were endometrioid adenocarcinomas (EAC) and 1/17 cases (5.9%) was a serous carcinoma associated with ovarian endometriosis. Patients’s age was 27-76 years (mean age 58 years). Typical ovarian endometriosis was documented in 8/17 (47%) of the tumors. In 9/17 cases, areas of fibrosis or cystic lesions infiltrated by iron-laden macrophages and endometrial-like stroma, consistent with endometriosis, were observed.

CONCLUSION:

In comparison with common epithelial ovarian cancers, CCC and EACs of the ovary were presented at earlier stages. Cytoreductive surgical treatment is critical in order to plan appropriate post-operative management.

J Midlife Health. 2010 Jul;1(2):91-2.

Post-salpingectomy endometriosis: An under-recognized entity.

Chakrabarti I, Ghosh N.

Source

Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.

Abstract

We report a case of a 48-year old lady, who presented with complaints of lower abdominal pain and menorrhagia for the last four months. The patient had undergone bilateral salpingectomy four years back by the Pomeroy technique. Ultrasonography revealed an ovarian cyst on the right side. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and the specimen was sent for histopathological examination. It revealed that the normal mucosa of the tubectomy stump was completely replaced by endometrial tissue. Tubal endometriosis remains an under-recognized entity, due to less extensive routine sampling of the fallopian tubes, and they may be also be associated with other pathologies, as was in the present case.

Pathology. 2011 Aug;43(5):420-32.

Morphological subtypes of ovarian carcinoma: a review with emphasis on new developments and pathogenesis.

McCluggage WG.

Source

Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom.

Abstract

SUMMARY: Ovarian carcinomas comprise a heterogeneous group of neoplasms, the four most common subtypes being serous, endometrioid, clear cell and mucinous. In recent years, our understanding of the underlying pathogenesis and initiating molecular events in the different tumour subtypes has greatly increased, and although ovarian carcinoma is often considered clinically as one disease, there is now a much greater realisation that the various subtypes have a different natural behaviour and prognosis. At present, adjuvant therapy is mainly dependent upon tumour stage and grade rather than type; however, this is likely to change in the future with the development of new chemotherapeutic agents and targeted therapies and clinical trials are necessary to evaluate the efficacy of different agents in clear cell, mucinous and low grade serous carcinomas, neoplasms which are considered relatively resistant to traditional chemotherapeutic regimes. In this review, the major subtypes of ovarian carcinoma are discussed. It is now firmly established that there are two distinct types of ovarian serous carcinoma, low grade and high grade, the former being much less common and arising in many cases from a serous borderline tumour. Low grade and high grade serous carcinoma represent two distinct tumour types with a different underlying pathogenesis rather than low grade and high grade variants of the same neoplasm. Both are usually advanced stage (stage III or IV) at diagnosis. B-raf and k-ras mutations are important molecular events in low grade serous carcinomas while high grade serous carcinomas are almost always associated with TP53 mutation. There is now emerging and compelling evidence that many high grade serous carcinomas (by far the most common subtype of ovarian carcinoma) actually arise from the epithelium of the distal fallopian tube. Future studies regarding the initiating molecular events in the development of this aggressive neoplasm should concentrate on this site. Primary ovarian mucinous carcinomas are uncommon, almost always unilateral and stage I, and largely of so-called intestinal or enteric type. Most arise in a stepwise manner from a pre-existing mucinous cystadenoma and mucinous borderline tumour. Endometrioid and clear cell carcinomas typically present as low stage neoplasms and in many, or most, cases arise from endometriosis; the former are usually well differentiated and there is now evidence that the majority of neoplasms reported in the past as high grade endometrioid carcinoma are of serous type. WT1 is useful in this regard since it is a relatively specific marker of a serous phenotype. It is recommended that different subtypes of ovarian carcinoma are graded using different systems rather than employing a universal grading system.

J Clin Endocrinol Metab. 2011 Jun 29. [Epub ahead of print]

Identification of Estrogen Response Element in the Aquaporin-2 Gene That Mediates Estrogen-Induced Cell Migration and Invasion in Human Endometrial Carcinoma.

Zou LB, Zhang RJ, Tan YJ, Ding GL, Shi S, Zhang D, He RH, Liu AX, Wang TT, Leung PC, Sheng JZ, Huang HF.

Source

Department of Reproductive Endocrinology, Women’s Hospital (L.-B.Z., R.-J.Z., G.-L.D., D.Z., R.-H.H., A.-X.L., T.-T.W., P.C.K.L., H.-F.H.), and Department of Pathophysiology (Y.-J.T., S.S., J.-Z.S.), School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, China; Key Laboratory of Reproductive Genetics (D.Z., A.-X.L., T.-T.W., J.-Z.S., H.-F.H.), Ministry of Education, Hangzhou, Zhejiang 310006, China; and Department of Obstetrics and Gynecology (P.C.K.L.), Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z4.

Abstract

Background: Accumulating evidence suggests that aquaporins (AQP) can facilitate cell migration, invasion, and proliferation in tumor development in addition to water transport. Objective: The aim of this study was to examine AQP2 expression in the endometrial tissues from patients with endometrial carcinoma (EC) and determine the roles and mechanisms of AQP2 in estrogen-related cell migration, invasion, adhesion, and proliferation of Ishikawa (IK) cells. Approach: AQP2 expression levels were measured in human endometrial cells and estradiol (E(2))-treated IK cells, and the estrogen-response element was identified. After blocking down and up-regulating the endogenous expression of AQP2 in IK cells, cell morphology, capacity for invasion, migration and adhesion, and expression markers of membrane/cytoskeleton were analyzed. Results: AQP2 was expressed in endometrial tissues from patients with EC and endometriosis, both of which are estrogen-dependent diseases. In IK cells, E(2) dose-dependently increased AQP2 expression, which was blocked by the estrogen receptor inhibitor ICI182780. An estrogen-response element was identified in the AQP2 promoter. E(2) significantly increased the migration, invasion, adhesion, and proliferation of IK cells. AQP2 knockdown attenuated E(2)-enhanced migration, invasion, and adhesion. AQP2 knockdown reduced not only the E(2)-enhanced expression of F-actin and annexin-2 but also the E(2)-induced alteration of cell morphology. Moreover, higher expression levels of F-actin and annexin-2 were detected in the endometrial tissues from patients with EC. Conclusions: AQP2 mediates E(2)-enhanced migration, invasion, and adhesion through alteration of F-actin and annexin-2 expression and reorganization of F-actin, and inhibition of AQP may be a potential method for antitumor therapy.

Hum Reprod. 2011 Jun 29. [Epub ahead of print]

IVF and endometriosis-related symptom progression: insights from a prospective study.

Benaglia L, Somigliana E, Santi G, Scarduelli C, Ragni G, Fedele L.

Source

Infertility Unit, Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, Italy.

Abstract

BACKGROUND A possible and neglected concern in women with endometriosis undergoing IVF is the potential risk of progression of the disease. We set up a prospective study mainly aimed at evaluating the impact of IVF on endometriosis-related symptoms. MATERIALS AND METHODS Women with surgical or echographic diagnosis of endometriosis and selected for IVF were included. In the month preceding the IVF attempt and at a second evaluation 3-6 months after the cycle, women who did not get pregnant underwent clinical assessment and transvaginal ultrasonography. Each patient was requested to complete a questionnaire on the presence, severity and modifications of endometriosis-related symptoms before and after the IVF cycle. RESULTS Overall, 64 patients completed the study protocol. The Biberoglu-Behrman Scores and the Verbal Rate Scales for dysmenorrhea, dispareunia and chronic pelvic pain did not worsen after the procedure. Other endometriosis-related symptoms also did not change. There was no modification in size and number of endometriomas and deep peritoneal nodules. The number (%) of women reporting general improvement and worsening were 14 (22%) and 7 (11%), respectively. CONCLUSIONS IVF does not expose women to a consistent risk of endometriosis-related symptoms progression.

Hum Reprod. 2011 Jun 29. [Epub ahead of print]

Non-health-care costs associated with endometriosis.

Simoens S, Meuleman C, D’Hooghe T.

Source

Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Onderwijs en Navorsing 2, Herestraat 49, PO Box 521, 3000 Leuven, Belgium.

Abstract

BACKGROUND This study aims to quantify the non-health-care costs of endometriosis in a sample of Belgian patients over a 30-month period. METHODS A longitudinal study enrolled patients who underwent surgical treatment for endometriosis in University Hospitals Leuven. Self-reported patient questionnaires measured costs at 1 month prior to surgical treatment and at 6, 12, 18 and 24 months following treatment. The number of days of work absence was valued using gross monthly income to estimate costs of productivity loss. Analysis included patient expenditure on support with household activities. The costs per patient over 6 months were obtained by linear extrapolation. RESULTS Of 394 eligible patients, 180 participated in the study (response rate of 46%). The highest productivity loss was incurred during the 6 months preceding surgical treatment (€1514 ± 2576) and the 6 months following treatment (€2496 ± 4144). Mean costs dropped to €115-€225 during the following 6-month periods. Similarly, costs of support with household activities peaked during the 6 months preceding surgical treatment (€982 ± 908) and during the subsequent 6 months (€981 ± 1085), after which they dropped to €500-€675 during the following 6-month periods. Patients with severe endometriosis (Stage IV) (€4943) had higher total non-health-care costs over the 30-month period than patients with minimal-to-moderate endometriosis (Stages I-III) (€4510) (P = 0.048). CONCLUSIONS As our study did not include a control population of women without endometriosis, patients were asked to report non-health-care costs associated with endometriosis only. Results show that the highest non-health-care costs associated with endometriosis are incurred during the 6 months prior to and following surgical treatment.

Hum Reprod. 2011 Jun 29. [Epub ahead of print]

Application of the histone deacetylase inhibitors for the treatment of endometriosis: histone modifications as pathogenesis and novel therapeutic target.

Kawano Y, Nasu K, Li H, Tsuno A, Abe W, Takai N, Narahara H.

Source

Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita, Japan.

Abstract

BACKGROUND Accumulating evidence suggests that various epigenetic aberrations play definite roles in the pathogenesis of endometriosis. We investigated the histone acetylation status in endometriosis and the application of the histone deacetylase inhibitors (HDACIs) for the treatment of endometriosis. METHODS The levels of acetylated histones in the endometriotic cyst stromal cells (ECSCs) and normal endometrial stromal cells (NESCs) were evaluated. The effects of the HDACIs on cell proliferation, the cell cycle, apoptosis of ECSCs and NESCs, and the expression of genes related to these cellular events were investigated. The effects of HDACIs on histone acetylation in chromatin of the promoter region of the cell cycle regulatory genes in ECSCs were also investigated. RESULTS The acetylated histone levels were significantly lower in ECSCs than in NESCs (P < 0.025). HDACIs inhibited cell proliferation and induced cell cycle arrest and apoptosis of ECSCs. The effects of HDACIs on NESCs were marginal or weak. These HDACIs induced an accumulation of acetylated histones in total cellular chromatin and in the promoter regions of the p16(INK4a), p21(Waf1/Cip1), p27(Kip1) and cycle checkpoint kinase 2 genes in ECSCs. HDACIs induced the protein expression of these cell cycle regulators and suppressed the protein expression of Bcl-2 and Bcl-X(L) in ECSCs. CONCLUSIONS The present findings demonstrated that aberrant histone modifications are present in endometriosis and that HDACIs reactivated epigenetically silenced genes, resulting in the suppression of cell proliferation, induction of cell cycle arrest and apoptosis of ECSCs. HDACIs are therefore promising agents for the treatment of endometriosis.

J Reprod Immunol. 2011 Jun 27. [Epub ahead of print]

Identification of anti-syntaxin 5 autoantibody as a novel serum marker of endometriosis.

Nabeta M, Abe Y, Takaoka Y, Kusanagi Y, Ito M.

Source

Department of Molecular Pathology, Ehime University Graduate School of Medicine, Toh-on, Ehime 791-0295, Japan; Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toh-on, Ehime 791-0295, Japan.

Abstract

The sensitivity and specificity of CA125, as a sole serum marker of endometriosis, are not high enough for routine clinical assessment. To explore new markers for the diagnosis of endometriosis, serum autoantibodies in endometriotic patients were investigated employing a fibroblast cell line, two-dimensional (2D) gel electrophoresis and Western blotting. Proteins reacting with serum autoantibodies by Western blotting were identified using MASCOT analysis. ELISAs were then prepared using recombinant proteins and titers of serum autoantibodies were determined in the endometriotic patients, disease controls, and healthy subjects. Among the autoantibodies identified, anti-syntaxin 5 (STX5) autoantibody levels were significantly elevated in endometriotic patients. Sensitivity (53.6%) and accuracy (72.2%) of the serum anti-STX5 autoantibody assay were better than those of serum CA125 levels (36.2% and 62.9%, respectively) for diagnosis. The sensitivity of anti-STX5 autoantibody was remarkably high in Stage II (80.0%) compared with that of CA125 (40.0%). A combination assay of anti-STX5 autoantibody with CA125 improved the overall sensitivity to 69.6%. We conclude that serum anti-STX5 autoantibody, which was discovered by a proteomic approach, is a potential new serum marker for the diagnosis of endometriosis. This initial study now requires validation by further clinical evaluation.

Gynecol Endocrinol. 2011 Jun 30. [Epub ahead of print]

Effect of follicular fluid oxidative stress parameters on intracytoplasmic sperm injection outcome.

Bedaiwy MA, Elnashar SA, Goldberg JM, Sharma R, Mascha EJ, Arrigain S, Agarwal A, Falcone T.

Source

Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University , Cleveland , USA.

Abstract

Out of the 138 included patients, 42 (30%) achieved pregnancy after ICSI. Log ROS, TAC, and the ROS-TAC score were not significantly different across diagnoses. Pregnant cycles were associated with significantly lower ROS (P  A total of 138 consecutive women who had ICSI were included in this study. FF ROS and TAC were measured by enhanced chemiluminescence and colorimetric assay, respectively, and then the ROS-TAC score was calculated. Results. The purpose of this study was to evaluate the association between the follicular fluid (FF) reactive oxygen species (ROS) levels, total antioxidant capacity (TAC) and ROS-TAC score and pregnancy after intracytoplasmic sperm injection (ICSI). Methods. Objective.< 0.001), higher TAC (P < 0.001) and higher ROS-TAC scores (P < 0.001). After adjusting for age, there was a significant positive correlation between log ROS and the number of follicles on the day of HCG administration (correlation 0.20, 95% CI: 0.02, 0.39) as well as the number of oocytes retrieved (correlation 0.18, 0.001, 0.36) but not with TAC. Interestingly, in women with endometriosisHigher FF TAC, higher FF ROS-TAC scores and lower FF ROS levels are associated with pregnancy after ICSI. Oxidative stress parameters may be markers of metabolic activity within the follicle. , higher TAC levels and higher ROS-TAC scores were associated with a higher likelihood of finding normal oocytes (P = 0.005 and P = 0.002, respectively). Conclusion.

PLoS One. 2011;6(6):e21221. Epub 2011 Jun 21.

Reconstruction of endometrium from human endometrial side population cell lines.

Cervelló I, Mas A, Gil-Sanchis C, Peris L, Faus A, Saunders PT, Critchley HO, Simón C.

Source

Fundación IVI-Instituto Universitario IVI, Universidad de Valencia, INCLIVA, Valencia, Spain.

Abstract

Endometrial regeneration is mediated, at least in part, by the existence of a specialized somatic stem cell (SSC) population recently identified by several groups using the side population (SP) technique. We previously demonstrated that endometrial SP displays genotypic, phenotypic and the functional capability to develop human endometrium after subcutaneous injection in NOD-SCID mice. We have now established seven human endometrial SP (hESP) cell lines (ICE 1-7): four from the epithelial and three from the stromal fraction, respectively. SP cell lines were generated under hypoxic conditions based on their cloning efficiency ability, cultured for 12-15 passages (20 weeks) and cryopreserved. Cell lines displayed normal 46XX karyotype, intermediate telomerase activity pattern and expressed mRNAs encoding proteins that are considered characteristic of undifferentiated cells (Oct-4, GDF3, DNMT3B, Nanog, GABR3) and those of mesodermal origin (WT1, Cardiac Actin, Enolase, Globin, REN). Phenotype analysis corroborated their epithelial (CD9+) or stromal (vimentin+) cell origin and mesenchymal (CD90+, CD73+ and CD45-) attributes. Markers considered characteristic of ectoderm or endoderm were not detected. Cells did not express either estrogen receptor alpha (ERα) or progesterone receptor (PR). The hESP cell lines were able to differentiate in vitro into adipocytes and osteocytes, which confirmed their mesenchymal origin. Finally, we demonstrated their ability to generate human endometrium when transplanted beneath the renal capsule of NOD-SCID mice. These findings confirm that SP cells exhibit key features of human endometrial SSC and open up new possibilities for the understanding of gynecological disorders such as endometriosis or Asherman syndrome. Our cell lines can be a valuable model to investigate new targets for endometrium proliferation in endometriosis.

Arch Gynecol Obstet. 2011 Jun 28. [Epub ahead of print]

Timing of intrauterine insemination: an attempt to unravel the enigma.

Rahman SM, Karmakar D, Malhotra N, Kumar S.

Source

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, 110029, India.

Abstract

INTRODUCTION:

Controlled ovarian stimulation (COS) with intrauterine insemination (IUI) is an effective treatment in cases of cervical factor, unexplained infertility and mild male factor. The optimal timing of IUI after human chorionic gonadotrophin (hCG) after COS with clomiphene citrate is debatable and may be a factor limiting success of same. This study was designed to scientifically determine if variation in the timing of IUI could affect the cycle outcome.

MATERIALS AND METHODS:

In a prospective randomized trial couples with mild male factor, unexplained infertility and mild endometriosis who underwent COS with IUI were recruited. COS was achieved with clomiphene citrate. Two hundred and four women underwent 461 cycles of IUI. Women were randomized to two groups: group I (104 patients, 231 cycles) had IUI 36 h after hCG, while group II (100 patients, 230 cycles) had IUI 24 h after hCG. Primary outcome included pregnancy rate per couple and per cycle.

RESULTS:

Fifty-four patients had pregnancy with and pregnancy rate per couple and per cycle were 32.6 and 14.7% in group I and 20 and 8.6% in group II, respectively (not statistically different).

CONCLUSIONS:

Altering timing of IUI after COS does not enhance pregnancy rates. IUI 36 h after hCG has marginally better pregnancy rates than 24 h. Timing of insemination may be kept at 24 or 36 h after hCG injection to suit the convenience of the clinic or care provider. The lack of statistical significance indicates need for larger studies to draw guidelines.

 

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