Efficacy of combined metformin–letrozole in comparison with bilateral ovarian drilling in clomiphene-resistant infertile women with polycystic ovarian syndrome

Objectives

To compare the hormonal-metabolic profiles and reproductive outcomes between women receiving metformin plus letrozole and women undergoing bilateral ovarian drilling in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS).

Methods

In this randomized study, 146 patients were randomly allocated into group 1 (n = 73) who received metformin plus letrozole, and group 2 (n = 73) who underwent bilateral ovarian drilling. Comparison was done between the basal and after treatment biochemical values for each group, in addition reproductive outcomes after treatment were compared between both groups.

Results

There was significant reduction in testosterone (p ≤ 0.001), fasting insulin (p ≤ 0.001), and fasting glucose/fasting insulin ratio (p = 0.029) in metformin plus letrozole group, while there was significant reduction in FSH, LH and LH/FSH ratio in bilateral drilling group (p ≤ 0.001, 0.001 and 0.001). No significant difference in cycle regularity (p = 0.82), ovulation (p = 0.24), pregnancy rate (p = 0.32) and abortion rate (p = 0.51) between both groups.

Conclusion

Both metformin plus letrozole and bilateral ovarian drilling are similarly effective as second-line strategies for the treatment of women with PCOS who do not conceive with CC.     

Vitamin D improves endometrial thickness in PCOS women who need intrauterine insemination: a randomized double-blind placebo-controlled trial

Purpose

To determine whether administration of vitamin D affects the success rates of intra uterine insemination (IUI) in infertile polycystic ovarian syndrome (PCOS) women and their endometrial thickness.

Methods

This randomized, double-blind, placebo-controlled trial was conducted in an infertility clinic of Women’s Hospital, and 110 infertile PCOS patients undergoing IUI were randomly divided to receive vitamin D or placebo. Endometrial thickness, IUI results, number of dominant follicles, duration of IUI cycle, and dose of HMG used in IUI were determined.

Results

The endometrial thickness was significantly different in the group treated with vitamin D versus the placebo group (p = 0.003). There was no statistical difference in pregnancy out come between the two groups (RR = 1.167, CI 95 % 0.70–1.93). No statistical difference was found in number of dominant follicles (p = 0.96), duration of IUI cycles (p = 0.70) and dose of HMG used for IUI (p = 0.95).

Conclusions

It seems that administration of vitamin D induces endometrial proliferation in PCOS women during IUI cycle.     

A panoramic view to relationships between reproductive failure and immunological factors

Purpose

To examine the possible roles of various immunological factors in recurrent miscarriage and unexplained infertility.

Methods

The synthesis and review of the relevant current literature in English language.

Results

Substantial evidence suggests that antiphospholipid antibodies, lupus anticoagulant, antisperm antibodies, antithyroid antibodies, anti-endometrial antibodies, antiovarian antibodies, anti-C trachomatis antibodies, cytokines, and immunological events in endometriosis and premature ovarian failure due to immunologic factors may contribute to reproductive failure including unexplained infertility and/or non-chromosomal recurrent miscarriage.

Conclusions

Elimination or suppression of the immunological factors related with reproductive failure might occupy an important place in the treatment of unexplained infertility and non-chromosomal recurrent miscarriage.     

The effect of obesity on inflammatory markers in patients with PCOS: a BMI-matched case–control study

Background

Previous studies have shown increased inflammatory activity in patients with polycystic ovary syndrome (PCOS); however, it remains uncertain whether this increased inflammatory activity is a consequence of the disorder itself or of the accompanying obesity. We therefore aimed to test the inflammatory marker levels in obese and lean patients with PCOS by using two separate control groups with matching body mass index (BMI).

Method

A total of 120 women in reproductive age with (n = 62) and without (n = 60) PCOS were recruited for the study. Patients with PCOS were divided into two groups as obese (n = 32) and lean (n = 30) PCOS groups according to BMI. Two BMI-matched control groups were created. Furthermore, high sensitive CRP protein (hsCRP), neutrophils, lymphocytes, white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) were evaluated with complete blood count.

Results

The hsCRP (5.5 ± 0.8 vs. 3.1 ± 0.7, p < 0.001), neutrophil count (3.8 ± 0.4 vs. 2.9 ± 0.7, p < 0.001), leukocyte count (7.2 ± 1.8 vs. 5.6 ± 1.6, p < 0.001), and NLR (2.6 ± 1.4 vs. 1.5 ± 0.4, p < 0.001) were higher in patients with PCOS compared to the control group while lymphocyte count was lower (1.71 ± 0.65 vs. 1.98 ± 0.39, p = 0.008). Similarly, both obese and lean patients with PCOS had higher levels of hsCRP, neutrophils, leukocytes and NLR ratios compared to BMI-matched controls. The correlation analysis revealed a moderate correlation between NLR and hsCRP (r 0.459, p < 0.001), and between HOMA-IR (r 0.476 p < 0.001) and BMI (r 0.310, p 0.001).

Conclusion

Our study results demonstrated that both lean and obese patients with PCOS have increased inflammatory markers compared to BMI-matched control groups indicating that the inflammation seen in PCOS might be related with the presence of the disorder rather than with obesity.     

Prospective analysis of ovarian reserve markers as determinant in response to controlled ovarian stimulation in women undergoing IVF cycles in low resource setting in India

Introduction

The objective of this study was to determine whether ovarian reserve markers can predict ovarian response in women undergoing their first cycle of assisted reproduction.

Materials and methods

This prospective observational study included 292 infertile patients undergoing their first IVF trial in the Assisted Reproductive Unit in a tertiary care hospital. Day 2 follicle stimulating hormone (FSH), Inhibin B, anti-Mullerian hormone (AMH), antral follicle count (AFC) and ovarian volume was measured before commencement of controlled ovarian hyperstimulation. The main outcome measures were oocytes retrieved and this was correlated with ovarian reserve markers.

Results

The mean age was 31.8 (±4.4) years and mean duration of infertility 8.2 (±3.9) years. The correlation between oocytes retrieved and age, day 2 FSH, Inhibin B, AMH, AFC and volume of the ovary was calculated. A negative correlation was found with age (r = ?0.22, p < 0.001) and day 2 FSH (r = ?0.35, p < 0.001). A positive correlation was seen with AMH (r = 0.15, p = 0.022), AFC (r = 0.48, p < 0.05) and volume (r = 0.17, p = 0.009). In the bivariate analysis, 1 year increase in age was found to decrease the oocytes retrieved count by 0.37 with a significant p value. The independent significant factors found in multiple linear regression analysis were day 2 FSH and AFC.

Discussion

The present study concludes that day 2 FSH and AFC are promising biomarkers for ovarian reserve in predicting ovarian response to gonadotropin stimulation in IVF patients.     

Follicular sensitivity index (FSI): a novel tool to predict clinical pregnancy rate in IVF/ICSI cycles

Purpose

This study aims to introduce a new tool (the Follicular Sensitivity Index; FSI) for objective assessment of follicular responsiveness to exogenous gonadotropins and to evaluate its ability to predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI.

Methods

FSI was calculated as preovulatory follicle count (PFC) × 100,000/[antral follicle count (AFC) × total received FSH doses]. One thousand women were included and were divided according to the FSI tertile values into three groups. The primary outcome was clinical pregnancy defined by the presence of an intrauterine gestational sac 5 weeks after embryo transfer.

Results

There was progressive increase in the clinical pregnancy rate from the low to the high FSI groups (0.27 ± 0.4 vs 0.4 ± 0.4 and 0.58 ± 0.4; p < 0.001). Receiver operator curves showed that FSI had a greater area under the curve than those of the AFC, PFC, and the FSH dose (0.638 vs 0.509, 0.538, and 0.589 respectively). Multivariate logistic regression analysis showed that the correlation between FSI and pregnancy was independent of potential confounding factors like age and body mass index (p < 0.001).

Conclusion

FSI can predict the clinical pregnancy rate in women with unexplained infertility or tubal factor undergoing IVF/ICSI using GnRH agonist protocol. Higher FSI values had significantly higher oocyte yield and fertilization and clinical pregnancy rates. Wider implications of these findings include the potential use of FSI to define absolute criteria of poor/good ovarian response in IVF/ICSI cycles, guide future IVF cycle management for the same couples, and guide cycle cancelation criteria for poor ovarian response.

     

Anti-Mullerian Hormone: A New Marker of Ovarian Function

Objectives

The aim of this study was to determine day 3 Serum AMH, FSH, LH, Estradiol (E₂), Inhibin B levels, ovarian volume, and antral follicular count to assess ovarian function.

Methods

This study was conducted on 130 infertile women between age 18 and 43 years. Day 3 Serum AMH level was estimated by sandwich enzyme immunoassay; Serum FSH, S. LH, S. E₂, by solid-phase two-site chemiluminescent immunometric assay; Inhibin B by ELISA; and Ovarian volume and AFC, by transvaginal ultrasonography.

Results

With advancing age, Serum AMH level (p < 0.0001), AFC (p < 0.05), ovarian volume (>0.05), and Inhibin B (>0.05) were decreased, and Serum FSH (p < 0.05), LH (p > 0.05), and E₂ (p < 0.05) were increased. Serum AMH level was 4–6.8 ng/ml with optimal fertility in 26.15 % cases and 2.2–4.0 ng/ml with satisfactory fertility in 53.85 % cases. Serum AMH levels were more strongly correlated with AFC (p < 0.0001) and ovarian volume (p < 0.0001).

Conclusion

Serum AMH levels were more robustly correlated with AFC than FSH, LH, E₂, and Inhibin B on day 3 of the cycle. This suggested that serum AMH might be taken as single test to reflect ovarian reserve.     

Polycystic ovarian syndrome and congenital uterine anomalies: the hidden common player

Objective

To study the association between polycystic ovary syndrome (PCOS) and congenital uterine (Müllerian) anomalies in infertile patients. The ultimate aim was to check for a common factor linking both reproductive health problems.

Design

A prospective observational study.

Setting

Tertiary referral infertility center.

Subjects and methodology

3,900 infertile patients were included. The diagnoses of PCOS and uterine anomalies were made. Patients with or without PCOS were correlated to the presence or absence of uterine anomalies and statistically assessed.

Main outcome measures

Study of the prevalence of PCOS/uterine anomalies in the studied population and the ratio of coexistence.

Results

The prevalence of PCOS in the studied cohort was 10.48 %. 409 (10.48 %) patients were confirmed to have PCOS, while 204 (5.23 %) were with confirmed uterine anomalies. Of the patients with confirmed PCOS, almost one-third (n = 149, 31.4 %) had uterine anomalies, while in patients with confirmed uterine anomalies, almost three-fourths (n = 149, 73 %) had PCOS.

Conclusions

There is evident association between PCOS and uterine anomalies in infertile patients. We suggest a genetic rather than a developmental defect to be a possible common player for the development of both PCOS and uterine anomalies.     

Prognostic role of E-cadherin in patients with advanced serous ovarian cancer

Purpose

To analyse correlation between expression of E-cadherin and clinical and pathological features and overall survival in advanced-stage serous ovarian carcinoma.

Methods

The expression of E-cadherin was analysed immunohistochemically in formalin-fixed, paraffin-embedded samples from 54 patients with advanced-stage serous ovarian cancer and related to clinicopathological characteristics and patients survival. The clinicopathological characteristics included the stage according to the International Federation of Gynecology and Obstetrics (FIGO), tumour differentiation, number of mitoses per 10 high-power fields (HPF), residual tumour size, and vascular invasion. Only patients with serous ovarian cancer FIGO stages III–IV were included. Overall survival (OS) was defined as time from surgery to the last follow-up date on 01.10.2010. OS was evaluated using Kaplan–Meier method, and log-rank test was used to asses the differences between the positive and E-cadherin negative group. Multivariate analysis was completed using the Cox proportional hazard regression model.

Results

E-cadherin immunoreactivity was not associated with FIGO stage, tumour grade, number of mitotic figures per 10 HPF, residual tumour volume or vascular invasion. Negative E-cadherin expression significantly predicted shorter OS (p < 0.001). The multivariate analyses showed that negative E-cadherin (p < 0.001), FIGO stage (p = 0.012) and residual tumour size >1 cm after the initial cytoreductive surgery (p < 0.001) were predictors of shorter OS.

Conclusion

Negative E-cadherin expression like presence of residual tumour after primary cytoreductive surgery and higher FIGO stage seem to predict unfavourable clinical outcome in patients with advanced-stage serous ovarian cancer. Negative expression of E-cadherin was shown to be a significant independent predictor of poorer OS. E-cadherin as marker has prognostic value.     

The role of anti-Mullerian hormone in predicting the response to clomiphene citrate in unexplained infertility

Objective

To determine the role of anti-Mullerian hormone (AMH) levels in predicting the response to clomiphene citrate (CC) therapy for ovulation induction in women with unexplained infertility.

A macrophage activation marker chitotriosidase in women with PCOS: does low-grade chronic inflammation in PCOS relate to PCOS itself or obesity?

Objective

Polycystic ovary syndrome (PCOS) is described as a low-grade chronic inflammatory state where the macrophage infiltration increased in visceral fat play the major role. The aim of this study was to assess chitotriosidase (ChT) activity (an activated macrophage marker) in women with PCOS and controls and to evaluate its correlation with anthropometric and biochemical parameters.

Study design

Seventy-nine women with PCOS and 60 healthy controls were included in the study. PCOS and controls were divided into two subgroups according to body mass indexes (BMIs) as normoweight (<25?kg/m²) and overweight (≥25?kg/m²). ChT activity, biochemical (free testosterone, luteinizing hormone, insulin resistance index, etc.) and clinical parameters [BMI, waist-to-hip ratio, modified Ferriman–Gallwey scores (mFG)] were analyzed according to groups.

Results

Serum ChT activity was significantly (p?r 0.598, p?r 0.525, p?r 0.402, p 0.001) and total testosterone (r 0.168, p 0.048) for the combined groups (PCOS?+?controls). In multivariant linear regression analysis participants’ PCOS status (presence or absence) and LH levels were the main predictors of ChT activity in the whole study population (p 0.002 and p 0.041, respectively).

Conclusion

ChT activity elevates in PCOS independent of obesity. Our findings support the concept of PCOS is a state of low-grade chronic inflammation where the macrophages could play the major role. Hyperandrogenism might also be related to this inflammatory state and can be a subject of further trials.     

Neoadjuvant chemotherapy equalizes the optimal cytoreduction rate to primary surgery without improving survival in advanced ovarian cancer

Purpose(s)

To evaluate results of neoadjuvant chemotherapy (NACT) following debulking surgery in patients with extensive metastatic disease and/or poor medical performance

Method(s)

Advanced stage epithelial ovarian cancer patients were treated with either NACT followed by debulking surgery or primary surgery followed by adjuvant chemotherapy after assessment of the extent of disease by laparoscopy or laparotomy.

Results

Out of 297, 223 patients were in the primary surgery group, whereas 74 of them met NACT criteria. Optimal cytoreduction rates were 63.2 % in primary surgery group and 60.8 % in NACT group, respectively (p: 0.709). In the primary surgery group, the overall survival was significantly higher (p: 0.002). Mean patient age was more advanced (p: 0.014) and the performance status of patients was poorer (p < 0.001) in NACT group. Only patient group (primary surgery or neoadjuvant chemotherapy) (p: 0.001) retained significance as predictors of survival in multivariate analyses.

Conclusion(s)

Improved rate of optimal cytoreduction with NACT in advanced ovarian cancer patients does not prolong survival. The extent of disease at diagnosis is the primary determinant of survival. Randomizing patients with equally extensive disease and performance status to either NACT or primary debulking surgery in a future study will better clarify benefits attributed to NACT.     

Effect of ethinyl estradiol–cyproterone acetate treatment on asymmetric dimethyl-arginine levels in women with polycystic ovary syndrome

Purpose

Our study was undertaken to evaluate the levels of asymmetric dimethyl-arginine (ADMA) in a group of patients affected with polycystic ovary syndrome (PCOS)—under ethinyl estradiol–cyproterone acetate treatment or not—as compared with a group of healthy controls.

Methods

Fifty-eight women with PCOS and 45 patients as control group were included in the study. The 58 women with PCOS were separated into two groups: Group A (n = 29) were treated with an oral contraceptive pill containing 0.035 mg of ethinyl estradiol (EE) and 2 mg of cyproterone acetate (CA) (Diane-35) for 6 months. Group B (n = 29) did not take any drug. Group C (n = 45) was healthy women as control group. Serum levels of ADMA, lipid and glucose metabolism parameters, hormone profile were measured on the sixth month of treatment.

Results

ADMA levels were similar in women with PCOS and controls, whereas ADMA levels significantly decreased after a period of 6 months treatment with EE + CA in women with PCOS. ADMA levels and insulin resistance were decreased with treatment. However, patients with PCOS had significantly higher total cholesterol and Low-density lipoprotein cholesterol (LDL-C) compared to controls, treatment with EE + CA did not provide any improvement on lipid parameters.

Conclusion

Serum ADMA levels and insulin resistance were lower in PCOS group treated with EE + CA than control group.     

Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate

Purpose

To compare two different surgical techniques, stripping or cystectomy, in patients treated with the same post-operative medical therapy in terms of recurrence of endometrioma, recurrence of pain and spontaneous pregnancy rate within 2 years from surgery.

Methods

The inclusion criteria of this study were: (1) 25–40 years old; (2) ovarian endometrioma more than 3 cm of diameter detected by transvaginal ultrasonography (3) regular menstrual cycle (4) post-operative treatment with GnRH analogs, (5) tubal patency assessed by laparoscopic chromopertubation (6) normal human semen characteristics. Exclusion criteria were uterine myoma, previous medical treatment for endometriosis, presence of adenomyosis, previous surgery of ovarian endometrioma, multiple cysts, bilateral involvement, co-existence of deep endometriosis. Patients were assigned to two study groups: group A (N = 45) patients undergoing stripping technique and group B (N = 64) patients undergoing cystectomy technique for ovarian endometrioma.

Results

In group B the percentage of ultrasonographic recurrence (15.4 %, N = 15) is much lower than in group A (55.6 %, N = 25). (p value 0.001). In group B the percentage of symptomatic recurrence (21.8 %, N = 14) is much lower than in group A (53.3 %, N = 24) (p value 0.001). Spontaneous pregnancy rate in group A patients was of 4.4 % (N = 2) and in group B 22.3 % (N = 21), (p value 0.0072). However, the percentage of specimen with adjacent healthy ovarian tissue was lower in group A (26.6 %) than in group B (50 %) (p value 0.01).

Conclusions

Among the different treatment options for surgical treatment of ovarian endometrioma, in our experience cystectomy appears to be the most appropriate treatment, both in terms of recurrence and pregnancy rate.     

Lymph node metastasis in patients with epithelial ovarian cancer macroscopically confined to the ovary: review of a single-institution experience

Background

To evaluate the patterns of lymphatic spread in epithelial ovarian cancer (EOC) macroscopically confined to the ovary and to determine risk factors for lymph node metastasis.

Materials and methods

All patients with clinically apparent stage IA/B/C EOCs who underwent staging surgery between January 2003 and February 2013 were retrospectively identified.

Results

Two hundred and thirty-six (n = 236) consecutive patients were operated for primary epithelial ovarian carcinoma. Sixty-two of these patients (26.2 %) who underwent a comprehensive staging procedure including pelvic and paraaortic lymphadenectomy were diagnosed with tumors confined to one or two ovaries (stage IA/B/C). Of these 62 patients, 17 (27.4 %) had upstaged disease and 8 (12.9 %) had lymph node metastasis. Tumor histology was serous in 25 patients (40.3 %), mucinous in 23 patients (37 %), endometrioid in 9 patients (14.5 %), and clear cell in 5 patients (8 %). Positive lymph node status was found in 20 % (5/25) of those with serous histology while this rate was only 8.1 % (3/37) in those with non-serous disease. Although the presence of ascites was not associated with an increased risk of lymph node involvement (p = 0.24), positive peritoneal cytology (p = 0.001) and grade 3 disease (p = 0.001) were significant predictors of lymph node involvement.

Conclusion

All patients diagnosed with EOC macroscopically confined to the ovary should be considered for comprehensive staging surgery including pelvic and paraaortic lymphadenectomy.     

Comparison of the effects of laparoscopic bipolar electrocoagulation and intracorporeal suture application to ovarian reserve in benign ovarian cysts

Purpose

Aim of the present study is to determine the effects of bipolar electrocoagulation and intracorporeal suture on the ovarian reserve after ovarian cystectomy.

Methods

Sixty patients aged 18–42 years old and with a persistent adnexal mass were recruited to the study. Patients were randomized into suture hemostasis group or bipolar hemostasis group. Laparoscopic ovarian cystectomy was performed to all patients. Hemostasis was obtained by bipolar coagulation in 30 patients and by intracorporeal sutures in 30 patients. Serum levels of FSH, LH, estradiol, inhibin B and ultrasonographic measurements (antral follicle count and ovarian volume) were analyzed and recorded at day 3 of menstrual cycle, 1 and 3 months after the surgery.

Results

Basal FSH level measurement at the postoperative third month was significantly increased to 6.96 ± 1.86 mIU/ml (p < 0.05) in the bipolar electrocoagulation group. However, the decreased ovarian volume and antral follicle count was restored at the postoperative third month in the bipolar electrocoagulation group. Preoperative and postoperative FSH, LH, estradiol and inhibin B levels and ultrasonographic measurements were similar in the intracorporeal suture group.

Conclusion

The unwanted effect of bipolar electrocoagulation on ovarian reserve is probably transient and causes minimal damage to ovary. FSH levels may be slightly elevated. Gentle use of bipolar electrocoagulation or intracorporeal are not found to effect ovarian reserve.     

Preoperative clinical and radiological features of metastatic ovarian tumors

Purpose

To investigate the clinical characteristics and pre-operative imaging features of non-genital metastatic ovarian tumors.

Methods

A retrospective case series study that compared 18 patients with histologically confirmed non-genital metastatic ovarian tumors (the study group) with 25 patients who were diagnosed with a primary ovarian cancer (control group).

Results

The most common primary disease was breast cancer (n = 10; 55 %), followed by colon cancer, gastric cancer, lymphoma, and unknown primary malignancy. The diagnosis of the previous primary neoplasm preceded the ovarian tumor diagnosis by 1–20 years (mean 7 years). No differences were found in the presenting signs and symptoms between the two groups. Statistically significant differences were noted between the two groups in the composition of the adnexal mass on sonography (p < 0.0005) and the CA-125 levels (p = 0.007). The presence of a complex adnexal mass with papillary projections and CA-125 >170 U/ml predicted primary ovarian cancer in 95.7 % of patients. Pre-operative CT scan revealed a greater tendency toward omental involvement and ascites in the control group (p = 0.058). The median risk of malignancy index (RMI) 2 score was significantly higher in the control group compared to the study group (8,000 and 1,120 respectively, p = 0.001). Using a RMI 2 cut-off level of 3,800 for diagnosing primary ovarian cancer versus metastatic ovarian cancer, the sensitivity was 70 %, with a positive predictive value of 87.5 %.

Conclusion

Pre-operative sonography findings, CA-125 levels and RMI 2 scores can be highly accurate in differentiating between primary and metastatic ovarian tumors.     

Telomere length is short in PCOS and oral contraceptive does not affect the telomerase activity in granulosa cells of patients with PCOS

Purpose

Our study aimed to investigate the association of telomerase activity (TA) and telomere length (TL) in granulosa cells (GCs) with IVF outcomes of polycystic ovary syndrome (PCOS) patients, and the effects of oral contraceptive pill (OCP) pretreatment on these two parameters.

Methods

One hundred sixty-three infertile women were enrolled and divided into a PCOS group (n = 65) and a non-PCOS group (n = 98). The PCOS group was further divided into an OCP pretreatment group (n = 35) and a non-OCP pretreatment group (n = 30), a TA <0.070 group (n = 34) and a TA ≥0.070 group (n = 31), and a TL <1 group (n = 41) and a TL ≥1 group (n = 24), respectively.

Results

No obvious differences were observed in TA between these groups. The TL was 0.971 in PCOS group and 1.118 in non-PCOS group (P = 0.005). The patients with TL ≥1 accounted for 36.9% in PCOS group and 54.1% in non-PCOS group (P = 0.032). The average duration of infertility for PCOS patients was 5 years in TA <0.070 group and 4 years in TA ≥0.070 group (P = 0.038), and 5 years in TL <1 group and 3 years in TL ≥1 group (P = 0.006), respectively. No obvious differences were observed in IVF outcomes between these groups. No obvious differences were observed in TA, TL, or IVF outcomes between OCP pretreatment group and non-OCP pretreatment group in PCOS patients.

Conclusions

Shorter TL was found in PCOS patients. The TA levels did not change significantly in PCOS patients. PCOS patients with a lower TA level and shorter telomeres had an earlier onset of infertility symptoms. No predictive value was found for TA and TL in terms of embryo quality or IVF outcomes in PCOS patients, and no effect OCP pretreatment was observed on either TA and TL.

     

Endometrial thickness measurement throughout a menstrual cycle in non-obese infertile patients with polycystic ovary syndrome

Purpose

To analyze the changes in the endometrial thickness in infertile polycystic ovary syndrome (PCOS) patients throughout an entire menstrual cycle and compare the changes to those seen in infertile patients without PCOS.

Methods

This prospective, cross-sectional study was conducted in a total of 58 non-obese, infertile women with PCOS. The endometrial thickness was measured at three different times throughout the menstrual cycle by ultrasound. Age- and body mass index (BMI)-matched control group consisted of 62 non-obese infertile patients without PCOS. Demographic, hormonal and the ultrasonographic measurements of the two groups were compared.

Results

Day 3 levels of LH were significantly different between the groups (p?=?0.013). Ovarian volume measurement was significant between the groups (p?=?0001). All the endometrial thickness measurements in the early, mid-cycle and late luteal phases were also significantly different; p?=?0.001 for all.

Conclusion

The study demonstrated an increased endometrial stripe measurements throughout a menstrual cycle in infertile patients with PCOS, when compared to infertile patients without PCOS.     

Epigenetic and immunohistochemical characterization of the Clusterin gene in ovarian tumors

Purpose

To characterize abnormal epigenetic changes and protein expression of the clusterin gene in a large series of ovarian malignant and borderline tumors.

Methods

Protein expression and promoter methylation of clusterin gene in 181 primary ovarian epithelial cancer, 40 borderline ovarian tumors, 54 ovarian cancer mesenteric metastasis, and 10 normal ovarian samples were analyzed by immunohistochemical staining and methylation-specific PCR.

Results

Overexpression of clusterin protein was frequently seen in various ovarian epithelial tumors, being detected in 102 of 181 (56 %) primary ovarian epithelial cancers, 21 of 37 (57 %) borderline ovarian tumors. Surprisingly, clusterin protein expression was significantly reduced in mesenteric metastasis (20 of 54; 37 % cases), as compared to primary ovarian carcinoma (p = 0.01). Overexpression of clusterin protein was significantly correlated with high-grade histology (p = 0.002) and high FIGO stages (p = 0.05). Clusterin promoter hypermethylation was detected in 24 of 181 (13 %) primary ovarian epithelial cancer, 8 of 54 (14 %) mesenteric metastasis, and 10 of 37 (27 %) borderline ovarian tumors. Overall, clusterin promoter hypermethylation was significantly correlated with decreased protein expression in these samples (p < 0.001).

Conclusions

Increased clusterin expression is correlated with more aggressive biologic behavior in ovarian cancer. Promoter methylation of the clusterin gene can be readily detected, though at low frequencies, in ovarian epithelial tumors and is significantly associated with decreased protein expression of the gene.