Efficacy of low-dose hCG in late follicular phase in controlled ovarian stimulation using GnRH agonist protocol

Objective

Safe, simple and cost-effective protocol is an important goal in ART cycles. The aim of this prospective study was whether administration of low-dose hCG in late follicular phase can be used clinically to replace gonadotropin administration in GnRH long protocol.

Materials and methods

122 patients who were candidates for ART enrolled the study and randomly divided into two groups. The control group (n?=?62) received standard long protocol and gonadotropin administration continued until the day of hCG injection (10,000?IU) for final follicular maturation. The study group (n?=?60) received GnRH long protocol and when at least ??6 follicles with mean diameter ??12?mm were observed in both ovaries, hMG was displaced by 200?IU per day of hCG until final follicular maturation.

Results

There were no significant differences in age, basal FSH, infertility duration and infertility etiology between two groups. There were no statistically significant differences between two groups regarding chemical pregnancy, clinical pregnancy, ongoing pregnancy, and abortion per cycle (50, 40, 40, and 20?% in study group vs. 45.2, 35.5, 35.5, and 21.4?% in control group, respectively). Mean dose of used gonadotropins was significantly higher in control group than that in the study group (2,524?±?893?IU in control group and 1,439?±?433?IU in study group) (p?=?0.000).

Conclusion

According to our data, we recommend the use of low-dose hCG in GnRH long protocol because of lower doses of used gonadotropins.     

Use of Letrozole versus clomiphene-estradiol for treating infertile women with unexplained infertility not responding well to clomiphene alone,comparative study

Background

Clomiphene Citrate (CC) considered as first line treatment option for superovulation in patient with unexplained infertility. However, there is discrepancy between ovulation and conception rates.

IVF/ICSI outcomes of the OCP plus GnRH agonist protocol versus the OCP plus GnRH antagonist fixed protocol in women with PCOS: a randomized trial

Objective

To compare the IVF/ICSI outcomes of the long GnRH agonist and the fixed GnRH antagonist protocol in women with PCOS.

Design

Randomized controlled trial.

Setting

Baskent University Department of Obstetrics and Gynecology.

Patients

Three hundred women with PCOS.

Interventions

IVF/ICSI following the long GnRH agonist down-regulation or the fixed GnRH antagonist protocols.

Main outcome measures

Ongoing pregnancy rates.

Results

Ongoing pregnancy rates were 36.4?% in the OCP?+?GnRH agonist group and 35.9?% in the OCP?+?GnRH antagonist group (p?>?0.05). Progesterone levels on the day of hCG (0.76?±?0.71 vs. 0.58?±?0.50), endometrial thickness on the day of hCG (11.57?±?2.50 vs. 10.50?±?2.01), total gonadotropin used (1388.71?±?482.39 vs. 1253.25?±?415.81), and duration of COH (9.07?±?1.96 vs. 8.39?±?1.75) were significantly lower in the OCP?+?GnRH antagonist group.

Conclusion

The OCP?+?long GnRH agonist and the OCP?+?fixed GnRH antagonist protocols yield similar ongoing pregnancy rates in women with PCOS. Although this study consisting three hundred patients, seems to be large enough in a single center, we were not able to reach to the actual size of power analysis which was approximately 3,000.     

Is letrozole superior to clomiphene for ovarian stimulation prior to intrauterine insemination?

Objective

To compare the efficacy of letrozole with clomiphene citrate for ovarian stimulation prior to intrauterine insemination.

Methods

A total of 272 patients underwent 362 cycles of stimulation prior to IUI from January 2009 to May 2011. One hundred and twenty-six patients (170 cycles) received letrozole 5 mg and 146 patients (192 cycles) received clomiphene citrate 100 mg for 5 days starting on day 3 of the cycle. Intrauterine insemination was done 36 ± 4 h after hCG injection in 99 patients (131 cycles) in the letrozole group and 115 patients (136 cycles) in the clomiphene group. The number of mature follicles and serum E2 levels was monitored on the day of hCG. Endometrial thickness was noted on the day of hCG and IUI as well. The pregnancy rate, the miscarriage rate, and other parameters were evaluated only for patients who underwent IUI.

Results

The mean number of mature follicles was significantly more in the clomiphene group (1.66 ± 1.69 vs. 1.41 ± 1.53) than in the letrozole group. No significant difference in endometrial thickness on the day of hCG administration was found; however, endometrial thickness was statistically significantly higher in the clomiphene group on the day of IUI (9.28 ± 1.43 vs. 8.77 ± 1.34). Serum E₂ levels on the day of hCG were statistically significantly higher in the clomiphene group (501.09 ± 2.45 vs. 214.79 ± 2.43 pg/ml). Pregnancy rate was 9.2 %/cycle and 12.12 %/patient in the letrozole group, and 8.1 %/cycle and 9.5 %/cycle in the clomiphene group; these differences were not statistically significant.

Conclusion

This study found no superiority of letrozole over clomiphene when used for ovarian stimulation and IUI.     

Triggering final oocyte maturation with gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation: an extended experience

Purpose

To analyze the cycle outcomes and the incidence of ovarian hyperstimulation syndrome (OHSS), when oocyte maturation was triggered by gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation.

Methods

One hundred twenty-nine women aged?≤?45 years, diagnosed with stage?≤?3 breast cancer, with normal ovarian reserve who desired fertility preservation were included in the retrospective cohort study. Ovarian stimulation was achieved utilizing letrozole and gonadotropins. Oocyte maturation was triggered with GnRHa or hCG. Baseline AMH levels, number of oocytes, maturation and fertilization rates, number of embryos, and the incidence of OHSS was recorded.

Results

The serum AMH levels were similar between GnRHa and hCG groups (2.7?±?1.9 vs. 2.1?±?1.8; p?=?0.327). There was one case of mild or moderate OHSS in the GnRHa group compared to 12 in the hCG group (2.1 % vs. 14.4 %, p?=?0.032). The maturation and fertilization rates, and the number of cryopreserved embryos were significantly higher in the GnRHa group.

Conclusions

GnRHa trigger improved cycle outcomes as evidenced by the number of mature oocytes and cryopreserved embryos, while significantly reducing the risk of OHSS in breast cancer patients undergoing fertility preservation.     

Comparison of endometrial receptivity of clomiphene citrate versus letrozole in women with polycystic ovary syndrome: a randomized controlled study

Abstract

The aim of the study was to compare the effect of clomiphene citrate (CC) and letrozole on endometrial receptivity for ovulation induction in women with polycystic ovary syndrome (PCOS). A randomized controlled study included 160 patients diagnosed with PCOS, out of which 80 patients received 50?mg of CC and 80 patients received 2.5?mg of letrozole for successful ovulation induction. Endometrial thickness and pattern, the blood flow of uterine artery and subendometrial region, endometrial volume and vascularization index were measured. The ratio of multilayered endometrial pattern in letrozole group was significantly increased on the day of human chorionic gonadotropin (hCG) administration compared with CC group (77.5% vs. 55.0%). The volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of endometrium on the day of hCG administration and 7–9?days after ovulation in letrozole group were significantly increased. The biochemical pregnancy rate, clinical pregnancy rate, and ongoing pregnancy rate in letrozole group were significantly increased compared with CC group (36.3%, 30.0%, 22.5% vs. 21.3%, 13.8%, 10.0%, respectively). Letrozole increased pregnancy rates by improving endometrial receptivity compared with CC in patients with PCOS.     

Vitamin D as a follicular marker of human oocyte quality and a serum marker of in vitro fertilization outcome

Purpose

This study investigated the relationship between the vitamin D [25(OH)D] level in individual follicles and oocyte developmental competence.

Methods

A prospective cohort study in a private infertility center. Infertile women (N?=?198) scheduled for intracytoplasmic sperm injection (ICSI) and a single embryo transfer (SET) provided serum samples and 322 follicular fluid (FF) specimens, each from a single follicle on the day of oocyte retrieval.

Results

FFs corresponding to successfully fertilized oocytes (following ICSI) contained significantly lower 25(OH)D level compared with those that were not fertilized (28.4 vs. 34.0 ng/ml, P?=?0.001). Top quality embryos on the third day after fertilization, when compared to other available embryos, developed from oocytes collected from follicles containing significantly lower 25(OH)D levels (24.56 vs. 29.59 ng/ml, P?=?0.007). Positive hCG, clinical pregnancy, and live birth rates were achieved from embryos derived from oocytes that grew in FF with significantly lower 25(OH)D levels than in follicles not associated with subsequent pregnancy. The concentration of 25(OH)D in FF in women with negative hCG was 32.23?±?20.21 ng/ml, positive hCG 23.62?±?6.09 ng/ml, clinical pregnancy 23.13?±?6.09 ng/ml, and live birth 23.45?±?6.11 ng/ml (P?<?0.001). Women with serum 25(OH)D?<?20 ng/ml had not only a higher fertilization rate (71 vs. 61.6%, P?=?0.026) and a higher clinical pregnancy rate (48.2 vs. 25%, P?=?0.001), but also higher miscarriage rate (14.5 vs. 3.8%, P?=?0.013) compared with those with levels ≥?20 ng/ml.

Conclusion

This study reveals that the level of 25(OH)D in FF correlates negatively with the oocytes’ ability to undergo fertilization and subsequent preimplantation embryo development. Oocytes matured in FF with low 25(OH)D concentration are more likely to produce top quality embryos and are associated with higher pregnancy and delivery rates. On the other hand, low serum vitamin D concentration is associated with higher miscarriage rates.

     

Letrozole ovulation induction: an effective option in endometrial preparation for frozen–thawed embryo transfer

Purpose

To evaluate the clinical efficacy of letrozole on ovulation induction and hormone replacement therapy (HRT) during endometrial preparation for frozen–thawed embryo transfer (FET).

Methods

We analyzed totally 1,230 cycles of patients that underwent FET from October 2010 to September 2012. Seven hundred and thirteen cycles of patients with ovulation disorders that underwent FET were randomly assigned to two groups by case control study. 359 cycles received letrozole ovulation induction and 354 cycles received HRT during endometrial preparation for FET, respectively. In the corresponding period, 517 cycles of patients with normal ovulation in the natural cycle group for FET endometrial preparation served as controls. Reproduction-related clinical outcomes of patients in the three groups were compared.

Results

The embryo implantation rate of patients in letrozole group (30.4 %) was significantly higher than the HRT group (22.8 %, P < 0.05). The clinical pregnancy rate of patients in the letrozole group (53.2 %) was significantly higher than the HRT group (44.4 %, P < 0.05), while no significant difference was observed between the letrozole and natural cycle groups (51.3 %, P > 0.05). Estradiol levels on the day of human chorionic gonadotropin administration in the letrozole group were significantly lower than those in the natural cycle group (280.32 ± 125.39 pg/ml and 351.06 ± 123.03 pg/ml, respectively; P < 0.05). The live birth rate of patients in letrozole group (44.6 %) was significantly higher than the HRT group (32.5 %, P < 0.05), while abortion rate (12.0 %) was significantly lower than the HRT group (21.0 %, P < 0.05). There were no significant differences in number of mature follicles, endometrial thickness, duration of follicle growth between the letrozole and the natural cycle groups, and there were no significant differences in twin birth rate and ectopic pregnancy rate among the three groups (all P values >0.05).

Conclusions

Ovulation induction with letrozole during endometrial preparation for FET has a higher rate of pregnancy success and a lower abortion rate than HRT. Letrozole treatment exhibits clinical progression and outcomes similar to those patients undergoing a natural cycle or normal ovulation cycle. Therefore, letrozole treatment may be an effective option in endometrial preparation for FET in patients with ovulation disorders or irregular menstruation.     

Sequential clomiphene/corifollitrophin alpha as a technique for mild controlled ovarian hyperstimulation in IVF: a proof of concept study

Purpose

Mild controlled ovarian hyperstimulation (COH), combined with oocyte retrieval (OR) under local anaesthesia (LA), may provide low-impact IVF. Since a single injection of corifollitrophin alfa (CFA) provides 7 days of COH, we hypothesised that clomiphene-citrate (CC) followed by CFA may provide adequate COH response from one single FSH injection. Therefore, the aim was to assess IVF outcomes after a novel clomiphene citrate/CFA (CC/CFA) protocol, compared to women undergoing standard rFSH COH protocols (good prognosis comparative cohort:GPCC) in a 1:2 matched design.

Materials and methods

In this pilot study of 25 patients (ANZCTR id:ACTRN12612000740897, MINIVA:Minimal_Stimulation_in_IVF), we examined the effectiveness of oral clomiphene (100 mg-days 2–6) followed by CFA in a GnRH antagonist protocol producing a single injection COH stimulation regime. All OR were conducted under LA pre-ovarian block. Cycle outcomes were compared to a matched good prognosis comparative cohort (GPCC) undergoing standard rFSH COH.

Results

Mild stimulation was achieved with less oocytes being collected compared to the GPCC (6.4?±?0.7 vs. 10.7?±?0.9, p?<?0.001), resulting in a reduced number of good quality embryos available for transfer/cryopreservation (3.7?±?0.6 vs. 5.7?±?0.5, p?=?0.01). While embryo quality was similar between the two groups, endometrial thickness was significantly lower in the group receiving CC/CFA. Pregnancy rates were significantly lower in the CC/CFA cohort compared to GPCC (31.8 vs. 57.1%, p?=?0.04) and 44% of CC/CFA participants required supplemental rFSH in order to achieve the hCG trigger criteria.

Conclusion

Sequential clomiphene CFA protocol does not appear to be an optimal regime for low impact IVF treatment as it does not provide adequate COH from a single CFA injection and results in lower fresh embryo transfer pregnancy rates and fewer embryos for cryopreservation.

     

Fundamental role of folliculo-luteal function in recurrent miscarriage

Purpose

To re-evaluate the role of folliculo-luteal function (FLF) in recurrent miscarriage (RM) on the basis of new hormonal diagnostic criteria.

Methods

A prospective, randomized, single-blinded, placebo-controlled study was carried out at 110 apparently healthy patients with three or more miscarriages not related to any presumable predisposing factors of RM were investigated. In the treatment group FLF was normalized preconceptionally. Women in the control group received placebo. FLF was regarded as physiological when the mean of three progesterone (P) values measured every second day between the 4th and 9th day after ovulation or before menstruation was 21.0?±?2.0?ng/ml.

Results

A significant difference (p?<?0.001) was found between the physiological and placebo groups in the occurrence of live births: 93 versus 56?%, pregnancy losses: 7 versus 44?%; premature delivery per births: 10 versus 57?%. Luteal mean P and estradiol values were significantly (p?<?0.001) different in cases of spontaneous abortions and premature and mature deliveries, respectively (P: 14.6?±?2.2, 20.2?±?2.7, 27.6?±?3.9?ng/ml). A strong and significant correlation (p?<?0.001) was found between luteal mean P values and the duration of pregnancy (r?=?0.85), as well as between the P means measured in the luteal phase and different parameters of the newborns: weight (r?=?0.89), weight percentile (0.86) and length (0.73). Retrospective analysis of our data suggests that a luteal P mean value of 29.3?±?2.9?ng/ml characterising patients with singular, mature, eutroph newborns seems to be the most favorable P value for successful reproduction in RM.

Conclusion

Determining the oocyte quality and placentation, FLF quantitatively determines the outcome of pregnancy: its duration and different characteristics of the newborns in RM.     

Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women

Objective

This study was designed to compare sequential clomiphene citrate/hMG regimen to hMG regimen for ovulation induction in clomiphene citrate-resistant women.

Study design

A comparative prospective study.

Patients and methods

Ninety infertile women were randomized to receive either sequential CC/hMG regimen (45 women) or low-dose step-up protocol of hMG (45 women). All participants had received at least six consecutive cycles of clomiphene citrate for ovulation induction within the last year before inclusion in this study, but they did not conceive. The CC/hMG regimen group received clomiphene citrate 100 mg/day for 5 days, followed by hMG 75 IU for 4 days. The hMG group received low-dose step-up protocol for 10–14 days. To detect the number and size of the follicles, TVS was done on cycle day 8 and repeated daily or every other day according to follicular development. When one to three follicles reached a diameter ≥18 mm, hCG injection was scheduled. Before hCG injection, the E2 level and endometrial thickness were evaluated. β-hCG levels were measured on cycle day 22.

Results

There was no significant difference between the two studied groups regarding the demographic data, sperm parameters, and day 3 FSH, LH and estradiol. Also, there was no significant difference between the two studied groups regarding endometrial thickness, number of mature follicles, peak of E2 before hCG injection and number of cases that developed ovarian cyst or OHSS. The dose of gonadotropins used was significantly low in the CC/hMG group compared to the hMG group (295.2 ± 75.5 vs. 625.3 ± 65.0, respectively), and the pregnancy rate was significantly high in the CC/hMG group compared to the hMG group [12 (26.7 %) vs. 3 (6.7 %), respectively, p < 0.05].

Conclusion

The sequential CC/hMG regimen is as effective as hMG regimen for ovulation induction, produces satisfactory pregnancy results and reduces the treatment cost.     

Do intrauterine growth restricted fetuses of the hypertensive and normotensive mothers differ from each other?

Purpose

To investigate if normotensive and hypertensive patients with intrauterine growth restricted (IUGR) fetuses were different with respect to maternal and fetal characteristics and Doppler flow.

Methods

The records of patients with IUGR fetuses who had to be delivered before 34th gestational week because of fetal distress were examined. Early Doppler abnormalities were defined as increased umbilical artery resistance and redistribution of blood flow in the middle cerebral artery while late Doppler abnormalities were defined as the absence or reversal of umbilical artery blood flow and Doppler flow changes in venous Doppler. t Test, Chi-square test and Mann–Whitney U test were used for the comparison of data as appropriate. p?<?0.05 was considered statistically significant.

Results

Thirty-six patients were hypertensive while 42 were normotensive. Gestational week at admission for hypertensive and normotensive groups (30.8?±?3.6 vs. 32.3?±?3.1) (p?=?0.057), time to delivery (7.1?±?12.6 vs. 4.3?±?9.1?days) (p?=?0.267) and gestational week at delivery (31.8?±?3.1 vs. 32.9?±?2.9) (p?=?0.117) were similar. Birth weight was significantly lower (1242?±?534 vs. 1516?±?504?g) (p?=?0.02) in the normotensive group. The frequency of having oligohydramnios (64.2?% for normotensive and 44.4?% for hypertensive patients) (p?=?0.079) was similar in both groups. Early Doppler abnormalities were more common in hypertensive group (75 vs. 40.5?%) (p?=?0.001) while late Doppler abnormalities were more common in normotensive group (25 vs. 59.5?%) (p?=?0.001).

Conclusion

Birth weight was lower and late Doppler abnormalities were more common in the normotensive group while early Doppler abnormalities were more common in hypertensive group.     

Sequential low-dose step-up and step-down protocols with recombinant follicle-stimulating hormone in polycystic ovary syndrome: prospective comparison with step-down protocol

Purpose

To assess the differences in follicular development comparing two sequential low-dose step-up and step-down protocols (A: 37.5?IU/day, B: 75?IU/day) with a step-down protocol (C: 150?IU/day) using recombinant human follicle stimulating hormone (rFSH) in women with polycystic ovarian syndrome (PCOS).

Methods

In this prospective observational comparative study, 60 PCOS women were treated with one of the three protocols for only one cycle.

Result(s)

Monofollicular development was similar among the three protocols but the total number of follicles >10?mm in diameter was significantly lower in group A (1?±?0.94 vs 6.3?±?2.45 vs 8.6?±?4.45; P?=?0.001 A vs B; P?<?0.001 A vs C). Cycle cancellation rate was higher in protocol A and in protocol C because of no ovarian response and excessive multifollicular development, respectively. The total amount of rFSH for complete cycle was significantly lower in protocol A (P?=?0.02 A vs B; P?=?0.007 A vs C). No mild or severe hyperstimulation syndrome (OHSS) was observed.

Conclusion(s)

A and B protocols seem to be a more effective approach than the step-down protocol. In both groups, the pregnancy rate for started cycle was the same. Protocol A has allowed the development of a lower number of small follicles, single pregnancies, but an excessive number of cancelled cycles occurred. In protocol B no cycle cancellation occurred, though the total rFSH dosage was significantly higher than the protocol A and two twin pregnancies were observed.     

Changes in endometrial receptivity in women with Asherman’s syndrome undergoing hysteroscopic adhesiolysis

Objective

To determine whether there is any improvement in the endometrial receptivity in infertile women with Asherman??s syndrome undergoing hysteroscopic adhesiolysis.

Materials and methods

This was a prospective observational clinical analysis of 40 infertile patients who underwent hysteroscopic adhesiolysis for Asherman??s syndrome in a tertiary level hospital. Endometrial thickness and blood flow impedance of the uterine spiral artery by transvaginal color pulsed Doppler ultrasound was measured post-menstrual on day 2/3 and post-menstrual on day 21 pre- and post-hysteroscopic adhesiolysis or at a randomly chosen time in patients with amenorrhea.

Results

The age of the patients was 18?C36?years (mean 29.2?years). The mean duration of infertility was 6.9?years. There were 27 (67.5?%) women with primary infertility and 13 (32.5?%) had secondary infertility. 22 (55?%) women had had genital tuberculosis in the past. A significant improvement in the endometrial thickness was observed on day 2 (p?p?p?Conclusions A significant improvement in the endometrial thickness was observed post-adhesiolysis. A high blood flow impedance of spiral artery perhaps impairs growth of the endometrium making it unsuitable for successful implantation.     

Comparison of uterine artery Doppler in pregnant women with thrombophilia treated by LMWHs and without thrombophilia

Objective

The aim of this study was to use uterine artery Doppler ultrasonography to investigate the cases of women with thrombophilia who used LMWH during the 18?C22-week period of gestation.

Methods

This retrospective study was conducted at our university between January 2005 and July 2010. 64 patients were treated with low-dose LMWHs (enoxaparine 40?mg) from the beginning of pregnancy until 36?weeks of gestation. Fifty control subjects were also included in this study. Transabdominal ultrasound examination and bilateral uterine artery Doppler measurements pulsatility index (PI), resistive index (RI), and systole/diastole measurement (S/D) were performed during the 18?C22-weeks period of gestation.

Results

No significant differences were found between the groups with respect to maternal age or gestational age at the time of uterine artery Doppler. However, the mean PI (1.07?±?0.46 for LMWH group and 0.91?±?0.31 for control, p?=?0.036) and the mean RI (0.59?±?0.12 for LMWH group and 0.54?±?0.10 for control, p?=?0.021) were significantly higher in the trombophilia group.

Conclusion

Women with trombophilia still have an increased mean PI and RI, as determined by uterine artery Doppler ultrasonography during the 18-22-week period of gestation, even if they use LMWH.     

Comparison of different starting gonadotropin doses (50, 75 and 100?IU daily) for ovulation induction combined with intrauterine insemination

Purpose

To prevent multiple pregnancies the goal of ovulation induction by gonadotropins is to achieve only mono-follicular development. The most important issue is therefore to determine the starting dose. The aim of this study is to compare three different starting doses of follitropin beta to assess the lowest effective dose.

Methods

We evaluated 92 cycles with ovarian stimulation for patients with unexplained infertility, anovulatory disorder or mild male factor. We prospectively divided patients into 50, 75 and 100?IU groups based on patients’ response to clomiphene citrate treatment.

Results

We performed 87 intrauterine inseminations (95?% of cycles with ovulation induction). Five cycles were cancelled. We achieved 15 pregnancies; total pregnancy rate was 18?%. Pregnancy rate was 22, 10 and 28?% in 50, 75 and 100?IU follitropin beta groups. The average number of follicles was 2.0?±?0.8, 2.2?±?1.1 and 2.5?±?1.8 (ns), total dose of gonadotropins (IU) 483?±?192, 600?±?151 and 830?±?268 (p?Conclusions This study suggests that based on the dose which was chosen according to clomiphene citrate response, all treatment regimes were effective for ovulation induction. 50?IU of follitropin beta daily is the appropriate starting dose to support ovulation for clomiphene citrate-sensitive women. The disadvantage may be an increased risk of cycle cancellation due to low ovarian response. Daily doses 75 or 100?IU of rFSH increase total consumption of gonadotropins.     

Characteristics and prognosis of coexisting adnexa malignancy with endometrial cancer: a single institution review of 51 cases

Objective

To explore and compare the differences in the clinicopathological characteristics and prognosis of synchronous primary endometrial and ovarian cancers with primary endometrial cancer metastatic to adnexa.

Materials and methods

Between January 1997 and December 2009, 51 cases with endometrial cancer simultaneously with adnexa malignancy were identified. Among them, there were 18 cases with synchronous primary cancers of the endometrium and ovary (Group A) and 33 cases with primary endometrial cancer metastatic to the adnexa (Group B). Clinical and pathologic information was obtained from medical records. Parametric methods were used to compare clinical and pathologic features. Kaplan?CMeier survival analysis was performed and compared using log-rank test.

Results

The mean age at diagnosis of the disease was 56.6?±?10.8?years (range 34?C76?years) in Group A and 53.1?±?9.5?years (range 37?C76?years) in Group B. The two groups?? distribution of preoperative image findings, size of endometrial lesion, myometrial invasion, unilateral or bilateral, cervix invasion, and postoperative radiation existed significant differences. With a mean follow-up time of 4.3?±?3.4?years (range 2?C11?years), 5-year overall survival (OS) was 75 and 56% in Groups A and B, respectively (p?=?0.034). The univariate analysis showed only postoperative radiation and synchronous tumors were independent factors which affected OS (p?=?0.015; p?=?0.034) and progression-free survival (PFS) (p?=?0.015; p?=?0.036), respectively. Not any feature was revealed by multivariate analysis as independent prognostic factors.

Conclusion

Our results showed that OS and PFS of synchronous primary ovarian cancer in patients with endometrial cancer is better than those with ovarian metastasis patients. Pre- and intra-operative, intensive and careful assessment, and strict and continuous postoperative surveillance should pay attention to the endometrial cancer patients who preserved ovary for having possibility of coexisting occult ovarian lesions.     

BiClamp? forceps was significantly superior to conventional suture ligation in radical abdominal hysterectomy: a retrospective cohort study in 391 cases

Objective

To evaluate the efficacy and security of ERBE BiClamp^? forceps in radical abdominal hysterectomy for managing those cervical cancers, extending to other gynecologic cancers such as endometrial cancer and ovarian cancer as well.

Methods

A retrospective cohort study was made in 391 cases from 450 FIGO IA2-IIB cervical cancers between November 2005 and September 2010. After baseline character analysis, the conventional group (n?=?195) was compared with the BiClamp group (n?=?196) on the basis of surgical outcome and complications. Data analysis was based on intention to treat with statistics software SPSS17.0.

Results

Comparison between conventional suture ligation and BiClamp^? forceps is as follows: the operation time was 247.7?±?47.7?min for the conventional suture ligation versus 224.1?±?36.2?min (P?? forceps, estimated blood loss was 769.2?±?310.4?ml versus 534.8?±?232.5?ml (P?P?P?P?=?0.085), postoperative blood transfusion rate was 17.0 versus 15.6% (P?=?0.818), closed suction drainage was 268.8?±?162.0?ml versus 208.3?±?141.7?ml (P?P?P?=?0.027).

Conclusion

With obvious decrease of operation time, blood loss, postoperative complications, hospital stay and particularly, intra-operative blood transfusion rate, BiClamp^? forceps has been proved more efficient and controllable in radical abdominal hysterectomies of cervical cancers than conventional suture ligations, extending to endometrial cancers and ovarian cancers, hence deserves to be popularized.     

Estradiol Level on Day 2 and Day of Trigger: A Potential Predictor of the IVF-ET Success

Objective

To evaluate role of serum estradiol levels in predicting likelihood of pregnancy in women undergoing GnRH-a protocol in IVF-ET cycles.

Design

A 3-year retrospective analysis of estradiol levels on down-regulated day 2, day 6, and day of hCG trigger and subsequent clinical pregnancy rates.

Setting

A university hospital tertiary referral centre.

Population or Sample

Women undergoing IVF treatment.

Methods

Hormonal assessment on the down-regulated day 2, day 6, and day of hCG trigger.

Main Outcome Measure(s)

Comparison of hormonal profile, antral follicular count on day 2, endometrial thickness on day of trigger, and number of oocytes retrieved between pregnant and the non-pregnant group. The prediction of IVF success was based on the quantitative levels of estradiol on a specific day in down-regulated cycle.

Result(s)

The overall pregnancy rate was 32.25 % (50/160). Estradiol level on down-regulated day 2 was 31.9 ± 12.6 and on the day of trigger was 1,996.46 ± 1,252.36 in pregnant women, which was significantly higher as compared to estradiol levels in non-pregnant women (27.6 ± 12.3 and 1,525.1 ± 1,116.42, respectively). It was found to be a significant prognostic marker for successful IVF treatment. Estradiol levels on down-regulated day 6 were found to be non-significant between the two groups.

Conclusion(s)

Estradiol level on down-regulated day 2 of menstrual cycle and on the day of trigger was found to have a significant impact on the success of IVF-ET.     

Environmental tobacco smoke and stress as risk factors for miscarriage and preterm births

Back ground

Exposure of pregnant women to environmental tobacco smoke has been shown to be associated with low birth weight. Many studies have suggested that stress have a role in the etiology of preterm birth.

Aims

This study carried out from June 2008 to March 2009 to find the relation between environmental tobacco smoke, stress and miscarriage and preterm births.

Methods

A total of 33 subjects consisted of multiparous pregnant women that were in their early third trimester were chosen for this investigation. Subjects were divided into test group women with adverse pregnancy outcome, control group women with successful pregnancy. Four ml of unstimulated whole saliva were collected. The concentrations of cotinine and cortisol were evaluated using commercially available ELISA kit.

Results

Pregnancies in which the average standardized cortisol during history of previous miscarriage(s) which occurred within 6th–27th week or/and history of preterm labor which occurred within 28th–36th weeks of gestation, demonstrated higher cortisol level (1.0201?±?0.1855?ng/ml) compared to control group 0.9757?±?0.2860?ng/ml (P?=?0.323); statistical analysis showed no significant differences. Women of control group were more likely to be environmental tobacco smoke exposed (1.2714?±?1.7639?ng/ml) than women with miscarriage and preterm births (0.9889?±?0.5498?ng/ml).

Conclusion

The results from this primarily study demonstrated no association between cotinine, cortisol, miscarriage and preterm births.