BACKGROUND: The aim of this study was to determine whether, in polycystic ovarian syndrome (PCOS) patients, HCG action prolonged for 4 h improves the action of angiogenic substances ovarian renin ...angiotensin system and vascular endothelial growth factor (VEGF), and consequently follicular maturation, oocyte quality and oocyte fertilization competence. METHODS: In this prospective study 20 patients with PCOS undergoing IVF were included. Oocyte retrieval was carried out either 34 or 38 h after HCG administration. Each follicle was analysed for prorenin, active renin, VEGF and estradiol. Oocytes were evaluated for quality (mature, immature, degenerated oocytes), as were the embryos (low or high). RESULTS: In the HCG +38 h group there were 245 follicles, and in the HCG +34 h group 240 follicles. In the HCG +38 h group, log active renin was lower (2.78 ± 0.20 versus 2.91 ± 0.25; P<0.001) and VEGF higher (2276.0 ± 790.1 versus 1946.6 ± 954.5 pg/ml; P<0.001). The odds ratio for obtaining oocytes from follicles was 1.6 95% confidence interval (CI) 1.1–2.6; P=0.02, and for developing high quality embryos 7.6 (95% CI 2.8–20.9; P<0.001) in favour of the HCG +38 h group. CONCLUSIONS: Follicular maturation and oocyte quality are related to the intrafollicular influences of active renin and VEGF in a time-dependent manner after HCG administration, whereas fertilization competence is related to VEGF only.
Summary
In this study we sought to evaluate whether psychological factors in males affect semen quality and pregnancy. In 1076 men of infertile couples, psychological factors, i.e. exposure to acute ...stress, coping with stress, the WHO (five) Well‐Being Index and the Zung’s Anxiety Scale Inventory scores were assessed by a questionnaire at the time of semen analysis. Relationships between psychological factors and semen quality (sperm concentration, rapid and progressive motility and normal morphology) were assessed. In 353 men with infertility duration of ≤1.5 years, sperm concentration ≥5 × 106 sperm/mL and a female partner with a laparoscopically confirmed tubal patency, we looked prospectively for relations between psychological factors and the occurrence of a natural pregnancy at a 6‐month follow‐up (n = 124), and first‐trimester loss (n = 18). Anxiety trait, found in 19% of men, was related to previous in vitro fertilization/intracytoplasmic sperm injection attempts (p = 0.014), cigarette intake (p = 0.006), alcohol intake (p = 0.026) and sexual difficulties (p < 0.001). Regression analyses indicated a significant positive relationship between the level of sperm concentration and the WHO (five) Well‐Being Index score, each successive score number accounting for a 7.3% increase in sperm concentration (p = 0.039), whereas no correlation was found between psychological factors and sperm rapid progressive motility and normal morphology. Poorer coping with stress was related to the occurrence of a first‐trimester miscarriage (p = 0.016) in the female partner. Possible depression in males is related to decreased sperm concentration, and poor coping with stress is associated with increased occurrence of early miscarriage.
Abstract
Aim:
The etiology of endometriosis remains unknown, but increasing
evidence suggests that immune regulation may be important. Our study aimed
to evaluate peripheral blood lymphocyte ...subpopulations during the menstrual
cycle in women with peritoneal and ovarian endometriosis relative to healthy
women.
Methods:
In this study, 65 women with endometriosis (37 in the
follicular phase and 28 in the luteal phase of the menstrual cycle) and 61
healthy women (33 in the follicular phase and 28 in the luteal phase) were
enrolled. Flow cytometric analysis measured peripheral blood lymphocyte
subpopulations. The serum levels of cortisol were also determined.
Results:
In healthy controls, we detected an increased
concentration of cytotoxic (CD8
+
) T cells and activated (HLA-DR)
T cells in the luteal phase compared with the follicular phase of the
menstrual cycle (p = 0.020 and p = 0.045), whereas no such fluctuation was
detected in endometriosis. However, a marked increase in regulatory T-cell
concentration in the luteal phase was detected only in endometriosis
patients (p = 0.005). Women with endometriosis had higher levels of serum
cortisol (p = 0.022), which correlated with the concentration of regulatory
T cells (p = 0.048).
Conclusions:
Women with endometriosis do not
exhibit fluctuations in the concentrations of cytotoxic and activated
peripheral blood lymphocytes during the menstrual cycle. The marked
fluctuation of regulatory T cells detected in endometriosis could be
attributed to altered immune response.
Abstract Objective To analyze the relationship between QTc interval and cardiovascular risk factors in women with polycystic ovary syndrome (PCOS). Methods Study group included 119 PCOS women (age: ...32.2 ±5.2 years) and the control group 64 age-matched healthy women; they all underwent QT interval measurement, and plasma levels of high-sensitivity CRP (hsCRP), endothelin-1 (ET1), insulin, and testosterone determinations. Results In PCOS women hsCRP (2.35 ± 2.14 mg/L vs. 1.01 ± 1.28 mg/L; P = 0.04), ET1 (23.6 ± 10.3 ng/L vs. 7.7 ± 15.9 ng/L; P = 0.01), and insulin (16.5 ± 7.8 mIU/L vs. 11.8 ±10.7 mIU/L; P = 0.03) levels were significantly higher, and QTc interval significantly shorter than in controls (401 ± 61 ms vs. 467 ± 61 ms; P = 0.007). In 67 (56%) PCOS patients with a short QTc interval (< 400 ms), plasma testosterone levels were significantly higher than in PCOS women with normal QTc interval (2.3 ± 2.1 nmol/L vs. 1.4 ± 1.7 nmol/L; P = 0.02). Conclusions In patients with polycystic ovary syndrome increased testosterone levels may attenuate the effects of coronary risk factors.
Context
: The presence of several cardiovascular risk factors is observed in women with polycystic ovary syndrome (PCOS). On the other hand, the QTc interval duration, which is related to cardiac ...arrhythmia and sudden death, has not been investigated thoroughly in PCOS population.
Objective
: To investigate QTc interval duration and its relation to testosterone in women with PCOS.
Design
: Cross sectional case-control study.
Setting
: Outpatient setting, tertiary university medical centre.
Patients
: We enrolled 119 consecutive patients in whom PCOS was diagnosed based on oligomenorrhea, infertility (>2 yr), ineffective ovarian stimulation, and ultrasonographic criteria. The control group (controls) included 64 age-matched healthy women without clinical or laboratory evidence of PCOS.
Interventions
: In all participants we measured QTc interval duration on a standard electrocardiogram and determined plasma levels of high sensitivity C-reactive protein (hsCRP), endothelin-1 (ET-1), insulin, and testosterone.
Main outcome measure
: Shorter QTc interval duration in PCOS patients.
Results
: When compared to controls, PCOS patients displayed higher values of hsCRP (2.35±2.14 mg/l
vs
1.18±1.24 mg/l;
p
=0.01), ET-1 (23.6±10.3 ng/l
vs
12.9±20.7 ng/l;
p
=0.03), insulin (18.5±7.8 mIU/l
vs
10.7±9.1 mIU/l;
p
=0.02), and testosterone (2.7±2.1 nmol/l
vs
1.4±1.7 nmol/l;
p
=0.01). QTc interval in PCOS patients was significantly shorter than in controls (401±61 msec
vs
467±61 msec;
p
=0.007), and inversely related to the plasma levels of testosterone (Spearman −0.45,
p
=0.005).
Conclusions
: QTc interval in PCOS patients is short, and inversely associated with increased levels of testosterone. QTc interval duration is not part of an adverse cardiac risk profile in PCOS.
Abstract To elucidate the effects of inflammation on sperm quality, this study analysed classical sperm characteristics, leukocytes and elastase in neat semen, and sperm apoptotic markers, i.e. ...changes in plasma membrane phospholipid asymmetry, mitochondrial membrane potential (MMP), DNA integrity and intracellular reactive oxygen species (ROS), in semen prepared by density gradient using flow cytometry from 348 men of infertile couples. Increased leukocytes (⩾0.1 × 106 /ml) were associated with a decreased sperm concentration, motility and normal morphology ( P ⩽ 0.001). Sperm necrosis and DNA denaturation were increased (31.3 versus 26.6%, P = 0.020; 15.5 versus 11.5%, P = 0.011, respectively), whereas spermatozoa with normal MMP were decreased (64.1 versus 70.0%, P = 0.004). High leukocyte levels (⩾1 × 106 /ml) were not associated with any of the observed sperm parameters. At low elastase concentration (100–290 μg/l), DNA denaturation was higher (16.1 versus 10.5%, P = 0.024) compared with very low elastase concentration (<100 μg/l). A high elastase concentration (290–1000 μg/l) was associated with higher ROS index compared with low elastase concentration (1.28 versus 1.01, P = 0.016). Slightly increased leukocytes and elastase are associated with slightly poorer sperm characteristics and/or increased sperm necrosis, DNA denaturation and intracellular ROS and decreased MMP.
Elastase–inhibitor complex was assessed by immunoassay in the seminal plasma of 312 men attending the outpatient infertility clinic. Using receiver operating characteristic (ROC) curve analysis, ...elastase at the cut-off value of ≥290 ng/ml was shown to be efficient (sensitivity 79.5%, specificity 74.4%) in the detection of genital tract inflammation as defined by leukocytospermia (>1×106 leukocytes/ml). The prevalence of increased elastase in 292 infertile men was significantly higher (34%) as compared with that (5%) observed in 20 fertile men (P = 0.02). Moreover, high elastase concentration (≥290 ng/ml) was observed in 66 of the 264 men (25%) without leukocytospermia. A significant positive correlation was found between elastase concentration and patient age (r = 0.202, P < 0.0001) and the number of leukocytes (r = 0.330, P < 0.0001). A negative correlation was found between elastase concentration and semen volume (r = –0.146, P = 0.01) and the percentage of spermatozoa with single-stranded DNA (r = –0.194, P = 0.024), but there was no correlation between elastase and sperm reactive oxygen species production. A higher seminal elastase concentration was significantly associated with tubal damage in female partners (P < 0.001). After norfloxacine antibiotic therapy, decrease in elastase concentration was observed in 15 (25%) of the 60 treated patients. Tubal damage in the partner negatively affected the response to antibiotic therapy. In conclusion, granulocyte elastase is a reliable screening test for silent genital tract inflammation of the couple. The elastase–inhibitor complex may have a protective effect in reducing sperm DNA denaturation.
To describe the etiology of hypergonadotropic amenorrhea (HA) and outline the subgroup of infertile women that might achieve pregnancy with their own eggs despite premature ovarian failure.
In this ...retrospective study we enrolled 70 women aged 32.5 +/- 5.71 years. After a detailed history of the disease, measurements of follicle-stimulating hormone, estradiol, prolactin and thyroid-stimulating hormone levels, determination of the karyotype and fragile X premutation syndrome, and a quick ACTH test, estrogen-progestin replacement therapy was introduced.
In 17 of the 70 women, HA was due to chromosomal abnormalities, in 16 to extensive gynecologic surgery, in ten to oral contraceptive use, in four to chemo- and radiotherapy; in 23 HA was idiopathic. After estrogen-progestin replacement therapy, three women with idiopathic HA conceived and delivered healthy babies.
Estrogen-progestin replacement therapy in pharmacological doses might be beneficial to women with idiopathic HA, having normal prolactin levels, adrenal and thyroid function, and a normal karyotype.
Ovarian aging and infertility Meden-Vrtovec, H
Clinical and experimental obstetrics & gynecology,
2004, Letnik:
31, Številka:
1
Journal Article
Recenzirano
Ovarian aging is expressed with altered menstrual cyclicity, endocrine and biochemical profiles and impaired fertility. Shortening of the menstrual cycle may be the first signal of diminished ovarian ...reserve. Hormonal interplay in the aging ovary is manifested as a monotropic FSH rise, decreased inhibin B concentrations and fluctuating estradiol concentrations. Due to social changes, childbearing has been delayed, thus the group of women in their late thirties seeking infertility treatment has been increasing. Intrauterine insemination (IUI) usually precedes more sophisticated assisted reproductive technology (ART) treatments such as in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI). We present the outcomes of ART treatments achieved in our institution in women over 38 compared to younger women. The pregnancy rate after IUI was 3.7% in women over 38 years, and 28.6% in women less than 38 years; after IVF-ET the cumulative pregnancy rate was 16% (the miscarriage rate 21%) in women over 38, and 28% (13%) in women less than 38 years; the cumulative pregnancy rate after ICSI was 9% (the miscarriage rate 26%) in women over 38, and 27% (the miscarriage rate 14%) in women younger than 38 years. Women in advanced age should therefore be properly counselled and informed about poor success rates, and about the high cost of infertility treatment.
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