BACKGROUND In the 17th, 18th and 19th century the scientists were intensively occupied with »climactericdisease« in men and it was not until 20th century when attention was paid to climacteric ...offemale too. In the second half of the 20th century hormone replacement therapy (HRT)became popular for alleviation of climacteric symptoms and prevention of osteoporosis.Together with beneficial effects of HRT unwanted side effects were registered.Several large scale hormone trials (Nurses Health Study, Heart and Estrogen-progestinReplacement Study – HERS, Estrogen Replacement and Atherosclerosis – ERA, Postmenopausal Estrogen/progestin Interventional Trial – PEPI, Women’s Health Initiative – WHI,The Million Women Study, Raloxifene Use in the Heart – RUTH) revealed an increased riskfor the development of invasive breast cancer and cardiovascular events and decreasedrisk of colorectal cancer and osteoporosis. Overall criticism of the mentioned trials concerns the age of women included in the studies (more than 60 years on average). Recentmeta-analysis of randomized trial shows 40 % reduction in total mortality in women whostarted HRT younger than 60 years at baseline. This analysis provides a promising evidence of HRT emphasizing early start i.e., in the first years after menopause. CONCLUSIONS Last decade in the field of menopausal medicine is characterized by discussions aboutbenefits and risks of HRT. The experts reached consensual position statement that benefitsovercome risks of HRT when introduced in early postmenopause
Background: Since women nowadays experience late decision for the delivery of the first child the question of screening strategies for ovarian reserve determination and fertility potential seems to ...be crucial. As the most reliable marker of ovarian function FSH determination has been used, but the method is limited with fluctuation from physiologic to pathologic levels up to some years before exhaustion of ovarian reserve. In the past ten years determination of anti-Müllerian hormone (AMH) concentration in serum has become most relevant. AMH is produced and secreted by granulosa cells and regulates the development of primary follicles with inhibitory action on FSH secretion. AMH does not only predict the pool of small antral follicles but can also be a predictor of oocyte quality. In men AMH determination has been useful in diagnostic procedures for intersex conditions with abnormal testicular differentiation, while in women AMH tends to be the most reliable marker for small antral follicle pool in premature ovarian failure and the marker of increased reserve of small antral follicles in women with polycystic ovaries. Conclusion: Recent scientific and clinical data suggest that AMH determination will be used as the most reliable marker of ovarian follicular status.
Oocytes retrieved from gonadotrophin-stimulated cycles in polycystic ovarian syndrome (PCOS) patients are of different quality and different developmental potential. We hypothesized that oocyte ...quality and fertilization potential might be related to the follicular fluid active renin and vascular endothelial growth factor (VEGF) concentrations. In this prospective study 20 patients with PCOS undergoing in vitro fertilization (IVF) (conventional IVF or intracytoplasmic sperm injection—ICSI) were included. Each follicular aspirate was analysed for active renin and VEGF. Oocytes and embryos were checked for quality. In empty follicular aspirates active renin concentrations were higher (mean difference: 0.05 pg/ml; range: 0.01 to 0.09 pg/ml;
P=0.01) and VEGF concentrations were lower (mean difference: 169 pg/ml; range: 330 to −8 pg/ml;
P=0.034) than in the aspirates containing normal appearing MII oocytes. Follicular fluid VEGF concentrations were lower in immature than in normal appearing MII oocytes (mean difference: −548 pg/ml; range: −1064 to −32 pg/ml;
P=0.034). VEGF concentrations were higher in aspirates containing normal appearing MII oocytes that fertilized compared to those MII oocytes that did not (2238±691 vs. 1877±902 pg/ml;
P=0.045). Differentiation of normal appearing MII oocytes that fertilize from those that do not might be the consequence of better expression and action of RAS substances and VEGF.
Objective: To find the differences between human granulosa-luteal cells obtained during early timed follicular aspiration to prevent severe ovarian hyperstimulation syndrome (OHSS) and during ...normally timed follicular aspiration.
Design: Retrospective analysis of clinical laboratory data.
Setting: In vitro fertilization unit, University Department of Obstetrics and Gynecology, Ljubljana, Slovenia.
Patient(s): Twenty women undergoing IVF-ET at high risk for OHSS.
Intervention(s): Cells were obtained from the follicles of women who were stimulated with hMG and hCG during an early timed follicular aspiration of one ovary, 10–12 hours after hCG, and during a normally timed follicular aspiration of the contralateral ovary, 32–36 hours after hCG administration.
Main Outcome Measure(s): Subpopulations of granulosa-luteal cells were observed by computerized image analysis in which hCG was localized using immunoperoxidase staining.
Result(s): Early timed follicular aspirates contained no oocytes and only a scant number of granulosa cells. Granulosa-luteal cells were smaller than those from normally timed follicular aspirates. We identified three subpopulations in early timed follicular aspirates: nonluteinized, small luteinized, and medium luteinized cells. In normally timed follicular aspirates, four subpopulations were identified, including large luteinized cells. The normally timed follicular aspirates contained more hCG-stained cells. Three staining types of hCG localization were found: on the surface membrane, on the surface membrane and within the cytoplasm, and only within the cytoplasm of cells from normally timed follicular aspirates. Early timed follicular aspirates contained only cells with membrane hCG localization.
Conclusion(s): We found differences in morphometric characteristics and hCG localization between human granulosa-luteal cells obtained during early timed follicular aspiration to prevent severe OHSS and during normally timed follicular aspiration.
Insulin resistance is a common characteristic of women with polycystic ovary syndrome (PCOS) who are known to differ in their in-vitro fertilization outcomes compared to non-PCOS patients. As insulin ...resistance can be found in a considerable proportion of normal individuals, we assessed its contribution to ovarian responsiveness and fertilization rate. 26 non-PCOS patients undergoing IVF for the first time were investigated. Insulin resistance was evaluated by using a euglycemic hyperinsulinemic clamp technique. According to multiple regression analysis insulin sensitivity, expressed as insulin stimulated glucose disposal rate, during euglycemic clamp (r = -0.81, p < 0.05 and r = -0.89; p < 0.01) and basal estradiol level (r = -0.54; p < 0.05 and r = -0.56; p < 0.05) appeared significant negative predictors of the number of fertilized oocytes and embryos, respectively. Furthermore, basal glucose level appeared independently as a significant positive predictor of the number of fertilized oocytes and the number of embryos. (r = 0.90; p < 0.01 and r = 0.96; p < 0.01 respectively). We conclude that blood glucose concentration and insulin resistance respectively are independent predictors of IVF outcome.
Abstract The purpose of this prospective randomized study was to evaluate use of a hyaluronan-rich transfer medium in fresh and frozen–thawed single blastocyst transfer. The study included 279 single ...blastocyst transfers in women aged <37 years in their first, second or third treatment cycle. According to the type of single blastocyst transfer (fresh elective or frozen–thawed) the women were divided into two study and two control groups. In both study groups ( n = 130) transfers were performed using hyaluronan and in the control groups ( n = 149) a conventional transfer medium was used. The results indicate that fresh elective single blastocyst transfer with hyaluronan results in significantly higher pregnancy rates in a selected subgroup of women; those with ≥2 blastocysts developed to day 5 and a previous implantation failure (55% versus 10%; P = 0.012). Overall pregnancy rates after fresh elective and frozen–thawed single blastocyst transfer were similar in both study and control groups.
Abstract Factors that influenced the clinical results of 220 first-attempt intracytoplasmic sperm injection (ICSI) cycles with testicular spermatozoa were evaluated in 107 men with non-obstructive ...azoospermia, 72 with obstructive azoospermia and 41 with aspermia. Linear and logistic regression analysis showed that the fertilization rate depended positively on Johnsen score ( P = 0.016) and on the type of ovarian stimulation: a higher fertilization rate was observed after ovarian stimulation with agonist and recombinant FSH than after stimulation with agonist and urinary menopausal gonadotrophin ( P = 0.026). Embryo development to the blastocyst stage was predicted positively by the number of injected oocytes ( P = 0.016) and negatively by male FSH concentration ( P = 0.019). A higher proportion of blastocysts developed after the use of frozen–thawed spermatozoa in comparison to fresh spermatozoa ( P = 0.034). Embryo development to the blastocyst stage influenced pregnancy ( P = 0.002) and live birth outcomes ( P = 0.005); live birth was also predicted by female age ( P = 0.046). Embryo culture to day 5 in comparison to day 2 did not provide higher live birth rates. In azoospermia/aspermia, the ICSI outcome depends on both male factors (FSH, Johnsen score, sperm status and motility) and female factors (age, number of injected oocytes).
Background: Premature ovarian failure (POF) and connected problems are usually underestimated by the therapists. Precise analysis of etiology and adequate treatment enable resumption of reproductive ...function in some groups of the women with POF.Methods: Etiology of POF is heterogenous. It can be defined as genetic, autoimmune, iatrogenic, the rest presents as idiopathic. Among basic diagnostic procedures there are precise patient’s history and determinations of FSH, LH, TSH, inhibin B, AMH (antimüllerian hormone) concentration, kariotype and ACTH test. Additional procedures encomprise determinations of atherogenic factors (LDL, HDL, VLDL, hSCRP), determination of lenght of Q-T interval on standard EKG and immunologic investigations on cellular and humoral level. Therapeutic possibilities include estrogen replacement treatment in case of idiopathic etiology and corticosteroid administration in case of autoimmune etiology of POF.Conclusions: Precise analysis of POF etiology enables specific treatment and resumption of reproductive function in some forms of POF (idiopathic and autoimmune).
We describe 4 consecutive hypertensive women with polycystic ovary syndrome, classified according to the National Institute of Child Health and Human Development (NICHD) criteria, treated with ...telmisartan 40 mg/d for six months. Blood pressure, menstrual pattern, body mass index (BMI), homeostasis model assessment of insulin resistance, testosterone, dehydroepiandrosterone sulfate (DHEAS), and androstenedione were recorded and measured before and after telmisartan treatment. Obese hypertensive polycystic ovary syndrome patients had a decrease in systolic blood pressure. Marked drop-off in serum androgen concentrations was observed in all four patients. Three patients improved their menstrual cyclicity. The improvements were independent of changes in weight. The reduction of androgen concentrations and improvement in menstrual pattern was achieved despite a non-significant change of fasting insulin levels in patients, who were not considered severely insulin resistant at baseline. These findings may provide a new basis for a proper choice of the antihypertensive drug in hypertensive women with polycystic ovary syndrome.
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