Individual 17-Hydroxyprogesterone Responses to hCG Are Not Correlated With Follicle Size in Polycystic Ovary Syndrome.

Context:In women with polycystic ovary syndrome (PCOS), 17-hydroxyprogesterone (17-OHP) responses to gonadotropin stimulation vary from increased to indistinguishable compared with normal controls. Objective:To determine whether 17-OHP responses to recombinant-human chorionic gonadotropin (r-hCG) are individually correlated to the size of antral follicles among women with PCOS. Design Setting and Participants:A prospective study conducted in 19 women with PCOS and 20 normal controls at an academic medical center. Interventions:Blood samples were obtained before and 24 hours after administration of 25 μg of r-hCG. Ovarian imaging was conducted with three-dimensional pelvic ultrasonography. Each subject underwent a 2-hour oral glucose tolerance test. Main Outcome Measures:Basal and stimulated levels of 17-OHP, androgens, estradiol, progesterone, anti-Mullerian hormone (AMH), insulin, glucose, follicle number, and size. Results:In women with PCOS, mean antral follicle count (AFC) was greater than that of controls, although the size of cohort follicles within individual subjects was not correlated to 17-OHP responses. The numbers of 2- to 3-mm and 3- to 4-mm follicles in PCOS were significantly greater than in controls, whereas differences between larger follicles were not observed. Increased AMH in PCOS was correlated to AFC, but not 17-OHP responses. Insulin sensitivity did not correlate to r-hCG‒stimulated 17-OHP after adjustment for body mass index. Conclusions:17-OHP responses to hCG in individuals with PCOS were not correlated to the distribution of antral follicles. Greater numbers of small antral follicles in women with PCOS than in controls suggest an extension of accelerated growth from the preantral stage

Efektywność leczenia zespołu bólowego miednicy mniejszej metodą neurektomii przedkrzyżowej u pacjentek z i bez endometriozy

Abstract Objective: Presacral neurectomy (PSN) is used in treatment of central chronic pelvic pain (CPP); however, the confounding effect of concomitant resection of endometriosis remains uncertain. This study was undertaken to evaluate and compare the effectiveness of presacral neurectomy (PSN) in the presence and absence of endometriosis. Material and Methods: Twenty-three women with midline CPP (age 30.3+/-7.9, range 21-46) unresponsive to medical therapy were recruited to the study. Endometriosis was absent in seven and present in sixteen subjects. Laparoscopic PSN using a harmonic scalpel was performed in all subjects; simultaneous excision of endometriotic lesions was also carried out in subjects with endometriosis. Intensity of dysmenorrhoea and pelvic pain was measured by visual analogue pain scale (VAPS) at 3 and 12 months postoperatively. Results: Dysmenorrhoea decreased at 3 months by 75% (P=0.018) in those without endometriosis and by 78% (P=0.001) in those with endometriosis. At 12-months, dysmenorrhea increased in women with endometriosis (P=0.008), but not in those without endometriosis. Pelvic pain not related to menses decreased by 67% (P=0.0007) and by 87% (P=0.028), respectively, in women with and without endometriosis. Dyspareunia, declined dramatically at 3 and 12 months to a median score of 0 (the majority of subjects had no discomfort; PStreszczenie Cel pracy: Neurektomia przedkrzyżowa jest stosowana w leczeniu zespołu bólowego miednicy mniejszej, jakkolwiek sumaryczny efekt jednoczasowo przeprowadzonej resekcji ognisk endometriozy pozostaje niejasny. Prezentowana praca ma na celu porównanie skuteczności laparoskopowej neurektomii przedkrzyżowej w przypadku obecności endometriozy, oraz u chorych, u których ta choroba nie występuje. Materiał i metody: Badaniem objęto dwadzieścia trzy kobiety z centralnie zlokalizowanym przewlekłym bólem miednicy mniejszej (wiek 30,3+/-7,9; 21-46 lat), nieodpowiadającym na leczenie farmakologiczne. Endometriozę stwierdzono u 16 pacjentek. W badanej grupie wykonano laparoskopową neurektomię przedkrzyżową z zastosowaniem skalpela harmonicznego, uzupełnioną o wycięcie ognisk endometriozy w 16 w/w przypadkach. Nasilenie bólu towarzyszącego krwawieniu miesiączkowemu oraz bólu niezwiązanego z krwawieniem oceniano na podstawie wzrokowej skali bólu (VAPS) przed zabiegiem oraz po 3 i 12 miesiącach po operacji. Bolesność stosunków płciowych oceniono z zastosowaniem czterostopniowej skali. Wyniki: Po 3 miesiącach od operacji intensywność bólu związanego z krwawieniem miesiączkowym zmniejszyła się znacząco w obu grupach pacjentek (u chorych bez endometriozy o 75% (P=0,018), a w grupie z endometriozą o 78% (P=0,001). Po 12 miesiącach zaobserwowano wzrost intensywności odczuwanego bólu u kobiet z endometriozą (P=0,008), natomiast u pacjentek bez endometriozy poprawa była na niezmienionym poziomie. Odczuwalność bólu w miednicy mniejszej niezwiązanego z krwawieniem miesiączkowym zmniejszyła się na skutek operacji o 67% (P=0,0007) i o 87% (P=0,028) odpowiednio w grupie z endometriozą i bez endometriozy. Bolesność stosunków płciowych zmniejszyła się istotnie 3 miesiące po operacji i efekt utrzymywał się nadal po 12 miesiącach (większość pacjentek nie podawała żadnego dyskomfortu,

Resveratrol Is Not as Effective as Physical Exercise for Improving Reproductive and Metabolic Functions in Rats with Dihydrotestosterone-Induced Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a reproductive and metabolic disorder associated with obesity and insulin resistance that often precedes the development of type-2 diabetes. Rats continuously exposed to dihydrotestosterone from prepuberty display typical reproductive and metabolic PCOS characteristics including anovulation, polycystic ovaries, insulin resistance, and obesity. Our aim was to investigate if resveratrol improves reproductive and metabolic functions in PCOS rats. The effect was compared to exercise. Control and PCOS rats were treated with vehicle or resveratrol (400 mg · kg−1 · day−1) for 5-6 weeks. Another group of PCOS rats received vehicle treatment and exercised for 5-6 weeks. Insulin sensitivity was determined by euglycemic-hyperinsulinemic clamp. The glucose infusion rate was lower in the PCOS-vehicle group compared to control-vehicle rats (P<0.05). Exercise increased insulin sensitivity compared with PCOS-vehicle rats (P<0.05), but resveratrol did not. Resveratrol treatment and exercise resulted in smaller adipocytes, upregulated estrogen-related receptor α gene expression in subcutaneous fat, and improved estrus cyclicity in the previously acyclic PCOS rats. Although resveratrol had positive effects on adiposity and cyclicity in a similar manner to exercise, resveratrol does not seem to be a good candidate for treating insulin resistance associated with PCOS because no improvement in insulin sensitivity was observed in PCOS rats on normal chow

Lipophilic statins inhibit growth and reduce invasiveness of human endometrial stromal cells

PURPOSE:To compare effects of lipid-soluble statins (simvastatin, lovastatin, atorvastatin) and water-soluble statin (pravastatin) on growth and invasiveness of human endometrial stromal (HES) cells. METHODS:Endometrial biopsies were collected during the proliferative phase from five volunteers. HES cells were isolated and cultured in the absence or in the presence of simvastatin, lovastatin, atorvastatin, and pravastatin. Effects of statins on DNA synthesis, cell viability, activity of caspases 3/7 and invasiveness were evaluated. RESULTS:The proliferation of HES cells was significantly decreased by simvastatin (by 47-89%), lovastatin (by 46-78%), and atorvastatin (by 21-48%) in a concentration-dependent manner. Activity of executioner caspases 3/7 was significantly increased by simvastatin (by 10-25%), lovastatin (by 19%) and atorvastatin (by 7-10%) in a concentration-dependent manner. The greatest effects were observed in response to simvastatin. Accounting for the effects of statins on cell number, the invasiveness of HES cells was significantly decreased in cells treated with simvastatin (by 49%), lovastatin (by 54%), and atorvastatin (by 53%). Pravastatin had little or no effects on any of the tested endpoints. CONCLUSIONS:Present findings demonstrate that only lipid-soluble among tested statins were effective in inhibition of growth and invasiveness of HES cells. These findings may have clinical relevance in treatment of endometriosis