50 research outputs found
Rola insuliny i wybranych adipocytokin u pacjentek z zespo艂em policystycznych jajnik贸w (PCOS)
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. It is manifested
by hyperandrogenism, polycystic ovaries on ultrasound, oligomenorrhoea and anovulation. PCOS patients
are more vulnerable to metabolic disorders: insulin resistance, obesity, endothelium dysfunction, atherosclerosis,
and activation of proinflammatory factors. This association shows that PCOS might be an ovarian manifestation
of a metabolic syndrome. Insulin resistance is also strongly correlated with reproductive failure. Approximately 100
factors, secreted in adipose tissue, are responsible for its regulation. Adipocytokines have been found to play an
important role in regulating insulin sensitivity. Abnormal levels of adipokines are detected in patients with insulin
resistance.
Studies indicate that these factors, and their different activity in PCOS women, may affect changes observed in their
metabolism and, especially, may participate in the development of insulin resistance. There are several adipokines
whose role has been thoroughly investigated and many that we still know very little about, for example apelin and
visfatin.
Counseling PCOS patients about the possibility of developing metabolic syndrome, diabetes mellitus, and cardiovascular
diseases should be a standard of care.Zesp贸艂 policystycznych jajnik贸w (PCOS) jest najcz臋stsz膮 endokrynopati膮 w艣r贸d kobiet w wieku rozrodczym.
Manifestuje si臋 hiperandrogenizmem, obrazem policystycznych jajnik贸w w ultrasonografii, zaburzeniami
miesi膮czkowania o typie rzadkich miesi膮czek lub zaburzeniami owulacji. Pacjentki z PCOS s膮 bardziej nara偶one
na zaburzenia metaboliczne: insulinooporno艣膰, oty艂o艣膰, nieprawid艂owo艣ci endothelium, mia偶d偶yc臋 i aktywacj臋
czynnik贸w prozapalnych. Te zale偶no艣ci mog膮 艣wiadczy膰 o tym, 偶e PCOS mo偶e by膰 jajnikow膮 postaci膮 zespo艂u
metabolicznego. Insulinooporno艣膰 silnie koreluje r贸wnie偶 z zaburzeniami rozrodu. Istnieje oko艂o 100 czynnik贸w
produkowanych przez tkank臋 t艂uszczow膮, odpowiedzialnych za funkcje regulacyjne. Adipocytokiny s膮 wa偶nymi
czynnikami reguluj膮cymi wra偶liwo艣膰 organizmu na insulin臋. U pacjentek z insulinooporno艣ci膮 zauwa偶alne s膮
nieprawid艂owe poziomy adipocytokin.
Badania pokazuj膮, 偶e te czynniki i ich odmienna aktywno艣膰 u kobiet z PCOS, mo偶e mie膰 wp艂yw na zmiany w ich
metabolizmie, a w szczeg贸lno艣ci w rozwoju insulinooporno艣ci. Istnieje wiele adipokin, kt贸rych rola jest dobrze
poznana, lecz nadal rola wielu z nich jest niedostatecznie zbadana: mi臋dzy innymi apeliny i wisfatyny.
Ocena czynnik贸w ryzyka zaburze艅 metabolicznych, cukrzycy oraz choroby sercowo-naczyniowej powinna by膰
standardem u kobiet z PCOS
Pronuclear scoring as a predictor of embryo quality in in vitro fertilization program.
Many strategies have been proposed for the selection of viable embryos for transfer in human assisted reproduction. These have included morphological scoring criteria for 20, 28, 44 and 68 h after insemination. The embryo selection is based on morphology, degree of fragmentation and development to the 8-cell. All have shown some correlation with implantation. However, the overall success of these methods is still limited, with over 50% of all transferred embryos failing to implant. Pronuclear zygote morphology has gained much attention recently due to its positive value in predicting implantation and pregnancy. This prospective study involved 178 conventional IVF patients only. The key aspects of pronuclear scoring and namely the presence of a cytoplasmic halo were related to day 3 of development and morphology in a retrospective study. The Z-score and the presence/absence of a halo had significant effect on the rate of development on day 3 embryo. Low Z-score result in slow development and poor morphology. The absence of a halo also resulted in slow and poor development, low morphology, increased fragmentation
Pregnancy in a patient with seminal hypersensitivity
We report a case of a 32-year-old woman with seminal fluid allergy and secondary infertility. She was unable to have unprotected intercourses due to hypersensitivity to the sperm of her spouse. The symptoms started after the delivery of her first child. She was referred to our division for desensitization by means of the intravaginal rush method. The patient was hospitalized for monitoring, and an intravenous line was placed. The first attempt of desensitization was unsuccessful, because of her general hypersensitivity reaction. After the second intravaginal graded challenges, with the use of whole seminal plasma, none of the allergic symptoms appeared. She conceived in a natural way within a month after the treatment. Intravaginal desensitization is an effective and convenient approach for patients with postcoital hypersensitivity reaction who wish to get pregnancy
Zastosowanie selektywnych modulator贸w receptora progesteronowego w leczeniu mi臋艣niak贸w macicy oraz ich przysz艂o艣膰 w ginekologii
Uterine leiomyomata are benign, monoclonal tumors arising from smooth muscle cells, which belong to one of the most common pathologies of the female genital system. Current pharmacotherapies (oral contraceptives, progestins, GnRH analogs) are ineffective or of limited use for long-term treatment. Although there is still much debate regarding their etiology, it is very likely that progesterone and progesterone receptor play a key role in their development. Profound importance of progesterone in the female reproductive system has led to discovery of synthetic progesterone receptor ligands, which can poses the activity ranging from pure agonist activity, trough mixed agonist/antagonist activity, to pure antagonist activity. Development of selective progesterone receptor modulators (SPRM) has created new therapeutic options and has great potential in a number of gynecologic indications. So far, ulipristal acetate has been approved for emergency contraception, mifepristone as a progesterone receptor antagonist because of the unique property of this compound for termination of pregnancy. Recently, the European Commission has authorized ulipristal acetate for the pre-operative treatment of uterine fibroids. Superior efficacy of ulipristal acetate versus placebo, to reduce excessive uterine bleeding and to reduce total fibroid volume prior to surgery was demonstrated. Moreover, non-inferior efficacy of ulipristal acetate versus Gonadotropin Releasing Hormone (GnRH)-agonist to reduce excessive uterine bleeding prior to surgery of uterine fibroids has been documented. Ulipristal acetate is also characterized by a superior side-effect profile in comparison to leuprolide acetate in terms of serum estradiol levels and the proportion of patients with moderate-to-severe hot flashes during treatment. Regarding safety profile, except elevation of liver enzymes after telapristone and onapristone treatment, to date no serious untoward effects of other SPRM have been reported. The issue of endometrial effects of these compounds remains to be resolved, although observation that intrinsic agonist activity of SPRM prevents endometrial proliferation may suggest future use of these agents in prevention of endometrial hyperplasia. Other promising applications, including endometriosis, endometrial cancer, Cushing鈥檚 disease, Alzheimer disease or long-term contraception, are currently in development.Mi臋艣niaki macicy to 艂agodne, monoklonalne guzy wywodz膮ce si臋 z kom贸rek mi臋艣ni g艂adkich nale偶膮ce do najcz臋stszych patologii uk艂adu rozrodczego kobiet. Ich etiologia pozostaje ci膮gle tematem otwartej debaty, jakkolwiek wydaje si臋, i偶 kluczow膮 rol臋 w ich rozwoju odgrywa progesteron oraz receptor progesteronowy. Dotychczasowe zachowawcze metody leczenia mi臋艣niak贸w (doustna antykoncepcja, gestageny lub analogi GnRH) s膮 nieskuteczne b膮d藕 niemo偶liwe do stosowania w d艂ugotrwa艂ej terapii. Pojawienie si臋 selektywnych modulator贸w receptora progesteronowego (SPRM) otworzy艂o nowe mo偶liwo艣ci terapeutyczne. Obecnie preparaty te s膮 zarejestrowane w dora藕nej antykoncepcji, terminacji ci膮偶y i w leczeniu mi臋艣niak贸w. Ponadto na etapie bada艅 klinicznych trwaj膮 pr贸by zastosowania SPRM w leczeniu endometriozy, raka endometrium, choroby Cushinga, choroby Alzheimera czy w d艂ugotrwa艂ej antykoncepcji
Statins in the treatment of polycystic ovary syndrome
Summary Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 6-9% of women in reproductive age. It is characterized by hyperandrogenism, oligo- or anovulation and infertility. PCOS is associated with important cardiovascular risk factors including: obesity, dyslipidemia , systemic inflammation and endothelial dysfunction. Statins are well-tested medications reducing a broad range of cardiovascular risk factors. The primary mode of action of statins is inhibition of HMG-Co A reductase, a rate-limiting step of cholesterol synthesis. In recent randomized studies in PCOS women, statins have decreased testosterone level, improved menstrual cycle regularity and lipid profile
Planning and preparation for pregnancy among women with and without a history of infertility
Objectives: Preconception counseling, maternal health-related habits, diet, folic acid consumption, substances abuse, may all impact the outcome of pregnancy. The aim of this study was to compare the planning and preparation for pregnancy among pregnant women with and without infertility.
Material and methods: A survey of health behaviors prior to and during pregnancy that could affect pregnancy outcomes, including laboratory tests performed, stimulant usage, initiation of prenatal care, and folic acid intake, was conducted among 400 pregnant women. The study group included 121 women (30.25%) diagnosed with prior infertility, while the control group included 279 women (69.74%) who did not report any problems conceiving.
Results: All patients (100%) from the study group and 70,97% from the control group planned their pregnancy(p < 0.0001). Patients in the study group performed significantly more laboratory tests prior to pregnancy, including: complete blood count, urine analysis, fasting blood glucose concentration, testing for toxoplasmosis, and Pap smear, compared with the control group (p < 0.0001). There was no difference between groups regarding the knowledge of when and why folic acid supplementation is required (p > 0.05).
Conclusions: Effective education of women, regarding pregnancy planning and behaviours, that may impact pregnancy outcome is still a serious challange to public health in Poland. Our study indicates that reaching general population with the education is most important to achieve best results in preconceptional care
Efektywno艣膰 leczenia zespo艂u b贸lowego miednicy mniejszej metod膮 neurektomii przedkrzy偶owej 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 przedkrzy偶owa jest stosowana w leczeniu zespo艂u b贸lowego miednicy mniejszej, jakkolwiek sumaryczny efekt jednoczasowo przeprowadzonej resekcji ognisk endometriozy pozostaje niejasny. Prezentowana praca ma na celu por贸wnanie skuteczno艣ci laparoskopowej neurektomii przedkrzy偶owej w przypadku obecno艣ci endometriozy, oraz u chorych, u kt贸rych ta choroba nie wyst臋puje. Materia艂 i metody: Badaniem obj臋to dwadzie艣cia trzy kobiety z centralnie zlokalizowanym przewlek艂ym b贸lem miednicy mniejszej (wiek 30,3+/-7,9; 21-46 lat), nieodpowiadaj膮cym na leczenie farmakologiczne. Endometrioz臋 stwierdzono u 16 pacjentek. W badanej grupie wykonano laparoskopow膮 neurektomi臋 przedkrzy偶ow膮 z zastosowaniem skalpela harmonicznego, uzupe艂nion膮 o wyci臋cie ognisk endometriozy w 16 w/w przypadkach. Nasilenie b贸lu towarzysz膮cego krwawieniu miesi膮czkowemu oraz b贸lu niezwi膮zanego z krwawieniem oceniano na podstawie wzrokowej skali b贸lu (VAPS) przed zabiegiem oraz po 3 i 12 miesi膮cach po operacji. Bolesno艣膰 stosunk贸w p艂ciowych oceniono z zastosowaniem czterostopniowej skali. Wyniki: Po 3 miesi膮cach od operacji intensywno艣膰 b贸lu zwi膮zanego z krwawieniem miesi膮czkowym zmniejszy艂a si臋 znacz膮co w obu grupach pacjentek (u chorych bez endometriozy o 75% (P=0,018), a w grupie z endometrioz膮 o 78% (P=0,001). Po 12 miesi膮cach zaobserwowano wzrost intensywno艣ci odczuwanego b贸lu u kobiet z endometrioz膮 (P=0,008), natomiast u pacjentek bez endometriozy poprawa by艂a na niezmienionym poziomie. Odczuwalno艣膰 b贸lu w miednicy mniejszej niezwi膮zanego z krwawieniem miesi膮czkowym zmniejszy艂a si臋 na skutek operacji o 67% (P=0,0007) i o 87% (P=0,028) odpowiednio w grupie z endometrioz膮 i bez endometriozy. Bolesno艣膰 stosunk贸w p艂ciowych zmniejszy艂a si臋 istotnie 3 miesi膮ce po operacji i efekt utrzymywa艂 si臋 nadal po 12 miesi膮cach (wi臋kszo艣膰 pacjentek nie podawa艂a 偶adnego dyskomfortu,
Czy istnieje zwi膮zek mi臋dzy rozwojem zespo艂u metabolicznego u kobiet z zespo艂em policystycznych jajnik贸w, a polimorfizmem C677T genu reduktazy metylenotetrahydrofolianowej?
Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS is characterized by anovulation, polycystic ovaries, hyperandrogenism leading to infertility, dermatological and psychological problems, as well as the risk of developing Metabolic Syndrome (MetS) and cardiovascular disease (CVD). The exact cause of PCOS remains unclear. Various biochemical and genetic markers have been implicated in predisposition to PCOS, but no single variant has been associated with the syndrome. Some authors connect hyperhomocysteinemia (HHcy) with MetS and its components. The MTHFR gene C677T polymorphism is a common genetic abnormality leading to hyperhomocysteinemia.
Objectives: The aim of the study was to confirm the existence of a possible correlation between metabolic disturbances in PCOS and the MTHFR C677T polymorphism.
Material and methods: A total of 98 patients diagnosed with PCOS according to the Rotterdam criteria and 101 age-matched healthy controls were included in the study. Genotyping of MTHFR C677T was performed by the real time PCR method.
Results: Statistically significant differences were observed between those two groups with regard to body mass index (BMI), waist circumference (WC), hip circumference (HC), fasting insulin, total cholesterol (TC), and triglycerides (TG). No significant differences in the prevalence of the genotypes of the MTHFR C677T gene polymorphism were found between the PCOS group and controls. Despite the lack of significant differences, we observed a tendency for a higher prevalence of the TT genotype in the PCOS group (p = 0.06). No statistically significant differences were observed between the PCOS group and the control group in terms of the presence of the MetS components and the predisposition to develop MetS.
Conclusions: Our study did not confirm an association between the MTHFR C677T gene polymorphism and the development of MetS in PCOS. Further studies with larger sample size might be useful to determine this association.Wst臋p: Zesp贸l policystycznych jajnik贸w ( PCOS) jest najcz臋stszym zaburzeniem endokrynologicznym u kobiet w wieku rozrodczym, charakteryzuj膮cym si臋 brakiem owulacji, jajnikami policystycznymi oraz hiperandrogenizmem, kt贸re prowadz膮 do niep艂odno艣ci, problem贸w dermatologicznych i psychologicznych oraz zwi臋kszaj膮 ryzyko rozwoju zespo艂u metabolicznego i choroby sercowo-naczyniowej. Przebadano wiele biochemicznych i genetycznych marker贸w, kt贸re mog艂yby mie膰 wp艂yw na rozw贸j PCOS, jednak jak do tej pory nie uda艂o si臋 wskaza膰 jednego pewnego czynnika. Istniej膮 badania 艂膮cz膮ce hiperhomocysteinemi臋 z zespo艂em metabolicznym i jego sk艂adowymi. Cz臋stym zaburzeniem genetycznym prowadz膮cym do hiperhomocysteinemi jest polimorfizm C677T genu reduktazy metylenotetrahydrofolianowej (MTHFR).
Cel: Celem badania by艂o zweryfikowanie zwi膮zku zaburze艅 metabolicznych w zespole policystycznych jajnik贸w z polimorfizmem genu C677T MTHFR.
Materia艂 i metody: 98 pacjentek ze zdiagnozowanym PCOS na podstawie kryteri贸w Rotterdamskich zosta艂o por贸wnane ze 101 pacjentkami z grupy kontrolnej dobranej zgodnie wiekowo. Metoda real-time PCR zosta艂a u偶yta do wykonania oznacze艅 genetycznych.
Wyniki: Istotne statystycznie r贸偶nice mi臋dzy grupami zauwa偶ono w Body Mass Index (BMI), obwodzie talii, obwodzie bioder, poziomie insuliny na czczo, cholesterolu ca艂kowitego, tr贸jgliceryd贸w. Nie zauwa偶ono istotnych statystycznie r贸偶nic w wyst臋powaniu genotyp贸w polimorfizmu C677T genu MTHFR mi臋dzy grup膮 badan膮, a kontroln膮. Zaobserwowano jedynie tendencj臋 do cz臋stszego wyst臋powania genotypu TT w grupie kobiet z PCOS (p = 0,06). Nie zauwa偶ono r贸偶nic statystycznych mi臋dzy cz臋sto艣ci膮 wyst臋powania sk艂adowych zespo艂u metabolicznego oraz w rozwoju pe艂noobjawowego zespo艂u metabolicznego mi臋dzy tymi grupami.
Wnioski: Nasze badanie nie potwierdzi艂o zwi膮zku polimorfizmu genu C677T MTHFR z rozwojem zespo艂u metabolicznego w PCOS. Dalsze badania na wi臋kszej grupie pacjentek mog艂yby by膰 pomocne w ocenie tego zwi膮zku
Cost-effectiveness of IVF infertility treatment in different legislative settings
Summary Over three decades of experience enabled contemporary medicine to develop an advanced and highly efficient assisted reproductive technology (ART). Currently, we are witnesses to a nationwide debate in Poland concerning recommendation and law regulations for ART. This article expresses an opinion of medicine doctors who are specialists in the field of reproductive medicine in Poland. The authors expain why infertility is a wide and important socio-economic problem and why legislative proposals of the consevative members of the Polish Parliament expose patients to lower pregnancy rate, higher procedure cost and higher risk of complications. Authors also make analysis of different law regulations in Europe, concluding that the efficient ART model should limit the number of transferred embryos, allow cryopreservation of the embryos and impose the obligation to use the frozen embryos