The implications of male human papilloma virus infection in couples seeking assisted reproduction technologies

Human papilloma virus (HPV) is one of the most common viral sexually-transmitted diseases worldwide. The prevalence of HPV is higher in infertile males when compared with fertile men and ranges between 10 and 35.7% in men affected by unexplained infertility. HPV can bind to spermatozoa and can potentially be transferred to fertilized oocytes. Viral detection in blastocysts and trophoblastic cells is associated with impaired embryo development and poor pregnancy outcomes. Nevertheless, attempts to eliminate HPV-DNA from sperm samples through routine washing techniques have failed. In assisted reproduction technologies (ART), intracytoplasmic sperm injection involves no natural selection of the sperm cell, which means that these procedures have a plausible risk of injecting sperm containing HPV. The possible detrimental effects of HPV on ART in couples with infected male partners are summarized in this review

Menstrual cycle variability of ca 72-4 in healthy women

Objectives: CA 72-4 is not approved as a tumormarker but has been used as an adjunct marker in gynecological practice. The study aims to evaluate the menstrual cycle variability of CA 72-4 in a population of healthy women. Design and methods: Forty apparently healthy regularly menstruating subjects were included in the crosssectional study designed in the University Obstetrics and Gynecology outpatient clinic. Venous blood samples from each participant were collected twice: first at the follicular phase (2nd–5th days of the menstrual cycle) for FSH, estradiol, CA 125, CA 72-4 and the other at the luteal phase (21st-24th days of the menstrual cycle) for progesterone, CA 125 and CA 72-4 levels. Results: CA 72-4 values were similar in follicular and luteal phase of the menstrual cycle in apparently healthy regularly menstruating subjects (1.15 U/mL (0.2–5.4) vs 1.15 U/mL (0.56–6.3); p= 0.326 respectively). Ovulatory or smoking status did not have an effect on CA 72-4 values (p N 0.05). Conclusion: This first clinical study about the menstrual cycle variability of CA 72-4 revealed that the menstrual cycle does not have a significant impact on CA 72-4 values and that it can be measured at any time during the menstrual period

Early second trimester retinol-binding protein-4 values in cases with or without gestational diabetes mellitus risk factors: A cross-sectional study

Aim: Retinol-binding protein-4 (RBP-4) has been correlated with different degrees of insulin resistance includinggestational diabetes mellitus (GDM). Presence of risk factors for GDM is an indication for early screening.We studied RBP-4 values in the early second trimester of pregnancy in pregnant subjects with or without GDMrisk factors and compared the results by routine GDM screening methodology.Methods: Seventy-nine patients with at least one GDM risk factor and 46 patients without any GDM riskfactors were enrolled in the cross-sectional study as risk and control groups, respectively. In the early secondtrimester, RBP-4 values were measured, in addition to fasting plasma glucose and 50-g glucose challenge testin all subjects.Results: The RBP-4 values in 16–18th weeks of pregnancy were not significantly different between risk andcontrol groups (95.3 ± 20.1 vs 103.1 ± 24.4 µg/mL, respectively; P = 0.055) although fasting plasma glucoselevels and 50-g glucose challenge test results were higher in the risk group than the control group (75.3 vs69.3 mg/dL and 112.4 vs 97.5 mg/dL, respectively; P < 0.05).Conclusion: Presence of GDM risk factors does not have an impact on early second trimester RBP-4 values inpregnant subjects

Erectile function in SRY positive 46,XX males with normal phenotype

Introduction The 46,XX male syndrome is a rare disorder of sex development and has two different forms, depending on the sex-determining region's presence on the Y chromosome (SRY) gene. The SRY positive 46,XX males are usually diagnosed during infertility workup. We evaluated the erectile function of 46,XX SRY positive males and compared it with healthy males. Material and methods Ten patients with azoospermia and 46,XX SRY positive disorder who referred to a urology clinic with infertility were analyzed retrospectively. Controls were chosen from healthy males at similar ages. The physical examination was performed, and serum hormones were obtained at admission. The clinical assessment of erectile dysfunction was evaluated by the International Index of Erectile Function (IIEF) questionnaire. Results There was no statistically significant difference between the two groups in terms of age, serum prolactin, luteinizing hormone (LH) levels and IIEF scores (P >0.05). In 46,XX males, serum follicle-stimulating hormone (FSH) levels were significantly higher, and total testosterone levels and testicular volumes were found to be significantly lower when compared to controls (p <0.001, p <0.05, p <0.01, respectively). Conclusions This study indicates that these males' erectile function is similar to those of 46,XY males

Anti-Mullerian hormone and insulin resistance in classic phenotype lean PCOS

Purpose This study is designed to explore the correlation between AMH levels and IR in normal weight PCOS women. Materials and methods This prospective study was conducted on 55 patients, who were admitted to obstetrics and gynecology department of a university clinic. Study group was consisted of 34 patients diagnosed as polycystic ovary syndrome (PCOS) according to the Rotterdam Criteria, whereas control group was consisted of 21 healthy volunteers without any features of clinical or biochemical hyperandrogenism, who had regular menstrual cycles. BMI C 25 kg/m2 were considered overweight and obese and excluded. Blood samples were obtained during days 2–3 after spontaneous menses or progesterone-induced withdrawal bleeding after overnight fasting for at least 12 h. The weight, height, hip and waist circumferences of the patients were measured. Fasting insulin and glucose (FPG) levels were used for calculating different insulin resistance indexes (Homeostatic Model Assessment (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI)). Results No significant difference was found between PCOS and control groups regarding the mean age, BMI, waist to hip ratio (WHR), mean values of FPG, FPG/insulin ratio and HOMA B (p[0.05). AMH values were significantly higher in PCOS cases when compared with controls (4.7 vs. 3.4 ng/mL) (p\0.05).The mean values of HOMAIR and QUICKI indexes were significantly higher among PCOS cases when compared with controls. E2 levels were significantly lower and Total-T were significantly higher in PCOS patients. When PCOS cases are categorized according to the existence of IR, no difference in Total-T and AMH levels between both groups. Although not statistically significant, a negative correlation of AMH with HOMA-IR and a positive correlation with QUICKI index were found. Among the hormone parameters, AMH was found to be positively correlated with Total-T (r = 0.332, p = 0.013). Conclusion Although the relation between AMH and androgen production is supported by current evidence, the mechanism underlying the relation between AMH and insulin resistance is not clear yet

Sex-hormone-binding globulin early in pregnancy for the prediction of severe gestational diabetes mellitus and related complications

Aims: The aim of this study was to evaluate the predictive value of sex-hormone-binding globulin (SHBG) for the diagnosis of gestational diabetes mellitus (GDM), and to clarify the association between SHBG levels and GDM complications/medication requirements. Material and Methods: Among the participants (n = 93) who provided blood samples between 13 and 16 weeks’ gestation, 30 cases subsequently developed GDM. Complications and medical interventions were noted. The best cut-off point of SHBG and diagnostic performance were calculated. Results: The mean age was 28.45 - 5.0 years. SHBG levels were lower in the GDM group (n = 30) when compared with non-GDM (n = 63) cases (<0.01). Among the GDM women, SHBG was lower in the insulin therapy group (n = 15) compared with medical nutritional therapy alone (n = 15) (P < 0.01). A good predictive accuracy of SHBG was found for GDM requiring insulin therapy (area under the curve: 0.866, 95% confidence interval: 0.773–0.959). An SHBG threshold for 97.47 nmol/L had a sensitivity of 80.0%, specificity 84.6%, positive predictive value 50.0% and negative predictive value 95.7%. The calculated odds ratio for SHBG < 97.47 nmol/L was 12.346 (95% confidence interval: 1.786–83.33). Conclusions: SHBG is valuable for screening women early in pregnancy for GDM risk; however, a standard assay for analyses and a threshold level of serum SHBG for a constant gestational week has to be determined

The impact of route of anesthesia on maternal and fetal ischemia modified albumin levels at cesarean section: a prospective randomized study

Objective: Ischemia modified albumin has been shown to increase in ischemic situations, and has also been shown to increase in fetal cord blood in deliveries by cesarean section. The aim of this study is to reveal whether anesthesia has an impact on maternal and fetal cord ischemia modified albumin levels. Methods: Seventy two women with uncomplicated term pregnancies were randomized to spinal (n = 37) or general anesthesia (n = 35) groups. The blood pressure, oxygen saturation, and pulse rate of the patients were recorded during the procedure. Maternal blood samples of ischemia modified albumin (IMA) were taken 10 min from the start of the procedure. The fetal cord blood samples of IMA were taken immediately after birth. Results: Maternal (0.99 ± 0.19 vs. 0.80 ± 0.27) and fetal (1.00 ± 0.21 vs. 0.70 ± 0.26) IMA levels were significantly higher in the general anesthesia group. Fetal IMA levels were positively correlated with maternal gravidity (r = 0.31; P = 0.008), parity (r = 0.25; P = 0.028), and fetal birth weight (r = 0.23, P = 0.045). Also, as time from incision to delivery lengthens, fetal IMA levels increase (r = 0.29, P = 0.012). Conclusion: Fetal cord ischemia modified albumin levels were higher in the general anesthesia group, therefore, it is proposed that regional anesthesia should be the preferred route of anesthesia for an elective cesarean section, at least until the impact of high fetal cord IMA levels are manifested

Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations

Paraovarian or paratubal cysts (PTCs) constitute about 10 % of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion. Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed. Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem. Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature

The association between ischemia modified albumin and placental histopathology in uncomplicated term deliveries

Ischemia modified albumin (IMA) is a marker of ischemia elevated in different clinical conditions and its use for hypoxia in perinatology is of current interest. We aimed to investigate the association between maternal and cord blood IMA levels and placental histopathological findings in uncomplicated term deliveries. In this study, placental histopathological evaluation in uncomplicated deliveries that ended with healthy newborns revealed 80.6% vasculopathy. The results support the hypothesis that hypoxia exceeding the placental reserve ends with fetal compromise. Moreover, the presence of maternal vasculopathy in placenta is not correlated with maternal and fetal IMA levels

Atherogenic dyslipidemia, subclinical atherosclerosis, non-alcoholic fatty liver disease and insulin resistance in polycystic ovarian syndrome

Objective: We aimed to explore the relationship between insulin resistance (IR) and small dense lipoprotein (sd-LDL) particles, carotid intima-media thickness (CIMT) and non-alcoholic fatty liver disease (NAFLD) in young normal weight PCOS cases. Methods: This prospective, case-control study was designed in a University Hospital and 34 women with PCOS and 21 healthy controls were enrolled. Fasting plasma glucose, insulin, lipid (including sd-LDL particles) and hormone profiles, abdominal ultrasound and CIMT were evaluated. Results: IR was present in 68% of PCOS group while in none of controls. High density lipoprotein (HDL), very low density lipoprotein (VLDL), triglycerides (TG), and sd-LDL were higher in patients with IR (p<0.05). A positive correlation of sd-LDL with IR, VLDL and TG was found. A significantly higher rate of NAFLD and CIMT was found in PCOS. Totaltestosterone levels were weakly and positively correlated with CIMT (r=0.277, p=0.041). Conclusion: Insulin resistance and NAFLD are highly prevalent among young normal weight PCOS patients. When compared to controls levels of sd-LDL and CIMT are increased in PCOS. Insulin resistance is the key parameter for NAFLD and atherogenic dyslipidemia in PCOS. Hence, screening for NAFLD may be valuable for detection and prevention of liver disease. Higher levels of sd-LDL in insülin resistant PCOS cases necessiates treating PCOS for I