Gynecological Endocrinology最新文献

Purpose: Previous studies have reported the involvement of long noncoding RNAs (lncRNAs) in reproductive diseases via the regulation of target genes. This study aimed to determine whether lnc-prostate androgen-regulated transcript 1 (lnc-PART1)could be used as a biomarker of unexplained recurrent pregnancy loss (URPL) and a possible predictor of poor pregnancy outcomes in women with URPL.

Materials and methods: Sixty patients with URPL and 15 healthy women were included in this study. PART1 expression was detected in plasma and endometrial tissues using a quantitative reverse transcription polymerase chain reaction. Logistic regression and receiver operating characteristic curve analyses were performed to analyze the association between PART1 expression and pregnancy outcomes in women with URPL.

Results: The expression of PART1transcript variant 2 was significantly up-regulated in the endometrial specimens from patients with URPL compared to control tissues. High tissue expression levels of PART1transcript variant 2 were associated with poor pregnancy outcomes in women with URPL, indicating that it could serve as a potential risk factor. Additionally, PART1 could serve as a potential risk factor for adverse pregnancy outcomes in patients with URPL (OR = 4.374; 95% CI = 1.052-18.189; p = .042).

Conclusion: lncRNA PART1 transcript variant 2 was highly expressed in patients with URPL. Therefore, it is important to conduct in-depth studies on the relationship between PART1 expression and URPL.

Objective: Comparison of hormonal, metabolic and inflammatory markers of glutathione with metformin and Diane-35 in a rat model of PCOS induced by dehydroepiandrosterone.

Methods: Twenty-five female rats were randomized into four groups. Group 1 was administered a subcutaneous dose of 0.2 ml saline/day. Group 2 was given 0.2 ml of 1% carboxymethyl cellulose (CMC)/day orally for 28 days. A PCOS model was established with DHEA in rats. Group 3 was given 4.5 mg/kg/day of Diane-35 orally dissolved in 1% CMC for 28 days. Group 4 was given 300 mg/kg/day of metformin orally dissolved in 1 ml of saline for 28 days, and Group 5 was administered 100 mg/kg of glutathione intraperitoneally on days 35, 42, and 49. On day 56, the rats were sacrificed. Serum markers and follicle count were examined.

Results: Serum IL-6, hs-CRP, insulin, testosterone, SHBG, and MDA values were significantly lower in the glutathione group than in the PCOS group (p = 0.0006, p = 0.023, p = 0.0082, p = 0.0007, p = 0.0048, and p < 0.0001, respectively).The number of all follicles was similar between the control and glutathione groups (p < 0.05). When we compared the other groups with the PCOS group, the number of primary, secondary, atretic, and cystic follicles was significantly lower in the metformin and glutathione groups. The number of primordial and antral follicles was significantly higher than in the PCOS group.

Conclusions: Glutathione plays anti-inflammatory and antioxidant roles, similar to metformin, by lowering serum IL-6, insulin, testosterone, CRP, and MDA levels; decreasing atretic/cystic follicle count; and improving antral follicle count and folliculogenesis in PCOS patients.

Objective: To investigate the effect of body mass index (BMI) on progesterone (P) level on trigger day in gonadotropin-releasing hormone antagonist (GnRH-ant) cycles.

Methods: This study was a retrospective cohort study. From October 2017 to April 2022, 412 in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) patients who were treated with GnRH-ant protocol for controlled ovarian hyperstimulation (COH) in the reproductive center of our hospital were selected as the research objects. Patients were divided into three groups according to BMI level: normal weight group (n = 230):18.5 kg/m²≤BMI < 24 kg/m²; overweight group (n = 122): 24 kg/m²≤BMI < 28 kg/m²; Obesity group (n = 60): BMI ≥ 28 kg/m². Variables with p < .10 in univariate analysis (BMI, basal FSH, basal P, FSH days, Gn starting dose and E₂ level on trigger day) and variables that may affect P level on trigger day (infertility factors, basal LH, total FSH, HMG days and total HMG) were included in the multivariate logistic regression model to analyze the effect of BMI on P level on trigger day of GnRH-ant protocol.

Results: After adjustment for confounding factors, compared with that in normal weight patients, the risk of serum P elevation on trigger day was significantly lower in overweight and obese patients (OR = 0.434 and 0.199, respectively, p < .05).

Conclusion: The risk of P elevation on trigger day in GnRH-ant cycles decreased with the increase of BMI, and BMI could be used as one of the predictors of P level on trigger day in GnRH-ant cycles.

Ovulatory disorders are a common cause of abnormal uterine bleeding in women of reproductive age. The International Federation of Gynecology and Obstetrics currently offers a causal classification system for ovulatory disorders but does not provide clear management recommendations. There remains regional disparity in treatment practices, often influenced by institutional and insurance regulations as well as cultural and religious practices. A panel of experts evaluated current gaps in ovulatory disorder management guidelines and discussed potential strategies for addressing these unmet needs. Key gaps included a lack in consensus about the effectiveness of combined estrogen and progestogen versus progestogen alone, a paucity of evidence regarding the relative effectiveness of distinct hormonal molecules, a lack of data regarding optimal treatment duration, and limited guidance on optimal sequencing of treatment. Recommendations included development of a sequential treatment-line approach and development of a clinical guide addressing treatment scenarios common to all countries, which can then be adapted to local practices. It was also agreed that current guidelines do not address the unique clinical challenges of certain patient groups. The panel discussed how the complexity and variety of patient groups made the development of one single disease management algorithm unlikely; however, a simplified, decision-point hierarchy could potentially help direct therapeutic choices. Overall, the panel highlighted that greater advocacy for a tailored approach to the treatment of ovulatory disorders, including wider consideration of non-estrogen therapies, could help to improve care for people living with abnormal uterine bleeding due to ovarian dysfunction.

Purpose: This study aimed to compare the efficacies of Femoston and Dydrogesterone therapy in patients with incomplete abortions.

Methods: Patients with incomplete abortions were included if they preferred medication over surgical intervention. The participants were categorized into three groups: the Femoston group received Femoston, the Dydrogesterone group was administered Dydrogesterone, and the control group was followed up without treatment. Basic clinical information, complete abortion success rate, and menstrual recovery rate were collected to evaluate the efficacy of Femoston and Dydrogesterone in patients with incomplete abortions.

Results: We analyzed 332 patients with incomplete abortions. The success rate of complete abortion was significantly higher in the Femoston group than in the control group (relative risk (RR)=1.708, 95% CI 1.304-2.237, p = .001) and the Dydrogesterone group (RR = 1.200, 95% CI 1.015-1.418, p = .023). The effectiveness of Dydrogesterone was also significantly higher than that in the control group (RR = 1.439, 95% CI 1.068-1.938, p = .015). After 60 days, the rate of menstrual recovery in the Femoston group was significantly higher than that in the control group (RR =1.322, 95% CI 1.103-1.609, p = .001), while the rate in the Dydrogesterone group was significantly lower than that in the Femoston group (RR =1.200, 95% CI 1.035-1.391, p = .009).

Conclusions: Femoston and Dydrogesterone were effective in treating incomplete abortions, with Femoston being more effective. Patients receiving Femoston had shorter menstrual recovery times than those receiving dydrogesterone. Therefore, Femoston and Dydrogesterone are potential treatment options for incomplete abortion, with Femoston being the more effective.

Objective: To present a young girl with pyruvate kinase deficiency (PKD) and concurrent severe hemolytic anemia who underwent fertility preservation and cryopreservation. Clinical symptoms, diagnosis, treatment, and new strategies for fertility protection and preservation in PKD patients who require allogeneic hematopoietic stem cell therapy are explored.

Case presentation: Six-year-old girl with persistent unconjugated hyperbilirubinemia and severe hemolytic anemia since birth, continuous elevation of bilirubin levels and severe splenomegaly. She was diagnosed with PKD, an open laparotomy for splenectomy was performed and ovarian tissue cryopreservation (OTC) was used to preserve fertility and ovarian endocrine function. Due to the previous donor being unsuitable, it took five months to find and match a new hematopoietic stem cell donor. Five months after OTC, the patient underwent high-dose busulfan and ciclosporin chemotherapy in preparation for peripheral blood stem cell transplantation and received rabbit anti-T-lymphocyte globulin to prevent graft-versus-host disease. Her red and white blood cells, hemoglobin and platelets are now generally within the normal range, total bilirubin and direct bilirubin in liver function have also normalized and AMH is below the lower limit of normal. Until now, no signs of a negative impact of OTC have been observed.

Conclusion: Hematopoietic stem cell transplantation is essential for effective treatment of pyruvate kinase deficiency. We assess OTC as the only possible fertility preservation method for children who cannot undergo embryo and oocyte cryopreservation.

Objective: We carried out this study to explore the possibility of initiating goserelin therapy during the non-menstrual period in patients diagnosed with adenomyosis.

Methods: 115 premenopausal adenomyosis patients were enrolled and divided into three groups based on their menstrual cycle phase during the initial outpatient visit: menstrual, follicular, and luteal. Each received a 3.6 mg subcutaneous dose of goserelin monthly for three months. The endpoints encompassed alterations in uterine volume, dysmenorrhea Numerical Rating Scale (NRS) score, CA125 level, hemoglobin (HGB) after a 12-week treatment course, and the occurrence and duration of uterine hemorrhage during the first treatment cycle.

Results: Analysis revealed that the timing of goserelin therapy initiation in the menstrual cycle did not significantly impact its effectiveness in reducing uterine size, alleviating pain, lowering CA125 levels, or improving hemoglobin concentrations. However, patients starting treatment during the luteal phase experienced increased uterine bleeding (reference: menstrual period, OR = 4.33, 95% CI 1.23-15.25, p = .023).

Conclusions: The results suggested non-inferiority of goserelin therapy initiated during the non-menstrual period, but the uterine bleeding rate was higher in the luteal phase group. Therefore, goserelin treatment for outpatient adenomyosis patients should not be limited to starting during the menstrual period; it can also be initiated outside the menstrual period, providing more convenience for patients as most consultations occur outside the menstrual period. However, the use of goserelin during the luteal phase should be avoided to reduce the risk of exacerbated bleeding, especially in anemic patients with heavy menstrual bleeding. This study highlights the importance of individualizing treatment initiation based on the patient's health profile to optimize therapeutic outcomes and minimize adverse effects.

Trial registration: ChiCTR2200059548.

Objective: This research was conducted to assess the therapeutic advantage of combined letrozole and clomiphene citrate versus monotherapy for polycystic ovarian syndrome (PCOS) patients.

Study design: Five databases were searched using the search string: (letrozole and clomiphene) AND (clomiphene OR clomiphene citrate OR CC) AND (letrozole OR LE) AND (ovulation induc* OR fertility induc* OR fertility preserv*) AND (polycystic ovarian syndrome OR PCOS). All statistical analyses were conducted in Review Manager 5.4.1. Random effect-effect model was used to pool risk ratio (RR), mean difference (MD), and odds ratio (OR) and their corresponding 95% confidence interval (CI). Moreover, qualitative analysis was conducted to qualitatively analyze ovulation, secondary outcomes, and cycle characteristics.

Results: One clinical trial and three randomized clinical trials (RCTs) were used in the study. Two studies were used in a quantitative analysis showing that combination was superior for ovulation induction (RR = 1.86 [1.37, 2.53]; p < 0.0001; I² = 0%), but the number of follicles ≥15 mm was significantly associated with the combination (MD = 0.40[0.14, 0.66]; p = 0.002; I² = 0%). On subgroup analysis, only hot flushes were significantly associated with the combination (RR = 2.67[1.12, 6.36]; p = 0.03; I² = 0%). The meta-analysis of two studies reported a significantly higher ovulation rate and number of dominant follicles in the combination therapy group compared with the LE alone arm but no significant difference in pregnancy rate, endometrial thickness, and adverse events.

Conclusion: Our study demonstrates a significant effect of the combination on ovulation induction. The combination yielded a better chance of conception and viable pregnancy. Further studies are needed to determine the live birth rate. HighlightsCombined Letrozole and Clomiphene is superior to either of these drugs alone for ovulation induction in PCOS.Our results conclude that the combination results in better ovulation, cycle characteristics, and secondary changes.Only the incidence of hot flushes as an adverse effect is increasingly reported in combination.