Day Of Menstrual Cycle Research Articles

Hysterosalpingography Findings among Women Presenting for Infertility Evaluation

Objective: To determine the pattern of hysterosalpingography (HSG) findings among women presenting with infertility. Methods: From June 2021 to March 2022, this study included 100 women who visited the Nishtar hospital's infertility clinic. All these patients underwent HSG evaluation. The HSG examination was planned to take place between the seventh and twelfth day of the patient's menstrual cycle, and before the patient had any sexual activity. Patients were instructed to take a nonsteroidal anti-inflammatory medication such 400 milligrams of ibuprofen half an hour before their hysterosalpingograms as a preparation for the possibility that they may experience some level of discomfort during the procedure. HSG findings were noted for each patient. Results: The mean of participants was 32.5±1.2 years. Mean infertility duration was 5.5±4.3 years. On hysterosalpingography examination, right fallopian tube occlusion was found in 7% patients, left in 13% and bilateral in 25% patients. Hydrosalpinx was diagnosed in right fallopian tube in 7.0% patients, in left in 5% patients and in both fallopian tubes in 3% patients. Overhanging tubes were diagnosed in 8% patients and beaded tubes in 1.0% patients. Regarding uterine pathologies, fibroids were diagnosed in 21% patients, and synaechiae in 8% patients. Regarding cervical pathologies, irregular pattern was found in 2% patients, patulous in 2% and in stenosis in 1.0% patients. Conclusion: Hysterosalpingogram, an essential instrument in the evaluation of infertility, plays a significant part in identifying illnesses that affect the female reproductive system. According to the findings of this study, tubal diseases are the leading cause of female infertility. Keywords: Infertility, Tubal abnormalities, Hysterosalpingogram

Identifying risk factors for post-operative bleeding in women undergoing loop electrosurgical excision procedure for cervical dysplasia.

Loop electrosurgical excision is a procedure utilised in the treatment of high-grade squamous intraepithelial lesion (HSIL) of the cervix. Post-operatively women may experience immediate and/or delayed per vaginal bleeding. The objective of this prospective pilot study was to assess the feasibility of identifying and quantifying patients' subjective experiences of post-operative bleeding following a loop electrosurgical excision procedure (LEEP) for HSIL. In addition, an analysis of demographical, lifestyle and surgical factors was undertaken to assess for any statistically significant correlation with post-operative bleeding. This study included 110 patients who underwent a LEEP for biopsy-proven or suspected HSIL between 2017 and 2020. Subjective data were collected from weekly post-operative surveys and correlated with procedural data. Primary outcome assessed was the subjective rate of bleeding experienced. Baseline demographics were age, body mass index (BMI), specimen size, human papilloma virus variant and histopathology. Other variables of interest collected were exercise intensity, and alcohol intake. No association of statistical significance was discovered between age, BMI, or day of menstrual cycle. There was a statistically significant association between exercise intensity or specimen size (greater than the median) and increased bleeding, primarily in the first 2 weeks. Women who undergo intense or prolonged exercise in the post-operative period may experience heavier bleeding particularly in the first 2 weeks post-LEEP. Heavy bleeding was also associated with a larger specimen size. There was no correlation between BMI, age or any other demographical factor.

Effect of menstrual cycle on outer hair cells (OHC’s) and efferent auditory pathway in females – An Indian study

Menstrual cycle occurs in females every months for ones where the endometrium which is the thick lining of the uterus wall where the fertilized egg is attached during pregnancy, this will shed every month. Sodium, chloride, and water reabsorption capacity increases by high-level progesterone during this period. When there is a change in water and sodium reabsorption which may in term affect the functioning of the auditory system especially peripheral auditory system. Otoacoustic emissions (OAE’s) arise from outer hair cells (OHC’s) which is situated on the basilar membrane that is seen inside the inner ear. The changes in the hormonal levels during the menstrual cycle has a clinically less significant effect on the suppression of TEOAE’s, one of the type of OAE. The current study targeted the testing during three different phases of the menstrual cycle (Day 1 to Day 28) - Follicular phase, Ovulation phase and Luteal phase. The amount of suppression (3dB) caused during different phases of the menstrual cycle for each individual frequencies was compared and analyzed. The study shows that TEOAE, CSTEOAE’s and suppression did not exhibit any statistically significant differences at all the frequencies between the different phases of the menstrual cycle. There are no significant correlation findings between menstrual cycle and outer hair cell function, and menstrual cycle and efferent auditory pathway functioning, considering the complaints of hearing and balance problem during the menstrual cycle period by.

Estradiol, stress reactivity, and daily affective experiences in trauma-exposed women.

Women experience higher risk for PTSD following trauma compared with men. Fluctuations in ovarian hormones might contribute to this greater vulnerability, given that estradiol is associated with affect and stress reactivity. Our objective was to test the relations between menstrual cycle-related changes in estradiol, affect, stress reactivity, and trauma-related symptoms. We assessed trauma-related symptoms in ethnically diverse naturally cycling women with a history of trauma during a clinical interview. Participants also completed a 10-day ecological momentary assessment (EMA) that included lower- and higher-estradiol phases. We tested associations between estradiol and PTSD symptoms and stress reactivity to a trauma reminder using Spearman correlation and Wilcoxon rank-sum tests. We tested the effect of menstrual cycle day on daily affect using multilevel modeling. Estradiol was negatively associated with symptom severity (rs = -.36), and participants in low- versus high-estradiol cycle phases at interview had higher sympathetic (r = .35) and lower hypothalamic-pituitary-adrenal axis (r = .41) reactivity. Across the EMA period, participants showed a decrease in daily PTSD symptoms (b = -.39), negative (b = -.11) and positive (b = -.24) affect, and variability in daily valence (b = -.07) and arousal (b = -.08), from the low- to high-estradiol phase. Consistent with prior evidence of more aversive affective experiences in low-estradiol states, lower estradiol was associated with higher trauma-related symptoms. In addition, trauma-exposed women showed a discordant pattern of stress reactivity to a trauma reminder, higher daily symptoms, and greater affective lability in a low-estradiol phase. Given that our sample consisted of high-functioning trauma-exposed women, these results should be replicated in women with PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Early Pregnancy Loss: Manual Vacuum Aspiration (MVA) Vs. Conventional Evacuation and Curettage

Objective: The purpose of this study is to assess the effectiveness of manual vacuum aspiration vs standard evacuation and curettage in the case of early pregnancy loss: HMC hospital, Peshawar, gynecologic and obstetrics department Study Design: A Single-center study Duration and place of study: From January 1st, 2017, to January 30th, 2020, the study was carried out in the gynecological and obstetrics unit B of the HMC hospital, Peshawar. Patient Methodology: One thousand and sixty-three (603) patients were studied. According to the inclusion criteria, all patients who experienced an early miscarriage (18-42 years old) were recruited for the research. The lottery approach was used to split the patients into two groups. Those in Group A who had been treated by MVA Group B were individuals who had traditional surgical evacuation and curettage. Age and BMI were obtained after obtaining written consent from the patient. The patient's entire blood picture, blood group, hepatitis serology, and coagulation profile were analyzed as part of a baseline assessment. Ultrasound and the starting day of the last menstrual cycle were used to determine gestational age. Two hours before the surgery, misoprostol 400mcg was used to ripen the cervical lining. Aseptic procedures were followed during the process. Ultrasound was used to verify that both methods had successfully evacuated the uterus. Results Group A had a mean age of 27 years, while Group B had a mean age of 29 years, both with a standard deviation of 7.55 years in Group A. Approximately 40% of the patients in Group A were mono para, and 60% of the patients in Group B were multipara. Forty-two percent of patients in Group B were first-time paras, whereas 58 percent of patients in Group B were second-time paras. In Group A, 40% of the patients were first-time mothers, whereas 60% were multiple mothers. There were 42 percent primi gravida and 58 percent multi gravida in Group B. Aspiration using manual vacuum and conventional evacuation and curettage were equally successful for 92% and 82% percent of patients, respectively. Keywords: Early Pregnancy Loss, M .V. A, Conventional Evacuation And Curettage

Effects of Pelvic Floor Muscle Massage on the Pregnancy Outcome of Frozen Embryo Transfer in Patients with Thin Endometrium.

Objective To observe the effects of pelvic floor muscle mass on the priority outcome of frozen embryo transfer in patients with thin endometrium. Methods The patients who were prepared for freeze-thaw embryo transfer were randomly divided into the study group and control group. Both groups of patients began to take estradiol valerate tablets 3 mg on the third day of menstrual cycle and added progesterone for luteal support after 14 days. Both groups selected high-quality embryos for embryo transfer on the day of embryo transfer. The basic information, embryo transfer, intimal thickness, intimal type, clinical pregnancy rate, and early abortion rate of the two groups were compared. Results The intimal thickness of patients in the control group and the study group on the second day of menstruation was (0.49 ± 0.03) and (0.45 ± 0.02) and that before progesterone was (1.17 ± 0.03) and (1.20 ± 0.04), respectively (P < 0.05). At the same time, the number of excellent embryos in the study group was significantly higher than that in the control group (P < 0.05), but there was no significant difference in the number of transplants between the two groups (P > 0.05). The proportion of intimal blood flow of type III + II in the study group was significantly higher than that in the control group (P < 0.05). The main adverse pregnancy outcomes of the whole group included biochemical pregnancy, early abortion, and ectopic pregnancy. The incidence of biochemical pregnancy in the control group and the study group was 63.3% (38/60) and 40.0% (24/60), respectively. The incidence of biochemical pregnancy in the control group was significantly higher than that in the study group, but there was no significant difference in the incidence of early abortion and ectopic pregnancy between the two groups (P > 0.05). Conclusion Pelvic floor muscle massage can improve endometrial thickness and subendometrial blood flow, so as to improve the pregnancy rate of frozen thawed embryo transfer patients.

O-167 Microfluidics to mimic female reproductive tract

Abstract The female reproductive tract (FRT) consists of major organs of the ovary, the female gonad, and downstream fallopian tube, uterus, and cervix. There are intimate relationships between cells in each reproductive organ as well as between each organ to sustain women’s menstrual cycle and fertility. So far, there are few effective in vitro or ex vivo models that both faithfully recapitulate the hallmarks of female reproduction and possess scalability. In this presentation, I will first introduce how we used an alginate hydrogel-based 3D encapsulated in vitro follicle growth (eIVFG) system to engineer a mini-ovary, which can recapitulate key ovarian functions as occurring in vivo, including gonadotropin-dependent folliculogenesis, oocyte maturation, ovarian steroidogenesis, ovulation, and luteinization. Next, I will introduce how we used the emerging microfluidic technology to engineer an FRT-on-a-chip. The FRT-on-a-chip allows organ-organ integration of hormonal signaling, which simulates women’s 28-day menstrual cycle and also the pregnancy-like endocrine loops. In summary, the engineered mini-ovary and FRT-on-a-chip are new powerful tools for studying female reproductive biology, disease, contraception, drug development, and toxicology.

P-332 Management of Thin Endometrium by hysteroscopic instillation of G-CSF mobilized progenitor cells combined with platelet-derived growth factor concentrate into the sub endometrial region-A case series

Abstract Study question Can hysteroscopic instillation of G-CSF mobilized progenitor cells combined with platelet derived growth factor concentrate into subendometrial region help patient with thin endometrium conceive? Summary answer Hysteroscopic subendometrial administration of stem cells represents a safe effective alternative method for patients recommended surrogacy, fail to improve despite using all possible treatment options. What is known already Thin endometrium is still a challenge in ART, and is considered sub-optimal for transfer and associated with lower implantation and pregnancy rates. For such patients and their treating physicians, chronically thin endometrium results in repeated expensive IVF cycles, cycle cancellations, unplanned cryopreservation of embryos and, in most extreme cases in the utilization of gestational carriers. Strategies like hysteroscopic adhesiolysis, estrogen, vasoactive chemical measures, and infusion of growth factors into the uterus, have little or no effect. Recently, many studies have successfully used stem cells or PRP alone or in combination for rejuvenation of reproductive tissues and organ failure. Study design, size, duration Case series study involving 20 patients with persistent non-responsive thin endometrium were included and underwent frozen embryo transfer over a period of 18 months from July 2020-December 2021 at A4 fertility center, Chennai Participants/materials, setting, methods 20 patients with thin endometrium and more than two implantation failures were included. Two doses of subcutaneous G-CSF were given on Menstrual Cycle Day 3&amp;4, followed by 60ml venous blood aspirated on MCD 5. Seragen’s selective enrichment protocol was used to prepare circulating endothelial progenitor cells and growth factors concentrate. With 2.9mm hysteroscope and single lumen ovum pickup needle harvested cells and growth factors were implanted in sub-endometrial zone on all four walls of cavity. Main results and the role of chance 20 patients with thin endometrium of less than 7mm and previously more than two implantation failures were included. In spite of routine HRT with Estradiol valerate and intrauterine PRP instillation, endometrium was non-responsive. After another failed attempt using letrozole for ovulation induction to improve endometrial thickness, we ventured into the option of hysteroscopic stem cell instillation. Average endometrial thickness increased from 6.35±0.6mm to 7.32±0.7mm. Out of 20 patients who underwent FET, 12(60%) became pregnant of whom 2(10%) delivered successfully. 6(30%) uneventful pregnancies are ongoing and 4(20%) had miscarriage and 8 patients didn’t conceive are recruited for ET in the next cycle. Many studies have successfully used stem cells or PRP for rejuvenation of reproductive tissues. When these growth-promoting cells and growth factor from platelets are delivered into basal layer which is origin of endometrial cells quality of the endometrium can be improved. While bone marrow is excellent source for obtaining stem cells to treat endometrial pathologies, main challenge is invasiveness of collection. To overcome this, we have adopted G-CSF mobilization to mobilize endothelial progenitor cells from bone marrow into circulation for easy collection and concentration. Limitations, reasons for caution Further research is needed to provide opportunity for women with refractory thin endometrium to conceive without surrogacy. Our study provides promising information for future randomized, controlled trials with large sample size in this field.This study has limitation of being small size with the women serving as their own historical controls. Wider implications of the findings We demonstrated that the proposed combination of two less invasive yet proven therapeutics combined with targeted delivery could be new ray of hope in females recommended for surrogacy or who fail to improve despite all possible treatment options and reduces emotional and financial burden associated with surrogacy and repeated IVFcycles. Trial registration number Not Applicable

P-429 The prevalence and assessment of uterine natural killer cells (uNK) by Immunohistochemistry (IHC) in women undergoing IVF

Abstract Study question What is the prevalence of raised uNK cells in an IVF population? Identifying demographic factors that are predictive of a raised uNK result? Summary answer The prevalence of uNK was high for those with RIF and history of miscarriage. Age was the only statistically significant factor for predicting positive results. What is known already uNK cells play two important roles in implantation; regulation of trophoblastic invasion and spiral artery modelling. Both these crucial mechanisms are required for bringing about a state of endometrial receptivity. The current evidence is centred on raised uNK status in women undergoing IVF being associated with a detrimental pregnancy outcome. This could be either due to NK cells being cytotoxic to embryo endometrium complex or causing aberrant placentation. Their exact function is unclear and the prevalence has only been determined in small observational studies. Study design, size, duration This was a prospective analysis of 203 patients who had uNK testing through immunohistochemistry and subsequently embarked on IVF treatment. Patients undergoing both fresh and frozen in vitro fertilisation (IVF) cycles at NURTURE fertility, Nottingham, UK were approached over a period of 6 months at different stages of their fertility history. Participants/materials, setting, methods uNK biopsy was arranged one month before undergoing IVF to ensure results before embryo transfer. The procedure was carried out in the mid-luteal phase of the menstrual cycle (day 19-24). Samples were fixed and analyzed by IHC. The age, BMI, timing of the biopsy, cause of infertility was recorded. The details of the subsequent IVF cycle, embryo quality, and pregnancy outcome were also collected prospectively. The data was analyzed using SPSS version 25. Main results and the role of chance The prevalence of raised uNK status was noted to be 61.6% (CI 54.9-68.3) in the IVF population. Furthermore the prevalence in women with no previous IVF treatment (primary infertility) was also high 66.7% (CI 54.4-78.9). One of the main strengths of this work was women were recruited from a highly successful IVF center. The clinical pregnancy rates are 2-3 fold higher than the national average e.g. 65% for women aged under 35 versus 29% respectively (HFEA 2018). This is mainly due to stringent laboratory processes leading to the creation of optimal quality embryos and their transfer. Therefore if IVF did not result in a pregnancy, then endometrial receptivity or adverse maternal immunology could be contributory factors. Although the prevalence of raised uNK status was high for those with RIF and a history of miscarriage, there were only statistically significant associations found for age in terms of predicting a positive result. Therefore IHC has to be complimented with another technique such as flow cytometry to determine if uNK is significant in implantation and pregnancy success. Limitations, reasons for caution uNK status is influenced by hormonal, menstrual cycle variability, pathogenic and laboratory interpretation. Therefore to gauge an accurate assessment of whether immune cells are implicated in pregnancy, a functional aspect of study or repeat sampling in the same cycle is required. Wider implications of the findings It is known that immune cell function declines with age. They may also be detrimental to pregnancy outcomes and contribute to the age-related decline in fertility. Designing a randomized controlled trial whereby patients tested for uNK are allocated to therapy such as prednisolone. This may address both issues. Trial registration number N/A

Beverage intake and ovarian reserve among women from a fertility center

To evaluate the associations of caffeinated, alcoholic, and sweetened beverage intakes with antral follicle count (AFC), a well-accepted biomarker of ovarian reserve. Observational prospective cohort study. Fertility center at an academic hospital. This study includes 567 women seeking fertility care at the Massachusetts General Hospital who participated in the Environment and Reproductive Health Study. None. Women self-reported consumption of caffeinated (coffee, tea, soda), alcoholic (wine, beer, liquor), sugar-sweetened, and artificially sweetened beverages using a validated food-frequency questionnaire. Antral follicle count was assessed using a transvaginal ultrasound performed on the 3rd day of an unstimulated menstrual cycle or on the 3rd day of a progesterone withdrawal bleed. Median (interquartile range) age and AFC were 35.0 (32.0-38.0) years and 13.0 (9.0-18.0), respectively. Median (range) intake of caffeinated, alcoholic, sugar-sweetened, and artificially sweetened beverages in servings/day were 1.08 (0-7.08), 0.35 (0-3.84), 0.04 (0-4.80), and 0.04 (0-7.50), respectively. All examined beverages were unrelated to AFC. The multivariable adjusted mean AFC (95% confidence interval) for women in the top and bottom quartiles of intake were 13.8 (13.0-14.7) and 13.8 (12.9-14.7) for caffeinated beverages; 13.8 (13.0-14.7) and 13.8 (13.0-14.6) for alcoholic beverages; 13.5 (12.6-14.4) and 13.3 (12.4-14.2) for sugar-sweetened beverages; and 13.2 (12.4-14.1) and 13.4 (12.6-14.3) for artificially sweetened beverages. Low-to-moderate intakes of caffeinated, alcoholic, sugar-sweetened, and artificially sweetened beverages were unrelated to ovarian reserve, as measured by AFC, in a cohort of women seeking fertility care.

Effect of Lumbar Spinal Mobilization on Primary Dysmenorrhea Among University Students

Background: Lumbar spine mobilization provides a bodily inducement that affects one or more of the joint mechanoreceptors, muscle spindle systems, or Golgi tendon organs, resulting in reduced muscle tone and decreased pain. As primary dysmenorrhea is one of the common problems among half of adolescent girls and it is one of the reason for female’s absenteeism in class or work. All over the world, many studies have concluded the signs and symptoms of dysmenorrhea such as pain and mood swing. Hence, this investigation is used to catch on the effect of using non-pharmacology management to alleviate the pain for females suffering from primary dysmenorrhea. Objective: This study intention is to find out the effect of lumbar spinal mobilization on primary dysmenorrhea among university students. Methods: A quantitative, quasi-experimental research design with pre and post-test was used in this study. 20 subjects who met the inclusion criteria and aged between 18 to 26 were included and dispensed into two groups. Participants in Group A (n=10) were given LSM and hot pack whereas those in Group B (n=10) were only provided with hot pack. Treatment was commenced on the second day of menstrual cycle. Numerical pain rating scale (NPRS) was collected before and after the treatment. Results: Data was analysed by using SPSS version 26. Parametric paired ‘t’ and unpaired ‘t’ tests were used to analyse the data. Paired ‘t’ test was used to analyse the data with each group while unpaired ‘t’ test was to analyse the data between two groups. Both group A and B have shown a significant reduction in NPRS score (p&lt; 0.001). However, when comparing the two groups, unpaired ‘t’ test exhibited no significant differences (p&gt;0.05). Conclusion: In closure, lumbar spinal mobilization had proven no significant effect for university students who suffered from primary dysmenorrhea. KEYWORDS: Hot Pack, Lumbar Spinal Mobilization, Primary Dysmenorrhea, University Students.

Examining Individual Factors Influencing Adherence and Response to Wholegrains and Nuts in a Series of Interventional N-of-1 Studies

ObjectivesInter-individual variations in response to dietary interventions are common, which can be affected by physiological and behavioural factors. N-of-1 studies, where a series of measurements are collected on an individual level over time, can provide insights into the factors which affect response for a single volunteer. The MI-DIET study is a series of N-of-1 studies to investigate what factors, at an individual level, influence a) adherence to a wholegrain and nuts intervention and b) blood pressure response.Methods14 volunteers with mildly elevated blood pressure (120/80–140/90mmHg), and who were low consumers of wholegrain foods, were recruited. Each volunteer carried out a 24-week N-of-1 study, composed of three 8-week periods (observation, intervention and follow-up). Throughout the study, volunteers responded to semi-personalised morning and evening questionnaires using a wrist-worn device (PRO-Diary, CamNtech Ltd.), which also monitored activity levels via actigraphy, and took their blood pressure daily using a wireless monitor (QardioArm, Qardio Inc.). During the intervention period, participants were provided with and asked to consume 3–4 portions of wholegrains and a handful of nuts each day, in line with the Dietary Approaches to Stop Hypertension (DASH) diet.ResultsTo date, 11 volunteers have completed the study, and 2 volunteers have withdrawn. Each volunteer's data is analyzed on an individual level using N-of-1 dynamic modelling analysis. Results to date include a significant association between menstrual cycle day and blood pressure in one volunteer (p < 0.01), while consumption of chocolate or cakes was associated with fewer portions of wholegrains being consumed by another volunteer (p < 0.05).ConclusionsCollecting repeated measurements on an individual level can identify relevant predictors of compliance and response to a dietary intervention for a given person. Subsequent aggregated analysis of variables measured across multiple volunteers will enable us to further understand factors which may underpin differential response to dietary interventions.Funding SourcesBiotechnology and Biological Sciences Research Council (BBSRC) UK and Unilever Foods Innovation Centre, Wageningen, The Netherlands: Collaborative Training Partnership (CTP) PhD.

Diagnostic use of CA 125 values measured on the 2nd and 14th days of the menstrual cycle in endometriosis

Background/Aim: This study examines the difference of serum CRP and CA 125 levels between the menstrual and non-menstrual phases of the menstrual cycle (days 2 and 14) and aims to investigate the diagnostic value of these markers for the early diagnosis of endometriosis. Methods: There were 36 patients in the study group and 30 patients in the control group (n = 66) in this prospective case-control study. The patients in the study group, who were prediagnosed with endometriosis, were tested for serum CA 125 and CRP on the 2nd and 14th days of menstrual cycle preoperatively (during menstruation and non-menstrual phase) and underwent surgery. The women in the control group were patients who visited the outpatient clinic for a regular checkup without any gynecological complaints. Results: The CA 125 levels were significantly higher on the 2nd day of the menstrual cycle than the 14th day in the study group [108.15 (90.33) U/mL and 58.60 (39.53) U/mL, respectively, P < 0.001]. In the control group, the CA 125 levels were also significantly higher on the 2nd day than the 14th day [22.97 (15.42) U/mL and 13.82 (6.82) U/mL, respectively, P < 0.001]. When the comparison was made between the CRP levels on the 2nd and 14th day for the study group [4.52 (4.45) mg/L and 2.82 (3.79) mg/L, respectively], the levels were significantly higher on the 2nd day (P < 0.001). The difference of CA 125 and CRP levels between the days [for the study group: ΔCA 125 = 49.55 (56.89) U/mL, ΔCRP = 1.69 (3.45) mg/L and for the control group ΔCA 125 = 9.14 (11.95) U/mL, ΔCRP = 1.42 (4.74) mg/L] were higher for both markers in the study group, and the differences with the control group were statistically significant (P < 0.001 for ΔCA 125 and P = 0.033 for ΔCRP). Conclusion: Our data indicates that it may be possible to support the diagnosis with the evaluation of CA 125 levels during different phases of menstruation separately.

Renal Vascular Resistance Does Not Differ Between Younger Men and Women

PurposeThe incidence of acute kidney injury is nearly two‐fold higher risk in men compared to women. A common cause of acute kidney injury is supply‐demand mismatch that is characterized by the presence of a comparatively low renal oxygen supply (i.e., blood flow) relative to tissue oxygen demand. Thus, it is possible that the control of renal blood flow differs between men and women. For instance, the vasodilator actions of estrogen may protect against excessive renal vasoconstriction or more readily promote renal vasodilation in pre‐menopausal women compared to men. However, whether renal vascular control, a function of both vasoconstrictor and vasodilator capacities, differs between men and women is unknown. Therefore, this study tested the hypotheses that (1) renal vasoconstriction during a sympathetic stimulus (i.e., the cold pressor test, CPT) will be greater in young healthy men compared to young healthy women, and (2) renal vasodilation following an oral protein load will be greater in women compared to men.MethodsHealthy, men (n=13, age 26 ± 3 years) and eumenorrheic women (n=12, age 23 ± 3 years, 4 ± 1 day of menstrual cycle) completed a 2‐min CPT after one hour of supine rest to assess renal vasoconstriction. A whey protein shake (1.2 g of protein/kg of body weight) was ingested 1‐h post‐CPT to assess renal vasodilation. Blood pressure (Penaz method) was measured continually. Renal segmental artery blood velocity (BV, Doppler ultrasound) was measured before and during the CPT (1‐ and 2‐min), and pre‐protein and 75‐ and 150‐min post‐protein. Segmental artery vascular resistance (VR) was calculated as mean arterial pressure (MAP) divided by segmental BV. Data are presented as mean ± SD.ResultsMAP increased in both men and women from pre‐CPT to 2 min (p&lt;0.001), and the magnitude of increase did not differ between men (peak: +25 ± 13 mmHg) and women (peak: +23 ± 9 mmHg, p=0.667). Peak reductions in segmental BV (men: ‐1.3 ± 3.2 cm/s, women: ‐3.7 ± 2.9 cm/s, p=0.065) and increases in segmental VR (men: +1.5 ± 1.0 mmHg/cm/s, women: +2.1 ± 1.0 mmHg/cm/s, p=0.155) during the CPT did not differ between men and women. MAP did not differ between men and women pre‐protein or at 75‐min post‐protein (p&gt;0.586) but was higher in men at 150‐min post‐protein (86 ± 7 mmHg vs. 78 ± 8 mmHg, p=0.042). Peak increases in segmental BV following protein ingestion were greater in women (+5.3 ± 2.2 cm/s) compared to men (+2.7 ± 2.4 cm/s, p=0.009). Similarly, peak reductions in segmental VR were greater in women (‐1.1 ± 0.6 mmHg/cm/s) compared to men (‐0.6 ± 0.6 mmHg/cm/s, p=0.030) following protein ingestion.ConclusionRenal vasoconstrictor responses to sympathetic stimulation do not appear to differ between healthy men and women. However, women displayed greater renal vasodilatory responses to an oral protein load. Therefore, renal vascular control differs between healthy men and women tested in the early follicular phase of the menstrual cycle. These findings may provide mechanistic insights in support of observations that acute kidney injury incidence differs between men and women.

Differentiated approach to the treatment of external genital endometriosis as prevention of recurrence

The objective: to evaluate the effectiveness of a differentiated approach in the postoperative management of patients with external genital endometriosis (EGE) to determine the regression of clinical symptoms and reduce the number of recurrences. Materials and methods. 207 patients with different forms of EGE after surgical treatment of the endometriosis foci removal were examined. After the determination of the prevalence of the pathological process (intraoperatively), the subjects were divided into three groups. A1 group (n=67) included women with severe disease who had an optimized approach for postoperative management. A2 group (n=75) included patients with moderate severity of EGE and the traditional treatment approach. B group was a comparison group (n=65) and was formed from patients with severe disease who were traditionally treated.Clinical-anamnestic, laboratory, morphological, immunohistochemical methods, gynecological examination data, ultrasound examination of the pelvic organs were used during the examination of women with EGE; magnetic resonance imaging (MRI) – if necessary. The standard approach included surgical treatment (laparoscopic method), removal of visible endometrioid heterotopias and the medical treatment from the 1st day of the next menstrual cycle after surgery (progestins (dienogest 2 mg) for 6 months or gonadotropin-releasing agonists in the presence of comorbidity of hyperplastic processes for 3-6 months in combination with add-back therapy). In the absence of reproductive plans combined oral contraceptives or intrauterine levonorgestrel-releasing system were used. Patients were observed for 1 month, 1 year after surgery, and then once a year. The optimized approach included surgery (laparoscopy or laparotomy) with the removal of endometrioid heterotopias, use of nonsteroid anti-inflammatory drugs in the postoperative period for 5 days, then dienogest 2 mg for 3-6 months was used by the cases of algomenorrhea and other manifestations of pain. The pathogenetic therapy was started on the 2nd or 3rd day of the postoperative period. Patients were observed for 2 months after surgery, then every 3 months for 1 year. The severity of pain was assessed on the Biberoglu and Behrman (B’n’B) and Numerical Rating Scale (NRS) scales. Recurrence of the disease was diagnosed in the presence of endometrioid heterotopia according to ultrasound examination and/or MRI, as well as the appearance of clinical complaints (pain) in 6 months after their absence.Results. In one year after the first surgery, recurrence of the disease was found in 13.43 % of women in A1 group, 12 % – A2 group and 24.61 % – B group. The average value of pain on the NRS scale in 12 months after treatment was 3.26 points in A1 group, 2.47 – A2 group and 1.59 – B group, on the B’n’B scale - 1.94, 1.61, and 1.40 points, respectively. Conclusions. The applying an optimized approach in the management of patients with severe and moderate external genital endometriosis (more radical surgery, the prescription at once in the postoperative period the hormonal therapy and nonsteroid anti-inflammatory drugs, more frequent observation after surgery) compared with traditional treatment lead to decrease the pain severity on 3.26 points on the Biberoglu and Behrman scale and 1.94 points – the Numerical Rating Scale, and reduce the recurrence rate by 45.4%.

To determine the association of serum AMH levels with oocyte quality in infertile women who underwent controlled ovarian stimulation (COS) for IVF cycles

There is well documented evidence showing a decline in female fertility with advanced age. This decline includes a significant reduction in the quantity as well as the quality of the oocyte available in the ovarian reserve. The present study was conducted to determine the association of serum AMH levels with oocyte quality in infertile women who underwent controlled ovarian stimulation (COS) for IVF cycles. The present retrospective study conducted in IVF Department of Nowrosjee Wadia Maternity Hospital for 10 months. Total 100 patients were included in the study. Serum AMH levels and number of antral follicle (on second day of menstrual cycle) on transvaginal sonography was done for all patients. Fertilization was checked followed by embryo quality. Statistical analysis was performed by ANOVA. Significance was attributed to events with a p&lt;0.05. A Total 100 patients were studied. The patients were divided into five groups based on AMH levels; the groups had 0, 44, 20, 26 and 10 patients respectively. Age was found to be independent predictor of ovarian reserve. There was no significant difference between the groups in relation to BMI.

Maternal physiology and blastocyst morphology are correlated with an inherent difference in peri-implantation human embryo development

To determine what patient and embryo characteristics are correlated with the developmental potential of the peri-implantation embryo. Retrospective study. Research laboratory. Six hundred fifty-one cryopreserved human blastocysts donated for research with informed patient consent. Not applicable. Blastocyst attachment to fibronectin-coated plates, trophectoderm outgrowth area, epiblast cell number, total cell number, human chorionic gonadotropin secretion. Patients' body mass index, age, follicle-stimulating hormone: luteinizing hormone ratio on menstrual cycle day 3, antral follicle count on menstrual cycle day 3, antimüllerian hormone level on menstrual cycle day 3, and blastocyst morphological grade were correlated with peri-implantation development outcomes. After controlling for good-quality morphological grades, blastocysts from patients of advanced maternal age developed fewer epiblast cells than blastocysts from younger patients. Extended embryo culture during the peri-implantation period mirrors several disparities in fertility treatment outcome that we see clinically, including those from patients with advanced maternal age, high body mass index, and low ovarian reserve and from embryos with lower-quality morphological grades. This model system may be useful by providing an alternative or more sensitive endpoint assessment in studying patient, clinical, or laboratory factors that may influence preimplantation embryo developmental potential.

Стан мікрофлори та ступінь вираженості місцевого імунного захисту в ендометрії жінок з безпліддям, що розвивається на тлі хронічного ендометриту поєднаного з бактеріальним вагінозом

The purpose of the study was to evaluate the taxonomic profile of the microbiota and the state of local immunity in the endometrium of women with infertility under conditions of chronic endometritis combined with bacterial vaginosis. Materials and methods. Diagnosis of chronic form of endometritis was performed on clinical symptoms, medical history, scraping, endoscopic and ultrasound examinations. All women were divided into three groups: Group I – 12 healthy women, who had no signs of chronic endometritis and formed a control group; Group II – patients with severe chronic endometritis (n = 16); Group III – patients with chronic endometritis developed on the background of bacterial vaginosis (n = 12). Diagnosis of bacterial vaginosis in patients was performed by detecting an increase in the pH of vaginal secretions &gt;4.5, the presence of homogeneous vaginal discharge with an unpleasant odor, detection of vaginal epitheliocytes with adherent gram-variable microorganisms, detection of "fishy" odor. The study was performed in the second phase of the menstrual cycle (day 18-23). Endometrial aspirate for the study of microflora was selected using a device for obtaining endometrial cytology Endobrash Standard for Endometrial Cytology. Results and discussion. It was found that the development of chronic endometritis on the background of bacterial vaginosis increases the frequency of detection of opportunistic anaerobic microflora in the endometrium compared to women without bacterial vaginosis. It has been shown that a decrease in the level of T-helpers and an increase in the level of T-suppressors / killers in the endometrium are exacerbated in patients with chronic endometritis developed against the background of bacterial vaginosis. Thus, the level of CD4 + cells decreased by 1.6 times, and the level of CD8 + cells increased by 1.9 times compared to healthy women. Against this background, the level of B-lymphocytes and IgA in the endometrium of women with chronic endometritis and bacterial vaginosis decreased. Conclusion. The development of chronic endometritis is associated with an increase in the frequency of detection and quantitative content in the endometrium of Streptococcus spp., Staphylococcus spp. The development of bacterial vaginosis is accompanied by the detection in the endometrium of new species of microorganisms – Prevotella spp., Mobiluncus spp. The imbalance of the endometrial microflora is accompanied by significant violations of local cellular and humoral immune defense, which is expressed by a decrease in the level of T-helpers, B-lymphocytes and IgA with a simultaneous increase in T-suppressors / killers in women with chronic endometritis. The established changes amplify at a bacterial vaginosis

Bifidobacterium Is Enriched in Gut Microbiome of Kashmiri Women with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a very common endocrine condition in women in India. Gut microbiome alterations were shown to be involved in PCOS, yet it is remarkably understudied in Indian women who have a higher incidence of PCOS as compared to other ethnic populations. During the regional PCOS screening program among young women, we recruited 19 drug naive women with PCOS and 20 control women at the Sher-i-Kashmir Institute of Medical Sciences, Kashmir, North India. We profiled the gut microbiome in faecal samples by 16S rRNA sequencing and included 40/58 operational taxonomic units (OTUs) detected in at least 1/3 of the subjects with relative abundance (RA) ≥ 0.1%. We compared the RAs at a family/genus level in PCOS/non-PCOS groups and their correlation with 33 metabolic and hormonal factors, and corrected for multiple testing, while taking the variation in day of menstrual cycle at sample collection, age and BMI into account. Five genera were significantly enriched in PCOS cases: Sarcina, Megasphaera, and previously reported for PCOS Bifidobacterium, Collinsella and Paraprevotella confirmed by different statistical models. At the family level, the relative abundance of Bifidobacteriaceae was enriched, whereas Peptococcaceae was decreased among cases. We observed increased relative abundance of Collinsella and Paraprevotella with higher fasting blood glucose levels, and Paraprevotella and Alkalibacterium with larger hip, waist circumference, weight, and Peptococcaceae with lower prolactin levels. We also detected a novel association between Eubacterium and follicle-stimulating hormone levels and between Bifidobacterium and alkaline phosphatase, independently of the BMI of the participants. Our report supports that there is a relationship between gut microbiome composition and PCOS with links to specific reproductive health metabolic and hormonal predictors in Indian women.

Effect of acupuncture on pregnancy outcomes of frozen embryo transfer in patients with anovulatory infertility

To observe the effect of conventional ovulation induction protocol and acupuncture combined with conventional ovulation induction protocol on pregnancy outcomes of frozen embryo transfer (FET) in patients with anovulatory infertility. A total of 60 patients with anovulatory infertility were randomized into an observation group and a control group, 30 cases in each group. In the control group, conventional ovulation induction protocol was applied to prepare endometrium. On the basis of the control group, acupuncture was started on the 2nd day of menstrual cycle in the observation group，Baihui (GV 20), Mingmen (GV 4), Geshu (BL 17), Guanyuan (CV 4), Qihai (CV 6), etc. were selected, once every other day, until 1 day before transplantation. The clinical pregnancy rate, embryo implantation rate, endometrial morphology on HCG trigger day, ovulation rate and cycle cancellation rate were compared in the two groups. The endometrial thickness before treatment and on HCG trigger day, TCM symptom score before and after treatment were observed in the two groups. In the observation group, the embryo implantation rate and clinical pregnancy rate were higher than the control group (P<0.05), endometrial thickness and endometrial morphology on HCG trigger day were superior to the control group (P<0.05). After treatment, the TCM symptom score in the observation group was decreased compared with before treatment (P<0.05), and the variation was greater than the control group (P<0.01). On the basis of the conventional ovulation induction protocol, acupuncture could enhance the embryo implantation rate and clinical pregnancy rate of FET, improve the endometrial receptivity of patients with anovulatory infertility.