Normal Hormonal Profile Research Articles

AB128. The impact of hormonal factors on sperm motility improvement after subinguinal microsurgical varicocele.

ObjectiveFor infertile patients with varicoceles, subinguinal microsurgical varicocele repair is well-documented to improve sperm quality. However, not all men with varicoceles are necessary for surgical repair; neither every patient may benefit from this operation. Men with varicoceles but normal semen parameters may still have normal hormonal profile, but men with varicoceles and OAT syndrome may present with abnormal hormones. In our previous study, for patient with idiopathic and varicocele-related OAT syndrome, several hormonal factors are correlated with semen parameters. The purpose of this study is to see if these factors may still associate semen parameters improvements after the subinguinal microsurgical repair for patients with varicoceles and OAT syndrome.MethodsFrom 2003 to 2014, totally 155 non-azoospermic infertile males had received subinguinal microsurgical varicocele repair in our hospital. They were assessed with semen parameters and serum hormone profiles pre- and 3-month post-operatively. Semen parameters included sperm concentration, percentage of motile sperm and normal form. Hormonal analyses included follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estrodiol (E2), prolactin (Prl), and their combinative ratios including T/E, T/FSH, T/LH, T/(FSH×LH), Prl×T/FSH, Prl×T/LH, Prl×T/(FSH×LH), and Prl×T. Each factor and parameter was divided into increasing or non-increasing group. The correlation between changes of each hormonal combinative profile and improving semen parameter was also calculated respectively with paired t-test and Chi-square test.ResultsIn the included 154 infertile males with varicoceles, 90 (58.1%) were of left side varicocele, 63 (40.6%) were of bilateral, and 2 (1.3%) was of right side only. All patients were presented with abnormality in at least one of the three semen parameters (OAT syndrome). After the surgery, sperm concentration and sperm motility were increased significantly (P=0.015 and <0.001 respectively). Hormonal change was noted by increase in T, E2, Prl and decrease in FSH, LH after the surgery. Only changes on T (P=0.046), Prl (P=0.007), Prl×T/FSH (P=0.002), Prl×T/LH (P<0.001), and Prl×T (P<0.001) reached statistical significance. The increase of percentage of motile sperm was significantly correlated with positive change on T (P=0.041), Prl (P=0.046), T/(FSH×LH) (P=0.042), Prl×T/FSH (P=0.001), Prl×T/LH (P=0.007), Prl×T/(FSH×LH) (P=0.011), and Prl×T (P=0.004). Among them, the change of Prl×T/FSH could predict a most significantly increase in sperm motility after the surgery.ConclusionsIn our non-azoospermic varicocele-bearing infertile men receiving subinguinal microsurgical varicocele repair, their sperm count and motility improved after the operation. For the most significantly increased semen parameters, which are motility, several hormonal profiles were associated. Among them, increase of Prl×T/FSH was the most significant correlative factor to sperm motility improvement after the surgery. This result gives us another picture for the role of hormones on patients with varicoceles and OAT syndrome.

Laparohysteroscopy in female infertility: A diagnostic cum therapeutic tool in Indian setting

Aims:To evaluate the role of laparohysteroscopy in female infertility andto study the effect of therapeutic procedures in achieving fertility.Settings and Design:Patients with female infertility presenting to outpatient Department of Obstetrics and Gynecology were evaluated over a period of 18 months.Materials and Methods:Fifty consenting subjects excluding male factor infertility with normal hormonal profile and no contraindication to laparoscopy were subject to diagnostic laparoscopy and hysteroscopy.Statistical Analysis Used:T-test.Results:We studied 50 patients comprising of 24 (48%) cases of primary infertility and 26 (52%) patients of secondary infertility. The average age of active married life for 50 patients was between 8 and 9 years. In our study, the most commonly found pathologies were PCOD, endometroisis and tubal blockage. 11 (28.2) patients conceived after laparohysteroscopy followed by artificial reproductive techniques.Conclusions:This study demonstrates the benefit of laparohysteroscopy for diagnosis and as a therapeutic tool in patients with primary and secondary infertility. We were able to achieve a higher conception rate of 28.2%.

A rare case of male infertility: Sertoli only syndrome

Sertoli cell-only syndrome (SCOS) is not an uncommon finding in testicular biopsies that are performed in patients with infertility. The salient histopathologic feature of SCOS is the absence of germ cells. Many of these patients have a normal karyotype and normal secondary male sexual characteristics, yet are infertile and azoospermic or severe oligozoospermic. This case report describes a 29-year-old male patient who presented with primary infertility, normal physical characteristics and hormonal profile with SCOS detected on testicular biopsy.

The Prevalence and Patterns of Endocrinopathies Amongs Azoospermic Male Partners at a Fertility Clinic in Benin City

Aim and Objective: We undertook this study to evaluate the prevalence, trend and patterns of endocrine abnormalities among azoospermic male partners of infertile couples investigated for male infertility in our fertility centre. Setting: A private IVF hospital treating infertility with assisted reproduction technology in Benin City, Nigeria. Methodology: A prospective, observational and a descriptive study of the analysis of the hormonal profile of azoospermic male partners of the infertile couples, who presented at St Augustine Medical center, Benin City, Nigeria over a five-year period from May 2007 through December 2012 was undertaken. Results: A total of 686 men were investigated for infertility within this period, fifty-eight (8.45%) of them with a mean age of 43.72±1.5years were found to be azoospermic. Of the 58 azoospermic men, fourty-eight (82.76%) had one or more abnormal hormonal profile parameter, while ten (17.24%) had a normal hormone profile pattern. Of the forty-eight Azoospermic men with abnormal hormone profile pattern, twenty-two (37.93%) had increased serum FSH and LH, mildly increased prolactin and low testosterone, 15 (25.86%) had increased serum FSH, normal LH and prolactin with reduced testosterone, 4 (6.9%) had increased serum LH, normal FSH and prolactin with reduced testosterone, 2 (3.45%) had low LH, FSH and testosterone with high prolactin while 5 (10.42%) had elevated prolactin levels, normal gonadotrophins (LH & FSH) and low testosterone. Ejaculate volume was normal in 48(82.76%) of the azoospermic men when the mean semen volume was 3.30±0.19mls; and mean serum hormone levels were LH; 9.54 ± 0.89, FSH; 22.77± 2.70, Prolactin; 18.54± 2.50, Testosterone; 3.01 ± 0.22. The ejaculate volume was low in 10 (17.24%) men with a mean semen volume of 0.89±0.07 and mean serum hormone levels; LH; 13.75±3.12, FSH; 23.48±4.45, Prolactin; 15.87±2.46, Testosterone; 3.08±0.46. Conclusion: Endocrinopathies are common among azoospermic male partners of infertile couples in Benin City. The most prevalent pattern of endocrinopathy suggests testicular failure. Majority of men don't show-up early enough for infertility screening. Azoospermia was most prevalent among business men followed by civil servants. The main reason for the endocrinopathies is not clear, but exposures to certain environmental/occupational factors which can disrupt endocrine function are likely to be contributory.

Psychosexual and social consequences in a woman with undiagnosed Mayer-Rokitansky-Küster-Hauser syndrome

Purpose: To report a woman with devastating psychosexual and social consequences as a result of undiagnosed Mayer-Rokitansky- K&#x00FC;ster-Hauser syndrome (MRKH) syndrome. Materials and Methods: An 18-year-old woman was referred after being divorced for “absent vagina and uterus”. On examination, secondary sexual characteristics were normal. Vaginal and rectal examinations revealed absent vagina and uterus. Investigations showed normal hormonal profile, 46 XX karyotype, and normal intravenous pyelography. Pelvic ultrasonography and magnetic resonance imaging (MRI) confirmed the absence of the uterus and presence bilateral ovaries. Results: A diagnosis of MRKH syndrome was made and she underwent successful modified laparoscopic Vecchietti operation for creation of a new vagina. Vaginal dilators were used after the surgery. Two years of follow up confirmed that vaginal length was about ten cm. Conclusion: The proper diagnosis, counseling, and prompt treatment of MRKH syndrome can prevent tragic consequences.

English

Infertility has always been one of the most elusive symptom complexes that perplex a gynecologist. Laparoscopy is the most rapidly evolving area in medicine. AIMS AND OBJECTIVES: To evaluate the role of hysterolaparoscopy in comprehensive work up of infertility and to help in planning appropriate management. To identify the incidence of various pathological condition in female reproductive tract leading to infertility. To develop the plan of therapy for such patient. To analyze the rate of complications in diagnostic hysterolaparoscopy. MATERIAL AND METHODS: 100 infertile women with primary infertility of the age group 18-40 years with normal hormone profile and without male factor infertility were randomly selected from Infertility clinic of rural tertiary care hospital over 2 and 1⁄2 year from 1st January 2011 to October 2013. Initially all women were examined by taking detailed history, physical examination, basic endocrinological investigations, USG pelvis, endometrial biopsy and semen analysis. After that general examination, systemic and genital examinations were carried out on patients selected for the study. Hysterolaparoscopy was performed in post menstrual phase under general anesthesia. RESULTS: The present study showed maximum cases of infertility (40%) in the age group of 21-25 years followed by (35%) cases of infertility in the age group of 26-30years. Mean age of women was 24.6 years. On laparoscopy 34 patients revealed abnormal findings and rest had normal pelvic findings. Tubal blockage without adhesion was found to be the most important abnormality and was seen in 11 cases followed by tubal blockage with adhesion 7 cases. Laparoscopy revealed 18 cases of tubal blockage (11 bilateral and 7 unilateral) and 78 cases were with normal tubal patency. Out of 78 cases, 12 cases had other abnormalities (endometriosis-2, PCOD-3, peritubal adhesions-7) 21 women conceived after ovulation induction, IUI and tubal cannulation (cornual). Of them 10 have delivered and 11 are yet to deliver. CONCLUSION: Diagnostic hysterolaparoscopy is an effective and safe tool in comprehensive evaluation of infertility, particularly for detecting tubal blockages, peritoneal endometriosis, adnexal adhesions and bicornuate uterus. Needless to emphasize that hysterolaparoscopy is a very useful tool that can detect various structural abnormalities can be considered as a definitive day care procedure for evaluation and treatment of female infertility.

Proteomic Identification and Analysis of Human Endometrial Proteins Associated with Unexplained Infertility

Unexplained infertility (UI) represents about 25-30% of all known types of female infertility. To date, UI remains an unsolved problem in a subgroup of infertile but otherwise healthy women and the molecular causes of UI are not yet known. In the current study, we have compared and analyzed the proteomic profile of receptive phase (LH+7) endometrium from fertile and infertile women, with a view to identify the appropriate protein target signatures that may be responsible for defective endometrial receptivity as a cause of UI. 12 Differentially expressed proteins (8 up-regulated and 4 down-regulated) were identified by Liquid Chromatography-Mass Spectrometric analysis. These differentially expressed proteins were involved in immunological response, glycolytic pathway, lipid metabolism, blood agglutination, protein synthesis, molecular chaperone, antioxidant system, mitochondrial ATP generation, and Ca+2 signalling. The expression of four differentially expressed proteins such as HSPβ-1, Apolipoprotein-A1, IGK@ protein, and RPLP2 were further validated by immunoblotting and immuno-histochemical analysis in separate biopsy samples, and also in in-vitro experimental model of decidualization of human endometrial stromal cells (hESCs). This study explored several proteins that may have functional significance as regards the initiation and maintenance of the window of receptivity. Results of this study might be helpful in understanding the molecular basis of endometrial defects in a subset of infertile women having normal ovulation and hormonal profile. To our understanding, this is the first study to demonstrate the differential endometrial protein profiling in women with endometrium basedunexplained infertility.

A study of liver disorder and its consequences in pregnant women with jaundice in tertiary care centre in Belgaum, Karnataka, India

Pregnancy with jaundice is regarded as high risk pregnancy so it is considered very important sign during antenatal check up. Incidence of jaundice in pregnancy is 0.4-0.9/1000 in India. It complicates 3-5% of pregnancies and is one of the important causes of maternal and neonatal morbidity and mortality worldwide. The normal physiological and hormonal profiles may alter throughout the pregnancy. The present retrospective study was carried out in the Department of Obstetrics and Gynecology, KLE's Dr. Prabhakar Kore Hospital and research centre from September 2011 to August 2012 to determine the causative factors responsible for jaundice in pregnant women and to assess its consequences in pregnancy. During this retrospective study of 3 years, 9,612 deliveries were conducted. Among them 9,167 were live birth and 445 were stillbirth. Overall 37(0.4%) women had clinical and biochemical evidences of jaundice. Their mean age was 24.78±3.66 years and the mean period of gestation (34.7±3.42 weeks). Among them predominant cause of jaundice was HELLP 24(64.86%) followed by acute viral hepatitis and Leptospirosis 5(13.51%) of each. Severe PIH was the most common co-morbid conditions observed in 20(54.05%) of the pregnant women. And the commonest cause of maternal mortality 15(53.57%) was HELLP followed by severe anaemia 3(10.75%). Among 37 births, 53.85% were live births, 28.21% were fresh still births and 17.95% were macerated still births. Among the 53.85% of live births, foetal mortality was seen in 4.76%. Pregnancy with liver disorder results in very high foetal as well as maternal morbidity and mortality. HELLP was found to be the predominant cause of Jaundice and associated mortality in pregnancy. It might cause mild to severe complication in pregnancy. Pregnancy with liver disorder results in high foetal as well as maternal morbidity and mortality. Thus early diagnosis and proper management is essential to reduce the high maternal mortality in pregnant women with jaundice.

Monitoring of ovarian activity by daily measurement of urinary excretion rates of oestrone glucuronide and pregnanediol glucuronide using the Ovarian Monitor, Part III: Variability of normal menstrual cycle profiles

What are the characteristics of, and how variable are, individual normal menstrual cycle profiles of excretion rates for the urinary metabolites oestrone glucuronide (E1G) and pregnanediol glucuronide (PdG)? There is a continuum of menstrual cycle profiles that differ from standard textbook profiles but which can be understood simply in terms of growth, atresia and ovulation of ovarian follicles. Point-of-care assays with the Ovarian Monitor pre-coated assay tubes, using urine samples diluted to a constant volume per unit time, give laboratory accurate clinical data for individual menstrual cycles. Lay operators can perform the point-of-care assay system at home to achieve reliable and reproducible results, which can be used for natural family planning. This prospective study involved 62 women, with normal menstrual cycles, recruited from three centres: Palmerston North, New Zealand, Sydney, Australia and Santiago, Chile. The study lasted 3 years. Women collected daily urine samples and determined their E1G and PdG rates with a pre-coated enzyme assay system known as the Ovarian Monitor. For two cycles, the assays were repeated in a study centre and the results were averaged to give 113 individual menstrual cycles for analysis. The cycles were displayed individually in a proprietary database program. The individual normal hormonal profiles were more complex than the classic composite curves for 40% of the cycles. Of 113 ostensibly normal cycles, only 91 were potentially fertile and 22 had some luteal phase defect. The oestrone glucuronide and PdG excretion rates were reliable and informative in the non-invasive elucidation of ovulation and ovarian function for both simple and complex profiles. Daily monitoring revealed the variability of normal menstrual cycle profiles. The LH peaks were variable and ambiguous markers for ovulation. The study consisted of cycles only from women with regular cycles of 20-40 days duration. All the women were intending to avoid a pregnancy during the study thus the limits of the fertile window were not tested. The principles established in this study should apply to cycles of any length. All peaks in oestrone glucuronide excretion should be tested by concurrent measurements of PdG, which gives a positive indication of the fate of the follicle it represents. The Ovarian Monitor provides a useful addition for practitioners of natural family planning. Financial support for this study was obtained from the UNDP/UNFPA/World Bank/WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP). D.G.C. is currently employed by and holds stock in Manawatu Diagnostics Ltd, a company in the development phase of a potentially competing product. The remaining authors have nothing to declare.

Allan–Herndon–Dudley syndrome (AHDS) in two consecutive generations caused by a missense MCT8 gene mutation. Phenotypic variability with the presence of normal serum T3 levels

Allan–Herndon–Dudley syndrome (AHDS), an X linked condition, is characterized by severe intellectual disability, dysarthria, athetoid movements, muscle hypoplasia and spastic paraplegia in combination with altered TH levels, in particular, high serum T3 levels. Mutations in the MCT8 gene coding for the monocarboxylate thyroid hormone transporter 8 have been associated with AHDS. Here we describe a family with the presence of a MCT8 gene mutation, p.A224T, in three consecutive generations. In two generations its presence was detected in the hemizygous state in two males with neurological abnormalities including mental retardation, axial hypotonia, hypertonia of arms and legs and athetoid movements. One of them presented normal thyroid hormone levels. Mutation was also detected, although in the heterozygous state, in three females showing thyroid hormone levels in the normal range. Our results show the difficulty of distinguishing AHDS from patients with X-linked intellectual disability solely on the basis of clinical features and biochemical tests, and we advise screening for MCT8 mutations in either young or older patients with severe intellectual disability, axial hypotonia/dystonia, poor head control, spastic paraplegia, and athetoid movements even when they have normal thyroid hormone profiles.

Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients

OBJECTIVE:To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres.MATERIALS AND METHODS:This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha) throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included.RESULTS:Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesion (12%) in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups.CONCLUSIONS:Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.

Male Fertility, Obesity, and Bariatric Surgery

Obesity has become a new worldwide health problem with significant impact not only on cardiovascular diseases but also on many other related disorders, highlighting infertility. Obesity may adversely affect male reproduction by endocrinologic, thermal, genetic, and sexual mechanisms. There is good evidence that obesity can be associated with reduced sperm concentrations, but studies about sperm motility, morphology, and DNA fragmentation have been less numerous and more conflicting. Although weight loss is the cornerstone of the treatment of obesity-related infertility, with promising results in restoring fertility and normal hormonal profiles, bariatric surgery impact on male fertility is still unclear and until now there is not enough data to support the informed consent in this scenario. Physicians are encouraged to highlight possible positive and/or negative impacts concerning male capacity of fertilization when informing patients. A balanced judgment and a personalized case-by-case management with patient involvement in decisions are fundamental in this setting and indication of cryopreservation of semen samples should be considered in selected circumstances. Well-structured trials controlled for confounders including female factors and based on solid outcomes (ie, birth rates) must urgently come up to clarify this emerging scenario.

The effect of magnified bilateral varicocele ligation on semen quality and the natural paternity rate in subfertile men, based on the sum of varicocele grading

ObjectiveTo evaluate the effect of magnified bilateral varicocele ligation on the semen quality and natural paternity rate in subfertile men, based on the sum of varicocele grading. Patients and methodsIn a prospective longitudinal study, 78 patients (mean age 36.5years, range 21–56) with a total of 156 varicoceles underwent bilateral varicocele ligation. Patients included had bilateral, primary and clinically palpable varicoceles, with a normal hormonal profile and abnormal semen; patients excluded had unilateral varicocele, or were recurrent cases, had infraclinical varicocele or had a genetic abnormality. Patients were classified into five groups (A–E), based on the findings of a physical examination; A included 13 patients with grade sum II (I+I), B included 21 with grade sum III (II+I), C included 25 with grade sum IV (II+II) or (III+I), D included 11 with grade sum V (III+II) and E included eight with grade sum VI (III+III). The follow-up was scheduled at 3, 6 and 12months to assess semen variables and the natural paternity rate; 16 patients continued to a 36-month follow-up. Data were analysed statistically using a paired t-test to compare the mean sperm variables before and after surgery, with P<0.05 considered to indicate significant differences. ResultsOf the 78 patients, 74 completed the follow-up at 3months and only seven missed the 6-month follow-up. Overall, the mean sperm density, total sperm motility and sperm morphology increased from 13.44 to 26.48×106/mL, 27.4% to 53% and 41.4% to 65.0%, respectively; the differences were statistically significant for all variables (P<0.001). For each group separately there were significant improvements for both sperm density and motility, but for sperm morphology there were significant improvements in all groups except E, where the improvement was not correlated with those in the other groups. The paternity rate (by natural pregnancy) at 2years was 26.9%, and this increased to 41% within 3years. ConclusionMagnified bilateral varicocele ligation based on the sum of varicocele grading significantly improved semen quality and the natural paternity rate in subfertile men.

Mutational analysis of the GYS2 gene in patients diagnosed with ketotic hypoglycaemia

Ketotic hypoglycaemia is a common form of hypoglycaemia in childhood. Biochemically, patients present with fasting hypoglycaemia but with normal hormonal and metabolite profiles (low serum alanine levels in some patients). Glycogen Storage Disease Type 0 (GSD0) is an autosomal recessive disease due to mutations in the GYS2 gene. Patients with GSD0 also present with fasting ketotic hypoglycaemia. The frequency of GSD0 in patients presenting with ketotic hypoglycaemia is not known. To understand the frequency of GSD0 in patients presenting with ketotic hypoglycaemia and to report a novel mutation in the GYS2 gene. The GYS2 gene was sequenced in 50 patients diagnosed with ketotic hypoglycaemia. All exons (including exon and intron boundaries) of the GYS2 gene were sequenced following amplification of the coding region by polymerase chain reaction (PCR). No mutations in GYS2 were found in 49 patients. One patient had a novel homozygous mutation (c.1802T>G; p. Leu601X) in exon 14 of the GYS2 gene. We believe this is the 18th mutation reported so far. This mutation is predicted to lead to premature truncation of the glycogen synthase protein with no function. This patient presented with fasting ketotic hypoglycaemia associated with postprandial hyperglycaemia and elevated lactate level. GSD0 is relatively rare in patients presenting with ketotic hypoglycaemia and a normal biochemical profile. Sequencing of the GYS2 gene is more likely to be positive in patients with fasting ketotic hypoglycaemia and concomitant postprandial hyperglycaemia with hyperlactataemia.

Polycystic ovary syndrome: Is obesity a sine qua non? A clinical, hormonal, and metabolic assessment in relation to body mass index

Objective:To determine the proportion of polycystic ovarian syndrome (PCOS) patients who have normal body mass index (BMI) and to compare the clinical, hormonal, and metabolic profile between lean and overweight patients of PCOS.Materials and Methods:One hundred consecutive infertile women with PCOS were studied and divided into lean (BMI between 18.5 and 23) and overweight (BMI ≥ 23). Metabolic and hormonal profile (serum FSH, LH, testosterone, prolactin, TSH on days 2–3 of menstrual cycle; serum progesterone premenstrually; serum insulin—fasting and 2 hours postglucose, glucose tolerance test, and fasting serum lipid profile) was performed along with pelvic sonogropahy; and clinical features, viz. waist hip ratio, hirsutism, acne, acanthosis nigricans, and clitoromegaly were recorded.Results:42% of the PCOS subjects had normal BMI. Average age, hirsutism (80.9% vs. 89.7%), irregular cycles (92.8% vs. 96.6%), acne (9.5% vs. 15.5%), clitoromegaly (2.3% vs. 3.4%), endometrial thickness >4 mm (9.5% vs. 15.5%), and hormonal profile were similar in the lean and overweight PCOS groups. Family history of diabetes (9.5% vs. 24.1%), abnormal glucose tolerance test (GTT) (4.7% vs. 10.3%), deranged lipid profile (14.2% vs. 31%), and 2-hour postprandial insulin levels were higher in the overweight PCOS (P < 0.05). Insulin resistance was observed in 83.3% of lean PCOS but was still lower than 93.1% seen in overweight PCOS (P < 0.05).Conclusion:42% of the PCOS had normal BMI, but clinical and hormonal profile was similar to PCOS patients with elevated BMI (overweight/obese). However, insulin resistance is observed in 83.3% of lean PCOS. Family history of diabetes, impaired GTT, deranged lipid profile, and insulin resistance were more prevalent in overweight PCOS.

Normal puberty is not equal to normal gonadal function in male and female childhood cancer survivors

Studies of gonadal function in pediatric cancer survivors have often been limited to self-reported data on menstrual function and pregnancies. Our objective was to assess puberty and gonadal function in a cohort of childhood cancer survivors through detailed history and laboratory evaluations. Retrospective chart review Childhood cancer survivors (≥10 years old) who received long-term care at WRAMC from January 1, 1985 to July 1, 2010 were identified through medical records. Survivors who started cancer treatments after 18 years of age or received gonadectomy were excluded. Detailed treatment history, puberty development including Tanner stages and testicular volume in males, as well as gynecological history in female survivors were obtained. FSH, LH, estradiol and testosterone levels were analyzed. This cohort included 39 male (age 10-21 years) and 35 female (age 10-29 years) childhood cancer survivors. Males: 100% received cancer treatments by age 16 and 79% by 12. Among 23 survivors who were treated with alkylating agents, those with abnormal puberty (n = 4) also had brain radiation or surgery. All patients with testicular failure (n = 4) received alkylating agents and/or brain radiation. Females: 98% received treatments by age 16 and 68% by 10. Abnormal puberty (n = 3) was only seen after cranial radiation. Although 60% were treated with alkylating agents, all had normal puberty and 90% had normal sex hormone profiles. Two survivors with premature ovarian failure had normal puberty; both had been treated with alkylating agents. Most childhood cancer survivors had normal puberty and sex hormone profiles in early adulthood despite gonadotoxic chemotherapy before puberty. Cranial radiation significantly increased risks for abnormal puberty and early gonadal failure. Normal puberty may not correlate with normal fertility or gonadal function later in life, and close follow-up is essential.

Hashimoto's disease in a bilateral benign cystic ovarian teratoma: a case report

A wide array of tissues derived from all the three germinal layers is seen in ovarian teratomas. Among these, thyroid tissue is present in 10% cases of all mature cystic teratomas. We report this case of Hashimoto's thyroiditis in a clinically euthyroid patient who tested positive for antithyroid peroxidase antibodies in spite of normal thyroid hormone profile. While the histological features of several disorders of thyroid tissue may be discovered, Hashimoto's thyroiditis is extremely rare finding in ovarian teratomas.

Acne da mulher adulta: aspectos epidemiológicos, diagnósticos e terapêuticos

Adult female acne (AFA) is a dermatosis of increasing incidence; hyperandrogenism is present in many cases, but there are patients without hormonal abnormalities. To analyze the prevalent characteristics in adult women with acne without hyperandrogenism. A survey of 226 medical records with AFA complaints was conducted; of these, 116 (51.3%) had a normal hormonal profile and were, therefore, included in the study. We investigated age, ethnicity, clinical profile of acne, complementary exams, previous treatment, prescribed treatment and evolution. The mean age was 33.9 years and the predominant clinical grade of acne was moderate inflammatory (grade 2). The face was the most affected area. Topical retinoids were the most prescribed drugs, and systemic medication was prescribed to 53.4% of the patients. Total regression was observed in 31 patients (26.7%) within 12 weeks of treatment. Adverse reactions to topical treatment occurred in 21.5% of the patients. The clinical manifestations of AFA in patients without hyperandrogenism are moderate, with predominance of inflammatory lesions. Treatment is similar to that of acne vulgaris; however, special attention should be taken with more irritating medication since this group appears to be more predisposed to skin irritations.

An appraisal of serum preptin levels in PCOS

Plasma preptin levels were higher in women with PCOS compared with the control group (mean±SD, 823.2±140.7 vs. 324.9±147.3 pg/mL). This article suggests a potential role of preptin in the pathogenesis of PCOS.

Obesity: modern man's fertility nemesis

The obesity pandemic has grown to concerning proportions in recent years, not only in the Western World, but in developing countries as well. The corresponding decrease in male fertility and fecundity may be explained in parallel to obesity, and obesity should be considered as an etiology of male fertility. Studies show that obesity contributes to infertility by reducing semen quality, changing sperm proteomes, contributing to erectile dysfunction, and inducing other physical problems related to obesity. Mechanisms for explaining the effect of obesity on male infertility include abnormal reproductive hormone levels, an increased release of adipose-derived hormones and adipokines associated with obesity, and other physical problems including sleep apnea and increased scrotal temperatures. Recently, genetic factors and markers for an obesity-related infertility have been discovered and may explain the difference between fertile obese and infertile obese men. Treatments are available for not only infertility related to obesity, but also as a treatment for the other comorbidities arising from obesity. Natural weight loss, as well as bariatric surgery are options for obese patients and have shown promising results in restoring fertility and normal hormonal profiles. Therapeutic interventions including aromatase inhibitors, exogenous testosterone replacement therapy and maintenance and regulation of adipose-derived hormones, particularly leptin, may also be able to restore fertility in obese males. Because of the relative unawareness and lack of research in this area, controlled studies should be undertaken and more focus should be given to obesity as an etiolgy of male infertility.