[Show abstract][Hide abstract] ABSTRACT: Adverse perinatal outcomes in singleton IVF pregnancies have been most often explained by parental underlying diseases and so far laboratory conditions during embryo culture are still not explored well. The following review discusses the current state of knowledge on the influence of IVF laboratory procedures on the possible perinatal outcome. The role of improved media for human embryo culture is unquestionable. Addition of certain components to culture media and their effect on embryo survival and implantation rates have been taken into consideration recently and studied on animal model. Impact of media on perinatal outcome in IVF offspring has also been studied. It has been discovered that epigenetic changes and neonatal birth weight are probably associated with the use of specific culture media, as is the relation between placental size and its influence on perinatal outcome. There are still questions in the discussion about duration of embryo culture (cleavage stage versus blastocyst transfer). Some of the IVF methods, such as in vitro maturation of oocytes and freezing/thawing procedures, also require well-powered randomized controlled trials in order to define their exact impact on perinatal outcome. Constant further research is needed to assess the impact of laboratory environment on fetal and postnatal development.
[Show abstract][Hide abstract] ABSTRACT: Despite the vast experience in controlled ovarian hyperstimulation, there are still women who respond poorly to gonadotropins, which results in few oocytes at retrieval, reduced number of embryos for transfer and consequently unsatisfactory pregnancy rates. Although such patients are quite common in IVF practice, the exact prevalence of so-called "poor responders" is difficult to estimate due to the variety of applied definitions. The urgent need for an internationally accepted definition of poor ovarian response (POR) was addressed by an ESHRE Workshop held in Bologna in 2010, where the consensus was reached and criteria were finally established. The application of this uniform definition may allow a correct estimate of POR prevalence and, what is more important, designing proper trials to assess and finally compare the interventions used in POR patients. The article describes the possible physiology of POR and patient characteristics, mentions risk factors and laboratory tests of decreased ovarian reserve. Finally it reviews the possible management of POR with different stimulation protocols in the light of EBM. Basing on published meta-analyses, various additional alternatives (such as estradiol priming, the addition of rLH, growth hormone, androgens and androgen-modulating agents, aspirin) are also summarized. Despite the two decades of trying, there is still no consensus on what is best for POR. No single treatment can be recommended over another, as the evidence for all of them is insufficient. It is obvious that interventions used in POR require properly designed large randomized studies, because until now there is no evidence-based treatment for that particular group of patients.
Full-text · Article · Aug 2015 · Neuro endocrinology letters
[Show abstract][Hide abstract] ABSTRACT: The present study aimed at performing proteomic analysis of matched eutopic endometrium and ovarian endometrioid cysts from women with endometriosis in order to discover any abnormal protein expression related to the disease.
The study included 8 women with stage III/IV endometriosis according to revised American Fertility Society (rAFS) classification and one woman with no signs of the disease as a reference. Proteomic analysis was performed using a novel isobaric tag-based methodology for relative and absolute peptide quantiﬁcation (iTRAQ) coupled with multidimensional liquid chromatography and tandem mass spectrometry.
The selection of 419 proteins was found in all endometriosis specimens. Using normal eutopic endometrium from woman without endometriosis as a reference, some proteins expressions were significantly increased in all endometriosis samples. They included collagen α1(XIV), calmodulin, collagen α(VI), plexin, integrin αVβ3, transgelin, desmin, and vimentin. The comparison of these proteins' expression in paired eutopic and ovarian endometriosis samples has revealed that only vimentin was significantly increased in ovarian endometrioma.
It was confirmed that endometriosis is associated with different expression of proteins in endometriotic samples. Nevertheless, further studies seem to be necessary as they may reveal possible markers that would be useful in clinical diagnosis of the disease.
Full-text · Article · Dec 2013 · Neuro endocrinology letters
[Show abstract][Hide abstract] ABSTRACT: Despite significant scientific progress, etiology of endometriosis remains enigmatic. New advances in molecular biology have allowed the use of proteomics in demystifying this puzzling disease. Proteomics is a technology that permits the visualization of thousands of proteins inside a cell, tissue, or organism, and simultaneous observation of any alterations in protein expression and post-translational modification that may have important, clinical implications. Owing to its capacity to reveal the structural and functional properties of proteins, proteomics might illuminate the biology of the disease much better than genomics can. This state-of-the-art technology allows us to globally compare the expression and regulation profiles of proteins found in endometriosis with normal eutopic tissues (endometrium and peritoneum), as well as to compare those found in the different forms of endometriosis (i.e., peritoneal endometriosis, endometrioma, and adenomyoma). Proteomic analysis has been employed in endometriosis research in hope of discovering endometriosis-specific proteins, pathways, and potential biomarkers for precise, early detection. In recent years, several published studies have compared serum and peritoneal fluid protein content in women with and without endometriosis, as well as protein composition in endometrial implants, eutopic endometrium, endometriomas, menstrual blood and urine. It appears that use of proteomics could revolutionize our understanding of etiopathogenesis of the disease. Some of the identified proteins could indeed be responsible for the onset and progression of endometriotic implants. Because early stages of endometriosis may be difficult to diagnose, it would be of the utmost importance to identify specific biological markers of the disease. Additionally specific implant proteins could become targets for molecular treatment of endometriosis. It is very challenging, however to draw clear conclusions from the analysis of the obtained samples. First of all, the samples are usually pathologically confirmed to be endometriotic, but from a molecular stand point, the particular portion of the sample that is analyzed may matter greatly; none of the methods allow us to gain information about the molecular and pathological pattern of the same sample. Secondly it is very difficult to define an 'unaffected peritoneum' as a control for the endometriotic lesions. Thirdly the variety of options in each individual makes it difficult to see the molecular picture of the diseased area (such as the ovary or peritoneum) clearly ideally the samples would be of greater value if obtained at an early age, that is, before puberty in each individual and then again when endometriosis occurs later in reproductive age. Such a project cannot be performed prospectively although it may be considered as retrospective analysis of obtained material in some patients after successful chemotherapy due to oncological conditions.
Full-text · Article · Oct 2013 · Ginekologia polska
[Show abstract][Hide abstract] ABSTRACT: Introduction of robotic surgery in the first decade of the 21 century was one of the biggest breakthroughs in surgery since the introduction of anesthesia. For the first time in history the surgeon was placed remotely from the patient and was able to operate with the device that has more degrees of freedom than human hand. Initially developed for the US Military in order to allow surgeons to be removed from the battlefield, surgical robots quickly made a leap to the mainstream medicine. One of the first surgical uses for the robot was cardiac surgery but it is urology and prostate surgery that gave it a widespread popularity Gynecologic surgeons caught on very quickly and it is estimated that 31% of hysterectomies done in the United States in 2012 will be done robotically. With over half a million hysterectomies done each year in the US alone, gynecologic surgery is one of the main driving forces behind the growth of robotic surgery Other applications in gynecology include myomectomy oophorectomy and ovarian cystectomy resection of endometriosis and lymphadenectomy Advantages of the surgical robot are clearly seen in myomectomy The wrist motion allows for better more precise suturing than conventional "straight stick" laparoscopy The strength of the arms allow for better pulling of the suture and the third arm for holding the suture on tension. Other advantage of the robot is scaling of the movements when big movement on the outside translates to very fine movement on the inside. This enables much more precise surgery and may be important in the procedures like tubal anastomosis and implantation of the ureter Three-dimensional vision provides excellent depth of field perception. It is important for surgeons who are switching from open surgeries and preliminary evidence shows that it may allow for better identification of lesions like endometriosis. Another big advantage of robotics is that the surgeon sits comfortably with his/her arms and head supported. This results in much less fatigue and therefore increases precision and potentially may decrease the number of medical errors. The eyes of the surgeon are directed at where the hands should be, which is more natural, allows for a more natural body position and mimics open surgery Robot also enables better teaching, especially when two consoles are used. The surgeon and the student may be either sharing the instruments with two consoles or switching between one another. In a situation where the student operates, the surgeon can use the telestation to teach. Robotic simulator attached to one of the consoles allows students to practice after hours. In summary surgical robot is a great tool, especially in gynecology but also in urology cardiac surgery general surgery and laryngology The device will evolve and most likely with time will eliminate laparoscopy
Full-text · Article · Dec 2012 · Ginekologia polska
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVEs: To verify the relation between pregnancy duration and cervical length (CL) at 22-24 wks of spontaneous and IVF singleton gestations and to assess its predictive value for preterm delivery (< 37 wks).
CL at 22-24 wks was performed according to FMF recommendations in 344 women who conceived spontaneously and in 107 IVF singleton pregnancies. The results of CL in both groups were divided into subgroups: ≤ 29 mm, 30-34 mm; 35-39 mm; 40-44 mm; 45-49 mm and ≥ 50 mm. They were subsequently correlated with mean durations of gestation within subgroups and parameters of accuracy were calculated. Correlation and regression analysis was performed.
The average age of women in both groups was 28.1 y.o. (SD=4.2 years) and 33.4 y.o. (SD=4.1 years), respectively. The mean gestation age at delivery was 38.9 wks (SD=2.1 wks) vs. 37.9 wks (SD=2.3 wks) and the rate of prematurity equaled 7% vs. 15%, respectively. Regardless the method of conception there is a positive correlation between the CL and the duration of gestation. The regression analysis showed that the significant increase in pregnancy duration was correlated with CL ≥ 35 mm (correlation coefficient greater for spontaneous vs. IVF: rxy=0.418 vs rxy=0.341; p<0.001). All CL parameters of accuracy were better for spontaneous in comparison to IVF pregnancies.
IVF singleton pregnancy carries additional risk factors for preterm delivery. Therefore mid-gestational cervical length is less sensitive predictor than in spontaneous singleton gestations.
Full-text · Article · Aug 2011 · Neuro endocrinology letters
[Show abstract][Hide abstract] ABSTRACT: Endometriosis has been considered an epigenetic disease. Single nucleotide polymorphisms (SNPs) located in genes encoding enzymes of the folate and choline metabolism may affect DNA methyltransferase activity.
We studied 16 SNPs in 12 folate and choline metabolism genes, including BHMT (rs7356530 and rs3733890), BHMT2 (rs625879), CBS (844ins68), CHDH (rs893363 and rs2289205), CHKA (rs7928739), MTHFD1 (rs2236225), MTHFR (rs1801133), MTR (rs1805087), MTRR (rs1801394), PCYT1A (rs712012 and rs7639752), PEMT (rs4244593 and rs4646406) and TCN (rs1801198) in one hundred and sixty-three infertile women with minimal endometriosis and one hundred and fifty fertile women.
There were no significant differences between genotype and allele frequencies of these gene variants in infertile women with endometriosis (n=163) and controls (n=150). The lowest, but not statistically significant, p values of the trend test were observed for the CBS 844ins68 and MTR rs1805087 (ptrend=0.0527 and ptrend=0.0771, respectively) polymorphisms. However, the exhaustive multifactor dimensionality reduction analysis revealed an epistatic interaction between rs1801133 of MTHFR and rs4244593 of PEMT in endometriosis-associated infertility (p=0.0240).
Our results showed moderate evidence for the contribution of SNPs located in genes encoding folate and choline metabolism enzymes to infertility in women with endometriosis.
No preview · Article · Mar 2011 · European journal of obstetrics, gynecology, and reproductive biology
[Show abstract][Hide abstract] ABSTRACT: Overactive bladder (OAB) is one of the major causes of urinary incontinence. Therapy is in most cases conservative, and anticholinergics blocking muscarinic receptors are core drugs in the treatment in this indication. Constipations belong to the most frequent side effects of these drugs. Since constipations, particularly in women, are independent, frequent, disorder, this feature of antimuscarinic drugs deserves special attention. In the article, we discuss constipations in women with OAB and influence of antimuscarinics available in Poland on regularity of bowel function. http://www.ptmp.com.pl/png/png4z1_2011/PNG41-10-Piotrowski.pdf
[Show abstract][Hide abstract] ABSTRACT: Conventional meta-analysis has estimated the sensitivity and specificity of hysterosalpingography (HSG) to be 65% and 83%. The impact of patient characteristics on the accuracy of HSG is unknown. The aim of this study was to assess by individual patient data meta-analysis whether the accuracy of HSG is associated with different patient characteristics.
We approached authors of primary studies reporting on the accuracy of HSG using findings at laparoscopy as the reference. We assessed whether patient characteristics such as female age, duration of subfertility and a clinical history without risk factors for tubal pathology were associated with the accuracy of HSG, using a random intercept logistic regression model.
We acquired data of seven primary studies containing data of 4521 women. Pooled sensitivity and specificity of HSG were 53% and 87% for any tubal pathology and 46% and 95% for bilateral tubal pathology. In women without risk factors, the sensitivity of HSG was 38% for any tubal pathology, compared with 61% in women with risk factors (P = 0.005). For bilateral tubal pathology, these rates were 13% versus 47% (P = 0.01). For bilateral tubal pathology, the sensitivity of HSG decreased with age [factor 0.93 per year (P = 0.05)]. The specificity of HSG was very stable across all subgroups.
The accuracy of HSG in detecting tubal pathology was similar in all subgroups, except for women without risk factors in whom sensitivity was lower, possibly due to false-positive results at laparoscopy. HSG is a useful tubal patency screening test for all infertile couples.
Full-text · Article · Dec 2010 · Human Reproduction Update
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Ovarian function is controlled not only by endocrine system, but also by autocrine/paracrine regulation in the ovarian cells,
which may be mediated by a network of cytokines. The aim of this study was to elucidate the involvement of a multifunctional
cytokine, interleukin-6 (IL-6), in human ovarian function especially in human luteolysis.
Material and Methods:
All subjects were women with normal menstrual cycles (28-35 days), which gave their informed consent to participate in this
study. The mean age of the subjects was 39.0 ± 8.7 years (range: 22-53 years, n = 37). Ovarian samples were collected at the
time of gynecological operation, and follicular or luteal tissue was isolated macroscopically from each sample. Blood serum
was also collected at the same time. All subjects were divided into 3 phases of ovarian cycle (follicular, early-mid luteal,
and late luteal phase), according to the date of menstrual cycle and serum hormonal values (classified into follicular phase,
if progesterone (P) < 2.0 ng/ml, classified into early-mid luteal phase, if progesterone (P) > 2.0 ng/ml, and classified into
late luteal phase, if E2 < 80 pg/ml) at the point of operation. The relative expression levels of IL-6 (n = 37) and its receptors (gp130 and IL-6Rα,
n = 21) mRNA in granulosa, theca and luteal cells were analyzed with quantitative RT–PCR using TaqMan technology. The relative
values of IL-6 protein in the ovarian tissue were also analyzed with immunoblotting (n = 21). The localization of IL-6 and
its receptors, gp130 and IL-6Rα, in the ovarian tissues was examined by immunohistochemical staining (n = 8). All data are
presented as the mean ± S.D. Inter-group differences were confirmed with Kruskal-Wallis test, and post-hoc test (Scheffe's
F) was used for detecting the significant differences between the groups.
The relative level of IL-6 mRNA in late luteal phase (4.46 ± 2.05, n = 8) was significantly higher than those of follicular
(1.55 ± 0.94, n = 18: p < 0.00005) and early-mid luteal phase (2.13 ± 0.92, n = 11: p < 0.005). The relative level of mRNA
for gp130 in late luteal phase (8.35 ± 5.46, n = 7) was significantly higher than those of follicular phase (1.67 ± 1.93,
n = 8: p < 0.05), and the level of IL-6Rα mRNA in late luteal phase (11.66 ± 9.71, n = 7) was significantly higher than those
of follicular phase (1.33 ± 2.32, n = 8: p < 0.05) and early-mid luteal phase (2.72 ± 2.40, n = 6: p < 0.05). The relative
value of IL-6 protein in the late luteal phase (0.935 ± 0.070, n = 7) was also significantly higher than those of follicular
phase (0.751 ± 0.049, n = 8: p < 0.001) and early-mid luteal phase (0.762 ± 0.104, n = 6: p < 0.005). The immunohistochemistry
for IL-6 showed positive staining mainly in luteal cells and follicular granulosa cells, and partially in theca cells. The
positive staining for gp130 was identified in luteal and granulosa cells as well as the endothelial cells of the capillary vessels.
IL-6Rα immunoreactivity was observed in luteal, granulosa and theca cells.
Analysis for periodic changes of mRNA and protein revealed that IL-6 was highly expressed in the human ovary of late luteal
phase during natural ovarian cycle. The expression of both IL-6 receptors mRNA were also enhanced in the human ovary of late
luteal phase during natural ovarian cycle. Immunohistochemical staining showed that IL-6 and its receptors, gp130 and IL-6Rα,
were localized in human luteal cells of regressing phase during natural ovarian cycle. These results suggest that IL-6 may
act on the corpus luteum of regressing phase and play a significant role to regulate the human ovarian function, possibly
as a promoter of human luteolysis.
Full-text · Article · Jun 2010 · Human Reproduction
[Show abstract][Hide abstract] ABSTRACT: The relationship between endometriosis and cancer has been widely discussed in the literature but is still not well clarified. Perhaps significantly, soluble human leukocyte antigen-G (sHLA-G) has been identified in the microenvironment of both ovarian cancer and endometrioma. The aim of this study has been to evaluate the sHLA-G levels in the blood sera of women with deep endometriosis and ovarian endometrioma over the course of the menstrual cycle and to compare to the levels of sHLA-G in the blood sera of women with ovarian cancer.
In our study, we examined the blood sera obtained from 123 patients operated on because of ovarian cancer (65 cases), ovarian endometrioma (30 cases), and deep endometriosis (28 cases). We decided to compare the levels of sHLA-G in patients with endometriosis to those found in patients with ovarian cancer with respect to the menstrual cycle phases. The sHLA-G concentration level was measured by enzyme-linked immunosorbent assay kit.
The level of sHLA-G concentration in the blood serum of patients with deep endometriosis fluctuates over the course of the menstrual cycle, and during the proliferative and secretory phases, it remains at a high level comparable to that found in patients with ovarian cancer. By contrast, the level of sHLA-G concentration in the blood serum of patients with ovarian endometrioma fluctuates minimally over the course of the different menstrual cycle phases and, as in patients with ovarian cancer, it remains at high level during the proliferative phase.
sHLA-G blood serum concentration levels would seem to provide important information regarding the degree of immune system regulation disturbance in both ectopic endometrial cells and the cancer cell suppressive microenvironment.
No preview · Article · Feb 2010 · American Journal Of Reproductive Immunology
[Show abstract][Hide abstract] ABSTRACT: The presence of immunosuppressive cells within the endometrium and decidua is crucial for establishing maternal immune tolerance against fetal antigens. We decided to evaluate the subpopulations of Treg cells and B7H4 macrophages in eutopic endometrium typified by Arias Stella reaction during the development of Fallopian tube pregnancy as well as in decidua at the time of spontaneous abortion (SA), and to compare these findings to those observed in the endometrium during the secretory cycle phase of healthy women.
The decidual tissue samples evaluated in our study were obtained from 26 women who underwent curettage as a result of the following circumstances: five of the women because of a laparoscopic procedure necessitated by Fallopian tube pregnancy, and 11 of them because of SA. The control group consisted of 10 patients on whom curettage was preformed as an additional procedure during laparoscopic myomectomy. The presence of regulatory T-cells and B7H4-positive macrophages in the samples was analysed by fluorescence-activated cell sorter (FAC-Scan).
Both the percentages of FOXP3(+) cells in the subpopulation of CD25(+) CD4(+) T lymphocytes and the percentage of B7H4-positive cells in the macrophage subpopulation found in the deciduae of patients suffering SA were higher than those found in eutopic endometrium with Arias Stella reaction. No such differences in the percentages of these cells were observed when the tissue samples from patients with SA were compared with those from the control group. The percentage of B7H4-positive macrophages, however, was found to be significantly lower in endometrium with Arias Stella reaction in comparison to that observed in secretory endometrium.
The alterations in both the Treg cell and suppressive B7H4(+) macrophage subpopulations would seem to be related to the suppression of maternal immune cells in the endometrium at the beginning of decidualization.
No preview · Article · May 2009 · American Journal Of Reproductive Immunology
[Show abstract][Hide abstract] ABSTRACT: Urinary incontinence is one of the most common and most bothersome health problems in women, and overactive bladder is one of the main reasons for it. Amongst a number of therapeutic options available, the primary choice is usually pharmacotherapy, based on anticholinergic drugs blocking muscarinic receptors. In this review we present practical aspects of treatment with these drugs, including their availability and differences in efficacy, convenience and safety. In Poland, two types of p.o. drugs have been available
– for administration at least two-times daily (oxybutynin, tolterodine) or once daily (darifenacin, solifenacin and new antimuscarinic drug – fesoterodine). It seems, that solifenacin and fesoterodine feature the best balance between efficacy and tolerability. Gastrointestinal tolerability profile is the major factor differentiating these two drugs – solifenacin causes more constipations and less mouth dryness than fesoterodine. http://www.ptmp.com.pl/png/png2z4_2009/PNG24-09-Piotrowski.pdf
[Show abstract][Hide abstract] ABSTRACT: To analyze the indications, safety and feasibility of laparoscopic myomectomies performed during the last 10 years.
The studied material consisted of 187 typically performed laparoscopies, mostly due to uterine myomas. All the patients underwent an ultrasound examination at the time of admission and those with the maximum of 3 tumors, where the largest tumors were less than 10cm in diameter, were qualified for endoscopic surgery.
Out of 187 women, 39 patients had laparoscopy performed twice, with a 3-4 months interval for GnRH analogues treatment. Among 164 operative laparoscopies myomas were enucleated in 132 of the women (80.5%). In the case of 18 patients (9.6%) there was a need for laparoconversion resulting from the difficulties with enucleation, adhesions, and the size or localization of the tumor. There were also 62 cases of diagnostic laparoscopy, where myomas were either too large or too small to be enucleated. On analyzing the number and size of the tumors it occurred that a single myoma was the most frequent finding, while more than half of all the enucleated uterine tumors found during diagnostic and operative endoscopies were up to 2cm in diameter.
Laparoscopic myomectomy is a safe and reliable surgical alternative for women suffering from symptomatic myomas and is a method of choice in young patients of reproductive age. Beside skillful surgical techniques, a proper qualification for the operation is essential for the desired outcome.
No preview · Article · Mar 2008 · Neuro endocrinology letters
[Show abstract][Hide abstract] ABSTRACT: To compare the efficacy of microlaparoscopy and laparoscopy in the assessment of pelvic region in infertile women.
47 patients (aged 24-35) had microlaparoscopy and subsequent laparoscopy performed in order to diagnose the cause of infertility. Pelvic region assessment was performed in both procedures and the results were afterwards compared in regard to duration of the operations and findings reported by independent surgeons. The data was statistically analyzed using Statistica for Windows 5.1.
There were no major differences in the assessment of the pelvic region and found abnormalities in the analyzed postoperative protocols. All the diagnosed abnormalities were described similarly by both surgeons; the differences referred only to subjectively evaluated sizes of findings. The assessment of the pelvic region during microlaparoscopy was fully satisfactory in all cases, none required earlier than scheduled conversion to laparoscopy. The duration of endoscopic procedures was calculated from the moment of trocars insertion into the peritoneal cavity. The average duration time of microlaparoscopic evaluation was 6'20"+/-45", while in laparoscopy - 3'40"+/-32" (p<0.0001).
Microlaparoscopy and laparoscopy are of similar efficacy in the assessment of small pelvis organs and in detecting pathological changes. Both procedures differ significantly only in regard to the duration.
Full-text · Article · Oct 2007 · Neuro endocrinology letters