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Choe SA, Ku SY, Jee BC, Suh CS, Kim SH, Choi YM, Kim JG, Moon SY. Significance of the serum CA-125 level in intrauterine insemination cycles. Clin Exp Reprod Med 2011; 38:164-7. [PMID: 22384437 PMCID: PMC3283066 DOI: 10.5653/cerm.2011.38.3.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 03/04/2011] [Accepted: 06/20/2011] [Indexed: 11/13/2022] Open
Abstract
Objective There are limited data regarding the significance of elevated serum CA-125 level during IUI cycles, even though it is used widely during the initial evaluation of infertile patients. The aim of this study was to investigate the prognostic value of serum CA-125 levels during IUI cycles. Methods Among the patients with controlled ovarian stimulation and IUI cycles at Seoul National University Hospital from Jan 2005 through Dec 2009, 92 cases with no identified endometriotic lesion, ovarian tumor, salpingeal lesion, or uterine myoma were selected. To compare the clinical characteristics between the pregnancy group and the non-pregnancy group, the Mann-Whitney U test and Fisher's exact test were used. Results The overall pregnancy rate was 18.5% (17/92). The pregnancy group showed a higher number of follicles 16 mm in diameter (p=0.036), endometrial thickness (p<0.001), ampules of gonadotropin (p=0.009), and higher body mass index (p=0.022) than the non-pregnancy group. No significant difference was observed in the serum CA-125 level or the proportion of patients with CA-125 exceeding 17 IU/mL between the two groups. Conclusion The prognostic value of serum CA-125 level among infertile patients with IUI cycles is considered limited.
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Affiliation(s)
- Seung Ah Choe
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Yup Ku
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Min Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Gu Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Shin Young Moon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Predictive factors for pregnancy after intrauterine insemination (IUI): An analysis of 1038 cycles and a review of the literature. Fertil Steril 2010; 93:79-88. [DOI: 10.1016/j.fertnstert.2008.09.058] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 09/16/2008] [Accepted: 09/16/2008] [Indexed: 11/22/2022]
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Abstract
UNLABELLED This review will address the current understanding of the relationship between prolactin (PRL) and endometriosis-associated infertility. Although the exact mechanisms of action of hyperprolactinemia in patients with endometriosis-associated infertility have not been clearly established, this report reviews results from relevant studies in the literature. These include serum PRL levels in endometriosis-associated infertility, PRL receptors in ectopic endometriotic tissues, basal PRL levels after TSH and Danazol (isoxazolic derivative of the synthetic steroid 5alpha-ethinyl-testosterone) therapy, peritoneal fluid and nocturnal serum PRL levels in endometriosis, infertility, and luteal phase PRL concentrations in patients with endometriosis. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to explain the relationship between prolactin- and endometriosis-associated infertility, relate endometriosis with infertility, and summarize two ways in which prolactin and endometriosis may be linked in the pathophysiology of infertility.
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D'Cruz OJ, Uckun FM. Targeting mast cells in endometriosis with janus kinase 3 inhibitor, JANEX-1. Am J Reprod Immunol 2007; 58:75-97. [PMID: 17631002 DOI: 10.1111/j.1600-0897.2007.00502.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Endometriosis (EMS) is a chronic inflammatory disease of multifactorial etiology characterized by implantation and growth of endometrial glands and stroma outside the uterine cavity. EMS is a significant public health issue as it affects 15-20% of women in their reproductive age. Clinical symptoms may include pelvic pain, dysmenorrhea, dyspareunia, pelvic/abdominal masses, and infertility. Symptomatic treatments such as surgical resection and/or hormonal suppression of ovarian function and analgesics are not as effective as desired. Consequently, there is an enormous unmet need to develop effective medical therapy capable of preventing the occurrence and recurrence of EMS without undesirable side-effects. EMS-associated intra-abdominal bleeding episodes, local inflammation, adhesions, and i.p. immunologic dysfunction leads to pelvic nociception and pelvic pain. Increasing evidence supports the involvement of allergic-type inflammation in EMS. Invasion of mast cells, degranulation, and proliferation of interstitial component are observed in endometriotic lesions. Presence of activated and degranulating mast cells within the nerve structures can contribute to the development of pain and hyperalgesia by direct effects on primary nociceptive neurons. Therefore, treatments targeting endometrial mast cells may prove effective in preventing or alleviating EMS-associated symptoms. The Janus kinase 3 (JAK3) is abundantly expressed in mast cells and is required for the full expression of high-affinity IgE receptor-mediated mast cell inflammatory sequelae. JANEX-1/WHI-P131 is a rationally designed novel JAK3 inhibitor with potent anti-inflammatory activity in several cellular and in vivo animal models of inflammation, including mouse models of peritonitis, colitis, cellulitis, sunburn, and airway inflammation with favorable toxicity and pharmacokinetic profile. We hypothesize that JAK3 inhibitors, especially JANEX-1, may prove useful to prevent or alleviate the symptoms of EMS.
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Affiliation(s)
- Osmond J D'Cruz
- Drug Discovery Program, Paradigm Pharmaceuticals, St Paul, MN 55113, USA.
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Yang WCV, Chen HW, Au HK, Chang CW, Huang CT, Yen YH, Tzeng CR. Serum and endometrial markers. Best Pract Res Clin Obstet Gynaecol 2006; 18:305-18. [PMID: 15157644 DOI: 10.1016/j.bpobgyn.2004.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2004] [Indexed: 11/22/2022]
Abstract
Endometriosis is a benign but aggressive disease. It occurs when shed endometrium from the female reproductive tract grows at a site outside the uterus. The physiological changes in endometriosis-abnormal tissue growth, invasion, and adhesion phenomena-are similar to those seen in tumorous tissues. Although the etiology of endometriosis is not well understood, the disease is widely accepted to result from the ectopic implantation of refluxed menstrual tissues. In addition, immunologic changes, genetic factors, and environmental factors might also affect a woman's susceptibility to develop endometriosis. Thus far, laparoscopic examination is required to confirm the presence of endometriosis; there is no reliable marker for its diagnosis. Many studies are therefore focusing on identifying markers for the diagnosis and follow-up of endometriosis. This chapter provides a systematic review of these studies, including recent findings from our group on the identification of molecules, in serum and/or endometrium, which are associated with the development of endometriosis at different stages. From this research, we hope to be able to suggest how to approach the potential markers. The identification of highly sensitive and specific markers of endometriosis should facilitate the development of accurate and non-invasive techniques for diagnosis and prognosis.
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Affiliation(s)
- Wei-Chung Vivian Yang
- Graduate Institute of Biomedical Materials, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan, ROC
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Yang WCV, Au HK, Chang CW, Chen HW, Chen PH, Chen CC, Tang YL, Wang IT, Tzeng CR. Matrix remodeling and endometriosis. Reprod Med Biol 2005; 4:93-99. [PMID: 29699214 DOI: 10.1111/j.1447-0578.2005.00098.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The physiological changes in endometriosis involving multiple steps of matrix remodeling include abnormal tissue growth, invasion, and adhesion formation. Endometriosis-associated abnormal matrix remodeling is affected by several molecular factors including proteolytic enzymes and their inhibitors, which mediate tissue turnover throughout the reproductive tract to maintain the integrity of the endometrium, and ovarian steroids, which normally regulate reconstruction and breakdown of endometrium in the menstrual cycle. In addition, various growth factors, such as platelet-derived growth factor, transform growth factor β, and epidermal growth factor, direct modulation of growth, activation, and chemotaxis which may facilitate endometrial cell adhesion onto the peritoneal mesothelium during the development of endometriosis. Furthermore, cell adhesion molecules are believed to be critically involved in most cellular-level processes including cellular differentiation, motility, and attachment with the extracellular matrix. The present review focuses on the abnormal matrix remodeling process and its possible regulatory mechanism in association with endometriosis development. As a greater understanding of the cause of endometriosis is achieved, better treatment of the disease and its prevention become possible. (Reprod Med Biol 2005; 4: 93-99).
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Affiliation(s)
| | - Heng-Kien Au
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Ching-Wen Chang
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Huei-Wen Chen
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Pi-Hua Chen
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Cheng Chen
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Yun-Long Tang
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - I-Te Wang
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Chii-Ruey Tzeng
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
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Seidman JD, Sherman ME, Bell KA, Katabuchi H, O'Leary TJ, Kurman RJ. Salpingitis, salpingoliths, and serous tumors of the ovaries: is there a connection? Int J Gynecol Pathol 2002; 21:101-7. [PMID: 11917218 DOI: 10.1097/00004347-200204000-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We have observed luminal and mucosal calcifications frequently surrounded by a mantle of bland epithelium in the fallopian tubes ("salpingoliths") of women with serous tumors of the ovaries. These lesions resemble noninvasive peritoneal "implants" in women with advanced stage atypical proliferative serous tumors (APSTs) and micropapillary serous carcinomas (MPSCs). The presence of salpingitis and salpingoliths was prospectively evaluated in 358 women with a variety of nonneoplastic and neoplastic ovarian conditions and compared with 87 previously reported women with APSTs/MPSCs in an effort to determine whether these lesions were specifically associated with serous tumors. The frequency of chronic salpingitis among women without ovarian pathology was 27%, and the frequency of salpingoliths was 4%. Serous epithelial tumors (cystadenomas, APST/MPSC, and carcinomas) were significantly more often associated with chronic salpingitis (53%) and salpingoliths (32%) than all other cases with or without ovarian neoplasms (p<0.01). APSTs/MPSCs were associated with salpingoliths significantly more frequently than all other groups (p<0.001). For patients with APSTs/MPSCs, salpingoliths were found significantly more often in advanced stage (FIGO II and III) patients (51%) than stage I patients (24%) (p<0.01), but salpingitis, present in 60% of these patients, was not stage-dependent (p>0.05). Chronic salpingitis was identified in 66% of women with endometriosis, which was significantly more frequent than those with normal ovaries (27%) (p<0.001). In conclusion, fallopian tube abnormalities may be related to both the high frequency of infertility and the noninvasive peritoneal implants in women with APSTs/MPSCs. Whether the fallopian tubes with salpingoliths are the source of the peritoneal "implants," the recipient of implants, or are independent is unknown. In addition, the high frequency of salpingitis in women with endometriosis may be related to the mechanism of endometriosis-associated infertility.
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Affiliation(s)
- Jeffrey D Seidman
- Department of Pathology, Washington Hospital Center, Washington, DC 20010, USA
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Miller KA, Pittaway DE, Deaton JL. The effect of serum from infertile women with endometriosis on fertilization and early embryonic development in a murine in vitro fertilization model. Fertil Steril 1995; 64:623-6. [PMID: 7641919 DOI: 10.1016/s0015-0282(16)57802-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the effect of serum from infertile women with endometriosis on fertilization and embryonic development in a murine IVF model. DESIGN Pretreatment and post-treatment comparison of murine oocyte fertilization and early embryonic development with the addition of serum supplements from infertile women with endometriosis. SETTING Tertiary care academic medical center. PATIENTS Sera from 10 fertile women without endometriosis and 28 infertile women with endometriosis both before and after laser laparoscopy. RESULTS When compared with serum from fertile women, serum from infertile women with endometriosis inhibited fertilization rates (51% versus 81%) and subsequent embryonic development rates (46% versus 79%). The inhibitory effect was greater as the stage of endometriosis increased. Treatment of endometriosis by laser laparoscopy improved both fertilization (51% versus 56%) and early embryonic development rates (46% versus 58%). CONCLUSIONS Serum from infertile women with endometriosis inhibits both fertilization and early embryonic development in the murine IVF model. Inhibition of fertilization and early embryonic development rates increases as the stage of endometriosis increases. Improved fertilization and early embryonic development rates are observed after treatment of endometriosis by laser laparoscopy.
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Affiliation(s)
- K A Miller
- Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157-1067, USA
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Leiva MC, Hasty LA, Pfeifer S, Mastroianni L, Lyttle CR. Increased chemotactic activity of peritoneal fluid in patients with endometriosis. Am J Obstet Gynecol 1993; 168:592-8. [PMID: 8438934 DOI: 10.1016/0002-9378(93)90500-i] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Our purpose was to investigate the ability of the peritoneal fluid of patients with endometriosis to induce chemotaxis of neutrophils and macrophages. STUDY DESIGN Peritoneal fluid samples of patients with endometriosis (n = 20), normal fertile controls (n = 12), or patients with medical suppression (n = 8) were evaluated for chemotactic activity. Results of chemotactic activity were analyzed by analysis of variance. RESULTS Peritoneal fluid of patients with endometriosis demonstrated a significantly higher chemotactic activity than that of patients without endometriosis or with medical suppression. Patients who had received medical treatment had the lowest chemotactic activity. (p < 0.001 for endometriosis vs control or treatment patients, p = 0.005 for control group vs treatment group). CONCLUSIONS Patients with endometriosis have a higher chemotactic activity in their peritoneal fluid; prior medical treatment significantly reduces this activity. This chemotactic factor has an estimated weight of 20 kd. The nature and source of this chemotactic factor remains to be determined.
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Affiliation(s)
- M C Leiva
- Department of Obstetrics and Gynecology, University of Pennsylvania, School of Medicine, Philadelphia 19104
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Abstract
Endometriosis results in significant pelvic pain, dysmenorrhea, and infertility. Recognition of the signs and symptoms of endometriosis can result in early diagnosis and treatment. Management includes surgical intervention to debulk large lesions and pharmacologic therapy to produce a medical oophorectomy. Primary care physicians should suspect endometriosis in infertile patients with pelvic pain.
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Affiliation(s)
- B S Apgar
- Department of Family Practice, University of Michigan, Chelsea 48118
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