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Altered aquaporin expression in women with polycystic ovary syndrome: hyperandrogenism in follicular fluid inhibits aquaporin-9 in granulosa cells through the phosphatidylinositol 3-kinase pathway

Posted: May 20, 2010 at 8:15 am

BACKGROUND

The present study was designed to evaluate whether the alteration of aquaporin-9 (AQP-9) expression in granulosa cells (GCs) of patients with polycystic ovary syndrome (PCOS) was associated with the hyperandrogenism in follicular fluid (FF).

METHODS

We recruited infertile women with PCOS (n = 14) and infertile women with tubal blockage (controls, n = 31) for this study. We examined total testosterone (TT), free androgen index (FAI), sex hormone-binding globulin (SHBG), FSH, LH and estradiol in FF. Real-time PCR and western blotting were performed to assess AQP-9 expression in GCs, including effects of dihydrotestosterone (DHT) in vitro.

RESULTS

AQP-9 protein was localized in the nucleus, cytoplasm and cell membrane of the human GCs. The TT, FAI and LH levels were all higher, and SHBG levels lower, in the FF of women with PCOS versus controls (P = 0.0145, 0.0001, 0.0191, 0.0001, respectively). AQP-9 mRNA level in GCs of patients with PCOS was tightly correlated with the TT, SHBG levels and FAI in FF (P = 0.0020, 0.0001, 0.0020, respectively). In vitro, DHT (10–9 mol/l) decreased AQP-9 mRNA (lowest at 12 h) and protein levels in control GCs (P = 0.0005, 0.0247, respectively). The inhibitory effect of DHT on AQP-9 mRNA was attenuated by LY294002, a phosphatidylinositol 3-kinase (PI3K) inhibitor (P = 0.0013). Fifty micromolar 4-(hydroxymercuri) benzoic acid sodium salt (PMB) and 10–9 mol/l DHT blunted the swelling of GCs in hypotonic medium, respectively (P = 0.0350, 0.0027).

CONCLUSION

Hyperandrogenism in FF of women with PCOS inhibited AQP-9 in GCs through the PI3K pathway.

Recommendation and review posted by G. Smith

Fast-release orodispersible tramadol as analgesia in hysterosalpingography with a metal cannula or a balloon catheter

Posted: May 20, 2010 at 8:15 am

BACKGROUND

This study aimed to evaluate the potential benefit, in terms of pain relief, of the new oral fast-release orodispersible galvanic form of tramadol in women undergoing hysterosalpingography (HSG) with either a metal cannula or a balloon catheter.

METHODS

In a randomized, double-blind, placebo-controlled, 2 x 2 factorial-design trial, conducted at a single academic centre, 128 women were assigned into groups: (I) tramadol and a metal cannula, (II) tramadol and a balloon catheter, (III) placebo and a metal cannula or (IV) placebo and a balloon catheter. The primary end-point was pain registered by the patients on 10-cm visual analogue scales (VASs) at various times during and after the procedure. Secondary end-points included side effects and pain as assessed by the same physician during HSG.

RESULTS

The main effect of tramadol versus placebo medication (i.e. I and II versus III and IV) was a statistically significant difference (P < 0.001) in self-reported VAS of –0.91 (–1.35 to –0.47) on the absolute and –33% (–48% to –17%) on the relative scale in favour of tramadol. Likewise, there was a significant benefit for tramadol against placebo medication for physician-perceived VAS pain scores (39% relative reduction; P < 0.001). The main effect of the balloon catheter versus metal cannula (i.e. II and IV versus I and III) was a non-significant (P = 0.82) difference in patient-reported VAS of –0.05 (–0.49 to +0.39) and –2% (–21% to +17%). There were no medication–HSG device interactions and no differences in side effects.

CONCLUSIONS

During and after HSG, fast-release orodispersible tramadol significantly reduces pain without increasing side effects.

Recommendation and review posted by G. Smith

Xenotransplantation of cryopreserved human ovarian tissue into murine back muscle

Posted: May 20, 2010 at 8:15 am

BACKGROUND

Ovarian tissue (OT) cryopreservation and transplantation are options for fertility preservation in young female cancer patients.

METHODS

We investigated xenotransplantation of human OT into back muscle (B) of severe combined immunodeficiency mice. OT follicle content was evaluated by stereomicroscopy and pre-transplantation. Xenograft survival, follicular development (with/without FSH administration), apoptosis and vascularization were compared in B- versus K-site (under the kidney capsule) several times after grafting using histology, immunohistochemistry and magnetic resonance imaging. In vitro maturation (IVM) was also performed.

RESULTS

Anastomoses which developed from existing human and invading murine vessels were seen in OT at both sites, but angiogenesis was more prominent at the B- than K-site (P < 0.001). Vascularization and follicle size were correlated in the B-group (Spearman's coefficient 0.73; P < 0.001). FSH increased early (8 days) micro-vessel formation in B but not in K grafts (P < 0.0001, versus no FSH). B-site grafts showed a better histological morphology and survival (P = 0.0084), formation of larger antral follicles (P = 0.005), more metaphase-II (MII) oocytes, growing follicles (P = 0.028) and slightly fewer apoptotic follicles than K grafts. One MI oocyte from B underwent IVM and reached MII stage next day.

CONCLUSIONS

To our knowledge, this is the first report of MII and IVM–MII oocytes obtained from B xenografts. We report the largest oval-shaped antral follicles containing an MII oocyte obtained after OT xenotransplantation to date. Xenografting in the mouse B should be further explored as a method for human OT transplantation.

Recommendation and review posted by G. Smith

Predictors of psychological distress in patients starting IVF treatment: infertility-specific versus general psychological characteristics

Posted: May 20, 2010 at 8:15 am

BACKGROUND

The distress that couples experience in IVF treatment is well-documented though research exploring factors that might contribute to the distress is scarce and the role of infertility-specific versus more general psychological characteristics in predicting psychological distress remains unexplored. This exploratory study aimed to describe, explore and test a self-constructed conceptual framework designed to understand the relative impact of infertility-specific and general psychological characteristics, in predicting psychological distress.

METHODS

Validated self-report questionnaires that measured the concepts of the encompassing framework (personality characteristics self-criticism and dependency, attachment in the partner relationship, child wish, coping, intrusiveness, infertility-related stress and general psychological distress) were completed by 106 women and 102 men before starting the first IVF/ICSI treatment at a university hospital-based fertility centre. Data were analysed by hierarchical multivariate linear regression analysis and path analysis.

RESULTS

The overall conceptual psychological framework explained 55% of the variance in psychological distress. The strongest predictors of psychological distress were general psychological characteristics: passive and active coping, self-criticism and dependency and intrusiveness. A path analysis confirmed the framework and highlighted the mediating role of coping and intrusiveness. In the final analysis, none of the infertility-specific variables significantly predicted psychological distress.

CONCLUSIONS

The current study of patients starting IVF-treatment demonstrated that general psychological characteristics, specifically active and passive coping, personality characteristics, dependency and self-criticism and intrusiveness, are more important in predicting the variability in psychological distress than infertility-specific concerns. The results raise important questions for infertility counselling. However, the cross-sectional nature of the study only allows for insight into baseline measurement (before starting the first IVF-treatment) and therefore this area of research could benefit from additional longitudinal studies.

Recommendation and review posted by G. Smith

Psychological adjustment, knowledge and unmet information needs in women undergoing PGD

Posted: May 20, 2010 at 8:15 am

BACKGROUND

Women often enter preimplantation genetic diagnosis (PGD) treatment following traumatic reproductive and genetic histories, the detrimental psychological effects of which are known to be long lasting in some cases. In addition, attempting IVF with PGD requires an in-depth understanding of the aspects of the technology. The level of information that is required and retained by women entering treatment is important for clinicians to understand. To date, neither of these issues has been explored empirically. To address this, we assessed mood and information-seeking behavior in a sample of women entering PGD.

METHODS

Fifty women entering PGD treatment completed self-administered questionnaires that assessed anxiety, depression, knowledge of technical aspects of PGD, expectancy of establishing a pregnancy and unmet information needs.

RESULTS

Anxiety and depression rates were similar to normal population data. State anxiety was associated with degree of financial worry [β = 0.36, t = 2.60, P = 0.01, 95% confidence interval (CI): 0.03–0.23], and living in an inner metropolitan area (β = 0.30, P = 0.03, 95% CI: 0.32–10.81). Unmet information needs were positively associated with women's education (β = 0.97, P = 0.01, 95% CI: 0.22–1.73). Lastly, expectancy of establishing a pregnancy was above that of what clinicians provide as realistic PGD pregnancy chances and, unexpectedly, was also associated with degree of financial worry (β = 0.36, P = 0.01, 95% CI: 0.07–0.56).

CONCLUSIONS

Women entering PGD are emotionally well adjusted although the financial costs associated with PGD are associated with increases in anxiety. The study is limited by its small sample size and the fact that partners were not assessed.

Recommendation and review posted by G. Smith

Mothers of IVF and spontaneously conceived twins: a comparison of prenatal maternal expectations, coping resources and maternal stress

Posted: May 20, 2010 at 8:15 am

BACKGROUND

This study explores the differences in prenatal maternal expectations, coping resources and maternal stress between first time mothers of IVF twins and first time mothers of spontaneously conceived twins. The role of prenatal maternal expectations in the prediction of maternal stress was examined, as well as the mediating and moderating effect of coping resources on the association between pregnancy-type group and maternal stress.

METHOD

Mothers of twins from various regions in Israel were included in this prospective and cross-sectional study in which 88 mothers of IVF-conceived twins and 98 mothers of spontaneously conceived twins were interviewed twice. First, at 33–36 weeks of their pregnancy they completed a socio-demographic questionnaire and the maternal expectations questionnaire; then at 6 months after birth they completed a questionnaire regarding the delivery and medical condition of the infants, and their coping resources and maternal stress.

RESULTS

Compared with mothers who conceived spontaneously, IVF mothers had more positive prenatal maternal expectations, but poorer coping resources and higher levels of maternal stress 6 months after birth. Maternal expectations had no predictive power regarding maternal stress, although the mother's coping resources were significantly related to maternal stress and mediated the association between pregnancy type and maternal stress.

CONCLUSIONS

IVF-pregnant women bearing twins should be considered a high-risk group. Early identification of these mothers is essential for timely psychosocial interventions in order to enhance their resources and decrease maternal stress. Further longitudinal studies are required to determine causality in more ethnically-diverse mothers of twins.

Recommendation and review posted by G. Smith


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