A. Criniti

Dynamic Anchoring of PKA Is Essential during Oocyte Maturation

In the final stages of ovarian follicular development, the mouse oocyte remains arrested in the first meiotic prophase, and cAMP-stimulated PKA plays an essential role in this arrest. After the LH surge, a decrease in cAMP and PKA activity in the oocyte initiates an irreversible maturation process that culminates in a second arrest at metaphase II prior to fertilization. A-kinase anchoring proteins (AKAPs) mediate the intracellular localization of PKA and control the specificity and kinetics of substrate phosphorylation. Several AKAPs have been identified in oocytes including one at 140 kDa that we now identify as a product of the Akap1 gene. We show that PKA interaction with AKAPs is essential for two sequential steps in the maturation process: the initial maintenance of meiotic arrest and the subsequent irreversible progression to the polar body extruded stage. A peptide inhibitor (HT31) that disrupts AKAP/PKA interactions stimulates oocyte maturation in the continued presence of high cAMP. However, during the early minutes of maturation, type II PKA moves from cytoplasmic sites to the mitochondria, where it associates with AKAP1, and this is shown to be essential for maturation to continue irreversibly.

Applications of intraoperative ultrasound in gynecological surgery.

Purpose of review Gynecologists are well trained in office-based ultrasound, but are less experienced in the field of intraoperative ultrasound. Many gynecologic procedures may benefit from the use of real-time ultrasonography. The purpose of this review is to summarize the current use of intraoperative ultrasound in gynecologic procedures. Recent findings Evaluation and assessment of the value of intraoperative ultrasound in gynecological procedures is essentially non-existent. The role of intraoperative ultrasound in gynecology is in its infancy, with anecdotal experience and literature involving predominantly case reports. Intraoperative ultrasound is helpful in laparoscopic myomectomy, particularly when the uterine contour is normal. It is also useful in defining pelvic anatomy in cases of complex reproductive procedures. Intraoperative ultrasound improves precision in characterizing ovarian lesions, particularly in the setting of endometriomas or dermoid cysts. It has been shown to decrease both operative time and complication rates in dilation and curettage procedures. Intraoperative ultrasound reduces recurrence and re-operation rates after hysteroscopy by facilitating more-complete resection of uterine myomas. Ultrasound guidance improves the efficiency of embryo transfer in in-vitro fertilization and could potentially be beneficial in other ‘blind’ gynecological procedures. Summary Intraoperative ultrasound appears to be a safe and valuable tool for the gynecologic surgeon. Ultrasound improves visualization of anatomy, reduces complication and re-operation rates, and facilitates completion of more cases via less-invasive endoscopic approaches.

Antral follicle count and serum follicle-stimulating hormone levels to assess functional ovarian age.

OBJECTIVE: The objective of this study was 2-fold. The first was to estimate side-to-side variation in antral follicle counts. The second was to determine whether basal follicle-stimulating hormone levels on days 2, 3, and 4 of the same menstrual cycle are significantly different. METHODS: Forty-one patients between the ages of 20 and 42 years undergoing monitoring for in vitro fertilization-embryo transfer were evaluated ultrasonographically for antral follicle number. The antral follicle counts were determined for each ovary by experienced ultrasonographers at the time of suppression check ultrasonography. In a separate study, 62 normal subjects (ages 20–25 and 40–45 years) underwent serial sequential serum follicle-stimulating hormone determinations on days 2–4 of the menstrual cycle, and these levels were compared. RESULTS: There was no significant difference between right and left antral follicle counts (P = .30). Serial follicle-stimulating hormone values were not significantly different on days 2, 3, or 4 of the menstrual cycle (P = .22). CONCLUSION: There is no significant difference between right-sided and left-sided antral follicle counts within the same individual. In turn, there is no significant difference in serial follicle-stimulating hormone levels on days 2, 3, or 4 of the menstrual cycle. LEVEL OF EVIDENCE: III