Hiroko Kurioka

Increased prevalence of luteinizing hormone β-subunit variant in patients with premature ovarian failure

OBJECTIVE To evaluate the significance of an LH variant with a mutant beta-subunit (Trp8 to Arg8 and Ile15 to Thr15) in gynecologic disease, including infertility. DESIGN Clinical study. SETTING Department of Obstetrics and Gynecology, Shimane Medical University Hospital, Izumo, Japan. PATIENT(S) Two hundred forty-five Japanese women with endocrine disorders and/or gynecologic disease and 153 healthy, nonpregnant, fertile Japanese women. INTERVENTION(S) A blood sample was collected. MAIN OUTCOME MEASURE(S) The ratio of LH values from the SPAC-S and Immulyze assays (LH ratio: SPAC-S LH/Immulyze LH) was used to determine variant (< or =0.5) or wild-type (>0.5) LH status according to a demonstrated relation between the ratio and the sequence of the LH beta-subunit gene. RESULT(S) The LH ratio was lower (0.80+/-0.31) in the 245 patients than in the controls (1.00+/-0.38), and the variant was more frequent in the patients (18.4%) than in the controls (8.5%). We found no difference in the frequency of the variant between infertile and fertile patients. The prevalence of infertility did not differ between patients with variant LH and patients with normal LH. Ovulatory disorders, hyperprolactinemia, premature ovarian failure, menstrual disorders, and luteal insufficiency were significantly more frequent in patients with the variant. CONCLUSION(S) Variant LH may contribute to female reproductive disorders, including infertility and premature ovarian failure.

Efficacy and safety of oral estriol for managing postmenopausal symptoms.

OBJECTIVE to assess the therapeutic efficacy and safety of oral estriol for the treatment of climacteric symptoms in postmenopausal women. METHODS 68 postmenopausal women with climacteric symptoms received oral estriol, 2 mg/day, daily for 12 months. We evaluated the degree of climacteric complaints with estriol therapy; serum levels of gonadotropins, estradiol (E2) and lipids; biochemical markers of bone metabolism; blood pressure; and side effects both at baseline and during treatment. Climacteric symptoms were assessed according to the menopausal index (MI), a version of the Kupperman index that had been modified for Japanese women. RESULTS oral estriol therapy significantly reduced total MI scores. The greatest relief was noted for hot flushes, night sweats, and insomnia. Estriol treatment significantly lowered serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) concentrations but did not affect any of the other parameters (lipids, bone, liver and blood pressure) during the study period. Slightly vaginal bleeding occurred in 14.3% of those who underwent natural menopausal women. Histologic evaluation of the endometrium and ultrasound assessment of the breasts following 12 months of estriol treatment found normal results in all women. CONCLUSION Estriol is a safe and effective alternative for relieving climacteric symptoms in postmenopausal Japanese women.

Benign or Malignant Ovarian Neoplasms and Ovarian Endometriomas

STUDY OBJECTIVE To investigate clinical features and biologic behavior of ovarian cancer that might be closely related to endometrioma and/or endometriosis. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS All 324 women who were operated for endometriomas and/or ovarian tumors 5 cm or greater in diameter between January 1988 and December 1997. INTERVENTION One hundred twelve women underwent laparoscopic surgery and 212 had laparotomy. MEASUREMENTS AND MAIN RESULTS All tissues were evaluated histologically. Clinical examinations including ultrasound and serum tumor makers were performed in all patients preoperatively. No malignancies were found at laparoscopic surgery (76 endometriomas, 36 ovarian tumors). The frequency of endometriosis in benign, borderline malignant, and malignant tumors was 9.7%, 12.5%, and 11.4%, respectively. Endometriosis was present most frequently (40%) in women with endometrioid adenocarcinoma. It was present in 81 patients with endometriomas and 25 with ovarian neoplasms. Of these, nine women (8.5%) had malignant tumors, including borderline malignancy. Among patients with malignant tumors, those without endometriosis were significantly older (mean +/- SD age 54.9 +/- 16.2 yrs) than those with endometriosis elsewhere in the pelvis (45.9 +/- 8.9 yrs). CONCLUSION Endometriosis may be closely related to ovarian tumors such as endometrioid adenocarcinoma. Surgeons should be aware of this possibility, and candidates for laparoscopic surgery should be carefully selected based on preoperative evaluations.

Influence of missense mutation and silent mutation of LHβ-subunit gene in Japanese patients with ovulatory disorders

The frequency of variant LHβ containing two point mutations (T986–C and T1008–C) and its relationship to reproductive disorders differ widely between ethnic groups. In a Japanese population, variant luteinizing hormone (LH) correlates with ovulatory disorders. Here we examined the relationship between two missense mutations and five silent mutations (C894–T, G1018–C, C1036–A, C1098-T and C1423–T) in the LHβ gene, and ovulatory disorders. We studied 43 patients with ovulatory disorders, 79 patients with normal ovulatory cycles, and 23 healthy men who agreed to join our DNA analysis. PCR-amplified LHβ-subunit gene sequences were compared with a base sequence of wild-type LH reported after direct sequencing. The highest frequency (0.945) of novel allele was observed at the position of the C1036–A transition. No homozygotes for wild-type LHβ (C1036) were identified. The frequency of novel allele in patients with polycystic ovary syndrome, endometriosis, premature ovarian failure and luteal insufficiency was significantly different from that of healthy women. The frequencies of novel alleles (C894–T, C1098–T and C1423–T) in patients with ovulatory disorders were significantly higher than those with normal ovulatory cycles. The mean incidence of point mutation in patients with ovulatory disorders was higher than in those with normal ovulatory cycles. Among patients with variant LH, five silent mutations were identified in 87.5% of patients with ovulatory disorders, whereas only a few silent mutations were identified in patients with normal ovulatory cycles. In a Japanese population, five silent mutations of variant LH could have influenced two missense mutations and/or other unknown missense mutations, causing ovulatory disorders.

Uterine adenomatoid tumors confirmed by immunohistochemical staining

Abstract We present a 39-year-old nulliparous woman who consulted our clinic for an 8-year history of infertility with no notable symptoms. There apparent uterine leiomyomas were found incidentally on clinical examination and imaging. The surgically enucleated specimens were white in color with variable consistency poorly defined margins. The tissues stained positive for cytokeratin but were negative for CD34 antibodies, indicating a mesothelial origin. Staining for vimentin and HBME1 was also strongly positive, supporting a mesothelial origin of the tumors. The patient became pregnant 6 months after surgery. A healthy male infant was delivered at term. Immunohistochemical staining establish the diagnosis of benign adenomatoid tumors derived from mesothelial tissue.

Utility of early second-look laparoscopy after infertility surgery

STUDY OBJECTIVE To evaluate the efficacy of early second-look laparoscopy (ESLL) and the usefulness of the American Fertility Society (AFS) adhesion score at ESLL in terms of reproductive prognosis. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Ninety-two consecutive women undergoing infertility surgery between January 1983 and December 1996. INTERVENTION We performed ESLL in all but 32 patients, 27 of whom underwent surgery before institution of the protocol. MEASUREMENTS AND MAIN RESULTS The pregnancy rate in 1 year was significantly higher in women having ESLL than in those not having the surgery. The AFS score was not significantly different in pregnant and nonpregnant patients. CONCLUSION Early second-look laparoscopy may improve fecundity in women requiring fertility surgery. (J Am Assoc Gynecol Laparosc 6(2):165-168, 1999)

Influence of Midluteal Serum Prolactin on Outcome of Pregnancy After IVF-ET: A Preliminary Study

AbstractPurpose: To investigate the relationship between serum prolactin levels in the midluteal phase and the prognosis of pregnancy after IVF-ET. Methods:Design: Prospective study; Setting: Shimane Medical University Hospital; Patients: 29 patients completing their 34th IVF cycle; and Main outcome measures: Serum levels of prolactin, estradiol-17β, and progesterone in the midluteal phase. Results: Midluteal prolactin levels were significantly lower in patients with early pregnancy loss than in the successful pregnancy group. The mean progesterone/prolactin ratio and the estradiol-17β/prolactin ratio were highest in patients with early pregnancy loss and were lowest in patients with successful pregnancies. Conclusions: Findings of this study suggest that measurement of the serum prolactin concentration in the midluteal phase is useful for predicting the outcome of IVF-ET.

Benign teratoma in an 85-year-old woman

Abstract Background: In women over the age of 50, a mature cystic teratoma is reportedly likely to change into a malignant form. A mature cystic teratoma that remained in a benign form in a very old woman is a rare event. We report a case of a benign cystic teratoma, which is the oldest in Japan. Case: An 85-year-old Japanese woman with a pelvic mass measuring 8.90×5.81 cm by ultrasonography was referred to our Department for detailed. Transvaginal ultrasonography, magnetic resonance imaging, and serum concentrations of tumor markers led to a diagnosis of a mature cystic teratoma. Histological findings postoperatively confirmed the presence of a mature cystic teratoma. Conclusions: This case report describes a mature cystic teratoma which is the second oldest case reported in the world. We reconfirmed that a mature cystic teratoma in elderly women is not frequent, but does occur.

Estradiol-17β measurement in women receiving conjugated estrogens: Dissociation between two commercial methods

To investigate problems associated with measurement of estradiol-17beta (E2) in hormone replacement therapy (HRT), two commercial immunometric methods (Coat-A-Count E2 and Immulyze E2) were used to assay E2 concentrations and the two results were expressed as E2 ratios. Samples were obtained from 97 Japanese women receiving HRT and 168 unmedicated women. The largest differences between methods (P < 0.001) occurred in patients receiving oral conjugated estrogen (CE), while the best concordance was found in unmedicated women; like these controls, patients receiving oral estriol or transdermal E2 showed no significant difference between methods. Defining an E2 ratio > or = 2.0 as an abnormal discordance, the mean E2 ratio and the frequency of abnormal discordance in the CE group were 2.15 +/- 1.18 and 43.6%, respectively. No abnormal discordance for E2 occurred in other groups. In serial serum samples from the control group, no significant difference was seen between the mean E2 ratio at first measurement and those at a subsequent measurement. Similarly, no significant difference in the ratio was seen when two serial samples from CE patients were compared. However, E2 ratios after prescription of CE were significantly higher than before treatment in all patients. In conclusion, although measurement of E2 is important in patients receiving HRT, validity of the test methods must be carefully weighed for patients receiving CE.

Three-dimensional ultrasonic volume measurement of the ovary in women with polycystic ovary syndrome

ObjectiveTo explore the ability of 3D volume measurement to evaluate the ovaries of normal women and women with polycystic ovary syndrome (PCOS).Methods3D images of the ovaries of 10 patients with polycystic ovary syndrome (PCOS) and 10 normal women with regular menstrual cycles were reconstructed. Three-dimensional ultrasonography was used to calculate ovarian volume, stromal volume, and follicular number in each patient. A Voluson 530D ultrasound system (Medison) with software version 4 was used to obtain the images. The trapezoid formula was used to measure ovary and follicle volume by outlining the areas of multiple parallel sections at different distances from the ovary and follicle. Stromal volume was determined by subtracting the sum volume of the follicles from ovarian volume.ResultsOvarian volume in normal and PCOS women was 5.66±2.30 cm3 and 9.41±3.08 cm3, respectively (P=0.0002); stromal volume was 4.54±1.83 cm3 and 8.31±3.07 cm3, respectively (P=0.0005); and follicular number was 3.55±1.57 and 11.25±4.33, respectively (P=0.0001). Stromal volume and follicular number correlated closely with ovarian volume in PCOS patients (r2=0.944,P=0.0001 and r2=0.486,P=0.006, respectively).ConclusionAccurate volume measurement with 3D ultrasound allows quantitative evaluation of the ovary. The excellent reconstructive images and convenient volume measurement of 3D ultrasound support its use in obstetrics and gynecology.