Sungwook Chun

THE ASSOCIATION BETWEEN ENDOMETRIOSIS AND POLYMORPHISMS IN THE INTERLEUKIN-1 FAMILY GENES IN KOREAN WOMEN

To investigate the association between polymorphisms of the interleukin‐1 (IL‐1) family genes and endometriosis in Korean women.

Association between polymorphisms in tumor necrosis factor (TNF) and TNF receptor genes and circulating TNF, soluble TNF receptor levels, and bone mineral density in postmenopausal Korean women.

Objective: The aim of the present study was to investigate the relationship of polymorphisms in the tumor necrosis factor (TNF)-&agr;, TNF-&bgr;, and TNF receptor (TNFR) genes to circulating TNF, soluble TNFR (sTNFR) levels, and bone mineral density (BMD) in women. Methods: The TNF-&agr; G(−308)A, C(−857)T, C(−863)A, T(−1031)C, TNF-&bgr; A252G, TNFRI A36G, TNFRII T676G, A1663G, A1668G, and C1690T polymorphisms were analyzed in 377 postmenopausal Korean women. The levels of serum TNF-&agr;, TNF-&bgr;, sTNFRI, sTNFRII, and bone turnover markers were measured. BMD was examined by dual energy x-ray absorptiometry. Results: After adjustment for age, body mass index, and years since menopause, no significant differences in BMD of the lumbar spine and femoral neck and serum levels of bone turnover markers were detected, according to single polymorphisms in TNF and TNFR genes and combined polymorphisms. However, the frequencies of the TT genotype of TNF-&agr; T(−1031)C polymorphism, the non-AA genotype of TNF-&bgr; A252G polymorphism, and the GG genotype of TNFRII A1663G polymorphism were significantly higher in osteoporotic women than in women with normal BMD, respectively (P < 0.05). The TNFRII T676G polymorphism affected the serum sTNFRI and sTNFRII levels. The serum sTNFRII levels in the CC genotype of TNFRII C1690T polymorphism were the highest, with a G or C allele dose effect, and the TNFRII G676C/C1690T haplotype genotype also affected serum sTNFRII levels. Conclusions: TNF-&agr; T(−1031)C, TNF-&bgr; A252G, and TNFRII A1663G polymorphisms may be genetic factors for osteoporosis in Korean postmenopausal women, and the TNFRII T676G and C1690T polymorphisms and their combined polymorphism affected serum sTNFRII levels. The TNFRII T676G polymorphism also affected the serum sTNFRI levels.

Serum luteinizing hormone level and luteinizing hormone/follicle-stimulating hormone ratio but not serum anti-Mullerian hormone level is related to ovarian volume in Korean women with polycystic ovary syndrome

Objective The aim of the present study was to investigate the relationship between ovarian follicle count and volume on ultrasonography and serum hormone levels including the levels of the anti-Müllerian hormone (AMH) and gonadotropin in women with the polycystic ovary syndrome (PCOS). Methods A total of 118 Korean women aged 18-35 years who were newly diagnosed with PCOS at a university hospital were included in this study. Serum LH, FSH, and AMH levels were measured in the early follicular phase, and the total antral follicle count (TFC) and the total ovarian volume (TOV) were assessed by ultrasonography. The correlations between serum hormonal parameters and ultrasonography characteristics in women with PCOS were evaluated using Pearsons correlation coefficients and a linear regression analysis. Results Serum AMH levels were significantly correlated with serum LH levels and LH/FSH ratios, and TFC and TOV were significantly correlated with each other on ultrasonography. Serum AMH and LH levels and the LH/FSH ratio were significantly correlated with TFC. Statistically significant correlations between TOV and the LH level (r=0.208, p=0.024) and the LH/FSH ratio (r=0.237, p=0.010) were observed. However, the serum AMH level was not significantly correlated with the ovarian volume, and this result did not change after adjusting for age and body mass index. Conclusion Serum AMH is not related to the ovarian volume in women with PCOS. My results suggest that serum LH level and the LH/FSH ratio may be more useful than the serum AMH level for representing the status of the ovarian volume in women with PCOS.

Relationship between inhibin-α gene polymorphisms and premature ovarian failure in Korean women.

Objective:The aim of this study was to determine the relationship between inhibin-&agr; (INH&agr;) gene polymorphisms and the prevalence of premature ovarian failure (POF) in Korean women. Methods:The INH&agr; −124A/G, −16C/T, 679G/A, and 769G/A polymorphisms were analyzed in 52 women with POF and 55 normal healthy women using polymerase chain reaction-restriction enzyme fragment length polymorphism analysis. Results:The 679G/A and 769G/A polymorphisms were not observed. The frequencies of the C allele of the INH&agr; −16C/T polymorphism and the G allele of the INH&agr; −124A/G polymorphism were significantly lower in the women with POF than in the normal control women. The frequencies of the CG haplotype allele of these INH&agr; −16C/T and −124A/G gene polymorphisms were also significantly lower in the women with POF than in the control women. Conclusions:The INH&agr; −16C/T and −124A/G polymorphisms are genetic factors associated with the prevalence of POF in Korean women.

Comparison of early postoperative decline of serum antiMüllerian hormone levels after unilateral laparoscopic ovarian cystectomy between patients categorized according to histologic diagnosis

OBJECTIVE To evaluate the change of ovarian reserve after unilateral laparoscopic ovarian cystectomy (LOC) in the early postoperative period between patients divided according to histologic diagnosis of cyst type. MATERIALS AND METHODS Sixty-five patients who were undergoing unilateral LOC for benign ovarian disease were included in this study. All participants were divided into three groups according to histologic diagnosis: endometrioma (n=26), mature teratoma (n=24), and other benign cyst (n=15). Serum samples were collected preoperatively and 3-days postoperatively and assayed for antiMüllerian hormone (AMH) levels, and the changes between the two samples were analyzed. RESULTS Preoperative AMH levels were not significantly different between the three groups. On postoperative Day 3 AMH levels of all three groups were significantly reduced compared with preoperative AMH levels. The rates of decline of AMH levels after LOC in patients with endometrioma (26.37±20.70%) and in those with teratoma (28.25±22.16%) were both significantly higher than those with other benign cyst (12.03±18.56%). No statistically significant differences were found in the rate of decline of AMH levels between patients with endometrioma and teratoma. Decline of AMH after LOC was not significantly correlated with age, body mass index, the size of cyst, or preoperative AMH levels. CONCLUSION Our results suggest that ovarian reserve is reduced after unilateral LOC in the early postoperative period, and that the postoperative decline of AMH levels after LOC is similar between patients with endometrioma and those with mature teratoma.

Uterine adenomyosis which developed from hypoplastic uterus in postmenopausal woman with mayer-rokitansky-kuster-hauser syndrome: a case report.

Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) is characterized by vaginal agenesis with variable Müllerian duct abnormalities. We report here a case of uterine adenomyosis which developed from a hypoplastic uterus in a patient with MRKHS. A 55-year-old postmenopausal woman visited a university hospital for pelvic mass. She had underwent vaginoplasty via the McIndoe procedure for MRKHS at 15 years of age. Pelvic magnetic resonance imaging showed a 5.4 × 4.8 × 4.7 cm mass suspicious for a uterine myoma. She received total abdominal hysterectomy with bilateral salpingo-oophorectomy, and neither the cervix nor endometrium was found grossly in the surgical specimen. The final histologic diagnosis was uterine adenomyosis.

Accuracy of three dimensional ultrasound and treatment outcomes of intrauterine adhesion in infertile women

OBJECTIVE To determine the accuracy and usefulness of three-dimensional transvaginal ultrasound (3D-TVUS) in diagnosing intrauterine adhesion (IUA) and to evaluate treatment outcomes associated with fertility. MATERIALS AND METHODS IUA patients (110) underwent hysteroscopy to definitively diagnose and treat adhesiolysis. Morphologic characteristics of endometrium suggesting IUA, such as marginal irregularity, thinning, defects, obliteration, fibrosis, and calcification, were identified and recorded by 3D-TVUS. The sensitivity of 3D-TVUS findings and the attainment of postoperative fertility were evaluated prospectively. The clinical records were followed up for 2 years for obstetrical outcomes and analyzed. RESULTS On comparing the findings of 3D-TVUS with those of hysteroscopy in 110 patients, 45 (88.23%) patients were confirmed as IUA by hysteroscopy among 51 (46.36%) patients, with one finding in 3D-TVUS; 42 (97.67%) patients were confirmed among 43 (39.09%) patients with two findings; and 16 (100%) patients were confirmed among 16 (14.55%) patients with over three findings. A pregnancy rate of eight out of 47 (17.02%) was achieved in patients who desired fertility. CONCLUSION 3D-TVUS assessment of the uterus provides an accurate depiction of adhesion and extent of cavity damage in patients with suspected IUA.

1-h Postprandial glucose level is related to the serum anti-Müllerian hormone level in women with polycystic ovary syndrome

Abstract The aim of this study was to evaluate the relationship between the serum anti-Müllerian hormone (AMH) level and parameters related to insulin resistance in Korean women with polycystic ovary syndrome (PCOS). A total of 95 Korean women aged 18–33 years who were newly diagnosed with PCOS according to the Rotterdam Consensus at a university hospital were included in this study. Blood samples were collected from all participants during the early follicular phase using tubes without anticoagulants after an overnight fasting to determine the serum AMH level and other biochemical parameters, and then a standard 2-h 75-g oral glucose tolerance test (OGTT) was performed for all participants. All patients with PCOS were divided into two groups based on the serum AMH level: group 1 (AMH < 10.0 ng/ml) and group 2 (AMH ≥ 10.0 ng/ml). The clinical variables were not significantly different between the two groups. The mean postprandial glucose level at 1 h (PPG1) in group 1 (111.70 ± 4.9 mg/dl) was significantly lower than that in group 2 (136.76 ± 9.86 mg/dl). No significant differences between the two groups were found in the other insulin resistance-related parameters. In conclusion, the serum AMH level may be related to PPG1 in women with PCOS.

Efficacy of hyaluronan-rich transfer medium on implantation and pregnancy rates in fresh and frozen-thawed blastocyst transfers in Korean women with previous implantation failure.

Objective To evaluate the effect of hyaluronan-rich transfer medium on pregnancy and implantation rates in fresh and frozen-thawed embryo transfers in Korean women with previous implantation failure. Methods This retrospective study included 283 blastocyst transfers in patients with previous embryo transfer failure at a private fertility clinic. In the study group (n=88), blastocyst transfers were performed using an hyaluronan-rich transfer medium prior to transfer, whereas blastocyst transfers without any treatment served as controls (n=195). According to the type of transfer (fresh elective or frozen-thawed), all the blastocyst transfers were divided into two study and two control groups. Results The patients mean age, serum anti-Müllerian hormone level, causes of infertility, embryo quality, and the number of transferred embryos were comparable between the study and control groups. There were no significant differences in clinical pregnancy rate (45.5% vs. 43.1%), implantation rate (28.9% vs. 28.8%), and clinical abortion rate (10.0% vs. 8.3%) between the two groups, and these findings were not changed after subgroup analysis according to the type of transfer. Conclusion The use of hyaluronan-rich transfer medium in the blastocyst transfer does not appear to have any significant effect on the implantation and pregnancy rates in patients with previous implantation failure.

Bone Density in Patients with Cervical Cancer or Endometrial Cancer in comparison with Healthy Control; According to the stages.

Objective: To evaluate the bone mineral density (BMD) in the lumbar spine and femur in postmenopausal women with cervical cancer and endometrial cancer without bone metastasis in comparison with that in healthy control postmenopausal women, and to assess the loss of BMD according to the cancer stage. Materials and methods: We analyzed the BMD of the lumbar spine and femur using dual-energy X-ray absorptiometry (DXA) in 218 patients with cervical cancer, 85 patients with endometrial cancer, and 259 healthy controls. The serum levels of calcium (Ca), phosphorus (P), osteocalcin (OSC), and total alkaline phosphatase (ALP), and urine deoxypyridinoline(DPL) were measured in all participants. Results: Age, body mass index, parity, and time since menopause were not significantly different between the three groups. Serum Ca level was higher in the cervical cancer group (p = 0.000), however, urine DPL was lower in endometrial cancer group (p = 0.000). The T-scores of basal BMD at the second and fourth lumbar vertebra (L2, L4) were significantly lower in patients with cervical cancer (p = 0.038, 0.000, respectively) compared to those in the healthy control groups. Additionally, the incidence of osteoporosis and osteopenia basal status of bone mass was significantly higher in patients with cervical cancer compared to that in controls (p = 0.016). No differences in basal BMD of the lumbar spine and femur were observed between patients with cervical cancer according to their stages. Conclusion: Our results suggest that postmenopausal women with cervical cancer have a lower BMD and are at increased risk of osteoporosis in the lumbar spine before receiving anticancer treatment compared with postmenopausal women with endometrial cancer.