Yoshinori Okamura

Clinical use of colony-stimulating factor-1 in ovulation induction for poor responders.

OBJECTIVE To evaluate the benefit of colony-stimulating factor-1 (CSF-1) adjuvant therapy to poor responders during a controlled ovarian hyperstimulation (COH) cycle. DESIGN Prospective clinical study. SETTING University hospital, general hospital, and private IVF clinic in Japan. PATIENT(S) Thirty normogonadotropic patients who did not respond to conventional COH protocols. INTERVENTION(S) Eight million units of recombinant human CSF-1 were administered IV every other day during ovarian stimulation using FSH or hMG to 30 normogonadotropic poor responders. Serum CSF-1 concentrations were assayed on day 3. Additional studies were performed in a private IVF clinic on 27 poor responders with low serum CSF-1 levels. MAIN OUTCOME MEASURE(S) Pregnancy rates (PR). In addition, number of mature follicles, cycle cancellations, amount of required gonadotropins were documented. RESULT(S) Significantly more mature follicles, fewer cycle cancellations, and lower amounts of required gonadotropins were seen in the group treated with CSF-1. Five (16.7%) pregnancies were achieved. The CSF-1-effective patients displayed significantly lower serum CSF-1 concentrations. In a private IVF clinic, CSF-1 treatment increased the number of mature oocytes, fertilized eggs, and transferred embryos. Cycle cancellations decreased from 18.5%-3.7%; 11 pregnancies (40.7%) resulted from treatment. CONCLUSION(S) Concomitant administration of CSF-1 and hMG improved follicle developments, especially in patients with low serum CSF-1 levels in the early follicular phase.

Treatment of cervical pregnancy with ultrasound‐guided local methotrexate injection

Cervical pregnancy (CP) is a rare type of ectopic pregnancy. While methotrexate (MTX) is generally the first‐line method of choice for clinically stable women, there is still no consensus on the most appropriate treatment for this abnormal pregnancy. The aim of this study was to investigate the efficacy of a single local MTX injection under transvaginal ultrasound guidance for the initial treatment of CP and to assess post‐treatment fertility.

Malignant mesenchymal tumors of the ovary in three cases: Histology, immunohistochemistry, and ultrastructural observations

Primary ovarian sarcoma is a rare neoplasm. The diagnosis sometimes becomes difficult by light microscopic examination alone because of the rarity and heterogeneity of these tumors. Immunohistochemical and ultrastructural studies are very useful for diagnosis. Here, we describe two cases of ovarian sarcomas: fibrosarcoma and leiomyosarcoma, and a case of carcinosarcoma (homologous malignant mixed müllerian tumor). In addition to histological findings, immunohistochemical and ultrastructural observation was undertaken to make a final diagnosis. Clinical outcome was variable in the three cases. It was unlikely to be related to the disease stage or treatment, such as surgical excision or anticancer drugs, whereas the mitotic index may be an important prognostic indicator in ovarian sarcomas.

Venous thromboembolism due to oral contraceptive intake and spending nights in a vehicle -a case from the 2016 kumamoto earthquakes-

A 40-year-old woman experiencing sudden dyspnea went to her personal doctor for advice. She was previously diagnosed with endometriosis and prescribed oral contraceptives for treatment. During earthquakes, she spent 7 nights sleeping in a vehicle. The patient had swelling and pain in her left leg and high D-dimer concentration levels. A contrast-enhanced computed tomography scan revealed a contrast deficit in the bilateral pulmonary artery and in the left lower extremity. She was diagnosed with pulmonary thromboembolism (PTE), and anticoagulation therapy was initiated. This present case is the first report of PTE attributed to the use of oral contraceptives after earthquakes.

Clinical Management of Primary Ovarian Insufficiency

Primary ovarian insufficiency (POI) is typically used to describe ovarian dysfunction when the underlying mechanism is unknown, although genetic defects, chemotherapy, radiotherapy, or surgery is also known to be causative. The incidence is rare, affecting approximately 1 in 100 women under the age of 40 years. POI is characterized by a triad of amenorrhea, low serum estradiol levels, and elevated serum follicle-stimulating hormone levels. The condition leads not only to infertility but also to ovarian hormone deficiency that is associated with health risks that include menopausal symptoms, decreased bone mineral density, and increased cardiovascular risk. Hormone replacement therapy should therefore be commenced as soon as possible to prevent adverse health risks. In cancer patients who are to receive chemotherapy or radiotherapy, fertility preservation options should be offered, though embryo donation and adoption are considered as alternatives. Given that recent studies in genetically modified animal models have revealed that the underlying mechanism involves increased follicle activation and subsequent early follicle exhaustion, new therapeutic strategies are needed.

Polycystic ovary syndrome: early diagnosis and intervention are necessary for fertility preservation in young women with endometrial cancer under 35 years of age

Polycystic ovary syndrome (PCOS) is a significant risk factor for premenopausal endometrial cancer (EC) and/or atypical endometrial hyperplasia (AEH). The aim was to elucidate the clinical background and detailed menstrual history of EC and/or AEH in young women with PCOS.