Human papillomavirus prevalence and genotype distribution among Turkish women with or without cervical lesion

Context

Human papillomavirus (HPV) infection is the main cause of cervical cancer, but the risk is associated with the various HPV genotypes which may be found in women with or without clinical findings.

Aims

We aimed to identify HPV prevalence and genotype distribution in women with or without cervical lesions admitted to Gynaecology and Obstetrics Clinics of one of the largest private hospitals in Istanbul between 2013 and 2017.

Subjects and Methods

In the present study, cervical cytobrush samples collected from 2464 women with different cytological conditions, and investigated for the presence of HPV, and the different genotypes. Results were evaluated based on the HPV positivity in different cytological findings, and ages. Furthermore, distribution of high-risk (HR) and low-risk (LR) genotypes in different groups was investigated.

Results

Among all participants, 1925 (78.1%) was with the normal cytological condition, 354 (14.4%) with ASC-US; 151 (6.1%) with low-grade squamous intraepithelial lesion (LSIL), and 34 (1.4%) with high-grade squamous intraepithelial lesion (HSIL). Our results showed that 649 out of 2464 patients (26.3%) were positive, and 1815 (73.7%) were negative for the presence of HPV. Among 649 positive patients, 223 (34.3%) were found positive for more than one genotype. HPV 16 was found the most common HR-HPV type in ASC-US and LSIL whereas HPV 18 was the most common in HSIL. HPV 6 was found the most common LR-HPV type in ASC-US and LSIL whereas HPV 11 was the most common in HSIL. 26.9% of women <50 years old, and 22.3% of women ≥50 years old was positive for HPV. The most common HR-HPV genotype was 16 in both groups with (19%) or without (17%) abnormal cytology.

Conclusions

We concluded that HPV prevalence and genotype distribution in women with or without clinical findings is an important predictor of cervical cancer.

Clomiphene citrate changes metabolite content of follicular fluid of PCOS women

OBJECTIVE

To determine whether clomiphene citrate (CC) treatment affects the metabolite contents of a dominant follicle in polycystic ovary syndrome (PCOS).

PATIENTS AND METHODS

Twenty non-obese primary infertile anovulatory PCOS women undergoing CC treatment and ten fertile women were enrolled. 6 out of 20 patients had impaired glucose tolerance test (IGT). CC was given at a dose of 150 mg on days 3-7 of cycles in the first group. 10 fertile women with a regular menstrual cycle and normal ovaries during ultrasound examination were accepted as control group. They were not given any drug for ovarian stimulation. Transvaginal sonography and follicular tracking were done to each group of participant. Both groups of subjects underwent magnetic resonance spectroscopy when the dominant follicle with a mean diameter of at least 16-18 mm was detected. Lactate (Lac), N-acetylaspartate (NAA), creatine 1 (Cr1), creatine 2 (Cr2) and choline (Cho) signal of dominant follicles were measured. Peak of each metabolite was measured in units. Voxels were placed in the center of dominant follicle.

RESULTS

Compared to control group significantly decreased Cho signal was found in follicular fluid of PCOS subjects taking clomiphene. Almost three-fold decline in Cho signal was detected in PCOS group compared to Cho signal of control group (0.64±1.01 vs. 2.01 ±1.13). On the other hand, significantly increased Lac signal was detected in the dominant follicle of PCOS subjects taking clomiphene compared to control group. Almost 2 fold increase in Lac signal was noted after clomiphene treatment (1.90±0.32 vs. 0.93±2.21). The results of spectroscopy signals obtained from PCOS subjects without IGT and PCOS subjects with IGT were similar.

CONCLUSIONS

Unbalanced production of Cho signal in the follicular fluid may have occurred secondary to membrane damage of cumulus-oocyte-complexes due to CC therapy.

AFC vs. AMH: prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation

OBJECTIVE

To assess the clinical value of antral follicle count (AFC) and anti-Mullerian hormone (AMH) for the prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation for IVF using GnRH antagonist treatment.

PATIENTS AND METHODS

Fifty patients with endometrioma who underwent their first IVF/ICSI cycle with GnRH antagonist treatment were included in the study. The average AMH values were recorded as 1.5-2 ng/mL. Fifty infertile women are not suffering from endometrioma were selected from those with male factor infertility as control. They were matched according to both serum AMH levels and age. Serum samples have been collected before the IVF treatment for determining AMH levels in both groups of subjects. Likewise, each group of subject underwent ultrasound scan for AFC on day 3. Total number of oocytes retrieved during OPU, the number of transferred embryo, implantation and clinical pregnancy rates, live birth and abortion rates, total dose of rhFSH were noted in both groups of subjects.

RESULTS

Day 3 AFC was significantly higher in the control group compared to women with endometrioma. Both the number of retrieved oocytes during oocyte pick-up, MII oocytes and 2 PN embryo were significantly lower in the endometrioma. Likewise, the fertilization, implantation, clinical pregnancy and live birth rates of endometrioma group were significantly lower than those in the control group. The total rFSH dose was higher in the endometrioma group than those in control. The percentage of abortion in the endometrioma group was found to higher compared to those with controls.

CONCLUSIONS

AFC is more sensitive than the AMH in detecting ovarian response in women with ovarian endometrioma. The individualization of GnRH antagonist protocols in subjects having endometrioma might be improved by using an AFC-tailored approach instead of AMH.

Follicular fluid cerebellin and betatrophin regulate the metabolic functions of growing follicles in polycystic ovary syndrome

Objective

The aim of this study was to assess the changes of follicular fluid (FF) and serum levels of cerebellin precursor protein 1 (cbln1) and betatrophin in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with a gonadotropin-releasing hormone (GnRH) antagonist protocol.

Methods

Twenty infertile women with PCOS and 20 control women diagnosed as poor responders undergoing ovarian stimulation with a GnRH antagonist were included. Blood samples were obtained during ovum pick-up. Follicular fluid from a dominant follicle was collected from the subjects. Using enzyme-linked immunosorbent assays, FF and serum levels of cbln1 and betatrophin were measured in both groups of participants. Metabolic and hormonal parameters were also determined and correlated with each other.

Results

Both groups of women had similar serum and FF betatrophin levels (55.0±8.9 ng/mL vs. 53.1±10.3 ng/mL, p=0.11). The serum and FF betatrophin levels of poor responders were found to be similar (49.9±5.9 ng/mL vs. 48.9±10.7 ng/mL, p=0.22). Conversely, the FF cbln1 levels of PCOS women were found to be significantly higher than the serum cbln1 levels (589.1±147.6 ng/L vs. 531.7±74.3 ng/L, p<0.02). The FF cbln1 levels of control participants without PCOS were significantly higher than their serum cbln1 levels (599.3±211.5 ng/L vs. 525.3±87.0 ng/L, p=0.01). Positive correlations were detected among body mass index, insulin resistance, serum insulin, total testosterone, and betatrophin levels in the PCOS group.

Conclusion

Follicular fluid betatrophin and cbln1 concentrations may play a pivotal role on follicular growth in PCOS subjects undergoing IVF/ICSI with an antagonist protocol.