Gluten-free diet - remedy for infertility or dangerous trend?

Association between celiac disease (CD) and infertility has been a point of consideration for many years. There are lots of studies which present contradictory results. It is accepted that women with unexplained infertility have three times higher risk of CD compared to the healthy women. This finding leads to the conclusion that a gluten-free diet (GFD), as the only effective method of treatment CD, is important to improve fertility. It is observed that women diagnosed with CD and treated by GFD, have positive pregnancy outcomes including better effects of assisted reproductive technology (ART). Excluding gluten from diet by women without CD diagnosis could bring adverse outcomes, because the risk of malnutrition if diet is unbalanced. On the other hand, some research show that not only GFD but CD is related to malnutrition which could be the cause of problems with getting pregnant or with termination of pregnancy. Regarding CD influence on women's reproductive system, it is not only connected with unexplained infertility and adverse pregnancy outcomes, but also with delayed menarche, early menopause and decrease of anti-Müllerian hormone (AMH). What is more, non-celiac wheat sensitivity affects the reproductive system by increasing risk of menstrual disorders too. The main aim of this paper is presenting scientific facts about the link between gluten elimination and fertility. It is very important to provide patients with reliable fact-checked information in the context of their symptoms.

Macro-TSH - tips and tricks for gynecologists

Thyroid disorders are one of the most common endocrinopathies in women of reproductive age. Measurement of TSH (thyroid-stimulating hormone) concentration in women planning pregnancy/pregnant is a golden standard of thyroid function assessment. When the laboratory findings do not correspond with the clinical signs, it is reasonable to mark macro-TSH.

Fresh insight into premature ovarian insufficiency

Premature ovarian insufficiency (POI) is one of the vital reasons of anovulatory infertility among women under 40 years old. However, because of the unacknowledged causative factor in most cases, it still remains a huge challenge in gynecology. Recently, the most promising opportunities in diagnosing are connected with the use of some serum biomarkers, such as interleukin-17 (IL-17), Frizzled-5 protein, Soggy-1 protein and other cytokines. Additionally, environmental toxicants such as chemicals and heavy metals might be relevant in the near future when investigating the causes of premature ovarian insufficiency. One of the main aims of the therapy is to focus on maintaining fertility among women with POI, since it is essential for patients considering their young age. Among the newest approaches listed there are different types of stem cells, oocytes donation and in-vitro activation, all of which are recently gaining in importance.

A comprehensive use of ultrasound examination in infertility workup

Considering the growing availability of ultrasound diagnostic methods in gynecology, its role in the infertility setting is increasing.In this review, we present an up-to-date ultrasound based diagnostic scheme in infertility workup comprising the evaluation of ovarian anatomy and function, uterine exploration, as well as tubal patency. The possibility of performing the vast majority of infertility diagnostics by ultrasound in the ambulatory settings is not only attractive and beneficial to patients, but also to health care system.Thus, it is vital for gynecologists to implement modern non-invasive ultrasound modalities in their everyday practice.

Circulating omentin-1 levels and inflammation in polycystic ovary syndrome

OBJECTIVES

The aim of the study was to analyze interrelation between plasma omentin-1 levels and nutritional status and inflammation in PCOS.

MATERIAL AND METHODS

A cross-sectional study involving 86 PCOS (47 obese) and 72 Non-PCOS women (41 obese) determined anthropometric parameters and body composition. Serum glucose, insulin and omentin-1, TNF-α, sTNFRs, IL-6 and sR-IL6 were measured in the fasting state.

RESULTS

Plasma omentin-1 levels were significantly lower in the PCOS than in the Non-PCOS group and both corresponding normal weight and obese subgroups. In three analyzed least-angle regression (LARS) models the lower plasma omentin- 1 levels was associated with PCOS occurrence, higher circulating TNF-α and lower IL-6 levels.

CONCLUSIONS

Suppressed omentin-1 levels in PCOS are characteristic for this disturbance and proinflammatory cytokines are factors modifying secretion of this adipokine.

Circulating vaspin levels and nutritional status and insulin resistance in polycystic ovary syndrome

OBJECTIVES

The study aimed to assess the associations between circulating vaspin levels and nutritional status (assessed on tha basis of BMI) as well as insulin resistance in PCOS.

MATERIAL AND METHODS

Eighty-seven PCOS women, 48 obese and 39 normal weight, were enrolled in the cross-sectional study. Seventy-two Non-PCOS women, 41 obese and 31 normal weight, constituted a control group. Body mass, height and waist circumference as well as body composition by bioimpedance were measured. In the morning (16h after the last meal) we determined: serum glucose, insulin, androgens, gonadotropin (LH, FSH) and sex hormone-binding globulin (SHBG) as well as plasma vaspin levels. Standard HOMA-IR formula was used to assess insulin resistance (IR).

RESULTS

Plasma vaspin levels were significantly lower in PCOS, both normal weight and obese, than in Non-PCOS groups. Vaspin levels were similar in normal weight and obese PCOS subgroups. There was no association between plasma vaspin levels and anthropometric parameters in PCOS group. While in Non-PCOS group a negative correlation between plasma vaspin levels and body mass (r = -0.26; p < 0.05) was found. We did not observe correlations between plasma vaspin levels and serum glucose and insulin concentrations as well as HOMA-IR values, however, in multivariable, stepwise backward regression waist circumference and HOMA-IR values explained 18.0% of plasma vaspin levels variability in the study subjects.

CONCLUSIONS

PCOS occurrence is associated with decreased vaspin levels. The influence of nutritional status on vaspin level observed in Non-PCOS is abolished in PCOS women, possibly by more severe insulin resistance.

Mayer-Rokitansky-Küster-Hauser syndrome - case studies, methods of treatment and the future prospects of human uterus transplantation

OBJECTIVE

We aimed to present patients with the Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) coming from one center and presenting all the possibilities of its treatment, at the forefront with the uterine transplantation.

PATIENTS AND METHODS

The presented work is an example of different types of MRKH syndrome diagnosed in 25 women who were diagnosed in the Department of Gynecological Endocrinology due to the primary amenorrhea from 01/2001 to 06/2018.

RESULTS

Patients suffering from MRKH syndrome are capable of having genetic offspring but are unable to give birth to their own child, due to an absence of the uterus, blindly terminated vagina, and normal ovaries. Patients suffering from this syndrome have the opportunity to receive treatment in accordance with their current needs. However, there are many medical, technical, and ethical limitations in achieving the most important therapeutic target: uterine transplantation and childbirth.

CONCLUSIONS

Until a few years ago, patients with an absolute uterine factor of infertility, including women with MRKH syndrome, had a real choice of only two equally controversial options giving a chance for motherhood - surrogacy and adoption. However, modern transplantation has shown that a third option - a uterine transplant - exists and is available.

The correlation between the concentration of hepcidin in serum and the occurrence of insulin resistance and hyperandrogenemia in women with polycystic ovary syndrome

OBJECTIVE

Scarce clinical and experimental studies suggest that hepcidin can be a protein participating in the development of metabolic disorders, while its synthesis and concentration in the circulation outside of the iron metabolism parameters can be influenced by hormones. The aim of the present study was to determine the correlation between the concentration of hepcidin in serum and the occurrence of insulin resistance and hyperandrogenemia in women with PCOS.

PATIENTS AND METHODS

Five groups of women with PCOS were divided based on: correct body mass (17 without hyperandrogenemia and insulin resistance - G1; 17 with hyperandrogenemia and without insulin resistance - G2; 11 without hyperandrogenemia and with insulin resistance - G3; 10 with hyperandrogenemia and insulin resistance - G4), metabolic and hormonal parameters and selected markers of iron metabolism.

RESULTS

Serum glucose levels were significantly higher in the group G3 than G1 and in the group G4 than G1 and G2. Serum insulin levels and HOMA-IR values were significantly higher in the groups G3 and G4 than G1 and G2. Serum androstenedione levels were significantly higher in the group G2 than G1 and G3 than G2. Serum transferrin levels were significantly lower in the group G1 than in the reaming study groups.

CONCLUSIONS

It has been demonstrated that insulin resistance and hyperandrogenemia appear to be the factors decreasing the concentration of transferrin circulation, but not the remaining parameters of the iron metabolism in the studied women. No relationship between the concentration of hepcidin circulation and other studied parameters of the iron metabolism and the parameters of the carbohydrate metabolism was discovered. Androstenedione can stimulate hepcidin synthesis in women with PCOS with correct body mass.

Hormonal and metabolic aspects of acne vulgaris in women with polycystic ovary syndrome

OBJECTIVE

Acne vulgaris in women can indicate a systemic disease, such as polycystic ovary syndrome (PCOS), which is associated with hormonal and metabolic disorders. The aim of this study was to investigate the influence of hormonal and metabolic disorders on acne vulgaris in women with PCOS.

PATIENTS AND METHODS

The study included 110 women with PCOS. Women were divided according to their androstenedione concentration: within reference range (n=66) or higher (n=44). All patients were between 17-36 years old. Acne was graded according to the US FDA scale for a five-category global system (acne global severity scale). Hirsutism was defined using a modified Ferriman-Gallwey method. Fasting plasma glucose, insulin, luteinizing hormone, follicle-stimulating hormone, 17α-hydroxyprogesterone, 17-beta-estradiol, sex hormone-binding globulin and androgen (androstenedione, total testosterone, free testosterone, dehydroepiandrosterone sulfate) were assessed, as were prolactin and cortisol concentrations. Thyrotropin and free thyroxine concentrations were also measured. The free androgen index (FAI) and homeostatic model assessment-insulin resistance (HOMA-IR) index were calculated.

RESULTS

The average age and rating on the hirsutism scale were similar in both analyzed groups. A higher percentage of severe acne was observed in the group of women with an androstenedione concentration within reference range than in the group with the higher concentration. Meanwhile, the severity of acne in the group of PCOS women with the higher androstenedione concentration was correlated with higher concentrations of total testosterone, free testosterone, dehydroepiandrosterone sulfate, and cortisol. Increased glucose concentration was also proportional to the severity of acne. We did not observe a statistically significant correlation between the severity of acne and the androstenedione concentration. In the group of PCOS women as a whole, the severity of acne was correlated only with higher dehydroepiandrosterone sulfate concentration; other androgens did not affect the severity.

CONCLUSIONS

The acne global severity scale in PCOS women is associated with higher concentrations of total testosterone, free testosterone, dehydroepiandrosterone sulfate, and FAI value. Higher concentrations of androstenedione did not affect acne severity.

The effect of abdominal obesity in patients with polycystic ovary syndrome on metabolic parameters

OBJECTIVE

Polycystic ovarian syndrome and obesity contribute to the metabolic complications for women of reproductive age. The aim of present study was to analyze the effect of abdominal obesity expressed using waist/hip ratio (WHR) in patients with polycystic ovary syndrome on metabolic parameters.

PATIENTS AND METHODS

The study included 659 women with PCOS with WHR <0.8 and ≥0.8 aged between 17 and 44 years. Patients were tested for follicular stimulating hormone, luteinizing hormone, 17-beta-estradiol, dehydroepiandrosterone sulfate, androstenedione, sex hormone binding globulin, and total lipid profile during the follicular phase (within 3 and 5 days of their menstrual cycle). Also, fasting glucose and insulin concentrations, and after, oral-glucose glucose administration, were determinate. De Ritis and Castelli index I and II were calculated.

RESULTS

Women with WHR ≥0.8 had higher concentration of glucose and  insulin (both fasting and after 120 min of oral administration of 75 g glucose), as well as HOMA-IR value, than women with WHR value < 0.8. Also, abdominal obesity disorders hormonal parameters. Higher free androgen index and lower concentration of sex hormone binding globulin and dehydroepiandrosterone sulfate were found in female with WHR ≥ 0.8. Follicular stimulating hormone, luteinizing hormone, androstenedione, and 17-beta-estradiol, were on similar level in both groups. Elevation in triglycerides, total cholesterol, and low-density lipoprotein levels, as well as decrease in high density lipoprotein level in serum of women with WHR value ≥ 0.8, were found when compared to women with WHR < 0.8. A statistically significant correlation was found between WHR value and glucose, insulin, sex hormone binding globulin, free androgen index and lipid profile parameters.

CONCLUSIONS

Abdominal obesity causes additional disorders in metabolic and hormonal parameters in PCOS women, which confirmed changes in analyzed parameters between PCOS women with WHR < 0.8 and WHR ≥ 0.8 and statistically significant correlations between WHR value and analyzed parameters.

Thyroid disorders in polycystic ovary syndrome

OBJECTIVE

Thyroid disorders, especially Hashimoto's thyroiditis (HT), are observed significantly more often in patients with polycystic ovary syndrome (PCOS) than in the general population - approximately 27% and 8%, respectively. This is extremely important in young women, because both disorders are connected with fertility problems. As HT and PCOS occur together, fertility problems may become a serious clinical issue in these patients.

MATERIALS AND METHODS

A systematic literature review in PubMed of PCOS- and HT-related articles in English, published until December 2015 was conducted.

RESULTS

The reasons for joint prevalence still remain unclear. Genetic and autoimmune backgrounds are recognized to be possible common etiological factors. Three genetic polymorphisms have been described to play a role in PCOS as well as in HT. They are polymorphism of the gene for fibrillin 3 (FBN3) regulating the activity of transforming growth factor-b (TGF-b) and regulatory T cell levels, gonadotropin-releasing hormone receptor (GnRHR) polymorphism and CYP1B1 polymorphism standing for estradiol hydroxylation. High estrogen-to-progesterone ratios owing to anovulatory cycles, as well as high estrogen levels during prenatal life, disrupt development of the thymus and its function in maintaining immune tolerance, and are suspected to enhance autoimmune response in PCOS. Vitamin D deficiency could be also involved in the pathogenesis of HT and PCOS.

CONCLUSIONS

The above-mentioned common etiological factors associated with fertility problems in HT and PCOS require further research.

Immunohistochemical localization of selected pro-inflammatory factors in uterine myomas and myometrium in women of various ages

Uterine myomas represent one of the most frequently manifested benign tumors in women. They originate from smooth muscle cells of myometrium or its blood vessels. Many studies suggest that inflammation and pro-inflammatory factors may play a role in the carcinogenesis with an involvement of the transcription factor NF-kappaB which activity can be controlled by various environmental factors, including many cytokines. The aim of the study was to investigate the expression of NF-B, interleukin-1β (IL-1β), tumor necrosis factor a (TNF-α), cyclooxygenase 2 (COX-2) and inducible nitric oxide synthase (iNOS) in myometrium and uterine myomas of women of various age. The expression of NF-kappaB, selected cytokines and enzymes was estimated in women of reproductive or perimenopausal age by semiquantitative immunohistochemistry. The expression of the examined proteins was higher in myomas than in control myometrium and was dependent on the size of myomas and the age of women. However, the expression of the cytoplasmic NF-kappaB observed in uterine myomas was independent on the size of myomas and no significant differences were observed in the number of stained nuclei between control and myoma groups. Thus, the expression of proinflammatory factors in myomas was not accompanied by the nuclear activation of NF-kappaB p65. The results of our study indicate that the examined factors may be involved in the pathogenesis of benign tumors and not only malignant diseases.

Ozonotherapy in an induced septic shock. I. Effect of ozonotherapy on rat organs in evaluation of free radical reactions and selected enzymatic systems

The confirmed advantageous effects of oxygen/ozone therapy in several clinical conditions stimulated experimental studies on effects of the therapy in rats with an induced septic shock. The studies were conducted on adult male rats of Wistar strain. Four groups of the animals, each of 15 rats, included: I--control group, (C); II--animals intraperitoneally administered with O(2)/O(3) (CO), III--rats given of Escherichia coli endotoxin (lipopolysaccharide-LPS) (CL), IV--rats administered with the lipopolysaccharide plus administered with the oxygen/ozone mixture (OL). Activities of catalase and superoxide dismutase and of free radical reactions were estimated. The exposure to LPS augmented activities of SOD and of catalase in liver, lungs and heart. In all the examined organs LPS induced significant changes in levels of free radicals. Except of the lungs, parallel administration of the rats with LPS and ozone/oxygen revoked development of the alterations. The obtained results point to a strong, stabilizing and regenerative effect of ozonotherapy.

Lipid peroxidation and activity of antioxidative enzymes in the rat model of ozone therapy

Hypothetical, therapeutic effects of ozone were investigated in an animal model. One ml of oxygen or mixture of 40 micrograms ozone with oxygen were injected intraperitoneally to male rats for 10 days. Previously, rats had been poisoned with 50 ppm Cd2+ in drinking water for 12 weeks. Exhaustive treadmill running was applied to some animals before sacrification. Ozone injections increased iron-ascorbate-stimulated lipid peroxidation (LPO) in the liver and kidney, catalase (CAT) activity in the heart and glutathione S-transferase (GST) activity in the heart, kidney and liver. Oxygen increased GST activity in the brain and reduced glutathione peroxidase (GPX) activity in the kidney. Cadmium enhanced LPO in the liver and GST activity in the brain, heart, kidney and liver. In contrast to ozone, cadmium inhibited GPX activity in the brain, kidney and liver. Cadmium combined with ozone enhanced the changes of GPX activity in the kidney and liver, that of GST activity in the heart, kidney and liver as well as of CAT activity and LPO in kidney. The results suggest that ozone injections combined with tested factors may provoke an oxidative stress. The effects of ozone therapy can not be explained as the results of ozone action on the antioxidative enzymes in rat.

Ozonotherapy

The medical use of ozone intraarterially, subcutaneously, intramuscularly and externally and in autohaemotransfusion or as a gas introduced into body cavities, as well as drops, compresses or liquids for rinsing etc. brings about very good therapeutic results. Ozone exerts a positive effect on oxygen and nutrient supply of cells, it enhances immunological processes, inhibits inflammatory processes, has a bacterio-, fungi- and virusostatic action when there is impaired resistance to microorganisms, improves rheological properties of the blood and exhibits no side effects in patients. Consequently ozonotherapy may be regarded asan effective method of treatment.

Ultrastructural studies on organs of cadmium-poisoned rats treated with oxygen-ozone mixture

Rats poisoned with cadmium acetate during 12 weeks, at a dose of 50 mg/dm3 given in drinking water, were treated with oxygen-ozone mixture as intraperitoneal injection during the last 10 days of the experiment, at a daily dose of 1 cm3 and ozone concentration 40 micrograms/cm3. The mixture was made of medical oxygen with a Bioozon U type apparatus produced by B. Prochazka GmbH, Germany, Reutlingen. Control groups included animals treated with the above mixture with no cadmium, and rats poisoned with cadmium, with no oxygen-ozone treatment. Liver and cardiac muscle were examined in TEM Philips EM 301. Morphological traits of a protective of the mixture against cadmium-poisoning were observed in both those organs. This was expressed as weaker destructive changes within the endoplasmic reticulum, basal cytoplasm and lysosome of the hepatocytes, and additionally as a stabilization of contractile apparatus fibres in the heart myocytes.