The protective effects of resveratrol pretreatment in cyclophosphamide-induced rat ovarian injury: an vivo study

OBJECTIVES

To explore whether resveratrol (Res) pretreatment could exert a protective effect on cyclophosphamide (Cy) induced ovarian toxicity in a rat model.

METHODS

Twenty-four female 7-week old Sprague-Dawley rats were randomly divided into four groups: Con, administered with vehicle solutions; Cy, treated with Cy; Res + Cy, treated with Cy + Res combined; Res, treated with Res. After 21 d of treatments, the rats were euthanized and blood samples were collected to evaluate the levels of anti-Müllerian hormone (AMH). The Ovaries were processed for immunohistochemical and western blotting.

RESULTS

Cy-treat caused the decrease of body weights and ovarian weight. AMH was lower in Cy group, whereas AMH levels were similar among other groups. Histomorphology showed a large number of primordial follicles were activated in Cy groups, whereas the primordial follicles were inhibited in the Res and Res + Cy groups. The expressions of Sirt1, Foxo3a were up-regulated and p53, Caspase-3, and Bax were down-regulated in Res + Cy and Res groups (p < .05).

CONCLUSIONS

Res can prevent the primordial follicle activation and decrease apoptosis induced by Cy. Res may be an effective protection for ovarian function during chemotherapy, which means a new nonsurgical application for protection of ovarian reserve.

Decision regret and associated factors following oocyte cryopreservation in patients with diminished ovarian reserve and/or age-related fertility decline

PURPOSE

To evaluate the prevalence and factors associated with decision regret following oocyte cryopreservation (OC) in women with diminished ovarian reserve (DOR) and/or age-related fertility decline (ARFD).

METHODS

A cross-sectional survey study was conducted to five hundred fifty-two women with DOR and/or ARFD who underwent OC between 2014 and 2019 in two private-assisted reproductive units in Istanbul, Turkey. Decision regret was measured using the validated Decision Regret Scale (DRS).

RESULTS

The median and mean DRS scores were 10 (interquartile range: 25) and 13.4 (SD: 13.2, range 0-70), respectively. Eighty-five (52.5%) women reported mild regret and 26 (16%) had moderate to severe regret. Decision regret was inversely associated with the belief in fate regarding childbearing and trust in the efficacy of OC.

CONCLUSIONS

The prevalence of severe decision regret among patients with DOR and/or ARFD undergoing OC is low. Women who had belief in fate and trusted in the efficacy of oocyte cryopreservation had significantly lower decisional regret.

The Protective Effects of L-Carnitine and Zinc Oxide Nanoparticles Against Diabetic Injury on Sex Steroid Hormones Levels, Oxidative Stress, and Ovarian Histopathological Changes in Rat

Diabetes mellitus is a common chronic metabolic disorder. This study aimed to investigate the effects of co-treatment with L-carnitine (LC) and zinc oxide nanoparticles (ZnONPs) on serum levels of sex hormones, oxidative stress, and ovarian histopathology in streptozotocin (STZ)-induced diabetic rats. Female Wistar rats (n = 56, 180-220 g) received a single intraperitoneal (IP) injection of STZ (65 mg/kg). They were randomly assigned into the following groups: diabetic group (Dia), Dia+Met group (100 mg metformin/kg/day), Dia+LC group (200 mg/kg/day), Dia+ZnONPs group (10 mg/kg/day), and Dia+LC+ZnONPs group (200 mg LC/kg/day and 10 mg ZnONPs/kg/day). Control group (Ctl) received the same volume of STZ solvent. After 21 days of treatment, blood serum was centrifuged for sex hormone assays. The right ovary was used for biochemical analysis, and the left ovary was fixed in 10% neutral buffered formalin for histological assessment. The levels of estradiol, progesterone, FSH, and LH significantly increased in the Dia+ZnONPs+LC group (P < 0.001) compared with the Dia group. Co-treatment with LC and ZnONPs reduced malondialdehyde and carbonyl protein and increased glutathione, catalase, and superoxide dismutase activities in ovarian tissue compared with the Dia group (P < 0.05). Moreover, the number of all ovarian follicles significantly increased in this group compared with the Dia group (P < 0.05). The results of this study indicated that co-treatment with LC and ZnONPs could preserve ovarian function by increasing sex hormones levels and antioxidant activity and decreasing lipid peroxidation in diabetic rats. Therefore, this compound supplementation may improve ovulation and fertility in people with diabetes mellitus.

An assessment of the protective effect of gonadotropin-releasing hormone agonist and antagonist on bleomycin-induced ovarian toxicity in rats

The aim of this study is to evaluate the effect of GnRH agonist or GnRH antagonist therapy on bleomycin-administered rats by examining ovarian follicle counts and AMH levels. A total of 30 female Wistar albino rats aged 4-6 months were randomly divided into 4 groups. First, an intramuscular injection of bleomycin (30 mg/m2) was administered to all except the control group on the 1st, 8th and 15th days. The control group (Group I) was administered 0.1 mL intramuscular saline on those days. The bleomycin group (Group II) was followed up without any further treatment. The bleomycin + GnRH agonist group (Group III) was administered subcutaneous GnRH agonist triptorelin (1 mg/kg) at the same time as the bleomycin injections. The bleomycin + GnRH antagonist group (Group IV) was administered 1 mg/kg cetrorelix acetate subcutaneously, concurrently with the bleomycin. Although AMH levels were lower in the bleomycin group than in all the other groups, there was no statistically significant difference between the groups in terms of AMH levels (p > .05). In the bleomycin + cetrorelix acetate and bleomycin + triptorelin groups, significantly higher primordial, secondary and tertiary follicle counts were determined compared to the bleomycin group (p < .001). In conclusion the harmful effects of bleomycin on ovarian reserve can be reduced by the simultaneous administration of GnRH agonist or GnRH antagonist.

Protective effect of Tualang honey against cadmium-induced morphological abnormalities and oxidative stress in the ovary of rats

BACKGROUND

To investigate the protective effects of Tualang honey against the toxicity effects induced by cadmium (Cd) on the ovary.

METHODS

A total of 32 female Sprague Dawley rats were taken and randomly divided into four groups (n = 8). Throughout the experimental period of 6 weeks, negative control-NC (vehicle deionized water), positive control-CD (Cd at 5 mg/kg), Tualang honey followed by Cd exposure-TH (Tualang honey at 200 mg/kg and Cd at 5 mg/kg) and Tualang honey control-THC (Tualang honey at 200 mg/kg) groups, were administered orally on a daily basis.

RESULTS

Rats exposed to Cd were significantly higher in ovarian weight, number of antral and atretic follicles as compared to the NC group. The disruptive effects of Cd on ovarian follicles were associated with a disruption in gonadotropin hormones and decreases in follicular stimulating hormone (FSH) and luteinizing hormone (LH). Moreover, a significant formation of oxidative stress in ovarian Cd-exposed rats has been proven by increasing the level of lipid peroxidation products (malondialdehyde) and decreasing the levels of enzymatic antioxidant (catalase). Interestingly, a daily supplementation of high antioxidant agents such as Tualang honey in these animals, caused significant improvements in the histological changes. Additionally, less atretic follicles were observed, restoring the normal level of LH and FSH (P < 0.001), and normalizing the ovarian malondialdehyde (P < 0.05) and catalase levels in comparison with CD group (P < 0.05).

CONCLUSIONS

Tualang honey has protective effects against Cd-induced ovarian toxicity by reducing morphological abnormalities, restoring the normal levels of gonadotropin hormones and stabilizing equilibrium levels of lipid peroxidation and antioxidant enzyme in ovaries of rats.

Granulocyte Colony-Stimulating Factor Prevents Ischemia/Reperfusion-Induced Ovarian Injury in Rats: Evaluation of Histological and Biochemical Parameters

Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein commonly used in the field of medicine to treat neutropenia. Granulocyte colony-stimulating factor has also crucial roles in ameliorating the ischemia/reperfusion (I/R) injury in particular tissues. In this study, we aimed to investigate the protective effect of G-CSF on ovarian damage in experimental ovarian I/R injury. Thirty adult female rats were used. Rats were separated randomly into 5 groups; Group 1: sham group (abdominal wall was opened and closed surgically), Group 2: torsion group with 3-hour ischemia using vascular clips. Group 3: torsion + G-CSF group with 3-hour ischemia 30 minutes after the administration intraperitoneal (i.p.) of 100 µg/kg of G-CSF. Group 4: torsion-detorsion group with 3 hour ischemia and 3 hour reperfusion. Group 5: torsion-detorsion + G-CSF group with 3 hour ischemia followed by 100 µg/kg of G-CSF i.p. administration 30 minutes prior to 3 hour of detorsion/reperfusion. Ovarian tissue damage was scored on histopathology. Ovarian tissue malondialdehyde (MDA) was measured biochemically. In comparison with the sham group, both the torsion and torsion-detorsion groups had significantly higher scores for follicular degeneration, vascular congestion, edema, hemorrhage, and leukocyte infiltration (P < .05). When compared group torsion-detorsion + G-CSF to group torsion-detorsion, parameters aforementioned significantly decreased in group torsion-detorsion + G-CSF (P < .05). Granulocyte colony-stimulating factor has also decreased MDA levels notably both in the torsion + G-CSF and torsion-detorsion + G-CSF groups (P < .05, P < .01). Our experimental study suggests that G-CSF can be a novel agent for the treatment of ovarian I/R injury.

The protective effect of Gingko biloba in a rat model of ovarian ischemia/reperfusion injury: Improvement in histological and biochemical parameters

BACKGROUND

Ovarian torsion is one of the most common gynecological emergencies, which especially affects women of reproductive age.

OBJECTIVES

We aimed to evaluate the effect of Ginkgo biloba (GB) supplementation in ovarian ischemia/ reperfusion injury in an experimental torsion/de-torsion rat model.

MATERIAL AND METHODS

This study was carried out in the Ege University Faculty of Medicine in Izmir, Turkey. Thirty mature female Sprague-Dawley albino rats were randomly divided into 5 groups: in Group 1 (control), the abdominal wall was only opened and closed; in the torsion group (Group 2), ischemia was induced for 3 h, using atraumatic vascular clips to create a torsion model; in the torsion/GB group (Group 3), the rats were given 80 mg/kg (oral gavage) of GB 30 min before torsion was induced and the torsion model was formed; in the torsion/de-torsion group (Group 4), the rats underwent 3 h of ischemia and then the vascular clips were removed and reperfusion took place for 3 h; in the torsion/de-torsion/GB group (Group 5), the rats underwent 3 h of ischemia followed by GB (oral gavage) 30 min prior to a 3-h reperfusion period. Ovarian tissue damage was evaluated by a histopathological scoring system. Ovarian tissue malondialdehyde (MDA) and plasma pentraxin-3 were measured.

RESULTS

In comparison with the sham group, both the torsion and torsion/de-torsion groups had significantly higher scores for follicular degeneration, vascular congestion, edema, hemorrhage, and leukocyte infiltration. Ginkgo biloba significantly decreased these scores in both groups. Ovarian malondialdehyde and plasma pentraxin 3 were significantly higher both in the torsion and torsion/de-torsion groups compared with the sham group. Ginkgo biloba decreased these levels significantly both in the torsion/GB and torsion/de-torsion/GB groups.

CONCLUSIONS

Supplementing GB during a surgical procedure decreases ischemia/reperfusion injury to an ovary in an experimental rat model based on histopathological parameters, tissue malondialdehyde, and plasma pentraxin-3 levels.

The protective effects of gonadotropin-releasing hormone agonist on ovarian functions in breast Cancer patients receiving chemotherapy

In recent decades, the incidence rate of breast cancer has increased dramatically worldwide and has become one of the most prevalent cancers in women. According to the global data provided by the WHO, there were more than 1.7 million new cases of breast cancer in 2012, accounting for 25% of all reported cancer cases and 15% of all reported deaths among females. To most young patients, especially those younger than 40 years of age, chemotherapy should be taken into consideration as a treatment modality, even if the tumor size is small or without lymphatic metastasis. A significant portion of the patients will suffer from the side effects that result from long-term chemotherapy regimens, such as myelosuppression, heart failure, and development of a second primary malignancy. Ovarian suppression and premature ovarian failure (POF) are the most common side effects reported as they have notable clinical symptoms; the incidence rates have been reported to be in a range of 10-90%. Gonadotropin-releasing hormone agonists (GnRH-a), also termed luteinizing hormone release hormone agonists (LHRH-a), may very well offer a solution to treating these side effects. This article aims to summarize advanced studies concerning protective effects of GnRH-a on ovarian functions in the setting of breast cancer under chemotherapy.

Aliskiren - a promising strategy for ovarian ischemia/reperfusion injury protection in rats via RAAS

The aim of this study was to evaluate the effects of aliskiren, direct renin inhibitor, as an antioxidant and tissue protective agent and evaluate the molecular, biochemical, and histopathological changes in experimental ischemia and ischemia/reperfusion injury in rat ovaries. Forty-eight female rats were randomly divided into eight groups: in Group 1, only sham operation was performed. Group 2 received 100 mg/kg aliskiren and sham operated. In Group 3, 3 h-period of bilateral ovarian ischemia was applied. Group 4 received a 3-h period of ischemia followed by 3 h of reperfusion. Groups 5 and 6 received 50 and 100 mg/kg, respectively, of aliskiren and bilateral ovarian ischemia was applied (after a 3-h period of ischemia, both ovaries were surgically removed). To Groups 7 and 8, 50 and 100 mg/kg of aliskiren were administered, respectively, and the induction of ischemia was performed. At the end of a 3-h period of ischemia, bilateral vascular clips were removed, and 3 h of reperfusion continued. After the experiments, IL-1β, IL-6, TNF-α, and iNOS mRNA expressions and SOD, GSH, MDA, renin, and angiotensin-II levels were determined and histopathological changes were examined in rat ovaries. Aliskiren treatment normalized excessive changes in cytokine and oxidative stress markers in both ischemia and ischemia/reperfusion injury. Histopathologically, treatment with aliskiren ameliorated the development of ischemia and/or ischemia/reperfusion tissue injury. This study concluded that aliskiren treatment is effective in reversing ischemia and/or ischemia/reperfusion induced ovary damage via the improvement of oxidative stress, reduction of inflammation, and suppression of the renin-angiotensin aldosterone system.

Postoperative administration of dienogest for suppressing recurrence of disease and relieving pain in subjects with ovarian endometriomas

To assess the effect of dienogest on recurrence of ovarian endometriomas and severity of pain after laparoscopic surgery, a retrospective study of 81 patients was performed at three institutions in Osaka, Japan. Patients had a six-month minimum follow-up after laparoscopic surgery for ovarian endometriomas performed between June 2012 and August 2014. Patients who chose to receive 2 mg dienogest daily and those who were managed expectantly postoperatively were included. Recurrence was defined as the presence of endometriomas of more than 2 cm. A visual analog scale (VAS) was used to score the intensity of pelvic pain. The cumulative recurrence rate and absolute VAS score changes between the baseline and at 6, 12, 18 and 24 months after the start of administration were evaluated in both groups. The recurrence rate was 16.5% and 24.0% in the expectant management group at 12 and 24 months, respectively. No recurrences occurred in the dienogest treatment group. The rate of VAS score reduction was significantly higher in the dienogest than in the expectant management group. Dienogest is effective on the recurrence of ovarian endometrioma and relieving pelvic pain after laparoscopic surgery.

Biochemical, Histopathological and Immunohistochemical Evaluation of the Protective and Therapeutic Effects of Thymoquinone against Ischemia and Ischemia/Reperfusion Injury in the Rat Ovary

AIM

To evaluate the antioxidant effects of thymoquinone (TQ) and to investigate the biochemical, histopathological and immunohistochemical changes in experimental rat ovarian torsion.

METHODS

A total of 48 female adult rats were used in this study and randomly divided into 7 groups: (1) sham operation; (2) bilateral 3-hour ovarian ischemia; (3) 3-hour ischemia and 3-hour reperfusion; (4) and (5) rats were administered 20 and 40 mg/kg of TQ, respectively, before 0.5 h of ischemia, and then 3 h of ovarian ischemia was applied; (6) and (7) 3-hour ovarian ischemia was applied; 2.5 h after the induction of ischemia, rats were administered the same doses of TQ; at the end of 3 h of ischemia, a 3-hour reperfusion was applied. Histologic changes under light microscopy, immunoreactivity for anticaspase-3 and serum levels of malondialdehyde, interleukin-6, catalase and glutathione peroxidase were noted and compared between the 7 groups.

RESULTS

Ischemia and ischemia/reperfusion cause a deterioration of biochemical and histopathological parameters. Administration of TQ seems to reverse these alterations and alleviate the injury. Antioxidant defense mechanisms appear to be enhanced by the administration of TQ.

CONCLUSION

TQ at different doses attenuates ovarian ischemia and ischemia/reperfusion injury in rats.

Amelioration of lead induced changes in ovary of mice, by garlic extract

OBJECTIVE

To observe the effects of lead acetate and protective role of garlic extract on the histomorphology of the ovary in an animal model.

METHODS

The experimental trial was conducted at the Department of Anatomy, Army Medical College Rawalpindi, in association with the National Institute of Health (NIH), Islamabad, from April to June 2013. It comprised 30 adult non-pregnant female mice (BALBc strain) weighing 25-27 gms. They were divided into three equal groups of 10 mice each. Group A, taken as control, was given normal diet. Group B was given lead acetate at a dose of 30 mg/kg/day. Group C was given lead acetate 30 mg/kg/day and garlic extract 500 mg/kg/day through oral gavage tube for two months. Animals were dissected a day after the last dose. Size, shape, colour and consistency of the ovary was observed. The right ovary was processed, embedded and stained for histological study. Primary follicles were counted and noted. SPSS 18 wsa used for statistical analysis.

RESULTS

The primary follicular count decreased significantly in Group B while it relatively increased in Group C. Morphology of the ovary was affected after exposure to lead acetate in Group B, while in Group C results were the same as in the Group A controls regarding gross architecture of the ovary.

CONCLUSION

Lead alters the normal histology and affects the physiology of the ovary. It interferes with the development of growing follicles in the ovary. Lead, being a reproductive toxicant, can be a cause of infertility in exposed females.

Activated AKT pathway promotes establishment of endometriosis

The pathogenesis of endometriosis remains unclear, and relatively little is known about the mechanisms that promote establishment and survival of the disease. Previously, we demonstrated that v-akt murine thymoma viral oncogene homolog (AKT) activity was increased in endometriosis tissues and cells from ovarian endometriomas and that this increase promoted cell survival as well as decreased levels of progesterone receptor. The objective of this study was to demonstrate a role for AKT in the establishment of ectopic lesions. First, a dose-dependent inhibition of AKT in stromal cells from human ovarian endometriomas (OSIS) as well as endometrial stromal cells from disease-free patients (ESC) with the allosteric AKT inhibitor MK-2206 was demonstrated by decreased levels of phosphorylated (p)(Ser473)-AKT. Levels of the AKT target protein, p(Ser256)-forkhead box O1 were increased in OSIS cells, which decreased with MK-2206 treatment, whereas levels of p(Ser9)-glycogen synthase kinase 3β did not change in response to MK-2206. Although MK-2206 decreased viability of both OSIS and ESC in a dose-dependent manner, proliferation of OSIS cells was differentially decreased significantly compared with ESC. Next, the role of hyperactive AKT in the establishment of ectopic lesions was studied using the bigenic, PR(cre/+)Pten(f/+) heterozygous mouse. Autologous implantation of uterine tissues was performed in these mice. After 4 weeks, an average of 4 ± 0.33 lesions per Pten(f/+) mouse and 7.5 ± 0.43 lesions in the PR(cre/+)Pten(f/+) mouse were found. Histological examination of the lesions showed endometrial tissue-like morphology, which was similar in both the Pten(f/+) and PR(cre/+)Pten(f/+) mice. Treatment of mice with MK-2206 resulted in a significantly decreased number of lesions established. Immunohistochemical staining of ectopic lesions revealed decreased p(Ser473)-AKT and the proliferation marker Ki67 from MK-2206-treated mice compared with vehicle-treated mice. Furthermore, levels of FOXO1 and progesterone receptor increased in lesions of mice receiving MK-2206. These results demonstrate that heightened AKT activity plays an active role in the establishment of ectopic endometrial tissues.

Factors associated with the laterality of recurrent endometriomas after conservative surgery

We evaluated the laterality of primary endometrioma and characteristics of patients according to the laterality of recurrent endometrioma in 140 women with recurrent endometrioma after conservative surgery. Histologically confirmed recurrent endometriomas were found on the left side in 49 patients (35.0%), the right in 44 (31.4%) and bilaterally in 47 (33.6%). The sites of primary endometrioma were not associated with those of recurrent endometrioma, and the recurrence rate in the treated ovary (59.8%) was similar to that of the intact ovary (69.0%) at the primary surgery. Proportions of stage IV endometriosis and posterior cul-de-sac obliteration were higher in patients with bilateral recurrence than in those with unilateral recurrence (p < 0.01 for all comparisons) and in patients with contralateral recurrence than in those with ipsilateral recurrence (p < 0.05 for all comparisons), but no differences were found in other characteristics of participants according to the laterality or pattern of recurrence. In conclusion, the lateral distribution of recurrent endometrioma was not associated with that of the primary lesion, and endometrioma did not recur more frequently in the treated ovary. An advanced stage and the presence of posterior cul-de-sac obliteration were factors associated with bilateral or contralateral recurrence of endometrioma.

Biochemical and histopathological investigation of the protective effect of disulfiram in ischemia-induced ovary damage

It was biochemically and histopathologically investigated whether disulfiram has protective effects on ischemia-induced ovary damage. For this purpose, levels of tGSH, superoxide dismutase (SOD), malondialdehyde (MDA), and 8-OH Gua/Gua were investigated in ischemic rat ovary tissue. Results show that used doses of disulfiram (10, 25, and 50 mg/kg) prevent MDA, a product of ischemia-induced lipid peroxidation, formation in female rat ovary tissue and prevent decrease of enzymatic and non-enzymatic (SOD, GSH) antioxidant parameters. Additionally, all doses of disulfiram significantly prevent DNA damage when compared to control group. Fewer histopathological findings were observed in tissues with higher antioxidant levels and lower oxidant and DNA damage levels.

Examination of the effect of melatonin use in Pomeroy method of tubal ligation on ovarian histology in rats

OBJECTIVE

To examine the effects of melatonin use in the unilateral Pomeroy method of tubal ligation on ovarian histology in rats.

SETTING

Firat University Medical School, Obstetrics and Gynecology Department, Elaziğ.

MATERIAL AND METHOD

Thirty adult, female rats of Wistar albino species with regular cycles were randomly allocated to three groups in the estrus phase: G1 (n: 10): The abdomen was opened and closed. G2 (n: 10): The group where the abdomen was opened, and the Pomeroy method of tubal ligation was performed. G3 (n: 10): The group where the abdomen was opened, and Pomeroy method of tubal ligation was performed 15 min after 10 mg/kg/ip melatonin administration. Abdomens of all rats were opened six months later and left oophorectomy was performed. Samples of the left ovary were fixed in formaldehyde. The preparations were stained with hematoxylin eosin, and primordial, primary, secondary and tertiary follicles were counted. All the numbers were added up to determine the ovarian follicle reserve. An atretic follicle count was made. The corpus luteum and corpus albicans were counted, and the number of total corpuses were calculated. Regression of angiogenesis within the corpus luteum was examined. Presence of fibrosis on ovarian stroma was examined. An ordinal scale was formed for the regression of angiogenesis within the corpus luteum and presence of fibrosis (none: 0p, present: 1p, markedly present: 2). Follicle cysts in the ovary were counted. Kruskal Wallis variance analysis was used in the statistical analysis of data; p < 0.05 were considered significant.

RESULTS

The comparison between G1 and G3 showed that all values were similar (p > 0.05, Kruskal Wallis variance analysis). When G2 was compared with G1 and G3, regression of angiogenesis in the corpus luteum was found to be significantly lower (p < 0.05, Mann Whitney U test), while atretic follicle count and fibrosis were significantly higher in G2 (p < 0.05, Mann Whitney U test).

CONCLUSION

The Pomeroy method of tubal ligation reduces regression of angiogenesis in the corpus luteum, and increases atretic follicles and fibrosis development. Melatonin use restores these harmful effects. Melatonin can be used to refrain from this negative effect of the Pomeroy method of tubal ligation on the ovary.

[Effect of NF-kappaB activation inhibitor curcumin on the oogenesis and follicular cell death in immune ovarian failure in mice]

In experiments on CBA mice, we studied the influence of an inhibitor of nuclear transcription factor kappaB activation curcumin, obtained from Curcuma longa, on the meiotic maturation of oocytes and apoptotic and necrotic death of follicular cells at immune ovary failure induced by immunization of animals with allogenic ovarian extracts. NF-kappaB plays a pivotal role in the induction of genes encoding pro-inflammatory factors (cytokines, adhesion molecules, inducible NO-synthase and cyclooxygenase) and in regulation of cell proliferation and death. It has been shown that immunization of mice increased the death of follicular cells through anapoptotic and necrotic pathways, which led to inflammatory response (according to blood leukogram and impairment the oocyte meiotic maturation at metaphase I and II). Intragastric administration of curcumin (Sigma, USA, 2 mg of the mouse weight, four times a week during the period of immunization) reduced the number of the follicular cells died through apoptotic and especially necrotic pathway. Curcumin attenuated an inflammatory response and improved the meiotic maturation of oocytes impaired under experimental immune ovarian failure in mice.

Caffeic acid phenethyl ester prevents ovary ischemia/reperfusion injury in rabbits

Protective effect of caffeic acid phenethyl ester (CAPE) on ovary ischemia/reperfusion (IR) injury was investigated in this study. Twenty four New Zealand rabbits were divided into 4 groups as follows: group S served as sham. Group C was intraperitoneally injected with CAPE (8.5mg/kg). In groups E+IR and C+IR, 1% ethanol and CAPE was given intraperitoneally before torsion, respectively. Then, the ovaries were subjected to IR in both groups. Ovary reduced glutathione (GSH) level and glutathione peroxidase (GSH-Px) activity in group E+IR were significantly reduced compared to that of group S. GSH level and GSH-Px activity was significantly increased in group C+I/R. Thiobarbituric acid reactive substances (TBARS) and catalase (CAT) activity in group E+I/R was significantly higher than in group S. CAT activity was decreased to normal levels by CAPE treatment in group C+I/R, while TBARS in group C+IR was significantly reduced compared to that of E+IR. According to histopathological examination, severe congestion, hemorrhage, edema and leukocyte infiltration were observed in E+I/R group. CAPE prominently reduced degenerative effects of IR injury thus it alleviates free radical damage. In conclusion, CAPE which is able to prevent IR-induced injury in the ovaries may be of therapeutic value before the surgical correction.

The role of iron in the pathogenesis of endometriosis

BACKGROUND

Endometriosis may cause symptoms including chronic pelvic pain and infertility, and increases susceptibility to the development of ovarian cancer. Genomic studies have started to delineate the wide array of mediators involved in the development of endometriosis. Understanding the mechanisms of endometriosis development and elucidating its pathogenesis and pathophysiology are intrinsic to prevention and the search for effective therapies.

METHOD OF STUDY

The present article reviews the English language literature for biological, pathogenetic and pathophysiological studies on endometriosis. Several recent genomic studies are discussed in the context of endometriosis biology.

RESULTS

Severe hemolysis occurring during the development of endometriosis results in high levels of free heme and iron. These compounds oxidatively modify lipids and proteins, leading to cell and DNA damage, and subsequently fibrosis development. Recent studies based on genome-wide expression analysis technology have noted specific expression of heme/iron-dependent mediators in endometriosis. The heme/iron-dependent signaling pathway of endometriosis, which is providing new insights into the regulation of inflammation, detoxification and survival, is discussed.

CONCLUSION

Several important endometriosis-specific genes overlap with those known to be regulated by iron. Other genes are involved in oxidative stress. Iron has a significant impact on endometriotic-cell gene expression. This review summarizes recent advances in the heme/iron-mediated signaling and its target genes, outlines the potential challenges to understanding of the pathogenesis and pathophysiology of endometriosis, and proposes a possible novel model.

[Fetal echocardiography in fetal ovarian cysts]

OBJECTIVES

The aim of the study was to evaluate the outcome of fetuses with ovarian cysts in relation to fetal echocardiography.

MATERIAL AND METHODS

In the Department for Diagnosis and Prophylaxis of Birth Defects at the Polish Mother's Memorial Hospital in Lodz fetal echocardiography was performed in 21 fetuses with ovarian cysts between the years 1995-2006.

OUTCOMES

In 18 out of 21 (86%) fetuses we have found normal heart anatomy (NHA) and in 3 fetuses congenital heart defect (CHD). In 7 out of 18 (39%) fetuses with NHA there were functional anomalies, including 5 fetuses with hypertrophy Four neonates with hypertrophy required surgical procedures after the delivery. Prenatal hypertrophy was not observed in case of only one neonate which was operated after the delivery.

CONCLUSIONS

1. Fetal echocardiography studies were very often abnormal in fetus with ovarian cysts (mainly as functional anomalies). 2. Functional anomalies detected in fetal echocardiography more often resulted in surgical procedures after the birth, whereas normal heart study was more often connected with spontaneous regression of ovarian cyst (p=0.0265).

Does sphingosine-1-phosphate have a protective effect on cyclophosphamide- and irradiation-induced ovarian damage in the rat model?

The aim of this study was to assess the possible protective effect of sphingosine-1-phosphate (S1P), a polar sphingoid metabolite that seemingly promotes cell survival, on cytotoxin- and irradiation-induced ovarian injury in the rat model. Administration of S1P into ovarian bursa before whole-body irradiation led to decreased percentage of apoptotic cells, mostly in primordial follicles; however, S1P was not effective against apoptosis in rats that were given intraperitoneal cyclophosphamide.

[Assessment of the usefulness of ultrasound screening in fetal ovarian cysts]

OBJECTIVES

The aim of the study was to assess the usefulness of ultrasound in management and prognosis in fetal ovarian cysts.

MATERIAL AND METHODS

The study included 38 fetuses with cyst in abdominal cavity, who, between 1995 and 2006, underwent an ultrasound examination in our unit at the Polish Mother's Memorial Hospital in Lodz, The Department for Diagnosis and Prevention of Birth Defects.

RESULTS

In all 38 fetuses with cyst in abdominal cavity we have diagnosed 27 (74%) cases of ovarian cyst. In 14 (74%) fetuses cysts regressed spontaneously, including all cysts < or = 40mm (n = 7). In 3 cases with cysts > 40mm needle aspiration has been successfully performed, without any further complications. Surgical neonatal treatment has been performed in 5 cases in prenatal cysts > 40mm without prenatal aspiration. In 3 cases cysts > 40mm regressed spontaneously. Ovarian cysts in 22 (87%) cases were an isolated malformation; in 5 (19%) cases other malformations were present

CONCLUSIONS

1. Fetal ovarian cysts < or = 40mm required only ultrasound assessment and, in majority of cases, revealed the tendency to spontaneous regression. 2. Cysts > 40mm in maximal diameter have signaled complications more often and required surgical procedure after birth. 3. In utero, aspiration of fetal ovarian cyst > 40mm may lead to cyst regression, making the surgery after birth unnecessary.

Ovarian repositioning in pediatric cancer patients: Flexible techniques accommodate pelvic radiation fields

Treatments for childhood cancer and consequent long-term survival rates continue to improve. As the success of these therapies advances, premature ovarian failure and sterility have become an increasingly evident long-term morbidity. Abdominal and pelvic radiation have been specifically shown to induce early menopause and decreased fertility. In order to minimize radiation injury, we utilized novel techniques to reposition ovaries in two girls with pelvic tumors prior to initiation of pelvic radiation. One girl with a sacral Ewing sarcoma underwent laparoscopic anterior suspension of the ovaries, using a simple and easily reversible technique. The second patient, who underwent hysterectomy for a recurrent uterine rhabdomyosarcoma, underwent widely lateral and cephalad repositioning of the ovaries. Both procedures were well tolerated, with no significant morbidity. In both cases the ovaries were moved well beyond the planned radiation field. We propose that open or laparoscopic ovarian repositioning in children is a simple, flexible, and reversible option to reduce radiation injury to the ovaries in pediatric cancer patients.

Prevention of autoimmune gastritis in mice requires extra-thymic T-cell deletion and suppression by regulatory T cells

BACKGROUND AND AIMS

Autoimmune gastritis is one of the most common autoimmune diseases and is caused by a CD4(+) T-cell response to the gastric H(+)/K(+) ATPase encoded by Atp4a and Atp4b (H(+)/K(+) ATPase). Here, we have elucidated events that result in immunological tolerance to the H(+)/K(+) ATPase and thus the prevention of autoimmune gastritis.

METHODS

T cells from H(+)/K(+) ATPase-deficient mice and H(+)/K(+) ATPase-specific T-cell receptor transgenic mice were purified and transferred to wild-type (WT) or H(+)/K(+) ATPase-deficient recipients to assess the impact of exposure to antigen on pathogenicity.

RESULTS

The CD4(+) T-cell population from H(+)/K(+) ATPase-deficient mice was highly effective at inducing gastritis when compared with T cells from WT mice and, as a population, was comparatively resistant to the suppressive activity of regulatory T cells. Exposing T cells from H(+)/K(+) ATPase-deficient mice to H(+)/K(+) ATPase in WT mice decreased their ability to induce gastritis and resulted in a population that could be more easily suppressed by T(reg) cells. Transfer of clonotypic antigen-inexperienced H(+)/K(+) ATPase-specific T cells into WT mice resulted in extra-thymic clonal deletion.

CONCLUSIONS

Prevention of autoimmune gastritis requires the extra-thymic purging of highly autoaggressive H(+)/K(+) ATPase-specific T cells to produce a T-cell repertoire that is more susceptible to the suppressive activity of regulatory T cells. Taken together with recent published data describing the role of T-cell receptor signalling in the maintenance of regulatory T-cell populations, we propose that exposure of T cells to antigen in the periphery is able to both delete autoaggressive specificities and maintain regulatory T-cell activity, establishing a balance between pathogenicity and regulation.

[Fetal ovarian cysts--420 cases from literature--metaanalysis 1984-2005]

Despite an improvement in prenatal ultrasonographic diagnosis, the management of fetal ovarian cysts remains controversial. 420 fetuses with ovarian cyst from Medline data base have been analyzed. In 209 cases (50%), the cysts regressed spontaneously and in 145 cases (35%) cysts were complicated by torsion and intracystic hemorrhage. Surgical treatment was performed in 174 cases (41%) of neonates. Cysts < 50mm regressed spontaneously in 98% (n = 79), and cysts > 50mm in 93% resulted in complications (n = 14). After the diagnosis of fetal ovarian cysts < 50mm, serial ultrasound monitoring was recommended by the vast majority of the authors. In cases of > 50mm cysts, needle aspiration was an option in selected cases (n = 28). Spontaneous regression cysts > 50mm after needle aspiration was observed in 89% (n = 25) of the cases. Prenatal aspiration of ovarian cysts appears effective and safe, however, in the course of the last twenty years it has been performed relatively rarely.

[Natural history of fetal/newborn ovarian cyst]

OBJECTIVE

Fetal and neonatal ovarian cysts are detected freguently by ultrasonography. Prenatal ovarian cysts have a follicular or luteal origin. Their natural history is a spontaneous involution. Pre- and postnatal changes in the sonographic aspects allow to choose the appropriate therapeutical indications: conservative approach, surgery, or percutaneous aspiration. MATERIALALS AND METHODS: In retrospective review from 1992-2004 authors present 26 patients with ovarian cysts.

RESULTS

Fifteen patients were diagnosed by prenatal ultrasonography carried out between 33 and 39 weeks of gestation. Postnatally 14 were observed only and their cysts regressed, 10 with cysts larger than 4 cm, had surgical exploration, 2 patients with cysts between 2 to 4 cm were candidates for percutaneous aspiration.

CONCLUSION

1. The conservative treatment and clinical observation using ultrasonography is recommended when the ovari cystic is 40 mm in diameter. 2. When the ovari cystic is bigger then 40 mm in diameter it is recommended to perform puncture and fluid aspiration from the cystis under ultrasonography control. 3. The surgical intervention was planned when the ovari cystis was heterogenous and has been growing for a few months.

[Study of the prevention of chemotherapy-induced ovarian damage by gonadotropin-releasing hormone agonist in rat model]

OBJECTIVE

To study the effect of gonadotropin-releasing hormone agonist (GnRHa) against cyclophosphamide (CTX) induced gonado toxicity in female rats.

METHODS

Eighty Fischer 344 rats were divided into four groups which received normal saline, CTX, GnRHa and CTX + GnRHa respectively. We measured the serum estradiol and follicle-stimulating hormone (FSH) concentration monthly, and respectively killed half of the rats two months and three months later to compare the weight of the ovary, the numbers of the follicle and the mean diameter of the follicles.

RESULTS

After three months, in the rats in the CTX group, the serum estradiol and FSH were (148.3 +/- 16.5) pmol/L and (16.90 +/- 1.90) U/L respectively. They were significantly higher than (91.8 +/- 9.9) pmol/L and (7.60 +/- 0.30) U/L in the rats in the combination therapy group (P < 0.05). The follicle number of rats in the CTX group was 550 +/- 50 and the follicle number in the combination group was 1250 +/- 160. There was significant difference between two groups (P < 0.05). Between rats in the control and combination therapy groups, there was no obvious difference in all the indexes we examined.

CONCLUSIONS

Combination of the CTX and GnRHa in the rat model could decrease the CTX-induced damage to the ovarian function.

The protective effect of caffeic acid phenethyl ester on ischemia-reperfusion injury in rat ovary

OBJECTIVE

This experimental study was designed to determine the changes in tissue levels of malondialdehyde, end-product of lipid peroxidation (MDA), reduced glutathione (GSH) and xanthine oxidase (XO) and the effect of caffeic acid (3,4-dihydroxycinnamic acid) phenethyl ester (CAPE) on these metabolite levels after adnexal torsion-detorsion model in rats.

METHOD

Forty adult female albino rats were divided into five groups: basal control (n = 8), sham operation (n = 8), torsion-detorsion plus saline (n = 8), torsion-detorsion plus CAPE (n = 8). and only torsion (n = 8). Rats in the sham operation group underwent a surgical procedure similar to the other groups but the adnexa was not torsioned. Rats in the torsion group were killed after 360 degrees clockwise adnexal torsion for 3 h and ovaries were harvested. CAPE was injected intraperitoneally 30 min before detorsion in the CAPE/detorsion group and saline was administered in the saline/detorsion group. After 3 h of adnexal detorsion, the rats in both groups were killed and adnexa were surgically removed.

RESULTS

MDA levels and XO activities in torsion-detorsion plus saline group increased significantly when compared to basal control, torsion and sham operation groups (P < 0.001). In the CAPE group, MDA levels and XO activities were lower than those of torsion-detorsion plus saline group, and differences between the two groups were statistically significant (P < 0.001). GSH levels in torsion-detorsion plus saline group were decreased significantly when compared to basal control and sham operation groups (P < 0.001). GSH levels in the CAPE group were higher than those of torsion-detorsion plus saline group, and differences between the two groups were statistically significant (P < 0.004). Morphologically, polymorphonuclear leukocytic infiltration and vascular dilatation were obvious in the ischemia-reperfusion damaged ovary, a change partially reversed by CAPE.

CONCLUSIONS

These results suggest that administration of CAPE has beneficial effects in the prevention of ischemia-reperfusion injury of the ovaries.

Transient abdominal ovariopexy for adhesion prevention in patients who underwent surgery for severe pelvic endometriosis

OBJECTIVE

To assess adhesion reformation and subsequent fertility after a transient ovariopexy performed during severe pelvic endometriosis surgery.

DESIGN

Retrospective study.

SETTING

University hospital.

PATIENT(S)

Twenty young women who underwent severe pelvic endometriosis surgery.

INTERVENTION(S)

Unilateral or bilateral transient ovariopexy to the anterior abdominal wall was performed as the last step in the surgical procedure. Median duration of ovariopexy was 4 days.

MAIN OUTCOME MEASURE(S)

Adhesion reformation and subsequent fertility.

RESULT(S)

This well-tolerated procedure induced neither specific complication nor prolonged hospital stay. A second-look laparoscopy, performed in eight patients (40%), has shown a reduction of the occurrence, the extent, and the severity of ovarian adhesions. Two thirds of the suspended ovaries had no or smooth adhesions at second-look laparoscopy, even though all ovaries were initially adherent. Fifteen infertile women without male infertility factors tried actively to conceive after surgery. In this group of patients, four conceived spontaneously, and four conceived after IVF (total pregnancy rate = 53.3%). Seven patients delivered, and one pregnancy is ongoing. Median pregnancy delay was 11.5 months (range, 4-24 months).

CONCLUSION(S)

Transient ovariopexy appears to be a simple, safe, and effective technique in preventing postoperative adhesion reformation in severe pelvic endometriosis.

Influence of the Women's Health Initiative trial on the practice of prophylactic oophorectomy and the prescription of estrogen therapy

Physicians have become more conservative regarding prophylactic oophorectomy after publication of the Women's Health Initiative trial. They are less likely to prescribe estrogen therapy for women who have a high risk of coronary heart disease and more likely to use nonoral routes for estrogen therapy.

Prevention of cyclophosphamide-induced ovarian damage by concomitant administration of GnRHa in mice: a dose-dependent relationship?

OBJECTIVE(S)

This experimental study investigates the dose-related effects of cyclophosphamide (Cy) on primordial follicular reserve in young mice, and examines whether the concomitant administration of a gonadotropin-releasing hormone agonist (GnRHa) may protect gonadal reserve, even at different doses of Cy.

METHODS

Forty sexually mature virginal Balb/c mice aged five to six weeks were administered different doses (0, 50, 75,100 mg/kg) of Cy. Another 40 animals were treated with increasing doses (0, 50, 75, 100 mg/kg) of Cy in combination with GnRHa. GnRHa treatment was initiated one week prior to chemotherapy and also continued after chemotherapy for one week. The ovaries were removed seven days after Cy administration and the total number of primordial follicles in both ovaries was counted.

RESULTS

Primordial follicular destruction occurred at all levels of Cy exposure. There was a positive correlation between increasing doses of Cy and higher proportion of follicular loss (p < 0.0001). GnRHa was not able to protect against the chemotherapy-induced negative effect on primordial follicular count at low doses (50 mg/kg and 75 mg/kg). Mean +/- SD primordial follicle count in the 100 mg/kg Cy-treated group was significantly lower than in the 100 mg/kg Cy + GnRHa treatment group (73.9 +/- 33.1 vs 89 +/- 17.9, p = 0.047).

CONCLUSION

Our data suggest a possible ovarian protective effect of GnRHa cotreatment only at high doses of Cy treatment. However, in spite of co-administration of GnRHa, loss of primordial follicular reserve occurred at all doses of Cy in mice.

Maternal autoantibody triggers de novo T cell-mediated neonatal autoimmune disease

Although human maternal autoantibodies may transfer transient manifestation of autoimmune disease to their progeny, some neonatal autoimmune diseases can progress, leading to the loss of tissue structure and function. In this study we document that murine maternal autoantibody transmitted to progeny can trigger de novo neonatal pathogenic autoreactive T cell response and T cell-mediated organ-specific autoimmune disease. Autoantibody to a zona pellucida 3 (ZP3) epitope was found to induce autoimmune ovarian disease (AOD) and premature ovarian failure in neonatal, but not adult, mice. Neonatal AOD did not occur in T cell-deficient pups, and the ovarian pathology was transferable by CD4(+) T cells from diseased donors. Interestingly, neonatal AOD occurred only in pups exposed to ZP3 autoantibody from neonatal days 1-5, but not from day 7 or day 9. The disease susceptibility neonatal time window was not related to a propensity of neonatal ovaries to autoimmune inflammation, and it was not affected by infusion of functional adult CD4(+)CD25(+) T cells. However, resistance to neonatal AOD in 9-day-old mice was abrogated by CD4(+)CD25(+) T cell depletion. Finally, neonatal AOD was blocked by Ab to IgG-FcR, and interestingly, the disease was not elicited by autoantibody to a second, independent native ZP3 B cell epitope. Therefore, a new mechanism of neonatal autoimmunity is presented in which epitope-specific autoantibody stimulates de novo autoimmune pathogenic CD4(+) T cell response.

CD40 ligand in pathogenesis of autoimmune ovarian disease of day 3-thymectomized mice: implication for CD40 ligand antibody therapy

The blockade of CD40 ligand (CD40L) is effective in autoimmune disease prevention. Recently, a brief period of CD40L mAb treatment was reported to induce tolerance and enhancement of CD4(+)CD25(+) regulatory T cell activity. We therefore determined the efficacy of CD40L mAb treatment in autoimmunity that resulted from CD4(+)CD25(+) regulatory T cell deficiency. Autoimmune ovarian disease (AOD) and oocyte autoantibody response of day 3-thymectomized (d3tx) mice were inhibited by continuous CD40L mAb treatment from day 3, or from days 10-14, whereas CD40L mAb treatment confined to the neonatal week was ineffective. The enhanced expression of memory markers (CD44 and CD62L(low)) on CD4(+) T cells of the d3tx mice was unaffected by CD40L mAb treatment. In contrast, their increased T cell activation markers (CD69 and CD25) were eliminated by CD40L mAb treatment. Moreover, ex vivo activated T cells of d3tx mice expressed elevated intracellular IFN-gamma, and this was also blocked by CD40L mAb. The memory T cells, although nonpathogenic in CD40L mAb-positive environment, transferred severe AOD to CD40L mAb(-) neonatal recipients. Most importantly, CD40L mAb treatment inhibited AOD in recipients of T cells from d3tx donors with severe AOD and led to regression of AOD in d3tx mice documented at 4 wk. Therefore, 1) the continuous presence of CD40L mAb both prevents and causes regression of AOD in the d3tx mice; and 2) the multiple steps of the d3tx autoimmune disease, including T cell activation, cytokine production, T cell-mediated inflammation, and tissue injury, are CD40L dependent.

[Isolated ovarian abscess in the puerperium]

Isolated ovarian abscess is the infection of the ovary without tubal involvement. A number of predisposing factors have been identified. The appearance after spontaneous vaginal birth is rare. The clinical presentation is varied, the symptoms are not specific. Proper diagnosis necessitates the complete evaluation of clinical signs, laboratory tests and imaging techniques. The effective treatment is mostly operative. The authors present the detailed management of a postpartum patient with an isolated abscess of the right ovary. Antenatal identification and treatment of cervico-vaginal infection along with strict antiseptic way of care during labor and delivery may result in less prevalent and less severe postnatal maternal inflammatory complications.

Involvement of nitric oxide and the ovarian blood follicle barrier in murine follicular cyst development

OBJECTIVE

To test the involvement of nitric oxide in murine ovarian follicular cysts.

DESIGN

Controlled animal study.

SETTING

Academic research environment.

ANIMAL(S)

Immature female B6D2F1 mice at 23 +/- 2 days old. Ovarian cysts were induced by implanting miniosmotic pumps that delivered and maintained constant levels of hCG. Nitric oxide studies included the delivery of nitric oxide synthase (NOS) inhibitors, N(G)-nitro-L-arginine methyl ester (L-NAME), or N(G)-nitro-D-arginine methyl ester, by the same method. Ovulation assays measured cumulus oocyte complexes and blood follicle barrier (BFB) function.

RESULT(S)

Chronic treatment with hCG induced enlarged ovaries containing multiple follicular cysts, which were approximately double the size of follicles in sham-operated mice. These cysts enclosed few, if any granulosa cells, secreted high levels of testosterone, and had impaired ovarian BFB function. Inhibition of NOS by L-NAME during ovarian cyst formation reduced the size of follicular cysts, sustained normal testosterone levels, and maintained hormonal BFB reactivity in cystic follicles.

CONCLUSION(S)

Nitric oxide was found to be involved in the formation of hCG-induced murine follicular cysts and complications associated with these cysts were ameliorated by the NOS inhibitor L-NAME.

Combined treatment by pentoxifylline and tocopherol for recipient women with a thin endometrium enrolled in an oocyte donation programme

BACKGROUND

To evaluate the effect of an antifibrotic treatment by a combination of pentoxifylline (PTX) and tocopherol (vitamin E) in patients with a thin endometrium who were enrolled in an oocyte donation programme.

METHODS

Eighteen oocyte recipients who failed to develop a pre-ovulatory endometrial thickness of at least 6 mm after receiving vaginal micronized estradiol were enrolled in the study. The patients received a combination of PTX (800 mg/day) and vitamin E (1000 IU/day) for 6 months. The main outcome measurements were the change in endometrial thickness and the pregnancy and delivery rates after treatment.

RESULTS

Endometrial thickness increased significantly (P <0.001), with a mean of (+/-SD) 4.9 +/-0.6 mm before and 6.2 +/- 1.4 mm after treatment, with 72% (13/18) of patients being good responders. Five patients either did not respond to the treatment or responded only slightly. Three patients, of which two had received previous radiotherapy, became spontaneously pregnant, and two became pregnant after embryo transfer. Three patients did not have embryo transfer. A total of four babies were delivered. The pregnancy rate was thus 33% and the delivery rate 27%.

CONCLUSION

Treatment by combination of PTX and vitamin E appears to improve the pregnancy rate in patients with a thin endometrium by increasing the endometrial thickness and improving ovarian function. This was especially noticeable in patients who had previously received total body irradiation.

Dietary bisphenol A prevents ovarian degeneration and bone loss in female mice lacking the aromatase gene (Cyp19 )

We previously generated mice lacking aromatase activity by targeted disruption of Cyp19 (ArKO mice), and reported phenotypes of the female mice, showing hemorrhage formation and follicular depletion in the ovary, diminution in uterine size, and bone loss. In the present study, we examined the influence of dietary bisphenol A (BPA), a monomer used for the production of polycarbonate and known to have estrogenic activity, on these phenotypes of the ArKO mice. When ArKO mice were fed chow diets supplemented with 0.1% or 1% (w/w) BPA for 5 months, they were protected from ovarian degeneration, uterine diminution and bone loss in a dose-dependent manner. Northern blot analyses of ovarian RNA of ArKO mice showed differences in the expression levels of insulin-like growth factor (IGF)-I, IGF-I receptor, growth differentiation factor 9 and bone morphogenetic protein 15 as compared with those in the ovaries of wild-type mice. The differences in the expression levels were restored by dietary BPA. In the ArKO uteri, expression of progesterone receptor and vascular endothelial growth factor mRNAs was diminished, and was restored by BPA to the levels in wild-type mice. In contrast, BPA had little effect on the ovarian, uterine and skeletal structures of wild-type mice. In conclusion, estrogenic effects of BPA on the reproductive tract as well as skeletal tissue were evident in adult female ArKO mice. These results suggest that the ArKO mouse is an animal model suitable for studying effects of estrogenic chemicals as well as estrogen in vivo.

Unilateral massive ovarian edema in a woman with polycystic ovaries

Massive ovarian edema is a rare cause of ovarian enlargement in young women. We report the case of a 20-year-old woman with unilateral massive ovarian edema with findings on ultrasound of an enlarged policystic ovary and pedicle arterial and venous blood flow observed with color and pulsed wave Doppler examination. Massive ovarian edema can be managed conservatively and blood flow in the pedicle of the ovary is detected by color and pulsed wave Doppler examination.

Autoimmune ovarian disease: mechanism of induction and prevention

Research on murine autoimmune ovarian disease (AOD) models suggests that the following sequence of events operate in prevention and induction of AOD. Potentially pathogenic T cells for oocyte antigens that exist in normal mice are kept in check by regulatory CD25(+) T cells. Oocyte-specific pathogenic T cells are activated when the regulation is lost, as after day 3 thymectomy, or when T cells are stimulated through molecular mimicry. Activated, proinflammatory T cells induce interstitial ovarian inflammation without disruption in ovarian function. Activated T cells also help B cells that respond to endogenous oocyte antigens, to produce oocyte autoantibodies of diversified specificities. Autoantibodies, nonpathogenic in themselves, retarget T cell-mediated inflammation to ovarian follicles resulting in ovarian atrophy and ovarian failure. Future studies should determine the applicability of these findings to human ovarian autoimmunity.

Hormonal contraception and ovarian pathology

Despite sporadic ovarian follicle development, hormonal contraception consistently and uniformly prevents steroidogenesis and ovulation. For their suppressive activity on ovarian androgen production, oral contraceptives remain the treatment of choice for acne and hirsutism in most hyperandrogenic women. Inhibition of the synthesis of endometrial estrogen receptors explains the effectiveness of hormonal contraception in the therapy of dysfunctional uterine bleeding and in the treatment of pain associated with pelvic endometriosis. Through the inhibition of ovarian cyclicity, the contraceptive pill lowers the incidence of functional ovarian cysts, benign breast disease, dysmenorrhea and premenstrual syndrome and shows a consistent and long-lasting protection against ovarian and endometrial cancer.

Fetal ovarian cyst decompression to prevent torsion

BACKGROUND/PURPOSE

Neonates who have ovarian torsion caused by an ovarian cyst often lose their ovary because the torsion and infarction occurred antenatally. Because ultrasound scan has been so effective in diagnosing ovarian cysts in utero, we have a better understanding of their natural history and can select appropriate cases for cyst decompression in utero to prevent torsion. The authors reviewed experience with seven fetuses who had fetal ovarian cyst.

METHODS

During a 26-month period, seven patients were referred for the evaluation of fetal ovarian cyst. The mean gestational age at presentation was 31.9 +/- 3.6 weeks (+/-SD; range, 27 to 37 weeks). There was no history of maternal risk factors such as diabetes mellitus or fetal risk factors such as hyperthyroidism or placentomegally. All seven cases involved isolated unilateral cysts without associated anomalies or chromosomal abnormalities. Mean initial cyst diameter was 3.4 +/- 1.7 cm (+/-SD; range, 1 to 6.1). Indications used for ovarian cyst decompression included anechoic cysts with a diameter > or =4 cm, a cyst "wandering" about the abdomen on serial sonograms, or demonstrating rapid enlargement (>1 cm/wk).

RESULTS

All but one cyst progressed in size during observation. One fetal ovarian cyst (diameter, 2 cm) subsequently regressed spontaneously and another (diameter, 2.1 cm) stabilized during prenatal ultrasound surveillance. One "cyst" observed with a diameter of 3.5 cm proved to be a persistent cloaca. Four fetal ovarian cysts met criteria for decompression. Because of fetal position, decompression could not be performed in one. One cyst (seen before defining criteria for decompression) with a diameter of 5 cm was observed only and underwent torsion. Two cysts (diameters, 6.1 cm and 4 cm) were decompressed in utero under local anesthesia with ultrasound guidance, of 95 mL and 35 mL, respectively. High cyst fluid progesterone (12,041 and 1,990 ng/dL, respectively) and testosterone (1,298 and 2,900 ng/dL, respectively) confirmed the etiology of the cyst as ovarian. Neither cyst recurred, and postnatal ultrasound scan confirmed resolution. There was no maternal or fetal morbidity or mortality and only the patient observed before development of criteria for decompression lost her ovary because of torsion.

CONCLUSIONS

Fetal ovarian cysts tend to present as isolated unilateral lesions in normal fetuses in the third trimester. Spontaneous regression of fetal ovarian cysts may occur. Fetal ovarian cyst decompression, in select cases, may preserve ovaries at risk for torsion.

Postoperative adhesion formation and reproductive outcome using Interceed after ovarian surgery: a randomized trial in the rabbit model

The efficacy of an oxidized regenerated cellulose barrier (Interceed) in reducing postoperative adhesion formation and improving reproductive outcome after ovarian surgery was evaluated in a prospective randomized trial. Twenty-nine New Zealand White female rabbits were submitted to a mid-line laparotomy and a standardized surgical incision was made on both ovaries. At random, one ovary was entirely wrapped in a sheet of Interceed, whereas the contralateral ovary was left uncovered. Four weeks following surgery, the rabbits were mated with a male of proven fertility. Two weeks later, a second-look laparotomy was performed by a blinded observer who evaluated the incidence and score of adhesions, the number of corpora lutea in each ovary, the number of embryos in the ipsilateral uterine horn and also calculated the nidation index for each side. Adhesions were observed in 66% of Interceed-covered and in 97% of control ovaries (P < 0.0001). The adhesion score on the Interceed side was significantly lower than on the control side. The nidation index for the Interceed side was significantly higher than for the control side. The authors conclude that, in the rabbit model, Interceed significantly reduces the incidence and score of postoperative ovarian adhesions and significantly improves reproductive outcome.

Is it necessary to perform a prophylactic oophorectomy during hysterectomy?

OBJECTIVE

To evaluate the subsequent pelvic sonographic characteristics as well as the clinical outcome following hysterectomy with and without oophorectomy.

STUDY DESIGN

A prospective study of sonographic evaluation of 164 women, aged 29-72 years, with a history of hysterectomy was performed. Ninety-one patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and 73 women had either hysterectomy (abdominal or vaginal) only or hysterectomy with unilateral salpingo-oophorectomy.

RESULTS

The mean time interval between surgery and sonographic evaluation was 4.3 years (range, 1-25 years). Out of the 73 women with left ovaries, 37 (50.7%) were found to have pelvic lesions and four women underwent re-operations following these findings. The histologic finding were cystadenoma, hydrosalpinx with periovarian adhesions and two paraovarian cysts. In comparison, only five of the 91 women (5.5%) following bilateral salpingo-oophorectomy were found to have pelvic lesions (P < 0.0005). None of the women with prophylactic oophorectomy were operated upon following these findings.

CONCLUSIONS

In comparison to patients after total hysterectomy and bilateral salpingo-oophorectomy, women with prior hysterectomy and ovarian preservation are prone to subsequent pelvic lesions. They need to be closely followed with clinical, laboratory and sonographic means, and may undergo reoperations in order to rule out the possibility of neoplasia.