No abstract

We have investigated the possible roles of oncostatin M (OSM), which is a member of the interleukin-6 family of cytokines, in endometrial and endometriotic stromal cell growth. Endometrial and endometriotic stromal cells were collected from the uterus or ovarian chocolate cysts. We observed the expression of mRNA transcripts for OSM, OSM receptor subunit beta, leukaemia inhibitory factor receptor subunit (LIFR), and glycoprotein 130 in endometrial and endometriotic stromal cells. We also examined the effects of OSM (0-50 ng/ml) and LIF (0-10 ng/ml) on endometrial and endometriotic stromal cell proliferation and evaluated the effects of OSM on endometrial stromal cell differentiation. The presence of 10-50 ng/ml OSM significantly suppressed endometrial stromal cell growth in secretory phase tissue but not in proliferative phase tissue. In contrast, stromal cells in endometriotic tissues were resistant to the inhibitory effects of OSM. Addition of LIF did not influence the growth of endometrial stromal cells. We also showed that 10 ng/ml OSM stimulated markers of differentiation causing increased prolactin secretion and cyclooxygenase-2 gene expression in endometrial stromal cells from the secretory phase. These results suggest that OSM may play a pivotal role in regulating the growth and differentiation of endometrial cells. Endometriotic cells may behave differently from normal endometrial cells in terms of the inhibitory response to OSM.

Aims: Dydrogesterone is a retro-progesterone preparation widely used for over a half century. We sought to evaluate the efficacy and safety of dydrogesterone in Japanese women with dysmenorrhea. Methods: This study was conducted as an open-label, single-arm, multicenter study. One dydrogesterone 5-mg tablet (Duphaston) was administered orally twice daily for 21 days from the 5th to 25th day of each menstrual cycle. A total of 44 (safety analysis) and 31 patients (efficacy analysis) were enrolled. Total dysmenorrhea score, dysmenorrhea subscale scores, dysmenorrhea visual analog scale, severity of menstruation-related lower abdominal pain, low back pain, headache, and nausea/vomiting, basal body temperature, and serum estradiol and progesterone levels were evaluated. Results: Baseline of the total dysmenorrhea score was 4.61, which went down over time following the administration of dydrogesterone, and the decrease was statistically significant at and after 2nd cycle of menstruation. Mean change from baseline at the final evaluation point was −1.84 (P < 0.001). Severity of menstruation-related lower abdominal pain, low back pain, headache, and nausea/vomiting, in the evaluated menstruation cycles tended to decrease over time. Basal body temperature showed a biphasic pattern in 70% at baseline, 50% in 2nd menstruation cycle, and 61% in 5th menstruation cycle, and at least half of the patients may have had ovulation during the treatment. Incidence of adverse drug reactions was 31.8%, and the most common adverse event was metrorrhagia. Conclusion: Dydrogesterone is efficacious, safe, and clinically beneficial in patients with dysmenorrhea, thereby indicating that dydrogesterone can be considered as a treatment option for patients with dysmenorrhea.

The aim of our study was to determine the efficacy of postponing administration of human chorionic gonadotropin while continuing daily gonadotropin-releasing hormone agonist therapy (‘coasting’) to prevent the occurrence of severe ovarian hyperstimulation syndrome (OHSS) for patients with polycystic ovary (PCO) syndrome. Five patients with PCO who had been hospitalized due to severe OHSS in previous in vitro fertilization and embryo transfer or intrauterine insemination cycles at the Tottori University Hospital were included in the study. The rates of mature oocytes and fertilization were comparable between the cycles. A singleton pregnancy was achieved in a patient during the coasting cycle, and none of the women developed severe OHSS in coasting cycles. The results suggest that coasting may be an alternative method for reducing the severity of OHSS in patients with PCO.

Objective: To evaluate the reproductive outcomes after radical salpingectomy or conservative surgery for ectopic pregnancy (EP), with attention to tubal patency and peritubal adhesions.Design: Retrospective study.Setting: Department of Obstetrics and Gynecology, Tottori Prefectural Central Hospital.Patients: Among 94 patients who underwent surgery for EP between 2000 and 2010, 51 patients who desired subsequent pregnancy were followed.Interventions: Of the 51 patients, 40 had undergone salpingectomy and 11 had received conservative surgery. Main outcome measures:The pregnancy rate and the time to conception after surgery were examined. The intrauterine pregnancy (IUP) and repeat EP (REP) rates were compared between the salpingectomy and conservative surgery groups. The revised American Fertility Society (re-AFS) adnexal adhesion scores were compared between the IUP and REP groups.Results: A total of 35 of the 51 (68.6%) patients had pregnancies during the follow-up interval. Twenty (57.1%) patients conceived within 1 year, and 30 (85.7%) conceived within 1.5 years after surgery. Postoperative hysterosalpingography confirmed patency of the contralateral tube in 22/25 of the salpingectomy cases and in 8/9 of the conservative surgery cases.The variation in IUP rates for salpingectomy (47.1%) and conservative surgery (77.8%) was not statistically significant.No significant difference was found in the REP rate between the salpingectomy (8.8%) and conservative surgery (11.1%) groups. However, the re-AFS adhesion score was significantly lower in the IUP group compared with the REP group (1.2±0.4 vs. 5.8±2.3, respectively).Conclusions: Women without contralateral tubal damage can be expected to conceive within 1.5 years after surgery for EP, regardless of surgical procedure. REP is related to adnexal adhesions.