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Objective To evaluate the effects of gonadotropin-releasing hormone agonists (GnRH-a) on fertility in women with mild endometriosis who are undergoing in vitro fertilization and embryo transfer (IVF-ET) procedures. Design Prospective, randomized, controlled trial. Setting Three tertiary university hospitals. Patient(s) Four hundred infertile women with mild endometriosis, documented with laparoscopy, undergoing IVF and 200 women with tubal factor infertility. Intervention(s) Administration of GnRH-a for 3 months before an IVF attempt (group A, n = 200) or IVF without GnRH-a (group B, n = 200). Main Outcome Measure(s) Follicular fluid (FF) levels of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8, and IL-1 receptor antagonist; fertilization rate (FR), implantation rate (IR), quality of embryos, and clinical pregnancy rate (PR). Result(s) Women who received GnRH-a had a statistically significantly reduced concentration of FF cytokines compared with women who did not receive this regimen. Women in group B had a reduced FR (61.7; 95% CI, 59.20–64.20) compared with the women in group A (72.7; 95% CI, 70.50–74.90) and compared with the women with tubal factor infertility (74.7; 95% CI, 72.00–77.24). The embryo quality, IR, and clinical PR showed no statistically significant improvement in the women of group A compared with group B. Conclusion(s) Women who received GnRH-a for 3 months had a lower concentration of FF cytokines. These women had also a higher FR than the women who did not receive GnRH-a. However, the IR, embryo quality, and clinical PR showed no statistically significant difference when comparing the two groups. ClinicalTrials.gov ID NCT01269125.

Objective To evaluate basal metabolic rate (BMR) in women with PCOS and to determine its association with insulin resistance (IR). Design Prospective assessment of BMR in women with PCOS. Setting Outpatient clinic of the Division of Reproductive Endocrinology. Patient(s) The study included 91 Greek women with PCOS and biochemical hyperandrogenemia, with mean age 24.03 ± 0.55 years and mean body mass index (BMI) 26.67 ± 0.69 kg/m 2 , and 48 matched regularly menstruating women, with mean age 26.33 ± 0.93 years and mean BMI 23.35 ± 0.85 kg/m 2 , as control subjects. Intervention(s) Assessment of BMR by indirect calorimetry, IR by HOMA and QUICKI indices, fasting insulin, and fasting glucose/insulin ratio. Main Outcome Measure(s) Reduced BMR in PCOS with or without IR. Result(s) Adjusted BMR was 1,868 ± 41 kcal/day in the control group, 1,445.57 ± 76 in all PCOS women, 1,590 ± 130 in PCOS women without IR and 1,116 ± 106 in PCOS women with IR. Adjusted BMR showed a statistically significant difference between women with PCOS and control subjects, with lowest values in the group of PCOS women with IR, even after adjusting all groups for age and BMI. Conclusion(s) Women with PCOS, particularly those with IR, present a significantly decreased BMR.

Objective To correlate the presence of renal agenesis/dysgenesis to the prevalence of KAL1 gene defects in patients with sporadic Kallmann syndrome (KS). Design Prospective assessment of renal structure and DNA sequence analysis of the KAL1 gene. Setting Outpatient clinics of the divisions of endocrinology of university hospitals. Patient(s) Sixteen male patients with sporadic KS. Intervention(s) Assessment of renal structure by abdominal ultrasounds scans and DNA extraction, polymerase chain reaction amplification, and DNA sequence analysis of all 14 exons of the KAL1 gene. Main Outcome Measure(s) KAL 1 gene structure and presence of renal dysgenesis. Result(s) Renal dysgenesis was identified in only two of 16 KS patients. Genetic defects were found in only two patients with KS, that is, in those with the identified renal dysgenesis. The first gene defect was identified in a patient with associated right renal agenesis who had two point mutations in the KAL1 gene: the first was a G to A transition in exon 11, turning codon 514 encoding glutamic acid into lysine; and the second was a G to A transition in exon 13, turning codon 660 encoding alanine into threonine. The second gene defect was identified in a patient with ichthyosis, right renal agenesis, and mirror movements of the upper limbs (synkinesia) and comprised a deletion of exons 5–10 of the KAL1 gene and a complete deletion of the steroid sulphatase gene. Conclusion(s) The phenotype of renal agenesis/dysgenesis strongly indicates the existence of KAL1 gene defects in the genotype of patients with sporadic KS, providing evidence for the X-linked mode of inheritance and offering the opportunity for genetic counseling.

Introduction Disorders possibly associated with insulin resistance (IR) are hyperandrogenemia, hirsutism, irregular menstrual cycles, central obesity and polycystic ovarian syndrome (PCOS). It is known that PCOS is related to a high risk of endometrial hyperplasia after many years of estrogen stimulation from anovulation. Objectives The purpose of the study was to estimate the thickness of the endometrium in women with IR without a diagnosis of PCOS and in women with PCOS without IR. Study design Three groups of women included in the study: 15 women diagnosed as IR without PCOS, 16 women diagnosed as PCOS without IR and 20 women used as controls matched for age and body mass index (BMI) with the previous patients. Thickness of the endometrium was estimated in all cases with a transvaginal ultrasound in three consecutive measures during a cycle. Results The mean thickness of the endometrium was statistically higher in the PCOS group (11.1 mm), and in the IR group (9.6 mm), compared with the control group (6.2 mm) (F = 13.1, p Conclusions It is concluded that both in women diagnosed as having insulin resistance without PCOS, and in women with PCOS without insulin resistance, the ultrasonographically estimated thickness of the endometrium is relatively high and a closer follow-up of these women is required in order to detect those in risk to develop hyperplasia and/or atypia.