OBJECTIVE: To measure amniotic fluid levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor (TGF)-beta2 and to characterize their levels with respect to advancing gestational age and pregnancy-related complications. STUDY DESIGN: Amniotic fluid was collected from a total of 37 patients, 2 of whom had twin pregnancies. Twenty-seven specimens were collected in the second trimester and 10 specimens were collected in the third trimester. VEGF, bFGF and TGF-beta2 were isolated from centrifuged amniotic fluid and quantified using commercially available ELISA kits. Concentrations of growth factors were expressed in pg/mL. RESULTS: The growth factors under investigation were present in most but not all amniotic fluid specimens throughout pregnancy. The levels of VEGF, bFGF and TGF-beta2 were inconsistent and did not show a statistically significant association with gestational age, number of fetuses, or the presence of hypertension and/or diabetes. One significant finding emerged from the data: smokers had significantly higher amniotic fluid levels of VEGF compared to nonsmokers (p = 0.03). CONCLUSION: VEGF, bFGF and TGF-beta2 are detectable in second and third trimester amniotic fluid. Smoking appears to correlate with increased amniotic fluid VEGF during pregnancy. VEGF may represent a molecular marker of hypoxia and is an interesting focus for future investigation.

OBJECTIVE: To measure amniotic fluid levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor (TGF)-beta2 and to characterize their levels with respect to advancing gestational age and pregnancy-related complications. STUDY DESIGN: Amniotic fluid was collected from a total of 37 patients, 2 of whom had twin pregnancies. Twenty-seven specimens were collected in the second trimester and 10 specimens were collected in the third trimester. VEGF, bFGF and TGF-beta2 were isolated from centrifuged amniotic fluid and quantified using commercially available ELISA kits. Concentrations of growth factors were expressed in pg/mL. RESULTS: The growth factors under investigation were present in most but not all amniotic fluid specimens throughout pregnancy. The levels of VEGF, bFGF and TGF-beta2 were inconsistent and did not show a statistically significant association with gestational age, number of fetuses, or the presence of hypertension and/or diabetes. One significant finding emerged from the data: smokers had significantly higher amniotic fluid levels of VEGF compared to nonsmokers (p = 0.03). CONCLUSION: VEGF, bFGF and TGF-beta2 are detectable in second and third trimester amniotic fluid. Smoking appears to correlate with increased amniotic fluid VEGF during pregnancy. VEGF may represent a molecular marker of hypoxia and is an interesting focus for future investigation.

We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners.

We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners.

We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners.

The objective of this study was to compare letrozole-stimulated cycles to natural cycles in 208 patients undergoing intrauterine insemination (IUI) between July of 2004 and January of 2007. Group I (n = 47) received cycle monitoring only (natural group), Group II (n = 125) received letrozole 2.5 mg/day on cycle days three to seven, and Group III (n = 36) received letrozole 5 mg/day on cycle days three to seven. There were no differences between the groups in endometrial thickness or P4 on the day of hCG. Estradiol levels had higher variation in the second half of the follicular phase in both letrozole-treated groups compared to the control group. Estradiol per preovulatory follicle was similar in both letrozole cycles to that observed in the natural cycles. LH was lower on the day of hCG administration in the letrozole 2.5 mg/day group vs. the natural group. In summary, letrozole results in some minor changes in follicular, hormonal and endometrial dynamics compared to natural cycles. Increased folliculogenesis and pregnancy rates were observed in the letrozole-treated groups compared to the natural group. These findings need to be confirmed in larger, prospective studies.

The objective of this study was to compare letrozole-stimulated cycles to natural cycles in 208 patients undergoing intrauterine insemination (IUI) between July of 2004 and January of 2007. Group I (n = 47) received cycle monitoring only (natural group), Group II (n = 125) received letrozole 2.5 mg/day on cycle days three to seven, and Group III (n = 36) received letrozole 5 mg/day on cycle days three to seven. There were no differences between the groups in endometrial thickness or P4 on the day of hCG. Estradiol levels had higher variation in the second half of the follicular phase in both letrozole-treated groups compared to the control group. Estradiol per preovulatory follicle was similar in both letrozole cycles to that observed in the natural cycles. LH was lower on the day of hCG administration in the letrozole 2.5 mg/day group vs. the natural group. In summary, letrozole results in some minor changes in follicular, hormonal and endometrial dynamics compared to natural cycles. Increased folliculogenesis and pregnancy rates were observed in the letrozole-treated groups compared to the natural group. These findings need to be confirmed in larger, prospective studies.

The objective of this study was to compare letrozole-stimulated cycles to natural cycles in 208 patients undergoing intrauterine insemination (IUI) between July of 2004 and January of 2007. Group I (n = 47) received cycle monitoring only (natural group), Group II (n = 125) received letrozole 2.5 mg/day on cycle days three to seven, and Group III (n = 36) received letrozole 5 mg/day on cycle days three to seven. There were no differences between the groups in endometrial thickness or P4 on the day of hCG. Estradiol levels had higher variation in the second half of the follicular phase in both letrozole-treated groups compared to the control group. Estradiol per preovulatory follicle was similar in both letrozole cycles to that observed in the natural cycles. LH was lower on the day of hCG administration in the letrozole 2.5 mg/day group vs. the natural group. In summary, letrozole results in some minor changes in follicular, hormonal and endometrial dynamics compared to natural cycles. Increased folliculogenesis and pregnancy rates were observed in the letrozole-treated groups compared to the natural group. These findings need to be confirmed in larger, prospective studies.

The objective of this study was to compare letrozole-stimulated cycles to natural cycles in 208 patients undergoing intrauterine insemination (IUI) between July of 2004 and January of 2007. Group I (n = 47) received cycle monitoring only (natural group), Group II (n = 125) received letrozole 2.5 mg/day on cycle days three to seven, and Group III (n = 36) received letrozole 5 mg/day on cycle days three to seven. There were no differences between the groups in endometrial thickness or P4 on the day of hCG. Estradiol levels had higher variation in the second half of the follicular phase in both letrozole-treated groups compared to the control group. Estradiol per preovulatory follicle was similar in both letrozole cycles to that observed in the natural cycles. LH was lower on the day of hCG administration in the letrozole 2.5 mg/day group vs. the natural group. In summary, letrozole results in some minor changes in follicular, hormonal and endometrial dynamics compared to natural cycles. Increased folliculogenesis and pregnancy rates were observed in the letrozole-treated groups compared to the natural group. These findings need to be confirmed in larger, prospective studies.

Bckground: The main cause for discontinuation of DMPA use is irregular menstrual bleeding. The exact pathophysiological mechanisms of irregular bleeding have remained unclear. Transvaginal Doppler is a non invasive method for studying changes of blood flow which may highlight the underlying pathology in those cases with irregular uterine bleeding. The aim of the study was to quantify the uterine and subendometrial microvasculature in DMPA users with irregular bleeding pattern in comparison to DMPA users with amenorrhea .Study design: This is a case control study. Forty users of DMPA were divided into two groups: one group included 20 users with irregular uterine bleeding and the second group included 20 amenorrheic users. Pulsatility Index (PI) and resistant Index (RI) of uterine and subendometrial blood vessels were determined. Power Doppler Energy (PWE) used to qunitify the subendometrial area signal percentage. Results: There is significant reduction of PI and RI in uterine artery and subendometrial microvasculature in cases with irregular uterine bleeding. Conclusion: Irregular uterine bleeding with DMPA associated with increased perfusion of uterine and subendometrial blood vessels. Key words: DMPA, PI, RI, subendometrial doppler