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Background: The use of insulin-sensitizing drugs has been shown to improve both the reproductive and the metabolic aspects of PCOS. However, the mechanisms by which metformin exerts its effects in PCOS are still not completely understood. There is growing evidence of a direct effect of metformin on ovarian steroidogenesis, independent of its effects on insulin sensitivity. Methods: We evaluated the short-term effects of metformin compared to placebo on basal and LH-stimulated androgen secretion as well as on hormonal and metabolic parameters in 19 women with PCOS during a four-day randomized, double-blinded placebo-controlled clinical trial. In a three month follow-up evaluation, we investigated the longer-term therapeutic effects of metformin on ovulation, metabolic and endocrine parameters. Results: Compared to placebo, 2 days of metformin was associated with a borderline significant reduction in the free androgen index (FAI) (p = 0.05) and with a reduction in the serum concentration of LH-stimulated testosterone (T) (p = 0.03). Following three months of use, a decline in serum T was observed, independent of changes in weight, metabolic parameters, or insulin sensitivity. Conclusions: In women with PCOS, Metformin induces a prompt decrease in LH-stimulated T secretion after only several days of use. This action precedes the medication's effects on insulin sensitivity or weight loss. [ABSTRACT FROM AUTHOR]

The serial measurement of serum hCG concentrations is an important clinical tool used to differentiate normal from abnormal pregnancies. At hCG values below which ultrasonography can be diagnostic, the comparison of a patient''s hCG dynamics to those of established expected curves of rise or fall can aid the clinician in determining when to follow expectantly and when to intervene. Still, this method has some limitations and should never supersede clinical judgment based on symptoms or signs. [Copyright &y& Elsevier]

The objective of this case-control study of 242 reproductive-age women was to determine the concentration of afamin in the serum and peritoneal fluid of women with and without endometriosis and to test afamin as a diagnostic marker of endometriosis. Afamin levels were altered significantly in the peritoneal fluid of women with endometriosis compared with disease-free controls, correlated with vitamin E levels, and are consistent with increased oxidative stress in the peritoneal cavity of women with endometriosis. [ABSTRACT FROM AUTHOR]

Objective: To validate recently characterized curves of hCG rise and fall that are seen in viable and nonviable pregnancies in a population of women who have pregnancies of unknown location. Design: Historical cohort study. Setting: University hospital. Patient(s): One thousand two hundred forty-nine women with symptomatic early pregnancies. Intervention(s): None. Main Outcome Measure(s): Comparison of observed hCG values to predicted hCG values; time to diagnosis of ectopic pregnancy; accuracy of diagnosis. Result(s): Of the 1,249 patients included in this study, 196 had ectopic pregnancy (EP); 261, intrauterine pregnancy (IUP); and 792, spontaneous abortion (SAB). By determining the rate of change in hCG values from two consecutive visits and comparing them with a minimal rise of 35% in 2 days (the bound that is defined by the 99.9% confidence interval [CI] for the rise of hCG in an IUP) or a minimal fall of 21%–35% (the bound that is defined by the 90% CI for the fall of hCG in an SAB), we were able to make the diagnosis of EP an average of 2.5 days sooner than by standard clinical practice. Only 12% of patients had an EP go undiagnosed by using these rules, because the curve of rise or fall of their hCG mimicked that of a non-EP gestation. Conclusion(s): Recently redefined curves of rise and fall in hCG for IUP and SAB are valid for clinical use on the basis of our application to this large cohort of patients. Using them can shorten the time needed to make the diagnosis of EP. Use of a more conservative cutoff for minimal rise in hCG, one as slow as 35% over 2 days, to characterize a potentially viable gestation would minimize potential interruption of a desired pregnancy. [Copyright &y& Elsevier]

The article discusses the issues related to ectopic pregnancies. Damaged fallopian tubes from prior tubal surgery or pelvic infection, smoking, and conception using assisted reproduction are predisposing factors to ectopic pregnancies. Symptoms of and risk factors for ectopic pregnancies are enumerated. Diagnostic procedures for ectopic pregnancies are explained.

To compare the short-term effects of metformin (M), naltrexone (N), and a combination of OC and prednisolone (OC/Pr) on the metabolic state and the ovarian function of PCOS women, we randomized 29 women to a 3-month course of therapy. We observed significant improvements in hyperandrogenemia and ovulation rates in PCOS women of all three groups, in the absence of changes in the metabolic state, suggsting that insulin resistance in PCOS patients is only one of several factors leading to hyperandrogenemic ovarian failure. [ABSTRACT FROM AUTHOR]