Pregnancy overt diabetes,symptoms of pregnancy 7 weeks after giving birth youtube,early symptoms of pregnancy back pain 9dpo - How to DIY

Context: A critical body mass of adipose tissue is essential for the normal development of female reproductive functions. 25.Anifandis G, Koutselini E, Louridas K, Liakopoulos V, Leivaditis K, Mantzavinos T, et al.
Demonstrates large uterine fibroid with speckled areas of high and low signal intensity (Red Arrow). Soft tissue mass and haemorrhage within a right tubular complex consistent with an ectopic pregnancy within the fallopian tube which is likely to have ruptured (Red Arrows). Right adnexal tubular cystic mass (Red Arrow) with peripheral high T1 signal intensity (White Arrows).
31 year old pregnant patient, at 36 weeks gestation presented with severe virilisation symptoms including a deep voice, with unknown cause. Well defined cystic tubular mass (Red Arrows) occupying the right side of the abdomen and upper pelvis. 30 year old pregnant patient, 14 weeks gestation, who presented for routine early pregnancy sonography. MRI features of the bilateral adnexal masses were consistent with mature cystic ovarian teratomas with no evidence to suggest malignant features.
In left adnexa complex heterogeneous, predominantly cystic mass with high signal intensity within it, indicating a fatty component (Yellow Arrows). In right adnexa smaller cystic mass, with high signal intensity on T1WIs indicating fatty component (Yellow Arrows). 28 year old female pregnant patient, 20 weeks gestation, presented for routine antenatal sonography and bilateral adnexal cystic masses identified. Demonstrating complex cystic mass situated in the pelvis within the pouch of Douglas (Red Arrows), originating from the left ovary. Demonstrating a complex right sided adnexal mass (within Red Arrows), multiple thick septations (Yellow Arrows), there are solid nodules on the septations (Blue Arrows). MRI features demonstrate a right sided multi loculated cystic mass of ovarian origin with solid components which are suspicious for malignancy.
Demonstrating loss of the high signal intensity in the macroscopic fat component of the mass on the right adnexal mass (Red Arrows) and on the left (Yellow Arrows). Left solid adnexal mass, originating from the left ovary (Yellow Arrow), suggestive of malignancy. Defining the origin of a pelvic mass and localising it to the ovaries can often cause diagnostic uncertainty. Subserosal or submucosal leiomyomas may be pedunculated on long stalks and as a result appear adnexal in origin.
They are a common cause for an apparent adnexal mass on USS and MRI proves helpful in distinguishing these from true ovarian masses. On MRI leiomyomas are well circumscribed lesions with low T2 signal intensity compared to myometrium. Sub serosal fibroids have a beak or claw shaped interface with the uterus and bridging vessels between the uterus and fibroid which are a useful diagnostic sign.
Red degeneration is the most common type of degeneration during pregnancy and occurs due to rapid growth with resulting haemorrhagic infarction. On USS these are seen as well circumscribed masses with areas of cystic change or heterogeneous echogenicity.
Doppler shows circumferential vascularity or absence of flow if a pedunculated leiomyoma is torted.
Red degeneration also has high T1signal intensity centrally and low T2 signal intensity peripherally.
Central areas of high signal intensity (Yellow Arrow) surrounded by a low signal intensity corresponding to obstructed peripheral veins (Red Arrow). A heterotopic pregnancy is very rare and is one in which both an extra-uterine pregnancy and intra-uterine pregnancy develop simultaneously. MRI can also help distinguish between eccentric endometrial implantation and an interstitial ectopic pregnancy.
MRI radiological findings include an adnexal mass with haemorrhagic fluid in the peritoneum which has high T1 signal intensity.
A pathological follicular cyst can measure up to 20cm and result from excessive accumulation of fluid or haemorrhage. Cysts are seen as a well defined cystic adnexal mass of low signal intensity on T1WIs and high signal intensity on T2WIs. There is prominent blood flow within the cyst wall and the thickness is variable measuring from 2 to 20 mm. If the cyst contains predominantly intact red blood cells there is low signal intensity on T2WIs. Theca Lutein Cysts also known as hyper reaction luteinalis are rare functional ovarian masses secondary to the overstimulation of the ovaries by endogenous or exogenous gonadotrophins. Due to its large size, may obstruct labour and if it does not spontaneously regress may require removal during pregnancy. Massive ovarian oedema is characterised by marked enlargement of one or rarely both ovaries due to gross diffuse stromal oedema resulting in peripherally placed follicles.
MRI shows an enlarged ovary that is hyperintense on T2WIs with multiple ovarian follicles seen pushed towards the peripheral cortex due to stromal oedema. Some cysts demonstrate low signal intensity on T2WIs which is in keeping with blood products and are consistent with haemmorhagic cysts (Yellow Arrow). Bilateral ovarian enlargement caused bilateral vesicoureteric junction obstruction and bilateral hydronephrosis.
The ovarian enlargement regressed post partum and the patients’ virilisation symptoms resolved.
On USS endometriomas appear as single or multiple adnexal masses with diffuse low level internal echoes.
Characteristic findings are hyperechoic foci within the wall of an internally echogenic cyst.
The cysts demonstrate homogenous high signal intensity on T1WIs and gradations of low signal on T2WIs.
During pregnancy solid components within an endometrioma can either demonstrate the rare occurrence of malignant transformation or ectopic decidualisation.


The latter is detected on MRI when the decidualised endometrioma shows similarity in signal intensity and texture to the decidualised endometrium in the uterus. This finding coupled with smooth lobulation and prominent vascularity on Doppler imaging of solid components is more suggestive of ectopic decidualisation than malignant transformation or an ovarian malignancy (16).
Pregnant patients with symptoms refractive to initial therapy in whom there is diagnostic uncertainty may benefit from imaging with MRI which has been shown to be superior to TVS in radiological assessment. On USS is has a characteristic thick wall cystic “sausage” shaped appearance and contains complex fluid. On MRI there is a ‘sausage’- shaped distended adnexal tubular structure containing fluid of variable character. Contains incomplete smooth septae (Yellow Arrows) characteristic of a dilated fallopian tube (FT). There are no specific sonographic features and the diagnosis is reliant upon comparison with the contralateral ovary. There is enlargement and wall thickening of the ipsilateral fallopian tube by greater than 10 mm. Benign Cystic Teratoma also known as a dermoid cyst is the most common germ cell neoplasm of the ovary. The liquid sebaceous material within the cyst is similar to fat density and is high signal intensity on T1WIs.
Leptin, an adipocyte-derived hormone encoded by the 'Ob' gene has been proposed as a peripheral signal indicating the adequacy of nutritional status for reproductive functions. Overt leptin response to controlled ovarian hyperstimulation negatively correlates with pregnancy outcome in in vitro fertilization­-embryo transfer cycle.
Adiposity, plasma leptin concentration and reproductive function in active and sedentary females. Decreased leptin levels in normal weight women with hypothalamic amenorrhea: The effects of body composition and nutritional intake.
Leptin attenuates follicular apoptosis and accelerates the onset of puberty in immature rats. The adipose gene product, leptin: Evidence of a direct inhibitory role in ovarian function. Synchronicity of frequently sampled 24 h concentrations of circulating leptin, luteinizing hormone and estradiol in healthy women. Circulating leptin in women: A longitudinal study in the menstrual cycle and during pregnancy. Cloning and characterization of human leptin receptor using a biologically active leptin immunoadhesin. Baseline non-fasting serum leptin concentration to body mass index ratio is predictive of IVF outcomes. Estradiol supplementation during the luteal phase may improve the pregnancy rate in patients undergoing in vitro fertilization-embryo transfer cycles. Evidence that exclusive use of Follistin may produce better pregnancy results than the use of Gonal-F following in vitro fertilization (IVF) - embryo transfer (ET).
Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Leptin and ovarian folliculogenesis: Implications for ovulation induction and ART outcomes.
Gonadotropin stimulation reduces VEGF expression in the mouse uterus during the peri-implantation period. Expression of leptin receptor in human endometrium and fluctuation during the menstrual cycle. Role of an estrogen-upregulated 64.0 KDa uterine fluid glycoprotein in improving fertility in women. Oocyte influences on early development: The regulatory proteins leptin and STAT 3 are polarized in mouse and human oocytes and differentially distributed within the cell of the preimplantation stage embryo. Transvaginal ultrasound measurement of endometrial thickness as a biomarker for estrogen exposure. Clinical outcome of oocyte cryopreservation after slow cooling with a protocol utilizing a high sucrose concebtration.
Orsi Molecular Reproduction and Development. On right ovary, benign cyst and the left adnexal mass demonstrates MRI characteristics of a mucinous ovarian benign cystadenoma. A woman has to eat healthy and nutritious food to make sure she's giving her best to the baby. There are multiple soft tissue excrescences (White Arrows) at the posterior aspect of the mass.
Though leptin is widely present in reproductive tissues, its relationship to reproductive hormones is still poorly understood.
Coadministration is not recommended.Calcium antagonistsRisk of atrioventricular conduction disturbances, left ventricular failure, and hypotension may be increased with coadministration of oral or IV calcium antagonists. These were surgically removed post partum and the radiological findings were confirmed on histology. Aims: Present investigation attempts to explore ovarian response to secretory profile of leptin and its impact on pregnancy outcome in women undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer (IVF-ET). Settings and Design: Patients enrolled for IVF-ET underwent pituitary-ovarian suppression by 'Long Protocol' GnRH-agonist downregulation followed by ovarian stimulation. Materials and Methods: Sera were procured at different phases of IVF-ET for the assay of estradiol, progesterone, human chorionic gonadotropin, and for leptin. Luteinized granulosa cells were cultured in vitro to evaluate their steroidogenic potential. Statistical Analysis Used: Statistical analyses were done by student's t-test, ANOVA, and Chi-square tests as applicable.
Controversial results have been reported during hormone replacement therapy (HRT), oral contraceptive intake, and ovulatory disorders. Results: Positive correlation was observed between serum and ovarian follicular fluid leptin. The present study is centered on the objective of evaluating the ovarian response to the circulating leptin level and its impact on pregnancy outcome in women undergoing COH for IVF-ET.


A negative correlation was noted between the serum leptin levels and endometrial thickness.
Conclusions: Elevated leptin response may exert adverse impacts on pregnancy success during IVF-ET possibly by modulating uterine receptivity.
The investigations were performed with the approval from the institutional research ethics board.
Gonadotrophin stimulation was commenced only when complete pituitary-ovarian suppression has been achieved by prior administration of GnRH-a. The stimulated cycles were monitored by daily transvaginal ultrasonography (TVS) and intermittent assessment of serum E 2 levels.
The daily dose of gonadotrophin was individualized according to an individual dose-response scheme. LGCs from the FF of individual patients were collected by centrifugation of follicular contents at 1500 rpm for 10 minutes and pellets were washed two times with HAM F-10. Percoll (50%) column centrifugation was done at 500 rpm for 30 minutes followed by the aspiration of granulosa cells from the interface for culture. Cells were cultured in 15 mm 4-well culture plates (NUNC, Denmark) for 48 hours at 37°C in a humified, 95% air-5% CO 2 incubator (Forma Scientific). Outcome measures Samples of maternal serum were collected on the day of hCG administration, at the time of oocyte retrieval, and on day 16 post-transfer. Sera were procured after centrifugation and stored at -40°C for the assay of estradiol, progesterone, hCG, and for leptin.
Moreover, based on morphology, oocytes were graded into high quality and dysmature oocytes and accordingly follicular aspirates were categorized under three groups: those yielding high quality oocytes, dysmature oocytes, or no oocyte.
Stimulation outcome was assessed with respect to number of antral follicle produced, number of oocytes retrieved, gradation of oocytes, fertilization, and cleavage rates. Embryo development was assessed on post-retrieval day 3 (three) on the basis of number and morphology of blastomeres. Among the whole patient population, basal leptin concentrations correlated with BMI [Figure 1]. Maternal serum leptin levels increased significantly from hCG-day to OPU day in ~80% of the patients [Table 2], while in the rest there were very negligible rise.
In none of the patients who achieved pregnancy, leptin levels on OPU day increased over 50% of hCG day, and no patient with > 60% leptin increase achieved pregnancy. There were no differences in the number of retrieved oocytes among women having low, medium, or high FF leptin levels on OPU day [Table 3]. Oocyte retrieval rates were also comparable between the medium and higher serum leptin group.
30% reduction in hCG-stimulated E 2 production was evidenced when granulosa cells were collected from follicles yielding no oocytes [Figure 3].
Rates of fertilization, cleavage, and embryo development were comparable between the oocyte populations collected from low, medium, and high serum or FF leptin levels [Table 3]. There was a gradual rise in E2 production in response to an increment in the hCG dose in all the three groups. The hypothalamic-pituitary control over ovarian functions however is precisely governed by a plethora of external and internal principles including many of ovarian origin. Leptin has emerged as a potential regulator of many reproductive functions including gametogenic and steroidogenic potential of ovary. The major highlights of the present findings include an overall adverse impact of leptin on pregnancy outcome in IVF-ET.
During COH, a positive correlation between serum and FF leptin concentrations was noted, but between the follicles leptin level variation was commonly observed. This signifies that follicles do not produce leptin and different follicles may differentially respond to a common systemic signal. Successful implantation and establishment of pregnancy is dependent on a synchronized interaction between the embryo and secretory endometrium.
Impaired uterine receptivity may be a possible factor involved in the high leptin level-associated pregnancy failure. Endometrial thickness is considered an indirect marker of endometrial potential to support pregnancy. Moreover, expression of leptin mRNA in human secretory endometrium [23] suggests that endometrium may be capable of responding to leptin. An estrogen up-regulated 64.0 kDa uterine fluid protein is reported to correlate positively with endometrial thickness as well as its receptivity. On the other hand, quality of transferred embryo plays a crucial role in implantation and pregnancy success. Reports [27] indicate that endometrial thickness bears positive correlation with follicular phase serum estradiol concentration. A significant difference was observed in the endometrial thickness between the three subgroups.
We, therefore, hypothesize that increased leptin response to COH may exert adverse impacts on pregnancy success by way of modulating uterine receptivity.
This hypothesis gets further support by the observation of successful pregnancy in the cycles characterized by low pre-transfer leptin levels. In our patient population, eight patients had more than one transfer cycles (maximum three) with cryopreserved [28] embryos because of pregnancy failure in the stimulated cycle. It was observed that pregnancy was achieved in the cycles when leptin levels dropped significantly from that of the stimulated cycle. Apparently, a positive correlation was noted between leptin and estradiol, while progesterone exhibited no correlation. In vitro culture studies to evaluate the steroidogenic potential of LGCs collected from follicles with similar leptin milieu but producing mature, immature oocytes or no oocyte responded identically to hCG in the absence of leptin. But a 30% reduction in hCG-induced estradiol production was evident in the presence of leptin when LGCs were collected from follicles producing no oocyte.Taken together, these observations provide possible indication of attenuating effects of leptin on endometrial bed preparation that may be involved in pregnancy failure in women with elevated leptin response.
The small population size limits the statistical power to judge the precise correlation; however, elevated leptin response in COH exhibits a trend to adversely impact endometrial bed preparation and consequent pregnancy outcome.



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