Role of low-molecular-weight heparin in altering uterine artery blood flow in recurrent spontaneous abortion: a prospective study

Objective This study aimed to determine the role of uterine artery blood flow (UABF) in recurrent spontaneous abortion (RSA) and to determine a viable option to promote the outcome of pregnancy. Methods A total of 421 women were prospectively recruited for this research. UABF indices, including the systolic/diastolic ratio, pulsatility index and resistance index, during the midluteal phase were compared between patients with RSA and women without RSA (controls). After low-molecular-weight heparin (LMWH) was administered to patients with RSA, indices at 7, 10, and 12 weeks of gestation were compared between the two groups. Results UABF indices during the midluteal phase were significantly higher in the RSA group than in the control group. After LMWH was administered to the RSA group, UABF indices in the first trimester were similar to those in the control group. The rate of spontaneous miscarriage was also similar between the groups after LMWH treatment. Conclusions Our study shows that sufficient uterine perfusion is crucial for a successful pregnancy. LMWH reduces the rate of spontaneous miscarriage in patients with RSA to a similar rate in women without RSA. LMWH might play a role in decreasing UABF resistance and increasing uterine perfusion.

Effects of the Menstrual Cycle on Serum Carnitine and Endurance Performance of Women

This study aimed to investigate the effect of the menstrual cycle on serum carnitine and the endurance performance of healthy women. Fifteen eumenorrheic women underwent cycle ergometer exercise at 60% maximal oxygen uptake (V̇ O2max) for 45 min, followed by exercise at an intensity that was increased to 80% V̇ O 2max until exhaustion, during two menstrual cycle phases, including the early follicular phase (FP) and the midluteal phase (LP). The blood levels of estradiol, progesterone, total carnitine, free carnitine, and acylcarnitine were assessed. Compared with the FP, the LP had significantly lower serum total carnitine (p<0.05) and free carnitine (p<0.01). Moreover, the group with decreased endurance performance in the LP than in the FP showed a significantly higher change in serum free carnitine compared with the group that showed improved endurance performance in the LP than in the FP (p<0.05). The results of this study suggested that the changes in serum free carnitine during the menstrual cycle might influence endurance performance.

Dual-Task Paradigm Reveals Variation in Left Hemisphere Involvement in Verbal Processing Across the Menstrual Cycle in Normally Cycling Women

Cognitive performance and cerebral hemispheric function are known to vary with fluctuating levels of estradiol and progesterone across the menstrual cycle in naturally cycling females. However, the literature is mixed with regard to how each hemisphere may be affected by elevated ovarian hormones. To better understand this, the current study employed a dual-task paradigm to examine potential shifts in hemispheric involvement for a verbal problem-solving task across the menstrual cycle in 30 right-handed, normally cycling young adult females (18–21 years old). To our knowledge, no study to date has utilized dual-task procedures to directly investigate the potential shifts in hemispheric function across the menstrual cycle. Specifically, participants were tested during both menses and their estimated midluteal phase where they engaged in repetitive unilateral finger-tapping while concurrently solving anagrams silently or aloud. Analysis of finger-tapping interference during the dual-task conditions revealed that solving anagrams silently was lateralized to the left hemisphere while solving anagrams aloud yielded a pattern of more bilateral hemispheric involvement, both of which were consistent across both menses and midluteal phases. Analysis of cognitive performance, however, revealed that silent anagrams performance while tapping with the right, but not left, hand significantly increased during the midluteal phase. Consistent with a number of other studies using different methodological approaches, the current dual-task findings suggest that when ovarian hormone levels are putatively elevated, there is enhanced recruitment of left hemisphere resources while performing a lateralized verbal task.

Successful Pregnancy following Mixed Double Embryo Transfer in a Patient with Variable Window of Implantation

The process of embryo implantation is carried out during the receptive stage of the endometrium in the midluteal phase of the menstrual cycle, known as window of implantation (WOI). It has been assumed that the WOI is not a constant variable in all women and the determination of its displacement is of crucial importance, especially for patients with recurrent implantation failure (RIF). Furthermore, in rare cases it could have different duration and position in the menstrual cycle even in the same woman but during different periods. Here, we report a 37-year-old woman with RIF, who was previously classified as idiopathic but has now been diagnosed as having a variable WOI. This interpretation was done after the performance of immunohistochemical and histomorphological analyses of endometrial biopsies taken in the midluteal phase during three sequential menstrual cycles. In order to solve the problem with pinpointing a variable WOI, a specific type of embryo transfer, called mixed double embryo transfer (MDET), was done where one Day 3 and one Day 5 good quality embryos were transferred simultaneously 7 days after ovulation. A viable single pregnancy was confirmed by ultrasound scan and a healthy girl was born. This case showed a unique approach in overcoming the problem in RIF patients with variable WOI.