Dehydroepiandrosterone sulfate and insulin resistance in patients with polycystic ovary syndrome

To the Editor:

We would like to thank Dr. Brennan et al for their fine article (1). In this study, they found that dehydroepiandrosterone (DHEAS) was negatively correlated to insulin resistance in patients with polycystic ovary syndrome (PCOS) and the independent variables that affect the insulin resistance, in decreasing importance, were body mass index (BMI), waist-to-hip ratio (WHR), age, DHEAS, free testosterone (T), sex hormone binding globulin (SHBG) and 17-hydroxyprogesterone (17-OHP).

Is perifollicular vascularity assessment always feasible and clinically effective?

To the Editor:

We read with great interest the recent paper by Robson et al. (1). The authors described their experience on power Doppler assessment of perifollicular vascularity (PV) at the time of ultrasound-guided transvaginal oocyte retrieval in infertile patients who underwent in vitro fertilization (IVF) showing that this procedure is practical and reproducible, and concluding that it should be tested in larger studies in order to define its clinical value.

Good news for women who suffer from endometriosis

To the Editor:

I read with great interest the study of Seracchioli et al (1), and I would like to start by warmly congratulating the authors. In fact, as gynecologist involved in the management of endometriosis, I have always been aware that postoperative long-term suppression of menses ought to follow the surgical procedure in order to reduce the recurrences. Now we have LE-1 data supporting the usefulness of postoperative long term medical treatment, and this is very good news for our patients!

Modified ultrasound scanning is a cost-effective method for the detection of deep infiltrating endometriosis

To the Editor:

We were very pleased to read the well-written study of Bazot et al (1), which compares the value of physical examination, transvaginal sonography (TVS), rectal endoscopic sonography, and magnetic resonance imaging (MRI) for the assessment of different locations of deep infiltrating endometriosis (DIE).

Generational Amnesia

To the Editor:

I read with interest the study by Deb and colleagues who have surveyed UK gynecologists to determine their preferred method for performing endometrial ablation (EA) (1). Certainly there is value in determining the relative use of various EA techniques on a national level, remembering that the outcome will likely vary considerably among various countries and provider systems.

Careful cardiovascular screening and follow-up of women with Turner syndrome before and during pregnancy is necessary to prevent maternal mortality

To the Editor:

The recent paper from Boissonnas et al. (1) reporting the tragic death from aortic dissection and rupture of  a women with Turner syndrome in the third trimester of an oocyte donation pregnancy raises important issues concerning the current guidelines for attempting pregnancy in women with this disorder (2). The current ASRM guidelines require preliminary cardiovascular screening using echocardiography to identify women with known risk factors for aortic complications such as abnormal aortic valve, aortic dilation (diameter >4 cm) or coarctation. However, recent studies show that routine transthoracic echocardiography fails to reveal significant pathology in many women with Turner syndrome (3, 4) and that 4 cm may signify  aortic dilation in small women (5).