The use of androgens or androgen-modulating agents in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis.
Hum Reprod Update. 2012 Feb 3;
Authors: Bosdou JK, Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Zepiridis L, Tarlatzis BC
Abstract
BACKGROUNDThe aim of this meta-analysis was to evaluate the role of androgens or androgen-modulating agents on the probability of pregnancy achievement in poor responders undergoing IVF.METHODSMedline, EMBASE, CENTRAL, Scopus and Web of Science databases were searched for the identification of randomized controlled trials evaluating the administration of testosterone, dehydroepiandrosterone (DHEA), aromatase inhibitors, recombinant luteinizing hormone (rLH) and recombinant human chorionic gonadotrophin (rhCG) before or during ovarian stimulation of poor responders.RESULTSIn two trials involving 163 patients, pretreatment with transdermal testosterone was associated with an increase in clinical pregnancy [risk difference (RD): +15%, 95% confidence interval (CI): +3 to +26%] and live birth rates (RD: +11%, 95% CI: +0.3 to +22%) in poor responders undergoing ovarian stimulation for IVF. No significant differences in clinical pregnancy and live birth rates were observed between patients who received DHEA and those who did not. Similarly, (i) the use of aromatase inhibitors, (ii) addition of rLH and (iii) addition of rhCG in poor responders stimulated with rFSH for IVF were not associated with increased clinical pregnancy rates. In the only eligible study that provided data, live birth rate was increased in patients who received rLH when compared with those who did not (RD: +19%, 95% CI:+1 to +36%).CONCLUSIONSBased on the limited available evidence, transdermal testosterone pretreatment seems to increase clinical pregnancy and live birth rates in poor responders undergoing ovarian stimulation for IVF. There is insufficient data to support a beneficial role of rLH, hCG, DHEA or letrozole administration in the probability of pregnancy in poor responders undergoing ovarian stimulation for IVF.
PMID: 22307331 [PubMed - as supplied by publisher]
Serum levels of the ovarian cancer biomarker HE4 are decreased in pregnancy and increase with age.
Am J Obstet Gynecol. 2011 Dec 30;
Authors: Moore RG, Miller MC, Eklund EE, Lu KH, Bast RC, Lambert-Messerlian G
Abstract
OBJECTIVE: The purpose of this study was to establish normal ranges for human epididymis protein 4 (HE4) serum levels in healthy women. STUDY DESIGN: HE4 levels were measured in healthy women and analyzed by age, menopausal status, and pregnancy status. Upper 95th percentiles were determined for normal ranges. RESULTS: Serum samples from 1101 healthy women and 67 pregnant women were analyzed. Above the age of 40 years significant elevations in HE4 concentrations emerged with advancing age. The upper 95th percentile for HE4 levels was 89 pmol/L for premenopausal women, 128 pmol/L for postmenopausal women, and 115 pmol/L for all women. There was a significant difference in the median serum HE4 levels in premenopausal women (46.6 pmol/L) compared with postmenopausal women (57.6 pmol/L; P < .001). In pregnant women, median HE4 concentrations were significantly lower than their premenopausal counterparts (P < .001). CONCLUSION: HE4 serum concentrations vary significantly on the basis of age. These variations must be considered when the upper limit of normal for HE4 is determined.
PMID: 22301440 [PubMed - as supplied by publisher]
OBJECTIVE: We investigated self-reported occupational exposure to antineoplastic drugs, anesthetic gases, antiviral drugs, sterilizing agents (disinfectants), and X-rays and the risk of spontaneous abortion in US nurses. STUDY DESIGN: Pregnancy outcome and occupational exposures were collected retrospectively from 8461 participants of the Nurses’ Health Study II. Of these, 7482 were eligible for analysis using logistic regression. RESULTS: Participants reported 6707 live births, and 775 (10%) spontaneous abortions (<20 weeks). After adjusting for age, parity, shift work, and hours worked, antineoplastic drug exposure was associated with a 2-fold increased risk of spontaneous abortion, particularly with early spontaneous abortion before the 12th week, and 3.5-fold increased risk among nulliparous women. Exposure to sterilizing agents was associated with a 2-fold increased risk of late spontaneous abortion (12-20 weeks), but not with early spontaneous abortion. CONCLUSION: This study suggests that certain occupational exposures common to nurses are related to risks of spontaneous abortion.
PMID: 22304790 [PubMed - as supplied by publisher]
Early detection of placental inflammation by MRI enabling protection by clinically relevant IL-1Ra administration.
Am J Obstet Gynecol. 2012 Jan 13;
Authors: Girard S, Tremblay L, Lepage M, Sebire G
Abstract
OBJECTIVE: We studied whether magnetic resonance imaging (MRI) could be used to detect placental inflammation before the detection of irreversible tissue damage. Next, we tested whether this early detection would enable the administration of treatment (ie, interleukin-1 receptor antagonist [IL-1Ra]) in a realistic clinical time after diagnosis. STUDY DESIGN: Pregnant rats were injected intraperitoneally with lipopolysaccharide with/without delayed IL-1Ra. MRI was performed at different time after the injection, and placentas were collected for comparison. Placental inflammation was assessed by determination of the levels of inflammatory cytokines. RESULTS: Placental inflammation was detected by MRI as early as 3 hours after maternal administration of lipopolysaccharide, concomitantly to IL-1β up-regulation. This was observed before any tissue damage, which appeared only at 24 hours after the administration of lipopolysaccharide. Delayed IL-1Ra administration (after MRI diagnosis) protected the placenta, as seen by the preserved tissue integrity and limited macrophages infiltration in the placental parenchyma. CONCLUSION: These findings established a noninvasive diagnostic method for early in utero detection of placental inflammation that would allow the administration of placentoprotective intervention within a clinically relevant delay after diagnosis.
PMID: 22304959 [PubMed - as supplied by publisher]
2009 H1N1 vaccination by pregnant women during the 2009-10 H1N1 influenza pandemic.
Am J Obstet Gynecol. 2011 Dec 30;
Authors: Dlugacz Y, Fleischer A, Carney MT, Copperman N, Ahmed I, Ross Z, Buchman T, Fried AM, Cabello C, De Geronimo M, Sweetapple C, Besthoff CM, Silverman RA
Abstract
OBJECTIVE: Pregnant women were identified at greater risk and given priority for 2009 H1N1 vaccination during the 2009 through 2010 H1N1 pandemic. We identified factors associated with acceptance or refusal of 2009 H1N1 vaccination during pregnancy. STUDY DESIGN: We conducted an in-person survey of postpartum women on the labor and delivery service from June 17 through Aug. 13, 2010, at 4 New York hospitals. RESULTS: Of 1325 survey respondents, 34.2% received 2009 H1N1 vaccination during pregnancy. A provider recommendation was most strongly associated with vaccine acceptance (odds ratio [OR], 19.4; 95% confidence interval [CI], 12.7-31.1). Also more likely to take vaccine were women indicating the vaccine was safe for the fetus (OR, 12.4; 95% CI, 8.3-19.0) and those who previously took seasonal flu vaccination (OR, 7.9; 95% CI, 5.8-10.7). Race, education, income, and age were less important in accepting vaccine. CONCLUSION: Greater emphasis on vaccine safety and provider recommendation is needed to increase the number of women vaccinated during pregnancy.
PMID: 22306303 [PubMed - as supplied by publisher]
Authors: Cahill AG, Roehl KA, Odibo AO, Zhao Q, Macones GA
Abstract
OBJECTIVE: We sought to estimate the association between fetal gender and first-stage labor curve at term. STUDY DESIGN: Within a large, retrospective cohort study of consecutive, singleton term labor patients who delivered in the second stage, we compared the active phase of first-stage labor by fetal gender. The primary outcome was length of active stage 1. Interval-censored regression was used to estimate the effect of fetal gender on the duration of active first stage (4-10 cm) and was adjusted for relevant covariates. RESULTS: Of 2400 women, 2373 women had complete labor information and were available for this analysis. Male gender was associated with both a statistically significantly longer active first stage of labor (4.6 vs 4.0 hours; P = .002) and stratified analyses by parity and labor type. CONCLUSION: Male fetuses are associated with longer active phase of the first stage of labor and, specifically, may need to be considered in the setting of arrest diagnoses.
PMID: 22306304 [PubMed - as supplied by publisher]
Comparison of Treatment Outcomes between Squamous Cell Carcinoma and Adenocarcinoma in Locally Advanced Cervical Cancer.
Gynecol Oncol. 2012 Jan 28;
Authors: Katanyoo K, Sanguanrungsirikul S, Manusirivithaya S
Abstract
PURPOSE: To compare the treatment outcomes between squamous cell carcinoma (SCC) and adenocarcinoma (ACA) in locally advanced cervical cancer patients. METHODS: All medical records of stage IIB-IVA of cervical cancer patients who had been completed treatment between 1995 and 2008 were reviewed. ACA 1 case was matched for SCC 2 cases with clinical stage, tumor size, treatment modalities (radiation therapy (RT) vs concurrent chemoradiation (CCRT)). Treatment outcomes including response to RT/CCRT, time to complete response (CR), patterns of treatment failure and survival outcomes were analyzed. RESULTS: A total of 423 patients with stage IIB-IVA (141 ACA: 282 SCC) were included. Most of the patients (about 60%) had stage IIB. The overall complete responses (CR) between ACA and SCC were 86.5% and 94.7%, respectively (p=0.004). Median time to clinical CR from RT/CCRT of ACA were 2months (0-5months) compared with 1month (0-4months) for SCC (p=0.001). Pelvic recurrence and distant failure were found in 2.1% and 14.9% in ACA, and corresponding with 3.9% and 15.6% in SCC. The 5-year overall survival rates of ACA compared to SCC were 59.9% and 61.7% (p=0.191), respectively. When adjusted all prognostic factors, clinical staging was only one factor that influenced to overall survival, while tumor histology was not affected factor. CONCLUSION: ACA in locally advanced cervical cancer had poorer response rate from treatment and also used longer time to achieve CR than SCC. However, these effects were not determinant of survival outcomes.
PMID: 22293041 [PubMed - as supplied by publisher]
A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer.
Gynecol Oncol. 2012 Jan 28;
Authors: Brotto LA, Erskine Y, Carey M, Ehlen T, Finalyson S, Heywood M, Kwon J, McAlpine J, Stuart G, Thomson S, Miller D
Abstract
GOAL: The goal of this study was to evaluate a mindfulness-based cognitive behavioral intervention for sexual dysfunction in gynecologic cancer survivors compared to a wait-list control group. METHODS: Thirty-one survivors of endometrial or cervical cancer (mean age 54.0, range 31-64) who self-reported significant and distressing sexual desire and/or sexual arousal concerns were assigned either to three, 90-minute mindfulness-based cognitive behavior therapy sessions or two months of wait-list control prior to entering the treatment arm. Validated measures of sexual response, sexual distress, and mood, as well as laboratory-evoked physiological and subjective sexual arousal were assessed at pre-, one month post-, and 6-months following treatment. RESULTS: There were no significant effects of the wait-list condition on any measure. Treatment led to significant improvements in all domains of sexual response, and a trend towards significance for reducing sexual distress. Perception of genital arousal during an erotic film was also significantly increased following the intervention despite no change in physiologically-measured sexual arousal. CONCLUSIONS: A brief mindfulness-based intervention was effective for improving sexual functioning. Geographic restrictions permitted only a select sample of survivors to participate, thus, the generalizability of the findings is limited. Future studies should aim to develop online modalities for treatment administration to overcome this limitation.
PMID: 22293042 [PubMed - as supplied by publisher]
Treatment outcomes in a large cohort of patients with invasive Extramammary Paget’s disease.
Gynecol Oncol. 2012 Jan 28;
Authors: Karam A, Dorigo O
Abstract
OBJECTIVE: The outcome of patients with invasive Extramammary Paget’s disease (EMPD) is poorly studied. The goal of the current study was to analyze the incidence, treatment approaches and outcome of patients with invasive EMPD. METHODS: We searched the SEER program database for patients diagnosed with invasive EMPD between 1973 and 2007. Demographic data, outcome and therapeutic modalities were included in the analysis. Disease specific survival (DSS) was calculated from the time of original diagnosis. RESULTS: 1439 patients were diagnosed with invasive EMPD. Most patients (80.4%) had localized disease, while 17.1% had locoregional spread, and 2.5% had distant disease. 1230 (86.4%) patients underwent site directed surgery, and 92 (6.4%) patients radiotherapy. 139 (9.7%) patients did not undergo any surgery or radiation therapy. The 5-year DSS was 94.9% for localized disease, 84.9% for regional disease and 52.5% for distant disease. Multivariate analysis showed a significantly shorter DSS associated with older age and advanced stage treatment modality (HR for death 1.07 and 2.5). Site directed surgery was associated with a significantly improved outcome when compared to patients who underwent no intervention (HR 0.44). Patients who received radiation, alone or in combination with site directed surgery, did not fare any better than patients who underwent surgery alone. CONCLUSIONS: The DSS of patients with invasive EMPD is generally favorable. A poor outcome was associated with older age, advanced stage and treatment modality. The association between a shortened DSS and the use of radiotherapy, alone or in combination with surgery, is surprising and warrants further investigation.
PMID: 22293043 [PubMed - as supplied by publisher]
PubMed requires this notice of disclaimer is present.
