1
|
Vasileva R, Wohrer H, Gaultier V, Bucau M, Courcier H, Ben Miled S, Gonthier C, Koskas M. Pregnancy and obstetric outcomes after fertility-sparing management of endometrial cancer and atypical hyperplasia: a multicentre cohort study. Hum Reprod 2024; 39:1231-1238. [PMID: 38719783 DOI: 10.1093/humrep/deae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/08/2024] [Indexed: 06/04/2024] Open
Abstract
STUDY QUESTION What are the pregnancy and obstetric outcomes in women with atypical hyperplasia (AH) or early-stage endometrial cancer (EC) managed conservatively for fertility preservation? SUMMARY ANSWER The study found a live birth rate of 62% in patients with AH or EC after conservative treatment, with higher level of labour induction, caesarean section, and post-partum haemorrhage. WHAT IS KNOWN ALREADY Fertility-sparing treatment is a viable option for women with AH or EC during childbearing years, but the outcomes of such treatments, especially regarding pregnancy and obstetrics, need further exploration. STUDY DESIGN, SIZE, DURATION This retrospective cohort study analysed data from January 2010 to October 2022, involving 269 patients from the French national register of patients with fertility-sparing management of AH/EC. PARTICIPANTS/MATERIALS, SETTING, METHODS Women above 18 years of age, previously diagnosed with AH/EC, and approved for fertility preservation were included. Patients were excluded if they were registered before 2010, if their treatment began <6 months before the study, or if no medical record on the pregnancy was available. MAIN RESULTS AND THE ROLE OF CHANCE In total, 95 pregnancies in 67 women were observed. Pregnancy was achieved using ART in 63 cases (66%) and the live birth rate was 62%, with early and late pregnancy loss at 26% and 5%, respectively. In the 59 cases resulting in a live birth, a full-term delivery occurred in 90% of cases; 36% of cases required labour induction and 39% of cases required a caesarean section. The most common maternal complications included gestational diabetes (17%) and post-partum haemorrhaging (20%). The average (±SD) birthweight was 3110 ± 736 g; there were no significant foetal malformations in the sample. No significant difference was found in pregnancy or obstetric outcomes between ART-obtained and spontaneous pregnancies. However, the incidence of induction of labour, caesarean section, and post-partum haemorrhage appears higher than in the general population. LIMITATIONS, REASONS FOR CAUTION The retrospective nature of the study may introduce bias, and the sample size might be insufficient for assessing rare obstetric complications. WIDER IMPLICATIONS OF THE FINDINGS This study offers valuable insights for healthcare providers to guide patients who received fertility-sparing treatments for AH/EC. These pregnancies can be successful and with an acceptable live birth rate, but they seem to be managed with caution, leading to possible tendency for more caesarean sections and labour inductions. No increase in adverse obstetric outcomes was observed, with the exception of suspicion of a higher risk of post-partum haemorrhaging, to be confirmed. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Radostina Vasileva
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- Faculty of Medicine, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Henri Wohrer
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Victor Gaultier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Margot Bucau
- Department of Anatomic Pathology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Hélène Courcier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Selima Ben Miled
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Clementine Gonthier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Martin Koskas
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
| |
Collapse
|
2
|
Cannarella R, Crafa A, Curto R, Condorelli RA, La Vignera S, Calogero AE. Obesity and male fertility disorders. Mol Aspects Med 2024; 97:101273. [PMID: 38593513 DOI: 10.1016/j.mam.2024.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
Often associated with obesity, male infertility represents a widespread condition that challenges the wellbeing of the couple. In this article, we provide a comprehensive and critical analysis of studies exploring the association between obesity and male reproductive function, to evaluate the frequency of this association, and establish the effects of increased body weight on conventional and biofunctional sperm parameters and infertility. In an attempt to find possible molecular markers of infertility in obese male patients, the numerous mechanisms responsible for infertility in overweight/obese patients are reviewed in depth. These include obesity-related functional hypogonadism, insulin resistance, hyperinsulinemia, chronic inflammation, adipokines, irisin, gut hormones, gut microbiome, and sperm transcriptome. According to meta-analytic evidence, excessive body weight negatively influences male reproductive health. This can occurr through a broad array of molecular mechanisms. Some of these are not yet fully understood and need to be further elucidated in the future. A better understanding of the effects of metabolic disorders on spermatogenesis and sperm fertilizing capacity is very useful for identifying new diagnostic markers and designing therapeutic strategies for better clinical management of male infertility.
Collapse
Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Roberto Curto
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| |
Collapse
|
3
|
Chen Y, Ma G, Gai Y, Yang Q, Liu X, de Avila JM, Mao S, Zhu M, Du M. AMPK Suppression Due to Obesity Drives Oocyte mtDNA Heteroplasmy via ATF5-POLG Axis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307480. [PMID: 38499990 PMCID: PMC11132083 DOI: 10.1002/advs.202307480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/23/2024] [Indexed: 03/20/2024]
Abstract
Due to the exclusive maternal transmission, oocyte mitochondrial dysfunction reduces fertility rates, affects embryonic development, and programs offspring to metabolic diseases. However, mitochondrial DNA (mtDNA) are vulnerable to mutations during oocyte maturation, leading to mitochondrial nucleotide variations (mtSNVs) within a single oocyte, referring to mtDNA heteroplasmy. Obesity (OB) accounts for more than 40% of women at the reproductive age in the USA, but little is known about impacts of OB on mtSNVs in mature oocytes. It is found that OB reduces mtDNA content and increases mtSNVs in mature oocytes, which impairs mitochondrial energetic functions and oocyte quality. In mature oocytes, OB suppresses AMPK activity, aligned with an increased binding affinity of the ATF5-POLG protein complex to mutated mtDNA D-loop and protein-coding regions. Similarly, AMPK knockout increases the binding affinity of ATF5-POLG proteins to mutated mtDNA, leading to the replication of heteroplasmic mtDNA and impairing oocyte quality. Consistently, AMPK activation blocks the detrimental impacts of OB by preventing ATF5-POLG protein recruitment, improving oocyte maturation and mitochondrial energetics. Overall, the data uncover key features of AMPK activation in suppressing mtSNVs, and improving mitochondrial biogenesis and oocyte maturation in obese females.
Collapse
Affiliation(s)
- Yanting Chen
- National Center for Internatinal Research on Animal Gut NutritionJingsu Key Laboratory of Gastrointestinal Nutrition and Animal HealthCollege of Animal Science and TechnologyNanjing Agricultural UniversityNanjing210095China
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
| | - Guiling Ma
- National Center for Internatinal Research on Animal Gut NutritionJingsu Key Laboratory of Gastrointestinal Nutrition and Animal HealthCollege of Animal Science and TechnologyNanjing Agricultural UniversityNanjing210095China
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
| | - Yang Gai
- National Center for Internatinal Research on Animal Gut NutritionJingsu Key Laboratory of Gastrointestinal Nutrition and Animal HealthCollege of Animal Science and TechnologyNanjing Agricultural UniversityNanjing210095China
| | - Qiyuan Yang
- Department of MolecularCell and Cancer BiologyUniversity of Massachusetts Chan Medical SchoolWorcesterMA01655USA
| | - Xiangdong Liu
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
- Department of Cancer biologyDana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA02215USA
| | - Jeanene M. de Avila
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
| | - Shengyong Mao
- National Center for Internatinal Research on Animal Gut NutritionJingsu Key Laboratory of Gastrointestinal Nutrition and Animal HealthCollege of Animal Science and TechnologyNanjing Agricultural UniversityNanjing210095China
| | - Mei‐Jun Zhu
- School of Food SciencesWashington State UniversityPullmanWA99164USA
| | - Min Du
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
| |
Collapse
|
4
|
Vedelek V, Bicskei P, Tábi M, Lajkó N, Ékes C, Bereczki K, Meixner-Csáti Z, Sinka R, Vágvölgyi A, Zádori J. Endometrium development patterns and BMI groups among in vitro fertilization patients; prognostic aspects. Front Endocrinol (Lausanne) 2024; 15:1379109. [PMID: 38737557 PMCID: PMC11082419 DOI: 10.3389/fendo.2024.1379109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/22/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction The impact of the obesity pandemic on female reproductive capability is a factor that needs to be investigated. In addition, the link between endometrial thickness and in vitro fertilization (IVF) outcomes is contentious. Goal Our goal was to analyze the association among endometrium development, hormone levels, embryo quality, clinical pregnancy, anamnestic parameters, and body mass index (BMI) in women receiving IVF treatment. Patients and methods 537 participants undergoing IVF/ICSI cycles with successful oocyte retrieval were enrolled. Subjects were divided into four BMI based groups: underweight (UW; n=32), normal weight (NW; n=324), overweight (OW; n= 115), obesity (OB; n=66). Anthropometric and anamnestic parameters, characteristics of stimulation, endometrial thickness on the day of hCG injection, at puncture, at embryo transfer, FSH, LH, AMH, partner's age and the semen analysis indicators, embryo quality, clinical pregnancy, were recorded and analyzed. Support Vector Machine (SVM) was built to predict potential pregnancies based on medical data using 22 dimensions. Results In accordance with BMI categories, when examining pregnant/non-pregnant division, the average age of pregnant women was significantly lower in the UW (30.9 ± 4.48 vs. 35.3 ± 5.49 years, p=0.022), NW (34.2 ± 4.25 vs. 36.3 ± 4.84 years, p<0.001), and OW (33.8 ± 4.89 vs. 36.3 ± 5.31 years, p=0.009) groups. Considering FSH, LH, and AMH levels in each BMI category, a statistically significant difference was observed only in the NW category FSH was significantly lower (7.8 ± 2.99 vs. 8.6 ± 3.50 IU/L, p=0.032) and AMH (2.87 ± 2.40 vs. 2.28 ± 2.01 pmol/L, p=0.021) was higher in pregnant women. There were no further statistically significant differences observed between the pregnant and non-pregnant groups across any BMI categories, especially concerning endometrial development. Surprisingly, BMI and weight correlated negatively with FSH (r=-0.252, p<0.001; r=-0.206, p<0.001, respectively) and LH (r= -0.213, p<0.001; r= -0.195, p<0.001) in the whole population. SVM model average accuracy on predictions was 61.71%. Discussion A convincing correlation between endometrial thickness development and patients' BMI could not be substantiated. However, FSH and LH levels exhibited a surprising decreasing trend with increasing BMI, supporting the evolutionary selective role of nutritional status. Our SVM model outperforms previous models; however, to confidently predict the outcome of embryo transfer, further optimization is necessary.
Collapse
Affiliation(s)
- Viktor Vedelek
- Department of Genetics, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Petra Bicskei
- Institute of Reproductive Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Mariann Tábi
- Institute of Reproductive Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Noémi Lajkó
- Institute of Reproductive Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Csaba Ékes
- Institute of Reproductive Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Kristóf Bereczki
- Institute of Reproductive Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Zsófia Meixner-Csáti
- Institute of Reproductive Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Rita Sinka
- Department of Genetics, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Anna Vágvölgyi
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - János Zádori
- Institute of Reproductive Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| |
Collapse
|
5
|
Liu S, Zhou X, Jie H, Zheng Z, Cai B, Mai Q, Zhou C. Higher Cumulative Live Birth Rate but Also Higher Late Miscarriage Risk in Non-Obese Women with Polycystic Ovary Syndrome Undergoing the First IVF/ICSI Cycle. Int J Womens Health 2024; 16:289-298. [PMID: 38415060 PMCID: PMC10898478 DOI: 10.2147/ijwh.s445021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
Purpose To determine the impact of polycystic ovary syndrome on in vitro fertilization/intracytoplasmic sperm injection and embryo transfer outcomes while analyzing the influencing factors. Patients and Methods A retrospective cohort study comprised 4839 patients who underwent their first cycle of IVF/ICSI treatment from January 2016 to December 2021. Cumulative pregnancy rates, cumulative live birth rates, and late miscarriage rates compared between the PCOS group and control group. Subgroup analysis and binary regression were used to analyze the influence of BMI on clinical outcomes among individuals diagnosed with PCOS. Results Non-obese PCOS patients exhibited higher cumulative pregnancy rates, cumulative live birth rates, and late miscarriage rates compared to the control group with the normal BMI population (84.7% vs71.2%, P < 0.001; 74.1% vs 61.6%, P < 0.001; 4.1% vs 2.0%, P = 0.002), but there was no significant difference in early miscarriage rates between the two groups. Conclusion Non-obese PCOS patients demonstrated a notably higher cumulative live birth rate but also a higher risk of late miscarriage compared to non-PCOS females with a normal BMI.
Collapse
Affiliation(s)
- Simin Liu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, People's Republic of China
| | - Xiu Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, People's Republic of China
| | - Huiying Jie
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, People's Republic of China
| | - Zetong Zheng
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, People's Republic of China
| | - Bing Cai
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, People's Republic of China
| | - Qingyun Mai
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, People's Republic of China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, People's Republic of China
| |
Collapse
|
6
|
Fabozzi G, Cimadomo D, Maggiulli R, Vaiarelli A, Badajoz V, Aura M, Canosa S, Bongioanni F, Benini F, Livi C, Zacà C, Borini A, Alviggi E, Iussig B, Hebles M, Sànchez P, Cimadomo V, Rienzi L, Llàcer J. Association between oocyte donors' or recipients' body mass index and clinical outcomes after first single blastocyst transfers-the uterus is the most affected. Fertil Steril 2024; 121:281-290. [PMID: 37549838 DOI: 10.1016/j.fertnstert.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To assess whether high body mass index (BMI) in either oocyte donors or recipients is associated with poorer outcomes after the first single blastocyst transfer. DESIGN Retrospective study including 1,394 first blastocyst single embryo transfers (SETs) conducted by 1,394 recipients during oocyte donation cycles with the gametes retrieved from 1,394 women (January 2019-July 2021). Four BMI clusters were defined for both donors and recipients (underweight: <18.5 kg; normal weight: 18.5-24.9 kg; overweight: 25-29.9 kg; and obese: ≥30 kg). SETTING Network of private IVF centers. PATIENTS A total of 1,394 recipients aged 42.4 ± 4.0 and with a BMI of 23.2 ± 3.8 kg/m2, and 1,394 donors aged 26.1 ± 4.2 and with a BMI of 21.9 ± 2.5 kg/m2. INTERVENTION All oocytes were vitrified at 2 egg banks and warmed at 8 in vitro fertilization clinics that were part of the same network. Intracytoplasmic sperm injection, blastocyst culture, and either fresh or vitrified-warmed SETs were conducted. Putative confounders were investigated, and the data were adjusted through regression analyses. MAIN OUTCOME MEASURES The primary outcome was the live birth rate (LBR) per SET according to donors' and/or recipients' BMI. The main secondary outcome was the miscarriage rate (<22 gestational weeks) per clinical pregnancy. RESULTS The LBR per blastocyst SET showed no significant association with donors' BMI. Regarding recipients' BMI, instead, the multivariate odds ratio was significant in obese vs. normal-weight recipients (0.58, 95% confidence interval, 0.37-0.91). The miscarriage rate per clinical pregnancy was also significantly associated with recipients' obesity, with a multivariate odds ratio of 2.31 (95% confidence interval, 1.18-4.51) vs. normal-weight patients. A generalized additive model method was used to represent the relationship between predicted LBR or miscarriage rates and donors' or recipients' BMI; it pictured a scenario where the former outcome moderately but continuously decreases with increasing recipients' BMI to then sharply decline in the BMI range of 25-35 kg/m2. The miscarriage rate, instead, increases almost linearly with respect to both donors' and recipients' increasing BMI. CONCLUSION Obesity mostly affects the uterus, especially because of higher miscarriage rates. Yet, poorer outcomes can be appreciated already with a BMI of 25 kg/m2 in both oocyte donors and recipients. Finer markers of nutritional homeostasis are therefore desirable; recipients should be counseled about poorer expected outcomes in cases of overweight and obesity; and oocyte banks should avoid assigning oocytes from overweight donors to overweight and obese recipients.
Collapse
Affiliation(s)
- Gemma Fabozzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; IVIRMA Global Research Alliance, B-WOMAN, Rome, Italy; Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy
| | - Danilo Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy.
| | - Roberta Maggiulli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Alberto Vaiarelli
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | | | - Monica Aura
- IVIRMA Global Research Alliance, GINEFIV, Barcelona, Spain
| | | | | | | | - Claudia Livi
- IVIRMA Global Research Alliance, DEMETRA, Florence, Italy
| | - Carlotta Zacà
- IVIRMA Global Research Alliance, 9.baby, Bologna, Italy
| | - Andrea Borini
- IVIRMA Global Research Alliance, 9.baby, Bologna, Italy
| | - Erminia Alviggi
- IVIRMA Global Research Alliance, GENERA, Clinica Ruesch, Naples, Italy
| | - Benedetta Iussig
- IVIRMA Global Research Alliance, GENERA, GENERA Veneto, Marostica, Italy
| | - Maria Hebles
- IVIRMA Global Research Alliance, GINEMED, Sevilla, Spain
| | | | | | - Laura Rienzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy; Department of Biomolecular Sciences, the University of Urbino "Carlo Bo", Urbino, Italy
| | | |
Collapse
|
7
|
Luu TH, Kuhn K, Bradford AP, Wempe MF, Wittenburg L, Johnson RL, Carlson NE, Kumar TR, Polotsky AJ. Effects of pulsatile intravenous follicle-stimulating hormone treatment on ovarian function in women with obesity. Fertil Steril 2023; 120:890-898. [PMID: 37276947 PMCID: PMC10526695 DOI: 10.1016/j.fertnstert.2023.05.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To establish conditions for effective hypothalamic suppression in women with normal and high body mass index (BMI) and test the hypothesis that intravenous (IV) administration of pulsatile recombinant follicle-stimulating hormone (rFSH) can overcome the clinically evident dysfunctional pituitary-ovarian axis in women with obesity. DESIGN Prospective interventional study. SETTING Academic medical center. PATIENT(S) Twenty-seven normal-weight women and 27 women with obesity, who were eumenorrheic and aged 21-39 years. INTERVENTION(S) Two-day frequent blood sampling study, in early follicular phase, before and after cetrorelix suppression of gonadotropins and exogenous pulsatile IV rFSH administration. MAIN OUTCOME MEASURE(S) Serum inhibin B and estradiol (E2) levels (basal and rFSH stimulated). RESULT(S) A modified gonadotropin-releasing hormone antagonism protocol effectively suppressed production of endogenous gonadotropins in women with normal and high BMIs, providing a model to address the functional role of FSH in the hypothalamic-pituitary-ovarian axis. The IV rFSH treatment resulted in equivalent serum levels and pharmacodynamics in normal-weight women and those with obesity. However, women with obesity exhibited reduced basal levels of inhibin B and E2 and a significantly decreased response to FSH stimulation. The BMI was inversely correlated with serum inhibin B and E2. In spite of this observed deficit in ovarian function, pulsatile IV rFSH treatment in women with obesity resulted in E2 and inhibin B levels comparable with those in normal-weight women, in the absence of exogenous FSH stimulation. CONCLUSION(S) Despite normalization of FSH levels and pulsatility by exogenous IV administration, women with obesity demonstrate ovarian dysfunction with respect to E2 and inhibin B secretion. Pulsatile FSH can partially correct the relative hypogonadotropic hypogonadism of obesity, thereby providing a potential treatment strategy to mitigate some of the adverse effects of high BMI on fertility, assisted reproduction, and pregnancy outcomes. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov #NCT02478775.
Collapse
Affiliation(s)
- Thanh Ha Luu
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Katherine Kuhn
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Andrew P Bradford
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael F Wempe
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Luke Wittenburg
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nichole E Carlson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - T Rajendra Kumar
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alex J Polotsky
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Shady Grove Fertility, Greenwood Village, Colorado
| |
Collapse
|
8
|
Carreira A, Araújo B, Lavrador M, Vieira I, Rodrigues D, Paiva S, Melo M, Paiva I. From Bariatric Surgery to Conception: The Ideal Timing to Optimize Fetal Weight. Obes Surg 2023; 33:2859-2865. [PMID: 37480424 PMCID: PMC10435401 DOI: 10.1007/s11695-023-06755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/02/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Bariatric surgery (BS) increases the risk of small for gestational age (SGA) neonates. Guidelines recommend postponing pregnancy for 12-24 months, but optimal surgery-to-conception interval (BSCI) remains uncertain. We aimed to evaluate the impact of BSCI on birth weight and SGA. MATERIALS AND METHODS Retrospective cohort study of 42 pregnancies following BS, including Roux-en-Y gastric bypass, gastric sleeve, adjustable gastric banding and biliopancreatic diversion. Neonates were classified as SGA if birth weight < 10th percentile. Optimal BSCI was obtained from the analysis of ROC curves, and pregnancies were compared by that cut-off. RESULTS There was a linear association between BSCI and birth weight and an inverse association with SGA, with each additional month of BSCI translating into additional 4.5 g (95%CI: 2.0-7.0) on birth weight and -6% risk of SGA (95%CI: 0.90-0.99). We established a cut-off of 24.5 months of BSCI for lower risk of SGA. Pregnancies conceived in the first 24 months had a more than tenfold increased risk of SGA (OR 12.6, 95%CI: 2.4-66.0), even when adjusted for maternal age, gestational diabetes and inadequate gestational weight gain. CONCLUSION BSCI was associated with birth weight and SGA. Our results are in line with the recommendations of BSCI of at least 24 months to reduce the risk of SGA.
Collapse
Affiliation(s)
- Ana Carreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário de Coimbra, 3004-561, Coimbra, Portugal.
| | - Bárbara Araújo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário de Coimbra, 3004-561, Coimbra, Portugal
| | - Mariana Lavrador
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário de Coimbra, 3004-561, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548, Coimbra, Portugal
| | - Inês Vieira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário de Coimbra, 3004-561, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548, Coimbra, Portugal
| | - Dírcea Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário de Coimbra, 3004-561, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548, Coimbra, Portugal
| | - Sandra Paiva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário de Coimbra, 3004-561, Coimbra, Portugal
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário de Coimbra, 3004-561, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548, Coimbra, Portugal
| | - Isabel Paiva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário de Coimbra, 3004-561, Coimbra, Portugal
| |
Collapse
|
9
|
Gao J, Liu M, Liu J, Shi P, Cui H, Zhao S, Zhang X, Tao C. Effect of high-fat diet on the lipid profile of ovarian granulosa cells and female reproduction in mice. PLoS One 2023; 18:e0287534. [PMID: 37368884 PMCID: PMC10298767 DOI: 10.1371/journal.pone.0287534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Currently, comorbidities of obesity are becoming increasingly frequent. For example, obese women are more susceptible to reproductive diseases; however, the underlying mechanism remains poorly understood. The present study aimed to explore the effect of obesity on female reproduction and discuss changes of the lipid profile in ovarian granulosa cells. Fifty female mice were randomly divided into two groups, one group was fed high-fat diet, the other group was fed standard control diet, food and water freely. After 12 weeks of feeding, the average body weight of the high-fat diet mice (19.027g) was significantly higher than that of the standard control diet mice (36.877g) (P < 0.05). The tissue sections were stained with oil red O, and the online software mage Pro plus 6.0 analyzed the staining results, the lipids in the ovaries and endometria were found to be different between the two groups. Liquid chromatography-electrospray ionization with tandem mass spectrometry (LC-ESI-MS/MS) analysis of ovarian granulosa cells (GCs) was performed, with a total of 228 different lipids being identified, the abundant of 147 were increased and 81 were decreased in the high-fat diet group. Among them, PI (18:1/20:1) was the most different lipid, and high-fat feeding was 85 times higher than standard control group. Among these different lipids, 44% in phospholipid metabolism, 30% in glycerolipid metabolism, and 30% in fat digestion and absorption. The results of this study laid a theoretical foundation of the effects of diet-induced obesity on female reproduction.
Collapse
Affiliation(s)
- Jinchun Gao
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei Province, China
| | - Mingchao Liu
- College of Veterinary Medicine, Hebei Agricultural University, Baoding, Hebei Province, China
| | - Jingge Liu
- College of Animal Science and Food Engineering, Jinling Institute of Technology, Nanjing, China
| | - Peihua Shi
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei Province, China
| | - Haoliang Cui
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei Province, China
| | - Shunran Zhao
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei Province, China
| | - Xinbo Zhang
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei Province, China
| | - Chenyu Tao
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei Province, China
| |
Collapse
|
10
|
Ennab F, Atiomo W. Obesity and female infertility. Best Pract Res Clin Obstet Gynaecol 2023; 89:102336. [PMID: 37279630 DOI: 10.1016/j.bpobgyn.2023.102336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/22/2023] [Accepted: 03/30/2023] [Indexed: 06/08/2023]
Abstract
Infertility is a significant global health issue, with a negative impact on people's wellbeing and human rights. Despite the longstanding association between obesity and infertility, there remains uncertainty, about the precise mechanisms underpinning this association and best management strategies. In this article, we aimed to address these uncertainties by reviewing the recent literature, and focusing on studies which evaluated live birth rates. We found that just over half of the studies, investigating the relationship between preconception maternal weight and live birth rates found an inverse correlation. There was, however, insufficient evidence, that preconception maternal lifestyle or pharmacological interventions in obese women with infertility, resulted in improved live birth rates. The implications for clinical practice and future research are highlighted. For example, the need to consider some flexibility in applying strict preconception body mass index targets, limiting access to fertility treatment, and a need for large clinical trials of new pharmacological options and bariatric surgery.
Collapse
Affiliation(s)
- Farah Ennab
- College of Medicine, Mohammed Bin Rashid University of Medicine, and Health Sciences, Building 14, Al Razi St., Umm Hurair 2, Dubai Healthcare City, P.O. Box 505055, Dubai, United Arab Emirates.
| | - William Atiomo
- College of Medicine, Mohammed Bin Rashid University of Medicine, and Health Sciences, Building 14, Al Razi St., Umm Hurair 2, Dubai Healthcare City, P.O. Box 505055, Dubai, United Arab Emirates.
| |
Collapse
|
11
|
Li J, Shi H, Bu Z, Kong H, Ye T, Guo Y. Effect of body mass index on the cumulative live birth rate over multiple complete IVF cycles in women with polycystic ovary syndrome: A retrospective study. Obes Res Clin Pract 2023; 17:130-136. [PMID: 36922274 DOI: 10.1016/j.orcp.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/24/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of body mass index (BMI) before treatment on the cumulative live birth rate (CLBR) over multiple complete in vitro fertilization (IVF) cycles in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS This study is a single-center retrospective cohort study. It included 5016 patients with PCOS who started their first IVF cycle in our hospital between 2009 and 2018. Kaplan-Meier and log-rank tests were used for the comparison of CLBR across BMI groups. Univariate, multivariate models and stratification analysis were used to evaluate possible influencing factors of CLBR. Smoothing curve fitting was applied to present the correlation between BMI and CLBR. A one-line linear regression model was compared with a two-piecewise linear model using a log-likelihood ratio test. RESULTS During the 8-year follow-up, 3604 women (71.85%) obtained at least one live birth. The study population was grouped according to BMI, with BMI ranging from [14.53-23.00) kg/m2 in the normal weight group, [23.00-27.50) kg/m2 in the overweight group, and [27.50-37.80] kg/m2 in the obese group, respectively. The CLBR of the obese group and the overweight group were significantly lower than the normal weight group. In the multivariate regression model, HR for CLBR was 0.86 [95%CI: 0.78-0.95] for the obese group, and 0.93 [0.86-1.00] for the overweight group, compared with the normal weight group as control. The curve fitting after adjustment for confounding factors and log-likelihood ratio test showed a one-line linear negative correlation between BMI and CLBR. CONCLUSION We concluded that the BMI of PCOS patients had a negative one-line linear correlation with CLBR over multiple complete cycles.
Collapse
Affiliation(s)
- Jing Li
- Reproduction and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, China
| | - Hao Shi
- Reproduction and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, China
| | - Zhiqin Bu
- Reproduction and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, China
| | - Huijuan Kong
- Reproduction and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, China
| | - Tian Ye
- Reproduction and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, China
| | - Yihong Guo
- Reproduction and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Reproduction and Genetics, Zhengzhou, China.
| |
Collapse
|
12
|
Miñambres I, de Hollanda A, Vilarrasa N, Pellitero S, Rubio MA, Flores L, Caixàs A, Lobo S, Martinez Salamanca JI, Acevedo B, Moizé V, Andreu A, Escalada J. Obesity and fertility. Position statement. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 1:110-115. [PMID: 36907798 DOI: 10.1016/j.endien.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 03/12/2023]
Affiliation(s)
- I Miñambres
- Servicio de Endocrinología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - A de Hollanda
- Servicio de Endocrinología, Hospital Clínic, Barcelona, Centro de Investigación Biomédica en red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain.
| | - N Vilarrasa
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge-IDIBELL, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - S Pellitero
- Servicio de Endocrinología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació, Badalona, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - M A Rubio
- Servicio de Endocrinología. Hospital Clínico San Carlos, Madrid, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - L Flores
- Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española para el Estudio de la Obesidad, SEEDO, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - A Caixàs
- Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Departamento de Medicina Universitat Autònoma de Barcelona, Sabadell, Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española para el Estudio de la Obesidad, SEEDO, Spain
| | - S Lobo
- Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Grupo de Interés de Endocrinología Reproductiva, Sociedad Española de Fertilidad (SEF), Spain
| | - J I Martinez Salamanca
- Servicio de Urología, Hospital Universitario Puerta de Hierro, Majadahonda, Lyx Instituto de Urología, Universidad Francisco de Vitoria, Asociación Española de Urología, Spain
| | - B Acevedo
- Servicio de Ginecología y Obstetricia, Unidad de Reproducción Asistida, Hospital Fundación Jiménez Díaz, Madrid, Profesor asociado de Medicina de la Universidad Autónoma de Madrid (UAM), Sociedad Española de Ginecología y Obstetricia (SEGO), Spain
| | - V Moizé
- Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Sociedad Española de Dietética y Nutrición (SEDYN), Spain
| | - A Andreu
- Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Sociedad Española de Dietética y Nutrición (SEDYN), Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - J Escalada
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Pamplona, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | | |
Collapse
|
13
|
Rodolakis A, Scambia G, Planchamp F, Acien M, Di Spiezio Sardo A, Farrugia M, Grynberg M, Pakiž M, Pavlakis K, Vermeulen N, Zannoni G, Zapardiel I, Tryde Macklon K. ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma. Facts Views Vis Obgyn 2023; 15:3-23. [PMID: 37010330 PMCID: PMC10392114 DOI: 10.52054/fvvo.15.1.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: The standard surgical treatment of endometrial carcinoma (EC) consisting of total hysterectomy with bilateral salpingo-oophorectomy drastically affects the quality of life of patients and creates a challenge for clinicians. Recent evidence-based guidelines of the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) provide comprehensive guidelines on all relevant issues of diagnosis and treatment in EC in a multidisciplinary setting. While also addressing work-up for fertility preservation treatments and the management and follow-up for fertility preservation, it was considered relevant to further extend the guidance on fertility sparing treatment.
Objectives: To define recommendations for fertility-sparing treatment of patients with endometrial carcinoma.
Materials and Methods: ESGO/ESHRE/ESGE nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of EC (11 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2016, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 95 independent international practitioners in cancer care delivery and patient representatives.
Results: The multidisciplinary development group formulated 48 recommendations for fertility-sparing treatment of patients with endometrial carcinoma in four sections: patient selection, tumour clinicopathological characteristics, treatment and special issues.
Conclusions: These recommendations provide guidance to professionals caring for women with endometrial carcinoma, including but not limited to professionals in the field of gynaecological oncology, onco-fertility, reproductive surgery, endoscopy, conservative surgery, and histopathology, and will help towards a holistic and multidisciplinary approach for this challenging clinical scenario.
What is new? A collaboration was set up between the ESGO, ESHRE and ESGE, aiming to develop clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing treatment in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.
Collapse
|
14
|
Rodolakis A, Scambia G, Planchamp F, Acien M, Di Spiezio Sardo A, Farrugia M, Grynberg M, Pakiz M, Pavlakis K, Vermeulen N, Zannoni G, Zapardiel I, Macklon KLT. ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma . Hum Reprod Open 2023; 2023:hoac057. [PMID: 36756380 PMCID: PMC9900425 DOI: 10.1093/hropen/hoac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Indexed: 02/08/2023] Open
Abstract
STUDY QUESTION How should fertility-sparing treatment of patients with endometrial carcinoma be performed? SUMMARY ANSWER Forty-eight recommendations were formulated on fertility-sparing treatment of patients with endometrial carcinoma. WHAT IS KNOWN ALREADY The standard surgical treatment of endometrial carcinoma consisting of total hysterectomy with bilateral salpingo-oophorectomy drastically affects the quality of life of patients and creates a challenge for clinicians. Recent evidence-based guidelines of the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) provide comprehensive guidelines on all relevant issues of diagnosis and treatment in endometrial carcinoma in a multidisciplinary setting. While addressing also work-up for fertility preservation treatments and the management and follow-up for fertility preservation, it was considered relevant to further extend the guidance on fertility-sparing treatment. STUDY DESIGN SIZE DURATION A collaboration was set up between the ESGO, the European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESGE), aiming to develop clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing treatment in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. PARTICIPANTS/MATERIALS SETTING METHODS ESGO/ESHRE/ESGE nominated an international multidisciplinary development group consisting of practising clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (11 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2016, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgement was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 95 independent international practitioners in cancer care delivery and patient representatives. MAIN RESULTS AND THE ROLE OF CHANCE The multidisciplinary development group formulated 48 recommendations in four sections; patient selection, tumour clinicopathological characteristics, treatment and special issues. LIMITATIONS REASONS FOR CAUTION Of the 48 recommendations, none could be based on level I evidence and only 16 could be based on level II evidence, implicating that 66% of the recommendations are supported only by observational data, professional experience and consensus of the development group. WIDER IMPLICATIONS OF THE FINDINGS These recommendations provide guidance to professionals caring for women with endometrial carcinoma, including but not limited to professionals in the field of gynaecological oncology, onco-fertility, reproductive surgery, endoscopy, conservative surgery and histopathology, and will help towards a holistic and multidisciplinary approach for this challenging clinical scenario. STUDY FUNDING/COMPETING INTERESTS All costs relating to the development process were covered from ESGO, ESHRE and ESGE funds. There was no external funding of the development process or manuscript production. G.S. has reported grants from MSD Italia S.r.l., advisory boards for Storz, Bayer, Astrazeneca, Metronic, TESARO Bio Italy S.r.l and Johnson & Johnson, and honoraria for lectures from Clovis Oncology Italy S.r.l. M.G. has reported advisory boards for Gedeon Richter and Merck. The other authors have reported no conflicts of interest. DISCLAIMER This document represents the views of ESHRE, ESGO and ESGE which are the result of consensus between the relevant stakeholders and where relevant based on the scientific evidence available at the time of preparation. The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type.
Collapse
Affiliation(s)
- Alexandros Rodolakis
- Correspondence address. Unit of Gynaecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens 115 28, Greece. E-mail:
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Maribel Acien
- Obstetrics and Gynecology Department, San Juan University Hospital, Miguel Hernández University, Alicante, Spain
| | - Attilio Di Spiezio Sardo
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Napoli, Campania, Italy
| | | | - Michael Grynberg
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France,AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France,University Paris-Saclay, Saint-Aubin, France
| | - Maja Pakiz
- Department for Gynecologic and Breast Oncology, University Medical Centre, Maribor, Slovenia
| | - Kitty Pavlakis
- 1st Pathology Department, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece,Pathology Department, “IASO” Women's Hospital, Athens, Greece
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology, Strombeek-Bever, Belgium
| | - Gianfranco Zannoni
- Department of Pathology, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ignacio Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
| | | |
Collapse
|
15
|
Rodolakis A, Scambia G, Planchamp F, Acien M, Di Spiezio Sardo A, Farrugia M, Grynberg M, Pakiz M, Pavlakis K, Vermeulen N, Zannoni G, Zapardiel I, Macklon KLT. ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma. Int J Gynecol Cancer 2023; 33:208-222. [PMID: 36746507 DOI: 10.1136/ijgc-2022-004047] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The standard surgical treatment of endometrial carcinoma, consisting of total hysterectomy with bilateral salpingo-oophorectomy, drastically affects the quality of life of patients and creates a challenge for clinicians. Recent evidence-based guidelines of the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) provide comprehensive information on all relevant issues of diagnosis and treatment in endometrial carcinoma in a multidisciplinary setting. While addressing also work-up for fertility preservation treatments and the management and follow-up for fertility preservation, it was considered relevant to further extend the guidance on fertility-sparing treatment.A collaboration was set up between the ESGO, the European Society of Human Reproduction and Embryology (ESHRE), and the European Society for Gynaecological Endoscopy (ESGE), aiming to develop clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing treatment (patient selection, tumor clinicopathological characteristics, treatment, special issues) in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.ESGO/ESHRE/ESGE nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (11 experts from across Europe). To ensure that the guidelines are evidence-based, the literature published since 2016, identified by a systematic search, was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 95 independent international practitioners in cancer care delivery and patient representatives.
Collapse
Affiliation(s)
- Alexandros Rodolakis
- Unit of Gynaecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Maribel Acien
- Obstetrics and Gynecology Department, San Juan University Hospital, Miguel Hernández University, Alicante, Spain
| | - Attilio Di Spiezio Sardo
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Napoli, Campania, Italy
| | | | - Michael Grynberg
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France.,AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France.,University Paris-Saclay, Saint-Aubin, France
| | - Maja Pakiz
- Department for Gynecologic and Breast Oncology, University Medical Centre, Maribor, Slovenia
| | - Kitty Pavlakis
- 1st Pathology Department, Alexandra Hospital, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece.,Pathology Department, "IASO" Women's Hospital, Athens, Greece
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology, Strombeek-Bever, Belgium
| | - Gianfranco Zannoni
- Department of Pathology, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ignacio Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
| | | |
Collapse
|
16
|
Rodolakis A, Scambia G, Planchamp F, Acien M, Di Spiezio Sardo A, Farrugia M, Grynberg M, Pakiž M, Pavlakis K, Vermeulen N, Zannoni G, Zapardiel I, Tryde Macklon KL. ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma. Facts Views Vis Obgyn 2023; 15. [PMID: 36739613 DOI: 10.52054/fvvo.14.4.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The standard surgical treatment of endometrial carcinoma (EC) consisting of total hysterectomy with bilateral salpingo-oophorectomy drastically affects the quality of life of patients and creates a challenge for clinicians. Recent evidence-based guidelines of the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) provide comprehensive guidelines on all relevant issues of diagnosis and treatment in EC in a multidisciplinary setting. While also addressing work-up for fertility preservation treatments and the management and follow-up for fertility preservation, it was considered relevant to further extend the guidance on fertility sparing treatment. Objectives To define recommendations for fertility-sparing treatment of patients with endometrial carcinoma. Materials and Methods ESGO/ESHRE/ESGE nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of EC (11 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2016, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 95 independent international practitioners in cancer care delivery and patient representatives. Results The multidisciplinary development group formulated 48 recommendations for fertility-sparing treatment of patients with endometrial carcinoma in four sections: patient selection, tumour clinicopathological characteristics, treatment and special issues. Conclusions These recommendations provide guidance to professionals caring for women with endometrial carcinoma, including but not limited to professionals in the field of gynaecological oncology, onco-fertility, reproductive surgery, endoscopy, conservative surgery, and histopathology, and will help towards a holistic and multidisciplinary approach for this challenging clinical scenario. What is new? A collaboration was set up between the ESGO, ESHRE and ESGE, aiming to develop clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing treatment in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.
Collapse
|
17
|
Gautam D, Purandare N, Maxwell CV, Rosser ML, O'Brien P, Mocanu E, McKeown C, Malhotra J, McAuliffe FM. The challenges of obesity for fertility: A FIGO literature review. Int J Gynaecol Obstet 2023; 160 Suppl 1:50-55. [PMID: 36635080 PMCID: PMC10107441 DOI: 10.1002/ijgo.14538] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity has been linked to infertility through several mechanisms, including at a molecular level. Those living with obesity face additional barriers to accessing fertility treatments and achieving a successful pregnancy, which can contribute to their economic and psychosocial stressors. There is scope to further improve care for people living with obesity and infertility with empathy, via a multidisciplinary approach.
Collapse
Affiliation(s)
- Divya Gautam
- Department of Obstetrics and Gynecology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nikhil Purandare
- Department of Obstetrics and Gynecology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Cynthia V Maxwell
- Maternal Fetal Medicine, Sinai Health and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Edgar Mocanu
- RCSI Department of Reproductive Medicine, Rotunda Hospital, Dublin, Ireland
| | - Ciaran McKeown
- Department of Obstetrics and Gynecology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Jaideep Malhotra
- Malhotra Nursing and Maternity Home, Agra, India.,Rainbow Hospital, Agra, India
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | | |
Collapse
|
18
|
Lefebvre T, Fréour T, Duval G, Ploteau S, Marchand P, Le Bizec B, Antignac JP, Cano-Sancho G. Associations between internal concentrations of fluorinated and organochlorinated chemicals in women and in vitro fertilization outcomes: A multi-pollutant study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 313:120087. [PMID: 36087895 DOI: 10.1016/j.envpol.2022.120087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
The impact of persistent organic pollutants (POPs) on reproductive health is still poorly understood, even though infertility management has high associated societal and economical costs. The aims of this study were to characterize the internal levels of polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs) and perfluoroalkylated substances (PFAS) in women undergoing in vitro fertilization (IVF); and evaluate their association with IVF outcomes, individually and as mixtures in a combined multipollutant approach. Thus, 136 women undergoing IVF treatment at Nantes University Hospital (France) were prospectively recruited between 2019 and 2020. Serum samples were analyzed using liquid chromatography with tandem-mass spectrometry for 14 PFAS. Follicular fluid was analyzed with gas chromatography coupled to high resolution mass spectrometry for 14 PCBs and 25 OCPs. Intermediate and clinical IVF outcomes were ascertained by embryologists and clinicians using standardized protocols. Multivariate Poisson regression models and Bayesian Kernel Machine Regressions (BKMR) were used to identify individual and joint associations between POPs and IVF outcomes adjusting for age, body mass index (BMI) and anti-Müllerian hormone. The results showed that most POPs were widely present in women, and globally not associated with clinically relevant IVF outcomes, like live birth rates. Nonetheless, negative associations between PCB138 and trans-nonachlor with useable blastocysts were identified, β -0.28 (95%CI [-0.52; -0.04] p = 0.02) and β -0.22 (95%CI [-0.40; -0.03] p = 0.02). Conversely, PCB28 showed positive associations with the number of useable blastocysts, pregnancy rate and live birth rate. The BKMR analysis suggested the lack of association of the mixture with intermediate and clinical outcomes. The study supports the need of conducting further studies in a larger population sample in order to ensure sufficient statistical power to identify modest effects and a robust stratification analysis to account for the large underlying disease heterogeneity.
Collapse
Affiliation(s)
- Tiphaine Lefebvre
- LABERCA, Oniris, INRAE, Nantes, France; CHU Nantes, Nantes Université, Service de Médecine et Biologie de La Reproduction, Gynécologie Médicale, 38 Bd Jean Monnet, Nantes, France; Faculty of Medicine, Nantes Université, France
| | - Thomas Fréour
- CHU Nantes, Nantes Université, Service de Médecine et Biologie de La Reproduction, Gynécologie Médicale, 38 Bd Jean Monnet, Nantes, France; Faculty of Medicine, Nantes Université, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
| | - Gauthier Duval
- CHU Nantes, Nantes Université, Service de Médecine et Biologie de La Reproduction, Gynécologie Médicale, 38 Bd Jean Monnet, Nantes, France
| | - Stéphane Ploteau
- CHU Nantes, Nantes Université, Service de Médecine et Biologie de La Reproduction, Gynécologie Médicale, 38 Bd Jean Monnet, Nantes, France; CHU Nantes, Department of Gynecology and Obstetrics, 38 Bd Jean Monnet, Nantes, France
| | | | | | | | | |
Collapse
|