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Carbone L, Di Girolamo R, Conforti A, Iorio GG, Simeon V, Landi D, Marfia GA, Lanzillo R, Alviggi C. Ovarian reserve in patients with multiple sclerosis: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023; 163:11-22. [PMID: 37017322 DOI: 10.1002/ijgo.14757] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To summarize recent evidence about ovarian reserve markers in women affected by multiple sclerosis (MS) compared with healthy controls, as women with MS seem to be characterized by lower anti-Müllerian hormone (AMH) levels. METHODS The research was conducted using PubMed (MEDLINE), Scopus, ClinicalTrial.gov, OVID and Cochrane Library from inception of each database to June 30, 2022. Studies comparing ovarian reserve markers between women with MS and healthy controls were considered eligible for inclusion. The primary outcome was serum AMH (ng/mL) levels. Results were reported as pooled odds ratio (OR) for categorical outcomes and as mean difference (MD) for continuous variables, with their 95% confidence intervals (CIs). The random effect model of DerSimonian and Laird was adopted for all analyses. A P-value less than 0.05 was considered significant. RESULTS Serum AMH circulating levels were not significantly different (MD -0.25, 95% CI -0.83 to 0.32; P = 0.390), as well as blood levels of follicle-stimulating hormone or ovarian volume. However, antral follicle count (AFC) and estradiol blood levels were significantly lower, and luteinizing hormone (LH) levels were significantly higher in women with MS than in controls. CONCLUSION A significant difference in AFC, estradiol and LH levels was observed, but not for AMH levels.
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Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Raffaella Di Girolamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Gabriele Iorio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vittorio Simeon
- Department of Mental Health and Public Medicine, Unit of Medical Statistics, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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2
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Auran E, Cascante S, Blakemore J. Two is not always greater than one: patients with one ovary have similar assisted reproductive technology (ART) outcomes compared to patients with two ovaries. J Assist Reprod Genet 2022; 39:1789-1796. [PMID: 35716337 PMCID: PMC9428067 DOI: 10.1007/s10815-022-02534-9] [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: 12/12/2021] [Accepted: 06/04/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To assess assisted reproductive technology (ART) outcomes in patients with one ovary compared to two ovaries. METHODS We performed a retrospective cohort study of all patients with one ovary who underwent ≥ 1 ART cycle between 2012 and 2020 at a large university-affiliated fertility center. Patients were 3-to-1 matched with two ovary controls during the same period. Primary outcome was metaphase II oocytes (MIIs) retrieved per cycle. Secondary outcomes included ovarian reserve markers, laboratory outcomes, and live birth rates (LBRs). RESULTS A total of 104 one ovary patients (158 cycles; median age 35.5 years) were matched to 312 two ovary patients (474 cycles; median age 35.0 years). In one ovary patients, anti-Mullerian hormone was lower (median 1.1 vs. 2.2, p < 0.01) and day 2 follicle-stimulating hormone was higher (median 7.4 vs. 6.2, p < 0.01). One ovary patients yielded median 7.5 MIIs and 10 oocytes per cycle, fewer than two ovary patients (11.0 and 14.5, respectively; p < 0.01). However, one ovary patients had ≥ 50% the MII and oocyte yield of two ovary patients (Z > 5.8, p < 0.01). Fertilization and blastocyst formation rates, euploidy rate, and rate of ≥ 1 embryo for transfer were equivalent between groups (p > 0.40). Among the one and two ovary groups, LBRs per transfer (45.8% vs. 46.6%, p = 1.00) and per patient who underwent transfer (68.3% vs. 73.9%, p = 0.55) were equivalent. CONCLUSION One ovary patients yielded fewer MIIs and oocytes than two ovary patients, but had ≥ 50% the yield of two ovary patients, suggesting a compensatory mechanism in oocyte yield in the solitary ovary. One and two ovary patients had equivalent LBRs.
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Affiliation(s)
- Emily Auran
- grid.137628.90000 0004 1936 8753New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Sarah Cascante
- grid.137628.90000 0004 1936 8753New York University Langone Fertility Center, 660 First Avenue, 5th Floor, New York, NY 10016 USA
| | - Jennifer Blakemore
- grid.137628.90000 0004 1936 8753New York University Langone Fertility Center, 660 First Avenue, 5th Floor, New York, NY 10016 USA
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3
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Rodriguez-Wallberg KA, Nilsson HP, Lind T. Live birth and pregnancy rates after in vitro fertilization/intracytoplasmic sperm injection in women with previous unilateral oophorectomy: a systematic review and meta-analysis. Fertil Steril 2022; 117:992-1002. [PMID: 35277262 DOI: 10.1016/j.fertnstert.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To quantify the effect of unilateral oophorectomy (UO) on the rates of live birth and pregnancy in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). DESIGN Systematic review and meta-analysis. SETTING Search of databases of published articles. PATIENT(S) The final analytical cohort encompassed 1,057 IVF/ICSI cycles in women with previous UO and 45,813 IVF/ICSI cycles in control women. Eighteen studies were identified by database searches of MEDLINE, Embase, Web of Science, and cited references. The review encompassed studies published up to June 1, 2021. INTERVENTION(S) UO prior to IVF/ICSI. MAIN OUTCOME MEASURE(S) The primary outcomes were the rates of live birth and pregnancy following IVF/ICSI. The secondary outcomes included the amount of gonadotropins administered for ovarian stimulation and the number of retrieved oocytes. RESULT(S) The studies were rated from medium to high quality (from 5 to 8) according to the Newcastle-Ottawa Quality Assessment Scale. All studies were observational, with inherent bias, and heterogeneity was high. The primary outcome of live birth had a significantly lower odds ratio (OR) in women with previous UO compared with controls (OR = 0.72, 95% confidence interval [CI] 0.57 to 0.91, z = -2.72). The OR for pregnancy rate per initiated treatment cycle was also significantly lower in women with previous UO compared with controls (OR = 0.70, 95% CI 0.57 to 0.86, z = -3.35). Additionally, the dose of administered gonadotropins was significantly higher and the number of retrieved oocytes was significantly lower in women with UO. CONCLUSION(S) The meta-analysis showed a significant detrimental effect of UO on the rates of live birth and pregnancy. The analysis further supports previous data showing a decreased sensitivity to gonadotropins and a lower number of recovered oocytes in women with previous UO. STUDY REGISTRATION NUMBER PROSPERO 2020, CRD42020160313.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Laboratory of Translational Fertility Preservation, Karolinska Institute, Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynaecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden.
| | - Hanna P Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Tekla Lind
- Department of Obstetrics and Gynaecology, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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4
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Endometrioma surgery-a systematic review and meta-analysis of the effect on antral follicle count and anti-Müllerian hormone. Am J Obstet Gynecol 2022; 226:33-51.e7. [PMID: 34265271 DOI: 10.1016/j.ajog.2021.06.102] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Accurate preoperative counseling about whether an endometriotic cystectomy has a detrimental effect on the ovarian reserve has been a considerable challenge, because studies assessing the postoperative antral follicle counts and anti-Müllerian hormone levels have reported conflicting results. Our objective was to explore the impact of endometriotic cystectomy on both the anti-Müllerian hormone levels and antral follicle counts, with focus on prospective studies in which both variables were measured for each woman concurrently (overcoming unmeasured confounding), in the same setting (overcoming surgical technique differences), and at the same 3 postoperative time points, namely early (1-6 weeks), intermediate (2-6 months) and late (9-18 months), to overcome time-sensitive changes. DATA SOURCES Databases of PubMed, ClinicalTrials.gov, the Cochrane Library, Web of Science, and EBSCO were searched between January 2000 and October 2020. STUDY ELIGIBILITY CRITERIA Only prospective cohort studies that evaluated the impact of endometriotic stripping cystectomy on anti-Müllerian hormone levels and antral follicle counts in the same women, at matching time points, and in the same setting were eligible. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors performed the screening and data extraction independently. RESULTS A total of 14 prospectively designed studies were eligible for the meta-analysis and included 650 women. The included studies had a low risk of bias. The postoperative weighted mean differences in serum anti-Müllerian hormone levels dropped significantly when compared with the preoperative levels by an estimated 1.77 ng/mL (95% confidence interval, 0.77-2.77; P<.001), 1.17 ng/mL (95% confidence interval, 0.66-1.67; P<.001), and 2.13 ng/mL (95% confidence interval, 1.61-2.65; P<.001) at the early (1-6 weeks), intermediate (2-6 months), and late (9-18 months) time points, respectively. This corresponded to a mean reduction in serum anti-Müllerian hormone levels at each of the 3-time points of 44.4%, 35.1%, and 54.2%, respectively. Conversely, the postoperative weighted mean difference in the antral follicle count estimates did not change significantly at any of the 3 time points; the early antral follicle count was 0.70 (95% confidence interval, -2.71 to 3.56; P=.63), the intermediate count was -0.94 (95% confidence interval, -2.53 to 0.65; P=.25), and the late count was 2.58 (95% confidence interval, -0.43 to 5.58; P=.09). Overall, high levels of heterogeneity were encountered (I2 ranging between 92% and 94% for the anti-Müllerian hormone levels and between 94% and 98% for the antral follicle counts at the 3 time points), which were attenuated when similar anti-Müllerian hormone assays were compared, and the meta-regression suggested that age did not contribute to heterogeneity. CONCLUSION Endometriotic cystectomies are associated with a significant reduction in the serum anti-Müllerian hormone levels but not in the antral follicle counts, with the detrimental effects on the anti-Müllerian hormone levels consistently detectable at the early-, intermediate-, and late-postoperative time points. In women with endometrioma, the anti-Müllerian hormone level may provide a more accurate assessment of the risk for iatrogenic depletion of the ovarian reserve.
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Aljahdali GL, Alkhaldi FA, Almujarri SF, Alsadhan HF, Yaqoub AS, Alsahabi JA, Masud N, Felemban AA. Live Birth Rate Comparison Between Single vs. Double Ovary Women With Assisted Reproduction: A Single Tertiary Center Study. Cureus 2021; 13:e14876. [PMID: 34104604 PMCID: PMC8179779 DOI: 10.7759/cureus.14876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction
One of the major hardships faced by married couples is the inability to conceive a child. This issue is becoming more prevalent given the increasing rate of infertility worldwide. Assisted reproductive technology (ART) has brought hope to infertile couples. We aim to estimate the live birth rate (LBR) and pregnancy rate in women with one ovary compared with those with two ovaries. Methods A retrospective cohort study of women who underwent ART at King Abdulaziz Medical City (Jan 2000 - Dec 2018) was conducted. Five cycles of patient data were collected. The LBR (both conditional and cumulative) was compared between women with one and two ovaries. Results The final analysis included 403 women. Of these, 9% (n = 37) had one ovary. The majority (59%, n = 233) had primary infertility. A male-associated factor accounted for 52% (n = 208) of the infertility cases. The total number of live births was 164; and the overall LBR from five cycles was estimated as 9%, 16%, 18%, 18%, and 15%, respectively. In the double ovary group, the highest rate was in the fourth cycle [19% (12-26)], while in the single ovary group peaked in the third cycle [27% (9-46)]. Pregnancy was at its highest in the first cycle, accounting for 88 pregnancies. Conclusion The outcomes of ART varied between study groups. LBR was lower in single ovary women. The average of five cycles in the single and double ovary groups was 13% and 15%, respectively. Nevertheless, there was no significant difference in LBR between single or double ovary women.
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Affiliation(s)
- Ghadeer L Aljahdali
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Fatimah A Alkhaldi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Sarah F Almujarri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Haifa F Alsadhan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Amirah S Yaqoub
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Jawaher A Alsahabi
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Nazish Masud
- Research Unit, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Afaf A Felemban
- Department of In-Vitro Fertilization, King Abdulaziz Medical City, Riyadh, SAU.,Research, King Abdullah International Medical Research Center, Riyadh, SAU
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6
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Schleedoorn MJ, Mulder BH, Braat DDM, Beerendonk CCM, Peek R, Nelen WLDM, Van Leeuwen E, Van der Velden AAEM, Fleischer K, Turner Fertility Expert Panel OBOT. International consensus: ovarian tissue cryopreservation in young Turner syndrome patients: outcomes of an ethical Delphi study including 55 experts from 16 different countries. Hum Reprod 2021; 35:1061-1072. [PMID: 32348471 PMCID: PMC7493129 DOI: 10.1093/humrep/deaa007] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/09/2020] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION What is the standpoint of an international expert panel on ovarian tissue cryopreservation (OTC) in young females with Turner syndrome (TS)? SUMMARY ANSWER The expert panel states that OTC should be offered to young females with TS, but under strict conditions only. WHAT IS KNOWN ALREADY OTC is already an option for preserving the fertility of young females at risk of iatrogenic primary ovarian insufficiency (POI). Offering OTC to females with a genetic cause of POI could be the next step. One of the most common genetic disorders related to POI is TS. Due to an early depletion of the ovarian reserve, most females with TS are confronted with infertility before reaching adulthood. However, before offering OTC as an experimental fertility preservation option to young females with TS, medical and ethical concerns need to be addressed. STUDY DESIGN, SIZE, DURATION A three-round ethical Delphi study was conducted to systematically discuss whether the expected benefits exceed the expected negative consequences of OTC in young females with TS. The aim was to reach group consensus and form an international standpoint based on selected key statements. The study took place between February and December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Anonymous panel selection was based on expertise in TS, fertility preservation or medical ethics. A mixed panel of 12 gynaecologists, 13 (paediatric) endocrinologists, 10 medical ethicists and 20 patient representatives from 16 different countries gave consent to participate in this international Delphi study. In the first two rounds, experts were asked to rate and rank 38 statements regarding OTC in females with TS. Participants were offered the possibility to adjust their opinions after repetitive feedback. The selection of key statements was based on strict inclusion criteria. MAIN RESULTS AND THE ROLE OF CHANCE A total of 46 participants completed the first Delphi round (response rate 84%). Based on strict selection criteria, six key statements were selected, and 13 statements were discarded. The remaining 19 statements and two additional statements submitted by the expert panel were re-evaluated in the second round by 41 participants (response rate 75%). The analysis of the second survey resulted in the inclusion of two additional key statements. After the approval of these eight key statements, the majority of the expert panel (96%) believed that OTC should be offered to young females with TS, but in a safe and controlled research setting first, with proper counselling and informed consent procedures, before offering this procedure in routine care. The remaining participants (4%) did not object but did not respond despite several reminders. LIMITATIONS, REASONS FOR CAUTION The anonymous nature of this study may have led to lack of accountability. The selection of experts was based on their willingness to participate. The fact that not all panellists took part in all rounds may have resulted in selection bias. WIDER IMPLICATIONS OF THE FINDINGS This international standpoint is the first step in the global acceptance of OTC in females with TS. Future collaborative research with a focus on efficacy and safety and long-term follow-up is urgently needed. Furthermore, we recommend an international register for fertility preservation procedures in females with TS. STUDY FUNDING/COMPETING INTEREST(S) Unconditional funding (A16-1395) was received from Merck B.V., The Netherlands. The authors declare that they have no conflict of interest.
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Affiliation(s)
- M J Schleedoorn
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B H Mulder
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D D M Braat
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C C M Beerendonk
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Peek
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W L D M Nelen
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E Van Leeuwen
- Medical Ethics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A A E M Van der Velden
- Paediatric Endocrinology, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, The Netherlands
| | - K Fleischer
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Koch T, Jørgensen JT, Christensen J, Dehlendorff C, Priskorn L, Simonsen MK, Duun-Henriksen AK, Andersen ZJ, Juul A, Bräuner EV, Hickey M. Breast cancer rate after oophorectomy: A Prospective Danish Cohort Study. Int J Cancer 2021; 149:585-593. [PMID: 33729548 DOI: 10.1002/ijc.33563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/19/2021] [Accepted: 02/26/2021] [Indexed: 11/06/2022]
Abstract
The association between oophorectomy and risk of breast cancer in the general population is uncertain. The aim of our study was to determine the breast cancer rate in women from the general population after oophorectomy (performed before/after menopause), and whether this varies by use of hormone replacement therapy (HRT), hysterectomy, body mass index (BMI) and shift work. The study included 24 409 female nurses (aged ≥45 years) participating in the Danish Nurse Cohort. Nurses were followed from cohort entry until date of breast cancer, death, emigration or end of follow-up at 31 December 2018, whichever came first. Poisson regression with log-transformed person-years as the offset examined the association between oophorectomy and breast cancer (all ages and stratified by menopausal status at time of oophorectomy). The potential modifying effect of HRT use, hysterectomy, BMI and shift work on the associations was estimated. During 502 463 person-years of follow-up, 1975 (8.1%) nurses were diagnosed with breast cancer. Bilateral oophorectomy was associated with a reduced breast cancer rate compared to nurses with preserved ovaries, adjusted rate ratio (95% confidence interval): 0.79 (0.64; 0.99). Similar associations (magnitude and direction) were detected for unilateral oophorectomy and when stratifying according to menopausal status at time of oophorectomy, but without statistical significance. Unilateral and bilateral oophorectomy is associated with a reduced breast cancer rate in women from the general population. This association is not modified by use of HRT, hysterectomy, BMI or shift work.
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Affiliation(s)
- Trine Koch
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jane Christensen
- Statistics and Data Analysis, Danish Cancer Society, Copenhagen, Denmark
| | | | - Laerke Priskorn
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mette K Simonsen
- Diakonissestiftelsen and Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Centre for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing F, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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8
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Compensatory Ovarian Hypertrophy after Unilateral Oophorectomy: Evaluation of Ovarian Volumes in Pediatric and Adolescent Populations. J Pediatr Adolesc Gynecol 2020; 33:631-638. [PMID: 32688053 PMCID: PMC7725918 DOI: 10.1016/j.jpag.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/06/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Limited data exist on the morphologic and physiologic effect on the remaining ovary after unilateral oophorectomy, especially in the pediatric population. Our aim is to evaluate ovarian volumes following unilateral oophorectomy to determine whether compensatory ovarian hypertrophy occurs in the remaining contralateral ovary. DESIGN This was a retrospective chart review of ovarian volume measured on ultrasounds that were completed after unilateral oophorectomy. Postoperative ovarian volumes were compared to established radiologic standards. SETTING Large tertiary care academic children's hospital in Atlanta, GA. PARTICIPANTS Female patients less than 21 years old who underwent unilateral oophorectomy. MAIN OUTCOME MEASURES Ovarian volumes measured on postoperative ultrasounds. RESULTS A total of 93 patients met inclusion criteria for this study. Serial ultrasounds were performed in slightly more than half of the patients (n = 48, 51.6%), totaling 193 postoperative ovarian volumes. The average age of oophorectomy was 10.8 years. Prior to surgery, the majority of patients presented with abdominal pain (n = 51, 54.8%) or pelvic mass (n = 51, 54.8%), and most (n = 77, 82.8%) had benign final pathology. Ovarian volumes were compared to 4 published radiologic ultrasound standards. More than 62.2% of ovarian volumes from girls who had previously had unilateral oophorectomy were larger than age-matched standard ovarian volumes. CONCLUSION Ovarian enlargement occurs in the contralateral ovary following unilateral oophorectomy in the pediatric and adolescent population. This supports the concept of compensatory ovarian hypertrophy. This knowledge provides valuable information for interpretation of radiologic images in young female individuals who have undergone oophorectomy, and can assist with counseling on the risk of adnexal complications due to ovarian hypertrophy after unilateral oophorectomy.
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Gasparri ML, Ruscito I, Braicu EI, Sehouli J, Tramontano L, Costanzi F, De Marco MP, Mueller MD, Papadia A, Caserta D, Bellati F. Biological Impact of Unilateral Oophorectomy: Does the Number of Ovaries Really Matter? Geburtshilfe Frauenheilkd 2020; 81:331-338. [PMID: 33692594 PMCID: PMC7938940 DOI: 10.1055/a-1239-3958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022] Open
Abstract
Although unilateral oophorectomies are performed more often than bilateral ones in women of reproductive age, their clinical consequences have been less intensively investigated. Experimental models in animals have shown that compensatory mechanisms occur after a unilateral oophorectomy (UO). This review aims to summarize the available evidence on the biological effects of unilateral oophorectomy on women. Evaluated outcomes include age at onset of menopause, risk of cardiovascular and neurological disease, risk of mortality and fertility outcome after spontaneous conception or in vitro fertilization (IVF). Results were compared with findings reported after bilateral oophorectomy and/or ovarian excision and/or women with intact ovaries. An electronic database search was performed using PubMed and Scopus, followed by a manual search to identify controlled studies that compared women after UO with women with two intact ovaries. In particular, a systematic review of
fertility outcomes after IVF was performed, and the data were summarized in a table. Women who underwent UO had a similar age at menopause and similar clinical pregnancy rate compared to women with two ovaries. However, decreased ovarian reserve affecting the quantity but not the quality of the ovarian pool after IVF was observed in the UO group. Furthermore, an increased risk of neurological disease and even an increased risk of mortality was observed in women with single ovary. These data need to be confirmed by further studies, and a plausible mechanism of action must be identified. At present, patients who undergo UO can be reassured with regard to their reproductive potential and their age at onset of menopause.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Università Svizzera Italiana, Lugano, Switzerland
| | - Ilary Ruscito
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.,Department of Gynaecology, European Competence Center for Ovarian Cancer, Campus Virchow Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elena Ioana Braicu
- Department of Gynaecology, European Competence Center for Ovarian Cancer, Campus Virchow Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynaecology, European Competence Center for Ovarian Cancer, Campus Virchow Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luca Tramontano
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Università Svizzera Italiana, Lugano, Switzerland
| | - Flavia Costanzi
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Paola De Marco
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Università Svizzera Italiana, Lugano, Switzerland
| | - Donatella Caserta
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Filippo Bellati
- Gynecologic Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
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10
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Abrahami N, Izhaki I, Younis JS. Is there a difference in ovarian reserve biomarkers and ovarian response between the right and left ovaries? Reprod Biomed Online 2020; 41:416-424. [DOI: 10.1016/j.rbmo.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/09/2020] [Accepted: 06/10/2020] [Indexed: 01/30/2023]
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11
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El-Badry D, Maha AI, Amal ZL. Hormonal and biochemical studies on female dromedary camels affected with multiple ovarian cysts. Small Rumin Res 2020. [DOI: 10.1016/j.smallrumres.2020.106138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Fertility preservation strategies in borderline ovarian tumor recurrences: different sides of the same coin. J Assist Reprod Genet 2020; 37:1217-1219. [PMID: 32189179 DOI: 10.1007/s10815-020-01738-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022] Open
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13
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Pediatric ovarian volumes measured at ultrasound after contralateral unilateral oophorectomy. Pediatr Radiol 2019; 49:632-637. [PMID: 30656406 DOI: 10.1007/s00247-018-04336-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/08/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Changes that occur in the remaining ovary after contralateral oophorectomy are not well described. OBJECTIVE To determine average ovarian volume in pediatric patients after contralateral oophorectomy compared to age-matched controls with two normal ovaries. MATERIALS AND METHODS We performed a retrospective review of ultrasound examinations and electronic medical records of patients ages 0-18 years who had unilateral oophorectomy from 2000 to 2017 (n=64). We used 384 consecutive normal age-matched ovaries for comparison, analyzing mean ovarian volumes. RESULTS Higher mean ovarian volume (mL) was observed in patients who had oophorectomy compared to controls in the first decade of life (P<0.003) and second decade of life (P<0.0003). Higher mean ovarian volume was seen in both premenarchal and menstruating patients with prior oophorectomy when compared to controls (P<0.05 and P<0.0001, respectively). When comparing volume during menstrual cycle, we saw higher mean ovarian volumes in the oophorectomy group compared to the control group for the follicular (P<0.0001), pre-ovulatory (P=0.0005) and luteal phases (P<0.0003). We provide an updated reference of normal ovarian volumes for pediatric patients, with values similar to those already reported in the literature. CONCLUSION Ovarian volume is higher in pediatric patients with one normal ovary following contralateral oophorectomy. The provided normative volumes can be used in evaluating these patients.
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14
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Laparoscopic unilateral oophorectomy for ovarian tissue cryopreservation in children. J Pediatr Surg 2019; 54:543-549. [PMID: 30782317 PMCID: PMC6383797 DOI: 10.1016/j.jpedsurg.2018.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/21/2018] [Accepted: 06/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND/PURPOSE Many survivors of childhood cancer will experience premature gonadal insufficiency or infertility as a consequence of their medical treatments. Ovarian tissue cryopreservation (OTC) remains an experimental means of fertility preservation with few reports focused on the surgical technique and postoperative outcomes for OTC in children. METHODS This is a single institution, retrospective review of OTC cases from January 2011 to December 2017. Children were eligible for OTC if they had a greater than 80% risk of premature ovarian insufficiency or infertility owing to their anticipated gonadotoxic medical treatment. RESULTS OTC was performed in 64 patients. Median age was 12 years old (range: 5 months-23 years). Nearly half (48%) of the patients were premenarchal. Laparoscopic unilateral oophorectomy was performed in 84% of patients. There were no surgical complications. In 76% of patients, OTC was performed in conjunction with an ancillary procedure. The majority (96%) of patients were discharged within 24 hours. Median time from operation to medical therapy was six days, with no unanticipated treatments delays attributable to OTC. CONCLUSIONS Laparoscopic unilateral oophorectomy for OTC can be performed safely, in combination with other ancillary procedures, as an outpatient procedure without delaying medical therapy for children facing a fertility-threatening diagnosis or treatment. LEVEL OF EVIDENCE IV.
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15
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Lind T, Holte J, Olofsson JI, Hadziosmanovic N, Gudmundsson J, Nedstrand E, Lood M, Berglund L, Rodriguez-Wallberg K. Reduced live-birth rates after IVF/ICSI in women with previous unilateral oophorectomy: results of a multicentre cohort study. Hum Reprod 2019; 33:238-247. [PMID: 29211889 DOI: 10.1093/humrep/dex358] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is there a reduced live-birth rate (LBR) after IVF/ICSI treatment in women with a previous unilateral oophorectomy (UO)? SUMMARY ANSWER A significantly reduced LBR after IVF/ICSI was found in women with previous UO when compared with women with intact ovaries in this large multicentre cohort, both crudely and after adjustment for age, BMI, fertility centre and calendar period and regardless of whether the analysis was based on transfer of embryos in the fresh cycle only or on cumulative results including transfers using frozen-thawed embryos. WHAT IS KNOWN ALREADY Similar pregnancy rates after IVF/ICSI have been previously reported in case-control studies and small cohort studies of women with previous UO versus women without ovarian surgery. In all previous studies multiple embryos were transferred. No study has previously evaluated LBR in a large cohort of women with a history of UO. STUDY DESIGN, SIZE, DURATION This research was a multicentre cohort study, including five reproductive medicine centres in Sweden: Carl von Linné Clinic (A), Karolinska University Hospital (B), Uppsala University Hospital (C), Linköping University Hospital (D) and Örebro University Hospital (E). The women underwent IVF/ICSI between January 1999 and November 2015. Single embryo transfer (SET) was performed in approximately 70% of all treatments, without any significant difference between UO exposed women versus controls (68% versus 71%), respectively (P = 0.32), and a maximum of two embryos were transferred in the remaining cases. The dataset included all consecutive treatments and fresh and frozen-thawed cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS The exposed cohort included 154 women with UO who underwent 301 IVF/ICSI cycles and the unexposed control cohort consisted of 22 693 women who underwent 41 545 IVF/ICSI cycles. Overall, at the five centres (A-E), the exposed cohort underwent 151, 34, 35, 41 and 40 treatments, respectively, and they were compared with controls of the same centre (18 484, 8371, 5575, 4670 and 4445, respectively). The primary outcome was LBR, which was analysed per started cycle, per ovum pick-up (OPU) and per embryo transfer (ET). Secondary outcomes included the numbers of oocytes retrieved and supernumerary embryos obtained, the Ovarian Sensitivity Index (OSI), embryo quality scores and cumulative pregnancy rates. We used a Generalized Estimating Equation (GEE) model for statistical analysis in order to account for repeated treatments. MAIN RESULTS AND THE ROLE OF CHANCE The exposed (UO) and control women's groups were comparable with regard to age and performance of IVF or ICSI. Significant differences in LBR, both crude and age-adjusted, were observed between the UO and control groups: LBR per started cycle (18.6% versus 25.4%, P = 0.007 and P = 0.014, respectively), LBR/OPU (20.3% versus 27.1%, P = 0.012 and P = 0.015, respectively) and LBR/ET (23.0% versus 29.7%, P = 0.022 and P = 0.025, respectively). The differences in LBR remained significant after inclusion of both fresh and frozen-thawed transfers (both crude and age-adjusted data): LBR/OPU (26.1% versus 34.4%, P = 0.005 and P = 0.006, respectively) and LBR/ET (28.3% versus 37.1%, P = 0.006 and P = 0.006, respectively). The crude cancellation rate was significantly higher among women with a history of UO than in controls (18.9% versus 14.5%, P = 0.034 and age-adjusted, P = 0.178). In a multivariate GEE model, the cumulative odds ratios for LBR (fresh and frozen-thawed)/OPU (OR 0.70, 95% CI 0.52-0.94, P = 0.016) and LBR (fresh and frozen-thawed)/ET (OR 0.68, 95% CI 0.51-0.92, P = 0.012) were approximately 30% lower in the group of women with UO when adjusted for age, BMI, reproductive centre, calendar period and number of embryos transferred when appropriate. The OSI was significantly lower in women with a history of UO than in controls (3.6 versus 6.0) and the difference was significant for both crude and age-adjusted data (P = <0.001 for both). Significantly fewer oocytes were retrieved in treatments of women with UO than in controls (7.2 versus 9.9, P = <0.001, respectively). LIMITATIONS, REASONS FOR CAUTION Due to the nature of the topic, this is a retrospective analysis, with all its inherent limitations. Furthermore, the cause for UO was not possible to obtain in all cases. A diagnosis of endometriosis was also more common in the UO group, i.e. a selection bias in terms of poorer patient characteristics in the UO group cannot be completely ruled out. However, adjustment for all known confounders did not affect the general results. WIDER IMPLICATIONS OF THE FINDINGS To date, this is the largest cohort investigated and the first study indicating an association of achieving reduced live birth after IVF/ICSI in women with previous UO. These findings are novel and contradict the earlier notion that IVF/ICSI treatment is not affected, or is only marginally affected by previous UO. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Tekla Lind
- Department of Obstetrics and Gynecology, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Jan Holte
- Carl von Linné Clinic, Uppsala Science park, 751 83 Uppsala, Sweden.,Uppsala Centre for Reproductive Biology, Box 7054, 75007 Uppsala, Sweden
| | - Jan I Olofsson
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm Sweden.,Department of Obstetrics and Gynaecology, Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden
| | - Nermin Hadziosmanovic
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarsköldsväg 50A, 75237 Uppsala, Sweden
| | - Johannes Gudmundsson
- Department of Women's and Children's Health, Reproductive Medicine Centre, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Elizabeth Nedstrand
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Linköping University Hospital, 58185 Linköping, Sweden
| | - Mikael Lood
- Department of Obstetrics and Gynaecology, Fertility Unit, Örebro University Hospital, Södra Grevrosengatan, 701 85 Örebro, Sweden
| | - Lars Berglund
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarsköldsväg 50A, 75237 Uppsala, Sweden
| | - Kenny Rodriguez-Wallberg
- Department of Obstetrics and Gynaecology, Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Karolinska universitetssjukhuset Z1:00, 17176 Stockholm, Sweden
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16
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Lind T, Olofsson JI, Berglund L, Rodriguez-Wallberg K. Reply: Is single ovary a detrimental factor for live-birth rate in IVF? Understanding the real clinical effect of unilateral oophorectomy. Hum Reprod 2018; 33:540-541. [PMID: 29415225 DOI: 10.1093/humrep/dey008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tekla Lind
- Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden and Department of Oncology-Pathology, Karolinska Institutet, Z1:00, 17176 Stockholm, Sweden
| | - Jan I Olofsson
- Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden and Department of Oncology-Pathology, Karolinska Institutet, Z1:00, 17176 Stockholm, Sweden
| | - Lars Berglund
- Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden and Department of Oncology-Pathology, Karolinska Institutet, Z1:00, 17176 Stockholm, Sweden
| | - Kenny Rodriguez-Wallberg
- Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden and Department of Oncology-Pathology, Karolinska Institutet, Z1:00, 17176 Stockholm, Sweden
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17
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Lass A. Is single ovary a detrimental factor for live-birth rate in IVF? Hum Reprod 2018; 33:539-540. [PMID: 29401286 DOI: 10.1093/humrep/dey007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/13/2022] Open
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18
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Younis JS, Naoum I, Salem N, Perlitz Y, Izhaki I. The impact of unilateral oophorectomy on ovarian reserve in assisted reproduction: a systematic review and meta-analysis. BJOG 2017; 125:26-35. [DOI: 10.1111/1471-0528.14913] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 01/24/2023]
Affiliation(s)
- JS Younis
- Reproductive Medicine Unit; Department of Obstetrics & Gynecology; Poriya Medical Center; Tiberias Israel
- Faculty of Medicine in Galilee; Bar-Ilan University; Safed Israel
| | - I Naoum
- Reproductive Medicine Unit; Department of Obstetrics & Gynecology; Poriya Medical Center; Tiberias Israel
| | - N Salem
- Reproductive Medicine Unit; Department of Obstetrics & Gynecology; Poriya Medical Center; Tiberias Israel
| | - Y Perlitz
- Reproductive Medicine Unit; Department of Obstetrics & Gynecology; Poriya Medical Center; Tiberias Israel
- Faculty of Medicine in Galilee; Bar-Ilan University; Safed Israel
| | - I Izhaki
- Department of Evolutionary and Environmental Biology; University of Haifa; Haifa Israel
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19
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Rosendahl M, Simonsen MK, Kjer JJ. The influence of unilateral oophorectomy on the age of menopause. Climacteric 2017; 20:540-544. [DOI: 10.1080/13697137.2017.1369512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Rosendahl
- Department of Gynecology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
| | - M. K. Simonsen
- Diakonissestiftelsen & Research Unit, Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - J. J. Kjer
- Department of Gynecology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
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20
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Beckmann MW, Dittrich R, Findeklee S, Lotz L. Surgical Aspects of Ovarian Tissue Removal and Ovarian Tissue Transplantation for Fertility Preservation. Geburtshilfe Frauenheilkd 2016; 76:1057-1064. [PMID: 27761026 PMCID: PMC5065421 DOI: 10.1055/s-0042-115017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 01/16/2023] Open
Abstract
Introduction: The removal of ovarian tissue prior to starting oncologic treatment and the subsequent transplantation of this tissue after completing therapy have become increasingly important surgical fertility-preserving techniques. The aim of this review was to investigate the different surgical techniques used for this method reported in the literature to date and to discuss the advantages and disadvantages of the respective techniques. Review: A search was done in MEDLINE using a defined algorithm to find studies published between January 2004 and December 2015. All study designs were included in our review if they contained statements on the surgical technique used. We found 16 publications (8 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 1898 female patients which reported on the surgical technique used for ovarian biopsy and 15 publications (7 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 455 women which mentioned the surgical technique used for ovarian transplantation. Different surgical techniques can be used both for ovarian biopsy and for the transplantation of ovarian tissue. A number of different surgical routes have been used, and the amount of tissue extracted, the instruments used, the treatment of the ovary, the transplantation site, the blood supply to the transplanted ovarian tissue and the procedure used for simultaneous surgical interventions vary. Conclusion: In future, one of the tasks will be to establish a standard surgical method for ovarian extraction and transplantation which will have a low rate of complications and a high pregnancy and birth rate while ensuring that the transplanted tissue is fully functional.
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Affiliation(s)
- M. W. Beckmann
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - R. Dittrich
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S. Findeklee
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - L. Lotz
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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21
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Anazodo A, Levine J, Sender LS. From the Editor-in-Chief's Desk. J Adolesc Young Adult Oncol 2016; 5:209-10. [PMID: 27585253 DOI: 10.1089/jayao.2016.29004.lss] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Antoinette Anazodo
- 1 Sydney Youth Cancer Service, Sydney Children's Hospital , Sydney, Australia
| | - Jennifer Levine
- 2 Pediatric Oncology, Columbia University Medical Center , New York, New York
| | - Leonard S Sender
- 3 University of California , Irvine, California.,4 CHOC Children's Hospital , Orange, California
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22
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Cagnacci A, Bellafronte M, Xholli A, Palma F, Carbone MM, Di Carlo C, Grandi G. Impact of laparoscopic cystectomy of endometriotic and non-endometriotic cysts on ovarian volume, antral follicle count (AFC) and ovarian doppler velocimetry. Gynecol Endocrinol 2016; 32:298-301. [PMID: 26850447 DOI: 10.3109/09513590.2016.1142523] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect on ovarian reserve and blood flow of unilateral laparoscopic stripping of endometriotic versus non-endometriotic cysts. DESIGN Prospective observational study. SETTING Tertiary university gynecology unit. PATIENTS During the study period, 71 subjects underwent the first laparoscopic surgery for removal of a monolateral benign ovarian cyst. INTERVENTIONS Trans-vaginal ultrasound scans of the pelvis about six months after surgery. MAIN OUTCOME MEASURES Ovarian volume, Antral Follicle Count (AFC) and Resistance Index (RI) of ovarian artery of the operated and the contralateral ovary. RESULTS Among 71 cysts, 39.4% were endometriotic and 60.6% non-endometriotic benign cysts. All the procedures were performed by the same experienced surgeons with a standardized technique. No major complications were reported during surgery. The mean (±SD) age and BMI of women were 31.0 ± 6.8 years and 24.2 ± 3.3 kg/m(2), respectively. Mean diameter of the removed cysts was smaller for endometriotic than non-endometriotic cysts (4.35 ± 1.77 cm versus 6.33 ± 3.71 cm, p = 0.046). In comparison to non-operated, volume of the operated ovary was significantly lower and with a reduced AFC, with no difference between endometriotic and non-endometriotic cysts (-2.41 ± 2.35 versus -2.00 ± 2.23 cm(3), p = 0.496) (-3.45 ± 3.07 versus -2.43 ± 1.95, p = 0.11). Ovarian artery RI was higher in the operated ovary with no difference between endometriotic and non-endometriotic cysts (0.19 ± 0.14 versus 0.14 ± 0.10, p = 0.455). The difference in ovarian volume (r = 0.178), AFC (r = 0.094) and RI (r = 0.079) between operated and non-operated ovary was not dependent on the diameter of the removed cyst. CONCLUSION Ovarian surgery is associated with a decline of ovarian reserve, independently on the histological type and the diameter of the removed cyst.
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Affiliation(s)
- Angelo Cagnacci
- a Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Manuela Bellafronte
- a Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Anjeza Xholli
- a Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Federica Palma
- a Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Maria Maddalena Carbone
- a Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Costantino Di Carlo
- b Department of Obstetrics and Gynecology , University Federico II , Naples , Italy
| | - Giovanni Grandi
- a Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
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23
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Letourneau J, Chan J, Salem W, Chan SW, Shah M, Ebbel E, McCulloch C, Chen LM, Cedars M, Rosen M. Fertility Sparing Surgery for Localized Ovarian Cancers Maintains an Ability to Conceive, but is Associated With Diminished Reproductive Potential. J Surg Oncol 2015; 112:26-30. [PMID: 26193338 DOI: 10.1002/jso.23942] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/06/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about fertility outcomes after fertility sparing surgery (FSS) for localized ovarian cancers. METHODS A random sample of 783 women treated for ovarian cancer were identified from the California Cancer Registry for survey (age 18-40 years at diagnosis; diagnosed from 1993-2007). We evaluated outcomes including post-treatment amenorrhea, infertility, early menopause (age <45), and disease recurrence. Logistic regression was used to determine the probability of amenorrhea, infertility, and recurrence. Censored data methods were used to determine the probability of early menopause. RESULTS A total of 382 women replied. One hundred and sixteen and 266 completed our survey. Two hundred and forty-five reported treatment with potential to impact fertility (i.e., systemic chemotherapy ± radiation/surgery to the abdomen/pelvis). A total of 125 had disease/stage eligible for FSS and 82 (66%) underwent FSS. While many who attempted conception did conceive, 32% did not. Younger age at diagnosis was associated with higher rates of early menopause (P < 0.001) after FSS. Recurrence rates for those undergoing FSS were 8-10%, while none of the women who underwent non-FSS surgery had a recurrence. CONCLUSIONS FSS maintains an ability to conceive for most patients. However, after FSS, there may be risks of infertility, early menopause with earlier age of treatment, and increased probability of disease recurrence.
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Affiliation(s)
- Joseph Letourneau
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California.,Department of OBGYN, University of North Carolina, Chapel Hill, North Carolina
| | - Jessica Chan
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California.,Department of OBGYN, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wael Salem
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Sai-Wing Chan
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Meera Shah
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Erin Ebbel
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California.,Department of OBGYN, Cornell University, Ithaca, New York
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Lee-May Chen
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Marcelle Cedars
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
| | - Mitchell Rosen
- Department of OBGYN, University of California San Francisco School of Medicine, San Francisco, California
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24
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Fruzzetti F, Bucci F, Perini D, Gadducci A. Unilateral adnexal agenesis and dermoid cyst: fertility implications. Gynecol Endocrinol 2015; 31:438-40. [PMID: 25893269 DOI: 10.3109/09513590.2015.1014786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the loss of potential fertility in a 23-year-old nulliparous woman who attended the outpatient gynaecological endocrinology clinic for amenorrhea and hot flushes started after a laparoscopic surgery for dermoid cyst. During surgery an unilateral ovarian and fallopian tube agenesis were found. The hormonal evaluation was performed. The results evidenced high plasma levels of LH and FSH. Their values were 56.6 and 121.3 mUI/ml, respectively. The concentrations of plasma E2 were < 20 pg/ml and of AMH were <0.08 ng/ml. Genetic analysis showed normal karyotype (46, XX). We think that if an embryological defect is suspected, an appropriate counselling about fertility preservation along with the assessment of hormonal levels before ovarian surgery should be recommended to all women in the reproductive age in order to offer future reproductive chances.
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Affiliation(s)
- Franca Fruzzetti
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
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Somigliana E, Viganò P, Filippi F, Papaleo E, Benaglia L, Candiani M, Vercellini P. Fertility preservation in women with endometriosis: for all, for some, for none? Hum Reprod 2015; 30:1280-6. [PMID: 25883035 DOI: 10.1093/humrep/dev078] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/17/2015] [Indexed: 12/14/2022] Open
Abstract
The increasing confidence with the techniques of oocyte and ovarian cortex freezing has prompted their potential use for patient categories other than those at risk of early menopause due to cancer treatments. Women affected by every iatrogenic or pathologic condition known to compromise ovarian function severely have been considered as potential candidates for fertility preservation. Among them, women with endometriosis may represent a particularly suitable group since they are at increased risk of premature ovarian exhaustion and about half of them will experience infertility. Based on the currently available notions on the intricate relationships between endometriosis, infertility and damage to the ovarian reserve, we speculate that fertility preservation may be of interest for women with endometriosis, in particular for those with bilateral unoperated endometriomas and for those who previously had excision of unilateral endometriomas and require surgery for a contralateral recurrence. Young age at diagnosis may be an independent but pivotal additional factor to be taken into consideration in the balance of the pros and cons of fertility preservation. On the other hand, we argue against the introduction of fertility preservation for endometriosis in routine clinical practice. To date, only few cases have been reported and there are insufficient data for robust cost-utility analyses. It is noteworthy that endometriosis is a relatively common disease and systematically including affected women in a fertility preservation program would have profound clinical, logistic and financial effects. More clinical data and in-depth economic analysis are imperative prior to recommending its routine use.
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Affiliation(s)
- Edgardo Somigliana
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Viganò
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Filippi
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Papaleo
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Benaglia
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Candiani
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Vercellini
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy Università degli Studi di Milano, Milan, Italy
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Refaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol 2015; 13:30. [PMID: 25884617 PMCID: PMC4403912 DOI: 10.1186/s12958-015-0025-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/03/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment. METHODS The scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected. RESULTS A history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence. CONCLUSIONS EP/HP are tragic events in a couple's reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.
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Affiliation(s)
- Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdiyah Campus, PO Box 7607, Makkah, KSA.
| | - Elizabeth Dalton
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia.
| | - William L Ledger
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia.
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Honorato TC, Henningsen AA, Haadsma ML, Land JA, Pinborg A, Lidegaard Ø, Groen H, Hoek A. Follicle pool, ovarian surgery and the risk for a subsequent trisomic pregnancy. Hum Reprod 2015; 30:717-22. [PMID: 25586783 DOI: 10.1093/humrep/deu357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY QUESTION Is there an association between trisomic pregnancy, a marker for decreased oocyte quality, and the reduced oocyte quantity that follows ovarian surgery? SUMMARY ANSWER Previous ovarian surgery is not associated with an increased risk for a subsequent trisomic pregnancy. WHAT IS KNOWN ALREADY Ovarian surgery diminishes the number of oocytes. The risk for a trisomic pregnancy is suggested to be higher in women with fewer oocytes, independent of their chronological age. STUDY DESIGN, SIZE, DURATION This is a matched case-control study. Cases are women with a confirmed trisomic pregnancy occurring between 1 January 2000 and 31 December 2010 regardless of pregnancy outcome and controls are women that had a live born child without a trisomy. In total, there were 8573 participants in the study; 1723 cases and 6850 controls. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained from Danish medical registries. Matching criteria were maternal age and year of conception. Number of controls matched per case ranged from one to four. Among cases and controls with a trisomic pregnancy, 2.7% (46/1723) versus 2.5% (172/6850) had undergone ovarian surgery before pregnancy. MAIN RESULTS AND ROLE OF CHANCE History of ovarian surgery is not associated with a higher risk for a subsequent trisomic pregnancy (odds ratio = 1.00, 95% confidence interval 0.99-1.01). Subgroup analyses by indication of surgery and interval between ovarian surgery and pregnancy do not show an effect on trisomic pregnancy risk. LIMITATIONS, REASONS FOR CAUTION The medical registries used to select cases and controls did not contain information on surgical technique nor volume of ovarian tissue resected, previous trisomic pregnancy prior to the ovarian surgery or long-term use of oral contraceptives. Therefore, correction for these factors was not performed. WIDER IMPLICATIONS OF THE FINDINGS We did not confirm the hypothesis that ovarian surgery, a marker for decreased oocyte quantity, is related to trisomic pregnancy, a marker for decreased oocyte quality. This suggests that ovarian surgery, which has a direct reductive effect on the size of the follicle pool, may affect oocyte quality differently when compared with the reduction in follicle pool size due to ageing. STUDY FUNDING/COMPETING INTERESTS The study was supported by grants from the Gratama Stichting, University of Groningen and the University Medical Center Groningen, The Netherlands. Ø.L. has within the last 3 years received honoraria for speeches in pharmacoepidemiological issues, not related to this study. The Department of Obstetrics and Gynaecology receives unrestricted educational grants from Ferring Pharmaceuticals. A.H. received a grant from ZonMW (i.e. National Dutch Scientific funding) for a RCT not related to this publication. Dr A.H. received speakers fee from MSD for an educational presentation. All other authors have no conflict of interest.
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Affiliation(s)
- T C Honorato
- Department of Epidemiology, HPC FA40, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A A Henningsen
- Fertility Clinic, Rigshospitalet, University of Copenhagen, København, Denmark
| | - M L Haadsma
- Department of Clinical Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J A Land
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Pinborg
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, København, Denmark
| | - Ø Lidegaard
- Gynecological Clinic, Rigshospitalet, University of Copenhagen, København, Denmark
| | - H Groen
- Department of Epidemiology, HPC FA40, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Boujenah J, Bricou A, Moreaux G, Grynberg M, Sifer C, Hugues JN, Poncelet C. [Unilateral borderline ovarian tumor and unilateral adenexectomy?]. ACTA ACUST UNITED AC 2014; 42:635-9. [PMID: 25164163 DOI: 10.1016/j.gyobfe.2014.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/17/2014] [Indexed: 12/17/2022]
Abstract
To perform an adnexectomy in case of unilateral borderline tumor must consider the risk of recurrence, the preservation of fertility, and to integrate a global comprehensive management of a couple. Adnexectomy can be considering as a legitimate option when the woman desire a pregnancy. The risk of recurrence is low and the global survey high. Identification of woman with a high risk of recurrence is necessary. Adnexectomy can be considering as a legitimate option to preserve fertility in case of unilateral tumor. However, ovarian reserve data are missing after the surgery. Adnexectomy can be considering for the management of infertile woman with unilateral borderline tumor. IVF can be performed in the absence of any poor prognosis factor. Management with ovarian cryopreservation and In vitro Maturation remain unclear.
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Affiliation(s)
- J Boujenah
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH Leonard-de-Vinci, université Paris-13, 93000 Bobigny, France.
| | - A Bricou
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH Leonard-de-Vinci, université Paris-13, 93000 Bobigny, France
| | - G Moreaux
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH Leonard-de-Vinci, université Paris-13, 93000 Bobigny, France
| | - M Grynberg
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH Leonard-de-Vinci, université Paris-13, 93000 Bobigny, France
| | - C Sifer
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH Leonard-de-Vinci, université Paris-13, 93000 Bobigny, France
| | - J N Hugues
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH Leonard-de-Vinci, université Paris-13, 93000 Bobigny, France
| | - C Poncelet
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; UFR SMBH Leonard-de-Vinci, université Paris-13, 93000 Bobigny, France
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