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De Geyter C, Calhaz-Jorge C, Goossens V, Magli CM, Smeenk J, Vesela K, Vermeulen N, Wyns C. EuMAR: a roadmap towards a prospective, cycle-by-cycle registry of medically assisted reproduction in Europe. Hum Reprod Open 2023; 2023:hoad011. [PMID: 37113274 PMCID: PMC10126319 DOI: 10.1093/hropen/hoad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
More than 20 years ago, the survey of activities in medically assisted reproduction (MAR) was initiated in Europe and resulted in cross-sectional annual reports, as issued by the European IVF Monitoring (EIM) consortium of ESHRE. Over time, these reports mirror the continuous development of the technologies and contribute to increased transparency and surveillance of reproductive care. Meanwhile, progressive changes of existing treatment modalities and the introduction of new technologies resulted in the need of a cumulative approach in the assessment of treatment outcomes, which warrants a prospective cycle-by-cycle data registry on MAR activities, including fertility preservation. This change in the paradigm of data collection in Europe towards the construction of cumulative outcome results is expected to generate additional insights into cross-institutional but also cross-border movements of patients and reproductive material. This is essential to improve vigilance and surveillance. The European monitoring of Medically Assisted Reproduction (EuMAR) project, co-funded by the European Union, will establish a registry for the transnational collection of prospective cycle-by-cycle MAR and fertility preservation data on the basis of an individual reproductive care code (IRCC). The rationale for the project and the objectives are presented here.
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Affiliation(s)
- Christian De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | | | - Veerle Goossens
- European Society of Human Reproduction and Embryology, Central Office, Strombeek-Bever, Belgium
| | | | - Jesper Smeenk
- Elisabeth Twee Steden Hospital, Tilburg, The Netherlands
| | - Kristina Vesela
- European Society of Human Reproduction and Embryology, Central Office, Strombeek-Bever, Belgium
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology, Central Office, Strombeek-Bever, Belgium
| | - Christine Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Wyns C, De Geyter C, Calhaz-Jorge C, Kupka MS, Motrenko T, Smeenk J, Bergh C, Tandler-Schneider A, Rugescu IA, Goossens V. ART in Europe, 2018: results generated from European registries by ESHRE. Hum Reprod Open 2022; 2022:hoac022. [PMID: 35795850 PMCID: PMC9252765 DOI: 10.1093/hropen/hoac022] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
STUDY QUESTION What are the data and trends on ART and IUI cycle numbers and their outcomes, and on fertility preservation (FP) interventions, reported in 2018 as compared to previous years? SUMMARY ANSWER The 22nd ESHRE report shows a continued increase in reported numbers of ART treatment cycles and children born in Europe, a decrease in transfers with more than one embryo with a further reduction of twin delivery rates (DRs) as compared to 2017, higher DRs per transfer after fresh IVF or ICSI cycles (without considering freeze-all cycles) than after frozen embryo transfer (FET) with higher pregnancy rates (PRs) after FET and the number of reported IUI cycles decreased while their PR and DR remained stable. WHAT IS KNOWN ALREADY ART aggregated data generated by national registries, clinics or professional societies have been gathered and analysed by the European IVF-monitoring Consortium (EIM) since 1997 and reported in 21 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN, SIZE, DURATION Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE on a yearly basis. The data on treatment cycles performed between 1 January and 31 December 2018 were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons of 39 countries. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall, 1422 clinics offering ART services in 39 countries reported a total of more than 1 million (1 007 598) treatment cycles for the first time, including 162 837 with IVF, 400 375 with ICSI, 309 475 with FET, 48 294 with preimplantation genetic testing, 80 641 with egg donation (ED), 532 with IVM of oocytes and 5444 cycles with frozen oocyte replacement (FOR). A total of 1271 institutions reported data on IUI cycles using either husband/partner’s semen (IUI-H; n = 148 143) or donor semen (IUI-D; n = 50 609) in 31 countries and 25 countries, respectively. Sixteen countries reported 20 994 interventions in pre- and post-pubertal patients for FP including oocyte, ovarian tissue, semen and testicular tissue banking. MAIN RESULTS AND THE ROLE OF CHANCE In 21 countries (21 in 2017) in which all ART clinics reported to the registry, 410 190 treatment cycles were registered for a total population of ∼ 300 million inhabitants, allowing a best estimate of a mean of 1433 cycles performed per million inhabitants (range: 641–3549). Among the 39 reporting countries, for IVF, the clinical PR per aspiration slightly decreased while the PR per transfer remained similar compared to 2017 (25.5% and 34.1% in 2018 versus 26.8% and 34.3% in 2017). In ICSI, the corresponding rates showed similar evolutions in 2018 compared to 2017 (22.5% and 32.1% in 2018 versus 24.0% and 33.5% in 2017). When freeze-all cycles were not considered for the calculations, the clinical PRs per aspiration were 28.8% (29.4% in 2017) and 27.3% (27.3% in 2017) for IVF and ICSI, respectively. After FET with embryos originating from own eggs, the PR per thawing was 33.4% (versus 30.2% in 2017), and with embryos originating from donated eggs 41.8% (41.1% in 2017). After ED, the PR per fresh embryo transfer was 49.6% (49.2% in 2017) and per FOR 44.9% (43.3% in 2017). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 50.7%, 45.1%, 3.9% and 0.3% of all treatments, respectively (corresponding to 46.0%, 49.2%. 4.5% and 0.3% in 2017). This resulted in a reduced proportion of twin DRs of 12.4% (14.2% in 2017) and similar triplet DR of 0.2%. Treatments with FET in 2018 resulted in twin and triplet DRs of 9.4% and 0.1%, respectively (versus 11.2% and 0.2%, respectively in 2017). After IUI, the DRs remained similar at 8.8% after IUI-H (8.7% in 2017) and at 12.6% after IUI-D (12.4% in 2017). Twin and triplet DRs after IUI-H were 8.4% and 0.3%, respectively (in 2017: 8.1% and 0.3%), and 6.4% and 0.2% after IUI-D (in 2017: 6.9% and 0.2%). Among 20 994 FP interventions in 16 countries (18 888 in 13 countries in 2017), cryopreservation of ejaculated sperm (n = 10 503, versus 11 112 in 2017) and of oocytes (n = 9123 versus 6588 in 2017) were the most frequently reported. LIMITATIONS, REASONS FOR CAUTION The results should be interpreted with caution as data collection systems and completeness of reporting vary among European countries. Some countries were unable to deliver data about the number of initiated cycles and/or deliveries. WIDER IMPLICATIONS OF THE FINDINGS The 22nd ESHRE data collection on ART, IUI and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Although it is the largest data collection on MAR in Europe, further efforts towards optimization of both the collection and reporting, with the aim of improving surveillance and vigilance in the field of reproductive medicine, are awaited. STUDY FUNDING/COMPETING INTEREST(S) The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.
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Affiliation(s)
| | - C Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - C De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - M S Kupka
- Fertility Center-Gynaekologicum, Hamburg, Germany
| | - T Motrenko
- Human Reproduction Center Budva, Budva, Montenegro
| | - J Smeenk
- Elisabeth Twee Steden Ziekenhuis, Tilburg, The Netherlands
| | - C Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University, Göteborg, Sweden
| | | | - I A Rugescu
- National Transplant Agency, Bucharest, Romania
| | - V Goossens
- ESHRE Central Office, Strombeek-Bever, Belgium
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Wyns C, De Geyter C, Calhaz-Jorge C, Kupka M, Motrenko T, Smeenk J, Bergh C, Tandler-Schneider A, Rugescu I, Vidakovic S, Goossens V. O-150 Assisted reproductive technology (ART) in Europe 2019 and development of a strategy of vigilance Preliminary results generated from European registers by the ESHRE EIM consortium. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
What are the reported data on cycles in ART, IUI and fertility preservation interventions in 2019 as compared to previous years, as well as the main trends over the years?
Summary answer
The 23rd ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, a small decrease in the number of transfers (IVF + ICSI) with more than one embryo with a trend to decreasing multiple delivery rates, outcomes for IUI cycles are similar to previous years.
What is known already
Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analyzed by the European IVF-monitoring Consortium (EIM) and reported in 22 manuscripts published in Human Reproduction and Human Reproduction Open.
Study design, size, duration
Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between January 1 and December 31 2019 in 32 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations.
Participants/materials, setting, methods
In all, 1133 clinics offering ART services in 32 countries reported a total of 784 192 treatment cycles, involving 116 615 with IVF, 285 481 with ICSI, 250 997 with frozen embryo replacement (FER), 55 121 with preimplantation genetic testing (PGT), 71 413 with egg donation (ED), 473 with IVM of oocytes and 4092 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 1033 institutions offering IUI in 25 and 20 countries, respectively. A total of 123 106 treatments with IUI-H and 43 798 treatments with IUI-D were included. A total of 20 400 fertility preservation (FP) interventions from 12 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and post-pubertal patients were reported.
Main results and the role of chance
In total, 1133 IVF clinics participated (90.0% of registered clinics in the participating countries). Next to these also 1033 IUI units reported their data. In the 32 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2019 were similar to those observed in 2018 (28.5% and 34.7% versus 28.8% and 34.1%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2018 (25.3% en 33.1% versus 27.3% and 32.1%). After FER with own embryos the PR per thawing is still on the rise, from 33.4% in 2018 to 35.0% in 2019. After ED the PR per fresh embryo transfer was 50.1% (49.6% in 2018) and per FOR 44.1% (44.9% in 2018). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 61.1%, 36.2%, 2.6% and 0.2% of all treatments, respectively (corresponding to 50.7%, 45.1%, 3.9% and 0.3% in 2018). This resulted in a proportion of singleton, twin and triplet DRs of 89.7%, 10.1% and 0.2%, respectively (compared to 87.4%, 12.4% and 0.2%, respectively in 2018). Treatments with FER in 2019 resulted in twin and triplet DR of 8.3% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 9.5% after IUI-H (8.9% in 2018) and at 12.0% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.8% and 0.4%, respectively (in 2018: 8.4% and 0.3%) and 6.4% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%). The majority of FP interventions included the cryopreservation of oocytes (n = 9 813 from 10 countries) and of ejaculated sperm (n = 9 521 from 12 countries).
Limitations, reasons for caution
As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. For this abstract some countries were not able to provide adequate data about the number of centers and initiated cycles and deliveries.
Wider implications of the findings
The 23rd ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control and completeness of the data and offer higher transparency and vigilance in the field of reproductive medicine.
Trial registration number
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Affiliation(s)
- C Wyns
- Cliniques universitaires Saint-Luc, Université Catholique de Louvain , Brussels, Belgium
| | - Ch De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel , Switzerland
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa , Portugal
| | - M.S Kupka
- Fertility Center - Gynaekologicum , Hamburg, Germany
| | - T Motrenko
- Human Reproduction Center Budva , Montenegro
| | - J Smeenk
- Elisabeth Twee Steden Ziekenhuis , Tilburg, the Netherlands
| | - C Bergh
- Dept of Obstetrics and Gynecology, Inst of Clinical Sciences, Göteborg University , Göteborg, Sweden
| | | | | | - S Vidakovic
- Institute of Obstetrics and Gynecology, Clinical Center Serbia «GAK» , Serbia
| | - V Goossens
- ESHRE Central Office , Grimbergen, Belgium
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Kirkman-Brown J, Calhaz-Jorge C, Dancet E, Lundin K, Martins M, Tilleman K, Thorn P, Vermeulen N, Frith L. O-104 Providing accurate information – impact of ancestry testing. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Providing information to patients and, or donors at the ART clinic is essential but challenging, especially in the case of reproductive donation.
Recent developments in direct-to-consumer genetic testing combined with social media have increased the degree of difficulty. Concepts such as donor anonymity, secrecy and disclosure have to be revisited and totally re-thought as the anonymity of donors, their relatives and also of the children born through donation is no longer guaranteed.
This potentially has significant effects on everyone involved: to donors who donated under the assumption that their donation was completely anonymous, to recipients who were under the impression that they could keep donor conception a secret and to donor offspring who were unaware of their donor-assisted conception. It is also effectively retrospective affecting everyone who has, is or might participate.
Providing the correct information to donors, ART couples and donor-conceived offspring is the key, and advise for such information provision will be presented in line with the recently published ESHRE good practice recommendations for information provision for those involved in reproductive donation.
Trial registration number
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Affiliation(s)
- J Kirkman-Brown
- The University of Birmingham , Centre for Human Reproductive Science- IMSR, Birmingham, United Kingdom
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa , Lisboa, Portugal
| | - E Dancet
- KU Leuven, Department of Development and Regeneration , Leuven, Belgium
| | - K Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital , Gothenburg, Sweden
| | - M Martins
- University of Porto, Faculty of Psychology and Education Sciences , Porto, Portugal
| | - K Tilleman
- Department for Reproductive Medicine, Universitair Ziekenhuis Gent , Ghent, Belgium
| | - P Thorn
- Private Practice, Couple and Family Therapy , Infertility Counseling, Mörfelden, Germany
| | - N Vermeulen
- ESHRE Central Office , Strombeek-Bever, Belgium
| | - L Frith
- Centre for Social Ethics and Policy, University of Manchester , Manchester, United Kingdom
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Kirkman-Brown J, Calhaz-Jorge C, Dancet EAF, Lundin K, Martins M, Tilleman K, Thorn P, Vermeulen N, Frith L. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac001. [PMID: 35178481 PMCID: PMC8847071 DOI: 10.1093/hropen/hoac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION What information and support should be offered to donors, intended parents and donor-conceived people, in general and in consideration of the availability of direct-to-consumer genetic testing and matching services? SUMMARY ANSWER For donors, intended parents and donor-conceived offspring, recommendations are made that cover information needs and informed consent, psychosocial implications and disclosure. WHAT IS KNOWN ALREADY Trends indicate that the use of donor-assisted conception is growing and guidance is needed to help these recipients/intended parents, the donors and offspring, navigate the rapidly changing environment in which donor-assisted conception takes place. STUDY DESIGN, SIZE, DURATION A working group (WG) collaborated on writing recommendations based, where available, on evidence collected from a literature search and expert opinion. Draft recommendations were published for stakeholder review and adapted where relevant based on the comments received. PARTICIPANTS/MATERIALS, SETTING, METHODS Papers retrieved from PUBMED were included from 1 January 2014 up to 31 August 2020, focusing on studies published since direct-to-consumer genetic testing has become more widespread and accessible. The current paper is limited to reproductive donation performed in medically assisted reproduction (MAR) centres (and gamete banks): donation outside the medical context was not considered. MAIN RESULTS AND THE ROLE OF CHANCE In total, 32 recommendations were made for information provision and support to donors, 32 for intended parents and 27 for donor-conceived offspring requesting information/support. LIMITATIONS, REASONS FOR CAUTION The available evidence in the area of reproductive donation is limited and diverse with regards to the context and types of donation. General conclusions and recommendations are largely based on expert opinion and may need to be adapted in light of future research. WIDER IMPLICATIONS OF THE FINDINGS These recommendations provide guidance to MAR centres and gamete banks on good practice in information provision and support but should also be considered by regulatory bodies and policymakers at a national and international level to guide regulatory and legislative efforts towards the protection of donors and donor-conceived offspring. STUDY FUNDING/COMPETING INTEREST(S) The development of this good practice paper was funded by European Society of Human Reproduction and Embryology (ESHRE), covering expenses associated with the WG meetings, the literature searches and dissemination. The WG members did not receive any payment. The authors have no conflicts of interest to declare. DISCLAIMER This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE 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. †ESHRE pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
| | - Jackson Kirkman-Brown
- Centre for Human Reproductive Science, University of Birmingham, IMSR, Birmingham, UK
- Correspondence address. University of Birmingham, IMSR, Birmingham B15 2TT, UK. E-mail: ;
| | | | - Eline A F Dancet
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Kersti Lundin
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mariana Martins
- University of Porto, Faculty of Psychology and Education Sciences, Porto, Portugal
| | - Kelly Tilleman
- Department for Reproductive Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Petra Thorn
- Private Practice, Couple and Family Therapy, Infertility Counseling, Mörfelden, Germany
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology (ESHRE) Central Office, Strombeek-Bever, Belgium
| | - Lucy Frith
- Centre for Social Ethics and Policy, University of Manchester, Manchester, UK
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Bhandari HM, Mitchell T, Duffy J, Mania A, Konsta N, Sarris I, Boyer P, Calhaz-Jorge C, Matik S, Ma Q, Ma F, Siristatidis C, Bosco L, Pomeroy KO, von Byern J, Mocanu E, Drakeley A, Kupka MS, Lara-Molina EE, Le Clef N, Ombelet W, Patrat C, Pennings G, Semprini AE, Tilleman K, Tognon M, Tonch N, Woodward B. ESHRE guideline: medically assisted reproduction in patients with a viral infection/disease. Hum Reprod Open 2021; 2021:hoab037. [PMID: 36733615 PMCID: PMC9887941 DOI: 10.1093/hropen/hoab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 02/05/2023] Open
Abstract
STUDY QUESTION What is the recommended management for medically assisted reproduction (MAR) in patients with a viral infection or disease, based on the best available evidence in the literature? SUMMARY ANSWER The ESHRE guideline on MAR in patients with a viral infection/disease makes 78 recommendations on prevention of horizontal and vertical transmission before, during and after MAR, and the impact on its outcomes, and these also include recommendations regarding laboratory safety on the processing and storage of gametes and embryos testing positive for viral infections. WHAT IS KNOWN ALREADY The development of new and improved anti-viral medications has resulted in improved life expectancy and quality of life for patients with viral infections/diseases. Patients of reproductive age are increasingly exploring their options for family creation. STUDY DESIGN SIZE DURATION The guideline was developed according to the structured methodology for the development of ESHRE guidelines. After the formulation of nine key questions for six viruses (hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human papilloma virus, human T-lymphotropic virus I/II and Zika virus) by a group of experts, literature searches and assessments were performed. Papers published up to 2 November 2020 and written in English were included in the review. Evidence was analyzed by female, male or couple testing positive for the virus. PARTICIPANTS/MATERIALS SETTING METHODS Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. There were 61 key questions to be answered by the guideline development group (GDG), of which 12 were answered as narrative questions and 49 as PICO (Patient, Intervention, Comparison, Outcome) questions. A stakeholder review was organized after the finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help providers meet a growing demand for guidance on the management of patients with a viral infection/disease presenting in the fertility clinic.The guideline makes 78 recommendations on prevention of viral transmission before and during MAR, and interventions to reduce/avoid vertical transmission to the newborn. Preferred MAR treatments and interventions are described together with the effect of viral infections on outcomes. The GDG formulated 44 evidence-based recommendations-of which 37 were formulated as strong recommendations and 7 as weak-33 good practice points (GPP) and one research only recommendation. Of the evidence-based recommendations, none were supported by high-quality evidence, two by moderate-quality evidence, 15 by low-quality evidence and 27 by very low-quality evidence. To support future research in the field of MAR in patients with a viral infection/disease, a list of research recommendations is provided. LIMITATIONS REASONS FOR CAUTION Most interventions included are not well-studied in patients with a viral infection/disease. For a large proportion of interventions, evidence was very limited and of very low quality. More evidence is required for these interventions, especially in the field of human papilloma virus (HPV). Such future studies may require the current recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in MAR for patients with a viral infection/disease, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in the field. STUDY FUNDING/COMPETING INTERESTS The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive any financial incentives, all work was provided voluntarily. A.D. reports research fees from Ferring and Merck, consulting fees from Ferring, outside the submitted work. C.P. reports speakers fees from Merck and MSD outside the submitted work. K.T. reports speakers fees from Cooper Surgical and Ferring and consultancy fees as member of the advisory board BioTeam of Ferring, outside the submitted work. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Edgar Mocanu
- Department of Reproductive Medicine, Rotunda Hospital, Royal College of Surgeons in Ireland , Dublin, Ireland
| | - Andrew Drakeley
- Department of Reproductive Medicine, Liverpool Women’s Hospital , Liverpool, UK
| | - Markus S Kupka
- Department Gynaecology and Obstetrics, Gynaekologicum Hamburg , Hamburg, Germany
| | | | - Nathalie Le Clef
- European Society of Human Reproduction and Embryology , Grimbergen, Belgium
| | - Willem Ombelet
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk Faculty of Medicine and Life Sciences, Hasselt University , Hasselt, Belgium
| | - Catherine Patrat
- APHP Centre—University of Paris, Cochin, Service de Biologie de la Reproduction—CECOS , Paris, France
| | - Guido Pennings
- Department of Philosophy and Moral Science, Bioethics Institute Ghent (BIG) Ghent University , Gent, Belgium
| | | | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital , Gent, Belgium
| | - Mauro Tognon
- Department of Medical Sciences, University of Ferrara School of Medicine , Ferrara, Italy
| | - Nino Tonch
- Department of Reproductive Medicine, Amsterdam University Medical Centre, Location AMC , Amsterdam, The Netherlands
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Wyns C, De Geyter CH, Calhaz-Jorge C, Kupka MS, Motrenko T, Smeenk J, Bergh C, Tandler-Schneider A, Rugescu IA, Vidakovic S, Goossens V. O-042 Assisted Reproductive Technology (ART) in Europe 2018 and development of a strategy of vigilance. preliminary results generated from european registers by ESHRE. Hum Reprod 2021. [DOI: 10.1093/humrep/deab126.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What are the reported data on cycles in ART, IUI and fertility preservation interventions in 2018 as compared to previous years, as well as the main trends over the years?
Summary answer
AUTHOR: The 22th ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, a small decrease in the number of transfers (IVF + ICSI) with more than one embryo with a trend to decreasing multiple delivery rates, higher pregnancy and delivery rates after FER compared to fresh IVF and ICSI cycles, and outcomes for IUI cycles similar to previous years.
What is known already
Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analysed by the European IVF-monitoring Consortium (EIM) and reported in 21 manuscripts published in Human Reproduction and Human Reproduction Open.
Study design, size, duration
Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between January 1 and December 31 2018 in 34 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organisations.
Participants/materials, setting, methods
In all, 1004 clinics offering ART services in 34 countries reported a total of 827 545 treatment cycles, involving 132 332 with IVF, 342 589 with ICSI, 260 013 with frozen embryo replacement (FER), 44 854 with preimplantation genetic testing (PGT), 42 869 with egg donation (ED), 406 with IVM of oocytes and 4482 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 783 institutions offering IUI in 24 and 20 countries, respectively. A total of 132 624 treatments with IUI-H and 43 140 treatments with IUI-D were included. A total of 12 609 fertility preservation (FP) interventions from 13 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and postpubertal patients were reported.
Main results and the role of chance
In total, 1004 IVF clinics participated (93.4% of registered clinics in the participating countries). Next to these also 783 IUI units reported their data. In the 34 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2018 were similar to those observed in 2017 (28.7% and 41.6% versus 29.4% and 39.0%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2017 (26.3% en 40.9% versus 27.3% and 40.2%). After FER with own embryos the PR per thawing is still on the rise, from 30.2% in 2017 to 33.0% in 2018. After ED the PR per fresh embryo transfer was 49.8% (49.2% in 2017) and per FOR 39.6% (43.3% in 2017). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 51.1%, 45.4%, 3.4% and 0.1% of all treatments, respectively (corresponding to 46.0%, 49.2%, 4.5% and 0.3% in 2017). This resulted in a proportion of singleton, twin and triplet DRs of 86.9%, 12.8% and 0.3%, respectively (compared to 85.5%, 14.2% and 0.3%, respectively in 2017). Treatments with FER in 2017 resulted in twin and triplet DR of 9.3% and 0.1%, respectively (versus 11.2% and 0.2% in 2017). After IUI, the DRs remained similar at 9.1% after IUI-H (8.9% in 2017) and at 12.3% after IUI-D (12.4% in 2017). Twin and triplet DRs after IUI-H were 8.4% and 0.3%, respectively (in 2017: 8.1% and 0.3%) and 6.7% and 0.2% after IUI-D (in 2017: 6.9% and 0.2%). The majority of FP interventions included the cryopreservation of ejaculated sperm (n = 8 257 from 13 countries) and of oocytes (n = 3230 from 13 countries).
Limitations, reasons for caution
As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. For this abstract a number of countries was not able to provide adequate data about the number of centers and initiated cycles and deliveries.
Wider implications of the findings
The 22nd ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control and completeness of the data and offer higher transparency and vigilance in the field of reproductive medicine.
Trial registration number:
Study funding:
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Affiliation(s)
- C Wyns
- Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - CH De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Switzerland
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - MS Kupka
- Fertility Center - Gynaekologicum, Hamburg, Germany
| | - T Motrenko
- Human Reproduction Center Budva, Montenegro
| | - J Smeenk
- Elisabeth Twee Steden Ziekenhuis, Tilburg, the Netherlands
| | - C Bergh
- Dept of Obstetrics and Gynecology, Inst of Clinical Sciences, Göteborg University, Göteborg, Sweden
| | | | | | - S Vidakovic
- Institute of Obstetrics and Gynecology, Clinical Center Serbia «GAK», Serbia
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
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Wyns C, De Geyter C, Calhaz-Jorge C, Kupka MS, Motrenko T, Smeenk J, Bergh C, Tandler-Schneider A, Rugescu IA, Vidakovic S, Goossens V. ART in Europe, 2017: results generated from European registries by ESHRE. Hum Reprod Open 2021; 2021:hoab026. [PMID: 34377841 PMCID: PMC8342033 DOI: 10.1093/hropen/hoab026] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 05/27/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What are the data on ART and IUI cycles, and fertility preservation (FP) interventions reported in 2017 as compared to previous years, as well as the main trends over the years? SUMMARY ANSWER The 21st ESHRE report on ART and IUI shows the continual increase in reported treatment cycle numbers in Europe, with a decrease in the proportion of transfers with more than one embryo causing an additional slight reduction of multiple delivery rates (DR) as well as higher pregnancy rates (PR) and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the number of IUI cycles increased and their outcomes remained stable. WHAT IS KNOWN ALREADY Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been gathered and analyzed by the European IVF-monitoring Consortium (EIM) and communicated in a total of 20 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN SIZE DURATION Data on European medically assisted reproduction (MAR) are collected by EIM for ESHRE on a yearly basis. The data on treatments performed between 1 January and 31 December 2017 in 39 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. PARTICIPANTS/MATERIALS SETTING METHODS Overall, 1382 clinics offering ART services in 39 countries reported a total of 940 503 treatment cycles, including 165 379 with IVF, 391 379 with ICSI, 271 476 with FER, 37 303 with preimplantation genetic testing (PGT), 69 378 with egg donation (ED), 378 with IVM of oocytes, and 5210 cycles with frozen oocyte replacement (FOR). A total of 1273 institutions reported data on 207 196 IUI cycles using either husband/partner's semen (IUI-H; n = 155 794) or donor semen (IUI-D; n = 51 402) in 30 countries and 25 countries, respectively. Thirteen countries reported 18 888 interventions for FP, including oocyte, ovarian tissue, semen and testicular tissue banking in pre- and postpubertal patients. MAIN RESULTS AND THE ROLE OF CHANCE In 21 countries (20 in 2016) in which all ART clinics reported to the registry, 473 733 treatment cycles were registered for a total population of approximately 330 million inhabitants, allowing a best-estimate of a mean of 1435 cycles performed per million inhabitants (range: 723-3286).Amongst the 39 reporting countries, the clinical PR per aspiration and per transfer in 2017 were similar to those observed in 2016 (26.8% and 34.6% vs 28.0% and 34.8%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2016 (24% and 33.5% vs 25% and 33.2% in 2016). When freeze all cycles were removed, the clinical PRs per aspiration were 30.8% and 27.5% for IVF and ICSI, respectively.After FER with embryos originating from own eggs the PR per thawing was 30.2%, which is comparable to 30.9% in 2016, and with embryos originating from donated eggs it was 41.1% (41% in 2016). After ED the PR per fresh embryo transfer was 49.2% (49.4% in 2016) and per FOR 43.3% (43.6% in 2016).In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 46.0%, 49.2%, 4.5% and in 0.3% of all treatments, respectively (corresponding to 41.5%, 51.9%. 6.2% and 0.4% in 2016). This resulted in a reduced proportion of twin DRs of 14.2% (14.9% in 2016) and stable triplet DR of 0.3%. Treatments with FER in 2017 resulted in a twin and triplet DR of 11.2% and 0.2%, respectively (vs 11.9% and 0.2% in 2016).After IUI, the DRs remained similar at 8.7% after IUI-H (8.9% in 2016) and at 12.4% after IUI-D (12.4.0% in 2016). Twin and triplet DRs after IUI-H were 8.1% and 0.3%, respectively (in 2016: 8.8% and 0.3%) and 6.9% and 0.2% after IUI-D (in 2016: 7.7% and 0.4%). Amongst 18 888 FP interventions in 13 countries, cryopreservation of ejaculated sperm (n = 11 112 vs 7877 from 11 countries in 2016) and of oocytes (n = 6588 vs 4907 from eight countries in 2016) were the most frequently reported. LIMITATIONS REASONS FOR CAUTION As the methods of data collection and levels of reporting vary amongst European countries, interpretation of results should remain cautious. Some countries were unable to deliver data about the number of initiated cycles and deliveries. WIDER IMPLICATIONS OF THE FINDINGS The 21st ESHRE report on ART, IUI and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, efforts should continue to optimize data collection and reporting with the perspective of improved quality control, transparency and vigilance in the field of reproductive medicine. STUDY FUNDING/COMPETING INTERESTS The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.
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Affiliation(s)
| | - C Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ch De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - M S Kupka
- Fertility Center-Gynaekologicum, Hamburg, Germany
| | - T Motrenko
- Human Reproduction Center Budva, Budva, Montenegro
| | - J Smeenk
- Elisabeth Twee Steden Ziekenhuis, Tilburg, The Netherlands
| | - C Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University, Göteborg, Sweden
| | | | | | - S Vidakovic
- Clinical Center Serbia «GAK», Institute of Obstetrics and Gynecology, Beograd, Serbia
| | - V Goossens
- ESHRE Central Office, Grimbergen, Belgium
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De Geyter C, Wyns C, Calhaz-Jorge C, de Mouzon J, Ferraretti AP, Kupka M, Nyboe Andersen A, Nygren KG, Goossens V. 20 years of the European IVF-monitoring Consortium registry: what have we learned? A comparison with registries from two other regions. Hum Reprod 2021; 35:2832-2849. [PMID: 33188410 PMCID: PMC7744162 DOI: 10.1093/humrep/deaa250] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How has the performance of the European regional register of the European IVF-monitoring Consortium (EIM)/European Society of Human Reproduction and Embryology (ESHRE) evolved from 1997 to 2016, as compared to the register of the Centres for Disease Control and Prevention (CDC) of the USA and the Australia and New Zealand Assisted Reproduction Database (ANZARD)? SUMMARY ANSWER It was found that coherent and analogous changes are recorded in the three regional registers over time, with a different intensity and pace, that new technologies are taken up with considerable delay and that incidental complications and adverse events are only recorded sporadically. WHAT IS KNOWN ALREADY European data on ART have been collected since 1997 by EIM. Data collection on ART in Europe is particularly difficult due to its fragmented political and legal landscape. In 1997, approximately 78.1% of all known institutions offering ART services in 23 European countries submitted data and in 2016 this number rose to 91.8% in 40 countries. STUDY DESIGN, SIZE, DURATION We compared the changes in European ART data as published in the EIM reports (2001–2020) with those of the USA, as published by CDC, and with those of Australia and New Zealand, as published by ANZARD. PARTICIPANTS/MATERIALS, SETTING, METHODS We performed a retrospective analysis of the published EIM data sets spanning the 20 years observance period from 1997 to 2016, together with the published data sets of the USA as well as of Australia and New Zealand. By comparing the data sets in these three large registers, we analysed differences in the completeness of the recordings together with differences in the time intervals on the occurrence of important trends in each of them. Effects of suspected over- and under-reporting were also compared between the three registers. X2 log-rank analysis was used to assess differences in the data sets. MAIN RESULTS AND THE ROLE OF CHANCE During the period 1997–2016, the numbers of recorded ART treatments increased considerably (5.3-fold in Europe, 4.6-fold in the USA, 3.0-fold in Australia and New Zealand), while the number of registered treatment modalities rose from 3 to 7 in Europe, from 4 to 10 in the USA and from 5 to 8 in Australia and New Zealand, as published by EIM, CDC and ANZARD, respectively. The uptake of new treatment modalities over time has been very different in the three registers. There is a considerable degree of underreporting of the number of initiated treatment cycles in Europe. The relationship between IVF and ICSI and between fresh and thawing cycles evolved similarly in the three geographical areas. The freeze-all strategy is increasingly being adopted by all areas, but in Europe with much delay. Fewer cycles with the transfer of two or more embryos were reported in all three geographical areas. The delivery rate per embryo transfer in thawing cycles bypassed that in fresh cycles in the USA in 2012, in Australia and New Zealand in 2013, but not yet in Europe. As a result of these changing approaches, fewer multiple deliveries have been reported. Since 2012, the most documented adverse event of ART in all three registers has been premature birth (<37 weeks). Some adverse events, such as maternal death, ovarian hyperstimulation syndrome, haemorrhage and infections, were only recorded by EIM and ANZARD. LIMITATIONS, REASONS FOR CAUTION The methods of data collection and reporting were very different among European countries, but also among the three registers. The better the legal background on ART surveillance, the more complete are the data sets. Until the legal obligation to report is installed in all European countries together with an appropriate quality control of the submitted data the reported numbers and incidences should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS The growing number of reported treatments in ART, the higher variability in treatment modalities and the rising contribution to the birth rates over the last 20 years point towards the increasing impact of ART. High levels of completeness in data reporting have been reached, but inconsistencies and inaccuracies still remain and need to be identified and quantified. The current trend towards a higher diversity in treatment modalities and the rising impact of cryostorage, resulting in improved safety during and after ART treatment, require changes in the organization of surveillance in ART. The present comparison must stimulate all stakeholders in ART to optimize surveillance and data quality assurance in ART. STUDY FUNDING/COMPETING INTEREST(S) This study has no external funding and all costs are covered by ESHRE. There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ch De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | - C Wyns
- Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - J de Mouzon
- Institut National de Santé et de la Recherche Médicale, Service de Gynécologie Obstétrique II et de Médecine de la Procréation, Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris, France
| | | | - M Kupka
- Fertility Center-Gynaekologicum, Hamburg, Germany
| | - A Nyboe Andersen
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
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Carvalho M, Leal F, Mota S, Aguiar A, Sousa S, Nunes J, Calhaz-Jorge C. The effect of denudation and injection timing in the reproductive outcomes of ICSI cycles: new insights into the risk of in vitro oocyte ageing. Hum Reprod 2021; 35:2226-2236. [PMID: 32951048 DOI: 10.1093/humrep/deaa211] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/23/2020] [Indexed: 12/30/2022] Open
Abstract
STUDY QUESTION Does the time elapsed between oocyte pick-up (OPU) and denudation or injection affect the probability of achieving a live birth (LB) in ICSI cycles? SUMMARY ANSWER Prolonged oocyte culture before denudation (>4 h) was associated with an increase in clinical pregnancy (CP), LB and cumulative LB (CLB) rates when compared with earlier denudation timings. WHAT IS KNOWN ALREADY Oocyte maturation is a complex and dynamic process involving structural and biochemical modifications in the cell necessary to support fertilization and early embryo development. While meiotic competence is easily identifiable by the presence of an extruded first polar body, cytoplasmic maturation cannot be assessed microscopically. Culturing oocytes with their surrounding cumulus cells (CCs) prior to ICSI can enhance the completion of in vitro cytoplasmic maturation; conversely, prolonged culture may induce cell degeneration. The optimal culture intervals prior to oocyte denudation and/or injection have not yet been established and may prove relevant for the improvement of ICSI reproductive outcomes. STUDY DESIGN, SIZE, DURATION This is a single-centre retrospective cohort analysis of 1378 ICSI cycles performed between January 2005 and October 2018. Data were categorized according to: (i) the time interval between OPU and denudation (<3 h, 3-4 h and ≥4 h), (ii) the time interval between denudation and ICSI (<1.5 h, 1.5-2 h, ≥2 h) and (iii) the time interval between OPU and ICSI (<5 h, 5-6 h and ≥6 h). The effect of these timings on fertilization, CP, LB and CLB rates were compared. The culture intervals between different procedures were dependent exclusively on laboratory workload. PARTICIPANTS/MATERIALS, SETTING, METHODS ICSI cycles performed in women younger than 40 years old using autologous gametes with at least one metaphase II injected oocyte were included. The effect of oocyte culture duration prior to denudation and injection of the oocytes was compared using multivariable regression accounting for potential confounding variables. MAIN RESULTS AND THE ROLE OF CHANCE Fertilization and oocyte damage rate after ICSI was found to be independent of the time interval to denudation (<3 h, 3-4 h and ≥4 h) and/or injection (<5 h, 5-6 h and ≥6 h). Extending oocyte culture before denudation significantly improved CP (29.5%, 42.7% and 50.6%, respectively), LB (25.1%, 34.4% and 40.7%, respectively) and CLB rates (26.0%, 36.1% and 42.2%, respectively), particularly if the time interval was at least 4 h. Additionally, LB (31.7%, 35.8% and 27.4%, respectively) and CLB rates (34.2%, 36.6% and 27.7%, respectively) were also dependent on the time from OPU to injection. LIMITATIONS, REASONS FOR CAUTION This study is limited by its retrospective nature and potential unmeasured confounding cannot be excluded. Furthermore, the effect of even shorter or longer periods of culture before denudation and/or injection were not evaluated and should not be extrapolated from these results. WIDER IMPLICATIONS OF THE FINDINGS Our findings propose new evidence of a previously unrecognized protective effect of the CCs-oocyte interactions in human ART, raising the question of a possible downstream effect in embryogenesis which significantly affects LB rates. Additionally, this is the first study to suggest a negative effect of further extending culture before ICSI on LB and CLB rates, thus potentially allowing for the narrowing of an optimal ICSI time interval. Simple strategies such as the establishment of more effective time frames to perform these procedures and adjusting laboratory practice may prove beneficial, ultimately improving ICSI reproductive outcomes. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Carvalho
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
| | - F Leal
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
| | - S Mota
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
| | - A Aguiar
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
| | - S Sousa
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
| | - J Nunes
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
| | - C Calhaz-Jorge
- Reproductive Medicine Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal.,Faculdade de Medicina da Universidade de Lisboa,, Lisbon, Portugal
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Reis-de-Carvalho C, Vaz-de-Macedo C, Ortiz S, Colaço A, Calhaz-Jorge C. Cervical Mesonephric Adenocarcinoma: A Case Report of a Rare Gynecological Tumor from Embryological Remains of the Female Genital Tract. Rev Bras Ginecol Obstet 2021; 43:329-333. [PMID: 33784759 PMCID: PMC10183855 DOI: 10.1055/s-0041-1725051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Malignant mesonephric tumors are uncommon in the female genital tract, and they are usually located where embryonic remnants of Wolffian ducts are detected, such as the uterine cervix. The information about these tumors, their treatment protocol, and prognosis are scarce. CASE REPORT A 60-year-old woman with postmenopausal vaginal bleeding was initially diagnosed with endometrial carcinoma. After suspicion co-testing, the patient underwent a loop electrosurgical excision of the cervix and was eventually diagnosed with mesonephric adenocarcinoma. She was subjected to a radical hysterectomy, which revealed International Federation of Gynecology and Obstetrics (FIGO) IB1 stage, and adjuvant radiotherapy. The follow-up showed no evidence of recurrence after 60 months. CONCLUSION We present the case of a woman with cervical mesonephric adenocarcinoma. When compared with the literature, this case had the longest clinical follow-up without evidence of recurrence, which reinforces the concept that these tumors are associated with a favorable prognosis if managed according to the guidelines defined for the treatment of patients with cervical adenocarcinomas. Though a rare entity, it should be kept in mind as a differential diagnosis for other cervical cancers.
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Affiliation(s)
- Catarina Reis-de-Carvalho
- Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Santiago Ortiz
- Department of Pathology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Anabela Colaço
- Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Carlos Calhaz-Jorge
- Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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De Geyter C, Calhaz-Jorge C, Kupka MS, Wyns C, Mocanu E, Motrenko T, Scaravelli G, Smeenk J, Vidakovic S, Goossens V. Corrigendum. ART in Europe, 2015: results generated from European registries by ESHRE. Hum Reprod Open 2020; 2020:hoaa038. [PMID: 32995563 PMCID: PMC7508022 DOI: 10.1093/hropen/hoaa038] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - C De Geyter
- Reproductive Medicine and Gynaecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland.,ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
| | - C Calhaz-Jorge
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - M S Kupka
- Department of Gynaecology and Obstetrics, Fertility Center - Gynaekologicum, Hamburg, Germany
| | - C Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - E Mocanu
- Department of Reproductive Medicine, Rotunda Hospital and RCSI, Dublin, Ireland
| | - T Motrenko
- Human Reproduction Center, Budva, Montenegro
| | - G Scaravelli
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, Rome, Italy
| | - J Smeenk
- Department of Obstetrics and Gynaecology, Elisabeth Twee Steden Ziekenhuis, Tilburg, the Netherlands
| | - S Vidakovic
- Institute of Obstetrics and Gynaecology, Clinical Center Serbia «GAK», Belgrade, Serbia
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
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Wyns C, Bergh C, Calhaz-Jorge C, De Geyter C, Kupka MS, Motrenko T, Rugescu I, Smeenk J, Tandler-Schneider A, Vidakovic S, Goossens V. ART in Europe, 2016: results generated from European registries by ESHRE. Hum Reprod Open 2020; 2020:hoaa032. [PMID: 32760812 PMCID: PMC7394132 DOI: 10.1093/hropen/hoaa032] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Indexed: 01/18/2023] Open
Abstract
STUDY QUESTION What are the reported data on cycles in ART, IUI and fertility preservation (FP) interventions in 2016 as compared to previous years, as well as the main trends over the years? SUMMARY ANSWER The 20th ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, with a decrease in the number of transfers with more than one embryo causing a reduction of multiple delivery rates (DR), as well as higher pregnancy rates and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the outcomes for IUI cycles remained stable. WHAT IS KNOWN ALREADY Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analysed by the European IVF-monitoring Consortium (EIM) and reported in 19 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN SIZE DURATION Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between 1 January and 31 December 2016 in 40 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. PARTICIPANTS/MATERIALS SETTING METHODS In all, 1347 clinics offering ART services in 40 countries reported a total of 918 159 treatment cycles, involving 156 002 with IVF, 407 222 with ICSI, 248 407 with FER, 27 069 with preimplantation genetic testing, 73 927 with egg donation (ED), 654 with IVM of oocytes and 4878 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 1197 institutions offering IUI in 29 and 24 countries, respectively. A total of 162 948 treatments with IUI-H and 50 467 treatments with IUI-D were included. A total of 13 689 FP interventions from 11 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and postpubertal patients were reported. MAIN RESULTS AND THE ROLE OF CHANCE In 20 countries (18 in 2015) with a total population of approximately 325 million inhabitants, in which all ART clinics reported to the registry, a total of 461 401 treatment cycles were performed, corresponding to a mean of 1410 cycles per million inhabitants (range 82-3088 per million inhabitants). In the 40 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2016 were similar to those observed in 2015 (28.0% and 34.8% vs 28.5% and 34.6%, respectively). After ICSI, the corresponding rates were also similar to those achieved in 2015 (25% and 33.2% vs 26.2% and 33.2%). After FER with own embryos, the PR per thawing is still on the rise, from 29.2% in 2015 to 30.9% in 2016. After ED, the PR per fresh embryo transfer was 49.4% (49.6% in 2015) and per FOR 43.6% (43.4% in 2015). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 41.5%, 51.9%, 6.2% and 0.4% of all treatments, respectively (corresponding to 37.7%, 53.9%, 7.9% and 0.5% in 2015). This resulted in a proportion of singleton, twin and triplet DRs of 84.8%, 14.9% and 0.3%, respectively (compared to 83.1%, 16.5% and 0.4%, respectively in 2015). Treatments with FER in 2016 resulted in twin and triplet DR of 11.9% and 0.2%, respectively (vs 12.3% and 0.3% in 2015). After IUI, the DRs remained similar at 8.9% after IUI-H (7.8% in 2015) and at 12.4% after IUI-D (12.0% in 2015). Twin and triplet DRs after IUI-H were 8.8% and 0.3%, respectively (in 2015: 8.9% and 0.5%) and 7.7% and 0.4% after IUI-D (in 2015: 7.3% and 0.6%). The majority of FP interventions included the cryopreservation of ejaculated sperm (n = 7877 from 11 countries) and of oocytes (n = 4907 from eight countries). LIMITATIONS REASONS FOR CAUTION As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. A number of countries failed to provide adequate data about the number of initiated cycles and deliveries. WIDER IMPLICATIONS OF THE FINDINGS The 20th ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control of the data, transparency and vigilance in the field of reproductive medicine. STUDY FUNDING/COMPETING INTERESTS The study has no external funding and all costs were covered by ESHRE. There are no competing interests.
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Affiliation(s)
| | - C Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - C Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University, Göteborg, Sweden
| | - C Calhaz-Jorge
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ch De Geyter
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
| | - M S Kupka
- Fertility Center-Gynaekologicum, Hamburg, Germany
| | - T Motrenko
- Human Reproduction Center Budva, Budva, Montenegro
| | - I Rugescu
- National Transplant Agency, Slovakia, Romania
| | - J Smeenk
- Elisabeth Twee Steden Ziekenhuis, Tilburg, the Netherlands
| | | | - S Vidakovic
- Institute of Obstetrics and Gynecology, Clinical Center Serbia «GAK», Belgrade, Serbia
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
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De Geyter C, Calhaz-Jorge C, Kupka MS, Wyns C, Mocanu E, Motrenko T, Scaravelli G, Smeenk J, Vidakovic S, Goossens V. ART in Europe, 2015: results generated from European registries by ESHRE. Hum Reprod Open 2020; 2020:hoz038. [PMID: 32123753 PMCID: PMC7038942 DOI: 10.1093/hropen/hoz038] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/03/2019] [Indexed: 11/20/2022] Open
Abstract
STUDY QUESTION What are the European trends and developments in ART and IUI in 2015 as compared to previous years? SUMMARY ANSWER The 19th ESHRE report on ART shows a continuing expansion of treatment numbers in Europe, and this increase, the variability in treatment modalities and the rising contribution to the birth rates in most participating countries all point towards the increasing impact of ART on European society. WHAT IS KNOWN ALREADY Since 1997, the ART data generated by national registries have been collected, analysed and reported in 18 manuscripts published in Human Reproduction. STUDY DESIGN, SIZE, DURATION Collection of European data by the European IVF-Monitoring Consortium (EIM) for ESHRE. The data for treatments performed between 1 January and 31 December 2015 in 38 European countries were provided by national registries or on a voluntary basis by clinics or professional societies. PARTICIPANTS/MATERIALS, SETTINGS, METHODS From 1343 institutions in 38 countries offering ART services a total of 849 811 treatment cycles, involving 155 960 with IVF, 385676 with ICSI, 218098 with frozen embryo replacement (FER), 21 041 with preimplantation genetic testing (PGT), 64 477 with egg donation (ED), 265 with IVM and 4294 with FOR were recorded. European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 1352 institutions offering IUI in 25 countries and 21 countries, respectively. A total of 139 050 treatments with IUI-H and 49 001 treatments with IUI-D were included. MAIN RESULTS AND THE ROLE OF CHANCE In 18 countries (14 in 2014) with a population of approximately 286 million inhabitants, in which all institutions contributed to their respective national registers, a total of 409 771 treatment cycles were performed, corresponding to 1432 cycles per million inhabitants (range: 727–3068 per million). After IVF the clinical pregnancy rates (PRs) per aspiration and per transfer were slightly lower in 2015 as compared to 2014, at 28.5 and 34.6% versus 29.9 and 35.8%, respectively. After ICSI, the corresponding PR achieved per aspiration and per transfer in 2015 were also slightly lower than those achieved in 2014 (26.2 and 33.2% versus 28.4 and 35.0%, respectively). On the other hand, after FER with own embryos the PR per thawing continued to rise from 27.6% in 2014 to 29.2% in 2015. After ED a slightly lower PR per embryo transfer was achieved: 49.6% per fresh transfer (50.3% in 2014) and 43.4% for FOR (48.7% in 2014). The delivery rates (DRs) after IUI remained stable at 7.8% after IUI-H (8.5% in 2014) and at 12.0% after IUI-D (11.6% in 2014). In IVF and ICSI together, 1, 2, 3 and ≥4 embryos were transferred in 37.7, 53.9, 7.9 and in 0.5% of all treatments, respectively (corresponding to 34.9, 54.5, 9.9 and in 0.7% in 2014). This evolution towards the transfer of fewer embryos in both IVF and ICSI resulted in a proportion of singleton, twin and triplet DR of 83.1, 16.5 and 0.4%, respectively (compared to 82.5, 17.0 and 0.5%, respectively, in 2014). Treatments with FER in 2015 resulted in twin and triplet DR of 12.3 and 0.3%, respectively (versus 12.4 and 0.3% in 2014). Twin and triplet delivery rates after IUI-H were 8.9 and 0.5%, respectively (in 2014: 9.5 and 0.3%), and 7.3 and 0.6% after IUI-D (in 2014: 7.7 and 0.3%). LIMITATIONS, REASONS FOR CAUTION The methods of data collection and reporting vary among European countries. The EIM receives aggregated data from various countries with variable levels of completeness. Registries from a number of countries have failed to provide adequate data about the number of initiated cycles and deliveries. As long as incomplete data are provided, the results should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS The 19th EIM report on ART shows a continuing expansion of treatment numbers in Europe. The number of treatments reported, the variability in treatment modalities and the rising contribution to the birth rates in most participating countries point towards the increasing impact of ART on reproduction in Europe. Being the largest data collection on ART worldwide, detailed information about ongoing developments in the field is provided. STUDY FUNDING/COMPETING INTEREST(S) The study has no external funding and all costs are covered by ESHRE. There are no competing interests.
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Affiliation(s)
- C De Geyter
- Reproductive Medicine and Gynaecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland.,ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
| | - C Calhaz-Jorge
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - M S Kupka
- Gynaecology and Obstetrics, Fertility Center - Gynaekologicum, Hamburg, Germany
| | - C Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - E Mocanu
- Reproductive Medicine, Rotunda Hospital and RCSI, Dublin, Ireland
| | - T Motrenko
- Human Reproduction Center, Budva, Montenegro
| | - G Scaravelli
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, Rome, Italy
| | - J Smeenk
- Obstetrics and Gynaecology, Elisabeth Twee Steden Ziekenhuis, Tilburg, the Netherlands
| | - S Vidakovic
- Institute of Obstetrics and Gynaecology, Clinical Center Serbia «GAK», Belgrade, Serbia
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
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15
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Calhaz-Jorge C, De Geyter CH, Kupka MS, Wyns C, Mocanu E, Motrenko T, Scaravelli G, Smeenk J, Vidakovic S, Goossens V. Survey on ART and IUI: legislation, regulation, funding and registries in European countries: The European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod Open 2020; 2020:hoz044. [PMID: 32042927 PMCID: PMC7002185 DOI: 10.1093/hropen/hoz044] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/14/2019] [Indexed: 12/02/2022] Open
Abstract
STUDY QUESTION How are ART and IUI regulated, funded and registered in European countries? SUMMARY ANSWER Of the 43 countries performing ART and IUI in Europe, and participating in the survey, specific legislation exists in only 39 countries, public funding (also available in the 39 countries) varies across and sometimes within countries and national registries are in place in 31 countries. WHAT IS KNOWN ALREADY Some information devoted to particular aspects of accessibility to ART and IUI is available, but most is fragmentary or out-dated. Annual reports from the European IVF-Monitoring (EIM) Consortium for ESHRE clearly mirror different approaches in European countries regarding accessibility to and efficacy of those techniques. STUDY DESIGN, SIZE, DURATION A survey was designed using the online SurveyMonkey tool consisting of 55 questions concerning three domains—legal, funding and registry. Answers refer to the countries’ situation on 31 December 2018. PARTICIPANTS/MATERIALS, SETTINGS, METHODS All members of EIM plus representatives of countries not yet members of the Consortium were invited to participate. Answers received were checked, and initial responders were asked to address unclear answers and to provide any additional information they considered important. Tables of individual countries resulting from the consolidated data were then sent to members of the Committee of National Representatives of ESHRE, asking for a second check. Conflicting information was clarified by direct contact. MAIN RESULTS AND THE ROLE OF CHANCE Information was received from 43 out of the 44 European countries where ART and IUI are performed. Thirty-nine countries reported specific legislation on ART, and artificial insemination was considered an ART technique in 35 of them. Accessibility is limited to infertile couples in 11 of the 43 countries. A total of 30 countries offer treatments to single women and 18 to female couples. In five countries ART and IUI are permitted for treatment of all patient groups, being infertile couples, single women and same sex couples, male and female. Use of donated sperm is allowed in 41 countries, egg donation in 38, the simultaneous donation of sperm and egg in 32 and embryo donation in 29. Preimplantation genetic testing (PGT) for monogenic disorders or structural rearrangements is not allowed in two countries, and PGT for aneuploidy is not allowed in 11; surrogacy is accepted in 16 countries. With the exception of marital/sexual situation, female age is the most frequently reported limiting criteria for legal access to ART—minimal age is usually set at 18 years and maximum ranging from 45 to 51 years with some countries not using numeric definition. Male maximum age is set in very few countries. Where permitted, age is frequently a limiting criterion for third-party donors (male maximum age 35 to 55 years; female maximum age 34 to 38 years). Other legal constraints in third-party donation are the number of children born from the same donor (in some countries, number of families with children from the same donor) and, in 10 countries, a maximum number of egg donations. How countries deal with the anonymity is diverse—strict anonymity, anonymity just for the recipients (not for children when reaching legal adulthood age), mixed system (anonymous and non-anonymous donations) and strict non-anonymity. Public funding systems are extremely variable. Four countries provide no financial assistance to patients. Limits to the provision of funding are defined in all the others i.e. age (female maximum age is the most used), existence of previous children, maximum number of treatments publicly supported and techniques not entitled for funding. In a few countries, reimbursement is linked to a clinical policy. The definition of the type of expenses covered within an IVF/ICSI cycle, up to what limit and the proportion of out-of-pocket costs for patients is also extremely dissimilar. National registries of ART and IUI are in place in 31 out of the 43 countries contributing to the survey, and a registry of donors exists in 18 of them. LIMITATIONS, REASONS FOR CAUTION The responses were provided by well-informed and committed individuals and submitted to double checking. Since no formal validation was in place, possible inaccuracies cannot be excluded. Also, results are a cross section in time and ART and IUI legislations within European countries undergo continuous evolution. Finally, several domains of ART activity were deliberately left out of the scope of this ESHRE survey. WIDER IMPLICATIONS OF THE FINDINGS Results of this survey offer a detailed view of the ART and IUI situation in European countries. It provides updated and extensive answers to many relevant questions related to ART usage at national level and could be used by institutions and policymakers in planning services at both national and European levels. Study funding/competing interest(s) The study has no external funding, and all costs were covered by ESHRE. There were no competing interests. ESHRE Pages are not externally peer reviewed. This article has been approved by the Executive Committee of ESHRE.
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Affiliation(s)
- C Calhaz-Jorge
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,ESHRE Central Office, Belgium
| | - C H De Geyter
- Institute of Reproductive Medicine and Gynecological Endocrinology (RME), Basel, Switzerland
| | - M S Kupka
- Center for Reproductive Medicine, Gynaekologicum Hamburg, Hamburg, Germany
| | - C Wyns
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - E Mocanu
- Rotunda Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - T Motrenko
- Human Reproduction Center Budva, Budva, Montenegro
| | - G Scaravelli
- Registro Nazionale della Procreazione Medicalmente Assistita, Istituto Superiore di Sanità, Roma, Italy
| | - J Smeenk
- Department of Obstetrics and Gynaecology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands
| | - S Vidakovic
- Clinical Center Serbia, ``GAK'' Institute for Obstetrics and Gynecology, Belgrade, Serbia
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16
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Vargas S, Valente MP, Almeida MM, Neves J, Calhaz-Jorge C. Isolated Non-16/18 High-Risk Human Papillomavirus Cervical Infection: Re-Evaluation After One Year. ACTA MEDICA PORT 2019; 32:588-592. [PMID: 31493362 DOI: 10.20344/amp.10183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/10/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION High-risk human papillomavirus cervical infection is currently a well-established cause of cervical cancer. However, only a few women with persistent infections will develop cervical precancerous and malignant lesions. Approximately 20% of all cervical cancers are attributable to non-16/18 serotypes. This study aims to evaluate the results of our clinical approach to women with this infection. MATERIAL AND METHODS We conducted an observational and prospective study from September 2012 to September 2017, which included women with isolated non-16/18 high-risk human papillomavirus infection (with normal cytology). After re-evaluation, two groups were compared: women with spontaneous regression of the infection and women with persistent infection. Clinical and demographic data were analysed as well as the rate of progression to precancerous and malignant lesions. RESULTS We included 165 women, of which 121 were re-evaluated with co-test at least one year later. After re-evaluation, 13.2% of women revealed precancerous lesions but only two (1.7%) of them presented high-grade squamous intraepithelial lesions. Sixty-seven women (55.4%) showed spontaneous regression of the infection and 54 women (44.6%) maintained it. Women with persistent infection developed more precancerous lesions (27.8%; p < 0.001) and high-grade squamous intraepithelial lesions (3.7%; p < 0.001). There was also an association between persistent infection and postmenopausal status. DISCUSSION Human papillomavirus 16/18 cervical infection is associated with higher risk of cervical cancer when compared with other serotypes. CONCLUSION Re-evaluation with co-test one year after the diagnosis of isolated non-16/18 human papillomavirus infection seems to be a reasonable approach.
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Affiliation(s)
- Sara Vargas
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisboa. Portugal
| | - Maria Pulido Valente
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisboa. Portugal
| | - Margarida Mendes Almeida
- Departamento de Anatomia Patológica. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisboa. Portugal
| | - Joaquim Neves
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisboa. Departamento de Ginecologia e Obstetrícia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Carlos Calhaz-Jorge
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisboa. Departamento de Ginecologia e Obstetrícia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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17
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De Geyter C, Calhaz-Jorge C, Kupka MS, Wyns C, Mocanu E, Motrenko T, Scaravelli G, Smeenk J, Vidakovic S, Goossens V, Gliozheni O, Strohmer H, Obruca, Kreuz-Kinderwunschzentrum SPG, Petrovskaya E, Tishkevich O, Wyns C, Bogaerts K, Balic D, Sibincic S, Antonova I, Vrcic H, Ljiljak D, Pelekanos M, Rezabek K, Markova J, Lemmen J, Sõritsa D, Gissler M, Tiitinen A, Royere D, Tandler—Schneider A, Kimmel M, Antsaklis AJ, Loutradis D, Urbancsek J, Kosztolanyi G, Bjorgvinsson H, Mocanu E, Scaravelli G, de Luca R, Lokshin V, Ravil V, Magomedova V, Gudleviciene Z, Belo lopes G, Petanovski Z, Calleja-Agius J, Xuereb J, Moshin V, Simic TM, Vukicevic D, Romundstad LB, Janicka A, Calhaz-Jorge C, Laranjeira AR, Rugescu I, Doroftei B, Korsak V, Radunovic N, Tabs N, Virant-Klun I, Saiz IC, Mondéjar FP, Bergh C, Weder M, De Geyter C, Smeenk JMJ, Gryshchenko M, Baranowski R. ART in Europe, 2014: results generated from European registries by ESHRE†. Hum Reprod 2018; 33:1586-1601. [DOI: 10.1093/humrep/dey242] [Citation(s) in RCA: 314] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ch De Geyter
- Institute of Reproductive Medicine and Gynecological Endocrinology (RME), Vogesenstrasse 134, Basel, Switzerland
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
| | - C Calhaz-Jorge
- CNPMA, assembleia da Republica, Palacio de Sao Bento, Lisboa, Portugal
| | - M S Kupka
- Gynaekologicum Hamburg, Gynaecology and Obstetrics, Altonaer Strasse 59, Hamburg, Germany
| | - C Wyns
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av. Hippocrate, 10, Brussels, Belgium
| | - E Mocanu
- Human Assisted Reproduction Ireland Rotunda Hospital, HARI Unit, Master's House, Parnell Square, 1 Dublin, Ireland
| | - T Motrenko
- Medical Centre Cetinje, Human Reproduction Department, Vuka Micunovica 4, Cetinje, Montenegro
| | - G Scaravelli
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, Roma, Italy
| | - J Smeenk
- Department of Obstetrics and Gynaecology, St Elisabeth Hospital Tilburg, Hilv, The Netherlands
| | - S Vidakovic
- Institute for Obstetrics and Gynecology, Clinical Center Serbia ‘GAK’, Visegradska 26, Belgrade, Serbia
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
| | - Orion Gliozheni
- University Hospital for Obst&Gynecology, Departement of Obstetrics & Gynecology, Bul.B.Curri, Tirana, Albania. Tel: +355-4-222-3632; Fax: +355-4-225-7688; Mobile: +355-682029313. E-mail:
| | - Heinz Strohmer
- Lazarettgasse 16-18, 1090 Wien, Austria. Tel: +43-40-111-1400; Fax: +43-40-111-1401. E-mail:
| | - Obruca
- Lazarettgasse 16-18, 1090 Wien, Austria. Tel: +43-40-111-1400; Fax: +43-40-111-1401. E-mail:
| | | | | | - Oleg Tishkevich
- Centre For Assisted Reproduction ‘Embryo’ Belivpul, Filimonova Str. 53, 220114 Minsk, Belarus. Tel: +375-29-622-2722; Fax: +375-17-237-6404; Mobile: +375-296222722; E-mail:
| | - Christine Wyns
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av. Hippocrate, 10, 1200 Brussels, Belgium. Tel. +32-27-64-6576; Fax: +32-27-64-9050; E-mail:
| | - Kris Bogaerts
- I-Biostat, Kapucijnenvoer 35 bus 7001, 3000 Leuven, Belgium. Tel: +32-016-33-6890; Fax: +32-016-33-7015. E-mail:
| | - Devleta Balic
- Zavod za humanu reprodukciju ‘Dr Balic’, Kojsino 25, 75000 Tuzla, Bosnia—Herzegovina. Tel: +387-35-26-0650; Mobile: +387-61140222; E-mail:
| | - Sanja Sibincic
- Health Centre Medico-S, Jevrejska 58/A, 78000 Banja Luka, Bosnia—Herzegovina. Tel: +387-51-232-100; Mobile: +387-65515942; E-mail:
| | - Irena Antonova
- ESHRE certified clinical embryologist (2011), Ob/Gyn Hospital Dr Shechterev, 25-31, Hristo Blagoev Strasse, 1330 Sofia, Bulgaria. Tel: +359-88-712-7651; E-mail:
| | - Hrvoje Vrcic
- Zagreb University Medical School, Obstetrics and Gynecology, Petrova 13, 10000 Zagreb, Croatia. Tel: +385-14-60-4646; Fax: +385-14-63-3512; E-mail:
| | - Dejan Ljiljak
- Clinical Hospital Centre ‘Sestre milosrd’, Department for Biology of Human Reproduction, Ob/Gyn Clinic, Vinogradska c. 29, 10000 Zagreb, Croatia. Tel: +385-378-7597; Fax: +385-13-76-8272; Mobile: +385-378-7125; E-mail:
| | - Michael Pelekanos
- Fertility Centre Aceso, 1, Pavlou Nirvana str., 3021 Limassol, Cyprus. Tel: +357-99-64-5333; Fax: +357-25-82-4477; Mobile +30-6944248433; E-mail:
| | - Karel Rezabek
- Medical Faculty, University Hopsital, CAR-Assisited Reproduction Centre, Gyn/Ob departement, Apolinarska 18, 12000 Prague, Czech Republic. Tel: +420-22-496-7479; Fax: +420-22-492-2545; Mobile: +420-724685276; E-mail:
| | - Jitka Markova
- Institute of Health Information and Statistics of the Czech Republic, Palackeho namesti 4, 12801 Prague, Czech Republic. Tel: +420-22-497-2832; Mobile: +420-72-182-7532; E-mail:
| | - Josephine Lemmen
- Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Tel: +45-35-450-934; Fax: +45-35-454-945; Mobile: +45-30285712; E-mail:
| | - Deniss Sõritsa
- Tartu University Hospital and Elitre Clinic, Tartu, Estonia. Tel: +372-740-9930; Fax: +372-740-9931; E-mail:
| | - Mika Gissler
- THL National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Tel: +385-29-524-7279; E-mail:
| | - Aila Tiitinen
- Helsinki University Central Hospital, Dept. of Ob/Gyn, Haartmaninkatu, 2, PO Box 140, 00029 HUS—Helsinki, Finland. Tel: + 358-50-427-1217; E-mail:
| | - Dominique Royere
- Agence de la Biomédecine, 1 Av du stade de France, 93212 Saint-Denis La Plaine Cedex, France.Tel.: +33-15-593-6555; Fax: +33-15-593-6561; E-mail:
| | - Andreas Tandler—Schneider
- Fertility Centre Berlin; Spandauer damm 130; 14050 Berlin; Germany. Tel: +49-30-23-320-8110; Fax: +49-30-23-320-8119; E-mail:
| | - Markus Kimmel
- D.I.R. Geschäftsstelle, Torstrasse 140, D-10119 Berlin, Germany. Tel: +49-303-980-0743; E-mail:
| | - Aris J Antsaklis
- Professor of Obstetrics and Gynecology, University of Athens, President Hellenic Authority of Assisted Human Reproduction. Tel: +30-694-429-9699; E-mail:
| | - Dimitris Loutradis
- Athens Medical School, 1st Department of OB/GYN, 62, Sirinon Street, 17561 P. Faliro, Athens, Greece. Tel: +30-19-83-3576; Fax: +30-19-88-3834; Mobile: +30-693-242-1747; E-mail:
| | - Janos Urbancsek
- Semmelweis University, 1st Dept. of Ob/Gyn, Baross utca 27, 1088 Budapest, Hungary. Tel: +36-12-66-0115; Fax: +36-12-66-0115; E-mail:
| | - G Kosztolanyi
- University of Pecs, Dept. of Medical Genetics and Child Development, Jozsef A.u.7., 7623 Pecs, Hungary. Tel: +36-72-53-5977; Fax: +36-72-53-5972; E-mail:
| | - Hilmar Bjorgvinsson
- Art Medica, Baejarlind 12, 201 Kopavogur, Iceland. Tel: +354-515-8100; Fax: +354-515-8103; E-mail:
| | - Edgar Mocanu
- Human Assisted Reproduction Ireland Rotunda Hospital, HARI Unit, Master’s House, Parnell Square, 1 Dublin, Ireland. Tel: +353-18-07-2732; Mobile: +353-86-81-8839; Fax: +353-18-72-7831; E-mail:
| | - Giulia Scaravelli
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, 00161 Roma. Tel: +39-49-90-4050; Fax: +39-49-90-4324; E-mail:
| | - Roberto de Luca
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, 00161 Roma. Tel: +39-064-990-4320; E-mail:
| | - Vyacheslav Lokshin
- The Urban Centre of Human Reproduction, Tole Be Street 99, 50012 Almaty, Kazakhstan. Tel: +7-727-234-3434; Fax: +7-727-264-6615; Mobile: +7-7017558209; E-mail:
| | - Valiyev Ravil
- The Scientific Centre for Obstetrics, Gynecology and Perinatology, Dostyk street 125, 050020 Almaty, Kazakhstan. Tel: +7-727-300-4530; Fax: +7-727-300-4529; Mobile: +7-7772258189; E-mail:
| | - Valeria Magomedova
- Jusu Arsti Private Clinic, Apuzes 14, 1046 Riga, Latvia. Tel: +371-67-87-0029; E-mail:
| | - Zivile Gudleviciene
- Baltic American Clinic, IVF Laboratory, Nemencines rd 54 A, 10103 Vilnius, Lithuania. Tel: + 370-52-34-2020; Mobile: +370-68682417; E-mail:
| | - Giedre Belo lopes
- Northway Medical Centre, S. Žukausko g. 19, Vilnius 08234, Lithuania. Tel: + 370-529-8290; E-mail:
| | - Zoranco Petanovski
- Re-medika Hospital; Jane dandaniski 87/1/4, 1000 Skopje, Macedonia. Tel: +389-23-07-3335; Mobile: +389-72443114; E-mail:
| | - Jean Calleja-Agius
- University of Malta, 12, Mon Nid, Gianni Faure Street, TXN2421 Tarxien, Malta. Tel: +356-21-69-3041; Mobile: +356-99-55-3653; E-mail:
| | - Josephine Xuereb
- Mater Dei Hospital Malta, Apt 1 Hampton Place, BKR 104 B’Kara, Malta. Tel: +356-99-99-2382; E-mail:
| | - Veaceslav Moshin
- Medical Director at Repromed Moldova, Centre of Mother @ Child protection, State Medical and Pharmaceutical University ‘N.Testemitanu’, Bd. Cuza Voda 29/1, Chisinau, Republic of Moldova. Tel: +373-22-26-3855; Mobile: +373-69724433; E-mail:
| | - Tatjana Motrenko Simic
- Medical Centre Cetinje, Human Reproduction Departement, Vuka Micunovica 4, 81310 Cetinje, Montenegro. Tel: +382-41-23-2690; Fax: +382-41-23-1212; Mobile: +382-69-05-2331; E-mail:
| | - Dragana Vukicevic
- Hospital ‘Danilo I’, Humana reprodukcija, Vuka Micunovica bb, 86000 Cetinje, Montenegro. Tel: +382-67-55-1371; E-mail:
| | - Liv Bente Romundstad
- St. Olavs Hospital, Postboks 3250 Sluppen, Olav Kyrres gt.17, 7006 Trondheim, Norway. Tel: +47-73-86-8000; Fax: +47-73-86-7602; Mobile: +47-90-55-0207; E-mail: ,
| | - Anna Janicka
- VitroLive, Kasprzaka 2 A, 71-074 Szczecin, Poland. Tel: +48-69-167-6305; E-mail:
| | - Carlos Calhaz-Jorge
- CNPMA, assembleia da Republica, Palacio de Sao Bento, 1249-068 Lisboa, Portugal. Tel: +351-21-391-9303; Fax: +351-21-391-7502; E-mail:
| | - Ana Rita Laranjeira
- CNPMA, Assembleia da Republica, Palaio de Sao Bento 1249-068 Lisboa, Portugal. Tel: +351-21-391-9303; Fax: +351-21-391-7502; E-mail:
| | - Ioana Rugescu
- Gen Secretary of AER Embryologist association and Representative for Human Reproduction Romanian Society. Tel: +40-74-450-0267; E-mail:
| | - Bogdan Doroftei
- Univ. of Medicine and Pharmacy Iasi; Teaching Hospital Obgyn ‘Cuza Voda’; Cuza Voda Str. 34; 700038 Iasi; Romania. Tel: + 40-23-221-3000/int. 176; Mobile: +40-744515297; E-mail: ;
| | - Vladislav Korsak
- International Centre for Reproductive Medicine, General Director, Liniya 11, Building 18B, Vasilievsky Island, 199034 St-Petersburg, Russia C.I.S. Tel: +7-812-328-2251; Fax: +7-812-327-1950; Mobile: +7-921-965-1977; E-mail:
| | - Nebosja Radunovic
- Institute for Obstetrics and Gynecology, Visegradska 26, 11000 Belgrade, Serbia. Tel: +38-111-361-5592; Fax: +38-111-361-5603; Mobile: +381-63200204; E-mail:
| | - Nada Tabs
- Klinika za ginekologiju i akuserstvo, Klinicki centar Vojvodine, Branimira Cosica 37, 21000 Novi Sad, Serbia. Mobile: +381-63508185; E-mail:
| | - Irma Virant-Klun
- University Medical Centre Ljubljana, Departement of Obstetrics and Gynecology, Slajmerjeva 3, 1000 Ljubljana, Slovenia. Tel: +386-1-522-6013; Fax: +386-1-431-4355; Mobile:+386-31625774; E-mail:
| | - Irene Cuevas Saiz
- Hospital General de Alicante, Infertility Dept., Av Pintor Baeza, 12, 03010 Valencia, Spain;. Tel: +34-96-197-2000; Fax: +34-91-799-4407; Mobile +34-677245650; E-mail:
| | - Fernando Prados Mondéjar
- Hospital de Madrid-Montepríncipe, HM Fertility Centre Monteprincipe, C/Montepríncipe 25, 28660 Boadilla del Monte, Spain. Tel: +34-91-708-9931; Mobile +34-646737237; E-mail:
| | - Christina Bergh
- Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Bla Straket 6, 413 45 Göteborg, Sweden. Tel: +46-31-342-1000, +46-73-688-9325; Fax: +46-31-41-8717; Mobile +46-736889325; E-mail:
| | - Maya Weder
- Administration FIVNAT, Postfach 754, 3076 Worb, Switzerland. Tel: +41-031-819-7602; Fax + 41-031-819-8920; E-mail:
| | - Christian De Geyter
- University Women’s Hospital of Basel, Abteilungsleiter gyn. Endokrinologie und Reproduktionsmedizin, Spitalstrasse 21, 4031 Basel, Switzerland. Tel: +41-61-265-9315; Fax: + 41-61-265-9194; E-mail:
| | - Jesper M J Smeenk
- St Elisabeth Hospital Tilburg, Dept. of obstetrics and Gynaecology, Hilv, The Netherlands. Tel: +31-13-539-3108; Mobile: +31-622753853; E-mail:
| | - Mykola Gryshchenko
- IVF Clinic Implant Ltd, Academician V.I.Gryshchenko Clinic for Reproductive Medicine, 25 Karl Marx Str., 61000 Kharkiv, Ukraine. Tel: +380-57-12-4522; Fax: +380-57-70-507-0703; Mobile +380-57705070703; E-mail:
| | - Richard Baranowski
- Deputy Information Manager, Human Fertilization and Embryology Authority (HFEA), Finsbury Tower, 103-105 Bunhill Row, London EC1 Y 8HF, UK. Tel: +44-020-7539-3329; Fax: +44-020-7377-1871; E-mail:
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Simões-Pereira J, Nunes J, Aguiar A, Sousa S, Rodrigues C, Sampaio Matias J, Calhaz-Jorge C. Influence of body mass index in anti-Müllerian hormone levels in 951 non-polycystic ovarian syndrome women followed at a reproductive medicine unit. Endocrine 2018; 61:144-148. [PMID: 29470775 DOI: 10.1007/s12020-018-1555-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/31/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Anti-Müllerian hormone (AMH) is a useful marker of ovarian reserve. Obesity/overweight are increasing and may affect the reproductive health. Previous studies regarding the effect of body mass index (BMI) on AMH levels are discordant. Our main goal was to evaluate the influence of BMI on AMH levels in women without polycystic ovarian syndrome. METHODS Revision of medical records of 951 women who performed AMH determinations as part of their fertility workup, between 2011 and 2016. RESULTS Median AMH concentration was 1.75 [interquartile range (IQR) 2] ng/mL (12.9 pmol/mL) and median age at AMH determination was 35 (IQR 6) years. These women evidenced a median BMI of 23 (IQR 5) kg/m2. Caucasian women were more represented [889(89.3%)]. Smoking habits (present/past) were present in 359(36.1%), and 147(14.8%) harboured a history of ovarian surgery. On univariable analysis AMH was not correlated with BMI (r = 0.048/p = 0.135); the only factors influencing AMH were age (p < 0.001), ethnicity (p = 0.004), and previous ovarian surgery (p < 0.001). On multivariable analysis, age was the only variable significantly associated with AMH, evidencing a reduction of 6.2% for each additional year (p < 0.0001). Furthermore, we verified a trend suggesting an AMH reduction of 22% (p = 0.08) in black patients comparing with the caucasian ones, when controlling for the other variables. CONCLUSION We report one of the largest series evaluating the influence of BMI on AMH levels and, consequently, on ovarian reserve. BMI does not seem to affect AMH levels. The reported concerns on infertility in overweight and obese women may be related to follicular development/oocyte maturation or endometrial disorders, rather than decreased ovarian reserve.
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Affiliation(s)
- Joana Simões-Pereira
- Endocrinology Department, Insituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal.
| | - Joaquim Nunes
- Gynaecology, Obstetrics and Reproductive Medicine Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Ana Aguiar
- Gynaecology, Obstetrics and Reproductive Medicine Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Sandra Sousa
- Gynaecology, Obstetrics and Reproductive Medicine Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Cátia Rodrigues
- Gynaecology, Obstetrics and Reproductive Medicine Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Joaquim Sampaio Matias
- Clinical Pathology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Carlos Calhaz-Jorge
- Gynaecology, Obstetrics and Reproductive Medicine Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Mendes S, Carvalho C, Rodrigues G, Barata S, Calhaz-Jorge C, Osório F. Successful Treatment of Endometriosis-Related Hemorrhagic Ascites: A Report of Three Cases. Surg Technol Int 2018; 32:150-155. [PMID: 29689592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Endometriosis-related ascites is rare and is frequently confused with an ovarian malignancy. Since it affects women in reproductive age, its diagnosis and therapy are even more challenging. These patients usually present with abdominal distension, pelvic pain, and weight loss, but a careful questioning usually reveals the typical endometriosis symptoms-such as dysmenorrhea and dyspareunia. We present three cases of endometriosis-related ascites, one of them with pleural effusion. All cases were associated with extensive disease and required laborious laparoscopic surgery, medical therapy with gonadotropin releasing hormone analogs, and long-term follow-up. One of the patients delivered twins following an in vitro fertilization (IVF) cycle without recurrence of ascites. We aim to raise awareness toward the importance of considering endometriosis in a patient with ascites of unknown origin.
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Affiliation(s)
- Sofia Mendes
- Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal
| | - Catarina Carvalho
- Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal
| | - GonÇalo Rodrigues
- Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal
| | - Sónia Barata
- Minimally Invasive Surgery Department/Obstetrics and Gynecology Department Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal
| | - Carlos Calhaz-Jorge
- Chief of Gynecology Department, Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal, Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Filipa Osório
- Minimally Invasive Surgery Department/Obstetrics and Gynecology Department Hospital da Luz, Minimally Invasive Surgery Department/Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal
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Ferraretti AP, Nygren K, Andersen AN, de Mouzon J, Kupka M, Calhaz-Jorge C, Wyns C, Gianaroli L, Goossens V. Trends over 15 years in ART in Europe: an analysis of 6 million cycles. Hum Reprod Open 2017; 2017:hox012. [PMID: 31486803 PMCID: PMC6276702 DOI: 10.1093/hropen/hox012] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/21/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
Study question Was the European IVF Monitoring (EIM) Consortium, established in 1999 by ESHRE, able to monitor the trend over time of ART in Europe? Summary answer The initial aims of the EIM programme (to collect and publish regional European data on census and trends on ART utilization, effectiveness, safety and quality) have been achieved. What is already known ART data in Europe have been collected and reported annually in Human Reproduction. Study design, size, duration A retrospective data analysis and summary of the first 15 years of ART activity in Europe (1997–2011) was carried out, using the key figures from the annual ESHRE reports and focusing on how the practice of ART has evolved over the years. Participants/materials, setting, method A total of 5 919 320 ART cycles are reported, including IVF, ICSI, frozen embryo relacment and egg donation, resulting in the birth of more than 1 million infants. A total of 1 548 967 IUIs are also reported, including husband/partner’s semen and donor semen cycles. The most relevant and complete data are analysed and discussed. Main results and the role of chance With some fluctuations, the number of countries and clinics reporting to EIM increases significantly from 1997 to 2011. A constant increase was also registered in the number of annual cycles reported. Since 2005, the estimation of the EIM coverage on the total European activity was >80%. In countries with 100% of coverage, the mean availability of ART increased from 765 cycles per million inhabitants in 1997 to 1269 cycles per million inhabitants in 2011, and the proportion of ART infants of the total number of infants born in the country increased from 1.3% to 2.4%. The proportion of women aged > 39 years undergoing IVF and ICSI cycles gradually increased. For 12 consecutive years, the proportion of ICSI versus IVF cycles showed a marked increase before reaching a plateau from 2008. The proportion of transfers with three or more embryos decreased constantly and the proportion of SETs increased over the time period. The triplets deliveries were reduced from 3.7% in 1997 to less than 1% since 2005 (0.6% in 2011). The effectiveness (evaluated as clinical pregnancy rate per aspiration and per embryo transfer) increased until 2007, then the figure remained stable. The cumulative percentage of documented pregnancy losses was 17%. No differences have been noted in terms of outcomes in the IUI cycles. Limitations, reasons for caution The data presented are accumulated from countries with different collection systems, regulations, insurance coverage and different practices. Each year a number of countries have been unable to provide some of the data. Wider implications of the finding(s) The first summary of 15 years of the EIM reports offers interesting data on census and trends on ART utilization, safety and quality in Europe. The primary aim of the ESHRE effort in supporting European data collection has been reached. Owing to its importance inside and outside the professional community, European data collection and publication on ART have to be supported and implemented. Study funding/competing interest(s) None.
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Affiliation(s)
- A P Ferraretti
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - K Nygren
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - J de Mouzon
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - M Kupka
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C Calhaz-Jorge
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C Wyns
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - L Gianaroli
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
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Calhaz-Jorge C, De Geyter C, Kupka MS, de Mouzon J, Erb K, Mocanu E, Motrenko T, Scaravelli G, Wyns C, Goossens V, Gliozheni O, Strohmer H, Obruca, Kreuz-Kinderwunschzentrum SPG, Petrovskaya E, Tishkevich O, Wyns C, Bogaerts K, Antonova I, Vrcic H, Ljiljak D, Pelekanos M, Rezabek K, Markova J, Lemmen J, Erb K, Sõritsa D, Gissler M, Tiitinen A, Royere D, Tandler A, Kimmel M, Loutradis D, Antsaklis AJ, Urbancsek J, Kosztolanyi G, Bjorgvinsson H, Mocanu E, Scaravelli G, Lokshin V, Ravil V, Magomedova V, Gudleviciene Z, Belo lopes G, Petanovski Z, Calleja-Agius J, Moshin V, Motrenko Simic T, Vukicevic D, Romundstad LB, Janicka A, Calhaz-Jorge C, Laranjeira AR, Rugescu I, Doroftei B, Korsak V, Radunovic N, Tabs N, Tomazevic T, Virant-Klun I, Hernandez JH, Alcalá JAC, Bergh C, Weder M, De Geyter C, Smeenk JM, Gryshchenko M, Baranowski R. Assisted reproductive technology in Europe, 2013: results generated from European registers by ESHRE†. Hum Reprod 2017; 32:1957-1973. [DOI: 10.1093/humrep/dex264] [Citation(s) in RCA: 219] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - C Calhaz-Jorge
- Faculdade de Medicina de Universidade de Lisboa, Portugal
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C De Geyter
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- University Women's Hospital of Basel, Abteilungsleiter gyn. Endokrinologie und Reproduktionsmedizin, Switzerland
| | - M S Kupka
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- Kinderwunschzentrum Altonaer Strasse im Gynaekologicum Hamburg, Germany
| | - J de Mouzon
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- INSERM, France
| | - K Erb
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- Odense University Hospital, Fertility Clinic, Denmark
| | - E Mocanu
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- HARI Unit, Rotunda Hospital, Ireland
| | - T Motrenko
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- Human Reproduction Centre Budva, Montenegro
| | - G Scaravelli
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- National Health Institute, Woman, Child and Adolescent Health Unit, Italy
| | - C Wyns
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- UCLouvain, Belgium
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
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Marques P, Ferreira F, Soares AP, Nunes J, Sousa S, Aguiar A, Calhaz-Jorge C. Clinico-biochemical characteristics of 229 Portuguese infertile women with polycystic ovary syndrome: clinical relevance and relationship with fertility treatment results. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog3147.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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De Geyter C, Wyns C, Mocanu E, de Mouzon J, Calhaz-Jorge C. Data collection systems in ART must follow the pace of change in clinical practice. Hum Reprod 2016; 31:2160-3. [DOI: 10.1093/humrep/dew199] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/18/2016] [Indexed: 11/14/2022] Open
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Luz R, Barros J, Aguiar A, Rodrigues C, Soares AP, Nunes J, Sousa S, Calhaz-Jorge C. Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome. ACTA MEDICA PORT 2016; 29:441-448. [PMID: 27914154 DOI: 10.20344/amp.6377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 11/09/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome is the most frequent cause of anovulatory infertility and management involves a multistep approach. Laparoscopic ovarian diathermy is accepted as a second-line treatment of patients who failed to respond to clomiphene citrate. The aims of this study were to determine the efficacy of this technique at short and long-term and to perform an analysis of predictive factors of spontaneous pregnancy. MATERIAL AND METHODS This retrospective study involved 76 women who underwent laparoscopic ovarian diathermy between 2004 and 2013 in a university hospital. Main outcomes were cycle regularity and pregnancy. Short-term outcomes recorded during followup in our centre were reviewed and long-term outcomes were evaluated by a telephone interview to all women whose surgery was undertaken more than three years ago. Clinical and biochemical data were analysed as predictive factors of spontaneous conceptionin patients without other infertility factors. RESULTS Menstrual cycle regularity was initially achieved in 53 (70%) women and in the long-term follow-up subgroup, 52% (12/23) had regular periods. In general, 53 (70%) women conceived and 77 pregnancies were achieved, 60% of which were spontaneous. The only prognostic factor found to be significantly associated with spontaneous conception was a shorter duration of infertility (< 3 years) (p < 0.05). DISCUSSION Laparoscopic ovarian diathermy showed pregnancy rates comparable to other ovulation induction treatments with the advantage of having a long lasting beneficial effect in menstrual regularity and fertility. CONCLUSION Laparoscopic ovarian diathermy is a safe and effective treatment option for anovulatory infertility in women with polycystic ovary syndrome.
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Affiliation(s)
- Rita Luz
- Serviço de Ginecologia e Obstetrícia. Centro Hospitalar de Setúbal. Setúbal. Portugal
| | - Joana Barros
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Ana Aguiar
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Cátia Rodrigues
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Ana Paula Soares
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Joaquim Nunes
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Sandra Sousa
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Carlos Calhaz-Jorge
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
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Kupka MS, D'Hooghe T, Ferraretti AP, de Mouzon J, Erb K, Castilla JA, Calhaz-Jorge C, De Geyter C, Goossens V. Assisted reproductive technology in Europe, 2011: results generated from European registers by ESHRE. Hum Reprod 2016; 31:233-48. [PMID: 26740578 DOI: 10.1093/humrep/dev319] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/05/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION The 15th European IVF-monitoring (EIM) report presents the results of treatments involving assisted reproductive technology (ART) initiated in Europe during 2011: are there any changes in the trends compared with previous years? SUMMARY ANSWER Despite some fluctuations in the number of countries reporting data, while the overall number of ART cycles has continued to increase year by year, the pregnancy rates in 2011 decreased slightly to those reported in 2010, and the number of transfers with multiple embryos (3+) and the multiple delivery rates declined. WHAT IS KNOWN ALREADY Since 1997, ART data in Europe have been collected and reported in 14 manuscripts, published in Human Reproduction. STUDY DESIGN, SIZE, DURATION Retrospective data collection of European ART data by the EIM Consortium for the European Society of Human Reproduction and Embryology (ESHRE); cycles started between 1 January and 31 December 2011 are collected on a yearly basis. The data are collected by National Registers, when existing, or on a voluntary basis by personal information. PARTICIPANTS/MATERIALS SETTING, METHODS From 33 countries (+2 compared with 2010), 1064 clinics reported 609 973 treatment cycles including: IVF 138 592, ICSI 298 918, frozen embryo replacement (FER) 129 693, egg donation (ED) 30 198, in vitro maturation 511, preimplantation genetic diagnosis/screening 6824 and frozen oocyte replacements 5237. European data on intrauterine insemination (IUI) using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 861 IUI laboratories in 24 countries. A total of 174 390 IUI-H and 41 151 IUI-D cycles were included. MAIN RESULTS AND THE ROLE OF CHANCE In 17 countries where all clinics reported to the ART register, a total of 361 972 ART cycles were performed in a population of 285 million inhabitants, corresponding to 1269 cycles per million inhabitants. For all IVF cycles, the clinical pregnancy rates per aspiration and per transfer were stable with 29.1 and 33.2%, respectively, and for ICSI, the corresponding rates also were stable with 27.9 and 31.8%, respectively. In FER cycles, the pregnancy rate per thawing increased to 21.3% if compared with previous years. In ED cycles, the pregnancy rate per fresh transfer decreased to 45.8% (47.4% in 2010) and increased to 33.6% (33.3% in 2010) per thawed transfer. The delivery rate after IUI-H decreased to 8.3 (8.9 in 2010), and to 12.2% (13.8% in 2010) after IUI-D. In IVF and ICSI cycles, 1, 2, 3 and 4+ embryos were transferred in 27.5, 56.7, 14.5 and 1.3% of cycles, respectively. The proportions of singleton, twin and triplet deliveries after IVF and ICSI (added together) were 80.8, 18.6 and 0.6%, respectively, resulting in a total multiple delivery rate of 19.2% compared with 20.6% in 2010, 20.2% in 2009, 21.7% in 2008, 22.3% in 2007 and 20.8% in 2006. In FER cycles, the multiple delivery rate was 13.2% (12.8% twins and 0.4% triplets). Twin and triplet delivery rates associated with IUI cycles were 9.7/0.6% and 7.3/0.3%, following IUI-H and IUI-D treatment, respectively. LIMITATIONS, REASONS FOR CAUTION The method of reporting varies among countries, and registers from a number of countries have been unable to provide some of the relevant data such as initiated cycles and deliveries. As long as data are incomplete and generated through different methods of collection, results should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS The 15th ESHRE report on ART shows a continuing expansion of the number of treatment cycles in Europe, with more than 600 000 cycles reported in 2011. Since 2006, the proportion of IVF to ICSI cycles has reached a plateau after a small decrease in 2009. Pregnancy and delivery rates after IVF remained relatively stable compared with 2010 and 2009. The pregnancy rate per aspiration in ICSI cycles declined for the first time by 0.9%. The multiple delivery rate is lower than ever before. STUDY FUNDING/COMPETING INTERESTS The study had no external funding; all costs are covered by ESHRE. There are no competing interests.
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Affiliation(s)
| | | | - M S Kupka
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - T D'Hooghe
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - A P Ferraretti
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - J de Mouzon
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - K Erb
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - J A Castilla
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C Calhaz-Jorge
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - Ch De Geyter
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
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Marques P, Ferreira F, Soares AP, Nunes J, Sousa S, Aguiar A, Calhaz-Jorge C. Clinico-biochemical characteristics of 229 Portuguese infertile women with polycystic ovary syndrome: clinical relevance and relationship with fertility treatment results. CLIN EXP OBSTET GYN 2016; 43:812-817. [PMID: 29944229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) affects 6-20% of reproductive-age women. The authors aimed to evaluate the characteristics of PCOS women and its relationship with fertility treatment outcomes. MATERIALS AND METHODS The authors reviewed records of PCOS women assisted at Hospital Santa Maria. Fertility treatment results were assessed as pregnancy rate, number of cycles, and miscarriage rate. RESULTS They identified 229 PCOS women, 179 (78.2%) had waist circumference > 80 cm, 72 (31.4%) had type 2 diabetes mellitus (T2DM) familial history and glucose abnormalities, hypertriglyceridemia and low cholesterol-HDL were detected in 23(10.1%), 15 (6.6%) and 103 (45.0%), respectively. Pregnancy was achieved in 164 women. The mean number of cycles to achieve pregnancy was 2.7 (±2.2). Statistical analysis identified factors associated with longer/higher number of treatments: primary infertility, T2DM familial history, hypertriglyceridemia, and low cholesterol-HDL. Waist circumference > 80 cm, older age, and increased LH level were associated with miscarriage. CONCLUSIONS Primary infertility, T2DM familial history, hypertriglyceridemia, low cholesterol-HDL, older age, waist circumference > 80 cm, and high LH may confer poorer fertility treatment results.
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Andrade C, Barata S, António F, Alho C, Calhaz-Jorge C, Osório F. Laparoscopic Neurolysis of Deep Endometriosis Infiltrating Left Femoral Nerve: Case Report. Surg Technol Int 2015; 27:163-168. [PMID: 26680392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pelvic endometriosis may infiltrate somatic nerves causing severe neuropathic symptoms with a high impact on quality of life. It is a medical condition poorly known, and few published data about involvement of femoral nerve are available. We report an isolated unilateral endometriosis lesion of the left lumbar region infiltrating the femoral nerve in a 38-year-old woman. She described severe dysmenorrhea, dyspareunia, dischezia, and chronic pelvic pain with irradiation to the anterior part of the left thigh. After investigation, it was identified as a 5-centimeter endometriotic nodule involving the femoral nerve and the psoas muscle. The patient was treated by two laparoscopic surgeries with neurolysis of the involved somatic nerve by a multidisciplinary team, with improvement of the symptoms. Laparoscopic neurolysis is the first approach advocated in these cases, leading to relief of neurological symptoms resulting from nerve infiltration by endometriosis.
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Affiliation(s)
- Cláudia Andrade
- Department of Obstetrics and Gynecology Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal, Department of Obstetrics and Gynecology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Sónia Barata
- Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Francisco António
- Department of Neurosurgery, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Conceição Alho
- Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Carlos Calhaz-Jorge
- Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal, CAM - Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Filipa Osório
- Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria, Lisbon, Portugal, Faculdade de Medicina de Lisboa, CAM - Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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Calhaz-Jorge C, Feki A, Farquharson R. European view of subspecialty training on behalf of the European Society of Human Reproduction and Embryology (ESHRE). Fertil Steril 2015; 104:8-11. [PMID: 26051100 DOI: 10.1016/j.fertnstert.2015.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 11/28/2022]
Abstract
Specialist training in reproductive medicine within Europe continues to evolve. Recent revisions, updates, and initiatives have helped to refine the core educational needs for the specialist trainee.
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Affiliation(s)
| | - Anis Feki
- Department of Obstetrics and Gynecology, Fribourg, Switzerland
| | - Roy Farquharson
- Gynaecology Department, Liverpool Womens Hospital, Liverpool, United Kingdom.
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Nogueira-Silva C, Costa P, Martins C, Barata S, Alho C, Calhaz-Jorge C, Osório F. Validation of the Portuguese Version of EHP-30 (The Endometriosis Health Profile-30). ACTA MEDICA PORT 2015; 28:347-56. [PMID: 26421788 DOI: 10.20344/amp.5778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 05/11/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Endometriosis Health Profile Questionnaire-30 is currently the most used questionnaire for quality of life measurement in women with endometriosis. The aim of this study is to evaluate the psychometric properties and to validate the Portuguese Endometriosis Health Profile Questionnaire-30 version. MATERIAL AND METHODS A sequential sample of 152 patients with endometriosis, followed in a Portugal reference center, were asked to complete a questionnaire on social and demographic features, the Portuguese version of the Endometriosis Health Profile Questionnaire-30 and of the Short Form Health Survey 36 Item â version 2. Appropriate statistical analysis was performed using descriptive statistics, factor analysis, internal consistency, item-total correlation and convergent validity. RESULTS Factorial analysis confirmed the validity of the five-dimension structure of the Endometriosis Health Profile Questionnaire-30 core questionnaire, which explained 83.2% of the total variance. All item-total correlations presented acceptable results and high internal consistency, with Cronbach's alpha ranging between 0.876 and 0.981 for the core questionnaire and between 0.863 and 0.951 for the modular questionnaire. Significant negative associations between similar scales of Endometriosis Health Profile Questionnaire-30 and Short Form Health Survey 36 Item â version 2 were demonstrated. Data completeness achieved was high for all dimensions. The emotional well-being scale in the core questionnaire and the infertility scale in the modular section had the highest median scores, and therefore the most negative impact on the quality of life of participating women. DISCUSSION The test-retest reliability and responsiveness of the questionnaire should be evaluated in future studies. CONCLUSION The present study demonstrates that the Portuguese version of the Endometriosis Health Profile Questionnaire-30 is a valid, reliable and acceptable tool for evaluating the health-related quality of life of Portuguese women with endometriosis.
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Affiliation(s)
- Cristina Nogueira-Silva
- Instituto de Investigação em Ciências da Vida e da Saúde. Escola de Ciências da Saúde. Universidade do Minho. Braga. Portugal. Instituto de Investigação em Ciências da Vida e da Saúde/3Bâs â Laboratório Associado do Governo Português. Braga/ Guimarães. Portugal. Serviço de Ginecologia e Obstetrícia. Hospital de Braga. Braga. Portugal
| | - Patrício Costa
- Instituto de Investigação em Ciências da Vida e da Saúde. Escola de Ciências da Saúde. Universidade do Minho. Braga. Portugal. Instituto de Investigação em Ciências da Vida e da Saúde/3Bâs â Laboratório Associado do Governo Português. Braga/ Guimarães. Portugal
| | | | - Sónia Barata
- Clínica Universitária de Obstetrícia e Ginecologia. Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria. Lisboa. Portugal
| | - Conceição Alho
- Clínica Universitária de Obstetrícia e Ginecologia. Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria. Lisboa. Portugal
| | - Carlos Calhaz-Jorge
- Clínica Universitária de Obstetrícia e Ginecologia. Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria. Lisboa. Portugal. Departamento de Obstetrícia e Ginecologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Filipa Osório
- Clínica Universitária de Obstetrícia e Ginecologia. Centro Hospitalar Lisboa Norte - Hospital Universitário de Santa Maria. Lisboa. Portugal. Departamento de Obstetrícia e Ginecologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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Abstract
Emerging evidence indicates that somatic stem cells (SSCs) of different types prominently contribute to endometrium-associated disorders such as endometriosis. We reviewed the pertinent studies available on PubMed, published in English language until December 2014 and focused on the involvement of SSCs in the pathogenesis of this common gynecological disease. A concise summary of the data obtained from in vitro experiments, animal models, and human tissue analyses provides insights into the SSC dysregulation in endometriotic lesions. In addition, a set of research results is presented supporting that SSC-targeting, in combination with hormonal therapy, may result in improved control of the disease, while a more in-depth characterization of endometriosis SSCs may contribute to the development of early-disease diagnostic tests with increased sensitivity and specificity. Key message: Seemingly essential for the establishment and progression of endometriotic lesions, dysregulated SSCs, and associated molecular alterations hold a promise as potential endometriosis markers and therapeutic targets.
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Affiliation(s)
- Dusan Djokovic
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal ; Serviço de Obstetrícia e Ginecologia, Centro Hospitalar de Lisboa Ocidental, Hospital de São Francisco Xavier , Lisbon , Portugal
| | - Carlos Calhaz-Jorge
- Clínica Universitária de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de Lisboa , Lisbon , Portugal ; Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução, Centro Hospitalar de Lisboa Norte , Lisbon , Portugal
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Kupka MS, Ferraretti AP, de Mouzon J, Erb K, D'Hooghe T, Castilla JA, Calhaz-Jorge C, De Geyter C, Goossens V, Strohmer H, Obruca, Kreuz-Kinderwunschzentrum SPG, Bogaerts K, Biostat I, D'Hooghe T, Kyurkchiev S, Antonova I, Rezabek K, Markova J, Erb K, Gissler M, Tiitinen A, Royere D, Buhler K, Uszkoriet M, Loutradis D, Tarlatzis BC, Kosztolanyi G, Urbancsek J, Bjorgvinsson H, Mocanu E, Scaravelli G, Lokshin V, Ravil V, Gudleviciene Z, Matkeviciute G, Lazarevski S, Moshin V, Simic TM, Vukicevic D, Hazekamp JT, Kurzawa R, Calhaz--Jorge C, Laranjeira AR, Rugescu I, Korsak V, Radunovic N, Tabs N, Tomazevic T, Virant-Klun I, Hernandez JH, Castilla Alcala JA, Bergh C, Weder M, De Geyter C, Smeenk JMJ, Lambalk C, Veselovsky V, Baranowski R. Assisted reproductive technology in Europe, 2010: results generated from European registers by ESHRE. Hum Reprod 2014; 29:2099-113. [DOI: 10.1093/humrep/deu175] [Citation(s) in RCA: 306] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
INTRODUCTION Angiogenesis is a key factor for the successful establishment and growth of endometriotic lesions. MATERIAL AND METHODS We performed a literature search in PubMed and reviewed the most pertinent studies published until January 2014 and focused on the endometriosis-associated angiogenesis and/or anti-angiogenic strategies for the treatment of this gynecological disorder. RESULTS The present review provides a concise summary of the known molecular mechanisms that promote vascularization of endometriotic lesions and may serve as potential therapeutic targets. We also present a systematic overview of the inclusive and exclusive anti-angiogenic agents that have been already studied in cell cultures, animal models and/or endometriosis patients. DISCUSSION AND CONCLUSION The integration of anti-angiogenic approaches in the multimodal management strategies for endometriosis patients will be conditioned by the outcomes of future assessments regarding the effectiveness of such treatments, the risk of drug resistance development and the incidence of unacceptable side effects.
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Affiliation(s)
- Dusan Djokovic
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. & Instituto de Medicina Molecular. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Carlos Calhaz-Jorge
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. & Clínica Universitária de Obstetrícia e Ginecologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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Santos-Ribeiro S, Coelho A, da Costa TD, Barata S, Alho C, Osório F, Calhaz-Jorge C. Laparoscopic re-anastomosis of a uterine avulsion following cold-knife conization. Surg Technol Int 2014; 24:231-235. [PMID: 24532481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This report presents an exceptional case of uterine avulsion following a cold-knife conization, an unprecedented surgical complication of a common gynecological procedure. Furthermore, it describes the outcomes of the conservative laparoscopic reconstruction that was performed. A 30-year-old nulliparous was referred to our department with secondary amenorrhea and cyclic pelvic pain following a cold-knife conization performed 9 months previous in another institution. The patient underwent a diagnostic laparoscopy, which confirmed that the cervix had been completely resected and that the uterine and vaginal cavities were no longer in contact. We performed an end-to-end utero-vaginal anastomosis followed by a prophylactic cerclage. No intraoperative or postoperative complications were observed. One month after surgery the patient was asymptomatic with normal withdrawal bleeding and remained asymptomatic during her 12-month follow-up consult. To our knowledge, this is the first time that this serious complication with a potential for irreversible damage to reproductive function is reported as a complication of cervical conization. Although our conservative surgical correction repaired the anatomy and reestablished menstruation outflow, further follow-up is necessary to confirm the extent to which reproductive function was restored.
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Affiliation(s)
- Samuel Santos-Ribeiro
- Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal
| | - Ana Coelho
- Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal
| | - Teresa Diniz da Costa
- Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal
| | - Sónia Barata
- Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal
| | - Conceição Alho
- Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal
| | - Filipa Osório
- Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal
| | - Carlos Calhaz-Jorge
- Obstetrics and Gynecology Department University Hospital of Santa Maria Lisbon, Portugal
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Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29:400-12. [PMID: 24435778 DOI: 10.1093/humrep/det457] [Citation(s) in RCA: 1249] [Impact Index Per Article: 124.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION What is the optimal management of women with endometriosis based on the best available evidence in the literature? SUMMARY ANSWER Using the structured methodology of the Manual for ESHRE Guideline Development, 83 recommendations were formulated that answered the 22 key questions on optimal management of women with endometriosis. WHAT IS KNOWN ALREADY The European Society of Human Reproduction and Embryology (ESHRE) guideline for the diagnosis and treatment of endometriosis (2005) has been a reference point for best clinical care in endometriosis for years, but this guideline was in need of updating. STUDY DESIGN, SIZE, DURATION This guideline was produced by a group of experts in the field using the methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to January 2012 and consensus within the guideline group on all recommendations. To ensure input from women with endometriosis, a patient representative was part of the guideline development group. In addition, patient and additional clinical input was collected during the scoping and review phase of the guideline. PARTICIPANTS/MATERIALS, SETTING, METHODS NA. MAIN RESULTS AND THE ROLE OF CHANCE The guideline provides 83 recommendations on diagnosis of endometriosis and on the treatment of endometriosis-associated pain and infertility, on the management of women in whom the disease is found incidentally (without pain or infertility), on prevention of recurrence of disease and/or painful symptoms, on treatment of menopausal symptoms in patients with a history of endometriosis and on the possible association of endometriosis and malignancy. LIMITATIONS, REASONS FOR CAUTION We identified several areas in care of women with endometriosis for which robust evidence is lacking. These areas were addressed by formulating good practice points (GPP), based on the expert opinion of the guideline group members. WIDER IMPLICATIONS OF THE FINDINGS Since 32 out of the 83 recommendations for the management of women with endometriosis could not be based on high level evidence and therefore were GPP, the guideline group formulated research recommendations to guide future research with the aim of increasing the body of evidence. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the implementation of the guideline. The guideline group members did not receive payment. All guideline group members disclosed any relevant conflicts of interest (see Conflicts of interest). TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- G A J Dunselman
- Department of Obstetrics & Gynaecology, Research Institute GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Nogueira-Silva C, Santos-Ribeiro S, Barata S, Alho C, Osório F, Calhaz-Jorge C. [Total laparoscopic hysterectomy: retrospective analysis of 262 cases]. ACTA MEDICA PORT 2014; 27:73-81. [PMID: 24581196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/09/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Hysterectomy is one of the most common gynecological procedures and may be performed either by vaginal approach, laparotomy or laparoscopy. Although total laparoscopic hysterectomy has multiple advantages, conflicting major complication rates have been previously reported. OBJECTIVES To describe our experience performing TLH and to evaluate complication rates. MATERIAL AND METHODS A retrospective observational study of all total laparoscopic hysterectomy performed in our department, by the same surgical team, between April 2009 and March 2013 (n = 262), was conducted. Medical records were reviewed for patient characteristics, operating time, uterine weight, post-operative hemoglobin variation, length of hospital stay, and intra and postoperative complications. RESULTS Patient average age was 48.9 ± 9.0 years and 49.2% had previous abdominopelvic surgery. The average body mass index was 26.5 ± 4.5 kg/m(2) and 42% of women were either overweight or obese. The mean operating time during the total study period was 77.7 ± 27.5 minutes, but it decreased significantly as the surgical team's training increased. Average uterine weight was 241.0 ± 168.4 g and average hospital stay was 1.49 ± 0.9 days. The mean postoperative hemoglobin variation was -1.5 ± 0.8 g/dL. The major and minor complication rates were 1.5% (n = 4) and 11.5% (n = 30), respectively. One procedure was converted to laparotomy and two women had a vaginal vault dehiscence. No important urinary tract or bowel injuries occurred. CONCLUSIONS This study demonstrates that, in experienced hands, total laparoscopic hysterectomy is safe and with low complications rates.
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Affiliation(s)
- Cristina Nogueira-Silva
- Serviço de Ginecologia e Obstetrícia. Hospital de Braga. Braga. & Instituto de Investigação em Ciências da Vida e da Saúde. Escola de Ciências da Saúde. Universidade do Minho. Braga. Portugal
| | - Samuel Santos-Ribeiro
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. & Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Sónia Barata
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. & Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Conceição Alho
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. & Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Filipa Osório
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. & Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Carlos Calhaz-Jorge
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. & Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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Calhaz-Jorge C, Cordeiro I, Leal F, Carvalho M, Soares A. Obesity and implantation rate in ART. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Furia GU, Kostelijk EH, Vergouw CG, Lee H, Lee S, Park D, Kang H, Lim C, Yang K, Lee S, Lim C, Park Y, Shin M, Yang K, Lee H, Beyhan Z, Fisch JD, Sher G, Keskintepe L, VerMilyea MD, Anthony JT, Graham JR, Tucker MJ, Tucker MJ, Freour T, Lattes S, Lammers J, Mansour W, Jean M, Barriere P, El Danasouri I, Gagsteiger F, Rinaldi L, Selman H, Antonova I, Milachich T, Valkova L, Shterev A, Barcroft J, Dayoub N, Thong J, Abdel Reda H, Khalaf Y, El Touky T, Cabry R, Brzakowski R, Lourdel E, Brasseur F, Copin H, Merviel P, Yamada M, Takanashi K, Hamatani T, Akutsu H, Fukunaga T, Inoue O, Ogawa S, Sugawara K, Okumura N, Chikazawa N, Kuji N, Umezawa A, Tomita M, Yoshimura Y, Van der Jeught M, Ghimire S, O'Leary T, Lierman S, Deforce D, Chuva de Sousa Lopes S, Heindryckx B, De Sutter P, Herrero J, Tejera A, De los Santos MJ, Castello D, Romero JL, Meseguer M, Barriere P, Lammers J, Lattes S, Leperlier F, Mirallie S, Jean M, Freour T, Schats R, Al-Nofal M, Vergouw CG, Lens JW, Rooth H, Kostelijk EH, Hompes PG, Lambalk CB, Hreinsson J, Karlstrom PO, Wanggren K, Lundqvist M, Vahabi Z, Eftekhari-Yazdi P, Dalman A, Ebrahimi B, Daneshzadeh MT, Rajabpour Niknam M, Choi EG, Rho YH, Oh DS, Park LS, Cheon HS, Lee CS, Kong IK, Lee SC, Liebenthron J, Montag M, Koster M, Toth B, Reinsberg J, van der Ven H, Strowitzki T, Morita H, Hirosawa T, Watanabe S, Wada T, Kamihata M, Kuwahata A, Ochi M, Horiuchi T, Fatemeh H, Eftekhari-Yazdi P, Karimian L, Fazel M, Fouladi H, Johansson L, Ruttanajit T, Chanchamroen S, Sopaboon P, Seweewanlop S, Sawakwongpra K, Jindasri P, Jantanalapruek T, Charoonchip K, Vajta G, Quangkananurug W, Yi G, Jo JW, Jee BC, Suh CS, Kim SH, Zhang Y, Zhao HJ, Cui YG, Gao C, Gao LL, Liu JY, Sozen E, Buluc B, Vicdan K, Akarsu C, Tuncay G, Hambiliki F, Bungum M, Agapitou K, Makrakis E, Liarmakopoulou S, Anagnostopoulou C, Moustakarias T, Giannaris D, Wang J, Andonov M, Linara E, Charleson C, Ahuja KK, Ozsoy S, Morris MB, Day ML, Cobo A, Castello D, Viloria T, Campos P, Vallejo B, Remohi J, Roldan M, Perez-Cano I, Cruz M, Martinez M, Gadea B, Munoz M, Garrido N, Meseguer M, Mesut N, Ciray HN, Mesut A, Isler A, Bahceci M, Munoz M, Fortuno S, Legidos V, Muela L, Roldan M, Galindo N, Cruz M, Meseguer M, Gunasheela S, Gunasheela D, Ueno S, Uchiyama K, Kondo M, Ito M, Kato K, Takehara Y, Kato O, Edgar DH, Krapez JA, Bacer Kermavner L, Virant-Klun I, Pinter B, Tomazevic T, Vrtacnik-Bokal E, Lee SG, Kang SM, Lee SW, Jeong HJ, Lee YC, Lim JH, Bochev I, Valkova L, Kyurkchiev S, Shterev A, Wilding M, Coppola G, Di Matteo L, Dale B, Hormann-Kropfl M, Kastelic D, Montag M, Schenk M, Fourati Ben Mustapha S, Khrouf M, Braham M, Kallel L, Elloumi H, Merdassi G, Chaker A, Ben Meftah M, Zhioua F, Zhioua A, Kocent J, Neri QV, Rosenwaks Z, Palermo GD, Best L, Campbell A, Fishel S, Calimlioglu N, Sahin G, Akdogan A, Susamci T, Bilgin M, Goker ENT, Tavmergen E, Cantatore C, Ding J, Depalo R, Smith GD, Kasapi E, Panagiotidis Y, Papatheodorou A, Goudakou M, Pasadaki T, Nikolettos N, Asimakopoulos B, Prapas Y, Soydan E, Gulebenzer G, Karatekelioglu E, Budak E, Pehlivan Budak T, Alegretti J, Cuzzi J, Negrao PM, Moraes MP, Bueno MB, Serafini P, Motta ELA, Elaimi A, Harper JC, Stecher A, Baborova P, Wirleitner B, Schwerda D, Vanderzwalmen P, Zech NH, Stanic P, Hlavati V, Gelo N, Pavicic-Baldani D, Sprem-Goldstajn M, Radakovic B, Kasum M, Strelec M, Simunic V, Vrcic H, Khan I, Urich M, Abozaid T, Ullah K, Abuzeid M, Fakih M, Shamma N, Ayers J, Ashraf M, Milik S, Pirkevi C, Atayurt Z, Yazici S, Yelke H, Kahraman S, Dal Canto M, Coticchio G, Brambillasca F, Mignini Renzini M, Novara P, Maragno L, Karagouga G, De Ponti E, Fadini R, Resta S, Magli MC, Cavallini G, Muzzonigro F, Ferraretti AP, Gianaroli L, Barberi M, Orlando G, Sciajno R, Serrao L, Fava L, Preti S, Bonu MA, Borini A, Varras M, Polonifi A, Mantzourani M, Mavrogianni D, Stefanidis K, Griva T, Bletsa R, Dinopoulou V, Drakakis P, Loutradis D, Campbell A, Hickman CFL, Duffy S, Bowman N, Gardner K, Fishel S, Sati L, Zeiss C, Demir R, McGrath J, Yelke H, Atayurt Z, Yildiz S, Unal S, Kumtepe Y, Kahraman S, Atayurt Z, Yelke H, Unal S, Kumtepe Y, Kahraman S, Aljaser F, Hernandez J, Tomlinson M, Campbell B, Fosas N, Redondo Ania M, Marina F, Molfino F, Martin P, Perez N, Carrasco A, Garcia N, Gonzalez S, Marina S, Redondo Ania M, Marina F, Molfino F, Fosas N, Martin P, Perez N, Carrasco A, Garcia N, Gonzalez S, Marina S, Scaruffi P, Stigliani S, Tonini GP, Venturini PL, Anserini P, Guglielmo MC, Coticchio G, Albertini DF, Dal Canto M, Brambillasca F, Lain M, Caliari I, Mignini Renzini M, Fadini R, Oikonomou Z, Chatzimeletiou K, Sioga A, Oikonomou L, Kolibianakis E, Tarlatzis B, Nottola SA, Bianchi V, Lorenzo C, Maione M, Macchiarelli G, Borini A, Gomez E, Gil MA, Sanchez-Osorio J, Maside C, Martinez MJ, Torres I, Rodenas C, Cuello C, Parrilla I, Molina G, Garcia A, Margineda J, Navarro S, Roca J, Martinez EA, Avcil F, Ozden H, Candan ZN, Uslu H, Karaman Y, Gioacchini G, Giorgini E, Carnevali O, Bianchi V, Ferraris P, Vaccari L, Borini A, Choe S, Tae J, Kim C, Lee J, Hwang D, Kim K, Suh C, Jee B, Ozden H, Candan ZN, Avcil F, Uslu H, Karaman Y, Catt SL, Sorenson H, Vela M, Duric V, Chen P, Temple-Smith PD, Pangestu M, Yoshimura T, Fukunaga N, Nagai R, Kitasaka H, Tamura F, Hasegawa N, Kato M, Nakayama K, Takeuchi M, Aoyagi N, Yasue K, Watanabe H, Asano E, Hashiba Y, Asada Y, Iwata K, Yumoto K, Mizoguchi C, Sargent H, Kai Y, Ueda M, Tsuchie Y, Imajo A, Iba Y, Mio Y, Els-Smit CL, Botha MH, Sousa M, Windt-De Beer M, Kruger TF, Muller N, Magli C, Corani G, Giusti A, Castelletti E, Gambardella L, Gianaroli L, Seshadri S, Sunkara SK, El-Toukhy T, Kishi I, Maruyama T, Ohishi M, Akiba Y, Asada H, Konishi Y, Nakano M, Kamei K, Yoshimura Y, Lee JH, Lee KH, Park IH, Sun HG, Kim SG, Kim YY, Choi EM, Lee DH, Chavez SL, Loewke KE, Behr B, Han J, Moussavi F, Reijo Pera RA, Yokota H, Yokota Y, Yokota M, Sato S, Nakagawa M, Sato M, Anazawa I, Araki Y, Virant-Klun I, Knez K, Pozlep B, Tomazevic T, Vrtacnik-Bokal E, Lim JH, Vermilyea MD, Graham JR, Levy MJ, Tucker MJ, Carvalho M, Cordeiro I, Leal F, Aguiar A, Nunes J, Rodrigues C, Soares AP, Sousa S, Calhaz-Jorge C, Braga DPAF, Setti AS, Figueira RCS, Aoki T, Iaconelli A, Borges E, Ozkavukcu S, Sonmezer M, Atabekoglu C, Berker B, Ozmen B, Isbacar S, Ibis E, Menezes J, Lalitkumar PGL, Borg P, Ekwurtzel E, Nordqvist S, Vaegter K, Tristen C, Sjoblom P, Azevedo MC, Figueira RCS, Braga DPAF, Setti AS, Iaconelli A, Borges E, Remohi Gimenez J, Cobo A, Castello D, Gamiz P, Albert C, Ferreira RC, Braga DPAF, Figueira RCS, Setti AS, Resende S, Iaconelli A, Borges E, Colturato SS, Braga DPAF, Figueira RCS, Setti AS, Resende S, Iaconelli A, Borges E, Ferrer Buitrago M, Ferrer Robles E, Munoz Soriano P, Ruiz-Jorro M, Calatayud Lliso C, Rawe VY, Wanggren K, Hanrieder J, Hambiliki F, Gulen-Yaldir F, Bergquist J, Stavreus-Evers A, Hreinsson J, Grunskis A, Bazarova A, Dundure I, Fodina V, Brikune J, Lakutins J, Pribenszky C, Cornea M, Reichart A, Uhereczky G, Losonczy E, Ficsor L, Lang Z, Ohgi S, Nakamura C, Hagiwara C, Kawashima M, Yanaihara A, Jones GM, Biba M, Kokkali G, Vaxevanoglou T, Chronopoulou M, Petroutsou K, Sfakianoudis K, Pantos K, Perez-Cano I, Gadea B, Martinez M, Muela L, Cruz M, Galindo N, Munoz M, Garrido N, Romano S, Albricci L, Stoppa M, Cerza C, Sanges F, Fusco S, Capalbo A, Maggiulli R, Ubaldi F, Rienzi L, Ulrick J, Kilani S, Chapman M, Losada C, Ortega I, Pacheco A, Bronet F, Aguilar J, Ojeda M, Taboas E, Perez M, Munoz E, Pellicer A, Meseguer M, Boumela I, Assou S, Haouzi D, Monzo C, Dechaud H, Hamamah S, Dechaud H, Boumela I, Assou S, Haouzi D, Monzo C, Hamamah S, Nakaoka Y, Hashimoto S, Amo A, Yamagata K, Nakano T, Akamatsu Y, Mezawa T, Ohnishi Y, Himeno T, Inoue T, Ito K, Morimoto Y. EMBRYOLOGY. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rodrigues C, Santos P, Simões D, Valério MO, Calhaz-Jorge C. [Langerhans cell histiocytosis and breast]. ACTA MEDICA PORT 2011; 24 Suppl 3:713-714. [PMID: 22856419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a rare systemic disorder, with a diversified presentation and natural history. It can compromise any organ. We report a case of a 32-year-old woman who came to our clinic with an asymptomatic palpable breast mass. She underwent excisional biopsy. Immunohistochemical and pathological evaluation revealed Langerhans cell histiocytosis. No multisystem involvement was found.
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Affiliation(s)
- Cátia Rodrigues
- Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução, Hospital de Santa Maria, Lisbon, Portugal
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Engman M, Bystrom B, Varghese S, Lalitkumar PGL, Gemzell-Danielsson K, Romeu C, Urries A, Lierta M, Sanchez Rubio J, Sanz B, Perez I, Casis L, Salerno A, Nazzaro A, Di Iorio L, Bonassisa P, Van Os L, Vink-Ranti CQJ, de Haan-Cramer JH, Rijnders PM, Jansen CAM, Nazzaro A, Salerno A, Marino S, Granato C, Pastore E, Brandes M, Hamilton CJCM, de Bruin JP, Bots RSGM, Nelen WLDM, Kremer JAM, Szkodziak P, Wozniak S, Czuczwar P, Paszkowski T, Wozniak S, Szkodziak P, Czuczwar P, Paszkowski T, Agirregoitia N, Peralta L, Mendoza R, Exposito A, Matorras R, Agirregoitia E, Chuderland D, Ben-Ami I, Kaplan-Kraicer R, Grossman H, Satchi- Fainaro R, Eldar-Boock A, Ron-El R, Shalgi R, Custers IM, Scholten I, Moolenaar LM, Flierman PA, Dessel TJHM, Gerards MH, Cox T, Janssen CAH, van der Veen F, Mol BWJ, Wathlet S, Adriaenssens T, Verheyen G, Coucke W, Smitz J, Feliciani E, Ferraretti AP, Paesano C, Pellizzaro E, Magli MC, Gianaroli L, Hernandez J, Rodriguez-Fuentes A, Garcia-Guzman R, Palumbo A, Radunovic N, Tosic T, Djukic S, Lockwood JC, Adriaenssens T, Wathlet S, Van Landuyt L, Verheyen G, Coucke W, Smitz J, Karayalcin R, Ozcan SARP, Ozyer S, Gurlek B, Kale I, Moraloglu O, Batioglu S, Chaudhury K, Narendra Babu K, Mamata Joshi V, Srivastava S, Chakravarty BN, Viardot-Foucault V, Prasath EB, Tai BC, Chan JKY, Loh SF, Cordeiro I, Leal F, Soares AP, Nunes J, Sousa S, Aguiar A, Carvalho M, Calhaz-Jorge C, Karkanaki A, Piouk A, Katsikis I, Mousatat T, Koiou E, Daskalopoulos GN, Panidis D, Tolikas A, Tsakos E, Gerou S, Prapas Y, Loufopoulos A, Abanto E, Barrenetxea G, Agirregoikoa J, Anarte C, De Pablo JL, Burgos J, Komarovsky D, Friedler S, Gidoni Y, Ben-ami I, Strassburger D, Bern O, Kasterstein E E, Komsky A, Maslansky B, Ron-El R, Raziel A, Fuentes A, Argandona F, Gabler F, Galleguillos A, Torres A, Palomino WA, Gonzalez-Fernandez R, Pena O, Hernandez J, Palumbo A, Avila J, Talebi Chahvar S, Biondini V, Battistoni S, Giannubilo S, Tranquilli AL, Stensen MH, Tanbo T, Storeng R, Abyholm T, Fedorcsak P, Johnson SR, Foster L, Ellis J, Choi JR, Joo JK, Son JB, Lee KS, Helmgaard L, Klein BM, Arce JC, Sanhueza P, Donoso P, Salinas R, Enriquez R, Saez V, Carrasco I, Rios M, Gonzalez P, Macklon N, Guo M, Richardson M, Wilson P, Chian RC, Eapen A, Hrehorcak M, Campbell S, Nargund G, Oron G, Fisch B, Ao A, Freidman O, Zhang XY, Ben-Haroush A, Abir R, Hantisteanu S, Ellenbogen A, Hallak M, Michaeli M, Fainaru O, Maman E, Yong G, Kedem A, Yeruahlmi G, Konopnicki S, Cohen B, Dor J, Hourvitz A, Moshin V, Croitor M, Hotineanu A, Ciorap Z, Rasohin E, Aleyasin A, Agha Hosseini M, Mahdavi A, Safdarian L, Fallahi P, Mohajeri MR, Abbasi M, Esfahani F, Elnashar A, Badawy A, Totongy M, Mohamed H, Mustafa F, Seidman DS, Tadir Y, Goldchmit C, Gilboa Y, Siton A, Mashiach R, Rabinovici J, Yerushalmi GM, Inoue O, Kuji N, Fukunaga T, Ogawa S, Sugawara K, Yamada M, Hamatani T, Hanabusa H, Yoshimura Y, Kato S, Casarini L, La Marca A, Lispi M, Longobardi S, Pignatti E, Simoni M, Halpern G, Braga DPAF, Figueira RCS, Setti AS, Iaconelli Jr. A, Borges Jr. E, Vingris L, Setti AS, Braga DPAF, Figueira RCS, Iaconelli Jr. A, Pasqualotto FF, Borges Jr. E, Collado-Fernandez E, Harris SE, Cotterill M, Elder K, Picton HM, Serra V, Garrido N, Casanova C, Lara C, Remohi J, Bellver J, Steiner HP, Kim CH, You RM, Nah HY, Kang HJ, Kim S, Chae HD, Kang BM, Reig Viader R, Brieno Enriquez MA, Toran N, Cabero L, Giulotto E, Garcia Caldes M, Ruiz-Herrera A, Brieno-Enriquez M, Reig-Viader R, Toran N, Cabero L, Martinez F, Garcia-Caldes M, Velthut A, Zilmer M, Zilmer K, Haller T. Kaart E, Karro H, Salumets A, Bromfield JJ, Sheldon IM, Rezacova J, Madar J, Cuchalova L, Fiserova A, Shao R, Billig H. POSTER VIEWING SESSION - FEMALE (IN) FERTILITY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Navarro-Costa P, Nogueira P, Carvalho M, Leal F, Cordeiro I, Calhaz-Jorge C, Gonçalves J, Plancha CE. Incorrect DNA methylation of the DAZL promoter CpG island associates with defective human sperm. Hum Reprod 2010; 25:2647-54. [PMID: 20685756 PMCID: PMC2939755 DOI: 10.1093/humrep/deq200] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Successful gametogenesis requires the establishment of an appropriate epigenetic state in developing germ cells. Nevertheless, an association between abnormal spermatogenesis and epigenetic disturbances in germline-specific genes remains to be demonstrated. METHODS In this study, the DNA methylation pattern of the promoter CpG island (CGI) of two germline regulator genes--DAZL and DAZ, was characterized by bisulphite genomic sequencing in quality-fractioned ejaculated sperm populations from normozoospermic (NZ) and oligoasthenoteratozoospermic (OAT) men. RESULTS OAT patients display increased methylation defects in the DAZL promoter CGI when compared with NZ controls. Such differences are recorded when analyzing sperm fractions enriched either in normal or defective germ cells (P< 0.001 in both cases). Significant differences in DNA methylation profiles are also observable when comparing the qualitatively distinct germ cell fractions inside the NZ and OAT groups (P= 0.003 and P= 0.007, respectively). Contrastingly, the unmethylation pattern of the DAZ promoter CGI remains correctly established in all experimental groups. CONCLUSIONS An association between disrupted DNA methylation of a key spermatogenesis gene and abnormal human sperm is described here for the first time. These results suggest that incorrect epigenetic marks in germline genes may be correlated with male gametogenic defects.
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Affiliation(s)
- Paulo Navarro-Costa
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal.
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Navarro-Costa P, Pereira L, Alves C, Gusmão L, Proença C, Marques-Vidal P, Rocha T, Correia SC, Jorge S, Neves A, Soares AP, Nunes J, Calhaz-Jorge C, Amorim A, Plancha CE, Gonçalves J. Characterizing partial AZFc deletions of the Y chromosome with amplicon-specific sequence markers. BMC Genomics 2007; 8:342. [PMID: 17903263 PMCID: PMC2151955 DOI: 10.1186/1471-2164-8-342] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 09/28/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AZFc region of the human Y chromosome is a highly recombinogenic locus containing multi-copy male fertility genes located in repeated DNA blocks (amplicons). These AZFc gene families exhibit slight sequence variations between copies which are considered to have functional relevance. Yet, partial AZFc deletions yield phenotypes ranging from normospermia to azoospermia, thwarting definite conclusions on their real impact on fertility. RESULTS The amplicon content of partial AZFc deletion products was characterized with novel amplicon-specific sequence markers. Data indicate that partial AZFc deletions are a male infertility risk [odds ratio: 5.6 (95% CI: 1.6-30.1)] and although high diversity of partial deletion products and sequence conversion profiles were recorded, the AZFc marker profiles detected in fertile men were also observed in infertile men. Additionally, the assessment of rearrangement recurrence by Y-lineage analysis indicated that while partial AZFc deletions occurred in highly diverse samples, haplotype diversity was minimal in fertile men sharing identical marker profiles. CONCLUSION Although partial AZFc deletion products are highly heterogeneous in terms of amplicon content, this plasticity is not sufficient to account for the observed phenotypical variance. The lack of causative association between the deletion of specific gene copies and infertility suggests that AZFc gene content might be part of a multifactorial network, with Y-lineage evolution emerging as a possible phenotype modulator.
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Affiliation(s)
- Paulo Navarro-Costa
- Centro de Genética Humana, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal
- Unidade de Biologia da Reprodução, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal
| | - Luísa Pereira
- IPATIMUP – Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-465 Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Cíntia Alves
- IPATIMUP – Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-465 Porto, Portugal
| | - Leonor Gusmão
- IPATIMUP – Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-465 Porto, Portugal
| | - Carmen Proença
- Centro de Genética Humana, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal
| | - Pedro Marques-Vidal
- Unidade de Nutrição e Metabolismo, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal
| | - Tiago Rocha
- Unidade de Medicina da Reprodução, Maternidade Dr. Alfredo da Costa, 1069-089 Lisboa, Portugal
| | - Sónia C Correia
- Unidade de Medicina da Reprodução, Maternidade Dr. Alfredo da Costa, 1069-089 Lisboa, Portugal
| | - Sónia Jorge
- Unidade de Medicina da Reprodução, Maternidade Dr. Alfredo da Costa, 1069-089 Lisboa, Portugal
| | - António Neves
- Unidade de Medicina da Reprodução, Maternidade Dr. Alfredo da Costa, 1069-089 Lisboa, Portugal
| | - Ana P Soares
- Unidade Pluridisciplinar de Reprodução Humana, Hospital de Santa Maria, 1649-028 Lisboa, Portugal
| | - Joaquim Nunes
- Unidade Pluridisciplinar de Reprodução Humana, Hospital de Santa Maria, 1649-028 Lisboa, Portugal
| | - Carlos Calhaz-Jorge
- Unidade Pluridisciplinar de Reprodução Humana, Hospital de Santa Maria, 1649-028 Lisboa, Portugal
| | - António Amorim
- IPATIMUP – Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-465 Porto, Portugal
- Faculdade de Ciências da Universidade do Porto, 4169-007 Porto, Portugal
| | - Carlos E Plancha
- Unidade de Biologia da Reprodução, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal
| | - João Gonçalves
- Centro de Genética Humana, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal
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Passos F, Calhaz-Jorge C, Graça LM. Endometriosis is a possible risk factor for spontaneous hemoperitoneum in the third trimester of pregnancy. Fertil Steril 2007; 89:251-2. [PMID: 17669403 DOI: 10.1016/j.fertnstert.2007.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 02/06/2007] [Accepted: 02/06/2007] [Indexed: 12/14/2022]
Abstract
Two patients with spontaneous hemoperitoneum, occurring in the third trimester of pregnancy, had in common previous surgery for moderate endometriosis and successful in vitro fertilization. Although it is not possible to establish a direct causal relationship, we must be aware of this rare but potentially serious complication as the wide use of assisted reproduction increases the number of such patients becoming pregnant.
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Affiliation(s)
- Filipa Passos
- Department of Obstetrics and Gynecology, Hospital de Santa Maria, Lisboa, Portugal.
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Abstract
BACKGROUND Endometriosis is an important clinical situation associated with subfertility. It would be very useful to identify patients at increased risk for endometriosis prior to laparoscopy. In the present study, we evaluate the demographic and clinical characteristics in a cohort of Portuguese subfertile women in relation to the presence of endometriosis. METHODS Consecutive subfertile patients scheduled for laparoscopy were interviewed prior to the procedure. At subsequent laparoscopy, the presence of endometriosis was scored according to the revised classification of the American Society for Reproductive Medicine (ASRM). Data available from the medical history were tabulated against the presence or absence of endometriosis. We used logistic regression analysis to evaluate whether data from the patient's medical history could predict the presence of endometriosis. RESULTS Among the 1079 women that were studied, 358 had minimal/mild endometriosis and 130 had moderate/severe endometriosis. Primary subfertility, regularity of menstrual cycles, dysmenorrhoea, chronic pelvic pain, obesity, ever use of oral contraceptives and smoking were the most important predictors of endometriosis. The prediction model had an area under the receiver operating characteristic curve of 0.71. CONCLUSIONS Both the presence of endometriosis (all stages) and the presence of severe endometriosis per se can be predicted from the medical history. These data should be used in the decision to perform laparoscopy at an early stage or a later stage in the work-up for subfertility.
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Affiliation(s)
- C Calhaz-Jorge
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
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Calhaz-Jorge C, Chaveiro E, Nunes J, Costa AP. Implications of the diagnosis of endometriosis on the success of infertility treatment. CLIN EXP OBSTET GYN 2004; 31:25-30. [PMID: 14998182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE Endometriosis is a clinically very heterogeneous disorder and its implications on the resolution of infertility are not clear. METHODS Clinical data of 783 consecutive infertile couples were retrospectively analyzed in three groups: A--with minimal/mild endometriosis: B--with moderate/severe endometriosis; C--without endometriosis. Subgroups of groups A and C with unexplained infertility were also compared. RESULTS Endometriosis was found in 349 patients (44.6%)--263 in group A and 86 in group B. Group C comprised 434 patients. Overall pregnancy rates were 57.0% for group A, 48.8% for B and 55.8% for C (not statistically different). Of couples in groups A, B, C, respectively, 39.2%, 51.1% and 39.2% needed IVF (B vs C - p = 0.042; B vs A - p = 0.059). Of couples in group A 45.6% that underwent IVF achieved a pregnancy by this technique; corresponding numbers were 43.2% for group B and 46.5% for C. Overall pregnancy rates in couples with unexplained infertility in groups A (n = 116) and C (n = 110) were respectively, 58.6% and 56.4%; IVF was needed in 40.5% and 32.7% of those couples, and the cumulative pregnancy rates resulting from IVF were 40.4% and 47.2% (NS). CONCLUSION The diagnosis of endometriosis had no influence on the successful resolution of infertility although moderate/severe endometriosis was related to a greater need for IVF. Couples with unexplained infertility had similar pregnancy rates either in the presence or in the absence of minimal/mild endometriosis.
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Affiliation(s)
- C Calhaz-Jorge
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, Hospital de Santa Maria, Lisbon, Portugal
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Calhaz-Jorge C, Costa AP, Santos MC, Palma-Carlos ML. Peritoneal fluid concentrations of interleukin-8 in patients with endometriosis depend on the severity of the disorder and are higher in the luteal phase. Hum Reprod 2003; 18:593-7. [PMID: 12615831 DOI: 10.1093/humrep/deg122] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous evaluations of the relationship between the concentrations of interleukin-8 (IL-8) in the peritoneal fluid and endometriosis led to non-consistent results. Our purpose was to investigate the correlation of the concentrations of IL-8 in the peritoneal fluid with the stage of endometriosis, the presence of red lesions and the phase of the menstrual cycle. METHODS Ninety-two patients with infertility (n = 87) or undergoing sterilization (n = 5) had peritoneal fluid samples collected at laparoscopy. IL-8 determinations were performed using an enzyme-linked immunosorbent assay. RESULTS The concentrations of IL-8 in the peritoneal fluid of the 68 women with endometriosis were not significantly different from those of the 24 controls. Patients with moderate/severe stages had IL-8 significantly higher than controls (P = 0.008) and marginally higher than patients with minimal/mild endometriosis (P = 0.053). Concentrations of IL-8 were significantly higher in patients than in controls in the luteal phase. Red lesions were associated with significantly increased levels of peritoneal fluid IL-8 only in the luteal phase. CONCLUSIONS Our findings reinforce the importance of IL-8 in the pathogenesis of endometriosis.
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Affiliation(s)
- C Calhaz-Jorge
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal.
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Calhaz-Jorge C, Costa AP, Santos MC, Palma-Carlos ML. Soluble intercellular adhesion molecule 1 in the peritoneal fluid of patients with endometriosis correlates with the extension of peritoneal implants. Eur J Obstet Gynecol Reprod Biol 2003; 106:170-4. [PMID: 12551787 DOI: 10.1016/s0301-2115(02)00263-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the correlation of the concentrations of soluble intercellular adhesion molecule 1 (sICAM-1) in the peritoneal fluid (PF) with the extent of peritoneal endometriotic lesions and with the presence of red lesions (RLs). STUDY DESIGN Sixty-seven patients with endometriosis and 19 controls with normal pelvis had PF samples collected during laparoscopy. RESULTS The concentrations of sICAM-1 in the PF of patients and controls were not different. Patients with peritoneal implant scores 4 or more had higher concentrations of sICAM-1 in the PF than those with implant scores less than 4 (P=0.018) and controls (P=0.031). No significant difference was found in sICAM-1 levels in patients with and without RLs. No correlation was detected between sICAM-1 and interleukin 1beta (IL-1beta) in either patients or controls. CONCLUSIONS The increased concentrations of sICAM-1 in the PF of patients with greater implant scores may indicate an active shedding of the molecule from the endometriotic peritoneal tissue. No significant association was found with the presence of RLs. The levels of IL-1beta in the PF were not a relevant factor influencing the concentrations of sICAM-1.
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Affiliation(s)
- C Calhaz-Jorge
- Department of Obstetrics and Gynaecology, Human Reproduction Unit, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
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Maas JW, Calhaz-Jorge C, ter Riet G, Dunselman GA, de Goeij AF, Struijker-Boudier HA. Tumor necrosis factor-alpha but not interleukin-1 beta or interleukin-8 concentrations correlate with angiogenic activity of peritoneal fluid from patients with minimal to mild endometriosis. Fertil Steril 2001; 75:180-5. [PMID: 11163835 DOI: 10.1016/s0015-0282(00)01656-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the angiogenic activity of peritoneal fluid in women with minimal to mild endometriosis and to investigate the relationship between this activity and the concentration of macrophage-derived angiogenic factors and clinical variables, such as phase of menstrual cycle, type of lesion, and revised American Society for Reproductive Medicine classification. DESIGN In vivo bioassay. SETTING Tertiary-care university medical center. PATIENT(S) Fifty-two female volunteers with laparoscopic findings indicating minimal to mild endometriosis. INTERVENTION(S) Peritoneal fluid was collected at the start of laparoscopy. A standard amount of peritoneal fluid was applied to a chick embryo chorioallantoic membrane assay. MAIN OUTCOME MEASURE(S) Angiogenic response was assessed by determining the vascular density index. RESULT(S) 85% of the peritoneal fluid samples induced angiogenesis in the chick embryo chorioallantoic membrane bioassay. Tumor necrosis factor-alpha and total protein were significantly related to the vascular density index, whereas interleukin-1beta, interleukin-8, and clinical variables appeared to not affect the angiogenic response. CONCLUSION(S) The results confirms previous findings of peritoneal fluid angiogenic activity in women with minimal to mild endometriosis and indicate involvement of tumor necrosis factor-alpha.
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Affiliation(s)
- J W Maas
- Research Institute Growth and Development (GROW), Department of Obstetrics and Gynaecology, Academisch Ziekenhuis Maastricht, Maastricht, The Netherlands.
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Calhaz-Jorge C, Costa AP, Barata M, Santos MC, Melo A, Palma-Carlos ML. Tumour necrosis factor alpha concentrations in the peritoneal fluid of infertile women with minimal or mild endometriosis are lower in patients with red lesions only than in patients without red lesions. Hum Reprod 2000; 15:1256-60. [PMID: 10831551 DOI: 10.1093/humrep/15.6.1256] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tumour necrosis factor alpha (TNFalpha) of peritoneal fluid is believed to have important pro-inflammatory and angiogenic activities in the complex mechanisms of development of peritoneal endometriotic lesions. We have evaluated the concentrations of TNFalpha and macrophages in peritoneal fluid of infertile women with minimal or mild endometriosis and related them to the presence of peritoneal red lesions alone (red lesions only group; n = 11) or their absence (non-red lesions group; n = 36). A group of 39 infertile normo-ovulatory patients with normal pelvic anatomy was used as controls. TNFalpha concentrations did not differ between controls and either group of patients. Patients with red lesions only had significantly lower concentrations of TNFalpha in peritoneal fluid (P < 0.05) and had a higher proportion of samples with undetectable concentrations (P < 0.05) than patients without red lesions. The significant difference in TNFalpha concentrations was present when comparing the groups of patients in the proliferative phase but not in the secretory phase. Macrophage concentrations were not different in the groups. Our findings are compatible with an impairment of macrophage function and therefore lend support to the theory that an inappropriate immunological response of the peritoneal environment to regurgitated endometrium may play a part in the initial phases of endometriotic implants.
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Affiliation(s)
- C Calhaz-Jorge
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, Hospital de Santa Maria, Lisboa Codex, Portugal.
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Calhaz-Jorge C, Costa A, Santos M, Palma-Carlos M, Pereira-Coelho A. P-152. Is the peritoneal environment of women with minimal/mild endometriosis different from that in other women? Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Calhaz-Jorge C, Leal F, Cordeiro I, Proença H, Barata M, Pereira-Coelho AM. Pituitary down-regulation in IVF cycles: is it necessary to use strict criteria? J Assist Reprod Genet 1995; 12:615-9. [PMID: 8580660 DOI: 10.1007/bf02212585] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE In a retrospective study we have reviewed the data of 570 consecutive IVF cycles in which a GnRH agonist (GnRHa) was started in the early follicular phase (long protocol). Cycles were divided in groups according to estradiol levels before HMG administration: A, < 20 pg/ml; B, 20 to 50 pg/ml; C, 51 to 100 pg/ml. Our objective was to determine if the degree of pituitary suppression had any effect on the ovarian response to stimulation by exogenous gonadotropins, and/or on the IVF outcome. RESULTS There were no significant differences in cycle cancellation rates, no. of days of stimulation and ampoules of HMG, serum estradiol after HMG, no. of oocytes retrieved and fertilization rates between groups. Pregnancy rates (19.4%, 21% and 31.8%/cycle, and 24.1%, 27.5% and 37.8% / embryo transfer, respectively) and live-birth rates (16.2%, 16.1% and 25.0%/cycle, 20.1%, 21.2% and 29.7%/embryo transfer, respectively) were also not significantly different. CONCLUSIONS The degree of pituitary suppression had no effects on either the ovarian response to gonadotropins (including HMG requirements) or the overall IVF results.
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Affiliation(s)
- C Calhaz-Jorge
- Department of Obstetrics and Gynecology, Santa Maria's Hospital, Lisboa, Portugal
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