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Rozen G, Polyakov A. Prednisone and Live Birth Rate in Patients With Recurrent Implantation Failure. JAMA 2023; 330:971. [PMID: 37698569 DOI: 10.1001/jama.2023.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- Genia Rozen
- Obstetrics and Gynaecology Department, Melbourne University, Melbourne, Victoria, Australia
| | - Alex Polyakov
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Lu Y, He Y, Sun Y. Prednisone and Live Birth Rate in Patients With Recurrent Implantation Failure-Reply. JAMA 2023; 330:972. [PMID: 37698566 DOI: 10.1001/jama.2023.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- Yao Lu
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaqiong He
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Sun
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Cavalcante MB, Barini R. Prednisone and Live Birth Rate in Patients With Recurrent Implantation Failure. JAMA 2023; 330:970-971. [PMID: 37698570 DOI: 10.1001/jama.2023.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, Brazil
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Gurunthalingam MP, Katiyara V, Singh MP. Prednisone and Live Birth Rate in Patients With Recurrent Implantation Failure. JAMA 2023; 330:971-972. [PMID: 37698571 DOI: 10.1001/jama.2023.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
| | - Vikas Katiyara
- All India Institute of Medical Sciences-Raipur, Raipur, India
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Abstract
BACKGROUND To compare the efficacies of gonadotropin-releasing hormone (GnRH) pulse subcutaneous infusion with combined human chorionic gonadotropin and human menopausal gonadotropin (HCG/HMG) intramuscular injection have been performed to treat male hypogonadotropic hypogonadism (HH) spermatogenesis. METHODS In total, 220 idiopathic/isolated HH patients were divided into the GnRH pulse therapy and HCG/HMG combined treatment groups (n = 103 and n = 117, respectively). The luteinizing hormone and follicle-stimulating hormone levels were monitored in the groups for the 1st week and monthly, as were the serum total testosterone level, testicular volume and spermatogenesis rate in monthly follow-up sessions. RESULTS In the GnRH group and HCG/HMG group, the testosterone level and testicular volume at the 6-month follow-up session were significantly higher than were those before treatment. There were 62 patients (62/117, 52.99%) in the GnRH group and 26 patients in the HCG/HMG (26/103, 25.24%) group who produced sperm following treatment. The GnRH group (6.2 ± 3.8 months) had a shorter sperm initial time than did the HCG/HMG group (10.9 ± 3.5 months). The testosterone levels in the GnRH and HCG/HMG groups were 9.8 ± 3.3 nmol/L and 14.8 ± 8.8 nmol/L, respectively. CONCLUSION The GnRH pulse subcutaneous infusion successfully treated male patients with HH, leading to earlier sperm production than that in the HCG/HMG-treated patients. GnRH pulse subcutaneous infusion is a preferred method.
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Affiliation(s)
- Jianli Lin
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Jiangfeng Mao
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
| | - Xi Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
| | - Wanlu Ma
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
| | - Ming Hao
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
| | - Xueyan Wu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
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Yuan S, Gao F, Xin Z, Guo H, Shi S, Shi L, Yang X, Guan J. Comparison of the efficacy and safety of phloroglucinol and magnesium sulfate in the treatment of threatened abortion: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e16026. [PMID: 31192955 PMCID: PMC6587576 DOI: 10.1097/md.0000000000016026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To compare the clinical efficacy and safety of phloroglucinol (PHL) and magnesium sulfate (MS) in the treatment of threatened abortion through systematic review. METHODS Foreign databases, such as the Cochrane Library, PubMed and EMBASE, and Chinese databases, including the China Biology Medicine disc (SinoMed), China National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP) and WanFang Data, were searched. Published randomized controlled trials (RCTs) documents obtained from these databases were included if they were associated with the research objective. The search timeframe was from the beginning of the establishment of each database to May 2018. Document selection, data abstraction and document quality evaluation were independently performed by 2 investigators. A combined analysis of the data was performed for those documents that fulfilled the study requirements; Rev Man 5.3 and Stata 12.0 software were used to compare and analyze the 2 drugs in terms of the total effective rate (TER), rate of adverse events, time required to relieve uterine contractions, onset time, time of complete relief of uterine contraction symptoms, medication duration and length of hospital stay. RESULTS A total of 21 RCT trials were included in the present research, according to the inclusion criteria. However, the quality of the included studies was low. The meta-analysis suggested that the TER and drug onset time of PHL were higher than those for MS, while the rate of adverse events, the time required to relieve uterine contractions, time to complete relief of uterine contraction symptoms, drug continuous treatment time and length of hospital stay were shorter than those for MS. CONCLUSION The clinical efficacy of PHL is better than that of MS, and PHL obviously results in fewer adverse reactions than MS. However, due to poor quality of evidence, high quality, multi-center RCTs with large samples are required for further verification.
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Affiliation(s)
- Shaofei Yuan
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Fengli Gao
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Zhong Xin
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Haijun Guo
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Suqin Shi
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Lei Shi
- Department of Pharmacy, Huhhot First Hospital, Yuquan District, Huhhot, Inner Mongolia
| | - Xia Yang
- Department of Pharmacy, Baogang Hospital (The Third Affiliated Hospital of Inner Mongolia Medical University), Kundulun District, Baotou, Inner Mongolia Autonomous Region
| | - Jingzhi Guan
- Department of Pharmacy, Inner Mongolia International Mongolian Hospital, Hohhot, Inner Mongolia, China
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Gunnala V, Melnick A, Irani M, Reichman D, Schattman G, Davis O, Rosenwaks Z. Sliding scale HCG trigger yields equivalent pregnancy outcomes and reduces ovarian hyperstimulation syndrome: Analysis of 10,427 IVF-ICSI cycles. PLoS One 2017; 12:e0176019. [PMID: 28441461 PMCID: PMC5404765 DOI: 10.1371/journal.pone.0176019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 02/09/2017] [Accepted: 04/04/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate pregnancy outcomes and the incidence of ovarian hyperstimulation syndrome (OHSS) using a sliding scale hCG protocol to trigger oocyte maturity and establish a threshold level of serum b-hCG associated with optimal oocyte maturity. DESIGN Retrospective cohort. SETTING Academic medical center. PATIENTS Fresh IVF cycles from 9/2004-12/2011. INTERVENTION 10,427 fresh IVF-ICSI cycles met inclusion criteria. hCG was administered according to E2 level at trigger: 10,000IU vs. 5,000IU vs. 4,000IU vs. 3,300IU vs. dual trigger (2mg leuprolide acetate + 1,500IU hCG). Serum absorption of hCG was assessed according to dose and BMI. MAIN OUTCOME MEASURES Oocyte maturity was analyzed according to post-trigger serum b-hCG. Fertilization, clinical pregnancy, live birth and OHSS rates were examined by hCG trigger dose. RESULTS Post-trigger serum b-hCG 20-30, 30-40, and 40-50 mIU/mL was associated with reduced oocyte maturity as compared b-hCG >50 (67.8% vs. 71.4% vs. 73.3% vs. 78.9%, respectively, P<0.05). b-hCG 20-50 mIU/mL was associated with a 40.1% reduction in live birth (OR 0.59, 95% CI 0.41-0.87). No differences in IVF outcomes per retrieval were seen for varying doses of hCG or dual trigger when controlling for patient age. The incidence of moderate to severe OHSS was 0.13% (n = 14) and severe OHSS was 0.03% (n = 4) of cycles. CONCLUSIONS Moderate stimulation with sliding scale hCG at trigger and fresh transfer is associated with low rates of OHSS and favorable pregnancy rates. Doses as low as 3,300IU alone or dual trigger with 1,500IU are sufficient to facilitate oocyte maturity.
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Affiliation(s)
- Vinay Gunnala
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Alexis Melnick
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Mohamad Irani
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - David Reichman
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Glenn Schattman
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Owen Davis
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, United States of America
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Klein K, Yang J, Aisenberg J, Wright N, Kaplowitz P, Lahlou N, Linares J, Lundström E, Purcea D, Cassorla F. Efficacy and safety of triptorelin 6-month formulation in patients with central precocious puberty. J Pediatr Endocrinol Metab 2016; 29:1241-1248. [PMID: 26887034 DOI: 10.1515/jpem-2015-0376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Triptorelin is an established treatment for central precocious puberty (CPP) as 1- and 3-month formulations. The current triptorelin 22.5 mg 6-month formulation is approved for prostate cancer therapy. This is the first study in patients with CPP. METHODS The efficacy and safety of the triptorelin 6-month formulation in CPP were investigated. The primary objective was to evaluate the efficacy in achieving luteinizing hormone (LH) suppression to pre-pubertal levels at month 6. This was an international, non-comparative phase III study over 48 weeks. Eighteen medical centers in the US, Chile and Mexico participated. Forty-four treatment naïve patients (39 girls and five boys) aged at treatment start 2-8 years for girls and 2-9 years for boys with an advancement of bone age over chronological age ≥1 year were to be included. Triptorelin was administered im twice at an interval of 24 weeks. LH, follicle stimulating hormone (FSH) (basal and stimulated), estradiol (girls), testosterone (boys), auxological parameters, clinical signs of puberty and safety were assessed. RESULTS Forty-one patients (93.2%) showed pre-pubertal LH levels (stimulated LH ≤5 IU/L) at month 6 and maintained LH suppression through month 12. The percentage of patients with LH suppression exceeded 93% at each time point and reached 97.7% at month 12. No unexpected drug-related adverse events were reported. CONCLUSIONS The triptorelin 6-month formulation was safe and effective in suppressing the pituitary-gonadal axis in children with CPP. The extended injection interval may improve compliance and increase comfort in the management of CPP.
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Giannakopoulos A, Fryssira H, Tzetis M, Xaidara A, Kanaka-Gantenbein C. Central precocious puberty in a boy with 22q13 deletion syndrome and NOTCH-1 gene duplication. J Pediatr Endocrinol Metab 2016; 29:1307-1311. [PMID: 27235670 DOI: 10.1515/jpem-2015-0484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/19/2016] [Indexed: 12/25/2022]
Abstract
The 22q13 deletion syndrome or Phelan-McDermid syndrome is a neurodevelopmental disorder associated with developmental delay, hypotonia, delayed or absent speech, autistic-like behavior, normal to accelerated growth and dysmorphic faces. We report the occurrence of central precocious puberty in a boy diagnosed with Phelan-McDermid syndrome. At the age of 1 year, our patient presented with increased testicular volume for his age, bone age advancement and growth acceleration. Stimulated gonadotropin levels demonstrated a premature activation of the hypothalamic-pituitary-gonadal (HPG) axis. Central precocious puberty was treated with gonadotropin-releasing hormone (GnRH) analog. Molecular diagnosis with array-comparative genomic hybridization (CGH) revealed a major deletion of 5.8 Mb at the 22q13 chromosomal region and a 25 kb duplication at the 9q34.3 region that included the NOTCH-1 gene. On the background of 22q13 deletion syndrome and data from animals on the effect of abnormal NOTCH-1 gene expression on kisspeptin neuron formation, we discuss the probable role of Notch signaling in the premature activation of the HPG axis.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/drug therapy
- Abnormalities, Multiple/genetics
- Chromosome Deletion
- Chromosome Disorders/diagnosis
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 9
- Cytogenetic Analysis
- Delayed Diagnosis
- Drug Monitoring
- Gene Duplication
- Gonadotropin-Releasing Hormone/adverse effects
- Gonadotropin-Releasing Hormone/analogs & derivatives
- Gonadotropin-Releasing Hormone/therapeutic use
- Greece
- Humans
- Infant, Newborn
- Male
- Puberty, Precocious/diagnosis
- Puberty, Precocious/drug therapy
- Puberty, Precocious/genetics
- Receptor, Notch1/genetics
- Reproductive Control Agents/adverse effects
- Reproductive Control Agents/therapeutic use
- Treatment Outcome
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Lee PA, Luce M, Bacher P. Monitoring treatment of central precocious puberty using basal luteinizing hormone levels and practical considerations for dosing with a 3-month leuprolide acetate formulation. J Pediatr Endocrinol Metab 2016; 29:1249-1257. [PMID: 27740929 DOI: 10.1515/jpem-2016-0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 08/29/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Peak gonadotropin-releasing hormone or agonist (GnRHa) stimulated luteinizing hormone (LH) testing with leuprolide acetate (LA) is commonly used to document suppression during therapy for central precocious puberty (CPP). The objective of the study was to investigate suitability of using basal LH levels to monitor GnRHa treatment and to determine optimal transition from 1-month to 3-month LA formulations via a post hoc analysis of a randomized, open-label, 6-month study. METHODS A total of 42 children with CPP, pretreated with 7.5-, 11.25-, or 15-mg 1-month LA formulations were randomized to 11.25- or 30-mg 3-month LA. Basal LH/peak-stimulated LH levels were measured at weeks 0, 4, 8 and 12. Positive/negative predictive values and sensitivities/specificities were determined for basal LH vs. LH-stimulation results. RESULTS Pretreatment with any 1-month formulation for the most part did not affect continuation of suppression after transitioning to 3-month formulation (mean peak-stimulated LH levels remained < 4 IU/L). Basal LH predicted suppression escape (basal LH-level cutoff ≥ 0.6 IU/L predicted 70% of those failing suppression). Tolerability was similar, regardless of dose. CONCLUSIONS Our data indicate that a basal level of <0.60 IU/L is adequate for monitoring suppression approximately two-thirds of the time. Furthermore, the effectiveness and safety of 3-month LA treatments are not influenced by previous CPP therapies.
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Stringer EM, Vladutiu CJ, Manuck T, Verbiest S, Ollendorff A, Stringer JSA, Menard MK. 17-Hydroxyprogesterone caproate (17OHP-C) coverage among eligible women delivering at 2 North Carolina hospitals in 2012 and 2013: A retrospective cohort study. Am J Obstet Gynecol 2016; 215:105.e1-105.e12. [PMID: 26829508 DOI: 10.1016/j.ajog.2016.01.180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 10/09/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although a weekly injection of 17-hydroxyprogestone caproate is recommended for preventing recurrent preterm birth, clinical experience in North Carolina suggested that many eligible patients were not receiving the intervention. OBJECTIVE Our study sought to assess how well practices delivering at 2 major hospitals were doing in providing access to 17-hydroxyprogesterone caproate treatment for eligible patients. STUDY DESIGN This retrospective cohort analysis studied all deliveries occurring between January 1, 2012, and December 31, 2013, at 2 large hospitals in North Carolina. Women were included if they had a singleton pregnancy and history of a prior spontaneous preterm birth. We extracted demographic, payer, and medical information on each pregnancy, including whether women had been offered, accepted, and received 17-hydroxyprogesterone caproate. Our outcome of 17-hydroxyprogesterone caproate coverage was defined as documentation of ≥1 injection of the drug. RESULTS Over the 2-year study period, 1216 women with history of a prior preterm birth delivered at the 2 study hospitals, of which 627 were eligible for 17-hydroxyprogesterone caproate eligible after medical record review. Only 296 of the 627 eligible women (47%; 95% confidence interval, 43-51%) received ≥1 dose of the drug. In multivariable analysis, hospital of delivery, later presentation for prenatal care, fewer prenatal visits, later gestation of prior preterm birth, and having had a term delivery immediately before the index pregnancy were all associated with failed coverage. Among those women who were "covered," the median number of 17-hydroxyprogesterone caproate injections was 9 (interquartile range, 4-15), with 84 of 296 charts (28%) not having complete information on the number of doses. CONCLUSION Even under our liberal definition of coverage, less than half of eligible women received 17-hydroxyprogesterone caproate in this sample. Low overall use suggests that there is opportunity for improvement. Quality improvement strategies, including population-based measurement of 17-hydroxyprogesterone caproate coverage, are needed to fully implement this evidence-based intervention to decrease preterm birth.
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Affiliation(s)
- Elizabeth M Stringer
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Catherine J Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Tracy Manuck
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sarah Verbiest
- School of Social Work, University of North Carolina, Chapel Hill, NC
| | - Arthur Ollendorff
- Department of OB/GYN, Mountain Area Health Education Center, Asheville, NC
| | - Jeffrey S A Stringer
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - M Kathryn Menard
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
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Ring JD, Lwin AA, Köhler TS. Current medical management of endocrine-related male infertility. Asian J Androl 2016; 18:357-63. [PMID: 27098657 PMCID: PMC4854080 DOI: 10.4103/1008-682x.179252] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 01/16/2023] Open
Abstract
Male factor contributes to 50%-60% of overall infertility but is solely responsible in only 20% of couples. Although most male factor infertility is ascertained from an abnormal semen analysis, other male factors can be contributory especially if the sample returns normal. Male infertility can be due to identifiable hormonal or anatomical etiologies that may be reversible or irreversible. This manuscript will highlight existing guidelines and our recommendations for hormone evaluation for male infertility and empiric therapies including multivitamins, estrogen receptor modulators (clomiphene), estrogen conversion blockers (anastrozole), and hormone replacement.
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Affiliation(s)
- Joshua D Ring
- Division of Urology, Department of Surgery, Southern Illinois University, Springfield, IL 62794, USA
| | - Aye A Lwin
- Division of Urology, Department of Surgery, Southern Illinois University, Springfield, IL 62794, USA
| | - Tobias S Köhler
- Division of Urology, Department of Surgery, Southern Illinois University, Springfield, IL 62794, USA
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Samsami A, Zarei A, Shahrivar S. Effects of estradiol injection on outcome of in-vitro fertilization: a randomized, double-blind, placebo controlled trial. CLIN EXP OBSTET GYN 2016; 43:875-879. [PMID: 29944242] [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 To evaluate the effects of estradiol (E2) supplementation on pregnancy outcome in patients with unexplained infertility undergoing in vitro fertilization (IVF). MATERIALS AND METHODS A total of 100 women with unexplained infertility and candidates for IVF, were included in this study and were randomly assigned to receive E2 supplementation or placebo during the luteal phase. The E2 serum levels in the hCG administration day and third and seventh day after ovum retrieval were measured in control group. The rate of pregnancy was also quantified and compared between the two study groups. RESULTS There was no significant difference between two study groups regarding baseline characteristics. E2 level decreased significantly in third (1765.34 ± 680.09; p < 0.001) and seventh (1459.66 ± 593.80; p < 0.001) days after ovum retrieval (2411.16 ± 713.52). The authors found that the serum level of E2 was significantly lower in those who received E2 supplementation at day 3 (p < 0.001) and 7 (p<0.001). However the pregnancy rate was not significantly different between two study groups (p = 0.849). In the same way, there was no significant difference between two study groups regarding the number of retrieved oocytes (p = 0.563) and number of MII oocytes (p = 0.103). CONCLUSIONS E2 supplementation during the luteal phase in patients with unexplained infertility undergoing IVF, is associated with decreased serum levels of E2 after hCG injection. However the fertility outcome was not affected by E2 supplementation.
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Yang S, Pang T, Li R, Yang R, Zhen X, Chen X, Wang H, Ma C, Liu P, Qiao J. The individualized choice of embryo transfer timing for patients with elevated serum progesterone level on the HCG day in IVF/ICSI cycles: a prospective randomized clinical study. Gynecol Endocrinol 2015; 31:355-8. [PMID: 25558791 DOI: 10.3109/09513590.2014.995620] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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] [Indexed: 11/13/2022] Open
Abstract
This study analyzed the clinical outcomes of patients with elevated progesterone level on the HCG day in IVF/ICSI cycles, with different timing of embryo transfer. A total of 123 patients were involved in this prospective randomized clinical study. Group 1: blastocyst transfer group, 38 cases; Group 2: frozen-thawed embryo transfer group (first FET cycle), 42 cases; Group 3: fresh embryo transfer group, 43 cases. The basal FSH level was comparable among three groups (6.7 ± 3 versus 7.0 ± 2 versus 6.9 ± 2.4, p = 0.897). The clinical pregnancy rate was highest in group 2, lowest in group 3, with significantly difference (31.6% versus 38.1% versus 13.9%, p = 0.037). The implantation rate and live birth rate were still lowest in group 3 (21.9% versus 19.8% versus 6.7%, p = 0.016 and 18.4% versus 31% versus 11.6%, p = 0.081). In conclusion, the elevated progesterone level will affect clinical pregnancy rate in fresh embryo transfer cycles. We suggest frozen-thawed embryo transfer for these patients. However, for those patients who expressed the wish to have fresh embryo transfer, they should be suggested fresh blastocyst transfer, if they have more than five good quality embryos.
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Affiliation(s)
- Shuo Yang
- Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital , Beijing , China
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Haas J, Lantsberg D, Feldman N, Manela D, Machtinger R, Dar S, Rabinovici J, Orvieto R. Modifying the luteal phase support in natural cycle frozen-thawed embryo transfer improves cycle outcome. Gynecol Endocrinol 2015; 31:891-3. [PMID: 26288149 DOI: 10.3109/09513590.2015.1075502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With the recent trend toward single embryo transfer (ET), cryopreservation of extraneous embryos is becoming increasingly prevalent. Several replacement protocols for frozen-thawed ET (FET) exist, with no advantage of one protocol over the others. All consecutive patients undergoing natural cycle Day-3 FET cycles between May 2012 and March 2015 in our IVF unit were evaluated. While following spontaneous ovulation, all patients received progesterone luteal support. Since June 2014, patients underwent the same aforementioned natural cycle FET cycles, with two additional injections, one of recombinant hCG (250 mcg) and the other of GnRH-agonist (triptorelin 0.1 mg), on the day of transfer and 4 d later, respectively. While the patients' clinical characteristics, the prevalence of embryos that survived the thawing process and the number of embryos transferred were comparable between the earlier as compared with the later period, implantation rate, positive β-hCG, clinical, and ongoing pregnancy rates were significantly higher during the later period. We, therefore, suggest that when natural cycle FET is offered, the addition of two injections of recombinant hCG and GnRH-agonist, on the day of transfer and 4 d later, respectively, might increase clinical pregancy rates. Further large prospective studies are needed to elucidate the aforementioned recommendation prior to its routine implementation.
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Affiliation(s)
- Jigal Haas
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Daniel Lantsberg
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Noa Feldman
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Daphna Manela
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ronit Machtinger
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Shir Dar
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Jaron Rabinovici
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Raoul Orvieto
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Wei M, Zhang XM, Gu FL, Lv F, Ji YR, Liu KF, She H, Hu R. The impact of LH, E2, and P level of HCG administration day on outcomes of in vitro fertilization in controlled ovarian hyperstimulation. CLIN EXP OBSTET GYN 2015; 42:361-366. [PMID: 26152012] [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: 06/04/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the impact of luteinizing hormone (LH), estradiol (E2) and progesterone (P) levels on the day of human chorionic gonadotropin (HCG) administration on outcomes of in vitro fertilization (IVF) in controlled ovarian hyperstimulation (COH). STUDY DESIGN In this retrospective study, 129 infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) treatments were included; these cycles were stratified according to LH levels of ≥ 1.12 IU/L or < 1.12 U/L and according to E2 levels of ≥ 1,005.89 pmol/L or < 1,005.89 pmol/L. The main outcome measure was the clinical pregnancy rate. RESULTS The clinical pregnancy rate was significantly higher in the group with LH ≥ 1.12 IU/L than in the group with LH < 1.12 U/L (43.28% vs. 30.65%, p < 0.05). The clinical pregnancy rate was also higher in the group with E2 ≥ 1,005.89 pmol/L than in the group with average E2 < 1,005.89 pmol/L (42.86% vs. 30.51%, p < 0.05). Among the LH, E2, and P levels on the day of HCG administration, LH level was the most important predictor of outcomes of IVF in COH. The present data showed an adverse effect of low serum LH level (LH < 1.12 IU/L) on the day of HCG administration on clinical pregnancy rate. E2 level can also predict the outcomes of IVF in COH. CONCLUSIONS Low serum LH level (LH < 1.12 IU/L) and low serum E2 level (average E2 < 1,005.89 pmol/L) on the day of HCG administration led to low clinical pregnancy rates, while the P level on the day of HCG administration may have had little effect on clinical pregnancy.
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Check JH, Amui J, Choe JK, Cohen R. The effect of a rise or fall of serum estradiol the day before oocyte retrieval in women aged 40-42 with diminished egg reserve. CLIN EXP OBSTET GYN 2015; 42:282-284. [PMID: 26151993] [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: 06/04/2023]
Abstract
PURPOSE To determine the effect of a drop in serum estradiol the day after injection of human chorionic gonadotropin (hCG) in in vitro fertilization-embryo transfer (IVF-ET) cycles in women aged 40-42 with diminished oocyte reserve. MATERIALS AND METHODS Retrospective study with further requirement that the female partner had a day 3 serum follicle stimulating hormone (FSH) of ≥ 12 miU/mL and ≥ five antral follicles. RESULTS A drop in serum estradiol the day after hCG injection is not associated with a lower chance of pregnancy compared to those women whose serum estradiol increases. However, their chances of releasing the oocyte before retrieval is significantly higher. CONCLUSIONS A drop in serum estradiol in women of advanced reproductive age with diminished oocyte reserve should not signal the need to cancel the retrieval.
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Fusi FM, Arnoldi M, Bosisio C, Lombardo G, Ferrario M, Zanga L, Galimberti A, Capitanio E. Ovulation induction and luteal support with GnRH agonist in patients at high risk for hyperstimulation syndrome. Gynecol Endocrinol 2015; 31:693-7. [PMID: 26527503 DOI: 10.3109/09513590.2015.1025379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to compare GnRHa trigger and luteal addition of triptorelin to hCG trigger for final oocyte maturation in women at high risk for OHSS undergoing IVF. A total of 423 patients were divided in two groups both stimulated using antagonist short protocol. Gonadotropins 75-150 UI/day were started on day 2-5, GnRH antagonist was added when the lead follicle was >14 mm and the final trigger was obtained with hCG 250 µg or triptorelin 0.2 mg. The luteal phase was supported with progesterone alone in the hCG group, with progesterone plus triptorelin 0.1 every other day from embryo transfer in the triptorelin group. In the triptorelin group we did neither have to suspend any embryo transfer, nor we have any early clinical OHSS. In the control group, 13 patients were suspended due to symptomatic high risk for OHSS and two patients developed a clinically significant OHSS. No statistically significant difference was observed in terms of clinical and ongoing pregnancy rates and implantation rates. Our results indicate that a protocol including GnRHa as trigger and an intensive luteal phase supported with GnRHa is safer than a standard antagonist protocol using hCG as trigger. It displays similar results, therefore it can be used as the first choice in patients at high risk for OHSS.
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Affiliation(s)
- Francesco M Fusi
- a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and
- b School of Obstetrics, University of Milano-Bicocca , Milano , Italy
| | - Mariangela Arnoldi
- a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and
| | - Chiara Bosisio
- a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and
| | - Grazia Lombardo
- a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and
| | - Marina Ferrario
- a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and
| | - Laura Zanga
- a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and
| | - Alessia Galimberti
- a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and
| | - Enrica Capitanio
- a Maternal and Pediatric Department , USSD Centro PMA, Ospedale Papa Giovanni XXIII , Bergamo , Italy and
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Rohayem J, Tüttelmann F, Mallidis C, Nieschlag E, Kliesch S, Zitzmann M. Restoration of fertility by gonadotropin replacement in a man with hypogonadotropic azoospermia and testicular adrenal rest tumors due to untreated simple virilizing congenital adrenal hyperplasia. Eur J Endocrinol 2014; 170:K11-7. [PMID: 24394723 DOI: 10.1530/eje-13-0449] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Classical congenital adrenal hyperplasia (CAH), a genetic disorder characterized by 21-hydroxylase deficiency, impairs male fertility, if insufficiently treated. PATIENT A 30-year-old male was referred to our clinic for endocrine and fertility assessment after undergoing unilateral orchiectomy for a suspected testicular tumor. Histopathological evaluation of the removed testis revealed atrophy and testicular adrenal rest tumors (TARTs) and raised the suspicion of underlying CAH. The remaining testis was also atrophic (5 ml) with minor TARTs. Serum 17-hydroxyprogesterone levels were elevated, cortisol levels were at the lower limit of normal range, and gonadotropins at prepubertal levels, but serum testosterone levels were within the normal adult range. Semen analysis revealed azoospermia. CAH was confirmed by a homozygous mutation g.655A/C>G (IVS2-13A/C>G) in CYP21A2. Hydrocortisone (24 mg/m(2)) administered to suppress ACTH and adrenal androgen overproduction unmasked deficient testicular testosterone production. As azoospermia persisted due to sustained hypogonadotropic hypogonadism, a combined s.c. gonadotropin replacement with human chorionic gonadotropin (hCG) (1500 IU twice weekly) and FSH (human menopausal gondadotropin (hMG) 150 IU three times weekly) was initiated. RESULTS Normalization of testosterone levels and a stable low sperm concentration (0.5 mill/ml) with good sperm motility (85% A+B progressive) were achieved within 21 months of treatment. Despite persisting TARTs, while receiving treatment, the patient successfully impregnated his wife twice, the latter impregnation leading to the birth of a healthy girl. CONCLUSIONS TARTs in unrecognized (simple virilizing) CAH may lead to unnecessary orchiectomy. In hypogonadotropic, azoospermic CAH, a combined treatment with oral corticosteroids and subcutaneously administered hCG and FSH can successfully restore testicular testosterone production and fertility, even if only one hypoplastic and atrophic testis with adrenal rest tumors is present.
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Affiliation(s)
- Julia Rohayem
- Center of Reproductive Medicine and Andrology, Clinical Andrology, University of Muenster, Albert-Schweitzer-Campus 1, Building D11, D-48149 Muenster, Germany
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Abstract
BACKGROUND Anovulation is a common cause of infertility. Drugs used to treat anovulation include selective oestrogen receptor modulators, aromatase inhibitors and gonadotrophins. Ovulation triggers are used with these drugs, as a surrogate for the hormonal surge seen in spontaneous menstrual cycles, to control the timing of ovulation and the timing of sexual intercourse. Ovulation triggers given without reliable evidence of oocyte maturity could be inappropriately timed; they increase costs, and the need to time intercourse precisely after the ovulation trigger is given adds to psychological stress.This is an update of a Cochrane review first published in Issue 3, 2008, of the Cochrane Database of Systematic Reviews. OBJECTIVES To determine the benefits and harms of administering an ovulation trigger to anovulatory women receiving treatment with ovulation-inducing agents in comparison with spontaneous ovulation following ovulation induction. SEARCH METHODS We updated searches of the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to November 2013. We checked conference proceedings, trial registries and reference lists and contacted researchers. SELECTION CRITERIA Parallel-group, randomised, controlled trials (RCTs) evaluating the administration of an ovulation trigger to anovulatory women receiving treatment with ovulation-inducing agents. DATA COLLECTION AND ANALYSIS We independently assessed trial eligibility and trial quality and extracted data. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous data and used the random-effects model in meta-analyses when significant heterogeneity was present. We assessed overall quality of the evidence by using the GRADE approach. MAIN RESULTS No new trials were identified. This review includes two RCTs with low risk of bias that compared urinary human chorionic gonadotrophin (hCG) versus no treatment in anovulatory women receiving clomiphene citrate. Urinary hCG did not result in an increase in live birth rate over no hCG (OR 0.97, 95% CI 0.52 to 1.83; two trials, 305 participants, I(2) = 16%; low-quality evidence), but very serious imprecision around the effect estimate reduces our confidence in the apparent lack of effect of hCG as an ovulation trigger in clomiphene-induced cycles in anovulatory women.Among this review's secondary outcomes, urinary hCG may not increase ovulation rate (OR 0.99, 95% CI 0.36 to 2.77; two trials, 305 participants, I(2) = 55%; low-quality evidence), clinical pregnancy rate (OR 1.02, 95% CI 0.56 to 1.89; two trials, 305 participants, I(2) = 35%; low-quality evidence) or miscarriage rate in pregnant women (OR 1.19, 95% CI 0.17 to 8.23; two trials, 54 participants, I(2) = 0%; low-quality evidence). Multiple pregnancies and preterm deliveries were uncommon, and ovarian hyperstimulation syndrome, adverse events and deaths were not reported as outcomes in either trial. We found no trials evaluating other ovulation triggers. AUTHORS' CONCLUSIONS Evidence is inadequate to recommend or refute the use of urinary hCG as an ovulation trigger in anovulatory women treated with clomiphene citrate. We found no trials evaluating the use of ovulation triggers in anovulatory women treated with other ovulation-inducing agents.
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Affiliation(s)
- Korula George
- Bangalore Baptist HospitalReproductive Medicine UnitBellary RoadHebbalBangaloreKarnataka StateIndia560024
| | - Mohan S Kamath
- Christian Medical College and HospitalReproductive Medicine UnitIda Scudder RoadVelloreTamil NaduIndia632004
| | - Raju Nair
- Matha Assisted Reproductive Centre(m.arc)Reproductive Medicine UnitMatha Hospital, ThellakomKottayamkeralaIndia686016
| | - Prathap Tharyan
- Christian Medical CollegeSouth Asian Cochrane Network & Centre, Prof. BV Moses Centre for Evidence‐Informed Health Care and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
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Marinov B, Andreeva A. [Recombinant human chorionic gonadotropin - always contemporary]. Akush Ginekol (Sofiia) 2014; 53 Suppl 1:46-48. [PMID: 25510043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Harmanci A, Cinar N, Bayraktar M, Yildiz BO. Oral contraceptive plus antiandrogen therapy and cardiometabolic risk in polycystic ovary syndrome. Clin Endocrinol (Oxf) 2013; 78:120-5. [PMID: 22702394 DOI: 10.1111/j.1365-2265.2012.04466.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/09/2012] [Accepted: 06/03/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Oral contraceptives alone or in combination with antiandrogens are commonly used in the treatment for polycystic ovary syndrome (PCOS). We aimed to determine the effects of ethinyl estradiol/drospirenone (EE-DRSP) plus spironolactone therapy on inflammation and cardiometabolic risk in PCOS. DESIGN Prospective cohort study. PATIENTS Twenty-three lean, normal glucose-tolerant patients with PCOS and 23 age- and body mass index (BMI)-matched healthy control women. MEASUREMENTS Androgens, high-sensitivity C-reactive protein (hsCRP), homocysteine, lipids, fasting insulin, and glucose levels during a standard 75-g, 2-h oral glucose tolerance test were measured. Patients with PCOS were evaluated before and after receiving EE-DRSP (3 mg/30 μg) plus spironolactone (100 mg/day) for 6 months. Healthy controls were evaluated at baseline only. RESULTS hsCRP, homocysteine, lipids, insulin and glucose levels were similar between patient and control groups at baseline. EE-DRSP plus spironolactone increased hsCRP and homocysteine levels in patients with PCOS (0.50 ± 0.28 vs 1.5 ± 1.3 mg/l, P < 0.05 and 13.1 ± 5.2 vs 17.6 ± 5.3 μm, P < 0.05, respectively). BMI, waist-to-hip ratio, LDL, HDL cholesterol and triglycerides, and glucose tolerance did not change. Modified Ferriman-Gallwey hirsutism scores, testosterone levels and free androgen index improved (9.1 ± 4.2 vs 6.2 ± 3.4, P = 0.001; 80.6 ± 31.1 47.8 ± 20.3 ng/dl, P < 0.05; and 10.5 ± 7.4 vs 1.1 ± 0.8, P < 0.001, respectively). CONCLUSIONS EE-DRSP plus spironolactone therapy in 6 months improves androgen excess in lean PCOS women without any adverse effects on adiposity, glucose tolerance status or lipid profile. However, this combination increases hsCRP and homocysteine levels.
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Affiliation(s)
- Ayla Harmanci
- Endocrinology and Metabolism Unit, Department of Internal Medicine, Hacettepe University School of Medicine, Hacettepe, Ankara, Turkey
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Abstract
Striking evidence indicates endothelial impairment in polycystic ovary syndrome (PCOS) but the mechanisms linking PCOS status to cardiovascular risk remain elusive. Platelet/endothelial cell adhesion molecule (PECAM)-1 is a soluble (s) signaling molecule involved in inflammation and angiogenesis with predictive value for endothelial dysfunction in patients at risk. In a prospective, controlled study, sPECAM-1 levels and the relationships to metabolic, inflammatory and vascular PCOS traits were evaluated in 26 patients and 29-age- and body mass index-matched controls. To assess endothelial injury, carotid artery intimae-media thickness (CIMT) and brachial artery flow-mediated vasodilatation (FMD) were employed. Of the 26 women with PCOS, 25 completed a six-month metformin combined with ethinylestradiol 0.3 mg/drospirenone 3 mg therapy. Soluble PECAM-1 levels were increased in PCOS (p = 0.018 vs. Controls) and significantly decreased at follow-up (p = 0.0002). Smoking and weight had no effect on sPECAM-1 dynamics. In both univariate and multivariate analysis, basal sPECAM-1 was inversely related to FMD (r = -0.311, p = 0.021) but not CIMT. To conclude, sPECAM-1 is increased in PCOS, an effect reversed by combined metformin and anti-androgenic contraceptive therapy. Elevated sPECAM-1 contributes to endothelial dysfunction however further studies are inquired to assess its relevance as biomarker and potential therapeutic target in PCOS.
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Abstract
PURPOSE To compare the efficacy of different stimulation protocols on pregnancy outcomes in poor responders undergoing in vitro fertilization (IVF). MATERIALS AND METHODS This was a retrospective study to compare the efficacy of four different protocols including gonadotropin-releasing hormone (GnRH) agonist (long, short and miniflare) and GnRH antagonist on pregnancy outcomes in poor responders. This investigation was performed on 566 poor respond patients who were candidates for IVF. Main outcome measures included the total number of oocytes and mature oocytes retrieved, pregnancy rates, implantation and overall cancellation rates which were compared between four mentioned groups. RESULTS Number of follicles >18 mm on hCG day were significantly higher in GnRH-a long versus GnRH antagonist, GnRH-a short and GnRH-a miniflare protocols. The mean number of oocytes and mature oocytes retrieved were significantly higher in GnRH-a long versus miniflare (4.7 ± 3.05 versus 3.26 ± 2.9 and 3.69 ± 3.1 versus 2.65 ± 2.2, respectively). There were no significant differences in implantation, pregnancy and overall cancellation rates between four groups. CONCLUSION The present study suggests that the application of four different protocols in poor respond patients seem to have similar efficacy in improving clinical outcomes such as implantation, pregnancy rates and cancellation rate even though GnRH-a long protocol yielded more retrieved oocytes and mature oocytes compared to GnRH-a miniflare protocol.
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Affiliation(s)
- Tahereh Madani
- Department of Endocrinology and Female Infertility, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. tmadani @royaninstitute.org
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Yousefi B, Azargon A. Predictive factors of intrauterine insemination success of women with infertility over 10 years. J PAK MED ASSOC 2011; 61:165-168. [PMID: 21375168] [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: 05/30/2023]
Abstract
OBJECTIVE The relationship between maternal age, duration of infertility, pre-ovulatory follicles, endometrial thickness and motile sperms with intra uterine insemination (IUI) success in women with infertility over 10 years was surveyed. METHODS We performed a descriptive - cross sectional study among couples (n=26) with a history of infertility for more than 10 years who were treated with IUI. The data was collected between 2000 and 2007 in the fertility ward of Amiralmomenin Hospital of Semnan University of Medical Sciences. Patients underwent a basic fertility workup and the ovarian hyperstimulation was done with clomiphene citrate (CC) and human chorionic gonadotrophin (hMG) alone or in combination. A volume of 0.3-0.4 ml suspension of processed spermatozoa (after swim-up procedure) was introduced into the uterine cavity 36h after human chorionic gonadotrophin (hCG) administration. The comparison between variables was performed by chi-square and student's test on SPSS (Version 10.0). RESULTS The total number of women with infertility over 10 years referring to fertility ward was 26. Seven of them became pregnant after treatment (27%). Majority of these pregnancies (87.5%) were achieved in the first cycle. Pregnant cases were 30-37 years of age with a history of infertility for up to ten years. The comparison of data between two groups showed that maternal age (P<0.03) and number of motile sperms (P<0.05) had a significant relationship with the results of treatment. CONCLUSION Number of motile spermatozoa and women age are factors with the highest impact on pregnancy after IUI treatment in women with infertility for over 10 years.
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Affiliation(s)
- Behpour Yousefi
- Department of Anatomical Sciences, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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26
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Abstract
BACKGROUND AND OBJECTIVE Acne is a common dermatologic condition that extends into middle age, particularly among women, and is associated with substantial healthcare resource utilization. Drospirenone (DRSP), a synthetic progestin, has anti-androgenic activity, and women using DRSP 3.0 mg/ethinyl estradiol (EE) 0.02 mg as a 24/4 regimen (DRSP/EE-24/4) for contraception also may use it for treatment of moderate acne. The study used a US national healthcare database to assess acne-related healthcare resource utilization among women aged 18-45 years before (pre-index) and after (post-index) initiation of DRSP/EE-24/4. METHODS Resource utilization and costs were evaluated by age group (18-25, 26-35, or 36-45 years) and by type of acne medication (systemic antibiotic, topical, or anti-androgen). RESULTS Data for 1340 women were evaluated. Overall, drug costs, medical costs, and total costs were decreased by 38%, 37%, and 37%, respectively (p<0.0001 for all) between the pre-index and post-index periods; significant differences were evident across age groups and acne medication categories. Total costs were significantly decreased for patients (41%) and healthcare plans (36%; p<0.0001 for both) overall and across age groups and drug classes. Acne-related claims and number of days using acne medication were reduced (by 37% each; p<0.0001 for both). STUDY LIMITATIONS The study was retrospective in design and had a limited follow-up period. Database limitations restricted assessment of medication compliance and adherence. CONCLUSION DRSP/EE-24/4 use was associated with substantial reductions in acne-related healthcare resource utilization, and reductions occurred regardless of age or type of acne medication. DRSP/EE-24/4 therefore represents a cost-effective option for the treatment of acne among women using DRSP/EE-24/4 for oral contraception.
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Affiliation(s)
- Vijay N Joish
- Bayer HealthCare Pharmaceuticals, Wayne, NJ 07470, USA.
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Moosavifar N, Mohammadpour AH, Jallali M, Karimiz G, Saberi H. Evaluation of effect of silymarin on granulosa cell apoptosis and follicular development in patients undergoing in vitro fertilization. East Mediterr Health J 2010; 16:642-645. [PMID: 20799592] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
To investigate the effects of silymarin on follicular development, we enrolled 40 healthy women undergoingin vitro fertilization (IVF) due to male factor infertility in this trial. They underwent ovulation induction and on a random and blind basis, patients were assigned to receive silymarin (70 mg x 3/day) or placebo from the beginning of the induction cycle. The number and quality of oocytes retrieved were evaluated and apoptosis of > or = granolusa cells was studied. There was no significant difference between the groups for mean number of follicles 18 mm (P = 0.131), mean number of oocytes retrieved (P = 0.209) or endometrial thickness (P = 0.673). However, the proportion of total apoptosis in the study group was significantly lower than in the placebo group (P = 0.032). These data suggest that administration of silymarin in IVF patients concomitantly with gonadotropin results in reduction of granolusa cell apoptosis but does not have any effect in promotion of follicular development, oocyte retrieval or endometrial thickness.
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Affiliation(s)
- N Moosavifar
- Women's Health Research Centre, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
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Bruni Bresciani V. [Extracontraceptive benefits of EE/DRSP (Yaz) in 24+4 day regimen]. Minerva Ginecol 2010; 62:261-266. [PMID: 20595950] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Extracontraceptive benefits are common to all oral contraceptives; however, some benefits are more pronounced with particular associations. To improve acne, hirsutism and premenstrual symptoms, for example, oral contraceptives containing drospirenone are more effective. This interesting progestin has marked antiandrogenic and antimineralcorticoid activity. EE/DRSP 24+4 (24 tablets containing hormones plus 4 containing placebo) features an innovative dosing regimen. Shortening of the hormone-free period augments the inhibition of ovulation and reduces fluctuations in hormones, with beneficial effects on withdrawal symptoms, including headache, breast tenderness, mood swings and pelvic pain. Use of EE/DRSP 24+4 for 3 days longer than conventional oral contraceptives also has extracontraceptive benefits, as demonstrated in clinical trials which have evaluated improvement in premenstrual symptoms, acne and hirsutism.
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Affiliation(s)
- V Bruni Bresciani
- SOD di Ginecologia dell'Infanzia e dell'Adolescenza, Dipartimento di Scienze per la Salute della Donna e del Bambino, Università di Firenze, Florence, Italy
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Ritzén EM, Kollin C. Management of undescended testes: how and when? Pediatr Endocrinol Rev 2009; 7:32-37. [PMID: 19696714] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Incomplete descent of one or both testicles from the abdominal cavity, through the inguinal canal into the scrotum is the most common abnormality in new-born boys; 3-5% are affected. Although a majority of these retained testes will descend spontaneously during the first few months after birth, about one percent of all boys will require some sort of treatment in order to achieve best possible testicular function. Thousands of publications deal with different aspects on cryptorchidism - most of them try to improve the mode of treatment; why, when and how should treatment be delivered? In order to summarize the present state of the art, a consensus conference with experts from the Nordic countries was called in August 2006. The conclusions and the appropriate literature reviews can be found in the May issue of Acta Paediatrica 2007.
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Affiliation(s)
- E Martin Ritzén
- Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
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Abstract
The human corpus luteum is a temporary endocrine gland that develops after ovulation from the ruptured follicle during the luteal phase. It is an important contributor of steroid hormones, particularly progesterone, and is critical for the maintenance of early pregnancy. Luteal-phase dysfunction can result in premature regression of the gland, with a subsequent shift to an infertile cycle. Understanding the mechanism of steroidogenesis during corpus luteum growth and regression is crucial for evaluating the normal physiology and pathophysiology of reproductive cycles. The rate-limiting step in corpus luteum steroidogenesis is the transport of cholesterol to the site of steroid production. Steroidogenic acute regulatory protein is a key player in this process and is positively correlated with progesterone concentrations throughout the early and mid-luteal phase. Changes in the endocrine environment brought on by the gonadotrophins used for ovarian stimulation are thought to underlie the corpus luteum dysfunction associated with IVF cycles. While ovarian hyperstimulation syndrome is associated with human chorionic gonadotrophin (HCG), studies suggest that exogenous progesterone provides necessary luteal support in patients undergoing IVF. The current trend towards simple stimulation protocols and the use of single-embryo transfers provide further opportunity to revisit HCG administration as luteal support.
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Affiliation(s)
- Luigi Devoto
- Universidad de Chile, Hospital Clinico San Borja-Arriaran, Santiago, Chile.
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Atanassova M, Sandeva M. [Application of Pregnyl during the first trimester of the pregnancy]. Akush Ginekol (Sofiia) 2009; 48 Suppl 2:50-53. [PMID: 20380103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Shi CX. [Clinical characteristics of endometriosis and its treatment by Chinese and Western medicine]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2008; 28:966-968. [PMID: 19213332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
BACKGROUND Anovulation is a common cause for infertility. Drugs used to treat anovulation include selective estrogen receptor modulators, aromatase inhibitors and gonadotrophins. Ovulation triggers are used with these drugs, in order to time intercourse. Ovulation triggers without reliable evidence of oocyte maturity could be inappropriately timed, increase costs and psychological stress. This review evaluates different ovulation triggers used when treating anovulatory women with ovulation inducing agents compared to spontaneous ovulation. OBJECTIVES To determine the efficacy of administering an ovulation trigger compared to spontaneous ovulation in anovulatory women being treated with ovulation inducing agents. SEARCH STRATEGY We searched the Menstrual Disorders and Subfertility Group Trials Register (August week 1 2007), Cochrane Central Register of Controlled Trials (CENTRAL Cochrane library issue 3 2007) and the electronic databases MEDLINE (1950 July week 4 2007), EMBASE(1980 to week 31 2007) and CINAHL (1982 to August week 1 2007) for studies in all languages. SELECTION CRITERIA Randomised controlled trials (RCT). DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed quality and extracted data. Disagreement was resolved by discussion with the third author and by contacting trial authors. Categorical data were analysed using relative risks and their 95% confidence intervals. A random effects model was used in the presence of significant heterogeneity. MAIN RESULTS Two RCTs comparing urinary hCG versus no treatment in anovulatory women receiving clomiphene citrate were identified. Urinary hCG did not result in increases in the primary outcome of live birth rate over no treatment { OR 0.98, 95% CI 0.52 to 1.83}.Among the secondary outcomes, urinary hCG did not increase ovulation rate ( OR 0.95, 95% CI 0.49 to 1.83), clinical pregnancy rate (OR 1.02, 95% CI 0.56 to 1.88), multiple pregnancy rate (OR 0.47, 95% CI 0.05 to 4.59), miscarriage rate( OR 1.18, 95% CI 0.18 to 7.66) and preterm delivery (OR 0.12,95% CI 0.00 to 6.29) compared to no treatment. Trials evaluating other ovulation triggers were not identified. AUTHORS' CONCLUSIONS There is inadequate evidence to recommend or refute the use of urinary hCG, as an ovulation trigger, in anovulatory women being treated with clomiphene citrate. We did not find trials evaluating the use of ovulation triggers in anovulatory women, being treated with other ovulation inducing agents.
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Affiliation(s)
- Korula George
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Ida Scudder Rd, Vellore Tamil Nadu, Vellore-632 004 S, India.
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Battista L, Chung JH, Lagrew DC, Wing DA. Complications of labor induction among multiparous women in a community-based hospital system. Am J Obstet Gynecol 2007; 197:241.e1-7; discussion 322-3, e1-4. [PMID: 17826404 DOI: 10.1016/j.ajog.2006.12.027] [Citation(s) in RCA: 27] [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: 08/03/2006] [Revised: 10/05/2006] [Accepted: 12/18/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to examine complications of labor induction compared to spontaneous labor in multiparas. STUDY DESIGN This was a retrospective cohort study of multiparous women with live, singleton pregnancies at term, who had no contraindications to labor or labor induction. Cesarean delivery was the primary outcome. RESULTS Of the study subjects, 7208 experienced spontaneous labor, 2190 underwent labor induction with oxytocin, and 239 underwent labor induction requiring cervical ripening agents. Oxytocin-induced multiparas were 37% more likely to require cesarean compared to those with spontaneous labor (OR, 1.37; 95% CI, 1.10-1.71) and nearly 3 times more likely to undergo cesarean when cervical ripening agents were used (OR, 2.82; 95% CI, 1.84-4.53). Women requiring cervical ripening were also 10 times more likely to spend more than 12 hours in labor than those with spontaneous labor. CONCLUSION Multiparas undergoing labor induction are at increased risk for obstetric complications compared to spontaneous labor.
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Affiliation(s)
- Leah Battista
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Orange, USA
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Beckers A. [Hypogonadism due to LH deficiency]. Bull Mem Acad R Med Belg 2007; 162:291-298. [PMID: 18404998] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 30-year-old man was investigated for delayed puberty and infertility. These investigations showed a complete absence of circulating luteinizing hormone (LH). Genetic studies revealed a missense mutation in the LHbeta gene (G36D). This mutation disrupts a vital cystine knot motif and abrogates the heterodimerization and secretion of LH. Treatment with hCG was instituted, which led to arise in testosterone and improvement in spermatogenesis. After in vitro fertilization the patient had a son who was heterozygous for the G36D mutation. A second patient with similar clinical and biological presentation has been explored. A non-frame shift deletion of 3 base-pairs was discovered at position 20 which led to the deletion of a lysine residue. The proband and his prepubescent brother were homozygotic for this mutation. These cases illustrate the important physiological role of LH in male sexual maturation and fertility.
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Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with levels of between 4 and 10 per cent reported (Dunaif 1995, Norman et al 2002). However, figures for its prevalence vary considerably and estimates of 'true' prevalence must be made with caution since there is no overall consensus on the diagnostic criteria that must be satisfied to make a diagnosis (Ledger and Clark 2003). Giving information and patient education are integral to many nursing roles and as more women are being diagnosed with PCOS, patients are seeking information from nurses as well as other health professionals. This article provides an overview of PCOS, including its clinical features, pathophysiology, long-term health consequences and possible treatments.
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Vercellini P, Frontino G, De Giorgi O, Pietropaolo G, Pasin R, Crosignani PG. Endometriosis: preoperative and postoperative medical treatment. Obstet Gynecol Clin North Am 2003; 30:163-80. [PMID: 12699264 DOI: 10.1016/s0889-8545(02)00059-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [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: 11/28/2022]
Abstract
The quality of the evidence that supports the use of medical treatment before conservative surgery for endometriosis is manifestly poor, and no recommendations can be made based on the results of the published studies. There are practical advantages inherent to this schedule, but whether this translates into better conception rates and reduced pain recurrence rates is unproven. The effect of drug therapy after surgery can be assessed better as data from seven true randomized, controlled trials are available. The results of the current review do not support the notion that suppressing ovarian activity postoperatively increases the long-term pregnancy rate. As far as pelvic pain is concerned, more data are needed to verify the reduced symptoms recurrence rate found in four trials in women who were allocated to postoperative medical therapy, particularly in view of the different results obtained in some of the considered studies. The observed differences among various drugs used before or after surgery are limited in clinical terms and, in the absence of formal randomized comparisons, are difficult to interpret. Because of their tolerable side effects and limited cost, progestins with or without estrogens should be considered strongly as first-line postoperative medical treatment if and when suppression of ovulation after conservative surgery is deemed opportune.
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Affiliation(s)
- Paolo Vercellini
- Luigi Mangiagalli Department of Obstetrics and Gynecology, University of Milano, Via Commenda, 12 20122 Milano, Italy.
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Abstract
In the coming years, basic science research into the mechanisms of endometriosis development and persistence almost certainly will open new avenues for treatment. A wide armamentarium of medical therapies already exists, however. The efficacy of most of these methods in reducing endometriosis-associated pain is well established. The choice of which to use depends largely on patient preference after an appropriate discussion of risks, side effects, and cost. Typically, oral contraceptives and NSAIDs are first-line therapy because of their low cost and mild side effects (Box 6). Because of its greater potential for suppressing endometrial development, consideration should be given to prescribing a low-dose monophasic oral contraceptive continuously. If adequate relief is not obtained or if side effects prove intolerable, consideration should be given to the use of progestins (oral, intramuscular, or IUD) or a GnRH agonist with immediate add-back therapy. Progestins are less expensive, but GnRH agonists with add-back may be better tolerated. If none of these medications proves beneficial or if side effects are too pronounced, then repeat surgery is warranted. The surgery may have analgesic value and serves to reconfirm the diagnosis. Finally, if endometriosis is identified at the time of surgery, then consideration should be given to prescribing medical therapy postoperatively.
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Affiliation(s)
- Neal G Mahutte
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA.
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