1
|
Brady PC. Ovarian tissue transplantation: a science coming of age. Fertil Steril 2024; 121:262-263. [PMID: 38065470 DOI: 10.1016/j.fertnstert.2023.12.001] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Paula C Brady
- Columbia University Fertility Center, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
2
|
Wang CN, Kurtzman JT, Ratan RB, Brady PC, Badalato GM. Oocyte cryopreservation during graduate medical training: A survey of trainees. Am J Surg 2023; 226:717-720. [PMID: 37321891 DOI: 10.1016/j.amjsurg.2023.05.026] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/24/2023] [Accepted: 05/18/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Connie N Wang
- Columbia University Irving Medical Center, Department of Urology, New York, NY, USA.
| | - Jane T Kurtzman
- Columbia University Irving Medical Center, Department of Urology, New York, NY, USA.
| | - Rini B Ratan
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, New York, NY, USA.
| | - Paula C Brady
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, New York, NY, USA.
| | - Gina M Badalato
- Columbia University Irving Medical Center, Department of Urology, New York, NY, USA.
| |
Collapse
|
3
|
Meernik C, Jorgensen K, Wu CF, Murphy CC, Baker VL, Brady PC, Nitecki R, Nichols HB, Rauh-Hain JA. Disparities in the use of assisted reproductive technologies after breast cancer: a population-based study. Breast Cancer Res Treat 2023; 198:149-158. [PMID: 36607486 PMCID: PMC10184512 DOI: 10.1007/s10549-022-06857-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Equitable access to oncofertility services is a key component of cancer survivorship care, but factors affecting access and use remain understudied. METHODS To describe disparities in assisted reproductive technology (ART) use among women with breast cancer in California, we conducted a population-based cohort study using linked oncology, ART, and demographic data. We identified women age 18-45 years diagnosed with invasive breast cancer between 2000 and 2015. The primary outcome was ART use-including oocyte/embryo cryopreservation or embryo transfer-after cancer diagnosis. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) to identify factors associated with ART use. RESULTS Among 36,468 women with invasive breast cancer, 206 (0.56%) used ART. Women significantly less likely to use ART were age 36-45 years at diagnosis (vs. 18-35 years: PR = 0.17, 95% CI 0.13-0.22); non-Hispanic Black or Hispanic (vs. non-Hispanic White: PR = 0.31, 95% CI 0.21-0.46); had at least one child (vs. no children: adjusted PR [aPR] = 0.39, 95% CI 0.25-0.60); or lived in non-urban areas (vs. urban: aPR = 0.28, 95% CI 0.10-0.75), whereas women more likely to use ART lived in high-SES areas (vs. low-/middle-SES areas: aPR = 2.93, 95% CI 2.04-4.20) or had private insurance (vs. public/other insurance: aPR = 2.95, 95% CI 1.59-5.49). CONCLUSION Women with breast cancer who are socially or economically disadvantaged, or who already had a child, are substantially less likely to use ART after diagnosis. The implementation of policies or programs targeting more equitable access to fertility services for women with cancer is warranted.
Collapse
Affiliation(s)
- Clare Meernik
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paula C Brady
- Columbia University Fertility Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Gynecologic Oncology and Reproductive Medicine, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| |
Collapse
|
4
|
Jorgensen K, Meernik C, Wu CF, Murphy CC, Baker VL, Jarmon P, Brady PC, Nitecki R, Nichols HB, Rauh-Hain JA. Disparities in Fertility-Sparing Treatment and Use of Assisted Reproductive Technology After a Diagnosis of Cervical, Ovarian, or Endometrial Cancer. Obstet Gynecol 2023; 141:341-353. [PMID: 36649345 PMCID: PMC9858239 DOI: 10.1097/aog.0000000000005044] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the presence of sociodemographic and clinical disparities in fertility-sparing treatment and assisted reproductive technology (ART) use among patients with a history of cervical, endometrial, or ovarian cancer. METHODS We conducted a population-based cohort study of patients aged 18-45 years who were diagnosed with cervical cancer (stage IA, IB), endometrial cancer (grade 1, stage IA, IB), or ovarian cancer (stage IA, IC) between January 1, 2000, and December 31, 2015, using linked data from the CCR (California Cancer Registry), the California Office of Statewide Health Planning and Development, and the Society for Assisted Reproductive Technology. The primary outcome was receipt of fertility-sparing treatment , defined as surgical or medical treatment to preserve the uterus and at least one ovary. The secondary outcome was fertility preservation , defined as ART use after cancer diagnosis. Multivariable logistic regression analysis was used to estimate odds ratios and 95% CIs for the association between fertility-sparing treatment and exposures of interest: age at diagnosis, race and ethnicity, health insurance, socioeconomic status, rurality, and parity. RESULTS We identified 7,736 patients who were diagnosed with cervical, endometrial, or ovarian cancer with eligible histology. There were 850 (18.8%) fertility-sparing procedures among 4,521 cases of cervical cancer, 108 (7.2%) among 1,504 cases of endometrial cancer, and 741 (43.3%) among 1,711 cases of ovarian cancer. Analyses demonstrated nonuniform patterns of sociodemographic disparities by cancer type for fertility-sparing treatment, and ART. Fertility-sparing treatment was more likely among young patients, overall, and of those in racial and ethnic minority groups among survivors of cervical and ovarian cancer. Use of ART was low (n=52) and was associated with a non-Hispanic White race and ethnicity designation, being of younger age (18-35 years), and having private insurance. CONCLUSION This study demonstrates that clinical and sociodemographic disparities exist in the receipt of fertility-sparing treatment and ART use among patients with a history of cervical, endometrial, or ovarian cancer.
Collapse
Affiliation(s)
- Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine and the Department of Health Services Research, University of Texas MD Anderson Cancer Center, and the Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas; the Department of Public Health Sciences, Duke University School of Medicine, Durham, North Carolina; the Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Tulane University School of Medicine, New Orleans, Louisiana; the Columbia University Irving Medical Center, Columbia University Fertility Center, New York, New York; and the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Rauh-Hain JA, Zubizarreta J, Nitecki R, Melamed A, Fu S, Jorgensen K, Brady PC, Baker VL, Chavez-MacGregor M, Giordano SH, Keating NL. Survival outcomes following pregnancy or assisted reproductive technologies after breast cancer: A population-based study. Cancer 2022; 128:3243-3253. [PMID: 35767282 PMCID: PMC9378486 DOI: 10.1002/cncr.34371] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study sought to determine the impact of pregnancy or assisted reproductive technologies (ART) on breast-cancer-specific survival among breast cancer survivors. METHODS The authors performed a cohort study using a novel data linkage from the California Cancer Registry, the California birth cohort, and the Society for Assisted Reproductive Technology Clinic Outcome Reporting System data sets. They performed risk-set matching in women with stages I-III breast cancer diagnosed between 2000 and 2012. For each pregnant woman, comparable women who were not pregnant at that point but were otherwise similar based on observed characteristics were matched at the time of pregnancy. After matching, Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of pregnancy with breast-cancer-specific survival. We repeated these analyses for women who received ART. RESULTS Among 30,021 women with breast cancer, 553 had a pregnancy and 189 attempted at least one cycle of ART. In Cox proportional hazards modeling, the pregnancy group had a higher 5-year disease-specific survival rate; 95.6% in the pregnancy group and 90.6% in the nonpregnant group (HR, 0.43; 95% CI, 0.24-0.77). In women with hormone receptor-positive cancer, we found similar results (HR, 0.43; 95% CI, 0.2-0.91). In the ART analysis, there was no difference in survival between groups; the 5-year disease-specific survival rate was 96.9% in the ART group and 94.1% in the non-ART group (HR, 0.44; 95% CI, 0.17-1.13). CONCLUSION Pregnancy and ART are not associated with worse survival in women with breast cancer. LAY SUMMARY We sought to determine the impact of pregnancy or assisted reproductive technologies (ART) among breast cancer survivors. We performed a study of 30,021 women by linking available data from California and the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. For each pregnant woman, we matched at the time of pregnancy comparable women who were not pregnant at that point but were otherwise similar based on observed characteristics. We repeated these analyses for women who received ART. We found that pregnancy and ART were not associated with worse survival.
Collapse
Affiliation(s)
- J. Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jose Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Shuangshuang Fu
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Paula C. Brady
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Valerie L. Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD, United States
| | - Mariana Chavez-MacGregor
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sharon H. Giordano
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| |
Collapse
|
6
|
Brady PC, Cummings ME, Gruev V, Hernandez T, Blair S, Vail A, Garcia M. In situ measurements of reef squid polarization patterns using two-dimensional polarization data mapped onto three-dimensional tessellated surfaces. J R Soc Interface 2021; 18:20210703. [PMID: 34814730 DOI: 10.1098/rsif.2021.0703] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Reef squids belong to a group reputed for polarization sensitivity, yet polarization patterns of reef squid have not been quantified in situ. To quantify polarization patterns from video polarimetric data, we developed a protocol to map two-dimensional polarization data onto squid-shaped three-dimensional tessellated surfaces. This protocol provided a robust data container used to investigate three-dimensional regions-of-interest, producing data lineouts derived from the squid's geometry. This protocol also extracted polarimeter and squid body orientations and the solar heading from polarization images. When averaged over the solar heading, the ventral midline gave a low degree of polarization (2.4 ± 5.3%), and the area between the ventral and flank midlines had higher values (9.0 ± 5.3%). These averaged data had a large discontinuity in the angle of polarization (AoP) at the mantle's ventral midline (64 ± 55°), with larger discontinuities measured on individual squid. Ray-tracing calculations demonstrated that the AoP pattern was not related to the squid's surface-normal geometry. However, the AoP followed virtual striation axes on the squid's surface oriented 24° to the squid's long axis, similar in angle (27°) to the striations of birefringent collagen fibres documented in other squid species' skin.
Collapse
Affiliation(s)
- P C Brady
- Integrative Biology, University of Texas at Austin School of Biological Sciences, Austin, TX 78712-0128, USA
| | - M E Cummings
- Integrative Biology, University of Texas at Austin School of Biological Sciences, Austin, TX 78712-0128, USA
| | - V Gruev
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - T Hernandez
- University of California San Diego, La Jolla, CA, USA
| | - S Blair
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - A Vail
- University of Cambridge, Cambridge, UK
| | - M Garcia
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
| |
Collapse
|
7
|
Rauh-Hain JA, Nitecki R, Melamed A, Zubizarreta J, Fu S, Clapp MC, Brady PC, Kaimal AJ, Giordano SH, Chavez Mac Gregor M, Keating NL. Pregnancy after breast cancer: A population-based study of survival and obstetric outcomes. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18783] [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: 11/20/2022] Open
Abstract
e18783 Background: Studies have suggested that pregnancy after breast cancer is safe, but the women who are able to conceive after cancer may also have a better prognosis. We sought to evaluate survival and obstetric outcomes among breast cancer patients in a population-based cohort. Methods: We studied women aged 18-45 years with a history of stage I-III breast cancer reported to the California Cancer Registry (CCR, 2000-2012). CCR data were linked to the 2000-2012 California Office of Statewide Health Planning and Development (OSHPD) birth cohort to ascertain both oncologic characteristics and obstetric outcomes. We compared overall survival (OS) for breast cancer patients who did or did not conceive at least 1 year after diagnosis. Breast cancer patients who conceived were matched in a 1:5 ratio to breast cancer patients who did not conceive via optimal bipartite matching accounting for follow-up time such that controls were diagnosed within a 3-month window of the cases and were alive at the time the case delivered; the distributions of cases and controls were directly balanced on socioeconomic and clinical covariates including stage, hormone receptors, and receipt of chemotherapy and radiation. For the obstetric outcomes, propensity score matching in a 1:5 ratio was used to match the same breast cancer patients who conceived to population based controls without cancer who delivered during the study years. Wald statistics, conditional Cox proportional hazards model, and conditional logistic regressions were used to evaluate outcomes. Results: We matched 417 patients aged 18-45 years at time of breast cancer diagnosis who conceived at least one year following diagnosis with 2,085 breast cancer patients who did not conceive. All covariates were balanced within 0.1 mean standardized difference. The majority of the cohort was non-Hispanic White (51%), with stage II disease (53%). The 5-year overall survival for cases relative to controls was 97.6% and 95.7% respectively. There was no difference in overall survival between patients who conceived and those who did not conceive following treatment for breast cancer (HR 0.58, 95% CI 0.3-1.1). Breast cancer patients did not have higher risks of preterm birth before 37 weeks (odds ratio [OR] 0.91, 95% CI 0.39-2.14), small-for-gestational age birthweight ( < 10th percentile: OR 0.93, 95% CI 0.67-1.29; < 5th percentile: OR 0.67, 95% CI 0.39-1.14), cesarean delivery (OR 1.12, 95% CI 0.92-1.35), severe maternal morbidity (OR 1.14, 95% CI 0.61-2.12), or neonatal morbidity (OR 1.08, 95% CI 0.77-1.53) relative to controls. Conclusions: In a population-based cohort, breast cancer patients who conceived at least 1 year after diagnosis did not have worse OS than matched breast cancer patients who did not conceive. Breast cancer patients who conceived during the study period did not have an increased risk of adverse obstetric outcomes compared to population-based controls without cancer.
Collapse
Affiliation(s)
| | | | - Alexander Melamed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Bercow A, Nitecki R, Brady PC, Rauh-Hain JA. Outcomes after Fertility-sparing Surgery for Women with Ovarian Cancer: A Systematic Review of the Literature. J Minim Invasive Gynecol 2021; 28:527-536.e1. [PMID: 32861046 DOI: 10.1016/j.jmig.2020.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare reproductive and oncologic outcomes of patients diagnosed with early-stage epithelial ovarian carcinoma, borderline ovarian tumors, or nonepithelial ovarian carcinoma according to receipt of fertility-sparing surgery or conventional surgery. DATA SOURCES PubMed was searched from January 1, 1995, to May 29, 2020. METHODS OF STUDY SELECTION Studies were included if they (1) enrolled women of childbearing age diagnosed with ovarian cancer between the ages of 18 years and 50 years, (2) reported on oncologic and/or reproductive outcomes after fertility-sparing surgery for ovarian cancer, and (3) included at least 20 patients. TABULATION, INTEGRATION, AND RESULTS The initial search identified 995 studies. After duplicates were removed, we abstracted 980 unique citations. Of those screened, 167 publications were identified as potentially relevant, and evaluated for inclusion and exclusion criteria. The final review included 44 studies in epithelial ovarian cancer, 42 in borderline ovarian tumors, and 31 in nonepithelial ovarian carcinoma. The narrative synthesis demonstrated that overall survival does not seem to be compromised in patients undergoing fertility-sparing surgery compared with those undergoing conventional surgery, although long-term data are limited. Areas of controversy include safety of fertility-sparing surgery in the setting of high-risk factors (stage IC, grade 3, and clear cell histology), as well as type of surgery (salpingo-oophorectomy vs cystectomy). It seems that although there may be some fertility compromise after surgery, pregnancy and live-birth rates are encouraging. CONCLUSION Fertility-sparing surgery is safe and feasible in women with early-stage low-risk ovarian cancer. Pregnancy outcomes for these patients also seem to be similar to those of the general population.
Collapse
Affiliation(s)
- Alexandra Bercow
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital (Dr. Bercow); Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital (Dr. Bercow), Boston, Massachusetts
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (Drs. Nitecki and Rauh-Hain), Houston, Texas
| | - Paula C Brady
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center (Dr. Brady), New York, New York
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (Drs. Nitecki and Rauh-Hain), Houston, Texas.
| |
Collapse
|
9
|
Selter J, Huang Y, Williams SZ, Brady PC, Melamed A, Hershman DL, Wright JD. Use of fertility preservation services in male reproductive-aged cancer patients. Gynecol Oncol Rep 2021; 36:100716. [PMID: 33665292 PMCID: PMC7907757 DOI: 10.1016/j.gore.2021.100716] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022] Open
Abstract
While fertility preservation is a major concern among reproductive age cancer patients, little is known about access and use of fertility preserving services. We examined use of fertility preserving services among men with common solid tumors. A total of 3648 men age 18-40 including 2610 (71.6%) with testicular cancer, 939 (25.7%) with colorectal and 99 (2.7%) with prostate cancer were identified. Fertility preservation services were utilized in 9.3% of men overall including 4.1% who underwent fertility evaluation only and 7.8% who had a fertility preservation procedure. The rate of fertility preservation services rose from 6.6% (95%CI, 3.2-10.0) in 2008 to 12.4% (95%CI, 7.3-17.5) in 2017 (P = 0.04). Use of fertility preservation service was more common in patients with testicular (11.6%, aRR = 3.31; 95% CI 2.22-4.92) and prostate cancer (6.1%, aRR = 3.14; 95% CI 1.28-7.70) compared to those with colon cancer (3.4%). Younger men were more likely to utilize fertility preservation services. 11.5% of men age ≤ 35 years vs. 5.2% of men 36-40 used these services (P < 0.0001). Fertility preservation services were used in 10.8% of those who received chemotherapy (aRR = 1.81; 95% CI, 1.45-2.27) and in 8.1% of those who received radiation (aRR = 1.30 95% CI, 0.98-1.73). Medicaid patients were less likely to receive fertility preservation services than those with commercial insurance (0.7% vs. 10.1%; aRR = 11.58, 95%CI 2.10-63.69). These data indicate that while use of fertility preserving services is increasing, overall use of services is low among reproductive age males with cancer.
Collapse
Affiliation(s)
- Jessica Selter
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.,New York Presbyterian Hospital, United States
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States
| | - S Zev Williams
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.,New York Presbyterian Hospital, United States
| | - Paula C Brady
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.,New York Presbyterian Hospital, United States
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.,Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States.,New York Presbyterian Hospital, United States
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, United States.,Department of Epidemiology, Mailman School of Public Health, Columbia University, United States.,Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States.,New York Presbyterian Hospital, United States
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.,Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States.,New York Presbyterian Hospital, United States
| |
Collapse
|
10
|
Brady PC, Forman EJ. An oncofertility prediction tool? Forecasting fertility after cancer. Fertil Steril 2020; 115:323-324. [PMID: 33386112 DOI: 10.1016/j.fertnstert.2020.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Paula C Brady
- Columbia University Fertility Center, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Eric J Forman
- Columbia University Fertility Center, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
11
|
Gemmell LC, Wright JD, Brady PC. Triple stimulation (TriStim) before bilateral oophorectomy in a young woman with ovarian cancer: a case report and review of the literature. Fertil Res Pract 2020; 6:17. [PMID: 33110610 PMCID: PMC7586661 DOI: 10.1186/s40738-020-00087-y] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/18/2020] [Indexed: 11/10/2022]
Abstract
Background Double ovarian stimulation (DuoStim) involves two rounds of controlled ovarian stimulation (COS) and oocyte retrieval in immediate succession. It represents a promising approach to increase oocyte yield for patients with diminished ovarian reserve or those with limited time before fertility-threatening oncologic treatment. We report the case of a 31-year-old woman with Stage IC endometrioid ovarian cancer who underwent a triple stimulation or "TriStim," completing three rounds of COS and oocyte retrieval within 42 days prior to bilateral salpingo-oophorectomy. Case presentation A 31 year old nulligravid woman presented for fertility preservation counseling following a bilateral ovarian cystectomy that revealed Stage IC endometroid adenocarcinoma arising within endometrioid borderline tumors. The patient was counseled for bilateral salpingo-oophorectomy, lymph node dissection, and omentectomy followed by three cycles of carboplatin/paclitaxel. Prior to this, all within six weeks, the patient underwent three rounds of controlled ovarian stimulation using an antagonist protocol and human chorionic gonadotropin (hCG) trigger, resulting in vitrification of nine two-pronuclear zygotes (2PN), after which definitive surgery was performed. Conclusions Advantages of DuoStim procedures are increasingly recognized, especially for oncology patients with limited time before potentially sterilizing cancer treatment. To our knowledge, this is the first report of a triple stimulation ("TriStim"). Our case highlights that triple stimulation is a viable option for patients needing urgent fertility preservation in order to maximize egg and embryo yield within a limited time period.
Collapse
Affiliation(s)
- Laura C Gemmell
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center/New York Presbyterian Hospital, 622 west 168th street, New York, NY 10032 USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Irving Medical Center, New York, USA
| | - Paula C Brady
- Department of Obstetrics and Gynecology, Columbia University Fertility Center, Columbia University Irving Medical Center, New York, USA
| |
Collapse
|
12
|
Robles A, Robles BN, Gemmell LC, Brady PC, Forman EJ, Williams Z. UNIVERSAL SCREENING OF COVID-19 IN ASYMPTOMATIC PATIENTS STARTING FERTILITY TREATMENT IN NEW YORK CITY. Fertil Steril 2020. [PMCID: PMC7548679 DOI: 10.1016/j.fertnstert.2020.08.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
13
|
Tanen A, Nohria A, Jang YJ, Brady PC. IMPACT OF AN EARLY PREGNANCY EDUCATION PACKET ON PATIENT QUESTION VOLUME. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1347] [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: 11/16/2022]
|
14
|
Robles A, Robles BN, Gemmell LC, Brady PC. FERTILITY PRESERVATION WITH IN VIVO OOCYTE RETRIEVAL AMONG YOUNG WOMEN WITH OVARIAN CANCER: A CASE SERIES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.10.024] [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: 11/28/2022]
|
15
|
Selter JH, Spurlin EE, Brady PC. Gender inequality in leadership and academic rank in academic reproductive endocrinology programs. J Assist Reprod Genet 2020; 37:1959-1962. [PMID: 32564240 DOI: 10.1007/s10815-020-01866-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/11/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To identify gender differences in leadership and academic rank within academic reproductive endocrinology (REI) programs with fellowships in the USA. METHODS Official institutional websites of the 2017-2018 American Board of Obstetrics and Gynecology (ABOG)-accredited reproductive endocrinology fellowship programs were reviewed, and gender representation at each leadership position and academic rank (Division and Fellowship Director and Full, Associate, and Assistant Professor) was recorded. Univariate comparisons were performed using Chi-square tests, with significance at p < 0.05. RESULTS Among 49 ABOG-accredited reproductive endocrinology programs, 263 faculty were identified, 129 (49.0%) male and 134 (51.0%) female. Division directors were 69.3% male and 30.7% female (p = 0.006). Similarly, fellowship directors were 65.3% male and 34.6% female (p = 0.03). Full professors (n = 101) were more frequently male (70.3% vs. 29.7%, p < 0.001). There was no difference in gender among associate professors (n = 60, 51.7% male vs. 48.3% female, p = 0.79), while significantly more assistant professors were female than male (n = 102, 73.6% vs. 26.4%, p < 0.001). CONCLUSION While a majority of residents in obstetrics and gynecology and half of reproductive endocrinology academic faculty are female, women are still underrepresented among leadership positions and full professors in academic reproductive endocrinology programs with fellowship programs.
Collapse
Affiliation(s)
- Jessica H Selter
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
| | - Emily E Spurlin
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Paula C Brady
- Department of Obstetrics and Gynecology, Columbia University Fertility Center, Columbia University Irving Medical Center, 5 Columbus Circle, Penthouse, New York, NY, 10019, USA
| |
Collapse
|
16
|
Brady PC, Horne AW, Saunders PT, Thomas AM, Missmer SA, Farland LV. Research priorities for endometriosis differ among patients, clinicians, and researchers. Am J Obstet Gynecol 2020; 222:630-632. [PMID: 32142827 DOI: 10.1016/j.ajog.2020.02.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 01/01/2023]
|
17
|
Peregrine J, McGovern PG, Brady PC, Ginsburg ES, Schlaff W. Restoring fertility in women aged 40 years and older after tubal ligation: tubal anastomosis versus in vitro fertilization. Fertil Steril 2020; 113:735-742. [PMID: 32228877 DOI: 10.1016/j.fertnstert.2020.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Jamie Peregrine
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Peter G McGovern
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Paula C Brady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York; Columbia University Fertility Center, New York, New York
| | - Elizabeth S Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - William Schlaff
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
| |
Collapse
|
18
|
Brady PC, Farland LV, Racowsky C, Ginsburg ES. Hyperglycosylated human chorionic gonadotropin as a predictor of ongoing pregnancy. Am J Obstet Gynecol 2020; 222:68.e1-68.e12. [PMID: 31401260 DOI: 10.1016/j.ajog.2019.08.004] [Citation(s) in RCA: 6] [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: 04/03/2019] [Revised: 07/14/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hyperglycosylated human chorionic gonadotropin, the predominant human chorionic gonadotropin variant secreted following implantation, is associated with trophoblast invasion. OBJECTIVE To determine whether the initial serum hyperglycosylated human chorionic gonadotropin differs between ongoing and failed pregnancies, and to compare it to total serum human chorionic gonadotropin as a predictor of ongoing pregnancy. MATERIALS AND METHODS Women undergoing fresh/frozen in vitro fertilization cycles at a university-based infertility clinic with an autologous day 5 single embryo transfer resulting in serum human chorionic gonadotropin >3 mIU/mL (n = 115) were included. Human chorionic gonadotropin was measured 11 days after embryo transfer in a single laboratory (coefficient of variation <6%). Surplus frozen serum (-80oC) was shipped to Quest Laboratories for measurement of hyperglycosylated human chorionic gonadotropin (coefficient of variation <9.1%). Linear regression analyses adjusted for oocyte age a priori were used to compare human chorionic gonadotropin and hyperglycosylated human chorionic gonadotropin in ongoing pregnancies (>8 weeks of gestation) and failed pregnancies (clinical pregnancy loss, biochemical and ectopic pregnancies). RESULTS A total of 85 pregnancies (73.9%) were ongoing. Hyperglycosylated human chorionic gonadotropin and human chorionic gonadotropin values were highly correlated (Pearson correlation coefficient 92.14, P < .0001), and mean values of both were positively correlated with blastocyst expansion score (P value test for trend < .0004). Mean human chorionic gonadotropin and hyperglycosylated human chorionic gonadotropin were significantly higher in ongoing vs failed pregnancies. Among ongoing pregnancies vs clinical losses, mean hyperglycosylated human chorionic gonadotropin, but not human chorionic gonadotropin, was significantly higher (19.0 vs 12.2 ng/mL, β -8.1, 95% confidence interval -13.0 to -3.2), and hyperglycosylated human chorionic gonadotropin comprised a higher proportion of total human chorionic gonadotropin (4.6% vs 4.1%; risk ratio, 0.79; 95% confidence interval, 0.66-0.94). CONCLUSION Measured 11 days after single blastocyst transfer, hyperglycosylated human chorionic gonadotropin and human chorionic gonadotropin values were highly correlated, but only mean hyperglycosylated human chorionic gonadotropin and its ratio to total human chorionic gonadotropin were significantly higher in ongoing pregnancies vs clinical pregnancy losses. Further evaluation of hyperglycosylated human chorionic gonadotropin, including in multiple embryo transfers and multiple pregnancy, and using serial measurements, is required.
Collapse
Affiliation(s)
- Paula C Brady
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Leslie V Farland
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine Racowsky
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Elizabeth S Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
19
|
Selter J, Spurlin E, Brady PC. The state of women in academic reproductive endocrinology programs. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.375] [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: 11/28/2022]
|
20
|
Vitez SF, Chen L, Brady PC, Wright JD. Utilization of gonadotropin-releasing hormone agonists for preservation of ovarian function in women with breast cancer receiving chemotherapy. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.412] [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: 10/25/2022]
|
21
|
Brady PC, Farland LV, Ginsburg ES. Serum Human Chorionic Gonadotropin Among Women With and Without Obesity After Single Embryo Transfers. J Clin Endocrinol Metab 2018; 103:4209-4215. [PMID: 30137414 DOI: 10.1210/jc.2018-01057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/14/2018] [Accepted: 08/14/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Serum human chorionic gonadotropin (hCG) levels are essential for diagnosing and monitoring early pregnancy. Obesity is a health care epidemic; however, the performance of this vital serum hormone in women with an elevated body mass index (BMI) is unknown. OBJECTIVE To investigate the association of BMI with serum hCG values and rate of hCG increase. DESIGN Retrospective cohort study. SETTING University-based infertility clinic. PATIENTS Women undergoing fresh vs frozen in vitro fertilization cycles with single-day three or five embryo transfers resulting in singleton live births (≥24 weeks' gestational age) from 2008 to 2015. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The initial hCG (mIU/mL, 16 days after oocyte retrieval) and 2-day percentage of hCG increases among BMI categories were compared using multivariable linear and logistic regression, adjusted a priori for the day of embryo transfer. RESULTS The initial serum hCG values correlated inversely with the BMI (P < 0.0001, test for trend). Low initial hCG values (<100 mIU/mL) were significantly more common across increasing BMI classes, from 1.4% of normal weight patients to 15.6% of those with a BMI ≥40 kg/m2 (P = 0.001, test for trend). The mean 2-day hCG increases were similar and normal (≥53%) across the BMI groups. CONCLUSIONS Patients with obesity achieving live births had statistically significantly lower initial serum hCG values compared with patients who were nonobese. However, the mean 2-day percentage of increases in hCG were similar across BMI categories. The initial hCG values might lack sensitivity for live births in patients with obesity. The rate of hCG increase remains the mainstay of monitoring very early pregnancies after in vitro fertilization. Future studies should investigate whether serum analyte ranges should be adjusted according to the BMI.
Collapse
Affiliation(s)
- Paula C Brady
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leslie V Farland
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
22
|
Brady PC, Molina RL, Muto MG, Stapp B, Srouji SS. Diagnosis and management of a heterotopic pregnancy and ruptured rudimentary uterine horn. Fertil Res Pract 2018; 4:6. [PMID: 30279994 PMCID: PMC6162954 DOI: 10.1186/s40738-018-0051-7] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/17/2018] [Indexed: 11/23/2022]
Abstract
Background Heterotopic pregnancies implanted in a rudimentary uterine horn account for 1 in 2–3 million gestations, and confer significant risk of morbidity due to uterine rupture and hemorrhage. Case presentation A 34-year-old nullipara presented with acute pelvic pain at 17 weeks of gestation with dichorionic-diamniotic twins, one in each horn of an anomalous uterus first diagnosed in pregnancy as bicornuate. Three-dimensional ultrasound and MRI revealed myometrial disruption in the left rudimentary uterine horn, and the patient underwent an uncomplicated abdominal hemi-hysterectomy. Fourteen days later, an uncomplicated dilation and curettage was performed for a fetal anomaly in the remaining twin in the right unicornuate uterus. Conclusion This case demonstrates the utility of magnetic resonance imaging and three-dimensional ultrasound in the assessment of myometrial integrity in a gravid patient with a heterotopic pregnancy and ruptured rudimentary uterine horn. This case demonstrates the importance of pre-pregnancy diagnosis and management of mullerian anomalies.
Collapse
Affiliation(s)
- Paula C Brady
- 1Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Rose L Molina
- 2Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215 USA
| | - Michael G Muto
- 1Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Brenna Stapp
- 3Department of Obstetrics and Gynecology, Elliot Hospital, Manchester, NH 03103 USA
| | - Serene S Srouji
- 1Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115 USA
| |
Collapse
|
23
|
Mehm AR, Steensma DP, Srouji SS, Ginsburg ES, Brady PC. Fertility preservation in women with marrow failure syndromes prior to allogeneic stem cell transplantation. Am J Hematol 2018; 93. [PMID: 29756247 DOI: 10.1002/ajh.25130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Alexander R Mehm
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David P Steensma
- Department of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Serene S Srouji
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paula C Brady
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
24
|
Chung EH, Brady PC, Smith KK, Davis MR, Muto MG, Ashby RK, Ginsburg ES. Combined Oocyte Retrieval and Robot-assisted Hysterectomy in a Super Morbidly Obese Patient with Endometrial Carcinoma. Anticancer Res 2018; 38:1467-1470. [PMID: 29491073 DOI: 10.21873/anticanres.12372] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/10/2022]
Abstract
AIM To report on the unique, innovative management of a super morbidly obese patient presenting for fertility preservation in the setting of Grade 2 endometrioid endometrial adenocarcinoma. CASE REPORT A back-to-back oocyte retrieval and robot-assisted total laparoscopic hysterectomy (RA-TLH) with bilateral salpingo-oophorectomy (BSO) was performed in a 37-year-old nulligravid woman with super morbid obesity (BMI 63 kg/m2) with endometrial cancer. MAIN OUTCOME MEASURE the successful retrieval of oocytes for fertility preservation and oncologic intervention via RA-TLH with BSO in the same operative and anesthetic episode. RESULTS This combined procedure strategy was successful in our case and is a feasible option for similar high-risk patients in the future. CONCLUSION Identifying safe and effective approaches for oocyte retrieval in morbidly obese patients represents a pressing need as obesity rates rise among reproductive-aged women. Back-to-back oocyte retrieval and RA-TLH with BSO are not only feasible, but could also decrease significant anesthetic risks for morbidly obese patients.
Collapse
Affiliation(s)
- Esther H Chung
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.
| | - Paula C Brady
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - Kimberly Keefe Smith
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - Michelle R Davis
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - Michael G Muto
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - Rachel K Ashby
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| |
Collapse
|
25
|
Insogna IG, Farland LV, Missmer SA, Ginsburg ES, Brady PC. Outpatient endometrial aspiration: an alternative to methotrexate for pregnancy of unknown location. Am J Obstet Gynecol 2017; 217:185.e1-185.e9. [PMID: 28433735 DOI: 10.1016/j.ajog.2017.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pregnancies of unknown location with abnormal beta-human chorionic gonadotropin trends are frequently treated as presumed ectopic pregnancies with methotrexate. Preliminary data suggest that outpatient endometrial aspiration may be an effective tool to diagnose pregnancy location, while also sparing women exposure to methotrexate. OBJECTIVE The purpose of this study was to evaluate the utility of an endometrial sampling protocol for the diagnosis of pregnancies of unknown location after in vitro fertilization. STUDY DESIGN A retrospective cohort study of 14,505 autologous fresh and frozen in vitro fertilization cycles from October 2007 to September 2015 was performed; 110 patients were diagnosed with pregnancy of unknown location, defined as a positive beta-human chorionic gonadotropin without ultrasound evidence of intrauterine or ectopic pregnancy and an abnormal beta-human chorionic gonadotropin trend (<53% rise or <15% fall in 2 days). These patients underwent outpatient endometrial sampling with Karman cannula aspiration. Patients with a beta-human chorionic gonadotropin decline ≥15% within 24 hours of sampling and/or villi detected on pathologic analysis were diagnosed with failing intrauterine pregnancy and had weekly beta-human chorionic gonadotropin measurements thereafter. Those patients with beta-human chorionic gonadotropin declines <15% and no villi identified were diagnosed with ectopic pregnancy and treated with intramuscular methotrexate (50 mg/m2) or laparoscopy. RESULTS Across 8 years of follow up, among women with pregnancy of unknown location, failed intrauterine pregnancy was diagnosed in 46 patients (42%), and ectopic pregnancy was diagnosed in 64 patients (58%). Clinical variables that included fresh or frozen embryo transfer, day of embryo transfer, serum beta-human chorionic gonadotropin at the time of sampling, endometrial thickness, and presence of an adnexal mass were not significantly different between patients with failed intrauterine pregnancy or ectopic pregnancy. In patients with failed intrauterine pregnancy, 100% demonstrated adequate postsampling beta-human chorionic gonadotropin declines; villi were identified in just 46% (n=21 patients). Patients with failed intrauterine pregnancy had significantly shorter time to resolution (negative serum beta-human chorionic gonadotropin) after sampling compared with patients with ectopic pregnancy (12.6 vs 26.3 days; P<.001). CONCLUSION With the use of this safe and effective protocol of endometrial aspiration with Karman cannula, a large proportion of women with pregnancy of unknown location are spared methotrexate, with a shorter time to pregnancy resolution than those who receive methotrexate.
Collapse
|
26
|
Brady PC, Missmer SA, Laufer MR. Bladder Involvement in Stage I Endometriosis. J Pediatr Adolesc Gynecol 2017; 30:503-504. [PMID: 28400322 DOI: 10.1016/j.jpag.2017.03.143] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/22/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Endometriosis-the ectopic implantation of endometrial-like tissue-affects 10% of adolescent females and adults. Bladder involvement, causing dysuria and hematuria, occurs in a very small number of endometriosis patients. CASE The patient presented at age 12 years with dysuria and pelvic pain. Laparoscopy revealed stage I endometriosis. Postoperatively, she reported persistent dysuria and passage of tissue in her urine. Cystoscopy showed diffuse erythema; urine cytology revealed glandular and spindle cells suggestive of endometriosis. She was transitioned from oral contraceptives to an intranasal gonadotropin-releasing hormone agonist, with symptom resolution. SUMMARY AND CONCLUSION Intravesicular endometriosis coinciding with stage I disease supports a mechanism of endometriosis dissemination other than direct bladder infiltration. Patients with endometriosis who complain of urinary symptoms warrant assessment, because intravesicular bladder involvement cannot be excluded using pelviscopy.
Collapse
Affiliation(s)
- Paula C Brady
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
| | - Stacey A Missmer
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Marc R Laufer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
27
|
Brady PC, Missmer SA, Laufer MR. Hepatic Adenomas in Adolescents and Young Women with Endometriosis Treated with Norethindrone Acetate. J Pediatr Adolesc Gynecol 2017; 30:422-424. [PMID: 28024920 DOI: 10.1016/j.jpag.2016.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endometriosis-ectopic implantation of endometrial-like tissue-affects 10% of female adolescents and adults. First-line treatment includes progesterone only (such as norethindrone acetate [NET-A]) or combined estrogen/progestin oral contraceptive pills. Estrogen-containing contraceptives confer increased risk of hepatic adenomas, whereas the association with NET-A is very rarely reported. CASE Three adolescents with stage I to II endometriosis managed with NET-A (up to 15 mg/d for 28-78 months) were diagnosed with hepatic adenomas at ages 17-22 years. They previously received estrogen-containing medications, which were stopped 24 months or longer before diagnosis of hepatic adenoma. SUMMARY AND CONCLUSION NET-A in a dose greater than 10 mg/d might be associated with increased risk for hepatic adenomas, likely due to peripheral conversion to ethinyl estradiol. Use of NET-A might not be advisable in patients with known hepatic adenomas.
Collapse
Affiliation(s)
- Paula C Brady
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
| | - Stacey A Missmer
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Marc R Laufer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
28
|
Brady PC, Soiffer RJ, Ginsburg ES. Continuation of a Levonorgestrel Intrauterine Device During Hematopoietic Stem Cell Transplant: A Case Report. Anticancer Res 2017; 37:1985-1987. [PMID: 28373471 DOI: 10.21873/anticanres.11541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/02/2017] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND During treatment of hematologic malignancies in premenopausal women, both menstrual suppression and contraception are crucial. Continuation of hormonal intrauterine devices (IUDs) - widely used and highly effective contraceptives that also decrease menstrual flow - is controversial during hematopoietic stem cell transplants (SCTs) due to infectious and vaginal bleeding concerns. CASE REPORT A 23-year-old nulligravid female was diagnosed with acute myeloid leukemia (AML, positive for FLT3-ITD, DNMT3A and RUNX1, with normal cytogenetics). She elected to retain her existing levonorgestrel-containing IUD during chemotherapy and SCT. During and following treatment, she remained amenorrheic without infection, despite severe neutropenia and thrombocytopenia. Eight months later, she remains in remission without IUD-related complications. DISCUSSION This is the first report of levonorgestrel IUD retention during hematopoietic SCT. Despite severe neutropenia and thrombocytopenia, the patient developed neither pelvic infection by retaining her IUD nor significant vaginal bleeding. Future studies are needed to confirm the safety of levonorgestrel IUDs in women undergoing SCT.
Collapse
Affiliation(s)
- Paula C Brady
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A.
| | - Robert J Soiffer
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A
| |
Collapse
|
29
|
Brady PC, Ginsburg ES. An Updated Review of Ectopic Pregnancies Resulting from Assisted Reproduction. Curr Obstet Gynecol Rep 2017. [DOI: 10.1007/s13669-017-0196-0] [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: 10/20/2022]
|
30
|
Brady PC, Missmer SA, Farland LV, Ginsburg ES. Clinical predictors of failing one dose of methotrexate for ectopic pregnancy after in vitro fertilization. J Assist Reprod Genet 2017; 34:349-356. [PMID: 28058611 DOI: 10.1007/s10815-016-0861-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/07/2016] [Accepted: 12/12/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the clinical predictors of failure of a single dose of methotrexate (MTX) for management of ectopic pregnancy after in vitro fertilization (IVF). METHODS A retrospective cohort study was performed of women who conceived ectopic pregnancies following fresh or frozen IVF cycles at an academic infertility clinic between 2007 and 2014, and received intramuscular MTX (50 mg/m2). Successful single-dose MTX treatment was defined as a serum beta-human chorionic gonadotropin (hCG) decline ≥15% between days 4 and 7 post-treatment. Logistic regression models adjusted for oocyte age, number of embryos transferred, and prior ectopic pregnancy were used to estimate the adjusted odds ratio (OR) (95% confidence interval [CI]) of failing one dose of MTX. RESULTS Sixty-four patients with ectopic pregnancies after IVF were included. Forty required only one dose of MTX (62.5%), while 15 required additional MTX alone (up to four total doses, 23.4%), and 9 required surgery (14.1%). By multivariable logistic regression, the highest tertiles of serum hCG at peak (≥499 IU/L, OR = 9.73, CI 1.88-50.25) and at first MTX administration (≥342 IU/L, OR = 4.74, CI 1.11-20.26), fewer embryos transferred (OR = 0.37 per each additional embryo transferred, CI 0.19-0.74), and adnexal mass by ultrasound (OR = 3.65, CI 1.10-12.11) were each correlated with greater odds of requiring additional MTX and/or surgery. CONCLUSION This is the first study to report that in women with ectopic pregnancies after IVF, higher hCG-though well below treatment failure thresholds previously described in spontaneous pregnancies-fewer embryos transferred, and adnexal masses are associated with greater odds of failing one dose of MTX. These findings can be used to counsel IVF patients regarding the likelihood of success with single-dose MTX.
Collapse
Affiliation(s)
- Paula C Brady
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Leslie V Farland
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| |
Collapse
|
31
|
Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract 2015; 1:15. [PMID: 28620520 PMCID: PMC5424401 DOI: 10.1186/s40738-015-0008-z] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. FINDINGS Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. CONCLUSION This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
Collapse
Affiliation(s)
- Danielle M. Panelli
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Catherine H. Phillips
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Paula C. Brady
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| |
Collapse
|
32
|
Styer AK, Gaskins AJ, Brady PC, Sluss PM, Chavarro JE, Hauser RB, Toth TL. Dynamic antimüllerian hormone levels during controlled ovarian hyperstimulation predict in vitro fertilization response and pregnancy outcomes. Fertil Steril 2015; 104:1153-61.e1-7. [PMID: 26315051 DOI: 10.1016/j.fertnstert.2015.07.1161] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/13/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the patterns of change in serum antimüllerian hormone (AMH) during controlled ovarian hyperstimulation (COH) and their relation to concurrent response and in vitro fertilization (IVF) pregnancy outcomes. DESIGN Prospective cohort study. SETTING Academic medical center. PATIENT(S) A total of 113 consecutive fresh IVF embryo transfer cycles from September 1, 2012 through January 1, 2013. INTERVENTION(S) Serial serum AMH measurements were analyzed on each day that serum estradiol (E2) was drawn during COH. MAIN OUTCOME MEASURE(S) Relationship between the rate of COH AMH change [Δ ng/mL per day] (stratified into tertiles), and ovarian response, and pregnancy outcomes. RESULT(S) During COH, AMH declined. Age and ovarian reserve testing were associated with the rate of AMH decline (RAD). Women with intermediate and minimal RAD had statistically significantly fewer follicles ≥ 12 mm, lower peak serum E2, fewer oocytes, and inferior early embryo development compared with women with the greatest RAD. Compared with patients with the lowest RAD, clinical pregnancy was more likely in patients with the greatest RAD in the total population (adjusted odds ratio 3.51; 95% confidence interval, 1.03, 11.94) and among patients older than 35 years (adjusted odds ratio 6.95; 95% confidence interval, 1.09, 44.1). CONCLUSION(S) The rate of COH AMH decline was associated with ovarian reserve testing, oocyte yield, embryo progression, and clinical pregnancy rates, particularly in women older than 35 years. These results suggest that dynamic AMH levels may provide a novel intracycle approach to predict response and treatment outcomes after IVF.
Collapse
Affiliation(s)
- Aaron K Styer
- Vincent Department of Obstetrics and Gynecology, Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Medical School, Harvard University, Boston, Massachusetts.
| | - Audrey J Gaskins
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Paula C Brady
- Vincent Department of Obstetrics and Gynecology, Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Medical School, Harvard University, Boston, Massachusetts
| | - Patrick M Sluss
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge E Chavarro
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Russ B Hauser
- Vincent Department of Obstetrics and Gynecology, Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Medical School, Harvard University, Boston, Massachusetts; Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Thomas L Toth
- Vincent Department of Obstetrics and Gynecology, Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Medical School, Harvard University, Boston, Massachusetts
| |
Collapse
|
33
|
Brady PC, Styer AK. Laparoscopic uteroovarian ligament truncation and uterosacral oophoropexy for idiopathic recurrent ovarian torsion: case report and review of literature. Fertil Res Pract 2015; 1:2. [PMID: 28620507 PMCID: PMC5415195 DOI: 10.1186/2054-7099-1-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/23/2014] [Indexed: 11/10/2022]
Abstract
Background Unilateral recurrent ovarian torsion in adults is unusual following treatment of common underlying risk factors (e.g. benign cysts). Subtle anatomic etiologies, such as an elongated uteroovarian ligament and robust ovarian volume, are commonly underappreciated and may contribute to idiopathic recurrent unilateral torsion in adults. As seen in this case, combined surgical procedures may be required to prevent recurrence. Case 28 year old nulligravid woman with seven episodes of right ovarian torsion (without adnexal pathology)—six of those within 18 months—refractory to a series of previous surgical interventions. Laparoscopic uteroovarian ligament truncation with interval uterosacral ligament oophoropexy was employed. Ovarian torsion has not occurred in 45 months. Conclusion Uteroovarian ligament truncation and uterosacral ligament oophoropexy is a feasible and effective combined surgical approach for the prevention of recurrent idiopathic ovarian torsion in adults without obvious risk factors.
Collapse
Affiliation(s)
- Paula C Brady
- Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 USA
| | - Aaron K Styer
- Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 USA.,Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Harvard Medical School, Yaw 10A, 55 Fruit Street, Boston, MA 02114 USA
| |
Collapse
|
34
|
Brady PC, Kaser DJ, Ginsburg ES, Ashby RK, Missmer SA, Correia KF, Racowsky C. Serum progesterone concentration on day of embryo transfer in donor oocyte cycles. J Assist Reprod Genet 2014; 31:569-75. [PMID: 24619510 DOI: 10.1007/s10815-014-0199-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/24/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the association between serum progesterone (P) levels on the day of embryo transfer (ET) and pregnancy rates in fresh donor IVF/ICSI cycles. METHODS Fresh donor cycles with day 3 ET from 10/2007 to 8/2012 were included (n = 229). Most cycles (93 %) were programmed with a gonadotropin releasing hormone (GnRH) agonist; oral, vaginal or transdermal estradiol was used for endometrial priming, and intramuscular P was used for luteal support (50-100 mg/day). Recipient P levels were measured at ET, and P dose was increased by 50-100 % if <20 ng/mL per clinic practice. The main outcome measure was rate of live birth (> = 24 weeks gestational age). Generalized estimating equations were used to account for multiple cycles from the same recipient, adjusted a priori for recipient and donor age. RESULTS Mean recipient serum P at ET was 25.5 ± 10.1 ng/mL. Recipients with P < 20 ng/mL at ET, despite P dose increases after ET, were less likely to achieve clinical pregnancy (RR = 0.75, 95 % CI = 0.60-0.94, p = 0.01) and live birth (RR = 0.77, 95 % CI = 0.60-0.98, p = 0.04), as compared to those with P ≥ 20 ng/mL. P dose increases were more often required in overweight and obese recipients. CONCLUSIONS Serum P levels on the day of ET in fresh donor IVF/ICSI cycles were positively correlated with clinical pregnancy and live birth rates. An increase in P dose after ET was insufficient to rescue pregnancy rates. Overweight and obese recipients may require higher initial doses of P supplementation. Future research is needed to define optimal serum P at ET and the interventions to achieve this target.
Collapse
Affiliation(s)
- Paula C Brady
- Department of Obstetrics, Gynecology and Reproductive Biology, Division of Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | | | | | | | | | | |
Collapse
|
35
|
Brady PC, Simpson LL, Lewin SN, Smok D, Lerner JP, D'Alton ME, Herzog TJ, Wright JD. Safety of conservative management of ovarian masses during pregnancy. J Reprod Med 2013; 58:377-382. [PMID: 24050025] [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: 06/02/2023]
Abstract
OBJECTIVE To determine the clinical outcomes and risk factors for persistence of ovarian cysts in pregnant women. With the increased use of ultrasound in pregnancy, the identification of incidental ovarian masses is becoming more common. STUDY DESIGN An observational study of women with ovarian masses identified before 24 weeks of pregnancy was performed. Only women who underwent follow-up imaging or surgery were included. Factors associated with persistence and outcomes of women who underwent surgery were analyzed. RESULTS Of the 803 women with available follow-up, the cysts resolved in 707 (88.1%) patients. Fifty (6.2%) women underwent surgical intervention. Women with persistent cysts were younger, more often Hispanic, detected at a later gestational age, had larger cysts, and more often had complex or solid components (p < 0.05 for all). Overall, 1 (0.1%) malignancy was diagnosed (a patient with a B-cell lymphoma), while 3 (0.4%) women had borderline epithelial ovarian tumors. CONCLUSION Ovarian masses identified during pregnancy have a low risk of malignancy. The majority of women can be serially monitored without intervention.
Collapse
Affiliation(s)
- Paula C Brady
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 8th Floor, New York, NY 10032, USA
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Brady PC, Correia KF, Missmer SA, Hornstein MD, Barton SE. Early beta-human chorionic gonadotropin trends in vanishing twin pregnancies. Fertil Steril 2013; 100:116-21. [DOI: 10.1016/j.fertnstert.2013.02.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/20/2013] [Accepted: 02/28/2013] [Indexed: 11/16/2022]
|
37
|
Montero FJ, Simpson LL, Brady PC, Miller RS. Fetal omphalocele ratios predict outcomes in prenatally diagnosed omphalocele. Am J Obstet Gynecol 2011; 205:284.e1-7. [PMID: 22071066 DOI: 10.1016/j.ajog.2011.06.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/10/2011] [Accepted: 06/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate whether ratios considering omphalocele diameter relative to fetal biometric measurements perform better than giant omphalocele designation at predicting inability to achieve neonatal primary surgical closure. STUDY DESIGN Cases of fetal omphalocele that underwent evaluation between May 2003 and July 2010 were identified. Inclusion was restricted to live births with plan for postnatal repair. Omphalocele diameter upon antenatal ultrasound was compared with abdominal circumference, femur length, and head circumference, yielding the respective omphalocele (O)/abdominal circumference (AC), O/femur length (FL), and O/head circumference (HC) ratios. The absolute measurements were used to classify giant lesions. Omphalocele ratios and giant omphalocele designations were evaluated as predictors of inability to achieve primary repair. RESULTS Among 25 included cases, staged or delayed closure occurred in 52%. With an optimal cutoff of 0.21 or greater, O/HC best predicted the primary outcome (sensitivity, 84.6%; specificity, 58.3%; odds ratio, 7.7). The O/HC of 0.21 or greater outperformed giant designations. CONCLUSION The O/HC of 0.21 or greater best predicted staged or delayed omphalocele closure. Giant omphalocele designation, regardless of definition, poorly predicted outcome.
Collapse
|
38
|
Montero FJ, Brady PC, Miller RS, Simpson LL. 406: Standardized predictors of fetal omphalocele: can they detect inability to perform primary operative repair? Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.425] [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: 11/26/2022]
|
39
|
Brady PC, Chen X, Burke WM, Deutsch I, Sun X, Herzog TJ, Wright JD. Detection and significance of parametrial micrometastases in early-stage cervical cancer. Anticancer Res 2011; 31:243-247. [PMID: 21273605] [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
BACKGROUND Parametrial metastases are rare in women with small, node-negative cervical tumors. We examined the incidence of micrometastases in women with pathologically negative parametria. PATIENTS AND METHODS Patients with IA-IB cervical cancer who underwent radical hysterectomy and had no evidence of parametrial metastases were examined. Immunohistochemistry (IHC) using a cytokeratin antibody was performed in parametrial sections. RESULTS Among 46 patients, a parametrial micrometastasis was identified in 1 (2.2%). Micrometastases were seen in 5% of women with lymphvascular space invasion (LVSI) and in 0 (0%) patients without LVSI (p=0.43). The patient with a parametrial micrometastasis experienced recurrence and died from her disease. In a previous report, we defined patients with tumors <2 cm, negative pelvic lymph nodes, and no LVSI as being at low-risk for parametrial disease. There were no micrometastases in this group of women in the current series. CONCLUSION Parametrial micrometastases are uncommon in early-stage cervical cancer.
Collapse
Affiliation(s)
- Paula C Brady
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | | | | | | | | | | | | |
Collapse
|
40
|
Brohez M, Brady PC, Rennie CP, Slabach R, Perez J, Hall TS. Substance abuse and diagnosis of cervical spine injuries: policy consideration. Conn Med 2008; 72:69-73. [PMID: 18306832] [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
BACKGROUND Cervical spine injury occurs in 2% to 6% of patients with blunt injury. Standard cervical radiographs are widely accepted as a primary screen, but may miss injuries. Diagnoses are further confounded by patients' use of alcohol or drugs, which may delay diagnosis. OBJECTIVE To compare the rate of incomplete cervical radiographs and to compare the sensitivity of cervical radiographs and neck computed tomography (CT) in patients with cervical spine injury, with and without substance abuse. DESIGN A retrospective chart review. SETTING A community teaching hospital. PATIENTS Eighty-five high-severity trauma cases between 6/1/03 and 5/28/05. METHODS Retrospective chart review of cervical spine imaging studies, alcohol levels, toxicology screens and clinical diagnosis. RESULTS Cervical radiographs generated false negatives or incomplete studies in all injured patients with significant levels of alcohol (> or = 80 mg/ dL) or drugs detected on toxicology screens. Cervical CT produced no false negatives. CONCLUSIONS Drug and alcohol screens are important adjunct studies to identify patients with substance abuse who are more prone to sustain cervical spine injury that is likely to be missed by plain cervical radiographs. Cervical CT maybe a better primary imaging study for detection of cervical spine injury in trauma patients with suspected substance abuse.
Collapse
|
41
|
|