RESUMO
OBJECTIVE: To investigate which attributes of reproductive endocrinology and infertility (REI) fellowship applicants are most valued by fellowship program directors during the match process. STUDY DESIGN: An electronic survey was administered to determine characteristics most favored by program directors in the selection of REI fellows. A 5-point Likert scale was utilized to rank characteristics, with 1 being "most important" and 5 being" least important." The main outcome measures were factors desired by REI fellowship directors. RESULTS: The overall response rate was 61%. Objective factors that ranked highly were training at a competitive obstetrics and gynecology (OB/GYN) residency program, and clinical or basic science research experience. First authorship research ranked favorably regardless of whether it was in the form of a peer-reviewed paper, oral presentation, or poster abstract. Personal interview and perceived ability to work well with others were subjective factors considered favorably by REI fellowship directors. CONCLUSION: When selecting REI fellows for interviews, fellowship directors value candidates who have trained at competitive OB/GYN residency programs, who have clinical or basic science research experience, and who have contributed to scientific literature as first author. When subsequently ranking fellowship applicants, however, the most important factors are those found in the interview process, such as identification as a "team player".
Assuntos
Bolsas de Estudo , Ginecologia/educação , Internato e Residência , Obstetrícia/educação , Critérios de Admissão Escolar , Humanos , Infertilidade , Masculino , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To determine if current recommendations for weight gain in twin pregnancies according to maternal prepregnancy body mass index (PPBMI) influence perinatal outcomes. METHODS: We identified women with twins enrolled in a maternity risk screening and education program with initial screening and prenatal care initiated at <20 weeks and delivery at >23.9 weeks. Women with normal, overweight, or obese PPBMI were included (n = 5129). Pregnancy outcomes were compared between those women with weight gain meeting or exceeding 2009 Institute of Medicine recommendations and patients who did not meet weight gain guidelines. RESULTS: Rates of spontaneous preterm delivery at <35 weeks were higher in all PPBMI groups for those with weight gain below guidelines. In all PPBMI groups, numbers of pregnancies with both infants weighing >2500 g or >1500 g were significantly higher for women gaining weight at or above guidelines. Logistic regression analysis was utilized to assess multivariate impact on outcome of spontaneous preterm delivery at <35 weeks showing that regardless of PPBMI level, women who gain below recommended guidelines are 50% more likely to deliver spontaneously at <35 weeks. CONCLUSION: In twin pregnancies, weight gain below recommended guidelines determined by maternal PPBMI is associated with higher rates of spontaneous preterm delivery at <35 weeks.
Assuntos
Composição Corporal/fisiologia , Índice de Massa Corporal , Peso Corporal/fisiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Gravidez de Gêmeos/fisiologia , Nascimento Prematuro/etiologia , Aumento de Peso/fisiologia , Adulto , Feminino , Guias como Assunto , Humanos , Recém-Nascido , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Estados UnidosRESUMO
A woman presented with virilization symptoms and elevated testosterone; however, a neoplastic source of excess androgen was not found on imaging. Eventually, the patient revealed she was exposed to transdermal testosterone used by her partner. This case highlights the importance of considering exogenous androgens in the differential diagnosis of virilization.
Assuntos
Androgênios/efeitos adversos , Testosterona/efeitos adversos , Virilismo/induzido quimicamente , Feminino , Humanos , Adulto JovemRESUMO
We sought to determine if outcomes of nulliparous twin pregnancies differ based on maternal age. Nulliparous women with current twin pregnancies were identified from a database of women enrolled for outpatient nursing surveillance. Data were stratified into four groups by maternal age: less than 20, 20 to 34, 35 to 39, and greater than or equal to 40 years. Maternal and neonatal outcomes for women less than 20, 35 to 39, and 40 or more were compared with 20- to 34-year-old controls using Kruskal-Wallis, Mann-Whitney, and Pearson chi-square analyses. We analyzed 2144 nulliparous twin pregnancies. Patients ≥35 years (34 to 39, 78.5% or ≥40, 85.9%) were more likely to have cesarean deliveries compared with controls 20 to 34 years old (71.2%). Women aged 35 to 39 were less likely to deliver at <37 weeks, and women in the ≥40 group were less likely to deliver at <35 weeks due to spontaneous preterm labor compared with the controls. Neonates born to women aged 35 to 39 had a greater gestational age at delivery and larger average birth weight than controls. Maternal and neonatal outcomes were not adversely influenced by advanced maternal age in nulliparous women carrying twin gestations.
Assuntos
Peso ao Nascer , Idade Materna , Resultado da Gravidez , Gravidez Múltipla , Adulto , Cesárea , Distribuição de Qui-Quadrado , Feminino , Idade Gestacional , Humanos , Trabalho de Parto Prematuro , Paridade , Gravidez , Estatísticas não Paramétricas , Gêmeos , Adulto JovemRESUMO
PURPOSE: Poor nutritional status has been associated with increased postoperative morbidity and mortality in surgical patients. The purpose of this study is to evaluate if decreased nutritional parameters correlate with increased postoperative complications regardless of other risk factors in the gynecologic cancer patient. METHODS: A retrospective chart review was performed among women who underwent surgical management for gynecologic malignancies from October 2006 to June 2008. Variables included age, race, medical comorbidities, cancer type/stage, preoperative albumin, absolute lymphocyte count (ALC), and body mass index (BMI), estimated blood loss (EBL), intraoperative blood transfusion (BT), intraoperative or postoperative complications, intensive care unit (ICU) admissions, hospital readmissions, reoperations, and cancer recurrence. RESULTS: Three hundred gynecologic oncology patients with preoperative nutritional parameters were included in the study. Decreased albumin was significantly associated with more postoperative complications (p < 0.001), hospital readmissions (p = 0.01), reoperations (p = 0.03), ICU admissions (p < 0.001), and cancer recurrence (p < 0.001). Decreased ALC and BMI preoperatively was also significantly associated with higher incidence of cancer recurrence (p = 0.01, p = 0.01). Surgical cases involving increased EBL (p = 0.01, p < 0.001) and more BT (p < 0.001, p < 0.001) had significantly more postoperative complications and more ICU admissions. Multivariable logistic regression found preoperative albumin to be an independent predictor of increased postoperative complications. CONCLUSIONS: Decreased albumin is significantly associated with more postoperative complications, hospital readmissions, reoperations, ICU admissions, and cancer recurrence. This nutritional parameter is an important predictor of postoperative morbidity and mortality. Thus, it is important to assess nutritional status preoperatively and offer nutritional support or alternate treatment options if necessary.
Assuntos
Neoplasias dos Genitais Femininos/complicações , Neoplasias dos Genitais Femininos/cirurgia , Desnutrição/complicações , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Transfusão de Sangue , Índice de Massa Corporal , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Cuidados Críticos , Feminino , Humanos , Incidência , Complicações Intraoperatórias , Modelos Logísticos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Readmissão do Paciente , Prognóstico , Reoperação , Estudos Retrospectivos , Albumina Sérica/metabolismoRESUMO
OBJECTIVE: To compare blood loss and need for blood transfusions in women who underwent abdominal myomectomies after receiving vasopressin or combined vasopressin and tourniquet. METHODS: A retrospective chart review was performed reviewing abdominal myomectomies that took place at our institution. Subjects were divided into three groups: no intervention, vasopressin, or combined vasopressin and tourniquet. Blood loss, need for blood transfusion, and drop in hemoglobin and hematocrit were compared across all groups. RESULTS: One-hundred and thirty-two subjects were included in the study. No statistically significant difference was found between groups in blood loss, drop in hemoglobin or hematocrit, or blood transfusions. CONCLUSION: Combined vasopressin and tourniquets was not associated with a statistically significant decrease in blood loss or need for blood transfusion.
Assuntos
Perda Sanguínea Cirúrgica , Hemostasia Cirúrgica/métodos , Leiomioma/cirurgia , Torniquetes , Neoplasias Uterinas/cirurgia , Vasopressinas/uso terapêutico , Adulto , Transfusão de Sangue , Volume Sanguíneo , Feminino , Hematócrito , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To determine whether fresh embryo transfers are at a higher risk of abnormal implantation compared with frozen embryo transfers while accounting for the embryo stage at transfer. DESIGN: Retrospective cohort study. SETTING: Not applicable. PATIENT(S): We used data from the Society for Assisted Reproductive Technologies to identify all fresh and frozen autologous IVF cycles from 2004-2013 resulting in a positive pregnancy test. The cycles were parameterized into a four-level predictor of [1] fresh blastocyst transfer, [2] fresh non-blastocyst transfer, [3] frozen blastocyst transfer, and [4] frozen non-blastocyst transfer. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): We examined a composite outcome of abnormal implantation, defined as biochemical pregnancy, ectopic/heterotopic pregnancy, and first-trimester pregnancy loss. Regression modeling was performed with repeated measures multivariable logistic regression, adjusted for age, parity, number of embryos transferred, infertility diagnosis, and calendar year of treatment. RESULT(S): Of 509,938 cycles analyzed, 31.8% resulted in abnormal implantation. Compared with a fresh blastocyst transfer, a fresh non-blastocyst transfer had a 22% increase risk of abnormal implantation, a frozen blastocyst transfer had a 36% increase risk, and a frozen non-blastocyst transfer had a 57% increase risk. When individual outcomes were analyzed, fresh embryo transfers had a lower risk of biochemical pregnancy and pregnancy loss but a higher risk for ectopic/heterotopic pregnancy. CONCLUSION(S): Fresh blastocyst transfers had the lowest overall risk of abnormal implantation but a higher risk of ectopic/heterotopic pregnancy. Although embryo cryopreservation is indicated in certain treatment cycles, elective embryo cryopreservation may not be the optimal strategy to adopt for all cycles.
Assuntos
Criopreservação/estatística & dados numéricos , Perda do Embrião/mortalidade , Transferência Embrionária/mortalidade , Infertilidade/mortalidade , Infertilidade/terapia , Resultado da Gravidez/epidemiologia , Gravidez Ectópica/mortalidade , Adolescente , Adulto , Distribuição por Idade , Estudos de Coortes , Criopreservação/métodos , Transferência Embrionária/estatística & dados numéricos , Feminino , Fertilização in vitro , Humanos , Incidência , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
The neuropeptide kisspeptin is essential for sexual maturation and reproductive function. In particular, kisspeptin-expressing neurons in the anterior rostral periventricular area of the third ventricle are generally recognized as mediators of estrogen positive feedback for the surge release of LH, which stimulates ovulation. Estradiol induces kisspeptin expression in the neurons of the rostral periventricular area of the third ventricle but suppresses kisspeptin expression in neurons of the arcuate nucleus that regulate estrogen-negative feedback. To focus on the intracellular signaling and response to estradiol underlying positive feedback, we used mHypoA51 cells, an immortalized line of kisspeptin neurons derived from adult female mouse hypothalamus. mHypoA51 neurons express estrogen receptor (ER)-α, classical progesterone receptor (PR), and kisspeptin, all key elements of estrogen-positive feedback. As with kisspeptin neurons in vivo, 17ß-estradiol (E2) induced kisspeptin and PR in mHypoA51s. The ERα agonist, 1,3,5-Tris(4-hydroxyphenyl)-4-propyl-1H-pyrazole, produced similar increases in expression, indicating that these events were mediated by ERα. However, E2-induced PR up-regulation required an intracellular ER, whereas kisspeptin expression was stimulated through a membrane ER activated by E2 coupled to BSA. These data suggest that anterior hypothalamic kisspeptin neurons integrate both membrane-initiated and classical nuclear estrogen signaling to up-regulate kisspeptin and PR, which are essential for the LH surge.
Assuntos
Estrogênios/farmacologia , Hipotálamo Anterior/citologia , Kisspeptinas/metabolismo , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Animais , Células Cultivadas , Estradiol/farmacologia , Feminino , Kisspeptinas/genética , Camundongos , Camundongos Endogâmicos C57BL , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transdução de Sinais/efeitos dos fármacosRESUMO
OBJECTIVE: To report our center's pregnancy rates (PR) by intravaginal insemination (IVI) or intrauterine insemination (IUI) in 82 couples with male partners with spinal cord injuries. DESIGN: Retrospective analysis. SETTING: Major medical center. PATIENT(S): Male patients with spinal cord injuries and their female partners. INTERVENTION(S): Intravaginal insemination and IUI. MAIN OUTCOME MEASURE(S): Pregnancy and live birth outcomes. RESULT(S): Overall, 31 of the 82 couples (37.8% PR) achieved 39 pregnancies. Sperm were obtained by masturbation, penile vibratory stimulation, or electroejaculation in 4 men (4.9%), 42 men (51.2%), and 36 men (43.9%), respectively. Intravaginal insemination, performed mostly at home by selected couples, was undertaken in 45 couples, 17 of whom (37.8% PR) achieved 20 pregnancies. Intrauterine insemination was performed in 57 couples, 14 of whom (24.6% PR) achieved 19 pregnancies, with a cycle fecundity of 7.9%. Eighteen and 21 live births occurred by IVI and IUI, respectively. CONCLUSION(S): The methods of IVI and IUI are reasonable options for this patient population. These methods warrant consideration before proceeding to assisted reproductive technologies (ART).
Assuntos
Infertilidade Masculina/terapia , Inseminação Artificial Homóloga , Traumatismos da Medula Espinal/complicações , Adulto , Distribuição de Qui-Quadrado , Feminino , Florida , Humanos , Infertilidade Masculina/etiologia , Nascido Vivo , Masculino , Pessoa de Meia-Idade , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: We report a case of a large giant cell tumor of the thoracic spine presenting with spinal cord compression during pregnancy. CASE: A 24-year-old woman presented at term with lower back pain, bilateral lower extremity weakness, numbness, and bowel and bladder incontinence. Magnetic resonance imaging revealed a spinal soft tissue mass compressing the spinal cord. The patient delivered a healthy girl by cesarean then underwent a T8-T9 laminectomy, posterior spinal decompression, and instrument fusion. Two days later, she had a thoracotomy, corpectomy of the vertebral body, and anterior tumor debulking. Ultimately, the patient was discharged to inpatient rehabilitation with improved lower extremity strength and returned bowel and bladder function. CONCLUSION: Obstetricians should be vigilant regarding progressive neurologic symptoms during pregnancy.
Assuntos
Neoplasias Ósseas/diagnóstico , Tumor de Células Gigantes do Osso/diagnóstico , Paresia/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Compressão da Medula Espinal/diagnóstico , Neoplasias Ósseas/reabilitação , Neoplasias Ósseas/cirurgia , Cesárea , Descompressão Cirúrgica , Incontinência Fecal/diagnóstico , Incontinência Fecal/reabilitação , Incontinência Fecal/cirurgia , Feminino , Tumor de Células Gigantes do Osso/reabilitação , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Recém-Nascido , Laminectomia , Imageamento por Ressonância Magnética , Paresia/reabilitação , Paresia/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/reabilitação , Complicações Neoplásicas na Gravidez/cirurgia , Compressão da Medula Espinal/reabilitação , Compressão da Medula Espinal/cirurgia , Fusão Vertebral , Toracotomia , Resultado do Tratamento , Incontinência Urinária/diagnóstico , Incontinência Urinária/reabilitação , Incontinência Urinária/cirurgia , Adulto JovemRESUMO
OBJECTIVE: To determine if outcomes after in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI) using sperm from men with spinal cord injury (SCI group) differ from those of other etiologies of male factor infertility (non-SCI group). In men with SCI, to determine if IVF/ICSI outcomes differ with sperm obtained by penile vibratory stimulation (PVS group) versus electroejaculation (EEJ group). DESIGN: Retrospective analysis. SETTING: University medical center and major infertility center. PATIENT(S): Couples with male factor infertility due to SCI versus other etiologies. INTERVENTION(S): PVS, EEJ, surgical sperm retrieval, and IVF/ICSI. MAIN OUTCOME MEASURE(S): Rates of fertilization, pregnancy, and live birth. RESULT(S): A total of 31 couples in the SCI group underwent 48 cycles of IVF/ICSI, and a total of 297 couples in the non-SCI group underwent 443 cycles of IVF/ICSI. The SCI group had lower fertilization rates but similar pregnancy and live birth rates compared with the non-SCI group. These rates, however, did not differ significantly when the PVS group was compared with the EEJ group. CONCLUSION(S): IVF/ICSI of sperm from men with SCI yield lower fertilization rates but similar pregnancy and live birth outcomes as IVF/ICSI of sperm from men with other etiologies of male factor infertility. Sperm collected by PVS versus EEJ in men with SCI appear to result in similar IVF/ICSI success rates.
Assuntos
Estimulação Elétrica/métodos , Infertilidade Masculina/terapia , Resultado da Gravidez , Injeções de Esperma Intracitoplásmicas/métodos , Traumatismos da Medula Espinal/complicações , Vibração/uso terapêutico , Adulto , Ejaculação/fisiologia , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Pessoa de Meia-Idade , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Sêmen/citologiaRESUMO
OBJECTIVE: To determine threshold ß-hCG levels predictive of an ongoing pregnancy (OP), live birth (LB), and multiple gestation (MG) in IVF cycles resulting from day-3 (D3) vs. day-5 (D5) embryo transfers (ET), to compare IVF cycle characteristics and pregnancy outcomes in D3 vs. D5 ET groups, and to assess the degree to which maternal characteristics and cycle parameters were predictive of higher ß-hCG levels. DESIGN: Retrospective analysis. SETTING: Infertility center. PATIENT(S): Women who had ET performed for IVF cycles between July 2004 and January 2010. INTERVENTION(S): Embryo transfer performed on either D3 or D5 after oocyte fertilization. MAIN OUTCOME MEASURE(S): Beta-hCG on day 15 after oocyte fertilization. RESULT(S): Beta-hCG levels were significantly higher with D5 ET compared with D3 ETs (D3: 103.6 ± 4.4 IU/L vs. D5: 198.0 ± 10.6 IU/L), and a multivariate analysis demonstrated that D5 ET was a significant predictor of higher ß-hCG levels. The ß-hCG thresholds predictive of OP were 78 IU/L and 160 IU/L for D3 and D5 ET, which predicted OP in 96% and 91% of cases, respectively. Similarly, for LB, the ß-hCG thresholds were 94 IU/L (79% positive predictive value [PPV]) and 160 IU/L (88% PPV), and for MG were 250 IU/L (18% PPV) and 316 IU/L (34% PPV), respectively. CONCLUSION(S): Initial ß-hCG levels are dependent on the day of ET and are a reliable and highly predictive tool for OP outcomes.