No protection of the ovarian follicle pool with the use of GnRH-analogues or oral contraceptives in young women treated with escalated BEACOPP for advanced-stage Hodgkin lymphoma. Final results of a phase II trial from the German Hodgkin Study Group.

BACKGROUND: The reduction of treatment-related toxic effects is the main goal in the current trials of the German Hodgkin Study Group (GHSG). In this regard, the protection of the ovarian reserve in young women is very important. Therefore, the GHSG investigated the use of gonadotropin-releasing hormone-analogues (GnRH-a) and oral contraceptives (OC) in young women with advanced-stage Hodgkin lymphoma (HL). PATIENTS AND METHODS: Women (18-40 years) were randomly assigned either to receive daily OC or monthly GnRH-a during escalated combination therapy with bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc). Hormonal levels were determined at baseline, during therapy, and at follow-up. RESULTS: The study was closed prematurely after an interim analysis of 12 patients in arm A (OC) and 11 in arm B (GnRH-a), 9 and 10 are assessable for the primary end point. Women's median age was 25 years in both arms. The anti-Mullerian hormone level after at least 12 months was reduced in all patients. For the entire study cohort, the respective ovarian follicle preservation rate was 0% (95% confidence interval 0% to 12%). CONCLUSION: We observed no protection of the ovarian reserve with hormonal co-treatment during BEACOPPesc. This result supports efforts of ongoing trials to reduce chemotherapy intensity and toxicity. Alternative strategies for the protection of fertility must be offered to young female HL patients before the start of BEACOPPesc therapy.

Uterine mechanisms of ipsilateral directed spermatozoa transport: Evidence for a contribution of the utero-ovarian countercurrent system.

OBJECTIVE: Spermatozoa transport into uterus and fallopian tubes is directed to the side of the dominant follicle and seems to be controlled by the ipsilateral ovary. The objective of this study was to evaluate the temperature in the fallopian tubes as well as the concentrations of estradiol and progesterone in the utero-ovarian veins draining the ipsilateral ovary and compare these to the contralateral side of the uterus. STUDY DESIGN: A prospective clinical study. SETTING: Academic-assisted reproductive technology program. SUBJECTS: Temperature was measured in both oviducts of 10 patients each in the early phase as well as during the late follicular phase during the course of examination of tubal patency and function. Blood samples of the ovarian veins were obtained during hysterectomy in 10 premenopausal patients with regular menstrual cycles. Five of the women were in the early follicular phase and 5 were in the late follicular phase. RESULTS: Late follicular phase temperature as well as concentrations of estradiol and progesterone were significantly higher in the ipsilateral tube and the utero-ovarian veins draining the ipsilateral ovary as compared to the contralateral side. No such differences were found during the early follicular phase of the cycle. CONCLUSIONS: These data support our view that the uterus and fallopian tubes during the late follicular phase immediately before ovulation are composed of two functional units with different functional properties acting as a peristaltic pump resulting in increased transport of spermatozoa into the oviduct ipsilateral to the ovary bearing the dominant follicle and that this effect is mediated in part by the utero-ovarian countercurrent system.

[The evaluation of the second-look operation of patients with ovarian carcinoma and tubal carcinoma by means of a retrospective comparison study]. / Die Wertigkeit der Second-Look-Operation bei Patientinnen mit einem Ovarialkarzinom oder Tubenkarzinom mittels einer retrospektiven Vergleichsstudie.

INTRODUCTION: This investigation is a retrospective analysis to evaluate the influence of second-look surgery on the relapse-free and overall survival of patients with ovarian and tubal carcinomas. METHOD: For 208 patients with and without second-look operation out of 469 of the total collective, a matched analysis and a Cox regression model were established in the framework of a multivariate analysis. RESULTS: Second-look surgery in patients with ovarian cancer had no significant influence on the relapse-free and overall survival. The 10-year survival was equal in both groups: CONCLUSION: Second-look surgery cannot be justified on the basis of clinically noninvasive methods such as radiological findings with additional use of tumor markers. It should only be done in control clinical trials to evaluate new means of treatment.