Maternity After Orthotopic Liver Transplantation: Can the Use of Biological Fertility Indicators Help? Our Own Experience and Literature-based Recommendations.

Over the last 5 decades, the fulfillment of maternity wishes in solid organ transplanted women has become a reality. Despite pregnancy contraindication in transplanted women during the early post-transplant period, such a condition can be overcome after 12 months if patients show a good clinical evolution and do not present other general pre-conceptional findings. This article presents the case report of a young female liver transplanted patient that used symptothermal method as a reliable family planning method. After her gestational contraindication was lifted, observation of biological fertility indicators and fertility-guided sexual intercourse helped her fulfill her maternity wish and conceive and carry out a healthy offspring. Based on this case and on the available bibliographic evidence, this paper reviews the potential implications of the use of this kind of approach as a safe and effective alternative to assisted reproduction technology in the management of potential infertility problems in the young female transplanted population, a population which according to literature has higher rates of unsuccessful parenthood and might also be more vulnerable to iatrogenicity of ovarian hyperstimulation process and to multiple pregnancy.

Severe pain during hysterosalpingo-contrast sonography (HyCoSy): a systematic review and meta-analysis.

PURPOSE: To assess the frequency of severe pain perception during hysterosalpingo-contrast sonography (HyCoSy) in infertile women and to assess whether there are differences in the frequency of associated pain according to the contrast used. DESIGN: Systematic review and meta-analysis. PATIENTS: Women undergoing HyCoSy due to infertility. INTERVENTIONS: Searches were carried out in two databases (Pubmed and Web of Science). We included prospective or retrospective cohort observational studies that specified the type of contrast used during HyCoSy and reported data regarding the number of patients who perceived severe pain during the procedure and the scale used for pain perception score. MAIN OUTCOME MEASURES: Pooled frequency of severe pain perception during HyCoSy and the pooled frequency of severe pain perception based on the contrast used. RESULTS: Twenty-nine studies were included in this meta-analysis including a total of 7139 patients. In 10 studies, Saline solution with air was used as contrast EchoVist™ was used in ten studies, in five studies, SonoVue™ was used and in four studies, ExEm-Foam™ was used as contrast. Pooled estimated frequency of severe pain perception during HyCoSy was 6% (95% CI 4-9). No statistically significant differences have been described regarding frequency of severe pain perception in relation to the different contrasts used. CONCLUSIONS: HyCoSy is a tolerable outpatient procedure. We did not find any evidence that one specific contrast was better tolerated than any other was.

Three-Dimensional Hysterosalpingo-Contrast-Sonography for the Assessment of Tubal Patency in Women with Infertility: A Systematic Review with Meta-Analysis.

BACKGROUND/AIMS: We aimed at performing a systematic review to determine the diagnostic accuracy of three-dimensional (3D) hysterosalpingo-contrast-sonography (HyCoSy) for detecting tubal occlusion. METHODS: A systematic review in Medline database search from January 1989 to October 2015 to identify relevant studies evaluating 3D-HyCoSy. Eligibility criteria were studies assessing the role of 3D-HyCoSy for diagnosing tubal occlusion in infertile women. Index test was 3D-HyCoSy. Reference standard was laparoscopy with dye test or X-ray hysterosalpingography. Quality was assessed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity for the method were estimated. RESULTS: A total number of 88 papers were identified. After exclusions, nine studies were ultimately included. Pooled estimated sensitivity was 98% (95% CI 91-100) with a moderate heterogeneity (I2: 64.8%, 95% CI 39.6-89.9; and Cochran Q 22.7, p < 0.001). Pooled estimated specificity was 90% (95% CI 83-95) with significant heterogeneity (I2: 80.3%, 95% CI 68.1-92.5; and Cochran Q 40.6, p < 0.001). Positive likelihood ratio was 10.3 (95% CI 5.6-18.7) and negative likelihood ratio was 0.02 (95% CI 0.00-0.21). CONCLUSION: 3D-HyCoSy is an accurate test for diagnosing tubal occlusion in women with infertility.

Androgen therapy in women: for whom and when.

Androgens play a primary role in female physiopathology. The age-related reduction in the production of ovarian and adrenal androgens may significantly affect women's health. The decline of circulating androgens results from a combination of two events: reduced ovarian production and aged-related decline in adrenal androgen synthesis. The relative androgen deficiency in pre- and postmenopausal women may induce impairment of sexual function, libido, well-being, energy and may contribute to reduced cognitive functions. Whether androgen deficiency also affects cardiovascular or bone biology in women during reproductive aging is still controversial. Both in the central nervous system and peripheral tissues, there are multiple ways whereby androgens target their specific actions through a particular tropism of the brain areas that are involved in sexual function, behavior and cognition. Among circulating available androgens that are involved in several domains of sexual response, adrenal androgens seem to be related to some sexual symptoms as well as diminished cognitive function in postmenopausal women. The possibilities of treating low sexual desire/hypoactive sexual desire disorder are multifaceted and should include the combination of both pharmacological treatments able to maximize biological signals that drive the sexual response as well as individualized psychosocial therapies to overcome personal and relational difficulties. Transdermal testosterone has been proved to be effective but the use of additional treatment like oral or vaginal dehydroepiandrosterone is still controversial, despite many evidences support it. The decision to treat premenopausal or postmenopausal women with signs/symptoms of androgen insufficiency is mainly based on the clinical judgment, together with estrogens co-administration and following informed consent related to the unknown long-term risks.

Women's attitudes towards mechanisms of action of birth control methods: a cross-sectional study in five European countries.

AIMS AND OBJECTIVES: To assess women's attitudes towards the mechanisms of action of birth control methods. BACKGROUND: When addressing women's knowledge of and attitudes towards birth control methods, researchers frequently focus on side effects, effectiveness or correct use. Women's opinions about mechanisms of action have been much less investigated, and research is usually concentrated on the EC pill. DESIGN: Cross-sectional study. METHODS: Women, aged 18-49, from Germany, France, the UK, Sweden and Romania were randomly selected (n = 1137). They were asked whether they would use a method that may work after fertilisation or after implantation and whether they would continue using it after learning it may have such effects. Logistic regression was performed to evaluate the influence of certain characteristics on women's attitudes. RESULTS: Almost half of women in Romania and Germany would not use methods with postfertilisation effects, while the lowest percentages were found in Sweden and in France. Regarding methods with postimplantation effects, higher percentages were found in all the countries. Highly educated women and those using a highly effective method were more likely to use methods with postfertilisation effects. On the contrary, married women, those who stated that human life begins at fertilisation and women with middle/high religiosity were less likely to consider using methods that may act after fertilisation. CONCLUSIONS: One-third of European women reported that they would not consider using a method that may have postfertilisation effects. RELEVANCE TO CLINICAL PRACTICE: Given that postfertilisation effects may not be acceptable to some women, informing them of which methods may have these effects is essential to obtaining complete informed consent and to promoting women's autonomy.

Knowledge and beliefs about mechanism of action of birth control methods among European women.

BACKGROUND: Adequate knowledge is essential for making informed decisions. We attempted to determine the level of knowledge about mechanisms of action of birth control methods in five representative samples of European women. STUDY DESIGN: Randomly selected women, aged 18-49 years, completed an anonymous survey in Germany, France, the UK, Sweden and Romania (N=1137). Participants were asked about how contraceptive methods work and if providers should inform them about this issue. Multiple linear regression was used to evaluate women's characteristics associated with their knowledge of mechanisms of action. RESULTS: The majority of women identified the unequivocal mode of action of condoms, sterilization and abortion. Fewer than 2% identified all possible mechanisms of action of hormonal contraceptives and intrauterine devices. Highly educated women correctly identified the mechanism or mechanisms of action of more methods than less educated women (ß=0.22, 95% confidence interval 0.01-0.43). Regardless of their sociodemographic characteristics and their belief about when human life begins, most women (75%) stated that the provider should inform them about possible postfertilization effects. CONCLUSIONS: European women have low knowledge about mechanisms of action of several contraceptive methods. The majority want to be informed about possible postfertilization effects. Since adequate knowledge is essential for making informed decisions, providers are encouraged to inform women about all possible mechanisms of action of contraceptives.