Effect of various contraceptives on oocyte yield and maturation in patients undergoing planned oocyte cryopreservation.

RESEARCH QUESTION: Do the various forms of hormonal and non-hormonal contraceptives have any association with ovarian stimulation outcomes, such as oocyte yield and maturation, in patients undergoing planned oocyte cryopreservation (POC)? DESIGN: This retrospective cohort study included all patients who underwent POC cycles between 2011 and 2023. The use of types of contraception before a POC cycle was recorded. The study evaluated the median number of cumulus-oocyte complexes obtained after vaginal oocyte retrieval and the proportion of metaphase II oocytes that underwent vitrification among all the cohorts. RESULTS: A total of 4059 oocyte freezing cycles were included in the analysis. Eight types of contraceptive method were recognized in patients undergoing ovarian stimulation: intrauterine device (IUD), copper (n = 84); IUD, levonorgestrel low dose (<52 mg) (n = 37); IUD, levonorgestrel (n = 192); subdermal etonogestrel implant (n = 14); injectable medroxyprogesterone acetate (n = 11); etonogestrel vaginal ring (n = 142); combined oral contraceptive pills (n = 2349); and norelgestromin transdermal patch (n = 10). The control group included patients not using contraceptives or using barrier or calendar methods (n = 1220). Among all the cohorts the median number of cumulus-oocyte complexes retrieved during oocyte retrieval was comparable (P = 0.054), and a significant difference in oocyte maturity rate with median number of vitrified oocytes was found (P = 0.03, P < 0.001, respectively). After adjusting for confounders a multivariate analysis found no association between the type of contraceptive and proportion of metaphase II oocytes available for cryopreservation. CONCLUSIONS: Among the various forms of contraception, none was shown to have an adverse association with oocyte yield or maturation rate in patients undergoing POC.

Role of Female Research at the Asociacion Mexicana de Cirugia General Annual Meeting: A Retrospective Analysis From 2013 to 2019.

Background: Academic surgery has been a traditionally male-dominated field. Female contribution remains challenging. In Mexico, there is no published evidence regarding gender disparity in academic surgery. We aimed to analyze the female role in clinical research submitted to the Asociación Mexicana de Cirugía General (AMCG). Methods: Retrospective study evaluating abstracts submitted to AMCG annual meetings from 2013 to 2019. Categorical variables were compared using χ2 test. Univariate logistic regression was performed to calculate odds ratios (OR) followed by a log-binomial logistic regression model to obtain the adjusted relative risk (aRR) for acceptance as an oral presentation. Results: Overall, 7,439 abstracts were analyzed of which 24.2% were submitted by females. Female-submitted abstracts increased from 22.5% to 25.3% during 2013-2019 (p = 0.15). The proportion of 47 abstracts submitted by females was higher in the resident group (27.7% vs. 18.8%; p < 0.001). The percentage of females' abstracts selected for oral presentation was less than the percentage of males' 49 abstracts selected for presentation (9% vs. 11.5%; p = 0.002). Females' abstracts submitted have a 50 23.5% decreased chance of being selected for oral presentation (OR = 0.765, CI 95%, 0.639-0.917, 51 p = 0.003). However, after adjusting for research type and trainee status, the gender of the oral 52 presenting author showed no association (aRR = 0.95, CI 95%, 0.8-1.1, p = 0.56). Conclusion: In Mexico, the female role in academic surgery is still limited. These results should 55 encourage professors and program directors to identify and address factors contributing to gender 56 disparities.

Neoadjuvant chemotherapy and interval debulking surgery for advanced ovarian cancer, an alternative with multiple advantages.

Ovarian cancer, which is mostly diagnosed in advanced stages, is a disease with high mortality among women. Until now, no screening strategies have been accepted and are currently under study because although they help in the diagnosis at early stages, they do not increase survival. The gold standard treatment for advanced ovarian cancer is based on primary debulking surgery (PDS) follow by adjuvant chemotherapy (ACT) with paclitaxel and carboplatin. Recently, treatment alternatives have been proposed: neoadjuvant chemotherapy (NAC) with interval debulking surgery (IDS). This approach has been controversial due to the lack of clinical data on the validity as a safe and successful procedure and because of the high morbidity and mortality associated to this disease. The most important prognostic factor for survival is no residual tumor after surgery; despite of this, numerous tumors do not fulfill the criteria for performing a PDS and associated morbidity is unacceptable high. Based on selected clinical features, NAC-IDS could be a reasonable alternative to those patients with reversible contraindications to primary surgery with the only objective of improving survival and quality of life (QOL). Although, several papers have reported that NAC could induce ACT resistance, neither randomized controlled trials nor meta-analyses have demonstrated this fact. The true is that more advantages have been reported: NAC groups trend toward higher QOL and lower rates of postoperative adverse events. This has been confirmed by two randomized clinical trials, but further studies are needed to support the role of NAC. Meanwhile, patients should receive the best opportunities and the best option for treating this type of cancer.