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1.
JAMA ; 322(22): 2203-2210, 2019 12 10.
Artículo en Inglés | MEDLINE | ID: mdl-31821431

RESUMEN

Importance: An increasing number of children worldwide are born after the use of fertility treatment, although it remains unclear whether the treatment affects the risk of childhood cancer and whether any associations observed are due to the use of specific drugs, the use of specific procedures, or the underlying infertility. Objective: To examine the association between different types of fertility treatments and cancer risk in children. Design, Setting, and Participants: A retrospective cohort study based on Danish population-based registry data and the Danish Infertility Cohort (individual record linkage) that included 1 085 172 children born in Denmark between January 1, 1996, and December 31, 2012, linked with parental information. There were a total of 2217 children diagnosed with cancer (follow-up occurred during 1996-2015). Exposures: Maternal fertility treatment during the index pregnancy, including the use of fertility drugs (clomiphene [n = 33 835], gonadotropins [n = 57 136], gonadotropin-releasing hormone analogs [n = 38 653], human chorionic gonadotropin [n = 68 181], progesterone [n = 41 628], and estrogen [n = 16 948]) and assisted reproductive technology (in vitro fertilization [n = 19 448], intracytoplasmic sperm injection [n = 13 417], and frozen embryo transfer [n = 3356]). Each exposure was examined separately and compared with children born to fertile women. Main Outcomes and Measures: Hazard ratios and incidence rate differences for childhood cancer. Results: After 12.2 million person-years of follow-up (mean, 11.3 years), the incidence rate of childhood cancer was 17.5 per 100 000 for children born to fertile women (n = 910 291) and 44.4 per 100 000 for children born after the use of frozen embryo transfer (n = 3356). Compared with children born to fertile women, the use of frozen embryo transfer was associated with an elevated risk of childhood cancer (14 cancer cases; hazard ratio, 2.43 [95% CI, 1.44 to 4.11]; incidence rate difference, 26.9 [95% CI, 2.8 to 51.0] per 100 000), mainly due to an increased risk of leukemia (5 cancer cases; incidence rate, 14.4 per 100 000; hazard ratio, 2.87 [95% CI, 1.19 to 6.93]; incidence rate difference, 10.1 [95% CI, -4.0 to 24.2] per 100 000) and sympathetic nervous system tumors (<5 cancer cases; hazard ratio, 7.82 [95% CI, 2.47 to 24.70]). There were no statistically significant associations with the use of the other types of fertility treatment examined. Conclusions and Relevance: Among children born in Denmark, the use of frozen embryo transfer, compared with children born to fertile women, was associated with a small but statistically significant increased risk of childhood cancer; this association was not found for the use of other types of fertility treatment examined.


Asunto(s)
Transferencia de Embrión/efectos adversos , Neoplasias/etiología , Técnicas Reproductivas Asistidas , Adulto , Niño , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Fertilización In Vitro , Humanos , Incidencia , Masculino , Neoplasias/epidemiología , Embarazo , Técnicas Reproductivas Asistidas/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Inyecciones de Esperma Intracitoplasmáticas
2.
Fertil Steril ; 112(1): 89-97.e1, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31277770

RESUMEN

OBJECTIVE: To evaluate whether intrauterine injection of hCG before embryo transfer can improve IVF-ET outcomes. DESIGN: Meta-analysis. SETTING: Not applicable. PATIENT(S): Infertile women who underwent IVF-ET and received an intrauterine injection of hCG before ET. INTERVENTION(S): Infertile women treated with or without intrauterine hCG injection before ET. MAIN OUTCOME MEASURE(S): The primary outcomes were live birth rate (LBR), ongoing pregnancy rate (OPR), and clinical pregnancy rate (CPR), and the secondary outcomes were implantation rate (IR) and miscarriage rate (MR). Odds ratios with 95% confidence intervals (CIs) and successful ET rates were pooled to determine the effects of hCG on IVF-ET outcomes. RESULT(S): Fifteen randomized controlled trials (RCTs) with a total of 2,763 participants were included. Infertile women in the experimental group (treated with intrauterine hCG injection before ET) exhibited significantly higher LBR (44.89% vs. 29.76%), OPR (48.09% vs. 33.42%), CPR (47.80% vs. 32.78%), and IR (31.64% vs. 22.52%) than those in the control group (intrauterine injection of placebo or no injection). Furthermore, MR was significantly lower (12.45% vs. 18.56%) in the experimental group than in the control group. CONCLUSION(S): The findings of this meta-analysis indicate that intrauterine injection of hCG can improve LBR, OPR, CPR, and IR after IVF-ET cycles. In addition, different timing and dosages of hCG administration may exert different effects on IVT-ET outcomes. Notably, infertile women treated with 500 IU hCG within 15 minutes before ET can achieve optimal IVF-ET outcomes.


Asunto(s)
Gonadotropina Coriónica/administración & dosificación , Transferencia de Embrión , Fármacos para la Fertilidad Femenina/administración & dosificación , Fertilización In Vitro , Infertilidad Femenina/terapia , Gonadotropina Coriónica/efectos adversos , Implantación del Embrión/efectos de los fármacos , Transferencia de Embrión/efectos adversos , Femenino , Fertilidad/efectos de los fármacos , Fármacos para la Fertilidad Femenina/efectos adversos , Fertilización In Vitro/efectos adversos , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/fisiopatología , Inyecciones , Nacimiento Vivo , Embarazo , Complicaciones del Embarazo/etiología , Índice de Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Resultado del Tratamiento
3.
Fertil Steril ; 112(1): 98-104, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31133384

RESUMEN

OBJECTIVE: To compare the influence of dual suppression with the use of GnRH agonist plus aromatase inhibitor compared with suppression with the use of GnRH agonist alone or no suppression at all in patients with idiopathic recurrent implantation failure (RIF). DESIGN: Retrospective cohort study. SETTING: University-affiliated reproductive center. PATIENT(S): A total of 523 infertile women who failed two blastocyst transfers underwent a third frozen blastocyst transfer. Women with known endometriosis were excluded. INTERVENTION(S): A total of 204 subjects were not pretreated, 143 received 2 months of GnRH agonist (3.75 mg intramuscular leuprolide acetate monthly) only, and 176 received GnRH agonist and aromatase inhibitor (5 mg oral letrozole daily for 60 days). Demographic and stimulation information was collected and cycle outcomes reported. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates. RESULT(S): Age, antral follicle count, basal FSH levels, duration of infertility, previous pregnancies, and full-term deliveries were similar (P>.05). Clinical pregnancy rates were higher among women who received GnRH agonist plus letrozole compared with women who received GnRH agonist only or women without pretreatment (63%, 42%, and 40%, respectively; P<.0001). Live birth rates were higher among women who received GnRH agonist plus letrozole compared with the other groups (56%, 36%, and 34%; P<.0001). No differences in pregnancy outcomes were noted between patients who did not receive pretreatment and those in the GnRH agonist only group. CONCLUSION(S): In patients with RIF, treatment with a GnRH agonist plus letrozole may improve live birth rates in subsequent cycles. We hypothesize that this improvement is due to alterations in the endometrium receptivity or treatment of undiagnosed endometriosis.


Asunto(s)
Inhibidores de la Aromatasa/uso terapéutico , Implantación del Embrión/efectos de los fármacos , Transferencia de Embrión , Fármacos para la Fertilidad Femenina/uso terapéutico , Fertilización In Vitro , Hormona Liberadora de Gonadotropina/agonistas , Infertilidad Femenina/terapia , Letrozol/uso terapéutico , Leuprolida/uso terapéutico , Adulto , Inhibidores de la Aromatasa/efectos adversos , Quimioterapia Combinada , Transferencia de Embrión/efectos adversos , Femenino , Fertilidad/efectos de los fármacos , Fármacos para la Fertilidad Femenina/efectos adversos , Fertilización In Vitro/efectos adversos , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/fisiopatología , Letrozol/efectos adversos , Leuprolida/efectos adversos , Nacimiento Vivo , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Factores de Riesgo , Insuficiencia del Tratamiento
4.
Reprod Biol ; 19(2): 145-148, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31133458

RESUMEN

Vascular endothelial growth factor (VEGF) is the most important angiogenic mediator in ovarian hyperstimulation syndrome OHSS. Studies proved that cabergoline administration blocks the increase in vascular permeability via dephosphorylation of VEGF receptors and hence can be used as prophylactic agent against OHSS. This study aimed at evaluating the effectiveness of early administration of cabergoline in the prevention of OHSS in high risk cases prepared for ICSI. This case series study was conducted on 126 high risk patients prepared for ICSI using the fixed antagonist protocol. High risk patients were defined as having more than 20 follicles >12 mm in diameter, and/or E2 more than 3000 pg/ml when the size of the leading follicle is more than 15 mm. When the size of the leading follicle reached 15 mm, cabergoline was administered (0.5 mg/day) for 8 days. Patients were followed up clinically, ultrasonographically and hematologically. The final E2 was 6099.5 ±â€¯2730 and the mean number of retrieved oocytes was 19.7 ±â€¯7.8. The clinical pregnancy rate was 62/126 (49.2%). There were no significant changes (p > 0.05) comparing hematological parameters, renal function tests and liver function tests between the day of HCG and the day of blastocyst transfer. The incidence of severe OHSS in this group was 1/126 (0.9%), while moderate OHSS was 12 (9.5%) and there were no cases of critical OHSS. We concluded that early administration of cabergoline is a safe and potentially more effective approach for prophylaxis against OHSS in high risk cases.


Asunto(s)
Cabergolina/administración & dosificación , Cabergolina/uso terapéutico , Hormona Liberadora de Gonadotropina/análogos & derivados , Gonadotropinas/efectos adversos , Síndrome de Hiperestimulación Ovárica/tratamiento farmacológico , Adulto , Agonistas de Dopamina/administración & dosificación , Agonistas de Dopamina/uso terapéutico , Esquema de Medicación , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Fármacos para la Fertilidad Femenina/uso terapéutico , Hormona Liberadora de Gonadotropina/administración & dosificación , Hormona Liberadora de Gonadotropina/efectos adversos , Hormona Liberadora de Gonadotropina/uso terapéutico , Gonadotropinas/administración & dosificación , Gonadotropinas/uso terapéutico , Humanos , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Factores de Riesgo , Inyecciones de Esperma Intracitoplasmáticas , Adulto Joven
5.
BJOG ; 126(9): 1127-1133, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31006176

RESUMEN

BACKGROUND: At the end of the 1980s, several studies suggested a potential increased risk of neural tube defects (NTDs) with ovulation induction/fertility drugs, especially with clomiphene citrate (CC). A previous meta-analysis of observational studies evaluating the risk of NTDs associated with the use of CC performed in 1995 found a risk ratio of 1.08 (95% CI 0.76-1.51). Since then, additional studies have been published and the risk of NTDs associated with periconceptional CC exposure may have changed. OBJECTIVE: To perform an updated quantitative meta-analysis of the risk of NTDs associated with periconceptional CC exposure. SEARCH STRATEGY: MEDLINE, Web of Science, and Scopus were searched (October 2018). SELECTION CRITERIA: Comparative cohort and case-control studies investigating the risk of NTDs after periconceptional CC exposure. DATA COLLECTION AND ANALYSIS: Pooled effect sizes with corresponding 95% CIs were calculated using random effects models, comparing the risk of NTDs between pregnancies exposed and not exposed to CC. MAIN RESULTS: Thirteen studies met the inclusion criteria, totalling 218 819 pregnancies. Periconceptional exposure to CC was not significantly associated with an increased risk of NTDs (pooled odds ratio 1.21, 95% CI 0.88-1.66). No heterogeneity between studies was observed (I2  = 26%). A funnel plot and asymmetry test were not suggestive of publication bias. CONCLUSION: Our meta-analysis confirms that exposure to CC before or in early pregnancy was associated with a 21% increased risk of NTD in relation to CC exposure; however, this increased risk is not statistically significant. TWEETABLE ABSTRACT: A new meta-analysis finds that clomiphene citrate exposure before or in early pregnancy is not associated with an increased risk of NTDs.


Asunto(s)
Anomalías Inducidas por Medicamentos/epidemiología , Clomifeno/efectos adversos , Fármacos para la Fertilidad Femenina/efectos adversos , Exposición Materna/efectos adversos , Defectos del Tubo Neural/epidemiología , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Infertilidad Femenina/tratamiento farmacológico , Defectos del Tubo Neural/inducido químicamente , Estudios Observacionales como Asunto , Oportunidad Relativa , Inducción de la Ovulación/métodos , Embarazo , Factores de Riesgo
6.
Fertil Steril ; 111(6): 1177-1185.e3, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31029432

RESUMEN

OBJECTIVE: To investigate whether the duration of estrogen administration before euploid embryo transfer affects clinical outcome. DESIGN: Retrospective cohort study. SETTING: Private, academic fertility center. PATIENT(S): Patients (n = 1,439) undergoing autologous freeze-only in vitro fertilization with preimplantation genetic testing (PGT) followed by endometrial preparation with estrogen and progesterone in a frozen, euploid blastocyst transfer cycle. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Primary outcome was live birth, and secondary outcomes included implantation, clinical pregnancy, early pregnancy loss, live birth, infant birthweight, low birth weight, infant gestational age at delivery, and preterm birth. RESULT(S): The duration of estrogen administration (mean: 17.5 ± 2.9 days; range: 10-36 days) before frozen embryo transfer did not impact implantation (odds ratio [OR] 0.99; 95% confidence interval [CI], 0.95-1.03), clinical pregnancy (OR 0.98; 95% CI, 0.94-1.01), early pregnancy loss (OR 1.03; 95% CI, 0.95-1.12), or live birth (OR 0.99; 95% CI, 0.95-1.03). The duration of estrogen exposure did not affect infant birthweight (in grams) (ß= -10.65 ± 8.91) or the odds of low birth weight (OR 0.87; 95% CI, 0.68-1.13). For every additional day of estrogen administration, we observed a reduction in gestational age at delivery (in weeks) (ß= -0.07 ± 0.03), but the odds of preterm delivery were not affected (OR 1.05; 95% CI, 0.95-1.17). CONCLUSION(S): Variation in the duration of estradiol supplementation before progesterone initiation does not impact frozen, euploid blastocyst transfer outcome. The duration of estrogen administration was inversely correlated with gestational age at delivery, but this did not translate into an increase in preterm delivery. Further studies are required on the downstream effects of endometrial preparation on the placental-endometrium interface.


Asunto(s)
Blastocisto , Criopreservación , Implantación del Embrión/efectos de los fármacos , Endometrio/efectos de los fármacos , Estradiol/administración & dosificación , Fármacos para la Fertilidad Femenina/administración & dosificación , Fertilización In Vitro , Infertilidad/terapia , Transferencia de un Solo Embrión , Adulto , Esquema de Medicación , Endometrio/fisiopatología , Estradiol/efectos adversos , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Humanos , Infertilidad/diagnóstico , Infertilidad/fisiopatología , Nacimiento Vivo , Embarazo , Complicaciones del Embarazo/etiología , Índice de Embarazo , Estudios Retrospectivos , Factores de Riesgo , Transferencia de un Solo Embrión/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Vitrificación
7.
J Neurooncol ; 143(1): 137-144, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30868355

RESUMEN

PURPOSE: Meningiomas are more common in females and 70-80% express the progesterone receptor, raising the possibility that high-dose exogenous estrogen/progesterone exposure, such as occurs during fertility treatments, may increase the risk of developing a meningioma. The goal of this study was to report the incidence of prior fertility treatment in a consecutive series of female meningioma patients. METHODS: A retrospective review (2015-2018) was performed of female patients with meningioma, and those with prior fertility treatment were compared to those without fertility treatment using standard statistical methods. RESULTS: Of 206 female patients with meningioma, 26 (12.6%) had a history of fertility treatments. Patients underwent various forms of assisted reproductive technology including: in vitro fertilization (50.0%), clomiphene with or without intrauterine insemination (34.6%), and unspecified (19.2%). Median follow up was 1.8 years. Tumors were WHO grade I (78.6%) or grade II (21.4%). Patients who underwent fertility treatments presented at significantly younger mean age compared to those who had not (51.8 vs. 57.3 years, p = 0.0135, 2-tailed T-test), and on multivariate analysis were more likely to have multiple meningiomas (OR 4.97, 95% CI 1.4-18.1, p = 0.0154) and convexity/falx meningiomas (OR 4.45, 95% CI 1.7-11.5, p = 0.0021). CONCLUSIONS: Patients in this cohort with a history of fertility treatment were more likely to present at a younger age and have multiple and convexity/falx meningiomas, emphasizing the importance of taking estrogen/progesterone exposure history when evaluating patients with meningioma. Future clinical studies at other centers in larger populations and laboratory investigations are needed to determine the role of fertility treatment in meningioma development.


Asunto(s)
Infertilidad Femenina/epidemiología , Infertilidad Femenina/terapia , Neoplasias Meníngeas/epidemiología , Meningioma/epidemiología , Técnicas Reproductivas Asistidas , Adulto , Edad de Inicio , Anciano , Clomifeno/efectos adversos , Clomifeno/uso terapéutico , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Fármacos para la Fertilidad Femenina/uso terapéutico , Estudios de Seguimiento , Humanos , Neoplasias Meníngeas/metabolismo , Neoplasias Meníngeas/patología , Meningioma/metabolismo , Meningioma/patología , Persona de Mediana Edad , Clasificación del Tumor , Receptores Estrogénicos/metabolismo , Receptores de Progesterona/metabolismo , Técnicas Reproductivas Asistidas/efectos adversos , Estudios Retrospectivos , Factores de Riesgo
8.
Fertil Steril ; 111(3): 571-578.e1, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30683591

RESUMEN

OBJECTIVE: To evaluate whether a combination of letrozole and clomiphene citrate (CC) results in higher ovulation rates than letrozole alone in infertile women with polycystic ovary syndrome (PCOS). DESIGN: Open-label randomized controlled trial. SETTING: Academic medical center using two clinic sites. PATIENT(S): Women 18-40 years of age with a diagnosis of infertility and PCOS as defined by the Rotterdam criteria and no other known cause of infertility. INTERVENTIONS(S): Participants were randomized in a 1:1 ratio, stratified by age and body mass index, to either 2.5 mg letrozole alone or the combination of 2.5 mg letrozole and 50 mg CC daily on cycle days 3-7 for one treatment cycle. MAIN OUTCOME MEASURE(S): Ovulation defined as mid-luteal serum progesterone concentration ≥3 ng/mL. RESULT(S): Seventy patients were randomized: 35 to letrozole alone and 35 to letrozole and CC. Results were analyzed according to the intention-to-treat principle. Women who received the combination of letrozole and CC had a statistically higher ovulation rate compared with those who received letrozole alone (27 of 35 women [77%] vs. 15 of 35 women [43%]). There were no serious adverse events or multiple-gestation pregnancies in either group. The side-effects profile was similar in the two treatment groups. CONCLUSION(S): The combination of letrozole and CC was associated with a higher ovulation rate compared with letrozole alone in women with infertility and PCOS. Further studies are needed to evaluate the effect on live birth rate. CLINICAL TRIAL REGISTRATION NUMBER: NCT02802865.


Asunto(s)
Clomifeno/administración & dosificación , Fármacos para la Fertilidad Femenina/administración & dosificación , Infertilidad Femenina/tratamiento farmacológico , Letrozol/administración & dosificación , Inducción de la Ovulación/métodos , Ovulación/efectos de los fármacos , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Adolescente , Adulto , Factores de Edad , Biomarcadores/sangre , Índice de Masa Corporal , Clomifeno/efectos adversos , Femenino , Fertilidad/efectos de los fármacos , Fármacos para la Fertilidad Femenina/efectos adversos , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/fisiopatología , Iowa , Letrozol/efectos adversos , Nacimiento Vivo , Inducción de la Ovulación/efectos adversos , Síndrome del Ovario Poliquístico/diagnóstico , Síndrome del Ovario Poliquístico/fisiopatología , Embarazo , Índice de Embarazo , Progesterona/sangre , Resultado del Tratamiento , Adulto Joven
9.
Trials ; 20(1): 50, 2019 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-30646929

RESUMEN

BACKGROUND: Women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with poor ovarian respond (POR) always have very low clinical pregnancy rates. In previous data, dehydroepiandrosterone (DHEA) was suggested as a promising treatment and maybe has a good pregnancy outcome. But there is no sufficient evidence from randomized clinical trials evaluating the effect of DHEA preconceptional treatment on live birth in POR. METHODS: This trial is a multicenter active-placebo double-blind clinical trial (1:1 treatment ratio of active versus placebo). The infertile POR patients undergoing IVF or ICSI will be enrolled and randomly assigned to two parallel groups. Participants in these two groups will be given 4-12 weeks' treatment of DHEA or placebo, respectively. The primary outcome is live birth rate. DISCUSSION: The results of this study will provide evidence for the effect of preconceptional DHEA treatment on IVF outcome in POR. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-IPR-15006909 . Registered on November 9, 2015.


Asunto(s)
Deshidroepiandrosterona/administración & dosificación , Fármacos para la Fertilidad Femenina/administración & dosificación , Fertilización In Vitro , Infertilidad Femenina/terapia , Ovario/efectos de los fármacos , Ovulación/efectos de los fármacos , Atención Preconceptiva/métodos , Deshidroepiandrosterona/efectos adversos , Método Doble Ciego , Técnicas de Cultivo de Embriones , Transferencia de Embrión , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/fisiopatología , Nacimiento Vivo , Estudios Multicéntricos como Asunto , Recuperación del Oocito , Ovario/fisiopatología , Inducción de la Ovulación , Embarazo , Índice de Embarazo , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Inyecciones de Esperma Intracitoplasmáticas , Factores de Tiempo , Resultado del Tratamiento
10.
Fertil Steril ; 111(3): 505-509, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30598170

RESUMEN

OBJECTIVE: To study the safety and efficacy of ovarian stimulation and oocyte cryopreservation as a method of fertility preservation in women with Turner syndrome (TS). DESIGN: Retrospective cohort study. SETTING: Reproductive medicine clinic. PATIENT(S): Seven women with TS who attended the clinic between 2011 and 2017. INTERVENTION(S): Ovarian stimulation and oocyte cryopreservation. MAIN OUTCOMES MEASURE(S): Number of oocytes cryopreserved, ovarian hyperstimulation syndrome. RESULT(S): The oocyte retrieval rates (mean ± SD, 9 ± 3.16) in women with TS were comparable to the published data from healthy women. The oocyte yield was higher than expected based on the low antimüllerian hormone levels. There was no correlation between baseline antimüllerian hormone or antral follicle count levels and the number of oocytes retrieved. CONCLUSION(S): Oocyte cryopreservation after ovarian stimulation appears to be safe and successful in women with mosaic TS who wish to consider fertility preservation.


Asunto(s)
Criopreservación , Fármacos para la Fertilidad Femenina/uso terapéutico , Preservación de la Fertilidad/métodos , Infertilidad Femenina/terapia , Oocitos , Inducción de la Ovulación/métodos , Ovulación/efectos de los fármacos , Síndrome de Turner/complicaciones , Adolescente , Adulto , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Preservación de la Fertilidad/efectos adversos , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/etiología , Infertilidad Femenina/fisiopatología , Recuperación del Oocito , Síndrome de Hiperestimulación Ovárica/inducido químicamente , Reserva Ovárica/efectos de los fármacos , Inducción de la Ovulación/efectos adversos , Embarazo , Estudios Retrospectivos , Resultado del Tratamiento , Síndrome de Turner/diagnóstico , Síndrome de Turner/genética , Adulto Joven
11.
Eur Rev Med Pharmacol Sci ; 22(22): 8042-8059, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30536354

RESUMEN

OBJECTIVE: Infertile women requiring ovarian stimulation and assisted reproduction techniques (ART) are faced with difficult issues. The fear that using hormones could increase their risk of cancer is the most significant. One of the main challenges for assessing cancer risk after ART is the difficulty to separate it from the underlying condition of infertility per se. The delay or the inability to achieve a pregnancy is an important risk factor for breast, endometrial and ovarian cancer. We analyzed the current literature on the topic. MATERIALS AND METHODS: The published literature in Medline and Cochrane was screened using the following keywords: ovulation induction, reproductive techniques, clomiphene, in vitro fertilization, fertility agents, female/adverse effects, female/toxicity gonadotropins/ adverse effects or gonadotropins/toxicity and "neoplasms or cancer". RESULTS: A total of 95 articles were evaluated. Limited evidence suggests that high doses or many cycles of clomiphene citrate could increase the risk of endometrial cancer, although the confounding factors of polycystic ovarian disease and overweight are not always considered. In some studies, ART modestly increased the risk of borderline ovarian cancer. Fertility treatments do not increase the risk of breast, cervical, endometrial and ovarian cancers, thyroid, melanoma and colon cancer. CONCLUSIONS: Women can be reassured that fertility drugs do not appear to significantly increase the risk of invasive ovarian, endometrial, breast or other cancers, while achieving a pregnancy at an earlier age is a significant protective factor.


Asunto(s)
Consejeros/normas , Fármacos para la Fertilidad Femenina/administración & dosificación , Infertilidad Femenina/epidemiología , Infertilidad Femenina/terapia , Neoplasias/epidemiología , Técnicas Reproductivas Asistidas , Adulto , Clomifeno/administración & dosificación , Clomifeno/efectos adversos , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Fertilización In Vitro/efectos adversos , Fertilización In Vitro/métodos , Humanos , Neoplasias/inducido químicamente , Inducción de la Ovulación/efectos adversos , Inducción de la Ovulación/métodos , Embarazo , Técnicas Reproductivas Asistidas/efectos adversos , Factores de Riesgo
13.
Trials ; 19(1): 632, 2018 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-30445999

RESUMEN

BACKGROUND: Polycystic ovary syndrome (PCOS) affects between 8 and 18% of women and is the leading cause of female anovulatory infertility. Unfortunately, common treatments for women trying to conceive can be ineffective as well as disruptive or harmful to patients' quality of life. Despite evidence that women with PCOS have expressed the need for alternative fertility treatments, lifestyle interventions incorporating a nutritional plan with supplementation, increased physical activity, and techniques for stress management have not been combined as a program and studied in this population. Literature suggests that each of these individual components can positively influence reproductive hormones and metabolic health. METHODS/DESIGN: This is a randomized controlled trial which will include 240 women diagnosed with PCOS, according to the Rotterdam criteria, who are trying to conceive. Participants will be randomized to either a comprehensive lifestyle intervention program or prescribed an oral fertility medication, letrozole. These two groups will be further randomized to consume either myo-inositol or a placebo. Participants will be between the ages of 18 and 37 years. Exclusion criteria include women who have already begun fertility treatment, who are currently using myo-inositol or have taken it within the past 3 months, or who are being treated for, or have a history of, an eating disorder. The primary outcome will be the ovulation rate, the secondary outcome will be conception. Other outcomes include miscarriage rates, validated rating measures of overall quality of life (including social, relational, mind/body and emotional sub-categories) and mental health scores (depression, anxiety, and stress). DISCUSSION: This trial will determine the effectiveness of a structured lifestyle-based comprehensive intervention program for women with PCOS experiencing infertility. In addition, it will determine whether supplementing with myo-inositol provides any further benefit. The objective of this study is to assess a possible non-pharmacological solution to ovulatory dysfunction in these patients and perhaps improve other associated features of PCOS. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02630485 . Registered on 15 December 2015.


Asunto(s)
Fármacos para la Fertilidad Femenina/administración & dosificación , Estilo de Vida Saludable , Infertilidad Femenina/terapia , Inositol/administración & dosificación , Letrozol/administración & dosificación , Ovulación/efectos de los fármacos , Síndrome del Ovario Poliquístico/terapia , Administración Oral , Adolescente , Adulto , Ejercicio , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/etiología , Infertilidad Femenina/fisiopatología , Inositol/efectos adversos , Letrozol/efectos adversos , Atención Plena , Países Bajos , Educación del Paciente como Asunto , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/diagnóstico , Síndrome del Ovario Poliquístico/fisiopatología , Embarazo , Resultado del Embarazo , Índice de Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Terapia por Relajación , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
14.
Medicine (Baltimore) ; 97(44): e13038, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30383669

RESUMEN

This retrospective study investigated the efficacy and safety of letrozole for patients with polycystic ovary syndrome (PCOS).Totally, 136 cases of infertility women with PCOS were analyzed. Of those, 68 patients received letrozole, and were assigned to Letrozole group. The other 68 cases received clomiphene, and were assigned to clomiphene group. Patients in both groups were treated up to 5 treatment cycles. The primary endpoint included infant outcomes. The secondary endpoints consisted of the number of women in conception, pregnancy, pregnancy loss, and ovulation. In addition, any kinds of adverse events were also recorded.Cases in the Letrozole group did not show better outcomes neither in primary endpoint (live birth, P = .11; birth weight, P = .95; infant gender, P = .85), nor in secondary endpoints (the number of women in conception, P = .07; pregnancy, P = .12; pregnancy loss, P = .47; pregnancy loss in first trimester, P = .70; and ovulation, P = .09), compared with cases in the clomiphene group. Moreover, no adverse events differ significantly between 2 groups.This study demonstrated that the efficacy of letrozole is not superior to the clomiphene in patients with PCOS.


Asunto(s)
Inhibidores de la Aromatasa/uso terapéutico , Clomifeno/uso terapéutico , Fármacos para la Fertilidad Femenina/uso terapéutico , Nitrilos/uso terapéutico , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Triazoles/uso terapéutico , Adulto , Inhibidores de la Aromatasa/efectos adversos , Clomifeno/efectos adversos , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Humanos , Infertilidad Femenina/tratamiento farmacológico , Letrozol , Nitrilos/efectos adversos , Embarazo , Resultado del Embarazo , Índice de Embarazo , Estudios Retrospectivos , Resultado del Tratamiento , Triazoles/efectos adversos
15.
Indian J Ophthalmol ; 66(10): 1504-1505, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30249855

RESUMEN

Clomiphene citrate is a common drug used for the treatment of chronic anovulation, especially in polycystic ovary syndrome (PCOS) patients. The drug potentially has systemic and ocular side effects. Here, we present ocular side effects in a PCOS patient and emphasize the need to pay attention to visual complaints during treatment course with clomiphene citrate.


Asunto(s)
Clomifeno/efectos adversos , Trastornos de la Visión/inducido químicamente , Agudeza Visual/efectos de los fármacos , Campos Visuales/efectos de los fármacos , Administración Oral , Adulto , Anovulación/tratamiento farmacológico , Anovulación/etiología , Clomifeno/administración & dosificación , Femenino , Fármacos para la Fertilidad Femenina/administración & dosificación , Fármacos para la Fertilidad Femenina/efectos adversos , Estudios de Seguimiento , Humanos , Síndrome del Ovario Poliquístico/complicaciones , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/fisiopatología
16.
Ginekol Pol ; 89(8): 407-413, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30215458

RESUMEN

OBJECTIVE: This study aimed to investigate and compare the pregnancy and live birth rates in IVF cycles of frozen-thawed embryo transfers and fresh embryo transfers in a group of women with a high risk of Ovarian hyperstimulation syndrome (OHSS). MATERIAL AND METHODS: The study group consisted of 254 women with a high level of response to controlled ovarian hyperstimulation. The patients who received fresh cycle embryo transfers with calcium infusions are referred to as the Fresh Ca+ group, and those without the calcium therapy are called the Fresh Ca- group; and we used correspondingly similar terminology for the Frozen group. RESULTS: We observed no statistically significant differences between the cycles of fresh and frozen-thawed embryo transfers in patients with a high risk of OHSS in terms of implantation, clinical pregnancy, and live birth rates. Furthermore, these implantation, clinical pregnancy and live birth rates were not different in the cycles with or without calcium treatment. There was no statistical difference in the OHSS rates between the fresh and frozen-thawed cycles; although, the OHSS rates were less in the two calcium infusion groups (Fresh Ca+ and Frozen-thawed Ca+) than in the without-calcium group. There was no OHSS development in the subjects of the Frozen-thawed Ca+ group. CONCLUSION: Our study results suggest that fresh and frozen-thawed embryo transfers have similar IVF results in patients with a high risk of OHSS. Calcium infusion is beneficial in preventing OHSS without altering pregnancy rates. Both IVF protocols with calcium infusion can safely be applied in high-responder patients without lowering success rates.


Asunto(s)
Blastocisto , Gluconato de Calcio/administración & dosificación , Criopreservación , Transferencia de Embrión , Fármacos para la Fertilidad Femenina/administración & dosificación , Fertilidad/efectos de los fármacos , Infertilidad/terapia , Inducción de la Ovulación , Inyecciones de Esperma Intracitoplasmáticas , Adulto , Gluconato de Calcio/efectos adversos , Técnicas de Cultivo de Embriones , Transferencia de Embrión/efectos adversos , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Humanos , Infertilidad/diagnóstico , Infertilidad/fisiopatología , Infusiones Intravenosas , Nacimiento Vivo , Síndrome de Hiperestimulación Ovárica/etiología , Síndrome de Hiperestimulación Ovárica/fisiopatología , Síndrome de Hiperestimulación Ovárica/prevención & control , Inducción de la Ovulación/efectos adversos , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Factores de Riesgo , Inyecciones de Esperma Intracitoplasmáticas/efectos adversos , Resultado del Tratamiento , Adulto Joven
17.
Trials ; 19(1): 455, 2018 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-30134964

RESUMEN

BACKGROUND: Progress in vitrification techniques has allowed reproductive physicians to consider new strategies for using progestin as an alternative to a GnRH analogue to improve in vitro fertilisation (IVF). However, the role of progestin in blocking luteinising hormone (LH) surges and its potential in clinical practice are unclear, especially for poor responders. We designed a prospective randomised controlled trial (RCT) to compare the efficacy of a gonadotropin-releasing hormone (GnRH) antagonist and progestin in blocking LH surges and premature ovulation in poor responders. METHODS/DESIGN: Poor responders who meet the Bologna criteria will be randomised to one of two stimulation regimens-gonadotropin-releasing hormone (GnRH) antagonist or progestin-primed ovarian stimulation (PPOS)-using a computer-generated random number. Fresh embryos were transferred in the GnRH antagonist group and frozen embryos were transferred in the PPOS group. The primary outcome is the incidence of premature LH surges. Secondary outcomes include the number of oocytes retrieved, the number of embryos available for transfer, implantation rates and clinical pregnancy. The sample size for this trial is estimated as 340 participants, with 170 participants in each group. The data analysis will be by intention to treat. DISCUSSION: To our knowledge, this is the first RCT to examine the efficacy of administering progestin orally to block LH surges and premature ovulation compared with the GnRH antagonist protocols in poor responders undergoing IVF treatment. TRIAL REGISTRATION: www.chictr.org.cn . ChiCTR-IPR-17010906 . Registered on 18 March 2017.


Asunto(s)
Fármacos para la Fertilidad Femenina/administración & dosificación , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Infertilidad/tratamiento farmacológico , Hormona Luteinizante/sangre , Acetato de Medroxiprogesterona/administración & dosificación , Menotropinas/administración & dosificación , Inducción de la Ovulación/métodos , Ovulación/efectos de los fármacos , Congéneres de la Progesterona/administración & dosificación , Inyecciones de Esperma Intracitoplasmáticas , Administración Oral , Adulto , Biomarcadores/sangre , China , Protocolos Clínicos , Criopreservación , Implantación del Embrión , Transferencia de Embrión , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Humanos , Infertilidad/sangre , Infertilidad/diagnóstico , Infertilidad/fisiopatología , Masculino , Acetato de Medroxiprogesterona/efectos adversos , Menotropinas/efectos adversos , Recuperación del Oocito , Inducción de la Ovulación/efectos adversos , Embarazo , Índice de Embarazo , Congéneres de la Progesterona/efectos adversos , Estudios Prospectivos , Proyectos de Investigación , Resultado del Tratamiento , Adulto Joven
18.
Turk Kardiyol Dern Ars ; 46(5): 401-405, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-30024398

RESUMEN

Clomiphene citrate is a drug that stimulates ovulation and is commonly used in cases of female infertility. Generally, it is recognized as a safe agent for ovulation induction, but rarely, it is associated with life-threatening conditions. A 36-year-old woman who had been prescribed clomiphene citrate for infertility was admitted to the emergency department for chest pain lasting for 2 hours. She had no history of smoking, and she did not have any cardiac risk factor for myocardial infarction (MI). An electrocardiogram performed on admission revealed ST-elevation in the precordial leads. She was taken to the catheter laboratory for ST-elevation myocardial infarction, and the coronary angiography revealed total occlusion of the midportion of the left anterior descending artery (LAD) with a heavy thrombus burden. The circumflex and right coronary arteries were normal. After balloon dilatation, a 2.75x15-mm drug eluting stent was implanted in the mid part of the LAD. The patient had an uncomplicated recovery. Before discharge, echocardiography revealed apical akinesis; anterior and lateral hypokinesis; and an ejection fraction of 45% with mild mitral regurgitation. Although clomiphene citrate is a relatively safe drug for ovarian stimulation, it has been associated with serious side effects, such as MI. Physicians should be aware of the potential risks of clomiphene citrate, especially in patients with risk factors for coronary artery disease.


Asunto(s)
Clomifeno/efectos adversos , Fármacos para la Fertilidad Femenina/efectos adversos , Inducción de la Ovulación , Infarto del Miocardio con Elevación del ST/diagnóstico , Adulto , Angiografía Coronaria , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Infarto del Miocardio con Elevación del ST/inducido químicamente , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Stents
19.
J Obstet Gynaecol Res ; 44(6): 1036-1041, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29924470

RESUMEN

OBJECTIVES: The aim of the study was to evaluate the incidence of congenital fetal anomalies reported among infertile Iranian women treated with letrozole compared to those treated with Clomiphene Citrate (CC). METHODS: This retrospective case-control study was performed based on information available from infertile patients referred to the Akbar-Abadi Hospital IVF Center, Tehran, Iran, undergoing ovulation induction (OI) or intrauterine insemination (IUI) cycles from 2007 to 2014.We compared sonographic findings, fertility results, pregnancy complications and congenital anomalies in two groups of women treated with letrozole and CC. RESULTS: Overall, the results of the 2009 cycles including 1237 CC cycles and 772 letrozole cycles were evaluated. In spite of a higher chance of ovulation following CC treatment, overall fertility rates were similar in the two treatment groups. The frequency of adverse outcomes of pregnancy was similar in the two groups, except for the incidence of first trimester abortion, which was significantly higher in the CC-treated group. The frequency of fetal anomalies and major chromosomal abnormalities in the Letrozole group was 4.76% (five cases), and in the CC group, it was 2.12% (three cases). This difference was not statistically significant. CONCLUSION: Based on the findings of this study, it seems that the incidence of congenital anomalies in offspring after OI with letrozole is not increased compared to the CC group.


Asunto(s)
Anomalías Inducidas por Medicamentos/etiología , Inhibidores de la Aromatasa/efectos adversos , Clomifeno/efectos adversos , Fármacos para la Fertilidad Femenina/efectos adversos , Infertilidad Femenina/terapia , Nitrilos/efectos adversos , Inducción de la Ovulación/efectos adversos , Resultado del Embarazo , Triazoles/efectos adversos , Adulto , Femenino , Humanos , Infertilidad Femenina/tratamiento farmacológico , Irán , Letrozol , Embarazo
20.
Int J Rheum Dis ; 21(6): 1287-1292, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29879312

RESUMEN

OBJECTIVE: To determine the effect of leuprolide acetate, a synthetic gonadotropin-releasing hormone analog (GnRH-a) on ovarian function preservation in systemic lupus erythematosus (SLE) patients treated with cyclophosphamide (CYC) in clinical practice. METHODS: We enrolled 30 premenopausal female SLE patients who fulfilled the 1997 American College of Rheumatology revised criteria and were treated with intravenous CYC (IVCY) in 2008-2017. We used Kaplan-Meier survival estimates to compare the GnRH-a-treated patients and those not treated with GnRH-a as controls. We performed Cox regression analyses to identify factors associated with premature ovarian failure (POF), incidences of cardiovascular events, strokes and osteoporosis after IVCY therapy. RESULTS: After a mean follow-up of 41 months, POF developed in one of the 16 GnRH-a-treated patients (6%) versus seven of the 14 controls (50%). Significantly improved cumulative ovarian protection over time was observed in the GnRH-a-treated group (P = 0.030). The hazard model analysis showed that treatment with GnRH-a during IVCY therapy is an independent factor associated with POF after IVCY therapy (adjusted hazards ratio = 0.12, 95% CI 0.01-0.67, P = 0.013) but not incidences of cardiovascular events, strokes or osteoporosis. CONCLUSION: The combined use of GnRH-a with IVCY therapy was associated with a significant reduction of POF among premenopausal women with SLE, suggesting that the addition of GnRH-a can be a strategy to prevent POF among premenopausal women with SLE after IVCY therapy.


Asunto(s)
Ciclofosfamida/efectos adversos , Fármacos para la Fertilidad Femenina/uso terapéutico , Preservación de la Fertilidad/métodos , Inmunosupresores/efectos adversos , Infertilidad Femenina/prevención & control , Leuprolida/uso terapéutico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Ovario/efectos de los fármacos , Insuficiencia Ovárica Primaria/prevención & control , Administración Intravenosa , Adulto , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Ciclofosfamida/administración & dosificación , Femenino , Fármacos para la Fertilidad Femenina/efectos adversos , Preservación de la Fertilidad/efectos adversos , Humanos , Inmunosupresores/administración & dosificación , Incidencia , Infertilidad Femenina/inducido químicamente , Infertilidad Femenina/epidemiología , Infertilidad Femenina/fisiopatología , Estimación de Kaplan-Meier , Leuprolida/efectos adversos , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/inmunología , Análisis Multivariante , Osteoporosis/epidemiología , Ovario/fisiopatología , Premenopausia , Insuficiencia Ovárica Primaria/inducido químicamente , Insuficiencia Ovárica Primaria/epidemiología , Insuficiencia Ovárica Primaria/fisiopatología , Modelos de Riesgos Proporcionales , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
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