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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.
Clin Ter ; 170(5): e364-e367, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31612194

RESUMEN

In the last 40 years, the number of elderly patients that require Assisted Reproductive Technologies (ART) has risen enormously, especially after heterolougus fertilization techniques have become available. In recent years, the incidence of peripartum cardiomyopathy (PPCM) has substantially grown, as a consequence of the combined effect of increased maternal age, consequent high prevalence of hypertension and metabolic syndrome (MS). That cohort of women may be exposed to a greater number of cardiac, obstetric and anesthesio-logical complications, therefore the incidence of medico-legal issues, litigation, liabilities and claims over the past years has significantly risen. Cardiovascular and hormonal changes during pregnancy can challenge even the healthiest of individuals, and in that pregnant population the risk is even greater. These patients should be monitored before the ART, during pregnancy, delivery and puerperium, to avoid heart failure, thrombotic problems, embolic complications, stroke and death. Management issues regarding pregnancy and delivery are elaborate, including anesthesia considerations. This new population of women needs an accurate cardiac risk stratification with a thorough cardiovascular history and examination, 12 lead ECG, and transthoracic echocardiogram. Therefore, a comprehensive multidisciplinary assessment and management can provide the best opportunity to improve maternal and neonatal outcomes.


Asunto(s)
Síndrome Metabólico/etiología , Complicaciones Cardiovasculares del Embarazo/etiología , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Síndrome Metabólico/prevención & control , Embarazo , Complicaciones Cardiovasculares del Embarazo/prevención & control , Mujeres Embarazadas , Técnicas Reproductivas Asistidas/efectos adversos , Factores de Riesgo
3.
Isr Med Assoc J ; 21(10): 653-657, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31599505

RESUMEN

BACKGROUND: Complete hydatidiform mole and a co-existing normal fetus (CHMCF) is associated with a high complication rate. A possible association with assisted conception might increase the prevalence of CHMCF. OBJECTIVES: To study the potential association between assisted conception and the risks of CHMCF. METHODS: Case series at a single university hospital from 2008 to 2018 are presented and contrasted with data from a comprehensive literature review (1998-2018). Cases were identified from the institutional database that matched the sonographic criteria for CHMCF. A literature review showed comparable cases. RESULTS: None of the three pregnancies presented in this article resulted in a viable fetus, all were aborted. One of the three patients needed chemotherapy due to gestational trophoblastic neoplasia (GTN). A literature search identified 248 reported cases in which 22 fetuses (9%) reached term, 88/248 (35%) progressed to GTN, and 25/120 (21%) were conceived following assisted conception. From 2008 until 2018 at our medical facility, there were 3144 twin pregnancies of which 1667 (53%) were conceived using assisted conception. In our cohort, there was no statistical trend for assisted conception as an etiological factor for CHMCF. CONCLUSIONS: No association between assisted conception and the risk for CHMCF was established at our hospital, although approximately one-quarter of all reported CHMCF pregnancies are attributed to assisted conception technology. However, these data are not always reported, making it difficult to draw definitive conclusions.


Asunto(s)
Mola Hidatiforme/patología , Embarazo Gemelar , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Neoplasias Uterinas/patología , Aborto Eugénico , Aborto Inducido , Adulto , Femenino , Humanos , Mola Hidatiforme/terapia , Enfermedad Iatrogénica , Embarazo , Técnicas Reproductivas Asistidas/efectos adversos , Ultrasonografía Prenatal/métodos , Neoplasias Uterinas/terapia
4.
Biomed Res Int ; 2019: 2095730, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31380413

RESUMEN

Currently, the use of assisted reproductive technology (ART) is increasing. Because of the poor prognosis of retinopathy of prematurity (ROP), the association between ART and the ROP has been explored in several studies, but the result was still inconclusive. Conducting a meta-analysis, we evaluated the risk of ROP in relation to the ART. Subgroup analysis as well as groups with different embryo numbers and different ROP stages was further analyzed. The PubMed, Embase, and Cochrane Library databases were searched for studies recording data about both the use of ART and ROP occurrence simultaneously. Odds ratios (ORs) and 95% confidence interval (95%CI) were calculated to analyze the association by using random- or fixed-effect models based on heterogeneity test. In total 15 observational studies containing 10392 ART cases and 39474 spontaneous conception cases were included. Results showed that there was a significant association between the use of ART and ROP occurrence in the offspring (OR = 1.34, 95% CI: 1.05 to 1.73, P = 0.02). With subgroup analysis, we found that the influence actually came from a subgroup of ART, the in vitro fertilization (IVF). Moreover, there was a significant association between ART and ROP in singletons. Though insignificant, the ORs were larger than 1 in the analysis between ART and stage 1 and 2 ROP. But ART showed significant association with stage 3 ROP. Our study preliminarily indicated that the use of IVF was associated with higher risk of ROP occurrence. And ART is more likely to result in severe ROP and ROP in singletons. Further specific, high-quality studies with large sample size are still needed to draw more precise conclusion.


Asunto(s)
Fertilización In Vitro/efectos adversos , Reproducción/fisiología , Técnicas Reproductivas Asistidas/efectos adversos , Retinopatía de la Prematuridad/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Retinopatía de la Prematuridad/complicaciones , Retinopatía de la Prematuridad/fisiopatología , Factores de Riesgo
5.
Fertil Steril ; 112(1): 19-23, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31277762

RESUMEN

The development of assisted reproductive technology (ART) through four decades has led to offer the ultimate treatment for nearly all forms of infertility. The only remaining factor of childlessness however that still eludes ART and its routine variants are the absolute uterine infertility factors, for which the only option is an experimental approach, uterus transplantation. Progresses has been made over the past few years, and more are underway for simplifying the process notably for simplifying the uterus extraction step performed in the uterus donor. Furthermore, as the technique is being better mastered, the original indications for uterus transplantation, the congenital or acquired absence of the uterus, are now widened to also include incurable uterine fibrosis, or Asherman's syndrome. The ART-related practicalities of uterus transplantation, ovarian stimulation and uterine priming are being discussed in the present review.


Asunto(s)
Infertilidad Femenina/cirugía , Técnicas Reproductivas Asistidas , Donantes de Tejidos/provisión & distribución , Útero/trasplante , Femenino , Fertilidad , Supervivencia de Injerto , Humanos , Infertilidad Femenina/diagnóstico , Infertilidad Femenina/fisiopatología , Nacimiento Vivo , Donadores Vivos/provisión & distribución , Embarazo , Índice de Embarazo , Técnicas Reproductivas Asistidas/efectos adversos , Factores de Riesgo , Resultado del Tratamiento
6.
Eur J Contracept Reprod Health Care ; 24(4): 294-298, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31204856

RESUMEN

Objective: Our study aimed to investigate the predisposing factors for recurrence of an ectopic pregnancy (EP) following single-dose methotrexate (MTX) treatment for a primary EP. Methods: This was a retrospective cohort study performed in a tertiary care medical centre including all patients diagnosed with primary EP and treated with a single-dose regimen of intramuscular MTX. EPs with future recurrence were compared with first time only EPs, to identify risk factors for recurrent EP. Forward stepwise multivariate logistic regression analyses were subsequently carried out. Results: The study included 272 women. Of those, 22 (8.1%) had a recurrent EP. Women in the recurrent EP group had a higher rate of abortions (45.5% vs 32.7%; p = 0.02), previous pelvic surgery (45.5% vs 6.5%; p < 0.001) and both pelvic and uterine surgery (4.5% vs 1.6%; p < 0.001). Conception by assisted reproductive technology (ART) was more common among the non-recurrent EP group (23.0% vs 4.5%; p = 0.04). Success of single-dose MTX treatment was lower in the recurrent EP group compared with the non-recurrent EP group (36.4% vs 65.7%; p = 0.006). A history of pelvic surgery was independently associated with recurrent EP (adjusted odds ratio [OR] 17.6; 95% confidence interval [CI] 4.9, 63.2; p = 0.001). Treatment success of single-dose MTX was independently protective for recurrent EP (adjusted OR 0.25; 95% CI 0.08, 0.76; p = 0.02). Conclusions: Among women with an EP, attention should be paid to those with previous pelvic surgery. Efforts should be made to achieve medical treatment success to prevent recurrent EP.


Asunto(s)
Abortivos no Esteroideos/uso terapéutico , Metotrexato/uso terapéutico , Embarazo Ectópico/epidemiología , Embarazo Ectópico/etiología , Adulto , Femenino , Genitales/cirugía , Humanos , Israel/epidemiología , Modelos Logísticos , Embarazo , Técnicas Reproductivas Asistidas/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
7.
BMC Pregnancy Childbirth ; 19(1): 149, 2019 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-31046710

RESUMEN

BACKGROUND: The objective of this systematic review and meta-analyses was to assess the risk of preeclampsia among women who conceived with assisted reproductive technology (ART). METHODS: We searched the ISI Web of Knowledge, Medline/PubMed, Scopus, and Embase (from inception to May 2017) for English language articles using a list of key words. In addition, reference lists from identified studies and relevant review articles were also searched. Data extraction was performed by two authors, and the study quality was assessed using the Newcastle-Ottawa Scale. Random-effects model meta-analysis was applied to pool the relative risks (RR) across studies. RESULTS: A total of 48 studies (5 case-control studies and 43 cohort studies) were included in this meta-analysis. The Cochran Q test and I2 statistics revealed substantial heterogeneity (Q = 26,313.92, d.f. = 47, p < 0.001 and I2 = 99.8%). Meta-analysis showed a significant increase in preeclampsia in women who conceived by ART compared with those who conceived spontaneously (RR = 1.71, 95% CI = 1.11-2.62, p = 0.015). CONCLUSIONS: The findings of this systematic review indicate that the use of ART treatment is associated with a 1.71-fold increase in preeclampsia.


Asunto(s)
Preeclampsia/etiología , Técnicas Reproductivas Asistidas/efectos adversos , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Preeclampsia/epidemiología , Embarazo , Riesgo
8.
Fertil Steril ; 112(1): 120-129.e2, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31043232

RESUMEN

OBJECTIVE: To investigate whether female coffee consumption affects the chance of achieving a clinical pregnancy and a live birth among women and couples receiving medically assisted reproduction (MAR) treatment. DESIGN: Cohort study with prospectively collected exposure data. SETTING: Public fertility clinic. PATIENT(S): A total of 1,708 women and potential partners undergoing fertility treatment, contributing with 1,511 intrauterine insemination (IUI) cycles, 2,870 in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles, and 1,355 frozen embryo transfer cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy and live birth in consecutive treatment cycles in the Danish national health registries, enabling complete follow-up, and estimation of the cumulative chance of live birth for three consecutive treatment cycles. RESULT(S): Among women receiving IVF or ICSI treatment, coffee consumption did not seem to affect the chance of achieving a clinical pregnancy and a live birth. Women treated with IUI who had a daily coffee consumption of 1-5 cups were more likely to achieve a clinical pregnancy (adjusted relative risk 1.49; 95% confidence interval, 1.05-2.11) and live birth (adjusted relative risk 1.53; 95% confidence interval, 1.06-2.21) compared with the reference group of coffee abstainers. CONCLUSION(S): Women consuming 1-5 cups versus none had a 1.5-fold higher probability of achieving a pregnancy or a live birth when receiving IUI. No associations were found, however, between women's daily coffee consumption and achieving a pregnancy or a live birth from IVF/ICSI.


Asunto(s)
Café , Infertilidad/terapia , Técnicas Reproductivas Asistidas , Adulto , Café/efectos adversos , Dinamarca , Femenino , Fertilidad , Humanos , Infertilidad/diagnóstico , Infertilidad/fisiopatología , Nacimiento Vivo , Masculino , Embarazo , Índice de Embarazo , Estudios Prospectivos , Técnicas Reproductivas Asistidas/efectos adversos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
9.
Int J Dev Biol ; 63(3-4-5): 217-222, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31058298

RESUMEN

Since the birth of the first baby conceived by in vitro fertilization (IVF), assisted reproductive technologies (ART) have been constantly evolving to accomodate needs of a growing number of infertile couples. Rapidly developing ART procedures are directly applied for human infertility treatment without prior long-term safety evaluation. Although the majority of ART babies are healthy at birth, a comprehensive assessment of the long-term risks associated with ART is still lacking. An increased risk of epigenetic errors has been associated with the use of ART, which may contribute to the onset of civilization disease later in adolescence/adulthood and/or in subsequent generations. Therefore, our investigations should not focus on (or be limited to) the occurrence of a few very rare imprinting disorders in ART children, which might be associated with parental age and/or the use of ART, but on the possibly increased disease susceptibilities later in life and their potential transmission to the subsequent generations. Retrospective studies do not offer exhaustive information on long-term consequences of ART. Animal models are useful tools to study long-term effects including transgenerational ones and the epigenetic risk of a given ART procedure, which could then be translated to the human context. The final goal is the establishment of common guidelines for assessing the epigenetic risk of ART in humans, which will contribute to two key objectives of the Horizon2020 programme, i.e. to improve our understanding of the causes and mechanisms underlying health and disease, and to improve our ability to monitor health and prevent/manage disease.


Asunto(s)
Epigénesis Genética , Técnicas Reproductivas Asistidas/efectos adversos , Animales , Femenino , Humanos , Placenta/metabolismo , Embarazo , Técnicas Reproductivas Asistidas/tendencias , Factores de Riesgo
10.
J Assist Reprod Genet ; 36(6): 1091-1099, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31079266

RESUMEN

PURPOSE: Proprotein convertase subtilisin/kexin type 9 (PCSK9) and lipoprotein (a) (Lp[a]) levels are associated with cardiovascular risk. To investigate PCSK9 and Lp(a) levels of children born after assisted reproduction technologies (ART) compared with naturally conceived (NC) controls. METHODS: In this exposure-matched cohort study, 73 racial-, sex-, and age-matched children (mean age 98 ± 35 months) of ART (intracytoplasmic sperm injection [ICSI] n = 33, classic in vitro fertilization [IVF] n = 40) and 73 NC children were assessed. Blood lipid profile, including PCSK9 and Lp(a) levels, was measured. Children were grouped according to age (< 8 years, 8-10 years, ≥ 10 years). RESULTS: In the overall population, PCSK9 levels were related to total cholesterol, low-density lipoprotein, and systolic blood pressure, while Lp(a) levels were related to age, apolipoprotein-B, birth weight, height, waist-to-hip ratio, insulin resistance, insulin, and high-sensitivity C-reactive protein. No significant differences were observed regarding lipid biomarkers between ART and NC children. However, a significant interaction was found between age groups and conception method (p < 0.001) showing that PCSK9 levels increase with age in ART children, while they decline with age in NC offspring. IVF children showed higher levels of adjusted mean Lp(a) than ICSI (13.5 vs. 6.8 mg/dl, p = 0.010) and NC children (12.3 vs. 8.3 mg/dl, p = 0.048). CONCLUSIONS: We show that PCSK9 levels increase with age in ART children, indicating a gradual deterioration of lipidemic profile that could lead to increased cardiovascular risk. Moreover, our results indicate that ART method may be of importance given that classic IVF is associated with higher levels of Lp(a).


Asunto(s)
Enfermedades Cardiovasculares/sangre , Lipoproteína(a)/sangre , Proproteína Convertasa 9/sangre , Técnicas Reproductivas Asistidas/efectos adversos , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/genética , Enfermedades Cardiovasculares/patología , Niño , Preescolar , Femenino , Fertilización In Vitro/efectos adversos , Humanos , Resistencia a la Insulina/genética , Masculino , Factores de Riesgo , Inyecciones de Esperma Intracitoplasmáticas/efectos adversos
11.
Maturitas ; 125: 81-84, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31133222

RESUMEN

The increasing maternal age at first birth is well recognized, but much less discussed are the fact that the prevalence of advanced paternal age (APA) is also increasing and the societal implications of this trend. Over the past 40 years in the United States, the proportion of infants born to fathers of APA, which has been variably defined as above 35 or above 45, increased from ˜4% to 10% (Khandwala et al., 2017, 2018) While there has been extensive research regarding infertility and comorbidities in the aging mother, relatively few studies have explored similar reproductive factors in aging men. However, evidence does suggest a decrease in fertility and an increase in pregnancy complications such as gestational diabetes, intrauterine growth restriction and preterm birth. Additionally, the offspring of fathers of APA have increased risks of chromosomal and non-chromosomal birth defects and an increased incidence of childhood autism and cancers. This review explores the data, with the intent that key counseling points, including the suggestion of sperm banking, can be highlighted when advising the midlife and older man who is considering paternity.


Asunto(s)
Edad Paterna , Resultado del Embarazo , Adulto , Trastorno Autístico/epidemiología , Niño , Consejo , Familia , Femenino , Fertilidad , Humanos , Recién Nacido , Masculino , Edad Materna , Persona de Mediana Edad , Embarazo , Nacimiento Prematuro/epidemiología , Técnicas Reproductivas Asistidas/efectos adversos , Riesgo , Bancos de Esperma , Estados Unidos
12.
Best Pract Res Clin Endocrinol Metab ; 33(1): 127-132, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-31130446

RESUMEN

Although an increased risk of pre-eclampsia in pregnancies conceived after infertility treatment has been reported, it remains unknown whether preconceptional minimalisation of known risk factors would help in preventing pre-eclamsia. Obesity and preconceptional blood pressure are discussed as major risks for the development of pre-eclampsia and low doses of aspirins, folic acid, statins and metformin are discussed as potential preventive treatments to decrease the risk of pre-eclampsia. In the present review we discuss whether present-day reproductive medicine could progress towards complication-free pregnancy.


Asunto(s)
Infertilidad/terapia , Preeclampsia/prevención & control , Atención Preconceptiva/métodos , Técnicas Reproductivas Asistidas/efectos adversos , Femenino , Humanos , Preeclampsia/etiología , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/prevención & control , Factores de Riesgo
13.
Vet Clin North Am Food Anim Pract ; 35(2): 265-276, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31103180

RESUMEN

Large offspring syndrome (LOS) is a fetal overgrowth condition in bovines most often observed in offspring conceived with the use of assisted reproductive technologies (ART). Phenotypes observed in LOS include, overgrowth, enlarged tongues, umbilical hernias, muscle and skeleton malformations, abnormal organ growth and placental development. Although LOS cases have only been reported to be associated with ART, fetal overgrowth can occur spontaneously in cattle (S-LOS). S-LOS refers to oversized calves that are born at normal gestation lengths. ART-induced LOS has been characterized as an epigenetic syndrome, more specifically, a loss-of-imprinting condition. We propose that S-LOS is also a loss-of-imprinting condition.


Asunto(s)
Enfermedades de los Bovinos/patología , Trastornos del Crecimiento/veterinaria , Técnicas Reproductivas Asistidas/veterinaria , Animales , Síndrome de Beckwith-Wiedemann/genética , Síndrome de Beckwith-Wiedemann/patología , Síndrome de Beckwith-Wiedemann/veterinaria , Bovinos , Enfermedades de los Bovinos/etiología , Enfermedades de los Bovinos/genética , Femenino , Trastornos del Crecimiento/genética , Trastornos del Crecimiento/patología , Humanos , Embarazo , Técnicas Reproductivas Asistidas/efectos adversos
14.
J Assist Reprod Genet ; 36(7): 1299-1313, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31127477

RESUMEN

PURPOSE: Despite the growing body of research implying an impact of in vitro fertilization (IVF) on imprinted genes and epigenetics, few studies have examined the effects of underlying subfertility or prenatal stress on epigenetics, particularly in terms of their role in determining infant birthweights. Both subfertility and prenatal stressors have been found to impact epigenetics and may be confounding the effect of IVF on epigenetics and imprinted genes. Like IVF, both of these exposures-infertility and prenatal stressors-have been associated with lower infant birthweights. The placenta, and specifically epigenetically regulated placental imprinted genes, provides an ideal but understudied mechanism for evaluating the relationship between underlying genetics, environmental exposures, and birthweight. METHODS AND RESULTS: In this review, we discuss the impacts of IVF and infertility on birthweight, epigenetic mechanisms and genomic imprinting, and the role of these mechanisms in the IVF population and discuss the role and importance of the placenta in infant development. We then highlight recent work on the relationships between infertility, IVF, and prenatal stressors in terms of placental imprinting. CONCLUSIONS: In combination, the studies discussed, as well as two recent projects of our own on placental imprinted gene expression, suggest that lower birthweights in IVF infants are secondary to a combination of exposures including the infertility and prenatal stress that couples undergoing IVF are experiencing. The work highlighted herein emphasizes the need for appropriate control populations that take infertility into account and also for consideration of prenatal psychosocial stressors as confounders and causes of variation in IVF infant outcomes.


Asunto(s)
Depresión/genética , Epigénesis Genética/genética , Fertilización In Vitro/efectos adversos , Impresión Genómica/genética , Metilación de ADN/genética , Depresión/psicología , Femenino , Humanos , Recién Nacido de Bajo Peso , Embarazo , Técnicas Reproductivas Asistidas/efectos adversos
15.
Gynecol Endocrinol ; 35(8): 651-656, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30935259

RESUMEN

To analyze the management of severe ovarian hyperstimulation syndrome based on aspects of its etiology and pathogenesis a systematic review of the literature was done. An evaluation of clinical trials, meta-analysis, case-reports and reviews assessing the management of different conditions related to ovarian hyperstimulation syndrome was made using the following data sources: MEDLINE Pubmed (from 1966 to July 2018) and the Cochrane Controlled Clinical Trials Register, Embase (up to July 2018). The role of intra-abdominal hypertension in the development of the severe forms of ovarian hyperstimulation syndrome and its complicated outcomes was assessed. The pathophysiology and clinic of intra-abdominal hypertension syndrome are almost identical to moderate and severe forms of ovarian hyperstimulation syndrome and associated organ dysfunction. The classic triad (respiratory disorders, reduction in venous return, and restriction of perfusion in internal organs) is present in severe ovarian hyperstimulation syndrome as well as in intra-abdominal hypertension syndrome. This review provides recommendations for the management of ovarian hyperstimulation syndrome and insight into the different medical complaints of this syndrome. The principles of therapy for intra-abdominal hypertension syndrome might be considered in the treatment of severe forms of ovarian hyperstimulation syndrome.


Asunto(s)
Síndrome de Hiperestimulación Ovárica , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Síndrome de Hiperestimulación Ovárica/diagnóstico , Síndrome de Hiperestimulación Ovárica/epidemiología , Síndrome de Hiperestimulación Ovárica/etiología , Síndrome de Hiperestimulación Ovárica/terapia , Inducción de la Ovulación/efectos adversos , Inducción de la Ovulación/métodos , Embarazo , Técnicas Reproductivas Asistidas/efectos adversos , Técnicas Reproductivas Asistidas/historia , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Técnicas Reproductivas Asistidas/tendencias , Resultado del Tratamiento
16.
Fertil Steril ; 112(1): 130-139, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31003618

RESUMEN

OBJECTIVE: To determine the health outcomes for adults aged 22-35 years old who were conceived via assisted reproduction technology (ART) compared with adults of the same age conceived without use of ART. DESIGN: Cohort study. SETTING: Not applicable. PATIENT(S): Adult men and women aged 22-35 years who were conceived with and without use of ART. INTERVENTION(S): Questionnaire and clinical review. MAIN OUTCOME MEASURE(S): Vascular structure (carotid artery intima-media thickness, pulse wave velocity), vascular function (blood pressure), metabolic markers (fasting blood glucose, insulin, and standard lipid profiles), anthropometric measurements, and respiratory function (spirometry). RESULT(S): The mean age of the 193 ART and 86 non-ART participants was 27.0 and 26.9 years, respectively. There were no substantial intragroup differences in demographics or vascular intermediate phenotypes, metabolic parameters, or anthropometric measures, before or after adjusting for perinatal factors and a quality of life measure with four domains. Diastolic blood pressure was lower in the ART men than the non-ART men (adjusted mean difference -4.4 mm Hg, 95% CI, -8.7 to -0.1). The ART group reported a higher prevalence of ever having asthma, (40.8% vs. 28.6%; odds ratio 1.7; 95% CI, 1.0-3.0), but expiratory flow rates were similar. CONCLUSION(S): This study of the health of 193 adults conceived via ART, the largest to date globally, found no evidence of increased vascular or cardiometabolic risk, or growth or respiratory problems in the ART group compared with a non-ART group from the same source population. Follow-up observation for reproductive and later-onset adverse health effects remains important.


Asunto(s)
Estado de Salud , Técnicas Reproductivas Asistidas , Adulto , Factores de Edad , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Femenino , Humanos , Masculino , Técnicas Reproductivas Asistidas/efectos adversos , Enfermedades Respiratorias/diagnóstico , Enfermedades Respiratorias/epidemiología , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Victoria/epidemiología , Adulto Joven
18.
Emerg Med Clin North Am ; 37(2): 239-249, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30940369

RESUMEN

Although only accounting for a small percentage of infants born in the United States each year, assisted reproductive technology (ART) has become a more common means of conception since the first in vitro fertilization baby was born in 1978. An understanding of the ART process, medications, and complications is becoming essential for emergency medicine practice. Much of the surveillance data focuses on ART complications that are likely to be less relevant in the acute care setting, but ovarian hyperstimulation syndrome, ectopic pregnancy, and ovarian torsion are 3 diagnoses with high potential morbidity and mortality that emergency physicians should not miss.


Asunto(s)
Técnicas Reproductivas Asistidas/efectos adversos , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Síndrome de Hiperestimulación Ovárica/diagnóstico , Síndrome de Hiperestimulación Ovárica/terapia , Embarazo , Embarazo Ectópico/diagnóstico , Embarazo Ectópico/terapia , Embarazo Heterotópico/diagnóstico , Embarazo Heterotópico/terapia
19.
J Obstet Gynaecol Res ; 45(7): 1296-1302, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31012210

RESUMEN

AIM: To share the experience of local aspiration and instillation of methotrexate (MTX) to selective reduction of live interstitial pregnancy and to evaluate its clinical effect and the outcome of intrauterine pregnancy. METHODS: Twelve patients with heterotopic interstitial pregnancy were enrolled at Women's Hospital, Zhejiang University School of Medicine, from 2006 to 2017. All the pregnancies were derived from assisted reproductive technology (ART). The transvaginal aspiration to interstitial pregnancy sac and local instillation of MTX (range from 12.5 to 30 mg) were performed for the patients under ultrasound-guide. The prognosis and pregnancy outcomes were followed up. RESULTS: No severe side effects of medical treatment were observed in all patients. Three cases underwent subsequent laparotomy cornual resection, and no perioperative complications were found in these three patients. Twelve patients gave birth to 13 healthy infants without congenital anomalies. The average birth weight and gestational age was 2837 g (SD ± 605 g) and 36.8 weeks (SD ± 2.4 weeks). No growth anomalies and mental retardation were observed in live birth offspring. CONCLUSION: The transvaginal ultrasound-guided aspiration and injection of MTX might be a feasible alternative treatment for heterotopic interstitial pregnancy when vital signs of patients are stable.


Asunto(s)
Abortivos no Esteroideos/administración & dosificación , Metotrexato/administración & dosificación , Reducción de Embarazo Multifetal/métodos , Embarazo Heterotópico/terapia , Embarazo Intersticial/terapia , Técnicas Reproductivas Asistidas/efectos adversos , Adulto , Colposcopía/métodos , Estudios de Factibilidad , Femenino , Humanos , Embarazo , Resultado del Embarazo , Embarazo Heterotópico/etiología , Embarazo Intersticial/etiología , Resultado del Tratamiento , Ultrasonografía Intervencional/métodos
20.
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
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