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1.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(10): 1207-1212, 2019 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-31801718

RESUMO

OBJECTIVE: To compare the effects of cetrorelix and ganirelix in gonadotropin-releasing hormone antagonist (GnRH-ant) cycles for preventing premature luteinizing hormone (LH) surges and on clinical outcomes of IVF-ET cycles. METHODS: We retrospectively analyzed 2572 GnRH-ant cycles of in vitro fertilization and embryo transfer from January, 2013 to December, 2016, including 1368 cycles with cetrorelix treatment and 1204 cycles with ganirelix treatment. The baseline characteristics of the patients and the clinical outcomes of the two groups were compared. RESULTS: Compared with those receiving ganirelix treatment, the patients with cetrorelix treatment had a significantly younger age (33.10 vs 33.89 years, P < 0.001) and a lower body mass index (21.57 vs 21.84 kg/m2, P=0.024). After adjustment for age and body mass index of the patients, no significant differences were found between the two groups in the levels of follicle-stimulating hormone (FSH), LH, estradiol (E2), progesterone (P) levels either at the baseline or on the day of hCG triggering, or in the number of oocytes retrieved (P > 0.05). The two groups also had comparable percentages of patients with LH > 10 U/L on the day of hCG triggering (3.7% vs 3.2%) and similar spontaneous ovulation rate (0.6% vs 0.5%), clinical pregnancy rate (47.7% vs 45.9%) and live birth rate (37.5% vs 33.6%) following fresh embryo transfer (P > 0.05). The incidence of moderate to severe ovarian hyperstimulation syndrome, however, was significantly higher in ganirelix group than in cetrorelix group (0.7% vs 0.1%, P=0.006). CONCLUSIONS: Cetrorelix and ganirelix can achieve comparable effects for preventing premature LH surges and can achieve similar clinical outcomes of GnRH-ant cycles, but ganirelix is associated with a significantly higher incidence of moderate to severe ovarian hyperstimulation syndrome.


Assuntos
Fertilização In Vitro , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Antagonistas de Hormônios/uso terapêutico , Hormônio Luteinizante/fisiologia , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Hormônio Luteinizante/sangue , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Resultado do Tratamento
3.
Int J Mol Sci ; 20(18)2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31491902

RESUMO

This study aimed to investigate the effect of gonadotropin-releasing hormone agonist (GnRHa) treatment on the expression of neuritin 1 (NRN1) in women with ovarian endometriosis. We collected tissues and serum from women with endometriosis treated with (n = 45) or without (n = 37) GnRHa. NRN1 mRNA and protein levels were measured using qPCR and Western blot. Immunolocalization of NRN1 in endometriotic tissues was examined using immunohistochemistry. In addition, a follow-up study was carried out to monitor the serum level of NRN1 in patients before and after GnRHa treatment. Both mRNA (p = 0.046) and protein (p = 0.0155) levels of NRN1 were significantly lower in endometriotic tissues from patients receiving GnRHa treatment compared to the untreated group. Both epithelial and stromal cells of endometriotic tissues from untreated women with endometriosis exhibited stronger staining of NRN1 but not in those who were treated with GnRHa. The follow-up study showed that the serum level of the NRN1 concentration decreased significantly from 1149 ± 192.3 to 379.2 ± 80.16 pg/mL after GnRHa treatment (p = 0.0098). The expression of NRN1 was significantly lower in women with ovarian endometriosis treated with GnRHa. These results suggest that NRN1 may be a biomarker response to the effect of GnRHa treatment for patients with ovarian endometriosis.


Assuntos
Endometriose/etiologia , Endometriose/metabolismo , Hormônio Liberador de Gonadotropina/agonistas , Neuropeptídeos/genética , Ovário/patologia , Adulto , Biomarcadores , Biópsia , Endometriose/tratamento farmacológico , Endometriose/patologia , Feminino , Proteínas Ligadas por GPI/genética , Proteínas Ligadas por GPI/metabolismo , Expressão Gênica , Regulação da Expressão Gênica/efeitos dos fármacos , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/farmacologia , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Neuropeptídeos/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Adulto Jovem
4.
Medicine (Baltimore) ; 98(31): e16616, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374027

RESUMO

BACKGROUND: To compare the efficacies of gonadotropin-releasing hormone (GnRH) pulse subcutaneous infusion with combined human chorionic gonadotropin and human menopausal gonadotropin (HCG/HMG) intramuscular injection have been performed to treat male hypogonadotropic hypogonadism (HH) spermatogenesis. METHODS: In total, 220 idiopathic/isolated HH patients were divided into the GnRH pulse therapy and HCG/HMG combined treatment groups (n = 103 and n = 117, respectively). The luteinizing hormone and follicle-stimulating hormone levels were monitored in the groups for the 1st week and monthly, as were the serum total testosterone level, testicular volume and spermatogenesis rate in monthly follow-up sessions. RESULTS: In the GnRH group and HCG/HMG group, the testosterone level and testicular volume at the 6-month follow-up session were significantly higher than were those before treatment. There were 62 patients (62/117, 52.99%) in the GnRH group and 26 patients in the HCG/HMG (26/103, 25.24%) group who produced sperm following treatment. The GnRH group (6.2 ±â€Š3.8 months) had a shorter sperm initial time than did the HCG/HMG group (10.9 ±â€Š3.5 months). The testosterone levels in the GnRH and HCG/HMG groups were 9.8 ±â€Š3.3 nmol/L and 14.8 ±â€Š8.8 nmol/L, respectively. CONCLUSION: The GnRH pulse subcutaneous infusion successfully treated male patients with HH, leading to earlier sperm production than that in the HCG/HMG-treated patients. GnRH pulse subcutaneous infusion is a preferred method.


Assuntos
Hormônio Liberador de Gonadotropina/uso terapêutico , Hipogonadismo/tratamento farmacológico , Substâncias para o Controle da Reprodução/uso terapêutico , Espermatogênese/efeitos dos fármacos , Adolescente , Adulto , Gonadotropina Coriônica/uso terapêutico , Vias de Administração de Medicamentos , Esquema de Medicação , Combinação de Medicamentos , Hormônio Foliculoestimulante/sangue , Hormônio Liberador de Gonadotropina/administração & dosagem , Humanos , Bombas de Infusão , Hormônio Luteinizante/sangue , Masculino , Menotropinas/uso terapêutico , Substâncias para o Controle da Reprodução/administração & dosagem , Testosterona/sangue , Adulto Jovem
5.
J Manag Care Spec Pharm ; 25(7): 836-846, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232203

RESUMO

BACKGROUND: Central precocious puberty (CPP), early onset of puberty caused by the premature activation of the hypothalamic-pituitary-gonadal axis, is a rare disease affecting children of both sexes. There is limited evidence that quantifies the economic burden of CPP. OBJECTIVE: To characterize the health care resource utilization (HRU) and costs among patients with CPP who were treated with gonadotropinreleasing hormone (GnRH) agonists, for those insured commercially and with Medicaid. METHODS: Eligible CPP patients for this retrospective cohort analysis were aged ≤ 12 years; were diagnosed between January 1, 2010, and September 30, 2014; and had at least 1 prescription for an FDA-approved GnRH agonist: leuprolide or histrelin (first prescription = index date). CPP patients had to be continuously enrolled in the MarketScan Commercial or Medicaid Database for at least 12 months before and after the index date. Control patients were randomly selected from all eligible non-CPP patients and N:1 matched on demographic characteristics with up to 20 controls per case. Clinical comorbidities, HRU, and costs were compared between study cohorts. Health care costs were examined via multivariable analysis to adjust for baseline differences between patients and controls. Treatment patterns among CPP patients were also characterized. RESULTS: There were 1,236 CPP patients and 24,206 controls with commercial insurance and 673 CPP patients and 11,965 controls with Medicaid insurance who met the inclusion criteria. Across payers, the mean age of CPP patients ranged from 7.6 years (Medicaid) to 8.5 (commercial), and 80%-87% were female. The mean observed duration (SD) of treatment with any approved GnRH agonist was 1.51 (0.98) years for commercial patients and 1.22 (1.04) for Medicaid patients. The mean age of discontinuation among patients who ceased GnRH agonist treatment ranged from 8.7 to 9.6 years. In the first year post-index, CPP patients had a greater number of unique diagnosis codes, unique medications, and comorbid conditions than controls. They also had significantly higher all-cause and diseasemonitoring related HRU. After adjusting for baseline characteristics, CPP patients with Medicaid insurance spent 6.42 times more ($16,768 [$31,460] vs. $2,610 [$4,897]), and patients with commercial insurance spent 12.25 times more ($19,940 [$20,132] vs. $1,628 [$1,645]) on health care in the year following treatment initiation than matched controls. CONCLUSIONS: Patients with CPP have substantially more comorbidities and greater HRU and costs than their non-CPP peers. DISCLOSURES: All funding for this study was provided by AbbVie, which participated in analysis and interpretation of data, drafting, reviewing, and approving the publication. All authors contributed to the development of the publication and maintained control over the final content. Soliman and Grubb are employed by AbbVie and hold stock in AbbVie. Bonafede and Nelson are employed by IBM Watson Health, which received funding from AbbVie to conduct this study. Klein is a paid consultant of AbbVie but was not compensated for any work on development of this manuscript for publication. Portions of this work were presented at Pediatric Academic Societies (PAS) 2018 Meeting, May 5-8, 2018, in Toronto, Canada, as a poster presentation titled "Examination of Economic Burden Among Commercially Insured Patients with Central Precocious Puberty (CPP)."


Assuntos
Efeitos Psicossociais da Doença , Seguro Saúde/economia , Medicaid/economia , Puberdade Precoce/tratamento farmacológico , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/economia , Hormônio Liberador de Gonadotropina/uso terapêutico , Custos de Cuidados de Saúde , Humanos , Leuprolida/economia , Leuprolida/uso terapêutico , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Puberdade Precoce/economia , Estudos Retrospectivos , Estados Unidos
7.
Curr Med Sci ; 39(3): 431-436, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209815

RESUMO

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women. Progestin-primed ovarian stimulation (PPOS) protocol, which used oral progestin to prevent premature luteinizing hormone (LH) surges in ovarian stimulation, has been proved to be effective and safe in patients with PCOS. The aim of the present study was to compare the efficacy of PPOS protocol with that of the traditional gonadotropin-releasing hormone (GnRH) antagonist protocol in patients with PCOS. A total of 157 patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were recruited into this study. The patients were divided into two groups by the stimulation protocols: the GnRH antagonist protocol group and the PPOS protocol group. There was no significant difference in the clinical characteristics between the two groups. Dose and duration of gonadotropin were higher in the PPOS protocol group. Estradiol levels on the day of human chorionic gonadotropin (hCG) administration were significantly lower in the PPOS protocol group. Fertilization rates and the number of good quality embryos were similar between the two groups. Remarkably, we found 6 patients with moderate ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist protocol group but 0 in the PPOS protocol group. A total of 127 women completed their frozen embryo transfer (FET) cycles. There were no significant differences between the two groups in terms of clinical pregnancy rate per transfer, implantation rate, first-trimester miscarriage rate and on-going pregnancy rate per transfer. To conclude, PPOS protocol decreased the incidence of OHSS without adversely affecting clinical outcomes in patients with PCOS.


Assuntos
Fármacos para a Fertilidade Feminina/uso terapêutico , Hormônio Liberador de Gonadotropina/análogos & derivados , Antagonistas de Hormônios/uso terapêutico , Infertilidade Feminina/terapia , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/fisiopatologia , Progestinas/administração & dosagem , Adulto , Gonadotropina Coriônica/administração & dosagem , Transferência Embrionária/métodos , Estradiol/sangue , Feminino , Fertilização In Vitro/métodos , Expressão Gênica , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Hormônio Liberador de Gonadotropina/genética , Hormônio Liberador de Gonadotropina/metabolismo , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Masculino , Síndrome de Hiperestimulação Ovariana/induzido quimicamente , Síndrome de Hiperestimulação Ovariana/diagnóstico , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Ovário/efeitos dos fármacos , Ovário/metabolismo , Ovário/fisiopatologia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Gravidez , Taxa de Gravidez , Progestinas/efeitos adversos , Estudos Prospectivos , Injeções de Esperma Intracitoplásmicas/métodos , Resultado do Tratamento
8.
Chin Med J (Engl) ; 132(12): 1448-1453, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31205103

RESUMO

BACKGROUND: There is no absolute consensus for the best time for triggering. The aim of this study was to investigate the effect of different proportion of dominant follicles (PDF) on the human chorionic gonadotropin (HCG) day for the clinical outcomes in patients with polycystic ovary syndrome (PCOS) of different ovarian stimulation protocols. METHODS: A total of 371 cycles of the gonadotropin-releasing hormone (GnRH) agonist long protocol and 347 cycles of GnRH antagonist protocol from January 2014 to December 2016 were included in this retrospective study. Based on the PDF on the day of the HCG administration, the included patients were divided into three groups: Group A (low PDF), PDF <20%; Group B (medium PDF), 20%≤ PDF ≤40%; Group C (high PDF), PDF >40%. The measurements regarding ovarian stimulation characteristics, fertilization rate, top quality embryo rate, clinical pregnancy rate, and ovarian hyperstimualtion syndrome (OHSS) rate were compared in different PDF groups with different protocols. RESULTS: In both the GnRH antagonist protocol and GnRH agonist long protocol, the characteristics such as mean age, anti-Mullerian hormone, antral follicle count (AFC), and body mass index were comparable between groups. The number of oocytes retrieved decreased statistically significantly as the PDF and rate of matured oocytes increased. In the GnRH agonist long protocol, the rate of normally fertilized oocytes was highest in Group A (59.74 ±â€Š31.21 vs. 49.70 ±â€Š37.95, 49.67 ±â€Š36.62; F = 3.743, P = 0.025). There were no significant differences in the rate of top-quality embryos and the clinical pregnancy rate between the groups. The clinical pregnancy rate was similar in the three groups (63.6%, 62.5%, 67.5%, respectively, χ = 0.989, P = 0.911). The moderate and severe OHSS rate increased statistically significantly when the PDF increased, which was highest in group C (1.4%, 3.1%, 6.7%, respectively, χ = 12.014, P = 0.017). In the GnRH antagonist protocol, there were no significant differences in the rate of top-quality embryos, the rate of normally fertilized oocytes, the clinical pregnancy rate, and the moderate and severe OHSS rate between the groups. The clinical pregnancy rate in Group C was higher than that in Group A (57.9% vs. 46.6%, χ = 10.850, P = 0.093). CONCLUSIONS: In the GnRH antagonist protocol, PDF on the HCG day of less than 20% may be unfavorable to the clinical pregnancy rate in PCOS. In the GnRH agonist long protocol, delaying the HCG trigger timing has no good effect on clinical pregnancy and the risk of OHSS might increase in patients with PCOS.


Assuntos
Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Folículo Ovariano/efeitos dos fármacos , Folículo Ovariano/fisiologia , Síndrome do Ovário Policístico/tratamento farmacológico , Síndrome do Ovário Policístico/fisiopatologia , Adulto , Gonadotropina Coriônica/uso terapêutico , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Hormônio Liberador de Gonadotropina/metabolismo , Hormônio Liberador de Gonadotropina/uso terapêutico , Antagonistas de Hormônios/uso terapêutico , Humanos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
9.
Taiwan J Obstet Gynecol ; 58(3): 328-329, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31122518

RESUMO

OBJECTIVE: To report a rare case of polypoid endometriosis with initial impression of ovarian cancer and review the published literature about this disease. CASE REPORT: A 23-year-old female presented with sudden onset of acute lower abdominal pain. Image studies revealed an irregular shaped, heterogeneous mass at the cul-de-sac, but without ascites or enlargement of pelvic or paraaortic lymph nodes. Blood tests showed an elevated CA-125 value (1317 U/ml). Resection of the mass was performed by laparotomy and the frozen section and final pathology both revealed polypoid endometriosis. Post-operative gonadotropin-releasing hormone agonist was given for 6 months followed by oral contraceptives. She remained disease free 3 years after operation. CONCLUSION: Polypoid endometriosis is an uncommon and distinctive variant of endometriosis. Gynecologists should be aware of this rare form of a commonly benign disease to avoid excessive resection in younger patients of childbearing age.


Assuntos
Endometriose/diagnóstico , Endometriose/patologia , Pólipos/patologia , Antígeno Ca-125/sangue , Diagnóstico Diferencial , Endometriose/terapia , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Neoplasias Ovarianas/diagnóstico , Ultrassonografia , Adulto Jovem
10.
Chemotherapy ; 64(1): 36-41, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31117081

RESUMO

BACKGROUND: Fertility and gonadal function represent one of the most important aspects for long-term lymphoma survivors. AIMS: The aim of our study was to determine possible risk factors, such as age at treatment, chemotherapeutic regimen, protection with oral contraceptives (OCs), and gonadotropin-releasing hormone (GnRH) analogues in female patients treated for Hodgkin's lymphoma (HL) or non-Hodgkin lymphoma (NHL) at a reproductive age. METHODS: Patients between the age of 16 and 50 years at the time of HL or NHL diagnosis were selected. Eligible patients were requested to respond to a questionnaire by phone interview about fertility, menstrual status, sexual aspects, and treatment with OCs or GnRH analogues during chemotherapy. RESULTS: The resumption of menstrual activity was associated with the use of the OCs and GnRH analogues during chemotherapy (p = 0.008 and 0.034, respectively). At univariate analysis, the use of OCs during chemotherapy was associated with a lower risk of amenorrhea (prevalence ratio [PR] = 0.37; 95% CI 0.17-0.82). A higher age at the time of treatment correlated positively with therapy-induced amenorrhea, with a difference of 12.8 years between the mean age at diagnosis of the women with therapy-induced amenorrhea and those who resumed their menses. Amenorrhea was significantly higher in women receiving R-CHOP than in women treated with ABVD (PR = 6.00; 95% CI 2.32-15.54). Moreover, NHL had an infertility PR of 1.51 (95% CI 0.86-2.45) at multivariate analysis compared to HL. CONCLUSIONS: This study suggests a possible role of pharmacological prophylaxis with OCs and GnRH analogues.


Assuntos
Doença de Hodgkin/terapia , Linfoma não Hodgkin/terapia , Administração Oral , Adolescente , Adulto , Amenorreia/tratamento farmacológico , Amenorreia/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Anticoncepcionais/farmacologia , Anticoncepcionais/uso terapêutico , Feminino , Fertilidade/efeitos dos fármacos , Hormônio Liberador de Gonadotropina/farmacologia , Hormônio Liberador de Gonadotropina/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/radioterapia , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/radioterapia , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Adulto Jovem
11.
Reprod Biol ; 19(2): 145-148, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31133458

RESUMO

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.


Assuntos
Cabergolina/administração & dosagem , Cabergolina/uso terapêutico , Hormônio Liberador de Gonadotropina/análogos & derivados , Gonadotropinas/efeitos adversos , Síndrome de Hiperestimulação Ovariana/tratamento farmacológico , Adulto , Agonistas de Dopamina/administração & dosagem , Agonistas de Dopamina/uso terapêutico , Esquema de Medicação , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Fármacos para a Fertilidade Feminina/uso terapêutico , Hormônio Liberador de Gonadotropina/administração & dosagem , Hormônio Liberador de Gonadotropina/efeitos adversos , Hormônio Liberador de Gonadotropina/uso terapêutico , Gonadotropinas/administração & dosagem , Gonadotropinas/uso terapêutico , Humanos , Síndrome do Ovário Policístico/tratamento farmacológico , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Adulto Jovem
12.
Fertil Steril ; 112(2): 258-265, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31103285

RESUMO

OBJECTIVE: To evaluate differences in euploidy rates between IVF cycles triggered with either GnRH agonist (GnRHa) or hCG. DESIGN: Retrospective cohort study. SETTING: University-affiliated fertility center. PATIENT(S): A total of 366 patients performing 539 IVF cycles utilizing preimplantation genetic testing for aneuploidy (PGT-A). INTERVENTION(S): Gonadotropin-releasing hormone agonist or hCG trigger of oocyte maturation during IVF cycles. MAIN OUTCOME MEASURE(S): Rate of euploid embryos. RESULT(S): Patients in the GnRHa trigger arm were younger, with a lower body mass index and higher antimüllerian hormone level, and they had a higher number of oocytes retrieved and embryos biopsied. Euploid rate per embryo biopsied was higher after GnRHa trigger than after hCG trigger (37.8% ± 2.1% vs. 30.3% ± 1.8%), but multivariate regression analysis controlling for potential confounding factors did not show any differences between the two groups. Moreover, the euploid rate per oocyte retrieved was not significantly different overall (GnRHa vs. hCG: 33.9% ± 2.2% vs. 28.0% ± 1.9%). The anticipated decline in the rate of euploid embryos per oocyte retrieved went from 15.8% ± 1.2% for age <35 years to 4.3% ± 0.9% for patients aged ≥41 years. There were no significant differences between the two groups after stratifying by age and controlling for PGT-A testing modality. CONCLUSION(S): Both GnRHa and hCG trigger result in comparable euploid rates. Trigger with GnRHa should therefore be considered a valid option for trigger modality in freeze-all PGT-A cycles, in view of its demonstrated effectiveness and known safety enhancement.


Assuntos
Gonadotropina Coriônica/uso terapêutico , Fármacos para a Fertilidade Feminina/uso terapêutico , Testes Genéticos/estatística & dados numéricos , Hormônio Liberador de Gonadotropina/uso terapêutico , Indução da Ovulação/métodos , Ploidias , Diagnóstico Pré-Implantação/estatística & dados numéricos , Adulto , Aneuploidia , Feminino , Fertilização In Vitro/estatística & dados numéricos , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/genética , Infertilidade Feminina/terapia , Ciclo Menstrual/efeitos dos fármacos , Oogênese/efeitos dos fármacos , Oogênese/genética , Indução da Ovulação/efeitos adversos , Indução da Ovulação/estatística & dados numéricos , Gravidez , Estudos Retrospectivos
13.
Reprod Biol Endocrinol ; 17(1): 43, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077214

RESUMO

BACKGROUND: Almost all of the previous studies related with co-administration of letrozole in IVF cycles were performed in poor responders and letrozole may reduce the total gonadotropin dose required for ovarian stimulation, and the pregnancy rate did not decrease in poor responders. This study aimed to assess whether high responders co-treatment with letrozole reduced supraphysiological late follicular phase estradiol levels and the incidence of premature progesterone elevated at the end of the follicular phase, thereby impacting positively on endometrial receptivity. METHODS: A randomized parallel controlled study in a university-affiliated center include 130 high responders between October 2015 and August 2016. The patients were randomized on the first stimulation day of the IVF cycle and from stimulation day 5 receive letrozole (group A) or without letrozole treatment (group B). RESULTS: Although estradiol levels were significantly lower in the letrozole group (group A) (P < 0.001), progesterone elevation (> 1.5 ng/mL was considered as a rise) on the day of hCG triggering (15.4, 7.7%) was not statistically significant (P = 0.170). RecFSH, the recovery rate of eggs, the high-quality embryo rate, and the thickness of endometrium (P = 0.776) were similar between the letrozole group(group A) and control groups (group B). Clinical pregnancy rates were 53.1% (26/49) and 72.9% (35/48) in the letrozole and control groups, respectively, with a statistical significance (P = 0.043).Live birth rates were 42.9% (21/49) and 62.5% (30/48),showed a marginally significant difference (P = 0.053). The miscarriage rate did not significantly differ between the two groups. CONCLUSIONS: In this pilot study, letrozole supplementation could not reduce the incidence of premature progesterone rise during the late follicular phase in stimulated in vitro fertilization cycles in expected high responders, producing a harmful effect on the pregnancy outcome. TRIAL REGISTRATION: China Clinical Trial Registration Center: ChiCTR-IPR-15006211 URL of the trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=10731 . Trial registration date: 8 April, 2015. Date of first patient's enrolment: 5 October, 2015.


Assuntos
Letrozol/uso terapêutico , Indução da Ovulação/métodos , Adulto , Gonadotropina Coriônica/uso terapêutico , Estradiol/sangue , Feminino , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Letrozol/efeitos adversos , Projetos Piloto , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Progesterona/sangue
14.
Endocrinol Metab Clin North Am ; 48(2): 341-355, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31027544

RESUMO

Transgender women often seek hormone therapy to attain feminine physical features congruent with their gender identity. The aim of feminizing hormone therapy (FHT) is to provide suppression of endogenous testosterone and to maintain estradiol levels within the normal female range. Overall, FHT is safe if provided under supervision of an experienced health care provider and has been shown to improve quality of life. Data on care of transgender women are scarce and high-quality evidence-based recommendations are lacking. This article aims to review the published literature on FHT and provide guidance to clinicians caring for transgender women.


Assuntos
Antagonistas de Androgênios , Terapia de Reposição de Estrogênios , Disforia de Gênero , Hormônio Liberador de Gonadotropina , Transexualismo , Antagonistas de Androgênios/efeitos adversos , Antagonistas de Androgênios/uso terapêutico , Terapia de Reposição de Estrogênios/efeitos adversos , Disforia de Gênero/tratamento farmacológico , Disforia de Gênero/metabolismo , Hormônio Liberador de Gonadotropina/efeitos adversos , Hormônio Liberador de Gonadotropina/análise , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Transexualismo/tratamento farmacológico , Transexualismo/metabolismo
15.
Int J Hyperthermia ; 36(1): 486-492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994010

RESUMO

OBJECTIVE: To evaluate the combined efficacy of high-intensity focused ultrasound (HIFU), gonadotropin-releasing hormone agonist (GnRH-a) and the levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of severe adenomyosis. METHOD: Four hundred and sixty-six patients with adenomyosis admitted to the Department of Gynecology of Shanghai First Maternity and Infant Hospital underwent HIFU treatment, and then were consecutively administered with GnRH-a 1 d, 1 month and 3 months after HIFU treatment. The uterine size was then measured with ultrasound or MRI 2-4 weeks after three cycles of GnRH-a injection. The LNG-IUS was then inserted when the uterine length less than 9 cm. The visual analog scale (VAS), verbal rating scale (VRS), menstrual volume score, uterus volume, MRI, serum levels of hemoglobin and CA125 were measured at pre and 3-, 6-, 12-month post-HIFU. RESULTS: Dysmenorrhea and menorrhagia significantly relieved after combined treatment with HIFU, GnRH-a and the LNS-IUS. The uterine volume shrank and returned to its normal size. The serum CA-125 level was reduced to the normal level after the combined treatment. CONCLUSIONS: The combined therapeutic regimen of HIFU, GnRH-a and LNS-IUS is safe, effective and efficient for curing severe adenomyosis.


Assuntos
Adenomiose , Tratamento por Ondas de Choque Extracorpóreas/métodos , Hormônio Liberador de Gonadotropina/uso terapêutico , Levanogestrel/uso terapêutico , Adenomiose/diagnóstico por imagem , Adenomiose/tratamento farmacológico , Adenomiose/patologia , Adenomiose/terapia , Feminino , Hormônio Liberador de Gonadotropina/farmacologia , Humanos , Levanogestrel/farmacologia
16.
J Endocrinol Invest ; 42(10): 1231-1240, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30953318

RESUMO

PURPOSE: In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments. METHODS: Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents. RESULTS: the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality. CONCLUSIONS: The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.


Assuntos
Cultura , Disforia de Gênero/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Percepção , Puberdade/efeitos dos fármacos , Pessoas Transgênero/psicologia , Transexualismo/psicologia , Adolescente , Adulto , Feminino , Disforia de Gênero/epidemiologia , Identidade de Gênero , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/uso terapêutico , Terapia de Reposição Hormonal/psicologia , Humanos , Entrevistas como Assunto , Masculino , Memória/fisiologia , Pessoa de Meia-Idade , Procedimentos de Readequação Sexual , Maturidade Sexual/efeitos dos fármacos , Inquéritos e Questionários , Transexualismo/terapia , Adulto Jovem
17.
Taiwan J Obstet Gynecol ; 58(2): 255-260, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30910149

RESUMO

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is a major complication of assisted reproductive technologies (ART). Polycystic ovary syndrome (PCOS) is a risk factor for OHSS. The aim of this randomized clinical trial (RCT) was to study the effect of low-dose aspirin (LDA) on the development of OHSS and ART outcomes in PCOS during ART. MATERIALS AND METHODS: This double-blinded placebo controlled RCT was performed on 232 PCOS infertile women in their first ART cycles during 2010-2016. LDA and placebo capsules were prepared, packed and specified by code numbers in similar shapes. One package was given to every woman and asked to take one capsule/day since the 21st day of her cycle prior to the gonadotropin stimulation. Gonadotropin releasing hormone agonist long protocol and triggering by human chorionic gonadotropin were used. Development of moderate to severe OHSS and their ART outcomes were documented then the codes were broken and data analyzed. Chi-square and Mann-Whitney U tests were used for the statistical analyses. RESULTS: Eighteen cases that did not follow the study design were excluded. 214 cycles remained for the final analyses with 109 cases in LDA and 105 in the placebo group. Rate of the moderate to severe OHSS in LDA group was 34.9% compared to 30.5% in placebo group (P = 0.494). Fertilization rate was 71.8% vs 65.1% (P = <0.001) and the mean number of grade III embryos were 3.28 ± 3.53 vs 1.46 ± 1.42 (P = 0.014) in LDA and placebo groups, respectively. The mean number of the oocytes in different grades, total and frozen embryos also implantation and clinical pregnancy rates were not different between the groups. CONCLUSION: Moderate to Severe OHSS was not decreased but fertilization rate and the mean number of poor quality embryos were increased in LDA arm. REGISTRATION NUMBER: IRCT 201105216541N1.


Assuntos
Aspirina/administração & dosagem , Hormônio Liberador de Gonadotropina/uso terapêutico , Oócitos/efeitos dos fármacos , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/efeitos adversos , Adulto , Aspirina/efeitos adversos , Método Duplo-Cego , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Hormônio Liberador de Gonadotropina/efeitos adversos , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Infertilidade Feminina/etiologia , Recuperação de Oócitos/estatística & dados numéricos , Síndrome de Hiperestimulação Ovariana/diagnóstico , Síndrome do Ovário Policístico/complicações , Gravidez , Resultado do Tratamento , Adulto Jovem
18.
Best Pract Res Clin Endocrinol Metab ; 33(3): 101262, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30733078

RESUMO

Precocious puberty is defined as the appearance of secondary sex characteristics before 8 years of age in girls and before 9 years of age in boys. Central precocious puberty (CPP) is diagnosed when activation of the hypothalamic-pituitary axis is identified. It is a rare disease with a clear female predominance. A background of international adoption increases its risk, with other environmental factors such as endocrine disruptors also being associated with CPP. The causes of CPP are heterogeneous, with alterations of the CNS being of special interest. Physical injuries of the CNS are more frequent in boys, while idiopathic etiology is more prevalent among girls. However, in the last decade the number of idiopathic cases has diminished thanks to the discovery of mutations in different genes, including KISS1, KISS1R, MKRN3, and DLK1 that cause CPP. For the diagnosis of CPP, hormone studies are needed in addition to the clinical data regarding signs of pubertal onset. For this purpose, the GnRH test continues to be the gold standard. Imaging analyses, such as bone age and brain MRI, are also very useful. Furthermore, genetic testing must be incorporated in the diagnosis of CPP, especially in familial cases. Early puberty has been related to various consequences in the medium and long term such as behavioral problems, breast cancer, obesity, and metabolic comorbidities. However, there are few studies that have exclusively analyzed patients with CPP. GnRH analogs are the most frequent treatment election with the main objective being to improve adult height. Currently, there are new formulations that are being investigated.


Assuntos
Neoplasias/etiologia , Puberdade Precoce/fisiopatologia , Criança , Feminino , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Masculino , Puberdade Precoce/complicações , Puberdade Precoce/tratamento farmacológico , Puberdade Precoce/genética
19.
Gynecol Endocrinol ; 35(8): 732-736, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30806524

RESUMO

This study evaluated the serum level of MKRN3 and investigated its diagnostic usefulness in girls with central precocious puberty (CPP). In total, 41 girls with CPP and 35 age-matched normal control girls were enrolled. Serum values of MKRN3 were measured in both groups. Gonadotropin and estradiol concentrations were evaluated after 6 and 12 months of GnRH agonist (GnRHa) treatment in CPP patients. The MKRN3 concentrations were much lower in the patient group than in the control group (p = .005). Over 1 year of GnRHa treatment in patients, the gonadotropin concentrations were significantly decreased (p < .05), while the MKRN3 concentrations were unchanged (p > .05). MKRN3 levels were inversely correlated to standard deviation (SD) in height (r = -0.46, p = .000), SD in weight (r = -0.32, p = .005), Tanner stage (r = -0.41, p = .000), and bone age (r = -0.46, p = .000). Based on ROC analysis, the area under curve was 0.758 for MKRN3, with 82.9% sensitivity and 68.5% specificity. The measurement of serum MKRN3 level may provide some help for CPP prediction, but relatively various values need further validation.


Assuntos
Biomarcadores/sangue , Puberdade Precoce/sangue , Puberdade Precoce/diagnóstico , Ribonucleoproteínas/sangue , Estudos de Casos e Controles , Criança , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/uso terapêutico , Humanos , Valor Preditivo dos Testes , Prognóstico , Puberdade Precoce/tratamento farmacológico
20.
Cancer ; 125(7): 1070-1080, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30748008

RESUMO

BACKGROUND: There is no consensus on the association between the use of androgen deprivation therapy (ADT) and the risk of developing depression. This study investigated the association between ADT use and the development of depression, outpatient psychiatric services, inpatient psychiatric services, and suicide in a homogeneous group of men with prostate cancer (PC) treated with definitive radiation therapy (RT) after controlling for multiple sources of selection bias. METHODS: This was a retrospective, observational cohort study of 39,965 veterans with PC who were treated with definitive RT and were diagnosed by the US Department of Veterans Affairs health care system between January 1, 2001, and October 31, 2015. Exposure was ADT initiation within 1 year of the PC diagnosis. The primary outcome was new development of depression. Secondary outcomes were outpatient psychiatric use, inpatient psychiatric use, and suicide. RESULTS: During follow-up, 934 patients were newly diagnosed with depression, 7825 patients used outpatient psychiatric services, 358 patients used inpatient psychiatric services, and 54 patients committed suicide. In the multivariable competing risks regression model, ADT was associated with the development of depression (subdistribution hazard ratio [SHR], 1.50; 95% confidence interval [CI], 1.32-1.71; P < .001). ADT was also associated with outpatient psychiatric utilization (SHR, 1.21; 95% CI, 1.16-1.27; P < .001). Finally, ADT was not associated with inpatient psychiatric utilization or suicide. CONCLUSIONS: An increase in the risk of depression and the use of outpatient psychiatric services was observed in a large cohort of men with PC who received ADT with definitive RT. These results may provide further evidence for the long-term risks of ADT for psychiatric health in the treatment of PC.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Transtorno Depressivo/epidemiologia , Neoplasias da Próstata/terapia , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Anilidas/uso terapêutico , Depressão/epidemiologia , Flutamida/uso terapêutico , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio Liberador de Gonadotropina/uso terapêutico , Gosserrelina/uso terapêutico , Hospitalização/estatística & dados numéricos , Humanos , Imidazolidinas/uso terapêutico , Leuprolida/uso terapêutico , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Nitrilos/uso terapêutico , Oligopeptídeos/uso terapêutico , Neoplasias da Próstata/psicologia , Radioterapia , Estudos Retrospectivos , Suicídio/estatística & dados numéricos , Compostos de Tosil/uso terapêutico
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