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1.
Ann Endocrinol (Paris) ; 81(5): 487-492, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32827451

RESUMO

OBJECTIVES: To highlight the self-reported experiences and disease perceptions of infertile women with polycystic ovary syndrome (PCOS). METHODS: A qualitative study using an inductive method was conducted on infertile women with PCOS who shared their self-reported experiences on French-speaking on-line forums. RESULTS: 785 comments by 211 women on 7 forums were analyzed. Women complained of late diagnosis and lack of information regarding PCOS. PCOS and infertility showed negative psychological impact on daily life. This impact appeared to be alleviated by the sharing of knowledge and experience enabled by these forums. CONCLUSION: The self-reported experience of infertile women with PCOS is interesting for health practitioners. The psychological impact of PCOS and perceptions of illness appear to be improved by sharing experiences between women with PCOS, suggesting a beneficial support role of online discussion forums.


Assuntos
Infertilidade Feminina/complicações , Internet , Síndrome do Ovário Policístico/complicações , Qualidade de Vida , Autorrelato , Adulto , Feminino , França/epidemiologia , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/psicologia , Disseminação de Informação , Internet/organização & administração , Internet/estatística & dados numéricos , Pessoa de Meia-Idade , Redes Sociais Online , Avaliação de Resultados da Assistência ao Paciente , Satisfação do Paciente/estatística & dados numéricos , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/psicologia , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Grupos de Autoajuda , Adulto Jovem
2.
J Ayub Med Coll Abbottabad ; 32(2): 255-258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584004

RESUMO

BACKGROUND: Polycystic ovary syndrome is the most commonly occurring endocrinopathy in females of reproductive age group. It is characterized by a wide range of signs and symptoms resulting from hormonal derangements leading to reduced fertility. METHODS: This was a crosssectional (comparative) study. We took 40 cases of polycystic ovary syndrome and 40 controls of infertility without polycystic ovary syndrome depending on the presence of clinical features and ultrasound scans. Blood samples were collected and assayed for luteinizing hormone and follicle stimulating hormone. Data was analyzed with SPSS-19. RESULTS: Luteinizing hormone to follicle stimulating hormone ratio was raised in 3 out of 35 patients (8%) in cases and in 2 out of 39 patients (5%) in controls. There was no statistically significant difference in the luteinizing hormone levels and the follicle stimulating hormone levels and the luteinizing hormone to follicle stimulating hormone ratio of the two groups as indicated by a p-value> 0.05. CONCLUSIONS: Luteinizing hormone to follicle stimulating hormone ratio was not found to be raised in majority of the polycystic ovary syndrome patients included in this study.


Assuntos
Hormônio Foliculoestimulante/sangue , Hormônio Luteinizante/sangue , Síndrome do Ovário Policístico , Estudos de Casos e Controles , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/complicações , Infertilidade Feminina/epidemiologia , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/epidemiologia
3.
BMC Womens Health ; 20(1): 92, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370796

RESUMO

BACKGROUND: Endometriosis have a negative influence on women's sexual life. The aim of the current study was to test a conceptual model considering the interrelated role of anxiety, depression, sleep quality, physical activity, BMI, stage of endometriosis, the intensity of dyspareunia and pelvic pain on sexual function (SF) in infertile women with endometriosis. Also test the mediating role of sleep quality, anxiety, and depression. METHOD: In the present cross-sectional study, 220 infertile women with a laparoscopically confirmed endometriosis were recruited. Data were collected using a socio-demographic checklist, Female Sexual Function Index (FSFI), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS). RESULTS: We found that anxiety, depression, sleep quality, BMI, level of education, stage of endometriosis, and dyspareunia have a direct effect on women's SF. In our study, sleep quality, anxiety, pelvic pain, and depression were the four major mediators that the higher scores lead to a decrease in the SF of endometriosis patients. The intensity of pelvic pain with an effect on sleep quality (SQ) and dyspareunia change women's SF. The lower level of physical activity, and higher BMI with indirect effect thorough anxiety, and SQ can worsen SF. Also, a higher level of anxiety leads to poor SQ and depression. Anxiety with both direct and indirect effect impress women's SF. CONCLUSION: It seems that the main risk factors for sexual dysfunction in women with endometriosis are higher rates of anxiety, depression, poor sleep quality, pelvic pain, and dyspareunia. In the care of women with endometriosis, not only laparoscopy and medical treatment should be performed but also psychotherapeutic and psychosexual help should be offered.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Dispareunia/etiologia , Endometriose/complicações , Infertilidade Feminina/complicações , Dor Pélvica/etiologia , Qualidade de Vida/psicologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Sono/fisiologia , Adulto , Estudos Transversais , Dispareunia/psicologia , Endometriose/diagnóstico , Endometriose/fisiopatologia , Feminino , Humanos , Saúde Mental , Dor Pélvica/psicologia , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/psicologia , Inquéritos e Questionários
4.
Sci Rep ; 10(1): 5968, 2020 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-32249791

RESUMO

Obesity exerts negative effects on the metabolic homeostasis of cells in various tissues, but how it influences ovum metabolism is not fully understood. Previous studies demonstrate that oocyte genes that regulate oxidative stress, lipid metabolism, and inflammation are highly expressed in obese women. However, the metabolic effects of these genetic variations are not clear. To address this gap, we conducted an exploratory evaluation of follicular fluid (FF) metabolites in underweight, normal-weight, overweight, and obese women undergoing in vitro fertilization (IVF) treatment. The FF samples from the underweight (Group A, n = 40), normal-weight (Group B, n = 40), overweight (Group C, n = 40), and obese women (Group D, n = 40) were analyzed using ultra-performance liquid chromatography high-resolution mass spectrometry. A novel, high-coverage, semi-targeted metabolomics method (SWATH to MRM) and a targeted metabolomics method were employed to identify and verify the differential metabolites between the four groups. Sixteen differentially expressed FF metabolites were identified. Increase of BMI was associated with upregulation of 5 metabolites, ganoderiol H, LPI (18:3), sedoheptulose 1,7-bisphosphate, austalide L and 2 - {[hydroxyl (3-hydroxy-4-methoxyphenylmethylidene] amino} acetic acid, and downregulation of 5 metabolites, 1-phenyl-1,3-elcosanedione, retinol acetate, p-Cresol sulfate, setariol and arachidonyl carnitine. These metabolites were enriched in different metabolic pathways of retinol metabolism and fatty acid metabolism. These obesity-related differential metabolites provide a pathogenesis mechanism that explains the decline of oocyte development during obesity. These results suggest that obesity affects follicular environment prior to pregnancy, a time-window that may be important for lifestyle interventions to decrease obesity levels.


Assuntos
Fertilização In Vitro , Líquido Folicular/metabolismo , Infertilidade Feminina/metabolismo , Metabolômica , Obesidade/metabolismo , Adulto , Cromatografia Líquida , Feminino , Humanos , Infertilidade Feminina/complicações , Metabolismo dos Lipídeos/fisiologia , Espectrometria de Massas , Redes e Vias Metabólicas/fisiologia , Obesidade/complicações , Estresse Oxidativo/fisiologia
5.
Am J Obstet Gynecol ; 223(3): 404.e1-404.e20, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32112734

RESUMO

BACKGROUND: Severe maternal morbidity continues to be an issue of national and global concern and is increasing in incidence. The incidence of infertility is also on the rise, and infertile women experience a higher risk of incident chronic medical disease and cancer, suggesting that fertility may serve as a window to a woman's overall health. OBJECTIVE: To investigate the risk of severe maternal morbidity by maternal fertility status. MATERIALS AND METHODS: This was a retrospective cohort analysis using Optum's de-identifed Clinformatics Data Mart Database between 2003 and 2015. Infertile women stratified by infertility diagnosis, testing, or treatment were compared to fertile women seeking routine gynecologic care. In both groups, only women who underwent pregnancy and delivery of a singleton during the follow-up period were included. Main outcomes were severe maternal morbidity indicators, defined by the Centers for Disease Control and Prevention and identified by International Classification of Diseases 10th Revision and Common Procedural Technology codes within 6 weeks of each delivery. Results were adjusted for maternal age, race, education, nulliparity, smoking, obesity, delivery mode, preterm birth, number of prenatal visits, and year of delivery. RESULTS: A total of 19,658 women comprised the infertile group and 525,695 women comprised the fertile group. The overall incidence of any severe maternal morbidity indicator was 7.0% among women receiving fertility treatment, 6.4% among women receiving a fertility diagnosis, 5.5% among women receiving fertility testing, and 4.3% among fertile women. Overall, infertile women had a significantly higher risk of developing any severe maternal morbidity indicator (adjusted odds ratio, 1.22; confidence interval, 1.14-1.31, P < .01) as well as a significantly higher risk of disseminated intravascular coagulation (adjusted odds ratio, 1.48; confidence interval, 1.26-1.73, P < .01), eclampsia (adjusted odds ratio, 1.37; confidence interval, 1.05-1.79, P < .01), heart failure during procedure or surgery (adjusted odds ratio, 1.54; confidence interval, 1.21-1.97, P < .01), internal injuries of the thorax, abdomen, or pelvis (adjusted odds ratio, 1.59; confidence interval, 1.12-2.26, P < .01), intracranial injuries (adjusted odds ratio, 1.77; confidence interval, 1.20-2.61, P < .01), pulmonary edema (adjusted odds ratio, 2.18; confidence interval, 1.54-3.10, P < .01), thrombotic embolism (adjusted odds ratio, 1.58; confidence interval, 1.14-2.17, P < .01), and blood transfusion (adjusted odds ratio, 1.50; confidence interval, 1.30-1.72, P < .01) compared to fertile women. Fertile women did not face a significantly higher risk of any maternal morbidity indicator compared to infertile women. In subgroup analysis by maternal race/ethnicity, the likelihood of severe morbidity was significantly higher among fertile black women compared to fertile white women. There was no difference between infertile black women and infertile white women after multivariable adjustment. CONCLUSION: Using an insurance claims database, we report that women diagnosed with infertility and women receiving fertility treatment experience a significantly higher risk of multiple indicators of severe maternal morbidity compared to fertile women. The increased risk of severe maternal morbidity noted among fertile black women compared to fertile white women is attenuated among infertile black women, who face risks similar to those of infertile white women.


Assuntos
Infertilidade Feminina/complicações , Complicações na Gravidez/epidemiologia , Técnicas de Reprodução Assistida , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Coagulação Intravascular Disseminada/epidemiologia , Eclampsia/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Infertilidade Feminina/terapia , Formulário de Reclamação de Seguro , Idade Materna , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Fatores de Risco
6.
Georgian Med News ; (298): 27-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32141843

RESUMO

Cervical insufficiency is a common problem in obstetrical care. There are not enough studies about its development in women with infertility. The aim of the article was to determine the risk factors of the development of cervical insufficiency in women with infertility associated with anovulation. The object of the study were 308 pregnant women (110 pregnant women with cervical insufficiency and without infertility, 92 pregnant women with infertility associated with anovulation and with cervical insufficiency, 76 pregnant women with infertility associated with anovulation and without cervical insufficiency, 30 pregnant women without cervical insufficiency and infertility (controls)). We analyzed the data of obstetrical anamnesis, gynecological diseases, extragenital pathology. In fertile women with cervical insufficiency the traumatic factor of the cervix (previous labors, gynecological procedures connected with cervical dilatation) was the main in the development of this pathology. While in the women with infertility associated with anovulation the forming of cervical insufficiency was associated with hormonal reasons (hyperandrogenism (OR=3.04, 95 % CI=1.15-8.05, p=0.03), diminished ovarian reserve (OR=6.00, 95 % CI=1.97-18.24, p=0.002), controlled ovarian stimulation with gonadotropin and clomiphene citrate use (OR=3.69, 95% CI=1.93-7.04, p<0.001), use of additional reproductive technology (OR=1.95, 95 % CI=1.05-3.63, p=0.03).


Assuntos
Anovulação/complicações , Colo do Útero/anormalidades , Gonadotropinas/uso terapêutico , Infertilidade Feminina/tratamento farmacológico , Anovulação/tratamento farmacológico , Clomifeno/efeitos adversos , Clomifeno/uso terapêutico , Feminino , Gonadotropinas/efeitos adversos , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/etiologia , Gravidez , Fatores de Risco
7.
Taiwan J Obstet Gynecol ; 59(1): 91-98, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039808

RESUMO

OBJECTIVE: To investigate the prevalence of female sexual dysfunction (FSD) and depression in primary infertile women with 25-Hydroxyvitamin D3 (25-OH VD) deficiency undergoing in-vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) treatment. MATERIALS AND METHODS: A total of 80 women with 25-OH VD3 deficiency (<20 ng/mL = group 1), 80 women with 25-OH VD3 insufficiency (20-29.9 ng/mL = group 2), and 80 women with a normal 25-OH VD3 level (30-60 ng/mL = group 3) were included the study. Female sexual function and depression were measured using the Female Sexual Function Index (FSFI) and Beck Depression Inventory (BDI). RESULTS: No statistically significant differences were found among the groups in terms of demographic characteristics, baseline and laboratory parameters. Statistically significant differences were observed among the groups with regard to FSD and depression. The FSFI (group 1 = 22.46 ± 2.13, group 2 = 25.82 ± 2.13 and group 3 = 28.66 ± 2.13, respectively) and sexual domain scores were low in women with 25-OH VD deficiency, and the number of women with depression (BDI score ≥ 17) was high (p < 0.05). Correlation analysis showed that the sexual domain scores were positively correlated with the 25-OH VD level, and the BDI score showed a significant negative correlation with the total FSFI score and 25-OH VD levels. CONCLUSION: The 25-OH VD status was associated with FSD and depression and that the degree of sexual dysfunction could depend on the severity of 25-OH VD levels. Further studies are needed to elucidate this issue.


Assuntos
Depressão/epidemiologia , Infertilidade Feminina/psicologia , Disfunções Sexuais Psicogênicas/epidemiologia , Deficiência de Vitamina D/psicologia , Vitamina D/análogos & derivados , Adulto , Depressão/etiologia , Feminino , Fertilização In Vitro , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/complicações , Prevalência , Disfunções Sexuais Psicogênicas/etiologia , Injeções de Esperma Intracitoplásmicas , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Adulto Jovem
8.
J Clin Endocrinol Metab ; 105(3)2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31955207

RESUMO

OBJECTIVE: The extent to which infertility and pregnancy independently increase risk of diabetes and subclinical atherosclerosis is not known. RESEARCH DESIGN AND METHODS: We conducted a secondary analysis of Diabetes Prevention Program (DPP) and the DPP Outcomes Study over a 15-year period. We included women who answered questions about gravidity and infertility at baseline (n = 2085). Infertility was defined as > 1 year of unsuccessful attempts to conceive; thus, women could have histories of infertility as well as pregnancy. Risk of diabetes associated with gravidity and infertility was calculated using Cox proportional hazards models adjusting for age, race/ethnicity, treatment arm, body mass index, and pregnancy during the study. Among women who underwent assessment of coronary artery calcification (CAC) (n = 1337), odds of CAC were calculated using logistic regression models with similar covariates. RESULTS: Among premenopausal women (n = 1075), women with histories of pregnancy and infertility (n = 147; hazard ratio [HR] 1.80; 95% confidence interval [CI] 1.30, 2.49) and women with histories of pregnancy without infertility (n = 736; HR 1.49; 95% CI 1.15, 1.93) had greater diabetes risk than nulligravid women without infertility (n = 173). Premenopausal nulligravid women with histories of infertility had a non-significant elevation in risk, although the number of these women was small (n = 19; HR 1.63; 95% CI 0.88, 3.03). Associations were not observed among postmenopausal women (n = 1010). No associations were observed between infertility or pregnancy with CAC. CONCLUSIONS: Pregnancy, particularly combined with a history of infertility, confers increased risk of diabetes but not CAC among glucose-intolerant premenopausal women.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Número de Gestações/fisiologia , Infertilidade Feminina/epidemiologia , Serviços Preventivos de Saúde , Adulto , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Incidência , Infertilidade Feminina/complicações , Estilo de Vida , Metformina/uso terapêutico , Pessoa de Meia-Idade , Gravidez , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/estatística & dados numéricos , Prevenção Primária/métodos , Prevenção Primária/organização & administração , Fatores de Risco , Comportamento de Redução do Risco , Resultado do Tratamento , Estados Unidos/epidemiologia
9.
Arthritis Care Res (Hoboken) ; 72(9): 1275-1281, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31282105

RESUMO

OBJECTIVE: Some treatments for systemic lupus erythematosus (SLE) can cause infertility, but the effect of SLE itself on fertility, particularly in African American women, is less clear. We undertook this study to examine infertility experiences in African American women with SLE compared to healthy women. METHODS: We enrolled women ages 22-40 years living in the Atlanta metropolitan area who were diagnosed with SLE after age 17 years. Women who had ever been treated with cyclophosphamide or who had a hysterectomy were excluded. African American women ages 22-40 years who were from the same area and recruited from a marketing list were used for comparison. Women were interviewed about their reproductive histories and goals. Periods of infertility were identified as times when women had regular, unprotected sex for ≥12 months without conceiving after 20 years of age. We separately considered any period of infertility and periods of infertility when attempting pregnancy. We used Cox proportional hazards regression to examine the association between SLE and time to infertility. Models were adjusted for age, nulliparity, and smoking. An age-matched analysis was also conducted to examine periods of infertility occurring after SLE diagnosis. RESULTS: Our sample included 75 women with SLE and 154 women without SLE. SLE was associated with any infertility (adjusted hazard ratio [HRadj ] 2.08 [95% confidence interval (95% CI) 1.38-3.15]), but less so with infertility when attempting pregnancy (HRadj 1.30 [95% CI 0.62-2.71]). The matched analysis generated similar point estimates. CONCLUSION: Women with SLE may be more likely to experience episodes of infertility, but this may not translate to an inability to meet reproductive goals.


Assuntos
Afro-Americanos , Infertilidade Feminina/complicações , Lúpus Eritematoso Sistêmico/complicações , Saúde da Mulher , Adulto , Feminino , Humanos , Projetos Piloto , Adulto Jovem
10.
Health Care Women Int ; 41(2): 147-158, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30924717

RESUMO

The authors' aim in this study was to determine the vitamin D levels of Turkish women who were undergoing in vitro fertilization (IVF). The study design was a descriptive cohort study of a total of 208 infertile women at an IVF center in Turkey. Our findings showed that 4.3% of the women had a replete vitamin D level, 23.6% of the women had insufficient vitamin D levels, and 72.1% of women had deficient vitamin D levels. Our findings suggest that much more effective vitamin D support programs should be implemented for women who are seeking to become pregnant.


Assuntos
Fertilização In Vitro , Infertilidade Feminina/terapia , Deficiência de Vitamina D/epidemiologia , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Adulto , Estudos de Coortes , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/complicações , Gravidez , Taxa de Gravidez , Prevalência , Turquia/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico
11.
Hum Reprod ; 34(11): 2274-2281, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31665298

RESUMO

STUDY QUESTION: Is female infertility predictive of a woman's future risk of early cardiovascular disease (CVD)? SUMMARY ANSWER: Female infertility does not seem to be predictive of early CVD during a mean follow-up of 9 years. WHAT IS KNOWN ALREADY: Associations between infertility and comorbidity have been found in several studies, but data on the association between female infertility and risk of CVD are scarce and inconclusive. STUDY DESIGN, SIZE, DURATION: In this nationwide cohort study, we included 87 221 women registered in the Danish National IVF register, undergoing medically assisted reproduction (MAR) between 1st of January 1994 and 31st of December 2015. The cohort was followed for incident hospitalization due to CVD in the Danish National Patient Register from enrollment to 31 December 2015. Women with a history of CVD prior to enrollment were excluded. Cox proportional hazard models with age as the underlying time scale were used to estimate hazard ratios (HR) with 95% CI of CVD among women with an infertility diagnosis, compared to women without an infertility diagnosis. All analyses were adjusted for educational attainment. PARTICIPANTS/MATERIALS, SETTING, METHODS: Female infertility and the reason for infertility was diagnosed and registered in the IVF register by specialists in Danish public and private fertility clinics since 1st of January 1994. In our cohort, 53 806 women (61.7%) were diagnosed with female factor infertility, while 33 415 (38.3%) did not have a female factor infertility diagnosis and made up the reference group. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 686 (1.3%) infertile women were hospitalized for CVD compared to 250 (0.7%) among women without an infertility diagnosis during a mean follow-up time of 9 years. We found no increased risk of early CVD in our analyses (adjusted HR 0.98, 95% CI: 0.85;1.14). Likewise, analyses stratified by specific infertility diagnosis, showed no risk difference. LIMITATIONS, REASONS FOR CAUTION: We were unable to adjust for confounding parameters such as body mass index, cigarette smoking or alcohol consumption. These results may not be generalizable to infertile women who do not seek out fertility treatment, or infertile women with other lifestyle characteristics than Danish women. WIDER IMPLICATIONS OF THE FINDINGS: Diagnosing female infertility or the time of MAR does not seem to be a window of opportunity where early screening for cardiovascular disease risk factors can have a prophylactic potential. STUDY FUNDING/COMPETING INTEREST(S): This study is part of the ReproUnion collaborative study, co-financed by the European Union, Interreg V ÖKS. None of the authors declare any conflict of interest.


Assuntos
Doenças Cardiovasculares/epidemiologia , Hospitalização , Infertilidade Feminina/epidemiologia , Sistema de Registros , Adulto , Doenças Cardiovasculares/complicações , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Feminino , Fertilidade , Fertilização In Vitro , Humanos , Infertilidade Feminina/complicações , Modelos de Riscos Proporcionais , Risco
12.
Hum Reprod ; 34(11): 2290-2296, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31600391

RESUMO

STUDY QUESTION: Does hormone stimulation during assisted reproductive technology (ART) treatment increase the risk of ovarian cancer? SUMMARY ANSWER: No increased risk of ovarian cancer was found among ART-treated women, with the exception of ART-treated women with endometriosis. WHAT IS KNOWN ALREADY: Previous studies on the association between ovarian stimulation during ART and ovarian cancer have shown conflicting results. The risk of ovarian cancer varies according to the cause of infertility, and only a few studies on ART treatment and risk of ovarian cancer have had sufficient data to address this issue. Endometriosis has been linked to an increased risk of ovarian cancer. STUDY DESIGN, SIZE, DURATION: Women undergoing ART treatment during 1994-2015 were registered in the Danish IVF register. Data were linked with data from the Danish Cancer Register and socio-demographic population registers using an individual person identification number assigned to people residing in Denmark. PARTICIPANTS/MATERIALS, SETTING, METHODS: All women undergoing ART treatment were age-matched with a random sample of the female background population and followed for up to 22 years. After relevant exclusions, the population consisted of 58 472 ART-treated women and 625 330 untreated women, all with no previous malignancies. Ovarian cancer risk was assessed using multivariable cox regression analyses with adjustment for educational level, marital status, parity and treatment year. Results are shown as hazard ratios (HRs) with corresponding CIs. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 393 (0.06%) women were diagnosed with ovarian cancer during follow-up (mean 9.7 years). Women treated with ART had an increased risk of ovarian cancer (HR 1.20, 95% CI 1.10-1.31), which diminished over time. The increased risk was apparent among women with female factor infertility (HR 1.36, 95% CI 1.25-1.48), whereas no female factor infertility was associated with a lower risk (HR 0.87, 95% CI 0.76-1.00). The risk was increased among women with endometriosis (HR 3.78, 95% CI 2.45-5.84), whereas no increased risk was found among ART-treated women with polycystic ovary syndrome, other female causes of infertility and unexplained infertility. LIMITATIONS, REASONS FOR CAUTION: The association between ART treatment and ovarian cancer is likely influenced by increased detection due to multiple ultrasound scans during ART treatment. WIDER IMPLICATIONS OF THE FINDINGS: Undergoing ART treatment without the presence of endometriosis was not associated with an increased risk of ovarian cancer, which is reassuring. Whether ART treatment increases the risk of ovarian cancer among women with endometriosis needs further investigation. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by a PhD grant to D.V. from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Funding for establishing the Danish National ART-couple II cohort was achieved from Ebba Rosa Hansen Foundation. The funders had no influence on data collection, analyses or results presented. The authors have no conflicts of interest to declare.


Assuntos
Endometriose/complicações , Infertilidade Feminina/complicações , Neoplasias Ovarianas/etiologia , Técnicas de Reprodução Assistida/efeitos adversos , Adulto , Dinamarca/epidemiologia , Endometriose/terapia , Feminino , Fertilização In Vitro , Seguimentos , Humanos , Infertilidade Feminina/terapia , Modelos de Riscos Proporcionais , Sistema de Registros , Análise de Regressão , Risco , Medição de Risco
13.
Orv Hetil ; 160(41): 1633-1638, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31587576

RESUMO

Introduction: Bowel endometriosis is when endometrial-like tissue penetrates the bowel serosa, or it reaches the subserous neurovascular plexus. The effect of surgery for colorectal endometriosis on infertility and pregnancy is not fully proven. Aim: The aim of the present study was to analyse the pregnancy outcome and mode of delivery of patients who underwent 'nerve sparing' anterior resection of the colon. Method: Between 2009 and 2017, we operated 121 patients with bowel endometriosis, and built up a prospective database where we assessed their wish of pregnancy, the way of the conception, pathologies during pregnancy and mode of delivery. Statistical analysis: The relationship between endometriosis and pregnancy pathologies was tested by a χ2 probe and Fisher's exact test, additionally the odds ratio (OR) and 95% confidence interval (CI) were determined. For p<0.05, the result was considered significant. Results: Out of 121 bowel endometriosis patients, 48 (39.6%) women got pregnant, 37 (30.5%) of them with in vitro fertilisation. The control group was built from patients who underwent in vitro fertilisation because of andrological factors. We found that women with endometriosis have a significantly higher risk for praeeclampsia (p = 0.023) and placenta praevia (p = 0.045) during pregnancy. Conclusions: Our study is a unique description of pregnancy outcome and mode of delivery after surgery for bowel endometriosis, which, despite the small number of cases, has yielded similar results to the previous multicentric studies. Orv Hetil. 2019; 160(41): 1633-1638.


Assuntos
Endometriose/cirurgia , Fertilidade/fisiologia , Fertilização In Vitro/métodos , Infertilidade Feminina/complicações , Endometriose/fisiopatologia , Feminino , Humanos , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Estudos Prospectivos
14.
Curr Opin Obstet Gynecol ; 31(6): 428-432, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31567447

RESUMO

PURPOSE OF REVIEW: Polycystic ovarian syndrome (PCOS) is a common reproductive disorder, which significantly impairs the fertility of 3-10% of women at reproductive age. It is getting very popular for women with PCOS to seek alternative therapies to treat PCOS, for example, acupuncture. This review examines the currently available evidence from the randomized controlled trial to guide future recommendation on using acupuncture to assist the treatment of PCOS. RECENT FINDINGS: PCOS is manifested by oligo-amenorrhoea, infertility, and hirsutism. The standard treatment of PCOS includes oral pharmacological agents, lifestyle changes, and surgical modalities. Pharmacologically based therapies are only effective in 60% of the patients, which are also associated with different side-effects. As such, acupuncture offered an alternative option. Acupuncture can affect ß-endorphin production, which may, in turn, affect gonadotropin-releasing hormone secretion and affecting ovulation and menstrual cycle. Therefore, it is postulated that acupuncture may induce ovulation and restore menstrual cycle via increasing ß-endorphin production. SUMMARY: Although modern medical science has discovered the action mechanisms underlying how acupuncture may manage the symptoms of PCOS, majority of the trials are small in sample size and lack of consistency in the choice of acupoints. Larger scale trials are needed to provide standardized protocols.


Assuntos
Terapia por Acupuntura , Síndrome do Ovário Policístico/terapia , Amenorreia/complicações , Amenorreia/terapia , Feminino , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/terapia , Menstruação , Meridianos , Ovulação , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
15.
Rev Bras Ginecol Obstet ; 41(10): 621-627, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31658490

RESUMO

Antiphospholipid antibody syndrome (APS) is a systemic, autoimmune, prothrombotic disease characterized by persistent antiphospholipid antibodies (aPLs), thrombosis, recurrent abortion, complications during pregnancy, and occasionally thrombocytopenia. The objective of the present study was to review the pathophysiology of APS and its association with female infertility. A bibliographic review of articles of the past 20 years was performed at the PubMed, Scielo, and Bireme databases. Antiphospholipid antibody syndrome may be associated with primary infertility, interfering with endometrial decidualization and with decreased ovarian reserve. Antiphospholipid antibodies also have direct negative effects on placentation, when they bind to the trophoblast, reducing their capacity for invasion, and proinflammatory effects, such as complement activation and neutrophil recruitment, contributing to placental insufficiency, restricted intrauterine growth, and fetal loss. In relation to thrombosis, APS results in a diffuse thrombotic diathesis, with global and diffuse dysregulation of the homeostatic balance. Knowing the pathophysiology of APS, which is closely linked to female infertility, is essential for new therapeutic approaches, specialized in immunomodulation and inflammatory signaling pathways, to provide important advances in its treatment.


Assuntos
Síndrome Antifosfolipídica , Infertilidade Feminina , Aborto Habitual , Adulto , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/fisiopatologia , Feminino , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/fisiopatologia , Pessoa de Meia-Idade , Gravidez
16.
Gynecol Endocrinol ; 35(sup1): 41-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31532320

RESUMO

Objective: To study clinical and laboratory parameters and morphological characteristics of the endometrium in women with impaired fat metabolism and failed IVF attempts. Materials and methods: Clinical examination, laboratory tests, morphological analysis, and immunohistochemistry of the endometrium were conducted in 76 patients with different BMI, followed up with infertility and failed IVF attempts. Patients were divided into four groups by body mass index (BMI): 1 group - 17 women with overweight, BMI = 25.0 - 29.9 kg/m2; 2 group - 15 women with class I obesity, BMI 30.0-34.9 kg/m2; 3 group - 14 women with class II obesity, BMI 35.0-39.9 kg/m2; and the control group of 30 women with normal weight, BMI 18.5-24.9 kg/m2. Results: Clinical and laboratory analysis revealed menstrual irregularities and hormonal imbalance such as hypoestrogenism. Immunohistochemistry of the endometrium found a significant decrease in the expression of ERα and PR receptors in the glands correlated to increasing BMI. Conclusion: Pregravid preparation of women with increased BMI and failed IVF attempts has to include life-style modification and weight reduction program to restore normal hormonal status and expression of estrogen and progesterone receptors, prevention of excessive proliferative processes in the endometrium, and improving endometrial receptivity.


Assuntos
Endométrio/patologia , Fertilização In Vitro , Infertilidade Feminina/patologia , Infertilidade Feminina/terapia , Transtornos do Metabolismo dos Lipídeos/patologia , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Endométrio/metabolismo , Receptor alfa de Estrogênio/metabolismo , Feminino , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/metabolismo , Estilo de Vida , Transtornos do Metabolismo dos Lipídeos/complicações , Transtornos do Metabolismo dos Lipídeos/metabolismo , Obesidade/metabolismo , Obesidade/patologia , Sobrepeso/complicações , Sobrepeso/metabolismo , Sobrepeso/patologia , Receptores de Progesterona/metabolismo , Falha de Tratamento , Adulto Jovem
17.
Hum Reprod ; 34(9): 1650-1660, 2019 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-31411334

RESUMO

STUDY QUESTION: Can plasma miRNAs be used for the non-invasive diagnosis of endometriosis in infertile women? SUMMARY ANSWER: miRNA-based diagnostic models for endometriosis failed the test of independent validation. WHAT IS KNOWN ALREADY: Circulating miRNAs have been described to be differentially expressed in patients with endometriosis compared with women without endometriosis, suggesting that they could be used for the non-invasive diagnosis of endometriosis. However, these studies have shown limited consistency or conflicting results, and no miRNA-based diagnostic test has been validated in an independent patient cohort. STUDY DESIGN, SIZE, DURATION: We performed genome-wide miRNA expression profiling by small RNA sequencing to identify a set of plasma miRNAs with discriminative potential between patients with and without endometriosis. Expression of this set of miRNAs was confirmed by RT-qPCR. Diagnostic models were built using multivariate logistic regression with stepwise feature selection. In a final step, the models were tested for validation in an independent patient cohort. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Plasma of all patients was available in the biobank of the Leuven Endometriosis Centre of Excellence. Biomarker discovery and model development were performed in a discovery cohort of 120 patients (controls = 38, endometriosis = 82), and models were tested for validation in an independent cohort of 90 patients (controls = 30, endometriosis = 60). RNA was extracted with the miRNeasy Plasma Kit. Genome-wide miRNA expression analysis was done by small RNA sequencing using the NEBNext small RNA library prep kit and the NextSeq 500 System. cDNA synthesis and qPCR were performed using the Qiagen miScript technology. MAIN RESULTS AND THE ROLE OF CHANCE: We identified a set of 42 miRNAs with discriminative power between patients with and without endometriosis based on genome-wide miRNA expression profiling. Expression of 41 miRNAs was confirmed by RT-qPCR, and 3 diagnostic models were built. Only the model for minimal-mild endometriosis (Model 2: hsa-miR-125b-5p, hsa-miR-28-5p and hsa-miR-29a-3p) had diagnostic power above chance performance in the independent validation (AUC = 60%) with an acceptable sensitivity (78%) but poor specificity (37%). LIMITATIONS, REASONS FOR CAUTION: The diagnostic models were built and tested for validation in two patient cohorts from a single tertiary endometriosis centre. Further validation tests in large cohorts with patients from multiple endometriosis centres are needed. WIDER IMPLICATION OF THE FINDINGS: Our study supports a possible biological link between certain miRNAs and endometriosis, but the potential of these miRNAs as clinically useful biomarkers is questionable in women with infertility. Large studies in well-described patient cohorts, with rigorous methodology for miRNA expression analysis, sufficient statistical power and an independent validation step, are necessary to answer the question of whether miRNAs can be used as diagnostics markers for endometriosis. STUDY FUNDING/COMPETING INTEREST(S): The project was funded by a grant from the Research Foundation - Flanders (FWO). A.V., D.F.O. and D.P. are PhD fellows from the FWO. T.D. is vice president and Head of Global Medical Affairs Fertility, Research and Development, Merck KGaA, Darmstadt, Germany. He is also a professor in Reproductive Medicine and Biology at the Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium and an adjunct professor at the Department of Obstetrics and Gynecology in the University of Yale, New Haven, USA. Neither his corporate role nor his academic roles represent a conflict of interest with respect to the work done by him for this study. The other co-authors have no conflict of interest. TRIAL REGISTRATION NUMBER: Not applicable.


Assuntos
Endometriose/sangue , Endometriose/diagnóstico , MicroRNAs/sangue , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos de Coortes , Endometriose/complicações , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/complicações , MicroRNAs/genética , Prevalência , Reação em Cadeia da Polimerase Via Transcriptase Reversa
18.
Reprod Biomed Online ; 39(2): 281-293, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31255606

RESUMO

This meta-analysis aimed to study whether pregnancy-related outcomes and complications differed between patients with polycystic ovary syndrome (PCOS) and those with other causes of infertility who had undergone IVF. A systematic search of PubMed, Embase, the Cochrane Library and Chinese databases was carried out to identify relevant studies published before July 2018. Outcomes were expressed as odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses and sensitivity analyses were also conducted. Twenty-nine studies were identified for inclusion. Women with PCOS had higher risks of miscarriage (OR 1.41, 95% CI 1.04-1.91), ovarian hyperstimulation syndrome (OR 4.96, 95% CI 3.73-6.60), gestational diabetes mellitus (OR 2.67, 95% CI 1.43-4.98), pregnancy-induced hypertension (OR 2.06, 95% CI 1.45-2.91), preterm birth (OR 1.60, 95% CI 1.25-2.04) and large-for-gestational-age babies (OR 2.10, 95% CI 1.01-4.37). Women with PCOS showed similar rates of clinical pregnancy, multiple pregnancy, ectopic pregnancy, small for gestational age and congenital malformations, and a higher live birth rate, compared with women without PCOS. This study provides an update on and comprehensive evidence to support the observation that despite the fact that PCOS patients achieve a better live birth rate, physicians should continue to consider them to be at high risk of adverse pregnancy-related outcomes.


Assuntos
Fertilização In Vitro/métodos , Síndrome do Ovário Policístico/terapia , Resultado da Gravidez , Aborto Espontâneo , Diabetes Gestacional/diagnóstico , Transferência Embrionária , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Humanos , Hipertensão Induzida pela Gravidez , Infertilidade Feminina/complicações , Infertilidade Feminina/terapia , Síndrome de Hiperestimulação Ovariana , Indução da Ovulação/efeitos adversos , Síndrome do Ovário Policístico/complicações , Gravidez , Taxa de Gravidez , Gravidez Múltipla , Nascimento Prematuro , Risco
19.
Artigo em Russo | MEDLINE | ID: mdl-31317890

RESUMO

AIM: To study the psychopathological characteristics of infertile women with sexual disorders in assisted reproductive technologies (ART) programs to develop therapeutic and rehabilitative interventions and improve the quality of life of the couple. MATERIAL AND METHODS: An open continuous comparative descriptive study of sexual health, psychopathological features and personality characteristics of 589 women with infertility seeking treatment using ART was performed in 2013-2017. Clinical-psychopathological, sexological and psychometric methods were used. RESULTS: Non-psychotic mental disorders, predominantly anxiety disorders (28.0%), were identified in 58,9% of patients. Sexual dysfunctions of a disease level, among which prevailed disorder of libido (25.0%), were identified in 18.34% of patients. A high comorbidity of sexual dysfunctions and borderline mental disorders was detected (100% in patients with sexual dysfunctions versus 44.9% in patients without sexual disorders). an analysis of premorbid personality characteristics and severity of psychopathological symptoms based on the results of mpt, scl - 90 showed that patients with sexual disorders scored significantly lower on domains 'extroversion' and 'tolerance to frustration', while scores on 'esoteric tendencies', 'neuroticism', 'obsession', 'sensitivity', 'depression', 'anxiety', 'hostility' and 'psychoticism' were higher; significant positive and negative correlations between domains were noted. Increased or high levels of anhedonia assessed with scale SHAPS were found in 100% of patients, 43.8% had alexithymia according to TAS and 18.19% showed increased and high levels of asthenia (MFI-20). CONCLUSION: Characteristics of the psychopathological structure of sexual dysfunctions in women with infertility in ART programs should be taken into account in the development of treatment and rehabilitation options and improvement of quality of life of the couple.


Assuntos
Infertilidade Feminina , Transtornos Mentais , Disfunções Sexuais Fisiológicas , Ansiedade , Feminino , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/psicologia , Transtornos Mentais/complicações , Qualidade de Vida , Técnicas Reprodutivas , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Fisiológicas/psicologia
20.
Reprod Health ; 16(1): 106, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307482

RESUMO

BACKGROUND: Vitamin D deficiency has been associated with an increased risk of abnormal pregnancy implantation leading to obstetric complications such as pre-eclampsia and fetal growth restriction. However, the effect of vitamin D on reproductive treatment outcomes in couples undergoing assisted reproductive treatment is poorly understood. This study investigates the association between vitamin D and reproductive treatment outcomes in women undergoing assisted reproductive treatments? METHODS: A prospective cohort study conducted at a large tertiary teaching hospital, United Kingdom. Five hundred women undergoing assisted reproductive treatment were recruited between September 2013 and September 2015. All participants had their serum vitamin D measured and their reproductive treatment outcomes collated. Women were categorised in to three groups: vitamin D replete (> 75 nmol/L), insufficient (50-75 nmol/L) and deficient (< 50 nmol/L) according to Endocrine Society guidance. The primary outcome was live birth. Secondary outcomes included biochemical pregnancy, clinical pregnancy and pregnancy loss rates. RESULTS: Vitamin D deficiency was found in 53.2% (266/500) of participants and vitamin D insufficiency was found in 30.8% (154/500) of participants. Only 16% (80/500) of women were vitamin D replete. The live birth rates for vitamin D deficient, insufficient and replete women were 23.2% (57/246), 27.0% (38/141) and 37.7% (29/77) respectively (p = 0.04). The respective live birth rates for vitamin D deficient, insufficient and replete women were 24.3, 27.1, 34.4% after adjustment for key prognostic factors (p = 0.25). CONCLUSIONS: Vitamin D deficiency and insufficiency are common in women undergoing assisted reproductive treatments. The crude live birth rate achieved in women undergoing assisted reproductive treatments are associated with serum vitamin D, although statistical significance is lost when adjusting for important prognostic variables. Vitamin D deficiency could be an important condition to treat in women considering fertility treatment. A research trial to investigate the benefits of vitamin D deficiency treatment would test this hypothesis. TRIAL REGISTRATION: Clinicaltrials.gov - NCT02187146 .


Assuntos
Infertilidade Feminina/terapia , Nascimento Vivo , Técnicas de Reprodução Assistida , Deficiência de Vitamina D/terapia , Vitamina D/administração & dosagem , Vitamina D/sangue , Adulto , Implantação do Embrião , Feminino , Humanos , Infertilidade Feminina/sangue , Infertilidade Feminina/complicações , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Estudos Prospectivos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Vitaminas/administração & dosagem , Vitaminas/sangue
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