4464 articles - 10.09.10
1: Fertil Steril. 2010 Aug 30; [Epub ahead of print]
Steward RG, Gill I, Williams DB, Witz CA, Griffith J, Haddad GF.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas.
Attempting to compare the rates of premature luteinization (PL), clinical pregnancy, and cycle cancellation in ovulation induction-intrauterine insemination (OI-IUI) cycles with and without the GnRH antagonist, cetrorelix, a randomized-controlled trial was undertaken in which patients were randomized to one of two OI-IUI protocols. Those in the cetrorelix arm showed a significantly reduced rate of PL and no change in clinical pregnancy or cycle cancellation rate, leading to the conclusion that GnRH antagonists can decrease the rate of PL, but appear to have no effect on pregnancy or cycle cancellation in gonadotropin OI-IUI cycles. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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PMID: 20810107 [PubMed - as supplied by publisher]2: Hum Reprod. 2010 Aug 17; [Epub ahead of print]
Zhang H, Legro RS, Zhang J, Zhang L, Chen X, Huang H, Casson PR, Schlaff WD, Diamond MP, Krawetz SA, Coutifaris C, Brzyski RG, Christman GM, Santoro N, Eisenberg E; for the Reproductive Medicine Network.
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA.
BACKGROUND Double-blind, randomized clinical trials are the preferred approach to demonstrating the effectiveness of one treatment against another. The comparison is, however, made on the average group effects. While patients and clinicians have always struggled to understand why patients respond differently to the same treatment, and while much hope has been held for the nascent field of predictive biomarkers (e.g. genetic markers), there is still much utility in exploring whether it is possible to estimate treatment efficacy based on demographic and baseline variables. METHODS The pregnancy in polycystic ovary syndrome (PPCOS) study was a prospective, multi-center, randomized clinical trial comparing three ovulation induction regimens: clomiphene citrate (CC), metformin and the combination of the two. There were 446 women who ovulated in response to the treatments among the entire 626 participants. In this report, we focus on the 418 women who received CC (alone or combined with metformin) to determine if readily available baseline physical characteristics and/or easily obtainable baseline measures could be used to distinguish treatment effectiveness in stimulating ovulation. We used a recursive partitioning technique and developed a node-splitting rule to build decision tree models that reflected within-node and within-treatment responses. RESULTS Overall, the combination of CC plus metformin resulted in an increased incidence of ovulation compared with CC alone. This is particularly so in women with relatively larger left ovarian volumes (>/=19.5 cubic cm), and a left ovarian volume <19.5 cubic cm was related to treatment outcomes for all subsequent nodes. Women who were older, who had higher baseline insulin, higher waist-to-hip circumference ratio or higher sex hormone-binding globulin levels had better ovulatory rates with CC alone than with the combination of CC plus metformin. CONCLUSIONS Polycystic ovary syndrome (PCOS) is a phenotypically diverse condition. Both baseline laboratory and clinical parameters can predict the ovulatory response in women with PCOS undergoing ovulation induction. Without a priori hypotheses with regard to any predictors, the observation regarding left ovary volume is novel and worthy of further investigation and validation.
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PMID: 20716558 [PubMed - as supplied by publisher]3: Fertil Steril. 2010 Aug 3; [Epub ahead of print]
Bodri D, Sunkara SK, Coomarasamy A.
Clinica Eugin, Barcelona, Spain; Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autonoma de Barcelona, Barcelona, Spain.
OBJECTIVE: To compare GnRH agonists and antagonists in oocyte-donation IVF treatment cycles by a systematic review and meta-analysis of trials. DESIGN: Systematic review and meta-analysis of randomized clinical trials (RCT). Systematic literature searches were conducted, and all randomized trials that compared GnRH agonists with antagonists in oocyte-donation IVF treatment cycles were included. Study selection, quality appraisal, and data extractions were performed independently and in duplicate. SETTING: Tertiary fertility center. PATIENT(S): A total of 1,024 oocyte donors treated in eight RCTs. INTERVENTION(S): Comparison of GnRH agonists versus antagonists in oocyte-donation IVF treatment. MAIN OUTCOME MEASURE(S): Ongoing pregnancy, oocytes retrieved, duration of stimulation, gonadotropin consumption, and ovarian hyperstimulation syndrome incidence (OHSS) per randomized oocyte donor. RESULT(S): Meta-analysis of these studies showed no significant difference in ongoing pregnancy rate between the GnRH agonists and antagonists (risk ratio [RR] 1.15, 95% confidence interval [CI] 0.97 to 1.36). The duration of stimulation was significantly lower with the GnRH antagonist protocol (weighed mean difference [WMD] -0.90 days, 95% CI -1.61 to -0.20). No significant differences were observed in the number of oocytes retrieved (WMD -0.60, 95% CI -2.26 to +1.07), gonadotropin consumption (WMD -264 IU, 95% CI -682 to +154), or OHSS incidence (RR 0.62, 95% CI 0.18 to 2.15). CONCLUSION(S): No significant differences were observed in ongoing pregnancy rate or the number of retrieved oocytes after donor stimulation with GnRH agonist or antagonist protocols. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20684954&dopt=ExternalLink
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PMID: 20684954 [PubMed - as supplied by publisher]4: Contraception. 2010 Jul;82(1):102-12. Epub 2010 Mar 29.
Paulen ME, Folger SG, Curtis KM, Jamieson DJ.
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
BACKGROUND: Women undergoing solid organ transplantation are advised to avoid pregnancy for up to 24 months following transplant surgery. STUDY DESIGN: We conducted a systematic review of the literature, from database (PubMed) inception through February 2009, to evaluate evidence on the safety and effectiveness of contraceptive use among women having undergone solid organ transplantation. RESULTS: From 643 articles, eight articles from seven studies satisfied review inclusion criteria; six articles pertained to kidney transplant patients, and two reported on liver transplant patients. Two reports of one prospective cohort of 36 kidney transplant recipients taking combined oral contraceptives (COCs) or using the transdermal contraceptive patch reported no significant changes in biochemical measures after 18 months of use for either group, although 13 women modified antihypertensive medication, and two women discontinued the study because of serious medical complications. Four case reports of five kidney recipients using intrauterine devices reported inconsistent findings, including both beneficial health effects and contraceptive failures. One retrospective, noncomparative study of 15 liver transplant recipients using COCs or the transdermal contraceptive patch found no significant changes in any biochemical measures obtained, no discontinuations or severe complications and no pregnancies after a 12-month follow up. One case report of a liver transplant recipient on cyclosporine and prednisone documented the development of cholestasis associated with high-dose (50 mcg ethinyl estradiol) COC use as treatment for heavy uterine bleeding. CONCLUSIONS: Very limited evidence on COC and transdermal contraceptive patch use among kidney and liver transplant recipients indicated no pregnancies and no overall changes in biochemical measures. Excluding case reports, evidence on other contraceptive methods or contraception among other types of solid organ transplants was not identified. Published by Elsevier Inc.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20682148&dopt=ExternalLink
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PMID: 20682148 [PubMed - in process]5: Contraception. 2010 Jul;82(1):95-101. Epub 2010 Mar 12.
Tepper NK, Paulen ME, Marchbanks PA, Curtis KM.
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. ntepper@cdc.gov
STUDY DESIGN: Women with peripartum cardiomyopathy (PPCM) have significant health risks during subsequent pregnancies and therefore have a critical need for safe and effective contraception. This systematic review examines evidence regarding the safety of contraceptive use among women with PPCM. METHODS: We searched the PubMed database for all primary research articles published through February 2009 that addressed the safety of any contraceptive method among women with PPCM or other cardiomyopathy of any type. RESULTS: Of 110 articles that addressed contraceptive safety among women with cardiac disease, three met our inclusion criteria. In these three studies, which included a total of five women with cardiomyopathy, though not specifically PPCM, cases of hypertension, transient ischemic attack (TIA), thromboembolism or heart failure were found among women with cardiac disease who used hormonal methods of contraception including combined oral contraceptives, progestin-only pills and depot medroxyprogesterone acetate. None of the studies reported any cases of cardiovascular complications or infective endocarditis among women with cardiac disease who used intrauterine devices (IUDs). CONCLUSIONS: We found no data concerning the safety of contraceptive use among women with PPCM, though we did find limited evidence of hypertension, TIA, thromboembolism and heart failure among women with cardiac disease who used hormonal methods of contraception. None of the studies reported any cases of cardiovascular complications or infective endocarditis among women with cardiac disease who used IUDs. Published by Elsevier Inc.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20682147&dopt=ExternalLink
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PMID: 20682147 [PubMed - in process]6: Contraception. 2010 Jul;82(1):86-94. Epub 2010 Mar 29.
Paulen ME, Zapata LB, Cansino C, Curtis KM, Jamieson DJ.
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
BACKGROUND: Weight loss after bariatric surgery often improves fertility but can pose substantial risks to maternal and fetal outcomes. Women who have undergone a bariatric surgical procedure are currently advised to delay conception for up to 2 years. STUDY DESIGN: We conducted a systematic review of the literature, from database (PubMed) inception through February 2009, to evaluate evidence on the safety and effectiveness of contraceptive use among women with a history of bariatric surgery. RESULTS: From 29 articles, five met review inclusion criteria. One prospective, noncomparative study reported 2 pregnancies among 9 (22%) oral contraceptive (OC) users following biliopancreatic diversion, and one descriptive study reported no pregnancies among an unidentified number of women taking OCs following laparoscopic adjustable gastric banding. Of two pharmacokinetic studies, one found lower plasma levels of norethisterone and levonorgestrel among women having had a jejunoileal bypass, as compared to nonoperated, normal-weight controls. The other study found no difference in plasma levels of D-norgestrel between women having a jejunoileal bypass of either 1:3 or 3:1 ratio between the length of jejunum and ileum left in continuity, but women with a 1:3 ratio had significantly higher plasma levels of D-norgestrel than extremely obese controls not operated upon. CONCLUSIONS: Evidence regarding OC effectiveness following a bariatric surgical procedure is quite limited, although no substantial decrease in effectiveness was identified from available studies. Evidence on failure rates for other contraceptive methods and evidence on safety for all contraceptive methods was not identified. Published by Elsevier Inc.
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PMID: 20682146 [PubMed - in process]7: Contraception. 2010 Jul;82(1):72-85. Epub 2010 Mar 29.
Zapata LB, Paulen ME, Cansino C, Marchbanks PA, Curtis KM.
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. lzapata@cdc.gov
BACKGROUND: There are theoretical concerns that use of hormonal contraceptives by women with inflammatory bowel disease (IBD) might increase disease relapse and risk of other adverse health outcomes, including thrombosis. In addition, there are concerns that IBD-related malabsorption might decrease the effectiveness of orally ingested contraceptives. The objective of this systematic review was to evaluate the evidence on the safety and effectiveness of contraceptive use among women with IBD. STUDY DESIGN: We searched the PubMed database for peer-reviewed articles relevant to contraceptive use and IBD that were published in any language from inception of the database through February 2009. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. RESULTS: From 207 articles, we identified 10 studies that met our inclusion criteria. Evidence from five cohort studies (Level II-2, fair to good) suggests no increased risk of IBD relapse with use of oral contraceptives. Evidence from two pharmacokinetic studies (not graded) suggests that women with mild ulcerative colitis and those with an ileostomy following a proctocolectomy with small ileal resections have plasma concentrations of steroid hormones after oral ingestion of higher doses of combined oral contraceptives that are similar to the plasma concentrations among healthy volunteers. No studies were found that examined the risk of thrombosis among women with IBD who used hormonal contraceptives. CONCLUSIONS: Limited evidence suggests there is no increased risk of disease relapse among women with IBD who use oral contraceptives, and there seem to be no differences in the absorption of higher-dose combined oral contraceptives between women with mild ulcerative colitis and small ileal resections and healthy women. Published by Elsevier Inc.
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PMID: 20682145 [PubMed - in process]8: Contraception. 2010 Jul;82(1):64-71. Epub 2010 Mar 29.
Farr SL, Folger SG, Paulen ME, Curtis KM.
U.S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. SFarr@cdc.gov
BACKGROUND: Women with rheumatoid arthritis (RA) and their clinicians may have unique concerns about certain methods of contraception. STUDY DESIGN: We conducted a systematic review of the literature in the MEDLINE database through February 2009 for peer-reviewed journal articles on use of any method of contraception, or progestins or estrogens, and progression of RA. RESULTS: We identified eight articles that met the inclusion criteria: six examined oral contraceptives (OCs), one progesterone, and one estrogen. We found no studies on other methods of contraception. For OCs, no consistent pattern of improvement or worsening of disease emerged and most patients showed little change in RA symptoms. We saw little improvement in the studies examining progesterone and estrogen. CONCLUSION: Although sparse and based primarily on older studies of poor quality, this information suggests that OC use is unlikely to affect RA disease progression. Research is needed on other forms of contraception, such as DMPA and IUD. Published by Elsevier Inc.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20682144&dopt=ExternalLink
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PMID: 20682144 [PubMed - in process]9: Contraception. 2010 Jul;82(1):56-63. Epub 2010 Mar 29.
Whiteman MK, Zapata LB, Tepper NK, Marchbanks PA, Curtis KM.
Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. acq5@cdc.gov
BACKGROUND: The objective of this systematic review is to evaluate the evidence for the safety of contraceptive use among women with endometrial hyperplasia. STUDY DESIGN: We searched the PubMed database for peer-reviewed articles published in any language from database inception through February 2009 concerning the safety of using any contraceptive method among women diagnosed with endometrial hyperplasia. We excluded case reports but included all other study designs. The quality of each individual piece of evidence was assessed using the United States Preventive Services Task Force grading system. RESULTS: We identified nine articles that met the criteria for review. Each study examined levonorgestrel intrauterine devices (LNG-IUDs); no studies were identified that examined other contraceptive methods. Overall, these studies suggest that LNG-IUD use is not associated with adverse health events among women diagnosed with endometrial hyperplasia. Disease regression with LNG-IUD use was observed in all women in seven studies, in 90% of women in one study, and in 67% of women in one study. Limitations of the studies include small sample sizes and lack of a comparison group or nonrandomized assignment to LNG-IUD. CONCLUSIONS: There is fair quality evidence indicating that use of the LNG-IUD is safe for women with endometrial hyperplasia and may have therapeutic benefits. Published by Elsevier Inc.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20682143&dopt=ExternalLink
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PMID: 20682143 [PubMed - in process]10: Contraception. 2010 Jul;82(1):41-55. Epub 2010 Mar 29.
Zapata LB, Whiteman MK, Tepper NK, Jamieson DJ, Marchbanks PA, Curtis KM.
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. lzapata@cdc.gov
BACKGROUND: There are concerns that intrauterine device (IUD) use by women with uterine fibroids might increase their uterine bleeding or risk for device expulsion. The objective of this systematic review was to evaluate evidence concerning the safety and effectiveness of IUD use among women with uterine fibroids. Key questions included whether IUD use is associated with increased risk for uterine bleeding among women with uterine fibroids and whether the presence of uterine fibroids is associated with an increased risk for device expulsion among IUD users. STUDY DESIGN: We searched the PubMed database for peer-reviewed articles relevant to IUD (copper or levonorgestrel-releasing) use and uterine fibroids published in any language from database inception through June 2009. We used standard abstract forms and a grading system to summarize and assess the quality of the evidence. RESULTS: From 202 articles found in the database search, we identified 11 studies that met our inclusion criteria, all of which examined outcomes among users of the levonorgestrel-releasing IUD (LNG-IUD). Evidence from 10 of 11 noncomparative studies (Level II-3, fair) suggests that LNG-IUD use among women with fibroids does not increase menstrual bleeding, and results from all 11 showed that menstrual blood loss decreased among women who continued to use the LNG-IUD through the end of the study period. Overall, serum levels of hemoglobin, hematocrit and ferritin increased among LNG-IUD users in studies that assessed these outcomes. Several studies reported some occurrences of irregular bleeding. Findings from two cohort studies (Level II-2, fair to poor) showed rates of LNG-IUD expulsion to be higher among women with uterine fibroids (11% in each) than among women without uterine fibroids (0% and 3%); however, in one study the difference was not statistically significant, and in the other significance testing was not conducted. Six prospective noncomparative studies reported expulsion rates of 0-20% among women with uterine fibroids. CONCLUSIONS: Most women with uterine fibroids are likely to have less menstrual blood loss and higher serum levels of hemoglobin, hematocrit and ferritin after insertion of an LNG-IUD, despite some occurrences of irregular bleeding. LNG-IUD users with uterine fibroids may have higher rates of expulsion than those without fibroids. Published by Elsevier Inc.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20682142&dopt=ExternalLink
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PMID: 20682142 [PubMed - in process]11: Contraception. 2010 Jul;82(1):38-40. Epub 2010 Mar 29.
Zapata LB, Whiteman MK, Marchbanks PA, Curtis KM.
Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA. lzapata@cdc.gov
BACKGROUND: Fertility-sparing treatment may be an option for women with early stage ovarian cancer and certain tumor types. This systematic review evaluated the evidence on the safety of intrauterine device (IUD) use by women with ovarian cancer. STUDY DESIGN: We searched the PubMed database for peer-reviewed articles relevant to IUD (copper or levonorgestrel-releasing) use and ovarian cancer published in any language from database inception through August 2009. We sought studies that examined outcomes among women using an IUD at or after ovarian cancer diagnosis. RESULTS: Of the 250 articles identified by our search strategy, none provided evidence (direct or indirect) regarding the safety of IUD use among women with ovarian cancer. CONCLUSIONS: No evidence on the safety of IUD use among women with ovarian cancer was identified. While there are some theoretical concerns that IUD use might affect monitoring of disease progression of sex cord-stromal tumors, or increase risk of pelvic infection or vaginal bleeding among women undergoing chemotherapy, we did not find any data to suggest that IUD use would lead to worsening of primary ovarian cancer. Published by Elsevier Inc.
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PMID: 20682141 [PubMed - in process]12: Contraception. 2010 Jul;82(1):17-37. Epub 2010 Mar 29.
Kapp N, Curtis K, Nanda K.
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. kappn@who.int
BACKGROUND: The use of progestogen-only contraceptives by breastfeeding women raises theoretical concerns regarding possible adverse effects on breastfeeding success, and infant health or growth. This review was conducted to determine from the literature whether use of progestogen-only contraceptives by breastfeeding women leads to adverse effects on lactation, or infant growth or health when compared to nonuse. STUDY DESIGN: We searched the Medline, Popline, Cochrane and LILACS databases for all articles published from database inception through May 2009. Studies were included if they investigated the use of progestogen-only methods in breastfeeding women and reported on clinical outcomes in either women or their infants. Standard data abstraction templates were used to systematically assess and summarize. Summary odds ratios were not calculated, given the heterogeneity of interventions, results and non-quantifiable outcomes reported. RESULTS: We identified 43 articles for this review. Overall, five randomized trials and 38 observational studies demonstrated no adverse effects of various progestogen-only methods of contraception on multiple measures of breastfeeding performance through 12 months in women using these methods in the postpartum period. Many of these studies also demonstrated no adverse effects of progestogen-only methods on infant growth, health or development from 6 months to 6 years of age. Additional studies demonstrated no effects on infant immunoglobulins or sex hormones of exposed male infants. A single study of a desogestrel pill reported two cases of gynecomastia in exposed infants. CONCLUSIONS: Evidence suggests that progestogen-only methods of contraception do not adversely affect breastfeeding performance when used during lactation. Evidence that progestogen-only contraception does not adversely affect infant growth, health, or development when used by breastfeeding women is consistent but methodologically limited. 2010 Elsevier Inc. All rights reserved.
Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20682140&dopt=ExternalLink
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PMID: 20682140 [PubMed - in process]13: Contraception. 2010 Jul;82(1):10-6. Epub 2010 Mar 9.
Kapp N, Curtis KM.
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. kappn@who.int
BACKGROUND: Postpartum women need effective contraception, but using hormonal contraceptives may affect breastfeeding performance and infant health outcomes. STUDY DESIGN: We searched the MEDLINE and Cochrane databases for all articles published through May 2009 for primary research studies that investigated clinical outcomes among breastfeeding women who used hormonal contraception or their infants. RESULTS: Three randomized controlled trials reported decreased mean duration of breastfeeding and higher rates of supplemental feeding among combined oral contraceptive (COC) users than among nonusers, while one multicountry trial found no differences in these parameters. Only one study demonstrated lower average weights during the first year of life for infants whose mothers used COCs while breastfeeding. None of the eight studies, four of which were observational, included in this review documented adverse infant health outcomes. CONCLUSIONS: Limited evidence demonstrates an inconsistent effect of COC on breastfeeding duration and success. The evidence is inadequate to determine whether a mother's use of these drugs affects breastfeeding duration or the infant's health. 2010 Elsevier Inc. All rights reserved.
Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20682139&dopt=ExternalLink
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PMID: 20682139 [PubMed - in process]14: Fertil Steril. 2010 Jul 30; [Epub ahead of print]
Li Y, Lin H, Li Y, Cao J.
Department of Social Medicine and Health Service Management, Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Third Military Medical University, Chongqing, People's Republic of China.
OBJECTIVE: To identify the factors associated with male semen quality from many socio-psycho-behavioral factors. DESIGN: Medline/PubMed, EMBASE, and CNKI were searched to identify relevant publications for systematic review and meta-analysis. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Thirteen socio-psycho-behavioral factors in 57 cross-sectional studies with 29,914 participants from 26 countries/regions were involved in this review. Six factors (age, body mass index [BMI], psychological stress, smoking, alcohol, and coffee consumption) were included in meta-analyses. RESULT(S): Smoking can deteriorate all of the sperm parameters of both fertile and infertile men, but it is not risk factor for semen volume in Switzerland and Iran and for sperm density in the United States, Denmark, and Brazil; higher age and alcohol consumption are risk factors for lower semen volume; and psychological stress can lower sperm density and sperm progressive motility and increase abnormal sperm. CONCLUSION(S): This review further suggested that higher age, smoking, alcohol consumption, and psychological stress were risk factors for semen quality. These results indicated that health programs focusing on lifestyle and psychological health would be helpful for male reproductive health. Well-designed studies are needed to further identify the role of more socio-psycho-behavioral factors in male semen quality. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20674912&dopt=ExternalLink
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PMID: 20674912 [PubMed - as supplied by publisher]15: Fertil Steril. 2010 Jul 30; [Epub ahead of print]
Var T, Tonguc EA, Doganay M, Gulerman C, Gungor T, Mollamahmutoglu L.
Zekai Tahir Burak Woman's Health Education and Research Hospital, Assisted Reproduction Unit, Ankara, Turkey.
OBJECTIVE: To evaluate the effects of three different luteal phase support protocols on pregnancy and implantation rates, as well as luteal phase hormone profile in intracytoplasmic sperm injection-ET cycles. DESIGN: A prospective, randomized study. SETTING: A tertiary teaching and research hospital. PATIENT(S): Two hundred eighty-eight patients who were undergoing intracytoplasmic sperm injection with a long protocol of controlled ovarian hyperstimulation. INTERVENTION(S): Group 1 (E(2) + P) received daily P plus 4 mg of E(2), group 2 (hCG + P) received P plus 1,500 IU of hCG, and group 3 (P only) received daily vaginal P gel. Blood samples were drawn on the day of hCG administration, as well as 7 and 10 days after the hCG for the E(2) and P measurements. MAIN OUTCOME MEASURE(S): The clinical pregnancy rate. RESULT(S): No difference existed between the E(2) + P and hCG + P groups with respect to pregnancy rate, but it was significantly lower in the P-only group.The implantation rate was significantly lower in the P-only group than in the other groups.The highest miscarriage rate was in the P-only group (38%). CONCLUSION(S): In assisted reproductive technology cycles including treatment with GnRH agonist, adding 4 mg of oral E(2) to P during the luteal phase significantly increased the pregnancy and implantation rates and decreased the miscarriage rate compared with the use of P only. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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PMID: 20674911 [PubMed - as supplied by publisher]16: Fertil Steril. 2010 Jul 22; [Epub ahead of print]
Jadoul P, Querleu D, Squifflet JL, Donnez J.
Department of Gynecology, Universite Catholique de Louvain, Brussels, Belgium.
OBJECTIVE: To evaluate the safety of conservative management of early cervical cancer. DESIGN: Case report and analysis of literature guidelines. SETTING: Academic teaching hospital. PATIENT(S): A 35-year-old, nulliparous woman treated by simple trachelectomy and pelvic lymphadenectomy for a well-differentiated, 12-mm squamous cell carcinoma infiltrating to a depth of 3 mm (stage Ib1) without lymphovascular space involvement. INTERVENTION(S): Follow-up. MAIN OUTCOME MEASURES(S): Recurrence and disease evolution. RESULT(S): Sixteen months after surgery, at 32 weeks' gestation, a local recurrence of 5 cm in diameter was diagnosed, associated with pelvic and interaortocaval lymph node involvement. Despite extensive radiotherapy, chemotherapy, and radical surgery, disease progression could not be halted. CONCLUSION(S): We report a case of early-stage cervical cancer, conservatively treated by simple trachelectomy and lymphadenectomy, that recurred although none of the known risk factors for recurrence were initially present, and despite the fact that literature guidelines were followed. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20655526&dopt=ExternalLink
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PMID: 20655526 [PubMed - as supplied by publisher]17: Hum Reprod. 2010 Sep;25(9):2203-9. Epub 2010 Jul 15.
Stephenson MD, Kutteh WH, Purkiss S, Librach C, Schultz P, Houlihan E, Liao C.
University of Chicago Recurrent Pregnancy Loss Program, Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Avenue (MC 2050), Chicago, IL 60637, USA. mstephen@babies.bsd.uchicago.edu
BACKGROUND: Idiopathic secondary recurrent miscarriage may be associated with an abnormal maternal immune response to subsequent pregnancies. Intravenous immunoglobulin (IVIG) has been studied in randomized controlled trials (RCTs) with conflicting results. Therefore, a definitive trial was proposed. METHODS: We conducted an investigator-initiated, multicentered, randomized, double-blinded, placebo-controlled trial comparing IVIG with saline in women with idiopathic secondary recurrent miscarriage, defined as a history of at least one prior ongoing pregnancy followed by three or more consecutive unexplained miscarriages. Subjects received either IVIG 500 mg/kg or the equivalent volume of normal saline. Preconception infusions were administered 14-21 days from the projected next menstrual period. With documentation of pregnancy, the subject received the same infusion every 4 weeks until 18-20 weeks of gestation. The primary outcome was an ongoing pregnancy of at least 20 weeks of gestation. RESULTS: A total of 82 patients enrolled, of whom 47 had an index pregnancy. All ongoing pregnancies resulted in live births. Therefore, the live birth rates were 70% (16/23) in the IVIG group and 63% (15/24) in the control group (P = 0.760); odds ratio (OR) 1.37 [95% confidence interval (CI) 0.41-4.61]. Including only clinical pregnancies (embryo with cardiac activity at 6 weeks of gestation), the live birth rates were equivalent, 94% (16/17) and (15/16), respectively (P > 0.999); OR 1.07 (95% CI 0.06-18.62). Meta-analysis of randomized controlled trials (RCTs) evaluating IVIG for idiopathic secondary recurrent miscarriage revealed live birth rates of 70% (31/44) in the IVIG group and 62% (28/45) in the control group (P = 0.503); common OR 1.44 (95% CI 0.59-3.48). CONCLUSIONS: This is the largest RCT to date in which IVIG was evaluated in women with idiopathic secondary recurrent miscarriage; no treatment benefit was found. The meta-analysis, which combined our study results with two prior RCTs, also showed no significant effect of treatment with IVIG.
Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20634190&dopt=ExternalLink
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PMID: 20634190 [PubMed - in process]18: Fertil Steril. 2010 Jul 2; [Epub ahead of print]
Prades M, Golmard JL, Schubert B, Poirot C.
Reproductive Biology Unit, University Hospital, Hopital Pitie-Salpetriere, Paris, France.
OBJECTIVE: To determine whether "pregnancy rate (PR) per thawed embryo," accounting for embryo losses, is more relevant than "PR per ET," generally used in the literature for expressing embryo cryopreservation results. DESIGN: Systematic review. SETTING: University teaching hospital. PATIENT(S): None. INTERVENTION(S): Analysis of reports from January 1983 to February 2009 involving thawing of human cryopreserved embryos. Of the 1,275 articles that were initially identified, 102 met the inclusion criteria. MAIN OUTCOME MEASURE(S): Comparisons between PR per ET and PR per thawed embryo, contribution of embryo loss to PR. RESULT(S): Overall PR, expressed per ET and per thawed embryo, was compared according to the different freezing speeds and cryoprotectants used. Statistical analysis revealed significant differences for four comparisons with one approach to expressing results, not identified with the other. All other statistical analyses gave similar results whichever way the results were expressed. The rate of thawed transferred embryos, a measure accounting for embryo losses, is a good prognostic factor for PR. CONCLUSION(S): Statistical analysis accounting for embryo losses can give results different from those published in the literature. Consequently, the clinical PR per thawed embryo may be a more informative measure for accurate analysis of practices. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20599194&dopt=ExternalLink
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PMID: 20599194 [PubMed - as supplied by publisher]19: Hum Reprod. 2010 Sep;25(9):2239-46. Epub 2010 Jun 30.
Cobo A, Meseguer M, Remohi J, Pellicer A.
Instituto Valenciano de Infertilidad (IVI), University of Valencia, Valencia, Spain. acobo@ivi.es
BACKGROUND: An efficient oocyte cryopreservation method is mandatory to establish a successful egg-banking programme. Although there are increasing reports showing good clinical outcomes after oocyte cryopreservation, there is still a lack of large controlled studies evaluating the effectiveness of oocyte cryo-banking. In this study, we aimed to compare the outcome of vitrified-banked oocytes with the gold standard procedure of employing fresh oocytes. METHODS: A randomized, prospective, triple-blind, single-centre, parallel-group controlled-clinical trial (NCT00785993), including 600 recipients (alpha = 0.05 and power of 80% for sample-size calculation) selected among 1032 eligible patients from November 2008 to September 2009, was designed to compare the outcome of vitrified-banked oocytes with the gold standard procedure of employing fresh oocytes. The study was designed to establish the superiority of the ongoing pregnancy rate (OPR) of fresh oocytes over that of vitrified oocytes, by performing a likelihood ratio test in a logistic regression analysis expressed as odds ratio (OR) with 95% confidence interval (CI). A limit of 0.66 for OR of vitrified versus fresh groups was defined to set up a possible conversion from superiority to non-inferiority. Randomization was performed 1:1 based on a computer randomization list in vitrification (n = 300) or fresh groups (n = 300). The primary end-point was the OPR per randomized patient i.e. intention-to-treat population (ITT). Secondary end-points were clinical pregnancy (CPR), implantation (IR) and fertilization rates, respectively. Additionally, embryo developmental characteristics were recorded. RESULTS: There were no differences in donor ovarian stimulation parameters, demographic baseline characteristics for donors and recipients, ovum donation indications or male factor distribution between groups (NS). The OPR per ITT was 43.7 and 41.7% in the vitrification and fresh groups, respectively. The OR of OPR was 0.921 in favour of the vitrification group. Nevertheless, the 95% CI was 0.667-1.274, thus the superiority of fresh group with respect to OPR was not proven (P = 0.744). Non-inferiority of the vitrified group compared with the fresh group was shown with a margin of 0.667, which was above the pre-established non-inferiority limit of 0.66. CPR per cycle (50.2 versus 49.8%; P = 0.933) or per embryo-transfer (55.4 versus 55.6% ; P = 0.974), and IR (39.9 versus 40.9%; P = 0.745) were similar for patients receiving either vitrified or fresh oocytes. The proportion of top-quality embryos obtained either by inseminated oocyte (30.8 versus 30.8% for Day-2; and 36.1 versus 37.7% for Day-3, respectively) or by cleaved embryos (43.6 versus 43.8% for Day-2 and 58.4 versus 60.7% for Day-3, respectively) was similar between groups (NS). CONCLUSIONS: This controlled-randomized, clinical trial confirmed the effectiveness of oocyte cryo-storage in an ovum donation programme, failing to demonstrate the superiority of using fresh oocytes with respect to the use of vitrified egg-banked ones in terms of OPR. Instead, the non-inferiority of vitrified oocytes was confirmed. These findings involve highly relevant issues that may open a new range of possibilities in ART.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20591872&dopt=ExternalLink
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PMID: 20591872 [PubMed - in process]20: Fertil Steril. 2010 Jun 24; [Epub ahead of print]
Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Papadimas I, Tarlatzis BC.
Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessalonica, Thessalonica, Greece.
OBJECTIVE: To reappraise the currently available evidence, providing the answer to the following question: does intravenous albumin administration reduce the risk of severe ovarian hyperstimulation syndrome (OHSS) occurrence following ovarian stimulation with gonadotrophins and GnRH analogues for IVF in high-risk patients? DESIGN: Systematic review and metaanalysis. SETTING: University-based hospital. INTERVENTION(S): Intravenous albumin administration in high-risk patients for prevention of severe OHSS occurrence. MAIN OUTCOME MEASURE(S): Severe OHSS occurrence. RESULT(S): Eight eligible randomized controlled trials were identified (n = 1,199 patients) that offered data for statistical pooling. No statistically significant difference in the occurrence of severe OHSS in patients who received intravenous albumin (n = 595) and those who did not (n = 604; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.52-1.22) was detected. Moreover, no statistically significant differences were present regarding the probability of pregnancy (OR, 0.83; 95% CI, 0.64-1.07) and first trimester pregnancy loss (OR, 1.44; 95% CI, 0.73-2.85) between patients who received intravenous albumin and those who did not. CONCLUSION(S): Based on the currently best available evidence, intravenous albumin administration in high-risk patients does not appear to reduce the occurrence of severe OHSS. This finding should be considered when implementing strategies for severe OHSS prevention. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20579987&dopt=ExternalLink
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PMID: 20579987 [PubMed - as supplied by publisher]