Fertility in men with spinal cord injury Čehić, Ermin; Kasum, Miro; Šimunić, Velimir ...
Gynecological endocrinology,
12/2016, Volume:
32, Issue:
12
Journal Article
Peer reviewed
Open access
Young men comprise the overwhelming majority of men with spinal cord injury (SCI), the incidence of which has been growing over the years. Due to advances in physical medicine and rehabilitation, ...remarkable improvements in survival rates have been reported, leading to life expectancies similar to those of the general population. However, many sexual and reproductive functions may be impaired due to erectile or ejaculatory dysfunction and semen abnormalities, characterised by low-sperm motility or viability in SCI males who have not become parents yet. Nevertheless, fatherhood is still possible through the introduction of specialised medical management, by using various medical, technical and surgical methods for sperm retrieval in combination with assisted reproductive techniques. Erectile dysfunction can be managed by the use of phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be obtained from the vast majority of anejaculatory men by medically assisted ejaculation through the use of penile vibratory stimulation or electroejaculation and via prostate massage or surgical procedures. Despite impaired sperm parameters, reasonable pregnancy rates similar to those in able-bodied subfertile cohorts have been reported. However, future research should focus on the optimisation of semen quality in these men and on improving natural ejaculation.
Full text
Available for:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
An increasing trend towards later childbearing has been reported recently in many developed countries. Although the incidence of reproductive age in women who have delayed pregnancy with cancer is ...10%, they may be concerned regarding the preservation of ovarian function due to advanced fertile age and with the impact of cancer treatment on later fertility. Among multiple strategies controlled, ovarian stimulation for embryo or oocyte cryopreservation is currently the most established method for fertility preservation. It is important to choose the appropriate ovulation induction protocol prior to oncologic treatment, because most of these patients have only the chance of a single cycle to conceive. Current treatment protocols offer a minimal time delay until oncologic treatment is commenced. In urgent settings, random-start ovarian stimulation represents a new technique which provides a significant advantage by decreasing the total time of the treatment, because it may be started irrespective of the phase of the cycle without compromising oocyte yield and maturity before cancer treatment. However, in patients with oestrogen-sensitive cancers stimulation, protocols using letrozole are currently preferred over tamoxifen regimens, and therefore, it may be highly advisable to use letrozole with gonadotrophins routinely as a safe, effective and novel protocol of ovulation induction.
Full text
Available for:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background: Oral hormonal contraception (OC) or the birth control pill that has been in use since 1960 is considered an efficient and reliable method of pregnancy prevention. In the early days the ...pill contained high doses of hormones, and the related complications were frequently reported. The composition of the pill has substantially changed, estrogen dose has been significantly decreased and so has the incidence of side effects. Despite the reduced estrogen dose, the risk for the development of vein thromboembolism has not significantly decreased, as the final effect depends on the interaction with the progestage+n component. The OC use is in itself an independent risk factor for the develop- ment of ischemic stroke event (RR = 1.5), and for the development of myocardial infarction (RR = 1.84). Recent studies show that second generation OC users were at a higher risk of cardiovascular disease than the third generation OC users. The risk of breast cancer is also marginally increased (RR = 1.09-fold increased risk). The discussion about an association between the development of cervical cancer and an increased incidence of the disease in OC users is inclined to attribute this increased incidence to human papilloma virus infec- tion rather than to OC use. Beneficial effects of OC use are manifested through decreased incidence of endometrial cancer, which is mostly true in women with a lower body mass index (BMI). Additionally, OC plays a protective role in the development of ovarian cancer; recent studies have reported that OC use has prevented 200 000 ovarian cancers and 100 000 deaths from the disease. Also, the risk of colorectal cancer is OC users is lower (RR = 0.72). Conclusions: Modern third generation OC preparations containing desogestrel and gestodene are a safe contraceptive method for all women except for those at increased risk of vein thrombosis.
Abstract
The purpose of this review is to analyse the sources and effects of follicular progesterone elevations during ovarian stimulation, with the underlying mechanisms and preventive strategies on ...the in vitro fertilisation pregnancy outcome. In the early follicular phase, a flare-up effect of gonadotrophin releasing hormone (GnRH) agonists and incomplete luteolysis in GnRH antagonist regimens can result in significant elevations of progesterone. In the late follicular phase, progesterone elevations in GnRH analogue cycles are the result of the ovarian stimulation itself, driven by high follicle stimulating hormone dosage, estradiol levels, the number of follicles and oocytes. It seems that progesterone elevations (> or = 1.5 ng/mL or 4.77 nmol/L) have a detrimental effect on the outcome of pregnancy, accelerating the endometrial maturation. The most appropriate choice to avoid the negative effects of follicular progesterone elevations is to cancel fresh embryo transfer and to transfer frozen-thawed embryos in natural cycles. To prevent follicular phase elevations it might be preferable to use milder stimulation protocols, earlier trigger of ovulation in high responders and single-blastocyst transfer on day 5. The optimal GnRH analogue protocols during the entire stimulation period appear to be the long agonist as well as "long" and long GnRH antagonist regimens.
Chinese abstract
这篇综述的目的是分析促排卵期间卵泡黄体激素的来源和作用，体外受精妊娠结局的机制及预防策略。在早卵泡期，促性腺激素释放激素（gonadotrophin releasing hormone，GnRH）激动剂的扳机效应和GnRH拮抗剂中不完整的黄体溶解效应会导致孕激素的升高。在晚卵泡期，GnRH类似物周期孕激素升高是促排卵本身，高卵泡刺激激素用量，雌二醇水平，卵泡和卵母细胞的数量驱动的结果。 孕激素升高似乎（>或=1.5ng/mL或4.77 nmol / L的）对妊娠结局产生不良影响，加速子宫内膜成熟。避免卵泡黄体激素升高的负面影响， 最合适的选择是取消新鲜胚胎移植，而在自然周期移植解冻的胚胎。为避免卵泡期卵泡黄体激素升高，可以使用温和的刺激方案，对高反应者进行较早的排卵诱发，并在第5天进行单个囊胚移植。在整个刺激周期最佳的GnRH类似物方案似乎是长激动剂"长"和长GnRH拮抗剂方案。
Full text
Available for:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objective To compare the efficacy and tolerability of two different types of vaginal progesterone (P), Crinone 8% gel (Fleet Laboratories Ltd., Watford, United Kingdom) and Utrogestan capsules ...(Laboratories Besins International, Paris, France), used for luteal support after in vitro fertilization (IVF) cycles. Design Cohort study. Setting In Vitro Fertilization Polyclinic, Zagreb, Croatia. Patients A total of 285 women aged ≤37 years undergoing IVF-embryo transfer treatment. Interventions Patients were treated with either Crinone 8% vaginal P gel (90 mg) administered daily, or Utrogestan vaginal capsules (2 × 100 mg) administered three times daily. Progesterone was administered from the day of oocyte retrieval (day 0) to menses or, in a case of pregnancy, until week 12. Main Outcome Measure Clinical pregnancy rate. The tolerability and acceptability of both preparations were determined by a questionnaire given to patients. Results The similar rates of clinical pregnancies (33 1% vs. 30 9%) were obtained by using either Crinone 8% vaginal P gel or Utrogestan vaginal capsules. Overall tolerability and acceptability were significantly better in the Crinone group than in the Utrogestan group. Conclusions The efficacy of the two vaginal P formulations was nearly the same, but the tolerability and acceptability of Crinone 8% gel were superior, in the opinion of patients.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
8.
LIJECENJE OSTEOPOROZE Simic, Petra; Giljevic, Zlatko; Simunic, Velimir ...
Arhiv za higijenu rada i toksikologiju,
03/2007, Volume:
58, Issue:
1
Journal Article
Peer reviewed
Open access
Osteoporoza je jedna od najčešćih metaboličkih bolesti i zahvaća 8 % do 10 % stanovništva. Budući da je prijelom najteža posljedica osteoporoze, vrlo je važno otkriti bolesnike koji imaju rizik ...nastanka prijeloma, dati im farmakološku terapiju i savjetovati im promjenu načina života. Nekoliko je lijekova pokazalo sposobnost smanjenja broja prijeloma kralježnice i/ili perifernog skeleta u bolesnika s osteoporozom. Antiresorptivni su lijekovi temelj terapije, ali su i anabolički lijekovi odnedavno proširili mogućnosti liječenja. Antiresorptivni lijekovi, estrogeni, selektivni modulatori estrogenskih receptora, bisfosfonati i kalcitonin, djeluju tako da smanjuju koštanu pregradnju. Paratireoidni hormon potiče novo stvaranje kosti popravljajući arhitekturu i gustoću kosti. Stroncijev ranelat smanjuje rizik osteoporotičnih prijeloma djelujući na oboje - smanjenje razgradnje i povećanje izgradnje kosti. Druga potencijalna liječenja osteoporoze također su opisana u ovome članku.
The aim of this study was to calculate the relative prevalence of all phenotypes of polycystic ovary syndrome (PCOS) and to compare them for anthropometrical, hormonal and metabolic differences ...according to the Rotterdam Criteria. A total of 300 women with PCOS aged 26.7 +/- 5.6 years (mean +/- SD) and 100 women aged 28.3 +/- 4.1 years (mean +/- SD) were included in a control group. Anthropometrical, hormonal and metabolic parameters were compared between the groups. The most prevalent phenotype in our population was the most severe, phenotype A (56.7%), followed by phenotype D (26.7%) and phenotype C (14.3%). Phenotype B was present in only 2.3% of patients. The four main phenotypes did not differ in age, BMI and WHR. Women with phenotypes A and C had increased levels of LH and an increased LH/FSH ratio along with elevated androgen levels compared to the other groups. Serum glucose levels did not differ between the groups studied, however, higher levels of insulin, GIR and HOMA-IR were found between phenotype A and the control group. Phenotype C PCOS or ovulatory PCOS have the same characteristics as classic PCOS, however in a more mild form, which represents a transition between the classic form and the control group. Compared to the control group, phenotype D had higher mean levels of serum testosterone (still within normal range) along with elevated LH levels and LH/FSH ratio, similar to classic PCOS. However, compared with women diagnosed with PCOS based on hyperandrogenism, oligo-ovulation and polycystic ovaries, these patients demonstrated milder endocrine and metabolic abnormalities. Therefore, from an endocrine point of view, our study supports the inclusion of a normoandrogenic anovulatory phenotype in PCOS diagnostic criteria.
The aim of the present study was to analyze retrospectively the safety and success rates of single- and two-dose methotrexate (MTX) protocols for the treatment of hemodynamically stable cases of ...ectopic pregnancy at University Department of Gynecology and Obstetrics, Zagreb University Hospital Center, during a five-year period. The study evaluated MTX treatment efficacy in 35 women with ectopic pregnancies in relation to the initial levels of human chorionic gonadotropin (hCG) and progesterone. Successful treatment was recorded in 32/35 women, 24/25 on single dose MTX and 8/10 on double dose MTX, whereas 3/35 patients underwent laparoscopy. The mean initial hCG level in all 35 patients on day 0 was 657.54 +/- 592.4 IU/L; 572.99 +/- 488.10 IU/L in those successfully treated with MTX and 1560.30 +/- 890.70 IU/L in those requiring additional laparoscopy (p < 0.005). The mean initial hCG level was 393.10 +/- 305.9 IU/L in patients successfully treated with a single dose of MTX and 973.5 +/- 722.40 IU/L in those with an additional dose of MTX (p < 0.002). The mean initial progesterone level was 16.36 +/-10.70 nmol/L in 35 MTX-treated ectopic pregnancy patients, 13.64 +/- 8.89 nmol/L in those with treatment success and 28.45 +/- 11.32 nmol/L in cases of treatment failure (p < 0.05). The mean level of progesterone on day 0 was 12.74 +/- 830 nmol/L in patients successfully treated with a single dose of MTX and 26.10 +/- 18.80 nmol/L in patients treated with double-dose MTX (p < 0.006). It is concluded that pretreatment values of hCG and progesterone are inversely related to medicamentous treatment success in selected cases ofhemodynamically stable patients, thus they may be used as an important predictor in the management of ectopic pregnancy treated with MTX.
PDF
