Background.
The use of gonadotropin‐releasing hormone analogs (GnRHas) for fertility preservation is not unequivocally accepted. It is controversial whether GnRHa can increase the pregnancy rate in ...survivors.
Patients and Methods.
This is a retrospective cohort study. Every patient referred for fertility preservation was offered cryopreservation of embryos, ova, and ovarian tissue and GnRHa. The patients were consecutively included. The primary outcome was spontaneous pregnancies. The secondary outcome was cyclic ovarian function (COF) versus premature ovarian failure (POF). These outcomes were assessed 2 years or more after chemotherapy.
Results.
We compared 286 patients who received gonadotropin‐releasing hormone agonist (GnRHa) with chemotherapy with 188 patients who were treated with chemotherapy alone. Ovarian function could be determined in 217 patients. Overall, 87% (127 of 146) of the patients in the GnRHa group retained COF and 13% (19 of 146) suffered POF, whereas in the control group, 49% (35 of 71) experienced COF and 51% (36 of 71) suffered POF (p = .0001). The odds ratio (OR) for preserving COF was 6.87 for the patients who received GnRHa (95% confidence interval CI 3.4–13.4). Overall 60% (112 of 188) of the survivors conceived: 69.3% (84 of 122) of the patients in the GnRHa group compared with 42.4% (28 of 66) in the control group (p = .006). In the GnRHa group, 123 healthy newborns were delivered, versus 40 in the controls. Spontaneous pregnancies occurred in 65.6% (80 of 122) of the survivors in the GnRHa group versus 37.9% (25 of 66) in the control group (p = .0004, OR 3.12, 95% CI 1.7–5.8).
Conclusion.
Adding GnRHa to chemotherapy significantly increases the OR for spontaneous conception, in addition to COF. It is suggested that GnRHa cotreatment should be added before and during gonadotoxic chemotherapy.
Implications for Practice:
The use of gonadotropin‐releasing hormone analogs (GnRHa) for fertility preservation is not unequivocally accepted and is even controversial. This study compared 286 patients who received GnRHa with chemotherapy with 188 patients who were treated with chemotherapy alone. Ovarian function could be determined in 217 patients. The odds ratio for preserving cyclic ovarian function was 6.87 for the patients who received GnRHa. Furthermore, the total and spontaneous pregnancy rate was significantly higher for those who received the agonist (p = .006). Adding GnRHa to chemotherapy significantly increased the odds ratio for spontaneous conception, in addition to preserving regular ovarian function. It is suggested that GnRHa cotreatment should be administered to young women in conjunction with gonadotoxic chemotherapy.
Patients who received gonadotropin‐releasing hormone agonist (GnRHa) with chemotherapy were compared with patients who were treated with chemotherapy alone to determine whether GnRHa can increase the pregnancy rate in survivors. The results indicated that adding GnRHa to chemotherapy significantly increases the odds ratio for spontaneous conception, in addition to cyclic ovarian function. It is suggested that GnRHa cotreatment should be added before and during gonadotoxic chemotherapy.
Aim
Ectopic pregnancy implantation on the tubal stump after salpingectomy is a rare location for extrauterine pregnancy, whose pathogenesis is still unknown. The purpose of this study was to examine ...whether the time interval elapsed from salpingectomy may predispose the embryo to implantation on the tubal stump in the next pregnancy subsequent to tube removal.
Methods
Nine women operated for stump pregnancy (study group) between 2008 and 2019 were retrospectively identified. For each case in the study group, 12 consecutive cases that underwent laparoscopic salpingectomy constituted the control group. A sample size of 100 control patients was calculated to achieve statistical power (97.8%) and an α of 0.05. The control groups were triple‐matched with the study group for patients' age, indications for salpingectomy (tubal pregnancy or hydrosalpinx prior to in vitro fertilization treatment) and mode of conception of the subsequent pregnancy following salpingectomy.
Results
Nine women underwent surgery for stump pregnancy during the study period. All women had a surgical history of laparoscopic salpingectomy. The time interval from prior salpingectomy to subsequent pregnancy was significantly shorter in study group than in the control group (4.3 ± 2.1 months vs. 15.6 ± 13.7 months, respectively, p = 0.016).
Conclusion
A possible association between the short time interval from prior salpingectomy to ectopic implantation on the tubal stump in the subsequent pregnancy was found. The clinical implications of these findings and in particular whether patients should be advised to wait at least 4 months from the salpingectomy to the subsequent pregnancy remain unclear.
To assess the influence of coronavirus disease 2019 (COVID-19) messenger ribonucleic acid vaccine on ovarian response and in vitro fertilization (IVF) treatment outcomes.
A retrospective cohort ...study.
A tertiary university-affiliated medical center and a private medical center.
The study included a total of 400 patients, 200 vaccinated women and 200 age-matched unvaccinated women, who underwent IVF in January–April 2021.
None.
The mean number of oocytes retrieved and clinical pregnancy rates in vaccinated vs. unvaccinated patients.
A total of 200 patients underwent oocyte retrieval 14–68 days after receiving COVID-19 vaccination. No difference was found in the mean number of oocytes retrieved per cycle (10.63 vs. 10.72) between vaccinated and unvaccinated patients. Among 128 vaccinated and 133 unvaccinated patients who underwent fresh embryos transfers, no difference was demonstrated in the clinical pregnancy rates (32.8% vs. 33.1%), with 42 and 44 clinical pregnancies, respectively. The fertilization rates and mean number of cryopreserved embryos were similar between the 2 groups in freeze-all cycles (55.43% vs. 54.29% and 3.59 vs. 3.28, respectively). Among vaccinated and unvaccinated patients who underwent fresh embryo transfers, no difference was noted in the fertilization rate (64.81% vs. 61.98%) and transferred embryos’ quality. Regression models applied demonstrated no effect of the vaccine on oocyte yields and pregnancy rates.
The COVID-19 messenger ribonucleic acid vaccine did not affect the ovarian response or pregnancy rates in IVF treatment. Women should be vaccinated for COVID-19 before attempting to conceive via IVF treatments, given the higher risk of severe illness in pregnant women.
Vacunación contra la enfermedad del coronavirus 2019 y resultados de tratamientos de infertilidad.
Evaluar la influencia de la vacuna de ácido ribonucleico mensajero contra la enfermedad por coronavirus 2019 (COVID-19) en la respuesta ovárica y los resultados de tratamientos de fecundación in vitro (FIV).
Estudio de cohorte retrospectivo.
Centro médico terciario adscrito a una universidad y a un centro médico privado.
El estudio incluyó un total de 400 pacientes, 200 mujeres vacunadas y 200 mujeres no vacunadas de la misma edad, que se sometieron a tratamientos de FIV desde enero a abril de 2021.
Ninguna.
El número medio de ovocitos recuperados y las tasas de embarazo clínico en pacientes vacunadas frente a no vacunadas.
Un total de 200 pacientes se sometieron a la extracción de ovocitos entre 14 y 68 días después de recibir la vacuna contra la COVID-19. No se encontraron diferencias en el número medio de ovocitos recuperados por ciclo (10,63 frente a 10,72) entre pacientes vacunadas y no vacunadas. Entre las 128 pacientes vacunadas y las 133 no vacunadas que se sometieron a transferencias de embriones frescos, no se observó diferencias en las tasas de embarazo clínico (32,8% frente a 33,1%), con 42 y 44 embarazos clínicos, respectivamente. Las tasas de fecundación y la media del número de embriones criopreservados fue similar entre los 2 grupos en los ciclos de congelación total (55,43 % frente a 54,29 % y 3,59 frente a 3,28, respectivamente). Entre las pacientes vacunadas y no vacunadas que se sometieron a transferencias de embriones frescos, no se observaron diferencias en la tasa de fecundación (64,81% frente a 61,98%) ni en la calidad de los embriones transferidos. Los modelos de regresión aplicados no demostraron ningún efecto de la vacuna sobre el rendimiento de los ovocitos y las tasas de embarazo.
La vacuna de ácido ribonucleico mensajero COVID-19 no afectó a la respuesta ovárica ni a las tasas de embarazo en los tratamientos de FIV. Las mujeres deben vacunarse contra COVID-19 antes de intentar concebir a través de tratamientos de FIV, dado el mayor riesgo de enfermedad grave en mujeres embarazadas.
Significant concerns about the poor health and prevalence of chronic illness amongst a number of ethnic minority populations have led to heightened debates about how best to improve the situation. ...For some the answer is to see their experiences as part of the general social class inequality in health, but recent evidence questions the extent to which social class can explain the variations in health which ethnic minorities experience. Researching the Cultural Differences in Health offers a range of accounts of how people in ethnic minority groups perceive and manage their illness. Some of the chapters focus on Bangladeshi, and other South Asian groups, as well as Afro-Caribbeans and Irish people. The illness conditions discussed include diabetes, hypertension, sickle-cell disorder, mental illness and coronary heart disease. This book will provide invaluable reading for those involved in providing health services for ethnic minorities, and all lecturers and students in medical and nursing education as well as those studying sociology and social administration.
PDF
