Although breast cancer (BC) occurs more often in older women, it is the most commonly diagnosed malignancy in women of childbearing age. Owing to the overall advancement of modern medicine and the ...growing global trend of delaying childbirth until later age, we find ever more younger women diagnosed and treated for BC who have not yet completed their family. Therefore, fertility preservation has emerged as a very important quality of life issue for young BC survivors. This paper reviews currently available options for fertility preservation in young women with early-stage BC and highlights the importance of a multidisciplinary approach to fertility preservation as a very important quality of life issue for young BC survivors. Pregnancy after BC treatment is considered not to be associated with an increased risk of BC recurrence; therefore, it should not be discouraged for those women who want to achieve pregnancy after oncologic treatment. Currently, it is recommended to delay pregnancy for at least 2 years after BC diagnosis, when the risk of recurrence is highest. However, BC patients of reproductive age should be informed about the potential negative effects of oncologic therapy on fertility, as well as on the fertility preservation options available, and if interested in fertility preservation, they should be promptly referred to a reproductive specialist. Early referral to a reproductive specialist is an important factor that increases the likelihood of successful fertility preservation. Embryo and mature oocyte cryopreservation are currently the only established fertility preservation methods but they require ovarian stimulation (OS), which delays initiation of chemotherapy for at least 2 weeks. Controlled OS does not seem to increase the risk of BC recurrence. Other fertility preservation methods (ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists) do not require OS but are still considered to be experimental techniques for fertility preservation.
The aim of this study is to examine the importance of tumor markers in the diagnosis of adnexal masses in pediatric and adolescent gynecology.
Relevant studies published over the last 20 years were ...identified by a PubMed/Medline search using different combinations of the following search terms: “tumor markers”, “adnexal masses” and “pedaitric and adolescent gynecology”. Additional papers were identified by reviewing reference lists of relevant publications. Particular emphasis was placed on original studies. Non-English publications were excluded. A systematic approach to study selection was not implemented. Instead, data were extracted based on their relevance to the topic.
By searching the literature, we found out 5 studies that met our criteria¹־⁵. Fifteen studies that were not original studies and represented a review of the literature and previously published studies were excluded.
Literature review consisted of 5 remarkable articles in the period from 1996–2016 and included 796 pediatric and adolescent patients with neoplastic ovarian masses and increase of tumor markers¹־⁵. Out of the total number of patients 127 (15.9%) were malignant ovarian tumors ¹־⁵. Lawrence et al in their study they found sensitivity and specifity for CA 125 59% and 81%, for CA 19-9 25% and 73%, for CEA 5% and 100%, for AFP 42% and 98%, for LDH 95% and 13%, for beta HCG 44% and 76%, for Inhibin A 32% and 97%, for Inhibin B 37% and 92%.² Lawrence et al reported proportion of cohort that received tumor marker testing for AFP 94%, beta HCG 78%, CA 125 54%, LDH 39%, CEA 26%, Inhibin A 25%, Inhibin B 23%, CA 19-9 13%.² Spinelli et al reported proportion of tumor marker testing in 88.3%.² Elevated values of tumor markers in malignant adnexal masses ranged from 54% to 100%.²ʼ³ʼ⁴
Tumor markers are important in the preoperative evaluation and differential diagnosis of adnexal masses in pediatric and adolescent gynecology, but also in making a decision about the radicality or fertility-sparing surgical procedure. When malignancy is suspected, a panel of tumor markers is necessary, because there is no single tumor marker that is sufficiently reliable. International collaborations and prospective studies are necessary to determine the reliable predictive value of tumor markers in the preoperative evaluation of adnexal masses.
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The aim of this review is to analyze the role of obesity on fertility outcome in women undergoing in vitro fertilization (IVF) with respect to clinical or live birth rates and pregnancy loss rates. ...Despite findings from several earlier and newer studies that obesity does not adversely affect pregnancy outcome in women attempting conception, numerous reports from mostly recent studies suggest that obesity undoubtedly impairs IVF outcomes. Obesity impairs ovarian responsiveness to gonadotrophin stimulation, requiring higher doses of medication, increased risk of cycle cancelation, pre-term delivery, low birth weight or miscarriage, and decreases implantation, clinical pregnancy or live birth rates compared to women of normal weight. The mechanisms underlying the adverse effects of female obesity on IVF outcome may be primarily explained by functional alterations to the hypothalamic-pituitary-ovarian axis. Additionally, obesity appears to affect deleteriously the number and quality of oocytes or embryos, and impairs endometrial decidualization which is necessary for uterine receptivity. Nevertheless, attaining normal body weight by the use of lifestyle modifications, including a healthy diet and exercise over time of several months before and during an IVF treatment, may be successful in achievement of gradual and sustainable weight loss with improvement of IVF outcome.
The role of macroprolactinemia in women with hyperprolactinemia is currently controversial and can lead to clinical dilemmas, depending upon the origin of macroprolactin, the presence of ...hyperprolactinemic symptoms and monomeric prolactin (PRL) levels. Macroprolactinemia is mostly considered an extrapituitary phenomenon of mild and asymptomatic hyperprolactinemia associated with normal concentrations of monomeric PRL and a predominance of macroprolactin confined to the vascular system, which is biologically inactive. Patients can therefore be reassured that macroprolactinemia should be considered a benign clinical condition, resistant to antiprolactinemic drugs, and that no diagnostic investigations or prolonged follow-up should be necessary. However, a significant proportion of macroprolactinemic patients appears to suffer from hyperprolactinemia-related symptoms and radiological pituitary findings commonly associated with true hyperprolactinemia. The symptoms of hyperprolactinemia are correlated to the levels of monomeric PRL excess, which may be explained as coincidental, by dissociation of macroprolactin, or by physiological, pharmacological and pathological causes. The excess of monomeric PRL levels in such cases is of primarily importance and the diagnosis of macroprolactinemia is misleading or inadequate. However, macroprolactinemia of pituitary origin associated with radiological findings of pituitary adenomas may rarely occur with similar hyperprolactinemic manifestations, exclusively due to bioactivity of macroprolactin. Therefore, in such cases with hyperprolactinemic signs and pituitary findings, macroprolactinemia should be considered a pathological biochemical condition of hyperprolactinemia. Accordingly, individualized diagnostic investigations with the introduction of dopamine agonists, or other treatment with prolonged follow-up, should be mandatory. The review analyses the laboratory and clinical significance of macroprolactinemia in hyperprolactinemic women suggesting clinically useful diagnostic and treatment strategies.
Various oncological and non-oncological diseases, as well as their treatments, can cause premature ovarian insufficiency and reduce a woman's reproductive potential. Fertility preservation is, ...therefore, becoming an emerging field of reproductive medicine allowing these patients to have their own biological children. The aim of this review is to analyze the importance of ovarian tissue cryopreservation as a fertility preservation method as well as its new role as a hormone replacement treatment. Although ovarian tissue cryopreservation is currently regarded as an experimental procedure, it is rapidly advancing and may become an established fertility preservation method in the near future. This method does not require ovarian stimulation or a subsequent delay in the initiation of cancer treatment. Furthermore, orthotopic ovarian tissue transplantation offers the unique opportunity of spontaneous conception. Due to the restoration of endocrine function following the procedure, ovarian tissue cryopreservation may also be used as tissue hormone replacement therapy in cases of premature ovarian insufficiency, to postpone menopause and prevent its troublesome symptoms and diseases. Even though the role of ovarian tissue cryopreservation as a new anti-aging treatment modality is quite promising, the safety and efficacy of this approach should be investigated in clinical settings.
The aim of this review is to analyse the effectiveness of exogenous kisspeptin administration as a novel alternative of triggering oocyte maturation, instead of currently used triggers such as human ...chorionic gonadotropin (hCG) or gonadotropin releasing hormone (GnRH) agonist, in women undergoing in vitro fertilisation (IVF) treatment. Kisspeptin has been considered a master regulator of two modes of GnRH and hence gonadotropin secretion, pulses and surges. Administration of kisspeptin-10 and kisspeptin-54 induces the luteinising hormone (LH) surge required for egg maturation and ovulation in animal investigations and LH release during the preovulatory phase of the menstrual cycle and hypothalamic amenorrhoea in humans. Exogenous kisspeptin-54 has been successfully administered as a promising method of triggering oocyte maturation, following ovarian stimulation with gonadotropins and GnRH antagonists in women undergoing IVF, due to its efficacy considering achieved pregnancy rates compared to hCG and GnRH agonists. Also, its safety in patients at high risk of developing ovarian hyperstimulation syndrome is noteworthy. Nevertheless, further studies would be desirable to establish the optimal trigger of egg maturation and to improve the reproductive outcome for women undergoing IVF treatment.
Providing adequate healthcare for premature infants is an important issue in perinatal medicine. The aim of this study is to assess the level of the perinatal healthcare institution (PHI) where the ...newborns were delivered and the possibilities of transporting them to the cantons of the Federation of Bosnia and Herzegovina. The authors also aimed to examine the overall survival of low birth-weight infants (LBWI) in the Federation of Bosnia and Herzegovina and to compare the survival of newborns according to the PHI where they were born and the PHI where they were treated.
This cross-sectional study included newborns of both sexes that were born in the maternity wards in 10 cantons of the Federation of Bosnia and Herzegovina with a gestational age between 22 and 42 weeks, and a birth weight less than 2500 g.
From the PHI of the first and second level, 159 newborns were referred to the third level. A total of 159/669 (23.7%) were referred from a second level PHI to a third level PHI, and 127/669 (l8.9%) LBWI were definitely taken care of. A total of 513/669 (76.8%) LBWI were definitely taken care of in the third level PHI. Out of a total of 159 LBWI referred from other PHI, only 31 (19.5%) LBWI were transported in less than 4 h, and 128 (80.5%) newborns were admitted to the third level PHI within 4 h of birth (
<0.0001). In second level PHI, most LBWI died in the first 12 h after birth, while in third level PHI, 69.2% of LBWI died after 1 week of life.
Based on world experience and assessment of the situation in Federation of Bosnia and Herzegovina, it is necessary to take measures to improve perinatal care and its regional organization.
The aim of the review is to analyse the combination of a gonadotrophin releasing hormone (GnRH) agonist with a human chorionic gonadotrophin (hCG) trigger, for final oocyte maturation in in vitro ...fertilisation (IVF) cycles. The concept being a ''dual trigger'' combines a single dose of the GnRH agonist with a reduced or standard dosage of hCG at the time of triggering. The use of a GnRH agonist with a reduced dose of hCG in high responders demonstrated luteal phase support with improved pregnancy rates, similar to those after conventional hCG and a low risk of ovarian hyperstimulation syndrome (OHSS). The administration of a GnRH agonist and a standard hCG in normal responders, demonstrated significantly improved live-birth rates and a higher number of embryos of excellent quality, or cryopreserved embryos. The concept of the ''double trigger" represents a combination of a GnRH agonist and a standard hCG, when used 40 and 34 h prior to ovum pick-up, respectively. The use of the ''double trigger" has been successfully offered in the treatment of empty follicle syndrome and in patients with a history of immature oocytes retrieved or with low/poor oocytes yield. Further prospective studies are required to confirm the aforementioned observations prior to clinical implementation.
The purpose of this review is to analyse current options for fertility preservation in young women with breast cancer (BC). Considering an increasing number of BC survivors, owing to improvements in ...cancer treatment and delaying of childbearing, fertility preservation appears to be an important issue. Current fertility preservation options in BC survivors range from well-established standard techniques to experimental or investigational interventions. Among the standard options, random-start ovarian stimulation protocol represents a new technique, which significantly decreases the total time of the in vitro fertilisation cycle. However, in patients with oestrogen-sensitive tumours, stimulation protocols using aromatase inhibitors are currently preferred over tamoxifen regimens. Cryopreservation of embryos and oocytes are nowadays deemed the most successful techniques for fertility preservation in BC patients. GnRH agonists during chemotherapy represent an experimental method for fertility preservation due to conflicting long-term outcome results regarding its safety and efficacy. Cryopreservation of ovarian tissue, in vitro maturation of immature oocytes and other strategies are considered experimental and should only be offered within the context of a clinical trial. An early pretreatment referral to reproductive endocrinologists and oncologists should be suggested to young BC women at risk of infertility, concerning the risks and benefits of fertility preservation options.
本文旨在分析目前针对年轻乳腺癌患者生殖力保护的选择方法。由于癌症治疗技术的进步及延迟生育,越来越多的乳腺癌似乎应将其生殖力保护视为一项重要的问题。目前乳腺癌幸存者生殖力保护的选择范围囊括了完善的标准技术及实验性或临床性干预研究。标准方法中,随机启动卵巢刺激方案作为一项新技术可显著降低体外受精周期的总体时长。然而,目前对于雌激素敏感的肿瘤患者,使用芳香化酶抑制剂刺激方案优于接受他莫昔芬治疗。胚胎和卵母细胞冻存被认为是当今乳腺癌患者生殖力保护最成功的技术。由于应用GnRH激动剂的远期疗效尚存争议,且考虑其安全性和有效性,目前将化疗期间应用GnRH激动剂视为患者生殖力保护的实验性方法。卵巢组织冻存、卵母细胞体外成熟技术及其他技术都处于实验性阶段,且仅处于临床试验范围内。对于存在不孕不育风险的年轻乳腺癌患者,在权衡生殖力保护方法利弊后,应给予早期及时转至生殖内分泌专家和肿瘤学专家进行诊治。
INFLUENCE OF MALE OBESITY ON FERTILITY Kasum, Miro; Anić-Jurica, Sonja; Čehić, Ermin ...
Acta clinica Croatica,
06/2016, Volume:
55, Issue:
2
Journal Article
Peer reviewed
Open access
The aim of this review is to analyze current diagnostic approaches to obesity in
adult men, the potential mechanisms linking obesity to infertility, and treatment options aimed at
improving ...reproductive health. Obesity has become a worldwide epidemic with the estimated prevalence
increasing from 28.8% to 36.9% between 1980 and 2013. In terms of diagnosis, numerous
simple techniques have been developed including body mass index, waist to hip ratio, waist circumference,
bioelectrical impedance analysis, ultrasound and skinfold measurements. Additionally, several
other less available but more accurate techniques have been suggested, such as air displacement plethysmography,
dual energy x-ray absorptiometry, computed tomography and magnetic resonance imaging.
In addition to cardiovascular and other disorders, male obesity can negatively affect the male reproductive
potential through abnormal reproductive hormone levels, reduced semen quality, increased
release of adipose-derived hormones and adipokines, as well as thermal, genetic and sexual mechanisms.
In the management of obesity related male infertility, natural weight loss is the cornerstone and
regular exercise the first-line treatment. Although bariatric surgery results in greater improvements in
weight loss outcomes when compared to non-surgical interventions, further research is required to
clarify its overall influence on male fertility.