Clinical Medicine Insights-Reproductive Health最新文献

{"title":"Fertility Preservation in Women With Endometriosis","authors":"N. Llarena, T. Falcone, R. Flyckt","doi":"10.1177/1179558119873386","DOIUrl":"https://doi.org/10.1177/1179558119873386","url":null,"abstract":"Infertility affects 30% to 50% of women with endometriosis. Women with endometriosis are at risk of decreased ovarian reserve, both because of the pathophysiology of the disease and iatrogenic injury resulting from surgical intervention. Fertility preservation must occur at multiple levels, including careful selection of surgical candidates, avoidance of repeat procedures, and meticulous surgical technique. Fertility preservation with oocyte or ovarian tissue cryopreservation may be considered on an individual basis for women with endometriosis, particularly those at risk of bilateral ovarian injury, such as women with bilateral endometriomas.","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87122953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian Tissue Transplantation: Experience From Germany and Worldwide Efficacy","authors":"L. Lotz, R. Dittrich, I. Hoffmann, M. Beckmann","doi":"10.1177/1179558119867357","DOIUrl":"https://doi.org/10.1177/1179558119867357","url":null,"abstract":"Extraction of ovarian tissue prior to oncologic therapy and subsequent transplantation is being performed increasingly often to preserve fertility in women. The procedure can be performed at any time of the cycle and, therefore, generally does not lead to any delay in oncological therapy. Success rates with transplantation of cryopreserved ovarian tissue have reached promising levels. More than 130 live births have been reported worldwide with the aid of cryopreserved ovarian tissue and the estimated birth rate is currently approximately 30%. In Germany, Austria, and Switzerland, the FertiPROTEKT consortium has successfully achieved 21 pregnancies and 17 deliveries generated after 95 ovarian tissue transplantations by 2015, one of the largest case series worldwide confirming that ovarian tissue cryopreservation and transplantation are successful. Approximately, more than 400 ovarian tissue cryopreservation procedures are performed each year in the FertiPROTEKT consortium, and the request and operations for ovarian tissue transplantation have increased in recent years. Therefore, recommendations for managing transplantation of ovarian tissue to German-speaking reproductive medicine centers were developed. In this overview, these recommendations and our experience in ovarian tissue transplantation are presented and discussed with international procedures.","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78795297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies","authors":"T. Barber, P. Hanson, M. Weickert, S. Franks","doi":"10.1177/1179558119874042","DOIUrl":"https://doi.org/10.1177/1179558119874042","url":null,"abstract":"Polycystic ovary syndrome (PCOS) is a common female condition typified by reproductive, hyperandrogenic, and metabolic features. Polycystic ovary syndrome is a genetic condition, exacerbated by obesity. There is a close link between obesity and PCOS based on epidemiological data, and more recently corroborated through genetic studies. There are many mechanisms mediating the effects of weight-gain and obesity on the development of PCOS. The metabolic effects of insulin resistance and steroidogenic and reproductive effects of hyperinsulinaemia are important mechanisms. Adipokine production by subcutaneous and visceral fat appears to play a part in metabolic function. However, given the complexity of PCOS pathogenesis, it is important also to consider possible effects of PCOS on further weight-gain, or at least on hampering attempts at weight-loss and maintenance through lifestyle changes. Possible mediators of these effects include changes in energy expenditure, mental ill health, or physical inactivity. In this brief review, we discuss the main mechanisms that underlie the association between obesity and PCOS, from divergent perspectives of weight-gain contributing to development of PCOS and vice versa. We also consider novel management options for women with obesity and PCOS.","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83297058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seroprevalences and Correlates of Hepatitis B and C Among Cameroonian Pregnant Women.","authors":"Florent Ymele Fouelifack,&nbsp;Jeanne Hortence Fouedjio,&nbsp;Jovanny Tsuala Fouogue,&nbsp;Loic Dongmo Fouelifa","doi":"10.1177/1179558118770671","DOIUrl":"https://doi.org/10.1177/1179558118770671","url":null,"abstract":"<p><strong>Background and rationale: </strong>Viral hepatitis B (VHB) and viral hepatitis C (VHC) are major public health issues in resource-poor countries where vertical transmission remains high.</p><p><strong>Aim: </strong>To assess prevalences and correlates of VHB and VHC among women attending antenatal clinic.</p><p><strong>Methods: </strong>A cross-sectional study at the Yaounde Central Hospital from January 1 to June 30, 2016. We included 360 pregnant women who were screened for hepatitis B virus surface antigen (HbsAg) and VHCAb by rapid diagnostic test (DiaSpot Diagnostics, USA) followed by confirmation of positive results by a reference laboratory. Odds ratios (95% confidence interval [CI]) were used to measure associations between variables. Statistical significance was set for <i>P</i>-value <.05.</p><p><strong>Results: </strong>Mean age was 27.9 ± 5.6 years. The prevalences of HbsAg and VHCAb were 9.4% (n = 34) and 1.7% (n = 6), respectively. Multiplicity of sex partners was significantly associated with HbsAg positivity (adjusted odds ratio [aOR]: 11.6; 95% CI: 5.1-26.7; <i>P</i> < .001) while none of the studied factors was associated with VHCAb.</p><p><strong>Conclusion: </strong>The high prevalence of hepatitis B among pregnant women supports systematic screening and free vaccination of pregnant women and women of childbearing age.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179558118770671","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36041775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protection for Children Born Through Assisted Reproductive Technologies Act, B.E. 2558: The Changing Profile of Surrogacy in Thailand.","authors":"Alessandro Stasi","doi":"10.1177/1179558117749603","DOIUrl":"https://doi.org/10.1177/1179558117749603","url":null,"abstract":"<p><p>The National Legislative Assembly of Thailand has enacted on February 19, 2015 the Protection for Children Born through Assisted Reproductive Technologies Act (ART Act). Its primary objective aims at protecting children born through assisted reproductive technologies and providing the legal procedures that the intended parents must follow. The focus of this article is to discuss the ongoing issues involving assisted reproduction in Thailand. After reviewing the past legal framework surrounding surrogate motherhood and the downsides of the assisted reproductive technology market in Thailand, the article will discuss the new ART Act and its regulatory framework. It will conclude that although the new law contains some flaws and limitations, it has so far been successful in tackling surrogacy trafficking and preventing reproductive scandals from occurring again.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179558117749603","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35783003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Complications on Patients' Assessment of the Outcome of Tension-Free Vaginal Tape Procedure.","authors":"David Shaker,&nbsp;Alexander J Lindgren,&nbsp;Gwenda Chapman","doi":"10.1177/1179558117742374","DOIUrl":"https://doi.org/10.1177/1179558117742374","url":null,"abstract":"<p><strong>Introduction: </strong>Our study aimed to assess the impact of managed complications of tension-free vaginal tape (TVT) on the patients' assessment of the results as measured by Patient Global Impression of Improvement (PGI-I).</p><p><strong>Materials and methods: </strong>This was a retrospective study, supplemented with a telephone interview, comparing patients who had complications of TVT procedures with those where no complications recorded. The primary outcome was the PGI-I score in the 2 groups.</p><p><strong>Results: </strong>A total of 118 invitations were sent. In all, 60 patients returned the signed consent and completed the telephone interview with one of the authors (response rate = 50.8%). Complications were recorded in 21 patients (group 1) and no complications in 39 patients (group 2). There was no statistically significant difference between PGI-I in both groups.</p><p><strong>Conclusions: </strong>Managed complications of TVT do not seem to affect patients' assessment of outcome as measured by PGI-I score.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179558117742374","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35273333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Contraceptive Choice Among Patients Seen at the \"Cameroon National Planning Association for Family Welfare\" Clinic Yaoundé.","authors":"Tameh Theodore Yangsi,&nbsp;Fouelifack Ymele Florent,&nbsp;Mbong Eta Ngole,&nbsp;Fomulu Nelson","doi":"10.1177/1179558117713016","DOIUrl":"https://doi.org/10.1177/1179558117713016","url":null,"abstract":"<p><strong>Background: </strong>To understand the low modern contraceptive prevalence in Cameroon, we reviewed the methods chosen and determined their side effects among patients in an urban setting.</p><p><strong>Methods: </strong>We conducted a cross-sectional study at the \"Cameroon National Planning Association for Family Welfare (CAMNAFAW) Clinic\" in Yaoundé. Data were processed by SPSS software version 20.0 for Windows, and all tests were considered statistically significant at <i>P</i> < .05.</p><p><strong>Results: </strong>Of the 1180 women sampled, the most chosen methods were as follows: depot medroxy progesterone acetate: 72.1% (787 of 1091), followed by oral combined contraceptives: 21.3% (232 of 1091), subcutaneous implants: 3.2% (35 of 1091), and intrauterine contraceptive devices: 1.9% (21 of 1091). A hundred and forty two (14.5%) of the 977 women received at least once (revisits) at the Center, reported at least one side effect. Irregular vaginal bleeding was the most frequent side effect: 44.6% (84 of 188 total documented side effects). Side effects were most common among users of subcutaneous implants: 28% (7 of the 25 implant users).</p><p><strong>Conclusions: </strong>Prescription of contraceptives should reflect not only the desire of couples but also the side effects associated with each method. This would optimize observance and adherence, consequently decreasing the failure rate.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179558117713016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35319577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femilis(®) 60 Levonorgestrel-Releasing Intrauterine System-A Review of 10 Years of Clinical Experience.","authors":"Dirk Wildemeersch, Amaury Andrade, Norman Goldstuck","doi":"10.4137/CMRH.S40087","DOIUrl":"10.4137/CMRH.S40087","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to update the clinical experience with the Femilis® 60 levonorgestrel-releasing intrauterine system (LNG-IUS), now up to 10 years in parous and nulliparous women, particularly with regard to ease and safety of insertion, contraceptive performance, retention, acceptability, continuation of use, impact on menstrual blood loss (MBL), and duration of action.</p><p><strong>Study design: </strong>Using the Femilis® 60 LNG-IUS releasing 20 µg of levonorgestrel/day, the following studies were conducted: an open, prospective noncomparative contraceptive study, an MBL study, a perimenopausal study, a study for the treatment of endometrial hyperplasia, and early cancer of the uterus, a residue study.</p><p><strong>Results: </strong>A total of 599 Femilis LNG-IUS were inserted in various clinical trials, the majority for contraceptive purposes. The total exposure in the first and second contraceptive studies, covering 558 parous and nulliparous women, was 32,717 woman-months. Femilis has high contraceptive effectiveness as only one pregnancy occurred. Expulsion of the LNG-IUS was rare with only two total and no partial expulsions (stem protruding through the cervical canal) occurred. Femilis was well tolerated, with continuation rates remaining high. Several MBL studies were conducted, totaling 80 heavy and normal menstrual bleeders, using the pictorial bleeding assessment chart method or the quantitative alkaline hematin technique. Virtually all women responded well with strongly reduced menstrual bleeding. Amenorrhea rates were high, up to 80% after three months, and ferritin levels simultaneously increased significantly. The Femilis LNG-IUS was tested in 104 symptomatic perimenopausal women for seamless transition to and through menopause, adding estrogen therapy when required. Patient tolerability appeared high as >80% requested a second and a third LNG-IUS. Twenty women presenting with nonatypical and atypical hyperplasia and one woman presenting with early endometrial carcinoma were treated with Femilis LNG-IUS. All histology specimens showed full regression, and patients remained in remission without signs of hyperplasia or cancer at yearly and ongoing follow-up examinations up to 10 years. Residual content of LNG was measured in 37 women having the Femilis LNG-IUS for up to 10 years. In 10 of the 102 women who had the Femilis 60 in situ for 10 years between 20% and 30% of the original 60 mg was recovered confirming the long duration of action of the Femilis 60 LNG-IUS.</p><p><strong>Conclusion: </strong>These studies suggest that the Femilis 60 LNG-IUS releasing 20 µg of LNG/day is an effective, well-tolerated, and well-retained contraceptive both in parous and in nulliparous women. The design of the LNG-IUS, with flexible transverse arm(s) length of 28 mm, allows for a simplification of the insertion technique and training requirements facilitating the use by nonspecialist providers in either ","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMRH.S40087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34324941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate Point-of-Care Detection of Ruptured Fetal Membranes: Improved Diagnostic Performance Characteristics with a Monoclonal/Polyclonal Immunoassay.","authors":"Linda C Rogers,&nbsp;Laurie Scott,&nbsp;Jon E Block","doi":"10.4137/CMRH.S38386","DOIUrl":"https://doi.org/10.4137/CMRH.S38386","url":null,"abstract":"<p><strong>Objective: </strong>Accurate and timely diagnosis of rupture of membranes (ROM) is imperative to allow for gestational age-specific interventions. This study compared the diagnostic performance characteristics between two methods used for the detection of ROM as measured in the same patient.</p><p><strong>Methods: </strong>Vaginal secretions were evaluated using the conventional fern test as well as a point-of-care monoclonal/polyclonal immunoassay test (ROM Plus(®)) in 75 pregnant patients who presented to labor and delivery with complaints of leaking amniotic fluid. Both tests were compared to analytical confirmation of ROM using three external laboratory tests. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.</p><p><strong>Results: </strong>Diagnostic performance characteristics uniformly favored ROM detection using the immunoassay test compared to the fern test: sensitivity (100% vs. 77.8%), specificity (94.8% vs. 79.3%), PPV (75% vs. 36.8%), NPV (100% vs. 95.8%), and accuracy (95.5% vs. 79.1%).</p><p><strong>Conclusions: </strong>The point-of-care immunoassay test provides improved diagnostic accuracy for the detection of ROM compared to fern testing. It has the potential of improving patient management decisions, thereby minimizing serious complications and perinatal morbidity.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMRH.S38386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34500563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cortisol-Metabolizing Enzymes in Polycystic Ovary Syndrome.","authors":"Zeev Blumenfeld,&nbsp;Gabi Kaidar,&nbsp;Nehama Zuckerman-Levin,&nbsp;Elena Dumin,&nbsp;Carlos Knopf,&nbsp;Ze'ev Hochberg","doi":"10.4137/CMRH.S35567","DOIUrl":"https://doi.org/10.4137/CMRH.S35567","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to assess the activity of cortisol-metabolizing enzymes in women with polycystic ovary syndrome (PCOS), using a fully quantitative gas chromatography/mass spectrometry (GCMS) method.</p><p><strong>Design: </strong>We investigated the glucocorticoid degradation pathways that include 11β-hydroxysteroid dehydrogenase (11β-HSD) type 1, 5α-reductase (5α-R) and 5β-reductase (5β-R), 3α-hydroxysteroid dehydrogenase, and 20α- and 20β-hydroxysteroid dehydrogenase (20α-HSD and 20β-HSD, respectively) in young nonobese women with PCOS, using a fully quantitative GCMS method.</p><p><strong>Setting: </strong>This study was conducted in a tertiary referral hospital in Israel.</p><p><strong>Patients: </strong>This study group consisted of 13 young women, aged 20.1 ± 2.8 years (mean ± SD), with the body mass index (BMI) of 22.6 ± 3.7 kg/m(2), diagnosed with PCOS according to the Rotterdam criteria. The control group consisted of 14 healthy young women matched for weight, height, and BMI.</p><p><strong>Interventions: </strong>Urine samples were analyzed using GCMS. We measured urinary steroid metabolites that represent the products and substrates of the study enzymes and calculated the product/substrate ratios to represent enzyme activity.</p><p><strong>Main outcome measures: </strong>The calculation of enzymatic activity, based on glucocorticoid degradation metabolites, was done by GCMS in PCOS vs. controls.</p><p><strong>Results: </strong>All glucocorticoid degradation metabolites were higher in the PCOS group than in controls. Of the adrenal enzymes, the activities of 21-hydroxylase and 17α-hydroxylase were reduced, whereas the activity of 17,20-lyase was enhanced in PCOS. Of the degradation enzymes, the activity of 11β-HSD type 1 was reduced in women with PCOS only when calculated from cortoles and cortolones ratios. The activities of 5α-R/5β-R were increased only when calculating the 11-hydroxy metabolites of androgens. The activity of 20α-HSD was elevated in the patients with PCOS and its relation with the substrate levels was lost.</p><p><strong>Conclusions: </strong>We confirm PCOS association with low 21-hydroxylase activity. PCOS is associated with dysregulation in glucocorticoid degradation. The activity of 5α-R is enhanced only through the backdoor pathway. Marked increase in the activity of 20α-HSD suggests a hitherto unknown derangement in PCOS.</p>","PeriodicalId":44130,"journal":{"name":"Clinical Medicine Insights-Reproductive Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMRH.S35567","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34539101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}