J.A. Garcia-Velasco

Oocyte vitrification as an efficient option for elective fertility preservation

OBJECTIVEnTo provide a detailed description of the current oocyte vitrification status as a means of elective fertility preservation (EFP).nnnDESIGNnRetrospective observational multicenter study.nnnSETTINGnPrivate university-affiliated center.nnnPATIENT(S)nA total of 1,468 women who underwent EFP because of age or having associated a medical condition other than cancer (January 2007 to April 2015).nnnINTERVENTION(S)nNone.nnnMAIN OUTCOME MEASURE(S)nSurvival and cumulative live birth rate (CLBR) per consumed oocyte.nnnRESULT(S)nMean age was higher with EFP due to age versus having an associated medical reason (37.7 y [95% confidence interval (CI) 36.5-37.9] vs. 35.7 y [95% CI 34.9-36.3]). In total, 137 patients (9.3%) returned to use their oocytes. Overall survival rate was 85.2% (95% CI 83.2-87.2). Live birth rate per patient was higher in women ≤35 years old than ≥36 years old (50% [95% CI 32.7-67.3] vs. 22.9% [95% CI 14.9-30.9]). CLBR was higher and increased faster in younger women. The gain in CLBR was sharp from 5 (15.4%, 95% CI -4.2 to 35.0) to 8 oocytes (40.8%, 95% CI 13.2-68.4), with an 8.4% gain per additional oocyte, in the ≤35-year-old group. The increase was slower with 10-15 oocytes, reaching a plateau CLBR of 85.2%. A milder increase (4.9% gain) was observed in the ≥36-year-old group (from 5.1% [95% CI -0.6 to 10.7] to 19.9% [95% CI 8.7-31.1] when 5-8 oocytes were consumed), reaching the plateau with 11 oocytes (CLBR 35.6%). Forty babies were born.nnnCONCLUSION(S)nAt least 8-10 metaphase II oocytes are necessary to achieve reasonable success. Numbers should be individualized in women >36 years old. We suggest encouraging women who are motivated exclusively by a desire to postpone childbearing because of age, to come at younger ages to increase success possibilities.

Rupture of an ovarian endometrioma during the first trimester of pregnancy

Rupture of an ovarian endometrioma presenting as a surgical emergency during pregnancy is a rare event. We report the first case to our knowledge of growth and rupture of an endometrioma in the first trimester of pregnancy. After laparotomy, the postoperative course was uneventful and the pregnancy is ongoing.

Circulating estradiol defines the tumor phenotype in menopausal breast cancer patients

OBJECTIVEnTo correlate circulating hormone levels with the clinical and biological features of the tumors in menopausal breast cancer patients.nnnDESIGNnCirculating hormone levels were measured in 161 previously untreated menopausal breast cancer patients within 72 h of their planned surgery. The obtained hormone levels were correlated with tumor size, histological and nuclear grade, histological score, axillary nodal status, DNA-ploidy and Ki67-, c-erb-B2-, p53, Bax-, VEGF- and Nup88-expression.nnnRESULTSnThe only statistically significant correlations found between circulating hormone levels and all tested variables were an inverse one between estradiol and the expression of the apoptosis-associated Bax gene (p=0.009), and again an inverse correlation between estradiol and the expression of c-erb-B2 (p=0.04). When comparing hormone levels with each other, a significant correlation between estradiol and progesterone (p<0.0001), an inverse one between estradiol and FSH (p=0.04) and a direct one between LH and prolactin (p=0.001) were found.nnnCONCLUSIONnHigher circulating estradiol levels in postmenopausal breast cancer patients are associated with molecular features usually defining a biologically less aggressive tumor phenotype.

Type of gonadotropin during controlled ovarian stimulation affects the endocrine profile in follicular fluid and apoptosis rate in cumulus cells.

OBJECTIVEnTo determine whether the type of gonadotropin affects the secretion of oocyte-specific factors, the endocrine pattern in follicular fluid, and the apoptosis rate in cumulus cells.nnnSTUDY DESIGNnProspective and observational study into an university-affiliated private in vitro fertilization setting. Ninety women included in our oocyte donation program were stimulated with human menopausal gonadotropin (hMG), recombinant follicle-stimulating hormone (FSH) or urinary FSH. Main outcome measures were growth-differentiation factor 9 (GDF-9) and bone morphogenetic protein 15 (BMP-15) expression, hormonal profile and apoptosis rate.nnnRESULTSnNo statistically significant differences were observed for GDF-9 and BMP-15 among the three treatment groups. Estradiol concentrations in follicular fluid were significantly higher in women treated with hMG compared with recombinant FSH or urinary FSH. Testosterone levels were also higher in the group treated with hMG. A statistically significant association was found between the degree of apoptosis in cumulus cells and the type of gonadotropin.nnnCONCLUSIONSnThe type of gonadotropin used during controlled ovarian stimulation significantly affects endocrine profiles in follicular fluid and the apoptosis rate in cumulus cells. However, there were no significant differences in the levels of oocyte-secreted factors between treatments.