Miguel Ángel Checa Vizcaíno

The effects of letrozole on ovarian stimulation for fertility preservation in cancer-affected women

Survival rates for fertile women with cancer have increased significantly, lending importance to considering the possibility of motherhood after cancer. This study was a retrospective analysis of a prospective database comparing two groups of patients who underwent fertility preservation after being diagnosed with either breast cancer or a non-hormone-dependent cancer between 2009 and 2011. Nineteen oncology patients were included in the study. The objective was to assess the efficacy of ovarian stimulation with aromatase inhibitors versus a standard antagonist protocol. This study sought to quantify oestradiol concentrations in patients receiving letrozole and to determine the length of time between diagnosis of malignancy and onset of fertility preservation. Number of mature oocytes retrieved in the non-hormone-dependent cancer group was comparable to that in the breast cancer group (15.4±8.19 versus 16.3±7.31). Oestradiol concentrations were higher for patients with non-hormone-dependent cancer (1666.4±739.42 pg/ml versus 829±551.11 pg/ml, P=0.006). There were no differences between the groups in the length of time between diagnosis and fertility preservation (17.4±4.93 versus 16.4±1.74 days). Oestradiol concentrations of breast cancer patients on the letrozole protocol remained much lower than those of patients on the antagonist protocol.

Outdoor air pollution and human infertility: a systematic review

Air pollution is a current research priority because of its adverse effects on human health, including on fertility. However, the mechanisms through which air pollution impairs fertility remain unclear. In this article, we perform a systematic review to evaluate currently available evidence on the impact of air pollution on fertility in humans. Several studies have assessed the impact of air pollutants on the general population, and have found reduced fertility rates and increased risk of miscarriage. In subfertile patients, women exposed to higher concentrations of air pollutants while undergoing IVF showed lower live birth rates and higher rates of miscarriage. After exposure to similar levels of air pollutants, comparable results have been found regardless of the mode of conception (IVF versus spontaneous conception), suggesting that infertile women are not more susceptible to the effects of pollutants than the general population. In addition, previous studies have not observed impaired embryo quality after exposure to air pollution, although evidence for this question is sparse.

Impact of air pollution on fertility: a systematic review

Abstract Air pollution has gained considerable interest because of the multiple adverse effects reported on human health, although its impact on fertility remains unclear. A systematic search was performed to evaluate the impact of air pollutants on fertility. Controlled trials and observational studies assessing animal model and epidemiological model were included. Occupational exposure and semen quality studies were not considered. Outcomes of interest included live birth, miscarriage, clinical pregnancy, implantation, and embryo quality. Ten studies were included and divided into two groups: animal studies and human epidemiological studies including the general population as well as women undergoing in vitro fertilization and embryo transfer (IVF/ET). Results from this systematic review suggest a significant impact of air pollution on miscarriage and clinical pregnancy rates in the general population, whereas among subfertile patients certain air pollutants seem to exert a greater impact on fertility outcomes, including miscarriage and live birth rates. Besides, studies in mammals observed a clear detrimental effect on fertility outcomes associated to air pollutants at high concentration. The lack of prospective studies evaluating the effect of air pollution exposure in terms of live birth constitutes an important limitation in this review. Thus, further studies are needed to confirm these findings. Chinese abstract 空气污染因对人类健康造成多种危害而受到了相当大的关注，但是空气污染对生殖能力的影响仍不清楚。为此进行了一项系统性研究来评估空气污染对生殖能力的影响，包括对动物模型和流行病学模型进行的对照试验和观察性研究评估。结果包含活产率、流产率、临床妊娠率、移植率和胚胎质量。共进行了10项研究并分为两组，即动物研究和人类流行病学研究，其中人类流行病学研究包含一般人群和进行体外授精-胚胎移植（in vitro fertilization and embryo transfer ，IVF/ET）的妇女。这项系统性回顾结果显示，空气污染对一般人群的流产率和临床妊娠率有很大影响，然而某些特定的空气污染物可能会对不孕患者的生育结局产生更大的影响，包括流产率和活产率。此外，在哺乳动物研究中观察到了一种与高浓度空气污染物有关的明显影响生育能力的不利作用。缺乏依据活产率评估空气污染暴露影响的前瞻性研究是本综述的一个重要限制。因此，这一结论需要进一步的研究来证实。

De novo urgency after tension-free vaginal tape versus transobturator tape procedure for stress urinary incontinence

OBJECTIVE To determine the frequency of de novo urgency after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI). STUDY DESIGN Prospective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2008. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery. RESULTS The study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P=0.025), 24 (24.8% vs 12.3%, P=0.033), and 36 (0% vs 24.7%, P=0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366). CONCLUSION Treatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.

The Value of Hysterosalpingography following Medical Treatment with Methotrexate for Ectopic Pregnancy

After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment. Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies. Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event. Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction. Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.

Accidental introduction of a contraceptive vaginal ring into the urinary bladder

Introduction and hypothesisA case of inadvertent self-introduction into the urethra of a folded contraceptive vaginal ring (NuvaRing®) in a 22-year-old woman is reported.MethodsThe patient presented with lower urinary tract symptoms, including dysuria, urgency, and terminal hematuria, that appeared a few minutes after insertion of the device.ResultsThe diagnosis was made by abdominal echography. The abdominal pelvic computed tomography scan confirmed the intravesical presence of the unfolded ring.ConclusionsVaginal contraceptive rings should be added to the list of potential intravesical foreign bodies causing lower urinary tract symptoms.A case of inadvertent self-introduction into the urethra of a folded contraceptive vaginal ring (NuvaRing®) in a 22-year-old woman is reported. The patient presented with lower urinary tract symptoms, including dysuria, urgency, and terminal hematuria, that appeared a few minutes after insertion of the device. The diagnosis was made by abdominal echography. The abdominal pelvic computed tomography scan confirmed the intravesical presence of the unfolded ring. Vaginal contraceptive rings should be added to the list of potential intravesical foreign bodies causing lower urinary tract symptoms.

Efecto del tratamiento con vitaminas, L-carnitina y coenzima Q10 en el índice de vacuolización y la fragmentación espermática en pacientes de fecundación in vitro

Resumen Objetivo La aparicion de nuevas herramientas de estudio en el campo de la andrologia nos ha permitido evaluar nuevos marcadores de calidad seminal, como la presencia de vacuolas en el nucleo del espermatozoide, mediante el uso de microscopia de alta magnificacion, y el grado de fragmentacion del acido desoxirribonucleico (ADN) espermatico. Ambos marcadores de calidad pueden verse afectados por la presencia de radicales libres de oxigeno, que favorecen la oxidacion celular. En el presente estudio piloto se plantea valorar la utilidad de un tratamiento con antioxidantes para reducir tanto el indice de vacuolizacion espermatica, como el grado de fragmentacion del ADN de una forma significativa. Material y metodos Estudio prospectivo para el que se selecciono a un total de 65 pacientes, de los cuales 33 finalizaron el estudio. Cada paciente entrego dos muestras de semen y realizo un tratamiento con antioxidantes mediante Androferti®. Se evaluo el indice de vacuolizacion en el nucleo del espermatozoide y la fragmentacion del ADN espermatico en cada una de las muestras entregadas. Resultados Se observa un aumento estadisticamente significativo de espermatozoides con grados de vacuolizacion I y II despues de un mes de tratamiento, asi como tambien una disminucion del grado de fragmentacion del ADN espermatico. Conclusiones A pesar de que se trata de un estudio clinico no aleatorizado, parece concluyente la importancia del uso de un tratamiento antioxidante para aumentar el exito de un ciclo de reproduccion asistida, con el objetivo de disminuir la influencia negativa de malformaciones en el nucleo espermatico y de la fragmentacion del ADN.