Mireia González-Comadran

Effects of transdermal testosterone in poor responders undergoing IVF: systematic review and meta-analysis

A systematic review and meta-analysis was performed to evaluate the effect of transdermal testosterone preceding ovarian stimulation in women with poor ovarian response undergoing IVF. Studies comparing pretreatment with transdermal testosterone versus standard ovarian stimulation among poor responders were included. The main outcome assessed was live birth. Three trials were included (113 women in the testosterone group, 112 in the control group). Testosterone-treated women achieved significantly higher live birth rate (risk ratio, RR, 1.91, 95% CI 1.01 to 3.63), clinical pregnancy rate (RR 2.07, 95% CI 1.13 to 3.78) and required significantly lower doses of FSH (RR -461.96, 95% CI -611.82 to -312.09). However, differences observed in clinical pregnancy per embryo transferred were not statistically significant (RR 1.72, 95% CI 0.91 to 3.26). No differences were observed regarding number and quality of the oocytes retrieved. In conclusion, transdermal testosterone significantly increases live birth and reduces the doses of FSH required. These findings support the theoretical synergistic role of androgens and FSH on folliculogenesis. The present data should be interpreted with caution because of the small number of trials and clinical heterogeneity. The identification of poor responders that could especially benefit from testosterone treatment should be addressed in further studies. The poor response to ovarian stimulation among women undergoing IVF is of great concern in reproductive medicine. Certain modalities have been tested to improve this response to gonadotrophin stimulation, although results from some studies have shown conflicting results. Hence, a systematic review and meta-analysis was performed in order to evaluate the effect of transdermal testosterone prior to ovarian stimulation among these women with poor ovarian response. The main outcome assessed was live birth rate. In all, three trials were included, which comprehended 113 women in the testosterone group and 112 in the control group. Women that were pretreated with transdermal testosterone achieved significantly higher live birth rate and clinical pregnancy rate and required significantly lower doses of exogenous FSH as compared with controls. However, when clinical pregnancy rate was adjusted per embryo transferred differences observed were not statistically significant. No differences were observed in the number and quality of the oocytes retrieved. In conclusion, transdermal testosterone prior to ovarian stimulation significantly increases live birth and reduces the doses of FSH required among poor responders. In addition, the identification of poor responders that could especially benefit from testosterone treatment should be addressed in further studies.

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。

The impact of donor insemination on the risk of preeclampsia: a systematic review and meta-analysis

A systematic review and meta-analysis were performed to evaluate whether women who conceive with donor sperm have an increased risk of preeclampsia compared with those who use their partners sperm. Studies that compared women who were impregnated by donor and partner sperm were included. The main outcomes assessed were preeclampsia and gestational hypertension rates. Altogether, 10,898 women (2342 pregnancies by donor sperm versus 8556 by the partners sperm) were included from seven observational studies. Conception using donor sperm was associated with an increased risk of preeclampsia (odds ratio [OR] 1.63, 95% CI 1.36-1.95) compared with using a partners sperm. No difference was observed in the risk of gestational hypertension (OR 0.94, 95% CI 0.43-2.03). In conclusion, pregnancies achieved by donor sperm significantly increase the risk of preeclampsia, although the underlying mechanisms remain unclear. Additional studies are required to confirm these findings.

High-grade squamous intraepithelial lesion could be managed conservatively in women up to 25 years: results from a retrospective cohort study.

Objective The aim of this study was to compare histologic findings and clinical outcomes of women up to 25 years with a high-grade squamous intraepithelial lesion (HSIL) compared to women older than 25 years. Materials and Methods Sixty-three women up to 25 years and 245 women older than 25 years with HSIL, diagnosed from June 1991 to September 2008, were examined and treated following the official Spanish guidelines. Colposcopic and histologic findings and needs for treatment were recorded, and patients were followed up for a minimum of 12 months. Results A total of 308 patients were evaluated; 63.49% of women up to 25 years and 77.10% of women older than 25 years with HSIL had cervical intraepithelial neoplasia (CIN) 2+ histology (p = .04). Also, 74.60% of women up to 25 years and 99.24% of women older than 25 years underwent an excisional procedure (p < .001). No significant or clinical differences were found in the 1-year follow-up outcomes (82.54% vs 78.37% had normal results; p = ns). Conclusions Women up to 25 years have less CIN 2+ histologic findings and less need for conization compared to older women. Our findings support the feasibility to design an adequate protocol for these younger women, which would be less aggressive and would, consequently, minimize obstetric long-term secondary effects.