Sara Peralta

Risk of thromboembolic events after recurrent spontaneous abortion in antiphospholipid syndrome: a case–control study

Objective To investigate whether patients having antiphospholipid syndrome (APS) as the only aetiological factor for recurrent spontaneous abortion (RSA) are at increased risk of thrombosis later in life. Methods A case–control study at a tertiary university referral centre. The study group consisted of 57 primary APS and RSA women (APS–RSA group). Control groups included: 86 patients with RSA of unknown aetiology (uRSA group), 42 patients with RSA and thrombophilic genetic defects as the only aetiologic factor for RSA (tRSA group) and 30 antiphospholipid antibody (aPL) positive but otherwise healthy women (aPL group). The main measurement was the thrombosis rate after long-term follow-up. Results APS–RSA patients had a significantly higher 12-year cumulative thrombotic incidence rate compared with the three comparator groups (19.3% vs 4.8%, 0.0% and 0.0%, respectively (log rank), p<0.001). Patients in the APS–RSA group had 25.6 thrombotic events per 1000 patient-years (95% CI 12.8 to 45.9). The OR of thrombosis in relation to the presence (APS–RSA group) or absence (uRSA and tRSA groups) of aPL in patients with RSA was 15.06 (95% CI 3.2 to 70.5). Conclusions Our data indicate that a history of RSA associated with aPL is a risk factor for subsequent thrombosis in the long term.

Day-5 inhibin B serum concentrations and antral follicle count as predictors of ovarian response and live birth in assisted reproduction cycles stimulated with gonadotropin after pituitary suppression

OBJECTIVE To investigate the usefulness of day-5 inhibin B and antral follicle count (AFC) in predicting ovarian response and live birth in the first cycle of assisted reproduction. DESIGN Prospective cohort study. SETTING University hospital. PATIENT(S) Ninety-eight infertile women treated with in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) comprising 72 normal responders and 26 poor responders. INTERVENTION(S) Ovarian stimulation with gonadotropin-releasing hormone agonist-gonadotropin treatment. MAIN OUTCOME MEASURE(S) Basal ultrasonographic (AFC, total ovarian volume) and basal (follicle-stimulating hormone, estradiol, and inhibin B) and stimulation day-5 (estradiol, inhibin B) hormone parameters. RESULT(S) The AFC had the best predictive value among the basal variables for outcome of ovarian stimulation. Among the dynamic hormone measurements, day-5 inhibin serum measurement emerged as the best predictive variable of poor response in IVF-ICSI cycles, but it was not statistically significantly better than basal AFC. The association of day-5 inhibin B with live-birth rate was statistically significant and stronger than the effect of any other variable investigated. CONCLUSION(S) Basal AFC and day-5 inhibin B have similar predictive properties for ovarian response in assisted reproduction cycles stimulated with gonadotropin after pituitary suppression, but day-5 inhibin B is a superior predictor of live birth.

The dilemma of menopause and hormone replacement – a challenge for women and health-care providers: knowledge of menopause and hormone therapy in Spanish menopausal women

Background An important goal in menopause research is to develop knowledge and identify interventions that strive to promote, maintain and enhance well-being for women. Objective To evaluate the knowledge of postmenopausal Spanish women about menopause and their knowledge of and trust in hormone replacement therapy (HRT) and to identify their sources of information and how those data are related to compliance with their prescription. Study design A total of 270 symptomatic postmenopausal women were personally interviewed using a structured questionnaire, which was designed to collect information on their familiarity with medical menopause studies, the menopause and the effects of HRT, their knowledge of alternative therapies, and to identify their sources of information. Results The most well-known menopausal complaints were hot flushes, sweats, irregular menstruation, cessation of menstruation, irritability and mood changes. Following suggestions of other symptoms by the interviewer, other complaints such as vaginal dryness, insomnia and depression/anxiety were also mentioned. HRT and phytoestrogens were recognized as treatments for the climacteric by most of the women. A womans decision to seek treatment was initiated in 77% of cases by the gynecologist, in 12% by the general practitioner, in 3% by friends/family and in 3% by books/magazines. The most frequent responses of women to the onset of menopausal symptoms were to talk with their partner (39%), to discuss it with their gynecologist (33%) or with their general practitioner (14%) and to talk with their friends/family or to read books/magazines (10%). Conclusions Vasomotor symptoms are recognized as the main complaint during the climacteric and HRT and phytoestrogens as the main therapies. Gynecologists play an important role in assuring compliance with therapies related to the menopause.

Pregnancy after orthotopic ovarian tissue transplantation using N-hexyl-2-cyanoacrylate

Cryopreservation of ovarian tissue in advance of cytotoxic therapies and later transplantation of the tissue is being performed increasingly often, and the total success rates in terms of pregnancy and delivery have been described in case series. Most pregnancies were achieved after orthotopic transplantation of tissue (in the peritoneum or the remaining ovary); however, treatment of the transplantation site during surgery is controversial. In this observational case-series study, we include four patients who underwent ovarian tissue transplantation between 2012 and 2016 by laparoscopy. Previously ovarian tissue was cryopreserved with slow freezing protocol prior to chemo- and/or radiotherapy. After cancer remission, the cryopreserved ovarian tissues were orthotopically re-transplanted in the ovarian medulla by laparoscopy, using N-hexyl-2-cyanoacrylate as an absorbable adhesion barrier. All patients regained ovarian function between 8 and 24 weeks after transplantation, as shown by follicle development and estrogen production. In patients 1 and 2 the ovarian function ended one year after transplantation. Patient 3 has regular menstrual cycles 2 years after the transplant and patient 4 currently has an ongoing spontaneous pregnancy. The use of N-hexyl-2 cyanoacrylate can facilitate the placement of ovarian pieces in orthotopic transplantation by laparoscopy without affecting the restoration and duration of ovarian activity.

Hiperandrogenismo ovárico. Valoración clínica y terapéutica

Los estados hiperandrogénicos son un conjunto de cuadros clínicos caracterizados por un exceso en la producción de andrógenos, con consecuencias clínicas no deseables. Puesto que se trata de esteroides normales en la mujer, la definición de su exceso se establece de acuerdo con criterios tanto sociales como clínicos o bioquímicos. Las consultas por hirsutismo, por ejemplo, responden a situaciones muy diferenciadas, donde, en ocasiones, no llega a objetivarse ningún signo clínicamente evidente. En nuestra sociedad, en cualquier caso, la aparición de vello en mejillas, aréolas mamarias o línea media abdominal suele considerarse anormal y no deseable. Esta situación se extiende al vello del labio superior o un exceso de él en los brazos. Otro signo dependiente de la producción androgénica y con semejante repercusión clínica es el acné. Con estos límites relativistas, se ha distinguido tres niveles conceptuales: hirsutismo, hipertricosis y virilismo. Los dos primeros hacen énfasis en la producción de pelo. Signos como el acné o la acantosis nigricans quedan fuera del cuadro clínico englobado por cualquiera de los tres. El hirsutismo, que afecta hasta un 15% de las mujeres, es el crecimiento excesivo de pelo terminal en las zonas andrógeno-dependientes en la mujer (fig. 1). Tiene origen en una actividad excesiva en la unidad pilosebácea como consecuencia de un exceso androgénico o de un aumento de la sensibilidad del folículo a los andrógenos1. Debe diferenciarse de la hipertricosis que consiste en el crecimiento uniforme de pelo suave y delgado (no terminal) en toda la superficie corporal (fig. 2). No es producido por un exceso androgénico, sino que Hiperandrogenismo ovárico. Valoración clínica y terapéutica

Endometrioma and Ovarian Reserve: A Surgical Approach

Ovarian endometriomas (OEs) are a frequent clinical manifestation of endometriosis. It is controversial how OE may affect women’s fertility, and it is an important consideration when planning treatment in women who want to retain the potential of future childbearing. This chapter will describe the association between OEs and diminished ovarian reserve, with a particular focus on spontaneous ovulation rates, markers of ovarian reserve, and response to ovarian stimulation. Based on current evidence, although there are plausible biological effects on the ovarian cortex surrounding OE and an impairment of the normal ovarian physiology, the impact of OE per se is not significant. There is a negligible detrimental effect on ovarian reserve with spontaneous ovulation not being impaired. Surgical removal of OE may worsen ovarian function by removing healthy ovarian cortex or compromising blood flow to the ovary. It is evident that surgical excision of OE acutely impairs ovarian function as measured by ovarian reserve markers. Additionally, a reduced response of the ovaries to gonadotrophins has been described after surgical removal of OE. Whether the decrease of ovarian function represents progressive or long-term impairment remains the subject of ongoing investigation.