Ectopic pregnancy, the implantation of an embryo outside the endometrial cavity, is the leading c... more Ectopic pregnancy, the implantation of an embryo outside the endometrial cavity, is the leading cause of morbidity and mortality in the first trimester. The embryo may be implanted in the fallopian tubes, ovaries, abdomen, or cervix, with the fallopian tubes being the site of implantation in 95% of cases. If left untreated, ectopic pregnancy can result in rupture of the fallopian tube, which can lead to hemorrhagic shock and death. The signs and symptoms of ectopic pregnancy and diagnosis and treatment are detailed in the chapter. Spontaneous abortion, defined as a natural termination of a pregnancy before 20 weeks’ gestation, occurs in almost 30% of known pregnancies and an estimated 50% of all conceptions. Causes include genetic, environmental, endocrine, and immunologic factors; anatomic abnormalities; antiphospholipid syndrome; and polycystic ovary syndrome. This review contains 6 figures, 7 tables, and 42 references. Keywords: Ectopic pregnancy, miscarriage, spontaneous abortion, early pregnancy loss, vaginal spotting
Eight highly competitive swimmers were followed over a 9-month period during a vigorous training ... more Eight highly competitive swimmers were followed over a 9-month period during a vigorous training schedule. When compared, four oligomenorrheic (group I, greater than 60 days without menses) and four eumenorrheic (group II) swimmers were not significantly different for age, years of training, body fat, intensity of training, and baseline estradiol (E2) levels. Both groups were challenged during the peak of their training schedule with 10 mg of naloxone and 10 mg of metoclopramide. The naloxone infusion revealed a significant increase in baseline luteinizing hormone (LH) levels in the oligomenorrheic swimmers when compared with the eumenorrheic swimmers. During the metoclopramide infusion prolactin (PRL) increased in all subjects, with a slightly higher increase in PRL in the eumenorrheic swimmers. The study suggests the menstrual dysfunction observed in these strenuously training swimmers to be related to the abnormalities of endorphin physiology as revealed by the elevation in LH after a naloxone infusion.
Objective: Peripheral blood stem cell transplant (PBSCT) can now cure SCD in adults, but may resu... more Objective: Peripheral blood stem cell transplant (PBSCT) can now cure SCD in adults, but may result in a loss of future fertility. Little is documented regarding fertility preservation in women with SCD. The aim of this study was to perform fertility preservation for women with SCD scheduled for PBSCT. Design: Prospective cohort of women with SCD undergoing fertility preservation prior to PBSCT at a large research hospital. Materials and Methods: Patients underwent standard controlled ovarian hyperstimulation (COH) using an antagonist protocol cycle with leuprolide trigger under close multidisciplinary (including reproductive endocrinologists and hematologists) monitoring. All patients were continued on therapeutic or started on prophylactic anticoagulation prior to beginning COH, and maintained on hydroxyurea. Results: Nine reproductive aged women were screened; 1 declined participation, 1 was diagnosed with unrecognized premature ovarian insufficiency, 1 had her fertility preservation cycle canceled due to poor response to fertility medications and 2 patients are scheduled for upcoming cycles. The remaining four women (ages 20, 34, 24, 27) successfully underwent COH, transvaginal oocyte retrieval and cryopreservation of mature eggs (n= 8, 13, 15, 21 oocytes, respectively). The third patient underwent two cycles due to low mature oocyte yield from her initial cycle. Headaches were reported by patients 1 and 2 following gonadotropin injections, with a negative neurologic workup including MRI in patient 2. Patient 3 underwent an exchange transfusion on day 10 of stimulation, which did not adversely impact serum reproductive hormone levels. Patients 3 and 4 reported an acute exacerbation of their chronic pain during COH, which responded well to intravenous fluids, IV and oral pain medications. Therefore, despite severe SCD and co-morbid conditions, the side effects were manageable. There were no venous thrombotic events. Conclusion: These results provide support that fertility preservation can be safely performed in women with SCD under the care of a multidisciplinary team. The safest stimulation protocol (i.e. antagonist cycle with leuprolide trigger for final oocyte maturation) was successful in all patients despite multiple risk factors for failed leuprolide trigger. Fertility preservation is important not only before PBSCT to cure their underlying disease, but also because of high rates of premature ovarian insufficiency in the SCD population post-transplant. Support: Intramural NICHD and NHLBI, NIH. Disclosures No relevant conflicts of interest to declare.
Seventy-two patients, 54 for 5 years and 18 for 6 years, were evaluated between 1 and 2 years and... more Seventy-two patients, 54 for 5 years and 18 for 6 years, were evaluated between 1 and 2 years and 5 and 6 years after bilateral neosalpingostomy. A 27.7% intrauterine pregnancy rate was reported in those patients treated between 1976 and 1978, with a 14% ectopic pregnancy rate. The subsequent 5- to 6-year follow-up study revealed an increase in the pregnancy rate to 41.6% and in the ectopic pregnancy rate to 17.1%. The increase in the pregnancy rate may reflect the ability of the fallopian tube for ciliogenesis and intrinsic repair. Thus if patients have not conceived within 2 years of neosalpingostomy for distal tubal obstruction, significant reproductive potential still exists.
DeckerMed Transitional Year Weekly Curriculum™, 2018
Infertility affects 12 to 18% of couples in the United States and may be due to female factors, m... more Infertility affects 12 to 18% of couples in the United States and may be due to female factors, male factors, or both. A systematic evaluation of the common causes of infertility can identify conditions that may be treated by the obstetrician-gynecologist to help the couple achieve their family-building goals or those that require referral to a subspecialist. This review discusses current recommendations regarding the workup and treatment of the common causes of infertility, including tubal and pelvic factors, ovulatory disorders, and male factors. Advances in assisted reproductive technology are also discussed, including the use of genetic screening in in vitro fertilization and fertility preservation options for individuals facing gonadotoxic therapy. This review contains 6 figures, 6 tables, and 50 references. Key words: anovulation, assisted reproductive technology, clomiphene citrate, infertility, letrozole, oocyte cryopreservation, ovulation induction, semen analysis, tubal fa...
Ectopic pregnancy, the implantation of an embryo outside the endometrial cavity, is the leading c... more Ectopic pregnancy, the implantation of an embryo outside the endometrial cavity, is the leading cause of morbidity and mortality in the first trimester. The embryo may be implanted in the fallopian tubes, ovaries, abdomen, or cervix, with the fallopian tubes being the site of implantation in 95% of cases. If left untreated, ectopic pregnancy can result in rupture of the fallopian tube, which can lead to hemorrhagic shock and death. The signs and symptoms of ectopic pregnancy and diagnosis and treatment are detailed in the chapter. Spontaneous abortion, defined as a natural termination of a pregnancy before 20 weeks’ gestation, occurs in almost 30% of known pregnancies and an estimated 50% of all conceptions. Causes include genetic, environmental, endocrine, and immunologic factors; anatomic abnormalities; antiphospholipid syndrome; and polycystic ovary syndrome. This review contains 6 figures, 7 tables, and 42 references. Keywords: Ectopic pregnancy, miscarriage, spontaneous abortion, early pregnancy loss, vaginal spotting
Eight highly competitive swimmers were followed over a 9-month period during a vigorous training ... more Eight highly competitive swimmers were followed over a 9-month period during a vigorous training schedule. When compared, four oligomenorrheic (group I, greater than 60 days without menses) and four eumenorrheic (group II) swimmers were not significantly different for age, years of training, body fat, intensity of training, and baseline estradiol (E2) levels. Both groups were challenged during the peak of their training schedule with 10 mg of naloxone and 10 mg of metoclopramide. The naloxone infusion revealed a significant increase in baseline luteinizing hormone (LH) levels in the oligomenorrheic swimmers when compared with the eumenorrheic swimmers. During the metoclopramide infusion prolactin (PRL) increased in all subjects, with a slightly higher increase in PRL in the eumenorrheic swimmers. The study suggests the menstrual dysfunction observed in these strenuously training swimmers to be related to the abnormalities of endorphin physiology as revealed by the elevation in LH after a naloxone infusion.
Objective: Peripheral blood stem cell transplant (PBSCT) can now cure SCD in adults, but may resu... more Objective: Peripheral blood stem cell transplant (PBSCT) can now cure SCD in adults, but may result in a loss of future fertility. Little is documented regarding fertility preservation in women with SCD. The aim of this study was to perform fertility preservation for women with SCD scheduled for PBSCT. Design: Prospective cohort of women with SCD undergoing fertility preservation prior to PBSCT at a large research hospital. Materials and Methods: Patients underwent standard controlled ovarian hyperstimulation (COH) using an antagonist protocol cycle with leuprolide trigger under close multidisciplinary (including reproductive endocrinologists and hematologists) monitoring. All patients were continued on therapeutic or started on prophylactic anticoagulation prior to beginning COH, and maintained on hydroxyurea. Results: Nine reproductive aged women were screened; 1 declined participation, 1 was diagnosed with unrecognized premature ovarian insufficiency, 1 had her fertility preservation cycle canceled due to poor response to fertility medications and 2 patients are scheduled for upcoming cycles. The remaining four women (ages 20, 34, 24, 27) successfully underwent COH, transvaginal oocyte retrieval and cryopreservation of mature eggs (n= 8, 13, 15, 21 oocytes, respectively). The third patient underwent two cycles due to low mature oocyte yield from her initial cycle. Headaches were reported by patients 1 and 2 following gonadotropin injections, with a negative neurologic workup including MRI in patient 2. Patient 3 underwent an exchange transfusion on day 10 of stimulation, which did not adversely impact serum reproductive hormone levels. Patients 3 and 4 reported an acute exacerbation of their chronic pain during COH, which responded well to intravenous fluids, IV and oral pain medications. Therefore, despite severe SCD and co-morbid conditions, the side effects were manageable. There were no venous thrombotic events. Conclusion: These results provide support that fertility preservation can be safely performed in women with SCD under the care of a multidisciplinary team. The safest stimulation protocol (i.e. antagonist cycle with leuprolide trigger for final oocyte maturation) was successful in all patients despite multiple risk factors for failed leuprolide trigger. Fertility preservation is important not only before PBSCT to cure their underlying disease, but also because of high rates of premature ovarian insufficiency in the SCD population post-transplant. Support: Intramural NICHD and NHLBI, NIH. Disclosures No relevant conflicts of interest to declare.
Seventy-two patients, 54 for 5 years and 18 for 6 years, were evaluated between 1 and 2 years and... more Seventy-two patients, 54 for 5 years and 18 for 6 years, were evaluated between 1 and 2 years and 5 and 6 years after bilateral neosalpingostomy. A 27.7% intrauterine pregnancy rate was reported in those patients treated between 1976 and 1978, with a 14% ectopic pregnancy rate. The subsequent 5- to 6-year follow-up study revealed an increase in the pregnancy rate to 41.6% and in the ectopic pregnancy rate to 17.1%. The increase in the pregnancy rate may reflect the ability of the fallopian tube for ciliogenesis and intrinsic repair. Thus if patients have not conceived within 2 years of neosalpingostomy for distal tubal obstruction, significant reproductive potential still exists.
DeckerMed Transitional Year Weekly Curriculum™, 2018
Infertility affects 12 to 18% of couples in the United States and may be due to female factors, m... more Infertility affects 12 to 18% of couples in the United States and may be due to female factors, male factors, or both. A systematic evaluation of the common causes of infertility can identify conditions that may be treated by the obstetrician-gynecologist to help the couple achieve their family-building goals or those that require referral to a subspecialist. This review discusses current recommendations regarding the workup and treatment of the common causes of infertility, including tubal and pelvic factors, ovulatory disorders, and male factors. Advances in assisted reproductive technology are also discussed, including the use of genetic screening in in vitro fertilization and fertility preservation options for individuals facing gonadotoxic therapy. This review contains 6 figures, 6 tables, and 50 references. Key words: anovulation, assisted reproductive technology, clomiphene citrate, infertility, letrozole, oocyte cryopreservation, ovulation induction, semen analysis, tubal fa...
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