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[PMID]:28965550
[Au] Autor:Haas J; Casper RF
[Ad] Endereço:Division of Reproductive Sciences, University of Toronto; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital; and TRIO Fertility, Toronto, Ontario, Canada.
[Ti] Título:In vitro fertilization treatments with the use of clomiphene citrate or letrozole.
[So] Source:Fertil Steril;108(4):568-571, 2017 Oct.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There has been increasing interest in combining the oral agents clomiphene citrate (CC) and letrozole with gonadotropins in IVF: for poor responders to reduce the amount of gonadotropins used, and in normal responders to reduce the incidence of ovarian hyperstimulation (OHSS). In normal responders, mild stimulation with the use of CC and gonadotropins was found to decrease the number of oocytes retrieved and result in good pregnancy rates, but in most studies the cumulative pregnancy rate was lower compared with conventional ovarian stimulation when frozen embryo transfers were considered. Coadministration of letrozole and gonadotropins has mainly been used in patients with breast cancer to prevent the massive elevation of serum E concentrations with the use of standard controlled ovarian hyperstimulation. CC and letrozole have both been used with gonadotropins in poor responders and have been shown to reduce the amount of gonadotropin used without reducing the pregnancy rate. Letrozole use with gonadotropins in IVF cycles may increase endometrial receptivity by increasing integrin expression in the endometrium and by lowering estrogen concentrations to more physiologic levels.
[Mh] Termos MeSH primário: Clomifeno/administração & dosagem
Fármacos para a Fertilidade Feminina/administração & dosagem
Fertilização In Vitro/métodos
Infertilidade Feminina/terapia
Nitrilos/administração & dosagem
Triazóis/administração & dosagem
[Mh] Termos MeSH secundário: Clomifeno/efeitos adversos
Quimioterapia Combinada/métodos
Feminino
Fármacos para a Fertilidade Feminina/efeitos adversos
Fertilização In Vitro/efeitos adversos
Gonadotropinas/administração & dosagem
Seres Humanos
Nitrilos/efeitos adversos
Síndrome de Hiperestimulação Ovariana/etiologia
Síndrome de Hiperestimulação Ovariana/prevenção & controle
Indução da Ovulação/métodos
Gravidez
Triazóis/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Fertility Agents, Female); 0 (Gonadotropins); 0 (Nitriles); 0 (Triazoles); 1HRS458QU2 (Clomiphene); 7LKK855W8I (letrozole)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171003
[St] Status:MEDLINE


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[PMID]:28906358
[Au] Autor:Wang L; Huang X; Li X; Lv F; He X; Pan Y; Wang L; Zhang X
[Ad] Endereço:aDepartment of Biobank, Clinical Medical College,Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou bDepartment of Obstetrical, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong cReproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China dThe University of Texas MD Anderson Cancer Center, Department of Anesthesiology & Perioperative Medicine, Houston, TX.
[Ti] Título:Efficacy evaluation of low-dose aspirin in IVF/ICSI patients evidence from 13 RCTs: A systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);96(37):e7720, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We conducted a systematic review and meta-analysis of existing literature to evaluate the different outcomes of low-dose aspirin on patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), including clinical pregnancy rate, implantation rate, live birth rate, miscarriage rate, fertilization rate, number of oocytes retrieved, and so forth. METHODS: Electronic databases including PubMed, MEDLINE, and Embase were searched between 1997 and March 2016 to identity eligible studies. The following comparisons between treatment groups were included: aspirin versus placebo; aspirin versus control group; aspirin versus aspirin + prednisolone + control. RESULTS: Thirteen randomized controlled trials which included 3104 participants were selected. There were no significant differences in implantation rate (RR = 1.15; 95% CI = 0.78-1.70), live birth rate (RR = 1.06; 95% CI = 0.93-1.21), miscarriage rate (RR = 1.28; 95% CI = 0.93-1.77), fertilization rate (RR = 0.91; 95% CI = 0.75-1.11), and endometrial thickness (WMD = 0.15; 95% CI = -0.38-0.67). But the research showed that aspirin treatment may improve the clinical pregnancy rate (RR = 1.16; 95% CI = 1.04-1.28) compared to placebo or no treatment, and reduce the number of oocytes retrieved (WMD = -0.68; 95% CI = -0.91-0.46). CONCLUSIONS: Our findings suggest that low-dose aspirin may improve the pregnancy rate in IVF/ICSI, with the recommended clinical use dose of 100 mg/day. Considering the limitation of included studies, further well-designed large-scaled RCTs are necessary to clarify whether aspirin may improve assisted reproduction outcomes in IVF/ICSI patients.
[Mh] Termos MeSH primário: Aspirina/administração & dosagem
Fármacos para a Fertilidade Feminina/administração & dosagem
Fertilização In Vitro
Injeções de Esperma Intracitoplásmicas
[Mh] Termos MeSH secundário: Relação Dose-Resposta a Droga
Feminino
Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Fertility Agents, Female); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007720


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[PMID]:28796038
[Au] Autor:Jiang S; Kuang Y
[Ad] Endereço:Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
[Ti] Título:Clomiphene citrate is associated with favorable cycle characteristics but impaired outcomes of obese women with polycystic ovarian syndrome undergoing ovarian stimulation for in vitro fertilization.
[So] Source:Medicine (Baltimore);96(32):e7540, 2017 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to explore the effect of clomiphene citrate (CC) on the cycle characteristics and outcomes of obese women with polycystic ovarian syndrome (PCOS) undergoing ovarian stimulation for in vitro fertilization (IVF).This is a retrospective cohort study, and it was conducted at the tertiary-care academic medical center.This study included 174 obese PCOS patients undergoing IVF.In the study group (n = 90), CC and human menopausal gonadotropin (HMG) were administered simultaneously beginning on cycle day 3, while in control group (n = 84) HMG was used only. Both of the 2 groups used medroxyprogesterone acetate (MPA) for preventing premature luteinizing hormone (LH) surges. Ovulation was cotriggered by a GnRH agonist and hCG when dominant follicles matured.The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the number of top-quality embryos, maturation rate, fertilization rate, cleavage rate, incidence of premature LH surge, and OHSS.The study group received obviously lower total HMG dose [1650 (975-4800) vs 2025 (1350-3300) IU, P = 2.038E-4] but similar HMG duration. While the antral follicle count (AFC) is higher in study group, the number of oocytes retrieved and top-quality embryos are remarkably less [5 (0-30) vs 13 (0-42), P = 6.333E-5; 2 (0-14) vs 3.5 (0-15), P = .003; respectively]. The mature oocyte rate is higher in study group (P = .036). No significant differences were detected in fertilization rate and cleavage rate between 2 groups.CC has a positive influence on cycle characteristics, but might be correlated with the impaired IVF outcomes (less oocytes retrieved and top quality embryos, lower oocyte retrieval rate) in obese PCOS patients undergoing IVF, when HMG and MPA are used simultaneously.
[Mh] Termos MeSH primário: Clomifeno/uso terapêutico
Fármacos para a Fertilidade Feminina/uso terapêutico
Infertilidade Feminina/complicações
Infertilidade Feminina/tratamento farmacológico
Obesidade/complicações
Síndrome do Ovário Policístico/complicações
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Adulto
Feminino
Fertilização In Vitro/métodos
Seres Humanos
Acetato de Medroxiprogesterona/administração & dosagem
Menotropinas/administração & dosagem
Oócitos/efeitos dos fármacos
Indução da Ovulação/métodos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Fertility Agents, Female); 1HRS458QU2 (Clomiphene); 61489-71-2 (Menotropins); C2QI4IOI2G (Medroxyprogesterone Acetate)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170827
[Lr] Data última revisão:
170827
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007540


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[PMID]:28655015
[Au] Autor:Wu XK; Stener-Victorin E; Kuang HY; Ma HL; Gao JS; Xie LZ; Hou LH; Hu ZX; Shao XG; Ge J; Zhang JF; Xue HY; Xu XF; Liang RN; Ma HX; Yang HW; Li WL; Huang DM; Sun Y; Hao CF; Du SM; Yang ZW; Wang X; Yan Y; Chen XH; Fu P; Ding CF; Gao YQ; Zhou ZM; Wang CC; Wu TX; Liu JP; Ng EHY; Legro RS; Zhang H; PCOSAct Study Group
[Ad] Endereço:Committee of Reproductive Medicine, World Federation of Chinese Medicine Societies, Beijing, China2Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China.
[Ti] Título:Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial.
[So] Source:JAMA;317(24):2502-2514, 2017 06 27.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Acupuncture is used to induce ovulation in some women with polycystic ovary syndrome, without supporting clinical evidence. Objective: To assess whether active acupuncture, either alone or combined with clomiphene, increases the likelihood of live births among women with polycystic ovary syndrome. Design, Setting, and Participants: A double-blind (clomiphene vs placebo), single-blind (active vs control acupuncture) factorial trial was conducted at 21 sites (27 hospitals) in mainland China between July 6, 2012, and November 18, 2014, with 10 months of pregnancy follow-up until October 7, 2015. Chinese women with polycystic ovary syndrome were randomized in a 1:1:1:1 ratio to 4 groups. Interventions: Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle, for up to 4 cycles. The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation; the control acupuncture group received superficial needle insertion, no manual stimulation, and mock electricity. Main Outcomes and Measures: The primary outcome was live birth. Secondary outcomes included adverse events. Results: Among the 1000 randomized women (mean [SD] age, 27.9 [3.3] years; mean [SD] body mass index, 24.2 [4.3]), 250 were randomized to each group; a total of 926 women (92.6%) completed the trial. Live births occurred in 69 of 235 women (29.4%) in the active acupuncture plus clomiphene group, 66 of 236 (28.0%) in the control acupuncture plus clomiphene group, 31 of 223 (13.9%) in the active acupuncture plus placebo group, and 39 of 232 (16.8%) in the control acupuncture plus placebo group. There was no significant interaction between active acupuncture and clomiphene (P = .39), so main effects were evaluated. The live birth rate was significantly higher in the women treated with clomiphene than with placebo (135 of 471 [28.7%] vs 70 of 455 [15.4%], respectively; difference, 13.3%; 95% CI, 8.0% to 18.5%) and not significantly different between women treated with active vs control acupuncture (100 of 458 [21.8%] vs 105 of 468 [22.4%], respectively; difference, -0.6%; 95% CI, -5.9% to 4.7%). Diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture (diarrhea: 25 of 500 [5.0%] vs 8 of 500 [1.6%], respectively; difference, 3.4%; 95% CI, 1.2% to 5.6%; bruising: 37 of 500 [7.4%] vs 9 of 500 [1.8%], respectively; difference, 5.6%; 95% CI, 3.0% to 8.2%). Conclusions and Relevance: Among Chinese women with polycystic ovary syndrome, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births. This finding does not support acupuncture as an infertility treatment in such women. Trial Registration: clinicaltrials.gov Identifier: NCT01573858.
[Mh] Termos MeSH primário: Terapia por Acupuntura
Clomifeno/uso terapêutico
Fármacos para a Fertilidade Feminina/uso terapêutico
Infertilidade Feminina/terapia
Nascimento Vivo/epidemiologia
Síndrome do Ovário Policístico/terapia
[Mh] Termos MeSH secundário: Terapia por Acupuntura/efeitos adversos
Terapia por Acupuntura/estatística & dados numéricos
Adulto
Índice de Massa Corporal
Clomifeno/efeitos adversos
Terapia Combinada/métodos
Contusões/etiologia
Diarreia/etiologia
Método Duplo-Cego
Esquema de Medicação
Feminino
Fármacos para a Fertilidade Feminina/efeitos adversos
Seres Humanos
Infertilidade Feminina/tratamento farmacológico
Infertilidade Feminina/etiologia
Síndrome do Ovário Policístico/complicações
Síndrome do Ovário Policístico/tratamento farmacológico
Gravidez
Método Simples-Cego
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Fertility Agents, Female); 1HRS458QU2 (Clomiphene)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170628
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.7217


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[PMID]:28427285
[Au] Autor:Schmidt PJ; Martinez PE; Nieman LK; Koziol DE; Thompson KD; Schenkel L; Wakim PG; Rubinow DR
[Ad] Endereço:From the Behavioral Endocrinology Branch, NIMH, Bethesda, Md.; the Intramural Research Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; the Biostatistics and Clinical Epidemiology Service, Clinical Center
[Ti] Título:Premenstrual Dysphoric Disorder Symptoms Following Ovarian Suppression: Triggered by Change in Ovarian Steroid Levels But Not Continuous Stable Levels.
[So] Source:Am J Psychiatry;174(10):980-989, 2017 Oct 01.
[Is] ISSN:1535-7228
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Premenstrual dysphoric disorder (PMDD) symptoms are eliminated by ovarian suppression and stimulated by administration of ovarian steroids, yet they appear with ovarian steroid levels indistinguishable from those in women without PMDD. Thus, symptoms could be precipitated either by an acute change in ovarian steroid levels or by stable levels above a critical threshold playing a permissive role in expression of an underlying infradian affective "pacemaker." The authors attempted to determine which condition triggers PMDD symptoms. METHOD: The study included 22 women with PMDD, ages 30 to 50 years. Twelve women who experienced symptom remission after 2-3 months of GnRH agonist-induced ovarian suppression (leuprolide) then received 1 month of single-blind (participant only) placebo and then 3 months of continuous combined estradiol/progesterone. Primary outcome measures were the Rating for Premenstrual Tension observer and self-ratings completed every 2 weeks during clinic visits. Multivariate repeated-measure ANOVA for mixed models was employed. RESULTS: Both self- and observer-rated scores on the Rating for Premenstrual Tension were significantly increased (more symptomatic) during the first month of combined estradiol/progesterone compared with the last month of leuprolide alone, the placebo month, and the second and third months of estradiol/progesterone. There were no significant differences in symptom severity between the last month of leuprolide alone, placebo month, or second and third months of estradiol/progesterone. Finally, the Rating for Premenstrual Tension scores in the second and third estradiol/progesterone months did not significantly differ. CONCLUSIONS: The findings demonstrate that the change in estradiol/progesterone levels from low to high, and not the steady-state level, was associated with onset of PMDD symptoms. Therapeutic efforts to modulate the change in steroid levels proximate to ovulation merit further study.
[Mh] Termos MeSH primário: Afeto/efeitos dos fármacos
Estradiol/farmacologia
Estrogênios/farmacologia
Inibição da Ovulação/metabolismo
Transtorno Disfórico Pré-Menstrual/metabolismo
Progesterona/farmacologia
Progestinas/farmacologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Fármacos para a Fertilidade Feminina/uso terapêutico
Hormônio Liberador de Gonadotropina/agonistas
Seres Humanos
Leuprolida/uso terapêutico
Meia-Idade
Análise Multivariada
Inibição da Ovulação/psicologia
Transtorno Disfórico Pré-Menstrual/tratamento farmacológico
Transtorno Disfórico Pré-Menstrual/psicologia
Método Simples-Cego
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Estrogens); 0 (Fertility Agents, Female); 0 (Progestins); 33515-09-2 (Gonadotropin-Releasing Hormone); 4G7DS2Q64Y (Progesterone); 4TI98Z838E (Estradiol); EFY6W0M8TG (Leuprolide)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170422
[St] Status:MEDLINE
[do] DOI:10.1176/appi.ajp.2017.16101113


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[PMID]:28397981
[Au] Autor:Helmy MEE; Maher MA; Elkhouly NI; Ramzy M
[Ad] Endereço:Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Shebin-Elkom, Egypt.
[Ti] Título:A randomized trial of local endometrial injury during ovulation induction cycles.
[So] Source:Int J Gynaecol Obstet;138(1):47-52, 2017 Jul.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate the effect of endometrial injury on pregnancy outcomes among infertile women taking clomifene citrate. METHODS: A prospective randomized trial was undertaken at an Egyptian hospital between January 26, 2015, and July 17, 2016. Eligible women (≥1 year primary/secondary/unexplained infertility, aged 20-35 years, day-2 follicle-stimulating hormone <12 IU/L, normal prolactin/thyroid function/uterine cavity, ≥1 patent tube, male partner with normal semen count and motility, 3 cycles of clomifene citrate without success) were randomly allocated (1:1) using computer-generated numbers into intervention (received endometrial injury on cycle day 15-24) or control groups (sham procedure). Women began ovulation induction on days 3-5 of the following cycle. Participants and investigators were not masked to group assignment. The primary outcomes were clinical pregnancy, spontaneous abortion, and multiple pregnancy rates. Women who completed follow-up were included in analyses. RESULTS: The intervention group included 52 women and the control group 53 women. The clinical pregnancy rate was significantly higher in the intervention group (37% [n=19]) than in the control group (13% [n=7]; P=0.006). No differences between the intervention and control groups were noted for spontaneous abortion rate (11% [2/19] vs 29% [2/7]; P=0.287) or multiple pregnancy rate (11% [2/19] vs 14% [1/7]; P=0.790). No adverse effects were reported. CONCLUSION: Endometrial injury before ovulation induction could improve chances of pregnancy and its outcomes. CLINICALTRIALS.GOV: NCT02345837.
[Mh] Termos MeSH primário: Clomifeno/uso terapêutico
Endométrio/lesões
Fármacos para a Fertilidade Feminina/uso terapêutico
Infertilidade Feminina/terapia
Indução da Ovulação/métodos
Resultado da Gravidez
[Mh] Termos MeSH secundário: Adulto
Endométrio/cirurgia
Feminino
Seres Humanos
Infertilidade Feminina/tratamento farmacológico
Infertilidade Feminina/fisiopatologia
Infertilidade Feminina/cirurgia
Fase Luteal/fisiologia
Ovulação/fisiologia
Gravidez
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Fertility Agents, Female); 1HRS458QU2 (Clomiphene)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12178


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[PMID]:28349511
[Au] Autor:Skalkidou A; Sergentanis TN; Gialamas SP; Georgakis MK; Psaltopoulou T; Trivella M; Siristatidis CS; Evangelou E; Petridou E
[Ad] Endereço:Department of Women's and Children's Health, Uppsala University, Kvinnokliniken, Akademiska Sjukhuset, Uppsala, Sweden, 75185.
[Ti] Título:Risk of endometrial cancer in women treated with ovary-stimulating drugs for subfertility.
[So] Source:Cochrane Database Syst Rev;3:CD010931, 2017 Mar 25.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Medical treatment for subfertility principally involves the use of ovary-stimulating agents, including selective oestrogen receptor modulators (SERMs), such as clomiphene citrate, gonadotropins, gonadotropin-releasing hormone (GnRH) agonists and antagonists, as well as human chorionic gonadotropin. Ovary-stimulating drugs may act directly or indirectly upon the endometrium (lining of the womb). Nulliparity and some causes of subfertility are recognized as risk factors for endometrial cancer. OBJECTIVES: To evaluate the association between the use of ovary-stimulating drugs for the treatment of subfertility and the risk of endometrial cancer. SEARCH METHODS: A search was performed in CENTRAL, MEDLINE (Ovid) and Embase (Ovid) databases up to July 2016, using a predefined search algorithm. A search in OpenGrey, ProQuest, ClinicalTrials.gov, ZETOC and reports of major conferences was also performed. We did not impose language and publication status restrictions. SELECTION CRITERIA: Cohort and case-control studies reporting on the association between endometrial cancer and exposure to ovary-stimulating drugs for subfertility in adult women were deemed eligible. DATA COLLECTION AND ANALYSIS: Study characteristics and findings were extracted by review authors independently working in pairs. Inconsistency between studies was quantified by estimating I . Random-effects (RE) models were used to calculate pooled effect estimates. Separate analyses were performed, comparing treated subfertile women versus general population and/or unexposed subfertile women, to address the superimposition of subfertility as an independent risk factor for endometrial cancer. MAIN RESULTS: Nineteen studies were eligible for inclusion (1,937,880 participants). Overall, the quality of evidence was very low, due to serious risk of bias and indirectness (non-randomised studies (NRS), which was reflected on the GRADE assessment.Six eligible studies, including subfertile women, without a general population control group, found that exposure to any ovary-stimulating drug was not associated with an increased risk of endometrial cancer (RR 0.96, 95% CI 0.67 to 1.37; 156,774 participants; very low quality evidence). Fifteen eligible studies, using a general population as the control group, found an increased risk after exposure to any ovary-stimulating drug (RR 1.75, 95% CI 1.18 to 2.61; 1,762,829 participants; very low quality evidence).Five eligible studies, confined to subfertile women (92,849 participants), reported on exposure to clomiphene citrate; the pooled studies indicated a positive association ( RR 1.32; 95% CI 1.01 to 1.71; 88,618 participants; very low quality evidence), although only at high dosage (RR 1.69, 95% CI 1.07 to 2.68; two studies; 12,073 participants) and at a high number of cycles (RR 1.69, 95% CI 1.16 to 2.47; three studies; 13,757 participants). Four studies found an increased risk of endometrial cancer in subfertile women who required clomiphene citrate compared to a general population control group (RR 1.87, 95% CI 1.00 to 3.48; four studies, 19,614 participants; very low quality evidence). These data do not tell us whether the association is due to the underlying conditions requiring clomiphene or the treatment itself.Using unexposed subfertile women as controls, exposure to gonadotropins was associated with an increased risk of endometrial cancer (RR 1.55, 95% CI 1.03 to 2.34; four studies; 17,769 participants; very low quality evidence). The respective analysis of two studies (1595 participants) versus the general population found no difference in risk (RR 2.12, 95% CI 0.79 to 5.64: very low quality evidence).Exposure to a combination of clomiphene citrate and gonadotropins, compared to unexposed subfertile women, produced no difference in risk of endometrial cancer (RR 1.18, 95% CI 0.57 to 2.44; two studies; 6345 participants; very low quality evidence). However, when compared to the general population, an increased risk was found , suggesting that the key factor might be subfertility, rather than treatment (RR 2.99, 95% CI 1.53 to 5.86; three studies; 7789 participants; very low quality evidence). AUTHORS' CONCLUSIONS: The synthesis of the currently available evidence does not allow us to draw robust conclusions, due to the very low quality of evidence. It seems that exposure to clomiphene citrate as an ovary-stimulating drug in subfertile women is associated with increased risk of endometrial cancer, especially at doses greater than 2000 mg and high (more than 7) number of cycles. This may largely be due to underlying risk factors in women who need treatment with clomiphene citrate, such as polycystic ovary syndrome, rather than exposure to the drug itself. The evidence regarding exposure to gonadotropins was inconclusive.
[Mh] Termos MeSH primário: Clomifeno/efeitos adversos
Neoplasias do Endométrio/induzido quimicamente
Fármacos para a Fertilidade Feminina/efeitos adversos
Gonadotropinas/efeitos adversos
Infertilidade Feminina/tratamento farmacológico
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Gonadotropina Coriônica/administração & dosagem
Gonadotropina Coriônica/efeitos adversos
Clomifeno/administração & dosagem
Quimioterapia Combinada/efeitos adversos
Neoplasias do Endométrio/epidemiologia
Feminino
Fármacos para a Fertilidade Feminina/administração & dosagem
Hormônio Liberador de Gonadotropina/administração & dosagem
Hormônio Liberador de Gonadotropina/efeitos adversos
Seres Humanos
Infertilidade Feminina/complicações
Indução da Ovulação
Estudos Retrospectivos
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Chorionic Gonadotropin); 0 (Fertility Agents, Female); 0 (Gonadotropins); 1HRS458QU2 (Clomiphene); 33515-09-2 (Gonadotropin-Releasing Hormone)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170720
[Lr] Data última revisão:
170720
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170329
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010931.pub2


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[PMID]:28228316
[Au] Autor:Bar Hava I; Blueshtein M; Ganer Herman H; Omer Y; Ben David G
[Ad] Endereço:The Fertility Center from A to Z, Assuta Medical Centre, Ramat Aviv, Tel-Aviv, Israel.
[Ti] Título:Gonadotropin-releasing hormone analogue as sole luteal support in antagonist-based assisted reproductive technology cycles.
[So] Source:Fertil Steril;107(1):130-135.e1, 2017 Jan.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the efficacy of GnRH agonists (GnRH-a) as sole luteal phase support in patients undergoing IVF in antagonist-based cycles compared with standard vaginal P preparations. DESIGN: Retrospective cohort. SETTING: Private fertility clinic. PATIENT(S): Patients who underwent antagonist-based cycles performed at our clinic between 2009 and 2015. INTERVENTION(S): Intranasal GnRH-a or vaginal P as luteal support. MAIN OUTCOME MEASURE(S): Live birth rates. RESULT(S): A total of 2,529 antagonist-based cycles from 1,479 women were available for analysis, in which GnRH-a were used in 1,436 cycles (56.7%) and P supplementation in 1,093 cycles (43.2%). Significantly higher live birth rates were demonstrated for the entire GnRH-a group compared with the P group. This result was even more prominent when women older than 35 years were considered separately. Furthermore, after adjustment for age, body mass index (BMI), past obstetric history, number of IVF cycles, oocyte retrieved and embryos transferred, GnRH-a was still associated with a higher rate of live birth (odds ratio 1.46, 95% confidence interval 1.10-1.94). Once a positive ß-hCG was achieved, chemical pregnancy rates (PRs) and miscarriage rates were not statistically different between the GnRH-a and the P supplementation group, and GnRH-a was associated with a higher rate of live births (odds ratio 1.59, 95% confidence interval 1.07-2.36). CONCLUSION(S): This large retrospective study suggests that repeated intranasal GnRH-a for luteal phase support is associated with a higher live birth rate compared with standard P supplementations.
[Mh] Termos MeSH primário: Fármacos para a Fertilidade Feminina/administração & dosagem
Fertilização In Vitro
Hormônio Liberador de Gonadotropina/administração & dosagem
Infertilidade/terapia
Fase Luteal/efeitos dos fármacos
Progesterona/administração & dosagem
[Mh] Termos MeSH secundário: Administração Intranasal
Administração Intravaginal
Adulto
Distribuição de Qui-Quadrado
Feminino
Fertilidade/efeitos dos fármacos
Fármacos para a Fertilidade Feminina/efeitos adversos
Fertilização In Vitro/efeitos adversos
Hormônio Liberador de Gonadotropina/efeitos adversos
Hormônio Liberador de Gonadotropina/análise
Seres Humanos
Infertilidade/diagnóstico
Infertilidade/fisiopatologia
Nascimento Vivo
Modelos Logísticos
Meia-Idade
Análise Multivariada
Razão de Chances
Gravidez
Taxa de Gravidez
Progesterona/efeitos adversos
Estudos Retrospectivos
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fertility Agents, Female); 33515-09-2 (Gonadotropin-Releasing Hormone); 4G7DS2Q64Y (Progesterone)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170224
[St] Status:MEDLINE


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[PMID]:28215488
[Au] Autor:Dosouto C; Haahr T; Humaidan P
[Ad] Endereço:The Fertility Clinic Skive Regional Hospital, Skive, Denmark; Hospital Universitario Dexeus, Barcelona, Spain. Electronic address: cardos@dexeus.com.
[Ti] Título:Gonadotropin-releasing hormone agonist (GnRHa) trigger - State of the art.
[So] Source:Reprod Biol;17(1):1-8, 2017 Mar.
[Is] ISSN:2300-732X
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:GnRH agonist (GnRHa) trigger for final oocyte maturation in GnRH antagonist co-treated IVF/ICSI cycles significantly reduces the risk of ovarian hyperstimulation syndrome (OHSS). GnRHa trigger followed by modifications of the standard luteal phase support (modified luteal phase support) secures fresh transfer in the majority of patients with excellent reproductive outcomes. In freeze all cycles (segmented cycles) GnRHa trigger allows oocyte retrieval with a minimal risk of early onset OHSS and good reproductive outcomes in subsequent frozen thaw cycles. Overall, two different luteal phase support strategies have been proposed when a fresh transfer is performed after GnRHa trigger. These involve either boosting the endogenous steroid production or adding exogenous steroids. The present review discusses the advancement of GnRHa trigger in fresh and segmented cycles and how a modified luteal phase support policy in fresh transfer cycles results in good reproductive outcomes as well as a high safety in terms of OHSS reduction. Finally, the new concept of an individualized luteal phase support policy taking the number of pre-ovulatory follicles into account when planning a fresh transfer in GnRHa triggered IVF/ICSI cycle is discussed.
[Mh] Termos MeSH primário: Manutenção do Corpo Lúteo/efeitos dos fármacos
Fármacos para a Fertilidade Feminina/uso terapêutico
Hormônio Liberador de Gonadotropina/agonistas
Síndrome de Hiperestimulação Ovariana/prevenção & controle
Medicina de Precisão
Receptores LHRH/agonistas
Transdução de Sinais/efeitos dos fármacos
[Mh] Termos MeSH secundário: Animais
Feminino
Fármacos para a Fertilidade Feminina/efeitos adversos
Fertilização In Vitro
Hormônio Liberador de Gonadotropina/antagonistas & inibidores
Hormônio Liberador de Gonadotropina/metabolismo
Seres Humanos
Técnicas de Maturação in Vitro de Oócitos
Infertilidade Feminina/terapia
Nascimento Vivo
Recuperação de Oócitos/efeitos adversos
Síndrome de Hiperestimulação Ovariana/epidemiologia
Reserva Ovariana/efeitos dos fármacos
Indução da Ovulação/efeitos adversos
Gravidez
Taxa de Gravidez
Receptores LHRH/antagonistas & inibidores
Receptores LHRH/metabolismo
Risco
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Fertility Agents, Female); 0 (GNRHR protein, human); 0 (Receptors, LHRH); 33515-09-2 (Gonadotropin-Releasing Hormone)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170221
[St] Status:MEDLINE


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[PMID]:28173995
[Au] Autor:Olgan S; Humaidan P
[Ad] Endereço:Division of Reproductive Endocrinology and IVF Unit, Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, 07059 Antalya, Turkey. Electronic address: safakolgan@gmail.com.
[Ti] Título:GnRH antagonist and letrozole co-treatment in diminished ovarian reserve patients: a proof-of-concept study.
[So] Source:Reprod Biol;17(1):105-110, 2017 Mar.
[Is] ISSN:2300-732X
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:The current study aimed to investigate the effects of luteal gonadotropin-releasing hormone (GnRH) antagonist pretreatment on the outcomes of diminished ovarian reserve (DOR) patients who were treated using a FSH/letrozole/GnRH antagonist (FLA) protocol. Thus, patients who had luteal GnRH antagonist pretreatment (AFLA) prior to stimulation were compared to patients who had the FLA protocol, only. An electronic database was used to identify patients and stimulation characteristics. Women who had a total antral follicle count (AFC) of <7 were included in the analysis. A total of 45 cycles using luteal GnRH antagonist pretreatment in combination with a letrozole/GnRH antagonist (AFLA) protocol were compared to 76 cycles using a FLA protocol, only. The total gonadotropin dose, duration of stimulation, and peak estradiol levels were comparable between the groups (p>0.05). However, the AFLA group had significantly more metaphase-2 (MII) oocytes (p=0.009), a higher oocyte maturity rate (MII/total oocytes) (p=0.029), and a higher mature oocyte yield (MII/AFC) (p=0.020) with more cleaved embryos (p=0.036), and a significantly reduced number of canceled cycles (26.7% vs. 44.7%; p=0.048). The clinical pregnancy rate per cycle was 22.2% vs. 13.2% (p=0.195) in the AFLA and FLA groups, respectively. Interestingly, a subgroup analysis including ESHRE Bologna criteria poor responder patients showed that the luteal administration of GnRH antagonist resulted in better outcomes when compared with the FLA protocol alone. In conclusion, luteal GnRH antagonist pretreatment improves ovarian stimulation parameters and reproductive outcomes in poor ovarian reserve IVF patients.
[Mh] Termos MeSH primário: Inibidores da Aromatase/uso terapêutico
Fármacos para a Fertilidade Feminina/uso terapêutico
Hormônio Liberador de Gonadotropina/antagonistas & inibidores
Nitrilos/uso terapêutico
Folículo Ovariano/efeitos dos fármacos
Indução da Ovulação/métodos
Insuficiência Ovariana Primária/tratamento farmacológico
Triazóis/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Quimioterapia Combinada
Estradiol/sangue
Estradiol/secreção
Feminino
Fertilização In Vitro
Hormônio Foliculoestimulante Humano/uso terapêutico
Seres Humanos
Infertilidade Feminina/etiologia
Infertilidade Feminina/terapia
Fase Luteal
Oogênese/efeitos dos fármacos
Folículo Ovariano/citologia
Folículo Ovariano/secreção
Reserva Ovariana
Gravidez
Taxa de Gravidez
Insuficiência Ovariana Primária/fisiopatologia
Proteínas Recombinantes/uso terapêutico
Estudos Retrospectivos
Turquia/epidemiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Aromatase Inhibitors); 0 (Fertility Agents, Female); 0 (Follicle Stimulating Hormone, Human); 0 (Nitriles); 0 (Recombinant Proteins); 0 (Triazoles); 0 (follitropin alfa); 33515-09-2 (Gonadotropin-Releasing Hormone); 4TI98Z838E (Estradiol); 7LKK855W8I (letrozole)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170209
[St] Status:MEDLINE



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