Fertility drugs and the risk of breast cancer.
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Several studies have investigated the possible relationship between fertility drugs and the risk of breast cancer. To provide further information on this issue, we analysed data from a case control study, conducted in Northern Italy between 1983 and 1991. Trained interviewers identified and questioned 3415 cases (women aged 23-74 years with histologically confirmed breast cancer) and 2916 controls (women aged 21-74 years admitted to the same hospitals for diseases other than malignant, hormonal or gynaecological conditions). Fifty (1.5%) cases and 53 (1.8%) controls reported any history of infertility; the corresponding multivariate odds ratios (OR) of breast cancer was 0.8 [95% confidence interval (CI) 0.5-1.1]. Sixteen (0.5%) cases and 11 (0.4%) controls reported ever using fertility drugs; the corresponding OR was 1.2 (95% CI 0.5-2.6). Allowance for potential confounding factors did not markedly modify these estimates. In conclusion, this study provides reassuring evidence on the absence of an association between fertility drug treatment and breast cancer risk. (+info)
Hormone and fertility drug use and the risk of neuroblastoma: a report from the Children's Cancer Group and the Pediatric Oncology Group.
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Previous epidemiologic studies have suggested an association between maternal sex hormone use during pregnancy, including infertility medication, and an increased risk of neuroblastoma in the offspring. The authors conducted a case-control interview study from 1992 to 1996 that included 504 children less than 19 years of age whose newly diagnosed neuroblastoma was identified by two national collaborative clinical trials groups in the United States and Canada, the Children's Cancer Group and the Pediatric Oncology Group. Controls, matched to cases on age, were identified by random digit dialing. No association was found for use of oral contraceptives before or during pregnancy (first trimester odds ratio (OR) = 1.0, 95% confidence interval (CI): 0.5, 2.1). The odds ratio was slightly elevated for history of infertility (OR = 1.4, 95% CI: 0.9, 2.1) and ever use of any infertility medication (OR = 1.2, 95% CI: 0.7, 2.2). Specifically, ever use of clomiphene was associated with a 1.6-fold increased risk (95% CI: 0.8, 3.0) but not periconceptionally or during the index pregnancy. A suggestive pattern was found for gender of the offspring, with an increased risk for males but not for females after exposure to oral contraceptives or clomiphene. This study did not find consistent and large increased risks for maternal use of hormones, but the suggestion of an association for male offspring requires further consideration. (+info)
Use of fertility drugs and risk of ovarian cancer.
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BACKGROUND: The potential association between fertility drugs and risk of ovarian cancer has been analysed using data from a case-control study conducted between January 1992 and September 1999 in four Italian areas. METHODS: Cases were 1031 women (median age 56, range 18-79 years) with incident, histologically confirmed epithelial ovarian cancer. Controls were 2411 women (median age 57, range 17-79 years) residing in the same geographical areas and admitted to the same network of hospitals for cases for a wide spectrum of acute, non neoplastic, non hormone-related conditions. RESULTS: A total of 15 cases and 26 controls reported use of fertility drugs. The corresponding odds ratio (OR) was 1.3 (95% confidence interval 0.7-2.5). The OR was 1.2 for women reporting last use <25 years before interview and 1.3 for >25 years. CONCLUSIONS: Considering calendar year at use, the OR was non-significantly above unity for women reporting fertility drug use after 1970. The OR was 0.6 among nulliparous women and 1.9 among parous ones. (+info)
Clinics in diagnostic imaging (106). Viable left tubal twin ectopic pregnancy.
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Live twin ectopic gestations are extremely rare. There are more than 100 reported twin tubal pregnancies but less than ten have foetal cardiac motions demonstrated in both embryos. We describe an additional patient with live twin ectopic gestation. A 32-year-old woman presented with increasing left-sided abdominal pains. She had a high beta-hCG level and a significant history of subfertility with previous surgical intervention. Transvaginal ultrasonography showed viable left tubal twin ectopic pregnancy. The diagnosis was confirmed at surgery. Factors that contribute to the risk of ectopic pregnancy, diagnosis and the management of this condition are described. (+info)
Uterine effects of metformin administration in anovulatory women with polycystic ovary syndrome.
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BACKGROUND: Metformin has been shown to improve fertility in anovulatory patients with polycystic ovary syndrome (PCOS), inducing not only a high ovulation and pregnancy rate but also reducing the incidence of miscarriages. The aim of the present study was to evaluate the uterine effects of metformin in patients with PCOS who ovulated under metformin. METHODS: Thirty-seven non-obese primary infertile anovulatory patients with PCOS and another 30 age- and body mass index-matched healthy women (control group) were studied. PCOS patients were treated with metformin (850 mg twice daily) for 6 months, whereas the control group did not receive any treatment. In these PCOS patients who ovulated whilst under metformin treatment (PCOS group) and in controls, uterine, sub-endometrial and endometrial blood flow, and endometrial thickness and pattern were evaluated using serial ultrasonographic assessments. RESULTS: Before treatment, uterine, sub-endometrial and endometrial blood flows were significantly lower in patients with PCOS than in the control group. All indexes of uterine vascularization were significantly improved in the PCOS group with metformin treatment and were not different from the controls. Nor was any difference in endometrial thickness and pattern detected between PCOS and control groups. After grouping the data of PCOS patients who ovulated under metformin for cycles with favourable/unfavourable reproductive outcome, no difference in any parameter was observed. CONCLUSIONS: Metformin improves all surrogate markers of endometrial receptivity in PCOS patients, without difference between patients who had favourable or unfavourable reproductive outcome. (+info)
Estrous behavior and initiation of estrous cycles in postpartum Brahman-influenced cows after treatment with progesterone and prostaglandin F2alpha.
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Spring-calving, crossbred (1/4 to 3/8 Brahman) primiparous (n = 56) and multiparous (n = 102) beef cows were used to evaluate the effects of progesterone, delivered via a controlled internal drug-releasing (CIDR) device, and prostaglandin F(2alpha) (PGF(2alpha)) on estrous behavior, synchronization rate, initiation of estrous cycles, and pregnancy rate during a 2-yr period. To determine luteal activity, weekly blood samples were collected 3 wk before initiation of a 75-d breeding season. Treated cows received a CIDR for 7 d beginning on d -7 of the breeding season. On d 0, CIDR were removed, and cows receiving CIDR were administered PGF(2alpha); control cows received no treatment. Cows were exposed to bulls, and estrous activity was monitored using a radiotelemetry system for the first 30 d of the breeding season. Treatment with CIDR-PGF(2alpha) increased (P < 0.05) the number of mounts received (22.5 +/- 3.0 vs. 13.7 +/- 3.9 for CIDR-PGF(2alpha) vs. untreated control cows, respectively) but did not influence duration of estrus or quiescence between mounts. Number of mounts received and duration of estrus were greater (P < 0.05) in multiparous compared with primiparous cows. Synchronization of estrus was greater (P < 0.05) in cows treated with CIDR-PGF(2alpha) (56%) compared with control cows (13%) during the first 3 d of the breeding season. More (P < 0.05) anestrous cows treated with CIDR-PGF(2alpha) than anestrous control cows were in estrus during the first 3 d (59 vs. 12%) and 30 d (82 vs. 63%) of the breeding season. Treatment with CIDR-PGF(2alpha) decreased (P < 0.05) the interval to first estrus after treatment during the first 30 d of the breeding season compared with control cows (5.5 +/- 1.1 vs. 9.0 +/- 1.4 d). First service conception rate was greater (P < 0.05) in CIDR-PGF(2alpha)-treated cows compared with control cows. Cyclic cows at initiation of the breeding season had an increased (P < 0.05) 75-d pregnancy rate compared with anestrous cows, and the pregnancy rate tended (P = 0.10) to be greater in multiparous compared with primiparous cows. We conclude that treatment of Brahman-influenced cows with progesterone via a CIDR for 7 d, along with administration of PGF(2alpha) at CIDR removal, increases the number of mounts received, improves synchronization and first service conception rates, decreases the interval to first estrus after treatment, and may be effective at inducing estrous cycles in anestrous cows. (+info)
Among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth dependent on the type of analogue used? A systematic review and meta-analysis.
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This systematic review and meta-analysis aimed to answer the following clinical question: among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth per randomized patient dependent on the type of analogue used? Eligible studies were randomized controlled trials (RCTs), published as a full manuscript in a peer-reviewed journal, that contained sufficient information to allow ascertainment of whether randomization was true and whether equality was present between the groups compared. A literature search identified 22 RCTs comparing GnRH antagonists and GnRH agonists that involved 3176 subjects. Where live birth was not reported in a study that fulfilled the inclusion criteria, an effort was made to contact the corresponding authors to retrieve the missing information. If this was not possible, the reported outcome measure, clinical pregnancy or ongoing pregnancy was converted to live birth in 12 studies using published data (Arce et al., 2005). No significant difference was present in the probability of live birth between the two GnRH analogues [odds ratio (OR), 0.86; 95% confidence intervals (CI), 0.72 to 1.02]. This result remains stable in subgroup analysis that ordered the studies by type of population studied, gonadotrophin type used for stimulation, type of agonist protocol used, type of agonist used, type of antagonist protocol used, type of antagonist used, presence of allocation concealment, presence of co-intervention and the way the information on live birth was retrieved. In conclusion, the probability of live birth after ovarian stimulation for IVF does not depend on the type of analogue used for pituitary suppression. (+info)
Conception rates to artificial insemination in primiparous, suckled cows exposed to the biostimulatory effect of bulls before and during a gonadotropin-releasing hormone-based estrus synchronization protocol.
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The objective of these studies was to evaluate whether exposing primiparous, suckled beef cows to the biostimulatory effect of bulls alters breeding performance associated with an estrus synchronization protocol that included GnRH followed 7 d later by PGF(2alpha) and fixed-time AI (TAI). This was a composite analysis of 3 experiments that evaluated (1) the effects of bull exposure at different days after calving (yr 1); (2) the biostimulatory effects of bull excretory products (yr 2); and (3) the biostimulatory effects of familiar and unfamiliar bulls (yr 3) on the resumption of ovarian cycling activity. In all studies, cows were exposed (biostimulated; n = 94) or not exposed (nonbiostimulated; n = 67) to bulls or excretory products of bulls for at least 60 d before the beginning of the estrus synchronization protocol. Average calving day did not differ among years and was 52 +/- 5 d. Year did not affect the proportions of biostimulated and nonbiostimulated cows that were cycling at the beginning of the estrus synchronization protocol; however, a greater (P < 0.001) proportion of biostimulated than nonbiostimulated cows were cycling at this time. In each year, cows were given GnRH followed by PGF(2alpha) 7 d later. Cows were observed for estrus twice daily (am and pm) after PGF(2alpha). Cows that exhibited estrus before 54, 60, and 64 h after PGF(2alpha) were inseminated by AI 12 h later in yr 1, 2, and 3, respectively. Cows that failed to show estrus were given GnRH and TAI at 62, 72, and 72 h after PGF(2alpha) in yr 1, 2, and 3, respectively. Conception rates were determined by transrectal ultrasonography 35 d after TAI in each year. The percentages of cows that exhibited estrus after PGF(2alpha) and before TAI, the interval from PGF(2alpha) to estrus, and the percentages of cows inseminated 12 h after estrus or at TAI did not differ between biostimulated and nonbiostimulated cows and were 51%, 54.7 +/- 7.3 h, 35%, and 65%, respectively. Conception rates for cows bred by AI 12 h after estrus did not differ between biostimulated and nonbiostimulated cows; however, the TAI conception rate was greater (P < 0.05) for biostimulated cows (57.6%) than for nonbiostimulated cows (35.6%). We conclude that TAI conception rates in an estrus synchronization protocol that includes GnRH followed 7 d later by PGF(2alpha) may be improved by the biostimulatory effect of bulls in postpartum, primiparous cows. (+info)