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Jayaprakasan K.,University of Nottingham | Jayaprakasan K.,Fertility Unit | Chan Y.,University of Nottingham | Islam R.,University of Nottingham | And 4 more authors.
Fertility and Sterility | Year: 2012

Objective: To estimate the probability of live birth, adverse treatment outcome, and extremes of ovarian response at different antral follicle count (AFC) cutoff levels in a large prospective cohort of women undergoing IVF treatment. Design: Prospective study. Setting: University-based assisted conception unit. Patient(s): A total of 1,012 consecutive subjects of all ages undergoing their first cycle of assisted reproductive techniques. Intervention(s): Transvaginal three-dimensional ultrasound assessment and venipuncture in the early follicular phase of the menstrual cycle. Main Outcome Measure(s): Live birth rate, poor ovarian response, and ovarian hyperstimulation syndrome (OHSS). Result(s): Analysis was performed in 1,012 subjects. Both age (r = 0.88) and AFC (r = 0.92) thresholds show significant linear relationship with the probability of live birth, but AFC demonstrates a stronger correlation. At AFC quartiles of 3-10, 11-15, 16-22, and ≥23, the mean live birth rates were 23%, 34%, 39%, and 44%, respectively. No live birth was observed in women with AFC <4. Antral follicle count was predictive of ovarian response, with a 67% likelihood of poor ovarian response for AFC ≤4. Although the risk of moderate or severe OHSS is 2.2% with AFC of ≤24, the risk increases to 8.6% at AFC of ≥24. The risk of OHSS increases further to 11% if there are signs and symptoms of polycystic ovary syndrome. Conclusion(s): Although age and AFC are significantly correlated with live birth, AFC demonstrates a stronger correlation. Antral follicle count thresholds are useful to predict live birth rates and risks of poor ovarian response and OHSS during IVF treatment. © 2012 by American Society for Reproductive Medicine. Source

Ferrero S.,Academic Unit of Obstetrics and Gynecology | Ferrero S.,University of Genoa | Racca A.,Academic Unit of Obstetrics and Gynecology | Racca A.,University of Genoa | And 7 more authors.
Journal of Minimally Invasive Gynecology | Year: 2016

Study Objective: To evaluate the efficacy of preoperative treatment with ulipristal acetate (UPA) in patients undergoing high complexity hysteroscopic myomectomy. Design: Retrospective analysis of a prospectively collected database (Canadian Task Force classification II-2). Setting: University teaching hospital. Patients: Patients of reproductive age requiring hysteroscopic myomectomy with STEPW (size, topography, extension, penetration, and wall) score 5 or 6. Interventions: Patients included in the study either underwent direct surgery (group S) or received a 3-month preoperative treatment with UPA (group UPA). Based on a power calculation, 25 patients were required in each study group. Measurements and Main Results: Myoma characteristics were similar in the 2 study groups. The 3-month UPA treatment caused a 21.9% (±10.3%) mean (±SD) percentage decrease in myoma volume. The number of complete resections (primary outcome of the study) was higher in group UPA (92.0%) than in group S (68.0%; p =034). The operative time was lower in group UPA than in group S (p =048), whereas there was no significant difference in fluid balance between the 2 study groups (p =256). The incidence of complications was similar in the 2 groups (p =609). Patient satisfaction at 3 months from surgery was higher in group UPA than in group S (p =041). Conclusion: A 3-month preoperative treatment with UPA increases the possibility of complete resection in high complexity hysteroscopic myomectomy. It decreases the operative time and improves patient satisfaction at 3 months from surgery. © 2016 AAGL. Source

Akesson E.,Academic Unit of Obstetrics and Gynecology | Gallos I.D.,Academic Unit of Obstetrics and Gynecology | Ganesan R.,Birmingham Womens Hospital | Varma R.,Guys and St Thomas NHS Foundation Trust | Gupta J.K.,Academic Unit of Obstetrics and Gynecology
Acta Obstetricia et Gynecologica Scandinavica | Year: 2010

We performed immunohistochemical analysis of estrogen (ERα) and progesterone receptors (PRA and PRB), phosphatase and tensin homolog (PTEN) and aromatase in endometrial hyperplasia treated with Mirena® (levonorgestrel-releasing intrauterine system; LNG-IUS) and explored their prognostic significance. The baseline pre-treatment endometrial hyperplasia of a selected prospective cohort was analyzed [complex (n = 29) and atypical (n = 5)]. Study participants were categorized into those that showed endometrial regression (responders, n = 28) and those that showed non-regression or histological progression to atypia or malignancy (non-responders, n = 6). Immunohistochemical expression was expressed as a histological score (HS). Responders compared to non-responders showed significantly higher HSs for estrogen and progesterone receptors. Absence of estrogen and progesterone receptors predicted non-responder status with likelihood ratios of 9.33 (95% CI 2.19-39.81) and 2.92 (95% CI 1.47-5.79), respectively. Neither PTEN nor aromatase expression were associated with LNG-IUS therapy responsiveness. Responsiveness of endometrial hyperplasia to LNG-IUS therapy may be determined through analysis of baseline estrogen and progesterone receptors, but these exploratory findings require confirmation in a larger dataset. Source

Bizzarri N.,Academic Unit of Obstetrics and Gynecology | Bizzarri N.,University of Genoa | Ghirardi V.,Academic Unit of Obstetrics and Gynecology | Ghirardi V.,University of Genoa | And 10 more authors.
Expert Opinion on Biological Therapy | Year: 2016

Introduction: Cervical cancer is still a major cause of morbidity and mortality in women. Early stages and locally advanced cervical cancer are currently treated respectively with surgery and chemoradiation with good prognosis. Persistent, recurrent and metastatic cervical cancers have a poor prognosis. Angiogenesis has been identified as a crucial factor for cervical cancer growth. Recently, research has increasingly focused on the development of targeted therapies, such as anti-angiogenic drugs. Amongst such drugs, bevacizumab, a recombinant humanized monoclonal antibody has been the subject of extensive investigation, including its use in cervical cancer. This was recently approved for the treatment of patients with metastatic, recurrent, or persistent cervical cancer.Areas covered: The aim of this review is to discuss the role of bevacizumab in both locally advanced and metastatic or recurrent cervical cancer and to analyze the studies that have led to the approval of bevacizumab in cervical cancer.Expert opinion: The use of bevacizumab in combination with other chemotherapies in cervical cancer has been proven safe and effective, with a significant improvement in overall survival of patients with advanced cervical cancer. Combination therapy using bevacizumab has been demonstrated to increase toxicity rates but it does not impair patients quality of life. © 2016 Taylor & Francis. Source

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