Population differences and the effect of vaginal progesterone on preterm birth in women with threatened preterm labor (.).

OBJECTIVE: Threatened preterm labor (tPTL) is a complication of pregnancy. Identification of women and clinical definition differs between countries. This study investigated differences in tPTL and effectiveness of vaginal progesterone to prevent preterm birth (PTB) between two countries. METHODS: Secondary analysis of a randomized controlled trial (RCT) from Argentina and Switzerland comparing vaginal progesterone to placebo in women with tPTL (n = 379). Cox proportional hazards analysis was performed to compare placebo groups of both countries and to compare progesterone to placebo within each country. We adjusted for baseline differences. Iatrogenic onset of labor or pregnancy beyond gestational age of interest was censored. RESULTS: Swiss and Argentinian women were different on baseline. Risks for delivery <14 days and PTB < 34 and < 37 weeks were increased in Argentina compared to Switzerland, HR 3.3 (95% CI 0.62-18), 54 (95% CI 5.1-569) and 3.1 (95% CI 1.1-8.4). In Switzerland, progesterone increased the risk for delivery <14 days [HR 4.4 (95% CI 1.3-15.7)] and PTB <37 weeks [HR 2.5 (95% CI 1.4-4.8)], in Argentina there was no such effect. CONCLUSION: In women with tPTL, the effect of progesterone may vary due to population differences. Differences in populations should be considered in multicenter RCTs.

Recreational use of phosphodiesterase type 5 inhibitors by healthy young men.

INTRODUCTION: In recent years, PDE5 inhibitors (PDE5i) use has become more popular among men without ED to enhance sexual performance. However, reports in the literature are scarce. AIM: The aim of this study was to evaluate the recreational use of PDE5i in healthy young men. MAIN OUTCOME MEASURES: We evaluated the recreational use of PDE5i among young and healthy men, their main reasons for use, how they were obtained these drugs, and the combination with alcohol or other drugs. METHODS: Descriptive, transversal study consisting in 400 brief surveys with structured multiple choice and open questions. Nonprobability samples (quota samples) included young men between 18 and 30 years of age in a public area (high schools, universities, and gyms) between August and November 2009. Collecting the questionnaires in a sealed box enforced confidentiality. The survey included demographic and sexual health data and PDE5i use characteristics. For statistical analysis we used Fisher's exact and Mann-Whitney tests. RESULTS: A total of 321 questionnaires were appropriate for the purposes of evaluation. Mean age and standard deviation were 25.1±3.3 years old. Regarding PDE5i use, 69 men (21.5%) mentioned trying the pill (being sildenafil the most commonly used one) at least one time in their lives and 37 (53.4%) men combined it with alcohol or drugs. Referred sources of acquisition PDE5i were 75.4% (N=52) from a friend, 17.4% (N=15) from a pharmacy/drugstore without a medical prescription, 4.3% (N=3) prescribed by a physician and 2.9% (N=2) through Internet. There were several reasons for taking PDE5i related to sexual confidence, erection quality, and better sexual performance. CONCLUSION: According to our results, 21.5% of healthy men between 18 and 30 years old used PDE5i as a recreational drug, mostly associated with alcohol or other drugs without medical control. This could have led to misuse and a public health problem. Further studies are needed to evaluate not only PDE5i recreational use prevalence, but also psychosocial determinants, long term safety, misuse, and abuse related to it.

A double-blind randomized placebo control study comparing the objective and subjective changes in female sexual response using sublingual apomorphine.

INTRODUCTION: Female sexual dysfunction and its therapeutic approach is a growing area. AIM: We aimed to assess the subjective and objective changes of the female sexual response, in patients with orgasmic sexual dysfunction using 3 mg SL Apomorphine (APO). METHODS: Twenty-four patients (mean age 32 years old, SD: 9.69) were included in a prospective randomized cross-over protocol. Sexual response was evaluated objectively (duplex ultrasound) and subjectively (self-reported questionnaire) following vibrator stimuli with the addition of 3 mg SL APO or placebo. MAIN OUTCOME MEASURE: Sexual response objective (PSV, EDV, RI) and subjective (arousal and lubrication degree and orgasm achievement). Adverse events were also recorded. RESULTS: Clitoral hemodynamical changes, particularly peak systolic velocity (PSV), were significantly higher with APO (P = 0.003), mean increase of PSV poststimulus was 72.50% with placebo (from 9.7 cm/second to 17.0 cm/second) and 139.14% with APO (from 9.7 cm/second to 21.4 cm/second). SUBJECTIVE CHANGES (AROUSAL AND LUBRICATION) WERE ALSO SIGNIFICATIVE WITH APO (P < 0.05). CONCLUSION: According to our observations, APO seemed to produce more subjective and objective changes in the sexual arousal phase of women with orgasmic sexual dysfunction than placebo. Future research is needed to evaluate the place of this drug in the treatment of the female sexual dysfunction.

Birth of a healthy baby after transfer of embryos that were cryopreserved for 8.9 years.

OBJECTIVE: To report successful pregnancy from embryos that had been cryopreserved for 8.9 years. DESIGN: Case report. SETTING: Fertility clinic of the University of Buenos Aires School of Medicine. PATIENT(S): A 43-year-old woman with ovarian failure and a 45-year-old man with nonobstructive azoospermia underwent embryo donation.I NTERVENTION(S): Five embryos that had been cryopreserved and stored since 1989 were thawed in 1998 and donated to an infertile couple. Endometrial preparation was performed with 17beta-estradiol and progesterone. The four embryos with better morphologic characteristics were transferred into the uterus. MAIN OUTCOME MEASURE(S): Post-thaw embryo survival, pregnancy, and birth. RESULT(S): Embryo survival was satisfactory as assessed by morphology. Pregnancy was confirmed by ultrasonography. A healthy baby weighing 2120 g was delivered by cesarean section at 36 weeks. CONCLUSION(S): Human 8-cell embryos may be viable after extended storage and can result in successful pregnancy.