Is aspirin effective in women undergoing in vitro fertilization (IVF)? Results from an individual patient data meta-analysis (IPD MA).

BACKGROUND: Aspirin is believed to improve the outcome of IVF, but previous conventional meta-analyses on the subject are conflicting. Therefore, we performed a meta-analysis with individual patient data (IPD MA) of randomized clinical trials (RCTs) on the subject. METHODS: A systematic literature search was conducted to identify RCTs assessing the effectiveness of aspirin in IVF. Authors were asked to share their original data. In a one step meta-analytic approach, the treatment effect of aspirin was estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression, based on the intention to treat principle. RESULTS: Ten studies fulfilled the inclusion criteria. Authors of six studies provided IPD, including 1119 patients (562 placebo and 557 aspirin). There were 160 clinical pregnancies in the aspirin (28.8%) and 179 (31.9%) in the placebo group [OR 0.86, 95% CI (0.69-1.1)]. There were 129 ongoing pregnancies in the aspirin (23.6%) and 147 in the placebo group (26.7%) [OR 0.85, 95% CI (0.65-1.1)]. Whereas the conventional meta-analysis limited to studies that could provide IPD showed an OR of 0.89 (95% CI 0.69-1.2), the conventional meta-analysis limited to the eight studies of which method of randomization could be confirmed showed an OR of 0.94 (95% CI 0.76-1.17) and the conventional meta-analysis including all 10 eligible RCTs identified with our search changed the OR to 1.07 (95% CI 0.81-1.41). This difference in direction of effect, derived from the studies not able to share IPD of which quality of randomization could not be confirmed. CONCLUSIONS: Aspirin does not improve pregnancy rates after IVF.

Recurrence of ovarian cyst after sclerotherapy.

AIM: The aim of this paper was to evaluate correlation between cyst recurrence and some cyst characteristics after sclerotherapy of non-neoplastic ovarian cyst with alcohol-erythromycin combination. METHODS: Fifty two cases of simple ovarian cysts were subjected to sclerotherapy with alcohol and erythromycin. Two patients were excluded due to suspicious cytologic result. All patients were followed-up monthly with color Doppler ultrasonography for over 12 months. Failure of procedure was considered if recurrent cyst diameter exceeds 5 centimeters detected by ultrasound. Cyst size, volume and color of aspirate, steroid hormone, and tumor marker levels of the cyst fluid were correlated to the recurrence rate. RESULTS: The fluid of cyst was serous in 32 cases and dark chocolate-colored in twenty cases. Cytological analyses of thirty cysts were acellular sediment, twenty were suitable with endometrioma and two were reported as suspicious. At 12-month follow-up, 12 cyst recurrences was detected. There was no difference in aspirated cyst volume, cyst size and FSH and LH content of recurrent and resolved cyst. The cyst wall thickness of recurrent cyst was higher than that of resolved cyst (P<0.001). The mean estradiol and progesterone concentrations of resolved cysts were significantly higher than that of recurrent cysts on the other hand, the mean CA125 levels in recurrent cysts (347.9±204.4) was significantly higher as compared to the mean CA125 concentrations of resolved cyst (16.75±22.45). CONCLUSION: Aspiration and sclerotherapy with alcohol and erythromycin yielded a relatively high recurrence rate in cyst with a bloody aspirate and high CA125 levels in cyst fluid.

The role of telomerase activity in predicting early recurrence of epithelial ovarian cancer after first-line chemotherapy: a prospective clinical study.

PURPOSE OF INVESTIGATION: To investigate the value of telomerase activity (TA) in the detection of early recurrence in primary epithelial ovarian cancer (EOC). METHOD(S): In this study, TA was studied in 30 patients with Stage III EOC and 50 control patients with benign gynecological disease. All enrolled EOC patients had had primary cytoreductive surgery and six cycles of platinum-based first-line chemotherapy previously. Semi-quantative TA measurements were done by TRAP assay in ascites, taken at second-look surgery, of cancer patients and in peritoneal washings, taken during planned surgery, of the control group. RESULT(S): Early recurrence was diagnosed in ten EOC patients (33.3%). Mean TA was statistically higher in EOC patients than in patients with benign disease. However, the mean TA was insignificantly lower in early recurrent EOC patients than in disease-free EOC patients. CONCLUSION(S): The value of TA is limited in the detection of early recurrence in primary EOC.