Efecto protector de los análogos de la GnRH sobre la capacidad reproductiva de las mujeres en edad fértil con neoplasia o enfermedad autoinmunitaria tratadas con fármacos citotóxicos. Resultado final de un ensayo clínico fase II / Protective effect of GnRH analogues on the reproductive capacity of women with neoplasia or autoimmune disease who require chemotherapy. Final results of a phase ii clinical trial

Fundamento y objetivo: Para evitar el efecto tóxico quimioterápico se ha propuesto la utilización de análogos agonistas de la GnRH (aGnRH) para inhibir la depleción de folículos ováricos. Existen controversias sobre su eficacia, por lo que se ha realizado un ensayo clínico para valorar el efecto protector de los análogos de la GnRH en mujeres afectadas de cáncer y enfermedades autoinmunitarias tratadas con fármacos citotóxicos. Pacientes y métodos: Ensayo clínico, de fase ii, unicéntrico y abierto. Durante el tratamiento quimioterápico se administraron 5 dosis de análogo antagonista de la GnRH en intervalos de 3 días y/o una dosis mensual de aGnRH. Se realizaron determinaciones hormonales previamente al inicio del tratamiento quimioterápico y al finalizar este. Resultados: La inclusión de las pacientes se concluyó precozmente al introducir como parámetro de evaluación de la reserva ovárica la determinación de hormona antimulleriana (HAM). De las 38 pacientes seguidas, 23 (60,5%, IC95% 43,4-76,0) presentaron valores de AMH por debajo de la normalidad tras la conclusión del tratamiento. Se realizó un análisis intermedio en el que se observó que el 86,6% (IC95% 71,9-95,6) de las pacientes recuperaban el ciclo menstrual, pero estas presentaban una reducción de los niveles de HAM. Conclusión: Aunque la mayoría de las pacientes presentaron recuperación de los ciclos menstruales, la reserva ovárica disminuyó en la mayoría de ellas, por lo que podemos concluir que la administración concomitante al tratamiento quimioterápico de análogos de la GnRH no preserva de la pérdida de la población folicular ovárica (AU)

Background and objective: In order to avoid the toxic effect of chemotherapy, it has been proposed to use GnRH agonist analogues (GnRHa) to inhibit the depletion of ovarian follicles. Nevertheless, there is controversy about its effectiveness. This clinical trial has been conducted with the aim to assess the protective effect of GnRH analogues on the reproductive capacity of women with malignancies or autoimmune diseases, which require chemotherapy. Patients and methods: Open phase ii single-center clinical trial. During chemotherapy, a total of 5 doses of GnRH antagonist analogue at a dose interval of 3 days and/or a monthly dose of GnRHa were administered. Hormonal determinations prior to the start of the CT treatment were conducted during treatment and at the end of it. Results: The inclusion of patients was prematurely concluded when incorporating the determination of anti-Müllerian hormone (AMH) as a parameter for assessing the ovarian reserve. Out of 38 patients, 23 (60.5%, 95%CI 43.4-76.0) had AMH values below normal following completion of treatment. An intermediate analysis was carried out observing that while most patients were recovering the menstrual cycle (86.6% 95%CI 71.9-95.6), they had reduced levels of AMH. Conclusion: Although most patients recovered their menstrual cycles, the ovarian reserve, assessed by the concentration of AMH, decreased in many patients. Therefore, we can conclude that the concomitant treatment of chemotherapy and GnRH analogues does not preserve the loss of follicular ovarian reserve (AU)

[Protective effect of GnRH analogues on the reproductive capacity of women with neoplasia or autoimmune disease who require chemotherapy. Final results of a phase ii clinical trial]. / Efecto protector de los análogos de la GnRH sobre la capacidad reproductiva de las mujeres en edad fértil con neoplasia o enfermedad autoinmunitaria tratadas con fármacos citotóxicos. Resultado final de un ensayo clínico fase II.

BACKGROUND AND OBJECTIVE: In order to avoid the toxic effect of chemotherapy, it has been proposed to use GnRH agonist analogues (GnRHa) to inhibit the depletion of ovarian follicles. Nevertheless, there is controversy about its effectiveness. This clinical trial has been conducted with the aim to assess the protective effect of GnRH analogues on the reproductive capacity of women with malignancies or autoimmune diseases, which require chemotherapy. PATIENTS AND METHODS: Open phase ii single-center clinical trial. During chemotherapy, a total of 5 doses of GnRH antagonist analogue at a dose interval of 3 days and/or a monthly dose of GnRHa were administered. Hormonal determinations prior to the start of the CT treatment were conducted during treatment and at the end of it. RESULTS: The inclusion of patients was prematurely concluded when incorporating the determination of anti-Müllerian hormone (AMH) as a parameter for assessing the ovarian reserve. Out of 38 patients, 23 (60.5%, 95%CI 43.4-76.0) had AMH values below normal following completion of treatment. An intermediate analysis was carried out observing that while most patients were recovering the menstrual cycle (86.6% 95%CI 71.9-95.6), they had reduced levels of AMH. CONCLUSION: Although most patients recovered their menstrual cycles, the ovarian reserve, assessed by the concentration of AMH, decreased in many patients. Therefore, we can conclude that the concomitant treatment of chemotherapy and GnRH analogues does not preserve the loss of follicular ovarian reserve.

Comparative study of the psychosocial risks associated with families with multiple births resulting from assisted reproductive technology (ART) and without ART.

OBJECTIVE: To determine whether the psychosocial risks associated with multiple births are increased as a consequence of the use of assisted reproductive technology (ART) in comparison with those not resulting from ART. DESIGN: Cross-sectional study. SETTING: Fertility units of a university hospital and a private hospital. PATIENT(S): Parents of single children and multiples (twins and triplets) between 6 months and 4 years of age (n = 636) were divided into two groups: those who conceived through ART (n = 265) and those who conceived through non-ART (n = 371). INTERVENTION(S): Administration of six scales, in office or by mail. MAIN OUTCOME MEASURE(S): Measurement scales of material necessities, social stigma, marital satisfaction, perceived stress, depression, quality of life, and their subscales. RESULT(S): The analysis of variance, Student's t-test, and χ(2)-test were applied. No effect was observed based on the use of ART in the psychosocial variables studied. Significant differences were obtained between the groups of single (SB) and multiple births (MB) with respect to material necessities, social stigma, marital satisfaction, depression, and quality of life. CONCLUSION(S): Having more than one child per birth, whether resulting from the use of ART or not, increases psychosocial risks for the parents. Assisted reproduction centers should include this information with the obstetric and neonatal risks, stressing the advantages of having one child per birth. Psychosocial risks are not increased as a result of having used ART, but the goal of avoiding the repeated use of ART does influence the desire to transfer the maximum number of embryos possible. Psychological counseling should be included before initiating ART, as well as when a multiple pregnancy is confirmed.

Psychosocial risks associated with multiple births resulting from assisted reproduction: a Spanish sample.

OBJECTIVE: To determine the psychosocial risks associated with multiple births (twins or triplets) resulting from assisted reproductive technology (ART). DESIGN: Transverse study. SETTING: Infertility units of a university hospital and a private hospital. PATIENT(S): Mothers and fathers of children between 6 months and 4 years conceived by ART (n = 123). The sample was divided into three groups: parents of singletons (n = 77), twins (n = 37), and triplets (n = 9). INTERVENTION(S): The questionnaire was self-administered by patients. It was either completed at the hospital or mailed to participants' homes. MAIN OUTCOME MEASURE(S): Scales measured material needs, quality of life, social stigma, depression, stress, and marital satisfaction. RESULT(S): Logistic regression models were applied. Significant odds ratios were obtained for the number of children, material needs, social stigma, quality of life, and marital satisfaction. The results were more significant for data provided by mothers than by fathers. CONCLUSION(S): The informed consent form handed out at the beginning of ART should include information on the high risk of conceiving twins and triplets and on the possible psychosocial consequences of multiple births. As soon as a multiple pregnancy is confirmed, it would be useful to provide information on support groups and institutions. Psychological advice should also be given to the parents.

[Isoflavones in menopause women]. / Isoflavonas en mujeres menopáusicas.

Phytoestrogens are composed derivatives of vegetables. The 2 main classes of interest to human health are lignans and isoflavones. Isoflavones exist in at least 15 different chemical forms and their effect on human health has been investigated to some extent (particularly, genistein and daidzein as high levels of these compounds are present in soybean). Isoflavones have similar structure to oestrogen and have the capacity to exert both oestrogenic and anti oestrogenic effects. They may block the effects of oestrogen in some tissues (e. g., the breast and endometrium), but act like an oestrogen in providing possible protection against bone loss and heart disease. Lignans are much more widespread in plant foods but investigation has been limited due to the complexity of measurement. The increasing interest in the use of the soybean and the phytoestrogens derived from the soybean is due to the results published on experimental animal actions, and in human case-control studies. There are many observational and epidemiologists studies that suggest the potential benefit of isoflavones on the menopause symptoms, the cardiovascular system, the osteoporosis and the estrogen dependent cancers, but many open questions exist. We must be very strict with certain observational studies by the possible influences of collateral factors to the isoflavones (exercise, type of diet, etc.), and attribute the beneficial effects may be due to own treatment.

Isoflavonas en mujeres menopáusicas / Isoflavones in menopause women

Los fitoestrógenos son compuestos derivados de vegetales. Los lignanos y las isoflavonas son los 2 tipos de fitoestrógenos que tienen más interés para la salud. Existen al menos 15 formas químicas diferentes de isoflavonas y su efecto sobre la salud se ha estudiado ampliamente (en especial la genisteína y la daidzeína, que se encuentran sobre todo en la soja). Las isoflavonas tienen una estructura química similar a los estrógenos y son capaces de ejercer efectos estrogénicos y antiestrogénicos. Bloquean el efecto estrogénico en algunos tejidos, como los de la mama y el endometrio, y actúan como estrógenos proporcionando un posible efecto cardioprotector y sobre la pérdida de masa ósea. Los lignanos están mucho más extendidos entre los alimentos vegetales, pero su investigación es más limitada porque su medición es muy compleja. El creciente interés por el uso de la soja y de los fitoestrógenos derivados de ella se debe a los resultados publicados sobre sus acciones en animales de experimentación y de estudios de casos y controles en humanos. Muchos son los trabajos observacionales y epidemiológicos que señalan el potencial beneficio de las isoflavonas sobre los síntomas de la menopausia, el sistema cardiovascular, la osteoporosis y los cánceres dependientes de estrógeno, pero existen muchos interrogantes abiertos. Debemos ser muy críticos al leer determinados trabajos observacionales, dada la posible influencia de factores colaterales a la ingesta de isoflavonas (ejercicio, tipo de dieta, etc.) que podrían interpretarse como propios de dicho tratamiento

Phytoestrogens are composed derivatives of vegetables. The 2 main classes of interest to human health are lignans and isoflavones. Isoflavones exist in at least 15 different chemical forms and their effect on human health has been investigated to some extent (particularly, genistein and daidzein as high levels of these compounds are present in soybean). Isoflavones have similar structure to oestrogen and have the capacity to exert both oestrogenic and anti oestrogenic effects. They may block the effects of oestrogen in some tissues (e. g., the breast and endometrium), but act like an oestrogen in providing possible protection against bone loss and heart disease. Lignans are much more widespread in plant foods but investigation has been limited due to the complexity of measurement. The increasing interest in the use of the soybean and the phytoestrogens derived from the soybean is due to the results published on experimental animal actions, and in human case-control studies. There are many observational and epidemiologists studies that suggest the potential benefit of isoflavones on the menopause symptoms, the cardiovascular system, the osteoporosis and the estrogen dependent cancers, but many open questions exist. We must be very strict with certain observational studies by the possible influences of collateral factors to the isoflavones (exercise, type of diet, etc.), and attribute the beneficial effects may be due to own treatment