RESUMO
OBJECTIVES: The objective of our study is to evaluate the impact of luteal phase support by hCG in intrauterine inseminations preceded by ovarian gonadotropin stimulation. METHODS: A retrospective study was conducted at the CHU of Nice between March 1, 2016 and October 31, 2017. During this period, 300 intrauterine inseminations were included in data analysis. Ovarian stimulation was performed by gonadotropins and a GnRH antagonist was added, if needed. Following a modification of standard operative procedure in the department, patients who performed an intrauterine insemination from December 1, 2016 received luteal phase support with two injections of hCG 1500 IU, performed at three days of interval. Pregnancy and ovarian hyperstimulation syndrome were the primary and secondary study endpoints, respectively. RESULTS: Out of 300 inseminations included in the analysis, 144 were performed with luteal phase support and 156 without support. No statistically significant difference in pregnancy rate was observed between these two groups (19.4% of pregnancy in the luteal phase support group and 15.38% in the group without luteal phase support, P=0.353). No ovarian hyperstimulation syndrome occurred over the course of the study. CONCLUSION: Our study shows a slight improvement of pregnancy rate in the group subjected to luteal phase support by hCG after intrauterine insemination, but the benefit was not significant. A randomised prospective study based on a large cohort could help to assess the effect of luteal phase support during intrauterine inseminations.
Assuntos
Gonadotropina Coriônica/administração & dosagem , Inseminação Artificial/métodos , Fase Luteal/efeitos dos fármacos , Adulto , Feminino , Hormônio Foliculoestimulante/administração & dosagem , França , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Humanos , Infertilidade/terapia , Fase Luteal/fisiologia , Masculino , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez , Estudos RetrospectivosRESUMO
Prolactinoma is the most frequent hormone-secreting pituitary tumor (100 for million patients) and a major cause of both female and male reproductive function disorders. Physician, gynecologist, urologist and sexologist can face this situation during their career. As part of the fertility restoration, treatment gives very satisfactory results. With adequate management, most women are expected to achieve successful pregnancies. The natural history of these tumors during pregnancy depends on their size with a risk of a clinically relevant estimate between 5 to 30 %. Their management is complex, requiring finding balance between effects of pregnancy on tumor growth and potential risks of overtreatment on fetal development. The aim of this study is to discuss the management of prolactinoma on woman before, during and after pregnancy, and to evaluate the medical and surgical alternatives regarding the actual literature.
Assuntos
Parto Obstétrico , Infertilidade/terapia , Neoplasias Hipofisárias/terapia , Complicações Neoplásicas na Gravidez/terapia , Prolactinoma/terapia , Atitude Frente a Saúde , Progressão da Doença , Feminino , Humanos , Infertilidade/etiologia , Masculino , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Prolactinoma/complicações , Prolactinoma/patologiaRESUMO
Uterine rupture during labor is a serious and uncommon obstetrical complication that can lead to severe prognosis for the mother and her child if not immediately diagnosed and treated. Most spontaneous uterine ruptures occur during labor in parturients with a scarred uterus and are much rarer on an unscarred uterus. We report the case of a uterine rupture on unscarred uterus to a 32 year-old woman after a labor induced by intravaginal prostaglandin and intravenous ocytocine injection. Our management is compared with the data from literature.