Nationwide survey of Japanese breast oncology and reproductive endocrinology departments about the impact of breast cancer treatment on fertility.

The purpose of this study is to assess the impact of breast cancer treatment on the reproductive potential. We conducted a nationwide survey of breast oncology and reproductive endocrinology and infertility (REI) departments using a questionnaire designed to assess the impact of breast cancer treatment on fertility. We received responses from 312 breast oncology departments (response rate, 31.9%) and 541 REI departments (response rate, 50.9%). The most common method of achieving pregnancy reported by breast oncology departments was natural insemination (69.6%), followed by assisted reproductive technology ( 15.6%) and intrauterine insemination (IUI; 14.8%). The most common method of achieving pregnancy reported by REI departments was conventional in vitro fertilization and/or intracytoplasmic sperm injection (51.0%), followed by natural insemination with or without ovulation induction (40.0%) and IUI (8.0%). The overall pregnancy rate for patients who underwent treatment for infertility at REI departments after breast cancer treatment was 39.0%. Vast patients who experienced breast cancer treatments conceived mainly by natural insemination based on the data from breast oncology departments. On the other hand, 61.0% of the patients who visited REI departments presumably due to infertility by natural insemination did not conceive even by infertility treatments with exclusive knowledge in REI departments.

Embryo transfer associated with hormone replacement therapy cycles using assisted reproductive technology increases placenta accreta spectrum.

AIM: To evaluate obstetric outcomes in embryo transfer (ET) during estrogen with progestin hormone replacement therapy (HRT) cycles using assisted reproductive technology (ART). METHODS: Of the 118 singleton pregnancies conceived with ART and delivered between January 2015 and December 2017, we reviewed the data of 87 cases that had information on HRT at the time of ET. Data on pregnancy outcomes included the presence of small for gestational age fetuses, hypertensive disorders of pregnancy, placenta previa (including low-lying placenta), placental abruption and placenta accreta spectrum (including placenta accreta, placenta increta and placenta percreta). We investigated the relationship between HRT cycles and adverse placental outcomes (placenta accreta spectrum, placental abruption, placenta previa, hypertensive disorders of pregnancy and small for gestational age fetuses). We then analyzed the associations that correlated with adverse placental outcomes. RESULTS: Patients with ET during HRT cycles were more likely to have placenta accreta spectrum. During the study period, 87 out of 118 singleton live births using ART had information on HRT (60 HRT cycles and 27 ovulation cycles). The incidence of placenta accreta spectrum was significantly higher in the HRT cycle group than in the ovulation cycle group (HRT cycle, 31.7% [19 of 60] vs ovulation cycle, 7.4% [2 of 27]; P < 0.01). CONCLUSION: The obstetric outcomes occurring in pregnancies involving HRT use may differ among ET cycles. ET during HRT cycles were associated with adverse obstetric outcomes due to placenta accreta spectrum. The potential interaction between HRT cycles and adverse placental events is novel and warrants further investigation.

Amniotic epithelial cells damage by oxidative stress in cases of diffuse chorioamniotic hemosiderosis.

The amniotic membrane plays an important role in the physiological maintenance and protection of the embryo. Indeed, dysfunction of the amniotic membrane is thought to have an adverse effect on the continuation of pregnancy. In this report, we examined the pathological changes in the amniotic epithelium in three cases of diffuse chorioamniotic hemosiderosis (DCH) and investigated the cause of necrosis of the amniotic epithelial cells and its relationship with oligohydramnios. Diffuse chorioamniotic hemosiderosis was confirmed in all three cases. More extensive amniotic epithelial necrosis led to more severe hemosiderosis. Immunostaining for 8-hydroxy-2'-deoxyguanosine, a marker of oxidative stress, was positive in the amniotic epithelial cells. We speculate that oxidative DNA damage of the amniotic epithelium occurs by decomposition products of blood cells in cases accompanying subchorionic hematomas and pathological DCH. Furthermore, disorder of the amniotic epithelium may disrupt the balance of the amniotic fluid volume and cause oligohydramnios.