Use of steroid pre-treatments in IVF-ICSI cycles with GnRH antagonist protocol and their impact on gestational outcomes.

Different steroid pre-treatments have been used to schedule the start of the ovarian stimulation in IVF cycles. Currently, there is controversy about their effects on gestational outcomes. We designed a three-armed randomised controlled trial (RCT). Eighty-six normoresponder patients undergoing IVF treatment with antagonist GnRH protocol were allocated to three different groups. In the group 1, 34 patients received oral contraceptive pill (OCP) from the first day of the cycle to five days before starting ovarian stimulation, in the group 2, 25 patients received 2 mg/12 hours of oral E2 valerate from day 25 of the previous cycle until the day before starting stimulation, and finally, in the group 3, 27 patients did not receive any treatment. There are no statistically significant differences neither in clinical pregnancy rate (CPR) (40.9% OCP vs. 28.6% E2 vs. 53.3% no treatment group, p=.388) nor live birth rate (LBR) (31.8% OCP vs. 28.6% E2 vs. 46.7% no treatment group, p=.537) between groups in fresh embryo transfer. Likewise, no differences were found in the cumulative CPR, nor in cumulative LBR. However, there is a tendency to worst outcomes in the E2 group. In this E2 group, we observed better results with longer exposition, although no significant differences are reached (E2 mean days in the pregnant group 8.29 vs. 6.83 in the non-pregnant group, p=.08). Our study shows no significant differences in pregnancy rates between groups, but the E2 group is trending at worse gestational results. Trial registration number: Eudra-CT registration number is 2014-001809-40.Impact StatementWhat is already known on this subject? Nowadays, there is much controversy about how pregnancy rates could be affected by the selection of steroid pre-treatments used in order to schedule IVF cycles. However, these treatments are widely utilised in clinical practice.What the results of this study add? The results support the clinical findings of most of the studies previously published. No significant differences in gestational outcomes were found between the groups treated with steroid pre-treatments and the control group. Additionally, oestrogen pre-treatment seems to be related to better pregnancy outcomes when the exposition is longer. Thus, an earlier start of this treatment in the luteal phase could be the optimal approach.What the implications are of these findings for clinical practice and/or further research? This study pretends to provide clarity about the treatment guidelines of steroid pre-treatments to schedule the clinical work without impact on gestational outcomes.

Effects of progesterone variation on IVF Progesterone variation during controlled ovarian stimulation: effects on in vitro results.

The objective of this study was to investigate the impact of the progesterone variation (PV) between early progesterone and preovulatory progesterone on pregnancy rate (PR), number of oocytes, and embryo quality. Three hundred and thirty-eight cycles of in vitro fertilisation were included and progesterone was measured on 5th day of stimulation GnRH as well as on the day of induction of ovulation. Fresh embryo transfer (ET) on the second-third day after follicular puncture was made in 152/338 cycles, with positive pregnancies in 61/152 (40%). In the cycles in which ET was cancelled (186/338) higher levels of estradiol and P2 were detected, as well as greater PV and number of oocytes obtained than those made in with fresh transfer. A greater PV was not associated with a worse clinical PR but with a minor embryo quality in the group of 35-37 years old patients.Impact StatementWhat is already known on this subject? Preovulatory progesterone (P2) elevation has been linked to worse results in IVF cycles. It has also been described been reported that there is a lower pregnancy rate (PR) in patients with high progesterone in the early follicular phase (P1). In our study, we measured P1 and P2 to evaluate the possible repercussion of progesterone variation (PV) (ratio of P2 to P1) on PR, a variable that has not previously been analysed.What do the results of this study add? Negative correlation between preovulatory progesterone and embryo quality was found, according to the literature. In the present study, a negative significant correlation between PV and embryo quality was also found, however, only in the group of 35-37 years old women.What are the implications of these findings for clinical practice and/or further research? This could indicate that a rapid increase in progesterone levels after the early follicular phase is related to a lower quality of the obtained embryos, although further studies are required to achieve greater statistical significance.

Efectividad del extracto de hoja de frambueso en la estimulación del parto / Effectiveness of raspberry leaf extract in labor induction

Objetivo: Evaluar la efectividad de la administración de 2,16 g/día de extracto de hoja de frambueso en el inicio del parto espontáneo y en la duración de éste, en comparación con la administración de placebo. Diseño: Estudio experimental, multicéntrico, paralelo, prospectivo y doble ciego, con asignación aleatoria al grupo control y experimental. Ámbito de estudio: Centros de Atención a la Salud Sexual y Reproductiva (ASSIR) de Sabadell y Barcelona, y salas de partos del Hospital Parc Taulí de Sabadell y del Hospital de Sant Pau de Barcelona. Sujetos: La muestra de estudio estará formada por 136 gestantes nulíparas que se encuentren en el tercer trimestre del embarazo, antes de la semana 37 de gestación; serán asignadas aleatoriamente 68 al grupo control y 68 al experimental. Intervención: Las gestantes del grupo experimental tomarán 6 cápsulas diarias (2 c/8 h; 2,16 g/día) de extracto de hoja de frambueso y las del grupo control tomarán, siguiendo la misma pauta, unas cápsulas de idéntica forma y color con un placebo (fructosa). Instrumentación: La matrona del ASSIR rellenará el registro de captación en la consulta de seguimiento del embarazo. La recogida de datos se realizará en la sala de partos. La gestante rellenará el diario de cumplimiento y lo entregará el día del parto. Determinación: Se estudiará si hay diferencias en el inicio del parto y en la duración de éste entre el grupo control y el experimental. Para el análisis de los datos, se utilizará el programa estadístico PASW 18.0 (AU)

To evaluate the effectiveness of the administration of 2.16 g / day of raspberry leaf extract at the beginning of spontaneous labor and duration of it, compared to placebo administration. Design: Experimental, multicenter, parallel, double-blind, prospective, randomized to the control group and experimental study assignment. Field of study: Centers of Attention to Sexual and Reproductive Health (ASSIR) of Sabadell and Barcelona, ​​and delivery rooms of the Hospital Parc Tauli de Sabadell and the Hospital de Sant Pau in Barcelona. Subjects: The study sample will consist of 136 nulliparous pregnant women who are in the third trimester of pregnancy before 37 weeks of gestation; 68 will be randomly assigned to the control group and 68 to the experimental. Intervention: Pregnant women in the experimental group will take 6 capsules daily (2 C / 8 h, 2.16 g / day) of raspberry leaf extract and the control group shall, following the same pattern, capsules of identical shape and color placebo (fructose). Instrumentation: Matron of ASSIR filled registration uptake in the pregnancy follow-up visit. Data collection will take place in the delivery room. Pregnant women fill the daily compliance and deliver the day of delivery. Determination: We will study whether there are differences in the onset of labor and the duration of the between control and experimental groups. For data analysis, the SPSS 18.0 statistical program was used (AU)

Groin angiosarcoma following radiotherapy for vulvar cancer.

BACKGROUND: Angiosarcomas account for less than 2% of all sarcomas. However, they represent 15% of radiotherapy-induced sarcomas, usually associated to the treatment for breast cancer, cervical cancer, and lymphomas. CASE REPORT: We report the case of a 56-year-old patient who developed a soft tissue angiosarcoma in the right groin 25 years after receiving radiotherapy for vulvar cancer. To our knowledge, this is the second case reported of a soft tissue angiosarcoma after radiotherapy for a vulvar cancer. CONCLUSION: Postradiation sarcoma must be considered in patients with a history of a previous tumor when a soft tissue mass is seen in the previously irradiated field, especially if the latent period is more than 3 or 5 years. The correct histologic interpretation of such lesions is important because it may result in early identification of the secondary malignancy and may contribute to better management and improved prognosis.