The Test Tube Baby: Out of Reach or Out of Luck? A Retrospective Look at the Impact of Basal FSH and Age on In Vitro Fertilization Success in a Clinic Operating Without Laboratory Value Thresholds or Age Limits?

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Objective: To assess the impact of age and FSH on IVF outcomes in an assisted reproductive technology clinic that does not have treatment thresholds based on age or laboratory FSH values. Design: Retrospective cohort study Setting: The Arizona Center For Fertility Studies in Phoenix, AZ Patient(s): Women who sought fertility treatment (with the exclusion of patients using donor or frozen oocytes) ages 18-50, representing a total of 1388 IVF cycles Intervention(s): IVF using nondonor embryos Main Outcome Measure(s): Live-birth rate per cycle started Result(s): A total of 1388 IVF cycles with autologous oocytes were analyzed to determine the impact of basal FSH and age on therapy outcomes. The pregnancy rates for individuals 18-34 years old were not significantly different and ranged from 41.1% to 34%. Pregnancy rates for individuals aged 35-39 years old exhibited a reduced pregnancy rate that ranged from 24.7% to 19.8%. For the eldest patients, a significant reduction in pregnancy rates was demonstrated with patients over the age of 40 having a pregnancy rate of 14.3%, and for those 41 years old and 42 and older having pregnancy rates of 7% and 6% respectively. The live birth rate also mirrored this trend with the youngest age group having a live birth rate of 38.9% and the eldest group of individuals aged 42-50 years having a live birth rate of 3.4%. While increasing FSH levels were associated with reduced numbers of oocytes retrieved and transferred during the IVF procedures, there was no statistically significant reduction in pregnancy rate or live birth rate in those with elevated basal FSH levels. Conclusion: The data analysis revealed that increasing age in this population does correlate with decreasing successful outcomes in IVF. At ages 36 and 40 years, there are significant reductions in pregnancy rate. At ages 38 and 40, there are significant reductions in live birth rate. Interestingly, there were no significant differences in pregnancy rate or live birth rate based on basal FSH level.This item is part of the College of Medicine - Phoenix Scholarly Projects 2011 collection. For more information, contact the Phoenix Biomedical Campus Library at [email protected]

Mayo Clinic Cancer Center experience of metastatic extramammary Paget disease 1998-2012

Extramammary Paget disease (EMPD) is a rare cutaneous malignancy. The most common presentation of EMPD is the vulva followed by perianal involvement. Most cases are localized to the dermis with treatment focused on surgery, topical treatment or radiotherapy. Recurrence is frequent despite therapies utilized. Metastatic extramammary Paget disease is uncommon and, as such, standard treatment guidelines do not exist. This study sought to evaluate the treatment regimens and outcomes of patients treated at a Mayo Clinic Center from 1998-2012. Cancer registry inquiry revealed 261 patients with report advanced Paget disease during these years. Ten cases of metastatic EPMD were identified with sufficient documentation for review. This review reveals support for utilizing localized radiation therapy for bulky disease sequentially with systemic chemotherapy consisting of carboplatin and paclitaxel or irinotecan. Further studies are necessary to define the optimal treatment regimen

Immunotherapy in pancreatic cancer treatment: a new frontier

Pancreatic cancer is a highly aggressive and lethal cancer characterized by high invasiveness, local and extensive dissemination at time of diagnosis and resistance to treatment. Few therapies have shown efficacy in the past and even standard of care therapies yield only modest improvements in the mortality of patients with advanced or metastatic disease. Efforts have been undertaken to study the pancreatic tumor microenvironment and have established its complex and immunosuppressive nature which could explain the high resistance to chemotherapy. Novel therapies targeting the tumor microenvironment with an aim to decrease this resistance, improve immune tolerance and increase the efficacy of the current treatment have shown some promising preliminary results in preclinical and clinical trials. We review the current advances in the field of immunotherapy and their effectiveness as a potential treatment strategy in the pancreatic cancer

Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition

© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. Background: Philadelphia chromosome negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia, polycythemia vera, and myelofibrosis, have severe function-limiting symptom burden that is experienced by the majority of patients. Previous studies have suggested that depression may be present in over a quarter of MPN patients, but to date no studies have evaluated the relationship between depression and other variables such as symptoms. Methods: A 70-item internet based survey regarding fatigue and mood symptoms was developed by a multidisciplinary team of MPN investigators, patients and patient advocates including Patient Health Questionnaire and the Myeloproliferative Neoplasm Symptom Assessment Form was completed by over 1300 patients with MPN diagnosis. Results: There were 309 respondents (23%) with PHQ-2 scores ≥ 3. In this analysis, we found worse systemic symptom burden in individuals reporting depressive symptoms. Conclusion: This analysis suggests the importance of depression in contributing to as well as confounding symptomatology in MPN patients, and suggests that this critical variable should also be addressed by clinicians and researchers alike when comprehensively assessing symptom burden etiologies