Early pregnancy complications after frozen-thawed embryo transfer in different cycle regimens: A retrospective cohort study.

OBJECTIVE Frozen-thawed embryo transfers (FET) are a key component of assisted reproductive technologies (ART) and various cycle regimens are used worldwide because of insufficient evidence to favour particular transfer schedules. In this study, we investigated the associations between different cycle regimens and early pregnancy complications as well as live birth rates (LBR) per pregnancy after FET. STUDY DESIGN We conducted a retrospective cohort study analysing a total of 7342 pregnancies after FET registered in the Swiss IVF Registry from 2014 to 2019. Women were divided into three groups according to the different cycle regimens: Natural Cycles (NC-FET, n = 998), low-dose Stimulation Cycles (SC-FET, n = 984) and Hormone Replacement Cycles (HRC-FET, n = 5360) leading to pregnancy. Outcomes included early pregnancy complications such as bleeding, miscarriages and ectopic pregnancies. Additionally, we evaluated LBR per pregnancy. Incidences were compared using Fisher's exact or Chi-square tests. Mean values were compared using t-tests. Multivariate mixed model analysis was performed with early pregnancy complications as outcome. RESULTS The incidence of bleeding in the first trimester (NC: 3.5 %, SC: 4.3 %, HRC: 8.4 %; p < 0.001) and miscarriage < 12 weeks (NC: 19.0 %, SC: 19.7 %, HRC: 29.1 %; p < 0.001) was highest in HRC-FET. Multivariate analysis revealed almost doubled adjusted odds ratios of bleeding in the first trimester (aOR 1.92; 95 % CI 1.30-2.81) and miscarriage < 12 weeks (aOR 1.82; 95 % CI 1.51-2.19) in HRC-FET vs NC-FET. There were comparable odds ratios in HRC-FET vs SC-FET. No differences were observed in the outcomes between SC-FET and NC-FET. Highest proportion of LBR per pregnancy (NC: 78.0 %, SC: 77.2 %, HRC: 68.2 %%; p < 0.001) was reported in NC-FET. CONCLUSIONS This is the latest large European register study evaluating early pregnancy complications and LBR per pregnancy after FET between all three different cycle regimens. Miscarriage rate was highest in HRC-FET which can be translated into lower LBR. Therefore, HRC-FET should be avoided and replaced by SC-FET or NC-FET to achieve better pregnancy outcomes

Impact of estrogens on resting energy expenditure: A systematic review.

The fear of weight gain is one of the main reasons for women not to initiate or to early discontinue hormonal contraception or menopausal hormone therapy. Resting energy expenditure is by far the largest component and the most important determinant of total energy expenditure. Given that low resting energy expenditure is a confirmed predictive factor for weight gain and consecutively for the development of obesity, research into the influence of sex steroids on resting energy expenditure is a particularly exciting area. The objective of this systematic review was to evaluate the effects of medication with natural and synthetic estrogens on resting energy expenditure in healthy normal weight and overweight women. Through complex systematic literature searches, a total of 10 studies were identified that investigated the effects of medication with estrogens on resting energy expenditure. Our results demonstrate that estrogen administration increases resting energy expenditure by up to +208 kcal per day in the context of contraception and by up to +222 kcal per day in the context of menopausal hormone therapy, suggesting a preventive effect of circulating estrogen levels and estrogen administration on weight gain and obesity development

Playing and Listening to Tailor-Made Notched Music: Cortical Plasticity Induced by Unimodal and Multimodal Training in Tinnitus Patients

Background. The generation and maintenance of tinnitus are assumed to be based on maladaptive functional cortical reorganization. Listening to modified music, which contains no energy in the range of the individual tinnitus frequency, can inhibit the corresponding neuronal activity in the auditory cortex. Music making has been shown to be a powerful stimulator for brain plasticity, inducing changes in multiple sensory systems. Using magnetoencephalographic (MEG) and behavioral measurements we evaluated the cortical plasticity effects of two months of (a) active listening to (unisensory) versus (b) learning to play (multisensory) tailor-made notched music in nonmusician tinnitus patients. Taking into account the fact that uni- and multisensory trainings induce different patterns of cortical plasticity we hypothesized that these two protocols will have different affects. Results. Only the active listening (unisensory) group showed significant reduction of tinnitus related activity of the middle temporal cortex and an increase in the activity of a tinnitus-coping related posterior parietal area. Conclusions. These findings indicate that active listening to tailor-made notched music induces greater neuroplastic changes in the maladaptively reorganized cortical network of tinnitus patients while additional integration of other sensory modalities during training reduces these neuroplastic effects

Hormone replacement cycles are associated with a higher risk of hypertensive disorders: retrospective cohort study in singleton and twin pregnancies.

OBJECTIVE To elaborate the associations of different cycle regimens (natural cycle = NC, stimulated cycle = SC, hormone replacement cycle = HRC) on maternal and neonatal adverse pregnancy outcomes after frozen-thawed embryo transfers (FET). DESIGN Population-based registry study. SETTING Swiss IVF Registry. POPULATION OR SAMPLE Singleton (n = 4636) and twin life births (n = 544) after NC-FET (n = 776), SC-FET (n = 758) or HRC-FET (n = 3646) registered from 2014 to 2019. METHODS Fifteen pregnancy pathologies were modelized for singleton and twin pregnancies using mixed models adjusted for cycle regimen, delivery, fertilization technique, chronic anovulation, age of mother and centre. MAIN OUTCOME MEASURES Maternal (vaginal bleeding, isolated arterial hypertension and preeclampsia) and neonatal (gestational age, birthweight, mode of delivery) adverse pregnancy outcomes. RESULTS In singleton pregnancies, the incidences of bleeding in first trimester, isolated hypertension and preeclampsia were highest in HRC-FET with doubled odds of bleeding in first trimester (adjusted odds ratio = aOR 2.23; 95% CI 1.33-3.75), isolated hypertension (aOR 2.50; 95% CI 1.02-6.12) and preeclampsia (aOR 2.16; 95% CI 1.13-4.12) in HRC-FET vs. NC-FET and with doubled respectively sixfold odds of bleeding (aOR 2.08; 95% CI 1.03-4.21) and preeclampsia (6.02; 95% CI 1.38-26.24) in HRC-FET vs. SC-FET. In twin pregnancies, the incidence of preeclampsia was highest in HRC-FET with numerically higher odds of preeclampsia in HRC-FET vs. NC-FET and vs. SC-FET. CONCLUSIONS Our data implied the highest maternal risks of hypertensive disorders in HRC-FET, therefore clinicians should prefer SC-FET or NC-FET if medically possible

Appraisal of clinical practice guidelines on the management of obstetric perineal lacerations and care using the AGREE II instrument

Pelvic floor trauma during childbirth is highly prevalent and is associated with long term risks of incontinence and pelvic organ prolapse. Societies and organizations have published clinical guidelines in order to standardise and improve the management of perineal care. The aim of this study was to systematically evaluate the quality of clinical guidelines on obstetric perineal trauma and care using the AGREE II instrument. We searched Medline, PubMed, Web of Science and ScienceDirect databases from inception until the 15th of December 2018 using the terms “guideline” OR “guidelines”, OR “guidance”, OR “recommendation" AND “obstetric anal sphincter injury”, OR “perineal laceration” OR “perineal tear” OR “perineal trauma” OR “vaginal tear”. Twelve guidelines were included, in English and Spanish.The assessment of the guidelines was performed using AGREE II by 5 appraisers.Ten guidelines scored more than 50 %, and 3 of them scored higher than 70 %. Two guidelines scored <50 % and were considered as low quality. Level of evidence and grade of recommendations were used by 7 guidelines of the 12 guidelines. Although some guidelines received high scores, there is space for improvement of the standards of guidelines

Primary Peritoneal Serous Borderline Tumors as a Therapeutic Challenge: a Systematic Review of the Literature

Primary peritoneal serous borderline tumors (PPSBT) are rare neoplasms that can present as an incidental finding at laparoscopy and raise concern regarding a primary ovarian tumor with peritoneal implants. The aim is to present an overview of all reported cases of PPSBT, including a case from our own department, with a focus on clinical presentation, diagnosis, therapeutic options, and prognosis. A search for articles containing various terminologies describing PPSBT was performed via PubMed. We included English and French language publications from 1966 to May 2019. All identified manuscripts (N = 15) were reviewed completely. To date, 229 cases of PPSBT have been reported in literature. Most patients present with infertility or abdominal pain. Diagnosis is based on histopathology since appropriate imaging or specific tumor markers are lacking. The main therapy applied in the majority of cases was simple (74 cases, 32.3%) or extended (136 cases, 59.4%) resection. Prognosis seems good, independent of the extent of surgery, with recurrence rates below 25%, and follow-up periods from 5 months to > 30 years. PPSBT is a rare condition, often found in women of reproductive age with a history of infertility or abdominal pain. In most cases, the diagnosis is established incidentally during laparoscopy or laparotomy followed by histopathology. Considering the good prognosis even with incomplete resection, limited surgery to retain fertility might be good initial options. Since the course of the disease can comprise decades, a long-term follow-up is crucial

Pelvic Inflammatory Disease – Schnittstellen zwischen Hausarztpraxis und gynäkologischer Spezialabklärung

Die «Pelvic Inflammatory Disease» (PID) beschreibt eine aufsteigende Entzündung des oberen weiblichen Genitaltraktes, beginnend bei einer Zervizitis über eine Endometritis zur Adnexitis. Sie ist ein häufiges und in den letzten Jahren wieder zunehmendes klinisches Bild, das sowohl in der gynäkologischen wie auch hausärztlichen Praxis vorkommt. Die Symptome sind unspezifisch, diskret ausgebildet oder ganz fehlend. Eine schnelle Diagnosestellung mit unverzüglicher Therapieeinleitung sowie eine gute interdisziplinäre Zusammenarbeit können das Langzeitrisiko der chronischen Unterbauchschmerzen, Sterilität und/oder Extrauteringravidität mindern. Screeningprogramme auf Chlamydien und Gonokokken, die die häufigsten Erreger der PID darstellen, sind bisher in der Schweiz nicht implementiert

Evaluation of the Gonadotoxicity of Cancer Therapies to Improve Counseling of Patients About Fertility and Fertility Preservation Measures: Protocol for a Retrospective Systematic Data Analysis and a Prospective Cohort Study.

BACKGROUND Cytotoxic treatments such as chemo- and radiotherapy and immune therapies are required in cancer diseases. These therapies have the potential to cure patients but may also have an impact on gonadal function and, therefore, on fertility. Consequently, fertility preservation treatments such as freezing of gametes and gonadal tissue might be required. However, as detailed data about the necessity to perform fertility preservation treatment are very limited, this study was designed to fill this data gap. OBJECTIVE Primary objective of this study is to analyze the impact of cancer therapies and chemotherapies on the ovarian reserve and sperm quality. Secondary objectives are to analyze the (1) impact of cancer therapies and chemotherapies on other fertility parameters and (2) probability of undergoing fertility preservation treatments in relation to specific cancer diseases and treatment protocols and the probability to use the frozen gametes and gonadal tissue to achieve pregnancies. METHODS First, previously published studies on the gonadotoxicity of chemo- and radiotherapies among patients with cancer will be systematically analyzed. Second, a prospective cohort study set up by approximately 70 centers in Germany, Switzerland, and Austria will collect the following data: ovarian function by analyzing anti-Müllerian hormone (AMH) concentrations and testicular function by analyzing sperm parameters and total testosterone immediately before and around 1 year after gonadotoxic therapies (short-term fertility). A follow-up of these fertility parameters, including history of conceptions, will be performed 5 and 10 years after gonadotoxic therapies (long-term fertility). Additionally, the proportion of patients undergoing fertility-preserving procedures, their satisfaction with these procedures, and the amount of gametes and gonadal tissue and the children achieved by using the frozen material will be analyzed. Third, the data will be merged to create the internet-based data platform FertiTOX. The platform will be structured in accordance with the ICD (International Classification of Diseases) classification of cancer diseases and will be easily be accessible using a specific App. RESULTS Several funding bodies have funded this study. Ten systematic reviews are in progress and the first one has been accepted for publication. All Swiss and many German and Austrian ethics committees have provided their approval for the prospective cohort study. The study registry has been set up, and a study website has been created. In total, 50 infertility centers have already been prepared for data collection, which started on December 1, 2023. CONCLUSIONS The study can be expected to bridge the data gap regarding the gonadotoxicity of cancer therapies to better counsel patients about their infertility risk and their need to undergo fertility preservation procedures. Initial data are expected to be uploaded on the FertiTOX platform in 2026. TRIAL REGISTRATION ClinicalTrials.gov NCT05885048; https://clinicaltrials.gov/study/NCT05885048. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51145

Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines

INTRODUCTION AND HYPOTHESIS Interstitial cystitis (IC) and bladder pain syndrome (BPS) are challenging and encompassing hypersensitivity disorders of the lower urinary tract. A variety of national and international guidelines have been published including guidance on nomenclature, definitions, etiopathology, diagnostics and treatment. A lack of universally established clinical guidance is apparent. The aim of this review is to evaluate key guidelines on this area of practice, identify variations, compare their recommendations and grade them using AGREE II. METHODS Literature searches were performed using the PUBMED and CINAHL database from January 1, 1983, to December 1, 2018, referring to the search strategy of AUA. Ten national and international guidelines were included into the analysis. We assessed the guidelines with the updated AGREE II. RESULTS Symptoms congruent in all guidelines are: pain, pressure, discomfort and frequency, urgency and nocturia. Urinalysis is a prerequisite for diagnostics, cystoscopy for most and urodynamics not part of the routine assessment. Treatment options are recommended stepwise. The highest level of evidence and consensus was identified for oral therapies. Nine guidelines had an overall quality score ≥ 50% and three scored ≥ 70% (AUA, GG, RCOG). CONCLUSIONS The guidelines are congruent in symptom reporting, quite congruent in diagnostics and vary to a high degree on treatment recommendations. The complexity of BPS and emerging evidence indicate the need for regular updating of the guidelines and a wider consensus