Autoimmune disorders: another possible cause for in-vitro fertilization and embryo transfer failure

This study was undertaken to investigate the role of autoantibodiesin association with in-vitro fertilization (IVF) and embryotransfer failure. Anticardiolipin, lupus anticoagulant, anti-deoxyribonucleicacid and antinuclear antibody, rheumatoid factor and antithyroidantibody concentrations were measured. The study group comprised50 IVF patients with three or more previously failed cyclesafter embryo transfer. The control group comprised 80 computer-matchedwomen: 40 who had conceived and delivered following three orless IVF and embryo transfer cycles, and 40 who were healthynulligravidas. The incidence of autoantibodies in the studygroup was 22.0%, compared with 2.5% in the IVF control group(P < 0.05) and 7.5% in the nulligravida group (P < 0.05).In the study group, no statistical difference was found betweenthe patients with unexplained infertility and those with mechanicalinfertility (23.0 and 20.8% respectively). The high occurrenceof autoantibodies found in patients who failed at least threeIVF and embryo transfer cycles could imply that these autoantibodiesmay be one of the possible causes of IVF failure in either mechanicalor unexplained infertility. Further investigations are requiredto indicate the autoantibody profile as part of the work-upafter three or more failed IVF and embryo transfer attempts.     

Familial breast cancer registry program in patients referred to the cancer institute of Iran

Introduction: Annually a considerable number of people die because of breast cancer, a common diseaseamong women also in Iran. Identifying risk factors and susceptible people can lead to prevention or at leastearly diagnosis. Among susceptibility risks, 5-10% of patients have a family history predisposing factor whichcan influence the risk of incidence among the family. Having a registry program can be a more practical wayto screen high risk families for preventive planning. Method: Based on inclusion criteria, a questionnaire wasprepared and after a pilot study on a small number of patients, actual data were collected on 400 patients andprocessed in SPSS 16.0. Results: Totally, 28.2%of the patients were younger than 40 years old and 36.8% hadthe included criteria for familial breast cancer (FBC). 102 patient’s samples could be compared for receptorpresentation. Similar to other studies, the number of triple negative breast cancers increased as the age decreased.Conclusion: The high percentage of patients with FBC among 400 cases in this study demonstrates that in orderto design an infrastructural diagnostic protocol and screening of patients with FBC, a precise survey related tofrequency and founder mutations of FBC is needed nationwide.     

Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence

Objective

To report our clinical experience in adnexal torsion.

Study design

A retrospective case review of surgically proven adnexal torsion.

Results

216 cases were identified. Mean age was 29 ± 12. Twenty-two were premenarchal, 59 had ovarian stimulation, 48 were pregnant (with a median gestational age of 7 weeks) and 14 were post-menopausal. The most common risk factor was a previous history of adnexal torsion. The main clinical features were sudden, intermittent pain. Forty-five percent of Doppler examinations demonstrated normal flow: premenarchal and postmenopausal patients had higher rates of abnormal flow, compared to pregnant patients or after ovarian stimulation. Median time from admission to diagnosis was 6 h. Laparoscopy was conducted in 81.0% of the cases, and laparotomy in the rest. Twenty-three cases of recurrent torsion were documented. The majority of these events occurred following detorsion only. An enlarged ovary was found in 77 cases, dermoid cyst in 8 cases, and one case was malignant. Sixty eight-cases underwent detorsion, in 82 cases a combined detorsion and cystectomy or fenestration were performed and 43 patients underwent partial or total adnexectomy. Adnexal fixation was conducted in 21 cases. Cyst drainage or cystectomy significantly reduced the chance of retorsion by 50% and 75%, respectively, compared to detorsion only.

Conclusion

Ovarian stimulation and early pregnancy are predisposing factors for ovarian torsion. Doppler flow studies may be a helpful diagnostic tool among premenarchal and post-menopausal women. Cystectomy should be considered in order to reduce the risk of retorsion.     

Ovarian stimulation and emergency in vitro fertilization for fertility preservation in cancer patients

Objective

To evaluate the outcome of ovarian stimulation and in vitro fertilization (IVF) in women undergoing fertility preservation prior to chemotherapy compared with healthy patients with infertility due to tubal factor.

Study design

Case control, retrospective study in an academic IVF unit. The study participants were 21 cancer patients and 1 patient with focal proliferative glomerulosclerosis, undergoing emergency IVF or intracytoplasmic sperm injection (ICSI; Group A) and 22 patients undergoing IVF for tubal factor (Group B). All patients underwent controlled ovarian stimulation, ovum pick-up, and embryo freezing or transfer. The outcome measures included: dose of gonadotropins, mean estradiol and progesterone levels, length of stimulation, number of retrieved oocytes, number of 2 pronuclei zygotes, fertilization rate, and clinical pregnancy rate. Student's t-test was used for assessment of group comparisons.

Results

Patients in Group A (mean age 32.8 ± 5.7 years) underwent 22 emergency IVF cycles for fertility preservation prior to chemotherapy. The mean number of days until human chorionic gonadotropin administration was 10.4 ± 4.8. Eleven cycles involved normal insemination while nine involved ICSI. In one cycle three arrested immature oocytes were retrieved, and in one cycle no oocytes were retrieved. Donor sperm was used in 9 cycles. Tamoxifen was part of the treatment protocol in 6 IVF cycles of breast cancer patients. The mean age of the women in Group B was 34 ± 4.2 years. There were no significant differences in any of the main outcome measures between the two groups. Thawed embryos were transferred in four cancer patients: two patients had colon cancer, one had breast cancer and one had pseudomyxoma peritonei. Two of these four women conceived and gave birth to healthy newborns.

Conclusions

Emergency IVF is a promising approach for preserving fertility in cancer patients. Current treatment protocols offer a minimal time delay until chemotherapy is commenced, and the ovarian stimulation outcomes are comparable to those of women with tubal factor.     

Pharmacological and psychological effects of caffeine ingestion in 40-km cycling performance

The ergogenic effects of caffeine are well documented. Research has yet to examine any psychological contribution to this effect. AIM: To explore the psychological and pharmacological effects of caffeine in laboratory cycling performance. METHOD: Fourteen male competitive cyclists performed 14 40-km time trials (eight experimental interspersed with six baseline). The experimental phase consisted of two trials for each of four experimental conditions: informed caffeine/received caffeine, informed no treatment/received caffeine, informed caffeine/received placebo, and informed no treatment/received no treatment. Conditions were nonrandomized. ANOVA was used to estimate main effects and interactions for mean values of power, heart rate, blood lactate, and maximal oxygen uptake. Probabilistic inferences for mean power were based on a smallest worthwhile change of 1.5%. RESULTS: Relative to baseline, a very likely beneficial main effect of receiving caffeine (3.5%; 95% confidence interval 1.5 to 5.5%), and a possibly beneficial main effect of being informed of caffeine (0.7%; -0.7 to 2.1%) were observed. A substantial interaction between belief and pharmacology indicated that caffeine exerted a greater effect on performance in conditions when subjects were informed that they had not ingested it, whereas belief exerted a greater influence on performance in the absence of caffeine (2.6%; -0.7 to 5.9%). A possibly harmful negative placebo (nocebo) effect was observed when subjects were correctly informed that they had ingested no caffeine (-1.9%; -4.1 to 0.3%). No clinically significant changes relative to baseline were observed in mean heart rate. Clear and substantial increases in blood lactate were evident after receipt of caffeine. Data for mean oxygen uptake were unclear. CONCLUSION: Our data support the ergogenic efficacy of caffeine but suggest that both positive and negative expectations impact performance.     

Experience with starting tacrolimus postoperatively after transsternal extended thymectomy in patients with myasthenia gravis

BACKGROUND: Thymectomy is a standard treatment of myasthenia gravis (MG). Immunomodulating agents are frequently given during the post-thymectomy latency period until complete remission is fully consolidated, but serious side effects is a relevant clinical problem for patients on long-term immunomodulating treatment. OBJECTIVE: To assess the effectiveness of starting tacrolimus in the immediate postoperative period in MG patients undergoing transsternal extended thymectomy, with complete stable remission (CSR) as the primary outcome of the study. METHODS: Forty-eight MG patients received tacrolimus, 0.1 mg/kg per day b.i.d. (started 24 h after thymectomy) and prednisone 1.5 mg/kg/day. Histologically, 34 patients had hyperplasia, 20 thymic involution, and 14 thymoma. Of the 48 patients, 40 completed 1 year of tacrolimus therapy, 38 completed 2 years, 27 completed 3 years, 21 completed 4 years, and 9 more than 5 years. Mean dose of tacrolimus was 4.9 mg/day (range 2-8 mg/day) with a mean plasma drug concentration of 7.6 ng/mL (range 7-9 ng/mL). Prednisone could be withdrawn after the first year in 93.7% of patients and at 2 years in 100%. RESULTS: The mean follow-up was 24.4 months, SD 17.3 (range 6-60 months). Improvement of muscular strength and decrease of anti-AChR antibodies were statistically significant (p < 0.001) shortly after operation. CSR was obtained in 33.4% of patients, pharmacological remission in 62.6%; 4% of patients had minimal symptoms. None of the patients with thymoma achieved CSR. The estimated median follow-up to obtain a CSR was 37.9 months (95% confidence interval [CI] 26.4-49.5 months). The overall crude CSR rate was 33.4%, with 47% for non-thymoma patients. The probability to achieve CSR at 3 years was 67% for the non-thymomatous group. CONCLUSIONS: Long-term immune-directed treatment with tacrolimus to improve the effectiveness of thymectomy in MG is feasible and was associated with a high rate of CSR in patients without thymoma.