Search

Adenomyosis, characterized by the presence of endometrial glands and stroma within the myometrium, can have a substantial impact on the quality of women's lives. Despite this, the epidemiologic research on this condition lags considerably behind that of other noncancerous reproductive health conditions. The lack of progress and knowledge is due in part to the challenges in designing valid epidemiologic studies, since the diagnosis of adenomyosis historically has been limited to the examination of uterine specimens from hysterectomy. This review describes the available data on the frequency of this condition and the epidemiologic investigation thus far into the risk factors for disease—highlighting the methodologic and inference challenges primarily around study sample selection. We conclude with providing recommendations for approaches to future epidemiologic study that capitalize on the advancements in imaging technology to detect adenomyosis and provide a fuller picture of the occurrence and risk factors for disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between demographic, lifestyle, and reproductive factors and the risk of ectopic pregnancy (EP).Design: Prospective cohort.Setting: United States.Patient(s): Nurses' Health Study II cohort comprising 41,440 pregnancies from 22,356 women.Intervention(s): Demographic, lifestyle, and reproductive factors self-reported in 1989 then updated every 2 years. Multivariable log-binomial regression models with generalized estimating equations were used to estimate adjusted risk ratios (aRR).Main Outcome Measure(s): Ectopic pregnancy.Result(s): Incident EP was reported in 411 (1.0%) pregnancies. Former and current smokers had 1.22 (95% confidence interval [CI], 0.97-1.55) and 1.73 (95% CI, 1.28-2.32) times, respectively, the risk of EP compared with never smokers. The risk of EP 10 years after quitting was similar to never smokers (aRR 0.90; 95% CI, 0.60-1.33). Women consuming ≥10 g/day of alcohol had 1.50 (95% CI, 1.08-2.09) times the risk of EP compared with never consumers. In utero exposure to diethylstilbestrol (aRR 3.55; 95% CI, 2.51-5.01), earlier initiation of oral contraceptives (aRR 2.64; 95% CI, 1.70-4.09 for <16 years vs. never), intrauterine device use (aRR 3.99; 95% CI, 2.06-7.72), or history of infertility (aRR 3.03; 95% CI, 2.48-3.71) or tubal ligation (aRR 16.27; 95% CI, 11.76-22.53) also were associated with a higher risk of EP.Conclusion(s): Women who were current or former smokers, consumed ≥10 g/day of alcohol, were exposed to diethylstilbestrol in utero, initiated oral contraceptives at earlier than age 16 years (which may be a marker of riskier sexual behaviors), and who had a history of infertility, intrauterine device use, or tubal ligation had a higher risk of EP. [ABSTRACT FROM AUTHOR]

Study Objective To explore the potential occurrence of long-term side effects and tolerability of gonadotropin-releasing hormone agonist (GnRHa) plus 2 different add-back regimens in adolescent patients with endometriosis. Design Follow-up questionnaire sent in 2016 to patients who participated in a drug trial between 2008 and 2012. Setting Tertiary care center in Boston, Massachusetts. Participants Female adolescents with surgically confirmed endometriosis (n = 51) who enrolled in a GnRHa plus add-back trial as adolescents. Interventions Leuprolide depot 11.25 mg intramuscular injection every 3 months, plus oral norethindrone acetate 5 mg daily or oral norethindrone acetate 5 mg daily and oral conjugated equine estrogens 0.625 mg daily. Main Outcome Measures Side effects during and after treatment, irreversible side effects, changes in pain, overall satisfaction. Results The response rate was 61% (25 of 41; 10 subjects could not be located). Almost all (24 of 25) reported side effects during treatment; 80% (16 of 21) reported side effects lasting longer than 6 months after stopping treatment. Almost half (9 of 20) reported side effects they considered irreversible, including memory loss, insomnia, and hot flashes. Despite side effects, participants rated GnRHa plus add-back as the most effective hormonal medication for treating endometriosis pain; two-thirds (16 of 25) would recommend it to others. More participants who received a modified 2-drug add-back regimen vs standard 1-drug add-back would recommend GnRHa and believed it was the most effective hormonal medication. Conclusion Subjects believed that GnRHa used with add-back was effective and would recommend it to others, despite significant side effects. Those who received 2-drug add-back reported more success than those who received standard add-back. A subset of patients reported side effects they consider to be irreversible. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and experience of migraines in adolescents with surgically confirmed endometriosis compared with those without endometriosis.Design: Cross-sectional study conducted within The Women's Health Study: From Adolescence to Adulthood-an ongoing longitudinal cohort.Setting: Boston Center for Endometriosis.Patient(s): Adolescent females enrolled November 2012 through November 2016. The case group included adolescents surgically diagnosed with endometriosis. The control group included adolescents without endometriosis, recruited from the local community and clinics.Intervention(s): Not available.Main Outcome Measure(s): An extensive online health questionnaire regarding medical history, lifestyle, medication use, anthropometrics, and symptom experience and treatments. Migraine diagnosis was self-reported. Migraine pain and noncyclic pelvic pain severity were rated using an 11-point numerical rating scale. Cyclic pelvic pain was categorized.Result(s): Adolescents with endometriosis were more likely to experience migraines (69.3%) than those without endometriosis (30.7%) (multivariable odds ratio = 4.77, 95% confidence interval 2.53, 9.02). For each 1-point increase in the migraine numerical rating scale, the odds of endometriosis increased by 22% (multivariable odds ratio = 1.22, 95% confidence interval 1.03, 1.44; Ptrend = .02). Among those with endometriosis, age of menarche was associated inversely with the odds of migraines. Participants with endometriosis and migraines have more dysmenorrhea than those without migraines.Conclusion(s): Adolescents with endometriosis are more likely to experience migraines than adolescents without endometriosis. A linear relationship exists between migraine pain severity and the odds of endometriosis, suggesting heightened pain sensitivity for adolescents with endometriosis. Due to the strong correlation, patients who present with either condition should be screened for comorbidity to maximize the benefits of care. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to investigate the clinical predictors of failure of a single dose of methotrexate (MTX) for management of ectopic pregnancy after in vitro fertilization (IVF). Methods: A retrospective cohort study was performed of women who conceived ectopic pregnancies following fresh or frozen IVF cycles at an academic infertility clinic between 2007 and 2014, and received intramuscular MTX (50 mg/m). Successful single-dose MTX treatment was defined as a serum beta-human chorionic gonadotropin (hCG) decline ≥15% between days 4 and 7 post-treatment. Logistic regression models adjusted for oocyte age, number of embryos transferred, and prior ectopic pregnancy were used to estimate the adjusted odds ratio (OR) (95% confidence interval [CI]) of failing one dose of MTX. Results: Sixty-four patients with ectopic pregnancies after IVF were included. Forty required only one dose of MTX (62.5%), while 15 required additional MTX alone (up to four total doses, 23.4%), and 9 required surgery (14.1%). By multivariable logistic regression, the highest tertiles of serum hCG at peak (≥499 IU/L, OR = 9.73, CI 1.88-50.25) and at first MTX administration (≥342 IU/L, OR = 4.74, CI 1.11-20.26), fewer embryos transferred (OR = 0.37 per each additional embryo transferred, CI 0.19-0.74), and adnexal mass by ultrasound (OR = 3.65, CI 1.10-12.11) were each correlated with greater odds of requiring additional MTX and/or surgery. Conclusion: This is the first study to report that in women with ectopic pregnancies after IVF, higher hCG-though well below treatment failure thresholds previously described in spontaneous pregnancies-fewer embryos transferred, and adnexal masses are associated with greater odds of failing one dose of MTX. These findings can be used to counsel IVF patients regarding the likelihood of success with single-dose MTX. [ABSTRACT FROM AUTHOR]

Objective: To determine whether public support for oocyte cryopreservation (OC) exists and if support varies by demographic factors.Design: Cross-sectional electronic survey.Setting: Not applicable.Patient(s): A nationally representative sample based on age, sex, and race of 1,064 people in the United States recruited by the company SurveyMonkey.Interventions(s): Completion of an online questionnaire.Main Outcome Measure(s): Supporters of OC for various indications were compared with participants who were neutral or in opposition by means of log binomial regression to calculate risk ratios. Statistical models were adjusted for demographic characteristics, including sex, race, age, income, sexual orientation, education, marital status, state political party affiliation, and history of being a parent.Result(s): OC for cancer patients was the indication most supported (89%), followed by delayed childbearing for career advancement (72%), current lack of a partner (63%), and insufficient funds for child rearing (58%). Despite considerable support for OC, only 37% agreed employers should fund egg freezing for employees. Older age was associated with lower support for all indications of OC. Younger age, single status, never being a parent, identifying as a sexual minority, and atheist/agnostic religion were associated with the survey taker personally considering OC. Compared with women, men demonstrated lower support for women undergoing OC for "lack of a male partner," and for future use of cryopreserved oocytes without being married.Conclusion(s): In a nationally representative sample, the majority of respondents support elective OC. The indication for OC was associated with significant differences in support. [ABSTRACT FROM AUTHOR]

Purpose: To study the perspectives of the United States population towards the use of preimplantation genetic diagnosis (PGD) in various clinical scenarios. Methods: Online cross-sectional population based questionnaire of a nationally representative sample according to age, gender, race/ethnicity, income, education and religion. Results: A total of 1006 completed the questionnaire with an overall response rate of 94 %. A majority supported PGD for diseases fatal early in life or those causing lifelong disability (72.9 and 66.7 %, respectively); only 48.0 % supported PGD for diseases that manifest late in life. Respondents were more supportive of PGD for genetic diseases if they were aware of PGD prior to the survey (OR = 1.64; CI = 1.13-2.39). However, a small proportion were in favor of genetically-based trait selection: 21.1 % supported PGD for sex selection, 14.6 % for physical traits and 18.9 % for personality traits. Compared to women, men were nearly two- to three-fold more supportive of PGD for sex selection (OR = 1.65; CI = 1.20-2.78), physical traits (OR = 2.38; CI = 1.60-3.48) and personality traits (OR = 2.31; CI = 1.64-3.26). Compared to Caucasians, Asians (OR = 3.87; CI = 1.71-8.78) and African Americans (OR = 1.61; CI = 1.04-2.74) were more supportive of PGD for sex selection. Conclusions: In a nationally representative sample, a majority supported PGD to identify early onset diseases. We noted significant variation in opinions by sex, race, and education. There was more support among those with prior knowledge of PGD suggesting that education about PGD may foster favorable opinions. This study identifies public knowledge and attitudes that may be used to shape future research hypotheses and clinical policies. [ABSTRACT FROM AUTHOR]

Background Endometriosis—ectopic implantation of endometrial-like tissue—affects 10% of female adolescents and adults. First-line treatment includes progesterone only (such as norethindrone acetate [NET-A]) or combined estrogen/progestin oral contraceptive pills. Estrogen-containing contraceptives confer increased risk of hepatic adenomas, whereas the association with NET-A is very rarely reported. Case Three adolescents with stage I to II endometriosis managed with NET-A (up to 15 mg/d for 28-78 months) were diagnosed with hepatic adenomas at ages 17-22 years. They previously received estrogen-containing medications, which were stopped 24 months or longer before diagnosis of hepatic adenoma. Summary and Conclusion NET-A in a dose greater than 10 mg/d might be associated with increased risk for hepatic adenomas, likely due to peripheral conversion to ethinyl estradiol. Use of NET-A might not be advisable in patients with known hepatic adenomas. [ABSTRACT FROM AUTHOR]

Objective: To evaluate how absolute uterine length changes as a result of pregnancy. Methods: Longitudinal repeated-measures study of all women presenting to a university-affiliated clinic for uterine sounding prior to in vitro fertilization (IVF) who went on to deliver at term and return for repeat measurement from 2002 to 2012. Change in uterine length was assessed by the Wilcoxon signed-rank test. Results: Among 495 women, mean pregnancy-associated change in uterine length was 0.0 cm (SD ± 0.7, p = 0.84), with 31% of women experiencing no change and 75% of women experiencing a change ≤0.5 cm. Mean uterine lengths at pre-cycle and repeat measurement were 7.2 cm (SD ± 0.7) and 7.2 cm (SD ± 0.7) with medians of 7.0 cm (IQR 7.0-7.5) and 7.0 cm (IQR 6.8-7.8), respectively. Change in uterine length did not vary by gestational number or within time interval between measurements (all p > 0.5). Conclusions: There was no difference in uterine length before and after term pregnancy. The finding of minimal variation in uterine length both across and within women suggests uterine length may be relatively stable such that patients undergoing IVF after term IVF pregnancy may not require repeat measurement. Future studies might assess pregnancy-associated sonographic changes in uterine volume and the relationship between uterine length and IVF outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of fertility treatments among a large cohort of women in the United States. Design: Cohort study. Setting: Nurses' Health Study II. Patient(s): Ten thousand thirty-six women who reported having used fertility treatment on biennial questionnaires from 1993–2009. Intervention(s): None. Main Outcome Measure(s): Data on patterns of treatment modality were collected via self-report from validated mailed questionnaires. Information on clomiphene, gonadotropin injections alone, and gonadotropin injections as part of intrauterine insemination (IUI) and in vitro fertilization (IVF) was queried. Result(s): Most women who reported fertility treatment used clomiphene (94%), with a large majority reporting clomiphene as their only form of treatment (73%). Of women who reported treatment more advanced than clomiphene, 13% had used gonadotropin injections alone, 11% IUI treatment, and 11% IVF. Several subgroups were more likely to use multiple treatment modalities and to initiate treatment with gonadotropins rather than clomiphene, including women living in states with insurance coverage of fertility procedures, with higher household income, younger in age, who remained nulliparous at the study close, and treated after 2000. Conclusion(s): Results should be interpreted cautiously, but to our knowledge, this represents the first study of fertility treatment patterns in the United States and could inform public health planning. [ABSTRACT FROM AUTHOR]

Purpose: To determine embryo and cycle-specific parameters associated with twin live birth in day 3 cryopreserved double embryo transfer (DET) cycles, and to propose a new prediction model for external validation. Methods: All cycles with autologous or donor cryopreserved DET of day 3 embryos from 2002 to 2011 at a single academic institution with a singleton or twin live birth were included ( n = 207). Patient characteristics, post-thaw embryo morphology and freeze-thaw parameters were compared between patients with a single and twin live birth. Results: Demographic characteristics were similar, except that patients delivering twins were younger at age of cryopreserved embryo transfer (CET), fewer were parous and more were anovulatory. Duration of embryo storage, time in culture post-thaw, endometrial thickness and use of assisted hatching were comparable. Six predictors of twin delivery were identified: patient age <35 year at CET, intact survival of the lead embryo, resumption of mitosis, 7-8 viable cells in the non-lead embryo, transfer of a lead embryo with ≥7 cells and a sum of ≥14 viable cells in the two transferred embryos. Regression modeling predicted a step-wise increase in the probability of twins with addition of each predictor; with all six present, the risk of twins was predicted to be 53 % and with none present, the risk decreased to 6 %. Conclusions: The six identified variables associated with twin live birth following day 3 cryopreserved DET have been applied to derive a prediction model for estimating the risk of twin delivery. External validation of the model is required prior to clinical application. [ABSTRACT FROM AUTHOR]

Objective: To assess pregnancy rates before and after a training intervention in which reproductive endocrinology and infertility fellows were required to perform 100 IUIs before performing ETs. Design: Retrospective cohort study. Setting: Large, academic training program. Patient(s): Not applicable. Intervention(s): Comparing pregnancy rates between two time periods: July 1998–June 2001 (before IUI intervention) and July 2001–June 2010 (after IUI intervention). Main Outcome Measure(s): Clinical pregnancy rate (PR) for the first 100 ETs performed by fellows before and after the IUI training; median attending physician PR during each time period served as the referent. Multivariate generalized estimating equations were used to calculate odds of pregnancy per ET for fellows as compared with attending physicians. Result(s): Multivariate analyses revealed no significant difference in PR for the first 100 ETs performed by fellows as compared with attending physicians, before or after the IUI training requirement (odds ratio 0.99, 95% confidence interval 0.82–1.20 and odds ratio 0.91, 95% confidence interval 0.81–1.30, respectively). The median attending physician PR in the preintervention group was exceeded by fellows after the first 70 ETs; fellows in the postintervention group exceeded the median attending physician PR after 100 ETs. The PR in both groups improved as fellows progressed from the first 20 to 100 ETs. Conclusion(s): The PR for the first 100 ETs performed by fellows was unchanged after implementing an IUI training requirement. The substantial variation noted among individual fellows decreased as more ETs were completed. [ABSTRACT FROM AUTHOR]

Abstract: Prolactin (PRL) and thyroid stimulating hormone (TSH) serve important roles in the reproductive and other systems. Active smoking is associated with changes in PRL and TSH secretion, but the relationship between secondhand tobacco smoke (STS) exposure and these hormones is unclear. We measured PRL and TSH in serum as well as cotinine in follicular fluid (to estimate STS exposure) among 314 nonsmoking women undergoing in vitro fertilization treatment. We observed a significant increase in PRL concentrations (p =0.03) among STS-exposed nonsmokers compared to unexposed nonsmokers. There was no significant difference in TSH concentration (p >0.4) among those exposed to STS compared to those who were unexposed. STS exposure is associated with an increase in circulating PRL but not TSH levels. Future studies are needed to confirm our results, identify biological mechanisms involved, and better understand the potential clinical and public health implications. [Copyright &y& Elsevier]

BACKGROUND: Hexachlorobenzene (HCB), dichlorodiphenyltrichloroethane (DDT), and dichlorodiphenyldichloroethylene (DDE) are persistent chlorinated pesticides with endocrine activity that may adversely affect the early stages of human reproduction. OBJECTIVE: Our goal was to determine the association of serum levels of HCB, DDT, and DDE with implantation failure, chemical pregnancy, and spontaneous abortion in women undergoing in vitro fertilization (IVF) from 1994 to 2003. METHODS: Levels of HCB and congeners of DDT and DDE were measured in serum collected during the follicular phase. Multivariable-adjusted statistical models accommodating multiple outcomes and multiple cycles per woman were used to estimate the relation between serum pesticide levels and IVF outcomes. RESULTS: A total of 720 women with a mean ± SD age 35.4 ± 4.2 years at enrollment contributed 774 IVF cycles. All samples had detectable levels of HCB, DDT, and DDE, with median levels of 0.087 ng/g serum for HCB, 1.12 ng/g serum for total DDT, and 1.04 ng/g serum for p,p´-DDE. Compared with the lowest quartile (Q1) of HCB, the lipid- and multivariable-adjusted odds ratio (OR) for failed implantation was significantly elevated for those with higher HCB quartiles [Q2-Q4; adjusted ORs: for Q2, 1.71; 95% confidence interval (CI): 1.03, 2.82; for Q3, 2.30; 95% CI: 1.39, 3.81; for Q4, 2.32; 95% CI: 1.38, 3.90] and showed a significantly increasing trend (p = 0.001). No statistically significant associations were observed between DDT/DDE and IVF outcomes or between HCB and chemical pregnancy or spontaneous abortion. CONCLUSIONS: Serum HCB concentrations were on average lower than that of the general U.S. population and associated with failed implantation among women undergoing IVF. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of prior chemotherapy and radiation on assisted reproductive technology (ART) outcomes. Design: Retrospective cohort study. Setting: University-based infertility clinic. Patient(s): Female cancer survivors who had received chemotherapy or radiation and all other women undergoing first-fresh IVF/intracytoplasmic sperm injection (ICSI) cycles. Intervention(s): Survivors’ ART outcomes were compared with all women undergoing first-fresh IVF/ICSI cycles and those with male-factor infertility only. Multivariate logistic and Poisson regression analyses were used to estimate the effect of cancer therapy on ART outcomes. Main Outcomes Measure(s): Number of oocytes retrieved and embryos obtained; odds of cycle cancelation, clinical pregnancy, and live birth. Result(s): Compared with others undergoing IVF/ICSI, survivors had significantly fewer oocytes retrieved and embryos available for transfer. In addition, survivors were significantly more likely to be canceled (odds ratio [OR] 5.60, 95% CI 2.94–10.66) and had lower pregnancy and live birth rates (OR 0.30, 95% CI 0.13–0.68; and OR 0.27, 95% CI 0.10–0.69; respectively). Odds ratios were stronger when the comparison group was restricted to those with male-factor infertility only. Conclusion(s): Women who have received systemic therapy for malignancy should be considered to be low responders and counseled that their per-cycle live birth rate is lower than that of their peers. These data strongly support offering fertility preservation before cancer therapy when possible. [ABSTRACT FROM AUTHOR]

Purpose. It is well known that chemotherapy regimens may have a negative effect on ovarian reserve, leading to amenorrhea or premature ovarian failure. There are little data regarding the effects of leukemia chemotherapy on ovarian reserve, specifically in women who received the chemotherapy as adults and are having regular menstrual periods. Our primary objective was to determine if premenopausal women with a history of chemotherapy for leukemia, without subsequent stem cell transplantation, have decreased ovarian reserve. Materials and Methods. Wemeasured ovarian reserve in five women who had been treated for acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML) and compared them to age-matched control women without a history of chemotherapy. Results. There appeared to be a trend towards lower antimullerian hormone and antral follicle counts and higher follicle-stimulating hormone levels in the leukemia group. Conclusion. Our results indicate that chemotherapy for AML or ALL without stem cell transplantation may compromise ovarian reserve. Although our results should be confirmed by a larger study, oncologists, infertility specialists, and patients should be aware of the potential risks to ovarian function and should be counseled on options for fertility preservation. [ABSTRACT FROM AUTHOR]

Purpose. It is well known that chemotherapy regimens may have a negative effect on ovarian reserve, leading to amenorrhea or premature ovarian failure. There are little data regarding the effects of leukemia chemotherapy on ovarian reserve, specifically in women who received the chemotherapy as adults and are having regular menstrual periods. Our primary objective was to determine if premenopausal women with a history of chemotherapy for leukemia, without subsequent stem cell transplantation, have decreased ovarian reserve. Materials and Methods. Wemeasured ovarian reserve in five women who had been treated for acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML) and compared them to age-matched control women without a history of chemotherapy. Results. There appeared to be a trend towards lower antimullerian hormone and antral follicle counts and higher follicle-stimulating hormone levels in the leukemia group. Conclusion. Our results indicate that chemotherapy for AML or ALL without stem cell transplantation may compromise ovarian reserve. Although our results should be confirmed by a larger study, oncologists, infertility specialists, and patients should be aware of the potential risks to ovarian function and should be counseled on options for fertility preservation. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between patient characteristics at diagnosis of premenopausal breast cancer, including gravidity, parity, age at menarche, age at first birth, alcohol use, smoking history, weight, height, and body mass index (BMI), with the development of persistent chemotherapy-related amenorrhea (CRA) in follow-up. Design: Retrospective cohort study. Setting: Dana Farber Cancer Institute and Brigham and Women’s Hospital. Patient(s): Premenopausal women with breast cancer. Intervention(s): We identified all premenopausal women who received standard adjuvant chemotherapy during 1997–2005 for whom menstrual data were available. Multivariable logistic regression models evaluating persistent amenorrhea at ≥6 month after completion of chemotherapy were conducted. Main Outcome Measure(s): Persistent chemotherapy-related amenorrhea (CRA) at ≥6 months from completion of chemotherapy. Result(s): A total of 431 women met eligibility criteria and had ≥6-months’ follow-up. Women with older (>13 years) vs. younger (12–13 years) age at menarche were more than twice as likely to remain amenorrheic. Current smokers had 2.4 greater odds of CRA vs. never smokers, although this association was not statistically significant (95% confidence interval, 0.86–6.75). Conclusion(s): Few identifiable factors contribute to the variability in CRA among premenopausal women after adjuvant chemotherapy for breast cancer. Further research to improve the prediction of CRA, premature menopause, and infertility in young breast cancer survivors is warranted. [ABSTRACT FROM AUTHOR]

Background: Infertility and early pregnancy loss are prevalent as is exposure to secondhand tobacco smoke (STS). Previous research has suggested a relationship between STS exposure and early pregnancy loss, but studies have been limited by small study sizes and/or imprecise methods for exposure estimation. IVF allows for the collection of follicular fluid (FF), the fluid surrounding the pre-ovulatory oocyte, which may be a more biologically relevant sample media than urine or serum in studies of early reproduction.Methods: In a retrospective analysis of a prospective cohort study, we measured cotinine in FF collected during 3270 IVF treatment cycles from 1909 non-smoking women between 1994 and 2003 to examine the relationship between STS exposure and implantation failure.Results: In adjusted models, we found a significant increase in the risk of implantation failure among women exposed to STS compared with those unexposed [odds ratio (OR) = 1.52; 95% confidence interval (CI) = 1.20-1.92; risk ratio (RR) = 1.17; 95% CI = 1.10-1.25]. We also found a significant decrease in the odds for a live birth among STS-exposed women (OR = 0.75; 95% CI = 0.57-0.99; RR = 0.81; 95% CI = 0.66-0.99).Conclusions: Female STS exposure, estimated through the measurement of cotinine in FF, is associated with an increased risk of implantation failure and reduced odds of a live birth. [ABSTRACT FROM AUTHOR]

The article discusses a study on the effect of obesity on oocyte and embryo quality in women undergoing in vitro fertilization (IVF). The researchers aimed to estimate the effect of body mass index (BMI) on oocyte and embryo parameters and cycle outcomes in women undergoing IVF. The researchers retrospectively evaluated 1,721 women undergoing a first IVF cycle with fresh, autologous embryos from 2007 to 2010 in an academic infertility practice. The study indicates that women with class II and III BMI obesity had fewer normally fertilized oocytes.

Abstract: We examined the relationship between cotinine measures in follicular fluid (FF) and urine to inform our exposure assessment strategy for an ongoing epidemiological study of secondhand tobacco smoke (STS) exposure and early pregnancy loss. Among subjects undergoing in vitro fertilization (IVF), we compared cotinine levels in paired urine and FF samples from the same women and examined FF cotinine levels over time. We found a weak rank-order relationship (Spearman r <0.2) and poor agreement for classifying nonsmoking individuals as exposed to STS (sensitivity=0.29–0.71; specificity=0.35–0.72) between cotinine concentrations in FF and urine. We observed fair reliability (ICC=0.42–0.52) in FF cotinine concentrations from women undergoing multiple IVF cycles. If available, FF cotinine concentrations may be desired as a biomarker of low-level tobacco smoke exposure over urinary cotinine in studies of early reproduction. Collection of multiple FF samples for cotinine analysis may be needed to accurately represent long-term STS exposure. [Copyright &y& Elsevier]

Objective: To identify cultural differences in access to infertility care. Design: Cross-sectional, self-administered survey. Setting: University hospital–based fertility center. Patient(s): Thirteen hundred fifty consecutive women who were seen for infertility care. Intervention(s): None. Main Outcome Measure(s): Details about demographic characteristics, health care access, and treatment opinions based on patient race or ethnicity. Result(s): The median age of participants was 35 years; 41% were white, 28% African American, 18% Hispanic, and 7% Asian. Compared with white women, African American and Hispanic women had been attempting to conceive for 1.5 years longer. They also found it more difficult to get an appointment, to take time off from work, and to pay for treatment. Forty-nine percent of respondents were concerned about the stigma of infertility, 46% about conceiving multiples, and 40% about financial costs. Disappointing one’s spouse was of greater concern to African-American women, whereas avoiding the stigmatization of infertility was of greatest concern to Asian-American women. Conclusion(s): While the demand for infertility treatment increases in the United States, attention to cultural barriers to care and cultural meanings attributed to infertility should be addressed. Enhanced cultural competencies of the health care system need to be employed if equal access is to be realized as equal utilization for women of color seeking infertility care. [Copyright &y& Elsevier]

Objective: To investigate whether egg retrieval at ≥36.5 hours improves IVF outcomes in women aged ≥40 years. Design: Retrospective cohort study. Setting: Academic medical center. Patient(s): First-attempt autologous IVF cycles without preimplantation genetic diagnosis, IUI conversion, or intentional delayed egg retrieval were included (n = 3,231). Cycles were stratified by age and hCG exposure (<36.5 vs. ≥36.5 hours). Intervention(s): None. Main Outcome Measure(s): Oocyte yield, maturity, fertilization, embryo quality, implantation, clinical pregnancy, and live birth were analyzed, controlling for age and gonadotropins. Stimulation type, hMG use, stimulation days, day-3 FSH level, and diagnosis were evaluated as potential confounders. Multivariable regression analyses were performed and Wald tests for trend calculated. Result(s): No consistent differences in oocyte yield, maturity, fertilization, or embryo quality were detected. No absolute differences in outcomes were noted among group comparisons. However, as age increased, significant trends toward improved implantation, clinical pregnancy, and live birth were detected at ≥36.5 hours. Conclusion(s): Extending exposure to hCG for ≥36.5 hours may be beneficial in patients aged ≥40 years. A prospective, randomized study is warranted to determine whether retrieval time merits revision for patients of advanced age, as well as the age cutoffs at which such protocols should be applied. [Copyright &y& Elsevier]

Objective: To determine the prevalence and the relative benefits conferred by selective and spontaneous reduction of one or more fetuses in trichorionic triamniotic triplet pregnancies on time to delivery. Design: Retrospective cohort study. Setting: Academic medical center. Patient(s): IVF patients with trichorionic triamniotic triplets between January 1998 and December 2007. Intervention(s): None. Main Outcome Measure(s): Gestational length at time of delivery. Result(s): Selective reduction to twins was used in 87 of the 153 (56.9%) triplet pregnancies that did not spontaneously reduce prior to <12 weeks, and was associated with longer gestation (13.9 days) with a fourfold greater likelihood of delivery at ≥34 weeks'' gestation (odds ratio [OR], 4.3; 95% confidence interval [CI] = 2.2–8.6), compared with pregnancies not undergoing selective reduction. Compared with ongoing triplets, spontaneous reduction at <12 weeks'' gestation (28 cases) was associated with longer gestation (13.7 days) and significantly greater likelihood delivering at or after 34 weeks'' gestation (OR, 3.7; 95% CI, 1.4–9.9). Conclusion(s): Selective reduction of one fetus was used in 56.9% of patients in this population. Early spontaneous reduction (<12 weeks) and selective reduction to twins each conferred similar benefits by extending time to delivery and increasing the likelihood of delivery at or after 34 weeks'' gestation. [Copyright &y& Elsevier]

Objective: To evaluate embryo yield after IVF in patients undergoing embryo banking before chemotherapy. Design: A retrospective cohort study. Setting: Hospital-based academic medical center. Patient(s): Thirty-eight women diagnosed with cancer or autoimmune disease presenting for IVF cycles, with or without intracytoplasmic sperm injection (ICSI), for embryo cryopreservation before any therapy were compared with 921 presumably fertile women undergoing IVF for male factor infertility from January 2001 through October 2007. Intervention(s): Standard IVF or ICSI protocol, embryo freezing, and ET. Main Outcome Measure(s): The number of 2 pronuclear (2PN) embryos created and suitable for cryopreservation or transfer. Result(s): No statistically significant differences were observed between preservation and male factor groups for number of embryos, number of oocytes, or amount of gonadotropin needed to stimulate follicular development. Peak serum E2 levels were significantly lower for women with disease-seeking fertility preservation. Conclusion(s): Women facing chemotherapy as treatment for cancer or systemic autoimmune disease infrequently undergo fertility preservation. If offered this potentially fertility-preserving option, these data suggest equivalent embryo yield compared with women with infertile male partners. Our data report no significant complications in subsequent births in those who sought fertility preservation, which is informative and encouraging for these women and their providers. [ABSTRACT FROM AUTHOR]

Objective: To determine whether oocyte donor FSH and age are independently associated IVF cycle success.Design: Retrospective cohort study.Setting: University hospital-based IVF clinic.Patient(s): Three hundred twelve donor/recipient pairs undergoing oocyte donation IVF.Main Outcome Measure(s): Number of mature oocytes and embryos, clinical pregnancy, and live birth rates.Result(s): Donors' basal FSH levels were not associated with IVF cycle outcomes. However, for every year increase in donor age, the number of mature oocytes decreased by 0.39 and the number of embryos decreased by 0.25 resulting in 1 less embryo for each 4-year increase in age, even in young donors. For every 100 pg/mL increase in estradiol on the day of hCG administration, the number of mature oocytes increased by 0.49 and the number of embryos increased by 0.36. For each additional 75 IU of gonadotropin used during stimulation, the likelihood of pregnancy and live birth decreased by 3.5%.Conclusion(s): Donor oocyte IVF cycle outcomes were not associated with donor basal FSH. However, donor age and estradiol level on the day of hCG administration were significantly associated with numbers of mature oocytes and embryos obtained, and the amount of gonadotropin used in the stimulation was significantly associated with the likelihood of pregnancy and live birth. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a prevalent but enigmatic gynecologic disorder for which few modifiable risk factors have been identified. Fish oil consumption has been associated with symptom improvement in studies of women with primary dysmenorrhea and with decreased endometriosis risk in autotransplantation animal studies.Methods: To investigate the relation between dietary fat intake and the risk of endometriosis, we analyzed 12 years of prospective data from the Nurses' Health Study II that began in 1989. Dietary fat was assessed via food frequency questionnaire in 1991, 1995 and 1999. We used Cox proportional hazards models adjusted for total energy intake, parity, race and body mass index at age 18, and assessed cumulatively averaged fat intake across the three diet questionnaires.Results: During the 586 153 person-years of follow-up, 1199 cases of laparoscopically confirmed endometriosis were reported. Although total fat consumption was not associated with endometriosis risk, those women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis compared with those with the lowest fifth of intake [95% confidence interval (CI) = 0.62-0.99; P-value, test for linear trend (Pt) = 0.03]. In addition, those in the highest quintile of trans-unsaturated fat intake were 48% more likely to be diagnosed with endometriosis (95% CI = 1.17-1.88; Pt = 0.001).Conclusion: These data suggest that specific types of dietary fat are associated with the incidence of laparoscopically confirmed endometriosis, and that these relations may indicate modifiable risk. This evidence additionally provides another disease association that supports efforts to remove trans fat from hydrogenated oils from the food supply. [ABSTRACT FROM AUTHOR]

Objective: To determine the success rates and utility of controlled ovarian hyperstimulation in conjunction with intrauterine insemination (COH/IUI) cycles in women aged 38–39 years versus women ≥40 years old. Design: Retrospective cohort study. Setting: Tertiary-care academic medical center. Patient(s): There were 130 women, 57 aged 38–39 years (42.6%) and 73 aged ≥40 years (57.4%), who underwent 262 IUI cycles (range 1–3 cycles per woman). Intervention(s): Infertility treatments with gonadotropins and IUI. Main Outcome Measure(s): Clinical pregnancy rates and live birth rates stratified by age. Result(s): The most common infertility diagnosis was diminished ovarian reserve, which was found more frequently among women aged ≥40 years than among the slightly younger group. The age-specific groups were similar in their baseline characteristics and cycle parameters. Women who were 38–39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women ≥40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle. Conclusion(s): The efficacy of COH/IUI cycles significantly decreases with age, but women aged 38–39 years had reasonable success during the first two cycles. However, for women aged ≥40 years, no benefit after a single cycle of COH/IUI was observed. Women aged ≥40 years should be considered for in vitro fertilization after one failed COH/IUI cycle. [Copyright &y& Elsevier]

The article presents a study which investigates the effects of paclitaxel (T) addition to doxorubicin and cyclosphamide (AC) and the use of dose dense (DD) and trastuzumab in chemotherapy related amenorrhea (CRA) in premenopausal women with breast cancer. The study performed the analysis to the women who received adjuvant AC chemotherapy or DD therapy and were diagnosed premenopausal. The results reveal that amenorrheic does not differ from patients who received AC-T from those who received AC.

Objective: To determine whether the use of GnRH antagonist in cycles converted from ovulation induction-IUI to IVF affects cycle outcome and pregnancy rates. Design: Retrospective cohort study. Setting: Academic research institution. Patient(s): One hundred eighty-two consecutive patients with ovulation induction-IUI to IVF conversions undergoing oocyte retrieval conducted at our institution from 2004 to 2006. Intervention(s): The relation between observation of fetal heartbeat and GnRH antagonist exposure was evaluated with use of multivariable logistic regression. The difference in intermediate cycle outcomes by antagonist exposure was estimated with use of linear regression. Main Outcome Measure(s): Fetal cardiac activity on early ultrasound, intermediate cycle parameters. Result(s): For patients given treatment with a GnRH antagonist, the odds ratio for achieving pregnancy was 2.13 (95% confidence interval = 1.03-4.39) compared with untreated patients, independent of age and E(2) levels on day of hCG. Patients given antagonist had 1.6 more follicles and 2.1 more oocytes retrieved, 1.9 more mature oocytes, and 2.3 more fertilized oocytes, and the fertilization rate was 9.7% higher. Conclusion(s): Gonadotropin-releasing hormone antagonist use in ovulation induction-IUI to IVF conversions was associated with increased pregnancy rates and improved intermediate cycle parameters, controlled for age and E(2) levels on day of hCG. Addition of a GnRH antagonist should be considered in ovulation induction-IUI to IVF conversions. [ABSTRACT FROM AUTHOR]

Objective: To examine in detail the geographic distribution of reproductive endocrinology and infertility (REI) fellowships in the United States. Design: Ecological. Setting: University-based REI fellowship program. Patient(s): None. Intervention(s): None. Main Outcome Measure(s): Number and location of REI fellowship positions. Result(s): A significant association was found between the number of REI fellowship positions and the number of categorical postgraduate year-1 (PGY-1) obstetrics and gynecology (OBGYN) residency positions within states. No association was observed among the land area, population, or population density within states. However, despite the fact that in the East, as in the United States overall, there was no association between population density and number of fellowships, West of the Mississippi River, as the population density increased, the number of REI fellowships increased linearly (test for heterogeneity = 0.007). Conclusion(s): First-year REI fellowship positions in the United States are correlated with the number of categorical PGY-1 OBGYN residency positions within a state. The geographically uneven distribution of fellowship positions may limit the choices for OBGYN residents wishing to pursue further training in REI. [Copyright &y& Elsevier]

In this retrospective, matched-paired study, yeast in the embryo culture medium was associated with a trend toward decreased developmental competency that was more pronounced when observed early in culture. Because live births occurred after transfer of embryos in the yeast-contaminated group, we concluded that yeast contamination is not a reason to cancel embryo transfer (ET). [Copyright &y& Elsevier]

Objective: To determine the opinions of infertility patients regarding selling extra embryos, and to investigate the relation between patient choice and demographic and socioeconomic characteristics. Design: Cross-sectional, self-administered survey. Setting: University hospital-based fertility center. Patient(s): 1350 consecutive women who presented for infertility care. Intervention(s): None. Main Outcome Measure(s): Patient opinion regarding selling extra embryos to other couples, and correlations with their demographic and socioeconomic background. Result(s): Of respondents with a definitive opinion, 56% felt that selling extra embryos to other couples should be allowed. After adjustment for observed predictors favoring selling extra embryos, we found statistically significantly lower support for selling embryos among patients who were Hispanic (relative to Caucasians) or had never been pregnant, whereas significantly greater support was observed among Hindu and secular women, patients being treated for male factor infertility, and those who in the past had or were currently undergoing intrauterine insemination. Age, education, marital status, and parity were not statistically significantly associated with the opinions about selling extra embryos to other couples. Conclusion(s): A large proportion of infertility patient participants approved of selling leftover embryos to other couples. However, some demographic and reproductive factors are significantly associated with patient opinion. [Copyright &y& Elsevier]

Objective: To determine the opinions among infertility patients regarding embryonic stem cell research and to investigate the relationship between patients'' choice and their demographic and socioeconomic characteristics. Design: Cross-sectional, self-administered survey. Setting: University hospital–based fertility center. Patient(s): A total of 1,350 consecutive women who presented for infertility care. Intervention(s): None. Main Outcome Measure(s): Patient opinion regarding embryonic stem cell research, and correlations to their demographic and socioeconomic background. Result(s): Of respondents with a definitive opinion, 73% felt that the use of left-over embryos for stem cell research should be allowed. After adjustment for observed predictors favoring embryonic stem cell research, we found significantly lower support for such research among patients who were younger, African American, Hispanic, less wealthy, Protestant, single, or trying to conceive for a longer duration. Those who in the past had or were currently undergoing assisted reproductive techniques were significantly more likely to approve, whereas reproductive history was not associated with the opinions about the use of spare embryos for stem cell research. Conclusion(s): The majority of infertility patients studied favor use of left-over embryos for stem cell research. Several demographic and socioeconomic factors, however, are significantly associated with patient opinion. [Copyright &y& Elsevier]

Purpose To determine the demand and preferences of infertility patients for sex selection for nonmedical reasons, and to investigate the relation between these choices and their demographic and socioeconomic characteristics. Methods A cross-sectional, self-administered survey by mail was conducted at a University hospital-based fertility center of 1,350 consecutive women who presented for infertility care, to assess patient demand and preferences for sex selection. Results Of respondents, 49% wanted to select the sex of their next child for no added cost. Of these patients, 56% had no living children and 37% had children all of one sex. After adjustment for observed predictors of gender preference, we found a significant preference for a female child among women who had only sons, had more living children, or were single. Nulliparous women did not significantly prefer one sex over the other. Among parous women, those with only daughters significantly desired to select a male child, whereas those with sons significantly desired to select a female child. Conclusion There is significant demand among infertility patients for preimplantation sex selection, with a significant portion of this demand coming from patients who do not have any children or have children all of one sex. [ABSTRACT FROM AUTHOR]

Most research treats endometriosis as a single entity, potentially obscuring informative subtype-specific associations with risk factors, biomarkers and treatment responses. A 2020 study raises the hypothesis that deep endometriosis oestrogen receptor-α expression might be associated with progestin treatment and the degree of post-surgical excision pain. [ABSTRACT FROM AUTHOR]

Background: Higher levels of endogenous sex steroid hormones are associated with increased risks of breast cancer in postmenopausal women. Data for premenopausal women are sparse, in part because of the complexity of measuring hormone levels that vary cyclically. We prospectively evaluated associations between plasma sex hormone levels and breast cancer risk among premenopausal women in a case-control study nested within the Nurses' Health Study II. Methods: From 1996 to 1999, blood samples were collected from 18 521 premonoupausal women during the early follicular and mid-luteal phases of their menstrual cycles. A total of 197 cases of breast cancer were diagnosed among these women after blood collection and before June 1, 2003: these cases subjects were matched to 394 control subjects. Logistic regression models, controlling for breast cancer risk factors, were used to calculate relative risks (RRs) and 95% confidence intervals (CIs). All statistical tests were two-sided. Results: Women in the highest (versus the lowest) quartiles of follicular total and free estradiol levels had statistically significantly increased risks of breast cancer (RR = 2.1 [95% CI - 1.1 to 4.1], Ptrend = .08, and RR = 2.4 [95% CI = 1.3 to 4.5]. Ptrend = .01, respectively); the associations were stronger for invasive breast cancer and for estrogen and progesterone receptor-positive (ER+/PR+) tumors. Luteal estradiol levels were not associated with breast cancer risk. Higher levels of total and free testosterone and androstenedione in both menstrual cycle phases were associated with modes, non-statistically significant increases in overall risk of breast cancer and with stronger, statistically significant increases in risks of invasive and ER+/PR+ cancers (e.g., RR of invasive cancers for the top [versus bottom] quartile of luteal total testosterone levels = 2.0 [95% CI = 1.4 to 6.0], Ptrend = .02). Levels of estrone, estrone sulfate, progesterone, and sex hormone-binding globulin were not associated with breast cancer risk. The absolute number of cases observed over 3 years were 30 among women in the lowest 25% of follicular total estradiol levels and 50 among women in the highest 25%. Conclusions: Levels of circulating estrogens and androgens may be important in the etiology of premenopausal breast cancer. [ABSTRACT FROM AUTHOR]

The article presents clinical research that determines whether exercise before human in vitro fertilization (IVF) affects the outcomes of the fertilization cycle. Outcomes under investigation include successful live birth, pregnancy loss, implantation failure, failed fertilization, and cycle cancellation.

Purpose: To compare pregnancy rates of embryo transfers performed by a patient's own IVF physician to pregnancy rates of embryo transfers performed by other physicians on the IVF team. Methods: Retrospective cohort study; University hospital. Results: A total of 3029 embryo transfers were included. 434 patients (14%) had an embryo transfer by their own IVF physician. There was no difference in pregnancy rates comparing patients who had embryos transferred by a different physician than their own IVF physician when all cycle attempts were analyzed [Odds ratio (OR) 1.1; Confidence interval (CI) 0.9-1.4]. There was no significant difference between the groups' population characteristics. A subset analysis of 1st cycle only embryo transfers (n = 1416) also revealed no difference in pregnancy rates [OR 1.1; CI 0.8-1.5]. Conclusions: Patients can be reassured that their chances of pregnancy are the same whether their embryo transfer is performed by their own physician or another physician in the practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate a previously hypothesized relation between natural hair color and endometriosis. Design: Prospective cohort study. Setting: Nurses’ Health Study II with 10 years of follow-up. Participant(s): A total of 90,065 women, 25–42 years old, who had never been diagnosed with endometriosis, infertility, or cancer at baseline in 1989. Main Outcome Measure(s): Incidence of laparoscopically confirmed endometriosis according to natural hair color. Result(s): During 379,422 person-years of follow-up, 1,130 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. After adjusting for age, calendar time, parity, race, and body mass index at age 18, we observed no association overall. However, compared with women with any other hair color, we observed an increased rate of endometriosis among women with naturally red hair who had never been infertile (incidence rate = 1.3, 95% confidence interval [CI] = 1.0–1.7), but a decreased rate among women with naturally red hair among women who were infertile (incidence rate = 0.4, 95% CI = 0.2–1.2); P value, test for heterogeneity = .03. Conclusion(s): Overall, we did not observe a significant relation between red hair color and the rate of endometriosis, however this prospective cohort study suggests that the relation may differ by infertility status. [Copyright &y& Elsevier]

Along the Texas-Mexico border, the prevalence of neural tube defects (NTDs) among Mexican-American women doubled during 1990-1991. The human outbreak began during the same crop year as epizootics attributed to exposure to fumonisin, a mycotoxin that often contaminates corn. Because Mexican Americans in Texas consume large quantities of corn, primarily in the form of tortillas, they may be exposed to high levels of fumonisins. We examined whether or not maternal exposure to fumonisins increases the risk of NTDs in offspring using a population-based case-control study. We estimated fumonisin exposure from a postpartum sphinganine:sphingosine (sa:so) ratio, a biomarker for fumonisin exposure measured in maternal serum, and from maternal recall of periconceptional corn tortilla intake. After adjusting for confounders, moderate (301-400) compared with low (≤ 100) consumption of tortillas during the first trimester was associated with increased odds ratios (ORs) of having an NTD-affected pregnancy (OR = 2.4; 95% confidence interval, 1.1-5.3). No increased risks were observed at intakes higher than 400 tortillas (OR = 0.8 for 401-800, OR = 1.0 for > 800). Based on the postpartum sa:so ratio, increasing levels of fumonisin exposure were associated with increasing ORs for NTD occurrences, except for the highest exposure category (sa:so > 0.35). Our findings suggest that fumonisin exposure increases the risk of NTD, proportionate to dose, up to a threshold level, at which point fetal death may be more likely to occur. These results also call for population studies that can more directly measure individual fumonisin intakes and assess effects on the developing embryo. [ABSTRACT FROM AUTHOR]

Background: Sex hormone concentrations are associated with breast cancer risk among women not using postmenopausal hormones (PMH); however, whether a relationship exists among PMH users is unknown. Therefore, we conducted a prospective, nested case-control study within the Nurses' Health Study (NHS) cohort to examine the association between plasma sex hormone concentrations and postmenopansal breast cancer among women using PMH at blood collection. Methods: Blood samples were collected from 1989 to 1990. During follow-up through May 31, 2000, 446 women developed breast cancer and were matched by age, date and time of day of blood collection, and fasting status to 459 control subjects (PMH users) who did not develop cancer. We used conditional logistic regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). We compared hormone concentrations of the 459 control subjects with those of 363 postmenopansal NHS participants not taking PMH. All statistical tests were two-sided. Results: PMH users had statistically significantly higher estradiol, free estradiol, sex hormone-binding globulin, and testosterone, and lower free testosterone concentrations than non-PMH users. Among PMH users, we found modest associations with breast cancer risk when comparing the highest versus lowest quartiles of free estradiol (RR = 1.7, 95% CI = 1.1 to 2.7; Ptrend = .06), free testosterone (RR = 1.6, 95% CI = 1.1 to 2.4; Ptrend = .03), and sex hormone-binding globulin (RR = 0.7, 95% CI = 0.5 to 1.1; Ptrend = .04), but not of estradiol or of testosterone. However, estradiol and free estradiol were statistically significantly positively associated with breast cancer risk among women older than 60 years (RR = 2.8, 95% CI = 1.5 to 5.0; Ptrend = .002 and 2.6, 95% CI = 1.4 to 4.7; Ptrend = .001, respectively) and among women with a body mass index of less than 25 kg/m² (RR = 1.8, 95% CI = 1.1 to 3.1, Ptrend = .01 and 2.4, 95% CI = 1.4 to 4.0, Ptrend = .003, respectively). Conclusion: Although women using PMH have a different hormonal profile than those not using PMH, plasma sex hormone concentrations appear to be associated with breast cancer risk among PMH users. [ABSTRACT FROM AUTHOR]

Objective: To determine the demand and preferences of infertility patients for sex selection and the method and sex they would choose, and to investigate the relationship between these choices and their demographic and socioeconomic characteristics. Design: Cross-sectional survey. Setting: University hospital-based fertility center. Patient(s): One thousand five hundred consecutive women who presented for infertility care. Intervention(s): None. Main outcome measure(s): Self-report questionnaire assessing the demand and preferences for sex selection. Result(s): Of respondents, 40.8% wanted to select the sex of their next child for no added cost. Of these patients, 45.9% had no living children and 48.4% had children all of one sex. After adjustment for observed predictors of gender preference, we found a significant preference for a female child among women who were older, not religious, willing to pay for sex selection, had more living children, had only sons, or had a diagnosis of male infertility. Nulliparous women did not significantly prefer one sex over the other. Among parous women, those with only daughters significantly desired to select a male child, whereas those with sons significantly desired to select a female child. In terms of the method of sex selection, 55.0%, 41.0%, and 4.0% of the patients would use sperm separation, preimplantation genetic diagnosis, or neither method, respectively. Conclusion(s): There is significant demand among infertility patients for preimplantation sex selection, with a significant portion of this demand coming from patients who do not have any children or have children all of one sex. [Copyright &y& Elsevier]

Background: Levels of endogenous hormones have been associated with the risk of breast cancer among postmenopansal women. Little research, however, has investigated the association between hormone levels and tumor receptor status or invasive versus in situ tumor status. Nor has the relation between breast cancer risk and postmenopausal progesterone levels been investigated. We prospectively investigated these relations in a case-control study nested within the Nurses' Health Study. Methods: Blood samples were prospectively collected during 1989 and 1990. Among eligible postmenopausal women, 322 cases of breast cancer (264 invasive, 41 in situ, 153 estrogen receptor [ER]-positive and progesterone receptor [PR]-positive [ER+PR+], and 39 ER-negative and PR-negative [ER-/PR-] disease) were reported through June 30, 1998. For each case subject, two control subjects (n = 643) were matched on age and blood collection (by month and time of day). Endogenous hormone levels were measured in blood plasma. We used conditional and unconditional logistic regression analyses to assess associations and to control for established breast cancer risk factors. Results: We observed a statistically significant direct association between breast cancer risk and the level of both estrogens and androgens, but we did not find any (by year) statistically significant associations between this risk and the level of progesterone or sex hormone binding globulin. When we restricted the analysis to case subjects with ER+/PR+ tumors and compared the highest with the lowest fourths of plasma hormone concentration, we observed an increased risk of breast cancer associated with estradiol (relative risk [RR] = 3.3, 95% confidence interval [CI] = 2.0 to 5.4), testosterone (RR = 2.0, 95% CI = 1.2 to 3.4), androstenedione (RR = 2.5, 95% CI = 1.4 to 4.3), and dehydroepiandrosterone sulfate (RR = 2.3, 95% CI = 1.3 to 4.1). In addition, all hormones tended to be associated most strongly with in situ disease. Conclusion: Circulating levels of sex steroid hormones may be most strongly associated with risk of ER+/PR+ breast tumors. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relation between the fetal environment and endometriosis. Design: Prospective cohort study. Setting: Nurses'' Health Study II with 10 years of follow-up. Participant(s): Eighty-four thousand, four hundred forty-six women aged 25–42 who had never been diagnosed with endometriosis, infertility, or cancer at baseline in 1989. Main outcome measure(s): Incidence of laparoscopically confirmed endometriosis according to birthweight, prematurity, multiple gestation, diethylstilbestrol (DES) exposure, and having been breastfed. Result(s): During 566,250 woman-years of follow-up, 1,226 cases of laparoscopically-confirmed endometriosis were reported among women with no past infertility. After adjusting for age, calendar time, parity, race, and body mass index at age 18, we observed a linear increase in the incidence rate with decreasing birthweight (rate ratio [RR] = 1.3 for birthweight <5.5 pounds versus 7.0–8.4 pounds, 95% confidence interval [CI] = 1.0–1.8, P value, test for trend = .01). In addition, women who were born as one of a multiple gestation (i.e., twins or greater number) were at increased risk even after controlling for birthweight (RR = 1.7, CI = 1.2–2.5). The rate of endometriosis was also 80% greater among women exposed to diethylstilbestrol in utero (RR = 1.8, CI = 1.2–2.8). Neither premature delivery nor having been breastfed were associated with the incidence of endometriosis. None of these effect estimates were modified by infertility status at the time of endometriosis diagnosis. Conclusion(s): The fetal environment is associated with subsequent laparoscopically confirmed endometriosis in this cohort of US women. [Copyright &y& Elsevier]

OBJECTIVE: To clarify the temporal complexities of the relation between reproductive factors and endometriosis. METHODS: We analyzed 10 years of prospective data from the Nurses' Health Study II cohort. Information was obtained through questionnaires sent every 2 years to 116,678 women aged 25-42 years when enrolled in 1989. Cox proportional hazards models were used to adjust for age, calendar time, and confounding variables. RESULTS: During 726,205 woman-years of follow-up, 1,721 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. Greater incidence was observed among women with an earlier age at menarche (rate ratio of 1.3 comparing menarche at age < 10 to age 12 years; 95% confidence interval [CI] 1.0-1.8; P value, test for trend < .001) and shorter cycle length during late adolescence (rate ratio of 1.3 comparing < 26 days to 26-31 days; 95% CI 1.1-1.5). Time to cycle regularity was not associated with risk. Among parous women, a linear decrease in risk was observed with number of live-born children (rate ratio of 0.5 comparing > 3 with 2 children; 95% CI 0.4-0.7; P value, test for trend < .001) and lifetime duration of lactation if time since last birth was less than 5 years (rate ratio of 0.2 comparing > 23 months with never; 95% CI 0.1-0.4; P value, test for trend < .001). CONCLUSION: Hormonal and anatomical changes associated with menstruation and pregnancy may affect the rate of laparoscopically confirmed endometriosis. Within this cohort, risk was greatest among nulliparous women with earlier age at menarche and shorter menstrual cycles. Among parous women, parity and lifetime duration of lactation were associated with decreased risk. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relation between tubal ligation, change in menstrual cycle characteristics, and early follicular phase hormones.Design: Cross-sectional analysis of women 36-44 years of age.Setting: The greater Boston area.Patient(s): Nine hundred seventy-six premenopausal women with intact uteri.Intervention(s): A comparison of women with and without a history of tubal ligation.Main Outcome Measure(s): Menstrual and reproductive histories were self-reported. Early follicular phase blood samples were obtained to assess FSH, LH, and E(2). We compared menstrual cycle changes from the first 5 years after menarche with completion of the baseline questionnaire in women with and without a prior history of tubal ligation.Result(s): Cycle length, cycle regularity, menses length, flow volume, dysmenorrhea, and hormone levels were similar in women with and without a history of tubal ligation. However, among parous women with a history of cesarean section, those with a tubal ligation >5 years ago experienced a marginal increase in volume of menstrual flow compared with women with no tubal ligation history.Conclusion(s): We found no significant change in menstrual cycle characteristics or hormone levels in women with or without a history of tubal ligation. However, tubal ligation may have a modest effect on the change in menstrual flow volume over time among parous women with a history of cesarean section. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain is heterogeneous with potentially clinically informative subgroups. We aimed to identify subgroups of pelvic pain based on symptom patterns and investigate their associations with inflammatory and chronic pain-related comorbidities. Latent class analysis (LCA) identified subgroups of participants (n = 1255) from the Adolescence to Adulthood (A2A) cohort. Six participant characteristics were included in the LCA: severity, frequency, and impact on daily activities of both menstruation-associated (cyclic) and non-menstruation-associated (acyclic) pelvic pain. Three-step LCA quantified associations between LC subgroups, demographic and clinical variables, and 18 comorbidities (10 with prevalence ≥10%). Five subgroups were identified: none or minimal (23%), moderate cyclic only (28%), severe cyclic only (20%), moderate or severe acyclic plus moderate cyclic (9%), and severe acyclic plus severe cyclic (21%). Endometriosis prevalence within these 5 LCA-pelvic pain-defined subgroups ranged in size from 4% in "none or minimal pelvic pain" to 24%, 72%, 70%, and 94%, respectively, in the 4 pain subgroups, with statistically significant odds of membership only for the latter 3 subgroups. Migraines were associated with significant odds of membership in all 4 pelvic pain subgroups relative to those with no pelvic pain (adjusted odds ratios = 2.92-7.78), whereas back, joint, or leg pain each had significantly greater odds of membership in the latter 3 subgroups. Asthma or allergies had three times the odds of membership in the most severe pain group. Subgroups with elevated levels of cyclic or acyclic pain are associated with greater frequency of chronic overlapping pain conditions, suggesting an important role for central inflammatory and immunological mechanisms. [ABSTRACT FROM AUTHOR]