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36. Are infertility treatments a potential risk factor for cancer development? Perspective of 30 years of follow-up

Author

Liat, Lerner-Geva, Lerner-Geva, Liat, Jaron, Rabinovici, Rabinovici, Jaron, Liraz, Olmer, Olmer, Liraz, Tzvia, Blumstein, Blumstein, Tzvia, Shlomo, Mashiach, Mashiach, Shlomo, Bruno, Lunenfeld, and Lunenfeld, Bruno

Subjects
Adult, Infertility, medicine.medical_specialty, Reproductive Techniques, Assisted, Endocrinology, Diabetes and Metabolism, Population, Breast Neoplasms, Medical Records, Cohort Studies, Endocrinology, Breast cancer, Ovulation Induction, Risk Factors, medicine, Humans, Registries, Israel, education, Ovarian Neoplasms, Gynecology, education.field_of_study, Obstetrics, business.industry, Incidence, Endometrial cancer, Absolute risk reduction, Obstetrics and Gynecology, Cancer, Fertility Agents, Female, medicine.disease, Endometrial Neoplasms, Cancer registry, Female, Ovarian cancer, business, Infertility, Female, Follow-Up Studies
Abstract

The aim of the present study was to evaluate the possible risk for cancer development in infertile women with over 30 years of follow-up. Cancer development was assessed through linkage with the National Cancer Registry updated to 31 December 2005 in a cohort of 2431 women who were treated for infertility at the Sheba Medical Center in Israel during the period 1964-1974 and contributed more than 84,000 women years of follow-up. Standardized incidence ratios (SIR) were calculated between the observed cancer cases and the expected cancer rates in the general population. The mean age at the end of follow-up was 62.7 years. Eighteen cases of ovarian cancer were observed as compared to 18.1 expected (SIR = 1.0; 95% CI = 0.59-1.57). For breast cancer, 153 cases were observed as compared to 131.9 expected (SIR = 1.16; 95% CI = 0.98-1.36), and for endometrial cancer, 30 cases were observed as compared to 17.8 expected cases (SIR = 1.69; 95% CI = 1.14-2.41). No excess risk associated with exposure to gonadotropins was observed. Infertility was found to be associated with significant increased risk for endometrial cancer and borderline increased risk for breast cancer. Ovarian cancer risk was not found to be elevated. No significant excess risk was associated with treatment with ovulation induction.

Published
2012
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39. Factors influencing the obstetric and perinatal outcome after oocyte donation.

Author

Sheffer-Mimouni, Galit, Mashiach, Shlomo, Dor, Jehoshua, Levran, David, and Seidman, Daniel S.

Abstract

Background: We evaluated interactions between perinatal outcome after oocyte donation and various maternal factors.Methods: The study included 134 parturients after oocyte donation. Data were collected from medical files and personal interviews. Stepwise logistic regression analyses were used to evaluate associations between perinatal outcomes and selected maternal variables.Results: Fifty percent of the women were >43 years old, 30.6% were >45 years and 67.9% were nulliparous. The rates of pregnancy induced hypertension (PIH), gestational diabetes and first and second trimester vaginal bleeding (STB) were 27.6, 23.9, 43.3 and 6% respectively, while 72% had Caesarean deliveries. The rates of preterm (PD), low birth weight (LBW), small for gestational age (SGA) deliveries and major malformations were respectively 14.9, 14.9, 7.6 and 2.2%. Using a logistic regression, PD was significantly associated with PIH, STB and maternal smoking. LBW deliveries were significantly associated with PIH, STB, nulliparity and maternal smoking. SGA babies were significantly associated with PIH. These perinatal outcomes were not associated with advanced maternal age or ovarian failure.Conclusions: There is a high risk of obstetric complications in singleton oocyte donation pregnancies, but the perinatal outcomes are favourable. Patients should be counselled about these risks and monitored for these complications during pregnancy. [ABSTRACT FROM AUTHOR]

Published
2002
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40. Management and outcome of pregnancy in women with thrombophylic disorders and past cerebrovascular events.

Author

Soriano, David, Carp, Howard, Seidman, Daniel S, Schiff, Eyal, Langevitz, Pnina, Mashiach, Shlomo, and Dulitzky, Motti

Subjects
PREGNANCY complications, THROMBOEMBOLISM
Abstract

Objective: To evaluate the maternal and fetal outcome in a cohort of women undergoing a subsequent pregnancy after a previous cerebrovascular event in the presence of thrombophilia.Patients: Fifteen pregnancies were followed up in 12 women with past cerebrovascular events and thrombophilic disorders. The cerebrovascular events occurred during a previous pregnancy in five patients. Six patients had a bad obstetric history including intrauterine fetal death in four cases, early onset of severe preeclampsia in two cases and one infant that was small for gestational age. THE THROMBOPHILIC DISORDERS INCLUDED: anti-phospholipid syndrome, protein C, S or antithrombin III deficiencies, mutations of the methyltetrahydrofolate reductase (MTHFR). All patients received prophylactic treatment with low molecular weight heparin and low dose aspirin.Results: Thromboembolic complications occurred in four pregnancies. Postpartum complications occurred in one patient; deep vein thrombosis and pulmonary emboli after stopping anticoagulation treatment. No patient had long-term neurologic damage. All pregnancies except one resulted in live births. (mean gestational age at delivery 36 +/- 3. 7 weeks, mean birth weight 2656 +/- 811 g). The one remaining pregnancy was electively terminated. There was one neonatal death due to the complications of severe prematurity in a woman with severe HELLP syndrome.Conclusion: This preliminary data suggests that women with a history of cerebrovascular events and thrombophilic disorders receiving prophylactic treatment, have a relatively favorable pregnancy outcome; however, they remain at significant risk during pregnancy. Further studies are necessary to determine the optimal prophylactic treatment. [ABSTRACT FROM AUTHOR]

Published
2002
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42. Cervical Shirodkar cerclage may be the treatment modality of choice for cervical pregnancy.

Author

Mashiach, Shlomo, Admon, Dahlia, Oelsner, Gabriel, Paz, Baram, Achiron, R., and Zalel, Yaron

Abstract

Background: Our objective was to evaluate the use of cervical suture in cervical pregnancy.Methods and Results: All cases of cervical pregnancy diagnosed and treated in the gynaecological department at the Sheba Medical Center between 1994-2000 were included in the study. Eight such cases were diagnosed. The first four cases were treated medically. The last four cases (the study group) of cervical pregnancy, including one case of heterotopic pregnancy, were treated successfully with placement of Shirodkar cerclage.Conclusion: Cervical cerclage may be considered as the treatment of choice in cases of cervical pregnancies. It may be the only therapy in cases of heterotopic pregnancies (intrauterine and cervical pregnancy). [ABSTRACT FROM AUTHOR]

Published
2002
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43. Maternal and neonatal outcome of 846 term singleton breech deliveries: seven-year experience at a single center.

Author

Schiff, Eyal, Friedman, Steven A., Mashiach, Shlomo, Hart, Oded, Barkai, Gad, Sibai, Baha M., Schiff, E, Friedman, S A, Mashiach, S, Hart, O, Barkai, G, and Sibai, B M

Subjects
CESAREAN section, DELIVERY (Obstetrics), NEONATAL death, HOSPITAL care, BREECH delivery, COMPARATIVE studies, RESEARCH methodology, EVALUATION of medical care, MEDICAL cooperation, PREGNANCY, RESEARCH, SURGICAL complications, EVALUATION research, RETROSPECTIVE studies
Abstract

Objective: Our purpose was to evaluate the maternal and neonatal outcome of 846 consecutive term singleton breech deliveries at a single center.Study Design: We reviewed the maternal and neonatal charts of all women who delivered singleton breech fetuses between 1984 and 1990 and divided them into two groups: women who fulfilled the criteria for trial of labor (group 1, n = 613) and those who did not meet these criteria and underwent scheduled cesarean section (group 2, n = 233).Results: In group I, 326 women (53.2%) were delivered vaginally. There were no maternal deaths. Febrile morbidity and length of hospitalization were significantly higher in the women who required cesarean section in labor compared with those delivered vaginally. In the total study population there were no stillbirths and eight neonatal deaths, 6 of which had major malformations incompatible with life. The remaining two deaths occurred in group I (0.33% corrected neonatal mortality in group 1). Newborns in Group 1 exhibited a higher rate of trauma with borderline statistical significance (3.0% vs 0.5%, p = 0.052). No significant differences were found in the rates of low Apgar scores, intubation, and intensive care unit admission.Conclusion: Although certain short-term outcome variables may appear less favorable in term singleton breech infants delivered vaginally, large randomized studies of short- and long-term outcome should be undertaken because current data are not sufficiently conclusive to warrant routine cesarean section for term breech presentation. [ABSTRACT FROM AUTHOR]

Published
1996
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