Human reproduction
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Maternal ageing is a very important factor in aneuploidy. It is associated with an increased risk of a liveborn trisomy, especially Down's syndrome, and with a dramatic increase in trisomic conceptions, the majority of which miscarry. A total of 585 volunteer couples who were planning pregnancies participated in a prospective study of reproduction. ⋯ Use of oral contraceptives for > or = 9 years was associated with a spontaneous abortion rate of 11.3%, which is about half the rate (23%) which was found in couples who had not used the pill. However, the effect of pill taking was correlated with female age, and when age was examined as an independent factor, the reduction in miscarriage was only statistically significant in women > 30 years old, where the rate of abortion reduced from 28 to 7%. Because age-related aneuploidy in humans probably occurs as a direct or an indirect result of follicle depletion, it is proposed that the long-term use of the oral contraceptive pill protects against abortion due to aneuploidy by preserving the number of follicles.
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Randomized Controlled Trial Clinical Trial
Randomized trial of misoprostol and cervagem in combination with a reduced dose of mifepristone for induction of abortion.
Mifepristone (600 mg) in combination with a prostaglandin has been demonstrated to be a safe, acceptable alternative to vacuum aspiration for induction of abortion in the first 9 weeks of pregnancy. However, the efficacy and side-effects of different prostaglandins used in combination with mifepristone have not been assessed in a randomized trial. In this study, 800 women seeking an abortion at gestational age < or = 63 days amenorrhoea were randomized to receive either 0.5 mg gemeprost by vaginal pessary (group I) or 600 micrograms misoprostol (group II) by mouth approximately 48 h after taking 200 mg mifepristone by mouth. ⋯ However, there were significantly more ongoing pregnancies in the women who received misoprostol than in those who received gemeprost (nine versus one, P < 0.01) and in eight of these 10 women the gestation was > 49 days. Fewer women in group II required analgesia than in group I (48 versus 60%, P < 0.001) although the number requesting opiate was similar in each group (6.9 versus 5.2%, P > 0.4). The incidence of nausea and vomiting after misoprostol (47.8 and 21.9% respectively) was higher (P < 0.001) than after gemeprost (33.9 and 12% respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Comparative Study
Subzonal insemination, partial zona dissection or intracytoplasmic sperm injection? An easy decision?
This review aims to analyse and compare the results to date of subzonal insemination (SUZI), partial zona dissection (PZD) and intracytoplasmic sperm injection (ICSI) to evaluate critically whether it is now possible to replace SUZI and PZD by ICSI. It appears that ICSI is a much more efficient assisted reproduction technique than SUZI and PZD for resolving cases of severe male infertility and/or repeated failure of conventional in-vitro fertilization (IVF). For ICSI compared with SUZI and PZD, fertilization (49.4, 17.7 and 16.8% respectively), percentage of patients reaching embryo transfer (91.0, 55.1 and 23.3% respectively), percentage of transfers performed with two or three embryos (83.3% ICSI and 39.3% SUZI), pregnancy rate per embryo replacement (28.2, 18.7 and 16.5% respectively) and pregnancy rate per oocyte retrieval (24.8, 10.3 and 3.8% respectively) are all improved. In addition, cases of severely impaired semen characteristics, which were condemned to infertility for life with conventional IVF, SUZI or PZD, can now be treated and resolved efficiently with ICSI.
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Clinical Trial Controlled Clinical Trial
Effects of a single post-ovulatory dose of RU486 on endometrial maturation in the implantation phase.
The effect of a single post-ovulatory dose of RU486 on endometrial maturation was studied in the implantation phase. A total of 11 healthy women were followed for one control and one or two treatment cycles. In treatment cycles, a dose of 200 or 400 mg RU486 was administered on day luteinizing hormone (LH)+2. ⋯ The treatment with RU486 did not disturb the normal menstrual rhythm but caused a significant inhibition in the endometrial development. Glandular progesterone receptor staining was significantly more pronounced after RU486 treatment, while there was a reduction in the Dolichos biflorus agglutinin lectin binding, indicating inhibition of the normal secretory transformation of the endometrium. It is likely that these effects on endometrial development and secretory activity represent the basis of the contraceptive effect of post-ovulatory RU486 treatment.
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Case Reports
Ovarian cyst formation in two pre-menopausal patients treated with tamoxifen for breast cancer.
Pre-menopausal tamoxifen treatment causes hyperoestrogen production and ovarian cyst formation. Two pre-menopausal breast cancer patients who were treated with tamoxifen developed both permanent supraphysiological oestrogen concentration and ovarian cysts. Serum oestrogen decreased to post-menopausal concentrations and ovarian cysts completely resolved during and following simultaneous treatment with tamoxifen and gonadotrophin-releasing hormone agonist (GnRHa). In pre-menopausal breast cancer patients, GnRHa may prevent possible side-effects of tamoxifen, such as ovarian cysts and supraphysiological oestrogen production.