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Medical treatment of endometriosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
A large number of open studies have shown that gonadotropin releasing hormone agonists reduce pain, and several randomised trials have compared gonadotropin releasing hormone agonists with danazol18,19. Six months’ treatment with gonadotropin releasing hormone agonists significantly reduces pain, and this reduction is noted as early as the second month of treatment. This reduction in pain is maintained after stopping treatment, and 6 months later pain is still reduced compared to baseline. Neither treatment is superior for the relief of pain, and they differ only in their side-effect profile. A gonadotropin releasing hormone agonist has also been shown to be effective as a short-term first-line treatment for women with chronic pelvic pain prior to laparoscopy20.
Use of Blastocyst Culture
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
Mohamed A. Aboulghar, Mona M. Aboulghar
In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have become procedures used throughout the world and are expanding for the treatment of female and male subfertility. It is well recognized that assisted reproductive technology (ART) is associated with higher fetal and maternal risks. The first IVF pregnancy was achieved after day 2 embryo transfer (1). Since then, scientific research continued to improve the outcome of IVF. Improvement of ovarian stimulation using gonadotropin-releasing hormone agonist (GnRHa) (2) or GnRh-antagonist (3) protocols helped to increase pregnancy rates. Modification of embryo transfer techniques and development of softer catheters were steps forward toward better results (4). The improvement of laboratory standards and modifications of the culture media helped to achieve high-quality embryos (5).
Female Chronic Pelvic Pain
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Frank F. Tu, Sangeeta Senapati, Gregory Goldstein, Alexandra Roybal
Cyclic pelvic pain often responds well to sex hormone modulation. Hormonal therapy impacts on nociception likely include alterations in pain sensitivity as well as direct inhibition of ovarian or uterine inflammation related to ovulation or menses. Oral contraceptives are the best-tolerated initial approach for hormonal suppression. In one small, Italian, randomized, controlled trial, oral contraceptives were found to show effectiveness for endometriosis-associated pain (29). Notably, they do slightly increase the risk of venous thromboembolism, particularly in women with undetected thrombophilias. Similarly, randomized, controlled trials have demonstrated moderate improvement in pelvic pain symptoms following both gonadotropin-releasing hormone agonist treatment and oral progestins (30, 31). Prolonged gonadotropin-releasing hormone agonist therapy can cause bone loss, mood changes, and menopausal symptoms, so women may require hormone replacement therapy with estrogen or progesterone, and bone density monitoring. In some women, progestins are associated with irregular bleeding, fluid retention, and modest weight gain. Insertion of a progestin-contained intrauterine device may be an alternative with fewer side effects, as the systemic absorption is largely limited to the pelvis (32, 33). Danocrine, a once-popular androgenic treatment, is less commonly used today because of virilizing side effects.
Optimizing sleep across the menopausal transition
Published in Climacteric, 2023
Associations between vasomotor symptoms and objective sleep disturbance (PSG or actigraphy) are less consistent [23]. Several studies have not found an association between vasomotor symptoms and overall objective sleep quality [43,47,62–65]. Another study that examined hot flash events and PSG awakenings showed a time of night effect: physiological hot flashes (measured with sternal skin conductance) were more likely to precede PSG awakenings in the first half of the night but awakenings were more likely to precede hot flashes in the second half of the night [66]. Others, including our own work, have found that the majority of nocturnal physiological hot flash events are linked with PSG awakenings, regardless of time of night, and/or with more WASO [67–69]. For example, we found that 69% of nocturnal hot flashes were associated with an awakening/arousal (Figure 2) and wake time associated with hot flashes contributed an average of 27% to total WASO [68]. Similarly, in an experimental model of new-onset hot flashes in young premenopausal women treated with a gonadotropin-releasing hormone agonist that simulates menopause, 66% of objectively measured vasomotor symptoms were associated with an awakening [69]. The strong overlap in timing between many hot flash events and awakenings suggests there may be a common mechanism within the central nervous system in response to estrogen withdrawal, although further work is needed to investigate this possibility.
Successful live birth after in vitro maturation treatment in a patient with autoimmune premature ovarian failure: a case report and review of the literature
Published in Gynecological Endocrinology, 2021
Lucie Chansel-Debordeaux, Elisabeth Rault, Chloé Depuydt, Volcy Soula, Claude Hocké, Clément Jimenez, Hélène Creux, Aline Papaxanthos-Roche
Since controlled ovarian hyperstimulation alone gives poor results in such a situation, various approaches have been used to increase pregnancy rates, including immunosuppressive therapy and DHEA supplementation, with or without IVF. Some studies showed the value of corticosteroids for improving the pregnancy success rate in a subset of patients with previous IVF failures and high serum AOA levels [33,50]. Indeed, decreasing the high, endogenous, ineffective FSH, by gonadotropin releasing hormone agonist associated to controlled ovarian hyperstimulation and corticosteroids were sometimes effective in generating conceptions in patients with POF [51]. The release of the FSH receptors occupancy from the endogenous FSH, may give way to receptor stimulation by exogenous FSH, combined with amelioration of the autoimmune disturbance by glucocorticoids cotreatment. The mechanism of action of corticosteroids is thought to involve a reduction in perifollicular inflammatory macrophages around follicles, which can then restore folliculogenesis in dormant small follicles [15]. In another study, corticosteroids did not influence ovarian responsiveness to gonadotropins in patients with POF [52]. Some studies noted higher pregnancy rates with DHEA supplementation in patients with diminished ovarian function [53,54]. Estrogens have also proven beneficial for the recovery of ovarian function via the restoration of receptor sensitivity to gonadotropins, thus promoting folliculogenesis [9]. However, to date no treatment for autoimmune oophoritis has demonstrated efficacy and safety in prospective randomized placebo-controlled studies.
In vitro fertilization outcome in women with endometrial tuberculosis and tubal tuberculosis
Published in Gynecological Endocrinology, 2020
Wenrong Dai, Linna Ma, Yurong Cao, Di Wu, Ting Yu, Jun Zhai
(1) Short-acting GnRH-agonist protocol in the mid-luteal phase: Based on the controlled ovulation stimulation long protocol [7], gonadotropin-releasing hormone agonist (GnRH-a, Triptorelin, Hui Ling, Switzerland) was injected to decrease serum gonadotropin levels. (2) Long-acting GnRH-agonist protocol in early follicular phase: a single dose of 3.75 mg long-acting GnRH agonist Triptorelin (Diphereline, IPSEN, Paris, France) was administrated on day 2 or 3 of the menstrual cycle, for 30 to 40 days. When pituitary desensitization was achieved in both protocols with serum FSH suppressed to <5 mIU/mL, LH to <5 mIU/mL, and estradiol to <50 pg/mL, an evaluation was performed to validate an endometrial thickness of <5 mm and a diameter of the largest ovarian follicle of <10 mm. Then recombinant follicle-stimulating hormone or human menopausal gonadotropin was injected to stimulate follicle growth.