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Vagios S, Velmahos CS, Cherouveim P, Dimitriadis I, Bormann CL. The impact of different sperm preparation methods on clinical pregnancy and live birth rates in intrauterine insemination cycles: a retrospective single-center cohort study. Fertil Steril 2023; 120:617-625. [PMID: 37225072 DOI: 10.1016/j.fertnstert.2023.05.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the impact of 2 different sperm preparation methods, density gradient centrifugation and simple wash, on clinical pregnancy and live birth rates in intrauterine insemination (IUI) cycles with and without ovulation induction. DESIGN Retrospective single-center cohort study. SETTING Academic fertility center. PATIENTS In total, 1,503 women of all diagnoses sought IUI with fresh-ejaculated sperm. EXPOSURE Cycles were divided into 2 groups on the basis of sperm preparation technique: density gradient centrifugation (n = 1,687, unexposed group) and simple wash (n = 1,691, exposed group). MAIN OUTCOME MEASURES Primary outcome measures consisted of clinical pregnancy and live birth rates. Furthermore, adjusted odds ratios and 95% confidence intervals for each outcome were calculated and compared between the 2 sperm preparation groups. RESULTS Odds ratios did not differ between density gradient centrifugation and simple wash groups for clinical pregnancy and live birth (1.10 [0.67-1.83] and 1.08 [0.85-1.37], respectively). Additionally, when cycles were stratified using ovulation induction rather than adjusted for, no differences in clinical pregnancy and live birth odds were noted between sperm preparation groups (gonadotropins: 0.93 [0.49-1.77] and 1.03 [0.75-1.41]; oral agents: 1.78 [0.68-4.61] and 1.05 [0.72-1.53]; unassisted: 0.08 [0.001-6.84] and 2.52 [0.63-10.00], respectively). Furthermore, no difference was seen in clinical pregnancy or live birth when cycles were stratified using sperm score or when the analysis was limited to first cycles only. CONCLUSION Overall, no difference was noted in clinical pregnancy or live birth rates between patients who received simple wash vs. density gradient-prepared sperm, suggesting similar clinical efficacy between the 2 techniques for IUI. Because the simple wash technique is more time-efficient and cost-effective compared with the density gradient, adoption of this technique could lead to comparable clinical pregnancy and live birth rates for IUI cycles, although optimizing teamwork flow and coordination of care.
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Affiliation(s)
- Stylianos Vagios
- Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts
| | | | - Panagiotis Cherouveim
- Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Dimitriadis
- Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles L Bormann
- Department of Obstetrics, Gynecology, and Reproductive Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Cherouveim P, Vagios S, Hammer K, Fitz V, Jiang VS, Dimitriadis I, Sacha CR, James KE, Bormann CL, Souter I. The impact of cryopreserved sperm on intrauterine insemination outcomes: is frozen as good as fresh? Front Reprod Health 2023; 5:1181751. [PMID: 37325242 PMCID: PMC10264626 DOI: 10.3389/frph.2023.1181751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Frozen sperm utilization might negatively impact cycle outcomes in animals, implicating cryopreservation-induced sperm damage. However, in vitro fertilization and intrauterine insemination (IUI) in human studies are inconclusive. Methods This study is a retrospective review of 5,335 IUI [± ovarian stimulation (OS)] cycles from a large academic fertility center. Cycles were stratified based on the utilization of frozen (FROZEN, n = 1,871) instead of fresh ejaculated sperm (FRESH, n = 3,464). Main outcomes included human chorionic gonadotropin (HCG) positivity, clinical pregnancy (CP), and spontaneous abortion (SAB) rates. Secondary outcome was live birth (LB) rate. Odds ratios (OR) for all outcomes were calculated utilizing logistic regression and adjusted (adjOR) for maternal age, day-3 FSH, and OS regimen. Stratified analysis was performed based on OS subtype [gonadotropins; oral medications (OM): clomiphene citrate and letrozole; and unstimulated/natural]. Time to pregnancy and cumulative pregnancy rates were also calculated. Further subanalyses were performed limited to either the first cycle only or to the partner's sperm only, after excluding female factor infertility, and after stratification by female age (<30, 30-35, and >35 years old). Results Overall, HCG positivity and CP were lower in the FROZEN compared to the FRESH group (12.2% vs. 15.6%, p < 0.001; 9.4% vs. 13.0%, p < 0.001, respectively), which persisted only among OM cycles after stratification (9.9% vs. 14.2% HCG positivity, p = 0.030; 8.1% vs. 11.8% CP, p = 0.041). Among all cycles, adjOR (95% CI) for HCG positivity and CP were 0.75 (0.56-1.02) and 0.77 (0.57-1.03), respectively, ref: FRESH. In OM cycles, adjOR (95% CI) for HCG positivity [0.55 (0.30-0.99)] and CP [0.49 (0.25-0.95), ref.: FRESH] favored the FRESH group but showed no differences among gonadotropin and natural cycles. SAB odds did not differ between groups among OM and natural cycles but were lower in the FROZEN group among gonadotropin cycles [adjOR (95% CI): 0.13 (0.02-0.98), ref.: FRESH]. There were no differences in CP and SAB in the performed subanalyses (limited to first cycles or partner's sperm only, after excluding female factors, or after stratification according to female age). Nevertheless, time to conception was slightly longer in the FROZEN compared to the FRESH group (3.84 vs. 2.58 cycles, p < 0.001). No significant differences were present in LB and cumulative pregnancy results, other than in the subgroup of natural cycles, where higher LB odds [adjOR (95% CI): 1.08 (1.05-1.12)] and higher cumulative pregnancy rate (34% vs. 15%, p = 0.002) were noted in the FROZEN compared to the FRESH group. Conclusion Overall, clinical outcomes did not differ significantly between frozen and fresh sperm IUI cycles, although specific subgroups might benefit from fresh sperm utilization.
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Affiliation(s)
- Panagiotis Cherouveim
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Stylianos Vagios
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, United States
| | - Karissa Hammer
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Victoria Fitz
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Victoria S. Jiang
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Caitlin R. Sacha
- Division of Reproductive Endocrinology and Infertility, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Kaitlyn E. James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Charles L. Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Vagios S, Sacha CR, James KE, Hammer KC, Fitz VW, Dimitriadis I, Bormann CL, Souter I. The impact of anti-Müllerian hormone on endometrial thickness in gonadotropin stimulation/intrauterine insemination cycles: is there an effect on pregnancy outcomes? J Assist Reprod Genet 2023; 40:845-850. [PMID: 36745295 PMCID: PMC10224886 DOI: 10.1007/s10815-023-02736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/27/2023] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To study the association, if any, between anti-Müllerian hormone (AMH) and pre-ovulatory endometrial thickness (ET) in gonadotropin/intrauterine insemination (IUI) cycles. METHODS This retrospective cohort study included a total of 964 patients undergoing 1926 gonadotropin/IUI cycles at an academic fertility center. Primary outcome measure was the association between serum AMH and measured ET on the day of and the day before human chorionic gonadotropin hormone (hCG) ovulation trigger. The effect of a model combining AMH and ET on early pregnancy outcomes was a secondary measure. RESULTS In 52.8% of cycles, ET was last assessed and recorded on the day of hCG administration, while in the remaining 47.2% on the day prior to trigger. In unadjusted regression models, AMH was weakly correlated with ET on hCG trigger day [bAMH (95%CI) = 0.032 (- 0.008, 0.070), p = 0.015]. When adjusting for potential confounders, the positive correlation became significant [0.051 (0.006, 0.102), p = 0.047]. Similar findings were observed when assessing the correlation between AMH and ET on the day prior to hCG trigger. ET was non-significantly associated with the odds of clinical pregnancy, when adjusting for potential confounders, except for when restricting the analysis to couples with idiopathic infertility [OR (95%CI), p-value: 0.787 (0.623, 0.993), 0.044]. CONCLUSION Our findings support an effect of serum AMH on endometrial development in gonadotropin induced cycles, even when adjusting for the diagnosis of PCOS. ET was not associated with the odds of achieving a clinical pregnancy, except for couples with idiopathic infertility.
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Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Karissa C Hammer
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Victoria W Fitz
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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Gordon CE, Hammer KC, James K, Lanes A, Vagios S, Starosta A, Hornstein M, Souter I. Optimizing pregnancy outcomes in intrauterine insemination cycles by stratifying pre-wash total motile count and patient-specific factors: a patient counseling tool. J Assist Reprod Genet 2022; 39:2811-2818. [PMID: 36342575 PMCID: PMC9790824 DOI: 10.1007/s10815-022-02636-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study is to clarify which pre-wash total motile count are associated with improved clinical pregnancy rate (CPR) and live birth rate (LBR) based on maternal age, AMH level, stimulation regimen, and infertility diagnosis. METHODS This was a retrospective cohort study of first completed IUI cycles at two academic fertility centers from 5/2015 to 9/2019. Cycles were stratified by pre-wash TMC, maternal age, AMH level, stimulation regimen, and infertility diagnosis. The primary outcome was CPR and secondary outcomes were live birth and miscarriage. RESULTS One thousand one hundred fifty-four cycles were analyzed. Of the 162 cycles that resulted in a CPR (14.0%), most had an insemination TMC > 20 million. Compared to TMC > 20 million, there was no difference in CPR or LBR for lower TMC categories, excluding the TMC < 2 million group, in which there were no pregnancies. When TMC was stratified by deciles, there was also no difference in CPR and LBR, including within the lowest decile (TMC 0.09-8.6 million). Younger age and higher ovarian reserve parameters were associated with higher pregnancy and LBR when stratified by TMC. There was no difference in pregnancy and LBR when considering different stimulation protocols. CONCLUSIONS Our data suggest that pregnancy and LBR are equivalent above a TMC of 2 million. Data stratified by TMC and patient parameters can be used to counsel patients pursuing ART.
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Affiliation(s)
- Catherine E. Gordon
- Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery, 75 Francis St, Boston, MA 02115 USA
| | - Karissa C. Hammer
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Yawkey Suite 10a, 55 Fruit St, Boston, MA 02114 USA
| | - Kaitlyn James
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Yawkey Suite 10a, 55 Fruit St, Boston, MA 02114 USA
| | - Andrea Lanes
- Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery, 75 Francis St, Boston, MA 02115 USA
| | - Stylianos Vagios
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Yawkey Suite 10a, 55 Fruit St, Boston, MA 02114 USA
| | - Anabel Starosta
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, 20 York St, New Haven, CT 06510 USA
| | - Mark Hornstein
- Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery, 75 Francis St, Boston, MA 02115 USA
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Yawkey Suite 10a, 55 Fruit St, Boston, MA 02114 USA
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Zhang Y, Mustieles V, Williams PL, Souter I, Calafat AM, Demokritou M, Lee A, Vagios S, Hauser R, Messerlian C. Association of preconception mixtures of phenol and phthalate metabolites with birthweight among subfertile couples. Environ Epidemiol 2022; 6:e222. [PMID: 36249269 PMCID: PMC9555928 DOI: 10.1097/ee9.0000000000000222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
Although parental preconception exposure to some phenols and phthalates have been associated with reduced birthweight, few studies have examined these chemicals as complex mixtures.
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Cherouveim P, Vagios S, Hammer K, Fitz V, Jiang V, James K, Dimitriadis I, Bormann C, Souter I. O-184 The impact of cryopreserved sperm on Intrauterine Insemination (IUI) outcomes: Is frozen as good as fresh? Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Are the outcomes of IUI cycles [with or without ovarian stimulation (OS)] comparable when frozen instead of fresh-ejaculated sperm is utilized?
Summary answer
Overall, clinical outcomes did not differ significantly between frozen and fresh sperm IUI cycles, although specific subgroups might benefit from fresh sperm utilization.
What is known already
At present, data from animal studies point towards less favorable outcomes with frozen sperm utilization, implicating cryopreservation-induced damages to the cytoskeleton, DNA, and acrosome leading to adverse effects on spermatozoa’s motility, viability, and ability to fuse with the oocyte. Assisted Reproductive Technology (ART) data, mostly focusing on severe male factor infertility diagnoses, suggest no major differences between in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles utilizing frozen over fresh sperm, often surgically extracted. Nevertheless, contemporary data from IUI(±OS) cycles are still scarce.
Study design, size, duration
Data from 5335 IUI(±OS) cycles (time-period: 01/2004-12/2021) from a large academic fertility center were retrospectively reviewed. Cycles were stratified in two groups based on utilization of frozen instead of fresh-ejaculated sperm for the IUI [FROZEN (n = 1871, all infertility diagnoses), and FRESH (n = 3464, idiopathic infertility diagnosis only), respectively]. Cycle outcomes were compared between groups.
Participants/materials, setting, methods
Participants: women seeking IUI (±OS) treatments.
Outcome Measures: HCG-positivity, clinical pregnancy (CP), spontaneous abortion (SAB) rates. Initial analysis included all cycles irrespective of OS regimen. Cycles were then stratified by OS regimen into three subgroups [injectable gonadotropins, oral medications (OM): clomiphene-citrate and letrozole, and unstimulated/natural]. Odds ratios (OR) for all relevant outcomes were calculated utilizing logistic regression and adjusted for maternal age, day-3 FSH, and OS regimen. Time-to-pregnancy and first-cycle only analyses were also performed.
Main results and the role of chance
Unadjusted HCG-positivity, and CP were lower in the FROZEN compared to the FRESH group (12.2% vs. 15.6%, p < 0.001; 9.4% vs. 13.0%, p<.001, respectively), which persisted only among OM after stratification (9.9% vs. 14.2% HCG-positivity, p=.030; 8.1% vs. 11.8% CPR, p=.041, for FROZEN compared to FRESH, respectively).
Among all cycles, adjOR(95%CI) for HCG-positivity and CP were respectively: 0.75(0.56-1.02), and 0.77(0.57-1.03), ref: FRESH). Following stratification by OS regimen, adjOR(95%CI) for HCG-positivity and CP showed no difference between groups among gonadotropin and natural cycles but favored the FRESH group in OM cycles [HCG-positivity: 0.55(0.30-0.99); CP: 0.49(0.25-0.95), ref.: FRESH]. SAB odds did not differ between groups among OM and natural cycles but were lower in the FROZEN compared to FRESH group among gonadotropin cycles [adjOR(95%CI): 0.13(0.02-0.98), ref.: FRESH]. However, regarding the latter comparison, numbers were small and the 95%CI wide. When analysis was limited to first-cycles only and further stratified by OS regimen, the previously noted differences in CP and SAB odds no longer existed within the OS subgroups.
Nevetheless, time-to-conception was slightly longer in the FROZEN compared to the FRESH group (3.84 vs. 2.58 cycles, p<.001).
Limitations, reasons for caution
Study is limited by its retrospective nature. The two groups differed somewhat in age, infertility diagnosis, utilized OS regimen, and as expected in total motile sperm counts. Despite the less favorable characteristics of the FROZEN group, no detrimental effect of sperm cryopreservation on IUI outcomes was noted.
Wider implications of the findings
Our study, the largest to date, showed no significant difference in IUI outcomes between cycles utilizing frozen instead of fresh-ejaculated sperm. Although, specific subgroups might benefit from fresh sperm utilization and time-to-pregnancy might be shorter with fresh over frozen sperm, patients should be counselled about the non-inferiority of frozen sperm.
Trial registration number
Not applicable
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Affiliation(s)
- P Cherouveim
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - S Vagios
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - K Hammer
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - V Fitz
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - V Jiang
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - K James
- Deborah Kelly Center for Outcomes Research - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology , Boston MA, U.S.A
| | - I Dimitriadis
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - C Bormann
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
| | - I Souter
- Massachusetts General Hospital Fertility Center - Massachusetts General Hospital and Harvard Medical School, Department of Obstetrics/Gynecology and Reproductive Biology - Division of Reproductive Endocrinology and Infertility , Boston MA , U.S.A
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Velmahos C, Vagios S, Cherouveim P, Dimitriadis I, Bormann C. O-299 Analyzing the impact of simple wash versus density gradient sperm preparations on intrauterine insemination outcomes. Is the cost-effective and time-efficient option just as good? Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
How do different sperm preparations, such as simple-wash (SW) and density-gradient (DG), impact intrauterine insemination (IUI) outcomes among women seeking fertility treatments?
Summary answer
Using a population from a large, academic medical center, this study discerned no differences in pregnancy outcomes between SW and DG sperm preparations.
What is known already
IUI with or without ovulation induction (OI) is often a first-line treatment among couples seeking fertility services. SW and DG are two common methods used to prepare sperm for IUI. In comparison to its latter counterpart, the SW technique is lesser-used, yet is more time-efficient, and cost-effective due to its utilization of only a single centrifugation step. Since the impact of sperm preparation techniques on the post-processing sperm yield and its parameters varies by the method used, the cycle outcomes might differ as well. However, limited data exists on various sperm preparations’ impact on IUI clinical outcomes.
Study design, size, duration
Data from 3378 IUI+OI cycles (from 1503 women of all diagnoses seeking IUI with fresh-ejaculated sperm) that took place at a large academic fertility center between 9/2014 and 3/2021 were retrospectively reviewed. Cycles were either unstimulated (natural) or stimulated with either oral OI agents (clomiphene-citrate & letrozole) or gonadotropins. Cycles were divided in two groups based on sperm preparation technique: SW (n = 1691) and DG (n = 1687) and outcomes were compared between them.
Participants/materials, setting, methods
Sperm preparation: SW semen were mixed in 10ml MHM (FujiFilm) and centrifuged for 10min. DG semen were layered over 45:90 gradient of Isolate (FujiFilm), centrifuged for 20min, and washed twice (10min) in 10ml MHM.
Outcome measures: hCG-positivity (posHCGR), clinical pregnancy (CPR), spontaneous abortion (SABR), and livebirth rates/cycle (LBR).
Statistics: Logistic regression with Odds Ratios (OR) adjusted for both partners’ ages, day-3 FSH, stimulation, and sperm score (poor, fair, good, excellent). Sub-analysis limited cohort to first-cycles only.
Main results and the role of chance
Groups were comparable in patient [age (maternal, paternal), BMI, day-3 FSH, infertility diagnosis], and cycle characteristics [follicular response (measured as number of preovulatory follicles), and endometrial thickness]. Preprocessing sperm parameters differed slightly with higher mean sperm concentrations and lower total motility among SW cycles (75.3 + 57.0 vs. 71.0 + 51.3 million, p = 0.02; 48.6 + 19.6 vs. 52.5 + 20.2, p < 0.001, for SW and DG, respectively). posHCGR, CPR, SABR, and LBR per cycle did not differ between groups (15.8% vs. 15.4%, p = 0.76;13.7% vs. 13.2%, p = 0.62;18.1% vs. 18.5%, p = 0.93; 9.5 vs. 8.9%, p = 0.56; for SW and DG, respectively).
Odds for posHCG, CP, SAB, or LB did not differ between groups [adjOR(95%CI): 1.05(0.87-1.26), p = 0.65; 1.10(0.67-1.83), p = 0.71; 0.98(0.60-1.60), p = 0.94; 1.08(0.85-1.37), p = 0.66, respectively]. When cycles were stratified by type of ovarian stimulation, rather than adjusted for it, no difference was seen in any of the clinical outcomes within individual strata{adjOR(95%CI): [Oral OI: 1.00(0.74-1.37), p = 0.98; 1.78(0.68-4.61), p = 0.25; 0.97(0.40-2.38), p = 0.95; 1.05(0.72-1.53), p = 0.81], [Gonadotropins: 0.99(0.78-1.28), p = 0.96; 0.93(0.49-1.77), p = 0.83; 0.97(0.52-1.80), p = 0.96; 1.03(0.75-1.41), p = 0.87], [Natural: 2.36(0.97-5.76), p = 0.06; 0.08(0.001-6.84), p = 0.26; 0.20(0.003-11.02), p = 0.43; 2.52(0.63-10.00), p = 0.19], for posHCG, CP, SAB, and LB, respectively}. Similarly, no difference was seen in any of the clinical outcomes when cycles were stratified by sperm score or when analysis was limited to first-cycles only.
Limitations, reasons for caution
LBR were calculated excluding pregnancies with no information after discharge to obstetrics (approximately 16%). Although not significant, there might be minor variations in individual provider’s practices between time frames in which these techniques were implemented.
Wider implications of the findings
SW is a much simpler, time-efficient, and cost-effective sperm processing technique for IUI compared to DG, however remains infrequently utilized. Adoption of SW, over DG, could yield comparable clinical efficacy, yet optimize teamwork flow and lower healthcare costs, due to its non-labor-intensive and inexpensive nature.
Trial registration number
not applicable
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Affiliation(s)
- C Velmahos
- University of Massachusetts Medical School, Medical School , Worcester, U.S.A
| | - S Vagios
- Tufts Medical Center, Obstetrics and Gynecology , Boston, U.S.A
| | - P Cherouveim
- Massachusetts General Hospital, Obstetrics and Gynecology , Boston, U.S.A
| | - I Dimitriadis
- Massachusetts General Hospital, Obstetrics and Gynecology , Boston, U.S.A
| | - C Bormann
- Massachusetts General Hospital, Obstetrics and Gynecology , Boston, U.S.A
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Vagios S, Sacha CR, Hammer KC, Fitz VW, Dimitriadis I, Souter I, Bormann CL. The effect of semen collection at home on intrauterine insemination outcomes. Andrology 2022; 10:863-870. [PMID: 35332697 DOI: 10.1111/andr.13176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/16/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The WHO 2010 guidelines recognize at-home semen collection as an acceptable alternative to standard collection at the clinic in "exceptional circumstances". There is lack of sufficient data to determine the need for revisiting these recommendations for treatment purposes. OBJECTIVES To determine whether at home semen collection has any effect on intrauterine insemination (IUI) cycle outcomes. MATERIALS AND METHODS This is a retrospective cohort study of 729 IUI treatment cycles (382 patients) performed at an academic fertility center from 9/19/2019 to 12/31/2020. Semen collected at the "clinic" was used for 343 cycles before the Coronavirus Disease 2019 (COVID-19) pandemic (09/19/2019-3/21/2020), and "at-home" collected specimens were used for 386 cycles following revised protocols with COVID-19 driven changes (5/30/2020-12/31/2020). Logistic regression models were performed to evaluate the effect of "at-home" semen collection on achieving a positive pregnancy test (PPT) and a clinical pregnancy (CP). RESULTS Male and female partners' age, ovarian reserve biomarkers, and stimulation regimens used were similar in the "clinic" and "at-home" groups. In unadjusted models, "at-home" collection had no significant effect on the odds for a PPT [OR (95%CI): 0.733(0.503-1.069)] or CP [0.816(0.543-1.226)]. These results persisted even when adjusting for maternal age and anti-Müllerian Hormone: PPT [0.739(0.505-1.081)] and CP [0.826(0.547-1.248)]. Of the semen analysis parameters under evaluation, only motility appeared to significantly impact the odds of achieving a PPT [1.014(1.004-1.025)] and a CP [1.017(1.006-1.029)]. This effect was slightly attenuated for samples collected "at-home" [1.012(0.997-1.027) and 1.015(0.999-1.031), respectively for PPT and CP]. DISCUSSION This study adds important information to the limited literature regarding the effect of at-home semen collection on IUI outcomes. Under adequate protocols, at-home semen collection should be considered a safe alternative. Additional research is needed to optimize such protocols. CONCLUSION Our data suggest that at-home semen collection does not negatively impact IUI pregnancy outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA, 02114, USA
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA, 02114, USA
| | - Karissa C Hammer
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA, 02114, USA
| | - Victoria W Fitz
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA, 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA, 02114, USA
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA, 02114, USA
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Yland JJ, Zhang Y, Williams PL, Mustieles V, Vagios S, Souter I, Calafat AM, Hauser R, Messerlian C. Phthalate and DINCH urinary concentrations across pregnancy and risk of preterm birth. Environ Pollut 2022; 292:118476. [PMID: 34763012 DOI: 10.1016/j.envpol.2021.118476] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 05/21/2023]
Abstract
Preconception and prenatal exposure to phthalates has been associated with an increased risk of preterm birth. However, it is unclear whether there are periods of heightened susceptibility during pregnancy. This prospective cohort study included 386 women undergoing fertility treatment who gave birth to a singleton infant during 2005 through 2018. Eleven phthalate metabolites were measured in spot urine samples collected at each trimester. In approximately 50% of participants, two metabolites of 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH), a phthalate substitute, were also measured. The molar sum of four di(2-ethylhexyl) phthalate metabolites (∑DEHP) was calculated. We evaluated the associations of mean maternal biomarker concentrations with risk of preterm birth using modified log-binomial models and utilized multiple informant models to compare trimester-specific associations. We examined the relative biomarker concentration across gestation comparing women with preterm birth to women with term delivery using quadratic mixed model. The risk ratio for preterm birth associated with a one-unit increase in the natural log-transformed urinary concentrations of ∑DEHP (mean during pregnancy) was 1.21 (95% confidence interval (CI): 0.84, 1.72). In multiple informant models, these associations were strongest in the third trimester (RR = 1.51; 95% CI: 1.17, 1.95). Estimated mean ∑DEHP concentrations were higher among women with preterm than term delivery, especially late in gestation. Associations with preterm birth were also observed for each of the four individual DEHP metabolites. Detection of cyclohexane-1,2-dicarboxylic acid monocarboxyisooctyl ester (MCOCH), a metabolite of DINCH, appeared to be positively related to preterm birth. In this prospective cohort of subfertile couples, maternal ∑DEHP metabolite concentrations during pregnancy were associated with an increased risk of preterm birth, particularly during late gestation.
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Affiliation(s)
- Jennifer J Yland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Yu Zhang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Vicente Mustieles
- University of Granada, Center for Biomedical Research (CIBM), Spain. Instituto de Investigación Biosanitaria Ibs GRANADA, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 18100, Spain
| | - Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Russ Hauser
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carmen Messerlian
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA, USA.
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Dimitriadis I, Kanakasabapathy MK, Thirumalaraju P, Vagios S, Souter I, Shafiee H, Bormann CL. ARTIFICIAL INTELLIGENCE ASSISTANCE FOR THE QUALITY ASSESSMENT OF EMBRYO VITRIFICATION, WARMING AND TRANSFERS IN THE IVF LABORATORY. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sacha CR, Vagios S, Souter I, Kanakasabapathy MK, Thirumalaraju P, Shafiee H, Bormann CL. MATURITY OF OOCYTE COHORT IMPACTS BLASTOCYST DEVELOPMENT AS CLASSIFIED BY ARTIFICIAL INTELLIGENCE (AI). Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vagios S, Sacha CR, Hammer KC, Fitz VW, Dimitriadis I, Souter I, Bormann CL. P–034 Social distancing protocol changes during the COVID–19 pandemic; the effect of at-home semen collection on intrauterine insemination outcomes. Hum Reprod 2021. [PMCID: PMC8385885 DOI: 10.1093/humrep/deab130.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study question How have the coronavirus 2019 (COVID–19)-driven changes in semen collection protocols, from on-site to at-home collection, impacted intrauterine insemination (IUI) cycle outcomes? Summary answer Our data suggest that at-home semen collection within 2 hours of processing does not negatively impact semen parameters and IUI pregnancy outcomes. What is known already: There are mixed reports regarding the effect of at-home semen collection on IUI outcomes. In a study of 633 cycles, no differences in semen parameters or pregnancy rates were observed between home and clinic collections1. Conversely, in a smaller cohort, at-home collection was associated with worse pregnancy outcomes when IUI was coupled with gonadotropin stimulation, but not when coupled with clomiphene2. We previously reported no differences in semen parameters and in-vitro fertilization (IVF) embryo transfer outcomes, when cycles using semen collected at-home were compared to cycles with on-site collection3. However, such findings cannot necessarily be extended to the IUI setting. Study design, size, duration This is a retrospective cohort study of all 529 IUI cycles that took place in 2020 at an academic fertility center. Semen collected at the “clinic” was used for 143 cycles before the COVID–19 pandemic, and “at-home” collected specimens were used for the 386 cycles following the revised semen collection protocol. Participants/materials, setting, methods: Prior to the COVID–19 pandemic, semen was collected at our “clinic” and processed within ∼30 minutes. Post-COVID, in order to maintain social distancing, semen was collected “at-home”, at an IUI-approved cup, and transported to our center within 2 hours, while maintained to room temperature. Logistic regression models were performed to evaluate the effect of “at-home” collection on achieving pregnancy (positive pregnancy test-PPT) and clinical pregnancy (sonographic confirmation-CP), adjusting for age and anti-Mullerian hormone (AMH). Main results and the role of chance The mean age (SD) (years) of the female partner was 35.4 (4.2) vs. 35.4 (4.4) (p = 0.978) and of the male partner 36.6 (4.4) vs. 37.1 (p = 0.328) for the “clinic” vs. “at-home” groups, respectively. There were no significant differences in day–3 follicle stimulating hormone and AMH. In both groups the most common diagnoses were idiopathic and combined factors infertility (27.3% and 18.9% & 24.1% and 25.1%, respectively for the “clinic” & “at-home” groups, p = 0.376). Similarly, there were no differences regarding ovarian stimulation, and gonadotropins were the most common medication used in both groups (“clinic”: 44.1% vs. “at-home”: 39.4%, p = 0.775). Semen analysis parameters (volume, motility, forward progression, total motile count) were comparable between the 2 groups, with the exception of concentration (mil/ml) which was higher with “at-home” collection [66.1 (45.0) vs. 81.1 (63.0), p = 0.009]. In unadjusted models, “at-home” collection had no significant effect on the odds for a PPT [OR (95%CI): 0.691 (0.427–1.119), p = 0.133] or CP [0.751 (0.447–1.263), p = 0.281]. These results persisted even when adjusting for maternal age and AMH: PPT [0.708 (0.435–1.153), p = 0.165] and CP [0.773 (0.455–1.312), p = 0.340]. When sub-analysis was performed within the different medication groups, the above findings persisted for both gonadotropin and oral medication cycles. Limitations, reasons for caution The limitations of the study include its retrospective design and the absence of livebirth data, given the limited follow up period. However, regarding the latter, one can use the ongoing clinical pregnancy rate as an accurate estimate of livebirth. Wider implications of the findings: At-home semen collection within 2 hours of processing did not negatively impact semen analysis parameters or pregnancy outcomes following IUI. These data constitute an important addition to the current limited literature on the subject and provides an additional level of safety for our patients and staff during the COVID–19 crisis. Trial registration number Not applicable
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Affiliation(s)
- S Vagios
- Massachusetts General Hospital- Harvard Medical School, Obstetrics & Gynecology- Division of Reproductive Endocrinology and Infertility, Boston, USA
| | - C R Sacha
- Massachusetts General Hospital- Harvard Medical School, Obstetrics & Gynecology- Division of Reproductive Endocrinology and Infertility, Boston, USA
| | - K C Hammer
- Massachusetts General Hospital- Harvard Medical School, Obstetrics & Gynecology- Division of Reproductive Endocrinology and Infertility, Boston, USA
| | - V W Fitz
- Massachusetts General Hospital- Harvard Medical School, Obstetrics & Gynecology- Division of Reproductive Endocrinology and Infertility, Boston, USA
| | - I Dimitriadis
- Massachusetts General Hospital- Harvard Medical School, Obstetrics & Gynecology- Division of Reproductive Endocrinology and Infertility, Boston, USA
| | - I Souter
- Massachusetts General Hospital- Harvard Medical School, Obstetrics & Gynecology- Division of Reproductive Endocrinology and Infertility, Boston, USA
| | - C L Bormann
- Massachusetts General Hospital- Harvard Medical School, Obstetrics & Gynecology- Division of Reproductive Endocrinology and Infertility, Boston, USA
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Vagios S, Mitchell CM. Mutual Preservation: A Review of Interactions Between Cervicovaginal Mucus and Microbiota. Front Cell Infect Microbiol 2021; 11:676114. [PMID: 34327149 PMCID: PMC8313892 DOI: 10.3389/fcimb.2021.676114] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
At mucosal surfaces throughout the body mucus and mucins regulate interactions between epithelia and both commensal and pathogenic bacteria. Although the microbes in the female genital tract have been linked to multiple reproductive health outcomes, the role of cervicovaginal mucus in regulating genital tract microbes is largely unexplored. Mucus-microbe interactions could support the predominance of specific bacterial species and, conversely, commensal bacteria can influence mucus properties and its influence on reproductive health. Herein, we discuss the current evidence for both synergistic and antagonistic interactions between cervicovaginal mucus and the female genital tract microbiome, and how an improved understanding of these relationships could significantly improve women’s health.
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Affiliation(s)
- Stylianos Vagios
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Vincent Center for Reproductive Biology, Massachusetts General Hospital Research Institute, Boston, MA, United States
| | - Caroline M Mitchell
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Vincent Center for Reproductive Biology, Massachusetts General Hospital Research Institute, Boston, MA, United States
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Zhang Y, Mustieles V, Williams PL, Wylie BJ, Souter I, Calafat AM, Demokritou M, Lee A, Vagios S, Hauser R, Messerlian C. Parental preconception exposure to phenol and phthalate mixtures and the risk of preterm birth. Environ Int 2021; 151:106440. [PMID: 33640694 PMCID: PMC8488320 DOI: 10.1016/j.envint.2021.106440] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Parental preconception exposure to select phenols and phthalates was previously associated with increased risk of preterm birth in single chemical analyses. However, the joint effect of phenol and phthalate mixtures on preterm birth is unknown. METHODS We included 384 female and 211 male (203 couples) participants seeking infertility treatment in the Environment and Reproductive Health (EARTH) Study who gave birth to 384 singleton infants between 2005 and 2018. Mean preconception urinary concentrations of bisphenol A (BPA), parabens, and eleven phthalate biomarkers, including di(2-ethylhexyl) phthalate (DEHP) metabolites, were examined. We used principal component analysis (PCA) with log-Poisson regression and Probit Bayesian Kernel Machine Regression (BKMR) with hierarchical variable selection to examine maternal and paternal phenol and phthalate mixtures in relation to preterm birth. Couple-based BKMR model was fit to assess couples' joint mixtures in relation to preterm birth. RESULTS PCA identified the same four factors for maternal and paternal preconception mixtures. Each unit increase in PCA scores of maternal (adjusted Risk Ratio (aRR): 1.36, 95%CI: 1.00, 1.84) and paternal (aRR: 1.47, 95%CI: 0.90, 2.42) preconception DEHP-BPA factor was positively associated with preterm birth. Maternal and paternal BKMR models consistently presented the DEHP-BPA factor with the highest group Posterior Inclusion Probability (PIP). BKMR models further showed that maternal preconception BPA and mono(2-ethyl-5-hydroxyhexyl) phthalate, and paternal preconception mono(2-ethylhexyl) phthalate were positively associated with preterm birth when the remaining mixture components were held at their median concentrations. Couple-based BKMR models showed a similar relative contribution of paternal (PIP: 61%) and maternal (PIP: 77%) preconception mixtures on preterm birth. We found a positive joint effect on preterm birth across increasing quantiles of couples' total mixture concentrations. CONCLUSION In this prospective cohort of subfertile couples, maternal BPA and DEHP, and paternal DEHP exposure before conception were positively associated with preterm birth. Both parental windows jointly contributed to the outcome. These results suggest that preterm birth may be a couple-based pregnancy outcome.
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Affiliation(s)
- Yu Zhang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Vicente Mustieles
- University of Granada, Center for Biomedical Research (CIBM), Spain; Instituto de Investigación Biosanitaria Ibs GRANADA, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 18100, Spain
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Blair J Wylie
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, MA, USA; Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melina Demokritou
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alexandria Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, MA, USA; Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Massachusetts General Hospital Fertility Center, Harvard Medical School, Boston, MA, USA; Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
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Vagios S, Sacha CR, Hammer KC, Dimitriadis I, James KE, Bormann CL, Souter I. Response to ovulation induction treatments in women with polycystic ovary syndrome as a function of serum anti-Müllerian hormone levels. J Assist Reprod Genet 2021; 38:1827-1833. [PMID: 33934267 DOI: 10.1007/s10815-021-02217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess whether anti-Müllerian hormone (AMH) can predict response to ovulation induction (OI) with clomiphene citrate (CC), letrozole (LET), or follicle-stimulating hormone (FSH) in women with polycystic ovary syndrome (PCOS) undergoing OI/intrauterine inseminations (IUI). METHODS A total of 738 OI/IUI cycles from 242 patients at an academic center were stratified in three groups by medication: CC (n = 295), LET (n = 180), and FSH (n = 263), in a retrospective fashion. Ovarian response to treatment (RT, development of at least one dominant follicle) was assessed using mixed effects logistic regression models. RESULTS Overall, RT cycles had lower AMH levels compared to no-RT cycles (p < 0.001). This finding persisted when analysis was limited to oral agents but attenuated in FSH cycles. For CC and LET cycles, the predicted probability (PProb) for RT decreased as AMH levels increased (PProb (95%CI): 97% (93-100), 79% (70-88), and 75% (61-89); 85% (78-93), 75% (67-83), and 73% (63-86) for AMH pct.: ≤ 25th, ≥ 50th, and ≥ 75th, for CC and LET, respectively)). However, RT was noted in 98.5% of FSH/IUI cycles regardless of AMH. For CC cycles, those with AMH ≥ 75th pct. had lower odds for RT over cycles with AMH < 75th pct. (OR 0.2, 95%CI 0.04-0.8, p = 0.02). Similarly, lower odds for RT were observed in LET cycles with AMH ≥ 75th pct. (0.6, 0.3-1.4, p = 0.25). CONCLUSION In PCOS, increasing serum AMH levels are associated with lower probability of RT to oral agents. Our findings constitute a valuable tool for the clinician when counseling PCOS patients and designing a personalized ovulation induction treatment strategy.
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Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Karissa C Hammer
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
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Vagios S, Hsu JY, Sacha CR, Dimitriadis I, Christou G, James KE, Bormann CL, Souter I. Pretreatment antimüllerian hormone levels and outcomes of ovarian stimulation with gonadotropins/intrauterine insemination cycles. Fertil Steril 2021; 116:422-430. [PMID: 33823994 DOI: 10.1016/j.fertnstert.2021.02.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/02/2021] [Accepted: 02/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the association, if any, between serum antimüllerian hormone (AMH) levels and probability of clinical pregnancy and spontaneous abortion (SAB) in the infertility setting. DESIGN Retrospective cohort study. SETTING Academic fertility center. PATIENT(S) A total of 1,861 gonadotropin stimulation/intrauterine insemination cycles stratified by AMH levels into 3 groups: Low, <25th percentile (<0.7 ng/mL); Middle, ≥25th and <75th percentile (0.7-4.4 ng/mL); and High, ≥75th percentile (≥4.5 ng/mL). INTERVENTION(S) Intrauterine insemination after stimulation with gonadotropins. MAIN OUTCOME MEASURE(S) Cumulative probability of clinical pregnancy over a maximum of 3 and/or 6 cycles and SAB incidence risk rate (IRR). The Kaplan-Meier failure function (log rank test), Cox proportional hazards models, and multilevel mixed-effects Poisson regression models were performed to compare outcomes among the AMH groups. RESULT(S) Overall, in both unadjusted and adjusted models, the probability of achieving a clinical pregnancy was higher in the Middle and High AMH groups compared with that in the Low AMH group, both over 3 (hazard ratios [95% confidence interval], 1.55 [1.05-2.29] and 1.85 [1.22-2.81], respectively) and 6 (1.71 [1.17-2.48] and 2.12 [1.42-3.16], respectively) cycles. In the unadjusted models, the SAB IRR was higher among the Low AMH group (IRR [95% confidence interval], 2.17 (1.11-4.24]), with the relationship persisting after adjusting for age (1.83 [0.93-3.60]). When the SAB IRR were calculated separately for the subpopulations with and without polycystic ovary syndrome, a similar relationship was noted among the latter in the unadjusted (1.94 [0.97-3.88]) and adjusted (1.74 [0.86-3.49]) analyses. CONCLUSION(S) In women undergoing gonadotropin stimulation/intrauterine insemination, AMH appears to affect the probability of achieving a clinical pregnancy. A possible negative impact, independent of age, on the risk of SAB was also suggested.
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Affiliation(s)
- Stylianos Vagios
- Division of Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Jennifer Y Hsu
- Division of Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caitlin R Sacha
- Division of Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Dimitriadis
- Division of Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Georgios Christou
- Division of Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles L Bormann
- Division of Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Souter
- Division of Endocrinology and Infertility, Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Sacha CR, Vagios S, Hammer K, Fitz V, Souter I, Bormann CL. The effect of semen collection location and time to processing on sperm parameters and early IVF/ICSI outcomes. J Assist Reprod Genet 2021; 38:1449-1457. [PMID: 33704628 PMCID: PMC7946618 DOI: 10.1007/s10815-021-02128-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/23/2021] [Indexed: 11/02/2022] Open
Abstract
PURPOSE We aimed to assess whether home collection and increased time to semen processing are associated with altered sperm parameters, fertilization rates (FR), day 5 usable quality blastocyst development rates (D5-UQBR), or pregnancy rates (PR) in patients undergoing IVF/ICSI. METHODS This was a retrospective cohort study of patients undergoing IVF/ICSI before the coronavirus disease 2019 (COVID-19) pandemic ("clinic" collection, n = 119) and after COVID-19 ("home" collection, n = 125) at an academic fertility practice. Home collection occurred within 2 h of semen processing. Patient sperm parameters, FR (#2PN/MII), D5-UQBR (# transferable and freezable quality blastocysts/# 2PN), and PR in fresh transfer cycles were compared between clinic and home groups with t-tests. The association between time to processing on outcomes was assessed with regression modeling, controlling for potential confounders. RESULTS Mean male age was 37.9 years in the clinic group and 37.2 years in the home group (p = 0.380). On average, men were abstinent for 3.0 days (SD 1.7) in the clinic group and 4.1 days (SD 5.4) in the home group (p = 0.028). Mean time to semen processing was 35.7 min (SD 9.4) in the clinic group and 82.6 min (SD 33.8) in the home group (p < 0.001). There was no association between collection location and increased time to processing on sperm motility, total motile count, FR, D5-UQBR, or PR. CONCLUSIONS Our data suggest that increased time to processing up to 2 h with home semen collection does not negatively impact sperm parameters or early IVF/ICSI outcomes.
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Affiliation(s)
- Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 32 Fruit Street-Yawkey 10A, Boston, MA, 02114, USA.
| | - Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 32 Fruit Street-Yawkey 10A, Boston, MA, 02114, USA
| | - Karissa Hammer
- Massachusetts General Hospital Fertility Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 32 Fruit Street-Yawkey 10A, Boston, MA, 02114, USA
| | - Victoria Fitz
- Massachusetts General Hospital Fertility Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 32 Fruit Street-Yawkey 10A, Boston, MA, 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 32 Fruit Street-Yawkey 10A, Boston, MA, 02114, USA
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 32 Fruit Street-Yawkey 10A, Boston, MA, 02114, USA
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Vagios S, James KE, Sacha CR, Hsu JY, Dimitriadis I, Bormann CL, Souter I. A patient-specific model combining antimüllerian hormone and body mass index as a predictor of polycystic ovary syndrome and other oligo-anovulation disorders. Fertil Steril 2020; 115:229-237. [PMID: 33077236 DOI: 10.1016/j.fertnstert.2020.07.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/13/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether a patient-specific predictive model combining antimüllerian hormone (AMH) levels and body mass index (BMI) can aid in the diagnosis of polycystic ovary syndrome (PCOS) and other ovulatory dysfunction disorders (OVDYS) among infertile women. DESIGN Retrospective cohort study. SETTING Academic fertility center. PATIENT(S) One thousand and ten infertile women undergoing 3,160 intrauterine insemination (IUI) cycles, stratified by diagnosis in three groups: PCOS, OVDYS, and other etiologies. INTERVENTION(S) Ovulation induction followed by IUI or ultrasound-monitored natural cycles. MAIN OUTCOME MEASURE(S) The probability of either PCOS or OVDYS diagnosis based on AMH levels alone and a patient-specific predictive model that combines serum AMH and patient's BMI. RESULT(S) Median and interquartile range (IQR) for the serum AMH levels (ng/mL) were the highest in women with PCOS, and lowest in those with other infertility causes. Overall, for every 1 ng/mL increase in AMH, the odds of PCOS and OVDYS versus other causes increased by 55% and 24%, respectively. Postestimation from multivariate logistic regression models showed that PCOS diagnosis can be predicted with lower AMH values in women with a higher BMI compared with the AMH values predicting PCOS in normal-weight or underweight patients. The receiver operating characteristic curves reinforced these findings, and the best cutoffs for PCOS diagnosis were 7.5, 4.4, and 4.1 ng/mL for women belonging to the BMI groups 18.5-24.9, 25.0-29.9, and ≥30.0 kg/m2, respectively. CONCLUSION(S) Taking into account AMH and BMI, we developed a model that predicts the probability of an oligo-anovulation diagnosis, thus facilitating patient-specific counseling in the infertility setting.
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Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Kaitlyn E James
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Y Hsu
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Vagios S, Hesham H, Mitchell C. Understanding the potential of lactobacilli in recurrent UTI prevention. Microb Pathog 2020; 148:104544. [PMID: 33010368 DOI: 10.1016/j.micpath.2020.104544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
Urinary tract infections (UTIs) are one of the most common infections in women. The only proven preventive strategy for recurrent UTIs is prophylactic antibiotics. Given growing antibiotic resistance, the use of probiotics has been proposed as an alternative to antibiotics. Herein, we discuss the current evidence to support the possibility that exogenous lactobacilli may limit the pathogenicity of uropathogens such as E. coli. Probiotics appear to have a significant potential in prevention of recurrent UTI, however, additional data are needed to understand how they can be effectively used in clinical practice.
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Affiliation(s)
- Stylianos Vagios
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Vincent Center for Reproductive Biology, Massachusetts General Hospital Research Institute, USA
| | - Helai Hesham
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Vincent Center for Reproductive Biology, Massachusetts General Hospital Research Institute, USA
| | - Caroline Mitchell
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Vincent Center for Reproductive Biology, Massachusetts General Hospital Research Institute, USA.
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20
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Dimitriadis I, Vagios S, Souter I, Sacha C, Kanakasabapathy MK, Thirumalaraju P, Bormann CL, Shafiee H. THE USE OF DEEP-LEARNING CONVOLUTIONAL NEURAL NETWORKS (CNN) TO OBJECTIVELY COMPARE TWO DIFFERENT EMBRYO CULTURE MEDIA. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Dolisca S, Hammer KC, Vagios S, Hsu J, Sacha C, Souter I, Kanakasabapathy MK, Thirumalaraju P, Bormann CL, Shafiee H. IS THERE A DIFFERENCE IN IVF DEVELOPMENTAL OUTCOMES BETWEEN OOCYTES RETRIEVED IN ROOM TEMPERATURE OOCYTE COLLECTION MEDIUM OR MEDIUM MAINTAINED AT 37ºC? Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Sacha CR, Vagios S, Hammer KC, Fitz VW, Souter I, Bormann CL. WHEN AND WHERE DURING COVID-19: THE EFFECT OF AT-HOME SEMEN COLLECTION ON SPERM PARAMETERS, FERTILIZATION RATE, AND BLASTOCYST RATE. Fertil Steril 2020. [PMCID: PMC7548557 DOI: 10.1016/j.fertnstert.2020.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Vagios S, Doulgeraki T, Giannikaki E, Kavoura E, Papadimitriou C, Gakiopoulou H, Pavlakis K. Could Mismatch Repair Status Serve as a Biomarker for Immunotherapy in Endometrial Carcinoma? Anticancer Res 2020; 40:1669-1676. [PMID: 32132073 DOI: 10.21873/anticanres.14118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/10/2022]
Abstract
AIM To study whether mismatch repair (MMR) status is related to the expression of programmed cell death-ligand 1 (PD-L1) and CD8 counts in a series of grade 3 endometrial carcinomas. MATERIALS AND METHODS The expression of MMR protein PD-L1 and CD8+ cell count were evaluated by immunohistochemistry and related to several clinicopathological parameters. RESULTS Among 105 endometrial carcinomas, 40% were of endometrioid and 60% of non-endometrioid histology. MMR deficiency was observed in 28.6% of cases and was related to endometrioid histology (p<0.001), positive PD-L1 expression (p=0.047) and high CD8+ cell count (p=0.022). When examined by histotype, endometrioid MMR-deficient tumors were related only to PD-L1 expression (p=0.032) but not to high CD8+ cell count (p=0.231), whereas non-endometrioid MMR-deficient carcinomas were not related to either of these markers. MMR deficiency was associated with PD-L1+/CD8high status (p=0.006), whilst MMR proficiency was associated with PD-L1-/CD8low status. In MMR-proficient tumors, high CD8+ cell infiltration alone and combined with PD-L1- status was associated with better progression-free survival (p=0.013 and p=0.04, respectively). CONCLUSION MMR-deficient high-grade endometrioid tumors might be more likely to benefit from immunotherapy compared to other grade 3 endometrial carcinomas.
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Affiliation(s)
- Stylianos Vagios
- First Pathology Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Triada Doulgeraki
- First Pathology Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Elpida Giannikaki
- Pathology Department, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | | | - Christos Papadimitriou
- Oncology Unit, Second Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Harikleia Gakiopoulou
- First Pathology Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Kitty Pavlakis
- First Pathology Department, National and Kapodistrian University of Athens, Athens, Greece.,Pathology Department, IASO Women's Hospital, Athens, Greece
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Cherston C, Sacha C, Sabatini M, Hammer KC, Souter I, Vagios S, Bormann CL, Donahoe PK, Pepin D. HIGHER LEVELS OF MATERNAL SERUM ANTI-MULLERIAN HORMONE ARE ASSOCIATED WITH AN INCREASED MALE-TO-FEMALE NEONATE RATIO AFTER IVF/ICSI. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Nasioudis D, Ko EM, Kolovos G, Vagios S, Kalliouris D, Giuntoli RL. Ovarian preservation for low-grade endometrial stromal sarcoma: a systematic review of the literature and meta-analysis. Int J Gynecol Cancer 2020; 29:126-132. [PMID: 30640694 DOI: 10.1136/ijgc-2018-000063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the effect of ovarian preservation on oncologic outcomes for women with low-grade endometrial stromal sarcoma of the uterus. METHODS A systematic search of the Medline, Embase, Cohrane, and Web of Science databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies including patients with low-grade endometrial stromal sarcoma who had hysterectomy were identified. Data on tumor recurrence and death rate were pooled using a random effects model. RESULTS A total of 17 studies met the inclusion criteria and reported on 786 patients. Based on available information, ovarian preservation was noted in 190 patients while 501 had bilateral salpingo-oophorectomy. A significantly increased tumor recurrence rate was observed in the ovarian preservation group (89/190, 46.8%) compared with the bilateral salpingo-oophorectomy group (121/501, 24.2%) (OR 2.70, 95% CI 1.39 to 5.28). Based on data from 162 patients, no difference in death rate was noted between the ovarian preservation (2/34, 5.9%) and bilateral salpingo-oophorectomy (9/128, 7%) groups (OR 0.80, 95% CI 0.18 to 3.47). CONCLUSIONS Approximately one-quarter of patients with low-grade endometrial stromal sarcoma were managed with ovarian preservation. These women experienced a higher recurrence rate. Hormone exposure may be responsible for this elevated risk. Given the apparent high salvage rate, however, ovarian preservation may be an option only in a well-informed patient population.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA .,Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Georgios Kolovos
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Stylianos Vagios
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Dimitrios Kalliouris
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Robert L Giuntoli
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Vagios S, Sacha CR, Hsu JY, Dimitriadis I, Bormann CL, James KE, Souter I. Can anti-mullerian hormone (AMH) levels predict response to ovulation induction treatments in women with polycystic ovarian syndrome (PCOS)? Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Doulgeraki T, Vagios S, Kavoura E, Yiannou P, Messini I, Nonni A, Papadimitriou C, Vlachos A, Pavlakis K. Mismatch repair status in high-grade endometrial carcinomas of endometrioid and non-endometrioid type. J BUON 2019; 24:2020-2027. [PMID: 31786870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate mismatch repair (MMR) status in a series of high-grade endometrial carcinomas and correlate it with several clinicopathological characteristics and with survival. METHODS One hundred and one patients with high-grade endometrial carcinoma, both of endometrioid and of non-endometrioid type were included in the study. The expression of MLH1, MSH2, MSH6 and PMS2 was evaluated by immunohistochemistry. RESULTS In our cohort, 41 women had an endometrioid and 60 women a non-endometrioid carcinoma. Endometrioid histotype was statistically more frequent in deficient MMR (dMMR) tumors (73.3%), while non-endometrioid carcinomas in proficient (pMMR) cases (73.8%) (p<0.001). When analyzing the group of endometrioid and non-endometrioid carcinomas separately, only dMMR endometrioid cancers were found to be statistically related to deep myometrial invasion, lymph-node metastases and advanced stage (p=0.035, p=0.011 and p=0.028, respectively). Univariate and multivariate analysis revealed no relation between MMR status and progression-free survival (PFS) or overall survival (OS). Adjuvant treatment was not found to influence the course of the disease. When MMR proteins were studied separately, MLH1/PMS2 loss was related to deep myometrial invasion (p=0.019 and p=0.036, respectively) and MSH6 loss to lymph-node metastases (p=0.04). CONCLUSIONS In our group of high-grade endometrial carcinomas, MMR deficiency was statistically more frequent in endometrioid than in non-endometrioid cancers. Furthermore, only dMMR endometrioid type grade 3 carcinomas were found to be related with features indicative of aggressive behavior. Considering some unique relation of each MMR protein with distinct clinicopathological features, the assessment of all four proteins is proposed.
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Affiliation(s)
- Triada Doulgeraki
- 1st Pathology Department, National and Kapodistrian University of Athens, Athens, Greece
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28
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Vagios S, Yiannou P, Giannikaki E, Doulgeraki T, Papadimitriou C, Rodolakis A, Nonni A, Vlachos A, Pavlakis K. The impact of programmed cell death-ligand 1 (PD-L1) and CD8 expression in grade 3 endometrial carcinomas. Int J Clin Oncol 2019; 24:1419-1428. [PMID: 31197557 DOI: 10.1007/s10147-019-01484-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND To evaluate the expression of programmed cell death-ligand 1 (PD-L1) and CD8 in high-grade endometrial carcinomas and relate it to several clinicopathological parameters. METHODS One hundred and one (101) patients with high-grade endometrial carcinomas who were completely surgically staged were included in this study. PD-L1 and CD8 + expression was evaluated by immunohistochemistry. RESULTS In our cohort, 47 women (46.5%) had endometrioid carcinomas and 54 patients (53.5%) were diagnosed with non-endometrioid cancers. In endometrioid carcinomas, there was a significantly higher rate of positivity for PD-L1 expression (p = 0.042) and of intraepithelial CD8 + cell counts (p = 0.004) as opposed to non-endometrioid cancers. There were no significant relationships with any of the other clinicopathological features under study. Univariate and multivariate analysis revealed that only high intraepithelial CD8 + counts (p = 0.01) was associated with longer progression-free survival. Tumors positive for PD-L1 and high intraepithelial CD8 expression were mainly of endometrioid histology, whilst PD-L1-positive/CD8 low and PD-L1-negative/CD8 low tumors were mostly non-endometrioid carcinomas (p = 0.01). PD-L1 negative/CD8 high tumors had the longest progression-free survival (p = 0.032). CONCLUSIONS In grade 3 endometrial carcinomas, both of endometrioid and non-endometrioid type, high intraepithelial CD8 + counts represent an independent favorable prognostic factor and when related to PD-L1-negative tumors, a longer progression-free survival can be predicted. Immunotherapy could probably be considered for PD-L1-positive/CD8 + high tumors, which were mostly of endometrioid histology.
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Affiliation(s)
- Stylianos Vagios
- Pathology Department, National and Kapodistrian University of Athens, 75 Mikras Asias St, 11527, Athens, Greece.
| | - Petros Yiannou
- Pathology Department, "IASO" Women's Hospital, 37-39 Kifisias Ave, 15123, Athens, Greece
| | - Elpida Giannikaki
- Pathology Department, Venizeleio-Pananeio General Hospital, 44 Knossos Ave, 71409, Heraklion, Crete, Greece
| | - Triada Doulgeraki
- Pathology Department, "IASO" Women's Hospital, 37-39 Kifisias Ave, 15123, Athens, Greece
| | - Christos Papadimitriou
- Oncology Unit, 2nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, 71 Vas. Sophias Ave, 11528, Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Ave, 11528, Athens, Greece
| | - Afroditi Nonni
- Pathology Department, National and Kapodistrian University of Athens, 75 Mikras Asias St, 11527, Athens, Greece
| | - Athanassios Vlachos
- Department of Gynecological Oncology, "IASO" Women's Hospital, 37-39 Kifisias Ave, 15123, Athens, Greece
| | - Kitty Pavlakis
- Pathology Department, National and Kapodistrian University of Athens, 75 Mikras Asias St, 11527, Athens, Greece.,Pathology Department, "IASO" Women's Hospital, 37-39 Kifisias Ave, 15123, Athens, Greece
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Aravanis CV, Kapelouzou A, Vagios S, Tsilimigras DI, Katsimpoulas M, Moris D, Demesticha TD, Schizas D, Kostakis A, Machairas A, Liakakos T. Toll-Like Receptors -2, -3, -4 and -7 Expression Patterns in the Liver of a CLP-Induced Sepsis Mouse Model. J INVEST SURG 2018; 33:109-117. [PMID: 29847187 DOI: 10.1080/08941939.2018.1476630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: To investigate the expression of toll-like receptors (TLRs) in the liver of septic mouse model. Materials and methods: For this study seventy-two C57BL/6J mice were utilized. Sepsis was induced by cecal ligation and puncture (CLP) in the mice of the three septic (S) groups (euthanized at 24 hours, 48 hours and 72 hours). Sham (laparotomy)- operated mice constituted the control (C) groups (euthanized at 24, 48 and 72 hours). Blood samples were drawn and liver tissues were extracted and examined histologically. The expression of TLRs 2, 3, 4 and 7 was assessed via immunohistochemistry (IHC) and qrt-PCR (quantitative- Polymerase Chain Reaction). Results: Liver function tests were elevated in all S-groups in contrast to their time-equivalent control groups (S24 versus C24, S48 versus C48 and S72 versus C72) (p < 0.05). Liver histology displayed progressive deterioration in the septic groups. IHC and qrt-PCR both showed an increased expression of all TLRs in the septic mice in comparison to their analogous control ones (p < 0.05). Analysis of livers and intestines of the septic animals proved that all TLRs were significantly expressed in higher levels in the intestinal tissues at 24h and 48h (p < 0.05) except for TLR 3 in S48 (p > 0.05); whereas at 72 hours only TLR 4 levels were significantly elevated in the intestine (p < 0.05). Conclusion: TLRs seem to be expressed in significant levels in the livers of septic rodents, indicating that they have a possible role in the pathophysiology of liver damage in septic conditions.
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Affiliation(s)
- Chrysostomos V Aravanis
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Alkistis Kapelouzou
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Stylianos Vagios
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Michalis Katsimpoulas
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Theano D Demesticha
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian, University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alkiviadis Kostakis
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Anastasios Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Theodore Liakakos
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Moris D, Ntanasis-Stathopoulos I, Tsilimigras DI, Vagios S, Karamitros A, Karaolanis G, Griniatsos J, Papalampros A, Papaconstantinou I, Glantzounis GK, Spartalis E, Blazer DG, Felekouras E. Update on Surgical Management of Small Bowel Neuroendocrine Tumors. Anticancer Res 2018; 38:1267-1278. [PMID: 29491050 DOI: 10.21873/anticanres.12349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 02/07/2023]
Abstract
The widespread use of endoscopy and imaging in combination with the continuous update of the staging systems for neuroendocrine tumors has led to an increase in the incidence of small intestinal neuroendocrine tumors (si-NENs) globally. Despite high survival rates, severe complications may occur even in early stages due to the anatomic location of the primary site and the desmoplastic reaction. Surgery plays a central role in the management of patients with si-NENs. Excision of locoregional disease along with extensive lymph node dissection should be performed in fit patients, even in the presence of metastases. Multimodality treatment of liver metastases includes hepatectomy, ablative techniques and liver transplantation. Hormone therapy with somatostatine analogs is of high importance for symptomatic control; special caution should be exercised both pre- and intra-operatively. A multidisciplinary approach is essential in order to provide personalized therapeutics for patients with si-NENs. Clinical research and specialization in this field should be further encouraged.
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Affiliation(s)
- Demetrios Moris
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC, U.S.A.
| | - Ioannis Ntanasis-Stathopoulos
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Diamantis I Tsilimigras
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Stylianos Vagios
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Andreas Karamitros
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Georgios Karaolanis
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - John Griniatsos
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Alexandros Papalampros
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Ioannis Papaconstantinou
- Second Department of Surgery, National and Kapodistrian University of Athens, Aretaieio University Hospital, Athens, Greece
| | | | - Eleftherios Spartalis
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Dan G Blazer
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC, U.S.A
| | - Evangelos Felekouras
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Athens, Greece
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Tsilimigras DI, Moris D, Vagios S, Merath K, Pawlik TM. Safety and oncologic outcomes of robotic liver resections: A systematic review. J Surg Oncol 2018; 117:1517-1530. [PMID: 29473968 DOI: 10.1002/jso.25018] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/23/2018] [Indexed: 02/06/2023]
Abstract
The robotic system has emerged as a new minimally invasive technology with promising results. We sought to systematically review the available literature on the safety and the oncologic outcomes of robotic liver surgery. A systematic review was conducted using Medline (PubMed), Embase and Cochrane library through November 12th, 2017. A robotic approach may be a safe and feasible surgical option for minor and major liver resections.
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Affiliation(s)
| | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
| | - Stylianos Vagios
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katiuscha Merath
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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32
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Moris D, Tsilimigras DI, Vagios S, Ntanasis-Stathopoulos I, Karachaliou GS, Papalampros A, Alexandrou A, Blazer DG, Felekouras E. Neuroendocrine Neoplasms of the Appendix: A Review of the Literature. Anticancer Res 2018; 38:601-611. [PMID: 29374682 DOI: 10.21873/anticanres.12264] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
Appendiceal neuroendocrine neoplasms (ANENs) comprise rare tumors of the appendix, mainly affecting young populations and characterized by a rather favorable prognosis. The aim of this review was to summarize the current knowledge on these neoplasms, focusing on the management and follow-up of such patients, which still remain under debate. ANENs account for 0.16-2.3% of appendectomies and are usually diagnosed incidentally. The histopathological diagnosis includes the immunohistochemical profile of the tumor in regard to synaptophysin and chromogranin A, as well as the Ki-67 index. The surgical management of ANENs is either simple appendectomy or a more extensive oncological operation including right hemicolectomy. This depends on the stage and the presence of risk factors suggesting a more aggressive disease, such as the exact location, mesoappendiceal or lymphovascular invasion, and the proliferative rate of the tumor. Despite their indolent course, ANENs may relapse. Therefore, lifetime observation is necessary for patients with tumors >2 cm and >1 cm plus additional risk factors; however, more studies should be conducted in order to determine the optimal follow-up strategy.
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Affiliation(s)
- Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC, U.S.A.
| | | | - Stylianos Vagios
- First Department of Surgery, Laikon General Hospital, University of Athens, Athens, Greece
| | | | | | - Alexandros Papalampros
- First Department of Surgery, Laikon General Hospital, University of Athens, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, Laikon General Hospital, University of Athens, Athens, Greece
| | - Dan G Blazer
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC, U.S.A
| | - Evangelos Felekouras
- First Department of Surgery, Laikon General Hospital, University of Athens, Athens, Greece
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Tsilimigras DI, Bakopoulos A, Ntanasis-Stathopoulos I, Gavriatopoulou M, Moris D, Karaolanis G, Spartalis E, Vagios S, Kalfa M, Salla C, Avgerinos DV. Clear cell "sugar tumor" of the lung: Diagnostic features of a rare pulmonary tumor. Respir Med Case Rep 2017; 23:52-54. [PMID: 29276673 PMCID: PMC5734796 DOI: 10.1016/j.rmcr.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 12/15/2022] Open
Abstract
Clear cell tumor of the lung (CCTL) is an extremely rare neoplasm with about 50 cases reported in the literature so far. CCTL belongs to a family arising from putative perivascular epithelioid cells and is otherwise named as "sugar tumor" due to its high cellular glycogen concentration. Due to its rarity, diagnostic features of this entity are not widely known and this usually leads to misdiagnosis. Herein, we report a case of benign CCTL, which was primarily evaluated intraoperatively by FNA cytology and then by a pathological examination of the resected tumor. The cytologic preparations were moderately cellular and showed multiple large, irregular, cohesive clusters of ovoid or spindle tumor cells. Cells had clear cytoplasm, showing positivity with the periodic acid-Schiff (PAS) staining method owing to the glycogen (sugar) content. The rapid cytologic report excluded the possibility of malignancy and a middle lobectomy along with an anterior upper segmentectomy was performed. Immunochemistry revealed a diffuse positivity for HMB45, MART-1, SMA and focally for desmin, while specimen was negative for pancytokeratin cocktail AE1/AE3, cytokeratin7, cytokeratin20 and EMA. These findings confirmed the diagnosis of a benign CCTL. Due to its rarity and similarity with other clear cell tumors of the lung, awareness of this entity, recognition of the cytomorphologic features and familiarity with the associated clinical features can help clinicians avoid certain pitfalls in the diagnostic process. Considering its benign course, unnecessary extensive lung resections may also be avoided thus permitting conservative management of these patients.
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Affiliation(s)
- Diamantis I. Tsilimigras
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anargyros Bakopoulos
- Third Department of Surgery, Attikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, Alexandra General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Georgios Karaolanis
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Stylianos Vagios
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kalfa
- Cytopathology Department, Hygeia Hospital, Athens, Greece
| | | | - Dimitrios V. Avgerinos
- Department of Cardiothoracic Surgery, New York Presbyterian Medical Center, Weill Cornell College of Medicine, New York, NY, USA
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