scholarly journals SUN-289 Childhood-Onset, Adamantinomatous Craniopharyngioma and Successful Pregnancy: Results of Kraniopharyngeom 2000/2007

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Panjarat Sowithayasakul ◽  
Svenja Boekhoff ◽  
Hermann Lothar Muller
Keyword(s):  
Pregnancy Rate ◽  
Adult Female ◽  
Assisted Reproductive Techniques ◽  
Close Monitoring ◽  
Perinatal Complications ◽  
Childhood Onset ◽  
Adult Age ◽  
Increased Risk ◽  
Reproductive Techniques ◽  
Adamantinomatous Craniopharyngioma

Abstract Background: Hypopituitarism is associated with an increased risk of pregnancy complications, such as abortion, anemia, pregnancy-induced hypertension, placental abruption, premature birth, and postpartum hemorrhage. The advance of assisted reproductive techniques makes it possible to improve the pregnancy rate in hypopituitary patients. Data on female fertility, pregnancy, and outcome of offspring after childhood-onset, adamantinomatous craniopharyngioma (CP) are rare. Study design: Observational study on pregnancy rate and outcome of offspring after childhood-onset CP in adult, female patients recruited in KRANIOPHARYNGEOM 2000/2007. Patient cohorts: Since 2000, 451 CP patients (223 f / 228 m) have been recruited with high grade of completeness. 263 CP patients (128 f / 135 m) have reached adult age. 6 of 128 adult, female CP patients (5%) reported on 9 pregnancies giving birth to 10 healthy newborns. Results: The median age at time of CP diagnosis was 14.9 years. Complete surgical CP resections were achieved in 3 patients. No patient underwent postoperative irradiation. 5 natural pregnancies occurred in 3 CP patients presenting with postoperative normal pituitary function. 4 pregnancies were achieved in 3 CP with hypopituitarism under assisted reproductive techniques (after in median 4.5 cycles, range: 3-6 cycles). Median maternal age at pregnancy was 30 years, ranging from 22 to 41 years. 6 of 10 babies were delivered by caesarean section. Gestational age at delivery was in median 38 weeks, ranging from 34 to 43 weeks; median birth weight was 2,920 gram (range: 2,270-3,520 gram), the rate of preterm delivery (<38 weeks of gestation) was 33%. The rate of breastfeeding was 56%. Enlargements of CP cysts occurred in 2 women during pregnancy. Other severe complications during pregnancy, delivery and postnatal period were not observed. Conclusions: Pregnancies after CP are rare (5%) and almost half of the patients (45%) achieved pregnancies after assisted reproductive techniques, which are effective and safe in CP patients. With regard to existing deficiencies of hypothalamic-pituitary axes, close monitoring and care by an experienced reproductive physician is necessary. Furthermore, MRI monitoring especially of CP cysts is recommended during pregnancy. Severe perinatal complications, birth defects, and postnatal morbidity of the mothers and their offspring were not observed. Most CP patients complained about their initial lack of information on potential fertility under assisted reproductive techniques.

scholarly journals RARE-60. PREGNANCIES AFTER CHILDHOOD CRANIOPHARYNGIOMA – RESULTS OF KRANIOPHARYNGEOM 2000/2007

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii455-iii455
Author(s):  
Panjarat Sowithayasakul ◽  
Svenja Boekhoff ◽  
Brigitte Bison ◽  
Hermann L Müller
Keyword(s):  
Postnatal Period ◽  
Close Monitoring ◽  
Perinatal Complications ◽  
Childhood Onset ◽  
Increased Risk ◽  
Gestational Age At Delivery ◽  
Reproductive Techniques ◽  
Patients At Risk ◽  
Postoperative Irradiation ◽  
Median Birth Weight

Abstract BACKGROUND Data on female fertility, pregnancy, and outcome of offspring after childhood-onset craniopharyngioma (CP) are rare. STUDY DESIGN Observational study on pregnancy rate and offspring outcome in female CP patients recruited in KRANIOPHARYNGEOM 2000/2007. RESULTS A total of 451 CP patients (223 female) have been recruited, and 269 (133 female) were postpubertal at study. Six of 133 female CP patients (4.5%) with median age of 14.9 years at CP diagnosis had 9 pregnancies, giving birth to 10 newborns. Three patients achieved complete surgical resections. No patient underwent postoperative irradiation. Five natural pregnancies occurred in 3 CP patients without pituitary deficiencies. Four pregnancies in 3 CP patients with hypopituitarism were achieved under assisted reproductive techniques (ART) (median 4.5 cycles, range: 3–6 cycles). Median maternal age at pregnancy was 30 years (range: 22–41 years). Six babies (60%) were delivered by caesarean section. Median gestational age at delivery was 38 weeks (range: 34–43 weeks); median birth weight was 2,920 g (range: 2,270– 3,520 g), the rate of preterm delivery was 33%. Enlargements of CP cysts occurred in 2 women during pregnancy. Other complications during pregnancy, delivery, and postnatal period were not observed. CONCLUSIONS Pregnancies after CP are rare and were only achieved after ART in patients with hypopituitarism. Close monitoring by an experienced reproductive physician is necessary. Due to a potentially increased risk for cystic enlargement, clinical, ophthalmological, and MRI monitoring are recommended in patients at risk. Perinatal complications, birth defects, and morbidity of mothers and offspring were not observed.

scholarly journals Pregnancies after Childhood Craniopharyngioma: Results of KRANIOPHARYNGEOM 2000/2007 and Review of the Literature

2020 ◽  
Vol 111 (1-2) ◽  
pp. 16-26
Author(s):  
Panjarat Sowithayasakul ◽  
Svenja Boekhoff ◽  
Brigitte Bison ◽  
Hermann L. Müller
Keyword(s):  
Postnatal Period ◽  
Close Monitoring ◽  
Perinatal Complications ◽  
Childhood Onset ◽  
Increased Risk ◽  
Gestational Age At Delivery ◽  
Reproductive Techniques ◽  
Patients At Risk ◽  
Postoperative Irradiation ◽  
Median Birth Weight

<b><i>Background:</i></b> Data on female fertility, pregnancy, and outcome of offspring after childhood-onset craniopharyngioma (CP) are rare. <b><i>Study Design:</i></b> Observational study on pregnancy rate and offspring outcome in female CP patients recruited in KRANIOPHARYNGEOM 2000/2007 since 2000. <b><i>Results:</i></b> A total of 451 CP patients (223 female) have been recruited, and 269 (133 female) were postpubertal at study. Six of 133 female CP patients (4.5%) with a median age of 14.9 years at CP diagnosis had 9 pregnancies, giving birth to 10 newborns. Three patients achieved complete surgical resections. No patient underwent postoperative irradiation. Five natural pregnancies occurred in 3 CP patients without pituitary deficiencies. Four pregnancies in 3 CP patients with hypopituitarism were achieved under assisted reproductive techniques (ART) (median 4.5 cycles, range: 3–6 cycles). Median maternal age at pregnancy was 30 years (range: 22–41 years). Six babies (60%) were delivered by caesarean section. Median gestational age at delivery was 38 weeks (range: 34–43 weeks); median birth weight was 2,920 g (range: 2,270–3,520 g), the rate of preterm delivery was 33%. Enlargements of CP cysts occurred in 2 women during pregnancy. Other complications during pregnancy, delivery, and postnatal period were not observed. <b><i>Conclusions:</i></b> Pregnancies after CP are rare and were only achieved after ART in patients with hypopituitarism. Close monitoring by an experienced reproductive physician is necessary. Due to a potentially increased risk for cystic enlargement, clinical, ophthalmological, and MRI monitoring are recommended in patients at risk. Severe perinatal complications, birth defects, and postnatal morbidity of mothers and offspring were not observed.

scholarly journals Development of ICSI

Reproduction ◽  
2018 ◽  
Vol 156 (1) ◽  
pp. F51-F58 ◽  
Author(s):  
C L O’Neill ◽  
S Chow ◽  
Z Rosenwaks ◽  
G D Palermo
Keyword(s):  
Pregnancy Rate ◽  
Human Body ◽  
Assisted Reproductive Techniques ◽  
Semen Parameters ◽  
Male Factor Infertility ◽  
Fertilization Failure ◽  
Male Factor ◽  
Reproductive Techniques

The first conception outside of the human body that led to the birth of Louise Brown was a tremendous accomplishment, which opened the door to the utilization of assisted reproductive techniques globally. This brought the understanding that accomplishing life in a dish required several steps, the most obvious being the timing and characteristics of fertilization. It soon became obvious in the 1980s that the most disappointing phenomenon was unexpected and complete fertilization failure. Among the approaches that were attempted to treat male factor infertility, ICSI surfaced as the technique that brought the ratio of the gametes to 1:1 and was also able to grant consistent fertilization and a higher pregnancy rate. ICSI has now been implemented for a quarter of a century, proving itself as the ultimate technique utilizing ejaculated spermatozoa independent of the semen parameters and is the sole insemination method to be used with surgically retrieved spermatozoa. There are currently various indications for ICSI that are widely adopted, rendering it the most popular insemination method worldwide. The reliability of ICSI ensures its employment in upcoming techniques involving in vitro spermatogenesis and neogametogenesis.

scholarly journals Associated obstetric and perinatal determinants of vanishing twin pregnancies

2020 ◽  
Author(s):  
Virág Márton
Keyword(s):  
Gestational Diabetes ◽  
Perinatal Outcome ◽  
Assisted Reproductive Techniques ◽  
Neonatal Outcomes ◽  
Adverse Perinatal Outcome ◽  
Spontaneous Conception ◽  
Increased Risk ◽  
Reproductive Techniques ◽  
Vanishing Twin Syndrome ◽  
Twin Pregnancies

A retrospective cohort study was carried out to reveal the characteristics and the perinatal outcome of vanishing twin pregnancies after spontaneous conception and after assisted reproductive techniques (ART). Vanishing twin (VT) syndrome, defined as the disappearance of one of two embryos with the survival of the co-twin during the first trimester, has been known for more than four decades. Due to the high and ever growing number of assisted reproductive treatments, the incidence of twin pregnancies and thus of vanishing twin syndrome is high. Recent studies have only examined vanishing twins after ART, but we hypothesized that there is a difference in perinatal outcomes between VT pregnancies, depending on the mode of conception, possibly reflecting the potential differences between underlying pathomechanisms. Our study consisted of two parts. We initiated the first study to compare obstetric and neonatal outcomes between the survivors of VT pregnancies and matched originally singleton control pregnancies, and a second study to evaluate whether VT pregnancies after spontaneous conception have a more adverse perinatal outcome than those conceived after assisted reproductive techniques. The study involved 316 VT pregnancies: 81 after in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and 235 after spontaneous conception. Their data were derived from databases in a 22-year study period at the Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary. Our results proved that the frequency of VT pregnancies was significantly higher after natural conception than after ART. A comparison of VT pregnancies demonstrated a higher rate in pregestational and gestational diabetes mellitus (GDM) in IVF/ICSI cases than in spontaneously conceived VT pregnancies. Significant differences in the prevalences of pregnancies and intrapartum complications, and adverse neonatal outcomes were observed in vanishing twins born after IVF/ICSI as compared with those born after implantation without medical assistance, suggesting that adverse perinatal outcome in IVF/ICSI VT pregnancies may be more related to ART or infertility and underlying chronic diseases. Previous induced abortion and second-trimester fetal loss indicated an increased risk of VT pregnancies, while GDM and prematurity of previous pregnancies predicted VT and growth retardation, particularly in the spontaneously conceived VT group. Diabetes is classically defined as being associated with a higher miscarriage rate. We observed a higher recurrence rate of gestational diabetes and increased incidence of pregestational and gestational diabetes mostly in IVF/ICSI VT pregnancies, suggesting that diabetes may share a pathomechanism with VT. After identifying the causes that lead to vanishing twin syndrome, GDM, chronic maternal diseases, advanced maternal age and placentation anomalies all represented independent risk factors for VT following IVF/ICSI. It can be established that the VT phenomenon was a major prognosticator of intrauterine growth restriction for the remaining fetus in VT pregnancies after ART. In conclusion, according to our results, VT is quite frequent. VT pregnancies had a lower prevalence and a worse perinatal outcome following IVF/ICSI as compared with those of their spontaneously conceived counterparts.

scholarly journals Progesterone level on the day of hCG administration in relation to the pregnancy rates of patients undergoing assisted reproduction techniques

2017 ◽  
Vol 15 (3) ◽  
pp. 273-277 ◽  
Author(s):  
Renato de Oliveira ◽  
Fernanda Godoy Cabral ◽  
Waldemar de Almeida Pereira Carvalho ◽  
Emerson Barchi Cordts ◽  
Bianca Bianco ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Likelihood Ratio ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Assisted Reproductive Techniques ◽  
Progesterone Level ◽  
Predictive Capacity ◽  
Reproductive Techniques

ABSTRACT Objective To evaluate the predictive capacity for pregnancy of the progesterone level on the day of administering human chorionic gonadotropin, in women submitted to assisted reproductive techniques. Methods An observational study with 914 women submitted to assisted reproductive techniques from August 2014 to June 2016. Results Total pregnancy rate was 34.58%; in that, the pregnancy rate in women <35 years, between 35 and 38, and >38 years was, respectively, 42.3%, 38.7% and 16.1% (p<0.001). For embryo transfer in the same cycle, and progesterone of 1.3ng/dL, sensitivity was 4.78%, specificity, 84.18%, accuracy, 56.72%, positive likelihood ratio of 0.3019, and negative likelihood ratio of 1.1312, with receiver operating characteristic curve of 0.46 (95%CI: 0.42-0.49). Conclusion The progesterone level on the day of administering human chorionic gonadotropin of 1.3ng/dL differs from that empirically adopted at the study site (1.7ng/dL), and has a better predictive capacity for pregnancy in the patients studied. However, the low sensitivity of this examination raises questions about its real importance.

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