Antithrombotic therapy for pregnancy loss,Hum. Reprod. Update (November/December 2013) 19 (6): 656-673. First published online: June 13, 2013 doi: 10.1093/humupd/dmt019 by P.G. de Jong, M. Goddijn and S. Middeldorp
The review by de Jong and colleagues is a clear and useful update on the association between thrombophilia and pregnancy loss, a topic that has been widely explored. In reviewing the literature from the past 19 years, Jong et al. describe the pathogenetic mechanisms of and efficacy of antithrombotic therapy in reducing the rate of recurrent miscarriage. Early smaller studies reported good clinical efficacy of antithrombotic treatment. However, recent randomized controlled trials have not confirmed these early studies and demonstrate that antithrombotic therapy did not increase the chance of live birth in women with unexplained recurrent miscarriage. This update will be of much interest to those working on this topic.
Autotransplantation of cryopreserved ovarian tissue in cancer survivors and the risk of reintroducing malignancy: a systematic review, Hum. Reprod. Update 19 (5): 483-506 doi:10.1093/humupd/dmt020 by L. Bastings and colleagues
The topic discussed is highly current, of great interest to those working in reproductive medicine and oncology, and has relevant impact on women’s health. Ovarian tissue cryopreservation and autotransplantation in women with various forms of cancer is a procedure that is becoming diffuse worldwide. However, ovarian grafts from these patients may contain low numbers of residual malignant cells and lead to a recurrence of oncological disease. The systematic review by Bastings and colleagues identifies reassuring data on the safety of ovarian tissue autotransplanation in lymphoma and breast cancer patients. However, data suggests that it is advisable to refrain from ovarian tissue autotransplantation in women with leukaemia.
Placental protein 13 (PP13): a new biological target shifting
individualized risk assessment to personalized drug design combating
pre-eclampsia, Hum. Reprod. Update (July/August 2013) 19 (4):
391-405, doi:10.1093/humupd/dmt003 by Berthold Huppertz, Hamutal Meiri,
Sveinbjorn Gizurarson, George Osol and Marei Sammar.
In the review presented by Huppertz and colleagues, meta-analysis
revealed that a low serum level of placental protein 13 (PP13) in the
first trimester of pregnancy is a predictive marker of later development
of preeclampsia. Therefore, measurement of PP13 may help to identify
women at risk of preeclampsia, a disease which is a major cause of
foetal and maternal morbidity and mortality.
Huppertz et al. propose a therapeutic role for PP13 and suggest that
preeclampsia could be prevented in women with low serum levels by
The longer-term health outcomes for children born as a result of IVF treatment: Part I–General health outcomes, Hum Reprod Update 2013 19: 232-243 by Roger Hart and Robert J. Norman
The longer-term health outcomes for children born as a result of IVF treatment. Part II–Mental health and development outcomes, Hum Reprod Update 2013 19: 244-250 by Roger Hart and Robert J. Norman
The two systematic reviews by Robert Hart and Robert Norman in the May issue of HRU represent a real milestone in the longer term evaluation (beyond one year) of children born as a result of IVF. The reviews distinguish between general health and neurological/developmental outcomes, showing reassuring evidence with IVF. Some of the associations found are common in children born to couples with infertility. A possible association with cardiometabolic diseases in adults, and with depression in adolescence, needs to be addressed in future studies.
Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer—a systematic review and meta-analysis, Hum. Reprod. Update (March/April 2013) 19(2): 105-123 by Siristatidis C, Sergentanis TN, Kanavidis P, Trivella M, Sotirak Mi, Mavromatis I, Psaltopoulou T, Skalkidou A, and Petridou ET
The paper by Siristatidis and his group is a very clear analysis of the association between medication for ovarian stimulation in IVF and gynaecological cancers. There has been an ongoing discussion on this matter since the introduction of HRT many years ago prompted claims that the administration of exogenous hormones might be the cause of ovarian and endometrial cancers.
Throughout the past two decades, several publications have investigated this association - with differing conclusions.
The present paper includes data collected from 109,969 women exposed to IVF and shows that IVF women have a higher risk of ovarian and endometrial cancer than general population. However, this association disappears when infertile women are used as controls.
The story is not yet complete, but this systematic review is a clear statement and supports the classic concept that infertility per se is a risk factor for some gynaecological cancers.