OBJECTIVE: To investigate whether intrauterine perfusion of hCG before embryo transfer (ET) is effective in women experienced two or more implantation failures.
METHODS: Systematic review and meta-analysis. In the current meta-analysis, Pubmed, EMBASE and The Cochrane Library were searched for trials which compared the efficacy of intrauterine perfusion of hCG with no perfusion of hCG in women undergoing in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or frozen embryo transfer (FET) before ET. The primary outcomes are the clinical pregnancy rate (CPR) and live birth rate (LBR).
RESULTS: Six trials consisted of 1432 women were eligible for quantitative analysis. CPR (including 6 trials consisted of 1432 women) and LBR (including 3 trials consisted of 870 women) were significantly improved in the hCG group compared to the control group, with a CPR of 41.8 % vs. 31.2 % (RR 1.30, 95 % CI 1.14∼1.50, P < .001), an LBR of 27.8 % vs. 18.0 % (RR 1.52, 95 % CI 1.18∼1.96, P = .001).
CONCLUSIONS: Intrauterine perfusion of hCG is effective in improving clinical pregnancy rate and live birth rate in women who experienced two or more implantation failures, which might provide a potential therapeutical intervention for recurrent implantation failure (RIF). Although promising, further evidence from multicenter, randomized controlled trials are needed to confirm the conclusion from the current meta-analysis.

Despite the fact that menstrual psychosis has been described since the eighteenth century, there are only about 80 cases reported in the literature. The knowledge and awareness about the disorder remain poor, leading to inaccurate diagnoses and suboptimal treatment. This is the case of a 25-year-old woman with recurrent hospitalizations for mental status changes including psychotic phenomena and catatonia that appeared to follow a cyclical pattern that correlated with her menstrual periods, with complete symptom resolution and return to her usual level of functioning between episodes despite continued treatment with antipsychotic medications. This pattern remitted only after hormonal therapy was initiated. Through this case report, the authors review the literature on the menstrual psychoses, exemplified by this case, and discuss treatment options and prognosis. Menstrual psychosis is an underrecognized condition where psychotic symptoms recur cyclically with menses. Given the poor response that this entity shows to antipsychotic treatment, hormonal therapies have a prominent role.

In this systematic review and meta-analysis, the effect of intrauterine HCG infusion before embryo transfer on IVF outcomes (live birth rate, clinical pregnancy rate and spontaneous aboretion rate) was investigated. Searches were conducted on MEDLINE, EMBASE and The Cochrane Library. Randomized studies in women undergoing IVF and intracytoplasmic sperm injection comparing intrauterine HCG administration at embryo transfer compared with no intrauterine HCG were eligible for inclusion. Eight randomized controlled trials were eligible for inclusion in the meta-analysis. A total of 3087 women undergoing IVF and intracytoplasmic sperm injection cycles were enrolled (intrauterine HCG group: n = 1614; control group: n = 1473). No significant difference was found in the live birth rate (RR 1.13; 95% CI 0.84 to 1.53) and spontaneous abortion rate (RR 1.00, 95% CI 0.74 to 1.34) between women who received intrauterine HCG and those who did not receive HCG. Although this review was extensive and included randomized controlled trials, no significant heterogeneity was found, and the overall included numbers are relatively small. In conclusion the current evidence does not support the use of intrauterine HCG administration before embryo transfer. Well-designed multicentre trials are needed to provide robust evidence.

BACKGROUND: Traditional Chinese medicine has been widely used for the treatment of recurrent miscarriage in China and other Asian countries for long time. We conducted this review to systematically summarize the evidences of Chinese herbal medicine (CHM) for the prevention and treatment of recurrent miscarriage in randomized trials, and evaluate the effectiveness and safety of CHM compared with placebo or conventional medicine.
METHODS: We searched studies in PubMed, ClinicalTrials, the Cochrane Library, CNKI, SinoMed and VIP databases until December, 2012. Randomized trials on CHM alone or in combination with conventional medicine for recurrent miscarriage compared with placebo or conventional medicine were included. We evaluated the methodological quality of each included trials using the Cochrane risk of bias tool.
RESULTS: A total of 41 RCTs (3660 participants) were included. The majority of trials had a high or unclear risk of bias. CHM used alone or plus progesterone-based treatment showed superior effect over progesterone-based treatment in improving live birth rate and embryonic developmental state (measured by B ultrasound). However, there is substantial heterogeneity within each subgroup analysis (I2 ranging from 35% to 71%). CHM plus progesterone and hCG-based treatment was superior to progesterone and hCG-based treatment in improving the embryonic developmental state, but not live birth rate. No severe adverse events were reported in relation to CHM.
CONCLUSIONS: Some Chinese herbal medicines or in combination with progesterone-based treatment demonstrated potentially beneficial effect in improving live birth rate and embryonic developmental state for women with recurrent miscarriage. However, due to the substantial heterogeneity among the herbal interventions and limitations of methodological quality of the included trials, it is not possible to recommend any specific CHMs for recurrent miscarriage. Further rigorous clinical trials are warranted to evaluate the efficacy and safety of CHM.

OBJECTIVE: To assess the efficacy and safety of hCG to induce follicular stimulation.
METHODS: Systematic literature searches of PubMed, EMBASE, CENTRAL, and SciSearch databases. Randomized controlled trials (RCTs) using hCG in early or late follicular phases were included.
METHODS: Three reproductive medicine services of gynecology in Spain and two universities.
METHODS: A total of 1,068 women treated in 11 RCTs were included.
METHODS: Use of hCG versus other hormone treatments, no administration, or placebo during the period of follicular stimulation.
METHODS: Live birth, clinical pregnancy, mature oocytes, miscarriage, ovarian hyperstimulation syndrome (OHSS), and FSH doses.
RESULTS: No differences in live birth, miscarriage, and OHSS rates between hCG (given at either the early or late follicular phases) and different control regimens were found. Pooled analysis for clinical pregnancy showed significant differences in favor of hCG at the late follicular phase. The doses of FSH were lower in women treated with hCG at either the early or late follicular phase than in those treated with FSH alone.
CONCLUSIONS: The use of hCG in the early and late follicular phase in controlled ovarian stimulation has the advantage of decreasing the doses of FSH.

暂无摘要。

OBJECTIVE: To assess short-term side effects, long-term risks and efficacy of quinacrine sterilization (QS) in Chile.
METHODS: Review experience of 2,592 cases sterilized with 2 or 3 transcervical insertions of 252 mg quinacrine as pellets since 1977; review the Chilean pre-clinical experience and epidemiological studies on cervical, endometrial and other cancers.
RESULTS: Among 2,592 women who underwent QS, the total number of pregnancies was 119 (4.6%); 59 (49.5%) were carried to term with no birth defects related to QS. Nine cases were ectopic pregnancies. The ectopic pregnancy risk per 1,000 woman-years was 0.41, similar to that for surgical sterilization. The cumulative life-table pregnancy rates per 100 women at 10 years varied from 5.2 to 6.9. Mild and transient side effects were reported in 13.5% of quinacrine intrauterine insertions and pelvic inflammatory disease was diagnosed in 4 cases (0.15%). Long-term follow-up of quinacrine-sterilized patients shows no increased risk of cervical, endometrial or other cancer.
CONCLUSIONS: QS efficacy at 10 years is comparable to widely accepted tubal clip and single point bipolar electrocoagulation laparoscopic procedures. QS has a low risk of serious, immediate side effects. No long-term risks have been identified after 25 years of use.

Longterm use of marijuana has been found to cause physiological changes that can alter individual reproductive potential. The effects of marijuana depend on the dose and can include death from depression of the respiratory system. Longterm effects are however particularly hard to assess. Marijuana is absorbed rapidly and eliminated very slowly. The active principle, delta-9-tetrahidrocannabinol (delta-9-THC), is highly liposoluble and fixes to the serum proteins, passing to the lungs and liver for metabolization and to the kidneys and liver for excretion. As with estrogens, there is an enterohepatic circuit for reabsorption and elimination. 90% is eliminated in the feces, 65% within 48 hours. Because of the enterohepatic circuit and liposolubility, elimination requires 1 week for completion. The other important biotransformation of the active principle is hydroxilation; the hydroxilated derivatives are responsible for the psychoactivity of cannabis. Cannabis affects both neuroendocrine function and the germ cells. Studies on experimental animals have indicated that THC can cause a decline in the pituitary hormones follicle stimulating hormone, luteinizing hormone, and prolactin, and in the steroids progesterone, estrogen, and androgens. Human studies have shown that chronic users have decreased levels of serum testosterone. Because steroidogenesis can be restimulated with human chorionic gonadotropin, it appears that THC does not directly affect steroid production by the corpus luteum, but that its action is mediated by the hypothalamus. Because of its potent antigonadotropic action, THC is under study as an anovulatory agent. The same animal studies have shown that ovulation returns to normal 6 months after termination of use. High rates of anovulation and luteal insufficiency have been observed in women smoking marijuana at least 3 times weekly. THC accumulates in the milk. Animal studies have shown that THC depresses the enzymes necessary for lactation and causes a diminution in the volume of the mammary glands. In recent studies, significant amounts of the drug have been detected in both mothers\' milk and the blood of newborns. Animal studies indicate that THC crosses the placenta, achieving concentrations in the fetus as high as those in the mother. Animal studies also demonstrated increasing frequency of abortions, intrauterine death, and declines in fetal weight. The effects were probably due to an alteration in placental function. A human study likewise showed that marijuana use during pregnancy was significantly related to poor fetal development, low birth weight, diminished size, and decreased cephalic circumference. Congenital malformations have been observed in experimental animals exposed to THC. Declines in sperm volume and count and abnormal sperm motility have been observed in chronic marijuana users. In vitro studies show that THC produces a marked degeneration of human sperm.

This report summarizes research supported by the Program for Applied Research on Fertility Regulation (PARFR) to develop a long-acting, injectable, biodegradable miscrosphere delivery system for norethisterone (NET). This delivery system consists of microspheres composed of a biodegradable polymer and NET. The polymer 1st evaluated for making NET microspheres was dl-polylactic acid (PLA). This prototype system was tested in clinical trials involving 63 women at 3 centers. The results of these studies indicated that PLA microspheres are capable of delivering NET continously for about 6 months. The duration of ovarian suppression was dose dependent with a given microsphere formulation and size limit. The average number of bleeding and spotting days decreased with increasing time from injection. Up to 12 months was required for the PLA microspheres to completely degrade, however, and there was concern that repeated injections at 6-month intervals might allow an undesirable build-up of PLA in muscle tissues. Research efforts then centered on developing a polymer formulation that offered better synchronization between duration of NET release and biodegradation of the polymer. In the 2nd generation formulation, polyglycolic acid (PGA) was incorporated to achieve faster biodegradation. Phase II studies were based on a formulation that demonstrated improvements in the manufacturing process, pharmacokinetics of the NET microspheres, biodegradation kinetics of the polymer, and injectability. More precise control of release has been obtained, the drug loading and size distribution of the microspheres have been optimized, and the molar ratios of PLA and PGA have been changed. Although Phase II studies are still in progress, higher NET-loaded microspheres have been shown to product substantially faster release rates during the 1st 30 days post-treatment. In addition, increasing the NET concentration to 50% substantially improved formulation injectability. Few obstacles to eventual approval and widescale use of this injectable contraceptive system are anticipated. Studies are currently underway to provide better bleeding control.

Oral contraceptives agents (OCA) have been in use for more than two decades, and at the present time, 150 to 200 million women are using the preparations. Apart from their gynecologic influence, the hormones have been shown to affect a number of metabolic and nutritional processes, some advantageously and others disadvantageously. Concern over the nutritional status of females consuming OCA prompted this review. Eight vitamins and three minerals were investigated. Contraceptive steroid ingestion was shown to depress the physiologic levels of six nutrients (riboflavin, pyridoxine, folacin, vitamin B12, ascorbic acid and zinc), elevate the levels of three others (vitamin K, iron and copper) and provide little or no change in one (alpha tocopherol) and questionable increases in another (vitamin A). It was concluded that females consuming OCA should pay particular attention to vitamin and mineral intake and, if warranted, consume physiologic supplements of needed nutrients.
The state of knowledge concerning the effects of OCs (oral contraceptives) and mineral metabolism is assessed. A review of the literature indicates that OCs depress the levels of Vitamin B2, or riboflavin, Vitamin B6, or pyridoxine, folacin, Vitamin B12, Vitamin C, or ascorbic acid, zinc and elevate levels of Vitamin K, copper, and iron. The ingestion of OCs produces little effect on Vitamin E, or alpha tocopherol. Findings on the effects of OC ingestion on Vitamin A are ambiguous. OC users have 50%-80% higher serum levels of Vitamin A than nonusers; however, OC users may have a greater need for Vitamin A than nonusers. The need for riboflavin may also be higher for OC users. OC users need more pyridoxine and riboflavin is needed to oxidize pyridoxine phosphate to pyridoxal phosphate. Most studies support the contention that OC usage leads to a deficiency of Vitamin B6. Approximately 80% of all women using OCs for 6 or more months experience abnormal typtophan metabolism. In order to correct this problem, 25 mg daily, or 12 times the normal daily requirement, is needed. Some investigators recommend givng this dosage to women, who experience abnormal tryptophan metabolism, while others warn that the long-term effects of such high dosages are unknown. Most investigators recommend that OC users, with Vitamin B12 or Vitamin C deficiencies, should be given supplementary vitamins.