SEARCHLIGHT Navigating the Global Medical Network Of Sexual Health Issues for Sexual Health Matters

Mature women, method of conception and impact of pregnancy complications on newborn outcome.

Professional development is largely responsible for delay in starting a family. Increasing numbers of these mature women (>45 years old) are achieving pregnancy largely through assisted reproductive technology (ART). Porreco et al 1 investigated these women to determine the impact of pregnancy complications on newborn outcome. They studied women older than 45 years at their estimated date of delivery (EDD) compared with a control group less than 36 years at their EDD, matched by parity and plurality. All study patients and controls received uniform obstetric management in a single unit. The primary outcome was gestational age at birth stratified by plurality; secondary outcomes included birth weight, NICU (neonatal intensive care unit) days, composite neonatal morbidity, and a variety of obstetric complications. Fifty study and control patients were identified over a 5-year period. Study patients were older than controls, but the difference in “gamete” age was not significant. There was significantly more assisted reproduction (donor egg) and pre-eclampsia among study patients. Importantly, gestational age at birth and birth weights stratified by plurality were not different (86% power to detect 2-week gestational age difference, alpha 0.05). Hospital days, NICU days, and composite neonatal morbidity were not statistically different between study patients and controls.
It is concluded that when controlled for parity and plurality, mature women over 45 years conceiving largely through ART with donor eggs can expect newborn outcomes similar to younger women cared for in the same setting of a high-risk maternal-fetal practice.

1 Porreco RP, Harden L, Gambotto M and Shapiro H. Expectation of pregnancy outcome among mature women. American Journal of Obstetrics and Gynaecology Jan 2005: Vol 192, Issue 1 : 38-41.

Is CA125 predictive of clinical pregnancy in assisted conception?

In a retrospective study involving 182 consecutive pregnancies conceived after IVF or ICSI, and 41 control cycles without pregnancy from the same patients, Urbancsek et al 1 examined the correlation of CA-125 concentrations in serum samples collected for routine hCG measurements 11 ± 2 days after embryo transfer in relation to pregnancy and its outcome. The CA-125 levels were statistically significantly higher in pregnant than in non-pregnant patients. Within pregnant cycles, CA-125 concentrations correlated positively with levels of hCG and inhibin A. The CA-125 levels were statistically significantly lower in preclinical abortions than in clinical pregnancies. No statistically significant difference was observed between early pregnancy losses and ongoing pregnancies or singleton and multiple pregnancies, respectively. The predictive accuracy of CA-125 measurements was statistically significantly lower than that achieved with hCG or inhibin A.
Although CA-125 levels seem to be predictive of clinical pregnancy, they are not predictive of its outcome. Higher CA-125 concentrations may reflect higher endometrial receptivity but do not predict the number or viability of implanted embryos.

1 Urbancsek J, Hauzman EE, Lagarde AR, Osztovits J, Papp Z and Strowitzki T. Serum CA-125 levels in the second week after embryo transfer predict clinical pregnancy. Fertility and Sterility May 2005; Vol 83, Issue 5; 1414-1421.

Breast cancer and pregnancy

Breast cancer is rare in young women, with an increase in incidence in the fourth and fifth decades. A trend is to defer childbearing to later in life leading to increase in number of mature women getting pregnant. The issues of pregnancy and breast cancer are of importance as some women discover their breast cancer while pregnant and some may not have completed their family at the time of treatment. A recent review in the British Medical Journal discussed the case of a woman whose breast cancer was diagnosed during pregnancy. The therapeutic choices she was faced with at the time of diagnosis and after treatment are discussed. In summary, pregnant women with breast cancer have a similar prognosis to that of non-pregnant women with the disease. Evidence is lacking that termination of pregnancy changes the outcome of breast cancer. Pregnancy after breast cancer does not alter the outcome of treatment.

The ideal interval between treatment for breast cancer and subsequent pregnancy is unknown.

Barthelmes L. Davidson LA, Gaffney C Gateley CA. Pregnancy and Breast Cancer. British Medical Journal 2005; 330:1375-1378.

The typology of sex work

In a review article in Sexually Transmitted Infections (STI), Harcourt and Donovan1 compiled a global typography of commercial sex work using a Medline search and review of 681”prostitution” articles. At least 25 types of sex work were identified according to worksite, principal mode of soliciting clients, or sexual practices. These types of work are often grouped under the headings of "direct" and "indirect" prostitution, with the latter group less likely to be perceived or to perceive themselves as sex workers. In general, policing sex work can change its typology and location but its prevalence is rarely affected. The public health implications of sex work vary widely. They conclude that developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes.

1 Harcourt C and Donovan B. The many faces of sex work. Sex Transm Infect 2005; 81:201-206.

How far are we from ovarian transplantation?

Cryopreservation of ovarian tissue with subsequent auto transplantation has effectively preserved fertility in an animal model1 and eggs aspirated from cryopreserved ovarian tissue transplanted in heterotopic sites failed to result in pregnancy2. In a recent case report in New England Journal of Medicine, a group from Israel3 described a live birth after in vitro fertilization of thawed cryopreserved ovarian cortical tissue into ovaries of a 28-year-old woman who had ovarian failure after chemotherapy for non-Hodgkin’s lymphoma.

1 Meirow D, Nugent D. The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update 2001;7:535-43.
2 Gosden RG, Baird DT, Wade JC, Webb R. Restoration of fertility to oophorectomized sheep by ovarian autografts stored at –196°C. Hum Reprod 1994;9:597-603.
3 Meirow D, Levron J, Eldar-Geva T, Hardan I and Fridman , Zalel Y, Schiff E and Dor J. Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. New England Journal of Medicine 10.1056.

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