Fertility/Reproductive Medicine
Cohort Study: Levonorgestrel IUD Use Linked to Increased Breast Cancer Risk in Premenopausal Women
20 Oct, 2024 | 18:13h | UTCBackground: Levonorgestrel-releasing intrauterine systems (LNG-IUSs) are increasingly used, especially among Danish premenopausal women over 30 years old, as a preferred method of hormonal contraception. Previous studies have suggested an increased risk of breast cancer with LNG-IUS use but did not adequately address the duration of continuous use or account for other hormonal contraceptive exposures.
Objective: To assess the risk of breast cancer associated with continuous use of LNG-IUSs, accounting for other hormonal exposures.
Methods: In this nationwide Danish cohort study, 78,595 first-time LNG-IUS users aged 15–49 years from 2000 to 2019 were identified and matched 1:1 by birth year to nonusers of hormonal contraceptives. Exclusion criteria included prior hormonal contraceptive use within 5 years, previous cancer, postmenopausal hormone therapy, and pregnancy at baseline. Participants were followed from initiation until breast cancer diagnosis, other cancer, pregnancy, hormone therapy initiation, emigration, death, or December 31, 2022. Cox proportional hazards models adjusted for confounders estimated hazard ratios (HRs) for breast cancer associated with continuous LNG-IUS use.
Results: During a mean follow-up of 6.8 years, 1,617 breast cancer cases occurred: 720 among LNG-IUS users and 897 among nonusers. The mean age was 38 years. Continuous LNG-IUS use was associated with a higher breast cancer risk compared to nonuse (HR, 1.4; 95% CI, 1.2–1.5). HRs by duration were 1.3 (95% CI, 1.1–1.5) for 0–5 years, 1.4 (95% CI, 1.1–1.7) for >5–10 years, and 1.8 (95% CI, 1.2–2.6) for >10–15 years. Excess breast cancer cases per 10,000 users were 14 (95% CI, 6–23), 29 (95% CI, 9–50), and 71 (95% CI, 15–127), respectively. The trend test for duration was not statistically significant (P = .15).
Conclusions: Continuous use of LNG-IUSs was associated with an increased risk of breast cancer among women aged 15–49 years compared to nonuse of hormonal contraceptives. The absolute increase in risk was low.
Implications for Practice: Healthcare providers should inform women about the potential increased breast cancer risk associated with LNG-IUS use, especially considering its widespread and long-term use among premenopausal women. While the absolute risk increase is small, this information is essential for making informed contraceptive choices.
Study Strengths and Limitations: Strengths include the large, nationwide cohort and adjustment for multiple confounders. Limitations include potential underestimation of risk due to unrecorded LNG-IUS removals before the recommended duration, lack of a statistically significant trend with duration suggesting possible low statistical precision or non-causal association, and the possibility of unmeasured confounding.
Future Research: Further studies are needed to confirm these findings, clarify the causal relationship, and understand the mechanisms underlying the potential increased breast cancer risk with LNG-IUS use.
Cohort Study: Elevated autism spectrum disorder risk in children exposed to valproate during pregnancy
21 Mar, 2024 | 13:16h | UTCStudy Design and Population: This cohort study utilized two health care utilization databases in the United States, covering the period from 2000 to 2020, to investigate the association between prenatal exposure to antiseizure medications and the risk of autism spectrum disorder (ASD) in children. The study compared children exposed to topiramate, valproate, or lamotrigine during the second half of pregnancy to those unexposed to any antiseizure medication, specifically focusing on a population-based cohort of pregnant women and their offspring.
Main Findings: The cumulative incidence of ASD at 8 years of age was found to be higher in children exposed to these medications compared to the general population. Notably, the incidence was 6.2% for children exposed to topiramate, 10.5% for valproate, and 4.1% for lamotrigine among children born to mothers with epilepsy. However, after adjusting for potential confounders, the increased risk of ASD remained significant only for valproate exposure, with a hazard ratio of 2.67, indicating a substantial risk compared to unexposed children. Topiramate and lamotrigine showed no significant increase in risk after adjustment.
Implications for Practice: The findings underscore the importance of carefully considering the risks and benefits of using antiseizure medications during pregnancy. Specifically, valproate should be used with caution, if at all, given its significant association with an increased risk of ASD in offspring. This study supports the need for targeted counseling and monitoring of pregnant women with epilepsy and highlights the necessity for further research to fully understand the neurodevelopmental impact of prenatal exposure to antiseizure medications.
Reference: Sonia Hernández-Díaz et al. (2024). Cohort Study: Assessing Autism Spectrum Disorder Risk in Children Exposed to Antiseizure Medications During Pregnancy. N Engl J Med, 390(13), 1069-1079. DOI: 10.1056/NEJMoa2309359. Access the study here: [Link]
Review | Radiomics-based fertility-sparing treatment in endometrial carcinoma
24 Jul, 2023 | 13:00h | UTC
RCT | Time-lapse-based embryo selection does not improve pregnancy rates in IVF treatments
23 Jun, 2023 | 13:37h | UTCClinical outcomes of uninterrupted embryo culture with or without time-lapse-based embryo selection versus interrupted standard culture (SelecTIMO): a three-armed, multicentre, double-blind, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
News Release: New IVF Method: more expensive, not more effective – Amsterdam UMC
Commentary on Twitter (thread – click for more)
Time-lapse monitoring is increasingly used to culture and select embryos for transfer in IVF. Yet there is insufficient evidence for superior clinical results.
A study evaluated whether the embryo selection method can increase clinical results. 🧵https://t.co/DFqgCFHZ55
— The Lancet (@TheLancet) May 3, 2023
RCT | Prednisone fails to enhance live birth outcomes in women with recurrent implantation failure
5 May, 2023 | 15:31h | UTCPrednisone vs Placebo and Live Birth in Patients With Recurrent Implantation Failure Undergoing In Vitro Fertilization: A Randomized Clinical Trial – JAMA (free for a limited period)
See also: Visual Abstract
WHO Report | 1 in 6 people globally affected by infertility
5 Apr, 2023 | 13:47h | UTCNews Release: 1 in 6 people globally affected by infertility – World Health Organization
Report: Infertility Prevalence Estimates, 1990–2021 – World Health Organization
Key facts: Infertility – World Health Organization
Commentaries:
Infertility affects a ‘staggering’ 1 in 6 people worldwide, WHO says – CNN
One in six people worldwide affected by infertility, WHO reports – The Guardian
Commentary on Twitter (thread – click for more)
Around 1 in 6 people is affected by infertility in their lifetime: 🆕 WHO research.
This shows an urgent need to increase access to affordable, high-quality fertility care https://t.co/od9QQ9Qjvj pic.twitter.com/R8JtezT0kZ
— World Health Organization (WHO) (@WHO) April 4, 2023
Study shows there is little evidence of heightened pregnancy risks for IVF-conceived parents
24 Mar, 2023 | 12:53h | UTCNews Release: Little evidence that IVF conception heightens future pregnancy risks – BMJ Newsroom
Cohort Study | Infertility in women linked to increased risk of cardiovascular disease
23 Mar, 2023 | 12:39h | UTC
Commentary on Twitter
Women with infertility may have greater risk of #coronary #heart #disease, especially those diagnosed with #ovulation disorders/#endometriosis. #AHAJournals #GoRedforWomen @l_farland https://t.co/Izaloav4Np pic.twitter.com/Iqn4eQexJL
— JAHA (@JAHA_AHA) February 27, 2023
Cohort Study | IVF-conceived children have similar school-age educational outcomes as spontaneously conceived children
2 Mar, 2023 | 12:53h | UTCSchool-age outcomes among IVF-conceived children: A population-wide cohort study – PLOS Medicine
News Release: No link between IVF-assisted conception and school-age childhood development outcomes, study says – University of Melborn
Commentary: IVF Not Tied to Worse Developmental, Educational Outcomes – HealthDay
Registry of the international society of uterus transplantation: first report
24 Feb, 2023 | 13:29h | UTCRegistry of the International Society of Uterus Transplantation: First Report – Transplantation
Development of a model to estimate the optimal number of oocytes to attempt to fertilize in IVF
14 Feb, 2023 | 10:36h | UTC
Commentary on Twitter
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799935
Stillbirth after adolescent and young adult cancer: a population-based study
14 Feb, 2023 | 10:33h | UTCCommentary: Previous Cancer Treatment Not Tied to Higher Stillbirth Rate – HealthDay
RCT | Routine use of endometrial receptivity testing to guide the timing of frozen embryo transfer did not improve the rates of live birth
20 Jan, 2023 | 14:45h | UTCEffect of Timing by Endometrial Receptivity Testing vs Standard Timing of Frozen Embryo Transfer on Live Birth in Patients Undergoing In Vitro Fertilization: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentary on Twitter
Study findings do not support routine use of receptivity testing to guide the timing of embryo transfer during in vitro fertilization. https://t.co/p8jqTpRAfV #Research
— JAMA (@JAMA_current) December 6, 2022
Cohort Study | Neurodevelopmental disorders in offspring conceived via IVF vs. intracytoplasmic sperm injection
19 Jan, 2023 | 14:12h | UTC
Review | Pathophysiology, diagnosis, and management of endometriosis.
16 Dec, 2022 | 13:23h | UTCPathophysiology, diagnosis, and management of endometriosis – The BMJ
Cohort Study | Obstetric and perinatal outcomes of singleton births following single- vs. double-embryo transfer.
6 Dec, 2022 | 13:45h | UTC
Commentary on Twitter
Swedish study comparing outcomes in singleton births following either single or double embryo transfer found higher risks of very preterm birth and low birth weight after double embryo transfer, especially when using frozen embryos and blastocysts. https://t.co/CXRXrchbw1
— JAMA Pediatrics (@JAMAPediatrics) December 5, 2022
Guideline Synopsis | Diagnosis and treatment of infertility in men.
23 Nov, 2022 | 14:08h | UTCDiagnosis and Treatment of Infertility in Men – JAMA (free for a limited period)
Original Guideline: AUA/ASRM Guideline: Diagnosis and treatment of infertility in men
SR | Follicular flushing during oocyte retrieval in assisted reproductive techniques.
23 Nov, 2022 | 13:46h | UTCFollicular flushing during oocyte retrieval in assisted reproductive techniques – Cochrane Library
Commentary on Twitter
Updated #review! We are uncertain of the effect of follicular flushing on live birth rate and miscarriage rate compared to aspiration alone @exgeorgiou @meloordep @CochraneLibraryhttps://t.co/VoORVrg8X4#infertility #IVF pic.twitter.com/qmZdHWAGDm
— Cochrane Gynaecology & Fertility (@CochraneCGF) November 21, 2022
Perspective | The case for mild stimulation for in vitro fertilization.
14 Oct, 2022 | 14:07h | UTC
Commentary on Twitter
New Review paper from @GeetaNargund & the #ISMAAR committee recommends mild ovarian stimulation for IVF should be considered in all clinical scenarios, for effective pregnancy outcomes
Safer, better tolerated and less expensive than conventional IVF.https://t.co/Jv2H2ucQUc pic.twitter.com/LtOSfE98PG
— Reproductive BioMedicine Online (@RBMOnline) September 9, 2022
Systematic Review | Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome.
30 Sep, 2022 | 12:29h | UTC
Commentary on Twitter
Hot off the press! #Letrozole for #ovulation induction improves live birth and #pregnancy rates in #infertile women with anovulatory #PCOS, compared to SERMs (clomiphene citrate)
Read the full #Cochrane #review @CochraneLibrary https://t.co/coJ4rzvswz#PCOSAwarenessMonth pic.twitter.com/80ZmRibG5p— Cochrane Gynaecology & Fertility (@CochraneCGF) September 28, 2022
European Crohn’s and Colitis Guidelines on sexuality, fertility, pregnancy, and lactation.
29 Sep, 2022 | 13:30h | UTC
Cohort Study | Children conceived via assisted reproductive technologies are at increased risk of childhood cancers.
7 Sep, 2022 | 12:32h | UTCAssisted Reproductive Technology and Risk of Childhood Cancers – JAMA Network Open
Invited Commentary: Fertility Treatment and Childhood Cancer Risk – JAMA Network Open
Commentary on Twitter
Children born of assisted reproductive technology (ART) conception was associated with an increased risk of overall childhood cancers compared with those conceived naturally and those with subfertility and non-ART conception. #OpenAccess #Research https://t.co/HylUVE4gFg
— JAMA Network Open (@JAMANetworkOpen) August 31, 2022
Cohort Study | Fertility preservation procedures appear to be safe at the time of breast cancer diagnosis.
7 Sep, 2022 | 12:31h | UTCNews Release: Fertility preservation measures do not appear to increase the risk of breast cancer recurrence – Karolinska Institutet
Systematic Review | Luteal phase support for women trying to conceive by intrauterine insemination or sexual intercourse.
2 Sep, 2022 | 13:08h | UTC
Commentary on Twitter
❓ What is the effectiveness and safety of luteal support for those trying to conceive by intrauterine insemination #IUI or by sexual intercourse?
New @CochraneCGF systematic review looks at the evidence from 25 RCTs involving 5,111 participants. https://t.co/jjsetCMo3E pic.twitter.com/tWNtGx8rdC— The Cochrane Library (@CochraneLibrary) September 2, 2022
Cohort Study | Association of assisted reproductive technology with offspring growth and adiposity from infancy to early adulthood.
1 Aug, 2022 | 11:54h | UTC
Commentary on Twitter
This cohort study found that differences in early growth and adiposity for people conceived via assisted reproductive technology (vs. naturally) were small and reduced with older age. @aelhak19 @DeborahLawlor2 https://t.co/hwdldN6yDf
— JAMA Network Open (@JAMANetworkOpen) July 26, 2022