No abstract

Women with a history of bone, breast, brain or kidney cancer have reduced chances of childbirth compared with unaffected controls. On the contrary, thyroid cancer, melanoma and Non-Hodgkin's lymphoma survivors can be reassured about their reproductive prognosis.

Background Due to high purity, recombinant human chorionic gonadotropin (hCG) is suitable for subcutaneous injection, and hence for self-administration, in assisted reproduction. To increase usability and reduce the risk of dosing errors, a prefilled pen was produced. We investigated the ease of administration and satisfaction with the product amongst patients and healthcare professionals. Methods A survey was conducted amongst women with infertility who underwent in vitro fertilization treatments with recombinant hCG to trigger ovulation in various clinics in Italy. Results A total of 276 Italian women were interviewed. The median score of preference for the prefilled pen in comparison with hCG powder to be reconstituted in the solvent was rated as 9 (range 8–10), and 125 women answered that the prefilled pen had major advantages. Reasons for preference of the prefilled pen were linked to ease of use and safety: avoidance of dosage mistakes and of concern of such, ease of administration, certainty that the drug is correctly taken, safe administration and no anxiety. The procedure for recombinant hCG administration through the prefilled pen was judged as easy by 80% of respondents, with a median score of 9 (range 8–10) for easiness on a 1–10 scale. Out of 276 respondents, 249 (90%) had no problem with the injection. Conclusion Overall, the respondents reported a favourable perception of the prefilled pen with hCG, which was reported to be easy to use and perceived to prevent dosage mistakes.

Research question: Available evidence showed that the presence of ovarian endometriomas do not interfere with ovarian response to hyper-stimulation. However, the mean size of the endometriomas included in these studies is generally small and two recent investigations suggested that follicular development could be conversely impaired when focusing on larger endometriomas. However, these studies could not disentangle a clear threshold above which endometriomas could become detrimental.Design: To identify this threshold, we retrospectively selected women without a history of surgery for ovarian cysts and who underwent IVF in the presence of unilateral endometriomas with a mean diameter between 20 to 49 mm. Selected women were divided into three endometrioma size categories: 20-29 mm (Group 1, n=23), 30-39 mm (Group 2, n=23) and 40-49 mm (Group 3, n=21).Recruitment for each category was censored at about 21 women to ensure equal statistical power for every group. Results:The response to hyper-stimulation was equal or superior in the affected gonads in 8 women (35%, 95%CI: 16-57%), 7 women (30%, 95%CI: 13-53%) and 2 women (10%, 95%CI: 2-30%) in group 1, 2 and 3, respectively. The median [interquartile range] number of developed follicles in the affected and intact ovaries was 6 [3-7] and 5 [4][5][6][7][8][9] in group 1 (p=0.21), 4 [1-6] and 4 [3][4][5][6][7] in group 2 (p=0.08), 5 [3-7] and 7 [4][5][6][7][8] in group 3 (p=0.01), respectively. Conclusion:The threshold to be used to distinguish between endometriomas that could and could not interfere with ovarian response is 4 cm in diameter.