Ovarian stimulation with gonadotropins and letrozole for the purpose of fertility preservation is unlikely to cause substantially increased recurrence risk. Further research, including longer-term follow-up is needed to confirm these findings.

Among highly hypnotizable subjects, observed changes in subjective experience achieved during hypnosis were reflected by changes in brain function similar to those that occur in perception. These findings support the claim that hypnosis is a psychological state with distinct neural correlates and is not just the result of adopting a role.

Context: Breast cancer patients undergoing controlled ovarian hyperstimulation (COH) for embryo or oocyte cryopreservation should be induced by the method that leads to the least increase in estradiol (E 2 ) levels.Objective: The aim of the study was to determine the potency of anastrozole to suppress serum E 2 levels in breast cancer patients undergoing COH. Design and Setting:A prospective sequential cohort study was conducted in an academic center for reproductive medicine between Patients: Breast cancer patients presenting for fertility preservation participated in the study.Intervention: COH using FSH and letrozole (n ϭ 47) or anastrozole (n ϭ 7) was followed by oocyte retrieval and embryo cryopreservation. Main Outcome Measures:Serum E 2 levels, area under the curve for E 2 , and outcomes of COH cycles were measured.Results: There were no significant differences between the two groups regarding length of stimulation, total gonadotropin dose, number of follicles larger than 17 mm, and the lead follicle size on human chorionic gonadotropin (hCG) day and number of embryos cryopreserved. The mean E 2 levels on the day of hCG and post-hCG days were higher in the anastrozole group compared to the letrozole group (1325.89 Ϯ 833.17 and 2515.07 Ϯ 1368.52 vs. 427.78 Ϯ 278.24 and 714.38 Ϯ 440.83 pg⅐d/ml; P Յ 0.01), respectively, even when anastrozole dose was increased up to 10 mg/d. The mean area under the curve was significantly higher in the anastrozole group compared to the letrozole group (4402.93 Ϯ 1526.7 vs. 1287.48 Ϯ 732.17 pg⅐d/ml; P Ͻ0.004). Conclusions:Breast cancer patients who underwent ovarian stimulation with anastrozole had a significantly higher exposure to E 2 than those who were stimulated with letrozole. A CONSIDERABLE BODY of data on the use of aromatase inhibitors for ovulation induction has accumulated in recent years (1). Third-generation aromatase inhibitors (letrozole, anastrozole, and exmestane) entered practice primarily as first and second line treatment agents for the treatment of breast cancer (2, 3). The use of aromatase inhibitors for ovulation induction was first reported in 2001, where letrozole provided superior results to clomiphene and was associated with 50% lower estradiol (E 2 ) levels (4). E 2 rise during controlled ovarian hyperstimulation (COH) may not be safe in women diagnosed with breast cancer seeking fertility preservation. It has been clearly shown that estrogen stimulates breast cancer cell growth, even in low concentrations (5, 6). Using the ability of letrozole to suppress E 2 levels during ovarian stimulation, we recently used this drug in combination with FSH for ovulation induction to cryopreserve embryos or oocytes in breast cancer patients before chemotherapy. The combined letrozole-FSH protocol resulted in peak E 2 levels close to those seen in unstimulated cycles, and breast cancer recurrence rates were not increased compared with controls (7).Anastrozole is a nonsteroidal, competitive inhibitor of the aromatase enzyme, thus blocking the conversion of testos...

The effect of concurrent affective and alcohol use disorders on suicidal ideation and behavior was investigated. The Diagnostic Interview Schedule Version III-R (DIS) was administered to 307 adult veteran men ranging in age from 23 to 78. Participants were classified into one of four groups based on their final DIS diagnosis-lifetime unipolar depression and lifetime bipolar I disorder with or without a lifetime alcohol use disorder. Logistic regression analyses indicated that veterans with a major affective disorder were at greater risk for suicidality than veterans without an affective disorder. However, veterans with unipolar depression were at no greater risk for suicidality than those with bipolar I disorder. Unipolar and bipolar I disorders with a concurrent alcohol use disorder were always associated with an increased risk for suicidality.