Plasma levels of kisspeptin have been suggested as a biomarker for miscarriage. This study demonstrates kisspeptin assay stability in serum and its potential clinical utility as a biomarker for early pregnancy viability.

Primary debulking surgery (PDS) has remained the only treatment of ovarian cancer with survival advantage since its development in the 1970s. However, survival advantage is only observed in patients who are optimally resected. Neoadjuvant chemotherapy (NACT) has emerged as an alternative for patients in whom optimal resection is unlikely and/or patients with comorbidities at high risk for perioperative complications. The purpose of this review is to summarize the evidence to date for PDS and NACT in the treatment of stage III/IV ovarian carcinoma. We systematically searched the PubMed database for relevant articles. Prior to 2010, NACT was reserved for non-surgical candidates. After publication of EORTC 55971, the first randomized trial demonstrating non-inferiority of NACT followed by interval debulking surgery, NACT was considered in a wider breadth of patients. Since EORTC 55971, 3 randomized trials—CHORUS, JCOG0602, and SCORPION—have studied NACT versus PDS. While CHORUS supported EORTC 55971, JCOG0602 failed to demonstrate non-inferiority and SCORPION failed to demonstrate superiority of NACT. Despite conflicting data, a subset of patients would benefit from NACT while preserving survival including poor surgical candidates and inoperable disease. Further randomized trials are needed to assess the role of NACT.

OBJECTIVE: Epidemiologic studies have suggested that nulligravid women have a shorter life span than their parous counterparts. The effect of infertility, as opposed to elective nulligravidity, on mortality is unclear. Our objective was to determine the association of a history of infertility with all-cause mortality.DESIGN: Retrospective cohort study MATERIALS AND METHODS: This study included women (age 55-74) who were prospectively enrolled in the Prostate Lung, Colorectal, and Ovarian (PLCO) Cancer screening trial from 1992-2001 and followed for health-related outcomes including cause of death. We examined the effect of self-reported infertility (inability to conceive for one year or greater) on all-cause mortality and primary cause of death, as established by the National Center for Health Statistics. Outcomes were analyzed using multivariable linear, logistic, and cox regression modeling as appropriate with stepwise backward selection to adjust for relevant confounders.RESULTS: A total of 78,214 women from the PLCO database were included and followed for 13 years or until study withdrawal or death, 75,784 of which had data on fertility history. Infertility was reported in 14.5% (n¼11,006) of the study population. At the completion of follow up, infertile women were more likely to be deceased when compared to fertile women (HR1.10, 95%CI 1.03, 1.17, p¼0.005), however women from each cohort died at a similar age (Fertile: 73.83AE5.70 years, Infertile: 73.79AE5.88 years; p¼0.424). When examining primary cause of death, women with infertility were more likely to die from diabetes (HR 1.69, 95%CI 1.15, 2.49, p¼0.007) as compared to their fertile counterparts despite having a comparable prevalence of diabetes (Fertile: 6.34% (N¼4082), Infertile: 6.80% (N¼745). Infertility was not associated with an increased risk of ovarian cancer (HR 1.12, 95%CI 0.87, 1.45, p¼0.381) or greater risk of death from ovarian (HR 1.28, 95%CI 0.91, 1.80, p¼0.155) or endometrial cancers (HR 0.97, 95%CI 0.49, 1.93, p¼0.939). Notably, patients with infertility were 43% more likely to die of breast cancer (HR 1.43, 95%CI 1.06, 1.94, p¼0.019).CONCLUSIONS: Subfertility may be a harbinger of disease later in life. The present large retrospective study demonstrates increased risk of death from endocrine related diseases including diabetes and breast cancer among the infertile population. While these associations need to be confirmed in prospective studies, routine infertility care may present an opportunity for early screening and intervention for long-term health outcomes.