| Symptome traité : | | |
| Retard de conception- infertilité .. cacher .... voir plus ..
La définition standard de la stérilité implique habituellement l'absence de grossesse chez un couple engagé avec des rapports sexuels aléatoires sur une période de 12 mois.
Mais, avec des rapports sexuels en période fertile reconnue par l’observation de la glaire (rapports sexuels orientés par la connaissance de la période fertile), la grossesse est plus rapidement obtenue. Il a été démontré que, après 3 cycles avec des rapports en période fertile reconnue par l’observation de la glaire, 90 pour cent des femmes en couples de fertilité normale ont conçu un enfant.
Ces données suggèrent que la définition de la stérilité peut être modifiée (D'après T Hilgers, The NaProTechnology Revolution, page page 235, modifié): si le couple n'a pas conçu après 3 cycles de rapports sexuels axés sur la fertilité, il y a une forte suspicion d'un problème d'infertilité.
Il existe 2 types d'infertilité :
L'infertilité primaire se réfère à des couples qui n'ont pas conçu d'enfant.
L'infertilité secondaire se réfère à des couples qui ont conçu au moins une fois, mais qui n'y pas parviennent pas maintenant.
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| D'après J Clin Endocrinol Metab. 2015 mai; 100 (5): 1785-1791.
Le traitement à l'aspirine à faible dose (LDA) initié par avant la conception a entraîné:
une augmentation non significative de la fécondité de 14% chez les femmes ayant des antécédents de 1 à 2 fausses couches spontanées,
et une augmentation significative de 28% chez les femmes ayant des antécédents d'une seule fausse couche<20 semaines de gestation l'année précédente.
La LDA avant la conception peut augmenter la fécondité chez certaines femmes avec une fausse couche récente.
Fausse couche à répétition .. cacher .... voir plus ..
La définition des FCS précoces est variable selon les auteurs,correspondant littéralement à un arrêt de grossesse pendant la vie embryonnaire.
Les fausses couches spontanées répétées, sont définies par 2 fausses couches spontanées ou plus.
Dans plus de la majorité des cas, les couples pourront concevoir des enfants en bonne santé, sans assistance, même après avoir perdu deux grossesses.
Types de fausse couche: elles sont habituellement divisées en deux groupes: précoces et tardives.
. Les fausses couches à répétition précoces (au cours du premier trimestre) sont principalement attribuables à des problèmes génétiques ou chromosomiques de l'embryon, avec 50 à 80% des pertes spontanées ayant un nombre chromosomique anormal. Les anomalies de l'utérus peuvent également jouer un rôle dans les fausses couches précoces.
. Les fausses couches à répétition tardives peuvent être le résultat d'anomalies utérines, de problèmes auto-immuns, d'un col utérin incompétent ou d'un accouchement prématuré.
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| A randomised trial to evaluate the Effects of low dose Aspirin in Gestation and Reproduction (EAGeR): Design and baseline characteristics .. cacher .... voir plus ..
Background Low dose aspirin (LDA) has been proposed to improve pregnancy outcomes in couples experiencing recurrent pregnancy loss. However, results from studies of LDA on pregnancy outcomes have been inconsistent, perhaps because most studies evaluated LDA-initiated post-conception. The purpose of the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial was to determine whether preconception-initiated LDA improves live-birth rates in women with 1–2 prior losses. Methods We performed a multicenter, block randomised, double-blind, placebo-controlled trial. Study participants were recruited using community-based advertisements and physician referral to four university medical centers in the US (2006–12). Eligible women were aged 18–40 years actively trying to conceive with 1–2 prior losses. Participants were randomised to receive daily LDA (81 mg/day) or a matching placebo, and all were provided with daily 400 mcg folic acid. Follow-up continued for ≤six menstrual cycles while attempting to conceive. For those that conceived, treatment was continued until 36 weeks gestation. The primary outcome was the cumulative live birth rate over the trial period. Results 1228 women were randomised (615 LDA, 613 placebo). Participants had a mean age of 28.7, were mostly white (95%), well educated (86% >high school education), and employed (75%) with a household income >$100,000 annually (40%). Characteristics of those in the treatment and placebo arms were well-balanced. Conclusions We describe the study design, recruitment, data collection, and baseline characteristics of participants enrolled in EAGeR, which aimed to determine the effect of LDA on live birth and other pregnancy outcomes in these women.
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| Preconception Low Dose Aspirin and Time to Pregnancy: Findings From the Effects of Aspirin in Gestation and Reproduction Randomized Trial .. cacher .... voir plus ..
Objective: The objective was to determine the effect of preconception-initiated daily low-dose aspirin (LDA; 81 mg/day) treatment on time to pregnancy in women with a history of pregnancy loss. Design: This was a multicenter, block-randomized, double-blind, placebo-controlled trial. Participants were block-randomized by center and eligibility stratum. Setting: The study was conducted at four U.S.A. medical centers (2007–2012). Participants: Participants women aged 18–40 years actively attempting pregnancy, stratified by eligibility criteria: the “original” stratum, women with one loss <20 weeks gestation during the previous year; and the “expanded” stratum, women with one or two previous losses of any gestational age regardless of time since loss. Intervention: Daily LDA was compared with matching placebo for up to six menstrual cycles of attempting pregnancy. Main Outcome Measure: Time to hCG detected pregnancy and clinically confirmed pregnancy, analyzed by intention-to-treat, was measured. Results: Of the 1228 women randomly assigned to LDA (n = 615) or placebo (n = 613), 410 (67%) women receiving LDA achieved pregnancy compared to 382 (63%) receiving placebo, corresponding to a fecundability odds ratio (FOR) of 1.14 (95% CI: 0.97, 1.33). Among women in the original stratum (n = 541), LDA was associated with increased fecundability compared to placebo (FOR: 1.28; 95%CI: 1.02, 1.62). Conclusions: Preconception-initiated LDA treatment resulted in a nonsignificant increase in fecundability of 14% in women with a history of 1–2 pregnancy losses, and a significant increase of 28% in women with a history of only one pregnancy loss of <20 weeks gestation in the preceding year. Preconception-initiated LDA may increase fecundability in certain women with a recent early pregnancy loss.
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| Antimüllerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial .. cacher .... voir plus ..
Objective To evaluate if antimüllerian hormone (AMH) is associated with pregnancy loss. Design Prospective cohort study within a block-randomized, double-blind, placebo-controlled trial of low-dose aspirin. Setting Not applicable. Patient(s) Women (n = 1,228) were of ages 18–40 years with a history of one to two pregnancy losses and were actively attempting pregnancy without fertility treatment. Intervention(s) Not applicable. Main Outcome Measure(s) Pregnancy loss. Result(s) Relative risks (and 95% confidence interval [CIs]) of human chorionic gonadotropin (hCG)-detected and clinical pregnancy loss were assessed with the use of log binomial models with robust variance and inverse probability weights adjusted for age, race, body mass index, income, trial treatment assignment, parity, number of previous losses, and time since most recent loss. AMH levels were defined as: low (<1.00 ng/mL; n = 124), normal (referent; 1.00–3.5 ng/mL; n = 595), and high (>3.5 ng/mL; n = 483). Of the 1,202 women with baseline AMH data, 19 (17.3%) with low AMH experienced a clinical loss, compared with 61 (11.4%) with normal AMH and 50 (11.8%) with high AMH levels. Low or high AMH levels, compared with normal AMH, were not associated with clinical loss. Results for hCG-detected pregnancy loss mirrored those of clinical loss. Conclusion(s) AMH values were not associated with hCG-detected or clinical pregnancy loss in unassisted conceptions in women with a history of one to two previous losses. Our data do not support routine AMH testing for prediction of pregnancy loss. Clinical Trial Registration Number NCT00467363.
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| Antimüllerian hormone and pregnancy loss from the Effects of Aspirin in Gestation and Reproduction trial .. cacher .... voir plus ..
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