| Référence associée : | | |
| Natural procreative technology for infertility and recurrent miscarriage .. cacher .... voir plus ..
Objective To study the outcomes of women with infertility or miscarriage treated with natural procreative technology (NaProTechnology or NPT), a systematic medical approach to promoting conception in vivo; and to compare the outcomes with those previously published from a general practice in Ireland. Design Retrospective cohort study. Setting An urban Canadian primary care practice in which the physician had a part-time practice in NPT. Participants Couples with infertility or recurrent miscarriage who received treatment in the practice between August 2000 and July 2006. Intervention All couples were taught to identify the fertile time of their menstrual cycles using the Creighton Model FertilityCare System (CrMS) and completed a standard NPT evaluation. Many also received additional medical treatment to enhance conception in vivo. Main outcome measures Live birth was the primary outcome; secondary outcomes included conceptions, multiple births, low birth weight, and prematurity. Results A total of 108 couples received NPT and were included in the analysis, of which 19 (18%) reported having 2 or more previously unexplained miscarriages. The average female age was 35.4 years. Couples had been attempting to conceive for a mean of 3.2 years. Twenty-two participants (20%) had previously given birth; 24 (22%) had previous intrauterine insemination; and 9 (8%) had previous assisted reproductive technology. The cumulative adjusted proportion of first live births for those completing up to 24 months of NPT treatment was 66 per 100 couples, and the crude proportion was 38%. The cumulative adjusted proportion of first conceptions was 73 per 100 couples, and the crude proportion was 47%. Of the 51 couples who conceived, 12 couples (24%) conceived with CrMS instruction alone, 35 (69%) conceived with CrMS and NPT medical treatment, and 4 (8%) conceived after additional surgical treatment. All births were singleton births; 54% were born at 37 weeks’ gestation or later; and 78% had birth weights of 2500 g or greater. Conclusion Natural procreative technology in a family physician’s office was effective in treating infertility and miscarriage with outcomes that were comparable to those in an NPT general practice in Ireland. Larger multicentre prospective studies to compare NPT directly to other forms of infertility treatment are warranted.
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| Fausses couches spontanées précoces répétées: quelle prise en charge proposer en 2006?. Lejeune V. Gynécologie obstétrique & fertilité. 2006;34(10):927–937.
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| Lye S, Porter D: Demonstration that proges t er one blocks uterine activity in the ewe in vivo by a direct action
on the endometrium. J Repro Fertil 52:87-94, 1978. .. cacher .... voir plus ..
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| Progestogen for preventing miscarriage .. cacher .... voir plus ..
Background Background Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone. Therefore, progestogens have been used, beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. Objectives Objectives To determine the efficacy and safety of progestogens as a preventative therapy against miscarriage. Search methods Search methods We searched the Cochrane Pregnancy and Childbirth Group s Trials Register (1 August 2013), reference lists from relevant articles, attempting to contact authors where necessary, and contacted experts in the field for unpublished works. Selection criteria Selection criteria Randomized or quasi-randomized controlled trials comparing progestogens with placebo or no treatment given in an effort to prevent miscarriage. Data collection and analysis Data collection and analysis Two review authors assessed trial quality and extracted data. Main results Main results Fourteen trials (2158 women) are included. The meta-analysis of all women, regardless of gravidity and number of previous miscarriages, showed no statistically significant difference in the risk of miscarriage between progestogen and placebo or no treatment groups (Peto odds ratio (Peto OR) 0.99; 95% confidence interval (CI) 0.78 to 1.24) and no statistically significant difference in the incidence of adverse effect in either mother or baby. A subgroup analysis of placebo controlled trials did not find a difference in the rate of miscarriage with the use of progestogen (10 trials, 1028 women; Peto OR 1.15; 95% CI 0.88 to 1.50). In a subgroup analysis of four trials involving women who had recurrent miscarriages (three or more consecutive miscarriages; four trials, 225 women), progestogen treatment showed a statistically significant decrease in miscarriage rate compared to placebo or no treatment (Peto OR 0.39; 95% CI 0.21 to 0.72). However, these four trials were of poorer methodological quality. No statistically significant differences were found between the route of administration of progestogen (oral, intramuscular, vaginal) versus placebo or no treatment. No significant differences in the rates of preterm birth, neonatal death, or fetal genital anomalies/virilization were found between progestogen therapy versus placebo/control. Authors conclusions Authors conclusions There is no evidence to support the routine use of progestogen to prevent miscarriage in early to mid-pregnancy. However, there seems to be evidence of benefit in women with a history of recurrent miscarriage. Treatment for these women may be warranted given the reduced rates of miscarriage in the treatment group and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence. Larger trials are currently underway to inform treatment for this group of women.
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| Kauppila A, Hartikainen-Sorri A-L, Janne O, Tuimala R, Garvinen PA: Sup pres sion of threatened premature
la bor by administration of cortisol and 17 -hy droxy proges t er one caproate: A com par i son with Ritodrine.
Am J Obstet Gynec 138:404-408, 1980. .. cacher .... voir plus ..
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| Natural procreative technology for infertility and recurrent miscarriage: Outcomes in a Canadian family practice .. cacher .... voir plus ..
To study the outcomes of women with infertility or miscarriage treated with natural procreative technology (NaProTechnology or NPT), a systematic medical approach to promoting conception in vivo; and to compare the outcomes with those previously published ...
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| Klopper A, MacNaughton M: Hormones in Recurrent Abor tion. J Obstet Gynecol 1022-1028, 1966 .. cacher .... voir plus ..
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| Meis PJ, Klebanof M, Tom E, et. al: Pre ven tion of re cur rent preterm de liv ery by 17 -hy droxy proges t er one
ca proate. N Engl J Med 348:2379-2385, 2003. .. cacher .... voir plus ..
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| da Fonseca EB, Bittar RE, Carvalho MHB, Zugaib M: Pro phy lac tic ad min is tra tion of proges t er one by
vaginal sup pos i to ry to reduce the incidence of spon ta ne ous preterm birth in women at in creased risk: A
ran dom ized placebo-con trolled – blind study. Am J Obstet Gynec 188:419-424, 2003. .. cacher .... voir plus ..
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| Recurrent Pregnancy Loss. American College of Obstetricians and Gynecologists, Reproductive Endocrinology Precis, 2nd Edition, Washington, D.C., 2002. .. cacher .... voir plus ..
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| Corker CS, Michie E, Hobson B, et al: Hormonal Patterns in Conceptual Cycles and Early Pregnancy. Brit
J Obstet Gynaecol 83:489-494, 1976. .. cacher .... voir plus ..
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| Troubles de la folliculogénèse et fausse couche
Csapo A: Effects of progesterone, pros tag lan din F2á and its analogue ICI 81008 on the ex cit abil i ty and
thresh old of the uterus. Am J Obstet Gynec 124:367-378, 1976. .. cacher .... voir plus ..
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| Combined oestrogen and progesterone for preventing miscarriage .. cacher .... voir plus ..
Background Background Historically, oestrogen and progesterone were each commonly used to save threatened pregnancies. In the 1940s it was postulated that their combined use would be synergistic and thereby led to the rationale of combined therapy for women who risked miscarriage. Objectives Objectives To determine the efficacy and safety of combined oestrogen and progesterone therapy to prevent miscarriage. Search methods Search methods We searched the Cochrane Pregnancy and Childbirth Group s Trials Register (23 June 2013) CENTRAL (OVID) (The Cochrane Library 2013, Issue 6 of 12), MEDLINE (OVID) (1946 to June Week 2 2013), OLDMEDLINE (1946 to 1965), Embase (1974 to Week 25 2013), Embase Classic (1947 to 1973), CINAHL (1994 to 23 June 2013) and reference lists of retrieved studies. Selection criteria Selection criteria We included randomised controlled trials that assessed the effectiveness of combined oestrogen and progesterone for preventing miscarriage. We included one stratified randomised trial and one quasi-randomised trials. Cluster-randomised trials were eligible for inclusion but none were identified. We excluded studies published only as abstracts. We included studies that compared oestrogen and progesterone versus placebo or no intervention. Data collection and analysis Data collection and analysis Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors extracted data. Data were checked for accuracy. Main results Main results Two trials (281 pregnancies and 282 fetuses) met our inclusion criteria. However, the two trials had significant clinical and methodological heterogeneity such that a meta-analysis combining trial data was considered inappropriate. One trial (involving 161 pregnancies) was based on women with a history of diabetes. It showed no statistically significant difference between using combined oestrogen and progestogen and using placebo for all our proposed primary outcomes, namely, miscarriage (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.32 to 2.80), perinatal death (RR 0.94, 95% CI 0.53 to 1.69) and preterm birth (less than 34 weeks of gestation) (RR 0.91, 95% CI 0.80 to 1.04). In terms of this review s secondary outcomes, use of combined oestrogen and progestogen was associated with an increased risk of maternal cancer in the reproductive system (RR 6.65, 95% CI 1.56 to 28.29). However, for the outcome of cancer other than that of the reproductive system in mothers, there was no difference between groups. Similarly, there were no differences between the combined oestrogen and progestogen group versus placebo for other secondary outcomes reported: low birthweight of less than 2500 g, genital abnormalities in the offspring, abnormalities other than genital tract in the offspring, cancer in the reproductive system in the offspring, or cancer other than of the reproductive system in the offspring. The second study was based on pregnant women who had undergone in-vitro fertilisation (IVF). This study showed no difference in the rate of miscarriage between the combined oestrogen and progesterone group and the no treatment group (RR 0.66, 95% CI 0.23 to 1.85). The study did not report on this review s other primary outcomes (perinatal death or rates of preterm birth), nor on any of our proposed secondary outcomes. Authors conclusions Authors conclusions There is an insufficient evidence from randomised controlled trials to assess the use of combined oestrogen and progesterone for preventing miscarriages. We strongly recommend further research in this area.
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| Daya S, Ward S, Burrows E: Progesterone Profi les in Luteal Phase Defects and Outcome of Progesterone
Treatment in Patients with Recurrent Spontaneous Abortion. Am J Obstet Gynecol 158:225-232, 1988. .. cacher .... voir plus ..
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| Progesterone in Women with Recurrent Miscarriages .. cacher .... voir plus ..
To the Editor: In summarizing their well-executed randomized trial, Progesterone in Recurrent Miscarriages (PROMISE), Coomarasamy et al. (Nov. 26 issue)1 state that there is no evidence of benefit from progesterone supplementation “in the first trimester” of pregnancy among women who have had three or more miscarriages. We wish to clarify three points. First, the trial did not address progesterone supplementation in women with coexisting subfertility. Nearly 33% of the women screened for the trial were excluded because of subfertility (515 of 1568 women). Second, because progesterone plays a key role in the implantation of the embryo, benefit from supplementation may . . .
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| Naples JD, Batt RE, Sadijh H: Spon ta ne ous Abortion Rate in Patients with En dometri o sis. Obstet Gynecol
57:509-512, 1981. .. cacher .... voir plus ..
The endometriosis is associated with a higher risk of spontaneous abortion
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| Groll M: Endometriosis and Spon ta ne ous Abortion. Fertil Steril 41:933-935, 1984. .. cacher .... voir plus ..
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| Pittaway DE, Vernon C, Fayez JA: Spon ta ne ous Abortions in Women with En dometri o sis. Fertil Steril
50:711-715, 1988. .. cacher .... voir plus ..
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| Olive DL, Franklin RR, Gratkins LV: The Association Be tween Endometriosis and Spontaneous Abor tion:
A Ret ro spect of Clinical Study. J Reprod Med 27:333-338, 1982. .. cacher .... voir plus ..
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