Couples can
now be reassured regarding their concerns for adverse perinatal outcomes
because of advancing paternal age says the results of recent study in press in
American Journal of Obstetrics and Gynecology (ACOG).
The abstract
for this study was presented as a poster presentation at the American Society
for Reproductive Medicine Scientific Meeting October 15-19, 2016 in Salt Lake
City, Utah, USA.
The adverse
effects of increasing maternal age and ARTs are well known, but data on effects
of increased paternal age is scarce.
This is a large
population-based retrospective cohort study, stretching across 7 years that
examined 1,034,552 live births in state of Ohio.
The data was
stratified according to natural conception or use of ARTs.
It was seen
that:
The paternal
age varied between 12-87 years, mean 30 years.
Maternal age
ranged from 11-62 years, median 27 years.
ARTs were used
in 3118 pregnancies while 830,609 were due to natural conception.
Statistically
significant increased need for ARTs was observed with increasing paternal age: 0.1%
<30 years vs. 2.5% > 60 years, p<0.001.
After considering
increasing maternal age and other confounders, increased paternal age was not significantly
associated with preterm births, preeclampsia, Intrauterine growth retardation (IUGR),
congenital anomalies, genetic disorders or increased NICU admissions.
These results
were also same when the data was stratified according to the use of ARTs or
not.
The only limitation
of the study was data was derived from births register, only shortterm outcome was
looked at and compared to total sample size, pregnancies with advanced paternal
age was small.
The authors concluded
that, “Older paternal age does not appear to pose an independent risk of
adverse perinatal outcomes, either in pregnancies achieved with or without ART.”
Knowledge: Wisdom: Science: informations received form RCTs from diff count rue: - Ideally there are two broad groups of drugs which at used for Medl management : Group A drugs:- Mecanism of action:0ABroadly speaking there are two types of drugs: - A) Drugs acting on different parts of body including endometriotic sites these drugs act at H-P axis as well and thereby decreases the endogenous estrogens synthesis. Drugs acting on H-P -G Axis (so multiple known / unknown systemic adverse effects may ensue) e.g. OCP, and GNRHag. Both drugs are equally effective in relieving pelvic pain but have different side effects and therefore vary in terms of compliance. Of the two OC pill is less expensive than & GNRHag. The problem is relapse is common immediately after stopping.
ReplyDeleteKnowledge & Wisdom:-We have to brush up our previous knowledge & we have to read diff reputed Journals (as is this one) about utility & contraindicates about diff drugs:-Then what are the second group of drugs for diagnosed endometriosis?? Group B drugs: - drugs which act only on the endoterosis and spare the other important organs of body?? NASIDs--COX -2 inhibitor (Celecoxib, Roficoxib) 2) SPRM( Mifepristone) , & Onapristone, 3) Angiogenesis Inhibitors ( Inhibitors of VEGF and MNPs), 4) Progestogens ( Tab/Inj depot) have safest clinical profile and most cost effective but not as effective as others Painful symptoms - efficacy is similar to other drugs but the side effects are less and further reduced by the “add-back” HRT 6) Dienogest for 6 months, e.g.Endosis 2 mg do for 3 math . It will give good relief in pelvic pain due to endometriosis
ReplyDelete7) Aromatase Inhibitors 8) Danazol. 9) Immunomodulatory drugs.10) selective oestrogen receptor modulator drugs. (Loxoribine, TNF β & TNF-α inhibitors, (Trade:-Name is Infliximab) and Pentoxyphylline.
How effective are combined medical & surgical therapy? Hopefully, this is the most effective conservative approach for all stages. NSAID and COC are most popular and drugs of minimal concern. But, we have to remember that in cases with ovarian endometiromas and rectovaginal septum endometriosis – quite often advanced surgery is the answer-Dienogest will have minimal effect as is NG-IUS. Opinion of members Pl on these two sites of endometriosis.
ReplyDeleteAs dienogest do not cause ovulation suppression-so is it essential coupe should use barriers? I case she conceives and continyes te druf will there be any teratogencity?
ReplyDelete