Context While stages of reproductive aging for women in the general population are well described by STRAW+10 criteria, this is largely unknown for female adolescent and young adult cancer survivors (AYA survivors). Objective To evaluate applying STRAW+10 criteria in AYA survivors using bleeding patterns with and without endocrine biomarkers, and assess how cancer treatment gonadotoxicity is related to reproductive aging stage. Design The sample (n=338) included AYA survivors from the Window Study cohort. Menstrual bleeding data and dried blood spots for AMH and FSH measurements (Ansh DBS ELISAs) were utilized for reproductive aging stage assessment. Cancer treatment data were abstracted from medical records. Results Among participants, mean age 34.0±4.5 and at a mean of 6.9±4.6 years since cancer treatment, the most common cancers were lymphomas(31%), breast(23%), and thyroid(17%). Twenty-nine percent was unclassifiable by STRAW+10 criteria, occuring more frequently in the first 2 years from treatment . Most unclassifiable survivors exhibited bleeding patterns consistent with the menopausal transition, but had reproductive phase AMH and/or FSH levels. For classifiable survivors (48% peak reproductive, 30% late reproductive, 12% early transition, 3% late transition, 7% post-menopause), endocrine biomarkers distinguished among peak, early and late stages within the reproductive and transition phases. Gonadotoxic treatments were associated with more advanced stages. Conclusions We demonstrate a novel association between gonadotoxic treatments and advanced stages of reproductive aging. Without endocrine biomarkers, bleeding pattern alone can misclassify AYA survivors into either more or less advanced stages. Moreover, a large proportion of AYA survivors exhibited combinations of endocrine biomarkers and bleeding patterns that do not fit STRAW+10 criteria, suggesting the need for modified staging for this population.
Objective: To examine the association between prior cancer treatments, medical comorbidities, and voluntary childlessness in reproductive-aged women who are survivors of cancers diagnosed as adolescents and young adults (AYA survivors).
INTRODUCTION:Women of color in the United States have an increased risk of maternal morbidity and a higher risk of cesarean delivery (CD) compared to White women. This study aims to determine whether maternal race/ethnicity influenced mode of delivery (MOD) of twin gestations.METHODS:This was an IRB-approved, retrospective cohort study of all twin deliveries at a single institution between 1/1/2001 and 12/31/2018. Pregnancies delivered<24 weeks or with intrauterine fetal demise were excluded. The primary exposure, self-reported race/ethnicity, was categorized into five groups: White, Hispanic, non-Hispanic Black, Asian/Pacific Islander (PI)/Alaska Native (AN), and Other/Mixed. The primary outcome was CD. Statistical analyses included univariate analysis via Chi-square and ANOVA and logistic regression analysis.RESULTS:A total of 796 pregnancies were included; 377 (47.8%) of participants identified as White, 236 (29.9%) as Hispanic, 83 (10.5%) as Asian/PI/AN, 44 (5.6%) as Black, and 50 (6.3%) as Other/Mixed. BMI, maternal age at delivery, chorionicity, and parity were different by race/ethnicity groups, but gestational age at delivery was not. The overall rate of CD was 71.1% and did not vary by race/ethnicity (P=.51). There were no differences by race/ethnicity when analysis was limited to those delivering>34 weeks and birthweights>2,500 g (P=.07) or among only nulliparous women (P=.77). In multivariable analysis, only nulliparity was associated with increased risk of CD (P<.01).CONCLUSION:Rate of CD for twin gestations is high but was not related to maternal race/ethnicity in this cohort. Further study is needed to evaluate the indications for cesarean deliveries across racial/ethnic groups in twin gestations as this was not examined in this cohort.
In this review, we describe normal development of fetal genitalia throughout gestation as well as the identification of normal male and female genitalia on ultrasound. We use abnormal and ambiguous genitalia as illustrative tools to assist with the identification of normal genitalia and recognition of some of the most common abnormalities in external genitalia development.
Cross-sectional. MATERIALS AND METHODS: Female AYA survivors who were ages 18-39, were diagnosed with cancer at ages 15-35, completed primary cancer treatment, had at least one ovary were recruited from cancer registries, clinics and advocacy groups between 2015 and 2018 to the parent Reproductive Window study on ovarian function. Participants completed a web-based questionnaire on infertility risk counseling and preservation procedures prior to cancer treatment, as well as demographic, cancer, and reproductive characteristics. Cancer treatments were abstracted from primary records. Logbinomial regression models were used to test associations between gonadotoxic treatments (alkylating chemotherapy [AC], abdominopelvic radiation [RT], total body irradiation [TBI]) and fertility services (counseling and FP procedures) utilization, adjusting for confounding.RESULTS: 578 survivors, mean age 33.1 (SD 4.7) years and 73.8% white, met eligibility criteria and were diagnosed with cancer at a mean age of 26.1 (SD 5.8) years. The most common cancers were breast (27.7%), thyroid (19.7%), and Hodgkin lymphoma (17.3%). Gonadotoxic treatment exposures were 49.5% to AC, 7% to R 7 g/m 2 of cyclophosphamide equivalent dosing (CED), 4.3% to RT and 1.4% to TBI. Overall, 23.5% had counseling and 14.7% underwent FP procedures. In bivariable analysis, older age at diagnosis, infertility before cancer, cancer type, AC and CED, and RT were significantly associated with increased counseling. In adjusted analysis, age (aRR 1.09 [1.05-1.12]), CED < 7g/m2 vs. none (aRR 1.71 [1.27-2.28]), and CED R 7 g/m2 vs. none ) remained significantly associated with counseling. For FP procedures, older age at diagnosis, white race, AC, CED and RT were associated in bivariable analysis. In adjusted analysis, undertaking FP procedures was more likely with older age (aRR 1.09 [1.05-1.33]), white race (aRR 1.88 [1.1-3.2]), receipt of <7g/m2 CED vs. none ), receipt of >7g/m2 CED vs. none ), and RT (aRR 2. 45 [1.36-.3.30]).CONCLUSIONS: A minority of AYA cancer survivors undergo fertility services before cancer treatment, indicating a continued gap in care. Survivors who received alkylating chemotherapy or abdominopelvic radiation were more likely to undergo fertility services, supporting appropriately increased use of these services in women who are at higher risk of infertility.References: 1.
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