Rapid advance in oncology leads to increasing survival of oncologic patients. More and more of them live long enough to reach either the natural age of menopause or, as a side effect of their oncotherapy, experience the cessation of gonadal function, leading to premature ovarian insufficiency, with disturbing vasomotor symtoms and long-term negative cardiovascular and skeletal effects. Thus, an ever increasing number of cancer survivors search endocrinologic help in the form of hormone replacement therapy (HRT). The misinterpretation of the WHI (Women's Health Initiative) Study has lead to an irrational fear of female hormone replacement, both by the general population and medical professionals. It has seemed the logical and safe conclusion to many physicians to avoid HRT, supposing that this attitude definitely causes no harm, whereas the decision of prescribing estrogen alone or with progestins might bear oncologic and thromboembolic risks and may even lead to litigation in case of a potentially related complication. However, it was known even before the WHI results that premature menopause and hypogonadism decreases the life expectancy of women by years through its skeletal and cardiovascular effects, and this negative effect correlates with the length of the hypoestrogenaemic period. Therefore, the denial of HRT also needs to be supported by evidence and should be weighed againts the risks of HRT. Yet, the oncologic risk of HRT is extremely difficult to assess. In this work we review the latest evidence from in vitro experiments to clinical studies, regarding HRT in survivors of gynecologic and non-gynecologic cancers. Based on our literature research, we group tumours regarding the oncologic risk of properly chosen female hormone replacement therapy in cancer survivors as follows: 'HRT is advanageous' (e.g. endometrial cancer type I, cervical adenocarcinoma, haematologic malignancies, local cutaneous malignant melanoma, colorectal cancer, hepatocellular cancer); 'HRT is neutral' (e.g. BRCA 1/2 mutation carriers without cancer, endometrial cancer type II, uterinal carcinosarcoma and adenosarcoma, certain types of ovarian cancer, cervical, vaginal and vulvar squamous cell carcinoma, prolactinoma, kidney cancer, pancreatic cancer, thyroid cancer); 'HRT is relatively contraindicated' for various reasons (e.g. leiomyosarcoma, certain types of ovarian tumours, brain tumours, advanced metastatic malignant melanoma, lung cancer, gastric cancer, bladder cancer); 'HRT is diasadvantageous and thus contraindicated' (e.g. breast cancer, endometrial stroma sarcoma, meningioma, glioma, hormone receptor positive gastric and bladder cancer).

Endocrine disorders negatively influence the ovarian function, and increasing incidence of endocrine diseases with age may have further negative effects on pregnancy rate. Prospective cohort study of 231 consecutively enrolled patients underwent IVF treatment. In patients with known endocrine disorders, the laboratory parameters were corrected before IVF treatment. One hundred sixty one patients (69.7%) had at least one known and treated endocrine disorder (study group), and 70 patients were endocrine negative (control group). Endocrine disorders diagnosed were thyroid disorders (32.5%), diminished ovarian reserve (23.8%), insulin resistance (22.5%), PCOS (15.2%), hyperprolactinaemia (13.4%), obesity (12.1%), hypogonadotropic hypogonadism (0.8%) and congenital adrenal hyperplasia (0.2%). Before the IVF treatment, systematic endocrine laboratory examinations were performed in all patients. Higher age, BMI and FSH were found in the study group, while AMH level was lower. There were no differences in LH, E2, prolactin, TSH, FT3, FT4, TT, DHEAS, androstendione, 17-OHP and SHBG level between the study and control groups. The study group had higher baseline glucose, baseline insulin, 120-min glucose and 120-min insulin level after oral glucose tolerance test. With no difference in the IVF cycles performed, pregnancy rate was lower in the study group (61.43% vs. 34.16%; p = 0.003), and this difference (p = 0.0151) remained in age-corrected rates, as well. The analyses were also performed in individual endocrinology groups. The prevalence of endocrine disorders is high in females participating in IVF programs, and they are often accompanying each other. Even after proper correction, the presence of the endocrine disorder negatively influences the pregnancy rate in IVF treatment.

Összefoglaló. Bevezetés: Az endokrin betegségekhez társuló ovulációs diszfunkció gyakori vezető vagy társuló oka a női infertilitásnak, de optimális reprodukciós korban oki vagy ovulációindukciós kezeléssel többnyire rendezhető a fertilitás. Az in vitro fertilizációs (IVF-) kezelések vezető indikációi jelenleg az andrológiai és a női életkorból adódó, petefészek-eredetű infertilitás, de egyéb endokrin diszfunkció társulása befolyásolja a kezelési eredményeket. Célkitűzés: Az endokrin betegségek gyakoriságának vizsgálata az IVF-programban részt vevő párok nőtagjainál. Módszer: Az IVF-program előtti alkalmassági vizsgálatok során a vezető indikációtól függetlenül részletes endokrinológiai kivizsgálást végeztünk 231 nőnél (átlagéletkor 34 év). A vizsgálatok kiterjedtek a hypothalamus- és petefészek-funkcióra, a pajzsmirigyfunkcióra és pajzsmirigy-autoimmunitásra, a mellékvese-funkcióra, a szénhidrát-anyagcserére és az inzulinrezisztenciára. Az egyes endokrin betegségek előfordulásán túl azok társulási gyakoriságát is elemeztük. Eredmények: Az IVF vezető javallatainak megoszlása megfelelt a nemzetközi tendenciáknak, endokrin jellegű volt 87 esetben (37,6%; csökkent petefészek-tartalék: 55 eset és krónikus anovuláció: 32 eset). Társuló endokrin eltérést 141 esetben találtunk, így összesen 161 nőt érintett az endokrin diszfunkció (69,7%; átlagéletkor 35 év). Az endokrin diszfunkciók előfordulása gyakorisági sorrendben: pajzsmirigy-diszfunkció (32,5%), csökkent petefészek-tartalék (23,8%), pajzsmirigy-autoimmunitás (22,5%), polycystás ovarium szindróma (15,6%), inzulinrezisztencia (22,5%), elhízás (23,8%), hyperprolactinaemia (13,4%). Az endokrin betegségek társulása minden kórkép esetében fellelhető volt. Hypogonadotrop hypogonadismus 2, congenitalis adrenalis hyperplasia 1 esetben fordult elő. Nem találtunk endokrin eltérést 70 esetben (30,3%). Következtetés: Vizsgálatunk igazolja az endokrin diszfunkciók halmozott megjelenését és gyakori társulását az IFV-program résztvevőinél, bármely indikáció esetén. A részletes endokrin kivizsgálás és az IVF-kezelést végzők endokrin jártassága hozzájárulhat az IVF-kezelés sikerességéhez. Orv Hetil. 2022; 163(18): 712–719. Summary. Introduction: Ovulatory dysfunction associated with endocrine diseases is a common leading or associated cause of female infertility, but at optimal reproductive age, causal or ovulation-induction treatment can usually settle fertility. The leading indications for in vitro fertilization (IVF) treatments are currently andrological and originated from age-related ovarian infertility, but other accompanying endocrine dysfunctions affect treatment outcomes. Objective: To investigate the incidence of endocrine diseases in female members of couples participating in IVF program. Method: During aptitude tests prior to the IVF program, from the leading indication independently, a detailed endocrinological examination was performed in 231 women (mean age: 34 years). The studies of hypothalamic and ovarian function, thyroid function and thyroid autoimmunity, adrenal function, carbohydrate metabolism and insulin resistance were covered. In addition to the incidence of each endocrine disease, the frequency of their association was analyzed. Results: The distribution of IVF lead indications was in line with the international trends, it was endocrine nature in 87 cases (37.6%; decreased ovarian reserve in 55 cases and chronic anovulation in 32 cases). Associated endocrine abnormalities were found in 141 cases, and a total of 161 women was affected by endocrine dysfunction (69.7%; mean age: 35 years). Endocrine dysfunction incidences in order of frequency were thyroid dysfunction (32.5%), diminished ovarian reserve (23.8%), thyroid autoimmunity (22.5%), polycystic ovarian syndrome (15.6%), insulin resistance (22.5%), obesity (23.8%), hyperprolactinemia (13.4%). The endocrine disease associations were found in all of the cases above. Hypogonadotropic hypogonadism occurred in 2 cases, congenital adrenal hyperplasia occurred in 1 case. No endocrine abnormalities were found in 70 cases (30.3%). Conclusion: Our study confirms the cumulative appearance of endocrine dysfunctions and frequent association in IVF participants with any lead indication. The detailed endocrine examination and proficiency/skill in reproductive endocrinology of IVF practitioners may contribute to IVF treatment success. Orv Hetil. 2022; 163(18): 712–719.

Large fetal weight alone in Robson-1 parturients doesn't translate into a risk of Caesarean delivery higher then that of a vaginal birth Abstract Objective The authors analysed the Caesarean section rate as a function of birth weight among Robson-1 parturients and compared with that among the unselected obstetric population. Study design A retrospective analysis of birth weight, maternal height and the route of delivery was carried out in an unselected obstetric population of 26012 parturients. The authors compared birth weight centile distributions of vaginally, and that of abdominally delivered fetuses between Robson-1 parturients as well as those of the total obstetric population. ResultsThe 90th birth weight centile of fetuses delivered at 37, 38, 39, 40, 41, and 42 weeks gestation were 3960 g, 3960 g, 4000 g, 3950 g, 4000 g and 3820 g, respectively. Among Robson-1 parturients, 677 fetuses weighed >4000 g, and 448 patients (66%) were delivered vaginally. Maternal height did not influence either the birth-weight-percentiles or the Caesareanrates substantially. Above the birth weight of 4000 g, the Caesarean-rate among Robson-1 parturient rose similarly to that of the total obstetric population. In the knowledge of the most accurately estimated fetal weight, the odds of a Caesarean delivery among Robson-1 parturients was not different from that of the total obstetric population. Among pregnancies with fetuses weighing less than 5000 g, the Caesarean-rate was below 50% in both Robson-1 parturients and the total obstetric population of 10 years. ConclusionEven the best possible estimation of fetal weight cannot give a valid reason to downplay the intent of vaginal birth based on the fetal size above 3900g that would be associated with increased odds of Caesarean delivery.Large fetal weight alone in Robson-1 parturients doesn't translate into a risk of Caesarean delivery higher then that of a vaginal birth

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