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Reversible azoospermia: anabolic steroids may profoundly affect human immunodeficiency virus–seropositive men undergoing assisted reproduction
Reversible Azoospermia: Anabolic Steroids May Profoundly Affect Human Immunodeficiency Virus–Seropositive Men Undergoing Assisted Reproduction Joseph E. Pen˜a, MD, Melvin H. Thornton, II, MD, and Mark V. Sauer, MD Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia-Presbyterian Medical Center, College of Physicians & Surgeons, Columbia University, New York, New York
BACKGROUND: In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has recently been offered to human immunodeficiency virus (HIV)–serodiscordant couples where the man is seropositive and the woman seronegative to achieve pregnancy while minimizing the risk of HIV transmission. Anabolic steroids are commonly prescribed medications for adjunctive treatment of HIV disease to prevent muscle wasting. CASE: An HIV-serodiscordant couple presented for fertility care and evaluation. The man was found to be azoospermic. Further evaluation attributed his azoospermia to his treatment with testosterone and oxandrolone. After these agents were discontinued, his azoospermia resolved within 3 months. Normal sperm were then cryopreserved for future use, and his medications were resumed. Later the couple conceived by IVF-ICSI using the cryopreserved sperm. CONCLUSION: The popular use of anabolic steroids in HIVinfected men may predispose them to abnormal sperm production. (Obstet Gynecol 2003;101:1073–5. © 2003 by The American College of Obstetricians and Gynecologists.)
Human immunodeficiency virus (HIV) infection is common worldwide, with over 30 million infected individuals, many of whom are of reproductive age. In HIVserodiscordant couples where the man is infected and the woman is seronegative, in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has recently been offered in the hopes of achieving pregnancy while Address reprint requests to: Mark V. Sauer, MD, Columbia-Presbyterian Medical Center, Department of Obstetrics and Gynecology, 622 West 168th Street, PH 16-28, New York, NY 10032; E-mail: mvs9 @columbia.edu.
minimizing the risk of HIV transmission from one partner to the other.1–3 The use of anabolic steroids, including testosterone, has become an integral part of the adjunctive treatment of HIV disease, improving the muscle wasting associated with the disease.4 However, there are many known side effects related to their use, including an unfavorable effect on spermatogenesis leading to decreased fertility.5,6 We report a case of iatrogenic azoospermia discovered during the evaluation of an HIV-serodiscordant couple interested in assisted reproduction. CASE The treatment of HIV-discordant couples using IVFICSI was reviewed and approved by the Institutional Review Board and Ethics Committee of Columbia-Presbyterian Medical Center, New York. A couple presented for reproductive counseling. The woman was HIV-1 seronegative with no previous pregnancies. The man was a hemophiliac known to be HIV-1 seropositive for several years. They had maintained a stable relationship and had always used condoms since his diagnosis to avoid transmission of the virus. He was observed by an infectious disease specialist since diagnosis, and his primary care physician considered him to be in stable condition, as he had experienced no major illnesses during this period, never suffered from opportunistic infections, and had stable CD4⫹ lymphocyte counts and viral loads in the past year. He had been prescribed an antiviral regimen of lamivudine-zidovudine and efavirenz for several years. He was also being treated with testosterone (testosterone enanthate 200 mg intramuscularly every 2 weeks) and oxandrolone (10 mg orally twice a day) to enhance well-being and libido, while also preventing muscle wasting. Semen analysis was as follows: volume 1.8 mL and azoospermic with no white blood cells or agglutination noted. Repeat semen analysis 3 months later confirmed earlier results of azoospermia. The man denied any history of genital trauma, inguinal surgery, recent infection, or treatment with chemotherapy or radiation, and was referred to a urologist. Examination revealed normal secondary sexual characteristics. Testicular examination was normal, with no evidence of varicocele or peritesticular abnormalities. The prostate was normal to palpation, with no masses. Gynecomastia was not evident. Serum testosterone was 690 ng/dL (normal range 270 –1100). The decision was made to halt testosterone treatment because this is known to suppress spermatogenesis. However, within months of discontinuing treatment his serum testoster-
VOL. 101, NO. 5, PART 2, MAY 2003 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
0029-7844/03/$30.00 doi:10.1016/S0029-7844(02)02330-X
1073
one dropped to 30 ng/dL (with luteinizing hormone [LH] and follicle-stimulating hormone [FSH] both below the normal range) and he suffered notable depression and irritability that necessitated antidepressant medication. Repeat semen analysis 3 months after discontinuation of testosterone treatment continued to demonstrate azoospermia. The option of donor sperm was again recommended to the couple but was declined. The man was referred to a medical endocrinologist for the evaluation of central hypogonadism. Pituitary and thyroid disorders were ruled out by normal serum prolactin and thyroid hormone levels, respectively. Magnetic resonance imaging of the brain and pituitary were normal. With the discontinuance of testosterone treatment, the central hypogonadism was thought to be secondary to oxandrolone, an anabolic steroid, and it was discontinued. Within 3 months, testosterone levels increased to 134 ng/dL, and normal LH and FSH levels were demonstrated. A repeat semen analysis revealed a volume of 1 mL; sperm count, 63 ⫻ 106/mL; sperm motility, 60%; and sperm morphology, 80%. Sperm was cryopreserved and stored. The patient’s viral counts in the blood remained stable. Viral counts were undetectable in his sampled semen. The patient was restarted on testosterone replacement therapy and oxandrolone by his primary physician. With his azoospermia resolved, the couple decided to pursue IVF-ICSI. The woman underwent standard downregulation using a gonadotropin-releasing hormone agonist followed by ovarian hyperstimulation with gonadotropin. Intracytoplasmic sperm injection of retrieved oocytes after sperm preparation using a double wash swim-up method modified as previously described7 resulted in ten normally fertilized oocytes, and four embryos were transferred into the uterine cavity on the third day. Five eight-cell embryos of high quality were also cryopreserved. The patient failed to become pregnant and returned 2 months later for another attempt using the frozen embryos. After hormone replacement a second transfer occurred, resulting in the establishment of a singleton pregnancy. The patient is currently in the third trimester of pregnancy and remains HIV seronegative. COMMENT Human immunodeficiency virus–serodiscordant couples seeking methods to prevent virus transmission have traditionally been counseled on the use of HIV-negative donor sperm, consideration of adoption, or refraining from having children. Recent advances in the field of infertility treatment have given HIV-serodiscordant couples some optimism regarding their goal of having their
1074
Pen˜ a et al
Azoospermia in HIV-Discordant Couples
own genetically related children. The pioneering work of Semprini7 in the preparation of semen from HIV-positive men has led to its adjunctive use with intrauterine insemination. Others, including our institution, have reported on the use of IVF-ICSI to reduce viral exposure to the level of a few gametes.1–3 Human immunodeficiency virus disease is commonly associated with depressed serum testosterone levels. Approximately a third of HIV-infected men have serum total and free testosterone levels in the hypogonadal range.8 The etiology of the low testosterone levels is thought to be multifactorial. It may result from a primary problem with the testes, changes in the hypothalamuspituitary-gonadal axis, changes attributed to chronic systemic illness, or one of the many pharmaceutical agents typically used in the treatment of HIV.5 There is a wide variety of clinical manifestations of androgen deficiency including depression, insomnia, decreased libido, decreased memory, and decreased muscle and bone mass. Hypoandrogenism is associated with poor disease outcome in HIV-infected men.5,8 The use of anabolic steroids in HIV-infected men reverses the loss of lean body mass, increases muscle strength, improves sexual functioning and libido, and creates a sense of well-being.4,8 This has led to their widespread use in the treatment of HIV-infected men. Unfortunately, treatment with anabolic steroids may lead to deleterious effects on spermatogenesis, causing oligospermia or azoospermia.6 Prescribed androgens inhibit gonadotropin-releasing hormone release from the hypothalamus and suppress the release of FSH and LH from the pituitary. Spermatogenesis relies on gonadotropins for normal sperm development. Oxandrolone, one of the most commonly prescribed anabolic agents in the treatment of HIV,4,9 has also been shown to profoundly affect the male reproductive tract, including the arrest of spermatogenesis and severe depletion of Leydig cells in the rat.10 The evaluation revealed the man’s azoospermia was due to iatrogenic causes, likely secondary to the prescribed use of testosterone and oxandrolone. Management required careful consideration by and close communication among the patient’s many physicians. The patient was willing to discontinue treatment for 8 –12 weeks to allow normal spermatogenesis to occur. Once the patient was able to produce an adequate semen sample, cryopreservation of the sperm for future use was performed. The patient was then encouraged to restart his androgen supplementation to improve both physical and emotional well-being. Testicular sperm extraction or testicular sperm aspiration is not a viable option because of blood contamination concerns. Therefore, only nor-
OBSTETRICS & GYNECOLOGY
mospermic and oligospermic males are treatable with our protocol. With the increase in prevalence of HIV in the reproductive age population and the recent advances made in assisted reproductive technology, there is a growing interest in serodiscordant couples seeking fertility care. As with other patients, it is vitally important to be aware of and familiar with their medications. The common use of anabolic steroids by HIV-infected men may predispose them to abnormal sperm production and complicate their assisted reproductive technology treatment. A multidisciplinary approach to this dilemma is essential and encouraged to ensure a successful outcome.
REFERENCES 1. Marina S, Marina F, Alcolea R, Nadal J, Exposito R, Huguet J. Pregnancy following intracytoplasmic sperm injection from an HIV-1-seropositive man. Hum Reprod 1998;13:3247–9. 2. Loutradis D, Drakakis P, Kallianidis K, Patsoula E, Bletsa R, Michalas S. Birth of two infants who were seronegative for human immunodeficiency virus type 1 (HIV-1) after intracytoplasmic injection of sperm from HIV-1-seropositive men. Fertil Steril 2001;75:210–2. 3. Sauer MV, Chang PL. Establishing a clinical program for human immunodeficiency virus 1-seropositive men to father seronegative children by means of in vitro fertiliza-
Short Delay of Delivery to Allow Corticosteroid Adminstration in a Case of Preterm Antepartum Eclampsia Sarah H. Poggi, MD, and Alessandro Ghidini, MD Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC
BACKGROUND: The current recommendation for management of antepartum eclampsia is to take steps to deliver the fetus after stabilization of the maternal condition. We delayed delivery for 60 hours in a case of antepartum
Address reprint requests to: Alessandro Ghidini, MD, Georgetown University Hospital, Department of Obstetrics and Gynecology, 3800 Reservoir Road, NW, 3 PHC, Washington, DC 20007; E-mail: [email protected].
4. 5.
6.
7.
8.
9.
10.
tion with intracytoplasmic sperm injection. Am J Obstet Gynecol 2002;186:627–33. Newshan G, Leon W. The use of anabolic agents in HIV disease. Int J STD AIDS 2001;12:141–4. Cofrancesco J Jr, Whalen JJ 3rd, Dobs AS. Testosterone replacement treatment options for HIV-infected men. J Acquir Immune Defic Syndr Hum Retrovirol 1997;16: 254–65. Torres-Calleja J, Gonzalez-Unzaga M, DeCelis-Carrillo R, Calzada-Sanchez L, Pedron N. Effect of androgenic anabolic steroids on sperm quality and serum hormone levels in adult male bodybuilders. Life Sci 2001;68:1769–74. Semprini AE, Levi-Setti P, Bozzo M, Ravizza M, Taglioretti A, Sulpizio P, et al. Insemination of HIV-negative women with processed semen of HIV-positive partners. Lancet 1992;340:1317–9. Bhasin S, Javanbakht M. Can androgen therapy replete lean body mass and improve muscle function in wasting associated with human immunodeficiency virus infection? JPEN J Parenter Enteral Nutr 1999;23:S195–201. Berger JR, Pall L, Hall CD, Simpson DM, Berry PS, Dudley R. Oxandrolone in AIDS-wasting myopathy. AIDS 1996;10:1657–62. Grokett BH, Ahmad N, Warren DW. The effects of an anabolic steroid (oxandrolone) on reproductive development in the male rat. Acta Endocrinol (Copenh) 1992;126: 173–8.
Received April 25, 2002. Received in revised form June 14, 2002. Accepted June 27, 2002.
preterm eclampsia to allow administration of corticosteroids for fetal lung maturity enhancement. CASE: A primigravida presented with eclamptic seizure at 29 weeks’ gestation without focal neurological deficits. Clinical and laboratory assessment ruled out the presence of the syndrome of hemolysis, elevated liver enzymes, low platelets; abruption; disseminated intravascular coagulation; or acute renal failure. The fetal biometry was appropriate for gestational age, and there was a normal amount of amniotic fluid. Fetal testing was reassuring. Expectancy with intravenous magnesium sulfate infusion was continued for 60 hours, allowing administration of a course of corticosteroids for enhancement of fetal lung maturity. Maternal and neonatal outcomes were satisfactory. CONCLUSION: A 2-day delay in delivery in selected patients with preterm antepartum eclampsia allows administration of steroids for fetal lung maturity enhancement. (Obstet Gynecol 2003;101:1075– 8. © 2003 by The American College of Obstetricians and Gynecologists.)
The current recommendation for management of eclampsia when it occurs antepartum is to take steps to
VOL. 101, NO. 5, PART 2, MAY 2003 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
0029-7844/03/$30.00 doi:10.1016/S0029-7844(02)02329-3
1075
BACKGROUND: In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has recently been offered to human immunodeficiency virus (HIV)–serodiscordant couples where the man is seropositive and the woman seronegative to achieve pregnancy while minimizing the risk of HIV transmission. Anabolic steroids are commonly prescribed medications for adjunctive treatment of HIV disease to prevent muscle wasting. CASE: An HIV-serodiscordant couple presented for fertility care and evaluation. The man was found to be azoospermic. Further evaluation attributed his azoospermia to his treatment with testosterone and oxandrolone. After these agents were discontinued, his azoospermia resolved within 3 months. Normal sperm were then cryopreserved for future use, and his medications were resumed. Later the couple conceived by IVF-ICSI using the cryopreserved sperm. CONCLUSION: The popular use of anabolic steroids in HIVinfected men may predispose them to abnormal sperm production. (Obstet Gynecol 2003;101:1073–5. © 2003 by The American College of Obstetricians and Gynecologists.)
Human immunodeficiency virus (HIV) infection is common worldwide, with over 30 million infected individuals, many of whom are of reproductive age. In HIVserodiscordant couples where the man is infected and the woman is seronegative, in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has recently been offered in the hopes of achieving pregnancy while Address reprint requests to: Mark V. Sauer, MD, Columbia-Presbyterian Medical Center, Department of Obstetrics and Gynecology, 622 West 168th Street, PH 16-28, New York, NY 10032; E-mail: mvs9 @columbia.edu.
minimizing the risk of HIV transmission from one partner to the other.1–3 The use of anabolic steroids, including testosterone, has become an integral part of the adjunctive treatment of HIV disease, improving the muscle wasting associated with the disease.4 However, there are many known side effects related to their use, including an unfavorable effect on spermatogenesis leading to decreased fertility.5,6 We report a case of iatrogenic azoospermia discovered during the evaluation of an HIV-serodiscordant couple interested in assisted reproduction. CASE The treatment of HIV-discordant couples using IVFICSI was reviewed and approved by the Institutional Review Board and Ethics Committee of Columbia-Presbyterian Medical Center, New York. A couple presented for reproductive counseling. The woman was HIV-1 seronegative with no previous pregnancies. The man was a hemophiliac known to be HIV-1 seropositive for several years. They had maintained a stable relationship and had always used condoms since his diagnosis to avoid transmission of the virus. He was observed by an infectious disease specialist since diagnosis, and his primary care physician considered him to be in stable condition, as he had experienced no major illnesses during this period, never suffered from opportunistic infections, and had stable CD4⫹ lymphocyte counts and viral loads in the past year. He had been prescribed an antiviral regimen of lamivudine-zidovudine and efavirenz for several years. He was also being treated with testosterone (testosterone enanthate 200 mg intramuscularly every 2 weeks) and oxandrolone (10 mg orally twice a day) to enhance well-being and libido, while also preventing muscle wasting. Semen analysis was as follows: volume 1.8 mL and azoospermic with no white blood cells or agglutination noted. Repeat semen analysis 3 months later confirmed earlier results of azoospermia. The man denied any history of genital trauma, inguinal surgery, recent infection, or treatment with chemotherapy or radiation, and was referred to a urologist. Examination revealed normal secondary sexual characteristics. Testicular examination was normal, with no evidence of varicocele or peritesticular abnormalities. The prostate was normal to palpation, with no masses. Gynecomastia was not evident. Serum testosterone was 690 ng/dL (normal range 270 –1100). The decision was made to halt testosterone treatment because this is known to suppress spermatogenesis. However, within months of discontinuing treatment his serum testoster-
VOL. 101, NO. 5, PART 2, MAY 2003 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
0029-7844/03/$30.00 doi:10.1016/S0029-7844(02)02330-X
1073
one dropped to 30 ng/dL (with luteinizing hormone [LH] and follicle-stimulating hormone [FSH] both below the normal range) and he suffered notable depression and irritability that necessitated antidepressant medication. Repeat semen analysis 3 months after discontinuation of testosterone treatment continued to demonstrate azoospermia. The option of donor sperm was again recommended to the couple but was declined. The man was referred to a medical endocrinologist for the evaluation of central hypogonadism. Pituitary and thyroid disorders were ruled out by normal serum prolactin and thyroid hormone levels, respectively. Magnetic resonance imaging of the brain and pituitary were normal. With the discontinuance of testosterone treatment, the central hypogonadism was thought to be secondary to oxandrolone, an anabolic steroid, and it was discontinued. Within 3 months, testosterone levels increased to 134 ng/dL, and normal LH and FSH levels were demonstrated. A repeat semen analysis revealed a volume of 1 mL; sperm count, 63 ⫻ 106/mL; sperm motility, 60%; and sperm morphology, 80%. Sperm was cryopreserved and stored. The patient’s viral counts in the blood remained stable. Viral counts were undetectable in his sampled semen. The patient was restarted on testosterone replacement therapy and oxandrolone by his primary physician. With his azoospermia resolved, the couple decided to pursue IVF-ICSI. The woman underwent standard downregulation using a gonadotropin-releasing hormone agonist followed by ovarian hyperstimulation with gonadotropin. Intracytoplasmic sperm injection of retrieved oocytes after sperm preparation using a double wash swim-up method modified as previously described7 resulted in ten normally fertilized oocytes, and four embryos were transferred into the uterine cavity on the third day. Five eight-cell embryos of high quality were also cryopreserved. The patient failed to become pregnant and returned 2 months later for another attempt using the frozen embryos. After hormone replacement a second transfer occurred, resulting in the establishment of a singleton pregnancy. The patient is currently in the third trimester of pregnancy and remains HIV seronegative. COMMENT Human immunodeficiency virus–serodiscordant couples seeking methods to prevent virus transmission have traditionally been counseled on the use of HIV-negative donor sperm, consideration of adoption, or refraining from having children. Recent advances in the field of infertility treatment have given HIV-serodiscordant couples some optimism regarding their goal of having their
1074
Pen˜ a et al
Azoospermia in HIV-Discordant Couples
own genetically related children. The pioneering work of Semprini7 in the preparation of semen from HIV-positive men has led to its adjunctive use with intrauterine insemination. Others, including our institution, have reported on the use of IVF-ICSI to reduce viral exposure to the level of a few gametes.1–3 Human immunodeficiency virus disease is commonly associated with depressed serum testosterone levels. Approximately a third of HIV-infected men have serum total and free testosterone levels in the hypogonadal range.8 The etiology of the low testosterone levels is thought to be multifactorial. It may result from a primary problem with the testes, changes in the hypothalamuspituitary-gonadal axis, changes attributed to chronic systemic illness, or one of the many pharmaceutical agents typically used in the treatment of HIV.5 There is a wide variety of clinical manifestations of androgen deficiency including depression, insomnia, decreased libido, decreased memory, and decreased muscle and bone mass. Hypoandrogenism is associated with poor disease outcome in HIV-infected men.5,8 The use of anabolic steroids in HIV-infected men reverses the loss of lean body mass, increases muscle strength, improves sexual functioning and libido, and creates a sense of well-being.4,8 This has led to their widespread use in the treatment of HIV-infected men. Unfortunately, treatment with anabolic steroids may lead to deleterious effects on spermatogenesis, causing oligospermia or azoospermia.6 Prescribed androgens inhibit gonadotropin-releasing hormone release from the hypothalamus and suppress the release of FSH and LH from the pituitary. Spermatogenesis relies on gonadotropins for normal sperm development. Oxandrolone, one of the most commonly prescribed anabolic agents in the treatment of HIV,4,9 has also been shown to profoundly affect the male reproductive tract, including the arrest of spermatogenesis and severe depletion of Leydig cells in the rat.10 The evaluation revealed the man’s azoospermia was due to iatrogenic causes, likely secondary to the prescribed use of testosterone and oxandrolone. Management required careful consideration by and close communication among the patient’s many physicians. The patient was willing to discontinue treatment for 8 –12 weeks to allow normal spermatogenesis to occur. Once the patient was able to produce an adequate semen sample, cryopreservation of the sperm for future use was performed. The patient was then encouraged to restart his androgen supplementation to improve both physical and emotional well-being. Testicular sperm extraction or testicular sperm aspiration is not a viable option because of blood contamination concerns. Therefore, only nor-
OBSTETRICS & GYNECOLOGY
mospermic and oligospermic males are treatable with our protocol. With the increase in prevalence of HIV in the reproductive age population and the recent advances made in assisted reproductive technology, there is a growing interest in serodiscordant couples seeking fertility care. As with other patients, it is vitally important to be aware of and familiar with their medications. The common use of anabolic steroids by HIV-infected men may predispose them to abnormal sperm production and complicate their assisted reproductive technology treatment. A multidisciplinary approach to this dilemma is essential and encouraged to ensure a successful outcome.
REFERENCES 1. Marina S, Marina F, Alcolea R, Nadal J, Exposito R, Huguet J. Pregnancy following intracytoplasmic sperm injection from an HIV-1-seropositive man. Hum Reprod 1998;13:3247–9. 2. Loutradis D, Drakakis P, Kallianidis K, Patsoula E, Bletsa R, Michalas S. Birth of two infants who were seronegative for human immunodeficiency virus type 1 (HIV-1) after intracytoplasmic injection of sperm from HIV-1-seropositive men. Fertil Steril 2001;75:210–2. 3. Sauer MV, Chang PL. Establishing a clinical program for human immunodeficiency virus 1-seropositive men to father seronegative children by means of in vitro fertiliza-
Short Delay of Delivery to Allow Corticosteroid Adminstration in a Case of Preterm Antepartum Eclampsia Sarah H. Poggi, MD, and Alessandro Ghidini, MD Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC
BACKGROUND: The current recommendation for management of antepartum eclampsia is to take steps to deliver the fetus after stabilization of the maternal condition. We delayed delivery for 60 hours in a case of antepartum
Address reprint requests to: Alessandro Ghidini, MD, Georgetown University Hospital, Department of Obstetrics and Gynecology, 3800 Reservoir Road, NW, 3 PHC, Washington, DC 20007; E-mail: [email protected].
4. 5.
6.
7.
8.
9.
10.
tion with intracytoplasmic sperm injection. Am J Obstet Gynecol 2002;186:627–33. Newshan G, Leon W. The use of anabolic agents in HIV disease. Int J STD AIDS 2001;12:141–4. Cofrancesco J Jr, Whalen JJ 3rd, Dobs AS. Testosterone replacement treatment options for HIV-infected men. J Acquir Immune Defic Syndr Hum Retrovirol 1997;16: 254–65. Torres-Calleja J, Gonzalez-Unzaga M, DeCelis-Carrillo R, Calzada-Sanchez L, Pedron N. Effect of androgenic anabolic steroids on sperm quality and serum hormone levels in adult male bodybuilders. Life Sci 2001;68:1769–74. Semprini AE, Levi-Setti P, Bozzo M, Ravizza M, Taglioretti A, Sulpizio P, et al. Insemination of HIV-negative women with processed semen of HIV-positive partners. Lancet 1992;340:1317–9. Bhasin S, Javanbakht M. Can androgen therapy replete lean body mass and improve muscle function in wasting associated with human immunodeficiency virus infection? JPEN J Parenter Enteral Nutr 1999;23:S195–201. Berger JR, Pall L, Hall CD, Simpson DM, Berry PS, Dudley R. Oxandrolone in AIDS-wasting myopathy. AIDS 1996;10:1657–62. Grokett BH, Ahmad N, Warren DW. The effects of an anabolic steroid (oxandrolone) on reproductive development in the male rat. Acta Endocrinol (Copenh) 1992;126: 173–8.
Received April 25, 2002. Received in revised form June 14, 2002. Accepted June 27, 2002.
preterm eclampsia to allow administration of corticosteroids for fetal lung maturity enhancement. CASE: A primigravida presented with eclamptic seizure at 29 weeks’ gestation without focal neurological deficits. Clinical and laboratory assessment ruled out the presence of the syndrome of hemolysis, elevated liver enzymes, low platelets; abruption; disseminated intravascular coagulation; or acute renal failure. The fetal biometry was appropriate for gestational age, and there was a normal amount of amniotic fluid. Fetal testing was reassuring. Expectancy with intravenous magnesium sulfate infusion was continued for 60 hours, allowing administration of a course of corticosteroids for enhancement of fetal lung maturity. Maternal and neonatal outcomes were satisfactory. CONCLUSION: A 2-day delay in delivery in selected patients with preterm antepartum eclampsia allows administration of steroids for fetal lung maturity enhancement. (Obstet Gynecol 2003;101:1075– 8. © 2003 by The American College of Obstetricians and Gynecologists.)
The current recommendation for management of eclampsia when it occurs antepartum is to take steps to
VOL. 101, NO. 5, PART 2, MAY 2003 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
0029-7844/03/$30.00 doi:10.1016/S0029-7844(02)02329-3
1075