Category Archives: Δημοσιευμένες εργασίες


Autoimmune Diseases and Male Fertility: A Systematic Review

Evangelos Iliopoulos*

Background: During the last years new targeted regimen for several autoimmune diseases has been developed leading to an ameliorated quality of life for these patients. Nevertheless, their fertility potential seems to be impaired either by the activity of the autoimmune diseases or by the medical treatment used to suppress these conditions. This systematic review intends to reveal how autoimmune diseases and their regimen affect male fertility.
Methods: A search of English-language articles from electronic databases was conducted. The results that were used referred to impaired fertility in male patients with Systemic Lupus Erythematosus, Behcet’s disease, gout, dermatomyositis, celiac disease, rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, psoriasis and sarcoidosis.
Conclusion: Thirty-nine articles were finally included regarding the following diseases: Dermatomyositis, Systemic Lupus Erythematosus, Behcet’s disease, Gout, Celiac disease, Rheumatoid arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Psoriasis, Sarcoidosis as well as two systematic reviews. Cyclophosphamide therapy seems to impair fertility in male patients with Systemic Lupus Erythematosus and Behcet’s disease. Colchicine use may lead to sperm abnormalities in patients with gout whereas anti-TNF treatment in ankylosing spondylitis does not affect the fertility potential. Antisperm antibodies and sulphasalazine treatment in rheumatoid arthritis, as well as mesalazine, infliximab and methotrexate use in inflammatory bowel disease, result in gonadal dysfunction, respectively. More data addressing male fertility are needed for patients with Dermatomyositis, Sarcoidosis, Psoriasis and Celiac disease. Fertility impairment is common in autoimmune diseases. Henceforth, more studies are needed to identify the relationship between fertility and immunity.

Keywords: Autoimmune diseases; Male fertility; Sperm abnormalities; Semen quality; Fertility impairment

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What is the true place of a double stimulation and double oocyte retrieval in the same cycle for patients diagnosed with poor ovarian reserve? A systematic review including a meta-analytical approach

Konstantinos Sfakianoudis, Konstantinos Pantos, Sokratis Grigoriadis, Anna Rapani, Evangelos Maziotis, Petroula Tsioulou, Polina Giannelou, Adamantia Kontogeorgi, Agni Pantou, Nikolaos Vlahos, Michael Koutsilieris, Mara Simopoulou

Purpose This systematic review including a meta-analytical approach aims to investigate the safety and efficacy of employing a double ovarian stimulation (DuoStim) and a subsequent double oocyte retrieval in the same menstrual cycle, in poor ovarian reserve (POR) patients.
Methods A systematic search of literature was performed in the databases of PubMed/MEDLINE, Embase, and Cochrane Central Library up untilMarch 2019. Both prospective and retrospective cohort studies considered suitable for inclusion reported on women with POR undergoing a DuoStim in the follicular (FPS) and luteal phase (LPS) of the same menstrual cycle. Following the systematic review of the literature, a meta-analytical approach was attempted.
Results This study indicates that DuoStimis correlatedwith a higher number of retrieved oocytes,matureMII oocytes, and goodquality embryos in comparison to conventional stimulation. Additionally, LPS seems to be correlated with an equal or an even higher overall performance in comparison to FPS.
Conclusion DuoStim favors an enhanced clinical outcome in regard to the total number of yielded oocytes, mature oocytes, and available embryos, along with the quality of obtained embryos. Sourced data indicate that LPS is not correlated with a higher aneuploidy rate. This option may present as promising for the time-sensitive nature of POR patients’ management, by enabling a higher oocyte yield during a single menstrual cycle.

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The intertemporal evolution of contraception. Literature review

Leila Top, Nicolaos Salakos, Michalis Kaloeidas, Georgios Koumantakis, Perilkis Panagopoulos, Efthimios Deligeoroglou

Aim: The aim of this study is to summarize the methods used for contraception from antiquity to nowadays and to highlight the latest ones with their advantages and disadvantages.
Materials and Methods: In order to gather the following data, scientific papers from the PUBMED database, ancient texts, historical data, newer article-searching literature, contraceptive methods and the collection of books of the Family Planning Department of the 2nd Department of Obstetrics & Gynecology of the Aretaieion Hospital.
Results: Contraception is a means of controlling fertility, is an old and sexual function. The history of contraception began with the discovery of the relationship between intercourse and pregnancy. Over the years many contraceptive methods have emerged, involving mechanical components up to the use of pharmaceuticals, and several of them were natural and others were artificial.
Conclusions: Today contraception provides the couples with the opportunity to determine both the time and number of pregnancies. The progress in the decrease of the number of unwanted pregnancies and the provision of contraception with minimal side effects is a collective effort requiring constant collaboration of reliable clinics, scientists and volunteers of clinical trials in combination with the collaboration of the pharmaceutical industry, family planning organizations and the government. The new contraception alternatives are going to improve the opportunities of an appropriate, acceptable contraceptive method by the wider public, eliminating thus birth control failure.

Key Words: Contraception, methods of contraception, history of contraception, new methods of contraception.

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Assisted Reproduction in Congenital Adrenal Hyperplasia

Anastasios Chatziaggelou, Evangelos G. Sakkas , Raffaella Votino, Maria Papagianni , George Mastorakos

Congenital Adrenal Hyperplasia (CAH) is a group of autosomal recessive disorders characterized by defects of adrenal steroidogenesis due to mutations in one of the following enzymes: 21-hydroxylase (21OH), 11b-hydroxylase (11bOH), 17a-hydroxylase (17OH; also known as 17, 20-lyase), 3b hydroxysteroid dehydrogenase type 2 (3bHSD2), steroidogenic acute regulatory protein (StAR), P450 cholesterol side-chain cleavage (P450scc), and P450 oxidoreductase (POR). More than 95% of congenital adrenal hyperplasia cases are due to mutations in CYP21A2, the gene encoding the adrenal steroid 21-hydroxylase enzyme (P450c21). This work focuses on this type of CAH given that it is the most frequent one. This disease is characterized by impaired cortisol and aldosterone production as well as androgen excess. A variant of the CAH is the non-classic type of CAH (NCCAH), usually asymptomatic before the 5th year of age, diagnosed during puberty especially in patients visiting a fertility clinic. NCCAH is characterized mainly by anovulatory cycles and/or high androgen concentrations. Both types of CAH are associated with infertility. Given that the incidence of NCCAH is greater than that of CAH, patients suffering from NCCAH are more often diagnosed for the first time in a fertility clinic. Thus, screening for NCCAH should always be considered. The causes of infertility in CAH patients are multi-factorial including virilization of external genitalia, altered psychosocial development, and hormonal disorders. The main challenges encountered in assisted reproduction are the androgen excess-associated anovulatory cycles as well as the increased circulating progesterone concentrations during the follicular phase which impact endometrial receptivity, tubal motility, and cervical thickness. Administration of sufficient substitution dose of glucocorticoids usually resolves these problems and leads not only to successful assisted reproduction treatment but also to spontaneous pregnancy. Patients with CAH should be followed by a multidisciplinary team including gynecologist, endocrinologist, and pediatrician.

Keywords: infertility, IVF (in vitro fertilization), congenital adrenal hyperplasia (CAH), pregnancy, assisted reproduction (ART)

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Demographic, clinical and hormonal characteristics of patients with premature ovarian insufficiency and those of early menopause: data from two tertiary premature ovarian insufficiency centers in Greece


The aim of the study was to compare demographic, hormonal and clinical parameters in patients with premature ovarian insufficiency (POI) and women with early menopause in Greece. One hundred thirty-nine women of Greek origin, aged 14–45 years, referring for oligomenorrhea and having elevated FSH concentrations were divided into three groups regarding the age of menstrual disturbances onset [POI1: </=30 years (n = 42); POI2: 31–39 years (n = 36); early menopause: 40–45 years (n = 61)].

The mean age of menstrual disturbances onset and that of diagnosis in all POI and early menopause patients were 28.7 years (28.7 ± 7.7) versus 42.1 years (42.1 ± 1.5) and 33.8 years (33.8 ± 7.2) versus 43.3 years (43.3 ± 1.4), respectively. POI patients and women with early menopause were diagnosed, respectively, five years and approximately four to six months later than the age of menstrual disturbances onset. Moreover, FSH2 (second confirmatory FSH measurement at 4-to-6-weeks interval) was greater in all POI patients than in early menopause women (55.4 ± 33.9 vs. 32.4 ± 19.4; p < .05) whereas mean age of menarche was greater in early menopause women than in POI patients (13 ± 1.3 vs. 12 ± 2.2; p < .05). Furthermore, FSH2 was increased in all POI and decreased in early menopause patients.

Keywords: Premature ovarian insufficiencypremature ovarian failurehypoestrogenismsubfertilityearly menopause

Links between HPA axis and adipokines: clinical implications in paradigms of stress-related disorders

Panagiota Papargyri, Evangelia Zapanti, Nicolaos Salakos, Loukas, Papargyris, Alexandra Bargiota & George MASTORAKOS


Introduction: In the human organism, a constant interplay exists between the stress system [which includes the activity of the hypothalamic-pituitary-adrenal (HPA) axis] and the adipose tissue. This interplay is mediated by hormones of the HPA axis such as corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and glucocorticoids (GCs) and adipokines secreted by the adipose tissue. Areas covered: In this critical review, the bi-directional interactions between HPA axis and the most studied adipokines such as leptin and adiponectin, as well as the pro-inflammatory adipocytokines tumor necrosis factor (TNF) and interleukin (IL) 6 are presented. Furthermore, these interactions are described in normalcy as well as in specific clinical paradigms of stress-related disorders such as eating disorders, hypothalamic amenorrhea, and stress-related endogenous hypercortisolism states. Wherever new therapeutic strategies emerge, they are presented accordingly. Expert commentary: Additional research is needed to clarify the mechanisms involved in the interplay between the HPA axis and the adipose tissue. Research should be focused, in particular, on the development of new therapeutic means targeting dysfunctional adipose tissue in stress-related situations.



Ο μεταβολισμός ασβεστίου και οι διαταραχές του στην κύηση και γαλουχία

Αγγελοπούλου Α., Κασσή Ε., Μαστοράκος Γ., Ζαπάντη Ε.

Ο μεταβολισμός του ασβεστίου και των οστών βρίσκονται σε μια διαρκώς δυναμική κατάσταση στον ανθρώπινο οργανισμό. Ιδιαίτερα στην κύηση και τη γαλουχία, ο μεταβολισμός του ασβεστίου γίνεται ιδιαίτερα πολύπλοκος κα- θώς νέοι προσαρμοστικοί μηχανισμοί αναπτύσσονται ώστε να αντιμετωπιστούν οι αυξημένες ανάγκες του εμβρύου και του νεογνού. Οι προσαρμοστικοί αυτοί μηχανισμοί είναι διαφορετικοί στις δύο αυτές περιόδους. Ενώ στην κύηση υπερτερεί η αυξημένη εντερική απορρόφηση, κατά τη γαλουχία ο κύριος μηχανισμός εξοικονόμησης ασβεστίου εί- ναι η αυξημένη οστική απορρόφηση και η κινητοποίηση του ασβεστίου από τον σκελετό. Η παρούσα ανασκόπηση εστιάζει στον μεταβολισμό του ασβεστίου στη φυσιολογική κύηση και γαλουχία και στις διαταραχές που σχετίζονται με αυτόν στις δύο αυτές καταστάσεις. Η οστεοπόρωση που σχετίζεται με την κύηση είναι η συχνότερη διαταραχή του μεταβολισμού του ασβεστίου κατά την εγκυμοσύνη και εμφανίζεται κυρίως στο τελευταίο τρίμηνο. Στη διάρ- κεια της γαλουχίας, η οστική πυκνότητα φυσιολογικά ελαττώνεται κατά 2-3% ανά μήνα αλλά σταδιακά ο ρυθμός πέφτει. Κατά τον απογαλακτισμό, φυσιολογικά, η οστική απώλεια αναστρέφεται εντελώς και οι σκελετικές βλάβες σταδιακά αποκαθίστανται. Ιδιαίτερη προσοχή πρέπει να δίνεται στον χειρισμό γυναικών με έλλειψη βιταμίνης D και διαταραχές στην λειτουργία των παραθυρεοειδών αδένων, καταστάσεις που μπορεί να πρωτοδιαγνωσθούν στην κύηση και μπορεί να συνδεθούν με δυσμενείς συνέπειες για τη γυναίκα και το έμβρυο.



The effects of autoimmune disorders on mental health of women in reproductive age.

Hell Iatr 2018; 84: 15-22.

Salioni A-M, Christopoulos P, Zervas I, Mastorakos G.

Nowadays, we know how important is to understand being healthy. Contrary to this, we have to investigate more and more the hidden faces of longterm illnesses and find the reasons of morbidity. The activation of autoimmunity inclines to be increased in contemporary time, not only in Greece, but also globally, without understanding the causes. The systematic erythematosus lupus (SEL) and rheumatoid arthritis (RA) are, probably, two of the most characteristic examples of up to date chronic autoimmunity diseases. Women are more frequent affected than men in proportion of 3:1, a fact that create changes not only physical and organic, but also psychological. Additionally, there are a lot of chances either in childhood or in reproductive and old one. The psychological morbidity is taking place in most of these diseases, affecting the patients’ behavior and their position against them. Multiple factors are incriminated for their appearance, as fatigue, stress, anxiety, etc. In addition a lot of causes affect their development both at their remission and at their relapse. The depression dominate and is promptly correlated both with the systematic erythematosus lupus and rheumatoid arthritis.

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Increased risk of non-alcoholic fatty liver disease in women with gestational diabetes mellitus: A population-based cohort study, systematic review and meta-analysis.

J Diabetes Complications. 2019 Jun 27. pii: S1056-8727(19)30092-3. doi: 10.1016/j.jdiacomp.2019.06.006. [Epub ahead of print]

Lavrentaki A, Thomas T, Subramanian A, Valsamakis G, Thomas N, Toulis KA, Wang J, Daly B, Saravanan P, Sumilo D, Mastorakos G, Tahrani AA, Nirantharakumar K.

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