L.W. Milman

University of Pennsylvania, Filadelfia, Pennsylvania, United States

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Publications (5)18.36 Total impact

  • No preview · Article · Sep 2014 · Fertility and Sterility
  • L.W. Milman · A. Dokras
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is a common heterogeneous syndrome associated with morbidity involving multiple organ systems. Women with PCOS are at risk of cardiovascular disease (CVD) as reflected by increased traditional cardiovascular risk markers and markers of subclinical atherosclerosis, including increased carotid intima-media thickness (IMT), coronary artery calcification, and endothelial dysfunction. In addition, there is evidence to suggest an increased risk of endometrial cancer in patients with PCOS. Finally, several studies suggest that women with PCOS are at an increased risk of mental health disorders such as depression and anxiety. Frequent screening of all women with PCOS for associated comorbidities needs to be urgently implemented as early detection and timely intervention can reduce the overall health burden associated with this common disorder. © 2014 Springer Science+Business Media New York. All rights are reserved.
    No preview · Article · Nov 2013
  • L.W. Milman · M.D. Sammel · E. Freeman · K. Barnhart · A. Dokras

    No preview · Article · Sep 2013 · Fertility and Sterility
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    ABSTRACT: Despite the high prevalence of depressive symptoms in women, the precise role of sex hormones in mood changes during the menopausal transition is unclear. Previous studies have been inconsistent with regard to identifying the association of androgens, namely total testosterone, with depressive symptoms. The objectives of this study were to evaluate changes in serum total testosterone levels and depressive symptoms during the entire menopausal transition, and examine the impact of covariates on the association between concurrent serum total testosterone levels and depressive symptoms during this time period. A longitudinal cohort study (428 women at baseline with 3634 repeated measures) using data from the Penn Ovarian Aging Study, a population-based cohort of late reproductive-aged women, followed through the menopausal transition. Serum hormone parameters and depression scores using the Center for Epidemiological Studies of Depression scale (CES-D) were measured at each annual visit over a 14-year period. General linear (for testosterone) and a generalized negative-binomial model (for depressive symptoms) for repeated measures were used for analysis. Serum total testosterone levels increased progressively over the study period and were significantly associated with older age and with current smoking (p<0.001, respectively). In the post menopause total testosterone levels were significantly higher in African Americans compared to Caucasians (p=0.012). The proportion of women with CES-D ≥16 significantly decreased with increasing age and in the post-menopausal period, and were higher in women with a history of depression and hot flashes (p<0.001). The association between concurrent testosterone levels and high depressive symptoms (CES-D ≥16) differed by race (p=0.008). In Caucasians, but not African Americans, higher serum testosterone levels were associated with increased depressive symptoms after controlling for several variables including age, obesity status, hot flashes and menopausal status (RR 1.09, 95% CI 1.00-1.17, p=0.042). In our cohort, testosterone levels were low but progressively increased from premenopause through post menopause. In addition to age and history of depression, we identified race to have a significant interaction between the association of testosterone levels and depressive symptoms. This study further supports the associations between sex hormones and increased risk of having depressive symptoms, although the precise underlying mechanisms for this association remain unclear. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Sep 2013 · Fertility and Sterility
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    ABSTRACT: To study the association of perinatal outcome and IVF transfer type in a group of infertility patients with standardized treatment and similar prognosis. Retrospective cohort study. University-based infertility center, January 1998 to June 2006. Two hundred eighteen IVF pregnancies after fresh embryo transfer (ET); 122 IVF pregnancies after frozen ET. Assessment of perinatal outcome in fresh versus frozen ET pregnancies. Pregnancy outcomes after fresh versus frozen embryo transfer (ET). Primary outcome was a composite of three events: preterm delivery, intrauterine growth restriction, or low birth weight. Secondary outcomes were subtypes of pregnancy loss. Associations were assessed using multivariate logistic regression. The final sample included 340 pregnancies: 218 fresh and 122 frozen ETs. Singleton pregnancy was less likely after transfer of fresh embryos (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.23-0.67), and pregnancies after fresh ET were more likely to end in first-trimester loss (OR 1.82, 95% CI 1.05-3.13). Composite adverse outcome after transfer of fresh (44.0%) versus frozen (32.6%) embryos was higher (OR 1.52, 95% CI 0.90-2.56) and was strongly associated with twin gestation (OR 23.82, 95% CI 11.16-50.82). Perinatal morbidity is higher in IVF pregnancies conceived after a fresh ET compared with a frozen ET. Although some differences are related to conception with twin gestations, these findings suggest that adverse outcomes may be related to differences in IVF procedures.
    No preview · Article · Feb 2011 · Fertility and sterility