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Torre D, Francoeur NJ, Kalma Y, Gross Carmel I, Melo BS, Deikus G, Allette K, Flohr R, Fridrikh M, Vlachos K, Madrid K, Shah H, Wang YC, Sridhar SH, Smith ML, Eliyahu E, Azem F, Amir H, Mayshar Y, Marazzi I, Guccione E, Schadt E, Ben-Yosef D, Sebra R. Isoform-resolved transcriptome of the human preimplantation embryo. Nat Commun 2023; 14:6902. [PMID: 37903791 PMCID: PMC10616205 DOI: 10.1038/s41467-023-42558-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/15/2023] [Indexed: 11/01/2023] Open
Abstract
Human preimplantation development involves extensive remodeling of RNA expression and splicing. However, its transcriptome has been compiled using short-read sequencing data, which fails to capture most full-length mRNAs. Here, we generate an isoform-resolved transcriptome of early human development by performing long- and short-read RNA sequencing on 73 embryos spanning the zygote to blastocyst stages. We identify 110,212 unannotated isoforms transcribed from known genes, including highly conserved protein-coding loci and key developmental regulators. We further identify 17,964 isoforms from 5,239 unannotated genes, which are largely non-coding, primate-specific, and highly associated with transposable elements. These isoforms are widely supported by the integration of published multi-omics datasets, including single-cell 8CLC and blastoid studies. Alternative splicing and gene co-expression network analyses further reveal that embryonic genome activation is associated with splicing disruption and transient upregulation of gene modules. Together, these findings show that the human embryo transcriptome is far more complex than currently known, and will act as a valuable resource to empower future studies exploring development.
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Affiliation(s)
- Denis Torre
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - Yael Kalma
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, 64239, Israel
| | - Ilana Gross Carmel
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, 64239, Israel
| | - Betsaida S Melo
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Advanced Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Gintaras Deikus
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Advanced Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Kimaada Allette
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ron Flohr
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, 69978, Israel
- CORAL - Center Of Regeneration and Longevity, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
| | - Maya Fridrikh
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Advanced Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - Kent Madrid
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Advanced Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Hardik Shah
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Advanced Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ying-Chih Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Advanced Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Shwetha H Sridhar
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Advanced Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Melissa L Smith
- Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, KY, 40202, USA
| | - Efrat Eliyahu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Foad Azem
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, 64239, Israel
| | - Hadar Amir
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, 64239, Israel
| | - Yoav Mayshar
- Department of Molecular Cell Biology, Weizmann Institute of Science, 7610001, Rehovot, Israel
| | - Ivan Marazzi
- Department of Biological Chemistry, Center for Epigenetics and Metabolism, University of California, Irvine, CA, 92697, USA
| | - Ernesto Guccione
- Center for OncoGenomics and Innovative Therapeutics (COGIT); Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Eric Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dalit Ben-Yosef
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, 64239, Israel.
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, 69978, Israel.
- CORAL - Center Of Regeneration and Longevity, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel.
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Center for Advanced Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Barda S, Amir H, Mizrachi Y, Dviri M, Yaish I, Greenman Y, Sofer Y, Azem F, Hauser R, Lantsberg D. Sperm parameters in Israeli transgender women before and after cryopreservation. Andrology 2023; 11:1050-1056. [PMID: 36542410 DOI: 10.1111/andr.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The application of fertility preservation, initially intended for oncological patients prior to gonadotoxic treatment, has extended in recent years to transgender and gender-non-conforming individuals undergoing therapy for gender compatibility. OBJECTIVES To examine semen quality and survival in transgender women pursuing semen cryopreservation in the presence or absence of gender-affirming hormonal medication. MATERIALS AND METHODS In this retrospective cohort study, we reviewed data of 74 consecutive transgender women presenting for semen cryopreservation at a single center between 2000 and 2019. Semen parameters before and after cryopreservation were compared to a control group composed of 100 consecutive sperm bank donor candidates. A subgroup analysis of subjects who had used gender-affirming hormonal treatment was also performed. RESULTS Compared to the control group, transgender women had lower total sperm count (144.0 vs. 54.5 million, respectively, p < 0.001), lower sperm motility percentage (65.0% vs. 51.0%, respectively, p < 0.001), and lower total motile sperm count (94.0 vs. 27.0 million, respectively, p < 0.001). Values were further decreased in transgender women who had received hormonal treatment before sperm cryopreservation. Post-thawing motility rate remained lower in the transgender group compared to the control group (20.0% vs. 45.0%, respectively, p < 0.001), and the total motile count remained lower as well (2.7 vs. 9.0 million, respectively, p < 0.001). Following sperm cryopreservation, the post-thaw decreases in total motile sperm count were higher in the transgender group compared with the control group (91.5% vs. 90.0%). Further subdivision in the transgender group showed that the decrease in total motile sperm count was lower for transgender women who did not use gender-affirming hormonal treatment compared to those who did (-89.7% vs. -92.6%, respectively, p < 0.01). DISCUSSION AND CONCLUSION Sperm parameters in transgender women are poor compared to candidates for sperm donation representing the general population. Specimens collected after discontinuation of gender-affirming hormone treatments were further impaired. Moreover, post-thawing sperm total motile count, motility, and overall sperm survival were reduced in transgender women.
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Affiliation(s)
- Shimi Barda
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Israel Academic College, Ramat Gan, Israel
| | - Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michal Dviri
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Sofer
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Hauser
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Andayani RP, Wahyuni F, Ausrianti R, Reni I, Edo CWD, Amir H. Effectiveness of Virgin Coconut Oil and Regular Repositioning in Preventing Pressure Ulcers in Children. Med J Malaysia 2023; 78:511-514. [PMID: 37518923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Pressure ulcers have adverse effects on health. Thus, early detection of damage to skin integrity is important for preventing the occurrence of pressure sores. Virgin Coconut Oil (VCO) is a nonpharmacological therapy that can be applied to overcome the problem of damage to skin integrity. Virgin coconut oil contains antioxidants and is rich in vitamin E. Meanwhile, two-hourly repositioning is a nursing intervention performed to prevent pressure ulcers. MATERIALS AND METHODS This study aimed to evaluate the implementation of Virgin Coconut Oil and regular repositioning for preventing pressure sores. The designs used quasi experiment pretest and posttest nonequivalent control group; 86 participants were selected through a nonprobability sampling technique by consecutive sampling. RESULTS The fundings suggest that there is a significant difference in the Braden QD scores from before and after virgin coconut oil of the intervention group and repositioning of the control group (p<0.001). CONCLUSION Nurses are expected to be able to detect early damage to skin integrity by using the Braden QD Scale and to implement use Virgin Coconut Oil and repositioning.
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Affiliation(s)
| | - F Wahyuni
- STIKes MERCUBAKTIJAYA Padang, Indonesia
| | | | - I Reni
- STIKes MERCUBAKTIJAYA Padang, Indonesia
| | - C W D Edo
- STIKes MERCUBAKTIJAYA Padang, Indonesia
| | - H Amir
- Universitas Muslim Indonesia, West Sumatera 25146, Indonesia
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Baruch Y, Gold R, Eisenberg H, Amir H, Reicher L, Yogev Y, Groutz A. High Incidence of Obstetric Anal Sphincter Injuries among Immigrant Women of Asian Ethnicity. J Clin Med 2023; 12:jcm12031044. [PMID: 36769692 PMCID: PMC9917715 DOI: 10.3390/jcm12031044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/07/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Background: Obstetric anal sphincter injuries (OASI) may complicate vaginal deliveries. The aim of the present study was to explore the incidence and clinical characteristics of OASI among Asian women living in a Western country compared to local Caucasian women. (2) Methods: A retrospective cohort study of 380 women diagnosed with OASI, following singleton vaginal deliveries, during a 10-year period (January 2011 to December 2020). Exclusion criteria: age < 18 years, stillbirth, and breech presentation. Demographic, clinical, and obstetrical data were obtained, and a comparison between Asian and Caucasian women was performed. (3) Results: There were 35 cases of OASI among 997 women of Asian ethnicity compared to 345 cases of OASI among 86,250 Caucasian women (3.5% vs. 0.4%, respectively, p < 0.001). Asian women endured a significantly higher rate of fourth-degree OASI (17.1%) even though they bore smaller newborns (3318 g vs. 3501 g, p = 0.004), and birth weights rarely exceeded 3800 g (2.8% vs. 25.8%, p < 0.001). Asian ethnicity was also associated with a significantly higher risk for blood transfusion following OASI and a lower tendency for postpartum follow up. (4) Conclusions: Immigrant women of Asian ethnicity had a nine-fold higher rate of OASI, much higher than previously reported. Furthermore, Asian women had higher rates of fourth-degree OASI.
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Affiliation(s)
- Yoav Baruch
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +97-236-925-603
| | - Ronen Gold
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hagit Eisenberg
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hadar Amir
- Lis Maternity Hospital, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lee Reicher
- Lis Maternity Hospital, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yariv Yogev
- Lis Maternity Hospital, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Asnat Groutz
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Matot R, Kalma Y, Rahav R, Azem F, Amir H, Ben-Yosef D. Cleavage stage at compaction-a good predictor for IVF outcome. Int J Gynaecol Obstet 2022; 161:997-1003. [PMID: 36495286 DOI: 10.1002/ijgo.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyze whether cleavage stage at compaction, and not only kinetics, can serve as a reliable predictor for clinical outcome. METHODS A retrospective cohort study including 1194 embryos, classified by compaction initiation stage (Group 1: compaction at fewer than eight cells, Group 2: compaction at eight cells, Group 3: compaction at more than eight cells). Of these, 815 embryos were evaluated for morphokinetic preimplantation parameters, and 379 embryos were analyzed for clinical implantation following thawing and transfer of single blastocysts during the same period. RESULTS In total, 1194 embryos were analyzed. Embryos that underwent compaction from more than eight cells (Group 3) exhibited more synchronous cleavage compared with Groups 1 and 2 (at both S2 and S3; P < 0.001), and displayed a significantly lower fragmentation rate. The likelihood of obtaining top-quality blastocysts decreased by 73% and 44% when comparing Group 3 embryos with those of Groups 1 and 2, respectively, (P < 0.03). Clinical validation of the results shows that while compaction from fewer than eight cells barely produced blastocysts for transfer, compaction at eight or more cells is crucial for implantation and birth (birth rates 11.1% and 18.5% for Groups 2 and 3, respectively). CONCLUSION Cleavage stage at compaction has a direct effect on blastocyst quality and subsequent pregnancy, so can be included in newly developed deep learning models for embryo selection.
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Affiliation(s)
- Ran Matot
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Yael Kalma
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Roni Rahav
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel
| | - Dalit Ben-Yosef
- Fertility and IVF Institute, Tel-Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Tel Aviv, Israel.,Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
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Baruch Y, Gold R, Eisenberg H, Amir H, Yogev Y, Groutz A. Substantial Obstetric Anal Sphincter Injury during Vacuum Assisted Delivery: An Obstetrical Issue or Device Related? J Clin Med 2022; 11:jcm11236990. [PMID: 36498565 PMCID: PMC9736983 DOI: 10.3390/jcm11236990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Obstetric anal sphincter injuries (OASIS) might be associated with long-term urinary and anorectal morbidities. The aim of the study was to investigate the risk factors and clinical implications of OASIS associated with vacuum-assisted deliveries versus normal vaginal deliveries. METHODS A series of 413 consecutive OASIS cases were retrospectively analyzed. A comparison was made between OASIS cases diagnosed following vacuum-assisted deliveries versus OASIS cases diagnosed following normal vaginal deliveries. Multivariable analysis was used to study the association between vacuum-assisted deliveries and superficial (3A and 3B) versus deep (3C and 4) perineal tears. RESULTS The study population comprised 88,123 singleton vaginal deliveries. Diagnosis of OASIS was made in 413 women (0.47% of the total cohort), 379 (91.8%) of whom had third-degree tears and 34 (8.2%) of whom had fourth-degree tears. Among the 7410 vacuum-assisted deliveries, 102 (1.37%) had OASIS, whereas, among the 80,713 normal vaginal deliveries, only 311 (0.39%) had OASIS. In a multivariate analysis, only vacuum-assisted delivery was found to be associated with a significant risk of deeper (3C or 4) perineal tears (OR = 1.72; 95% CI 1.02-2.91; p = 0.043). CONCLUSIONS Vacuum-assisted instrumental intervention is a significant risk factor for OASIS and especially for deeper tears, independent of other maternal and obstetric risk factors.
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Affiliation(s)
- Yoav Baruch
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-36925603
| | - Ronen Gold
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hagit Eisenberg
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hadar Amir
- Lis Maternity Hospital, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yariv Yogev
- Lis Maternity Hospital, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Asnat Groutz
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Dekel C, Morey R, Hanna J, Laurent L, Ben-Yosef D, Amir H. Stabilization of hESCs in two distinct substates along the continuum of pluripotency. iScience 2022; 25:105469. [DOI: 10.1016/j.isci.2022.105469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/10/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
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Sciberras M, Karmiris K, Nascimento C, Tabone T, Nikolaou P, Theodoropoulou A, Mula A, Goren I, Yanai H, Amir H, Mantzaris GJ, Georgiadi T, Foteinogiannopoulou K, Koutroubakis I, Allocca M, Fiorino G, Furfaro F, Katsanos K, Fousekis F, Michalopoulos G, Camilleri L, Torres J, Ellul P. Mental Health, Work Presenteeism, and Exercise in Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:1197-1201. [PMID: 35239962 DOI: 10.1093/ecco-jcc/jjac037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic diseases, such as IBD, can lead to anxiety and depression which can have a significant impact on productivity at work [presenteeism]. The aim of this study was to assess the prevalence of depression/anxiety, presenteeism and exercise levels among IBD patients. METHODS This was a multicentre study whereby adult IBD patients, in clinical remission, were asked to answer a questionnaire anonymously. Hospital Anxiety and Depression Score [HADS], Stanford Presenteeism Scale [SPS-6] and Godin Exercise Score were also collected. RESULTS A total of 585 patients were recruited. The majority had Crohn's disease [CD, 62.2%] and were male [53.0%], with a median age of 39 years [IQR 30-49]. A psychiatric diagnosis was present in 10.8% of patients prior to their IBD diagnosis. A further 14.2% of patients were psychiatrically diagnosed after IBD diagnosis, this being commoner in CD patients [41.6% of CD, p <0.01]. A raised HADS-Anxiety or a HADS-Depression score ≥8 was present in 46.1% of patients, with 27.4% having a score ≥11. Low presenteeism at work was present in 34.0%. Patients diagnosed with depression/anxiety had a more sedentary lifestyle [p <0.01], lower presenteeism at work [p <0.01] and a higher rate of unemployment [p <0.01]. CONCLUSIONS A significant percentage of IBD patients in remission suffer from anxiety and/or depression. Risk factors for these are CD, female gender, use of biologic medications, long-standing and/or perianal disease. Depression/anxiety was associated with a sedentary lifestyle, lower presenteeism at work and unemployment. Validated screening tools and appropriate referrals to psychologists and/or psychiatrists should be employed within IBD clinics.
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Affiliation(s)
| | - Konstantinos Karmiris
- Venizeleio General Hospital, Heraklion, Greece.,Hospital Beatriz Ângelo, Loures, Portugal
| | | | | | - Penelope Nikolaou
- Venizeleio General Hospital, Heraklion, Greece.,Hospital Beatriz Ângelo, Loures, Portugal
| | | | | | - Idan Goren
- Rabin Medical Center, Petah Tikva, Israel.,affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henit Yanai
- Rabin Medical Center, Petah Tikva, Israel.,affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Rabin Medical Center, Petah Tikva, Israel.,affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Israeli T, Preisler L, Kalma Y, Samara N, Levi S, Groutz A, Azem F, Amir H. P-475 Similar fertilization rates and preimplantation embryo development among testosterone-treated transgender men and cisgender women. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
What are the effects of testosterone treatment on fertilization rates and preimplantation embryo development among transgender men who underwent fertility preservation?
Summary answer
Testosterone exposure among transgender men has no adverse impacts on fertilization rates and preimplantation embryo development and quality.
What is known already
Transmen are assigned female sex at birth but identify as men. This mismatch might induce distress that is termed gender dysphoria. Testosterone therapy induces “masculine” physical traits, suppresses “feminine” ones, and relieves gender dysphoria. More transmen present for testosterone therapy, their average age is decreasing, and many express the desire to have biological children. Therefore, understanding the effects of testosterone on fertility is crucial. Previous data suggest that despite testosterone treatment, the ovarian reserve and the in-vitro oocyte maturation are preserved among transmen. However, the fertility potential in terms of fertilization rate and early embryo development was not explored.
Study design, size, duration
This retrospective cohort study included 7 testosterone-treated transgender men and 34 cisgender women between April 2016 and November 2021.
Participants/materials, setting, methods
Testosterone-treated transgender men who cryopreserved embryos were compared to 10 fertile women who cryopreserved embryos and to 24 women who underwent IVF treatment due to unexplained or mechanical infertility. Statistical analyses compared assisted reproductive technology data and outcomes between the transgender men group and the two cisgender women groups. Morphokinetic and morphological parameters were compared between 210 embryos of transgender men and 411 embryos of cisgender women.
Main results and the role of chance
The transgender men (30.2±3.59 years) were significantly younger than the cisgender women who cryopreserved embryos (35.1±1.85 years; P = 0.005) and the cisgender women who underwent fertility treatment (33.8±3.23 years; P = 0.017). Among the transgender men, the mean length of testosterone exposure was 99.7±49.24 months (range 14-156 months) and the mean time of discontinuation of testosterone prior to stimulation was 6.57±2.14 months (range 4-10 months). After adjusting for the patient’s age, the fertilization rate was comparable between the transgender men and both cisgender women groups (P = 0.391 and 0.659). No significant differences in the number of cryopreserved embryos (7.2±5.09 and 3.5±2.66; P = 0.473) and the days on which they were frozen (P = 0.576) were observed between the transgender men and the fertile cisgender women. All morphokinetic parameters that were evaluated using time-lapse imaging, as well as the morphological characteristics, were comparable between transgender men and both groups of cisgender women.
Limitations, reasons for caution
All transgender men in our study discontinued the testosterone treatment before starting ovarian stimulation. Stopping hormonal therapy might cause considerable anguish and gender dysphoria. Therefore, further studies that include subjects who did not stop testosterone before fertility preservation are needed.
Wider implications of the findings
Transgender men have acceptable fertilization rates and normal preimplantation embryo development and quality after long-term testosterone treatment. Embryo cryopreservation is, therefore, a feasible and effective way for them to preserve their fertility for future biological parenting.
Trial registration number
Not applicable
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Affiliation(s)
- T Israeli
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Obstetrics and Gynecology , Tel Aviv, Israel
| | - L Preisler
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Obstetrics and Gynecology , Tel Aviv, Israel
| | - Y Kalma
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Obstetrics and Gynecology , Tel Aviv, Israel
| | - N Samara
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Obstetrics and Gynecology , Tel Aviv, Israel
| | - S Levi
- Sami Shamoon college of engineering , Mathematics, Ashdod, Israel
| | - A Groutz
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Obstetrics and Gynecology , Tel Aviv, Israel
| | - F Azem
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Obstetrics and Gynecology , Tel Aviv, Israel
| | - H Amir
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Obstetrics and Gynecology , Tel Aviv, Israel
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10
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Hoffman D, Kalma Y, Samara N, Haikin Herzberger E, Levi S, Azem F, Amir H. Maternal underweight does not adversely affect the outcomes of IVF/ICSI and frozen embryo transfer cycles or early embryo development. Gynecol Endocrinol 2022; 38:467-473. [PMID: 35471122 DOI: 10.1080/09513590.2022.2068522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To compare assisted reproductive technology (ART) outcomes and preimplantation embryo development between underweight and normal-weight women. METHODS This retrospective cohort study included 26 underweight women (body mass index [BMI] < 18.50 kg/m2) and 104 normal-weight women (BMI >20 and <24.9 kg/m2) who underwent a total of 204 in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles and 358 fresh/frozen embryo transfers (ET) in our institution between January 2016 and December 2018. Statistical analyses compared selected ART outcomes (ovarian stimulation, fertilization, and pregnancy) between both weight groups. Morphokinetic and morphological parameters were also compared between 346 and 1467 embryos of underweight and normal-weight women, respectively. RESULTS The mean ± standard deviation age of the underweight and normal-weight women was similar (31.6 ± 4.17 vs 32.4 ± 3.59 years; p = .323). There were no differences in the peak estradiol levels, the number of retrieved oocytes, the number of metaphase II oocytes, and the oocyte maturity rates between the two groups. The IVF/ICSI fertilization rates and the number of embryos suitable for transfer or cryopreservation were similar for both groups. All morphokinetic parameters that were evaluated by means of time-lapse imaging as well as the morphological characteristics were comparable between low and normal BMI categories. There were no significant differences in pregnancy achievement, clinical pregnancy, live births, and miscarriage rates between the suboptimal and optimal weight women. CONCLUSION Underweight status has no adverse impacts on the outcomes of IVF/ICSI with either fresh or frozen ET or on preimplantation embryo development and quality.
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Affiliation(s)
- Dana Hoffman
- Department of Anesthesiology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Kalma
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nivin Samara
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Haikin Herzberger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- IVF Unit, Meir Medical Center, Kfar Saba, Israel
| | - Sagi Levi
- Mathematics Unit, Sami Shamoon College of Engineering, Ashdod, Israel
| | - Foad Azem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hadar Amir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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11
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Israeli T, Preisler L, Kalma Y, Samara N, Levi S, Groutz A, Azem F, Amir H. Similar fertilization rates and preimplantation embryo development among testosterone-treated transgender men and cisgender women. Reprod Biomed Online 2022; 45:448-456. [DOI: 10.1016/j.rbmo.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
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12
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Lifshitz D, Yaish I, Wagner-Kolasko G, Greenman Y, Sofer Y, Alpern S, Groutz A, Azem F, Amir H. Transgender men's preferences when choosing obstetricians and gynecologists. Isr J Health Policy Res 2022; 11:12. [PMID: 35148780 PMCID: PMC8840634 DOI: 10.1186/s13584-022-00522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transgender men are a marginalized population with unique health care needs. However, their usage of health services is low because of considerable discrimination. A major factor in their avoidance is patient-provider interactions. METHODS This cross-sectional study included 102 transgender men who anonymously completed a 55-item questionnaire in clinic, between 10/2017 and 01/2019. In addition, 92 transgender women filled out the part about family physician's preferences. We examined which characteristics transgender men prefer in their obstetricians/gynecologists in order to promote their usage of healthcare services. RESULTS A small majority of the transgender men (54.1%) had no gender preference for their obstetrician/gynecologist, while 42.9% preferred a female obstetrician/gynecologist and 3.1% preferred a male obstetrician/gynecologist. Most transgender men with a same-gender preference preferred female obstetricians/gynecologists for both invasive procedures (e.g., pelvic examination, 97.4%) and non-invasive procedures (e.g., cesarean section, 60%). The reasons for preferences regarding invasive procedures were feeling comfortable, embarrassment and feeling that female obstetricians/gynecologists are gentler. Transgender men who preferred female obstetricians/gynecologists ranked ability (90.5%), sexual tolerance (92.9%) and gender identity tolerance (90.5%) as the top three desirable qualities of obstetricians/gynecologists, while the responders who did not prefer female ranked ability (94.6%), experience (92.9%) and knowledge (92.9%) as the top three qualities. Transgender men with female preferences considered female obstetricians/gynecologists to be more accepting of gender identity compared to the responders that did not prefer females (47.5% vs. 9.1%, P < .001).. CONCLUSION A small majority of the transgender men exhibited no gender preference when choosing an obstetrician/gynecologist, although 42.9% preferred females. The latter choice was associated with the assumption that female obstetricians/gynecologists are more tolerant towards their transgender men patients. Educating the medical staff about their special needs and establishing dedicated SGM centers staffed with high percentages of female healthcare providers are highly recommended.
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Affiliation(s)
- Dror Lifshitz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.
| | - Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Wagner-Kolasko
- Department of Family Medicine, Clalit Gan-Meir LGBT Clinic, Tel Aviv District, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Sofer
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Alpern
- Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Gold RS, Amir H, Baruch Y, Gordon D, Shimonov M, Groutz A. The Manchester operation - is it time for it to return to our surgical armamentarium in the twenty-first century? J OBSTET GYNAECOL 2022; 42:1419-1423. [PMID: 34985379 DOI: 10.1080/01443615.2021.1983785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We conducted a study to assess the efficacy and outcome results of Manchester operation for women with symptomatic elongation of uterine cervix between 2010 and 2020. Forty-five women were enrolled. Mean age was 54.2 ± 10.5 years, 57.5% were premenopausal. Mean follow up was 4.53 years. Most patients were pleased from the surgery: 29 (76.3%) very pleased and three (7.9%) quite pleased. There were four cases of late postoperative complications: hematometra, pyometra, vesicovaginal fistula and small bowel evisceration through the posterior vaginal fornix. All four cases required surgical interventions with complete recovery. Manchester operation is an effective procedure for symptomatic elongation of uterine cervix. The surgery is short, minimal blood loss and without significant intraoperative complications. However, it is not free of late postoperative complications and it is therefore important that the surgery will be carried out with a strict technique and by skilled surgeons who are capable to manage unique postoperative complications.Impact StatementWhat is already known on this subject? Elongation of the uterine cervix is a condition that has not been sufficiently studied. Up-to-date data regarding the efficacy and safety of the Manchester operation for patients with cervical elongation and normal pelvic support are scarce, as most previously published studies included mainly patients with uterine prolapse.What do the results of this study add? The present study presents the efficacy, complications and clinical outcomes of Manchester operation for women with elongation of the uterine cervix. Our results show that Manchester operation is safe, effective method for symptomatic uterine cervix elongation.What are the implications of these findings for clinical practice and/or further research? This suggests Manchester operation is an effective procedure for symptomatic uterine cervix elongation should be implemented more widely. It must be carried out with a strict technique by skilled surgeons capable to manage unique postoperative complications.
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Affiliation(s)
- Ronen S Gold
- Department of Obstetrics and Gynaecology, Urogynecology and Pelvic Floor Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Department of Obstetrics and Gynaecology, Urogynecology and Pelvic Floor Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Baruch
- Department of Obstetrics and Gynaecology, Urogynecology and Pelvic Floor Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Gordon
- Department of Obstetrics and Gynaecology, Urogynecology and Pelvic Floor Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Shimonov
- E. Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Asnat Groutz
- Department of Obstetrics and Gynaecology, Urogynecology and Pelvic Floor Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Barkai G, Amir H, Dulberg O, Itelman E, Gez G, Carmon T, Merhav L, Zigler S, Atamne A, Pinhasov O, Zimlichman E, Segal G. “Staying at Home”: A pivotal trial of telemedicine-based internal medicine hospitalization at a nursing home. Digit Health 2022; 8:20552076221125958. [PMID: 36133002 PMCID: PMC9483959 DOI: 10.1177/20552076221125958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background In-hospital stay of acutely ill elderlies could be reduced by increasing the
availability of community-based hospitalizations. The feasibility of
remotely managing these patients by specialized internists, without leaving
their nursing homes should be sought. In the current pivotal study, we aimed
to evaluate the aforementioned model. Methods This was a prospective, open-label study at a tertiary medical center and a
nursing home. The study aimed at comparing clinical outcomes of patients
hospitalized in each location. Results Over a period of 5.5 months, we recruited 18 patients designated for
hospitalization, meeting our inclusion criteria to either in-hospital stay
or staying in their nursing home and treated by means of telemedicine from
our tertiary medical center. The mean age was 85.3 years. Out of 114
hospitalization days, 44 days (48%) were at the nursing home. No significant
difference was noted in terms of age, gender, and length of stay between the
patients who were hospitalized in either location. In almost all cases,
diagnosis changed during hospitalization. Three patients died during the
study, all included in the in-hospital group. No safety breaching events
happened in the nursing home-hospitalization group. Conclusions Remote, telemedicine-based hospitalization of nursing home-dwelling elderlies
is safe and feasible, potentially reducing the length of in-hospital stay by
almost 50%. Larger studies in this realm are warranted.
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Affiliation(s)
- G Barkai
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
| | - H Amir
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
| | - O. Dulberg
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - E Itelman
- Sackler faculty of medicine, Tel Aviv university, Internal Medicine “I”, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - G Gez
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - T Carmon
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - L Merhav
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - S Zigler
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - A Atamne
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - O Pinhasov
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - E Zimlichman
- Sackler faculty of medicine, Tel Aviv university, Management Wing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - G Segal
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv university, Internal Medicine “I”, Chaim Sheba Medical Center, Ramat Gan, Israel
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15
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Alpern S, Yaish I, Wagner-Kolasko G, Greenman Y, Sofer Y, Lifshitz DP, Groutz A, Azem F, Amir H. Why fertility preservation rates of transgender men are much lower than those of transgender women. Reprod Biomed Online 2022; 44:943-950. [DOI: 10.1016/j.rbmo.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/07/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
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16
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Yaish I, Tordjman K, Amir H, Malinger G, Salemnick Y, Shefer G, Serebro M, Azem F, Golani N, Sofer Y, Stern N, Greenman Y. Functional ovarian reserve in transgender men receiving testosterone therapy: evidence for preserved anti-Müllerian hormone and antral follicle count under prolonged treatment. Hum Reprod 2021; 36:2753-2760. [PMID: 34411251 DOI: 10.1093/humrep/deab169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/19/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is the functional ovarian reserve in transgender men affected by testosterone therapy? SUMMARY ANSWER Serum anti-Müllerian Hormone (AMH) levels slightly decrease during testosterone treatment but remain within the normal range, suggesting preserved follicular ovarian reserve. WHAT IS KNOWN ALREADY Few small studies have investigated the impact of gender-affirming treatment on reproduction in transgender men. Conflicting results were reached concerning ovarian morphology and AMH levels in this context. STUDY DESIGN, SIZE, DURATION The study consisted of two arms. The first arm was a prospective pilot study, which enrolled 56 transgender men (median age 22.5 [interquartile range (IQR)-19-27.7] years), 27 of whom had polycystic ovary syndrome (PCOS), prior to the initiation of gender-affirming testosterone therapy. A structured assessment was conducted prior to, and at 3 and 12 months after treatment initiation. The second arm was a cross-sectional study that comprised 47 transgender men (median age 24 [IQR-20-31] years) who received testosterone for a median duration of 35 [IQR 13-62] months. The main outcome measures were serum AMH and antral follicle count (AFC) as indices of ovarian follicular reserve. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was conducted at a tertiary center for transgender health. Gender-affirming therapy was administered according to standard practice. AFC was determined by pelvic (abdominal or transvaginal) ultrasound and blood collection for measurements of AMH, testosterone, estradiol, LH and FSH was performed at the designated time-points. MAIN RESULTS AND THE ROLE OF CHANCE Prospective arm for the entire group we observed a decrease of 0.71 ng/ml in AMH levels between baseline and 12 months (P = 0.01). When expressed in age-specific percentiles, AMH went from the 47.37th to the 40.25th percentile at 12 months (P < 0.001). In a sub-group analysis, a decline of 9.52 points in age-specific percentile was seen in subjects with PCOS (P < 0.001), while no changes were detected in the non-PCOS group. Testosterone treatment did not affect AFC over time in the entire cohort. In the sub-group analysis, a mean decrease of 5.0 follicles was detected between baseline and the 12 months assessment (P = 0.047) only in subjects with PCOS. In the cross-sectional study, AMH inversely correlated with age but not with treatment duration. Notably AMH did not deviate from the 50th age-specific percentile. Finally, four men fathered biological children after being under testosterone treatment for up to 12 years. LIMITATIONS, REASONS FOR CAUTION The limited sample size of the pilot study should be kept in mind. An additional limitation is the lack of a control group in the prospective study, as each participant served as his own control. Also, roughly 40% of the ultrasound examinations were performed transabdominally, potentially affecting the accuracy of the AFC measurements.As study participants were quite young, our reassuring data may not apply to older transgender men, either because of an age-related decline in ovarian reserve or to possible long-term effects of testosterone therapy. Furthermore, the chances for fertility preservation may be more limited in subjects with PCOS. WIDER IMPLICATIONS OF THE FINDINGS This is an additional contribution to the emerging evidence that prolonged testosterone treatment may not be a major obstacle to later fertility potential in transgender men desirous of having children. Larger confirmatory studies, and particularly more with reproductive outcome data, are needed for evidence-based fertility counseling prior to treatment initiation in these subjects. STUDY FUNDING/COMPETING INTEREST(S) This study received no funding. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- I Yaish
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Tordjman
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Amir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Lis Maternity Hospital, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - G Malinger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Lis Maternity Hospital, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - Y Salemnick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Lis Maternity Hospital, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - G Shefer
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Serebro
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - F Azem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Lis Maternity Hospital, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - N Golani
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - Y Sofer
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel
| | - N Stern
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Greenman
- Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Parikh R, Sorek E, Parikh S, Michael K, Bikovski L, Tshori S, Shefer G, Mingelgreen S, Zornitzki T, Knobler H, Chodick G, Mardamshina M, Boonman A, Kronfeld-Schor N, Bar-Joseph H, Ben-Yosef D, Amir H, Pavlovsky M, Matz H, Ben-Dov T, Golan T, Nizri E, Liber D, Liel Y, Brenner R, Gepner Y, Karnieli-Miller O, Hemi R, Shalgi R, Kimchi T, Percik R, Weller A, Levy C. Skin exposure to UVB light induces a skin-brain-gonad axis and sexual behavior. Cell Rep 2021; 36:109579. [PMID: 34433056 PMCID: PMC8411113 DOI: 10.1016/j.celrep.2021.109579] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/12/2021] [Accepted: 07/30/2021] [Indexed: 12/11/2022] Open
Abstract
Ultraviolet (UV) light affects endocrinological and behavioral aspects of sexuality via an unknown mechanism. Here we discover that ultraviolet B (UVB) exposure enhances the levels of sex-steroid hormones and sexual behavior, which are mediated by the skin. In female mice, UVB exposure increases hypothalamus-pituitary-gonadal axis hormone levels, resulting in larger ovaries; extends estrus days; and increases anti-Mullerian hormone (AMH) expression. UVB exposure also enhances the sexual responsiveness and attractiveness of females and male-female interactions. Conditional knockout of p53 specifically in skin keratinocytes abolishes the effects of UVB. Thus, UVB triggers a skin-brain-gonadal axis through skin p53 activation. In humans, solar exposure enhances romantic passion in both genders and aggressiveness in men, as seen in analysis of individual questionaries, and positively correlates with testosterone level. Our findings suggest opportunities for treatment of sex-steroid-related dysfunctions. UVB exposure increases circulating sex-steroid levels in mice and humans UVB exposure enhances female attractiveness and receptiveness toward males UVB exposure increases females’ estrus phase, HPG axis hormones, and follicle growth Skin p53 regulates UVB-induced sexual behavior and ovarian physiological changes
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Affiliation(s)
- Roma Parikh
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Eschar Sorek
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Shivang Parikh
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Keren Michael
- Department of Human Services, The Max Stern Yezreel Valley Academic College, Jezreel Valley 1930600, Israel
| | - Lior Bikovski
- The Myers Neuro-Behavioral Core Facility, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; School of Behavioral Sciences, Netanya Academic College, Netanya 4223587, Israel
| | - Sagi Tshori
- Research Authority, Kaplan Medical Center, Rehovot, Israel; Department of Biochemistry and Molecular Biology, Institute for Medical Research Israel-Canada, The Hebrew University, Jerusalem, Israel
| | - Galit Shefer
- Research Authority, Kaplan Medical Center, Rehovot, Israel
| | | | - Taiba Zornitzki
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem, Rehovot, Israel
| | - Hilla Knobler
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem, Rehovot, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel; Institute of Endocrinology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mariya Mardamshina
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Arjan Boonman
- School of Zoology, Faculty of Life Sciences and the Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Noga Kronfeld-Schor
- School of Zoology, Faculty of Life Sciences and the Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hadas Bar-Joseph
- The TMCR Unit, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Dalit Ben-Yosef
- IVF Lab & Wolfe PGD-Stem Cell Lab, Fertility Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cell Biology and Development, Sackler Faculty of Medicine & Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Fertility Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Pavlovsky
- Department of Dermatology, Tel Aviv Sourasky (Ichilov) Medical Center, Tel Aviv 6423906, Israel
| | - Hagit Matz
- Department of Dermatology, Tel Aviv Sourasky (Ichilov) Medical Center, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tom Ben-Dov
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; Department of Otolaryngology, Head and Neck surgery, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Tamar Golan
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Eran Nizri
- Department of Dermatology, Tel Aviv Sourasky (Ichilov) Medical Center, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Daphna Liber
- Faculty of Humanities, Education and Social Sciences, Ono Academic College, Kiryat Ono, Israel
| | - Yair Liel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ronen Brenner
- Institute of Pathology, E. Wolfson Medical Center, Holon 58100, Israel
| | - Yftach Gepner
- School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv 69978, Israel
| | - Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Rina Hemi
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Ruth Shalgi
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tali Kimchi
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Ruth Percik
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; Institute of Endocrinology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Aron Weller
- Department of Psychology and the Gonda Brain Research Center, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Carmit Levy
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
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18
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Amir H, Perl L, Barda S, Lantsberg D, Sege. Becker A, Israeli G, Azem F, Oren A. P–441 Semen quality and cryopreservation in adolescent transgender females. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What are the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment?
Summary answer
Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI).
What is known already
The age of individuals seeking treatment for gender affirmation has fallen sharply in recent years and many of them are adolescents. Estrogen, the primary treatment for transgender women, is known to impair semen quality and fertility potential. Sperm cryopreservation enables young transgender females to circumvent GAH therapy-related fertility impairment and have genetically related children. There are recent data on semen quality among adult transgender women who preserve fertility before exposure to GAH therapy, but little is known about pubertal transgender female adolescents.
Study design, size, duration
This retrospective cohort study included 26 adolescent transgender females who underwent FP between June 2013 and October 2020.
Participants/materials, setting, methods
Before initiating gonadotropin-releasing hormone agonists solely or with GAH treatment, 25 adolescent transgender females were referred to FP in our Fertility Institute of a tertiary university-affiliated medical center. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of selected medical and lifestyle factors on the semen quality of our study participants.
Main results and the role of chance
The mean age at which adolescent transgender females underwent sperm cryopreservation was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data on semen quality in the general population of unscreened men, including volume (1.46 ml vs 3.2 ml, respectively, P = 0.001 ), sperm concertation (28*106/ml vs 64*106/ml, P < 0.001), total sperm number (28.2*106 vs 196*106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17*106 per vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. Attention-deficit/hyperactivity disorder (ADHD) diagnosis, history of depression/anxiety, medication for ADHD, and antidepressant drugs were found to correlate with hypospermia. No correlation was found between the time of FP, body mass index, autistic spectrum disorder diagnosis, cannabis use, testis tucking, or the levels of follicle-stimulating hormone, estradiol, and testosterone on the semen parameters.
Limitations, reasons for caution
Because no normal values of semen in adolescents are available and the absence of a matched control group, we used WHO 2010 semen data as reference values, and they may not be representative of the adolescent population.
Wider implications of the findings: Although adolescent transgender females have poor semen quality and limited stored semen samples suitable for advanced ART interventions, even before starting GAH therapy, we highly recommend sperm cryopreservation before initiating GAH treatment and thereby prevent further impairment of sperm quality associated with the hormonal treatment.
Trial registration number
Not applicable
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Affiliation(s)
- H Amir
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Racine IVF Unit- Fertility Institute- Lis Maternity Hospital, Tel Aviv, Israel
| | - L Perl
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Endocrinology and Diabetes Unit- Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - S Barda
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Racine IVF Unit- Fertility Institute- Lis Maternity Hospital, Tel Aviv, Israel
| | - D Lantsberg
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Racine IVF Unit- Fertility Institute- Lis Maternity Hospital, Tel Aviv, Israel
| | - A Sege. Becker
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Endocrinology and Diabetes Unit- Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - G Israeli
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Endocrinology and Diabetes Unit- Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - F Azem
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Racine IVF Unit- Fertility Institute- Lis Maternity Hospital, Tel Aviv, Israel
| | - A Oren
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Endocrinology and Diabetes Unit- Dana-Dwek Children’s Hospital, Tel Aviv, Israel
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19
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Gold RS, Baruch Y, Amir H, Gordon D, Groutz A. A tailored flexible vaginal pessary treatment for pelvic organ prolapse in older women. J Am Geriatr Soc 2021; 69:2518-2523. [PMID: 33979457 DOI: 10.1111/jgs.17223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To present a flexible protocol of vaginal pessaries for older women with significant pelvic organ prolapse (POP). DESIGN A prospective cohort study of 140 consecutive older women (aged ≥65 years) with significant POP treated with individually fitted vaginal pessaries. After initial insertion, each patient was invited for a first evaluation after 1 month and subsequent follow-ups at increasing intervals of 1 month. During each examination, the pessary was removed and the vagina was inspected for infection, bleeding, or erosions. All patients were advised to use a vaginal estrogen cream twice a week. SETTING The study was conducted during 2020 in the urogynecology clinic of a tertiary medical center. PARTICIPANTS The study cohort included 140 consecutive older women with significant and symptomatic POP treated with vaginal pessaries. MAIN OUTCOME Primary outcomes included time intervals between follow-up visits, pessary-associated complications, need to change the pessary, need to remove the pessary temporarily, and whether the patients eventually underwent POP surgery. RESULTS The mean age of the patients at the time of pessary fitting was 76.7 ± 9.2 years (range 65-100 years). Mean interval between follow-up examinations was 3.3 ± 1.1 months (range 1-6 months). Most patients (83.6%) used a ring pessary with support, but only a small number of patients were able to maintain the pessary by themselves. Of the 140 patients, five (3.6%) patients only eventually underwent POP surgery, and in 11 (7.9%) patients, the vaginal pessary had to be removed for 2-4 weeks because of significant vaginal discharge or superficial erosions. Additionally, 12 (8.6%) patients developed stress urinary incontinence following pessary insertion. CONCLUSIONS Customized management with vaginal pessary for symptomatic POP in older women is effective and safe, and is a suitable therapeutic alternative for older women who are unable or unwilling to undergo reconstructive pelvic surgery.
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Affiliation(s)
- Ronen S Gold
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Baruch
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Gordon
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Bayerl J, Ayyash M, Shani T, Manor YS, Gafni O, Massarwa R, Kalma Y, Aguilera-Castrejon A, Zerbib M, Amir H, Sheban D, Geula S, Mor N, Weinberger L, Naveh Tassa S, Krupalnik V, Oldak B, Livnat N, Tarazi S, Tawil S, Wildschutz E, Ashouokhi S, Lasman L, Rotter V, Hanna S, Ben-Yosef D, Novershtern N, Viukov S, Hanna JH. Principles of signaling pathway modulation for enhancing human naive pluripotency induction. Cell Stem Cell 2021; 28:1549-1565.e12. [PMID: 33915080 PMCID: PMC8423434 DOI: 10.1016/j.stem.2021.04.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/05/2021] [Accepted: 03/31/2021] [Indexed: 12/21/2022]
Abstract
Isolating human MEK/ERK signaling-independent pluripotent stem cells (PSCs) with naive pluripotency characteristics while maintaining differentiation competence and (epi)genetic integrity remains challenging. Here, we engineer reporter systems that allow the screening for defined conditions that induce molecular and functional features of human naive pluripotency. Synergistic inhibition of WNT/β-CATENIN, protein kinase C (PKC), and SRC signaling consolidates the induction of teratoma-competent naive human PSCs, with the capacity to differentiate into trophoblast stem cells (TSCs) and extraembryonic naive endodermal (nEND) cells in vitro. Divergent signaling and transcriptional requirements for boosting naive pluripotency were found between mouse and human. P53 depletion in naive hPSCs increased their contribution to mouse-human cross-species chimeric embryos upon priming and differentiation. Finally, MEK/ERK inhibition can be substituted with the inhibition of NOTCH/RBPj, which induces alternative naive-like hPSCs with a diminished risk for deleterious global DNA hypomethylation. Our findings set a framework for defining the signaling foundations of human naive pluripotency. Inhibition of SRC, PKC, and WNT consolidates human naive pluripotency induction Competitiveness of p53 depleted human PSCs in cross-species chimeric embryos Opposing net effect for ACTIVIN and WNT on mouse versus human naive pluripotency 2i and ERKi independent alternative human naive-like PSC conditions
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Affiliation(s)
- Jonathan Bayerl
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel.
| | - Muneef Ayyash
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Tom Shani
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Yair Shlomo Manor
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Ohad Gafni
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Rada Massarwa
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Yael Kalma
- Wolfe PGD‑Stem Cell Laboratory, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel‑Aviv, Israel
| | | | - Mirie Zerbib
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Hadar Amir
- Wolfe PGD‑Stem Cell Laboratory, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel‑Aviv, Israel
| | - Daoud Sheban
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Shay Geula
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Nofar Mor
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Leehee Weinberger
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Segev Naveh Tassa
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Vladislav Krupalnik
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Bernardo Oldak
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Nir Livnat
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Shadi Tarazi
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Shadi Tawil
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Emilie Wildschutz
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Shahd Ashouokhi
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Lior Lasman
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Varda Rotter
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Suhair Hanna
- Department of Pediatrics, Rambam Hospital, Haifa, Israel
| | - Dalit Ben-Yosef
- Wolfe PGD‑Stem Cell Laboratory, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel‑Aviv, Israel.
| | - Noa Novershtern
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel.
| | - Sergey Viukov
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Jacob H Hanna
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 7610001, Israel.
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21
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Amir H, Perl L, Barda S, Lantsberg D, Becker AS, Israeli G, Azem F, Oren A. Adolescent Transgender Females Present Impaired Semen Quality That Is Suitable for Intracytoplasmic Sperm Injection Even Before Initiating Gender-Affirming Hormone Treatment. Reprod Sci 2021; 29:260-269. [PMID: 33788173 DOI: 10.1007/s43032-021-00561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The present study aimed to determine the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment. This retrospective cohort study included 26 adolescent transgender females who underwent FP in our Fertility Institute between 06/2013 and 10/2020. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine the adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of medical and lifestyle factors on semen quality. The mean age at which adolescent transgender females underwent FP was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data, including volume (1.46 mL vs 3.2 mL, respectively, P = 0.001 ), sperm concentration (28 × 106/mL vs 64 × 106/mL, P < 0.001), total sperm number (28.2 × 106 vs 196 × 106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17 × 106/vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. No correlation was found between selected medical and lifestyle factors and poor semen parameters. Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI) rather than conventional IVF/intrauterine insemination (IUI).
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liat Perl
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimi Barda
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Raz A, Vardi J, Reisner Vain S, Meiri A, Barkan G, Azem F, Amir H. Unmet communication needs and moral work in the disposition decision concerning surplus frozen embryos: The perspectives of IVF users. Soc Sci Med 2021; 274:113804. [PMID: 33677202 DOI: 10.1016/j.socscimed.2021.113804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
The disposition decision is a frequently unresolved issue for many IVF users with surplus frozen embryos (SFEs), and this study draws attention to their experiences and moral work, locating it in the Jewish-Israeli context that legally enables the donation of SFEs to research but prohibits donation to other infertile people. To explore the (mis)understandings and (mis)communication underlying IVF users' decisions concerning the fate of their SFEs, the records of 674 IVF users with SFEs stored for more than 5 years during 1996-2011 were analyzed, and 89 IVF users with different disposition decisions were recruited for semi-structured interviews. With an average of 5.1 SFEs, after an average of 8 years of storage, no response to a written request for a disposition decision came from 60% (n = 404) of IVF users with SFEs. Payment for storage and defrosting were the two most frequent choices (13%, n = 89 and 89, respectively) followed by donation to research and transfer (7%, n = 47 and 45, respectively). Three themes emerged from the interviews: misunderstanding the consequences of not returning the disposition form, communication gaps regarding donation to research, and the unmet wish to donate embryos to infertile people. We conclude by discussing the experiences and views of IVF users as reflecting the implications of the liminality and boundary-work surrounding the frozen embryo as a moral work object, and their consequences for policy recommendations.
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Affiliation(s)
- Aviad Raz
- Dept. of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel.
| | - Jasmine Vardi
- Dept. of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | - Shelly Reisner Vain
- Dept. of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | - Amir Meiri
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 6423906, Israel
| | - Gali Barkan
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 6423906, Israel
| | - Foad Azem
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 6423906, Israel
| | - Hadar Amir
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 6423906, Israel
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23
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Barkai G, Gadot M, Amir H, Menashe M, Shvimer-Rothschild L, Zimlichman E. Patient and clinician experience with a rapidly implemented large-scale video consultation program during COVID-19. Int J Qual Health Care 2021; 33:6033552. [PMID: 33313891 PMCID: PMC7799005 DOI: 10.1093/intqhc/mzaa165] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/14/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has forced health-care providers to find creative ways to allow continuity of care in times of lockdown. Telemedicine enables provision of care when in-person visits are not possible. Sheba Medical Center made a rapid transition of outpatient clinics to video consultations (VC) during the first wave of COVID-19 in Israel. OBJECTIVE Results of a survey of patient and clinician user experience with VC are reported. METHODS Satisfaction surveys were sent by text messages to patients, clinicians who practice VC (users) and clinicians who do not practice VC (non-users). Questions referred to general satisfaction, ease of use, technical issues and medical and communication quality. Questions and scales were based on surveys used regularly in outpatient clinics of Sheba Medical Center. RESULTS More than 1200 clinicians (physicians, psychologists, nurses, social workers, dietitians, speech therapists, genetic consultants and others) provided VC during the study period. Five hundred and forty patients, 162 clinicians who were users and 50 clinicians who were non-users completed the survey. High level of satisfaction was reported by 89.8% of patients and 37.7% of clinician users. Technical problems were experienced by 21% of patients and 80% of clinician users. Almost 70% of patients but only 23.5% of clinicians found the platform very simple to use. Over 90% of patients were very satisfied with clinician's courtesy, expressed a high sense of trust, thought that clinician's explanations and recommendations were clear and estimated that the clinician understood their problems and 86.5% of them would recommend VC to family and friends. Eighty-seven percent of clinician users recognize the benefit of VC for patients during the COVID-19 pandemic but only 68% supported continuation of the service after the pandemic. CONCLUSION Our study reports high levels of patient satisfaction from outpatient clinics VC during the COVID-19 pandemic. Lower levels of clinician satisfaction can mostly be attributed to technical and administrative challenges related to the newly implemented telemedicine platform. Our findings support the continued future use of VC as a means of providing patient-centered care. Future steps need to be taken to continuously improve the clinical and administrative application of telemedicine services.
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Affiliation(s)
- Galia Barkai
- Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Moran Gadot
- Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel.,Oncology Center, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Hadar Amir
- Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,The Graduate School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Menashe
- Human Experience Unit, Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | | | - Eyal Zimlichman
- Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
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24
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Gold RS, Amir H, Groutz A. Late Spontaneous Bowel Evisceration through the Vaginal Vault after Vaginal Hysterectomy. Isr Med Assoc J 2021; 23:126-127. [PMID: 33595221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ronen S Gold
- Department of Urogynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Department of Urogynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Department of Urogynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Groutz A, Gold R, Gordon D, Azem F, Shimonov M, Amir H. Author Reply. Urology 2021; 149:265-266. [PMID: 33453197 DOI: 10.1016/j.urology.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Asnat Groutz
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Ronen Gold
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - David Gordon
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Foad Azem
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mordechai Shimonov
- E. Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Hadar Amir
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Amir H, Oren A, Klochendler Frishman E, Sapir O, Shufaro Y, Segev Becker A, Azem F, Ben-Haroush A. Oocyte retrieval outcomes among adolescent transgender males. J Assist Reprod Genet 2020; 37:1737-1744. [PMID: 32430731 DOI: 10.1007/s10815-020-01815-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare fertility preservation (FP) outcomes among adolescent transgender males with those of cisgender females. METHODS This retrospective cohort study included nine adolescent transgender males and 39 adolescent cisgender females who underwent FP between January 2017-April 2019 and September 2013-April 2019, respectively. The transgender males were referred before initiating testosterone, and the cisgender females were referred due to cancer diagnosis before starting anticancer treatment. Statistical analyses compared assisted reproductive technology (ART) data and FP outcomes between two groups. RESULTS Basal FSH levels (5.4 ± 1.7 mIU/mL) and AFC (19.8 ± 5.6) of all transgender males were normal compared with standard references. The mean age of transgender males and cisgender females was similar (16.4 ± 1.1 vs 15.5 ± 1.3 years, respectively, P = 0.064). The amount of FSH used for stimulation was significantly lower among the former compared with the latter (2416 ± 1041 IU vs 4372 ± 1877 IU, P < 0.001), but the duration of stimulation was similar (12.6 ± 4.0 and 10.1 ± 2.8 days, P = 0.086). Peak estradiol level was significantly higher among transgender males compared with cisgender females (3073 ± 2637 pg/mL vs 1269 ± 975 pg/mL, respectively, P = 0.018), but there were no significant differences in number of retrieved oocytes between the two groups (30.6 ± 12.8 vs 22 ± 13.2, P = 0.091), number of MII oocytes (25.6 ± 12.9 vs 18.8 ± 11.2, P = 0.134), or maturity rates (81.5 ± 10.0% vs 85.4 ± 14.6%, P = 0.261). CONCLUSIONS Adolescent transgender males have an excellent response to ovulation stimulation before initiating testosterone treatment. Oocyte cryopreservation is, therefore, a feasible and effective way for them to preserve their fertility for future biological parenting.
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emilie Klochendler Frishman
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Amir H, Yaish I, Oren A, Groutz A, Greenman Y, Azem F. Fertility preservation rates among transgender women compared with transgender men receiving comprehensive fertility counselling. Reprod Biomed Online 2020; 41:546-554. [PMID: 32651108 DOI: 10.1016/j.rbmo.2020.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION What is the fertility preservation rate among transgender women who have received professional fertility counselling compared with transgender men? DESIGN This retrospective cohort study included 56 transgender women and 56 transgender men referred for comprehensive fertility counselling at the Gender Clinic of the Tel Aviv Sourasky Medical Center's Fertility Institute between January 2017 and April 2019. Statistical analyses were performed to compare transgender men with transgender women who preserved fertility and transgender people who preserved fertility and those that did not. RESULTS The fertility preservation rate of transgender women was significantly higher than that of transgender men (85.7% versus 35.7%, respectively, P < 0.001). The fertility preservation rate among transgender women was associated with being older and not having undergone gender-affirming hormone (GAH) treatment. The fertility preservation rate was higher among adolescent transgender boys compared with adolescent transgender girls (35% versus 6.25%, respectively, P = 0.005). The duration of GAH treatment among the transgender men who preserved fertility was 70 months compared with 18.6 months for transgender women (P = 0.05). All transgender boys opted for oocyte cryopreservation, while half of the transgender men who had not started GAH opted for oocyte cryopreservation, and half of those who had already started on GAH opted for embryo cryopreservation. CONCLUSIONS High fertility preservation rates among transgender individuals were found after comprehensive fertility counselling. Fertility preservation rates among adults were higher among transgender women compared with transgender men, while the opposite was found in transgender adolescents.
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Groutz A, Gordon D, Shimonov M, Amir H. Do women with pelvic floor disorders prefer to be treated by female urogynecologists? Health Care Women Int 2019; 41:543-552. [PMID: 31242069 DOI: 10.1080/07399332.2019.1623798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The researchers' aim was to assess provider gender preference among women attending the urogynecology clinic. Two hundred women with pelvic floor disorders completed a detailed questionnaire regarding possible gender preferences in choosing their urogynecologist. One-third of women preferred a female doctor while two-thirds had no preference. We found that embarrassment during the pelvic examination was the main reason for same-gender preference. This preference was significantly associated with educational level and being religious. In conclusion, although one-third of female patients prefer female urogynecologists, professional skills are considered to be more important factors when it comes to actually make a choice.
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Affiliation(s)
- Asnat Groutz
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Gordon
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Shimonov
- E. Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yaish I, Malinger G, Foad A, Golani N, Yael S, Tordjman K, Amir H, Greenman Y, Stern N. OR11-3 Evidence for Preserved Ovarian Reserve in Transgender Men Receiving Testosterone Therapy: Anti-Mullerian Hormone Serum Levels Decrease Modestly after One Year of Treatment. J Endocr Soc 2019. [PMCID: PMC6555034 DOI: 10.1210/js.2019-or11-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Although successful pregnancies carried by transgender men have been reported, long-term effects of testosterone therapy on fertility remain unknown. Aims: To study markers of ovarian reserve during testosterone therapy. Methods: Prospective open-label study of transgender men prior and during treatment with testosterone. Sampling was conducted at baseline and 12 months after treatment initiation. Main outcome measures: Anti-Mullerian Hormone (AMH), gonadotropins and sex steroid serum levels; endometrial thickness and antral follicular count determined by pelvic US. Results: 52 subjects (23.4±6.1 y) were recruited, 32% of which were in a stable relationship. 17% expressed desire to have children while 26 (50%) were unsure about future parenthood. Four (7%) have already undergone fertility preservation procedures. Interestingly, 5 participants (9%) that initially were sexually attracted to women became bisexual under testosterone treatment. Complete data is available for 32 subjects. In the course of 12 months of treatment, AMH levels decreased from 5.65±0.52ng/ml at baseline to 4.89±0.65 ng/ml (p=0.036). Antral follicular count (16.9±1.4, 13.9±1.7) and endometrial thickness (6.9±0.7, 5.6±0.5 mm) remained unchanged. As expected, testosterone levels increased (0.84±0.1, 7 ±0.7 nmol/l; p<0.0001) and estradiol levels decreased (90.8±7.9, 55.4±4.6 pmol/l; p=0.0013) during therapy, with a concomitant decrease in LH (7.56±0.7, 3.8±0.6 mIU/ml; p=0.0012), but not FSH (5.1±0.41, 4±0.3; p=0.07 mIU/ml) levels. Conclusion: AMH levels slightly decrease during testosterone treatment but remain within the normal, "healthy" range, thus likely indicating well-preserved ovarian reserve. This assumption is corroborated by the unchanged antral follicular count. The significance of these findings on fertility potential remains to be explored. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.
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Affiliation(s)
- Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, , Israel
| | - Gustavo Malinger
- Lis Maternity Hospital, Tel Aviv-Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, , Israel
| | - Azem Foad
- Lis Maternity Hospital, Tel Aviv-Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, , Israel
| | - Nechama Golani
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, , Israel
| | - Sofer Yael
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, , Israel
| | - Karen Tordjman
- Inst of Endo, Metab and Hypert, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, , Israel
| | - Hadar Amir
- Lis Maternity Hospital, Tel Aviv-Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, , Israel
| | - Yona Greenman
- Inst of Endo, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, , Israel
| | - Naftali Stern
- Inst of Endo, Metab and Hypertension, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, , Israel
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Kalma Y, Bar-El L, Asaf-Tisser S, Malcov M, Reches A, Hasson J, Amir H, Azem F, Ben-Yosef D. Optimal timing for blastomere biopsy of 8-cell embryos for preimplantation genetic diagnosis. Hum Reprod 2019; 33:32-38. [PMID: 29165686 DOI: 10.1093/humrep/dex343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 11/16/2017] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION What is the optimal timing for blastomere biopsy during the 8-cell stage, at which embryos will have the best implantation potential? SUMMARY ANSWER Fast-cleaving embryos that are biopsied during the last quarter (Q4) of the 8-cell stage and are less affected by the biopsy procedure, and their implantation potential is better than that of embryos biopsied earlier during the 8-cell stage (Q1-Q3). WHAT IS KNOWN ALREADY Blastomer biopsy from cleavage-stage embryos is usually performed on the morning of Day 3 when the embryos are at the 6- to 8-cell stage and is still the preferred biopsy method for preimplantation genetic diagnosis (PGD) for monogentic disorders or chromosomal translocations. Human embryos usually remain at the 8-cell stage for a relatively long 'arrest phase' in which cells grow, duplicate their DNA and synthesize various proteins in preparation for the subsequent division. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort study. The study group (195 embryos) included all 8-cell stage embryos that underwent blastomere biopsy for PGD for monogenetic disorders and chromosomal translocations in our unit between 2012-2014 and cultured in the EmbryoScope until transfer. The control group (115 embryos) included all embryos that underwent intracytoplasmic sperm injection without a biopsy during the same period. PARTICIPANTS/MATERIALS, SETTING, METHODS The 8-cell stage was divided into four quarters: the first 5 h post-t8 (Q1), 5-10 h post-t8 (Q2), 10-15 h post-t8 (Q3) and at 15-20 h post-t8 (Q4). Non-biopsied control embryos were divided into four equivalent quarters. Embryos were evaluated for timing of developmental events following biopsy including timing of first cleavge after biopsy, timing of comapction (tM) and start of blastulation (tSB). Timing of these events were compared between PGD and control embryos, as well as with 56 PGD implanted embryos with Known Implantation Data (PGD-KID-positive embryos). MAIN RESULTS AND THE ROLE OF CHANCE Embryos that were biopsied during Q3 (10-15 h from entry into 8-cell stage) were delayed in all three subsequent developmental events, including first cleavage after biopsy, compaction and start of blastulation. In contrast, these events occurred exactly at the same time as in the control group, in embryos that were biopsied during Q1, Q2 or Q4 of the 8-cell stage. The results show also that embryos that were biopsied during Q1, Q2 or Q3 of the 8-cell stage demonstrated a significant delay from the biopsied implanted embryos already in t8 as well as in tM and tSB. However, embryos that were biopsied during Q4 demonstrated dynamics similar to those of the biopsied implanted embryos in t8 and tM, and a delay was noticed only in the last stage of tSB. LIMITATIONS, REASONS FOR CAUTION This is a retrospective study that is limited to the timing of biopsy that is routinely performed in the IVF lab. A prospective study in which biopsy will be performed at a desired timing is needed in order to differ between the effect of biopsy itself and the cleavage rate of the embryo. WIDER IMPLICATIONS OF THE FINDINGS Our findings showed that blastomere biopsy can be less harmful to further development if it is carried out during a critical period of embryonic growth, i.e during Q4 of the 8-cell stage. They also demonstrated the added value of time-lapse microscopy for determining the optimal timing for blastomere biopsy. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the routine budget of our IVF unit. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Y Kalma
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel
| | - L Bar-El
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel
| | - S Asaf-Tisser
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel
| | - M Malcov
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel
| | - A Reches
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel
| | - J Hasson
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel
| | - H Amir
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel
| | - F Azem
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel
| | - D Ben-Yosef
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv, Israel.,Department of Cell Biology and Development, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Amir H, Barbash-Hazan S, Kalma Y, Frumkin T, Malcov M, Samara N, Hasson J, Reches A, Azem F, Ben-Yosef D. Time-lapse imaging reveals delayed development of embryos carrying unbalanced chromosomal translocations. J Assist Reprod Genet 2018; 36:315-324. [PMID: 30421343 DOI: 10.1007/s10815-018-1361-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of the study was to compare the morphokinetic parameters of embryos carrying balanced chromosomal translocations with those carrying unbalanced chromosomal translocations using time-lapse microscopy. METHODS The study group included 270 embryos that underwent biopsies on day 3 for preimplantation genetic diagnosis (PGD) for chromosomal translocations in our unit between 2013 and 2015. All embryos were incubated under time-lapse microscopy and evaluated for timing of developmental events up to day 5. The timing of these events was compared between balanced and unbalanced embryos, potentially viable and nonviable variants, and maternal versus paternal inheritance of the translocation. RESULTS The PGD analysis found that 209 (77%) of the 270 biopsied embryos carried an unbalanced translocation. Embryos carrying unbalanced translocations, which are expected to lead to implantation failure or miscarriage, cleaved less synchronously and were delayed in time of cleavage to the 4-cell stage (t4) and in time of start of blastulation (tSB) compared with balanced embryos (P < 0.05). Furthermore, embryos carrying nonviable translocations demonstrated a significant delay at the time of pronuclei fading (tPNf) compared with those carrying potentially viable translocations (P < 0.05). Embryos whose unbalanced translocations were of maternal origin were significantly delayed in most of the morphokinetic parameters (including tPNf, t2, t3, t4, t6, t7, t8, cc2, s2, and tSB) compared with embryos carrying balanced translocations (P < 0.05). CONCLUSIONS Embryos carrying unbalanced chromosomal translocations mainly of maternal origin undergo delayed development and asynchronous cleavage that may lead to implantation failure or miscarriage.
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Affiliation(s)
- Hadar Amir
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Shiri Barbash-Hazan
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Yael Kalma
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Tsvia Frumkin
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Mira Malcov
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Nivin Samara
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Joseph Hasson
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Adi Reches
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Foad Azem
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Dalit Ben-Yosef
- IVF Lab & Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel. .,Department of Cell Biology and Development, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Leshem A, Groutz A, Amir H, Gordon D, Shimonov M. Surgically induced weight loss results in a rapid and consistent improvement of female pelvic floor symptoms. Scand J Urol 2018. [DOI: 10.1080/21681805.2018.1447600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Avner Leshem
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Lis Maternity and Women's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Lis Maternity and Women's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Lis Maternity and Women's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - David Gordon
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Lis Maternity and Women's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Shimonov
- E. Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Amir H, Hazan SB, Kalma Y, Cohen T, Frumkin T, Malcov M, Reches A, Hasson J, Azem F, Ben-Yosef D. Time-lapse imaging reveals delayed development of embryos carrying unbalanced chromosomal translocations. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hasson J, Limoni D, Malcov M, Frumkin T, Amir H, Shavit T, Bay B, Many A, Almog B. Obstetric and neonatal outcomes of pregnancies conceived after preimplantation genetic diagnosis: cohort study and meta-analysis. Reprod Biomed Online 2017; 35:208-218. [DOI: 10.1016/j.rbmo.2017.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
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Leshem A, Shimonov M, Amir H, Gordon D, Groutz A. Effects of Bariatric Surgery on Female Pelvic Floor Disorders. Urology 2017; 105:42-47. [PMID: 28315786 DOI: 10.1016/j.urology.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/21/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the effect of weight loss on urinary incontinence (UI), pelvic organ prolapse, colorectal-anal complaints, and sexual dysfunction among obese women undergoing bariatric surgery. MATERIALS AND METHODS One hundred sixty consecutive women who underwent bariatric surgery were prospectively enrolled. Four validated questionnaires (International Consultation on Incontinence Questionnaire-UI [ICIQ-UI], Bristol Female Lower Urinary Tract Symptoms-SF [BFLUTS-SF], Pelvic Floor Distress Inventory-20 [PFDI-20], and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 [PISQ-12]) were used to evaluate pelvic floor disorders and sexual dysfunction before and 3-6 months after surgery. RESULTS One hundred fifty participants (mean age: 43 ± 12.8 years; mean preoperative body mass index: 42 ± 4.6 kg/m2) completed all pre- and postoperative questionnaires. Preoperatively, 56 (37.3%) women had UI, 44 (29.3%) women had pelvic organ prolapse symptoms, and 66 (44%) women had colorectal-anal symptoms. Overall, surgically induced weight loss was associated with statistically significant improvement in UI (mean ICIQ score: 9.3 ± 3.9 vs 3.3 ± 3.8, P <.001), pelvic organ prolapse symptoms (mean PFDI score: 19 ± 13.2 vs 11 ± 12.8, P <.001), and colorectal-anal symptoms (mean PFDI score: 21 ± 15.9 vs 14 ± 14.9, P = .004). Moreover, half of preoperatively incontinent women and more than one quarter of women who had either pelvic organ prolapse or colorectal-anal symptoms reported complete resolution of their symptoms. Statistically significant improvement in sexual function was suggested by both BFLUTS-SF (0.3 ± 0.8 vs 0.1 ± 0.6; P = .011) and PISQ-12 (37.9 ± 6.1 vs 39.5 ± 5; P = .003) questionnaires. CONCLUSION Surgically induced weight loss was associated with a significant improvement in pelvic floor disorders, including UI, pelvic organ prolapse, and colorectal-anal symptoms, as well as improved sexual performance.
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Affiliation(s)
- Avner Leshem
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Shimonov
- E. Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Amir
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Gordon
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Amir H, Touboul T, Sabatini K, Chhabra D, Garitaonandia I, Loring JF, Morey R, Laurent LC. Spontaneous Single-Copy Loss of TP53 in Human Embryonic Stem Cells Markedly Increases Cell Proliferation and Survival. Stem Cells 2017; 35:872-885. [PMID: 27888558 DOI: 10.1002/stem.2550] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 10/17/2016] [Accepted: 11/01/2016] [Indexed: 01/17/2023]
Abstract
Genomic aberrations have been identified in many human pluripotent stem cell (hPSC) cultures. Commonly observed duplications in portions of chromosomes 12p and 17q have been associated with increases in genetic instability and resistance to apoptosis, respectively. However, the phenotypic consequences related to sporadic mutations have not been evaluated to date. Here, we report on the effects of a single-copy deletion of the chr17p13.1 region, a sporadic mutation that spontaneously arose independently in several subclones of a human embryonic stem cell culture. Compared to cells with two normal copies of chr17p13.1 ("wild-type"), the cells with a single-copy deletion of this region ("mutant") displayed a selective advantage when exposed to stressful conditions, and retained a higher percentage of cells expressing the pluripotency marker POU5F1/OCT4 after 2 weeks of in vitro differentiation. Knockdown of TP53, which is a gene encompassed by the deleted region, in wild-type cells mimicked the chr17p13.1 deletion phenotype. Thus, sporadic mutations in hPSCs can have phenotypic effects that may impact their utility for clinical applications. Stem Cells 2017;35:872-885.
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Affiliation(s)
- Hadar Amir
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California, USA
| | - Thomas Touboul
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California, USA
| | - Karen Sabatini
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California, USA
| | - Divya Chhabra
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California, USA
| | - Ibon Garitaonandia
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, La Jolla, California, USA
| | - Jeanne F Loring
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, La Jolla, California, USA
| | - Robert Morey
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California, USA
| | - Louise C Laurent
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California, USA
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Abstract
Background Patient preferences regarding the gender of their physicians is a highly sensitive issue, which can be particularly salient in intimate medical situations. Previously published studies found that women tend to prefer female physicians, especially in the case of obstetricians and gynecologists. Data regarding other intimate specialties, such as breast surgery, are scarce. The present study was undertaken to assess gender preferences of women regarding their choice of a breast surgeon. Methods Five hundred and fifteen consecutive women who attended breast clinics in two university-affiliated tertiary hospitals were prospectively enrolled. A 25-item anonymous questionnaire was completed by women independently and used to assess their preferences in selecting their breast surgeon. Of the 515 women, 500 (97 % response rate; mean age 50.6 ± 15.4 years) completed the anonymous questionnaire. Results Overall, 160 (32 %) women preferred to undergo breast examination by a female breast surgeon, 296 (59 %) had no preference, and only 44 (9 %) preferred a male surgeon. A same-gender preference was significantly and independently associated with younger age of the patients (Odds Ratio = 0.978, 95 % Confidence Interval 0.962–0.994, P = 0.007) and being married (Odds Ratio = 0.563, 95 % Confidence Interval 0.347–0.916, P = 0.021). However, only small and equal numbers of patients preferred to undergo breast surgery by a female (14 %) or a male (13 %) surgeon, and most patients (73 %) had no gender preferences. Furthermore, the three most important factors, which affected in general the actual selection, were surgical ability (93 %), experience (91.2 %) and knowledge (78.6 %), rather than physician gender per se. Conclusions Overall, about a third of women prefer a female breast surgeon for their breast examination. Embarrassment during the examination was the major reason for same-gender preference. In contrast, when it comes to breast operations, preference for a female surgeon is less pronounced, with the professional skills of the surgeons becoming the predominant consideration. The fact that almost a third of the potential patients prefer female surgeons with regard to their breast examinations emphasizes the need to increase the number of female surgeons. Such an increase can be achieved through academic and economic changes that will enable more women to specialize in general surgery. Trial registration Trial registration is not required for this type of research.
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Affiliation(s)
- Asnat Groutz
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Hadar Amir
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Caspi
- The Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Eran Sharon
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Yifat Amir Levy
- Department of Medicine, University of California, La Jolla, San Diego, CA USA
| | - Mordechai Shimonov
- E. Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
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Raz A, Amer-Alshiek J, Goren-Margalit M, Jacobi G, Hochberg A, Amit A, Azem F, Amir H. Donation of surplus frozen pre-embryos to research in Israel: underlying motivations. Isr J Health Policy Res 2016; 5:25. [PMID: 27822357 PMCID: PMC5097401 DOI: 10.1186/s13584-016-0085-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background The high number of IVF procedures performed in Israel has had an unforeseen consequence: accumulation of large amounts of surplus frozen embryos. After five years that the frozen embryos are kept for free, patients need to make an embryo disposition decision. One option is donation for research. The donation rate in Israel is very low. Our aim was to understand the attitudes, values and perceptions of female IVF patients that decided to donate their surplus frozen embryos to research. Methods The study setting was a tertiary IVF unit which during the 2000–2009 period treated 241 patients who had their frozen pre-embryos stored for more than five years. The study population consists of the 12 patients (from among the 241) who had decided to donate their excess frozen pre-embryos to research. In-depth interviews were carried out with 8 of those 12 patients. Results IVF patients who donated their surplus frozen pre-embryos to research viewed the frozen embryo as a valuable resource that does not have human identity yet. The majority expressed a gradualist approach to the human status of the embryo as requiring successful implantation and development in the uterus. All the respondents chose donation to research not because it was their first choice but because they did not want or were unable to use the pre-embryos in the future, in addition to not willing to thaw them. For many of the respondents, donation to research was accompanied by a sense of uncertainty. All would have preferred to donate their pre-embryos to infertile women or couples, an option which is currently prohibited in Israel. Conclusions The moral reasoning behind decisions that patients make regarding excess pre-embryos is important for health care practitioners to consider when offering decision-making alternatives and counseling. For our respondents, the scarcity of donating excess frozen pre-embryos to research may reflect patients' preference for embryo donation to infertile couples. Recommended ways to increase donation to research may include public education and awareness, as well as targeted communication with IVF patients by multi-professional IVF unit teams comprised of a medical doctor and a professional trained in bioethics.
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Affiliation(s)
- Aviad Raz
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jonia Amer-Alshiek
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Mor Goren-Margalit
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Jacobi
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alyssa Hochberg
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Ami Amit
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Foad Azem
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Hadar Amir
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
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Bar-El L, Kalma Y, Malcov M, Schwartz T, Raviv S, Cohen T, Amir H, Cohen Y, Reches A, Amit A, Ben-Yosef D. Blastomere biopsy for PGD delays embryo compaction and blastulation: a time-lapse microscopic analysis. J Assist Reprod Genet 2016; 33:1449-1457. [PMID: 27696105 DOI: 10.1007/s10815-016-0813-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/14/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of the study was to explore the effect of blastomere biopsy for preimplantation genetic diagnosis (PGD) on the embryos' dynamics, further cleavage, development, and implantation. METHODS The study group included 366 embryos from all PGD treatments (September 2012 to June 2014) cultured in the EmbryoScope™ time-lapse monitoring system. The control group included all intracytoplasmic sperm injection (ICSI) embryos cultured in EmbryoScope™ until day 5 during the same time period (385 embryos). Time points of key embryonic events were analyzed with an EmbryoViewer™. RESULTS Most (88 %) of the embryos were biopsied at ≥8 cells. These results summarize the further dynamic development of the largest cohort of biopsied embryos and demonstrate that blastomere biopsy of cleavage-stage embryos significantly delayed compaction and blastulation compared to the control non-biopsied embryos. This delay in preimplanation developmental events also affected postimplantation development as observed when the dynamics of non-implanted embryos (known implantation data (KID) negative) were compared to those of implanted embryos (KID positive). CONCLUSION Analysis of morphokinetic parameters enabled us to explore how blastomere biopsy interferes with the dynamic sequence of developmental events. Our results show that biopsy delays the compaction and the blastulation of the embryos, leading to a decrease in implantation.
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Affiliation(s)
- Liron Bar-El
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Yael Kalma
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Mira Malcov
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Tamar Schwartz
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Shaul Raviv
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Tania Cohen
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Hadar Amir
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Yoni Cohen
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Adi Reches
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Ami Amit
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel
| | - Dalit Ben-Yosef
- IVF Lab and Wolfe PGD-Stem Cell Lab, Racine IVF Unit, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, Israel. .,Department of Cell Biology and Development, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Abstract
OBJECTIVE Pre-implantation genetic diagnosis (PGD) is required in order to screen and diagnose embryos of patients at risk of having a genetically affected offspring. A biopsy to diagnose the genetic profile of the embryo may be performed either before or after cryopreservation. The aim of this study was to determine which biopsy timing yields higher embryo survival rates. STUDY DESIGN Retrospective cohort study of all PGD patients in a public IVF unit between 2010 and 2013. Inclusion criteria were patients with good-quality embryos available for cryopreservation by the slow freezing method. Embryos were divided into two groups: biopsy before and biopsy after cryopreservation. The primary outcome was embryo survival rates post thawing. RESULTS Sixty-five patients met inclusion criteria. 145 embryos were biopsied before cryopreservation and 228 embryos were cryopreserved and biopsied after thawing. Embryo survival was significantly greater in the latter group (77% vs. 68%, p < 0.0001). CONCLUSION Cryopreservation preceding biopsy results in better embryo survival compared to biopsy before cryopreservation.
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Affiliation(s)
- S Shinar
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - N Kornecki
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - T Schwartz
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - N Mey-Raz
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - H Amir
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - B Almog
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
| | - T Shavit
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
- c IVF Unit, Hillel Yaffe Medical Center , Hedera , Israel
| | - J Hasson
- a The Sarah Racine IVF Unit, Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
- b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel , and
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Amir H, Sabatini K, Chhabra D, Morey R, Laurent L. Spontaneous single-copy loss of TP53 in human embryonic stem cells markedly increases cell proliferation and survival. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
There are several studies on patients' preference for same-gender physicians, especially female preference for same-gender gynecologists. Data regarding the preferences of urology patients, of whom the majority are males, are scarce. The objective of this study is to assess provider gender preference among urology patients. One hundred and nineteen consecutive men (mean age 57.6 years) who attended a urology clinic in one university-affiliated medical center were prospectively enrolled. A self-accomplished 26-item anonymous questionnaire was used to assess patients' preferences in selecting their urologist. Of the 119 patients, 51 (42.8%) preferred a male urologist. Patients exhibited more same-gender preference for physical examination (38.3%), or urological surgery (35.3%), than for consultation (24.4%). Most patients (97%) preferred a same-gender urologist because they felt less embarrassed. Four patient characteristics were identified to be significantly associated with preference for a male urologist: religious status, country of origin, marital status, and a prior management by a male urologist. Of these, religious status was the most predictive parameter for choosing a male urologist. The three most important factors that affected actual selection, however, were professional skills (84.6%), clinical experience (72.4%), and medical knowledge (61%), rather than physician gender per se. Many male patients express gender bias regarding their preference for urologist. However, professional skills of the clinician are considered to be more important factors when it comes to actually making a choice.
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Affiliation(s)
- Hadar Amir
- 1 Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Beri
- 1 Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Yechiely
- 1 Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Amir Levy
- 1 Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Asnat Groutz
- 1 Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bordez L, Jourand P, Ducousso M, Carriconde F, Cavaloc Y, Santini S, Claverie JM, Wantiez L, Leveau A, Amir H. Distribution patterns of microbial communities in ultramafic landscape: a metagenetic approach highlights the strong relationships between diversity and environmental traits. Mol Ecol 2016; 25:2258-72. [PMID: 26994404 DOI: 10.1111/mec.13621] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 02/25/2016] [Accepted: 03/15/2016] [Indexed: 11/30/2022]
Abstract
Microbial species richness and assemblages across ultramafic ecosystems were investigated to assess the relationship between their distributional patterns and environmental traits. The structure of microorganism communities in the Koniambo massif, New Caledonia, was investigated using a metagenetic approach correlated with edaphic and floristic factors. Vegetation cover and soil properties significantly shaped the large phylogenetic distribution of operational taxonomic unit within microbial populations, with a mean per habitat of 3.477 (±317) for bacteria and 712 (±43) for fungi. Using variance partitioning, we showed that the effect of aboveground vegetation was the most significant descriptor for both bacterial and fungal communities. The floristic significant predictors explained 43% of the variation for both the bacterial and fungal community structures, while the edaphic significant predictors explained only 32% and 31% of these variations, respectively. These results confirm the previous hypothesis that the distribution of microorganisms was more structured by the vegetation cover rather than the edaphic characteristics and that microbial diversity is not limited in ultramafic ecosystems.
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Affiliation(s)
- L Bordez
- Laboratoire Insulaire du Vivant et de l'Environnement (LIVE), Université de la Nouvelle-Calédonie (UNC), BP R4, Avenue James Cook, 98851, Nouméa Cedex, Nouvelle-Calédonie.,Koniambo Nickel SAS (KNS), BP 696, 98860, Koné, Nouvelle-Calédonie.,IRD, Laboratoire des Symbioses Tropicales et Méditerranéennes (LSTM, UMR040), TA A-82/J, 34398, Montpellier cedex 5, France.,Institut Agronomique néo-Calédonien (IAC), BPA5, 98848, Nouméa, Nouvelle-Calédonie
| | - P Jourand
- IRD, Laboratoire des Symbioses Tropicales et Méditerranéennes (LSTM, UMR040), TA A-82/J, 34398, Montpellier cedex 5, France
| | - M Ducousso
- CIRAD, Laboratoire des Symbioses Tropicales et Méditerranéennes (LSTM, UMR082), TA A-82/J, 34398, Montpellier cedex 5, France
| | - F Carriconde
- Institut Agronomique néo-Calédonien (IAC), BPA5, 98848, Nouméa, Nouvelle-Calédonie
| | - Y Cavaloc
- Laboratoire Insulaire du Vivant et de l'Environnement (LIVE), Université de la Nouvelle-Calédonie (UNC), BP R4, Avenue James Cook, 98851, Nouméa Cedex, Nouvelle-Calédonie
| | - S Santini
- Laboratoire Information Génomique et Structurale (IGS), UMR7256 CNRS, Aix-Marseille Université, 13288, Marseille cedex 09, France
| | - J M Claverie
- Laboratoire Information Génomique et Structurale (IGS), UMR7256 CNRS, Aix-Marseille Université, 13288, Marseille cedex 09, France
| | - L Wantiez
- Laboratoire Insulaire du Vivant et de l'Environnement (LIVE), Université de la Nouvelle-Calédonie (UNC), BP R4, Avenue James Cook, 98851, Nouméa Cedex, Nouvelle-Calédonie
| | - A Leveau
- Koniambo Nickel SAS (KNS), BP 696, 98860, Koné, Nouvelle-Calédonie
| | - H Amir
- Laboratoire Insulaire du Vivant et de l'Environnement (LIVE), Université de la Nouvelle-Calédonie (UNC), BP R4, Avenue James Cook, 98851, Nouméa Cedex, Nouvelle-Calédonie
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Groutz A, Gordon D, Schachter P, Amir H, Shimonov M. Effects of bariatric surgery on male lower urinary tract symptoms and sexual function. Neurourol Urodyn 2016; 36:636-639. [DOI: 10.1002/nau.22980] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/31/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Asnat Groutz
- Sackler Faculty of Medicine, Urogynecology and Pelvic Floor Unit, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital; Tel Aviv University; Tel Aviv Israel
| | - David Gordon
- Sackler Faculty of Medicine, Urogynecology and Pelvic Floor Unit, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital; Tel Aviv University; Tel Aviv Israel
| | - Pinhas Schachter
- Sackler Faculty of Medicine, Department of Surgery, E. Wolfson Medical Center; Tel Aviv University; Tel Aviv Israel
| | - Hadar Amir
- Sackler Faculty of Medicine, Urogynecology and Pelvic Floor Unit, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital; Tel Aviv University; Tel Aviv Israel
| | - Mordechai Shimonov
- Sackler Faculty of Medicine, Department of Surgery, E. Wolfson Medical Center; Tel Aviv University; Tel Aviv Israel
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Amer-Alshiek J, Alshiek T, Amir Levy Y, Azem F, Amit A, Amir H. Israeli Druze women's sex preferences when choosing obstetricians and gynecologists. Isr J Health Policy Res 2015; 4:13. [PMID: 26034576 PMCID: PMC4450487 DOI: 10.1186/s13584-015-0013-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background Consideration and better understanding of patients’ needs on the part of the healthcare system might help increase the number of people seeking necessary medical care. Many studies have been conducted on patients’ preferences in choosing their health care provider, but the majority of them were conducted in modern western societies, establishing a need to explore other populations. The present study was performed in the Israeli Druze community which is composed of a uniquely traditional and religious population. We assessed the sex preference of Israeli Druze women regarding obstetricians/gynecologists, and identify other features that affect their choice. Method We conducted a cross-sectional study that included 196 Israeli Druze women who anonymously completed a 36-item questionnaire between January-July, 2011. Results Most (63.8%) of the responders preferred female obstetricians/gynecologists, while 74.5% had no sex preference for their family physicians. 68.6% of the religious women preferred female obstetricians/gynecologists as compared to 51.76% of those women who self-identified as secular. Most of the women (65%) preferred female obstetricians/gynecologists for intimate procedures, such as pelvic examination and pregnancy follow-up. The main reasons given were: feeling more comfortable with a female practitioner (69.7%), the belief that females are more gentle (56.6%), and being more embarrassed with male obstetricians/gynecologists (45.4%). Three factors were associated with the responders’ preferences for female obstetricians/gynecologists: their age and religious status, and the sex of their regular obstetricians/gynecologists. Women who preferred a female obstetrician/gynecologist assigned a lesser weight to the physician’s knowledge when choosing them. Older and religious women as well as those who attributed less weight to the physician’s professional knowledge were more likely to prefer a female obstetrician/gynecologist. Conclusions The majority of responders to our survey (Israeli Druze women), like those in other communities where religiousness and modesty are deeply rooted, prefer female obstetricians/gynecologists, with the overwhelming reasons given being feeling more comfortable and less embarrassed with females, and the notion that female obstetricians/gynecologists are more gentle during intimate procedures.
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Affiliation(s)
- Jonia Amer-Alshiek
- Department of Obstetrics and Gynecology, Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 6423906 Israel
| | - Tahani Alshiek
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yifat Amir Levy
- Neuroimmunology Laboratory, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ; Departments of Medicine, University of California, La Jolla, San Diego, CA USA
| | - Foad Azem
- Department of Obstetrics and Gynecology, Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 6423906 Israel
| | - Ami Amit
- Department of Obstetrics and Gynecology, Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 6423906 Israel
| | - Hadar Amir
- Department of Obstetrics and Gynecology, Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv, 6423906 Israel ; Departments of Medicine, University of California, La Jolla, San Diego, CA USA
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Garitaonandia I, Amir H, Boscolo FS, Wambua GK, Schultheisz HL, Sabatini K, Morey R, Waltz S, Wang YC, Tran H, Leonardo TR, Nazor K, Slavin I, Lynch C, Li Y, Coleman R, Gallego Romero I, Altun G, Reynolds D, Dalton S, Parast M, Loring JF, Laurent LC. Increased risk of genetic and epigenetic instability in human embryonic stem cells associated with specific culture conditions. PLoS One 2015; 10:e0118307. [PMID: 25714340 PMCID: PMC4340884 DOI: 10.1371/journal.pone.0118307] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/14/2015] [Indexed: 12/27/2022] Open
Abstract
The self-renewal and differentiation capacities of human pluripotent stem cells (hPSCs) make them a promising source of material for cell transplantation therapy, drug development, and studies of cellular differentiation and development. However, the large numbers of cells necessary for many of these applications require extensive expansion of hPSC cultures, a process that has been associated with genetic and epigenetic alterations. We have performed a combinatorial study on both hESCs and hiPSCs to compare the effects of enzymatic vs. mechanical passaging, and feeder-free vs. mouse embryonic fibroblast feeder substrate, on the genetic and epigenetic stability and the phenotypic characteristics of hPSCs. In extensive experiments involving over 100 continuous passages, we observed that both enzymatic passaging and feeder-free culture were associated with genetic instability, higher rates of cell proliferation, and persistence of OCT4/POU5F1-positive cells in teratomas, with enzymatic passaging having the stronger effect. In all combinations of culture conditions except for mechanical passaging on feeder layers, we noted recurrent deletions in the genomic region containing the tumor suppressor gene TP53, which was associated with decreased mRNA expression of TP53, as well as alterations in the expression of several downstream genes consistent with a decrease in the activity of the TP53 pathway. Among the hESC cultures, we also observed culture-associated variations in global gene expression and DNA methylation. The effects of enzymatic passaging and feeder-free conditions were also observed in hiPSC cultures. Our results highlight the need for careful assessment of the effects of culture conditions on cells intended for clinical therapies.
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MESH Headings
- Cell Culture Techniques
- Cell Differentiation
- Cell Line
- Cell Self Renewal
- Cell Transformation, Neoplastic/genetics
- Cells, Cultured
- Chromosome Aberrations
- Chromosome Deletion
- Chromosome Duplication
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 17
- Chromosomes, Human, Pair 20
- DNA Methylation
- Epigenesis, Genetic
- Gene Expression Profiling
- Genome, Human
- Genomic Instability
- Human Embryonic Stem Cells/cytology
- Human Embryonic Stem Cells/metabolism
- Human Embryonic Stem Cells/pathology
- Humans
- Phenotype
- Pluripotent Stem Cells/metabolism
- Polymorphism, Single Nucleotide
- Time Factors
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- Ibon Garitaonandia
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Hadar Amir
- Department of Reproductive Medicine, UCSD Healthcare, 9500 Gilman Drive, Mail Code 0695, San Diego, CA 92093, United States of America
| | - Francesca Sesillo Boscolo
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
- Department of Reproductive Medicine, UCSD Healthcare, 9500 Gilman Drive, Mail Code 0695, San Diego, CA 92093, United States of America
| | - Gerald K. Wambua
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Heather L. Schultheisz
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Karen Sabatini
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
- Department of Reproductive Medicine, UCSD Healthcare, 9500 Gilman Drive, Mail Code 0695, San Diego, CA 92093, United States of America
| | - Robert Morey
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
- Department of Reproductive Medicine, UCSD Healthcare, 9500 Gilman Drive, Mail Code 0695, San Diego, CA 92093, United States of America
| | - Shannon Waltz
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Yu-Chieh Wang
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Ha Tran
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Trevor R. Leonardo
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Kristopher Nazor
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Ileana Slavin
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Candace Lynch
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Yingchun Li
- Department of Pathology, UCSD Healthcare, 9500 Gilman Drive, Mail Code 0695, La Jolla, CA 92093-0612, United States of America
| | - Ronald Coleman
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - Irene Gallego Romero
- Department of Human Genetics, University of Chicago, 920 E 58th St, CLSC 317, Chicago, IL, 60637, United States of America
| | - Gulsah Altun
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
| | - David Reynolds
- Department of Biochemistry and Molecular Biology, Center for Molecular Medicine, Paul D. Coverdell Center for Biomedical and Health Sciences, University of Georgia, Athens, GA, 30602, United States of America
| | - Stephen Dalton
- Department of Biochemistry and Molecular Biology, Center for Molecular Medicine, Paul D. Coverdell Center for Biomedical and Health Sciences, University of Georgia, Athens, GA, 30602, United States of America
| | - Mana Parast
- Department of Pathology, UCSD Healthcare, 9500 Gilman Drive, Mail Code 0695, La Jolla, CA 92093-0612, United States of America
| | - Jeanne F. Loring
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
- * E-mail: (LCL); (JFL)
| | - Louise C. Laurent
- Center for Regenerative Medicine, Department of Chemical Physiology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States of America
- Department of Reproductive Medicine, UCSD Healthcare, 9500 Gilman Drive, Mail Code 0695, San Diego, CA 92093, United States of America
- * E-mail: (LCL); (JFL)
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Amir H, Yaniv D, Hasson J, Amit A, Gordon D, Azem F. Cabergoline for reducing ovarian hyperstimulation syndrome in assisted reproductive technology treatment cycles. A prospective randomized controlled trial. J Reprod Med 2015; 60:48-54. [PMID: 25745751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate whether cabergoline (Cb2), a dopamine agonist, reduces ovarian hyperstimulation syndrome (OHSS) in high-risk women undergoing assisted reproductive technology (ART), and to analyze whether cabergoline affects the outcome of ART. STUDY DESIGN Forty infertile women at risk of developing OHSS were enrolled in the trial. The inclusion criteria were as follows: infertile women undergoing IVF with serum estradiol concentration > 4,000 pg/mL or with > 20 follicles > 12 mm on the day of human chorionic gonadotropin (hCG) administration, and 18-40 years of age. They were randomized into 2 groups: the Cb2 group (n = 20) received 0.5 mg oral Cb2 per day for 8 consecutive days beginning on the day of hCG, and the control group (n = 20) received no medication. RESULTS Ascites was significantly lower (p = 0.008) in the Cb2 group as compared with the control group. The incidence of moderate OHSS was also significantly lower (p = 0.04) in the Cb2 as compared to the control group. There was no evidence of statistically significant differences regarding the parameters of ART outcome. CONCLUSION Our data supports the use of Cb2 in the management of high-risk women undergoing ART and, consequently, achieving lowered risk of OHSS, with no deleterious impact on ART outcomes.
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Amir H, Gophen R, Amir Levy Y, Hasson J, Gordon D, Amit A, Azem F. Obstetricians and gynecologists: which characteristics do Israeli lesbians prefer? J Obstet Gynaecol Res 2014; 41:283-93. [PMID: 25227636 DOI: 10.1111/jog.12512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to explore lesbians' preferences when choosing obstetricians/gynecologists. MATERIAL AND METHODS This cross-sectional study included 100 lesbian and 100 heterosexual women. A 40-item questionnaire assessed the correlation between a patient's sexual identity and her specific preferences for obstetricians/gynecologists. RESULTS The top five most important parameters for both groups in choosing obstetricians/gynecologists overlapped greatly. Four of those were experience, ability, knowledge and personality. Only one parameter differed: lesbians ranked 'sexually tolerant' as the third most important characteristic while heterosexuals ranked 'availability' as the fifth most important characteristic. Lesbians rated 'sexual tolerance' significantly higher than heterosexuals (P < 0.001). More lesbians (56%) preferred female obstetricians/gynecologists compared to heterosexuals (21%) (P < 0.001). When compared to heterosexuals, more lesbians preferred female obstetricians/gynecologists for intimate and non-intimate procedures (P < 0.001). But within the lesbian population, a higher percentage of subjects showed a preference for female obstetricians/gynecologists only for intimate procedures. Lesbians used the following to describe their preference for female obstetricians/gynecologists: feeling more comfortable; gentle; sympathetic; patient; more understanding of women's health; better physicians in general; and more sexually tolerant (P < 0.001 vs heterosexual). However, when we looked only at the lesbian population, the majority did not exhibit a preference for a female obstetrician/gynecologist for any of these reasons. The main reason given by the 56% of the lesbians who said they prefer female obstetricians/gynecologists was feeling more comfortable. CONCLUSION Overwhelmingly lesbians prefer sexually tolerant obstetricians/gynecologists regardless of their gender; however, only a small number of lesbian subjects in this study considered their obstetricians/gynecologists as displaying this characteristic.
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Affiliation(s)
- Hadar Amir
- Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv, Israel
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