Do sperm and lubricants gel well with each other? A systematic review

Vaginal lubricants are commonly used to aid sexual pleasure and/or to help combat vaginal dryness and dyspareunia. Several studies have reported their impact on sperm function, however there are no published guidelines to help healthcare professionals and couples select a vaginal lubricant that is 'sperm-safe'. To address this, we conducted a literature search using both PubMed and Scopus to identify and appraise manuscripts that reported the impact of lubricants on sperm function. We did not restrict the literature search by year of publication, and we only included manuscripts that looked at the impact of vaginal lubricants on human sperm. The quality of the eligible studies was assessed using the Björndahl et al., (2016) checklist for semen analysis, as most of the studies reported the findings of a basic semen analysis. A total of 24 articles were eligible for analysis with a total of 35 vaginal lubricants (that were available to buy over the counter) being included, 2 of which studied the effect of vaginal lubricants on sperm function in vivo, and 22 being conducted in vitro. KY Jelly, PreSeed and Astroglide were most studied, with most manuscripts focussing on their impact on sperm motility. A paucity of data on most lubricants combined with methodological variations between studies and limited/no reporting on pregnancy outcomes means greater efforts are required before an evidence-based guideline can be published.

P–394 Intralipid infusion at time of embryo transfer in women with history of recurrent implantation failure: a systematic review and meta-analysis

Study question

What is the effectiveness of IV Intralipid (IVI) in improving pregnancy rates in women undergoing IVF with history of Recurrent implantation failure (RIF) to improve reproductive outcomes.

Summary answer

The evidence to support the use of IVI at the time of embryo transfer in women with RIF is limited. More RCTs are needed. What is known already: Optimising the implantation process following embryo transfer remains a clinical challenge with 10% of couples undergoing IVF affected by (RIF). Immunotherapy could help to optimise endometrial receptivity and increase the chances for successful conception in women with history of RIF. Intra-venous Intralipid (IVI), a fat-based emulsion of soybean oil, glycerine, phospholipids, egg, and polyunsaturated fatty acids, has been evaluated in several trials as a potential intervention to downregulate the uNK cells and macrophages as well as inhibit the pro-inflammatory mediators including T1 helper cells. Evidence synthesis is needed to evaluate the effectiveness of this intervention.

Study design, size, duration

We performed this systematic review using a prospectively registered protocol (CRD42019148517) and reported in accordance with the PRISMA guidelines. Participants/materials, setting, methods: We searched MEDLINE, EMBASE and CENTRAL for any randomised trials evaluating the use of IVI at the time of embryo transfer in women undergoing assisted conception until September 2020. We extracted data in duplicate and assessed risk of bias using the Cochrane Risk of Bias tools. We meta-analysed data using a random effect model and reported on dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI).

Main results and the role of chance

We included five randomised trials reporting on 843 women with an overall moderate risk of bias. All trials used 20% IVI solution at the time of embryo transfer compared to normal saline infusion or no intervention (routine care). The IVI group had a higher chance of clinical pregnancy (172 vs 119, RR 1.55, 95%CI 1.16–2.07, I2 44.2%) and live birth (132 vs 73, RR 1.83, 95%CI 1.42–2.35, I2 0%) post treatment compared to no intervention.

Limitations, reasons for caution

Our findings are limited by the small sample size and the variations in treatment protocols and population characteristics.

Wider implications of the findings: Our meta-analysis offers an overview on the value of IVI to help women affected by RIF. Given the limitations and the quality of included trials, adopting the use of IVI a-la-carte to couples undergoing IVF remains immature. IVI should not be offered until larger RCTs demonstrate a persistent benefit.

Trial registration number

CRD42019148517

Provision of obstetrics and gynaecology services during the COVID-19 pandemic: a survey of junior doctors in the UK National Health Service

Objective

The coronavirus disease 2019 (COVID‐19) pandemic is disrupting health services worldwide. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID‐19 pandemic.

Design

Interview‐based national survey.

Setting

Women's healthcare units in the National Health Service.

Population

Junior doctors in obstetrics and gynaecology.

Methods

Participants were interviewed by members of the UK Audit and Research in Obstetrics and Gynaecology trainees' collaborative between 28 March and 7 April 2020. We used a quantitative analysis for closed‐ended questions and a thematic framework analysis for open comments.

Results

We received responses from 148/155 units (95%), most of the participants were in years 3–7 of training (121/148, 82%). Most completed specific training drills for managing obstetric and gynaecological emergencies in women with COVID‐19 (89/148, 60.1%) and two‐person donning and doffing of Personal Protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID‐19‐specific protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID‐19 emergency theatres (105/148, 70.8%). Most units reduced face‐to‐face antenatal clinics (117/148, 79.1%) and suspended elective gynaecology services (131/148, 88.5%). The 2‐week referral pathway for oncological gynaecology was not affected in half of the units (76/148, 51.4%), but half reported a planned reduction in oncology surgery (82/148, 55.4%).

Conclusion

The provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID‐19 pandemic seems to be in line with current guidelines, but strategic planning is needed to restore routine gynaecology services and ensure safe access to maternity care in the long term.

Tweetable abstract

Provision of obstetrics and gynaecology services during the acute phase of COVID‐19 is in line with current guidelines, strategic planning is needed to restore routine services and ensure safe access to care in the long term.

Provision of obstetrics and gynaecology services during the acute phase of COVID‐19 is in line with current guidelines, strategic planning is needed to restore routine services and ensure safe access to care in the long term.

This paper includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights16313

Evaluation of large aberrations using a lateral-shear interferometer having variable shear

A variable shear lateral shearing interferometer consisting of two holographically produced crossed diffraction gratings is used to test nonrotationally symmetric wavefronts having aberrations greater than 100 wavelengths and slope variations of more than 400 wavelengths/diameter. Comparisons are made with results of Twyman-Green interferometric tests for wavefront aberrations of up to thirty wavelengths. The results indicate that small wavefront aberrations can be measured as accurately with the lateral-shear interferometer as with the Twyman-Green interferometer and that aberrations that cannot be measured at all with a Twyman-Green interferometer can be measured to about 1% accuracy or better.

Method for evaluating lateral shearing interferograms

Wavefront shearing interferometers have inherent advantages over more conventional interferometers because they do not need a separate reference wavefront. However, the fringe patterns are less directly related to the wavefront shape. In this paper, a method is described that uses data obtained from two lateral shear interferograms sheared in orthogonal directions to describe a wavefront of any arbitrary shape. Analysis of the data defines the wavefront on a regular grid, using a least squares criterion to match the measured data to the reconstructed shear data. Because each point on the final wavefront is involved in at most four measurements, the matrices tend to have many zero elements, making them easily solvable by simple numerical techniques, even for several hundred points. An error analysis indicates that the accuracy of the final results can be as good as the accuracy of the measured data. The procedure is described, and results of a typical analysis are shown.

Computer program for the analysis of interferometric test data

The over-all design and capabilities of several proprietary computer programs to reduce and analyze various types of interferometric data are described. The following problems and methods of solution are discussed in greater detail: scaling and mapping errors; generation of artificial interferograms and holograms for testing without null lenses; combination of overlapping partial-aperture interferograms; the Ritchey-Common test for flat mirrors; and fitting of interferometric data with orthogonal polynomials.

General analysis of aplanatic cassegrain, gregorian, and schwarzschild telescopes

The properties of two-conic reflecting aplanats are analyzed and discussed on the basis of third order aberration theory. Techniques for designing infinite conjugate two mirror aplanats and computing their image properties are developed. The secondary mirror alignment characteristics of Ritchey-Chrétien and aplanatic Gregorian telescopes are examined and neutral point locations defined. Design configurations corrected for a third Seidel aberration (astigmatism, image curvature, or distortion) are identified and their properties discussed. The properties of Ritchey-Chrétien and aplanatic Gregorian telescopes are compared.

A variable refractive null lens

Null lenses, for use with rotationally symmetric but nonspherical surfaces, are extremely useful for testing during production. In general, each different system to be tested requires a different null lens. A variable null lens is proposed which consists of two aspheric plates, each of which introduces approximately fourth- or sixth-order spherical aberration. When the plates are inserted in a diverging beam, the effect on the wavefront may be changed by varying the plate spacing. The system may be used to test parabolas and other nonspherical mirrors at center of curvature, aspheric plates in conjunction with spherical mirrors, and various other systems. Once the two plates have been produced and measured, the spacing of the plates used may be determined for each test. This would normally be done by computer, using any of the optimization techniques for lens design. Examples are shown, and an estimate of obtainable accuracy is given.